Terms of Reference (TOR) to Develop fact sheets on Nepals National Sexual and Reproductive Health (SRH) Budget Introduction:Nepal's

health sector received only 6.24 percent of the national budget in 2009/010 which is inadequate to address the growing needs and demands of the population. Studies1 have shown that the regular budget (prepared by the Ministry of Finance and covering some 25% of the overall budget) and the Development Budget (prepared by the National Planning Commission, and covering the remaining 75% of the budget) are not well integrated and tend to be overoptimistic about resources availability. There are often substantial gaps of 15-25% between budgets and available funding. Health gap between rich and poor, between the rural and urban people has been a major concern in Nepal. Nearly one quarter of the population still have life expectancy less than 40 years and they live in extreme poverty in rural and remote areas. Wealthiest households use more government health services than their poorer counterparts. Studies 2have documented that health expenditure over the last decades has had limited impact on the health outcomes. Of all eight Millennium Development Goals (MDGs), the three dealing with health are the most off-track in the country. Against this backdrop Nepal has introduced free basic health care services to all from 2008. However, the efficacy of this remains to be seen. According to WHO data3 In absolute terms, the budget allocation for the whole nation and for the health sector has gradually been increasing over the last 30 years, but in percentage terms there has been no actual enhancement in the allocation for health. For example, in 1983-84 it was 4.6 percent, in 1993-94 it was 4.0 percent and in 2002-03 it was 4.9 percent. Unfortunately even the allocated budget for the health sector was hardly expended to the fullest. It is on an average 68 percent of the total allocation. Financial resources in the health sector have been coming down noticeably during the last few years due to mounting concern for maintaining internal security. External donors have also reduced their contributions to the health sector. Funding from the external donors is increasingly going to the international and national NGOs. Although the policy of the government, as per the 10th five- year plan, is to stress on giving priority to primary health care and to the poor in remote areas, in practice, distribution of funds is mainly urban-centric and more funds are being allocated for areas that already have better infrastructure, e.g., with better transportation and communication facilities.

1 2

http://www.gtz.de/de/dokumente/en-allocation-funds-drugs-nepal.pdf http://www.gtz.de/de/dokumente/en-health-care-nepal.pdf 3 http://www.searo.who.int/en/Section313/Section1523_6865.htm

Objective:Advocacy using evidence and lobbying are important tools for increasing national health development budget. At present, IPPF Member Association in Nepal- the Family Planning Association of Nepal (FPAN) is planning to do more focused policy advocacy with policymakers to increase health sector budget especially the SRH budget. Before engaging in policy advocacy, FPAN is studying the situation and wishes to develop advocacy materials on the issue. In this context, FPAN has carried out a study to review the National Budget, health sector budget, allocation of SRH budget as well as contraceptives budget from 2006 to 2011 to find out the major gaps and entry points on financing of SRH. In order to support the process undertaken by FPAN, IPPF SARO wishes to engage the services of a consultant to develop 4 advocacy fact sheets on Nepals investment in the health sector, and in particular on SRHR. The main objective of the factsheets would be To present the key findings from FPANs budget review in a clear and concise manner. To highlight the major gaps in the current budgetary allocation To give recommendations for policy makers to make them aware of the existing budget allocation patterns and advocate on increasing the portion of the health sector budget especially the sexual and reproductive health in the process of budget formulation. Scope of work:The findings of the FPAN budget analysis report (and any other secondary reports available on this) will be used to highlight each of the following components (each component to be a separate fact sheet): Adequacy: How much is budgeted for health sector as compared to the unmet needs? Highlight the following: Sources of funds (Bi later, multi later, national government, Un agencies, individuals, other agencies) Who funds what within the health sector (Safer motherhood, Family planning, safe abortion, HIV/AIDS, Tuberculosis etc) What is the % of GDP that Nepal spends on health care? Recommendations on adequacy. Priority: How does the budget for health as compare to other sector i.e. security, agriculture, education etc? What are the spending priorities of the country? (i.e. security, health, education, agriculture etc). What is the % of total health budget that is spent on SRH? What are the spending priorities within the health budget? Services, human resources?

Which are the interventions that are prioritized within the health budget and how much? How much budget is allocated to meet the MDGs goals relating to health? How much does SRHR get? Within the SRHR budget, please analyse the following questions: o What are the spending priorities within the SRHR budget? Services, human resources? o Which are the interventions that are prioritized within the SRHR components of the budget and how much? Recommendations on priority. Progress: Is government's response on this issue improving? What are the provisions that the funds finance currently within the health budget (an analysis of all the line items supported, and their relative allocations)? What are the systems to transfer funds from centre to district? (An analysis of funds transfer i.e time, authority, amount, banking etc) A resource gap analysis: between resource needs and expenditures- (lead question: Is the spending adequate as per the needs? If not, how much should ideally be allocated) Recommendations on the above. Equity: Are resources being allocated fairly? The consultant will analyze health sector budget based on following indicators: o An analysis of budget allocation according to district & geographical region (75 districts and 5 regions). o An analysis of budget allocation according to ecological region (Terai, hill and mountain). o An analysis of budget allocation according to ethnic minority (Chepang, Raute, Danuwar, Tharu etc) o An analysis of budgetary spending and its co-relations with poorest and least developed districts. o Recommendations on the above. Deliverables:o 4 fact sheets as detailed above, with each fact sheet consisting of 4 pages. Time-frame:o 25th July to 25th august.

o o o

Please apply with a cover letter that explains your suitability for the assignment, and a CV. The deadline for sending in your application is 21st July. Please address all your communication and proposal to bchatterjee@ippfsar.org