jif{ !, c+s !, j}zfv÷h]7–@)^^
VOL. 1, NO. 1, MAY/JUNE-2009
…Unf]an x]NyÚ
a'nl] 6g lsg <
s] x'g\
:jf:Yosf
kf“r cfwf/e"t
kl/jt{g <
–:jf:Yo dGqL lul//fhdl0f kf]v/]nsf] l6Kk0fL
:jf:Yo ;d:of g]kfnsf] cfwf/e"t txsf] ;d:of
xf] . o;sf] k|efjsf/L lg/fs/0f ljgf gofF g]kfn
aGg ;Sb}g . kl5Nnf] /fhgLlts kl/jt{gkl5
o;}sf/0f cGtl/d ;+ljwfgdf :jf:YonfO{ ;d]t
df}lns clwsf/sf ?kdf :yflkt ul/Psf] 5,
h;nfO{ ;+ljwfg;efdfkm{t\ aGg] gofF ;+ljwfgn]
;+:yfut ul/5f8\g5
] .
;+ljwfgn] :jf:YonfO{ df}lns clwsf/sf ?kdf
:yflkt u/] klg / ;/sf/n] To;cg'?k :jf:Yo
sfo{qmdx? NofP klg hg:t/df To;sf] r]ggf,
hfgsf/L k'ug] eg] gLlt jf sfo{qmd cfkm}d+ f lkmsf
x'G5g\ . of] a'nl] 6gn] g} hgtfdf Tof] r]tgf:t/
k'¥ofpF5 eGg] lglZrttf t xfdL ub}g{ f},+ t/ r]tgf:t/
k'¥ofpgsf nflu ;DalGwtx?df o;n] bafa l;h{gf
u¥of] eg] klg To;nfO{ xfdLn] pknlAw dfGg'kg]{
x'G5 .
cem hg:jf:Yo gLlt, ljZjJofkLs/0fsf] o;df
k|efj / hg:jf:Yodf Jofkf/Ls/0f xfd|f] a'nl] 6gn]
ax;sf nflu rf;f] /fVg] ljifo x'g\ . To:tf]
ax;n] hgkIfLo :jf:Yo gLltlgdf{0fdf, hgkIfLo
:jf:Yo gLlt k|Tofe"ltsf] cfGbf]ngdf ;xof]u k'¥ofof]
eg] Tof] xfd|f] csf]{ of]ubfg x'g5
] . :jf:Yo r]tgf,
:jf:Yo ax; / :jf:Yo hfgsf/L xfd|f] a'nl] 6gsf]
klxrfg x'g5
] , h;n] vf;u/L cfwf/e"t txsf
hgtfsf] :jf:Yo clwsf/sf] kf6f]df Pp6f OF6f
yk]sf] hlt of]ubfg lbg ;Sof] eg] xfdL nIod}
/x]sf] x'g5
] f}+ . a'nl] 6gn] Tof] of]ubfg k"/f ug{
;Sof] ls ;s]g < To;sf] Gofo ug{ kf7sx?nfO{
xfdL ljgd|tfk"js
{ cg'/f]w ub{5f}+ . lgMz'Ns :jf:Yosf]
lj:tf/ qmd
r'8fdl0f e08f/L
cGtl/d ;+ljwfg, @)^# n] …k|To]s
gful/snfO{ /fHoaf6 sfg'gdf Joj:yf
ePadf]lhd cfwf/e"t :jf:Yo ;]jf
lgMz'Ns ?kdf kfpg] xs x'g5
] Ú egL
:jf:Yo ;]jfnfO{ hgtfsf] df}lns xssf
?kdf :yflkt u/]sf] 5 . o;;“u}
hgcfGbf]ngkl5 ul7t g]kfn ;/sf/n]
ul/a, c;xfo, ljkGg ju{, ckfË, Ho]i7
gful/ssf] :jf:Yo ;]jfdf kx'rF j[l4
u/L pgLx?nfO{ cfw'lgs :jf:Yo
;]jfaf6 jl~rt x'g glbg] gLltcGtu{t
lgMz' N s :jf:Yo sfo{ q mdnfO{
k|fyldstfdf /fv]sf] 5 . o;cGtu{t
;/sf/n] k| f ylds :jf:Yo ;+ : yf
-k|fylds :jf:Yo s]Gb|, :jf:Yo rf}sL
/ pk:jf:Yo rf}sL_af6 cfwf/e"t :jf:Yo
;]jf k|bfg ub}{ cfO/x]sf] 5 . o;
sfo{ q mdaf6 k| f ylds :jf:Yo
;+:yfx¿af6 k|bfg ul/g] ;a} :jf:Yo
;]jfx¿ -k|jw{gfTds, k|lt/f]wfTds, ljz]if
:jf:Yo sfo{qmd / pkrf/fTds_ / oL
;]jfx¿cGt{ut cfjZos cf}ifwLx¿
hgtfn] lgMz'Ns kfpg]5g\ .
g]kfnsf] :jf:Yo gLlt, bf];|f]
bL3{sfnLg :jf:Yo of]hgf / cfjlws
of]hgfcg';f/ kl/jf/ lgof]hg, ;'/lIft
dft[ T j, vf] k , PsLs[ t afn/f] u sf]
Joj:yfkg, kf]if0f sfo{qmd, cf}nf],
sfnfhf/, hfkflgh OG;]kmnfO6L;,
Ifo/f]u, s'i7/f]u, Pr=cfO{=le=÷P8\;,
xfQLkfOn], :jf:Yo lzIff, d'v :jf:Yo,
k]zfut :jf:Yo, dfgl;s :jf:Yo Pj+
jftfj/0fLo :Jff:Yo / Ho]i7 gful/s,
ckfË sfo{qmdh:tf :jf:Yo sfo{qmd
;~rflnt 5g\ . /, s]Gb|Lo, If]qLo,
c~rn Pj+ lhNNff c:ktfnb]lv k|fylds
:Jff:Yo s]Gb| / :jf:Yo rf}sL;Dddf
ljz]if ;]jfsf] Joj:yf ul/Psf] 5 .
@
;fy} ;fd'bflos, lghL ;+:yfdf ;d]t
oL ;]jf pknAw 5g\ . ;fy} 3'DtL
lzlj/af6 klg pkrf/ ;]jf pknAw
u/fOPsf] 5 .
;g\ !(&* sf] …cNdf cf6fÚ
3f]if0ffcg';f/ k|fylds :jf:Yo ;]jf
h:tf]– vf]k, kl/jf/ lgof]hg, dft[
lzz' :Jff:Yo, kl/jf/ lgof]hg, :yfgLo
:t/sf /f]usf pkrf/, dxfdf/L /f]u
lgoGq0f tyf kf]if0f Pj+ cTofjZosLo
cf}ifwLsf sfo{qmdx¿ kl5Nnf] r/0fdf
k|efjsf/L agfOPsf 5g\ . ;f]sf] k|ltkmn
;d]t b]vfk/]sf] 5 . h:tf]– ;x>fAbL
ljsf; nIo k"/f ug{ ;Sg] ljZjsf &
/fi6«dWo] g]kfn klg /x]sf] ;g\ @))^
sf] …Pgl8PrP; ;e]Ú{ n] b]vfO;s]sf]
5 . vf;u/L afnd[To' / dft[dT[ o'df
;'wf/ b]lvPsf] 5 . oBlk ;+ljwfgdf
ePsf] dlxnf, blnt, cflbjf;L–
hghflt, dw] ; L, d' l :ndnufot
cNk;+Vos e"ldxLg, ;'sD' af;L, sd}of,
ckfË, lk5l8Psf] If]q tyf ;d'bfo /
åGå kLl8tsf nflu ;sf/fTds lje]bsf
cfwf/df ljz]if Joj:yf ug{] gLltcg';f/
dlxnf nlIft sfo{qmd tyf ;]jf /
afnaflnsfsf] :jf:Yo ;'wf/, ckfË
Pjd\ Ho]i7 gful/s tyf clt ul/a,
ul/anlIft sfo{qmd ;f]rc
] g'?k cem
Jofks agfpg ;lsPsf] 5}g .
cfwf/e"t :jf:Yo ;]jf eGgfn]
pk:jf:Yo rf}sL, :jf:Yo rf}sL /
k|fylds :jf:Yo s]Gb|af6 lbOg] ;]jfnfO{
a' l emG5 . To;f] xf] eg] lhNnf
c:ktfnaf6 lbOg] ;]jf s] xf] < c~rn,
If]q / s]Gb| :t/Lo c:ktfndfkm{t\ lbOg]
cfwf/e"t :jf:Yo ;]jf s] x'g] <
dxfgu/kflnsf, gu/kflnsfn] lbg]
cfwf/e"t ;]jf s] slt xf] < lghL
G L O B A L H E A LT H B U L L E T I N
;+:yfn] lbg] ;]jfdf cfwf/e"t ;]jf s]
x'g] < h:tf k|Zgx? cg'Ql/t b]lvPsf
5g\ . u|fdL0f clt ul/a jf ul/a,
;'sD' af;L / ;x/L >lds cflbsf] :ki6
ljj/0f /fvL pgLx¿nfO{ u'0f:t/Lo
:Jff:Yo ;]jf pknAw u/fpg] lhDd]jf/L
/fi6«sf] xf] eg] …sfg'gdf Joj:yf
ePadf]lhdÚ eGg] jfSof+znfO{ sfof{Gjog
ug{ cfjZos lgod, ljlgod, lgb{l] zsf
x'gk' 5{ cGoyf hlt pknlAw ug{ ;lsof],
ToxL g} cfwf/e"t :jf:Yo ;]jf xf] eGg]
JofVof Gofok"0f{ / clwsf/d'vL x'bF g} .
;/sf/n]
cGtl/d
;+ljwfgdf …k|To]s dlxnfnfO{ k|hgg
:Jff:Yo tyf k|hgg;DaGwL xs x'gÚ]
k|Tofe"t ul/Pcg';f/ lgMz'Ns sfo{qmddf
;'Ts]/L ;]jf lgMz'Ns x'g] Joj:yfnfO{
;d]l6Psf] 5 . o;cg';f/ @)^% df3
! b]l] v ;/sf/L c:ktfndf ;fwf/0f /
hl6n -ck|;
] g_ ;'Ts]/L ;]jf;d]t cfd
gful/snfO{ lgMz'Ns ul/Psf] 5 .
To;sf ;fy} ue{jtL ;]jf, ;'/lIft
ue{ktg ;]jf tyf :jf:Yo ;+:yfdf
;'Ts]/L x'bF f lxdfn, kxf8 / t/fO{df
qmdzM !% ;o, Ps xhf/ / kfFr ;o
?k}ofF pknAw u/fpg] ;d]t Joj:yf
ul/Psf] 5 .
To:t} cGtl/d ;+ l jwfgdf
ePsf] …k| T o] s afnaflnsfnfO{
kfngkf] i f0f, cfwf/e" t :jf:Yo /
;fdflhs ;'/Iff k|fKt ug{] xs x'gÚ]
Joj:yfcGtu{t o; jif{ PsLs[t afn
/f]u Joj:yfkg sfo{qmd &% lhNnfd}
k"/f ug{] nIo lnOPsf] 5 . ;fy} j[l4,
cg'udg / k/fdz{ tyf ;/sf/L,
u}/;/sf/L ;fem]bf/Ldf s'kf]lift aRrfsf]
k'g:yf{kgf, le6fldg P, cNj]08fhf]n
ljt/0f / ljl;lh, l8lkl6, kf]lnof],
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
bfb'/f, x]kf6fOl6; aLh:tf vf]k pknAw u/fOPsf] 5 . oL
dxTjk"0f{ pknlAw x'g\ .
hgcfGbf]ng )^@÷^# sf] nuQ} :jf:Yo tyf hg;+Vof
dGqfnon] !) a'bF ] cfwf/kq ;fj{hlgs u/L ul/a, c;xfosf]
kIfdf ;fdflhs ;'/Iff hfnf] a9fpFb} cfw'lgs :Jff:Yo ;]jfdf
nlIft ju{sf] kx'rF j[l4 ug{] s'/f cufl8 Nofof] eg] ;+ljwfgdf
cfwf/e"t :jf:Yo ;]jf lgMz'Ns ug{] Joj:yf ul/PkZrft\
cfwf/e"t tx -k|fylds :jf:Yo s]Gb|, :jf:Yo rf}sL /
pk:jf:Yo rf}sLaf6 lbOg] :jf:Yo ;]jf_df lgMz'Ns :jf:Yo
;]jfsf] sfo{qmd NofOof] .
