This is the unit 1 - Health Services of Health Services Management in Nepal of Bachelor of Public Health of NAMS College.

1. Unit: 1
HEALTH SERVICES IN NEPAL
By:
Vijaya Laxmi Shrestha
Lecturer (MPH, M. Phil)

2. Concept of Health Services
• Traditionally, a service that provides
medical treatment and care to the public or
a specific group.
• However, health services in today's context
includes preventive, promotive, curative
and rehabilitative services.
• Health services are provided by public and
private sector in Nepal.

3. contd....
Any activity performed by health professionals to
-assess, predict, maintain or improve the
individual’s physical, mental or psychological
health or status;
-diagnose, prevent, treat the individual’s illness,
injury or disability;
- palliative care or aged care service;
- surgical or related service; or
- the dispensing on prescription of a drug or
medicinal preparation by a pharmacist.

4. contd...
• Health services consist of health professionals,
organizations, and auxiliary health care workers
who provide health care to those in need.
• Health services serve individuals, families,
communities, and populations.
• They cover emergency, preventive, rehabilitative,
hospital, diagnostic, primary, palliative care.
• These services are centered around making
health care accessible, high quality, and patient-
centered.

5. Concept of Health System
• A health system or health care system is
the organization of people, institutions, and
resources that deliver health care services to
meet the health needs of target populations.
• Health systems always intend to provide services
that are safe, accessible, high quality, people-
centered, and integrated.
• Health systems are responsible for providing
health services for individual, families,
communities and population in general, and not
only care for patients.

6. Contd....
 Roemer (1991) defined a health system as “the
combination of resources, organization,
financing and management that culminate in
the delivery of health services to the
population.”
 According to WHO “A health system comprises
all organizations, institutions and resources
devoted to producing actions whose primary
intent is to improve, maintain and restore
health of populations."

7. Contd….
• A health system needs staff, funds, information,
supplies, transport, communications and overall
guidance and direction. And it needs to provide
services that are responsive and financially fair, while
treating people decently.
• A health system is the sum total of all the
organizations, institutions and resources whose
primary purpose is to improve health.
• Health system can also be defined as the structured
and interrelated set of all actors and institutions
contributing to health improvement.

8. Contd……
 Health systems have a responsibility not just to
improve people’s health but also to protect
against the financial cost of illness and treat them
with dignity.
 A health system is a functional network of health-
care providers, including public sector and
privately run services, which range from
traditional healers to the most technologically
advanced hospitals.

10. Health care financing
• A good health financing system raises
adequate funds for health, in ways that
ensure people can use needed services, and
are protected from financial catastrophe or
impoverishment associated with having to
pay for them.

11. Health workforce
• A well-performing health workforce is one
that works in ways that are responsive, fair
and efficient to achieve the best possible,
health outcomes at given/available resources
and circumstances (i.e. there are sufficient
staff, fairly distributed; they are competent,
responsive and productive).

12. Health Information System
• A well-functioning health information
system is one that ensures the production,
analysis, dissemination and use of reliable
and timely information on health
determinants, health system performance
and health status.

13. Health service delivery
• Good health services are those which
deliver effective, safe, qualitative health
interventions to those that need them,
when and where needed, with minimum
waste of resources.

14. Medical products and technology
• A well-functioning health system ensures
equitable access to essential medical
products, vaccines and technologies
which assures quality, safety, efficacy, cost-
effectiveness, and scientifically sound.

15. Leadership/Governance
• Leadership and good governance involves
ensuring that strategic policy frameworks exist
and are combined with effective oversight,
coalition building, regulation, attention to
system-design and accountability.

17. Health systems functions and outcomes
• Synergies here determine coverage of those
who need health services, the quality of these
services and the efficiency with which
resources are used in their delivery. And, these
in turn determine systems outcomes. Finally,
equity is an underlying and cross cutting issue
throughout a health system – how equitable
systems functions will determine equity in
systems outcomes.

18. • A good health system improves people’s lives tangibly
every day.
• A mother who gets a letter reminding her that her
young son is due for immunization against a life-
threatening illness is benefiting from a health system.
The same holds true for a family finally able to access
clean water at a well-tended pump in its village
because of a government sponsored sanitation project;
or a person with HIV/AIDS who gets antiretroviral
medicine, nutritional counseling and regular check-ups
at an affordable clinic.
• The ultimate responsibility for the overall performance
of a country's health system lies with government, but
good stewardship by regions, municipalities and
individual health institutions is also vital.

19. Models of Health Systems
Models Country Source of funding Type of providers
Beveridge
model
UK, Ireland,
Sweden, Norway,
Finland, Denmark,
Spain, Portugal,
Italy, Greece,
Canada, Australia
Taxation (State
Budget)
Universal scope (all
citizens)
Not related to
income
Public:
Predominantly public providers
and governmental ownership
National Health Service
Complete coverage with basic
health benefits and free access to
all citizens
Bismark
model
Germany, Holland,
Belgium, France,
Austria,
Switzerland,
Israel, Japan, CSEE
and FSU countries
Compulsory health
insurance premiums
paid by employers
and employees
Selective scope
Related to income
Mixed:
Public and private providers with
dominant social ownership
Coverage of 60-80% with basic
insurance “basket" of health
services
Private
insurance
model
USA Predominantly
private insurance
and funding
Medicare/Medicaid
Predominantly private providers:
Managed care