| dc.description.abstract | Background/objective The increasing burden of non-
communicable diseases (NCDs) in Nepal underscores the
importance of strengthening primary healthcare systems
to deliver efficient care. In this study, we examined the
barriers and facilitators to engaging community health
workers (CHWs) for NCDs prevention and control in Nepal.
Design We used multiple approaches including (a) review
of relevant literature, (b) key personnel and stakeholders’
consultation meetings and (c) qualitative data collection
using semistructured interviews. A grounded theory
approach was used for qualitative data collection and the
data were analysed thematically.
Setting Data were collected from health facilities across
four districts in Nepal and two stakeholder consultative
meetings were conducted at central level.
Participants We conducted in-depth interviews with
CHWs (Health Assistants, Auxiliary Health Workers,
Auxiliary Nurse Midwife) (n=5); key informant interviews
with health policymakers/managers (n=3) and focus group
discussions (FGDs) with CHWs (four FGDs; total n=27).
Participants in two stakeholder consultative meetings
included members from the government (n=8), non-
government organisations (n=7), private sector (n=3) and
universities (n=6).
Results The CHWs were engaged in a wide range of
public health programmes and they also deliver NCDs
specific programmes such as common NCDs screening,
provisional diagnosis, primary care, health education
and counselling, basic medication and referral and
so on. These NCD prevention and control services
are concentrated in those districts, where the WHO,
Package for prevention and control of NCDs) program
is being implemented. Some challenges and barriers
were identified, including inadequate NCD training,
high workload, poor system-level support, inadequate
remuneration, inadequate supply of logistics and drugs.
The facilitating factors included government priority,
formation of NCD-related policies, community support
systems, social prestige and staff motivation.
Conclusion Engaging CHWs has been considered
as key driver to delivering NCDs related services in
Nepal. Effective integration of CHWs within the primary
care system is essential for CHW’s capacity buildings,
necessary supervisory arrangements, supply of logistics
and medications and setting up effective recording and
reporting systems for prevention and control of NCDs in
Nepal. | en_US |
