Disasters such as flood, landslide have been experienced every year in Nepal.

According to UNICEF's study, Nepal has more than 90% under 1-year children were found suffering from Iron deficiency Anemia. Likewise 70% lactating mothers were found suffering from Iron deficiency Anemia. About 50% of under 5 years children were found malnourished and 11% are severely malnourished among them.

According to "The state of the world's Children 1998" the situation of safe water supply is available only for 60% of the population in Nepal.

Once almost controlled Malaria is now reemerging alarmingly year by year.

HIV/AIDS, CHD, Road Accidents are newly increasing diseases in Nepal. It is been estimated that there will be 2/3rd of HIV/AIDS cases load will be found in developing countries.

Unmeet need still high that is of great concern for family planning. Girls and women are being denied the same rights and privileges as their brother at home at work in the classroom or the clinic.

Management decisions will always involve both art and science; the desire is to increase the factual content of decision.

Now equity has been translated into age and sex group like mother and child. But it is not found to reach beyond topographically, deprived group of people or nationalities. So, there is need to redefine the equity on the basis of sociologically, economically not only technically. We have never succeed in applying the available knowledge to every country and every sector of the population within a country, The difference in morbidity and mortality rates between black and white population of united states as well a the disease differences between market economics and developing areas of the world make a point on a daily basis. WHO has concluded that there is wide variation between indigenous people and Non indigenous people within a country.

Because of social evolution we are facing complexity in terms of life style, violence, crime, accidents. To explore the proper way to breakthrough of a problem, behavioral science could be a most helpful discipline for Public Health.

There is also increasing trend of HIV/AIDS and STD. Now there is raising ethical question regarding privacy and confidentiality of a clients and patients. But these confidential group of people are free to contact with vulnerable group is a great concern of people's health or public health.

Problem of irrational use of drugs is now so serious that it a big challenge for Public health and Primary Health Care. Sir Oliver Wendell Dolmen proves it with this saying. It is as " If all the medicines in the world were dumped into the sea it would be much more better for humans, but so much worse for the fish."

According to CBS (1997) Literacy Rate in Nepal is 52.6% and Female Literacy Rate is only 37.8%. Girl students enrolled in school are only 39.86% and also their school-leaving rate is still high.

This concept was highlighted during Bamako (1984). Nepal has made a new Decentralization Act (1999). But decentralization itself is not goal it is only the means to achieve goal. Decentralization leads to local allocation of funds but curative care is generally valued more than preventive. Public health priorities and equity need to be protected.

There are so many cultural practices that harm health. For example Open defecation, Cutting Umbilicus with rusted blade or put cowdung over it etc.

We can take early marriage of girl child as a cultural stigma.

To measure as low the birth of a girl child may lead to neglect care of mother during delivery and lactation that is harmful for both mother and child for health.

Beliefs are still prevailed such as giving a leafy vegetable to mother or child can cause diarrhea during lactation.

Environmental Degradation: Refugees creating social, economic, cultural and health problem. E.g. Bhutanese Refugee in Nepal.

Lack of political commitment.

Dependency

	Donors are carrying vertically their program as selective approach. e.g. Vita. A. Program.
	Utilization of Political structure.

Lack of promoting and protecting Ethno-medicine.

Rational application of Existing knowledge.

Ethical Safeguards.

	Structure and scheme of Globalization.
	War and use of Biological, Chemical weapons.
	Structural Adjustment Program (SAP).

H. Philosophical Dimension.

Defining the boundaries of Public Health.

Redefining the boundaries with the inclusion of a range of new problems places new challenges on the use of public health approaches.

Improving the definition of Public Health Problems.

It is been felt that public health workers of today need to be involved in the poverty alleviation activities, education, attempts at empowerment and safety nets of various kinds.

Changing Public Perception of Public Health.

Fatalism is still the norm for large parts of the population in both the United States and the rest of the world.

The challenge of optimism.

New risks are emerging through new technology. Developed war, violence are found everywhere in the world. Social capitals are being dissolved and poor see no hope. Public Health leader must be in the midst and provide balance. It should be clear that those things beyond our control but to be judged on how we respond to what could be altered.

Predicting the predictable future.

Civilization is finally measured by how people treat each other not by the splendor of corporate office or the texture of a politician's suit. As a public health professional, we simply failed to predict the future in an appropriate way.

Protecting the future.

Together with other group, we must conscious of the impact of our actions on future populations, their numbers as well as their attributes on the physical environment including the ozone layer, rain forest preservation, acid rain, bio-diversity. Now it is necessary to define the common enemy. Therefore, public health personals should come up on the basis of national and local situation with the leadership of WHO, UNICEF and UN agencies. Also, needed to intensify their effort to disease control programs, population programs, environmental programs, education program, anti- poverty programs etc. Thus, the challenges to Primary Health Care present in the way of Health for All need to be explored multi-dimensionally as mentioned above.

©2002. Nawaraj Subba, MPH.

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