Progress of the Health and Population Sector, 2020/21 (NJAR Report)

NATIONAL JOINT ANNUAL REVIEW REPORT – 2021 (2078 BS)

The Ministry of Health and Population (MoHP) has published a progress report of the Health and Population Sector in 2020/21.

Major Achievements

While the COVID-19 pandemic demanded focused priority throughout the year, MoHP continued to implement the routine health programmes and provision of health services in FY 2020/21. The majority of activities carried out in 2020/21 were continuation of the programmes initiated in the past while focus was on the COVID-19 response management and vaccination in coordination with sectoral ministries, provincial and local levels and EDPs. Strengthening of the existing hospitals, establishing new health facilities at municipal level were also prioritised over the last year.

The major achievements in FY 2020/21 and highlights of 2021/22 are summarised below:

• National Strategy on Human Resources for Health in Nepal 2020/21- 2029/30 has been developed and endorsed by the MoHP. This assesses the situation of the HRH in Nepal and sets roadmap for the management of the HRH for future.
• The Health Institution Operation Standards (HIOS) has been developed and endorsed in 2021 as per the provision of Public Health Service Regulations 2020 (PHSR). Moreover, first amendment in the HIOS has been done incorporating provisions of Ayurveda and Alternative Medicines. These standards set the requirements that different types of the public and private health institutions have to fulfil to establish, operate and upgrade.
• MoHP, in collaboration with the Central Bureau of Statistics is conducting the Maternal Mortality Study following the National Population and Housing Census (NPHC). This study is expected to provide the robust estimates of the maternal mortality ratio at national and sub-national level in Nepal and can be supportive to design necessary interventions to reduce such mortalities.
• As per the reforms proposed in the policy and programme for 2020/21, draft legislations for establishing Centre of Disease Control (CDC), Food and Drug Administration (FDA), and the Health Accreditation Authority have been prepared. Moreover, consultation with provinces were conducted to collect feedback on the draft documents.
• Health Emergency Operations Centres (HEOCs) are functional in each of the seven provinces, cluster coordination mechanisms activated, and different guidelines/SOPs developed which played a crucial role in the management of the COVID-19 response.
• Although the number of the reported cases of COVID-19 is generally decreasing over the latest months, there remains the risk of resurgence of COVID-19 cases. Therefore, response actions are still being undertaken for the prevention of the transmission and other mitigation efforts against COVID-19. Remarkable progress has been made in vaccine coverage after vaccination campaign officially started on 27 January 2021.
• MoHP conducted two rounds of national sero-prevalence survey to find out possible infection by COVID-19. Preliminary findings from the second survey, completed in August, 2021, showed that the sero-prevalence in general population was found to be 70 percent.
• Documentation of health sector preparedness, response and lessons learnt on COVID-19 in Nepal is ongoing to inform the decision-making process ahead.
• Continuity of essential health services including diseases specific priority programs such as HIV, TB and Malaria during the pandemic by developing tailored guidelines and protocols.
• A draft of the Population Policy has been prepared and is in the consultation process.
• Resource package and reference manual on population have been developed to support the provinces and local levels in developing population related plans and programme.
• The policy of ‘one doctor, one health institution’ has been initiated in selected federal level hospitals.
• A guideline has been drafted to facilitate the pre-departure health assessment targeting to those who are going for foreign employment to minimise their suffering in the foreign country.
• As per the Government of Nepal’s (GoN) policy of ‘one municipality-one hospital’, establishment of hospital in 396 local levels (of 5-, 10- and 15-bed capacity) was initiated in 2020.
• Standard treatment protocols for Basic Health Services (BHS) and for Emergency Health Services have been developed and endorsed by the MoHP.
• The GoN has endorsed the Public Health Service Regulations 2020 (PHSR), the Safe Motherhood and Reproductive Health Rights Regulations 2020. The PHSR defines the package of basic health services along with other provisions for the operationalisation of the Public Health Services Act.
• Draft Minimum Service Standards for Ayurvedic health institutions has been prepared which will be applicable for different level of health facilities.
• The FMIP has been updated as the Nepal Health Sector Financial Management Strategic Framework, to guide financial management procedures. The framework was endorsed in 2020 and is being implemented.
• The Internal Control System Guidelines have been developed as per the Financial Procedures and Fiscal Accountability Act, 2076 (2019) and Financial Comptroller General Office (FCGO) directives. This guideline was recently endorsed by the MoHP in September 2021
