Community Health Insurance for Universal accesses to Health in Nepal

1. Background To fulfil its constitutional and international commitments, the Government of Nepal is currently implementing various health care programs, mainly aimed at providing free health care services to the general public or target groups. These programs include Aama Suraksha, the Uterine Prolapse Treatment Program, the Free Health Care Program and some additional free services for target groups. Substantial subsidies are also being provided for the treatment of heart disease, kidney problems, cancer and many other diseases. Some community-based health insurance schemes have been piloted by the Government of Nepal since 2003; there have also been several non-governmental initiatives at the community level to improve financial protection by pooling funds for health. However, despite budget allocations for the last three years, a Community health insurance program has not been implemented because of a lack of proper policies, legislation and institutional framework. 2. Current Situation: Universal accesses to Health Out-of-pocket health expenditure (% of private expenditure on health) in Nepal was last measured at 81.38 percent in 2013, according to the World Bank. Although major progress has been achieved in improving access to health care services in Nepal, reaching the poor and marginalized remains a challenge. The various social health protection interventions in place are fragmented, often fail to provide the necessary financial protection against catastrophic spending and are not always based on medical need. Unregulated out-of-pocket payments by private individuals when receiving health services exceed prepayments by governmental and non-governmental organizations. The need for such out-of-pocket payments prevents a substantial proportion of the population from accessing health care services and puts them at risk of impoverishment from catastrophic spending. For financial management in Nepal Out of total National Budget of only 5.89 percent was allocated for the health sector during the fiscal year 2013/14. Of the total health sector budget 69.02 percent was allocated for the execution of programs under the Department of Health Services Network. Also in terms of human resources for health sector, there are 45 percent vacant posts for a doctors. These data’s shows that there is huge gap in universal access of health care in Nepal.