Skip to main content

Table 3 Mental health systems governance matrix for Nepal

From: Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study

Governance principles Summary of challenges and enabling factors Recommendations
National level Health policy formulation level Policy implementation level
Strategic vision Interim constitution 2006 recognizes health as a fundamental right National mental health policy 1996 exists; no revisions to date Lack of implementation of 1996 mental health policy Integrate mental health policy provisions in 5 year health plan; establish an accountable mental health unit in MoH
Participation and consensus orientation Lack of participation of civil society, private sector and government departments in mental health decision making Increasing consultation with NGOs and other stakeholders in mental health policy formulation In some districts, the District Public Health Office and NGOs are partnering to provide mental health services in primary health care centers Establish coordination and collaboration within and beyond health sectors; build consensus among stakeholders regarding involvement of service users in policy, planning and service delivery
Rule of law Consumer Protection Act 1998 bans the production and sale of goods which are harmful to consumers’ health Fourth revisions of draft mental health act, but no official endorsement Mechanisms to monitor misuse of psychotropic drugs in place but rarely implemented Ratify mental health legislation in line with national and international human rights laws and legislation, and strictly enforce legal provisions in practice
Transparency Ranked 126 out of 175 by Transparency International on corruption perception index Processes and mechanism for ensuring transparency in mental health resource allocation and expenditure not well defined Performance assessment, promotion and transfer of district health manager and district health staff differ in policy and practice Develop mechanisms and procedures for monitoring and supervision of mental health programs to ensure transparency in health sector
Responsiveness to patients’ health needs The government policy and programs (2014) state the provision for national insurance program Health Policy 2014 recognizes the need to increase state’s investment to cover all health care expenses of disabled people, including psychosocial disability In the absence of clear policy guidelines to address responsiveness, the medical and non-medical expectations of populations not met Arrange motivational incentives and facilities for health worker retention in rural areas; strengthen mental health information use for the allocation of budget
Equity and inclusiveness Social security allowance is given to elderly, widow and disabled, including psychosocial disability Nepal Health Policy 2014 mentions that health services will be provided to poor, marginalized and vulnerable population on the principles of equity and social justice Knowledge about existence of disability allowances for people with mental illness is low, so very few people have received allowances Disseminate information about services available in the community for treatment of mental illness and benefits provided by the government
Effectiveness and efficiency Limited coordination, communication and consultation between bureaucrats and technocrats (clinicians) Frequent turnover of policymakers; no mental health unit under MoH for policy and planning Other support systems, such as supply of psychotropic drugs and regular supervision and monitoring, are lacking Regulate policy on staff turnover; provide training to health workers; ensure regular supply of essential psychotropic drugs and arrange separate counselling room within primary health care facilities
Accountability Public accounts committee of the parliament looks after accountability Mechanisms and processes for overseeing financial and administrative adherence in place No evidence on the effective enforcement of accountability measures Implement existing mechanisms and processes to make the health system accountable to the population in need of mental health services
Intelligence and information No national level study on mental health conducted The HMIS data not used in mental health policy, planning and service provision Mental health data collected from Out Patients Department registers maintained in district health facilities Build capacity of government staff for systematic record keeping, and monitoring and evaluation of mental health programs
Ethics Ethics of mental health research is monitored by Nepal Health Research Council To ensure bioethics, Nepal Health Research Council has an ethical review committee, and a monitoring and evaluation section Nepal Health Research Council monitoring team makes field visits to oversee the research activities of the organizations Sensitize researchers and health workers towards more ethical practice in the field of mental health research and service delivery