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Critical Review of NHSS-IP_Sagar Parajuli.pptx

  1. Critical Review of Nepal Health Sector Strategy (NHSS) & Implementation Plan (NHSS-IP) Sagar Parajuli Roll No:07 MPH Second Semester 2023 School of Health & Allied Sciences Pokhara University
  2. 2/7/2023 2 Presentation Outlines • Background • History of Strategic Planning in Nepal • Nepal Health Sector Strategy (2015-2020) • NHSS-Implementation Plan (2016-2021) • NHSS-IP Format & Sample • Development Process • Review on NHSS Progress • Critical Review Presentation followed by discussion
  3. 2/7/2023 Background; Nepal Health Sector Strategy • Nepal Health Sector Strategy (NHSS) considered as primary instrument for guiding health sector for defined period of time i.e. 5 years • Adopts vision and mission set by National Health Policies and carries ethos of constitutional provision for ensuring fundamental right of citizen to basic health services • Based on Sector Wide Approach (SWAp) and emphasizes partnership as well as multi-sectoral approach to address social determinants for achieving Universal Health Coverage (UHC), developed by government and partners • Views health as core for socio-economic development and aligns with government vision to upgrade from Least developed country to Middle Income developing Country by 2022 3
  4. 2/7/2023 Need of Nepal Health Sector Strategy • Despite significant reduction in Under five mortality by 73% and infant mortality by 67% in the period 1990-2014 during MDGs, reduction in neonatal mortality and malnutrition remain less comparably, • Health challenges like inequity, accessibility barriers (institutional, financial, geographical, socio-cultural) were identified, • Need of urban health services realized with growing urbanization, • Shifting demographic and epidemiological transition in burden of disease and increasing threats of natural disasters due to climate change • Need of restructuring and rebuilding health system as provisioned by the Constitution of Nepal followed by Earthquake in 2015 • Need of sectoral plans, interventions and for multi-sectoral approaches 4
  5. 2/7/2023 Basis of Nepal Health Sector Strategy 5 Health Outcomes Equity gap in Health Care Services Population Dynamics & Health Quality of Care Shifting burden of Diseases & Health Problems Post-disaster situation Health care Financing & Financing Protection Sector Management & Coordination Health System Strengthening Ayurveda Health Services & Alternative Medical System
  6. 2/7/2023 History of Strategic Planning in Nepal 6 2004 • Council of Ministers endorsed Health Sector Strategy: An agenda for reform in response to Poverty reduction strategy and MDGs, Vulnerable Community Development Plan 2004 2004 • Development of Nepal Health Sector Program (NHSP 2004-2009) guided by National Health Policy 1991, Second Long term Health Plan 1997-2017 & Health Sector Strategy 2010 • Extension of NHSP I to Nepal Health Sector Program II 2010-2015, with greater emphasis on partnership, accessibility, equity, inclusion, local governance and decentralized service delivery, GESI Strategy 2009 2015 • Development of Nepal Health Sector Strategy (2015-2020) and NHSS-Implementation Plan 2016-2021 based on expanded policy and monitoring framework of National Planning Commission (NPC), focuses on multi-sectoral collaboration
  7. 2/7/2023 Nepal Health Sector Strategy (2015-2020) Defined Health Sector as beyond exclusive domain of MoHP; multitudes of state line agencies and non-state actors working for socio-economic development Vision: All Nepali citizens have productive and quality lives with highest level of physical, mental, social and emotional Health. Mission: Ensure citizen’s fundamental rights to stay healthy by utilizing available resources optimally and through strategic cooperation between service providers, service users and other stakeholders. (National Health Policy 2014) 7
  8. 2/7/2023 Nepal Health Sector Strategy (2015-2020) Goal: Improved health status of all people through accountable and equitable health service delivery system Strategic Approaches or Principles 8
