3. National Health Policy,1991
• The National Health Policy was first adopted in 1991 (2048 BS)
to bring about improvement in the health conditions of the
people of Nepal.
• The primary objectives of health policy was to upgrade the
health standard of the majority of rural population by extending
Basic Primary Health Services up to the village level and to
provide the opportunity to the rural people to enable them to
obtain the benefits of modern medical facilities by making such
facilities accessible to them.
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4. Goals/Targets:
By the year 2000 AD, the following targets will be attained:
1. The infant mortality rate will be reduced to 50 per thousand
from present 107 per thousand.
2. The mortality rate of children below 5 year will be reduced to
70 per thousand from the present 197 per thousand.
3. The total fertility rate will be reduced to 4 from present 5.8
children per women of child bearing age.
4. The maternal mortality rate will be reduced to 4 per thousand
from present 8.5 per thousand live births.
5. The average life expectancy will be raised to 65 years from the
present 53 years.
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5. Components/Health Policies:
1. Preventive health services:
Under these services, priorities will be given to programme that directly help
to reduce infant and child mortality rates. The following main programmes shall be
operated under this services;
a. Family planning and MCH
b. Expanded programme on immunization
c. Safe motherhood
d. Diarrhea and Acute respiratory infection control measures
e. TB control
f. Leprosy control programmes
g. Malaria and Kalaazar control
h. Control and prevention of communicable disease
i. Initiation of prevention of non-communicable diseases
j. Initiation of primary health services in urban slums
k. Prevention of HIV/AIDS
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6. 2. Promotive health services:
These services includes the programmes that enables persons and
communities to live healthy lives such as;
a) HE and information: must be provided in effective manner from central to rural
levels.
b) Nutrition: launch programmes for promotion of breastfeedings, growth
monitoring, prevention of iodine deficiency disorder, iron and vitamin A
deficiency and HE to enable mothers to meet the daily requirements of children
through locally available resources.
c) Environmental health: inform people about personal hygiene, collect and
manage solid wastes, drinking water management and construction of latrines.
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7. 3. Curative health services:
The following curative health services will be made available at central, district and
village levels;
a) Preventive, promotive and curative health services will be made available in an
integrated way in rural areas through sub-health post, health post and primary
health care centers.
b) There will be atleast one hospital in each district of Nepal.
c) zonal hospital will be established gradually in each of zones of the country with
specialized services relating to pediatrics, gynaecology, general surgery, general
medicine, and eye care.
d) One regional hospital will be established in each 5 regions of the country with
hospital specialized services eg. Dermatology, orthopedics and psychiatrics.
e) Central hospital will be equipped with sophisticated diagnostic and other facilities.
f) Specialist services will be provided to remote mountain regions, as and when
required, through mobile teams.
g) A referral system will be developed through which the rural population will be
provided with the opportunities to obtain services from modern well equipped
hospitals, as and when required.
h) Diagnostic services eg. Laboratory, x-ray and other supportive services will be
strengthened in hospital all levels
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8. 4. Basic primary health services:
a) Sub-health post will be established in all VDCs and will employ a village health
worker, one maternal and child health worker and one auxiliary health worker.
b) One health post in the 205 electoral constituencies of the country with the
arrangements of two emergency beds and one maternity bed in these centers.
c) The health posts operating at present will provide all health services in VDCs
where they are located as is done by sub-health posts and will also provide
training for and supervise and monitor activities of sub-health posts.
5. Community participation in health services:
Participation of women volunteers, traditional birth attendants, and local
leaders in various social organizations will be mobilized for health programmes at
the ward levels.
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9. 6. Organizational and management reform:
a) Improvements will be made in the organization and managements of health
facilities at the central, regional and district level.
b) The technical and administrative supervision and follow-up system for health
organizations at various levels will be made more effective.
c) Hospitals and health facilities at different levels will be classified. A detailed info
of services available at the health facilities at different level cost of the services
and list of free services will be prepared and made public.
d) The collection, compilation, recording and reporting system for health information
at each level will be made more effective.
e) Improvements will be made in the transportation and support system for drugs
and equipments at various health facilities.
