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Strengthening Systems for Better Health in Nepal


  • Nepal’s overall health outcomes have improved but more needs to be done.
  • The SSBH activity will integrate systems from the national to the local level.
  • Over five years, SSBH will implement data-driven solutions to serve marginalized citizens.
The Challenge

Nepal’s overall health outcomes have improved notably in recent decades. However, despite impressive reductions in maternal and children-under-five mortality, there is still room for significant improvement to ensure the equitable delivery of quality health services.

The Approach

USAID’s Abt-led Strengthening Systems for Better Health (SSBH) Activity is designed to improve health outcomes, particularly for the most marginalized and disadvantaged groups. Programmatically, SSBH’s strategy is to improve access to—and the quality of—maternal, child and reproductive health services (with an emphasis on newborn care).

To improve access, the program is applying an integrated systems approach in the context of federalism in Nepal. This includes building sustainable capacity among provincial and municipal structures to plan, budget for and manage health service delivery in collaboration with local governments, Nepal’s Ministry of Health and Population officers and health service providers. The team is working with municipal councils and Health Facility Operation and Management Committees (HFOMCs) to address social, economic and geographic barriers that women and the most marginalized communities in the target geographic areas face in accessing health care.

The Activity’s health systems strengthening and information systems officers are working to inculcate a culture of data-driven quality improvement and performance management within the health system. They will also use technology to enhance the delivery of program interventions, and foster partnerships with the private sector to expand the reach and quality of critical public health services.

The Results

The project will begin tracking indicators this fiscal year.

Over the five-year contract SSBH will help Nepal:

  • Increase the number of health facilities that offer a full range of high quality, client-centered health services, particularly maternal, newborn child health and family planning (MNCH/FP) services.
  • Reduce financial and social barriers to accessing health care, including enhancing mechanisms that refer citizens to appropriate services in public and/or private facilities.
  • Expand and improve community outreach to broaden the coverage and reach of priority services.
  • Improve the capacity of managers and providers to address quality issues through institutionalized systems for evidence-driven quality improvement.
  • Coordinate with facility management teams that routinely incorporate community input on service availability and quality into local health services planning and budget execution processes.
  • Empower communities that need quality services, and hold facilities, HFOMCs and municipalities accountable.
  • Establish a stronger, more resilient health system that addresses the root causes of underperformance and uses data to drive management decisions that improve access to—and the use of—MNCH/FP services.