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Introduction: Healthcare quality and safety are paramount considerations in providing effective and efficient healthcare services. Ensuring high-quality care and minimizing errors are essential for improving patient outcomes and building trust in healthcare systems. While efforts to improve healthcare quality have been a focus globally, it is crucial to explore specific strategies and implications in developing countries. This article examines recent research articles and their implications for enhancing healthcare quality and reducing errors in developing countries. Strengthening Healthcare Infrastructure: Developing countries often face challenges related to limited resources, infrastructure, and technology.

Strengthening healthcare infrastructure is a critical step in improving healthcare quality. Research conducted in several developing countries has emphasized the importance of investing in robust healthcare systems, including healthcare facilities, equipment, and information technology (1). Upgrading infrastructure can enhance diagnostic capabilities, enable effective communication, and support evidence-based decision-making, ultimately improving patient care and safety.

Enhancing Healthcare Workforce Competence: A skilled and competent healthcare workforce is essential for delivering high-quality care. Research has shown that investing in training and continuous professional development programs can significantly enhance healthcare provider competence and improve patient outcomes. A study conducted in developing countries found that implementing structured training programs led to improved clinical knowledge, better adherence to protocols, and reduced medical errors (2). Fostering a culture of lifelong learning and providing opportunities for healthcare professionals to upgrade their skills can have a profound impact on healthcare quality and patient safety.

Implementing Quality Improvement Initiatives: Quality improvement initiatives are crucial for identifying areas of improvement and implementing evidence- based practices. Research in developing countries has highlighted the effectiveness of quality improvement strategies in enhancing healthcare quality and reducing errors. For example, a study conducted in a developing country context demonstrated that implementing a standardized checklist and protocol for surgical procedures led to a significant reduction in surgical complications and mortality rates (3). Emphasizing quality improvement through monitoring, feedback, and benchmarking can help healthcare systems identify areas for improvement and implement interventions to enhance patient safety.

Embracing Technology and Innovation: Technology and innovation play a transformative role in improving healthcare quality and safety. Recent research has explored the potential of telemedicine, electronic health records, and mobile health applications in enhancing healthcare delivery in developing countries. Studies have shown that telemedicine can increase access to specialty care and provide remote consultations, particularly in underserved areas (4). The adoption of electronic health records can improve care coordination, reduce medication errors, and enhance patient safety. Additionally, mobile health applications can facilitate patient engagement, promote health literacy, and support self- management (5). Embracing technology and innovation can bridge gaps in healthcare access, improve communication, and enhance patient safety in developing countries.

Strengthening Regulatory Frameworks: Establishing robust regulatory frameworks and standards is essential for ensuring healthcare quality and patient safety. Research has emphasized the importance of developing and enforcing regulations related to healthcare facility accreditation, licensing of healthcare professionals, medication safety, and infection control (6). Strengthening regulatory frameworks can help mitigate risks, promote accountability, and improve the overall quality of care in developing countries.

Conclusion: Improving healthcare quality and reducing errors are critical goals for healthcare systems in developing countries. Recent research articles have shed light on effective strategies for enhancing healthcare quality, including strengthening healthcare infrastructure, investing in workforce competence, implementing quality improvement initiatives, embracing technology and innovation, and strengthening regulatory frameworks. By implementing these strategies, developing countries can make significant progress in ensuring safe, effective, and patient-centered healthcare delivery.


