ASSESSMENT OF CLIENT SATISFACTION AND SERVICES AT OST CLINIC IN

SPARSHA NEPAL

To Prawchan KC
Sr.Program Manager/Community Expert
SPARSHA Nepal (Society for Positive
Atmosphere and Services for HIV and AIDs)

By Rodan Singh Maharjan

Bachelor in Community Development
Kathmandu University School of Arts
ACKNOWLEDGEMENT

I extend my deepest gratitude to my supervisor, Mr. Prawchan KC for his invaluable guidance,
support, and encouragement throughout the research study and also, I give my gratitude towards
my professor, Mrs. Dipesh Khadka for his expertise, patience and constructive feedback in the
subject of Applied Research and Field Placement.

I am also immensely thankful to the service sector and clients of the OST Clinic at SPARSHA
Nepal (Society for Positive Atmosphere and Services for HIV and AIDs) for their participation
and cooperation, without which this research would not have been possible. Their insights and
perspectives have enriched the findings of this study and contributed significantly to its depth
and accuracy.

Furthermore, I extend my sincere appreciation to the volunteers who generously dedicated their
time and efforts to assist in various aspects of this research. Their dedication, enthusiasm, and
unwavering commitment have been indispensable in ensuring the data collection and analysis.

Lastly, I would like to express my gratitude to SPARSHA Nepal (Society for Positive
Atmosphere and Services for HIV and AIDs) for providing the necessary resources and support
for this research project.

Thank you all for your invaluable contributions.

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ABBREVIATIONS

AIDS Acquired Immunodeficiency Syndrome

ART Antiretroviral therapy

BMT Buprenorphine Maintenance Treatment

CCU Clinical Care Unit

GDC German Development Cooperation

HAART Highly Active Antiretroviral therapy

HCV Hepatitis C virus

HIV Human Immunodeficiency Virus

IDUs Injecting drug users

MARPs Most AT Risk Populations

MMT Methadone Maintenance Therapy

MOH Ministry of Health

NCASC National Centre for AIDS STD Control

NGOs Non-Governmental Organizations

OST Opioid Substitution Therapy

OUD Opioid Use Disorder

PLWA People Living with AIDS

SCU Social Care Unit

SPARSHA Society for Positive Atmosphere and Services for HIV and AIDs

KUSOA Kathmandu University School of Arts

WHO World Health Organization

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TABLE OF CONTENTS

ABSTRACT ................................................................................................................................................. 5

1. BACKGROUND INFORMATION ................................................................................................... 6

2. RESEARCH OBJECTIVES .................................................................................................................. 7

3. METHODOLOGY ................................................................................................................................. 7

4.1 Questionnaire .................................................................................................................................... 7

4.2 Data Analysis ..................................................................................................................................... 7

4. RESULTS & FINDINGS ........................................................................................................................ 8

4.1 Age of Clients ..................................................................................................................................... 8

4.2 Gender Analysis................................................................................................................................. 8

5.3 Economic Status ................................................................................................................................ 9

4.4 History of Addiction in other family members ............................................................................. 10

4.7 Challenges of Clients....................................................................................................................... 13

4.8 Limitation of Clients ....................................................................................................................... 14

5. RECOMMENDATION ........................................................................................................................ 15

6. CONCLUSION ..................................................................................................................................... 17

7. ANNEX .................................................................................................................................................. 18

8. REFERENCE ........................................................................................... Error! Bookmark not defined.

