Ancient Period Pre- Unified Period Period of King Prithivi Narayan Shah Dev Rana Period Pre- Planned Period Planned Period 1st long term health plan second long term health plan National health policy 1991 Essential health care service National health sector strategy Millennium development goal Sustainable development goal

1. HISTORY OF DEVELOPMENT OF HEALTH
SYSTEM IN NEPAL
1

2. BACKGROUND
 The history of organization of health system in Nepal
has a long history.
 It has a traditional medical practice with faith healing,
naturopathy, yoga, ayurveda, homeopathy which play a
dominant role in providing health care services
2

3.  Likewise emergence of modern allopathic medicine,
establishment of hospitals and expansion of curative
health services in both public and private sectors.
 Emergence and Expansion of Preventive and Vertical
Health Services
 Integration of preventive and curative health services
3

4. DEVELOPMENT OF HEALTH SYSTEM OVER TIME
 Ancient Period
 Pre- Unified Period
 Period of King Prithivi Narayan Shah Dev
 Rana Period
 Pre- Planned Period
 Planned Period
4

5. ANCIENT PERIOD
 From Ramayana- Hanuman was told to bring the
Sanjeebini Buti from the mountains in the Himalayas
……many herbal medicines were in use then in these
lands
 Lord Buddha (563-477 BC)- said to have attended regularly
to all the sick disciples in his camps
5

6.  His teachings which said “to be born is to suffer, to die is to
suffer, and to fall sick is to suffer” motivated his followers to
look after the sick
 “Lord Buddha in his day enunciated the vinaya or
disciplinary rules for the monks.
6

7.  Ayurveda or “ Science of Life” was found as one of the
oldest system of medicine by WHO
 Arogyashala or Ayurvedic Hospitals existed in Nepal during
the period of Anshu Verma.
 public health policy intervention during this period was
related to safe motherhood and executive order issued by
the ruler
 AmshuVerma who started the system to cut the umbilical
cord immediately after the baby was born, 8

8. PRE- UNIFIED PERIOD (MALLA KING)
 Domain of traditional practices
 Raj Vaidhyas and Raj Gurus were the royal consultants and used to
work in epidemics
 Allopathy was introduced in Nepal with the coming of Christian
Missonaries doctor to treat smallpox, plague in kathmandu valley
during the period of Malla regime by Jay Prakash Malla.
 But no further developments took place in christian missionaries
 Pratap Malla established Ayurvedic Dispensary in hanuman Dhoka
Complex
 Traditional and indigenous system was deep rooted
9

9. PRE- UNIFIED PERIOD (MEDIVAL PERIOD 880-1763 AD)
 King Jayasthiti Malla introduced state-accredited traditional
birth attendants and prepared code of conduct.
 King Jayasthiti Malla issued code of conduct for Baidhyas
and Ayuvedic practitioners.
10

10. PERIOD OF KING PRITHIVI NARAYAN SHAH
 The first reference to the modern system of medicine or to
allopathic practitioners in this country occurs in an account
of the siege of Kirtipur by King Prithvi Narayan Shah in
1766/67
 It was Swarup Ratna, the King’s brother, who had been
cured of a wound by one Michael Angelo, a Capuchin
monk.
11

11. DURING RANA PERIOD
 In the era of 1850s, the major health problems were smallpox, cholera,
malaria, leprosy and postpartum complications which contributed to
significant morbidity and mortality.
 Both Ayurvedic and modern medicines were prevalent but modern
medicines were only for Rana families
 Jung Bahadur was a great believer in vaccination and had the children
of the Royal Household, his nephews and nieces and all his own
children vaccinated against smallpox.
 Dr. H. A. Oldfield was the residency doctor to Jung Bahadur and was
required to make weekly visits to Thapathali Durbar since 1850 (he was
the first doctor of Nepal who got salary from Nepal government)
12

12. SOME LANDMARKS SET BY RANA’S
 Formation of Guthi
 Prithvi Bir Hospital built in 1890 (1947 BS)
 A number of other hospitals were opened in administrative headquarters of a
number of districts at Birgunj, Jaleshwar, Hanumanagar (Rajbiraj), Nepalgunj and
Taulihawa.
 The separate laprosy hospital at Khokana was also further built at that time with a
capacity for 200 inmates
 In 1934 AD, Civil Medical School was established in Kathmandu with an aim to
produce compounders and dressers.
 Sukra Raj Tropical and Infectious Disease Hospital was also initially built in 1890
(1947 BS). It was shifted to its present site at Teku in 1950 (2007 BS).
13

13. OTHERS
 Singha Durbar Vaidhyakhana
 Millitary Hospital
 Malaria Survey
 Lalitpur Hospital
 HMG Hospitals
 Several Ayurvedic dispensaries
 Nepal Rajkiya Ayurvedic Vaidhyakhana
 Civil Medical School
 35 district hospital
 Cholera hospital in Teku
 Tuberculosis Sanatorium in Tokha,
 Malunga Leprosy Sanatorium in Syangja was established.
 Bir Hospital was also divided into Bir male and Bir female hospital to strengthen maternity
services
14

