Partners: HERD International, Nepal, Liverpool School of Tropical Medicine & Queen Margaret University, UK
Nepal is a fragile setting that faces developmental, political and environmental challenges. Since 2015, the country has been transitioning to a federal republic with three tiers of government (federal, provincial and local or municipality), where authority is devolved to local or municipality governments to make their own plans and programmes including delivery of basic health services. This decentralisation has allowed increased decision space at local levels, although this is constrained by systemic, capacity and resource issues. These constraints include inadequate staff and absenteeism, short opening hours of facilities, poor supervision and monitoring, shortage of supplies and medicines, weak monitoring and supervision, poor referral system between levels of care, weak engagement of stakeholders and poor financial management. The COVID-19 pandemic has excacerbated these issues. Strengthening the health system at the municipality level is critical. Some interventions are being implemented, however, local and context-specific evidence on how these interventions are being implemented, their effects and how they should be adapted is missing.
The aim of this study is to understand and support building resilient health systems by strengthening the capacity of local government in health sector governance and planning. This will enable the delivery of quality and gender-equitable basic health services that leave no one behind.
Our study design is participatory action research using a learning site. We will establish the learning site in Kapilvastu Municipality where we will work alongside local health systems stakeholders over three years to co-produce knowledge about the local health system and promote action that will strengthen the health system to deliver gender-equitable and quality services. The action research cycle includes working closely with local stakeholders to identify priority areas for action, develop and deliver interventions, and then adapt the interventions in critical reflection meetings. The cycle will be undertaken three times, addressing different priority areas. This will generate innovative, timely and relevant evidence with the aim of developing a stronger and more resilient health system, that is responsive, inclusive, gender-equitable and sustainable.
Top image: Kapilvastu Hospital (our learning site) during the COVID-19 pandemic. Patients can be seen being treated outside the hospital
Bottom image: A man looks at a Citizens’ Charter installed outside Kapilvastu Hospital. The charter contains information about services, costs, departments etc to give clients easy access to services.