Assessing Fiscal Space for Health in Nepal
Nepal has seen impressive improvements in health outcomes and has done well both in its rate of progress and relative to its income level. Infant mortality has been declining over the past five decades to 38.6 per 1,000 live births in 2009. Similar...
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| Language: | English en_US |
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Washington, DC
2013
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| Online Access: | http://documents.worldbank.org/curated/en/2011/07/16240700/assessing-fiscal-space-health-nepal http://hdl.handle.net/10986/12371 |
| Summary: | Nepal has seen impressive improvements
in health outcomes and has done well both in its rate of
progress and relative to its income level. Infant mortality
has been declining over the past five decades to 38.6 per
1,000 live births in 2009. Similarly, maternal mortality has
decreased to 380 per 100,000 live births in 2008. Life
expectancy has been steadily increasing to 67 years in 2009.
The rate of progress is better than those witnessed by
neighboring countries. But challenges remain in addressing
inequality, high and increasing out of pocket payments.
Geographic and income-related inequalities in population
health outcomes remain large and are increasing. For
example, not only is the decline in infant mortality not
uniform, some regions have seen an increase. The policy
response to these challenges has been to expand free care
services and pilot protection mechanism against the
financial risk of ill health. There is growing demand to
expand the package as well as the coverage of existing free
essential health care to all Nepalese; to introduce new
programs such as health insurance, and other similar
initiatives This note identifies efficiency gains as the
main potential source of additional fiscal space. The
analysis presented herein indicates that improvement in
health system efficiency i.e., getting more value for money
is by far the most plausible option for realizing additional
fiscal space for health in Nepal. As the note demonstrates,
the prospects for additional resources for health from all
other possible sources from conducive macroeconomic
conditions, re-prioritization of health, external resources,
and other health-sector specific sources is limited in
Nepal. On the other hand, there are many indications of
systemic inefficiencies in the health system of the country
and the challenge would be to focus on identifying and
implementing appropriate interventions to improve the
situation and reduce waste. The note highlights some
specific areas, such as those related to provider payments,
drug procurement mechanisms, and hospital and district grant
allocations whereby significant improvements in obtaining
better value for money can be realized. |
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