;a} uflj;df :jf:Yo ;+:yf vf]nL :jf:Yo ;]jf k|bfg
ug{] sfo{ @)$^ sf] hgcfGbf]ngsf] pknlAw xf] eg] lgMz'Ns
;]jfsf] Uof/]G6L ug],{ ul/a, c;xfo, ckfË, Ho]i7 gful/snfO{
k|fyldstfsf ;fy lgMz'Ns :jf:Yo ;]jf lbg] cyf{t\ pk:jf:Yo
rf}sL, :jf:Yo rf}sL tyf k|fylds :jf:Yo s]Gb|df cfd
gful/snfO{ :jf:Yo ;]jf lgMz'Ns ug{] sfo{ )^@÷^# sf]
hgcfGbf]ngsf] d'Vo pknlAw xf] . o;}u/L cfj @)^%.)^^
b]lv lhNnf c:ktfn;Dd $) k|sf/sf cf}ifwL ;d]t lgMz'Ns
ug{] sfo{ k|fyldstf ;fy ;'? ul/Psf] 5 .
t/ lgMz'Ns sfo{qmdnfO{ gsf/fTds 6Lsfl6Kk0fL ug{]
hdft klg 7"n} 5 . s] Tof] ;xL xf] < sbflk xf]Og .
sfof{Gjog kIfdf ;'emfj glbO{ gsf/fTds k|rf/ dfq ug{'
hgtfk|lt cGofo x'g hfG5 . lj;+ult t hgzlQm geO{
:jf:Yo ;+:yf vf]Ng', sd{rf/L ;?Jffdf :ki6 d"Nofª\sg
gx'g,' cg'udg ;'k/Lj]If0fsf] cefj x'g' / la/fdLaf6 p7fPsf]
/sdsf] lx;falstfa kf/bzL{ gx'gh
' :tf ljifox? x'g,\ h;af/]
lgMz'Ns sfo{qmdn] a9L Wofg lbPsf] 5 .
lgMz'Ns sfo{qmds} nflu :jf:Yo If]qsf] ah]6df j[l4
ePsf] 5 . s"n ah]6sf] %–^ k|ltztdf /xL cfPsf] :jf:Yosf]
ah]6 a9]/ & bzdna !@ k|ltzt;Dd k'us
] f] 5 . lgMz'Ns
:jf:Yo sfo{qmdnfO{ g} nlIft u/L sl/a ;ft ;o c:yfoL
:jf:YosdL{ egf{ ul/Psf] 5 . lgMz'Ns sfo{qmdsf] sfof{Gjog
kl5 g} cTofjZosLo cf}ifwLsf] k|of]uaf/] hgtfdfem 5nkmn,
ax; rn]sf] 5 . r]tgf clej[l4 ePsf] 5 . o; sfo{qmdn]
k|fylds :jf:Yo s]Gb|df Odh{G] ;L ;]jf ;~rfngdf hf]8
lbPsf] 5 eg] cf}ifwL lgoldt pknAw u/fpg] Joj:yf u/]sf]
5 . h;cg';f/ :Jff:Yo rf}sLdf #@ y/L / pk:Jff:Yo
rf}sLdf @@ y/L cf}iflw lgMz'Ns pknAw ePsf] 5 / k|f:jf
s]Gb|df #% / lhNnf c:ktfndf $) k|sf/sf cf}ifwL lgMz'Ns
pknAw ePsf] 5 . btf{ z'Ns Pj+ ;]jfz'Ns ;d]t lgMz'Ns
ul/Psf] 5 . 5fqj[lQsf lrlsT;s kl/rfng u/L w]/h
} ;f]
kb k"lt{ ul/Psf] 5 . :jf:Yosf] ah]6 lhNnfaf6 dfq vr{
ug{k' b{5 eGg] ;ª\sl' rt ljrf/af6 dfly p7]/ :yfgLo :t/;Dd
k7fOPsf] 5 . o;}u/L gful/s a8fkqdfkm{t\ :jf:Yo ;+:yf
vf]Ng] ;dodf ;d]t Ps?ktf NofOPsf] 5, Odh{G] ;L ;]jf
lbg}kg{] Joj:yf ug{ ;d]t o;n] d'Vo e"ldsf v]ns
] f] 5 .
o;} sfo{qmddfkm{t\ Ho]i7 gful/s tyf ckfËnfO{ ;d]t
;fdflhs ;'/Iff sfo{qmddf ;d]l6Psf] 5 . o;}u/L :jf:Yo
If]qdf pNn]Vo of]ubfg ug{] dlxnf :jf:Yo :jo+;l] jsfnfO{
G L O B A L H E A LT H B U L L E T I N
lgMz'Ns :jf:Yosf r'gf}tL
!= cTofjZos cf}ifwLx¿sf] u'0f:t/Lotf tyf cfk"lt{
Joj:yfkg
k|To]s uflj; tyf r'gfj If]qx¿df :yfkgf ul/Psf
nueu rf/ xhf/ ;fd'bflos :jf:Yo ;+:yfx¿ -k|fylds
:jf:Yo s]Gb|, :jf:Yo rf}sL / pk:jf:Yo rf}sL_af6
lgMz'Ns :jf:Yo ;]jf k|bfg ubf{ w]/} kl/df0fdf cTofjZos
cf}ifwLx¿sf] cfk"lt{ Joj:yfkg ug{' 7"nf] r'gf}tL xf] .
cf}ifwL 9'jfgL, e08f/0f / ;]jf k|bfg ug]{ a]nf;Dd
cf}ifwLsf] u'0f:t/ ;'lglZrt ug'{ klg 7"nf] k|fljlws
r'gf}tL xf] .
@= :jf:Yo ;+:yfx¿df hgzlQm kl/rfgn tyf k|efjsf/L
;]jf Joj:yfkg
lgMz'Ns :jf:Yo ;]jf sfo{qmd nfu' ePaf6 :jf:Yo
;+:yfx¿df ;]jfu|fxLx¿sf] ;ª\Vofdf pNn]vgLo a[l4
x'g hfg] 5 . o; cj:yfdf ;Dk"0f{ :jf:Yo ;+:yfx¿df
b/aGbLcg';f/ sd{rf/Lx¿sf] pkl:ylt x'g ;s]g eg]
;]jf ;~rfngsf] k|efjsf/Ltfdf k|lts"n c;/ kg{] 5 .
;Dk"0f{ :jf:Yo ;+:yfx¿df b/aGbLcg';f/ hgzlQmsf]
Joj:yfkg, k|efjsf/L ;'k/Lj]If0f tyf cg'udg Ps
k|dv
' r'gf}tL xf] .
#= :jf:Yo ;]jfsf] cjflG5t pkef]u
lgMz'Ns :jf:Yo ;]jf sfo{qmdcGt{ut :jf:Yo
;+:yfx¿df cfk"lt{ ul/g] cTofjZos cf}ifwLx¿sf] kl/df0fdf
pNn]vgLo a[l4 x'g] x'bF f :jf:YosdL{x¿af6 cfjZostf
eGbf a9L cf}ifwL l;kmfl/; x'g ;Sg] cj:yf cfpg
;S5 eg] ;]jfu|fxLaf6 klg cgfjZos :jf:Yo ;]jfsf]
pkef]u x'g ;Sg] ;d:of cfpg ;S5 . o;sf] cg'udg
klg Ps k|dv
' r'gf}tL xf] .
$= sfo{qmdsf] :yfloTj
olt w]/} kl/df0fdf cf}ifwL vl/b ubf{ l/Koflsª,
9'jfgL cflbdf klxn]sf] t'ngfdf w]/} vr{ a9\g] x'G5 /
x/]s jif{ qmlds ?kdf vr{ a[l4 x'g ;Sg] l:ylt
/xG5 . ;w}e+ l/ ljb]zL bftfx¿df dfq e/ kg{ ;ls+bg} .
To;}n] sfo{qmdsf] :yfloTj klg cfkm}d+ f 7"nf] r'gf}tL xf] .
gjLgk|;fb >]i7
;d]t o; sfo{qmdn] ;d]6s
] f] 5 . lg/Gt/ :jf:Yo ;]jfdf
vl6g] :jf:YosdL{nfO{ sfd u/]cg';f/ k|fT] ;flxt ug{k' b{5
eGg] s'/f klg sfo{qmdn] lgb{l] zt u/]sf] 5 . yk dxTjk"0f{
s'/f :yfgLo :t/df /fhgLlts bn / gful/s ;dfhåf/f
cg'udg ug{] Joj:yf ;d]t o; sfo{qmdn] ldnfPsf] 5 eg]
ul/aL lgjf/0f sf]if, :yfgLo ljsf;;Fu ;dGjo ug{] sfo{sf]
yfngL ePsf] 5 . o;/L x]bf{ lgMz'Ns sfo{qmd ;du| :jf:Yo
;]jf / Joj:yfkgnfO{ ;'b9[ Ls/0f ug{] of]hgfcg'?k cl3
a9]sf] 5 .
-n]vs lhNNff hg:Jff:Yo sfof{no, sf7df8f}+sf k|d'v tyf
lgMz'Ns :jf:Yo sfo{qmd s]Gb|Lo cg'udg ;ldltsf ;b:o x'g\ ._
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
#
ljs6 If]qdf
hlGdPs} cfwf/df,
hftLo jf ln+uLo
?kdf lk5l8Ps}
cfwf/df s;}n]
:jf:Yo ;]jf
gkfpg] l:yltsf]
ca cGTo ug}k{ 5{ .
ca xfd|f] Pp6}
hf]8 sfof{Gjog
:jf:Yo tyf hg;+VofdGqL lul//fhdl0f kf]v/]n
$
G L O B A L H E A LT H B U L L E T I N
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
:jf:Yo ;]jf k|fljlws ljifo dfq geP/ d"ntM of]
;fdflhs Gofosf] ljifo xf] . !) jifL{o hgo'4 /
)^@÷^# sf] P]ltxfl;s hgcfGbf]ngsf] lgb]z
{ adf]lhd
cGtl/d ;+ljwfgn] :jf:YonfO{ hgtfsf] df}lns
clwsf/sf ?kdf lglZrt ul/;s]sf] 5 / ToxL dfGotfdf
cfwfl/t x' F b } ;/sf/n] k| f ylds :jf:Yo ;] j f
cjwf/0ffnfO{ k'ghf{u/0f u/]/ gofF :jf:Yo k|0ffnL
cjnDag ul//x]sf] 5 . To;cg'?k g} hgtfsf]
cfwf/e"t txdf r/0fa4 ?kdf lgMz'Ns :jf:Yosf]
sfo{qmd nfu' ul/;lsPsf], k|;l' t ;]jfdf /fli6«o txd}
lgMz'Ns sfo{qmd nfu' ul/;lsPsf] / lhNnf
c:ktfnx¿af6 ;d]t ;"rLs[t cTofjZos cf}ifwLx¿df
lgMz'Ns sfo{qmd nfu' ul/;lsPsf] cj:yfdf To;sf]
k|efjsf/L sfof{Gjogsf b[li6n] xfdLn] ug'k{ g]{ w]/}
5 .
lrlsT;sx¿sf] ;lqmo ;xeflutf / ljj]sk"0f{
k|lta4tfljgf :jf:Yosf s'g} klg sfo{qmd ;kmn /
k|efjsf/L x'g ;Sb}gg\ . :jf:Yo ;"rsf+sdf g]kfn
l56f]l56f] k|ult ug]{ d'ns
' df k5{ . Toqf] åGåsf]
l:yltdf ;d]t g]kfnsf] :jf:Yo k|ulthgs cj:yfd}
/x\of] . o;aLrdf klg dft[ / lzz' d[To'b/df pNn]Vo
sdL cfPsf] 5 . lrlsT;sx¿ / cf}ifwLx¿sf]
pknAwtfsf] lglZrttf a9\b} uPsf] 5 . ;/sf/L
5fqj[lQdf k9]sf lrlsT;sx¿n] u|f| dL0f txdf b'O{ jif{
clgjfo{ ;]jf ug'k{ g]{ Joj:yf ub}{ To;cg'?k ufpFdf
k7fpg] k|lqmofsf] ;'?cft eO;s]sf] 5 . g]kfnsf
cGt/f{li6«o :jf:Yo ;fem]bf/x¿n] Ps} 5fgfd'lg, /fli6«o
:jf:Yo gLltcg'?k :jf:Yosf] Pp6} k|fyldstfdf cfpg]
k|lta4tf hgfO;s]sf 5g\ . k|fylds :jf:Yo /fHosf]
bfloTj xf] eGg] l;4fGt cfwfl/t xfd|f gLltx¿nfO{
xfdLn] sfo{qmlds ?kn] g} :yflkt ul/;s]sf 5f}+ .