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ABSTRACT

Opioid substitution therapy (OST) is an empirically supported strategy for individuals with
opiate dependence that substitutes the use of illegal drugs with the oral administration of
medically prescribed opiates, such as methadone and buprenorphine. OST has become an
essential strategy for managing the intricate issues associated with opioid addiction and
dependency. The success of OST programs relies heavily on client satisfaction with the services
provided. This report delivered the assessment of client satisfaction with OST programs and
evaluate the effectiveness of the services offered in SPARSHA Nepal (Society for Positive
Atmosphere and Services for HIV and AIDs). Additionally, evidence from several clinical trials,
longitudinal studies, and meta-analyses continuously bolsters the effectiveness of OST in
encouraging long-term recovery and lowering the risk of relapse in OUD patients. The self-
administered questions were included related to service delivery, client satisfaction, medical
availability, psychosocial services, outreach and follow up, doctors and staff accessibility.
However, the attitudes of family towards methadone and service accessibility in terms of
location showed the least satisfied with both at 78% and medical availability and psychosocial
services are highly satisfied with both being 97.5 % from the data and collected documents. The
research design incorporated mixed method to collect the data from 41 clients from their
participation through questionnaire and short interviews to discuss the challenges and limitation
through identifying the factors like transportation, stigma, peer pressure, side effects, language
and cultural barriers. Whereas relapse and transportation demonstrate the most challenged areas
of clients while after care, limited support and personal motivation displays the limitation of
OST services in SPARSHA Nepal. Measuring the precise number of people who have
effectively overcome their addiction to opioids can be difficult however this will be the gap
analysis of the study and furthermore the study is expected to give valuable insights into client’s
satisfaction with OST services in SPARSHA Nepal, identifying areas of strength and areas for
improvement within OST programs with evidence-based recommendations for enhancing client
satisfaction and service effectiveness. By this identification I hope it specific areas that require
improvement, this research can inform policy and practice decisions related to opioid addiction
treatment in SPARSHA Nepal. Eventually, the findings will contribute to the ongoing discourse
on the effectiveness of OST programs in SPARSHA Nepal and enhance client satisfaction and
outcomes of OST services.

Keywords: Opioid substitution therapy (OST), Self-Administered Questionnaire

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 1. BACKGROUND INFORMATION

Nepal Drug Users Survey report released by the Home Ministry in June 2020 found the number
of drug users in Nepal was 130,424 which shows the alarming rise in substance abuse among
youths in the country after a three-fold increase from 43,309 in 2008 to 91,534 hard drug users in
2012 it is increased by about 98% over the course of 6 years. Person who intakes opiates and
chemical substances like Brown Sugar, Cocaine, Heroin, LSD, Morphine, Buprenorphine etc. is
defined as hard drug users. They often find it challenging to break free from addiction, requiring
assistance from clinics and other social provisions to gradually achieve sobriety. One of the very
important and evidence-based interventions for prevention of HIV among IDUs and in reducing
hard drug use, criminal activity is the Opioid Substitution Therapy (OST). These services
comprise Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Treatment
(BMT) is in Nepal. Due to their addictive potential, effort and vigilance in controlling
prescriptions is needed to avoid misuse and dependence. Opioid substitution therapies are
commonly used to treat opioid dependence; however, there is minimal consensus as to which
therapy is most effective. The government has a limited involvement in providing treatment and
rehabilitation programs, and drug-dependent individuals have difficulty accessing comprehensive
health and psychosocial care.
Though the number of OST sites and the percentage of people in substitution therapy are
significantly higher in high-income countries than in low- and middle-income countries, harm
reduction initiatives are available in 80 countries in 2014, many of which are in Asia, where
traditional reliable support for law enforcement-oriented drug policies has gradually given way
to a willingness to test harm reduction approaches (Harm Reduction International, 2014; Reid &
Crofts, 2013). As a result, improving the scope and quality of OST programs is imperative in
order to maximize their positive effects on public health (Harm Reduction International, 2014).
Part of a national OST program overseen by the Ministry of Health, the OST site at SPARSHA is
one of 11 such sites that are currently operating throughout Nepal at public hospitals and through
non-governmental organizations (NGOs). Since 2009, German Development Cooperation (GDC)
has been a key technical partner in this effort and their own experience with OST in
collaborating closely with government and civil society partners to expand OST in Nepal from a
small pilot project to a sustainable national program. Previous studies have highlighted the
importance of client satisfaction in determining the success of OST programs (Kelly et al., 2017;
Merrall et al., 2019). Satisfied clients are more likely to adhere to their treatment plans, leading
to improved outcomes like reducing drug use, improving physical and mental health, and
preventing criminal activity (Kelly et al., 2017). As a result, this report addressed the assessment
of client satisfaction and services in the OST Clinic of SPARSHA Nepal. By using a self-
administered questionnaire to investigate client satisfaction level, limitations, and challenges;
additionally, interviews with the supervisor and counselor of the Social Unit, as well as nurse of
Medical Unit, were conducted. Based on the results, it was possible to identify the most
important areas for improvement.

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2. RESEARCH OBJECTIVES

1. To evaluate the level of satisfaction of clients receiving OST treatment at the clinic.

2. To identify the strengths and weaknesses of the services provided by the OST clinic

3. To suggest recommendations for improving the services provided by the OST clinic based on

the findings.

