The document discusses international health and globalization. It introduces concepts in international health like equity, poverty, environment, culture, and urbanization. It then discusses the history of international health organizations like the First International Sanitary Conference in 1851 and the establishment of WHO, UNICEF, and other agencies. Globalization is defined and its positive and negative impacts on health are described. The roles of WHO, World Bank, and other multilateral organizations in health promotion in Nepal are also summarized.

1. 12/16/2015 1

2. 12/16/2015 2

3. Nothing on earth is more international
than diseases
-Paul Russel
12/16/2015 3

4. IntroductionIntroduction
International Health is the study of health
issues that affect people living in the
developing world.
Deals with health across regional or
national boundaries.
Immunization, prophylactic medication,
post travel care, quarantine.
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5. Why International HealthWhy International Health
Health is an international concern because problem
in a part of the global affects to the other part.
Health problem can be solved or minimized through
joint efforts between the national or global efforts.
Experiences of one nation can be useful to other; eg
Malaria control program.
There has been raising relationship between the
nations (global relation) affecting health of one or
other.
12/16/2015 5

6. Concepts of International HealthConcepts of International Health
Equity and Health
Poverty and Health
Environment and Health
Culture and Health
Urbanization and Health
12/16/2015 6

7. Equity and HealthEquity and Health
The world’s resources are unequally
distributed.
 Disparities in health within and between
countries.
To reduce such disparities will require a
more equitable distribution.
12/16/2015 7

8. Inequalities can be illustrated between
countries of varying socioeconomic Profiles.
 Developing countries are susceptible to early
death, infant mortality, illness, and other poor
health indicators.
 Causes of these negative health outcomes:
living conditions marked by poverty, poor
shelter, and inadequate sanitation.
12/16/2015 8

9. Poverty and HealthPoverty and Health
The differences can be attributed primarily to
variation between urban and rural areas.
 Rural areas have barriers to health care,
education and employment.
 Urban have greater access to safe water and
sanitation.
12/16/2015 9

10. Environment and HealthEnvironment and Health
Developed countries are affected by
problems of pollution from air, water, and
noise.
 Health hazards created by industrialization,
urban growth, and quality of housing.
Inadequate sanitation— lack of safe water,
facilities for the disposal of solid wastes,
control of disease vectors, food safety, and
satisfactory housing.
12/16/2015 10

11. Culture and HealthCulture and Health
Sociocultural factors : These factors include
health-related beliefs about food, pregnancy,
childbirth, diseases, and sanitation practices.
Excessive consumption of food, alcohol, tobacco,
and drugs.
 Chronic or prolonged exposure to stress can
lead to hypertension, coronary heart disease, and
other impediments to health.
12/16/2015 11

12. Urbanization and HealthUrbanization and Health
Shift of populations from rural regions to urban
areas.
Individuals anticipate better jobs, education,
social services and other new opportunities.
Overcrowded and highly contaminated areas like
slums and shanty towns stricken with poverty.
Noise, traffic, and air pollution.
Effects of urbanization- greenhouse gas
emissions, ozone depletion, land degradation, and
coastal zone destruction. 12/16/2015 12

13. In order to protect against spread of diseases,
from one country to another, many attempts
were made in the past-like isolation of
travelers, quarantine etc.
International conferences were held &
organizations were set up for discussion,
agreement & cooperation on matter of
International health
12/16/2015 13

14. History/ Evolution of International health
12/16/2015 14

15. First International SanitaryFirst International Sanitary
Conference(1851)Conference(1851)
1st
International Sanitary Conference.
Objective: introduce order & uniformity into
quarantine measures.
Preparation of International Sanitary Code –
137 articles.[Cholera, Plague & Yellow Fever)
12/16/2015 15

16. Pan American ScientificPan American Scientific
Bureau(1902)Bureau(1902)
World’s first international health agency
Primarily intended to coordinate quarantine
procedures in American Societies.
1924 important document signed by
American Republic “the Pan American
Sanitary Code”
1947 bureau was renamed- Pan American
Sanitary organization(PASO)
1958 –named as PAHO
Head quarters: Washington DC
12/16/2015 16

