HEALTH SYSTEM OF NEPAL

PRESENTED BY:

DR. S.M. JASHIM UDDIN RAZIB ;

MPH (Health Service Management and Policy)

Department of Public Health and Hospital

Administration

ABOUT NEPAL Nationality: Nepali, Nepalese, Gorkhali

Religions: Hindu 81.34%, Buddhist 9.04%, Muslim 4.38%, Kirant 3.04%, other

2.2% (2011 census).

Literacy: Total population: 48.6%

Population: 29,033,914

Median age:total: 23.6 years

Population growth rate: 1.24%

Birth rate: 19.9 births/1,000 population (2016 est.)

Death rate: 5.7 deaths/1,000 population (2016 est.)

Net migration rate: -1.9 migrant(s)/1,000 population (2016 est.)

Total fertility rate: 2.18 children born/woman (2016 est.)

Urbanization: urban population: 18.6% of total population (2015)

Sex ratio: total population: 0.99 male(s)/female (2016 est.)

Life expectancy at birth: total population: 70.7 years

Maternal mortality rate: 258 deaths/100,000 live births (2015 est.)

Background

The health system in Nepal is 122 years old and based on

primary health care approach

The Health System introduced as the General Health Plan

in 1956 has been expanded by focusing on primary health

care, and a comprehensive network-like Health System

has been developed

Health services are mixed –both government and non-

government (for profit and not for profit)

The Health Care Systems

Health Service Delivery

Community based health services and interventions-immunization (mobile clinics -every month), Vitamin A and albendazole distribution (twice a year) & primary health care out reach clinics (mobile clinics- every month) from local health facility

Female community health volunteers and mothers groups

Hospital and facility based services-general, specialized and mobile

Health Service Organization

Sub Health Post

Health Post

Primary Health Care Centre

District Hospital

General Hospitals- zonal and regional headquarters

National Hospitals

NGO and Private Health Institutions

Health Governance

Ministry of Health and Population (MoHP) consists of 3

departments:

Department of Health Services (DoHS),

Department of Ayurveda (DoA),

Department of Drug Administration (DDA)

5 Regional Health Directorates (RHDs) directly under MoHP

61 districts are managed by District Health Office (DHO) with

support of District Public Health Officer (DPHO), whereas the

remaining 14 districts are managed by DPHO solely

Facility level health/hospital management committees

Regulatory bodies like Nepal Medical Council (NMC),

Nursing council, etc.

Health Financing

Government of Nepal

Donors

Local bodies –increasing trend for last two years

International non-government organizations

7.2% budget in health sector in current financial year

Levels Of Health Care

Primary:

SHPs (Sub-Health Post) HPs (Health Post) PHCCs (Primary Health Care Centers)

Secondary:

District hospitals Zonal hospitals Regional hospitals

Tertiary:

Central hospitals Teaching hospitals

Referral System In Nepal

Major Policies and Initiatives

Health sector reform

Sector wide approach

Millennium development goal

Poverty reduction

Social inclusion

Nepal health partnership compact and international health partnership plus

Global health initiative

Health System Funding Platform

Major Health Programmes

Institutional delivery declared free with maternity incentive scheme

Introduction of Free Health Care (service charges abolished and essential drugs provided for free)

Cash support to poor patients suffering from cancer, heart disease, CKD, Alzheimer’s disease and Parkinson’s disease

Compulsory 2 years posting of physicians (completing MBBS course in government scholarship) outside Kathmandu

Community based neonatal care

Nutrition supplemental programme

Challenges

Climate change and health

Equity, accessibility, quality and coverage of essential health care services

Nutrition

Inter agency coordination

Sustainability of health programme

Reemerging and new emerging diseases

Deployment and retention of Human Resources for Health(HRH) in remote and rural areas

Increase in non-communicable diseases