Open Access Research article

Injection practices in Nepal: health policymakers’ perceptions

Sudesh Gyawali1*, Devendra Singh Rathore2, Pathiyil Ravi Shankar3, Manisha Maskey4 and Vikash Kumar KC5

Author Affiliations

1 Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal

2 Department of Pharmacy, L.R. Institute of Pharmacy, Jabli-kyar, Solan, India

3 Department of Pharmacology, Xavier University School of Medicine, Oranjestad, Aruba, Kingdom of the Netherlands

4 Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal

5 Department of Statistics, PN Multiple Campus, Pokhara, Nepal

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BMC International Health and Human Rights 2014, 14:21  doi:10.1186/1472-698X-14-21

Published: 24 June 2014



The unnecessary and unsafe use of injections is common in developing countries like Nepal. Policymakers have an important role in promoting rational and safe injection use. Hence, the present study was carried out to explore the perception of health policymakers regarding safe injection practice in Nepal.


An exploratory qualitative study design was used in this study. Key policymakers from both the central and regional level were selected using purposive sampling. A semi-structured questionnaire advocated by the World Health Organization (WHO) was used after modifying the context. Interviews were conducted to clarify doubts and obtain additional information. The data was analyzed manually using deductive content analysis technique.


In total, eleven policymakers participated. All unanimously agreed that injection safety is a problem and seven participants reported that injections are overused. They shared the opinion that injections are administered by various providers, including formal and informal health providers, and also quacks. Almost half the respondents reported that the National Drug Policy discourages injection overuse, while others reported that the policy contains no provisions regarding injection overuse. Most policymakers stated that only single-use disposable injection equipment is used to provide injection, while others thought that sterilizable glass syringe is also used. More than half of the participants believed that the quality of injection equipment available in the Nepalese market is not regulated by any government institution. Almost two-third of the policymakers stated that syringes and needles are not reused, while the rest thought syringes might be reused without sterilization in some parts of the country. Almost half of the respondents stated that illegal commercialization of used syringes exists in Nepal. Almost all respondents thought that health care institutions have a waste management plan, while more than half of them opined that such plans are limited to tertiary care hospitals located in the capital.


The result of this study revealed a divergence of views among policymakers, even among those in the same ministry. Though there has been some effort from the government to increase the safety of injection practices, greater efforts are required, especially with regard to standardization of policies and procedures related to injection practice.

Drug policy; Hazardous waste; Health policy; Injection; Needle stick injury; Nepal