Nepal is going through a political transition from a unitary state to a federalized structure with new roles and responsibilities for local, provincial and federal governments.
Nepal’s Constitution enshrines the right to healthy living and access to health services as a fundamental human right. It guarantees every citizen with the right to free basic health services from the State, emergency health services, and equal access to health services.
Though it assures health as fundamental right, in practice it may take a long time to achieve because the government is struggling to expand financial protection in the case of illness for a long period of time.
Nepal’s commitment to universal health coverage (UHC) offers a starting point for rethinking the purpose and organization of the health system and an opportunity to introduce the quality of care agenda into policy discourse.
The prioritization of UHC is one of the remarkable outcomes of the 2018/19 health budget of Nepal. The budget increased healthcare expenditure by NPR 24·64 billion (US$ 228 million).
Despite the significant increase in government expenditure on health, out-of-pocket expenditure remains high, especially among older people.
Since 2018, the UHC Partnership (UHC-P) supports the finalization of basic health care service packages and strengthens capacity building regarding health service delivery at all levels.
The development of a health financing strategy and technical support regarding the strengthened health management information system are also part of the cooperation with the UHC-P.
Similarly, Nepal Health Sector Strategy (NHSS, 2015‐20) and NHSS IP (2016‐21) have the commitment to UHC, ensuring equitable access to quality health services, provision of basic health care services free and beyond basic through social protection scheme and has defined basic health service package.
Moreover, the government plans to scale-up the government health insurance program nationally and establish at least one healthcare facility in each ward. It expects to implement the free availability of essential medicines in all health facilities; local production of essential medicines.
However, the implementation is questionable with the budget that has been allocated. The proportion of current health funding is significantly lower than the government’s own target to attain 8% of the national budget for health expenditure, and the World Health Organization’s (WHO) recommendation of general government health expenditure of at least 5% of gross domestic product (GDP).
Nevertheless, these health-benefit packages do not include interventions that are key for maintaining intrinsic capacity and functional ability of older people such as restorative surgery (cataract, knee/hip replacement), assistive devices, functional nutritional supplements, multimodal physical exercises, and long term care.
The Global AgeWatch Insights 2018 report found that older people are unable to access available basic health services due to distance of medical facilities, cost, and a lack of information and discrimination by health workers. And while women are living longer, they spend more years in poor health in their old age.
Nepal can achieve progress in attaining UHC if the Government of Nepal considers health expenditure in a spirit of UHC that supports SDGs and strengthen its monitoring system to ensure the financial resources spent on health are used efficiently.
For this, policy-makers must address competing priorities, services, and financing mechanisms for older people and it must be inclusive so that on the road to UHC, no elder is left behind.
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