The Constitution of Nepal states that every citizen shall have the right to seek basic health services (BHS). Urban Health Policy (UHP) 2015 aims to increase access to and utilisation of quality health services with a focus on urban marginalised people. Despite these, delivering quality health services particularly in urban areas through the government health service delivery networks is an issue. Various challenges hinder the implementation process, especially human resource issues which directly affect the quality of health services. Hence, there is a need to develop a locally appropriate capacity enhancement model for health workers in urban health centres through supportive supervision, coaching and mentoring and mechanisms.
- Is it feasible to implement the capacity enhancement model – supportive supervision, coaching and mentoring- for health workers in urban health centres (UHC) in selected municipalities Nepal?
- If so, does the provision of the capacity enhancement model to the health workers of UHC improve the quality of care of the services provided?
This was a programme embedded implementation research, using a mixed method approach to develop and assess a supervision, coaching and mentoring model for the UHC. The study was conducted in Pokhara Metropolitan city where two urban health centres (UHC) and one health post were chosen as intervention sites. Selection of these health facilities was done in consultation with officials from the Pokhara metropolitan health division officials on the basis of their location, patient flow, availability of human resources and coverage of these health facilities.
The intervention included contracting a group of visiting team of experts for on-site mentoring and provide on the job training to the health workers in the selected health facilities at monthly intervals. Capacity enhancement was done in the areas of clinical diagnosis and treatment, enhancement of soft skills to promote patient centred care and strengthening the recording and reporting.
Quality improvement(QI) checklist tools were used at the baseline of the study to identify the gaps in the clinical skills of the health workers. The intervention was tailored according to the gaps identified. The outcome of the intervention was measured by the changes noted in the QI tool at the end of the study.
In Nepal, each health facility has a Health Facility Operation Management Committee (HFOMCs) who oversee the overall functioning of the health facility to ensure delivery of good quality basic health services to its catchment population. The HFOMC, chaired by the local elected representative (ward chair) comprise of a group of 8-9 people who represent the community, including the health facility in-charge. The HFOMC are also accountable to providing health services to the marginalized groups of people living in their community ensuring that no one is left behind with regards to utilisation of health services provided by the local health facility.
This study was undertaken with the aim to support Health Facility Operation Management Committee (HFOMCs) and UHCs to design and test a process to identify the marginalized groups within their catchment area and identify their barriers to accessing health services.
Will engagement of Health Facility Operational Management Committee (HFOMC) and UHC staffs help in identification of marginalized groups and facilitate to address the identified barriers to access health services?
Two UHCs along with their respective HFOMCs were chosen in two wards in Pokhara Metropolitan city. A simple tool was developed for use with HFOMC and UHC staff, informed by literature review and incorporating participatory approaches to assist in the identification of marginalised groups in the community. A workshop was conducted with the HFOMC members where social mapping process was used to identify the marginalized groups of people living in their community. During this process, the HFOMC and UHC members discussed the potential barriers for service access and came up with an agreed Plan of Action for the UHC to address these issues.
A validation process was conducted wherein our team members along with local FCHVs and social mobilisers validated the existence of the identified groups of marginalized people during social mapping. Few key informant interviews were conducted at the community with various groups of people to understand their health seeking behaviour and to understand their barriers to seeking health services from the local health facility.
Project focal person
Focal person for this project is Dr. Chandani Kharel
Associated Team Members
Shophika RegmiSenior Manager: Health System Research, Evaluation and Learning
Personal bio Ms Shophika has been working in health and social research for nearly a decade. During these years, she has led and managed research projects of different nature and scale, which include implementation research, evaluation research, national level surveillance study, large-scale survey and mixed methods studies. She also has a good experience of literature and policy reviews using systematic review and critical appraisal techniques. Having a keen interest in health systems research, her current engagements are focused on health [...]Learn more
Obindra Bahadur ChandQualitative Research Officer
Personal Bio An experienced health and social sciences researcher working and engaging in the broader area of health and development covering the wider area of medical anthropology and global health. These include health system research, cross-cultural context of health service delivery and development, access to health services and facilities for various groups of people as well as disability and disaster using primarily qualitative methods. He has more than 8 years of professional experience in qualitative research with expertise in designing, [...]Learn more
Abriti ArjyalResearch Manager: Qualitative and Multidisciplinary Science
Key Expertise Ms. Abriti Arjyal works as Research Manager – Multidisciplinary Qualitative Research – at HERD International and has experience in the area of public health, health system and service delivery research, social science and gender, and equity. She is an emerging young researcher with more than seven years of experience leading formative and operational field studies, evaluation studies, and literature reviews, with expertise in design and implementation of qualitative research, and various community and participatory based approaches. She has sound knowledge [...]Learn more
Sushil Chandra BaralManaging Director
Key Expertise Dr Sushil Chandra Baral is an experienced heatlh and development expert of Nepal, specialising in health systems strengthening and health policy and planning at the national and international level. He has twenty five years of experience in health systems and services, health policy and planning, operational research and social development sector in developing countries context. He has got considerable professional experience in health system, health policy and planning, health service delivery, health research and programme management. He has [...]Learn more
Private: Rajeev DhungelICT Consultant
Mr. Rajeev Dhungel has about 12 years of experience in the sector of Information Technology, ICT management, ICT incorporation into project and programme. At HERD he is primarily responsible to design, develop ICT infrastructure and development of innovative ICT initiation to switch from paper based business process to paper less business process. He is also responsible for integration of ICT into HERD project and programme. Dhungel has also worked as a customer support engineer and has considerable experience as an [...]Learn more