Internationalhealth.ppt

12/16/2015 1
Ashok Pandey
BPH, MPH, DGH
Research Associate
NHRC

12/16/2015 2
Unit 4: International public health 18 hours
4.1 Need for developing specific public health perspective to
international health: global aspirations regarding health and disease
a. Global aspiration on health: healthy world population;
healthy planet; health as fundamental human rights
b. Universal coverage of health services
c. Concept of global philosophy on Sarbajanahitaya
(Universal good for world people; SarbajanaSukhhaya
(Universal happiness)
4.2 Definition of international health, ,international public health
and synonymous term global health
4.3 Characteristics of international health
4.4 Historical background of international public health movement
4.5 Significant forces affecting to international health
4.6 Current international health issues demanding global public
health action

4.7 International public health
actions:
a. Enhancement of health promoting actions such as: Lifestyle change
global efforts
b. Risk factors and disease prevention efforts such as: global accident
prevention; global tobacco control including Framework Convention
on Tobacco Control, environmental pollution prevention efforts; global
consciousness raising on global warming and climate change
prevention; global efforts on violence reduction
c. Health protection efforts such as, Universal immunization,
eradication of polio, measles through immunizations
d. Control of pandemics such as HIV/ AIDs; Viral influenza (H1N1)
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4.8 Overview of international health movements and their implications in national
health policy, strategy and programs
a. Health for All Strategy (Alma Ata Declaration)
b. Primary Health Care Movement: Need, strategies, essential elements, obstacles
(selective primary health care strategy) to and revitalization efforts
c. Health Promotion Strategy (Ottawa Charter)
d. MDG Goals
e. Sustainable Development (Health components)
4.9 Overview of international cooperation and actors for health and medical services
with particular reference to Nepal cooperation
a. Introduction to :World Health Organization; UNFPA; UNICEF; UNDP; World Bank,
FAO
b. Introduction to bilateral organizations: such as USAID, JAICA, Indian Aid Mission,
DFID, GIZ
4.10 Introduction to International Non-Governmental Organizations
4.11 Influence of international health movements and international health actors in
national public health service and medical care systems: An overview of strengths and
limitations
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4.12 Globalization and affect on public health:
a. Globalization and food-nutrition
b. Globalization and emerging infectious globalization of
pharmaceutical industries and health and medical care
dilemmas diseases
c. International capital economy (privatization) and its
effects in health status of world people and particularly
on the people of under developed world; effect of capital
economy on public health actions and intervention
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4.13 Westernization of public health strategies in the under
development countries in the banner of globalization of
health: A critical review of strengths and weakness
4.14 Highlights of achievements in international efforts in health
and medicine
a. Enhancement of international networks
b. Eradication of some vaccine preventable diseases
c. Lifestyle change movement particularly in developed
countries
d. Framework Convention on Tobacco Control: National
incorporation of the convention
e. Collaborative research in health and medical technology
f. Global response to pandemics such as HIV/AIDS
g. Provisionof Global Funds for AIDS, malaria and
tuberculosis
h. International efforts to enhance Public Healt
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Nothing on earth is more international than
diseases
-Paul Russel
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Global aspiration on health:
healthy world population;
healthy planet;
health as fundamental human rights
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Healthy world population
 Creating a healthier world involves working to
promote and sustain health and well-being at all
ages, leaving no-one behind.
 WHO emphasizes work on healthier populations to
advance towards a world where all people enjoy healthy
lives and well-being, living in safe, supportive and
healthy environments as members of an inclusive
society.
 WHO’s Triple Billion targets and the Sustainable
Development Goals (SDGs) provide a bold and
ambitious agenda for achieving healthier populations
and a more sustainable world.
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Epidemiologic Transitions
First Generation of Diseases: Common
Childhood Infections, Malnutrition, Reproductive
Risks
Second Generation of Diseases Cardiovascular,
Oncotic Degenerative
Third Generation of Diseases: Environmental
Threats Air, water, chemical Ozone depletion,
global warming New/Emerging Infections
HIV/AIDS, Ebola virus, plague, Tuberculosis,
dengue, cholera
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Working areas
 Championing health across all goals
 Health promotion
 Social determinants of health
 Food safety and nutrition
 Environment, climate change and health
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Healthy planet
 For the last thousands of years, the planet Earth is providing
a hospitable environment for humans and other organisms to
flourish. The resources of the earth and the natural
greenhouse effect provide a comfortable environment and
the presence of water helps humans to survive and perform
their activities.
 Every creature depends on a healthy environment to achieve
good health and attain proper physical, social, emotional,
and psychological well-being.
 Human health and environmental health are inextricably
linked. Our collective resilience, well-being, nourishment,
and capacity to avert disease are fully connected to the food
we consume, the water we drink, the air we breathe, and the
resources provided by the earth.
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Healthy planet
A healthy planet supports healthy people
Everyone depends on a healthy environment for
good human health, with health understood as
physical, social and psychological well-being.
However, the poor are fundamentally dependent
on nature for its direct supply of air, water, land
and food to sustain their livelihood activities as
well as their day-to-day survival and health.
There are estimates that approximately 70% of the
poor depend directly on the land, water and air for
their lives and livelihoods
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Universal health coverage (UHC)
Universal health coverage (UHC) means
that all people have access to the full range
of quality health services they need, when
and where they need them, without
financial hardship.
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Universal health coverage (UHC)
• The UHC service coverage index (SDG indicator 3.8.1) increased
from 45 in 2000 to 68 in 2019.
• About 2 billion people are facing catastrophic or impoverishing
health spending (SDG indicator 3.8.2).
• Inequalities continue to be a fundamental challenge for UHC as
aggregated data masks within-country inequalities in service
coverage.
• The COVID-19 pandemic further disrupted essential services in
92% of countries at the height of the pandemic in 2021. In 2022,
84% of countries still reported disruptions.
• To build back better, WHO’s recommendation is to reorient health
systems using a primary health care (PHC) approach. Most (90%)
of essential UHC interventions can be delivered through a PHC
approach, potentially saving 60 million lives and increasing average
global life expectancy by 3.7 years by 2030.
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Concept of global philosophy on Sarbajanahitaya
 In the Universal Declaration, we proclaimed that
“everyone has the right to a standard of living adequate
for the health and well-being of himself and of his
family, including food, clothing, housing and medical
care and necessary social services”.
 Millennium Declaration, all States reaffirmed certain
fundamental values as being “essential to international
relations in the twenty-first century”: freedom, equality,
solidarity, tolerance, respect for nature, and shared
responsibility. They adopted practical, achievable
targets –- the Millennium Development Goals –- for
relieving the blight of extreme poverty and making such
rights as education, basic health care and clean water a
reality for all. 12/16/2015 16

Concept of global philosophy on Sarbajanahitaya
Universal Declaration of Human Rights
Total Article 30
Read it throughly
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Introduction
 International Health is the study of health
issues that affect people living in the
developing world.
 Deals with health across regional or
national boundaries.
 Immunization, prophylactic medication,
post travel care, quarantine.
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Why International Health
 Health is an international concern because problem in
a part of the global affects to the other part.
 Health problem can be solved or minimized through
joint efforts between the national or global efforts.
 Experiences of one nation can be useful to other; eg
Malaria control program.
 There has been raising relationship between the
nations (global relation) affecting health of one or
other.
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Concepts of International Health
 Equity and Health
 Poverty and Health
 Environment and Health
 Culture and Health
 Urbanization and Health
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Equity and Health
 The world’s resources are unequally
distributed.
 Disparities in health within and between
countries.
 To reduce such disparities will require a more
equitable distribution.
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 Inequalities can be illustrated between
countries of varying socioeconomic Profiles.
 Developing countries are susceptible to early
death, infant mortality, illness, and other poor
health indicators.
 Causes of these negative health outcomes:
living conditions marked by poverty, poor
shelter, and inadequate sanitation.
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Poverty and Health
 The differences can be attributed primarily to
variation between urban and rural areas.
 Rural areas have barriers to health care,
education and employment.
 Urban have greater access to safe water and
sanitation.
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Environment and Health
 Developed countries are affected by problems
of pollution from air, water, and noise.
 Health hazards created by industrialization,
urban growth, and quality of housing.
 Inadequate sanitation— lack of safe water,
facilities for the disposal of solid wastes,
control of disease vectors, food safety, and
satisfactory housing.
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Culture and Health
 Sociocultural factors : These factors include
health-related beliefs about food, pregnancy,
childbirth, diseases, and sanitation practices.
 Excessive consumption of food, alcohol, tobacco,
and drugs.
 Chronic or prolonged exposure to stress can lead
to hypertension, coronary heart disease, and other
impediments to health.
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Urbanization and Health
 Shift of populations from rural regions to urban
areas.
 Individuals anticipate better jobs, education,
social services and other new opportunities.
 Overcrowded and highly contaminated areas like
slums and shanty towns stricken with poverty.
 Noise, traffic, and air pollution.
 Effects of urbanization- greenhouse gas
emissions, ozone depletion, land degradation, and
coastal zone destruction. 12/16/2015 26

