Health Planning_Budgeting Process in Nepal.pdf

This document covers the overall framework of the current federal, provincial, and local government health and budgeting process.

1. Prepared By
Subash Wagle
Institute of Medicine (IOM)

A. Federal Level Health Planning/Budget Planning
1. Budget formulation
Top-down Approach

Macro-economic framework prepared by MOF ( Ministry of Finance) [2
nd

week of Kartik]

Identify revenue and expenditure by Research Committee [3
rd
week of
Kartik]

Note: Research Committee Members: Governer from Nepal Rastra Bank,
MOF Secretary, FCGO and Nepal Planning Commission VC (LEADER)

Research Committee sets the budget ceiling [2
nd
week of Mangsir]

National Natural Resources and Fiscal Commission ( रास्ट्रिय प्राकृस्ट्िक श्रोि स्ट्ित्तीय
आयोग ) provides insight on revenue, sharing and grant allocations base and
format preparation and recommending it to research committee

Circulate the budget ceiling and guidelines to all line ministries [3
rd
week of
Mangsir]

2. Now, Ministries circulate the budget ceiling guidelines to related
departments, district offices
[i.e. MOHP receives the budget ceiling and budget formulation guidelines
from the MOF and NPC (research committee) ]

The Policy, Planning and Monitoring Division (PPMD) under Policy and
Planning Section of MOHP sends budget ceilings and budget formulation
guidelines to sub-ordinate departments, central offices, national and
specialized hospitals and other entities.

Bottom Up Approach

Units/ Agencies ( i.e. Rural/Urban Municipalpity/ PHC/ HP/ other health
units) concurrently prepare the forthcoming years programs and budget
proposal and send it back to the concerned departments {sends to DCC +
DPHO } [2
nd
week of Poush]- Sending Mechanism= LMBIS (Line Ministry
Budget Information System)
Note: DCC: District Coordination Committee
DPHO: District Public Health Office

The departments (DPHO+ DCC) compile the programs and budgets of all
agencies under them and submit it to the respective Ministries (3
rd
week of
Pous
Here, DPHO+DCC Provincial MOSD (Ministry of Social Development)
Federal Ministry
[Some negotiations can take place between ministry
and departments before it is forwarded
to MOF and NPC for finalization]

3. Budget and Activities Proposed to MOF and NPC

Policy Discussion at NPC

Line Item Discussion at MOF ( About Policy and Priority Programs,
Collection of Suggestions)

Budget Draft Preparation

2. Sanction ( Permission granted by authorities to do something )
MOF prepares the estimated income and expenditure budget book (Red
Book) and budget draft under the leadership of Secretary from MOF, for the
coming years.

Budget is discussed itemwise and sector-wise by the members of parliament
( Revenue Consultation Committee, Economic Policy Advisory Committee.
Suggestions are sought from public, political parties and private sector)

Policy and Priorities presentation by President ( नीस्ट्ि िथा काययक्रम िाचन उक्त आथीक
िर्यको in parliament)

The final budget proposal is presented to the cabinet both at National
Assembly (रास्ट्रिय सभा) and House of Representative ( प्रस्ट्िस्ट्नस्ट्ि सभा )

The budget details approved by the cabinet are submitted to the president

4. With the president letter the finance Minister presents the budget to the
house of representatives ( Jestha 15 )

Clause-by-clause discussions (दफाबार छलफल ) are held in House of
Representatives for few days
Finance Minister repsonds to questions raised during the discussions

The house approved (passes) the budget through voting

3. Disbursement
After approval, MOF provides authorization for spending to
“Secretaries of each Ministries” ( i.e MOHP secretary Dr. Bikash
Devkota holds an authority for spending in health sector) and copy is
sent to FCGO (महालेखा स्ट्नयन्त्रकको कायायलय ) and Office of Auditor
General (महालेखा पररक्षकको कायायलय )

Secretary of MOHP provides authorization letters to Department’s Heads.
Department Head provides authorization to “Spending Unit Chief “ to
enable them to obtain fund from respective DTCOs ( District Treasury
Controller Office ) {कोर् िथा लेखा स्ट्नयन्त्रकको कायायलय }

4. Implementation and Accounting
Agencies withdraw funds from the Treasury Office

Carry out spending activities [involves program implementation, other
payment-related tasks]

5. Maintains accounts of withdrawal and expenditures in prescribed format

Periodically, they send details of work-done or expenditure to higher
authorities

At the end of fiscal year, they prepare financial statements and conduct
audits

5. Monitoring and Reporting
Monitoring means collecting, gathering and analyzing the information

Monitoring involves periodical review of budget in federal, provincial and
local level

District Treasurer Controller Office {कोर् िथा लेखा स्ट्नयन्त्रकको कायायलय } report to
the Financial Controller General Office (FCGO). FCGO keeps records of
source wise national account especially revenue, expenditure, loan and
grants.

Note: For more Details
Nepal National Health Accounts 2018/19 and 2019/20

Controlling by the MOF through technical measures and post budget
formulation control

6. Auditing and Analysis

6. Internal audit itself done by account section of health organization

External audit is done by District Treasurer Controller Office {कोर् िथा लेखा
स्ट्नयन्त्रकको कायायलय } and Chief Controller of Auditing Office or Office of
Auditor General (महालेखा परीक्षकको कायायलय ) at the every end of fiscal year

After audit, the report is submitted to president

President through Prime Minister, presents the report to the parliament as
per constitutional provisions

Parliament send the report to the public audit committee ( साबयजस्ट्नक लेखा सस्ट्मस्ट्ि )
for item wise analysis

7. B. Provincial Level Health Planning/Budgeting



1. Revenue and Expenditure Projections
• Timeline: By Mid-January
• Details:
o Provinces submit their financial projections for the upcoming fiscal year
(FY). Including revenue and expenditure estimates, to the Ministry of
Finance (MOF)
o Sets the groundwork for health budgeting at the provincial level.

2. Fiscal Equalization and Revenue Distribution
• Timeline: By Mid-March
• Details:

8. o Ministry of Finance (MoF) allocates fiscal equalization grants and
distribution of revenue to provinces, ensuring that financial resources are
fairly distributed to meet the health needs of all provinces.

3. Medium-Term Expenditure Framework (MTEF) and Budget Ceilings
• Timeline: By Mid-March
• Details:
o Ministry of Economic Affairs and Planning (MoEAP) provides budget
ceilings and guidelines for provincial ministries.
o Provincial health departments prepare budgets within these limits,
ensuring financial discipline.

4. Program Submission by Ministries
• Timeline: By Third Week of April
• Details:
o Provincial health ministries and agencies enter their health programs and
projects into the Provincial Local Budgeting and Management Information
System (PLMBIS).
o Must comply with given budget ceilings.

5. Pre-Budget Discussion
• Timeline: By May
• Details:
o Health departments submit reports on:
▪ Physical progress of previous fiscal year.
▪ Financial progress of previous and current fiscal years.
o Reports are reviewed by MoEAP and the Provincial Planning Commission.
o Helps adjust and finalize health priorities.

6. Budget Presentation
• Timeline: By Mid-June
• Details:

9. o Provincial governments present health budgets in respective provincial
assemblies.
o Budgets are discussed and approved.
o Approved budget outlines:
▪ Resource allocation for health services
▪ Infrastructure development
▪ Personnel management


C. Local Level Health Planning/ Budgeting Process