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The experiences of districts in implementing a national incentive programme to promote safe delivery in Nepal

Powell-Jackson, T; Morrison, J; Tiwari, S; Neupane, BD; Costello, AM; (2009) The experiences of districts in implementing a national incentive programme to promote safe delivery in Nepal. BMC Health Services Research , 9 , Article 97. 10.1186/1472-6963-9-97. Green open access

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Abstract

Background: Nepal's Safe Delivery Incentive Programme ( SDIP) was introduced nationwide in 2005 with the intention of increasing utilisation of professional care at childbirth. It provided cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We explored early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake.Methods: We conducted in ten study districts a series of key informant interviews and focus group discussions with staff from health facilities and the district health office and other stakeholders involved in implementation. Manual content analysis was used to categorise data under emerging themes.Results: Problems at the central level imposed severe constraints on the ability of district-level actors to implement the programme. These included bureaucratic delays in the disbursement of funds, difficulties in communicating the policy, both to implementers and the wider public and the complexity of the programme's design. However, some district implementers were able to cope with these problems, providing reasons for why uptake of the programme varied considerably between districts. Actions appeared to be influenced by the pressure to meet local needs, as well individual perceptions and acceptance of the programme. The experience also sheds light on some of the adverse effects of the programme on the wider health system.Conclusion: The success of conditional cash transfer programmes in Latin America has led to a wave of enthusiasm for their adoption in other parts of the world. However, context matters and proponents of similar programmes in south Asia should give due attention to the challenges to implementation when capacity is weak and health services inadequate.

Type: Article
Title: The experiences of districts in implementing a national incentive programme to promote safe delivery in Nepal
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/1472-6963-9-97
Publisher version: http://dx.doi.org/10.1186/1472-6963-9-97
Language: English
Additional information: © 2009 Powell-Jackson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Conditional cash transfers, middle-income countries, health-policy analysis, interventions, care
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/138563
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