federal level planning

1. Federal Level
Health Planning
in Nepal
Presented By:
Babita Shrestha
MPH/PHSM : 2nd Sem
SHAS, Pokhara University
2/4/2024 MPH II semester 1

2. Presentation Outline
• Introduction
• Functions of Policy and Planning Section
• Institutions and entities involved
• Relationship between three tiers of government
• Fiscal federalism
• Annual Health Planning and Budgeting Process at Federal Level
• Medium term expenditure framework (MTEF)
• Issues and challenges
• Conclusion
• References
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3. Introduction
• Planning is in essence, an organized, conscious and continual attempt to
select the best available alternatives to achieve specific
goals (Waterston et al., 1965)
• Nepal started development planning in 1956, after the demolition of the
Rana Regime which has been considered as the first turning point in
economic development of Nepal.
• The Constitution of Nepal 2015 changed the governing system of Nepal
from unitary to a three-tier federal structure constitutionally deriving
the role and responsibilities of each tier.
• Federal government begins to plan, this usually leads to the
establishment of planning machinery at the provincial level and local
level.
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4. Planning at Federal Level
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5. Functions of Policy and Planning
Section
• Formulate long, medium and short-term policies, strategies, plans,
guidelines, SOPs, protocols for federal, provincial and local health
related issues.
• Formulate general and development budget for the MoHP and the
offices under it.
• Economic evaluation of health programs, cost-effectiveness, cost benefit
analysis (CBA) and cost-effectiveness (CUA) analysis.
• To study the utilization potential of foreign aid received in the health
sector.
• Formulate and implement a policy on health financing and national
health accounting.
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6. Institutions and entities involved in the
planning process of Nepal
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Figure: Flow of national policy framework by the responsible
agencies.
Source: Dipak Bahadur Adhikari, 2021

7. Institutions and entities involved in the
planning process of Nepal
1) National Development Council (NDC)- to provide broad direction for
the planning.
2) National Planning Commission- to formulate the Plans on the basis
of direction provided by NDC.
3) Line Ministries- to set the sectoral targets, sectoral priorities,
strategies, objectives and working policies.
4) Ministers’ Council (Cabinet)- to approve and execute the plan.
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8. Institutions and entities involved in the
planning process of Nepal
5) Ministry of Finance- It is responsible for executing fiscal transfers
through the federal budget as per the recommendations of the NNRFC.
The MoF is the key institution responsible for preparing and
implementing the federal budget.
6). National Natural Resources and Fiscal Commission (NNRFC): is an
independent entity constituted by the Constitution for estimating fiscal
resources particularly for fiscal transfers and determining the basis for
distribution.
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9. National Planning commission
The National Planning Commission (NPC) is the apex advisory body of
the Government of Nepal for formulating a national vision, periodic plans
and policies for development.
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10. National Planning commission
• The National Planning Commissions’ roles will be policy formulation,
suggestion and regulation for overseeing the provincial and Local Level
particularly in monitoring, supervision and evaluation in plan
implementation.(Adhikari, 2021)
• The NPC leads the entire planning preparation.
• It assesses resource needs, identifies sources of funding, and allocates
budgets for socio-economic development.
• To provide guidelines to collect data and to carry out action-oriented
research necessary for the evaluation of new policies and for the refinement
of the planning process.
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11. Structure of National Planning
Commission
Chairman: Prime Minister
One full time Vice-Chairman: Government Appointee
Member: Six Government Appointees including at least one female
Ex-Officio Member: Chief Secretary
Ex-Officio Member: Secretary, MoF
Member Secretary: Secretary, NPC
Central Bureau of Statistics (CBS), functions as a specialized entity of
the NPC Secretariat, headed by a Director-General.
Source: (National Planning Commission Formation Order, 2074)
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12. Relationship between three tiers of government
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13. Pillars of Fiscal Federalism
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14. Key Achievement of Fiscal Federalism
• Expenditure assignment is provided by the Constitution.
• Provincial revenue powers are codified in the Constitution:
• A system of fiscal transfers is in place.
• The principle of equity is applied in fiscal transfers.
• Provincial revenue has been increasing.
• A mechanism for revenue-sharing and the sharing of royalties from
natural resources has been established.
• Limits for internal debt have been introduced.
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16. Horizontal Relation in Plan Formulation
• In the process of planning, each tier of the government will have to consult
the government ministries and departments, unit offices and other
development stakeholders established within the jurisdiction of the
respective governments.
• The National Planning Commission will coordinate/consult with the
NNRFC, the MoF and other federal ministries and departments; national
level NGOs and other development stakeholders, International
Development Partners (Through Ministry of Finance), and other relevant
stakeholders that directly/indirectly involve in the process of planning.
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17. Annual planning process
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Analysis of
current
situation
Setting Goal
Formulating
plan and
programs
Implementati
on process
Internal
Control
Information
management
and reporting
Monitoring
Evaluation and
Public
Announcement

