This document summarizes the program, progress and achievements of Logistic Management Section for the periods 2074/75 to 2075/76 and major half yearly progress of FY 2076/77 & brief logistic management report of COVID-19.
ACRONYMS
ADRA Adventist Development and Relief Agency APP Annual Procurement Plan APR Actual Procurement Rate ASL Authorized Stock Level BCG Bacille Calmette Guerin BoQ Bill of Quantity BHL Basic Health Logistics BHS Basic Health Services CAPP Consolidated Procurement Plan CAO Chief Administrative Officer CBS Central Bidding System CSD Curative Service Division CER Cost Estimate Rates CMC CAPP Monitoring Committee CMS Central Medical Stores COVID Corona Virus Infectious Disease CS Catalogue Shopping DDA Department of Drug Administration DFID Department of International Development, UK DG Director General DHIS District Health Information System DP Direct Purchase DPT Diphtheria, Pertussis, and Tetanus DoHS Department of Health Services e-GP electronic Government Procurement EDCD Epidemiology and Disease Control Division EDL Essential Drug List EDP External Development Partner EOP Emergency Order Point EPI Expanded Programme of Immunization EVM Effective Vaccine Monitoring FA Framework Arrangement FASP Forecasting and Supply Plan FCGO Finance Controller General Office FED Free Essential Drug FEFO First Expire First Out FP/RH Family Planning and Reproductive Health FWD Family Welfare Division FPAN Family Planning Association of Nepal FY Fiscal Year GAVI The Global Alliance for Vaccine GHRM Grievance Handling and Redressal Mechanism GHSC-PSM Global Health Supply Chain – Procurement and Supply Chain Management GHRM Grievance Handling and Redressal Mechanism GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH GoN Government of Nepal HF Health Facility HI Health Inspection HMIS Health Management Information System HSP Health Service Provider HP Health Post HR Human Resources HO Health Office ICB International Competitive Bidding ICT Information and Communication Technology IFB Invitation for Bidding INGO International Non-Government Organization IUCD Intra Uterine Contraceptive Device IMS Information Management System JE Japanese Encephalitis KPI Key Performance Indicators LARC Long Acting Reversible Contraception LLG Local Level Government LMD Logistics Management Division LMIS Logistics Management Information System LMS Logistics Management Section LWG Logistics Working Group MCH Maternal and Child Health MD Management Division MDVP Multi Dose Vial Policy M&E Monitoring and Evaluation MDAC Ministerial Development Action Committee MNCH Maternal Neonatal and Child Health MoHP Ministry of Health and Population MoSD Ministry of Social Development MoSoH Month of Stock on Hand MPP Master Procurement Plan MR Measles and Rubella MRP Maximum Retail Price MYP Multi-Year Procurement MSI Marie Stopes International NCASC National Center for AIDS and STD Control NCB National Competitive Bidding NGO Non-Government Organization NHP National Health Programme NHEICC National Health Education, Information and Communication Centre NHTC National Health Training Center NPHL National Public Health Laboratory NTC National Tuberculosis Center NIP National Immunization Programme NHSSP Nepal Health Sector Support Programme OPV Oral Polio Vaccine PCV Pneumococcal Conjugate Vaccine PHCT Provincial Health Coordination Team PHAMED Public Health Administration Monitoring and Evaluation Division PHD Province Health Directorate PHLMC Province Health Logistics Management Centre PIP Procurement Improvement Plan PPA Public Procurement Act PPS Public Procurement System PSCM Procurement and Supply Chain Management PPSF Public Procurement Strategic Framework PPMO Public Procurement Monitoring Office PPR Public Procurement Regulation PHCC Primary Health Care Center PHD Provincial Health Directorate PHLMC Provincial Health Logistic Management Center RDQA Routine Data Quality Assessment SBD Standard Bidding Document SC Supply Chain SCMWG Supply Chain Management Working Group SDP Service Delivery Point SoH Stock on Hand SQ Sealed Quotation Method PHTC Province Health Training Center SCI Save the Children International SCM Supply Chain Management SDG Sustainable Development Goal SDP Service Delivery Point SNG Sub National Government SOP Standard Operating Procedure ToR Terms of References ToT Training of Trainers TSB Technical Specification Bank TTF Thematic Trust Funds UAT User Acceptance Tests UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VFM Value for Money WHO World Health Organization
TABLE OF CONTENTS
EXECUTIVE SUMMARY 17 CHAPTER 1 INTRODUCTION 19 1. Background 19 2. Strategic Procurement 20 3. Logistics Cycle 21 4. Six Rights of Logistics 23 5. Quality Assurance Mechanism 23
CHAPTER 2 ORGANIZATIONAL STRUCTURE 26 Federal Level 26 1. Organogram of logistics management section 26 2 Scope of Work and ToR of Management Division and Logistic Management Section Province Level 26 3. Provincial Health Logistics Management Centers (PHLMC) 27 4. Local Level 28 5. Logistic Management functions at different level 28
CHAPTER 3 MAJOR LOGISTICS ACTIVITIES 31 A. Procurement 31 1. Strengthening Pre-bid Information Systems 31 1.1. Technical Specification Bank 31 1.2. Technical Specification Bank (TSB) Steps and Reports 32 1.3. Cost Estimation Practices 33 1.4. Quantification and forecasting 34 1.5. Quarterly Pipeline Monitoring 36 2. Standard Procurement Planning 36 2.1. CAPP Initiatives 36 2.2. Procurement Modality Analysis 37 2.3. Procurement Type Usage 37 2.4. Segregation of Categories Used 38 3. Standardization of Procurement Process 38 3.1. Usage of Standard Bidding Documents 38 3.2. Solicitation Periods 38 3.3. Bid Evaluation and Approval 39 3.4. ICT Initiatives in Solicitation of Bid 39 3.5. Contract Management 40 4. Other Initiatives 40 4.1. Grievance Handling Mechanism 40 4.2. Supplier’s Conference 40 4.3. Market Analysis of Pharmaceuticals 40
B. Supply Chain Management 41 1 Storage, Distribution and Inventory Management 41 1.1 Storage Guideline (13 Points) 41 1.2 Important Terms Used in Supply Chain Management 41 C. Logistic Management Information System (LMIS) 43 1. Quarterly LMIS Reporting and Scheduling 44 2. LMIS Activities 44 3. Electronics Logistics Management Information System (eLMIS) 44 I. eLMIS Implementation Expected Outcomes 45 II. eLMIS Implementation Requirements 45 III. eLMIS Intervention and Current Sites 46 IV. eLMIS Implementation 46 V. eLMIS Implementation Assessment and Adjustments Based on Lesson Learn 47 VI. COVID-19 Items Incorporated and eLMIS Reporting Tools 47 VII. eLMIS Scale-up Plan Approved and Rollout Team Mobilization 47 VIII. Data Governance 47 4. Online Information Management System (IMS) Support 47 5. Routine Data Quality Assessment (RDQA) 47
D. Effective Vaccine Management 49 I. Goal 49 II. Objectives of Cold chain and Vaccine Management 49 III. CMYP 49 IV. Vaccines 49 V. Cold Chain Equipments for Storage and Transportation 49 VI. Progress and Activities 49 VII. Wastage Rate of Vaccines-HMIS 52 VIII. Repair and Maintenance Status of Cold Chain Equipments 52
E. Repair and Maintenance of Biomedical Equipments 53 F. Expired Drugs Management 54 G. Supply Chain Management Working Group (SCMWG) 55
CHAPTER 4 CAPACITY BUILDING AND SYSTEM ENHANCEMENT 60 1. Capacity Building: Provincial and Local level Training on BHL and PPS 60 1.1 Capacity Building for Procurement 60 I. Workshop, Training and Technical Support 60 II. Procurement Clinic 60 III. Monitoring Management through Committee Approach 61 2. Basic Health Logistics and Public Procurement System Training Manual 61 I. Training of Trainers (TOT) on BHL and PPS 61 II. Training on Existing Package in 2075 62 III. Training Package Revision in 2075 62 IV. TOT on BHL and PPS Package Revised in 2075 62 V. TOT on BHL and PPS Package Revised in 2076 62 VI. Capacity Strengthening on BHL and PPS at Local and HF Level in 2075 63 VII. Capacity Strengthening on BHL at HF level 64 3. LMIS tools updated 66 4. New Ma. Le. Pa Forms and Formats 67 5. Capacity Development on eLMIS Implementation (Journey) 67 I. Software Customization 67 II. Master Data Finalization 67 III. eLMIS Familiarization Workshop 67 IV. eLMIS Training Curriculum Finalization 67 V. Training of Trainers (ToT) on eLMIS 67 VI. User Acceptance Tests (UAT) on eLMIS 67 VII. User’s Group Training 67 VIII. Develop Support Mechanism and Helpdesk 68 IX. eLMIS Standard Operating Procedures 68 X. Software Updates 68 XI. eLMIS monitoring and data utility for decision making 68 XII. eLMIS operational monitoring 68 XIII. eLMIS implementation assessment and adjustments based on lesson learnt 68 XIV. eLMIS review workshop 68
CHAPTER 5 TRENDS OF LOGISTICS INDICATOR 70 1. Procurement and Supply Chain Management of Commodities in Federal Context 70 2. Availability of Key Commodities 71 3. Reporting Status 72
CHAPTER 6 PLANNING, MONITORING AND EVALUATION 74 1. Major activities conducted 74 2. Budget Contribution in Red Book 75 3. EVM Activity 77 4. PHLMC progress 78 5. COVID-19 Logistics Management Activities 79 6. Issues in Logistic Management 80 7. Nepal health sector strategy 2015-2020, output and key intervention for procurement and supply chain management 81 8. DLI Indicators Related to PSCM 81
CHAPTER 7 CASE STORY 82
CHAPTER 8 MONITORING/SUPERVISION/WORKSHOP/SEMINAR 85
CHAPTER 9 PARTNER CONTRIBUTION FOR LOGISTICS MANAGEMENT 89
BIBLIOGRAPHY 94 ANNEXES 96 1. COVID-19 Logistics information 97 2. eLMIS Piloting and Scale-up Live Sites 100 3. Procurement Status FY 2076/77 106 4. Disbursement linked Indicator (DLI Target Vs Progress) 110 5. Available Cold Chain Equipment 113 6. Expired Medicines List 119 7. Biomedical Equipments Maintenance 121 8. Gazzete Notice for Drug Price 129 9. Store Management Instruction (13 Points) 135 10. Greivance Handling and Readdressal Mechanism Report 136 11. Auctioning Report 142 12. Guidelines for use of PPE 149 13. Procurement on Special Condition - PPA 2063 (2007) 150 14. FY 2077/78 Activities and Budget : Management Division 153 15. FY 2077/78 Activities and Budget : Province and Local Level 158 16. ToR of MD Sections 176 17. Picture Gallery 177 HEALTH LOGISTICS REPORT
EXECUTIVE SUMMARY Strong Logistics Management System is crucial for quality health services. No commodities No Program is starting slogan with availability of quality medicines, health commodities round the year is the major part to achieve logistics goals and objectives in health service delivery System. To meet this motto Logistics Management Division (LMD) was established in FY 2051/52 (AD 1994) under the Department of Health Services (DoHS). Logistic Management Section (LMS) is responsible for logistic management after federalism with revised structure role and responsibilities.
