Washington DC, April 20, 2010 – The World Bank will contribute a further US$ 129.2 million to help poor and underserved Nepalis access and use essential health care services. The Second Heath, Nutrition and Population (HNP) and HIV/AIDS Project approved today will support the Nepal Health Sector Program II, the Government of Nepal’s five year program (2010-2015). The project will build on the World Bank’s on-going support to Nepal’s health sector since 2004
More than 70 percent 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 project will support the expansion and strengthening of these services with a focus on better reaching the poor and excluded segments of the society.
Three development partners, the World Bank, the Department for International Development of the UK (DFID) and the Australian aid agency, AusAID, have agreed to pool finances to meet a slice of Nepal’s health sector expenditures. Other funding partners will provide technical and financial assistance directly.
The project includes two components: (i) Health Service Delivery and (ii) Health Systems Strengthening. Under the first component, the project will help the Government of Nepal deliver an affordable package of essential health services to the poor and excluded populations. This will be achieved by deploying more health personnel where they are needed, introducing exemption and incentive schemes, improving and expanding physical infrastructure and establishing community feedback mechanisms. This component will also help improve the nutritional status of children and pregnant women; expand coverage and improve effectiveness in the response to HIV and AIDS; and further reduce mortality and morbidity associated with pregnancy and child birth. An additional 5000 Female Community Health Volunteers will be recruited, trained and deployed to expand the public health services to rural areas, and windows for partnership arrangement with NGOs and other non state partners will be opened to efficient and effective delivery of HIV/AIDS, nutrition, reproductive, child health, and health promotion and education related activities.
Under the second component, the project will help improve the availability of human resources for health, especially in underserved areas; improve the sustainability of health care financing and design measures to protect against impoverishment due to ill-health; strengthen and expand the scope of monitoring and evaluation; and improve governance and accountability in the health sector. This component constitutes the World Bank’s support to a more harmonized support for health systems strengthening through joint financing by the government and several development partners.
“The project will support the government’s program to respond to the people’s expectations of inclusive and accountable public services,” says 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.”
Nepal’s health sector has seen impressive progress in the past few years. Infant mortality declined by 39 percent over the last fifteen years 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 percent from 118 to 61 deaths per 1,000 live births over the same period while neonatal and postnatal mortality also decreased by 34 percent and 48 percent, respectively. These declining trends in mortality rates continue as confirmed by a recent survey where both infant and under-five mortality have further declined to 41 and 50 per 1000 live births respectively in 2004-2008. Similarly, maternal mortality declined significantly from 530 per 100,000 live births in 1996 to 281 in 2006, a trend consistent with the data from the maternal mortality survey in 2009 which showed a Maternal Mortality Ratio (MMR) of 229. Several of Nepal’s immunization and nutrition programs are also performing very well.
However, not all segments of the society equally benefit from the progress. “Inequality in health outcomes, access and service utilization remains high,” says 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.”
In geographical terms, the mid and far west regions have the worst access to health services. Earlier surveys have shown that Dalits as well as ethnic and religious minorities have lower utilization of health services.
Informed by a comprehensive vision of an inclusive society, Nepal’s Interim Constitution gives Nepali citizens the right to publicly financed basic health services that are free to the user. In accordance with this vision, and in an effort to increase Nepal’s ability to meet the Millenium Development Goals (MDGs), the Government of Nepal has established universal free essential health services at the health post and sub-health post levels. The government has also introduced targeted free health care in Primary Health Centers and District Hospitals, and plans to expand these programs up to regional and national level facilities.
“The quality of services will be regularly monitored under the proposed support", says Nastu Sharma, Health Specialist at the World Bank. “This will be done through a range of activities, including the scaling up of social auditing mechanisms, periodic surveys and reviews of goods and works procured, and periodic facility surveys.”
Financing for the project will be a blend of credit and grant from the International Development Association, the World Bank’s concessionary lending arm.