18. Annual Health Planning and Budgeting
Process at Federal Level (1)
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• The evidence-based annual work planning and budgeting (AWPB) at all levels
of government needs to achieve universal health coverage and SDG by 2030.
• The Policy Planning, and Monitoring Division (PPMD) of Federal Ministry of
Health and Population (FMoHP) is responsible for the entire planning
process.
• The budget and program proposals is based on the objectives and targets of
the periodic plan, Medium term Expenditure Framework ( MTEF) and the
international commitment and annual plans and policies of the Government
of Nepal.
• Based on the budget ceilings provided by the Ministry of Finance (MoF) and
national planning commission (NPC), it takes lead role in preparing the
budget details that require for all departments, divisions, centres, and
hospitals.

19. Annual Health Planning and Budgeting Process at
Federal Level (2)
• The concern departments are responsible to prepare the budget of the
centers and division function under them.
• The Policy Planning, and Monitoring Division (PPMD’s) Planning Unit
reviews the draft budget from all department, centers, and hospitals. It
enter proposed budgets into the Electronic Annual Work Plan and Budget
(e-AWPB) and Line Ministries Budget Information System (LMBIS).
• The MoF compiles the sectoral budgets and prepares the national
budget with policy and programs.
• It announces it publicly through the budget speech and submits the
final budget to Parliament for endorsement.
• The Parliament endorses the budget of the coming fiscal year and the
“Red Book” is a budget authorization.
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20. Medium term expenditure framework
(MTEF)
• Based on Inter-Governmental Financial Management Transfer Act,
2074, and Local-level Budget Formulation Directives, 2076.
• Estimate and prepare budget with the expected outputs/targets of the
programme
• Includes detailed activity indicators, targets, and estimated budget for
three years, including funding sources and short programme
descriptions.
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21. Timeframe for federal budget and program formulation
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23. Issues and challenges
Project prioritization can be a significant challenge in federal planning, as it
involves making difficult choices about which programs and initiatives
should be given priority.
Lack of appropriate interrelationship between different vertical and
horizontal level of institutions and stakeholders.
Inadequate aligning or harmonising the exclusive functions of federal,
provincial and local government.
Federal parliamentarians distribute resources to their constituency-
based programs on their own without consulting provincial
governments.
Links between the localization of the SDGs and federal plans are weak.
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24. Issues and challenges (2)
• The federal government has retained several offices and projects that
come under the jurisdiction of provincial and local governments,
creating an overlap in expenditure assignments.
• Insufficient institutional development support provided by the federal
government to provincial governments.
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25. Conclusion
• The NPC is responsible to make road map for macroeconomic
development and planning process in the federal context of Nepal.
• The elected representatives and level personnel must enhance their
capacities to know how the planning and development activities
connect vertically with the planning entities.
• Three tiers of organizational structures of the planning units vary with
their role and responsibilities according to their weight provisioned
according to the constitution of Federal Nepal.
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26. Conclusion (2)
• Nepal’s developing experience of a federal system of governance has
gathered good momentum with regard to the exercise of the
constitutional rights of federal units.
• In the early stages of implementation, the exercise of federalism is
fraught with many challenges and constraints.
• The federal government has yet to prioritize the formulation of laws,
devolution of authority, allocation of resources, employee appointment
and retention, and capacity building.
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27. References
• Adhikari, D.B., 2021. Planning Guideline for Three Tires Government of Nepal. Theor. Econ.
Lett. 11, 558–571. https://doi.org/10.4236/tel.2021.113037
• Planning Guideline for Three Tires Government of Nepal [Internet]. [cited 2023 Jan 21].
Available from: https://www.scirp.org/journal/paperinformation.aspx?paperid=110062
• Planning-and-Budgeting-in-the-Provinces-of-Federal-Nepal.pdf
• Provincial Policy and Planning Commission (gandaki.gov.np)
• PDF, Asian development bank report chrome-
extension://efaidnbmnnnibpcajpcglclefindmkaj/https://asiafoundation.org/wp-
content/uploads/2021/06/Planning-and-Budgeting-in-the-Provinces-of-Federal-Nepal.pdf
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