Introduction
Health System Governance in Nepal is undergoing a profound transformation following the country’s shift to a federal structure. The constitution now mandates local governments with the exclusive responsibility for Health system governance in Nepal, which is undergoing significant transformation due to the country’s shift to a federal structure mandated by the 2015 Constitution. Under this new arrangement, local governments hold exclusive responsibility for planning, developing, and implementing basic health services (BHS) as per Schedule 8 of the Constitution. This decentralization aligns with the Nepal Health Sector Strategic Plan (NHSSP) 2023-2030, aiming to improve governance, increase governmental capacity, and achieve universal health coverage and equity. A core element of this strategy is the integration of Gender Equality and Social Inclusion (GESI) to ensure marginalized groups—including women, persons with disabilities, and Dalits—have better access to health services.
However, despite this clear mandate, local governments face challenges in effectively managing health services. These challenges include limited institutional, technical, and human resource capacity, inconsistent implementation of Minimum Service Standards (MSS) across health facilities, and gaps in evidence-based planning and budgeting that incorporate a GESI perspective. Without responsive planning through a GESI lens, many specific needs of marginalized populations remain unaddressed, hindering progress toward fairness and equitable healthcare access. Addressing these capacity gaps is essential to fulfill the constitutional and strategic goals of equitable health service delivery in Nepal.
Objectives
To enhance the institutional capacity of local governments for effective implementation and monitoring of the Basic Health Service Package in line with WHO health system building blocks, NHSSP 2023–2030, and revised MSS guidelines considering GESI in health.
Specific Objectives:
- Assess institutional, technical, and human resource capacities of selected local governments in relation to BHSP delivery.
- Support revision, contextualization, and implementation of Minimum Service Standards (MSS) at the local level and include GESI perspective.
- Strengthen systems for planning, monitoring, and reporting of BHSP indicators considering GESI in health.
- Build capacity of local government officials and health facility teams through training, coaching, and knowledge-sharing platforms.
- Promote multi-sectoral collaboration for addressing social determinants of health.Â
Major activities:
- Consultative Meeting
- Development of Assessment Tool
- Institutional Capacity Assessment
- Co-Creation Workshop
- Stakeholders Validation
Study team:Â
Mr. Bhogendra Dotel, Health System/Policy Expert
Mr. Sagar Dahal, Public Health Specialist (Primary Health Care, MSS)
Dr. Janak Thapa, Governance and Institutional Capacity Expert
Ms. Pragya Pokharel, Monitoring and Evaluation (M&E) Expert
Mr. Prabin Tiwari, Training and Capacity Development Facilitator
Study area: Lumbini and Sudur Paschhim ProvincesÂ
Duration: November 2025- June 2027