Health Care In Nepal Research Articles

Migration of Medical Doctors from Nepal: Analyzing Trends and Policy Implications

One way migration of health care professionals especially from low-income countries like Nepal has become a concerning issue where the already fragile health system of the country faces challenges of losing skilled health care professionals to high-income countries. This trend analysis provides insights into the dynamics of Nepal's healthcare workforce migration, it offers a tailored understanding of factors influencing migration patterns, and its impact on the general population of the country and globally. It helps formulate targeted policies for workforce retention, resource planning, and addressing the country's healthcare needs and comparison with the global context. Analyzing the migration trends of medical professionals enhances medical literature by offering a comprehensive understanding of the factors affecting healthcare systems, public health, economics, education, and policy development. This knowledge plays a vital role in shaping future policies in the field of medicine in Nepal.

Enhancing Performance of Health Assistants through Technical and Vocational Education and Training for Better Healthcare Access

This is a review article exploring critical role of Technical and Vocational Education and Training (TVET) programs in advancing capacities of health assistants and consequently strengthening healthcare access to the rural population in Nepal. The review was planned in the wake of the existing literatures on the study area that lacks a comprehensive examination to explores the role of health assistants in Nepal's healthcare delivery and assess the importance of TVET on their performance. A methodical literature search was conducted using various electronic databases like Google scholar and PubMed applying specific keywords, such as “Health Assistant", "Health Care Access", "Technical Education", "Vocational Education and Training”. It encompassed the studies published in the English language without limiting publication date, while the involved two authors independently evaluated the published articles' eligibility. These authors also carried out data extraction, culminating in a narrative summary of the findings. Of the total 37 literatures, most of them reported health assistant trained through TVET, play a vital role in improvement of healthcare access, thereby addressing the challenges. They bridge gaps in medical access, provide essential care, and promote community well-being, particularly in the underserved areas. TVET programs enhance skills through practical experiences and comprehensive training, resulting into significant improvement in healthcare access, especially in rural regions. Integrating innovative teaching methods and collaborations further enhances health assistant preparedness. Challenges, such as funding limitations and rural-urban divides persist, but opportunities exist in e-learning initiatives, partnerships, and professional development to improve health assistant education. Improving healthcare in Nepal by inculcating better skills to health assistants can address many healthcare problems.

Health Equity through Structural Adjustment by Nepal for Public Health

The study states at Nepal's healthcare system, emphasizing structural changes and obstacles to enhanced health of people. The federal system prioritizes social determinants, healthcare personnel, quality access, community involvement, and the impact of globalization on health while providing comprehensive services despite decentralization and collaboration. With an emphasis on social justice and the promotion of public health, this paper investigates Nepal's healthcare system and health equity in the context of globalization. Reviewing data, policy, implementation, and literature assists it to analyze and draw conclusion. In discussing Nepal's shift from a unitary to a three-level federal government structure, the article highlights the consequence of developing policies and programs that promote social justice and equity in health. In addition to calling for a massive effort by the public health community to discuss and analyze health crises related to globalization and develop social justice-based strategies for a world where health for all is a reality, it suggests that a single strategy should be developed to address health crises.

Free Basic Healthcare in Nepal: Can the Dream be Turned into Reality in the Pursuit of Universal Health Coverage?

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Hospital Equipment Maintenance Management for Reliable and Effective Health Care Services in Nepal

The management of biomedical engineering instruments accuracy in Nepali hospitals has been a pressing issue, largely attributed to the lack of qualified biomedical engineering operations management teams. This challenge becomes even more complex due to the vast array of biomedical equipment imported from abroad, many of which are not only diverse but also relatively expensive. The primary concern in Nepal is to establish an efficient and competent biomedical equipment accuracy management system that can optimize the precision, longevity, and reliability of these crucial medical devices. The absence of well-organized biomedical engineering operations management teams has far-reaching consequences, as it hinders the healthcare sector's ability to deliver superior and consistent services to patients, ultimately affecting diagnostic accuracy. To overcome this challenge, it is imperative to develop a well-managed and qualified biomedical engineering operations management workforce in hospitals and healthcare centers. This entails the acquisition of modern skills to effectively oversee, test, calibrate, and validate medical devices, thereby extending the lifespan of these instruments and ensuring consistent and accurate diagnostics for reliable healthcare services. The integration of such skills is essential for elevating the standards of healthcare in Nepal and enhancing the well-being of its population.

