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Table 3.5.2 Standard precautions for infection control Percentages of facilities with sterilization equipment somewhere in the facility and other items for standard precautions available in the general outpatient area of the facility on the day of the survey, by background characteristics, Nepal Health Facility Survey 2015 Managing authority Ecological region Earthquakeaffected Item Public Private Mountain Hill Terai districts (14) National average Any sterilization equipment 1 78.9 89.6 80.2 83.7 74.5 79.5 79.9 Safe final disposal of sharps waste 2 84.1 85.5 81.8 84.2 85.0 86.1 84.2 Safe final disposal of infectious waste 3 81.5 76.1 80.2 82.0 79.9 84.1 81.0 Appropriate storage of sharps waste 4 81.1 35.2 77.9 82.8 67.9 84.3 76.7 Appropriate storage of infectious waste 5 4.8 8.4 4.3 5.6 4.9 5.2 5.2 Disinfectant 6 62.4 64.2 63.3 67.8 55.1 76.8 62.6 Syringes and needles 7 84.2 63.8 80.7 83.7 80.6 85.2 82.2 Soap 55.8 74.3 52.3 60.2 55.5 63.1 57.5 Running water 8 46.3 75.6 44.2 54.9 42.7 54.5 49.2 Soap and running water 42.8 72.9 38.7 52.2 38.9 52.4 45.7 Alcohol-based hand disinfectant 25.6 48.0 22.7 30.4 25.7 34.0 27.7 Soap and running water or else alcohol-based hand disinfectant 52.5 84.6 50.8 60.6 50.0 63.2 55.5 Latex gloves 9 79.6 80.0 80.5 82.7 75.2 88.2 79.7 Medical masks 16.1 47.4 23.9 21.4 14.5 26.7 19.1 Gowns 6.8 30.9 4.5 11.0 8.0 7.4 9.1 Eye protection 1.7 4.0 1.3 2.0 2.1 0.5 2.0 Needle destroyer 2.4 27.5 5.6 4.6 4.9 4.9 4.8 Guidelines for standard precautions 10 3.3 7.9 4.5 4.8 2.0 6.3 3.7 All infection prevention items except eye protection 11 0.0 1.8 0.2 0.2 0.3 0.1 0.2 Number of facilities 871 92 118 492 353 200 963 1 Facility reports that some instruments are processed in the facility and the facility has a functioning electric dry heat sterilizer, a functioning electric autoclave, or a non-electric autoclave with a functioning heat source available somewhere in the facility, or an electric pot or other pot with heat source for high-level disinfection by boiling or high-level disinfection by steaming, or else facility had chlorine, formaldehyde, or glutaraldehyde for chemical high-level disinfection available somewhere in the facility on the day of the survey. 2 The process of sharps waste disposal is incineration, and the facility had a functioning incinerator with fuel on the day of survey, or else the facility disposes of sharps waste by means of open burning in a protected area, dumping without burning in a protected area, burning and then dumping, or removal offsite with storage in a protected area prior to removal offsite. 3 The process of infectious waste disposal is incineration, and the facility had a functioning incinerator with fuel on the day of survey, or else the facility disposes of infectious waste by means of open burning in a protected area, dumping without burning in a protected area, burning and then dumping, or removal offsite with storage in a protected area prior to removal offsite. 4 Sharps container observed in general outpatient service area, in area where HIV testing is done if facility does HIV testing, as well as in area where minor surgery is done if facility does minor surgery 5 Waste receptacles observed in general outpatient service area, in area where HIV testing is done if facility does HIV testing, as well as in area where minor surgery is done if facility does minor surgery 6 Chlorine-based or other country-specific disinfectants used for environmental disinfection available in the general outpatient area 7 Single-use standard disposable syringes with needles or else auto-disable syringes with needles available in the general outpatient area 8 Piped water, water in bucket with specially fitted tap, or water in pour pitcher available in the general outpatient area 9 Non-latex equivalent gloves are acceptable. 10 Any guideline for infection control in health facilities available in the general outpatient area 11 Facility meets all the following infection prevention criteria: sterilization equipment or equipment for high-level disinfection, safe final disposal of sharps waste, safe final disposal of infectious waste, appropriate storage of sharps waste, appropriate storage of infectious waste, disinfectant, syringes and needles, soap and running water or else alcohol-based hand disinfectant, latex gloves, medical masks, gowns, needle destroyer, and guidelines for standard precautions. Hand washing with soap and running water, or else disinfecting hands with alcohol-based hand disinfectant, is a critical infection control practice. At the time of the survey, around 6 in 10 health facilities had soap (58 percent) and nearly half had running water (49 percent). Forty-six percent of health facilities had both soap and running water. Alcohol-based hand disinfectant was available in just over one-fourth of facilities. Overall, soap and running water or