Nepal’s Municipalities Act 1990 gives individual municipalities responsibility for public health, but they varied widely in the extent to which they have taken this up. The concentration of most of the municipalities is toward building infrastructures in the city rather looking and spending resources for the health and education of the citizens. Most of the social services are provided by the government institutions and private sector providers in the urban areas of Nepal.  Particularly for public health and primary health care aspect less attention is given by the government in the urban sector. Most of the government resources for health in the urban area go to the clinical services that are provided through the hospitals.

LSMC Health Care Provision
Local Governance Act 1999 gives individual municipalities responsibility for public health and hygiene care and it also allows municipality to take care of the health services in the city.  Some classical role played by Municipalities in the public health concerns are: Food Quality inspection in the public eateries within the municipality, and Basic Primary Health care services and FP services through urban clinics. The scope and extent of these services also use to depend upon the income level of the municipalities.

In 1998 LSMC entered into an Agreement with a local NGO to open a Public Health Unit within the Community Development Section, appointed one staff member and begin to develop a primary health care strategy for the city. At that time the NGO ran 6 (half day per week) MCH clinics. Today LSMC/CDS provides health care staff, facilitates and resources for:

• 19 MCH/FP Clinics in 17 of the 22 wards
• Health Committee support in all wards
• Training of Tole (Neighbourhood) Health Promoters in all wards
• National Immunization and Vitamin A Days
• Numbers of out reach Clinic

Health Activities by LMCS

• EPI Coverage:  93%
• TT3 Coverage:  47%
• 3 times AN visit: 80%
• Family Planning Coverage: 60%

Ward Health Committees
Citizens committees are formed in each ward of the municipality. These committees contribute in coordinating and managing promotional and primary health care activities in the ward. Women and Marginalized group of people are also represented in these committees as lack of health awareness and reproductive health are two problematic areas.

Tole (Neighbourhood) Health Promoters (THP)
Volunteers aged 15 to 55, selected by their own communities are also mobilized through the community development section of the municipality. These volunteers are provided basic training on health care and promotion.  

These health volunteers make 3 monthly home visits to promote health awareness among the people and organise awareness raising events in their neighbourhoods. They also provide assistance during health camps and MCH clinics organized by district public health office.

PPP in TB – DOTS program
A unique partnership of Private providers (Nursing Home and private practitioners) government (District Hospital) and NGO has been developed to administer DOTS program for TB patients. This has helped in reducing the incidence of TB from 4% to 2% within five 5 years.

In partnership with Community Health Association Lalitpur (CHAL ), LSMC has been successful in operating low cost Social Service Clinics run by local doctors in community owned facilities. These clinics are usually operated in the early morning/evening or Saturday so that the poor and wage earners could be benefited. These clinics are getting popularity among the poor people.

Private Sector
There are several Nursing Home and private hospitals operated in the city. Some of them are providing supper speciality services also but most of them provide clinical tertiary level services. The prices are costly so these institutions are basically serving the reach and middle class people in general. Many poly clinics, diagnostic centres and pharmacists are also part of the private sector health service providers in the district. PHC project (Asia Urb) is collecting data of these private sector providers in the city.

New developments
On the first day of the current Nepali Year (13 April 2004) LSMC opened a new Health Section within its structure and so opened the way for health services to have a higher priority in the city’s planning and service provision.  This has happened after the PHC Development Project has started in the LSMC.

Community Health Program conducted by LSMC:
The range of health services that has been provided by LSMC in the recent past appear in the list, such as:

• Immunization program
• Vitamin A distribution
• Safe motherhood program
• Health education and promotion
• School health program
• TB Control/DOTS 
• Water and Sanitation program
• Refresher training for health care providers
• Health camp
• THP and TBA refresher training
• Solid waste management program

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