81314023-Technical advisory services on the development of the National Health Insurance scheme in Nepal

The German Federal Ministry for Economic Cooperation and Development (BMZ) has been supporting the development of the Nepalese health sector since 1994. There has been a steady improvement in the health of Nepal"s population since the end of the civil war in 2006, including a substantial reduction in maternal and infant mortality. Despite this progress there are still major regional disparities in levels of public service provision.

In September 2015, the Constitution of Nepal was promulgated, and it transferred many administrative and political functions to seven provinces and 753 municipalities as local governments. Although decentralization and devolution offer the prospect of creating health sector management systems with a greater focus on local needs, it also presents major challenges in terms of clarifying specific roles, getting used to new functions and building the capacity of subnational governments. The newly empowered local governments are now progressively prioritizing health.

Nonetheless, challenges remain in meeting the Sustainable Development Goals (SDGs), particularly in reducing the financial risks of major health expenditures; especially for poor households, and marginalized and vulnerable people is another challenge. The Government of Nepal has also formulated and adopted a health financing strategy to ensure the availability and efficient management of funding for the health sector. Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) was commissioned by the German government to support the Ministry of Health and Population (MoHP) for implementation of the Nepal Health Sector Strategic Plan (NHSSP 2023-2030) through the Support to the Health Sector Strategy (S2HSS II) project (2024-2027).

The overall goal of S2HSS II is to strengthen the institutional capacities of state actors in the health system, in particular the Ministry of Health and Population (MoHP), the Health Insurance Board (HIB) and the municipal health authorities, to enhance implementation of NHSSP. Building on past achievements, it focuses on three main areas: a) strengthening organizational management and improving the financial sustainability of national health insurance program, that involves supporting HIB to develop strategies for sustainable financing and efficient claims management, as a foundation to increase insurance coverage among poor and vulnerable populations, b) promoting evidence-based health management through data-driven decision-making and citizen participation, leading to efficient sectoral planning at sub-national level, c) strengthening digital health information systems by establishing standards, ensuring interoperability and allowing efficient data exchange leading to better data-driven decision-making, reduced costs, and enhanced public health outcomes. In the thematic area of social health protection, S2HSS II is advising the MoHP and the HIB on organizational development activities and measures to strengthen the core processes of these institutions and promote the strategic competence development of their experts and managers.

In addition, the support will also be extended to key social protection actors in the country like Social Security Fund (SSF), Employee"s Provident Fund (EPF), etc. Thematically, the work focuses on the key social health protection concepts, organisational development, the administration of national health insurance (gender responsive benefit packages, beneficiary management and financial management), the uses of information systems and operational research findings in social health insurance and evidence-based management.