Nepal Health Sector Strategy 2015‒2020.

The Nepal Health Sector Strategy 2015-2020 (NHSS), under the auspices of National Health Policy 2014, is the primary instrument to guide the health sector for the next five years. It adopts the vision and mission set forth by the National Health Policy and carries the ethos of Constitutional provision to guarantee access to basic health services as a fundamental right of citizens. It articulates nation’s commitment towards achieving Universal Health Coverage (UHC) and provides the basis for garnering required resources and investments. NHSS places health at the centre of overall socio-economic development. It guides the health sector’s response in realizing government’s vision to graduate Nepal from ‘Least Developed Country’ to ‘Middle Income Developing Country’ by 2022. NHSS is developed within the context of Sector Wide Approach (SWAp) and it sees partnership as a cornerstone for health development in Nepal. The government and development partners commit to align their efforts to NHSS priorities and are jointly accountable to achieve the results. NHSS also harnesses multi sectoral approach to address social determinants of health (pag. i).
Good nutrition is a key driver of development and economic growth whilst under-nutrition incurs significant productivity losses for individuals and ultimately for the nation. With this important realization, the government has accorded a top priority to address under-nutrition in the country. NHSS emphasises better implementation of these strategies and plans. Increasing use of harmful chemicals, antibiotics and pesticides on food products warrants greater attention of MoHP during the NHSS period. Multi-sector advocacy and communication strategies on nutrition and food security will be adopted (pags. 26 and 27).
As part of the development strategy of the GoN, NHSS defines the health sector as being beyond the exclusive domain of the Ministry of Health and Population (MoHP). It recognises that multitudes of state line agencies and non-state actors working for social and economic development are part of the health sector in their differing capacities. This strategy guides the government and development partners to further improve aid effectiveness in the health sector as agreed under Paris Declaration on Aid Effectiveness and subsequent high-level aid forums. NHSS articulates the goal and objectives for the next five years of the government and its development partners, who are mutually accountable for its achievement. The Implementation Plan (IP) and the Results-based Monitoring Framework are developed on the basis of this strategy. The Government of Nepal will progressively seek to fund the implementation of this strategy from internal and external resources. Specifically the government will aspire to fund the provision of Basic Health Services entirely from government revenues (pag. 41).
NHSS Vision states: "all Nepali citizens have productive and quality lives with highest level of physical, mental, social and emotional health" and carries the aspiration to bring about holistic change in individuals and society by improving the health status of the citizens leading to overall human, social and economic development. The vision statement alludes to the idea that increasing the investment in human health is central to Nepal’s development; healthy productive citizens are able to better society and drive economic growth. The vision aspires the sector to focus beyond its traditional role of delivering healthcare services to Nepali citizens. It establishes the mental, social and emotional well-being of individuals as integral facets of human health to enable citizens to live quality lives. Its Mission is: "Ensure citizens’ fundamental rights to stay healthy by utilizing available resources optimally and through strategic cooperation between service providers, service users and other stakeholders" (pag. 20).
Health is part of the broader development agenda more linked to the wider social determinants such as empowering of women, improving of rural and urban infrastructure, expanding access to clean air, water and sanitation, better waste management, and improving access to quality education. Ensuring health in all policies emphasises the importance of multi-sectoral working. While inter-sectoral coordination in health has been going on for a long time, more institutionalized way of setting-up multi-sectoral approach is a relatively new phenomena. NHSS reviews the current multi-sectoral approaches being practiced in areas such as nutrition and WASH and identifies ways to strengthen them. NHSS also calls for building capacities within MoHP to effectively harness multi-sector collaboration (pag. 25).
The present structure of the public health sector may require reorganizing to implement the forward-looking aspirations of the National Health Policy 2071 and emerging developments in the global health agenda. The recent earthquake induced disaster, which destroyed health infrastructure and damaged health systems in affected districts, while tragic, also provides an opportunity to restructure and rebuild health systems better. NHSS calls for reviewing current structure and functions at different tiers of health governance, developing and rolling-out restructuring plan, including redefining of roles and responsibilities of different health institutions. The post-disaster reconstruction and rebuilding plan, under NHSS, takes into consideration opportunities to restructure and rebuild systems to provide more effective and efficient health care services. The restructuring will also take into account establishing systems, structures and procedures for disaster and emergency preparedness at all levels. The post-earthquake scenario has also created additional health needs such as mental health and rehabilitation services to the affected population (pag. 23).