Determinants of health in rural Nepal: Utilising PHASE Nepal data to investigate social inequalities in health and healthcare amongst under-5s

Lead Research Organisation: University of Sheffield
Department Name: Politics

Abstract

This project aims to increase academic understanding, and develop appropriate options for responding to, inequalities in health and healthcare amongst under-5 children in remote rural areas of Nepal. These continuing inequalities represent a significant challenge for Nepal's efforts to promote social and economic development and meet the SDG targets. Whilst it is widely known that a variety of social and geographic factors contribute to determining health outcomes (including gender, caste/ethnicity and region), the currently available data lacks the degree of granularity to enable a robust exploration of the relationships between these various forms of inequality and i) health status; ii) utilisation of health services; and iii) quality/appropriateness of treatment received.

Whilst the existing data published by the Government of Nepal is available only in an aggregated format, PHASE Nepal - a high-profile and highly-respected NGO that supports government health facilities in some of the most remote areas of the country - has circa 50,000 records of health facility visits by under-5s that have not previously been analysed as they currently exist only in paper format. The project proposed here will allow, for the first time, for the digitisation and rigorous analysis of this individual patient-level data to further understand inequalities and to address a series of Research Questions related to the country's social and geographic inequalities:

RQ1: How do geography, age, gender, ethnicity and caste affect the nutrition status of under-5 children presenting in remote health facilities of Nepal?
RQ2: Is diagnosis and treatment for malnutrition affected by geography, and child's age, gender, ethnicity and caste?
RQ3: How do geography, and child's age, gender, ethnicity and caste affect health-seeking behaviours and utilisation of health services?
RQ4: How do geography, and child's age, gender, ethnicity and caste affect the treatment that under-5s receive at health centres?

The project builds upon a strong existing relationship between the University of Sheffield and PHASE Nepal. A previous collaboration, funded by IAA funds, allowed for the delivery of research methods training for PHASE Nepal staff and a preliminary analysis of PHASE's data assets and data management strategies. The project proposed here - which brings together social scientists and public health experts to understand health inequalities in their social context, and to develop policy and practice recommendations - was co-designed by PHASE Nepal staff members Dr. Pohl and Dr. Baidya and the Sheffield-based members of the team, ensuring that the research will be valuable to and actionable by PHASE Nepal themselves, as well as being of value to other health system stakeholders (not least Nepal's Ministry of Health and Population) and to a wider community of academic researchers.

Planned Impact

Better understanding how inequalities affect health status, health service utilisation and treatment provided, and the extent to which current health worker practices either mitigate or reinforce those inequalities, has the potential to impact on both academic and policy/practice audiences.

Given the project's overall objective of better understanding, and finding ways of reducing, health inequalities in remote Himalayan communities, significant emphasis has been placed on developing pathways of impact to ensure that the project's findings feed into policy and practice improvements. This will be achieved primarily through two events to be held in Kathmandu in the final month of the project, as well as through publication of the project findings and the depositing of the final dataset with the UK data service (see 'Academic beneficiaries').

A commitment to co-producing recommendations with potential users is intended to facilitate more effective uptake of the project's findings.

The events are described more fully in the Pathways to Impact statement, and comprise:

1. Training for health centre staff
The project proposed here will produce a number of new insights on practices within the health centres from which data is drawn relating to (amongst others):

The identification of particular sections of a community (e.g. by gender/caste/ethnicity) that are currently under-utilising health services in comparison to their peers;
The identification of deficiencies in the recognition of malnutrition or other health conditions
New knowledge about the extent to which antibiotic prescribing practices currently adhere to international guidelines.

At the conclusion of the project, we have budget for 50 members of front-line staff from the health centres to be brought to Kathmandu for a two-day workshop discussing the project's findings, co-developing possible responses to them (e.g. changes in current practices), and training staff in such changes

2. Stakeholder workshop and subsequent policy brief
The aim of the stakeholder workshop will be to present the project's findings and to collaboratively discuss policy and practice improvements that could help mitigate any adverse findings, utilising co-production techniques to increase the likelihood of uptake .

