BMC Health Services Research (Jul 2021)
Health system gaps in cardiovascular disease prevention and management in Nepal
- Archana Shrestha,
- Rashmi Maharjan,
- Biraj Man Karmacharya,
- Swornim Bajracharya,
- Niharika Jha,
- Soniya Shrestha,
- Anu Aryal,
- Phanindra Prasad Baral,
- Rajendra Dev Bhatt,
- Sanju Bhattarai,
- Durga Bista,
- David Citrin,
- Meghnath Dhimal,
- Annette L. Fitzpatrick,
- Anjani Kumar Jha,
- Robin Man Karmacharya,
- Sushmita Mali,
- Tamanna Neupane,
- Natalia Oli,
- Rajan Pandit,
- Surya Bahadur Parajuli,
- Pranil Man Singh Pradhan,
- Dipanker Prajapati,
- Manita Pyakurel,
- Prajjwal Pyakurel,
- Binuka Kulung Rai,
- Bhim Prasad Sapkota,
- Sujata Sapkota,
- Abha Shrestha,
- Anmol Purna Shrestha,
- Rajeev Shrestha,
- Guna Nidhi Sharma,
- Sumitra Sharma,
- Donna Spiegelman,
- Punya Shori Suwal,
- Bobby Thapa,
- Abhinav Vaidya,
- Dong Xu,
- Lijing L. Yan,
- Rajendra Koju
Affiliations
- Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences
- Rashmi Maharjan
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Biraj Man Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences
- Swornim Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Niharika Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Soniya Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Anu Aryal
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Phanindra Prasad Baral
- Department of Health Services, Non Communicable Diseases and Mental Health Section, Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal
- Rajendra Dev Bhatt
- Department of Biochemistry, Dhulikhel Hospital Kathmandu University Hospital
- Sanju Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Durga Bista
- Department of Pharmacy, Kathmandu University
- David Citrin
- Possible
- Meghnath Dhimal
- Nepal Health Research Council
- Annette L. Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, University of Washington
- Anjani Kumar Jha
- Nepal Health Research Council
- Robin Man Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular unit), Dhulikhel Hospital Kathmandu University Hospital
- Sushmita Mali
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Tamanna Neupane
- Nepal Health Research Council
- Natalia Oli
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital
- Rajan Pandit
- Department of Physiology, Nepal Medical College and Teaching Hospital
- Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College and Teaching Hospital
- Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
- Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre
- Manita Pyakurel
- School of Public Health, Central University of Nicaragua
- Prajjwal Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences
- Binuka Kulung Rai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital
- Bhim Prasad Sapkota
- Health Coordination Division, Ministry of Health and Population, Government of Nepal
- Sujata Sapkota
- Department of Pharmacy, Manmohan Memorial Institute of Health Sciences
- Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences
- Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences
- Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences
- Guna Nidhi Sharma
- Policy, Planning and Monitoring Division, Ministry of Health and Population, Government of Nepal
- Sumitra Sharma
- Department of Nursing, Kathmandu Medical College and Teaching Hospital
- Donna Spiegelman
- Center for Methods in Implementation and Preventive Science and Department of Biostatistics, Yale School of Public Health
- Punya Shori Suwal
- Department of Public Health, Nepal Institute of Health Sciences, Stupa Health Care Center Cooperative Limited
- Bobby Thapa
- Department of Nursing, Nepalgunj Nursing Campus, Institute of Medicine, Tribhuvan University
- Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital
- Dong Xu
- Global Health Institute, Sun Yat-Sen University
- Lijing L. Yan
- Global Health Research Center, Duke Kunshan University
- Rajendra Koju
- Dean, Kathmandu University School of Medical Sciences
- DOI
- https://doi.org/10.1186/s12913-021-06681-0
- Journal volume & issue
-
Vol. 21,
no. 1
pp. 1 – 13
Abstract
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.
Keywords