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 . 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
- 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)
Today and tomorrow Sulochana Dhakal-Rai will have her poster ‘Factors contributing to rising Caesarean Section rates in South Asia: a systematic review’ online at this year’s GLOW Conference [Global Women’s Research Society Conference]. This year for the first time, this international conference is held completely online. Sulochana’s PhD project is supervised by Dr. Pramod Regmi, P., Dr. Juliet Wood and Prof Edwin van Teijlingen at BU with Prof. Ganesh Dangal [Professor of Obstetrics and Gynaecology at Kathmandu Model Hospital] who acts as local supervisor in Nepal. Sulochana has already published two papers from her on-going thesis research [1-2].
- Dhakal-Rai, S., Regmi, PR, van Teijlingen, E, Wood, J., Dangal G, Dhakal, KB. (2018) Rising Rate of Caesarean Section in Urban Nepal, Journal of Nepal Health Research Council 16(41): 479-80.
- Dhakal Rai, S., Poobalan, A., Jan, R., Bogren, M., Wood, J., Dangal, G., Regmi, P., van Teijlingen, E., Dhakal, K.B., Badar, S.J., Shahid, F. (2019) Caesarean Section rates in South Asian cities: Can midwifery help stem the rise? Journal of Asian Midwives, 6(2):4–22.
New BU co-authored article ‘Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal’ will be published soon . This paper has been accepted by the international journal Global Health Action (published by Taylor & Francis). The international authorship comprises Nepal, Denmark and the UK.
Nepal is currently facing a double burden of non-communicable diseases (NCDs) and communicable diseases, with rising trends in the former. This situation will add great pressure to already fragile health systems and pose a major challenge to the country’s development unless urgent action is taken. The paper argues that while the primary health care approach offers a common platform to effectively address NCDs through preventive and curative interventions, its potential is not fully tapped in Nepal. In line with the Alma-Ata and Astana declarations, the authors propose an integrated approach for Nepal, and other low-and middle-income countries, including six key reforms to enhance the primary care response to the increasing burden of NCDs. These six key areas are: (1) Life-course approach to addressing NCDs; (2) Task shifting for NCD risk factor management; (3) Strengthening informal care givers; (4) Strengthening quality of PHC and health systems; (5) Establish strategic information management system; and (6) Healthcare financing.
Prof. Edwin van Teijlingen
- Gyawali, B., Khanal, P., Mishra, S.R., van Teijlingen, E., Meyrowitsch, D.W. (2020) Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal, Global Health Action (accepted) https://doi.org/10.1080/16549716.2020.1788262
Updated message (8 July 2020): due to floods in Assam this week this international conference has been postponed by a few weeks.
If you are interested in a more global perspective of COVID-19 you may want to attend the upcoming Online International Conference “COVID-19: A Global Perspective” to be held from 29 to 31 July, 2020 by the PG Department of Economics, Gossaigaon College, Gauhati University, Assam, INDIA. BU will be contributing to the sub-theme COVID-19 and its impact on the health sector.
Professor Edwin van Teijlingen
In early December the Maternal & Child Health Journal accepted our latest research paper on maternity care based in Nepal . The first author, Amrit Banstola, is based in Nepal and this exciting paper is co-authored with several Nepal-based collaborators as well as BU Visiting Faculty Prof. Padam Simkhada. Prof. Simkhada recently moved from Liverpool John Moores University to the University of Huddersfield. The target journal Maternal & Child Health Journal has an Impact Factor of 1.736.
The Government of Nepal is trying to expand and improve the quality of maternal and neonatal health service delivery in more remote areas of the country. However, relatively little is known about the preparedness of maternity care facilities to providing Emergency Obstetric Care (EmOC) in remote and rural areas. In order to achieve improvement maternal health services in one remote district to help achieve the sustainable development goals (SDGs). Our study assesses what birthing centres exist and how ready these are to provide EmOC services in Taplejung District.
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health
- Banstola, A., Simkhada, S., van Teijlingen, E., Bhatta, S., Lama, S., Adhikari, A, Banstola A., The availability of emergency obstetric care in birthing centres in rural Nepal: A cross-sectional survey, Maternal & Child Health Journal. (accepted).
Congratulations to FHSS academics Dr. Pramod Regmi and Dr. Nirmal Ayral who published an editorial yesterday in a scientific journal in Nepal. The paper ‘Experts warn Nepal Government not to reduce local Public Health spending’  was co-authored by Dr. Bibha Simkhada who has just been offered a post as Lecturer in Nursing in the Department of Nursing & Clinical Sciences, she shall be starting with us on November 1st. Further co-authors include FHSS Visiting Professor Padam Simkhada and Dr . Sujan Marahatta, the journal’s editor. He is based at Manmohan Memorial Institute of Health Sciences (MMIHS) in Kathmandu, Nepal. Bournemouth University has a long-standing research collaboration with MMIHS.
The editorial warns about the risks of losing the focus on public health and its wider national and global perspective in the recently changed political arena of Nepal. Since 2015 Nepal has moved from a central state to a federal republic, whereby the seven new Provinces have gained much more power and control in the decentralisation process. Moreover the first local elections for two decades in 2017 meant a lot of new and inexperienced local politicians were voted in. Many of these local people had little prior experience of political processes, governing health systems, the notion of priority setting, running sub-committees of elected representatives, political decision-making at local level, etc. The paper argues that Public Health can easily disappear of the radar. The untrained newly elected representatives with no political experience are most likely to be drawn into proposing and supporting popular measures including developing new buildings, black-top roads, hospitals, etc., rather than measures that increase the local or regional budget for teachers, Continuous Professional Development (CPD) for community health workers, and preventative public health measures in general. Buildings and roads are immediate demonstration to voters that politicians have done something useful, reducing maternal mortality by 2.6% or employing two additional health workers doesn’t give politicians neither the same publicity, nor do such policies have immediate signs of success, and hence are unlikely to be vote winners.
The Journal of Manmohan Memorial Institute of Health Sciences is part of the Open Access publishing of Nepal Journals OnLine (NepJOL) supported by INASP. The editorial also illustrates the kind of work conducted in Bournemouth University’s Integrative Wellbeing Research Centre (iWell).
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health (CMMPH)
Simkhada, P., Teijlingen van, E., Simkhada, B., Regmi, P., Aryal, N., Marahatta, S.B. (2018) Experts warn Nepal Government not to reduce local Public Health spending, Journal of Manmohan Memorial Institute of Health Sciences, 4(1): 1-3.