The workshop will be held in Kathmandu and will include approximately 30 representatives from the Government of Nepal (in particular the Ministry of Health and Population), International and National NGOs operating in the health sector in Nepal, and international donor agencies.

The key findings of the project will be presented and a range of plenary and small-group discussions utilised in order to allow participants to propose and discuss policy and practice issues that mitigate any problems found. At the conclusion of the workshop, these will (where agreement is found) be recorded and written up as part of a policy brief for wider circulation.
 
Description A major shortcoming of existing health data in Nepal is that individual patient-level data is not available. The project "Determinants of health in rural Nepal:
Utilising PHASE Nepal data to investigate social inequalities in health and healthcare amongst under-5s" was funded by the UK Economic and Social Research Council's GCRF NGO Secondary Data Analysis Initiative (Grant Ref: ES/T010436/1). The project's aim was to investigate how gender, caste and ethnic differences, as well as geography, affect nutrition status and health service utilisation of under- 5 children, and how they affect the treatment that these children receive. A retrospective study was carried out of IMNCI patient records from 23 health posts across 5 districts. A total of 33,860 paper-based records (from 2011 to 2020) were collected, digitised, and analysed for the study.

Key findings:

RQ1: How do geography, age, gender, ethnicity and caste affect the nutrition status of under-5 children presenting in remote health facilities of Nepal? (Tracer indicator: malnutrition).
Children residing in Mugu district (unadjusted OR 10.28) and Bajura district (unadjusted OR 4.91) were more likely to be underweight compared to children residing in Gorkha. Children belonging to Janajati (unadjusted OR 0.27), and Bhramin/Chhetri (unadjusted OR 0.80) ethnic groups were less likely to be underweight. Male children were about 0.74 times less likely to be underweight compared to female children based on an unadjusted model.

RQ2: Is diagnosis and treatment for malnutrition affected by geography and child's age, gender, ethnicity and caste? (Tracer indicator: recognition of malnutrition).
Children in Sindhupalchowk had 15.92 and those in Mugu had 13.31 times higher odds of getting correct treatment compared to Gorkha. Male children had 2.33 times higher odds of being correctly diagnosed as malnourished. Similarly, children who were diagnosed with GDS and those who had ear infection had more than 2.5 times higher odds of being correctly diagnosed. Older children were slightly less likely to be correctly diagnosed (OR=0.99). Older child had higher odds (1.02) while child with higher temperature had lower odds (0.69) of receiving correct treatment.

RQ3: How do geography, and child's age, gender, ethnicity and caste affect health-seeking behaviours and utilisation of health services? (Tracer indicators: 1. frequency of consultation, 2. Severity of symptoms for Acute Respiratory Infections)
Children with diarrhoea in Sindhupalchowk waited 2 days longer to attend a health post (coef=2.15) than those in Gorkha. Similarly, children in Humla and Mugu waited a little longer than a day (coef=1.65 and 1.41 respectively) more than those in Gorkha. Children with fever from Humla, Mugu and Bajura waited slightly longer than those from Gorkha (Beta coef=0.72, 0.90 and 0.68 respectively). Among ethnic groups, Thakuri and Sanyasi/Dasnami children presented at the health post slightly earlier (Coef=-0.40) compared to Dalit children. Madhesi children with ARI waited three days longer than dalit children before visiting the health post. Similarly, older children waited longer before visiting the health post compared to younger children. Children who had ARI and fever were more likely to make follow-up visits.

RQ4: How do geography, and child's age, gender, ethnicity and caste affect the treatment that under-5s receive at health centres? (Tracer indicator: antibiotic prescribing).
About 30% of children that met the ARI classification were not correctly diagnosed by health workers. 60% of children who were classified as having pneumonia/severe pneumonia by a health worker were not provided with the correct treatment. Health posts in Mugu had the highest proportion (85.6%) of correct diagnoses of pneumonia by health worker, while Humla had the lowest correct diagnosis (63.9%), closely followed by Gorkha (66.9%). Dalit children had the lowest correct diagnosis of pneumonia (although the highest correct treatment for pneumonia). Regarding correct treatment, Janajati children had the lowest proportion. Gender was significant at the 10% significance level and based on this, male children were 1.4 times more likely to be correctly diagnosed for pneumonia.

