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Microsoft word - health sector policy paper ndcm 2008 feb.

Policy Paper on Health Sector Development

1. Introduction

Modern health services initiated about 120 years ago in Nepal, with eight health facilities
established in different parts of the country at a time. The pace of growth of health
service was slow till 1950s and after that health sector took steady and continuous growth
with establishment of more health facilities at all level and establishment of health
facilities by non governmental organizations also in different parts of the country.
Government was the largest service provider followed by non governmental
organizations and the private sector had very small contribution till 1993. After
restoration of democracy in 1990, the public sector also has grown with establishment of
sub health posts and primary health centers and both the private for profit and not for
profit (NGO and cooperative) hospitals have grown significantly. The public sector has
established at least one modern health facility in every village development committee
and in the rural areas it is the only agency providing health services. The private and non
governmental sector is contributing mainly in secondary and tertiary care health services
and they are more concentrated in urban areas and district head quarters.
The human resource for health production also has grown significantly in last 15 years
with establishment of medical, nursing and allied health science institutions both in
public and private sector. As a result of this there is over production of some category of
human resources such as ANM, AHW etc already, though quality is an issue often raised.
Similarly, the pharmaceutical industry also has grown significantly with establishment of
40 plants of modern drugs and 18 plants of traditional drugs and currently meets one third
drug need of the country.
Overall growth of health sector has begun to contribute in national socio-economic
development by reducing morbidity & mortality from disease & making people healthy,
economically productive and live longer. The growth of health sector has also brought the
challenges along with the opportunities.
2. Overview of the performance of health sector since NDF 2004

2.1. The environment in health sector

The environment in health sector is guided by health sector strategy: an agenda for
reform approved by Government of Nepal in 2003. this strategy is prepared on the basis
of poverty reduction strategy, health sector reform, sector wide approach, second long
term health plan 1997-2017 and donor harmonization.
The Interim Constitution of Nepal promulgated in January 2007 and it has established the
basic health services as the fundamental right of every citizen of the country. Similarly,
the child health services and reproductive health services also have been taken as the
fundamental human right of the children and women.
2.2. Implementation of Sector Wide Program in Health Sector

Government of Nepal approved the Nepal Health Sector Program, Implementation Plan
(2004-09) and health sector wide program initiated from July 2004. Joint Financing
Agreement (JFA) signed for pool funding with International Development Association
(IDA) and Department for International Development (DFID). With the start of sector
wide program joint annual review for annual work plan and budget and performance
review is done twice a year. In accordance to the sector wide program, single reporting
system, account audit of the expenditures by office of the auditor general and single
foreign exchange account in Nepal Rastra Bank instituted for the purpose of the pool
partners. The non -pooled partners also started to align and harmonize their contributions
in the sector wide program on the basis of the of ear marked projects. Some signatories of
the ‘statement of intent’ have shown interest in pool funding, however the decision is yet
to come.
2.3. Aid Alignment and Harmonization

As part of the aid alignment and harmonization, statement of intent signed, in February
2004 by Government of Nepal and 11 external development partners and to
institutionalize this, health sector development partnership forum formed. This forum is
chaired by health secretary and includes other representatives from other government and
some non- governmental agencies despite EDPs who signed statement of intent. The
three year interim national development plan of Nepal (2007-08 -2009-10) approved by
Government of Nepal recently and as a part of alignment and harmonization the UN
agencies e.g. UNFPA, UNICEF, WHO and UNDP also prepared three year plan as
United Nations Development Assistance Framework. The agreement signed with the
Government of Germany supporting health sector is also three years as above.
2.4. New International Initiative: International Health Partnership

