Pokharel Rajani, Silwal Pushkar Raj
Support to the Health Sector Programme (S2HSP), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal.
Int J Health Plann Manage. 2018 Apr 10. doi: 10.1002/hpm.2530.
The World Health Organization has identified universal health coverage (UHC) as a key approach in reducing equity gaps in a country, and the social health insurance (SHI) has been recommended as an important strategy toward it. This article aims to analyze the design, expected benefits and challenges of realizing the goals of UHC through the recently launched SHI in Nepal. On top of the earlier free health-care policy and several other vertical schemes, the SHI scheme was implemented in 2016 and has reached population coverage of 5% in the implemented districts in just within a year of implementation. However, to achieve UHC in Nepal, in addition to operationalizing the scheme, several other requirements must be dealt simultaneously such as efficient health-care delivery system, adequate human resources for health, a strong information system, improved transparency and accountability, and a balanced mix of the preventive, health promotion, curative, and rehabilitative services including actions to address the social determinants of health. The article notes that strong political commitment and persistent efforts are the key lessons learnt from countries achieving progressive UHC through SHI.
世界卫生组织已将全民健康覆盖（UHC）确定为减少一个国家公平差距的关键方法，并推荐社会健康保险（SHI）作为实现这一目标的重要战略。本文旨在分析通过尼泊尔最近推出的社会健康保险来实现全民健康覆盖目标的设计、预期效益和挑战。在早期的免费医疗政策和其他几个垂直计划的基础上，社会健康保险计划于2016年实施，在实施后的短短一年内，实施地区的人口覆盖率就达到了5%。然而，要在尼泊尔实现全民健康覆盖，除了实施该计划外，还必须同时处理其他几个要求，如高效的医疗服务提供系统、充足的卫生人力资源、强大的信息系统、提高透明度和问责制，以及预防、健康促进、治疗和康复服务的均衡组合，包括采取行动解决健康的社会决定因素。文章指出，坚定的政治承诺和持续的努力是从通过社会健康保险实现渐进式全民健康覆盖的国家中学到的关键经验教训。
