Health system gaps in cardiovascular disease prevention and management in Nepal

Archana Shrestha, Rashmi Maharjan, Biraj Man Karmacharya, Swornim Bajracharya, Niharika Jha, Soniya Shrestha, Anu Aryal, Phanindra Prasad Baral, Rajendra Dev Bhatt, Sanju Bhattarai, Durga Bista, David Citrin, Meghnath Dhimal, Annette L Fitzpatrick, Anjani Kumar Jha, Robin Man Karmacharya, Sushmita Mali, Tamanna Neupane, Natalia Oli, Rajan Pandit, Surya Bahadur Parajuli, Pranil Man Singh Pradhan, Dipanker Prajapati, Manita Pyakurel, Prajjwal Pyakurel, Binuka Kulung Rai, Bhim Prasad Sapkota, Sujata Sapkota, Abha Shrestha, Anmol Purna Shrestha, Rajeev Shrestha, Guna Nidhi Sharma, Sumitra Sharma, Donna Spiegelman, Punya Shori Suwal, Bobby Thapa, Abhinav Vaidya, Dong Xu, Lijing L Yan, Rajendra Koju, Archana Shrestha, Rashmi Maharjan, Biraj Man Karmacharya, Swornim Bajracharya, Niharika Jha, Soniya Shrestha, Anu Aryal, Phanindra Prasad Baral, Rajendra Dev Bhatt, Sanju Bhattarai, Durga Bista, David Citrin, Meghnath Dhimal, Annette L Fitzpatrick, Anjani Kumar Jha, Robin Man Karmacharya, Sushmita Mali, Tamanna Neupane, Natalia Oli, Rajan Pandit, Surya Bahadur Parajuli, Pranil Man Singh Pradhan, Dipanker Prajapati, Manita Pyakurel, Prajjwal Pyakurel, Binuka Kulung Rai, Bhim Prasad Sapkota, Sujata Sapkota, Abha Shrestha, Anmol Purna Shrestha, Rajeev Shrestha, Guna Nidhi Sharma, Sumitra Sharma, Donna Spiegelman, Punya Shori Suwal, Bobby Thapa, Abhinav Vaidya, Dong Xu, Lijing L Yan, Rajendra Koju

Abstract

Background: Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal's health systems gaps to prevent and manage CVDs.

Methods: We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts' codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system.

Results: National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible.

Conclusion: Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

Keywords: CVDs; Health system building blocks; Health system performance; Nepal.

Conflict of interest statement

There are no competing interests.

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