17. Office International D‘HygieneOffice International D‘Hygiene
Publique (1907)Publique (1907)
Disseminate information on
communicable disease
Supervise international quarantine
measures
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18. Health Organization of League ofHealth Organization of League of
NationsNations
1923 established
To build a better world
Included “health organization to take steps
in matter of international concern for the
prevention and control of disease”
Worked in quarantine regulation,
epidemiological information, problems of
epidemic diseases, nutrition, rural hygiene,
training of public health workers
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19. The United Nations Reliefs andThe United Nations Reliefs and
Rehabilitation Administration 1943Rehabilitation Administration 1943
Recovery of World war
Care for health of displaced people
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20. Major areas in INH
Prevention and control of specific
diseases
Development of comprehensive health
services
Family health
Environmental health
Health statistics
Biomedical research
12/16/2015 20

21. GlobalizationGlobalization
Past and present
12/16/2015 22

22. Definitions of GlobalizationDefinitions of Globalization
A process by which nations, business and people
are becoming more connected and
interdependent across the globe through
increased economic integration and
communication exchange, cultural diffusion and
travel.
Globalization can be described as ‘…a widening,
deepening and speeding up of worldwide
interconnectedness in all aspects of
contemporary social life, from the cultural to the
criminal, the financial to the spiritual’ (Held and
McGrew 1999) 12/16/2015 23

23. Jan Aart Scholte (2000: 15-17) has argued thatJan Aart Scholte (2000: 15-17) has argued that
at least five broad definitions of 'globalizationat least five broad definitions of 'globalization’’
Globalization as internationalization
Globalization as liberalization
 Globalization as universalization
Globalization as westernization or
modernization
Globalization as deterritorialization- or as the
spread of supraterritoriality
12/16/2015 24

24. Aspects of Globalization-Aspects of Globalization-
Economic
Technological
Cultural
Political
Military
Health ( to be discussed exclusively)
12/16/2015 25

25. GlobalizationLiberalization
Deregulation
Cross border flows
Foreign Investment
Increased Trade
Privatization
All Services No subsidy No Preventive care
Increase Household Income
High Cost Red.Accessibility
Health
HIV Tob
DV
Medicalization
12/16/2015 26

26. Positive impact on HealthPositive impact on Health
There is a link between income and
health outcomes.
Rising income leads to
◦ better nutrition
◦ lower child mortality
◦ better maternal health and
◦ better female education
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27. Adverse effect on HealthAdverse effect on Health
Users fee : reduces the
accessibility of health facilities in
low income countries, in the studies
of several countries , utilization of
Health facilities dropped by 30%.
Increase in the prices of basic
drugs.
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28. Adverse effect on HealthAdverse effect on Health
Less or no preference to
preventive health care: as it is
not profit making
Erosion of Government health
structures: Non maintenance of
the public facilities and drain of
human resources to private sector
in search of more profit
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29. Adverse effect on HealthAdverse effect on Health
Cash crops replacing food crops:
Area of rice plantation in Philippines, in
the 20 years period 500000 hectors of
Rice land have been converted into
commercial crops.
During 1989 - 1994 in Russia: Crude
Death rate increase by 45%, life
expectancy of male decrease from 65 to
58,There was increase in 20000 deaths
in Russia,who could live longer if Russia
could not transfer to capitalism
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30. NepalNepal
Few Examples only
Commercialization of the means of
family Planning: Dhal ,Gulaf,
Sangini etc.
Sell of ORS, “Sutkeri Samagri”, cut
in subsidy
Introduction of User’s fee in public
health facilities
Privatization of Curative health:
increase availability of Modern
technologies & its Irrational use
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31. Role and contributions ofRole and contributions of
Multilateral agencies: (WHO, UNICEF,
UNFPA, World Bank, ADB, SAARC)
Bilateral partners (USAID, GIZ, DFID,
SDC)
Other health-related international
organizations in health promotion and
disease prevention programs in Nepal
12/16/2015 32

32. Multi lateral AgenciesMulti lateral Agencies
WHO
UNICEF
UNFPA
UNDP
ADB
World bank
SAARC
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33. 12/16/2015 34

34. ANAN INTRODUCTIONINTRODUCTION
The work of WHO affects the
lives of every person on this
planet, every day. From the food
we eat and the water we drink, to
the safety of the medications we
take, and the prevention and
control of the disease that
threaten. 12/16/2015 35

35. The World Health Organization
(WHO) is the international agency
within the United Nations’ system
responsible for health. WHO experts
produce health guidelines and
standards, and help countries to
address public health issues. WHO
also supports and promotes health
research. Through WHO,
governments can jointly tackle global12/16/2015 36

