Browsing by Author "Suwal, PS"
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Publication Assessment of Health Service Delivery to Address Cardiovascular Diseases in Nepal(Kathmandu University, 2021) Suwal, PS; Prajapati, D; Bajracharya, S; Shrestha, A; Maharjan, R; Shrestha, S; Jha, N; Koju, RP; Vaidya, AABSTRACT Background A health care delivery system is the organization of people, institutions, and resources designed to deliver health services. A comprehensive study to explore cardiovascular health service delivery in Nepal is lacking. Objective This study attempted to assess Nepal’s health system gap on organization and delivery of cardiovascular disease prevention and management services. Method This mixed-method study used the six building blocks of the World Health Organization health system framework: organization; access; coverage, utilization and demand; equity; quality of services; and outcomes. We conducted the desk reviews of national and international documents, performed several key informant interviews, calculated the relevant indicators, and assessed the Strengths, Weaknesses, Opportunities, and Threats of the cardiovascular health service delivery. Result We found that most of the cardiovascular services are concentrated in urban areas, and suffer from poor access, quality, utilization, and coverage in most of the areas resulting in poor health outcomes. Though the services have recently improved due to increased primary care interventions, there is scope for the development of competent human resources, advancement of technologies, development of national protocols, and improved monitoring and supervision. Improved disease system including the medical recording and reporting mechanism to incorporate and reflect the true burden of CVD in Nepal is lacking. Conclusion Despite having health facilities from grassroots to the central level, availability, access, and quality of cardiovascular health services are poor. Further improvement and equitable expansion of promotive, preventive, diagnostic, referral, and rehabilitative cardiovascular services are needed to ensure universal health coverage. KEY WORDS CVDs, Health-service delivery, Infrastructure, Needs-assessment, NepalPublication Study of Neighborhood Environment for Cardiovascular Health in a Squatter Area in Nepal(Kathmandu University, 2025) Oli, N; Vaidya, A; Rijal, D; Suwal, PS; Maharjan, BABSTRACT Background Behavioral risk factors for cardiovascular diseases are prevalent among the urban poor in Nepal. Understanding environmental factors such as the availability of retailers selling tobacco, alcohol, and junk food, as well as neighbourhood access to and the built environment’s support for physical activity is critical for addressing the rising burden of cardiovascular disease in the community. Objective To identify aspects of the community environment that contribute to behavioral risk factors, focusing on the food supply system, built environment, walkability, and the marketing, availability, and accessibility of tobacco and alcohol. Method Spatial data were collected in the Sinamangal-Minbhawan squatter area of Kathmandu using a mixed-method approach. Geographic Information System tool, direct field observations, including spot observation and transect walk, and Market Basket Surveys were done by a trained research team during the period March-May 2022. Data were analyzed using methodological triangulation, combining interviews, observations, GPS data, and Google Earth imagery in ArcMap 10.8. Thematic analysis of market basket survey interviews involved coding transcripts for cardiovascular disease-related behaviors, with codes refined into six key themes, including sociodemographic characteristics. Result We reported a few vegetable outlets and no fruit shops. There were 84 fast-food outlets and local restaurants with junk food and soft drinks available. We observed 77 tobacco outlets with a variety of tobacco products easily available to all. There were 48 alcohol outlets in the area, which, except for four outlets, were present together with tobacco and junk food outlets. Tobacco and alcohol products were largely consumed by men of all age groups. Conclusion Community-based health programs can raise awareness about the importance of healthy behavior. Advocacy efforts to promote policies that support improved access to healthy foods, smoke-free public spaces, and safe environments for physical activity are important to provide community members with healthy choices. KEY WORDS Food supply environment, Geographic information system, Market basket survey, Spatial analysis