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1. Health Care System In Federal
Democratic Republic Nepal
GROUP-B
BPH 6th Sem
EDENBURGH INTERNATIONAL COLLEGE
BIRATNAGAR MORANG

2. Group “B” Members:
1. Mohan Bastola (Leader)
2. Abigail Rai (Co-Leader)
3. Sanobabu Katuwal
4. Saroj Dahal
5. Dharmaraj Katwal
6. Janaki Chaudhary
7. Akriti Bhattarai

3. Content:
• Introduction to federal system
• Health system
• Major initiative in Health and National Health system
• Structure of health service delivery
• Health governance
• Organogram of different organization
• Public service Act
• SWOT analysis
• Conclusion

4. Introduction
• Federalism is a system of government in which a written
constitution divides the powers of government on a
territorial basic between a central or national government
and several regional governments, usually called states or
provinces.
• A system of governments under which significant powers are
divided between the central government and smaller
governmental units.

5. Introduction Contd…
• States or provinces are given considerable self rule, usually through
their own legislatures.
• In a federal form of government, power is divided between a central
and state and local governments.
• A document such as constitution, bill , draft etc. describes the rights,
responsibilities and duties of the central governments, states and the
local governments.

6. Introduction Contd…
• Nepal has entered from its unitary system into new “ Federal
democratic republic system” on 17th September 2015.
• Federal system is expected to bridge the persistent disparities
between rural and urban areas which are rooted from the past.
• The constitution give emphasis on right to clean water and hygiene
and equal access to health care.
• The transformation of government from centralized to federal has led
to effective supply of resources from the provinces and brought a
new wave in the health sector reform.

7. Introduction Contd…
• The Constitution of Nepal 2015, replacing the Interim Constitution
from 2007, defines Nepal as a federal democratic republic and
provisions three tiers of government: local, provincial, and federal.
• Since the last democratic election held in November 2017, Nepal
consists of 753 local governments, 7 provincial governments, and one
federal/central government.
• Local and provincial governments hold a variety of political, fiscal, as
well as administrative powers, while there are also concurrent powers
with the federal government.

8. Introduction Contd…
• As per the current constitutional provisions, 35 political, fiscal, as well
as administrative powers are given to the federal government, 21 to
the provincial governments, and 22 to the local governments.
• At the same time, there are 25 concurrent powers between federal
and provincial governments, whereas 15 are shared between federal,
provincial, and local governments.

9. Introduction Contd…
• Health care provision and health care financing should be organized
according to federal legislation and managed by federal government.
• Health system in Nepal is functioning under new governance with
ministry of health and population at central level, ministry of social
development at the provincial level and health section or health
department under the local level governments.

10. Federal government
7 province
77 district
6- metro city 11-sub metro-
city
276 Municipality
460 rural
municipality
New federal system:

11. Health system
• A health system as described by WHO is the sum total of all the
organizations, institutions and resources whose primary purpose is to
improve the health.
• Health system are the foundation to achieve and ensure health for all, the
3rd sustainable development goal, adjusted and balanced to meet the need
of various populations. They aim to:
Promote and improve health for individuals and groups.
 avert dangers to the health.
 protect people against financial disaster as consequences of ill health.
 provide equitable access to health care.
Enabling people to participate in decisions affecting their health.

12. Objectives of health care delivery:
• Should be organized to meet the needs of entire population and not
merely selected groups.
• should cover the full rage of preventive, curative and rehabilitation
services.
• Should be part of basic social services of a country.

13. Health service delivery
• Health service are mixed both governmental and non governmental
organization for profit and not for profit.
• The health system introduced as the general health plan in1956 and
has been expanded by focusing on primary health care, and a
comprehensive network like health system has been developed.
• Community based health services and interventions like:
Immunization
 vitamin A and albendazole distribution ( twice a year) and primary
health care out reach clinics ( mobile clinic- every months) from local
health facility.

14. Contd…….
• FCHVs and mothers groups.
• Hospital and facility based services- general, specialized and mobile
clinics.

15. Major program initiative in health
• Institutional delivery declared free with maternity incentives
schemes,
• introduction of free health care ( service charges abolished and
essential drugs provided free.
• Surgery of uterine prolapse.
• Treatment support to under privileged patients suffering from cancer,
heart diseases, chronic kidney disease.
• Compulsory two year rotation of physicians outside Kathmandu after
completing MBBS course under Government Scholarship.
• Nutrition supplementation programs.

16. National health care system
• Is managed by MoHP and is responsible for making necessary
arrangements and formulation of policies for effective delivery of:
Curative services.
Diseases prevention
Health promotion
Establishment of primary health care system.

17. Structure of health service delivery in Nepal:
In the federal structure, Nepalese health service has bee delivered
through chains of health care institutions organized into 3 tiers health
care delivery system. i.e. federal level, provincial level, and local level
health institutions.
Federal Government:
• Super specialized hospital
• At least one tertiary hospital in each province
• One academy of health sciences in each province.

18. Structure of health service delivery in Nepal Contd…
Provincial Level:
• Secondary hospital
• Provincial hospital
Local level Government:
• Basic health service center in each ward of local level
• Primary hospitals in each local level.

