Free dialysis in Nepal: Logistical challenges explored

Abstract

Nepal's Ministry of Health began offering free lifetime hemodialysis (HD) in 2016. There has been a large growth in renal replacement therapy (RRT) services offered in Nepal since 2010, when the last known data on the subject was published. In 2016, 42 HD centers existed (223% increase since 2010) serving 1975 end stage renal disease patients (303% increase since 2010); 36 nephrologists were registered (200% increase since 2010), 12 were trained in transplantation, and 790 transplants had been performed to date. We estimate the incidence of end stage renal disease to be 2900 patients (100 per million population). With an annual cost of approximately US$2300 per dialysis patient, offering free dialysis could potentially cost the government US$6.7 million per year, suggesting that 2.1% of the annual health budget would be allocated to 0.01% of the population. The geographic zone surrounding the capital city, Kathmandu, contains 50% of HD centers, but only 14.5% of Nepal's population. Forty-eight percent of the population lives within zones without HD service, therefore infrastructure challenges exist in providing equitable access to RRT. The aim of this article is to summarize the current statistics of RRT in Nepal.

Prevalence of Cardiovascular Risk Factors among Chronic Kidney Disease Patients Undergoing Hemodialysis in a Tertiary Care Center, Kathmandu, Nepal

“…However, this service does not cover medication cost. 31 Hence, newer health policies which offer coverage for basic medications as well as sufficient dialysis packages for the patients will be much helpful in improvement and management of this critically ill group of patients.…”

Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF

“…Although our study findings reinforce renal transplant as an effective RRT for improving QOL among people with ESRD, the health system in Nepal faces limited and inequitable access to transplant services. Furthermore, few nephrologists, long waiting times to receive transplant services and inadequate financial support add much to worry for people with ESRD [35].…”

Health related quality of life among end stage renal disease patients from low income country, Nepal: a cross sectional study using WHOQOL-BREF

“…Though our study ndings reinforce renal transplant as an effective renal replacement therapy for improving QOL among people with ESRD, health system in Nepal face limited and inequitable access to transplant services. Further, few nephrologists, long waiting time to receive transplant service and inadequate nancial protection adds much to worry for people with ESRD [31].…”

“…Expensive treatment mainly drugs, di culty in transportation during follow up and safety related issues might be contributing factors for lower QOL score in environment domain among dialysis patients as compared to transplant patients. The government pays hospital a xed amount for providing haemodialysis and transplant service for the destitute through its impoverishment citizen fund established in 2016 [19,31]. However, in the absence of renal registry and fully viable health insurance system to cover expenses associated with the treatment, patients with ESRD face a major setback in living a quality life [31,37].Importantly, the government subsidy through the impoverished citizen fund does not cover all treatment expenses and moreover, there is a low enrollment and limited ceiling in bene t package (NPR 100,000) in health insurance [38].…”

“…were undergoing thrice-a-week dialysis as recommended by KDIGO guidelines, which is higher compared to a previous study in India [7]where most of the dialysis patients were undergoing twice-a-week dialysis due to economic constraints. This may be because hospital based dialysis services for the needy are nanced by the government through impoverishment citizen fund in Nepal [31,44]. However, as said earlier, other costs such as distribution of dialysis and transplant facilities, transportation, living cost incurred due to distant health facility, and expensive drugs need to be paid out of pocket by the patients.…”