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

The 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. To evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability and affordability in Nepal. A 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. 27/33(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. Many 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.

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Déclaration de conflit d'intérêts

Declarations and Acknowledgements RS and DM are working for SUNITA, a three year UK Aid matched palliative care development project implemented by EMMSI and INF Nepal. No authors have any potential conflict of interest. Authors have no conflicts of interest to declare. RS and DM conceptualised the study and developed the method. RS performed data collection and analysis, discussing findings with other authors who suggested and supported further analysis. RS and DM wrote the original draft of the manuscript. All authors substantially revised and approved the study. Ethical approval was not sought, as there was no direct involvement of human participants and their data in this study.