Maternal and child health care practice of Tamang community

Health is the most important factor of human life. It is a multi-dimensional process and a quality of life which entails a dynamic interact among the physical, mental, social, emotional and spiritual aspects of life. Good health improves the quality of life. The major health problems of Nepal are highly related to maternal and child health care practices. So, MCH care is the very important component of primary health care in Nepal. Most of the women of Nepal are illiterate and ignorant regarding the high maternal and child mortality rate in Nepal. This research was based on descriptive research design with both quantitative and qualitative nature of information. The major results from the findings of this study reveals that 29.5 percent respondents had not antenatal checked up and 70.4 percent respondents had antenatal checked up. The majority of the respondent (34.1 percent) women had antenatal checked up of three times during pregnancy period, whereas 38 percent of the pregnant women had checked up for four times, few (6.9 percent) of the pregnant women had five times antenatal checked up during pregnancy period. It was found that majority of the respondents (63.6 percent) had antenatal checked in health post and most of the respondent’s (64.8 percent) first child bearing age was found to be 15-19 years of age and least of the (4.5 percent) respondent’s first child bearing age was found 25-29 years of age. Similarly, 47.7 percent of respondent mothers had taken one dose of TT injection and 31.9 percent of respondent mothers had taken non dose of TT injection.

Addressing Men's Health Needs in Nepal: An Ignored Public and Clinical Health Concern.

Despite men's poorer outcomes than women in many health issues such as life expectancy, ischemic heart disease, hypertension, diabetes, HIV/AIDS, traffic-related injuries, drug and alcohol abuse, etc, Nepal's health care strategy does not have an adequately focused program to address men's health needs. This comment aims to illustrate the differences in selected health indicators between men and women and suggest Nepal's health sector strategy 2022-2030 should address to advance men's health needs. Keywords: Health policy; men's health; Nepal.

Engrained with modernity: commodification, medicalisation, and cross-border medical travel for health care in Nepal

Biomedicine was introduced in Nepal by Christian Missionaries en route to Tibet and China. When Nepal entered the democratic era in the early 60s, a considerable influx of biomedicine was brought into Nepal by the modernizing state as part of the promise of national development. After the 60s, biomedicine expanded in Nepal mainly through private sector involvement. This had consequences in the health-care domain in Nepal including the commodification of health-care services and increasing medicalization. The practice and expansion of biomedicine is also closely associated with its social and cultural mediation. This article focuses to examine how the macro process of health development shaped the medical practices, especially the healing trajectories and cross-border medical travel of Maithili Brahmin women from Nepal’s Tarai. This article shows that the three prominent avenues of health-care services, namely, medicalization, commodification, and cross-border medical travel predominant in the study area, are thriving and intertwined in such a way that they are reciprocally strengthening each other. This article is based on primary ethnographic data generated from field research conducted in a social cluster among the women from Nepal’s Tarai.

Exploring the Challenges and Opportunities for Continuing Professional Development fo Nurses: A Qualitative Study with Senior Nurse Leaders in Nepal

Background: Continuing professional development for nurses is internationally recognised as a key factor in improving quality of care, career progression, job satisfaction and professionalization. Meeting the global and national challenge of Universal Health Coverage will require a flexible and skilled workforce. Since nurses are the backbone of health care in Nepal, their professional development is a key contribution to this task.
 Objective: To explore the views of senior nurses on the need and opportunities for continuing professional development in nursing in Nepal and current barriers to its development.
 Methods: Purposive sampling was used to identify participants and semi-structured interviews were conducted until saturation was reached. Interviews were transcribed verbatim and analysed using thematic analysis. 19 senior nurses, female (n=17) and male (n=2) working across the sector as clinicians, teachers and managers in Nepal participated in this study.
 Results: Analysis revealed several themes and subthemes, including: the conceptualisation of CPD in Nepal; provision and funding; barriers – fiscal, political and geographical challenges; and future priorities which included a discussion around basic skills versus advanced practice.
 Conclusions: The study provides an overview of opportunities and challenges for equitable access to continuing professional development in Nepal. Our findings illuminate the need for nurse leaders to work with policy makers and nursing organisations to establish the priorities for continuing development in light of increasing demand and expectations of health services.

