Nepal

More documents

Recommendations

Info

This report presents findings of the 2015 Nepal Health Facility Survey (2015 NHFS). The survey received funding from the United States Agency for International Development (USAID), the UK Department for International Development (DFID) and The World Health Organization (WHO). ICF provided technical assistance through the worldwide DHS Program, which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs. The Nepal Health Sector Support Program (NHSSP) - a DFID-funded technical assistance program supporting MoH to implement the second Nepal Health Sector Program (NHSP-2), also provided technical assistance to the survey. New ERA, a private research firm, implemented the survey. Additional information about the 2015 NHFS may be obtained from Ministry of Health, Ramshah Path, Kathmandu; Telephone: +977-1-4262543/4262802; Internet: http://www.mohp.gov.np; and New ERA, Rudramati Marg, Kalopul, P.O. Box 722, Kathmandu 44600, Nepal; Telephone: +977-1-4413603; E-mail: info@newera.com.np; Internet: http://www.newera.com.np/. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850 USA. Telephone: 301-407-6500; Fax: 301-407-6501; E-mail: info@DHSprogram.com; Internet: http://www.DHSprogram.com. Cover photos courtesy of Nepal Health Sector Support Program © 2016 Suggested citation: Ministry of Health, Nepal; New ERA, Nepal; Nepal Health Sector Support Program (NHSSP); and ICF. 2017. Nepal Health Facility Survey 2015. Kathmandu, Nepal: Ministry of Health, Nepal.
CONTENTS TABLES AND FIGURES ........................................................................................................................... ix PREFACE ................................................................................................................................................... xv FOREWORD ............................................................................................................................................ xvii ACKNOWLEDGMENTS ......................................................................................................................... xix ACRONYMS AND ABBREVIATIONS ............................................................................................... xxiii KEY FINDINGS ..................................................................................................................................... xxvii MAP OF NEPAL .................................................................................................................................... xxxii 1 OVERVIEW OF THE HEALTH SYSTEM IN NEPAL ............................................................. 1 1.1 Health Status in Nepal ......................................................................................................... 1 1.2 Enabling Policies and Strategies to Improve Health Status ................................................. 2 1.2.1 Constitution of Nepal ............................................................................................. 2 1.2.2 National Health Policy 2014 .................................................................................. 2 1.2.3 Nepal Health Sector Program ................................................................................ 4 1.2.4 MDGs and Sustainable Development Goals .......................................................... 5 1.3 The Health Care System ...................................................................................................... 6 1.3.1 Overview ................................................................................................................ 6 1.3.2 Governance Structure at the National Level .......................................................... 6 1.3.3 Decentralized Governance Structure at the District Level ..................................... 9 1.4 Health Financing ................................................................................................................. 9 1.4.1 Overview ................................................................................................................ 9 1.4.2 Goal ...................................................................................................................... 10 1.4.3 Donor Project Funding ......................................................................................... 10 2 METHODOLOGY ........................................................................................................................ 13 2.1 Overview ........................................................................................................................... 