Journal of Health and Social Welfare

Opportunities and Challenges in Implementing Fiscal Federalism: A Case Study of Nepal's Local Governance

Bhakta Bahadur Bhandari — 2026-03-08

Federalism enables power-sharing between central and regional administrations, with fiscal federalism focusing on resource allocation to improve governance. Nepal’s 2015 Constitution established a federal system emphasizing decentralization and participatory governance. Despite advancements like Performance-Based Grant Systems, challenges in resource allocation, infrastructure, and coordination persist. This study explored fiscal federalism’s challenges and opportunities to enhance governance and equitable development in Nepal. Using a descriptive cross-sectional design, data were collected from 384 local government officials involved in fiscal policy and management in Nepal. Data analysis, performed using SPSS version 20. The results highlight significant challenges, including insufficient funding (89.3%), political interference (89.6%), and lack of clear guidelines (85.9%). Opportunities identified include improved local economic growth (mean = 4.74), public service delivery (mean = 4.20), and accountability (mean = 4.17). However, the implementation of fiscal federalism is hindered by issues such as political instability (mean = 4.10) and resource allocation challenges (mean = 3.68). Despite these obstacles, respondents largely agree that fiscal federalism has contributed positively to local governance, with 94.3% agreeing that it has improved governance and 96% noting increased public participation. The study concludes that while fiscal federalism has shown promise in enhancing local autonomy and service delivery, addressing funding shortages, capacity deficits, and coordination challenges is crucial for maximizing its potential to foster equitable development and improve the quality of life in Nepal.

Assessing the Impact of Breathing Techniques on Asthma Symptoms and Quality of Life

Kusheswar Yadav — 2026-03-08

Asthma, a chronic respiratory condition affecting 1%-18% of the global population, leads to significant morbidity, healthcare costs, and around 180,000 deaths annually. Despite advances in pharmacological treatments, many individuals still experience persistent symptoms, reducing their quality of life. This study aims to assess the impact of breathing techniques as adjunct therapy on asthma-related quality of life. A randomized controlled trial was conducted with 80 participants, divided into an intervention group (40) and a control group (40). The ACT and AQLQ were used to evaluate asthma control and quality of life. Following two weeks of training in diaphragmatic and pursed-lip breathing, data were analyzed using SPSS with paired and independent t-tests. Results showed a slight improvement in the intervention group, with AQLQ scores increasing from 3.25 to 3.36 (p = 0.002). However, the control group had better asthma-related quality of life, with higher mean AQLQ scores (3.60 vs. 3.13) and a greater improvement in post-test scores. More participants in the control group reported minimal or no impairment. While breathing techniques slightly improved the quality of life in the intervention group, they were less effective than the overall improvements in the control group. Further research is needed to evaluate the effectiveness of breathing techniques compared to other interventions

From Paper to Digital: Advancing Public Health Surveillance through ICT in Kathmandu Valley

Shyam Adhikari — 2026-03-08

Background: Information and Communication Technology (ICT) has transformed public health surveillance globally, enabling real-time data collection, improved reporting, and early outbreak detection. In low-resource settings like Nepal, adoption is limited due to infrastructure gaps, workforce shortages, and low digital literacy. This study explored the role of IT in strengthening public health surveillance in Kathmandu Valley, identifying challenges, strategies, and future opportunities.

Methods: A qualitative research design was employed with seven purposively selected key informants, including IT experts and policymakers involved in public health surveillance. Data were collected through semi-structured interviews, transcribed, translated, and analyzed thematically to generate key insights.

Results: Public health surveillance systems in Kathmandu Valley are transitioning from paper-based to IT-enabled platforms such as the Health Management Information System (HMIS) and Early Warning and Reporting System (EWARS), enhancing real-time disease monitoring, reporting accuracy, and outbreak response. Key barriers included limited infrastructure, fragmented systems, skill gaps, and privacy concerns. Strategies to address these challenges included inclusive digital training, mobile-friendly and offline-capable applications, centralized data management, and resilient cybersecurity. Informants envisioned predictive, people-centered surveillance systems harnessing AI, big data, blockchain, wearable devices, and telemedicine, emphasizing ethical and equitable implementation.

Conclusion: ICT integration holds significant potential to improve public health outcomes in Kathmandu Valley. Effective adoption requires strategic planning, capacity building, equitable access, and sustained multi-stakeholder collaboration to achieve a resilient, responsive, and technology-driven surveillance system.