2. Concept of Health Policy
• Health policy refers to decisions, plans, and actions that are
undertaken to achieve specific health care goals within a
society.
• An explicit health policy can achieve several things: it defines
a vision for the future which in turn helps to establish targets
and points of reference for the short and medium term.
• It outlines priorities and the expected roles of different
groups; and it builds consensus and informs people.
3. Health Policy
• Health policy is a formal statement or
procedure within institutions (notably
government) which defines priorities and the
parameters for action in response to health
needs, available resources and other political
pressures.
• One of the key functions of public health
professionals is to influence and shape policy
decision at all levels for the benefit of the
population.
4. Health Policy
• Health policy is often considered in a narrow
sense, referring specifically to medical care issues
and the organization of health care services.
• However, health is influenced by a broad range of
policy decisions, not just those in the medical or
health field.
• A true health policy should therefore provide a
framework for health-promoting actions covering
the social, economic, and environmental
determinants of health.
5. Health Policy
• The modern health policy in its broader sense
is striving towards a continual process of
improving the population health.
• It represents the formal statements or
procedures within the government and
institutions by which the priorities and action
parameters are defined as response to health
needs, available resources, and various
political pressures.
6. Evidence-based health policy
• Evidence-based health policy attempts to
maximize the use of empirical research,
evaluation, and structured analysis as key
inputs into the policymaking process.
7. Component of Health Policy
1. Policy content,
2. Policy process,
3. Policy context and
4. Policy actors.
8. Policy content
• Systemic – structure of the health system.
• Programmatic – set for interventions and
operational guidelines for service delivery
• Organizational - structure of institutions
responsible for policy implementation.
• Instrumental - generating information to
enhance the functioning of the health system.
9. Policy process
• Rational model : that the process of policy
formulation is rational & based on correct
information.
• Incrementalist model : that the policy process is
more incremental, consists of slow bargaining
between different interest groups to select priorities
• Mixed scanning model: broad review of the policy
field without engaging in the detailed exploration of
options as suggested by the rational model.
• Punctuated equilibria model: which has recently been
applied to priority setting in the international health
policy arena.
10. Policy context
1. Quality of technical analysis;
2. Amount of political stability and support;
3. Capacity, motivation and support of the
bureaucracy;
4. the nature of culture and civil society
5. And the influence of international actors.
12. Policy Actors
• The role of actors and their power
relationships, as policy-making often depends
more on political compromise than on rational
debate (stakeholder or political mapping can
be useful in detailing these power structures,
and helps illuminate actors’ agendas).
14. Health policies of Nepal
• First Long Term Health Plan 1975
• National Health Policy1991
• Second Long Term Health Plan, 1997-2017
• Strategic Analysis to Operationalize SLTHP (2000)
• Local Self-Governance Act, 2055 (1999)
• Tenth Plan Poverty Reduction Strategic Paper (2002-07)
• Three Year Interim Plan (2064/65-2066/67)
• Free Health Care policy 2007
• National Ayurveda Health Policy 2052(1996)
15. Health policies of Nepal
National Drug Policy 1995
National Medicines Policy 2007
Safe Motherhood Policy
National Policy on Safe birth Attendance
National Safe Abortion Policy 2003
Vital Registration Act 2033
National Oral Health Policy
Mental Health (Treatment and Protection) Act 2006
Policy on Quality Assurance in Health Care Services
2064
16. Health policies of Nepal
• Health Care Technology Policy 2006
• Water Resource act 2049
• Nepal National Policy on Sanitation
• National Policy on Rural Water Supply and Sanitation
2004
• Policy on NGO participation in WATSAN Program1996
• Natural Disaster Management Act
• Natural Calamity (relief) act 1982
• National Blood Policy 2050(1993)
• National Health Research Policy
18. National Health Policy
• The national health policy was adopted in 1991 ( FY 2048 BS)
to bring about improvement in the health status of the people
of Nepal.
• The primary objective of the National Health Policy id to
extend the primary health care system to the rural population
so that the people get benefited from modern medical facilities
and trained health care providers
19. The National Health policy addresses the following
areas.
