2. Concept of Health politics
What is health ?
What is politics ? Is a means of political outlook or the science of government
Science : branch of knowledge involving systematized observation and experiment.
Government means :System by which a state is governed
Government act on control, rules, command, management, administration etc
Government should have citizens, territory , Rules and Sovereign
Health politics means attainment highest level of wellbeing of all citizens by means affairs of
state.
• Highest level of wellbeing
• means affairs of state.
3. What is political system?
Any collection of elements that interact in some way with one
another can be considered with system: a galaxy, a football
team, a legislature, a political party.
In thinking about what a political system is, it is helpful to keep
in mind several points that apply to any system.
A system is a frame work with which an observers or analyst
approaches or lens or perspective through which an observers
or analyst choose to view, some reality such as politics .
The political system of the United state of America includes
Congress, The president, the supreme Court, political Party,
interest groups, voters, new media and so forth.
4. Health politics means attainment highest level of
wellbeing of all citizens by means affairs of state.
• highest level of wellbeing
• means affairs of state.
• State : political community under one government
5. Health politics depends on
• Country's Socialistic model
• Country's well fare model
• Country's Capitalistic model
• International commitment and agreement
6. Characteristics Socialistic model
• Means of production
• State Responsibility
• Common Pool
• Social justice and Equity
• Citizens as assets
7. Characteristics Well fare state
• Basket fund
• Social /Private health insurance
• Community drugs programs
• Citizens as a liability/assets
• Act and regulation prepared by Governments
E.g Health, Education free in UK, manage
Family physician.
8. Capitalistic model
• Government prepare rules and regulation
• Competitive markets
• Quality control by GOVT
• Citizens as liability
• Various scheme to fulfill the people's needs
• Denmark
9. International Commitment and
agreement
• Bucharest conference 1974 well fare approach
• CEDAW 1979 : concerning against woman's
violence
• Earth summit
• Cairo conference 1994
• Beijing women's conference 1995
10. Political aspects.
• Slovakia, the former Communist country that shifted some
state health care costs to individuals a few years ago to reduce
its budget deficit, is rolling back some of those changes even
as its neighbors start to address costs in their own health care
systems.
• Regional governments also are evaluating Slovakia's 2004
decision to open the health insurance market to for-profit
companies.
• East European policy makers and officials from nonprofit
organizations focused on Slovakia's experience Wednesday at
a gathering in Prague that is examining ways to reduce
government spending on health care to cut budget deficits.
• One obstacle is the risk of losing voter support, as Dzurinda
did. Slovaks voted him out of office last year.
11. • "The problem is to tell people why it is good for them, if they
didn't pay in the past," he said.
• The countries are trying to reduce their budget deficits in an
effort to meet the requirements for adopting the euro, which
would eliminate currency fluctuations and ease trade within
the 27-country European Union. Slovakia may be able to
convert to the euro as early as 2009 because its budget deficit
and debts are under control, the Organization for Economic
Cooperation and Development
• Fico, while keeping most economic policies that improved
Slovakia's finances, last year abolished almost all regulatory
fees on medical services. Those charges included 20 koruny, or
81 U.S. cents, on prescriptions and doctor's visits, as well as
50 koruny per night in the hospital.
• With those fees, the money the state spent on prescription
drugs had fallen to 31.5 percent of the health care budget in
2005 from 36.3 percent in 2003, according to government
data.
12. • The Czech Republic wants its nine state-funded health insurance
providers to convert to joint stock companies to make their
accounting more transparent, said Lucie Antosova, an adviser at
the health ministry.
• "If they are in debt, we have to calculate it as public debt,"
Antosova said. That could hurt any attempt to adopt the euro, she
said.
• Hungary, which is trying to tackle the European Union's widest
budget deficit, this year imposed fees on doctor's visits, slashed
drug subsidies and ended a free drug program. The state-
monopoly health insurer, which had been in deficit since 1994,
announced its first-ever quarterly surplus of 17 billion forint, or
$94 million. The health ministry is arguing for opening the
market to private insurers.
• Last week, the Czech Health Ministry proposed charging patients
30 koruny for outpatient visits and prescriptions, 60 koruny for a
day in a hospital and 90 koruny for emergency services.
