Nepal: Understanding the approaches needed to strengthen the service delivery of non-communicable disease programmes for the urban poor at the primary health care setting in Pokhara 

A basic health service, including Non-Communicable Disease (NCD) care, is defined as a fundamental human right under the Nepalese Constitution, and it is local government that has the mandate to deliver basic health services to the people. At a time when federalisation in Nepal is going through the institutionalisation process and the COVID-19 pandemic has exposed weaknesses in the existing health system and affected routine healthcare services, the need to understand how to strengthen service delivery for the urban poor is crucial.

Evidence suggests that in the federal context of Nepal, the health system is struggling with an undervalued health agenda within government priorities. Essential medicines are out of stock, human resources lack capacity and management, the information system has poor quality data and usage, and there are difficulties ensuring the quality of health care provision whilst the services undergo expansion. NCDs have emerged as a major public health concern and account for two thirds of total deaths in Nepal, and the double burden of infectious and non-communicable disease has exacerbated the situation among the urban poor populations. Evidence suggests that urgent action is needed to strengthen health systems in order to address the rising burden of NCDs among urban poor communities.

Marginalised populations already have limited access to health care services, and urban poor communities, for example those in informal settlements, are often overlooked in the planning process due to a lack of evidence and data and are therefore pushed further behind.  HERD International’s CHORUS project seeks to understand the approaches needed to strengthen the service delivery of NCD care for the urban poor at the primary health care setting in Pokhara. The project aims to improve health and reduce inequities in health outcomes in the urban communities.

The project needs assessment phase has the following key objectives:

  • To explore the perceptions and priorities of the stakeholders at the federal, provincial and municipality levels and within the health facilities on:
    • NCDs and the associated risk factors as priority interventions
    • The role of the private sectors in the overall health system, focusing on NCD service delivery
    • Potential solutions to strengthen the NCD care services, engaging with the private health sector and targeting the urban poor
  • To assess the capacity of the municipality to engage with the private health sectors and deliver the NCD care services at the three different municipality levels: system, organisational and individual
  • To map and identify the private health care facilities delivering NCD care services
  • To assess the service readiness of selected public and private health facilities in Pokhara Metropolitan City to deliver NCD prevention and care services
  • To map and understand the characteristics of the urban poor community, slum areas and squatter settlements in the selected wards of the Pokhara Metropolitan City and explore their NCD care seeking behaviour
  • To understand the barriers and enablers of the urban poor communities in accessing the basic NCD care services through gender and intersectionality lens and according to types of health provider (public, private).
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