/, ce\m kl/dflh{t u/]/ gofF /fli6«o lgltsf] ?kdf
Nofpg] tof/L ul//x]sf 5f}+ . lgMz'Ns :jf:Yosf
sfo{qmdx¿ ljz]if 9+un] ;kmn agfpgsf ;fy} zx/L
tyf jftjf/0fLo :jf:Yo / ;fdflhs ;'/Iff tyf
;xsf/Lx¿ ;+:yfut ug{ gofF dxfzfvf -k'ghf{u/0f_
g} v8f ug]{ u[xsfo{ nueu clGtd r/0fdf k'us
] f]
5 . :jf:Yo If]qaf6 ;x;|fAbL ljsf; nIo k|fKt ug]{
b]zx¿sf] cu|:yfgd} g]kfn k/]sf] 5 . :jf:Yodf ;xL
gLlt :yflkt eO/x]sf] cj:yfdf ca xfd|f] csf]{ ljif]z
hf]8 cg'udg / sfof{Gjog g} xf] / oL If]qx¿df klg
;a} lrlsT;sx¿sf] ;lqmoftf d h?/L b]Vb5' .
sfof{Gjogsf b[li6n] xfdLn] ug'k{ g]{ w]/} 5 . k|fylds
:jf:Yosf], cfwf/e"t txsf hgtfsf] :jf:Yo ;]jfsf]
lglZrttf, k|efjsfl/tf / k|ultljgf h:tf;'s} sfo{qmd
G L O B A L H E A LT H B U L L E T I N
:jf:Yodf
kf“r cfwf/e"t
kl/jt{g
)^@÷)^# sf] hgcfGbf]ngkl5 xfdLn] :jf:Yo
dGqfno ;Dxfn]sf 5f}+ . /, :jf:Yo If]qnfO{
g]kfnL hgtfsf] dfucg'?k kl/jt{gsf] k|lqmofdf
nu]sf 5f}+ . xfdLn] :jf:Yodf kl/jt{gsf] ofqf
!) a'b“ ] cfwf/kqaf6 z'? u/]sf lyof}+ . To;sf]
d"n s'/f …:jf:Yo hgtfsf] df}lns clwsf/Ú
xf] eGg] lyof] . kl5 cGtl/d ;+ljwfgn] ToxL
s'/fnfO{ :yflkt u¥of] . /, xfdL To;}sf]
pHofnf]df lx“8s
] f 5f}+ .
:jf:Yodf xfdLn] kf“rj6f cfwf/e"t kl/jt{g
NofPsf 5f}+ . klxnf], :jf:YonfO{ clwsf/jfbL
b[li6af6 x]g{] k|lqmofsf] z'?cft . ;+ljwfgt,M
sfg'gtM o;sf] lglZrttf ub}{ o;nfO{
cfdhgtfsfaLrdf :yflkt ug]{ k|lqmofdf xfdL
nfu]sf 5f}+ .
bf];f| ,] …k|fylds :jf:Yo /fHosf] lhDd]jf/L
xf]Ú eGg] s'/fsf] k|Tofe"ltsf nflu lgMz'Ns
:jf:Yosfo{qmdsf] ;'?cft . o;df z'?df
xfdLn] nlIft ;d"x ls6fg u/]/ lgMz'Ns :jf:Yo
sfo{qmdsf] z'?cft u¥of}+ . )^$ -df3 !_
b]lv :jf:Yorf}sL / pk:jf:Yorf}sLx¿dfkm{t\
lgMz'Ns :jf:Yo sfo{qmd z'? u¥of}+ . )^%
d+l;/ ! ut]af6 xfdLn] k|fylds :jf:Yo
s]Gb|x¿dfkm{t\ ;d]t lgMz'Ns :jf:Yo sfo{qmd
;'? u¥of}+ . /, df3 ! ut]bl] v b]zJofkL
?kdf k|;l' t ;]jfnfO{ lgMz'Ns u/]sf 5f}+ tyf
lhNnf c:ktfnaf6 lbOg] cTofjZos cf}iflwnfO{
klg lgMz'Ns u/]sf 5f}+ . lhNnf c:ktfn;Ddn]
lbg] ;]jf k|fylds :jf:Yo ;]jfleq kb{5 .
To;}n] xfdLn] lhNnf c:ktfn;Dddf klg
cTofjZos cf}ifwLx?df lgMz'Ns :jf:Yo
sfo{qmd nu]sf 5f}+ .
t] ; | f ] , :jf:Yo k| 0 ffnLdf kl/jt{ g .
:jf:YonfO{ clwsf/jfbL b[li6af6 x]l/;s]kl5
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
%
klg lkmsf x'G5g\ . To;}n] u|fdL0f / ;x/L :jf:Yo
;]jfdf h'g lje]bsf] l:ylt 5, ;fdflhs Gofo / gofF
g]kfn lgdf{0fsf] b[li6n] klg of] zf]egLo s'/f xf]Og .
Pp6} pbfx/0f – cf};tdf dft[ / lzz' d[To'b/df
pNn]Vo sdL cfP klg dft[ / lzz' d[To' b/ ;x/df
eGbf ufpFdf bf]Aa/ 5 . To;sf] cy{ ufpFdf :jf:Yo
;]jf cem} k|efjsf/L aGg ;s]sf] 5}g . oBlk ;x/leq}sf
ljkGgx?n] klg k|fylds :jf:Yo ;]jf gkfO/x]sf]
l:yltnfO{ ;Daf]wg ug{ j8f sfof{nox?df :jf:Yo
;+oGq :yflkt ug]{ u[xsfo{ eO/x]sf] 5 . ufpFdf
;|f]t, ;fwg, ;+/rgf / pks/0fx¿sf] cefj 5 .
To;sf] k"lt{sf b[li6n] ;/sf/n] 7f]; sfo{qmd t
NofpF5 g}, u|fdL0f :jf:Yodf k|fyldstfsf nflu
lrlsT;sx¿sf] klg ;lqmo ;xeflutf / ljj]sk"0f{
k|lta4tfsf] ck]Iff ub{5 . lsgls tflnd k|fKt,
of]Uo / ;Ifd lrlsT;sx¿ b'u{d ufpFdf hfFb} ghfg],
uP klg ljleGg axfgf agfP/ ToxfFaf6 plDsg]
cyf{t\ hgtfk|ltsf] pQ/bfloTj eGbf klg Sofl/o/
/ k};fnfO{ dxTj lbg] l:yltn] klg u|fdL0f jf b'u{d
:jf:Yo ;]jfnfO{ c;/ kfl//x]sf] 5 . h:tf] ls,
g]kfn d]l8sn sfplG;ndf em08} * xhf/ lrlsT;sx¿
…/lh:6]8Ú 5g\ t/ ;/sf/L ;]jfdf xhf/ lrlsT;s
dfq 5g\ . pgLx¿nfO{ cfslif{t ug]{ / l6sfpg]
s'/fdf ;/sf/sf] klg sdhf]/L xf]nf . To;sf] ;dLIff
xf] ; \ eGg] ck] I ff klg d ub{ 5 ' . ;/sf/
lrlsT;sx¿nfO{ ljz]if ;'ljwf lbP/, lrlsT;sx¿sf]
ljz]if1 aGg] rfxgfsf] klg ;Daf]wg u/]/ / ;?jf–
a9'jfdf kf/bzL{ / j}1flgs k2lt :yflkt u/]/ u|fdL0f
If]qsf] :jf:Yo kl/jt{gsf nflu hgzlQm k"lt{ ug{
vf]lh/x]sf] 5 . ljs6 If]qdf hlGdPs} cfwf/df,
hftLo jf ln+uLo ?kdf lk5l8Ps} cfwf/df s;}n]
:jf:Yo ;]jf gkfpg] l:yltsf] ca cGTo ug}{k5{ .
o;;F u } of] ;+ q md0fsfnLg hl6ntfsf aLr
lrlsT;sx¿n] h'g ;'/Iff …clglZrttfÚsf aLr klg
sfd ul//xg'ePsf] 5, o;nfO{ ;/sf/n] uDeL/tfk"js
{
lnPsf] 5 . ;/sf/ lrlsT;sx¿sf] ;'/Iffsf nflu
uDeL/ 5 . g]kfn lrlsT;s ;+3;lxtsf] ;xsfo{df
…:jf:YosdL{ ;'/Iff P]gÚ cfO;s]sf] 5 . o;n] c;'/Iffsf]
l:ylt cGTo u/fO{ 5f8\g] s'/fdf d ljZj:t 5' .
cGTodf, b]z ;+3Lotfdf hfFb5
} . ;+3Lo :jf:Yo k|0ffnL
s:tf] x'g] < o;df 7"nf] ax; / u[xsfo{ x'g' cfjZos
5 . ;/sf/ ;+jb] gzLn eP/ o;sf] u[xsfo{ ul//x]sf]
5 . o;df lrlsT;sx?sf] klg uDeL/ of]ubfg /xg]
cfzf d JoQm ub{5' .
/ k|fylds :jf:YonfO{ /fHosf] lhDd]jf/Ldf
kfl/;s]kl5 of] cToGt} cfjZos sbd xf] .
:jf:Yo k|0ffnLdf ;dli6ut ?kdf kl/jt{g
eg]sf]– Ps, :jf:Yo ;+:yfdf lrlsT;s /
:jf:YosdL{sf] clgjfo{ pkl:ylt . b'O{, !@
dlxgf g} Go'gtd cf}iflwsf] pknAwtf . tLg,
Go"gtd pks/0fsf] Joj:yf . /, rf/ :jf:Yo
;+:yfx¿df ejg / cGo ef}lts cfjZostfsf]
k"lt{ xf] . xfdL oxL k|lqmofdf 5f}+ . 5fqj[lQ
P] g cGtu{ t ;/sf/sf] nufgLdf k9] s f
ljBfyL{x¿n] kf“r jif{ b]zsf] ;]jf ug'{kg]{ Joj:yf
lyof] . t/ of] nfu" ePsf] lyPg . xfdLn] P]g
kl/jt{g u/L b'O{ jif{ ;]jf ug'{kg]{ agfof}+ . /,
o;sf] k|efjsf/L sfof{Gjog yfNof}+ . emG8}
tLg ;o lrlsT;sx¿ -5fqj[lQsf_ clxn]
ufp“ufp“ uPsf 5g\ .
rf}yf], :jf:Yo ;+:yfnfO{ ;d'bfo;“u hf]8g\ ]
gLlt . Pp6f :jf:YosdL{, sd{rf/LnfO{ dfq}
:jf:Yo;+:yf lhDdf lbP/ x'b“ g} . Toxf“ hgtfsf]
e"ldsf s] xf] :ki6 x'gk' 5{ . Jooef/hlt /fHon]
af]Sg] t/ Joj:yfkgdf rflx“ hgtfnfO{ ;fd]n
ug]{ k|lqmofdfkm{t\ :jf:Yo ;+:yf / hgtfsf] ;DaGw
;'b[9 ug]{ sfd xfdL ul//x]sf 5f}+ . kf“rf}+,
cGt/f{li6«o :jf:Yo ;fem]bf/Lsf] ;'?cft . xfd|f]
b]zdf :jf:Yo If]qdf sfd ug]{ w]/} cGt/f{li6«o
:jf:Yo ;fem]bf/ x'g'x'G5 . pxf“x¿ 5'§f5'§}
sfo{qmdx¿ cGtu{t xfdL;“u sfd ul//xg'ePsf]
5 . xfdLn] ;a} ;fem]bf/x¿nfO{ Pp6} 5ftfd'lg
NofP/ cGt/f{li6«o :jf:Yo ;fem]bf/Lsf] ;'?cft
u/]sf 5f}+ .
xfdLn] g]kfnsf :jf:Yo ;fem]bf/;lxt eP/
To;df x:tfIf/ ul/;s]sf 5f}+ . xfdLn] ca ;ft
jif{leqdf ;x;|fJbL nIo k"/f ug'k{ g]5
{ . o;aLr
^) ljsf;f]Gd'v b]zx¿df ul/Psf] ;e]I{ f0fdf klxnf]
r/0fdf ;ft b]zx¿ dfq ;x;|fJbL nIo k"/f
ug{;Sg] ;"rLdf k/], h;df g]kfn klg 5 .
a]nfotsf k|wfgdGqL uf]8g a|fpgn] cfof]hgf
ug'e{ Psf] cGt/f{li6«o :jf:Yo ;fem]bf/L (IHP) df
ToxL x}l;otdf xfdLn] x:tfIf/ u¥of},+ clxn]
To;df !$ b]z 5g\ . cGt/f{li6«o :jf:Yo
;fem]bf/x¿ Ps} 7fp“df a;]/ sfd ul/of] eg] dfq}
;x;|fAbL nIo k"/f ug{ ;lsG5 eGg] ;xdltdf
k'us
] f 5g\ / xfdL To;nfO{ Jojxf/df sfof{Gjog
ug]{ k|lqmofdf 5f}+ .
