Factors in health initiative success: Learning from Nepal’s newborn survival initiative

Abstract

What shapes the level of political priority for alleviation of significant health problems in low-income countries? We investigate this question in the context of the significantly increasing political priority for newborn survival in Nepal since 2000. We use a process-tracing methodology to investigate causes of this shift, drawing on twenty-nine interviews with individuals close to newborn health policymaking in Nepal and extensive document analysis. Shifts in the political context (commitments to the child health MDG), the strength of concerned actors (emergence of collective action, leadership, resources) and the power of ideas (problem status, existence of contextually relevant solutions, agreement on these points) surrounding the issue have been instrumental in elevating priority for newborn survival, if not institutionalizing that priority to ensure long-term support. The findings highlight the significance of political fragmentation in war-torn areas for impeding priority generation. Additionally, theories of social construction provide important insights to the roles of ideas in shaping health initiative success.

Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality

“…Some of these policy documents also emphasize improved access for poor and vulnerable groups [33]. Taken together, these policies and strategies provide both a conducive environment and a framework for developing, piloting and implementing newborn programs in the country [37]. …”

Ethical approval in developing countries is not optional

“…We do not want to imply that Smith and Neupane have conducted unethical or bad research; on the contrary, their research is excellent and timely 7. Moreover, it is the kind of health policy research that a country with limited research capacity desperately needs.…”

“…Despite this, in a recent paper in one of the leading international social science and medicine journals, Smith and Neupane (the authors) offered just one sentence about research ethics, namely: ‘Syracuse University’s Institutional Review Board exempted the study from review. '7 Nothing unusual for a health study in this kind of international journal. As part of their health policy study in Nepal, Smith and Neupane interviewed representatives of government agencies, international agencies and donors, non-governmental organisations, medical and research communities.…”

“…As part of their health policy study in Nepal, Smith and Neupane interviewed representatives of government agencies, international agencies and donors, non-governmental organisations, medical and research communities. They explained their selection criteria and added, ‘We selected interviewees based upon their close involvement in or knowledge of newborn survival advocacy, policy decisions, research and program implementation in Nepal.’7…”

Neonatal Home Care Practices and Care Seeking Behaviour in Rural Makwanpur of Nepal

“…1 The Ministry of Health and Population (MoHP), Nepal in 2009 initiated a pilot Community-Based Integrated Newborn Care Program (CB-NCP) in ten districts including a central hill district of Makwanpur. [9][10] This study assesses the state of newborn home-care practices and care-seeking behaviors of the recently delivered mothers to better inform the behavior change communication (BCC) efforts for effective implementation of CB-NCP.…”