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A High Level National Forum for Political Leaders and Policy Makers held in Kathmandu, 13-4-2023

Updated: May 4, 2023

The High-Level Forum for Political Leaders in Health System Development was recently convened in Nepal, bringing together 18 participants to discuss the country's transition towards federalization and its implications for the health sector. The forum aimed to shed light on the challenges and opportunities arising from this significant structural change and to explore strategies for strengthening the health system.

One of the key issues raised during the forum was the conditional grants provided by the central government to provincial and local levels. While these grants were intended to support the delivery of health services, participants noted that they often come with stringent requirements and limitations, making it difficult for subnational governments to effectively utilize the funds. There was a consensus among the participants that a more flexible and supportive approach to conditional grants is needed to enhance the health system at all levels.

The lack of coordination among different tiers of government was another major concern discussed. With the shift towards federalism, the responsibilities and authority in health service provision have been decentralized. However, the coordination mechanisms between the federal, provincial, and local levels have not been adequately established, leading to fragmentation and duplication of efforts. Participants stressed the importance of strengthening coordination mechanisms to ensure effective collaboration and resource sharing among different levels of government.

The uneven distribution of health manpower across the country was also highlighted as a significant challenge. While urban areas have relatively well-staffed health facilities, rural and remote regions face a severe shortage of healthcare professionals. This disparity in the distribution of human resources hampers access to quality healthcare services for the population residing in remote areas. The participants emphasized the need for targeted policies and incentives to attract and retain health workers in underserved regions, along with strategies to enhance the deployment and utilization of existing resources.

The forum also emphasized the importance of shifting the focus of the health system towards health promotion and prevention. While curative care has traditionally received more attention, participants recognized the need for a paradigm shift towards proactive measures that address the underlying determinants of health. This includes investing in primary healthcare, health education, disease prevention, and early detection programs. Strengthening public health interventions and prioritizing preventive healthcare would not only improve population health outcomes but also reduce the burden on the healthcare system.

The role of parliamentarians in health system development was a key aspect discussed during the forum. Participants highlighted the significance of parliamentary oversight in ensuring effective implementation of health policies and programs. They emphasized the need for parliamentarians to play an active role in human resource management, including monitoring the recruitment, deployment, and performance of health workers. Furthermore, the forum stressed the importance of adequate budget allocation for the health sector and the role of parliamentarians in advocating for increased health financing.

To address these challenges and capitalize on the opportunities presented by federalization, several recommendations were put forward by the participants. First, there is a need for clarity in the roles and responsibilities of different levels of government in the health sector. This would help establish clear lines of authority, avoid duplication of efforts, and promote effective coordination. Second, stronger engagement of local-level governments and communities is crucial to ensure that health services are tailored to the specific needs and context of each region. This includes empowering local governments to make decisions related to health service provision and involving communities in planning and implementation processes.

Third, participants emphasized the importance of evidence-based decision-making and scientific analysis in health workforce planning. Accurate data on population health needs, existing health workforce capacity, and future projections are essential for informed decision-making and resource allocation. Participants called for comprehensive workforce planning that takes into account factors such as population demographics, health service demands, and geographical distribution.

In conclusion, the High-Level Forum for Political Leaders in Health System Development provided a platform for meaningful discussions on the challenges and opportunities arising from Nepal's federalization process.

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