Nepal

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Five percent of all facilities offer HIV care and support services. Twelve percent of facilities offer antiretroviral therapy (ART) services. Among facilities offering these services, 80 percent had the first-line ART regimen available in the facility on the day of the assessment. Three out of every four facilities offer sexually transmitted infection (STI) services. However, less than 1 in 10 facilities have at least one provider with recent training on the diagnosis and treatment of STIs, and only 16 percent of facilities have the capacity to screen for syphilis infection. NON-COMMUNICABLE DISEASES A majority of health facilities in <strong>Nepal</strong> offer services for the diagnosis and/or management of chronic respiratory diseases, and 73 percent of facilities offer services for cardiovascular diseases. About one in five health facilities offer services for the diagnosis and/or management of diabetes. On average, no more than 5 percent of facilities offering services for diabetes, cardiovascular diseases, or chronic respiratory diseases have providers who received training in these services during the 24 months preceding the survey. The availability of guidelines for provision of non-communicable disease (NCD) services is consistently low. Equipment such as a blood pressure apparatus, weighing scale, and stethoscope is available in a majority of facilities that provide NCD services. Other equipment, such as height boards, peak flow meters, and spacer devices, is less available. The availability of essential medicines for these conditions is low in most facilities other than hospitals. TUBERCULOSIS TB diagnostic services were mostly concentrated at the primary health care center (PHCC) level and above. Nationally, TB treatment services were available in 86 percent of health facilities. TB diagnostic and treatment services together were available only in a third (30 percent) of facilities. Only one-third of facilities offering tuberculosis diagnosis and/or treatment services had diagnosis and treatment guidelines available. Facilities in the mountain region were least likely to have guidelines. Only 17 percent of facilities that offer tuberculosis diagnosis and/or treatment services had staff with any recent in-service training related to TB. Only 10 percent of facilities had the capacity to carry out TB smear microscopy or x-ray services for the diagnosis of TB. Less than 1 percent of facilities had the capacity to carry out culture and rapid diagnostic tests. Only 4 percent of facilities offering tuberculosis diagnosis and/or treatment services also had HIV diagnostic capacity. First-line anti-TB drugs were available in the majority (77 percent) of facilities. xxx • Key Findings
MALARIA Half of <strong>Nepal</strong>’s health facilities offer diagnosis and treatment for malaria. About one-fifth of health facilities have at least one staff member recently trained in malaria diagnosis and/or treatment. Sixty percent of facilities that offer malaria diagnosis and/or treatment services had first-line medicines (mainly chloroquine and primaquine) for the treatment of malaria available on the day of the assessment visit. Despite the policy of promoting free distribution of bed nets to antenatal care clients, only 11 percent of health facilities that provide malaria services had long-lasting insecticide-treated mosquito nets (LLINs) in stock for distribution. Key Findings • xxxi
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 21 and 22: ACKNOWLEDGMENTS T he 2015 Nepal Hea
Page 23: LIST OF CONTRIBUTORS Chapter 1 Ram
Page 26 and 27: GDP HA HDC HFOMC HIV HLD HMIS HP HT
Page 28 and 29: VDC VDRL WHO village development co
Page 30 and 31: Eighty-five percent of facilities o
Page 34 and 35: xxxii • Map of Nepal
Page 36 and 37: According to the 2013 Global Burden
Page 38 and 39: 1.2.3 Nepal Health Sector Program T
Page 40 and 41: 1.3 THE HEALTH CARE SYSTEM 1.3.1 Ov
Page 42 and 43: Figure 1.2 Health service delivery
Page 44 and 45: prepared on an incremental basis ac
Page 47 and 48: METHODOLOGY 2 2.1 OVERVIEW T he 201
Page 49 and 50: Health Facility Operation and Manag
Page 51 and 52: Assess the computer programs (CAPI
Page 53 and 54: Data Sorting, Editing, and Entry at
Page 55 and 56: Table 2.2 Results of facility conta
Page 57 and 58: Table 2.4 Distribution of providers
Page 59 and 60: 2.5.3 Sample for Observations and E
Page 61 and 62: Table 2.8 Distribution of observed
Page 63 and 64: FACILITY-LEVEL INFRASTRUCTURE, RESO
Page 65 and 66: Table 3.1 Availability of specific
Page 67 and 68: Figure 3.1 Availability of basic cl
Page 69 and 70: Overall, around three fourths of pr
Page 71 and 72: 3.3.3 Standard Precautions for Infe
Page 73 and 74: PHCCs, HPs, or UHCs had all of the
Page 75 and 76: Table 3.6 Capacity for processing e
Page 77 and 78: Table 3.7.2 Laboratory diagnostic c
Page 79 and 80: normal delivery services are consid
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3.4.2 Supportive Management for Pro
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Supportive Management Practices A f
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Table 3.13 HMIS status: HMIS report
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Table 3.15 Storage practice for med
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types, PHCCs (78 percent) were leas
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Table 3.19 Average number of client
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and counseling of clients on at lea
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Table 3.20c Compliance with service
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Table 3.21b Provision of quality fa
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Table 3.22 Financial audit, disaste
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CHILD HEALTH SERVICES 4 Key Finding
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According to the 2011 Nepal Demogra
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Figure 4.3 Trends in early childhoo
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4.2.2 Vitamin A Supplementation The
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Table 4.4 Guidelines, trained staff
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Figure 4.6 Items for infection cont
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Figure 4.7 Availability of essentia
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Figure 4.8 Vaccine storage (N=816)