Tackling the challenges of providing surgical services in low resource LMICs: Shortcomings in surgical healthcare in Nepal

Province-2 is small but densely populated area in the plains of Nepal with 20% of the population on 3% of the land. It is one of the two poorest provinces, with the lowest human and logistic resources. Therefore, there is an enormous and urgent need for improvement of appropriate health care facilities, accessible for all the people. The rural population remains desperately impoverished and to date the provincial and federal governments have lacked the funds to support these needy people.Our work aimed to create a small working model to address the existing problems by establishing the Janakpur Trauma and Orthopaedic Hospital, and ultimately in collaboration with Future Faces, the Craniofacial Centre Nepal, to provide appropriate care at an affordable price to the people in Province-2. This model has been successful, but one of the main challenge remains payments to the health care providers. It is difficult to balance the income and expenditure of hospital services in order to sustain these works and so regular external financial input is required for maintaining continuity of care.It is expected that government agencies and universities such as Madhesh Institute of Health Sciences (MIHS) should be able to educate and assist in the provision of standard care for common illnesses and create suitable human resources to face these challenges.

The second wave of COVID-19 hits Nepal: Burden for Nepal's healthcare system.

The second wave of COVID-19 hits Nepal: Burden for Nepal's healthcare system.

Assessment of Common Maternal Risk Factors in Fetal Malnutrition

Introduction: Nutritional assessment of the newborn gives the reflection of the growth process in the intrauterine period. The Clinical Assessment of Fetal Nutritional Status score (CAN score) method is only the method to assess the fetal malnutrition which includes the clinical observation for the presence of the sign of malnutrition in newborns. Since the fetal growth is related to availability of intrauterine nutrition and placental function, there may be several maternal factors associated with the fetal malnutrition.
 Objectives: The main objective of the study was to determine the prevalance of Fetal Malnutrition in term newborns and the role of maternal factors in the etiology of fetal malnutrition (FM) in the Neonatal and Maternity Units of B.P Koirala Institute of Health Sciences, Dharan.
 Methodology: This was a hospital based observational cross sectional study of consecutive, singleton, term live babies delivered between September 2019 to March 2020. Fetal malnutrition was diagnosed using Clinical Assessment of Fetal Nutritional Status score (CAN score) developed by Metcoff. The maternal history was obtained from the mother which included age, parity, socioeconomic class, pre pregnancy weight, number of antenatal care during pregnancy, history of maternal illness and drugs taken during pregnancy. Nutritional status of the mother was determined using weight, height, mid arm circumference (MAC) and the body mass index (BMI). Collected data was entered in Microsoft excel 2010 and converted it into SPSS 23 version software, for statistical analysis.
 Results: Of the 400 studied newborns, 73 [18%] had FM. The prevalence of teenage pregnancy, primiparity, lower maternal mid arm circumference and vegetarian diets were higher in the mothers of the babies who had suffered fetal malnutrition than the mothers of the babies without FM (p value <0.05).The adverse maternal condition like Pregnancy induced hypertension (PIH), Antepartum hemorrahge (APH), Urinary tract infection (UTI), fever during pregnancy had significant impact in the fetal malnutrition(p value <0.05).
 Conclusion: Improvement in the socioeconomic condition of women and good antenatal care could reduce most of the maternal factors associated with fetal malnutrition. There should be implementation of more accessible programs which address the issues of the maternal nutrition and the maternal health care in Nepal.

