Primary Care & Service Delivery

Bishnu Gautam, Vishnu Prasad Sapkota, Rajendra Raj Wagle · 2019 · Human Resources for Health

Nepal's OB-GYN shortage at the district level is measurable, not speculative: national fill rates for sanctioned physician/GP posts stand at just 37.9% (down from 56.5% in 2015), and Karnali province reports 0% of its sanctioned consultant and physician posts filled. Nepal also loses an estimated 2,000-2,400 doctors a year to emigration via NMC 'Good Standing Certificates,' over 70% of them permanently -- making retention packages for scarce specialists like OB-GYNs central to reducing Nepal's maternal mortality ratio of 151 per 100,000 live births (NDHS 2022). This DCE, designed to inform exactly the recruitment packages CEONC centres need, offers evidence directly usable by MoHP/DoHS and rural training institutions such as KAHS in Jumla.

Sarita Panday, Edwin van Teijlingen, Amy Barnes · 2024 · PLOS Global Public Health

Nepal's ~50,396 Female Community Health Volunteers (FCHVs) — unpaid since the programme began in 1988 and now paying half the NHIP premium as one of their few financial benefits — remain the backbone of rural primary healthcare, particularly in remote districts like Karnali where formal physician posts go unfilled. This qualitative study is among the few to ask FCHVs themselves, rather than policymakers, what sustains their motivation, directly speaking to DoHS's own documented concern about an ageing FCHV cadre and inconsistent compensation risking dropout. Its findings on opportunity costs and bureaucratic burden are directly relevant to the FY2026/27 budget decision to raise the FCHV transport stipend by 50% while stopping short of salarisation.

Prakash Raj Bhatt, Rabindra Bhandari, Shiksha Adhikari et al. · 2024 · PLOS Global Public Health

Digital health — specifically DHIS2 data quality — is named among Nepal's explicit 2026 digital-health reform priorities, and DHIS2 reporting now nominally covers all 753 local governments following the 2019 federal-structure rollout. Yet Nepal's federal design assigns local governments constitutional ownership of "basic health and sanitation" (Schedule 8) while health remains concurrently shared across all three tiers (Schedule 9) — a structural coordination gap documented by Wasti et al. (2023) — and this Gandaki-province study shows it concretely: DHIS2's servers, technical support, and training remain federally or provincially managed even though facility- and local-level staff carry the reporting burden.

Bikram Adhikari, Achyut Raj Pandey, Bipul Lamichhane et al. · 2023 · BMJ Open

Nepal's NCD burden is severe — NCDs cause 71.1% of deaths (GBD 2019) and hypertension affects 24.5% of adults (STEPS 2019) — yet the health system remains structured around a three-tier federal split where local governments (Constitution Schedule 8) hold responsibility for 'basic health and sanitation,' including the roughly 3,778 health posts and 187 PHCCs that serve as most Nepalis' first point of contact. This study's finding that facilities managed by local government were 96% less likely to be ready for CRD services (AOR 0.04) than federal/provincial hospitals exposes a critical devolution gap just as MoHP's WHO PEN package and the NCD Multi-Sectoral Action Plan (2021-2025) depend on exactly these peripheral facilities for screening, diagnosis and referral.

Rajshree Thapa, Ayse Zengin, Dinesh Neupane et al. · 2023 · Lancet Global Health

Nepal's NCD burden is large and rising -- hypertension affects 24.5% of adults (STEPS 2019) and NCDs account for 66-71% of all deaths (WHO 2022; Nepal Burden of Disease 2019) -- and the government's current reform priority is expanding WHO PEN-based NCD services at primary care using the same ~50,396-strong FCHV cadre this trial deployed. COBIN is a Nepal-based cluster RCT that directly tested the FCHV-delivered lifestyle-counselling model MoHP/DoHS are now trying to scale, and its finding that benefits reverse once FCHVs' active monitoring stops is a first-order caution for any FCHV-based NCD scale-up plan, not a generic 'intervention effectiveness' result.

