District Health Systems Assessment within Inter¬sectoral Context

Abstract

Background: In Nepal, some districts are found to be better in terms of it health indicators and coverage whereas some are still struggling hard to achieve its better health indicators and coverage. This study tried to identify and analyze the factors that are responsible to major four key functions of the health system as well as other contributors such as inter-sector coordination that may have equally important role in improving the function of health system. Methods: The design of the study was descriptive. The study was carried out from June-November, 2012. Six districts were selected purposively based on the performance indicators. Majority of data was collected using qualitative methods. Results: The main components in the district health system that needs an immediate attention are number of new posts to be created to fulfill the deficit, provision of area specific incentives and benefit packages. The major constraint for inter-sectoral coordination to be effective is lack of its planning and enforcement. The key areas where inter-sectoral coordination could be important are preventive and promotive health care, waste management, water supply and sanitation, health service utilization, pesticides and human health, agriculture and nutrition, air pollution. Conclusions: Bottom up approach should be enhanced for effective planning and management. Key areas need to be identified which will have significant impact on public health system by promoting inter‐sectoral coordination. Inter‐sectoral effort should be initiated from the central level and implemented in all the levels. Keywords: assessment; district health system; health system; inter-sectoral coordination.