 In order to protect against spread of diseases,
from one country to another, many attempts
were made in the past-like isolation of
travelers, quarantine etc.
 International conferences were held &
organizations were set up for discussion,
agreement & cooperation on matter of
International health
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History/ Evolution of International health
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First International Sanitary
Conference(1851)
 1st International Sanitary Conference.
 Objective: introduce order & uniformity into
quarantine measures.
Preparation of International Sanitary Code – 137
articles.[Cholera, Plague & Yellow Fever)
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Pan American Scientific
Bureau(1902)
 World’s first international health agency
 Primarily intended to coordinate quarantine
procedures in American Societies.
 1924 important document signed by
American Republic “the Pan American
Sanitary Code”
 1947 bureau was renamed- Pan American
Sanitary organization(PASO)
 1958 –named as PAHO
 Head quarters: Washington DC
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Office International D‘Hygiene
Publique (1907)
 Disseminate information on
communicable disease
 Supervise international quarantine
measures
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Health Organization of League of
Nations
 1923 established
 To build a better world
 Included “health organization to take steps
in matter of international concern for the
prevention and control of disease”
 Worked in quarantine regulation,
epidemiological information, problems of
epidemic diseases, nutrition, rural hygiene,
training of public health workers
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The United Nations Reliefs and
Rehabilitation Administration 1943
 Recovery of World war
 Care for health of displaced people
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Major areas in INH
 Prevention and control of specific diseases
 Development of comprehensive health
services
 Family health
 Environmental health
 Health statistics
 Biomedical research
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Significant forces affecting to
international health
Noncommunicable disease (NCD): NCDs include cancer,
cardiovascular diseases, chronic respiratory diseases, and
diabetes, and include such risk factors as alcohol and
tobacco use, obesity and unhealthy eating, and physical
inactivity. Their presence is global, but 77 percent of NCD
deaths occur in low- and middle-income countries.
Communicable Disease: Communicable diseases include
HIV/AIDS, influenza, malaria, neglected tropical diseases
(NTDs), sexually transmitted infections, tuberculosis, viral
hepatitis, and of course COVID-19, Ebola, and other
viruses. Food Security and
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Significant forces …
Nutrition: Hunger and famine remain global health problems despite
significant improvement in food security over recent decades. Even in
wealthier countries, natural disasters can expose political and economic
inequalities, and infrastructure is strained by population growth and
environmental change.
Environmental Health: The environment influences global health in a variety
of ways. Some scientists believe the virus that causes COVID-19 originally
crossed over from a wild animal, partly because of human encroachment on
what was once wilderness.
Health Inequity: Health and health equity are impacted by biological
determinants as well as the conditions in which people are born, grow, and
live.
Mental Health: mental health is a global health issue that is finally getting the
attention it deserves. Depression is a leading cause of disability, and suicide is
a leading cause of death among 15- to 29-year-olds
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Current international health issues
demanding global public health action
• Long COVID
• Mental health
• Impact of climate change
• Cardiovascular disease
• Lower respiratory infections
• Poverty's role in health
• Health systems strengthening
• Diabetes
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International public health actions
a. Enhancement of health promoting actions such as:
Lifestyle change global efforts
b. Risk factors and disease prevention efforts such as:
global accident prevention; global tobacco control
including Framework Convention on Tobacco Control,
environmental pollution prevention efforts; global
consciousness raising on global warming and climate
change prevention; global efforts on violence reduction
c. Health protection efforts such as, Universal
immunization, eradication of polio, measles through
immunizations
d. Control of pandemics such as HIV/ AIDs; Viral
influenza (H1N1)
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Global Health
 Definition: Health of populations in a
global context and transcends the
perspectives and concerns of individual
nations.
 Purpose: Improve health and achieve
equity in health for all people worldwide.
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Globalization
Past and present
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Definitions of Globalization
 A process by which nations, business and people are
becoming more connected and interdependent across
the globe through increased economic integration and
communication exchange, cultural diffusion and
travel.
 Globalization can be described as ‘…a widening,
deepening and speeding up of worldwide
interconnectedness in all aspects of contemporary
social life, from the cultural to the criminal, the
financial to the spiritual’ (Held and McGrew 1999)
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Jan Aart Scholte (2000: 15-17) has argued that at
least five broad definitions of 'globalization’
 Globalization as internationalization
 Globalization as liberalization
 Globalization as universalization
 Globalization as westernization or
modernization
 Globalization as deterritorialization- or as the
spread of supraterritoriality
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Aspects of Globalization-
 Economic
 Technological
 Cultural
 Political
 Military
 Health ( to be discussed exclusively)
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Globalization
Liberalization
Deregulation
Cross border flows
Foreign Investment
Increased Trade
Privatization
All Services No subsidy No Preventive care
Increase Household Income
High Cost Red.Accessibility
Health
HIV Tob
DV
Medicalization
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Nepal
Few Examples only
 Commercialization of the means of family
Planning: Dhal ,Gulaf, Sangini etc.
 Sell of ORS, “Sutkeri Samagri”, cut in
subsidy
 Introduction of User’s fee in public health
facilities
 Privatization of Curative health: increase
availability of Modern technologies & its
Irrational use
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Global aspiration on health: healthy world
population; healthy planet; health as
fundamental human rights
One in 20 people worldwide (4·3%) had no
health problems
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4.8 Overview of international health movements
and their implications in national health policy,
strategy and programs
a. Health for All Strategy (Alma Ata Declaration) b.
Primary Health Care Movement: Need, strategies, essential
elements, obstacles (selective primary health care strategy)
to and revitalization efforts
c. Health Promotion Strategy (Ottawa Charter)
d. MDG Goals
e. Sustainable Development (Health components)
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Primary Health Care
Historical Background
Investment on health
Results
Global experiences of alternative
approaches
49
12/11/2023

Conceptualizing Primary Health Care
Primary Health Care
Hardware Services
Elements
Structure
Persons
Equipment, etc.
Software Philosophy
Principles
50
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Primary Health Care
 In the year 1946 Sir Joseph Bhore
recommended in his report
 A PHC for every 30,000 pop & 20.000 pop in
hilly areas

ALMAATA DECLARATION
‘The main goal of Governments and World
Health Organization in the coming decades
should be the attainment by all people of the
world by the year 2000, a level of health that
would permit them to lead a socially and
economically productive life’
51ST WHA in 1998 reaffirmed the declaration for
the 21st century

Primary Health Care
 Definition:
In 1978 the alma-Ata conference( USSR)
“Is the essential health care made universally
accessible to individuals and acceptable to them ,
through their full participation and at a cost the
community and country can afford.”

PRIMARY HEALTH CARE
Definition:
PHC is essential health care based on practical, scientifically
sound, and socially acceptable methods and technology made
universally accessible to individuals and families in the
community through their full participation and at a cost that
the community and the country can afford… It forms an
integral part of the country's health system, of which it is the
central function and the main focus, and of the overall social
and economic development of the community

Basic Components of Primary
Health Care
(WIMEN & CHD)
1. Water & Sanitation,
2. Immunizations,
3. Mother & Child Care (&FP),
4. Essential Drugs,
5. Nutrition & Food
6. Curative Care,
7. Health Education,
8. Disease Control
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Principles of primary health care.
 Equitable distribution- urban & rural areas
 Community participation – trained SBA
 Intersectoral co-ordination- education ,
nutrition..etc
 Appropriate technology – ORS, growth
monitoring
 Focus on prevention activities- Polio, Malaria

1. Equitable distribution
 The first key principle in primary health care strategy is equity or
equitable distribution of health services
 Countries should find means to ensure every person’s access to
services.
 Something for all and most for those who need the most
 Health services must be shared equally by all people irrespective of
their ability to pay and all ( rich or poor, urban or rural) must have
access to health services
 health services are mainly in towns Inaccessibility to majority of
population
 Social injustice
 Availability -Insurance
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2. Community participation
 There must be a continuing effort to secure
meaningful involvement of the community in
the planning, implementation and maintenance
of health services, besides maximum reliance on
local resources such as manpower, money and
materials
 Community involvement: the involvement of
individuals in promoting their own health is
essential for the future well-being of the
community.
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3. Intersectoral coordination
 "primary health care involves in addition
to the health sector, all related sectors and
aspects of national and community
development, in particular agriculture,
animal husbandry, food, industry,
education, housing, public works,
communication and others sectors".
 To achieve cooperation planning at
country level is required to involve all
sectors
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4. Appropriate technology
 "technology that is scientifically sound,
adaptable to local needs, and acceptable to
those who apply it and those for whom it
is used, and that can be maintained by the
people themselves in keeping with the
principle of self-reliance with the
resources the community and country can
afford"
 Should be acceptable, cost-efficient, cheap
and available at the local level
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5. Focus on the prevention activity
Acquiring knowledge, through education for
health and/or the mobilization of communities
for immunization; the role of communities in
making decisions related to the provision of
resources for medical priorities. As prevention is
essential for solving the long-term problems of
the community, though it is not always the
solution to individual problems, preventive
services should exist alongside curative services.
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Models of primary health care
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Critically analyze the Comprehensive and
Selective Primary Health Care (PHC)
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SELECTIVE
PRIMARY HEALTH CARE
PHC implies that if one cannot afford to offer
universal coverage for even the most basic of
health care, one could would offer treatment
& preventive strategies for the few diseases
identified as having the greatest threat to
mortality, & which are amenable to
prevention / cure at low cost.

 Selective PHC was evolved from the broader concept of PHC. It is a more
cost focused approach than the traditional PHC and tries to improve the
health of a wide range of people
 An important part of selective PHC was the creation of political will for
funding opportunities.
 Selective PHC: “old wine in new bottles”
 These are the original diseases on which SPHC should focus:
 Diarrhoea
 Measles
 Malaria
 Whooping cough
 Neonatal tetanus.
 By 1988, acute respiratory infections gained weight (Warren 1988: 900).
12/11/2023 65

Selective PHC
ADVANTAGES
1. Donor friendly
2. Elimination of selected
disease
3. Easy to plan &
implement
4. Is focused & have more
impact
5. Easy to manage &
measure output
6. Require limited
resources
7. Improve quality of
services
DISADVANTAGES
1. Disease rather than health
oriented
2. Doesn’t ensure equity
3. Top down decision making
4. Neglect other problems
5. Leads to outbreak
6. Resources (tight) might not
be available for urgent needs
(emergencies)
7. Less community
involvement– donor priority

Comprehensive PHC
 Acknowledges other factors that contribute to poor
health including:
 social influences which look at the
◦ impacts of the key determinants of health which leads to the
social determinants of health
 Social justice and equity
 Community control
 Social change
 Manages factors that generate ill health
 Involves an approach to health care over a continuum
from health promotion to illness treatment
12/11/2023 67

Comprehensive PHC
ADVANTAGES
1. Looks at total health
care
2. Involvement of
community
3. Covers all elements of
PHC
4. Ensures equitable
distribution of resources
5. Facilitates effective
referral system
6. Government goal
DISADVANTAGES
1. More costly to implement
2. Takes long time to see
impact
3. Long time to process
4. Lack of specialized
treatment
5. Expensive
6. Inefficient referral system
???-- misuse

General Background
 During the early 1980s the term ‘health promotion’
was becoming increasingly used by a new wave of
public health activists
 who were dissatisfied with the rather traditional and
top-down approaches of ‘health education’ and
‘disease prevention’.

