This presentation is prepared as part of the Course assignment of " EPI 525: "Public Health Service Management" for the Master's Degree of Public Health (MPH), Pokhara University and can be used as reference materials for Local Level Health Planning

1. Review of Local Level
Planning
Presenter:
Jagat Prasad Upadhyay
MPH 2nd Semester
School of Health and Allied Sciences
(SHAS)
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2. Presentation Outline
• Background
• Process of local level planning
• Review of local level planning
• Challenges
• Recommendation
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3. Why Health is Planning Important?
• Planning provides a roadmap to achieve the goal or to reach the destination.
• It provides chronology of orders of different activities.
• Help us to spent resources efficiently.
• To match limited resources with many problems.
• To eliminate wasteful expenditure or duplication of expenditure.
• To develop the best course of action to accomplish a defined objectives.
• Planning Promotes innovative ideas and facilitates in decision Making
• Planning establishes standard for controlling
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4. Background
• Under federalism, the government structure in Nepal includes the
federal government, seven provinces, and 753 units of local
government (LG). Metropolitan, Sub-Metropolitan, Municipalities
and rural municipalities have got distinctive responsibility for
public service delivery and revenue-raising.
• The Local Government Operation Act (LGOA) 2074 defines legal
provisions for local government operations, roles, and
responsibilities.
• Like federal and provincial levels, local levels have mandates to
develop policies and legal frameworks, and to conduct planning
and budgeting exercises.
Local Government Number
Metropolitan 6
Sub-Metropolitan 11
Municipalities 276
Rural Municipalities 460
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5. Background
• The local government operation Act, (2074) provides for a bottom-up planning process for
local bodies at each level, starting at the settlement level (Tole level).
• The health programme content at local level must combine plans and budgets from all three
levels.
• Funds are primarily provided via conditional grants, mainly from the federal level. Besides
conditional grants, local levels pool resources from equalization, special, and complementary
grants (from federal and provincial levels), revenue distribution, and from local taxes and
other revenue streams. All these resources can be used to support basic health service (BHS).
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6. Background
• The Local Government Operation Act 2017, Part 3, Article 11 has explained the functions roles and
responsibilities of the Local Level in line with the distinctive functions roles and responsibilities specified in
Schedule 8 of the Constitution of Nepal.
• The Local level has to make a mid/short-term, periodic plan and local development strategies in order to
implement such function, role and responsibility systematically.
• The Local Level plays a significant role in functionalization of the whole planning and development process
by preparing local level development plan, including unit level cost estimation, based on
 policy and guidelines provided by the upper tiers of the governments;
 preparing the functional level project/programs for upper tiers;
 allocating the resources by developing certain priority sectors;
 facilitating/coordinating in project implementation, monitoring and evaluation.
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7. Schedule-8
List of Local Level Power
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Source: Constitution of Nepal, 2072

8. Duties and Power of Municipality/ Rural Municipality in Health sector
Source: Local Government Operation Act 2074
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9. Matters to be Considered While Framing local level Law or Policy
and Plan
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Source: Federation, Province and Local Level (Coordination and Inter-relation) Act, 2020 (2077)

10. Local Level Health System
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11. Interrelationship and sequencing towards annual
development plan
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12. Legal and operational frameworks for local level planning and budgeting.