^
G L O B A L H E A LT H B U L L E T I N
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
s:tf] 5 s0ff{nLsf] :jf:Yo <
k|ltJolQm s"n cfosf] b[li6n] g]kfn blIf0fk"jL{ Pl;ofsf]
;a}eGbf ul/a /fi6« -o'P; 8n/ @&)_ cGtu{t ub{5 . t/
klg )^@÷^# sf] dxfg\ hgcfGbf]ngkl5 ul7t ;/sf/
tyf :jf:Yo tyf hg;+Vof dGqfnon] :jf:Yok|lt lnPsf]
gLlt tyf of]hgf g]kfnsf] :jf:Yo If]qdf :yflkt eO{
To;n] ljZjsf] ;d]t Wofgfsif{0f ug{ ;kmn ePsf] 5 .
The Lancent gfds ljZj k|l;4 hg{nåf/f ^) j6f
ljsf;zLn b] z x¿df ul/Psf] ;j] { I f0fcg' ; f/ afn
:jf:Yo;DaGwL ;x;|fAbL ljsf; nIo k"/f ug{ ;Ifd ;ftj6f
/fi6«df g]kfn klg k/]sf] 5 . To;}u/L a]nfotL k|wfgdGqL
uf]8g{ a|fpgsf] g]tT[ jdf ePsf] cGt/f{li6«o :jf:Yo ;fem]bf/L
a}7sdf 5flgPsf ;ftj6f b]zx¿dWo] g]kfn klg k/]sf]
5 . @)^$ ;fndf ;fj{hlgs ePsf] 8]df]uf| lkms / :jf:Yo
;e]I{ f0fsf] k|ltj]bgn] g]kfnsf] :jf:Yo ;"rf+sdf pNn]vgLo
k|ult ePsf] / dft[:jf:Yo ;x;|fAbL nIo k"/f ug{ ;Sg]
b]zx¿dWo] g]kfn k'Ug ;kmn ePsf] b]vfPsf] 5 .
dGqfnon] cfwf/e"t txsf hgtfsf nflu b]ze/
lgMz'Ns :jf:Yo ;]jf sfo{qmddfkm{t\ :jf:Yo;DaGwL /fd|f
sfo{qmd cufl8 NofO{ sfof{Gjog ul//x]sf] b]Vg ;lsG5 .
dfly pNn]lvt sfo{x¿ x'b“ fx'b“ } klg s0ff{nLjf;Lx¿sf]
:jf:Yol:ylt ;Gtf]ifhgs 5}g . !) jif]{ ;z:q åGå /
P]ltxfl;s hgcfGbf]ngkl5 klg o; If]qdf dflg;x¿ /f]u,
ef]u, clzIff, s'kf]if0f cflb ;d:ofaf6 lklN;Psf 5g\ .
dfgj ;"rf+scg';f/ g]kfns} cf};t cfo' sd ePsf lhNnfx¿
sflnsf]6, d'u,' h'Dnf, x'Dnf / 8f]Nkf kb{5g\ . h;cGtu{t
d'ud' f cf};t cfo' k'?if #$ jif{ / dlxnf #@ jif{, sflnsf]df
k'?if ## jif{ / dlxnf #@ jif{ /x]sf] kfpg ;lsG5 .
G L O B A L H E A LT H B U L L E T I N
;d:t s0ff{nL If]qsf clwsf+z dlxnfx¿ kf7]3/ v:g]
-cfª v:g]_ /f]uaf6 kLl8t ePsf] kfpg ;lsG5 eg] afnd[To'b/
klg oL If]qx¿df pRr /x]sf] kfpg ;lsG5 . clwsf+z
a[4a[4fx¿ klg l6aL, bd, SofG;/ cflb /f]uaf6 kLl8t 5g\ .
To;}u/L a]nfa]nfdf km}ng] ljleGg ;?jf /f]ux¿ Emf8fkvfnf,
/utdf;L, lgdf]lgof, x}hf, Zjf;–k|Zjf;;DaGwL /f]ux¿n] oL
If]qsf afl;Gbfx¿nfO{ cfqmfGt agfPsf] 5 . lhNnf :jf:Yo
sfof{no, sflnsf]6sf cg';f/ @)^$ j}zfvb]lv c;f]h;Dd
o; lhNnfsf !^ j6f uflj;x¿df emf8fkfvfnf / x}hfaf6
#^ hgf, lgdf]lgofaf6 !% hgf / /utdf;Laf6 !^ hgf
dflg;sf] d[To' ePsf] lyof] eg] d[To' x'gx] ¿df clwsf+z dlxnf
tyf afnaflnsf /x]sf lyP .
clzIff;“u} hgr]tgfsf] cefj, s'kf]if0f, ;/;kmfOsf]
cefj / :jR5 lkpg] kfgLsf] cefjdf oxf“sf dflg;x¿
;fdfGo /f]u nfUbf klg lj/fdL eO{ d[To'sf] d'vdf kg{
;Sg] ;+efjgf al9/x]sf] kfpg ;lsG5 eg] Ps 3/sf
dflg;x¿df b]vfkg]{ ;fdfGo /f]u km}lnO{ ;Dk"0f{ ufp“nx] ¿
g} lj/fdL k/]sf] pbfx/0f a]nfa]nfdf b]Vg ;lsG5 .
;/sf/af6 s0ff{nLaf;Lx¿sf nflu lgMz'Ns :jf:Yo
;]jf sfo{qmd tyf To;cg';f/ 8An'Prcf], s]Pkmcf], ;?jf
/f]u lgoGq0f dxfzfvf, If]qLo d]l8sn :6f]/, g]kfnuGhaf6
;a} :jf:Yo ;+:yfx¿df lgMz'Ns cf}ifwLsf] k|aGw ldnfOPsf]
eP klg o;sf] s8fOsf ;fy sfof{Gjog ePsf] kfpg
;ls+bg} . b/aGbLcg';f/ 8fS6/x¿ ;DalGwt If]qdf ghfg]
kl/kf6L xfn klg ljBdfg /x]sf] kfpg ;lsG5 .
dx]Gb| If]qL
-If]qLn] s0ff{nLdf lgMz'Ns :jf:Yosf] cg'udg u/]sf lyP ._
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
&
xflb{s
z'esfdgf
:jf:Yosf] bfloTjnfO{
ha;Dd :yfgLo
;d'bfosf] lhDd]jf/Ldf
klg n}hfg ;ls+bg}
ta;Dd ;a}sf] nflu
:jf:Yon] ;fsf/ ?k
lng ;Sb}g . log}
dfGotf / b[li6sf]0fnfO{
ax;df n}hfg / gLlt
lgdf{0f ug{ d2t
k'¥ofpg of] a'nl] 6gnfO{
;kmntf ldnf];\ d]/f]
z'esfdgf 5 .
8f= ljZj/fh hf]zL
/lhi6f/ tyf o"/f]nf]lhi6
lrlsT;f lj1fg
/fli6«o k|lti7fg
jL/ c:ktfn
SIMPLEST & COMPLETE SOLUTION FOR SPECIFIC NEEDS FOR
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SINDHUSURGICALCONCERN
GPO Box: 11708, Thapathali, (Opposite to Machhapuchchhre Bank Ltd.)
Kathmandu, NepalTel: +977 1 4215130, 4100522, 4100523
Fax: +977 4100532, E-mail: bhandariyb@mail.com.np
*
G L O B A L H E A LT H B U L L E T I N
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
xflb{s z'esfdgf
:jf:Yo If]qdf ;/sf/n] NofPsf] gLlt sfo{qmdx?nfO{ k|efjsf/L agfpg dxTjk"0f{ of]ubfg
k'¥ofpg Unf]an x]Ny j'nl] 6gnfO{ ;kmntfsf] z'esfdgf JoQm ug{ rfxG5' .
k"j{ :jf:Yo ;lrj M 8f= lg/fsf/dfg >]i7
dfgl;s /f]u ljz]if1
xflb{s z'esfdgf
Unf]an x]Ny a'n]l6g k|sfzgn] :jf:Yo If]qdf k|lta4 eO{ nfluk/]sf :jf:YosdL{sf] cfjfhnfO{
;d]6L gLlt lgdf{0f txdf jsfnt ug{ ;kmntfsf] z'esfdgf JoQm ug{ rfxG5' .
pklgb]{zs M 8f= ntf jh|frfo{
k/f]ksf/ k|;"lt tyf :qL/f]u c:ktfn
yfkfynL, sf7df8f}+
xflb{s z'esfdgf
Unf]an x]Ny a'nl] 6g :jf:Yo If]qsf] ;+rf/ hutdf
sf];]9'+uf ;fljt x'g ;Ifd xf];\ eGg] z'esfdgf JoQm ub{5' .
lgb]z
{ s M ;fu/ bfxfn
dWodf~rn If]qLo :jf:Yo lgb]z
{ gfno, x]6f}8+ f
G L O B A L H E A LT H B U L L E T I N
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
(
:jf:Yo /
ljsf;
kl/k"/s x'g\
8f= dx]z df:s]
:jf:YogLlt ;Nnfxsf/ ;ldlt Pj+ g]kfn
:jf:Yo cg';Gwfg kl/ifb\sf cWoIf 8f=
dx]z df:s] :jf:Yo dGqfnosf gof“
gLlt, sfof{Gjog k|of; Pj+ r'gf}tLaf/]
…Unf]an x]Ny a'nl] 6gÚ;“u eGg'xG' 5 M
!)
G L O B A L H E A LT H B U L L E T I N
lgMz'Ns k|;l' t sfo{qmd;Dd cfOk'Ubf :jf:Yo dGqfnosf]
sfdsf] k|ultnfO{ s;/L x]g{ ;lsG5 <
:jf:YonfO{ hgtfsf] clwsf/sf] ?kdf cufl8 a9fOPsf]
5 . h'g s'/f ;g\ !($* df g} ljZj:jf:Yo ;+u7gsf]
ljwfgdf pNn]v lyof] . To;nfO{ klxnf] k6s Jojxf/d}
nfu" ug]{ kxn @)^@÷)^# sf] hgcfGbf]ngkl5 ag]sf]
;/sf/n] z'? u/]sf] xf] . o;aLrsf ;a} gLlt / sfo{qmdx?
:jf:Yodf hgtfsf] clwsf/ s;/L :yflkt ug]{ eGg]df
s]lGb|t 5g\ . !) jif]{ cfwf/kq, nlIft ;d"xnfO{ lgMz'Ns
:jf:Yo, cGtl/d ;+ljwfgd} :jf:YonfO{ df}lnsclwsf/sf]
?kdf :yfkgf, ah]6df j[l4 tyf hgtfsf] cfwf/e"t
txdf -;Dk"0f{ :jf:Yo / cTofjZos ;"rLs[t cf}iflw
;]jf_ / /fli6«o txd} k|;l" t ;]jfdf lgMz'Ns :jf:Yo
sfo{qmd o;aLrsf pknAwL x'g\ . cxn] pk:jf:Yorf}sL,
:jf:Yorf}sL / k|fylds :jf:Yo s]Gb|af6 lgMz'Ns :jf:Yo
sfo{qmd nfu" ePsf] 5 eg] lhNnf c:ktfnaf6 ;d]t
;"rLs[t cf}iflwdf lgMz'Ns ;]jf nfu" ePsf] 5 . /fli6«o
txdf k|;l' t ;]jf dfq xf]Og k|hgg :jf:Yo clwsf/nfO{
g} cufl8 a9fpg xfdL ;kmn ePsf 5f}+ .
o;nfO{ nfu" ug]{ :jf:Yo k|0ffnL s:tf] 5 <
lgMz'Ns :jf:Yo ;]jfsf nflu cf}iflw, pks/0f / hgzlQm
x'g' clgjfo{ 5 . To;}n] xfd|f] clxn]sf] d"nhf]8 :jf:Yo
k|0ffnLsf] ;'b9[ Ls/0fdf 5 . To;}sf nflu k|fylds :jf:Yo
cjwf/0ffnfO{ k'ghf{u/0f ug]{ sfo{qmd NofOPsf] xf] .