LMS has procurement, storage, cold chain, vaccine management and supply units as well as functional logistic management information resource center. Major role of LMS is to forecast, quantify, procure, store, distribute/transport of program commodities, e.g. essential medicines, vaccines, Family Planning and Reproductive Health (FP/RH) Commodities, biomedical equipment’s including procurement and distribution of transportation vehicles, ambulances, refrigerator van and proper disposal and auctioning of de-junking of commodities, equipment’s, furniture etc. Maintenance of biomedical equipment’s, transport vehicle and construction of Central, Provincial, District and local level warehouses are also an important function under logistic system for this we have to coordinate with other section as well.
Supply chain management is based on information i.e. Logistic Management Information System (LMIS). LMIS is vital function and quarterly reporting system which is compiled and analyzed by concerned authorities of all the levels of government. LMIS is functioning at Health Post (HP), Primary Health Care Center (PHCC), primary and secondary hospitals and it needs to be expanded up to all health facilities including tertiary hospitals. Currently COVID-19 logistics management information system has been initiated in federal and provincial hospitals and it should be strengthened in wider scale for all the commodities and biomedical equipment.
It is extremely important to have quality drug, vaccine, commodities and biomedical equipment management for quality health services. As per constitution of Nepal and its functional analysis logistics functions are primarily accomplished by local level government, as well as provincial health logistics management center has been established in 6 provinces, in karnali province they have revised organogram with logistics section in Provincial Health Directorate.
Major functions at federal level are policy, planning, act, rule, regulation, standards, facilitations to provincial and local level, guidelines and management of Vaccines, Commodities, buffer stock, program items including campaign and emergency health logistics management in case of health emergency and disaster. As of these two fiscal years’ review, Logistic Division Section has made significant contribution in terms of procurement planning, strengthening storage capacity as well as human resource capacity development in the context of federalism: • LMS has developed and approved standard technical specifications of medical equipment, medicines, vaccines, surgical consumables and contraceptives; and published it in the Technical Specification Bank (TSB). Thus, as of date there are 121 technical specifications of pharmaceuticals and 1109 specifications of medical equipment are available at the TSB • Supply Chain Working Group has been formed and functional at both federal and provincial level. • Annual Procurement Plan (APP) and Consolidated Procurement Plan (CAPP): APP and CAPP is maintained in consultation with division and center of DoHS. • LMS/MD developed the forecasting and supply plan guidebook and workbook
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This report is a compilation of information about health logistics activities that includes brief background, policies, strategies, coverage, achievements and pertaining issues. It includes two fiscal years and half yearly major outputs of this fiscal year as well as Covid-19 logistic information up to Jestha 2077, this report includes added information on cold-chain and biomedical equipment’s, expiry of medicine, rate list of some drugs and some information about PHLMCs and LLGs. In summary, following are the key activities and achievements: • Consensus Forecasting 2076/77 was carried out with national quantification of program drugs and EPI vaccines for the FY 2076/77 (2019/2020). • The standard time taken for Bid Evaluation and Approval in FY 2074/75 (2018/19) reduced to average 41 days in ICB and average 31 days in NCB, which shows improvement from the previous period. ie. 45 days and • LMD/DoHS is improving the use of ICT in bid proceedings since FY 2071/72 (2014/15). In FY 2072/73 (2016/17) LMS has used almost all bids (99.43%) through eGP I. • To ensure Health Systems competency in delivering the required LMIS functions, a total of 121 health staff received Training of Trainers (TOT) on Basic Health Logistics and Public Procurement System, 591 participants attended municipality level training and 636 participants attended health facility level training on basic logistics. • The training of 24 eLMIS master trainers were produced on Falgun 2074 as a cadre of government trainers from DoHS; LMD • Training Manual Revision to adopt in the revised context of federalism, Capacity strengthening on basic logistics to HSPs at Municipalities and health facilities, and Capacity development on LMIS and eLMIS review workshops. • eLMIS implemented and scaled up in in all provincial and central warehouses and up to Palika level in Province 5 and Karnali Province.
Logistics Management Information System (LMIS) is core component of overall logistics management. This is high time to implement electronic Logistics Management Information System (eLMIS) in all level of government and health institutions to get real time data on Logistics Management. Now, LMS is going to rollout and implement eLMIS to all institution accordingly eLMIS scale-up plan approved on 2077/02/01 by MoHP (Secretary level Decision) and roll out plan is approved by DoHS on Jestha 8, 2077. Now, LMS rollout and implement eLMIS to all institution as per the approved plan. Hope gaps on planning because of data error and unavailability will be solved by real time logistics information system of eLMIS.
Despite these achievements, there are some issues to be addressed, such evidence-based planning based on real time logistics information. Procurement, storage, timely supply and quality assurance are major areas in logistics management. Stock out of FP and MNH commodities has been persistently reported over the period of years, which needs to be addressed. Hence, Logistics Management System strengthening should be a priority for quality health services.
Area of eLMIS is broad in the context of Covid-19 also there was immediate need of realtime data of logistics which was a challenge as well as an opportunity so in this context we have started in hospital & province as well as in some palika. For the effective LMIS system we need resource including appropriate H.R. at all level.
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CHAPTER 1 INTRODUCTION
1. BACKGROUND Nepal is a federal democratic republic country with 3 tier of governments - Federal Government, Provincial Governments (7), and Local Government (753). The constitution has mentioned basic health and sanitation as citizen’s fundamental right. The Health System of Nepal is based on Universal Health Coverage, in the federal context, Ministry of Health and Population (MoHP) has three Departments namely Department of Health Services, Department of Ayurveda, Department of Drug Administration. MoHP has developed health policy 2076 with high priority for Universal Health Coverage. In the new structure of MoHP from FY 2075/76, there are 5 Divisions and 5 Centers under the Department of Health Services. Among them one of the Division is Management Division.
Management Division (MD) was established under the Department of Health Services (DoHS), MoHP in 2050/51 (1993) as Logistic Management Division (LMD) with a network of central and five regional medical stores, and seventy-five district level stores for strengthening supply chain management with evidence based decision making using the analysis of Logistics Management Information System(LMIS) data and Inventory Management System. In the federal context logistic management section in DoHS, 6 Provincial Health Logistic Management Center (PHLMC) one logistic management section in Karnali province,77 Health Office, 753 Local Government (Health Unit) and 6934 Service Delivery Points are functioning for health service delivery. Logistics function is to ensure a regular supply of medicines, equipment, and vaccines for the effective operation of health services in consultation with all health agencies and institutions.
The Logistic Management Section is responsible overall logistic management of department & vaccine, commodity management at national level. The Terms of References (ToR) of MD is responsible for logistic management, the focal point for information management, planning, coordination, supervision, and the monitoring and evaluation of health programmes. This section is also responsible for monitoring the quality of air, water and food products. It also monitors the construction and maintenance of public health institution buildings and supports the maintenance of medical equipment. More activities assigned to this division include including policy and planning related to health infrastructure and logistics management.
A key prerequisite for achieving significant improvements in health sector procurement is to have sustained high-level integrity leadership to create the accountability that will motivate various agencies to achieve the results for which they are responsible. The Ministry of Health and Population (MoHP), working closely with the Ministry of Finance, public procurement management office (PPMO) is well placed to create that inter/intra-ministerial accountability to coordinate the health sector procurement plan and programmes.
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The goal of the LMD restructuring is 'to improve efficiency and effectiveness in the health sector procurement, distribution, quality assurance, management of drugs and equipment & services to ensure value for money in the context of federalism. The outcomes of the LMD restructuring are to: • Ownership at province and local level • Strengthen health sector procurement. • Improve supply-chain management to put in place. • Strengthen effective partnership mechanism • Institutionalize the internal control system to reduce fiduciary risks in procurement and rational distribution. The logistics management contributes directly towards achieving the goals envisioned in the National Health Policy 2076. The NHP 2076 aspires to provide Universal health coverage (including prevention, promotion, treatment, rehabilitation and palliative care) for all Nepalese citizens. In addition, it has a key role towards the attainment of Public health act 2018, for ensuring availability of the basic health services (BHS) to all citizens, as well as the Safe Motherhood and Reproductive Health Rights Act 2018 which guarantees universal access of RH services including commodities to all women and girls in Need.
The 15th Five Year Development Plan (2019/20-2023/24) of Government of Nepal highlights the important aspects of logistic management pertaining to: Regulation of production, import, storage, distribution and utilization of medical equipment's, drugs and supplies; and Increase use of evidence-based decision making by strengthening health information system.
Goal Quality health commodities available at health facilities and community level round the year.
Overall Objective To plan and carry out the logistics activities for the uninterrupted supply of essential medicines, vaccines, contraceptives, equipment, HMIS/LMIS forms and allied commodities (including repair and maintenance of bio-medical equipment) for the efficient delivery of healthcare services from the health institutions of government of Nepal in the country.
Procurement and supply chain system ensures that essential products, necessary for program success and must be consistently available to customer. Public health program is linked directly to an effective and efficient supply chain Management. Modern supply chain management focuses more on people than goods. It is the people who make supply chain work and the customers who are served by the supply chain. Therefore, the goal of the Health Logistics System is to make available quality health commodities at health facilities and community level round the year.
2. STRATEGIC PROCUREMENT Strategic procurement is a systematic and fact-based approach for optimizing logistic management in improving the overall value proposition. Within logistic management section there is procurement unit; Logistic management section is in constant communication and coordination starting from consensus forecasting, quantification, and preparation of annual procurement plan with other divisions and centers. Every quarter, the status of procurement, supply schedule is reviewed in a pipeline meeting. LMS often time holds meeting with vendors to improve procurement. Thus, the strategic procurement is directed toward:
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• Value for money • Better service delivery • Improve the quality of goods and services • Increased profits • Good governance • Economic development
Objectives • To promote efficiency in Logistic Management • To ensure system is a fair, transparent and non-discriminatory manner to obtain Value for money • To ensure timely procurement and supply of essential medicines, vaccines, contraceptives, equipment, HMIS/LMIS forms and allied commodities uninterrupted (including coordination for repair and maintenance of bio-medical equipment) in equitable manner.