14.  With the advent of democracy in the country, greater
efforts were made and stronger measures taken to provide
basic health facilities to the people.
 Subsequent years saw the opening of more health centres
in different parts of the country.
 Also, HMG Nepal started periodic development plans.
15

15. AFTER DEMOCRACY
 In 1953AD, DoHS was established to carry out the
responsibility of promotion, regulation and management
of hospitals and ayurvedic dispensaries
 In 1954 AD, mission hospital was established in Tansen
under United Mission to Nepal (UMN).
 UMN also established women’s and children’s welfare
clinics in the Kathmandu Valley.
 In 1956 AD, Nepal Malaria Eradication Project was
launched as a vertical project in 1958 AD.
 Several vertical projects were established to control and
prevent Smallpox, Tuberculosis, Leprosy, Nutritional
disorders, and Family Planning and maternal and child
health issues.
16

16. AFTER DEMOCRACY
 In 1956 AD, the government declared to establish
one health centre in all 109 electoral constituencies
and this scheme initiated health services at the sub-
district level and also made policy decision to
establish hospitals in all 35 districts.
 In 1961 AD, the government declared to establish
zonal hospitals in all 14 zones to provide secondary
health care under the new administrative reform.
17

17. AFTER DEMOCRACY
 In the year 1972AD, the Institute of Medicine (IoM)
under the Tribhuvan University, heralded a new
dawn for medical education, allowing students to
train Auxiliary Nurse Midwives and Community
Medical Assistants.
 In 1975AD Institute of Medicine (IoM) started
certificate level of programmes in Nursing, General
Medicine, Health Laboratory, Pharmacy,
Radiotherapy, Physiotherapy, Health Education and
Sanitation.
 Again in 1975AD with the production of HRH
Government of Nepal declared to establish 1462
health posts in phases throughout the country to
deliver basic health services.
18

18. AFTER DEMOCRACY
 In 1978AD, Health training center was started to provide in-service
training to health workers.
 The government initiated actions to create an integrated health system
so as to phase out the then vertical project health programme in
1980AD.
 In 1986, the first regional hospital was established in Pokhara and
continued to establish in other development regions as well.
 In 1956 AD In the same time-period, non-government hospitals were
established to provide eye services in different parts of the country.
 In 1988AD, Mother’s group and Female Community Health Volunteer
Programme was initiated.1
19

19. AFTER DEMOCRACY
 In 1991AD, the first National Health Policy approved
with the aim to establish one modern health care health
facility (PHC or HP) in all 4000 municipalities or village
development committees.
 In 1993AD, National health training center was
established along with five regional health training
centers
 Again in 1993AD government established district health
offices in all 75 districts and 5 regional health
directorates.
 Integrated health management information system
(HMIS) was initiated in 1994AD.
 In 1996AD, BP Memorial Cancer Hospital was
established.
 In 2017AD, the comprehensive devolution of basic
health services to municipalities was done
20

20. EXISTING HEALTH SYSTEM CONSISTS OF THE
FOLLOWING
 Allopathic/ Modern system of medicine
 Ayurvedic system of medicine
 Homeopathic system of medicine
 Unani system of medicine
 Besides these, acupuncture, naturopathy, yoga etc
 In Nepal, various forms of traditional healing exists which
includes Dhami, Jhankri, Lama etc
21

21. HEALTH CARE DELIVERY SYSTEM IN NEPAL
 Traditional Medicine
 With System
 Without System
 With System
Ayurvedic, Homeopathy, Unani, Naturopathy
 Without system
Dhami, Jhankri, Sudeni, Jharphuke, Amchi
22

22.  Modern Medicine
 Public Sector
 Private Sector
 Non Profit Organization
 Profitable Organization
23

23. TRADITIONAL SYSTEM
 It includes diverse health practice approaches, knowledge
and belief incorporating plant, animal and/ or minerals
based medicines, spiritual therapies, manual techniques
and exercises, applied singularly or in combination to
maintain well- being as well as to treat diagnose or
prevent illness. (WHO)
24

24. WITHOUT SYSTEM
 Also known as traditional faith healing system
 It constitutes of almost entire health care systems of local
community
 It’s main objective is to treat the patient and eliminate the
causative agent with no scientific reason
 The system is more or less based on supernatural
causation of disease
25

25.  In general, the failure of home remedy to cure the sick
invites intervention from local community healers.
 They use traditional knowledge and techniques of faith
healing including herbal medicines
 The treatment method also includes praying for gods,
rituals, fasting, sacrifices, witchcrafts, applying various
materials etc
26

26. TRADITIONAL FAITH HEALERS
Dhami
 Mostly from tamang community in rural areas
 Thought to be a god gifted character
 Character can be inherited from the gurus
 They use mantras, herbs and plays drums to treat diseases like
malnutrition, invasion of body by evil spirits etc
 Peacock wings, dumsi’s feather, deer’s skin, dholak and trisul
are their weapons
 Sacrifices of hen and other animals are also demanded during
the treatment process
27

