Impact of investment case approach on equitable access to maternal and child health services in Nepal

Introduction: Investment Case (IC) aims to support the local level to prepare comprehensive equitable development plans that are responsive to the local barriers confined in the area of maternal and child health (MCH). The main aim of the study was to assess the effect of the intervention designed by applying the IC approach in improving MCH service outcomes in Nepal. Methods: The study used a mixed method quasi-experimental research design involving 16 intervention and 24 comparison districts. The Nepal Demographic Health Survey (NDHS) datasets (2011 and 2016) were used for this study. Difference-in-difference (DiD) analysis adopting linear regression was used in order to assess the effectiveness of the IC approach. Similarly, a phonomyography qualitative study with stakeholders involved in planning and implementing the IC approach was used to explore their perception on IC approach in equitable planning and budgeting in MCH services. Results: Improvements in the majority of the outcome variables (antenatal care check-up, skilled birth attendant assisted delivery, wasting and underweight) followed similar trends in both intervention and comparison districts, indicating that the districts implementing IC approach did not improve MCH outcomes when compared to control districts. DiD analysis showed a significant increase in wasting among children aged under five (β: 0.019; p = 0.002) in the intervention districts. Qualitative findings, however, showed that the stakeholders were positive towards the effectiveness of IC approach for district-level health planning. They believe that IC has helped to increase responsiveness and accountability of stakeholders. Conclusions: IC helped immensely for the planning process, making it evidence based, but was unable to deliver expected results at impact level within the allocated timeframe mainly due to the inadequate implementation of the agreed plans. Hence, execution of the agreed plans should be the key focus of future interventions

A case study of medicinal plants and their usage by the local community of Dilasaini Gaunpalika, Baitadi district, Nepal

An Ethnomedicinal survey study was conducted to get information about the usage of medicinal plants and the diversity of species found around the village. The main objective of the study was to document the plants for their medicinal and other uses. Ethnomedicinal plants are locally available used by tribal communities and local inhabitants for various medicinal purposes. Random sampling survey was conducted by selecting 50 households to access the medicinal plants and document their usage in Gokuleshwor, Baitadi. A total of 33 species of medicinal plants to treat 40 ailments was reported with their multipurpose use. During the survey, an equal proportion of males and females aged 14 to 78 were selected randomly. The literacy rate of the study area was 80% and 94% of the people were found to be involved in the collection of medicinal plants. The majority of the respondents (92%) used medicinal plants for minor diseases like cuts, wounds whereas few were found to use the medicinal plant for a long time to treat major diseases like cancer, tumor. The use of medicinal plants for skin infections, cuts and wounds, fever was found to be high followed by diarrhea, common cold, ulcer, asthma, jaundice, burns, piles, and eye inflammation. Most of the plants were found to be used for more than one disease. The conservation of Indigenous knowledge on the Ethnomedicinal plant should be promoted as most of the respondents were unaware of the conservation of medicinal plants

Investment case approach for equitable access to maternal neonatal and child health services: Stakeholders' perspective in Nepal

Background: Investment Case is a participatory approach that has been used over the years for better strategic actions and planning in the health sector. Based on this approach, a District Investment Case (DIC) program was launched to improve maternal, neonatal and child health services in partnership with government, non-government sectors and UNICEF Nepal. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services. Methods: This study adopted an exploratory phenomenography design with a purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and total 30 key informant interviews with district level stakeholders and six focus groups with community stakeholders were carried out. A deductive approach was used to explore the perception of local stakeholders of health planning and budgeting of the health care expenses on the local level. Results: Investment Case approach helped stakeholders in planning systematically based on evidence through collaborative and participatory approach while in comparison areas previous year plan was mainly primarily considered as reference. Resource constraints and geographical difficulty were key barriers in executing the desired plan in both intervention and comparison districts. Positive changes were observed in coverage of maternal and child health services in both groups. A few participants reported no difference due to the DIC program. The participants specified the improvement in access to information, access and utilization of health services by women. This has influenced the positive health care seeking behavior. Conclusions: The decentralized planning and management approach at the district level helps to ensure equity in access to maternal, newborn and child health care. However, quality evidence, inclusiveness, functional feedback and support system and local resource utilization should be the key consideration

Spousal Separation and Use of and Unmet Need for Contraception in Nepal: Results Based on a 2016 Survey

Nepal is facing a large-scale labour migration—both internal and international—driven by economic and employment opportunities. There is sparse literature available at the national level which examines the link between migration and contraceptive use. This study aimed at identifying contraceptive use and the unmet need for family planning (FP) and exploring its correlates among the married women of reproductive age (MWRA) by their husbands’ residence status, using data from Nepal Demographic Health Survey 2016–a nationally representative cross-sectional survey. A stratified two-stage cluster sampling in rural and a three-stage sampling in urban areas were used to select the sampling clusters, and data from 11,040 households were analyzed. Reported values were weighted by sample weights to provide national-level estimates. The adjusted odds ratio (aOR) was calculated using multiple logistic regressions using complex survey design, considering clusters, and stratification by ecological zones. All analyses were performed using Stata 15.0. Among the total MWRA, 53% were using a contraceptive method, whereas the proportion of contraceptive use among the cohabiting couple was 68%. The unmet need for contraceptive use was 10% among cohabiting couples and 50% among the noncohabiting couples. Contraceptive use was significantly low among the women reporting an induced abortion in the last five years and whose husbands were currently away. A strong negative association of spousal separation with contraceptive use was observed (aOR:0.14; p<0.001) after controlling other covariates, whereas a positive association was observed with the unmet need (aOR:8.00; p<0.001). Cohabiting couples had a significantly higher contraceptive use and lower unmet need compared with the couples living apart. Between 2006 and 2016, contraceptive use increased by 1% per year among cohabiting couples, although this increase is hugely attributable to the use of traditional methods, compared with modern methods. The labour migration being a significant and indispensable socioeconomic phenomenon for Nepal, it is necessary to monitor fertility patterns and contraceptive use by cohabitation status in order to ensure that the national family planning interventions are targeted to address the contraceptive and fertility needs of the migrant couples