Evaluation Study of Decentralized Health Facilities in Nepal

Background: After the enactment of Local Self Governance Act (LSGA) and its regulation 1999, Government of Nepal decided to decentralize management responsibility to its lower authorities. Although the government and its stakeholders who are involved in health sector decentralization have produced d...

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Main Author:	Adhikari, K
Format:	Technical Report
Language:	en_US
Published:	Nepal Health Research Council (NHRC) 2016
Subjects:	community decentralization health facilities local self governance act sub-health posts
Online Access:	http://103.69.126.140:8080/handle/123456789/265
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spelling	oai:103.69.126.140:123456789-2652022-11-08T10:29:33Z Evaluation Study of Decentralized Health Facilities in Nepal Health Care Delivery System Adhikari, K community decentralization health facilities local self governance act sub-health posts Background: After the enactment of Local Self Governance Act (LSGA) and its regulation 1999, Government of Nepal decided to decentralize management responsibility to its lower authorities. Although the government and its stakeholders who are involved in health sector decentralization have produced different studies, the comprehensive study covering the wider community coupled with literature review, self-observation and alongside the international experience was yet to be carried out. It was realized that a review of all related documents on decentralization of health facilities and handover status with the verification of SHPs with empirical data need to be carried out. This study is the one that has been carried out to realize those needs. Methods: Retrospective review coupled with cross sectional descriptive study was conducted. Information was basically collected from primary sources while literature review served the secondary source of information. Purposive sampling technique was applied putting the geographic regions into strata. Five districts, each representing each development region were selected. They were Jhapa, Lalitpur, Kaski, Banke and Kanchanpur. In-depth interviews and focused group discussions were carried out covering 30 SHPs (20% of the total handed over SHPs). Besides, on-site observation of few SHPs per district was also carried out. The data received were triangulated with other respondents. For in-depth interviews, key informants of central, district and village level were contacted. This research also reached out to the health management committee, SHP In-charges and exit clients level. Results: All categories of respondents and Sub-health post stakeholders were found positive towards the current effort of government in decentralizing its health services to local communities and emphasized the need of decentralized management of health services. However, this has also many weaknesses. Such weaknesses were found to be related with policy, process and most importantly with the mentality shift. The role at managerial level were found to be somewhat functioning. The health workers were not committed and motivated, health facilities lack required necessities, and there was no proper mechanism for staff professional development. Supply systems have always suffered from weak management. At the client level, very less amount of work was done to improve their service utilization part. Conclusions: The effort of government to decentralize its health services to local communities is most exciting and encouraging thing. In order to exploit the potentials of the decentralization in a full manner, the government, in particular the Ministry of Health and Population should document the impacts to date, learn from its experience and must demonstrate commitment to decentralization endeavors. Keywords: community; decentralization; health facilities; local self governance act; sub-health posts. 2016-11-09T04:58:35Z 2022-11-08T10:11:50Z 2016-11-09T04:58:35Z 2022-11-08T10:11:50Z 2006 Technical Report Nepal Health Research Council (NHRC) http://103.69.126.140:8080/handle/123456789/265 en_US application/vnd.openxmlformats-officedocument.wordprocessingml.document Nepal Health Research Council (NHRC)
institution	My University
collection	DSpace
language	en_US
topic	community decentralization health facilities local self governance act sub-health posts
spellingShingle	community decentralization health facilities local self governance act sub-health posts Adhikari, K Evaluation Study of Decentralized Health Facilities in Nepal
description	Background: After the enactment of Local Self Governance Act (LSGA) and its regulation 1999, Government of Nepal decided to decentralize management responsibility to its lower authorities. Although the government and its stakeholders who are involved in health sector decentralization have produced different studies, the comprehensive study covering the wider community coupled with literature review, self-observation and alongside the international experience was yet to be carried out. It was realized that a review of all related documents on decentralization of health facilities and handover status with the verification of SHPs with empirical data need to be carried out. This study is the one that has been carried out to realize those needs. Methods: Retrospective review coupled with cross sectional descriptive study was conducted. Information was basically collected from primary sources while literature review served the secondary source of information. Purposive sampling technique was applied putting the geographic regions into strata. Five districts, each representing each development region were selected. They were Jhapa, Lalitpur, Kaski, Banke and Kanchanpur. In-depth interviews and focused group discussions were carried out covering 30 SHPs (20% of the total handed over SHPs). Besides, on-site observation of few SHPs per district was also carried out. The data received were triangulated with other respondents. For in-depth interviews, key informants of central, district and village level were contacted. This research also reached out to the health management committee, SHP In-charges and exit clients level. Results: All categories of respondents and Sub-health post stakeholders were found positive towards the current effort of government in decentralizing its health services to local communities and emphasized the need of decentralized management of health services. However, this has also many weaknesses. Such weaknesses were found to be related with policy, process and most importantly with the mentality shift. The role at managerial level were found to be somewhat functioning. The health workers were not committed and motivated, health facilities lack required necessities, and there was no proper mechanism for staff professional development. Supply systems have always suffered from weak management. At the client level, very less amount of work was done to improve their service utilization part. Conclusions: The effort of government to decentralize its health services to local communities is most exciting and encouraging thing. In order to exploit the potentials of the decentralization in a full manner, the government, in particular the Ministry of Health and Population should document the impacts to date, learn from its experience and must demonstrate commitment to decentralization endeavors. Keywords: community; decentralization; health facilities; local self governance act; sub-health posts.
format	Technical Report
author	Adhikari, K
author_facet	Adhikari, K
author_sort	Adhikari, K
title	Evaluation Study of Decentralized Health Facilities in Nepal
title_short	Evaluation Study of Decentralized Health Facilities in Nepal
title_full	Evaluation Study of Decentralized Health Facilities in Nepal
title_fullStr	Evaluation Study of Decentralized Health Facilities in Nepal
title_full_unstemmed	Evaluation Study of Decentralized Health Facilities in Nepal
title_sort	evaluation study of decentralized health facilities in nepal
publisher	Nepal Health Research Council (NHRC)
publishDate	2016
url	http://103.69.126.140:8080/handle/123456789/265
work_keys_str_mv	AT adhikarik evaluationstudyofdecentralizedhealthfacilitiesinnepal AT adhikarik healthcaredeliverysystem
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Evaluation Study of Decentralized Health Facilities in Nepal

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