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BU conference presentation Federalisation & Nepal’s health system

international, Publishing, writing

The health system in Nepal’s unique federalisation experiment will be presented by Prof. Edwin van Teijlingen at a three-day conference at the Far Western University, Nepal on Saturday 8th February.  Nepal’s introduction of its federal system in the 2015 Constitution changed the way society, including its health system, was organised.  It meant that political changes and health systems changes occurred in parallel.  Prof. Edwin van Teijlingen explores the impact of federalisation on Nepal’s health system as part of an interdisciplinary mixed-methods study* called ‘The Impact of Federalisation on Nepal’s Health System: A longitudinal Analysis’.

First, implementing a new federal system is a slow, resource intensive process. While building new federal structures is important, challenging the status quo through strategic “unlearning and undoing” of old tendencies is also essential, as this creates spaces for new approaches that are more in line with federalism. This requires attention to emotional and political spheres, and not just structural or technical ones.

Federalisation, generally, brought decision making, resources and service delivery closer to the people, yet the process remains challenging and incomplete. Importantly, at the same time as federalism was being introduced, Nepal’s health system had to respond to COVID-19, making it difficult to disentangle the effects of the pandemic from those of federalisation. The health system is also part of a broader, complex, and interdependent set of socio-political, economic, legal, and cultural systems.

We found that the impact of federalisation varied across the six WHO building blocks and pre-existing conditions, e.g. wealthier regions often benefit disproportionately, exacerbating inequities in health.  Our study further highlighted: (a) the importance of leadership and governance, combined with financing mechanisms; (b) insufficient planning and misalignment between central and local levels resulting in inefficiencies; (c) weak health information systems hinder the ability to measure long-term effects.  Overall, unlocking the full potential of federalism will require political will and commitment at all three levels of government.

To date eight papers have been produced based in this project [1-8].

 

References:

  1. Koirala, B., Rushton, S., Adhikary, P., Balen, J., et al. (2024) COVID-19 as a challenge to Nepal’s newly federalised health system: capacities, responsibilities, and mindsets, Asia Pacific Journal of Public Health (online first) https://doi.org/10.1177/1010539524125012.
  2. Sapkota, S., Rushton, S., van Teijlingen, E., et al. (2024) Participatory policy analysis in health policy and systems research: reflections from a study in Nepal. Health Research & Policy Systems, 22 (No.7) https://doi.org/10.1186/s12961-023-01092-5 .
  3. Wasti, S.P., van Teijlingen, E., Simkhada, P., et al. (2023) Selection of Study Sites and Participants for Research into Nepal’s Federal Health System, WHO South-East Asia Journal of Public Health 12(2):116-119.
  4. 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.
  5. 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
  6. 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.
  7. 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.
  8. 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

Impact of federalisation on Nepal’s health system

conferences, international, Publishing, writing

On Boxing Day and the following day (Dec. 27th) a member of our research team, Amshu Dhakal based at Manmohan Memorial Institute of Health Sciences (MMIHSS), presented findings from our Nepal Federal Health System Project in Kathmandu.  The event, Nepal Health Conclave 2024, was organised by the Ministry of Health and Population and supported by WHO (World Health Organization) Nepal and UNFPA.  The event aimed to help strengthen Nepal’s health services.  This year’s conclave, themed “Bridging the Gap Between Global Expertise and National Needs”, brought together Nepalese diaspora health professionals and national stakeholders to foster collaboration and innovation in health systems.

Amshu presented two posters at the event: (1) The Impact of Decentralisation on Health Systems: A Systematic Review of Reviews which systematically reviewed how decentralisation affects health systems globally, highlighting key opportunities and challenges across WHO’s six building blocks; and (2) Transforming the Health System in Nepal: The Impact of Federalisation, which examined how the transition to a federal system reshaped Nepal’s health system, identifying gaps, opportunities, and actionable recommendations for improvement.

Our research team produced policy briefs in collaboration with government officials/stakeholders from all three levels of government.  The policy briefs can be accessed at the website of our Nepal Federal Health System Project.  This study was funded by the UK Health Systems Research Initiative [Grant ref. MR/T023554/1] to study the consequences for the health system of Nepal’s move from a centralised political system to a more federal government structure in 2015.  This joint project was led by the University of Sheffield in collaboration with Bournemouth University, the University of Huddersfield, Canter Bury Christ Church University and two institutions in Nepal, namely MMIHS and PHASE Nepal. 

