Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal

Gyawali, Bishal; Khanal, Pratik; Mishra, Shiva Raj; Teijlingen, Edwin van; Meyrowitsch, Dan Wolf

doi:10.1080/16549716.2020.1788262

Cited by 21 publications

(19 citation statements)

References 24 publications

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“…A limited number of government and private tertiary level facilities, all of which are in major cities, provide care to CVDs patients. The Ministry of Health and Population (MoHP) has also endorsed a package of essential non-communicable diseases (PEN) focusing on cardiovascular disease risk estimates and management of hypertension and diabetes in 2016; however, the program has reached 50 out of 77 districts [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Health system gaps in cardiovascular disease prevention and management in Nepal

Shrestha

Maharjan

Bajracharya

et al. 2021

BMC Health Serv Res

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Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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Section: Introductionmentioning

confidence: 99%

Health system gaps in cardiovascular disease prevention and management in Nepal

Shrestha

Maharjan

Bajracharya

et al. 2021

BMC Health Serv Res

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“…With the increasing socioeconomic and public health burden of non-communicable diseases in Nepal, the Government of Nepal has been making different preventive and curative efforts to curb the hypertension but to date, this remains insufficient. 7 We believe that public health campaigns like MMM play a crucial role in generating evidence and raising public awareness and political interest in hypertension prevention and management. From a logistics point of view, significant buy-in by the local government in MMM 2019 to take responsibility for promoting screening was encouraging.…”

Section: Discussionmentioning

confidence: 99%

May Measurement Month 2019: an analysis of blood pressure screening results from Nepal

Bhattarai

McLachlan

Khanal

et al. 2021

European Heart Journal Supplements

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May Measurement Month (MMM) is a global initiative to screen high blood pressure (BP) in the community and increase awareness at the population level. High BP is the leading risk factor for mortality worldwide and in Nepal. This study presents the results of the 2019 MMM in Nepal. Opportunistic BP screening was conducted in 30 out of 77 districts across Nepal and aged ≥18 years at the community and public places. BP was measured three times in a seated position. A total of 74 205 individuals participated in the study, mean age 39.9 years, and 58% were male. BP measurements for the second and third readings were available for 69 292 (93.3%) individuals. The proportion of the population that were hypertensive was 27.5% (n = 20 429). Among those hypertensives, 46.3% were aware of their hypertensive status and of these, 37.5% were on antihypertensive medication. Only 54.3% of those on antihypertensive medication had their BP controlled. Of the community screened, those self reporting to have diabetes, current tobacco users, and current alcohol drinkers were 6.7%, 23.6%, and 31.9%, respectively; 20.6% of the participants were overweight, and 6.5% were obese. Since the first BP screening campaign, MMM 2017 in Nepal, the number of participants screened has largely increased over the years. MMM’s success in Nepal is through a coordinated mobilization of trained health science students and volunteers in the communities. The Nepal MMM data demonstrates that large community-based BP screening campaigns are possible in low resource settings.

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“…Primary health care has attracted attention in many countries, and a series of measures have been taken to promote access to primary health care, such as India’s rural health centers [ 1 ], Nepal’s primary healthcare (PHC) system [ 2 ], and the Affordable Care Act (ACA) in the United States [ 3 ]. In China, primary health care is undertaken by primary medical and health care institutions (PMHCIs), primarily community health service centers and township hospitals, which provide general clinical care and basic public health services to residents [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study

Jia

Cao

et al. 2021

IJERPH

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In some countries, including China, primary health care is rarely utilized because of medical personnel shortages at primary medical and health care institutions (PMHCIs). Several studies suggest that the most effective solution is to guide qualified doctors and medical graduates to work in PMHCIs, but the studies and measures have been formulated only from the perspective of the government and PMHCIs; few have considered the subjective willingness of medical personnel. Therefore, it is necessary to explore the measures to develop human resources of PMHCIs from the guiding object. This research was divided into two parts based on implicit theory and a lexical approach. The first part collected the factors affecting their choosing PMHCIs for employment, and the second part used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) to explore the dimensions and paths of the influencing factors. At last, seven factors were obtained from the EFA, and the SEM hypothesis fit the data well. Internal Organization Development, Patient Factor, Remuneration and Development, and Family Support had a significantly positive effect on the Sense of Gain of medical personnel seeking employment at PMHCIs, whereas both Job Responsibilities and Condition of the City Where the PMHCI Is Located had no significant effect. In addition, the indirect effects of Internal Organization Development and Condition of the City Where the PMHCI Is Located on the Sense of Gain were significant. The Patient Factor, Family Support, and Remuneration and Development significantly mediated the relationship between the internal and external environment of the institution and the Sense of Gain, whereas the mediating effect of Job Responsibilities was not significant. The improvement of family support, remuneration and development, and patient factors increase the willingness of medical personnel to seek employment at PMHCIs. In addition, the internal and external environments of a PMHCI play a vital role in guiding medical personnel to PMHCIs for employment. This research provides theoretical support for improving the development of human resources, guiding medical personnel to work in PMHCIs, and promoting the use of primary care services.

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Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal

Cited by 21 publications

References 24 publications

Health system gaps in cardiovascular disease prevention and management in Nepal

Health system gaps in cardiovascular disease prevention and management in Nepal

May Measurement Month 2019: an analysis of blood pressure screening results from Nepal

A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study

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