Kuikel Bihari Sharan, Shrestha Archana, Xu Dong Roman, Shahi Brish Bahadur, Bhandari Bakhat, Mishra Ravi Kanta, Bhattrai Navaraj, Acharya Kiran, Timalsina Ashish, Dangaura Nripa Raj, Adhikari Bikram, Dhital Rabin, Karmacharya Biraj Man
Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Institute for Implementation Science and Health, Kathmandu, Nepal.
Dialogues Health. 2023 Dec;3:100142. doi: 10.1016/j.dialog.2023.100142. Epub 2023 Jun 10.
Nepal moved from a unitary government to a federal system of government in 2015 under its constitution. Nepal is a federal democratic republic governed by three levels of government: a federal, provincial, and local level. The response to COVID-19 in Nepal has been majorly led and controlled by the federal government. All three levels of government are performing their responsibilities; however, they face various challenges in responding to COVID-19. This study aimed to critically analyze Nepal's health system in the context of the COVID-19 response.
We conducted semi-structured in-depth interviews by telephone among the policymakers, health workers, and stakeholders at the federal, provincial, and local levels ( = 41) between January to July 2021. The interviews were audio recorded, transcribed into English, and coded using inductive-deductive approaches.
COVID-19 considerably impacted routine health care, mainly maternity services and immunization. Inadequate financial resources, inadequate human resources, and the lack of ventilators, ICUs, and X-ray services were the significant challenges in tackling and managing COVID-19 effectively.
The study found that all three levels of government perform their roles and responsibilities and effectively manage the pandemic. The federal and provincial governments focused more on the plans and policy development, while the local government demonstrated greater accountability in implementing those plans and policies. Therefore, all three tiers of government need to coordinate together for preparing and communicating information in times of emergency. Besides, it is imperative to empower local governments to maintain Nepal's federal health system.
2015年，尼泊尔根据其宪法从单一制政府转变为联邦制政府。尼泊尔是一个联邦民主共和国，由三级政府治理：联邦、省和地方。尼泊尔对新冠疫情的应对主要由联邦政府主导和控制。三级政府都在履行各自职责；然而，它们在应对新冠疫情时面临各种挑战。本研究旨在在新冠疫情应对背景下对尼泊尔的卫生系统进行批判性分析。
2021年1月至7月期间，我们通过电话对联邦、省和地方各级的政策制定者、卫生工作者和利益相关者（n = 41）进行了半结构化深入访谈。访谈进行了录音，转录成英文，并采用归纳-演绎法进行编码。
新冠疫情对常规医疗保健产生了重大影响，主要是孕产妇服务和免疫接种。财政资源不足、人力资源不足以及缺乏呼吸机、重症监护病房和X光服务是有效应对和管理新冠疫情的重大挑战。
研究发现，三级政府都履行了各自的角色和职责，并有效管理了疫情。联邦和省级政府更多地关注计划和政策制定，而地方政府在实施这些计划和政策方面表现出了更大的责任感。因此，三级政府需要共同协调，以便在紧急情况下准备和传达信息。此外，赋予地方政府权力对于维持尼泊尔的联邦卫生系统至关重要。
