Health sector readiness for the prevention and control of NCDs: A multi-method qualitative assessment in Nepal

Abstract

In Nepal, deaths attributable to NCDs have increased in recent years. Although NCDs constitute a major public health problem, how best to address this has not received much attention.

The objective of this study was to assess the readiness of the Nepalese health sector for the prevention and control of NCDs and their risk factors. The study followed a multi-method qualitative approach, using a review of policy documents, focus group discussions (FGDs), and in-depth interviews (IDIs) conducted between August and December 2020. The policy review was performed across four policy categories. FGDs were undertaken with different cadres of health workers and IDIs with policy makers, program managers and service providers. Researchers performed content analysis using the WHO health system building blocks framework as the main categories. Policy documents were concerned with the growing NCD burden, but neglect the control of risk factors. FGDs and IDIs reveal significant perceived weaknesses in each of the six building blocks. According to study participants, existing services were focused on curative rather than preventive interventions. Poor retention of all health workers in rural locations, and of skilled health workers in urban locations led to the health workers across all levels being overburdened. Inadequate quantity and quality of health commodities for NCDs emerged as an important logistics issue. Monitoring and reporting for NCDs and their risk factors was found to be largely absent. Program decisions regarding NCDs did not use the available evidence.

The limited budget dedicated to NCDs is being allocated to curative services. The engagement of non-health sectors with the prevention and control of NCDs remained largely neglected. There is a need to redirect health sector priorities towards NCD risk factors, notably to promote healthy diets and physical activity and to limit tobacco and alcohol consumption, at policy as well as community levels.

Conclusion

This study has revealed important limitations in the readiness of the Nepalese health sector to respond the growing NCD pandemic, pointing to the need for reform. There is a critical gap in the formulation and implementation of NCD-targeted policies and community-based programs–notably with regards to implementing evidence-based interventions to promote healthy diets and physical activity and to strengthen preventive interventions concerned with tobacco and alcohol consumption–across the six building blocks of the health system.

With an increasing life expectancy, a growing elderly population will further exacerbate existing problems and this must be taken into account in advancing the health sector response to NCDs. Moreover, urbanization and changed lifestyles in Nepalese society must be considered, and sectors other than health involved with successful prevention and control of NCD risk factors.

Much of this study’s assessment of health sector readiness is derived from the perceptions of different cadres of health workers and health decision-makers at national, provincial and community levels; future research should follow up with a quantitative assessment of health sector readiness, trying to triangulate qualitative and quantitative insights.

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