Federal System

Nepal switched from a unitary to a three-tiered federal government. As federalism accelerates, the national health system can accelerate its own decentralization process, reducing access inequities and improving health outcomes. The shift toward federalism opens up various possibilities for the national healthcare system. This is due to the fact that decision-making has been devolved to the federal, provincial, and local governments, allowing them to make decisions that are more representative of their localised health needs. The main challenge during the transition period is to ensure that medical commodities and services are available at all times. This necessitates increasing the capacity of local governments to manage drug procurement and general logistics, as well as adequate human resources in local healthcare facilities. This article summarizes the efforts done thus far in the framework of health sector federalization and synthesizes the progress and obstacles encountered thus far, as well as prospective next steps. This report is being written at a critical period in which it is necessary to examine federalism initiatives and propose a path ahead. As Nepal moves toward a federalized health system, we propose that the challenges associated with the transition be critically examined and mitigated while the potential of the federal health system is unveiled.

The Department of Health Services (DoHS) provides preventive, promotional, and curative health services throughout Nepal. The Department of Health and Population is one of three departments within the Ministry of Health and Population.

The health post (from an institutional standpoint) is the first point of contact for basic health services, according to the DOHS and MoHP institutional structure. In reality, the HP serves as a referral center for the TBAS and FCHVS volunteer cadres, as well as a venue for community-based activities such as PHC outreach clinics and EPI clinics. Each level above the HP serves as a referral point in a network that extends from the HP to the PHCC, then to district zonal and regional hospitals, and finally to Kathmandu's specialty tertiary care centers. This referral hierarchy was created to ensure that the bulk of the population receives public health and minor care in easily accessible locations at a reasonable cost. In the other direction, the system serves as a support mechanism for lower levels, offering logistical, financial, supervisory, and technical assistance from the center to the periphery.

• To provide technical assistance to the GoN (Government of Nepal) in developing and expanding health institutions created in accordance with these principles.
• Determine the workforce requirements for health institutions and generate such manpower through the development of short and long-term plans.
• To assure the regional supply of medications, equipment, instruments, and other materials by correctly managing these resources.
• To mobilize assistance in the implementation of authorized programs by drafting, or requesting the production of, objective programs on various elements of public health (family health, family planning, child health, infectious disease control, eradication of malnutrition, control of AIDS and STDs).
• To coordinate the prompt resolution of problems caused by natural disasters and diseases.
• Establishing partnerships with foreign countries and international institutions with the goal of improving efficacy and developing health services, as well as assisting the Ministry of Health in getting foreign aid by clearly specifying the areas of collaboration.
• To foster an environment that encourages the private sector, non-governmental organizations, and international institutions to participate in health care, to maintain relationships and coordination, and to control the quality of health care through regular supervision and inspection.
• Maintaining statistics, statements, and information on health services in a systematic manner, updating and publishing them as needed.
• Fixing designated positions of personnel up to gazetted 2nd class, inter-departmental action and award, and so on.
• To resolve audit errors at the central, project, and regional levels.

The Department of Health Services (DoHS) provides preventative, promotional, and curative health services throughout Nepal. The Department of Health and Population is one of three departments within the Ministry of Health and Population (MoHP). The health post (from an institutional standpoint) is the first point of contact for basic health services, according to the DoHS and MoHP institutional framework. In actuality, the HP serves as a referral center for the TBAS and FCHVS volunteer cadres, as well as a venue for community-based activities such as PHC outreach clinics and EPI clinics. Each level above the HP serves as a referral point in a network that extends from the HP to the PHCC, then to district zonal and regional hospitals, and finally to tertiary care centers in Kathmandu. This referral hierarchy was created to ensure that the bulk of the population receives public health and minor care in easily accessible locations at a reasonable cost. In reverse, the system serves as a support mechanism for lower levels, providing logistical, financial, supervisory, and technical assistance from the center to the periphery.

• To provide technical assistance to the GoN (Government of Nepal) in developing and expanding health institutions created in accordance with these principles.
• Determine the workforce requirements for health institutions and generate such manpower through the development of short and long-term plans.
• To assure the regional supply of medications, equipment, instruments, and other materials by correctly managing these resources.
• To mobilize assistance in the implementation of approved programs by planning and requesting the planning of objective programs connected to various aspects of public health (family health, family planni child health, infectious disease cont eradication of malnutrition, control AIDS and STDs).
• To coordinate the prompt resolution of problems caused by natural disasters and diseases.
• Establishing partnerships with foreign countries and international institutions with the goal of improving efficacy and developing head services, as well as assisting the Ministry of Health in getting foreign funds by clearly outlining the areas of collaboration.
• To provide an enabling environment for the private sector, non-governmental organizations, and international institutions to participate in health services, to maintain relationship coordination, and to control the quality of health services through frequent supervision and inspection.
• To keep data statements and information about health services up to date and publish them as needed.
• Fix designated employee positions up to gazetted 2nd class, inter-directorate transfer, initiate departmental action and provide reward, and so on.
• To resolve audit irregularities at the central, project, and regional levels.

Organogram at Province Level Ministry of Social Development Provincial health directorate

7 sections proposed for each provincial health directorate

• Policy, monitoring and regulations section
• Curative services and disease control section
• Ayurveda and miscellaneous curative section
• Health education, information and communication section
• Nursing service management section Program, coordination and population management section
• Administration section

Divisions at province Level

Administration, Planning and Monitoring Division

Administration, Planning and Monitoring Unit

Economic administration unit

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