This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Review of current health service planning in Nepal from province to local levelMohammad Aslam Shaiekh
This document summarizes a review of health service planning in Nepal from the provincial to local levels. It describes the new federal system of government in Nepal with three tiers (federal, provincial, local). At the local level in Pokhara Metropolitan City, the findings show 41 health facilities serving 479,000 people. A top-down and bottom-up approach is used for health program and budget planning. At the provincial level, the Gandaki Province health directorate provides technical support to 11 districts. The challenges of implementing health planning under federalism include coordination between levels of government and building capacity of newly elected local bodies. Recommendations focus on collaboration, clarifying roles, training, and strengthening infrastructure and resources at the
Early Warning And Reporting System (EWARS) in NepalPublic Health
The Early Warning and Reporting System (EWARS) is a hospital-based sentinel surveillance system in Nepal that monitors six priority infectious diseases. EWARS was established in 1997 with 8 sentinel sites and has since expanded to 118 sites including central, provincial, and district hospitals. The main objectives of EWARS are to strengthen disease information flow and facilitate prompt outbreak response. Sentinel sites report disease data weekly or immediately to the Epidemiology and Disease Control Division, which analyzes trends, provides feedback, and coordinates rapid response teams if an outbreak is detected.
Health Insurance in Nepal aims to ensure access to quality healthcare without financial hardship. The program began in 2016 and has since expanded to 49 districts. Members pay an annual premium of NRs. 2500-3500 for a family of 5. Benefits include coverage of up to NRs. 100,000 per family per year. Stakeholders provide both support and criticisms, citing issues around awareness, enrollment rates, benefit packages, and quality of care. Expanding the program, improving facilities, and addressing concerns will help achieve universal health coverage in Nepal.
Organization Structure of Public Health System in Nepal.
Organization Profile (Structure, Functions, Roles, Responsibilities, ToR): http://bit.ly/HealthsystemsNepal
Organization Structure of Public Health System in Nepal | Health System Nepal | Current Health system of Nepal | Organization Structure of Nepalese Health System | Public Health System | Health Governance System in Nepal |Health Organization Profile | https://publichealthupdate.com |
More updates: https://publichealthupdate.com
The document discusses India's national health policies from 1983 to the present. It provides an overview of key events in India such as the establishment of the Planning Commission in 1950 and the goals and achievements of the National Health Policies of 1983, 2002, and 2017. The current National Health Policy of 2017 aims to achieve universal health coverage and access to affordable healthcare services while strengthening the health system through increased funding, expanded infrastructure and workforce.
National health policy & plan process in nepalAnkita Kunwar
The document outlines key aspects of national health policy and planning in Nepal. It discusses the concept of health policy and its components. It provides an overview of Nepal's national health policy adopted in 1991 and its objectives. It also summarizes the primary objectives and initiatives of Nepal's major five-year plans from the first to ninth plans, highlighting the country's efforts to develop its health system and improve population health over time through primary healthcare expansion, integration of vertical programs, and increasing access to services.
The Nepal Health Sector Strategy (NHSS) 2015-2020 provides strategic guidance for the health sector over five years. Its goal is to improve health status through accountable and equitable health services. NHSS outlines nine outcomes, including rebuilding health systems and improving quality of care. It identifies key outputs needed to achieve each outcome, along with interventions, indicators, targets, data sources, and timelines to monitor progress in strengthening Nepal's health sector.
Healthcare Delivery System in Federal Context of NepalSonali Shah
The document summarizes Nepal's health care system under its new federal democratic republic system. Some key points:
- Nepal transitioned to a federal system in 2015 to reduce disparities between rural and urban areas. Health care is now organized at the federal, provincial and local levels.
- The constitution guarantees citizens the right to free basic health services and emergency care. Health care provision and financing are managed at the federal level according to federal legislation.
- Nepal's health care system includes public, private, traditional and voluntary sectors. It has a primary, secondary and tertiary level referral system with health posts, primary health centers, district/zonal hospitals and central/regional hospitals.
- Key health programs
The National Health Policy was adopted in 1991 in Nepal with the primary objective of extending primary health care services to the rural population. It had 15 components including preventive, promotive, and curative health services. Some key achievements include establishing new sub-health posts and primary health centers in all districts to improve access to basic services. Community participation in health services increased through over 50,000 female community health volunteers. However, some targets around hospital expansion and developing specialized services were not fully realized. Overall the policy helped reduce child mortality but challenges remain around human resource development, management, and inter-sectoral coordination.
1. Health system development concerns how a country organizes its health sector functions including health services, workforce, financing, and policies.