A structural social work approach to oral health care in Nepal

Structural social work (SSW) is a critical theory that frames poverty, violence, and disease as the product of oppressive social structures. SSW concepts were applied to a rural dentistry project in Nepal. Delivery of oral health care in Nepal is influenced by capitalist, colonialist, and scientific-modernist ideologies that disadvantage the rural poor. Jevaia Oral Health Care operationalizes SSW principles of tension relief, consciousness-raising, collectivization, and power-brokering, but is limited in tackling structural problems around etiological aspects of oral disease. SSW offers useful and important practice strategies for improving oral health care in Nepal.

Trends in and determinants of visiting private health facilities for maternal and child health care in Nepal: comparison of three Nepal demographic health surveys, 2006, 2011, and 2016

BackgroundMaternal and child health care services are available in both public and private facilities in Nepal. Studies have not yet looked at trends in maternal and child health service use over time in Nepal. This paper assesses trends in and determinants of visiting private health facilities for maternal and child health needs using nationally representative data from the last three successive Nepal Demographic Health Surveys (NDHS).MethodsData from the NDHS conducted in 2006, 2011, and 2016 were used. Maternal and child health-seeking was established using data on place of antenatal care (ANC), place of delivery, and place of treatment for child diarrhoea and fever/cough. Logistic regression models were fitted to identify trends in and determinants of health-seeking at private facilities.ResultsThe results indicate an increase in the use of private facilities for maternal and child health care over time. Across the three survey waves, women from the highest wealth quintile had the highest odds of accessing ANC services at private health facilities (AOR = 3.0, 95% CI = 1.53, 5.91 in 2006; AOR = 5.6, 95% CI = 3.51, 8.81 in 2011; AOR = 6.0, 95% CI = 3.78, 9.52 in 2016). Women from the highest wealth quintile (AOR = 3.3, 95% CI = 1.54, 7.09 in 2006; AOR = 7.3, 95% CI = 3.91, 13.54 in 2011; AOR = 8.3, 95% CI = 3.97, 17.42 in 2016) and women with more years of schooling (AOR = 1.2, 95% CI = 1.17, 1.27 in 2006; AOR = 1.1, 95% CI = 1.04, 1.14 in 2011; AOR = 1.1, 95% CI = 1.07, 1.16 in 2016) were more likely to deliver in private health facilities. Likewise, children belonging to the highest wealth quintile (AOR = 8.0, 95% CI = 2.43, 26.54 in 2006; AOR = 6.4, 95% CI = 1.59, 25.85 in 2016) were more likely to receive diarrhoea treatment in private health facilities.ConclusionsWomen are increasingly visiting private health facilities for maternal and child health care in Nepal. Household wealth quintile and more years of schooling were the major determinants for selecting private health facilities for these services. These trends indicate the importance of collaboration between private and public health facilities in Nepal to foster a public private partnership approach in the Nepalese health care sector.

Poster Presentation

Poster Presentation

A Case Study of Canine Transmissible Venereal Tumour in Community Dog

Dogs the first animals to be associated with humans have suffered most in unplanned urbanised societies. Community dogs are of serious health and safety problems in developing countries and many are seen suffering in the streets with various problems. Canine transmissible venereal tumour (CTVT), an only transmittable oncogenic disease seen frequently in these community dogs. Veterinary Teaching Hospital (VTH) located at Paklihawa Campus, Institute of Agriculture and Animal Science (IAAS). Tribhuvan University (TU) is the major centre for canine health care in Nepal. A dog was brought with complaints of bleeding from the rear and visible reddish mass. The mass in the genital region was diagnosed to be venereal tumour by cell cytology. For the treatment of CTVT, surgical intervention along with chemotherapy (vincristine @0.025mg/ Kg) was done. To remove the ectoparasite, amitraz bath and ivermectin (0.2mg/Kg) was used. The dog completely recovered and it was returned in its original territory.

