Health Facilities In Nepal Research Articles

Emergency obstetric and newborn care signal functions: The situation in health facilities in Nepal between 2015 and 2021

Expanding access to facility-based delivery services and improving the functionality of emergency obstetric and neonatal care (EmONC) are important strategies toward achieving a maternal mortality ratio of 70 deaths per 100,000 live births by 2030. In this study the researchers assess signal functions at designated facilities in Nepal, using Nepal Health Facility Survey data for 2015 and 2021. The functionality of basic and comprehensive EmONC sites was low, declining over the six-year period. Lack of progress may partly be attributed to the COVID-19 pandemic. Nepal needs to expand EmONC sites strategically, strengthen referral systems, improve service readiness, and periodically assess service quality.

Assessing the Nepalese health system's readiness to manage gender-based violence and deliver psychosocial counselling.

Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors' physical, sexual and mental health care needs. However, there is a notable lack of evidence regarding such readiness in Nepal. This study, utilizing a concurrent triangulation design, evaluated the readiness of public health facilities in Nepal's Madhesh Province in managing VAW, focusing on providers' motivation to offer psychosocial counselling to survivors. A cross-sectional study was conducted across 11 hospitals and 17 primary health care centres, where 46 health care providers were interviewed in February-April 2022. The study employed the World Health Organization's tools for policy readiness and the Physician Readiness to Manage IPV Survey for data collection. Quantitative and qualitative data were collected via face-to-face interviews and analysed using descriptive and content analysis, respectively. Only around 28% of health facilities had trained their staff in the management of VAW. Two out of 11 hospitals had a psychiatrist, and a psychosocial counsellor was available in four hospitals and two out of 17 primary health care centres. Two-thirds of all health facilities had designated rooms for physical examinations, but only a minority had separate rooms for counselling. Though a few health facilities had guidelines for violence management, the implementation of these guidelines and the referral networks were notably weak. Hospitals with one-stop crisis management centres demonstrated readiness in VAW management. Health providers acknowledged the burden of IPV or domestic violence and expressed motivation to deliver psychosocial counselling, but many had limited knowledge. This barrier can only be resolved through appropriate training and investment in violence management skills at all tiers of the health system.

Institutionalization of Minimum Service Standards (MSS) for Health Facilities in Nepal:

Access to health facilities alone, without quality services, does more harm than the benefit to the people’s health. Nepal has invested more than two decades in expansion of number of health facilities and the journey is still on to balance level of health facilities based on the federal structure. Institutionalization of Minimum Service Standards (MSS) for health facilities in Nepal implemented by Ministry of Health and Population is an exemplary Plan-Do-Study-Act (PDSA) cycle for health facilities readiness and service availability for quality improvement. From its design, development, stakeholders’ engagement, implementation to development of action plan makes MSS lively and outcome oriented tool. MSS for health facilities in Nepal is an effort of government to prepare foundation of readiness and service availability to move ahead with effective quality service utilization. Digitalization of the all sets of MSS, development of MSS to cover the existing type of the health facilities currently present in the country and access of data set for researchers is the way forward. Developing standards for national accreditation system and international collaboration is the next step to embrace. Furthermore, MSS gradually reported through self assessment of the health facilities with occasional monitoring by the local, provincial and federal government and gap fulfillment through routine annual work plan and budgeting is the future direction. It is high time MoHP moves ahead with service specific quality improvement tools integrated with MSS assessment prepare them for high quality health systems that can adapt to changing health needs and health shocks.

Knowledge and attitude toward COVID-19 booster dose among health care professionals in Nepal: a cross-sectional study.

A cross-sectional study was conducted from December 2021 to January 2022 among health care professionals working at public health facilities in Nepal. Multivariable logistic regression was performed to identify predictors that correlate with knowledge and attitude toward COVID-19 booster dose. P value less than 0.05 was considered statistically significant. A total of 300 participants were included in the final analysis. Among the study participants, 68.0% and 78.6% had good knowledge and favorable attitude toward COVID-19 booster dose, respectively. Female health care workers and those who had received a single dose of COVID-19 vaccine had significantly lower odds of having good knowledge of COVID-19 booster dose. Similarly, participants with lower educational levels and those who had received a single dose of COVID-19 vaccination had an unfavorable attitude toward COVID-19 booster dose. This study showed a satisfactory level of knowledge and attitude of health care professionals toward COVID-19 booster dose in Nepal. Health care professionals' positive attitude toward COVID-19 booster dose vaccine is key to the patient and community safety. Personalized education and risk communication can aid in improving overall awareness and attitudes toward COVID-19 booster dose in such populations.

Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis

IntroductionAn increasing number of studies have reported disruptions in health service utilisation due to the COVID-19 pandemic and its associated restrictions. However, little is known about the effect of lifting...

Using mobile health to strengthen the communication skills for effective delivery of health information in Nepal: A qualitative study of the perspectives of Female Community Health Volunteers

Background Female Community Health Volunteers (FCHVs) play an important role in linking community members-particularly marginalised and vulnerable women and health facilities in Nepal. There has been increased use of mobile phones amongst FCHVs and their support to improve the quality of health services FCHVs provide, with positive results. Under the leadership of Ministry of Health and Population (MoHP), Department of Health Services (DoHS), and investment by the UK Department for International Development (DFID) via Nepal Health Sector Support Programme 3 (NHSSP 3), BBC Media Action designed and tested an innovative mobile phone-based solution that can best support FCHVs in their work as health promoters in local communities. This study aimed to examine the changes in the FCHVs-beneficiary interaction and communication since the introduction of a mobile-based intervention (Mobile Chautari). Methods A qualitative study was conducted in three districts of Nepal: Tehrathum, Darchula and Rautahat using in-depth interviews, focus group discussions with FCHVs, pregnant women and mothers with children less than 5 years old, mothers-in-law, and health facility staff. In addition, observation of Health Mothers Group (HMG) meeting was also conducted. Data analysis was conducted using thematic analysis. Results The mHealth intervention was acceptable to the FCHVs and the use of Mobile Chautari helped FCHVs recognise the value of communication aids and facilitate effective discussions in HMG meeting. FCHVs felt more confident when talking about health issues and communicated more effectively with diverse beneficiaries. FCHVs felt that Mobile Chautari improved their status in the communities, which also helped enhance trust between FCHVs and communities. Conclusions Mobile Chautari has the potential to strengthen the communication skills of FCHVs and bridge the gap between the FCHVs and their beneficiaries. Mobile Chautari appears to be a promising way to communicate health related information and communicate with diverse clients. In the short period the study has been able to show the potential of Mobile Chautari and how it could support positive behaviour change.

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

BackgroundAccess to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal.MethodsData for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05.ResultsThe mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities.ConclusionsPrivate facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.

Predictors for timely initiation of breastfeeding after birth in the hospitals of Nepal- a prospective observational study

BackgroundTimely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal.MethodA prospective observational study was conducted in four public hospitals between July and October 2018. All women admitted in the hospital for childbirth and who consented were included in the study. An independent researchers observed whether the neonates were placed in skin-to-skin contact, delay cord clamping and timely initiation of breastfeeding. Sociodemographic variables, obstetric and neonate information were extracted from the maternity register. We analysed predictors for timely initiation of breastfeeding with Pearson chi-square test and multivariate logistic regression.ResultsAmong the 6488 woman-infant pair observed, breastfeeding was timely initiated in 49.5% neonates. The timely initiation of breastfeeding was found to be higher among neonates who were placed skin-to-skin contact (34.9% vs 19.9%, p - value < 0.001). The timely initiation of breastfeeding was higher if the cord clamping was delayed than early cord clamped neonates (44.5% vs 35.3%, p - value < 0.001). In multivariate analysis, a mother with no obstetric complication during admission had 57% higher odds of timely initiation of breastfeeding (aOR 1.57; 95% CI 1.33, 1.86). Multiparity was associated with less timely initiation of breastfeeding (aOR 1.56; 95% CI 1.35, 1.82). Similarly, there was more common practice of timely initiation of breastfeeding among low birthweight neonates (aOR 1.46; 95% CI 1.21, 1.76). Neonates who were placed skin-to-skin contact with mother had more than two-fold higher odds of timely breastfeeding (aOR 2.52; 95% CI 2.19, 2.89). Likewise, neonates who had their cord intact for 3 min had 37% higher odds of timely breastfeeding (aOR 1.37; 95% CI 1.21, 1.55).ConclusionsThe rate of timely initiation of breastfeeding practice is low in the health facilities of Nepal. Multiparity, no obstetric complication at admission, neonates placed in skin-to-skin contact and delay cord clamping were strong predictors for timely initiation of breastfeeding. Quality improvement intervention can improve skin-to-skin contact, delayed cord clamping and timely initiation of breastfeeding.

