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Decentralization in Nepal
As decentralization takes on a high profile in overall governance reform and Nepal’s national development initiatives, the NHSP -1 recognized decentralization of health services as one of the overarching sector reform strategies and a key approach to achieving the MDGs. The Interim Constitution of Nepal, 2007, which represents the spirit of Jana Andolan II and the road map toward sustaining peace in Nepal, shows clear commitment of the state towards a more decentralized system of governance. The Interim Constitution guarantees basic health as a fundamental human right of the citizens of Nepal and the recently shared draft report of CA Committees further elaborated the existing provisions and prepared specific provisions to be included in the new constitution. These constitutional provisions created a ground for the next phase of health sector reform in Nepal and decentralized governance underlies it. It is widely recognized in the health sector that decentralized health management helps to the health sector that decentralized health management helps to improve health service delivery with increased level of downward accountability, community ownership and wider coverage giving better access to local people, especially the poor and excluded groups. The broad objective underlying decentralization is to bring government closer to the people with the view to empower them and to make service delivery more effective, efficient and equitable. The Local Self-Governance Act (LSGA), 1999, has given authority to the local bodies (Village Development Committees (VDC), municipalities, and District Development Committees (DDCs)) to operate and manage health institutions at local level. However, due to absence of elected officials in these institutions sine mid-July 2002, implementation of the Act has remained ineffective. The following are the key issues related to dentralisation and local governance in the health sector in Nepal.
- Weak community participation and local health governance
- Centralized planning and budgeting practices, and weak planning linkage
- Weak downward accountability and local ownership
- Transparency and fiduciary risk