Health System and Health System Strengthening in Nepal Dr BR Marasini, MBBS, MPH Senior Health...

Health System and Health System Strengthening in Nepal

Dr BR Marasini, MBBS, MPH

Senior Health Administrator

Ministry of Health and Population

Background

• The health system in Nepal is 122 years old and based on primary health care approach

• Very different diseases in plain southern part and high mountain north parts

• Health services are mixed –both government and non-government (for profit and not for profit)

The Health Care Systems

• Allopathic or modern medicine

• Traditional medicine – Ayurveda and Amchi

• Homeopathy

• Unani

• Other complimentary systems

Health Service Delivery

• Community based health services and interventions- immunization (mobile clinics -every month), Vitamin A and albendazole distribution (twice a year) & primary health care out reach clinics (mobile clinics- every month) from local health facility

• Female community health volunteers and mothers groups

• Hospital and facility based services-general, specialized and mobile

Health Service Organization

• Sub health post

• Health post

• Primary health centre

• District hospital

• General hospitals- zonal and regional headquarters

• National hospitals

• NGO and Private health institutions

Health Governance

• Ministry of Health and Population• Three Departments - Health Services,

Drug Administration and Ayurveda• Regulatory bodies- Medical Council,

Nursing Council etc• Five Regional Health Directorates• 75 District Public/Health Offices• Facility level health/hospital management

committees

Human Resource for Health

• 18 medical and five dental colleges• Nursing colleges• Pharmacy colleges• Allied health professional colleges• 80% positions of the public health facilities

are now fulfilled• Fulfillment of vacant positions health

personnel also initiated through local initiative

Health Financing

• Government of Nepal

• Donors

• Local bodies –increasing trend for last two years

• International non-government organizations

• 7.2% budget in health sector in current financial year

Infrastructure Development

• Building of 700 (apprx.) health facilities is under construction (new or expansion or major renovation)

• More equipments and logistic support with better timely maintenance initiated

• The main focus of infrastructure development is maternity services

Major Policies and Initiatives

• Health sector reform • Sector wide approach• Millennium development goal• Poverty reduction• Social inclusion • Nepal health partnership compact and

international health partnership plus• Global health initiative• Health System Funding Platform

Major Programme Initiatives in Health Sector

• Institutional delivery declared free with maternity incentive scheme

• Introduction of Free Health Care (service charges abolished & essential drugs provided free)

• Surgery of uterine prolapse • Cash support to poor patients suffering from

cancer, heart disease, chronic kidney disease, Alzheimer's disease & Parkinson's disease

Major Health Programme----

• Compulsory two year posting of physicians out side Kathmandu completing MBBS course in government scholarship

• Community based neonatal care

• Nutrition supplementation programme

Health Outcomes and Progress Towards Health Sector MDGs-1

Indicators 1990 2001 2006 2009 2015MDG-1: Nutritional stunting (height for age) %

57 48 42.7 30

MDG-4:Neonatal mortality rate/1000 live births

50 39 33 20 16

MDG-4: Infant mortality rate/1000 live births

108 79 48 41 34

Health Outcomes and Progress Towards Health Sector MDGs-2

Indicators 1990 2001 2006 2009 2015

MDG-4: Under five Child mortality rate/1000 live births

161.6 91 61 50 54

MDG-5: Maternal mortality ratio/100000 live births

515 539 (1996)

281 229 134

Total Fertility Rate 4.6 4.1 3.1 2.9 2.4

Health Outcomes and Progress Towards Health Sector MDGs-3

Indicators 1990 2001 2006 2009 2015

MDG-6: HIV prevalence in 15-49 year/100,000 population

- 290 490 (2007)

390 (2009)

Halt & reverse

MDG-6: Tuberculosis prevalence rate/ 100,000 population

460 310 280 Halt & reverse

MDG-6: Malaria prevalence rate/100,000 population at risk

196 52 25 Halt & reverse

Core Intermediate Health IndicatorsIndicators Current status Target for

2015Remarks

Contraceptive prevalence rate

49.6% (any) 45.1% (modern -2009)

67%

Skilled Birth attendance rate

28.8% (2009) 60% Institutional 24.4%

Immunization rate –DPT3

83% (HMIS-2010)

100%

Knowledge on Prevention of HIV Infection (at least one method)

Female-58.3%

Male- 81%

(NDHS-2006)

Female-100%

Male-100%

Health Sector Budget and Expenditure by Year

Financial year Total Health Budget

(NRs billions)

Health sector budget as a percent of national budget

Actual expenditure rate as a percent of

planned budget

2004-05 6.5 5.86 70.0

2005-06 7.5 5.95 76.5

2006-07 9.2 6.40 81.0

2007-08 12.2 7.15 81.0

2008-09 14.9 6.33 84.9

2009-10 17.8 6.24 90.0

Challenges

• Climate change and health

• Equity, accessibility, quality and coverage of essential health care services

• Nutrition

• Inter agency coordination

• Sustainability of health programme

• Reemerging and new emerging diseases

Challenges

• Deployment and retention of HRH in remote and rural areas

• Increase in non-communicable diseases

Thanking you for your kind patience