“Health is Wealth”

Without a question, the sweetest fruit on the tree of life is good health, so is the foundation of eternal happiness. Even if we buy all the food in the world, our poor health will prevent us from eating. Our lives are built on the foundation of our health. Its importance goes much beyond the absence of disease; mental, emotional, physical, and social well-being are all included. This article talks about the structural problems and underlying flaws in our healthcare system, illuminating the intricacies that lie in the way of fair access, high-quality treatment, and long-term solutions.

Universal Health Coverage (UHC) is a noble goal aimed at ensuring that all individuals and communities receive the quality health services they need without suffering financial hardship. UHC makes sure that one is safe from facing financial hardships in accessing necessary health treatments, regardless of their socioeconomic level. It encourages equity and equal chances for everyone to live healthy lives. Nepal's commitment to UHC offers a starting point for rethinking the purpose and organisation of the health system and an opportunity to introduce the quality of care agenda into policy discourse. Expanding service coverage without quality will likely not result in improved health or financial risk protection—outcomes that are necessary to justify the substantial resource investment made towards achieving UHC. The agendas for universality and quality of care can and should be synergistic. The Commission recommends ensuring universal access to care with a minimum quality guarantee, and Nepal has already taken some steps in this direction: the 2017 National Health Insurance Act1 and the forthcoming National Health Institution Quality Authority Act2 provide the legal framework towards this goal3.

The number of health facilities registered in Nepal is highlighted in the Department of Health Services' (DoHS) Nepal Health Facts Sheet 2023. According to the fact sheet, there are a total of 14,313 health facilities that provide services and are registered under the reporting mechanism of DoHS. These comprise the Basic Health Service Center (BHSC), health posts, public hospitals, primary healthcare centres (PHCC), and non-public facilities. With the goal to guarantee fair financial management and accomplish universal health coverage (UHC) in Nepal, the government of Nepal recently approved a new ten-year health finance plan. The National Health Financing Strategy 2080- 2090 includes strategic interventions to expand fiscal space for health, strengthen social protection, improve resource generation, and improve health financing governance, accountability, and transparency in the health sector.

Over the past twenty years, Nepal has made significant progress in improving the health of its people, especially in the areas of life expectancy, mother and child survival, and the prevention of infectious diseases. From 539 deaths per 100,000 live births in 1996 to 151 in 2013, maternal mortality decreased. The under-five mortality rate (U5MR) decreased from 118 per 1000 live births to 33 between 1996 and 2022, while the neonatal mortality rate (NMR) decreased from 50 per 1000 live births to 21. Additionally, the percentage of children stunted decreased from 57 to 25 percent (Table 2.1). By 2022, the total fertility rate has dropped from 4.6 in 1996 to 2.1, the replacement level. Even if there is progress in the health sector according to the different websites, the health system of Nepal has faced several criticisms. Low insurance penetration is one of the greatest issues facing Nepal’s insurance sector. In Nepal, insurance penetration was only 1.69% in 2020, compared to a global average of 7.23%3, according to a report by the Insurance board. This indicates that a sizable section of the populace still lacks insurance, making them susceptible to monetary shocks brought on by illnesses, mishaps or natural catastrophes. A comprehensive strategy that includes workforce development, healthcare infrastructure improvements, financial changes, and public health initiatives is needed to address these shortcomings. In order to enhance health outcomes for the people of Nepal, cooperation between government institutions, civil society organisations, and foreign partners is essential.

The 753 local governments (rural and urban municipalities) are responsible for the provision of primary health services (Department of Health Services, n.d.). It was hoped that these changes could contribute to making the health system more responsive to local needs and more accountable to citizens. In practice, however, the shift from a highly centralised health system to a more decentralised model under federalism has faced both structural and operational issues including infrastructural weaknesses, a shortage of skilled staff, health worker absenteeism, poor accountability, delays in procurement and a lack of coordination(Vaidya et al., 2020). In addition, there has been confusion about the mandates, roles and responsibilities of the different levels of governance, and the lines of reporting between them (Thapa et al., 2018). However, no previous study has systematically explored key health system stakeholders’ perspectives on the opportunities and challenges for the health system resulting from federalisation.

Subsequently, Nepal's transition to a federal government has opened up prospects for better health care, much more work has to be done and continued efforts to reform the health system are still needed. Participants recognized several important opportunities to enhance Nepal's health system, including the devolution of power and resources, the adoption of new health policies, and expanding resources (finance, health staff, supplies, and health information system). The system is still changing, so it might take some time to fully reap the rewards of federalization.10

References:

• National Health Insurance Act, 2074.

• Health Institution Quality Management Authority Act, 2074.

• In Nepal, health insurance for all. (2017). [Dataset]. In the Forefront Group. https://doi.org/10.1377/forefront.20171027.743636

• Department of Health Services. (n.d.). http://dohs.gov.np/

• गृह पृष्ठ - Ministry of Law, Justice and Parliamentary Affairs. (2024, May 14). 

• Vaidya, A., Simkhada, P., & Simkhada, B. (2020). The impact of federalization on the health sector in Nepal: new opportunities and challenges. Journal of Nepal Health Research Council, 17(4), 558–559. https://doi.org/10.33314/jnhrc.v17i4.2217

• Thapa, R., Bam, K., Tiwari, P., Sinha, T. K., & Dahal, S. (2018). Implementing federalism in the health system of Nepal: Opportunities and challenges. International Journal of Health Policy and Management, 8(4), 195–198. https://doi.org/10.15171/ijhpm.2018.121

• Ministry of Law, Justice and Parliamentary Affairs. https://www.moljpa.gov.np/

• Rushton, S. et al. Overcoming the challenges facing Nepal’s health system during federalisation: an analysis of health system building blocks. Health Res Policy Sys 21, 117 (2023). https://doi.org/10.1186/s12961-023-01033-2