Year 2020 ends with summing up the Nepal Health Sector Strategy 2015-2020 is the primary instrument to guide the health sector of the last five years. Under the auspices of National Health Policy 2014, Nepal Health Sector Strategy 2015-2020 (NHSS) is the primary instrument to guide the health sector for the next five years. It adopts the vision and mission set forth by the National Health Policy and carries the ethos of Constitutional provision to guarantee access to basic health services as a fundamental right of every citizen. It articulates nation’s commitment towards achieving Universal Health Coverage (UHC) and provides the basis for garnering required resources and investments. NHSS places health at the centre of ovel all socio-economic development. It guides the health sector’s response in realizing government’s vision to graduate Nepal from ‘Least Developed Country’ to ‘Middle Income Developing Country’ by 2022.
NHSS is developed within the context of Sector Wide Approach (SWAp) and it sees partnership as a cornerstone for health development in Nepal. NHSS was developed jointly by the government and its development partners. Both the government and development partners commit to align their efforts to NHSS priorities and are jointly accountable to achieve the results. NHSS also harnesses multi sectoral approach to address social determinants of health. In the past two decade, Nepal has made notable progress on improving the overall health outcomes of the citizens. Between the period of 1990 and 2014, Nepal impressively reduced under-five mortality by 73% and infant mortality by 67%. Similarly, Nepal was able to reduce maternal mortality by 76% between the period of 1996 and 2013. During this period, polio is towards eradication phase while leprosy is at elimination stage. Considerable efforts have been made to halt and reverse the trends of tuberculosis, HIV and malaria. However, comparably less progress was made in reducing neo-natal mortality and malnutrition.
Despite this progress, the country faces many health challenges including inequity. Many citizens continue to face financial, socio-cultural, geographical, and institutional barriers in accessing health services. Despite efforts to reduce gender inequality, the women of Nepal are still marginalized in society which affects their health and well being. Therefore, the government has introduced special programmes and incentives, such as free health care programme and safe delivery incentive scheme, to reduce inequity in health. For the last few decades, the government has emphasized on improving access to health care services by expanding health facilities and strengthening community based interventions. Extension of access to health care services and improving the quality of health care remain a major challenge. The expansion of urban health services, owing to rapid urbanization is a burning challenge. Shifting burden of diseases and natural disaster induced health problems is yet another challenge. While communicable diseases continue to pose problems, there is now a growing prevalence of non-communicable diseases. There are also increasing threats of natural disasters due to climate change. Likewise, there are increasing number of deaths and injuries due to road accidents.
Summing up the Nepal Health Sector Strategy 2015-2020 (contd)
The devastating earthquake of April 2015 and subsequent aftershocks resulted in 1200 health facilities being affected. Reconstruction and maintenance of these health facilities is another challenge. This calls for a strong effort for emergency preparedness and response management. The current structure of MoHP, which is more than 25 years old, may not be prepared enough to address the contemporary and emerging health challenges. There is a need of restructuring of MoHP in line with the federalist structure as provisioned by the constitution and ensure equitable distribution of health facilities with reference to geography and population. Apart from that, certain components of health systems need further strengthening to improve the health outcome of the citizens.
To sustain the achievements made in the health sector and address the aforementioned challenges,
NHSS stands on four strategic principles:
1. Equitable access to health services
2. Quality health services
3. Health systems reform
4. Multi-sectoral approach
Under these strategic principles, NHSS envisions for equitable service utilization, strengthening service delivery and demand generation to underserved populations, including the urban poor. NHSS calls for greater partnerships with local level institutions and community groups to empower women, promote supportive cultural practices and curb gender-based violence in the society. NHSS focuses on improving the quality of care at points of service delivery. As warranted by National Health Policy 2014, an autonomous accreditation body will be established during NHSS period for quality assurance of health services in public and private sectors. NHSS emphasizes on strengthening research and promoting the use of evidence. It also aspires to leverage modern technologies for better health information management, increased access to health services, better management of procurement and supply chain, and more effective and efficient construction of health facilities.
To strengthen decentralization planning and budgeting, NHSS priorities the implementation of the Collaborative Framework for Strengthening Local Health Governance in Nepal. NHSS also expands state and non-state partnership by building mutually beneficial partnerships between the public and private sectors. At the same time, NHSS aims to strengthen institutional capacity of MoHP to better regulate public and private health systems.
NHSS recognises the importance of multi-sector approach to address social determinants of health. While the culture of inter-sectoral workings in health has been going on for a long time, NHSS emphasizes on more institutionalized way of setting-up multi-sectoral approaches. For the next five years, NHSS focuses on promoting healthy lifestyles and healthy environment through multi-sectoral action. This includes: recognizing young people as a starting point to promote healthy lifestyle; leveraging health facilities as a learning environment for healthy lifestyle and behavior; tackling malnutrition and promoting the consumption of healthy foods; reducing the ever-rising deaths and injuries through road traffic accidents; and promoting healthy environment including better response to climate change related health risks.
NHSS strives towards the goal to ‘improve health status of all people through accountable and equitable health service delivery system.’ NHSS stipulates the following nine outcomes to achieve this goal:
- Rebuilt and strengthened health systems: Infrastructure, HRH management, Procurement and supply chain management.
- Improved quality of care at point-of-delivery
- Equitable utilization of health care services
- Strengthened decentralized planning and budgeting
- Improved sector management and governance
- Improved sustainability of health sector financing
- Improved healthy lifestyles and environment
- Strengthened management of public health emergencies