KATHMANDU, APRIL 13

This week researchers from the UK and Nepal meet with Provincial and Federal MPs and high level policy makers to discuss the interim findings of a federalisation and health study.

The meeting today highlighted how federalisation of the political system affected Nepal's health care organisation.

The 2015 Constitution brought federalisation and with it, significant changes to the health system.

To understand these changes researchers worked in three provinces where they interviewed 243 stakeholders at all three levels of government.

They also conducted 31 Participatory Policy Analysis workshops at the local and province levels.

The research summarised the findings for the invited MPs, and invited their reflections on the political possibilities and obstacles to moving forward with the development of the country's health system.

The researchers reported both positive and negative changes in the decentralised health system of Nepal.

Positive aspects included, for example, improvements in the availability of resources for health, the construction of new health posts and hospitals, better availability of essential medicines in many places.

The research team also commented on the positive management of COVID-19, compared to other many countries. Some negative aspects were: communication between levels of government didn't always function well, several health workforce-related issues, issues of oversight and coordination in buying medicines resulting in both shortages and overstocking.

There were also financial issues with some local level governments unable to spend the budget, whilst others didn't allocate enough money for health.

Prof Simon Rushton from the University of Sheffield stated: 'There appeared to be more health workers available at the local level since the start of federalisation, and there appeared to be less absenteeism due to more effective local management. However, at the same time there are still problems with lack of appropriate expertise in some roles, retention of staff, and lack of career development pathways for health workers.'

Dr Jiban Karki (PHASE Nepal) added, 'There is a need for education and training of local policymakers on how to do health budgeting more effectively.'

Looking at the future, Professor Sujan Marahatta said, 'The project over the next year will be working with health system staff at all levels to provide training and implement some of the key lessons learned from this project.'

This interdisciplinary study 'The impact of federalisation on Nepal's health system: a longitudinal analysis' is being carried out between 2020- 2024, funded by the Health System Research Initiative, a UK collaboration between three funders: the MRC (Medical research Council), the Foreign, Commonwealth & Development Office, and the Welcome Trust.

The team includes researchers from Manmohan Memorial Institute of Health Sciences (Kathmandu), and PHASE Nepal (Bhaktapur), and three UK institutions (the universities of Sheffield, Bournemouth, and Huddersfield).

Prof Edwin van Teijlingen (Bournemouth University, UK), reminded that 'in any country there must be continuous discussion about which health policy decisions should be taken at what level. The balance between health decisions required to be taken at the national level, the appropriate Public health approach to dealing with Dengue fever, provincial level, the location of district hospitals, and those best taken at the local level, providing culturally appropriate health services to the community.'

A version of this article appears in the print on April 14, 2023, of The Himalayan Times.