Submited on: 26 Sep 2010 05:51:22 AM GMT
Published on: 26 Sep 2010 07:11:04 AM GMT
 

1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Partly
3 Is this a new and original contribution? No
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? No
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? Yes
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? No
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    Prof. Nastu Sharma in his article has discussed a very important issue of inequity in health outcomes, that he has rightly pointed out as often overlooked because of the overall progress made. He has tried to capture experiences from other countries, and has made a very good comparative analysis between high, middle and low income countries.

     

    Given the dicussion is made on Nepal Health sector, my first point of clarification would be, how this analysis would fit in the context of Nepal? Since Nepal has made significant health gains specially in MDG 4 and 5 in recent times, does this mean that Nepal has a well functioning health system? What has worked for Nepal despite the challenges that exists? A little elaboration on reasons and analysis of what worked and what not would be valuable.

     

    Secondly, while I agree with prof. Sharma on investing in early years, the statement about " disparity of vulnerabilities, risks...between the poor and the better off is greater  among infants and young children than the older age', is not well substantiated. The learning on 'why' and 'what worked' if mentioned to would be valuable, given the discussion section on the other hand states, 'disparities in child health have decreaed in comparision to maternal health'. If we take an example of child health outcomes in Nepal specially on National Vitamin A program (NVAP) and Community Based Integrated Management of Childhood Illness (CBIMCI), we can see that coverage of both the programs is above 90% and the disparity across gender and caste is minimal or almost negligible (Vitamin A coverage among girls is 91.7% and boys is 92.4%).

     

    Thirdly , it would be valuable to include Nepal's learning on community based interventions, and the contribution of Female Health Community Volunteers(FCHVs), which is a key to Nepal's progress on MDG 4 and 5.

     

    Finally, the article is very informative and includes good data and analysis, therefore, few elaborations and restructuring paragraphs for improved flow of arguments will generate better clarity.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I am working as Health Sector Program Manager in AusAID and have been regularly engaged in various aspects of planning, monitoring and policy dialogue around Nepal Health Sector Program. My experience in social development field is of more than a decade. I have Masters degree in Gender and Development from University of Melbourne, and have done few papers on women's health.

  • How to cite:  Maskey Pradhan L .Review of the article by Prof. Nastu Sharma[Review of the article 'Health Inequities and Investing in the Early Life Years: Lessons to reach to Poor and Vulnerable in Nepal ' by Sharma N].WebmedCentral 2011;2(1):WMCRW00339
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http://www.webmedcentral.com/article_view/711
Posted by Mr. Ram C Silwal on 10 Nov 2010 06:25:38 AM GMT

  • Other Comments:

    Prof. Sharma has raised very much pertinent issues of Nepal highlighting disparities of services for poor and vulnerable people of Nepal. Though the Government of Nepal has declared free services (basic/primary services) for all people through public health facilities, disparities on service utilization still a major challenge. High staff absenteeism (in public health facilities) in rural areas and low level of empowerment for demand of services by poor and marginalised population are still a challenges, which should be further discussed. In addition to his conclusion notes, I also would like to focus the expansion of family planning, maternal, newborn and child health services for increasing access to these poor population. Female Community Health Volunteers (FCHVs) in Nepal are well known community level cadres, who work for raising awareness, and expansion of community based approaches/services delivery are now have been a priority of the government.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I have been working in the field of maternal, newborn and child health for more than a decade from community to policy level in Nepal.

  • How to cite:  Silwal R C.http://www.webmedcentral.com/article_view/711[Review of the article 'Health Inequities and Investing in the Early Life Years: Lessons to reach to Poor and Vulnerable in Nepal ' by Sharma N].WebmedCentral 2011;1(11):WMCRW00127
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