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Innovative Strategies to Strengthen Health System Resilience and Equity in Nepal’s Fragile State

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Innovative Strategies to Strengthen Health System Resilience and Equity in Nepal’s Fragile State

This abstract is linked to Subtheme 1, Enhancing health system resilience; absorbing shocks and sustaining gains, and supports two field building dimensions: Innovative practice in health systems development; and Novel strategies for developing capacity.

Purpose: To present innovative strategies and practices that international and country-level policy makers and local communities can use to increase the resilience of weak health systems coping with unforeseen shocks in a post-conflict/fragile state setting, and help sustain health gains.


Nepal is a fragile state that is coping with political instability, unforeseen natural disasters (the 2015 earthquakes, landslides, flooding), poverty and inequities that leave the most marginalized and disadvantaged groups (M/DAGs) without adequate healthcare.  To enhance health system resilience and protect it from future shocks, USAID funded the Health for Life (H4L) project to work in 14 of Nepal’s most disadvantaged districts and communities as well as help with the response and recovery effort in 10 earthquake affected districts. H4L uses novel strategies and approaches to improve health system resilience and access to and use of health services by reducing social exclusion and disparities between advantaged and disadvantaged populations. Although the country is currently engaged in promulgating a new constitution and electoral system, which is bringing some additional challenges, these approaches are also providing new opportunities through strengthened local governance and citizen engagement and oversight to improve public service delivery, activities currently being supported by the project. First, the project is building on a new multi-sectoral Collaborative Framework drafted and brokered by H4L between the Ministry of Health (MoH) and the Ministry of Federal Affairs and Local Development (MoFALD) that sets the stage for improving local health governance and flexible funding from the MoH. Second, H4L is investing heavily in evidence-based local health planning conducted by revitalized Health Facility Operations and Management Committees (HFOMCs) as part of the government’s 14-step participatory planning process. Third, the project is scaling up a Quality Improvement (QI) system at health facilities that identifies the gaps to health facility readiness and improves quality of care. Fourth, H4L is introducing innovative interventions to the health system such as identifying pregnant women, especially from M/DAG populations, registering and tracking them with mobile phone technology to increase their use of antenatal care, deliveries at birthing centers, postnatal care and postpartum family planning.  Early lessons learned for building health system resilience to mitigate shocks and sustain gains include: (1) establishing a nationwide framework, including funding, for strengthening local health governance; (2) engaging communities, especially M/DAGs, in identifying and carrying out solutions in support of their health facilities; (3) completing the local planning cycle by identifying shortcomings and building local capacity and ownership; and (4) not only mainstreaming social inclusion but introducing new interventions to reduce inequalities.

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