Assessment of Health System Performance in Nepal - Ministerial ...

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Health System Performance 2010Figure 3.1: Coverage of ImmunizationSource: MoHP, (2009b); Annual reports, various yearsFigure 3.2: Monitoring of stuntingSource: Annual reports, various yearsThese two graphs begin to explain why the desired results have not been achieved in thehealth system; the government has continuously increased funding for health programmes,but institutional capacity has remained the same. The health results are remarkably consistent,showing an initial improvement in outcomes followed by a drop in results and eventualdecline, as in Figure 3.2. The fact sheets from various annual reports covering 13 years arepresented in appendix A, and they bear out the same conclusion.It is difficult to show the relationships between all health programmes and health outputs inFigures, but we have presented an econometric analysis in the cost effectiveness section.Figure 3.3 is the representative curve for all health programmes and health outputs.Obviously, if there are no health programmes, health outputs will be zero. As health11
Health System Performance 2010programmes P 1 , P 2 , P 3 , and so on are implemented, health outputs are improved H 1 , H 2 , H 3 .Clearly, there is a positive relationship between health programmes and health results(outputs); results increase as health care packages or programmes are increased. During theinitial phase of implementation, the rate of improvement in outcomes is proportional toincreases in the health programmes. Over time, however, the rate of change falls off. If weincrease health programmes, P 3 to P 4 , health outputs remain constant (H 3 ). This is the point ofstagnation. The data from the last 13 years suggests that now are now almost at this point ofstagnation.Figure 3.3: Health production function3.2 Determining factors for health production functionHealth programmes (service packages), the allocated budget, human resources, and healthinstitutions determine health production function. When health outputs fail to increase despiteincreases to the health budget and health programmes, health institutions and humanresources – that is to say capacity - may be critical to increasing health.3.2.1 Public health institutionsThe population per public health institution is defined as the ratio of people to health careinstitutions. It is one of the indicators measuring distribution of public health serviceproviders in relation to the size of the population. The data on health institutions andpopulation size are derived from the Ministry of Health and Population 2007Annual Report.The results, as seen in Figure 3.4, demonstrate that public health institutions (hospitals,primary health care centres, health posts, and sub-health posts) serve almost equal numbers ofpeople in each region.12
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