Publication: Assessing Fiscal Space for Health in Nepal
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2011-07
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2013-02-15
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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.
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“World Bank. 2011. Assessing Fiscal Space for Health in Nepal. © World Bank. http://hdl.handle.net/10986/12371 License: CC BY 3.0 IGO.”
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Publication Assessing Fiscal Space for Health in Nepal(World Bank Group, Washington, DC, 2015-04)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.Publication Assessing Public Expenditure on Health from a Fiscal Space Perspective(World Bank, Washington, DC, 2010-02)This document delineates a simple conceptual framework for assessing fiscal space for health and provides an illustrative roadmap for guiding such assessments. The roadmap draws on lessons learned from analyses of seven fiscal space case studies conducted over the past two years in Cambodia, India, Indonesia, Rwanda, Tonga, Uganda, and Ukraine. The document also includes a summary of the fiscal space assessments from these seven case studies. Any assessment of fiscal space typically entails an examination of whether and how a government could feasibly increase its expenditure in the short-to-medium term, and do so in a way that is consistent with a country's macroeconomic fundamentals. Although fiscal space generally refers to overall government expenditure, for a variety of reasons there has been growing demand for a framework for analyzing fiscal space specifically for the health sector. This document outlines ways in which generalized fiscal space assessments could be adapted to take a more health-sector specific perspective: what is the impact of broader macroeconomic factors on government expenditures for health? Are there sector-specific considerations that might expand the set of possible options for generating fiscal space for health? 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Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.Publication Rwanda : Fiscal Space for Health and the MDGs Revisited(World Bank, Washington, DC, 2009-11)This paper revisits the issue of fiscal space requirements for achieving health millennium development goals (MDGs) in Rwanda. The paper updates and extends work on financing for the health MDGs prepared by the Ministry of Health (MoH) in 2006. It draws on papers prepared by World Bank staff for a comprehensive health sector review and information collected during a field visit to Kigali in March 2008. The context is one of large recent increases of financing from development partners (donors) combined with far reaching reforms of health sector management. The paper aims to provide a concise summary of the key issues for policymakers in Rwanda, development partners, and to inform a broader international audience of the prospects for scaling up financing for health in order to substantially raise the health status of low income country populations. The plan of the paper is as follows: section one describes the demographic and health context, the strategic objectives through to 2015, and recent and prospective progress towards achieving these objectives; section two briefly explains the distinctive features of health financing with an emphasis on primary and secondary services needed to achieve strategic objectives; section three considers financial flows in the health sector; section four elaborates a forward-looking fiscal space for health scenario; section five compares projections of fiscal space and alignment of health spending with a costing scenario developed using the marginal budgeting for bottlenecks (MBB) tool; section six concludes with a discussion of the uses and potential of government-development partner compact for health sector financing in support of a long term health strategy.
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