Services In Nepal Research Articles

Evolution of Helicopter Services and Their Development From a Medical Standpoint: Nepal

Nepal is a landlocked country in the heart of the Himalayan region. Its remote villages and mountainous terrain provide a unique set of challenges in health care. As a result, the last decade has seen major developments in the use of helicopters in retrieval medicine. This has helped to improve accessibility to health care in even the most rural areas. Despite the assorted challenges, the helicopter emergency medical service in Nepal is a part of the medical system. This article provides a comprehensive overview of the history of helicopter and air medical services in Nepal.

Assessing the economic and nutritional value of pollination services in Nepal

Pollination is a key ecosystem service crucial for supporting agricultural production, economic growth, social inclusion, and environmental protection. Understanding the economic value of pollination and its impact on human health and nutrition is essential for effective pollinator conservation and management. This study evaluates the economic and nutritional value of pollination services in Nepal and quantifies historic changes in pollinator reliance. Using public data on agricultural production and commodity prices, in combination with published nutritional composition values, we employ the dependency-ratio method to quantify economic and nutritional value across different regions of the country and through time. We conservatively estimate the annual economic value of pollination services in Nepal at US $477 million, representing 9% of total agricultural revenue. Pollinator-dependent crops, particularly fruits and vegetables are the source of essential nutrients; 40% of plant-based vitamin A and 14% of vitamin C are directly attributable to insect pollination. The cultivated area of these pollinator-dependent crops has increased by 91% in Nepal over 20 years – 3.7 times faster than equivalent increases in non-pollinator-dependent crops. The decline in wild pollinators during the same time period poses a threat, leading to potential pollination deficits and crop losses. Our study underscores the importance of conserving and managing pollinators to ensure sustainable agriculture, food security, and nutrition. Targeted efforts, including policy interventions and conservation strategies, are needed to safeguard pollinator populations and enhance pollination services.

Understanding barriers to spinal cord injury rehabilitation services in Nepal: A qualitative study of rehabilitation professionals' perspectives.

This study aims to explore the perspectives of rehabilitation professionals regarding the barriers to spinal cord injury (SCI) rehabilitation services in Nepal. A qualitative study involved 15 rehabilitation professionals working in the Spinal Injury Rehabilitation Center in Nepal. After obtaining informed consent, in-depth semistructured interviews were conducted using Zoom and phone calls between June and July 2023. Braun and Clarke's thematic analysis approach was utilized to analyze the interviews and generate themes from the participants' responses. The participants represented nine different rehabilitation professions. Over half of them were female (53.33%), and 86.67% had one to 10 years of experience in SCI rehabilitation. From in-depth interviews, four themes depicting barriers to rehabilitation were identified: (a) resource constraints within the rehabilitation centers, (b) concerns related to finance, awareness, and support mechanisms, (c) systemic problems coupled with geographical and physical barriers, and (d) beliefs and practices influencing access and adherence to rehabilitation. Delivering effective rehabilitation services for people with SCI presents a range of barriers. Considering the critical importance of rehabilitation for this population, the findings underscore the necessity of engaging stakeholders at multiple levels, individuals, communities, and government agencies to address the identified barriers and improve rehabilitation services in Nepal. The implications of the findings are further discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cervical Cancer Screening Services in Nepal: A Descriptive Crosssectional Study.

Cervical cancer, the most prevalent cancer among women, is also the primary cause of cancer-related deaths in reproductive age women in Nepal. The study aims to assess the situation of cervical cancer screening services in Nepal. This cross-sectional study used quantitative methods to understand the situation of cervical cancer screening in 572 health facilities of Nepal. The research was conducted to assess screening facilities, the allocation of separate screening rooms, the availability of screening services on a routine basis throughout the week, screening facilities that are free of charge, human resources, and the availability of treatment. It was conducted in October to December 2022. The research was carried out among 572 healthcare facilities, out of which 134 (23.42%) had provision for cervical cancer screening services. Ethical approval was obtained from the Nepal Health Research Council (NHRC) under reference number 397/2022 P. Amongst those 134, 72 (53.73%) healthcare facilities had assigned separate rooms for screening intentions. One hundred and two (76.12%) healthcare facilities provided regular screening services throughout the week, while 112 (83.58 %) had free-of-charge screening services. Concerning trained personnel, 121 (90.30%) health facilities had personnel trained in visual inspection with Acetic acid, 9 (6.72%) had personnel trained in use of colposcopy, and 5 (3.73%) had personnel trained in use of Loop Electrosurgical Excision Procedure (LEEP). Lastly, 31 (23.13%) healthcare facilities offered treatment choices for cervical cancer. Most of the health care facilities did not have provision of cervical screening. Amongst those who had the provision, personnel trained in loop electrosurgical excision procedure colposcopy.