27. JHANKRI
 Easily found in mid hilly region of Nepal
 It is believed to be started from Dhaulagiri zone
 Accidents, stomach diseases like gastritis caused by evil
spirits and ghosts are treated
 Diagnosis is made by taking pulse rate, examining tongue
ear or even by examining the texture of stool and urine
 Treatment by means of jhar phuk, herbs, mantras, jackal/
tiger’s meat, bear’s fat etc
28

28. JHAR PHUKE
 Very common in Nepal
 Very cheap and has been in use to treat health problems
like headache, fever, bile disease, body ache, indigestion,
madness etc
 Mantra, rice, ashes, turmeric powder are commonly used
29

29. LAMA
 Common in Lama Community especially in north
 They are considered as religious body and provide
various health services to treat and stop the spread of
disease
30

30. SUDENI
 Are traditional birth attendants
 Provide reproductive and child health services
 Helps in treatment of stomach ache, back ache,
malnutrition, diarrhea and especially pregnancy
related conditions
 Treatment is carried out by massage, puja etc
31

31. AMCHI
 Is a tibetan medicine or healing practice existing in
the upper himalayan region of the country
 2 types of practioners, some are institutionally
trained and other follow tradition
 They have the concept that body becomes hot and
cold as a result of consuming hot or cold food an
treatment are based on hotness or coldness of the
human body 32

32. OTHERS
 Tantrik
 Gubaju
 Sherpa Gurus
33

33. WITH SYSTEM (TRADITIONAL/ MODERN)
 Allopathic/ Modern system of medicine
 Ayurvedic system of medicine
 Homeopathic system of medicine
 Unani system of medicine
 Besides these, acupuncture, naturopathy, yoga etc
34

34. AYURVEDIC SYSTEM
 Implies “Knowledge of life” and was traced back in vedic
times, about 5000 BC
 According to authorities, medical knowledge in the
Atharva veda (one of the four vedas) gradually developed
into science of Ayurveda
 Ayurveda adopted the physics of five elements called
Panchatatto in Nepali, the elements being earth, water,
fire, air, and sky with which the universe and the human
body are composed of.
35

35. PRINCIPLE OF AYURVEDA
 Based on “tridosha theory of diseases”
 The doshas or humors are:
 Vata (wind): Is related with nervous system
 Pitta (gall): Related with digestive system
 Kapha (mucus): Related with body secretions
 According to “tridosha theory of disease” disease is the
manifestation of disturbances in the equilibrium of three doshas,
when these are in perfect harmony, a person is said to be healthy
36

36. AYURVEDIC SYSTEM IN NEPAL
 Ayurvedic works started in 1935 BS
 Singhadarbar Baidhyakhana was established in Rana
regime
 On 31st Ashadh 2038, Ayurveda was separated from DoHS
and converted into Department of Ayurveda
 The ninth five year plan was committed to implement the
policies prescribed by the National Ayurveda Policy 1996
37

37. PROPOSED PLANS
 There is a policy to take Ayurvedic Hospitals up to the village
level
 Establishment of: 100 dispensaries, 50 health centres, 3
regional hospitals, 5 regional directorates, 1 training centre and
1 herbal garden (one in each region)
 Utilizing locally available herbs and produce herbal medicines
by setting up rural pharmacy in each region
 Also, to convert existing zonal dispensaries into district
ayurveda health centre and set up one ayurvedic dispensary
each amidst five VDC’s
38

38. AYURVEDIC FACILITIES
 50 bed ayurvedic hospital in Nardevi Kathmandu
 15 bed ayurvedic hospital in Belijhundi, Dang
 14 zonal ayurvedic ausadhalayas
 50 district ayurvedic health centres
 211 ayurvedic clinics and
 Tribhuvan University, Nepal sanskrit university and CTEVT are producing
ayurvedic manpowers
39

39. HOMEOPATHIC SYSTEM
 Propounded by: Physician Samuel Christian Hahnemann
Principle:
 Treatment of disease by the use of small amount of drug that, in healthy
persons, produces symptoms similar to those of disease being treated.
 “Law of similar” and “law of minimum dose” exists in homeopathic system
 Law of similar states that similar substance should be given a medicine
which in healthy persons produces symptoms similar to disease being
treated
 There are some successful results in homeopathic researches, however,
controversies regarding that field, as number of key concepts are not
consistent with the current understanding of scientific proofs.
40

40. HOMEOPATHIC SYSTEM IN NEPAL
 Pashupati homeopathic hospital in 2012 (10 bed inpatient
services along with OPD service)
 Homeopathic clinics and dispensaries are being operated
in private sector
 Though policies and plans to expand homeopathic services
from sixth five year plan, it is limited to Pashupati
homeopathic hospital in the government sector till now
41

41. UNANI SYSTEM
 Has extremely limited access to the people
 Unani treatment is available within the homeopathy hospital
 It was originated in GREECE
 The fundamental principle of the unani system recognizes that
disease is a natural process and symptoms of a disease are
body’s reaction to disease
 The unani system of medicine is based on the humoral theory-
which presupposes the presence of four humors…i.e. Dum
(blood), Balgham(phelgm), Safra (yellow bile) and Sauda (black
bile) 42

