Structure of Review Based on Continuity and Change in Nepals Health Service Policies and Programs: A Historical Assessment

Nepal’s health system has undergone remarkable transformation from reliance on traditional Ayurvedic practices to the gradual development of modern health services, yet progress has been uneven when assessed historically and against international standards. “This review followed the PRISMA-P and JBI guidelines for systematic reviews on the stabilities and changes in Nepal’s health policies and programs, tracing their evolution from the establishment of Bir Hospital in 1890 to the federal restructuring of 2015. Notable achievements include significant reductions in child and maternal mortality, improvements in life expectancy, development of community-based programs such as the Female Community Health Volunteers, and gradual increases in government health expenditure. However, persistent weaknesses remain, including inadequate and unstable public financing, inequitable distribution of services, rural urban disparities, malnutrition, and dependence on external funding. When compared with regional peers, Nepal’s health outcomes remain behind high-performing countries such as Sri Lanka and Maldives, and even Bangladesh in specific areas like community health delivery. The Universal Health Coverage service index remains low, highlighting gaps in quality and equity relative to global benchmarks. Federalization has opened opportunities for localized health governance but has also created challenges in coordination and capacity. Overall, Nepal’s health journey reflects important gains but also enduring structural barriers that hinder universal, high-quality coverage. Future improvements should focus on strengthening domestic financing, addressing inequities, improving service quality, and adapting lessons from regional and global best practices to achieve sustainable health improvements.