Federalisation: is it Facilitating Nepal in Achieving Universal Health Care

Abstract

Federalisation on Nepal’s progress towards UHC; and is conceived in the follow up to country signing up to UN 2030 Agenda for SDG. It includes, inter-alia a goal for achieving UHC, and alongside that in September, 2015 new constitution was promulgated, replacing the erstwhile unitary system of governance with a three tiered devolved federal state structure. Eight key informants, selected purposively from the three tiers of health system hierarchy, were interviewed to collect primary data, substantiated with secondary data from published and grey literature. At local level, elected Mayors and Councillors, responsible for health, often acted based on political expediency, and since were neither oriented nor was their capacity built, healthcare was not a priority. Thus, UHC targets were furtherpushedoff. But, where Local Health Coordinator was strong, some tangible improvements were also noted. The federated structure is still evolving, as planning and implementation arrangements were not proper and robust. It was like “thinking and planning alongside the implementation” and with regard to interventions like establishing district health offices, it was a “hit and trial”. On the other hand, provincial and local levels, which were relatively quick to organise, exercised the delegated authority in managing health sector. But, in the absence of uniform plans and guidelines, these bodies went in their own way, contributing to the “Americanisation of the health sector”. The federal level, in the process, resisted the change, to maintain its organisation, faltering also in developing robust plan, guidelines and supporting the new federalised structures. In September 2015, Nepal, together with 192 other countries, signed on to the “UN 2030 Agenda for Sustainable Development” , which includes a goal for achieving Universal Health Coverage (UHC). Under UHC, countries engage to improve access to affordable quality health care. In line with these, Nepal has set country-specific targets related to the Sustainable Development Gaols (SDGs) and UHC.