Association of social stigma of COVID-19 with work satisfaction, burnout and fatigue among healthcare workers in Nepal

Background: Stigma towards the patient of coronavirus disease (COVID-19) has been reported in various media reports, including negative behaviour among health care workers (HCWs) towards COVID-19 patients. Moreover, the negative behaviour of HCWs towards COVID-19 patients could affect the professional quality of life of these HCWs.Objective: We aimed to assess stigma related to COVID-19 patients among HCWs and explore its impact on their professional quality of life during COVID-19 pandemic in Nepal.Methods: An online cross-sectional study was carried out among 421 HCWs (health assistants 35.6%, nurses 33%, doctors 23.3% and paramedics 8.1%), 52.7% female, working in health facilities in Nepal. The measures included background characteristics, stigma in terms of - discrimination towards COVID-19 patients, acceptance of COVID-19 patients and fear of COVID-19, and professional quality of life in terms of - work satisfaction, burnout and fatigue. Descriptive and inferential statistics were utilised to analyze the data in SPSSvs20.Results: While around two-third of the study participants showed discriminating attitude towards COVID-19, a half showed negative attitude towards acceptance of COVID-19 patients, and a fifth reported attitude of fear of COVID-19. Multivariable regression analysis indicated that while presence of fear of COVID-19 was associated with low satisfaction, low burnout, and low fatigue; attitude of acceptance of COVID-19 patients was associated with low burnout and low fatigue; and attitude of discrimination towards COVID-19 patients was associated with only low satisfaction.Conclusion: Strategies directed towards - reducing fear and discrimination towards COVID-19 patients, and enhancing positive attitude of acceptance towards COVID-19 patients among HCWs, and thus, creating enabling environment for reducing their burnout and fatigue, and increasing work satisfaction are recommended.

Equity of geographical access to public health facilities in Nepal

IntroductionGeographical accessibility is important against health equity, particularly for less developed countries as Nepal. It is important to identify the disparities in geographical accessibility to the three levels of public...

Typhoid and Paratyphoid Cost of Illness in Nepal: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II.

BackgroundEnteric fever is endemic in Nepal and its economic burden is unknown. The objective of this study was to estimate the cost of illness due to enteric fever (typhoid and paratyphoid) at selected sites in Nepal.MethodsWe implemented a study at 2 hospitals in Nepal to estimate the cost per case of enteric fever from the perspectives of patients, caregivers, and healthcare providers. We collected direct medical, nonmedical, and indirect costs per blood culture–confirmed case incurred by patients and their caregivers from illness onset until after enrollment and 6 weeks later. We estimated healthcare provider direct medical economic costs based on quantities and prices of resources used to diagnose and treat enteric fever, and procedure frequencies received at these facilities by enrolled patients. We collected costs in Nepalese rupees and converted them into 2018 US dollars.ResultsWe collected patient and caregiver cost of illness information for 395 patients, with a median cost of illness per case of $59.99 (IQR, $24.04–$151.23). Median direct medical and nonmedical costs per case represented ~3.5% of annual individual labor income. From the healthcare provider perspective, the average direct medical economic cost per case was $79.80 (range, $71.54 [hospital B], $93.43 [hospital A]).ConclusionsEnteric fever can impose a considerable economic burden on patients, caregivers, and health facilities in Nepal. These new estimates of enteric fever cost of illness can improve evaluation and modeling of the costs and benefits of enteric fever–prevention measures.

Medicine Prescribing Pattern and Knowledge on Medicine Use at Different Level of Health Care Settings in Nepal.

It is imperative to have adequate knowledge about medicines being used for their proper administration so as to obtain desirable therapeutics effects. This study aims to assess the medicine prescribing pattern and patients' knowledge about medicine use at different level of health care settings in Nepal. A cross sectional study was conducted in randomly selected 88 health facilities in Nepal. Altogether 2200 patients, taken randomly after the doctor visit, were interviewed and assessed for the prescription. Out of total drugs prescribed from 88 health facilities (6,175), 68.91% were essential drugs, 23.74 % were antibiotics and 61 % of medicines were prescribed in generic names. And among patients receiving medicines, adequate response on medicine use was received on 49% of medicines out of 3,806 medicines dispensed. Greater percentages of medicines were prescribed from essential drug list in health facilities. Knowledge on medicine use was poor among people.

Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

IntroductionNepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal.MethodsData were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities.ResultsOf the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals.ConclusionsThese findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

Exploring the factors impacting on access and acceptance of sexual and reproductive health services provided by adolescent-friendly health services in Nepal.

