Health Sector Reform and Maternal Health in Nepal: Analysis of Equity and Efficiency

Abstract

Health sector reform is ongoing in many countries to bring out the efficiency, equity effectiveness. Nepal initiated health sector reform, through operational plan, Nepal health sector programme-implementation plan (2004-2009) .The major objective was to achieve millennium development goal through efficient and equitable health system. The government is now on Nepal health sector programme II (2010-2015), but the status of equity and efficiency is still unanswered. The present study was carried to assess the equity and efficiency in the maternal health programme, Priority 1 programme, before and after health sector reform. The equity analysis was done using data from the Nepal demographic health survey 2001, 2006 and 2011.The data were analyzed using the concentration index, highest-lowest difference, rate-ratio,percentage change. The inequality is determined across wealth, place of residence, administrative region and ethnicity. The result shows that wealth related inequity has decreased (decreasing concentration index) except for the poorest 20 (increased highest-lowest difference).The rural-urban gap is increasing in two indicators: institutional delivery and delivery conducted by skilled birth attendant. The inequality among the administrative region is decreasing. The ethnic and underprivileged populations are utilizing service at slower rate than the privileged population. The efficiency analysis was done for the year 2001, 2006 and 2011 using the output oriented data envelopment analysis method. The data on input and output indicators were collected from the multiple secondary sources. The technical and scale efficiency were determined for each 75 districts. The result shows that average technical efficiency score has decreased and scale efficiency score has increased after health sector reform. There exists the topographical variation on the distribution of efficiency score, resulting on the terai having the highest score and mountain the least score. In the year 2010, 22 out of 75districts were technically efficient. The narrowing wealth related inequity can be attributed to safe delivery incentive programme. The rural-urban distance can be attributed to difficult topography , absenteeism of health workers, infrastructure etc.The health access gap among ethnic group exist due to normative issue such as faith, cultural beliefs and the practical reasons such as economic, health service factor etc.The decreasing technical efficiency is due to lack of decentralization, unfilled sanctioned post,abseentism of health worker, the leakage of resources, unavailability of equipments .The increasing scale efficiency is due to increase in input resources mainly budget after the health sector reform,as most of the scale were increasing in return. The study recommends the proper decentralization, fulfillment of staff with inclusion of ethnic and underserved population and better procurement of equipment and drugs in health institution. The study recommends for further research on increasing gap on access of services between poorest and richest population despite of free service and monetary incentives. The study also recommends the efficiency study at different level of health institution and investigating the factors effecting on efficiency