| Author(s) |
Ministry of Health, Ramshah Path, Kathmandu New ERA, Kathmandu, Nepal NHSSP, Kathmandu, Nepal ICF, Rockville, Maryland USA |
| Table of contents |
TABLES AND FIGURES ........................................................................................................................... ix
PREFACE ................................................................................................................................................... xv
FOREWORD ............................................................................................................................................ xvii
ACKNOWLEDGMENTS ......................................................................................................................... xix
ACRONYMS AND ABBREVIATIONS ............................................................................................... xxiii
KEY FINDINGS ..................................................................................................................................... xxvii
MAP OF NEPAL .................................................................................................................................... xxxii
1 OVERVIEW OF THE HEALTH SYSTEM IN NEPAL ............................................................. 1
1.1 Health Status in Nepal ......................................................................................................... 1
1.2 Enabling Policies and Strategies to Improve Health Status ................................................. 2
1.2.1 Constitution of Nepal ............................................................................................. 2
1.2.2 National Health Policy 2014 .................................................................................. 2
1.2.3 Nepal Health Sector Program ................................................................................ 4
1.2.4 MDGs and Sustainable Development Goals .......................................................... 5
1.3 The Health Care System ...................................................................................................... 6
1.3.1 Overview ................................................................................................................ 6
1.3.2 Governance Structure at the National Level .......................................................... 6
1.3.3 Decentralized Governance Structure at the District Level ..................................... 9
1.4 Health Financing ................................................................................................................. 9
1.4.1 Overview ................................................................................................................ 9
1.4.2 Goal ...................................................................................................................... 10
1.4.3 Donor Project Funding ......................................................................................... 10
2 METHODOLOGY ........................................................................................................................ 13
2.1 Overview ........................................................................................................................... 13
2.2 Institutional Framework and Objectives of the 2015 NHFS ............................................. 13
2.2.1 Institutional Framework ....................................................................................... 13
2.2.2 Objectives of the 2015 NHFS .............................................................................. 14
2.3 Data Collection Methods ................................................................................................... 14
2.4 Implementation .................................................................................................................. 16
2.4.1 Survey Oversight ................................................................................................. 16
2.4.2 Questionnaire Adaptation .................................................................................... 16
2.4.3 Pre-test ................................................................................................................. 16
2.4.4 Main Training ...................................................................................................... 17
2.4.5 Data Collection .................................................................................................... 17
2.4.6 Data Management and Report Writing ................................................................ 18
2.4.7 Special Conventions during Data Analysis .......................................................... 19
2.5 Sampling ............................................................................................................................ 20
2.5.1 Sample of Facilities.............................................................................................. 20
2.5.2 Sample of Health Service Providers .................................................................... 22
2.5.3 Sample for Observations and Exit Interviews ...................................................... 25
3 FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, GENERAL SERVICE READINESS, AND QUALITY OF CARE ..... 29
3.1 Background........................................................................................................................ 29
3.2 Availability of Services ..................................................................................................... 30
3.2.1 Overall Availability of Specific Client Services .................................................. 30
3.2.2 Availability of Basic Client Services ................................................................... 32
3.3 Service Readiness: Basic Facility Infrastructure to Support Quality Service Provision and Client Utilization .... 34
3.3.1 Basic Amenities ................................................................................................... 34
3.3.2 Basic Equipment to Support Quality Health Services ......................................... 35
3.3.3 Standard Precautions for Infection Control in Service Delivery Area ................. 37
3.3.4 Waste Segregation ............................................................................................... 39
3.3.5 Safe Disposal of Health Care Waste .................................................................... 39
3.3.6 Capacity for Adherence to Standards for Quality Sterilization or High-Level Disinfection Processes .... 40
3.3.7 Diagnostic Capacity ............................................................................................. 41
3.3.8 Availability of Essential Medicines ..................................................................... 44
3.4 Management Systems to Support and Maintain Quality Services and Appropriate Client Utilization .... 46
3.4.1 Management Meetings, Quality Assurance, and Client Opinions ....................... 46
3.4.2 Supportive Management for Providers ................................................................ 49
3.5 Availability of Human Resources for Health .................................................................... 51
3.6 Health Management Information System (HMIS) ............................................................ 52
3.7 Logistics Management System .......................................................................................... 54
3.7.1 Storage Practices for Medicines ........................................................................... 54
3.7.2 Logistics Management Information System (LMIS) ........................................... 56
3.7.3 Timely Supply of Family Planning Commodities ............................................... 56
3.8 Health Facility Development and Management Committee .............................................. 57
3.9 Case Load Situation ........................................................................................................... 58
3.10 Quality of Care .................................................................................................................. 59