Conclusions and findings:
The study shows that a total of 13% of under-5 children presenting at health facilities were found to be underweight, of which 10% were classified as low weight and 3% as very low weight. A study conducted among under-5 children of Tharu community revealed that 17.5% of them were moderately underweight whereas 3.7% of them were severely underweight (Bhattarai et al., 2019). The anthropometric evaluation of under-5 children identified that around 28%, 41% and 18% were reported to be underweight, stunted and wasted respectively in a hill community of Ilam district in eastern Nepal (Gaurav et al., 2014).

Among the 13% of underweight under-5 children in our study, the proportion of underweight female children was slightly higher compared to male children. The prevalence of underweight among girls was also found to be slightly higher than in boys in rural areas of Dolakha and Kavre districts (Chataut & Khanal, 2016). However, prevalence of underweight was found to be greater in male (23.70%) than female (18.50%) among Tharu under-5 children (Bhattarai et al., 2019). A study conducted in the mountain region of Nepal showed that undernutrition in Humla was higher among male (20.4%) under-5 children than female (7.8%) (Thapa et al., 2013) and almost same for both male and female under-5 children in Mugu (15.5% for male and 16.2% for female) (Thapa et al., 2013).

Underweight children were found to be highest in Mugu (26%) and Humla (21%) and lowest in Gorkha (5%). Children from the western mountain region were found to have the highest negative coefficient compared with the other regions for linear growth among under-5 children (Kattel et al., 2017).

In regards to ethnic group, 20%, 19% and 17% Dalit, Others (Thakuri, Sanyasi/Dasnami) and Brahmin/Chhetri children were found to be underweight respectively. Children from the Dalit ethnic group were 1.34 times more likely to be underweight than other ethnicities (Karku, 2019). Data from the NDHS 2006, 2011, and 2016 elicited that the average WAZ scores were significantly lower among children in the Dalit group compared with upper caste groups (Lamichhane et al., 2020). Moreover, the children who were stunted, underweight, or wasted were also disproportionally distributed across caste-ethnic group (Lamichhane et al., 2020). Children in the Dalit group were found to be more underweight, and more emaciated than children in upper caste groups (Lamichhane et al., 2020).


1. Factors associated with weight of under-5 children: Bivariate analysis

Gender, ethnicity and district were found to be significantly associated with the weight of under-5 children. Male children were less likely to be underweight compared to female children. In relation to district, children residing in Humla and Mugu were more likely to be underweight compared to those living in Bajura, whereas children residing in Gorkha and Sindhupalchowk were less likely to be underweight. Regarding ethnicity, Janajati, Muslim, and Brahmin/Chhetri children were less likely to be underweight compared to Dalit children.

Although not demonstrated in this study, the age group of children has been found to be associated with underweight, with children aged more than 24 months more likely to be underweight than children aged 0-23 months in Ilam, in the eastern part of Nepal (Adhikari et al., 2017). Age greater than 12 months and being in the Dalit caste was found to be significantly associated with being underweight in the rural Terai of eastern Nepal (Pramod Singh et al., 2009). The same study showed that age of child, poverty and increasing birth order were highly significant risk factors for underweight and that mother's BMI, mother's education (6+ years of schooling), vitamin A treatments, and participation in a nutritional program were considered as strong protective factors for underweight (Pramod Singh et al., 2009)..

