Assessment of chronic kidney disease support program of government of Nepal, 2016.

Research Report.

SUMMARY: Chronic Kidney Disease (CKD) is defined as renal damage or decreased renal function for three or more months along with progressive destruction of renal mass with irreversible sclerosis and loss of nephrons. CKD is a global epidemic which is associated with high cost and financial burden to patients, families and health system of any country. The Government of Nepal, Department of Health Services (DoHS) through its special program on chronic diseases - 'Bipanna Nagarik Sahayata Kosh' has been supporting the people with a number of enlisted chronic diseases for their treatment and care. CKD and heart diseases are some of the conditions included in the program. This study aimed to comprehend the current scenario of on-going chronic disease support program of the government of Nepal with special focus on CKD. It was a qualitative study conducted in four different development regions. Chronic Kidney Diseases patients, representatives of central government institutions (MoH, DoHS), representatives from hospital management committee of different hospitals, and representatives of municipal governments from these development regions were purposively chosen for the study. Information was collected from 18 patients; five District Public Health Officers, eight hospital managers and one policy level officer of DoHS using in-depth interview, key informant interview and record review. Data was analysed using a qualitative content analysis approach. Findings from the study revealed that there is no clear definition of bipanna and thus it is difficult to ensure that the service is being utilized by the real needy ones. Participants also shared that the numbers of patients beyond the capacity of the health facilities has been a factor for delayed service delivery to the patients. Participants who were getting the service complained of less number and shorter session of dialysis than prescribed. Furthermore, the participants expressed about the high non-medical costs such as travel cost, lodging and fooding costs due to centralization of health facilities. They shared that even-though the program has proven to be great support to those who cannot afford the treatment on their own, the associated non-medical costs and problems with services has decreased the value. Service providers expressed their realization about lack of coordination among the different concerned authorities as a major barrier to ensure proper utilization of the fund under the program. They also shared lack of authority within District Health Office / District Public Health Office (DHO/ DPHO) to verify the status of the service seekers sometimes leads to recommendation for those who are not the actual bipanna. Regarding the sustainability of the program, participants suggested focusing on preventive measures and community awareness program rather than putting all the effort on curative services only. Besides, participants suggested on conducting screening programs such as creatinine test, blood urea test to identify the disease in the early stage. Participants opined that monitoring and supervision of the program should be strengthened to ensure that the needy ones are getting the services and the fund is not misused. They further suggested for coordination and communication among the hospital, DHO/DPHO and DoHS to identify the loop holes and hence improve the program implementation. Thus, the study shows that the guideline for the program needs revision in order to clarify the eligibility criteria for the patients to receive support. It also highlights the need for development of a mechanism that could be implemented nationwide to ensure the real needy ones are getting the service and the fund is not misused. Furthermore, the challenges faced by patients and hospitals should be addressed through decentralized service provision and capacity of the hospitals designated for these service, should be strengthen in order to provide quality service for the people. In addition, concerns for the preventive aspect and early identification of the disease should be taken into consideration and alternative approaches like insurance system need to be focused for reducing the cost of the program and make it sustainable.