The constitution of Nepal has clearly articulated basic health care as a fundamental right of its citizens. However, there are still critical needs and challenges of ensuring equitable access to quality health services for all in the federal context. Nepal’s new health policy 2019 aims at developing and expanding a health system for all with a particular focus on social justice and good governance. In this context, one of the strategic objectives of Fifteenth Plan (2019/20- 2023/24) is to transform the profit-oriented health sector gradually into a service-oriented sector. This can be achieved by enhancing social accountability of federal, provincial and local governments, and maintaining effective regulation for easily accessible and quality health services including preventive, promotional, curative and palliative care.
Nepal’s health sector strategy (2015-2020) had focused on equitable access to quality health services, health systems reform and multi-sector approach as guiding framework for implementation. Despite significant progress, there are still challenges of reaching the unreached populations, reducing high level of out-of-pocket expenditure for health care, effectively managing medical supplies and ensuring adequate human and financial resources.
Good news that Ministry of Health and Population (MoHP) has started participatory consultations with key stakeholders to prioritise key issues that need to be addressed in its new health strategy. Moreover, it is equally important to critically review the progress made in health sector so far and identify key policy gaps and new priorities for action.
Firstly, it is high time to strengthen federal health systems by ensuring effective implementation of national health policies and guidelines, enhancing community engagement and social accountability of the governments and key stakeholders. The new health strategy needs to realistically address health systems issues such as inadequate human and financial resources, poor health infrastructure, delayed procurement and lack of robust supply chain management and weak monitoring and evaluation systems.
Secondly, there are emerging needs of health equity policy analysis to better understand the existing challenges and opportunities of advancing universal health coverage. In this context, health in all policies is a guiding framework to enhance the health and well-being of all populations. Such policies broadly aim to address avoidable social inequalities that contribute to poor health experienced by socially disadvantaged groups in many communities.
Considering the growing burden of morbidity and mortality, more focus is needed on prevention and control both communicable and non-communicable diseases. Over the years, there have been significant investments in epidemics such as HIV, TB and malaria from both governments and other partners such as Global Fund, WHO, USAID and few others. Moreover, scaling up adolescent health, comprehensive sexuality education and family planning services are needed to reduce unwanted pregnancies and risks of HIV.
Likewise, effective implementation of National Human Resources for Health Strategy (2021-2030), Multi-sectoral Action Plan for Prevention and Control of Non-Communicable Diseases (2021-2025), National Health Financing Strategy (2021-2030) and other relevant national guidelines should receive high priority agenda for federal, provincial and local governments. Additionally, new strategic actions are needed to strengthen Integrated Health Information Management System (IHIMS) and promote digital health governance for advancing evidence-informed health policies and strategies for universal health coverage. Furthermore, integration of Geographic Information System (GIS) into local health systems is critical in health assessment and planning health interventions.
On the other hand, promoting urban health is a new priority agenda for policy makers and planners in most cities to ensure healthier environments and lifestyles that in turn reduce the risks of both communicable and non-communicable diseases. A closer look reveals that health is essential for fostering good livelihoods, building a productive workforce, creating resilient communities, enabling mobility, promoting social cohesion, and protecting poor and vulnerable populations.
Coherent strategies are needed to strengthen national capacity in preparedness and response during health emergencies and other disasters. The safe and effective vaccines against COVID-19 are seen as a critical path to ending the pandemic. Moreover, risk communication and community engagement are integral to the success of responses to health emergencies. To move forward, there are emerging needs of investing more resources in health policy and systems research that seeks to understand how different actors interact in the policy and implementation processes to contribute to policy outcomes. This also greatly helps to draw a comprehensive picture of how health systems respond and adapt to health policies, and how health policies can be shaped by the broader social determinants of health.
Resilient health systems
Notably, Nepal Health Research Council (NHRC) recently convened the national summit of health and population scientists to share experiences and learning around resilient health system in the context of advancing health policy and systems research. The new evidences have been instrumental in envisioning new strategic directions and priorities for actions.
To sum up, capacity building of provincial and local governments in resilient health system should be high priority agenda for action. Priority issues around right to health, gender, climate change, migration, environmental degradation, disasters, urban governance, preparedness and response during health emergencies need to be realistically addressed in health policies and strategies. In order to promote a rights-based approach, new health strategy should particularly focus on whole-of-society approach to address the unmet health care needs of those who are poor, socially excluded and left behind in the communities. The consistent efforts of development partners, civil society and private sectors are needed to advance the resilient health system and achieve the ambitious targets of health-related Sustainable Development Goals (SDGs) by 2030.
(PhD in global health, Bhandari writes on health and development issues)