General Background ( Contd…)
 This prompted the WHO to call a special meeting in
late 1984 in Copenhagen Denmark to provide
some clarity and direction which led to the first
substantive document on health promotion.
 The Concepts and Principles of Health Promotion
published in the first edition of Health Promotion
International in 1986 became the springboard for
the Ottawa Conference and Charter.

Introduction
 First International Conference on Health Promotion
 Held in Ottawa, Canada on 17-21 November, 1986.
 212 participants from 38 countries.

Aim of the conference
 To continue to identify action to achieve the
objectives of the World Health Organization
(WHO) Health for All by the Year 2000
initiative,.
 The Ottawa Conference was preceded by the
Alma Ata Primary Health Care Conference in
1978.

DECLARATIONS ON HEALTH
PROMOTION
First: Ottawa, Canada on Nov 21st 1986
Second: Adelaide, Australia in 1988
Third: Sundsvall, Sweden in 1991
Fourth: Jakarta Indonesia, July 1997
Sixth: Bangkok charter Thailand, August
2005
Fifth: Mexico city, June
2000
Seventh: Nairobi, Kenya, Oct
2009
Eighth: Helsinki, Finland 10-
14 June 2013
Ninth: Shanghai, China
21-24 November 2016

Health promotion
 Health promotion is the process of enabling
people to increase control over, and improve,
their health.
 Not just the responsibility of the health sector,
but goes beyond healthy lifestyles to wellbeing.

Conditions and resources needed for
good health
 Peace
 Shelter
 Education
 Food
 Income
 Stable ecosystem
 Sustainable resources
 Social justice and equity.

Basic strategies for health
Promotion
1. Advocate
2. Enable
3. Mediate
.

Good Health
is health
Good Health is
favored or
harmed by
• Source for social, economic
and personal development
• Important dimension of
quality of life
Health promotion action aims at making these
conditions favorable through advocacy for health
•Political, economic, social,
cultural, environmental,
behavioral and biological
factors
Strategies (Contd…..)
1. Advocate

Health Promotion focuses on achieving equity in
health
Health
Promotion
action aims
to
•supportive environment,
•access to information,
•life skills, and
•opportunities
For making healthy
choices
Reduce differences in
current health status and
ensuring equal
opportunities and
resources to
2. Enable
enable all
people to
achieve their
fullest health
potential.

Health Promotion
demands
coordinated
action by
• Governments
• Health and other social and economic
sectors
• Nongovernmental and voluntary
organization
• Local authorities
• Industry
• Media
Professional and social groups and health personnel have
a major responsibility to mediate between differing interests
in society for the pursuit of health
3. Mediate

Health Promotion Priorities Action
Areas
82

Health Promotion action means
1. Build healthy public policy –
 puts health on the agenda of policy makers in all sectors
 aware of the health consequences of their decisions and to accept
their responsibilities for health
 combines diverse approaches including legislation, fiscal
measures, taxation and organizational change.
 Joint action contributes to ensuring safer and healthier goods and
services, healthier public services.
 Requires identification of obstacles to the adoption of healthy
public policies in non-health sectors, and ways of removing
them.

Health Promotion action means (contd….)
2. Create supportive environments –
 Societies are complex and interrelated.
 Socio ecological approach to health
 conservation of natural resources throughout the world should be
emphasized
 Changing patterns of life, work and leisure have significant impact on
health.
 Health promotion generates living and working conditions that are
safe, stimulating, satisfying and enjoyable.
 The protection of the natural and built environments and the
conservation of natural resources must be addressed in any health
promotion strategy.

Health Promotion action means (contd….)
3. Strengthen community actions –
 Health Promotion works through concrete and
effective community action
 Empowerment of communities is the most
important
 community development draws on existing human
and material resources

Health Promotion action means(contd….)
4. Develop personal skills –
 Supports personal and social development through
providing information, education for health, and
enhancing life skills
 Enable people to exercise more control over their
own health and over their environments
 This has to be facilitated in school, home, work and
community settings.

Health Promotion action means (contd…)
5. Reorient health services –
 Health sector must move increasingly in a health
promotion direction, beyond its responsibility
for providing clinical and curative services.
 Reorienting health services also requires
stronger attention to health research, as well as
changes in professional education and training.

Moving into the future
 caring, ecology are essential issues in
developing strategies for health promotion.
 women and men should become equal partners
in each phase of planning, implementation and
evaluation of health promotion activities

Commitment to health promotion
 Move into the arena of healthy public policy,
and advocate a clear political commitment to
health and equity in all sectors.
 Focus attention on public health issues such as
pollution, occupational hazards, housing and
settlements.
 Respond to the health gap within and between
societies, and tackle the inequities in health

Commitment to health promotion (Contd..)
 Acknowledge people as the main health resource
and accept the community as the essential voice in
matters of its health, living conditions and
wellbeing.
 Reorient health services and their resources
towards the promotion of health; share power with
other sectors, disciplines and with people.
 Recognize health and its maintenance as a major
social investment and challenge, and address the
overall ecological issues of our ways of living

Call for International Action
The Conference calls on the World Health
Organization and other international
organizations to advocate the promotion of
health in all appropriate forums and to support
countries in setting up strategies and
programmes for health promotion.

Challenges
To demonstrate and communicate more widely to
developing countries that :
1. Health promotion policies and practices can
make a difference to health and quality of life.
2. The health promotion action can achieve
greater equity in health and can close the
health gap between population groups

Millennium Development Goals
(MDG)
94

Background
Before second world war
focus on how to be free (Liberation)
After second world war
free
focus on Policy, Health, education etc.
equity (How to reduce discrimination)
HFA (2000) MDG(2015) SDG(2030)
95

Background...
 In September 6-8, 2000, at the United Nations
Millennium Development Summit, 189 nations adopted
the Millennium Declaration to fulfill a collective
responsibility for sustainable development and poverty
eradication by the year 2015,
that have become known as the Millennium
Development Goals
 MDGs is a pivotal event in the history of the United
Nations.
11/12/2023 96

Commitments of Millennium Declaration
 Peace, security and disarmament
 Development and poverty eradication
 Protecting our common environment
 Human right, democracy and good governance
 Protecting the vulnerable
 Meeting the special needs of Africa
 Strengthening the UN.
11/12/2023 97

MDGs.....
Roadmap to implement Millennium Declaration in the
area of Development and Poverty eradication
• Goals – 8
• Targets -18 and
• Indicators- 48
• 3 out of 8 goals,
• 8 of the 18 targets and
• 18 of the 48 indicators
are directly related to health.
11/12/2023 98

MDGs
Goal 1. Eradicate extreme poverty and hunger
Goal 2. Achieve universal primary education
Goal 3. Promote gender equality and empowerment of women
Goal. 4 Reduce child mortality
Goal 5. Improve maternal health
Goal 6. Combat HIV/AIDS, Malaria and other diseases
Goal 7. Ensure environmental sustainability
Goal 8. Develop a global partnership for development
11/12/2023 99

Target vs. achievement
of MDGs Health indicators in
Nepal
11/12/2023 100

Nepal, despite being engulfed in a decade-
long armed conflict during the initial
years of MDG implementation, has made
significant progress against most targets.
11/12/2023 101

MDG 1: Reducing Poverty and Hunger
 Nepal has made substantial progress on reducing
poverty and hunger.
11/12/2023 102
2014 Target
2015
1. population were living
below the poverty line
23.8% 21 %

MDG 2: Achieving Universal Primary
Education
Nepal has made significant progress towards
achieving the MDG 2 targets with:
• ¾ the net enrolment rate (NER) in primary
education reaching 96.2 % in 2015 (MoF,2015);
• ¾ students who start in grade one who reach
grade five improving from 38 % in 1990 to 98.9
% in 2015 (CBS, 2014)
11/12/2023 103

MDG 3: Ensuring Gender Equality
11/12/2023 104
the achievements are probably not enough to achieve the MDG target by
2015.