Mark J. D. Jordans, Brandon A. Kohrt, Manaswi Sangraula et al. · 2021 · PLOS Medicine

Nepal's mental-health treatment gap exceeds 90%, with only about 0.17–0.22 psychiatrists per 100,000 people (most clustered around Kathmandu), and no Mental Health Act has ever been enacted despite a 1996 policy and a 2020 strategy — making task-shared, non-specialist delivery models central to any realistic scale-up. This trial was conducted in Morang district, itself marked by the 1996–2006 civil war and recurring floods, and shows that community members with no prior mental-health training, and no more than a high-school education, can be trained in about 20 days to deliver a treatment that measurably reduces psychological distress and depression. That evidence speaks directly to Nepal's stalled mhGAP scale-up and to post-disaster psychosocial response, including the unresolved mental-health burden from the 2015 Gorkha earthquake, where PTSD affected an estimated 19–23% of survivors.

Mark J. D. Jordans, Nagendra P. Luitel, Brandon A. Kohrt et al. · 2019 · PLOS Medicine

Nepal has no enacted Mental Health Act -- only a 1996 Mental Health Policy and a 2020 Strategy & Action Plan -- and carries a treatment gap of over 90% for common mental disorders, with psychiatrists concentrated overwhelmingly around Kathmandu (national density ~0.17-0.22 per 100,000). This PRIME programme evaluation, conducted in Chitwan district as the district-level mhGAP pilot the knowledge base identifies as grounding Nepal's mental-health evidence, is the most detailed real-world test of task-shared, primary-care mental healthcare in the country to date. Its four-stage evaluation of the care cascade -- contact, detection, treatment initiation, and outcomes -- is directly relevant to MoHP's stalled ambitions to scale mhGAP nationally, but its finding that only 1 in 34 people with depression and 1 in 23 with AUD achieved effective coverage overall is a critical caution against treating facility-level gains alone as evidence that Nepal's treatment gap is closing.

Neelam Dhakal, Pradip Gyanwali, Baburam Humagain et al. · 2023 · PLOS Global Public Health

Nepal's Free Drug List supplies roughly 98 essential medicines free of charge at public facilities under a system where the Department of Drug Administration (DDA) holds the federal (Schedule 5) mandate — via the Drugs Act 1978, Section 12 — to enforce quality standards, separate from the facility-level procurement and storage duties that Schedule 8 devolves to local governments. This nationwide NHRC study is the first to test the quality of these free, publicly-supplied essential medicines rather than commercially purchased drugs, finding 15.2% substandard — with the federal supply channel (62.2% of failures) implicated more than local-government procurement (37.4%), directly bearing on how quality-assurance responsibility should be divided across Nepal's three-tier federal health system.

Basant Adhikari, Kamal Ranabhat, Pratik Khanal et al. · 2024 · PLOS Global Public Health

Nepal's 2015 federal restructuring assigned 'basic health and sanitation' — including health posts, primary health centres, and local procurement — to the country's 753 local governments under Schedule 8 of the Constitution, while provinces and the centre retain concurrent authority under Schedule 9; this study's finding that local-level procurement tenders lacked even a basic shelf-life clause, unlike the 18-month minimum enforced at the province level, is exactly the kind of tier-coordination gap researchers have documented since federalism began. The medicines found most frequently out of stock — condoms, Depo-Provera injectables, oral contraceptive pills, and zinc — are the same family-planning and child-health commodities that Nepal's roughly 50,400 Female Community Health Volunteers (FCHVs) rely on for household-level delivery, so procurement delays at the local tier cascade directly into a flagship community health programme.

Sudhir Anand, Till Bärnighausen · 2004 · The Lancet

Nepal's own health workforce data illustrate the mortality link this cross-country study documents: only 37.9% of sanctioned physician and GP posts are filled nationally (down from 56.5% in 2015), Karnali — Nepal's poorest province — has 0% of its consultant and physician posts filled, and Kathmandu Valley has roughly 180 times the doctor density of remote districts (1 per 850 people versus 1 per 150,000). With Nepal's maternal mortality ratio still at 151 per 100,000 live births (NDHS 2022) and roughly 2,000-2,400 doctors a year obtaining Nepal Medical Council 'Good Standing Certificates' to emigrate, this study's finding that human-resources-for-health density predicts maternal and child mortality independently of income, poverty, and female literacy reinforces the evidence case behind MoHP's current health-workforce-retention reform priority.