The World Health Organization (WHO) is one of the specialized agencies of the UN system. According to its Constitution the main goal of WHO is the attainment by all people of the highest possible level of health. For that, the organization has developed a Corporate Strategy, which comprises four Strategic Directions and six Core Functions that guide WHO's work.
The Strategic directions are: (1) reducing excess mortality, morbidity and disability; (2) promoting healthy lifestyles and reducing risk factors to human health; (3) developing health systems that equitably improve health outcomes, respond to people's legitimate demands, and are financially fair; and (4) framing an enabling policy and creating an institutional environment for the health sector, and promoting an effective health dimension to social, environmental and development policy.
WHO provides technical assistance to the Ministry of Health and Population which operates nationwide. In addition, WHO has a central immunization and vaccine preventable disease office in Kathmandu and 9 field offices with 15 Surveillance Medical Officers (SMOs) that support a surveillance network of 73 active surveillance sites and 416 - weekly zero reporting sites consisting of hospitals, government and private clinics and health centers throughout the country. They are responsible for measles, neonatal tetanus and acute encephalitis syndrome cases as well as for outbreak investigation and control.
WHO co-operates at country, regional/inter-country and global levels by implementing a two-year detailed Programme Budget. This instrument is developed through close dialogue between WHO and the member countries. It is based on WHO's strategic directions and global expected results, and the identified needs and priorities of the countries as laid down in their national health policies, strategies and programmes and WHO Country Cooperation Strategy (2006-2011).
The WHO Country Cooperation Strategy 2006-2011 highlights the six components identified as WHO’s strategic agenda which are as follows:
These components of the strategic agenda have been aligned with the National Health Sector Programme-Implementation Plan. Strategic approaches identified in each of the six components indicate priorities where WHO will focus its efforts to support the government in achieving its national objectives. These priorities will be undertaken in collaboration with major stakeholders, including the external development partners.
Strengthening the health system
In spite of enhanced capacity in policy planning and strategic management, the main challenges ahead are: effectively reducing health inequities through cost effective interventions, multi-sectoral coordination and fair financing; systematically involving private and NGO sectors; promoting decentralization of health services aiming at community empowerment; and enhancing the health system’s responsiveness in respect of quality of care, and managerial accountability. All these are of crucial importance to achieving the health sector policy outcomes.
Control and prevention of disease and disability
The incidences of endemic tropical diseases are still major public health problems affecting mostly the poor in rural areas. Drug-resistant malaria is an emerging problem. HIV infection is in a phase of “concentrated epidemic”. Tuberculosis still remains a public health problem in Nepal. The TB program is largely funded by donor partners. Close to 3% of the surveyed patients had multi drug resistant tuberculosis. Kala-azar is an endemic disease in 12 Terai districts. Emerging disease threats and potential epidemics such as avian influenza are ever present. While WHO Immunization Preventable Diseases (IPD) has assisted the government to develop surveillance for vaccine-preventable diseases such as Japanese encephalitis and poliomyelitis, an integrated disease surveillance system is yet to be in place. Also, there is an urgent need to develop HRH competencies and facilities required for effective compliance with the provisions of the International Health Regulation. A national NCD prevention policy and strategy is being developed. Presently, community-based data are not available to plan evidence-based interventions.
Human resource development
A number of medical graduates and other categories are being produced every year in Nepal. However, there is an imbalance in the production of different categories of health professionals, resulting in lack of appropriate skill-mix in many cases. In some cases, the level of skills and competencies of the health workforce is below what is required for discharging their functions. Coordination among the concerned ministries, universities and institutions needs much improvement. The issue of human resource management with regard to deployment, retention, utilization and accountability is a major challenge. Hospital administration remains a relatively neglected area due to the paucity of competent managerial staff. The strategic HRH plan now in place is not adequately aligned with the policy priorities and requirements of health care delivery systems. Moreover, most of the existing human resource management practices are not conducive to optimal performance.
Child, adolescent and reproductive health
The health of adolescents, who comprise 23% of the population, has not received due attention until recently. This group is most vulnerable to HIV/AIDS. Half of the country’s 50,000 injecting drug users are 16-25 years old. More than 50% of women aged 20 - 24 are married by 18 years and 14% by 15 years. About one-fourth of births to adolescents are unplanned, 22% mistimed and 1% unwanted. The unmet need for family planning among adolescents is higher than the national average of 24.6 %. Under-5 and infant mortality rates are still very high; 61 and 48 per 1000 live births respectively. MMR of Nepal is one of the highest in the South-East Asia Region, 281 per 100,000 live births as per the Nepal Demography Health Survey 2006. More than 4000 women die every year due to pregnancy-related causes. The proportion of deliveries conducted by health personnel continues to be very low, only 28% as per Annual Report 2005/2006. The major challenge is how to ensure that all women and newborns are provided with a continuum of care throughout pregnancy, childbirth and the post-partum period, by skilled birth attendants.
The major problems in the field of environment are: inadequate safe water supply; low sanitation coverage and poor hygiene practices, particularly in rural areas; poor waste management practices; high prevalence of ambient and indoor air pollution; and inadequate public awareness about exposure to hazardous or chemical substances. Arsenic contamination of tubewell water in the Terai areas and microbial contamination of surface water are two major challenges to human health.
Emergency preparedness and response
Nepal is highly vulnerable to natural disasters, particularly high magnitude earthquake. The decade-long violent civil conflict has affected the delivery of basic public health and medical services to the population. Emergency preparedness and response is not adequately addressed in Ministry of Health and Population policies and planning. Further, there is a scarcity of financial resources, limited capacity and expertise in this area of utmost priority. Health sector emergency planning, seismic assessments of hospitals, mass casualty management training and identification of best public health practices are being carried out under this programme. It is important to continue these efforts as well as introduce new field-based and humanitarian interventions in response to complex and natural disasters. An expansion of the programme is expected in future.
Future directions of WHO technical assistance in Nepal fall within the strategic agenda of Country Cooperation Strategy. It will be implemented through the strategic objectives of the Medium Term Strategic Plan (MTSP) 2008-2013 and related biennial programme budgets. During the preparation of the workplans in related biennial budgets, the priorities identified in the Country Cooperation Strategy will be reflected in the relevant strategic objectives of the MTSP, and joint planning which will ensure consistency with WHO priorities and strategies and programmes.