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Table 2.3.2 Distribution of surveyed facilities, by managing authority (weighted) Number of surveyed facilities of each type, by managing authority, Nepal Health Facility Survey 2015 Managing authority Facility type Government/p ublic NGO/private not for profit Private for profit Mission/faithbased National average Zonal and above hospitals 6 0 0 0 6 District-level hospitals 16 0 0 0 16 Private hospitals 0 8 61 1 70 PHCCs 42 0 0 0 42 HPs 775 0 0 0 775 UHCs 32 0 0 0 32 Stand-alone HTCs 0 23 0 0 23 National average 871 31 61 1 963 2.5.2 Sample of Health Service Providers For the purposes of the NHFS, a health service provider was defined as someone who provided consultation services, counseling, health education, or laboratory services to clients. Thus, health workers were not eligible for observations or interviews if they took measurements or completed registers only and never provided professional client services. The sample of health service providers was selected from providers who were present in the facility on the day of the assessment and who provided services assessed in the 2015 NHFS. The aim was to interview an average of eight providers in each facility in order to include providers of the range of services being assessed. In facilities with fewer than eight health care providers, all of the providers present on the day of the visit were interviewed. In facilities with more than eight providers, efforts were made to interview eight providers, including all providers whose consultations were observed and who responded to any section of the facility inventory questionnaire. If interviewers observed fewer than eight providers, then they also interviewed a random selection of the remaining providers to obtain a total of eight provider interviews. Data were weighted during the analysis to account for the differentials caused by oversampling or undersampling of providers with a particular qualification in a facility type or province. In a few cases, the staff members present on the day of the assessment may not have been representative of the staff usually providing the services being assessed. 4 Table 2.4 provides information on the total number of health providers present in sampled facilities on the day of the survey and the number selected for interviews, by type of facility and provider. The table also shows the proportion of providers present at the time of the assessment who were interviewed according to provider type. Table 2.5 presents the weighted percent distribution and the weighted and unweighted numbers of interviewed providers, by background characteristics. 4 For example, the assessment may have taken place at the same time as an offsite training event for a group of specialists or on a day when evaluations took a certain type of provider away from service provision. 22 • Methodology
Table 2.4 Distribution of providers in facility provider sample frame and final provider sample selection (unweighted) Number of providers of each type who were present on the day of the survey (provider sample frame), number of each type selected for the health worker interview (SPA sample), and percentage of eligible providers of each type who were selected for the health worker interview, by type of facility and provider qualification, Nepal Health Facility Survey 2015 Qualifications of providers Facility type Zonal and above hospitals District-level hospitals Private hospitals PHCCs HPs UHCs Stand-alone HTCs Sample frame Number selected Sample frame Number selected Sample frame Number selected Sample frame Number selected Provider type Doctor 174 101 180 149 449 327 116 109 2 2 0 0 5 5 926 693 74.8 Nurse 203 107 304 246 467 286 453 411 464 456 33 33 37 36 1,961 1,575 80.3 Paramedic 62 35 174 113 228 169 432 389 601 585 40 40 36 30 1,573 1,361 86.5 Technician 113 43 148 101 249 178 154 140 25 23 0 0 90 81 779 566 72.7 Other clinical providers 27 1 29 8 78 4 2 2 6 4 1 1 3 1 146 21 14.4 National average 660 287 1,030 617 1,753 964 1,405 1,051 1,335 1,070 95 74 284 153 6,562 4,216 64.2 Sample frame Number selected Sample frame Number selected Sample frame Number selected Sample frame Total Number selected Percentage of total for provider type included in Nepal SPA sample Methodology • 23
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Nepal Health Facility Survey 2015 F
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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 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: Table 2.2 Results of facility conta
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
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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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