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International health

Nothing on earth is more international than diseases
-Paul Russel

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International health

  1. 1. 12/16/2015 1
  2. 2. 12/16/2015 2
  3. 3. Nothing on earth is more international than diseases -Paul Russel 12/16/2015 3
  4. 4. IntroductionIntroduction International Health is the study of health issues that affect people living in the developing world. Deals with health across regional or national boundaries. Immunization, prophylactic medication, post travel care, quarantine. 12/16/2015 4
  5. 5. Why International HealthWhy International Health Health is an international concern because problem in a part of the global affects to the other part. Health problem can be solved or minimized through joint efforts between the national or global efforts. Experiences of one nation can be useful to other; eg Malaria control program. There has been raising relationship between the nations (global relation) affecting health of one or other. 12/16/2015 5
  6. 6. Concepts of International HealthConcepts of International Health Equity and Health Poverty and Health Environment and Health Culture and Health Urbanization and Health 12/16/2015 6
  7. 7. Equity and HealthEquity and Health The world’s resources are unequally distributed.  Disparities in health within and between countries. To reduce such disparities will require a more equitable distribution. 12/16/2015 7
  8. 8. Inequalities can be illustrated between countries of varying socioeconomic Profiles.  Developing countries are susceptible to early death, infant mortality, illness, and other poor health indicators.  Causes of these negative health outcomes: living conditions marked by poverty, poor shelter, and inadequate sanitation. 12/16/2015 8
  9. 9. Poverty and HealthPoverty and Health The differences can be attributed primarily to variation between urban and rural areas.  Rural areas have barriers to health care, education and employment.  Urban have greater access to safe water and sanitation. 12/16/2015 9
  10. 10. Environment and HealthEnvironment and Health Developed countries are affected by problems of pollution from air, water, and noise.  Health hazards created by industrialization, urban growth, and quality of housing. Inadequate sanitation— lack of safe water, facilities for the disposal of solid wastes, control of disease vectors, food safety, and satisfactory housing. 12/16/2015 10
  11. 11. Culture and HealthCulture and Health Sociocultural factors : These factors include health-related beliefs about food, pregnancy, childbirth, diseases, and sanitation practices. Excessive consumption of food, alcohol, tobacco, and drugs.  Chronic or prolonged exposure to stress can lead to hypertension, coronary heart disease, and other impediments to health. 12/16/2015 11
  12. 12. Urbanization and HealthUrbanization and Health Shift of populations from rural regions to urban areas. Individuals anticipate better jobs, education, social services and other new opportunities. Overcrowded and highly contaminated areas like slums and shanty towns stricken with poverty. Noise, traffic, and air pollution. Effects of urbanization- greenhouse gas emissions, ozone depletion, land degradation, and coastal zone destruction. 12/16/2015 12
  13. 13. In order to protect against spread of diseases, from one country to another, many attempts were made in the past-like isolation of travelers, quarantine etc. International conferences were held & organizations were set up for discussion, agreement & cooperation on matter of International health 12/16/2015 13
  14. 14. History/ Evolution of International health 12/16/2015 14
  15. 15. First International SanitaryFirst International Sanitary Conference(1851)Conference(1851) 1st International Sanitary Conference. Objective: introduce order & uniformity into quarantine measures. Preparation of International Sanitary Code – 137 articles.[Cholera, Plague & Yellow Fever) 12/16/2015 15
  16. 16. Pan American ScientificPan American Scientific Bureau(1902)Bureau(1902) World’s first international health agency Primarily intended to coordinate quarantine procedures in American Societies. 1924 important document signed by American Republic “the Pan American Sanitary Code” 1947 bureau was renamed- Pan American Sanitary organization(PASO) 1958 –named as PAHO Head quarters: Washington DC 12/16/2015 16
  17. 17. Office International D‘HygieneOffice International D‘Hygiene Publique (1907)Publique (1907) Disseminate information on communicable disease Supervise international quarantine measures 12/16/2015 17
