As envisaged in the National Health Policy 1991, health facilities were extended up to village level. However, utilization of services provided by health facilities, especially preventive and promotive services, has been found to be limited because of limited accessibility.⁸ Therefore it was felt that services should be expanded closer to the community. Thus Primary Health Care Outreach (PHC/ORC) services was initiated and established in 1994.The political reorganization of Nepal in 2017 has ensured that health care is really mainly managed by the local government (Gaun Palika). An important task for the board is therefore to provide and coordinate care and cure.⁹

The local health system includes the following components:

• Primary Health Care Center
• Health Post
• Urban Health promotion Center
• Urban Health Center
• Community Health Unit
• Female Community Health Volunteers
• Expand program on Immunization Clinics
• Primary Health Care Outreach Clinic

Health Post (HP): Health posts are the first institutional contact point for basic health services. These lowest level health facilities monitor the activities of Female Community Health Volunteers (FCHVs) and the community based activities of Primary Health Care Outreach Clinics (PHC-ORCs) and Expanded Program on Immunization (EPI) clinics. In addition, they are the referral centers of FCHVs as well as venues for community based activities such as PHC-ORC and EPI clinics. Each level above the health post level is a referral point.

Female Community Health Volunteer (FCHV):FCHVs are contributing to promotion of safe motherhood, child health, family planning, and other community-based health services to promote health and healthy behavior of mothers and community people with support from health workers and health facilities.³ Theirs numbers are gradually increasing every year.

Primary health care is delivered through peripheral health facilities (approx. 4000 sub-health posts, health posts, and Public Health Centres) and provides essential services to most of the population. A peripheral health facility typically can provide out-patient clinical, pharmaceutical and nursing care, including non-complex surgeries. They can refer complex, unusual, special cases to the hospital. Despite the many challenges (natural, political and socioeconomic), Nepal has achieved impressive health gains in recent decades but quality is a serious challenge facing Nepal’s primary health care system.^1,4,5