7. Development and management of health manpower:
a) Capable manpower required for various health facilities will be developed in a
planned manner.
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10. b) Necessary cooperation will be extended for institutional development of the
Institute of Medicine (IOM) .
c) Necessary arrangements for training in foreign countries will be made in order to
produce those categories of manpower that cannot be produced within the country.
d) The training centers under MOH will be strengthened institutionally and their
production capacity will be raised, as required.
e) Arrangements will be made to provide special benefits for doctors and other
health personnel to encourage them to work in remote rural areas.
8. Private, non-government and inter-sectoral coordination:
a) Non-government organizations and associations will be encouraged to provide
health services under the prescribed policies of His Majesty’s Government.
b) Coordination will be maintained at each level with health related sectors including
agriculture, education, drinking bwater and local development.
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11. 9. Ayurved and other traditional health systems:
-Encouragement will be provided, as possible, to other traditional health systems including
homeopathy and naturopathy.
10. Drug supply:
-To improve the supply of drugs in government health organizations as well as health
facilities operated by private sector, the domestic production of essential drugs will be
increased. In the meantime the quality of the drugs will be upgraded by effective
implementation of the National Drug Policy.
11. Health research:
-Research in health sector will be encouraged. The outcome of research will be applied in
decision making for better management of health services.
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12. 12. Resource mobilization in health services:
a) National and international resources will be mobilized for health services.
b) Various alternative measures for resource mobilization for health services will be
the subject of experiment including health insurance, user’s charges, revolving
drugs schemes and so forth.
13. Regionalization and decentralization:
a) Regionalization and decentralization processes will be strengthened. Peripheral
health units will be made more autonomous and effective. For this, amendments
will be required in the existing decentralization regulation.
b) Arrangements will be made for the local level planning and management of
curative and promotive health services, with priority given to preventive health
services, from the district to village levels.
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13. 14. Blood transfusion services:
a) The Nepal Red Cross Society will be the only authorized organization to conduct
all programmes related to blood transfusion.
b) The practice of buying, selling, and depositing of blood will be prohibited.
15. Miscellaneous:
a) Safety standard will be developed for industrial establishment for health security
of workers engaged in industries and their implementation will be monitored.
b) Laws and regulations relating to health will be formulated as necessary.
c) Programmes relating to the welfare of disabled and handicapped persons will be
prepared in coordination with the private sector and non-governmental
organizations.
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14. National Health Policy, 2071
This national health policy 2071, a complete revision of national health policy
2048, has been introduced to promote , preserve, improve and rehabilitate
the health of the people by preserving the earlier achievement, appropriately
addressing the existing and newly emerging challenges and by optimally
mobilizing all necessary resources through a publicly accountable efficient
management.
OBJECTIVES:
1. To make available free the basic health services that existed as citizen’s
fundamental right.
2. To establish an effective and accountable health system will required
medicines, equipments , technologies and qualified health professional for
easy access to acquire quality health services by each citizen.
3. To promote people’s participation in extending health services.
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15. Components/Policies:
1. To make available in an effective manner the quality health
services, established as a fundamental right, ensuring easy
access within the reach of all citizens and provision of basic
health services at free of cost.
2. To plan produce, acquire, develop and utilize necessary human
resources to make health services affordable and effective.
3. To develop the ayurvedic medicine system through the
systematic management and utilization of available herbs in the
country.
4. To aim at becoming self-sufficient in quality medicine and
medical equipment through effortless and effective importation
and utilization with emphasis on internal production.
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5. To utilize in policy formulation, program planning, medical and treatment
system, the proven behaviours or practices obtained from researchers by
enhancing the quality of research to international standard.
6. To promote public health by giving high priority to education, information,
and communication programs for transforming into practice the access to
information and messages about health as a right to information.
7. To reduce prevalence of malnutrition promotion and usage of quality
healthy foods.
8. To ensure availability of quality health services through competent and
accountable mechanism and system for coordination, monitoring and
regulation.
9. To mainstreaming health in every policy of state by reinforcing
collaboration with health related various stakeholders.