  18. 18. Health Organization of League ofHealth Organization of League of NationsNations 1923 established To build a better world Included “health organization to take steps in matter of international concern for the prevention and control of disease” Worked in quarantine regulation, epidemiological information, problems of epidemic diseases, nutrition, rural hygiene, training of public health workers 12/16/2015 18
  19. 19. The United Nations Reliefs andThe United Nations Reliefs and Rehabilitation Administration 1943Rehabilitation Administration 1943 Recovery of World war Care for health of displaced people 12/16/2015 19
  20. 20. Major areas in INH Prevention and control of specific diseases Development of comprehensive health services Family health Environmental health Health statistics Biomedical research 12/16/2015 20
  21. 21. GlobalizationGlobalization Past and present 12/16/2015 22
  22. 22. Definitions of GlobalizationDefinitions of Globalization A process by which nations, business and people are becoming more connected and interdependent across the globe through increased economic integration and communication exchange, cultural diffusion and travel. Globalization can be described as ‘…a widening, deepening and speeding up of worldwide interconnectedness in all aspects of contemporary social life, from the cultural to the criminal, the financial to the spiritual’ (Held and McGrew 1999) 12/16/2015 23
  23. 23. Jan Aart Scholte (2000: 15-17) has argued thatJan Aart Scholte (2000: 15-17) has argued that at least five broad definitions of 'globalizationat least five broad definitions of 'globalization’’ Globalization as internationalization Globalization as liberalization  Globalization as universalization Globalization as westernization or modernization Globalization as deterritorialization- or as the spread of supraterritoriality 12/16/2015 24
  24. 24. Aspects of Globalization-Aspects of Globalization- Economic Technological Cultural Political Military Health ( to be discussed exclusively) 12/16/2015 25
  25. 25. GlobalizationLiberalization Deregulation Cross border flows Foreign Investment Increased Trade Privatization All Services No subsidy No Preventive care Increase Household Income High Cost Red.Accessibility Health HIV Tob DV Medicalization 12/16/2015 26
  26. 26. Positive impact on HealthPositive impact on Health There is a link between income and health outcomes. Rising income leads to ◦ better nutrition ◦ lower child mortality ◦ better maternal health and ◦ better female education 12/16/2015 27
  27. 27. Adverse effect on HealthAdverse effect on Health Users fee : reduces the accessibility of health facilities in low income countries, in the studies of several countries , utilization of Health facilities dropped by 30%. Increase in the prices of basic drugs. 12/16/2015 28
  28. 28. Adverse effect on HealthAdverse effect on Health Less or no preference to preventive health care: as it is not profit making Erosion of Government health structures: Non maintenance of the public facilities and drain of human resources to private sector in search of more profit 12/16/2015 29
  29. 29. Adverse effect on HealthAdverse effect on Health Cash crops replacing food crops: Area of rice plantation in Philippines, in the 20 years period 500000 hectors of Rice land have been converted into commercial crops. During 1989 - 1994 in Russia: Crude Death rate increase by 45%, life expectancy of male decrease from 65 to 58,There was increase in 20000 deaths in Russia,who could live longer if Russia could not transfer to capitalism 12/16/2015 30
  30. 30. NepalNepal Few Examples only Commercialization of the means of family Planning: Dhal ,Gulaf, Sangini etc. Sell of ORS, “Sutkeri Samagri”, cut in subsidy Introduction of User’s fee in public health facilities Privatization of Curative health: increase availability of Modern technologies & its Irrational use 12/16/2015 31
  31. 31. Role and contributions ofRole and contributions of Multilateral agencies: (WHO, UNICEF, UNFPA, World Bank, ADB, SAARC) Bilateral partners (USAID, GIZ, DFID, SDC) Other health-related international organizations in health promotion and disease prevention programs in Nepal 12/16/2015 32
  32. 32. Multi lateral AgenciesMulti lateral Agencies WHO UNICEF UNFPA UNDP ADB World bank SAARC 12/16/2015 33
  33. 33. 12/16/2015 34
  34. 34. ANAN INTRODUCTIONINTRODUCTION The work of WHO affects the lives of every person on this planet, every day. From the food we eat and the water we drink, to the safety of the medications we take, and the prevention and control of the disease that threaten. 12/16/2015 35
