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ACHIEVEMENT AND PROGRESS TOWARDS HEALTH RELATED MDGS IN NEPAL (Draft Seminar Paper)

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This is Draft Seminar paper which will present in my class for partial fulfillment of my Syllabus of BPH 8th semester. ''ACHIEVEMENT AND PROGRESS TOWARDS HEALTH RELATED MDGS IN NEPAL''

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ACHIEVEMENT AND PROGRESS TOWARDS HEALTH RELATED MDGS IN NEPAL (Draft Seminar Paper)

  1. 1. ACHIEVEMENT AND PROGRESS TOWARDS HEALTH RELATED MDGS IN NEPAL SAGUN PAUDEL A HEALTH SEMINAR PAPER SUBMITTED TO FULFILL THE PARTIAL REQUIREMENT OF BPH EIGHTH SEMESTER [HES 406.1 Health Seminar in Special Topics] SUBMITTED TO DEPARTMENT OF PUBLIC HEALTH LA GRAANDEE INTERNATIONAL COLLEGE POKHARA UNIVERSITY KASKI, NEPAL OCT, 2014
  2. 2. ACKNOWLEDGEMENT First of all i would like to thank my respected Supervisor Mr. Sudarshan Subedi for selection of the topic ‘‘Achievement and Progress towards Health Related Millennium Development Goals in Nepal’’. I express my humbly thanks to my respected BPH Program coordinator Mr. Nand Ram Gahatraj for giving opportunity to prepare this seminar paper. I am fully indebted to him for expert guidance, regular supervision, untiring encouragement, inspiration and valuable suggestion and full support during preparation of term paper. I also remember Mr. Jeewan Poudel, Deputy Program Coordinator of BPH and Mr. Amod dhoj Shresth, Faculty of BPH Program for their support and Guidance. I would like to convey my heartfelt thanks to all those who were directly or indirectly concerned with this and to all our well-wishers. This Seminar paper is written in simple language, with every bit of necessary information related to the topic so that studying independently also would not find any difficulties. I think that this effort will help every individual to understand about the information of the related topic. i
  3. 3. TABLE OF CONTENTS ACKNOWLEDGEMENT .......................................................................................... i TABLE OF CONTENTS ........................................................................................... ii LIST OF TABLE ...................................................................................................... iii ABBREVIATIONS .................................................................................................. iv 1. INTRODUCTION .............................................................................................. 1 2. OBJECTIVES .................................................................................................... 6 2.1. General objectives ....................................................................................... 6 2.2. Specific objectives ....................................................................................... 6 3. METHODOLOGY ............................................................................................. 7 4. FINDINGS ......................................................................................................... 8 4.1 Nepal government effort in health related MDGs ......................................... 8 4.2. Current situation of health related MDGs ........................................................ 8 4.2.1. MDG 4: Reduce Child Mortality ............................................................... 9 4.2.2. MDG 5: Improved maternal health ............................................................ 9 4.2.3. Goal 6: Combat HIV/ AIDS, malaria, and other diseases......................... 11 4.3. Post MDG Health agenda of United Nation ................................................... 14 5. CONCLUSION ................................................................................................ 16 6. RECOMMENDATION .................................................................................... 17 7. REFERENCES ................................................................................................. 18 ii
  4. 4. LIST OF TABLE Table 1: Child health indicators ................................................................................. 9 Table 2: Maternal health indicators .......................................................................... 10 Table 3: Reproductive health indicators ................................................................... 11 Table 4: HIV/AIDS control indicators ..................................................................... 12 Table 5: Malaria control indicators .......................................................................... 13 Table 6: Tuberculosis control indicators .................................................................. 14 iii
  5. 5. ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome CFC Chlorofluorocarbons CSWs Client of Sex Workers DoHS Department of Health Service DOTS Directly Observed Treatment Strategy FHD Family Health Division FSWs Female Sex Workers GDP Gross Domestic Product HIV Human Immune Deficiency Virus MDGs Millennium Development Goals MMR Maternal Mortality Ration MoHP Ministry of Health and Population MSM Men who have Sex with other Men NCASC National Center for AIDS and STI Control NCD Non-Communicable Diseases NFHP National Family Health Program NGOs Non-governmental Organizations NHSP National Health Sector Program NMR Neonatal Mortality Rate NPC National Planning Commission NTC National Tuberculosis Control Center ODA Official Development Assistance PHC Primary Health Care PHCC Primary Health Care Center iv
  6. 6. PPP purchasing power parity PWIDs People Who Inject Drugs SBA Skilled Birth Attendant TB Tuberculosis UN United Nation UNCDP United Nations Committee for Development Policy UNCT United Nations Country Team UNDP United Nations Development Program UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund UNV United Nations Volunteers VCT Voluntary Testing and Counseling WHO World Health Organization v
