Nepal is among the world’s poorest and least developed countries. This Himalayan nation has over the years received substantial financial support and technical assistance for its health, education and governance sectors from developed countries, with the US Agency for International Development (USAID) acting as the major donor. In 2022 alone, USAID and the government of Nepal inked a five-year Development Objective Agreement valued at $659 million, aimed at channelling funds to areas of health, agriculture, education and inclusive policy. Thus the US government’s decision to suspend USAID in January this year has had an adverse impact on Nepal’s health sector. It has affected crucial programmes such as maternal and child health and HIV testing and prevention, as well as national surveys, including micronutrient surveys, studies related to female community health volunteers, health facilities surveys—and the most important—the National Demographic and Health Survey (NDHS) 2026. The agency covered the full financial costs of the study; now, with funding cuts and authorities’ failure to secure alternative sources of funding, its future appears uncertain.
The NDHS has long shaped the country’s health profile. Carried out every five years, it has continued without interruption since 2001 and provided data and key information on the status of maternal and child health, fertility, family planning, HIV/AIDS, water, nutrition, sanitation, domestic violence, healthcare services and people’s access to them. For any country, reliable health data is vital to ensure a healthy present and future for its citizens, as it helps governments make decisions and allocate health resources accordingly. In Nepal, the health survey is the backbone of national health policies and programmes. It also measures the country’s performance on the Sustainable Development Goals by 2030. The country will be in the dark about its health status without a new survey, thereby compounding the challenges faced by the already struggling sector.
After the funding cuts by the US government, there has been an emphasis on government funding of health programmes and surveys like the NDHS. But experts say international agencies don’t consider data collected through government channels credible. As is often the case in Nepal, officials can exploit data to paint a rosy picture of the health sector to both donor agencies and the general public.
But it doesn’t have to be this way. It is not that Nepal lacks funds to finance the health surveys. For instance, the government sets aside a budget for the independent study of immunisation programmes. If this can be done, why can’t we do the same for the NDHS through transparent, accountable and independent national channels? And why not adequately fund the health sector to begin with? Nepal would do well to take this possibility into account, given past instances of manipulation in some studies—both funded and evaluated by USAID—that served the agency’s own interests. We cannot always rely on data from international agencies either, when the same agency serves as both funder and evaluator. Donors should be approached and persuaded when necessary. However, in the current fragile global policy landscape, self-sufficiency in the health sector has become more important than ever. And this starts with the collection and dissemination of the right data through credible channels.
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