Non-Communicable Disease Service Readiness in Nepal: A Further Analysis of Nepal Health Facility Survey- 2021

Objective To assess the readiness of public and private health facilities(HFs) in delivering Cardiovascular Diseases(CVDs), Diabetes Mellitus(DM), Chronic Respiratory Diseases(CRDs), and Mental Health(MH) services in Nepal. Methods We analyzed data on service readiness for CVDs, DM, CRDs, and MH from Nepal Health Facility Survey 2021 using Service Availability and Readiness Assessment manual of the World Health Organization. Readiness score was measured as the average availability of tracer items in percent, and facilities were considered “ready” for Non-Communicable Diseases (NCDs) management if scored ≥70 (out of 100). We performed weighted descriptive analysis, univariate and multivariable logistic regression to determine association of readiness of HFs with province, type of HFs, ecological region, quality assurance activities, external supervision, client’s opinion review, and frequency of HF meetings. The result of regression analysis are presented as odds ratio with 95% confidence interval(CI) and p-value. Results Of 1581 facilities offering any NCDs related services, 93.1%(95% CI: 90.9 to 94.7), 75.8%(95%CI: 72.4 to 78.8), 99.3%(95%CI: 98.3 to 99.7) and 26.0%(95%CI: 23.0 to 29.2) provide CVDs, DM, CRDs and MH-related services respectively. The overall readiness score for CVDs, DM, CRDs, and MH-related services were 38.1±15.4, 38.5±16.7, 32.6±14.7 and 24.0±23.1 respectively with readiness score lowest for the guidelines and staff training domain and highest for essential equipment and supplies domain. Peripheral public HFs were more likely to be ready to provide all NCDs-related services as compared to federal/provincial facilities. The HFs with external supervision in past 4 months were less likely to be ready to provide CRDs and DM related services and HFs reviewing client’s opinions were more likely to be ready to provide CRDs, CVDs and DM related services. Conclusion Readiness of HFs to provide CVDs, DM, CRDs, and MH-related services was sub-optimal in Nepal. It is recommended to reform policy to improve service readiness for NCDs. Strengths and limitations of this study ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study used secondary data from the nationally representative cross-sectional survey, NHFS 2021 that are openly available in the website of DHS program () I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data are publicly available in the website of DHS program ()