The Impact of Federalization on Health Sector in Nepal: New Opportunities and Challenges

Vaidya, Anju; Simkhada, Padam; Simkhada, Bibha

doi:10.33314/jnhrc.v17i4.2217

Cited by 16 publications

(18 citation statements)

References 2 publications

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“…Nepal moved to federalism since 2015 with signi cant devolution of power and resources from central government to provincial and local authorities (municipalities) including health system reformation. This has shifted the primary responsibility for health service provision to provincial governments and municipalities but has met a number of implementation challenges including unclear roles and responsibilities among the three tiers of governance in decision making, and in human and nancial resources management (29,30). This has resulted in poor co-ordination among the three tiers of governance affecting effective response to this pandemic.…”

Section: Discussionmentioning

confidence: 99%

Challenges in Providing Health Care Services During COVID-19 Pandemic: Exploration of Providers’ Perspectives in Nepal.

Karkee

Pyakurel

Paudel

et al. 2021

Preprint

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IntroductionThe rapid increase of COVID-19 cases since the beginning of May 2020, imposition of lockdown, and preparation activities to detect, manage and treat COVID-19 in public hospitals have impacted on the provision of non-COVID health care services resulting in increased morbidity and mortality in Nepal. This study aims to explore challenges in providing non-COVID as well as COVID-19 health care services through public hospitals in Eastern Nepal.MethodsA qualitative study with 25 key informants from three public hospitals in Eastern Nepal was conducted. Key informants were health care workers (HCWs) and managers of the hospitals. A thematic analysis was carried out to identify challenges in providing non-COVID and COVID-19 health care services.ResultsWe identified four themes: weak implementation; weak co-ordination and management; low accountability of HCWs and staff; and risk of infection and stigma as the challenges to provide COVID-19 health care services. We identified three themes: maintaining safety measures in hospitals, managing patients, and fear of infection as the challenges in provision of non-COVID health care services. Inadequate resources and HCWs, lengthy procurement process, and poor jobs specification were the main reasons for weak implementation. HCWs stated weak hospital administration while managers and focal persons complained of low accountability of HCWs and staff to manage COVID-19 health care services.ConclusionIn addition to inadequate resources; the risk of infection of COVID-19, maintaining safety measures in hospitals, ensuring clear leadership and governance, and preparing motivated and accountable HCWs and staff to get ‘work done’ are unique challenges observed in the study hospitals; and consequently need to be addressed.

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Section: Discussionmentioning

confidence: 99%

Challenges in Providing Health Care Services During COVID-19 Pandemic: Exploration of Providers’ Perspectives in Nepal.

Karkee

Pyakurel

Paudel

et al. 2021

Preprint

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“…In the federal structure in Nepal, health is one of the most decentralized sectors where basic health services falls under the exclusive functions of local government (32,33). The local governments have the authority to plan, operate, and manage their own health systems, so that health services can be brought closer to homes of residents.…”

Section: Resultsmentioning

confidence: 99%

Intersectional gender analysis for inclusive health system in Nepal; taking Tuberculosis as a case example – Where we are and what can be done?

Parajuli¹,

Kakchapati²,

Arjyal³

et al. 2023

Preprint

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Background Tuberculosis (TB) remains a major public health problem in low- and middle-income countries. As of 2021, Nepal is one of the high TB burden countries, with an increasing prevalence of cases. Literature suggests disparities in access to and utilization of health services and health status of people based on gender and other social stratifiers, leading to inequities in Nepal. TB is a disease, which is high among settings with common practice of gender and social inequities. This study aimed to a) explore inclusiveness of gender and other social stratifiers in the key health related national policies and health management information system (HMIS) b) to conduct disaggregated and intersectional analysis of the tuberculosis cases enrolled in the National Tuberculosis Programme (NTP). Methods Desk review of key policies and HMIS was conducted. Secondary data analysis was carried out from two data sources i.e. annual report data of NTP (2017–2021) and 628 recorded tuberculosis cases from two Directly-Observed Therapy, Short-course (DOTS) centres (2017/18-2018/19). Bivariate and multivariate analysis was carried out to measure association between social stratifers and types of TB, patient registration category and treatment outcome. Results While the NTP has initiated collecting data on age, sex, ethnicity and location since 2014/15 through the HMIS, limited data was available to unmask the role of other social determinants of TB. Similarly, various TB data have remained static as they were not analyzed and disseminated in annual report. National data showed sex and age wise variation among reported TB patients. Association between sex of the patient and types of tuberculosis (p < 0.05) was identified. Age and sex were associated with patients’ registration category during the time of enrolment into the TB treatment (p < 0.05). Significantly, higher number of males (22%) came for the re-treatment in comparison to females (15%) (p < 0.05). Females had 3.33 times (AOR = 3.33, 95%CI: 1.84–6.01, p < 0.001) higher successful treatment outcome in comparison to male patients. Rate of successful treatment gradually decreased by increase in age among both male and female patients. Conclusion Hence, sex was strong predictors of types and treatment outcome of TB. Therefore, suggest integration of an intersectional gender lens into the National TB Control programme and research in order to understand biological and the social construct of gender, as important determinantsas important determinants of TB. Trial registration: Not Applicable

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“…Nepal transitioned to a federal government system in 2015 with seven newly created provinces and 753 local governments (Vaidya et al, 2019). Devolution of responsibilities in the health sector to district level in Nepal began in 1999 with the Local Self Governance Act (LSGA) (Gurung, 2011).…”

Section: Nepalmentioning

confidence: 99%

“…The national health policy in 2019 mandates subnational governments to deliver basic healthcare services including preventive and promotive care related to reproductive, maternal, child health and nutrition (Vaidya et al, 2019). To ensure that health was not de-prioritised in the federal system the government channelled the health sector budget under a conditional grant so that delivery was uninterrupted (Thapa et al, 2019).…”

Section: Healthmentioning

confidence: 99%

Transition to Federal Health and Education Governance

Bolton¹

2021

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This report looks at transition from central to federal responsibilities for health and education in Nepal and Indonesia. Federalism is a complex process and it was outside of the scope of this review to investigate the extent to which it has been developed in these countries and the nature of its functioning. Challenges identified in the literature on transition to federalism and decentralisation include ensuring equitable distribution of finances and resources across states, slow transfer of power and lack of coordination between government levels, lack of capacity at local levels and incoherence in capacity building, ensuring continuity of medical supplies and continuity of health services during transition, and training local level health personnel in procurement. This report also notes some recommendation from experience on transition to decentralisation, including the need to put a clear legislative framework, to make a slowly phased transition is needed to allow for changes and adjustments, to consider conditional grants to ensure that health is not de-prioritised in a federal system.

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The Impact of Federalization on Health Sector in Nepal: New Opportunities and Challenges

Cited by 16 publications

References 2 publications

Challenges in Providing Health Care Services During COVID-19 Pandemic: Exploration of Providers’ Perspectives in Nepal.

Challenges in Providing Health Care Services During COVID-19 Pandemic: Exploration of Providers’ Perspectives in Nepal.

Intersectional gender analysis for inclusive health system in Nepal; taking Tuberculosis as a case example – Where we are and what can be done?

Transition to Federal Health and Education Governance

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