• Preventive Health services
• Promotive Health Services
• Basic Primary Health Services
• Ayurvedic and Traditional Health Service
• Organization and Management
• Community Participation in Health service
• Human resource for Health development
• Resource Mobilization in Health service
• Private Non Government Health services and Intersectoral
Coordination
• Decentralization and Regionalization
• Blood Transfusion Services
• Drug Supply
21. Five year plans of Nepal
• Documented and systematic planning is not available
before 1956 in Nepal. After Rana regime, the
democratic government started to develop and
implement medium term plan obviously for 5 year
duration.
22. Plan Period (in AD)
The Pre plan period 1951 - 1956
First 5 year plan 1956 - 1961
Second 3 year plan 1962 - 1965
Third 5 year plan period 1965 - 1970
Fourth 5 year plan 1970 - 1975
Fifth 5 year plan 1975 - 1980
Sixth 5 year plan 1980 - 1985
Seventh 5 year plan 1985 - 1990
Eight 5 year plan 1992 - 1997
Ninth 5 year plan 1997 - 2002
Tenth 5 year plan 2002 - 2007
Eleventh 3 year interim Plan 2007 - 2010
Twelfth 3 year Interim Plan 2010 -2013
Thirteenth 3 year Interim plan 2013 - 2016
23. First 5 year plan (1956 – 1961)
• Establishment of Malaria eradication program 1958
• Establishment of MoH in 1956
• Construction of first maternal hospital in 1959
• Production of nurses.
24. Second 3 year plan (1962 – 1965)
• Small fox survey in 1962
• Leprosy control 1964
• TB control in 1965
• 450 people were vaccinated against smallpox in
Kathmandu
• 3 hospitals and 8 health centers were added.
25. Third 5 year Plan (1965 – 1970)
• Stress on establishment of vertical projects, i.e
Leprosy eradication projects, smallpox
eradication project 1967, FP/MCH project1968
• Establishment of Central Health Laboratory in
1967.
26. Fourth 5 year plan (1970 – 1970)
• Integrated Basic Health service was started in 1971
• Contemplation of First Long Term Health Plan
• Community Health and Integrated Division under MoH was
set up
• Maternal Child Health Programme was initiated around fiscal
year 1973/74
27. Fifth 5 year plan (1975 – 1980)
The primary health objectives of the fifth plan was to raise life
expectancy through reduction in death rates, maintain regional
balance in the provision of health services and control
population.
• Integration of Vertical programmes in to health infrastructure
• Nepal Signed the Alma – Ata declaration in 1978
• Adopted PHC strategy for achieving Health for All 2000
28. Sixth 5 year plan (1980 – 1985)
Primary objectives of the sixth five year plan
incorporated similar health objectives of the fifth
plan, including for the reduction of people suffering
malnutrition and creation of healthy environment
through promotion of clean drinking water and
sanitation.
• COMBINA (Child spacing, Oral rehydration,
Maternal health, Breast feeding, Immunization,
Nutrition) was mooted
• Stressed on increasing food supply and provision of
clear drinking water.
29. Seventh 5 year Plan (1985 – 1990)
• The primary health objectives of the seventh five year
plan was to promote, physical, mental and community
health of general public and to prepare healthy
manpower to provide maximum number of people
with basic health services and to reduce the death
rate, increase longevity through promotional,
preventive and curative health services, population
control and extending maternity and child services.
30. Cont..
• Increased number of hospitals, hospital beds, health centers,
health posts and Ayurvedic Dispensaries.
• Give emphasis on Basic Minimum Health Need to achieve
HFA by 2000
• National Health Information System has been functioning
1988
• Guidelines was formulated for established Health Post
(walking distance, population, accessibility)
• Five regional health directorates of health services were
established .
31. Eighth 5 year plan (1992 – 1997)
The primary health objective of the eighth plan was to
increase rural access to basic primary health and
doctor’s service to rural population, effective
implementation of population control through
mother child health and family planning service
and development of specialized services within the
country.