42. NATUROPATHY
 Diseases cured through the use of air, water, soil,
exercise- yogashan and dieting
 It is believed that in around 100 AD, Nepalese people
practised natural therapy in the form of mud, water and
herbs
 There is no hospital or institute for providing naturopathic
services in public sector
 But more than 2 dozens of private naturopathy hospital
and treatment centres are providing services
43

43. ALLOPATHIC SYSTEM
 Allopathy refers to modern medicine
 Started from ancient Greek
 The greatest physician in Greek medicine was Hippocrates
(460- 370 BC), called the “ Father of Medicine”
 He studied and classified diseases based on observation
and reasoning giving new direction to medical thought
 Allopathy is a method of treating disease, opposite to
homeopathy, with remedies that produce effects different
from those caused by the diseases itself 44

44. ALLOPATHIC SYSTEM IN NEPAL
 Today, allopathic system has been a backbone of the health
care system in Nepal i.e. all levels of health care is based
upon service delivery through allopathic system of health
services
 The first allopathic medical college, Institute of Medicine,
was established later in 1972BS
 Modern allopathic medicine has been tremendously
developing
45

45. PUBLIC HEALTH AFTER 2007 (1950-1990
PERIOD)
 This period can be said to be the transition period in the
health status of Nepalese people. This phase is
characterized by the:
a. Expansion of services
b. Development of human resources for health in the
country
c. Planned development - establishment of Ministry of
Health
d. Last 10 years – beginning of PHC, beginning of
privatization, development of system 46

46. •Pre-Plan Period, 1951-56
•First Five Year Plan, 1956-62
•Second Five Year Plan, 1962-65
•Third Five Year Plan, 1965-70
•Fourth Five Year Plan, 1970-75
•Fifth Five Year Plan, 1975-80
47
PLANS IN CHRONOLOGICAL ORDER

47. PLANS CONTD…
 The First Long Term Health Plan, 1975-1990
 Sixth Five Year Plan, 1980-1985
 Seventh Five Year Plan, 1985-1990
 National Health Policy, 1991
 Eighth Five Year Plan, 1992-1997
 Ninth Five Year Plan, 1997-2002
 Tenth Five Year Plan, 2002-2007
48

48. PLANS CONTD…
 Second Long Term Health Plan (1997-2017)
 Commitment of GON to MDG (2000)
 Three Year Interim Plan( 2007-2010)
 Health Sector Strategy; Agenda for Change (2003)
 NHSP-IP I (2003-2009)
 NHSP-IP II (2010-2015 )
49

49. THE FIRST FIVE YEAR PLAN, 1956-1961
 More emphasis on the curative aspect of health
 In keeping with the expected expansion of the
health services an organization of Ministry of health
was done in 1956
 Additional curative facilities including maternity
hospital (first) built in 1959
 Expansion of health facilities outside Kathmandu
valley
53

50. THE SECOND FIVE YEAR PLAN, 1962-1965
 Emphasis on curative aspect was continued but the
importance of the preventive aspect was accepted
 Survey initiated for smallpox eradication 1962
 Leprosy control pilot project 1963
 Tuberculosis control pilot project 1965
 450 thousand people were vaccinated against small pox
in kathmandu
 3 hospital and 8 health center were added
54
 Major focus on small pox eradication, control of malaria in
Tarai , Leprosy and TB with human resource empowerments
throgh training

51. THE THIRD FIVE YEAR PLAN PERIOD, 1965-1970
 Stress was still on the curative aspects of health but
the importance of the preventive aspect was
accepted
 Stress on prevention led to the establishment of
vertical projects such as:
 Leprosy eradication project 1965
 Smallpox eradication project 1967
 Family planning and maternal and child health
project, 1968
55
 Major focus on small pox eradication, control of malaria in
Tarai , Leprosy and TB with human resource empowerments
through training

52. THE FOURTH FIVE YEAR PLAN PERIOD
1970-1975
 Integrated basic health service piloted from Bara
was started in 1971 and later on Kaski
 Contemplation of first long term health plan
 Community health and integrated division under
MOH was set up
 Maternal child health program was initiated in
1973
56
 Major focus on small pox eradication, control of malaria in
Tarai , Leprosy and TB with human resource empowerments
through training

53. THE FIFTH FIVE YEAR PLAN, 1975-1980
 IOM emphasized to increase health manpower
production to meet the expected increased requirements
because of the expanding health services
 Nepal became signatory of the Alma-Ata conference held
in 1978 and accepted the PHC as being an effective
method by which essential health services were to be
provided to the community in an acceptable and
affordable way, and with their full participation, to attain
HFA by 2000
57
 The major focus on raise on life expectancy through reduction
in death rate , maintain regional balance in provision of health
service and control of population growth

54. THE FIRST LONG TERM HEALTH PLAN (FLTHP), 1975-
1990
 The FLTHP adopted the previous policy of gradual
expansion of basic health care to the major section of
the population living in the rural areas more emphasis
was given to check population growth by popularizing
family planning and maternal and child health
58

