{"id":2660,"date":"2026-07-08T09:50:11","date_gmt":"2026-07-08T08:50:11","guid":{"rendered":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/?p=2660"},"modified":"2026-07-08T09:51:49","modified_gmt":"2026-07-08T08:51:49","slug":"study-finds-decentralisation-strengthens-community-health-governance-in-nepal","status":"publish","type":"post","link":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/","title":{"rendered":"Study finds decentralisation strengthens community health governance in Nepal\u00a0"},"content":{"rendered":"<p class=\"wp-block-paragraph\"><em>Decentralisation can strengthen community health, but only if local governments have the power and resources to lead.<\/em>\u00a0<\/p>\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" src=\"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2026\/07\/Roosa-s.jpg\" alt=\"\" class=\"wp-image-2662\" \/><\/figure>\n<p class=\"wp-block-paragraph\">For more than three decades, Nepal&#8217;s Female Community Health Volunteers (FCHVs) have been the backbone of primary health care, connecting families with essential maternal, child and community health services. When Nepal adopted a federal system in 2015, responsibility for managing these volunteers shifted from the national government to local municipalities. The expectation was clear: bringing decision-making closer to communities would create more responsive, accountable and effective community health services.&nbsp;<\/p>\n<p class=\"wp-block-paragraph\">The study published in <a href=\"https:\/\/academic.oup.com\/heapol\/article\/41\/Supplement_1\/i17\/8715292\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Health Policy and Planning<\/em><\/a> examined how the governance of Nepal\u2019s main Community Health Workers (CHW) cadre, the female community health volunteers (FCHVs), has been impacted by the country\u2019s transition towards federalism in 2015.&nbsp;<\/p>\n<p class=\"wp-block-paragraph\">Using&nbsp;extensive document analysis of&nbsp;259 documents&nbsp;and interviews,&nbsp;focus groups&nbsp;with policymakers,&nbsp;health managers, community health workers and development partners across Nepal, researchers assessed how federalisation has changed the governance of the country&#8217;s community health workforce.&nbsp;&nbsp;<\/p>\n<p class=\"wp-block-paragraph\">The study found that federalism has strengthened several aspects of governance. Local governments are better positioned to understand community needs and have greater opportunities to adapt volunteer incentives and service delivery to local priorities. Stakeholders also reported improvements in participation, transparency, accountability and responsiveness compared with the previous more centralised system.&nbsp;<\/p>\n<p class=\"wp-block-paragraph\">However, the research also shows that federalisation remains incomplete.&nbsp;<\/p>\n<p class=\"wp-block-paragraph\">Although municipalities are now responsible for managing community health programmes, during year 5 after the federal transition, municipalities often lacked the authority, financial autonomy and institutional capacity needed to carry out these responsibilities effectively. Much of the funding continues to come through conditional grants from the federal government, limiting local flexibility. Roles and responsibilities between federal, provincial and municipal governments remain unclear in some areas, while coordination across different levels of government continues to present challenges. Enforcement of national policies, monitoring systems and leadership capacity also vary considerably between municipalities.&nbsp;<\/p>\n<p class=\"wp-block-paragraph\">The researchers argue that these findings reflect an important lesson for countries pursuing decentralisation. Simply transferring responsibilities to local governments through Constitutional stipulations is not enough. Decentralisation must be accompanied by genuine decision-making authority, sustainable financing, clear institutional roles and investment in local leadership and management capacity. Without these, local governments cannot fully realise the benefits that decentralisation is intended to deliver.&nbsp;<\/p>\n<p class=\"wp-block-paragraph\">The study also highlights the importance of including community health workers themselves in governance processes. While donors, NGOs and government agencies often participate in decision-making, FCHVs and their representative organisations are not consistently consulted, despite being central to delivering frontline services. Greater participation from community health workers could strengthen policy decisions and improve programme implementation.\u00a0<\/p>\n<p class=\"wp-block-paragraph\">As many low- and middle-income countries continue to strengthen community health systems and pursue decentralised governance, Nepal&#8217;s experience offers valuable lessons. Federal reforms have created stronger foundations for responsive local health governance, but achieving their full potential will require continued investment in local capacity alongside greater fiscal and administrative autonomy.&nbsp;<\/p>\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.ntnu.edu\/employees\/roosa.s.tikkanen\" target=\"_blank\" rel=\"noreferrer noopener\">Roosa Sofia Tikkanen<\/a>, first author of the paper, said: \u201cOur research shows that federalism has improved how community health workers are governed, but unclear roles across different levels of government reduce accountability.\u201d\u00a0<\/p>\n<p class=\"wp-block-paragraph\">The researchers conclude that empowering municipalities while easing unnecessary central control will be essential if Nepal is to achieve its constitutional goals of universal access to healthcare and good governance. These lessons extend beyond Nepal, offering practical insights for policymakers seeking to build resilient, locally accountable community health systems.\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Decentralisation can strengthen community health, but only if local governments have the power and resources&#8230;<\/p>\n","protected":false},"author":919,"featured_media":2664,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2660","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","odd"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Study finds decentralisation strengthens community health governance in Nepal\u00a0 - Health Policy and Planning Debated<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Study finds decentralisation strengthens community health governance in Nepal\u00a0 - Health Policy and Planning Debated\" \/>\n<meta property=\"og:description\" content=\"Decentralisation can strengthen community health, but only if local governments have the power and resources...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/\" \/>\n<meta property=\"og:site_name\" content=\"Health Policy and Planning Debated\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-08T08:50:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-08T08:51:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2026\/07\/rt_small.