32. Cont..
• Target of establishing SHP, PHCC, Ayurvedic dispensaries,
reducing TFR, leprosy were set
• Launched polio drop services since 1996/97 for 0-5 years
children
• Implemented DOTS strategy in 10 districts to reduce
morbidity and mortality of TB
• Leprosy Control Programme was expanded nationwide
while target was to expand in 71 districts from 56 districts
• Integration of DPHO and District hospital under DHO
33. Ninth 5 year Plan (1997 – 2002)
The primary objectives of the ninth five year plan was
to ensure preventive, promotional, curative and
rehabilitating health and family planning services as a
part of human right to bring about a perceivable
improvement in health status
34. Cont..
• Increased number of SHP and PHCC
• Essential Drug Lists were prepared for SHP, HP,
PHCC AND District hospitals.
• Reproductive Health Clinical Protocol was prepared
• Concept of PPP (Public private partnership) was
emphasized
• Human Organ Transplantation Act 1998 was
prepared.
35. Tenth 5 year plan (2002 – 2007)
The primary objectives of tenth plan was to increase
services for poor and backward and marginalized
community and people
• It is Nepal’s poverty Reduction Strategy Paper(PRSP)
• Following the Local self government Act 1999,
started to handover SHP, HP AND PHCC to local
budies
36. Cont…
• Developed national capacity to produce human
resource in health sectors
• Started bottom – up planning
• Set the targets and meet most of the targets
37. Interim plan (2007 – 2010)
Bridge between 10th and 11th plan maximize
effort to attainment MDGs
• Provision of free services in peripheral levels
• Provision of free obstetrical services..
• Aama Surkshya Program
38.
39. 12th third Year Plan (2010 -2013)
• Emphasis on quality health care service.
• Increase on access of quality health service.
Strategy
• Strengthening the human resource,
construction and reconstruction of health
infrastructure.
• For control of Malnutrition, multisectoral
nutritional policy has been launched.
For detail follow the page no. 193 to onwards
43. Introduction
• National Planning Commission (NPC) is the apex body for
formulating development plans and policies of the country
under the directives of the National Development Council
(NDC)
• Planning functions at the central level are widely scattered
over a number of institutions. At least, five
institutions/agencies are directly involved in the planning
process
44. Cont..
1. The Cabinet
2. The National Development Council which is sometimes
referred to as "Development Parliament" (NDC)
3. The National Planning Commission (NPC)
4. Development Ministries, and
5. Departments and the Regional/Zonal Offices of Ministries
Each of these institutions does play a varying role at different
stages of the planning process.
45. Development plans are prepared for fix period
1. Long term plan (10-20 years)
• based on longer-term growth prospects with general
targets based on only rough approximations of the
likely supply of, and the demand for, resources
2. Medium term plans
• A medium term plan-a five-year plan in the context
of Nepal indicates total investment and investment
by sectors for the entire plan period and the targets
to be achieved at the end of the plan period
46. 3. Annual Plan
• Operational/ strategic plan
• Effective guides to action, output and expenditures
must be determined for each year.
• Based on medium-term plan objectives and programs
for implementation
47. National Planning Commission
(Final recommendation for budgetary allocation)
Line agencies/ministries
Recommendation for budget
District Council
Prioritization coordination, integration, fund
allocation, forwarding
Ilika Planning workshop
Coordination between projects, integration, and
prioritization
Settlement
Need Collection
VDC Council
VDC Plans, prioritized project, resource allocation
Top-
down
Process
Ministry of Finance
Resource allocation
INGOs/Donor
agencies
Resource allocation
Fig: Health Planning Process of Nepal
48. • DOHS get the budget from MOHP and goes in NPC in first
Kartika than goes to lower health organization.
• current planning system of Nepal is started from SHP by
organizing VDC meeting and detect the required material then
send to PHC/HP and it conduct the same meeting and make
annual plan send to include HP plan and send to the district
level and make annual plans
• This plan has to be approved in the district community
meeting before the plan is sent to region by the end of 30th
Falgun.
• Then region collect the report and make annual plan sent to
center on 15th of Baishaka in the one way planning take place
49. Macro level Planning process of central level
planning
• National Planning Commission (NPC) is the apex body for
formulating development plans under the direction of the National
development council
• NPC prepares the draft of Approach Paper for the forthcoming
development plan
• Initially, the main objective and targets are determined for the
plan period
• Financial plan is prepared
• Preparation of sector planning, the principal outputs of sector
planning the sectorial chapter in the five year plan or may be
Interim Plan
50. Cont..
• Sectorial chapters lay the basic foundation of the
plan’s objectives and sectorial targets
• A draft Approach Paper prepared and presented to
the NDC for suggestions.
