Analysis of Health Sector Budget of Nepal
DOI:
https://doi.org/10.31729/jnma.2757Keywords:
health care; budget; financing; unitary system; federalism.Abstract
Introduction: Primarily, health sector connects two segments - medicine and public health, where medicine deals with individual patients and public health with the population health. Budget enables both the disciplines to function effectively. The Interim Constitution of Nepal, 2007 has adapted the inspiration of federalism and declared the provision of basic health care services free of cost as a fundamental right, which needs strengthening under foreseen federalism.
Methods: An observational retrospective cohort study, aiming at examining the health sector budget allocation and outcome, was done. Authors gathered health budget figures (2001 to 2013) and facts published from authentic sources. Googling was done for further information. The keywords for search used were: fiscal federalism, health care, public health, health budget, health financing, external development partner, bilateral and multilateral partners and healthcare accessibility. The search was limited to English and Nepali-language report, articles and news published.
Results: Budget required to meet the population's need is still limited in Nepal. The health sector budget could not achieve even gainful results due to mismatch in policy and policy implementation despite of political commitment.
Conclusions: Since Nepal is transforming towards federalism, an increased complexity under federated system is foreseeable, particularly in the face of changed political scenario and its players. It should have clear goals, financing policy and strict implementation plans for budget execution, task performance and achieving results as per planning. Additionally, collection of revenue, risk pooling and purchasing of services should be better integrated between central government and federated states to horn effectiveness and efficiency.
Keywords: health care; budget; financing; unitary system; federalism.
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Health and Population, Ramshahpath, Kathmandu, Nepal.
2012 April.
52. World Helath Organization. Monitoring the Building Blocks
of the Health System: A Handbook of Indicators and their
Measurement Strategies. 2010.
State Challenges and Opportunities. Sangam Journal.
2009;1(1):11. Available from: http://www.ccd.org.np/
resources/Krishna%20Khanal%20Democracy%20and%20
Federalization%20Article%20for%20Sangam%20Journal_
ENG.pdf.
2. Citizen Survey 2013: Nepal in Transition Nepal Democracy
Survey Round III June 2013. Joint survey by State of
Democracy in South Asia/Nepal chapter / and International
IDEA. Available from: http://www.idea.int/asia_pacific/
nepal/upload/Citizen-Survey-Report-2013.pdf.
3. Murray C JL and Frenk J, A WHO Framework for Health
System Performance Assessment, Evidence and Information
for Policy, World Health Organization. P.10. http://www.
who.int/health-systems-performance).
4. Hort K Goss J Hopkins S and Annear P. Conceptual
frameworks, health financing data and assessing
performance: A stock-take of tools for health financing
analysis in the Asia-Pacific region. Health Policy and Health
Finance Knowledge Hub (Working Paper Series no. 5). The
Nossal Institute for Global. April 2010.
5. Dhakal RP. Analysis of Implementation Challenges of
health Sector Decentralization Policy of Nepal, (PhD Thesis),
College of Public Health, Chulalongkorn University. 2009,
Pg.8.
6. The Interim Constitution of Nepal, 2063 (2007) as amended
by the first to sixth amendments. UNDP:Nepal; 2009
Jan. Part3, section 16, sub-section 2, p. 56-70. Distributed
by Centre for Constitutional Dialogue (CCD), Alfa Beta
Complex, Buddhanagar, Kathmandu, Nepal.
7. Budget Analysis 2011/ 12. Ministry of Health and
Population Ramshahpath, Kathmandu, Nepal, 2012.
Available from: http://www.nhssp.org.np/health_
financing/Budget%20Analysis%202011-12.pdf.
8. Shiva Raj Adhikari. An Evaluation of Nepal’s Free Health
Care Schemes: Evidence from a Quasi-Experimental Design.
(Working paper). July, 2013. Available from: http://papers.
ssrn.com/sol3/papers.cfm?abstract_id=2289344.
9. Annual Report, Department of Health Services, 2067/68
(2010/2011), Government of Nepal, Ministry of Health and
Population, Kathmandui, Nepal; 2011.