  9. 2/7/2023 Nepal Health Sector Strategy (2015-2020) Strategic Approaches or Principles 1. Equitable access to health services: addressing demand and supply side barriers in accessibility, GESI in all policy, address urban poor and context (socio-economic, demographic characteristics) 2. Quality Health services: Improving quality at point of delivery, developing minimum service standards for both public and private sector, focuses on major quality dimensions (effective, safe, client-centered, timely, equitable, culturally appropriate, efficient and reliable), envisions development of Quality Assurance autonomous body 3. Health Sector Reform: restructuring health sector, rebuilding health system, decentralized planning & budgeting, prioritizes the implementation of the ‘Collaborative Framework for Strengthening Local Health Governance in Nepal’ 9
  10. 2/7/2023 Nepal Health Sector Strategy (2015-2020) Strategic Approaches or Principles Health Sector Reform: provision of flexible health grant, making linkages at three tiers for planning and budgeting, emphasis on disaster preparedness, state and non-state partnership, regulation across public and private health system, research and use of evidence, application of modern technologies 4. Multi-sectoral approach: Emphasis on social determinants of health, prioritizes Health in all policies, promoting healthy lifestyle and environment through collaboration, Children as starting point, healthy school environment, HFs as learning environment for healthy lifestyle, improved road safety, nutrition as cross-cutting issue, establishing multisectoral response to climate change 10
  11. 2/7/2023 Nepal Health Sector Strategy (2015-2020) Includes 9 outcome statements with 29 indicators and 26 output statement with 56 output level indicators 11 Outcome 1 Rebuilt and strengthened health systems: Infrastructure, HRH management, Procurement and supply chain management; 7 outputs, 41 key interventions Outcome 2 Improved quality of care at point-of-delivery; 3 outputs, 17 key interventions Outcome 3 Equitable utilization of health care services; 2 outputs, 15 key interventions Outcome 4 Strengthened decentralized planning and budgeting; 1 output, 7 key interventions Outcome 5 Improved sector management and governance; 5 outputs, 16 key interventions Outcome 6 Improved sustainability of health sector financing; 2 outputs, 9 key interventions Outcome 7 Improved healthy lifestyles and environment; 1 output, 11 key interventions Outcome 8 Strengthened management of public health emergencies; 2 outputs, 12 key interventions Outcome 9 Improved availability and use of evidence in decision making processes at all levels; 3 outputs, 18 key interventions
  12. 2/7/2023 Nepal Health Sector Strategy (2015-2020) 12
  13. 2/7/2023 Nepal Health Sector Strategy 2015-2020 Moving towards Universal Health Coverage (UHC) 1. Basic health services: provision of basic health services for every citizen 2. Social health protection: National health security program (health insurance) for services beyond BHS for ensuring equitable access 3. Health service delivery tier: delivery arrangement and partnership with non- state sectors, expansion of ayurveda and other allied health services, provision of community health unit, decentralization and delegation of authority 4. Financial management: internal revenue generation and external support 5. Implementing NHSS and measuring sector performance 13
  14. 2/7/2023 Nepal Health Sector Strategy 2015-2020 14
  15. 2/7/2023 Nepal Health Sector Strategy 2015-2020 Measuring sector performance under NHSS • Establishment of Health Sector Partnership Forum to review progress on NHSS, through quarterly meeting under chairmanship of secretary-MoHP • Instruments for measuring sector performance 1. Result Framework of NHSS 2. Mid-term review (MTR) of NHSS; carried out by a team of independent external experts to assess the progress made in achieving the outcomes and results of NHSS 3. Regular Performance Review 15
  16. 2/7/2023 Nepal Health Sector Strategy 2015-2020 Result Framework • The NHSS Results Framework monitors sector performance on an annual basis. • The Framework sets out a range of key indicators at Goal, Outcome and Output level. • NHSS Results Framework (RF), with indicator matrix includes baseline, milestone, target, data source, disaggregation, periodicity and responsible agency for each indicator. 16
  17. 2/7/2023 Nepal Health Sector Strategy 2015-2020 17 Result Framework includes – Code – Indicator – Baseline – Target – Data Source – Monitoring frequency – Responsible Agency – Remark
