Partners: HERD International, Nepal
In the first phase of ReBUILD, a three-year participatory action research study in a Kapilvastu municipality aimed to understand and support health system resilience by strengthening local level capacity in health sector planning, financing and governance. Based on the learning and evidence from that first Learning Site, a second project (2024-26) was initiated in another Kapilvastu municipality where intensive intervention were also being applied. The learning has been shared across all local levels within the district.
Implementation research was designed to strengthen coordination mechanisms and improve the maternal health system in Kapilvastu district. This research aimed to:
The study focused on several nodes of ReBUILD’s resilience framework to understand the relationships and interconnectedness between the nodes and identify root causes affecting service delivery. From July 2024, a researcher was embedded in the learning site, coordinating all field related activities and providing technical support to the health section.
This research had three phases: baseline, intervention and evaluation.
The first phase of the study consisted of household surveys, social mapping, health facility assessments and qualitative interviews and discussions with stakeholders at provincial, local and community levels. Household surveys provided information on the knowledge, awareness and utilisation of maternal health services in the community; in-depth interviews and discussions support in identification of factors influencing use of maternal health services, and key informant interviews in identifying potential shocks and stressors for the local health system and service delivery.
The intervention phase involved designing and implementing interventions. Co-creation was the core of this learning site work and so a series of workshops were conducted with diverse stakeholders including elected officials, such as the Municipality Mayor, Deputy-Mayor, ward chairs and ward members, plus officials from health and other cross cutting sections, health workers, partner organisations working in maternal health and community representatives. In the workshops, findings from the baseline phase were presented, sharing details of strengths, gaps and challenges to develop a common understating of the situation. Then intervention packages were co-created based on the identified gaps and available resources. The packages operated at three levels; system, health facilities and communities.
At the system level, the co-created intervention packages primarily supported the health section in building capacity, strengthening governance mechanism and following evidence-based planning, resource allocation and implementation to improve maternal health services. Interventions were implemented intensively in this learning site and the knowledge and experiences generated shared with other municipalities within the district, promoting scale up. A regular Mayor’s meeting, where the Mayor and Health Section Chief of all local levels discuss issues, was one such platform. The meeting was led by the Coordination Committee and technically supported by the Health Office, both at the district level with responsibility for facilitating coordination, capacity building and technically supporting implementation activities at the local level.
Facility level interventions were identified in the co-creation process and largely focused on building the capacity of health workers to improve delivery of quality maternal health services.
Interventions at this level seek were primarily community engagement activities which aimed to improve awareness of the importance of seeking maternal health care. Again, co-creation sessions were conducted where local people collectively discussed and explored issues which are leading to low uptake of maternal health services in their communities and identify solutions and strategies to address them.
At the end of the project, evaluation assessed the feasibility, effectiveness and scalability of the interventions to establish effective and functional coordination mechanisms and to improve the utilisation of maternal health services where institutional delivery is the main outcome measure.
Shophika Regmi of HERD International speaking on ReBUILD’s Learning Sites in Nepal
Image: A mothers’ group takes part in a discussion on optimal nutrition and family planning for pregnant women and new mothers in Kapilvastu Municipality. The meeting is led by a Female Community Health Volunteer trained by HERD International and using a flipbook designed by HERD and supported by the ReBUILD for Resilience consortium.