Dulal R K, Magar A, Karki S D, Khatiwada D, Hamal P K
Nepal Association of Medical Editors, Kathmandu, Nepal.
Health Policy, Planning and Financing, London School of Hygiene and Tropical Medicine, London, United Kingdom.
JNMA J Nepal Med Assoc. 2014 Apr-Jun;52(194):811-21.
Primarily, health sector connects two segments - medicine and public health, where medicine deals with individual patients and public health with the population health. Budget enables both the disciplines to function effectively. The Interim Constitution of Nepal, 2007 has adapted the inspiration of federalism and declared the provision of basic health care services free of cost as a fundamental right, which needs strengthening under foreseen federalism.
An observational retrospective cohort study, aiming at examining the health sector budget allocation and outcome, was done. Authors gathered health budget figures (2001 to 2013) and facts published from authentic sources. Googling was done for further information. The keywords for search used were: fiscal federalism, health care, public health, health budget, health financing, external development partner, bilateral and multilateral partners and healthcare accessibility. The search was limited to English and Nepali-language report, articles and news published.
Budget required to meet the population's need is still limited in Nepal. The health sector budget could not achieve even gainful results due to mismatch in policy and policy implementation despite of political commitment.
Since Nepal is transforming towards federalism, an increased complexity under federated system is foreseeable, particularly in the face of changed political scenario and its players. It should have clear goals, financing policy and strict implementation plans for budget execution, task performance and achieving results as per planning. Additionally, collection of revenue, risk pooling and purchasing of services should be better integrated between central government and federated states to horn effectiveness and efficiency.
首先，卫生部门连接着两个领域——医学和公共卫生，其中医学关注个体患者，公共卫生关注人群健康。预算使这两个学科都能有效运作。2007年尼泊尔临时宪法借鉴了联邦制的理念，宣布提供免费基本医疗服务是一项基本权利，在预期的联邦制下这一权利需要得到加强。
开展了一项观察性回顾性队列研究，旨在考察卫生部门预算分配及结果。作者收集了卫生预算数据（2001年至2013年）以及来自可靠来源公布的事实。通过谷歌搜索获取更多信息。使用的搜索关键词为：财政联邦制、医疗保健、公共卫生、卫生预算、卫生筹资、外部发展伙伴、双边和多边伙伴以及医疗可及性。搜索限于英文和尼泊尔语发表的报告、文章及新闻。
在尼泊尔，满足民众需求所需的预算仍然有限。尽管有政治承诺，但由于政策与政策实施不匹配，卫生部门预算甚至未能取得有益成果。
由于尼泊尔正在向联邦制转变，可以预见联邦制体系下复杂性会增加，尤其是面对不断变化的政治形势及其参与者。它应该有明确的目标、筹资政策以及严格的预算执行、任务履行和按计划取得成果的实施计划。此外，中央政府和联邦州之间应更好地整合税收征管、风险共担和服务采购，以提高效力和效率。
