10 Years of Increasing Policy Attention for Newborns in Nepal
Written by: Stephanie Smith, Assistant Professor of Public Administration, University of New Mexico
The following piece is the second in a series on generating political priority for newborn health. Read the first. It originally appeared on the Healthy Newborn Network blog and is reposted here with permission.
Newborn survival rose quickly on Nepal’s health policy agenda over the course of the past decade. Nepal adopted its first national newborn health strategy in 2004, conducted a comprehensive assessment of newborn health and programs in 2007, and implemented pilots of a community-based newborn care program with promise for nationwide scale up in 2009. A recent study found that this rise was facilitated by the formation of a network of concerned actors who pushed for policy action, significant leadership from health policymakers in Nepal, high-level political commitments to the United Nations Millennium Development Goals and the emergence of reliable and contextually relevant evidence concerning the problem and its solutions. Findings of the study were published in Social Science & Medicine in February 2011.
Our study asked how the level of political priority for newborn survival had changed in Nepal, why, and with what implications for other health issues. We conducted 29 interviews with individuals with close knowledge of Nepal’s newborn survival policies and programs and undertook extensive document analysis in 2008 and 2009 to investigate these questions. Interviewees and documents represent a wide range of sources, including government, UN agencies, bilateral development agencies, non-governmental organizations, health professionals and researchers, reports and published research.
Four factors were key to increasing political priority (defined as the authoritative allocation of human, financial and technical resources equal to the severity of the problem) for newborn survival in Nepal.
- A policy window opened in 2000 as the government of Nepal and international organizations committed to achieving the Millennium Development Goals, particularly MDG 4 to decrease under-five child mortality by two-thirds by 2015. This common goal and a 2001 call by Nepal’s prime minister to reduce neonatal mortality laid the groundwork for increasing cooperation between high-level government officials and international development partners to address the problem.
- Although Nepal’s neonatal mortality rate was on the decline (decreasing from 50 to 33 between 1996 and 2006), data indicating that neonatal mortality was growing as a proportion of infant and child mortality (increasing from 63 to 69 percent of infant mortality and from 42 to 54 percent of under-5 child mortality between 1996 and 2006) caught the attention of health policymakers and development partners seeking to achieve the child survival MDG. Growing international, regional and local evidence concerning the problem and solutions appropriate to the Nepali context (including The Lancet Neonatal Survival Series published in 2005, research conducted by MIRA [Mother and Infant Research Activities] and under the MINI [Morang Innovative Neonatal Health Intervention] project in Nepal, and by Dr. Abhay Bang in India), helped to convince concerned actors and policymakers that the problem was tractable and that they could work together to address it.
- Recognizing newborn survival as a problem requiring additional and more specific attention than it had been afforded within safe motherhood and broader child survival frameworks in the 1990s, a network of concerned actors formed to push for solutions in the early 2000s. SNL provided resources to help the network, including representatives from government and international development organizations, health professionals and researchers, get started. Facilitated by leadership from the directors of Nepal’s Family and Child Health Divisions (under the Ministry of Health) throughout the 2000s, the network of concerned actors helped to inform Nepal’s first national newborn health strategy (adopted in 2004), conduct ongoing assessments of the problem, identify solutions appropriate for Nepal’s remote populations and bring pilots of a Community-based Newborn Care Package to fruition in 2009.
Priority for newborn survival in Nepal has increased significantly since the turn of the century; however, challenges to securing the issue’s place on Nepal’s policy agenda and scaling up intervention strategies remain. Engaging an expanded network of concerned actors, including political leaders, civil society and actors outside the capital would likely strengthen the initiative. An advocacy strategy that addresses concerns of Nepal’s overlapping maternal, newborn and child health policy networks and of political leaders could help to secure the issue’s place on the policy agenda into the future. Adapting to Nepal’s evolving political context will also be a key challenge.
Photo: Jonathan Hubschman / Save the Children