Issues N Chalenges in Health Management

7/28/2012
Supervisors Mrs. Pushpa Parajuli Professor and HOD Med/Sur Mr. Gayanand Mandal Asst. Professor BPKIHS Dharan
Presented By Rachana Sharma M.Sc. Nursing, 1st Year. BPKIHS

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Sharma R., Issues and challenges of health management in Nepal
CONTENTS
Terms
Issues Health Management in Nepal 1. Trends, Issues and Challenges in policy development of
Health Management in Nepal

2. Issues and Challenges in socioeconomic development 3. Issues and Challenges in health education and sciences
4. Issues and Challenges in health resources

5. Issues and Challenges in development of health system 6. Issues and Challenges in health status Opportunities Summary
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GENERAL OBJECTIVES
Participants will be able to

Explain overall issues and challenges of health management in Nepal
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TERMS
ISSUES: Topic of discussion- an important topic that people are discussing or arguing about. Problem/worry (informal)- problem or worry that somebody has with something.
CHALLENGE: 1. a new or difficult task that tests somebodys ability and skill. 2. To question whether a statement or an action is right, legal, etc.
-oxford dictionary
Issues and Challenges of Health Management in Nepal

Nepal is a land-locked country of about 27 million people in an area of 147,181 square kilometers.
The country is in the middle of its demographic transition(late expanding).
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Despite an increase in the contraceptive prevalence rate (41%), the population is growing at a rate of 2.25%, (relatively higher compared to other countries in the Region).
GDP per capita of only US$ 294 About 80% of the population depends on agriculture for livelihood The share of the agriculture sector in GDP is only 40%
Tourism, one of the main sources of income in the past, has been affected adversely due to civil conflict and violence. Remittance from foreign employment has been the major income source. The Human Development Index has improved from 0.296 in 1975 to 0.553 in 2007.
The population living below the national poverty line has declined from 42% (19901995) to 31% (2003-2004). 7/28/2012 8
1. TRENDS, ISSUES AND CHALLENGES IN POLICY DEVELOPMENT
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A National Health Policy (NHP)

A National Health Policy (NHP) in Nepal was formulated in 1991. the objective of NHP is to enhance the health status of the population, 86% of which is rural. The NHP is a comprehensive policy
addresses service delivery the administrative structure of the health system.
The 8th Health Plan (1992-1997), 9th Health Plan (1997-2002) and Second Long Term Health Plan (SLTHP) (1997-2017) were developed in keeping with the NHP.
The main features the development of integrated and essential health care services at the district level and below, active community participation and
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mobilization of the private sector to facilitate (MCH/FP an integral part of PHC services) Inter and Intra sectoral coordination, decentralization of health administration, developing the traditional system of medicine, and promoting the participation of national and international NGOs, private enterprises and foreign investors.
The main constraints are: frequent changes of government, limited national resources for health services development, centralized administration, ineffective management and supervision, difficult geographic conditions and slow economic growth.
2. ISSUES AND CHALLENGES IN SOCIOECONOMIC DEVELOPMENT
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2. ISSUES AND CHALLENGES IN SOCIOECONOMIC DEVELOPMENT
Economic Demographic Social Food supply and nutritional status Life style
2.1 Economic
The GDP per capita increased from US $149 in 1992/93 to US $224 in 1995/96. The annual growth rate of the GDP increased from 3.29% in 1992/93 to 4.90% in 1995/96. The proportion of the population living below the poverty line in 1988/89 was 40% (National Planning Commission), (other estimates cite higher levels, e.g. 71% (World Bank) and 66% (UNDP)).
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Wide gap in development between urban and rural sectors, 86% of the population live and work in rural areas, with the majority living below the poverty level. 80% of the total national income is concentrated in 10% of the households (Rastra Bank Survey 1988/89).
Gender disparities limit the full participation of women in development. Future plans include economic liberalization employment promotion programmes with skill training, area specific programmes targeted at low income population groups/families, more decentralization, and tighter fiscal policies. 18
2.2 Demographic
National census conducted in 2001, population - 23,214,681(2.7million in 2006). Annual population growth rate is 2.27 % (2.25 in 2006) Total fertility rate (TFR) 4.1 (2001/2002). The crude birth rate (CBR) is 33.58 per 1000 population and Crude death rate (CDR) 9.96 (2001/2002).
2.3 Social
The adult literacy rate males (15 years and over) is 65.08 % and females 42.49% (2001). Progress in the field of education Increasing school enrolment rates.
Development and expansion communication media.

