Nepal’s overall maternal and infant mortality rates have declined for decades—but reaching underserved populations with high-quality health services remains a challenge. To improve health outcomes for all, a strong, interconnected health system comprising both public and private facilities and care providers is essential.
While the public health system remains a cornerstone of Nepal’s health system, the private health sector plays an important role in increasing the availability and range of services for mothers and newborns. Private facilities and providers provide substantial amounts of care, so it’s crucial to ensure their quality and integration into the larger health care system. In 2016, for example, 72 percent of caregivers seeking care chose a private provider for a child sick from fever, diarrhea, or an acute respiratory infection.
Since 2018, the Abt-led USAID’s Strengthening Systems for Better Health (SSBH) Activity has partnered with government and private health actors to improve health services in 138 communities in Karnali and Lumbini, paving the way for better public-private collaboration.
In its work with the private health sector, the SSBH Activity has focused on improving service quality, identifying barriers to accessing care, and recommending ways to address them.
Improving quality of care
To comprehensively assess the quality of care for newborn and child health services in Karnali Province, the SSBH Activity surveyed 39 facilities jointly with USAID’s flagship private health sector project—the Abt-led Sustaining Health Outcomes through the Private Sector (SHOPS) Plus—as well as district and municipal health counterparts. The results of the survey enabled stakeholders to identify opportunities for private providers to improve quality of care, including by strengthening their diagnostic skills and better managing patient referrals.
The SSBH Activity and SHOPS Plus also partnered with district health offices to include private providers in government-led training and certification through mid-2020. Follow-up coaching through mid-2021 showed improved use of treatment protocols and better reporting. In Birendranagar Municipality, for instance, seven out of 11 private health facilities were reporting outcomes by mid-2021, compared with just two when training started.
“The training and the certificate have inspired us to enhance service quality,” said a manager of a private polyclinic in Birendranagar. “We can promptly and properly refer neonates and children to higher health facilities due to the knowledge obtained through this training.”
Contributing to an improved referral system
A 2021-2022 SSBH Activity assessment found that Nepal lacks an efficient and consistent referral system for sick children between private and public facilities, which is essential to reducing poor health outcomes for this population. The Activity recommended several steps for a referral process for the public sector, private sector, and development partners—with the government taking the lead. The government will train private providers on government-recommended referral mechanisms, make emergency equipment available at private points of care, and help private providers ensure caregivers can access municipal emergency funds.
Expanding private health sector engagement
To identify pathways to increased engagement, the SSBH Activity convened representatives in November 2022 from national, provincial, and local governments; private health providers and their umbrella organizations; project implementing partners; and members of the global health community. Recommendations included:
- Institutionalize and promote public-private dialogue. In Nepal, broad stakeholder participation may take place at government-led Joint Annual Review meetings, quarterly meetings hosted by the National Planning Commission, and dedicated, local meetings such as the former "Swasthya Chautari” meetings that convened public, private, and development partner representatives.
- Improve the quality of care in the private health sector. Private providers can benefit from training and materials offered to public counterparts. In Nepal, training priorities for private providers—especially those who participate in public programs for health—include improving clinical skills (e.g., safe deliveries), managing referrals (e.g., for neonates) and complying with government standards to deliver a basic care package.
- Strengthen supportive supervision of the private health sector. Private professional health councils, such as the Association of Private Health Institutions of Nepal, can be an excellent point of entry to develop and deliver supportive supervision.
- Expand financing programs that promote equitable, affordable access to essential health services. Financing initiatives can enable low-income households to access health care at public and private providers. These programs may include subsidized insurance programs and programs that enable clients to access essential services free of charge.
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