Background
Methods
Overview of the health system in Nepal
Epidemiology of malaria in Nepal
Study setting
Indicator | Kanchanpur | Kailali | Dadeldhura |
---|---|---|---|
Blood slides tested | 13,410 | 10,187 | 727 |
Positive cases (% of total sample collected) | 87 (0.7) | 295 (2.9) | 14 (1.9) |
Number of positive cases treated (% of slide positivity) | 85 (97.7) | 268 (90.8) | 14 (100) |
Plasmodium vivax | |||
Indigenous | 34 | 121 | 5 |
Imported | 48 | 48 | 9 |
Plasmodium falciparum | |||
Indigenous | 1 | 7 | 0 |
Imported | 5 | 18 | 0 |
Capacity-building exercise
Brainstorming on elimination of malaria and health system thinking
Training on health system thinking and financing approaches
Box 1: Outline of the training manual
Assessment of the gaps on current initiatives for malaria elimination
Results
General perceptions of malaria trends in three districts
Areas | Demand | Supply | Local perception of the gap |
---|---|---|---|
LLIN | There is a high demand for LLIN at community level. Even existing LLIN need replacement as many may have worn out. The willingness to pay for LLINs is low, however, especially among the disadvantaged groups | The last distribution of the LLINs by the district authorities was 4 years before. Currently, only high-risk groups, such as infants and pregnant mothers in high-risk geographic areas them. The government attempted to provide LLINs to disadvantaged groups a few years ago with limited success | There is an excess demand for LLIN |
IRS | There is a high demand for IRS at the community level, especially in high-risk areas, such as the ones near the forest belt and brick factories In suburban areas, households are buying IRS themselves to spray at community level as they suspect the quality of IRS sprayed by the government | Supply of IRS is low at community level and the district public health offices have targeted specific areas to spray each year (free of cost) | There is an excess demand for IRS |
Diagnosis and treatment | There is a high demand for the diagnosis and treatment of malaria, mainly due to increased awareness among the population | Many health facilities are equipped with basic diagnosis and treatment services. However, microscopy services are available only in a few health facilities, as are laboratory chemicals | There is a lack of microscopy services for testing blood samples in health facilities |
Human resource | The communities seek qualified health workers in the public health facilities and either seek alternatives (i.e., the private providers) or forego diagnosis and treatment when they are not available | There exists a shortage of skilled and trained health workers in all health facilities. The existing human resources, including the few lab technicians, health assistants, have limited training on malaria diagnosis and treatment. The female community health volunteers also lack malaria-specific knowledge | There are insufficient number of health workers and in cases where they are present, they are insufficiently trained on the diagnosis and treatment of malaria |
Demand: strengths and challenges
LLIN
“Nowadays even the poorest people in the society use the mosquito nets; they use it even after sewing the holes in it”.
Insecticide residual spray (IRS)
“These days the spray is not as effective to kill the mosquito as it used to be, we see a lot of mosquitoes even after the spray”.
“a few risky pockets such as the communities living nearby forest belts and those living nearby brick industry require intensive IRS which is yet to be met by the government authority”.
Diagnosis and treatment
“If an individual in community gets fever, we directly go to private clinic because we get quicker access to the services”.
“medicines are not available in public health facilities, … very less frequently they do have enough medicines for us, quite often, human resources are not available while accessing facility, and diagnosis also takes time as compared to private facility”.
“… people these days do not delay in consulting health facility (public or private) whenever they get any sort of fever…”).
Household and community efforts
Supply: strengths and challenges
Governance
“……the management committee has contributed a lab assistant locally which is vital for diagnosis and treatment of malaria…”.
“[The] local municipality is organizing public accounting sessions annually regularly, however the participation of local public is not as much as is generally expected”.
“The reason for reduction in malaria may be attributed to Roll-back Malaria … in past years.”
“As malaria cases are falling the attention towards prevention is falling to 90% of previous efforts.”
“…Mostly the cases are imported and local authority pays less attention on it.”
“Now no more quarterly meetings held for malaria prevention and slide collection campaigns…”
“… Health is not on the top priority list of the Municipality.”
“… [Local] management committee though monitors the health facility staff time to time, we have virtually less power to exercise when it comes to correcting staff”.
Finance
“we spend 5–10% budget in some ways for malaria”.
“…lab’s expenditure and salary of the lab technician is managed by health post management committee.”
“The development committee of Municipality is providing … salary amount to me.”
“…Some of them has been using even by purchasing other mosquito nets from market.”
“People… go to private clinics and drugstores for diagnosis and treatment.”
Medicines and technology
“There is also shortage of RTD testing kits so …Only those cases of fever with some observed symptoms are tested for RTD”
“We cannot cover whole community for IRS, therefore, we are covering only high risk and pocket areas. We do have limited amount of IRS available from the district”
“This year LLIN nets were distributed only to ANCs.”
“Sadly there is high demand of nets and sprays but we have not been able to provide them any.”
“It has been more than 3 years the last time government distributed the LLIN. We would like to request the concerned authority to distribute LLIN again as we have realized that these nets are quite useful”.
“[There] is no shortage of medicines for malaria in our stores”.
“Almost all health facilities here have basic diagnosis and treatment facility available.”
Service delivery
“People… generally, go to private clinics and drugstores for diagnosis and treatment”; “nowadays, more people seek services from private sectors than from us.”
“LLINs were distributed but whether they are using properly or not is another story…”.
Human resources
“…availability of doctor is the problem, they are frequently transferred..”; “During their (doctors) absence … people face real problems of health”
“There is huge work load in lab. …”
“The FCHVs also need training programmes related to malaria every 1-2 years because their role is vital in malaria awareness”.
Information
“The decrease in malaria case is solely due to increase in public awareness”.
“The role of health organizations is basically to educate and make aware people regarding malaria).
“We organize various programmes among which malaria also falls…”
“… there are public hearings from time to time. But …does not focus only on malaria…”).