Background: Nepal’s national social health insurance (SHI) program, which started in 2016, aims to achieve universal health coverage (UHC), but it faces severe challenges in achieving adequate population coverage. By 2018, enrolment and dropout rates for the scheme were 9 percent and 38 percent respectively. Despite government's efforts, retaining the members in SHI scheme remains a significant challenge. The current study therefore aimed to assess the factors associated with social health insurance program dropout in Pokhara, Nepal. Methods: A cross-sectional household survey of 355 households enrolled for at least one year in the national social health insurance program was conducted. A structured questionnaire was used to conduct face-to-face interviews with household heads were conducted using a structured questionnaire. Data was entered in Epi-Data and analysed using SPSS. The factors associated with social health insurance program dropout were identified using bivariate and multiple logistic regression analyses. Results: The findings of the study revealed a dropout prevalence of 28.2% (95% confidence interval: 23.6%-33.2%). Households having more than five members [adjusted odds ratio (aOR) 2.19, 95% CI: 1.22-3.94], belonging to underprivileged ethnic groups (Dalit/Janajati) (aOR 2.36, 95% CI: 1.08-5.17), living on rented homes (aOR: 4.53, 95%CI 1.87-10.95), absence of chronic illness in family (aOR 1.95, 95%CI: 1.07-3.59), perceived good health status of the family (aOR 4.21, 95%CI: 1.21-14.65), having private health facility as first contact point (aOR 3.75, 95%CI: 1.93-7.27), poor availability of drugs (aOR 4.75, 95%CI: 1.19-18.95) and perceived unfriendly behaviour of service providers (aOR 3.09, 95%CI: 1.01- 9.49) were statistically significant factors associated with SHI dropout. Conclusion: In Pokhara, more than one-fourth of households have dropped out of the Social Health Insurance Scheme, which is a significant number. Dropping out of SHI is most commonly associated with a lack of drugs, followed by rental housing, family members’ reported good health status and unfriendly service provider behaviour. Efforts to reduce SHI dropout must focus on addressing drugs availability issues and improving providers’ behaviour towards scheme holders. Increasing insurance awareness, including provisions to change first contact points, may help to reduce dropouts among rented households, which make up a sizable proportion of the Pokhara metropolitan area.
Background Institutional delivery is one of the important strategies to reduce the maternal related risk at the time of delivery. Satisfaction of women on labor and delivery care services has good influence on their health and results in subsequent utilization of health services. This study was focused to assess women’s satisfaction and its’ associated factors with institution delivery services in public health institutions.Methods Cross- sectional study was conducted among 169 participants from June 2018 to November 2018 among women (having under one year children) residing in Tanahun district. Simple random sampling, face to face interview and semi structured interview schedule was used for the collection of data. Data were entered in Epi-Data and analyzed by SPSS. Ethical approval was obtained from Institutional Review Committee at Pokhara University and maintained during the process of research.Results The age of the participants were between 16 to 40 years with median age 25 years (IQR = 7 Years). Most (93.5%) of the participants were Hindu. Majority of the participants (57.4%) and their husbands (60.4%) had secondary level education. Almost all pregnancies (99.4%) are planned and normal delivery was most common (77.5%). The study shows that 55% of the women performed delivery in public health facilities. The study states high satisfaction score in health status of women after delivery (4.8) and lowest in availability of visitor's bed (2.99). Women's satisfaction and religion was seen to be significantly associated.Conclusion Majority of the participants were satisfied with the services provided by public health facilities. Although, number of birthing centers were increasing, facilities in the health institution is not sufficient as required. Different factors such as cleanliness of delivery room, availability of staffs, medicine, visitor's bed and behavior of staff are some issues to be improved.
Background: Maternal morbidity and mortality remains one of the biggest public health
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