This covers Historical development of health care services in Nepal of Unit 1.

1. Historical Development
of Health Services in
Nepal
By:
Vijaya Laxmi Shrestha
Lecturer (MPH, M. Phil.)

2. THOSE WHO FAIL TO READ
HISTORY ARE DESTINED TO
SUFFER THE REPETITION OF ITS
MISTAKES

3. Background
 The organization of health services
has a long history of traditional
medical practice with faith healing,
naturopathy, yoga, Ayurved,
homeopathy, which are playing a
dominant role in providing health care
services.

4. HISTORICAL BACKGROUND
 Ancient period
 Pre-Unified period
 Period of King PN Shah
 Rana Period
 Pre-Planned Period
 Planned Period

5. Ancient Period
 Ramayan- Hanuman was sent to bring
Sanjeebini Buti from Himalaya, reflects to the
use of herbal medicines for health care.
 Hanuman brought fragments of a part of
Himalayas to provide drugs for the wounded
in the Rama-Ravana battle.
 Lord Buddha also attended regularly to all the
sick disciples in his camp and has also laid
essential qualities in a person attending to the
sick should have as well as guidelines on
healthy living.

6. Contd….
 Faith healing techniques and other
ancient methods were in use, eg,
dhamis, jhankris, jharphuk, Jyapoos,
Sharma Gurus, sudeni etc.
 Arogyashala or Ayurvedic hospital
existed in Nepal during the reign of
Anshu Verma (605-620 AD).
 Ayurved or “science of life” was found as
one of the oldest system of medicine by
WHO later.

7. Specific temples worshipped
for protecting specific
diseases
Temple Protection against
Sital Mai In the Pashupati area to protect against smallpox
kandeutathan At Kupandole for ear ailments
Bhatbhatini For children when frightened by spirits
Way Sya Dyo At Bangemudha for Toothache
Swayambhu Ajima
Sarati Maya
For wellbeing of children
Santanewor/Gyaneswo
r Mahadev
For infertility
Kumbheswar to cure skin diseases including leprosy

8. Pre-unified Period (Malla
King)
 Domain of traditional practices
 Raj Vaidhyas and Raj Gurus were the royal
consultant and worked in epidemic.
 Allopathy was introduced in Nepal with the
coming of Christian Missionaries during the
period of Malla Regime by Jay Prakash
Malla.
 King Pratap Malla allowed Father Greuber,
an Austrian Capuchin monk and Father
Dorville to preach, teach and conduct health
and education services in Nepal in 1624 AD.

9. contd...
 During this period, some other fathers
who were expelled from Tibet came into
Kathmandu.
 But no further development took place.
 Pratap Malla (1641-1674) established
Ayurvedic Dispensary in hanuman
Dhoka Complex.
 Traditional and indigenous system was
deep-rooted
 Poor hygiene and environmental
sanitation

10. Period of King Prithvi Narayan
Shah (1723-1775 AD)
 His wounded brother Sur Pratap Shah
was treated by western medicines –
first recorded Michel Angelo
 Ayurvedic and traditional healing
system were prevalent.
 Later missionaries were chased away
 Father Georgian noted the danger of
awal plague in Makawanpur

11. contd...
 Kirkpatrick, also writes that malaria
was present in lowest valleys and the
Terai.
 The prevalence of malaria was also
confirmed by the death of Senior
Queen in 1841 from malaria.
 Lack of sanitation, poor waste
disposal, no drainage and sewerage
system

12. During Rana Period (1846-1951AD)
 Both Ayurvedic and modern medicines
were prevalent but modern medicines
were only for Rana families.
 Jung Bahadur Rana brought vaccines
for his families after his visit to Great
Britian.
 His eldest boy was vaccinated by Dr. HA
Oldfield in 1850.
 Similarly taking ‘Kabiraj’ along with Jung
Bahadur Rana to Britian indicates the

13. contd...
 Dr. HA Oldfield has stated that the parts
of Kathmandu were dirty with no proper
disposal of wastes causing various
illnesses and fever in his book
'sketches in Nipal'.
 Absolute absence of drainage system,
stagnant gutters on each side of
streets, running immediately below the
house fronts, filthy in all cities.

14. contd...
 The air and water of Kirtipore was very
healthy and pure and goitre was not
seen in the inhabitants of Kirtipore.
 The prevalence of malaria still existed.
 There was maternal death in Rana
family.
 One of JB's sister died due to
tuberculosis.

15. (Contd………)
 Some other land marks of
development of health care system
are:
◦ Formation of Guthi as fund for Health
Care and Social Welfare
◦ Khokana Leprosy Asylum (1857 AD) as a
first health institution set locally by Nepali
authorities. It was used as detention
centre rather than treatment centre.
◦ Establishment of Prithvi Bir Hospital (1890
AD) as a first hospital in Kathmandu.

