-
Harvey, O., van Teijlingen, E., Parrish, M. (2022) Mixed-methods research on androgen abuse – a review, Current Opinion in Endocrinology & Diabetes (accepted)
- Harvey, O., Parrish, M., van Teijlingen, E, Trenoweth, S. (2021) Libido as a reason to use non-prescribed Anabolic Androgenic Steroids, Drugs: Education, Prevention & Policy 29:3,276-288,DOI: 10.1080/09687637.2021.1882940
- Harvey, O., Keen, S., Parrish, M., van Teijlingen, E. (2019) Support for people who use Anabolic Androgenic Steroids: A Systematic Literature Review into what they want and what they access. BMC Public Health 19: 1024 https://doi.org/10.1186/s12889-019-7288-x https://rdcu.be/bMFon
- Harvey, O., Parrish, M., van Teijlingen, E., Trenoweth, S. (2020) Support for non-prescribed Anabolic Androgenic Steroids users: A qualitative exploration of their needs Drugs: Education, Prevention & Policy 27:5, 377-386. DOI 10.1080/09687637.2019.1705763
- Harvey, O., (2019) ECR Spotlight: From Social Work to Studying Steroids, HED Matters 2(2):16-19.
Category / REF Subjects
Dealing with difficult reviewers
This week saw the publication of another Bournemouth University paper on academic writing and publishing. This latest paper ‘Struggling to reply to reviewers: Some advice for novice researchers‘ has been published in the scientific journal Health Prospect: Journal of Public Health. This journal is published in Nepal and it is Open Access, hence freely available across the globe.
Peer review is the process by which academic journals assess and regulate the quality of content they publish, by inviting academic experts to review your submitted manuscripts. It is a process of quality control. Once you have submitted your paper to a journal the editor will select potential peer reviewers within the field of research to peer-review your manuscript and make recommendations. In many case the peer review process can be a positive experience for you as it allows you to develop your skills and improve your written work. For example, good reviewers may notice potential imbalances, point out missing key references or highlight different potential perspectives, and thus help you to enhance the overall quality of the paper. On some occasions, however a reviewer can be a complete pain in the neck!
The paper is written by a multidisciplinary team based in the Department of Nursing Sciences (Dr. Regmi), the Department of Social Sciences and Social Work (Dr. Harvey), and the Department of Midwifery & Health Sciences (Dr. Taylor & Prof. van Teijlingen). The authors bring their combined expertise in midwifery, social work, health education, sociology and health services research to offers the readers advice how to deal with the more difficult reviewers.
Reference:
- Harvey, O., Taylor, A., Regmi, P.R., van Teijlingen, E. (2022) Struggling to reply to reviewers: Some advice for novice researchers Health Prospect: Journal of Public Health 21(2):19-22
New paper on COVID-19 rumours in Nepal
The project is apart of the Health Research Network for Migrant Workers in Asia and it is led by Dr. Pramod Regmi (Department of Nursing Sciences), Dr. Shovita Dhakal-Adhikari (Department of Social Sciences and Social Work), Dr. Nirmal Aryal (formerly Department of Midwifery & Health Sciences and soon to be appointed in the Department of Nursing Sciences), external collaborator Dr. Sharada Prasad Wasti from the University of Huddersfield, and Prof. Edwin van Teijlingen (Department of Midwifery & Health Sciences).
Reference:
- Regmi, P., Dhakal Adhikari, S., Aryal, N., Wasti, S.P., van Teijlingen, E. (2022) Fear, Stigma and Othering: The Impact of COVID-19 Rumours on Returnee Migrants and Muslim Populations of Nepal, International Journal of Environmental Research and Public Health Accepted
RESEARCH PARTICIPANTS NEEDED FOR MRI STUDY
Have you ever wanted a picture of your brain?
We are looking for participants to take part in our MRI study,
examining memory and inhibition across adulthood.
We would like to hear from people between the ages of 20-35 or over the age of 60 years.
You would be asked to complete two tasks in the brain scanner.
