Publications Summary

Document Type
Further Analysis
Publication Topic(s)
Child Health and Development, Health facilities/SPA surveys
Nepal SPA, 2021
Recommended Citation
Acharya, Kiran and Shireen Assaf. 2023. Changes in Service Availability, Readiness, Process of Care, and Caregiver Satisfaction with Child Curative Services: A Comparison between the 2015 and 2021 Nepal Health Facility Surveys. DHS Further Analysis Reports No. 146. Rockville, Maryland, USA: ICF.
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Publication Date
December 2023
Publication ID


This study assesses changes in service availability, service readiness, infection prevention and control, adherence to the process of care, and caregiver satisfaction with child curative services in health facilities of Nepal. We conducted an analysis using data from two nationally representative comprehensive Nepal Health Facility Surveys conducted in 2015 and 2021. We used a simple additive index that produced scores by adding binary variables. The scores for service readiness, infection prevention and control, adherence to the process of care, caregiver satisfaction, and their background characteristics were compared between the two surveys to determine any significant difference. Availability of services was high in both surveys and did not change significantly. The child curative service readiness improved significantly in all provinces, with public hospitals showing the most improvement. Facilities that performed regular quality assurance activities, conducted staff management meetings, conducted management committee meetings, and had systems in place to determine opinions showed higher service readiness. The infection prevention and control score also increased significantly in all provinces. Adherence to the process of care score increased significantly, especially in public hospitals and Primary Health Care Centers. Caregiver satisfaction in public health facilities increased significantly in 2021, with the highest increase seen in Karnali Province. The treatment of diarrhea and pneumonia differed slightly between 2015 and 2021. Continued investment and support for public hospitals, Primary Health Care Centers, and Basic Health Care Centers are recommended to sustain and enhance their child curative service readiness. Regular quality assurance activities, staff management meetings, and management committee meetings should be maintained to ensure ongoing improvement. Furthermore, it is crucial to ensure adherence to the facility based Integrated Management of Neonatal and Childhood Illnesses protocol for treating common illnesses such as diarrhea and pneumonia.


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