Policies, Plans, and People

Judith Justice uses an interdisciplinary approach to show how anthropologists and planners can combine their expertise to make health care programs culturally compatible with the populations they serve.

Judith Justice is Associate Professor of Health Policy and Medical Anthropology, University of California, San Francisco.

Abbreviations
Preface

1 Introduction

Nepal: The Setting
Research Methods


2 The Health Bureaucracies: Structure and Culture 
The Dynamics of Nepal's Bureaucracy 
Government Structure 
Traditional Patterns in Administrative Behavior 

The International Donor Agencies 
The World Health Organization (WHO) 
The United States Agency for International Development (USAID) 

Interaction Between the Government and the Agencies 
Nepali Administrators and International Advisors 

3 Policies and Plans 
International Health Policy and Nepal 
Hospital-Based and Vertical Programs 
The Shift to Integrated Basic Health
Services 
Integrated Community Health Program and Primary Health Care 

The Planning Process 
Country Health Programming 
Further Planning Efforts 
Planning for Community Participation: A Case Example 

4 Delivering Services to Rural Villages 
A Partially Integrated Health Post 
A Fully Integrated Health Post 
The Local Panchayat 
Shortages 

The Villagers' Response to Services 
The District Health Office 

Problematic Roles of Health Workers 
The Invisible Health Worker: The Peon 
The Community Health Volunteer and the Village Health Worker 

5 Sources and Channels of Information
Sources of Information
Reports
Field Travel
Formal and Informal Meetings

The Flow of Information within Government 
Data, Plans, and Targets 
Vertical Barriers 
Horizontal Barriers 

Reliance on Quantitative Data 

6 Sociocultural Information and the Health Planning Process 
The Anthropologist's Role in Planning Using Sociocultural Information to
Improve Health Planning: A Case Study 
Some Suggestions for Changing the ANM's Role 

Overcoming Obstacles in the Health Bureaucracy 

Appendixes 
1. A Chronology of Health-Sector Events in Nepal 
2. Profile of Health Workers in ICHP 
3. Job Descriptions for ICHP 
Functions of Community Health Volunteer 
Village Health Worker 
Assistant Nurse-Midwife (ANM) 

Notes 
Bibliography 
Index