  • Ghosh, B., & Gupta, R. (2020). Healthcare infrastructure in developing countries: Perspective of global health. Healthcare Informatics Research, 26(4), 255-259.
  • Okyere, I., Mwanri, L., & Ward, P. (2017). Improving healthcare delivery in low- resource settings: Implications for workforce development and continuing professional development training. Journal of Healthcare Leadership, 9, 11-19.
  • Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A. H., Dellinger, E. P., … & Gawande, A. A. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360(5), 491- 499.
  • Andreatta, P., Debpuur, D., Danquah, A., Perosky, J., & Saxton, A. (2019). Telemedicine in low-resource settings: A systematic review. Frontiers in Public Health, 7, 3.
  • Tomlinson, M., Rotheram-Borus, M. J., Swartz, L., & Tsai, A. C. (2013). Scaling up mHealth: Where is the evidence? PLoS Medicine, 10(2), e1001382.
  • Ghaffar, A., Langlois, E. V., & Rasanathan, K. (2012). Strengthening health systems through embedded research. Bulletin of the World Health Organization, 90(11), 842-842A.
  • Alkhenizan, A., & Shaw, C. (2011). Impact of accreditation on the quality of healthcare services: A systematic review of the literature. Annals of Saudi Medicine, 31(4), 407-416.
  • Chokshi, D. A. (2014). Improving health services in developing countries—From evidence to action. New England Journal of Medicine, 370(6), 498-501.
  • Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., … & Qi, J. (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196-e1252.
  • World Health Organization. (2018). Medication safety in high-risk situations. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/275655/WHO- UHC-HIS-SDS-2018.21-eng.pdf
  • World Health Organization. (2019).Infection prevention and control in health care. Retrieved from https://www.who.int/infection-prevention/publications/ipc- global-report-2019/en/

Nepal healthcare quality and patient safety

Nepal, like many other developing countries, faces challenges in healthcare quality and patient safety. To address these concerns and improve the quality of care, several changes and recommendations have been put forward based on recent research findings. Here are some key recommendations supported by relevant references:

Strengthening Healthcare Infrastructure: Investing in healthcare infrastructure is crucial to improve the quality and safety of patient care. This includes ensuring adequate availability of healthcare facilities, medical equipment, and essential supplies. A study published in BMC Health Services Research emphasized the need for infrastructure development in Nepal’s healthcare system to enhance service delivery and patient outcomes (1).

Enhancing Healthcare Workforce Competence: Improving the competence and skills of healthcare professionals is essential for delivering quality care. This can be achieved through comprehensive training programs, continuing education, and professional development initiatives. A study published in the Journal of Nepal Health Research Council highlighted the importance of strengthening healthcare workforce competence to enhance patient safety and improve healthcare quality in Nepal (2).

Implementing Quality Improvement Initiatives: Introducing quality improvement initiatives can significantly impact healthcare quality and patient safety. These initiatives involve implementing evidence-based guidelines, protocols, and standardized practices. A research article published in the Journal of Nepal Medical Association emphasized the need for quality improvement initiatives to enhance patient safety and reduce medical errors in Nepal (3).

Embracing Technology and Digital Health Solutions: Adopting technology and digital health solutions can enhance healthcare quality and patient safety. This includes implementing electronic health records, telemedicine, and mobile health (mHealth) applications. A study published in the Journal of Medical Internet Research highlighted the potential of mHealth interventions in improving healthcare delivery and patient outcomes in resource-limited settings like Nepal (4).

Strengthening Regulatory Framework and Accreditation Systems: Establishing robust regulatory frameworks and accreditation systems is vital for ensuring quality care and patient safety. These frameworks should include guidelines for healthcare standards, safety protocols, and monitoring mechanisms. A study published in the Journal of Nepal Medical Association emphasized the importance of regulatory oversight and accreditation in improving healthcare quality and patient safety in Nepal (5).

Promoting Patient Engagement and Empowerment: Engaging and empowering patients in their healthcare journey can contribute to improved quality and safety. This involves promoting shared decision-making, patient education, and involving patients in their care plans. A systematic review published in BMJ Open highlighted the positive impact of patient engagement strategies on healthcare quality and patient safety outcomes (6).

By implementing these changes and recommendations, Nepal can work towards improving healthcare quality and patient safety. It is essential for policymakers, healthcare leaders, and stakeholders to collaborate and prioritize these areas to bring about positive changes in the healthcare system.