A Critical Analysis of Safe Abortion Road Map in Nepal.

Abortion was legalized by the 2002 Muluki Ain to combat the surging rates of maternal mortality and morbidity. By 2021, the Maternal Mortality Rate plummeted to 151 from 539 in 1996. The decline in the abortion-related maternal mortality attributes to the implication of progressive abortion policies that includes expanded safe abortion services introduction of medical abortion, constitutional recognition of abortion, the mandates by Safe Motherhood and Reproductive Health Rights Act, and free-of-cost abortion services in government health facilities. This review study delves into exploring the contemporary abortion policies and its implications on women's access to safe abortion services as well as the factors that affect the access. This study incorporates findings from extensive desk review of abortion services in Nepal. The 2021 safe abortion services Program Implementation Guideline aims to expand safe abortion sites; however, the Nepal's challenging geography ensues its inequitable distribution, especially in mountainous area. Policy provisions on information and financial accessibility to abortion are well navigated by the Safe Motherhood and Reproductive Health Rights Act and regulation but consistent to sporadic gaps in its implementation were comprehended in this study. This paper further discussed the Safe Motherhood and Reproductive Health Rights Act's regressive mandate of 28-week gestational limit at any condition and the role of gender in abortion decision-making under the pretext of factors influencing safe abortion services. The review study recommends strategies: improving capacity for abortion services under federalism, combating stigma, improving the private sector's readiness, and building a resilient health system.

Trends and Inequities in Use of Abortion Services in Nepal: A Nepal Demographic and Health Survey Data Analysis 1996-2022 A.D.

Despite policy advances and public health initiatives in Nepal to improve access to reproductive healthcare, disparities persist in utilization of abortion services. Grounded in longitudinal data from the Nepal Demographic and Health Survey from 1996 to 2022, this study aims to shed light on evolving patterns in pregnancy outcomes and inequities in use of abortion services across ecological zones and wealth quintiles. Utilizing six rounds of Nepal Demographic and Health Survey data, pregnancy outcomes were categorized as abortion, delivery, miscarriage, or stillbirth. Income-related inequality in the utilization of abortion services was assessed through the concentration index, ranging from -1 to 1. Trends over time were evaluated using the annual rate of change. The ARC indicated a substantial rise in induced abortion rates, surging from 0.4% in 1996 to 8.8% in 2022. In contrast, live births witnessed a decline from 92.8% to 81.2%. Significant variations were observed across ecological zones and wealth quintiles, with the Mountain zone and the Poorest group experiencing the most pronounced increases in induced abortion rates. By 2022, the concentration index reached a near-zero value, signifying a near-elimination of income-related disparities in the use of induced abortion services. The findings suggest that while there has been significant progress in access to and use of abortion services in Nepal, particularly post-2002 policy shifts, challenges remain. Women from lower socio-economic backgrounds continue to face barriers, indicating the need for a multi-pronged approach to address residual challenges. Nepal has made remarkable strides in enhancing equitable access to and use of induced abortion services, but more needs to be done to guarantee equitable access for all women. Future efforts should focus on policy reforms, infrastructural improvements, and societal change to eliminate existing barriers to reproductive healthcare.

