health

1. Health plans and policies

2. First long term health plan (1975-1990)
• A First Long Term Health Plan (1975 - 90) was formulated with a calendar of
operations for the Fifth, Sixth and Seventh Five Year Plans.
• The main emphasis was the provision of comprehensive basic health
services to the majority of the rural population.
• This plan majorly emphasizes on popularizing family planning plus
maternal and child health to check population growth.

3. Cont…
• The reason for the compilation of the FLTHP was basically to ensure
consistent and proper functioning of the health services in an
environment prone to be subjected to personal whims of the political
leaders and their technical and non-technical advisors.

4. Target of First Long Term Health Plan
 Number of Hospitals 95
 Beds 4415 (4665)
 Health posts 1462
 Control of Small-pox, TB, Leprosy
 Human Resources to be developed in country
 Expand services of FP
 Develop Basic Health service in rural & remote areas
 Strengthen the hospital services
 Environmental Health and Health Education
 Establish Regional Directorate and District Health Office
 Career ladder for health workers
 Para-military training to all health workers
 Laboratory services at regional level

5. Achievement of First Long Term Health Plan (as
reviewed in SLTHP)
• Health Posts 816
• Health Centers 18
• District Hospitals 61
• Zonal Hospitals 9
• Total Hospitals 114
• Total beds 4848
• Total Doctors 1182
• Total Nurses 2980

6. Second long term health plan (1997-2017)
• Presented by yourself.

7. Periodic plans
• Pre-Plan Period, 1951-56
• First Five Year Plan, 1956-61
• Second Five Year Plan, 1962-65
• Third Five Year Plan, 1965-70
• Fourth Five Year Plan, 1970-75
• Fifth Five Year Plan, 1975-80

8. Plans…
• Sixth Five Year Plan, 1980-85
• Seventh Five Year Plan, 1985-90
• Eighth Five Year Plan, 1992-97
• Ninth Five Year Plan, 1997-2002

9. Cont..
• Tenth five Year plan:-
• Following the local self government ant 1999, started to hand over SHP, HP
and PHCC to local bodies
• Developed national capacity to produce human resource in health sector
• Started bottom up approach
Distinct Features
• It is Nepal’s poverty reduction strategy paper (PRSP)
• It recognizes the role of local bodies
• It uses modern planning and logical framework to define institutional
task
• It has clearly defined Priorities: P1, P2 and P3 projects
• Extensive monitoring and evaluation provisions, including
commitment for annual poverty monitoring

10. Cont…
• First three Year Interim Plan, 2007/8- 2009/10:-
• Laying a foundation for economic and social transformation
• Adopting an inclusive development process and carrying out targeted programs
while focusing on excluded group
• Establishing the right of all citizens to free basic health care services without any
discrimination.
• Second three Year Interim Plan, 2009/10- 2011-12
• Encouraging partnerships between public and private organizations, NGOs
• Developing appropriate referral systems
• Controlling and treating NCDs like, cancer, heart disease, mental health problems,
DM, HTN

11. Cont…
• Third three year interim plan, 2012/13- 2014/15
• To increase the access and quality of free and basic health services by
improving policy and strategy
• To develop the capacity of health institutions for effective conduction of
preventive, promotive, curative and rehabilitative service by managing
HR, medicine and equipment
• To mobilize the community and civil society for health service
awareness.
• To strengthen the monitoring and evaluation work.

12. Essential Health Care Services
• “Essential Health Care Services at the District level and below” are
priority public health measures and essential curative services for the
treatment of common illness and injuries:- that GoN will ensure the
availability to the total population.
• These services address the most essential health needs of the
population and are highly cost effective.
• Provision of Essential Health Care Services is linked to the recognition
that the resources available to the health sector through GoN and its
donor partners are inadequate to address all of the possible health care
needs of the people.

13. Content of Essential health care services for
the modern system of medicine
1. Appropriate treatment of common diseases and injuries
2. Reproductive health services
3. EPI + hepatitis B vaccine
4. Condom promotion and distribution
5. Leprosy control
6. Tuberculosis control
7. Integrated management of childhood illness
8. Nutritional supplementation, enrichment, nutrition education and
rehabilitation
9. Prevention and control of blindness

14. Cont…
10.Environmental sanitation
11. School health service
12. Prevention of deafness
13. Substance abuse including tobacco and alcohol control
14. Mental health services
15. Accident prevention and rehabilitation
16. Community based rehabilitation
17. Occupational Health
18. Emergency preparedness and management

15. Nepal Health Sector Programme-
Implementation Plan (NHSP-IP) (2003-2007)
• The aim of Government of Nepal is to provide an equitable high
quality of health care system for the Nepalese people.
• To meet this, along with other policy and plan GoN has formulated
NHSP-IP.
• Nepal Health Sector Program is a sector wide approach (SWAP) with
an agreed of Programme performance indicator and policy reform
milestones for the Programme duration.
• The programme seeks to address inequities in the system and
improve the health of the people.