Strategies • Logistics planning for procurement, storage and distribution of essential health care commodities. • Introduce effective and efficient procurement mechanisms like Multi-Year Procurement (MYP), Central Bidding System (CBS) for programme items and E-Bidding. • Use of LMIS information in the decision making at all levels. • Strengthen physical facilities at the central, provincial, district and local level governments for the storage and distribution of health commodities. • Promote web based LMIS and equipment/expendable items inventory system in local level government and province. • Repair and maintenance of bio-medical equipment, instruments, cold-store and transportation vehicles. • Capacity building and enhancement of human resources on logistics management at all levels. • Implement and facilitate for effective logistic management at all level and effective pull system for year-round availability of Essential Drugs, Vaccines and other health commodities at all levels (Federal, Provincial, and Local Level Governments).
3. LOGISTICS CYCLE
POLICY Serving Customers
Q ng ua ri li to ty ni M o o M n y it t o li r a in u g Q
Inventory LMIS Pipeline Monitoring Product Management Organization & Staffing Storage & Budgeting Supervision Selection
Distribution Evaluation
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Quantification & Procurement ADAPTABILITY
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KEY DEFINITIONS Supply chain: refers to flow of products, services, resources, and information that ultimately fulfill customer’s request Supply chain management is the process of managing and coordinating flows of goods, services, information, and resources from the source to end-users. Logistics management: refers to management of what happens within an organization while purchasing and delivering products/materials from suppliers to end-users Logistics cycle: shows how the different components of health supply chain systems are interdependent Product Selection: Product selection is done based on the Essential Drug List (EDL) and standard treatment guidelines Quantification: Quantification is the process of estimating quantities and costs of health products and determining when they should be delivered to ensure an uninterrupted supply. Procurement: Procurement is a critical function within the supply chain that ensures health products are purchased and made available to customers as planned. Inventory Management: After products have been procured and received, they must be stored until needed. The inventory manager is responsible for overseeing product storage in service delivery points before and after distribution. Storage and distribution: Proper storage and distribution are needed to ensure product reach the end-users without their quality being compromised. Serving customers: The logistics system is designed to optimize customer service. Each person who works in logistics must remember that he or she selects, procures, stores, or distributes products to meet customer needs. Logistics management information system (LMIS): A logistics management information system (LMIS) is a system of records and reports, whether paper-based or electronic, used to aggregate, analyze, validate, and display data from all levels of the logistics system. This is also known as the heart of logistics cycle Other activities at the heart of the logistics cycle: Other activities that help to drive or support the logistics cycle include organization and staffing/supply chain workforce, budget/financing, supervision, and monitoring and evaluation/performance management and risk management. Policy and Legislation: These are government regulations and procedures which affect all elements of a logistics system. Adaptability: The adaptability of the logistics system is the ability to obtain resources needed to address increase in demand. Quality monitoring: It is important to understand the role of quality monitoring in ensuring an efficient and effective logistics system. Quality monitoring refers not only to the quality of the product, but also to the quality of service. Quality monitoring should be four times as following: ▸ Between product selection and quantification and procurement to emphasize why quality monitoring is important role in selection quantifying and procuring the right products. ▸ Between quantification and procurement and inventory management to ensure quality of health commodities during distribution and at the time of receipt. ▸ Between inventory management and serving customers to ensure quality is maintained during storage and when patient receive them for use. ▸ Between serving customers and product selection to determine if customers are satisfied with quality of both products and service they received.
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Importance of effective logistics • Effective supply chain enhances quality of care by providing adequate, appropriate supplies to health facilities and increasing professional satisfaction to deliver a higher quality of service. • Effective supply chain improves cost efficiency and effectiveness by reducing losses due to overstock, expiry, damage and pilferage. • An effective supply chain system includes the following components: ▸ Warehouses from central, intermediary and other storage facilities where health commodities are held until given to another facility or patients. ▸ Transportation assets from large trucks to smaller trucks that move products from the warehouses to health facilities ▸ Maintained Coldchain from factory to client and patients. ▸ Service delivery point where customers receive the products that they need. These include hospitals, primary health centers and health posts. Patients may also receive products in the community from community health worker.
4. SIX RIGHTS OF LOGISTICS
FOR THE SIX RIGHTS THE RIGHT RIGHT OF GOODS COST LOGISTICS
AT THE IN THE RIGHT RIGHT TIME QUANTITIES
TO THE IN THE RIGHT RIGHT PLACE CONDITION
5. QUALITY ASSURANCE MECHANISM Quality assurance in procurement is an approach of preventing defects in supplied products and avoiding problems when delivering products or services to the people. Thus quality assurance mechanism involve implementation of inspection and structured testing as a measure of quality assurance. It comprises administrative and procedural activities implemented, so that the requirements will be fulfilled as ‘fit for purpose’. A systematic measurement, comparison with a standard, monitoring of processes, testing and inspection are major components of quality assurance mechanism. A quality is all about meeting the needs and expectations of user with respect to functionality, design, reliability, durability, and price. And, quality assurance is a positive declaration on a product or service, which gives confidence or guarantee that the product will work without any problems as per the expectations or requirements, there will be no side and adverse effect.
LMS is well familiar and sensible about the need of quality assurance in the goods and services procured and distributed to the needy people. LMS takes all measures of quality assurance since from the need identification, developing specification, evaluation of bids and award to production and delivery of goods by the suppliers. Similarly, the measures are taken in storing, distributing to the service points and delivering to the people. Following are major procedures in quality assurance mechanism:
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Standardization of Technical Specifications: The first step of quality control and assurance in procurement is defining specifications. So, LMS has developed and approved standard technical specifications of medical equipment, medicines, vaccines, surgical consumables and contraceptives; and published it in the Technical specification Bank (TSB). LMS uses only the approved specifications from TSB in all its procurement. Certain standards are mandatory in all the medical equipment as applicable like: • IEC 60601 – medical equipment (in patient environment) • IEC 61010 – laboratory equipment • IEC 60335-1 and -2-24 – refrigerators and freezers (electrical safety) and also relevant section of WHO E003 • CE or USFDA, European CE • The units are used as metric unit or SI units
Similarly, in case of Pharmaceutical items, requirement of pharmacopoeia specifications in general, by dosage form and monograph specifications are given. The monograph specification includes the various test requirements as specified in the pharmacopoeia are also given. Similarly, packaging specifications for a specific item has also been mentioned. These specifications eases in the technical evaluation. These specifications are also helpful both PSI and PDI processes as well as in laboratory quality testing processes. Every pharmaceutical item must have been manufactured by at least WHO recommended guidelines and duly certified by the respective regulatory authority. Some of the products like vaccines and hormonal contraceptives are required to meet the WHO-PQ standard. Nutritional products are followed the UNICEF and WFP standards, whereas insecticides are to be recommended by WHOPES.
Use of Standard Bidding Document: LMS uses only the standard bidding documents prescribed by the PPMO and uses the eGP portal of PPMO. The eligibility, and qualification criteria are used standard in order to select the quality and tested goods. Evaluation of bid and award are based on the compliance of pre-defined criteria on the bidding documents.
Pre-shipment and Post-delivery Inspection and Tests: As per the requirement the goods ordered are inspected at the production site before dispatching by an independent agency and tested at the approved laboratory. Similarly, the goods are tested after receipt at LMS warehouse. Medical equipment are inspected and tested individually in presence of the supplier. Verification of technical specification and its functional outputs are checked. Whereas medicines and other goods are tested by sampling. For sampling, generally the number of batches are determined as per the square root formula. Then for the number of batches all batches are selected by system attic random sampling method. The samples are taken from the boxes/packages which are again determined by square root formula from each batch selected. All medicines are tested in ISO 17025:2005 certified laboratories or National Medicine Laboratory items. The testing protocols are adapted as per the respective claimed pharmacopeia monograph. LMS keeps a separate control sample of each sample tested for verification, if any adverse results noticed in future.
Standardized Storage and Distribution: The received goods are stored in a well standard warehouses and then supplied to the provinces and other health institutions as per the supply chain principles. A Good Storage Practice and Good Distribution Practices are followed in storage and distribution stages. The vaccines and
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other medicines requiring cold chain are stored and carried with well-equipped cold chain stores and by cold chain carriers. Standard procedures requiring loading, unloading and transportation are followed.
There is in need of a Quality Assurance Institution for medical equipment, medicines and other health products. Despite, there are Department of Food Technology and Quality Control for assuring the quality in food product and nutritious food, and Department of Drugs Administration (DDA) for regulating drugs and its raw materials in Nepal. DDA regulates the drugs by issuing GMP Certification, batch validation, issuing Production License, Import License and Marketing License; which are means of quality assurance of pharmaceutical products. But, the role of DDA is seen as market surveillance rather than certification. Initiation by DDA has been taken to regulate and certify the quality of medical equipment also, which is not yet accomplished. DDA has the responsibility of medical products which also includes personal protective equipment’s as well.
We are also using private laboratories for samoe quality test in the days to come it should be strengthen at federal, province and some strategic areas to assure the quality of drugs and commodities.
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CHAPTER 2 ORGANIZATIONAL STRUCTURE
FEDERAL LEVEL 1. ORGANOGRAM OF LOGISTICS MANAGEMENT SECTION
Ministry of Health and Population (MoHP)
Department of Health Service (DoHS)
Management Division
Integrated Health Environmental health and Logistics Management Infrastructure Management Information healthcare waste Section Development Section Section management Section
Section Chief (SPHA 9/10 level HI)
Section officer (2) Pharmacy Mechanical Computer Public Health Biomedical Health Gazetted third Officer (7/8 Engineer officer C.C.A.-3 officer Engineer (7/8 Assistant (5,6,7 class Admin/ G level H. (Gazeted third (Gazeted third (4,5,6 level /H.I) (7/8 Level/H.I) level H. Bibidh) level/H.I) Admin) Pharmacy) class Eng/M.Eng) class/ Bibidh)
2. SCOPE OF WORK AND TOR OF LOGISTICS MANAGEMENT SECTION • Support the MoHP to develop national policies, acts, rules, guidelines, quality standards, protocols about the procurement and supply (of drugs and equipment) • Support MoHP to prepare the standard and specification bank of drugs and health equipment at national level • Procurement and supply (in provinces) of essential health items like vaccines and family planning devices • Facilitate the province and local levels in procurement and supply of required drugs and equipment • Coordinate and facilitate to institutionalize the supply management information system at national level • Manage essential equipment in the agencies under the DoHS
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PROVINCE LEVEL
Provincial Health Logistic Ministry of Social Provincial Health Directorate-7 Management Center Development (MoSD) +1 Logistics Management Section (PHLMC) – 6
Terms of Reference (PHLMC) Hospital development and • Planning, monitoring and curative service division Health Office – 77 procurement section • Storage, distribution and technical support section • Administration Section Policy, law, standards, planning and public health division Provincial Health Training Center
3. PROVINCIAL HEALTH LOGISTICS MANAGEMENT CENTERS (PHLMC)
Director (11 Level/PHA/GHS/HI/Pharmacy/IM)
(SPHA 9/10 Level HI)
Pharmacy Officer Biomedical Section Officer Account Officer (7/8 Level Engineer (Gazeted Third Class (Gazeted Third H.Pharmacy) (7/8 Level H.Bibidh) Admin/G.Admin) Class Account)
Refrigeration Pharmacy Computer Technician C.C.A-2 Assistant Operator (5/6 Level Eng (4/5/6 Level/H.I) (5/6/7 Level (5 Level/Bibidh) /Pharmacy) /Electrical)
Heavy Vehicle Light Vehicle Loader Packer-2 Driver Driver-2 Office Assistant (No class (No class Eng (No class Eng (No class Admin/GA) Admin/GA) /Mechanical) /Mechanical)
Provincial Health Logistics Management Centers (PHLMC) are established in six provinces under Ministry of Social Development (MoSD) to ensure round year availability of medicines, equipment and materials and to strengthen supply chain management system in the province. There are three different offices at provincial level for health service management which includes Ministry of Social Development (MoSD), Provincial Health Directorate (PHD) and Provincial Health Logistics Management Centers (PHLMC). In Karnali province there is logistics management section within Provincial Health Directorate (Revised Organogram by province).
