Universal Access to Essential Medicines: An Evaluation of Nepal’s Free Health Care Scheme

Adhikari, Shiva Raj; Pandey, Achyut Raj; Ghimire, Mamata; Thapa, Arjun Kumar; Lamsal, Dinesh Kumar

doi:10.3126/jnhrc.v16i1.19361

Cited by 7 publications

(8 citation statements)

References 6 publications

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“…However, availability and stock out of medicines in the studied villages of Annapurna region was comparable to other places of Nepal when compared to a study from Adhikari et al carried out in 2014 which reported 92.44% availability and 0.324 days of stock-out of medicines [15]. Study from Adhikari et al included both primary healthcare facilities and private drug retailers and was carried out in all three geographical region of Nepal the mountains, hills and plains while our study was carried out in the hills and mountain region only and did not included primary health care facilities and private drug retailers due to their absence in the studied villages [15]. This improvement could be due to both better logistics provision (better physical infrastructure of health facilities, good walking trails, access to porters and mules to carry goods and additional financial support from VDCs) in the Annapurna region because of sustainable tourism and local development initiatives, and improvement in the delivery of free basic healthcare services over the years since their inception in 2007 [8, 17].…”

Section: Discussionsupporting

confidence: 70%

“…The overall state of access to medicines in the studied villages of the Annapurna region was good in comparison to a Nepalese study (2014) in Kathmandu, Banke and Bardia districts which reported 50–77% availability and 30% stock out of medicines, and international studies in Kenya (2009) with 46 days stock-out of medicines and in Jamaica (2010) with 90 days stock-out of medicines and unaffordable medicines prices [17–19]. However, availability and stock out of medicines in the studied villages of Annapurna region was comparable to other places of Nepal when compared to a study from Adhikari et al carried out in 2014 which reported 92.44% availability and 0.324 days of stock-out of medicines [15]. Study from Adhikari et al included both primary healthcare facilities and private drug retailers and was carried out in all three geographical region of Nepal the mountains, hills and plains while our study was carried out in the hills and mountain region only and did not included primary health care facilities and private drug retailers due to their absence in the studied villages [15].…”

Section: Discussionmentioning

confidence: 78%

“…The literature also show that there is a linkage between medicines and local community efforts, medicines and international aid, medicines and an inadequate health system and other societal features in the Annapurna region [1–5, 13–15]. However, there is a dearth of studies investigating the interaction between medicines, society, health systems and stakeholders, and the impact on access to and use of medicines.…”

Section: Introductionmentioning

confidence: 99%

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Access to and use of medicines in the Annapurna region of Western Nepal and possible impacting factors

Heydon

Norris

2019

J of Pharm Policy and Pract

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Improving access to medicines is a major healthcare challenge for low-income countries because the problem traverses health systems, society and multiple stakeholders. The Annapurna region of Nepal provides a valuable case study to investigate the interplay between medicines, society and health systems and their effects on access to and use of medicines. Government health facilities and international aid organizations provide some healthcare in the region, communities participate actively in healthcare organization and delivery, there is an important tourism sector and a mostly rural society. This study investigates access to and use of medicines through health facility and household-based studies using standardised tools and through a series of structured key informant interviews with various stakeholders in health. Overall, access to essential medicines at public health facilities was good, but this was not benefitting households as much as it should. People were using the private sector for medicines because of their perception about the quality and limited numbers of government-supplied free medicines. They utilised money from remittances and tourism, and subsidised healthcare from non-government organizations (NGOs) to access healthcare and medicines. A pluralistic healthcare system existed in the villages. Inappropriate use of medicines was found in households and was linked to the inadequate health system, socioeconomic and sociocultural practices and beliefs. Nevertheless, the often disadvantaged Dalit users said that they did not face any discrimination in access to health services and medicines. The government as the main stakeholder of health was unable to meet people’s health services and medicines needs; however, health aid agencies and the local community supported these needs to some extent. This study shows that the interconnectedness between medicines, society and health systems impacts the way people access and use medicines. Improving access to medicines requires an improvement in public’s perception about quality, actual coverage and appropriate use of medicines and health services via collaborative contributions of all stakeholders. Electronic supplementary material The online version of this article (10.1186/s40545-019-0172-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Access to and use of medicines in the Annapurna region of Western Nepal and possible impacting factors