This is a new international health initiative coordinated by British Government to support
achieving the health sector millennium development goals using the approach of Paris
Declaration on Aid Effectiveness- 2005. Nepal is one of the signatories out of the eight
countries in initial phase and agencies committed to support this initiative are DFID,
WHO, Norway Government, UNICEF, UNFPA, ILO, Bill and Melinda Gates
Foundation, GAVI, Global Fund, World Bank etc.
2.5. Policy Initiatives in Health Sector

a. Maternity Incentive Scheme

In February 2005 Government of Nepal declared maternity scheme, a demand side
financing to promote the maternal health and to achieve the millennium development
goal no 5 - the maternal health. Under this scheme pregnant woman attending health
facility for child delivery will be provided cash up to NRs 1500.00 in high mountain
region, NRs 1000.00 in hilly region & NRs 500.00 in terai or plain part of Nepal as
transport compensation. In case delivery attended by a trained health personnel at home,
he/she will be paid NRs 300.00, but client will not get the incentive. The delivery
services are provided free of cost in25 low human development index districts and in
other districts the client has to pay the users fee. Currently the incentive scheme is limited
to public sector health facilities and medical colleges, both public and private. Recent
evaluation of this scheme has shown that the utilization of the scheme by the pregnant
women is quite satisfactory, while there are some administrative problems as well.
b. Pro Poor Guideline for Health Services

This scheme introduced in February 2006 to increase the access of the poor in hospital
services. This scheme is limited to district hospitals and primary health care centers and
under this scheme ultra poor and poor will get free or subsidized services in emergency
conditions and conditions that need indoor admission and treatment. Individuals needing
treatment in emergency or indoor services has to pay NRs 100.00 as a registration fee,
but for ultra poor, the scheme will subsidize all expenses including registration fee and
receive free treatment and for poor fifty percent exemption in registration fee and all
treatment expenses will be covered by the scheme and well off people, no subsidy or has
to pay the total charges for registration and treatment. The ultra poor has been
categorized as those households whose annual income is sufficient for buying food for
six months, the poor for more than six months and less than one year and well off more
than one year. Evaluation is under plan and the findings can be helpful for further
improvement if required especially in the context of utilization of services by the target
c. Free Essential Health Care Services in Health Post and Sub Health Post

Some essential health services related to maternal health, child health and control of
communicable diseases were free since long time and from mid January 2008, 22 items
of essential drugs for sub health post and 32 essential drug items for health post also
made free throughout the country and it will be expanded up to district hospitals in
phases. Similarly, registration fee also abolished in these health facilities in an effort to
increase the access of the people to health services and remove the financial for barrier
for utilizing health services and establish health as basic fundamental human right of
every citizen in accordance to the Interim Constitution of Nepal.
d. Establishment of New Health facilities or Upgrading of Health Facilities

After July 2004 four district hospitals established –in Dolpa, Kalikot, Mugu and Rolpa
districts and two regional hospitals established in Hetauda (partnership approach) of
central development region and Surkhet of mid western development region. District
hospital of Dang upgraded to 50 bed general hospital and 25 primary health care centers
also established in different parts of the country by upgrading health post and sub health
posts. New facilities established in traditional medicine services also.
e. Disaggregating Health Service Utilization Data

Pilot study on disaggregating of health services data on the basis of the age, gender, caste,
ethnicity and religious minority started in three districts in the current year. This will help
to develop additional interventions in health services for the weaker sections of the
f. Japanese Encephalitis Vaccine

Japanese Encephalitis is responsible for 300-500 deaths and 3000-5000 cases affecting
mainly children in terai and some hilly districts every year. Mass vaccination to every
body living in high risk area and routine immunization to one year child initiated in phase
wise with the single dose JE vaccine. As a result of this, the number of deaths and cases
due to JE dropped remarkably in 2007.
g. Malaria Prevention by Vector Control

Malaria especially the plasmodium vivax malaria is endemic in 65 districts of the Nepal,
and severe type of malaria known as plasmodium falciparum malaria is endemic in
certain areas of the country only. To control the vector and there by reduce the cases,
long lasting insecticide treated bed nets (LLIN) distributed in highly endemic areas
focusing poor people and falciparum malaria. In the last three years 304,122 pieces of
bed nets distributed in terai districts.
h. Avian Flu Control Program