2. Nepal has developed its health system over three historical periods from ancient to modern times, establishing hospitals, clinics, and public health programs at
Nepal Health Sector Program Implementation Plan II (NHSP-IP2)Dip Narayan Thakur
The document summarizes Nepal's Health Sector Implementation Plan II (NHSP-IP II). NHSP-IP II aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and utilization of essential health services. It reviewed achievements and shortcomings of NHSP-IP I and outlined NHSP-IP II's vision, goals, strategies, and financing plans. Key points included reducing morbidity and mortality through accessible, affordable, quality care; addressing sustainability issues in health financing; and achieving greater efficiency through health systems strengthening. Progress was made in areas like immunization and maternal health, but challenges remained around nutrition, non-communicable diseases, and equity gaps.
The current five year plan in Nepal's health services aims to increase rural access to basic primary health services and doctors. It focuses on effective implementation of population control through mother and child health and family planning services. The plan also seeks to develop specialized health services within the country. Key targets include establishing more health posts, primary health care centers, and Ayurvedic dispensaries. It also aims to reduce the total fertility rate and cases of leprosy.
The document summarizes Nepal's health care delivery system in the context of transitioning to a federal system. It describes the three levels of government - federal, provincial, and local - and how health care provision and financing will be organized at each level according to federal legislation. It also provides details on the different levels of Nepal's health care system from primary to tertiary care, and the services provided at each level. Major policies and reforms being implemented to improve the health system in federal Nepal are also mentioned.
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
The Nepal Health Service Act 2053 outlines the framework for governing Nepal's public health services. It establishes health services and employee classifications. Its objectives are to fill vacant health service posts, motivate employees, establish codes of conduct, and provide retirement benefits. The Act has undergone several amendments and contains 11 chapters covering topics like employee conduct, security, punishment and appeals, and miscellaneous provisions. However, some challenges remain such as ineffective performance evaluation and lack of emphasis on research.
The document discusses the health care system in Nepal under its new federal democratic republic system. It provides an introduction to federalism and describes how power is divided between the central, provincial, and local governments in Nepal. It then outlines the major components of Nepal's health system including its structure for health service delivery, governance structure at different levels, and key organizations. It also discusses some of the major health initiatives in Nepal and provides organizational charts and the Public Service Act relating to regulating health institutions.
AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner
This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.
The document presents the key aspects of India's National Health Policy of 2017. The policy was introduced to address the changing health priorities in India and the growing burden of non-communicable diseases. It aims to achieve universal health coverage and increase trust in the public health system by focusing on quality. The policy's objectives include progressively achieving universal health coverage and increasing life expectancy to 70 years by 2025. It proposes increasing public health expenditure to 2.5% of GDP and focuses on preventive healthcare, communicable diseases, mental health, and programs for mothers, children, adolescents and immunization. The conclusion emphasizes developing new vaccines and digital tools to improve healthcare efficiency.
Each year, the OHE sponsors a lecture that explores a timely issue in medicine or health economics. At the 22nd Annual Lecture, the issues and challenges of universal health care coverage in low- and middle-income countries were presented by Professor Anne Mills of the London School of Hygiene and Tropical Medicine.
The audio of this lecture now is available at http://news.ohe.org/2014/08/19/annual-lecture-2014-universal-health-coverage/
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
Universal health coverage means that everyone has access to health care services including preventive, promotive, curative and rehabilitative care when needed at an affordable cost. The key objectives of universal health coverage are to ensure equitable access to quality health services for all, regardless of ability to pay, and provide financial protection so that costs of care do not cause financial hardship. Universal health coverage aims to make health care available, accessible and affordable for entire populations.
This document discusses strategies for achieving whole system change towards universal health coverage through primary healthcare renewal. It outlines that removing user fees, improving drug supply, maintaining health worker motivation, strengthening supervision and the gatekeeping role of primary care facilities requires considering the interlinkages of a system-level intervention. Whole system change to achieve good health at low cost requires effective primary care, fair financing, new health worker roles and payment mechanisms, and essential drug supply. Primary healthcare increases access, manages common health issues, prevents diseases, focuses on the individual and avoids unnecessary care. Universal health coverage aims to ensure all people obtain needed health services without financial hardship and requires raising funds, reducing financial barriers, allocating funds efficiently, meeting priority needs through integrated care
Health Financing for UHC – two sides of the coinHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Universal Health Care: Perceptions, Values, and IssuesRenzo Guinto
From the workshop "Universal Health Care: The First Step to Global Health Equity" held last August 5-9, 2012 in Mumbai, India during the 61st General Assembly March Meeting of the International Federation of Medical Students' Associations (IFMSA). Brought to you by the IFMSA Global Health Equity Initiative (http://www.ifmsa.org/Activities/Initiatives/The-IFMSA-Global-Health-Equity-Initiative).
