Collaborative Framework for Strengthening Local Health Governance in Nepal Signed by MoHP and MoFALD (December 1, 2013)
1. Collaborative Framework: A Milestone in Strengthening Local Health Governance
This Collaborative Framework paves the road in strengthening working relationships between the Ministry of Health and Population (MoHP) and Ministry of Federal Affairs and Local Development (MoFALD) at different levels resulting in a win-win for both partners. It is a milestone towards strengthening participatory development and local governance in the long-run.
MoHP will benefit by leveraging additional resources and management support at village, municipal and district levels for improving access to and coverage of service delivery, improving quality of health services and strengthening transparency and accountability at local level. MoFALD will benefit by aligning health planning, programming, monitoring and evaluation practices under the broader framework of local governance, which has not been the case in the past. Such alignment will help harmonize local development activities, create synergy and manage social determinants of health at all levels and finally bring effective and sustained health outcomes.
It is expected that the Collaborative Framework will strengthen local governance, participatory development and will benefit both parties by making health a prioritized local development agenda leading to better human development.
2. Framework Principles
The Framework includes recognition of best practices and lessons learned from the Local Health Governance Strengthening Pilot Program (2010-2013) and long-term efforts in locally-based approaches, which created a solid foundation for developing this collaborative framework intended to have nationwide impact. It includes the following principles:
a) Strengthened local governance and local health systems
b) Multi-sectoral approach for better health outcomes
c) Health as a local development agenda
d) Responsiveness, local leadership and ownership
e) Community empowerment, participation and accountability
f) Sustainable capacity built
3. Roles and Responsibilities of Key Partners
The Collaborative Framework laid down the roles and responsibilities of key partners from national level to the village levels based on the agreed principles. It includes the roles and responsibilities of MoHP and FoFALD at national level, local bodies (DDCs, Municipalities and VDCs), D/PHOs and health facilities, and association of local bodies (NAVIN, ADDCN and MuAN).
4. Health Financing and Resource Mobilization
The Collaborative Framework also includes some new resource provisions for health. The provision of annual flexible health grants to be provided by the MoHP (through District Development Funds) to districts and facilities and mobilization of additional grants to be provided through the Local Governance and Community Development Programme – II (LGCDP-II) will further leverage resources to address local health needs. These resources will help fill resource gaps locally. The provision of proper accounting, reporting and transparency to me maintained through social/public audit (within the framework of local governance) will further enhance equity and need-based service delivery at the local level.
MoFALD will receive and act on a list of prioritized health indicators at the beginning of every fiscal year (including ANC, child immunization, and others) from the MoHP and will instruct local bodies to allocate resources to achieve targets for these health indicators as a part of guidance to utilize grants. VDCs, through their annual grant provisions of NPR 3 million plus NPR 1.5 million based on performance, DDCs and municipalities will allocate appropriate budgets to achieve targets for the prioritized health indicators based on the local conditions, disparities among households and communities, and other contextual concerns. MoFALD, in collaboration with MoHP, will review and update monitoring and evaluation criteria (including Minimum Conditions and Performance Measures (MCPM)) to include critical health-related indicators, which will help ensure institutionalization.
5. Collaborative Framework Signing Ceremony
In the presence of Mr. Vidyadhar Mallik, Honorable Minister of Ministry of Health and Population (MoHP) and Ministry of Federal Affairs and Local Development (MoFALD), a Collaborative Framework was signed by the Secretaries from both Ministries at a ceremony held at the MoHP’s meeting hall on December 1, 2013. The framework is based on the experiences and lessons learned from a number of local health governance and community-led initiatives in the health sector of Nepal. The framework includes a long-term vision, strategic objectives, principles, roles and responsibilities of collaborating partners at national, district, municipal, and village levels.
The Honorable Minister highlighted that this initiative represents a new dimension of the decentralization process in Nepal and lessons learned from it will help the MoHP adapt to its stewardship role when the country federalizes. The Secretaries expect the framework will help incorporate health concerns in the local development agenda and will greatly facilitate working with other devolved sectors. Comprehensive guidelines for implementation will be prepared soon.
