Background on Nepal
Nepal is a small country sandwiched between two giant neighbours – India to the south and China to the north.
Its fame includes Sagarmatha (Mount Everest) the world’s highest peak, the ancient temples and palaces of Kathmandu and the evocative fables of Shangri-La.
Nepal is as complex as it is fascinating. 27 million people from 120 diverse ethnic and languages groups – emerging from Indo-European, Tibetan and Burmese roots – populate a geographically diverse country from the steamy sub-tropical plains in the south, rising abruptly through the middle hills to the high, harsh and sparsely populated mountain districts.
Healthcare development and palliative care
Whilst Nepal is one of the most economically poorly developed nations in the world – 147th of 188 according to the UNDP, it punches above its weight in healthcare development.
Over 2000 Nepalis graduate from medical school each year, the majority studying in Nepal’s own medical schools.
The government health service is well organised, with central referral hospitals in Kathmandu and major cities and towns and a system of small hospitals, primary care centres and health posts in its 63 rural districts.
Palliative care too has been provided in Nepal for the last 15 years, with dedicated and visionary doctors and nurses setting up small hospice units and establishing palliative care services in some larger hospitals.
The Nepalese Association for Palliative Care
The Nepalese Association for Palliative Care (NAPCare), formed in 2009, has been active in establishing training which has been adopted and is now run by the government.
NAPCare also worked with the government to introduce a robust system for morphine prescribing. Nepal is now self-sufficient in morphine production – with both immediate and sustained release formulations available.
NAPCare, supported by a long-term partner, Two Worlds Cancer Collaborative of Canada, has now turned its attention to developing a national strategy with the aim of making palliative care available to everyone who needs it.
To that end, a Forum exploring the various aspects of a strategy: service provision, training, governance, logistics of supply and research, was held in Kathmandu from 15 to 17 February this year.
The forum was attended by palliative care stakeholders, senior officials from the Ministry of Health and Population, WHO and a number of international experts.
Results from a recent survey of palliative care provision in Nepal and projections of likely need for it were presented to inform discussions.
Professor Max Watson, from Northern Ireland Hospice, a long-time friend of Nepal, facilitated the discussions.
His wealth of experience guided the delegates as they considered how to enable palliative care in Nepal to be established as an element of the country’s public health.
Continuing to work with government and WHO, NAPCare has set itself a target of completing the strategy in the next six months.
Turning strategy into reality
The work to turn strategy into reality will of course take much longer. Nepal has many challenges to overcome in its quest to provide comprehensive health care.
Whilst the infrastructure for health has been established, lack of funding limits which services can be provided and the mountainous terrain poses barriers to achieving even basic healthcare provision in remote rural areas.
In this context, new models of palliative care need to be developed with specialist services in the larger hospitals and primary palliative care in rural areas.
NAPCare has therefore set itself a great challenge. However, whilst this may be so, the Forum demonstrated that there is no lack of vision and enthusiasm to make palliative care for all in Nepal a reality.