USAID's support in the health sector is one of the most longstanding and successful development assistance programs in Nepal. In spite of over ten years of insurgency, Nepal has made great strides in key health areas. However, discrepancies between urban and rural populations’ access to health care is evidenced by the fact that rural women, on average, give birth to four children while urban women now average only two children. Through a strong and collaborative partnership with the Government of Nepal, activities reach more than 14 million men and women of reproductive age and 3.6 million children under the age of five. USAID activities aim to implement the government’s long-term goal of reducing fertility and child mortality, and protecting the lives of Nepalese families, focusing on the following areas:

• Maternal and Child Health: reducing child mortality by increasing access to quality selected maternal and child health services.
• Family Planning: expanding access to and the use of quality, voluntary family planning services.
• HIV/AIDS: preventing the spread of and controlling HIV/AIDS by enhancing the prevention-to-care continuum, and treating other sexually-transmitted infections among most-at-risk groups.
• Health Sector Reform: supporting Ministry of Health efforts in decentralizing health care services from the national to the district level.
• Social Marketing and Franchising: contributing significantly to the achievements of maternal, child, family planning and HIV/AIDS activities in Nepal through targeted awareness initiatives.
• Avian and Pandemic Influenza: preparedness and response supporting the Government of Nepal's National Action Plan.

KEY ACCOMPLISHMENTS

MATERNAL AND CHILD HEALTH

• Nepal has achieved a more than 45% drop in child mortality since 1996 and is among only 16 countries in the world (and one of six in Asia) that are on track to achieve the MDG goal of reducing under-five mortality by two-thirds. Further, the maternal mortality ratio in Nepal declined remarkably from 539 to 281 per 100,000 live births in just 10 years. These remarkable gains were achieved despite the protracted conflict.
• USAID supports the government’s network of 50,000 Female Community Health Volunteers nation-wide. Working in every district of Nepal, the volunteers are sometimes the only providers of basic health services in remote areas.
• USAID technical and financial assistance has expanded community-based treatment for child pneumonia – the number one cause of child mortality in Nepal – to cover two-thirds of all expected cases of pneumonia in 75 districts.
• USAID interventions in child health include providing Vitamin A supplements to over 3,600,000 children 6-60 months of age twice a year. This supplementation has become a national program, averting about 15,000 child deaths annually. Over 90% of all children in Nepal are reached by the USAID-supported Vitamin A campaign.
• Research supported by USAID on community-based essential newborn care and treatment of sick newborns has influenced national policies in these areas.

FAMILY PLANNING

• USAID supports improved access to quality family planning services and increased availability of key reproductive health commodities both through public and private sector social marketing activities - contributing to a 25% increase in the prevalence rate for modern contraceptive methods since 2000, as well as a 25% decrease in the fertility rate.

HIV/AIDS

• Nepal faces a concentrated HIV epidemic. The HIV prevalence rate is believed to be about 0.5% in the general population with pockets of higher prevalence among groups that have high risk behaviors such as injecting drug users, men who have sex with men, female sex workers and their clients, and men who migrate to India for seasonal work.
• USAID supports surveillance and monitoring of the HIV epidemic, as well as targeted prevention efforts by increasing knowledge and promoting behavior change. These prevention programs have brought infection rates down significantly and stabilized HIV prevalence below 2% in several of the high risk groups. HIV/AIDS prevention efforts have also increased condom use significantly, with over 77% of female sex workers in Kathmandu reporting regular use.
• In collaboration with the Global Fund for AIDS, TB and Malaria, USAID supports the national HIV/AIDS drug supply and logistics management system that provides free anti-retroviral treatment to HIV/AIDS patients. USAID also supports community-based care, support and treatment programs for people living with HIV/AIDS.