The constitution of Nepal guaranteed basic health services are delivered free of cost to the citizens of the country and has been recognized reproductive health as women’s human right.  Sexual and Reproductive Health services including family planning, pre-post counseling on safe abortion and post abortion contraceptives, SAS services up to 12 weeks of pregnancy, Post abortion care including post abortion complication management are deliver through Basic health service package (BHSP) from different tier of health facilities in the country.  Those services which are not included in the BHSP will be deliver through  social health security and other health programs from the federal, provincial and local government.

Evidence shows that the low utilization of contraception lead to unintended pregnancy which is the major cause for women to seek abortion service. The reason behind the low utilization of SRH services are due to inadequate infrastructure, insufficient trained service providers, inadequate quantities of commodities, quality of care and cost associated with services. Therefore, to fulfill the constitution mandate towards universal health coverage including universal access to sexual and reproductive health services it is necessary to collect the information about the expenditure from household and private sectors while pursuing SRH services. It is known that the health financing in Nepal mainly includes government’s tax, external funds from international aid in the form of grants and loan and out of pocket expenditure.

Hence, it is necessary to the strength and weaknesses of the existing health financial system of the nation and how they affect the utilization and health seeking behavior for SRH services mainly family planning, safe abortion service and post abortion care in Nepal.  The main objective of this assessment is to identify the financial gap for essential SRH services in the country and compile relevant information to make recommendations for strengthening health financing mechanism to improve access to good quality, affordable SRH services, as mandated by the government.  A descriptive cross-sectional study design will be followed for this assessment which will take place in 3 districts of the country. A mixed methods approach i.e. qualitative and quantitative methods will be adopted to explore the financing arrangement for SRH services and its utilization. Information will collected from desk review of the existing documents were published in the last 5 years, key informant interviews (KII) with concerned stakeholders and service costing analysis. Purposive sampling will be followed for the selection of the stakeholders. The sample size for the assessment will be 32, which will be selected by using purposive sampling method.  Though these are a preliminary sample for KII. After the desk review identification, measurement and valuation of cost will be done for the quantitative analysis. In the qualitative analysis KII will be recorded, transcribed and translated into English. After translations, information will be divided into different theme and thematic analysis will be carried out.

This assessment will generate the evidence which will help policy makers to address health financing challenges and gaps for SRH services particularly on FP, SAS and PAC to support achievement of universal access to SRH services in Nepal.

Objectives:

To assess the health financing arrangements for SRH essential services in public, private and NGO sector and how it affects utilization and health seeking behavior.

To assess the cost associated to access SRH services from different sectors in Nepal to identify the financial gap

To recommend the measures to be taken by different sectors, based on best practices in the low and middle-income countries, to ensure that women can access and avail the quality SRH services without facing any financial burden for the available free SRH services as mandated by the government

Partner:

WHO Nepal

Duration

November 2020 to April 2021