National Health Policy - 1991 An overview

1. National Health Policy
2048 (1991)
An Overview
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Prepared By: Muskan Pudasainee
MPH 2nd Semester
School of Health and Allied Sciences (SHAS)

2. Outline of the presentation
• Policy Context
• Background
• Vision and Objectives
• Policy Actors
• Policy Contents
• Components
• Review of National Health Policy
• Conclusion & Recommendation
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3. Policy Context
• Soon after the re-establishment of a constitutional monarchy and
multi-party democracy in Nepal in 1990, The government
developed a National Health Policy (NHP) in 2048 B.S (1991 AD)
with a certain vision, objectives, and components.
• The Alma-Ata Declaration of 1978 emerged as a major milestone
of the twentieth century in the field of public health, and it
identified primary health care as the key to the attainment of the
goal of Health for all.
• To achieve this status of Health for all, the government formulated
this policy.
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4. Background
What was the current health status during that period?
• Lack of political commitment, inappropriate strategies, and
weakness in the implementation of preventive, promotive, and
curative health programs up to the grass root level for the past 30
years.
• CDR – 16 per thousand, CBR – 41 per thousand, Child mortality
rate, 107 per thousand, MMR – 8.5 per thousand, Mortality rate of
child below 5 – 197 per thousand.
• 1 hospital for 168 thousand person, 1 Doctor for 92 thousand
person, 1 hospital bed available for 4 thousand person, 1 health
post for 24 thousand rural person.
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5. Vision and Objectives
• Vision: The government is committed to creating a socio-
economic environment that allows all Nepalese citizens to lead
healthy lives.
• Objectives: The primary objectives of the health policy are:
oTo upgrade the health standard of the majority of the rural
population by extending basic primary health services up to the
village level.
oTo provide the opportunity to rural people to obtain the benefits
of modern medical facilities by making them accessible to them.
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6. Target of the Health Policy
• By the year 2000, the following targets will be attained:
1. The infant mortality rate will be reduced to 50 per thousand
from the present 107 per thousand.
2. Mortality rate of children below 5 years will be reduced to 70
per thousand from the present 197 per thousand.
3. Total fertility rate will be reduced to 4 from the present 5.8
4. The maternal mortality rate will be reduced to 4 per thousand
from the present 8.5 per thousand.
5. Life expectancy will be raised to 65 years from the present 53
years.
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7. Why National Health Policy?
• National health policy is to extend the primary healthcare system
to the rural population so that they benefit from modern medical
facilities and the services from trained healthcare providers.
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8. 8
Policy Actors

9. Policy Actors
• Policy Makers: High-level technical groups (Politicians,
Bureaucrats)
• Policy Influencers: Politician groups, Oppositions (They usually
raise comments/issues)
• The Public: Audience, Taxpayers, Voters, Consumers
• The Media: Print/Electronic Media, Television (They usually raise
issues)
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10. Policy Contents
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11. Components of Health Policy
There are 15 components of the Health Policy, 1991, they are:
1. Preventive Health services 8. Drug supply
2. Promotive health services 9. Provision of resource mobilization
3. Curative health services 10. Health research
4. Basic primary health services 11. Regionalization and Decentralization
5. Mobilization of public participation in
health services
12. Improvement in organization and
management aspect
6. Development and management of
health human resources
13. Private, Non-governmental and Inter –
Sectoral coordination
7. Ayurveda and traditional health system 14. Blood transfusion service
15. Miscellaneous
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12. 1. Preventive Health services
• Provided for the prevention of the diseases.
• Priority given to those programs which directly helps to reduce infant
and child mortality rates.
• Services to be provided in an integrated way through sub health centers
at rural level.
Main programs operated under these services are:
Family planning and Maternal and child health
programs
Diarrhea and acute respiratory infection
control program
Expanded immunization program Prevention of AIDS
Tuberculosis control program Safe motherhood program
Malaria and Kalazar Control Control of epidemic of communicable diseases
Initiation of prevention of Non communicable
diseases
Initiation of Primary Health services in Urban
slums
Leprosy control program 12

13. 2. Promotive Health services
• Programs that enable persons and communities to live healthy
lives are included under the promotive services.
a) Health Education and Information – From center to rural level
b) Nutrition Program
growth monitoring
promotion of breast-feeding
prevention of iodine deficiency disorders, iron and vitamin 'A' deficiency
health education
c) Environmental Health
personal hygiene
collect and manage solid wastes
inspect and examine hotel foods, drinking water and other edible products
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14. 3. Curative Health Services
• Services will be made available in an Integrated way from SHP and
PHCC’s in rural areas
• At least one hospital in each district
• One Zonal hospital in each zones: specialized services like
gynecology, eye, ear, surgery etc.
• One Regional hospital in each 5-development region: specialized
services like dermatology, Ortho etc
• Mobile camps for specialized services in remote mountain regions
• Strengthen diagnostic services
• Strengthen Referral system
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15. 4. Basic Primary Health Services
• Sub-health posts will be established in each VDC of Nepal to
provide preventive, promotive and curative health services. Each
Sub-HP will have:
⁻ 1 village health worker
⁻ 1 maternal and child health worker
⁻ 1 auxiliary health worker
• One health Post in each 205 election constituencies of Nepal. (To
be upgraded to PHC centers later)
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16. 5. Mobilization of public participation in
health services
6. Development and management of health
human resources
• Women volunteers, traditional birth attendants (Sudenies) and local
leaders of various social organization will be mobilized for health
programs at ward levels.
• Capable human resources to be developed in planned manner
• Essential training will be conducted in foreign countries
• Strengthen training centers under the MoH
• Reform in transfer, promotion, and career development
• Special benefits for health personnel to encourage them to work in
remote rural areas 16

