The role of local government in tackling a global pandemic: A lesson from Nepal

This paper critically analyses the scope of leadership in Nepal at the local government level when tackling the wider impacts of COVID-19, with a particular focus on health service delivery in line with World Health Organisation (WHO) frameworks. In-depth interviews with 66 representatives from local governments (LG) in the Madhesh and Sudurpaschim provinces were conducted, along with analysis of routine data from health management information systems. We found that Maternal Child Health (MCH) services at local health institutions were largely unimpacted, stocks of essential medicine were available, and the LGs exhibited determination and capability in getting to grips with the crisis, despite inadequate knowledge and resources. Nevertheless, there was sizeable shrinkage in the utilisation of services, which triggered public health concerns of a different nature, the LGs were inadequately prepared in regards to the capacity and availability of human resources, and there were explicit gaps in terms of coordination among all three tiers of government and a lack of role clarity that delayed the response to the pandemic at the local level.  Our recommendations include continued investment in local MCH services, capacity building for local leaders with a focus on human resource management in emergency contexts, and the simplification of public procurement processes, particularly during crises, enabling LGs and other local actors to expediate procurement and improve response times.