HEALTH FOR LIFE REPORT ON RAPID ASSESSMENT OF DISTRICT HEALTH SYSTEMS 2013 ARGHAKANCHI A REPORT ON RAPID ASSESSMENT OF DISTRICT HEALTH SYSTEMS 2013 ARGHAKHANCHI MAY 2013 TEAM MEMBERS FOCAL PERSON) HEALTH FOR LIFE HALL 401, OASIS COMPLEX PATANDHOKA TABLE OF CONTENTS ABBREVIATION………………………………………………………………………………………………….ii KEY FINDINGS OF RAPID ASSESSMENT OF DISTRICT HEALTH SYSTEM..……………………….….iii 1. RAPID ASSESSMENT OF DISTRICT HEALTH SYSTEMS…………………………………………… 1 2. INTRODUCTION OF PYUTHAN DISTRICT…………………………………………………………..…3 3. DHO STRUCTURE AND SYSTEMS …………………………………………………………………..…4 4. SERVICE STATISTICS ………………………………………………………………………….…….. ……7 5. HEALTH FACILITY MANAGEMENT COMMITTEE AND LOCAL HEALTH GOVERNANCE …...9 6. SERVICE DELIVERY/QUALITY IMPROVEMENT ……………………………………………………11 7. LOGISTICS MANAGEMENT SYSTEM ………………………………………………………………….13 8. BEHAVIOR CHANGE COMMUNICATION …………………………………………………………….15 9. ADOLESCENTS AND YOUTH FRIENDLY SERVICES … ………………………………………… ….18 10. GENDER EQUALITY AND SOCIAL INCLUSION ……………………………………………………...19 Annexes Annex: 1 Contact information of DHO Program focal person…………………….21 Annex: 2 List of RHCC Members ………………………………………………………………21 Annex: 3 List of persons met during RA visit…………………………………………….22 i ABBREVIATIONS AHW Auxiliary Health Worker ANM Auxiliary Nurse Mid-wife AFHS Adolescents Friendly Health Services AFS Adolescents Friendly Services BC Birthing centre BCC Behavior Change Communication BEONC Basic Essential Obstetric and Newborn Care BNMT Britain Nepal Medical Trust CB-IMCI Community-Based Integrated Management of Childhood Illness CB-NCP Community-Based Newborn Care Package CEONC Comprehensive Essential Obstetric and Neonatal Care DAG Disadvantaged Group FCHV Female Community Health Volunteer FEFO First expiry first out HFOMC Facility Management Committee FP Family Planning FY Fiscal Year GESI Gender Equality and Social Inclusion HA Health Assistant H4L Health for Life HF Health Facility HP Health Post HFOMC Health Facility Operation and Management Committee HMIS Health Management Information System I/NGO International/Non-Governmental Organization IT Information Technology IUCD Intra Uterine Contraceptive Device LDO Local Development Office LMIS Logistics Management Information System MO Medical Officer MNCHN Maternal Neonatal Child Health and Nutrition MgSO4 Magnesium Sulphate MSC Matri Surakshya Chakki M&S Monitoring and Supervision MWDR Mid-western Development Region N Number NPC National Planning Commission PHCC Primary Health Care Center QI Quality Improvement QAWG Quality Assurance Working Group RA Rapid assessment RHCC Reproductive Health Coordination Committee RHD Regional Health Directorate SAC Social Awareness Centre SHP Sub Health Post SN Staff Nurse USAID Unites States Agency for International Development VDC Village Development Committee WCDO Women and Child Development Office WDR Western Development Region KEY FINDINGS FROM RAPID ASSESSMENT OF DISTRICT HEALTH SYSTEMS- ARGHAKHANCHI TOTAL POPULATION 197,632 NUMBER OF VDCS 42 MUNICIPALITY 0 DHO STRUCTURE AND Public Health facilities: SYSTEMS District Hospital-1, PHCCs-2, HPs -17 and SHPs-22 Private Health facilities: Private hospitals -1, Community hospital-0 Meetings: Ilaka Incharges monthly meeting- 2nd and 3rd of every month QAWG- formed but no meeting held yet. RHCC- Meets quarterly Health Workforce: Following technical positions at DHO is not filled-in- Statistical assistant, FP focal person, Malaria focal person, and Health Educator and Computer operator. Positions at HFs – 1 MO, 1 SN, 26 ANMs, 7 AHWs and 1 HA are hired on contract basis. Among total contracted (n=36), DHO hired 1 MO, 1 SN and 20 ANM whereas, each 5 ANM and AHW hired from VDC. Similarly, each 1 ANM and HA along with 2 AHW hired from NPC. Monitoring and Supervision: M&S system and plan exists at district level and district from ilaka to SHPs. Integrated supervision is not practiced yet even it is developed. IT infrastructure at D/PHO: Desktops-7, Laptops-5, Printers-6 Well established internet facility. Two HFs has computers. Supervisors skilled in using MS Word and Excel-6. Health Facility level entry in HMIS software. Rapid Response Team: Functioning well at the district and HF level SERVICE STATISTICS BCG coverage is in increasing trend from FY 2065/66 to 2066/67 and decreased in FY 2067/68 and FY 2068/69. In the FY 2068/69 measles coverage was 79.49 percent which is decreased in compare to FY 2067/68 and 2066/67. Data shows district is falls in problematic category as it is below the national average. Severe pneumonia and dehydration cases shows fluctuating trend. More children having pneumonia are being treated with antibiotics in the FY 2067/68.However it decreased to some extent in FY 2068/69. Drop out from ANC first to