36. 194 countries and two associate
members are WHO' s membership.
They meet every year at the
World Health Assembly in Geneva
to set policy for the organization,
approve the Organization' s
budget, and every five years, to
appoint the Director- General.
Their work is supported by the
Health Assembly. Six regional12/16/2015 37

37. A shORT hIsTORy TO TheA shORT hIsTORy TO The
AChIevemeNTsAChIevemeNTs
When diplomats met in San Francisco
to form the United Nations in 1945,
one of the things they discussed was
setting up a global health organization.
WHO’s Constitutions came into force
on 7 April 1948 - a date we now
celebrate every year as World Health
Day. Delegates from 53 of WHO’s 55
original member states came to the
12/16/2015 38

38. • 1948: International Classification
of Disease
• 1952 – 1964: Global Yaws Control
Program
• 1974: Onchocerciasis Control
Program
• 1979: Eradication of Smallpox
• 1988: Global Polio Eradication
Initiative Established
• 2003: WHO Framework
Convention on Tobacco Control12/16/2015 39

39. PRIORITIzATION Of PROgRAms INPRIORITIzATION Of PROgRAms IN
NePAlNePAl
• Demography
• Economy
• Poverty and Human Development
• Education
• Nutrition
• Food Security
• Social and Health Inequity
• The conflict 12/16/2015 40

40. • Vulnerability and Disaster
• Governance and Public Sector Reform
• Epidemiology and Disease Burden
• Health Policy Orientation and Priorities
• Decentralization of Health Services
• Health Financing
• Human Resource
• Summary of Health Challenges and
Opportunities
- Health system including HRH
- Disease control, environmental and
emergency health
- Maternal and Reproductive Health
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41. WhO CORe fUNCTIONsWhO CORe fUNCTIONs
Providing leadership on matters critical to
health and engaging in partnerships where joint
action is needed;
• Shaping the research agenda and stimulating
the generation, translation and dissemination of
valuable knowledge;
• Setting norms and standards, and promoting
and monitoring their implementation;
• Articulating ethical and evidence- based policy
options;
• Providing technical support, catalyzing change,
and building sustainable institutional capacity;
• Monitoring the health situation and assessing
health trends.
12/16/2015 42

42. hOW DOes WhO sPeND ITshOW DOes WhO sPeND ITs
mONey?mONey?
The World Health Assembly has approved a budget which
divides WHO’s spending into 4 interdependent categories:
1. essential health interventions (such as response to epidemic
alerts and reduction of maternal and child mortality);
2. health systems, policies and products (such as the quality
of medicines and technologies);
3. determinants of health (such as nutrition and tobacco-
use); and
4. effective support for Member States (such as increasing
investment in knowledge management and information
technology and ensuring staff security).
12/16/2015 43

43. esTImATeD exPeNDITUReesTImATeD exPeNDITURe
Essential health interventions (53
%)
Effective support for Member
States (21 %)
Health policies, systems and
products (13 %)
Determinants of health (11 %)
12/16/2015 44

44. WORLD BANK
12/16/2015 45

45. IntroductionIntroduction
Conceived in 1944 to reconstruct war-
torn Europe, the world Bank has evolved
into one of the world’s largest sources of
developmental assistance, with a mission
of fighting poverty with passion by helping
people help themselves.
A vital source of financial and technical
assistance for developing countries
around the world.
12/16/2015 46

46. ObjectivesObjectives
To fight poverty with passion and professionalism
for lasting results. To help people help themselves
and their environment by providing resources,
sharing knowledge, building capacity, and forging
partnership in the public and private sectors.
To promote sustainable private sector investment
in developing countries, helping to reduce poverty
and improve people’s lives.
To promote foreign direct investment into
developing countries to help support economic
growth, reduce poverty, and improve people’s
lives.
12/16/2015 47

47. The world bank group consists ofThe world bank group consists of
The International Bank for
Reconstruction for Development(IBRD) .
The international Development
Association (IDA).
The international Finance Cooperation
(IFC)
The Multilateral Investment Guarantee
Agency(MIGA).
The International Centre for Settlement
of Investment Disputes (ICSID).
12/16/2015 48

48. The World Bank Group is involvedThe World Bank Group is involved
inin
Agriculture and Rural Development
Aid Effectiveness
Combating Corruption
Conflict Prevention and reconstruction
Debt relief
Economic research and data
Education
Empowerment and participation
12/16/2015 49

