Background
Methods
Nepal’s health system
Study design
Data collection tools
Data collection
Data analysis
Results
General readiness | Public facilities n = 870 | Private facilities n = 70 | Total n = 940 |
---|---|---|---|
Basic amenities | |||
Power | 44.3 | 99.4 | 48.4 |
Water source | 80.0 | 89.4 | 80.7 |
Room with privacy | 76.7 | 95.7 | 78.1 |
Adequate sanitation facilities | 80.0 | 98.4 | 81.4 |
Communication equipment | 12.1 | 98.4 | 18.5 |
Access to computer with internet | 4.2 | 78.7 | 9.7 |
Emergency transportation (ambulance) | 56.4 | 94.5 | 59.2 |
Mean domain score of basic amenities (±SD) | 50.5 (18.6) | 93.5 (9.6) | 53.7 (21.3) |
Basic equipment | |||
Blood pressure apparatus | 94.0 | 95.6 | 94.1 |
Stethoscope | 97.9 | 96.7 | 97.8 |
Adult scale | 88.2 | 94.1 | 88.6 |
Child scale | 40.3 | 25.6 | 39.2 |
Thermometer | 92.8 | 96.4 | 93.0 |
Light source | 47.6 | 88.8 | 50.7 |
Mean domain score of basic equipment (±SD) | 76.8 (17.5) | 82.9 (18.3) | 77.2 (17.6) |
Standard precautions for infection prevention | |||
Safe final disposal of sharps | 84.0 | 85.4 | 84.2 |
Safe final disposal of infectious wastes | 81.5 | 74.6 | 81.0 |
Appropriate storage of sharps waste | 81.1 | 34.0 | 77.6 |
Appropriate storage of infectious waste | 4.8 | 4.7 | 4.8 |
Disinfectant | 62.4 | 63.1 | 62.5 |
Single-use, standard disposable or auto-disable syringes | 84.2 | 60.1 | 82.4 |
Soap and running water or alcohol-based hand rub | 55.8 | 73.9 | 57.1 |
Disposable latex gloves | 79.6 | 83.0 | 79.9 |
Guidelines on standard precautions | 3.3 | 5.3 | 3.5 |
Mean domain score of standard precautions for infection prevention (±SD) | 59.6 (18.8) | 53.8 (21.9) | 59.2 (19.1) |
Diagnostic capacity | |||
Blood glucose test | 3.7 | 58.0 | 7.7 |
Hemoglobin test | 9.3 | 93.3 | 15.5 |
HIV diagnostic capacity | 8.9 | 87.1 | 14.7 |
Malaria diagnostic capacity | 18.6 | 95.3 | 24.3 |
Syphilis RDT | 5.6 | 78.1 | 11.0 |
Urine test for pregnancy | 25.4 | 90.0 | 30.2 |
Urine dipstick- protein | 9.8 | 90.5 | 15.8 |
Urine dipstick- glucose | 7.7 | 91.8 | 14.0 |
Mean domain score of diagnostic capacity (±SD) | 11.1 (22.9) | 85.5 (21.5) | 16.6 (30.0) |
Essential medicines | |||
Amitriptyline tablet | 4.7 | 58.3 | 9.8 |
Amlodipine tablet or alternative calcium channel blocker | 5.1 | 68.3 | 11.2 |
Amoxicillin syrup/suspension or dispersible tablet | 21.6 | 57.4 | 24.2 |
Amoxicillin tablet | 89.6 | 71.4 | 88.3 |
Ampicillin powder for injection | 4.0 | 36.7 | 6.4 |
Beclometasone inhaler | 3.2 | 33.0 | 6.0 |
Ceftriaxone injection | 18.0 | 43.6 | 19.9 |
Enalapril tablet or alternative ACE inhibitor e.g. lisinopril, ramipril, perindopril | 13.9 | 57.0 | 18.0 |
Fluoxetine tablet | NA | NA | NA |
Gentamicin injection | 63.5 | 64.4 | 63.6 |
Glibenclamide tablet | 1.4 | 30.3 | 4.2 |
