About Proposal

The constitution of Nepal under clause 35 Right relating to health mention ‘Every citizen shall have the right to free basic health services from the state, and no one shall be deprived of emergency health services.’ Public health service act 2018 includes different articles related to emergency health services. This act is formulated to ensure the constitutional rights related to health. The act has defined emergency health services as primary treatment provided to a person who is at risk of life due to emergency events or accidental condition and makes them risk free. Under section 2 – Rights and duties of service of service users, and health institution’s liability, articles related to emergency health services have been addressed. It states that,

• Each health facility will provide emergency health services as defined.
• It is the responsibility of every health facility and health worker to provide emergency health services.
• If emergency services of all degree not available at respective health facility, it will refer the client with appropriate management to other health facility for additional treatment and services.
• The cost for emergency care should be covered by the health insurance of the patient; if the patient is not under insurance scheme or if total fee is not covered by the insurance, the amount should be borne by patient party, family members or patients’ guardian. However, health care needs covered by basic health care services should be borne by health institutions.

Similarly, other articles related to emergency health services under Public health service act are, Article 33 – Establishing emergency health service fund and Article 48- Emergency health service and management. Ministry of Health and Population is working on regulation of Public Health Service Act. Basic health services package has already been developed by the ministry and some basics emergency health services have already been incorporated in this package. At this juncture, Ministry of Health and Population and WHO are looking for technical assistance to define emergency health services for each level of health facility as stated by the act.

Standard treatment protocol (STP) list the preferred pharmaceutical and nonpharmaceutical treatments for common health problems experienced by people in a specific health system. As such, they represent one approach to promoting therapeutic effective and economically efficient prescribing. When implemented effectively, an STP offers advantages to patients (e.g., it provides more consistency and treatment efficacy), providers (e.g., it gives an expert consensus, quality of care standard, and basis for monitoring), supply managers (e.g., it makes demand more predictable and allows for prepackaging), and health policy makers (e.g., it provides focus for therapeutic integration of special programs and promotes efficient use of funds). Effective implementation, however, is perhaps the greatest challenge in introducing STP.

The proposed methodological approaches include:

• Review of emergency health services package and service provisions at various level of health facilities with a specific focus on Primary Health Care Facilities
• Organize preliminary meeting with key government officials and WHO for consensus on protocol format and proceedings of protocol development
• Develop tools and methodology, identify participants for consultative meetings
• Literature review and development of the draft protocol in line with essential health service package
• Consultation meetings with subject experts from department of health services, ministry of health and population, experts working in emergency department of different level of health facilities, relevant and other relevant stakeholders
• Sharing in technical working group meeting for consensus and feedback
• Review of protocols by subject experts
• Incorporate feedback received from consultations and process for the approval
• Coordinate with the ministry focal points for the endorsement of standard treatment protocols of emergency health services package

Partner:

WHO and Curative Service Division, DoHS, MoHP

Duration:

October 2020 to December 2020