Abstract
Background
Nepal, like other low- and middle-income countries, is experiencing a rapid increase in the number of older adults and the rate of aging in the population. This has increased the number of older adults with age-associated chronic illnesses, which in turn will escalate the demand for specialized healthcare and long-term care in Nepal. However, very little is known regarding the current healthcare system and health policies for older adults in Nepal. In this paper, we aimed to advance this understanding.
Methods
We reviewed the existing literature on the health, healthcare system, and policies related to older adults in Nepal.
Results
Our findings revealed that older adults have a high prevalence of chronic conditions such as cardiovascular, musculoskeletal, and chronic kidney diseases, and the number of patients with Alzheimer’s disease and related dementias is on the rise. Additionally, there is a decline in historical family caregiving for several reasons such as international migration of offspring, and the country currently lacks a skilled geriatric workforce and formal long-term care support and services (LTSS). Together, this has created a challenge in adequately meeting the health and care needs of the older population. Findings also indicated that several geriatric health policies exist in the country, which ensure primarily free healthcare services for older adults. However, economic constraints limit the financial resources to implement these policies, build appropriate care facilities, and improve access and utilization.
Conclusion
Therefore, the government must develop sustainable financing to adequately provide quality healthcare and LTSS for older adults as the population ages.
Keywords: Aging, Older Nepali, Long-term care
Background
Nepal is a low-middle income country (LMIC) that, like many other LMICs, is facing rapid transitions in population age and social structures. These transitions pose important challenges in addressing the healthcare needs of the rapidly increasing number of older adults. This review aims to describe the existing healthcare systems and policies for the healthcare needs of older adults in Nepal and identify the gaps in these as the population continues to age. We will first describe recent demographic and social transitions that have occurred in South Asian countries including Nepal. Next, we will summarize the existing data on the health and well-being of Nepal’s current generation of older adults. Then, we will describe the current healthcare system and health policy in Nepal and end with some conclusions on the changes that may be required to adequately address the health and care needs of Nepali older adults in the context of the ongoing demographic and social transitions in Nepal.
Demographic and social transitions in South Asia
The South Asia region comprises the countries of Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. These countries differ in population size, national income, rate of population aging, and other factors. For example, Afghanistan is classified as a low-income country (Gross National Income per capita (GNI) = 380 USD), the Maldives as an upper-middle income country (GNI = 10,880 USD), while all other countries are classified as lower middle-income countries with a GNI ranging between 1340 and 3610 USD [1, 2].
The first aspect of the demographic transition in South Asia is the rapid increase in the total number of older adults. The Asia–Pacific region is expected to experience a substantial increase in the absolute number of adults 60 years and older, which is projected to more than double from 697 million in 2020 to nearly 1.3 billion in 2050, by which time they may represent almost a quarter of the total population in the region [3]. Due to its population size, India comprises by far the largest number of older adults (≥ 65 years) in the region, including 90 million older adults in 2020 and estimated to grow to 109 million in 2025 [4]. Other large population countries such as Bangladesh and Pakistan follow with an estimated 10 million and 11 million older adults in 2025, respectively, while small countries like Bhutan and the Maldives will have 56,000 and 26,000 older adults, respectively [4]. The relative growth varies also by country, ranging from an expected increase of almost 6.5 times in the Maldives, to a somewhat smaller relative growth of 2.5 to 3.5 times in the more populous countries of India and Bangladesh, respectively, by 2050 [4].
The second feature of the demographic transition in South Asia is the rapid increase in the rate of population aging, i.e., the proportion of older adults in the total population, in each country. The rate of population aging in South Asia is also considerably faster compared to that in high-income countries (HICs) that went through this demographic transition in the twentieth century. For example, between 2020 and 2050, the percentage of older adults (≥ 65 years) in the total population is projected to increase from 10.8% to 22.6% in Sri Lanka, from 6.4% to 13.8% in India, and from 3.6% to 20.9% in the Maldives [4]. If the rate of population aging is expressed as the number of years it took for the percentage of the older adult population (≥ 65 years) to grow from being 7% to 14% of the total population, this demographic transition took much longer in HICs such as France (115 years) and Sweden (86 years) [5] compared to only 26 years in India [6]. Thus, unlike the HICs that had several decades to create policies and build infrastructures to cater to the unique needs of their older residents, the South Asian countries have far fewer years to adapt to the substantial changes in population structure. In addition, they will face the urgency of addressing the needs of their growing older populations and establishing the necessary infrastructures promptly with on average far fewer socio-economic resources compared to the HICs.
