In the recent years, health sector reform in Nepal has been accorded high priority on the national development agenda. The focus has mainly been on ensuring people's rights to access essential health care services at all levels. Health is one of the important sectors in development as it contributes substantially to economic growth and sustainable development. So the efforts to increase access to, along with the utilisation of, essential healthcare services based on the National Health Policy and the Second Long-Term Health Plan (1997-2017) are praiseworthy. Furthermore, strengthening the current health system is crucial to achieve universal coverage of essential health services at all levels.  

Change and progress  

Reforming the health sector was a long-awaited agenda, which only began in 2004 with support from several development partners. More notably, the Nepal Health Sector Plan II (2010-2015) has been a major landmark in terms of delivering tangible outputs in the areas of service delivery and improved governance for health sector management. Additionally, socio-economic barriers to access healthcare in communities have been substantially reduced in recent years through the provision of free services in health facilities.

Over the decades, Nepal has made considerable progress in achieving some of the targets of the Millennium Development Goals (MDGs), particularly in health. More importantly, the countdown to 2015 has already begun in terms of measuring progress in each indicator and identifying ways to accelerate actions in addressing the resource gaps for specific interventions. In this context, the government and external development partners are enthusiastically reviewing the progress made, thinking of how these ambitious targets can be achieved by 2015 and framing the post-2015 development agenda for action.

In the face of political instability and prolonged conflict in the last decade, poverty reduction remains the most daunting of challenges among the MDGs. Still, the proportion of the population below the poverty line has significantly declined to 23.8 percent and the target for 2015 is likely to be achieved if the present rate of decline is consistently sustained.  

According to the 2013 MDG progress report, the goal of reducing child mortality by two-thirds in between 1990 and 2015 has already been achieved. Similarly, reducing maternal mortality ratio by three-quarters is also on track to be achieved by 2015. Nepal, as one of the 189 countries committed to achieving the MDGs, has put enormous effort into meeting the ambitious targets. In doing so, the support from external development partners, civil society and private sectors has made a huge difference.

Focus on the poor

Despite these remarkable achievements, there is a need to focus on addressing geographic and demographic disparities in reducing both child and maternal mortality. For instance, stunting among children is still increasing among the poorest quintile, which indicates that more targeted nutrition interventions are needed for the poorest of the poor and the socially marginalised in rural communities.

Furthermore, the targets for reducing the neo-natal mortality rate, increasing contraceptive prevalence and halting the spread of HIV/AIDS by 2015 are less likely to be achieved. Even to sustain the recent progress on child mortality, it has been realised that neo-natal mortality and morbidity have to be drastically reduced. Therefore, the post-2015 agenda should include consolidating and sustaining the MDG achievements so far, accelerating the pace of meeting unmet targets and addressing gaps. More notably, MDG achievements thus far have not been uniform. There are still major concerns regarding equitable access to quality healthcare services for all.

To address these issues, health sector reform, including a range of health systems to strengthen initiatives through several strategic policies and plans, is needed. The tenth plan and the poverty reduction strategy paper were aligned with poverty reduction and MDGs. Now, the government has adopted a sector-wide appr-oach (SWAp) in the health sector to enhance coordination and the harmonisation of efforts between the government and external development partners. This has been instrumental in adopting common approaches across the sector under government leadership, which helps ensure accountability and transparency.

Keeping up progress

Therefore, there is increasing interest among government and development partners to adopt SWAp in their development assistance framework. This is because SWAp reduces aid fragmentation and duplication. More importantly, it enhances government ownership and leadership for transparent sector budget processes. It also minimises transaction costs associated with external funding. Eventually, SWAp will help achieve the ambitious targets for the health sector MDG.

The agenda to reform the health sector needs to consider the increasing importance of aid effectiveness. Over the years, there has been enormous funding support from development partners for national health plans and programmes. It is high time to assess the effectiveness of aid in the health sector in terms of delivering concrete outcomes and impacts. As the new government is still engaged in the unfinished political agenda of peacebuilding, constitution writing and state restructuring, the agenda beyond 2015 should definitely receive high priority to continue and sustain the momentum of the ongoing progress.

Bhandari is with Nutrition and Food Security Secretariat at the National Planning Commission. Views expressed are personal (talk2jhabindra@gmail.com)