The State of Urogynecology Services in Nepal

The International Conference on Population and Development (ICPD) in 1994 gave an important impetus to Reproductive Rights and Reproductive health. It made it a goal for the world government to have universal access to the full range of high-quality reproductive health services by the year 2015. Nepal has committed to ICPD resolution and denounced all forms of discrimination against women (1). Pelvic floor disorders have been classified as Reproductive Health Morbidities, and particularly Pelvic Organ prolapse has been identified as a public health problem. It is one of the causes of maternal morbidity and gender discrimination among females. One of the studies identified about half a million women needing surgical treatment of prolapse immediately; however, trained doctors were lacking (2). The prevalence of other pelvic disorders is also expected to be high and awaiting more extensive epidemiological studies (3).

The government of Nepal has prioritized Pelvic Organ Prolapse and has created funds to provide free POP surgery for needy women. This has drawn criticism for deviating from the fundamental approach of proper assessment of Pelvic Floor Disorders and neglecting conservative management wherever applicable. The Nepal Society of Obstetrics and Gynecology emphasized the development of Urogynecology as a Subspeciality by forming the Urogynecology Subcommittee in 2014. BP Koirala Institute of Health Sciences, with the support of the FIUGA and the International Urogynecology Association, developed the curriculum and has started a two-year Urogynecology subspeciality program to train the regional human resources to treat urogynecological disorders (4). The program is a benchmark not only for Nepal but also for South Asia. The Government of Nepal has also revisited the strategies and now has more priorities for screening for Pelvic floor disorders and making a proper referral. Midlevel providers training manual has been in practice who are often the first contact for clients. This is expected to spread good community awareness as well as make proper referrals and encourage follow-up. District hospitals are expected to provide secondary-level services, and academic institutions and central hospitals are expected to provide services to more complex clients and manage the referrals. We are far from these objectives being met. More efforts and planning are needed, including proper infrastructure, adequate provision of trained human resources, including specialized gynecologists, and quality health care services accessible to all Nepalese women. Only a single Urogynecology program in the country will not be sufficient to cater to the needs of the country. This is considered the beginning, but more organized, sustained effort is expected from the Government and other stakeholders to minimize morbidities and improve the quality of life of Nepali women.

References

1. UNFPA Nepal: Health Related quality of life of women suffering from Pelvic Organ Prolapse: 2013
2. UNFPA Nepal: Study on selected reproductive health morbidities among women attending reproductive health camps in Nepal: 2016
3. https://www.fiuga.org/index.php/nepal-project/
4. M Saifuddin, Regmi MC : Pelvic Floor Disorder / Obstetric Fistula Obstetrics and Gynecology Clinics of North America,2022,