Need of The Ministry of Health in Federal Democratic Republic of Nepal

The constitution of Nepal provides appointing a council of ministers both at federal and provincial levels without defining portfolios. There is a political agreement that MOH will be retained at the federal level. This article draws evidences around the world to meet health needs of Nepalese, the role of provincial ministry of health and coordinating structure at district/local level. The constitution emphasises on health and pronounced in 46 articles which provides guidance for the creation of federalized governance levels at federal, provincial and local levels. Retaining ministry of health at federal level without creating devolved structure at province and local levels in health sector will create difficulty in translating the spirit of the constitution and may not be effective in addressing health issues nationally and meeting global achievements like SDGs. It is suggested to establish an elaborate health system accordingly in Nepal to ensure constitutional mandate of health as a basic human right. Keywords:constitution; federalism; health sector,ministy of health. [PubMed

Training evaluation: a case study of training Iranian health managers

<p>Abstract</p> <p>Background</p> <p>The Ministry of Health and Medical Education in the Islamic Republic of Iran has undertaken a reform of its health system, in which-lower level managers are given new roles and responsibilities in a decentralized system. To support these efforts, a United Kingdom-based university was contracted by the World Health Organization to design a series of courses for health managers and trainers. This process was also intended to develop the capacity of the National Public Health Management Centre in Tabriz, Iran, to enable it to organize relevant short courses in health management on a continuing basis. A total of seven short training courses were implemented, three in the United Kingdom and four in Tabriz, with 35 participants. A detailed evaluation of the courses was undertaken to guide future development of the training programmes.</p> <p>Methods</p> <p>The Kirkpatrick framework for evaluation of training was used to measure participants' reactions, learning, application to the job, and to a lesser extent, organizational impact. Particular emphasis was put on application of learning to the participants' job. A structured questionnaire was administered to 23 participants, out of 35, between one and 13 months after they had attended the courses. Respondents, like the training course participants, were predominantly from provincial universities, with both health system and academic responsibilities. Interviews with key informants and ex-trainees provided supplemental information, especially on organizational impact.</p> <p>Results</p> <p>Participants' preferred interactive methods for learning about health planning and management. They found the course content to be relevant, but with an overemphasis on theory compared to practical, locally-specific information. In terms of application of learning to their jobs, participants found specific information and skills to be most useful, such as health systems research and group work/problem solving. The least useful areas were those that dealt with training and leadership. Participants reported little difficulty in applying learning deemed "useful", and had applied it often. In general, a learning area was used less when it was found difficult to apply, with a few exceptions, such as problem-solving. Four fifths of respondents claimed they could perform their jobs better because of new skills and more in-depth understanding of health systems, and one third had been asked to train their colleagues, indicating a potential for impact on their organization. Interviews with key informants indicated that job performance of trainees had improved.</p> <p>Conclusion</p> <p>The health management training programmes in Iran, and the external university involved in capacity building, benefited from following basic principles of good training practice, which incorporated needs assessment, selection of participants and definition of appropriate learning outcomes, course content and methods, along with focused evaluation. Contracts for external assistance should include specific mention of capacity building, and allow for the collaborative development of courses and of evaluation plans, in order to build capacity of local partners throughout the training cycle. This would also help to develop training content that uses material from local health management situations to demonstrate key theories and develop locally required skills. Training evaluations should as a minimum assess participants' reactions and learning for every course. Communication of evaluation results should be designed to ensure that data informs training activities, as well as the health and human resources managers who are investing in the development of their staff.</p

Health sector reforms: Factors influencing the policy process for government initiatives in the Punjab (Pakistan) health sector 1993-2000

The health sector in the Punjab (Pakistan) suffers from many shortcomings and to combat these, successive governments undertook different reform interventions. The most critical of these took place during the period 1993-2000, when the Punjab government introduced seven reforms in rapid succession, with decentralisation as a strategy common to all. Substantial inputs were made, but some of these were abandoned, others forgotten and yet others remained. Nonetheless, like many countries, where few governments have initiated any planned evaluation of reform efforts, there is also no evidence of any study having been undertaken in the Punjab. This study aims to explore factors that influenced the policy process for the health sector reforms undertaken by the government and to draw lessons for contributing to ongoing and future initiatives. In preparing to achieve this aim, frameworks were developed for the health system and the policy process for health sector reform. This is a qualitative research study, which employs a case study approach. Four cases were selected for study and, based on a framework for analysing the policy process, data was collected using interviews, focus group discussions and document reviews. With the help of a tailor-made computer-assisted data processing system, the qualitative data was analysed and findings are presented as four single-case studies. The cross-case analysis led to generating discussion and developing a multiple-case study and identifying factors influencing the policy process for the Punjab health sector reforms. The study revealed that six factors principally influenced the policy process in terms of their origin, design and implementation. These are: (1) the absence of clearly defined principles and purposes; (2) the insufficient involvement of the stakeholders; (3) the lack of a holistic view of context, focusing on the health sector; (4) the shortcomings of the policy machine-, (5) the need for a proper implementation structure; and (6) the administrative fatigue of donors. Given these findings, there are certain implications for the Punjab health sector, particularly overhauling the policy machine, developing the capacity of policyrnakers for policy analysis, and broadening the stakeholders' base

Factors influencing the policy process for government initiatives in the Punjab (Pakistan) health sector 1993-2000

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