Health Policy For Better Service

Jhabindra Bhandari

 

Nepal’s health sector has an interesting history. In a country like ours where vast majority of the people live in rural areas and rely on subsistence agriculture, improved and equal access to quality health care services for all is one of the high priority agenda for Sustainable Development Goal (SDGs). For the last several decades, the government has put all its efforts to ensure that through policies, strategies, and plans of action.

Changed context
As part of the broader effort to that direction, health-related policies were reviewed to enable health sector to better navigate the changed context of decentralised governance in the country, and to bring to fruition the Constitution’s vision of improved and equal access to quality health services for all. While several health-related policies are available, there is a growing need to develop an umbrella health policy at the federal level that covers the health system building blocks and sets out the responsibilities of all tiers of the government.
In the changed context of decentralised governance, the Ministry of Health and Population (MoHP) recently convened a wider consultation meeting to share an overview of the draft national health policy and seek important suggestions for consideration. This was an interesting exercise as key stakeholders from the government, civil society, private sector, academic institutions and development partners in health sector actively participated in the discussions and provided their inputs for further improvement.
While reviewing the national health policy in a multi-sectoral approach, the stakeholders emphasised the emerging need to align this with national development policies and periodic plans, Nepal Health Sector Strategy (2015-2020), and SDGs. At the same time, equity and multi-sectoral dimension should be more pronounced to ensure the principles and objectives of universal health coverage.
According to World Health Organisation (WHO), the universal health coverage means that all people and communities can use the promotional, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardships. The new national health policy has timely considered this approach towards provision of quality health care services for all.
Over the years, there have been significant efforts to improve health status of rural population. From the beginning, the medical education has greatly advanced with the establishment of new health science academy, medical colleges, and teaching hospitals in the country. This has significant impacts on the extension of health services across the country. Additionally, the relative progress in education, communication, transport, agriculture, food supplies and physical infrastructure has tremendously contributed to improve health status of populations at large.
As a matter of fact, health sector reform was considered as a high priority by both the MoHP and the key external development partners. Nepal’s progress in health sector Millennium Development Goals (MDGs) was much appreciated and highly recognised globally. The partnership and cooperation from the development partners, civil society organisations and private sector have been instrumental in strengthening health systems for better health services.
Despite some significant progress, there are still challenges in Nepal’s health sector. The increasing occurrence of both communicable and non-communicable diseases, natural disasters, climate change, road accidents and associated injuries are key challenges in public health. Likewise, rural health care suffers more profoundly as there is increasing trend of migration from rural to urban areas. Thus, increasing migration and urbanisation have profound impacts on health care services to poor and marginalised communities.
For the first time, the health policy has recognised the importance of population management and family planning as an integral part of overall socio-economic development. In this context, the health risks and vulnerabilities associated with migration are prioritised in the strategic interventions to protect and promote the health rights of migrants in the country and abroad. More importantly, the MoHP is developing migration health policy to address the health care needs of migrants and their families at large.
Though Nepal has made good progress in maternal and child health, there are still increasing challenges of reducing maternal and neo-natal mortality rates in the remote districts where human resources, physical infrastructure of health facilities, transportation and supplies of medicine and other essential logistics have been key issues to ensure quality health services to the rural poor.
Like other sectors, the health sector suffers from political instability, resource mobilisation and human resource management to ensure effective implementation of health policies, strategies, guidelines and plans. Therefore, strengthening institutional mechanisms and structures to facilitate effective implementation of the health policy is crucial to ensure responsiveness and efficiency in delivering the tangible results in this sector. Moreover, social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In most cases, health facility management committees provide the accountability interface between health providers and citizens or users of health services.
On the other side, there are certain areas where health care policy needs to pay more attention to effectively address the mental health, environmental health, health care needs of senior citizens, sexual and reproductive health issues of adolescents and youth, health and nutrition of women and children including disabled populations. The guiding principles of new health policy importantly highlight the emerging needs for ensuring quality health care services and advancing universal health coverage. The right to health care, equity in health, multi-sector approach and partnership to improve health governance are some of the salient features of the health policy.

Approaches
There are some strategic approaches in terms of guiding and facilitating actions for its effective implementation at all levels. The provision of free health care services, health insurance and equitable access to health care including emergency health services, and research for evidence-informed policy interventions are critical to advance the health and well-being of entire populations.
(Bhandari is a PhD scholar in Public Health at Chulalongkorn University, Thailand) 

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