Study settings

Nepal is divided into seven provinces and its health system comprises federal, provincial and local level healthcare facilities.²² Nepal’s public health system is hierarchical and comprises community healthcare units, primary healthcare centres, district/provincial hospitals and tertiary hospitals. In parallel, private hospitals, nursing homes, polyclinics and pharmacies serve much of the population. People seek assistance at the public and private facilities depending on the severity of illness, accessibility of services and their financial circumstances.²² This study was conducted in purposively selected three tertiary teaching hospitals each located in province 1 (B. P. Koirala Institute of Health Sciences/BPKIHS), province 3 (Patan Academy of Health Sciences/PAHS) and province 5 (Universal College of Medical Sciences/UCMS), and the drug shops located around these hospitals (figure 1).

Study sites from various provinces and hospitals. The map was designed using the free and open-source GIS software: QGIS. The shape files were obtained from the Government of Nepal, Ministry of Federal Affairs and Local Development and were publicly available for unrestricted use (https://data.humdata.org/dataset/admin-shapefiles-of-nepal-mofald).