3. METHODOLOGY

The study practiced mixed methods research design, incorporating both quantitative and
qualitative data collection methods. The research study used a simple random sampling to select
more than 40 participants using the clinics register as a sampling frame in the OST clinic of
SPARSHA. Data are collected using self-administered questionnaires and semi structured
interviews. The questionnaire includes demographic information, drug used, history of addiction
in other family members, OST program challenges, limitation and satisfaction with services and
recommendation for improvement. The self-administered questionnaire was design to focus on
clients’ experiences with OST services, challenges encountered, and recommendations for its
sustainability and development.

4.1 Questionnaire

The use of self-questionnaire with multiple choice questions to seeks and gather valuable
feedback from patients who have utilized the clinic's services. The research collected within the
sample of 41 clients using self-administered questionnaire on their demographic, satisfaction
level in terms of certain factors, challenges, limitations and recommendation. The questionnaire
was prepared with the purpose of conveniency, reverence and with ethical consideration.

4.2 Data Analysis

Quantitative data were analyzed using descriptive statistics, including frequency distributions,
means, and standard deviations. Inferential statistics were used to compare differences between
groups based on demographic variables such as age, gender, economic status, feature of drug use
and history of addiction in family members. Qualitative data analyzed using thematic analysis.
Themes will be identified and interpreted to provide insights and recommendation into client’s
experiences with OST services.

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4. RESULTS & FINDINGS

4.1 Age of Clients

The age of clients is between 24 – 51 years old and it shows that between 27 – 37 years of age
clients has the highest number to be enrolling in OST Clinic.

4.2 Gender Analysis

The data shows the participation highest number of male members while it shows no number of
female members participation.

Gender
Frequency Percent Valid Percent Cumulative
Percent
Valid Male 41 100.0 100.0 100.0

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5.3 Economic Status

The data shows that maximum number of clients enrolling in OST is medium and lower income
status while there is no record of higher-income status within the research sample of 41 clients as
per the findings.

Economic Status

Frequency Percent Valid Percent Cumulative Percent

Valid Medium 33 80.5 80.5 80.5
Low 8 19.5 19.5 100.0
Total 41 100.0 100.0

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4.4 History of Addiction in other family members

The data shows the history of addiction in other family members at past is the lowest being
9.8%, not present is 75.6% being the highest number and 14.6% is present.

History of Addiction in other family members

Cumulative
Frequency Percent Valid Percent Percent
Valid At Past 4 9.8 9.8 9.8
Not Present 31 75.6 75.6 85.4
Present 6 14.6 14.6 100.0
Total 41 100.0 100.0

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4.5 Features of Drug Use before enrolling in this OST Service

The highest number of drug use before enrolling in OST Service is brown sugar which is 80.5%
and this need to be addressed frequently as the data shows the rise of drug abuse.

Types of Drug Use

Cumulative
Frequency Percent Valid Percent Percent
Valid Brown Sugar 33 80.5 80.5 80.5
Inject 8 19.5 19.5 100.0
Total 41 100.0 100.0

4.6 Satisfaction Level of Clients

Through self-administered questionnaire the survey was taken from the of sample of 41 clients to
rate from the range of 1 to 10. As from the collect data the maximum percentage of client’s
satisfaction level was found in the medical availability and psychosocial services being 97.5%,
while doctors and staff’s accessibility being, outreach and follow up, social responsibility
towards family members is 97.4%, 87.9% and 90.2%. However, the attitudes of family towards
methadone and service accessibility in terms of location shows least satisfied with 78% from the
data analysis tools and findings.

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 Social
ResponsibiAttitudes Service
Doctors lity of family General Accessibi
Medical Psychosoc Out Reach and Staff towards towards Health lity in
RATIN Availabilit ial and Accessib family methadon Conditio terms of
GS y Services Follow Up ility members e n Location
1 1 3 1 2
Val 2 1 2
id 3 1
4 1 1 1 4
5 1 4 2 1 5
6 6 1 1
7 3 6 3 1 2 1 1
8 6 4 6 3 5 6 6 4
9 2 11 4 6 7 8 10 5
10 29 19 25 29 23 16 22 21
Tota 41 41 41 41 41 41 41 41
l

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 4.7 Challenges of Clients

The data shows the measurement of sampled of 41 clients among them 10 clients said that they
faced the challenges like transportation and relapse triggers with both being 75.6%.

