Ministry of Healthcare & Nutrition

Broader Approaches to Health

Strategic Frame Work for Health Development

Peoples’ Needs

Changing /developing world

Continuing /emerging /evolving

problems Available resources

Challenges

• Health Services• Human Resources for Health• Health Sector Management and Stewardship• Tsunami and Conflict-affected Areas• Optimizing the Private Sector Contribution• Focusing on Vulnerable Groups• Inter-sectoral Collaboration• Demographic and Epidemiological Transition • Health Financing and Resource Allocation

0

0.5

1

1.5

2

2.5

1940 1943 1946 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000

Year

% S

har

e o

f G

DP

MOH Health Share of GDP Nominal (R+C) Exp.

* MOH Health Expenditure combines Recurrent & Capital Expenditures , 2003 is based on Estimates

Figure 01

Health Financing and Resource Allocation1939 to 2003

Health financing and resource allocation

2005 2006 2007 2008 2009

Total government expenditure on health (Rs bn)

47 63 75 88 103

As a percentage of GDP 1.9 2.2 2.3 2.4 2.5

As a percentage of total government expenditure

5.7 5.7 5.8 6.2 7.2

Recurrent expenditure as a % of total govt. health expenditure

80 74 76 69 66

Per Capita Exp (Rs) 2,311 3,228(30 US$)

3,824 4,469 5,231

Source: MOFP

Investment in 2006National level Rs. Mn % of Total

Curative services 28,022 78.0

Preventive services 2,758 08.0

Nutrition 870 02.0

Health sector training 2,154 06.0

Health Research 118 0.6

Estate health 55 0.2

General health services 1,174 3.0

Budget proposals 2,027

Provincial levelProvincial Councils 19,777

Source: MOFP

Capital Recurrent %

Foreign Aid 5,636 15.0

Foreign Aid Related Domestic Funding

1,620 4.4

Domestic Funding

5,151 24,811 80.6

Total 12,357 24,811 100.0

Method of financing-2006

Source: MOFP

Government Policy

“I consider it my responsibility to preserve the freehealth service and safeguard the right of every citizen for the benefits there under. In this regard immediate action will be taken to enhance theseservices both qualitatively and quantitativelythrough increased budgetary provisions.”

ENSURING GOOD HEALTH

Strategic Framework for Health Development

Strengthen Individual, Household and Community Actions for Health

Improve Health Services Delivery and Health Actions

ImproveHuman Resource

Development &

Management

Improve Health Financing,

Resource Allocation & Utilization

StrengthenStewardship & Management

Functions

Inter-relationships among the Five Strategic Objectives

STRATEGIC OBJECTIVE 1 : TO IMPROVE COMPREHENSIVE HEALTH SERVICES DELIVERY AND HEALTH ACTIONS, WHICH REDUCE THE DISEASE BURDEN AND PROMOTE HEALTH

Immediate Objectives:

• To rationalize and strengthen the network of health facilities and services (that includes allopathic and indigenous as well as public and private services)

• To introduce technology assessment at the central MoH and access appropriate technologies

• To ensure adequate drugs, other medical supplies and equipment are in place

• To enhance the quality of service delivery (assuring responsiveness to needs)

• To reduce priority diseases/conditions through strategic interventions

• To improve the health status of vulnerable populations (including marginalized and underprivileged groups)

• To promote inter-sectoral coordination for disease control and prevention

• To increase public confidence and patient/client satisfaction in the health services.

STRATEGIC OBJECTIVE 2 :TO EMPOWER COMMUNITY TOWARDS MORE ACTIVE PARTICIPATION IN MAINTAINING AND PROMOTING THEIR HEALTH

Immediate Objectives:

• To monitor public perception of their needs and of the health system towards serving as input for improvement.

• To improve participation of civil society and non-governmental organizations in promoting behavioural and lifestyle changes.

• To improve public awareness of their rights, responsibilities and options for care as well as to establish an ombudsman system.

STRATEGIC OBJECTIVE 3:TO IMPROVE THE MANAGEMENT OF HUMAN RESOURCES FOR HEALTH

Immediate Objectives:• To improve the technical and managerial

competencies of health staff in both curative and preventive sectors.

• To rationalize the development and management of human resources for health.

• To improve the performance of human resources in the health sector.

STRATEGIC OBJECTIVE 4 :TO IMPROVE HEALTH FINANCE MOBILIZATION, ALLOCATION AND UTILIZATION

Immediate Objectives:• To increase government financial support at all levels to strengthen the financial

sustainability of the health sector

• To improve allocative efficiency and equity

• To identify and test alternative financing mechanisms (including various forms of health insurance, possible fees, co-payment, earmarked taxes and others) with a view towards national implementation. Adopt best option.

• To make optimal use of financial resources (through cost-effective strategies that will be identified, adopted and re-evaluated for the management of priority diseases/conditions).

• To optimise private sector contribution, initially establishing an information-sharing mechanism to include reporting on service use and quality as well as financing.

• To strengthen financial management (including capacity, authority, autonomy, monitoring and supervision, and use of available resources).

STRATEGIC OBJECTIVE 5 :TO STRENGTHEN STEWARDSHIP AND MANAGEMENT FUNCTIONS OF THE HEALTH SYSTEM

Immediate Objectives:

• To institutionalise effective mechanisms for policy development within existing units.

• To enhance efficiency, effectiveness and accountability of the MoH and decentralised units,

autonomy in management • To strengthen managerial performance at national

and decentralised levels.

STRATEGIC OBJECTIVE 5 : contd…TO STRENGTHEN STEWARDSHIP AND MANAGEMENT FUNCTIONS OF THE HEALTH SYSTEM

Immediate Objectives:

• To strengthen and introduce monitoring and evaluation of performance, which are related to health outcomes, in all health institutions.

• To strengthen the system for regulating the services of public and private providers.

• To strengthen health information system.

• To strengthen capacity in health research.