Strengthening the health system, Nepal
Despite a decade of conflict and political instability, Nepal has made impressive health gains and is one of only a handful of countries to have achieved Millennium Development Goals 4 and 5. However, significant disparities in health outcomes and access to care persist between Nepal’s 126 distinct ethnic/caste groups, income groups and between people living in different regions.
The Government of Nepal is committed to increasing the health and nutrition status of the Nepali people by improving access to and use of quality essential services, especially targeting the poorest people, those living in remote areas and women and children.
We have been working in Nepal for nearly 20 years. We currently provide technical support to the Government of Nepal to implement its health sector programme through the Nepal Health Sector Support Programme (NHSSP), working in partnership with Crown Agents and Oxford Policy Management. We focus on strengthening the performance and interconnectedness of the health system building blocks: essential health service delivery, strategic information, health workforce, procurement of commodities, health infrastructure, health financing and policy.
Our experts work within government departments alongside national staff to:
- Create the structures and capacity to integrate gender and social inclusion across the health system’s building blocks and down through the health service delivery structure.
- Strengthen and expand equitable delivery of quality essential health care. Our team is improving women’s access comprehensive obstetric care in case of an emergency during childbirth.
- Improve the quality and use of evidence in planning and delivery of health care so that services are better designed to meet the health needs of the population.
- Improve health commodity procurement systems so that life-saving medical products, vaccines and technologies are available throughout the country.
- Develop services that are accessible to all, irrespective of gender, poverty, caste or ethnicity, so that those most in need have greater access to care.
- Strengthen health financing and public financial management to ensure that systems are operational, responsive, sustainable, transparent and are linked to planning.
- We have supported the Family Health Division to increase the number of districts that have at least one facility providing comprehensive emergency obstetric and neonatal care for women experiencing complications during childbirth, from 33 districts in 2010, to 54 districts in 2013. This was achieved by providing direct clinical mentoring support to obstetricians and by rolling out strategies improving access and referral for women in remote areas with obstetric complications.
- We worked with the Department of Health Services to integrate family planning services with immunisation services with the aim of improving access to family planning services. By introducing this small change to service design, the use of family planning methods among post-partum women was increased significantly. Based on our results, the government is rolling out the integration of services more widely.
- We have improved availability of support services for victimised and marginalised people, including survivors of gender-based violence by supporting the set-up of 17 one-stop crisis management centres, serving 2,090 clients. Social service units have also been established in eight hospitals.
- We have supported the piloting and scale-up of social audits across the sector, empowering citizens to demand accountability and rights, raising awareness of providers’ responsibilities and improving facility governance. Social auditing was conducted in 602 facilities of 45 districts in 2014.
- Systems for financial reporting have been strengthened by developing and supporting the roll-out of the Transaction Accounting and Budget Control System. This innovative web-based system enables the Ministry of Health to prepare good quality and timely financial monitoring reports. It has been rolled out across the whole of Nepal.
- We have introduced a system of e-bidding for infrastructure projects with the aim of introducing greater competition and transparency in the procurement of large-scale building contracts. A cost saving of 12 per cent was achieved in the first year – saving the Government of Nepal approximately £3.4 million.
- Our experts have developed integrated building designs for health facilities to increase the quality of buildings and also reduce construction costs. Within the first year of their use, these new designs are estimated to have saved the Government of Nepal £2.97 million in construction costs.
- We have supported the upgrading of the web-based Health Infrastructure Information System (HIIS) to help plan new facilities and track the condition of existing buildings.
- We carried out an innovative study to increase access to and uptake of health care services in remote districts of Nepal.
The under-five mortality rate was lowered from 142 per 1,000 live births in 1990 to 42 per 1,000 live births in 2013
Maternal mortality has been reduced from 790 to 190 per 100,000 live births in the same period
The percentage of births attended by a skilled birth attendant has increased from 37% in 2012 to 55% in 2014
Social auditing conducted in 602 facilities in 45 districts in 2014