For more information about the workshop, visit http://www.scribd.com/doc/193822108/Universal-Health-Care-PreGA-Program
Chapter 2 Identifying a Research ProblemJairo Gomez
This chapter discusses identifying a research problem and question. It explains that a research problem is the topic being studied, whether descriptively or experimentally. Good research questions are specific, clear, refer to the problem, note any interventions, and identify participants. The chapter provides examples of research problems and questions and discusses narrowing a topic and developing questions that clarify the research approach.
The health system in Egypt faces challenges as a developing country with a large population of over 83 million people. The medical education system includes 6 years of study plus an internship year to become a doctor. Hospitals are divided into primary, secondary, and tertiary levels, with university hospitals providing free tertiary care. However, the system is strained, with long wait times, fewer hospital beds than other countries, and heavy patient loads. Continuing medical education allows doctors to specialize in areas like internal medicine and plastic surgery.
Application of a test or a procedure to large number of population who have no symptoms of a particular disease for the purpose of determining their likelihood of having the disease.
This document discusses smart governance of pharmaceutical systems within universal health coverage (UHC) frameworks. It notes that governance occurs at the macro, meso, and micro levels and involves regulating many facets of pharmaceutical systems like quality, supply chains, and access. The key challenges of governance are outlined as determining who and what is covered, how to access covered items, costs, quality of delivered items, and out-of-pocket costs. Four essential practices of smart governance are identified as transparency, coherent decision-making structures, consistency and stability, and stakeholder participation with supervision and regulation. The roles of various players like WHO, governments, insurers, and industry are also briefly discussed.
Health financing strategies uhc 27 09 12Vikash Keshri
This document discusses health financing strategies for universal health coverage. It begins by defining universal health coverage and providing historical perspectives. It then discusses the current state of health financing in India, including low public spending, high private out-of-pocket expenditures, and variations between states. The document outlines that achieving universal health coverage requires raising sufficient funds, removing financial barriers, and using resources efficiently. It examines strategies for generating more health resources, utilizing resources effectively to prevent waste, and proposes the key recommendations of India's High Level Expert Group on universalizing access to affordable healthcare.
Presntation by Zorayda E. Leopando, MD, MPH
Professor of Family and Community Medicine University of the Philippines Manila at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012
The document summarizes recommendations from the High Level Expert Group on achieving Universal Health Coverage in India. It discusses expanding health coverage to all citizens through a national health package, increasing public spending on health to 3% of GDP, strengthening primary healthcare and developing norms for facilities at each level of care. It also emphasizes improving human resources for health, community participation, and access to medicines. The overall vision is to ensure equitable access to quality health services for all Indians.
ACHIEVEMENT AND PROGRESS TOWARDS HEALTH RELATED MDGS IN NEPAL (Draft Seminar ...Public Health Update
This is Draft Seminar paper which will present in my class for partial fulfillment of my Syllabus of BPH 8th semester. ''ACHIEVEMENT AND PROGRESS TOWARDS HEALTH RELATED MDGS IN NEPAL''
ACHIEVEMENT AND PROGRESS TOWARDS HEALTH RELATED MDGS IN NEPALPublic Health Update
This document discusses Nepal's progress towards achieving the health-related Millennium Development Goals. It provides an overview of Nepal's efforts to support the goals and current data on key health indicators related to reducing child mortality, improving maternal health, and combating diseases like HIV/AIDS, malaria, and tuberculosis. While Nepal has faced challenges from political instability, it has exceeded targets for reducing child mortality and is on track to meet most health goals. The document recommends continuing efforts to fully achieve all remaining targets and integrate health programs with local governance to support sustainable development.
The document discusses health services and primary health care in Egypt. It provides background on the Ministry of Health and Population, which was established in 1936. It outlines Egypt's health system, which includes primary, secondary, and tertiary levels of care provided through public health units and hospitals. The document also discusses health insurance in Egypt, challenges in the health system, and strategic plans for health sector reform focusing on infrastructure development and improving human resources. It defines primary health care and reviews its principles, approaches like GOBI-FFF, essential services, and role in Egypt through primary health units. Criteria for effective primary health care include coordination, community participation, customer satisfaction, and monitoring and evaluation.
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
The National Health Policy 2017 aims to raise public health expenditure to 2.5% of GDP to provide comprehensive primary health care through 'Health and Wellness Centers'. It envisions a larger package of assured primary care that includes services for non-communicable diseases, geriatrics, mental health, and palliative care. The policy also looks to improve regulatory standards for quality healthcare and reform regulatory systems to promote domestic manufacturing of drugs and devices as well as medical education.
Localization of Universal Health Coverage for Equitable Health Outcomes in NepalDeepak Karki
Presentation entitled "Localization of Universal Health Coverage for Equitable Health Outcomes in Nepal" by Dr Shiva Raj Adhikari on the 18th Anniversary of Nepalt Health Economics Association.
