General practitioner and obstetric service in rural Nepal: A way forward

Joshi, Arbin; Awale, P; Bohler, Eric

doi:10.3126/njog.v4i1.3330

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…A study in BH’s catchment area demonstrated institutional capacity and distance from home to be key factors influencing women’s decisions regarding home vs institutional birth [ 14 ]. In a single-facility study in rural Nepal, 93% of cesarean sections were performed on an emergency basis [ 22 ], supporting the notion that presentations are often late, and timely referrals are infeasible in the remote hills of Nepal.…”

Section: Discussionmentioning

confidence: 90%

Role of the general practitioner in improving rural healthcare access: a case from Nepal

Gauchan¹,

Mehanni²,

Agrawal³

et al. 2018

Hum Resour Health

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BackgroundThere is a global health workforce shortage, which is considered critical in Nepal, a low-income country with a predominantly rural population. General practitioners (GPs) may play a key role improving access to essential health services in rural Nepal, though they are currently underrepresented at the district hospital level. The objective of this paper is to describe how GPs are adding value in rural Nepal by exploring clinical, leadership, and educational roles currently performed in a rural district-level hospital.Case presentationWe perform a descriptive case study of clinical and non-clinical services offered at Bayalpata Hospital prior to and following the initiation of GP-level services in 2013. Bayalpata is a district-level public hospital managed through a public private partnership by the nonprofit healthcare organization Possible. We found that after general practitioners were hired, additional clinical services included continuous emergency obstetric care, major orthopedic surgeries, appendectomy, tubal ligation, and vasectomy. This time period was associated with increased emergency department visits, inpatient admissions, and institutional birth rate in the hospital’s catchment area. Non-clinical contributions included the development of a continuing medical education curriculum and implementation of a series of quality improvement initiatives.ConclusionsGPs have potential to bring significant value to rural district hospitals in Nepal. Clinical impact may include expanded access to surgical and emergency obstetric services, which would more fully align with local health needs, and could further reduce Nepal’s maternal mortality rate. Task-shifting and structured training programs would be required to increase orthopedic surgery capacity, but this would contribute to meeting local healthcare needs. Non-clinical impact may include supervision of health workers and leadership in continuing medical education and quality improvement initiatives. These changes can lead to improved health worker recruitment and retention in rural posts. Limitations include generalizability of our results to other district hospitals in Nepal and lack of data from control hospitals. This analysis provides an additional perspective on the potential value GPs can add in rural Nepal, through provision of a wide range of clinical and non-clinical services. It supports the expansion of GPs to additional district hospitals in Nepal’s public sector.

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Section: Discussionmentioning

confidence: 90%

Role of the general practitioner in improving rural healthcare access: a case from Nepal

Gauchan¹,

Mehanni²,

Agrawal³

et al. 2018

Hum Resour Health

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show abstract

“…Additionally, incorporating GPs into obstetric services is seen as a means to enhance maternal healthcare in rural Nepal. [2][3][4] GPs are already leading most of the district-level hospitals in Nepal, providing holistic primary health care. This primary health care model led by GPs is identified as an effective platform for addressing Non-Communicable Diseases (NCDs) through preventive and curative interventions.…”

Section: Introductionmentioning

confidence: 99%

General Practice Reformative Agenda 2024 (protocol)

Shrestha,

Ghimire,

Bajracharya

et al. 2023

jgpeman

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The healthcare system undergoes frequent reforms, including various services. General practice (GP), a longstanding specialty in Nepal, now requires further changes, due to changing and growing needs of the country. To facilitate this, it's essential to identify key areas for reform supported by evidence. To gather evidence, we've designed a qualitative study based on grounded theory. The researcher aims to engage with a large number of GPs using virtual methods. Participants will be contacted through focused group discussions, key-person interviews, polls, and debates. In the first round, key issues will be identified, and in the second round, potential solutions will be explored. Our goal is that these findings will assist stakeholders in pinpointing gaps in policies, educational strategies, research, and the overall development of GPs. With the implementation of these findings, we anticipate a well-defined role for GPs within the national health system.

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“…In some areas, General Practitioners (GPs) are providing primary health care including basic surgical care and caesarean sections. 1,2 We have no criteria to test GPs about their surgical abilities and to allow them to perform certain type of surgeries. We lack the national data about how many major surgeries are being performed by GPs.…”

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confidence: 99%

Rural surgery: Time for a new specialty!

Joshi¹

2010

jgpeman

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General practitioner and obstetric service in rural Nepal: A way forward

Cited by 3 publications

References 8 publications

Role of the general practitioner in improving rural healthcare access: a case from Nepal

Role of the general practitioner in improving rural healthcare access: a case from Nepal

General Practice Reformative Agenda 2024 (protocol)

Rural surgery: Time for a new specialty!

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