;g\ !(&* df cNdfcf6fdf ePsf] ljZj;Dd]ngdf k|fylds
:jf:Yo cjwf/0ff cfPsf] lyof] . ToxL ;dtf, ;fdflhs
Gofo, :yfgLo ;|ft] ;fwgsf] kl/rfng, :yfgLo ;xeflutf,
;a} If]q;“u ldn]/ cufl8 hfg] h:tf cjwf/0ffx? ag]sf
lyP . aLrdf Tof] s'/f ;';K' t /x\of] . ljZja}s
+ nufotsf
;+:yfx?sf] :jf:Yodf nufgL ug]{, z'Ns nufpg] /
:jf:YonfO{ :jfjnDaL agfpg]h:tf s'/fx?n] klg oL
cjwf/0ffx? ;';K' t /x] . To;}n] :jf:YonfO{ ljsf;;“u
hf]8/] n}hfg'kg]{ h'g d'n bfloTj 5, To;nfO{ k'ghf{/0f
ug]{ ;f]rfO xfd|f] xf] .
:yfgLo ljsf;sf sfo{qmdx?, l;+rfO, s[lif, kfgL,
…:oflg6];gÚ, …Go'6;
]« gÚh:tf kIfx?;“u ldn]/ sfd ug{
;lsof] eg] dfq :jf:Yo ;d[4 x'g;S5 . o;sf nflu
:jf:Yodf ah]6 j[l4 d"n r'gf}tL xf] . xfdL :jf:yodf
s'n ah]6sf] !) k|ltzt ah]6 x'gk' g]{ n8fO“df klg
o;}sf/0f 5f}+ . lsgls xfdLn] dGqfnoaf6 :jf:Yo sfo{qmd
z'? ubf{ ;/sf/L vr{df :jf:Yo ;]jf lng] hgtf #)
k|ltzt lyP . af“sL &) k|ltztn] cfkm\g} vr{df :jf:Yo
pkrf/ ub{y] . Tof] l:ylt 36]/ clxn] qmdzM $% / %%
k|ltztdf em/]sf] 5 . xfdL o;df cem} ;'wf/ ug{ rfxG5f}+ .
sfof{Gjog kIfdf slQsf] k|efjsfl/tf 5 <
g]kfnsf] ;Gbe{df :jf:Yo If]q g} o:tf] If]q xf], hxf“
tntn;Ddsf ;d'bfodf :jf:YosdL{x? jf :jo+;l] jsfx?
k'Ug] l:ylt ag]sf] 5 . !)–!% jif{bl] vsf] cys d]xgtn]
of] ;Dej ePsf] xf] . t/ oltdfq kof{Kt 5}g . :jf:Yodf
b/aGbL g} yf]/} 5 . b/aGbL ePs} 7fp“df klg hgzlQm
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
zflGt
k|lqmof
tfls{s
lgisif{d
k'¥ofpg
b]zsf]
abln“b
kl/l:y
:jf:Yo
hgtfn
kl/jt{g
cg'el" t
lbnfp
s'/f g
d"n
k|fylds
xf] .
fnfO{
s
fdf
g
bf]
yltdf
oaf6
nfO{
gsf]
t
pg]
g} xfd|f]
stf
k"lt{ ug{ ;lsPsf] 5}g . a9LeGbf a9L ;Ifd dflg;nfO{
;/sf/L ;]jfdf cfslif{t ug'k{ g]{ l:ylt 5 . lsgls klxnf
…k|fOe]6 ;]S6/Ú jf …Unf]an dfs]6{ Ú x]//] dfq kl5 ;/sf/L
;]jfnfO{ x]g]{ l:ylt 5 . g]kfnh:tf] ul/j b]zdf
s0ff{nLh:tf ljs6 If]qx?df :jf:Yo hgzlQm k'¥ofpg
pgLx?sf] cfly{s ;'/Iffsf ;fy;fy} …Sofl/o/Ú, 6«l] gª,
ljdf, cWoog;“u ;DalGwt Kofs]h Nofpg] tof/L eO/x]sf]
5 . o;sf nflu cGt/f{li6«o :jf:Yo ;fem]bf/x?af6
klg yk ;xof]u kfpg xfdL ;kmn ePsf 5f}+ . hgtfn]
lgMz'Ns dfq xf]Og u'0f:t/Lo :jf:Yo ;]jf kfpg'kg]{
sf]0faf6 xfdL o;f] ul//x]sf 5f}+ . :jf:Yo dGqfnocGtu{t
emG8} #) xhf/ sd{rf/L, %) xhf/ :jo+;l] jsf ePsf]
;Gbe{df dflyaf6 dfq ;]jfsf] cg'udg ug]{ sfd x'g
;Sb}g . To;}n] ;d'bfon] g} cg'udg ug]{ kl/kf6L xfdL
:yflkt ub}5
{ f}+ . To;cGtu{t x/]s dlxgf :jf:Yo ;+:yf
/ hgtfaLr ;d:of / r'gf}tLsf af/]df cGt/lqmof x'G5 .
To;}n] r]s Ps Aofn]G; u5{ . Pscsf{nfO{ ;xof]u
x'G5 .
of] b'O{ tLg jif{sf aLrdf hgzlQm k"lt{sf b[li6n] slQsf]
;kmntf kfOPsf] 5 <
z'?df k|fylds :jf:Yos]Gb|, lhNnf c:ktfnx?df w]/}
lrlsT;sx? k'us
] f lyPgg\ . clxn] To;df ;'wf/ cfPsf]
5 . xfdLn] ;/sf/L 5fqj[lQdf k9]/ cfPsf 8fS6/x?n]
b'O{ jif{ b'ud{ df :jf:Yo ;]jf k'¥ofpg}kg]{ k|fjwfg z'?
u¥of},+ To;af6 w]/} ;xof]u k'us
] f] 5 . xfdL pxf“x?sf]
pRr sb/ ub{5f}+ . ;fy} g;{ / cGo :jf:YosdL{x?sf]
;] j f klg a9] s f] 5 . ;/sf/;“ u ;DalGwt
ljZjljBfnox?;“u ;dGjo u/]/ lrlsT;sx?nfO{ s;/L
ljsf; ug],{ s;/L cfsif{s Kofs]h lbP/ cfslif{t ug]{
eGg] u[xsfo{ eO/x]sf] 5 . Pp6f cfwf/zLnf ag]sf] 5 .
o;n] b'O–{ tLg jif{df Pp6f kl/0ffddf cjZo g} k'¥ofpg]5 .
csf]{ s'/f, :jf:Yo ;]jfdf ;'/Iffsf] k|Zg, ;'/Iffsf] lrGtf
klg uDeL/ 5 . To;}n] o;lj?4 :jf:YosdL{ ;'/Iff P]g
;+;b\af6 kfl/t eO;s]sf] 5 . :jf:YosdL{x?sf] ;'/Iffsf
nflu ;dGjosf] cleef/f p7fpg dGqfno tof/ 5 . t/
hgtfsf] ;]jfdf sfd ubf{ cfkm}a+ f6 uNtL ePsf] 5 t
5}g < eg]/ :jf:YosdL{x? uDeL/ x'g' klg cToGt} h?/L
5 .
:jf:Yo ;+/rgfsf] ;'b9[ Ls/0fsf nflu s] ul/“b5
} <
s:tf] ;+:yfdf s:tf] pks/0fx? rflxG5 < o;df xfdLn]
Pp6f u[xsfo{ ul/;s]sf 5f}+ . vl/b k|lqmof r':t /
kf/bzL{ x'gk' g]{ s'/f o;;“u hf]l8Psf] 5 . d'ntM xfdL
clxn] ef}lts ;+/rgfsf] ljsf; / k'glg{df{0fdf s]lGb|t
5f}+ . åGån] Iflt k'us
] f / a9fpg'kg]{ k|fylds :jf:Yos]Gb|,
:jf:Yorf}sL, ;fd'bflos c:ktfnx? agfpg'kg]{ 5g\ .
PDa'nG] ;x? cfjZos 5g\ . oL ;asf nflu ah]6sf]
r'gf}tL 5 . oBlk To;sf nflu ah]6 a9fpg, ;xof]u
ug{ ;/sf/, bft[;:+ yf …ufeLÚ tyf cGo ;a} ;fem]bf/x?
;sf/fTds 5g\, tof/ 5g\ .
g]kfnsf cGt/f{li6«o :jf:Yo ;fem]bf/x? :jf:Yosf] Pp6}
k|fyldstfdf, Pp6} 5ftfd'lg cfP . To;n] s] ;+st] u5{ <
G L O B A L H E A LT H B U L L E T I N
cGt/f{li6«o :jf:Yo ;fem]bf/Lsf] klxnf] nx/sf ;ft b]z
dWo] g]kfn klg k/]kl5 bftfx? / xfdLaLrsf] ;xsfo{sf]
…d]sflgHdÚ s] x'g;S5 eg]/ xfdLn] ;xdltkq ljsf;
u¥of}+ / To;df g]kfnsf ;a} cGt/f{li6«o :jf:Yo
;fem]bf/x?;lxt x:tfIf/ u¥of}+ . To;df ;/sf/sf] :jf:Yo
gLlt s} jl/kl/ sfdx? s]lGb|t x'g] pNn]v 5 . :jf:Yodf
cfO/x]sf] ;xof]usf] k|efjsf/L sfof{Gjog xf];,\ ;dGjo
xf];\ eg]/ g} o;f] ul/Psf] xf] . oBlk xfdL cfkm\g}
v'§fdf pleg'k5{ . ;xof]uLx?sf] ;xof]u xfdL cfkm}+
cfTdlge{/ gaGbf;Dd dfq xf] . xfdL :jfYodf cfkm}+
cfTdlge{/ x'g rfxG5f}+ . :jf:Yosf sfo{qmdx?sf]
k|efjsfl/tfsf] kf6f]af6 xfdL t'ngfTds ?kdf cufl8
5f}+ . o;sf] d"Nof+sg;lxt ;fem]bf/x? xfdLnfO{ cem}
;xof]u a9fpg pTk|l] /t ePsf x'g\ .
tkfO{+ k|dv
' /xg'ePsf] :jf:Yo gLlt ;Nnfxsf/ ;ldlt /
g]kfn :jf:Yo cg';Gwfg kl/ifb\sf] sfdnfO{ klg o;;“u
hf]8/] x]g{ ;lsG5 <
oL b'j} lgsfox? dGqfnosf c+u x'g\ . :jf:Yosf gLltx?
