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The impact of federalisation on Nepal's health system: a longitudinal analysis

联邦化对尼泊尔卫生系统的影响：纵向分析

基本信息

批准号：
MR/T023554/1
负责人：
Simon Rushton
金额：
$ 109.18万
依托单位：
University of Sheffield
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2020
资助国家：
英国
起止时间：
2020 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FT023554%2F1
关键词：
impact federalisation Nepal health system

项目摘要

Nepal is currently in the midst of a process of radical constitutional reform. After almost a decade operating under a post- conflict Interim Constitution, the highly contested political process of agreeing on a model for the country's future governance finally came to an end in late 2015, when a new Constitution was adopted by the Constituent Assembly. The 2015 Constitution heralded a complete restructuring of the country's political system, creating a Federal Republic with significant devolution of power and resources from the central government to seven newly-created Provinces, each with its own legislature. Implementation of the new Constitution has already delivered the first local elections in 20 years, which were held in late 2017.The new Constitution brings about significant changes in the health system. Nepal's national health system has historically been unitary and centralised, with the Ministry of Health and Population providing the resources and directing health services for the entire country. The new Constitution places the responsibility for health service provision primarily with the seven new Provincial governments, with significant powers and responsibilities being further devolved to Municipalities/Rural Municipalities. All of this has put Nepal's health system in a period of rapid, and far-reaching, transformational change.In theory, these changes have opened up the possibility for greater localism and responsiveness to communities' health needs. In practice, national health policy has not (yet) been revised to reflect the new system. Furthermore, there are fears regarding the capacity of the newly formed Provincial and Municipal governments to successfully take on their new roles, as well as doubts about the 'readiness' of the health system to adapt to the changes. How the transition to a Federal Republic unfolds within the health system, how the system itself responds to the reforms. These concerns are central to our project.This project uses Participatory Policy Analysis (PPA) to track this immense health system reform effort in real time, drawing upon the experiences, perceptions and expertise of health system actors from across all levels of government. We will work with policymakers at the federal, provincial and municipal levels, as well as with community-level providers (primary health centre staff and the Female Community Health Volunteers who are on the frontline of delivering maternal and child health services in rural communities). The project aims to uncover the perceptions of this wide range of different stakeholders and to bring them into dialogue with one another - bridging governance and practice levels - in order to identify systemic design deficits, delivery gaps and capacity constraints in the emerging system that may be impacted by, and in turn impact upon, the reform process.Supporting the PPA with a mixture of quantitative and in-depth qualitative work, the research team will iteratively track developments and perceptions within the health sector, across all of the health system building blocks and all levels of government, over a vital period in the creation of the new system. This will allow us to better understand the dynamic process of this transformational change. We will work with stakeholders to co-produce new knowledge of relevance to policy and practice in Nepal, but also to a variety of academic and policy audiences elsewhere.

尼泊尔目前正处于彻底的宪法改革进程之中。经过近十年的冲突后临时宪法运作后，就国家未来治理模式达成一致的备受争议的政治进程终于在 2015 年底结束，制宪会议通过了新宪法。 2015 年宪法预示着该国政治体系的彻底重组，建立了一个联邦共和国，中央政府将权力和资源大量下放给七个新创建的省，每个省都有自己的立法机构。新宪法的实施已经在2017年底举行了20年来的第一次地方选举。新宪法给卫生系统带来了重大变化。尼泊尔的国家卫生系统历来是统一和集中的，由卫生和人口部为整个国家提供资源并指导卫生服务。新宪法将提供卫生服务的责任主要由七个新的省政府负责，重要的权力和责任进一步下放到市/乡镇。所有这一切使尼泊尔的卫生系统进入了一个快速、深远的转型变革时期。理论上，这些变化为更大程度的地方主义和对社区健康需求的响应提供了可能性。实际上，国家卫生政策尚未进行修订以反映新制度。此外，人们还担心新成立的省市政府是否有能力成功履行新职责，以及卫生系统是否“准备好”适应这些变化。向联邦共和国的过渡如何在卫生系统内展开，系统本身如何应对改革。这些问题是我们项目的核心。该项目利用参与式政策分析 (PPA) 来实时跟踪这一巨大的卫生系统改革工作，借鉴各级政府卫生系统参与者的经验、看法和专业知识。我们将与联邦、省和市各级的政策制定者以及社区一级的提供者（基层卫生中心工作人员和在农村社区提供妇幼保健服务第一线的女性社区卫生志愿者）合作。该项目旨在揭示广泛的不同利益相关者的看法，并使他们相互对话——弥合治理和实践水平——以确定新兴系统中可能受到改革进程影响并反过来影响改革进程的系统设计缺陷、交付差距和能力限制。研究团队将通过定量和深入的定性工作相结合的方式支持 PPA，并反复跟踪在创建新系统的关键时期，卫生部门、卫生系统所有组成部分和各级政府的发展和看法。这将使我们更好地理解这一转型变革的动态过程。我们将与利益相关者合作，共同创造与尼泊尔政策和实践相关的新知识，同时也与其他地方的各种学术和政策受众相关。