Health Service Spillover in City-Centered Local Governments in Nepal

Abstract

Every citizen has the right to receive basic health services from their local government without any discrimination. However, city-centered local governments in Nepal face challenges in managing (spillover) health services. In this context, this study explored the presence of spillover in the health service, using a qualitative case study approach. We conducted in-depth interviews with representatives from three local governments: Mahalaxmi, Gokarneshwor, and Bhaktapur to gain a comprehensive understanding. The findings reveal that the studied local governments are aware of their constitutional responsibilities to provide basic health services to citizens. Nevertheless, challenges arise in effectively managing health services due to the unpredictable demand, making it difficult to manage resources efficiently. Similarly, maintaining accurate records of people’s residency is problematic, as they often provide incorrect information or are unwilling to disclose it. The influx of temporary and seasonal migrants from other local governments poses risks to the provision of basic health services. However, these local governments have demonstrated effective handling of emergency health situations, particularly amidst the Nepal Covid-19 epidemic. To manage the spillover of health services and ensure that all citizens have access to their constitutional right to health services, it is crucial for local, federal, and provincial government entities to collaborate. This research sheds light on an important yet underexplored aspect of public health management, offering valuable insights for policymakers and practitioners alike.