• NPC revise the Approach Paper according to the
suggestions given by the NDC
• The detailed plan document is prepared based on the
Approach Paper
51. Micro level planning process of central level
planning
• Basic sectorial planning process is undertaken by the
respective development related ministry based on the plan
document
• NPC’s various sectorial taskforces review the plan and
present sectorial report
• After the preparation of the detailed plan document, it is
put forward to the cabinet for its approval
• The plan is executed after the Cabinet approval
53. Health Planning
• Health planning is process of deciding in advance
what health services are to be delivered in order to
achieve the greater health goals.
• Planning in health sectors from DoHS to SHP
54. Characteristics of Planning
• Planning is a process
• Planning is future oriented
• Planning is pervasive. It is a function of every manager.
Its nature and scope differ according to the level of
managers
• Goal – focused: Planning not only sets goals but also
selects actions to achieve them.
• Decision – oriented: planning involves decisions at all
level, of management. Decisions in respect of objectives,
activities and resources are prime concern of planning.
• Efficiency – Oriented: Planning is directed toward
efficiency at all level of management. Efficiency means
greater output at lower cost, doing thing right.
55. TYPES OF HEALTH PLANNING
Health planning includes several specific, often connected,
types of planning:
1. Health services planning
2. Health system planning
3. Health goals planning
4. Population health planning
56. 1. Health Service Planning
• Health services planning relates to the planning in a
specific type of service or sector- maternal health
service delivery for example.
• This type of planning can be undertaken by
government or devolved (delegated) to providers.
• The Task Forces Groups formed by DoHS are a good
example of taking a specific sectoral approach to
service planning.
57. Cont..
• The Task Forces’ work is a strategic planning
exercise that produced several options for
system design and implementation approaches.
• This planning may be an output of the strategic
directions of the organization, but is usually
considered as program or operational planning.
58. 2. Health System Planning
• In every nation, a recognized goal of government will
form an efficient and well-organized health system.
• The system itself is usually planned at national
government level, and by such Department of health
services. Health “system” implies:
Client access to a range of appropriate, and
appropriately connected/integrated, services
Operational efficiency and a sustainable operation.
59. Cont..
• A well-organized and functioning system of health
services is like the connectivity of the human body
system. Both require:
Command centers
A supportive contextual infrastructure and
A series of linked and inter-supporting activities.
There are two essential phases of health systems
planning:
The design and system development phase
Implementation of the system management and
operations components.
60. Cont..
• A health system cannot be achieved via a one-time
organization of providers. It is necessary to establish
mechanisms for the ongoing running and adjustments
of the system.
• A health system planning has the most potential for
payoff in improved health because it can include both
health services and population health within its
strategic directions.
61. 3. Health Goals Planning
• National government is responsible for identifying
the goal of the health sector of a country.
• The health sector goal of a country is based on the
health status and existing health problems which a
government wants to achieve through its long term
plan.
62. 4. Population Health Planning
• The World Health Organization’s definition of
health is relevant to all health planning, but
particularly underlines the population health
approach.
63. Steps In Health planning
1. Analysis of Health Situation.
2. Establishment of objectives and goals
3. Assessment of resources
4. Fixing priorities
5. Write of formulated plan
6. Programming and implementation
7. Monitoring
8. Evaluation
64. 1. Analysis of health situation
• It involves the collection, assessment and
interpretation of information in such a way as to
provide clear picture of health situation.
• In this step generally following items of data are
analysis:
i. Population, its age and sex structure
ii. Statistics of morbidity and mortality
iii. Epidemiological distribution of different diseases
iv. Medical care facilities and other health agencies,
both public and private
65. Cont…
V. Technical manpower of various categories
VI. Attitude and beliefs of the population towards
diseases.
66. 2. Establishment of objectives and goals
• Objectives and goals are guide the effort, with out
objectives established, there is likely to be haphazard
activity.
