Lessons from Nepal Health Sector Programme (NHSP) 2004-10
Nepal has experienced two decades of steady improvement in health outcomes and impact. Progress accelerated and was accompanied by significant improvements in equality of access during the first NHSP (2004-10). Nepal met or exceeded nearly all of the outcome and service output targets that were set for 2004-10, and is on track to NHSP-1 saved 96,000 deaths and nearly 3.2 million disability-adjusted life years (DALYs) at a cost of $144 per DALY saved. The current plan thus represents a continuation and further refinement of earlier policies and plans that were based on the implementation of cost-effective, evidence-based health interventions. If the targets of NHSP-2 are broadly achieved by public health spending in line with a “middle case” scenario, this achievement would be broadly maintained, saving a further 45,000 deaths and nearly 1.5 million DALYs at a cost of $147.
Expenditure in health remains low at 5.3 percent of GDP ad per capita health expenditure at USD 18.09 in 2006. More than 55 percent (USD 0.9) of total health expenditures is financed through out-of-pocket expenditure by households at the time of service. EDPs finance nearly half of Government spending on health, and the substantial gains achieved in reducing child and maternal mortality will examines three scenarios for the future growth in resources available, low, middle and high. All three scenarios adopt the 2010-11 budget ceiling for health that was proposed by the Ministry of Finance in February 2010, but they make different assumptions about absorption and about future growth in resources.
Budget Proposed by MoF for 2010-11
|NRs. 2009-10 Prices||Low case||Middle case||High case|
|GON spending on NHSP, NRs. (billions)||57,90||59.17||73.98|
|EDP spending on NHSP NRs. (billions)||41.73||55.81||69.36|
|Total public expenditure for health NRs. (billions)||99.63||114.98||143.34|
|Spending per capita, US$ (average)||8.62||9.92||12.32|
Problems that are addressed in the next NHSP period include sustaining and expanding the existing essential health care services (EHCS) package to those who have yet to benefit from it, achieving further progress in reducing maternal and newborn deaths, addressing the continuing problem of very high levels of malnutrition, increasing the use of modern methods of family planning, dealing with the challenge of new, neglected, and reemerging diseases, and finding and affordable way of responding to increasing levels of non-communicable disease. Community-based mental health and promotional and preventive eye, oral and environmental health services are proposed as additions to the essential health care services package.
NEPAL HEALTH SECTOR PROGRAMME IMPLEMENTATION PLAN II (NHSP-IP 2) 2010-2015
NHSP-2’s vision or goal is to improve the health and nutritional status of the Nepali population, especially for the poor and excluded. The Government will contribute to poverty reduction by providing equal opportunity for all to receive high-quality and affordable health care services. The three objectives set out in the results framework are:
- To increase access to and utilization of quality essential health care services;
- To reduce cultural and economic barriers to accessing health care services and harmful;
- Cultural practices in partnership with non-state actors;
- To improve the health system to achieve universal coverage of essential health services.
The table below shows the outcome and impact indicators with progress since 1991 and the targets to 2015 that are relevant, and were chosen to reflect the health MDG targets.
Target Vs Achievement of MDGs