  7. 7. 1. INTRODUCTION The United Nations Millennium Development Goals are eight goals that all 191 UN member states have agreed to try to achieve by the year 2015. The United Nations Millennium Declaration, signed in September 2000 commits world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are derived from this Declaration, and all have specific targets and indicators. The Eight Millennium Development Goals are: 1. Eradicate extreme poverty and hunger; 2. Achieve universal primary education; 3. Promote gender equality and empower women; 4. Reduce child mortality; 5. Improve maternal health; 6. Combat HIV/AIDS, malaria, and other diseases; 7. Ensure environmental sustainability; and 8. Develop a global partnership for development. The MDGs are inter-dependent; all the MDG influence health, and health influences all the MDGs. For example, better health enables children to learn and adults to earn. Gender equality is essential to the achievement of better health. Reducing poverty, hunger and environmental degradation positively influences, but also depends on, better health.1 The MDGs are an eight-point road map with measurable targets and clear deadlines for improving the lives of the world's poorest people. World leaders have agreed to achieve the MDGs by 2015.2 The MDGs outline major development priorities to be achieved by 2015. Numerical targets are set for each goal and are monitored by 48 indicator.3 Millennium Development Goals4 Goal 1: Eradicate extreme poverty and hunger Target 1:  Halve between 1990 and 2015, the proportion of people whose income is 1 less than $1 per day.
  8. 8. 2 Indicator:  Proportion of population below $1 (1993 PPP) per day Target 2:  Halve, between 1990 and 2015, the proportion of people who suffer from hunger. Indicator:  Prevalence of underweight children under five years of age  Proportion of population below minimum level of dietary energy consumption Goal 2: Achieve universal primary education Target 3:  Ensure that, by 2015, children everywhere, boys and girls alike, will be able to  Complete a full course of primary schooling. Indicator:  Net enrollment ratio in primary education  Proportion of population starting grade 1 who reach grade 5  Literacy rate of 15-24 years old Goal 3: Promote gender equality and empower women Target 4:  Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015. Indicator:  Ratio of girls to boys in primary, secondary and tertiary education  Ratio of literate women to men, 15-24 years old Goal 4: Reduce Child Mortality Rate Target 5:  Reduce by two thirds, between 1990 and 2015, the Under-five mortality rate. Indicator:
  9. 9.  Under-five mortality rate  Infant mortality rate  Proportion of eye year children immunized against measles. 3 Goal 5: Improve Maternal Health Target 6:  Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Indicator:  Maternal mortality ratio  Proportion of births attended by skilled health personnel Goal 6: Combat HIV/ AIDS, malaria, and other diseases Target 7:  Have halted by 2015 and begun to reverse the spread of HIV / AIDS. Indicator:  HIV prevalence among pregnant women aged 15-24 years  Condom use rate of contraceptive prevalence rate  Condom use at last high- risk sex  Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV / AIDS  Contraceptive prevalence rate  Ratio of school attendance of orphans to school attendance of non-orphans aged 10- 14 years Target 8:  Have halted by 2015 and began to reverse the incidence of malaria and other major diseases. Indicator:  Prevalence and death rates associated with malaria
  10. 10.  Proportion of population in malaria-risk areas using effective malaria 4 prevention and  treatment measures  Prevalence and death rate associated with tuberculosis  Proportion of tuberculosis cases detected and cured under DOTS Goal 7: Ensure Environmental Sustainability Target 9:  Integrate the principles of sustainable development into country policies and program; reverse loss of environmental resources Indicator:  Proportion of land area covered by forest  Ratio of area protected to maintain biological diversity to surface area  Energy use (kg oil equivalent) per $1 GDP  Carbon dioxide emission per capita and consumption of ozone depleting CFCs  Proportion of population using solid fuels Target 10:  Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation Indicator:  Proportion of population with sustainable access to an improved water source, urban and rural  Proportion of population with access to improved sanitation, urban and rural Target 11:  By 2020, to have achieved a significance improvement in the lives of at least 100 million slum-dwellers. Indicator:  Proportion of households with access to secure tenure. Goal 8: Develop a global partnership for development
  11. 11. 5 Target 12-18:  Develop further an open, rule –based, predictable, non-discriminatory trading and financial system. Address the Special Needs of the Least Developed Countries. Address the special needs of landlocked developing countries and Small Island developing States.  Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term. In co-operation with pharmaceutical companies, provide access to affordable, drugs in developing countries.  In co-operation with the private sector, make available the benefits of new technologies, especially information and communications. Indicator:  Net ODA as percentage of Development Assistance Committee donor’s Gross National Income.  Unemployment rate of young people aged 15-24 years, each sex and total  Proportion of population with access to affordable essential drugs on a sustainable basis. 3 of 8 goals, 8 of 18 targets and 18 of 48 indicators of progress are health related.
