Strengthening Dengue Diagnostic Services in Bagmati Province, Nepal

Evidence from a 110-facility assessment across 6 districts | PHRD Nepal & FIND | May 2026

The Issue

Dengue is rapidly expanding across Nepal, including hill and urban districts of Bagmati Province, yet access to quality-assured diagnostics remains uneven. A cross-sectional assessment of 110 health facilities (government, private, and diagnostic centers) across Kathmandu, Bhaktapur, Lalitpur, Makwanpur, Chitwan, and Kavre found strong testing coverage but persistent gaps in quality assurance, procurement reliability, affordability, and confirmatory diagnostic capacity.

Key Findings

90.9%	97%	84.8%
of facilities perform dengue testing on-site (n=110)	rely on combo RDTs (NS1/IgM/IgG) as primary diagnostic	procure test kits via private distributors/wholesalers
22.2%	NPR 450-5,000	88.9%
of facilities reported quality issues (false positives/negatives, invalid results)	range in patient cost per test, highly inconsistent pricing	of facilities would adopt a validated multiplex febrile (dengue/chikungunya) panel

Testing volume declined from 75,542 tests (16,790 positive) in 2024 to 55,991 tests (12,566 positive) in 2025, with 2023 cited as the heaviest dengue year. Confirmatory methods (ELISA/RT-PCR) remain largely unavailable even in tertiary centres, and government facilities depend entirely on centralized supply while private facilities rely almost exclusively on private distributors, a split that drives stock-outs (80% of facilities cite unreliable suppliers as the top procurement barrier) and price disparities of up to 10x across facility types.

 Recommendations

• Establish a national list of WHO-listed/CE-marked dengue diagnostics to guide procurement and build facility trust in non-branded products.
• Strengthen public procurement and supply chains to reduce stock-outs, supplier delays, and reliance on a fragmented private distributor market.
• Expand confirmatory testing (ELISA/RT-PCR) capacity at referral hospitals and laboratories to address the diagnostic gap beyond RDTs.
• Standardize and subsidize patient pricing for dengue RDTs, given evidence that higher costs correlate with increased patient refusal of testing.
• Pilot a validated multiplex febrile (dengue/chikungunya) panel, nearly 9 in 10 facilities are ready to adopt one, contingent on national guidelines, regulatory approval, and affordable pricing.
• Harmonize surveillance data systems (10+ platforms currently in use) and close the 20% reporting gap to national/provincial surveillance.

Source: PHRD Nepal & FIND, “Assessment of Current Dengue Diagnostic Practices Across Health Facilities in Bagmati Province” (May 2026). Based on a stratified facility survey (n=110) across 13 districts of Bagmati Province.