The South Asia region is also undergoing important social transitions. These include changes in the overall labor economy, for example, changes in types of work, and income. In the past few decades, India and Bangladesh have contributed to the region's economic growth, mainly due to the agricultural transformation from small-scale subsistence farming to commercialization and the development of new jobs in manufacturing, trade and service sectors [7]. Another significant change is the rising trend of international labor migration of young adults within or outside the region and sending remittances to their families in their country of origin. South Asian countries received nearly 22% (189 billion) of global remittances in 2023 compared to 19% (97 billion) in 2011 [8] with a notable variation within the countries. For example, India is the largest remittance receiving country globally, yet remittances contributed to only 3.4% of its Gross Development Product (GDP) compared to 7% of the GDP in Pakistan and Sri Lanka in 2023 [8].
Case study of Nepal
General overview
Nepal is a small mostly mountainous country in South Asia sandwiched between China and India. Nepal has been a Federal Democratic Republic since 2008 and is administratively divided into seven provinces under the national federal government. Many federal and provincial policies are carried out, overseen, and implemented by local governments. The total population of Nepal was 29 million in 2021 [9] and the people in Nepal belong to 142 different caste and ethnic groups [10]. Almost one-sixth belong to the Chettri, which is the largest ethnic group. Nepali is the official language in the country even if only little less than half of the population (44.9%) uses Nepali as their primary language. There are 123 other languages used throughout the country. About 80% practice the Hindu religion, another 8% are Buddhists [10]. Like other LMICs in South Asia, Nepal is also undergoing important demographic and social transitions, leading to both a rapidly growing older adult population [11] and rapid changes in the labor economy and family structures [9].
Older adult population
Older adults in Nepal are usually addressed as “Jestha Nagarik” or “Senior Citizens” and defined as those who have reached the age of 60 years [12]. According to the 2021 national census, there were almost 3 million (2,977,318) adults 60 years and over in Nepal, comprising 10.2% of the total population. A slight majority (51.5%) of them were females [9]. A little over three-fifths (63%) of older adults live in urban municipalities with the remaining 27% living in rural ones [9]. Only about a third (31%) of older adults are literate, including a substantial gender disparity with 48% of older men and only 15% of older women being literate [13].
Changes in labor economy and family structure
Nepal has undergone substantial economic and social transformations in the past two decades. Economically, the service sector surpassed agriculture as the nation’s primary GDP contributor in 2011 and industry, tourism, and personal remittances from international migrant workers are other emerging economies driving the nation’s GDP [14]. Nepal heavily relies on foreign remittances, constituting a significant share of its GDP, which accounted about 22.8% in 2019 [15]. During COVID-19, many foreign migrants returned home resulting in a decrease in the country’s remittance inflow, amounting to just 20.4% of the GDP in 2022. With the current post-COVID rise in labor migration, remittances have increased again and were back up to 22.7% of its GDP in 2023 [15]. Currently, ranked as the fifth country to rely on foreign remittances globally [8], remittances have become a critical source of income to a majority of households in the country. It is conceivable that reliance on foreign remittances as a primary driver of the GDP continues to increase as Nepal transitions from being a predominantly agricultural to a mixed economy.
Similarly, in the social domain, Nepal has witnessed drastic changes in migration patterns and household structures. Between 1981 and 2021, adult emigration has almost tripled to 7.4% and nearly 23.4% households have a member living abroad [9], mainly for employment [14]. Additionally, young married women from households receiving remittances often move to urban areas for their children's education and younger working couples are increasingly leaving their parents' homes following marriage and living in nuclear families [16, 17] because of desire for autonomy and perceived challenges in meeting their parental expectations regarding household responsibilities [18]. This has led to an increase in nuclear families and a decline in average household size from about 6 persons in 1991 to 4 persons in 2021 [9]. Consequently, this shift towards preference for smaller nuclear families over multigenerational households among young adults has resulted in middle-aged and older adults living alone or with only a spouse without children to provide care when needed.
