Non-Communicable Disease Service Readiness in Nepal: A Further Analysis of Nepal Health Facility Survey- 2021

Objective To assess the readiness of public and private health facilities(HFs) in delivering Cardiovascular Diseases(CVDs), Diabetes Mellitus(DM), Chronic Respiratory Diseases(CRDs), and Mental Health(MH) services in Nepal. Methods We analyzed data on service readiness for CVDs, DM, CRDs, and MH from Nepal Health Facility Survey 2021 using Service Availability and Readiness Assessment manual of the World Health Organization. Readiness score was measured as the average availability of tracer items in percent, and facilities were considered “ready” for Non-Communicable Diseases (NCDs) management if scored ≥70 (out of 100). We performed weighted descriptive analysis, univariate and multivariable logistic regression to determine association of readiness of HFs with province, type of HFs, ecological region, quality assurance activities, external supervision, client’s opinion review, and frequency of HF meetings. The result of regression analysis are presented as odds ratio with 95% confidence interval(CI) and p-value. Results Of 1581 facilities offering any NCDs related services, 93.1%(95% CI: 90.9 to 94.7), 75.8%(95%CI: 72.4 to 78.8), 99.3%(95%CI: 98.3 to 99.7) and 26.0%(95%CI: 23.0 to 29.2) provide CVDs, DM, CRDs and MH-related services respectively. The overall readiness score for CVDs, DM, CRDs, and MH-related services were 38.1±15.4, 38.5±16.7, 32.6±14.7 and 24.0±23.1 respectively with readiness score lowest for the guidelines and staff training domain and highest for essential equipment and supplies domain. Peripheral public HFs were more likely to be ready to provide all NCDs-related services as compared to federal/provincial facilities. The HFs with external supervision in past 4 months were less likely to be ready to provide CRDs and DM related services and HFs reviewing client’s opinions were more likely to be ready to provide CRDs, CVDs and DM related services. Conclusion Readiness of HFs to provide CVDs, DM, CRDs, and MH-related services was sub-optimal in Nepal. It is recommended to reform policy to improve service readiness for NCDs. Strengths and limitations of this study Nationally representative sample of health facilities in Nepal, with coverage of all seven provinces and 77 districts Survey has adopted a highly standardized survey with the globally accepted research protocol. Variables for readiness analysis are based on standardized WHO’s SARA guideline and thus, findings are comparable to findings from other countries. Weighted analysis has been performed, which takes into account the complex sampling procedures and adjusts for non-response and disproportionate sampling. Since the survey was conducted while the COVID-19 pandemic was ongoing, there could be some impact of the pandemic on study results.