HSSP – III) NHSSP Quarterly Report July 2018 to September 2018 Recommended referencing: Nepal Health Sector Support Programme III – 2017 to 2020 (January 19). Kathmandu, Nepal ABBREVIATIONS AWPB Annual Workplan and Budget BC Birthing Centre BEONC Basic Emergency Obstetric and Neonatal Care CAPP Consolidated Annual Procurement Plan CEONC Comprehensive Emergency Obstetric and Neonatal Care CHD Child Health Division CMC Case Management Committee CSD Curative Services Division DDA Department of Drug Administration DDR Disaster Risk Reduction DFID Department for International Development DHO District Health Office DoHS Department of Health Services DRR Disaster risk reduction DUDBC Department of Urban Development and Building Construction eAWPB electronic Annual Work Plan and Budget EDCD Epidemiology and Disease Control Division EDP External Development Partner e-GP e-Government Procurement EHRS Electronic Hospital Reporting System EOC Emergency Obstetric Complication EPI Expanded Programme on Immunisation EWARS Early Warning and Reporting System FA Framework Agreements FCGO Financial General Comptroller Office FCHV Female Community Health Volunteer FHD Family Health Division FMIP Financial Management Improvement Plan FMoHP Federal Ministry of Health and Population FMR Financial Monitoring Report FP Family Planning FWD Family Welfare Division GBV Gender-Based Violence GESI Gender Equity and Social Inclusion GIZ German Corporation for International Cooperation i HFOMC Health Facility Operation and Management Committee HIIS Health Infrastructure Information System HMIS Health Management Information System HQIP Health Quality Improvement Plan HRFMD Human Resource and Financial Management Division HVAC Heating, ventilation, and air conditioning IAIP Internal Audit Improvement Plan IT Information Technology JAR Joint Annual Review JCM Joint Consultative Meeting KFW German Development Bank LCD Leprosy Control Department LMD Logistics Management Division LMS Logistics Management Section LNOB Leave No One Behind M&E Monitoring and Evaluation MTR Mid Term Review MPDSR Maternal and Perinatal Death Surveillance and Response MSS Minimum Service Standards MoFAGA Ministry of Finance and General Administration MoWCSC Ministry of Women, Children, and Senior Citizens MoUD Ministry of Urban Development NDHS Nepal Demographic Health Survey NGO Non-Government Organisation NFHS National Family Health Survey NHEICC National Health Education Information and Communication Centre NHSP Nepal Health Sector Programme NHSS Nepal Health Sector Strategy NHSSP Nepal Health Sector Support Programme NHTC National Health Training Centre NPR Nepalese Rupees NPSAS Nepal Public Sector Accounting Standards NSSD Nursing and Social Security Division OCAT Organisational Capacity Assessment Tool OCMC One-stop Crisis Management Centre OPMCM Office of Prime Minister and Council of Ministers PBGA Performance-Based Grant Agreement ii PD Payment Deliverable PFM Public Financial Management PHAMED Public Health Administration Monitoring and Evaluation PHC Primary Health Centre PHCRD Primary Health Care Revitalisation Division PIP Procurement Improvement Plan PNC Postnatal care PPMD Policy, Planning, and Monitoring Division PPMO Public Procurement Management Office Programme The Nepal Health Sector Support Programme QARD Quality Assessment and Regulation Division QIP Quality Improvement Plan RANM` Roving Auxiliary Nurse Midwife RDQA Routine Data Quality Assessment RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health SAS Safe Abortion Services SBA Skilled Birth Attendants SDG Sustainable Development Goals SMNH Safe Motherhood and Neonatal Health SOP Standard Operating Procedures SSU Social Service Unit STTA Short-Term Technical Assistance TA Technical Assistance TABUCS Transaction Accounting and Budget Control System TARF Technical Assistance Response Fund TOR Terms of Reference TOT Training of Trainers TSB Technical Specifications Bank TUTH Tribhuvan University Teaching Hospital TWG Technical Working Group UNFPA United Nations Population Fund VP Visiting Provider WHO World Health Organization WOREC Women's Rehabilitation Center iii CONTENTS Abbreviations.........................................................................................................................1 Executive summary................................................................................................................6 1 Introduction.....................................................................................................................1 1.1 Overview..................................................................................................................1 1.2 The development context.........................................................................................1 1.3 Sector response and analysis..................................................................................1 1.4 Changes to the Technical Assistance Team.............................................................2 1.5 Risk Management....................................................................................................2 1.6 Logical framework....................................................................................................2 1.7 Technical Assistance Response Fund......................................................................2 2 Progress in the Quarter...................................................................................................4 2.1 Health Policy and Planning......................................................................................4 2.2 Health Service Delivery..........................................................................................10 2.3 Procurement and Public Finance Management......................................................24 2.4 Evidence and Accountability...................................................................................36 2.4 Evidence and Accountability...................................................................................36 2.5 Health Infrastructure...............................................................................................43 3 Conclusions...................................................................................................................53 Appendix 1 Update of log frame........................................................................................55 Appendix 2 Payment Deliverables....................................................................................80 Appendix 3 Risk Matrix Assessment.................................................................................81 Appendix 5: Success Story...............................................................................................95 iv EXECUTIVE SUMMARY Precis This report is the fifth Quarterly update of the Nepal Health Sector Support Programme 3 covering the period from July 1st, 2018 to September 30th, 2018. The Federal Ministry of Health and Population has completed restructuring at the National level; sub-National structures development is still in process. The Learning Laboratory concept is being established with most field assessments completed. A concept-note for an innovation to support nutrition is being developed. Most planned technical assistance interventions were on-time and are achieving stated result targets. Changes of key personnel in the Ministry are the most significant challenge to institutional capacity enhancement through technical assistance. The technical assistance team provided various analyses, draft briefs, and other content-related interventions. Transactional assistance and functionary duties are often included in the technical assistance role. It is reiterated that the international experience in devolution informs us that focal areas for technical support include (1) strengthening national stewardship of devolution, (2) strengthening local governance of healthcare, (3) strengthening human resources management and developing workforce incentives, and (4) developing and installing workable healthcare delivery systems adapted to local needs. As raised last Quarter, a detailed framework and work plan to support sector devolution is absent. Provincial and local governments will require a well-planned, appropriately timed Ministerial stewardship, and skilled technical support, to attain the capacity and competencies to govern, plan, manage, deliver, and monitor health services. The Programme has raised this matter with the Ministry at various levels, and with the World Health Organisation and the Department for the International Development in Nepal. The development context The health sector remains in the early stages of devolution following federalisation. Many changes in key positions have been witnessed. Uncertainty in the permanence of incumbents to key positions remains. Sub-national structures are under deliberation. Significant sector capacity-related issues are emerging at sub-national levels. District Health Office engagement in healthcare service delivery remains, but the role is becoming less clear in terms of the management and monitoring of healthcare services. Healthcare data quality and upward flow remains a concern and there is little to affirm data that can be or is used in health governance. Technical assistance Most technical assistance personnel are located on the campuses of their respective counterparts, thus enabling ease of access. Most technical assistance is demand-driven. Field visits to support