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Governance and Purchasing Function under Social Health Insurance in Nepal: Looking Back and Moving Forward

2024-03-12T05:51:38Z

Title: Governance and Purchasing Function under Social Health Insurance in Nepal: Looking Back and Moving Forward Authors: Sapkota, Vishnu Prasad; Bhusal, Umesh Prasad Abstract: Abstract Nepal is pursuing Social Health Insurance as a way of mobilizing revenues to achieve Universal Health Coverage. The Social Health Insurance governance encourages service providers to maintain quality and efficiency in services provision by practicing strategic purchasing. Social Health Security Programme is a social protection program which aspires to achieve the goals of Social Health Insurance. Social Health Security Development Committee needs to consider following experiences to function as a strategic purchaser. The Social Health Security Development Committee need to be an independent body instead of falling under Ministry of Health. Similarly, purchasing of health services needs to be made strategic, i.e., Social Health Security Development Committee should use its financial power to guide the provider behavior that will eventually contribute to achieving the goals of quality and efficiency in service provision. The other social health security funds should be merged with Social Health Security Development Committee and develop a single national fund. Finally, the state has to regulate and monitor the performance of the SHI agency. Keywords: Design; global experiences; Nepal; purchaser; Social Health Insurance; Social Health Security Programme. Description: Viewpoint

Chondrodysplasia Punctata: A Case Report of Fetal Warfarin Syndrome

2024-03-12T05:52:18Z

Title: Chondrodysplasia Punctata: A Case Report of Fetal Warfarin Syndrome Authors: Songmen, Swachchhanda; Panta, Om Biju; Paudel, S Sharma; Ghimire, Ram Kumar Abstract: Abstract Chondrodysplasia punctata is abnormal calcification in the cartilage of developing bones and has been seen in association with deranged vitamin K metabolism. Warfarin, an oral anticoagulant acting on vitamin K dependent clotting factors is known to cause chondrodysplasia punctata. Despite the knowledge of the condition the management of patients with prosthetic heart valves might require use of the drug for anticoagulation. Here, we present a case of a fetal warfarin syndrome in a second born child of a 27 year lady under warfarin for prosthetic heart valve. The pregnancy was complicated by polyhydramnios in third trimester and terminated at term by normal vaginal delivery. The baby was well, except for facial dysmorphism in the form of depressed nasal bridge, narrow nares and suspected left choanal atresia. Radiograph revealed stippled ephiphysis of vertebra, femora and humera supporting diagnosis of fetal warfarin syndrome. The baby did not develop any perinatal complication and was discharged home. Keywords: Chondrodysplasia punctata; fetal warfarin syndrome; vitamin K deficiency. Description: Case Study

Admitting Deserving Medical Students from Rural and Disadvantaged: Patan Academy of Health Sciencesâ€™ Approach

2024-03-12T05:52:55Z

Title: Admitting Deserving Medical Students from Rural and Disadvantaged: Patan Academy of Health Sciencesâ€™ Approach Authors: Upadhyay, Shambhu Kumar; Bhandary, Shital; Bhandari, Dil Bahadur; Dulal, Ram Krishna; Baral, Kedar Prasad; Gongal, Rajesh Nath; Acharya, Paras Kumar; Shrestha, Shrijana; Shah, Jay Narayan; Karki, Arjun Abstract: Abstract Background: Patan Academy of Health Sciences (PAHS) aims to produce physicians who would be able and willing to serve in the rural areas. Recognizing the critical importance of student selection strategy, among others, in achieving the program goals, it has adopted an innovative scheme for selecting medical students. This paper describes PAHS medical student selection scheme that favors enrollment of deserving applicants from rural and disadvantaged groups so as to help improve distribution of physicians in rural Nepal. Methods: A student admission committee comprising a group of medical educators finalized a three-step student selection scheme linked with scholarships after reviewing relevant literatures and consultative meetings with experts within and outside Nepal. The committee did local validation of Personal Quality Assessment (PQA) that tested cognitive ability and personality traits, Admission OSPE (Objective Structured Performance Examination) that assessed non-cognitive attributes of applicants. It also provided preferential credits to applicantsâ€™ socio-economic characteristics to favor the enrollment of deserving applicants from rural and disadvantaged groups through Social Inclusion Matrix (SIM). Three different categories of scholarship schemes namely Partial, Collaborative and Full were devised with Partial providing 50% and other two categories each providing 100% coverage of tuition fee. Results: PAHS student selection scheme succeeded in enrolling more than half of its students from rural areas of Nepal, including about 10% of the students from that of the most backward region of the country. About one third of students were female and about the same were from public and community school. Sixty percent of students receive different categories of scholarships. Conclusions: Limited findings indicate the success of the selection scheme in enrolling high proportion of applicants from rural and disadvantageous groups and enable them to pursue study by providing scholarships. Keywords: Admission OSPE; innovative student selection scheme; Nepal; Personal Quality Assessment; Social Inclusion Matrix. Description: Medical Education

Clinical Outcome of Autologous Serum Therapy in Chronic Idiopathic Urticaria

2024-03-12T05:53:26Z

Title: Clinical Outcome of Autologous Serum Therapy in Chronic Idiopathic Urticaria Authors: Karn, Dharmendra; KC, Shekhar Abstract: Abstract Background: Quality of life in chronic idiopathic urticaria is hampered as efficacy of H1-antihistamines is limited. Autologous serum containing tolerance-generating anti-idiotype antibodies is a novel and cost-effective therapy. This study was conducted to evaluate the efficacy of autologous serum therapy (AST) among chronic urticaria patients with autologous skin prick test positive and negative status. Methods: Untreated 102 patients of chronic urticaria were enrolled in a non-randomized interventional study. Patients were categorized into two groups based on autologous serum skin prick test as test positive (ASST +) and test negative (ASST -). Patients were then treated with intramuscular injection of 0.05ml per kg body weight of autologous serum weekly for 10 weeks. Urticaria activity scoring (UAS) tool was used for quantification of the symptoms. Weekly recording of UAS (range: 0-42) was made before the therapy (baseline) and during the therapy for 10 weeks. Results: Significant improvement with AST in the mean UAS was noted from baseline to 10 weeks in both the group of patients (14.6 Â± 6.3 and 10.2 Â± 5.1 for ASST+ group ; 16.9 Â± 7.8 and 8.6 Â± 4.8 for ASST- group; at baseline and 10 weeks, respectively (p-value for both <0.05)). However no statistical significance was found while comparing the efficacy of the therapy against ASST + and ASST - Groups (p-value > 0.05). Conclusions: Irrespective of autologous skin prick test results, autologous serum therapy showed significant improvement in patients with chornic idiopathic urticaria. AST can, thus, be an effective treatment modality for it. Keywords: Autologous serum skin prick test; autologous serum therapy; chronic urticaria Description: Original Article