Languag
e and Long Knowle
Transpo Peer Side Culture Waiting Social Financial dge Relapse
rtation Stigma Pressure Effects Barriers List Isolation Barriers Barriers Triggers
(Yes) 10 3 4 7 1 1 6 5 2 10
% (24.4%) (7.3%) (9.8%) (17.1%) (2.4%) (2.4%) (14.6%) (12.2%) (4.9%) (24.4%)

Missin 31 38 37 34 40 40 35 36 39 31
% (75.6%) (92.7%) (90.2%) (82.9%) (97.6%) (97.6%) (85.4%) (87.8%) (95.1%) (75.6%)

FULL 41 41 41 41 41 41 41 41 41 41
(100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0)

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 4.8 Limitation of Clients

The table shows the percentage of limitation within sampled clients which states that the
continuity of care, limited support, limited treatment and health complication are major
limitation faced by the clients in OST center.

Limitation of Clients

Lack of Lack of Physical

Lack of Lack of Personal Access to Limited Health
After Continuit Motivatio Harm Limited Limited Availabili Complica
Care y of Care n Reduction Support Treatment ty tions
N (yes) 6 4 6 3 6 1 5 3
% (14.6%) (9.8%) (14.6%) (7.3%) (14.6%) (2.4%) (12.2%) (7.3%)
Missi 35 37 35 38 35 40 36 38
% (85.4%) (90.2%) (85.4%) (92.7%) (85.4%) (97.6%) (87.8%) (92.7%)
Total 41 41 41 41 41 41 41 41
(100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0)

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5. RECOMMENDATION

The recommendation is mostly based on the findings from clients’ opinions and answers which
were collected through the self-administered questionnaire. They are as follows:

1. Expand the scope of testing to include a more comprehensive assessment of client needs and
health conditions beyond the primary services.

2. Emphasize the importance of maintaining a clean and hygienic environment within the clinic
premises.

3. Increase the availability of medical professionals (doctors) to cater to the growing demand for
services.

4. Implement comprehensive training and educational programs for all clinic staff to ensure high-
quality service delivery and patient care.

5. Organize and conduct social programs aimed at addressing addiction and fostering a
supportive community environment.

6. Enhance engagement with clients by introducing personalized care strategies and support
mechanisms.

7. Consider extending the operating hours of the clinic to accommodate the needs of a larger
client base.

8. Explore the possibility of opening additional branches in different locations to improve

accessibility for clients.

9. Conduct a feasibility study on opening the OST clinic in other areas to address the gap in
service availability.

10. Address the issue of limited availability in other locations due to high demand and explore
solutions for improving accessibility.

11. Address transportation-related constraints that lead to increased time and expenses for clients
accessing the clinic's services.

12. Foster a supportive social environment that encourages open discussions about addiction and
potential solutions within the community.

13. Implement measures to rectify any mistakes and rebuild trust with clients' families to support
the recovery process.

14. Evaluate opportunities for further enhancement of facilities and resources within the clinic to
better meet client needs.

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15. Provide opportunities for personal development for medical professionals (doctors) to
enhance their skills and patient care capabilities.

16. Explore avenues for providing work and occupation support for individuals in recovery as a
part of holistic care.

17. Consider involving clients in counseling sessions as part of their future contribution to
promoting a drug-free lifestyle.

18. Evaluate the possibility of providing temporary stay or housing support for clients in need of
additional care and support.

19. Emphasize the importance of fostering an open and supportive environment for individuals
struggling with addiction.

20. Develop a system to accommodate clients who may arrive late for medication services to
ensure their needs are met.

21. Stress the importance of regular, ongoing counseling to support clients throughout their
recovery journey.

22. Prioritize promotion and awareness campaigns targeted at family members to foster a
supportive environment.

23. Address the issue of limited access to services for clients who travel to ensure continuity of
care.

24. Investigate the feasibility of expanding services to other branches throughout Nepal to
improve accessibility.

25. Consider strategies for drug control and awareness efforts within the clinic and its outreach
programs.

These recommendations address various aspects of client satisfaction and service enhancement at
the OST Clinic.

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6. CONCLUSION

In conclusion, the findings from this research point to numerous opportunities for enhancing
client satisfaction and improving services at the OST Clinic in SPARSHA Nepal. Through the
comprehensive analysis of client feedback and recommendations for improvement, it is evident
that there are key areas in which the clinic can evolve to better meet the needs of its clients.

