Ps-P12-2: Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal

Abstract

Objective:Good governance and leadership to address non-communicable diseases and minimization of their risk factors is crucial to improve healthy life expectancy particularly in low- and middle-income countries. The objective of this study was to understand and document cardiovascular disease (CVD) programs and policy formulation process and epitomize the challenges and opportunities for leadership and good governance for the health system to address non-communicable diseases particularly cardiovascular diseases in Nepal.Design and method:A national level task force was formed to coordinate and steer the overall needs assessment process. A qualitative study design was adopted using The Health System Assessment Approach Manual. Eighteen indicators under six topical areas of leadership and governance in cardiovascular health were assessed. Health laws, policies, regulatory standards, planning and strategy documents and reports on civil society engagement were reviewed. Seven key stakeholders from ministry, professional councils and non-governmental organizations working on CVD were identified and in depth interviews were conducted. Field notes and tape records of interview were compiled and transcribed. Strength, weakness, opportunities and threats in each topical area of leadership and governance were analyzed.Results:Voice and accountability exist in planning for health from the local level. The government has shown strong willingness and has a strategy to work together with the private and non-government sectors in health however, the coordination with non-state actors during policy formulation has not been effective. There are strong rules in place for regulatory quality, control of corruption and maintaining financial transparency. The government frequently relies on evidence generated from large-scale surveys for health policy formulation and planning but research in cardiovascular health has been below par. There is a scarcity of CVD-specific treatment protocols at all levels of government coupled with weak reporting from the private sector. Expensive health care with ineffective cost control over drugs and services, medical malpractice with commission system and lack of interest among donors to invest in CVD were important challenges for strong leadership and governance.Conclusions:Despite plenty of opportunities, much homework is needed to improve leadership and governance in cardiovascular health in Nepal. The government needs to designate a workforce for specific programs to help monitor the enforcement of health sector regulations, allocate enough funding to encourage CVD research and work towards developing CVD-specific guidelines, protocols, and capacity building. The government needs to leverage the opportunities associated with the current decentralized health system.

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.…”

“…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.…”

“…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).…”