49. CONT…….CONT…….
Energy and mining
Environment
Financial sector
Gender
Globalization
Governance
Health, nutrition and population
Indigenous peoples
12/16/2015 50

50. Cont..Cont..
 Information and communication technologies infrastructures
 Labor and social protection
 Law, regulation, and judiciary
 Manufacturing and services
 Poverty
 Private sector development
 Social development
 Sustainable development
 Trade
 Transport
 Urban development
 water
12/16/2015 51

51. However world bank isHowever world bank is
The world's largest funder of education
The world’s largest external funder of the
fight against HIV/AIDS
A leader in the fight against corruption
world wide
A strong supporter in debt relief
The largest international financier of
biodiversity project
The largest international financier of water
supply and sanitation projects
12/16/2015 52

52. Funding policiesFunding policies
Offers two basic types of funding
instruments
1) Investment Loan
2) Development policy Loan
World Bank provides fund to a member
country depending on it’s eligibility
through either IBRD or IDA
12/16/2015 53

53. Lending operation are developed in the “
World Bank Project Cycle”
12/16/2015 54

54. Involvement of World Bank inInvolvement of World Bank in
NepalNepal
Health 50 million
Peace Project 50 million
Water 27 million
Rural Poor People Support 253 million
 Second Higher Education Project 80 million
Nepal Combats Avian Influenza 18 million
Poverty Alleviation Fund 25 million
Economic reforms 3 million
12/16/2015 55

55. Roles and contributionsRoles and contributions
To provide low-interest loans, interest-free credit
and grants to developing countries for education,
health, infrastructure, communications and many
other purposes.
Efforts are coordinated with wide range of
partners, including government agencies, civil
society organization other aid agencies and the
private sector.
The Bank group’s work focuses on the
achievement of the millennium development goals.
To address issues related to gender, community
development, indigenous people.
12/16/2015 56

56. 12/16/2015 57

57. UNICEF IN NEPAL 2008-2010UNICEF IN NEPAL 2008-2010
UNICEF celebrated 40 years of work in Nepal
in 2008
UNICEF’s three year programme(2008-2010)
are aligned with the Interim plan to help
achieve the development goals stated within it.
The 2008-2010 programmed is focused on the
poorest and most excluded, including young
people impacted by the conflict.
12/16/2015 58

58. prioritizationprioritization
One approach – six programmes in Nepal
DACAW(decentralised action for children and
women)
Child protection
Education
Health and nutrition
HIV/AIDS
Wash
Social policy
12/16/2015 59

59. DACAWDACAW
This approach is UNICEF’S PRIMARY Vehicle
for directing a range of interventions to rural
communities across Nepal
It aims to strengthen the capacity of individuals
and communities
Ministry of local Development is the lead
implementing agency, along with other
ministries
Focus on the most disadvantaged communities
in 23 of the75 districts in Nepal
12/16/2015 60

60. Child protectionChild protection
Child protection systems eg.village and
district paralegal committees
Children affected by Armed conflict
Legislation and policies for child
protection
12/16/2015 61

61. educationeducation
Early childhood development
Formal primary education
Non formal primary education
Peace education and emergency
education
12/16/2015 62

62. Health and NutritionHealth and Nutrition
Child survival
Maternal health
Nutrition
National health sector support
12/16/2015 63

63. HIV/AIDSHIV/AIDS
Prevention of mother to child
transmission
Paediatric HIV/AIDS treatment
Adolescent HIV/AIDS prevention
Protection and care for children affected
by HIV/AIDS
12/16/2015 64

64. washwash
Quality water supply
Environmental sanitation and hygiene
National district level sector support
12/16/2015 65

65. Social policySocial policy
Policy and institutional support
Child rights promotion
Monitoring and evaluation
12/16/2015 66

66. Roles and contributions of UNICEFRoles and contributions of UNICEF
Strengthening communities through
decentralization in favour of children and
women
 building an environment that protects
children against violence, exploitation and
abuse
12/16/2015 67

67. Contd…Contd…
Build the capacity of paralegal committees,
women's federations and child clubs to raise
awareness of early intervention, reconciliation
and mediation and advocate against violence,
exploitation and abuse
Increase access to quality basic education,
especially for girls and disadvantaged group
12/16/2015 68

68. Improve maternal health, reduce childhood
morbidity through improved management of
childhood illness due to ARI, diarrhoea and
vaccine preventable diseases
Expanding a newborn health package which
include treatment of severe neonatal infection,
birth asphyxiation,hypothermia
12/16/2015 69