Avian flu control and prevention program launched in 2005, as joint action between
Department of Health Services and Directorate of Live Stocks under the Ministry of
Agriculture. As a part of the control program, orientation, awareness campaign, capacity
building and surveillance works has been started.
2.5. Scaling Up of the Health programs and Interventions

Following programs scaled up after the implementation of the Nepal Health Sector
Program 2004-09-
a. Integrated Management of Childhood Illness

This intervention is training of health personnel in major killer diseases in childhood. It
has been extended as community based integrated management of childhood illness by
training female community health volunteers and traditional healers. In the current year
this program will reach to 60 districts. This intervention has proved to be effective in
improving the child health by reducing morbidity and mortality and achieving MDG goal
no 4.
b. Safe Abortion Services

Abortion legalized in 2002 by parliament with amendment of civil penal code that
criminalizes the medical abortion. The safe abortion services scaled up in a very short
time and services now available in 172 sites of 71 districts and till December 2007,
158,000 women have utilized the abortion service. The partnership approach in
expanding services was the main strategy behind the development of national network of
c. Drug Supply in Peripheral Health Facilities

As an effort to ensure supply of essential drugs in all health facilities, community drug
program introduced in 56 districts, though implementation status is in different phases.
Under this program, local committee is formed at facility level to ensure management of
drug focusing availability of quality drugs at an affordable price. The committee also
procures drugs that are not listed under the essential drugs list.
Push vs. pull system of drug supply implemented in 14 districts, so that the health facility
will demand necessary drugs according to the local requirement. This system has reduced
expiry of drugs as well as procurement of unnecessary drugs.
d. HIV & AIDS Control and Prevention

Anti- retro viral therapy provided free of cost from 14 hospitals to 1172 persons living
with AIDS. The number of voluntary counseling and testing centers is 96 in 40 districts.
The prevention of mother to child transmission scheme implemented in 9 hospitals and
there are 48 HIV positive women enrolled in this scheme. The CD4 count centers are 4 in
the country.
e. School Immunization Program

School immunization program started in schools of 12 districts in an effort to eradicate
neonatal tetanus. Under this scheme school children at primary school level are given
three doses of tetanus toxoid vaccine. This is initiated to sustain and support the neonate
tetanus elimination program.
f. Communicable Disease Elimination/Eradication Programs

Following disease elimination programs are at different stages of elimination-
Neonatal Tetanus Elimination – Met the target of elimination and Nepal received
certification of elimination from WHO in 2005.
Poliomyelitis Eradication – Poliomyelitis eradication program is facing problem with
imported cases from neighboring country after a polio case free interval for four years
(2002-2004). The eradication program needs to be continued till the neighboring country
also become free of polio cases.

Filarial Elimination- Filarial elimination campaign is implemented in 21 districts and
mass single dose of drugs administered for consecutive five years in the same district.
Leprosy Elimination -The leprosy elimination should have achieved the prevalence rate
less than 1/10,000 population by 2005, and could not be achieved as more cases reported
by eastern terai districts. The prevalence rate is 1.4 per 10,000 populations in 2006-07
and it is expected to reach the elimination target less than 1 per 10,000 populations by
2009. Many districts have already achieved the target of elimination.
Trachoma Elimination -This is a GO-NGO partnership program implemented by Nepal
Netra Jyoti Sangh, a Kathmandu based national NGO working in the area of eye services.
Trachoma is a blinding disease; endemic in western terai and under this program
treatment of cases, prevention by administering mass drug at individual level and
improvement of basic sanitation practices are main interventions. This elimination
program is initiated to meet the objectives of the ‘Vision 2020’ in 2004.
Kala-azar Elimination - Kala-azar elimination is a three country (Bangladesh, India and
Nepal) initiative, supported by WHO in an effort to eliminate by 2015.
g. Improvement in Drug Quality

