15th Five Year Development Plan (2019/20-2023/24) of Government of Nepal

Sector: Health and Nutrition

(Unofficial translation by Pratik Khanal, Public Health Professional)

Background

The Constitution of Nepal 2015 has ensured every citizen the provision of basic health services from the state as fundamental right. By taking into note the importance of healthy and productive citizens in national development. It is the state’s responsibility to ensure quality and equitable access to universal health care by increasing investment in health sector. In notion of fair and inclusive state, it is a necessity to transform health sector from profit oriented to service oriented sector. As per the constitution’s sole and shared right, the responsibility of health has been given to federal, provincial and local level government with the activities including health policy, guideline development, quality assurance, monitoring, conventional medicine, control of communicable diseases placed in the jurisdiction of the federal government. For its effective implementation, inter-ministerial coordination and collaboration is a necessity.

As a result of implementation of different health service related programs, infant mortality, neonatal mortality and under-five mortality has been reduced to 32, 21 and 39 per 1000 live births while maternal mortality has been reduced to 239 per 100,000 live births and total fertility rate is 2.3. Likewise, stunting among under-five children has decreased to 36%. In this context, the national action plan is to achieve Sustainable Development Goals (SDGs) taking into account the different international commitments made by Nepal, existing policies of Government of Nepal as well as main problems, challenges and opportunities of health and nutrition sector. It has been felt necessary to increase investment in modern medicine, Ayurvedic, Natural and Homeopathic Medicine, health governance and research for making population healthy. In this plan, state will play the lead role to provide health services to people’s door steps while private and cooperative sector will play complementary role.

Main Problems

• Lack of fulfillment of people’s expectation of access to quality and uniform health services
• Inadequate development of service oriented and public health responsible health services and human resources
• The return of investment in health sector was poor
• Lack of adequate modern equipment and specialist doctors in public sector health facilities
• Communicable and Non-communicable diseases
• Malnutrition
• Accident and disaster related health consequences
• Changes in lifestyle and food behavior due to globalization leading to increase in Non-communicable diseases
• Increase in mental health problems
• Inconsistency in health workforce product and utilization
• Climate change
• Increasing food insecurity
• Natural disasters leading to humanitarian problems
• Anti-microbial resistance (AMR)
• Low decline rate of MMR
• Under-nutrition among more than one-third of under-five children and reproductive aged women
• Ineffective regulation and coordination for private sector’s participation in community based health services

Opportunities and Challenges

Challenges

• Establishing equitable access to all sectors of health
• Delivery of free and quality basic health services in all local level governments with universal access
• Provision of health services with focus on ultra-poor and vulnerable population
• Decreasing out of pocket expenditure
• Ensuring availability and adequate source of health financing
• Management of health facilities in federal system
• Effective implementation of health insurance
• Gradual transformation of profit oriented health sector to service oriented sector.
• Management of socially responsible and qualified skill mix health workforce
• Self-reliance in production of drugs
• Addressing health problems resulting from climate change, rampant urbanization and unhealthy lifestyle
• Effective management and regulation of drugs and medical equipments
• Management of integrated and technology friendly health information system to fulfill the health information needs of all levels and increased use of data in monitoring, evaluation, review, policy formation and decision making process.
• Development of mechanism to record cause of deaths
• Regular research
• Maintaining governance in health and nutrition sector through quality assurance and regulation of health services.

Opportunities

• Sharing responsibility on health service related constitutional rights among federal, provincial and local level governments.
• Implementation of health insurance based on policy and legal provision.
• Increasing investment in health sector from provincial and local level governments through their own funding source
• Increasing civic sense on health as well as development of infrastructure
• Expansion of health networks to community level
• Focus of existing health policy and programs on management and quality of health services
• Evidence being prioritized by all levels of government in policy formulation and decision making process.

Vision, Goal, Objectives and Action Plan

Vision

Healthy, productive, responsible and happy citizens

Goal

To ensure access to quality health services at the population level by strengthening and expanding health system at all levels.

Objectives

• Develop and expand all types of health services equitably in central, province and local level.
• Enhance the government’s responsibility and effective regulation for ensuring accessible and quality health services; transform health sector from pro-profit to service sector.
• Increase access to and utilization of health services through multi-sectoral coordination and collaboration; make service providers and service users more responsible and promote healthy lifestyle.

Strategy and action plan

1. Ensuring access to quality basic and specialized health services
Action Plan

1. Necessary package and protocol will be developed and implemented for universal access to free basic health services.
2. Utilize telemedicine and modern technology in health sector; develop and implement guideline for mobile health program in coordination with private and development sector to expand access of health services to rural population.
3. Community based rehabilitation centers will be established in all levels.
4. Based on disease burden and effectiveness, immunization services will be provided and immunization fund will be strengthened for making immunization services sustainable.
5. Promotional programs will be conducted for improving relation between service providers and service users.
6. Adequate budget will be ensured for effective implementation of Nepal Health Infrastructure Development Protocol and Minimum Service Protocol for improving quality of health services at all levels of health facility.

2. Develop and expand Ayurvedic, natural medicine and other complementary medicines in a planned way.

Action Plan

1. Institutional mechanism will be developed for identification, collection, preservation and promotion of locally available medicinal herbs and minerals.
2. Health tourism will be promoted by establishing service center for Ayurveda and other complementary medicine at national level.

3. Address health needs of population of all age groups based on life cycle approach with more focus on maternal and child health, adolescent health and family management services.