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of
the
20
Health education
school curricula non-formal adult education programmes.
A multisectoral safe motherhood, control of STD/AIDS, human resource development, etc. Programmes for women's development, poverty alleviation more effective decentralization(implication)
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The major constraints are difficulties in enhancing literacy among the female and rural populations, conservative social customs and traditions, the topography of the country centralized planning and administration with ineffective coordination and implementation. long-term health plan emphasize on primary health care by the year 2017.
Remoteness
2.4 Food supply and nutritional status

protein-energy malnutrition does not seem to have undergone any significant change since the early 90s.
The prevalence of underweight (weightfor-age) in children under 5 years was 47.1% and that of stunting 54.1% in 1998.
Poverty and lack of food supply
A study, among women of reproductive age reported a level of anemia of 63%. declined iodine deficiency, vitamin A deficiency- significantly decreased The main constraints for improving nutritional status are poor accessibility of service provision, lack of community participation in growth monitoring activities,
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shortage of trained health personnel lack of legal provisions for monitoring and control of iodization of salt weak targeting poor compliance with iron supplementation.
More efforts need to direct at intersectoral collaboration, better monitoring and community mobilization.
2.5 Lifestyle
An epidemiological study among the rural community in the hilly region revealed that:
85.4% of males aged 15 and over and
62.4% of females were regular smokers. prevalence of tobacco is 38.4% (2000/2001) with 48.4% in males and 28.7% in females.
Diseases related to lifestyles are on the increase, particularly those due to smoking and alcohol and drug abuse.
The main constraints are : low literacy, poverty, cultural beliefs, lack of trained manpower, 7/28/2012 poor media promotion limited resources. Sharma R., Issues and challenges
of health management in Nepal
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3. ISSUES AND CHALLENGES IN HEALTH SERVICES
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3. ISSUES AND CHALLENGES IN HEALTH SERVICES

Health education and promotion Maternal health and child health/family planning Immunization
Prevention and control of locally endemic disease
Treatment of common disease and injuries General protection of the environment
Water supply and sanitation
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Achievement NHSP-I Impact Indicator 2001

Maternal Mortality Ratio Total Fertility Rate Adolescent Fertility Rate (15-19 years) CPR (modern methods) Under-five Mortality Rate Infant Mortality Rate Neonatal Mortality Rate % of underweight children HIV prevalence among pregnant women aged 15-24 years TB case detection and success rates (%) Malaria annual parasite incidence per 1,000 415 4.1
Target for NHSP-II 2010-11

229 2.9 250 3.0
2006
281 3.1
2009
2015
134 2.5
110
35 91 64 43 48.3 NA
98
44 61 48 33 38.6 NA
NA
45.1 50 41 20 39.7 NA
98
48 55 44 30 34
70
55 38 32 16 29
Halt and reverse trend
70 89
0.40
65 89
0.28
71 88
NA
75 89
85 90
Halt and reverse trend
3.1 Health education and promotion