The majority of children had a normal MUAC measurement (86%). The proportion of children with MAM and SAM was 10% and 4% respectively. More female children (15%) were found to have SAM and MAM than male children (13%). Similarly, majority (20%) of children belonging to Dalit and Others (Thakuri, Sanyasi/Dasnami) had yellow and red measurement. Children living in Humla and Mugu had the highest proportion of SAM whereas children in Sindhupalchowk and Gorkha had the lowest proportion. Weight, gender, district and ethnicity were found to be significantly associated with the MUAC of children. Male children were less malnourished compared to female children. Children living in Humla and Mugu were more likely to have acute malnutrition compared to children in Bajura. However, children in Gorkha and Sindhupalchowk were less likely to have acute malnutrition compared to Bajura. Regarding ethnicity, children belonging to Janajati, Muslim, Brahmin/Chhetri were less likely to be malnourished compared to Dalit children.

Malnutrition continues to be a major health problem among children of mountainous regions (Thapa et al., 2013). In Nepal, special attention should be paid to the mountain zones especially in the Mid- and Far-western regions (Karku, 2019). Broader and longer-term interventions focusing on child nutrition promotion is essential to reduce underweight among under-five children (Adhikari et al., 2017). Hence, prevention of malnutrition in children should be given a high priority in the implementation of ongoing care programs (Thapa et al., 2013).

The second research question examined whether diagnosis and treatment for malnutrition is affected by geography, child's age, gender, ethnicity and caste. Records of children age 2 to 59 months was assessed to understand whether health workers correctly diagnosed malnourished children. Further, children age 2 to 59 months identified as low weight and very low weight were assessed to learn whether health workers correctly followed the guidelines for the treatment of malnourished children.

2. Weight status of children age 2-59 months, correct diagnosis and treatment for malnutrition

The weight status of only 60% of children aged 2 to 59 months was recorded. Among those, 13.6% were underweight, with 3.5% being very low weight. A study conducted among under-5 children of Tharu community revealed that 17.5% of them were moderately underweight whereas 3.7% of them were severely underweight (Bhattarai et al., 2019). A study related to wasting also demonstrated that the prevalence of severe wasting was 1.9% in Nepal (Harding et al., 2018). In order to study whether health workers successfully diagnosed malnutrition, weight status was calculated based on age and weight of children following WHO guidelines. Weight status was calculated for 26,079 children out of which 31.1% were found to be underweight with 13% very low weight. The trend of malnutrition was found to be increasing with increase in age (Gaurav et al., 2014). Besides underweight, the larger proportion of children age 0-59 months in Nepal are stunted and underweight (Devkota & Panda, 2016).

Among a total of 26,089 children, the weight status of more than 50% was either incorrectly diagnosed or was not reported. Only 12.4% were correctly diagnosed by the health worker. Among children diagnosed as low weight or very low weight by health workers, more than 70% were not provided correct treatment based on the guidelines.

Both correct diagnosis and correct treatment of malnourished children aged 2 months to 59 months was very low in all five districts. Correct diagnosis as well as correct treatment was lowest in Gorkha district. Correct treatment was highest in Humla and Mugu (just a little over 30%) while correct diagnosis was highest in Mugu (21.5%). In general, the proportion of correct diagnosis and treatment increased over time. Correct diagnosis of malnutrition decreased from 2070 to 2072, then gradually increased after 2072. Three national representative household surveys (NDHS 2006, 2011 and 2016) revealed that the mean z-scores for stunting (height-for-age) showed slight improvement between 2006 and 2016 (-1.92 in 2006 and -1.29 in 2016) (Adhikari et al., 2019). Also, the proportion of child stunting decreased from 49.3% in 2006 to 35.8% in 2016 (Adhikari et al., 2019). This study finding showed that correct treatment of malnutrition increased from 2070 to 2072, but decreased in 2073, and then saw a sharp increase after 2073.

With regards to ethnicity, children recorded in the 'Muslim' ethnic category were among those with the lowest correct diagnosis made by health workers, but were among the highest for correct treatment for malnutrition. But overall, the proportion of Madhesi and Muslim children in this study were very low (less than 1%), as would be expected in these five districts. The highest proportion of children to be correctly diagnosed as malnourished was among the 'other' (Thakuri, Sanyasi/Dasnami) ethnic group (16.9%).

