Search

Introduction: Stress among health care professionals is harmful because of adverse psychological and physiological changes, which lead to decrease productivity. This study aimed to explore the experienced causes of stress, its effects and coping strategies among nurses. Methods: In-depth interview was conducted among nurses working in different hospitals of the Pokhara metropolitan, Nepal. The nurses were selected purposively. Data saturation was gained with fifteen interviews. Data analysis was done by adopting the Conventional Qualitative Content Analysis technique and summative analysis process. Results: Three domains were identified from the study – causes of stress, effects of stress, and coping strategies for stress. The causes of stress were workload, lack of proper logistics, insufficient staffs, undesirable relation among colleagues, patient’s condition, patient’s relatives, and visitors, being blamed for other’s mistakes, senior’s behaviors, workplace violence, work- shift, patient’s death, and sufferings, job positions, work-life balance, health condition, job dissatisfaction, dignity and social status, family problems and lack of experience. The effects of stress experienced by the nurses were medication errors, delay of services, loss of concentration in work, degradation of the hospital’s goodwill, headache, insomnia, frustration and depression, lethargy, and loss of appetite. Nurses adopted listening to music, playing games, surfing the internet, watching television, doing household chores, sharing events and incidents, calm down, and crying as the coping strategies for the stress they experienced. Conclusion: Due to several stress factors and their effects, the performance of nurses in a hospital setting was challenging. It was affecting the physical, mental, and social aspects of nurses’ life. However, they adopted coping strategies to help themselves in reducing the level of stress. An environment must be created by family members, organization, management team, nation, concerned authority, and possible stakeholders so that the nurses will be able to work with total concentration, devotion, and commitment.

Introduction: Job satisfaction has been identified as key factor of health worker retention and turnover in Low and middle income countries. In Nepal, only 55% of the health workers were satisfied with their current jobs. There is limited amount of literature in the areas related to factors affecting job satisfaction. This study aimed to assess the level of job satisfaction and its associated factors among PHC level health workers in Kaski district. Methodology: Health facility based cross sectional, quantitative study was conducted collecting quantitative data from all PHC level health facilities (3 Primary Health Care Center and 45 Health Posts) health workers of Kaski district, Nepal through face to face interview. The perceived 12 item job satisfaction scale was developed and used to identify job satisfaction. The association between the independent and outcome variable was analyzed by using chi square test. Results: The results showed two-third (66%) of PHC level health workers were satisfied with their current jobs in overall job satisfaction at Kaski district. The study showed that Health Assistant were more satisfied than Auxiliary Nurse Midwifery and Auxiliary Health Workers. Sex (OR=1.80, 95%CI=1.0-3.26), level of working post (OR= 2.62,95%CI=.1.44-4.77) salary (OR= 3.96,95%CI=2.07-7.57) ,pension (OR=3.96, 95%CI=2.07-7.57) training (OR=5.01, 95%CI=2.66-9.39) , opportunity for promotion (OR=2.80, 95%CI=1.54-5.09) , reward provision (OR=3.63,95% CI=1.94-6.77) and role in decision making OR=5.08,95% CI=2.34-11.04) were found to be significantly associated with overall job satisfaction. Conclusion: Two- third of the PHC level health workers of Kaski district were found to be satisfied with their job. Responsible bodies need to make provisions to improve the job satisfaction level of health professional so as to improve the healthcare services of PHCCS and HPs. Key words: Job satisfaction, Health workers, Primary health care level

Free Health Service is a priority program and a boon to all citizens mostly for the poor and marginalized groups. It is a timely and exemplary program of government but some people have deviation in their normal behaviour as services have been provided free. A descriptive cross-sectional approach was done to assess moral hazard on free health care services by consumers. An interview schedule was used to collect quantitative data and in depth interview with health workers for qualitative data in selected eleven health facilities. The study showed the prevalence of moral hazards of free health care services by the consumers. Two-third (65%) respondents had medicines at home. Around one-third (33%) of respondent had self demanded for the medicines. Two-third (67.6%) doesn't seek for health services during health problems. One-fourth (23.6%) had poster at home for non IEC purpose. Age, education level, travelling time to health facility, occupation, and satisfaction towards services were significantly associated with availability of medicines at home. Age, education level, health workers behaviour were significantly associated with self demand of medicines. Peoples are misutilizing the services as, government bear the burden of cost. There was deviation in the normal behaviour of the peoples due to no registration fees and free drugs availability. Many people like to take medicines and have a notion that there is a pills for every ill as a result they self demand for the medicines and mostly don’t consume full dose which can develop drug resistance. Visit to health facilities to collect medicines at home have increase unnecessary burden to health facilities and also increase in morbidity status. The result can inform developing proper policy and safety measures to drop off moral hazard on free health care services.