  12. 12. 6 2. OBJECTIVES 2.1.General objectives  To Explore the Achievement and Progress of Health Related MDGs in Nepal. 2.2.Specific objectives  To know the effort of Nepal Government to achieve Health Related MDGs.  To find out the current situation of Health related MDG indicators.  To know the Global post-MDG agenda.
  13. 13. 3. METHODOLOGY To prepare this Seminar paper Google was used to retrieve the necessary documents. Google Scholar advanced Google search, EndNote was used to retrieve the articles. The articles, Publications and notes related to MDGs were downloaded and studied. Various secondary data sources Available on internet are used for preparation of this seminar paper. 7
  14. 14. 4. FINDINGS 4.1 Nepal government effort in health related MDGs Nepal is one of 189 countries committed to the MDGs, a pledge it has renewed in its national development plans. The primary medium‐term strategy and implementation plan for reaching its MDGs, the Tenth Plan; Poverty Reduction Strategy Paper; 2002/03–2006/07 incorporated the MDGs into its strategic framework. The Three- Year Interim Plan 2006/07–2009/10 adopted after the Tenth Plan maintained the focus on poverty reduction and growth but also stressed the need for the state to assume a greater strategic presence in development, especially in remote areas, and for socially marginalized groups to be included. The plan after that, the Three- Year Plan 2010/11–2013/14, continued the call for strategic investment in areas in need of greater focus if Nepal’s MDGs are to be achieved.5 UNDP and the other UN agencies in Nepal are actively supporting the Government in fulfilling its commitment to the MDGs. The Local Governance and Community Development Program, a large-scale joint program of UNDP, UNCDF, UNICEF, UNFPA, UN Women and UNV on effective service delivery at the local level has been in operation since 2009 which will help create enabling environment at local level in achieving MDGs. UN agencies are also supporting the government in implementing various programs on the ground in the area of poverty reduction and employment. 4.2. Current situation of health related MDGs MDGs 4; Reduce child mortality, 5; improved maternal health and 6; Combat HIV/AIDS, malaria and other disease are directly related to Health. Despite the political instability during the post-conflict period, Nepal has already exceeded a few MDG targets for 2015, under-five mortality rate per 1,000 live births ;attained 50 against the target of 54, maternal mortality ratio (per 100,000 live births, and death rate associated with TB ;per 100,000 of population.6 MDGs Progress Report 2013 points out, the Government of Nepal’s commitment to achieving the MDGs, coupled with required policy reforms has borne fruit. Nepal is on track and is likely to achieve most of its MDG targets, despite the prolonged political instability. The targets for poverty reduction, maternal mortality, and boys 8
  15. 15. and girls enrollment in primary education are either achieved or likely to be achieved. Even in areas where Nepal is lagging behind, particularly in sanitation, it has already internalized an acceleration framework in the form of the MDG Acceleration Framework to mobilize adequate resources to expedite progress by 2015. 4.2.1. MDG 4: Reduce Child Mortality Target: Reduce the under-five mortality rate by two-thirds between 1990 and 2015. Childhood mortality declined markedly over the past 20 years, between 1990 and 2011. IMR declined from 108 to 46 and the U5MR from 162 to 54 per 1,000 live births. The NMR is proving more stubborn. While NMR did drop considerably between 2001 and 2006, from 43 to 33 per 1,000, it did not decline any further between 2006 and 2011. Table 1: Child health indicators Indicator 1990 2000b 2005 2010 2013 Target 4.2.2. MDG 5: Improved maternal health Target 5A: Reduce maternal mortality by three-quarters between 1990 and 2015. 9 (2015) Infant mortality rate (per 1,000 live births) 108a 64 48c 46 46 (2011) 36 Under-five mortality rate (per 1,000 live births) 162a 91 61c 54 54 (2011) 54 Proportion of the one-year-old children immunized against measles (%) 42d 71 85e 88 88 (2011) >90 a- Ministry of Health ,New Era, & Macro International Inc. (1996) b- MoHP, New Era, & Macro International Inc. (2001). c- MoHP, New Era, & Macro International Inc. (2006). d- d- MoHP, New Era and ICF International (2011). e- NPC & UNCT (2005).
