In line with the constitution of Nepal (2007) which enshrined health as the basic right of citizens, the Government of Nepal (GoN), Ministry of Health (MoH) provisioned essential health care services to be delivered free of cost at the point of use since 2008. Expansion of free care has led to many other initiatives i.e. Aama and Newborn Surakshya Program, Uterine Prolapse etc. To provide access to health care beyond the free care and to reduce out of pocket expenditure which currently stands at more than 50% of the total health expenditure, since 2015 the GoN has rolled out a Social Health Insurance scheme throughout the country in a phase wise manner. In 2017/2018 the program is slated to cover 25 districts. The Nepal Health Sector Strategy (NHSS) 2016-2021 guides priority activities in the health sector. It has set improving the efficiency, economy and transparency of procurement and supply chain of essential medicines and equipment as one of the outcome objectives.
With Financial support from USAID, HERD International is implementing this study to identify facilitators and barriers in procurement and supply chain management and prescribing patterns of providers. The findings will ultimately help to inform the existing PSM of essential drugs and commodities at all three tiers of the governments: Federal, provincial and local, and suggesting a re-structuring of the functions considering the federal context to ensure the essential drugs are available at the point of care.
Overall purpose of the project:
To examine the factors that associate to the stock out of free essential medicines at government health facilities.
The specific objectives of the study are as follows:
- To identify the top five factors associating to the stock out.
- To examine medicine prescription practices by the health provider
- To examine medicine dispensing practices at health facilities
- To assess client’s demand for medicines and user- factors that may potentially associate to stock outs.
- To explore the procurement and supply chain management mechanisms of drugs in the federal context.
Project focal person
Project’s focal person is Dr. Chandani Kharel
Methodology that we plan to employ is a mixed method study, both qualitative and quantitative approaches to collect and analyze data. A total of 272 health facilities have been selected across 7 provinces to enumerate in this study. Quantitative research through structured questionnaire aided interviews will be conducted. A total of 420 exit client interview will be conducted in selected 272 health facilities, 168 observation of client-health worker interaction will be conducted and 420 prescription audit will be conducted to help us identify the number and types of medicines and antibiotic prescribed. Qualitative data collection through semi-structured interviews (SSIs) will be conducted. A total of 76 SSI will be conducted, 10 at central level, 14 at provincial level, 27 district level/local level, 7 at PHCC level and 18 at HP level.
Province 1, Districts – Sunsari, Sankhuwasabha, Ilam
Province 2, Districts – Siraha, Saptari, Sarlahi
Province 3, Districts – Kavre, Makwanpur, Nuwakot
Province 4, Districts – Mustang, Manang, Baglung
Province 5, Districts – Kapilbastu, Arghakhanchi, Nawalparasi
Province 6, Districts – Mugu, Humla, Dolpa
Province 7, Districts – Doti, Bajura, Dadeldhura
Associated Team Members
Abriti ArjyalResearch Manager: Qualitative and Multidisciplinary Science
Key Expertise Ms. Abriti Arjyal works as Research Manager – Multidisciplinary Qualitative Research – at HERD International and has experience in the area of public health, health system and service delivery research, social science and gender, and equity. She is an emerging young researcher with more than seven years of experience leading formative and operational field studies, evaluation studies, and literature reviews, with expertise in design and implementation of qualitative research, and various community and participatory based approaches. She has sound knowledge [...]Learn more
Sushil Chandra BaralManaging Director
Key Expertise Dr Sushil Chandra Baral is an experienced heatlh and development expert of Nepal, specialising in health systems strengthening and health policy and planning at the national and international level. He has twenty five years of experience in health systems and services, health policy and planning, operational research and social development sector in developing countries context. He has got considerable professional experience in health system, health policy and planning, health service delivery, health research and programme management. He has [...]Learn more
Shophika RegmiSenior Manager: Health System Research, Evaluation and Learning
Personal bio Ms Shophika has been working in health and social research for nearly a decade. During these years, she has led and managed research projects of different nature and scale, which include implementation research, evaluation research, national level surveillance study, large-scale survey and mixed methods studies. She also has a good experience of literature and policy reviews using systematic review and critical appraisal techniques. Having a keen interest in health systems research, her current engagements are focused on health [...]Learn more
Saugat Pratap KCKnowledge Management Officer
Personal bio Mr. KC has always stuck by the words “in an increasingly competitive, cautious and accelerated world, those who are willing to take risks, step out of their comfort zone and into the discomfort of uncertainty will be those who will reap the biggest rewards”. He received his Bachelor’s degree from Rangsit University in Thailand in International Relations and development and completed his Masters of Public Health from BRAC James P. Grant School of Public Health from Bangladesh, after [...]Learn more
Private: Puja KCProject Officer - Audio Visual and Communication
Personal Bio Ms. Puja K.C is a registered public health professional working in health research. She has more than five years of professional working experience in the quantitative and qualitative research projects related to maternal, newborn and child health, reproductive health, NCDs, injury, disability, urban health, and health system. She is working as a Research and Data Management Officer at HERD International. She possesses expertise in data management, tools and database designing , training facilitation, field implementation, desk monitoring and [...]Learn more