Universal health coverage (UHC) assures all types of health service and protects all citizens financially in any conditions due to illness. Globally, the UN sustainable development goal (SDG) provides high priority for UHC as a health related goal. The National health system of Nepal has prioritized in similar way. The aim of this study is to explore the challenges and opportunities on the road to UHC in Nepal. We used varieties of search terminologies with popular search engines like PubMed, Google, Google Scholar, etc. to identify studies regarding Nepal’s progress towards UHC. Reports of original studies, policies, guidelines and government manuals were taken from the web pages of Ministry of Health and its department/division. Searches were designed to identify the status of service coverage on UHC, financial protection on health particularly, health insurance coverage with its legal status. Other associated factors related to UHC were also explored and presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. We found 14 studies that were related to legal assurance, risk pulling and financing of health service, 11 studies associated to UHC service coverage status and, 7 articles linked to government stewardship, health system and governance on health care. Constitutional provision, global support, progress on the health insurance act, decentralization of health service to the grass root level, positive trends of increasing service coverage are seen as opportunities. However, existing volunteer types of health insurance, misleading role of trade unions and high proportion of population outside the country are main challenges. The political commitment under the changing political context, a sense of national priority and international support were identified as the facilitating factors towards UHC. To achieve UHC, service and population coverage of health services has to be expanded along with financial protection for marginalized communities. Government stewardship, support of stakeholders and fair contribution and distribution of resources by appropriate health financing modality can speed up the path of UHC in Nepal.

Background and Aims: Access to safe and sufficient drinking Water, Sanitation, and good Hygiene (WASH) facilities in schools play a crucial role in preventing students from numerous Neglected Tropical Diseases, improving the learning environment in schools, and creating resilient communities living in a healthy environment. This study aims to explore the impact of combining WASH facilities on students' health status, school attendance, and educational achievements.Methods: Four schools, two with improved and two without improved WASH facilities, were selected purposively from Dhanusha and Chitwan districts of Nepal. A total of 24 participants, 16 students, and eight teachers were also purposively selected based on the Theory of Data Saturation. The participants were interviewed face‐to‐face using study guidelines; Key Informants Interview for teachers and In‐depth Interview for students. The data were audio recorded and analyzed thematically using Dedoose 9.0.17 qualitative data management and analysis software.Results: School WASH facilities have a significant impact on students' health and well‐being. Poor school‐WASH facilities hindered students' school attendance, particularly for menstruating girls. School without separate toilets for girls, including menstruation hygiene facilities, lack of water and soap, sanitary pad, and secure toilet's door often have higher rates of absenteeism among girls. Poor teacher and students' relationships, students' low interest in education, household chores, and participation in social customs also contribute to students' absence from school and low educational performance. It is important to note that inadequate WASH facilities affect not only students, but also teachers in the same school.Conclusion: The lack of safe and sufficient drinking water, unimproved sanitation, and poor hygiene facilities were seen by students and teachers as reducing their health and well‐being, school attendance, and academic performance. Thus, schools need prioritize and promote the provision of improved WASH facilities for the betterment of students' health, attendance, and educational proficiency.

The Health Insurance Program (HIP) in Nepal is experiencing low enrolment and high dropout rates, but the causes of these issues have remained unknown. This study aimed to explore the causes of dropouts of the HIP implemented by the Health Insurance Board, Nepal.

Background: Many studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal. Methods: We employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable. Results: Data showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41–60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17–44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09–8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61–8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34–2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI. Conclusion: Knowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.

The enrollment in Health Insurance (HI) is considered as a sustainable way of financing for health and preparedness for catastrophic health care cost during receiving health services. Various socio-demographic factors are still unanswered regarding their influence. A study aiming to assess the factors associated with the enrollment of HI was conducted in 2018 in two districts of Nepal namely Kailali and Baglung. The study was cross-sectional covering 810 (405 enrolled and 405 not-enrolled) randomly selected households (HH). Socio-demographic variables were considered as independent variables and enrollment in HI as dependent variable. An interview schedule was used as a tool for data collection. Univariate, bivariate and multivariate analyses were performed to analyze the data. The data show that various socio-demographic characteristics are associated with the enrollment of HI. A significant statistical difference is seen between enrollment to HI and HH headship, age group of respondents, ability to feed the family, presence of chronic diseases in family, knowledge on HI, willingness to pay (WTP) for HI, having HI guidelines or books, participation in HI related training, interactions with neighbours, access to communication media: the radio/FM and TV, hoarding boards (HB), newspapers, posters/pamphlets/brochures; and access to health facilities. The results further show that female heads appear more likely to enroll (aOR = 1.47) in HI than the male. HH headship of the respondents also seem more likely to enroll. Higher age respondents are less likely to enroll. Interestingly, literate respondents and joint families are less likely to enroll than illiterate and nuclear families respectively. However, respondents having knowledge in HI seem more likely to enroll (aOR = 28.97, p1.673, p