National Health Planning

Session Objectives
At the end of the session the BSc 3rd year students will be able
to,
Define Planning
Define Health Planning
Define National Health Planning
Describe Types of Health Planning
Explain Health Planning system of Nepal
Explain the five year plans
Planning
• Planning is considered as a process which involves the determination
of future course of action.

What action
Why an action

How to take When to

action take
Introduction

Health planning is the process of allocating

resources to best meet goals within given
resource constraints, and the subsequent
monitoring and evaluation of the results
achieved, all of which feeds into subsequent
plans.
Types of Health Planning
Based on time frame

Based on used

Based on hierarchy
Types of Health planning ….
• Based on use

Single use plans

Standing use plans

Short term planning
These are operational plans.

These are prepared by lower management.

They are for short-term,

Generally annual, quarter, month etc.

Medium term planning

These are strategic plans.

They are prepared for 1-5 years.
It defines tactical goals for implementing corporate plan.

E.g. ?

Three year interim plans, five year plans etc.

Types of Health planning ….
Long-term plan
These are plan that extend for more than 5 years.

They are prepared by top level management. E.g. Long-term

health plans, Millennium development goals, Sustainable
Developmental goals etc.
Types of planning
(Based on use )
• Single-use plan:

They are prepared for non-repetitive activities. They are used

only once.

E.g. Health Budget Allocation .

Types of planning
(Based on use )…
Standing plans:

• They are developed for ongoing repetitive activities.

E.g. Vision ,Mission, goals, policies, strategies, procedures etc.

Based on hierarchy

Strategic planning (grand planning)

Tactical planning

Operational planning
Strategic planning (grand planning)

• It is long term planning for five years or more. –

• It is done by top management (e.g. MoH, DoHS).

• It provides long-term direction and scope to the organization.

E.g. second long term health plan.

Tactical planning

It is middle term planning from one to five years.

 It is done by middle management for divisional or departmental

activities

e.g. regional health organizations).

Operational planning

• It is short term planning generally, annual, quarterly or monthly.

• It is the action plan for each functional unit (HP, SHP, PHCCs).

• It is prepared by lower management

 Health Planning System in Nepal
Macro level
Ministry of finance
Resource allocation National Planning Commission
  Final recommendation for budgetary allocations
Top-
 
down
Line agencies/ministries proces
INGOs/ Donor s
Recommendations for budget
agencies
Resource allocation
District Council
Prioritization, co-ordination, integration, fund
allocation, forwarding District level
planning
Ilaka Planning Workshop
Coordination between projects, integration, and
priortization

VDC Council
Botto
VDC plans, prioritized project, resource
m-up
allocation
appro
ach
Settlement
Need Collection
Five year plans
Five year plans

Five year plan for Nepal is a particular programme

which aims for social, economic and health
development of a nation.

The central purpose of the programme is to raise

production, employment, standard of living, improving
health status of people throughout the country.
 The first five year plan (1956-1961)

National development plan was launched.

Objectives were:
To increase gross domestic product.
Provide employment and improve living standards of people.
Focused on institutionalisation of curative services.

Ministry of health and maternity hospital (1956) were

34 hospitals. , 24 dispensaries and 63 Ayurvedic
established
dispensaries
 Second five year plan (1961-1965)
Emphasis both preventive and curative medicine for the first
time.
Survey initiated for smallpox-1962
Projects for leprosy (1963) and TB (1965) control were
launched.
Royal drug research laboratory (1964) and assistant nursing
midwife (ANM) training programme started.
 Third five year plan (1965-1970)
More extensive efforts were developed to help plan health
strategies for the future.
The concept of preventive medicine had become well
established in planning and budgeting.

Idea of rural health post was introduced and 9 posts had been
built by 1970.

Other achievements : development of projects like smallpox

eradication project (1967) , family planning (1968).

Central health laboratory established- 1967

Idea of rural health post was introduced and 9 posts
had been built by 1970.

