Nepal

11.3.1 Guidelines, Trained Staff, and Diagnostics
Guidelines and Training
Among facilities that offer malaria diagnosis and/or treatment services, only 20 percent had
guidelines in the facility (Table 11.1). Guidelines were found most often in health posts and PHCCs (23
percent each) and least often in private hospitals (less than 1 percent).
As for staff training, nearly one-fourth (23 percent) of facilities had at least one staff member who
received in-service training in malaria diagnosis in the 24 months before the survey, and 18 percent had staff
with recent training in malaria treatment. The availability of trained staff was quite limited in zonal and
above hospitals and private hospitals relative to other types of facilities.
Diagnostics
Overall, only 43 percent of facilities offering malaria services had the ability to diagnose malaria
on-site (Table 11.1). Four in 10 facilities had RDTs available, while 16 percent had equipment and reagents
for malaria microscopy. A large majority of hospitals (89-93 percent) and PHCCs (77 percent) had RDTs
and/or malaria microscopy, compared to smaller proportions of health posts (29 percent) and urban health
centers (UHCs) (14 percent). This is not surprising since health posts and UHCs are not expected to have
malaria microscopy while they might have RDTs.
11.3.2 Medicines and Commodities for Malaria Services
Given the occurrence of malaria in high- and moderate-risk areas, appropriate medicines need to be
available at facilities in those areas. The NHFS results showed that 60 percent of all facilities offering malaria
services had at least one first-line antimalarial medicine available on the day of the survey (Table 11.2). As
expected, facilities in the terai region (74 percent) were more likely to have first-line treatment available than
facilities in the hill (39 percent) or mountain (30 percent) regions.
With regard to the availability of specific antimalarial medicines, facilities offering malaria services
most often had chloroquine tablets (57 percent). Around one in three facilities had primaquine, and 8 percent
had quinine. Two percent or less of facilities had any other antimalarials, including ACT.
Most facilities offering malaria services were able to treat fever. Paracetamol, a common feverreducing
medicine, was available in tablet form in 96 percent of facilities. Eighty-five percent had
paracetamol syrup or dispersible pediatric-dose tablets.
Despite the policy of promoting free distribution of bed nets to antenatal care (ANC) clients, only
11 percent of health facilities that provide malaria services had long-lasting insecticide-treated mosquito nets
(LLINs) available for distribution to clients. PHCCs were best supplied with nets (18 percent). Only 16
percent of facilities in the terai region, where many areas are at high and moderate malaria risk, had LLINs
to distribute.
206 • Malaria