Nepal health financing in Light of federalism and pandemic
Introduction
Nepal is now a Federal Democratic Republic state after the promulgation of the Constitution of Nepal in 2015.1 The country has three tires of government – one federal, seven provincial and 753 local governments.2 Each level of government is authorised to execute its powers by enacting laws, policies, programs, and annual budgets within its respective jurisdiction, as defined by the Constitution. In subjects under their authority, all three levels can write and issue laws governing their financial authorities, charge taxes, collect income, create a yearly budget, establish plans and programs, and put them into action. The early stages of Federalism also met with the global spread of COVID-19 which brought unprecedented difficulties in financing health. Along with the political changes, there has been some fresh data on health outcomes. For instance, life expectancy increased to 70 years in 2017, up from about 38 years in 1960. The infant mortality rate has also declined from 216 per 1000 live births in 1960 to 27 per 1000 live births in 2019. The maternal mortality ratio also declined from 553 to 186 per 100,000 live births between 2000 and 2017 in Nepal. Against this backdrop, this viewpoint offers an understanding of the various dynamics that need to be considered in developing a health budget and the challenges that Nepalese policymakers face in the current light of federalism, pandemic and long-term health goals.