10. To ensure the right of citizen to live in healthy environment through
effective control of environmental pollution for protection and promotion of
health.
17. National Health Policy, 2076
Guiding Principles:
• Universal Health Coverage.
• Diversification of equitable health insurance.
• Restructuring Health care.
• Multi sectorial coordination and cooperation in all
health policies.
• Special Health services focused to most
marginalized class people.
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18. Objectives:
• To develop, expand and improve all kinds of health systems in
accordance with the federal structure
• To improve the quality of services provided by health institutions at all
levels and to create easy access
• To develop and expand the health system based on social justice and
good governance for all the citizens in the federal structure ensuring
access and consumption of quality health services.
• To strengthen the social health security system by including the most
marginalized class.
• To promote government, non-government and private sectors
cooperation and multi sectorial partnership.
• To transform non-profit health sector into service oriented health
services.
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19. Policies:
1. Basic health service will be ensured free of cost from all levels of health
institutions.
2. Easy access of specialist services will be ensured via Health Insurance.
3. Easy access to Basic Emergency Health Services to all Nepali Citizen will be
ensured.
4. Health System will be restructured as per the federal system into Central,
Provincial and Local level. Improvement, Development and Extension of Health
system.
5. In accordance with the concept of universal health coverage, promotional,
preventive therapeutic and rehabilitative services shall be developed and
expanded in an integrated manner.
6. Promote cooperation and partnership between governmental, non-
governmental and private Health sectors, management and monitoring them. In
addition encourage investment in Health education, services and research among
private, internal and external investors.
7. Integrated development and expansion of Ayurveda, Yoga, Homeopathy and
natural treatment system.
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20. CONTD..
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8. For easily accessible, effective and quality health services, based on
population geography and federal structure, development and expansion
of quality health workers and management of health services.
9. Development, expansion and improvement of Health Professional
Council to make health services provided by providers effective, efficient
and qualitative.
10. Encouraging for the production of quality drugs and health related
technologies; and make access and appropriate use of quality drugs and
health related technologies via efficient production, import, storage,
monitoring distribution and effective management will be ensured.
11. For controlling Communicable disease, Insect related diseases, animals
related diseases, climate change, other diseases and outbreaks,
preparedness and mitigation of disasters, integrated solution will be
applied.
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12. Development and expansion of integrated system and making
individual, family, society and related bodies for Control and management of
Non-communicable diseases.
13. To improve nutritional status, discourage use of contaminated
and harmful foods and increase in the assess, use , production and
promotion of healthy foods.
14. Increase in the quality of health research as per the international
guidelines and apply the facts obtained from research in the policy
development, planning, and development and their effective use.
15.The health management information system shall be made modern,
qualitative and technology friendly and integrated health information
system shall be developed.
22. 16. Right to information related to health and right of a beneficiary to
know about the treatment shall be ensured.
17. Mental health, oral, eye, ENT health services shall be developed
and extended.
18. Ensure quality of services provided by hospitals and other health
institutions.
19. Renovation and change of health related policy, health system
structure and management in relation to need of time to maintain
good governance.
20. Development and ,expansion of safe motherhood, child health,
adolescent health and reproductive health
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21. Management of special fund for sustainable development of health
sector.
22. Management of Increasing urbanization, internal and external
migration and solve public health problems due to them.
23.Decision making and organizing programs after population related
research, data Management, and analysis.
24.Scientific investigation and control of Control air, water, sound,
environment pollution, and food pollution.
25.Appropriate management to reduce risk in public health from
immigration process and health security of Nepalese living abroad.
24. STRATEGIES:
1) Free basic health services shall be ensured from health institutions of all levels as
specified:
i) Basic health services shall be provided by the health institution free of cost. Local
government shall provide basic health services including some additional services as
per need.
ii) Necessary policy ,legal and institutional arrangement shall be made by state and
local government to make basic health services effective .
2) Specialized services shall be made easily accessible through health insurance:
i) Treatment services that are not included in the basic health services shall be
strengthened and integrated into the insurance system.
ii) All citizens shall be covered by health insurance system .