ANC fourth visits is highly significant and in the FY 2068/69 it was 51.59 percent and 28.97 percent respectively. SBA deliveries are in increasing trend (11.39 percent in FY 2065/66 to 23.6 percent in FY 2068/69) Contraceptive Prevalence Rate in FY 2068/69 was 22.01 percent HEALTH FACILITY HFs are not handed over to VDC. MANAGEMENT COMMITTEE Among formed all HFs’ (n=42) HFOMC, received capacity building iii AND LOCAL HEALTH trainings and refresher in the last 3 years. GOVERNANCE At community level groups such as -Forestry Users Group, Mothers’ Group, Drinking Water Users Group, Irrigation Users Group, Road Rural Users Group, Cooperatives, and Media are functioning. SERVICE CEONC trained service providers are available but not providing service DELIVERY/QUALITY due to absence of blood bank and anesthesia in the district whereas, 3 IMPROVEMENT BEONC service sites (District hospital, Thada PHCC, Balkot PHCC) are functional. Community-based service delivery-MSC program is implemented in 2012 whereas, CB-NCP implemented in 2010 through HealthRight Int’l. Satellite FP clinics-02 IUCD services - 13 HFs. Implant services - 12 HFs Birthing centers - 14 Placenta pits - 4 LOGISTICS MANAGEMENT All tracer drugs and commodities available on the day of visit. SYSTEM Drugs with most problems of stock outs in the year- Cotim-P, ORS, Iron. Drugs with most problems of over stock in the last year- Condom. Functioning refrigerators-6, sufficient for maintaining cold chain, and have regular power back up system for the cold chain room. First Expiry First Out (FEFO) -not maintained well. Web-based LMIS reporting system. Data entry person not recruited. BEHAVIOR CHANGE FM stations – 2 COMMUNICATION Several I/NGOs engaged in BCC activities In current FY 2069/070, total 130 school health program on HIV/AIDS, RH/FP, Menstruation Hygiene and Adolescent Health were organized in 130 schools (approximately 6500 students benefited). Villages that were highly populated by DAG Argha, Bangi, Rabawn, Siddhara, Maidan, Kudalpani, Pokharathok. Ethnic/Caste group derived from service utilization Gandharav, Kami, Sarki, Magar, Kumal were the deprived castes group. Villages that still practice early marriage and Early Child Bearing Julukae, Gokhunga, Siddhara. High Migrants VDCs–Thada,Jukena,Nuwakot, Siddhara ADOLESCENTS AND YOUTH AYFS- 13 sites supported by DHO FRIENDLY SERVICES NRCS conducted Peer Review training to 28 schools in the current FY. WCO has formed ‘KISHORI SAMUHA’ to share RH related information and transfer life skill training to adolescent. GENDER EQUALITY AND GESI committee is formed but no meeting has been held yet. OCMC has not SOCIAL INCLUSION been established. GESI focal person has received orientation. No GESI activities have been initiated. 1. RAPID ASSESSMENT OF DISTRICT HEALTH SYSTEMS 1.1 HEALTH FOR LIFE Health for Life (H4L) is a five-year bilateral agreement between the Ministry of Health and Population (MoHP) and the Unites States Agency for International Development (USAID) which focuses on Systems Strengthening and improving the Maternal Neonatal Child Health and Nutrition/Family Planning (MNCHN/FP) service delivery at district and sub-district levels in 14 districts. 12 of the 14 districts are in the Mid-western Development Region (MWDR) –Arghakhanchi , Bardiya, Arghakanchi, Surkhet, Salyan, Pyuthan, Dailekh, Kalikot, Jumla, Rukum, Jajarkotand Rolpa and two are in the Western development Region (WDR) of Nepal- Argakhanchi and Arghakhanchi .The project will be implemented between 2012 and 2017. 1.2 RAPID ASSESSMENT AND ITS OBJECTIVES Rapid assessment (RA) is a method of analyzing situation of a district where issues are not well defined and where there is not sufficient time or other resources for in-depth quantitative research. RA uses intensive team interaction in both the collection and analysis of data instead of prolonged field work and iterative data analysis and additional data collection to quickly develop a preliminary understanding of a situation from the insider’s perspective. The main purpose of carrying out the current Rapid Assessment is to understand the current situation of the health service delivery system and other associated systems of the Arghakhanchi district so as to help in planning activities at district level. Specifically, the objectives of the RA includes Understanding the demographic profile of the district Understanding the existing health care delivery system of the district Knowing the functionality of the Facility Management Committees Understanding the status of health indicators Analyze strengths and weakness of the DHO systems Identification of potential Local Technical Assistance Partners (LTAPs) Exploring feasibility for the implementation of specific programs