- Immunization law tabled in parliament for vote
- Public immunization fund established, private immunization fund under development
- Resource tracking operational at national level
- GVAP milestones featured in two national work plans
National Immunization Program (NIP)
The Nepali NIP is in the Child Health Division (CHD), Department of Health Services (DOHS), Ministry of Health and Population (MOHP).
Government Spending on Immunization
Over the period 2006-2013, Nepal’s Gross National Income increased from US$350 to US$730 per capita, more than doubling in eight years. According to the WHO/UNICEF Joint Reporting Form (JRF), the Nepali government spent $12 on routine immunization per surviving infant in 2006. By 2013, this figure had fallen to $6, reflecting a 50 percent decrease. In addition, the government share of total routine immunization expenditures dropped from 63 percent to 46 percent from 2006-2013. Caveats: Reporting for JRF Indicator 6500 is complete but there are inconsistencies across the other JRF financial indicators. The data suggest that Nepal has not progressed towards country ownership of its immunization program.
Vaccination Financing Mechanism
By April 2012, the Ministry of Finance Budget & Program Division proposed NPR 20 million for its 2012/2013 budget. The Minister of Finance dedicated NPR 10 million to the public immunization trust fund, the National Immunization Fund, in his 2013 budget speech.
In March 2013, the public fund Steering Committee was established and met for the first time. An expert hired by the Committee completed the first draft of the Fund Regulations the following April.
In November 2013, the NIP, CHD, and MOHP finalized the Regulations and the Chief Secretary of the Ministry of Law & Justice (MOLJ) approved them. They were subsequently published in the Nepal Gazette. The Government of Nepal established the National Immunization Fund on 8 July and deposited the NPR 10 million into it.
A Managing Committee to oversee the Fund is currently under development, as is a separate, private fund spearheaded by Rotary International-Nepal.
Tracking Expenditure Flows
Nepal’s expenditure tracking process is as follows:
- Regional and district level health officers submit their monthly expenditure and programmatic reports to the District Treasury Controller’s Offices (DTCOs) before the 7th of every month. They send analogous quarterly reports to the Finance Section in the MOHP Department of Health Services.
- Each DTCO submits its combined financial report to the Office of the Auditor General Control (OAGC). The OAGC audits and verifies the reports before entering them into the National Compilation Form, which is relayed to the Auditor General.
- The Auditor General enters the information from the National Compilation Form into the annual financial report and conveys it to the President of Nepal.
The government has advanced resource tracking practices on both federal and district levels:
- Federal: The CHD inserted a national expenditure tracking analysis into its Annual Work Plan (AWP) in August 2013. From July 2013-January 2014, the NIP generated immunization budget allocations for 2008-2012, and both budget allocations and absolute & relative expenditures for 2010-2012. The team used this data in the five-year expenditure tracking analysis, which they completed in January 2014.
- District: In May 2014, the Kathmandu district EPI drafted resource tracking guidelines during a workshop organized by the CHD. Using the Kathmandu EPI’s guidelines, the CHD developed a set of model resource tracking parameters and disseminated them to Kaski, Chitwan and Morang districts that same month. There are seventy-five administrative districts in Nepal.
Legislation for Sustainability
Nepal is governed under an interim constitution, which came into force on 15 January 2007. The interim constitution recognizes several health-related rights. Article 16, “Right regarding Environment and Health”: (2) Every citizen shall have the right to basic health services free of cost from the State as provided for in the law. Part 4 Responsibilities, directive principles and policies of the State Article 33. Responsibilities of the State:
The State shall have the following responsibilities: (h) to pursue a policy of establishing the rights of all citizens to education, health, housing, employment and food sovereignty.
The completed Concept Paper for a Legislative Working Committee was presented to the CHD in November 2011. The Committee used feedback from provincial health teams and all MOHP departments to improve draft law in May 2012. The following June, the Committee incorporated recommendations from an even wider audience from the MOHP to improve the draft law further. The Health Secretary approved the new draft in August.
The MOF spent late 2012 working on inserting a provision on tax exemptions to contributors to the National Immunization Fund. The draft was then elaborated by the MOHP Legal Department and sent to the MOLJ in January 2013.
In January 2014, the MOHP Legal Officer established another Working Committee to streamline the approved National Immunization Fund Regulations (FRs) into the draft law. The Council of Ministers gave feedback on this effort, which were incorporated into the draft law in June and July. The Committee addressed a second round of comments from the Health Minister in August and September. In October and November, the Council of Ministers approved the draft law and the President agreed to support the law’s passage through parliament.
In January 2015, the immunization law was tabled in parliament for a vote.
