• J Pain Symptom Manage · Apr 2024

    Availability and Affordability of Essential Palliative Care Medicines in Nepal: A cross-sectional study.

    • Rajeev Shrestha, Bruce Hayes, Arjun Poudel, and Daniel Munday.
    • INF Green Pastures Hospital, Pokhara, Nepal. Electronic address: rajiv2stha@gmail.com.
    • J Pain Symptom Manage. 2024 Apr 4.

    ContextThe government of Nepal adopted 2017 Nepalese National Strategy for Palliative Care (NSPC), which proposed that Essential Palliative Care Medicines (EPCMs) listed by International Association for Hospice and Palliative Care (IAHPC) should be available at each healthcare institution. In 2017 after the issuing of NSPC, the Lancet Commission developed an EPCM list.ObjectiveTo evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability and affordability in Nepal.MethodA cross-sectional descriptive study of availability of EPCMs in Nepal, their inclusion in National Essential Medicines List (NEML), Government Health Insurance Medicines List (GHIML), Government Fixed Rate Medicines List (GFRML) and free medicines list. Affordability was assessed using the WHO Daily-Define-Dose and the Nepal Government-defined minimum daily wage.Result27/33(82%) of the IAHPC-EPCMs and 41/60(68%) of the recommended formulations were available in Nepal. All the Lancet Commission recommended EPCMs were available in Nepal. Morphine was available in all formulations used in palliative care. 22%, 18% and 10% of IAHPC-EPCMs were available cost free via district hospitals, primary health centres and health posts, respectively. Government had not included opioids on both free and fixed price list. 24/33(73%) of IAHPC-EPCMs were available on the GHIML. 19/41(46%) available EPCMs were affordable.ConclusionMany EPCM formulations included in NSPC of Nepal are not available, and most available EPCMs are unaffordable if purchased out-of-pocket. While the availability is better with government health insurance scheme, many people are not registered for this. Further improvements should follow the development of a Nepalese palliative care formulary.Copyright © 2024. Published by Elsevier Inc.

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