The establishment in 1993 of a National Health Education, Information and Communication Center (NHEICC) under the Department of Health was a milestone in efforts at health promotion. safe motherhood, family planning, immunization, nutrition, HIV/AIDS 7/28/2012 33
The main constraints are shortage of trained personnel, inadequate training of health personnel in communication skills, duplication of efforts in comparison with activities of NGOs, and shortage of funds.
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3.2 Maternal and child health/family planning
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There have been some improvements in the MCH/FP indicators in Nepal though much still needs to be done. About 35% of pregnant women are attended by trained personnel during pregnancy; 13.5% of deliveries are attended by trained health personnel (1999/2000). The reported infant mortality rate (IMR) in 2001 was 64.2 per 1000 live births,
the maternal mortality ratio (MMR) was 415 per 100,000 live births. The total fertility rate (TFR) 4.1 (2001/2002), and the contraceptive prevalence rate (CPR) 34.5% (1999/2000).
Efforts are being directed at training TBAs and female community health volunteers as outreach health workers.
Under-5 and infant mortality rates are still very high, 61 and 48 per 1000 live births respectively. The neonatal mortality accounts for twothirds of infant mortality rate. The major challenge to ensure that all women and newborns are provided with a continuum of care throughout pregnancy, childbirth and the postpartum period, by skilled birth attendants (SBAs).
Nutrition and food safety: About half of under-five children are affected by stunting. The proportion of underweight children is around 48% of them, 10% suffer from acute malnutrition and 13% by a combination of stunting, vitamin A deficiency and iron deficiency. Food availability and security remains uneven particularly in hill and mountain region.
3.3 Immunization
The proportion of infants that have been fully immunized by their first birthday with all EPI vaccines was 43.3% (1996). The coverage of individual vaccines in 2001/2002 were DPT 80%, OPV 80%, measles 75% and BCG 95%. women immunized with two doses/booster dose of tetanus toxoid (TT) during pregnancy was 24.2%(1999/2000)
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3.4 Prevention and control of locally endemic diseases

Nepal has a high burden of endemic communicable diseases, the most important ones being Malaria, TB, Kalaazar, Japanese Encephalitis, Filariasis. During the last years, HIV/AIDS has substantially contributed to the increase of this burden.
Major progress has been achieved towards the elimination of Leprosy.
Improvements in the response to disease outbreaks could be made through the establishment of an Early Warning and Response System (EWARS).
The Vector-Borne Diseases Research and Training Center in Hetauda research activities and training of health manpower in vector-borne disease control. 7/28/2012 43
3.5 Treatment of common diseases and injuries

The country continues to be afflicted by communicable diseases and upward trends of lifestyle related non-communicable diseases.
Incidence of diarrheal diseases and acute respiratory tract infection continue to be high (219 and 319 per 1000 population respectively). 44
7/28/2012 Sharma R., Issues and challenges of health management in Nepal
Vector borne diseases like malaria, visceral leishmaniasis, lymphatic filariasis, japanese encephalitis and recent emergence of dengue infection are major public health problems together with TB and HIV/AIDS.
Increasing incidence of diabetes, hypertension, CVD and cancer have been observed.
The main constraints are inadequate training of health workers and volunteers, lack of monitoring and supervision, and irregular supply of drugs. It is planned to involve NGOs in monitoring and supervision at community level.
3.6 General protection of the environment

Nepals environmental challenges are interrelated and detrimental to health.
High population growth and pervasive poverty, leads environmental problems.
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Environment and deforestation
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The main environmental issues are water pollution due to: poor sewage and sanitation, industrial discharge and wastes, and pesticides from agricultural sources.
Air pollution is due to combustion of fossil fuels, vehicular emissions, industrial emissions and combustion of bio-mass affect on: deterioration of air quality, resulting in respiratory and eye problems.
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The rapid urbanization affects on healthy life style. Administratively, the Nepal Environment Policy and Action Plan was adopted in 1993 and an Environmental Protection Council established in the same year.
In 1995 a Ministry of Population and Environment was created. T
The main constraints in the implementation of environmental measures: lack of resources and trained manpower, weak infrastructure and coordination, and lack of awareness on environmental issues.
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Water pollution
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3.7 Water supply and sanitation