55. GENERAL OBJECTIVES OF FIRST LONG TERM
HEALTH PLAN
 To improve the status of physical and mental
health and community health, prepare healthy
manpower for National development
 Gradually provide health services to reduce
morbidity, mortality and improve the life expectancy
of the people .
59

56. POLICIES AND STRATEGIES (FLTHP)
 Provide preventive and general curative care to
96% of people living in rural area
 Reduce population growth rate
 Establish at least one district hospital in each
district.
 Integrate vertical projects
 Study effectiveness of ayurvedic drugs, provide
preventive as well as family planning services from
ayurvedic dispensaries
 Produce health manpower within the country
60

57. FLTHP POLICIES AND STRATEGIES CONTD…
 Organizational change to improve effectiveness of
health services
 Regulate Non Government Organizations and
Mission hospitals and take over and run by
Government of Nepal by 2047
 Gradually establish hospital development and
management committee for ensuring community
involvement .
 Improve environmental health and nutritional status
 Gradually improve drug production and self
sufficiency
 Gradually introduce user fees 61

58. FLTHP PRIORITIES
 Expansion of basic health services in rural, difficult
and backward areas
 Expand FP/MCH services
 Human resource production within the country
 Eradicate malaria, small pox, TB, leprosy
 Intensify nutrition education and environmental
sanitation
 Improve hospital services
62

59. THE SIXTH FIVE YEAR PLAN PERIOD, 1980-1985
 Stress on – increasing food supply
 Clean drinking water
 Sanitation population growth check
 The ultimate aim was to improve the health status of the
people
 The concept of Basic Minimum Needs (BMN) came up
and COMBINA (Child spacing, oral rehydration , maternal
health, breast feeding, immunization, nutrition) as a
Nepalese version of Basic Minimum Health Needs
(BMHN) came up
63
 The major focus on reduction on malnutrition, creation of
healthy environment through promotion of clean drinking
water and sanitation.

60. SEVENTH FIVE YEAR PLAN, 1985-1990
 Organizational integration had been completed .
 A national health information system was being developed
with WHO collaboration and has been functioning since 1988.
 Reporting had been integrated in 27 out of 75 district
 Family planning program as a national health program was
initiated in 1965.
 Five regional health directorate were established.
 Given emphasis on basic minimum health by establishing
hospital, health center and ayurvedic dispensaries to achive
health for all.
64
 The major focus on providing basic health service (preventive
and curative) for maximum people.
 Population control and extend maternal and child health
service

61. NATIONAL HEALTH POLICY, 1991
 The National Health Policy (1991) established a
policy framework to guide health sector
development.
 The objectives of the National Health Policy was
to upgrade the health standards of the majority
of the rural population by strengthening the
primary health care system, making effective
health care services readily available at the local
level. 65

62. NATIONAL HEALTH POLICY 1991
Background:
 High IMR, MMR
 Democratic Movement 1991
 High Political Commitment
Objective:
 Expand health services to the rural people
 Accessibility and availability of primary health
care
 Areas addressed are preventive, promotive and
curative health services 66

63. 1. Preventive and promotive health services;
2. Basic primary health services;
3. Curative health services;
4. Ayurvedic and other traditional health services;
5. Organization and management;
6. Community participation in health services;
7. Human resources for health development;
8. Drug supply;
9. Resource mobilization in health services;
10. Health research;
11. Private, NGO health services and inter-sectoral coordination;
12. Decentralization and regionalization
67
SPECIFIC OBJECTIVES OF NATIONAL
HEALTH POLICY

64. EIGHTH FIVE YEAR PLAN, 1992-1997
 Eighth five year plan should have started in 1990 but it was delayed
because of jana andolan
 The new organogram came into existence as the answer to the
proper functioning and efficient health services delivery
 The four objectives have been synthesized from the health section of
the eighth plan
1. Improve the general health condition of the people in order to
provide health manpower for the country’s development
2. Extend basic and primary health services to improve the health
status of rural population
3. Extend mother and child health servcies & FP to the local level to
make the population control programme more effective and
4. Develop specialized health services in order to people quality
services throughout the country
68

65. ORGANOGRAM 1993
MOH
DOHS
Central level
regional level
Zonal level
District level
PHCC
HP
SHP
DDA DOA
69

66. NINTH FIVE YEAR PLAN 1997- 2002- POVERTY
FOCUS
 Increased number of SHP and PHCC
 Prepared essential drug list for SHP, Hp and PHCC and
distric hospital
 Reproductive health clinical protocol was prepared
 Concept of PPP emphasized
 Human organ transplantation act was prepared
70
 The major focus on preventive, curative and rehabilitative
health service
 Family planning
 uplift health manpower for income generating activities

67. TENTH PLAN (POVERTY REDUCTION STRATEGY
PAPER) 2002-2007
 To reduce the magnitude of poverty among the Nepali
people substantially and sustainably by developing and
mobilizing the healthy human resources.
71

