Jhabindra Bhandari

In recent years, many developing countries around the world have experienced new public health challenges as well as rapid economic growth, migration and urbanisation. This has undoubtedly created opportunities for many, but left others behind. In order to address some critical challenges of global health, the World Health Organisation (WHO) is initiating a new campaign to build a fairer and healthier world on the occasion of World Health Day, which is marked on 7 April every year.

Disruption of livelihoods
The COVID-19 pandemic has profoundly impacted recent health gains, pushed more people into poverty, and food insecurity, and amplified gender, social and health inequities. Moreover, this has caused significant loss of lives, disrupted livelihoods and undermined well-being around the globe. And the poor health systems will have negative impact on Sustainable Development Goal (SDGs).
As a matter of fact, some communities are able to live healthier lives and have better access to health services than others due to the conditions in which they are born, grow, live, work and age. However, there are other communities who are still facing serious challenges to secure their daily income, have safe housing conditions, better education and employment opportunities.
Additionally, it is unfortunate to note that they largely experience greater gender inequality, and have little or no access to safe environments, clean water and air, food security and health services. And it has profound impacts on our societies and economies.
Therefore, there are critical needs to ensure that everyone has living and working conditions that are conducive to good health.  At the same time, there is an emerging need to monitor health inequities, and to ensure that all people are able to access quality health services when and where they need them. 
According to World Health Statistics (2020), life expectancy and healthy life expectancy (HALE) have increased by over 8 per cent globally between 2000 and 2016, and remain profoundly influenced by income. In addition, there are increasing evidences that that overall access to essential health services improved from 2000 to 2017, with the strongest increase in low- and lower middle-income countries.
Due to the inadequacy of service coverage in low-resource settings, the overall access to essential health services is still low. Moreover, compared with the advances against communicable diseases, there has been inadequate progress in preventing and controlling non-communicable diseases.
Like many developing countries, Nepal is pursuing the 2030 Agenda for Sustainable Development with strong political will and commitment. Yet, multi-dimensional poverty, structural constraints, mountainous geophysical features and detrimental impacts of climate change continue to pose a serious challenge for rapid, inclusive and sustainable development in the country.
A recent national review report on SDGs by the National Planning Commission shows that there are significant health gains over the decade. Due to several efforts made by the government in the health sector, as well as strong community engagement, child mortality, for an example, is decreasing in Nepal. The under-five mortality rate reduced from 91 to 38 per 1000 during 2000-2015. And it further came down to 28 per 1000 in 2019.
Similarly, national safe motherhood initiatives has led the maternal mortality ratio (MMR) to drop from 850 per 100,000 live births in 1990 to 539 in 1996, 281 in 2005 and 258 in 2015. It is now at 239 per 100,000 live births in 2018/19. The national target is to reduce the MMR to 70 per 100,000 live births by 2030. This is a remarkable progress indeed.
The health sector is a priority agenda for investment. In this context, Ministry of Health and Population (MoHP) is developing national health financing strategy to ensure adequate resources are available for meeting the basic health needs of entire populations. The remarkable progress such as free basic health care systems in health posts, primary health care centers and 25-bed district hospitals are being established, and 70 types of basic drugs have been available free of cost. Additionally, the government plans to increase the percentage of people associated with health insurance from 7 per cent at present to 60 per cent by the end of fiscal year 2023/24.

Critical capacity gaps
In the federal context, there are critical capacity gaps in terms of human resources, guidelines, health information systems, supplies of essential drugs and logistics and health infrastructures in order to ensure participatory planning and management of health services at the local level. While some of the provincial health offices have developed their health polices, strategies and priorities, it is crucial to ensure they have adequate technical capacity to effectively implement the policies and strategies for better health outcomes across the provinces. In addition, strengthening health information systems is vital to monitor progress towards the SDGs.
In the changing socio-political context, global health governance has emerged as a key concept that captures the dynamic roles, interests, and diverse activities of multiple actors in global health. On the other side, global health security underpins the current framework for international preparedness and response to emerging infectious diseases. Persistent threats of outbreaks and inherent challenges are barriers to global health security. More importantly, strengthening global health security will require enhanced national capacity on International Health Regulations (IHR) for a robust health emergency response.

(Bhandari is senior research fellow in global health and health systems.talk2jhabindra@gmail.com)