MDG 4: Reducing Child Mortality
 Nepal has successfully achieved all MDG
4
 indicators and is considered a ‘fast track’
country
 for reducing child mortality.
11/12/2023 105
Nepal has successfully achieved all MDG 4 indicators

MDG 5: Reducing Maternal Mortality
11/12/2023 106

MDG 6: Combat HIV, AIDS,
Malaria and Other Diseases
11/12/2023 107

MDG 6: Combat HIV, AIDS,
Malaria and Other Diseases
11/12/2023 108

MDG 6: Combat HIV, AIDS, Malaria
and Other Diseases
11/12/2023 109

MDG 7: Ensure Environmental
Sustainability
11/12/2023 110

MDG 8: Develop a Global Partnership for
Development
• Nepal’s total foreign aid utilization increased
from NPR 14 billion in 2000 to NPR 55 billion
in 2014.
• This has led to an increase in the share of
foreign aid in GDP to 2.6 % in 2014
11/12/2023 111

Sustainable Development Goals
2016-2030
11/12/2023 112

SDG
• The UN Conference on Sustainable Development held in Rio de
Janeiro in June 2012
• UN General Assembly (UNGA) held in September 2014 prepared
solid foundation for SDGs
• Finally agreed in the UNGA held in September 2015.
• Nepal, as a member of the UN, is a part of this global initiative.
– For Nepal's socio-economic development
11/12/2023 113

The agenda for Sustainable Development
11/12/2023 114

SDG 1 Ending poverty in all its forms
everywhere.
Till 2015
 Less than 25 % of the
population are living below
poverty line
(US$ 1.25 per day).
 The poverty gap ratio has
narrowed to 5.6 percent
Target by 2030
 Poverty is targeted to
decline
from 23.8% to 5 %
11/12/2023 115

SDG 2 Ending hunger, achieving food security,
improving nutrition and promoting sustainable
agriculture.
Till 2015
 Still 30 % of under five
children are underweight
 Stunting persists in 37.4 %
of under five children
 Wasting in 11.3 % this age
group.
Target by 2030
 End hunger
 End all forms of
malnutrition
 Double agricultural
productivity and the
incomes of small-scale food
producers.
11/12/2023 116

SDG 3 Ensure healthy lives and promote
well-being for all people of all ages.
Target by 2030
• Reduce MMR to less than 70 per lakh
live births,
• to reduce preventable deaths to less than
1 % in newborns and children
• to eliminate the prevalence of the HIV,
TB, malaria, other tropical and water
borne diseases.
• NCD reduce by one-third
• Raising the proportion of births
attended by SBA to 90 %.
• Strengthen the prevention and treatment
of substance abuse,
• Halve by 2020 the number of deaths
and injuries from RTA
11/12/2023 117

SDG 4 Ensure inclusive and equitable quality
education and promote lifelong learning
opportunities for all.
Till 2015
• Nepal has made good
progress in primary
education
• NER now standing at 96.2
%
• Literacy rate of 15–24 year
olds at 88.6 %
Target by 2030
 Enrolment almost 100 and
 95 percent of students
being enrolled in grade one
to reach grade eight, and
 90 % of children attending
pre-primary education.
11/12/2023 118

SDG 5 Achieving gender equality and
empowering all women and girls.
Till 2015
 Progress on ensuring equal
access to education, with
gender parity.
Target by 2030
 eliminating gender disparity
in
◦ all levels of education,
◦ wage discrimination at similar
work,
◦ physical and sexual violence,
and
◦ all harmful practices
11/12/2023 119

SDG 6 Ensuring the availability and
sustainable management of water and sanitation
Till 2015
• Basic water supply coverage
in Nepal was 83.6 % in 2014
• while sanitation had reached
70.3 % of the population.
• Two-thirds of the Nepali
population now use latrines
and
• 30 % people were connected
to sewerage systems.
Target by 2030
• 95 percent of households
having access to piped
water supplies
• Open defecation free
• All urban households being
connected to a sewerage
system.
11/12/2023 120

SDG 7 Access to affordable, reliable,
sustainable and modern energy all.
Till 2015
 Nearly three-quarters of
households use solid
fuels for cooking
while more than a quarter
use liquid petroleum
gas (LPG).
 Nearly three-quarters of
households have access to
electricity in their dwellings
Target by 2030
 99 % of households with
access to electricity, only 10
% of households using
to firewood for cooking,
 to generation of at least 10
thousand megawatts
of electricity
11/12/2023 121

SDG 8 Inclusive and
sustainable
economic growth
Target by 2030
 at least 7 % per annum
growth in per capita gross
domestic product (GDP)
 growth of labour intensive
sectors like agriculture and
construction by 5 and 10 %
respectively.
11/12/2023 122

SDG 9 Resilient infrastructure, inclusive
and sustainable industrialization, and innovation.
Till 2015
• So far, 12,500 km of the
country’s strategic road
network and
• about 53,000 km of the
local road network have
been built.
• The share of industry in the
country’s total output is
only 15 %.
Target by 2030
 to increase road density
from the current 0.44
km/km to 5 km/km
 grow access to
telecommunications (tele-
density) to 100 %
raise the share of industry
in total output to 25%
11/12/2023 123

SDG 10 Reducing inequality within
and among countries.
Till 2015
 In Nepal, consumption
inequality (as measured by
the Gini coefficient) 2014
was estimated at 0.33 %.
Target by 2030
 reducing consumption
inequality from 0.33 to 0.16
%,
 and increasing social,
economic, and political
empowerment indices to
0.70 %.
11/12/2023 124

SDG 11 Aspires to make cities and
human settlements inclusive
Till 2015
 7 % of Nepal's urban
population lives in squatter
settlements
 and only 30 percent of
houses are safe to live in.
Target by 2030
• reducing multidimensional
poverty,
• doubling the proportion of
households living in safe
houses,
• making 50 % of roads safe
(for driving) by
international standards,
• and creating at least 50 new
satellite cities.
11/12/2023 125

SDG 12 Intends to ensure sustainable
consumption and production patterns.
Till 2015
 In Nepal, only 10 % of
water resources have been
used
 and fossil fuels only 12.5 %
of energy consumption.
Target by 2030
 Limiting fossil fuel
consumption to 15 % of
energy consumption and
 improving the soil organic
matter from 1 % in 2014 to
4 % in 2030.
11/12/2023 126

SDG 13 Calls for urgent action to
combat climate change and its impacts.
Till 2015
 In Nepal, the total emission
of CO2, at 0.10 metric
tonnes per capita, is
negligible and the
 consumption of ozone
depleting substances (ODS)
is only 0.88 ODS tonnes.
Target by 2030
 halving the emission of
CO2, ODS and greenhouse
gases from agricultural,
transportation, industrial
and commercial sectors.
11/12/2023 127

SDG 14 Conserving and sustainably
using the oceans, seas and marine
resources
Till 2015
 so is not
relevant for Nepal.
Target by 2030
 But as mountain resources
are so crucial for Nepal's
fresh water resources,
hydropower, livelihood,
agriculture, adventure
tourism
11/12/2023 128

SDG 15 Calls for protecting, restoring and
promoting the sustainable use of terrestrial
ecosystems
Till 2015
• Nepal's current forest cover
including bushes and
grassland is 39.6 percent.
• Protected areas cover 23.2
percent of the country’s land
area.
Target by 2030
 To increase forest cover to
45 percent and
 To increase rotected areas
to 25 percent.
11/12/2023 129

SDG 16 Promoting peaceful and
inclusive societies
Till 2015
 Nepal scores only 3 out of 6
for transparency,
accountability and
corruption in public life.
 Violence against children
and women is common
Target by 2030
 improving the transparency
and accountability score to
5, and the score on the good
governance scale to 2
 ending deaths from violent
conflict, violence against
women and violence
against children,
11/12/2023 130

SDG 17
 is about strengthening the means of
implementation and revitalizing the global
partnership for sustainable development.
11/12/2023 131

4.9 Overview of international cooperation
and actors for health and medical services
with particular reference to Nepal
cooperation
a. Introduction to :World Health
Organization; UNFPA; UNICEF; UNDP;
World Bank, FAO
b. Introduction to bilateral organizations:
such as USAID, JAICA, Indian Aid
Mission, DFID, GIZ
12/16/2015 133

 Bilateral flows are provided directly by a
donor country to an aid recipient country.
 Multilateral flows are channeled via an
international organization
12/16/2015 134

Difference between bilateral and
multilateral donors
Bilateral aid usually refers to assistance given
directly from a donor government to a recipient
country. The donor government may provide this
assistance directly to the recipient government or
to non-governmental institutions operating in the
recipient country. This aid is sometimes managed
by a government agency charged with this task.
Multilateral aid means between more than two
parties. This is used where a donor country sends
funds to multilateral organization such as the
World Bank and the United Nations, which in turn
administer aid donations to several recipient
countries.
12/16/2015 136

• The main difference between multilateral and
bilateral aid is related to the way in which funds
are transferred.
• In bilateral aid, it is country to country, and in
multilateral, it is unearmarked aid from countries
to multilateral agencies, such as the Word Bank,
European Union, and the United Nations, and
then to recipient countries. This is a crucial
difference because in the case of bilateral aid
individual countries are the only one to decide
whom to give money to, and for which purpose.
12/16/2015 137

Multi lateral Agencies
 WHO
 UNICEF
 UNFPA
 UNDP
 ADB
 World bank
 SAARC
12/16/2015 138

Introduction
The work of WHO affects the lives of
every person on this planet, every day.
From the food we eat and the water we
drink, to the safety of the medications we
take, and the prevention and control of the
disease that threaten.
Dr LEE Jong-wook
Director-General
12/16/2015 140

The World Health Organization (WHO) is the
international agency within the United Nations’
system responsible for health. WHO experts
produce health guidelines and standards, and help
countries to address public health issues.
WHO also supports and promotes health research.
Through WHO, governments can jointly tackle
global health problems and improver people’s
well-being.
12/16/2015 141
Introduction ….

