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ACKNOWLEDGMENTS T he 2015 <strong>Nepal</strong> Health Facility Survey (NHFS) was conducted under the aegis of the Public Health Administration Monitoring and Evaluation Division (PHAMED) of the Ministry of Health. The survey is a joint result of an excellent collaboration between the Ministry of Health and health development partners. The NHFS provides rich information on the supply side of the health system that will complement findings from population surveys to explain health outcomes and service utilization. I would like to express my deep sense of appreciation for the contributions of a number of different stakeholders in designing and implementing this survey and producing a very informative report. My sincere gratitude goes to all of the members of the Technical Advisory Committee and the Technical Working Group for their time, support, and valuable input. I appreciate the leadership of Dr. G.D. Thakur, then chief of PHAMED. Also, sincere thanks go to Ram Chandra Khanal, Giri Raj Subedi, Satya Acharya, Jhabindra Pandey, and Shivlal Sharma of PHAMED for their support during the different phases of the survey. In addition, special gratitude goes to the United States Agency for International Development (USAID), the UK Department for International Development (DFID), and the World Health Organization (WHO) for funding this survey. I would particularly like to thank Shanda Steimer, Daniel Sinclair, Daniel VerSchneider, and Sabita Tuladhar from USAID; Natasa Mesko, Dr. Deepak Paudel, and Deepak Karki from DFID; Pradeep Poudel and Dr. Suresh Mehta from the <strong>Nepal</strong> Health Sector Support Program (NHSSP); Susheel Chandra Lekhak from WHO; and Dr. Shilu Adhikari and Chandra Mani Dhungana from the United Nations Population Fund (UNFPA). Similarly, I appreciate the substantial technical assistance of the ICF team throughout the survey. I am also very thankful to the hard-working and committed survey team from New ERA for successfully implementing the survey. Special thanks go to the quality assurance officers, field supervisors, and enumerators for their tireless efforts in making the fieldwork successful. I am also grateful to all of the staff of the health facilities that willingly cooperated with the survey teams and provided the information that we have analyzed in this report. Finally, I appreciate the contributions of the respondents—providers, clients, and management committee members—who answered the enumerators’ questions and allowed them to make observations. Dr. Dipendra Raman Singh Chief Hospital Administrator Public Health Administration Monitoring and Evaluation Division (PHAMED) Ministry of Health Acknowledgments • xix
Page 1: Nepal Health Facility Survey 2015 F
Page 4 and 5: This report presents findings of th
Page 6 and 7: 3 FACILITY-LEVEL INFRASTRUCTURE, RE
Page 8 and 9: 7 DELIVERY AND NEWBORN CARE .......
Page 11 and 12: TABLES AND FIGURES 1 OVERVIEW OF TH
Page 13 and 14: Figure 4.3 Trends in early childhoo
Page 15 and 16: Table 7.12 Postpartum exit delivery
Page 17: PREFACE T his is the first comprehe
Page 22 and 23: 2015 NHFS TECHNICAL ADVISORY COMMIT
Page 25 and 26: ACRONYMS AND ABBREVIATIONS ACT AHW
Page 27 and 28: NIP NMS NMSP NSV NTC NTP NVP OPD OP
Page 29 and 30: KEY FINDINGS T he 2015 Nepal Health
Page 31 and 32: ANTENATAL CARE SERVICES Ab
Page 33 and 34: MALARIA Half of Nepal’s health
Page 35 and 36: OVERVIEW OF THE HEALTH SYSTEM IN NE
Page 37 and 38: Objectives Policies 1. Provide free
Page 39 and 40: 6. Improved sustainability of healt
Page 41 and 42: Figure 1.1 Ministry of Health divis
Page 43 and 44: 1.3.3 Decentralized Governance Stru
Page 45: health financing in 2009/10 but dro
Page 48 and 49: Program, WHO’s Service Availabili
Page 50 and 51: 3. What issues affect clients’ an
Page 52 and 53: and Morang districts. Following the
Page 54 and 55: assumed to have received these meas
Page 56 and 57: Table 2.3.2 Distribution of surveye
Page 58 and 59: Table 2.5 Distribution of interview
Page 60 and 61: Table 2.7—Continued Background ch
Page 62 and 63: Table 2.8—Continued Background ch
Page 64 and 65: Basic management and support. Secti
Page 66 and 67: 3.2.2 Availability of Basic Client
Page 68 and 69: 3.3 SERVICE READINESS: BASIC FACILI
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With the exception of an adult weig
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Table 3.5.2 Standard precautions fo
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Table 3.5.4 Safe disposal of health
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conditions as malaria and TB depend
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Table 3.7.3 Laboratory diagnostic c
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Table 3.8.2 Availability of tracer
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Quality Assurance Quality assurance
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Table 3.10 Supportive management pr
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however, is the low proportions of
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3.7 LOGISTICS MANAGEMENT SYSTEM 3.7
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3.7.2 Logistics Management Informat
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Table 3.18 Activities of HFOMC and
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Table 3.20 Health facilities meetin
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Health facilities in the terai regi
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Table 3.21a Provision of quality AN
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Table 3.21c Provision of quality IM
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3.12 FREE HEALTH CARE Family planni
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package had just been finalized, wi
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Figure 4.2 Trends in nutritional st
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Table 4.1 Availability of child hea
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Table 4.3.2 Frequency of availabili
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two-thirds of facilities had an inf
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4.3.4 Medicines and Commodities for
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With regard to staff training, only
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Table 4.10 Infection control for va
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Table 4.11.2 Assessments and examin
