Conditional cash transfer policies in maternal health service utilization in <scp>Nepal</scp>: Analysis of safe delivery incentive program (<scp><i>Aama Surakshya Karyakram</i></scp>) using Kingdon's multiple streams framework

Khanal, Geha Nath

doi:10.1002/hpm.2691

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…The problem stream helped to explain why and how some issues attract public and policymakers' attention, while others do not . As most interviewees pointed out, the issue caught government attention mainly due to the nutrition, demographic and epidemiological transition (indicators or statistics of the problem) in Iran.…”

Section: Resultsmentioning

confidence: 99%

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis

Edalati

Omidvar

Roudsari

et al. 2019

Health Planning & Management

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Background: Nutrition labelling is a strategy to promote healthy eating and combat non-communicable diseases (NCDs). The present study aimed to provide an analysis of the nutrition labelling policy and its opportunities to improve in Iran.Methods: Data were collected by 1) reviewing relevant documents and 2) semi-structured interviews with stakeholders through purposive and snowball sampling, continued until data saturation was achieved. A deductive content analysis was used by applying the policy triangulation framework and the Kingdon multiple stream theory. MAXQDA software was used to manage data analysis.Results: Iran, is the first country in the Eastern Mediterranean region which has accomplished to implement nutrition traffic light labelling. The main contextual factors that affected nutrition labelling policy to become a national included health, political commitment, and international factors. Poor involvement of media for public awareness of nutrition traffic labeling, the inconsistency of nutrition traffic light color ranking using food standard guidelines, lack of consistency between nutrition traffic light colors and the healthy/unhealthy nature of some food products and the absence of a comprehensive evaluation plan were among the policy challenges identified.Conclusions: Strengthening the governance for a healthy food environment is recommended to improve the program.Also, establishing national portion sizes for food labelling,

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Section: Resultsmentioning

confidence: 99%

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis

Edalati

Omidvar

Roudsari

et al. 2019

Health Planning & Management

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“…Finally, financial protection against economic consequences of disease and injury has been done through various cost-sharing interventions like free basic health services, conditional cash transfer mechanisms, subsidies to disadvantaged and minority groups, and implementation of a national health insurance programme. However, these interventions are implemented rather on a fragmented basis (Witter et al, 2011;Knaul et al, 2012;Khanal, 2018;Ranabhat et al, 2019). The major actions and the guiding policy instruments for social protection in health in Nepal is presented in Figure 1.…”

Section: Social Protection In Health Sector In Nepalmentioning

confidence: 99%

Social Protection in Health: Characteristics and Coverage of Health Insurance Programme in Nepal

Khanal¹,

Regmi

2020

J. Social Protection

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The agenda of social protection has become very popular in recent years. Several social protection programs in healthcare are designed to increase the healthcare coverage, ensure financial protection and enhance the scope and quality of services and access to medicines which ultimately paves the way for universal health coverage. The national health insurance programme (NHIP) is one of the approaches implemented in Nepal to cover healthcare expenditure. This paper discusses the gradual development of the health insurance programme in Nepal and the key features of NHIP that have been implemented since 2016. It further highlights the implementation status of NHIP, the milestones it covered, and the role of political parties in implementing NHIP in Nepal. Furthermore, the paper discusses the challenges associated with enrollment of formal and non-formal sectors, the mismatch between geographical coverage and the number of service contact points, and commitment from the political parties for effective implementation of NHIP. It seeks major implementation reforms to ensure effective implementation of NHIP.

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“…Nepal has introduced different social protection schemes to reduce such catastrophic expenditures. These schemes aim to improve the health status of people, and include voluntary private insurance, Social Security Fund (SSF), Employee Provident Fund (EPF) and enterprise private insurance, free healthcare, conditional cash transfer programmes, impoverished citizens’ programme and National Health Insurance Program (NHIP) [ 13 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the National Health Insurance Program of Nepal: are political promises translated into actions?

Khanal¹,

Bharadwaj

Upadhyay

et al. 2023

Health Res Policy Sys

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Background Despite political promise to reduce out-of-pocket (OOP) expenditure on healthcare through the National Health Insurance Program (NHIP) of Nepal, its implementation is challenging with low enrolment and high drop-out rates. Program performance can often be linked with political economy considerations and interests of stakeholders. This study aimed to develop an in-depth understanding of organizational and systemic challenges in implementing NHIP. Methods We conducted a structured narrative review of available literature on the NHIP in Nepal. We analysed data using a political economy analysis for health financing reform framework. The findings were explained under six broad categories: interest groups, bureaucracy, budgets, leadership, beneficiary and external actors. In addition, we triangulated and further presented the literature review findings using expert opinions (views expressed in public forums). Results Nepal has formulated acts, rules, regulations, and policies to implement NHIP. Under this program, the Health Insurance Board (HIB) is the purchaser of health services, and health facilities under the Ministry of Health and Population (MoHP) are the providers. The NHIP has been rolled out in all 77 districts. Several challenges have hindered the performance of NHIP at the policy and implementation levels. Challenges under interest groups included inadequate or delayed reimbursement and drop-out of hospitals in implementing the programme. Bureaucracy-related challenges were hegemony of provider over the purchaser, and inadequate staff (delay in the approval of organogram of HIB). There was inadequate monitoring of premium collection, and claim reimbursement was higher than collected premium. Challenges under leadership included high political commitments but weak translation into action, consideration of health insurance as poor return on investment, and intention of leaders to privatize the NHIP. Beneficiaries experienced compromised quality of care or lack of services when needed, high drop-out rates and low interest in renewal of premiums. External actors provided technical assistance in policy design but limited support in implementation. Conclusions Despite enabling a policy environment, the NHIP faced many challenges in implementation. There is an urgent need for institutional arrangements (e.g. digitalization of claims and reimbursement, endorsement of organogram of HIB and recruitment of staff), increased coverage of financial protection and service (increased benefit package and introduction of cost-sharing/co-payment model), legislative reforms (e.g. legal provision for cost-sharing mechanism, integration of fragmented schemes, tripartite agreement to reimburse claims and accreditation of health facilities to ensure quality healthcare), and leveraging technical support from the external actors. High levels of commitment and accountability among political leaders and bureaucrats are required to strengthen financial sustainability and implementation.

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Conditional cash transfer policies in maternal health service utilization in Nepal: Analysis of safe delivery incentive program (Aama Surakshya Karyakram) using Kingdon's multiple streams framework

Cited by 9 publications

References 20 publications

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis

Social Protection in Health: Characteristics and Coverage of Health Insurance Programme in Nepal

Evaluation of the National Health Insurance Program of Nepal: are political promises translated into actions?

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