Health System Development in Nepal

Marasini, Baburam

doi:10.31729/jnma.4839

Cited by 8 publications

(9 citation statements)

References 7 publications

(9 reference statements)

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“…Nepal is constantly developing its health system. Majority of wards (small administrative units) of urban and rural municipalities have at least one health institution such as health post or urban health clinics [ 33 ]. We can mobilize currently existing resources for hypertension and healthy lifestyle education as we had conducted in our study.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial

Khanal

Bhandari²,

Dhungana

et al. 2021

PLoS ONE

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Background Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. Methods We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. Results 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01–4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63–2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001). Conclusions Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal. Trial registration ClinicalTrial.gov: NCT02981251

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Section: Discussionmentioning

confidence: 99%

Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial

Khanal

Bhandari²,

Dhungana

et al. 2021

PLoS ONE

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“…During ancient and medieval periods, health and disease were mainly curative focused and mostly resolved with Spells, Chants, Herbals, Ayurveda, and other Traditional Medicines including Yin-Yang that originated in ancient China. To a meager, some thrusts for participation and health financing from the state level were observed during Lichchhavi (ancient) and Malla (medieval) kingships in Nepal, like state-funded Ayurvedic Health House (Arogyashala), regulating the umbilical cord from the state level, and services to provide without discrimination of caste and ethnicity ( 66 ), herbal medicine use in China ( 67 ), use of herbal cosmetics in ancient India ( 68 ), and such. These systems are rooted in communities; they are easy to use and access, and they even have less frequent and less severe side effects, implicating wider acceptability.…”

Section: Development and Chronology Of Uhcmentioning

confidence: 99%

Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review

Ranabhat

Acharya

Adhikari

et al. 2023

Front. Public Health

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The goal of universal health coverage (UHC) from the United Nations (UN) has metamorphized from its early phase of primary health care (PHC) to the recent sustainable development goal (SDG). In this context, we aimed to document theoretical and philosophical efforts, historical analysis, financial and political aspects in various eras, and an assessment of coverage during those eras in relation to UHC in a global scenario. Searching with broad keywords circumadjacent to UHC with scope and inter-disciplinary linkages in conceptual analysis, we further narrated the review with the historical development of UHC in different time periods. We proposed, chronologically, these frames as eras of PHC, the millennium development goal (MDG), and the ongoing sustainable development goal (SDG). Literature showed that modern healthcare access and coverage were in extension stages during the PHC era flagshipped with “health for all (HFA)”, prolifically achieving vaccination, communicable disease control, and the use of modern contraceptive methods. Following the PHC era, the MDG era markedly reduced maternal, neonatal, and child mortalities mainly in developing countries. Importantly, UHC has shifted its philosophic stand of HFA to a strategic health insurance and its extension. After 2015, the concept of SDG has evolved. The strategy was further reframed as service and financial assurance. Strategies for further resource allocation, integration of health service with social health protection, human resources for health, strategic community participation, and the challenges of financial securities in some global public health concerns like the public health emergency and travelers' and migrants' health are further discussed. Some policy departures such as global partnership, research collaboration, and experience sharing are broadly discussed for recommendation.

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“…Furthermore, the health system is strengthened by people's participation and better management of health information and drug supply. 3 The role of FCHVs in the promotion of health in Nepal is unexplainable. They are directly involved in health promotion activities like sanitation, nutrition, family planning, human immunodeficiency virus (HIV), maternal and child health care.…”

Section: The Female Community Health Volunteers: Unsung Heroesmentioning

confidence: 99%

The female community health volunteers: unsung heroes

Lageju

Neupane

Jaiswal

2022

Int J Community Med Public Health

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In the 1980s, Nepal commenced a programme of female community health volunteers (FCHVs), commonly known as “Mahila swoyemsewika”, which means “female volunteer”. Their roles were to support family planning in the early days, especially by distributing birth control pills and condoms. Gradually, their roles were extended to include other programmes. The volunteers are influential in achieving the health-related Millennium Development Goals and other targets. This programme has been the backbone of the health system in Nepal for the past three decades.

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Health System Development in Nepal

Cited by 8 publications

References 7 publications

Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial

Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial

Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review

The female community health volunteers: unsung heroes

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