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Persons with disability have the same sexual and reproductive health needs as people without disability but their rights have consistently been overlooked. They face numerous challenges to access sexual and reproductive health services in Nepal, however coherent evidence on nature, size, and extent of these challenges are not available. We carried out a literature review to explore barriers and facilitators encountered by persons with disability while accessing sexual and reproductive health services in Nepal. We reviewed published government policies on reproductive health and disability, searched PubMed database and used google scholar search engine to find literature published between 2011 to 2021 that reported on barriers and facilitators to sexual and reproductive health rights for person with disability in Nepal. Out of 2145 identified literature only 21 literatures meeting the eligibility criteria were included in the analysis. We found inadequate inclusion of PWDs in health sector policies, lack of knowledge about SRH needs, misconception and poor attitude and lack of social support in accessing SRH rights and services. In Nepal, people with disabilities face multitude of barriers in accessing sexual and reproductive healthcare. Multilevel measures informed by further studies on vulnerabilities and experience of different subgroups of PWDs.

Objective: To assess the readiness of public and private health facilities(HFs) in delivering Cardiovascular Diseases(CVDs), Diabetes Mellitus(DM), Chronic Respiratory Diseases(CRDs), and Mental Health(MH) services in Nepal. Methods: We analyzed data on service readiness for CVDs, DM, CRDs, and MH from Nepal Health Facility Survey 2021 using Service Availability and Readiness Assessment manual of the World Health Organization. Readiness score was measured as the average availability of tracer items in percent, and facilities were considered "ready" for Non-Communicable Diseases (NCDs) management if scored ≥70 (out of 100). We performed weighted descriptive analysis, univariate and multivariable logistic regression to determine association of readiness of HFs with province, type of HFs, ecological region, quality assurance activities, external supervision, client's opinion review, and frequency of HF meetings. The result of regression analysis are presented as odds ratio with 95% confidence interval(CI) and p-value. Results: Of 1581 facilities offering any NCDs related services, 93.1%(95% CI: 90.9 to 94.7), 75.8%(95%CI: 72.4 to 78.8), 99.3%(95%CI: 98.3 to 99.7) and 26.0%(95%CI: 23.0 to 29.2) provide CVDs, DM, CRDs and MH-related services respectively. The overall readiness score for CVDs, DM, CRDs, and MH-related services were 38.1 (SD=15.4), 38.5(SD=16.7), 32.6 (SD=14.7) and 24.0 (SD=23.1) respectively with readiness score lowest for the guidelines and staff training domain and highest for essential equipment and supplies domain. Peripheral public HFs were more likely to be ready to provide all NCDs-related services as compared to federal/provincial facilities. The HFs with external supervision in past 4 months were less likely to be ready to provide CRDs and DM related services and HFs reviewing client's opinions were more likely to be ready to provide CRDs, CVDs and DM related services. Conclusion: Readiness of HFs to provide CVDs, DM, CRDs, and MH-related services was sub-optimal in Nepal. It is recommended to reform policy to improve service readiness for NCDs. Keywords: health facilities; readiness; cardiovascular; diabetes; chronic respiratory disease; mental health

Introduction: Increased availability of Newborn care practices in health facilities (HFs) plays an important role in improving the survival and well-being of newborns. In this paper, we aimed to determine newborn care practices among HFs between 2015 and 2021, and associated factors among public and private HFs in Nepal. Methods: We performed a secondary analysis of Nepal Health Facility Surveys 2015 and 2021. We summarized categorical variables with a weighted percent and 95% confidence interval (CI). We compared proportions using the z-test of proportion and reported differences in percentage points, 95% CI, and p-value. We applied univariate and multivariable logistic regression analysis to determine the association of the availability of seven newborn care practices. Results: The percentage of facilities with all seven newborn care practices was 50.5% (95% CI: 44.6, 56.3) in 2015 and 83.7% (95%CI: 79.8, 87.0) in 2021 with an overall increase of 34.2 percent points (95% CI: 27.9, 38.7). The availability of all seven newborn care practices significantly increased from 2015 to 2021 in each subcategory of the ecological region, all provinces except Madhesh, and all types of HFs except federal/provincial hospitals. In 2021, private hospitals had lower odds of having all seven newborn care practices compared to federal/provincial hospitals (AOR= 0.17, 95% CI: 0.07, 0.04). Similarly, in 2021, Sudurpaschim province had 2.87 (95% CI: 1.06, 8.31) higher odds of having all seven newborn care practices compared to Koshi province. In 2021, newborn care practices did not differ significantly based on ecological belt, quality assurance activities, external supervision, delivery service-related training and frequency of HF meeting. Conclusion: There was a significant increase in the availability of seven newborn care practices between 2015 and 2021 and in each category of ecological region, province, and type of facility. The type of facility and provinces were associated with the availability of newborn care practices among HFs in Nepal.

Nepal is now a Federal Democratic Republic state after the promulgation of the Constitution of Nepal in 2015. This viewpoint offers an understanding of the various dynamics that need to be considered in developing a health budget and the challenges that Nepalese policymakers face in the current light of federalism, pandemic and longterm health goals.