Transforming Nepal’s health policy landscape

The Constitution of Nepal has established basic healthcare as a fundamental right of its citizens. In the context of the federal governance system, it is the responsibility of the state to ensure easy access to quality health services for all. The national health policy 2019 primarily aims to develop and expand a health system based on social justice and good governance. Moreover, the policy has laid emphasis on the social health protection system by integrating the most marginalized sections within and across societies. 

At a recent press conference, Health Minister Pradeep Paudel presented his key health priorities and action plan to ensure people have easy access to quality health care services at all levels. The rationale of these priorities is largely based on the guiding principles of national health policy, 16th plan and the 2030 agenda for sustainable development. Ensuring equitable access to healthcare is a primary agenda of health sector reforms. 

In the federal context, the first and foremost priority is to develop a solid strategic roadmap to improve coordination with clarity on roles and responsibilities within and across three levels of governments in order to harmonize effective implementation of national health policies, strategic guidelines and the emerging priorities. The idea of establishing an integrated health infrastructure development project is innovative and timely as it provides a clear picture of existing human resources, health infrastructure, health financing mechanisms, logistics and supply chain management at all levels. 

Undoubtedly, this strategic approach will facilitate federal, provincial and local governments to identify new opportunities and gaps, and address existing challenges in delivering quality healthcare services. Strengthening the institutional capacity of local health governments and health facilities is one of the critical challenges in the health sector due to limited human resources, inadequate health infrastructure and supplies, poor monitoring and evaluation systems of healthcare services. 

Therefore, the ambitious action plan to increase the coverage of health insurance as well as other social security schemes is easier said than done. Evidence suggests that national health insurance and other social protection services are facing serious implementation challenges. However, it is yet to be seen how the new priorities of the health minister are implemented in the months to come. The ground reality is that without realistically addressing persistent structural barriers in health systems and ensuring effective implementation of policy and regulatory frameworks, one can not simply hope for significant reform in the health sector.

Other emerging issues such as mental health, non-communicable diseases, disaster and health emergencies need a more pragmatic approach for actions to enhance the capacity of local governments for multi-sector response in the health sector. Interestingly, migrant health has also received  priority in order to address the health care needs of migrants and their families. 

By formulating a new population policy, there is an increasing focus on strategizing demographic dividend for sustainable socioeconomic development. The health security of marginalized and indigenous populations is another priority, but again needs a clear strategic roadmap for implementation. Among many other priority areas, one of the praiseworthy initiatives is to improve nutritional status of children under five years of age, adolescents and mothers by enhancing the institutional capacity of provincial and local governments to effectively implement the multi-sector nutrition plan at the communities. 

Though there is explicit focus on urban health systems, climate change and associated environmental health risks for consideration, it is interesting to see how these issues will be effectively mainstreamed in federal health systems for timely action. In addition to enhancing the capacity of hospitals across the country, improving physical infrastructure of the health facilities in the rural areas is a high priority in the health agenda. 

Moreover, there is a critical need to strengthen procurement and supply chain management by ensuring transparency and efficient practices to avoid any interruptions in supplies of drugs and other essential logistics. Ensuring safety, quality and efficacy of medicines is crucial. At the same time, public awareness on road safety is equally important to reduce the mortality, injuries and disability. Health promotion and communication strategies for behavior change are also critical to a healthy lifestyle. 

Therefore, the key stakeholders are now enthusiastically looking forward to effective implementation of the priorities as highlighted by the health minister. Without good governance and strong political commitments, the ambitious plans are less likely to deliver the expected results. The implementation mechanisms and structures must be strengthened with clear terms of reference and a strategic roadmap for reform. Establishing robust monitoring and evaluation systems should be a high priority action point to track the progress and realistically address the bottlenecks in health systems at all levels. 

Despite some notable progress in the health sector, the federal health system has a long way to go to meet the wider expectations of people in accessing and utilizing quality healthcare services at the local level. There is still hope that effective implementation of the new priorities in the health sector will have profound implications in ensuring equity and social justice at large.  

The author is a health policy analyst