69. Promotion of breast feeding
The national immunization programme is
supported to achieve universal coverage
Supplementary campaigns for measles
and polio are carried out nationally
12/16/2015 70

70. Fifteen emergency obstetric cares services are
provided in 8 districts
Increase skilled attendance at birth in DACAW
district
Vit.A supplements and de-worming tablets are
provided bi- annually to 3.4 million children
Iron supplements for pregnant and breast
feeding mothers
12/16/2015 71

71. Reduce incidence of diseases from inadequate
sanitation and water supply
Install sanitary, child friendly toilets, separate
for girls and boys and safe drinking water
facilities, in 450 schools
Student have knowledge and skill to maintain
the cleanliness of sanitation and practice of
proper hand washing, through the formation of
child clubs and training and hygiene campaign
12/16/2015 72

72. Emergency preparedness and response
Increase awareness of HIV/AIDS prevention
Raise awareness among policy makers, the
media and the general public through popular
radio initiative SSMK, broadcasting to millions
of children on issues concerning them
12/16/2015 73

73. FUNDING POLICYFUNDING POLICY
The full three year programme is
budgeted at USD 68,214,000
 of which USD 20,214,000 has been
allocated internally
 USD 48,000,000 is required to be raised
from donors over the three years
12/16/2015 74

74. United Nations Fund for
Population Activities
(UNFPA)
12/16/2015 75

75. 12/16/2015 76
Organisational BackgroundOrganisational Background
UNFPA, the United Nations Population Fund, is an
international development agency that promotes the
right of every woman, man and young people to
enjoy a life of health and equal opportunity.
UNFPA supports countries in using population data
for policies and programmes to reduce poverty and
to ensure that every pregnancy is wanted, every
birth is safe, every young person is free of HIV/AIDS,
and every girl and woman is treated with dignity and
respect.

76. 12/16/2015 77
Organisational BackgroundOrganisational Background
UNFPA assists developing countries, countries with
economies in transition and other countries on their
request.
Established in 1969,
 it is currently assisting 140 Countries and is the
largest multilateral source of population assistance.

77. 12/16/2015 78
Organisational BackgroundOrganisational Background
UNFPA started its assistance to GoN from
early 1970s, has supported implementing
five country programme cycles
corresponding to GoN 6th
, 7th
, 8th
, 9th
and 10th
developmental plans.

78. 12/16/2015 79
AreaArea
Improve Access to Reproductive Health
(Implementing partner Family Health Division/DoHS)
Strengthen NationalTraining and
Management Capacity (implementing partners- National
HealthTraining Centre and Management Division)
Increasing Awareness on RH and Gender
Issues (Implementing partner National Health Education, Information
and Communication Centre)

79. 12/16/2015 80
AreaArea
Besides the Country Programme other
projects being supported by UNFPA is :
Parenthood Project in partnership with
Rotary Club through Hospital and
Rehabilitation Centre for Disabled Children
(HRDC).

80. 12/16/2015 81
STRATEGIESSTRATEGIES
 UNFPA support to Nepal is designed to complement the
activities of other providers of RH care and most importantly
those of Government of Nepal in line with the Nepal Health
Sector Programme Implementation Plan (NHSP-IP) and is also
designed to have a catalytic and synergetic role in improving
RH and in exploring and developing innovative approaches.

81. 12/16/2015 82
STRATEGIESSTRATEGIES
A key strategy of UNFPA is to assist DoHS to
develop its human resource needs and capacity both
for delivery of quality RH services and management
of RH programmes. UNFPA is considering to
contribute to the pool fund of the Nepal Health
Sector Strategy.

82. United Nation DevelopmentUnited Nation Development
Programme (UNDP)Programme (UNDP)
12/16/2015 83

83. UNDP is the UN's global
development network, an
organization advocating for change
and connecting countries to
knowledge, experience and
resources to help people build a
better life.
It is on the ground in 166
countries, working with them on
their own solutions to global and
national development challenges.
12/16/2015 84

84.  World leaders have pledged to achieve
the Millenium Development goals,
including the overarching goal of
reducing poverty in half by 2015. UNDP's
network links and coordinates global and
national efforts to reach these Goals.
UNDP focus is helping countries build
and share solutions to the challenges of:
 Democratic Governance
 Poverty Reduction
 Crisis Prevention and Recovery
 Energy and Environment
 HIV/AIDS
12/16/2015 85

