After federalism, health services in Nepal are shared by three levels of government. Knowing who runs what helps you in the exam and in the job, because you will report to and work with all three.
Who does what
| Level | Main bodies | Main responsibilities |
|---|---|---|
| Federal | Ministry of Health and Population, Department of Health Services, Department of Ayurveda, Department of Drug Administration | National policy, standards and laws, specialised and teaching hospitals, vaccines and some central procurement, disease control programmes |
| Province | Province Ministry of Health (in Koshi, the Ministry of Health), Health Directorate, Health Supply Management Centre, Public Health Laboratory | Province hospitals, supervision of districts, supply chain, province-level programmes and data |
| Local | Health section of the rural municipality or municipality | Health posts, basic health service centres, community and urban health units, basic hospitals, immunisation, FCHVs |
The service chain
- Community: Female Community Health Volunteers (FCHVs) and outreach clinics.
- Health post / basic health service centre: first contact for most people; antenatal care, delivery in birthing centres, immunisation, family planning, common illnesses.
- Basic hospital (local) and primary hospitals: more beds and basic surgery.
- Province and general hospitals: specialist care, for example Koshi Hospital in Biratnagar.
- Federal and specialised hospitals: tertiary and teaching hospitals such as B.P. Koirala Institute of Health Sciences in Dharan.
Patients should move up this chain through referral, which also matters for health insurance claims.
Why this matters for AHW and ANM staff
Most AHWs and ANMs work at health posts run by local levels, follow national protocols set by the federation, and receive medicines and supervision through the province. Knowing this three-way link is useful in interviews.
Memory tip: “Federal makes rules, province supplies and supervises, local delivers.”
Practice questions
Health posts are managed by:
- a) the federal government
- b) the province government
- c) local levels
- d) the District Administration Office
Show answer
Answer: c. Basic health is a local level power under Schedule 8.
B.P. Koirala Institute of Health Sciences is in:
- a) Biratnagar
- b) Itahari
- c) Dharan
- d) Dhankuta
Show answer
Answer: c. Dharan, Sunsari.
Community health work at household level is mainly done by:
- a) FCHVs
- b) CIAA staff
- c) ward police
- d) teachers
Show answer
Answer: b. Female Community Health Volunteers.