Nepal’s Health Facility Operation and Management Committees: exploring community participation and influence in the Dang district’s primary care clinics

Gurung, Gagan; Derrett, Sarah; Hill, Philip C.; Gauld, Robin

doi:10.1017/s1463423618000026

Cited by 18 publications

(37 citation statements)

References 35 publications

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“…This caste hierarchy often produces unequal power relation between the service providers and service users where service users from the marginalized community have less power to negotiate for change in the health service providers attitude and behaviour [32,56,57]. In a qualitative study by Gurung et al, a Dalit member of the health management committee has stated how caste hierarchy system has suppressed their voice and participation in the accountability process [58].…”

Section: Gender Normsmentioning

confidence: 99%

“…Any form of discrimination is prohibited by law in Nepal, however, the issue of caste-based discrimination is still deeply deep-rooted in the community [39,58,59]. Hence, the existing informal power relationship and the dynamics of social structures needed to taken into consideration to ensure the effectiveness of the social accountability process.…”

Section: Gender Normsmentioning

confidence: 99%

“…Similarly, the issue of political interference in the health sector has been also well reported. Often politic acts as a driving force in the formation and functioning of the health management committee [58] The business group have greater influence over the political infiltration and often resist the political intervention in the sphere of the economy in Nepal and they have been able to make the health sector a profit-making investment [32,67]. The running private and teaching hospitals becoming one of the lucrative areas to get the best benefits out of the investment for business groups and politician [67].…”

Section: Political and Economic Contextmentioning

confidence: 99%

“…Similarly, the issue of political interference in the health sector has been also well reported. Often politic acts as a driving force in the formation and functioning of the health management committee [58] that interfere with the social accountability process [24,36]. The decisions are often made on the political ground by the leaders rather than the community's concerns.…”

Section: Political and Economic Contextmentioning

confidence: 99%

“…The decisions are often made on the political ground by the leaders rather than the community's concerns. The bureaucracy of health facility, kinship and health worker's power tend to determine the level of community participation in the accountability interventions [36,58,65].…”

Section: Political and Economic Contextmentioning

confidence: 99%

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Improving maternal health services through social accountability interventions in Nepal: An analytical review of existing literature

Nepal¹,

Dangol²,

Kwaak

2019

Preprint

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Background: The persistent equity and quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. The Government of Nepal has emphasized on responsive and accountable maternal health services since 2005, while social accountability interventions have been commenced as a strategical approach. This review is an attempt to critically explore the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute informed policy. Methods: A literature review and desk study were done between December 2018 to May 2019. An adapted framework of social accountability by Lodenstein et al. 2013 was used for critical analysis and synthesis of the existing literature from Nepal and other low- and middle-income countries (LMICs). The literature was searched and extracted from the search engines i.e. google and google scholar using keywords. The searched includes both published and grey literature. Results: The review found different social accountability interventions initiated by the government and external development partners in maternal health services in Nepal. The evidence from Nepal and other LMICs showed that the social accountability interventions improve the quality of maternal health services through improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. The strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions: The evidence show that social accountability interventions have the potential to improve the quality of maternal health services in Nepal. Critical factors of successful outcomes in maternal health services include quality implementation of the interventions. Similarly, continuous effort is needed from policymaker to strengthen monitoring and regulatory mechanism of the health system and decentralization, improve access to the information and establishment of proper channels to capture complaints and feedback from the community to ensure the effectiveness of the interventions for the long run. Furthermore, research is needed to evaluate the impact of the existing social accountability interventions in the reduction of maternal mortality in Nepal.

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Section: Gender Normsmentioning

confidence: 99%

Section: Gender Normsmentioning

confidence: 99%

Section: Political and Economic Contextmentioning

confidence: 99%

“…Similarly, the issue of political interference in the health sector has been also well reported. Often politic acts as a driving force in the formation and functioning of the health management committee [58] that interfere with the social accountability process [24,36]. The decisions are often made on the political ground by the leaders rather than the community's concerns.…”

Section: Political and Economic Contextmentioning

confidence: 99%

Section: Political and Economic Contextmentioning

confidence: 99%

See 3 more Smart Citations

Improving maternal health services through social accountability interventions in Nepal: An analytical review of existing literature

