Use of Data for Decision Making in Planning Process of Local Health System in Nepal: A Critical Note on Problems and Prospects
Globally, the use of evidence in planning and policy development and health is not a new phenomenon. Yet, initially, it was limited to specific disciplines such as evidence-based medicine. Over the years this trend has spread across various disciplines and sectors, which include global health and international development. The key events in the arena of global development for setting universal goals such as Millennium Development Goals (MDGs), the Paris Declaration on Aid Effectiveness (2005), Sustainable Development Goals (SDGs) have further triggered the use of evidence in the planning process. These events have reinforced ideas such as Evidence-Based Policy (EBP) and planning in many sectors including health. Based on the qualitative approach, this article deals with two-fold objectives (a) to highlight the use of evidence in policy and planning (b) to explain prospects and problems of using evidence in policy and planning in the cross-roads of recently restructured local health system in politically changed context of Nepal.
This article is part of a broader research project “Survey for Urban Equity (SUE)” which applied mixed methods and simultaneously conducted in three Asian cities, namely Pokhara, Dhaka, and Hanoi. This article is based on Nepal-specific findings where information was primarily generated from twelve In-depth Interviews (IDIs) collected between October 2017 to November 2018 with a wide range of people holding different social, political and administrative positions in metropolitan city. These included mayor, deputy mayor, other elected officials, in-charge of health facilities, among others. The iterative process of qualitative data collection and analysis was followed. Data was further organized thematically with the aid of NViVo 11.
The findings highlight that the use of evidence to better inform health sector planning process and policy formulation is growing, which in principle, begins at the community/tole level. There is an active involvement of key actors such as members of health facility operation and management committee with vital role of health facility in-charge, elected officials, health team of municipality office including others in developing ward level health plan and program. Although the use of data in ward level planning is reported, the health plan is found to be guided by municipality guidelines and templates. The majority of these key actors, responsible for the management and promotion of community health system are positive and willing to use evidence and the benefits and importance of using data are discussed to the greater extent during planning and policy formulation at various platforms. Despite realization of the importance, local government in the changing political/Federal context has been facing several challenges in terms of availability and use of evidence including, lack of data/evidence in many areas such as disability, mental health etc., data when exist are incomplete and of poor quality and fragmented data, lack of capacity to use and analyze data, and lack of resources (both human and capital) which affect evidence-informed planning at local level.
Importance and practice of evidence-based planning and policy formulation has increased recently. However, this calls for system strengthening for effective and efficient use of evidence which could eventually contribute to achieving universal health coverage through the local health system.
Key Words: Health System Research, Qualitative Method, Evidence, Policy and Planning, Bottom-up Approach