194 countries and two associate members are
WHO's membership. They meet every year at
the World Health Assembly in Geneva to set
policy for the organization, approve the
Organization's budget, and every five years, to
appoint the Director-General.
Their work is supported by the Health Assembly.
Six regional committee focus on health matters
o a regional nature.
12/16/2015 142
Introduction …

Short history to the achievements
When diplomats met in San Francisco to form the United
Nations in 1945, one of the things they discussed was setting up
a global health organization.
WHO’s Constitutions came into force on 7 April 1948 - a date we
now celebrate every year as World Health Day.
Delegates from 53 of WHO’s 55 original member states came to
the first World Health Assembly in June 1948.
They decided that WHO’s top priorities would be malaria,
women’s and children’s health, tuberculosis, venereal disease,
nutrition and environmental sanitation – many of which are still
working on today.
12/16/2015 143

• 1948: International Classification of Disease
• 1952 – 1964: Global Yaws Control Program
• 1974: Onchocerciasis Control Program
• 1979: Eradication of Smallpox
• 1988: Global Polio Eradication Initiative Established
• 2003: WHO Framework Convention on Tobacco
Control
• 2004: Adoption of the Global Strategy on Diet,
Physical Activity and Health
• 2005: World Health Assembly revises the
International Health Regulations
12/16/2015 144
Short history to the achievements …

Prioritization of programs in Nepal
• Demography
• Economy
• Poverty and Human Development
• Education
• Nutrition
• Food Security
• Social and Health Inequity
• The conflict
12/16/2015 145

• Vulnerability and Disaster
• Governance and Public Sector Reform
• Epidemiology and Disease Burden
• Health Policy Orientation and Priorities
• Decentralization of Health Services
• Health Financing
• Human Resource
• Summary of Health Challenges and Opportunities
- Health system including HRH
- Disease control, environmental and emergency
health
-Maternal and Reproductive Health
12/16/2015 146
Prioritization of programs in Nepal …

Who core functions
 Providing leadership on matters critical to health and
engaging in partnerships where joint action is needed;
 Shaping the research agenda and stimulating the
generation, translation and dissemination of valuable
knowledge;
 Setting norms and standards, and promoting and
monitoring their implementation;
 Articulating ethical and evidence-based policy
options;
 Providing technical support, catalyzing change, and
building sustainable institutional capacity;
 Monitoring the health situation and assessing health
trends. 12/16/2015 147

How does who spend its money?
The World Health Assembly has approved a budget which
divides WHO’s spending into 4 interdependent
categories:
1. essential health interventions (such as response to
epidemic alerts and reduction of maternal and child
mortality);
2. health systems, policies and products (such as the
quality of medicines and technologies);
3. determinants of health (such as nutrition and tobacco-
use); and
4. effective support for Member States (such as increasing
investment in knowledge management and information
technology and ensuring staff security).
12/16/2015 148

Estimated expenditure
 Essential health interventions (53 %)
 Effective support for Member States
(21 %)
 Health policies, systems and products
(13 %)
 Determinants of health (11 %)
12/16/2015 149

World bank: Loan
12/16/2015 150

Introduction
 Conceived in 1944 to reconstruct war-torn
Europe, the world Bank has evolved into
one of the world’s largest sources of
developmental assistance, with a mission
of fighting poverty with passion by
helping people help themselves.
 A vital source of financial and technical
assistance for developing countries around
the world.
12/16/2015 151

Objectives
 To fight poverty with passion and professionalism
for lasting results. To help people help themselves
and their environment by providing resources,
sharing knowledge, building capacity, and forging
partnership in the public and private sectors.
 To promote sustainable private sector investment
in developing countries, helping to reduce poverty
and improve people’s lives.
 To promote foreign direct investment into
developing countries to help support economic
growth, reduce poverty, and improve people’s
lives.
12/16/2015 152

The world bank group consists of
 The International Bank for Reconstruction
for Development(IBRD) .
 The international Development
Association (IDA).
 The international Finance Cooperation
(IFC)
 The Multilateral Investment Guarantee
Agency(MIGA).
 The International Centre for Settlement of
Investment Disputes (ICSID).
12/16/2015 153

The World Bank Group is involved
in
 Agriculture and Rural Development
 Aid Effectiveness
 Combating Corruption
 Conflict Prevention and reconstruction
 Debt relief
 Economic research and data
 Education
 Empowerment and participation
12/16/2015 154

CONT…….
 Energy and mining
 Environment
 Financial sector
 Gender
 Globalization
 Governance
 Health, nutrition and population
 Indigenous peoples
12/16/2015 155

Cont..
 Information and communication technologies infrastructures
 Labor and social protection
 Law, regulation, and judiciary
 Manufacturing and services
 Poverty
 Private sector development
 Social development
 Sustainable development
 Trade
 Transport
 Urban development
 water
12/16/2015 156

However world bank is
 The world's largest funder of education
 The world’s largest external funder of the
fight against HIV/AIDS
 A leader in the fight against corruption world
wide
 A strong supporter in debt relief
 The largest international financier of
biodiversity project
 The largest international financier of water
supply and sanitation projects
12/16/2015 157

Funding policies
Offers two basic types of funding
instruments
1) Investment Loan
2) Development policy Loan
World Bank provides fund to a member
country depending on it’s eligibility
through either IBRD or IDA
12/16/2015 158

Understanding
the Project
Cycle
Country
Assistant
Strategies
Project
Identification
Preparation
Appraisal
Approval
Implementation
and supervision
Implementation
Completion
Evaluation
Lending operation are developed in the “
World Bank Project Cycle”
12/16/2015 159

Involvement of World Bank in
Nepal
 Health 50 million
 Peace Project 50 million
 Water 27 million
 Rural Poor People Support 253 million
 Second Higher Education Project 80 million
 Nepal Combats Avian Influenza 18 million
 Poverty Alleviation Fund 25 million
 Economic reforms 3 million
12/16/2015 160

Roles and contributions
 To provide low-interest loans, interest-free credit
and grants to developing countries for education,
health, infrastructure, communications and many
other purposes.
 Efforts are coordinated with wide range of
partners, including government agencies, civil
society organization other aid agencies and the
private sector.
 The Bank group’s work focuses on the
achievement of the millennium development goals.
 To address issues related to gender, community
development, indigenous people.
12/16/2015 161

UNICEF IN NEPAL 2008-2010
 UNICEF celebrated 40 years of work in Nepal
in 2008
 UNICEF’s three year programme(2008-2010)
are aligned with the Interim plan to help achieve
the development goals stated within it.
 The 2008-2010 programmed is focused on the
poorest and most excluded, including young
people impacted by the conflict.
12/16/2015 163

Prioritization
 One approach – six programmes in Nepal
 DACAW(decentralised action for children and
women)
 Child protection
 Education
 Health and nutrition
 HIV/AIDS
 Wash
 Social policy
12/16/2015 164

DACAW
 This approach is UNICEF’S PRIMARY Vehicle
for directing a range of interventions to rural
communities across Nepal
 It aims to strengthen the capacity of individuals
and communities
 Ministry of local Development is the lead
implementing agency, along with other
ministries
 Focus on the most disadvantaged communities
in 23 of the75 districts in Nepal
12/16/2015 165

Child protection
 Child protection systems eg.village and
district paralegal committees
 Children affected by Armed conflict
 Legislation and policies for child
protection
12/16/2015 166

Education
 Early childhood development
 Formal primary education
 Non formal primary education
 Peace education and emergency education
12/16/2015 167

Health and Nutrition
 Child survival
 Maternal health
 Nutrition
 National health sector support
12/16/2015 168

HIV/AIDS
 Prevention of mother to child transmission
 Paediatric HIV/AIDS treatment
 Adolescent HIV/AIDS prevention
 Protection and care for children affected
by HIV/AIDS
12/16/2015 169

WASH
 Quality water supply
 Environmental sanitation and hygiene
 National district level sector support
12/16/2015 170

Social policy
 Policy and institutional support
 Child rights promotion
 Monitoring and evaluation
12/16/2015 171

Roles and contributions of UNICEF
 Strengthening communities through
decentralization in favour of children and
women
 building an environment that protects children
against violence, exploitation and abuse
 Promotion of breast feeding
 The national immunization programme is
supported to achieve universal coverage
 Supplementary campaigns for measles and polio
are carried out nationally
12/16/2015 172

Contd…
 Build the capacity of paralegal committees, women's
federations and child clubs to raise awareness of early
intervention, reconciliation and mediation and advocate
against violence, exploitation and abuse
 Increase access to quality basic education, especially for
girls and disadvantaged group
 Improve maternal health, reduce childhood morbidity
through improved management of childhood illness due
to ARI, diarrhoea and vaccine preventable diseases
 Expanding a newborn health package which include
treatment of severe neonatal infection, birth
asphyxiation,hypothermia
12/16/2015 173

Contd…
 Fifteen emergency obstetric cares services are provided in 8
districts
 Increase skilled attendance at birth in DACAW district
 Vit.A supplements and de-worming tablets are provided bi-
annually to 3.4 million children
 Iron supplements for pregnant and breast feeding mothers
 Reduce incidence of diseases from inadequate sanitation
and water supply
 Install sanitary, child friendly toilets, separate for girls and
boys and safe drinking water facilities, in 450 schools
 Student have knowledge and skill to maintain the
cleanliness of sanitation and practice of proper hand
washing, through the formation of child clubs and training
and hygiene campaign
12/16/2015 174

FUNDING POLICY
 The full three year programme is
budgeted at USD 68,214,000
 of which USD 20,214,000 has been
allocated internally
 USD 48,000,000 is required to be raised
from donors over the three years
12/16/2015 175

United Nations Fund for
Population Activities
(UNFPA)
12/16/2015 176

12/16/2015 177
Organisational Background
 UNFPA, the United Nations Population Fund, is an
international development agency that promotes
the right of every woman, man and young people
to enjoy a life of health and equal opportunity.
 UNFPA supports countries in using population
data for policies and programmes to reduce
poverty and to ensure that every pregnancy is
wanted, every birth is safe, every young person is
free of HIV/AIDS, and every girl and woman is
treated with dignity and respect.

12/16/2015 178
Organisational Background
 UNFPA assists developing countries, countries with
economies in transition and other countries on their
request.
 Established in 1969,
 it is currently assisting 140 Countries and is the
largest multilateral source of population assistance.
 UNFPA started its assistance to GoN from early
1970s, has supported implementing five country
programme cycles corresponding to GoN

12/16/2015 179
Area
 Improve Access to Reproductive Health (Implementing
partner Family Health Division/DoHS)
 Strengthen National Training and Management
Capacity (implementing partners- National Health
Training Centre and Management Division)
 Increasing Awareness on RH and Gender Issues
(Implementing partner National Health Education,
Information and Communication Centre)
 Besides the Country Programme other projects being
supported by UNFPA is : Parenthood Project in
partnership with Rotary Club through Hospital and
Rehabilitation Centre for Disabled Children (HRDC).

