Explanation:
Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system.
Keywords: Challenges and Opportunities, Decentralization, Federalism, Health Reform, Health Sector, Nepal
Background
With the promulgation of its constitution in 2015, Nepal replaced a unitary government with a federal system of government.1 This process has made Nepal a federal democratic republic governed with three levels of government: a federal level, seven provinces and 753 local government.2 It also led to local elections in late 2017 for the first time in two decades, a landmark achievement signalling that federalism is being implemented.2 With the ongoing restructuring of the health system delivery, this article aims to synthesize the progress and challenges to date and potential ways forward based on the perspective of the federal government. The progress of federalization in Nepal is also considered in light of the experiences of other countries that have implemented federalism, and these remarks may be pertinent to progressively guide the management of the health sector federalization.
Current Situation in Nepal
During the last few decades, Nepal Government has made significant progress towards reducing maternal, under-five and infant mortality rates. During the same period, Nepal was able to halt and reverse the trends of tuberculosis