Health and well-being of older adults
Currently, the best available nationwide estimates on morbidity and mortality in Nepali older adults come from the 2019 Global Burden of Disease (GBD) study [19], which suggest a high prevalence of non-communicable diseases (NCDs) and their increased role in death and disability rates [20]. For example, digestive (55%) and musculoskeletal (50%) disorders, cardiovascular diseases (CVD; 35%), chronic kidney diseases (CKD; 34%), chronic obstructive pulmonary disease (COPD; 26%), and diabetes mellitus (22%) are the major drivers of morbidity and disability, and COPD, CVD, and cancer are the top three leading causes of death. There is also a high prevalence of mental disorders among older adults. GBD reported about 17% prevalence of mental disorders among Nepali older adults, with anxiety (4%) and depressive disorders (9%) as the most prevalent conditions. Furthermore, even less is known about age associated NCDs such as Alzheimer’s disease and related dementias (ADRD). In recent years, screening and diagnosis of ADRD has increased. Nepal was thought to harbor 78,000 cases of ADRD in 2015, which is estimated to almost double in 2030 [21]. In 2019, the prevalence of ADRD was about 7% in older Nepali, but as expected was substantially higher (11%) among 80 years and older [20]. The growing burden of NCDs will undoubtedly put increasingly larger demands on the health care and support systems for current and future generations of older adults in Nepal.
There have also been notable changes in the support and care systems of older adults in Nepal. Family members, primarily adult children look after older Nepali. Historically, a married son and his family live with his parents and provide support and care to them as needed [16]. However, this type of intergenerational support is rapidly declining due to the increasing preferences for nuclear family and escalating migration of younger adults, especially men, with profound consequences for household composition and dynamics [16, 22, 23]. Consequently, older adults are being left behind without children or other family members nearby, resulting in smaller social support networks [17, 22], increased feelings of loneliness and isolation [24], and increased challenges in receiving much needed support and care, particularly in the presence of health problems. In addition, children’s inability to meet caregiving needs of their parents and lack of family caregivers has heightened the risk of inadequate provision of long-term care for older adults with chronic conditions. Currently, older adults are relying on limited community-based care services in Nepal [17].
Health care system and policy for older adults
After Nepal transitioned into federalism, the country’s healthcare shifted from a centralized government system to a decentralized three-level government, including federal, provincial, and local [25]. The federal Ministry of Health and Population oversees the overall national health sector by allocating budget, formulating health policies, and developing programs [25]. The provincial and local governments are responsible for catering and implementing those at respective levels [25]. Healthcare is administered at all three levels by public and private sectors [26]. In 2015, Nepal’s Constitution declared free basic health care as a right of every Nepali citizen [27] and the Health Insurance Act was enacted in 2017 [28], which the government implements with the National Health Insurance Program (NHIP) [29]. Enrollment in NHIP is voluntary and requires an annual premium per household through which free basic healthcare services (outpatient and inpatient visits, and emergency care) and certain medications can be Accessed in select government health facilities [29]. These services are delivered through general and specialized hospitals, primary health care centers, health posts, and community health centers, which constitute the nation’s public health sector [26]. Health care through the private sector is provided by fee for service through general and specialized hospitals, out-patient clinics and nursing homes.
The healthcare system for older adults in Nepal is embedded within the country’s overall health system. While older adults can seek care through both public and private sectors, the government fully subsidizes the household for older adults’ enrollment in NHIP including an additional benefit of Nepalese rupees 100,000 (about 756 USD) to cover healthcare expenses [29]. Those who do not buy into the NHIP can access healthcare services through either public or private sectors at their own expense. Although geriatric hospitals do not exist, public hospitals with 100 beds and more are required to have a geriatric unit [30]. Old-age homes (OAHs), and recently, day centers and care homes, have been established in the country. Currently, 2451 older adults (1380 women and 1071 men) live in 114 OAHs throughout the country [30], among which about eleven OAHs receive governmental grants [31] and philanthropic contributions for operation and the rest are privately-owned [17]. Although the government has plans to train 300 medical doctors and 500 nurses to provide geriatric care by 2030 [32], the geriatric workforce is currently limited [33]. About four board certified geriatricians currently practice in the country; geriatric nurses and other geriatric health care professionals are almost non-existent [31] and their exact number is not recorded.
While older adults can seek care in either the public or private sector, extra policies and benefits are in place for them. Following the development of the Senior Citizens Act 2006 (SCA) [12] and the NHIP, targeted health benefits including discounts and subsidies are provided for older adults. Recently, in 2021, Geriatric Health Service Strategy (GHSS) was developed, which outlines a decade-long framework for geriatric service delivery offering free healthcare at government-run hospitals and health facilities to (a) those who are 60 years and older and belong to deprived and marginalized groups; (b) those 65 years and older living with disabilities or mental illnesses, and (c) all adults 70 years and older [32]. Similarly, GHSS also ensures that Nepali adults 60 years and over receive subsidies in select medical care services including those for age-related diseases such as Alzheimer’s disease, Parkinsons, and NCDs such as cancer, heart and kidney diseases, reflecting the country’s latest comprehensive effort towards addressing the emerging healthcare needs among older Nepali [32].
