Health care System in Federal Democratic Republic of Nepal

1. Health Care System
in Federal Democratic
Republic of Nepal
Dr. Sonali Kumari Shah
M.D.Hospital Administration
BPKIHS,Nepal

2. INTRODUCTION
Nepal has entered from its unitary system into a new “Federal
Democratic Republic system” on 17 September 2015.
Federal system is expected to bridge the persistent disparities
between rural and urban areas which are rooted from the past.
According to the new constitution Federal Democratic Republic of
Nepal shall be divided into three main level of structure : Federal,
Provincial and Local.
The constitution gives emphasis on right to clean water and hygiene
and equal access to health care.

3. The transformation of government from centralized to federal has
led to effective supply of resources from the provinces and brought
a new wave in the health sector reform.
Health care provision and health care financing should be
organized according to federal legislation and managed by federal
government.
Thus, proper implementation, good governance and accountability
is crucial.

4. Article 35:
(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 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

5. Objectives of Health Care
Delivery
•should be organized to meet the needs of entire
population and not merely selected groups
•should cover the full range of preventive,
curative and rehabilitation services
•should be a part of basic social services of a
country

6. Timeline of Health System
YEAR ACTIVITIES
1970s Focused on establishment of district health services
1990s National health policy introduced in 1991
2006 Political change in Nepal
Declared targeted free care at district hospitals & PHCC (IPD and ER)
2007 Interim constitution of Nepal focusing on free basic health care services
Declared the abolishing user fees at HP/SHP nationwide & made service free to
all
2008 Implemented the policy of free to all health posts and SHPs
Expanded universal free care to PHCC level
2009 Declared free outpatient care at DHs to the targeted population nationwide
Declared 40 free essential drugs free to all at district hospitals nationwide
Primary Health Care Revitalization Division established.
2014 National Health Insurance Policy adopted
2015 Social Health Security Program regulation and formation of Social Health Security
Development Committee
2016 Social Health Security Program (Started in three districts )
2017 Further expansion of SHSP to five more districts

7. National Health Care System
• Health care system of Nepal is managed by Ministry of Health
(MoH)
• MoH is responsible for making necessary arrangements and
formulation of policies for effective delivery of :
– Curative Services
– Disease Prevention
– Health Promotion
– Establishment of Primary Health Care System

9. New Federal system

10. Ministry of Health and Population
Department of health Services
Department of Drug
Administration
Department of Ayurvedic and
Alternate Medicine
Health Emergency and Disaster
management unit

11. Organogram of MOHP

13. Department of health services

15. Health Councils
• Nepal Medical Council
• Nepal Nursing Council
• Nepal Ayurvedic Medical Council
• Nepal Health Professional Council
• Nepal Pharmacy Council and
• Nepal Health Research Council

16. Development Partners Support
The SWAp now supports the implementation of the new Nepal
Health Sector Strategy (NHSS, 2016– 2021).
The Joint Financing Arrangement (JFA) has been signed by
various partners and the government.
The JFA elaborates the pool funding arrangement and parallel
financing mechanism as bilaterally agreed between the
government and the donor partners

17. National Health Policy- 2071
In the context of health as a fundamental right of the people
established by Nepal’s constitution, it is the responsibility of the
nation to maintain the achievement made in
• controlling communicable diseases
• to reduce infant and maternal mortality rate to the desired
level, to control the ever increasing prevalence of non-
communicable diseases
• timely management of unpredictable health disasters, and to
provide quality health services to senior citizens, physically
and mentally impaired people, single women especially poor
and marginalized and vulnerable communities.

18. 208
Sub Health Post
2247

19. Number of Beds

22. Health Care System
• Public Health Sector
• Private Sector
• Traditional system
• Voluntary health agencies
• National health programs

23. Health System in Federal Nepal
Key tasks
•Functional Analysis
•Structural Arrangements
•Transition Management Plan
MoH formed a high level team and a technical task team to
carry out the task.

