Health Insurance Coverage Remains Below 20% Among Working-Age Adults Despite Improved Access to Healthcare: Survey

Health insurance coverage in Nepal remains limited despite steady improvements in access to healthcare services, electricity, telecommunications and digital connectivity, according to the latest National Multidimensional Indicator Survey released by the National Statistics Office (NSO).

The survey shows that only 17.8 percent of women and 19.6 percent of men aged 15–49 are enrolled in health insurance schemes, highlighting a persistent gap in financial risk protection even as institutional healthcare utilisation continues to rise.

The NSO on Sunday made public the findings of the Nepal Multidimensional Indicator Survey 2081/82 (2024/25), the fourth such nationwide survey conducted to generate nationally and provincially comparable data to support policy planning, monitoring and evaluation.

Healthcare Access Improves, Outcomes Vary By Region

According to the report, infant mortality stands at 27 deaths per 1,000 live births, while under-five mortality is 31 per 1,000 live births. Neonatal mortality is recorded at 17 per 1,000 live births.

Provincial disparities remain stark. Sudurpaschim Province recorded the highest neonatal mortality rate at 26 per 1,000 live births, while Bagamati Province reported the lowest at 10. Infant and under-five mortality rates were also highest in Sudurpaschim and lowest in Bagamati and Gandaki provinces.

Among women who gave birth in the two years preceding the survey, 85 percent received at least four antenatal care visits. Institutional deliveries accounted for 90.5 percent of births, while 91.4 percent were attended by skilled birth attendants. Caesarean section deliveries stood at 25.3 percent.

Fertility Trends And Family Planning

Nepal’s total fertility rate has declined to 1.9 live births per woman. The adolescent birth rate stands at 48 live births per 1,000 girls aged 15–19, while 11.2 percent of women aged 20–24 reported giving birth before the age of 18.

Among currently married women aged 15–49, 35 percent reported using some form of family planning, with 55.2 percent expressing satisfaction with modern family planning services.

Infrastructure, Digital Access And Consumer Readiness

The survey indicates near-universal access to electricity, with 96.7 percent of households connected nationwide.

Telephone access—either fixed or mobile—has reached 95.5 percent of households, while 82 percent of households reported using internet-enabled devices, reflecting growing digital penetration and potential for digital service delivery, including fintech and insurtech solutions.

Nutrition And Education Indicators

Among children under five, 24.3 percent are underweight and 31.5 percent are stunted, while 7.6 percent are wasted and 2.6 percent overweight. Stunting is highest in Madhes Province and lowest in Bagamati Province.

Participation in early childhood education stands at 57.9 percent for children aged 36–59 months. School exclusion rates remain low at the primary level but rise to 13.2 percent at the secondary level (grades 9–12).

Birth registration coverage for children under five has reached 85.4 percent, with Karnali Province reporting the highest rate at 95.8 percent and Koshi Province the lowest at 78.4 percent.

Water, Sanitation And Public Health Risks

While 98.2 percent of the population uses improved drinking water sources, bacterial contamination was detected in drinking water of 60.4 percent of households. Improved sanitation coverage stands at 92.4 percent, and handwashing facilities are available in 86.4 percent of households.

Policy Relevance

The NSO said the survey provides a critical statistical foundation for federal and provincial planning, sustainable development goal (SDG) monitoring, and multidimensional poverty measurement.

The survey covered 12,960 households across 540 enumeration areas nationwide, collecting data on health, nutrition, education, mental health and water quality among women, men, children and adolescents.