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There are store at each 77 Health offices within the province’s majority have designated standard warehouses some have old storage rooms which includes cold chain facility.
4. LOCAL LEVEL
Metropolitan City/ Sub Metropolitan City/ Municipality/ Rural Municipality
Health Section
Basic Health Facilities
Local level governments are in the process of gradual improvement to institutionalize the logistics management system in place. Some Palika have proper facility for storage including cold chain but some have to be improved.
5. LOGISTIC MANAGEMENT FUNCTIONS AT DIFFERENT LEVEL 5.1 FEDERAL LEVEL Logistics Management Section (LMS) is one of the core sections of Management Division. The major purpose of the LMS is to forecast, procure, store and distribute health commodities, equipment and instruments to districts and health facilities to enable the provision of basic healthcare services. It is also responsible for repairing and maintaining bio‐medical equipment, instruments and transport vehicles. Since establishment of LMS, has made continuous effort to bring improvement in the health logistics system. The major activities are as follows:
• Annual Procurement Plan (APP) and Consolidated Procurement Plan (CAPP): APP and CAPP is maintained in consultation with division and center of DoHS. • Facilitation on provincial and local level to prepare on procurement plan and procedure: Onsite coaching and training. • Facilitation on forecasting and quantification of program commodities and medicines at Federal, Province and Local Level: Training and feedback. • Procure, storage, distribution, re-distribution, transportation / reverse logistics of medicines, equipment of Health commodities at federal, provincial, district and local level. • Proper management / safe disposal of expired, breakage, unused, medicines, health commodities and biomedical equipment: Some initiation has been started. • Strengthen Logistics Management Information System (LMIS) and eLMIS: Logistic Management Information Resource Center (LMISRC). Currently LMIS system is in place and expansion of eLMIS is in the process. • Strengthen storage capacity and good practice.
5.2 PROVINCE LEVEL Major Functions of PHLMC: • Based on provincial need and as per national standard prepare guidelines and standards to support policy and law related to procurement and supply of medicine and commodities
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• Prepare provincial health logistics supply plan • Regular storage and supply of instruments, equipment, medicines and other health logistics as per need of health facilities or health service delivery units • Management of provincial buffer stock of medicine and health related materials for the emergency situation • Facilitate and coordinate for regular procurement and supply of instruments, equipment, medicines and other health logistics to the local level government entity.
Current status of PHLMC functionality • Procurement planning: PLHMC has been preparing regular procurement plan based on past consumption record, morbidity data and changed population structure of local government entity. • Receive and supply: PLHMC has been receiving regular supply essential medicine, vaccine and FP commodities from federal MoHP/DoHS warehouse. Annually PLHMC perform own procurement of medicine, equipment and materials as per annual plan. The budget for procurement used from federal government as conditional and provincial government as unconditional grant. • Storage: PHLMC performs regular storage of medicine, vaccine, contraceptives, nutrition supplements and other health logistics as per standards and protocols. Cold chain has been maintained for storing vaccine and other lifesaving drugs. • Technical backup, Supervision and Monitoring: PHLMC extends technical support and onsite coaching to health office and local government entity to strengthen Supply Chain Management (SCM). • Coordination: PHLMC has been performing regular coordination between MoSD, MoHP and local government related to SCM and regular supply of medicines and commodities. • Supply Chain Management (SCM) Working Group: The technical network of government and EDPs has formed and functional in various provinces including Sudurpashchim province. SCM working group intended to support PHLMC to strengthen SCM in the provinces • Provincial Health Coordination Team (PHCT): A wider network of government and health sector EDPs working in provinces has been formed and functional. Issues related to health logistics and SCM regularly discussed in the forum.
5.3 HEALTH OFFICE Health Offices are established at district level with changed role and responsibilities. Before the federalism District Health Office had over all responsibility of Health System Management of the district. But now district has limited responsibility of coordination, monitoring and technical supervision and facilitation of the health services in the district. District coordinates with Local Level Governments and LLGs coordinates to the Service Delivery Points. In terms of Supply Chain Management districts receive commodities from PHLMCs and supply to the LLGs.
Current status of district level functionality • Procurement planning: Health office has no budget to procure commodities district only support receiving the commodities from province and supplying to the LLGs. • Receive and supply: It has been receiving regular supply essential medicine, vaccine and FP commodities from PHLMC and supply to the LLGs. In terms of vaccine District supply directly to the Service Delivery Points (SDP). • Storage: It performs regular storage of medicine, vaccine, contraceptives, nutrition supplements and other health logistics as per standards and protocols. Cold Chain has been maintained for
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storing vaccine and other lifesaving drugs. • Technical backstop: It extends technical support and onsite coaching to LLGs and SDPs to strengthen SCM. • Coordination: It has been performing regular coordination between Province, local government and SDPs related to SCM and regular supply of medicines and commodities. • Capacity enhancement & facilitation: Health office currently act as a technical back-up for each Palika & SDPs, onsite coaching, feedback & facilitation are most important functions for logistics management. • Integrated information system: Facilitation and monitor the district level HMIS, LMIS, DHIS2 and other information system.
5.4 LOCAL LEVEL Local Level Government has major responsibility of Management of health logistics for effective and efficient health service delivery among community level service delivery points. LLGs are accountable for round year availability of medicines, equipment and materials to strengthen supply chain management system in the SDPs of its catchment area for the effective health service delivery.
Current status of local level functionality • Procurement planning: LLG has authority of planning, quantification and forecasting of health commodities as well as it to procure commodities district only support receives the commodities from district and supply to the SDPs. • Receive and supply: LLG has been receiving regular supply essential medicine, vaccine and FP commodities from districts and supply to the SDPs. • Storage: LLG performs regular storage of medicine, contraceptives, nutrition supplements and other health logistics as per standards and protocols. • Supervision and Monitoring: LLG extends technical support and onsite coaching to SDPs to strengthen SCM. • Coordination: LLG has been performing regular coordination with district and SDPs related to SCM and regular supply of medicines and commodities. • Logistics Management Information System (LMIS): LMIS is core function for effective logistics management & good governance. Collection, compilation, data entry of quarterly LMIS report and analysis, planning for necessary quantity of commodities for Health Facilities.
Procurement Quality Planning Assurance
Storage Evaluation LOGISTICS MANAGEMENT FUNCTIONS
Supply Chain Monitoring Management
Information Training Management Workshop
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CHAPTER 3 MAJOR LOGISTICS ACTIVITIES
A. PROCUREMENT The principles of economy, efficiency, efficacy, competition, accountability, and transparency in procurement procedures as well as Logistics management seek and lead towards Value for Money (VFM) of health expenditures. Quality service delivery comes along with the procurement of quality medicines and equipment. Logistics Management Section (LMS) is responsible for implementing procurement functions in federal level. Before the devolution of the procurement functions to the provinces and local levels FY 2075/076 (2018/19) the responsibility was confined with then Logistics Management Division (LMD) of DoHS. The functions of then LMD and now LMS has been internalized through the procurement and distribution of free essential drugs and equipment at all levels by implementing following four pillars of improvements:
i) pre-bid information systems like, TSB and LMIS improvements; ii) efficient procurement planning like APP, MPP and CAPP; iii) strengthening standard procurement process through executing health sectoral new SBDs and e-GP system; and iv) enhancing capacity building program on local, province and federal level.
1. STRENGTHENING PRE-BID INFORMATION SYSTEMS Pre-bid information management is very crucial for effective bidding procedures. Some legal requirements to initiate bidding process are mandatory as per PPA and PPR. Technical Specifications, Cost Estimates and SBDs preparations and approvals before bid are mandatory and very crucial for effective, transparent and competitive bidding procedures. In this regard, DoHS-LMS have been reforming these preparation and approval process and its timing by using ICT applications before the bidding procedure. Strengthening of pre-bid information and planning systems mainly includes Market analysis, TSB, Cost Estimation, SBDs preparation and APP/MPP approvals and their timeliness.
1.1 TECHNICAL SPECIFICATION BANK Technical Specification is a legal document mandatorily required for procurement management initiation as per PPA and PPR. Without this document procurement proceeding cannot be started and due to the reason, it is operationalized in a formal manner in every institution. In LMS/ DoHS, Technical Specification Bank (TSB) is a bank, operated through software, containing the technical specifications of pharmaceuticals and medical equipment. It was designed and operated in FY 2071/72 (2015/16) and updated with standard coding of pharmaceuticals and equipment in FY 2073/74 (2017/18). FY 2073/74 commonly used free essential 108 pharmaceuticals and 1089 equipment had been uploaded with their unique codes in modified TSB system in LMD’s website. It is open to use for all users even outside of health sector also.
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A guideline for use of TSB was prepared and an orientation training to the staff of DoHS have conducted in FY 2073/74 for its effective usage. At present, almost all Technical Specifications of drugs and equipment are used from TSB for the required bidding process in DoHS. The technical specifications are prepared by the divisions themselves and these divisions are using TSB only for the reference. In FY 2075/076 (2018/19) additional 13 technical specifications of pharmaceuticals including vaccines and hormones and 20 specifications of equipment are endorsed and uploaded in the TSB system. Thus, as of date there are 121 technical specifications of pharmaceuticals and 1109 specifications of medical equipment are available at the TSB. At this moment more than 800 TSB users (individuals/institutions including all users from local to federal level) are registered in the TSB. Similarly, more than 20,000 downloads and more than 13,000 searches for different specifications are recorded (MD/IT 2020)
The updating of TSB is a continuous process. Hence in current fiscal year there are 208 pharmaceutical specifications are updated and in the process of uploading in the TSB after completing the agreed procedure. Similarly, updating of technical specifications of medical equipment are also in process.