27. Traditional system
-Ayurveda
-Homeopathy
-Unregistered Practitioner

28. FCHV
• Program Initiated in 1988/89.
• 5th
December is celebrated as FCHV Day to show respect to
FCHVs.
• In 19th
November 2009, FCHV Program in Nepal received
GAVI awards for the highest average annual rate of reduction
of child mortality among all of the 72 GAVI countries since
1990.

31. Sub-health posts
•Sub‐healthpost is the first institutional contact point for
basic health services.
•Referral center of the volunteer cadres of TBAs and
FCHVs as well as a venue for community-based
activities such as PHC outreach clinics and EPI clinics
•SHPs monitor the activities of FCHVs as well as
community‐based activities by PHC outreach clinics and
EPI clinics.

33. Health Posts
•Same as SHP as well as birthing centers in the respective
VDC.
•Each level above the SHP is a referral point in a network
from SHP to Health Post (HP) to Primary Health Care Centre
(PHCC), on to district, zonal sub‐regional and regional
hospitals, and finally to tertiary level hospitals
39

34. Health post
Health assistant/Senior
AHW
AHW
ANM

35. PHC
• Highest center among the primary level health
centre
• Cases from Subhealth Post and health Post are
referred to PHC.

36. Medical Officer
Staff nurse
Auxillary health worker
(AHW)
Health assistant
Lab assistant
Auxillary Nurse
Midwifery(ANM)
Cold chain assistant

37. Services provided by PHC
• Safe motherhood and newborn care
• Family planning
• Child Health
• Immunization
• Nutrition
• Health Education and Counseling
• First aid treatment

39. Secondary Level Health
Centers
• Zonal hospital – 10
• District hospitals – 75
referral centers for the primary health centers
Provide acute care: necessary treatment for a short period of
time for a brief but serious illness, injury or other health
condition, such as in a hospital emergency department.
Also provide skilled attendance during childbirth, intensive
care, and medical imaging services.

41. Tertiary Level Health Center
•Highest level of health centre in referal system of health services
•Central hospitals and regional hospital serve as the tertiary
referral centers
•Here, patients are referred from smaller hospitals for major
operations, consultations with sub-specialists and when
sophisticated intensive care facilities are required.

42. Central Hospitals- 8
• Bir hospital
• Thapathali maternity hospital
• Kanti children hospital
• Sukraraj tropical hospital
• Gangalal heart center
• Bharatpur cancer hospital
• Human body transplant center
• TUTH

43. Hospitals in Nepal:
Private hospitals and Government hospitals:
According to data from the Ministry of Health and
Population (MoHP), there are:
366 private hospitals in Nepal among which 99 hospitals
are located in the Kathmandu Valley.
In comparison, 123 government hospitals are under the
MoHP

44. Health Workforce

46. Human Resource
Development
•MD/MBBS: National Academy of Medical Science, Tribhuwan
University, Kathmandu University, BP Koirala Institute of Health
Sciences and 20 affiliate colleges (MBBS only).
•4 University (Tribhuwan University, Kathmandu University,
Pokhara University and Pubanchal University) and BPKIHS produce
paramedics (Bachelors and Masters).
•Council for Technical Education and Vocational Training
(CTEVT) produces general medical practitioners (Certificate Level).

47. Major policies
• Health sector reform
• Sector wide approach
• Millenium development goal
• International health partnership
• Global Health Initiative
• Health System Funding Platform

48. Financing

50. Nepal Budget Statement
Highlights and Tax Rates for FY
2076-77 (2019-20)

51. EXISTING FREE HEALTH
CARE IN NEPAL
SOCIAL HEALTH SECURITY PROGRAM
Necessary financial contribution:
Contribution of NPR 3,500 for family up to 5 members
 NPR 700 additional for member
Services received:
Worth NPR 1,00,000 for family with 5 members
 Each additional member  additional service of NPR
20,000
 Maximum ceiling will be of NPR2,00,000.

52. Recent Health Indicators of Nepal

55. Source:unicef

57. Thank You…