Review of current health service planning in Nepal from province to local level
1. Practical Skill Development
on
Review of current health service
planning in Nepal from province to
local level
( PSD work was carried out in the partial fulfillment of PSD 525 Public Health
Service Management)
Presented by
Group A
MPH II Semester
School of Health and Alied Sciences
Pokhara University
15/10/2020
2. Group Members
Name of Students
Mohammad Aslam Shaiekh
Selina Shiwakoti
Nabin Prasad Chaudahry
Jene Shrestha
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3. Introduction
• Process of setting goals and choosing the actions to
achieve these goals.
• Nepal’s new Constitution envisions three tiers of
Governments in Nepal (Federal, provincial and local)
• Seven provinces of Nepal were formed on 20
September 2015.(1)
• Each district (77) has local units.
• It includes : 6 metropolitan Cities, 11 Sub-
Metropolitan Cities, 276 Municipalities and 460
Rural Municipalities. (2)
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4. Introduction
• In provincial and local health system, bottom-up and
top-down approach for effective is followed, in
Gandaki Province.(3)
• Health planning is done on the basis of budget. (4, 5,
6)
• Budgeting every year is based on unconditional
budget and conditional budget provided by federal
government to provincial and local
governments.(4,5,6)
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5. Rationale of the study
• The government of Nepal has adopted the new
federal system and experiencing the different
strategies to govern the federal, provincial and
local government system which is very new
concept.
• Changing different structure, organogram,
staffing pattern, role and responsibility and the
planning and budgeting system may be differ in
each level of government system.
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6. Objectives:
General Objective:
• To review the current health planning and budgeting
system from province to local level in Nepal.
Specific Objectives:
• To explore the health program planning system in
provincial and local level.
• To explore the health budget planning system in
provincial and local level.
• To identify the challenges of implementing the health
system planning and budgeting in federal system of
Nepal.
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7. Methodology:
Study area:
Two government organizations were visited
• At Province Level: Health Directorate, Gandaki
Province
• At Local Level: Pokhara Metropolitan city, Kaski
Field visit duration:
• The duration of this field practice was 3 days
(21-23 April 2019).
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8. Methodology
Technique and tools used for Review of System:
• Rapport building through the phone call with
focal person of PHD to confirm the date for
visiting the PHD to collect the required
information
• Interaction
• Meeting - formal and informal
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9. Findings and Results
At Local Level:
Pokhara Metropolitan city :Total Population
4,79,000
• 33 wards
• 41 service outlets : It includes
1 Hospital,
2 PHCs,
1 Urban Health Promotion Centre,
2 Ayurvedic Dispensary,
16 Urban Health Clinics and
19 Health Posts
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10. Findings and Results
• 88 PHC-ORC,
• 112 immunization clinics and
• 654 FCHVs
• Monitoring of FCHVs by Metropolitan City at
every 6 months
• At every 3rd day of month, the monthly meeting
of in-charge of health facilities was conducted,
review of progress report was done, and the
information was reported in HMIS 9.3.
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11. Findings and Results:
• System of top-down and bottom up approach for
program planning and budget planning.
• Top down approach is using for conditional
health program planning and budgeting and
bottom up approach is using for unconditional
budget planning for health in metropolitan city
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13. Ministry of Finance
Resources allocation
National Planning Communication (NPC)
Final recommendation for budgetary allocation
EDPS/Donor agencies
Resources allocation
Line agencies/Ministry
Recommendation for budget
(MOHP, MOE, MoFAGA),
MoPIT, MWCSC, DoHS
Ministry of federal affair and
general administration, ministry
of education, ministry of physical
infrastructure and transport,
Ministry of women, children and
senior citizen,
Ministry of water supply and
sewage
Ministry of forest and
environment
(Multi-lateral/Bi-lateral
agencies,
I/NGOs)
District Coordination
Committee
Municipality/Rural Municipality
Assembly/Council (Prioritize,
coordination, fund allocation and
approval
Need collection, Ward health
planning and prioritization
workshop
Basic Health facilities
(PHCC, HP, UHC, CHU)
PHC/ORC, FCHVs)
NGOs /CBOs, Child club,
youth clubs and INGOs.
Agriculture, livestock,
education sectors
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FederalgovernmentLocalGovernment
Source: MOHP, MoFAGA
14. Revenue and consulting
committee:
1.Rural/Municipality vice-chair person/deputy-chief
- Coordinator
2.Rural/Municipality executive officer
- Member
3. Allocated 2 respected member including 1 female by
Municipality - Member
4. Local Federation of Nepalese chambers of
commerce and industry chief or representative
- 2 Member
5.Rural/Municipality revenue- section officer
- Secretary member
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15. Resource estimation and budget
ceiling allocation committee:
• Rural/Municipality chairperson/Mayor
- Coordinator
• Rural/Municipality deputy-chairperson/deputy-
Mayor - Member
• Representative member(female, dalit and
municipal member) allocated by
rural/municipality chairperson/Mayor
- 3 members
• Rural/Municipality Planning section chief
- Member Secretary
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16. Program planning and
budgeting Committee
• Rural/Municipality chairperson/Mayor
- Coordinator
• Sector wide officer or representatives 6 members
- Members
• Rural/Municipality executive officer
- Secretary Member
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17. Health Planning and budgeting
process at Provincial Level
• 11 Districts in the Gandaki province
• Provincial health directorate under the MoSD.