12/16/2015 180
Strategies
 UNFPA support to Nepal is designed to complement the
activities of other providers of RH care and most importantly
those of Government of Nepal in line with the Nepal Health
Sector Programme Implementation Plan (NHSP-IP) and is
also designed to have a catalytic and synergetic role in
improving RH and in exploring and developing innovative
approaches.
 A key strategy of UNFPA is to assist DoHS to develop its
human resource needs and capacity both for delivery of
quality RH services and management of RH programmes.
UNFPA is considering to contribute to the pool fund of the
Nepal Health Sector Strategy.

United Nation Development
Programme (UNDP)
12/16/2015 181

Introduction
 UNDP is the UN's global development
network, an organization advocating for
change and connecting countries to
knowledge, experience and resources to
help people build a better life.
 It is on the ground in 166 countries,
working with them on their own solutions
to global and national development
challenges.
12/16/2015 182

 World leaders have pledged to achieve the
Millenium Development goals, including the
overarching goal of reducing poverty in half by
2015. UNDP's network links and coordinates
global and national efforts to reach these Goals.
 UNDP focus is helping countries build and share
solutions to the challenges of:
 Democratic Governance
 Poverty Reduction
 Crisis Prevention and Recovery
 Energy and Environment
 HIV/AIDS
12/16/2015 183

UNDP in Nepal
 UNDP first established its office in Nepal in
1963 to support the Nepalese in their struggle
against poverty.
 Since 1963, UNDP has worked at building
linkages that address effective design and
implementation of 'poverty alleviation'
programmes in Nepal.
12/16/2015 184

Geographical focus
 UNDP's activities span almost 75 districts
and 1,000 out of 4,000 villages.
 The number of projects ranged from 25 and
currently consolidated into 16. Some of
them are being closed by mid 2008 with the
completion of past cooperation.
 However, about 10 new programmes are
expected to be formulated in line with the
newly approved Country Programme
12/16/2015 185

Current Programme priorities
 Transitional Governance
 Inclusive Growth & Sustainable
Livelihood
 Peace Building and Recovery
 Energy, Environment and Natural Disaster
Management
 HIV/AIDS
12/16/2015 186

Type of assistance and programming
 The Country Cooperation Framework (CCF-I, 1997-2001) for
Nepal was designed in consistence with the Government's
Ninth Development Plan (1997-2001) and UNDP's mandate.
 UNDP's Country Cooperation Framework (CCF II, 2002-2007)
has completed its programming cycle of six years which
addressed poverty alleviation by supporting development
projects in the areas of Democratic Governance, Pro-Poor
policies and Sustainable Livelihood, Energy, Environment and
Natural Disaster Management, Crisis Prevention and Recovery
(CPR) and Responding to HIV/AIDS.
 In early 2008, UNDP approved its Country Programme
Document (CPD) for 2008-2010 in support of the Interim
Development Plan of the Government of Nepal

12/16/2015 187

Resources
 UNDP is funded from its own regular resources, other
United Nations sources of financing, and from bilateral
and other external donors.
 During the period of 2002-2007, UNDP's assistance
reached to $US 84 million including the resources
mobilized from bilateral donors.
 For the current Country Programme Action Plan (CPAP)
period of 2008-2010, UNDP together with its donor
partners expects to provide assistance worth of US$94.0
million.
 Of this $25 million is expected to be from UNDP's regular
source.
12/16/2015 188

Resources …
 Of the total programme delivery of US$
27 million through the 33 ongoing
projects in 2007, 32 percent was from
UNDP resources, 18 per cent from
Global Fund for AIDS, Tuberculosis and
Malaria (GFATM), Global Environment
Facility (GEF), UN Peace Fund and
other Thematic Trust Funds, 2 percent
from United Nations Capital
Development Fund (UNCDF) and 48
percent from bilateral donors
12/16/2015 189

SAARC South Asian Association for
Regional Development
The economic and geographic organisation
of eight countries
SAARC provides its charter, summit
declaration, activities, events and
publication for the socio-economic
development of member countries
Nepal has embarked on a NPR 180 million
plan to renovate and beautify the capital
for the upcoming 18th SAARC summit
12/16/2015 190

Asian Development Bank (ADB)
Fighting poverty in ASIA and the
pacific
 Nepal has made notable socioeconomic
progress over the years, particularly in the
areas of poverty incidence, and meeting a
majority of the MDGs Which are likely to
be met by 2015.
 ADB’s country partnership strategy, 2013-
2017 supports the government’s
development objective of acclerated and
inclusive economic growth.
12/16/2015 191

Contd …
 It seeks to address the infrastructure
bottlenecks in the areas of
 Energy
 Air
 Road and transport
 Water supply and sanitation and irrigation
 Business
 Employment opportunities
12/16/2015 192

Areas of cooperation
 Agriculture and rural
 Biotechnology
 Culture
 Economic trade
 Education
 Energy
 Environment
 Finance
 Information, communication and media
 Poverty alleviation
 Science and technology
 Security aspects
 Social development
 Tourism
12/16/2015 193

Bilateral partners
 USAID,
 GIZ, German Technical Cooperation (GTZ)
 DFID,
 SDC
12/16/2015 194

USAID
In September 1997, the United States Agency for
International Development (USAID) signed a
bilateral Strategic Objective (SO) Agreement with
HMG for a five-year period (1997-2002). Our
programme includes activities not only with the
MOH but also with the NGO and private sectors.
The SO agreement focuses on four major sectors,
including:
 family planning (FP);
 maternal and child health (MCH);
 prevention and control of HIV/AIDS/STIs; and
 control of infectious diseases.
12/16/2015 195

GTZ: Primary Health Care
Project (PHCP)
Since 1994, the Primary Health Care Project (PHCP) has
been supporting His Majesty’s Government of Nepal,
Ministry of Health in the implementation of the National
Health Policy adopted in 1991, which stresses
improving primary health care services in the country.
In order to improve the health situation, especially of rural
communities, the National Health Policy emphasises
community participation, decentralisation, integration of
traditional health care providers, establishment of health
facilities at the community level, development and
management of health manpower, promotion of private,
non-government and intersectoral co-ordination and
resource mobilisation.
12/16/2015 196

Achievements
1. Developing a District Health System
 Community participation in health planning and renovation of
health facilities
 Street Drama training to increase health awareness
2. Developing Managerial Capacity
 Development of the Human Resource Development Information
System (HuRDIS)
 Integration of gender-disaggregated data into the Management
Information System
3. Improving the Quality of Training
 Development of an operational plan for the National Health
Training Centre (NHTC)
 Functional analysis of the National Health Training Centre (NHTC)
4. PHCP and the future
12/16/2015 197

DEPARTMENT FOR INTERNATIONAL
DEVELOPMENT (DFID)
The Department for International
Development (DFID)’s aim is the
elimination of poverty in poorer countries.
Specific objectives include:
a) policies and actions which promote
sustainable livelihoods;
b) better education, health and opportunities
for poor people; and
c) protection and better management of the
natural and physical environment.
12/16/2015 198

Roles and contributions
 DFID has contributed to continuing increases in
contraceptive prevalence.
 Its contribution is flexible and not tied to any
particular commodity, helping to reduce stock-
outs.
 In Safer Motherhood, on-site whole-team
training has been completed in some areas
(infection control), appropriate referral rates are
increasing, the increasing access component is
making progress on reducing barriers to access,
and physical improvements work has started.
 District Health Strengthening
12/16/2015 199

SWISS AGENCY FOR DEVELOPMENT AND
COOPERATION (SDC)
 The Rural Health Development Project (RHDP) is
a bilateral project of Government of Nepal and the
Swiss Agency for Development and Cooperation.
 The overall goal of the project is to contribute to
improving the health status of women, girls, boys
and men through participatory development of a
locally adapted and affordable health system.
 The primary objective of the project is to
empower women, girls, boys and men to enhance
their health conditions and have access to
improved comprehensive health services at the
local level.
12/16/2015 200

Roles and Contributions
 Promotive Health Activities
 Community Initiatives:
 Strengthening the Local Health System
 Promotion of Drug Scheme
 Skill Development of Health Workers
 Coordination and Alliance-Building
 Integration of Gender Balanced Approach
 AIDS Awareness
 Reactivation of Jiri Hospital
12/16/2015 201

Other health-related international organizations
in health promotion and disease prevention
programs in Nepal
United mission to nepal (UMN)
Save the children fund (UK, japan, etc)
Netherlands leprosy relief (NLR)
Cooperative for assistance and relief everywhere
(care)
Britain Nepal Medical Trust (BNMT)
NOREC
AHF
NORAD, etc
12/16/2015 202

Nepali organisation
 AAMAA Milan Kendra (Mothers Club)
 Nepal CRS Company
 Family Planning Association Of Nepal
(FPAN)
 Nepal Red Cross Society
 New Era
 Public Health Research Society Nepal, etc
12/16/2015 203

FAMILY PLANNING ASSOCIATION
OF NEPAL (FPAN)
 The Family Planning Association of Nepal
(FPAN) came into existence in 1959. Beginning
with three districts in its early years, today it
covers 42 of Nepal's 75 districts.
 Given its extensive coverage, innovative
programmes and its ability to provide
comprehensive RH/FP services, the Association is
regarded as the leading NGO working in
reproductive health.
 FPAN acquired joint membership of the
International Planned Parenthood Federation
(IPPF) in 1960 and full-fledged membership in
1969.
12/16/2015 204

STRATEGIES
 To provide FP services based on informed choice,
with particular emphasis on spacing methods, as
well as to provide basic mother and child health
services for safe motherhood and child survival.
 To strengthen advocacy for increasing
governmental and public awareness
 To develop and implement an information,
education and motivation (IEM)
 To develop and implement a continuing
programme of orientation and training for various
categories of volunteers and staff of the
Association
12/16/2015 205

4.10 Introduction to International Non-
Governmental Organizations
12/16/2015 206

Intergovernmental Organization IGO
Non-governmental Organization NGO
• established by treaty
• is a legal entity w/ int’l legal status - can enter into
treaties
• probably has a legislative body (of gov’t
representatives)
• may have a dispute resolution body
• may have an executive body (secretariat)
• no international legal status
• non-governmental representatives
• may serve consultative role to IGOs
• some are very influential

• facilitating and participating in treaty
making
• producing soft law via non-treaty
obligations from resolutions,
declarations, etc.
IGOs play a role in creating international
law:

National - International
 These nation-state developments contrast with
what seems to be happening at the global,
transnational level
Rise of NGOs in humanitarian assistance,
development etc and the crisis of
multilateralism—is this pointing to a shift in
international relations away from nation states
as actors and constituting element of
multilateralism? Are we witnessing the
emergence of a new international welfare
system based on private actors?