A higher proportion of male children were correctly diagnosed (17.2%) and correctly treated (27.1%) for malnourished children when compared with female children.


3. Factors associated with correct diagnosis and correct treatment among children age 2 to 59 months

The bivariate logistic regression showed significant association of correct diagnosis of malnutrition with district, visit year, ethnicity, gender, age and diarrhea. Children from Humla, Mugu and Bajura had significantly higher odds of being correctly diagnosed compared to Gorkha. Children from Mugu had the highest odds, more than 5 times higher than Gorkha. The odds of correct diagnosis seem to gradually increase over time. Among the ethnic groups, 'other' ethnic group children had higher odds of being correctly diagnosed (OR=1.18) compared to Dalit children. Janajati, Madhesi, Muslim and Brahmin/Chhetri children had lower odds of being correctly diagnosed. Children who did not have diarrhea seem to have significantly lower odds of being correctly diagnosed compared to those who had diarrhea.

Regarding the correct treatment of malnourished children, district, visit year, ethnicity and fever had significant association, while gender had no association. Children in Humla had the highest odds of being correctly treated for malnutrition (OR=7.76) closely followed by those in Mugu (OR=7.74). The odds of a child getting correct treatment seem to increase after 2073 (2016/2017). Among the ethnic groups, Janajati had significantly lower odds of getting correct treatment. Children who did not have fever had significantly lower odds of getting correct treatment compared to those children who had fever.
The third research question (RQ 3) examined whether geography, and child's age, gender, ethnicity and caste affect health-seeking behaviors and utilization of health services of Nepal. The mean number of days suffering from ARI, diarrhea and fever symptoms before presenting at the health facility was longer among children from Humla (4.1 days) and Mugu (4.5 days) and shorter among children from Bajura (3.7 days), Sindhupalchowk (3.4 days) and Gorkha (3.2 days). Regarding ethnic groups, children belonging to the Madhesi group had the most days (4.3 days) of suffering from ARI whereas Muslim children had the fewest (2.9 days) of all. The average days of diarrhea suffering was equal (4 days) for all ethnic groups except for Janajati children (3 days).
Females had slightly more ARI and fever days compared to males, although none of the days were significant among the two gender groups. Children suffering from ARI and their visit to health post seemed to increase from 2068 to 2072, but then again decrease after 2072. The children who also had GDS, diarrhoea or ear infection had more ARI and fever days on average.

Based on the available follow-up dates, the results of children going for follow up were computed. The highest follow up was found to be in Sindhupalchowk (5.7%) whereas the lowest was in Humla (2.1%). With regards to ethnicity, Janajati children had the highest (4.5%) follow up whereas it was lowest among Madhesi (1.3%). There was not much difference in the follow-up rate between male (3.8%) and female (3.7%) children. Follow up seemed to decrease over the time period.

4. Factors associated with visit to health post for children having ARI, diarrhea and fever

The bivariate regression analysis presented the results for three outcome variables: ARI, diarrhea and fever days before visiting to health post. The variables district, ethnicity, child age, GDS, diarrhea and fever were all significantly associated with outcome variables for ARI. Children in Humla, Mugu and Bajura had significantly higher ARI days compared to Gorkha. The number of days before visiting to health post among children suffering from ARI was higher among Janajati than Dalits. The number of days of ARI symptoms before visiting a health post increased significantly as children grew older. Similarly, GDS, diarrhea and fever also had significant association with ARI days.

The fourth research question (RQ 4) examined whether geography, and child's age, gender, ethnicity and caste affect the treatment that under-5s receive at health centers. ARI classification was based on the available non-missing symptoms and only 15% were classified based on it. Among these children, more than 60% had pneumonia and 15% had severe pneumonia. However, among the 25% of children whose ARI classification was recorded by health workers, 34.3% had pneumonia and less than 1% had severe pneumonia. Based on these two classifications, correct diagnosis of ARI by health workers was calculated for 2,542 children. The ARI classification of 31% of these children was not correctly diagnosed by the health worker. Among the 2,823 children who were classified as having severe pneumonia and pneumonia by health workers, over 75% children were not provided with the correct treatment.

