NATIONAL SURGICAL PLANNING IN NEPAL: USING A QUANTITATIVE SITUATIONAL ANALYSIS TOOL TO GUIDE POLICY DEVELOPMENT nardeen_dawood@hms.harvard.edu

PW07-13

NATIONAL SURGICAL PLANNING IN NEPAL: USING A QUANTITATIVE SITUATIONAL ANALYSIS TOOL TO GUIDE POLICY DEVELOPMENT

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Dinesh Koirala dinesh@nsi.edu.np Nick Simons Institute Lalitpur Nepal

Daniel Corlew daniel_corlew@hms.harvard.edu Harvard Medical School Program in Global Surgery and Social Change Boston United States

Tarsicio Uribe-Leitz pablo.uribe-leitz@childrens.harvard.edu Boston Children’s Hospital Department of Plastic and Oral Surgery Boston United States

Ruma Rajbhandari rrajbhandari@mgh.harvard.edu Massachusetts General Hospital Department of Medicine Boston United States

United States

Oral or Poster

Approximately 1.6 billion people living in South Asia lack access to safe, timely, and affordable surgical care. Nepal plans to address this gap with the introduction of a National Surgical Plan (NSP), a country-driven framework for surgical system strengthening. This quantitative situational analysis aims to identify priorities for policy development and implementation.

The Nick Simons Institute in collaboration with the Ministry of Health and Population (MoHP) utilized a standardized Surgical Capacity Assessment Tool (SCAT) for cross-sectional evaluation of 12 public health care facilities between February-April 2025. Facilities span diverse geographic contexts and levels of care. The SCAT assessed the following indicators: infrastructure, generalist and specialist surgical workforce, service delivery, and information management.

The 12 surveyed facilities reported a total of 109,712 admissions per year. Infrastructure assessment revealed a mean score of 4.6 on a 0-5 point scale, reflecting electricity, water, internet, and supplemental oxygen availability. Workforce and service delivery estimates indicate approximately 305 combined surgical, anesthetic, and obstetric providers, over half of whom were generalists, and a case volume of 49,714 surgeries per year. To date, 91.7% of surveyed facilities use a combination of paper charts and an electronic medical record (EMR) for information management.

Nepal’s surgical care system presents opportunities to enhance its surgical workforce, service delivery, and information management. The MoHP is steadily progressing toward surgical system strengthening by building on prior successes, such as investments in infrastructure and task-shifting, while continuing to engage stakeholders in the development and implementation of a National Surgical Plan.