1. Health system gaps in cardiovascular disease prevention and management in Nepal
- Author
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Donna Spiegelman, David Citrin, Niharika Jha, Swornim Bajracharya, Punya Shori Suwal, Guna Nidhi Sharma, Meghnath Dhimal, Sushmita Mali, Anmol Purna Shrestha, Dong Xu, Anjani Kumar Jha, Sumitra Sharma, Rajan Pandit, Rajeev Shrestha, Dipanker Prajapati, Manita Pyakurel, Sanju Bhattarai, Rajendra Koju, Archana Shrestha, Sujata Sapkota, Pranil Man Singh Pradhan, Anu Aryal, Binuka Kulung Rai, Robin Man Karmacharya, Phanindra Prasad Baral, Natalia Oli, Rashmi Maharjan, Bobby Thapa, Durga Bista, Abha Shrestha, Tamanna Neupane, Biraj Man Karmacharya, Abhinav Vaidya, Soniya Shrestha, Annette L. Fitzpatrick, Lijing L. Yan, Bhim Prasad Sapkota, Surya B. Parajuli, Rajendra Dev Bhatt, and Prajjwal Pyakurel
- Subjects
medicine.medical_specialty ,Economic growth ,Service delivery framework ,Population ,030204 cardiovascular system & hematology ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Nepal ,medicine ,Humans ,030212 general & internal medicine ,CVDs ,Human resources ,education ,education.field_of_study ,Government ,Medical Assistance ,business.industry ,Health Policy ,Public health ,Nursing research ,Research ,Government Programs ,Cardiovascular Diseases ,Health system performance ,Public aspects of medicine ,RA1-1270 ,business ,Health system building blocks ,Delivery of Health Care - Abstract
Background 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. Methods 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. Results 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. Conclusion 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.
- Published
- 2021