13 2.2 Institutional Framework and Objectives of the 2015 NHFS ............................................. 13 2.2.1 Institutional Framework ....................................................................................... 13 2.2.2 Objectives of the 2015 NHFS .............................................................................. 14 2.3 Data Collection Methods ................................................................................................... 14 2.4 Implementation .................................................................................................................. 16 2.4.1 Survey Oversight ................................................................................................. 16 2.4.2 Questionnaire Adaptation .................................................................................... 16 2.4.3 Pre-test ................................................................................................................. 16 2.4.4 Main Training ...................................................................................................... 17 2.4.5 Data Collection .................................................................................................... 17 2.4.6 Data Management and Report Writing ................................................................ 18 2.4.7 Special Conventions during Data Analysis .......................................................... 19 2.5 Sampling ............................................................................................................................ 20 2.5.1 Sample of Facilities.............................................................................................. 20 2.5.2 Sample of Health Service Providers .................................................................... 22 2.5.3 Sample for Observations and Exit Interviews ...................................................... 25 Contents • iii
Page 1: Nepal Health Facility Survey 2015 F
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 32 and 33: Five percent of all facilities offe
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
Page 81 and 82:
Overall, 37 percent of health facil
Page 83 and 84:
3.4.2 Supportive Management for Pro
Page 85 and 86:
Supportive Management Practices A f
Page 87 and 88:
Table 3.13 HMIS status: HMIS report
Page 89 and 90:
Table 3.15 Storage practice for med
Page 91 and 92:
types, PHCCs (78 percent) were leas
Page 93 and 94:
Table 3.19 Average number of client
Page 95 and 96:
and counseling of clients on at lea
Page 97 and 98:
Table 3.20c Compliance with service
Page 99 and 100:
Table 3.21b Provision of quality fa
Page 101 and 102:
Table 3.22 Financial audit, disaste
Page 103 and 104:
CHILD HEALTH SERVICES 4 Key Finding
Page 105 and 106:
According to the 2011 Nepal Demogra
Page 107 and 108:
Figure 4.3 Trends in early childhoo
Page 109:
4.2.2 Vitamin A Supplementation The
Page 112 and 113:
Table 4.4 Guidelines, trained staff
Page 114 and 115:
Figure 4.6 Items for infection cont
Page 116 and 117:
Figure 4.7 Availability of essentia
Page 118 and 119:
Figure 4.8 Vaccine storage (N=816)
Page 120 and 121:
Table 4.11.1 Assessments and examin
Page 122 and 123:
4.4.1 Full Assessment IMCI/IMNCI Ge
Page 124 and 125:
4.5 CLIENT OPINIONS Before leaving
Page 126 and 127:
With regard to the topics of in-ser
Page 128 and 129:
Service readiness. Section 5.3, inc
Page 130 and 131:
Table 5.1 Availability of family pl
Page 132 and 133:
Table 5.3.1 Family planning service
Page 134 and 135:
Table 5.4.1 Methods of family plann
Page 136 and 137:
5.3 SERVICE READINESS 5.3.1 Service
Page 138 and 139:
Table 5.7 Items for infection contr
Page 140 and 141:
Table 5.8.1 Client history and phys
Page 142 and 143:
Privacy during a family planning co
Page 144 and 145:
Table 5.10.1 Components of counseli
Page 146 and 147:
Table 5.11.1 Feedback from family p
Page 148 and 149:
5.6.2 Training Continual training f
Page 151 and 152:
ANTENATAL CARE 6 Key Findings Abou
Page 153 and 154:
Facilities providing ANC services i
Page 155 and 156:
6.2). Fifty-three percent of the fa
Page 157 and 158:
6.3.4 Medicines The national antena
Page 159 and 160:
who are anemic. Only around 4 in 10
Page 161 and 162:
Physical Examinations and Preventiv
Page 163 and 164:
Table 6.8.2 Basic physical examinat
Page 165 and 166:
Table 6.9.1 Content of antenatal ca
Page 167 and 168:
Table 6.9a.1 Content of antenatal c
Page 169 and 170:
Table 6.10.1 Content of antenatal c
Page 171 and 172:
6.5.1 Client Knowledge Tables 6.11.
Page 173 and 174:
Table 6.12.2 Feedback from antenata
Page 175 and 176:
With regard to supervision of ANC p
Page 177 and 178:
Table 6.16 Guidelines, trained staf
Page 179 and 180:
DELIVERY AND NEWBORN CARE 7 Key Fin
Page 181:
A quarter of facilities that offer
Page 184 and 185:
Page 186 and 187:
Table 7.3.2 Medicines and commoditi
Page 188 and 189:
than facilities in the hill (75 per
Page 190 and 191:
Considering the signal functions se
Page 193 and 194:
Table 7.6 presents the proportion o
Page 195 and 196:
7.6 BASIC MANAGEMENT AND ADMINISTRA
Page 197 and 198:
Table 7.10 Training for providers o
Page 199 and 200:
Table 7.12 Postpartum exit delivery
Page 201:
Table 7.13.2 Postpartum check/advic
Page 204 and 205:
new infections have dropped to belo
Page 206 and 207:
Table 8.1 Availability of HIV testi
Page 208 and 209:
had waste receptacles. Half of the
Page 210 and 211:
176 • HIV/AIDS and Sexually Trans
Page 212 and 213:
Good record-keeping systems to trac
Page 214 and 215:
premature babies, and stillborn bir
Page 216 and 217:
To be considered ready to provide S
Page 218 and 219:
Chronic respiratory diseases. Secti
Page 220 and 221:
Page 222 and 223:
Table 9.2 Diagnostic capacity and e
Page 224 and 225:
Figure 9.3 Items to support quality
Page 226 and 227:
have spacers for inhalers. The latt
Page 228 and 229:
Figure 9.6 Medicines and commoditie
Page 230 and 231:
Although the number of TB cases and
Page 232 and 233:
Only one-third of facilities in Nep
Page 234 and 235:
terai (13 percent) regions. Similar
Page 237 and 238:
MALARIA 11 Key Findings Half of Ne
Page 239 and 240:
years, ACT stocks at health facilit
Page 241 and 242:
Table 11.2 Availability of malaria
Page 243 and 244:
11.4.2 Treatment Readiness to Treat
Page 245 and 246:
REFERENCES Bhandari, G. P., M. R. A
Page 247 and 248:
National Centre for AIDS and STD Co
Page 249:
2016 - 2021 NHSS RF INDICATORS MATR
Page 252 and 253:
7 8 Radhika Bogati Nisha Khadka Sad
Page 255 and 256:
QUESTIONNAIRES Appendix C Appendix
Page 257 and 258:
NEPAL HEALTH FACILITY SURVEY - 2015
Page 259 and 260:
FACILITY IDENTIFICATION 001 NAME OF
Page 261 and 262:
FIND THE MANAGER, THE PERSON IN-CHA
Page 263 and 264:
SECTION 2: GENERAL FILTER QUESTIONS
Page 265 and 266:
SOURCE OF WATER 330 What is the mos
Page 267 and 268:
360* Does this facility have any ro
Page 269 and 270:
SECTION 4: STAFFING - MANAGEMENT -
Page 271 and 272:
420X CHECK Q006 FACILITY TYPE IS FA
Page 273 and 274:
HMIS FIND THE PERSON RESPONSIBLE FO
Page 275 and 276:
SECTION 5: PROCESSING OF INSTRUMENT
Page 277 and 278:
602 CHECK Q600 FACILITY-BASED WASTE
Page 279 and 280:
SECTION 7: BASIC SUPPLIES - CLIENT
Page 281 and 282:
SECTION 8: DIAGNOSTICS 800 CHECK Q1
Page 283 and 284:
811* Please tell me if: (a) (b) (c
Page 285 and 286:
830 Does this facility do any blood
Page 287 and 288:
847C* Does this facility do any tes
Page 289 and 290:
861 Does this facility do any TB te
Page 291 and 292:
SECTION 9: MEDICINES AND COMMODITIE
Page 293 and 294:
MEDICINES FOR NON-COMMUNICABLE DISE
Page 295 and 296:
MATERNAL AND CHILD HEALTH 906* Are
Page 297 and 298:
SECTION 9.2: CONTRACEPTIVE COMMODIT
Page 299 and 300:
SECTION 9.3: ANTI-TB DRUGS 930 CHEC
Page 301 and 302:
944* Are any of the following Fusio
Page 303 and 304:
1006* ASK YOUR RESPONDENT TO SHOW Y
Page 305 and 306:
SECTION 11: CHILD GROWTH MONITORING
Page 307 and 308:
1210 I would like to know if the fo
Page 309 and 310:
