Nepal

Table 3.20c Compliance with service delivery protocols/guidelines for IMNCI services (NHSS RF: OP2.1.1)
Among all facilities, the percentages complying with IMNCI service delivery protocols/guidelines, by background characteristics,
Nepal Health Facility Survey 2015
Background
characteristic
Provider
asked about
client's
complaints 1
Physical
examination 2
Provider
wrote on
client health
card
Advised on
continued
feeding
Advised on
signs and
symptoms to
immediately
bring the
child back to
the facility All five items
Number of
facilities
Facility type
Zonal and above hospitals 14.7 55.3 66.3 58.7 29.6 3.7 6
District-level hospitals 1.3 55.3 89.5 52.6 25.0 0.0 16
Private hospitals 1.2 28.3 30.0 25.8 13.9 0.9 70
PHCCs 4.4 46.5 72.2 41.2 19.4 1.5 42
HPs 3.1 32.0 43.1 32.1 7.6 0.9 775
UHCs 0.0 12.7 32.2 14.3 9.4 0.0 32
Managing authority
Public 3.1 32.5 45.1 32.4 8.7 0.9 870
Private 1.2 28.3 30.0 25.8 13.9 0.9 70
Ecological region
Mountain 1.8 37.2 38.6 39.7 11.2 0.2 118
Hill 2.4 33.9 42.2 28.9 7.9 0.9 482
Terai 4.0 28.2 48.4 33.5 10.0 1.1 340
Earthquake-affected districts (14) 2.5 30.7 41.6 27.4 12.8 2.2 194
National average 2.9 32.2 44.0 31.9 9.1 0.9 940
Note: Stand-alone HTCs and Sukra Raj and Bir hospitals are excluded.
1
Provider asked about or caretaker mentioned the “main symptoms of diarrhea” and “general danger signs like child is unable to
drink or breastfeed” and “child has had convulsions with the current illness” and “cough or difficult breathing” or counted respiration
for 60 seconds during the physical examination. Cough or difficult breathing refers to children age 2-59 months and counted
respiration (breaths) for 60 seconds refers to children below age 2 months, as per the IMNCI protocol.
2
Provider took the child's temperature by thermometer or felt the child for fever or body hotness and weighed the child on the day of
the visit.
3.10.3 Provision of quality services
The 2015 NHFS used exit interviews to assess the quality of care provided to ANC, family planning,
and IMNCI clients visiting the health facility on the day of the survey. Table 3.21a presents information on
quality of care for ANC clients in terms of services provided by a skilled birth attendant (SBA), counseling
on at least three danger signs, clients’ recommendation of the facility to others, and clients reporting no
problems regarding waiting time
Almost all of the ANC clients (97 percent) observed reported that they would recommend the
facility to others. Likewise, more than two-thirds of clients reported that they had no problem regarding
waiting time. However, less than half of clients (43 percent) received ANC services from an SBA, and only
19 percent reported that they were counseled on at least three danger signs
Overall, health facilities were in compliance with all four tracer items in the case of only 5 percent
of ANC clients. Health posts and PHCCs were most likely to be in compliance (7 percent each), followed
by district-level hospitals (5 percent). Public facilities were more likely than private facilities to provide
quality ANC services
Facility-Level Infrastructure, Resources, Management, and General Service Readiness • 63