Heydon

Norris

2019

J of Pharm Policy and Pract

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“…The government of Nepal has been providing the essential medicines to government and public health facilities across the country even before the pandemic [ 45 ]. During the pandemic, the patients had timely access to life saving medicines for COVID-19 complications, as reflected in this study.…”

Section: Discussionmentioning

confidence: 99%

Experiences of COVID-19 patients admitted in a government infectious disease hospital in Nepal and its implications for health system strengthening: A qualitative study

et al. 2021

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Introduction The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient’s experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening’s implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal. Methods In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization’s six building blocks of health system as a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines. Results Most patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the health system such as financing, governance and leadership, and access to medicines reflected upon by the patients’ thankfulness to the hospital and the government for the treatment they received. The responses also reflected the inter-connectedness between the different building blocks of health system. Conclusion This study approached a unique way to strengthen the health system by exploring patients’ feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government’s role to continue its efforts to strengthen the health system.

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“…interventions in countries such as Nepal [82,90], Ugunda [117,118] Rwanda [75], Tanzania [50,77], Ethiopia [119], Afghanistan [62] and…”

Section: Discussionmentioning

confidence: 99%

Best Practices in Achieving Universal Health Coverage: A Scoping Review

Koohpayehzadeh

Azami-Aghdash

Derakhshani

et al. 2020

Preprint

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Background: Universal health coverage (UHC) is a very important and effective policy in the health system of countries worldwide. Using the experiences and learning from the best practices of successful countries in the UHC can be very helpful. Therefore, the aim of the present study is to provide a scoping review of successful global interventions and practices in achieving UHC. Methods:The present study is a scoping review study has conducted using the Arkesy and O'Malley framework. To gather information the databases of Embase, PubMed, The Cochrane Library, Scopus, SID and MagIran have searched using the keywords of Universal health coverage, Universal healthcare coverage, Universal health care coverage, Strength*, Transfer*, interventions, improve*, program*, innovations, initiative, Financing, "Service delivery", Stewardship, "Resource generation", from 2000 to 2019. Content-Analysis was also used to analyze the data.Results: Out of 4257 articles, 57 evidence finally included in the study. The results showed that of the 40 countries that had successful interventions, most were Asian. The interventions were financial protection (40 interventions that categorized to 14 items), service coverage (31 interventions that categorized to 7 items), population coverage (36 interventions that categorized to 9 items) and quality (18 interventions that categorized to 7 items) respectively. Also, the successful result were conducted financial protection (14 items), service coverage (7 items), population coverage (9 items) and quality (7 items)) respectively. Conclusion:This study provides a comprehensive and clear view of successful interventions in achieving to UHC. Therefore, with consideration to lessons learned from successful interventions, policymakers can be designing appropriate interventions to their country. a significant impact on health promotion, easier access to health care for those in need, and improved public health, especially for the poor [12].Given the importance of achieving UHC for high-and middle-income countries, the number of countries trying to achieve this has increased in the last two decades [13, 14]. In addition, nowadays countries by increasing their knowledge and awareness of strategies and applying the experiences of successful countries, as well as acquiring the necessary capabilities to meet their urgent needs, are trying to take the path of achieving UHC [15][16][17]. Like other high-income countries that have achieved UHC, low and middle-income countries, with taking into account the structure and resources that they have, on the path to UHC, undertake measures such as mobilizing resources, fulfilling the political commitments necessary to implement health-related policies, and implementing effective reforms and interventions in macro-national policies [1, 18, 19]. The UHC can be one of the most challenging political processes that require the support of various stakeholders, including health system policymakers [4]. Although all countries pursue the same goal of achieving UHC, the path...

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Universal Access to Essential Medicines: An Evaluation of Nepal’s Free Health Care Scheme

Cited by 7 publications

References 6 publications

Access to and use of medicines in the Annapurna region of Western Nepal and possible impacting factors

Access to and use of medicines in the Annapurna region of Western Nepal and possible impacting factors

Experiences of COVID-19 patients admitted in a government infectious disease hospital in Nepal and its implications for health system strengthening: A qualitative study

Best Practices in Achieving Universal Health Coverage: A Scoping Review

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