Ibuprofen tablet | 18.0 | 74.3 | 22.2 |
Insulin regular injection | 4.3 | 50.8 | 19.9 |
Metformin tablet | 2.6 | 67.8 | 7.5 |
Omeprazole tablet or alternative such as pantoprazole, rabeprazole | 46.2 | 72.8 | 48.2 |
Oral Rehydration Solution (ORS) | 93.3 | 77.8 | 92.2 |
Paracetamol tab/injection | 99.4 | 73.3 | 97.4 |
Salbutamol tab or inhaler | 78.2 | 68.0 | 77.4 |
Simvastatin tablet or other statin e.g. atorvastatin, pravastatin, fluvastatin | 0.6 | 19.5 | 2.4 |
Zinc sulphate tab | 98.1 | 61.3 | 95.4 |
Mean domain score of items of essential medicine (±SD) | 31.4 (10.6) | 56.0 (35.7) | 33.3 (15.5) |
General services readiness (Median (Q1, Q3)) | 50.3 (42.4, 63.3) | 75.2 (65.8, 84.3) | 53.8 (43.7, 69.4) |
Readiness index specific to services for CVDs
Services for CVDs | Public facilities n = 870 | Private facilities n = 70 | Total n = 940 |
---|---|---|---|
Diagnosis and treatment facilities | 71.3 | 94.6 | 73.1 |
Guidelines on diagnosis and treatmenta | 1.4 | 1.3 | 1.4 |
Mean guidelines domain index (±SD) | 1.4 | 1.3 | 1.4 |
Trained staffa | 1.4 | 3.1 | 1.3 |
Mean trained staff domain index (±SD) | 1.4 | 3.1 | 1.3 |
Equipmenta | |||
Stethoscope | 97.9 | 96.9 | 97.8 |
Blood pressure | 93.5 | 95.7 | 93.7 |
Adult weighing scale | 87.0 | 93.5 | 87.6 |
Oxygen | 4.4 | 55.1 | 9.3 |
Mean equipment domain index (±SD) | 67.1 (20.2) | 81.2 (27.4) | 68.2 (21.1) |
Medicinesa | |||
Amlodipine/nifedipine | 5.1 | 68.3 | 11.2 |
Beta-blockers (atenolol) | 13.9 | 57.0 | 18.0 |
Aspirin | 4.2 | 63.5 | 9.9 |
Thiazide | 2.1 | 26.2 | 4.4 |
Mean medicines domain index (±SD) | 2.6 (9.8) | 39.1 (29.0) | 5.4 (15.5) |
Readiness index specific to services for CVD (Median (Q1, Q3)) | 18.8 (18.8, 18.8) | 31.3 (18.9, 37.5) | 18.8 (18.8, 25.0) |
Readiness index specific to services for diabetes
Services for diabetes | Public facilities n = 870 | Private facilities n = 70 | Total n = 940 |
---|---|---|---|
Diagnosis and treatment facilities | 15.1 | 95.2 | 21.1 |
Guidelines for diagnosis and treatmenta | 4.8 | 2.5 | 4.1 |
Mean guidelines domain index | 4.8 | 2.5 | 4.1 |
Trained staffa | 1.5 | 2.5 | 1.9 |
Mean staff domain index | 1.5 | 2.5 | 1.9 |
Equipmenta | |||
Blood pressure | 93.5 | 95.7 | 94.2 |
Adult weighing scale | 84.8 | 93.5 | 87.7 |
Height board/stadiometer | 26.7 | 35.9 | 29.8 |
Mean equipment domain index (±SD) | 37.9 (22.3) | 71.4 (27.5) | 40.4 (24.4) |
Diagnostic capacitya | |||
Blood glucose | 5.5 | 24.7 | 11.9 |
Urine protein | 39.7 | 82.2 | 53.9 |
Urine glucose | 40.2 | 85.1 | 55.3 |
Mean diagnostics domain index (±SD) | 4.7 (17.6) | 63.1 (30.5) | 9.0 (24.3) |
Medicinesa | |||
Metformin | 16.5 | 69.5 | 34.3 |
Glibenclamide | 6.4 | 30.1 | 14.3 |
Injectable insulin | 4.3 | 50.8 | 19.9 |
Injectable glucose solution | 46.7 | 69.9 | 54.5 |
