Abstract
Nepal’s Primary Health Care (PHC) is aligned vertically with disease control programs at the core and a vast network of community health workers at the periphery. Aligning with the globalization of health and the factors affecting global burden of diseases, Nepal echoes the progressive increase in life expectancy, changes in diseases patterns, including the current impact of COVID-19. Nepal’s health system is also accommodating recent federalization, and thus it is critical to explore how the primary health care system is grappling the challenges amidst these changes. In this review, we conducted a narrative synthesis of literature to explore the challenges related to transformation of Nepal’s primary health care delivery system to meet the demands incurred by impact of globalization and recent federalization, covering following database: PubMED, Embase and Google Scholar. Of the 49 articles abstracted for full text review, 37 were included in the analyses. Existing theories were used for constructing the conceptual framework to explain the study findings. The results are divided into four themes. Additional searches were conducted to further support the narrative synthesis: a total of 46 articles were further included in the articulation of main findings. Transforming Nepal’s primary health care system requires a clear focus on following priority areas that include i) Revised efforts towards strengthening of community based primary health care units; ii) Adapting vertical programs to federal governance; iii) Reinforcing the health insurance scheme; and iv) Strengthening an existing network of community health workers and health human resources. This review discusses how these broad goals bear challenges and opportunities.
Highlights
Nepal has made significant progress on health indicators over the past several decades [1]
Significant progress has been achieved by such a vast network of primary health care system (PHC) in Nepal, a lot of which are reflected in millennium and sustainable development goal indicators [2]
Globalization of health and the indicators have triggered Nepal to reform the health system, the core of which lies in improving primary health care system
Summary
Nepal has made significant progress on health indicators over the past several decades [1]. The impressive achievement in health indicators was the result of globalization in health including economic development via-a-viz strengthening of primary (mostly peripheral) health care (PHC) health care (PHC) system through investments to establish the health care infrastructure. PHC service in Nepal has been active since 1978 through a network of district and the distal network that reaches to the community served by health posts and sub-health posts. Significant progress has been achieved by such a vast network of PHC in Nepal, a lot of which are reflected in millennium and sustainable development goal indicators [2]. Transforming health system to achieve millennium and sustainable development goal indicators reflects how globalization has promoted health system to adopt these goals. The infant mortality rate declined by two fold from 78 deaths per 1000 live births in 1990 to 32 deaths per 1000 live births in 2016 and pregnancy related mortality rate declined by half from 543 deaths per 100,000 live births in 1989–1996 to 259 deaths in 2009–2016 [1, 2]
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