  35. 35. The World Health Organization (WHO) is the international agency within the United Nations’ system responsible for health. WHO experts produce health guidelines and standards, and help countries to address public health issues. WHO also supports and promotes health research. Through WHO, governments can jointly tackle global12/16/2015 36
  36. 36. 194 countries and two associate members are WHO' s membership. They meet every year at the World Health Assembly in Geneva to set policy for the organization, approve the Organization' s budget, and every five years, to appoint the Director- General. Their work is supported by the Health Assembly. Six regional12/16/2015 37
  37. 37. A shORT hIsTORy TO TheA shORT hIsTORy TO The AChIevemeNTsAChIevemeNTs When diplomats met in San Francisco to form the United Nations in 1945, one of the things they discussed was setting up a global health organization. WHO’s Constitutions came into force on 7 April 1948 - a date we now celebrate every year as World Health Day. Delegates from 53 of WHO’s 55 original member states came to the 12/16/2015 38
  38. 38. • 1948: International Classification of Disease • 1952 – 1964: Global Yaws Control Program • 1974: Onchocerciasis Control Program • 1979: Eradication of Smallpox • 1988: Global Polio Eradication Initiative Established • 2003: WHO Framework Convention on Tobacco Control12/16/2015 39
  39. 39. PRIORITIzATION Of PROgRAms INPRIORITIzATION Of PROgRAms IN NePAlNePAl • Demography • Economy • Poverty and Human Development • Education • Nutrition • Food Security • Social and Health Inequity • The conflict 12/16/2015 40
  40. 40. • Vulnerability and Disaster • Governance and Public Sector Reform • Epidemiology and Disease Burden • Health Policy Orientation and Priorities • Decentralization of Health Services • Health Financing • Human Resource • Summary of Health Challenges and Opportunities - Health system including HRH - Disease control, environmental and emergency health - Maternal and Reproductive Health 12/16/2015 41
  41. 41. WhO CORe fUNCTIONsWhO CORe fUNCTIONs Providing leadership on matters critical to health and engaging in partnerships where joint action is needed; • Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; • Setting norms and standards, and promoting and monitoring their implementation; • Articulating ethical and evidence- based policy options; • Providing technical support, catalyzing change, and building sustainable institutional capacity; • Monitoring the health situation and assessing health trends. 12/16/2015 42
  42. 42. hOW DOes WhO sPeND ITshOW DOes WhO sPeND ITs mONey?mONey? The World Health Assembly has approved a budget which divides WHO’s spending into 4 interdependent categories: 1. essential health interventions (such as response to epidemic alerts and reduction of maternal and child mortality); 2. health systems, policies and products (such as the quality of medicines and technologies); 3. determinants of health (such as nutrition and tobacco- use); and 4. effective support for Member States (such as increasing investment in knowledge management and information technology and ensuring staff security). 12/16/2015 43
  43. 43. esTImATeD exPeNDITUReesTImATeD exPeNDITURe Essential health interventions (53 %) Effective support for Member States (21 %) Health policies, systems and products (13 %) Determinants of health (11 %) 12/16/2015 44
  44. 44. WORLD BANK 12/16/2015 45
  45. 45. IntroductionIntroduction Conceived in 1944 to reconstruct war- torn Europe, the world Bank has evolved into one of the world’s largest sources of developmental assistance, with a mission of fighting poverty with passion by helping people help themselves. A vital source of financial and technical assistance for developing countries around the world. 12/16/2015 46
  46. 46. ObjectivesObjectives To fight poverty with passion and professionalism for lasting results. To help people help themselves and their environment by providing resources, sharing knowledge, building capacity, and forging partnership in the public and private sectors. To promote sustainable private sector investment in developing countries, helping to reduce poverty and improve people’s lives. To promote foreign direct investment into developing countries to help support economic growth, reduce poverty, and improve people’s lives. 12/16/2015 47