13. Politics means
1. Relationships involving powers rule, or authority ‘
lasswel”
2. Relationships involving territoriality
3. Relationships in associations capable of self
sufficiency
1 and 2 ; weber
1, 2 and 3 by Aristotle
Politics is simply the exercise of influences
14. Why individual participate in
politics
• Value the reward to be gained
• Think the alternative are important
• Are confident that they can help to change the
outcome
• Believe the outcome will be unsatisfactory if they do
not act
• Have knowledge or skill that bears on questions at
hand
• Most overcome fewer obstacle to act
• Are mobilized by others to participate
16. Relationship between health and
politics
Health Politics
Ends Means
State of physical.... Constitution, Vision,
mission
Policy, strategy
Plan
17. • For Health Professional : Health ends
• But Politician : Health means ?
• But Politician: Power ends or over all
development
18. World trend of health politics
It is difficult to define trend of world health politics. Because they are
not going onward in same pace and line, some times they are
changing their path dramatically eg USSR
Demography cycle
First stage high stationery
Second Stage : early expanding : High priority FP,
..................
Fifth stage : Declining : High priority birth, attraction scheme to
developing countries, Permanent resident from ....
• Change of disease pattern ;
communicable disease to non communicable disease
• Service demand by people ; quality of services, abortion care
19. Trends of health politics
• Welfare approach: Health facilities was
provided to women
• Right based approach : right to get Health
services
• Equity : justice
• Equality: equal opportunity
20. Trends of health politics
• The united nation conference on Human Right at Teheran in 1968
recognized family planning as a human right
• Bucharest conference in 1974 endorsed same view as above ; all couples
and individuals have basic human right to decide freely.
• The world conference of the international women's year in 1975 also
declared the right of women to decide freely
• Cairo conference 1994 ; component of reproductive health
• Beijing conference 1995. emphasis on equality,
• Minimum health services to maximum people
• Alma-Ata conference in 1978 : 134 country called revolutionary approach
to health care
• Health for all by the year 2000.
• Millennium Development Goal
• Users fee in health services
• Abolition of user's fee
21. • The majority of European nation have a national health
scheme that is administered federally.
• Developing countries tend to provide health services, although
not a level of sophistication available in developed countries.
• Voluntary health agencies have flourished in United state than
Europe.
• In the developing nation NGOs have played an even important
role in promoting health are constrained from specific
activities by political and economic limitation .
• Gaps between the ‘haves ‘ and ‘have-nots’
• Socialized public health : social dimension of public health
emerged
• Health for all movement ; Health for all by the year 2000.
• Primary Health care : restructuring of health system
22. • Health system reforms
• Eradication and elimination of disease
Small pox eradicated and poliomyelitis under
eradication and leprosy elimination
• Globalization of public health: Globalization
has been a phenomenon that is characteristics
by world wide interdependence in all aspects –
economic, political , social and cultural
23. New Philosophy of Health
• Health is a fundamental health right
• Health is the essence of productive life and not the of
ever increasing expenditure on medical care
• Health is an integral part of development
• Health is inter sectoral
• Health is central to the concept of quality of life
• Health involves individuals, state and international
responsibility
• Health and its maintenance is major social investment
• Health is world –wide social goal
24. Dimension of health
• Physical dimension – perfect functioning of the body
• Mental dimension- State of harmony between oneself
and others, e.g knowing or cognition
• Social dimension – wellbeing of the whole person in
the context of his social network.
• Spiritual dimension –It is intangible "some thing "that
transcends physiology and physiology.
• Emotional dimension- relate to feeling
• Vocational dimension – It is part of human existence .
Work are source of satisfaction and enhanced selfsteem.
25. Quality of life depend on
• Physical quality of life index ( IMR, life
expectancy at age one and literacy)
PQLI measures social, economic and political
policies
• Human development index
Longevity ( life expectancy at birth)
knowledge ( adult literacy rate and mean years
of schooling)and Income ( GDP per capita in
purchasing power –parity dollar)
27. Political perspective in Primary Health
care
• It is a comprehensive approaches for health for
all It needs to be revitalized
• It is a selective approaches so can not fulfill
the people's health need
Miscellaneous
Highest unmet need of FP was found (37
%)among the adolescence ( both)
28. "There is social and economic inequalities that
lead to poverty, under nutrition and high child
Mortality. As a result , in spite of global
campaign for child survival, millions of
children continue to die from the disease of
poverty " by David werner and David Standers
In 1892 USA did not accept cholera in their
country so loose a lot of lives.
