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Master i International Social Welfare and Health Policy ; The recognition of right to sanitation has been a significant step and an important vehicle that has helped different organizations make their plans on what needs to be done and implement actions to inequities and injustice in the access to sanitation services. This study aims to analyze the implementation of the new right to sanitation enacted by the right holders through international law in the three South-Asian countries including Nepal, India and Bangladesh. The study also intends to address various challenges and difficulties faced while implementing plans of action to improve sanitation sector in these countries. The study further aims to discuss and analyze efforts being made and difficulties faced while implementing these efforts in these countries. The study will compare the progress in sanitation sector among them. The available reports submitted by the government and the civil society organizations working in three South-Asian countries (Nepal, India and Bangladesh) from the website of the Office of High Commissioner for Human Rights that were submitted under International Covenant on Economic, Social and Cultural rights and Convention on Rights of the Child will be used and analyzed. The study uses Literature review to analyze these UN documents submitted from 2000 to 2015 in the context of these three South-Asian countries. The findings of the study showed that different types of approaches were made by the government and non-government organizations to promote sanitation and to achieve sanitation coverage as aimed by MDGs. These approaches were targeted to reach the most vulnerable and disadvantaged group of people who were devoid of the sanitation facilities. Some of the main approaches made by different institutions in these three countries are a) awareness programs to promote sanitation and spread the messages of sanitary and hygienic practices b) sanitation campaigns to increase the involvement of the people in the community c) increase the demand for construction of sanitary latrines by providing them with subsidies or making the sanitary wares affordable d) initiating Sanitation and Hygiene education in schools to promote sanitation via child to child and child to community means e) implementing programs to eradicate discrimination practices for girls and lower-caste groups in the society and provide them with sanitation facilities. Significant progress has been achieved in all the three countries but they are still lagging due to different challenges. Bangladesh showed significant progress in sanitation coverage with reduction of open defecation to only 1 percent compared to other two countries. The study brings into light varied approaches that are being made and challenges that are being faced by government, non-government, and civil society organizations while implementing the programs and strategies related to sanitation. This can help the stakeholders and policymakers develop understanding that process of promotion of sanitation situation requires learning, planning, and behavior change. Moreover, reaching the target for sanitation coverage is only possible through the integration of approaches based on participation, non-discrimination, equality, accountability and effective evaluation afterward. ; publishedVersion

The promulgation of constitution of Nepal in 2015 has shifted the unitary government of Nepal towards federalism with significant devolution of power to seven newly created provinces, each with their own unicameral legislature. The major challenges during the transition phase in health sector are spillover effects, unclear roles and responsibilities of local authorities, human resource management and strengthening capacity at local level as per local need. Despite these challenges, federalism brings fertile ground for the local government to work more closely with their people; with more effective financing and planning based on evidences and their need. Keywords: Federalism; health sector; Nepal; challenges; opportunities.

Background: Currently, most of the countries across the globe follow the International Association of the Diabetes and Pregnancy Study Groups criteria in the diagnosis of gestational diabetes mellitus, which is based on the analysis of Hyperglycemia and Adverse Pregnancy Outcome study. The International Association of the Diabetes and Pregnancy Study Groups criterion comes with its benefits and doubts. Although it has been adopted worldwide, diagnosis of gestational diabetes mellitus with single test and only one positive value has always been debated and is often criticized. This study aimed to assess if the participant with lesser degree of glucose intolerance increases the incidence of false positive diagnosis of gestational diabetes mellitus with 75gm Oral Glucose Tolerance Test based on International Association of the Diabetes and Pregnancy Study Groups criteria.Methods: This prospective, interventional study was conducted in outpatient department of a tertiary hospital of China over a period of 12 months. 48 patients who were diagnosed with gestational diabetes mellitus in 24-31 weeks of pregnancy by 75mg Oral Glucose Tolerance Test were selected via conventional sampling technique based on lesser degree (less severe, not in need of immediate medical attention) of glucose intolerance. These patients underwent second Oral Glucose Tolerance Test within 2-3 weeks of first test. Patients with normal 2nd Oral Glucose Tolerance Test were observed closely throughout their gestational period and compared with the control group.Results: The mean values of data of control and case group were compared and 37.5% of the patients failed to reproduce the same result with the second test and all of them having normal maternal and fetal outcome without any treatment of gestational diabetes mellitus (t-test, p=0.05).Conclusions: With International Association of the Diabetes and Pregnancy Study criteria, more patients with lesser degree of glucose intolerance have been falsely diagnosed and treated as gestational diabetes mellitus.Keywords: Gestational diabetes mellitus; international association of the diabetes and pregnancy study groups; Oral glucose tolerance test .