  47. 47. The world bank group consists ofThe world bank group consists of The International Bank for Reconstruction for Development(IBRD) . The international Development Association (IDA). The international Finance Cooperation (IFC) The Multilateral Investment Guarantee Agency(MIGA). The International Centre for Settlement of Investment Disputes (ICSID). 12/16/2015 48
  48. 48. The World Bank Group is involvedThe World Bank Group is involved inin Agriculture and Rural Development Aid Effectiveness Combating Corruption Conflict Prevention and reconstruction Debt relief Economic research and data Education Empowerment and participation 12/16/2015 49
  49. 49. CONT…….CONT……. Energy and mining Environment Financial sector Gender Globalization Governance Health, nutrition and population Indigenous peoples 12/16/2015 50
  50. 50. Cont..Cont..  Information and communication technologies infrastructures  Labor and social protection  Law, regulation, and judiciary  Manufacturing and services  Poverty  Private sector development  Social development  Sustainable development  Trade  Transport  Urban development  water 12/16/2015 51
  51. 51. However world bank isHowever world bank is The world's largest funder of education The world’s largest external funder of the fight against HIV/AIDS A leader in the fight against corruption world wide A strong supporter in debt relief The largest international financier of biodiversity project The largest international financier of water supply and sanitation projects 12/16/2015 52
  52. 52. Funding policiesFunding policies Offers two basic types of funding instruments 1) Investment Loan 2) Development policy Loan World Bank provides fund to a member country depending on it’s eligibility through either IBRD or IDA 12/16/2015 53
  53. 53. Lending operation are developed in the “ World Bank Project Cycle” 12/16/2015 54
  54. 54. Involvement of World Bank inInvolvement of World Bank in NepalNepal Health 50 million Peace Project 50 million Water 27 million Rural Poor People Support 253 million  Second Higher Education Project 80 million Nepal Combats Avian Influenza 18 million Poverty Alleviation Fund 25 million Economic reforms 3 million 12/16/2015 55
  55. 55. Roles and contributionsRoles and contributions To provide low-interest loans, interest-free credit and grants to developing countries for education, health, infrastructure, communications and many other purposes. Efforts are coordinated with wide range of partners, including government agencies, civil society organization other aid agencies and the private sector. The Bank group’s work focuses on the achievement of the millennium development goals. To address issues related to gender, community development, indigenous people. 12/16/2015 56
  56. 56. 12/16/2015 57
  57. 57. UNICEF IN NEPAL 2008-2010UNICEF IN NEPAL 2008-2010 UNICEF celebrated 40 years of work in Nepal in 2008 UNICEF’s three year programme(2008-2010) are aligned with the Interim plan to help achieve the development goals stated within it. The 2008-2010 programmed is focused on the poorest and most excluded, including young people impacted by the conflict. 12/16/2015 58
  58. 58. prioritizationprioritization One approach – six programmes in Nepal DACAW(decentralised action for children and women) Child protection Education Health and nutrition HIV/AIDS Wash Social policy 12/16/2015 59
  59. 59. DACAWDACAW This approach is UNICEF’S PRIMARY Vehicle for directing a range of interventions to rural communities across Nepal It aims to strengthen the capacity of individuals and communities Ministry of local Development is the lead implementing agency, along with other ministries Focus on the most disadvantaged communities in 23 of the75 districts in Nepal 12/16/2015 60
  60. 60. Child protectionChild protection Child protection systems eg.village and district paralegal committees Children affected by Armed conflict Legislation and policies for child protection 12/16/2015 61
  61. 61. educationeducation Early childhood development Formal primary education Non formal primary education Peace education and emergency education 12/16/2015 62
  62. 62. Health and NutritionHealth and Nutrition Child survival Maternal health Nutrition National health sector support 12/16/2015 63
  63. 63. HIV/AIDSHIV/AIDS Prevention of mother to child transmission Paediatric HIV/AIDS treatment Adolescent HIV/AIDS prevention Protection and care for children affected by HIV/AIDS 12/16/2015 64
  64. 64. washwash Quality water supply Environmental sanitation and hygiene National district level sector support 12/16/2015 65
  65. 65. Social policySocial policy Policy and institutional support Child rights promotion Monitoring and evaluation 12/16/2015 66