The proportion of the population with access to safe drinking water in 1996 was reported to be 59% (urban 61%, rural 59%).
sewage lines run parallel to water mains: resulting in contamination during periods of low water pressure and in the presence of breakages in the systems, which has posed public health threats.
The proportion of the population with adequate excreta disposal facilities is reported to be 23% (urban 74%, rural 18%).
Priority has been accorded to safe drinking water supply and sanitation during the past two decades. Community involvement has been obtained to some degree.
The main constraints have been : rapid urbanization,

diminishing spring water sources due to deforestation pollution of surface water sources by industrial waste sewer lines fed into rivers.
4. ISSUES AND CHALLENGES IN HEALTH RESOURCES
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4. ISSUES AND CHALLENGES IN HEALTH RESOURCES

Human resources for health
Financial resources
Physical infrastructure
Essential drugs and supplies
International partnership for health
4.1 Human resources for health

Imbalances in the health workforce due to shortages of personnel and geographical maldistribution. Low productivity is related to poor working conditions, low remuneration and limited career opportunities.
The number of health personnel in 2001/2002 in different categories were physicians 1,259 (per 58 10,000 population was 0.54.) and nurses 6,216.
To meet human resource requirements at PHC level, the training of maternal and child health workers (MCHWs), auxiliary health workers (AHWs) and auxiliary nurse midwives (ANMs) to the government as well as training institutes in the private sector. Some efforts have also been made to improve career development and motivate health personnel through improvements in their working environment.
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4.2 Financial resources for health

The total national health expenditure for 2000 as a proportion of the GDP was 5.4%, The government health expenditure as a proportion of total health expenditure was 23.5%, There has been greater involvement of the private sector in establishing nursing homes, pharmacies, training institutes and even medical colleges.
The main constraints are: the wide gaps between committed and allocated funds, and between disbursed and
reimbursed funds under the development scheme for the electoral constituencies,
lack of delegation of authority, and lack of skilled personnel in financial management.

To ensure efficient use of financial resources the government has introduced a three-year rolling plan for making financial projections, a decentralized budget system, and improved audit and financial systems. The implementation of the Local Governance Act promulgated in 1998 created conducive conditions for decentralization and shows first positive results.
4.3 Physical infrastructure

According to the National Health Policy a sub-health post (SHP) is to be available in each Village Development Committee (VDC) area. Similarly, one primary health center was to be established in each of 205 electoral constituencies.
By 2001/2002, there were 3179 SHPs, 711 health posts and 180 primary health centers. The efforts of the government for strengthening the infrastructure, particularly in rural areas, are supported by the external development partners.
The local communities play an increasing role in planning, establishing and managing their health infrastructures.
The implementation of the Local Governance Act has resulted in developing community ownership of them. Constraints:
poor building maintenance due to budgetary allocation, insufficient water supply or sewerage systems, only 13% have electricity, and only 29% have residential quarters. Standard items of furniture and equipment are lacking.
4.4 Essential drugs and supplies

A rough estimate of 40% has been made regarding the availability of essential drugs at remote facilities.
A nationwide community based cost sharing programme is being implemented, which includes aspects such as training, supplies, monitoring and supervision.
Establishing co-ordination among governmental, non-governmental and private organizations involved in the activities related to drug.
The main constraints are: lack of adequately trained manpower, Non-availability of transport when needed, inadequate drug storage facilities.
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4.5 International partnerships for health

The funding support through international partnerships for health expressed as a proportion of the total expenditure on health development increased from 40% in 1993 to 62% in 1996. The main constraints include: a gap between committed and allocated funds,
lack of delegation of decision-making ineffective coordination.
authority
in
To overcome these shortcomings, a donor coordination committee has been formed in the Ministry of Health (MOH) to mobilize funds.
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The Finance Section of the Department of Health Services (DOH) is responsible for ensuring accountability in resource utilization.
A Joint MOH/Donor Coordination Mechanism proves its usefulness in these processes. The main partners are WHO, UNICEF, UNDP,
UNFPA, World Bank, GTZ, DFID, USAID, JICA, SDC.
5. ISSUES AND CHALLENGES IN DEVELOPMENT OF THE HEALTH SYSTEM
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5. ISSUES AND CHALLENGES IN DEVELOPMENT OF THE HEALTH SYSTEM
Health policies and strategies Intersectoral cooperation Organization of the health system Managerial process Health information system
Community action
Emergency preparedness
Health research and technology
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5.1 Health policies and strategies

