Embedded learning site research for strengthening health systems resilience: lessons from Nepal’s decentralized context
This presentation was made at the 8th Global Symposium on Health Systems Research in Japan in November 2024 by Shophika Regmi of HERD International.
The 2015 decentralization reform in Nepal transferred political, administrative and fiscal authority and responsibilities to local governments, including responsibility for delivering basic health services. However, devolution has been challenging due to capacity gaps at subnational levels, limiting the ability to effectively plan, prioritize, and implement equitable and responsive health programmes and budget. Poor accountability and monitoring mechanism, limited decision space, political interference, and inadequate coordination have further hindered long-term health sector progress. This study emphasizes the importance of, and shares learnings from, embedded participatory action research in strengthening health system resilience and addressing justice and inclusion in fragile contexts.