  66. 66. Roles and contributions of UNICEFRoles and contributions of UNICEF Strengthening communities through decentralization in favour of children and women  building an environment that protects children against violence, exploitation and abuse 12/16/2015 67
  67. 67. Contd…Contd… Build the capacity of paralegal committees, women's federations and child clubs to raise awareness of early intervention, reconciliation and mediation and advocate against violence, exploitation and abuse Increase access to quality basic education, especially for girls and disadvantaged group 12/16/2015 68
  68. 68. Improve maternal health, reduce childhood morbidity through improved management of childhood illness due to ARI, diarrhoea and vaccine preventable diseases Expanding a newborn health package which include treatment of severe neonatal infection, birth asphyxiation,hypothermia 12/16/2015 69
  69. 69. Promotion of breast feeding The national immunization programme is supported to achieve universal coverage Supplementary campaigns for measles and polio are carried out nationally 12/16/2015 70
  70. 70. Fifteen emergency obstetric cares services are provided in 8 districts Increase skilled attendance at birth in DACAW district Vit.A supplements and de-worming tablets are provided bi- annually to 3.4 million children Iron supplements for pregnant and breast feeding mothers 12/16/2015 71
  71. 71. Reduce incidence of diseases from inadequate sanitation and water supply Install sanitary, child friendly toilets, separate for girls and boys and safe drinking water facilities, in 450 schools Student have knowledge and skill to maintain the cleanliness of sanitation and practice of proper hand washing, through the formation of child clubs and training and hygiene campaign 12/16/2015 72
  72. 72. Emergency preparedness and response Increase awareness of HIV/AIDS prevention Raise awareness among policy makers, the media and the general public through popular radio initiative SSMK, broadcasting to millions of children on issues concerning them 12/16/2015 73
  73. 73. FUNDING POLICYFUNDING POLICY The full three year programme is budgeted at USD 68,214,000  of which USD 20,214,000 has been allocated internally  USD 48,000,000 is required to be raised from donors over the three years 12/16/2015 74
  74. 74. United Nations Fund for Population Activities (UNFPA) 12/16/2015 75
  75. 75. 12/16/2015 76 Organisational BackgroundOrganisational Background UNFPA, the United Nations Population Fund, is an international development agency that promotes the right of every woman, man and young people to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.
  76. 76. 12/16/2015 77 Organisational BackgroundOrganisational Background UNFPA assists developing countries, countries with economies in transition and other countries on their request. Established in 1969,  it is currently assisting 140 Countries and is the largest multilateral source of population assistance.
  77. 77. 12/16/2015 78 Organisational BackgroundOrganisational Background UNFPA started its assistance to GoN from early 1970s, has supported implementing five country programme cycles corresponding to GoN 6th , 7th , 8th , 9th and 10th developmental plans.
  78. 78. 12/16/2015 79 AreaArea Improve Access to Reproductive Health (Implementing partner Family Health Division/DoHS) Strengthen NationalTraining and Management Capacity (implementing partners- National HealthTraining Centre and Management Division) Increasing Awareness on RH and Gender Issues (Implementing partner National Health Education, Information and Communication Centre)
  79. 79. 12/16/2015 80 AreaArea Besides the Country Programme other projects being supported by UNFPA is : Parenthood Project in partnership with Rotary Club through Hospital and Rehabilitation Centre for Disabled Children (HRDC).
  80. 80. 12/16/2015 81 STRATEGIESSTRATEGIES  UNFPA support to Nepal is designed to complement the activities of other providers of RH care and most importantly those of Government of Nepal in line with the Nepal Health Sector Programme Implementation Plan (NHSP-IP) and is also designed to have a catalytic and synergetic role in improving RH and in exploring and developing innovative approaches.
  81. 81. 12/16/2015 82 STRATEGIESSTRATEGIES A key strategy of UNFPA is to assist DoHS to develop its human resource needs and capacity both for delivery of quality RH services and management of RH programmes. UNFPA is considering to contribute to the pool fund of the Nepal Health Sector Strategy.