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Table 4.11.1 Assessments and examin
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4.4.1 Full Assessment IMCI/IMNCI Ge
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4.5 CLIENT OPINIONS Before leaving
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With regard to the topics of in-ser
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Service readiness. Section 5.3, inc
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Table 5.1 Availability of family pl
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Table 5.3.1 Family planning service
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Table 5.4.1 Methods of family plann
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5.3 SERVICE READINESS 5.3.1 Service
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Table 5.7 Items for infection contr
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Table 5.8.1 Client history and phys
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Privacy during a family planning co
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Table 5.10.1 Components of counseli
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Table 5.11.1 Feedback from family p
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5.6.2 Training Continual training f
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ANTENATAL CARE 6 Key Findings Abou
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Facilities providing ANC services i
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6.2). Fifty-three percent of the fa
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6.3.4 Medicines The national antena
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who are anemic. Only around 4 in 10
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Physical Examinations and Preventiv
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Table 6.8.2 Basic physical examinat
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Table 6.9.1 Content of antenatal ca
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Table 6.9a.1 Content of antenatal c
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Table 6.10.1 Content of antenatal c
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6.5.1 Client Knowledge Tables 6.11.
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Table 6.12.2 Feedback from antenata
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With regard to supervision of ANC p
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Table 6.16 Guidelines, trained staf
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DELIVERY AND NEWBORN CARE 7 Key Fin
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A quarter of facilities that offer
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Table 7.3.2 Medicines and commoditi
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than facilities in the hill (75 per
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Considering the signal functions se
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Table 7.6 presents the proportion o
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7.6 BASIC MANAGEMENT AND ADMINISTRA
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Table 7.10 Training for providers o
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Table 7.12 Postpartum exit delivery
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Table 7.13.2 Postpartum check/advic
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new infections have dropped to belo
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Table 8.1 Availability of HIV testi
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had waste receptacles. Half of the
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176 • HIV/AIDS and Sexually Trans
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Good record-keeping systems to trac
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premature babies, and stillborn bir
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To be considered ready to provide S
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Chronic respiratory diseases. Secti
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Table 9.2 Diagnostic capacity and e
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Figure 9.3 Items to support quality
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have spacers for inhalers. The latt
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Figure 9.6 Medicines and commoditie
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Although the number of TB cases and
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Only one-third of facilities in Nep
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terai (13 percent) regions. Similar
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MALARIA 11 Key Findings Half of Ne
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years, ACT stocks at health facilit
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Table 11.2 Availability of malaria
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11.4.2 Treatment Readiness to Treat
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REFERENCES Bhandari, G. P., M. R. A
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National Centre for AIDS and STD Co
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2016 - 2021 NHSS RF INDICATORS MATR
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7 8 Radhika Bogati Nisha Khadka Sad
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QUESTIONNAIRES Appendix C Appendix
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NEPAL HEALTH FACILITY SURVEY - 2015
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FACILITY IDENTIFICATION 001 NAME OF
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FIND THE MANAGER, THE PERSON IN-CHA
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SECTION 2: GENERAL FILTER QUESTIONS
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SOURCE OF WATER 330 What is the mos
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360* Does this facility have any ro
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SECTION 4: STAFFING - MANAGEMENT -
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420X CHECK Q006 FACILITY TYPE IS FA
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HMIS FIND THE PERSON RESPONSIBLE FO
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SECTION 5: PROCESSING OF INSTRUMENT
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602 CHECK Q600 FACILITY-BASED WASTE
