Suchergebnisse

Background: Despite various supply-side efforts, out of pocket expenditure occupies a considerable portion of healthcare financing in Nepal. With the recent process of federalization in country, there is additional scope for contextualized planning at provincial level to prevent catastrophic health expenditure among Nepalese households. In this context, this study intends to estimate the proportion of population facing catastrophic health expenditure at national and provincial level and identify the determinants of catastrophic health expenditure.Methods: This study involved analysis of Nepal Living Standard Survey III, which was a cross sectional study. Out of 5,988 households comprising 28,460 individuals, data from total of 7,911 individuals who reported having acute or chronic illness was extracted and analyzed in the study.Results: In the study, 11.11% of households had faced catastrophic health expenditure. Catastrophic health expenditure was found to be 11.3% in Province 1, 9.4% in Province 2, 10.7% in Bagmati Province, 10% in Gandaki Province, 11.7% in Lumbini Province, 13.3% in Karnali Province and 13.4% in Sudurpaschim Province. Household size, literacy status of household head, consumption quintile, urban or rural residence, type of illness and type of health facility visited were identified as determinants of catastrophic health expenditure.Conclusions: A tenth of households, most of whom lying below poverty line, residing in rural areas, suffering from chronic illness are facing catastrophic healthcare burden. The government needs to pursue its equity-oriented strategies preventing catastrophic health expenditure and impoverishment associated with it.Keywords: Catastrophic health expenditure; out of pocket payment; Nepal

Background: Access to high quality medicines is often considered as one of the main obstacle in achieving health for all. With the objective of increasing access to health services of poor segment of population, government of Nepal has implemented free health care program. However, there is strong need for evaluating the performance and coverage of free health Care scheme. In this context, this study aims to provide better understanding on the implementation status of free health care scheme in context of Nepal.Methods: It is a qualitative study conducted in 7 districts of Nepal. Total of 14 focused group discussion were conducted among service providers and service users. All the discussions were carried in neutral and natural setting making sure that each of participants feels free to express their opinion. Focused group discussions were transcribed, translated into English, coded and analyzed manually.Results: Participants shared that free health care has contributed positively in making essential health services reachable, affordable and accessible to all specially benefiting poor segment of population. However, multitude of factors like geographical access, perception of community people towards health services, availability of medicines, laboratory services and human resources come into play determining the utilization of health services. Service providers recommended that there need to be improvements in procurement and supply system for uninterrupted supply of services.Conclusions: Despite having some problems in availability of medicines, human resource and diagnostic services, free health care has improved access to health services specially for poor population. Decentralizing the procurement process can be one promising option to overcome the inappropriate supply of medicines.Keywords: Access to medicine; financial risk; free health care; Nepal; poor.

BACKGROUND: The Nepalese Government has made significant progress toward the elimination of malaria. However, given the surge in the prevalence of non-communicable diseases, such as diabetes and hypertension, and the localized nature of malaria prevalence, malaria elimination will remain a challenge. In the current study, the authors sought to understand local perceptions on threats to malaria elimination in three endemic districts. METHODS: The authors conducted a capacity-building exercise embedded within a qualitative study. The study component aimed to understand how local policymakers and actors perceive challenges in malaria elimination. For them to be able to articulate the challenges, however, an understanding of malaria elimination in the context of a broader health system in Nepal would be required. The capacity-building component, thus, involved providing that knowledge. RESULTS: Although the prevalence of malaria is high in the three districts where the study was conducted, there are significant gaps in human resources, diagnosis and treatment, and the provision of indoor residual spraying and long-lasting insecticide treated nets. More importantly, the authors' experience suggests that it may be possible to capitalize on local expertise in order to identify gaps in malaria elimination at a sub-national level by building in a capacity-building exercise within a study. CONCLUSIONS: Locals in three malaria-endemic districts of Nepal perceive that there are significant gaps in human resources, diagnosis and treatment, the provision of insecticide treated nets, and indoor residual spraying.

Background: Access to medicine for the poor is recognized to be difficult task and one of the major challenges in achieving universal health coverage, particularly in low-and- middle income countries. In order to ensure the availability of essential medicines free of cost in public health facilities, Nepal has also commenced Free Health Care Services (FHCS). So, this study aims to evaluate availability, expiry, and stock-out duration of essential medicines at front line service providers in Nepal.Methods: Cross-sectional survey was conducted 28 public health facilities, 7 district warehouses, and 14 private pharmacies in 7 districts of Nepal. The survey was conducted during the March and April 2014. Survey tools recommended by the WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations was used with slight modification as per Nepal's situation.Results: The availability of medicine was found to be 92.44% in this study. The percentage of expired medicines in district warehouse was found to be 8.40. The average stock-out duration in district warehouse was 0.324 days.Conclusions: Although the availability of essential medicines at peripheral health facilities was found to be satisfactory with lesser proportion of expired medicines, a strong monitoring and evaluation of expired and stock medicines are desirable to maintain and improve the access to essential medicines.

Context Human-induced changes in climate and land cover have altered the distribution of fauna around the globe. Some reptiles have been found to be vulnerable to these changes; therefore, studies to identify the impact of the changes on other groups of reptiles are necessary. Aims We aimed to study the impact of climate and land cover change on the yellow monitor (Varanus flavescens) in Nepal. We also aimed to identify the current distribution range and predict the potential distribution under multiple climate change, corresponding land cover change, and dispersion scenarios in the near- and mid-future. Methods We used available presence locations with a candidate set of the least-correlated environmental variables and an Ensemble of Small Models (ESM), a Species Distribution Model (SDM) approach suitable for species with small sample size. Additionally, dispersal scenarios of 1 km, 5 km, and 10 km were added to the model to determine the future distribution under the dispersal scenarios. Key results We found soil particle size, distance to forest, precipitation of wettest quarter, bulk density, and elevation were the five most important variables contributing to the distribution of the species. The Terai lowland and wide valleys in Outer Himalayas are currently suitable but are expected to experience a substantial decrease under most future climate projections and dispersal scenarios. Conclusions The distribution is mostly dependent on soil-related variables; however, climatic variables might have a greater impact on future suitability. Implications Limiting emissions contributing to climatic changes, conserving the soil outside the protected areas, and the potential areas where the species will not experience habitat loss might contribute to the conservation of the species.