The ceremony was attended by senior officials of both Ministries, together with representatives of Associations (ADDCN, Muan and NAVIN). Secretaries and Joint Secretaries of both Ministries highlighted the importance of their collaborative effort to local governance and expressed their commitment to effective implementation.
6. Process Followed in Preparing Collaborative Framework
The Collaborative Framework is designed based on the consolidated experiences and lessons learned from the implementation of Local Health Governance Strengthening Program (LHGSP, a pilot program implemented from 2010 to 2013) and other community-led initiatives in the health sector.
The entire design process was led by the Policy Planning and International Cooperation Division (PPICD), and in summary, the following steps were followed:
a) Joint assessment of LHGSP led by PPICD, MoHP (March-April 2013) and draft report submitted by an independent consultant (May 2013)
b) Dissemination of assessment findings and recommendations with key stakeholders in the health sector (May-June 2013)
c) Further dissemination of findings and recommendations of LHGSP assessment by PPICD with wider stakeholders in the health sector (UNICEF, SAVE, NHSSP, USAID, WHO, H4L and others) and agreed on next steps (11 June 2013)
d) Preparatory meeting at UNICEF to consolidate evidence of decentralized and community-led approaches in the health sector (19 June 2013) where H4L, SAVE, NHSSP, HSSP/GiZ and UNICEF representatives participated
e) Sharing of best practices and experiences of community-led initiatives in the health sector by key implementing partners (USAID, HSSP/GiZ, NHSSP, Plan Nepal, UNICEF, SAVE, HRI, CARE, SDC, UNFPA) (15 July, 2013)
f) Based on the workshop (15 July) where partners’ lessons were consolidated, a draft concept note was prepared and shared with key partners and sectoral ministries to further design local health governance approaches and a collaborative framework (August 2013)
g) Wider sharing of consolidated lessons in consultative meeting at MoHP (16 August 2013) where all related ministries/departments/agencies participated
• Ministry of Federal Affairs and Local Development
• Ministry of Education
• National Planning Commission
• Ministry of Finance
• Ministry of Women, Children and Social Welfare
• Ministry of Cooperatives and Poverty Alleviation
• Ministry of Physical Planning and Urban Development
• MoHP Senior Officials
• Department of Health Services, and all divisions and centers
• Department of Ayurveda
• Key health sector partners working in local health governance: HSSP/GiZ, H4L, USAID, UNICEF, NHSSP
h) The meeting extensively addressed a) consolidated lessons in the health sector; b) Concept Note and decision to form a Task Force to draft collaborative framework to be signed by MoHP and MoFALD (10 members coordinated by Dr. Chand, PPICD, representing MoHP together with Mr. Purusottam Nepal, Under Secretary of MoFALD and LGCDP Manager, among other members)
i) The Task Force members from MoHP and MoFALD (plus 2 invitees from LGCDP team) met and discussed key elements of the framework, principles, and roles and responsibilities (22 September 2013)
j) A draft was prepared based on the agreed principles and roles and responsibilities and shared with both Ministry teams (1 October 2013)
k) MoHP invited all Senior Officials from all Departments, Divisions, including Directors, and Centers on 15 November 2013 to discuss the draft framework in detail, and formulate recommendations. The meeting was chaired by Chief Specialist, PPICD/MoHP
l) MoFALD also internally discussed the draft collaborative framework and addressed consolidated recommendations/feedback
m) All Senior Officials from MoFALD and MoHP (Secretaries, Joint Secretaries, DGs, Division Directors, and Center Heads) teams jointly met on 24 November 2013 and extensively discussed both Ministries’ recommendations/feedback. The meeting was chaired by the Honorable Minister, Mr. Vidyadhar Mallik
n) Three Joint Secretaries and LGCDP Manager and his team from MoFALD and PPICD from MoHP organized a series of discussion sessions on the week of 25 November and finalized the Collaborative Framework to sign
o) In the presence of Mr. Vidyadhar Mallik, Honorable Minister of both Ministries, both Ministries’ Secretaries signed the Collaborative Framework after a brief presentation of its principles, and both Ministries and other stakeholders’ roles and responsibilities (1 December 2013).