WHO Country Cooperation Strategy 2023–2027: Nepal

The Nepal–WHO Country Cooperation Strategy (CCS) 2023–2027 sets out how the World Health Organization will work with the country over the next five years. It is informed by the aspirations of the Nepal Health Sector – Strategic Plan 2023–2030, the Fifteenth Five-Year Plan (2019/2020–2023/2024) of the Government of Nepal, WHO global Strategic Priorities, as articulated in the Thirteenth General Programme of Work (GPW 13) with the SDG-based Triple Billion targets, and the United Nations Sustainable Development Cooperation Framework for Nepal 2023–2027.

The four Strategic Priorities of the CCS 2023–2027 are:

1. Strengthening the federal health system with a focus on primary health care and institutional capacity-building to achieve universal health coverage, identify implementation bottlenecks and reach vulnerable and underserved populations;
2. Enhancing the national capacity for managing health security threats, using an all-hazard approach, and building resilient health systems at federal and subnational levels;
3. Harnessing the use of data, research and digital technologies for guiding health planning, innovation and monitoring of service delivery at federal, provincial and local government levels; and
4. Addressing determinants for better health outcomes through multisectoral platforms and effective partnerships.

Strategic priorities for Nepal – WHO cooperation

1. Strengthen the federal health system by focusing on primary health care and institutional capacity-building to achieve universal health coverage, identify implementation bottlenecks and reach the vulnerable and underserved population.

Focus areas:
Health system strengthening

• Ensure technical support for implementation, review and monitoring of the Health Sector Strategic Action Plan, based on WHO normative work, translating international guidelines and evidence-based best practices into action.
• Provide technical support to the MoHP for developing technical briefs and guidance notes on health system strengthening in the federal context.
• Strategize technical assistance to accelerate implementation of federal, provincial and local-level health policies, frameworks and guidelines.
• Technical support in implementation and monitoring of basic health services delivery.

Human resources for health
This involves technical assistance in effective planning for equitable distribution of well-qualified human resources at federal, provincial and local government levels, as part of the implementation of the National Human Resources for Health Strategy (2021–2030) with a special focus on PHC.

• Promote PHC-based health workforce policies and practices and advocacy for increasing health staff in rural, hard-to-reach and underserved areas.
• Strengthen HRH information system for strategic planning, projections of human resource needs and reviews of the organizational structure of health facilities to better manage HR recruitment and deployment.
• Enhance human resource competency through training of health staff, including adoption of digital transformation in training and education as well as system mapping of Health Training system to support in the update & development of national health training strategy.
• Strengthen human resources in regulatory institutions at the federal level.
• Supporting to improve the institutional capacity of Health Training system at federal and province level.

Public financing of the health sector, paying attention to access to services for all people, including underprivileged and vulnerable groups, and out-of-pocket expenditure, involves:

• advocacy and technical assistance for improved social protection in the health sector through the provision and efficient financing mechanism for basic health services and support to the health insurance system in reviewing health insurance benefit package, strengthening provider payment mechanism, and developing health insurance related plans, strategies, and policies.
• National health accounts (NHA) at national and provincial levels, along with technical and policy briefs that are produced annually; the capacity of national and provincial stakeholders is built on the preparation and use of NHA to institutionalize these at federal and provincial levels; and
• the National Health Financing Strategy (2022–2032) and its effective implementation to enhance fiscal space for investments in the health sector.

Quality of health care

• Technical support using WHO guidelines for enhancing quality health services at national, provincial and facility levels involves:
  – ensuring quality diagnostic services through internal and external quality assurance systems;
  – implementing health service quality standards, protocols and guidelines.
• In collaboration with partners support Government to improve and maintain WASH infrastructures and promote WASH at health-care facilities as being essential for improving the quality of care and preventing the spread of antimicrobial resistance and ensure technical support for development and implementation of the roadmap for WASH at health-care facilities.
• Support different levels of government for institutional development and capacity building regarding HCWM and WASH in health care facilities
• Enhance support for scaling up of water and sanitation for health facility improvement tool (WASHFIT)
• Perform compliance monitoring of national standards for WASH at healthcare facilities, including WASH at health-care facilities indicators in IHMIS.
• Ensure technical support for implementation of service standards and infection prevention guidelines at the point of health service.
• Promote minimum reference standards for safety and quality of Ayurveda practice in line with the WHO Traditional Medicine Strategy.
• Develop and implement patient safety action plan for assuring quality health services at point of care.

Adoption of digital technology in health service delivery, information management and monitoring in line with WHO guideline involves recommendations on digital interventions for health system strengthening.

Access to essential medicines and diagnostics, having in place institutional capacity for regulation and quality assurance of local production and import of pharmaceuticals, diagnostics and vaccines (Department of Drug Administration):

• Continue support for the assessment of the Department of Drug Administration and the National Medicines Laboratory, using the WHO Global Benchmarking tool for evaluation of national regulatory system of medical products, and facilitate implementation of the Institutional Development Plan (IDP).

Ensure technical support to facilitate domestic production of essential medicines.

• Assess the current situation of local pharmaceutical manufacturing to recommend an action plan to facilitate domestic production of quality essential medicines.
• Ensure capacity-building of local manufacturers of medicines with regard to the current good manufacturing practices (CGMP), technology transfer and WHO prequalification.
• Ensure capacity-building to monitor the safety of vaccines and biologicals.

Strengthen the National Medicines Laboratory to improve the quality control and quality assurance mechanism of medical products.

Ensure technical assistance to enhance the regulatory mechanism for oversight of private health-care providers with a special emphasis on quality of care, adherence to national treatment guidelines, reporting essential health data to national programmes and formulating policies that minimize out-of-pocket payments.

2. Enhancing the national capacity for managing health security threats, using an all-hazard approach, and building resilient health systems at federal and subnational levels;

3. Harnessing the use of data, research and digital technologies for guiding health planning, innovation and monitoring of service delivery at federal, provincial and local government levels; and

4. Addressing determinants for better health outcomes through multisectoral platforms and effective partnerships.