Abstract
Investment Case is a participatory approach that has been used over the years for better strategic actions and planning in the health sector. Based on this approach, a District Investment Case (DIC) program was launched to improve maternal, neonatal and child health services in partnership with government, non-government sectors and UNICEF Nepal. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services. This study adopted an exploratory phenomenography design with a purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and total 30 key informant interviews with district level stakeholders and six focus groups with community stakeholders were carried out. A deductive approach was used to explore the perception of local stakeholders of health planning and budgeting of the health care expenses on the local level. Investment Case approach helped stakeholders in planning systematically based on evidence through collaborative and participatory approach while in comparison areas previous year plan was mainly primarily considered as reference. Resource constraints and geographical difficulty were key barriers in executing the desired plan in both intervention and comparison districts. Positive changes were observed in coverage of maternal and child health services in both groups. A few participants reported no difference due to the DIC program. The participants specified the improvement in access to information, access and utilization of health services by women. This has influenced the positive health care seeking behavior. The decentralized planning and management approach at the district level helps to ensure equity in access to maternal, newborn and child health care. However, quality evidence, inclusiveness, functional feedback and support system and local resource utilization should be the key consideration.
Highlights
Nepal reduced maternal mortality from 800 in 1990 to 213 in 2015 per 100000 live births and is progressing towards achieving the Sustainable Development Goal (SDG) target of 70 per 100000 live births by 2030 [1]
This study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the District Investment Case (DIC) program in ensuring equity in access to maternal and child health services
A deductive approach was used to explore the perception of local stakeholders of health planning and budgeting of the health care expenses on the local level
Summary
Nepal reduced maternal mortality from 800 in 1990 to 213 in 2015 per 100000 live births and is progressing towards achieving the Sustainable Development Goal (SDG) target of 70 per 100000 live births by 2030 [1]. The National Safe Motherhood Program in 1997 [4], the National Safe Motherhood Plan 2002–2017 [5], the SBA policy in 2006 [6], the National Neonatal Health Strategy 2004 [7], and the Community Based Newborn Care Program in 2007 are some of the major programs, plans and policies to be highlighted Notwithstanding these improvements, equity gaps in maternal and neonatal service utilization across geography, ethnicity and economic status have always been existing and is clearly evident from the findings of the Nepal Demographic Health Surveys of 2006, 2011 and 2016 [8,9,10,11].
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