Contents

1. NJAR Agenda
2. NJAR Objectives
3. MoHP
4. DoHS
5. Provinces
6. DDA
7. DoAA
8. DUDBC
9. HIB
10. Reflection from pre-NJAR field visit
11. COVID-19 response
12. Federal hospitals
13. Academies
14. Councils
15. NHA
16. NHFS
17. NHFS2021 (Preliminary Findings)
18. EDPs
19. AIN
20. Key issues and priority actions, MoHP

Objectives

• Jointly review the annual progress of Health Sector policy, Strategy and Plan
• Build shared understanding among all stakeholders on achievements and challenges
• Identify the strategic priority areas that need to be included in next Health Sector Strategy
• Review COVID-19 pandemic preparedness and response at all spheres of Government
• Agree on the strategic actions to be included in the next year’s Annual Work Plan and Budget (AWPB).

Major Issues and Priority Action Points

Key Success Factors

• Dedication: Dedication and commitment especially of front-liners during COVID-19 pandemic and to scale-up of COVID-19 vaccination.
• Service continuity: Continuity of essential services during COVID-19
• Improved reporting: Improvement of reporting from peripheral health facilities
• Contribution: Engagement of and contribution of different stakeholders (development partners, INGOs, private hospitals, volunteers) to address health sector needs (e.g. vaccines, critical care equipment, community engagement etc)
• Exemplary initiatives: Exemplary initiatives by different local levels, hospitals and academia during pandemic.

Key Issues

• Coordination: gaps between three tiers of government for planning and health service delivery, poor linkages with academia and insurance authority.
• HRH: Insufficient HRH due to vacant positions, lack of updated organizational structure and skills gap in context of federalism.
• Information Systems: Integration and interoperability issues between MIS and fragmented EHR, untimely and incomplete reporting from federal hospitals and private sector.
• Procurement and Supply Chain: Logistics management capacity, Functionalization and maintenance of medical equipment, stock-out of drugs and supplies, duplication in procurement process, quality and cost concerns, role and functions at different levels.
• Hospital services: Unstandardized and inadequate health care waste management.
• Service delivery: Unclear modality for ensuring delivery of BHS, Delayed reimbursement of insurance claims, service quality concerns.
• Governance: Inadequate use of governance mechanisms and tools.
• COVID-19: Risk posed by new variant, vaccine coverage, POE management.

Priority action points

Governance and Management

• Prepare a concept note/guideline for the organizational harmonization and facilitate O&M survey of the health sector institutions/hospitals (HCD and AD, by March 2022).
• Strengthening mechanism for collaboration between academy of health sciences and provincial governments for service expansion and delivery (PPMD, by April 2022).
• Regularize technical interaction, cross learning, periodic review, joint planning, and coordination meetings between federal, provincial and local level (HCD and PPMD, by March 2022).
• Finalize Acts/Bills for CDC, FDA, NHAB, Umbrella Act for Academics and Federal Hospital (PPMD, by April 2022).

Coordination/Collaboration

• Coordinate with Ministry of Education to review and revise the school and university level health related curriculum (HCD/NHEICC, March 2022).
• Collaborate with Medical Education Commission and Councils to develop a detailed work plan to realign the seats and curriculum in line with the HRH Strategy 2078 (HCD by March 2022).

Procurement and Supply Chain Management

• Develop a guideline to define clear scopes and functions of federal, provincial and local level for procurement of medicines, supplies, equipment and commodities (MD/DoHS, by March 2022).
• Advocate to revise Public Procurement Act and Regulation to address issues and challenges faced by health sector and facilitate process for (PPMD, by March 2022).
• Proceed to endorse Public Procurement Framework to facilitate Central Bidding and Local Purchasing (PPMD, by March 2022).
• Establish mechanism and regularize technical backstopping to province and local level to ensure quality and appropriate supply of medicine and commodities (MD, by May 2022).

Information Management

• Develop standards of integrated Electronic Health/Medical Record System and facilitate roll out and adaptation (PPMD by Feb 2022).
• Facilitate mechanisms to regularize on-time and complete reporting from low reporting health institutions (both public and private) (MD by Feb 2022).
• Create inter-operability between HF registry and HMIS and facilitate harmonization of interoperability between different health related information systems (PPMD, June 2022).
• Strengthen nation-wide community and facility based Maternal and Perinatal Death Surveillance and Response in the post-Maternal Mortality Study following Census 2021 (FWD, by July 2022).
• Regularize Trimester Knowledge Sharing Forums to share key findings from research and program review to guide policy and program planning (PPMD/NHRC, March 2022).