;kmn x'gsf nflu ;Nnfxsf/ ;ldltsf] u[xsfo{n] /fd|f]
;xof]uL e"ldsf v]ns
] f] 5 . To:t} xfdLn] Jojxf/df
ptf/]sf gLltx? 7Ls 5g\ ls 5}gg\, slt pknlAw, slt
sl7gfO ePsf] 5, ;'wfg],{ kl/dfh{g ug]{ ljifo s] x'g,\
cg';Gwfgn] :ki6 kfb{5 . h:tf] ls clxn] xfdL lgMz'Ns
:jf:Yo sfo{qmdsf] cg'udg ul//x]sf 5f}+ . cg';Gwfgn]
k|df0f lbG5 / k|df0fn] xfjfbf/L x}g ;xL gLlt agfpg
dfu{lgb]z
{ ub{5 . cg';Gwfg / sfof{Gjogsf] rln/xg]
rqm x'g\ .
ljZj :jf:Yo ;+u7gdf klg tkfO{+ ;lqmo x'gx' G' 5 . Toxf“
tkfO{s
+ f] s] of]ubfg x'g5
] <
clxn] ljZj :jfYo ;+u7gn] dnfO{ blIf0f Pl;ofsf !!
b]zdf @ jif{df ePsf :jf:Yo cg';Gwfgsf sfo{x?sf]
;dLIff ug]{ / kf“r jif{sf nflu cg';Gwfg /0fgLlt tof/
ug]{ uxg Pj+ dxTjk"0f{ lhDd]jf/L lbPsf] 5 . d}n] klxnf]
sfd k"/f ul/;s]sf] 5' . bf];f| ] sfd z'? x'b“ 5
} . g]kfnn]
klxnf] k6s o:tf] e"ldsf kfPsf] 5 .
cGTodf s]xL <
gLltx? sfof{Gjogsf b[li6n] xfd|f] d"n Wofg ;d'bfodf
5 . ;d'bfon] of] xfd|f] nflu xf] jf o;sf nflu vr{ ug{
tof/ 5f}+ eGg] l:ylt cfpg'k5{ . :jf:Yo / ljsf;
;xsfl/tfaf6 cufl8 a9\g rfxG5f}+ xfdL . csf]{ s'/f
ufp“sf ul/jx?sf ;fy} ;x/sf ul/jx?nfO{ klg xfdLn]
Wofg lbg' h?/L 5, hf] pk]lIft ePsf] ;To xf] . oxL
ah]6dfkm{t\ To;nfO{ ;dfwfg ug]{ u[xsfo{df 5f}+ xfdL .
x/]s j8fdf …g;{Úx?sf] jl/kl/ Pp6f :jf:Yo ;+/rgf
agf];\ eGg] x]tn
' ] xfdL k|oTg ul//x]sf 5f}+ . To:t} 3/3/df
k'Ug ;Sg] u/L zx/L dlxnf :jf:Yo :jo+;l] jsfx?sf]
g]6js{ klg xfdL lj:tf/ ug]{ of]hgfdf 5f}+ . zflGt
k|lqmofnfO{ tfls{s lgZsif{df k'¥ofpg b]zsf] abln“bf]
kl/l:yltdf :jf:Yoaf6 hgtfnfO{ kl/jt{gsf] cg'el" t
lbnfpg] s'/f g} xfd|f] d"n k|fyldstf xf] . Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
!!
ARTICLE
Status of Reproductive
Health of Women in Nepal
Dr. Tirtha Rana
G
overnment of Nepal in its Interim Constitu
tion, 2006 has declared Right to Reproduc
tion. Subsequently, the Interim Health Plan
of Nepal, 2007 specifies universal access to
reproductive health service as a fundamental right of
people of Nepal. In accordance with the above
committment of the Government, specific measures
are already adopted by the Government to implement
relevant programs and important decisions are made
to ensure safe child delivery and to increase access
to and utilization of services to address the
reproductive health problems in women of Nepal.
Successful implementation of such programs is
expected to contribute to health and socio economic
development of the family and overall population of
the nation. The paragraphs below will highlight the
prevalent reproductive health issues in Nepal
including challenges and actions taken to address
the problems.
Reproductive Health (RH) services are provisioned
as a package of services comprised of: Family
Planning; Safe Motherhood and Newborn care;
Prevention and management of abortion and
complications; Adolescent sexual and Reproductive
Health; Prevention and management of Reproductive
tract related illnesses (RTI), Sexually transmitted
illness (STI), HIV/AIDS including Prevention to mother
to child transmission of HIV/AIDS (PMTCT);
Prevention and management of subfertility;
Prevention and management of gynaecological
morbidities including Uterine Prolapse, screening and
treatment of breast and cervical cancer, problems
related to menopause and of elderly women such as
osteoporosis, and; care and support to women
affected by gender and sexual based violence
(GSBV). Women in Nepal especially face critical
challenges of multiple burden of limited access to
!@
G L O B A L H E A LT H B U L L E T I N
information, increased domestic work, a sole earning
member in the family, low access to essential and
reproductive health care. This is more observed in
female-headed households of rural remote areas
during the present post-conflict period because most
of male members of the family are abroad for
employment. Generally, it can be said that
reproductive health problem is gradually receiving
increased attention in issues such as safe
motherhood and new born care, family planning and
abortion while other problems are less accorded
unless they are of life threatening condition. Many of
RH problems are not complained by woman herself
even among the better off families. It happens due
to a variety of negative societal factors and due to
fear of rejection by the spouse and family.
Maternal Death
The Nepal Demographic and Health Survey (NDHS)
undertaken in the year 2006 has reported the
maternal mortality ratio (MMR) for Nepal for the
period 1999-2005 as 281 deaths per 100,000 live
births. It indicates a significant progress made within
a period of last ten years with 48 percent decline in
the MMR between the period of 1990-96 and 200006. This figure is aimed to be lowered to 213 in order
to achieve the Millennium development Goal (MDG)
for maternal health by 2015. However, still many
women in Nepal die due to maternal health related
problems which contribute to 18 percent of total
death in women. The total maternal deaths per year
is estimated at 4,478 with an average of six women
dying every day and a life time risk of 1 in 32.
Pregnancy and child birth related complications are
reported to contribute to three percent of disability
adjusted life years lost (MDG Need Assessment in
Nepal, 2007).
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
Fertility and Family Planning
Over the last 30 years, total fertility rate (TFR) in Nepal
has reduced by more than half. The total fertility rate
declined from 6.3 births per woman in 1976 to 3.1
births per woman in 2006. Fertility is considerably
higher in rural than in urban areas with a rural urban
gap of 1 birth per woman. Education and wealth have
a marked effect on fertility, uneducated mothers
having twice as many births as women with SLC and
higher education. Women in the lowest wealth status
give birth to two and a half times as many births as
women in the highest wealth status. Knowledge of
at least any modern method of family planning is
nearly universal among ever-married and currently
married women of age 15-49 years. With rising
awareness of family planning methods and increased
availability of family planning services the use of
contraceptive has steadily increased over the years.
The use of modern contraceptive methods among
currently married women increased 14 fold in the past
thirty years from 3 percent in 1976 to 45 percent in
2006, which is mainly attributed to a rise in the use
of female sterilization and injectables. Unmet need,
however, is still high with 25 percent of eligible couples
not having access to methods of family planning at
right time with right kind of contraceptives. Unmet
need is highest among women who do not participate
in any household decisions and among women who
believe that wife beating is justified.
Family planning program is one of the oldest programs
of the Ministry of Health and Population and is
implemented progressively in close partnership with
donor agencies and NGOs and private health providers.
However, the challenge for improving information and
education activities in order to reduce the unmet need
and to dispel the fear and misconceptions about surgical
methods and certain specific contraceptive methods is
critically important. It is important to provide right kind of
counseling to couples right from premarital stage to after
child birth for spacing and for a specific kind of
contraceptive to choose from variety of methods.
Adequately trained, motivated and competent service
providers with sound incentives and infrastructural
support need to be in place for serving surgical and
specific methods such as Norplant and IUDs with
expanded coverage, especially in high population
districts and among rural poors.
Antenatal Care to Pregnant Women
Antenatal care (ANC) from a skilled birth attendant
(SBAs), which is provided from either by a doctor or
by nurse or midwife as the trained health workers is
G L O B A L H E A LT H B U L L E T I N
reported to be increased from 24 percent in 1996 to
28 percent in 2001 and 44 percent in 2006 but is
certainly less than prescribed four or more ANC visits.
The percentage of women who made four or more
antenatal visits during their pregnancy tripled during
the last 10 years, from 9 percent in 1996 to 14 percent
in 2001 and 29 percent in 2006. Less than three
fourth of women took iron tablets and only 20 percent
took de-worming pills during the antenatal period.
Safe Motherhood and new born care
Percentage of births assisted during child delivery
by a SBA has doubled in the last ten years from 9
percent in 1996 to 19 percent in 2006 which makes
obvious that less than one of five births (81 percent)
takes place at home in Nepal. Eighteen percent of
births took place in a health facility with 13 percent
delivered in a public sector health facility and 4
percent in a non-government facility, and less than 1
percent in a private facility (NDHS, 2006). There is
increase in rate of caesarean section mostly in private
health institutions with more than five percent of child
delivery in such facility. Less than one in five women
receives post natal care according to NDHS 2006.
The opportunities and challenges are many and
demand a tactical approach. Government has
introduced Maternity Incentive Scheme in the year
2005 in order to address the problem of safe child
delivery and facilitate women and family to deliver
child assisted by a trained health worker in a health
facility and to increase the use of skilled birth
attendants for child delivery. This scheme provides
cash incentive to woman, health facility and the
service providers to cover the cost of transportation
and drugs to the woman, to health facility in order to
improve the health facility to provide skilled services
and a kind of cash incentive to service providers. From
the year 2008, Government has also declared to
provide free child delivery from public health facilities.
Necessary important actions to increase access to
and utilization of services are many such as there is
a need of expansion of sites comprehensive and basic
obstetric services that are strategically located to
serve the target population and which are well
equipped with competent team of service providers,
physical facility and supplies to be addressed in
partnership with other stakeholders such as NGOs,
private sector health service providers and health
related human resource training institutions.
Neonatal & Infant Mortality and Newborn Care
Data from the NDHS, 2006 reports that infant
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
!#
mortality ratio (IMR) has significantly declined at 48
per 1,000 live births. The decline in IMR is mostly
attributed to success in routine child immunization
including for measles, decrease in diarrheal
diseases and due to acute respiratory illnesses. The
child nutrition status is not improving and yet is in
high order with 49 % of under five years stunted,
13% with wasting and 39% of them as underweight
(NDHS, 2006). The decline in neonatal mortality over
the same period is reported as 33 percent from 50
deaths per 1000 live births to 33 from 1996. Mortality
is lower in urban areas than in rural areas and more
in poor and socially deprived people e.g. dalit and a
few janjatis. Hospital based data suggest that the
major direct causes of neonatal death in Nepal are
infection, birth asphyxia/trauma, prematurity and
hypothermia.
Safe motherhood by name implies care of mother
and the new born. In order to reduce the IMR,
challenge in coming years will be to reduce the
neonatal mortality that is significantly contributing
to the infant mortality. Hence a double pronged
approach is required to address safe motherhood
and take care of new born through promotion of
safer pregnancy and manage the problems of child
delivery to reduce the problem of neonatal
infection, birth asphyxia/trauma, prematurity and
hypothermia.
Abortion and its Prevention and Management
The Abortion Law in Nepal came was promulgated
and into effect from the year 2002 which was a land
mark decision of the Government that provides right
to women to terminate unwanted pregnancy under
the conditions of; pregnancy of 12 weeks gestation or
less for any woman; pregnancies of 18 weeks gestation
if the pregnancy is as a result of rape or incest; and
pregnancies of any duration with recommendation of
a medical practitioner if the life of the mother is at risk,
if her physical or mental health is at risk, or if the foetus
is deformed. There a large number of sites nearing
200 providing abortion services which are of
government and of private sector including nongovernmental organizations (NGO).
However, in most of the private and NGO facilities
the cost for comprehensive abortion care is quite
expensive and at many times beyond the reach of
poor women. Most of them compromise to carry on
with unwanted pregnancy due to inability to pay. Sex
determination test during antenatal period poises risk
to increase abortion services for an unjust cause of
!$
G L O B A L H E A LT H B U L L E T I N
discrimination against daughters that is due to age
long practice of gender bias for girl child in education,
inheritance of property and dowry related. Making
free abortion services to poor and needy women
through the existing service sites and monitoring the
quality of abortion services will be equally important
besides the expansion of service sites and skills
required. Introduction of emergency contraceptive pill
in a few districts when will be gradually expanded to
other areas is expected to bring down the incidence
of abortion.
Adolescent Sexual and Reproductive Health (ASRH)
Out of the total population of Nepal, 32.5 percent are
between the ages of 10 to 24 years (young people);
and 23 percent are between the ages of 10-19 years
(adolescents). Child bearing begins early in Nepal.
An early start to childbearing affects the overall health
and nutritional status of a growing girl and thereby
her developing opportunities in educational and
employment which is directly associated with higher
levels of fertility, morbidity and mortality. Nineteen
percent of women age 15-19 already had a birth or
were pregnant with their first child (NDHS, 2006).
Proportion of teenage pregnancies had declined from
24 percent in 1996 to 21 percent in 2001 and to 19
percent in 2006. Use of modern method
contraceptives among adolescents has increased
from 6.5 percent 1996 to 13.8 percent in 2006. Teen
aged abortion and HIV/AIDS with increase in RTI and
STI are very likely to increase the need of abortion
related service and for management of complication
of unsafe abortions.