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"2153\" \/>\n\t<meta property=\"og:image:height\" content=\"2552\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"lshmj24\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"lshmj24\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/\"},\"author\":{\"name\":\"lshmj24\",\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/#\\\/schema\\\/person\\\/2a6a2082bb464908598817f3748b834b\"},\"headline\":\"Study finds decentralisation strengthens community health governance in Nepal\u00a0\",\"datePublished\":\"2026-07-08T08:50:11+00:00\",\"dateModified\":\"2026-07-08T08:51:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/\"},\"wordCount\":583,\"image\":{\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/files\\\/2026\\\/07\\\/rt_small.jpg\",\"articleSection\":[\"Uncategorized\"],\"inLanguage\":\"en-GB\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/\",\"url\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/\",\"name\":\"Study finds decentralisation strengthens community health governance in Nepal\u00a0 - Health Policy and Planning Debated\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/files\\\/2026\\\/07\\\/rt_small.jpg\",\"datePublished\":\"2026-07-08T08:50:11+00:00\",\"dateModified\":\"2026-07-08T08:51:49+00:00\",\"author\":{\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/#\\\/schema\\\/person\\\/2a6a2082bb464908598817f3748b834b\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/2026\\\/07\\\/08\\\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/files\\\/2026\\\/07\\\/rt_small.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/files\\\/2026\\\/07\\\/rt_small.jpg\",\"width\":2153,\"height\":2552},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/#website\",\"url\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/\",\"name\":\"Health Policy and Planning Debated\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/#\\\/schema\\\/person\\\/2a6a2082bb464908598817f3748b834b\",\"name\":\"lshmj24\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/f21ec90bcb4ad6079bd96e6bdf405506007b94358cdc740babdbb9633795b168?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/f21ec90bcb4ad6079bd96e6bdf405506007b94358cdc740babdbb9633795b168?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/f21ec90bcb4ad6079bd96e6bdf405506007b94358cdc740babdbb9633795b168?s=96&d=mm&r=g\",\"caption\":\"lshmj24\"},\"url\":\"https:\\\/\\\/blogs.lshtm.ac.uk\\\/hppdebated\\\/author\\\/lshmj24\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Study finds decentralisation strengthens community health governance in Nepal\u00a0 - Health Policy and Planning Debated","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/","og_locale":"en_GB","og_type":"article","og_title":"Study finds decentralisation strengthens community health governance in Nepal\u00a0 - Health Policy and Planning Debated","og_description":"Decentralisation can strengthen community health, but only if local governments have the power and resources...","og_url":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/","og_site_name":"Health Policy and Planning Debated","article_published_time":"2026-07-08T08:50:11+00:00","article_modified_time":"2026-07-08T08:51:49+00:00","og_image":[{"width":2153,"height":2552,"url":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2026\/07\/rt_small.jpg","type":"image\/jpeg"}],"author":"lshmj24","twitter_misc":{"Written by":"lshmj24","Estimated reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/#article","isPartOf":{"@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/"},"author":{"name":"lshmj24","@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/#\/schema\/person\/2a6a2082bb464908598817f3748b834b"},"headline":"Study finds decentralisation strengthens community health governance in Nepal\u00a0","datePublished":"2026-07-08T08:50:11+00:00","dateModified":"2026-07-08T08:51:49+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/"},"wordCount":583,"image":{"@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2026\/07\/rt_small.jpg","articleSection":["Uncategorized"],"inLanguage":"en-GB"},{"@type":"WebPage","@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/","url":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/","name":"Study finds decentralisation strengthens community health governance in Nepal\u00a0 - Health Policy and Planning Debated","isPartOf":{"@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/#primaryimage"},"image":{"@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2026\/07\/rt_small.jpg","datePublished":"2026-07-08T08:50:11+00:00","dateModified":"2026-07-08T08:51:49+00:00","author":{"@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/#\/schema\/person\/2a6a2082bb464908598817f3748b834b"},"inLanguage":"en-GB","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/"]}]},{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2026\/07\/08\/study-finds-decentralisation-strengthens-community-health-governance-in-nepal\/#primaryimage","url":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2026\/07\/rt_small.jpg","contentUrl":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/files\/2026\/07\/rt_small.jpg","width":2153,"height":2552},{"@type":"WebSite","@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/#website","url":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/","name":"Health Policy and Planning Debated","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-GB"},{"@type":"Person","@id":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/#\/schema\/person\/2a6a2082bb464908598817f3748b834b","name":"lshmj24","image":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/secure.gravatar.com\/avatar\/f21ec90bcb4ad6079bd96e6bdf405506007b94358cdc740babdbb9633795b168?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/f21ec90bcb4ad6079bd96e6bdf405506007b94358cdc740babdbb9633795b168?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/f21ec90bcb4ad6079bd96e6bdf405506007b94358cdc740babdbb9633795b168?s=96&d=mm&r=g","caption":"lshmj24"},"url":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/author\/lshmj24\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/posts\/2660","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/users\/919"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/comments?post=2660"}],"version-history":[{"count":1,"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/posts\/2660\/revisions"}],"predecessor-version":[{"id":2663,"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/posts\/2660\/revisions\/2663"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/media\/2664"}],"wp:attachment":[{"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/media?parent=2660"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/categories?post=2660"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/wp-json\/wp\/v2\/tags?post=2660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}