Indian Healthcare - Transitional Shift Towards Sustainable & Mobile Care Bhavik Doshi
The Indian Healthcare sector constitutes mainly of hospitals, pharmaceuticals, Diagnostics, Insurance and Medical Equipment. The Indian Healthcare industry is growing by a rate of CAGR of 18% and is expected to grow to CAGR of 21% till 2020. This instills the signs of fulfillment of Vision 2020. The major factors influencing are increase in population, shift in demograpics, rise in disposable income, Increase in incedence of lifestyle related disease, rising literacy, tax benefits and rise in insurance coverage. Moeover the public health expenditure in India is very low which give the platform for the development. A holistic approach of "stakeholder relationship management" is required to bring about the trasntional shift in healthcare. New models are required to provide affordable and accessible solutions of healthcare. Public Private Partnership (PPP) model can be a boon to be provided as a solution. India has always been taking a leapfrog in welcoming new technological platforms. A classic example of such leapfrog of technology is transition of telecommunation from landlines to cell phones avoiding the transition to pagers. The introduction of mHealth have already created a revolution in changing the dimension of healthcare & cut-shorted the boundary between doctors and rural patients and have enhanced outreach and coverage.
Ayushman bharat comprehensive primary health care through healthRajeswari Muppidi
- The document discusses the establishment of Health and Wellness Centers (HWCs) in India as part of the Ayushman Bharat program to provide comprehensive primary healthcare through improved public health centers.
- The HWCs aim to expand services, increase access through population enumeration and empanelment, and improve health outcomes through a continuum of care across various levels of the healthcare system. They will work to reduce costs, mitigate disease risks, and ease overcrowding at higher-level facilities.
- Key goals for HWCs include delivering comprehensive preventive, promotive, curative, rehabilitative and palliative care through adequately staffed and equipped centers integrated with mobile units, health promotion, community
The document discusses health systems and financing. It begins by defining a health system as all actors, institutions, and resources that undertake health actions, with the primary intent of improving health. Not all policies that influence health are part of the health system. The document then discusses the goals of health systems, including improving health and ensuring financial contribution. It outlines the key functions of health systems as stewardship, financing, resource generation, and service delivery. The document emphasizes the importance of aligning financing with national health plans to avoid fragmentation. It also discusses concepts of coverage, effectiveness, and factors that influence health outcomes.
Health Care Reform and Harm Reduction: Laura Hanen, Rachel McLean - HRC 2010Harm Reduction Coalition
A presentation by Laura Hanen (NASTAD) and Rachel McLean (California Department of Public Health) on what health care reform means for harm reduction and drug user health. Presented at the Harm Reduction Coalition's 8th National Conference, November 18-21, 2010 in Austin, Texas.
This document proposes a plan to universalize access to quality primary healthcare in India. It discusses some of the key problems in healthcare access such as poor rural facilities, malnutrition, and high infant mortality. It then outlines a proposed biennial door-to-door health inspection program led by teams consisting of doctors, nurses, and municipal representatives. The program would check sanitation, nutrition, and provide basic medical aid and awareness. Implementing such inspections through a dedicated body in each block could help ensure even underprivileged communities receive quality primary care. Challenges to the plan include funding, staffing, and ensuring standards are uniformly applied.
The document discusses India's plan to establish 150,000 Health and Wellness Centres (HWCs) by transforming existing primary health centres to deliver comprehensive primary health care services. The HWCs aim to expand access to services like management of communicable and non-communicable diseases, reproductive care, palliative care, and health promotion. They will operate under principles like population coverage, continuity of care through referrals, community engagement, and use of technology. The success relies on adequate staffing, infrastructure, supplies and financing at HWCs, as well as coordination with secondary and tertiary facilities.
Integrating Financing Schemes to Achieve Universal Coverage in Thailand:Anal...CREHS
1) Thailand achieved universal health care coverage in 2002 by introducing a tax-funded universal coverage scheme that provided insurance to 47 million people not covered by other programs.
2) The universal coverage policy aimed to remove financial barriers to healthcare through tax-funding and shifting costs from out-of-pocket payments to taxes.
3) Analysis found the universal coverage policy improved equity in healthcare use and financial risk protection, with healthcare use becoming more pro-poor and out-of-pocket costs becoming less regressive over time.
NHM Overview of Gov of Bharat. The presentation is very helpful.pritoshitconsultant
The National Health Mission (NHM) aims to provide universal access to equitable, affordable, and quality healthcare services. It seeks to strengthen primary healthcare through initiatives like Health and Wellness Centers and increasing public expenditure on healthcare. The NHM addresses issues such as low access to healthcare, fragmented programs, and shortages in human resources. It focuses on improving healthcare management through measures like community involvement, decentralization, and flexible financing. The ultimate goal is to support states in providing comprehensive and high-quality healthcare that meets people's needs.
