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Nepal’s federal transition and ongoing public health threats make resilience strengthening at the local government level a critical priority. A cross-sectional mixed-methods study in Kapilvastu District assessed local health system resilience capacities and identified gaps using document review, key informant interviews, and stakeholder workshop inputs plus secondary data on minimum service standards, human resources, infrastructure, and disaster incidence.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/mapping-health-system-resilience-in-federal-nepal-perspectives-and-lessons-from-local-government-level/457719/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/mapping-health-system-resilience-in-federal-nepal-perspectives-and-lessons-from-local-government-level/457719.png","ImageObject",300,407,{"name":92,"@type":93},"jay","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What kinds of pressures affect health system resilience in Nepal?","Question",{"text":112,"@type":113},"The study highlights acute shocks such as disasters and disease outbreaks, alongside chronic stressors including rising burdens of chronic diseases and persistent constraints in health delivery.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the research conducted in Kapilvastu District?",{"text":117,"@type":113},"It used a cross-sectional mixed-methods approach, combining review of 21 policy and programme documents, 13 key informant interviews, a stakeholder consultative workshop, and secondary data analysis.",{"name":119,"@type":110,"acceptedAnswer":120},"What key gaps were identified at the local government level?",{"text":121,"@type":113},"Gaps included unclear roles and responsibilities across government tiers, weak coordination and institutional capacity, limited evidence use, weak disease surveillance, and insufficient financial and human resources, with medicine and infrastructure shortfalls reducing public trust.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},457719,1791338696,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},3985747858866,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Pandey et al. BMC Health Services Research (2026) 26:30 BMC Health Services Research  \n[https://doi.org/10.1186/s12913-025-13494-y](https://doi.org/10.1186/s12913-025-13494-y)  \nRESEARCH Open Access  \nMapping health system resilience in federal Nepal: perspectives and lessons from local government level  \nAchyut Raj Pandey 1*, Shophika Regmi 1, Aney Rijal 1, Suprich Sapkota 1, Anil Dhungana 1, Abriti Arjyal 1, Sophie Witter2, Joanna Raven3 and Sushil Baral 1  \nAbstract  \nBackground Health systems worldwide are vulnerable to both acute shocks, which strain the health system for a relatively short period of time, and chronic stressors, which place persistent pressure on the health system. Given Nepal’s frequent exposure to public health threats, recent transition to a federal structure and systemic constraints, strengthening resilience at the local government level has emerged as a critical priority. We assessed the health system resilience capacities and identified gaps at the local government level to inform later interventions.  \nMethods We conducted a cross-sectional study using a mixed-methods approach in the local governments of Kapilvastu District. Data collection involved: a review of 21 policy and programme documents, 13 key informant interviews (KIIs), and one stakeholder consultative workshop. Additionally, we conducted secondary data analysis focusing on minimum service standards (MSS), human resource availability, health infrastructure, and the incidence of disasters in the study area. Qualitative data and the workshop reflection reports were analysed using NVivo 11, adopting a thematic framework approach, while quantitative data were descriptively summarized using Microsoft Excel. We shared the key results and validated data with health officials in a local government in Kapilvastu district. Results Local health systems in Nepal encounter both acute shocks, such as frequent episodes of disasters (floods, fires, landslides) and disease outbreaks, and persistent stressors, including an increasing burden of chronic diseases. Although there are some opportunities with quick decision-making and good understanding of the local context among decision makers, the resilience capacity of local health systems is undermined by unclear roles and responsibilities across three tiers of governments, weak coordination, sub-optimal institutional capacity, poor evidence use practices, weak disease surveillance, insufficient financial and human resources and limited financial flexibility. Gaps in medicines and infrastructure were found to reduce public trust and thus the utilization of services. Addressing these issues requires capacitation of local governments to undertake the responsibilities assigned to them, strengthening governance mechanisms, increasing financial flexibility, and improving multi-sectoral coordination.  \n*Correspondence:  \nAchyut Raj Pandey [achyutrajpandey2014@gmail.com](achyutrajpandey2014@gmail.com)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.","cbCailX8DjeOrPuB","https://ap.wps.com/l/cbCailX8DjeOrPuB","pdf",1512661,14,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusion\n## Keywords","[{\"question\":\"What kinds of pressures affect health system resilience in Nepal?\",\"answer\":\"The study highlights acute shocks such as disasters and disease outbreaks, alongside chronic stressors including rising burdens of chronic diseases and persistent constraints in health delivery.\"},{\"question\":\"How was the research conducted in Kapilvastu District?\",\"answer\":\"It used a cross-sectional mixed-methods approach, combining review of 21 policy and programme documents, 13 key informant interviews, a stakeholder consultative workshop, and secondary data analysis.\"},{\"question\":\"What key gaps were identified at the local government level?\",\"answer\":\"Gaps included unclear roles and responsibilities across government tiers, weak coordination and institutional capacity, limited evidence use, weak disease surveillance, and insufficient financial and human resources, with medicine and infrastructure shortfalls reducing public trust.\"}]","Mapping health system resilience in federal Nepal - perspectives and lessons from local government level | PDF",1790750224,35]