Current co-ordination mechanism of health system in Nepal

Current Coordination Mechanism of
Health System in Nepal
Prakash Raj Sharma
MPH, 2nd Semester
Pokhara University, Kaski
E-mail: infoprs81@gmail.com

Presentation Outline
• Meaning and definition of coordination
• Elements
• Features
• Principles
• Need for coordination
• Types
• Techniques of establishing coordination
• Current coordination mechanism in health sector
• Issues and challenges
• Way forward
Prakash Raj Sharma, MPH 2nd Semester, Pokhara University 2

Meaning of Coordination
• Coordination is the process of linking together the activities of various
departments & people to achieve unity of action and harmonization of
efforts for attaining organizational goals.
• Coordination is a planned collaboration of two or more persons,
departments, programs or organizations who are concern with
achieving a common goal.

Definition of Coordination
• “Coordination is a set of human and structural mechanism designed to
link the parts of enterprise together to help achieve the specified
objective.” -- Glueck
• “Coordination is the degree to which each of the various
interdependent part of a social system operates according to the
requirement of the other part of the total system.” --Prince, 1972

Elements of Coordination
Coordination
Unity of action
Understanding
Communication
Cooperation

1. Unity of action: Harmonization of work efforts through unity of
action to achieve goals.
2. Co-operation: Voluntary & willing co-operation of all levels of
managers is essential for coordination.
3. Understanding: Managers and workers should clearly understand the
goals to be achieved and interrelationships among jobs and people
should be clearly understood.

4. Communication: Essential for flow of information to achieve co-
ordination. Two way communication facilitates co-ordination

Features of Coordination
 Continuous and dynamic process.
 Relevant for group efforts and not individual effort.
 Emphasizes unity of efforts.
• Helps in the integration of functions.
 Responsibility of every manager in the organizations.

Principles of co-ordination
• Principles of direct contact: Face to face direct contact achieves effective
co-ordination
• Principle of early start: Start at early stage of planning and policy making
• Principles of continuity: Continuous process
• Principles of reciprocal relationships: Coordination can not be ordered and
regarded as reciprocal relationships

• Principle of environmental adaptation: It should not be rigid and adapt to
changing forces in internal and external environment
• Principle of clear goals and relationships: Clear objectives and clearly
defined authority and responsibility

Need for coordination
• Integration: Different departments create diversity in organization and
coordination brings harmonization.
• Interdependence: Departments and people in an organization are
interdependent in work situations and coordination needed for smooth
functioning.
• Efficiency: Coordination is needed for efficient utilization of physical,
human, financial and information resource management.

Types of Coordination
Broadly, coordination is classified as:
1. Internal Coordination
2. External Coordination

1. Internal coordination
It refers to the coordination of activities of team in an organization.
Internal coordination may be
A. Vertical and Horizontal coordination
B. Substantive and procedural coordination

A. Vertical & Horizontal Coordination
Vertical Coordination :
It refers to the coordination of superior authority with his subordinates and vice
versa. Example: Health post In-charge should have coordination with AHW, ANM,
etc. and vice versa.
Horizontal coordination:
It refers to the coordination between the authorities (e.g. divisional
coordination/departmental coordination) and employees of other department. It
exists in between the employees of same status in an organization.

B. Substantive & Procedural Coordination
Every organization has two dimensions: substantive and procedural.
Substantive involves deciding what to do and procedural dimension involves how
to do.
• In substantive coordination, emphasis is put to how interrelated activities should
be divided so that these are preformed in synchronized way.
• Procedural coordination involves prescribing the procedure for performing those
activities which have impact on more than one department.

2. External Coordination
• External coordination refers to the establishment of relationship with the
activities of all those who are not the part of the organization. It is the
establishment of a relationship between the employees of the organization
and outsiders of the organization.
Example: Health office has to establish relationship with the LL,
NGO/INGOs, education sector, agriculture sector, schools, etc.