• Constitution of Nepal, 2072
• Local Government Operation Act, 2074
• Intergovernmental Fiscal Transfer Act, 2074
• Reference guidelines for Local Level Planning and Budgeting, 2017 (MoFAGA)
• Handbook for Local Level Planning and Budgeting, 2020 (MoFAGA)
• Planning and Budgeting Guidelines for the Local Level (National Planning Commission)
• Planning and Budgeting Guidelines for the Health Sector, 2018 (MoHP)
• Programme Implementation Guidelines, various years (MoHP)
• Sustainable Development Goals
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13. Timeframe for Formulation of Annual Work Plan and Budget at the
Local Level
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14. Steps of Local Level Planning
1. Preparation Phase (at the end of Poush/ at the end of Chaitra)
• Update the profile and situation analysis of local government
• Perform estimation of revenues at local government
• Outline the Medium Term Expenditure Framework (MTEF) for three consecutive fiscal years
• LGs submit the revenue forecast and estimation of expenditure to the Ministry of Finance (at Federal
level) and relevant Province based on the revenue estimation and resource mapping
• Formation/Adjustment of Sectoral committees, allocate roles and responsibilities
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15. Steps of Local Level Planning
2. Resource projections and determining the ceiling (within Baisakh 10th)
• Receive the budget ceiling and guidelines from federal and provincial levels
• Determine budget ceilings and establish thematic committees for each sector
• Provide Guidelines for each sectoral committee
• Hold pre-budget session with stakeholders for budget discussion
• Prepare Policy and Programme then submit to Assembly
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16. Steps of Local Level Planning
3. Selection of project/activities at Tole/Cluster level (at the end of Baisakh)
• Rural/Municipality gives direction to each ward committee to conduct tole/cluster level plan
formulation.
• In meeting all classes, genders, communities (women, Dalits, indigenous tribes, Madheshi, Tharu,
Muslim, backward society, disabled person, marginalized, youth, children, senior citizens, gender
and sexual minorities etc.) participation should be ensured.
• In the meeting plan discuss to support the development, empowerment, health, education and
infrastructure development of all communities.
• Involve active community based organization and stakeholder in meetings
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17. Steps of Local Level Planning
4. Project selection and prioritization at Ward level (within 15th Jestha )
• Plan/program received by ward committee should be separated into groups according to
thematic areas and prioritize the program on the basis of limit and guidance from local level
• With ward committee decision Submit budget ceiling and guidelines to budget and program
formulation committee coordinated by head/deputy head of the rural municipality/
municipality, within jestha 15.
• If certain important plan/program of tole level exceed the ward budget ceiling then the ward
committee can also prepare a separate list and submit it to the rural municipality/
municipality.
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18. Steps of Local Level Planning
5. Budget plan formulation at palika level (Within 5th of Ashad )
• The local level can establish a committee for economic, social, health, infrastructure development, forest management,
environment protection, disaster management, and good governance by assigning responsibilities to the executive
members of the local level for the development program to be conducted within their area.
• The committee prepares the integrated budget of the plans decided upon after discussion (plans received from the
ward), proposed plans received from all divisions, section and sub-section as well as the plans submitted by non-
governmental organizations that work in cooperation with local government.
• Every year, the budget and program formulation committee must present to the executive a draft of the annual budget
and program within 5th Ashad. Additionally, this committee prepares the draft of the policy and program and submits it
to the executive for approval.
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19. Steps of Local Level Planning
6. Approval by Executive Body and submission to Local Assembly (Within 10th of Ashad )
• The budget and program formulation committee prepared the policy, program, revenue, and expenditure estimates for the
upcoming fiscal year, which must be approved by the rural municipal or municipal executive meeting within 10th Ashad
every year.
• Following proposals related to the budget and annual plan must be approved by the executive meeting.
a. Local government policies and programs
b. The Finance Bill (proposed rates of revenue tax for the coming year);
c. Appropriation Bill (Details of Withdrawal of Funds from Local Reserve Fund and Programmatic and Headline
Expenditures);
d. Budget statement (including actuals for the previous fiscal year, revised estimates for the current fiscal year, and
estimated income and expenditure statements for the upcoming fiscal year),
e. Annual Development Program (list of detailed programs and proposed amount of funds).
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20. Steps of Local Level Planning
7. Approval of AWPB by the Local Assembly (at the end of Ashad)
• Approved plan, policy, program and budget from executives meeting of municipality must submit to
local council.
• And there were 15 days discussion on submitted document, after discussion they finalize which program
to pass by majority or return back to local level executive committee with feedback.
• Approved program and budget by local assembly must publish for general information and in office
website.
• Mayor give authority to chief administrative officer to use pass budget, after receiving that chief
administrative officer give responsibility to all divisions, section and sub-section for plan
implementation.
