BU Research Blog

December 22, 2023

New Nepal paper published

international, Publishing, writing Edwin van Teijlingen

BMJ Global Health published our latest paper today under the title ‘The impact of decentralisation on health systems: a systematic review of reviews‘ [1]. This so-called review of reviews is part of a larger study funded by the UK Health Systems Research Initiative [Grant ref. MR/T023554/1]. in this larger Nepal Federal Health System Project we study the consequences for the health system of Nepal’s move from a centralised political system to a more federal government structure. This joint project is led by the University of Sheffield in collaboration with Bournemouth University, the University of Huddersfield, and two collaborating institutions in Nepal, namely Manmohan Memorial Institute of Health Sciences (MMIHS) and PHASE Nepal. We have managed to publish four papers from this project prior to today’s one. [2-5]

This latest paper, is Open Access and it includes nine reviews, each addressing somewhat different questions, contexts and issues. More negative than positive impacts of decentralisation on health system building blocks were identified. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on the overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself. This review highlights some of the common potential issues to consider in advance.

Prof. Edwin van Teijlingen

CMWH (Centre for Midwifery & Women’s Health)

References:

Sapkota, S., Dhakal, A., Rushton S., et al. (2023) The impact of decentralisation on health systems: a systematic review of reviews. BMJ Global Health 8:e013317. doi:10.1136/bmjgh-2023-013317.
Wasti, S.P., van Teijlingen, E., Rushton, S., et al. (2023) Overcoming the Challenges Facing Nepal’s Health System During Federalisation: An Analysis of Health System Building Blocks, Health Research Policy & Systems 21(117) https://doi.org/10.1186/s12961-023-01033-2
Sapkota, S., Panday, S., Wasti, S.P., et al. (2022) Health System Strengthening: The Role of Public Health in Federal Nepal, Journal of the Nepal Public Health Association 7(1):36-42.
Adhikary, P., Balen, J., Gautam, S., et al. (2020) 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 3 (3): 1-11.
Rushton, S., Pandey, S., van Teijlingen, E., et al. (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

April 22, 2023

Extensive media coverage in Nepal last week

international, Knowledge Exchange, Public engagement Edwin van Teijlingen

The interdisciplinary research project ‘The impact of federalisation on Nepal’s health system: a longitudinal analysis’ was reported in several national media in Nepal last week. This project running from 2020 to 2024 is, funded by the Health System Research Initiative, a UK collaboration between three funders: the MRC (Medical research Council), the Foreign, Commonwealth & Development Office, and the Welcome Trust.

The 2015 Constitution brought federalisation and with it, significant changes to the health system. To understand these changes researchers worked in three provinces where they interviewed 243 stakeholders, at all three levels of government. They also conducted 31 Participatory Policy Analysis workshops at local and province levels. The team includes researchers from Manmohan Memorial Institute of Health Sciences (Kathmandu), and PHASE Nepal (Bhaktapur), and three UK institutions (the Universities of Sheffield, Bournemouth, and Huddersfield). It researchers from the UK and Nepal meet with Provincial and Federal MPs to discuss the interim findings of a federalisation and health study.

News articles appeared in national newspapers in Nepal, both in English and Nepali. The Nepali article appeared in the country’s oldest newspaper Gorkhapali, see copy here! Bournemouth University [Thank you Nathaniel Hobby and Stephen Bates] also publicized our press release on this project online. The journalist Nam Raj Bhatta published an item in the online Nepali-language newspaper NepalHealthOnline on April 13. The main meeting to discuss the interim findings of our project took place on Thursday 13 April an hotel close Nepal’s parliament. The interim results highlight how federalisation of the political system has affected Nepal’s health care organisation. The research team summarized the findings for the invited MPs and local and provincial political leaders, and invited their reflections on the political possibilities and obstacles to moving forward with the development of the country’s health system. The Himalayan Times published the article on top of this BU Research Blog as well as the special interview with the University of Sheffield based PI Prof. Simon Rushton.

Prof. Edwin van Teijlingen

Centre for Midwifery, Maternal & Perinatal Health

June 17, 2022

New paper on federalisation of health system in Nepal

international, Publishing, writing Edwin van Teijlingen

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)

January 13, 2021

2021: More COVID-19 publications

open access, Publishing, writing Edwin van Teijlingen

The year 2021 started in many ways in the same way as it had ended with a country gripped in COVID-19 and a national lock down to limit the spread of the disease. It is appropriate timely that the first publication from our international collaboration, studying the health system in Nepal, focuses on COVID-19 [1]. This academic paper forms part of our on-going study of the decentralisation of the Nepal health system. The study is run by the University of Sheffield, the University of Huddersfield and Bournemouth University in the UK and PHASE Nepal and Manmohan Memorial Institute of Health Sciences in Nepal. The study is funded by the UK Health Systems Research Initiative.

This paper was unplanned as nobody (neither in the UK or in Nepal) had heard of COVID-19 when we submitted the grant application in mid-2019. It was only when we started our project officially in April 2020 that COVID-19 had become the pandemic it is today. We took the opportunity to assess some of the early evidence on the effectiveness of the actions taken to deal with COVID-19 by the national government as well as provincial and local governments and the levels of cooperation and coordination between them.

Authors on this include BU PhD graduate Dr. Pratik Adhikary and FHSS Visiting Professor Padam Simkhada, as well as our collaborator on other funded projects, Dr. Sujan Marahatta from Manmohan Memorial Institute of Health Sciences (Nepal).

Prof. Edwin van Teijlingen

CMMPH

Reference:

Adhikary P, Balen J, Gautam S, Ghimire S, Karki JK, Lee AC, Marahatta SB, Pandey S, Pohl G, Ruston S, Sapkota S, Simkhada PP, Subedi M, van Teijlingen ER, 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)

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