  16. 16. Drastic decline in MMR from 850 maternal deaths per 100,000 live births in 1990 to just 281 in 2006, Nepal is well on track to meet its targets for MDG 5. In fact, according to the maternal mortality and morbidity study carried out in eight districts in 2009, the MMR was 229 per 100,000 live births, just slightly above the 2015 target of 213; and, in 2012 it was estimated that Nepal’s MMR was 170 in 2010, Post-partum hemorrhage is main cause followed by pre-eclamsia/eclampsia, abortion complications, obstructed labor, other direct causes, and puerperal sepsis. Now day’s women deliver with the help of a SBA has increased. Table 2: Maternal health indicators Indicator 1990 2000 2005c 2010 2013 Target(2015) Maternal mortality ratio (per 100,000 live 850a 415b 281d 229 170e 213 births) TARGET 5B: Target 5B: Achieve Universal access to reproductive health by 2015. Nepal considers family planning services as an integral part of maternal health. The large reduction in the MMR between 1990 and 2006 has, in part, been attributed to the increased use of family planning services. Under NHSP-II, the government increased its investment in family planning and developed a strong policy framework so that it could meet the MDG targets of 67 percent contraceptive prevalence and total fertility 2.5 by 2015. 10 Proportion of births attended by skilled birth attendant (%) 7f 11g 19h 36 50i 60 Sources a- UNDP (1992). b- NPC (2002). c- MoHP, New Era, & Macro International Inc. (2006). d- FHD (2009). e- WHO, UNICEF, UNFPA & The World Bank (2012). f- NFHP (1995). g- MoHP, New Era & Macro International Inc. (2001). h- MoHP, New Era & ICF International (2011). i- FHD (2013).
  17. 17. Table 3: Reproductive health indicators Indicator 1990 2000b 2005c 2010f 2013d Target (2015) Contraceptive prevalence rate (modern 24a 35.4 44.2 - 43.2 67 methods) (%) 11 Adolescent birth rate (births per 1,000 women aged 15-19 years) n/a 110 98e n/a 81 70 Antenatal care coverage At least one visit (%) n/a 48.5 73.7 89.9 85g 100 At least four visits (%) n/a 14 29.4 50.2 50.1 80 Unmet need for family planning (%) n/a 26.5 24.6 - 27 15 Sources: a- MoHP (1992) b- MoHP, New Era & Macro International Inc. (2001) c- MoHP, New Era, & Macro International Inc. (2006) d- MoHP, New Era, & ICF International (2011) e- MoHP (2010) f- DoHS (2010) g- DoHS (2011) 4.2.3. Goal 6: Combat HIV/ AIDS, malaria, and other diseases Target 6A: Have halted and begun to reverse the spread of HIV/AIDS by 2015 Target 6B: Achieve universal access to treatment for HIV/AIDS for all those who need it by 2010 HIV infection continues to be confined within certain population groups. It is a ‘concentrated epidemic’ with PWIDs, MSM, and FSWs, in these groups that have the highest rates of infection. In 80 percent of cases, the infection is transmitted sexually. Males who migrate to India for work and visit FSWs are the bridging populations that transmit HIV to low-risk populations, primarily rural women. Effective interventions to stop the spread of HIV through preventive measures have been implemented, particularly among key high-risk population groups such as PWID, MSM, FSWs, and CSWs.