REWARD: £20 Amazon Voucher
For more information please contact: mconstantinou@bournemouth.ac.uk
My Turing Scheme experience in Nepal
My name is Sulochana Dhakal-Rai. I am a final-year PhD student at Faculty of Health and Social Sciences (FHSS). My PhD research is related to factors affecting the rising rate of CS in urban hospitals in Nepal. There are several reasons to choose BU to do PhD study. Firstly, this university offers strong professional orientation with focus on academic excellence and employability to multinational students from multicultural background. Secondly, it provides opportunities to students for undertaking different activities, for example – international student exchange programme. I am always keen to be involved in such types of activities for my personal and professional development.
I applied for Turing Scheme Fund to do research activities in Nepal. The application process was very easy. I had received positive support from my supervisors and team of international grants. I was delighted to participate in international mobility, because I had a chance not only sharing my research experience to student and teachers at Manmohan Memorial Institute of Health Sciences (MMIHS), Kathmandu, but also to do my own research activities (secondary data verification and analysis).
Although, it was hot weather, polluted and over-crowded in Kathmandu, I enjoyed eating Nepali cuisine, meeting own people and speaking Nepali language. For me, there was not any problem in local language and culture. However, it was uncomfortable using public transport at times. I had suffered from of an episode of indigestion problem as well.
I loved meeting students and teachers of MMIHS. During my stay in MMIHS, I had the opportunity to share experience about my research study, using mixed methods in research study and my experience working as a foreign nurse in UK to relevant teachers and students. They were really good and inspiring people. I always received respect and support from them while I was there.
After this international activity, I have learnt how to work with people from different organisation and different place. I have developed my confidence in employability and career skills. I would like to express my thanks to Bournemouth University for providing me such a golden opportunity. I strongly recommend to other student at Bournemouth University to participate these kinds of international mobility programmes.
Sulochana Dhakal-Rai.
Bournemouth University Turing Scheme recipient in Kathmandu
Last month Ph.D. student Sulochana Dhakal-Rai in the Faculty of Health & Social Sciences (FHSS) returned from her successful trip to Nepal. Sulochana was awarded funding for her traineeship ‘Induction and sensitisation to field research health in Nepal.’ She presented at sessions organised for M.Sc. Nursing students at Manmohan Memorial Institute of Health Science (MMIHS) in Kathmandu. The feedback she received helped her prepare for her fieldwork in Nepal, moreover it was especially helpful in focusing her qualitative analysis of the thesis data. Soluchana also met with various academics at MMIHS to exchange ideas and research plans. Sulochana also took the opportunity to visit staff in maternity hospitals which are taking part in the Ph.D. research study which focuses on ‘The Rising Rates of Caesarean Section in Urban Nepal’. Sulochana has three FHSS supervisors, Dr. Juliet Wood, Dr. Pramod Regmi and Prof. Edwin van Teijlingen as well as Nepal-based supervisors Dr. Ganesh Dangel (FHSS Visiting Faculty) and Dr. Keshar Bahadur Dhakal.
Sulochana also contributed to a one-day workshop introducing systematic reviews as a methodology which ran on Sunday 29th May. This event was jointly organised between MMIHS and Bournemouth University as part Professors Vanora Hundley and Edwin van Teijlingen’s visit to Nepal.
Training on the Fuzzy Cognitive Mapping technique
A 3-day training on the Fuzzy Cognitive Mapping (FCM) technique has recently taken place, led by Dr Gonzalo Nápoles of Tilburg University, The Netherlands. Five BUBS academics belonging to the Digital Marketing Research Group participated in the training: Dr. Miguel Moital (organiser), Dr. Elvira Bolar (Leader of the group), Dr. Ediz Ackay, Dr. Danni Liang, and Dr. Kaouther Kooli. The training was funded by QR funds and was an opportunity to develop skills on a versatile and upcoming research technique, which is expected to be welcomed by high quality journals.
The FCM technique is a cause-effect relationship knowledge-based method for modelling complex decision-making systems of humans. It emerges from a combination of cognitive mapping and Fuzzy logic and artificial neural network, and this method is increasingly used in social sciences and humanities research. FCM is suitable to both data generated by the researcher as well as big data. The technique can be applied to a variety of research settings, such as consumer behaviour, organisational decision making and social/public policy decision-making.
