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Background: Investment Case is a participatory approach that has been used over the years for better strategic actions and planning in health sector. Based on this approach, in partnership with government, non-government partners, and UNICEF Nepal, District Investment Case (DIC) program was launched to improve maternal neonatal and child health services. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services. Methods: This study adopted exploratory phenomenography design with purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and a total of 30 key informant interviews with district-level stakeholders and six focus groups with community stakeholders were carried out. A rigorous iterative analysis process using a phenomenographic approach was used. Results: Investment Case approach helped stakeholders in planning systematically based on evidence through a collaborative and participatory approach while in comparison areas past year plan was mainly taken as reference. Resource constraints and geographical difficulty were key barriers in executing the desired plan in both intervention and comparison districts. Positive changes were observed in the coverage of maternal and child health services in both groups. However, few reported no difference due to the DIC program. The participants specified the improvement in access to information, access, and utilization of health services by women. This has influenced positive healthcare-seeking behavior. Conclusions: The decentralized planning and management approach at the district level helps to ensure the equity in access to maternal, newborn, and child health care. However, quality evidence, inclusiveness, functional feedback and support system, and local resource utilization should be a key consideration. Janak Kumar Thapa, Doris Stöckl, Raj Kumar Sangroula, Dip Narayan Thakur, Asha Pun, Meena Thapa, Mahesh Kumar Masky Binjwala Shrestha, Maria Delius * CIHLMU, Center for International Health, LudwigMaximilians-University, Munich, Germany Little Buddha College of Health Science Kathmandu.

Prevalence andRisk Factors of Hypertension among Elderly Population in Social Welfare Center Old Age Home, Pashupati, Kathmandu