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Almost 6 in 10 children received an
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4.6 BASIC MANAGEMENT AND ADMINISTRA
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FAMILY PLANNING SERVICES 5 Key Find
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Figure 5.1 Trends in use of modern
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Table 5.2 Frequency of availability
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Tables 5.4.1 and 5.4.2 present info
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However, 10 percent of facilities p
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Figure 5.3 Items to support quality
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5.4 ADHERENCE TO STANDARDS FOR QUAL
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Table 5.8.2 Client history and phys
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Table 5.9.2 Components of counselin
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Table 5.10.2 Components of counseli
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Table 5.12 Client knowledge about c
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Table 5.14 Training for family plan
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Provider training and supervision.
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Table 6.2 Guidelines, trained staff
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6.3.3 Laboratory Tests Having the c
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Table 6.6 Characteristics of observ
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Table 6.7.2 General assessment and
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Table 6.8.1—Continued Components
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Table 6.8.2—Continued Managing au
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Table 6.9.2 Content of antenatal ca
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Table 6.9a.2 Content of antenatal c
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Table 6.10.2 Content of antenatal c
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Table 6.11.2 Antenatal care clients
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Table 6.13 Supportive management fo
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Table 6.15 Availability of services
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The first line of defense against m
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Emergency obstetric and newborn car
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Figure 7.1 Availability of maternal
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7.3.2 Medicines and Commodities for
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Figure 7.3 Essential medicines and
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Figure 7.4 Items for infection cont
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Table 7.5 Signal Functions for emer
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eported that it is routine practice
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Table 7.9 provides information on t
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Table 7.11 Mode of delivery Among i
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Table 7.13.1 Postpartum checks/advi
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HIV/AIDS AND SEXUALLY TRANSMITTED 8
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8.2 HIV TESTING AND COUNSELING HIV
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8.2.2 Service Readiness Table 8.1 p
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Overall, 11 percent of HIV testing
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Figure 8.2 Availability of HIV/AIDS
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Table 8.6a Availability of antiretr
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Table 8.7 Guidelines, trained staff
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NON-COMMUNICABLE DISEASES 9 Key Fin
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institutions reported a higher prev
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Tables 9.1 and 9.2 and Figures 9.1
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9.3.2 Service Readiness for Cardiov
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Figure 9.4 Medicines and commoditie
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Figure 9.5 Items to support quality
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TUBERCULOSIS 10 Key Findings TB di
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Facilitating and promoting research
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Table 10.1 Availability of tubercul
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and isoniazid) (Table 10.2). Around
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Vision: A malaria-free Nepal by 202
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11.3.1 Guidelines, Trained Staff, a
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11.4 MALARIA SERVICES IN FACILITIES
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Table 11.5 Treatment of malaria in
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Ministry of Health and Population (
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World Health Organization (WHO). 20
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PERSONS INVOLVED IN THE 2015 NHFS A
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NHSSP Mr. Pradeep Poudel Dr. Suresh
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222 • Appendix C
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224 • Appendix C
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TOTAL NUMBER OF PROVIDER INTERVIEWS
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MODULE 1: GENERAL INFORMATION AND S
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MODULE 2: GENERAL SERVICE READINESS
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EXTERNAL SUPERVISION 350 Does this
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370C CHECK Q006 FACILITY IS NOT A P
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SECTION 4: STAFFING - MANAGEMENT -
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QUALITY ASSURANCE NOTIFY THE RESPON
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470 CHECK Q110 INPATIENT CARE NO IN
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SECTION 6: HEALTH CARE WASTE MANAGE
