Building resilient local health systems

Introduction

ReBUILD for Resilience is an international research consortium funded by the UK government, dedicated to strengthening resilience and building stronger systems for health across multiple levels and sectors in fragile and shock-prone settings, namely Lebanon, Myanmar, Nepal and Sierra Leone. These settings face significant challenges due to fragility, violence, conflict and other shocks, eroding efforts to build healthy, equitable and prosperous societies. Innovative, timely and contextually tailored evidence generated in partnership with key local and national stakeholders is critical to developing and sustaining resilient health systems, which are currently lacking in these regions. Through this consortium, we aim to generate high quality, practical, multidisciplinary, operationally-relevant and scalable health system research in these settings.

As part of ReBUILD for Resilience, HERD International is implementing several research projects aimed at strengthening health systems at both national and subnational levels in Nepal. These projects are guided by the consortium’s resilience framework and Theory of Change and drawing on the foundation of these framework and ToC, HERD team developed a ToC specific for Nepal, which guides the system strengthening efforts through our learning site projects. Hence our learning site projects are designed to operationalize the ToC, ensuring that our initiatives are strategically aligned with our overall objectives and context-specific needs. We ensure a sustained focus on equity, gender, disability and social inclusion throughout the programme stages, aligning with the consortium’s Gender, Equity and Justice strategy 2020.

Learning site 1

The three-year participatory action research (2021-2024) entitled “Understanding and strengthening local health governance and planning to build resilient local health systems that leave no one behind: a learning site approach in Kapilvastu Municipality of Lumbini Province” is a three year research project. The project aims to understand and support the resilience of local health system focusing in Kapilvastu municipality of Kapilvastu district, which lies in Lumbini Province. We support in strengthening capacity of local government in health sector governance, planning and financing, that will enable to deliver quality and gender equitable health services.

We assess how interventions are implemented, and how decision space, demand for services, capacity and performance can be strengthened at this level. Such approach was facilitated by trusting relationships between research team and local system stakeholders and enable platform for research team to implement activities flexibly and collaboratively with local health system team focusing on local priorities.

Implementation approaches

We adopted participatory approaches, embracing co-creation at the heart of our project activities, including generation of evidence, prioritization of problems, development of action plan, implementation and monitoring of activities as well as in learning and adaptation of interventions for continuous improvements.

Our key intervention approaches are:

1. Sensitization of local stakeholders including elected officials on health and health system resilience, as reflected in local plans and budget.
2. Development of evidence-based and responsive action plan adopting cocreation approaches, conducting Group Model Building Workshops with elected officials, section officers, health workers and partner organization.
3. Development of evidence-based, responsive and participatory annual work plan and budget.
4. Enhancement of the data quality, evidence synthesis and use to inform policies, plans and practices for improved health system learning and decision making.
5. Formation and operationalization of various structures and committees for improved governance and effective planning such as Municipal Health Committee at municipality, Health Facility Operation and Management Committees at Basic Health Service Centres and Rapid Response Team (RRT) at municipality and health facilities.
6. Improvement of health sector governance, willingness and readiness to respond to emergencies and maintain access to essential health services during crisis and in normal times.
7. Strengthening monitoring and supervision mechanisms of the health system.
8. Establishing intersectoral coordination for effective and sustainable health outcomes. 

For more information on R4R, please visit the main website from here: https://rebuildconsortium.com/rebuild-for-resilience/

Please visit our learning site here: https://kapilvastumun.gov.np/