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 |