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What drives health policy formulation: Insights from the Nepal maternity incentive scheme?

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  • Ensor, Tim
  • Clapham, Susan
  • Prasai, Devi Prasad

Abstract

Although maternal health outcomes have improved considerably in Nepal, continued low levels of skilled attendance and unequal access to safe emergency obstetric care continues to be central policy concern. The financial costs of delivery exacerbated are thought to continue to represent a major barrier to care to accessing services. Policy interest in this area moved swiftly. Skilled birth attendance came under the spotlight in 2001 while research on costs was commissioned in 2003. The resulting conclusions suggested substantial costs particularly on the demand side in the form of transport costs. After the research was completed the Government moved quickly to develop policy on financial barriers to skilled attendance leading to the Maternity Incentive Scheme that was implemented in 2005. We explored the reasons for policy acceptance and implementation based on recent studies in this area and a series of key informant interviews in the country. A variety of reasons can be shown to be important in ensuring that the research was utilised quickly. The conduct of the research process was importance, particularly by ensuring that results were communicated widely in a way that responded to both technical and political policy-making concerns. A convergence of political interests that meant that the policy became an ideal vehicle for improving the flagging fortunes of the government was also seen as crucial in expediting policy change although it also meant that the policy had to be adjusted to cater to political rather purely technical concerns. The experience also underlines the importance of political champions within or close to government in advocating a strong policy line through channels that researchers can rarely access.

Suggested Citation

  • Ensor, Tim & Clapham, Susan & Prasai, Devi Prasad, 2009. "What drives health policy formulation: Insights from the Nepal maternity incentive scheme?," Health Policy, Elsevier, vol. 90(2-3), pages 247-253, May.
  • Handle: RePEc:eee:hepoli:v:90:y:2009:i:2-3:p:247-253
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    References listed on IDEAS

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    1. Shiffman, Jeremy, 2003. "Generating political will for safe motherhood in Indonesia," Social Science & Medicine, Elsevier, vol. 56(6), pages 1197-1207, March.
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    Cited by:

    1. Powell-Jackson, Timothy & Hanson, Kara, 2012. "Financial incentives for maternal health: Impact of a national programme in Nepal," Journal of Health Economics, Elsevier, vol. 31(1), pages 271-284.
    2. Coffey, Diane, 2014. "Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India," Social Science & Medicine, Elsevier, vol. 114(C), pages 89-96.
    3. Tulsi Ram Bhandari & V Raman Kutty & P Sankara Sarma & Ganesh Dangal, 2017. "Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-10, August.
    4. Rafael Cortez & Seemeen Saadat & Sadia Chowdhury & Intissar Sarker, 2014. "Maternal and Child Survival: Findings from five countries experience in addressing maternal and child health challenges," Health, Nutrition and Population (HNP) Discussion Paper Series 91294, The World Bank.
    5. Geha Nath Khanal, 2019. "Conditional cash transfer policies in maternal health service utilization in Nepal: Analysis of safe delivery incentive program (Aama Surakshya Karyakram) using Kingdon's multiple streams framework," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 131-141, January.

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