The National Health formulated in 1991. Policy (NHP) was
8th, 9th Five Year Plan and SLTHP were based on the policy objectives. The principal objective was to upgrade the health status of the majority of the rural population by strengthening the PHC system.
The NHP also refers to the gradual development of: the Ayurvedic and traditional systems of medicine, improvement in the organization management of health care services, community participation, development of human resources for health, resource mobilization, private sector and NGO participation, and decentralization/regionalization.
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In developing policies, strategies and plans, there is a process of broad consultation that involves the principal stakeholders from the community, the private sector, international and local NGOs, the government and the donor community.
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5.2 Intersectoral cooperation

The National Planning Commission (NPC) provides overall leadership in ensuring inter-sectoral cooperation for health development. A government/WHO coordination committee also promotes intersectoral coordination.
The main health programme areas for inter-sectoral cooperation are: HIV/AIDS and STD control, Safe Motherhood, IEC for health, Health Management Information System (HMIS), Nutrition, and National Immunization Programme.
The main constraints are: the weak links that exist in the area of inter-sectoral coordination, the low priority given to health by other sectoral ministries, and the lack of an agenda and a work plan for improving inter-sectoral coordination and cooperation.
5.3 Organization of the health system

Since the early 1990s, notable progress has been made in improving the PHC service health posts and sub-health improving outreach services by providing more female MCH workers, village health workers, and female community health volunteers at VDC level.
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Medical supplies, equipment and drugs have also been supplied to the extent possible.
Recent legislation has also been introduced to address issues that have hindered staffing of rural health facilities.
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Constraints to better organization of the health system: The highly centralized decision making with limited delegation of authority, overlapping roles and responsibilities at various levels lack of support to the decentralization process with regard to decision making, planning, financing and management, have been
5.4 Managerial process

During the last years, considerable efforts have been undertaken for improving organizational and management aspects of health services delivery at central, regional and district levels.
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Positive examples are: the integration of hospitals and public health offices into single District Health Offices, more focus on technical and administrative supervision, improving logistics for supplies, drugs and equipment, and making VDCs more responsible for essential services, including health.
In 1993 a master plan for development and utilization of human resources (revised in 1995) was prepared.
In the planning constraints were: process, the main
the lack of inter and intra sectoral coordination, lack of skilled manpower.
wide-ranging discretionary(open) powers that limit decentralization in spite of district development and village development legislation, planning responsibility at regional levels but no authority, The budgeting process is centralized.
Lack of supportive supervision with faultfinding mainly due to lack of managerial and technical skills among supervisors.
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Centralized Development of human resources for health is resulting in mismatch between supply and needs.
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5.5 Health information system

In 1995, the establishment of a new Health Management Information System was completed. Since then, it has proved its usefulness for the management process. In the initial phase, only performance statistics at PHC level were obtained district wise. Subsequently, hospital morbidity and mortality statistics and other health service data were incorporated.
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The new integrated health information system is a simple, uniform recording and reporting system, applicable nationwide, and for the first time it has been possible to produce a complete integrated annual district health system (DHS) report.
Regular feedback to districts and regions has had a positive effect on improving the completeness and accuracy of data as well as on the utilization of data.
5.6 Community action

The influence of community action has been reflected in rural areas through the involvement of health volunteers, e.g. female community health volunteers and trained TBAs.
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EDPs role in system strengthening / community empowerment