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CLIENT LATRINE 620 Is there a toile
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CLIENT EXAMINATION ROOM AT THIS POI
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804* Please tell me if (Static serv
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818 Is there an established system
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PARASITOLOGY/BACTERIOLOGY 840X Does
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SYPHILIS 854 Does this facility do
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873 Are records maintained for the
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MEDICINES FOR WORM INFESTATION 902
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ANTI-FUNGAL MEDICINES 904* Are any
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908A Are any of the following OTHER
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924C Routinely, when you order cont
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SECTION 9.4: ANTIRETROVIRAL MEDICIN
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MODULE 3: SERVICE-SPECIFIC READINES
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1015A OBSERVE ICEPACKS CONDITIONING
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SECTION 12: CHILD CURATIVE CARE SER
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INFECTION CONTROL 1250 ASSESS THE R
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1306* May I see the other job aids
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1315 CHECK Q1302.07 & Q1302.08. IUC
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SECTION 14: ANTENATAL CARE 1400 CHE
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1420 OBSERVE IF THE BELOW ACTIVITIE
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SECTION 15: PMTCT OF HIV INFECTION
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1613 Do providers of delivery servi
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1624* Does this facility routinely
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SECTION 17A: KALAAZAR / LEISHMANIAS
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1818* ASK TO SEE EACH OF THE FOLLOW
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SECTION 19: TUBERCULOSIS 1900 CHECK
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INFECTION CONTROL 1950 ASSESS THE T
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INFECTION CONTROL 2050 ASSESS THE H
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TESTS TO MONITOR CLIENTS ON ART 210
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SECTION 23: NON-COMMUNICABLE DISEAS
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CLIENT EXAMINATION ROOM 2350 ASSESS
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SECTION 26: BLOOD TYPING AND COMPAT
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BLOOD STORAGE 2720 Has the facility
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COMMENTS ABOUT RESPONDENT: INTERVIE
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1. EDUCATION AND EXPERIENCE 102 I w
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CARDIO-VASCULAR DISEASES 209 In you
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5. MATERNAL HEALTH SERVICES ANC - P
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6. SEXUALLY TRANSMITTED INFECTIONS
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8. WORKING CONDITIONS IN FACILITY 8
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328 • Appendix C
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Sample List for ANTENATAL CARE Obse
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332 • Appendix C
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4. Observation of Antenatal-Care Co
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NO. QUESTION / OBSERVATIONS CLINICA
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NO. QUESTION / OBSERVATIONS DEWORMI
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NO. QUESTION / OBSERVATIONS OVERALL
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1. Information About Visit - ANTENA
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NO. QUESTIONS CODING CLASSIFICATION
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2. Client Satisfaction NO. QUESTION
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3. Client Personal Characteristics
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Sample List for FAMILY PLANNING Obs
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352 • Appendix C
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4. Observation of Family Planning C
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NO. QUESTIONS / OBSERVATIONS QUESTI
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NO. QUESTIONS / OBSERVATIONS CODES
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NO. QUESTIONS / OBSERVATIONS 5. CLI
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NO. QUESTIONS / OBSERVATIONS POST P
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368 • Appendix C
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1. Information About Visit - FAMILY
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NO. QUESTIONS CODING CLASSIFICATION
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Sample List for SICK CHILD Observat
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380 • Appendix C
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4. OBSERVATION OF SICK CHILD CONSUL
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390 • Appendix C
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1. Information About Visit - CARETA
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118 Did the provider tell you anyth
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128 What did the provider tell you
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402 • Appendix C
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100. BACKGROUND S.N. Question/Infor
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S.N. Question/Information Coding Ca
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416 • Appendix C
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1.0 BACKGROUND S.N. Question/Inform
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Q.N. Questions Coding Categories Sk
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422 • Appendix C
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424 • Appendix C
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PROVIDER QUALIFICATION CATEGORY: GE
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