19. Health Governance:
At Center Level:
Ministry of health and Population: for policy and guidelines.
Department: health service, drug administration, and Ayurveda
Regulatory bodies: Nepal medical council, Nursing Council etc.
At Province level:
Ministry of social development: policy and guideline formation at
provincial level.
Health division: health training center, procurement and supply chain
management, health directorate, public health laboratory.

20. Health Governance Contd…….
At District level:
District (Public) health office: technical support to rural/municipality
and health facilities.
At municipality and rural Municipality level:
 rural/municipality general assembly: Planning, management and
approval of program.
Health unit: monitoring and conducting health programs.
HFMOC at ward Level: Local Level Planning.

22. Organogram and Reporting Mechanism of Nepalese Health System in Federal Context

26. Organogram of the health system at province
level:
Ministry of
social
Development
Health
Division
Provincial
Public health
Laboratory
Provincial
Health
Directorate
Provincial
Procurement
and supply
chain
management
Provincial
health
training
center

28. Organogram at district Level.
• In 32 district, health office is led by Senior/ administrator (9/10th
level).
• Includes eleven categories of staffs ( total 14 staffs including
statistician, driver and office staffs)
• In 25 district health office is led by senior/ public health officer
(7th/8th level).
• Including 1 categories of staffs ( total 12 staffs including statistician,
driver and office staffs)

29. The public Service Act, 2075 (2018)
Chapter-3
Relating to health system and management of service:
Operating and regulation of health institution :
1. The provision relating to level wise structure of the health
institutions and the services to be provided by such institution shall
be prescribed by the ministry.
2. Minimum standard relating to health institution and the service
shall be determined by the ministry.
3. Each health institution shall provide subject to the standards
referred to in sub section(2).

30. Operating and regulation of health institution :
4. The health institution established and in operation prior to the
commencement of this Act, shall fulfill the standard prescribed
pursuant to subsection (2) within the time specified by the ministry.
5. The federal, provincial and local levels may, in order to provide
service, carry out necessary partnership with private or non-
governmental health institutions.
6. The government of Nepal may determine the standard, license and
regulation of the service to be provided by the private and non-
governmental, private or cooperative, or non- profit- making or
community health institution by a notification in the Nepal Gazette,

31. Operating and regulation of health institution :
7. The federation, concerned province or local level may issue license
to operate any health institution pursuant to the standard determined
under sub- section(6).
8. The provisions relating to issuing license to any health institution
referred to in sub-section(7), and renewal thereof and carrying out
monitoring, evaluation and regulation of such a health institution shall
be accordance with the provincial and local law.
9. Not with standing anything contained in sub-section(8), the
provincial and local level may issue a license renew and carry out
monitoring and regulation of health institution under this act, until the
enactment of the provincial and local law.

32. SWOT Analysis of federal Health System of Nepal
Strengths:
• Local and creative approach
• bridge the persistent disparities between rural and urban health.
• Access to quality health care.
• Resources to all the people
• Optimum use of resources.
• Creating ideas sharing between all level governments

33. Weakness
• Lack of proper implementation,
• Proper coordination is lacking.
• Leakage and absence of optimum use of health resources.
• No proper bearing of responsibilities.
• HRH needs are not completed as per the new structure including
staffing.
• Lacking of accountability.
• Misuse of power( dispute within government for power).

34. Opportunities
• Establishment of effective PPP through clear partnership guidelines.
• Provides fertile ground for more effective budgeting and needs-based and
evidence-based planning.
• Empowerment of local level government to manage and provide quality
health services and to take ownership of the health programmes.
• Enhancement in service delivery i.e. local participation and accountability
in the process will push healthcare forward.
• Increasement financial resources for health from provincial and local
government.

35. Threats:
• Unstable political Situation.
• Difficult geographical terrain.
• New or increased competition
• Staff dissatisfaction.
• Political disconnect between local and state governmental
authorities.
• Lack of regulatory clarity surrounding legal and antitrust issues.

36. Conclusion
• Federalism is an important opportunity for Nepal to achieve UHC.
• Enacting it in the health sector must be backed by legislation and
quality standards, along with sound financing, logistics, human
resources, and an emphasis on empowering and capacitating local
and provincial governments through strengthening leadership and
governance mechanisms.

37. Conclusion contd..
• This context, federalism and resulting increases in healthcare
accessibility and financing options present a strong prospect to
strengthen the health system in Nepal.
• Effective coordination and communication channels plays an
important role in between different level of government for ensuring
the provision of basic health services, increasing population coverage
in health insurance and other social security measures and in
providing quality and equitable health service.

38. References:
• https://kathmandupost.com/columns/2019/12/15/health-systems-in-federal-nepal-challenges-
and-opportunities
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499910/
• https://publichealthupdate.com/organogram-and-reporting-mechanism-of-nepalese-health-
system-in-federal-context/
• https://www.external-democracy-promotion.eu/the-new-federal-structure-in-nepal-challenges-
and-opportunities-for-quality-governance/
• http://www.slideshare.net/kishooami/health-system-of-Nepal-
229030068?from_m_app=android
• http://www.slideshare.net/sonalishah51/sonali-shah?from_m_app=android
• http://www.slideshare.net/JahirHussein/current-health-system-nepal-after-health-reform-
2018?from_m_app=android

39. You are those person
without whom this
program could not be
conducted.
Thank you so much for
coming for us.
We are extremely grateful.

40. Any
Questions ?