Techniques of Establishing Coordination
• Clarifying the authority & responsibility for each individual & departments.
• Establishment of effective communication system through direct contact,
staff meeting etc.
• Formulation of clear rule and procedure for coordination.
• Establishment of information exchange system between departments,
organizations.

Techniques of Establishing Coordination
• Formulation of task force group: A temporary group representative of from
those department facing problems.
• Formulation of committees to promote effective communication and sharing
of ideas for better implementation
• Management by hierarchy: Provision of boss or coordinator or coordination
by leadership.

Current coordination mechanism in health
sector

Level of Coordination in Health Sector
1. Coordination at Federal Level
2. Coordination at Provincial Level
3. Coordination at Local Level

Coordination in Health
Federal ministries other
than health (Finance,
education, agriculture
etc.)
Other Provincial
Ministries and
Directorates
Schools, Colleges,
Agriculture, Veterinary
Office etc.
MoHP/Departments/
Divisions/Centres/ Federal
Hospitals
MOSD/PMoHP/PHD
Local Level/Local Health
Facilities
EDPs, Private Health Institutions
and Hospitals
I/NGOs operating at Provincial
Level
Local NGOs/CBOs
Central
Level
Local
Level
Provincial
Level

Coordination at Federal Level

Coordination at Federal Level
Health Coordination Division of MoHP is responsible for maintaining
coordination at federal level. It has 4 sections:
1) Provincial and local health coordination Section
2) Multi-sectoral coordination section
3) Development support coordination section
4) Public coordination information section

1. Provincial and local health coordination section
1) Provides necessary co-ordination and technical assistance to conduct
health programs at the province and local level as per work extension.
2) Acts as the liaison unit for the province and local level health.
3) Keeps records of human resources working in the health sector. Conducts
the need assessment of HRH and also formulates policies and plans for
human resource development.
Source: Asst. prof. Dr. Hari Prasad Kaphle

4) Collection, processing, analysis, distribution, storage, updating, utilizing
and publishing human resource information.
5) Conducts necessary research and studies on quality of human resources,
human resource mobilization and benefit packages.
6) Formulates the plan related to human resources training, motivation and
career development.

7) Monitors the effectiveness of human resources working on various
health institutions and provides the necessary recommendations.
8) Strengthening the Human Resource Information Section (HuRIS)
Information System.
9) Conducts TNA for HRH

2. Multi-sectoral coordination section
This section coordinates with other sectors of government and NGOs in the
following areas where multi sectoral effort is necessary.
• Food and Nutrition
• Agriculture and veterinary sector
• Women, children and social welfare
• Water, Hygiene and sanitation
• Environment
• Anti microbial resistance Prakash Raj Sharma, MPH 2nd Semester, Pokhara University 27

• Occupational health and safety
• Health tourism
• School health
• Natural disasters
• Road Traffic Safety
• Health of labour migrant etc.

3. Development support coordination section
• Coordination and collaboration with bilateral and multilateral
agencies.
• Effective regulation and utilization of foreign resources/aids.
• Regulation and coordination with international NGOs.
• Nomination for foreign scholarships, trainings, study tours.
• Deals with other matters, including taxes, customs and duties as per
the agreement between the Government of Nepal and the foreign body.

4. Public coordination information section
• Work on communication management.
• Grievance management.
• Collection and management of information from the provincial and local
levels.
• Publication of official statement of the MoHP.
• Carry out other functions related to the transparency of the Ministry's work
activities.

Coordination at Provincial Level

Secretary (11th level,
Health)
Planning, Coordination and Population
Section
Minister
Provincial
Ministry
of
Health
and
Population
Provincial Health Directorate
Health
office
Hospitals
Health
Section,
LL
• Provincial Public Health Laboratory
• Health Training Center
• Health Logistic Management Center
Policy, Planning & Coordination section
Primary Co.
Sec Co.