Despite the mostly free healthcare system for older adults in Nepal, several challenges persist, including issues of utilization and accessibility. For example, the majority of older adults are unaware of free and discounted healthcare services, leading to underutilization [34, 35]. Moreover, a sizeable portion prefers traditional healers such as Dhami and Jhankri as initial treatment choice [35, 36]. Older adults face difficulties accessing public healthcare services [36], mainly in rural areas [34]. Specialized care services are available in big cities only, which typically requires at least a day trip. Also, there is a lack of trust in the quality of public services due to shortages of free medications and long waiting times in hospitals. In response, older adults turn to private hospitals and clinics for their care needs, regardless of economic status [36]. As a result, families end up having a high out-of-pocket healthcare expenditure, imposing a significant economic burden on households.
Lastly, poorly equipped healthcare facilities and the lack of a competent workforce trained in geriatric care make it challenging to deliver high-quality care to older adults in Nepal. Federal regulations require dedicated geriatric units in select hospitals, yet compliance is inconsistent [32]. Geriatric workforce is almost non-existent and medical education in Nepal does not offer geriatric specialization, further exacerbating the workforce shortage. Day centers and old-age homes are scarce, geographically limited, expensive [24], and the care provided is not regulated/monitored [37]. Additionally, the absence of rehabilitation, palliative care, assisted living and skilled nursing facilities point to the urgent need to build such facilities, especially given the rapidly growing older adults with comprehensive care needs due to NCDs and ADRD. The country has initiated policies to institutionalize long-term care for decades, but substantial progress has yet to be achieved. For example, the government declared to build and pilot test the operation of a 500 bed capacity senior citizen home with an accompanying geriatric hospital in 2007 [38] but allocated funds only in 2021 [39]. In 2024, the national budget only allocated funds to construct one 165-capacity old-age home and one 45-bed geriatric hospital [40]. In sum, despite the development of promising policies and guidelines in recent years to address the health care needs of older adults, effective implementation has been hampered due to a lack of urgency to prioritize geriatric care, lack of resources, and lack of governmental oversight.
Conclusions
The pace of population aging in Nepal will lead to a rapidly increasing number of older adults with NCDs and ADRD, which in turn will escalate the demand for adequate healthcare services and long-term care. Yet, important challenges lay ahead to address the care needs of current and future generations of older adults in Nepal. First, despite having geriatric health policies in place to provide affordable healthcare to older Nepali, economic constraints limit the financial resources to build appropriate care facilities and improve access and utilization. Second, there are currently very few educational resources and opportunities to produce a skilled geriatric workforce trained to provide high quality care for older adults. Third, the decline in traditional family caregiving systems due to the growing tendency of offspring generations of not co-residing with their aging parents poses another important challenge to address the care needs of older adults, further underscoring the urgent need to strengthen the availability of long-term care facilities across the country. In conclusion, several governmental policies and programs are currently in place in Nepal designed to support the health care needs of older adults. At the same time, much of the health care and long-term care infrastructure will require more sustainable financing, more rapid build-up of facilities and improvements in care if the country is to respond adequately to the needs of the rapidly growing number of older adults.
Acknowledgements
Not applicable.
Abbreviations
- LTSS
Long-term care support and services
- LMIC
Low-middle income country
- GNI
Gross National Income per capita
- HIC
High-income country
- GDP
Gross Development Product
- GBD
Global Burden of Disease
- NCD
Non-communicable diseases
- CVD
Cardiovascular diseases
- CKD
Chronic kidney diseases
- COPD
Chronic obstructive pulmonary disease
- ADRD
Alzheimer’s disease and related dementias
- NHIP
National health insurance program
- OAH
Old-age home
- SCA
Senior Citizens Act 2006
- GHSS
Geriatric Health Service Strategy
Author contributions
UD wrote the first draft of the manuscript. CFMdL reviewed, edited, and finalized it. All other coauthors (EB, UB, US, AS, LS, DG) reviewed and edited the manuscript. All authors have read and approved the manuscript.
Funding
This work was supported by the National Institutes of Health (grant number R01AG074079 (CMdL/DG)).
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.World Bank. World Bank Open Data [online]. 2022. https://data.worldbank.org. Accessed 9 Nov 2023.