  82. 82. United Nation DevelopmentUnited Nation Development Programme (UNDP)Programme (UNDP) 12/16/2015 83
  83. 83. UNDP is the UN's global development network, an organization advocating for change and connecting countries to knowledge, experience and resources to help people build a better life. It is on the ground in 166 countries, working with them on their own solutions to global and national development challenges. 12/16/2015 84
  84. 84.  World leaders have pledged to achieve the Millenium Development goals, including the overarching goal of reducing poverty in half by 2015. UNDP's network links and coordinates global and national efforts to reach these Goals. UNDP focus is helping countries build and share solutions to the challenges of:  Democratic Governance  Poverty Reduction  Crisis Prevention and Recovery  Energy and Environment  HIV/AIDS 12/16/2015 85
  85. 85. UNDP in NepalUNDP in Nepal UNDP first established its office in Nepal in 1963 to support the Nepalese in their struggle against poverty. Since 1963, UNDP has worked at building linkages that address effective design and implementation of 'poverty alleviation' programmes in Nepal. 12/16/2015 86
  86. 86. Geographical focusGeographical focus UNDP's activities span almost 75 districts and 1,000 out of 4,000 villages.  The number of projects ranged from 25 and currently consolidated into 16. Some of them are being closed by mid 2008 with the completion of past cooperation. However, about 10 new programmes are expected to be formulated in line with the newly approved Country Programme 12/16/2015 87
  87. 87. Current Programme prioritiesCurrent Programme priorities Transitional Governance Inclusive Growth & Sustainable Livelihood Peace Building and Recovery Energy, Environment and Natural Disaster Management HIV/AIDS 12/16/2015 88
  88. 88. Type of assistance and programmingType of assistance and programming  The Country Cooperation Framework (CCF-I, 1997- 2001) for Nepal was designed in consistence with the Government's Ninth Development Plan (1997-2001) and UNDP's mandate.  UNDP's Country Cooperation Framework (CCF II, 2002- 2007) has completed its programming cycle of six years which addressed poverty alleviation by supporting development projects in the areas of Democratic Governance, Pro-Poor policies and Sustainable Livelihood, Energy, Environment and Natural Disaster Management, Crisis Prevention and Recovery (CPR) and Responding to HIV/AIDS. 12/16/2015 89
  89. 89. In early 2008, UNDP approved its Country Programme Document (CPD) for 2008- 2010 in support of the Interim Development Plan of the Government of Nepal 12/16/2015 90
  90. 90. ResourcesResources UNDP is funded from its own regular resources, other United Nations sources of financing, and from bilateral and other external donors. During the period of 2002-2007, UNDP's assistance reached to $US 84 million including the resources mobilized from bilateral donors. 12/16/2015 91
  91. 91. For the current Country Programme Action Plan (CPAP) period of 2008-2010, UNDP together with its donor partners expects to provide assistance worth of US$94.0 million. Of this $25 million is expected to be from UNDP's regular source. 12/16/2015 92
  92. 92. Of the total programme delivery of US$ 27 million through the 33 ongoing projects in 2007, 32 percent was from UNDP resources, 18 per cent from Global Fund for AIDS, Tuberculosis and Malaria (GFATM), Global Environment Facility (GEF), UN Peace Fund and other Thematic Trust Funds, 2 percent from United Nations Capital Development Fund (UNCDF) and 48 percent from bilateral donors 12/16/2015 93
  93. 93. SAARC South Asian Association forSAARC South Asian Association for Regional DevelopmentRegional Development Economic and geographic organisation of eight countries SAARC provides its charter, summit declaration, activities, events and publication for the socio-economic development of member countries Nepal has embarks on a NPR 180 million plan to renovate and beautify the capital for the upcoming 18th SAARC summit 12/16/2015 94
  94. 94. Asian Development Bank (ADB)Asian Development Bank (ADB) Fighting poverty in ASIA and the pacificFighting poverty in ASIA and the pacific Nepal has made notable socioeconomic progress over the years, particularly in the areas of poverty incidence, and meeting a majority of the MDGs Which are likely to be met by 2015. ADB’s country partnership strategy, 2013-2017 supports the government’s development objective of acclerated and inclusive economic growth. 12/16/2015 95
  95. 95. It seeks to address the infrastructure bottlenecks in the areas of Energy Air Road and transport Water supply and sanitation and irrigation Business Employment opportunities 12/16/2015 96
  96. 96. Areas of cooperationAreas of cooperation  Agriculture and rural  Biotechnology  Culture  Economic trade  Education  Energy  Environment  Finance  Information, communication and media  Poverty alleviation  Science and technology  Security aspects  Social development  Tourism 12/16/2015 97
  97. 97. Bilateral partnersBilateral partners USAID, GIZ, DFID, SDC 12/16/2015 99
