Senior Citizens in Nepal: Policy Gaps and Recommendations

Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan

OBJECTIVE

This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan.

METHODOLOGY

This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023).

RESULTS

Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place.

CONCLUSIONS

This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.

Ethnomedicinal plants in Champadevi rural municipality, Okhaldhunga district, Nepal

BACKGROUND

Okhaldhunga is a hilly district with fragile socioeconomic conditions, limited access to health care, social stigma, and poor resource management, where most people rely on medicinal plants for primary health care. The use of medicinal plants for primary health care varies with socioeconomic attributes. Following the intra-cultural analysis, we documented and tested the hypothesis that use of medicinal plants in Champadevi, Okhaldhunga, Nepal, depends on socioeconomic variables.

METHODS

We interviewed 224 respondents, 53.12% female and 46.88% male, including 31 Brahmin, 157 Chhetri, 13 Dalit, and 23 Janajati, and conducted three focused group discussions and seven key informant interviews to record the ethnomedicinal plants used in Champadevi rural municipality, Okhaldhunga District. The relative frequency of citation (RFC) was computed to know the importance of the species. A generalized linear model (GLM) was used to see the relationship between medicinal plants reported with the sociocultural variables, which include age, gender, occupation, education, ethnicity, and religion.

RESULTS

We documented 149 medicinal plants, including 69 herbs, 22 shrubs, nine climbers, 48 trees, and one parasitic plant, belonging to 68 families and 130 genera, and used to treat 48 distinct diseases and ailments. Plant parts, leaf, and digestive disorders were frequently treated during healing. Curcuma angustifolia was the most cited species with RFC 0.9554. The respondents' knowledge of medicinal plant use varied significantly with age (p = 0.0001) and occupation (p = 0.003). Changes in land use, population decline of medicinal plant species, and unsustainable harvesting practices constituted the local threats to medicinal plants and associated knowledge. Elders died without passing on their knowledge to the younger generations during sociocultural transformation, and youth disinterest coupled with the free availability of allopathic medicine led to knowledge erosion.

CONCLUSIONS

The use of medicinal plants in Champadevi, Okhaldhunga, was significantly depended on two socioeconomic variables age and occupation. Ethnomedicinal plants are essential in the primary healthcare system in Nepal; however, their availability and practices are declining. Thus, plans regulating land use change and human migration, acknowledging traditional healthcare practices, and raising awareness of the significance of traditional medical practices as complementary healthcare practices should be strengthened.