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Health System and Health System Strengthening in Nepal

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

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Health System and Health System Strengthening in Nepal

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  1. Health System and Health System Strengthening in Nepal Dr BR Marasini, MBBS, MPH Senior Health Administrator Ministry of Health and Population

  2. 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)

  3. The Health Care Systems • Allopathic or modern medicine • Traditional medicine – Ayurveda and Amchi • Homeopathy • Unani • Other complimentary systems

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Health Outcomes and Progress Towards Health Sector MDGs-1

  14. Health Outcomes and Progress Towards Health Sector MDGs-2

  15. Health Outcomes and Progress Towards Health Sector MDGs-3

  16. Core Intermediate Health Indicators

  17. Health Sector Budget and Expenditure by Year

  18. 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

  19. Challenges • Deployment and retention of HRH in remote and rural areas • Increase in non-communicable diseases

  20. Thanking you for your kind patience

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