Action Plan

1. Services related to maternal and neonatal health; child health and adolescent health; and family management services will be further strengthened and expanded.
2. Health services will be made gender, elderly and disabled friendly.
3. Provision will be done for screening and diagnosis facilities for timely identification of health risks.
4. Provision will be made for free screening and diagnosis of diseases like breast cancer and cervical cancer.
5. Evidence based midwifery education and services as well as special programs will be developed and implemented for reduction of maternal mortality. 

4. Develop and expand health facilities based on population distribution and geography; and build technically sound and social responsible health workforce

Action Plan

1. At least one basic health service center in each ward; primary hospital in each municipality; secondary level hospital, specialized hospital and one health science academy in province level and super-specialty hospitals in central level will be established.
2. Expanded health services will be implemented in public sector hospitals with additional services to increase access to services and implement ‘One doctor/health worker-One health facility’ approach.
3. A master plan will be developed for effective management of health workforce and health institutions.
4. Scholarship will be provided for study in different health science disciplines based on country’s health needs.

5. Increase government financing in health and build sustainable health financing system.

Action Plan

1. Integrated national health financing strategy will be developed and implemented.
2. Basic health services will be provided free of cost; health insurance will be implemented for covering treatment of specialized and other health services.

6. Management and regulation of cooperation and collaboration between public-private and non-government sector.

Action Plan

1. One school-one health worker’ policy will be implemented in coordination with education sector.
2. Umbrella structure of health related professional councils will be developed by strengthening its workforce, organogram and working area.
3. Integrated act will be developed for management of health science academies.
4. Guideline will be developed for coordination with private, community and non-government health institutions.
5. Clinical governance will be maintained by incorporating public, private, community and cooperative sector. Regulation of health care cost will be done by developing specific guideline.
6. Regulatory mechanism will be developed and province and local government will be made responsible for management of health care waste.

7. Regulation of production, import, storage, distribution and utilization of medical equipments, drugs and supplies.

Action Plan

1. Self-reliance in production of drugs will be built.
2. Promotion of farming of medical herbs and development of medical industries will be done along with effective production, storage and distribution of medical goods.
3. Regulatory mechanism will be developed to address antibiotic resistance; implement generic prescribing, set price of drugs and quality control measures and for drug research.

8. Implement integrated measures for control of communicable and non-communicable diseases as well as for disaster preparedness and response.

Action Plan

1. Integrated institutional mechanism will be developed for prevention, control, elimination, monitoring, surveillance and research of communicable and non-communicable diseases.
2. Long term plan will be developed through multi-sectoral coordination for effective implementation of prevention, control and treatment services of non-communicable and chronic diseases.
3. Control and treatment programs will be developed based on research for addressing sickle cell anemia, Thalassemia and other genetic diseases.
4. Access to mental health services will be expanded at all levels.
5. Health care services related to eye, ear, nose, throat and oral health will be gradually developed and implemented in central, province and local level.
6. Guideline for rapid response to disaster, improvement of ambulance services and mobilization of skilled health workers will be developed and implemented.

9. Increase use of evidence based decision making by strengthening health information system.

Action Plan

1. Use of evidence in decision making at all levels will be promoted through quality and user-friendly data management approach.
2. Data management will be made technology friendly at health facility level for electronic reporting and electronic health record will be gradually expanded in all health facilities.
3. A system for integrating locally generated health data with national portal will be developed.
4. Survey, research and studies will be done based on national health needs and priorities and the evidence generated will be used in policy making and designing programs.

10. Expand working area of Nepal health Research Council to province level.

Action Plan

1. Institutional arrangement of NHRC will be established in province level in coordination with academic sectors.

11. Develop measures to prevent and manage the public health threats of imported cases.

Action Plan

1. Management information system will be developed for responding threat of imported infectious cases; and policy and institutional measures will be formulated for providing screening and health care services.

12. Effective implementation of multi-sectoral nutrition plan through coordination and collaboration.

Action Plan

1. Nutrition related mechanisms and nutrition sensitive and nutrition focused programs will be implemented from all health facility levels.
2. Access to and utilization of quality and healthy foods will be improved and promotion of healthy food behaviors for reducing malnutrition will be done.

13. Incorporate health in all policies through multi-sectoral coordination.

Action Plan

1. ‘One Health Approach’ will be implemented by incorporating health in all policies through multi-sectoral approach.
2. Control and regulation of tobacco and alcohol use, chemicals and unhealthy foods will be done; scientific and effective health messages will be developed to reduce the use of health harming processed foods.
3. Advocacy and coordination will be done with stakeholders to promote healthy food behavior, physical activity and clean environment.
4. Mechanism will be developed in central, province and local level for public health impact assessment before the approval of industries, project or any other services.

Expected outcomes

• At the end of the five year plan, life expectancy of Nepalese population will increase to 72 years.
• Maternal mortality will be reduced from 239 to 99 per 100,000 live births; neonatal mortality will be reduced from 21 to 14 per 1000 live births and under-five mortality will be reduced from 39 to 24 per 1000 births.
• Prevalence of under-weight among under-five children will be reduced from current 27% to 15 % while stunting will be reduced from 36% to 20%.
• Nepalese population will receive basic health services free of cost.
• Population coverage in health insurance will increase to 60%; Out of pocket payment will be reduced from 55% to 40% and government investment in health sector will increase from 4% to 8%
• Proportion of population residing within 30 minutes of distance to health facility will be 80%.
• The proportion of women attending at least four Antenatal check-up will increase from 69% to 81%, delivery attended by skilled birth attendant will increase from 58% to 79% and children receiving full immunization services will increase from 78% to 95%.
• Malaria, Kala Azar and Lymphatic filariasis will be eliminated from Nepal.

DOWNLOAD PDF FILE (Unofficial translation)

15th Five Year Development Plan (2019/20-2023/24)