Leadership development among public health officials in Nepal: A grounded theory.

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.

Job Description of Public Health Officials in Nepal.

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.

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

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.