Health System and EPI Program
Immunization is an essential component of Nepal’s Second Long‐Term Health Plan 1997‐2017. The Child Health Division of the Department of Health Services, Ministry of Health and Population, is the home of Nepal’s National Immunization Program (NIP). The federal NIP team provides leadership, normative and managerial support. Implementation is the responsibility of EPI sections in the five regional and 75 district Health Directorates. Each district has an EPI supervisor and one cold chain assistant who report to the District Health Officer. At the community level immunizations are delivered through 15,000 immunization clinics staffed by auxiliary health workers and female volunteer health workers.
Inputs to the NIP are coordinated through an Inter‐Agency Coordinating Committee.
Over the period 2006-2011, Gross National Income (GNI) in Nepal increased from $320 to $540 per capita. According to the WHO/UNICEF-Joint Reporting Form (JRF) Database, Nepal’s government expenditure on routine immunization fluctuated from 2006-2011. The largest government expenditure was reported in 2006, a value of $7.9 million. A decrease of $5.8 million then occurred the subsequent year. In 2008 government expenditures increased $2.4 million, accounting for a total of $4.4 million. Government expenditures decreased the following years, $1.9 million in 2009 and $1 million in 2010. Finally, in 2011 government expenditures increased to $2.9 million. On average, Nepal spent $5 per infant on routine immunization.
Nepal is a republic with a multi-party system. Until May 28, 2008, Nepal was a constitutional monarchy. On that date, the constitution was altered by the Constituent Assembly to make the country a republic.
Currently, the position of president (head of state) is occupied by Dr. Ram Baran Yadav. The position of prime minister (head of government) is held by Dr. Baburam Bhattarai. Executive power is exercised by the prime minister and his cabinet, there are 25 ministries. The legislative power is vested in the Constituent Assembly. On January 15, 2007, the old parliament was dissolved and replaced by the 330-member interim legislature of Nepal. The new interim legislature consists both of members of the old parliament as well as members appointed by an agreement between the Seven Party Alliance and the Communist Party of Nepal (Maoist). In July 2012, the Parliament was dissolved and new elections are planned for December 2012.
In parliament, the Women, Children and Social Welfare Committee looks after health issues and budgets.
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,
Article 35. State Policies:
(1) The State shall pursue a policy of raising the standard of living of the general public by fulfilling basic needs such as education, health, transportation, housing, and employment of the people of all regions, by equitably distributing investment of economic resources for balanced development of the country.
(8) The State shall pursue a policy of encouraging maximum participation of women in national development by making special provision for their education, health and employment.
(10) The State shall pursue a policy which will help to uplift the economically and socially backward indigenous ethnic groups, Madhesis, Dalits, including marginalized communities, and workers and farmers living below the poverty line by making provisions for reservations in education, health, housing, food security and employment for a certain period of time.
In December 2010, Nepal’s parliament requested the government to prepare draft legislation to create a National Immunization Trust Fund and a National Immunization Act supporting the National Immunization Program. Over 2011-2012 Nepal has drafted an Immunization Law.
- January 2012: Health Committee of Legislature Parliament of Nepal convened a briefing on immunization financing attended by Ministry of Health and Ministry of Finance officials.
- April 2012: Two Nepal Parliament staff peer exchangers attended Sabin-sponsored briefings in Sri Lanka and Cambodia.
- July 2012: Peer exchangers from Nepal participated in the 4th Asian Sub-regional Symposium and Second Sub-national Parliamentary Briefing in Cambodia.
- January 3013: A SIF-sponsored meeting was held in Kathmandu. Participants included representatives from the Policy, Planning and International Cooperation Division of Ministry of Health, Legal Department of MoH, EPI Team, Ministry of Finance, Parliament Secretariat, UNICEF, Rotary and Sabin. During the meeting participants discussed the establishment of the Immunization Fund, guidelines for developing regulation to operationalize the Immunization Fund, as well as review the comments on the Immunization Law draft received from the Ministry of Education, Ministry of Local Development and Ministry of Finance.