Background: The characteristics of research proposals submitted to the Nepal Health Research Council reflect the trend of health-related researches being conducted in Nepal. The objective of the study was to analyze research proposals submitted for the ethical review in Nepal Health Research Council from 2017 to 2019.Methods: A retrospective record review of research proposals received over three years from 2017 to 2019 were analyzed. A total of 2,305 research proposals was included in the study. The number of research studies per year, types of study design, priority area of research, and rejected proposal were the intended variables for the study. Results: 91.45% (503), 92.19% (748), and 755 (80.1%) of received proposals were approved from Ethical Review Board in 2017, 2018 and 2019. The number of research proposals increased every year (550 in 2017, 812 in 2018, and 943 in 2019). Among the approved proposals non-communicable disease (n=150;15.90%) in 2019} was the topmost prioritized area in all three years followed by reproductive health [93 (9.86%) in 2019] and communicable disease [67 (7.10%) in 2019] respectively. Quantitative research was more than two-third in all the years. Among the approved proposals, more than half were for an academic purpose [ 610 (64.69%)]. The reason for the rejection of the proposal was the conduction of research before ethical approval [2 (0.36%) in 2017, 2 (0.25%) in 2018, and none in 2019].Conclusions: There was a rising trend of research proposals for ethical clearance being submitted to the Nepal Health Research Council. Research related to non-communicable disease followed by reproductive health was the commonest one. Keywords: Ethical approval; ethical review board; research proposals; record review

Background: Preparedness, readiness, and response status of any country is integral in identifying, managing, and preventing COVID-19 pandemic. The objective of this study is to assess the status of the Government of Nepal designated COVID hospitals and COVID clinics to respond against COVID-19. Methods: A cross sectional study was conducted with the focal persons of COVID hospitals and COVID clinics using a semi-structured questionnaire from April 26, 2020 to May 27, 2020 via face to face interview with onsite observation and telephonic interview in few unreachable health facilities. Results: Government of Nepal designated COVID hospitals and COVID clinics demonstrated efforts in establishing preparedness plans and committees such as COVID management core team (96.7% and 86%), provision of coordination with the government authority (both 100% ), preparedness response plan (93.3% and 84%), and infection prevention and control committee (63.3% and 65.6%) to respond to COVID-19 respectively. The participants reported differences in training provided to their health care workers with maximum COVID hospitals (80%) providing training on use of personal protective equipment and least (43.3%) on handling dead bodies. Only half of the COVID clinics (49.5%) had provision of triage systems.Conclusions: COVID hospitals and COVID clinics in Nepal demonstrated different status of COVID pandemic preparedness and readiness. In case of surge, Nepalese hospitals would struggle due to lack of trained workforce and infrastructure. Interdisciplinary, multi-sectoral collaboration with various focused strategies, including in-service training to staff, is paramount to increase preparedness and readiness. Keywords: COVID-19; Nepal; preparedness; readiness

Background: Public health emergency is vulnerable time where maintaining ethical principles is obligatory while doing research, on the other hand, it is the same time when breach in ethics is much likely whenever a researcher is unaware, unprepared or hastens to do research. The aim of this study was to assess ethical issues of the coronavirus disease 2019 (COVID-19) related research proposals submitted during the early stages of pandemic in Nepal.Methods: Retrospective analysis of COVID-19 related research proposals and their informed consent document submitted to the ethical review board at Nepal Health Research Council was done for the study. The analysis was done as per the National Ethical Guidelines, Standard Operating Procedure for Health Research in Nepal and World Health Organization guidelines for infectious disease outbreak, 2016 under ethically relevant headings. Descriptive data were analyzed in SPSS v24.Results: The major issues were observed in the informed consent documents where 55% were lacking principal investigator's contact information, 68% not having participant selection criteria, 70% without clear informed consent taking process, 57% without explanation of possible risks. Similarly, 68% of the interventional studies' consent form didn't mention possible adverse events and mitigation mechanisms.Conclusions: Most of the research proposals related to COVID-19 were devoid of major ethical elements which took longer time for receiving approval and eventually delayed the opportunity for evidence generation in critical time. More attention is needed to increase awareness and to develop capacity of researchers, reviewers, ethics committees and relevant stakeholders at the time of health emergencies.Keywords: COVID-19; ethics pandemic; research proposals