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SECTION 7: BASIC SUPPLIES - CLIENT
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SECTION 8: DIAGNOSTICS 800 CHECK Q1
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811* Please tell me if: (a) (b) (c
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830 Does this facility do any blood
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847C* Does this facility do any tes
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861 Does this facility do any TB te
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SECTION 9: MEDICINES AND COMMODITIE
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MEDICINES FOR NON-COMMUNICABLE DISE
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MATERNAL AND CHILD HEALTH 906* Are
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SECTION 9.2: CONTRACEPTIVE COMMODIT
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SECTION 9.3: ANTI-TB DRUGS 930 CHEC
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944* Are any of the following Fusio
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1006* ASK YOUR RESPONDENT TO SHOW Y
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SECTION 11: CHILD GROWTH MONITORING
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1210 I would like to know if the fo
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SECTION 13: FAMILY PLANNING 1300 CH
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EQUIPMENT AND SUPPLIES 1314* I woul
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INFECTION CONTROL 1350 ASSESS THE R
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1407* As part of ANC services, plea
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INFECTION CONTROL 1450 ASSESS THE R
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1509* Do you have the national guid
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SECTION 16: DELIVERY AND NEWBORN CA
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EQUIPMENT AND SUPPLIES FOR ROUTINE
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PMTCT DURING LABOR AND DELIVERY 162
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SECTION 17: MALARIA 1700 CHECK Q102
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SECTION 18: SEXUALLY TRANSMITTED IN
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1851 INFECTION CONTROL AND CONDITIO
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1910 CHECK Q1902 AND Q1908 NO TB DI
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SECTION 20: HIV TESTING AND COUNSEL
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SECTION 21: HIV TREATMENT 2100 CHEC
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SECTION 22: HIV CARE AND SUPPORT 22
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BASIC SUPPLIES AND EQUIPMENT 2330 A
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SECTION 24: MINOR SURGICAL SERVICES
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SECTION 25: CESAREAN DELIVERY 2500
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SECTION 27: BLOOD TRANSFUSION SERVI
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SECTION 30: GENERAL FACILITY LEVEL
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201* CHECK [Q103] FOR PROVIDER OCCU
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4. FAMILY PLANNING SERVICES 400 In
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DELIVERY SERVICES 506 In your curre
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7. DIAGNOSTIC SERVICES 700 In your
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808 Among the various things relate
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Sample List for ANTENATAL CARE Obse
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Sample List for ANTENATAL CARE Obse
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NO. QUESTION / OBSERVATIONS CODES F
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NO. QUESTION / OBSERVATIONS ROUTINE
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NO. QUESTION / OBSERVATIONS DANGER
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NO. QUESTIONS CODING CLASSIFICATION
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205 What is the total amount you pa
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Sample List for FAMILY PLANNING Obs
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Sample List for FAMILY PLANNING Obs
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Nepal Health Facility Survey 2015 O
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NO. QUESTIONS / OBSERVATIONS CLIENT
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NO. QUESTIONS / OBSERVATIONS FOR Q1
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NO. QUESTIONS / OBSERVATIONS CODES
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NO. QUESTIONS / OBSERVATIONS 9. IMP
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Nepal Health Facility Survey 2015 F
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Sample List for SICK CHILD Observat
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Sample List for SICK CHILD Observat
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Nepal Health Facility Survey-2015 O
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NO. 5. PROVIDER INTERACTION WITH CA
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Nepal Health Facility Survey-2015 S
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110 Has [HE/SHE] had watery and fre
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TREATMENT AND CARETAKER COMFORT LEV
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UNDERWEIGHT 136A Did the provider t
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Sample List for POST PARTUM WOMEN D
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Nepal Health Facility Survey - 2015
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200. ACCESSING CARE AND DECISION MA
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S.N. Question/Information Coding Ca
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Nepal Health Facility Survey 2015 H
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2.0 Composition, Training and Knowl
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3.0 Participation Q.N. Questions Co
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Facility No.:____________________ T
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STAFF LISTING FORM: HEALTH WORKERS
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