85. UNDP in NepalUNDP in Nepal
UNDP first established its office in Nepal in
1963 to support the Nepalese in their struggle
against poverty.
Since 1963, UNDP has worked at building
linkages that address effective design and
implementation of 'poverty alleviation'
programmes in Nepal.
12/16/2015 86

86. Geographical focusGeographical focus
UNDP's activities span almost 75 districts
and 1,000 out of 4,000 villages.
 The number of projects ranged from 25
and currently consolidated into 16. Some of
them are being closed by mid 2008 with the
completion of past cooperation.
However, about 10 new programmes are
expected to be formulated in line with the
newly approved Country Programme
12/16/2015 87

87. Current Programme prioritiesCurrent Programme priorities
Transitional Governance
Inclusive Growth & Sustainable
Livelihood
Peace Building and Recovery
Energy, Environment and Natural
Disaster Management
HIV/AIDS
12/16/2015 88

88. Type of assistance and programmingType of assistance and programming
 The Country Cooperation Framework (CCF-I, 1997-
2001) for Nepal was designed in consistence with the
Government's Ninth Development Plan (1997-2001) and
UNDP's mandate.
 UNDP's Country Cooperation Framework (CCF II, 2002-
2007) has completed its programming cycle of six years
which addressed poverty alleviation by supporting
development projects in the areas of Democratic
Governance, Pro-Poor policies and Sustainable Livelihood,
Energy, Environment and Natural Disaster Management,
Crisis Prevention and Recovery (CPR) and Responding to
HIV/AIDS.
12/16/2015 89

89. In early 2008, UNDP approved its Country
Programme Document (CPD) for 2008-
2010 in support of the Interim
Development Plan of the Government of
Nepal
12/16/2015 90

90. ResourcesResources
UNDP is funded from its own regular
resources, other United Nations sources
of financing, and from bilateral and other
external donors.
During the period of 2002-2007, UNDP's
assistance reached to $US 84 million
including the resources mobilized from
bilateral donors.
12/16/2015 91

91. For the current Country Programme Action
Plan (CPAP) period of 2008-2010, UNDP
together with its donor partners expects to
provide assistance worth of US$94.0 million.
Of this $25 million is expected to be from
UNDP's regular source.
12/16/2015 92

92. Of the total programme delivery of US$ 27
million through the 33 ongoing projects in
2007, 32 percent was from UNDP
resources, 18 per cent from Global Fund
for AIDS, Tuberculosis and Malaria
(GFATM), Global Environment Facility
(GEF), UN Peace Fund and other Thematic
Trust Funds, 2 percent from United
Nations Capital Development Fund
(UNCDF) and 48 percent from bilateral
donors
12/16/2015 93

93. SAARC South Asian Association forSAARC South Asian Association for
Regional DevelopmentRegional Development
Economic and geographic organisation of
eight countries
SAARC provides its charter, summit
declaration, activities, events and
publication for the socio-economic
development of member countries
Nepal has embarks on a NPR 180 million
plan to renovate and beautify the capital
for the upcoming 18th
SAARC summit
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94. Asian Development Bank (ADB)Asian Development Bank (ADB)
Fighting poverty in ASIA and the pacificFighting poverty in ASIA and the pacific
Nepal has made notable socioeconomic
progress over the years, particularly in
the areas of poverty incidence, and
meeting a majority of the MDGs Which
are likely to be met by 2015.
ADB’s country partnership strategy,
2013-2017 supports the government’s
development objective of acclerated and
inclusive economic growth.
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95. It seeks to address the infrastructure
bottlenecks in the areas of
Energy
Air
Road and transport
Water supply and sanitation and
irrigation
Business
Employment opportunities
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96. Areas of cooperationAreas of cooperation
 Agriculture and rural
 Biotechnology
 Culture
 Economic trade
 Education
 Energy
 Environment
 Finance
 Information, communication and media
 Poverty alleviation
 Science and technology
 Security aspects
 Social development
 Tourism
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98. Bilateral partnersBilateral partners
USAID,
GIZ,
DFID,
SDC
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99. USAIDUSAID
Introduction: In September 1997, the United
States Agency for International Development
(USAID) signed a bilateral Strategic Objective
(SO) Agreement with HMG for a five-year period
(1997-2002). Our programme includes activities
not only with the MOH but also with the NGO
and private sectors. The SO agreement focuses
on four major sectors, including:

