How Nepali Politics Collapsed the Health System l A Critical Analysis

How Nepali Politics Collapsed the Health System l A Critical Analysis

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  CRITICAL ANALYSIS HowNepaliPolitics CollapsedtheHealthSystem A CriticalAnalysis for Health Academicians and Researchers school Health Academicians medical_services Health Workers search Researchers PHC-Nepal January 2026
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  ExecutiveSummary This presentation criticallyexamines how Nepali politics has systematically collapsed the healthcare system through decades of instability, governance failures, and misplaced priorities. crisis_alert Political Instability 1996-2006 civil war, constant regime changes account_balance Federalization Crisis 2015 constitutional shift created coordination gaps coronavirus COVID-19 Failure Government prioritized politics over pandemic response groups Workforce Crisis 26.6% vacancies, 62.1% physician shortage payments Financing Gaps 54.2% out-of-pocket payments, insurance enrollment 21.4% trending_down System Collapse Health system facing imminent collapse KeyImpact 0to 8,520 COVID-19 cases in 2 months (Mar-May 2021) 4,000 Doctors on nationwide strike (2014) 60.2years Healthy life expectancy (2021) PHC-Nepal
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  Nepal'sHealthSystem:HistoricalEvolution From centralized todecentralized: Nepal's health system has undergone multiple transformations, each shaped by political decisions and policies. 1975 flag First Long-Term Health Plan Expanded primary healthcare to rural areas 1990 location_city Local Health Service Structure Nationwide network at Village Development Committee level 2007 verified Free Basic Healthcare Fundamental right established in Interim Constitution 2015 account_balance Federal Constitution Health as fundamental right, three-tier governance established 2019 description National Health Policy 2019 Focus on universal health coverage and quality services SystemStructure Federal Level Policy formulation, national standards, specialized care Provincial Level Basic hospital services, coordination with federal/local Local Level Primary health services, community health programs PHC-Nepal
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  PoliticalInstabilityTimeline Nepal's political turmoilhas systematically undermined healthcare development over decades of conflict and transition. 1996-2006 CIVIL WAR ERA warning Maoist Insurgency Decade-long conflict disrupted all public services 8,000+deaths 2006-2015 TRANSITION PERIOD autorenew Interim Government Political stalemate hindered health system development 2015-2020 FEDERALIZATION account_tree Constitutional Restructuring Transition to federal system created implementation gaps 2020-2026 CRISIS DEEPENS trending_down COVID-19 & Governance Failures Political instability resurged during pandemic ImpactonHealthSystem cancel Disrupted Planning Health policies delayed or changed attach_money Funding Gaps Inconsistent budget allocations sync_problem Coordination Failures Fragmented health service delivery people_outline Workforce Drain Health worker migration increased local_hospital Infrastructure Neglect Delayed facility upgrades and maintenance PHC-Nepal
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  The2015Constitution&Federalization gavel PoliticalRestructuring Nepal's constitutiontransitioned from unitary to federal system, fundamentally restructuring health governance. verified_user Health as Fundamental Right Every citizen has right to free basic health services emergency Emergency Care Guarantee No one shall be deprived of emergency healthcare account_balance Three-Tier Governance Federal, provincial, and local governments AdministrativeStructure Provincial Level 7provinces Basic hospital services and coordination Local Level 753governments Primary health services delivery Federal Level policy Policy formulation and national standards Budget allocation • Regulatory frameworks • Specialized care PHC-Nepal
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  FederalHealthSystemStructure Three-TierGovernance Source: Journal ofHealth Policy and Planning account_balance Federal Government Policy & Standards check_circle Policy formulation check_circle Budget allocation check_circle National standards check_circle Specialized hospitals location_city Provincial Governments 7 Provinces check_circle Basic hospital services check_circle Coordination role home Local Governments 753 Municipalities check_circle Primary health services check_circle Community programs PHC-Nepal
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  ImpactofFederalizationonHealthSystem The transition tofederalism created significant operational challenges that have hampered health service delivery. sync_problem Poor Coordination Communication gaps between federal, provincial, and local governments schedule Delayed Funds Release Budget delays hamper timely service delivery and procurement people Staff Maldistribution Unequal workforce distribution across regions and facilities shopping_cart Procurement Problems Complex and delayed procurement processes for medicines and supplies visibility_off Limited Supervision Weak monitoring of service quality and data reporting SystemicIssues help_outline Confusion Over Mandates Unclear roles and responsibilities between governance tiers call_split Fragmented Reporting Multiple reporting lines create accountability gaps trending_down Implementation Lag Policies formulated but not effectively executed at local level PHC-Nepal