Vision
Strong system, weak community
More Community Empowerment to Improve the Balance between System and Community
Other community action includes the formation of ward health committees, mothers groups, women's coordinating committees, PHC/ health post/sub health post management committees and hospital helping committees.
Constraints: Social and health inequity (the health gaps between the poor and the rich are very wide).
5.7 Emergency preparedness

Vulnerability to disasters: Nepal is a highly disaster-prone country. Several types of natural hazards like floods, landslides and drought affect different geographical zones annually with a varying degree of damage to the health infrastructure and peoples health.
Nepal, in particular Kathmandu valley is vulnerable to earthquakes, therefore, preparedness for such a disaster needs to be further strengthened.
Under the leadership of the Epidemiology and Disease Control Division of the Department of Health Services a strong and active multisectoral working group has been established.
It comprises Government authorities, local and international NGOs and external development partners. 94
First results of its work were, among others, the wide dissemination of information to the public, training of a large number of health staff, and a structural assessment of hospitals in the Kathmandu Valley and other parts of the country.
Emergency Preparedness and Response Plans are being formulated under the leadership of the Focal Point for Emergency Preparedness in the DoH.
Disaster plan
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5.8 Health research and technology

The Nepal Health Research Council(NHRC) is the main body for planning and coordinating research activities related to bio-medical and operational research. The Bulletin of the NHRC is used for informing decision-makers and researchers of new developments related to health. The provision of grants.
97
Action at community level helps: to raise the understanding of the need for evidence based work and for the use of locally generated data and information.
Support provided by WHO and other development partners aims at capacity building, focusing on health priorities and effective use of research results.
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Technological Issues
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Skilled manpower for recent technologies
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6. TRENDS, ISSUES AND
CHALLENGES IN
HEALTH STATUS
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6. TRENDS, ISSUES AND CHALLENGES IN HEALTH STATUS

Life expectancy Mortality
Morbidity
Disability Overall assessment and strategic issues Future vision
6.1 Life expectancy

The life expectancy at birth has increased from 55 years for males and 53.5 for females in 1995 to 58.9 years (both male and female) in 2001/2002. The main constraints have been illiteracy, difficult terrain, lack of trained manpower, and limited resources
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6.2 Mortality The registration of vital events is grossly inadequate in Nepal. Lack of data does not allow a realistic assessment of either mortality or morbidity.
Based on hospital data (1998/99), five leading causes of mortality were reported as Pneumonia, other cardiopulmonary diseases, encephalitis/meningitis, septicemia and diarrhoea.
6.3 Morbidity Information on morbidity is unreliable and is not classified by age or sex. The main causes of morbidity reported for 1999/2000 were skin diseases, diarrhoeal diseases, acute respiratory infections, intestinal worms, gastritis, pyrexia of unknown origin, ear infection, chronic bronchitis, anemia and abdominal pain.
6.4 Disability The disabled are the most vulnerable and neglected group in Nepal. A survey in six districts estimates the prevalence of disability at 3%. The main disabilities are visual impairment (cataract and vitamin A deficiency) and hearing loss (suppurative otitis media).
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Preventive programmes associated with disability include vitamin A supplementation, iodization of salt, EPI, and prevention of accidents. The Association for the Disabled and the Association for the Welfare of the Blind have launched national programmes to educate the population regarding disabilities.
The main constraints are the low priority given to disability, poverty, and inadequate health care provision. 107
6.5 Overall assessment strategic issues
and
Since early 1990s, some improvement in health status has been observed.
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Expansion of the PHC network has been achieved by establishing PHC centers and sub-health posts at electoral constituency level and village development committee level respectively, together with the use of trained volunteer female community health workers for outreach services.
Poverty is a major concern and poverty alleviation is a prime goal in the 9th Five Year Plan (1997-2002).
6.6 Future vision The future vision of the government is to provide equitable access to quality health care services in both rural and urban areas. To achieve equity, access to health will need to be provided to vulnerable groups such as women and children, the rural and urban poor, the underprivileged, and marginalized population groups.
To meet the main health problems of the people, the government will give priority to health promotion and prevention and to the development and implementation of a set of "Essential Health Care Services" (a priority package of public health measures and essential clinical services including traditional and other systems of medicine) that will be available to the entire population.
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Central to this vision of health and development is the recognition of selfreliance, gender sensitivity in health programmes, full community participation, private sector participation (public/private mix), and decentralization as characteristics essential to the health system.
Opportunities
1. Strengthening the health system: 2. Control and prevention of disease and disability: 3. Human resource development: 4. Healthier environment: 5. Child, adolescent and reproductive health: 6. Emergency preparedness and response:
Strengthening the health system

