Health Governance & Federalism

Prakash Raj Bhatt, Rabindra Bhandari, Shiksha Adhikari et al. · 2024 · PLOS Global Public Health

Digital health — specifically DHIS2 data quality — is named among Nepal's explicit 2026 digital-health reform priorities, and DHIS2 reporting now nominally covers all 753 local governments following the 2019 federal-structure rollout. Yet Nepal's federal design assigns local governments constitutional ownership of "basic health and sanitation" (Schedule 8) while health remains concurrently shared across all three tiers (Schedule 9) — a structural coordination gap documented by Wasti et al. (2023) — and this Gandaki-province study shows it concretely: DHIS2's servers, technical support, and training remain federally or provincially managed even though facility- and local-level staff carry the reporting burden.

Ashish KC, Uwe Ewald, Omkar Basnet et al. · 2019 · PLOS Medicine

Nepal's institutional delivery rate has risen from 9% in 2001 to 79.4% (NDHS 2022), so most Nepali mothers now give birth in a facility — yet neonatal mortality has stagnated at 21 per 1,000 live births since 2016, meaning the bottleneck has shifted from getting women to facilities toward the quality of care they receive once there. This trial evaluates the Ministry of Health and Population's own Nepal Perinatal Quality Improvement Package (NePeriQIP), scaled up to 12 government hospitals, making it a direct, government-owned test of whether hospital leadership and resuscitation-training reforms can convert Nepal's high institutional-delivery rate into fewer intrapartum deaths. Because the trial (2017–2018) pre-dates full devolution of facility governance under Nepal's federal structure — where local governments now own "basic health and sanitation" and provinces own "health services" — its centrally-led model needs re-testing under the current three-tier system.

Samita Giri, Kari Risnes, Oddvar Uleberg et al. · 2018 · PLOS ONE

The 2015 Gorkha earthquake sequence killed roughly 8,800 people, injured about 22,000, and destroyed or damaged more than 1,200 health facilities (446 destroyed, 765 damaged) — exposing how a single earthquake can simultaneously generate a casualty surge and cripple the facilities meant to treat it. Only about 58% of damaged health facilities had been rebuilt five years on, and Nepal remains one of the world's most seismically exposed countries, so the surge-capacity gaps this study documents are a live, unresolved concern rather than a historical one. As a single non-government hospital study, its specific caseload figures may not generalise to public referral hospitals with different capacity or catchment, but the core lesson — that a pre-existing triage system, not an improvised one, determined how well the surge was managed — is broadly transferable across Nepal's disaster-prone districts.

Neelam Dhakal, Pradip Gyanwali, Baburam Humagain et al. · 2023 · PLOS Global Public Health

Nepal's Free Drug List supplies roughly 98 essential medicines free of charge at public facilities under a system where the Department of Drug Administration (DDA) holds the federal (Schedule 5) mandate — via the Drugs Act 1978, Section 12 — to enforce quality standards, separate from the facility-level procurement and storage duties that Schedule 8 devolves to local governments. This nationwide NHRC study is the first to test the quality of these free, publicly-supplied essential medicines rather than commercially purchased drugs, finding 15.2% substandard — with the federal supply channel (62.2% of failures) implicated more than local-government procurement (37.4%), directly bearing on how quality-assurance responsibility should be divided across Nepal's three-tier federal health system.

Basant Adhikari, Kamal Ranabhat, Pratik Khanal et al. · 2024 · PLOS Global Public Health

Nepal's 2015 federal restructuring assigned 'basic health and sanitation' — including health posts, primary health centres, and local procurement — to the country's 753 local governments under Schedule 8 of the Constitution, while provinces and the centre retain concurrent authority under Schedule 9; this study's finding that local-level procurement tenders lacked even a basic shelf-life clause, unlike the 18-month minimum enforced at the province level, is exactly the kind of tier-coordination gap researchers have documented since federalism began. The medicines found most frequently out of stock — condoms, Depo-Provera injectables, oral contraceptive pills, and zinc — are the same family-planning and child-health commodities that Nepal's roughly 50,400 Female Community Health Volunteers (FCHVs) rely on for household-level delivery, so procurement delays at the local tier cascade directly into a flagship community health programme.

Sharada Prasad Wasti, Edwin van Teijlingen, Simon Rushton et al. · 2023 · Health Research Policy and Systems

Nepal's 2015 Constitution assigns health as a concurrent (Schedule 9) responsibility across all three tiers of government — federal, provincial, and local — a constitutional design that this paper's own authors identify as a named source of coordination failure between the Ministry of Health and Population, the seven provincial health directorates, and Nepal's 753 local governments. Nepal still operates under the pre-federal 1997 Health Service Act, with no federalism-aligned successor yet enacted, leaving local elected officials and health workers navigating budget duplication, staff-adjustment mismatches, and delayed fund releases documented across Bagmati, Lumbini, and Karnali provinces in this study.