31. Constitution of Nepal 2004 (1948)
• Judiciary function
• High court
• Parliamentary judiciary committee
• Human right -symbolic
32. Constitution Nepal 1962(2019)
• Hindu State
• National Animal
• Active king
Constitution Nepal 1990(2047)
• District court
• Applete court
• Supreme court
Human right
Constitutional king
Health -Guiding principle
33. Constitution 2063 (interim)
• Federal system
• Social inclusion
• Religion
• Health : Basic health service as a fundamental
human right
• Public commission
• National security council
• Auditor General
34. 2072 constitution
• New constitution implemented from 3rd
Ashwin, 2072.
• It has repealed Interim Constitution 2063.
• It has adopted federalism, first time in history
of Nepal.
• Power has been decentralized.
35. It includes
• Citizenship
• Fundamental Rights and Duties
• Structure of State and Distribution of State
Power
• Judiciary
• Appointment of President
• Appointment of Prime Minister
• Constitutional Commissions and Bodies
• Other Constitutional Clauses
36. 35. Right relating to health:
(1) Every citizen shall have the right to free basic
health services from the State, and no one shall
be deprived of emergency health services.
(2) Every person shall have the right to
get information about his or her medical
treatment.
(3) Every citizen shall have equal access to
health services.
(4) Every citizen shall have the right of access
to clean drinking water and sanitation.
39. Function of parliament
• Representative from people
• Preparation of Law
• Budget approved and monitoring
• Control activities of executive and make them
responsible to ward the people.
40. Authority parliam
entary
presidency Remarks
Prepare law Approved by
king or
president
Approved by
president
Budget approved Authority to
parliament
Authority to
parliament
Elect head of GOVT YES NO
To take action against
judge
YES YES dxfcleof]u
Appointment YES YES
42. Function of parliament
• Approve Act, Regulation, Policy, Long-term-
periodic and short term plan
• Discussion, rejection and Approve budget and
program by majority of parliament members
• Formation of subject committee by involving the
parliament Members
• President, voice president, Pri-minister and
Chairmen and voice chairmen are elected by
majority of members
• Can withdraw to the pri-minister by their simple
majority
43. Characteristics of parliament members
• They are representative from Party so they are
more conscious about their party's manifesto.
• Directed and guided by party decision
• Are responsibility for Social sectors (Health
education, security etc)
• Are directly and indirectly elected by peoples
• They get facilities (Monthly salary with
allowance) from Government of Nepal
44. Prepared documents by parliament
• New Health Policy 2075/71/48
• Health services Act 2053
• Health Service Regulation 2054
• Long term Health Plan 2054-2074)
• Nepal health Sector Program - Implementation
Plan (2004-2009)
• Establishment of Nursing home and hospital
guideline 2061
45. Role of health advocacy and lobbing in
health policy formation
46. Advocacy by
• Electronic media Radio, TV etc
• Paper media : Gorkhapatra, Kantipur, Nagarik,
• Mass media
• Small group: Role play, street drama etc.
• Individual: counseling, interview, personnel
contract
49. Executive Function
• To determine policy and regulation
• To prepare the bills to submit at parliament
• To rise national income by tax and other means
• To distribute resource and expenditure management
• To establish foreign policy and relationship
• To establish regulatory mechanism
• Personnel Appointment for public affairs
Parliament and supreme court balance the
function of council of minister.
50. System of executive
Parliamentary system:
1. head of govt and head of state – different, In same
person in both institution –rarely.
2. England- King and Nepal- president, Pri-Minister-
head of GOVT but president - ceremonial , GOVT
responsible for parliament.
3. Pri-Minister - dismiss parliament
51. In Nepal
Under the Constitution, executive power is vested in a
Council of Ministers headed by a Prime Minister.
The Prime Minister and other members of the Council
of Ministers are chosen through a ‘political consensus’
among the main political parties, failing which a leader
commanding majority support in parliament is
appointed as the Prime Minister.
The Prime Minister and the Council of Ministers are
collectively responsible to Parliament while individual
ministers are responsible to both Parliament and the
Prime Minister.
52. Power and Functions of the
Executive
The function of executive is increasing day by
day in this modern age.
There is a lot of work that the executive has to
perform. It is the duty of the executive to
maintain law and order in the country.
Executive has to fulfil the basic needs of the
people like food, shelter, clothing, education and
health services.
