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Table 3 Problems stated by the Government, EDPs and INGOs for Aid Integration (N = 26)

From: Perceptions of government knowledge and control over contributions of aid organizations and INGOs to health in Nepal: a qualitative study

Difficulties GoN* EDPs* INGOs* Total* Comments
Issues related to the political context and government stability, structure and capacity
1 Political instability 1 7 2 10 The change in Nepal’s ministers occurs frequently, bringing changes in personnel and policies in the MoHP, and influencing the way resources are handled. Personnel who are appointed politically often are not experienced or qualified. Political instability also brings frequent mass strikes and lack of security.
2 Lack of human resources in the Government 3 4 2 9 Despite the increase in budget allocation to health, increase in funds and programs, the MoHP still follows the personnel organogram created in 1993. The Policy, Planning and International Cooperation Division (PPICD) director’s post stood vacant for more than six months after resignation of the former director. The SWC does not have separate departments for health related INGOs and NGOs and there are too many INGOs for GoN to handle. One government KI said, “Weak government system in our country does not have the capacity to run enormous resources provided by international donors.”
3 Convoluted Bureaucracy - 5 4 9 When working with government, processes are “painfully slow”. The SWC takes several months to several years to approve projects, a process which can only be fastened via bribes or personal connections. The money almost finishes before the project reaches the community due to numerous payments made to government officials on the way.
6 There are two secretaries in Ministry of Health and Population 1 4 - 5 The secretary of health and population’s roles are interchanged from time to time, making donors “annoyed” and confused. Their roles often overlap and are not clearly delineated creating “a sense of malaise” and one KI stated, “The two secretaries compete about going to particular meetings, for example the JAR meeting of January 2011, creating unnecessary complications.
7 Corruption in the government - 3 2 5 Two EDP KIs said that their organizations used to give grants to the central government but stopped doing so and instead started giving grants directly to NGOs and INGOs.
11 Government’s system of monitoring and evaluation isnot effective - 3 - 3 Government’s mechanisms of monitoring like JAR are not effective, people do not come prepared to them and a lot of issues are missed out.
13 Government does not use donated money effectively - 2 - 2 In the early months of 2011, a large amount of grant money was stopped because the government’s financial report was not satisfying.
Issues related to intersectoral relationships and alignment within the sector
4 Lack of coordination between government bodies 3 3 1 7 The news of new agreements between the government and EDPs or INGOs is not communicated between government bodies involved. There are internal conflicts between bureaucrats and technocrats in the MoHP. Due to lack of coordination between MoHP and SWC, there is a duplication of projects.
5 EDPs sometimes do not follow through with commitments 3   3 6 Donors and EDPs can be “unpredictable” in that they will promise a certain amount as grant, which is then added to the budget but later they do not follow through. Some donors continue to support more vertical programs that do not support SWAp, working under agreements that were signed prior to implementation of SWAp.
8 Absence of India and China in the EDP forum - 3 - 3 Both India and China contribute to Nepali health system in their “own piece meal approach”, making hospitals, donating ambulances, etc. without consulting any other EDPs. They don’t participate in coordinating meetings.
10 Problems in auditing due to differences in fiscal years among donors and Nepal Government 1 2 - 3  
Issues related to competence of government employees
9 Difficulties working with local level government bodies 1 1 1 3 There is a lack of ownership in the district level, as government officials expect the EDP or INGO to take full responsibility of any projects they fund. The DDC is supposed to coordinate all stakeholders working in the community, but they don’t have complete database of all organizations working in the area.
12 Non professionalism of government employees - 2 - 2 GoN personnel do not attend meetings regularly and sometimes postpone them for personal reasons. The GoN does not take the initiative to organize meetings and has problems with keeping deadlines.
  1. * These numbers are not meant to imply statistical significance but are given to clarify which groups of informants tend to hold which opinion.