Adapting to Federalism in Nepal: CLA in Health Systems Strengthening

In 2018, Nepal’s transition to federalism resulted in municipal governments bearing responsibility for delivering basic health services to their constituents. USAID’s Strengthening Systems for Better Health (SSBH) Activity makes use of CLA components to collaborate with government counterparts in their efforts to improve the quality, access, and outcomes of maternal and child health, particularly among hard-to-reach and marginalize populations. SSBH also uses technical evidence gathered at municipal level to identify priority needs and key lessons and adapts its technical assistance to relevant stakeholders based on these findings.

SSBH conducted a Health Systems and Capacity Assessment (HSCA) across 105 municipalities in 2018/19 as a collaborative effort with local officials and health staff. The findings of this assessment were used to develop customized technical assistance plans that reflected lessons learned and major priority areas for intervention. Technical assistance is implemented by multidisciplinary teams (MDTs) at local level, who are responsible for initiating collaboration with government and health sector counterparts, sharing lessons, and adapting technical, logistical, and in-kind support based on technical evidence gathered on the ground.

In the intervening years, annual updates to the HSCA highlighted changing needs and contexts at local levels, which SSBH adapts to update technical assistance. The CLA approach taken by SSBH encourages evidence-based scenario planning to determine where SSBH support is most required, pausing and reflecting on challenges and achievements, and promoting continual open relationships with relevant stakeholders with the aim of sustaining and replicating better health outcomes.