53. The following are the major
functions of the executive:
• To run the administration of the country efficiently and provide basic
service to the people.
• Executive makes important appointments and transfers, and controls and
supervises all civil and military departments and their subordinates.
• To maintain law and order and protect the country from foreign invasion.
• To impose taxes and run various development works.
• To sign treaties and make good diplomatic relations, depute ambassadors to
foreign countries.
• To present the budget in the parliament and operate it after the approval of
the parliament.
• To summon, adjourn or postpone the session of the parliament.
• To table the draft bill in the parliament for appropriate laws.
54. Presidency system
1. Executive function by president
2. Directly elected president
3. Different – parliament and president
4. No member of parliament in council of minister
5. Appointment by president in vital post of public affair however
parliament approve these post with person.
6. Power with president (pocket veto)
7. Budget and law approved by parliament so there should be
coordination among them.
55. Mixed system
• Adopted sustainable and strengthened system found in
presidency model
• Adopted democratic and responsible characteristics system
found in parliamentary model France, Srilanka etc.
• President-direct
• Pri-minister by parliament
• Same party - Pri-mister and president or different
• Some time dispute in power sharing
56. Power sharing system
• Government is made on the basis of member
of parliament or percent of vote received by
party
Example Africa – national congress + National
party+ Inkatha = National government led by
Nelson Mandela.
57. Executive Aspects of health
Approved Act, regulation, policy and directive are implemented by
executive body of government. Main executive body of government
is Ministry of council headed by Pri-minister . Existing power of
ministry of council are delegated to concerning minister for
execution of Act, regulation, policy etc.
Some example the main role of MoHP is to deliver quality of health
services up to the rural level by mobilizing the governmental and
non governmental organization.
For the delivery of health services MoHP have to accomplish following
task
• Preparation of organo- gram from centre to district level
• Identify level and types of services on basis of approved act,
regulation and policy
• Recruit personnel on the basis of health Act and regulation as well
as public service commission
• Deputed on JOB
58. • Performance appraisal
• Carrier development
• Arrange training seminar from concerning
organization
• Transfer
• Retirement
• Carrot and stick
• Right person in right place
• PME
59. • Some level upgrading takes place by performance appraisal
and promotion by public commission
• Promotion takes place by free competition, internal
competition
• After 20 years health personnel can get pension (half of basic
salaries)
• All provision like recruitments, promotion, leave, job security,
penalty etc. are already mentioned in Act and regulation.
• The court decide on the basis of written act and regulation.
However there is no separate procurement act for health
services.
• Department of health service and District public health office have to
follow same procurement act as others sectors.
• Health sector has demanded separate Act and regulation in procurement .
63. Unit 7. Political issues in Health
Political pressure, propaganda and public health
Pressure by
• Different sister organization of parties . Youth Force, YCL etc
• Self help groups
• Informal organization
• Civil society
Propaganda on
• Disaster
• Epidemic
• Voting
• Emergency services
• Medicine supply
• Available of human resources
• Death report
• Essential commodities Eg vaccine , vit A, Iron
• Free health services
65. Basic types
Black: Propaganda that purports to emanate
from a source other than the true one.
Grey: Grey Propaganda is a type
of propaganda where the correct source of the
information is never directly credited and the
sponsor’s identity is concealed.
White: White propaganda is propaganda that
does not hide its origin or nature.
66. Public Health Mandates of political parties
• Introduce of new vaccine ?
• Introduce of new program ?
• Change of health policy
• Reforms and restructuring
• Health insurance ; voluntary or social
• Health service : Gon responsibility or social
marketing
• Federal or central GOV.