68. TENTH PLAN CONTD...
 Making essential health care services (EHCS)
available to all people
 Establishing decentralised health system (SHP, HP
and PHCC to the local government to increase
community participation
 Special health service to control communicable and
non-communicable diseases
 Establishing Public-private partnership in the
delivery of health care services
 Bottom up approach of planning
 Reproductive health services 72

69. TENTH PLAN CONTD...
Four pillars of poverty reduction strategy:
1. Broad based economic growth
2. Social sector development including human
development
3. Targeted programs including social inclusion (to
bring marginalised, poor, vulnerable, deprived
group into main stream of development)
4. Good governance
73

70. SECOND LONG TERM HEALTH PLAN (1997-
2017)
Objectives
 Improve health status of the people
particularly those whose health needs are
often not met;
 The most vulnerable groups, women and
children, rural population ,the poor, the
under privileged and marginalized
74

71. •Ministry of Health has felt the need of having a perspective health
plan for the coming 20 years to guide health sector development in
response to changing trends in the society.
•The perspective health plan will result in the improved health status
of the population particularly those whose health needs often are
not met: the most vulnerable groups, women and children, the rural
population, the poor, the underprivileged and the marginalised.
75
RATIONALE FOR A NEW SLTHP

72. TARGETS TO BE ACHIEVED BY 2017
 IMR will be reduced to 34 from 75/1000 LB
 U5MR reduced to 62 from 118
 TFR reduced to 3.05 from 4.5
 Life expectancy increased to 68 from 56
 CPR to be increased to 58
 EHCS at District level will be available to 90
percent of population
 Health resource will be increased to 10% of
National budget
76

73. SLTHP-STRATEGIES
 Preventive ,promotive and curative services
 Basic Primary health services
 Decentralization
 Alternative medicine
 Organization and Managements
 Human Resource for Health
 Community Participation
 Resource mobilization
 Intersectoral collaboration
 Decentralization and regionalization
 Blood Transfusion
 Drug supply
 Health research 77

74. SLTHP-IMPORTANT FEATURES
 Perspective Plan
 Provides vision for Health Sector for 20 years
 Strategies for improvement of public sector health
programmes
 Strategies for enhancing efficiency and
effectiveness of health care system
 Offers guidance and support to private and NGO
sector
 Assists EDPs to direct financial and technical
resources to improve Health Situation 78

75. SLTHP- EQUITABLE ACCESS
 Recognizes existing disparities in health status
assuring equitable access by extending quality
essential services with full community participation,
gender sensitivity focusing strategically on the need
of health services for every citizen Which will be
accepted as an important part of human right
79

76. SLTHP-HUMAN RESOURCE
 Appropriate numbers, types and technically
competent and socially responsible health
persons necessary for the provision of
quality health care through the country,
particularly in under served areas
80

77. SLTHP-BEYOND EHCS, PPP AND NGO
PARTICIPATION
 In addition to EHCS, specialist service are to be
extended gradually on a cost effective basis
 To create necessity and to encourage the private
sector and NGO, policy arrangements are made
for strengthening their role in developing health
services infrastructure in the country
81

78. ESSENTIAL HEALTH CARE SERVICES (EHCS)
82

79. ESSENTIAL HEALTH CARE SERVICES (EHCS)
 SLTHP priorities preventive and promotive
services based on PHC approach
 EHCS are priority public health measures and
are essential clinical and curative services for
the appropriate treatment of common diseases
 Set of service package strategically designed to
deliver services to the people at the District
Level and below
83

80. ESSENTIAL HEALTH CARE SERVICES
CONTD...
Rational behind EHCS:
 Availability of limited resources to address all health
care needs of the population
 Cost effectiveness of intervention
 Minimization of operational cost through the
delivery of integrated services
 Focus of available resources by identifying and
defining EHCS at each level of health services 84

81. ESSENTIAL HEALTH CARE SERVICES
CONTD...
Areas are:
1. Appropriate treatment of common diseases and
injuries
2. Reproductive health
3. The expanded programme on immunisation (EPI)
and Hepatitis B vaccine
4. Condom promotion and distribution
5. Leprosy control
6. Tuberculosis control
7. Integrated Management of Childhood Illness
85

82. ESSENTIAL HEALTH CARE SERVICES
CONTD...
8. Nutritional supplementation, enrichment, nutrition education
and rehabilitation
9. Prevention and control of blindness
10. Environmental sanitation
11. School health services
12. Vector borne disease control
13. Oral health services
14. Prevention of deafness
15. Substance abuse, including tobacco and alcohol control
16. Mental health services
17. Accident prevention and rehabilitation
18. Community-based rehabilitation
19. Occupational health
20. Emergency preparedness and management
86

83. 87
THREE YEAR PLAN

84.  To establish the right of the citizen to free basic
health care services.
 Public health issues preventive, promotional and
curative health services will be implemented as per
the principles of primary health services.
THREE YEAR INTERIM PLAN (2007/2008 –
2009/2010)
88

