NATIONAL HEALTH POLICY, 1991
The National Health Policy was adopted in 1991 (2048 BS) to bring about improvements in the health conditions of the people of Nepal. The primary objective of the National Health Policy is to extend the primary healthcare system to the rural population so that they benefit from modern medical facilities and the services from trained healthcare providers. The National Health Policy addresses the following areas:
1.1: PREVENTIVE HEALTH SERVICES
Priority is given to programs that directly help reduce infant and child mortality. Services are to be provided in an integrated manner throughout the country through the national health systems network.
1.2: PROMOTIVE HEALTH SERVICES
The programs that enable people to live healthy lives will be given priority.
1.3: CURATIVE HEALTH SERVICES
Curative health services will be made available at all health institutions-central, regional, zonal, and district hospitals; primary health care centers (PHCCs), health posts (HPs), and sub-health posts (SHPs). Hospital expansion will be based on population density and patient loads. Mobile teams will be organized to provide specialist services to remote areas. A referral system will be developed to direct the rural population to well-equipped institutions.
1.4: BASIC PRIMARY HEALTH SERVICES
Sub Health Posts will be established in a phased manner in all Village Development Committees (VDCs). One Health Post in 205 electoral constituencies will be upgraded in a gradual manner and converted to a Primary Health Care Centre.
1.5: AYURVEDIC AND OTHER TRADITIONAL HEALTH SERVICES
The ayurvedic system will be developed and other traditional health systems (such as Unani, Homeopathy, and Naturopathy) will be encouraged.
1.6: ORGANISATION AND MANAGEMENT
Improvements will be made in the organization and management of health facilities at the central, regional and district levels. This will include the integration of the district hospitals and the public health offices into District Health Offices.
1.7: COMMUNITY PARTICIPATION IN HEALTH SERVICES
Community participation will be sought at all levels of healthcare through the participation of female community health volunteers (FCHVs), traditional birth attendants (TBAs), and leaders of various local social organizations. VDCs will provide sites for the location of SHPs.
1.8: HUMAN RESOURCES FOR HEALTH DEVELOPMENT (HRH)
Technically competent human resources will be developed for all health facilities. Training centers and academic institutions will be strengthened to produce competent human resources.
1.9: RESOURCE MOBILISATION IN HEALTH SERVICES
National and international resources will be mobilized and alternative concepts (such as health insurance, user charges, and revolving drug schemes) will be explored and affected wherever possible.
1.10: PRIVATE, NON-GOVERNMENTAL HEALTH SERVICES AND INTER-SECTORAL COORDINATION
The Ministry of Health & Population will coordinate activities with the private sector, non-governmental organizations (NGOs), and non-health sectors of GoN. The private sector and NGOs will be encouraged to provide health services to expand services and access.
1.11: DECENTRALISATION AND REGIONALISATION
Decentralization and regionalization will be strengthened; peripheral units will be made more autonomous. DHOs and DPHOs will have a prominent role in the planning and management of preventive, curative, and promotive health services from district to village levels.
1.12 BLOOD TRANSFUSION SERVICES
The Nepal Red Cross Society will be authorized to conduct all programs related to blood transfusion. The practice of buying, selling, and depositing blood will be prohibited.
1.13 DRUG SUPPLY
Improvements will be made in the supply of drugs by increasing domestic production and upgrading the quality of essential drugs through the effective implementation of the National Drug Policy.
1.14 HEALTH RESEARCH
Health research will be encouraged for helping evidence-based policy formulation and better management of health services.
2 OPERATIONAL GUIDELINES ON POLICIES AND PROGRAMS OF THE MINISTRY OF HEALTH AND POPULATION
The policies and programs of the Ministry of Health and Population and the actions and activities of its officials will be as directed by the spirit and feelings of the Jana Andolan II (Peoples€™ Revolution, 2006/2007) 2062/63.
With the prime objective of bringing about a change in the overall health of a Nepali and towards creating a healthy Nepali society, the Ministry of Health and Population will perform the following tasks:
2.1 We express our strong commitment to the worldwide recognition of "health being the basic right of people". Our special focus will be on people of economically and socially deprived groups, sex, tribes, communities, and regions to guarantee the health of the overall Nepali people.