17. 7. Ayurveda and traditional health system
• Ayurveda system will be developed in a gradual manner along
with encouragement to other traditional health systems like
Unani, Homeopathic and Naturopathy.
8. Drug supply
• Increase the domestic production of essential drugs
• Quality of the drugs will be upgraded by revising the national drug
policy.
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18. 9. Provision of resource mobilization in health
services
• National and Foreign donor agencies will be requested for
necessary cooperation for providing resources to implement the
program under the policies.
• Experiment alternative measures: Health Insurance, User's
Charges and Revolving Drug Scheme.
10. Health research
• Research in health sector will be encouraged.
• The outcome of research will be applied in management decision
making.
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19. 11. Regionalization and Decentralization
•Peripheral health units shall be made more autonomous and
effective.
•District health organizations shall be given the most prominent
role.
•Micro planning procedures will be adopted to provide health
services to all target groups, particularly those below the poverty
line.
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20. 12. Improvement in organization and
management aspect
• Operate hospitals and Public health at district levels in an integrated
way.
•Technical and administrative supervision and follow-up.
•List of free services shall be prepared and made public.
•Effective collection, compilation, recording and reporting systems.
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21. 13. Private, Non-governmental and Inter –
Sectoral coordination
• Operate private institutions to extend health service by obtaining
permission from Nepal government.
• Involve NGOs and institutions in health services as per policies.
• Necessary coordination with agriculture, education, drinking
water and local development
14. Blood transfusion service
• Authorize Nepal Red Cross Society to carry out all activities related
to blood transfusion.
• Prohibit buying, selling and depositing of blood.
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22. 15. Miscellaneous
• Safety standards for industries: health security of the workers
• Formulate Heath acts and regulations
• Publicity the negative effects of drug abuse, alcoholic drinks and
smoking
• Programmes relating to the rehabilitation of the disabled and
handicapped persons
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23. Review of National Health
Policy 1991
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24. Strengths/Positive Aspects
• It is the first policy that government came through which still has
an impact on further creating new policies/strategies.
• New sub-sectoral health policies and strategies
• A large contribution to reducing infant and child mortality:
Integrated services and SHPs
• SHPs in all VDCs, HP in Illakas and PHCC in constituencies
• Mobilization of FCHV’s
• VDCs donating space for SHPs
• Involvement of many public and private institutions
• New National Drug Policy 1995: Increased domestic drug
production
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25. Strengths/Positive Aspects
• National budget increased and large amount of aid by EDPs
• Strengthen human resources by providing appropriate training
• Progress against publicity of smoking, tobacco products, alcohol
• Decentralization (Transfer of responsibility/authority) as new
concept.
• Workload sharing, e.g Blood transfusion service to be provided by
red cross.
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26. Weakness/Issues
• Hospital per district was achieved, but Zonal, Regional and Central
with special services not fully developed
• Many private and other health facilities are available, but most are
located in urban areas and focused on curative services
• Nepal Health Research Council (NHRC) was established in 1991
but minimum use of findings for decision making
• Inadequate use of data generated
• Decentralization hampered by lack of local representatives
• Challenge of retaining health personnel in rural and remote
postings
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27. Weakness/Issues
• Focused mainly on rural areas and addressed little on the health
need of urban people.
• Lack of attention to the special needs of women, children, poor
and other vulnerable groups.
• Lack of attention to inter-sectoral issues: WASH, medical waste
management, climate change, environmental health and geriatric
services.
• No focus on occupational Hazard
• No specific policies on social security and health protection issues
• More focus on quantity rather than quality
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28. Conclusion & Recommendation
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National Health Policy-1991
addresses some modalities of
delivery of health care services as
well as information and
administrative issues. But, not to
the overarching health needs and
future demands of citizens across
Nepal.
Hence, Based on this policy, new
health policies can be prepared
with rigorous discussions
involving stakeholders, retired and
working health staff including
FCHVs, users of health services,
students, and private institutions
for the justified outputs.

29. References
• National Health Policy, 2048 (lawcommission.gov.np)
• http://library.nhrc.gov.np:8080/nhrc/bitstream/handle/1234567
89/38/554.pdf?sequence=1
• An Analysis of National Health Policy 1991 | Health Prospect
(nepjol.info)
• (PDF) National Health Policy of Nepal-Time to Revisit and Reform
(researchgate.net)
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