Good manufacturing practice (GMP) guideline of WHO adopted by Nepal to improve
drug quality in the country and all the national manufacturers has to receive the GMP
certificate by February 2009. In Nepal, there are 40 modern drug manufacturing factories
and out of them 11 have already received GMP certification. GMP certification is also
required for the international manufacturers importing drugs in Nepal.
h. Out Reach Program: Specialty Mobile Clinics

Ministry of Health and Population used to conduct five to ten mobile specialist clinics
every year in remote and hard to reach areas focusing poor and vulnerable groups in past.
Since 2005, this service scaled up by increasing number of clinics to 30-40 every year.
The services diversified by adding single specialty mobile clinics such as prolapse of
uterus clinic, ear nose and throat clinics and orthopedics clinic despite the general
specialty mobile clinic. The single specialty out reach clinics found to be more beneficial
for the poor and vulnerable groups as it is organized in rural and remote areas and there
are target populations. Single specialty mobile clinics, managed by public sector also
supplemented by arranging additional clinics by external development partners and non
governmental organizations.
3. Health Status and Health Indicators
Nepal Demographic & Health Survey -2006 published in June 2007 and results show
significant improvement in maternal and child health indicators. The maternal mortality
also decreased by 48% and Nepal reached very near to millennium development goal
related to child health. The study also has shown challenges in the health sector as well
such as two third part of the infant mortality is due to neonatal mortality, which is more
difficult to reduce by simple measures and result showed very less improvement in
nutritional indicators & in fact deterioration in some indicators such as wasting in
children. Results of the study are shown in table 1-
Table 1: Major health indicators according to NDHS 2006 Indicators (weight for height) Maternal mortality ratio Under five mortality 118/1000 live 91/1000 live 61/1000 live 2.1/1000 population Male -2.4/1000 population households with mosquito nets Knowledge of HIV NA Male method Life expectancy at birth 56.5 60.4 63.3 Nepal in years
4. Increase in Health Sector Budget and Financial Performance

In the Nepal Health Sector Program the Government of Nepal has made formal
commitment to increase the health sector budget gradually and will allocate at least 7%
budget by 2008-09. But the commitment has been fulfilled by allocating 7.14% budget in
health sector in the 2007-08 financial year as shown in table 2. The provision of pool
funding, costing of the resources required and donor harmonization has made significant
contribution in increasing the budget. The per capita expenditure by Government in
health has increased to 8.00 US Dollar per year in 2007-08, which is a jump by 3.00 US
dollars in comparison to 5.00 US dollar in 2004-05. Poor financial performance or poor
absorption capacity of the health ministry is the concern raised and this area also has
begun to improve as shown in table 2. However, improvement in financial management
is a major concern and needs additional effort to improve this area satisfactorily.
Table 2: National budget vs. health sector budget with absorption percentage
S No
Budget in billions sector budget out of percentage (NRs)
5. More Budget for Essential Health Care services

Ministry has reversed the trend of higher budget allocation in urban areas and less budget
allocation in rural areas for essential health care services, which was prevalent before
implementation of Nepal Health Sector Programme. This policy change has to be made
as the census of 2001 has shown that 84 percent live in rural areas, while 16 percent live
in the urban areas and there was a disproportionate and inequitable budget allocation. In
last three financial years, health ministry has consistently allocated at least two third
budgets in essential health care services and this has contributed in the improvement of
the health services.
6. Improvement in Health Management and Health System

6.1. Infrastructure Development

As the Ministry of Health & Population has low capacity in building construction,
authority transferred to Department of Urban Development and Building Construction for
the health facility construction and maintenance. In last three years, 387 building
construction projects initiated and out of them 88 completed. The external development
partners are contributing by constructing 9 district level medical stores in different
districts as separate projects. Ministry of Health & Population had no maintenance plan
of health facilities earlier, so building maintenance plan for health facilities prepared in
2007 and it is under implementation.
6.2. Human Resource Management