Laying foundations for transformation: Insights from local government engagement on climate-resilient rural water services in Nepal

Transformative change in how local governments support rural water services is required to accommodate the increasingly extreme effects of climate change on water service systems. This study explores the potential for contextualised soft systems thinking activities to prepare local government officials with responsibilities pertaining to rural water services in Nepal to shift towards more transformative thinking. First, the study presents the findings of focus group discussions in two rural districts of Nepal that identified common climate-related problems for rural water access including water shortages, contamination, and unequal burden of impacts. Second, we facilitated workshops with local government and non-government stakeholders, drawing on the focus group findings to frame the challenges for rural water linked to climate change that require local government response. We designed the workshops drawing on ‘transformative spaces’ concepts and included soft systems thinking activities to foster systemic perspectives. Participants learned about worldviews, leverage points, rich pictures, root cause analysis, and theory-of-change based action planning. Following the workshops, the study team participated in reflective sensemaking in which they deliberated on their experiences and notes from facilitating the workshops to assess the extent to which the participants demonstrated transformative thinking about rural water systems. The workshop approach showed promise in shifting how local government participants think about rural water services beyond technical fixes towards addressing deep-seated issues. However, further work is required to foster new relationships necessary to support transformation and grapple with ethical dilemmas pertaining to power dynamics at community and government levels. Nevertheless, the approach presented here is a replicable, low-cost way to prepare local government stakeholders in Nepal for transforming their thinking and systems to ways that enable sustainable rural water service delivery under threats of climate change.

The differential needs and expectations from general practitioners in oncology between high-income countries and low- and-middle-income countries: results from a survey of Canadian and Nepali oncologists.

To address the shortage of oncologists in the wake of the rapidly increasing global cancer burden, general practitioners of oncology (GPOs) have been added to cancer care teams worldwide. GPOs are family physicians with additional training in oncology and their roles differ by both country and region. In this study, we aimed to learn about the roles and expectations of GPOs from the perspective of oncologists in Canada and Nepal. A survey was designed and administered to Canadian and Nepali Oncologists between February and November 2022 using Research Electronic Data Capture, a secure web-based software platform hosted at Queen's University in Kingston, Ontario, Canada. Participants were recruited through personal networks/social media in Nepal and the survey was distributed through an email list provided by the Canadian Association of Medical Oncologists. The survey received 48 responses from Canadian and 7 responses from Nepali oncologists. Canadian respondents indicated that in terms of educational content delivery, clinics with oncologists followed by didactic lectures by oncologists were thought to be the most effective, followed by a small group learning and online education. Nepali oncologists also indicated didactic lectures by oncologists and small group learning would be the most effective teaching techniques, followed by online education and clinics with oncologists. Critical knowledge domains and skills most relevant for GPO training identified by Canadian respondents were managing pain and other common symptoms of cancers, as well as treatment of common side effects, followed by goals of care discussion, post-treatment surveillance for recurrence, and the management of long-term complications from treatment. Respondents from Nepal, however, suggested an approach to diagnosis to patient with increased risk of cancer, and cancer staging were the most critical knowledge domains and skills. The majority of oncologists in both countries thought a training program of 6-12 months was optimal. We found many similarities in oncologist's opinions of GPOs between the two countries, however, there were also some notable differences such as the need to provide cancer screening services in Nepal. This highlights the need to tailor GPO training programs based on local context.

Pediatric oncology services in Nepal: A special focus on pharmacy practice.

The role of clinical pharmacists or oncology pharmacists in pediatric oncology has been established as important in anticancer regimen review, dose calculation, recommendation, chemocounseling, identification of drug-related problems, its resolution, and, prevention and monitoring of adverse drug reactions within high-income countries. With several hospitals providing pediatric oncology services in Nepal, clinical pharmacist involvement in these hospitals is very poor. Upon reviewing the reputed organization and association focused on pediatric oncology pharmacy practice, it looks imperative for Nepal to initiate clinical pharmacy services which will further help in improving patient health outcomes. As such in this commentary, we try to accentuate the pediatric oncology services and pediatric pharmacy practice within Nepal and try to pinpoint the potential areas for clinical pharmacists to focus if they intend to provide services in pediatric oncology pharmacy practice.

Striving towardsafe abortion services in Nepal: A review of barriers and facilitators.

Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion-related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio-cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio-cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio-cultural, geographic/accessibility, and health systems factors. The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse-midwives and community health volunteers are key facilitators.

High Interest in the Use of mHealth Platform for HIV Prevention among Men Who Have Sex with Men in Nepal.

Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition.

Exploring Antenatal Health Care Service Utilization in Nepal: A Comprehensive Analysis

The utilization of maternal health care is one of the important factors in reducing the incidence of maternal mortality. Studies in Nepal and in developing countries shows that various demographic, socio-economic and economic factors are associated with ANC service utilization. The main objective of this study is to identify and examine socio-demographic and economic factors affecting antenatal healthcare service utilization in Nepal. This study used data from the Nepal Demographic and Health Survey 2016 and analyzed the data using logistic regression analysis. This research analyzes ANC (antenatal care) concerning dependent variables: age, birth order, religion, ethnicity, educational attainment, province, residence, and wealth indices. Maternal health has been receiving increased attention in the global health, development, and human rights agenda, representing a priority area for accelerating progress on the SDGs and sustaining the gains of the MDGs. Bivariate analysis was conducted for all variables, and some of them were statistically significant at the 5 percent significance level (since p &lt; 0.05). The dichotomous use of modern maternal healthcare utilization, namely whether a woman utilized maternal health care or not, employed dichotomous logistic regression to determine which factors best explain and predict the outcome of maternal health care utilization during pregnancy. A positive estimated value indicates that the odds favor the event and the event is likely to occur, while a negative value indicates that the event is not likely to occur. ANC visits of women decrease with birth order. Based on empirical results, the major factors for ANC services were income, awareness, access to health care services, and birth order attended. The level of awareness among women about the utilization of maternal healthcare in the study area was low. Maternal healthcare service utilization differed across various components of maternity. It would be better to increase awareness about the utilization of modern maternal healthcare for mothers and improve access to healthcare services in their villages to minimize transportation costs and waiting times from the government's side, thus increasing the utilization of maternal health care services in Nepal.

Future Policy Direction of Special/Inclusive Education in Nepal

This study critically analyzed the future policy direction of special/inclusive education in Nepal. Using qualitative data collected through document analysis, interviews, and focus group discussions. This study is based on the premises of qualitative research design under the interpretative paradigm followed by critical interpretive design to analyze and interpret the field data. For this, 15 (fifteen) policy experts from Ministry of Education, Science, and Technology, Department of Education, university professors, and 11 head teachers from 6 special and 5 integrated schools, and special education council members and members of disabled related organizations were purposively selected as the informants.&#x0D; The establishment of the Disability Right Commission at central level would be much effective for the overall development of special/inclusive education in Nepal. It has also been found that establishment of the special/inclusive education council secretariat would contribute to further expansion of special/inclusive education service in Nepal. Development of a provincial level master plan for special/inclusive education training for stakeholders has been strongly recommended for the overall development of special education in the country. The study also suggested that future policy development and its practice is to be based on research-based evidence. It also recommended for establishment of at least one special education center and one model school in each province, and at least one support center at each local level.&#x0D; This study implies that a coherent policy-making is required through the consultation with the relevant stakeholders from the central, provincial, and local level in such a way that there is minimum gap in the power sharing among agencies at different levels of governance. Finally, this study suggests for developing future policies that support establishment of residential schools, individual education plan, transitional planning and individualized family service plans to enhance the promotion of disability sector in Nepal.

Scaling up Business Development Services Through Incubation Centers

Micro, small and community based enterprises needed embedded business development services to start, scale up and sustain a business. This study aimed to proposes a conceptual framework to establish a business incubation center to scale up business development services in Nepal. This paper has used qualitative research that includes (i) interaction with stakeholders, (ii) focus group discussion, and (iii) observation. A qualitative content analysis approach was used to analyze the contents of the discussion. Key points and quotes were extracted, synthesized. The study suggests a greater need of sustained business development services and incubation model would provide that specially to micro, small and community based enterprises. establishing business incubation center at local level with joint collaboration between local government, academia, professionals and private sectors can provide a sustainable model.