3)Access to basic emergency health services shall be ensured for all citizen .
i) Specified Emergency health service should be provided by all level of health
institution regularly .
ii) Trauma care center at major highway-at least one ambulance at local level .
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25. CONTD..
4) Health system shall be restructured, improved ,developed and expanded
at federal state and local levels as per the federal structure:
i)Diagnostic services shall be made modern and technology-friendly and the national
public health laboratory and diagnostic center shall be established .
ii) Necessary legal and institutional arrangements shall be made to strengthen the
health system in line with the federal structure.
iii)Relevant modern technology shall be used or modernized to make health services
qualitative and cost-effective .
iv)Partnership, collaboration between government and non government sector and
community participation shall be promoted.
v)With Public-private partnership and through volunteer blood donors , availability of
safe blood and blood-related items shall be ensured.
vi)Human organ transplant ,organ donate services and organ donation of brain dead
person shall be managed, developed and expanded.
vii)Medico-legal services shall be developed and expanded to all state and primary
hospitals.
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26. 5) In accordance with the concept of universal health coverage,
promotional, preventive, curative, rehabilitative and palliative services
shall be developed and expanded in an integrated form:
i) People’s responsibility to keep themselves healthy and healthy lifestyle shall be
promoted through health awareness programmes.
ii) Private and non-governmental organizations shall be promotes to establish
rehabilitative and palliative service centers.
6)Collaboration and partnerships among governmental, non-governmental
and private sectors shall be promoted, managed and regulated in the
health sector and private, internal and external investments in health
education, services and researches shall be encouraged and protected.
7)Ayurveda, naturopathy, yoga and homeopathy shall be developed and
expanded in an integrated way:
i) Existing and traditional health care systems shall be enlisted, managed and
regulated as per specified parameters.
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27. 8) In order to make health services accessible, effective and qualitative,
skilled health human resources shall be developed and expanded
according to the size of population, topography and federal structure,
hence managing health services:
i)Necessary health human resources shall be obtained, developed and utilized based
on short term and long term plans for federal structure.
ii)An umbrella act shall be formulated and implemented for the development and
expansion of health science academics. The concept of teaching district shall be
implemented throughout the country.
9) Structures of health professional councils shall be developed, expanded
and improved to make health services provided by individuals and
institutions effective, accountable and qualitative:
i)Institutional and technical capacity of health related councils shall be increased.
ii)Code of conduct shall be enforced to make the services providers professional and
accountable to the health of benrficiaries.
10) Domestic production of quality drugs and technological health
materials shall be promoted and their access and proper utilization shall
be ensured.
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28. i) National production of essential drugs and technological health materials shall be
encouraged and self-reliance shall be increased.
ii) Guidelines and standards shall be developed to receive and utilize medicines,
equipments , medical supplies as per the need from international, national and local
government, non-government and private entities.
11) Integrated preparedness and response measures shall be adopted to
combat communicable diseases, insect borne and animal-borne diseases,
problems related to climate change, other diseases, epidemics and disasters.
i) Coordination and advocacy shall be done to promote domestic and community waste
management and environmental cleanliness.
12) Individuals, families, societies and concerned agencies shall be made
responsible for prevention and control of non-communicable diseases and
integrated health system shall be developed and expanded:
i)Multi-sectoral coordination, promotional and structural arrangements shall be
implemented to prevent road accidents and other disasters( fire, lightening strike).
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29. 13) In order to improve nutritional, situation, adulterated and harmful
foods shall be discouraged and promotion, production use and access to
qualitative and healthy foods shall be expanded;
i) Multi sectoral nutrition policy and programmes including food security
shall be updated and implemented with priority.
ii) School health programme and nutrition education programme shall
be strengthened developed and implemented.
14) Health researches shall be made of international standards and finding
and fact of such report shall be effectively used in policy formulation,
planning and health system development;
i) Health research and technical human resources shall be motivated to
researches in coordination with academic and educational institution.
ii) Knowledge, skills and indigenous medicinal herbs, Ayurveda and
traditional healthcare shall be research and recorded protected and
promoted as intellectual property.
