Ethical and Practical Challenges in Conducting Fieldwork on a Sensitive Topic (HIV) in Nepal

This short one-page piece addresses issues that arose during the fieldwork of the first author. He as a PhD student experienced a number of practical issues and challenges while conducting fieldwork for his PhD thesis in Nepal at the end of 2009. The key issues that arose involved gaining access to and conducting interviews in hospitals in Nepal, especially in out-patient departments. Obtaining access to people living with HIV was a major challenge. He faced difficulties getting approval/support for the research because HIV is a stigmatising and sensitive issue in Nepal, and research is still not considered a priority area. Delays increased the costs of research and shortened the time available to complete the fieldwork. Without obtaining written approval from the hospital director, it was not possible to start and the absence of such a key person on the days of fieldwork caused delays in obtaining approval and consequently resulted in delayed data collection. Ethical issues and challenges inevitably arose during the fieldwork. Confidentiality was a major issue, and conducting interviews in out-patient departments made recruitment difficult due to lack of privacy

Employee Commitment Before and After an Economic Crisis: A Stringent Test of Profile Similarity

Researchers have recently begun to take a person-centered (profile) approach to investigate how the affective, normative, and continuance commitment mindsets combine within the three-component model of organizational commitment (Meyer & Allen, 1991). The meaningfulness of the profiles identified in this research depends, in part, on evidence that similar profiles emerge across samples, particularly those drawn for a common population. We conducted a particularly stringent test of similarity by comparing profiles for samples of employees drawn from a large Turkish conglomerate prior to (N = 346) and following (N = 797) a major economic crisis. Using procedures recently introduced by Morin et al. (2016), we found similarity in the number (seven) and structure of the profiles before and after the crisis; only the distribution of individuals across profiles (i.e., the relative size of the profiles) differed. We also found similarity in the patterns of relations with theoretical antecedent, correlate, and outcome variables, suggesting that a common set of principles might be operating regardless of major differences in the work environment. In addition to providing strong evidence for the meaningfulness of commitment profiles, this study is one of the first to investigate the impact of an economic crisis on employee commitment

Plans for the next GRAPE balloon flight

The Gamma RAy Polarimeter Experiment (GRAPE) was first flown on a 26-hour balloon flight in the fall of 2011. GRAPE consists of an array of Compton polarimeter modules (based on traditional scintillation technologies) designed to operate in the energy range from 50 keV up to 500 keV. The ultimate goal is to operate GRAPE in a wide FoV configuration for the study of gamma-ray bursts. For the first (demonstration) balloon flight, GRAPE was configured in a collimated mode to facilitate observations of known point sources. The Crab nebula/pulsar, the active Sun, and Cygnus X-1 were the primary targets for the first flight. Although the Crab was detected, the polarization sensitivity was worse than expected. This paper will review the plans for the next GRAPE balloon flight, which is scheduled to take place in the fall of 2014 from Ft. Sumner, NM. These plans involve several modifications designed to improve the polarization sensitivity, including an expansion of the array of polarimeter modules from 16 to 24 and improvements to the instrument shielding. Sensitivity estimates of the resulting instrument, based on GEANT4 simulations, will be presented

Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks.

Nepal's move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal's health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal's health system as it adapts to federalisation. This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders' practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework. Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting. Our findings suggest that since federalisation, Nepal's health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system. [Abstract copyright: © 2023. Crown.

Factors affecting the uptake of institutional delivery, antenatal and postnatal care in Nawalparasi district, Nepal

© 2019, Kathmandu University. All rights reserved. Background Maternal deaths and complications are highly preventable with good antenatal, postnatal and skilled care during childbirth. Inadequate information on the factors affecting these services could be barrier to a reduction of maternal deaths in low-income countries. Objective To assess the uptake of antenatal, postnatal and skilled care during childbirth. Method A cross-sectional study was conducted in eight villages of Nawalparasi district in southern Nepal. A total of 447 women who had given birth within the preceding 24 months were recruited using multistage random sampling. Data were collected using a pre-tested semi-structured questionnaire. Chi-square tests were used to assess association between variables. Result Over 70% of women had gone for at least four antenatal care check-ups while only 14.3% had at least three postnatal check-ups in their last pregnancies. The proportion of institution delivery was 54%. Women’s literacy was associated with the uptake of antenatal services (p=<0.001), postnatal care (p=0.04) and institutional delivery (p=<0.001). Knowledge of antenatal (p=<0.001) and postnatal care was also associated with uptake of respective services (p=<0.001). Conclusion The uptake and knowledge of antenatal care was much better than of postnatal care. Home delivery rates were still very high. A scaling-up of education and awareness-raising interventions in this community could help improve the uptake of maternal health services

Participatory policy analysis in health policy and systems research: reflections from a study in Nepal.

Background Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country’s move to federalism on its health system, we reflect on the method’s strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach’s strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. Main body We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues – especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants’ understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. Conclusions PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders’ needs, it has great potential as a method in health policy and systems research

Nepalese Health System Response to Fight Against COVID-19 Pandemic

The novel coronavirus or COVID-19 is a new highly infectious virus affecting a large population across the globe. There is no specific therapeutic drug available against covid-19 hence the most effective public health measures need to strictly be adhered to without delay. Range of issues were reported to fight against COVID-19 in the current health system of Nepal which should be addressed and strengthened the full spectrum of the health system for its effective and sustainable response. It is crucial to understand the current health system at the local and provincial level and strictly adhere the federal government policies and plan as per the protocol for maintaining minimum infection prevention and control measures with having preventive and safety measures to both service providers and community people. To tackle those daily increasing number of COVID-19 cases, it provides an opportunity for the three tires of governments to reprioritize the health service in the national agenda for the effective prevention and response it. Although National health policy 2019 clearly articulated the need for equitable access and quality of health care services to all. Evidence shows that Nepal is in risk zone because of comparably weak health system that should be aware of all three tires of governments of Nepal and strengthen and control the present threat posed the daily increasing cases of pandemic

Overcoming the Challenges Facing Nepal’s Health System During Federalisation: An Analysis of Health System Building Blocks

Introduction Nepal’s move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal’s health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal’s health system as it adapts to federalisation. Methods This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders’ practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework. Results Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting. Conclusion Our findings suggest that since federalisation, Nepal’s health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system

Health system strengthening: the role of public health in Federal Nepal

This article addresses some of the key Public Health approaches around the ongoing federalisation of the state of Nepal and the associated decentralisation processes in its health system. We start by outlining the main roles of the discipline of Public Health and the contribution it can make to the reform process. Then the next section introduces our on-going study into the effects of the establishment of the Federal Republic of Nepal on the organisation and running of the country’s health system. To capture the Public Health benefits of decentralisation, the process should not be only ‘top-down’, directed by policy elites. Although in theory Nepal’s health system has undergone a process of decentralisation, in practice policy and planning is often still being led by the Federal government, despite the clear roles and responsibilities of the three tiers of government in health service delivery. To improve policy and planning in the newly decentralised health system structure, there needs to be meaningful incorporation of the views of stakeholders at all levels (even the very lowest levels). Our project aims to play a part in addressing this by capturing a wide variety of experiences of the decentralisation process