Hospital Management

• Conduct infrastructure and equipment audit on a regular basis in all Federal and Provincial hospitals (QSRD by June 2022).
• Develop SOP for equipment repair and maintenance in each province and implement (MD by June 2022).
• Develop Provincial Hospital Development Plan to guide service expansion, infrastructural development, referral mechanism and to capacitate Hospital Development Committees (CSD by June 2022).
• Strengthen interventions for improving quality of care (including waste management) based on the findings of half-yearly MSS and other reviews (QSRD, June 2022).

Peripheral Health Facilities

• Standardize profile (name, infrastructure design and criteria, human resource needs, services to deliver, budgetary provisions) of all peripheral level facilities (e.g. BHSCs, UHC, CHU) (PPMD, March 2022).
• Establish mechanism and strengthen coordination between three tiers of government for operation of basic hospitals (CSD, June 2022).

Infrastructure Development

• Review and update infrastructure related criteria for government owned health institutions (PPMD, by June 2022).
• Develop comprehensive multi-year Health Institution Development Plan (including infrastructure development and maintenance plan, service delivery plan).

Ayurveda and Alternative Medicine

• Develop Roadmap for Ayurveda and Alternative Medicines (DoAAM, April 2022).
• Scale-up Citizen Wellbeing Program (e.g. Nagarik Aaryogya Karyakarma) throughout all local levels (DoAAM, June 2022)
• Include Health Insurance in Ayurveda and Alternative medicine.
• Rollout A-HMIS to all ayurvedic health institutions.

Drug and Medical Products

• Extend institutional arrangement for drug regulation at each province through O&M (DDA/MoHP, June 2022).
• Ensure requirements of GMP certification and quality assurance of Ayurvedic medicines (DDA, June 2022).
• Develop new legal provisions for Emergency use authorization of drugs and vaccines (DDA, July 2022).
• Revise drug act including its scope of regulation to cover health products (DDA, July 2022).
• Conduct policy dialogue to increase domestic manufacturing of drugs (DDA, July 2022).
• Strengthen Health Informatics/technology Assessment Team (QSRD, June 2022).

Service Delivery

• Develop a mechanism to monitor availability and utilization of Basic Health Services (CSD, June 2022).
• Prepare mechanism and modalities to integrate Ayurveda services through existing health facilities through single outlet (PPMD, March 2022).
• Initiate online enrollment and improve drug availability to improve coverage for health insurance (HIB, June 2022).

Organization Structure and HR Management

• Develop mechanism to deploy and mobilize specialized cadre from federal level and advocate with concerned ministries (AD, June 2022).
• Facilitate cross-learning for recruitment, retention, motivation of critical human resources in coordination with Provincial Public Service Commission (AD/HCD by Feb 2022).
• Develop Human Resource Capacity Building Plan at Federal and Provincial Level based on training needs (NHTC, June 2022).
• Build capacity of local and provincial level health officials through modular training packages, coaching and mentoring (NHTC, June 2022).

COVID-19 / Health Emergency Preparedness & Response

• Finalize the Health Emergency Preparedness and Response Plan at federal and Provincial level based on mapping of needs, scope, resource (PPMD by April 2022).
• Review and finalize scope of COVID-19 designated hospitals (PPMD, by Feb 2022).
• Update COVID-19 protocols, standards and guidelines based on the needs and lessons learned (QSRD, Feb 2022).
• Review and update National Vaccination Deployment Plan (DoHS, by Feb 2022).
• Review vaccination coverage, post-vaccination surveillance and facilitate approaches to improve coverage in low coverage areas (DoHS, Feb 2022).

Recommended

• Progress of the Health and Population Sector, 2020/21 (NJAR Report)
• Progress of the Health and Population Sector, 2019/20
• Health Sector Progress Report 2018, Ministry of Health & Population
• Annual Report 2077/78- Health Directorate, Gandaki Province
• Department of Health Services Annual Report- 2076/77 (2019/20)
• DoHS Annual Report FY 2075-76 (Raw Data)