• family planning (FP);
• maternal and child health (MCH);
• prevention and control of HIV/AIDS/STIs; and
• control of infectious diseases.
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100. To implement these programmes, USAID
has an annual budget of up to $17 million
(USAID/Washington plus bilateral funds)
to support technical assistance, training,
IEC and the purchase of essential
commodities. Below is a brief summary
of each of the USAID programmes in the
four sectors.
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101. GTZ: Primary Health CareGTZ: Primary Health Care
Project (PHCP)Project (PHCP)
Since 1994, the Primary Health Care Project (PHCP) has
been supporting His Majesty’s Government of Nepal,
Ministry of Health in the implementation of the
National Health Policy adopted in 1991, which stresses
improving primary health care services in the country.
In order to improve the health situation, especially of
rural communities, the National Health Policy
emphasises community participation, decentralisation,
integration of traditional health care providers,
establishment of health facilities at the community level,
development and management of health manpower,
promotion of private, non-government and
intersectoral co-ordination and resource mobilisation.
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102. ACHIEVEMENTSACHIEVEMENTS
1. Developing a District Health System
 Community participation in health planning
and renovation of health facilities
 Street Drama training to increase health
awareness
2. Developing Managerial Capacity
 Development of the Human Resource
Development Information System
(HuRDIS)
 Integration of gender-disaggregated data
into the Management Information System
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103. 3. Improving the Quality of Training
 Development of an operational plan for
the National Health Training Centre
(NHTC)
 Functional analysis of the National
Health Training Centre (NHTC)
4. PHCP AND THE FUTURE
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104. DEPARTMENT FORDEPARTMENT FOR
INTERNATIONAL DEVELOPMENTINTERNATIONAL DEVELOPMENT
(DFID)(DFID)
The Department for International
Development (DFID)’s aim is the
elimination of poverty in poorer
countries. Specific objectives include:
a)policies and actions which promote
sustainable livelihoods;
b)b) better education, health and
opportunities for poor people; and
c)c) protection and better management of
the natural and physical environment.
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105. AREAS OF TECHNICAL ANDAREAS OF TECHNICAL AND
GEOGRAPHICAL SUPPORTGEOGRAPHICAL SUPPORT
British Embassy providing technical
programme support and technical staff on
the Safer Motherhood and District Health
projects.
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106. Roles and contributionsRoles and contributions
DFID has contributed to continuing increases in
contraceptive prevalence.
Its contribution is flexible and not tied to any
particular commodity, helping to reduce stock-
outs.
In Safer Motherhood, on-site whole-team training
has been completed in some areas (infection
control), appropriate referral rates are increasing,
the increasing access component is making
progress on reducing barriers to access, and
physical improvements work has started.
District Health Strengthening
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107. SWISS AGENCY FOR DEVELOPMENT ANDSWISS AGENCY FOR DEVELOPMENT AND
COOPERATION (SDC)COOPERATION (SDC)
The Rural Health Development Project (RHDP)
is a bilateral project of Government of Nepal and
the Swiss Agency for Development and
Cooperation.
The overall goal of the project is to contribute to
improving the health status of women, girls, boys
and men through participatory development of a
locally adapted and affordable health system.
The primary objective of the project is to
empower women, girls, boys and men to enhance
their health conditions and have access to
improved comprehensive health services at the
local level.
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108. Roles and ContributionsRoles and Contributions
Promotive Health Activities
Community Initiatives:
Strengthening the Local Health
System
Promotion of Drug Scheme
Skill Development of Health Workers
Coordination and Alliance-Building
Integration of Gender Balanced
Approach
AIDS Awareness
Reactivation of Jiri Hospital
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109. Other health-related international organizationsOther health-related international organizations
in health promotion and disease preventionin health promotion and disease prevention
programs in Nepalprograms in Nepal
UNITED MISSION TO NEPAL (UMN)
SAVE THE CHILDREN FUND (U
NETHERLANDS LEPROSY RELIEF (NLR)
COOPERATIVE FOR ASSISTANCE AND
RELIEF EVERYWHERE (CARE)
BRITAIN NEPAL MEDICAL TRUST (BNMT)
KREDITANSTALT FÜR WIEDERAUFBAU
(KfW) THE GERMAN DEVELOPMENT BANK
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110. FAMILY PLANNING ASSOCIATIONFAMILY PLANNING ASSOCIATION
OF NEPAL (FPAN)OF NEPAL (FPAN)
The Family Planning Association of Nepal (FPAN)
came into existence in 1959. Beginning with three
districts in its early years, today it covers 42 of
Nepal's 75 districts.
Given its extensive coverage, innovative
programmes and its ability to provide
comprehensive RH/FP services, the Association is
regarded as the leading NGO working in
reproductive health.
FPAN acquired joint membership of the
International Planned Parenthood Federation
(IPPF) in 1960 and full-fledged membership in
1969.
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111. STRATEGIESSTRATEGIES
To provide FP services based on informed
choice, with particular emphasis on spacing
methods, as well as to provide basic mother and
child health services for safe motherhood and
child survival.
To strengthen advocacy for increasing
governmental and public awareness
To develop and implement an information,
education and motivation (IEM)
To develop and implement a continuing
programme of orientation and training for
various categories of volunteers and staff of the
Association
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112. NEPAL RED CROSS SOCIETYNEPAL RED CROSS SOCIETY
AAMAA MILAN KENDRA
(MOTHERS CLUB)
NEPAL CRS COMPANY
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113. Difference between bilateralDifference between bilateral
and multilateral donorsand multilateral donors
Bilateral aid usually refers to assistance given
directly from a donor government to a recipient
country. The donor government may provide this
assistance directly to the recipient government
or to non-governmental institutions operating in
the recipient country. This aid is sometimes
managed by a government agency charged with
this task.
Multilateral aid means between more than two
parties. This is used where a donor country
sends funds to multilateral organization such as
the World Bank and the United Nations, which in
turn administer aid donations to several recipient
countries.
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114. Bilateral flows are provided directly by a
donor country to an aid recipient
country.
Multilateral flows are channeled via an
international organization
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115. 12/16/2015 116

