Kathmandu reflects a rich cultural heritage blended with modern lifestyle. The cosmopolitan city has a multi-linguist and multi-cultured society where people from across all Nepal’s regions and ethnicity groups reside.
Kathmandu Metropolitan City is fast growing, with uncontrolled urban development and a rapidly growing population with a high population density. In recent years the city has experienced devastating natural disasters in the form of an earthquake and a flood. The continued unplanned urban expansion has seen marginalisation of the urban poor. The escalating land and building prices put housing beyond the reach of many, resulting in increasing numbers of people living in the slum and informal squatter settlements.
Parasites are prevalent amongst those using untreated water and those who are illiterate; HIV infection rates in street children in Kathmandu is nearly 20-fold higher than the general population; TB cases are significantly higher. Hypertension rates are higher amongst those living in slum areas. A study conducted in the Sinamangal squatter area of Kathmandu found high levels of cardiovascular disease risk factors including smoking, high alcohol consumption, poor diet, and a lack of physical exercise.
Pollution caused by the rapid increase in population and the industrial environment represent additional hazards to the health of the urban poor, as does the discharge of large volumes of untreated domestic sewage and industrial effluent into the river systems and chemical and biological pollution of shallow ground water through septic tanks and industrial waste.
The resilience of the urban poor is strong. Social organisation within the informal settlements and local initiatives and self-help schemes help to reduce vulnerability. However, there is a lack of public investment in slums and squatter areas, and the health challenges are multifaceted, and local government policies are not keeping pace with the changing health needs of the urban poor.
The new state architecture of Nepal, as defined by the 2015 constitution, has 3 tiers of government (federal, provincial and local), for which new legislation, institutions and administrative procedures are being formalised. In the new structure, health is one of the most decentralised sectors, with local government holding responsibility for primary health care functions and urban health governance, whilst federal government is responsible for overall policy. Whilst the new structure is still in its nascent stage, clarity of functions between the tiers is still being defined, and as the urban health system is new to the local government bodies there is a need and opportunity look at how to strengthen capacity, and cross sector collaboration to ensure the health needs of the urban poor can be addressed.