Improving soil fertility is essential for increasing crop productivity and meeting the food demand of Nepal’s growing population. This chapter presents the challenges in soil fertility and fertilizer sector and suggests potential strategies, including role and responsibilities of respective stakeholders to improve soil fertility and fertilizer management practices. Nepalese agriculture faces multiple challenges in improving soil fertility. Farmers’ nutrient management practices are based on outdated and blanket fertilizer recommendations. Farmers often lack access to extension services, and most are unaware of even the guidelines for application of outdated fertilizer recommendations. The chronic fertilizer shortage, worsened by inefficient procurement and distribution systems, and climate change impacts, further exacerbates these issues. Addressing these challenges requires integrated interventions across policy, institutional, human resources, and research and extension services, to adapt to evolving agricultural and climatic dynamics. The Government of Nepal should first ensure timely access to quality fertilizers. Research should focus on crop- and site-specific integrated soil fertility management practices (ISFM) that combine organic and inorganic inputs, following the 4Rs (right source, right rate, right time, and right placement) of nutrient stewardship to improve fertilizer use efficiency and net farm returns. This chapter proposes a roadmap focusing on five key areas: (i) research activities on developing effective and efficient fertilizer management practices that are crop- and site-specific involving public and private partners, (ii) extension services for evaluating and commercializing efficient fertilizer application technologies, (iii) scaling ISFM practices through dealers, retailers, cooperatives, and development partners, supported by extension agents, and providing farmers access to soil testing facilities at local level, (iv) revising policy to improve fertilizer supply and promote balanced fertilization strategies, and (v) improving soil health and fertilizer use efficiency strategies for reducing reliance on inorganic fertilizers by promoting the use of organic inputs, where applicable. These reforms on soil fertility and fertilizer sub-sector aim to revitalize Nepal’s stagnant agricultural sector, thereby increasing productivity and sustainability.