Governance challenges in the Nepalese primary health care system: time to focus on greater community engagement?

Nepal has seen impressive recent health gains through a successful community-based health program. However, governance challenges remain within the Nepalese primary health care system that include under-staffing and absenteeism, limited health facility opening hours, poor supervision and monitoring, and insufficient financial management. We propose that these be addressed through expanded community engagement and a power shift towards local communities, enhancing skills of community representatives in co-managing health facilities and of service providers to effectively engage the community, increased quality of community participation, and improved documentation of the process and impact of engagement on health outcomes. Copyright © 2015 John Wiley & Sons, Ltd.