1.2 TECHNICAL SPECIFICATION BANK (TSB) STEPS AND REPORT INTRODUCTION Technical Specification Bank (TSB) is a web based system which is in operational from 2017/10/11manages technical specification documents of medical equipment and Pharmaceuticals goods. Specifications are first drafted and uploaded to the system by authorized user. The system will auto generate the codes of the specifications formulated by Logistics Management Division (LMD). The specification documents are then published to registered users for downloading. The system provides easy and user friendly interface for document uploading, search and downloading.
APPLICATION USER CASES SUPER ADMIN ADMIN REGISTERED USERS/END USERS Can change all the possible setting Can change all the possible setting Can change all the possible setting and documents of the system and documents of the system and documents of the system
• Since the time of TSB being functional, total 1,008 numbers of users have requested for registration and been registered in the TSB for accessing the specifications related to medical equipment and pharmaceutics where till date officially approved and accepted specifications of 1,089 types medical equipment and 108 types of pharmaceutics have been updated in the TSB.
TOTAL NO. OF TECHNICAL SPECIFICATIONS UPLOADED IN THE TSB MEDICAL EQUIPMENTS PHARMACEUTICS 1,089 108
• REGISTERED USERS / END USERS:(under categories: individual, private entities/suppliers and government entities/institutions)
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REGISTERED USERS/ END USERS PRIVATE ENTITIES/ GOVERNMENT ENTITIES/ INDIVIDUAL SUPPLIERS INSTITUTIONS NO. OF USERS 450 308 250
• ACTIVITIES BY USERS: Total 49260 No.s of activities ACTIVITIES SEARCHING OF SPECIFICATION DOWNLOADING OF SPECIFICATION Both almost equal in numbers (in every case of login by users, technical spec- Ratio/Frequency ifications are searched and most of the times serched technical specificaions are downloaded)
OVERALL SUMMARY IN TABULAR FORM: PARTICULARS NUMBERS Total No. of users registered 1,008 No. of medical equipments in TSB 1,089 No. of Pharmaceutics in TSB 108 Avereage No. of user requests currently 4 Average No. of user requests overall 2-3 Total No. of activites till now 49,260 Avereage No. of activities (Daily) 50-60
1.3 COST ESTIMATION PRACTICES Cost Estimate is an unambiguous document required for procurement initiation. PPA and PPR have mandatory provision to prepare and approval of Cost Estimate before solicitation of bids. While preparing the Cost Estimates following common procedures are adopted:
• Collection of last years and current years’ actual rates of procurement; • Prevailing market rate; • Other prevailing market rates and additional transportation, taxes and other logistical costs; and • Any other official rates published/announced by agencies like Chamber of Commerce, wherever available.
Following the PPA and PPR provisions, cost estimation of medicines and equipment is very common legal practice in LMS before beginning of procurement process. Besides, DDA as a regulatory authority have published the maximum retail price (MRP) of 96 drugs in Shrawan 2072 (August 2015) for general purposes, which may also be the basis of cost estimates practices in then LMD. But this MRP issuance of drugs does not cover all free and essential drugs that LMD procured before. So LMS considered these MRPs only as reference rates and did not take principle considerations while preparing the cost estimation of drugs before procurement process.
LMS also kept previous years’ actual procurement rates records. Prevailing local market official rates are collected direct from markets and other rates are collected from big purchasers like Bir Hospital, Patan Hospital and TU Teaching Hospitals. Keeping all these considerations, the final cost estimate rates (CER) are approved by the DG of DoHS.
It seems to be a common practice of approval of cost estimates along with technical specifications before the IFB notice publication in almost all bids.
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. GoN/MoH have published MRP of common and essential drugs as Gazette Notifi cation in Nepal Rajpatra; Part-5, Section-65, Number-12; August 03, 2015 (Shrawan 18, 2072); Ministry of Law and Justice(MoLJ)
We can see two scenarios; one is based on per unit CER and actual procurement rate (APR) of LMD itself and another scenario is the comparisons of MRP issued by DDA and APR of LMD practices of FY 2072/73 to 2073/74 (2016/17 to 2017/18).
There is no procurement of free essential drugs (FED) in FY 2074/75 (2018/19) as the responsibility was under provinces and local governments. Table-1 summarizes the MRP of DDA with CER and APR comparisons of DoHS practices on cost estimation for 11 FED which are common among the DDA price list and LMD procurement list. Comparing the MRP and actual APR of these 11 drugs in FY 2072/73 (2016/17) and FY 2073/74 (2017/18), it is found vast differences in MRP and ARP almost ranges between 61-93% low bidding value as against of MRP.
TABLE 1: ANALYSIS OF MRP AND APR IN FY 2072/73 TO 2073/74 (2016/17 AND 2017/18)
% OF LMD YEAR OF DDA MRP CER OF APR OF SN NAME OF DRUGS APR WITH CER AND 2015 LMD LMD DDA MRP APR 1 Amoxicillin 250mg DT 5.00 2.45 1.94 61% low 2073/74 2 Amoxicillin Capsule 500mg 8.00 3.29 2.89 64% low 2073/74 3 Azithromycin Tablet 250mg 17.45 8.70 4.30 75% low 2073/74 4 Azithromycin Tablet 500mg 30.00 12.28 8.37 72% low 2073/74 5 Ceftriaxone powder for Injection 1g 90.00 32.38 27.58 69% low 2073/74 6 Ciprofloxacin Tablet 500mg 8.00 3.69 2.05 74% low 2073/74 7 Fluconazole Capsule 150mg 24.00 9.69 3.65 85% low 2073/74 8 Amlodipine Tablet 5mg 5.00 1.45 0.35 93% low 2073/74 9 Tinidazole Tablet 500mg 5.00 3.15 1.27 75% low 2072/73 10 Metformin Tablet 500mg 2.00 1.22 0.42 79% low 2072/73 11 Alprazolam Tablet 0.25mg 1.70 0.97 0.49 71% low 2072/73 Source: Nepal Rajpatra; Part-5, Section-65, Number-12; August 03, 2015 and LMD procurement records.
1.4 QUANTIFICATIONS AND FORECASTING Quantification Commodity security is essential for the effective delivery of quality health services. It exists when people are able to choose, obtain and use products whenever they need them. Quantification is one of the major functions of logistics cycle. It is the process of estimating the quantities and costs of the product required for a specific health program (or service) and determining when the products should be delivered to ensure an uninterrupted supply for the program. Quantification is critical to supply chain management because it links information on services and commodities from the facility level to program policies and plans at the national level which is then used to inform decision makers for financing and procurement of commodities. It included the forecasting and supply plan (FASP).
Forecasting Forecasting is estimating the quantity of each product that will be dispensed to customers during a future period usually two or more years. Different types of data and information are required during each step of quantification. Data from the health management information system (HMIS) and logistics management information system (LMIS) were provided to the participants including consumption data, demographic data, morbidity data and program
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considerations such as non-communicable diseases, mental health and family planning programs have special considerations such as unmet needs, contraceptive prevalence rate, infertility, spousal separation and method mix. In addition, policy documents were also referred frequently.
Supply plan helps to ensure continuous supply within the maximum and minimum levels, that entails coordinating timing of funding disbursement from multiple sources with procurement lead times, delivery schedules and ensuring buffer stock. Every year, the working group forecasts for coming three-year period with periodic review. The group consists of representation from various divisions under DoHS/MOHP, districts, social marketing organizations and EDPs.
Activities in FY 2076/77 Forecasting and Supply Plan Guidebook To institutionalize MoHP capacity for evidence-based, coordinated forecasting and supply planning of health commodities at all levels of the supply chain in the federal structure, MD developed the forecasting and supply plan guidebook and workbook with support from GHSC- PSM which was approved and endorsed by DoHS.
Program Division Budget share for Health Commodities - FY 2076/77 (2019/20 ) (Total Budget NPR. 4.60 billion)
Tuberculosis 6% FP Program 6%
HIV/AIDS/STD 3% Safe Motherhood Program 2% NPHL 3%
Mental Health 2%
NIP
Mental Health Safe Motherhood Program
Tuberculosis Epidemiology 22% Epidemiology
Eye, ENT and Oral Health HIV/AIDS/STD
NPHL FP Program NIP 52%
Eye, ENT and Oral Health 4%
Consensus Forecasting 2076/77 MD organized 2-days workshop on national quantification of program drugs and EPI vaccines for the FY 2076/77 (2019/2020) on April 4-5, 2019 with the support of GHSC-PSM. Participants conducted data analysis, assumption building, forecasting and supply planning exercises. The team produced a national forecast and supply plan for 700 items for FY 2076/77 (2019/2020) for all divisions and centers. The estimated budget for this forecast is NPR. 4.60 billion.
Establish Quantification Capacity at Provinces During FY 2076/77, MD with the support of GHSC-PSM project provided technical assistance to three provinces in quantification of health commodities in Province 5, Province 1 and Sudhurpaschim Pradesh based on data generated from eLMIS and HMIS data. It helped provinces to systematically forecast commodity requirements and estimate costs for uninterrupted supplies of health commodities.
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Develop Quantification Capacity for Local Level Governments The quantification of health commodities at the central level has been effective to determine the quantities for the next fiscal year. In recent federal context, LMS organized the trainings to build capacity of provinces and LLGs health staff using quantification guidebook and workbook in all the seven provinces including Province 1, Province 2, Bagmati Province, Gandaki Province, Province 5, Karnali Province and Sudhurpaschim Province. The objective of the training was to ensure that dedicated supply chain workforce (health coordinators) are in place and have appropriate skills to manage health commodities. Further, in order to maximize utilization of the resources, GHSC-PSM field staff was also trained to carry out the FASP activities in provinces and LLGs to ensure continuous support and close coordination in training other LLGs.
1.5 QUARTERLY PIPELINE MONITORING To be successful, public health programs must always have enough medicines and supplies to meet the needs of their clients. At the same time, programs must avoid surpluses that waste products and money. In each quarter, LMS conducts Quarterly Pipeline Review meetings to review, monitor, and evaluate the procurement, shipment, distribution, transportation and stock status of selected key commodities. The meeting is participated by program divisions and centers of DoHS, external donor partners and stakeholders like social marketing agency. In the meetings shipment schedules, shipment status (planned, ordered and received), actual consumption and months-of-stock-on-hand of health commodities were discussed.
