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FEATURE STORY

Providing Essential Health Services to Nepal’s Poorest and Most Excluded

April 20, 2010



The objective of the project is to enable the Government of Nepal to increase access to essential health care services and their utilization by the underserved and the poor.

Health indications
Nepal’s health sector has seen impressive progress in the past few years. Infant mortality declined from 79 deaths per 1,000 live births in 1991-94 to 48 deaths in 2001-2005. An even more impressive decline was observed in under-five mortality, which declined by 48% from 118 to 61 deaths per 1,000 live births over the same period.

A recent survey (NFHP 2009) confirmed that the declining trends in mortality rates continue; both infant and under-five mortality have further declined to 41 and 50 per 1000 live births respectively in 2004-2008. Several of Nepal’s immunization and nutrition programs are also performing very well. Between 1996 and 2006, full immunization coverage rose from 43%to 83%.

However, not all segments of the society equally benefit from the progress. “Inequality in health outcomes, access and service utilization remains high,” said Albertus Voetberg, Lead Health Specialist at the World Bank. “The poor have the largest unmet demand for family planning, make the lowest use of maternal care, have the lowest vaccination coverage, and are least likely to seek care when ill.”

Access to esscential health
The Government of Nepal’s five year program (2010-2015) focuses especially on providing poor and underserved Nepalis access to essential health care services. More than 70% of the Ministry of Health and Population budget finances “essential health services”, referring to a specific package of cost-effective interventions which seek to improve reproductive, maternal and child health, to prevent the impact of non-communicable diseases and to control communicable diseases.

The World Bank’s Second Heath, Nutrition and Population (HNP) and HIV/AIDS Project ($129.2 million), approved on April 20, 2010, supports the expansion and strengthening of these services with a focus on better reaching the poor and excluded segments of the society.

“The project will support the government’s program to respond to the people’s expectations of inclusive and accountable public services,” said Susan Goldmark, the World Bank Country Director for Nepal. “The geographic coverage of essential services will be expanded, and policies aimed at increasing access and utilization by the poor and under-served populations will be more systematically implemented.”

Community involvment
The involvement of the communities has been critical to the achievements in the health sector. Under the project, local communities manage thousands of health facilities. The government of Nepal provides the clinics’ doctors and staff and operational cost, while communities provide oversight for day to day operation of the clinic.

With the large number of donors active in Nepal, program coordination is important. Since 2004, the Department for International Development of the UK (DFID), the Australian aid agency, AusAID, and the World Bank has pooled finances to meet a slice of Nepal’s health sector expenditures and other partners have expressed interest in joining this mechanism in the near future. This has helped harmonization among the development partners in the health sector and has reduced transaction costs to the government.