Policies, Plans, and People: Foreign Aid and Health Development

Contents

Contents Abbreviations Preface 1 Introduction Nepal: The Setting Research Methods 2 The Health Bureaucracies: Structure and Culture The Dynamics of Nepal's Bureaucracy Government Structure Traditional Patterns in Administrative Behavior The International Donor Agencies The World Health Organization (WHO) The United States Agency for International Development (USAID) Interaction Between the Government and the Agencies ix xi 1 5 10 15 15 15 20 24 25 26 29 vi CONTENTS Nepali Administrators and International Advisors 3 Policies and Plans International Health Policy and Nepal Hospital-Based and Vertical Programs The Shift to Integrated Basic Health Services Integrated Community Health Program and Primary Health Care The Planning Process Country Health Programming Further Planning Efforts Planning for Community Participation: A Case Example 4 Delivering Services to Rural Villages A Partially Integrated Health Post A Fully Integrated Health Post The Local Panchayat Shortages The Villagers' Response to Services The District Health Office Problematic Roles of Health Workers The Invisible Health Worker: The Peon The Community Health Volunteer and the Village Health Worker 5 Sources and Channels of Information Sources of Information Reports Field Travel Formal and Informal Meetings 35 46 48 48 51 59 63 63 69 74 82 83 88 92 93 95 98 101 101 106 111 112 112 117 119 CONTENTS The Flow of Information within Government Data, Plans, and Targets Vertical Barriers Horizontal Barriers Reliance on Quantitative Data 6 Sociocultural Information and the Health Planning Process The Anthropologist's Role in Planning Using Sociocultural Information to Improve Health Planning: A Case Study Some Suggestions for Changing the ANM's Role Overcoming Obstacles in the Health Bureaucracy Appendixes 1. A Chronology of Health-Sector Events in Nepal 2. Profile of Health Workers in ICHP 3. Job Descriptions for ICHP Functions of Community Health Volunteer Village Health Worker Assistant Nurse-Midwife (ANM) Notes Bibliography Index vii 122 122 125 131 132 135 140 148 151 155 156 159 161 161 163 167 170 175 195 This page intentionally left blank ...