  • Pradhan, P., & Sreeramareddy, C. T. (2017). Infrastructure Availability in Primary Health Centers of Nepal. BMC Health Services Research, 17(1), 388.
  • Bista, B., & Piryani, R. M. (2019). Patient Safety Practices in Medical and Surgical Wards of a Tertiary Care Hospital in Nepal. Journal of Nepal Health Research Council, 17(1), 116-121.
  • Gurung, A., & Upadhyay, M. P. (2019). Assessment of Patient Safety Climate in Selected Wards of Hospitals in Eastern Nepal. Journal of Nepal Medical Association, 57(216), 223-229.
  • Ghimiray, A., et al. (2020). Efficacy of mHealth Interventions in Health Promotion for Patients with Non-Communicable Diseases in Low- and Middle-Income Countries: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Medical Internet Research, 22(1), e13784.

Possible reasons of Dissatisfaction of patients in Nepal

Patients may complain about the services they receive from doctors and nurses in Nepal for several reasons. It is important to note that these complaints do not represent the entire healthcare workforce in the country, but rather highlight areas where improvements can be made. Some common reasons for patient complaints include:

Communication Issues: Effective communication between healthcare providers and patients is crucial for building trust and ensuring quality care. Patients may complain about healthcare providers who do not communicate clearly, use technical jargon that patients cannot understand, or fail to listen to their concerns and preferences. Improving communication skills and promoting patient-centered care can help address these issues.

Lack of Empathy and Respect: Patients expect to be treated with empathy, dignity, and respect during their healthcare encounters. Complaints may arise when healthcare providers display a lack of empathy, fail to address patients’ emotional needs, or exhibit unprofessional behavior. Promoting a culture of empathy and respect within the healthcare system is essential for improving patient experiences.

Long Waiting Times and Delays: Long waiting times and delays in receiving healthcare services can lead to patient dissatisfaction and complaints. Factors such as inadequate staffing, limited resources, and inefficient processes contribute to these delays. Streamlining healthcare workflows, optimizing resource allocation, and implementing appointment systems can help reduce waiting times and improve patient satisfaction.

Inadequate Information and Informed Consent: Patients have the right to receive clear and comprehensive information about their medical conditions, treatment options, and potential risks and benefits. Complaints may arise when healthcare providers fail to provide adequate information or obtain informed consent before procedures or treatments. Enhancing informed consent practices and ensuring patients are well-informed about their care can address these concerns.

Medical Errors and Patient Safety: Incidents of medical errors or lapses in patient safety can result in patient complaints. These errors can include medication mistakes, misdiagnoses, surgical complications, or healthcare-associated infections. Strengthening patient safety protocols, implementing quality improvement initiatives, and fostering a culture of open reporting and learning from errors can help mitigate these issues.

Lack of Availability and Accessibility: Limited access to healthcare services, particularly in rural areas, can lead to patient complaints. Patients may face challenges in accessing timely and affordable care, including long travel distances, limited healthcare facilities, and financial barriers. Expanding healthcare infrastructure, increasing healthcare workforce capacity, and implementing strategies to address geographic and financial barriers can improve accessibility and reduce patient complaints.

Addressing these concerns requires a multi-faceted approach involving healthcare providers, policymakers, and the healthcare system as a whole. By prioritizing patient-centered care, promoting effective communication, ensuring patient safety, and improving access to healthcare services, Nepal can work towards addressing patient complaints and enhancing the overall patient experience.

Note: The reasons mentioned above are based on common themes reported in patient complaints but may not represent the entire healthcare system in Nepal.


  • Ministry of Health and Population, Nepal. (2015). National Patient Safety Policy and Strategic Framework 2015-2020. Retrieved from https://extranet.who.int/sph/docs/file/3464
  • Regmi, M. C., et al. (2019). Patient Experience in Outpatient Departments of Public Hospitals in Nepal: A Descriptive Cross-sectional Study. Journal of Nepal Health Research Council, 17(2), 151-157.