Policy, Planning and Coordination Section, HD
• Supports Ministry of Social Development or provincial Ministry of Health
and Population in formulating long-term and short-term health plans,
policies, strategies and programmes.
• Facilitates provincial government in formulating maternal and newborn,
immunization, child health, adolescent, reproductive health, primary health
care policies, strategies, standards and protocols.
• Supports provincial government to prepare periodic and annual plan and
programs at provincial level
Source: Asst. prof. Dr. Hari Prasad Kaphle

• Facilitation for implementation of health programmes at provincial and
local level.
• Coordination and facilitation of local governments and other stakeholder in
technical affairs.
• Assistance in the formulation of provincial plans, policies, laws and
standards in various health issues.

• Priority setting for provincial level health research and conducting research
and studies.
• Development and management of human resources in health at provincial
level.
• Review, monitoring, supervision and evaluation of health projects and
programs .

• Development, study and research on financing system in health at
provincial level
• Inter-agency coordination and collaboration for determination of food,
water, foodstuffs, sound and air quality standard and their implementation.
• Collaboration and co-ordination with federal and local level on health
issues.

• Inter-provincial collaboration and co-ordination on health issues.
• Provincial planning for health infrastructure development.
• Provincial health programme monitoring and supervision.
• Multi sectoral coordination for health and nutrition promotion.

Coordination at Local Level
• Local government is responsible for coordination in health n LL.
• Health section of local government establish the coordination with local
health facilities, schools, colleges, local NGOs, community based
organizations and local clubs for the implementation of different health
programmes.

• Health section coordinates with primary hospitals, primary health care
centers, urban health centers, urban health promotion centers, health posts,
basic health units and community health units for the provision of basic and
primary health care services.
• Coordination with schools, colleges, agriculture, veterinary and other
governmental agencies for implementation of public health programmes.

• Health section of local government should also have to coordinate and
collaborate with local NGOs, clubs, community based organizations, local
hospitals and other agencies for implementation of health programmes and
projects.

Issues and challenges
• Legal Coordination:
-As per the constitution, the relations between the Federation, States, and Local level
shall be based on the principles of cooperation, co-existence and coordination, but act
related to coordination has yet to be formulated.
• Programmatic coordination:
- Duplication of health programs.
- Blanket approach is used by federal government to allocate health programs to
province and LL although they have different needs.

-Programmes remain unimplemented or partially implemented due to the
federal government’s failure to transfer power, with clarity, to the provincial
and local governments. Example: Construction of primary hospital.
• Financial coordination:
- Akthiyari at the middle or at the end of the fiscal year without consulting the
receiver.
• Administrative coordination:
- The transfer of staff from federal employment to other tiers continues to be
contentious.

- low morale due to undemocratic hierarchy: Medical officer of PHCC and
primary hospital is senior than health section chief of LL as well as HO chief,
MoSD/PMoHp secretary vs HD director, Hospital Me.Su. Etc.
• Confusing roles and responsibilities of Federal, State and LL.

Way Forward
• Formulate federal act to build proper coordination mechanism.
• Need based programme planning and implementation.
• Programme guidelines and Akthiyari should be prepared and send in time.
• Hierarchy and seniority of HRH should be ensured.
• HRH should be deputed and transfer as per the need of province and local level.
• Interaction programme should be organized regularly between 3 tier of government.
• Roles and responsibilities of federal, state and local level should be clarified.

References
• Neupane, P., Bhandari, D., Tsubokura, M., Shimazu, Y., Zhao, T., & Kono, K. (2021). The Nepalese health care
system and challenges during COVID-19. Journal of global health, 11, 03030. https://doi.org/10.7189/jogh.11.03030
• conomicsdiscussion.net/management/coordination/type-of-coordination/31960
• https://kathmandupost.com/columns/2019/12/15/health-systems-in-federal-nepal-challenges-and-opportunities
• https://mohp.gov.np/en/about-us/divisions/health-coordination-division/provincial-local-health-coordination
• https://mohp.gandaki.gov.np/pages/organogram
• https://hd.gandaki.gov.np/

THANK YOU !

Current co-ordination mechanism of health system in Nepal

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