There is a huge gap for sexual and reproductive
health (SRH) information and services for young
people. While the number of in-school and out-ofschool education programs that incorporate basic RH
issues as part of overall life skills and HIV peer
education are on increase, but not adequate. There
is limited capacity amongst teachers and health
providers to provide necessary youth-friendly
information, services and counseling. In addition, this
issue requires a wider participation and commitment
through a multi-sectoral approach. Nepal has already
implemented a short project in a test basis named
“Reproductive Health Initiative for young and
adolescents (RHIYA) which was proven a show case
in the international circle. Scaling up such initiatives
with involvement of wider network of various
communities, youth and political youth groups at the
community level is required to mobilize support and
enhance program successes.
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
RTI/STI/HIV/AIDS
Seven per cent of sexually active women and two
per cent of sexually active men were found having
had a sexually transmitted infection (STI) and/or STI
symptoms in previous 12 months, and about 200,000
new episodes of STIs reported annually. A study
conducted by Institute of Medicine in 2006 also
reported 18.8 percent women had knowledge on
transmission of STI/RTIs and the majority were aware
that RTI/STIs is transmitted by unsafe sex.
Syndromic treatment of STI is on practice in many
public health facilities and in a few NGO service
outlets.
Since, identification of the first HIV positive case in
the country in 1988, the epidemic has gradually
spread throughout the country with Nepal at a
concentrated epidemic phase. It is estimated that
currently there are more than 70,000 HIV positive
people. HIV prevalence among the general population
is estimated at less than one percent but mainly
concentrated among injecting drug users, migrants
and client of sex workers. Findings from the NDHS
2006 NDHS showed that 73 percent of women and
92 percent of men aged 15-49 years have heard of
AIDS and are aware on means of prevention of
HIV/AIDS.
HIV/AIDS and STI is agreed to be addressed through
a coordinated multi-sectoral response. It is well
understood to stand as a development issue rather
than the health problem. Addressing this issue
requires strong political, bureaucratic and
stakeholders’ commitment with assured resource
flow, behavioural change programs and monitoring
actions including for care, treatment and support for
people living with AIDS, orphans and spouses.
National Action Plan for prevention and control of
HIV/AIDS, 2008-2011 soon to be approved by the
Government will be the guiding document for a
coherent and multidisciplinary response for Nepal
HIV/AIDS Program by Government and other
stakeholders.
Reproductive Tract Related Illnesses
Reproductive tract illnesses are a hidden RH
problem and are not considered a problem although
a large number of women suffer from such illness
and live with it. It is a common problem found among
the better off and poor families and most of the time
not heard by family members or not complained by
women themselves due to a variety of negative
societal factors. Data on various kinds of
G L O B A L H E A LT H B U L L E T I N
reproductive tract morbidities is no adequately
recorded in Nepal.
Uterine Prolapse: NDHS 2006 reported six percent
of women had various degrees of uterine prolapse.
Study carried out by the Institute of Medicine,
UNFPA and WHO in 2006 indicated uterine
prolapse in 10 percent of surveyed women with
600,000 of them suffering from various degree of
this reproductive health problem. And about
200,000 of them were noted to be in immediate
need of surgical treatment. Uterine prolapse occurs
when the uterus falls down due to relaxation of
tissues around it in the pelvic cavity that can no
longer hold the uterus in its normal position. The
uterus descends downwards and eventually comes
out of the vaginal opening. Uterine prolapse is
found in all age group right from 20 years to over
90 years. It is a debilitating problem in women of
Nepal and is caused as a result of unsafe
motherhood practices and hard physical labour, in
particular during pre-and-post-partum periods.
Social factors restricting women’s optimal health
and denial for their human right and reproductive
rights are the root causes of this health problem in
addition to low level of awareness and unhealthy
reproductive practices with inadequate access to
and utilization of maternal and reproductive health
services. The past eleven years old conflict in
Nepal has added physical, social and financial
burdens to women of Nepal. Increasing migration
of young and productive men population out of the
country led women’s increased economic and
household workloads. Hence, heavy manual works
that were traditionally performed by men has fallen
upon the women with increased responsibility to
maintain the family. Women headed households are
a common picture in rural Nepal with old aged
population and children to look after, aggravating
neglect to women’s own health and nutrition that
increases the occurrence of uterine prolapse.
Institute of Medicine/UNFPA/WHO study of 2006
has noted a finding of 7.4 percent of women
suffering from infertility. Uro-genital fistula was seen
in only 3 cases. However, more recently problem
of cervical cancer is also reported and strategic
action towards prevention and management is
under development.
Reproductive tract illnesses in women are rooted in
neglected status of women. Hence action towards
prevention and management is lagging behind with
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
!%
insufficient research work and response. It needs
to be tackled from a wider perspective and through
a broad spectrum of efforts to raise women’s status,
empowerment, combating violence against women
including health and education efforts. For
prevention and management of uterine prolapse,
conducting surgical camps is not the only means. It
is well understood that safe child delivery practice,
good health and nutritional status of women, physical
rest during antenatal period and in post natal period
are highly important. Change of traditional practice
towards women from family members and
community requires sharing of information and
communication to prevent the problem and adequate
care and support from family. It could be achieved
with inbuilt formal and informal education system
and creating a conducive and supportive
environment for enabling women to take care of her
health.
Gender and Sexual Based Violence
Evidence from the last census, the Nepal Living
Standard Survey 2004 and other studies show quite
clearly that in Nepal, woman especially from an
excluded group are mostly deprived and suffer the
worst in health. Violence against women and its
implication in women’s morbidity and mortality has
not been well considered. Domestic violence is
widespread. NDHS 2006 reported 23 percent of
women and 22 percent of men age 15-49 believe
that a husband is justified in beating his wife for at
least one of five specified reasons: if she burns the
food, if she argues with him, if she goes out without
telling him, if she neglects the children, and if she
refuses to have sexual intercourse with her husband.
Trafficking of girls is another form of gender based
violence.
It is well understood that many health problems in
women occur as a result of gender and sexual
violence and abuse to women and the girl child. To
mention a few of them are as malnutrition, early
marriage, early child bearing, too many children, rape,
RTIs and STIs, uterine prolapse, abortion, etc.
Mainstreaming action towards prevention and
management of gender and sexual based violence
while designing the RH programs and action plans
would be important step including public education
and enforcement measures to protect women’s
RH rights.
29 March 2009
!^
G L O B A L H E A LT H B U L L E T I N
DHULIKHEL
MOUNTAIN
RESORT PVT. LTD.
CITY OFFICE :
Lazimpat, Kathmandu, Nepal, P.O. BOX # 3203
Reservation Phone no- 977- 1 - 4420774 / 4420776
Fax : + 977- 1- 4420778, E-mail : dmrktm@wlink.com.np
Web Site: http://www.dhulikhelmountainresort.com
RESORT:
Khawa, Nepal.
E-Mail Address: dmr.khawa@gmail.com
Resort Phone no.: ++977-11-490664,
++ 977-11-490660, ++977 -1- 6226627( CDMA)
Resort Fax no.: ++977-11-490662
RESORT POSTAL ADDRESS:
Kavre District, Panchkhal Ward # 1, Khawa.
Location of the resort : 4 Kilometres beyond Dhulikhel
town, a place called Khawa. (On the Araniko highway
towards the chinese boarder.)
A PIONEER OF RESORT CONCEPT IN NEPAL
Established in 1981, Dhulikhel Mt: Resort pioneered a
resort concept in Nepal. Situated 34 km. east of
Kathmandu towards Tibetan border on the Arniko
Highway beyond Dhulikhel town, a place called Khawa.
Built within the area of 20 acres of land and designed
with ethnic architectural concept with traditional
thatched roofs blending well with the surroundings, the
resort has serene atmosphere and it is enhanced by
beautiful garden and orchard. The unique resort hotel
offers international standard accommodation and
meals. During the winter period one can get the clear
view of the great Himalayan Panoramic range. While
visiting the resort, visitors can get engaged with
different optional activities such as hiking, trekking,
excursion and white water rafting. There are numbers
of trekking/hiking routes available, which are combined
with the historical sites and it en-routes to typical
Nepalese village, giving the opportunity to experience
rural Nepal in a short period of time. It is a hub for
nature culture and adventure lovers.
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
8f= lg/fsf/dfg >]i7
:jf:Yodf
d]/f] cg'el" t
d}n] hflu/ vf“bfb]lv g} k|fljlws tyf k|zf;lgs sfd
u/]“ . cyf{t\ la/fdL hf“Rg], ck/];g ug]h
{ :tf sfdsf
;fy} c:ktfnsf] OGrfh{ ePsfn] k|zf;lgs sfd klg
u/]“ . OGrfh{n] c:ktfn Joj:yfkg, cfly{s, k|zf;lgs
/ sd{rf/L k|zf;g ;a} x]gk{' b{Yof] . d}n] w]/} lhNnfdf
o:tf] sfo{ u/]“ . o;qmddf ;fdfGo k|zf;g dGqfno
tyf cGo u}/;/sf/L ;+:yfx¿n] lbPsf] k|zf;g;DaGwL
tflnd klg lnP“ . o;}n] Pp6f lrlsT;sn] ug]{
k|fljlwsb]lv sd{rf/Ln] ug]{ k|zf;lgs sfdsf nflu
klg cfkm"nfO{ ;'?b]lv g} ltvfg]{ df}sf kfP“ .
d]/f] ;]jf ;'? @)#( ;fn j}zfvaf6 ePsf] xf] .
c:ktfnsf] 8fO/]S6/ x'b“ f lgdf{0fsf sfo{x¿ klg ul/of] .
d @)^) ;fndf ljlzi6 >]0fLsf] afx|f“} txdf a9'jf eP“ /
dGqfnodf cfP“ . dGqfnodf sfd ubf{ pk;lrj,
;x;lrjx¿n] 6]lSgsn If]qsf] dfG5] ePsfn] k|zf;lgs
If]qsf] sfd ub}g{} eGg] ;f]rs
] f /x]5g\ . t/ hflu/
vfPs} lbgb]lv k|zf;g rnfPsf] cg'ejsf sf/0f
k|zf;gsf] sfd ul//x]sfx¿ eGbf /fd|f] sfd ug{ d
;kmn eP“ . s'g} lsl;dsf] cK7]/fx¿ ePg . To;}n]
lgldQ ;lrj eP/ klg w]/} sfd u/]“ . b'O{ jif{ cufl8;Dd
d bf];|f] JolQm lyP“, To;}n] ;lrj aflx/ hf“bf d}n] sfd
ug{ ;s]“ . hgdf]rf{sf cWoIf clds z]/rg pkk|wfg
tyf :jf:YodGqL x'“bf d g} lgldQ ;lrj lyP“ . jt{dfg
:jf:YodGqL lul//fhdl0f kf]v/]n / /fHodGqL zzL
>]i7 axfnL x'“bf klg lgldQ ;lrj d g} lyP“ . o;/L
cgluGtLk6s lgldQ ;lrj x'g kfPsfn] ;lrjdf a9'jf
x'b“ f dnfO{ s'g} gof“ sfd kfPsf]h:tf] ePg .
k'/fgf] :jf:Yo ;]jf P]gdf ;lrjsf] sfd k|zf;lgs
G L O B A L H E A LT H B U L L E T I N
sfd ePsfn] ;fdfGo k|zf;gaf6 cfpg'k5{ eGg] 9+un]
x]l/Psf] lyof] . @)^! ;fnb]lv xfdLn] ;lrj klg
:jf:Yo If]qaf6} x'gk' 5{ eGg] s'/f p7fPsf lyof},“ ;fdfGo
k|zf;gdGqL, d'Vo ;lrj, k|wfgdGqL cflbnfO{ e]6/] .
t/ s;}n] klg o;nfO{ uDeL/tfk"js
{ lnPgg\ / s'g}
k|lqmof cufl8 a9]g . clds z]/rg cfpg'ePkl5 pxf“n]
o;df alnof] 9+un] c8fg /fVg'eof] . P]gdf ;+zf]wg
ug'{kg]{ ePsfn] Tof] Joj:yf ul/of] . of] t ;lrjsf
nflu dfq eof] . tNnf]:t/sf] :jf:YosdL{nfO{ klg cGofo
ePsf] lyof] . h'g lsl;dn] :t/j[l4 x'gk' g]{ lyof], ToxL
txdf ePsf] lyPg . klxn] h'g txdf hflu/ vfof],
To;}af6 l/6fo8{ x'g'kg]{ cj:yf lyof] . To;sf] cGTosf
nflu clds z]/rgn] 7"nf] e"ldsf v]Ng'ePsf] 5 .