Status of the Building Blocks for Sustainable Water, Sanitation, and Hygiene (WASH) Systems in Nepal: A Review

The paper aims at reviewing the building blocks of sustainable water, sanitation, and hygiene (WASH) systems in the context of Nepal. The study consisted of a descriptive research design based on secondary data that were collected from different published documents. The review was made through descriptive comparison, percentages, graphs, and ratios to compare whether the country’s status is in line with the global context. The study concludes that the proportion of the population having safely managed water services in Nepal (16 percent) is quite lower than the global average (73 percent). Moreover, the proportion of the population having safely managed sanitation services in Nepal (51 percent) is slightly lower than the global average (57 percent). Similarly, the proportion of the population having basic hygiene services in Nepal (64 percent) is lower than the global average (75 percent). Furthermore, the findings on the status of water, sanitation, and hygiene (WASH) systems are mixed in the context of Nepal. Some of them have good progress and some of them need to be accelerated to go a long way to achieve sustainable development goals (SDGs) by 2030. The study further concludes that institutionalization, policy and legislation, and accountability mechanisms at the federal level have been initiated while it is yet to materialize at the provincial and local levels. In the case of planning, only 10 percent of rural/municipalities completed their WASH plan. In terms of finance, there is not only a resource gap but also two-thirds of the total country’s WASH budget has been allocated at the federal level. Action research should be prioritized to capture learning and awareness leading to adaptation and knowledge creation in the sector. The study can be extended by incorporating the citizens’ views on WASH systems strengthening in the context of Nepal.

Follow-up assessment of visceral leishmaniasis treated patients and the impact of COVID-19 on control services in Nepal

BackgroundFollow-up assessment of visceral leishmaniasis (VL) treated cases is important to monitor the long term effectiveness of treatment regimens. The main objective of this study was to identify the gaps and challenges in the follow-up of treated VL cases, to monitor treatment outcome and to assess the impact of COVID-19 on VL elimination services and activities.MethodsClinicians treating VL patients, district focal persons for VL, and patients treated for VL in seven high endemic districts in Nepal during 2019–2022 were interviewed to collect data on challenges in the follow-up of VL treated patients as per national strategy.ResultsFollow up status was poor in two districts with the largest number of reported cases. The majority of cases were children under 10 years of age (44.2%). Among 104 VL treated cases interviewed, 60.6% mentioned that clinicians had called them for follow-up but only 37.5% had complied. Among 112 VL treated cases followed up, 8 (7.14%) had relapse and 2 (1.8%) had PKDL. Among 66 cases who had VL during the COVID-19 lock down period, 32 (48.5%) were diagnosed within 1 week; however, 10 (15.1%) were diagnosed only after 4 weeks or more. During the COVID-19 pandemic, there was no active search for VL because of budget constraints and lack of diagnostic tests, and no insecticide spraying was done.ConclusionRelapses and PKDL are challenges for VL elimination and a matter of concern. Successful implementation of the national strategy for follow up of treated VL cases requires addressing elements related to patients (awareness, transport, communication) clinicians (compliance) and organization of service delivery (local health worker training and deployment). COVID-19 did not have much impact on VL diagnosis and treatment; however, public health programmes including active case detection and insecticide spraying for vector control were severely reduced.

Community forestry dominates the recent land greening amid climate change in Nepal

The Himalaya Plateau including Nepal is ‘greening up’ that has important implications to ecosystem services such as water supply, carbon sequestration, and local livelihoods. Understanding the combined causes behind greening is critical for effective policy makings in forest management and climate change adaptation towards achieving sustainable development goals. This national scale study comprehensively examined the natural and anthropogenic drivers of the long-term trend of vegetation dynamics across Nepal by correlation analysis and multiple linear regression analysis. We integrated multiple sources of data including global satellite-based leaf area index (LAI), climate data, landcover data, and forest land management information. Our study reveals a remarkable annual mean LAI increase of 22% (0.009 m2 m−2 yr−1) (p < 0.05) from 1982 to 2020, with an acceleration in the rate of increase to 0.016 m2 m−2 yr−1 (p < 0.05) after 2004. The community forestry (CF) program, forest area changes, and soil moisture availability accounted for 40%, 12%, and 10% of LAI temporal variability, respectively. Our analysis found soil moisture and forest area changes to be the primary drivers of the greening trend before 2004, while CF and forest expansion were the dominant factors thereafter. Additionally, interannual vegetation dynamics were significantly influenced by winter precipitation, incoming solar radiation, and pre-monsoon soil moisture. The projections based on four Earth System Models from Coupled Model Intercomparison Project Phase 6 suggest that Nepal’s greening trend is expected to continue at a rate of 0.009 m2 m−2 yr−1 (p < 0.05) throughout the 21st century. We conclude that forest management program (CF) amid climate change that alters water and energy conditions have enhanced land greening, posing both opportunities and risks to ecosystem services in Nepal. This study provides much needed national-level information for developing forest management policies and designing Nature-based Solutions to respond to climate change and increasing demands for ecosystem services in Nepal.