85. THREE YEAR INTERIM PLAN (2007/2008 –
2009/2010) CONTD...
The following policies will be implemented:
1. Special programs will be launched in an integrated manner (by
involving the government, private sector and NGOs) to increase
the citizens' access to basic health services.
2. Special health programs will be launched targeting those
deprived of health care-indigenous nationalities (Adibasi Janajati),
Dalits, people with disability and Madhesi people.
3. Human, financial and physical resources provided by the
government, private sector and NGOs would be managed
effectively for improving the quality of health care services. 89

86. THREE YEAR INTERIM PLAN (2007/2008 –
2009/2010) CONTD...
4. Considering their success, Community Drug
Program and Community Cooperative Clinic services
will be encouraged.
5. Mutual relationship between health science and
medical and public health studies will be
strengthened to make health services effective,
efficient and pro-people.
6. Research in health sector will be encouraged,
promoted and expanded.
90

87. THREE YEAR INTERIM PLAN (2009/10 -
2012/13)
Goal
 The goal of the Plan is to improve the living
standards of all Nepalese people, reduce poverty to
21 percent, and achieve MDGs by 2015 through
sustainable economic growth, generating dignified
and gainful employment opportunities, reducing
economic inequalities, achieving regional balances,
and eliminating social exclusions.
91

88. THREE YEAR INTERIM PLAN (2009/10 -
2012/13)
 The Plan is formulated incorporating health as a
fundamental right of all citizens, MDGs and the
second National Health Strategic Plan (NHSP).
Objective
 To increase the utilization of quality health service
by ensuring availability and accessibility of health
services to the citizens of all class, region and
society.
92

89. 93
FREE ESSENTIAL HEALTH CARE
SERVICES

90.  The Interim Constitution of Nepal 2063 has
emphasized that every citizen shall have the rights
to basic health services free of costs as provided by
the law.
 GON decided to provide EHCS (emergency and
inpatient services) free of charge to poor, destitute,
disabled, senior citizens and FCHVs up to 25
bedded district hospitals and to all citizens in all
PHCCs (16 Nov, 2008) and all citizens at SHP/HP
level (8 Oct, 2007), Make free essential drugs to all
citizens since 14th Jan 2009 94
FREE ESSENTIAL HEALTH CARE SERVICES

91. FREE ESSENTIAL HEALTH CARE SERVICES
 Implemented from 15th Jan 2008, policy is to
provide primary health care services free of cost to
every citizen and special attention, that is, safety
net to poor, vulnerable and marginalized people.
95

92. FREE ESSENTIAL HEALTH CARE SERVICES
OBJECTIVES
 To secure the right of the citizens to the health services
 To increase access of health services especially for the poor, ultra-
poor, destitute, disabled, senior citizens and FCHVs
 To reduce the morbidity and mortality especially of the poor,
marginalized and vulnerable people
 To secure the responsibility of state towards the people's health
services
 To provide quality essential health care services effectively
 To provide equity of health services 96

93. MILLENNIUM DEVELOPMENT GOALS
(MDGS)
 At the millennium summit of September 2000, the
member states of the United Nations adopted the
Millennium Declaration, which aims to bring peace,
security and development to all people.
 The Millennium Development Goals (MDGs), drawn
from the Millennium Declaration, are a ground
breaking international development agenda for the
21st century to which all nations are committed.
97

94. MDGS GOALS
 Goal 1. Eradicate extreme poverty and hunger
 Goal 2. Achieve universal primary education
 Goal 3. Promote gender equality and empower
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 98

95. MDGS TARGETS DIRECTLY RELATE TO HEALTH
 Target 5. Reduce by two-thirds between 1990 and 2015 the under 5
mortality rate
 Target 6. Reduce by three-quarters, between 1990 and 2015, the
maternal mortality ratio
 Target 7. Have halted by 2015 and begun to reverse the spread of
HIV/AIDS
 Target 8. To have halted by 2015 and begun to reverse the incidence
of malaria and other diseases
 Target 9. Integrate the principles of sustainable development into
country policies and programmes and reverse the loss of
environmental resources
 Target 10. Halve by 2015, the population without sustainable access
to safe drinking water and basic sanitations
 Target 17. In cooperation with pharmaceutical companies, provide
access to affordable essential drugs in developing countries 99

96. NEPAL HEALTH SECTOR PROGRAM (NHSP-
IP) 2004-2010
 NHSP is a sector wide program focused on performance
results and health policy reforms implemented under a
sector wide approach with an agreed set of program
performance indicators and policy reform milestones for
the program implementation plan.
 Three outputs for strengthening the health service
delivery:
a. Delivery of EHCS
b. Decentralised management of service
c. Public private partnership
100

97. NHSP-IP I CONTD...
Five outputs for improvement in institutional
capacity and management development:
a. Sector management
b. Health financing and financial management
including alternative financing
c. Physical asset management and procurement
d. Human resource management
e. Health management information system and
quality assurance
101

98. NEPAL HEALTH SECTOR PROGRAM(NHSP-IP II) 2010-
2015
Rational for NHSP-IP II:
 Continue NHSP-IP I
 Increase access and utilization of EHCS
 Address disparities
 Increase domestic financing in health services
 Improve health system & efficiency improvements
 Excellent use of resources
102