Participants unanimously considered to have learned a lot over the three days. Dr Nápoles was able to explain the complexity of FCM principles in an accessible way, with engaging discussions taking place around how the technique can be used in social sciences / marketing research. Participants agreed that the ability of FCM to answer different research questions while enabling looking at the data in different ways opens up many opportunities for research. Plans for future collaboration with Dr. Nápoles at both individual and institutional level were discussed.
Dr Gonzalo Nápoles, from the Tilburg School of Humanities and Digital Sciences (Department of Cognitive Science and Artificial Intelligence), is a leading contributor to the development of the technique, having several publications on it. He is the lead developer of the FCM EXPERT software tool which can be used to carry out FCM analysis.
Can you help, sir?
Working in South Asia over the past two decades I have learnt to expect emails asking for help. Often from people I have met perhaps just once or twice or who are my friends on Facebook or LinkedIn. I tried to help if I can, but often I can’t. My friends and colleagues in Nepal, Pakistan, Bangladesh and India have a slightly different idea of how UK officialdom works. Perhaps they have a better and more realistic idea than I have, but that’s a different blog one day.
This week I wrote a reference for an employee of Green Tara Nepal, a charity we have been collaborating with for decades. This is someone I have had general dealing with, not someone who work on one of our projects. I have had interesting research discussions with her in Kathmandu, so I was happy to write her a reference. This morning I received a request via Facebook from someone from Nepal whom I have been advising on a number of job applications in Australia and the UK. On my advice, he had recently applied to a post at a university in London. Yesterday I asked me what to do as he had not heard from them. I advised him to email HR at that university and ask for an update. This morning his question was: “Can you ask them on my behalf, Sir”. I kindly replied: “Sorry, not my university”, not going into confidentiality issues, the data protection act, etc.
What I find fascinating as a sociologist is the ‘traditional society’ thinking behind these questions, which must be something along the lines of: “Edwin is in a senior position, he must be powerful, hence, he has influence in high places. I know him so he can help me achieve my goals.” The interesting other side of the coin is, of course, that if I do something, speak to someone on their behalf, write a reference or recommendation, etc. and the person is successful this success is (partly) attributed to me. And when I say that that’s not the way decision-making works in the UK, it is likely to be regarded as false modesty.
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health (CMMPH)
Celebrating FHSS Visiting Faculty’s contribution
It just occurred to me this morning that my last two scientific publications, including the one highlighted yesterday on the BU Research Blog are co-authored with academics who are FHSS Visiting Faculty. Yesterday’s paper ‘‘A survey of Post-Traumatic Stress Disorder, Anxiety and Depression among Flood Affected Populations in Kerala, India‘ [1], was co-authored by two of our Visiting Faculty: Prof. Padam Simkhada (in the School of Human & Health Sciences at the University of Huddersfield) and Dr. Brijesh Sathian (in the Geriatrics & Long-term Care Department at Rumailah Hospital, Qatar). Whilst last week’s publication ‘COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU (neonatal intensive care units)—an exploratory cross-sectional study‘ in the journal Acta Paediatrica [2] was co-authored by two Visiting Faculty members from University Hospitals Dorset NHS Foundation Trust. The two clinicians, who co-authored this international paper, are both based at Poole Maternity Hospital: Prof. Minesh Khashu (Lead Consultant Neonatologist) and Ms. Jillian Ireland (Professional Midwifery Advocate).
Both papers are Open Access, and hence free to access for anybody across the globe.
References:
- Asim, M., Sathian, B., van Teijlingen, E., Mekkodathil, A. A., Babu, M. G. R., Rajesh, E., Kumar, R. N., Simkhada, P., & Banerjee, I. (2022). A survey of Post-Traumatic Stress Disorder, Anxiety and Depression among Flood Affected Populations in Kerala, India . Nepal Journal of Epidemiology, 12(2), 1203–1214. https://doi.org/10.3126/nje.v12i2.46334
- Adama E.A., Koliouli F., Provenzi L., Feeley N., van Teijlingen E., Ireland J., Thomson-Salo F., Khashu M and FINESSE Group (2022) COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU—an exploratory cross-sectional study, Acta Paediatrica (forthcoming) https://onlinelibrary.wiley.com/doi/full/10.1111/apa.16455
British Journal of Social Work special issue on the voice and influence of people with lived experience
Follow the thoughts and reflections of the guest editorial team through our special issue blog series. The special issue of the British Journal of Social Work: Voice and Influence of people with lived experience is written, edited and reviewed by people with lived experience of social work. To date we have received 140 submissions across the three categories of academic papers, reflective pieces and creative artefacts. Follow our progress as we work toward publication in Spring 2023 via our blog series here
Invitation to the BCP Poverty Truth Commission launch
We would like to invite you to the Bournemouth, Christchurch ad Poole Poverty Truth Commission launch on Thursday 14th July 10-12.