Other achievements : development of projects like

smallpox eradication project (1967) , family planning
(1968).

Central health laboratory established- 1967

 Fourth five year plan (1970-75)
 Health priorities changed from curative service to
preventive services.

Institute of medicine established-produce new paramedical

workers and train existing medical personnel.

Community health and integration division was

established.

This made health programs cost effective

 Fifth five year plan (1975-80 )
Process of integration was further developed.

Prior to this plan, health services were provided by different

mechanisms.

Basic curative-hospitals , health centres and health posts.

These services were static in nature with no outreach.

Geographical conditions posed an obstacle for
establishing effective centres

It was difficult for a percentage of population to

receive services
 Sixth five year plan (1980-1985)
Focuses on decentralization

Emphasises the establishment of four regional health

development centres.

Authority delegated to the regional centre to formulate ,

implement , monitor and evaluate plans and programmes
of respective regions
 Seventh five year plan (1985-90)
Focuses on minimum basic health needs of the
people.
Primary health care and sanitation were mentioned
in the planning document.
Health care services expanded in rural areas.
Preventive measures also strengthened in order to
control and prevent malarial , tuberculosis , leprosy
and other contagious and epidemic diseases.
Family planning program intensified-control population

Maternal and child welfare services programs adopted to

improve nutrition status.
Ayurvedic , homeopathy health care developed as integral parts
of basic health services.

Emphasized on private sector’s participation in health service

development.
Eighth five year plan
(1992-1997)
Emphasized on providing ‘Health for All’ by:

Bringing an improvement in public health status

Producing healthy manpower for development

Making maternity health and family planning services
effective.
Specialist oriented health services available in country
Ninth five year plan (1997-2002)
Objective of supporting poverty eradication.

Improving health status with the help of preventive ,

promotional , curative and rehabilitative means of
health services.
Policies of enhancing health status of people.

Extending specialist health services.

Making modern and traditional curative

services effective.
Developing and expanding reproductive health services.

Mobilization of private and non-government sectors.

Improvement in cost effectiveness of institutional health

services.

Promotion of people’s participation inter regional co-

ordination were also adopted.
Second Long-Term Health Plan (1997-2017) was
started for the period of 20 years
 Tenth five year plan
(2002-2007)
Making essential health care services available to all.

Establishing public-private NGOs partnership in the

delivery of health care services
Improving quality of care through total quality
management of human , financial and physical
resources.
To date, management of total of 1,433 health agencies
of 28 districts have been handed over to local bodies.

National capacity to produce healthy human resources

at all levels has been developed.

The Health Sector Strategy- an agenda for

change was formulated and endorsed by the
council of ministers in 2003.
Interim Plans

From 2007 onwards three year plan had been formulated as

country is unable to have a full five year plan due to the
protracted political transition.
Eleventh three year plan (2007-2010)

Seeks to establish the right of the citizens to free basic

health care services.

Following policies implemented:

Special programs was launched in an integrated manner

Human , financial and physical resources provided by the
government , private sector and NGOs would be managed
effectively for improving quality of health care services.

Community drug program and community co operative

clinics services will be encouraged.

Mutual relationship between health science and medical

and public health studies will be strengthened.

Research will be promoted

 Twelfth three year plan(2011-2013)
Goal was to improve the living standard of
people
Reduction of poverty to 21%
Through sustainable economic growth
Generating dignified and gainful employment.

Reducing economic inequalities.

Achieving regional balances.

Eliminating exclusions.

Strategies were:
To achieve employment centric poverty alleviation oriented ,
sustainable and broad-based economic growth

To develop physical infrastructures

To emphasise on inclusive and equitable development

to achieve sustainable peace.

To contribute to socio economic and social services.

To make development works result oriented .

The thirteenth three year plan (2014-
2016)

Has a long term perspective of transforming Nepal into

developing country within these three years.

Strategies were:

Alleviation of poverty and improving standard of living.

