Impact of investment case approach on equitable access to maternal and child health services in Nepal

Thapa, Janak Kumar (2022): Impact of investment case approach on equitable access to maternal and child health services in Nepal. Dissertation, LMU München: Medizinische Fakultät

Abstract

Introduction: Investment Case (IC) aims to support the local level to prepare comprehensive equitable development plans that are responsive to the local barriers confined in the area of maternal and child health (MCH). The main aim of the study was to assess the effect of the intervention designed by applying the IC approach in improving MCH service outcomes in Nepal. Methods: The study used a mixed method quasi-experimental research design involving 16 intervention and 24 comparison districts. The Nepal Demographic Health Survey (NDHS) datasets (2011 and 2016) were used for this study. Difference-in-difference (DiD) analysis adopting linear regression was used in order to assess the effectiveness of the IC approach. Similarly, a phonomyography qualitative study with stakeholders involved in planning and implementing the IC approach was used to explore their perception on IC approach in equitable planning and budgeting in MCH services. Results: Improvements in the majority of the outcome variables (antenatal care check-up, skilled birth attendant assisted delivery, wasting and underweight) followed similar trends in both intervention and comparison districts, indicating that the districts implementing IC approach did not improve MCH outcomes when compared to control districts. DiD analysis showed a significant increase in wasting among children aged under five (β: 0.019; p = 0.002) in the intervention districts. Qualitative findings, however, showed that the stakeholders were positive towards the effectiveness of IC approach for district-level health planning. They believe that IC has helped to increase responsiveness and accountability of stakeholders. Conclusions: IC helped immensely for the planning process, making it evidence based, but was unable to deliver expected results at impact level within the allocated timeframe mainly due to the inadequate implementation of the agreed plans. Hence, execution of the agreed plans should be the key focus of future interventions.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Keywords Investment Case, Maternal and Child Health, Nepal, Quasi-experimental study
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 24. Oktober 2022
• 1. Bericht­erstatter:in: Stöckl, Doris