How is Nepal’s move to federalism impacting on the health system? New research project launches.

On April 1st, a major new collaborative project launched examining the consequences for the health system of Nepal’s move to a federal government structure.

SCHARR Regent Court building and courtyard

The three-year project is UK-funded by the MRC, Wellcome Trust and DFID under the Health Systems Research Initiative.

The project is collaboration between researchers at the Universities of Sheffield, Bournemouth and Huddersfield in the UK and the Manmohan Memorial Institute of Health Science and PHASE Nepal in Kathmandu. Jointly led by Dr. Simon Rushton and Dr. Julie Balen at the University of Sheffield, it brings together an interdisciplinary team including experts in public health, health systems, law, health economics, politics and policy, sociology, and medicine. 

Over the next three years, our team will work with stakeholders at all levels of the health system, from the federal Ministry down to the village-level Female Community Health Volunteers who are on the frontline of health service delivery in rural areas. Together we will help identify good practices and implementation challenges in moving to a federal system.

Nepal’s move to a federal system is a result of major constitutional and political changes. The 2015 Constitution heralded a complete restructuring of the country's political system, creating a Federal Republic with significant devolution of power and resources from the central government to seven newly-created Provinces, each with its own legislature.

The new Constitution brings about significant changes in the health system. Nepal's national health system has historically been unitary and centralised, with the Ministry of Health and Population providing the resources and directing health services for the entire country through district health offices. The new Constitution shifts primary responsibility for health service provision to the seven new Provincial governments, with significant powers and responsibilities being further devolved to Municipalities/Rural Municipalities, giving very little power to the pre-existing district health offices. All of this has put Nepal's health system in a period of rapid, and far-reaching, transformational change, which this project aims to understand and capture in real-time. The project aims to identify areas of good practice and spread these around the country. 

The project will employ several researchers in Nepal through the Manmohan Memorial Institute of Health Sciences and PHASE Nepal. As a result of the current COVID-19 crisis, data collection is currently scheduled to start in late 2020.

For further information on the project, contact Dr. Simon Rushton ( and Dr. Julie Balen (

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