67. Political instability, war and their effect on health
public and health service system
• Health staffs retention –low
• Brain drain
• Low service utilization
• Low quality of health services
• High cost
• Low community participation
• Low social mobilization
• Increased morbidity and mortality rate
68. Issues of Health politics
• Political party’s manifesto and implementation
• Influence of neighboring country
• Severity between capitalistic countries and socialistic countries
• Destructive critic instead of Constructive critic
• Donor driven health program
• capacity building
• Globalization
• Equity ; uneven access to political resources
• Budget allocation to health
• Political culture
• Driving and restraining forces exist in community
• Diverse people and ideas
• Decision making
69. Challenges at implementation phase
• At the implementation phase the various obstacles does occur
that disturb the service are, Political challenges -political
propaganda, quality of political decision
• Security challenges-political instability, civil war,
• Social challenges- fooding, shelter, social norm
• Judicial challenges- low feasibility of Act, unavailable of
proper Act
• Environment challenges- pollution
• Religious & ethnic challenges- large ethnic group having
different value and norms
• Economical challenges- cost recovery problem
• Physical challenges-transportation, buildings
69
70. Structural adjustment program and their effect on
public health
• Policies to reform health care system
• Introduction private funding instruments
• Decentralization of health finance
• Reform of management structures
• Reforms of human resources
• Promoting cost effectiveness of the delivery system
71. Introduction
• International Monetary Fund (IMF or Fund)
• Structural Adjustment Programs (SAPs)
• The IMF and Health Spending
• In Focus: IMF Programs and Health Spending
in Low-Income Countries
72. International Monetary Fund
• IOs, global economic governance, and the IMF
• History and mandate
– Technical support
– Lending (‘lender of last resort’)
– 1980s and late-2000s lending boom
• Influence and legacy
– Fund programs (SAPs)
– ‘Conditionality’
73. Structural Adjustment
• Evolution of conditionality
– Core competencies
– Extension to non-core
– Country ownership and poverty reduction
• Controversial conditions
– Devaluation
– Trade liberalisation
– Fiscal discipline
– Consumption taxes
– Privatisation
74. Structural Adjustment
• Some general criticisms of Fund programs
– Poor track record
– ‘One size fits all’
– ‘Mission creep’
– Micro-management (e.g. size of bread loaf)
– ‘Loose coupling’ of discourse and practice
– Agents of neoliberalism and/or neoimperialism
75. IMF Programs and Health Spending
Core claims by critics IMF response (Gupta, 2010)
1. Health spending has decreased in
countries with IMF-supported programs
1. Previous analyses of Fund-supported
programs have already shown this claim to
be untrue
2. Countries are forced to decrease health
spending to meet rigid fiscal deficit
conditions
2. IMF-supported programs have been
very flexible by accommodating larger
fiscal deficits and continuing to protect
priority social expenditures
3. Conditions on wage ceilings imposed in
program countries prevent desirable
increases in health spending
3. There is no conditionality that limits
health spending in Fund-supported
programs
4. Increased aid intended for the health
sector has been diverted to repay domestic
debt or increase reserves
4. When faced with volatile sources of
finance, governments often attempt to
maintain a stable flow of social
expenditures by smoothing the use of
available financing.
76. Unit 8: Health Law and Act
Concept about judicial health
Structure and level of judicial body
Importance of health jurisprudence and law in public health aspects
Brief about law, Body of monitoring of law
Brief discussion about the Health service Act 2053, Local governance and
decentralization Act
Brief account of Act and Law related to
• - Health behavior modification through legal measures and challenges
• - Control of contra health products
• - Control of health hazards through health laws and regulation
• - Legal protection against the threats to physical
• - Mental and social health of public
• - Health law and preventive public health
• - Epidemics and health laws
Implementation strategy of health law for providing of social justice and challenges
78. UN Declaration ( 13 dec,1985and 25nov 1985)
Principle for independent judiciary function
• Constitution as a main regulatory document for state
or country
• Evidence based impartial decision
• Supreme court should be capable to define their
owned role and responsibility by doing appropriate
decision at time
• Judiciary decision change –from high court
• Working procedure and salary of Judge should be
mentioned by law
79. Judicial Aspects of health
Executive body should have implemented Act, regulation, policy .
If not implemented properly, supreme court can rise the
question to executive body of government. Supreme court can
ask the questions, punish, dismiss etc.
Challenges in implementation strategy
Health Service Act 2053 is isolated from the other civil service
Act since 2054.2.14 So, Health service Act and regulation has
following characteristics
There is level system ( second level to twelve level ) of health
personnel who are working from sub health post to Ministry of
health and population
80. Health law
• Constitution, Health Act 2053, Regulation2055, health policy
1991 and revised health policy 2015, 2019
• Implementation to the MOHP and below concerning to health
workers.
• Strategy : To provide 24 hrs. health services to the people.
• Challenge : inadequate health workers, lack of social
responsible, untrained, lack of infrastructure, legal issues in
regulation personnel , regulation of health facilities
• Control of contra health product by self government Act 1999.
