Context
The German Federal Ministry for Economic Cooperation and Development (BMZ) has been supporting the development of the Nepalese health sector since 1994. Significant progress has been made with respect to the health status of the Nepalese population including a substantial reduction in maternal and infant mortality. However, some systemic deficits persist. These relate to the lack of efficiency and effectiveness in the centralised, yet fragmented administration, insufficient social protection in case of illness and an urban health system unable to keep pace with the rapid rate of urbanisation. The quality, availability and, in part, also the acceptance of essential health services is still inadequate among large segments of the population, especially among the poor.
Objective
Equitable access to health services for the population in selected districts and municipalities is improved.
Approach
The project is closely aligned with the Nepal Health Sector Strategy (2015–2020). It advises the national authorities responsible for steering the sector on designing reforms and supports implementation in selected districts and municipalities in the Far Western, Mid Western and Central development regions. The project concentrates on five fields of activity:
Implementing a social health insurance system including strengthening hospital management
Raising the quality of health care services in sexual and reproductive health
Strengthening governance in health (including urban health)
Upgrading and networking existing health information systems to prepare for a future national health information platform
Improving the delivery of medical and psycho-social services for drug users (up to June 2016)
The project cooperates closely with South Korea, in particular, through a cofinancing arrangement. Other important partners are the German KfW Development Bank, United Kingdom, USA, United Nations Population Fund (UNFPA), World Bank, World Health Organization (WHO), and Global Fund to Fight AIDS, Tuberculosis and Malaria.
The consulting firms GFA Consulting Group, with Jhpiego as a technical partner, and m4health, with Options UK and evaplan GmbH as technical partners, support the implementation of the project.
Results
The project follows up on the Nepali-German Health Sector Support Programme (HSSP). The following results have been achieved in three of the areas in which activities are being continued:
Social health insurance including hospital management
The project has made a key contribution to the political debate on health financing and social protection in case of illness. In 2014, the Nepalese Cabinet adopted a policy decision to introduce a national health insurance scheme. The Ministry of Health has prepared guidelines for the implementation of this scheme, which will be rolled out throughout the country, starting in the districts of Kailali, Ilam and Baglung.
Sexual and reproductive health
The project supports the implementation of components of the Nepal Health Sector Strategy, for example by designing and organising the establishment of information services and providing local financial contributions. A mobile telephone-supported information campaign with regular short messages on topics of sexual and reproductive health was successfully created and launched. To date, around 2.4 million text messages have been received and interactive elements have been used 133,000 times.
In birthing centres, coaching and mentoring have been introduced as an innovative approach to on-the-job training. This instrument is being used to dovetail the development of skills and performance of both medical personnel and managers.
The project has significantly enhanced the political debate on the official introduction of midwifery as a new profession and its contribution to improving maternal and child health.
Medical and psychosocial services for drug users
These services were initially offered only by public health facilities. The project has supported the expansion of these services to include non-governmental organisations (NGOs). Opioid substitution therapy is now available in eight hospitals and four NGO-run substitution centres. At the end of 2015, these service providers were treating more than 1,000 patients a day.