Nepal¹,

Dangol²,

Kwaak

2019

Preprint

View full text Add to dashboard Cite

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Who makes health governance decisions at the local level? A cross sectional study from primary health facilities in Tanzania

Kesale,

Kinyaga,

Mwakasangula

et al. 2023

Health Science Reports

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Background and AimsLower‐ and middle‐income countries have decentralized decision‐making at the community level, as well as community governance structures, to encourage community participation in governance processes, particularly in primary healthcare (PHC). In Tanzania, decentralization resulted in the establishment of Health Facility Governing Committees (HFGCs) to encourage community participation in the governance of primary health facilities to improve the quality and responsiveness of health service delivery. Nonetheless, despite the presence of HFGCs, PHC delivery remains ineffective and of poor quality. It is unclear who makes governance decisions at PHC facilities to ensure that services delivered are of expected quality and respond the community's needs, tastes, and preferences. This paper aims to assess the perspectives of members of the HFGC on who make governance decision in the context of fiscal decentralization.Design and MethodsA cross‐section design was used to collect both quantitative and qualitative data. A four‐multistage sampling technique was adopted to selects regions, council, health facilities, and HFGC members. Respondents who participated in structured questionnaire responses were chosen using proportional sampling, whereas those who participated in in‐depth interviews and Focus Group Discussions were chosen using purposive selection. The data was analyzed descriptively and thematically.ResultsThe study revealed that HFGCs members perceive that governance decisions in primary health facilities are primarily made by the health facility management, and later are presented in HFGCs. As such, HFGCs are used a passively used to justify participation in decision that was already made by the management, which contradict with the principal of decentralization that emphasizes community participation on fiscal decisions.ConclusionDecentralization of PHC facilities does not guarantee the participation of community members in fiscal decision of their respective primary health facilities through HFGCs. HFGC is passively used governance structure to substitute community participation in primary health facilities' fiscal decisions. Enforcement mechanisms are required to facilitate effective community participation.

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The functionality of health facility governing committees and their associated factors in selected primary health facilities implementing direct health facility financing in Tanzania: A mixed‐method study

Kesale

Mahonge

Muhanga

2022

Health Science Reports

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Background: In Lower and Middle-Income Countries (LMICs), decentralization has dominated the agenda for reforming the organization of service delivery (LMICs).The fiscal decentralization challenge is a hard one for decentralization. As they strive to make decisions and use health facility funding, primary healthcare facilities encounter the obstacles of fiscal decentralization. LMICs are currently implementing fiscal decentralization reforms to empower health facilities and their Health Facility Governing Committees (HFGCs) to improve service delivery. Given the scarcity of systematic evidence on the impact of fiscal decentralization, this study examined the functionality of HFGCs and their associated factors in primary healthcare facilities in Tanzania that were implementing fiscal decentralization through Direct Health Facility Financing (DHFF).Methods: To collect both qualitative and quantitative data, a cross-sectional approach was used. The research was carried out in 32 primary healthcare facilities in Tanzania that were implementing the DHFF. A multistage sample approach was utilized to pick 280 respondents, using both probability and nonprobability sampling procedures. A structured questionnaire, in-depth interviews, and focus group discussions were used to gather data. The functionality of HFGCs was determined using descriptive analysis, and associated factors for the functioning of HFGCs were determined using binary logistic regression. Thematic analysis was used to do qualitative research.Result: HFGC functionality under DHFF has been found to be good by 78.57%. Specifically, HFGCs have been found to have good functionality in mobilizing communities to join Community Health Funds 87.14%, participating in the procurement process 85%, discussing community health challenges 81.43% and planning and budgeting 80%. The functionality of HFGCs has been found to be associated with the planning and budgeting aspects p value of 0.0011, procurement

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Nepal’s Health Facility Operation and Management Committees: exploring community participation and influence in the Dang district’s primary care clinics

Cited by 18 publications

References 35 publications

Improving maternal health services through social accountability interventions in Nepal: An analytical review of existing literature

Improving maternal health services through social accountability interventions in Nepal: An analytical review of existing literature

Who makes health governance decisions at the local level? A cross sectional study from primary health facilities in Tanzania

The functionality of health facility governing committees and their associated factors in selected primary health facilities implementing direct health facility financing in Tanzania: A mixed‐method study

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