2.2 Our strong commitment lies in the fact that the state has a major role to deliver all kinds of health services to the people, be it preventive, promotive, or curative. Towards primary health care, the services will be provided according to the proclamation of the Alma Ata Declaration. Ayurveda and other alternative medical practices will be conserved and promoted.
2.3 The present health budget will be increased. Steps will be taken to provide more funds available to the health sector as in other social welfare sectors. In order to ensure additional funding for health services, budgetary cuts will be enforced in the budget for Royal Palace and Nepal Army. The budget allocated to the health sector will be used in an effective and efficient way and there will be no letup in administration for financial corruption and other irregularities in the health sector. System of reward and punishment will be practiced with full commitment. International donor organizations will also be encouraged to extend their cooperation according to the spirit and feelings of this Guideline.
2.4 Special initiatives will be taken to create a provider-friendly atmosphere for doctors and health workers to work in villages and rural areas. Their career development and opportunity for higher education will be ensured. A two way feedback system will be made operational.
2.5 Medical education will be made responsive to the requirement of the health sector of Nepal and a coordination mechanism will be strengthened with the Ministry of Education, the Universities, and other teaching organizations. Necessary steps will be taken to involve such teaching institutions for quality health care providers for the people.
2.6 Support will be provided through necessary policy directives and supervision of the private sector in order for them to function responsibly in society. A cooperative approach to health will be taken in a way that ensures the participation and ownership of the community.
2.7 District health system will be organized according to the concept of integrated approach and decentralization principle. To empower the people through the mechanism of health-related activities, community-based health workers will be empowered. Special initiatives will be taken to tap the inherent capabilities of these health workers and health volunteers and ensure effective use of it in their role as a bridge between the people and the health institutions.
2.8 Realizing the fact that health and development have an interdependent relation, the Ministry will make a concerted effort for effective intersectional coordination.
2.9 The population policy of Nepal will be strongly steered towards the aim of reducing poverty and hunger.
2.10 The Ministry of Health and Population will take immediate steps to provide health security to the families of those seriously injured and those who obtained martyrdom during the Jana Andolan II.
3 SECOND LONG TERM HEALTH PLAN, 1997-2017
The Ministry of Health and Population of the Government of Nepal has developed a 20-year Second Long-Term Health Plan (SLTHP) for FY 2054-2074 (1997-2017). The aim of the SLTHP is to guide health sector development for the overall improvement of the health of the population, particularly those whose health needs are often not met.
The SLTHP addresses disparities in healthcare, taking into account gender sensitivity and equitable community access to quality healthcare services. The aims of the SLTHP are to provide a guiding framework to develop successive periodic and annual health plans that improve the health status of the population; to develop appropriate strategies, programs, and action plans that reflect national health priorities that are affordable and consistent with available resources; and to ensure co-ordination among public, private and NGO sectors and development partners.
The SLTHP envisions a healthcare system with consideration of equity and access and quality services in both rural and urban areas. The system would encompass the principles of sustainability, community participation, decentralization, gender sensitivity, effective and efficient management, and public-private partnerships.
3.1 Objectives
The objectives of the SLTHP are as follows:
- To improve the health status of the population of the most vulnerable groups, particularly those whose health needs often are not met - women and children, the rural population, the poor, the underprivileged and the marginalized population;
- To extend to all districts cost-effective public health measures and essential curative services for the appropriate treatment of common diseases and injuries;
- To provide technically competent and socially responsible health personnel in appropriate numbers for quality healthcare throughout the country, particularly in under-served areas;
- To improve the management and organization of the public health sector and to increase the efficiency and effectiveness of the healthcare system;
- To develop appropriate roles for NGOs, and the public and private sectors in providing health services; and
- To improve inter-and intra-sectoral coordination and to provide the necessary support for effective decentralization of health care services with full community participation.