• Health behavior modification by carrot and stick
81. • Control of health hazards government Act and
regulation
• Legislation to mental illness
• Legislation on abortion
• Legislative approaches health prevention and
promotion
• Legislation to change smoking behaviour
• Tax and price policies
• Restricting smoking in public places
• Restricting smoking in public work place
• Mandating health education
82. Judicial aspect of health at the international
level
• The formally development of medical jurisprudence
at international from the establishment of UN and
WHO.
• The several conventions, seminar before the
establishment of WHO, play vital role for the
development of legal medicine etc.
• The principle and rule of the various conference and
organization keep the right of international
development of judicial aspect of health.
82
83. Judicial aspect of health at the
international level.......
• First international sanitary conference 1851
• Pan American sanitary bureau 1902
• Office international D ‘hygiene Poblique 1907
• The health organization of the league of Nations 1923
• The United Nation relief and rehabilitation
administration 1943
• WHO 1945
83
85. Brief discussion about the Health service Act 2053,
Local governance and decentralization Act
Nepal medical council Act 2020: The person who pass the bachelor
level of medical science from the recognizes university called
doctors who should be associated with medical service.
Nepal health professional council Act 2053 (Public health, HA, CMA
etc): The person who passes the Intermediate, bachelor, master and
doctorate degree level of professional medical science from
recognizes university called health professional that should be
associated with health service provider.
85
86. Why Health Service Act in Nepal?
• Health service is different then other service it
is directly linked with the life of people.
• Health service required to people any time (24
hours)
• Health service is a emergency services
87. Objective of health service act of
Nepal
1. To fulfill the vacant post of health services
2. To Motivate employee of health service
3. To establish code of conduct and disciplinary
action of HRH
4. Provision of gratuity, pension for employee
after retirement
88. Amendments of Health Service Act of
Nepal
1. Nepal Health Service (1st Amendment) Act, 2055:
2055/10/27 (10th Feburary1999)
2. Health Related Some Nepal Acts Amendment Act, 2058 :
2058/5/6 (22nd August 2001)
3. Nepal Health Service (2nd Amendment) Act, 2058: 2058/7/22
(7th November 2001)
4. Nepal Health Service (3rd Amendment) Act, 2063: 2063/8/22
(8th December 2006)
5. Republic Strengthening and Some Nepal Laws Amendment
Act, 2066: 2066/10/7 (21st Jan 2010)
6. Nepal Health Service (4th Amendment) Act, 2070: 2070/12/12
(26th March 2014)
89. Chapter of health service act 2053
There are 11 chapter of health service act of Nepal:-
Chapter 1 Preliminary
Chapter 2 Constitution of health service (स्वास ्््य सेवा को गठन)
Chapter 3 Fulfillment of vacancy of health service
Chapter 4 Transfer, deputation (काज) and promotion
Chapter 5 Provisions relating to nomination for study and training
Chapter 6 Salary, allowance, festival expenses and other facilities
Chapter 7 Retirement, gratuity and pension
Chapter 8 Conduct (आचरण)
Chapter 9 Service security
Chapter 10 Punishment and appeal (सजाय र पुनरावेदन)
Chapter 11 Miscellaneous
90. I. Professional (MOH)
1. Nepal medical council act 2020
2. Nepal health professional council act 2053
3. Nepal nursing council act 2052
4. Nepal pharmacy council act 2057
5. Nepal ayurvedic council act 2045
90
Brief account of Act and Law related to health
91. II. Research/Service/Health manpower
production
1. Nepal health research council act 2047
2. BP Koirala institute of health science act 2049
3. BP Koirala memorial cancer hospital act 2053
4. Martyr Gangalal national heart centre act 2057
91
92. III. Administration
1. Nepal health service act 2053
2. Drugs act 2035
IV. Curative
1. Human organ transplantation act 2055
2. Drug act 2035
92
94. VII. Food
1. Food act 2023
2. Vehicular and transport act 2049
VIII.Welfare
1. The constitution act 1990
2. The labour act 1992
3. The child right act 1992
4. Disabled protection and welfare act 2039
94
95. IX. Epidemic and disaster
1. Infectious disease act 2020
2. Natural disaster act 2039
X. Manpower production
1. Universities' Acts
2. CTEVT
95
96. XI. Controlling
1. Police act 2012
2. Public offence and punishment act 2027
3. Black marketing and other social offence act
4. Drug abuse control act 2053
96
97. XII. Health behaviour modification through
legal measures
1. Ilaz Garne Ko or on medical practice I Muluki Ain
– The civil code (Muluki Ain 1963)
– The civil code (Muluki Ain 1976)
