Nepal recently moved from unitary system to federal system with three tiers of government. The constitution of Nepal 2015 has envision, country into seven provinces, 77 districts, 753 paalikas and 6743 wards. Main aspect of the Constitution of Nepal, 2015 is the transfer of power from central/federal to the provincial and local government. Paalika has beings considered as smallest electoral unit in Federalism which has several potential opportunities along with challenges on health system. Paalikas have the accountability to ensure health and education as its priority. Paalikas has to ensure proper delivery of preventive, promotive and curative health services through different levels of health institutions and regulate all activities related to health services at the ward level. The paalikas has to work to improve efficiency, address disparities and improve the health status of the people by assuring equitable access to quality health care services.
According to constitution of Nepal, 2015 decisions making power has been also devolved to federal, provincial and paalikas so that they can make decision for the betterment of health services at local level. The local level (paalikas) has the autonomy to make local laws, acts, policies and strategies within their jurisdictions.
Despite of many geographical circumstances, Nepal was able to halt and reverse the trends of tuberculosis, HIV and malaria with elimination of polio, maternal and neonatal tetanus and leprosy. For instance in 2016, infant and child mortality reduced from 46 to 32 and from 54 to 39 per 1000 live births respectively within the last five years (NDHS 2016). Despite this progress, equitable access to healthcare is still a major challenge in Nepal similarly, rise of non-communicable diseases, including mental health, natural disaster induced health problems and an increasing number of deaths and injuries due to road accidents are an increasing challenge that the health sector needs to respond to effectively and efficiently.
Some key challengesthat could be associated with federalism as seen in the context of other countries such as de prioritization of social sectors like leading to decline in proportions of budgets, lack of clarity in the delineation of authority within the jurisdiction of the different layers of the government, management of human resources are challenges that Nepal will continue to face for a couple of years.
In understanding these challenges, Province 2 has sensitization on need of health policy considering the current needs of support in health system strengthening at local level for technical support. According to the National Demographic Health Survey-2016, neonatal mortality rate in the province 2 is 30, whereas the national average is 21; infant mortality rate is 43 in the province while the national average is 32; under-five mortality rate is 52 against the national average of 39.
Likewise, the prevalence of anaemia among children aged six months to five years is 58 against the national average of 53; the prevalence of anaemia among women aged between 15 years and 49 years is 59 while the national average is 41.
Similarly, only 65 percent children of the province have received basic vaccination, while the national average is 78 percent; birth delivery rate in health care facilities is 45 percent while the national average is 57 percent; women aged 15-19 years, who are currently regnant are, 27 percent in the province but the national average is 17.
Moreover, children under five who are stunted are 37 percent while the national average is 36 percent. All the health indicators in the province 2 are lowest compared to other parts of the country which needs a support to the paalika to identify their health issues, their current challenges and establish a vision for future which in turn helps to establish targets. This whole process will be carried out with engagement of local government as they are solely responsible to formulate and endorse the health policy.
Save the Children, Nepal
To technical support to develop the health policy in Godaita Minicipality.
To facilitate and support municipal level in preparing health policy.
Formation and orientation of municipal level steering committee and technical working group.
Qualitative information gathering
Key stakeholder workshop and validation.