Health Systems Strengthening

Strong health systems are critical to achieving the Sustainable Development Goals and ensuring good standards of health and equitable health outcomes for all. Yet many governments struggle to provide the right preventive care or treatment at the right time, in the right quantity and at the right cost.

In Nepal, the government is committed to increasing the health and nutrition status of the Nepalese people by improving access to and use of quality essential services, especially targeting the poorest people, those living in remote areas and women and children. Strengthening the building blocks of an effective health system including human resources for health, infrastructure, procurement and supply chain management and sustainable health financing is critical. As is improved sector management and governance, and strengthened decentralized planning and budgeting as the country moves towards a federal structure.

We have been working in Nepal since 1997 providing technical support to the government to implement its health sector programmes. We focus on strengthening the performance and interconnectedness of different areas of the health system including essential health service delivery, procurement of commodities, health infrastructure, health financing and policy.

We have worked at all levels within the system – from strengthening the quality of primary health care services in rural areas to the development of evidence-based policies, plans and budgets at national level. We work across sectors, for example making links between health systems and investments in infrastructure. We also ensure mainstreaming of gender and social inclusion throughout the health system including addressing issues such as gender-based violence.

Our work to strengthen health systems includes:

  • Working in partnership with national health ministries to build capacity and develop tailored and integrated strategies aligned to health sector policy and plans
  • Placing teams of long-term advisors alongside national government counterparts to strengthen core areas of the health system
  • Strengthening human resource development and management systems to improve the recruitment, training, deployment and retention of qualified health workers
  • Supporting staff from national to district level to strengthen governance and foster joint planning, coordination and communication across departments and with other key ministries
  • Improving accountability of health staff through social auditing at facility level
  • Working with health ministries to find innovative ways of harnessing and focusing the energies of communities, NGOs and the private sector to expand coverage and access.

Our innovations  

We have pioneered a facility based approach to improving quality of care by working with health facility operation and management committees to develop quality improvement indicators and regular planning and review processes.

We have introduced a system of e-tendering for infrastructure projects to increase competition and transparency in the procurement of large-scale building contracts. Our experts have developed integrated building designs for health facilities to increase the quality of buildings and also reduce construction costs. We have supported the introduction and upgrading of the web-based Health Infrastructure Information System (HIIS) to help plan new facilities and track the condition of existing buildings.

We have mainstreamed gender and social inclusion into the Ministry of Health’s planning and budgeting. This has improved the availability of support services for victimised and marginalised people, including survivors of gender-based violence by supporting the set-up of one-stop crisis management centres. Social service units have also been established in eight hospitals.

We have supported the piloting and scale-up of social audits across the sector, empowering citizens to demand accountability and rights, raising awareness of providers’ responsibilities and improving facility governance. Social auditing was conducted in 602 facilities of 45 districts in 2014.

We have supported the upgrading of the national Health Management Information System (HMIS) to a web-based system across the country that allows facilities to access data for local planning purposes.

Results

Maternal mortality has dropped from 901 to 258 per 100,000 live births between 1990 and 2015

Neonatal mortality has dropped from 59 to 22 per 1,000 live births between 1990 and 2015

The percentage of births attended by a skilled birth attendant has increased from 37% in 2012 to 55% in 2014

The e-tendering system led to a cost saving of 12% in first year – saving the Government of Nepal approximately £3.4 million

The integrated building designs for health facilities saved the Government of Nepal approximately £2.97 million in construction costs within the first year

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P.O.Box: 7830, Kupondole Height, Lalitpur, Nepal