In the FY 2076/77, LMS organized three quarterly pipeline monitoring meetings on Nov 26, 2018, Feb 22, 2019 and July 31, 2019 to share the stock status of the 37 key commodities including FP, EPI Vaccines and some program commodities. This forum reviewed stock status, orders and shipment status and took actions for smooth distribution to avoid stock out and overstock and rescheduling of the pipeline shipment as per requirement.
2. STANDARD PROCUREMENT PLANNING DoHS have started the procurement planning process by preparing APP and MPP since the year 2007 after the enactment of PPA and PPR. Then LMD is preparing and monitoring CAPP each year since FY 2010/11 in some limited program activity of DoHS. However, these efforts were centered and limited to the pool funded procurement activities and their consolidation in those days. Since 2012/13 LMS have been spending its much more time and effort to consolidate APPs of various divisions under DoHS.
2.1 CAPP INITIATIVES Since 2012/13 CAPP preparation begun in DoHS applying as a broader approach and started incorporating it’s all divisions into it. CAPP Monitoring Committee is formed in DoHS and endorsed by MoHP in 2017/18. The committee is monitoring the progress of CAPP execution quarterly. Table-2 shows CAPP values of different divisions under DoHS and actual execution in values in 2016-17 to 2018/19.
TABLE 2: CAPP OF DOHS AND ACTUAL EXECUTION IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19) (IN NPR MILLION) 2073/74 2074/75* DIVISION OF 2072/73 2072/73 CAPP 2073/74 2074/75* SN CAPP CAPP DOHS CAPP PLAN ACTUALS CAPP PLAN CAPP PLAN ACTUALS ACTUALS 1 LMD 1285.87 1285.87 218.54 80.86 517.70 282.57 2 CHD 881.92 566.82 655.40 378.41 424.77 389.43
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3 FHD 912.65 236.22 368.50 224.15 279.30 264.38 4 EDCD 161.32 160.28 378.09 309.24 321.11 237.47 5 MD 69.20 43.66 72.00 24.66 32.60 28.51 6 PHCRD 814.23 606.38 1031.52 587.87 - - 7LCD--4.50.99-- 8 NSSD - - - - 1.30 0.79 Total 4125.19 2899.23 2728.55 1606.18 1576.78 1203.15 Source: Various Years CAPP data of DoHS. * In 2018/19 the divisions under DoHS are restructured, but the budget was allocated as per previous structure.
2.2 PROCUREMENT MODALITY ANALYSIS: LMD/DoHS is using open, competitive and transparent modality of bidding in practice, In 2016/17 total number of contracts was 175 whereas it is reduced in 2017/18 to118 only and that in 2018/19 is 73. Main reason for this scenario is the reduction in CAPP budget due to the devolved procurement in local and province level.
TABLE 3: NUMBER OF CONTRACTS BY MODALITY 2016/17 2017/18 2018/19 SN PROCUREMENT MODALITY NOS. OF NOS. OF NOS. OF % % % CONTRACS CONTRACS CONTRACS 1 Open Bid Method (ICB) 116 66.29 57 48.31 23 21.50 2 Open Bid Method (NCB) 34 19.43 39 33.05 32 43.84 3 Sealed Quotation Method (SQ) 9 5.14 20 16.95 10 13.70 4 Catalogue Shopping (CS) 13 7.43 0 0.00 0 0.00 5 Direct Purchase (DP) 3 1.71 2 1.69 8 1.96 Total Contract 175 100 118 100 73 100 Source: Various Years CAPP data of DoHS
2.3 PROCUREMENT TYPE USAGE: Among all other procurement types, Goods (drugs and equipment) procurement is popular purchasing type in LMD/DoHS as its weightage is 96% in 2016/17 and slightly decreased to 93.22% in 2017/18 and it is only 89.04% in 2018/19. It consists of procurement of drugs, medical equipment, instruments, contraceptives, cold chain equipment, insecticides and other goods.
TABLE 4: SELECTION OF PROCUREMENT MODALITY & TYPE IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19)
PROCUREMENT TYPE 2016/17 2017/18 2018/19
SN PROCUREMENT MODALITY NON- NON- NON- GOODS GOODS GOODS SERVICES SERVICES SERVICES SERVICES SERVICES SERVICES CONSULTING CONSULTING CONSULTING CONSULTING CONSULTING CONSULTING CONSULTING CONSULTING CONSULTING CIVIL WORKS CIVIL CIVIL WORKS CIVIL CIVIL WORKS CIVIL
1 Open Bid Method (ICB) 116 - - - 57 - - - 23 - - - 2 Open Bid Method (NCB) 28 4 2 - 33 2 3 1 26 2 3 1 3 Sealed Quotation Method (SQ) 8 - - 1 18 1 - 1 8 1 - 1 4 Catalogue Shopping (CS) 13 ------5 Direct Purchase (DP) 3 - - - 2 - - - 8 - - - Total 168 4 2 1 110 3 3 2 65 3 3 2 % of Type of Procurement 96.00 2.29 1.14 0.57 93.22 2.54 2.54 1.70 89.04 4.11 4.11 2.74 Source: Various Years CAPP data of DoHS
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2.4 SEGREGATION OF CATEGORIES USED By segregating the total procurement needs of DoHS into 6 categories like drugs, medical equipment, civil works, Services, office supplies and vehicles, it seems to be an open bid method is most commonly used method. It comprises the highest value (44.6% in 2016/17, 55.9 % in 2017/18 and 43.3% in 2018/19) in procurement of drugs, and second is the procurement of medical equipment (43.4% in 2016/17, 23.7% in 2017/18 and 30.1% in 2018/19) in the type of procurement involved in LMD/DoHS with using open bid method as a prime method.
TABLE 5: CATEGORY OF PROCUREMENT MODALITY & TYPE IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19)
PROCUREMENT 2016/17 2017/18 2018/19 TYPE
SN PROCUREMENT MODALITY DRUGS EQUIPMENT OFFICE SUPPLIES VEHICLES WORKS CIVIL SERVICES DRUGS EQUIPMENT OFFICE SUPPLIES VEHICLES WORKS CIVIL SERVICES DRUGS EQUIPMENT OFFICE SUPPLIES VEHICLES WORKS CIVIL SERVICES
Open Bid 1 61 52 - 3 - - 53 3 - 1 - - 16 7 - - - - Method (ICB)
Open Bid 2 89924261764246136124 Method (NCB)
Sealed 3 Quotation 62---1583211116-11 Method (SQ)
Catalogue 4 -13------Shopping (CS)
Direct Purchase 5 3-----2-----215--- (DP)
Total 78 76 9 5 4 36628 9 7 3 525 22 17 1 3 5
% of Type of 44.6 43.4 5.14 2.86 2.29 1.71 55.9 23.7 7.63 5.93 2.54 4.24 34.3 30.1 23.3 1.37 4.11 6.85 Procurement Source: Various Years CAPP data of DoHS
3. STANDARDIZATION OF PROCUREMENT PROCESS After the introduction of PIP, 2014 LMD/DoHS started the standardization process of procurement system. In 2017/18 PIP revisited, restructured and endorsed by MoHP and implemented as a prime and live document as a procurement reform initiative. Following are some highlights of the achievements of the standardization of procurement process as per PIP update:
3.1 USAGE OF STANDARD BIDDING DOCUMENTS: All bidding documents are mandatorily referenced from the SBDs issued by the PPMO and used as per PPA and PPR. There are not any separate health sectoral standard bidding documents endorsed by PPMO yet. However, LMD/DoHS have drafted three sets of health sectoral specific SBDs for the procurement of drugs and equipment and sent them to PPMO for endorsement. One of them is SBD for Framework Arrangements. Several follow up and discussion meeting with PPMO have been conducted in FY 2018/19 as efforts for approvals.
In DoHS, it is very common practice that almost all Bidding Documents are approved by DG before the IFB notice publication. Since 2017/18, the online e-GP portal of PPMO have been used for bidding procedures in LMD and IFB publication also came through electronically. However, e-GP includes common SBDs for all, DoHS is practicing the e-GP with no health sectoral specific SBDs for the procurement of drugs and equipment.
3.2 SOLICITATION PERIODS: Bid publication and preparation time in practice is minimum of 30 days for NCB and 45 days for ICB as per PPA and PPR. Since LMD/DoHS is using open bid method of ICB and NCB type,
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almost all bids have been processed in a transparent and non-discriminant way, given wide range of standard time period (30 days for NCB and 45 days in ICB) for bid preparation and submission, except the time used in SQ and DC methods.
Public bid opening is held immediately after the deadline of submission of bid as per the stipulated date and time on bidding document. A systematic practice of bid opening report has been established. With exception of extended bid submission time, no bids have been seen delayed for bid opening.
3.3 BID EVALUATION AND APPROVAL: Bid evaluation and approval standard time is maximum of 120 days as per PPA and PPR. All ICB bids in LMS are evaluated within the maximum period of 90 days of time and all NCB bids are evaluated within the maximum period of 35 days of time in FY 2073/74 (2017/18). These periods in FY 2072/73 (2016/17) were 120 days for ICB and 90 days for NCB respectively. An effort of e-GP II execution in 2017/18 sharply reduced the time of bid evaluation and approval. The evaluation period in FY 2074/75 (2018/19) reduced to average 41 days in ICB and average 31 days in NCB. So, all procurement of drugs and equipment has improved to a good timing of bid evaluation and approval.
3.4 ICT INITIATIVES IN SOLICITATIONS OF BID: LMD/DoHS is improving the use of ICT in bid proceedings since FY 2071/72 (2014/15). In FY 2072/73 (2016/17) LMS has used almost all bids (99.43%) through eGP I, i.e, offline bidding medium issued by PPMO which is up to the bid submission only and other processes have completed manually. In FY 2073/74 (2017/18) LMS started the technical preparation for online eGP II which includes online bidding and evaluation process and started to use it in all modality of bidding process of procurement. About 59% of bids in contract value are processed and contracted through this system in this year. Following tables summarize the overall procurement proceedings of different divisions of DoHS in FY 2073/74 (2017/18) through e-GP.
