The focus of this paper is to examine the organisation of health care in Nepal from the literature available. After setting the study in context and examining health care in general, a more in-depth, look is taken at Primary Health Care (PHC) and how this recent emphasis is affecting nurse education. This leads into an analysis of whether or not nurses are the most appropriate personnel to deliver PHC. The fundamental issues of improving adult female literacy rates and providing a clean water supply are suggested as means whereby Nepal's health provision could be greatly improved.
PIP: Nepal has adopted the World Health Organization concept of primary health care (PHC) in the attempt to close the gap between urban and rural health care, and improve conditions for the vast majority of the population living in isolated rural areas. The author has drawn information from relevant journal articles, UNICEF, and the World Bank, as well as International Nepal Fellowship staff, a Christian mission working to improve health care in Nepal, to examine the organization of health care in Nepal. An opening section describes background geographical, demographic, socioeconomic, political, cultural, and epidemiological factors in the country. The author then takes an in-depth look at PHC, how the recent emphasis upon PHC affects nurse education, and whether or not nurses are the most appropriate personnel to deliver PHC. Studies have found encouraging results with the approach. It has, however, been argued that some villagers would prefer health workers to provide curative services rather than the message of health promotion and disease prevention. A recent curriculum change in nurse education has shifted the emphasis away from hospital-based work to a PHC approach, with students working in isolated villages. The practical problems of the approach are highlighted, along with the social and cultural difficulties. This study points to the importance of considering the social and cultural values of the population for whom services are intended. For example, young, unmarried nurses from urban areas are not socially acceptable to rural communities.