Health delivery service

The Himalayan Times

13 October 2023

The 2015 constitution has converted Nepal into a federal structure, with significant reforms of the health delivery system in terms of both structure and devolution of power and authority. Moving from a unitary system to a three-level federal system of government, the then national health delivery system was restructured accordingly to meet the needs of the new political and organisational structure. As the nation transitioned from a unitary system to the federal structure, governance system underwent a profound transformation. This shift had a significant impact on healthcare delivery services among others and demanded many changes to meet the needs of the hour “PM Dahal expresses determination to resolve problems in the health sector” (THT, October 11, Page 1).

Decentralization became, even in the federal structure, a key process that required a harmonised effort of all the concerned authorities to ensure that healthcare services remained accessible and equitable to all the people across all the provinces. Effective cooperation between federal and provincial authorities was a must in order to meet the high expectation of the people from all the government and semi government services including health delivery services. Another major challenge for all the levels of government in providing quality health service is human resource management. In the current context, putting all the health facilities under local level governance poses a major challenge, with limited staff and skills to manage health programmes. This system lacks clear direction, capacity, and clarity to drive health programmes.

Rai Biren Bangdel

Maharajgunj

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