• Each district have health offices under the
province, which technically support local level
health facilities.
• Provincial Assembly prioritizes, coordinates for
fund resource allocation and forward for review
and approval of health program and budget to
health directorate.
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18. Ministry of Finance
Resources allocation
National Planning Communication (NPC)
Final recommendation for budgetary allocation
Ministry of federal affair and
general administration, ministry
of education, ministry of physical
infrastructure and transport,
Ministry of women, children and
senior citizen,
Ministry of water supply and
sewage
Ministry of forest and
environment
EDPS/Donor agencies
Resources allocation
Line agencies/Ministry
Recommendation for budget
(MOHP, MOE, MoFAGA),
MoPIT, MWCSC, DoHS(Multi-lateral/Bi-lateral
agencies,
I/NGOs)
Ministry of social
development-7
Multi-lateral and Bi-lateral
agencies, I/NGOs,
Agriculture, livestock,
education
Provincial Health Directorate-
7
FederalgovernmentProvincialgovernment
Health Office
Provincial Assembly/Council
(Prioritization, coordination,
fund allocation, and approval
18Source: MOHP, MoFAGA5/10/2020
22. Planning and Budgeting
Process and Time Frame:
22
Source: Local level planning and budget drafting guidelines-2074
5/10/2020
23. Strengths
• Decentralization process reduce
disparities in access, and improve health
outcomes.
• Several potential opportunities for the
national healthcare system as decision-
making has been devolved to the federal,
provincial and local governments.
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24. Strengths
• Newly elected bodies can involve directly during
planning and budgeting in local level.
• Direct responsible for the allocation of budget
and planning as per local need and health
problem.
• Practice of good governance on planning and
budgeting of health program and activity with
full participation of local community and
stakeholders.
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25. Challenges at Province Level
•To ensure the uninterrupted supplies of medical
commodities and services in transition period.
• Less power of authority to provincial
government than local government and it has
just responsibilities to provide technical support
to local level and coordination between
provincial government and local government.
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26. Challenges at local Level:
• Issues like infrastructure development and
human resource development need to be
addressed.
• Budget disbursement is a major challenge as it is
harder to allocate and disburse budget in a
timely manner to multiple layered and widely
dispersed local authorities.
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27. Challenges at local Level
• Timely and effective monitoring and evaluation
of several fragmented local authorities and
agencies
• Delay in decision making could be an issue with
lack of prior experience and expertise.
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28. Conclusion:
• The federal governance redistributed the
decision making power and resources among the
central, provincial and local governments in all
sectors including health.
• Health system in Nepal is functioning under new
governance with Ministry of Health and
Population (MoHP) at the central level, Ministry
of Social Development at the provincial level and
health section or health department under the
local level governments.
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29. Conclusion
• The provincial governance contributes and
facilitate to local level governance for planning
and effective utilization of resources
• Effective coordination and communication
channels plays an important role between
different levels of governments for ensuring the
provision of basic health services, increasing
population coverage in health insurance and
other social security measures, and in providing
quality and equitable health services
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30. Recommendation
• Adequate collaboration and coordination
between different sector and tiers of government
• Clarify on job description of every Sections and
Division
• Orientation and capacity building to newly
elected bodies and health staffs on current health
planning and budgeting.
• Implementation of plan and activities on timely
manner
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31. Recommendation
• Scaling up the ability of local bodies to manage drug
procurement and general logistics and adequate
human and other resource in local healthcare
centers
• Proper Prioritization of Health activities
• Adequate infrastructure and human resource
management at local level through trainings and
capacity building activities
• Involvement of stakeholders and other sectors in
health system planning at local level government
need to strengthen
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32. Skill learning and
development:
• Exploring the information in detail through
interaction
• Cognitive skill on the process of health planning
and budgeting system in province and local level
• Familiar with the organizational structure and
staffing pattern of provincial health directorate
and health division of metropolitan city of Kaski
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34. REFERENCES:
1. Government of Nepal. Constitution of Nepal. http://www.
easynepalityping.com/nepali-sanvidhana. ccessed January 25, 2018.
Published 2015.
2.(MoFALD) MoFALD. Local level planning and budget Drafting guidelines.
2074. p. 1-12.
3.Hogarth J. Glossary of health care terminology. Copenhagen, World Health
Organization, Regional Office for Europe, 1975.
http://whqlibdoc.who.int/publications/9290201231.pdf WHO 1988
4.WHO | Health Systems Strengthening Glossary [Internet]. WHO. [cited 2019
May 12]. Available from:
https://www.who.int/healthsystems/hss_glossary/en/index5.html
5.Thapa R, Bam K, Tiwari P, Sinha TK, Dahal S. Implementing federalism in the
health system of Nepal: opportunities and challenges. Int J Health Policy
Manag. 2019;8(4):195–198. doi:10.15171/ijhpm.2018.121
6.Rubio DJ.The impact of decentralization of health services on health
outcomes: evidence from Canada. Appl Econ 2011;43(26)3907- 3917.
doi:10.1080/00036841003742579
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Health directorate review and approve the health budget and program planning and finally forward to Ministry of Social Development (MoSD) for approval of provincial program and budget.
MoSD forward it to the concerned ministry of federal government and final Federal government/National Planning Communication (NPC) Final recommendate for budgetary allocation
