NHSP-IP-2

Editor's Notes

1. Review of Nepal Health Sector Program-Implementation Plan 1 Budget and Expenditures (Health budget increased from 5.87% in 2004-5 to 7.16%in 2007-8. But declined in the two subsequent years to 6.33% and 6.24%) But spending with in health sector increased from 70% in 2004/05 to 85% in 2008/09 which was higher than NHSP I target Reduced Mortality and Morbidity
2. Government will continue to increase domestic financing of health services, but sustaining and building on the achievements of the health sector will require the generous level of support from the EDPs to be sustained and increased
3. Essential HCS changes over time and spatial distribution and also social distribution. (Provider vs. Consumer perspectives) Essential Health Care Services The three objectives set out in the results framework are: To increase access to and utilization of quality essential health care services To reduce cultural and economic barriers to accessing health care services and harmful cultural practices in partnership with non-state actors To improve the health system to achieve universal coverage of essential health services.
4. Say challenges and then say these strategic directions to combat them
5. Use of routine data at local and district levels is minimal because the focus is aggregation for the central government and surveys are often conducted to suit special interests rather than serve the SWAP Regular supervision and monitoring (Training curricula, guidelines and manuals will be developed to support monitoring and evaluation activities) Health facility surveys currently carried out in each trimester
6. Challenges to health financing Expenditure in health remains low at 5.3 percent of GDP in 2006. The per-capita health expenditure stood at USD 18.09 compared to USD 65 in Bhutan, USD 44 in Sri Lanka, USD 29 in India and USD 19 in Afghanistan (WHO 2008) The share of Government stands at 24% and EDPs (Sustainability concern) contribute 21% (of total health expenditure) More than 55% through out of pocket expenditure by households at the time of service Responding A mixed approach (lesson from success stories across globe) Cost recovery modality (exemption criteria will be developed for poor clients/patients, and grants to facilities will be provided on the basis of the outputs they provide to patients qualifying for free or subsidized treatment) Budget allocation based on distribution of facilities (Population, accessibility and cost of service in different places to combat inequity) AWPB process to monitor introduction of new programmes and interventions will be assessed based on their contribution to reduce inequality formula-based approach to resource allocation (to adjust per capita allocations to reflect the higher costs of delivering services in Hill and Mountain regions, the disease burden, and the relative poverty of the population) Ensuring formal insurance schemes with mainly better-off recipients recover all of their costs and are not implicitly receiving subsidized access to public-sector facilities microcredit to smooth the burden of unexpected health costs Government have piloted community health insurance schemes for both checking catastrophic spending and other health expenditure
7. It is much more difficult to predict the trend in aid to the health sector. Some 58% of total EDP spending during NHSP-1 took place in the final two years, reflecting catch-up from earlier low expenditure
8. U5MR- from 142 per thousand live birth in 1990 to 38 in 2014 infant mortality has also decreased by 67% - from 99 per thousand live births to 33 But Neonatal MR has not reduced proportionately NMR 53 per thousand live births in 1990 to 23 in 2014 (MICS) Though 18% of women fall under the Body Mass Index (BMI) of 18.5 – a cut-off point, indicating thinness or acute under-nutrition (higher in terai 26%) proportion obese women has increased to 14% (NDHS, 2011) Nepal has achieved Polio Free Status, Measles Mortality Reduction Goal, MNT elimination status, and control of Japanese Encephalitis CB-IMCI and CB-NCP merged to form CB-IMNCI more than 80% of household members continue to have E. coli risk level in their water
9. U5MR- from 142 per thousand live birth in 1990 to 38 in 2014 infant mortality has also decreased by 67% - from 99 per thousand live births to 33 But Neonatal MR has not reduced proportionately NMR 53 per thousand live births in 1990 to 23 in 2014 (MICS) Though 18% of women fall under the Body Mass Index (BMI) of 18.5 – a cut-off point, indicating thinness or acute under-nutrition (higher in terai 26%) proportion obese women has increased to 14% (NDHS, 2011) Nepal has achieved Polio Free Status, Measles Mortality Reduction Goal, MNT elimination status, and control of Japanese Encephalitis CB-IMCI and CB-NCP merged to form CB-IMNCI more than 80% of household members continue to have E. coli risk level in their water
10. NCDs account for “more than 44% of deaths, 80% of outpatient contacts, and 39% of DALYs lost