Advancing an Action Plan for Community Health Centres in Rural Communitiescachc
The document discusses advancing community health centres (CHCs) in rural communities. It outlines goals of discussing the evolution of CHCs, common challenges and opportunities in rural areas, and initiating discussion on a national rural CHC strategy. Presentations are given by representatives from health centres in Nova Scotia, Ontario, and New York on their centre's history, programs, partnerships, and value in addressing local health needs through a collaborative model. They discuss leveraging community assets, coordinating care, and demonstrating cost savings and improved outcomes through integrated services and addressing social determinants of health.
This document summarizes the presentation "Managing Social transitions for Health: The Experience from South Africa" by Charles Hongoro. It discusses how social changes globally and in South Africa have impacted health outcomes. It outlines the resulting demographic and epidemiological transitions in developing and developed countries. It then describes South Africa's experience in transforming its health system towards universal healthcare coverage, including establishing ward-based primary healthcare teams, integrated school health programs, and district clinical specialist support teams. The goals of universal health coverage in South Africa are also summarized.
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
- Universal health coverage (UHC) aims to ensure all people receive essential health services without financial hardship. This includes equitable access to promotion, prevention, treatment, rehabilitation and palliative care.
- Key challenges to achieving UHC include half the world's population lacking full coverage of essential health services and over 800 million people spending over 10% of household budgets on health care.
- India aims to achieve UHC through programs like Ayushman Bharat which establishes health and wellness centers and provides insurance coverage for secondary and tertiary care through Pradhan Mantri Jan Arogya Yojana (PM-JAY).
Health and wellness center by Dr. Jitender, MD PGIMERYogesh Arora
Health and wellness center is one of the two component of Ayushmann Bharat. HWC ensures comprehensive, quality, and affordable care to be achieved by all.
This document discusses health for all as a goal and outlines steps needed for universal health coverage in India by 2022. It recommends increasing public health expenditure to at least 3% of GDP, developing a national health package with essential services, strengthening human resources for health, and ensuring access to affordable medicines for all through price controls and expanding the essential drugs list. The goal is to make affordable, quality health services accessible to all Indians.
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
Indonesia has a mixed health system with both public and private provision of care. Key achievements include increased life expectancy and reductions in communicable disease rates. However, challenges remain such as the dual burden of disease, natural disasters, weak health information systems, and high out-of-pocket expenditures. Future prospects include expanding the use of telemedicine, incentivizing an even workforce distribution, and passing more legislation to clarify the health system framework.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
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SOAP stands for Subjective, Objective, Assessment, and Plan. This structured method of documentation is used widely in healthcare settings to ensure consistent and clear communication among healthcare providers. Each component of a SOAP note serves a specific purpose:
Subjective (S):
This section captures the patient's narrative, including their chief complaint, history of present illness (HPI), past medical history (PMH), family history (FH), social history (SH), and review of systems (ROS). It reflects the patient's perspective and is crucial for understanding their condition and concerns.
Objective (O):
The objective section includes measurable and observable data collected during the physical examination and diagnostic tests. This might involve vital signs, laboratory results, imaging studies, and physical exam findings. Objectivity is key to providing a factual basis for the assessment.
Assessment (A):
In the assessment section, the healthcare provider synthesizes the subjective and objective data to formulate a diagnosis or differential diagnoses. This analysis helps in understanding the patient's condition and guiding the treatment plan.
Plan (P):
The plan outlines the course of action, including treatment strategies, medications, diagnostic tests, patient education, and follow-up appointments. It provides a roadmap for managing the patient's condition and achieving desired health outcomes.
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and monitoring and assessing health trends.
WHO guidelines on Nutrition:
1. Guideline: iron and folic acid supplementation in menstruating women
2. Guideline: iron supplementation in preschool and school-age children
3. Guideline: Neonatal vitamin A supplementation
4. Guideline: Vitamin A supplementation during pregnancy for reducing the risk of mother-tochild transmission of HIV
5. Guideline: Vitamin A supplementation for infants 1-5 months of age
6. Guideline: Vitamin A supplementation in postpartum women
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2. Presentation by
Deepak Kumar Karki, General Secretary, NHEA
Devi Prasai, Vice-President, NEHA
Shiva Raj Adhikari, Member, NHEA
3. For Today
Universal Health Coverage (UHC):
Progress So Far and Way Forward in Nepal
4. What is Universal Health Coverage?
Universal health coverage means
that every person, everywhere,
has access to quality health care
without suffering financial hardship.
5. Why Now? (1)
Health is a human right and a
cornerstone of sustainable
development and global
security
Universal health coverage
changes the way that health
care is financed and delivered –
so it is more equitable and
more effective
6. Why Now? (2)
Because Nobody should go Bankrupt when They Get Sick
Because UHC is Attainable
Because UHC can Stop the World’s Biggest Killers
Because Health Transforms Communities, Economics and
Nations
Because Health is a Right, Not a Privilege
7. Background of UHC
Human dignity
•Recognizes that inequalities
in access to treatment or
gross disparities in health
outcomes creates indignity
Human security
•Recognizes that forced
payments for
healthcare are a source
of insecurity
Solidarity
• Implies that the burden
of funding healthcare
be distributed fairly,
and that the better-off
should assist the worst-off.