  18. 18. Access to basic HIV-related services such as VCT for HIV and other STIs should be expanded through integration with reproductive health and PHC services and the TB control program. Effective VCT services should be provided at every PHCC throughout the country to maximize access. NGOs and community based organization can provide services to high-risk groups, labor migrants and populations residing in remote areas, so their role should be expanded in coordination with government line agencies and other stakeholders. Table 4: HIV/AIDS control indicators Indicator 1990 2000 2005a 2010 2013 Target (2015) HIV prevalence among men and n/a n/a 0.15 n/a 0.12b Halt and women aged 15–24 years (%) TARGET 6C. Have halted and begun to reverse the incidence of malaria and other major diseases by 2015. According to DoHS report 2011, Malaria is almost exclusively confined within 13 high-risk and 18 moderate-risk districts though an additional 34 districts report 12 reverse the trend Condom use at last high-risk sexual encounter: youth 15–24 years n/a n/a 71.2 Males aged 15-49 years n/a 65.8c - Percentage of population aged 15–24 years with comprehensive knowledge of HIV/AIDS n/a n/a 35.6 n/a 29.8c - Proportion of population with advanced HIV infection receiving antiretroviral combination therapy (%) n/a n/a n/a 21d 28.7e 80 Sources a- NCASC (2006) b- NCASC (2011) c- MoHP, New Era & ICF International (2011) d- NCASC Fact Sheet (2009) e- NCASC (2012)
  19. 19. minimal rates of transmission. Ten districts have no risk. In 2011/12, the overall national clinical malaria incidence and annual parasite incidence rates per 1,000 people were 3.28 and 0.08 respectively. The CMI rate has fluctuated over the last five years, while the API rate has declined markedly over the past ten years. Table 5: Malaria control indicators Indicator 1990 2000 2005 2010b 2013 2015 target Clinical malaria incidence (per 1,000 people) n/a n/a 3.3a 5.67 3.23c Halt and reverse 13 the trend Annual parasite incidence (per 1,000 people) n/a 0.55 d 0.28a 0.11 0.08e 0.06 Death rate Associated with malaria (per 100,000 people at risk) n/a n/a 0.05f 0.04 0.00e Halt and reverse the trend Percentage of children under five with fever who are treated with appropriate anti-malarial drugs n/a n/a 3.23f 2.85 n/a 2.5 Percentage of children under five who sleep under a long-lasting insecticide-treated bed net n/a n/a 48.2f 94.2g 96.8h 100 Sources: a- DoHS (2007). b- DoHS, Epidemiology and Disease Control Division (EDCD) (2010). c- DoHS; 2011. d- DoHS; 2001. e- DoHS, Epidemiology and Disease Control Division; 2012a. f- DoHS, Epidemiology and Disease Control Division; 2006. g- PSI TraC Study conducted in 13 high–risk districts; 2010. h- DoHS, Epidemiology and Disease Control Division; 2012b. According to DoHS 2011, about 45 percent of the total population is infected with TB, and of them 60 percent are adult. Every year, 40,000 people develop active TB, and of them half are infectious and could spread the disease. The prevalence and death rates associated with TB per 100,000 people declined markedly between 1990 and 2011, from 460 to 238 and 43 to 21 respectively and the proportion of TB cases detected increased slightly, from 70 in 2001 to 73 in 2011. The proportion of TB
  20. 20. cases cured under DOTS was 90 percent in 2011, a level that, commendably, it has maintained for the last decade. Given that even the number of multi-drug resistant cases, which are more difficult to eradicate, is constant, Nepal is on track to achieve the MDG of 91 percent. The NTC developed a comprehensive national strategy for the period from 2010 to 2015, the National Tuberculosis Plan that builds on the previous one and outlines an enhanced and more focused commitment to tackling the TB epidemic, consistent with Nepal’s MDGs and Stop TB Partnership targets. Table 6: Tuberculosis control indicators Indicator 1990a 2000 2005 2010 2013 2015 target Prevalence rate associated with TB (per 460 310b 280c 244d 238e Halt and 100,000 people) 14 reverse the trend Death rate associated with TB (per 100,000 people) 43 23b 22c 22d 21e Halt and reverse the trend Proportion of TB cases detected (%) n/a 70f 70g 76h 73i 85 Proportion of TB case cured under DOTS (%) 40 89f 89g 90h 90i 91 Sources: 1- DoHS (2007). 2- DoHS, Epidemiology and Disease Control Division (EDCD) (2010). 3- DoHS (2011). 4- DoHS (2001). 5- DoHS, Epidemiology and Disease Control Division (EDCD) (2012a). 6- DoHS, Epidemiology and Disease Control Division (EDCD) (2005/06). 7- PSI TraC Study conducted in 13 high–risk districts (2010). 8- DoHS, Epidemiology and Disease Control Division (EDCD) (2012b). 4.3. Post MDG Health agenda of United Nation There is wide debate as to what development goals the global community should set next. The United Nations Secretary-General Ban Ki-moon has appointed a High-level Panel to advice on the global development agenda beyond 2015. In January 2012, the UN System Task Team on the Post-2015 UN Development Agenda was established.
