A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures.In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.

1. HEALTH
SYSTEM OF
NEPAL
PRESENTED BY:
DR. S.M. JASHIM
UDDIN RAZIB ;
MPH (Health Service Management and Policy)
Department of Public Health and Hospital
Administration

2. ABOUT NEPAL
 Nationality: Nepali, Nepalese, Gorkhali
 Religions: Hindu 81.34%, Buddhist 9.04%, Muslim 4.38%, Kirant 3.04%, other
2.2% (2011 census).
 Literacy: Total population: 48.6%
 Population: 29,033,914
 Median age:total: 23.6 years
 Population growth rate: 1.24%
 Birth rate: 19.9 births/1,000 population (2016 est.)
 Death rate: 5.7 deaths/1,000 population (2016 est.)
 Net migration rate: -1.9 migrant(s)/1,000 population (2016 est.)
 Total fertility rate: 2.18 children born/woman (2016 est.)
 Urbanization: urban population: 18.6% of total population (2015)
 Sex ratio: total population: 0.99 male(s)/female (2016 est.)
 Life expectancy at birth: total population: 70.7 years
 Maternal mortality rate: 258 deaths/100,000 live births (2015 est.)

3. Background
 The health system in Nepal is 122 years old and based on
primary health care approach
 The Health System introduced as the General Health Plan
in 1956 has been expanded by focusing on primary health
care, and a comprehensive network-like Health System
has been developed
 Health services are mixed –both government and non-
government (for profit and not for profit)

4. The Health Care Systems

5. Health Service Delivery
 Community based health services and interventions-
immunization (mobile clinics -every month), Vitamin A
and albendazole distribution (twice a year) & primary
health care out reach clinics (mobile clinics- every month)
from local health facility
 Female community health volunteers and mothers groups
 Hospital and facility based services-general, specialized
and mobile

6. Health Service Organization
 Sub Health Post
 Health Post
 Primary Health Care Centre
 District Hospital
 General Hospitals- zonal and regional headquarters
 National Hospitals
 NGO and Private Health Institutions

7. Health Governance
 Ministry of Health and Population (MoHP) consists of 3
departments:
Department of Health Services (DoHS),
Department of Ayurveda (DoA),
Department of Drug Administration (DDA)
 5 Regional Health Directorates (RHDs) directly under MoHP
 61 districts are managed by District Health Office (DHO) with
support of District Public Health Officer (DPHO), whereas the
remaining 14 districts are managed by DPHO solely
 Facility level health/hospital management committees
 Regulatory bodies like Nepal Medical Council (NMC),
Nursing council, etc.

8. Health Financing
 Government of Nepal
 Donors
 Local bodies –increasing trend for last two years
 International non-government organizations
 7.2% budget in health sector in current financial year

9. Levels Of Health Care
 Primary:
 SHPs (Sub-Health Post)
 HPs (Health Post)
 PHCCs (Primary Health Care Centers)
 Secondary:
 District hospitals
 Zonal hospitals
 Regional hospitals
 Tertiary:
 Central hospitals
 Teaching hospitals

10. Referral System In Nepal

11. Major Policies and Initiatives
 Health sector reform
 Sector wide approach
 Millennium development goal
 Poverty reduction
 Social inclusion
 Nepal health partnership compact and international
health partnership plus
 Global health initiative
 Health System Funding Platform

12. Major Health Programmes
 Institutional delivery declared free with maternity incentive
scheme
 Introduction of Free Health Care (service charges abolished
and essential drugs provided for free)
 Cash support to poor patients suffering from cancer, heart
disease, CKD, Alzheimer’s disease and Parkinson’s disease
 Compulsory 2 years posting of physicians (completing MBBS
course in government scholarship) outside Kathmandu
 Community based neonatal care
 Nutrition supplemental programme

13. Challenges
 Climate change and health
 Equity, accessibility, quality and coverage of essential
health care services
 Nutrition
 Inter agency coordination
 Sustainability of health programme
 Reemerging and new emerging diseases
 Deployment and retention of Human Resources for
Health(HRH) in remote and rural areas
 Increase in non-communicable diseases