8. Taking the Note
• United Nations GA/67 Session Global Health and Foreign Policy
Adopted on 12 December 2014
• World Health Report 2010, entitled “Health systems financing:
the path to universal coverage”
• Social Protection Floor Initiative endorsed by the United Nations
Chief Executives Board for Coordination in April 2009
• Mexico City Political Declaration on Universal Health Coverage,
adopted on 2 April 2012
• Bangkok Statement on Universal Health Coverage, adopted at the
Prince Mahidol Award Conference on 28 January 2012
• Tunis Declaration on Value for Money, Sustainability and
Accountability in the Health Sector, adopted on 5 July 2012
9. Why UHC?
As a means to achieve
better health or poverty
reduction or sustainable
development outcomes
Equity in outcomes or
opportunities or risk
protection are important as
ends in themselves
11. Requirements in measuring UHC
1. Measures of ends
• Indicators that assess the extent of UHC attainment across
countries in comparable and consistent manner to inform
policy and research
• To assess relative performance
• To assess improvements
• To help identify critical factors
2. Measures of means
• Indicators that assess critical factors that enable or prevent
attainment of UHC
• E.g. Public financing, risk-pooling, etc.
12. Definition
“Every citizen will have access to and utilization of
highest attainable standard of services without
financial difficulties”. WHO
Every citizen will have
access to and
utilization
Population
Coverage
highest attainable
standard of services
Service coverage
with quality
Without
financial
difficulty
Financial
coverage
14. What services do we include?
• Cost effective.
• Addresses the major burden of disease
• Serves the larger population.
• Improve health of poor and disadvantaged
• Ensuring the right of the citizen
• Availability of resource (fiscal space)
15. Including service may reduce the population coverage
of other services
90%90%90%
54%54%54%54%54%
Ensure the additional resource for added services
30%30%30%30%30%30%30%30%30%
3 services
5 services
9 services
Options 3
Options 2
Options 3
16. Adding service increases level of
financial protection
Out of Pocket
expenditure 74%
Hotchkiss at al, 1998
9 services
Out of Pocket
expenditure 62.5%
Prasai et al, 2006
Adding
CB IMCI,
10 services
Out of Pocket
expenditure 60 %
Shrestha et al,2011
Adding
4 more
services
13
1996
1999/2000
2006-08
17. Adding service
Before NHSP Included services in
NHSP 1
Included services in NHSP 2
Reproductive Health -Medical safe abortion
-UP(Prevention and M.
Child Health CB IMCI -CB Nutrition,
- CB newborn care
CD
NCD
disease control
-CB mental health Program
-Health promotion NCD
-Oral
-Eye Care
-Rehabilitation of Disabled
-Environmental Health
Curative Care Outpatient care
18. National Free Care Policy
a step towards UHC
Evolution Reforms
December 15, 2006 Declared targeted free care at district hospitals and
PHCC (inpatients and emergency care)
October 8, 2007 Declared the abolishing user fees at HPs/ SHPs
Nationwide and made service free to all
January 16, 2008- Implemented the policy of free to all health post and
sub health post
November 16, 2008 Expanded universal free care to PHCC level
January 15, 2009 -Declared free outpatient care at DHs to the targeted
population nationwide,
-Declared 40 free essential drugs free to all at district
hospitals nation wide
-Declared all essential drugs free to targeted groups
nationwide
19. Service coverage under universal and targeted
free are
Service covered All people Targeted groups
Outpatient care up to
district hospital
X X
Inpatient care X
Emergency care X
Support services
• Routine laboratory
test
X
•General X Rays X
Referral service X
20. Measuring UHC through three dimensions
Extend to
non-covered
Reduce cost
sharing &
Population: who is covered?
fees
Direct costs: proportion
of the costs covered
Current pooled funds
WHR, 2010
21. Reforms is Needed in the Health
System
• The implementation plan for universal coverage must
improve all dimensions of the health system.
• These dimensions include
• the ‘breadth’ (number of people protected),
• the ‘height’ (proportion of costs covered), and
• the ‘depth’ (range of services and benefits covered),
• as well as those additional factors that influence quality and
safe services that contribute to improving health status
22. Breadth: population covered
• Coverage breadth: 100%
population coverage:
• All population groups and their
families need to be covered:
• Formal sector employees,
informal sector workers, self-employed,
unemployed, students,
pensioners, rural/urban,
rich/poor, dalit/nondalit …
23. Population Coverage: service consultation
and self-reported adequacy of services
Percentage of service consultation
Percentage of self reported
adequacy of health services
25. Breadth
(increasing the number of people protected by the
health systems)
• Addressing physical, financial and access limitations.