16. contd...
◦ Later, Prithvi Bir Hospital were set up at
Birgunj, Jaleshwor, Rajbiraj, Nepalgunj and
Taulihawa
◦ Sukraraj Tropical and Infectious Hospital in
1890 AD.
◦ Chandra Loka Hospital at Bhaktapur in 1961
BS
◦ Tri chandra hospitals were built in Palpa &
Parasi then Jhapa, Sarlahi, Dhankuta, Doti,
Bardia, Ilam, Rangeli.
◦ Chandra Sale Dispensary was set up at Bir
hospital to make medicines more freely

17. (Contd………)
◦ 64 bedded Millitary Hospital (1926 AD)
◦ Malaria Survey in 1925
◦ Lalitpur Hospital was built in 1924
◦ Tokha Sanatorium by Chandra
Shamsher(1931AD)
◦ Ramghat dispensary in 1929
◦ In 1933, DoHS was established for the
promotion, regulation and management of
facilities provided by the government.

18. contd....
 The facilities under this DoHS were
◦ 33 HMG Hospitals
◦ several Ayurvedic dispensaries
◦ Nepal Rajkiya Ayurved Vidhyalaya
established in 1990 BS
◦ Singh Durbar Vaidhayakhana
◦ Civil Medical School established in 1990 BS
◦ a new health centre was opened at Sankhu
in 1949.
◦ a new building was built for Ramghat
dispensary and Homeopathic Hospital.

19. Contd…
 With the dawn of democracy in1951,
realizing the necessity of the people,
living predominantly in rural, remote,
difficult and primitive areas, HMG
Nepal started periodic development
plans with sets of programs including
health.

20. Pre-Planned period (1951-1956
AD)
 Emphasized on the training of Human
Resources
 Doctors training under Colombo Plan in
India
 Training of nurses in Bir Hospital Nursing
School with aid of WHO
 1st NGO Hospital was UMN (United
Mission to Nepal
 A plan for establishing a number of well
staffed health institutions in different
parts of the country including HPs,
PHCCs, District, Zonal & regional
Hospitals

21. (Contd……)
 In 1952, 33 hospitals, 50 doctors
 Compounders distributed medicines,
gave injections and dressings
 DoHS, established was to carry out the
responsibility of promotion, regulation
and management of hospitals and
Ayurvedic Dispensaries

22. Contd….
 A project for malaria eradication in
Chitwan Valley was started (1953 AD)
 In 1956
◦ 34 Hospitals of 625 beds
◦ 24 Dispensaries
◦ 63 Ayurvedic Aushadhalaya

23. Planned Period (1956-
2013/16)
 1st Five Year Plan (1956-1961)
 2nd Plan Period (1962-1965)
 3rd Plan Period (1965-1970)
 4th Plan Period (1970-1975)
 5th Plan Period (1975-1980)
 First Long term Health Plan (1975-1990)
 6th Plan Period (1980-1985)
 7th Plan Period (1985-1990)

24. cntd....
 8th Plan Period (1992-1997)
 9th Plan Period (1997-2002)
 Second Long Term Health Plan (1997-2017)
 10th Plan Period (2002-2007)
 11th Plan Three Year Interim Plan (2008-
2010)
 12th Plan, Three Year Interim Plan (2011-
2013)
 13th Plan, Three Year Interim Plan (2014-
2016)
 14th Plan, Three Year Interim Plan (2017-

25. Development progress
 Still focused on curative services.
 Organisation of Ministry of Health took
place in 1956.
 The first intake of girls in Bir Hospital
Nursing School took place in 1956 and
13 nurses were produced in 1960.
 HA school and training of Auxillary
Nurse Midwives (ANM) was started to
provide basic health care to rural
people.

26. cntd...
 Some vertical projects like malaria
eradication, smallpox eradication, TB &
Leprosy control and FP/MCH services were
in place.
 Health posts and hospitals were
constructed to provide health services.
 Vertical projects were later integrated to
provide services from one door at grassroot
level and also at central level.
 Concept of Basic minimum Health Needs
was developed during 6th plan period.

27. cntd...
 Emphasis was given to preventive and
promotive services along with curative
services.
 Strategies were developed to meet MDGs
 New organisational set up of MoH took place
in 1993 including 5 regional health directorate
in each regions.
 Establishment of District Health Offices
 Sub Health posts were established as the
smallest unit of health sector in each VDCs to
provide basic health services.
 National health policy 1991 was endorsed

28. cntd....
 Increased role of Private and NGO sectors in
strengthening Health System
 Ayurvedic and other alternative system of
medicines were incorporated in national health
system
 Health as a fundamental right was declared
during interim plan (2007-2010)
 Free health services at SHPs, HPs, PHCs and
district hospital was ensured.
 All the SHPs were upgraded to HPs by 2071,
some of HPs and PHCCs were upgraded into
PHCCs & district level hospitals as per need.

29. contd...
 Health services are being provided through 6
central Hospitals, 2 Regional hospitals, 3 sub
regional hospitals, 10 zonal hospitals, 85
district level hospitals, 200 PHCCs, 3808
Health posts, 51470 FCHVs, 12180 PHC/ORC
& 16,022 EPI clinics (annual report, 2073/74).
 There are also a large number of private health
facilities providing comprehensive health
services.
 Multi sectoral approach is being implemented
to conduct health related programs.
 Sustainable Development Goals (SDGs) are
set to be achieved by 2030.