99. NHSP-IP II CONTD...
Vision:
To improve the health and nutritional status of the
Nepali population and provide equal opportunity for
all to receive quality health care services free of
charge or affordable there by contributing to poverty
alleviation
103

100. NHSP-IP II CONTD...
Mission:
 Promote the health of Nepal’s people by facilitating
access to and utilisation of
essential health care : emphasising services to
women, children, the poor and excluded, and
changing risky life styles and behaviours of the most
at risk populations through behaviour change and
communication interventions
104

101. NHSP-IP II CONTD...
Value Statement:
 Equitable and quality health care services
 Patient/client centred health services
 Rights based approaches to health planning and
programming
 Culturally and conflict sensitive health services
 Gender sensitive and socially inclusive health
services.
105

102. NHSP-IP II CONTD...
Program and services for NHSP-IP II:
1. EHCS – FP & population, safe motherhood, adolescent
sexual and reproductive health, new born care, child
health, immunisation, IMCI, nutrition, communicable
diseases control, neglected tropical diseases, NCD &
injuries, mental health, eye care & oral health,
environmental health, curative care
108

103. NHSP-IP II CONTD...
2. Humanitarian response, emergency & disaster
management
3. Ayurvedic & alternative medicine
4. Working with non state actor
5. EDP & aid effectiveness
6. Inter sectoral coordination
7. Human resources
8. Physical investment
109

104. NHSP-IP II CONTD...
9. Financial management
10. Procurement
11. Governance & accountability
12. Costs & financing
13. Monitoring & evaluation
110

105. 111
REVITALISING PHC

106. WHY REVITALIZATION OF PHC NOW?
 Governments and Donors committed to attain MDGs and
committed to health sector reforms
 Role of sustainable health system for addressing existing
and new emerging health problems.
112

107. 113

108.  To provide free basic health service to all citizen as stated in
the law
 To ensure easy access of quality health services
 To implement health insurance
 To develop appropriate program and strategies
 To provide health services to urban poor, vulnerable,
marginalized & people with disability
 To implement program ensuring citizens right to clean
environment
 To achieve the Health sector’s MDG by making the delivery of
free health care services effective.
AIM OF REVITALIZATION
114

109. GOVERNMENT ACTIVITIES
Establishment of PHC Revitalization Division
 In 2009, MoHP constituted PHCRD as a new division
under DoHS.
 PHCRD assume the mantle to revitalize PHC in Nepal by
addressing emerging health challenges in close
collaboration with the other DoHS divisions and different
supporting actors.
115

110. PHCRD
Free
Health
Service
Urban
Health
Social
Health
Security
COMPONENTS OF PHCRD
116

111. 117
Source: WHO 2008

112. SUSTAINABLE DEVELOPMENT GOALS
 The Sustainable Development Goals (SDGs) were born at the
United Nations Conference on Sustainable Development in
Rio de Janeiro in 2012.
 The SDGs replace the Millennium Development Goals
(MDGs), which started a global effort in 2000 to tackle the
indignity of poverty.
 For 15 years, the MDGs drove progress in several important
areas: reducing income poverty, providing much needed
access to water and sanitation, driving down child mortality
and drastically improving maternal health.
 They also kick-started a global movement for free primary
education, inspiring countries to invest in their future
generations. Most significantly, the MDGs made huge strides
in combatting HIV/AIDS and other treatable diseases such as
malaria and tuberculosis.
118

113.  The SDGs are a bold commitment to finish what we
started, and tackle some of the more pressing
challenges facing the world today.
 All 17 Goals interconnect, meaning success in one
affects success for others.
 Dealing with the threat of climate change impacts
how we manage our fragile natural resources,
achieving gender equality or better health helps
eradicate poverty, and fostering peace and
inclusive societies will reduce inequalities and help
economies prosper.
 In short, this is the greatest chance we have to
improve life for future generations. 119

114. REFERENCES
 Annual Report, Department of Health Services Government of Nepal,
Ministry of Health and Population, Kathmandu 2066/67
 Dr Hemang Dixit Nepal’s Quest for Health
 Nepal health sector program implementation plan II 2010-2015 Ministry
of Health and Population, Government of Nepal
 http://dohs.gov.np/wp
content/uploads/chd/NHSP/Consolidated_NHSP2_IP.pdf
 http://www.nhssp.org.np/NHSSP_Archives/jar/2015/01NHSP2_result_fra
mework_indicator_february2015.pdf
 https://nepalindata.com/media/resources/bulkuploaded/Primary_health_c
are_revitalisation_nepal_2010_eng_april-17.pdf
 https://www1.undp.org/content/oslo-governance-
centre/en/home/sustainable-development-goals/background.html
 https://www.npc.gov.np/images/category/MDG-Status-Report-2016_.pdf
 https://dohs.gov.np/wp content/uploads/2014/04/NHSP_IP.pdf
 Baburam Marasini.Journal of Nepal medical assoication. View point on
Health System Development in Nepal . 2020;58(221):65-8
120

115. Thank You
121