The overarching themes of cleanliness, staff training, extended availability, community

engagement, and expanded service accessibility emerge as critical focal points for the clinic's
development. Additionally, the importance of holistic care, open communication, and ongoing
support for clients and their families underscores the significance of creating an environment that
fosters both physical and emotional healing.

By addressing the points raised in this research, the OST Clinic can not only elevate its standards
of care and service delivery but also effectively contribute to the broader goal of promoting a
drug-free and supportive community. These insights serve as a foundation for strategic decision-
making and action planning to realize the clinic's potential for growth and impact.

Ultimately, this study underscores the significance of client-centered care and the continual
pursuit of excellence in meeting the diverse needs of individuals seeking support at the OST
Clinic in SPARSHA Nepal. It is through the conscientious application of these recommendations
that the clinic can further its mission of providing compassionate, effective, and inclusive care to
those in need.

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7. ANNEX

18
 8. REFERENCE

Healthy DEvelopments. (2024, January 8). Opioid substitution therapy in Nepal – Healthy

DEvelopments. https://health.bmz.de/studies/opioid-substitution-therapy-in-nepal/

Today, N. (2023, June 26). Home Minister Shrestha calls for combined efforts to combat drug abuse.

Nepal Live Today. https://www.nepallivetoday.com/2023/06/26/home-minister-shrestha-calls-

for-combined-efforts-to-combat-drug-

abuse/#:~:text=There%20are%20130%2C424%20drug%20abusers%20in%20the%20country%2

C%20according%20to,have%20been%20in%20rehabilitation%20centers

Dennis, B. B., Naji, L., Bawor, M., Bonner, A. D., Varenbut, M., Daiter, J., Plater, C., Paré, G., Marsh,

D. C., Worster, A., Desai, D., & Samaan, Z. (2014). The effectiveness of opioid substitution

treatments for patients with opioid dependence: a systematic review and multiple treatment

comparison protocol. Systematic Reviews, 3(1). https://doi.org/10.1186/2046-4053-3-105

Ambekar, A., Pun, A., & Kumar, M. S. (2010). A review of Opioid Substitution Therapy (OST)

programme in Nepal. ResearchGate. https://doi.org/10.13140/RG.2.1.1492.8481

Aich, T. K., Dhungana, M., & Khanal, R. (2010). Pattern of buprenorphine abuse among opioid abusers

in Nepal. Indian Journal of Psychiatry, 52(3), 250. https://doi.org/10.4103/0019-5545.70978

Alarming rise in substance abuse among youths calls for policy-level intervention. (2023, June 18). The

Kathmandu Post. https://kathmandupost.com/national/2023/06/18/alarming-rise-in-substance-

abuse-among-youths-calls-for-policy-level-intervention

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SAMPLE OF SELF ADMINISTERD QUESTIONNAIRE
1. Name:
2. Age:
3. Address:
4. Ethnicity:
5. Phone no:
6. Economic Status High Medium Low
7. History of Addiction in other family members At Past Present Not Present
8. Features of Drug Use before enrolling in this
OST Service

RATE FROM 1 - 10
9. Medical Availability 1 2 3 4 5 6 7 8 9 10
10. Psychosocial Services 1 2 3 4 5 6 7 8 9 10
11. Out Reach and Follow Up 1 2 3 4 5 6 7 8 9 10
12. Doctors and Staff Accessibility 1 2 3 4 5 6 7 8 9 10
13. Social Responsibility towards family members 1 2 3 4 5 6 7 8 9 10
14. Attitudes of family towards methadone 1 2 3 4 5 6 7 8 9 10
15. My General Health Condition 1 2 3 4 5 6 7 8 9 10
16. My Service Accessibility in terms of Location 1 2 3 4 5 6 7 8 9 10

17. In short what are the challenges your faced in getting this OST service?
Transportation Long Waiting List
Stigma (Discrimination/ Judgement) Social Isolation
Peer Pressure Financial Barrier
Side Effects (nausea, constipation or drowsiness) Lack of Knowledge
Language and Culture Barriers Relapse Triggers
Others:

18. In short what can be the limitation of this OST service?

Lack of After Care Support Limited Support
Lack of Continuity of Care Limited Treatment
Lack of Personal Motivation Limited Availability
Lack of access to harm reduction Physical Health Complications
Others:
19. Describe in short how can it be improved?

20. Your thoughts on how can we achieve full 10 rate in this service?

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