2. Some public offence and punishment act, 2027 BS
3. Black marketing and other social offences act 2032
BS
4. Drug abuse control act, 2033 BS
97
98. XIII.Health behaviour modification
through legal measures …
3. Drug act, 2035 BS
4. Consumer protection act, 2054 BS
5. Human organ transplantation act, 2055 BS
6. Food act, 2033 BS
98
99. XIV.Control of health hazard through
health laws and regulations
1. Black marketing and other social offences act,
2032 BS
2. Drug abuse control act, 2033 BS
3. Pesticides act
4. Breast milk substitutes (Marketing control) act
2049 BS.
5. Environmental protection act, 2053 BS
6. Animal slaughter house and meat examinations
act, 2044 BS
99
100. • Law and regulation prohibit conduct that is injurious to health
of individual and community.
• Health legislation authorizes program and services that
promote health of individual and communities
• Legislation regulates the production of resources for health
care
• Legislation provides for the social financing of health care
• Legislation authorizes surveillance over the quality of health
care
• Regulation food and drugs
• Licensure of health personnel
Implementation strategy of health law for providing of
social justice and challenges
101. Legal Protection against threat to physical,
mental and social health of public
• Insurance by GOV
• Voluntary insurance
• Consumer act 2054
• Service provider act in process
• Handicap pension
• Free treatment after injury during official
work.
102. Legal provision for health services
• Leave is facilities not right
• Civil servant are under government (24 hour)
• There is no one month barrier for deputation
during epidemic
• Upgrading and carrier development who work
in remote district
• Authority delegation to sub -ordinate
103. Control of health hazards through
health law and regulation
• Mention duty hour in the regulation
• EIA ( environment Impact assessment )
• Factory act 1991
• Point out lead jacket, apron, gloves etc
• Mention of delivery (Husband and wife) and other leave
• Health Insurance
• Smoking free zone declared
• Pre-placement medical checkup
• Medical treatment facilities
• Consumer act 2054
• service provider act in process
• Identified job description of different level of health worker
including nurses
104. • Level of health services and degree of
personnel identified
• Standard of drinking water
• Housing standard identified
• Access of health services
• Long term, midterm and short-term plan
prepared.
Editor's Notes
The IMF is one of the ‘big three’ global economic governance organisations, the others being the World Bank and the World Trade Organisation
World Bank and IMF initiated in 1944 at the Bretton Woods Conference, formally established in 1944 (WB, then known as the International Bank for Reconstruction and Development) and 1945 (IMF)
World Bank deals with sectoral issues and big infrastructural projects (but shifted into economy-wide programs in 1980s for a couple of decades)
IMF is central to the functioning of the world economy (i.e. global financial stability)
‘Washington Consensus’ term is based on policy prescriptions of the IMF and WB (both located in Washington DC).
World Trade Organisation is involved in trade liberalisation, formed in 1995
Fund was established in 1945 with a mandate to safeguard global financial stability
Achieved via technical support – an uncontroversial and little-studied component
Achieved via provision of short-term loans to countries with balance of payment difficulties
IMF loans often used to repay external debt that the country is unable to service (i.e. in order to avoid default); they carry lower interest rates than private loans.
In 1980s, countries were becoming indebted with balance of payment crisis and rundown of foreign reserves due to: end of the mid 1970s commodity boom; macroeconomic mismanagement; oil shocks through the 1970s; perhaps the model was unsustainable in any case. In late-2000s global financial crisis.
In exchange for low-cost financing, borrowing countries agree on a list of policy reforms (i.e. ‘adequate safeguards’ for Fund finances)
SAPs refer to both the World Bank SALs (early-80s) and IMF’s SAF-family (mid-80s), but should in fact (and often do) refer to SBAs, EFFs as well
The Fund has had programs through the 50s and 60s but in the mid-80s – following in the footsteps of the WB’s SALs - came the idea that programs needed to address the underlying perverse institutions featuring in many borrowing countries. Thus, structural conditions were introduced (where previously were just quantitative ones).
