World Health Organisation, Nepal office

Discussion, Q&A

… on work on National Health Financing Strategy

• WHO support on the policy and strategy development level

• during 2021-2022 government of Nepal developed the National Health Financing Strategy through the rapid response initiative (RRI) approach* practiced in a voluntary program by P4H under their “Leadership for UHC” program, (method to gather key players in the sector / 100 days to focus on one topic and develop a strategy; rather than teaching technical issues it is teaching leadership methods; involving stakeholders not only from Ministry of Health, but also from Ministry of Finance and key stakeholders that have to come together to take decisions in health financing)

• 3 major components of this National Health Financing Strategy

  • national health insurance, (National Health Insurance Implementation Plan)

  • basic healthcare package and (Monitoring Framework for basic healthcare services; *social protection scheme)

  • emergency care

• National health insurance was already cleared by a committee under previous government, in a next step needs to be endorsed by ministries (Ministry of Finance + Ministry of Health), finally needs to be endorsed by the Cabinet – ongoing process due to a recent change of government in Nepal (Note: status Apr 2023)

• National Health Insurance Implementation Roadmap combines implementation steps defined under the Ministry of Health (national health strategy plan in Jan/Feb 2023) and Health Insurance Board (HIB) which had developed a similar kind of roadmap for 2030

… on efforts to install ‘Provide for Health’ - P4H country focal person for Nepal

• P4h network: not much presence of P4h in Nepal, government has not requested country focal point, even though WHO and GIZ have been trying to convince them since 2018

• WHO is trying to bridge to the P4h network on any activities e.g. the flagship programme of P4h on Leadership for UHC

• General info on Leadership for UHC program (https://l4uhc.world/): L4UHC enables senior decision-makers to develop the leadership skills and collective actions needed to bring universal health coverage (UHC) to life in their countries. The one-year programme helps multi-disciplinary teams from each country address specific obstacles to progressing their UHC plans more rapidly. It does this through a combination of proven methodologies and first-hand experiences

  • More info: https://l4uhc.world/5-key-benefits/.

• Nepal government adopts rapid response initiative (RRI) approach also for other areas

• Since 2016 P4H flagship program Leadership for UHC (GIZ was taking lead)

  • ‘Leadership for Health’ meetings between countries took place in several phases

  • In current phase module 2 took place in

  • Oct 2022 in Bangkok/Thailand;

  • meeting discussed for late summer / autumn in Sri Lanka

… on Capacity Building needs

• strengthening HIB requires more than training for individuals;

• challenges on HR side: currently only 2 people (Executive Director + 1 more officer at top management level) are supported through the Ministry, equipped with necessary decision making power

• programme of the WB and funding for District Level Institutions (DLIs) might provide more incentives to the government to strengthen the HIB – could mean a role for GIZ in capacity building (e.g. on costing analysis)

 … on support to Ministry of Health and Population, working on health information systems and partnerships related to eHealth

• WHO work on promoting digital systems and quality data at hospitals … on implementation level will also support better claims management at health insurance (e.g. Electronic Health Record and other digital systems at hospitals help to provide the quality data which is needed for AI claims management)

• Under eHealth strategy for Nepal, topics of international standards and interoperability are addressed as well as investments in digital infrastructure to facilitate scale-up of interoperable digital solutions; WHO also supported development of the e-Health roadmap

  • Objectives: leading to greater transparency and accountability and empowering decision-makers; provision of reliable, timely data and development of digital capacities is enabling new insights and analytical possibilities, strengthening the role of the government as policy-maker and steward of the health sector – important in the context of Nepal’s federalisation, where responsibilities for budgeting and planning health service delivery are being devolved to the local level

  • Nepal eHealth Strategy (EN, 2017) https://drive.google.com/file/d/1DnZiF32G1Wxwki-uRiArORxLafX_9_es/view

  • Digitalising Nepal’s health sector - A country’s journey towards an interoperable digital health ecosystem, publication in the German Health Practice Collection (2018) https://health.bmz.de/wp-content/uploads/GHPC_NEPAL_DIGI_SHORT_WEB.pdf ; https://health.bmz.de/wp-content/uploads/GHPC_NEPAL_DIGI_FINAL_WEB__.pdf (2017)

  • Roadmap on eHealth strategy Nepal https://old.mohp.gov.np/attachments/article/521/E-Health%20Roadmap.pdf

• Lately reviewing progress in implementation as compared to steps defined in roadmap, also revising document regarding big data, augmented reality / virtual reality (AR/VR), Electronic Health Records (EHRs), telemedicine etc.

• Current challenge: not sufficient human resource and resources in the Ministry to drive such developments; market itself on these things quite mature in Nepal – innovators are there; linking the innovators and the users is still difficult (… on side of public provided medical services)

• WHO showcases facilities using DHIS2, openIMIS and EHRs to other hospitals with intention to strengthen eHealth developments throughout Nepal

• Currently with support of GIZ ILO is working on the Interoperability Lab at the Ministry of Health

  • definition: “A health interoperability lab is a facility focusing on the interoperability of digital health applications. It is where the government, private sector, and academia can come together to test, create, innovate and connect digital health information systems. With digital health experts’ help, the lab ensures that health information systems are standards-based and interoperable.” (http://sil-asia.org/sil-asia-supports-health-interoperability-lab-set-up-in-nepal/ , SIL-Asia builds Capacity for Health Interoperability Lab Set-up in Nepal,  Standards and Interoperability Lab - Asia,  Mar 2021)

• For WHO and Ministry of Health the focus now is on extending Universal Health Coverage (UHC); considering to do an analysis and mapping of digital health programmes as MoH has no inventory of digital health programs in Nepal

• Understanding that WHO and GIZ need to build further partnerships to increase resources on digital health programme / health data (with the MoH)

Participants

• Paban Ghimire (Mr), National Professional Officer, Health Information Systems / World Health Organisation

• Roshan Karn (Mr), National Professional Officer, Health Financing / Office of the WHO Representative in Nepal

• Alexander SCHRADE (Mr), Senior Policy Officer, Division Health, Social Protection and Population Policy Division / German Federal Ministry of Economic Cooperation and Development (BMZ)

• Olivier PRAZ (Mr), Senior Policy Advisor, Global Programme Health / Swiss Agency for Development and Cooperation (SDC)

• Saurav Bhattarai (Mr), Component Lead openIMIS, Programme Social Protection Innovation and Learning, Gesellschaft fuer Internationale Zusammenarbeit (GIZ)

• Konstanze Lang, Advisor openIMIS, Global Programme Social Protection Innovation and Learning, Gesellschaft fuer Internationale Zusammenarbeit (GIZ)

• Helen Witte (Ms), Technical Advisor, Support to the Health Sector Strategy / GIZ Nepal