na

Educational satisfaction determines the quality of education system which interns affects the performance and achievement of students during study and finally future professional competencies. The objectives of this study were to identify the perceived status of satisfaction on educational conditions and teaching-learning environment and associated factors of it among the public health undergraduates. This was the descriptive cross sectional study carried out among 384 undergraduate students of public health studying in final year/semester of three universities of Nepal using self administered questionnaire. The result of the study showed that satisfactions on various components are below than average. Among the satisfied components, the major were in case of duration of course (46.1%), teaching skills of part time teacher (39.1%), curriculum and overall course of study (36.2%), research/dissertation guidance (34.6%) and teaching skills of full time teacher (33.6%). The satisfaction level was least in case of result timing/procedure (14.1%), tuition fee (23.7%), examination procedure (26.3%) and evaluation system (27.1%). Ethnicity, educational background, course duration, types of teacher, availability of books in library and availability of research papers/journals were found associated with educational satisfaction. The study concluded low educational satisfaction among public health under graduate students. It is recommended to take immediate action for improvements of different components of education system like curriculum structure & contains, teaching methodology, teaching learning materials, admission and examination procedure. Key words: Public health; Education; undergraduate course; satisfaction; Nepal

Leadership in public health is necessary, relevant, and important as it enables the engagement, management, and transformation of complex public health challenges at a national level, as well as collaborating with internal stakeholders to address global public health threats. The research literature recommends exploring the journey of public health leaders and the factors influencing leadership development, especially in developing countries. Thus, we aimed to develop a grounded theory on individual leadership development in the Nepalese context. For this, we adopted constructivist grounded theory, and conducted 46 intensive interviews with 22 public health officials working under the Ministry of Health, Nepal. Data were analysed by adopting the principles of Charmaz’s constructivist grounded theory. The theory developed from this study illustrates four phases of leadership development within an individual–initiation, identification, development, and expansion. The ’initial phase’ is about an individual’s wishes to be a leader without a formal role or acknowledgement, where family environment, social environment and individual characteristics play a role in influencing the actualisation of leadership behaviours. The ’identification phase’ involves being identified as a public health official after having formal position in health-related organisations. The ’development’ phase is about developing core leadership capabilities mostly through exposure and experiences. The ’expansion’ phase describes expanding leadership capabilities and recognition mostly by continuous self-directed learning. The grounded theory provides insights into the meaning and actions of participants’ professional experiences and highlighted the role of individual characteristics, family and socio-cultural environment, and workplace settings in the development of leadership capabilities. It has implications for academia to fulfill the absence of leadership theory in public health and is significant to fulfill the need of leadership models grounded in the local context of Asian countries.

Correction: On 17th May 2020 the third author's name was changed from 'Chiranjibi' to 'Chiranjivi' Budget allocated, especially for new pilot program should yield better health effects than the regular ones. The government of Nepal launched Integrated Public Health Campaign (IPHC), a new type of intervention to make rural and vulnerable communities more aware about basic level health care services and increase their utilization. This paper examines the cost of the campaign and its outcomes in terms of providing awareness, utilization of maternal health services and improving health indicators. The study followed a comparative quasi experimental design, study unit being the household and the campaign. Case and Control village development committees (VDCs) were selected from the same territory and matched based on the criteria of IPHC and other socio-demographic & health services characteristics. Cost calculation was based on direct method whereas the effectiveness was measured by analyzing the output of campaign between case and control VDC. The total cost of the campaign was NRs. 18, 00,000 with per household cost NRs. 585.93 and per capita cost NRs. 123.11. The awareness level of Free Health Services (FHS), Primary Health Care-Out Reach Centre and Safe Delivery Incentive Program (SDIP) was found to be 3.3, 2.65 and 1.95 times more in people of Case VDC than those of Control VDC. Moreover, there was no significant association between implementation of campaign with different practices of maternal health viz. Antenatal Care visit, delivery, SDIP and post natal care visit. The campaign was found effective in improving the status of OPD visit, measles, TT2+, growth monitoring of children and vitamin A supplementation to postpartum mothers. The campaign was effective in limited aspects. In case of its continuation, revision is necessary with the introduction of newer and better approaches. Economic Journal of Development Issues Vol. 23&24 No. 1-2, (2017) Combined Issue, Page : 113-122