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21. Example: Process for allocation of budget for nutrition and health
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Source: Article by Sharada Manandhar on Municipal budget allocation and utilization for nutrition in Nepal

22. Crucial components contributing towards strengthening
planning and budgeting process
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Sources: Based on MOFAGA (2020) and NPC (2019)

23. The Proposed Structure of the Local Planning Unit
• Chairman: Chief of Local Level
• Member: Deputy Chief, Local Level (local level)
• Member: Planning Expert, LL Appointee
• Member: Two Representatives from Ward Committees
• Member Secretary: Planning Officer, LL
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24. Federal and provincial roles in local planning
• The NPC and the PPC will be responsible to set the budget ceiling and will design the guidelines and directives for
implementation of both national, provincial development plan at local level.
• The Federal Government can take third party evaluation and effectiveness study of the plan at all three tiers of
governments.
• A common standard operational manual will be prepared for formulation, implementation, impact evaluation and
capacity enhancement of human resources.
• Comprehensive integrated coordination framework to link all development projects in the web needs to be
established and make them accessible to all levels of governments.
• There are still too many budget heads under the Federal conditional grants, reducing flexibility to address local
needs.
• Delays in sending the budget and the implementation guidelines from the federal and provincial level is still
common.
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25. Governance structure for planning at local level
• The Budget Formulation Committee and Sectoral Committees are mainly responsible in the planning and budgeting
process
• There is increasing clarity on the local level role in health sector management
• Local Level planning and budgeting includes sectoral planning at the municipal (palika) level and area-focused
planning at the ward level
• Budgets were found to be divided equally between wards despite unequal needs.
• Prioritization of the program and activities proposed for AWPB varies across LGs
• Different factors have contributed to gradually prioritizing the health sector in the local level planning and budgeting
• Budget proposals from divisions and sectoral committees usually exceed the ceilings and are adjusted in the
finalization process
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26. Use of available evidence in the planning process
• Local levels are expected to develop a Master Plan, Periodic Plan, and Medium Term Expenditure
Framework (MTEF) to feed into the planning process. Some LGs develop them, some do not.
• The programme bank, Municipal profiles, case studies, and learning briefs were found to be instrumental in
the planning process particularly to priorities resources
• There are multiple tools to support evidence-based decision making and planning at the local level, including:
information system reports; checklists; sector profiles; review meeting and committee minutes; cross-sectoral
and cross-municipality meetings; public statements from political leaders; and capacity enhancement tools
[such as Minimum Service Standards (MSS), Routine Data Quality Assessment (RDQA), and Organizational
Capacity Assessment (OCA)].
• Periodic Health Management Information System (HMIS) and Logistics Management Information System
(LMIS) reports
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27. Review of Local level Planning
Current Practice Recommendation
Similar local level activities being funded from multiple levels
indicating potential duplication in activities and resources.
While making Federal conditional grant provisions, areas of
additional financing from provinces or local levels should be
indicated to avoid duplication
The targets set in the Health Management Information System
(HMIS) do not always match with the local level reality
Local level performance should be also be analyzed at district level
for strategic planning.
Drug stock outs still remain a periodic problem in the majority
of LL sites. In contrast, the occasional oversupply of certain
medicines, often near expiry, has also been reported.
Support more effective procurement coordination to ensure
continuous availability of medicines at the health facility level.
There are still delays in sending the budget and implementation
guidelines from the federal and provincial levels
Priority should be given for ensuring timely release of budget and
implementation guidelines from the federal and provincial levels.
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28. Review of Local level Planning
Current Practice Recommendation
Some municipalities produce comprehensive profiles and fact sheets,
municipal level survey highlight major progress and challenges, feeding
evidence into the planning process.
Support LGs to prepare municipal profiles and fact
sheets and institutionalize in the sites where this
has been started.
The roll out of OCA, MSS, and RDQA created the opportunity for
participation by elected representatives, senior officials, and health staff
in a single platform to understand the complex health system functions
and challenges.
Introduce and maintain the OCA, MSS, and
RDQA tools in each LG.
Roles and responsibilities of individual staff in the local health sector
were not clearly defined, causing confusion and even conflicts in
programme implementation.