Growth of International NGO
Figure 8.1: Growth in international organisations: 1900-2000
(all active organisations)
0
5,000
10,000
15,000
20,000
25,000
30,000
1900
1906
1912
1918
1924
1930
1936
1942
1948
1954
1960
1966
1972
1978
1984
1990
1996
Source: Union of International Associations
Number
of
organisations
1975

More specifically…
What does the significant expansion of NGOs at
international level signify, mean?
1. ‘Filling a void’ or ‘pushing open space’
2. Greater numbers = greater complexity?
3. Quantitative expansion and qualitative change?
4. Beginning of more fundamental shift in
organizational form? Something new?
5. Emergence of new power relations, policy
regimes at global level? Something different?

So, what does it mean, then…?
1. ‘Filling a void’ or ‘pushing open space’ Both,
but increasingly more filling than pushing
around transnational goods, problems.
2. Greater numbers implies greater complexity –
quantitative expansion, qualitative change?
Both, but the latter is really what’s important
now.
3. Beginning of more fundamental shift in
organizational form? Yes, much innovation.
4. Emergence of new power relations, policy
regimes at global level? Complicated…but
rather likely, and full of uncertainty…

4.11 Influence of international health
movements and international health actors
in national public health service and
medical care systems: An overview of
strengths and limitations
12/16/2015 215

The Public health movement (PHM)
https://phmovement.org/
The PHM is a global network bringing together
grassroots health activists, civil society organizations
and academic institutions from around the world,
particularly from low and middle income countries
(L&MIC).
Currently have a presence in around 70 countries.
Guided by the People’s Charter for Health (PCH),
PHM works on various programmes and activities
and is committed to Comprehensive Primary Health
Care and addressing the Social, Environmental and
Economic Determinants of Health.
12/16/2015 216

Founding networks and organizations of the
People’s Health Movement
 International People’ Health Council (IPHC) which was a
coalition of grassroot health movements that had evolved out of
situations of popular struggle (including South Africa, Nicaragua,
Palestine, Bangladesh).
 Consumers International (CI) is a large network of 250 members
organization in 120 countries which seeks to achieve changes in
government policy and corporate behavior while raising awareness
of consumer rights and responsibilities.
 Health Action International (HAI) lobbies governments and
international bodies (such as WHO) to formulate codes, pass
resolutions and develop policies to ensure that people who need
them have access to safe, appropriate and affordable medicines and
these are used rationally. It monitors unethical behavior of industry
including the selling and promotional practices of drug companies.
12/16/2015 217

Contd ..
Third World Network (TWN) is a transnational alternative policy group and
international network of organizations that produce and disseminate analysis,
proposals and information tools related to ecological sustainability, development
and North – South relations.
Asian Community Health Action Network (Achan) is a network of community
health initiatives and institutions that seek to spread a philosophy of community-
based health care based on self-reliant human development for the oppressed poor.
Women’s Global Network for Reproductive Rights (WGNRR) advocates for
sexual and reproductive health and rights worldwide. Based in the global south,
they work with rights, justice and feminist frameworks and have a consultative
status with Ecosoc.
Dag Hammarskjold Foundation (DHF) was created in 1961 as the Swedish
national memorial to the late Dr. Dag Hammarskjold, Secretary General of the
UN. It plays a catalyst role in promoting innovative ideas, debates on
development, security and democracy and supported the People’s Health
Assembly preparatory process and its organization.
Gonoshasthaya Kendra (GK) is a community health development program in
Bangladesh, which began during the war for national independence. GK hosted the
first global People Health Assembly on their rural campus at Savar, Bangladesh.
12/16/2015 218

Health For All Campaign through
Thematic Areas
12/16/2015 219

4.12 Globalization and affect on
public health:
a. Globalization and food-nutrition
b. Globalization and emerging infectious globalization of
pharmaceutical industries and health and medical care
dilemmas diseases
c. International capital economy (privatization) and its
economy on public health actions and intervention
12/16/2015 220

Cross border disease like HIV AIDS, Malaria, polio, TB, Swine flu, Bird flu
etc and their impact in health system
 Global risks for health
 Public health crisis in developing countries
 Emerging infections
 Cross-Border Health Risks
 Cross border delivery of services
 Positive impacts of Cross border disease in health system
 Negative impacts of Cross border disease in health system
Global Health Issues; Bioterrorism, World Bank, IMF, Trade Related
Intellectual Property Rights and Health
 Definition of Global Health Issues
 History of Global Health Issues
 Trends of Global Health Issues
 Recent global health issues
 Advantages of Global Health
11/06/2014 Ashok Pandey
22
1

First, Second & Third Worlds
Industrialized countries where businesses operate independently of
governments North America, Western Europe, Japan and Australia
Communist countries, where governments plan the economies.
Russia, Eastern Europe (e.g., Poland), China
Poor, less developed countries, where businesses operate
independently of governments. capitalist (e.g., Venezuela) and
communist (e.g., North Korea, Saudi Arabia, Mali)
22
2

Developed and Developing
 Countries like Canada, the USA, Britain and Japan are regarded
as developed because of their industrialized and diverse
economies.
 Countries like Indonesia and Egypt are regarded as developing or
less developed (LDC’s).
 The world’s least developed countries, which often lack resources
– like Chad or Laos – are often described as least less developed
(LLDC’s).
22
3

Health Gap (2010)
Indicator Least dev.
countries
Developing
countries
Developed
countries
Life expectancy at birth 59 68 80
IMR 71 44 5
U5MR 110 63 6
MMR 410 53 14
Dr. pop ratio(10,000) 4 24 28
Nurse pop ratio (10,000) 10 40 81
Access to safe water %
population
65 93 100
Access to adequate sanitation
% population
37 73 100
22
4

World Ranking of health system
22
5

Very high human development
Rank Country HDI
1 Norway 0.955
2 Australia 0.938
3 United States 0.937
4 Netherlands 0.921
5 Germany 0.920
157 Nepal 0.463
UN, Human Development Report14 March 2013
22
6

The WHO South East Asia Region has 11 Member States
Rank Country HDI
12 South Korea 0.909
92 Sri Lanka 0.715
103 Thailand 0.690
104 Maldives 0.688
121 Indonesia 0.629
134 Timor Leste 0.576
136 India 0.554
140 Bhutan 0.538
146 Bangladesh 0.515
149 Burma 0.498
157 Nepal 0.463
UN, Human Development Report14 March 2013
22
7

Human Development Index
22
8

Literacy Rate
22
9

Life Expectancy
23
0

Global public health
Global health is the health of populations in a global context; it has been
defined as "the area of study, research and practice that places a priority on
improving health and achieving equity in health for all people worldwide".
Problems that transcend national borders or have a global political and
economic impact are often emphasized. Thus, global health is about
worldwide health improvement, reduction of disparities, and protection
against global threats that disregard national borders.
Global health is not to be confused with international health, which is
defined as the branch of public health focusing on developing nations and
foreign aid efforts by industrialized countries.
23
1

Global Health refers to
those health issues which
transcend national
boundaries and
governments and call for
actions on the global forces
and global flows that
determine the health of
people. (Kickbusch 2006)
 Global health and public
health are
indistinguishable.
(Frenk 2011)
Ashok Pandey
local
global
national
Global Health
11/06/2014
23
2

233
World Poverty Today
Among 8+ billion human beings, about
868 million are chronically undernourished (FAO 2012),
2000 million lack access to essential medicines
(www.fic.nih.gov/about/plan/exec_summary.htm),
783 million lack safe drinking water (MDG Report 2012, p. 52),
1600 million lack adequate shelter (UN Special Rapporteur 2005),
1600 million lack electricity (UN Habitat, “Urban Energy”),
2500 million lack adequate sanitation (MDG Report 2012, p. 5),
796 million adults are illiterate (www.uis.unesco.org),
218 million children (aged 5 to 17) do wage work outside their household —
often under slavery-like and hazardous conditions: as soldiers, prostitutes or
domestic servants, or in agriculture, construction, textile or carpet production.
ILO: The End of Child Labour, Within Reach, 2006, pp. 9, 11, 17-18.
23
3

234
At Least a Third of Human Deaths
— some 18 (out of 57) million per year or 50,000 daily — are due
to poverty-related causes, in thousands:
diarrhea (2163) and malnutrition (487),
perinatal (3180) and maternal conditions (527),
childhood diseases (847 — half measles),
tuberculosis (1464), meningitis (340), hepatitis (159),
malaria (889) and other tropical diseases (152),
respiratory infections (4259 — mainly pneumonia),
HIV/AIDS (2040), sexually transmitted diseases (128).
WHO: World Health Organization, Global Burden of Disease: 2004 Update, Geneva
2008, Table A1, pp. 54-59.