• Technical Specification Bank is upgraded with additional features including a separate COVID-19 section with 117 coded technical specifications of COVID-19 medicines, supplies and equipment in 2020/21. During the same year, 24 new technical specifications of medical equipment and 3 specifications of pharmaceutical area are also added in the TSB
• Construction and refurbishment of healthcare waste treatment centre and hospital laundry building including other support services have been completed at 12 COVID-19 designated hospitals.
• Endorsement of learning resource package (LRP) for Integrated training on HCWM/ IPC, WASH and Environmental Health by NHTC in June 2021 in blended e-learning mode with Learning Management System (moodle platform).
• Target of the disbursement linked indicators have been achieved making the progress in the sector and facilitating the release of the fund from the development partners.
• Various regulations, standards and guidelines have come into effect for the standardisation and quality assurance of medical education in Nepal as per the National Medical Education Act 2075.
• Despite the challenges posed by COVID-19, field work of the Health Facility Survey has been completed and data analysis and report writing works are ongoing.
• National Health Financing Strategy that guides the overall financing architect for the health sector has been drafted and shared with line ministries/stakeholders for their review and input.
• National Health Accounts capturing the health expenditure estimates of 2017/18 have been prepared.
• The Integrated Health Information Management System (IHMIS) roadmap (2020-2030) has been drafted and is in the process of finalisation.
• For effective management of COVID-19 related information linked to surveillance, specimen collection, testing, case management, logistics, and human capital, Information Management Unit (IMU) has been established and functional
• Nepal made commitments to develop climate-resilient and low-carbon health systems in response to growing evidence of the impact of climate change on people’s health in UN Climate Change Conference in Glasgow (COP26) Health Programme in 2021.
• Five district hospitals have been upgraded to 25-bed hospitals, while all remaining district hospitals have been upgraded to 50-bed hospitals. Provincial hospitals are being upgraded to have 200 beds and hospitals under the federal government are being upgraded to have 500 beds’ capacity.
• Establishment of a 300-bed communicable diseases control hospital at federal level, and similar 50-bed hospitals in each province, has been initiated.
• The Programme Implementation Guideline for FY 2020/21 (for the programme of provincial- and local-level activities) was prepared and made public through the MoHP website.
• The Health Facility Registry has been updated. It is a master registry which keeps record of all health institutions in the country, both public and non-governmental.
• The MoHP continues to expand the electronic reporting of service data from HFs. In FY 2019/20, 400 public HFs provided HMIS monthly reports electronically, which has increased to 1,871 HFs in FY 2020/21.
• Roll-out of e-LMIS is completed in all provinces by December 2020 and was expanded at 138 additional sites including 9 LLG, 9 SDPs and 5 hospitals in 2021.
• One of the national hospital, Bir Hospital, has started online appointment system for outpatient services by developing its own mobile application. The application ‘Bir Hospital Book Appointment’ allows users to book appointments with the doctors of their choice.
• Health insurance scheme has been introduced in a total of 739 local levels of 75 districts. As of September 2021, 18.74% of total population in Nepal have been enrolled in the health insurance scheme.
• Health Insurance Scheme’s database is connected with “Nagarik” (Citizens’) App making the tracking of services utilisation against the benefit ceiling easily accessible to the enrolled families.
• Thirteen additional One-stop Crisis Management Centres (OCMCs) have been established which makes a total of 80 OCMC sites in 77 districts. The MoHP has plan to establish new OCMCs in 8 hospitals in FY 2021/22.
• Seven Social Service Units (SSUs) were established in referral and district-level hospitals; the total number of SSUs has gone up to 44. The MoHP has plan to establish new SSUs in 14 hospitals in FY 2021/22.
• Leave No One Behind (LNOB) Budget Marker Guideline for the health sector (2078), OneStop Crisis Management Centre (OCMC) Operational Guideline (2077), Social Service Unit (SSU) Operational Guideline (2078), Geriatric Inclusive Health Service Guideline (2077), have been developed/revised and approved.
• Geriatric Health Service Strategy has been submitted for policy approval, and the draft Geriatric OPD Service Guidelines is close to completion.
• Six-month long “Psychosocial Counselling Training Curricula” package (2077) developed and approved by MoHP.
• Four additional geriatric wards established in different hospitals, making a total of 24 hospitals with geriatric wards. The MoHP has plan to establish new geriatric health services in 25 hospitals in FY 2021/22.

• Progress of the Health and Population Sector, 2019/20