The project so far
14 inspirational Community Commissioners (CCs) – those with lived experience of poverty locally – have agreed to become part of the Commission. They have been meeting together fortnightly since April to get to know each other, better understand the process, and tease out key themes common to their stories such as housing, mental health, rising costs, benefits. They have told the commission they already feel “less alone”, “really listened to” and “inspired”. They are now working together with the commission to design and prepare for the public launch event (10-12 on 14 July) where similar numbers of local leaders including myself (Mel Hughes) in my role as Academic lead for the BU PIER partnership will join them as Civic/Business Commissioners (CBCs) to work together to tackle the root causes of poverty over the coming year.
To book a place at the launch please register here
If you would like to discuss, please contact me directly mhughes@bournemouth.ac.uk
New BU disaster publication
Yesterday the latest issue of the Nepal Journal of Epidemiology carried our paper ‘A survey of Post-Traumatic Stress Disorder, Anxiety and Depression among Flood Affected Populations in Kerala, India‘ [1]. This paper was co-authored by two Faculty of Health & Social Sciences (FHSS) Visiting Faculty, namely Prof. Padam Simkhada (in the School of Human & Health Sciences at the University of Huddersfield) and Dr. Brijesh Sathian (in the Geriatrics & Long-term Care Department at Rumailah Hospital, Qatar). This study is longer-term follow-up of the 2018 floods in Kerala. The authors conducted a cross-sectional household survey between November 2019 to January 2020 in one district of Kerala with adults who had been directly exposed to the 2018 flood. The paper concludes that the vast majority of respondents (92% of women & 87% of men) still showed sub-clinical psychiatric symptoms one year after the flood. An earlier paper had argues for further research in India to explore “the long-term sequelae of catastrophic floods on physical and mental trauma on disaster-affected populations” [2].
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health (CMMPH)
References:
- Asim, M., Sathian, B., van Teijlingen, E., Mekkodathil, A. A., Babu, M. G. R., Rajesh, E., Kumar, R. N., Simkhada, P., & Banerjee, I. (2022). A survey of Post-Traumatic Stress Disorder, Anxiety and Depression among Flood Affected Populations in Kerala, India . Nepal Journal of Epidemiology, 12(2), 1203–1214. https://doi.org/10.3126/nje.v12i2.46334
- Asim, M., Mekkodathil, A., Sathian, B, Elayedath, R., Kumar N.R., Simkhada, P., van Teijlingen, E. (2019) Post-Traumatic Stress Disorder among the Flood Affected Population in Indian Subcontinent, Nepal Journal of Epidemiology 9(1): 755-758. https://www.nepjol.info/index.php/NJE/article/view/24003
Building International Partnerships
A current example he will highlight is one of Bournemouth University’s international research collaborations is the Nepal Federal Health System Project, led by the University of Sheffield. This three-year project (2020-2023) is funded by the Health Systems Research Initiative (incorporating the MRC, DFID, Wellcome Trust), it has partners in the UK and Nepal and bring together an interdisciplinary team of specialists in public health, sociology, health systems, social geography, health economic, political science, anthropology, medicine, emergency management, nursing & international development.
Sorry, the publication of your paper is being delayed because….
Yesterday a colleague in Nepal notified me that the publication of our latest paper has been delayed. This paper ‘Writing and publishing a reflective paper: Three case studies’ [1] is another method-type paper on aspects of academic writing and publishing published by BU academics and FHSS Visiting Faculty. A delay in getting in print is not uncommon in academic publishing, but usually the justification is that reviewers are sitting on the manuscript and not returning their report, or the journal editor can’t find academics to volunteer as reviewers, or the editor is ill. Occasionally the journal has too few papers to publish the next issue yet with your accepted paper in it, but this time the excuse was ever rarer.