To;sf nflu xfdLn] pxf“nfO{ wGojfb lbg}k5{ .
z]/rgHo"s} kxndf @)^# ;fndf P]g ;+zf]wg
x'“bf :jf:Yo dGqfnosf] ;lrjdf :jf:Yo If]qs} afx|f}“
txdf kf“r jif{ sfd u/]sf jf afx|f“} txsf] sd{rf/L
lgo'Qm ug{ ;Sg]5 eGg] k|fjwfg /flvof] . of] …;Sg]5Ú
eGg] zAbnfO{ lnP/ v]n ;'? eof] . :jf:Yo If]qsf
sd{rf/LnfO{ g/fv]/ k|zf;gs} /fVg] u[xsfo{ ;'? eof] .
z]/rgHo"n] k|wfgdGqL;“u k|ToIf s'/fsfgL ug'{eof] .
To;kl5 xfnsf] dGqLHo" cfpg'eof] / pxf“n] klg o;nfO{
dxTjk"0f{ ljifosf] ¿kdf lng'eof] . pxf“n] g} dlGqkl/ifb\df
7f8f] k|:tfj nfg'ef] . Toxf“ klg k|zf;gkl§sf JolQmx¿af6
lj/f]w eof] . slt;Dd eg] :jf:Yo If]q / k|zf;gkl§sf
u/L b'O{ ;lrj /fvf}“ g t eGg] s'/f klg p7\of] . t/
dGqLHo"n] Psbd} /fd|f] c8fg lng'eof] .
@)^$ d+l;/ % ut]sf] dlGqkl/ifb\sf] lg0f{on] dnfO{
;lrj lgo'Qm ug]{ lg0f{o u¥of] . Tof] P]ltxfl;s If0f
lyof] . lsgls g]kfndf klxnf]k6s :jf:Yo If]qaf6
:jf:Yo dGqfnodf ;lrj ag]sf] lyof] . o;sf] >]o
:jf:YodGqL lul//fhdl0f kf]v/]nnfO{ xfdL :jf:YosdL{n]
lbg}k5{ .
d ;lrjdf lgo'Qm eP/ b'O{ dlxgfdf w]/} sfd ug{
;Dej ePg . d]/f] w]/} ;do 5nkmn / ;ldlt;“usf]
a}7sd} laTof] . oBlk kf6g d]l8sn sn]h, aLkL sf]O/fnf
SofG;/ c:ktfn ljw]os cflb lgdf{0f ug]{ sfo{ eof] .
:jf:Yo ;'/Iff ljw]os klg aGof] . w]/} sfd ug{ ;lsGYof],
t/ ;do k'ug] .
;DalGwt dGqfnodf ljifosf] 1fg ePsf] dfG5]
;lrj x'“bf w]/} l56f] sfd x'G5 . kmfOn agfpg÷lg0f{o
ug{ ;lhnf] x'G5 . csf]{ aflx/sf dfG5]x¿;“u s'/f ug{
klg ;lhnf] x'G5 . :jf:YosdL{x¿n] sfd ubf{ ufp“bl] v
dflyNnf] tx;Dd a'em]sf] x'G5 . k|zf;g r':t x'G5
lsgls lg0f{o k|lqmof l56f] x'G5 . 6]lSgsn s'/f a'em\g]
ePsfn] ;xL lg0f{o x'G5 . o;sf] dtna ;Dk"0f{ ;d:of
xn x'G5 eGg] xf]Og, t/ k|zf;lgs If]qaf6 cfPsf]
JolQmn] eGbf l56f] sfd ug{ ;S5 .
7Ls ;dodf 7Ls lg0f{o ug'{ Ps k|zf;ssf]
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
!&
dxTjk"0f{ / geO{ gx'g] Ifdtf xf] . d}n] hflu/ vfPb]lv
g} k|zf;gk|lt rf;f] /fv]“ / hlxn] klg l56f]sf ;fy}
7Ls ;dodf ;xL lg0f{o ug]{ u/] . clxn];Dd s'g} klg
unt lg0f{o d}n] u/]sf] 5}g . oBlk slxn]sfxL“ P]g
lgodsf] cy{ km/s 9+un] a'em\bf ljjfbdf cfOof] xf]nf .
g]kfn ;/sf/n] d]/f] oxL Ifdtfsf] sf/0f c:ktfnsf]
lgb]z
{ s x'b“ } ;lrj;Dd aGg] cj;/ lbof] . d ;/sf/k|lt
s[t1tf k|s6 ub{5' . vf;u/L hgdf]rf{n] :jf:Yo dGqfno
;Dxfn]kl5 :jf:Yo If]qs} ;lrj agfpg h'g lsl;dsf]
e"ldsf dGqLx¿n] v]Ng'eof], Tof] g]kfnsf] Oltxf;df
/xg] 5 . klxn] klg d] l 8sn P;f] l ;P;g tyf
:jf:YosdGqLsf] tkm{af6 sf]l;; ePsf] lyof], t/ Tof]
;kmn x'g ;s]sf] lyPg . hgcfGbf]ng kl5 dGqLHo"x¿sf]
e"ldsfsf] sf/0f g} Tof] ;kmn ePsf] xf] . o;n] :jf:Yo
If]qsf] k|zf;gnfO{ plhNofpg Oltxf; g} a|s
] u/]sf] 5 .
hgdf]rf{n] :jf:Yo dGqfno ;Dxfn]kl5 :jf:Yo
If]qdf dxTjk"0f{ sfd ePsf 5g\ . ljz]iftM :jf:Yo P]g
kl/jt{ g u/] / tNnf] : t/b] l v ;lrj;Ddsf
:jf:YosdL{x¿nfO{ k|fT] ;flxt ug]{ sfd ePsf] 5 . lgMz'Ns
:jf:Yo sfo{qmd ;~rfng u/]/ cfwf/e"t hgtfdf k'¥ofpg]
sfd ePsf] 5 . hg:jf:Yo gLlt agfpg] sfd ePsf]
5 . csf]{ dGqLHo"s} lgu/fgLdf …pRr:t/Lo cg'udg
;ldltÚ ag]sf] 5 . Tof] 7"nf] sfd xf] . dGqLHo" ;lrj
tyf pRr:t/Lo clwsf/Lx¿nfO{ /fv]/ ;d:ofsf] ljZn]if0f
ug'x{ G' 5 / ca s] ug]{ eg]/ of]hgf agfpg'xG' 5 . of] klg
klxn] ePsf] lyPg . csf]{ dxTjk"0f{ s'/f] clxn];Dd d}n]
Pp6f klg To:tf] dGqL b]vs
] f] 5}g, h;n] c:ktfn–
c:ktfndf uP/, :jf:Yorf}sL, pk:jf:Yorf}sL k'u/] ,
:ynut lg/LIf0f u/]/ sd{rf/LnfO{ xf};nf lbPsf] xf];\ .
of] sfd clxn] ePsf] 5 . To:t} Unf]an PnfOG; km/
DoflS;g -ufeL_sf] HSS x]Ny ;]S6/ ;kf]6s
{ f] ;xof]u
klg xfdLnfO{ k|fKt ePsf] 5, dGqLHo"s} g]tT[ jdf la|6g] df
uP/ …cGt/f{li6«o :jf:Yo ;fem]bf/LÚdf x:tfIf/ ug]{ sfd
ePsf] 5 . of] ;f}efUo Pl;ofsf] sf]nlDaof / g]kfnn]
dfq k|fKt u/]sf 5g\ . of] x:tfIf/ ePkl5 8f]g/x¿n]
cfly{s ;xof]u lb“bf xfdLn] g} agfPsf] :jf:Yo gLltsf]
cfwf/df lbg] gLlt ag]sf] 5 . klxn] pgLx¿ cfkm}n
“ ]
gLlt agfp“y] . csf]{ klxn] ah]6sf] 7"nf] lx:;f s]Gb|df
/xg] / !# k|ltzt dfq lhNnfdf hfg] ub{Yof] . clxn]
lhNnfdf &) k|ltzt k|ToIf ¿kdf k'¥ofpg] Wo]o 5 .
kl5Nnf] ;dodf :jf:Yo If]qdf olt /fd|f] sfd x'gd' f
lglZrt ¿kdf hgdf]rf{sf] tkm{af6 dGqL ePsfx¿sf] 7"nf]
e"ldsf 5 . ah]6 a9fpg] ;jfndf klg of] b]lvG5 .
xfdLn] clds z]/rgsf] kfnfdf g} ;k|df0f :jf:Yo If]qdf
!) k|ltzt ah]6 x'gk' 5{ eGg] c8fg lnPsf lyof}“ . Tof]
c8fg clxn]sf dGqLHo"n] klg lng'ePsf] 5 . To:tf]
klxn]sf dGqLHo"x¿n] lng'xG' gYof] . cfly{s kf/blz{tfsf]
lx;fan] klg dGqfno clxn] rf]vf] 5 . x'g t ;tk|ltzt
g} /fd|f sfd ePsf 5g\ eGg ;ls“bg} . dGqLHo"nfO{ yfx}
glbO{ c¿n] kmfObf lnPsf x'g ;S5g\ . t/ dGqfno
kf/bzL{ 5 s'g} v/faL ;'Ggdf klg cfPsf] 5}g .
clxn]sf] P]gdf ePsf] :jf:YosdL{af6} ;lrj agfpg
;lsg]5 eGg] jfSof+znfO{ afWofTds agfpg h?/L 5
eg] b'ud{ 7fp“df hfg gdfGg] lrlsT;sx¿nfO{ Toxf“
s;/L k7fpg ;lsG5 eg]/ pRr:t/Lo cWoog x'g
h?/L 5 . d]l8sn Ph's;
] gdf b]lvPsf ljs[ltx¿nfO{
x6fp“b} gof“ bIf hgzlQm pTkfbg ug]t{ km{ Wofg hfg
h?/L 5 . To;sf nflu ;Dk"0f{ sn]hx¿n] d]l8sndf
Sjfln6L d]G6]g ug{ ;Sg] pRr:t/Lo ;ldlt lgdf{0f ug{
h?/L 5 . ;L6LeL6LcGtu{t pTkflbt cw{bIf hgzlQmnfO{
bIfsf] ¿kdf lng x'g] ls gx'g] eGg] gLlt agfpg h?/L
5 . c:ktfn ljsf; ;ldltsf] sfo{nfO{ Jojl:yt agfpg
h?/L 5 . Tof] /fhgLlts etL{sG] b| ag]sf] 5 . Toxf“
a:g] clwsf/Lx¿n] gof“ sd{rf/L egf{ ug]{ / To;nfO{
hflu/ v'jfpg la/fdLx¿nfO{ dfq a9fpg] sfo{ ePsf]
5, To;nfO{ /f]Sg'k5{ .
->]i7 k"j{ :jf:Yo ;lrj x'g\_
xflb{s z'esfdgf
Unf]an x]Ny a'nl] 6g :jf:Yo If]qsf] ;+rf/ hutdf
sf];]9'+uf ;fljt x'g ;Ifd xf];\ eGg] z'esfdgf JoQm ub{5' .
lgb]{zs M 8f= lznf jdf{
k/f]ksf/ k|;l" t tyf :qL/f]u c:ktfn
yfkfynL, sf7df8f}+ .
!*
G L O B A L H E A LT H B U L L E T I N
Unf]an x]Ny a'n]l6g, j}zfv÷h]7–@)^^
ue{ ;DalGw lg0f{o ug]{ dlxnfsf] k|hgg\ clwsf/ xf] .
Kfl/jf/ lgof]hgsf ;fwg ckgfcf},+ clglR5t ue{ x'gaf6 arf}+ .
o:tf] nf]uf] /flvPsf] :jf:Yo ;+:yfdf
dfq ;'/lIft ue{ktg ;]jf k|bfg ul/G5 .
t/ clglR5t ue{ /x]df ;'/lIft ue{ktg ;]jf lnO d[To' x'g af6 arf}+} .
;'/lIft ue{ktg ;]jf :jf:Yo ;]jf laefun] l:js[lt k|bfg u/]sf :jf:Yo ;+:yfx?af6 k|fKt ug{ ;lsG5 .
o; ;]jfcGt{ut lgDg ;]jfx? kb{5g\ M
k|hgg\ :jf:Yosf af/]df k/fdz{ ;]jf
:jf:Yo hfFr
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