• Objectives not only for the guide to action it also
measure work after it is done.
• Objectives should be established according to need of
people.
67. • The term resources implies the manpower,
money, materials, skills, knowledge and
techniques needed or available for the
implementation of the health program.
• Resources should be assessed and a balance is
struck between what is required and what is
available or likely to be available in terms of
resources.
3. Assessment of resources
68. 4. Fixing Priorities
• Community and political interest
• Financial constraints
• Mortality and morbidity data, diseases which can be
prevented at low cost.
Once priorities have been established
ALTERNATIVE PLANS for achieving them are also
formulated and assessed in order to determine
whether they are practicable and fasible.
69. 5. Write – up formulated plan
• The next major step in the planning process is
the preparation of the detailed plan or plans.
• Plan must be complete in all respects for the
execution of a project, the resource (inputs)
required are related to the results (outputs)
expected.
• Each stage of plan is defined and costed and
the time needed to implement is specified.
• The plan must contain working guidance to all
those responsible for execution.
70. 6. Programming and Implementation
• Once the health plan has been selected and approved
by the policy making authorities, programming and
implementation are begun.
• Plan execution depends upon the existence of
effective organization.
• The organizational structure must incorporate well
defined procedures to be followed and sufficient
delegation of authority to and fixation of
responsibility of different workers for achieving the
predetermined goal, objectives.
71. Cont..
• The main considerations at the implementation stage
include:
a) Definition of roles and tasks
b) The selection, training, motivation and supervision of
the manpower involved
c) Organization and communication
d) The efficiency of individual institution such as
hospitals or health centers.
72. 7. Monitoring
• Monitoring is the day to day follow up activities during
their implementation to insure that they are proceeding as
planed and are on schedule.
• It is a continuous process of observing, recording, and
reporting on the activities of the organization or project.
• Monitoring, thus, consists of keeping track of the course
of activities and identifying deviations and taking
corrective action if excessive deviations occur.
73. 8. Evaluation
• The purpose of evaluation is to assess the achievement of the stated
objectives of a programme, its adequacy, its efficiency and its
acceptance by all parties involved.
• Evaluation measures the degree to which objectives and targets are
fulfilled and the quality of the results obtained .
• It measures the productivity of available resources in achieving
clearly – defined objectives.
• It measures how much out put or cost effectiveness is achieved.
• It makes possible the reallocation of priorities and of resources on
the basis of changing health needs.
75. Introduction
• Program planning is a multi-step process that
generally begins with the definition of the problem and
development of an evaluation plan. Although specific
steps may vary, they usually include a feedback loop,
with findings from program evaluation being used
for program improvement.
76. Terminology in Health Planning
1. Objective: Is planned end point of all activities
Is precise
Is concerned with the problem itself
2. Target: Permits the concept of degree of achievement, so
it often refers to a discrete activity such as the number.
3. Goal: is defined as the ultimate desired state towards
which objectives and resources are directed.
• To known whether the goal is accomplished or not
various objectives and targets are formulated and
accomplishment of such objectives and targets signals
accomplishment of the goal.
77. 3. Goal: Ultimate desired state towards which objectives and
resources are directed
Is constrained by time or existing resources
Is necessarily attainable
4. Mission: is a description of fundamental principle of existence
of a programme
Is usually not time bound
Is a statement of purpose
5. Impact : is an expression of the positive effect of a program,
service or institution on the overall health development and on
related social and economic development
78. Planning in Health Sector
• Planning is a future oriented process of setting
goals/objectives/target and choosing the best way to
achieve these goals
• In Planning we decide Objectives and then we decide
the Activities to be executed and then resources
which are used during execution to obtain the
objectives.
79. Types of Planning
There are various type of plans the types of plan depend on
the complexity of operations and nature of organizations
According to managerial hierarchy:
1. Long term plans
2. Medium term plans
3. Short term Plans
According to use:
1. Single use plans
2. Standing use plans
80. Pre Planning
Pre planning is preparation for planning, the important
preconditions are:
1. Government Interest
2. Legislation
3. Organization for Planning
4. Administrative Capacity
81. 1. Government Interest:
Any plan for the health and welfare of a country must
be based on a strong “political will” as manifested
by clear directives or policies given the political
authority.
