NepalPopulation Planning
Terracing in the Rapti Valley, between Tulsipur and Salyan
Courtesy John N. Gunning
Although Nepal's population continued to grow at a
rapid pace
in the face of deteriorating per capita land availability,
the
country's economy as a whole remained underdeveloped.
Economic
growth barely kept pace with population growth. Given this
reality,
many viewed effective family planning as a national
imperative. The
need for family planning was recognized as early as 1958,
when a
private organization, the Nepal Family Planning
Association, was
established in Kathmandu. Although the government formally
adopted
a national family planning policy in 1965, its
availability was
limited to the Kathmandu Valley until 1968, when a
semiautonomous
board was established. This Nepal Family Planning and
Maternal
Child Health Board was authorized to formulate and to
implement
family planning policy and programs for the entire
country. Under
the auspices of the board, attempts have been made to
provide
family planning and maternal-child health services outside
the
Kathmandu Valley, with the help of paramedics and
health-care
workers who have some basic training. As of 1989, the
board offered
family planning services in fifty-two of Nepal's
seventy-five
districts. Despite these efforts, the rural population
generally
lacked access to family planning services.
Such services were provided by three means: stationary
offices,
mobile facilities, and door-to-door campaigns. The
stationary
offices generally were attached to a health-care
institution, such
as health posts, health centers, or hospitals. In addition
to the
staff at these institutions, the board assigned a minimum
of two
full-time workers to deliver family planning and
maternal-child
health services. However, it has been reported that most
health and
family planning workers in rural health posts rarely were
found in
their assigned units. As a result, the availability of
such
services in rural areas remained poor.
The mobile facilities were a product of necessity,
given the
remoteness of much of the population and the lack of local
family
planning facilities, or easy accessibility to such a
facility. They
reached a large part of the country and almost exclusively
stressed
permanent family limitation, that is, sterilization.
Mobile
sterilization camps moved around the country; local
residents were
notified of their scheduled arrival in advance and asked
to take
advantage of the service. A few days or even weeks prior
to the
arrival of the camp, a campaign was launched to motivate
and to
educate people about the benefits and needs of family
planning. The
camp generally lasted only a few days, rarely more than a
week.
Because most villagers were unwilling to come to family
planning
centers to obtain services, the Nepal Family Planning and
Maternal
Child Health Board launched a door-to-door campaign to
educate
villagers about family planning and to distribute oral
contraceptives and condoms on a periodic basis.
The government's direct expenditure on family planning
in
fiscal year
(FY--see glossary)
1985 was about 1 percent,
or NRs54.7
million (for value of the Nepalese
rupee--see Glossary),
of the
national budget. In the same year, the government spent
almost 16.5
percent of its total budget on health services. It was
difficult to
determine what percentage of the health budget was
channeled to
provide family planning services. Although the expenditure
on
family planning appeared to be relatively low given the
gravity of
the issue, the absolute budget amount had gone up
significantly in
the 1970s and 1980s: from NRs2.0 million in FY 1969, when
the board
was set up, to almost NRs55 million in FY 1985. In FY
1981, more
than 60 percent of the board's budget was borne by foreign
agencies.
In terms of absolute numbers, the diffusion of family
planning
increased significantly over two decades. In FY 1969, only
7,774
persons had adopted family planning; by FY 1985, the
number who had
adopted family planning had climbed to almost 340,000
persons.
Data as of September 1991
|