10. Ministry of Health and Population (MoHP). Progress Report
on Financial Management. In Nepal’s Health Sector 2012/13
Report Prepared for Joint Annual Review (JAR). January 2014,
Government of Nepal (GoN), Ramshah Path, Kathmandu,
Nepal (http://www.nhssp.org.np/jar/2014/03%20%20
Financial%20Mgt%20%20JAR%20Report%20Final.pdf).
11. Bhusal CL et al. Report of Status of Free Health Care Services
at Health Posts and Sub- Health Posts in Nepal. Nepal Health
Research Council, Kathmandu, Nepal; 2010.
12. Suvedi BK et al. Service Tracking Survey, 2011. Ministry of
Health and Population, Kathmandu, Nepal; 2012.
13. Nepal Health Sector Programme-II (NHSP-2) 2010 – 2015.
Government of Nepal, Ministry of Health and Population.
1 June 2010. P.93.
14. Ministry of Health and Population. Human Resources for
Health Strategic Plan 2011-2015 (Draft). January 2012, p.37.
15. Dhakal RP. Addressing the challenges to health sector
decentralization in Nepal: an inquiry into the policy and
implementation processes. Available from: http://www.
nmcth.edu/images/gallery/Editorial/YhxaUr_dhakal.pdf.
16. Bhusal CL et al. District Health Assessment: To Guide
the Design of the National Health Insurance Scheme,
Kathmandu, Nepal. 2013 June. p. 50.
17. Ensor T, Tiwari S, Assad AR. Health Financing & Financial
Management Capacity Assessment for Health Systems
Strengthening. 2000. p.15.
18. Central Bureau of Statistics, National Planning Commission
Secretariat, Government of Nepal, Kathmandu, Nepal,
November, 2012. National Population and Housing Census
2011, National Report. Volume 01, NPHC 2011.
19. Bhanu Prasad Acharya, How do budget reforms link to
development outcomes? A Nepalese Experience. The
Nepalese Journal of Public Financial Management (PEFA)
Journal Year - II Issue – 3, Dec 2013. P.1
20. Udaya Pant, Realistic Budgeting for capital Expenditure:
Suggested Draft Mechanism of Segregation of Budget into
Approved Budget Projects and Projects Carried Forward/
or in Pipeline, The Nepalese Journal of Public Financial
Management (PEFA).2013;2(3):73.
21. RTI International. Health System Performance. Research
Triangle Park, NC, USA. 2010.
22. WHO. Stastics. Availabe from: http://www.who.int/
countries/npl/en/.
23. Ban B, Tuladhar S, Pant S, and Suvedi BK. Review of Health
and Health Service Improvements in Nepal. J Nepal Health
Res Counc. 2012 May;10(21):76-81.
24. Distinctions Between Public Health & Medicine. Availabe
from: http://www.hsph.harvard.edu/about/public-healthmedicine/.
25. Jha N. Revitalizing Primary Health Care and activities in
Nepal. Health Renaissance 2013;11(3):185-191.
26. Ministry of Health, Nepal Health Sector program
implementation plan, NHSP-IP, Kathmandu, MInistry of
Health, Kathmandu; 27.
27. World Bank. The Millenium Development Goal for the
Health: Rising to the challenges, Washington DC, World
Bank. 2004.
28. Price R, Erlandsen E, and Joumard E. Spending Efficiency in
Health Care and Economic Growth. Availabe from: http://
hdl.handle.net/11094/22973 . p.57).
29. Brian Galligan. Federalism, Subnational Government and
Rights Protection. [online]. 2007 Sep 24-26 [cited 2009
Apr 3]. Available from: http://arts.monash.edu.au/psi/
news-and-events/apsa/refereed-papers/au-nz-politics/
galligan.doc
30. Federalism, Political Theories for Students. Availabe from:
http://www.encyclopedia.com/article-1G2-3424700014/
federalism.html. This indicates, creation of federations is not
the ending of problem forever.
31. States and union territories of India. Availabe from: http://
en.m.wikipedia.org/wiki/States_and_union_territories_of_
India.