  98. 98. USAIDUSAID Introduction: In September 1997, the United States Agency for International Development (USAID) signed a bilateral Strategic Objective (SO) Agreement with HMG for a five-year period (1997-2002). Our programme includes activities not only with the MOH but also with the NGO and private sectors. The SO agreement focuses on four major sectors, including:   • family planning (FP); • maternal and child health (MCH); • prevention and control of HIV/AIDS/STIs; and • control of infectious diseases. 12/16/2015 100
  99. 99. To implement these programmes, USAID has an annual budget of up to $17 million (USAID/Washington plus bilateral funds) to support technical assistance, training, IEC and the purchase of essential commodities. Below is a brief summary of each of the USAID programmes in the four sectors. 12/16/2015 101
  100. 100. GTZ: Primary Health CareGTZ: Primary Health Care Project (PHCP)Project (PHCP) Since 1994, the Primary Health Care Project (PHCP) has been supporting His Majesty’s Government of Nepal, Ministry of Health in the implementation of the National Health Policy adopted in 1991, which stresses improving primary health care services in the country. In order to improve the health situation, especially of rural communities, the National Health Policy emphasises community participation, decentralisation, integration of traditional health care providers, establishment of health facilities at the community level, development and management of health manpower, promotion of private, non-government and intersectoral co-ordination and resource mobilisation. 12/16/2015 102
  101. 101. ACHIEVEMENTSACHIEVEMENTS 1. Developing a District Health System  Community participation in health planning and renovation of health facilities  Street Drama training to increase health awareness 2. Developing Managerial Capacity  Development of the Human Resource Development Information System (HuRDIS)  Integration of gender-disaggregated data into the Management Information System 12/16/2015 103
  102. 102. 3. Improving the Quality of Training  Development of an operational plan for the National Health Training Centre (NHTC)  Functional analysis of the National Health Training Centre (NHTC) 4. PHCP AND THE FUTURE 12/16/2015 104
  103. 103. DEPARTMENT FORDEPARTMENT FOR INTERNATIONAL DEVELOPMENTINTERNATIONAL DEVELOPMENT (DFID)(DFID) The Department for International Development (DFID)’s aim is the elimination of poverty in poorer countries. Specific objectives include: a)policies and actions which promote sustainable livelihoods; b)b) better education, health and opportunities for poor people; and c)c) protection and better management of the natural and physical environment. 12/16/2015 105
  104. 104. AREAS OF TECHNICAL ANDAREAS OF TECHNICAL AND GEOGRAPHICAL SUPPORTGEOGRAPHICAL SUPPORT British Embassy providing technical programme support and technical staff on the Safer Motherhood and District Health projects. 12/16/2015 106
  105. 105. Roles and contributionsRoles and contributions DFID has contributed to continuing increases in contraceptive prevalence. Its contribution is flexible and not tied to any particular commodity, helping to reduce stock- outs. In Safer Motherhood, on-site whole-team training has been completed in some areas (infection control), appropriate referral rates are increasing, the increasing access component is making progress on reducing barriers to access, and physical improvements work has started. District Health Strengthening 12/16/2015 107
  106. 106. SWISS AGENCY FOR DEVELOPMENT ANDSWISS AGENCY FOR DEVELOPMENT AND COOPERATION (SDC)COOPERATION (SDC) The Rural Health Development Project (RHDP) is a bilateral project of Government of Nepal and the Swiss Agency for Development and Cooperation. The overall goal of the project is to contribute to improving the health status of women, girls, boys and men through participatory development of a locally adapted and affordable health system. The primary objective of the project is to empower women, girls, boys and men to enhance their health conditions and have access to improved comprehensive health services at the local level. 12/16/2015 108
  107. 107. Roles and ContributionsRoles and Contributions Promotive Health Activities Community Initiatives: Strengthening the Local Health System Promotion of Drug Scheme Skill Development of Health Workers Coordination and Alliance-Building Integration of Gender Balanced Approach AIDS Awareness Reactivation of Jiri Hospital 12/16/2015 109
  108. 108. Other health-related international organizationsOther health-related international organizations in health promotion and disease preventionin health promotion and disease prevention programs in Nepalprograms in Nepal UNITED MISSION TO NEPAL (UMN) SAVE THE CHILDREN FUND (U NETHERLANDS LEPROSY RELIEF (NLR) COOPERATIVE FOR ASSISTANCE AND RELIEF EVERYWHERE (CARE) BRITAIN NEPAL MEDICAL TRUST (BNMT) KREDITANSTALT FÜR WIEDERAUFBAU (KfW) THE GERMAN DEVELOPMENT BANK 12/16/2015 110
  109. 109. FAMILY PLANNING ASSOCIATIONFAMILY PLANNING ASSOCIATION OF NEPAL (FPAN)OF NEPAL (FPAN) The Family Planning Association of Nepal (FPAN) came into existence in 1959. Beginning with three districts in its early years, today it covers 42 of Nepal's 75 districts. Given its extensive coverage, innovative programmes and its ability to provide comprehensive RH/FP services, the Association is regarded as the leading NGO working in reproductive health. FPAN acquired joint membership of the International Planned Parenthood Federation (IPPF) in 1960 and full-fledged membership in 1969. 12/16/2015 111
