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Old fashioned, centralised and bureaucratic systems of natural resources management have been blamed for the failure to conserve forest resources. Such arrangements are alleged to result in top-down decision making processes, low levels of community participation, and lack of transparency. These criticisms have led to claims that the devolution of forest management to the community will improve resource management and more effectively deliver sustainable development. The devolution from the state to local communities of natural resource management access rights has been an important policy tool for forest management over the last several decades. This research examines to what extent, and how, decentralized forest governance delivers enhanced economic, social and environmental benefits. More specifically this study develops and tests a framework to assess how devolved forest governance performs across the indicators of participation, transparency, accountability, effectiveness, efficiency, and equity. A set of policy relevant and locally applicable governance indicators was developed through a participatory process that involved a large number of stakeholders including CFUG members and policy makers. To explore this topic, the study combines a single case study of devolved forest governance in Nepal with a medium-n research design of perceptions of community forestry operations in nine community forest user groups from three districts representing three different Nepalese ecological zones. A purposive sampling method was used to select CFUGs with different characteristics and CFUG members' opinions were collected using both qualitative and quantitative approaches. The study reveals that the key elements and indicators of governance are dialectically interconnected. Governance performance on one element and associated indicators shapes the outcome of other elements and indicators. Community forests located in the Middle Hills and High Mountains regions of Nepal generally perform well across the various governance indicators used, while a lower level of performance was observed in Terai region. However the research finds that ecological zone is not a determining factor of good governance; instead, socio-economic factors are found to shape the success of community forestry governance and outcomes. In addition, the research reveals that external agencies actually enhance community forest governance and outcomes as a result of synergy, interaction and cross-fertilization of knowledge between community forestry participants, government officials and other stakeholders. It is also the case that the better a community forest is governed, the more it flourishes and the wealthier it becomes. However, the distribution of the wealth and capital generated by a community forest remains a concern as the benefits are not being shared with the wider community. The research highlights the need to build the capacity of community forest users and, especially, to empower poor and disadvantaged people to ensure they obtain access to and are able to utilise the available resources. By developing an innovative framework to assess governance at local level, this study not only informs us about decentralised community forestry in Nepal, but the framework can also be utilised to assess community-based natural resource management initiatives in other developing countries.

Objective: To compare the outcome of standard wound care vs standard wound care with transverse distractive osteogenesis in chronic non-healing wounds of foot and ankle secondary to chronic limb ischemia. Design: A Prospective Randomized Controlled Trial Settings: Department of Orthopedics, Department of Surgery, Department of Emergency Medicine, BPKIHS, Dharan. Background: Many options are available for treatment of chronic wounds. The major hurdle for non-healing chronic wounds is the reduced vascular supply to the affected limb. This study tries to find out the true beneficial effect of transverse distractive osteogenesis which is proposed to increase vascularity and thus helping in healing of wounds. Methodology: 24 patients (From April 2017 – April 2018) were randomized to fall into two equal groups (12 each) for intervention. Group A wound receive standard wound care and Group B wound receive standard wound care combined with transverse distractive osteogenesis with Ilizarov apparatus. They were followed 3 months and assessed for various parameters for wound improvement. Results: There were total 24 patients (male n=13 and female n=11) with 12 in each group. There was no difference in age, gender, cause, timing of presentation between the two groups. Diabetic foot (75%, n=18) dominated the main cause. There was no statistical significance in Bates-Jensen wound Assessment score in initial 1 month of assessment. However, at 3 months, the mean BWAT score was 22.91 in distraction group vs 35.25 in standard wound care group; which was statistically significant (p=0.001). In the distraction groups, 2 patients had major complication of pin-tract infection and osteotomized part being sequestrum and had to be removed at 3 months. Definitive Wound closure was possible with split skin graft in 14 cases (37.5% vs 20%) and 2 reverse sural flaps (8.3%). All patients had positive culture result with monomicrobial status (74%) vs polymicrobial status (36%). No significant improvement in pain in patients with Burger’s disease was obtained. Conclusion: Distractive Angiogenesis greatly enhances the healing potential of wound secondary to chronic limb ischemia. However, the carries significant learning curve.

The policy document of Nepal has spelled out commitment to involving civil society organisations (CSOs) in improving human resources for health (HRH). However, lack of empirical evidences, it is very hard to figure out exact situation about the roles and engagement of CSOs in HRH management.A cross-sectional descriptive study was conducted using both quantitative and qualitative methods. Out of 404 sample health institutions, 747 health workforce from 375 health institutions were interviewed (10% non-response rate) using the probability proportionate to size method as per World Health Organization (WHO) guidelines.Nearly 75% respondents had opined that the political parties were supporting the health institutions in the grassroots. It was found that the support from the CSO was better in Hill (54.9%) compared to Terai (46.9%) and Mountain (46.7%). The support was significantly different between rural (CI: 0.5063-0.591) and urban (CI: 0.3055-0.4363) (p0.05, CI 95%). Mean index score of effectiveness of CSOs was found highest in Hills (0.3036) followed by Mountains (0.2669) and Terai (0.2589). Effectiveness of CSOs was found positively correlated with feeling of security by health workers and social prestige.The roles of civil society in HRH management still need to be recognized and well documented ensuring their active participation in formulation and implementation of policies, strategies and planning related to HRH for effective and quality healthcare services in Nepal.

