4 TENTH PLAN (2059/60-2063/64)
4.1 OVERARCHING NATIONAL OBJECTIVE
The overarching national objective of the Tenth Plan is to reduce the magnitude of poverty among the Nepali people substantially and sustainable by developing and mobilizing the healthy human resources.
4.2 OBJECTIVES
In order to provide capable and effective type of curative, preventive, promotional and rehabilitative health services and to make the reproductive health and family planning services available to reduce the growing population, the health service sector will have the following objectives:
4.2.1 Apart from improving the quality of health services, increase the access of the poor and disadvantaged people of the rural and remote areas to these services.
4.2.2 Besides the management of the growing population, access of reproductive health and family planning services will be extended to the rural areas extensively in consideration of maternal health service.
4.3 QUANTITATIVE GOALS
The goals of the health service sector are given in the following table:
| SN | Health Indicators | Status as of FY 2002 | Target of 10th plan | |
| General Growth | Alternative growth | |||
| 1 | Availability of Essential Health Care Service (in %) | 70 | 90 | 88 |
| 2 | Availability of the stipulated essential medicines in the specific institutions (%) | 80 | 90 | 89 |
| 3 | Provide essential health services with all health workers required (%) | 60 | 80 | 78 |
| 4 | Percent of women receiving prenatal service for four times | 14.3 | 18 | 17 |
| 5 | Women of 15-44 age group receiving TT vaccines (%) | 45.3 | 50 | 49 |
| 6 | Birth attendance by the trained health workers (%) | 13 | 18 | 17 |
| 7 | Contraceptive Prevalence Rate (in %) | 39 | 47 | 46 |
| 8 | Use of Condoms for safe sex (14-15 yrs) (%) | - | 35 | 35 |
| 9 | Total Fertility Rate (women of 15-49 yrs) | 4.1 | 3.5 | 3.6 |
| 10 | Crude Birth Rate (per 1000) | 34 | 30 | 30 |
| 11 | Maternal Mortality Ratio (per 100,000 live birth) | 415 | 300 | 315 |
| 12 | Newly born infant mortality rate (Neo-Natal Mortality Rate) per 1,000 live births | 39 | 32 | 33 |
| 13 | Infant Mortality per 1,000 live births | 64 | 45 | 47 |
| 14 | Child Mortality (<5 yrs.) per 1,000 live births | 91 | 72 | 74 |
| 15 | Crude mortality Rate | 10 | 7 | 7 |
| 16 | Life Expectancy at birth (years) | 61.9 | 65 | 64 |
Source: Tenth Plan (2059-2064) National Planning Commission
4.4 STRATEGIES
The following strategies have been developed:
4.4.1 Investment to provide essential health service to the poor and the backward communities will be increased gradually.
4.4.2 Ayurveda, naturopathy services and traditional healing systems (like homeopathy, Unani) will be developed as the supplementary health service. In order to conserve and promote these services, these remedial systems will be developed by the use and promotion of local medicinal herbs and by enhancing skills and expertise in the use of these.
4.4.3 Health services will be gradually decentralised in line with the Local Self-Governance Act, 1998 and the office-bearers of Local Health Administration and Management Committees will be involved in orientation programmes to enhance their working capability.
4.4.4 So as to raise the availability of and access to essential health services, main contributors to health problems such as safe motherhood, reproductive health, child health, nutrition, tuberculosis, kala-azar (typhus), malaria, Japanese encephalitis and other communicable diseases need to be addressed in order to enhance health services in rural and remote areas through special programs.
4.4.5 All government, non-government and private health institutions at the local level providing basic health services and at the central level providing specialist services will be effectively managed and strengthened by means of two-way communication system.
4.4.6 With the aim of improving the quality of health services provided in partnership by the government, private and non-government sectors, the human, financial and physical resources will be managed effectively.
4.4.7 The reproductive health program has an important role to play in the effective management of population. Family planning services will be made more extensive and effective based on the increasing informed choices. Moreover, it will help reduce maternal and child mortality as well.
4.5 POLICIES AND WORK PLANS
In order to fulfill the objectives of keeping the population growth within the desired rates, reducing the disease burden, and providing the people in general and the poor, women and children with the quality health services, the following policies are listed out.
- Extension of essential health services
- Ayurveda, naturopathy, Unani and other traditional health services management and decentralized health service
- Special health service to control communicable and non- communicable diseases
- Disseminating system
- Partnership/participation of the government, non-government and private sectors
- Reproductive health service
4.5.1 Basis of the Programs:
In line with the recommendations made by the Public Expenditure Review Commission and the policy of involving local elected bodies in the management of physical infrastructure and financial resources of the health institutions operating at the rural level, the health posts and primary health care centers will be handed over to the local elected bodies in the Tenth Plan.
Communicable diseases, malnutrition and the motherhood-related diseases are found to be the causes of 68 percent of all diseases and 50 percent of total mortality in Nepal. In order to implement such programs relating to control of contagious diseases, nutrition, reproductive health and family planning with due priority, it is necessary that in the days to come, the government and private institutions be listed and the places and norms of the services (including specialist-oriented services) be specified.
There is substantial disparity in the conditions of health services between the urban and the rural areas. An independent National Micro-economic Health Commission will be set up within the accepted structure of the national program of poverty eradication to conduct the health sector program in a coordinated manner.
The health service program are prioritized in the Tenth Plan on the following basis:
- Burden of diseases,
- Implementing capacity,
- Equity,
- Programs targeted to the poor, the oppressed and those deprived of opportunities,
- Programs contributing to poverty eradication,
- Availability of resources
There are 3 categories of programs P1, P2 and P3 based on descending order of priority.
| The Programs in First Priority
(P1) |
The Programs in Second Priority
(P2) |
The Programs in Third Priority
(P3) |
- Control of malaria - Typhus (kala-azar) - Natural disaster and management - Vector-borne diseases and their control, research and training - Tuberculosis - Leprosy - HIV/AIDS and Sexually Transmitted Diseases (STD) - Health information, communication and education - Supply management - Community medicine - Health insurance - Information management |
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