Human resource management has improved in comparison to NDF 2004 meeting, but
challenges are still there. Study carried out in 2006 by Ministry of Health & Population
has shown that 76 percent of health personnel posts were fulfilled in comparison to
sanctioned posts. The main problem of human resource is related to deployment and
retention of physicians and one category of nurses in peripheral health facilities. But there
is problem of deployment and retention of all categories of health personnel in high
mountain districts. Ministry has implemented the two year compulsory service scheme to
physicians, who studied the medical course under the scholarship scheme of the
Government of Nepal and in 2007, 141 medical doctors, who have completed the medical
course in scholarship have joined Department of Health Services to work in peripheral
health facilities. To improve the maternal health, 1000 maternal and child health workers
working in sub health enrolled in 18 month long ANM course and all of them have
graduated and now posted in their original duty stations. The vacant posts of maternal
and child health workers and assistant nurse midwives fulfilled by contractual service in
many districts. To improve the biomedical equipment maintenance system, one year
duration biomedical equipment technician course prepared and 37 persons have already
graduated in two batches.
The improvement of maternal health is a major concern and ministry has approved the
skilled birth attendant policy in 2007 and training of skilled birth attendants initiated to
meet the target of 60% delivery by skilled birth attendants by 2015. The total number
estimated is 8,000 SBA, based on geography and populations.
6.3. Decentralized Management of Health Facilities

Ministry initiated health sector decentralization in 2002 under the local self governance
act 1999 and till date hand over of 1433 sub health posts, health posts and primary health
centers to local health facility management committee completed in 28 districts.
Management of bigger hospitals is very challenging for local bodies, so hospital board
formed in 17 hospitals and total hospitals under the board are now 52. To enhance the
decentralization process social block grant system to districts initiated in Jhapa, Morang,
Saptari, Dhanusha, Parsa, Bhaktapur, Rupendehi, Kaski, Parbat, Dang, Banke, Jumla,
Kailali and Kanchanpur districts. In administrative decentralization some of the authority
of the ministry delegated to Department of Health Services and Regional Health
Directorates. Studies on decentralization have shown mixed effect, but all studies have
consistently shown increase in health service utilization. The main problem observed in
the decentralized management of health facilities is absence of elected bodies in the local
bodies and capacity to manage special sector such as health facilities. The hand over
process has to be stopped since the financial year 2006-07 due to present political context
and focus on constituent assembly elections.
5.4. Social inclusion in Health Sector

Inclusive policy implemented in some areas of the health sector. The local health facility
management committee is the very good example of the implementation of the inclusive
policy. The committee consists of five women representatives including representative of
the Janjati and Dalit. Inclusive policy introduced in under graduate courses admissions
too in government scholarship in medical and dental courses by Ministry of Education
and under this special quota allocated to women, Janjati and Dalit. Janakpur Nursing
Campus, under theMinistry of Health is the first institution to introduce inclusive scheme
on district, caste and ethnicity basis. Similarly, BP Koirala Institute of Health Science,
Dharan a medical university under the Ministry of Health & Population introduced
inclusive policy in al its academic programs providing special quota to Janjati, Madhesis
and Dalits. This institute has also allocated special quota to residents of the remote
districts. 100 Janjati, Dalit and Muslim women also completed ANM course organized by
Ministry of Health & Population.
Department of health services arranged general mobile clinics in all 205 electoral
constituencies targeting poor and disadvantaged groups.
Out of the total 20,000 employees under the Ministry of Health and Population, one third
employees are women.

