SURGICAL CARE DELIVERY IN NEPAL: A QUALITATIVE STUDY elisabeth_hansen@hsph.harvard.edu

PW07-03

SURGICAL CARE DELIVERY IN NEPAL: A QUALITATIVE STUDY

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

Scott Corlew dscorlew@gmail.com Harvard Medical School Program for Global Surgery and Social Change Boston United States

Tarsicio Uribe-Leitz puribeleitz@bwh.harvard.edu Boston Children's Hospital Department of Plastic and Oral Surgery, Boston Children’s Hospital Boston United States

Ruma Rajbhandari rrajbhandari@mgh.harvard.edu Nick Simons Institute Sanepa Nepal

United States

Oral or Poster

Surgical care delivery in Nepal faces numerous challenges including geography/terrain, remote populations, poverty, and specialized workforce shortages. This study describes barriers/facilitators to surgical care to inform a National Surgical Plan (NSP) to strengthen Nepal’s surgical system.

Semi-structured interviews were conducted between February-April 2025 with stakeholders from various clinical and administrative roles and hospital settings (local, provincial, and federally-owned hospitals and primary, secondary, and tertiary service levels in Nepal’s three geographic regions). Participants were identified via purposive sampling. Questions focused on health system domains (infrastructure, workforce, information management, service delivery). Inductive and deductive thematic analyses were conducted.

60 interviews were conducted with participants at 12 hospitals, including the Terai (n=6), Hilly (n=5) and Himalayan (n=1) regions, in general practice (n=8), surgery (n=7), obstetrics (n=6), orthopedics (n=3), anesthesia (n=12), nursing (n=12), and hospital administration (n=12). Primary codes corresponded to health system domains, with additional primary codes on external support, policy, and private healthcare facilities from inductive analysis. Prevalent subcodes emerged in each domain: blood product availability/utilities/space (infrastructure); task shifting/training/recruitment (workforce); referrals/delayed presentations/patient feedback (service delivery); health record accessibility/quality and safety monitoring/electronic record implementation (information management). Facilitators of care delivery included external support and responsive leadership; barriers included burnout/low morale, and unpredictable working environments (inconsistent basic utilities/weather/staff turnover).

This qualitative study highlights the challenges impacting surgical care delivery in Nepal. These preliminary findings provide essential insights to inform the development of Nepal’s NSP, ensuring that interventions are grounded in the context-specific realities faced by providers across diverse settings and regions.