Audit of Grants in Nepal
28 August 2019
Nepal is making significant progress in tackling HIV, tuberculosis and malaria. The number of patients on antiretroviral treatment has increased by 25% in the last three years, the TB treatment success rate is stable at 91%, and malaria cases have declined significantly. Nepal has been identified by WHO as one of 21 countries that have the potential to eliminate malaria by 2020. To achieve the UNAIDS 90-90-90 target by 2020, however, challenges in Nepal’s HIV program will need to be addressed: specifically, low testing coverage and yield, and monitoring of clients on treatment. To increase TB case detection, improvements are needed in the implementation of TB interventions such as contact tracing and private sector engagement.
Since federalization in 2018, health care delivery in Nepal has been devolved to provinces and municipalities. The Ministry of Health and Population (MoHP) is mainly responsible for policy formulation, resource mobilization, monitoring and regulation of health services, and the Ministry of Social Development (MoSD) was established to oversee health care delivery in the provinces. A lack of clarity in roles and responsibility around oversight, coordination and implementation has negatively affected supply chains, fund flow, and reporting of programmatic and logistics data. Leadership and ownership of the national disease strategies remain unclear, and reporting arrangements from the provinces and MoSD to MoHP are not defined. The capacity of the three national disease programs remains severely limited, despite investments in the last four years to build their capacity.