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Background: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. Methods: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. Results: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. Conclusions: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings.

Patient and public involvement (PPI) has emerged as a key consideration for organisations delivering health research and has spawned a burgeoning literature in the health and social sciences. The literature makes clear that PPI in health research encompasses a heterogeneous set of practices with levels of participation and involvement ranging from relatively minimal contributions to research processes to actively driving the research agenda. In this article, we draw on the work of Jurgen Habermas to explore the ways in which PPI was accomplished in a cancer research setting in England. Drawing on ethnographic data with PPI participants and professional researchers, we describe the ways in which the life-world experiences of PPI participants were shaped by the health research system. We argue that PPI in this setting is less about exploring differences with regard to a plurality of expertise and more about simply watching or supporting the professional researchers at work.

The idea that social inequality has deleterious consequences for population health is well established within social epidemiology and medical sociology (Marmot and Wilkinson, 2001; Scambler, 2012). In this article, we critically examine arguments advanced by Wilkinson and Pickett in The Spirit Level (2009) that in more unequal countries population health suffers, in part, because of the stress and anxiety arising from individuals making invidious or shame-inducing comparisons with others regarding their social position. We seek to extend their arguments, drawing on sociologically informed studies exploring how people reflect on issues of social comparison and shame, how they resist shame, and the resources, such as 'collective imaginaries' (Bouchard, 2009), which may be deployed to protect against these invidious comparisons. We build on the arguments outlined in The Spirit Level, positing a sociologically informed account of shame connected to contemporary understandings of class and neoliberalism, as well as inequality.

This article shifts focus from an individualised and anthropocentric perspective on obesity, and uses a new materialist analysis to explore the assemblages of materialities producing fat and slim bodies. We report data from a study of adults' accounts of food decision-making and practices, investigating circulations of matter and desires that affect the production, distribution, accumulation and dispersal of fat, and disclose a micropolitics of obesity, which affects bodies in both 'becoming-fat' and 'becoming-slim' assemblages. These assemblages comprise bodies, food, fat, physical environments, food producers and processing industries, supermarkets and other food retailers and outlets, diet regimens and weight loss clubs, and wider social, cultural and economic formations, along with the thoughts, feelings, ideas and human desires concerning food consumption and obesity. The analysis reveals the significance of the marketisation of food, and discusses whether public health responses to obesity should incorporate a food sovereignty component.

Neither spatial models of party competition nor the 'Westminster' model of British politics explain the phenomenon of Thatcherism. One explanation of its success, examined by Crewe and Searing, suggests that Mrs Thatcher sought to convert the Conservative party and the wider electorate to her distinctive brand of liberal Whiggism and traditional Toryism. They found little evidence of the success of this, however, among the British electorate as a whole. In this paper, data from the first national survey of Conservative party members demonstrates that she had little success in converting the Conservative party to these ideas either, although she did have a secure ideological base within the party. The results also suggest that her successor, John Major, has a rather different support base within the party from that of Mrs Thatcher. The implications of these findings for spatial models of party competition and the Westminster model of British politics are discussed.

In common with most other mass democratic parties the Conservative party has a large group of active members who sustain the party over time. A model is developed to explain variations in activism within the party, which takes account of the 'paradox of participation'. The results, based on the first national random sample survey of Conservative party members, show that activism is motivated by three classes of factors. Activism is motivated, firstly, by a variety of selective incentives, such as ambitions for elective office. It is motivated, secondly, by a desire for the party to achieve policy goals. These are 'collective goods', which are subject to the problem of free-riding. However, since activists can influence policy outcomes, via their contacts with party leaders, they have high levels of personal efficacy and a direct incentive to participate, which can override the paradox of participation. Finally, activism is motivated by expressive concerns, as measured by the strength of the respondent's partisanship, a motivation for involvement which lies outside a narrowly cast rational choice model of political participation.

AbstractChildhood obesity is a key public health concern. Obesity has an impact on morbidity and mortality, child development, and has links to child sexual abuse. The costs of childhood obesity on the health service and society are well recognised. Whether childhood obesity should also be a child protection concern has divided commentators and professionals. They pose a juxtaposition questioning whether childhood obesity is a consequence of neglect and obese children should potentially be removed from parents who do not seek to reduce their child's weight, whilst expressing resistance to a role focused on bodily surveillance. This research sought to identify existing practice, through interviews (N23) and focus groups (N3:24) with key professional stakeholders, from social care, health and education, in one area in the UK. The research aimed to explore the decision-making, views and experiences of those working with obesity and the child protection system. The data were subject to Framework Analysis. Key findings include multi-agency working, personal and professional standpoint, and the complex and nuanced impact of individual and agency thresholds on practice. The research demonstrates how the tensions surrounding a child protection paradigm impact on individual and agency practice, potentially inhibiting the support offered to service users.

Background: In Nepal, half of deliveries take place at home (HMIS 2014), while institutional birth assisted by skilled birth attendants (SBAs) are still infrequent. Objectives: This study explores factors influencing the utilization of health facilities for childbirth in a disadvantaged community of rural Nepal. Method: A qualitative study with two focus groups: mothers-in-law and husbands, and female community health volunteers. 28 semi-structured in-depth interviews were conducted with selected participants 20 mothers and 8 grass-root and policy level stakeholders. Data were analysed by three delays model of conceptual framework. Results: The main reasons for giving birth at home included cultural tradition, lack of awareness about danger signs during pregnancy and childbirth, about importance of skilled birth attendants and lack of knowledge about availability of free 24-hours delivery sites/birthing centers, inability to afford two way transportation costs despite transport incentives provided by government for institutional delivery, fear of episiotomy/surgery/physical abuse and health service provider's attitude for home delivery. Health facilities were mostly used by women who experienced complications during childbirth Policy Implications: Significant gaps from policy to grass root levels were identified which -suggests that dissemination of information about free delivery must be more effective. The health workers should convincingly inform families about benefits of institutional delivery, especially in marginalized/disadvantaged communities.

BACKGROUND: Over the past 20 years, Nepal has seen major improvements in childhood and maternal survival. In 2015, the Nepalese government introduced a new federal political structure. It is unclear how this has affected the health system, and particularly, maternal and child health care. Hence, this study aims to describe and analyse health facility preparedness in the light of the federalization process with regards to providing appropriate and timely maternal and neonatal health services. METHODS: A descriptive cross-sectional study was conducted in Jumla district, Nepal in 2019 covering all 31 state health facilities (HF) to assess the availability of maternal and neonatal health services including appropriate workforce and access to essential medicines. Tests of association between demographic factors and the probability of a facility experiencing a shortage of essential medicine within the last 3 months were also conducted as exploratory procedures. RESULTS: Out ot 31 HFs, more than 90% of them had all their staff positions filled. Most facilities (n = 21) had experienced shortages of essential medicines within the past 3 months. The most common out of stock medicine were: Amoxicillin (n = 10); paracetamol (n = 10); Vitamin A (n = 7); and Metronidazole (n = 5). Twenty-two HFs had referred maternal and newborn cases to a higher centre within the past 12 months. However, more worryingly, twenty HFs or their catchment communities did not have emergency ambulance transport for women and newborns. CONCLUSION: HFs reported better staffing levels than levels of available drugs. HFs should be supported to meet required minimal standards such as availability of essential medicines and the provision of emergency ambulance transport for women and newborns.