TABLE 6: BIDDING MEDIUM USED IN TERMS OF ACTUAL CONTRACT AMOUNT IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19) 2072/73 2073/74 2074/75
BIDING MEDIUM CONTRACT CONTRACT CONTRACT AMOUNT IN % PERCENTAGE AMOUNT IN % PERCENTAGE AMOUNT IN % PERCENTAGE MILLIONS MILLIONS MILLIONS e-GP I 2882.70 99.43 389.99 24.28 - - e-GP II - - 939.76 58.51 1,176.69 97.8 Other 16.53 0.57 276.44 17.21 26.46 2.2 Total 2899.23 100 1,606.18 100 1,203.15 100 Source: Various Years CAPP data of DoHS
The Table 6 shows impressive improvements in the usage of eGP system in bidding procedures. Almost 83% of bids in contract value have been processed through eGP and rests of 17% are from manual methods of bid which include some Direct Contracts too. Among total proceedings of FY 2073/74 (2017/18), 58.51% of bids in contract value are processed through online eGP II and 24.28% of bids in contract value are processed through offline eGP I procedures. Comparing to this, use of online eGP II in FY 2074/75 (2018/19) is increased at the highest level 97.8 % of CAPP value. After initiation of eGP II, the use of eGP I has been null.
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3.5 CONTRACT MANAGEMENT: Contract management in procurement is very challenging and crucial activity. It covers the period of commencement of contract to the completion of contractual liability and requires high level of monitoring to develop the mutual understanding to perform the contractual liabilities of both sides. Contract management activity has been practiced in LMS. Previously in 2069 – 2072 (2012 – 2015) a simple software of Contract Management System (CMS) was in use for monitoring of the active contracts in hand. However, LMD could not continue the institutional capacity to use this software for monitoring the contracts in hand. The eGP modules of PPMIS have not been in practice to monitor the contract management. CAPP-MC have been reported through manual efforts preparing into the Excel sheets from individual active contract files. Development of new CMS is planned to embed in the eCAPP system of TABUCS.
4. OTHER INITIATIVES 4.1 GRIEVANCE HANDLING MECHANISM: Grievance Handling and Redressal Mechanism is an important phenomenon in procurement and supply chain management, however, not given very much importance in our context. So, in FY 2073/74 (2017/18) a concept paper on the ICT based Grievance Handling and Redressal Mechanism (GHRM) have been endorsed by DoHS on behalf of MoHP and system software developed, approved and executed in FY 2074/75 (2018/19). This GHRM is installed in MD/ DoHS reported 55 grievances handled by the system in FY 2074/75 (2018/19). Annual Report on grievances received and resolved through GHRM system is available on the website of MD.
4.2 SUPPLIERS’ CONFERENCE To facilitate in use of eGP, TSB, GHRM system and online information on the MD website to the potential suppliers as well as to strengthen the bidding capacity of the suppliers with providing the knowhow about the important requirements of bidding procedure and lodging complaints and grievances related to procurement and supply chain through web-based GHRM then LMD and now MD is organizing periodic Suppliers’ Conference. The first Suppliers’ Conference was organized on 14 Mangsir 2074 (30 November 2017). Feeling the encouraging response of first Suppliers' Conference and realizing the need of periodic interaction with suppliers, second Suppliers' Conference was organized on 15 Baishakh 2076 (28 April 2019).
4.3 MARKET ANALYSIS OF PHARMACEUTICALS A large number of medical goods and services including medicines, vaccines, contraceptives, equipment, instruments and accessories are procured by all spheres of Governments. In the devolved context, since FY 2074/75 (2018-19), either local or the provincial governments at SNG level make most of the procurements of free and essential medicine. The procurement agencies do not have an updated information regarding the availability of items under the defined specifications. A large variation is observed in the prices offered by the suppliers in different institutions. Similarly, the capacity of Nepalese pharmaceutical industries in producing the free essential medicine in Nepal was not known yet. So, with the support from NHSSP a market analysis of essential medicines in Nepalese markets is done to assess the production cycle and availability of essential medicines manufactured by the domestic pharmaceutical industries in Nepal. The objectives were to assess the type of essential medicines, their dosage forms and strengths available; estimate the production capacity, compare the technical specifications and analyses the cost of medicines. The study also covered the procurement prices of essential medicines procured by Management Division, Provinces and some Palika as well as hospitals. The findings of the study are remained to disseminate among the stakeholders.
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B. SUPPLY CHAIN MANAGEMENT Supply chain management (SCM) is the oversight of materials, information, and finances as they move in a process from supplier to manufacturer to wholesaler to retailer to consumer. Supply chain management involves coordinating and integrating these flows both within and among companies. It is said that the ultimate goal of any effective supply chain management system is to reduce inventory (with the assumption that products are available when needed). In many countries the public sector distribution system or the supply chain frequently hybridized onto the existing administrative structure. Though it looks convenient administratively, however, distribution system should be based on functional, technical, and financial considerations. Streamlining the supply chain can often yield substantial result and cost savings. To determine the minimum levels required the supply chain managers must consider the total pipeline lengths; desired frequency and delivery speed; cost of transport, storage, handling; and operational constraints.
Basic elements for supply chain management 1. STORAGE, DISTRIBUTION AND INVENTORY MANAGEMENT: 1.1 Storage guideline (13 Points) I. Keep medicines in upright position, don’t touch into the wall II. Store should be dry and cross ventilation with ceiling heat insulation III. There should be sufficient light in the store IV. Stock should be arranged within each zone accordingly order system V. Stock should be stored off floor on pallets, on pallet racks or on shelves VI. Cleaning and inspection, protect from insects, rates and animals VII. Separation of wastage and expired items and process to dispose and destroy VIII. Recording of stock movements IX. Security management in store X. Cold Chain maintained to required items XI. Arrangement of fire extinguisher in the store XII. Follow FEFO system XIII. Keep away from heat and electricity to prevent rubber, latex made items
1.2 IMPORTANT TERMS USED IN SUPPLY CHAIN MANAGEMENT I. Pipeline: Pipeline is the entire chain of storage facilities and transportation links through which supply move from manufacturer to customer. II. Lead-time: The time interval between the date a product is ordered and the date it is received and available for use. Lead-time varies depending on the system, speed of deliveries, availability and reliability of transport, geographical accessibility, and weather. III. FEFO: First-to-expire, first out is an inventory management system that ensures the products with the earliest expiry date are the first products issued. This system moves older stock first to prevent expires. IV. Shelf-life: The length of time a material (drug and other essential items) may be stored without affecting the usability, safety, purity, or potency of the item. V. Maximum/Minimum (Max/Min): An inventory control method that requires each facility to set maximum and minimum desired stock levels for each item to ensure that quantities fall within the established range. This range depends on available storage facility, transportation facility, weather condition, and geographical accessibility. All health institution should be determined their Max and Min Quantity of each, and
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every item based on consumption, morbidity and population. It is also based on the nature of commodity, lead time, reporting time. VI. ASL: Authorized Stock Level (ASL) refers to the maximum allowed stock level of drugs and other programs items. It is different for different items. VII. EOP: Emergency Order Point (EOP) refers to the minimum allowed stock level of drugs and program items. EOP is different for different level. If it falls below the minimum authorized level an emergency order has to be made to concerned bodies. VIII. Under-stock: supply chain imbalance that occurs when stocks fall below the established minimum. This may result in un-served customers. IX. Overstock: Overstock is supply imbalance that occurs when stocks exceed the established maximum. This may result in losses due to expiry. X. Stock-out: Stock-out is depleted supply of a given product or products; a zero-stock balance. XI. Buffer-stock: Buffer-stock is a stock proportion of total supply that is kept for contingencies. This is directly related with disaster management. XII. PUSH System: Push system is a distribution system in which the higher-level facility decides what health commodities to push through the supply chain, how much to push, and where and when to push in the supply chain. XIII. PULL System: Pull system is a distribution system in which each lower level facility pulls essential health commodities through the supply chain by requisitioning (ordering) the required quantity at the time the essential health commodities are needed. XIV. MoSoH: Month of Stock on Hand (MoSoH) is a stock of drugs and other program items in month derived dividing total stocks by monthly dispense. XV. Inventory Control: It is a procedure that governs how supplies are received, stored, handled, and issued.
2. Inventory Management is a discipline primarily about specifying the shape and placement of stocked goods. It is required at different locations within a facility or within many locations of a supply network to precede the regular and planned course of production and stock of materials. New Forms and Formats: LMS is used now the new following Ma.Le.Pa Forms and Formats for inventory management which were circulated by Nepal Government FCGO.
Table below shows that the approval of Finance Audit Office has been decided dated 2076/02/19 according to letter dispatched no 322 dated 2076/03/01 FCGO Nepal as new Ma.Le.Pa Forms and Formats 13 out of 18 which are used in inventory management and should be implemented by all 3 level of governments.
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S. NO. NAME OF MA. LE. PA. FORM OLD MA.LE.PA NO. NEW MA.LE.PA NO. 1 Requisition 51 401 2 Purchase Order 45 402 3 Commodity Received 46 403 4 Issue Through Requisition 51 404 5 Commodity Issued 48 406 6 Expandable Commodities 52 407 7 Non-Expandable Commodities 47 408 8 Bin Card - 409 9 Commodity Dispose 50 410 10 Stock Inspection Report 49 411 11 Sub Stock Ledger - 412 12 Annual stock Status 57 413 13 Maintenance and protection record keeping - 414
2.1 Disposal and auctioning: Proper management of wastage and expired items in the store is another big challenge, should be destroy or proper dispose of these items away from environmental effect and follow accordingly guidelines (Auctioning/Destroy/Disposal Guideline 2067) and WHO Pharmaceutical Waste disposal Guideline. Pharmaceutical waste and as well as general waste can be disposing or destroy or auction or the wastage/expired or unused materials according to finance administrative regulations 2056 section 106 ka after the filled of stock inspection report form 410 and annual stock status form 413. Provision of subsidy, it is the only authority of secretary, government committee and ministry council.
MD/LMS also core work is the auctioning or disposed or destroy of waste and old materials including pharmaceutical waste in every year accordingly guidelines and government regulations
C. LOGISTICS MANAGEMENT INFORMATION SYSTEM (LMIS): LMIS in Nepal has a long history. As a part of strengthening the logistics system in 2052 (1995), LMIS was introduced and scaled up across the nation by 2054 (1997). Every quarter, more than 4,000 health institutions send LMIS reports in paper to LMIS Unit at LMD, where they are manually entered in the LMIS system installed. In 2065 (2008), LMD introduced web based LMIS up to the district level. In web based LMIS, districts, regions, and central warehouses keep transaction records and upload in the web at the end of each month. Moving a step forward, in 2073 (2016), the monthly web based LMIS was transformed to real-time online inventory management system (Online IMS) up to the district level. An integrated data repository is developed so that all historical data are accumulated in one system. LMIS is the important part for effective logistics management because LMIS data is used for planning, quantification, pipeline monitoring, supply plan, storage, distribution of commodities as decision making as soon.
Combines the forms and procedures required for gathering and organizing logistics information. The LMIS gathers information—quantities of product dispensed to users, stock levels, stock losses, Batch, Expiry and moves this data required for supply chain management through the system.
