Public-Private Partnerships in Health Service and Conflict Reduction in Nepal: A Policy Review

Abstract

Background: Recurrent nationwide strikes, hospital violence, legal clashes over medical negligence, and hospital withdrawals from national insurance highlight deep instability across Nepal's health sector. These crises stem from weak regulation, rapid privatization, and a nascent three-tier federal structure, raising the question of whether public-private partnerships (PPPs) can reduce health system conflict.

Methods: This study used a narrative review of academic literature, government policies, and media reports to categorize Nepal's health disputes into four categories. It analyzed Nepal's pioneer health PPP (NGO Possible and the Ministry of Health and Population) and benchmarked it against global PPP models in India, Mexico, Portugal, Spain, and Italy.

Results: Conflicts manifest as provider-community violence, health worker labor disputes, financing standoffs between insurers and hospitals, and intergovernmental coordination failures. Well-designed PPPs can mitigate these issues; however, Nepal's PPP policy framework, including its general 2019 PPP law, remains overly loose for the health sector, lacking standardized health-sector contracts, dedicated dispute resolution mechanisms, and adequate labor protections, often perpetuating systemic distrust.

Conclusions: PPPs can reduce sector-wide conflict only if supported by strong institutional frameworks. Nepal must overhaul its PPP policy by adopting five practical steps to construct standardized, equitable, and conflict-sensitive partnership systems.

Novelty: Prior Nepal-specific PPP scholarship has treated public-private partnerships mainly as a financing or service-delivery mechanism for reaching the Sustainable Development Goals. This review instead reframes PPPs explicitly as a conflict-governance tool and examines that framing in light of Nepal’s 2025-2026 strike wave, insurance crisis, and federal coordination failures. It contributes a four-part typology of health service conflict and a five-point conflict-sensitive PPP policy framework, neither of which, to the author's knowledge, has previously been proposed in the Nepal literature.