In late 2022 further funding was awarded by the Medical Research Foundation to Prof. Julie Balen, from Canterbury Christ Church University, to disseminate the findings of our UK Health Systems Research Initiative-funded research in Nepal. In terms of academic dissemination, we have published eight papers from this interdisciplinary project [1-8].

 

Prof. Edwin van Teijlingen

Centre for Midwifery & Women’s Health

 

References:

  1. Koirala, B., Rushton, S., Adhikary, P., Balen, J., et al. (2024) COVID-19 as a challenge to Nepal’s newly federalised health system: capacities, responsibilities, and mindsets, Asia Pacific Journal of Public Health (online first) https://doi.org/10.1177/1010539524125012.
  2. Sapkota, S., Rushton, S., van Teijlingen, E., et al. (2024) Participatory policy analysis in health policy and systems research: reflections from a study in Nepal. Health Research & Policy Systems, 22 (No.7) https://doi.org/10.1186/s12961-023-01092-5 .
  3. Wasti, S.P., van Teijlingen, E., Simkhada, P., et al. (2023) Selection of Study Sites and Participants for Research into Nepal’s Federal Health System, WHO South-East Asia Journal of Public Health 12(2):116-119.
  4. 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.
  5. 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
  6. 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.
  7. 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.
  8. 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

Editorial accepted by Frontiers in Public Health

international, open access, Publishing, writing

As part of the special issue in Frontiers in Public Health on ‘Evidence-based approaches in Aging and Public Health’ the guest editors included 15 academic papers.  These 15 contributions to the Special Issue were introduced in placed in perspective in our editorial ‘Editorial: Evidence-based approaches in Aging and Public Health‘ [1] which was accepted for publication two days ago.   The guest editors included two Visiting Faculty to FHSS: Prof. Padam Simkhada and Dr. Brijesh Sathian.

 

Prof. Edwin van Teijlingen

Centre for Midwifery & Women’s Health (CMWH)

Reference:

  1. Sathian, B., van Teijlingen, E., Simkhada, P., Kabir, R., Al Hamad, H. (2024) Editorial: Evidence-based approaches in Aging and Public Health, Frontier in Public Health 12 2024 https://doi.org/10.3389/fpubh.2024.1391432

It is all about experience

Delicious links, international, Knowledge Exchange, PG research, Publishing, student research, Women's Academic Network, writing

This week we published a paper on the experience of conducting fieldwork in the public health field in the Journal of Health Promotion. [1] Fieldwork is usually a crucial part of PhD research, not only in the health field. However, few researchers write about this, often challenging, process. This paper highlights various occasions where fieldwork in the area of public health, health promotion or community health was more difficult than expected or did not go as planned. Our reflections on working in the field are aimed at less experienced researchers to support them in their research development. Moreover, this paper is also calling upon health researchers to share more details about the process of doing fieldwork and its trials and tribulations. Our key advice is to be inquisitive and open-minded around fieldwork, followed by: be prepared for your fieldwork, conduct a risk assessment of what might go wrong, and consider your resources and options to overcome such trials and tribulations. Fieldwork can be unpredictable.  We believe it is important to share practical lessons from the field which helps other to better understand these tribulations, and learn from them. Finally, sharing such information may guide new researchers and help them identify strategies that can address those issues and challenges in their future studies.

Dr. Preeti Mahato (at Royal Holloway, University of London), Dr Bibha Simkhada and Prof. Padam Simkhada (both based at the University of Huddersfield) are all BU Visiting Faculty.  Moreover, I have had the pleasure of acting as PhD supervisor for five of my co-authors.  I have included in this blog what is probably my favourite fieldwork photo taken a decade ago by former BU PhD student Dr. Sheetal Sharma.

Prof. Edwin van Teijlingen

CMMPH (Centre for Midwifery, Maternal & Perinatal Health)

 

References:

  1. Mahato, P., Tamang, P., Simkhada, B., Wasti, S. P., Devkota, B., Simkhada, P., van Teijlingen, E.R. (2022) Reflections on health promotion fieldwork in Nepal: Trials and tribulations. Journal of Health Promotion 10(1): 5–12. https://doi.org/10.3126/jhp.v10i1.50978