Turning the informal into the new normal: Social accountability in a federalizing Nepal

Below is an excerpt of an article originally posted on the Global Partnership for Social Accountability Knowledge Platform. 

Over the last decade, Nepalis embarked on a historic transition that aims to alter the fundamental structures of government. After 240 years of a monarchy, a devastating civil war, nearly a decade of transitional government, and 11 years of wrestling to build a devolved system of government, a constituent assembly promulgated a new constitution in 2015. As a result, Nepalis cast their ballots in the first open election in a generation in 2017. As many remain hopeful for more responsive governance in the new federal system, questions remain on how longstanding social accountability mechanisms will evolve and adapt, including in response to the COVID-19 pandemic.

Despite the lack of formal local-level government structures over the past 20 years, Nepalis remain resilient and found ways to address their communities’ needs. Since opening in 1988, Pact Nepal has had a front-row seat to this rapidly-changing accountability ecosystem. Social accountability mechanisms and citizen groups emerged in the early 2000s. Even with the challenges of fully operationalizing such structures, Health Facility Operation and Management Committees and Female Community Health Volunteers became important channels that formalized the integration of citizen feedback into health service delivery.

Through projects like USAID’s Sajhedari Bikaas: Partnership for Local Development activity and the current UK FCDO-funded Social Accountability in the Health Sector (SAHS) project, Pact has critically examined and engaged in these questions. We have investigated the country’s health sector and shared our analysis to promote best practices and learning for effective social accountability in the health sector.

In 2020, Pact’s SAHS project synthesized key insights, trends, and recommendations. These included applied political economy analyses, case studies, and situational analyses anchored in primary qualitative data collected from key informant interviews and focus group discussions from seven provinces, 22 districts, and nearly 1,500 respondents. Pact’s analytic work has focused on how the federalization process – devolving power and building municipal governing bodies – has affected social accountability mechanisms in Nepal’s health sector.

The results offer a window into the accountability ecosystem in Nepal and, alongside it, some of the challenges accountability advocates may face around the world, particularly in places undergoing the federalization process. The full report, entitled Leaning into Local: Impact of Federalisation on Social Accountability Processes in the Health Sector of Nepal, explores the impact of federalism on social accountability in the health sector and examines some of the challenges Nepal faces devolving power to the municipal level.