 Activities within the health sector that address normative health
issues, global disease outbreaks and pandemics as well as
international agreements and cooperation regarding non-
communicable diseases;
 Commitment to health in the context of development assistance
and poverty reduction;
 Policy initiatives in other sectors – such as foreign policy and
trade
Global public health contd…
23
5

Key action areas for a global
public health
 Health as a global public good
 Health as a key component of global security
 Strengthen global health governance for
interdependence
 Health as a key factor of sound business
 Practice and social responsibility
 Ethical principle of health as global citizenship.
23
6

1st World success of public health
 Changes of developed societies: health societies
 a high life expectancy and ageing populations,
 an expansive health and medical care system,
 a rapidly growing private health market,
 health as a dominant theme in social and political
discourse and
 health as a major personal goal in life.
 Post-modern health societies of the developed world
stand in stark contrast to the situation in the poorest
countries.
23
7

Situation in the poor countries
 A falling life expectancy in many African countries;
 A lack of access to even the most basic services;
 An excess of personal expenditures for health of the poorest;
 Health as a neglected arena of national and development politics;
 Health as a matter of survival.
 Predominant pattern is still infectious diseases engendered by the
natural environment (malaria, tuberculosis and infant diarrhoea), as
well as AIDS and high rates of maternal deaths.
 Non communicable diseases are also beginning to plague these
regions
23
8

Some of the most important problems in
global health today
There are three broad cause groups of health
problems that, collectively, constitute the
world's total disease burden.
 Group 1: communicable, maternal,
perinatal and nutritional conditions;
 Group 2: non communicable diseases;
 Group 3: injuries.
23
9

15 leading individual GH
problems
1.lower respiratory
infections
6.cerebrovascular
disease;
(11) malaria;
2.diarrhoeal diseases 7.tuberculosis; (12) COPD;
3.conditions during the
perinatal period;
8.measles; (13) falls;
4.unipolar major
depression;
(9) road traffic
accidents;
(14) iron-
deficiency
5.ischemic heart disease (10)congenital
anomalies;
(15) anaemia
24
0

Other problems
 Non communicable diseases are the most widespread
diseases.
 We need to work together to share our knowledge about
these conditions for prevention and cure.
 Although many international programs and initiatives
target problems like AIDS, Malaria, TB, etc, chronic
disease becomes a major threat to human health as the
countries move through the epidemiologic transition.
24
1

Ashok Pandey 242
Brief History of the International
Health Regulations (IHR)
1851: first International Sanitary Conference, Paris
1951: first International Sanitary Regulations
(ISR) adopted by WHO member states
1969: ISR replaced and renamed the
International Health Regulations (IHR)
1995: call for Revision of IHR
2005: IHR (2005) adopted by the
World Health Assembly
2006: World Health Assembly vote that IHR (2005) will enter into
force in June 2007
11/06/2014

 To prevent, protect against control and
provide a public health response to the
international spread of disease in ways
that are commensurate with and restricted
to public health risks, and which avoid
unnecessary interference with
international traffic.
Ashok Pandey 24311/06/2014

Ashok Pandey 244
The purpose and scope of IHR
 To prevent, protect against, control and
provide a public health response to the
international spread of disease
 To establish a single code of procedures
and practices for routine public health
measures
11/06/2014

IHR (2005)
 The International Health Regulations are a
formal code of conduct for public health
emergencies of international concern.
 They're a matter of responsible
citizenship and collective protection.
 They involve all 193 World Health
Organization member countries.
24
5

IHR (2005)
 They are an international agreement that gives rise to
international obligations. They focus on serious public
health threats with potential to spread beyond a country's
border to other parts of the world.
 Such events are defined as public health emergencies of
international concern, or PHEIC. The revised
International Health Regulations outline the assessment,
the management and the information sharing for
PHEICs.
24
6

IHR (2005)
 IHRs serve a common interest.
 First of all, they address serious and unusual disease
events that are inevitable in our world today.
 They serve a common interest by recognizing that a
health threat in one part of the world can threaten health
anywhere, or everywhere.
 And they are a formal code of conduct that helps contain
or prevent serious risks to public health, while
discouraging unnecessary or excessive traffic or trade
restrictions for, quote, "public health," purposes.
24
7

Why have IHR?
 Serious and unusual disease
events are inevitable
 Globalisation - problem in one
location is everybody’s headache
 An agreed International Public
Health code of conduct for a global
approach
24
8

-ve Impact
 These emerging diseases represent a
significant cause of suffering and death,
and impose an enormous financial burden
on society.
 resistant to drug
 update our health threats legislation
 Public health emergencies
of international concern
24
9

+ve impact
 to strengthen preparedness planning
 to improve risk assessment and management of cross-border health
threats
 to establish the necessary arrangements for the development and
implementation of a joint procurement of medical countermeasures
vaccines and medicines
 to enhance the coordination of response at EU level by providing a
solid legal mandate to the Health Security Committee
Health Security Committee
25
0

THANK YOU
25
1

12/16/2015 252
Globalization and emerging infectious globalization of pharmaceutical
industries and health and medical care dilemmas diseases
Promotion of good clinical practice and the
development of national guidelines are
advocated. Government and industry both
have a role to play to maintain the right
balance.

THE WORLD OF MEDICINE
• Chinese medicine, established more than 5000 years ago, is the oldest,
encompasses many different practices including acupuncture and herbal
remedies, is rooted in the ancient philosophy of Taoism and life energy
(known as qi), and is currently practiced together with Western
medicine.
• Japanese medicine (Kampo) spun off from the Chinese system in the 7th
century, was developed through empirical trials of herbal medicine and
employs more than 140 standardized, regulated, ancient multiherb
formulas that are widely prescribed and covered by Japan's national
healthcare system.
• Tibetan medicine, a blend of many traditions involving the use of herbal
remedies, is not officially recognized as a health system but nonetheless
is widely practiced from Asia to the Middle East and increasingly in the
United States and Europe;
• Korean medicine (Koryo) evolved using Chinese medical concepts,
encompasses an exceptionally rich flora, and is practiced together with
Western medicine and researched for scientific validations today.
12/16/2015 253

THE WORLD OF MEDICINE
• Bhutanese medicine (gSo-ba-rig-pa), another ancient tradition
with roots in Buddhism and Tibetan traditional medicine,
utilizes 3000 species of plants and is practiced in tandem with
modern medicine6,7;
• Ayurveda in India is based on a strong belief in life energy,
uses 2000 plant species, and was founded on the concept that
a single consciousness connects everything in the universe8;
• Siddha, also practiced in India and similarly based on
imbalance of doshas or humors, uses an elaborate and unique
diagnostic technique and is integrated into the national health
care system7; and
• Unani, a Muslim-Hindu hybrid primarily influenced by
Greek, Persian, and Islamic medicine, uses a variety of diets
and drugs and is also part of the national health care systems
of Greece, Iran, and India
12/16/2015 254

Millions of people die from preventable or curable
diseases every week. But there is no market in the sense
that, unlike Viagra, medicines for leishmaniasis are needed
by poor people in poor countries. Pharmaceutical
companies judge that they would not get sufficient return
on research investment, so why, they ask, should they
bother? Their obligation to shareholders, they say,
demands that they put their effort into trying to find cures
for the diseases of affluence and longevity: heart disease,
cancer, Alzheimer’s. Of the thousands of new compounds
drugs companies have brought onto the market in recent
years, less than 1% have been for tropical diseases
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International capital economy (privatization) and its
economy on public health actions and interventions
12/16/2015 256

Privatization can refer to the act of
transferring ownership of specified property
or business operations from a government
organization to a privately owned entity. It
also means the withdrawal of the state from
an industry or sector partially or fully.
Privatization is opening up of an industry
that has been reserved for public sector to
the private sector.
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Aims of Privatisation
 Economic Efficiency: The paramount aim of
privatisation is to increase economic efficiency.
The belief that the private sector, with its profit-
oriented approach, can manage resources more
efficiently and effectively is a central motivation
for privatisation. Through privatisation,
governments seek to promote innovation,
improve service quality, and, in the process,
foster economic growth.
 Reducing Fiscal Burden: By privatising these
enterprises, governments can significantly lower
these costs, directing resources towards other
public needs.
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Aims of Privatisation
 Enhancing Competition: Privatisation is also viewed as a tool to
enhance market competition. By reducing state monopolies and inviting
private participation, markets can become more competitive. This
competition can drive businesses to offer better products and services,
benefiting consumers and the broader economy.
 Attracting Foreign Direct Investment (FDI): Privatisation can be a
viable strategy for attracting foreign direct investment. When
international corporations perceive opportunities in a privatised sector,
they may choose to invest, bringing in not only financial resources but
also global best practices and technological advancements.
 Inducing Market Discipline: Lastly, privatisation aims to induce
market discipline in the economy. In a competitive market, inefficient
firms can't survive for long. This harsh reality pushes privatised entities
to continuously innovate and improve, lest they be edged out by
competitors.
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Advantages of Privatisation
 Increased Efficiency and Productivity
 Enhanced Competition
 Attraction of Foreign Direct Investment
 Reduced Fiscal Burden on Government
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Disadvantages of Privatisation
 Risk of Private Monopolies
 Potential Job Losses
 Social Obligations May Be Ignored
 Economic Disparity
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4.13 Westernization of public health strategies
in the under development countries in the
banner of globalization of health: A critical
review of strengths and weakness
The process of Westernization comes when
non-Western societies come under Western
influence or adopt Western culture in
different areas such as technology, law,
politics, lifestyle, diet, clothing, language,
religion, and values
12/16/2015 266

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