Provincial Health System of Nepal After Federalism
Nepal’s transition to a federal system in 2015 marked a transformative shift in its governance, with the establishment of seven provinces. This restructuring introduced a new level of government, the provincial level, tasked with the responsibility to manage and deliver health services within each province, enhancing accountability and catering to local health needs.
Structure and Organization
Under federalism, the Ministry of Social Development (MoSD) is the principal body responsible for health at the provincial level. Each province has its own MoSD, which includes a Health Division, tasked with implementing health policies and managing provincial healthcare facilities. The provincial health system operates between the federal Ministry of Health and Population (MoHP) and the local governments, creating a three-tiered health governance structure.
Provincial health facilities include provincial hospitals, specialized healthcare centers, and district hospitals, all aimed at delivering advanced health services and supporting local health units. These facilities provide a bridge between primary care offered at local levels and specialized tertiary services available at federal institutions.
Health System Components
The provincial health system encompasses various services such as maternal and child health, disease prevention, immunization, and health promotion. Provincial governments have autonomy over health budgets, enabling more localized and responsive health interventions. However, the MoHP still provides policy direction, standards, and technical support to ensure consistency and quality across provinces.
Staffing and Human Resources
Each province has a Health Directorate, responsible for human resource management, including recruitment, training, and deployment of healthcare workers. Health staff at this level range from medical officers, nursing staff, and public health experts to administrative personnel. Provinces have the authority to manage their health workforce, which allows them to address specific staffing needs in line with local health challenges and population demands.
Roles and Responsibilities
The primary responsibilities of provincial governments include:
- Developing and implementing provincial health policies and plans.
- Coordinating with local governments to deliver comprehensive health services.
- Managing provincial health institutions and facilities.
- Overseeing the provision of essential health services, including immunization, maternal and child health, and disease control.
- Monitoring and evaluating health programs and services to ensure quality and accessibility.
Organogram of the Provincial Health System
The organogram of the provincial health system typically includes:
- Ministry of Social Development (MoSD): Led by the Minister of Social Development and supported by a Provincial Health Division.
- Health Directorate: A technical body overseeing health service delivery, reporting to the MoSD.
- Provincial Hospitals and Specialty Centers: Managed by the Health Directorate to provide direct health services.
- District Health Offices: Supporting health programs at the district level and coordinating with local health units.
After federal reforms, Nepal’s health sector was organized into three tiers: central, provincial, and local. Each level has its own staffing structure and organogram. Here, we present the staffing and organograms for the provincial level health system.
Please review the sanctioned Provincial Health Organogram:
It was approved by the Council of Ministers on 24 December 2018 (2075/09/09 BS). Initially, each province had a Ministry of Social Development encompassing Health, Education, and other social development authorities.
At the end:
The provincial health system in Nepal reflects a localized approach to healthcare, allowing provinces to respond to their unique health needs. Despite challenges in resource allocation and coordination, this federal approach aims to improve health outcomes through provincial autonomy and accountability.
References
- Ministry of Health and Population, Nepal. (2022). National Health Policy 2077 [Online] Available: https://mohp.gov.np
- World Health Organization (WHO). (2021). Strengthening Provincial Health Systems in Nepal [Online] Available: https://www.who.int/nepal
- Nepal Health Research Council (NHRC). (2020). Federal Health Governance in Nepal [Online] Available: https://nhrc.gov.np
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