Interconnectedness of Health and Economy in Post-COVID-19: A Systems Thinking Approach to Synergies, Trade-Offs, and Policy Responses in Nepal.

BACKGROUND: This study addresses the economic challenges posed by the Coronavirus Disease 2019 (COVID-19) pandemic, with a specific focus on Nepal. Employing a Systems Thinking approach, the study develops a comprehensive model that integrates macroeconomic interventions, exploring the trade-offs and synergies among various economic sectors. The interconnectedness of health, economic, and policy domains highlights the need for a holistic understanding of the pandemic's effects. METHODS: An exploratory research design was used. The model introduces three primary subsystems-import, local demand, and local production-illustrating their interdependence. The causal loop diagram depicts the implications of fiscal and monetary policies on the economy, emphasizing the synergy and trade-offs resulting from policy interventions. RESULTS: Findings reveal the significant economic impact of the pandemic on Nepal, leading to its negative growth rate in FY 2020/21, the first time Nepal has experienced this in the last two decades. The results show that both intended and unintended consequences are observed following the adoption of fiscal and monetary policy that aimed at minimizing the spread of virus suggesting a complex nature of relationship among the policy variables. The fiscal policy induced negative consequences on the increasing loan, slow revenue growth, while positive feedbacks are observed on increased investment opportunities, and boosting of local economy. The monetary measures yielded unintended consequences on the rising land prices, surge in share market. CONCLUSIONS: The study concludes by emphasizing the crucial role of informed policymaking in navigating the complex landscape, offering insights for creating a resilient and sustainable post-pandemic future.

Assessing the WHO-UNICEF primary health-care measurement framework; Bangladesh, India, Nepal, Pakistan and Sri Lanka.

Objective: To assess the availability of information on indicators of the World Health Organization and United Nations Children's Fund primary health-care measurement framework in Bangladesh, India, Nepal, Pakistan and Sri Lanka and to outline the opportunities for and challenges to using the framework in these countries. Methods: We reviewed global and national data repositories for quantitative indicators of the framework and conducted a desk review of country documents for qualitative indicators in February-April 2023. We assessed data sources and cross-sectional survey tools to suggest possible sources of information on framework indicators that were not currently reported in the countries. We also identified specific indicators outside the framework on which information is collected in the countries and which could be used to measure primary health-care performance. Findings: Data on 54% (32/59) of the quantitative indicators were partially or completely available for the countries, ranging from 41% (24/59) in Pakistan to 64% (38/59) in Nepal. Information on 41% (66/163) of the qualitative subindicators could be acquired through desk reviews of country-specific documents. Information on input indicators was more readily available than on process and output indicators. The feasibility of acquiring information on the unreported indicators was moderate to high through adaptation of data collection instruments. Conclusion: The primary health-care measurement framework provides a platform to readily assess and track the performance of primary health care. Countries should improve the completeness, quality and use of existing data for strengthening of primary health care.

Benefits and costs of alternative healthcare waste management: an example of the largest hospital of Nepal.

BACKGROUND: Management of health-care waste is an essential task, which has important consequences for public health and the well-being of society. Economic evaluation is important for strategic planning and investment programming for health-care waste management (HWM). A cost-benefit analysis of an alternative method of HWM in Bir hospital, Nepal was carried out using data recently collected from primary sources. METHODS: Data were collected using mixed quantitative and qualitative methods. Costs and benefits were measured in Nepalese rupees. The values of all inputs were costs associated with the alternative HWM. Benefits were defined as the reduction in cost of transportation; money obtained from selling of recycled waste; and risk reduction, among others. Break-even analysis and calculations of benefit-cost ratio were used to assess the alternative HWM. RESULTS: The alternative HWM reduces the cost of waste disposal by almost 33% per month, owing to reduction in the amount of waste for disposal. The hospital earns 3 Nepalese rupees per bed per day. The results suggest that a break-even point for costs and benefits occurs when 40% of the total beds of the hospital are covered by the alternative HWM, if the bed occupancy rate is at least 68%. If the alternative HWM is introduced in the hospital system, hospitals can reach the break-even point at 40 to 152 beds, depending on their performance in HWM. CONCLUSIONS: The results show the economic feasibility and financial sustainability of the alternative HWM. This alternative method of HWM is a successful candidate for replication in all public and private hospitals in Nepal.

Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences.

Households obtaining health care services in developing countries incur substantial costs, despite services generally being provided free of charge by public health institutions. This constitutes an economic burden on low-income households, and contributes to deepening their level of poverty. In addition to the economic burden of obtaining health care, the method of financing these payments has implications for the distribution of household assets. This effect on resource-poor households is amplified since they have decreased access to health insurance. Recent literature, however, ignores the importance of the method of financing health care payments. This paper looks at the case of Nepal and highlights the impact on households of paying for hospital-based care of Kala-azar (KA) by analysing the catastrophic, impoverishment and economic consequences of their coping strategies. The paper utilizes micro-data on a random selection of 50% of the KA-affected households of Siraha and Saptari districts of Nepal. The empirical results suggest that direct costs of hospital-based treatment of KA are catastrophic since they consume 17% of annual household income. This expenditure causes more than 20% of KA-affected households to fall below the poverty line, with the remaining households being pushed into the category of marginal poor; the poverty gap ratio is more than 90%. Further, KA incidence can have prolonged and severe economic consequences for the household economy due to the mechanisms of informal sector financing to which households resort. A heavy burden of loan repayments can lead households on a downward spiral that eventually becomes a poverty trap. In other words, the method of financing health care payments is an important ingredient in understanding the economic burden of disease.