Health system’s readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

Abstract

Background: The burgeoning rise of non-communicable diseases (NCDs) is posing serious challenges in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases (CRDs) services in Nepal. Methods: This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for CVDs, diabetes, and CRDs were assessed using the Service Availability and Readiness Assessment manual of the World Health Organization. Health facilities were categorized into public and private facilities. Results: Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (β = 2.87, 95%CI: 2.42-3.39), diabetes (β =3.02, 95%CI: 2.03-4.49), and CRDs (β = 15.95, 95%CI: 4.61-55.13) at private facilities were higher than the public facilities. Health facilities located in the hills had a higher readiness index for CVDs (β = 1.99, 95%CI: 1.02-1.39). Service readiness for CVDs (β = 1.13, 95%CI: 1.04-1.23) and diabetes (β = 1.78, 95%CI: 1.23-2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease-related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Compared to province 1, province 2 (β = 0.83, 95%CI: 0.73-0.95) had lower, and province 4 (β =1.24, 95%CI: 1.07-1.43) and province 5 (β =1.17, 95%CI: 1.02-1.34) had higher readiness index for CVDs.

Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal

“…Because of limited health services, including the drug shops in rural regions, patients reported a reliance on local health services/drug shops before deciding to travel in search of quality healthcare and reflects other evidence that indicates the urban–rural divide in health services across Nepal. 22 35 36 65–67 To maximise the reliability of findings, the perspectives of stakeholders with varied and conflicting interests were collected and triangulated. 30 Collecting data through a mix of SSIs and FGDs is likely to have compensated the limitations of the individual method.…”

“…Nepal is divided into seven provinces and its health system comprises federal, provincial and local level healthcare facilities. 22 Nepal’s public health system is hierarchical and comprises community healthcare units, primary healthcare centres, district/provincial hospitals and tertiary hospitals. In parallel, private hospitals, nursing homes, polyclinics and pharmacies serve much of the population.…”

“…People seek assistance at the public and private facilities depending on the severity of illness, accessibility of services and their financial circumstances. 22 This study was conducted in purposively selected three tertiary teaching hospitals each located in province 1 (B. P. Koirala Institute of Health Sciences/BPKIHS), province 3 (Patan Academy of Health Sciences/PAHS) and province 5 (Universal College of Medical Sciences/UCMS), and the drug shops located around these hospitals ( figure 1 ).…”

Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey

“…Moreover, Nepal is predominated by high proportion of rural and inaccessible areas where tertiary care centres are heavily constrained 54 , 55 . Therefore, the majority of the rural people rely on health assistants, quacks (unqualified persons pretending to have medical skills), and poorly trained drug dispensers for their treatment decision(s) 56 . Nonetheless, drug shops are a popular choice for OTC medication in both rural and urban regions and are affected by accessibility and functionality of the formal health services 35 .…”

“…In addition, Nepal also suffers from disproportionate physician to patients’ ratio and should be properly addressed 77 . For example, by establishing the health care structure in rural regions and incentivizing the health care workers to serve the rural regions in addition to other developmental works 77 , 78 . At the same time, patients in remote regions of Nepal with simple infectious conditions should not be restricted to utilize antibiotics where qualified health care workers including doctors and tertiary care centers can be days away 9 .…”