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Quality Improvement Structures in Nepal: Options for Reform

A review of framework conditions for quality improvement

Friendly care is an important part of quality health services

Improving the quality of health services has emerged as a top priority for the Government of Nepal. With German support, the Ministry of Health has recently assessed the existing framework conditions for quality improvement approaches and identified options for a system-wide approach to performance measurement.

Over the past two decades, the Government of Nepal has improved people’s access to health care by expanding health services and strengthening community-based interventions. However, the expansion of health services has not been accompanied by improved quality at the point of care.

In 2016 the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, commissioned by Germany’s Federal Ministry for Economic Cooperation and Development (BMZ), initiated a review to inform policy discussions about quality improvement in the health sector. The review assessed the current governance, legislative and organisational framework conditions for quality improvement approaches in the country, and also explored how the proposal in the Nepal Health Sector Strategy 2015-2020 to establish an independent quality improvement body could be realised.

The findings of the review have been published by the Ministry of Health in a report entitled Quality Improvement Structures in Nepal – Options for Reform. Key findings include:

  • At present there is not a coherent strategic framework for improving quality of care. The existing framework, which is shaped by different actors, is characterised by overlaps and duplicated efforts. As a result, it does not provide sufficient orientation to implement a gradual quality improvement process.
  • The regulatory framework for health institutions is patchy and the actual regulation of health care services is of limited effectiveness.
  • The absence of clearly defined and commonly agreed quality improvement goals, along with insufficient coordination among actors, contributes to a fragmented approach to quality improvement.
  • Although the country has rich experience with various quality improvement approaches, these have not been drawn together into a coherent quality improvement system.

On the basis of this assessment, the report outlines options for establishing an institutionalised performance measurement system which would complement other elements such as regulation, internal quality improvement, complaints management, incentives, regulated and not-regulated standards, clinical protocols and guidelines.

Franziska Fürst, May 2017

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