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  COVID-19Crisis:TheTippingPoint DevastatingSurge Patient receiving oxygenduring second wave (2021) March 10, 2021 0 Deaths 337 Cases May 14, 2021 203 Deaths 8,520 Cases Vaccination Rate 1.86% By May 18, 2021 vaccines warning System Collapse Health system at imminent risk of total failure PHC-Nepal
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  PoliticalDecisionsDuringCOVID-19 While cases surged,politicians prioritized power politics over pandemic containment. groups Political Rallies Mass gatherings organized despite rising infection rates campaign Inauguration Ceremonies PM and cabinet ministers traversed country for project launches account_balance Parliament Dissolution May 2021 - President dissolved parliament for elections festival Festivals Allowed Jatras proceeded, became super-spreader events celebration Kumbh Mela Attendance 100,000+ Nepalese attended religious gathering in India LeadershipFailure campaign "Under Control" Statement Prime minister reassured international community pandemic was "under control" without scientific evidence priority_high Political Priorities check_circle Intra-party power struggles check_circle Show of strength rallies check_circle Public image over public health crisis_alert Result Exponential spread, health system overwhelmed PHC-Nepal
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  HealthWorkforceCrisis Nepal faces severeshortage and maldistribution of healthcare professionals across all levels. Overall Vacancy Rate 26.6% Healthcare positions empty 2021 Data Physician Vacancy 62.1% Doctors vacant 2021 Data school Lack of Trained Staff Health facilities lack trained personnel for specialized services description Missing Protocols Lack of service-specific protocols and national standards NurseExodus trending_down High Unemployment Qualified nurses face significant unemployment rates in Nepal flight_takeoff Overseas Migration Nurses seek employment opportunities abroad due to lack of local positions warning Brain Drain Impact Loss of skilled healthcare workers exacerbates crisis PHC-Nepal
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  HealthWorkerProtests 2014NationwideStrike 4,000 Doctors participated location_on Patients forcedto seek distant services 2023Protests dangerous Workplace violence against health workers gavel Corruption in medical institutions business Privatization without regulation payments Low wages and pandemic allowance delays policy 2022 Ordinance Safety and Security of Health Workers Ordinance introduced error Weak Enforcement Violence continued despite ordinance PHC-Nepal
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  HealthcareFinancingChallenges Out-of-Pocket Payments 54.2% Of healthcareexpenditure 2019/20 Data Insurance Enrollment 21.4% Population covered 2022 Data InsuranceProgramIssues trending_down High dropout rates of enrollees and providers autorenew Low renewal of premiums schedule Delayed or inadequate reimbursement to facilities people Inadequate workforce participation sentiment_dissatisfied Low-quality care for beneficiaries FinancingStructure account_balance_wallet High Out-of-Pocket Burden Catastrophic health expenditure risks for vulnerable populations PHC-Nepal
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  InfrastructureDeficits Nepal's healthcare systemfaces critical shortages of essential medical infrastructure and supplies. local_hotel Hospital Beds Acute shortage air Ventilators Insufficient supply gas_meter Medical Oxygen Ran out during second wave medication Essential Medicines Frequent shortages masks PPE Limited availability biotech Test Kits Inadequate stock vaccines Vaccines Limited supply medical_services Emergency Care Unable to respond warning Infrastructure Collapse Health facilities lack resources to save lives PHC-Nepal
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  GovernanceFailures Systemic governance weaknesseshave undermined health system performance and service delivery. policy Weak Implementation Policies formulated but not executed effectively at local level account_balance Poor Accountability Lack of mechanisms to ensure responsibility for outcomes schedule Procurement Delays Slow and complex procurement processes for medicines and supplies sync_problem Coordination Gaps Poor communication between federal, provincial, and local governments help_outline Confusion Over Mandates arrow_forward Unclear roles and responsibilities arrow_forward Multiple reporting lines arrow_forward Lack of clear authority arrow_forward Overlap in responsibilities SystemicIssues crisis_alert Implementation Lag Policies remain on paper without translation into practice at local level visibility_off Limited Supervision Weak monitoring mechanisms for service quality and data reporting block Accountability Gap No clear responsibility assignment for health outcomes and failures error_outline Governance Collapse System unable to deliver essential health services PHC-Nepal
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  CorruptionandPrivatization Political interference andcorrupt practices have eroded trust in healthcare institutions and compromised service delivery. gavel Political Interference Political appointments and influence in medical institutions shopping_cart Procurement Corruption Corrupt practices in medicine and equipment procurement business_center Hiring Irregularities Corrupt hiring processes bypassing merit-based selection domain Unregulated Privatization Private sector expansion without proper regulation crisis_alert Health Worker Frustration arrow_forward Politicization driving tensions arrow_forward Corruption undermining trust arrow_forward Public-private sector conflicts arrow_forward Justice denied to workers SystemicImpact trending_down Erosion of Public Trust Loss of confidence in healthcare institutions due to corrupt practices local_hospital Service Quality Decline Compromised care due to corruption and unregulated privatization groups Worker Demoralization Health professionals frustrated by political interference and injustice error_outline Systemic Collapse Corruption destroying healthcare integrity PHC-Nepal