2. Legislation:
The social and health policies formulated may have to
be translated in to legislation as an example may be
cited the enactment of the medical termination.
82. 3. Organization for Planning:
There should be an organizational structure for the
preparation of the various parts of the plan.
4. Administrative Capacity:
One of the essential pre conditions of planning is
administrative capacity for proper coordination of
activities and implementation of the plan at all levels.
83. Importance and Purpose of Health Planning
• Planning provides a roadmap to achieve the goal or to
reach destination.
• Planning provides chronological orders of different
activities, assigns different jobs and duties
• Planning help us to spend resources efficiently.
Resources are limited in nature in developing
countries like Nepal, we have to achieve lots of
objectives and on other hand we have scarcity of
resource also.
84. Purpose of Planning is :
• To match the limited resources with many problems
• To eliminate wasteful expenditure or duplication of
expenditure
• To develop the best course of action to accomplish a
defined objectives.
85. STEPS IN PLANNING PROCESS
1. Stating the mission, or purpose of the
organization/programme,
2. Analyzing the external environment,
3. Assessing internal strengths and weaknesses and
external opportunities and threats (SWOT analysis),
4. Establishing goals,
5. Selecting activities for each objective; developing
detailed work plans,
6. Preparing a financial plan,
7. Introducing a monitoring and control system.
87. What is problem solving
• Problem solving is a mental process and is part of the
larger problem process that includes problem finding
and problem shaping.
• Problem solving occurs when an organism or an
artificial intelligence system needs to move from a
given state to a desired goal state.
88. Characteristics of difficult problems
Difficult problems have some typical characteristics that
can be summarized as follows:
1. Intransparency
• Commencement opacity
• Continuation opacity
2. Multiple goals
• Opposition
• Temporary
89. Cont..
3. Complexity (large numbers of items, interrelations
and decisions)
• Innumerability
• Connectivity (hierarchy relation, communication
relation, allocation relation)
• Heterogeneity
4. Time considerations
• Temporal constraints
• Phase effects
• Dynamics unpredictability
90. Basic Guidelines to Problem solving and Decision
Making
There are many approaches to problem solving on the
nature of the problem and the people involved in the
problem.
1. Define the problem
2. Look at potential causes for the problem
3. Identify alternatives for approaches to resolve the
problem
4. Select an approach to resolve the problem
5. Plan the implementation of the plan
6. Verify if the problem has been resolved or not
91. 1. Define the problem
• Defining the problem means writing down a short
description of the problem in terms “of the following
happening” writing such requires answers of some
questions like:
a. What can you see that causes you to think there’s a
problem
b. Where is it happening
c. How is it happening
d. With whom is it happening
e. Why is it happening
• Verifying your understanding of the problem
• Prioritize the problems
• Understand your role in the problem.
92. 2. Look at potential causes for the problem
• Find out the potential cause of problem
through talk with the those people who are
effected by it and who notice the problem
closely.
• Write down a description of the cause of the
problem and in terms of what is happening,
where, when, how, with, whom, and why.
93. 3. Identify alternatives for approaches to resolve the
problem
• Brainstrom for solutions to the problem
• Through brainstorming collect the ideas as
much as possible.
• Then Screening them to find the best idea.
94. 4. Select an approach to resolve the problem
When selecting the best approach, consider:
• Which approach is the most likely to resolve the problem
for the long term?
• Which approach is the most realistic to accomplish for
now ? Do you have resources? Are they affordable ? Do
you have enough time to implement the approach?
• What is the extent of risk associated with each
alternative?
95. 5. Plan the Implementation of the best alternative
(This is your action plan)
• Carefully consider “ what will the situation look like when the
problem is solved ?”
• What steps should be taken to implement the best alternative
to solving the problem? What systems or process should be
changed in your organization, e.g. a new policy or procedure?
Don’t resort to solutions where someone is “just going to try
harder”.
• How will you know if the steps are being followed or not ?
(these are your indicators of the success of your plan)
96. Cont..
• What resources will you need in terms of people,
money and facilities?
