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Health Services Availability and Readiness in Seven Provinces of Nepal

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Health Services Availability and Readiness in Seven Provinces of Nepal Health Services Availability and Readiness in Seven Provinces of Nepal Further Analysis of the 2015 Nepal Health Facility Survey DHS Further Analysis Reports No. 115 Government of Nepal Ministry of Health and Population DHS Further Analysis Reports No. 115 Health Services Availability and Readiness in Seven Provinces of Nepal Further Analysis of the 2015 Nepal Health Facility Survey Krishna Kumar Aryal1 Rajendra Dangol2 Pragya Gartoulla3 Giri Raj Subedi4 Ministry of Health and Population, Kathmandu, Nepal July 2018 1 DFID/NHSP3/MEOR, Abt Associates, Nepal 2 ICF 3 DFID/NHSP3/MEOR, Liverpool School of Tropical Medicine, Nepal 4 Ministry of Health and Population, Nepal Corresponding author: Krishna K Aryal, DFID Nepal Health Sector Programme 3 (NHSP3), Monitoring Evaluation and Operational Research (MEOR) Project, Abt Associates, Lalitpur-10, Lalitpur, Nepal; phone: +977 9851123730; email: [email protected] Ministry of Health New ERA and Population Editor: Bryant Robey Document Production: Joan Wardell This report presents findings from a further analysis undertaken as part of the follow-up to the 2015 Nepal Health Facility Survey (2015 NHFS). This study was carried out with support provided by the United States Agency for International Development (USAID) through The DHS Program (#AID- OAA-C-13-00095) and the UK Department for International Development (DFID). The views expressed are those of the authors and do not necessarily reflect the views of USAID or DFID or the United States Government or the UK Government. Additional information about the 2015 NHFS may be obtained from Ministry of Health and Population, Ramshah Path, Kathmandu; telephone: +977-1-4262543/4262802, internet: http://www.mohp.gov.np, and New ERA, Rudramati Marg, Kalopul, P.O. Box 722, Kathmandu, Nepal; telephone: +977-1- 4413603, e‑mail: [email protected], internet: http://www.newera.com.np/. The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate population, health, and nutrition programs. Additional information about The DHS Program can be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850 USA; telephone: +1 301-572- 0200, fax: +1 301-572-0999, email: [email protected], internet: www.DHSprogram.com. Recommended citation: Aryal, K. K., R. Dangol, P. Gartoulla, and G. R. Subedi. 2018. Health Services Availability and Readiness in Seven Provinces of Nepal. DHS Further Analysis Reports No. 115. Rockville, Maryland, USA: ICF. CONTENTS TABLES ................................................................................................................................................ vii FIGURES ............................................................................................................................................... xi FOREWORD ........................................................................................................................................ xiii ACKNOWLEDGMENTS ....................................................................................................................... xv ACRONYMS ....................................................................................................................................... xvii EXECUTIVE SUMMARY ..................................................................................................................... xix 1 INTRODUCTION ........................................................................................................................ 1 1.1 Objectives ..................................................................................................................... 1 1.2 Research Questions...................................................................................................... 2 1.3 Structure of the Report .................................................................................................. 2 2 METHODOLOGY ....................................................................................................................... 3 2.1 Definition of Key Terms ................................................................................................. 3 2.2 Sample and Sampling Weights ..................................................................................... 4 2.2.1 Sample of facilities ........................................................................................... 4 2.2.2 Sample of health workers and clients .............................................................. 4 2.2.3 Sampling weights ............................................................................................. 5 2.3 Final Sample ................................................................................................................. 5 2.3.1 Distribution of facilities ..................................................................................... 5 2.3.2 Distribution of providers and other respondents .............................................. 6 2.4 Data Analysis ................................................................................................................ 9 3 FINDINGS ON GENERAL SERVICE READINESS AND QUALITY OF CARE ..................... 11 3.1 Availability of Services ................................................................................................ 12 3.1.1 Availability of basic client services ................................................................. 12 3.2 Service Readiness: Basic Facility to Support Quality Service Provision and Client Use of Services .......................................................................................... 13 3.2.1 Waste segregation ......................................................................................... 13 3.2.2 Safe disposal of health care waste ................................................................ 14 3.2.3 Diagnostic capacity ........................................................................................ 15 3.2.4 Availability of essential medicines .................................................................. 17 3.3 Availability of Human Resources for Health ............................................................... 18 3.3.1 Sanctioned posts filled ................................................................................... 18 3.4 Logistics Management System ................................................................................... 18 3.4.1 Storage practice of medicines ........................................................................ 18 3.4.2 Timely supply of family planning commodities ............................................... 19 3.5 Quality of Care ............................................................................................................ 20 3.5.1 Minimum standard of quality of care .............................................................. 20 3.5.2 Compliance with service standards ............................................................... 21 3.5.3 Provision of quality services as per national standards ................................. 23 3.6 Free Health Care ......................................................................................................... 26 3.6.1 Clients receiving free health care................................................................... 26 4 CHILD HEALTH SERVICES ................................................................................................... 27 4.1 Availability of Child Health Services............................................................................ 27 4.1.1 Outpatient curative care, child growth monitoring, and child vaccination ...... 27 4.2 Service Readiness ...................................................................................................... 28 4.2.1 Guidelines, trained staff, and equipment for sick child care .......................... 28 4.2.2 Medicines and commodities for sick child care .............................................. 29 iii 4.2.3 Guidelines, trained staff and equipment for vaccination services .................. 33 4.2.4 Availability and storage of vaccines ............................................................... 34 4.3 Client Opinions ............................................................................................................ 35 4.3.1 Feedback from caretakers of observed sick children on service problems ........................................................................................................ 35 4.4 Supportive Management and Training of Service Providers ...................................... 36 4.4.1 General training and supervision ................................................................... 36 4.4.2 In-service training ........................................................................................... 36 5 FAMILY PLANNING SERVICES ............................................................................................. 39 5.1 Availability of Family Planning Services...................................................................... 39 5.1.1 Contraceptive method mix and method availability ...................................... 39 5.1.2 Specific methods offered ............................................................................... 40 5.1.3 Availability of family planning methods on the day of the assessment .......... 42 5.2 Service Readiness ...................................................................................................... 43 5.2.1 Service guidelines,
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