116. • The main difference between multilateral and
bilateral aid is related to the way in which funds
are transferred.
• In bilateral aid, it is country to country, and in
multilateral, it is unearmarked aid from countries
to multilateral agencies, such as the Word Bank,
European Union, and the United Nations, and
then to recipient countries. This is a crucial
difference because in the case of bilateral aid
individual countries are the only one to decide
whom to give money to, and for which purpose.
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117. Given the different nature of these two types of aid, one expects that multilateral aid
is more appropriate for developing purposes for the following reasons:
--Higher participation and resources: Multilateral aid encourages donor countries
to get together and donate. Small donations by itself maybe insignificant at the
global scale, but when combined with donations from many countries through
international organizations can become significant and help those countries in
need.
--Political neutrality and needs-driven: Multilateral aid tends to be less tied to the
political and strategic interests of individual donor countries and consequently is
able to focus more on the needs of poor countries. One can expect that
multilateral aid will help, in particular, in fragile and/or post-conflict societies,
especially when it takes the form of humanitarian assistance and post-conflict
reconstruction.
--Global governance: Multilateral aid, when delivered through international
organizations, will tend to adhere to widely-shared principles, standards, and
procedures. This will deepen the understanding that many of these problems are
not local, but global, and therefore have to be tackled by the corresponding
institutions and mechanisms. A corollary to that is that these institutions and
mechanisms will have to be strengthened, so as to be able to perform effectively
the assigned tasks.
.
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118. Concerning other aspects mentioned in the literature it is very difficult, at theoretical level, to
say if multilateral aid is better than bilateral for development proposes. For example it has
been said that multilateral aid allows for a more efficient allocation of resources than
bilateral aid. This is mainly due to the fact that international organizations possess specialized
professionals in the field which are unmatchable by any single country in the world and this
will allow for reduction in time and costs. However, this is questionable because the cost of
running a large scale organization can be extremely high because of the high level salaries
required to pay the trained personnel and the expenses of keeping the organization running.
In addition, turning to the time dimension, when aid funds are collected and managed by an
international organization some of these funds are often delayed and less of the funds reach
the intended destination.
The literature also states that multilateral aid is better that bilateral for development
proposes because it tends to avoid unnecessary coercive conditions on the recipient
countries. One of the strongest criticisms of bilateral aid is the tendency for donor's
countries to place strict political and economic conditions on the recipient counties.
However, multilateral aid has the potential to be equally or more coercive than bilateral aid.
The IMF austerity programs and structural adjustment policies in the developing countries is
an example of imposing harmful conditions on the recipient countries
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119. Thank you…….
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