We had submitted our paper to a brand new journal. A research collaborator in Kathmandu had asked me to submit a paper for the journal’s inaugural issue, which we did as we saw this a part of our role in academic capacity building in Nepal. The delay in publishing this journal is the shortage of ISSN [International Standard Serial Number] numbers in Nepal. Every good academic journal across the globe will have registered for a unique ISSN number [2]. Apparently the office issuing ISSN numbers in Paris head office has not delivered ISSNs to Nepal, and according to my colleague “many journals are waiting for a number …It’s not good news for the academic writers and scholars but we’re really sorry for late due to the unavailability of ISSN.”
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal and Perinatal Health
References:
- Arnold, R., Ireland, J., Mahato, P., van Teijlingen, E., (2022) Writing and publishing a reflective paper: Three case studies, Welham College Journal (accepted for publication)
- van Teijlingen, E.R., Dhakal Adhikari, S., Regmi, P.R., van Teijlingen, A., Aryal, N., Panday, S. (2021). Publishing, identifiers & metrics: Playing the numbers game. Health Prospect, 20(1).
Registration open: NIHR Training Camp 2022 virtual event, Tuesday 5 July, 12.30 – 17.15
Dear Colleagues
The NIHR doctoral training camp is a 3 day annual face to face event providing guidance and practical experience on putting together a successful application for funding.
By attending the virtual sessions run during day 1 of the NIHR Doctoral Training Camp, you will have access to the introductory plenary talks.
The event will include presentations on:
● How to sell yourself when applying for funding
● How to sell your project when applying for funding
● Effective patient and public involvement
● What funding panels are looking for in applications
Please see flyer relating to the virtual element of the NIHR Training Camp – Virtual 2022.pptx
Registration for the free event is here: Home Page – NIHR Doctoral Research Training Camp – Virtual (cvent.com)
Please do circulate to anyone that you feel this may be useful for.
Your local branch of the NIHR RDS (Research Design Service) is based within the BU Clinical Research Unit (BUCRU)
We can help with grant applications to National peer reviewed funders. We advise on all aspects of developing an application and can review application drafts as well as put them to a mock funding panel (run by RDS South West) known as Project Review Committee, which is a fantastic opportunity for researchers to obtain a critical review of a proposed grant application before this is sent to a funding body.
Contact us as early as possible to benefit fully from the advice
Feel free to call us on 01202 961939 or send us an email.
Parliamentary Knowledge Exchange Opportunity: Thematic Research Leads
Thematic Research Leads: Climate/Environment; International Affairs/Defence; Parliament, Public Administration and Constitution | 1 August 2022
Some very exciting news from Parliament – the Economic and Social Research Council (ESRC), POST and Parliament’s Knowledge Exchange Unit have launched new (paid!) roles for researchers keen to be involved in policy. The new Thematic Research Leads (TRLs) are aimed at mid-career university researchers who will work for three days per week (0.6 FTE) to place research evidence at the heart of UK Parliament through a pilot thematic policy hub of parliamentary staff. Colleagues undertake this role whilst retaining their substantive academic post for the remaining two days per week.
Thematic Research Leads will work alongside POST, library and select committee staff at UK Parliament to help ensure the best available research evidence feeds into scrutiny, legislation and debate. They will also strengthen and diversify connections between Parliament and the research community. The roles are funded by ESRC, appointees are expected to commence their role in January 2023. Details:
- Thematic Research Lead on Climate and Environment.
- Thematic Research Lead on International Affairs and Defence.
- Thematic Research Lead on Parliament, Public Administration and Constitution.
This webpage contains more information on the Thematic Research Lead Call, the shared ambitions of POST and the ESRC for this activity, and information on how to apply.
POST state: We really encourage applications from everyone regardless of their ethnicity, race, gender, religious beliefs, sexual orientation, age, marital status or whether or not they have a disability.
Colleagues who would need flexibility or hybrid working are encouraged to apply – POST are a flexible employee, are committed to support diversity and their employees, and will consider a range of requests to support colleagues to take up a post. Deadline: 1 August 2022
BU process for this opportunity
Because this is a funded position, RDS will need to treat your application in the way we normally would for any grant bid. With a submission deadline of 1 August, we look forward to receiving the completed e-ITBs by 4 July (for the costing request please attach an outline of how often you would want to travel, as this attachment is required).