- 2.World Bank. World Bank Country and Lending Groups-World Bank Data Help Desk [online]. 2024. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed 21 Feb 2024.
- 3.United Nations, Economic and Social Commission for Asia and the Pacific (ESCAP). Asia-Pacific Population and Development Report. 2023. https://www.unescap.org/kp/2023/asia-pacific-population-and-development-report-2023#. Accessed 23 Apr 2024.
- 4.United Nations, Department of Economic and Social Affairs. World population prospects 2019, volume i: comprehensive tables. 2019. https://population.un.org/wpp/Publications/Files/WPP2019_Volume-I_Comprehensive-Tables.pdf. Accessed 15 Dec 2023.
- 5.Kinsella K, He W. An aging world : 2008. 2009. https://www.census.gov/content/dam/Census/library/publications/2009/demo/p95-09-1.pdf. Accessed 21 Feb 2024.
- 6.International Institute for Population Sciences and United Nations Population Fund. India ageing report 2023. 2023. https://india.unfpa.org/sites/default/files/pub-pdf/20230926_india_ageing_report_2023_web_version_.pdf. Accessed 23 Apr 2024.
- 7.Taguchi H, Tsukada Y. Risk of premature deindustrialization: the case of the latecomer’s developing countries in Asia. Asian Econ Pap. 2022;21(2):61–77. 10.1162/asep_a_00851. [Google Scholar]
- 8.Ratha D, Chandra V, Kim EJ, Plaza S, Shaw W. Migration and development brief 39: Leveraging diaspora finances for private capital mobilization. 2023. https://www.worldbank.org/en/topic/migration/brief/remittances-knomad
- 9.National Statistics Office. National population and housing census 2021 results. 2023. https://censusnepal.cbs.gov.np/results/downloads/national. Accessed 1 Mar 2024.
- 10.National Statistics Office. National population and housing census 2021: National report on caste/ethnicity, language and religion. 2023. https://censusnepal.cbs.gov.np/results/files/result-folder/Caste%20Ethnicity_report_NPHC_2021.pdf. Accessed 1 Mar 2024.
- 11.Chalise HN, Bohora PK, Khanal TR. Older people and social security system in Nepal. Gerontol Geriatr Res. 2022. 10.26420/gerontolgeriatrres.2022.1075. [Google Scholar]
- 12.Nepal Law Commission. Senior Citizens Act, 2063 (2006). 2006. https://lawcommission.gov.np/en/?cat=575. Accessed 7 Jan 2024.
- 13.National Statistics Office. Census Dataset. Individual Table 17: Population aged 5 years and above by literacy status, NPHC 2021. https://censusnepal.cbs.gov.np/results/downloads/census-dataset. Accessed 28 Dec 2024.
- 14.Central Bureau of Statistics. Population monograph of Nepal volume II. 2014. https://nepal.unfpa.org/sites/default/files/pub-pdf/Population%20Monograph%20V02.pdf. Accessed 9 Nov 2023.
- 15.Asian Development Bank, Nepal Resident Mission. Nepal: Macroeconomic update. 2023. https://www.adb.org/sites/default/files/institutional-document/912721/nepal-macroeconomic-update-202309.pdf. Accessed 30 Apr 2024.
- 16.Speck S, Müller-Böker U. Population ageing and family change: older people’s perceptions of current changes in family composition in rural Nepal. Eur Bull Himal Res. 2020;55:7–37. 10.4000/ebhr.234. [Google Scholar]
- 17.Speck S, Müller-Böker U. Glimpses on emerging alternative living and care arrangements for elderly people in Nepal. J Soc Prot. 2021;2(01):1–18. 10.3126/jsp.v2i01.43772. [Google Scholar]
- 18.Thapa BK, Kattel SP. Impact of modernization on family and marriage system of Nepal. World Wide J Multidiscip Res Dev. 2019. 10.15171/ijhpm.2018.121. [Google Scholar]
- 19.Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. 10.1016/S0140-6736(20)30925-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Institute for Health Metrics and Evaluation. GBD Compare. 2020. http://vizhub.healthdata.org/gbd-compare. Accessed 14 Jan 2024.
- 21.Statisca. Nepal: projected number of people with dementia 2050. Statista. 2014 https://www.statista.com/statistics/738334/nepal-projected-number-of-people-with-dementia/. Accessed 21 Feb 2024.