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30. 15)The health management information system shall be made modern,
qualitative and technology-friendly and integrated health information system
shall be developed;
i) Health management information system, researches, surveys and
surveillance shall be used in monitoring, evaluation, policy, formulation,
programme development and decision making process and various levels.
ii) Security of health information shall be ensured and health information
of beneficiaries shall be maintained in e-recording system. iii) existing
surveillance system in the health sector shall strengthened and
integrated surveillance system shall be developed and implemented
16) Right to information related to health and right of beneficiary to know
about the treatment shall be ensured;
i) The service providers shall be made responsible in health information
flow.
ii)Communication materials that may directly or indirectly have adverse
effects on people's health and on society shall be discouraged and
regulated.
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31. 17) Mental health, oral, eye, ENT(ear nose and throat )health services
shall be developed and expanded;
i)Oral health, ENT treatment services shall be developed and expanded
at all levels.
ii) People access to mental health and psychosocial services shall be
ensured through primary hospitals by promoting transfer of knowledge
and skills, service-oriented skills and special trainings.
18) Quality of health services provided by all health institutions including
hospital shall be ensured;
i) Minimum service standard for health institutions of all levels shall be
developed and implemented after necessary amendments.
ii) Guidelines and standard treatments for health equipment including
vaccines, medicine, and all medical equipment shall be developed ,
updated and implemented.
iii) Necessary standard for effective management of health services that
use radiation shall be prepared and implemented.
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32. 19).Good governance and improvement shall be ensured in policy-related institutional and
managerial structure in health sector through timely amendments;
i).Necessary mechanisms shall be developed and used to address grievances,
complaints and suggestions of beneficiaries.
ii).Public hearing and social adults shall be arranged about the health services
provided by all health institutions.
iii).Institutional capacity shall be improved for effective management of health services
at all levels.
20) In accordance with the concept of health across the lifecycle, health services around
safe motherhood, child health, adolescence and reproductive health, adult and senior
citizen shall be developed and expanded;
i).Safe motherhood and reproductive health services shall be made of good quality,
affordable and accessible.
ii).In view of social determinants that affects women health, special programme shall
be implemented in coordination with concerns stake holders.
iii).Abortion services shall be made qualitative and effective as per the law.
iv).Health services related with infertility shall be gradually extended to the state
levels.
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33. 21) Necessary financial resources and special fund shall be arranged for sustainable
development of the health sector;
i) national health accounts with analytical detail of overall income, expenditure, distribution
and use of resources in the health sector shall be annually published and use in the
preparation of policies, programmes and plans.
ii) maximum portion of revenue generated from tobacco and alcohol product shall be used
in public health promotion programmes.
iii) economic support receive from international development partner shall be mobilized
based on result, priority and with avoidance of duplication.
22) Urbanization, internal and external migration shall be managed and public health problem
associated with such phenomena shall be resolved ;
i) Demographic information shall be analyzed to prepare plans for overall development, to
formulate projects and to development of programmes.
ii)A system to examine the cause of deaths shall be developed and linked with the vital
registration system.
iii) External and internal migration and urbanization shall be effectively managed.
iv) Guidelines shall be prepared and implemented to ensure health security of citizen going
for foreign employment.
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34. 23) Demographic statistics shall be managed, researched and analyzed to
link them with the policy decision and programme designing;
i)Actual demographic data with age distribution shall be updated
through the ward level health institutions and targeted health
programme shall be design for age- specific groups.
ii) Coordination shall be made with concerned agencies to establish
senior citizen care centers with public private partnership.
24) Antimicrobial resistance shall be reduced, one-door health policy shall
be developed and expanded for control and management of
communicable disease, environmental pollution such as air pollution,
sound pollution and water pollution shall be scientifically regulated and
controlled.
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35. 25) Necessary arrangements shall be made to reduce the risks of
immigration process on public health and to provide health protection to
Nepalese staying abroad.
i) Necessary mechanisms and procedures shall be developed and used
to promote and ensure access to and use of health services for Nepalese
abroad.
ii) Health examination for foreign national before entering Nepal shall be
made compulsory.
iii) Migration health management information system researches be
developed and implemented to manage the migration health
information.
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