SECTION 13: FAMILY PLANNING 1300 CH
Page 311 and 312:
EQUIPMENT AND SUPPLIES 1314* I woul
Page 313 and 314:
INFECTION CONTROL 1350 ASSESS THE R
Page 315 and 316:
1407* As part of ANC services, plea
Page 317 and 318:
INFECTION CONTROL 1450 ASSESS THE R
Page 319 and 320:
1509* Do you have the national guid
Page 321 and 322:
SECTION 16: DELIVERY AND NEWBORN CA
Page 323 and 324:
EQUIPMENT AND SUPPLIES FOR ROUTINE
Page 325 and 326:
PMTCT DURING LABOR AND DELIVERY 162
Page 327 and 328:
SECTION 17: MALARIA 1700 CHECK Q102
Page 329 and 330:
SECTION 18: SEXUALLY TRANSMITTED IN
Page 331 and 332:
1851 INFECTION CONTROL AND CONDITIO
Page 333 and 334:
1910 CHECK Q1902 AND Q1908 NO TB DI
Page 335 and 336:
SECTION 20: HIV TESTING AND COUNSEL
Page 337 and 338:
SECTION 21: HIV TREATMENT 2100 CHEC
Page 339 and 340:
SECTION 22: HIV CARE AND SUPPORT 22
Page 341 and 342:
BASIC SUPPLIES AND EQUIPMENT 2330 A
Page 343 and 344:
SECTION 24: MINOR SURGICAL SERVICES
Page 345 and 346:
SECTION 25: CESAREAN DELIVERY 2500
Page 347 and 348:
SECTION 27: BLOOD TRANSFUSION SERVI
Page 349 and 350:
SECTION 30: GENERAL FACILITY LEVEL
Page 351 and 352:
Page 353 and 354:
201* CHECK [Q103] FOR PROVIDER OCCU
Page 355 and 356:
4. FAMILY PLANNING SERVICES 400 In
Page 357 and 358:
DELIVERY SERVICES 506 In your curre
Page 359 and 360:
7. DIAGNOSTIC SERVICES 700 In your
Page 361 and 362:
808 Among the various things relate
Page 363 and 364:
Sample List for ANTENATAL CARE Obse
Page 365 and 366:
Sample List for ANTENATAL CARE Obse
Page 367 and 368:
Page 369 and 370:
NO. QUESTION / OBSERVATIONS CODES F
Page 371 and 372:
NO. QUESTION / OBSERVATIONS ROUTINE
Page 373 and 374:
NO. QUESTION / OBSERVATIONS DANGER
Page 375 and 376:
Page 377 and 378:
NO. QUESTIONS CODING CLASSIFICATION
Page 379 and 380:
Page 381 and 382:
205 What is the total amount you pa
Page 383 and 384:
Sample List for FAMILY PLANNING Obs
Page 385 and 386:
Sample List for FAMILY PLANNING Obs
Page 387 and 388:
Nepal Health Facility Survey 2015 O
Page 389 and 390:
NO. QUESTIONS / OBSERVATIONS CLIENT
Page 391 and 392:
NO. QUESTIONS / OBSERVATIONS FOR Q1
Page 393 and 394:
NO. QUESTIONS / OBSERVATIONS CODES
Page 395 and 396:
Page 397 and 398:
Page 399 and 400:
NO. QUESTIONS / OBSERVATIONS 9. IMP
Page 401 and 402:
Page 403 and 404:
Nepal Health Facility Survey 2015 F
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Sample List for SICK CHILD Observat
Page 413 and 414:
Sample List for SICK CHILD Observat
Page 415 and 416:
Nepal Health Facility Survey-2015 O
Page 417 and 418:
NO. 5. PROVIDER INTERACTION WITH CA
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Nepal Health Facility Survey-2015 S
Page 427 and 428:
110 Has [HE/SHE] had watery and fre
Page 429 and 430:
TREATMENT AND CARETAKER COMFORT LEV
Page 431 and 432:
UNDERWEIGHT 136A Did the provider t
Page 433 and 434:
Page 435 and 436:
Sample List for POST PARTUM WOMEN D
Page 437 and 438:
Nepal Health Facility Survey - 2015
Page 439 and 440:
200. ACCESSING CARE AND DECISION MA
Page 441 and 442:
S.N. Question/Information Coding Ca
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Nepal Health Facility Survey 2015 H
Page 453 and 454:
2.0 Composition, Training and Knowl
Page 455 and 456:
3.0 Participation Q.N. Questions Co
Page 457 and 458:
Facility No.:____________________ T
Page 459 and 460:
STAFF LISTING FORM: HEALTH WORKERS
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
show all

Nepal

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?