Severe Non-Communicable Disease Management through PEN-Plus: A Readiness Assessment Insights from Two District Hospitals of Nepal

Background: Non-communicable diseases (NCDs) pose a significant public health burden in Nepal, necessitating effective healthcare interventions. The Package of Essential NCD Interventions-Plus (PEN-Plus) program, led by the Ministry of Health and Population (MoHP) implemented by the Epidemiology and Disease Control Division (EDCD), aims to enhance specialized severe NCD care at district-level hospitals of Nepal. This study assesses the readiness of Damak Hospital in Jhapa district and Bardiya hospital in Bardiya district to implement the PEN-Plus program, focusing on healthcare resources, service delivery, referral mechanisms, and health information systems. Methods: The study conducted a rapid assessment to understand the capacity of two hospitals to initiate the PEN-Plus program in 2021. Data were collected through facility observations, structured surveys with hospital administrators and healthcare providers, and medical record reviews. The findings are presented in terms of hospital capacity, staffing, medication availability, and service provision. Results: The study found that both hospitals demonstrated availability of basic infrastructure and basic medical equipment for NCD care. However, there were notable gaps in advanced diagnostic tools such as echocardiograms and specialized laboratory facilities to diagnose severe NCDs like rheumatic heart diseases, congenital heart diseases and Type 1 Diabetes in District Hospitals. The staff capacity at both hospitals was insufficient, with a need for additional training in the management of severe NCDs. Data management systems were found to be underdeveloped, with limited capacity for patient tracking and follow-up. Conclusion: This study highlights critical gaps in severe NCD management in the current context of district-level hospitals in Nepal