You will need your Head of Department to agree in principle that you are able to commit 0.6FTE of your time if the application is successful and that we can arrange teaching replacement and funding, so please approach them as a first step. Full internal approvals will need to be completed by 26 July.
For guidance on the process please contact Beth Steiner and for any queries relating to the positions please contact Sarah Carter.
Finally the KEU outline why you should apply for this role:
“These roles, if proven, could become highly influential prestigious roles at the heart of Parliament, somewhat akin to the Government’s Chief Scientific Advisers, but shaped for a parliamentary context. The role offers an exciting opportunity for you to see first-hand how research feeds into policy, through shaping parliamentary work with your research expertise and participating in core parliamentary processes. You will be uniquely placed to build connections with parliamentary and government stakeholders to take forward through your career, and participation will provide you with rich and varied experiences to support you on an upward professional trajectory.”
Workshop ‘Sensitive Pasts and Difficult Presents: working with young people through participatory arts’ – 27th June, 2022
Some of you might be interested in this workshop, titled ‘Sensitive Pasts and Difficult Presents: working with young people through participatory arts‘, taking place this upcoming Monday, 27th June 2022, at BU (Talbot Campus). The workshop aims to bring together colleagues from across BU’s research centres, exploring how working with and for young people in sensitive contexts, both, locally and across the world, can be informed by interdisciplinary approaches (including Social Sciences, the Arts, and arts-based technologies).
Several colleagues will provide short presentations and thought pieces based on their research and experiences in the application of participatory arts-based methods in such contexts. Including a ‘world café’, the workshop aims to provide a forum to compare and exchange our experiences, learning and research outcomes rather than a classic, entirely lecture-based format.
This event is organised by the Centre for Seldom Heard Voices (Stephanie Schwandner-Sievers; RA Emily Fisher). The workshop includes colleagues from CEMP, CESJ, EMERGE, and further members are warmly invited to attend. We hope this event will be of particular interest to colleagues working in and through the participatory arts, specifically with vulnerable or marginalised groups, internationally or closer to home.
New paper on federalisation of health system in Nepal
Earlier this week the editor of the Journal of Nepal Public Health Association informed us the journal had accepted our latest paper ‘Health System Strengthening: The Role of Public Health in Federal Nepal’ [1]. 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. This is the third paper of our three-year project, which is UK-funded by the MRC, Wellcome Trust and DFID under the Health Systems Research Initiative and led by Dr. Julie Balen and Prof. Simon Rushton based at the University of Sheffield. The first two papers introduced our international research project ‘The impact of federalisation on Nepal’s health system: a longitudinal analysis’ [2], and focused on COVID-19 when examining the effects of changing Nepal’s constitution towards a federal republic on its health system [3].
Prof. Edwin van Teijlingen
CMMPH (Centre for Midwifery, Maternal & Perinatal Health Research)
References
- Sapkota, S., Panday, S., Wasti, S.P., Lee, A., Balen, J., van Teijlingen, E., Rushton, S., Subedi, M., Gautam, S., Karki, J., Adhikary, P., Marahatta, S., Simkhada, P. for the Nepal Federal Health System Team (2022) Health System Strengthening: The Role of Public Health in Federal Nepal, Journal of Nepal Public Health Association (forthcoming).
- Rushton, S., Pandey, S., van Teijlingen, E., Subedi, M., Balen, J., Karki, J., Simkhada, P. on behalf of the Nepal Federal Health System Team (2021) An Investigation into the Impact of Decentralization on the Health System of Nepal. Journal of Manmohan Memorial Institute of Health Sciences, 7(1): 3–14. https://doi.org/10.3126/jmmihs.v7i1.43146
- Adhikary, P., Balen, J., Gautam, S., Ghimire S., Karki J.K., Lee A.C., Marahatta S.B., Pandey S., Pohl G., Ruston S., Sapkota S., Simkhada P.P., Subedi M., van Teijlingen E.R., on behalf of the NFHS Team. The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system. Journal of Karnali Academy of Health Sciences. 2020; 3(3)