Health Federalism: The Role of Health Care Professionals in Nepal

Abstract

Nepal has entered from its unitary system into a new “Federal Democratic Republic State.†The
current constitution presents basic health care services as a fundamental right.The Ministry for Health
and Population has been providing resources to meet health demands, but managers are wrestling
to meet these demands. Persistent disparities between rural and urban and across regions resulted
inferior health outcomes e.g. life expectancy in an urban district like Bhaktapur is 71 years, whereas
in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past
systems prompted people to seek a different model. Ultimately, all political parties except one have
agreed on federalism. The exact number of federal states that are going to be created is unknown. In
federalism, all federated states have to assume certain relationships between the locality, the region,
and the nation that apply not only in politics but in health care too. Managing changes in health care
organization during the transitional period and after restructuring the unitary Nepal into federal
states should be carefully planned. In case, if new system also fails to deliver necessary health care
services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be
ignored. In order to outline a structure and give life to a health care system under federalism, health
care professionals need to engage themselves seriously.
Key Words: disintegration, disparities, federalism, health care, life expectancy