6.5. Effect of Conflict on Health

The health sector was less affected during the ten year long conflict and health service
delivery has improved after signing the peace accord by the Government of Nepal and
CPN (Maoist) on 21 November 2007, though new conflict emerged in ten districts of
eastern terai. Health service delivery is continuing despite some difficulties in these 11
conflict hit districts.
6.6. Quality Assurance in Health Care

Quality assurance is a major issue and a QA policy in health care approved by the cabinet
recently. Department of Health Services has formed the district quality assurance teams
in all 75 districts and training and orientation has already started.
6.7. HIV and AIDS Control Board

National Center for AIDS & STD control could not function because of lack of capacity
of the center. To improve the coordination in prevention and control activities national
HIV & AIDS control board formed recently.
7. Millennium Development Goals

The progress on health sector millennium development goals is as shown in table below.
The progress is satisfactory as the mortality in both maternal and child health is reduced
significantly in recent years. In the control of three major diseases the reduction of deaths due to malaria and tuberculosis is good, and the trend is already towards achievement side, while the trend in HIV is not satisfactory and needs additional efforts. HIV infection can also increase the cases of both tuberculosis and malaria and multi drug resistant tuberculosis and drug resistant malaria especially the falciparum malaria are also the threats for achievement in MDG 6 goal, Table 3: Millennium Development Goals for Health S Source- 11 Health Questions about the 11 SEAR Countries; World Health Organization,
South East Asia Region, New Delhi -2007
8. Health Disparity and Gaps

Health disparity has narrowed down in certain areas & access of the people in health
service has increased. The gender disparity in immunization has narrowed down
significantly. The unmet need for family planning services also decreased from 31
percent in 1996 to 25 percent in 2006.
The access of poor has increased if the service is available at the community level.
The increase in budget in essential health care services, pro poor guideline for poor and
ultra poor and maternity incentive scheme has increased the access of the poor in the
health services. However, the major gaps are still present though they have begun to
improve. The establishment of hospitals in urban areas by the public secto, NGO and
private sector has increased disparity in hospital bed per populations and physicians per
9. Current Challenges in Health Sector

The following challenges have been identified and prioritized by the ministry in view of
the requirement of additional investments -

9.1. Prolapse of Uterus

Recent studies have shown that uterine prolapse is a major problem in contrary to the
earlier understanding of low prevalence. Nepal Demographic & Health Survey 2006 has
shown that 7 percent women aged 15-49 years are experiencing prolapse of uterus
symptoms, while the study done by UNFPA, Nepal Country Office in 2006 has also
shown 600,000 women suffering from symptoms of prolapse uterus, with 186,000
suffering of complete procedontia and need surgical intervention or hysterectomy. A
national strategy has been drafted and to address the problem of resources a special fund
has been created.
9.2. HIV & AIDS Control

HIV & AIDS control and prevention measures are in progress and the prevalence has
begun to reverse in some high risk groups such as intravenous drug users and commercial
sex workers. The current situation is concentrated epidemic only, but there is a threat that
it can be general epidemic due to the migrant laborers. Problem is increasing in mid west
and far west development regions as the migrant laborers, go for work in big cies of India
and get infected there due to the their high risk behaviour and after returning home infect
their wives. Migrant workers from rest of the country go for work outside India with very
low HIV prevalence countries.
9.3. Avian Flu

Avian flu national action plan has been approved in 2005 and necessary control measures
started jointly with Live Stock Department of Ministry of Agriculture. The World Bank
has approved the grant of 15 million US dollar for the both sector. In view of the Nepal’s
strategic location in between China and India additional resources may require.
9.4. Nutrition

Nutritional indicators found not significantly improved in the Nepal Demographic and
Health Survey 2006 and current nutritional interventions in nutrition are limited to
Vitamin A and albendazole tablet distribution to under five children, iron tablet
distribution to pregnant women and iodization of salt. Some additional interventions such
as demonstration of feeding practices at all health facilities and establishment of nutrition
rehabilitation centers for managing third degree malnutrition is required.
9.5. Non -Communicable Diseases

Mortality and morbidity from non-communicable diseases such as chronic bronchitis,
diabetes, hypertension, stroke, and cancer is increasing very fast and the study done in
1999 has shown double burden of the disease in the country and no interventions
implemented except establishment of separate hospitals for cancer and heart disease by
public sector. In the terai region, high arsenic content has been found in the under ground
drinking water, which is the only source for water in many areas.
10. Three Year Interim National Development Plan- 2007-08- 2009-10