• How much time will you need to implement the
solution? Write a schedule that includes the start and
stop times.
• Who will primarily be responsible for ensuring
implementation of the plan?
• Communicate the plan to those who will be involved
in implementing it and, at least, to your immediate
supervisor.
•
97. 6. Monitor implementation of the plan
Monitor the indicators of success:
• Are you seeing what you would expect from the
indicators
• Will the plan be done according to schedule?
• If the plan is not being followed as expected, then
consider: Was the plan realistic? Are these plan
sufficient resources to accomplish the plan on
schedule? Should the plan be changed?
98. 7. Verify if the problem has been resolved or not
One of the best way to verify if a problem has been
solved or not is to resume normal operations in the
organizations. Still, following things should consider:
• What changes should be made to avoid this type of
problem in the future? Consider changes to polices
and procedures, training, etc.
99. Cont…
• Lastly consider “what did you learn from this
problem solving ?” consider new knowledge,
understanding and/or skills.
• Consider writing a brief memo that highlights the
success of the problem solving effort, and what you
learned as a result. Share it with your supervisor,
peers and subordinates.
101. Basic concepts and Difinations
WHO
Decentralization is transfer of authority or dispersal
of public planning, management and decision making
from the national level to sub-national levels [1990]
Promotion of primary health care was seen as
incompatible with centralized systems of health care
102. Cont..
World Bank
Transfer of authority and responsibility for public
functions from the central government to subordinate
or quasi-independent government organizations
and/or the private sector
103. Cont..
• Decentralizations restructuring of authority so that
there is a system of co-responsibility between
institutions of governance at the central, regional and
local levels according to the principle of solidarity,
thus increasing the overall quality and effectiveness
of the systems of governance, while increasing the
authority and capabilities of sub-national levels.“
UNDP
104. Rational
Improve efficiency? allocative and production
efficiency
Improve equity?
Improve quality of care?
Improve financial soundness?
Improve local accountability
105. Types of decentralization
1. Political
2. Fiscal
3. Market
4. Administrative
De-concentration Delegation
Devolution Privatization
106. Administrative Decentralization
• “is the transfer of responsibility for planning,
financing, and managing certain public
functions from the central government to lower
levels” (Rondinelli 1999).
107. Deconcentration - shifting power from the central
offices to peripheral offices of the same administrative
structure e.g. provincial department of health and its district
offices
o Functional: field officers are directly linked and controlled from
centre;
o Prefectoral: there is a layer [PREFECT] in between – commissioner
or governor;
Salient features
Shifting of power from the same structure;
Semi-autonomy to field officers in routine decision making;
Some planning functions according to central guidelines;
Administrative Decentralization
108. Delegation - shifts responsibility and
authority to semi-autonomous
organizations;
Salient features
o Functions are shifted to regions or functional bodies or
special project units;
o Independent from central government rules and regulations
in personnel, recruitment, budgeting and procurement;
o Examples: Social security institutions, separate regulatory
commission or accreditation commissions;
Administrative Decentralization
109. Administrative Decentralization
Devolution – transfer of functions or decision making authority
to legally incorporated local governments such as states,
provinces..etc ( Collins 1994);
Shifts responsibility and authority from the central offices (MoH) to
separate administrative structures still within public administration (
Bossert 1995)
• Responsibilities for services to local government
• Local governments elect their own representatives
• Raise their own revenues and
• Independent authority to make investment decisions
110. Decentralization in Nepal
• Decentralization and local self-governance have been made
operational in Nepal since the 1960s.
• In 1987, the centre (MoH) underwent change and as a result—
Regional Health Directorates were established in five
development regions in Nepal
• In 1999, Nepal enacted a Local Self-Government Act (LSGA)
• This Act, whose monitoring committee was chaired by the
Prime Minister, laid the foundation for establishing a local
self-governance system adopting a broad-based and cross-
sectoral approach.
111. Cont…
• This Act recognized the role of local self governance and
devolution of authority and responsibility to make local
authorities more responsive and accountable to people.
• The rationale for this Act was both philosophical and
practical and involved legislation, institutional provision,
resources (both financial and human) mobilization and
considerations, i.e. autonomy and equality
