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Dr Sudip Shrestha, MD

Dr Sudip Shrestha, MD. Medical oncologist Coordinator Palliative care services Bhaktapur Cancer Hospital Nepal. Greetings Himalayan Kingdom of Nepal. Topics of Discussion. Health statistics, Nepal Status of palliative care services, Nepal Future strategy. Health statistics.

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Dr Sudip Shrestha, MD

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  1. Dr Sudip Shrestha, MD Medical oncologist Coordinator Palliative care services Bhaktapur Cancer Hospital Nepal. Annual Meeting 2005

  2. Greetings Himalayan Kingdom of Nepal

  3. Topics of Discussion • Health statistics, Nepal • Status of palliative care services, Nepal • Future strategy.

  4. Health statistics

  5. Demographic • Nepal has 24.2 million inhabitants (estimate 2003) • 14 % of the population lives in urban and 86% in rural areas • Population growth is presently 2.27%

  6. Administrative • 5 development regions divided into 14 zones and 75 districts: • 3,995 Village Development Committees (VDC) and 58 municipalities. Each VDC has 9 wards and each ward comprises 3-5 villages.

  7. Contd.. • Per capita income is only US$220 • half of the population live on less than US$1 per day. • 38% of the population live below the poverty line. • Illiteracy is very high, with around 40% of men and 75% of women not able to read or write.

  8. Health indicators Overall health indicators are poor and differ significantly by region. • Around 70% of the overall disease burden is due to communicable diseases • Life expectancy at birth (year, 2003): • M- 60 • F- 61 • Adult mortality rate ( per 1000): • M- 290 • F-284

  9. Health economy • Health expenditure: US $ 11.2 per head ( 5.3% of GDP) • Out of this 69% by out of pocket. • Government input: 16% of total health expenditure. • NGO: about 15% of total health expenditure • No health insurance system.

  10. Public Health care Facilities • Governmental • Private • Non Governmental organizations: Missions, non profitable

  11. National health care Delivery system

  12. Contd…. • Only 29% of the poor can reach a health facility within half an hour, • While 57% of the wealthiest households can. • the bed to population ratio is 1 bed to 2,993 people. • The public sector has only one medical doctor for each 18,500 inhabitants. • one nurse for 4000 people, a paramedic or health assistant for 4500 people, a VHW for 6000 people,

  13. Status of palliative careNepal

  14. Palliative care in Nepal • No Well organized palliative care systems • Palliative care has to be done by primary physicians/ surgeons. • Subject of Least priority:

  15. Palliative care in NepalChallenges • Poverty • existence of other areas of priorities in health care, • lack of knowledge amongst medical professionals in the area of palliative care • Lack of morphine/ Unrealistic fears regarding opioids • Late diagnosis

  16. Palliative care Services, Nepal • Terminal care services in Pashupati Arya Ghat, next to the cementry, Kathmandu.(Not very scientific, more of traditional):1995 • Hospice Nepal, Lalitpur: 2000. • Palliative care service in Bhaktapur Cancer Hospital: 2004 • Palliative care Unit: Sheer Memorial Mission Hospital, Banepa: 2004 • Pain clinic : TUTH, Kathmandu: • Hospice: BPKMCH, Bharatpur : 2005 • Palliative care: Bir Hospital, Kathmandu (expected ). • Pain clinic: Nepal Medical college, Jorpati, Kathmandu: 2004 • Palliative care , Kanti children hospital, Kathmandu (expected) Mainly concentrated in and around Kathmandu, The Capital city. Only 50 inpatient beds

  17. Identified areas for improvement • Management of pain in advanced cancer • Management of other symptoms • Information and support for patients and carers • Attention to comfort and basic care those dying in hospitals. • The needs of patients care dyeing from non malignant illness.

  18. Most important things to do. • All health care professional consider palliative care an important part of their role, • Have adequate skills, knowledge, an specialist support to undertake it effectively. • Formal consideration of its importance by Heath Policy makers.

  19. INCTR for palliative care development in Nepal • Has been playing as an active catalyst since 2002. (INCTR/NNCTR) • Dr Stuart Brown (Director of the Palliative Care Program,INCTR) and team: Active initiation to develop palliative care, Nepal. • Regular visit and vision of Dr Ian Magrath (President, Director, INCTR ) has given us fuel in our mission.

  20. INCTR for palliative care development in Nepal • Four facilities were chosen as sites where palliative care would be developed : • Hospice Nepal, • Bhaktapur Cancer Hospital • Scheer Memorial Hospital • Kanti Children’s Hospital Kathmandu valley

  21. INCTR for palliative care development in Nepal contd…….. • Initiated to form a palliative care group. • Helped us to lobby for the palliative care with government’s policy makers. • CMEs by palliative care physicians and nurses from abroad. • Sponsored trainings in Calicut to physicians and nurses: • Preparation: a clinical guideline. • Helped with a vehicle for home hospice program: Hospice Nepal

  22. Palliative care: Activities • Palliative care groups: • Professionals, social workers of common interests to develop palliative care in Nepal. • Regular meetings, experience sharing and strategy planning. • Coordination with INCTR/NNCTR • Awareness: • CMEs, Workshops to professions. • public awareness: in groups, media, brochures etc. • Major breakthrough: Oral morphine availability. • Activities of individual palliative care setups • Subsidized, or free services. • Awareness/ training • Community activities. • Miscellaneous: • Courses: Certificate In essential palliative care (The Princes Alice Hospice, UK) • CMEs by experts from abroad.

  23. Future strategy

  24. Ultimate goal? To deliver palliative care service up to the level of the community.

  25. How can we achieve the goal? By integrating palliative care in our existing health care delivery system.

  26. Palliative care delivery system

  27. Palliative care delivery system

  28. Working strategy 1st Phase: • Getting together with common interest • To develop palliative care unit in some designated centers as a pilot project • To develop common guideline for palliative care • Net working the services. • To make a combine effort for making morphine available. (Available now) • Education about palliative care: • Public • Health care professionals • Government / Policy making level

  29. 2nd Phase To Form a trainers group/institute for palliative care • Objectives: • To train more and more man power (doctors, nurses, paramedics, volunteers) • To help other hospitals and institute to develop palliative care • Emphasis would be to achieve integration of palliative care in our existing health care delivery system (community out reach programme). • Will work together with government to achieve this goal.

  30. 3rd Phase • To Develop Specialist palliative care center in the country: work as a apex institute. • To expand the palliative care services national wide under National health care programme.

  31. Conclusions • Palliative care has been a long need in Nepal. • Needs a combined efforts from all the level to establish state of art Palliative care system in the country. • Aware ness among all the level is the first priority. • A module of palliative care service at a district level should be a initial pilot project and later can expand national wise • Technical Collaboration with International agencies like INCTR will definitely plays a key role for its success.

  32. Thank you

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