The three year national development plan, approved by Government focusing three areas
in development, reconstruction, rehabilitation and reintegration. The targets proposed in
the three year interim plan for health sector are as below-
Table 4: Target for health sector for next three years
S NO Indicators
Availability of essential health 79 90 care services (%) Proportion of four antenatal visits 29 40 to first antenatal visit TT vaccination in 15-44 year 63 75 women (%) Neonatal mortality rate/1000 live 34 30 births Infant mortality rate/1000 live 48 44 births Source: Three Year Interim Development Plan, National Planning Council, Kathmandu,
11. Financial Resources Required and Funding Gap

There is a funding gap even in the in the current year’s health sector budget. The funding
gap will increase significantly as shown in table 6 in coming years as the ministry has to
allocate more resources in the following areas-
• Achievement of millennium development goals including three year interim plan– especially for scaling up of safe motherhood and neonatal care activities and HIV and AIDS control & prevention activities • Implementation of additional nutritional interventions • Scaling up of communicable diseases and initiation of non- communicable disease • Health system improvement – information system, human resource development, infrastructure development and other areas Table 6: Estimated expenditure for 2007-08-2009-10 Estimated expenditure for  NDF 2008 
Estimated expenditure by inputs 
Share % 
Estimated expenditure by sources 
Share % 
Estimated expenditure by types 

Finding gaps 
Funding Gaps 
  ‐Donor existing commitments continued  The total gap per year is estimated to be around 80-100 million US dollar per year.
12. Future Actions of Ministry of Health and Population in Health Sector

Ministry of Health & Population will continue to act in the following areas-
-Improve deployment and retention of human resource for health
-Initiate production of midwife and community mid wife
-Scaling up of low cost high output interventions that can assist achieve MDG and three
year plan
-Demand side financing in Kala-azar Control
-Strengthen patient referral system
-Implement quality assurance in health service and human resource production by
initiating accreditation system
-Financial management -Ministry has identified financial management including
development of early reporting system as the prioritized agenda for coordination and
-Develop modalities of public -private -partnership
-Review essential health care package in the context of basic health care
-Integration of adolescent and sexual health program with population activities
-Establish municipal health office
-Improve harmonization in accordance to health sector strategy: an agenda for reform
-Explore alternative financing scheme for urban areas
-Enhance health sector reform with focus of good governance, transparency and human
rights if the political scenario improves
-Close coordination and collaboration with other stakeholders working in health sector
-Build consensus in international health partnership strategy
-Continue to develop inclusive policy in health management and services
13. Role of External Development Partners in Health Sector Development

Ministry expects availability of more resources from EDPs to scale up the millennium
development goals, health system improvement, implementation of three year interim
national development plan of health sector and sustaining the ongoing reforms in health
service delivery.
14. Fulfillment of Commitments of NDF -2004

Ministry of health and population has fulfilled all the major commitments done in NDF
2004 as far as the resources and political environment allowed. The proof of this is the
availability of increased resources in health sector for last four years almost doubling of
health sector budget in the year 2007-08 in comparison to the year 2004-05. Similarly,
the improvement of health indicators as shown by the Nepal Demographic and Health
Survey 2006 is another area of fulfillment of commitments.
15. Conclusion

Health sector strategy and sector wide program contributed significantly in health sector
development in Nepal. This is possible due to joint effort of government and external
development partners with the spirit of close coordination and harmonization to
maximize the available resources that helped to bring tangible changes in health status of
people of Nepal. Ministry of Health & Population will continue to work in the same
process, so that it can achieve the health sector millennium development goals and further
improve the health status of the people of Nepal. External assistance is crucial at this
juncture to sustain the current programs and services and implement new one and
ministry will continue policy reforms in health sector as far as the current political
environment allows and availability of the resources.


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