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National Urban Health Policy 2015 got finally approved by the Council of Ministers of Government of Nepal on April 21, 2015. What the policy means to Nepal and particularly the health sector, needs to be unfolded, understood, internalised and implemented for the greater cause of serving the urban population, particularly the unreached groups.

Rapid urbanisation has led to increasing burden on the municipal health care facilities. It is a bitter reality that urban poor living in slums face great health risks, especially the women and children. There is lack of clarity in policy regarding ways of handling urban health issues. With the absence of Urban Health Policy as a guiding framework to make further plans and programmes targeted towards urban poor population, there is a lack of data disaggregated by poverty level, meaning that the urban population appears to be healthy. The good health of the middle classes masked the high mortality and morbidity suffered by the urban poor. The Interim Constitution of Nepal 2007 safeguarded the health rights of the citizens under article 16 (Right regarding Environment and Health) where it is mentioned that: “every person shall have the right to live in a clean environment” and “every citizen shall have the right to get basic health service free of cost from the State as provided for in the law". National Health Policy 1991, Interim Health Policy (2007-10), Second Long Term Health Plan (1997-2017), Second Nepal Sector Programme (NHSP-2), the recent National Health Policy 2014 along with various other policies, strategies, plans and programmes have covered various aspects of health. However, the issues related to urban health hadn’t come through that explicitly, thereby making the Urban Health Policy – even contextually important.

Journey So Far

The road to sensitising urban health in Nepal began with the devolution of authorities to health services by strengthening the role of local bodies in order to increase the accessibility of basic health services to the people through the Local Self Governance Act 1999 and Local Self Governance Regulations 2000. Municipalities thus were supported through Primary Health Care Revitalisation Division (PHCRD) in the delivery of health services to the urban population. With PHCRD taking the ownership, the urban health centres were established to provide health services to the people. Health policies and strategies have not been adequately tailored enough to meet the demands of the unreached groups in the urban areas such as slum dwellers, daily-wage labourers, factory workers and other marginalised people. Urban dwellers are at a high risk caused due to social determinants such changing lifestyles, pollution, mass settlements, and increasingly high risk behaviours such as smoking, use of alcohol, unsafe sex and drug abuse. Despite the increased disease intensity and vulnerability in the urban areas, health policies, plans and programmes have not been focused on this rapidly growing population.  

It is an encouraging sign that other agencies such as Ministry of Federal Affairs and Local Development, Municipal Association of Nepal, Ministry of Urban Development and other development agencies (NGOs/CSOs, bilateral and multi-lateral agencies) have come on board along with the Ministry of Health and Population to take the urban health initiative forward.

Policy Perspectives: Translating Agenda into Action

With the policy now being approved and the activities will gradually be implemented, there is a greater need to focus on three key policy perspectives in order to ensure that all these policy development efforts are channelised in the right direction:

• Actors – need to shift gears from urban health agenda being personally-driven (encouraged only by section of individuals with keen interest in the issue) instead of being institutionally-driven
• Context – need to address the key issues/problems faced by the urban population, prioritising upon the urban poor and unreached groups and promoting the concepts of health equity and accessibility
• Evidence Generation – there needs to be clear evidence of health and service provision of urban poor through institutionalised information collection, recording and reporting mechanisms that would promote evidence-informed policy and strategy formulation 

Highlights of Urban Health Policy 2015 (Unofficial translation)

Vision

To ensure safety from the factors that adversely affects the health of the people residing in urban areas and the promotion of human development, prosperity and a healthy life in urban areas

Mission

To achieve social and economic prosperity for the urban population by improving their health status

Goal

Contribute to poverty reduction by improving the health status of the urban population particularly of women, children, poor and marginalised groups of society.

Objectives

Increase access and utilization of quality health care services particularly of women, poor, children and marginalised groups residing in urban areas as identified by the government

Policies

• Increase access to quality basic health services for people living in urban areas, especially women, children, poor, marginalized group and elderly population through modern Ayurvedic, homeopathic, unani and other treatment systems.

• Develop and scale up of integrated urban health programmes which address the factors that have a negative impact on the health of the people, particularly of the women, children, poor and the marginalised groups.

• Define specific roles and responsibilities of the organisations involved in urban health programmes to ensure uniformity in the delivery of quality-assured basic health services.

• Promote capacity building, community participation and human resource development of the related institutions in urban areas to establish a proper management system and ensure equitable distribution and utilisation of basic health services.

• Establish mechanisms for the monitoring and evaluation of services in urban health programmes and promote studies and research related to urban health.

• Manage and mobilise of the resources required for implementation of the Urban Health Policy.

Strategies

• In accordance with the policy of the Government of Nepal, to provide free health care services to all, through the expansion of basic health care service delivery in urban areas to increase their accessibility
• Develop/strengthen an effective, integrated and sustainable institutional mechanism in urban areas for delivery of health services
• Set certain criteria and standards for assessing the quality of the basic health services
• Prepare a detailed workforce plan for the implementation of urban health programmes
• Development and strengthening of the referral mechanism
• Develop a system to incorporate urban health programmes in local development plans
• Develop an effective method to address the issues that have a direct impact on human health
• Development of proper management system at policy and implementation level for effective implementation of the urban health programmes and improvement of curative services
• Develop a partnership among various national local, private and community programmes for the implementation and scale up of urban health programmes