  21. 21. The United Nations Development Group is leading efforts to catalyze a “global conversation” on the post-2015 agenda through a series of global thematic consultations and more than 50 national consultations. The post-2015 development framework is likely to have the best development impact if it emerges from an inclusive, open and transparent process with multi-stakeholder participation.7 Health priorities in the post-2015 era should include accelerating progress on the present health MDGs, advancing sexual and reproductive health and rights, reducing NCDs and their risk factors, and improving mental health. Many contributors argue that the new agenda needs to make people the priority in global health, not diseases. A two-pronged approach is needed: tackling the underlying determinants that cause or contribute to ill health, and creating health systems that are proactive, preventive, and can provide care throughout an individual’s life, with ongoing management for all health issues, including public health. Health goals and indicators in the next development agenda should encourage countries to address both these aims, by measuring not only health outcomes but also the creation of conditions that promote good health. Alongside the MDGs the post-2015 agenda offers an opportunity to harness new resources with which to tackle all health challenges in an integrated and sustainable manner.8 15
  22. 22. 5. CONCLUSION Health is the central part of sustainable development. If we achieve health related targets of MDGs we can develop our nation progressively. MDGs are interrelated if we can work better in health goals there is a positive progression on other MDGs achievement. Nepal has made significant progress in achieving its MDGs. In fact, given the difficult context; a decade-long armed conflict, political instability, and unfinished national political agenda regarding peace-building, constitution writing and state-restructuring its achievements should be considered remarkable. 16
  23. 23. 17 6. RECOMMENDATION  Nepal has a good progress on achieving MDGs the effort should be continue to achieve remaining targets of MDGS.  Those targets which are already achieved must be kept in same manner and sustain it and the programs, efforts shouldn’t discontinue.  The resources for MDGs must be increases i.e. financial resource, human resources and other resources.  Need to integrate health system to community and local governance system in large scale to achieve sustainable development.  After MDGs continue the basic 8 goals with some addition new goals of Post- 2015 Global agenda.  Create healthy environment for United Agencies for their support, investment for development.
  24. 24. 7. REFERENCES 1. WHO, Millennium Development Goals http://www.who.int/topics/millennium_development_goals/about/en/ 2. United, N. thematic areas/ Millenium development goals. http://www.un.org.np/thematicareas/mdg 3. Umesh, G. Millennium Development Goals in Nepal http://umeshg.com.np/millennium-development-goals-in-nepal/ 4. NRB (2006) Achieving Millennium Development Goals: Challenges for Nepal. http://red.nrb.org.np/publications/special_publication/Special_Publications-- Achieving%20Millennium%20Development%20Goals- %20Challenges%20for%20Nepal.pdf 5. NPC, G. o. N. (2013) Nepal Millennium Development Goals Progress Report 2013. http://www.np.undp.org/content/dam/nepal/docs/reports/millennium%20deve lopment%20goals/UNDP_NP_MDG_Report_2013.pdf 6. GON, N. (2010) MDGs progress report http://www.npc.gov.np/new/uploadedFiles/allFiles/mdg_2011.pdf 7. United, N. (2011) Accelerating progress towards the Millennium Development Goals: options for sustained and inclusive growth and issues for advancing the United Nations development agenda beyond 2015, Annual report of the Secretary http://daccess-dds-ny. un.org/doc/UNDOC/GEN/N11/410/40/PDF/N1141040.pdf 8. Want, t. w. w. (2013) Health in the post-2015 Agenda, Report of the Global Thematic Consultation on Health. the world we want, http://www.worldwewant2015.org/bitcache/aa5345b4af0fae1615b108c3e392 a2ca781ce2ec?vid=366802&disposition=attachment&op=download THANKYOU! 18

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