What drives health policy formulation: insights from the Nepal maternity incentive scheme?

Although maternal health outcomes have improved considerably in Nepal, continued low levels of skilled attendance and unequal access to safe emergency obstetric care continues to be central policy concern. The financial costs of delivery exacerbated are thought to continue to represent a major barrier to care to accessing services. Policy interest in this area moved swiftly. Skilled birth attendance came under the spotlight in 2001 while research on costs was commissioned in 2003. The resulting conclusions suggested substantial costs particularly on the demand side in the form of transport costs. After the research was completed the Government moved quickly to develop policy on financial barriers to skilled attendance leading to the Maternity Incentive Scheme that was implemented in 2005. We explored the reasons for policy acceptance and implementation based on recent studies in this area and a series of key informant interviews in the country. A variety of reasons can be shown to be important in ensuring that the research was utilised quickly. The conduct of the research process was importance, particularly by ensuring that results were communicated widely in a way that responded to both technical and political policy-making concerns. A convergence of political interests that meant that the policy became an ideal vehicle for improving the flagging fortunes of the government was also seen as crucial in expediting policy change although it also meant that the policy had to be adjusted to cater to political rather purely technical concerns. The experience also underlines the importance of political champions within or close to government in advocating a strong policy line through channels that researchers can rarely access.