BackgroundAll health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance. This article examines policy transfer and evidence use linked to it in low- and middle-income settings. The objective was to inform international investments in improved learning across health systems.MethodsThe article uses a comparative case study design, drawing on case studies conducted in Bangladesh, Burkina Faso, Cambodia, Ethiopia, Georgia, Nepal, Rwanda and Solomon Islands. One or two recent health system reforms were selected in each case and 148 key informants were interviewed in total, using a semi-structured tool focused on different stages of the policy cycle. Interviewees were selected for their engagement in the policy process and represented political, technical, development partner, non-governmental, academic and civil society constituencies. Data analysis used a framework approach, allowing for new themes to be developed inductively, focusing initially on each case and then on patterns across cases.ResultsThe selected policies demonstrated a range of influences of externally imposed, co-produced and home-grown solutions on the development of initial policy ideas. Eventual uptake of policy was strongly driven in most settings by local political economic considerations. Policy development post-adoption demonstrated some strong internal review, monitoring and sharing processes but there is a more contested view of the role of evaluation. In many cases, learning was facilitated by direct personal relationships with local development partner staff. While barriers and facilitators to evidence use included supply and demand factors, the most influential facilitators were incentives and capacity to use evidence.ConclusionsThese findings emphasise the agency of local actors and the importance of developing national and sub-national institutions for gathering, filtering and sharing evidence. Developing demand for and capacity to use evidence appears more important than augmenting supply of evidence, although specific gaps in supply were identified. The findings also highlight the importance of the local political economy in setting parameters within which evidence is considered and the need for a conceptual framework for health system learning.
Background In Nepal, neonatal mortality fell substantially between 2000 and 2018, decreasing 50% from 40 to 20 deaths per 1,000 live births. Nepal’s success has been attributed to a decreasing total fertility rate, improvements in female education, increases in coverage of skilled care at birth, and community-based child survival interventions. Methods A verbal autopsy study, led by the Integrated Rural Health Development Training Centre (IRHDTC), conducted interviews for 338 neonatal deaths across six districts in Nepal between April 2012 and April 2013. We conducted a secondary analysis of verbal autopsy data to understand how cause and age of neonatal death are related to health behaviors, care seeking practices, and coverage of essential services in Nepal. Results Sepsis was the leading cause of neonatal death (n=159/338, 47.0%), followed by birth asphyxia (n=56/338, 16.6%), preterm birth (n=45/338, 13.3%), and low birth weight (n=17/338, 5.0%). Neonatal deaths occurred primarily on the first day of life (27.2%) and between days 1 and 6 (64.8%) of life. Risk of death due birth asphyxia relative to sepsis was higher among mothers who were nulligravida, had <4 antenatal care visits, and had a multiple birth; risk of death due to prematurity relative to sepsis was lower for women who made ≥1 delivery preparation and higher for women with a multiple birth. Conclusions Our findings suggest cause and age of death distributions typically associated with high mortality settings. Increased coverage of preventive antenatal care interventions and counseling are critically needed. Delays in care seeking for newborn illness and quality of care around the time of delivery and for sick newborns are important points of intervention with potential to reduce deaths, particularly for birth asphyxia and sepsis, which remain common in this population.
Background:In Nepal, about 75% people rely on wood and other biomass fuels for cooking. The majority of Nepali families cook on a traditional stove, an open fire in the kitchen resulting in indoor air pollution, one of the key risk factors for Acute Lower Respiratory Infection (ALRI) among under-five children.The study aimed at exploring the association of indoor air pollution due to use of traditional cooking stoves with ALRI among under-five children in Rasuwa, a Himalayan district of Nepal. Methods:A cross-sectional survey was conducted in Rasuwa district from October to November 2011. The mothers with under-five children who lived in household using biomass fuels were interviewed. The totalsample size of 210, calculated on the basis of Proportion to Population Size, was selected by using cluster sampling method. Children who suffered from common cold and fast breathing/higher respiratory rate were defined as having ALRI. Logistic regression was used to find out association of types of cooking stove and other factors with ALRI among the children.Results: Only about 30% of the households used improved stoves for cooking. Nearly one-third (31.4%) of the children under five years of age who lived in household using biomass fuels suffered from ALRI. After adjusting for the factors like mother's group status, ethnic group, age of children, mother's group membership status and father's occupation, use of traditional/open type of cooking stove was found to be highly associated with ALRI [aOR:2.30; 95% CI (1.03-5.10)] among children.Conclusion: Exposure to smoke from a traditional stove is one of the factors leading to ALRI among children. The ALRI could be substantially reduced if these stoves be replaced by improved ones in rural areas of Nepal.
DOI: http://dx.doi.org/10.3126/njog.v5i2.5078NJOG 2010 Nov-Dec; 5(2): 43-45
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