Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal

Abstract

In Nepal, deaths attributable to NCDs have increased in recent years. Although NCDs constitute a major public health problem, how best to address this has not received much attention. The objective of this study was to assess the readiness of the Nepalese health sector for the prevention and control of NCDs and their risk factors. The study followed a multi-method qualitative approach, using a review of policy documents, focus group discussions (FGDs), and in-depth interviews (IDIs) conducted between August and December 2020. The policy review was performed across four policy categories. FGDs were undertaken with different cadres of health workers and IDIs with policy makers, program managers and service providers. We performed content analysis using the WHO health system building blocks framework as the main categories. Policy documents were concerned with the growing NCD burden, but neglect the control of risk factors. FGDs and IDIs reveal significant perceived weaknesses in each of the six building blocks. According to study participants, existing services were focused on curative rather than preventive interventions. Poor retention of all health workers in rural locations, and of skilled health workers in urban locations led to the health workers across all levels being overburdened. Inadequate quantity and quality of health commodities for NCDs emerged as an important logistics issue. Monitoring and reporting for NCDs and their risk factors was found to be largely absent. Program decisions regarding NCDs did not use the available evidence. The limited budget dedicated to NCDs is being allocated to curative services. The engagement of non-health sectors with the prevention and control of NCDs remained largely neglected. There is a need to redirect health sector priorities towards NCD risk factors, notably to promote healthy diets and physical activity and to limit tobacco and alcohol consumption, at policy as well as community levels.

COVID-19 Vaccine Uptake in Individuals with Functional Difficulty, Disability, and Comorbid Conditions: Insights from a National Survey in Bangladesh

“…Socio-demographic conditions of respondents may signi cantly in uence the likelihood of individuals receiving the COVID-19 vaccine from various perspectives [7]. Notably, increased age and education have been associated with non-communicable diseases in Bangladesh and other LMICs, with this study revealing a higher likelihood of receiving the COVID-19 vaccine recipients in these populations [18,28,43]. This connection is likely to be attributed to increased health care use and, therefore, awareness of their health conditions by people of relatively high age and socio-economic status.. We also found lower likelihoods of receiving the COVID-19 vaccine among unmarried or widowed/divorced/separated people.…”

Non-Communicable Disease Service Readiness in Nepal: A Further Analysis of Nepal Health Facility Survey- 2021

“…5 NCD services have been included in basic health care in Nepal although the service availability and preparedness remain very limited. 6 Apart from disease-specific interventions, Nepal Lancet NCDI poverty commission has pointed out the need for improving governance, strengthening health systems, and monitoring this extended group of priority NCDs. Commission also recommended that structured capacity-building programs for health service providers; promoting care packages, such as the PEN interventions for primary health care; increasing the availability of specialty services and personnel; and expanding progressive vertical programs providing free care for disease-specific areas could be useful in improving service availability and preparedness for NCDs.…”

“…There is a need to generate evidence to uncover gaps in NCD service readiness to facilitate evidence informed policy making to improve the service availability and uptake. 6 8 We aim to determine services availability and readiness of health facilities in Nepal to provide services related to NCDs including CVDs, CRDs, DM, and MH using nationally representative data from Nepal Health Facility Survey (NHFS), 2021.…”

Readiness of health facilities to provide services related to non-communicable diseases in Nepal: evidence from nationally representative Nepal Health Facility Survey 2021

“…NCD services have been included in basic healthcare in Nepal although the service availability and preparedness remain very limited 10. Apart from disease-specific interventions, Nepal Lancet Non Communicable Diseases and Injuries (NCDI) poverty commission has pointed out the need for improving governance, strengthening health systems and monitoring of priority NCDs such as CVDs, CRDs, DM and cancer by provincial and local government 11.…”

“…The increasing burden of NCDs in Nepal is often not matched with the sufficient healthcare response. There is a need to generate evidence to uncover gaps in NCDs’ service readiness to facilitate evidence-informed policy-making to improve the service availability and uptake 10 12. Thus, we aim to determine readiness of public and private HFs of Nepal to provide CRDs, CVDs, DM and MH-related services using nationally representative data from Nepal Health Facility Survey (NHFS) 2021.…”