Sandwiched between India and China, Nepal is a small landlocked lowermiddle- income country in South Asia. Once a peaceful country, it is striving to overcome the legacy of a 10-year Maoist rebellion, a royal massacre and continuing political chaos. Nepal has been in dispute with neighbouring Bhutan over the repatriation of hundreds of thousands of refugees in several camps in Nepal. In addition, the country experiences frequent natural disasters (floods and landslides) and faces several environmental challenges, including deforestation and a population explosion in southern Nepal.

Slightly bigger than England in size, Nepal is 885 km long and 200 km wide, with an area of 147 181 km2. It has a total population of nearly 28 million, and an annual population growth rate of 2.2%. Life expectancy at birth is 63 years. Almost 90% of the population still live in rural areas and 38% live below the poverty line. Nepal has an annual per capita income of less than US$300 (compared with US$800 in India and over US$1700 in China).

Health resources and statistics

Healthcare facilities in Nepal are generally poor (Box 1) and beyond the means of the majority. The provision of health services is constrained by low government spending, rugged terrain, lack of health education and poor public expectations. Most hospitals are located in urban areas; rural health facilities often lack adequate funding, trained staff and medicines and have poor infrastructure. In rural areas, patients sometimes have to be carried in a basket through the mountains for 3 or 4 days to reach the nearest primary care centre, which may in any case be devoid of trained medical personnel.

For administrative purposes, Nepal has been divided into five developmental regions, 14 zones and 75 districts. According to the institutional framework of the Department of Health Services, which is one of three departments under the Ministry of Health and Social Welfare, the sub-health posts (SHPs) are the first contact point for basic health services. Each level above the SHP is a referral point in a network from SHPs to health posts to primary care centres, and to district, zonal and regional hospitals, and finally to the specialist tertiary care centres in Kathmandu. Nepal currently has 10 tertiary care centres, 83 hospitals, 700 health posts and 3158 SHPs. There are a few private non-profit hospitals as well.