else alcohol-based hand disinfectant were observed in 56 percent of the health facilities. These items were more likely to be available at zonal and above hospitals (93 percent), private hospitals (86 percent), and stand-alone HTCs (82 percent) than at district-level hospitals (70 percent), PHCCs (65 percent), UHCs (51 percent), and HPs (51 percent). With respect to other infection control items, gloves (80 percent) were widely available, but facilities were much less likely to have medical masks (19 percent) or gowns (9 percent). The least available items were needle destroyers (5 percent), guidelines for standard precautions (4 percent), and eye protection (2 percent). In general, infection control items were more likely to be available at zonal and above hospitals and stand-alone HTCs than at other types of health facilities. However, only 3 percent of these facilities and no 38 • Facility-Level Infrastructure, Resources, Management, and General Service Readiness
PHCCs, HPs, or UHCs had all of the basic infection prevention items (excluding eye protection) on the day of the survey. The availability of items for infection prevention also varied by managing authority. Items were more likely to be available at private health facilities than public health facilities except for syringes and needles and the equipment necessary for safe disposal of infectious waste and appropriate storage of sharp waste. 3.3.4 Waste Segregation Proper waste segregation is an important step in infection prevention and control. In the 2015 NHFS, 86 percent of health facilities were found to be segregating waste at the time of collection (Table 3.5.3). All zonal and above hospitals were segregating waste at the time of collection. By managing authority, public facilities were somewhat less likely to segregate waste at the time of collection than private facilities. There was almost no variation in waste segregation practices by ecological region. Table 3.5.3 Segregation of waste (NHSS RF: OP2.3.1) Among all facilities, percentages reporting that they segregate waste generated at the facility at the time of collection, by background characteristics, Nepal Health Facility Survey 2015 Background characteristic Percentage of facilities that segregate waste at time of collection Number of facilities Facility type Zonal and above hospitals 100.0 6 District-level hospitals 92.1 16 Private hospitals 97.4 70 PHCCs 85.8 42 HPs 84.5 775 UHCs 85.6 32 Stand-alone HTCs 88.1 23 Managing authority Public 84.9 871 Private 95.1 92 Ecological region Mountain 86.7 118 Hill 86.0 492 Terai 85.5 353 Earthquake-affected districts (14) 91.2 200 National average 85.9 963 3.3.5 Safe Disposal of Health Care Waste Table 3.5.4 presents information on safe disposal practices in Nepal health facilities. Around 8 in 10 facilities disposed of sharps (84 percent) and other medical waste (81 percent) safely. Overall, 77 percent of the facilities in Nepal safely dispose of both sharps and medical waste. Facility-Level Infrastructure, Resources, Management, and General Service Readiness • 39
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Nepal Health Facility Survey 2015 F
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This report presents findings of th
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3 FACILITY-LEVEL INFRASTRUCTURE, RE
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7 DELIVERY AND NEWBORN CARE .......
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TABLES AND FIGURES 1 OVERVIEW OF TH
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Figure 4.3 Trends in early childhoo
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Table 7.12 Postpartum exit delivery
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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
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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
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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
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Page 63 and 64: FACILITY-LEVEL INFRASTRUCTURE, RESO
Page 65 and 66: Table 3.1 Availability of specific
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Page 77 and 78: Table 3.7.2 Laboratory diagnostic c
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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
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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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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 7.2 Guidelines, trained staff
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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 9.1 Guidelines, trained staff
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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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