USAID Nepal Family Health Program II Nepal Family Health Program II
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Local Health Governance

JSI Research & Training Institute, Inc. successfully implemented the Nepal Family Health Program II for the U.S. Agency for International Development from 2007 to 2012. For further information on project activites, visit the NFHP II page on jsi.com.


NFHP II addresses local-level governance of health facilities and services primarily through two important components - ‘Health Facility Management Strengthening Program’ (HFMSP) and ‘Local Health Governance Strengthening Program’ (LHGSP). These two programs focus on improving public-sector health facility governance and increasing use of health services by members of the community, especially by those who are marginalized and have limited access to health services.

Our approach is based on the assumptions that:

  • communities have a right to quality health care,
  • they also have a responsibility to support government efforts in providing community health services,
  • they have immense potential to foster local health governance, provided they are well equipped with capacity, resources and authority.

HFMSP aims to strengthen partnership between the health facility and communities in managing public-sector health services through the active involvement of 'Health Facility Operation and Management Committees' (HFOMC). Under the Government of Nepal's decentralization initiative, the HFOMC is a formally constituted body responsible for operating and managing local health facilities. They consist of a variety of community representatives. In delivering community health services, it is important to address both supply and demand sides. HFOMCs play an important role to ensure that community demands/needs are adequately met by public health facilities. To achieve the intended partnership, however, HFOMCs need to build their capacity in various areas of management. Building on the lessons of NFHP I, HFMSP has been designed to address these gaps. The approach involves a two-year period of support (one year intensive and one year limited technical support) including a three-day interaction session, two periodic review meetings at the interval of 4-6 months, regular follow up, and promotional activities.

Furthermore, capacity building should be accompanied by authority over funds and functionaries. Although, NFHP II has actively engaged HFOMCs in local health facility management through the HFMSP, in the absence of authority over funds and functionaries, capacity alone was not enough to enrich the role of the HFOMCs. Considering this reality and to gain first hand experience on devolving its limited financial and personnel authorities to the local level, the Ministry of Health and Population is piloting a program called LHGSP.

NFHP II implemented HFMSP in 2008 in a few VDCs of 4 districts, expanding to 13 districts in 2010. Out of the 13 districts, LHGSP is being implemented in two. Technical support is being provided to stakeholders, including the National Health Training Centre, to leverage additional resources to apply these approaches elsewhere.

To learn more about NFHP's work in local health governance, go to our Resources.