Factors Influencing Male Participation in Maternal Health Care among Married Couples in Nepal: A Population-based Cross-sectional Study

Background The male involvement in maternal health care is essential to reduce obstetric complications. However, there is little known about factors contributing to male participation in maternal health in Nepal. Objective To assess predisposing, enabling and reinforcing factors contributing male participation in maternal health care in Nepal. Method A population based cross-sectional study was conducted among 374 married couples. Ethical approval was obtained from Institutional Review Board of Kathmandu Medical College Teaching Hospital. The data was collected, using modified Safe Motherhood and Partnership Family Approach Model. Multivariable logistic regression was applied to account associated paternal factors. Concentration curve and concentration index were computed to measure equity gap between lowest and highest quintiles. Result While four out of ten husbands reported high level of their involvement in maternal health care practices, wives reported relatively less involvement of their husbands. Logistic regression showed that husband having low family income, knows about immunization, contact with family planning providers were more likely to participate. In contrary, according to wives, husbands' who have ever been to health facility, discuss family planning with others, contact with family planning providers and who knows about exclusive breast feeding were less likely to participate. The study also showed that socio-economic factors play a significant role. Conclusion Male involvement in maternal health care practices is low. Predisposing, enabling and reinforcing factors play a significant role; however, some contradictions among husbands' and wives' perspectives provide strong evidence on significance of communication within partners on maternal health care issues.

Health workforce perspectives of barriers inhibiting the provision of quality care in Nepal and Somalia – A qualitative study

ObjectiveIn this paper settings from Nepal and Somalia are used to focus on the perspectives of healthcare providers within two fragile health systems. The objective of this study was to describe barriers inhibiting quality healthcare in Nepal and Somalia from a health workforce perspective. MethodsData were collected through 19 semi-structured interviews with healthcare providers working in healthcare facilities. Ten interviews were conducted in Nepal and nine in Somalia. ResultsVarious structural barriers inhibiting the availability, accessibility, and acceptability of the quality care were similar in both countries. Barriers inhibiting the availability of quality care were linked to healthcare providers being overburdened with multiple concurrent jobs. Barriers inhibiting the accessibility to quality healthcare included long distances and the uncertain availability of transportation, and barriers to acceptability of quality healthcare was inhibited by a lack of respect from healthcare providers, characterised by neglect, verbal abuse, and lack of competence. ConclusionsInequality, poverty, traditional and cultural practices plus the heavy burden placed on healthcare providers are described as the underlying causes of the poor provision of quality care and the consequential shortcomings that emerge from it. In order to improve this situation adequate planning and policies that support the deployment and retention of the healthcare providers and its equitable distribution is required. Another important aspect is provision of training to equip healthcare providers with the ability to provide respectful quality care in order for the population to enjoy good standard of healthcare services.

Universal Particulars towards Maternal Health Circumstance

Maternal health is a crucial health problem in developing countries, especially in low resource settings, rural and poor communities. The main aim of this paper is to critically evaluate and explore the situation of maternal health care in Nepal. After reviewing the literature, I found that there are several direct and indirect causes as well as affecting factors in regarding maternal death in developing and least developed countries. In developing countries, women have been facing different problems during pregnancy and delivery period. Knowledge of maternal health and assessable health facilities are most essential in rural areas to save mothers from preventable maternal death.

Burgeoning Irrational Antibiotics use in Primary Health Care in Nepal

Rational use of drugs has immense impact on quality health care. Developing nations have 80% essential drug list prescription. Even though WHO estimates 15-25% antibiotics prescription in these regions, majority of Nepalese patients are prescribed more than one antibiotic in addition to inappropriate prescription in 10%-42% patients.Moreover, Nepal stands as a leading antibiotics prescribing Asian nation. Escalating irrational prescription and excessive over the counter use of antibiotics at peripheral regions of Nepal is possibly leading the emergence of multidrug resistant bacteria.Organisms like S. pneumoniae, K. pneumoniae, Salmonella spp., E. coli, N. gonorrhea, MRSA are rapidly developing first-line, second-line and multi-drug resistance in Nepal. Antimicrobial resistance is the biggest global health concern of the present day threatening the emergence of post antibiotic era. Timely intervention is must to safeguard future generation. Keywords: Antimicrobial resistance; irrational prescription; primary health care.