This study analyzed daily patterns and dynamics of PM2.5 concentrations in the Kathmandu Valley during three winters. The PM2.5 data showed a daily repetitive cycle which represents influence of local air flow and dispersion and accumulation of air pollutants in the valley. Two concentration peaks were observed in the morning and in the evening periods, and they fell down during the daytime and the nighttime periods. This indicates local emission sources as major contributors in the valley. The more pronounced morning peak compared to the evening peak showed that the upslope wind in the morning helped to move the polluted inversion layer downward, subsequently adding to freshly emitted pollutants and causing a sharp pollutant concentration rise in the morning. Katabatic wind and rise of temperature in the basin during the day helped the pollutant upflow and dilution, resulting in a sharp PM2.5 concentration decline. Through the afternoon, the decrease in air temperature followed by decrease in wind speed caused to lower PM2.5 peaks in the evening. Also, higher morning peaks of PM2.5 concentrations compared to the evening indicated pollution from the previous day is added to the fresh emission. The valley had increased PM2.5 from the beginning of October which continued till the first week of February. The increase in PM2.5 peak fit the logistic equation y = [k/(1 + exp (p - qx)] + a sin(bx) where k, p, q, a, and b are constants. © 2009.

Distribution and skill mix of health workforce has always been a challenge in rural Nepal. Workforce surpluses or shortages and inappropriate skill mix, decrease productivity and efficiency, deplete scarce resources and squander worker capabilities. This study was aimed at generating evidences on the current distribution and skill mix of health workforce in Nepal.A cross-sectional study was conducted using both qualitative and quantitative methods.Fifteen districts representing three eco-developmental regions of Nepal were selected using multi-stage cluster sampling method. Out of 404 sampled health institutions, 747 health workers from 375 health institutions were interviewed. Observation was carried out in 256 health facilities.Currently, the vacant positions are mostly of doctors 74(38%) technicians 28 (21%) nurses 50 (10%) and paramedics 26 (6%)with respect to sanctioned positions. Variations of fulfilled positions occurred in all three ecological belts, with the Hill belt having the highest proportion of vacant posts 116 (16%).On the basis of types of health facilities, ayurvedic centres have the highest fulfilled positions 55 (95%) and the lowest in primary healthcare centres (PHCCs) 162 (81%). Proper skill mix was observed in 6 (43%) of hospitals and 3(18%) of PHCCs.Only 132 (17.7%) of health workers have taken part in orientation on non-communicable diseases (NCDs) despite the increasing trend of NCDs.There is scarcity of health workforce with appropriate skills, particularly in rural Nepal. Sanctioned positions and categories of health workers need to be revised on the basis of population growth and epidemiological shifts.

In Nepal, the relationship of health worker and patient or community people is now deteriorating and the security and safety of health worker is becoming emerging issues. The poor relationship between community people and health worker is hampering the health service especially in rural setting. This study was aimed at finding the security perception and situation of health workforce in Nepal.A cross-sectional descriptive study was conducted using both quantitative and qualitative methods. Out of 404 sample health institutions, 747 health workforce from 375 health institutions were interviewed (10% non-response rate) using the probability proportionate to size method as per World Health Organization (WHO) guidelines.Nearly 168 (23%) of health workers felt some level of insecurity at their workplace. Mostly, doctors felt insecure at their workplace 24 (30%) and argued with service users , 26 (32.50%). Feeling of security was highest in central region 160 (83.30%). Nationwide, 121 (16%) of health workers faced some level of arguments with service users, which was highest in Tarai 64 (18.08%). Of the total harassment, both gender based and sexual harassment was higher among female health workers [20 (62.5%) and 13 (56.5%) respectively]. Only, 230 (30.7%) of health workers who suffered from workplace accidents got compensation and treatment.Higher proportions of health workers feel insecurity at workplace whereas provision of compensation was minimal. There is a need of strict implementation of Security of the Health Workers and Health Organizations Act, 2066 (2009) for effective health service delivery.

In microfiltration, a deposit of foulant tends to form on the membrane surface and this usually controls the performance of the filtration process. This paper discusses the influence of physical parameters such as aeration and permeates flux on migration and deposition of above micron particles on the membrane surface. Kaolin clay suspension of particle 3.7-8 mm with mean particle diameter 4.1 mm was used in this study. Equal amount of mass of deposited particles on the membrane surface created different transmembrane pressure (TMP) when operated at different aeration rates and permeate flux showing that there is a composite effect. The particle deposition rate at the beginning at lower flux was almost linear which changed to a sharp logarithamic rise at higher flux. The difference in TMP rise for the same amount of deposit demonstrated the selective nature of particle deposition. The mass of the particle deposition on the membrane surface could be described by two parameters: maximum deposition and time using a simple empirical logarithamic equation y=k/[1+exp(b-at)], where k, a, and b are constant; y is the particulate mass deposit (g/m2) and t is the time. The maximum particle mass deposition growth could be described by the equation dy/dt=1/4ka. © IWA Publishing 2010.