June 4, 2024
KATHMANDU – The 16th five-year periodic plan, proposed by the National Planning Commission, aims to reduce neonatal deaths to 13 from the existing 21 in every 1,000 live births. Public health experts, however, are sceptical of its success, as neonatal deaths have not declined since 2016, and the measures taken at present are not sufficient to lessen the ongoing death rates.
“Both the Nepal Demographic and Health Survey-2022 and the finance ministry’s recent report show neonatal deaths constantly high,” said Dr Shyam Raj Upreti, former director general at the Department of Health Services. “It will not be easy to pick high-hanging fruits. It requires a lot of investments and micro planning, which are currently lacking.”
A recent report by the Ministry of Finance shows that 21 neonates die in every 1,000 live births, the same results shown by the Nepal Demographic and Health Survey-2022, carried out by the Ministry of Health and Population.
The government’s target for Sustainable Development Goals is to reduce neonatal mortality to 12 deaths per every 1,000 live births by 2030.
The SDGs, a follow-up on the Millennium Development Goals (MDGs), aim to end poverty, hunger, and all forms of inequality in the world by 2030. Nepal has committed to meeting the goals.
The 16th five-year plan, which starts next fiscal year and ends in 2029, is aligned with the SDG targets.
Public health experts say meeting the goal is easier said than done. Most health facilities having birthing centres lack neonatal units, trained human resources, and quality services.
“Without ensuring quality services, which require trained human resources and advanced facilities, among others, it is impossible to reduce neonatal deaths,” said Upreti. “The government has made various plans to reduce child deaths—including neonatal deaths—but does not pay much attention to their effective implementation.”
The finance ministry’s recent report shows that the institutional delivery rate increased to 80 percent from 79 percent last year. The rise in institutional deliveries has contributed to lessening the maternal mortality rate, which is 151 in every 100,000 live births.
“Fifty percent of the neonates die in the first 24 hours of birth,” said Dr Abhiyan Gautam, chief of the Immunisation Section at the Family Welfare Division of the Department of Health Services. “Most of our health facilities, including birthing centres, lack proper infrastructures.”
Study shows that 85 percent of all deaths among children under the age of five in Nepal take place before a child’s first birthday, with 64 percent occurring during the first month of life.
Along with trained human resources, infrastructures and quality services, deaths of neonates are also linked to the antenatal care visit of pregnant women, access to health facilities, timely referral system and others, experts say.
The government has been taking various measures to reduce neonatal deaths, including planning to set up a ‘special newborn care unit’ in all district hospitals throughout the country. For that, concerned agencies under the health ministry have imparted training to all doctors, nurses and paramedics serving in Nuwakot, Dhading, Sindhupalchok and Makawanpur district hospitals.
Special newborn care units are general units designed to care for newborn children who fall ill shortly after birth. Doctors, nurses, and paramedics monitor ailing children admitted to the unit.
The health ministry has installed an underfloor heating system at birthing centres in four mountain districts to curb postpartum and neonatal deaths there.
Underfloor heating is a form of central heating that ensures indoor climate control for thermal comfort. It uses an electrical heating cable installed underneath the flooring.
Hypothermia, infection, low birth weight, premature birth, and abnormal birth asphyxia are among the leading causes of neonatal deaths, doctors say.
Some of the programmes being undertaken to lower child mortality include newborn care, kangaroo care, exclusive breastfeeding, infection prevention, chlorhexidine for umbilical cord care, and free neonatal care.
“Whatever the achievements we made so far were achieved by the measures taken as of now,” said Upreti. “The ongoing programme may not achieve further progress. Government must implement the programmes and plans to prevent more deaths.”