Health system gaps in cardiovascular disease prevention and management in Nepal.
Journal: BMC health services research
Volume: 21
Issue: 1
Year of Publication: 2021
Affiliated Institutions:
Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. archana@kusms.edu.np.
Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Department of Health Services, Non Communicable Diseases and Mental Health Section, Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.
Department of Biochemistry, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal.
Possible, New York, NY, USA.
Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal.
Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, USA.
Department of Surgery (Cardio Thoracic and Vascular unit), Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
Department of Physiology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal.
Department of Community Medicine, Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal.
Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
School of Public Health, Central University of Nicaragua, Managua, Nicaragua.
School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Health Coordination Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.
Department of Pharmacy, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.
Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Policy, Planning and Monitoring Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.
Department of Nursing, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
Center for Methods in Implementation and Preventive Science and Department of Biostatistics, Yale School of Public Health, New Haven, USA.
Department of Public Health, Nepal Institute of Health Sciences, Stupa Health Care Center Cooperative Limited, Jorpati, Kathmandu, Nepal.
Department of Nursing, Nepalgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Banke, Nepalgunj, Nepal.
Global Health Institute, Sun Yat-Sen University, Guangzhou, China.
Global Health Research Center, Duke Kunshan University, Kunshan, China.
Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Abstract summary
Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal's health systems gaps to prevent and manage CVDs.We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts' codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system.National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible.Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.
Authors & Co-authors:
Shrestha Archana A
Maharjan Rashmi R
Karmacharya Biraj Man BM
Bajracharya Swornim S
Jha Niharika N
Shrestha Soniya S
Aryal Anu A
Baral Phanindra Prasad PP
Bhatt Rajendra Dev RD
Bhattarai Sanju S
Bista Durga D
Citrin David D
Dhimal Meghnath M
Fitzpatrick Annette L AL
Jha Anjani Kumar AK
Karmacharya Robin Man RM
Mali Sushmita S
Neupane Tamanna T
Oli Natalia N
Pandit Rajan R
Parajuli Surya Bahadur SB
Pradhan Pranil Man Singh PMS
Prajapati Dipanker D
Pyakurel Manita M
Pyakurel Prajjwal P
Rai Binuka Kulung BK
Sapkota Bhim Prasad BP
Sapkota Sujata S
Shrestha Abha A
Shrestha Anmol Purna AP
Shrestha Rajeev R
Sharma Guna Nidhi GN
Sharma Sumitra S
Spiegelman Donna D
Suwal Punya Shori PS
Thapa Bobby B
Vaidya Abhinav A
Xu Dong D
Yan Lijing L LL
Koju Rajendra R
Study Outcome
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