- 22.Thapa DK, Visentin DC, Kornhaber R, Cleary M. Migration of adult children and quality of life of older parents left-behind in Nepal. Geriatr Gerontol Int. 2020;20(11):1061–6. 10.1111/ggi.14047. [DOI] [PubMed] [Google Scholar]
- 23.Upadhyay C. Elderly care: policy initiatives and older parents’ perception in Nepali society. Rupantaran : A Multidisciplinary Journal. 2021. https://www.academia.edu/96105190/Elderly_Care_Policy_Initiatives_and_Older_Parents_Perception_in_Nepali_Society
- 24.Khanal P, Rai S, Chalise HN. Children’s migration and its effect on elderly people: A study at old age homes in Kathmandu. 2018;1(1)
- 25.Thapa R, Bam K, Tiwari P, Sinha TK, Dahal S. Implementing federalism in the health system of Nepal: opportunities and challenges. Int J Health Policy Manag. 2018;8(4):195–8. 10.15171/ijhpm.2018.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Khanal GN, Bharadwaj B, Upadhyay N, Bhattarai T, Dahal M, Khatri RB. Evaluation of the national health insurance program of Nepal: are political promises translated into actions? Health Res Policy Syst. 2023;21(1):7. 10.1186/s12961-022-00952-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Nepal Law Commission. Constitution of Nepal. 2015. https://lawcommission.gov.np/en/wp-content/uploads/2021/01/Constitution-of-Nepal.pdf. Accessed 15 May 2024.
- 28.Nepal Law Commission. Health Insurance Act 2017. 2017. https://hib.gov.np/public/uploads/shares/notice_hib/health-insurance-act-2074.pdf. Accessed 15 May 2024.
- 29.Health Insurance Board. Brief annual report FY75–76 health insurance board. 2019. https://nhrc.gov.np/wp-content/uploads/2022/02/BoD-Report-Book-includ-Cover-mail-6_compressed.pdf. Accessed 1 Mar 2024.
- 30.Ministry of Finance. Economic survey (Unofficial Translation).2021. https://www.mof.gov.np/uploads/document/file/1633341980_Economic%20Survey%20(Engslish)%202020-21.pdf. Accessed 30 Apr 2024.
- 31.Shrestha L. Geriatric health in Nepal. 2014. https://ifa.ngo/wp-content/uploads/2013/03/IFA-presentation-2014.pdf. Accessed 31 Oct 2023.
- 32.Government of Nepal. Geriatric health service strategy. 2022. https://www.nhssp.org.np/Resources/GESI/Geriatric%20health%20service%20strategy%20English%20version%20-%202022.pdf. Accessed 1 Feb 2024.
- 33.Shrestha L. Geriatric health in Nepal: concerns and experience. Nepal Med Coll J NMCJ. 2013;15(2):148–52. [PubMed] [Google Scholar]
- 34.Shrestha S, Aro AR, Shrestha B, Thapa S. Elderly care in Nepal: are existing health and community support systems enough. SAGE Open Med. 2021;9:20503121211066380. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Acharya A, Adhikari R, Bhusal N. Pattern of health seeking behavior in elderly population. The Healer. 2022;3(2):7–7. [Google Scholar]
- 36.Poudel M, Ojha A, Thapa J, Yadav DK, Sah RB, Chakravartty A, et al. Morbidities, health problems, health care seeking and utilization behaviour among elderly residing on urban areas of eastern Nepal: a cross-sectional study. PLoS ONE. 2022;17(9): e0273101. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.National Human Rights Commission, Nepal. Monitoring synopsis of the senior citizens care centers. 2019. https://nhrcnepal.org/uploads/publication/Monitoring_Synopsis_of_the_Senior_Citizens_Care_Centers_2019-min.pdf. Accessed 8 Jan 2024.
- 38.Shrestha I, Dahal BP. Country Report Nepal, High-level meeting on the Regional Review of the Madrid International Plan of Action on Ageing (MIPAA). 2007. https://www.un.org/esa/socdev/ageing/documents/review_map/Nepal.pdf. Accessed 3 May 2024.
- 39.Ministry of Finance. Public announcement of income-expenditure details of fiscal year 2021/22. 2020. https://www.mof.gov.np/site/publication-detail/3064. Accessed 3 May 2024.
- 40.Ministry of Finance. Budget speech of fiscal year 2023/24. 2023. https://www.mof.gov.np/uploads/document/file/1688901593_TC%20-%20EDIT%20-%20FY2023_24%20Budget%20Speech_R2.pdf. Accessed 3 May 2024.
Associated Data
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Data Availability Statement
No datasets were generated or analysed during the current study.