ObjectiveThe Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence.MethodsA cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings.Results and prospectsOf a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30–290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3–393.9) and accessibility (OR = 74.4; 95% CI, 42.5–130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts.ConclusionAlthough enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.
Despite the importance of health literacy for health promotion, Nepalese undergraduate students are largely unaware of its importance. The present study assessed the health literacy levels of undergraduate health sciences students and explored various sociodemographic, clinical and health information-related factors associated with health literacy at Pokhara University in the Kaski district of western Nepal. A cross-sectional web-based observational study was conducted among 406 undergraduate students university students from five faculties at the School of Health and Allied Sciences affiliated with Pokhara University. Data on sociodemographic information, clinical characteristics and sources of health information were collected. Health literacy was assessed using the 44-item measure that captures the concept of health literacy across nine distinct domains. Associated factors were examined using a one-way analysis of variance followed by stepwise backward multiple linear regression analysis at the level of significance of 0.05. The mean score for the health literacy questionnaire was 3.13 ± 0.26. Outcomes of multivariable analyses demonstrated various factors associated with health literacy scores, including age (β = 0.10; p = 0.001), physical exercise (β = −0.13; p < 0.001), monthly household income (β = 0.05; p = 0.029) and routine health checkup (β = −0.14; p < 0.001). The study showed that there is a need to understand and address sociodemographic factors and clinical factors, including age, physical exercise, monthly household income and routine health checkups to improve health literacy levels among undergraduate students in western Nepal. More research, including longitudinal studies, is needed to better understand factors that influence health literacy among undergraduate students in Nepal.
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