The First Nepal Public Health Conference conducted virtually on October 10 & 11 in the year 2020 amidst COVID-19 pandemic and the early years of implementation of federal governance, and recognizing the need for urgent
actions from governments and stakeholders at all levels, we as a professional organization, and conference participants collectively commit to the following declarations with an appeal for building resilient health systems in federal governance.

Declaration 1

Recognizing COVID-19 as a serious threat to the health system and lives of people:

• There should be improved coordination across the three spheres of governments with clear alignment in roles and communication towards responding to public health emergencies.
• Capacity enhancement of province and local governments need to be strongly backed up by central government especially in cases of investigation and contact tracing, quarantine and isolation management, information management, logistics management, and human resources for health.
• A reformation of existing policies and practice is critical to making local governments in particular, more accountable and responsive for addressing emerging public health threats and health system deficits (deficiencies?).
• Multi-sectoral efforts are required for responding to the public health emergencies by fostering public-private partnerships, with more focus on poor and vulnerable sections of the society. These actions will demand leverage of knowledge, resources and action along with the use of technology across the health and non-health sectors.
• While addressing public health emergencies such as COVID-19, ensuring continuation of essential health services also need to be a health sector priority to reverse the damage to the health system and lives of the people.
• Addressing the motivation issues and safety of frontline health and social workers need to be a priority for the health institutions and governments at all levels.
• Adhering to basic public health standards as a civic responsibility is also of paramount importance during public health emergencies. For ensuring this, there should be clear risk communication through community engagement strategies which also need to include ways for addressing stigma and discrimination against those exposed or infected with infectious diseases such as COVID-19.

Declaration 2

Acknowledging federalism as an opportunity for all levels of governments to target health as a development priority:

• A broader policy dialogue, consultative planning processes, and need-based budgeting is required to better prioritize the healthcare needs of the people, particularly the most marginalized and vulnerable populations
• Capacity enhancement of sub-national governments to plan, deliver and monitor quality and equitable health services is urgently needed through facilitative and technical support from the federal government.
• Intense efforts are required to build the capacity of the health sector at all levels as well as effective utilization of existing resources and increased investment in public health.
• Clarity in roles, mechanisms to collaborate and cooperate between all levels of government, development partners, academia and civil society is needed. These should be institutionalized in our policies, plans and strategies both at the national and sub-national levels.
• Understanding and acting on the social determinants of health in all policy approaches need to be strengthened further for which the health system needs to be informed by continuous contextual learning and adopting to inform the policies and improve the programs.

Declaration 3

Admitting the necessity to build an effective health system response and reorienting the focus of the government to attain universal health coverage,

• A competent, motivated and supported health workforce to plan, to deliver services, to monitor health sector progress, to research for new ideas and to disseminate health system learning more widely is required.
• Provision of quality healthcare and protection of people from emerging and reemerging diseases, non-communicable diseases & risk factors, and mental health disorders need to be a health system priority.
• Quality investment of resources in research, innovation and development through a clear health financing strategy is necessary.
• Health security schemes should be streamlined, and health insurance systems must be improved as an opportunity to enhance equity, social justice and quality of care without any financial hardship.

Declaration 4

Taking into account the need for producing quality public health professionals through competency-driven education system,

• A consortium needs to be built among the universities, academic and development institutions for quality public health education so that they can share their resources, strengths and experiences.
• There is utmost need for curriculum revision to make it competitive to produce public health professionals with the necessary skill-sets needed to build a resilient health system.
• Proper recruitment and deployment of public health human resources is imperative for better health sector response.

Declaration 5

Reflecting on the need for building a robust, resilient and responsive health
systems at all levels of governments,

• A continuous advocacy will be done for prioritizing the health system response as a binding agenda for all and as an urgent and long-term goal to safeguard, protect and promote the good health and well being of the people.
• Collaboration with other professional associations, councils, academic institutes, elected representatives, civil societies, development partners and public health practitioners will be done to jointly achieve these endeavors.