Development of hydropower and energy sectors

Productivity growth of agro-sector

Basic education, health , drinking water and sanitation

Good governance
Roadways expansion
Development of physical infrastructures.
Tourism and trade
Reducing the existing trade deficit and attaining higher

economic growth.

Empowerment of targeted peoples.

Reducing poverty from 23.8 to 18 %

 socialism-oriented
prosperous nation

Fourteenth three year Plan

• The main objective of the plan would be to build an independent

and prosperous state while ensuring basic social service and
maintaining food, health, energy and job security to build a
welfare state.
The economic policies would be focused on the path of
prosperity while strengthening national economy through
participation, independent development and complementary
role of public, private and cooperatives sector as per the
policies and programmes.
Strategies

Graduating Nepal to Developing Country soon

Implementation of Financial Sector Developing Strategy

Necessary arrangement for PPP

Strategies…

Agriculture will be developed as dignified and respected

occupation

Agriculture loan, crops and livestock insurance

Establishment of resource centre in each province

 Second long term health plan

In 1997-2017 Government of Nepal- The Ministry of

Health developed a 20-year Second Long- Term
Health Plan (SLTHP) for FY 2054-2074 (1997-2017).

The aim of the SLTHP is to guide health sector

development in the improvement of the health of the
population; particularly those health needs are not
often met.
Objectives

To improve the health status of the population of the most

vulnerable groups, particularly those whose health needs
often are not met-women and children, the rural
population, the poor, the underprivileged, and the
marginalized populations.
Objectives…

• To extend to all districts cost-effective public health measures

and essential curative services for the appropriate treatment of
common diseases and injuries.
Objectives…

To provide the appropriate numbers, distribution and

types of technically competent and socially
responsible health personnel for quality healthcare
throughout the country, particularly in under-served
areas.
Objectives…

To improve the management and organization of the public

health sector and to increase the efficiency and effectiveness of
the healthcare system.
Objectives…

To develop appropriate role for NGOs, and the

public and private sectors in providing and
financing health services.
Objectives…

To improve inter-and intra-sectoral co-ordination and to provide

the necessary conditions and support for effective
decentralization with full community participation.
Targets

To reduce the infant mortality rate to 34.4 per thousand live
births;
To reduce the under-five mortality rate to 62.5 per thousand;
To reduce the total fertility rate of 3.05;
To increase life expectancy to 68.7 year;
To reduce the crude birth rate to 26.6 per thousand;
Targets…

To reduce the crude death rate to 6 per thousand;

To reduce the maternal mortality rate to 250 per hundred
thousand births;
To increase the contraceptive prevalence rate to 58.2 percent;
To increase the percentage of deliveries attended by trained
personnel to 95%;
To increase the percentage of pregnant women attending a
minimum of four antenatal visits to 80%;
Targets…

To reduce the percentage of iron-deficiency anemia among

pregnant women to 15%.
To increase the percentage of women of child-bearing age (15-
44) who receive tetanus toxoid to 90%.
To decrease the percentage of newborns weighing less than
2500grams to 12%.
To have essential health care services in the districts available
to 90% of the population living within 30 minutes travel time of
facilities.
Targets…

To have essential drugs available at 100% of facilities.

To equip 100% of facilities with staff to deliver essential health

care services.

To increase total health expenditure to 10% of total government

expenditure.
References
Vati Jogindra, Principles and Practice of Nursing Management and
Administration, New Delhi, Jaypee Publishers, 2013. Pg no. 153-154.
https://www.healthnet.org.national health plns Retrived on sept 1st
2017.
Three year interim Plan (unofficial translation ), Government of Nepal
National Planning Commission,Singhadurbar, Kathmandu, Nepal
December 2007 .
http://
nepaliheadlines.com/14th-three-year-plan-build-socialism-oriented-prosper
ous-natoin .
Retrived on sept 3rd 2017.
Policy paper on health Nepal, WHO, country office for Nepal,December-
2007.