9:15am - 9:30am (CDT) | 4018.0 - Readiness of primary healthcare facilities for the prevention and management of non-communicable diseases (NCDs) in Nepal: A mixed-methods study

Session: International and Community Health Research

Program: Community Health Planning and Policy Development

Author: Donna Spiegelman, ScD

Abstract

Background

Non-communicable diseases (NCDs) account for 60% of the total deaths in Nepal. In 2016, Nepal adopted the World Health Organization’s Package of Essential Non-communicable Disease Interventions (WHO-PEN) to curb the growing burden of NCDs.

Objective

This study evaluated the readiness of primary healthcare facilities for the prevention and management of NCDs, including cardiovascular diseases (CVDs), diabetes mellitus (DM), and chronic respiratory diseases (CRDs); and explored factors associated with NCD-specific service readiness.

Methodology

We used a convergent parallel mixed methods study design. We adapted the WHO Service Availability and Readiness Assessment (SARA) tool and assessed 105 primary healthcare facilities selected using multistage stratified random sampling. We performed a weighted descriptive analysis to calculate NCD-specific service readiness scores (0 to 100). Mann-Whitney U and Kruskal-Wallis tests were conducted to determine factors associated with NCD service readiness. Simultaneously, we conducted 47 in-depth interviews with PEN-trained health service providers delivering NCD services. Qualitative data were analyzed using a thematic approach.

Results

The median service readiness score of primary healthcare facilities was highest for CVDs (53.3 [IQR: 30.0]) followed by diabetes (48.8 [IQR: 30.9]) and CRDs (38.3 [IQR: 23.3]). Primary Healthcare Centers (PHCCs) had higher readiness compared to health posts. Primary healthcare facilities in the hills and southern plains and imposing user fees for NCD services had higher NCD-specific service readiness compared to primary healthcare facilities in the mountains and facilities not charging fees, respectively. The study’s qualitative findings converged with quantitative findings and explained key discrepancies in NCD readiness according to primary healthcare facility type, region, and applicability of user fees.

Conclusion

Primary healthcare facilities in Nepal lacked equipment, medicines, trained staff, and guidelines essential for NCD management. The government should rationally allocate healthcare resources and PEN-trained personnel in primary healthcare facilities without detracting from the overall aim of enhancing NCD-service readiness uniformly.

Public Health implications

The government must equip primary healthcare facilities with essential medical supplies while capacitating health service providers through regular PEN training and peer coaching sessions. The study’s findings will be imperative for the successful implementation of PEN interventions in Nepal and other lower-middle-income countries with similar healthcare settings.