Barriers and facilitators to the implementation of a national multisectoral action plan for the prevention and control of noncommunicable diseases in Nepal: perspectives of stakeholders

Abstract

Background Nepal adopted the Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (MSAP) in 2014. Implementation of the plan has been challenging, with limited participation from non-health sectors. Objectives The overall aim of the study was to gain the perspectives of key stakeholders involved in the Nepal MSAP on the barriers and facilitators to its implementation, through the participation of relevant sectors in the plan. Methods We held face-to-face semi-structured interviews with 12 stakeholders working in sectors involved in the MSAP. These sectors included the Office of the Prime Minister and Council of Ministries; Ministry of Health and Population (MOHP); Ministry of Education, Science and Technology; Ministry of Forest and Environment; academia; and professional organizations. Thematic analysis of transcripts was used to identify themes on awareness of NCDs, awareness of the MSAP, and barriers and facilitators to participation in the MSAP. Results Participants recognised NCDs as a growing and major burden in Nepal. However, a number of participants were not familiar with the MSAP, identifying a lack of leadership and poor dissemination. Political and systemic transformation, since the adoption of the MSAP, was seen as a key barrier to implementation. International commitments to develop multisectoral action made by the Government of Nepal were identified as drivers. The recent establishment of a separate section for NCDs and Mental Health within the Department of Health Services of MOHP and the promotion of a Health in All Policies (HiAP) approach in recent national documents, were both considered to support implementation. Conclusions The establishment of permanent multisectoral or multistakeholder mechanisms has been challenging despite strong political calls for their development. Moving beyond 2020, multisectoral action plans should engage with stakeholders from federal, provincial and local governments in order to develop costed action plans with specific roles and responsibilities for each sector.

Population-Level Interventions Targeting Risk Factors for Hypertension and Diabetes in Rwanda: A Situational Analysis

“…Strengthened community awareness campaigns and strengthened multi-sectoral collaboration and strengthen stakeholders' involvement in designing and planning of the ongoing interventions is essential and would be of a great importance to rise community and stakeholders knowledge and engagement in on going intervention. It is indeed reported as a key to successful implementation of NCDs prevention interventions in other settings (61,62). Training and involving more community members in design and implementation of these intervention would be a locally made solution to limited health professionals involved in these activities.…”

Implementation Research in Nepal – A Scoping Review, 2015-2022

“…The details and the conclusions of the included studies are presented in Table 2. The objectives of the studies are diverse that includes measuring implementation outcomes; 14,15 reporting implementation challenges; 16 adaptation; 17,18 exploring facilitators and barriers to implementation; 19,20 capacity building; 21 exploring readiness and capacity; [22][23][24][25][26][27][28] identify or test implementation strategy; [29][30][31][32][33] and stakeholder engagement. 9,34 Nine articles evaluated implementation.…”

“…9,34 Twelve research were conducted to understand what influenced implementation. [18][19][20][22][23][24][25][26][27][28]31,37 However, many of these articles are not specific to an EBP or implementation strategies. Seven of these articles investigated barriers to implement cardiovascular disease prevention and management in general, following the guidelines from the WHO health system building blocks.…”

“…[22][23][24][25][26][27]37 One article explored factors and barriers to implement a national multi-sectoral action plan. 20 Others explored facilitators and barriers to implementing health interventions or implementation strategies. 18,19,28,31 Five studies have not reported any theory or frameworks; 15,17,19,20,31 three reported using Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM); 29,30,33 Six have used health system building blocks framework; [22][23][24][25][26][27] one used Consolidated Framework for Implementation Research (CFIR); 38 one used performance of routine information system framework; 14 one used participatory implementation research; 16 Emerald capacity building activities; 35 two used Ray and Miller stakeholder engagement framework; 9,34 and one use health system assessment approach.…”

“…20 Others explored facilitators and barriers to implementing health interventions or implementation strategies. 18,19,28,31 Five studies have not reported any theory or frameworks; 15,17,19,20,31 three reported using Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM); 29,30,33 Six have used health system building blocks framework; [22][23][24][25][26][27] one used Consolidated Framework for Implementation Research (CFIR); 38 one used performance of routine information system framework; 14 one used participatory implementation research; 16 Emerald capacity building activities; 35 two used Ray and Miller stakeholder engagement framework; 9,34 and one use health system assessment approach. 37 Most of the research was funded by the European Union, National Institute of Health USA, United States Agency for International Development (USAID), Medical Research Council UK, or the WHO; four did not report funding sources; and one stated that there was no funding (Table 2).…”