3.2 Targets
The targets of the SLTHP are as follows:
- To reduce the infant mortality rate to 34.4 per thousand live births;
- To reduce the under-five mortality rate to 62.5 per thousand live births;
- To reduce the total fertility rate to 3.05;
- To increase life expectancy to 68.7 years;
- To reduce the crude birth rate to 26.6 per thousand population;
- To reduce the crude death rate to 6 per thousand population;
- To reduce the maternal mortality ratio to 250 per hundred thousand live births;
- To increase the contraceptive prevalence rate to 58.2 percent;
- To increase the percentage of deliveries attended by trained personnel to 95%;
- To increase the percentage of pregnant women attending a minimum of four antenatal visits to 80%;
- To reduce the percentage of iron-deficiency anemia among pregnant women to 15%;
- To increase the percentage of women of childbearing age (15-44) who receive tetanus toxoid (TT2) to 90%;
- To decrease the percentage of newborns weighing less than 2500 grams to 12%;
- To have essential healthcare services (EHCS) available to 90% of the population living within 30 minutes€™ travel time to health facility;
- To have essential drugs available around the year at 100% of facilities;
- To equip 100% of facilities with full staff to deliver essential health care services; and
- To increase total health expenditures to 10% of total government expenditures.
3.3 DELIVERY OF ESSENTIAL HEALTHCARE SERVICES
3.3.1 Essential Health Care Services for the Modern System of Medicine:
The Second Long Term Health Plan indicated that priority will be given to health promotion and prevention activities based on Primary Health Care principles. It identified Essential Health Care Services (EHCS) that address the most essential health needs of the population and that are highly cost-effective. EHCS are priority public health measures and are essential clinical and curative services for the appropriate treatment of common diseases. The EHCS for Ayurveda and other traditional systems of medicine are defined separately.
| Main Interventions* | Health Problems Addressed |
| Appropriate treatment of common diseases and injuries | Common Diseases and Injuries |
| Reproductive health | Maternal and Peri-natal health problems including other RH issues |
| The expanded program on immunisation (EPI) and Hepatitis B Vaccine | Diphtheria, Pertusis, TB, Measles, Polio, Neonatal Tetanus, Hepatitis B |
| Condom promotion and distribution | STD/HIV, Hepatitis B, Cervical Cancer |
| Leprosy control | Leprosy |
| Tuberculosis control | Tuberculosis |
| Integrated Management of Childhood Illness (IMCI) | Diarrhoeal Disease, Acute Respiratory Infection (ARI), Protein Energy Malnutrition (PEM), Measles and Malaria |
| Nutritional supplementation, enrichment, nutrition education and rehabilitation | PEM, Iodine Deficiency Disorders, Vitamin A Deficiency, Anaemia, Cardiovascular Disease Prevention, Diabetes, Rickets, Perinantal Mortality, Maternal Morbidity, Diarrhoeal Disease, ARI |
| Prevention and control of blindness | Cataracts, Glaucoma, Pterygium, Refractive Error, and other Preventable Eye Infections |
| Environmental sanitation | Diarrhoeal Disease, Acute Respiratory Infection, Intestinal Helminthes, Vector Borne Diseases, Malnutrition |
| School health services | Diarrhoeal Disease, Helminthes, Oral Health, HIV, STDs, Malaria, Eye and Hearing Problems, Substance Abuse, Basic Trauma Care |
| Vector borne disease control | Malaria, Leishmaniasis, Japanese Encephalitis |
| Oral health services | Oral Health |
| Prevention of deafness | Hearing Problems |
| Substance abuse, including tobacco and alcohol control | Cancers, Chronic Respiratory Disease, Traffic Accidents |
| Mental health services | Mental Health Problems |
| Accident prevention and rehabilitation | Post Trauma Disabilities |
| Community-based rehabilitation | Leprosy, Congenital Disabilities, Post Trauma Disabilities, Blindness |
| Occupational health | Chronic Respiratory Disease, Accident, Cancers, Eye and Skin Diseases, Hearing Loss |
| Emergency preparedness and management | Natural and Man-made disasters. |
* Main Interventions are listed in priority order
