Impact of federalization for health financing and workforce in Nepal

Springer Science and Business Media LLC - Tập 8 Số 1
Meifang Chen1, Dhirendra Man Thapa2, Recchioni Ma2, D. E. Weissglass3, Hao Li2, Biraj Karmachaya4
1Division of Social Science, Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
2School of Public Health/Global Health Institute, Wuhan University, Wuhan, China
3Division of Arts and Humanities, Global Health Research Center, Duke Kunshan University, Kunshan, China
4Department of Public Health and Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal

Tóm tắt

AbstractThe adoption of its 2015 constitution has converted Nepal to a federal government while simultaneously resulted in significant reforms of the health system in Nepal in terms of both structure and commitment. In this commentary, we review evidence ranging from health financing to health workforce development to show that the impact of federalization on Nepal’s health system and its efforts to achieve equitable and affordable universal health care have been mixed. On the one hand, careful efforts of the federal government to support subnational governments during the transition appears to have avoided serious disruption, subnational governments have successfully taken on the financial burden of the health system, and increase subnational control has allowed more flexible adaptation to changing needs than might have otherwise been possible. On the other hand, financing resource and ability disparities across subnational governments contributes to significant disparities in workforce development, and subnational authorities appear to have underestimated significant health issues (e.g. NCDs) in their budgets. We then provide three recommendations to improve the success of the Nepalese system: (1) to assess whether the services covered by health financing and insurance schemes like the National Health Insurance Program adequately address the needs of the rising burden of NCDs in Nepal, (2) to set clear minimum requirements on key metrics for subnational health systems, and (3) to extend grant programs to address resource disparities.

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Tài liệu tham khảo

Marasini B. Health system development in Nepal. JNMA J Nepal Med Assoc. 2020;58(221):65.

Ministry of Health Bagmati province. Annual Report Fiscal Year 2017–2018. Hetauda, Nepal: Government of Bagmati Province, 2022.

Ministry of Health and Population (MoHP). Ministry of Health and Population Organogram. Kathmandu, Nepal: MoHP,2023.

Bhattarai S, Arjyal A, Subedi M. Opportunities and challenges of implementing Federal Health System in Nepal at the time of the COVID-19 pandemic. Dhaulagiri J Sociol Anthropol. 2022;16(01):22–35.

Federal Ministry of Health and Population (FMoHP), British Embassy Kathmandu (BEK), Nepal Health Sector Support Programme (NHSSP). Health Sector Budget Analysis: First Five Years of Federalism. Kathmandu, Nepal: FMoHP, BEK, and NHSSP, 2022.

Thapa R, Bam K, Tiwari P, Sinha TK, Dahal S. Implementing federalism in the health system of Nepal: opportunities and challenges. Int J Health Policy Manag. 2019;8(4):195–8.

Nepal Health Research Council (NHRC), Ministry of Health and Population (MoHP), Institute for Health Metrics and Evaluation (IHME), Monitoring, Evaluation and Operational Research (MEOR). Nepal Burden of Disease 2019: A Country Report based on the 2019 Global Burden of Disease Study. Kathmandu, Nepal: NHRC, MoHP, IHME, and MEOR, 2021.

Ministry of Finance. Economic Survey 2017/18. Kathmandu: Government of Nepal, 2018.

Shrestha R, Shakya A. Health expenditure among the outpatient of type-2 diabetes in selected hospital of Kathmandu district: A cross sectional study. medRxiv. 2021:2021.05.27.21257843.

Cao WR, Shakya P, Karmacharya B, Xu DR, Hao YT, Lai YS. Equity of geographical access to public health facilities in Nepal. BMJ Glob Health. 2021;6(10):e006786. https://doi.org/10.1136/bmjgh-2021-006786.

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Tập 8 Số 1

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