Adolescent-friendly health programs have been in place in Nepal since 2008, yet uptake of the services for sexual and reproductive health remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their acceptance and utilization from the perspectives of adolescents, health care staff, and key community informants. This study applied a qualitative research design involving six focus groups with 52 adolescents and in-depth interviews with 16 adolescents, 13 key informants, and 9 health care providers from six adolescent-friendly health facilities in Nepal. Thematic analysis was conducted for data analysis. The key themes identified as barriers include access issues due to travel, institutional health care barriers, perceived lack of privacy and confidentiality, and the unprofessional attitudes of staff towards the sexual health needs of adolescents. These themes are underpinned by gendered ideology and a moral framework around the sexual behavior of adolescents. Interview responses suggested that health care providers take a policing role in prescribing adolescents’ conformity to this moral framework in their delivery of reproductive health care and services. While physical access to health services may be problematic for some adolescents, this is not the priority issue. Attention needs to be given to increasing the capacity of health care providers to deliver services without imposing their own and socially sanctioned moral frameworks around adolescent sexual behavior. Such capacity building should include training that is experiential and emphasizes the importance of confidentiality and non-judgmental attitudes.

Knowledge Regarding Prevention of Mother to Child Transmission of HIV/AIDS among Antenatal Mothers in Nepal

Background &amp; Objectives:Prevention of Mother to child Transmission (PMTCT) is a global intervention which aims at preventing mother to child transmission of Human Immunodeficiency Virus (HIV). The study aims to find out knowledge of pregnant women on Mother to child Transmission (MTCT) of HIV/AIDS (Acquired Immune Deficiency Syndrome).Materials &amp; Methods:A cross-sectional study was carried out at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal among the pregnant women who came to visit Antenatal Clinic. Data was collected using non-probability purposive sampling technique. Face to face interview was done and a structured questionnaire was developed for data collection. Data analysis and interpretation were done in SPSS and MS Excel.Results:The total number of respondents was 80 with a mean age of 27.4 years. 90% (n=72) respondents were found to be literate. 86.3% (n=69) were well aware of the knowledge on PMTCT. Majority of the respondents (40%) mentioned that radio, TV/Media were the main sources of information about HIV/AIDS. Out of 32.5% (26) who had heard about the window period, only 26.9% (n=7) gave the correct answer. 93.8% (n=75) were well known about the routes of transmission of HIV but only 10.1% (n=7) gave the correct answer about it. Further, 54% (n=43) respondents knew about the availability of drugs to reduce MTCT of HIV/AIDS.Conclusion:The level of awareness about PMTCT among antenatal mothers was satisfactory. However, knowledge was inadequate which imparts for the need of health education about MTCT of HIV/AIDS in every health facilities of Nepal.

PHP7 - Free Essential Medicines Through Public Health Facilities in Nepal: A Qualitative Study

PHP7 - Free Essential Medicines Through Public Health Facilities in Nepal: A Qualitative Study

The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal

BackgroundA globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1+3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown. MethodsInfants aged 6 weeks to 11 months, who had received <3 doses of OPV and had mild-moderate diarrhea or no diarrhea, were recruited at five health facilities in Nepal. Neutralizing antibody titers to poliovirus types 1 and 3 were measured before and 28 days after bOPV administration. The effect of diarrhea and other factors on seroconversion or boosting in antibody titers to poliovirus was assessed by multivariable analysis. ResultsInfants with diarrhea, versus those without diarrhea, had reduced response for poliovirus types 1 (56% [87/156] vs 66% [109/164]) and 3 (34% [70/209] vs 52% [122/236]). After adjusting for other factors, infants with diarrhea had significantly reduced response for type 3 (odds ratio [OR]=0.44, 95% CI 0.29–0.68), as did infants with >5 loose stools per day (OR=0.36, 95% CI 0.21–0.62). ConclusionsDiarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease. Clinical trial registryThis study is registered at clinicaltrials.gov as NCT01559636.

"I need to terminate this pregnancy even if it will take my life": a qualitative study of the effect of being denied legal abortion on women's lives in Nepal.

