Health System and Public Health Development in Nepal

1. Health System and Public Health Development in Nepal Dr Sushil Baral Executive Director HERD INTERNATIONAL Kathmandu, Nepal

2. Nepal Health Sector Strategy [NHSS] 2015-2020 and its linkages Vision National Health Policy 2014 Mission Goal Outcomes (9) National Health Sector Strategy (2015-2020) Output (26) Key Interventions NHSS Implementation Plan Broad Activities Annual WorkPlan and Budget

3. NHSS Strategic Directions

4. Key Outcomes (9) - NHSS • 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 decentralised 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 • Improved availability and use of evidence in decision-making processes at all levels

5. What is what and why?

6. A health system needs - fund, functions and functionaries Health, Health System and Health Care Health System: composition of all - the organizations, institutions and resources whose primary purpose is to improve health Health refers to a state of the human body and mind Health Carerefers to chemicals, devices, and services used by people to improve their health Health financing: a system of covering costs for health care

7. What confuses often? (1) • to think that the public sector service delivery system is “the health system” • Public sector is never the whole “health system” • Leaves out households • Private finance, Private supply chain • Private workforce training • Health systemsare plural

8. Health and Development स्वास्थ्यः विकासको आधार

9. Physical Health Mental Health स्वास्थ्य HEALTH ४ भावनात्मक स्वास्थ्य (Spiritual Health) Social Health

10. स्वास्थ्य सेवाHealth Services Preventive Promotive Palliative care Curative Rehabilitative

11. स्वास्थ्य प्रणाली (Health System) आर्थिक श्रोत (Financial Resource) मानव श्रोत (Human Resource) स्वास्थ्य पूर्वाधार (Health Infrastructure) जनताको स्वास्थ्य आवश्यकता पुर्ति औषधि तथा उपकरण (Drugs and Equipment) Health Information System सूचना प्रणाली

12. स्वास्थ्यर गरिबी चक्रको सम्बन्ध गरिबी चक्र

13. Some facts and figures

14. Fertility Trends Births per woman for the 3-year period before the survey Source: NDHS 2016

15. Fertility Regional Comparison Births per woman for the 3-year period before the survey Source: NDHS 2016

16. Trends in Teenage Childbearing Percent of young women age 15-19 who are mothers or pregnant with their first child Source: NDHS 2016

17. Age at First Sexual Intercourse Percent of women and men age 25-49 who had sexual intercourse by: Source: NDHS 2016

18. Difference between Wanted and Actual Fertility Rates Source: NDHS 2016

19. Trends in Childhood Mortality Deaths per 1,000 live births for the 5-year period before the survey Neonatal mortality Source: NDHS 2016

20. Trends in Delivery Care Percent of live births in the 5-year period before the survey Delivery at home Delivery assisted by skilled provider* Delivery in a health facility NDHS 2016 *Skilled provider includes doctor, nurse, or auxiliary nurse midwife.

21. Prevalence of Hypertension by Age Percent of women and men age 15 and above with hypertension Men Women NDHS 2016 Age in Years

22. Framework for People-Centered Health Systems Strengthening

23. Health Partnerships

24. External Development Partners • UNFPA* • UNICEF* • USAID* • WHO* • DFID* • Gavi* • Global Fund (GFATM) • JICA • KOICA • German Dev. Cooperation • GIZ • KfW • IOM • UNAIDS • World Bank *signatories of the JFA

25. Support to MoHP by External Development Partners - Overview External Development Partners (Bilaterals and Multilaterals) Support to the Ministry of Health and Population Nepal Health Sector Strategy (2015-2020) Pool Funding (Red Book) Annual Workplan and Budget Project Support through project implementing partners Non-pool funding but through Annual Workplan and Budget Overall health sector programmes Programme specific areas Division and Centres

26. Issues • understanding of health as an illness over wellness • health sector competing among other priorities • quality of care through a quality health system • clarity of roles and responsibility - governance and accountability • Human resource management • use of evidence in decision making, policies and plans • cost of health care born by individual/household

27. Health is a development priority - its progressive realization is evident Every government as a Health System - size and components may be different What works in one country may not work or produce similar result in other setting Contextually tailored health system model can produce high-quality result than a simple adoption Each system should consider - population health, progressive reform, adhering citizens’ health needs and values, multistakeholder and multidisciplinary a mechanism of continue reflection, review and innovation should be considered to inform and reform the system People and People centered care should remain in essence of any health system KEY MESSAGE

28. Suggested Reference • Management Sciences for Health. Health Systems in Action: An eHandbook for Leaders and Manag- ers. Cambridge, MA: Management Sciences for Health, 2010. Available online at http://www.msh.org/ resource-center/health-systems-in-action.cfm and as a CD-ROM • World Health Organization. “What Is a Health System?” Geneva: World Health Organiza- tion, 2005, http://www.who.int/features/qa/28/en/index.html • Everybody’s Business: Strengthening Health Systems to Improve Health Out- comes: WHO’s Framework for Action. Geneva: World Health Organization, http://www .searo.who.int/LinkFiles/Health_Systems_EverybodyBusinessHSS.pdf