As Nepal government issues new Health Sector GESI Strategy 2023, focus must be on its implementation

Last month, the Nepal government issued a new Gender Equality and Social Inclusion (GESI) Strategy for the Health Sector.  The strategy, according to the document, aims at ensuring equitable and quality health services while upholding accountability in the health sector to improve the access and use of health services by women and disadvantaged and marginalized groups.

Recognizing the constitutional provisions relating to equality, social justice and social security, the new strategy has also according high priority to the notion “Leave no one behind”, one of the key and transformative promises of the 2030 Agenda.

The strategy includes five major sections: i) Introduction, ii) Objective, strategy and action plan, iii) Institutional mechanism and arrangements for strategy implementation, iv) Arrangements for monitoring and evaluation, and v) Provision to review, revision, and annulment of the strategy.

Key provisions of the strategy

This strategy, according to the official document, is an upgraded version of the previous Gender Equality and Social Inclusion Strategy for the health sector that was introduced in 2009. The new strategy has been formulated to fulfill the constitutional requirements and to realize the targets of SDG 2030.

Rationale of the strategy

Recognizing the challenges and gaps to reach excluded groups including women, adolescent girls, persons with disabilities, sexual and gender minority (SGM) populations and economically and socially excluded groups,  the strategy has highlighted four-point rationale for the need of the strategy:

1. To maintain coordinative efforts among a three-level government in health service delivery with regard to Gender Equality and Social Inclusion (GESI)
2. To align the strategy with rights enshrined in the constitution of Nepal and Nepal’s commitment to Universal Declaration of Human Rights
3. To achieve Nepal’s commitment to Sustainable Development Goals 2030 and realize universal health coverage
4. To attain the long term goal of ensuring an inclusive state as envisioned by Nepal’s periodic plan

Priority areas of the strategy

In line with the provisions of fundamental rights and duties, and directive principles, policies and obligations of the state enshrined in the Constitution of Nepal and provisions of National Health Policy – 2019 for equitable access to health services and improvement in health system, the strategy has included three major priority areas:

1. To enhance trust of excluded groups on the health system by ensuring inclusive, quality and accountable health services delivery
2. To mainstream GESI into the health policies, institutional structures and systems of the federal, provincial and local levels of government and other agencies.
3. To ensure accountable, protective, distributive, and rehabilitative justice to essential health needs of the target groups

Objectives of the strategy:

The key strategic objectives laid down by the new GESI strategy are:

1. To mainstream GESI in the policy, strategy, law, plan, program and budget monitoring and evaluation of the health sector at federal, provincial and local levels.
2. To enhance equitable access of target groups in health services, internalize GESI into institutional mechanisms to empower target groups to demand their rights to and use basic health services.  
3. To conduct targeted programs so as to meet the specific health needs of vulnerable and excluded classes (groups) for ensuring their equal access to and utilization of health services

Strategies

In line with its rationale, objectives and priorities, the document has adopted a seven-point strategy:

1. To institutionalize GESI assessment and analysis methods into policy, strategy, planning and budget cycle of the health sector from GESI perspective
2. To enhance collaboration and partnerships including arrangement of institutional mechanism for GESI mainstreaming
3. To enhance the capacity and confidence of target groups to demand their rights to and use basic health services
4. To assess and analyze gaps in equitable access of target groups with regard to inclusive utilization of essential health services
5. To introduce targeted programs to meet the specific health needs of vulnerable and excluded groups for ensuring their equal access to and utilization of basic health services
6. To strengthen capacity of institutional mechanism to fulfill the specific health needs of excluded and vulnerable populations capacity
7. To encourage partnership and collaboration to ensure access of target groups to health services

Arrangements for strategy implementation

The strategy has mandated all responsible government agencies to ensure policy arrangement for the implementation of the strategy. As in the previous strategy, the new strategy includes the provision of GESI institutional mechanisms at four levels – i) GESI steering committee at federal level, ii) Facilitation Committee at Province Level, iii) Coordination committee at local level, iv) Coordination and facilitation committee at ward level.

Need to translate the strategy into action

Nepal government’s commitment to align the GESI strategy with the rights enshrined in the constitution and Nepal’s commitments to international instruments including Universal Declaration of Human Rights and Sustainable Development Goals is a commendable move.

That said, the focus of all levels of the government should be on the effective implementation of the strategy to ensure that no one is left behind. The newly introduced strategy carries a clear political message that gender and social inclusion will be prioritized by the government. The implementation, however, will be assessed on the basis of institutional capacities, political will to adhere to the commitment and allocation of resources. 

(Pragya Lamsal is Kathmandu-based development professional. Views are personal.)

[Related: Panel Discussion on Gender, Health and Sustainable Development Goals]