Health posts in Mugu had the highest proportion (84%) of correct diagnosis of pneumonia by health worker, while Humla had the lowest level of correct diagnosis (63.4%), closely followed by Gorkha (64.3%). Gorkha also had the lowest percent of correct treatment (7.6%) while the highest proportion was seen in Mugu (46.6%). There were very low samples from Nepali years 2068 to 2070 and 2077. There does not seem to have been a clear pattern of correct diagnosis growth from 2071 to 2072. The lowest proportion of correct diagnosis was seen in 2074, but seems to have improved in 2076 to 74% correct diagnosis. Correct treatment for pneumonia seems to have increased over time in general, from 3.4% in 2071 to 63.5% in 2076.

Children from the Dalit ethnic group had the lowest correct diagnosis of pneumonia whereas the 'other caste' group (Thakuri, Sanyasi/Dasnami) had the highest (72.7%), closely followed by Brahmin/Chhetri (70.7%). Regarding correct treatment, Brahmin/Chhetri had the lowest proportion. Other and Dalit ethnic groups had the highest correct treatment of pneumonia. With regards to gender, correct diagnosis of pneumonia was slightly higher among females, but less than 25% of both gender groups were correctly treated for pneumonia.


5. Factors associated with correct diagnosis of pneumonia and correct treatment of pneumonia

The bivariate logistic regression was done between correct diagnosis as well as correct treatment of pneumonia with the independent variables. The variable child's age and child having diarrhea was found to be significantly associated with correct diagnosis of pneumonia.
Children in Mugu had 3 times higher odds of being correctly diagnosed than children in Gorkha. The odds of a child getting correct treatment seem to increase after 2073 (2016/2017). From year 2071 to 2073 there does not seem to be a clear pattern. However, compared to reference year 2070, all years have lower odds of correct diagnosis of pneumonia.

Regarding the ethnic group, Brahmin/Chhetri and 'other' ethnic group children have significantly higher odds of being correctly diagnosed (OR=1.31 and 1.45 respectively) compared to Dalit children. Interestingly, among the gender groups, male children had significantly lower odds (OR=0.73) of being correctly diagnosed with pneumonia compared to females. Similarly, children who were referred by any of the CHW, HF, FCHV, or PHC/ORC had lower odds compared to those who were not referred by any of these. Children who had GDS and ear infection had lower odds, while those who had ARI and fever had higher odds of correct treatment compared to those who did not have these conditions.

The variables district, visit year, ethnicity, refered by, ARI, diarrhoea and fever were found to be significantly associated with correct treatment of pneumonia. Sindhupalchowk, Humla, Mugu and Bajura had higher odds of correct treatment compared to Gorkha. Among these, Mugu had 10.51 times higher odds and Sindhupalchowk had 7.37 times higher odds than Gorkha. Children who were referred by CHW, HF, FCHV, or PHC/ORC had 3.75 times higher odds of being correctly treated compared to those who were not referred. Children who had ARI and those who had fever also had higher odds of getting correct treatment; however those who had diarrhea had lower odds of getting correct treatment.



The overall findings suggest broader and longer-term interventions focusing on child nutrition promotion to reduce underweight among under-five children (Adhikari et al., 2017). There is a need for further investment in child nutrition by Nepal government and its development partners for the sustainable reduction of child mortality and morbidity, and for ensuring the optimal cognitive development of all Nepali children as well (Budhathoki et al., 2020).
Exploitation Route The award has led to the creation of a unique set of c.34,000 patient records (IMNCI) from 23,000 rural health posts in Nepal. These records routinely exist only in paper-based record books and individual patient records are not digitised. This project has created a digital dataset of these records that could be utilised by other researchers to pursue a variety of research questions. The dataset and supporting documentation will be uploaded t the UK Data Service Archive at the end of the award period.
Sectors Healthcare
 
