Public Health Life at the crossroads in federal Nepal.

The country is experiencing a massive epidemiological transition of public health in Nepal. The country is facing the burden of non-communicable diseases (NCDs) amidst a highly fragmented federal administration and a multitude of communicable diseases. Nepal made impressive progress in the maternal and child health indicators over the past 30 years. However, a structural paradox has emerged in which the clinical efficacy of the growing programs of interventions is now being jeopardised by considerable financial weaknesses, particularly increased out-of-pocket (OOP) expenses. The structural integrity of the healthcare system in Nepal is summarised in this paper. This paper identifies some of the most important governance gaps such as multi-role conflict of interest in the Ministry of Health and Population (MoHP), shrinking the allocation of health budget for the domestic health team (4.77%) and under-investment in the mental health infrastructure with health team as a passive buyer. When translated into a SWOT framework, we see that achieving the target of protecting the constitutionally guaranteed right to health requires some degree of conscious separation of the policy and provider functions, robust fiscal commitments and a rapid shift towards more preventive care and strategic procurement.