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Access to and quality use of non-communicable diseases medicines in Nepal

机译：尼泊尔获取和优质使用非传染性疾病药物

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Noncommunicable diseases are a major healthcare problem in Nepal and their burden is increasingevery year. Noncommunicable diseases (NCDs) bring additional challenges to the Nepalese healthcaresystem which is already experiencing infrastructure shortages, poor service delivery, inadequate essential medicines coverage and shortages of healthcare workers. The Nepal government provides a limited number of free essential medicines through the free essential healthcare services program. This consists of a basic healthcare package provided through primary healthcare (PHC) facilities and district hospitals. Though around 40 essential medicines are provided without charge, studies have reported problems with access especially in all rural areas. There is a need to improve access to, coverage and quality use of medicines. The government has decided to provide some free medicines for NCDs alongside free essential medicines to be distributed via current healthcare structures. Though well intended, this decision will put extra strain on the essential medicines program. It should be supplemented by a comprehensive NCDs policy that takes account of the issues of sustainability and quality use of medicines. Complex cases of NCDs will be managed by tertiary hospitals but most of the cases of NCDs especially for rural people and the poor will end up in secondary level public hospitals (district and zonal hospitals). Therefore, the government needs to strengthen these public hospitals. Meanwhile, given the severity of the NCDs problem in Nepal, the Ministry of Health and Population (MoHP) should liaise with nongovernmental and missionary hospitals especially in rural areas to run NCDs management services. The Ministry should encourage these hospitals to run hospital pharmacies to improve people’s access to and quality use of NCDs medicines. At the primary healthcare level, the Ministry could run NCDs prevention and control programs but existing PHC workers need training to perform proper dispensing of NCDs medicines. PHC facilities need a medical record system so that they can address the needs of NCDs patients requiring long term medication supply via a proximate PHC facility.
机译：非传染性疾病是尼泊尔的主要医疗保健问题，负担每年都在增加。非传染性疾病（NCDs）给尼泊尔的医疗系统带来了更多的挑战，该系统已经面临基础设施短缺，服务质量差，基本药物覆盖率不足以及医护人员短缺的问题。尼泊尔政府通过免费的基本保健服务计划提供了数量有限的免费基本药物。这包括通过基本医疗保健（PHC）设施和地区医院提供的基本医疗保健包。尽管免费提供了约40种基本药物，但研究报告了获取方面的问题，特别是在所有农村地区。需要改善药物的获取，覆盖范围和质量。政府已决定为非传染性疾病提供一些免费药物，以及免费的基本药物，这些药物将通过当前的医疗机构进行分发。尽管意图很好，但这一决定将给基本药物计划带来更多压力。应当以全面的非传染性疾病政策为补充，该政策应考虑到药物的可持续性和质量使用问题。非传染性疾病的复杂病例将由三级医院管理，但是大多数非传染性疾病的病例，尤其是针对农村人口和穷人的非传染性疾病，最终将落入二级公立医院（区和地方医院）。因此，政府需要加强这些公立医院。同时，鉴于尼泊尔非传染性疾病问题的严重性，卫生和人口部（MoHP）应与非政府和传教医院保持联系，特别是在农村地区，以提供非传染性疾病管理服务。卫生部应鼓励这些医院经营药房，以改善人们获取和使用非传染性疾病药物的质量。在基层医疗机构，卫生部可以执行非传染性疾病的预防和控制计划，但是现有的初级卫生保健工作者需要接受培训，以正确分配非传染性疾病的药物。 PHC设施需要医疗记录系统，以便可以通过附近的PHC设施满足需要长期药物供应的NCD患者的需求。

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