Mean medicines domain index (±SD) | 7.7 (13.7) | 54.4 (38.0) | 11.1 (20.7) |
Readiness index specific to services for diabetes (Median (Q1, Q3)) | 26.4 (16.7, 30.6) | 34.7 (26.4, 40.3) | 26.4 (20.8, 33.3) |
Readiness index specific to services for chronic respiratory diseases
Services for chronic respiratory diseases | Public facilities n = 870 | Private facilities n = 70 | Total n = 940 |
---|---|---|---|
Both diagnosis and treatment facilities | 94.1 | 94.9 | 94.1 |
Guidelines on the diagnosis and treatmenta | 4.9 | 0.6 | 4.6 |
Mean guidelines domain index | 4.9 | 0.6 | 4.6 |
Trained staffa | 9.4 | 3.4 | 9.0 |
Mean staff domain index | 9.4 | 3.4 | 9.0 |
Equipmenta | |||
Stethoscope | 97.8 | 96.9 | 97.7 |
Oxygen flow meter | 2.5 | 49.3 | 6.0 |
Spacers for inhalers | 2.1 | 25.0 | 3.8 |
Oxygen | 3.4 | 54.9 | 7.2 |
Mean equipment domain index (±SD) | 25.0 (11.4) | 53.9 (33.7) | 27.2 (16.1) |
Medicinesa | |||
Salbutamol inhaler | 79.7 | 68.2 | 78.8 |
Beclomethasone inhaler | 3.0 | 32.9 | 5.3 |
Prednisolone cap/tabs | 3.4 | 64.9 | 8.0 |
Hydrocortisone injection | 6.9 | 69.9 | 11.6 |
Epinephrine injectable | 5.2 | 59.1 | 9.2 |
Mean medicines domain index (±SD) | 19.3 (14.3) | 57.9 (39.6) | 22.2 (20.2) |
Readiness index specific to services for chronic resp. (Median (Q1, Q3)) | 11.3 (11.3, 16.3) | 26.3 (6.5, 37.5) | 11.3 (11.3, 18.8) |
CVDsa | Diabetesa | CRDsa | ||||
---|---|---|---|---|---|---|
Adjusted β (95%CI) | p-value | Adjusted β (95%CI) | p-value | Adjusted β (95%CI) | p-value | |
Province | ||||||
Province 1 | ref | ref | ref | |||
Province 2 | 0.83 (0.73–0.95) | 0.01 | 0.94 (0.53–1.66) | 0.89 | 1.18 (0.87–1.59) | 0.18 |
Province 3 | 1.05 (0.92–1.19) | 0.46 | 1.38 (0.86–2.23) | 0.33 | 1.29 (0.78–2.12) | 0.28 |
Province 4 | 1.24 (1.07–1.43) | 0.00 | 1.98 (1.08–3.61) | 0.88 | 1.36 (0.77–2.42) | 0.32 |
Province 5 | 1.17 (1.02–1.34) | 0.02 | 1.21 (0.73–2.01) | 0.22 | 1.36 (0.77–2.42) | 0.29 |
Province 6 | 0.01 (0.85–1.21) | 0.87 | 1.15 (0.58–2.29) | 0.83 | 0.73 (0.36–1.48) | 0.38 |
Province 7 | 0.06 (0.91–1.24) | 0.47 | 1.34 (0.73–2.45) | 0.33 | 1.25 (0.50–3.13) | 0.63 |
Health facility type | ||||||
Public facilities | ref | ref | ref | |||
Private facilities | 2.87 (2.42–3.39) | 0.00 | 3.02 (2.03–4.49) | 0.00 | 15.95 (4.61–55.13) | 0.00 |
Ecological region | ||||||
Mountains | 1.88 (0.78–0.99) | 0.68 | 1.19 (−0.14–0.9) | 0.49 | 1.07 (0.89–1.30) | 0.47 |
Hills | 1.99 (0.91–1.11) | 0.03 | 1.15 (0.78–1.707) | 0.46 | 1.13 (0.97–1.32) | 0.11 |
Terai | ref | ref | ref | |||
Urbanization | ||||||
Metropolitan | 0.99 (0.80–1.22) | 0.92 | 1.59 (0.89–2.85) | 0.12 | 0.80 (0.59–1.09) | 0.16 |
Urban Municipality | 1.13 (1.04–1.23) | 0.01 | 1.78 (1.23–2.59) | 0.00 | 1.02 (0.90–1.16) | 0.76 |
Rural Municipality | ref | ref | ref |