Major Factors Influencing the Utilization of Maternal Health Services in Nepal

Background: According to the World Health Organization, maternal health services (MHS) include antenatal care, perinatal care, and postnatal care. MHS have been underutilized in Nepal and are contributing to an increased morbidity and mortality in the region leading to various adverse outcomes for both mothers and their newborns. Many of these adverse outcomes can be avoided with increased use of antenatal, perinatal, and postnatal checkups. Methods: Literature reviews of existing information about MHS in Nepal presents an opportunity to identify the source of underutilization and by understanding the source, plans can be proposed to improve MHS. Search for the data was achieved through Medline, Springerlink, and Nepal journals online; with additional articles found by branching off the references of those articles. Publications were limited to those written or translated into English, and those related to Nepal demography. Articles were excluded if the report was not referring specifically to Nepal. In this study, all three natal periods are addressed. Results: Cultural aspects, educational aspects and accessibility have been determined to be the leading causes of the underutilization of MHS. Conclusion: Using this new understanding, interventions focused on improving and providing education about these barriers should lead to reduced morbidity and mortality among mothers and their newborns in Nepal.

Outcome of the critically ill patient brought to emergency department and their mode of transportation

Introduction: General Practice and Emergency Medicine is the backbone of the health system of a developing country like Nepal with a significant number of cases being encountered in the general practice clinics and Emergency Department (ED). However, Emergency Medical Services in Nepal face significant challenges with a need for numerous improvements. The medical care provided while using ambulance services in Nepal is insufficient. This study assessed the outcomes of patients brought to Patan Hospital's ED, considering the method of transportation used for their arrival. Method: A cross-sectional analytical study was conducted at Patan Hospital from April 2021 to March 2022. Total 72 patients were considered for the study. Frequency, Percentage, Median, and Inter-quartile Range were calculated for descriptive analysis. The Chi-square test was used for analytical study and p-value &lt;0.05 was considered statistically significant. Result: The maximum percentage of critically ill patient was 25.0% (in age group of &gt;60 years) and the minimum was 8.3% (in age group of 0-14 years). 66.7% were male and 33.3% were female. Among all, 34.7% patients presented to emergency via ambulance (33.3% via ka/kha and 1.4% via gha ambulance), 37.5% via private transportation (27.8% via bike and 9.72 via car) and 27.8% patients via public transportation (18.05% via taxi and 9.72 via micro/bus/tempo). There was no association between the modes of transportation and the mortality outcomes and ICU admission among the critically ill patient (p=0.385, and p=0.716 respectively). Conclusion: Regardless of the transportation method, there was no significant difference in mortality outcomes and the requirement for ICU care among critically ill patients presenting to the emergency department signifying the insufficient emergency medical services provided during the ambulance transportation.

The Evolution of Alternative Care in Nepal over the Last Decade and Way Forward

Our article focuses on the national efforts advancing children’s right to alternative care services in Nepal. It presents the government’s existing laws and policies in providing responsible care to children in need of special protection and for children who cannot be placed in parental care due to various reasons for family separation. This article also looks into the history of alternative care in Nepal and discusses the alternative forms of care practised in the communities and their evolution, upholding the best interest of the child. We share the promising practices of kinship care and foster care (informal and formal) for children at risk of separation and child institutionalisation and for children removed from orphanages and children’s homes for family reintegration, implemented by The Himalayan Innovative Society in Nepal in partnership with Forget Me Not and Hope and Homes for Children. We, finally, conclude by sharing the key challenges and opportunities in the implementation of alternative care services for children in Nepal driving the care reform in the country.