Global Vaccine Action Plan (GVAP) Implementation
In April 2014, the NIP streamlined SIF milestones from GVAP (resource tracking, high-level briefing/disseminating immunization law for widespread consensus, engaging the private sector to expand the immunization fund, etc.) into the Annual Work Plan (AWP). The following May, CHD, NIP and DOHS each finalized action plans to streamline relevant GVAP Strategic Objectives into the larger Nepal Health Sector Programme-III (NHSP-III)
Major SIF Program Efforts
- October 2014: Senior Program Officer and Rotary-Nepal co-organize high-level briefing with the President of Nepal.
- September 2014: Senior Program Officer organizes legislative workshop including international partners and national counterparts.
- August 2014: Senior Program Officer participates in three separate legislative workshops convened by MOH/MOLJ.
- July 2014: Senior Program Officers from Nepal and Mongolia co-organize Asia Peer Review Workshop on Sustainable Immunization Financing. Peer exchangers from Nepal, Sri Lanka, Cambodia, Mongolia, Indonesia and Vietnam participate.
- June 2014: Senior Program Officer organizes two legislative workshops with representatives from the MOH.
- May 2014: Senior Program Officer, CHD, NIP, and MOH organize municipal briefing in Kathmandu.
- May 2014: Senior Program Officer holds high-level briefing Health Minister on GVAP criteria.
- February 2014: Senior Program Officer organizes media briefing on National Immunization Fund Regulations.
- January 2014: Senior Program Officer and MOHP Legal Officer participate in first two workshops of the National Immunization Fund Working Committee.
- September 2013: Senior Program Officer and NIP manager participate in GAVI Health System Strengthening (HSS) Proposal Development Workshop.
- May 2013: Senior Program Officer holds conference on Interaction with Pediatricians on Immunization Law and Regulations for National Immunization Fund. Eighteen national peers attend.
- May 2013: Senior Program Officer organizes high-level briefing with Health Minister on national immunization fund and draft law.
- March 2013: Senior Program Officer holds consultative workshop on national immunization fund.
- February 2013: Senior Program Officer invites two Sri Lankan peer exchangers to subnational peer exchange in Rupandehi district of Nepal.
- February 2013: Senior Program Officer and Executive Vice President participate in second meeting of Rotary-Nepal’s Immunization Support Fund Working Committee.
- February 2013: Senior Program Officer and Executive Vice President participate in WHO/SEARO Regional Consultation on Measles Elimination and Rubella/CRS Control.
- January 2013: Senior Program Officer organizes consultative workshop on the establishment of the immunization fund and adoption of the draft law.
- October 2012: Senior Program Officer organizes peer exchange between Nepal and Cambodia on immunization financing strategies and legislation.
- June 2012: Senior Program Officer, UNICEF, CHD, MOH co-organize consultative briefing on draft law.
- May 2012: Senior Program Officer, UNICEF, Nepali government co-organize two subnational consultative briefings in eastern and mid-western regions, in addition to one at the central level.
- March 2012: Senior Program Officer, UNICEF and CHD co-organize consultative briefing on first draft of immunization law.
- March 2012: Senior Program Officer and Program Director organize parliamentary peer exchange on sustainable immunization financing between Nepal, Sri Lanka, and Cambodia.
- February 2012: Senior Program Officer participates in a WHO/SEARO & MOHP-organized parliamentary briefing.
- February 2012: Senior Program Officer shares SIF experiences at Lions Club-Nepal meeting.
- November 2011: Senior Program Officer and UNICEF co-organize workshop between Rotary and Lions Club.
- October 2011: Senior Program Officer participates in Immunization Law Drafting Committee meeting.
- October 2010: Seven Nepali peer exchangers attend SIF-organized Third Sub-Regional Symposium for Parliamentarians on Sustainable Immunization Financing in Cambodia.
- July 2010: Nine Nepali peer exchangers attend SIF-organized Second Sub-Regional Symposium for Parliamentarians on Sustainable Immunization Financing in Sri Lanka.
- June 2010: Senior Program Officer, Rotary Club of North Nepal, and UNICEF co-organize Countdown to 2015 and Sustainable Immunization Financing: Role of Civil Society Organizations.
- March 2010: Senior Program Officer and WHO co-organize the 15th Congress of the Nepal Pediatric Society’s (NEPAS) special session on Social Determinants of Neonatal Health.
- February 2010: Senior Program Officer, Program Director, UNICEF, and the Nepali parliament co-organize the first Sub-Regional Parliamentary Symposium on Child Health and Sustainable Immunization Financing.
- September 2009-January 2010: Senior Program Officer organizes three parliamentary briefings.
- December 2008: Senior Program Officer and Program Director conduct introductory briefings with MOH, NIP and MOF officials.