Belay, TekabeTandon, Ajay2015-08-132015-08-132015-04https://hdl.handle.net/10986/22389Nepal 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.en-USCC BY 3.0 IGOLIVING STANDARDSHEALTH CARE PROVIDERSINFANT MORTALITY RATESWASTEFORECASTSEMPLOYMENTFEMALE EDUCATIONRISKSHEALTH INSURANCE SYSTEMFINANCINGINFORMAL SECTORINCOMEUNDER-FIVE MORTALITYFEE FOR SERVICEHEALTH EXPENDITURESPUBLIC SECTORDOCTORSHEALTH ECONOMICSNEEDS ASSESSMENTSHARE OF HEALTH SPENDINGPRIMARY CARECOST-EFFECTIVENESSHEALTH SYSTEM EFFICIENCYMONITORINGHEALTH INSURANCEHEALTH CAREFINANCIAL PROTECTIONPROVISION OF HEALTH SERVICESFISCAL POLICYINCENTIVESNATIONAL HEALTH INSURANCEHEALTHECONOMIC POLICYBUDGETARY RESOURCESHEALTH WORKERSPOCKET PAYMENTSENVIRONMENTAL HEALTHBASIC HEALTH CAREHEALTH FACILITIESPUBLIC HEALTHLIFE EXPECTANCYHEALTH RESOURCESHOSPITALIZATIONADULT MORTALITYHEALTH SECTORCAPITATIONCHOICEPUBLIC EXPENDITURE ON HEALTHPROTECTION MECHANISMSPRIVATE HOSPITALSHEALTH STATUSCOSTSIMMUNIZATIONDEMAND FOR HEALTH SERVICESHEALTH INDICATORSHEALTH SYSTEMSFIXED COSTSPUBLIC HOSPITALSHEALTH CENTERSHEALTH SYSTEM PERFORMANCEEXTERNALITIESSOCIAL INSURANCENURSESHEALTH CARE SERVICESDEBTALLOCATIVE EFFICIENCYHEALTH SHAREMEDICAL CAREESSENTIAL HEALTH CARETUBERCULOSISHEALTH ORGANIZATIONHEALTH-SECTORMORTALITYHEALTH PROMOTIONHEALTH SPENDING SHAREHEALTH SPENDINGSOCIAL HEALTH INSURANCE SCHEMESMEDICAL EDUCATIONEQUITYINFANT MORTALITYWORKERSSOCIAL HEALTH INSURANCEHEALTH INSURANCE SCHEMESPUBLIC HEALTH CONCERNSPUBLIC EXPENDITURECROWDINGCAREHEALTH CARE POLICYHEALTH POLICYBUDGETSDEMANDHEALTH OUTCOMESINSURANCE CONTRIBUTIONSHOSPITAL REVENUESADULT MORTALITY RATEFAMILY PLANNINGMEDICAL SUPPLIESMEDICAL EQUIPMENTEXPENDITURESINCOME COUNTRIESHEALTH CARE FINANCINGFINANCIAL BARRIERSTEACHING HOSPITALSPRIVATE SECTORMEASUREMENTNUTRITIONBEDSHEALTH POSTSHEALTH CARE PROVIDERINSURANCE SYSTEMPRICE OF HEALTH CAREINTERNETNATIONAL HEALTHINSURANCEHEALTH RESULTSHEALTH SYSTEMINSURANCE PREMIUMSCOMMUNICABLE DISEASESLOW INCOMEESSENTIAL DRUGSCHILDRENDISEASE CONTROLRISKHUMAN RESOURCESDEMAND FOR HEALTHPOVERTYHEALTH INSURANCE CONTRIBUTIONSHEALTH EXPENDITUREILLNESSINCIDENCEPRIVATE SPENDINGPOPULATIONHOSPITAL BEDSHEALTH- SECTORFINANCIAL RISKSTRATEGYPRIVATE FINANCINGFEESHEALTH FINANCINGPUBLIC SPENDINGHOSPITALSHEALTH SERVICEINFANT MORTALITY RATEHEALTH SERVICESIMPLEMENTATIONHEALTH STRATEGYPROVIDER PAYMENTHUMAN DEVELOPMENTWorking PaperWorld Bank10.1596/22389