  18. 2/7/2023 Focuses of Nepal Health Sector Strategy 2015-2020 1. Equitable service utilization, health system strengthening and demand generation to underserved population including urban poor, promote supportive cultural practices, improving quality of care at point of delivery 2. Strengthening research and use of evidence 3. Leverage use of modern technologies for health information system 4. Implementation of Collaborative Framework for strengthening Local Health Governance in Nepal 5. State and Non-state partnership, regulation of public and private health system, shift from inter-sectoral to multi-sectoral approaches 6. Defines Basic Health Package and service delivery arrangements 18
  19. 2/7/2023 Guiding Policies for NHSS • The Constitution of Nepal 2015; basis for restructuring health system • National Health Policy 2014 • Local Self Governance Act • Development Cooperation Policy 2014; agenda for aid effectiveness in health sector • Multi-sectoral Nutrition Plan (MSNP) • International Health Commitment to Primary Health Care and Universal Health Coverage • Paris Declaration on Aid Effectiveness • Sustainable Development Goals 2030 19
  20. 2/7/2023 Introduction to NHSS-IP (2016-2021) • Nepal Health Sector Strategy- Implementation Plan (NHSS-IP) is an output- based plan with comprehensive set of activities necessary to achieve output, outcome and ultimately the goal of NHSS. • NHSS-Implementation plan and subsequent Annual Work Plan Budget (AWPB) translates NHSS into actions, guided by results based framework. • Includes sub-sectoral plans for departments, divisions, centers, NHRC • NHSS-IP (2016-2021) developed for NHSS 2016/17-2021/22 20
  21. 2/7/2023 NHSS-IP Framework 21
  22. 2/7/2023 NHSS-IP 2016-2021 22 1. Background of NHSS 2. Scope of NHSS-IP 3. Ministry of Health 4. Department of Ayurveda 5. Department of Drug Administration 6. Department of Health Services 6.1 Child Health Division 6.2 Family Health Division 6.3 Epidemiology and Disease Control Division 6.4 Leprosy Control Division 6.5 Primary Health Care Revitalization Division 6.6 Logistic Management Division 6.7 Management Division 6.8 National TB Center 6.9 National Center for AIDS and STD Control 6.10 NHEICC 6.11 NHTC 6.12 NPHL 6.13 National Health Research Council 6.14 Social Health Security Development Committee Annex: Proposed structural reforms NHSS-IP 2016-2021 Outline
  23. 2/7/2023 NHSS-IP 2016-2021 23 Layout for each Chapter 1. Background 2. Program components 3. Outputs & Interventions 4. Result Framework
  24. 2/7/2023 Development Process 24 Committee & Team Structure: Steering Committee- chaired by Secretary, MoHP, Technical Team- coordinated by chief PPMD-MoHP, Core task Team Process 1. Preparation and sharing of template to all departments/divisions/ centers 2. Drafting of Implementation Plan by technical working group (TWG) at divisions/centers comprising of relevant development partners 3. Compilation and Finalization by core task team 4. Round of meetings, email communication and face to face meetings for draft finalization; consultative workshops 5. Approval of draft
  25. 2/7/2023 Review of NHSS- NJAR Report 2021/22 25 Progress on NHSS Goal level Indicators 1. MMR- 174 per 100,000 live births 2. U5MR- 33 per 1000 live births 3. NMR- 21 per 1000 live births 4. Total Fertility Rate- 2.1 5. Stunting %- 25 % 6. % of women 15-49 years with BMI less than 18.5- 17.3% 7. Life lost due to RTA- 9.9 per 100000 population
  26. 2/7/2023 Review of NHSS- NJAR Report 2021/22 26 Progress on NHSS Goal level Indicators 8. Suicide rate - 23.4 per 100,000 population 9. DALY lost 10. Incidence of impoverishment due to OOP expenditure in Health Regular program review through NJAR, till 2018 National Annual Review & Joint Annual Review were separate
  27. 2/7/2023 Review of NHSS- NJAR Report 2021/22 27 Financing during NHSS Period
  28. 2/7/2023 Review of NHSS- NJAR Report 2021/22 28 Review based on Outcome- NHSS Progress Outcome 1 Rebuild and Strengthen Health Systems: Infrastructure, Human Resources for Health, Procurement, and Supply Chain Management • Health infrastructure developed as per plan and standards; Nepal Health Infrastructure Development Standards (NHIDS) and Integrated Health Infrastructure Development Program (IHIDP), Health Infrastructure Information System (HIIS) land acquisition and relocation policy • Damaged health facilities rebuilt • Improved management of health infrastructure • HRH- National Strategy on HRH 2077/78 - 2086/87, National Nursing and Midwifery Strategic Action Plan 2020-30 Outcome 2 Improved Quality of Care at Point-of-delivery Revision of National strategies and plans for improving the quality of care, and guidelines for implementing specific interventions like IMNCI, Reproductive Health, NHFS 2021, MSS
