Working with Non-State Actors
Private sector pharmacies are widespread in Nepal providing diagnosis and examination as well as drugs, and are a major recipient of out-of-pocket spending by all income groups. The rest of the private-for-profit sector is urban based and serces predominantly the better off. The for-profit private sector has over two thirds of the hospital beds and trains 90% of doctors. It remains heavily partnering with the Government and in delivering EHCS. Although contracting out service provision and the management of facilities has progressed very slowly, there are existing partnerships of differing types in many areas of the sector. Examples include NGO management of hospitals, NGOs conducting family planning, safe motherhood, TB, and HIV/ AIDS services, and the prevention and treatment of uterine prolapsed. Future directions will address clarifying PPP policy, further expansion of PPPs to provide services to underserved communities, encouraging the private sector to provide specialized services in rural areas, and implementing quality assurance and accreditation to private partners receiving public funds.
External Development Partners and Aid Effectiveness
Progress on the aid effectiveness agenda to which Nepal and EDPs have committed themselves through international agreements has been slow. Areas to be prioritized for faster progress in NHSP-2 are:
- More Ministry guidance on where non-pool EDPs should focus their support.
- Align EDP planning and approval cycles with the GoN budget cycle.
- Reducing transaction costs and rely on the SWAp planning and monitoring processes, minimize additional bilateral requirements, and conduct more joint missions, co-financing or “silent partner” arrangements.
- Prior Ministry agreement on all TA, and include an annual TA ‘plan’ to complement the AWPB.
- A strengthened SWAp management capacity in HSRU.
- A balanced partnership, with more attention in JARs to assessing EDP performance on aid effectiveness commitments.
- Improved longer term indications of support to facilitate planning through informal consultation if easier for EDPs.
The Ministry will ensure that multi-sectoral programmes are designed with key partners and there is effective inter-sectoral coordination and collaboration. A multi-sectoral approach will be adopted for both health and non-hea it interventions that promotes access to and utilization of services. Effective mechanisms for inter-sectoral coordination and collaboration will be established.
Deployment and retention of human resources (HR) is a major problem in the health sector. NHSP-2 will address the problems of fragmented HR management and incomplete HR information, and will revisit the skill needs for achieving the goals of NHSP-2. The current public workforce has increased only 3% while the population grew 35%, and about 25% of the workforce is unskilled. The Government aims to continue with ongoing programmes to upgrade the skills of the workforce. A modest first step is being taken towards a more multi-skilled workforce able to operate more integrated services. A cadre of public health supervisors is currently being trained to gradually replace more narrow trained supervisors working in specific vertical be addressed. Although there is spare capacity, some form of productivity required of staff as utilization increases will reduce the consequences for them. Problems of social exclusion will be addressed by allocating more staff to underserved areas, and recruiting them form marginalized groups.