Neonatal mortality is the prime indicator that contributes to child mortality. The out-of-pocket (OOP) expenditure for treatment remains a major barrier in treatment. The study aimed to calculate OOP of neonatal health care in Kaski district of Nepal. A total of 450 mothers (226 from rural and 224 from urban), having infants aged six months or less or the infants died within last six months, were interviewed face-to-face retrospectively for neonate period. Firstly, six out of 33 urban and ten out of 43 rural clusters were randomly selected from Kaski district and secondly, within each cluster, HHs were selected using EPI method as described by WHO. The mean out-of-pocket expenditure (OOP) of neonatal health care was NRs. 4,322 which was 2.7 percent of total non-food expenditure. Three percent HHs suffered catastrophic health expenditure due to neonatal OOP. It reached five percent when housing/rental cost was excluded from non-food expenditures. HHs with cases of ARI, diarrhea, and others such as Neonatal Tetanus (NT), constipation, eye infection, preterm, meconium engulf and allergy differed significantly from the HHs with cases of jaundice and fever at all three thresholds of catastrophic health expenditure. OOP also differed significantly according to the levels of health facilities. Economic Journal of Development Issues Vol. 21 & 22 No. 1-2 (2016) Combined Issue, Page: 1-21

Background: Job description of public health officials in Nepal has been prepared for assigning the definite role, responsibilities and authorities to exercise in different positions and circumstances. The purpose of this study was to analyse the job description of public health officials emphasizing the perspective of leadership and management.Methods: Document analysis method was used following the sequential process of skimming, reading and interpretation, and the themes were extracted by content analysis.Results: Job description of public health officials is mostly process and/or function oriented. Most of the officials are responsible for managing program and people rather than leading. Staff inspiration, motivation and encouragement, being one of the most important aspects of leadership, has been ignored in job description. District level officials are specifically assigned to manage programs and staff. As the position increases, the extent of practicing leadership increases and management decreases. Public health administrators have more leadership role as compared to public health officers; however, the proportion of management outweighs the leadership. Regional Directors have more leadership roles than other officials do. Conclusions: Role of public health officials vary from being a manager to a leader. Junior officials are predominantly the managers, mid-level officials are leadership-oriented managers, and top-level officials are leaders having managerial roles . In revising the job description (e.g., for the federal context), emphasis should be given to remove job duplication and role conflict, and should ensure role clarity, functions’ precision and output. Keywords: Document analysis; job description; leadership; Nepal; public health.

Background: Reproductive behavior and its decision making practices are generally exercised in one of the three ways – mutual, dominancy of husband or dominancy of wife. Gender norms and roles prevalent in society affect the practice of reproductive decision making among couples. The aim of this study was to identify the practice of decision making on different reproductive behavior among couples and to examine the associated factors of decision making. Methods: Descriptive cross sectional study was conducted in four Village Development Committee (VDCs) of Syangja district of Nepal by using structured interview schedule. The couples of reproductive age (15-49 years) having at least children of one year were the study population. Results: Decision making on the use contraceptives and plan for pregnancy was mostly mutual (62.1% and 74.8% respectively). Regarding the birth spacing, majority (42.4%) of couples had made no decision followed by mutual decision (41.4%). While 72.0 % couples had gone through mutual discussion to maintain the family size, 27.7% discussed not at all regarding the concerned matter. Only 37.7% of husbands had provided adequate time for nurturing and caring their children. Association was found between decision maker on pregnancy and times of pregnancy (P

Introduction Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. Methods A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. Results The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of “days of work loss” were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Conclusion Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a critical factor for many poor and remote households who attend the hospital for delivery. Current remuneration (10–15 USD for normal delivery, 30 USD for complicated delivery and 70 USD for caesarean section delivery) for maternity incentive needs to account the hidden costs by increasing it to 250 USD for normal delivery and 350 USD for C-section. Decentralization of the obstetric care to remote and under-privileged population might reduce the economic burden of pregnant women and can facilitate their attendance at the health care centers.