3.10.1 Minimum quality of care standards ..................................................................... 59
3.10.2 Compliance with service standards ...................................................................... 60
3.10.3 Provision of quality services ................................................................................ 63
3.11 Financial Audit and Disaster Preparedness ....................................................................... 66
3.11.1 Financial Audit .................................................................................................... 66
3.11.2 Disaster Preparedness .......................................................................................... 67
3.12 Free Health Care ................................................................................................................ 68
4 CHILD HEALTH SERVICES ..................................................................................................... 69
4.1 Background........................................................................................................................ 69
4.1.1 Health Situation of Children in Nepal .................................................................. 70
4.2 Availability of Child Health Services ................................................................................ 73
4.2.1 Outpatient Curative Care, Child Growth Monitoring, and Child Vaccination .... 73
4.2.2 Vitamin A Supplementation ................................................................................ 75
4.2.3 Frequency of Availability .................................................................................... 75
4.3 Service Readiness .............................................................................................................. 77
4.3.1 Guidelines, Trained Staff, and Equipment for Sick Child Care ........................... 77
4.3.2 Infection Control in Sick Child Services ............................................................. 79
4.3.3 Laboratory Diagnostic Capacity .......................................................................... 80
4.3.4 Medicines and Commodities for Sick Child Care ................................................ 81
4.3.5 Guidelines, Trained Staff, and Equipment for Vaccination Services ................... 82
4.3.6 Availability of Vaccines ...................................................................................... 83
4.3.7 Infection Prevention in Vaccination Services ...................................................... 84
4.4 Sick Child Care Practices .................................................................................................. 85
4.4.1 Full Assessment ................................................................................................... 88
4.4.2 Diagnosis-Specific Assessments and Treatment .................................................. 88
4.5 Client Opinions .................................................................................................................. 90
4.6 Basic Management and Administrative Systems............................................................... 91
4.6.1 Supervision .......................................................................................................... 91
4.6.2 Training ................................................................................................................ 91
5 FAMILY PLANNING SERVICES ............................................................................................. 93
5.1 Background........................................................................................................................ 93
5.1.1 NHFS Approach to Collection of Family Planning Service Information ............ 93
5.1.2 Family Planning Services in Nepal ...................................................................... 94
5.2 Availability of Family Planning Services .......................................................................... 95
5.2.1 Contraceptive Method Mix and Method Availability .......................................... 95
5.2.2 Frequency of availability of Family Planning Services ....................................... 96
5.2.3 Specific Methods Offered .................................................................................... 97
5.2.4 Availability of Family Planning Methods on the Day of the Assessment ......... 100
5.3 Service Readiness ............................................................................................................ 102
5.3.1 Service Guidelines, Trained Staff, and Equipment ............................................ 102
5.3.2 Infection Control ................................................................................................ 103
5.4 Adherence to Standards for Quality Service Provision ................................................... 105
5.4.1 Counseling and Client Assessment at First Family Planning Visits .................. 105
5.4.2 Counseling at All Family Planning Visits .......................................................... 109
5.5 Client Opinion and Knowledge ....................................................................................... 111
5.5.1 Major Problems .................................................................................................. 111
5.5.2 Clients’ Knowledge about Methods ................................................................... 112
5.6 Basic Management and Administrative Systems............................................................. 113
5.6.1 Supervision ........................................................................................................ 113
5.6.2 Training .............................................................................................................. 114
6 ANTENATAL CARE ................................................................................................................. 117
6.1 Background...................................................................................................................... 118
6.2 Availability of ANC Services .......................................................................................... 118
6.3 Service Readiness ............................................................................................................ 119
6.3.1 Service Guidelines, Trained Staff, and Equipment ............................................ 119
6.3.2 Infection Control ................................................................................................ 120
6.3.3 Laboratory Tests ................................................................................................ 122
6.3.4 Medicines ........................................................................................................... 123
6.4 Adherence to Standards ................................................................................................... 123
6.4.1 Characteristics of ANC Clients .......................................................................... 123
6.4.2 Components of ANC Consultations ................................................................... 124
6.5 Client Knowledge and Opinions ...................................................................................... 136
6.5.1 Client Knowledge .............................................................................................. 137
6.5.2 Client Complaints .............................................................................................. 138
6.6 Provider Training and Supervision .................................................................................. 139
6.7 Prevention of Mother-to-Child Transmission of HIV ..................................................... 141
6.7.1 Availability of PMTCT Services ....................................................................... 141
6.7.2 Availability of Guidelines, Trained Staff, Medicines, and Diagnostics ............. 142
6.8 Malaria in Pregnancy ....................................................................................................... 143