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  HealthOutcomes Nepal's health outcomesreflect both progress and challenges exacerbated by political instability. trending_up Healthy Life Expectancy 60.2years Improved 4.15 years since 2000 elderly Population Aging 5.8%2019 Expected to reach 7.1% by 2030 Leading Causes of Death (2021) arrow_forward 55% Non-communicable diseases arrow_forward 31% Communicable, maternal, perinatal, nutritional Chronic Disease Burden favorite Cardiovascular disease (top cause) air Chronic obstructive pulmonary disease HealthChallenges accessibility_new Aging Population Increasing elderly population demands chronic care services medical_services Health System Strain Collapsed infrastructure unable to meet growing demand monetization_on Financial Burden High out-of-pocket payments exacerbate poverty warning Crisis Looming Health system at breaking point PHC-Nepal
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  CaseStudy:OxygenShortage Tragic Reality A commonoccurrence during Nepal's second COVID-19 wave 1 Initial Isolation 38-year-old COVID-positive patient isolated at home with mild symptoms 2 Deterioration Pulse oximetry dropped to 88% on room air, shortness of breath developed 3 Hospital Admission Hospital bed found after hours of searching, received supplemental oxygen and medicines 4 Critical Shortage Two days after admission, hospital ran out of medical oxygen 5 Desperate Search Family and friends frantically searched for oxygen cylinders but found none warning Fatal Outcome Patient took his last breath gasping, a day after oxygen ran out crisis_alert System Failure Political negligence led to preventable deaths during the second wave PHC-Nepal
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  AlternativeHealthcareSolutions Strategic alternative deliveryarrangements can improve system sustainability and extend care access. people Task Shifting & Role Expansion check_circle Hypertension management check_circle Maternal-child health check_circle Infectious diseases check_circle Abortion care services check_circle Mental health support check_circle Chronic disease care videocam Telemedicine & Digital Health Leverage technology to extend reach to remote areas and reduce facility burden health_and_safety Community Workers Lay health workers at community level medical_services Mid-level Providers Underutilized nursing workforce account_tree Care Pathways Case management models ProvenStrategies verified Integrated Childhood Illness Management Successfully reduced maternal, neonatal, and child mortality verified Task Shifting to Lay Workers Effective for childbearing women and sick children lightbulb Cost-Effectiveness Needed Urgent need for evaluation data in Nepali context warning Implementation Gap Many promising models exist but remain unevaluated in low- income countries PHC-Nepal
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  RecommendationsforReform Urgent structural reformsare needed to rebuild Nepal's collapsed health system. gavel Strengthen Governance Accountability mechanisms and policy implementation hub Improve Coordination Between federal, provincial, and local governments payments Prioritize Funding Increase and allocate adequate health budget groups Workforce Retention Competitive salaries and safe working conditions medical_services Alternative Models Task shifting and telemedicine implementation shopping_cart Procurement Reform Efficient and transparent procurement processes verified_user Enforce Safety Ordinances Protect health workers from violence and ensure their safety PathForward arrow_forward Political Will All parties must unite for health system reform arrow_forward Implementation Policies must be translated into practice arrow_forward Monitoring Strong accountability mechanisms needed arrow_forward Innovation Embrace alternative healthcare delivery models PHC-Nepal
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  References 1 Sony, K.C.et al. (2025). Claiming justice in the health sector of Nepal: Exploring causes and consequences of protests among health care workers. PMC12206042 2 Wasti, S.P. et al. (2023). Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks. PMC10621174 3 Rai, P. et al. (2024). Healthcare System Sustainability Challenges in Nepal and Opportunities Offered by Alternative Healthcare Delivery Arrangements. PMC11261549 4 Adhikari, B. et al. (2021). COVID-19 crisis in Nepal: A case of systems and governance failure in a low-income country. Journal of Global Health Economics and Policy 5 World Health Organization (2022). WHO Data for Nepal. Available at: data.who.int/countries/524 6 New ERA & Ministry of Health and Population (2022). Nepal Demographic and Health Survey 2022. DHS Program AdditionalSources public World Bank Health Indicators Physicians per 1000 population, hospital beds per 1000, nurses and midwives data assessment Nepal In Data Comprehensive health statistics and indicators database school Bournemouth University Federalisation effects on Nepal's health system research health_and_safety Frontiers in Public Health National Health Policy and factors predicting its implementation medical_services Global Health: Science and Practice Health financing and expenditure studies in Nepal PHC-Nepal