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Accountability and generating evidence for global health interventions: The case of misoprostol in Nepal

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Original languageEnglish
Pages (from-to)49-64
JournalIDS Bulletin
Volume49
Issue number2
DOIs
Publication statusPublished - 8 May 2018

Abstract

Post Partum Haemorrhage (PPH) is a major cause of maternal morbidity and mortality in Nepal. Compounded by the remote terrain, endemic poverty, and a lack of access to health facilities, the use of misoprostol has advantages over the standard use of oxytocin for PPH management. Unlike oxytocin, misoprostol does not need injecting and a cold chain1. A pilot, managed through the USAID funded Nepal Family Health Programme, was implemented between 2005 and 2009 in Banke district of western Nepal. Its purpose was to determine the feasibility of community-based distribution of misoprostol for preventing PPH to pregnant woman through community volunteers working under government health services.

Drawing on our qualitative study involving interviews, reviews of documents and fieldwork in Kathmandu and Banke district, we reconsruct the social history of the design and the implementation of this pilot intervention, and the institutional relations involved in the practices for bringing misoprostol into national policy. In the intense and competitive global and national policy arena, sustained lobbying and getting the right people on board were as powerful drivers as the quality of the intervention itself. Underlying the intervention itself were strong ideological drivers and vested interests (of USAID, WHO and international research organisations), and complex national and international organisational politics. The case study takes us to the heart of the debate around the politics of generation of evidence for interventions in global health programmes, and ultimately the question of accountability for health policy and practice.

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