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Impact Evaluation of Approaches to Strengthen Health Facility Operation and Management Committees in Nepal: BASELINE REPORT June 2015

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Impact Evaluation of Approaches to Strengthen Health Facility Operation and Management Committees in Nepal: BASELINE REPORT June 2015 RIDA International Research Input and Development Action Cover photograph, by Jessica Fehringer, MEASURE Evaluation, shows a village in Syangia district of Nepal that was included in this survey. Impact Evaluation of Approaches to Strengthen Health Facility Operation and Management Committees in Nepal Baseline Report Jessica Fehringer* Prem Bhandari† Dirgha Ghimire† Jeevan Raj Lohani‡ Bidhya Dawadi‡ Vikas Acharya‡ Bishnu Adhikari† MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) under Cooperative Agreement GHA-A-00-08-00003-00 and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in association with Futures Group, ICF International; John Snow, Inc.; Management Sciences for Health, and Tulane University. The opinions expressed in this publication do not necessarily reflect the views of USAID or the United States government. June 2015 ISBN 978-1-943364-19-0 TR-15-114 * MEASURE Evaluation † Institute for Social and Environmental Research-Nepal ‡ Research Inputs & Development Action International ACKNOWLEDGEMENTS We would like to acknowledge the many people and organizations that provided support in the completion of this baseline research. To begin with, we express our great appreciation to the women, household members, community members, health facility staff, and other stakeholders who devoted their valuable time to share their invaluable experiences, opinions, and thoughts for the research. We also thank the many community leaders and health facility staff who provided information to the quantitative and qualitative teams. We thank the government of Nepal, including the Family Health Division of Ministry of Health and Population, particularly Dr. Puspha Chaudhary and the Child Health Division, particularly Dr. Krishna Prasad Paudel, for support for the intervention and evaluation. We also acknowledge the Department of Health Services and District Public Health offices from Baglung, Parbat, and Syangja, and the 12 health facilities that provided necessary support and information for the qualitative component. The U.S. Agency for International Development (USAID) Asia Bureau and the USAID Nepal mission provided financial support. We extend our appreciation to their staff, including Debendra Adhikari, Jessica Healey, and Hari Koirala (USAID/Nepal) and Kristina Yarrow and Vera Zlidar (USAID Asia Bureau) who provided input and other assistance. Ana Djapovic Scholl (USAID, Office of HIV/AIDS, Division of Strategic Planning, Evaluation and Reporting) and Patty Aleman (USAID) were instrumental in the inception of the Gender, Policy, and Measurement Program (GPM) and also provided feedback and assistance. The Institute for Social and Environmental Research-Nepal (ISER-N) and Research Inputs & Development Action International (RIDA) implemented the data collection and conducted the preliminary data analysis. Both organizations faced a variety of challenges, including data collection during the rainy season, staff vehicle accidents, and short timelines — all of which they handled with great skill. We thank Uttam Prasad Upadhyay, Laxmi Raman Ban, Kamana Uprety, and Kalpana BC who contributed at different stages of the study to the qualitative component. We thank Prem P. Pandit, Rajendra Ghimire, and Adina Gurung, district managers for the quantitative field data collection. We also thank Indra Chaudhary and Tula Ram Sinjali, study managers; Krishna Shrestha, programmer; and; Krishna Ghimire, administrative manager for the quantitative component. The intervention of focus for this evaluation research is being implemented through the impressive work of Suaahara staff, including Ravindra Thapa, Bindu Gautam, Peter Oyloe, Pooja Pandey, Sri Krishna Basnet, and Dr. Sameena Rajbhandari; and GPM staff, including Bhawana Subedi, Health Policy Project (HPP) consultant, and Beth Rottach and Rachel Kiesel of HPP. Furthermore, the MEASURE Evaluation staff contributing to the evaluation design and baseline implementation deserves abundant thanks: Lara Lorenzetti assisted with protocol and tool development as well as baseline research training; Ashley Marshall (formerly of MEASURE Evaluation) contributed to tool development; Laxmi Acharya served as the local evaluation baseline research manager (consultant); Peter Lance provided critical sampling expertise; Milissa Markiewicz and Abby Cannon contributed to the baseline report editing and writing; Nash Herndon edited and laid out the baseline report; Beth Robinson provided report feedback; and Denise Todloski designed the cover. CONTENTS ACKNOWLEDGEMENTS ............................................................................................................................................. II LIST OF TABLES AND FIGURES ............................................................................................................................... iv EXECUTIVE SUMMARY .......................................................................................................................................... ix INTRODUCTION ............................................................................................................................................................. IX BACKGROUND .............................................................................................................................................................. IX IMPACT EVALUATION DESIGN .......................................................................................................................................... XI METHODS AND BASELINE SAMPLE SIZES ........................................................................................................................... XII SUMMARY OF KEY RESULTS ........................................................................................................................................... XV CONCLUSIONS ............................................................................................................................................................. XX 1. INTRODUCTION ................................................................................................................................................. 1 BACKGROUND ............................................................................................................................................................... 1 SUAAHARA ................................................................................................................................................................... 2 STUDY SETTING ............................................................................................................................................................. 3 2. IMPACT EVALUATION AND BASELINE SURVEY ................................................................................................... 7 EVALUATION OBJECTIVES AND QUESTIONS ......................................................................................................................... 7 OUTCOMES OF INTEREST ................................................................................................................................................. 7 EVALUATION DESIGN ...................................................................................................................................................... 7 DEFINITIONS ................................................................................................................................................................. 9 QUANTITATIVE ............................................................................................................................................................ 10 QUALITATIVE .............................................................................................................................................................. 14 STUDY LIMITATIONS ..................................................................................................................................................... 16 3. TRAINING AND FIELDWORK ............................................................................................................................. 19 ETHICAL REVIEW AND PROTECTION OF HUMAN SUBJECTS .................................................................................................... 19 TRANSLATION AND REFINEMENT OF STUDY INSTRUMENTS ................................................................................................... 19 QUANTITATIVE FIELDWORK AND TRAINING ....................................................................................................................... 19 QUALITATIVE FIELDWORK AND TRAINING ......................................................................................................................... 20 4. PARTICIPANT AND HOUSEHOLD CHARACTERISTICS ......................................................................................... 23 HOUSEHOLD SURVEY .................................................................................................................................................... 23 WOMEN’S SURVEY ....................................................................................................................................................... 31 COMMUNITY SURVEY ..................................................................................................................................................
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