  29. 2/7/2023 Review of NHSS- NJAR Report 2021/22 29 Review based on Outcome- NHSS Progress Outcome 3 Equitable Distribution and Utilization of Health Services PNC Home visit provision, COVID19 vaccination, TCV, 8 new CEONC sites, SMNH Roadmap 2030, GBV Multisectoral coordination committee formed, GESI-targeted interventions, Social Service Units (SSUs) established in referral and district-level hospitals, Tuberculosis Free Nepal Declaration Initiative events at 25 local levels Outcome 4 Strengthened Decentralized Planning and Budgeting Use of Sub-National Treasury Regulatory Application System (SuTRA) to prepare budget formulation, implementation, accounting and reporting
  30. 2/7/2023 Review of NHSS- NJAR Report 2021/22 30 Review based on Outcome- NHSS Progress Outcome 5 Improved Sector Management and Governance Drafting of Nepal Health Sector Strategic Plan (2022-2030), Geriatric Health Service Strategy, Geriatric Health Service Operational Guideline and Geriatric Health Service Protocol, Digitisation of OCMC, SSU, and geriatric service recording and reporting tools in DHIS2 platform, Regular meetings of the Multisectoral Medico-Legal Service Implementation Committee, GESI strategy- Madhesh Province, National Ambulance Guideline 2021, MPDSR Guideline Outcome 6 Improved Sustainability of Healthcare Financing Government health expenditure as a percentage of the Gross Domestic Product (GDP) for FY 2020/21 is 2.4%. There is a 0.7 percentage increase compared to the NHSS baseline year (1.7% for FY 2016/17), comprehensive National Health Financing Strategy, Expansion of Health Insurance Program
  31. 2/7/2023 Review of NHSS- NJAR Report 2021/22 31 Review based on Outcome- NHSS Progress Outcome 7 Improved Healthy Lifestyles and Environment Developed the Health Promotions Strategy 2022-2030 (to be endorsed) and the Advocacy package for Sabridha Nepal, Swastha Nepali, Developed a Communication Strategy on Tobacco Control (to be endorsed), SAFER initiative, Addition of NRT to the essential drug list, Communication for Behavioral Impact (COMBI training) Outcome 8 Strengthened Management of Public Health Emergencies International Health Regulation (IHR) 2005 Orientation, COVID19 Screening, testing and vaccination, Surveillance Outbreak Response Management and Analysis System (SORMAS) under CORESMA (COVID-19 Outbreak Response Combining E-health, Serolomics, Modelling, Artificial Intelligence and Implementation Research) work package in Gandaki and Sudurpaschim Provinces
  32. 2/7/2023 Review of NHSS- NJAR Report 2021/22 32 Review based on Outcome- NHSS Progress Outcome 9 Improved Availability and Use of Evidence in Decision Making Processes at All Levels IHMIS roadmap (2022-2030) was endorsed as per the ministerial decision in 2022, HMIS tools revised after 9 years, Information Management Unit (IMU) under the Integrated Health Information Management Section (IHIMS) for the effective management of COVID-related information related to surveillance, HMIS e-learning modules, Recording and reporting tools of the One Stop Crisis Management Centre (OCMC), the Social Service Unit (SSU) and Geriatric health care in DHIS2, Health Facility Registry updated, Routine Data Quality Assessment (RDQA) tool and the e- learning package updated, Basic Health Service dashboard has been hosted at the FMoHP website
  33. 2/7/2023 Major Achievements NHSS 33 Policy, regulatory and strategic documents developed during NHSS Period 1. Immunization Act 2016 2. National Strategy on Reaching the Unreached, 2015-2030 3. National eHealth Strategy 2017 4. Health Insurance Act 2017 5. Disability Management (Prevention, Treatment and Rehabilitation) Policy 2017 6. The Right to Safe Motherhood and Reproductive Health Act 2018 7. Disaster Risk Reduction National Strategic Plan of Action, 2018 8. Social and Behavior Change Communication Strategy 2018 9. Public Health Service Act 2018