UNs Banks Bilaterals
Nepal Ministry of Health & Population
District
NGOs
NGOs
CBOs
Communities
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Human resource development: Nepals Administrative and Health Structure

Each VDC has nine ward & Health Facility
Each district consists of VDC
3 6 7
FCHV
9 8
Mothers group
Settlement
4 2
5
1
Nepal 75 districts
Each ward has 80-100 households and there is a Female Community Health Volunteer (FCHV) who provides maternal and child care services in the community. In each ward there is also a mother group coordinated by FCHV for community mobilization
Summary
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Overall Challenges in management of health in Nepal

Comprehensive framework of health policies and strategies. High-impact essential health care services (EHCS) package.
National Health Sector Plan II and the Second Long Term Health Plan.
Sharma R., Issues and challenges of health management in Nepal 117
The utilization of health workforce in the public sector.

Designing inequities. cost-effective interventions -
Inadequate to address the issue of multisectoral determinants of health.
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Challenges in primary level

Good policy, poor implementation
Limited resources (money, materials, human resources) Unstable government Dissolution of elected bodies at local government Poor leadership / management capacity Hypothetical/evidence-based Reward and punishment
In the context of current health issues in Nepal

Demographic changes
Epidemiological transition Public private partnership Sector wide approach
Restructuring resources.
of
health
system
and
Addressing changing migration patters. Program planning in urban slums and urban areas.
Integration of vertical program and improving quality of care- e.g. equity and equality.
Local level planning and decentralization- e.g. strengthening bottom-up planning.
Inter-sectoral coordination e.g. school, agriculture/nutrition.

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Summary of the Major Health Problems and Key Issues in Health

Pre-school children
ARI and diarrhoea emphasizes the need to ensure an improved domestic environment and better access to safe drinking water and sanitary disposal of excreta.
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Maternal and peri-natal disorders emphasizes the need for an effective reproductive health programme, in the remote areas. Improving the status of women in society (increasing female literacy, address the neglect of female children.)
The high burden due to preventable communicable diseases. Interventions aimed at modifying lifestyles such as smoking and drinking need to be considered.
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Issues directly related to the organization, operation and management of the health sector. These issues include:
The organizational culture the ways of working Politicization of the civil service frequent changes in government
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Weak planning and financial and human resources management.

Inadequate monitoring of sector performance (availability, accessibility, affordability, acceptability of services, equity)
Inadequate staff motivation; deployment and retention problems.

Over-centralization resulting lack of responsiveness to local needs.

insufficient clarity of organizational roles and responsibilities within the health sector, particularly in relation to decentralization
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Inputs are not linked to outputs.