16. Cont…
• NHSP-IP provides operational guidelines for implementing the
outputs of the Health Sector Reform Strategy during it’s five years
(2004-2009).
• The Focus is to increase the coverage and raise the quality of the
EHCS, with special emphasis on improved access for poor and
vulnerable groups.
• Achievement of this is expected to increase greater utilization of EHCS
by the people and ultimately to improve health status.

17. Outputs
1. Prioritized EHCS
2. Decentralized health management
3. Private and NGO sector development
4. Sector management
5. Financing and resource allocation
6. Management of physical assets
7. HRD, Quality of training, co-ordination between MoE, MoHP and CTEVT
8. Integrated management information system, implement quality
assurance Policy.

18. Program Outputs of NHSP - IP
Output One: Prioritised EHCS
1. Costing of resource allocation for EHCS
2. Redefine institutional arrangements for delivering
EHCS
3. Develop systems for priority access for poor and
vulnerable groups
4. Strengthen Outpatient Services
5. Enhance Behaviour Change Communication (BCC)
activities

19. Program Outputs of NHSP - IP
Output Two: Decentralised health
management
1. Introduce Local management of
Sub-health Posts
2. Create Hospital autonomy and initiate
resource mobilization

20. Program Outputs of NHSP - IP
Output Three: Private and NGO
sector developed
1. Establish district level Health Co-coordinating Committees.
2. Establish sub-committees or workgroups for specific program
areas to co-ordinate the work of government, donor and
I/NGO groups
3. Up-date Inventory of existing Private/NGO/Public involved in
health sector, by district
4. Define an appropriate Public/Private/NGO/ mix for each
district
5. Set quality standards and regulatory mechanisms for private
and NGO sector service delivery.

21. Sector Management Outputs of NHSP - IP
Output Four: Sector Management
1. Strengthen joint MoH/donor annual planning,
programming, budgeting and monitoring cycle
2. Strengthen ongoing MoH/Donor programmatic
collaboration
3. Strengthen Sector Management at the Central Level
4. Strengthen Regional and District Management
5. Capacity building at central and district levels
6. Assess institutional and organisational arrangements
systematically.
7. Re-define roles and responsibilities throughout the
health system.

22. Sector Management Outputs of NHSP - IP
Output Five: Financing and resource allocation
1. Identify health sector priorities and re-allocate
resources to those services.
2. Explore alternative financing arrangements, such as
community health insurance, explored.
3. Develop national guidelines for user fee practices
and other payments in public facilities
4. Strengthen drug financing mechanisms to support
increased and equitable availability of essential drugs

23. Sector Management Outputs of NHSP - IP
Output Six: Management of physical assets
1. Improve product selection and quality
2. Strengthen commodity distribution system
3. Expand and strengthen drug financing mechanism
4. Implement National Drug Policy in relation to
essential drug
5. Strengthen Logistics Management Information
System (LMIS)
6. Strengthen disaster relief commodities management
7. Establish quality and safety policies and systems

24. Sector Management Outputs of NHSP - IP
Output Seven: Human Resource Development
1. Locate HRD unit in an appropriate MoH structure
and reform it.
2. Improve personnel management system in a
effective way
3. Improve co-ordination and quality of in-service
training
4. Provide training in newly identified areas of training
needs
5. Improve co-ordination between the Ministry of
Education (MoE), MoH and CTEVT for preservice
education.

25. Sector Management Outputs of NHSP - IP
Output Eight: Integrated MIS and QA
Policy
1. Develop and establish integrated Management
Information System
2. Establish and implement Quality Assurance (QA)
Policy

26. Nepal Health Sector Strategy
• Nepal health sector strategy (NHSS) is a commitment to achieving the
improved health outcomes set out in government’s 10th five year plan,
PRSP, and MDGs.
• The NHSS proposes to take a strategic approach to reform making health
services available to all especially disadvantaged and poor group of
people in rural, remote areas.
• It acknowledges the role of private and NGOs service provider, the need
of decentralization of services.

27. National health policy 2071
• You have presented.
• Sub sectoral health policies:-
• National Blood policy (1993), revised in 2005
• National drug policy (1995)
• National AIDS policy, 1995, updated in 2011
• National mental health policy, 1995
• National Ayurveda health policy, 1996
• National safe motherhood policy, 1998
• National health research policy, 2003

28. Cont…
• National oral health policy and strategy, 2004
• National nutritional policy and strategy, 2004
• National safe abortion policy, 2006
• National skilled birth attendants policy, 2006
• Health care technology policy, 2006
• Policy on Quality health services, 2007
• Free essential health care policy, 2008
• Free delivery policy, 2009

29. • National Population policy, 2071

30. Assignment
1. Critically analyze the National health policy 2071. (300 words)
I. Introduction/Background
II. Rationale
III. Lacking in previous policy
IV. Present situation
V. Problems/challenges
VI. Conclusion