  34. 2/7/2023 Major Achievements NHSS 34 Policy, regulatory and strategic documents developed during NHSS Period 10. National Health Policy 2019 11. National SMNH Roadmap 2015-2030 12. Public Health Service Regulation 2020 13. National Adolescent Health and Developmemt Strategy 2020 14. National HRH Strategy 2020/21 15. National Health Financing Strategy (Draft) 16. UHC; Strategic Framework (Draft) 17. National Health Care Quality Assurance Framework 2022 18. IHMIS Roadmap 2022
  35. 2/7/2023 Critical Review of NHSS & NHSS-IP Importance & Significance: • Crucial for health sector improvement, management and for performance review as well as supports evidence-based policy development and program planning • Alignment with other sectoral plan and strategy like agriculture, urban development is essential at planning process Development Procedure: • Jointly prepared by Government and development partners • Participation from private sectors need to be ensured while developing 35
  36. 2/7/2023 Critical Review of NHSS & NHSS-IP Policy Framework & Instruments: • Guided by the Constitution of Nepal, National Health Policy and other applicable policies • Delegation of authority and provision for developing Health Sector Strategy at provincial and local level can support in improving overall health sector performance • Regulatory body as envisioned by National Health Policy can support in sector performance review 36
  37. 2/7/2023 Critical Review of NHSS & NHSS-IP Strengths • Adoption and progressive translation of the vision and mission of the National Health Policy 2014 to guide health sector for next five years • Identified four key strategic direction or approaches for achieving Universal Health Coverage • Define and supports implementation of Basic Health Service package • Focuses on monitoring of health sector performance under NHSS through result framework, Mid-term review and regular review • Provides guidance for development of AWPB • Emphasizes social health security programs, health insurance • Provides sectoral reforms and suggestions 37
  38. 2/7/2023 Critical Review of NHSS & NHSS-IP Strengths • Prioritizes research and practice of evidence-based planning, including NHRC in NHSS-IP • Structural Reforms 38
  39. 2/7/2023 Critical Review of NHSS & NHSS-IP Weakness • More focused on public health system • Less emphasis on private health sectors • More ambitious target set at national level • Mid Term Review at provincial and local level can monitor progress of NHSS • Result-based Framework; more focused on national level rather than provincial and local • Clear roles and responsibilities could be defined for three tiers for improving sector performance 39
  40. 2/7/2023 Critical Review of NHSS & NHSS-IP Opportunities • Promotion of multi-sectoral collaboration • Public private partnership for service delivery • Improving foreign aid effectiveness • Sector performance improvement and management at federal, provincial and local level • Scaling of social security programs like health insurance • Global partnership and collaboration 40
  41. 2/7/2023 Critical Review of NHSS & NHSS-IP Challenges • Global Economic Crisis • Emerging and re-emerging diseases and health problems- concentrated funds for single problem like COVID19 resulting into disruption of other services and programs • Natural Calamities and Disasters • Healthcare financing and protection • Limited foreign aid- with upgrade to Middle Income Developed Country (Bilateral and Multilateral organization) 41
  42. 2/7/2023 Way Forward • Delegation of authority in development of Health Sector Strategy at Provincial and local level for improving overall sector performance and for achieving Universal Health Coverage • Effective implementation of Basic Health Services and Social Security programs including health insurance • Localization of Health Sector strategy at provincial and local level • Meaningful participation and engagement of Private sectors in preparation and implementation of sector strategy • Mid-term Review practice • Defined roles and responsibilities for three tiers of government in implementation 42
  43. 2/7/2023 NHSS 2022-2030 43
  44. 2/7/2023 References • Nepal Health Sector Strategy 2015-2020. MoHP Nepal • Nepal Health Sector Strategy- Implementation Plan 2016-2021. MoHP Nepal • Progress of Health and Population Sector-NJAR Technical Report 2021/22. Ministry of Health & Population, Nepal Visit for each indicator review based on Result Framework-NHSS 44
  45. 2/7/2023 45 Thank You!

Notas del editor

  1. NRT- Nicotine Replacement Therapy