  110. 110. STRATEGIESSTRATEGIES To provide FP services based on informed choice, with particular emphasis on spacing methods, as well as to provide basic mother and child health services for safe motherhood and child survival. To strengthen advocacy for increasing governmental and public awareness To develop and implement an information, education and motivation (IEM) To develop and implement a continuing programme of orientation and training for various categories of volunteers and staff of the Association 12/16/2015 112
  112. 112. Difference between bilateralDifference between bilateral and multilateral donorsand multilateral donors Bilateral aid usually refers to assistance given directly from a donor government to a recipient country. The donor government may provide this assistance directly to the recipient government or to non-governmental institutions operating in the recipient country. This aid is sometimes managed by a government agency charged with this task. Multilateral aid means between more than two parties. This is used where a donor country sends funds to multilateral organization such as the World Bank and the United Nations, which in turn administer aid donations to several recipient countries. 12/16/2015 114
  113. 113. Bilateral flows are provided directly by a donor country to an aid recipient country. Multilateral flows are channeled via an international organization 12/16/2015 115
  114. 114. 12/16/2015 116
  115. 115. • The main difference between multilateral and bilateral aid is related to the way in which funds are transferred. • In bilateral aid, it is country to country, and in multilateral, it is unearmarked aid from countries to multilateral agencies, such as the Word Bank, European Union, and the United Nations, and then to recipient countries. This is a crucial difference because in the case of bilateral aid individual countries are the only one to decide whom to give money to, and for which purpose. 12/16/2015 117
  116. 116. Given the different nature of these two types of aid, one expects that multilateral aid is more appropriate for developing purposes for the following reasons: --Higher participation and resources: Multilateral aid encourages donor countries to get together and donate. Small donations by itself maybe insignificant at the global scale, but when combined with donations from many countries through international organizations can become significant and help those countries in need. --Political neutrality and needs-driven: Multilateral aid tends to be less tied to the political and strategic interests of individual donor countries and consequently is able to focus more on the needs of poor countries. One can expect that multilateral aid will help, in particular, in fragile and/or post-conflict societies, especially when it takes the form of humanitarian assistance and post-conflict reconstruction. --Global governance: Multilateral aid, when delivered through international organizations, will tend to adhere to widely-shared principles, standards, and procedures. This will deepen the understanding that many of these problems are not local, but global, and therefore have to be tackled by the corresponding institutions and mechanisms. A corollary to that is that these institutions and mechanisms will have to be strengthened, so as to be able to perform effectively the assigned tasks. . 12/16/2015 118
  117. 117. Concerning other aspects mentioned in the literature it is very difficult, at theoretical level, to say if multilateral aid is better than bilateral for development proposes. For example it has been said that multilateral aid allows for a more efficient allocation of resources than bilateral aid. This is mainly due to the fact that international organizations possess specialized professionals in the field which are unmatchable by any single country in the world and this will allow for reduction in time and costs. However, this is questionable because the cost of running a large scale organization can be extremely high because of the high level salaries required to pay the trained personnel and the expenses of keeping the organization running. In addition, turning to the time dimension, when aid funds are collected and managed by an international organization some of these funds are often delayed and less of the funds reach the intended destination. The literature also states that multilateral aid is better that bilateral for development proposes because it tends to avoid unnecessary coercive conditions on the recipient countries. One of the strongest criticisms of bilateral aid is the tendency for donor's countries to place strict political and economic conditions on the recipient counties. However, multilateral aid has the potential to be equally or more coercive than bilateral aid. The IMF austerity programs and structural adjustment policies in the developing countries is an example of imposing harmful conditions on the recipient countries 12/16/2015 119
  118. 118. Thank you……. 12/16/2015 120