A comparison between the old and the new system

1. Health Care Delivery
System of Nepal in the
Federal Context
Aavash Mishra
Aaditya Gautam
Aayushma Shrestha
Aarjabi Silwal
Nepalese Army Institute of Health Sciences- College of Medicine

2. INTRODUCTION
Nepal has entered from its unitary system into a new “Federal
Democratic Republic system”.
Federal system is expected to bridge the persistent disparities
between rural and urban areas which are rooted from the past.
According to the new constitution Federal Democratic Republic of
Nepal shall be divided into three main level of structure : Federal,
Provincial and Local.
The constitution gives emphasis on right to clean water and hygiene
and equal access to health care.

3. The transformation of government from centralized to federal has
led to effective supply of resources from the provinces and brought
a new wave in the health sector reform.
Health care provision and health care financing should be
organized according to federal legislation and managed by federal
government.
Thus, proper implementation, good governance and accountability
is crucial.

4. Objectives of Health Care
Delivery
•should be organized to meet the needs of entire
population and not merely selected groups
•should cover the full range of preventive,
curative and rehabilitation services
•should be a part of basic social services of a
country

5. National Health Care System
• Health care system of Nepal is managed by Ministry of Health(
MoH)
• MoH is responsible for making necessary arrangements and
formulation of policies for effective delivery of :
– Curative Services
– Disease Prevention
– Health Promotion
– Establishment of Primary Health Care System

6. Levels of Health Care
System
Primary
Level
Tertiary Level
Secondary
Level
Central
Hospitals
Regional
Hospitals
Community
Health
Centers
District
Hospitals
Health
Post
Sub-
Health
Post
FCHV,
TBA

8. Financing
-Government of Nepal
-Donors
-Local bodies
-International non-government organizations

9. Health Care System
• Public Health Sector
• Private Sector
• Traditional system
• Voluntary health agencies
• National health programs

10. Private Sector
-Private Hospitals,
-Nursing homes
-Dispensaries
-Polyclinics
-General practitioner and clinic

11. Traditional system
-Ayurveda
-Homeopathy
-Unregistered Practitioner

12. Divisions of DoHS
Management
Division
Child Health
Division
Family Health
Divison
Logistic
Management
Epidemiology
and disease
control division
Primary Health
Care
Revitalization
Division

13. Centres of DoHS
National
Tuberculosis
Control
Centre (NTC)
National Health
Training Centre
(NHTC)
Communication
Centre
(NHEICC)
National Health Education,
Information and
Communication Centre
(NHEICC)
National Centre for AIDS and
STD Control National Public
Health Laboratory (NPHL)

16. Primary level health center
• Lowest level of health center in the referral system of health
care services.
• It includes:
Primary health care centers/health centers – 208
Health posts – 1559
Sub health posts - 2247

17. Sub-health posts
•Sub‐healthpost is the first institutional contact point for
basic health services.
•Referral center of the volunteer cadres of TBAs and
FCHVs as well as a venue for community-based
activities such as PHC outreach clinics and EPI clinics
•SHPs monitor the activities of FCHVs as well as
community‐based activities by PHC outreach clinics and
EPI clinics.

19. Health Posts
•Same as SHP as well as birthing centers in the respective
VDC.
•Each level above the SHP is a referral point in a network
from SHP to Health Post (HP) to Primary Health Care Centre
(PHCC), on to district, zonal sub‐regional and regional
hospitals, and finally to tertiary level hospitals
39

21. PHC
• Highest center among the primary level health
centre
• Cases from Subhealth Post and health Post are
referred to PHC.

22. FCHV
• Program Initiated in 1988/89.
• 5th
December is celebrated as FCHV Day to show respect to
FCHVs.
• In 19th
November 2009, FCHV Program in Nepal received
GAVI awards for the highest average annual rate of reduction of
child mortality among all of the 72 GAVI countries since 1990.

23. Services provided by PHC
• Safe motherhood and newborn care
• Family planning
• Child Health
• Immunization
• Nutrition
• Health Education and Counseling
• First aid treatment

26. Secondary Level Health
Centers
• Zonal hospital – 10
• District hospitals – 75
referral centers for the primary health centers
Provide acute care: necessary treatment for a short period of
time for a brief but serious illness, injury or other health condition,
such as in a hospital emergency department.
Also provide skilled attendance during childbirth, intensive care,
and medical imaging services.

27. Tertiary Level Health Center
•Highest level of health centre in referal system of health services
•Central hospitals and regional hospital serve as the tertiary
referral centers
•Here, patients are referred from smaller hospitals for major
operations, consultations with sub-specialists and when
sophisticated intensive care facilities are required.

28. Central Hospitals- 8
• Bir hospital
• Thapathali maternity hospital
• Kanti children hospital
• Sukraraj tropical hospital
• Gangalal heart center
• Bharatpur cancer hospital
• Human body transplant center
• TUTH

29. Regional Health Directorate
•Regional Hospital- 3 (eastern, western & mid western)
•Sub regional hospital -3 ( Dadeldhura, Rapti & Narayani)
•Regional Health Training Centre 5
•Regional Medical Store 5
•Regional TB Centre 1

31. Human Resource
Development
• MD/MBBS: National Academy of Medical Science, Tribhuwan
University, Kathmandu University, BP Koirala Institute of Health
Sciences and 20 affiliate colleges (MBBS only).
• 4 University (Tribhuwan University, Kathmandu University,
Pokhara University and Pubanchal University) and BPKIHS produce
paramedics (Bachelors and Masters).
• Council for Technical Education and Vocational Training
(CTEVT) produces general medical practitioners (Certificate Level).

32. Major policies
• Health sector reform
• Sector wide approach
• Millenium development goal
• Poverty reduction
• Social inclusion
• International health partnership
• Global Health Initiative
• Health System Funding Platform

33. Summary of Old System

34. Health System in Federal Nepal
Key tasks
•Functional Analysis
•Structural Arrangements
•Transition Management Plan
MoH formed a high level team and a technical task team to
carry out the task.

38. Federal
Provincial
Local
Federal Superspecialized Hospital
Provincial Referral Hospital/Teaching Hospital
Municipal Hospital Village Health
Office
PHC,HP
Urban
Health
centers
Community
Health
Center

39. Thank You…