Nepal

Table 3.19 Average number of clients served during fiscal year 2013/14
Average number of inpatient admissions and outpatient client visits during fiscal year 2013/14, by facility type, Nepal
Health Facility Survey 2015
Facility type
Outpatient client
visits No. of facilities Inpatient admissions No. of hospitals
Zonal and above hospitals 96,534 6 23,755 4
District-level hospitals 18,933 12 1,248 9
Private hospitals 28,341 46 935 55
PHCCs 11,026 35 na na
HPs 4,973 642 na na
UHCs 4,097 27 na na
Stand-alone HTCs 25,325 18 na na
3.10 QUALITY OF CARE
Quality of care is a central focus of the Nepal Health Sector Strategy (NHSS) 2016-2021 with
respect to achieving better health outcomes. The NHFS gathered information on a large number of quality
aspects in line with “Swasthye sewako gunasthar sudhar padhatee,” a minimum standard of quality of care
developed by the Ministry of Health
This section deals with three indicators of health facility quality of care in the NHSS results
framework: meeting minimum standards of quality of care; complying with service delivery standards,
protocols, and guidelines; and providing quality services. The NHFS collected information on these three
indicators from the facility inventory, health provider interviews, observation protocols, and client exit
interviews
3.10.1 Minimum quality of care standards
The 2015 NHFS assessed a number of service delivery aspects to examine minimum standards of
quality of care at the point of delivery. This section explores nine tracer items designed to assess minimum
quality of care standards. Table 3.20 presents data on the status of these tracer items
The proportion of health facilities meeting the minimum standard of quality of care at the point of
delivery ranges from 0 percent availability of (Swasthye sewako gunasthar sudhar padhatee guideline) at
UHCs to 100 percent availability of (trained staff) at zonal and above hospitals, district-level hospitals, and
PHCCs. It is common for health facilities to have trained staff (92 percent), procedures for safe final disposal
of infectious waste (81 percent), waiting rooms (79 percent), soap and running water or alcohol-based hand
disinfectant (55 percent), and equipment and knowledge of processing time (64 percent). Overall, however,
it is uncommon for health facilities to meet the Swasthye sewako gunasthar sudhar padhatee guideline (6
percent), to have a clinical protocol (28 percent), or to have tracer medicines (30 percent).
Less than 1 percent of the facilities surveyed had all nine tracer items. Whereas 4 percent of districtlevel
hospitals had all nine tracer items, 1 percent or less of other types of facilities had all of the items
Availability of soap and running water or alcohol-based hand disinfectant in health facilities ranges
from 51 percent in UHCs to 93 percent in zonal and above hospitals; the national average is 55 percent.
These items are more commonly available in private facilities (86 percent) than in public facilities (53
percent). A larger proportion of health facilities in the hill region than in the terai and mountain regions have
soap and running water or alcohol-based hand disinfectant
Facility-Level Infrastructure, Resources, Management, and General Service Readiness • 59