Description 50 health staff from PHASE Nepal-supported health posts across the country were provided with two days of training based upon the findings of the study. This training covered: 1. Sharing of the key findings in relation to inequalities in healthcare access and quality of treatment; 2. A group discussion of the reasons for those inequalities 3. An interactive training session on patient experience, involving role play sessions and discussion, in order to enhance awareness and skills. In a follow up study (paper under review) participants reported increased levels of awareness on patient experience and on implicit bias amongst healthcare workers.
First Year Of Impact 2022
Sector Healthcare
Impact Types Policy & public services
 
Description Health worker training, PHASE Nepal, April 2022
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact In a follow up study (paper under review) participants reported increased levels of awareness on patient experience and on implicit bias amongst healthcare workers.
 
Title Community Based Integrated Management of Neonatal and Childhood Illness Records of Under-5 Patients at 23 Health Centres in Rural Nepal, 2013-2018 
Description Data (in the form of paper records) was collected from 23 health centres in rural areas of Nepal, totalling 33,860 records of individual patient contacts for children under 5 years of age. The format of the record books follows the WHO (Nepal) guidance on Community Based - Integrated Management of Neonatal and Childhood Illness (IMNCI). The data included on the forms includes the following information on all children under 5: unique identifier, date of visit, child's sex, age, ethnicity/caste, weight, temperature, symptoms of general danger signs, symptoms of acute respiratory infection (including respiratory rate), diarrhoea and dehydration symptoms, symptoms for fever and ear infections, mid upper arm circumference (MUAC) measurements, assessment of nutritional status, classification for one major diagnosis, medicine prescribed (name of medicine), follow up plan, and condition of child on the date of follow up. 
Type Of Material Database/Collection of data 
Year Produced 2021 
Provided To Others? Yes  
Impact N/A 
URL https://reshare.ukdataservice.ac.uk/854820/
 
Description PHASE Nepal 
Organisation PHASE Nepal
Country Nepal 
Sector Charity/Non Profit 
PI Contribution The 'Resilience Policymaking in Nepal' project added significantly to developing the partnership between PHASE Nepal and the University of Sheffield. During the project, PI Rushton and CIs Karki and Panday delivered a one week training course in Participatory Video Facilitation to 12 members of PHASE Nepal staff. Following that, PHASE established its own in-house Participatory Video Unit to work on monitoring and evaluation of its projects using PV techniques, and for further potential research studies (the first of which - a project funded by Medecins du Monde examining the health of Informal Waste Workers in Kathmandu - has already been completed). CI Karki successfully applied for £7000 of University of Sheffield QR GCRF funding to support the hiring of research trainer for PHASE Nepal to train 10 members of PHASE's staff in qualitative and quantitative research methods, from January-April 2019. This will lead to the establishment of a permanent Research Unit within PHASE. As part of this training programme, PI Rushton visited PHASE for one week in January 2019 and delivered training on research ethics in developing country settings. HSRI Federalisation project: PHASE Nepal is one of two Nepal-based partners in this project. Two postdoctoral researchers are employed through PHASE Nepal, who are working closely with colleagues at the Manmohan Memorial Institute of Health Sciences on data collection, facilitating the Participatory Policy Analysis workshops, developing publications, and holding regular meetings with health system stakeholders.
Collaborator Contribution PHASE Nepal continues to work with the project team on follow-on projects arising from the Resilience Policymaking project, providing in-kind support with office facilities, logistics etc, as well as support with the development of further funding proposals. A current project that developed from the Resilience Policymaking project is utilising PHASE staff from the Participatory Video Unit to undertake much of the village-level fieldwork.
Impact Resilience Policymaking in Nepal: Giving Voice to Communities. Workshop Report, January 2019. https://www.sheffield.ac.uk/polopoly_fs/1.828544!/file/NepalreportFINAL.pdf
Start Year 2016