7 DELIVERY AND NEWBORN CARE ...................................................................................... 147
7.1 Background...................................................................................................................... 145
7.1.1 Maternal and Newborn Health Status and Health Care Utilization ................... 146
7.2 Availability of Delivery and Other Maternal Health Services......................................... 146
7.3 Service Readiness ............................................................................................................ 149
7.3.1 Service Guidelines, Trained Staff, and Equipment for Delivery Services ......... 149
7.3.2 Medicines and Commodities for Delivery and Newborn Care .......................... 151
7.3.3 Infection Control ................................................................................................ 153
7.4 Signal Functions for Emergency Obstetric and Newborn Care (EmONC) ..................... 155
7.5 Newborn Care Practices .................................................................................................. 159
7.6 Basic Management and Administrative Systems............................................................. 161
7.6.1 Supervision ........................................................................................................ 161
7.6.2 Training .............................................................................................................. 161
7.7 Client Experience ............................................................................................................ 163
8 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS ............................................ 171
8.1 Background...................................................................................................................... 169
8.1.1 The HIV/AIDS Situation in Nepal ..................................................................... 169
8.1.2 Definitions of HIV/AIDS Services .................................................................... 170
8.2 HIV Testing and Counseling ........................................................................................... 171
8.2.1 Service Availability ........................................................................................... 171
8.2.2 Service Readiness .............................................................................................. 173
8.2.3 Infection Control ................................................................................................ 173
8.2.4 Basic Management and Administrative Systems for HIV Testing and Counseling .... 174
8.3 HIV Care and Support Services ....................................................................................... 175
8.4 Antiretroviral Therapy ..................................................................................................... 177
8.4.1 Service Availability ........................................................................................... 178
8.4.2 Service Readiness .............................................................................................. 178
8.5 Services for Sexually Transmitted Infections .................................................................. 179
8.5.1 NHFS Approach to Collection of Information on Sexually Transmitted Infections ..... 179
8.5.2 Health Situation Regarding STIs in Nepal ......................................................... 180
8.5.3 Service Availability ........................................................................................... 180
8.5.4 Service Readiness .............................................................................................. 180
9 NON-COMMUNICABLE DISEASES ...................................................................................... 185
9.1 Major Non-communicable Diseases in Nepal ................................................................. 184
9.1.1 Diabetes ............................................................................................................. 184
9.1.2 Cardiovascular Diseases .................................................................................... 185
9.1.3 Chronic Respiratory Diseases ............................................................................ 185
9.2 Diabetes: Service Availability and Readiness ................................................................. 185
9.2.1 Availability of Services for Diabetes ................................................................. 185
9.2.2 Service Readiness for Diabetes .......................................................................... 186
9.3 Cardiovascular Diseases: Service Availability and Readiness ........................................ 188
9.3.1 Service Availability for Cardiovascular Diseases .............................................. 188
9.3.2 Service Readiness for Cardiovascular Diseases ................................................. 189
9.4 Chronic Respiratory Diseases: Service Availability and Readiness ................................ 191
9.4.1 Service Availability for Chronic Respiratory Diseases...................................... 191
9.4.2 Service Readiness for Chronic Respiratory Diseases ........................................ 191
10 TUBERCULOSIS ....................................................................................................................... 197
10.1 Background...................................................................................................................... 195
10.1.1 Global Burden of Tuberculosis .......................................................................... 195
10.1.2 Health Situation Regarding Tuberculosis in Nepal ............................................ 196
10.1.3 Response of the Nepal National Tuberculosis Control Programme (NTP) ....... 196
10.2 Availability of TB Services ............................................................................................. 197
10.3 Service Readiness ............................................................................................................ 198
10.3.1 Guidelines and Trained Staff ............................................................................. 198
10.3.2 Diagnostic Capacity ........................................................................................... 199
10.3.3 Treatment and Availability of Medicines .......................................................... 200
11 MALARIA ................................................................................................................................... 205
11.1 Background...................................................................................................................... 203
11.1.1 Health Situation Regarding Malaria in Nepal .................................................... 203
11.2 Availability of Services for Malaria ................................................................................ 205
11.3 Service Readiness ............................................................................................................ 205
11.3.1 Guidelines, Trained Staff, and Diagnostics........................................................ 206
11.3.2 Medicines and Commodities for Malaria Services ............................................ 206
11.4 Malaria Services in Facilities Offering Curative Care for Sick Children ........................ 208
11.4.1 Readiness for Diagnosis ..................................................................................... 208
11.4.2 Treatment ........................................................................................................... 209
REFERENCES ......................................................................................................................................... 211
APPENDIX A 2016 – 2021 NHSS RF INDICATORS MATRIX ....................................................... 215
APPENDIX B PERSONS INVOLVED IN THE 2015 NHFS ............................................................. 217
APPENDIX C QUESTIONNAIRES ..................................................................................................... 221 |
