Law & Legal Studies

The Makwanpur Model: Making Public Healthcare in Nepal Work

Administrative decentralization is helping advance Nepal’s public healthcare & significantly improve its delivery across districts, argue Harsh Mahaseth of JGU and his co-author


Harsh Mahaseth, Lecturer at Jindal Global Law School, Faculty Coordinator for JGU Pro Bono Publicus, and a Research Analyst at Center for Southeast Asian Studies, Jindal School of International Affairs (JSIA), O.P. Jindal Global University, Sonipat, Haryana, India

Chitij Karki has recently completed his MBBS from KIST Medical College and Teaching Hospital, Nepal


March 11, 2017 marked a turning point in the administrative structure of the Nepalese government. The Constitution of Nepal, which had been promulgated in 2015, mandated political decentralization through federalism. Under the previous unitary system, political power had been concentrated in the national capital of Kathmandu. Now, in addition to the federal government in Kathmandu, two other tiers of government were added; the seven provincial governments and the 3,157 former village development committees were consolidated into 744 local units. The local governments’ role was significantly expanded with the intention of giving the nooks and crannies of the nation greater administrative autonomy through increased resource-sharing among the various tiers of the government.

A year later, in 2018, the district of Makwanpur made a landmark decision in Nepalese public health administration when it handed over control of the district’s 41 health posts and four primary health centers to its respective municipalities. This head-start in the federalization of the public health sector provided us with a window into this new administrative model’s challenges and opportunities. The Nepal government plans to expand universal health coverage (UHC), so we visited a municipality in this district recently to see whether this new-fledged approach is going to bring the district closer to the goal of UHC.

Published in: The Diplomat

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