• Strategies may include:
• Increasing the staffing levels of primary health care (PHC)
facilities, changing opening times of clinics;
• Encouraging and rewarding collective and integrated group
practices;
• Changing policies to encourage task-shifting or task-sharing,
building more clinics;
• Expanding mobile outreach services and home-based care,
subsidizing transport to and from health facilities and
expanding patient transport services.
26. Coverage Depth
• Coverage depth:
• Defined package of service
based on market
segmentation
• Available resources:
• What can the country
afford?
• Health service priorities
• Preferences for specific
services
29. Depth – increasing the range of services and
benefits covered by the system
• Service packages for various levels of care, aligned to local
burden of disease, define access and related services.
• Changes in facility staffing to allow a greater range of
services to be provided at designated PHC service delivery
points, task-shifting or task sharing
• To reduce the time costs of highly skilled professionals
(including shifting nursing tasks from professional nurses
to nursing assistants and from doctors to nurses and other
assistants) and spending more on health services than in
the past.
• Decide necessary on the scope of the essential service
package and on initiating periodic reviews of the package
30. Coverage Height
• The emphasis is on prepaid
and pooled contributions to
the health financing system
• Tax -based financing
• Social health insurance
• Mix of tax - based financing
• Mixes of community,
Cooperative and enterprise-based
health insurance,
other private health
insurance
31. Financial protection
Protecting people
from:
• financial
consequences of
illness and death
• financial
consequences
associated with the
use of medical care
No financial
hardship associated
with ill health
• Curative,
preventive,
promotive and
rehabilitative
services
What is the role of
direct out-of-pocket
(OOP) payments?
• Inequitable and
inefficient !
32. % Change in THE between 2000 and 2012
Health expenditure has grown
faster than income on a per capita
basis .
Health expenditure as a percentage of
GDP in 2012 was 5.5 % in Nepal, an
increase of 0.4 percentage points from
2000.
33. Change in share of public expenditure and OOP
between 2000 and 2012
The share of out-of-pocket has fallen
by 19.6 percentage points since
2000.
The share of public expenditure has
increased by 14.9 percentage points
since 2000.
34. Share of External Resources
• External resources
accounted for 10.1 %
of total health
expenditure in Nepal.
• There is negligible
change in share of
external resources
between 2005 and
2012.
35. Financial Coverage
Total Health Expenditure by Financing Sources
17.3
19.8 23.7
18.5 20.8 21
61.5
60.5
55.6
65.7
62.5
60.5
21.1
19.7 20.8 15.8
16.7 18.5
80
60
40
20
0
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
In Percent
Fiscal years
General government Private sector Rest of the World
36. Financial Coverage
5.0
5.2
THE as % of GDP
5.1
5.7
5.6
5.3
4.9
5.3
5.3
5.8
5.6
5.4
5.2
5.0
4.8
4.6
4.4
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
Per cent
Fiscal Years
37. Out of Pocket Payment and
Payment for Medicines in Nepal
61.5 60.5
55.6
65.7
62.5
60.5
OOP as % THE
34.5
32.6
26.0
30.8
27.7 26.0
Medicine as % of THE
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
38. Per Capita GDP and THE
294 323 350 390
464 465
Per capita GDP in USD
Per capita THE in USD
16.8 18 18.6 19.3
24.9 24.8
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
39. Government Expenditure and
Medicine Payment
1.5 1.5
1.6
1.5
2.0
2.1
Public health Expenditure as % GDP
34.5 32.6
26.0
30.8
Medicine as % of THE
27.7 26.0
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
41. Assessment of FP in Health
• Financial protection is generally assessed:
• based on out-of-pocket (OOP) spending on medical care
• and such payments are related to a threshold (e.g., poverty line)
• Two methods:
1) Catastrophic spending
Medical outlays that exceed a certain threshold (z) of household
income or resources (incl. non-subsistence expenditure).
2) Impoverishment
Medical outlays that are sufficient enough to dip a non-income
poor household into poverty
42. Catastrophic and Impoverishing Impact
OOP impacts have increased, such as the catastrophic impact (or financial shocks) have
increased 6 percent to 11 percent at 10 percent threshold from 1995/96 to 2003/04.
Similarly, improvising impact has increased 2.2 to 2.5 percentage point same study period.
43. Financial Coverage
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Catastrophic incidences based on total consumption
5 10 15 25
Share of Ability to pay (incidence)
Thresholds Levels
NLSS I NLSS II NLSS III
44. 50%
40%
30%
20%
10%
0%
Financial Coverage
Catastrophic Incidences based on
Non-Food Consumption
5 10 15 25 40
Share of Non Food Consumption
Threshold levels
NLSS I NLSS II NLSS III
46. Financial incidence analysis
The results from two Nepal living Standards Survey data 1995/96 and 2003/04 suggests
better off pay more for health care not only in absolute terms but also relative to
income. But poor don’t utilize health care as per their needs.
