Nepal Study Sites

Nepal adopted a decentralised system of governance in 2015, with three tiers:

• federal government – responsible for policy, standards, regulation and central hospitals (tertiary level care),
• provincial government – provincial hospitals (secondary level care) and logistics and technical support to local government, and
• local government – manages and delivers basic healthcare services.

Health workforce management is shared across the three tiers, however there are challenges with clarity of roles and coordination, affecting the motivation of the health workforce. We have selected two settings. Both are operating as sentinel sites which report to the Early Warning and Reporting System in the federal government.