Since the early 50s, health service in Nepal has been heavily and consistently supported by foreign aid – either via supporting the state mechanism to provide services or foreign aid supporting the beneficiaries directly, outside the state system. However, increasingly in the past few decades a large portion of foreign aid in health sector is channeled through project assistances. Health services are contracted (and sub-contracted) out to non-governmental organisations (NGOs) at national and local levels. This contracting out health service and interventions coincides with growing number of NGOs and private sector consulting firms working in health sector since the 1990s. Whether it is used to deliver services, generate evidence, provide technical assistance, and/or to strengthen the health system, a number of intermediary organizations and/or through consortium of organizations manage a substantive portion of foreign aid.
Based on an ethnographic study that looks at the foreign aid and MCH service development and delivery in Nepal since 1990, this paper discusses how project ideas are conceptualized, projects activities are out-sourced, implemented, managed and evaluated. Organisations regularly use transparency and aid efficiency argument while managing fund to run a project. More specifically, this paper unpacks the networks and relationships between the foreign aid providers, organisations that manage foreign aid and organizations that implement foreign aid funded projects are developed and maintained in order to achieve MCH targets. We take two of our research case studies – SAMMAN Project managed by Care Nepal and SRH project, which is managed by ADRA Nepal to illustrate how national-level NGOs secure fund and contract out projects activities to local NGOs in implementing districts.