Insufficient community involvement in the planning, implementation and supervision of service delivery. A rapidly expanding private sector with inadequate regulatory mechanisms.
Weak strategy for inter-sectoral collaboration.
Inadequate framework for and implementation of alternative financing schemes Inappropriate or unrealistic assumptions on the part of some development partners regarding the length of time required for projects to be sustainable in the public and NGO sectors.
References
National Policies, informal Sector Research and Study Centre, 1990 Department of Health services, Annual Report , 2007/2008 Bryant, John H:From Reorganization, Integration, and Decentralizationtowards Strengthening Health Systems, Nepal,WHO-Assignment Report,October 1993. Egger, D et al: Strengthening Management in LowIncome Countries,Making Health System Work.WHO, Geneva. Foster, Mick et al: Review of Nepal Health Sector Programme, 2007 GON/CBS:Districts of Nepal Indicators of Development, update 2003,ICIMOD/MENRIS, December 2003. 7/28/2012 Sharma R., Issues and challenges 131
of health management in Nepal
GON/ Survey Department & CBS:The Population and Socio-economicAtlas of Nepal, GON/ALA Project, 2004. http://www.searo.who.int/LinkFiles/Nepal_nepal.pdf 9th march 2011 http://www.who.int/countryfocus/cooperation_strategy/cc sbrief_npl_en.pdf 14th march 2011 http://203.90.70.117/PDS_DOCS/B3514.pdf 13th march2011 WHO country page http://www.nep.searo.who.int/ http://www.un.org.np/agencyprofile/profile.php?Age ncyID=12
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Issues N Chalenges in Health Management

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7/28/2012

Presented By Rachana Sharma M.Sc. Nursing, 1st Year. BPKIHS

Sharma R., Issues and challenges of health management in Nepal

Health Management in Nepal

4. Issues and Challenges in health resources

Participants will be able to

Sharma R., Issues and challenges of health management in Nepal

Issues and Challenges of Health Management in Nepal

Sharma R., Issues and challenges of health management in Nepal

1. TRENDS, ISSUES AND CHALLENGES IN POLICY DEVELOPMENT

Sharma R., Issues and challenges of health management in Nepal

A National Health Policy (NHP)

2. ISSUES AND CHALLENGES IN SOCIOECONOMIC DEVELOPMENT

Sharma R., Issues and challenges of health management in Nepal

2. ISSUES AND CHALLENGES IN SOCIOECONOMIC DEVELOPMENT

Development and expansion communication media.

2.4 Food supply and nutritional status

Poverty and lack of food supply

3. ISSUES AND CHALLENGES IN HEALTH SERVICES

Sharma R., Issues and challenges of health management in Nepal

3. ISSUES AND CHALLENGES IN HEALTH SERVICES

Achievement NHSP-I Impact Indicator 2001

Target for NHSP-II 2010-11

Halt and reverse trend

Halt and reverse trend

3.1 Health education and promotion

Sharma R., Issues and challenges of health management in Nepal

3.2 Maternal and child health/family planning

Sharma R., Issues and challenges of health management in Nepal

3.4 Prevention and control of locally endemic diseases

Major progress has been achieved towards the elimination of Leprosy.

3.5 Treatment of common diseases and injuries

3.6 General protection of the environment

Sharma R., Issues and challenges of health management in Nepal

Environment and deforestation

Sharma R., Issues and challenges of health management in Nepal

Sharma R., Issues and challenges of health management in Nepal

Sharma R., Issues and challenges of health management in Nepal

3.7 Water supply and sanitation

The main constraints have been : rapid urbanization,

4. ISSUES AND CHALLENGES IN HEALTH RESOURCES

Sharma R., Issues and challenges of health management in Nepal

4. ISSUES AND CHALLENGES IN HEALTH RESOURCES

4.1 Human resources for health

4.2 Financial resources for health

lack of delegation of authority, and lack of skilled personnel in financial management.

4.3 Physical infrastructure

4.4 Essential drugs and supplies

Sharma R., Issues and challenges of health management in Nepal

4.5 International partnerships for health

lack of delegation of decision-making ineffective coordination.

Sharma R., Issues and challenges of health management in Nepal

5. ISSUES AND CHALLENGES IN DEVELOPMENT OF THE HEALTH SYSTEM

Sharma R., Issues and challenges of health management in Nepal

5. ISSUES AND CHALLENGES IN DEVELOPMENT OF THE HEALTH SYSTEM

Health research and technology

5.1 Health policies and strategies

Sharma R., Issues and challenges of health management in Nepal