It is the country’s choice to select into a program, and it is usually coordinated through the Ministry of Finance
Countries sign an MoU that they will undertake X policies and meet Y targets in order to get tranche payments of credit, i.e. IMF credit is given out in tranches, with dispersal of subsequent credit tranches dependent on achieving certain conditions
Through these, IMF has had a decisive role in the long-term developmental trajectory of middle- and low-income countries (and now some high-income countries, e.g. Ireland, Portugal, Greece), and has come to influence a wide range of policy areas, including public health
Programs/conditions can be tough on a country, but the alternative – defaulting on external debt – can have even worse consequences
Programs can catalyze aid and private flows; failure for programs to materialize (i.e. IMF ‘stamp of approval’) can mean the government is cut off from other credit sources, including the WB, regional development banks, and private creditors – thus the IMF has huge leverage in pushing highly indebted countries to adopt its economic formula.
Most SSA countries – my region of interest - were on consecutive IMF/WB SAPs throughout the 1980s and 90s (and even to today).
Fund programs generally require borrowers to implement a set of reforms – known as ‘conditions’ – consisting of primarily austerity measures aimed at addressing current account imbalances.
Core competences:
Conditions attached were limited and predictable, requiring reforms to fiscal and monetary policy and exchange rate adjustments, with the aim of reaching a sustainable balance of payments position.
Quantitative floors/ceilings on fiscal deficit, international reserves, money circulation (credit to government, credit to public sector, net domestic assets), external debt
These had deleterious implications for countries’ economies, but nevertheless left the underlying economic system in-tact.
Extension to non-core:
In the mid-80s, the IMF started including in its programs an increasing number of ‘structural’ conditions that would later become known as Washington Consensus policies
SOE reform and pricing, SOE privatization, Labour issues, Social policy, Good governance, Legal reforms, Anti-corruption, Private sector development
Brought in to bring about long-lasting change in borrowing countries, a ‘lock-in’
Country ownership and poverty reduction:
In the 2000s came a rebranding of ESAF into PRGF (Poverty Reduction and Growth Facility)
Requirement for PRSPs (Poverty Reduction Strategy Papers)
Introduction of Redistributive conditions and rhetoric around country ownership of program
Currency devaluation:
A) Exports become cheaper and therefore more competitive in global markets
B) Imports become more expensive
C) This combination replenishes international reserves to use in repaying external creditors
D) Poor people who have savings in local currencies lose out, while the rich who hold foreign currencies win
E) Problematic for manufacturing and agriculturalists who rely on imported fertilizers and chemicals
F) Problematic where IMF has already pushed countries into export-oriented agriculture thus diminishing self-sufficiency and many basic food stuffs imported where they were previously grown locally, and so currency devaluation increases the price of these basic – now imported – foodstuffs.
Trade liberalisation:
A) Removal of quotas and reduction of tariffs
B) Rationale that the market can allocate more efficiently than the state
C) Domestic producers unable to compete with foreign players
Fiscal discipline:
A) Expenditure ceilings
B) Removal of subsidies
C) Cost-sharing
D) Controversy where subsidies are for basic needs goods (food, water, heating)
Consumption taxes:
A) VAT, GST, and so on (regressive taxes)
B) Controversy where they have increased the price of basic needs goods
C) In Rwanda they had a condition to decrease corporate taxes but incorporate a VAT tax, so there is a double standard.
D) Appear to be no conditions calling for progressive taxes
Privatisation:
A) Sell-off government owned enterprise on the rationale that private sector is more efficient
B) But... Private sector has no incentive to provide to poorer households
C) Increase in prices for water, electricity, housing, and in many cases poorer service, has been controversial
D) Privatisation used as tool to enrich the elite (e.g. Russia)
Poor track record:
On growth in particular (little or negative growth in SSA for most of 80s/90s despite near-constant IMF presence), but it does better on inflation
One size fits all:
The same policies are applied to completely different countries, with differing institutional histories, current environment, and so on (I’m not fully convinced, though they are all certainly ‘neoliberal’ in character)
Mission creep:
Fund creeping into areas they have no expertise in (e.g. governance, sectoral issues, perhaps even structural adjustment in general)
Micro-management:
Egypt’s 1991 SBA has a prior action on “the reduction in the size of the "popular" bread loaf”
Agents of neoliberalism and/or neoimperialism:
See condition controversies
Past inquiries into how the IMF affects public health spending have produced mixed results:
Analysts connect to IMF find positive impact
Analysts unconnected find negative impact