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Assessing Fiscal Space for Health in Nepal

Author

Listed:
  • Tekabe Belay
  • Ajay Tandon

Abstract

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.

Suggested Citation

  • Tekabe Belay & Ajay Tandon, 2015. "Assessing Fiscal Space for Health in Nepal," Health, Nutrition and Population (HNP) Discussion Paper Series 68260, The World Bank.
  • Handle: RePEc:wbk:hnpdps:68260
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    Cited by:

    1. Mohamed Keinan Hassan & Jane Gathenya & Mike Iravo, 2017. "Moderating Effect of Index Based Livestock Insurance on Socio-Cultural Factors Affecting Performance of Livestock Projects in North Eastern Kenya," International Journal of Academic Research in Business and Social Sciences, Human Resource Management Academic Research Society, International Journal of Academic Research in Business and Social Sciences, vol. 7(3), pages 99-116, March.

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    Keywords

    absenteeism; administrative management; adult mortality; Adult mortality rate; allocative efficiency; Annual reports; basic health care; budget constraint; budget process ... See More + budgetary resources; Bulletin; Cancer; capital flight; capitation; capitation payment; capitation payments; cost-effectiveness; crowding; debt; debt interest; demand for health; demand for health services; disease control; diseases; dissemination; distribution system; doctors; economic growth; economic growth rate; Economic Policy; economies of scale; efficiency gains; employment; environmental health; essential drugs; essential health care; existing resources; expenditure envelope; expenditures; expenditures on health; externalities; family planning; family planning commodities; fee for service; female education; financial barriers; financial crisis; financial position; financial protection; financial risk; fiscal conditions; fiscal policy; fiscal stability; fixed costs; forecasts; government budget; government budget constraint; government expenditure; government expenditures; government revenue; government revenues; government spending; growth rate; health care; Health Care Financing; Health Care Policy; Health Care Provider; HEALTH CARE PROVIDERS; health care services; health centers; Health Economics; health expenditure; health expenditures; health facilities; health financing; health indicators; health insurance; health insurance contributions; health insurance system; Health Organization; health outcomes; Health Policy; health posts; Health Promotion; health resources; health results; health sector; health service; health services; health share; health spending; health spending share; health status; health strategy; health system; health system efficiency; health system performance; Health Systems; health workers; health-sector; hospital; hospital beds; hospital revenues; hospitalization; hospitals; Human Development; Human Resources; ill health; illness; immunization; income; income countries; Infant; Infant mortality; infant mortality rate; infant mortality rates; informal sector; insurance premiums; interest payments; life expectancies; Life expectancy; lifestyles; live births; Living Standards; low income; macroeconomic conditions; macroeconomic environment; Malaria; maternal health; maternal mortality; Medical Care; Medical Care Expenditure; medical education; medical supplies; Millennium Development Goals; Ministry of Finance; Ministry of Health; mortality; multilateral donors; national dialogue; national goals; national health; national health insurance; national health systems; national income; National Planning; needs assessment; nurses; Nutrition; official development assistance; payment system; pocket payments; policy makers; policy response; political instability; political turmoil; Poor health; Population Discussion; potential users; Poverty Reduction; price of health care; primary care; Private financing; private hospitals; private sector; private spending; programs; progress; provider payment; provision of health services; provision of services; public expenditure; Public Expenditure on Health; public expenditure review; public expenditures; public health; public health concerns; public hospitals; public sector; public spending; quality of services; reform agenda; remittance; remittances; resource allocations; Richer countries; safe motherhood; sanitation; segments of society; service delivery; share of health spending; skilled birth attendance; social health insurance; social health insurance schemes; social insurance; social protection; teaching hospitals; tolerance; Total expenditure; total spending; transportation; Tuberculosis; Under-five mortality; urbanization; Vaccines; vulnerability; waste; workers; World Health Organization;
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