32. Michael Burgess. Comparative Federalism Theory and
practice. First published 2006 by Routledge. Park Square,
Milton Park, Abingdon, Oxon OX14 4RN, UK; p.1.
33. Ogden LL. How Federalism Shapes Public Health Financing,
Policy, and Program Options. J Public Health Management
Practice. 2012;18(4):317–322.
34. Griffith JR and RW Kenneth. The Well-Managed Health
Organization, Sixth Edition, Health Administration Press,
Chicago: Illinois AUPHA Press, Washington, DC, AUPHA,
HAP;2007. p.75.
35. George Schieber, Cristian Baeza, Daniel Kress, and Margaret
Maier. Financing Health Systems in the 21st Century.
Availabe from: http://www.ncbi.nlm.nih.gov/books/
NBK11772/pdf/ch12.pdf.
36. Gray AM, Clarke PM, wolstenholme JL, wordsworth S,
Applied Cost-Effectiveness Analysis in Healthcare, 2011:
Oxford university press, New York. 2011.p.1
37. OECD/WHO (2011), OECD Reviews of Health Systems:
OECD Publishing, Switzerland. 2011. Availabe from: http://
dx.doi.org/10.1787/9789264120914-en. p.157.
38. Crivelli L and Salari P. The inequity of the Swiss health
care system financing from a federal state perspective.
International Journal for Equity in Health. 2014;13:17.
Availabe from:. http://www.equityhealthj.com/
content/13/1/17.
39. The inequity of the Swiss health care system financing from
a federal state perspective. Availabe from: http://www.
equityhealthj.com/content/pdf/1475-9276-13-17.pdf
40. OECD/WHO (2011), OECD Reviews of Health Systems:
OECD Publishing, Switzerland; 2011. Availabe from: http://
dx.doi.org/10.1787/9789264120914-en. p.157.
41. The world health report 2000 - Health systems: improving
performance. Availabe from: http://www.who.int/
whr/2000/en/whr00_en.pdf?ua=1.
42. Central Bureau of Statistics. Estimation: 2012/13): Nepal.
2013.
43. Christie W. Should there be a ceiling on what percentage of
GDP countries spend on health? No. BMJ 2008;337:a1036.
44. Bosanquet N. Should there be a ceiling on what percentage
of GDP countries spend on health? Yes. BMJ 2008;337:a1040.
William D. Savedoff. What Should A Country Spend On
Health Care? Health Affairs. 2007;26 (4):962-970.
46. Dulal RK. Health Federalism: The Role of Health Care
Professionals in Nepal. J Nepal Med Assoc. 2009;48(174):191-5.
47. Preker AS and Harding A (Ed). Innovations in Health
Service Delivery: The Corporatization of Public Hospitals.
The World Bank, Washington, D.C. 2003 Jan. http://www.
who.int/bulletin/volumes/91/8/12-113985/en/ or doi
http://www.who.int/bulletin/volumes/91/8/12-113985.
pdf.
48. Roemer, MI. National Health Systems of the World , Vol. 1:
The countries: Oxford University Press, New York;1991.
49. Kutzin J. Health financing for universal coverage and
health system performance: concepts and implications for
policy. Availabe from: http://www.who.int/bulletin/
volumes/91/8/12-113985.pdf
50. Tiwari et al. Budget Analysis. January 2012. Ministry of
Health and Population, Ramshahpath, Kathmandu, Nepal.
2012.
51. Baker C. Designing Federal Structure in Nepal. Ministry of
Health and Population, Ramshahpath, Kathmandu, Nepal.
2012 April.
52. World Helath Organization. Monitoring the Building Blocks
of the Health System: A Handbook of Indicators and their
Measurement Strategies. 2010.
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Dulal, R. K., Magar, A., Karki, S. D., Khatiwada, D., & Hamal, P. K. (2014). Analysis of Health Sector Budget of Nepal. Journal of Nepal Medical Association, 52(194), 811–821. https://doi.org/10.31729/jnma.2757
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