Support the practice of assigning focal persons for
thematic areas at local level.
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29. Review of Local level Planning
Current Practice Recommendation
Development of the local level MTEF is an important
component of the planning process, but many local levels are
yet to do this.
Enhance institutional capacity to ensure that local
levels develop their MTEF during the planning
process
A programme bank consists of priority projects to be considered
during AWPB. A programme bank can help to speed up the
planning process at the local level
Establish a programme bank at each LG site.
In some LL sites, the HF “functionality status” was not up-to-
date in the health facility registry and hence in the HMIS.
Issues like listing of non-functional health facilities and
appearance of same health facilities more than once were
identified.
Update the health facility registry so that the database
of actual number of health facilities that are providing
services can be corrected and maintained in the
HMIS.
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30. New Initiatives
• Allocation of budget for Evidence generation activities including Research at local
level.
• Nutrition allowances targeting marginalized communities.
• Point of entry/Ground crossing (staff recruit)
• Focus on both supply and demand: performance-based incentives
• Workload-based readjustment of the health workers can help better manage
service delivery
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31. Issues/Challenges in Local Level Planning
• Developing and harmonizing health policies and priorities at all spheres of government;
• Re-aligning the health strategy, plan and budget across federal, provincial and local level
• Determining a health budget and programme consistent with national and international
commitments at all spheres of government
• Enhancing the capacity of officials engaged in planning at all spheres of government
• Standardizing the Medium Term Expenditure Framework (MTEF) applicable to all levels
of governments
• Aligning or harmonising the exclusive functions of federal, provincial and local
government.
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32. Issues/Challenges in Local Level Planning
• Lack of administrative and technical resources and other non-transparent practices at the
local level had delayed project implementation.
• Most of the local governments did not formulate the long-term vision in participatory
manner whereby the development is guided by exclusively mayors' vision. This led
municipalities were confused to localize the national and provincial goal, vision, and
policies
• The genuine needs of the people were sidelined. The elected representatives including
mayor, deputy mayor and ward chairs had great influence in both project selection and
implementation.
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33. Issues/Challenges in Local Level Planning
• Most of the leaders equate health service only with curative service with a high risk of
sustaining public health achievements.
• Budget disbursement is a major challenge because now it is harder to allocate and
disburse budget in a timely manner to multiple layered and widely dispersed local
authority.
• Less focus on disaster preparedness and management during planning.
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34. Recommendation
• Coordination, Collaboration, Cooperation and Co-existence among three tier of
government
• Adequate collaboration and coordination between different sector, tiers of government
and inter-palika level.
• Need based planning (according to disease pattern eg. NCD burden increasing, vector
borne disease in high mountain area).
• The elected representatives as well as the local level personnel must increase/enhance
their capacities to know how the planning and development activities connect vertically
with the planning entities to translate the national development policies to operationalize
at local level.
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35. Recommendation
• A work plan should be developed to avoid rushed project implementation and payments at
the end of the fiscal year. Work plans should be strictly followed.
• Adequate administrative and technical resources should be allocated for effective monitoring.
• After a project is completed, evaluation should be conducted in a timely manner. The
payment process should be simple and efficient.
• The budget allocation and implementation processes should maintain transparency and
remain accountable to citizens.
• Information of public importance, such as the criteria and list of projects prioritized at the
ward and municipal levels, should be published at ward and municipal offices.
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36. Example of Local Level Program Planning
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37. Example of Local Level Program Planning
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38. References
• Local Government Operation Act, 2074
• Nepal Health Sector Support Programme III (NHSSP-III)
• Handbook for Local Level Planning and Budgeting, 2020 (MoFAGA)
• Planning and Budgeting Guidelines for the Local Level (National Planning Commission)
• Planning and Budgeting Guidelines for the Health Sector, 2018 (MoHP)
• Strengthening local planning and budgeting to deliver Basic Health Care Services
• Federation, Province and Local Level (Coordination and Inter-relation) Act, 2020 (2077)
• Constitution of Nepal, 2072
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39. Thank You!
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