47. Health Care Utilization
Consumpti
on quintile
Consulted Not
consult
ed
Tota
Kabiraj/Baid
ya
Tradition
al
Doctors Paramedic l
Poorest 8.1 42.4 1.1 5.4 43.1 100
second 16.6 40.1 0.2 2.9 40.3 100
Third 20.6 42.4 0.2 2.5 34.4 100
Fourth 30.9 34.3 1.2 4.3 29.3 100
Richest 45.7 25.2 1.4 1 26.8 100
• It does not mean that poor are comparatively healthier than the rich people.
• In fact, they have greater incidence of disease but their inability to meet basic
requirement such as food availability makes them compelled to overlook health
problems.
48. Who gets benefit from health care?
0.3664
0.4932
0.2943
0.4642
0.2987
0.0281
Gini Hospital care Non hospital care
1995/96 2003/04
All concentration indices for hospital care and non-hospital care are significantly positive,
indicating pro-rich bias. But the concentration indices for non-hospital care are much closer
to zero, indicating proportionality than those for hospital care.
49. Who gets benefit from health care?....
0.1268
Kakwani Index
1995/96 2003/04
-0.0677 -0.1350
-0.4070
Hospital care Non hospital care
The Kakwani indices are significantly negative in 2003/04 indicating that public health
care is income inequality reducing, despite the fact that it typically not pro-poor. Non-hospital
care has greater power to reduce income inequality than hospital care.
51. Free Health Care
Facility Charge
SHP Khodpe, Baitadi Rs 10
Health Post Siddheshwore
Baitadi
Rs 10
PHC Patan, Baitadi Rs 5
PHC Manglabare, Morang Rs 10
PHC Manthali Rammechhap Rs 20
SHP Okhreni Ramechap Rs 10
HP Those Ramechap Rs.10
Thada PHC Argakhachi RS 10
52. Challenges
• How to implement policies that mitigate the financial
hardships still faced by the poor in using health services
• How to identify the poor for premium exemption
• How to increase fiscal space to cover those in the
informal sector
• Exploring the major determinants of the lack of financial
protection, including the detailed reasons for lack of
financial protection
• Assessing equity dimensions to financial risk protection
- by age, sex, location, SES, etc.
53. Health budget competing with other
social services budget (growth rate)
Education Health Drinking Water Local Development
2002/03 2003/04 2004/05 2005/06 2006/07 2007/08
The health sector has benefited in terms of receiving more resources due to
fluctuations in drinking water and local development services
54. Height – increasing the proportion of costs covered
by pre-financing (more funding and less waste)
• These may include a range of financing options:
• Social health protection coverage through national health services,
• Social health insurance, community-based insurance and mandated private health insurance
• Improvement efficiency of health system
• Improving procurement and administrative efficiencies,
• Creating synergistic effects For example, using the inputs of other sectors and departments that
impact on health determinants, such as water and sanitation, education and women and children
These may include a range of financing options:
• Social health protection coverage through national health services,
• Social health insurance, community-based insurance and mandated private health insurance
• Improvement efficiency of health system
• Improving procurement and administrative efficiencies,
• Creating synergistic effects For example, using the inputs of other sectors and departments that
impact on health determinants, such as water and sanitation, education and women and children.
55. Financing mechanisms
• It represents an integrated approach, respects existing coverage and
financing arrangements, and can be adjusted to the specific social
and economic context of each country
• Broadening sources of financing and better use of resources
• Money matters to the health care system, but it does not guarantee
efficient, equitable, and effective health care services. Health care
financing has the power to reform health care delivery and provide
incentives to providers to deliver efficient and effective health care
• Specific strategies to engage non-state providers to UHC
56. Engineering of UHC
Covering all services but not population
Financial coverage but not
population and services
Population coverage but not
Services and financial
57. Strategies
Categorize services into priority classes. Relevant criteria include
those related to cost-effectiveness, priority to the worse off, and
financial risk protection.
First expand coverage for high-priority services to everyone. This
includes eliminating out-of-pocket payments while increasing
mandatory, progressive prepayment with pooling of funds.
While doing so, ensure that disadvantaged groups are not left
behind. These will often include low-income groups and rural
populations
58. Glocalization: Designing of UHC
• Global localization = Glocalization
• Global agenda and designing and implementing based
on local condition (indigenous system) = UHC
Glocalization
• If Glocalization; UHC for Nepalese citizen
• If not Glocalization; Nepalese citizen for UHC
• Then, expected outcomes: blame to be given to
Nepalese citizen and cost of UHC on the head of
Nepalese citizen