BackgroundAlthough abortion was legalized in Nepal in 2002, many women are not able to obtain legal services. Using qualitative data from women who were denied legal abortion services, we examined reasons for seeking an abortion, options considered and pursued after being denied an abortion, reasons for delaying seeking care, as well as complications experienced among women who were denied legal abortion.MethodsAfter obtaining authorization from two health facilities in Nepal, we requested informed consent from all women who were seeking abortion services to complete a case report form to determine their eligibility for the study. We then recruited all eligible and interested women in to the study. Two months after recruitment, we conducted in-depth interviews with 25 women who were denied abortion services from the two recruitment facilities due to advanced gestational age (>12 weeks). Interviews were translated and transcribed, and the transcripts were analyzed through an iterative process grounded in thematic analysis, involving both a priori and emergent codes.ResultsEleven women were recruited from the government hospital and 14 from an NGO facility. The majority of women (15 women or 60 %) were living rural settings, ranged in age from 18 to 40 years and had an average of 2 children. None had completed any post-secondary education. Women most commonly cited financial concerns and health concerns as reasons for seeking termination. Not recognizing pregnancy, uncertainty about how to proceed, needing time to coordinate the trip to the facility or raise money, and waiting to know the sex of fetus were the commonly cited delays. Among the women interviewed, 12 decided to continue their pregnancies following denial, 12 terminated their pregnancies elsewhere, and one self-induced using medication. At least two women experienced significant complications after obtaining an abortion. Most women who continued their pregnancies anticipated negative consequences for their health, family relationships, and wellbeing.ConclusionsBarriers to seeking early abortion need to be addressed in order to reduce utilization of abortion services that may be unsafe and to improve women's health and wellbeing in Nepal.

Road map to scaling-up: translating operations research study's results into actions for expanding medical abortion services in rural health facilities in Nepal.

BackgroundIdentifying unsafe abortion among the major causes of maternal deaths and respecting the rights to health of women, in 2002, the Nepali parliament liberalized abortion up to 12 weeks of pregnancy on request. However, enhancing women’s awareness on and access to safe and legal abortion services, particularly in rural areas, remains a challenge in Nepal despite a decade of the initiation of safe abortion services.MethodsBetween January 2011 and December 2012, an operations research study was carried out using quasi-experimental design to determine the effectiveness of engaging female community health volunteers, auxiliary nurse midwives, and nurses to provide medical abortion services from outreach health facilities to increase the accessibility and acceptability of women to medical abortion. This paper describes key components of the operations research study, key research findings, and follow-up actions that contributed to create a conducive environment and evidence in scaling up medical abortion services in rural areas of Nepal.ResultsIt was found that careful planning and implementation, continuous advocacy, and engagement of key stakeholders, including key government officials, from the planning stage of study is not only crucial for successful completion of the project but also instrumental for translating research results into action and policy change. While challenges remained at different levels, medical abortion services delivered by nurses and auxiliary nurse midwives working at rural outreach health facilities without oversight of physicians was perceived to be accessible, effective, and of good quality by the service providers and the women who received medical abortion services from these rural health facilities.ConclusionsThis research provided further evidence and a road-map for expanding medical abortion services to rural areas by mid-level service providers in minimum clinical settings without the oversight of physicians, thus reducing complications and deaths due to unsafe abortion.

Availability and Use of Oxytocin in Health Facilities in Nepal

Introduction: Although maternal mortality is declining over the past 15 years, it is still high in Nepal. Postpartum haemorrhage is the leading cause of maternal deaths in Nepal. Oxytocin is one of the emergency drugs, which prevent and manage postpartum haemeorrhage, listed in essential drug list, and supplied to hospitals and Primary Health Care centers in Nepal. The study aimed to assess availability, storage condition, prescriber’s knowledge and practice of Oxytocin in Nepal. Methods: A descriptive cross-sectional explorative study was conducted in 40 health facilities of 10districts. Multiple methods–observation, interviews, store records and delivery charts analysis-were used to collect data. The respondents of the study (health facility in-charges, service providers and storekeepers) were interviewed with semi-structured questionnaire. The collected data was entered into MS-Excel and analyzed using SPSS version 17. Results: Oxytocin was available throughout the year in 35.5% of health facilities among them only 8.3% of health facilities stored Oxytocin in refrigerator. In-charges, service providers, were not aware of recommended temperature for Oxytocin storage. Similarly, 40.7% of the service providers used Oxytocin for prevention and management of postpartum haemorrhage, 31.9% and 27.4% of service providers used Oxytocin for augmentation and induction respectively. Conclusion: In some districts, the medicine was not available throughout the year. Majority of service providers were not aware of recommended indications to induction and augmentation. There should be a serious effort to orient the service providers about rational use of Oxytocin and store to maintain the efficacy of the drug.