Primary healthcare system readiness for the prevention and management of non-communicable diseases in Nepal

In 2016, Nepal adopted the World Health Organization’s Package of Essential Non-Communicable Disease Interventions (PEN) to address the rising burden of non-communicable diseases (NCDs). This study evaluated the primary healthcare system’s readiness to prevent and manage major NCDs, including cardiovascular diseases (CVDs), diabetes mellitus (DM), and chronic respiratory diseases (CRDs); and explored factors associated with NCD service readiness. We conducted a convergent parallel mixed-methods study between 2020 and 2022. We adapted the WHO Service Availability and Readiness Assessment (WHO-SARA) tool and quantitatively assessed 105 primary healthcare facilities selected through multistage stratified random sampling. Quantitative data were analyzed using survey-weighted descriptive and multivariable linear regression. Simultaneously, we conducted qualitative interviews with 23 health authorities and 47 health service providers involved in the PEN program. Qualitative data were thematically analyzed. NCD service readiness was highest for CVDs (48.4, 95% CI: 44.5–52.3), followed by DM (40.8, 95% CI: 36.1–45.5), and CRDs (34.8, 95% CI: 30.8–38.9). Primary Healthcare Centers (PHCCs), primary healthcare facilities in hilly regions, or those charging user fees, demonstrated higher NCD service readiness than health posts, mountain-region primary healthcare facilities, and those without user fees. Qualitative findings explored higher NCD service readiness through better infrastructure, staff training, and social health insurance. Conversely, staff turnover and supply shortages remained key challenges, particularly in health posts and remote areas. Primary healthcare facilities in Nepal lack equipment, medicines, trained staff, and NCD guidelines. Therefore, improving NCD service readiness requires strengthening the health workforce capacity and essential medicine supply chain management.