Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 8 4 2019 04 01 Implementing Federalism in the Health System of Nepal: Opportunities and Challenges 195 198 3579 10.15171/ijhpm.2018.121 EN Rajshree Thapa Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal Kiran Bam FHI 360 Nepal, LINKAGES Nepal Project, Kathmandu, Nepal Pravin Tiwari Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal Tirtha Kumar Sinha Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal Sagar Dahal Province Health Directorate, Ministry of Social Development, Dhankuta, Nepal Journal Article 2018 03 06 Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system. https://www.ijhpm.com/article_3579_efbd5a429ffb7cc9b002da8fd85fb0e7.pdf