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1. QUARTERLY LMIS REPORTING AND SCHEDULING All SDPs sites should prepare their LMIS report on the quarterly basis as fulfill the all report part as available of commodities are there as follow instruction or Audio Visual Aids (can access from website: www.dohslmd.gov.np). Then send the report 1 copy (Blue) to Local Level, 1 copy CC (Yellow) to Health Office and 1 copy (White) keep into office copy. Send the report as following schedule:
DEADLINE TO SEND DEADLINE TO ENTER THE DATA S.NO REPORTING MONTHS QUARTER FROM HFS BY HEALTH OFFICE AND LLGS 1 Shrawan, Bhadra and Ashwin 1st Within Kartik 7 Within Kartik 15 2 Kartik, Mangsir and Poush 2nd Within Magh 7 Within Magh 15 3 Magh, Falgun and Chaitra 3rd Within Baisakh 7 Within Baisakh 15 4 Baisakh, Jestha and Ashad 4th Within Shrawan 7 Within Shrawan 15 Purpose System of records and reports that use to collect, organize, and present logistics data gathered across all levels of the system to improve management decisions that govern the logistics system.
2. LMIS ACTIVITIES • LMIS resource centre: well-equipped training/meeting hall with data bank, data analysis and system control • LMIS supporting centre: Technical human resources to tackles on LMIS/eLMIS problems • M&E on LMIS/eLMIS: Stock monitoring, site visit, report generations • Audio Visual Aids development for instruction to fill quarterly LMIS report • Printing and distribution of LMIS forms and stock book to all 6000+Health Facilities.
3. E-ELECTRONIC LOGISTICS MANAGEMENT INFORMATION SYSTEM (ELMIS) The Ministry of Health and Population's (MoHP) overarching Nepal Health Sector Strategy, (NHSS), 2016-2021, Outcome 9.1 calls for the improved delivery of health care services using evidence-based decision making at all levels of supply chain. In line with this, MD introduced Electronics Logistics Management Information System (eLMIS) with Support of GHSC-PSM as an improved logistics management information system for informed and evidence-based decision making to strengthen public health supply chain management in Nepal. The software vendor in joint venture with a Nepali local company was selected to implement eLMIS in Ashwin 2074. Joint venture with local company was prioritized from initial conceptualization to ensure sustainability of the solution.
eLMIS has two major capability modules; reporting and transactional capabilities. Both options are used to ensure both the availability and visibility of data for informed decision making to ensure continuous availability of health commodities to end users.
A well-designed, well-operated supply chain driven by accurate and timely logistics data, inventory and pipeline information is critical to the success of any health system. Supply chain managers need to have clear visibility into all supply chain components such as forecasting, quantification, procurement, warehousing, inventory, distribution, pipeline information as well as funding, and policy.
As technology continues to evolve, public health systems policy makers and planners are looking for real time accurate data to make health commodities available at all levels of
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supply chain interruptedly. Traditional paper-based system no more suffices their need to serve the end users.
Introduction of automated eLMIS, program managers will have quicker access to aggregate and/ or specific data at their fingertips. eLMIS is the real time data system. Till the date, progress of eLMIS live from all Federal, Provincial health institutions and partial District, Local and SDP level.
I. eLMIS implementation expected outcomes The overall benefits of eLMIS implementation will be three-fold:
Strategic impacts • Availability of logistics data for measuring SC Performance. • Capture and analyze logistics data for informed decision making • Availability of real-time data enables MoHP to strengthen supply and demand planning, optimize transportation processes, control inventory costs and minimize risks that lead to Stockouts, expiries and wastage. • Capability to set up and report on KPIs for FP, MNCH, Vaccines, Essential drugs programs • Integration with Health information system for visibility and analytics • Full visibility and real time data for management of SCM.
Operational impacts • Reduced cycle time for doing some SC activities (e.g. Order processing and reporting) • Improved efficiencies in capturing consumption and other critical SC data • Reduced LOE required to prepare and process orders • Provided capabilities to SC performance enabling PHLMC, DHO, SDPs, and MD/DoHS of MoHP to make accurate decisions within appropriate timelines • Provided end-to-end visibility into operational data on a real time basis
Public health impacts • Increased availability of health commodities at SDPs • Reduced stockouts of health commodities
Outputs of eLMIS • Brief status of institutional strengths for its readiness in implementing eLMIS • Immediate needs to functionalize local governance system for eLIMS • Improved logistics management information system for supply chain planning including quantification, forecasting, procurement planning and monitoring of health commodities. • Strengthened supply chain management. • Enhance local level institutional capacity for procurement and supply chain management.
II. eLMIS implementation requirements Following resources are required for effective operationalization of eLMIS: • A computer installed with Windows Operating System and a printer in case of online and offline module • Internet connection of minimal 512 Kbps. • Uninterrupted smooth speed in case of online module. • Availability of seldom signal of Internet for periodic data synchronization in case of offline module.
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• Mobile signal of at least 2G/GPRS for mobile module for health facilities.
Medical stores at different levels, for example, stores of Palikas (Rural Municipalities and Municipalities) and above are recommended to use Online module.
Health Facilities that serves as service delivery point can use online module if they have uninterrupted internet service above 512 kbps; or offline module if uninterrupted internet service is not available. Smaller health facilities can also opt to use mobile module for reporting needs.
Human resource having knowledge of public health supply chain of responsible level with basic computer skills. • Inventory management, supply chain management skills for storekeeper level • Supply chain management and data interpretation skills for health managers • Data driven decision making for executives and decision makers.
III. eLMIS Intervention and Current Sites Currently eLMIS is used as repository of paper based quarterly LMIS reports from 6000+ health facilities throughout the country. In addition to LMIS reports data entry, eLMIS also serves as a centralized warehouse and inventory management system for day-to- day transactional operations. Since 1st Baishakh 2075, the eLMIS system has attained operational capacity in 129 sites. eLMIS is currently operational at Central Medical Stores (CMS): Family Planning Store, Cold Chain Store, NCASC, EDCD, NTC, and at Pathlaiya CMS, Provincial Medical Stores (PMS) of Butwal, Nepalgunj, Pokhara and Janakpur; all 77 health office (out of which 55 are using eLMIS for consumption data entry), 18 local municipalities aka local level governments (LLGs), 23 health facilities.
In order to facilitate smooth operations of eLMIS, three levels of support were established. First level (L1) of support is provided remotely by helpdesk. User can access helpdesk using a tollfree number, SMS or email. Second level (L2) support is provided through LMIS Officers. These officers are seconded at central stores, provincial stores and selected health offices to provide on-the-job support to all eLMIS operating sites. Level three support (L3) is provided by software vendor. The level three support provide services in case of any changes required on software and bug fixing. As system is already stabilized after being on operation for more than 2 years, majority of the of the support issues are resolved by local Nepali company as part of L1 & L2 support.
IV. eLMIS Implementation: eLMIS was rolled out on three stages to ensure the eLMIS implementation follows the commodity flow cycle. a. In Stage 1, which ended in Baishakh 2075, eLMIS was implemented and operationalized in 10 sites (6 CMS, 2 RMS and 2 district stores) including the Family Planning Store Teku, the Vaccine and Cold Chain Store Teku, the National Centre for AIDS and STD Control (NCASC) store Teku, the LMIS Centre Teku, the National Tuberculosis Center (NTC) Thimi, the Central Medical Store (CMS) Pathlaiya, the Regional Medical Store Butwal, the Regional Medical Store Nepalgunj, and Bardiya and Surkhet district stores.
b. In Stage 2, which ended in Ashadh 2075, the eLMIS was implemented and operationalized in 20 district stores and offline modules deployed at Humla, Jumla, Kalikot, Mugu and Dolpa district stores, which have limited internet access.
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c. In Stage 3, which ended in Bhadra 2075, eLMIS was implemented and operationalized at four local level governments of Bardiya and Surkhet and 23 of their health facilities.
V. eLMIS implementation assessment and adjustments based on lesson learnt: Management Division assessed eLMIS operational sites in Mangsir through support from GHSC-PSM project in Mangsir 2075. Assessments was conducted at representative eLMIS operational sites, this included all level of supply chain (i.e. CMS, PMS, district, LLGs and SDPs) and all types of eLMIS modules (i.e. online, offline and mobile modules of eLMIS). The recommendations of assessment were adopted into eLMIS as lesson learnt.
VI. COVID-19 Items Incorporated and Reporting Tools Logistics Management Section has supply COVID-19 items to the NPHL, PHLMC, PHD, HO, COVID-19 Treatment Hospitals and Clinics. COVID-19 items are incorporated in reporting systems (LMIS/eLMIS). LMS finalize a tool for COVID-19 items reporting as daily, weekly, monthly and as per required.
VII. eLMIS scale-up Plan Approval and Rollout Team Mobilization eLMIS scale-up approach, modality and requirements were prepared. Plan for all remains health institutions within 2077. Approval of eLMIS Scale-Up Plan on 2077/02/01 (Secretary Level decision MoHP) and Team Mobilization Rollout Plan has been approved on 2077/02/08 (AD May 21, 2020) –DoHS level decision.
VIII. Data Governance On Paush 18, 2074 (January 2, 2018), the project presented the master data it had compiled for the eLMIS to a meeting of the LMIS Task Force including PHAMED and MoHP representatives. This data is interoperable with the District Health Information System (DHIS), the Technical Specifications Bank and the Department of Drug Administration’s management information system. Subsequently, on Magh 26, 2074 (February 9, 2018), the project discussed the sharing of master data, including for the eLMIS, with PHAMED and LMD officials, NHSSP’s M&E Advisor and a representative of MoHP’s Health Registry. LMD shared the master data with PHAMED on Chaitra 8, 2074 (March 22, 2018).
In mid-2018, the health facilities part of the Health Registry went live and can be accessed http://182.93.95.152:8088/health-registry/ The project acquired a full listing of health facilities and is now working with Bileeta to standardize it in the eLMIS to ensure interoperability between the eLMIS and the Health Registry.
4. ONLINE INVENTORY MANAGEMENT SYSTEM (IMS) SUPPORT The project is also supporting Online Inventory Management System (IMS) to run a helpdesk for the system. The helpdesk continued to receive and deal with issues and queries about the system. Support team is also responsible for following up with districts for regular transactions in the Online IMS, consumption reporting, data monitoring and reporting, and negative balance verification and corrections. The support will continue until eLMIS is completely rollout in all sites.
5. ROUTINE DATA QUALITY ASSESSMENT (RDQA) Management Division has facing key challenge on quarterly basis LMIS reporting on its quality as timeliness, accuracy, completeness, fairness, consistency, validity, reliability. MD were
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initiated to improve data quality by RDQA. The overall objective of the RDQA assessment was to access data quality information by the Logistics management division from its distribution wings in obtaining its goals and objectives and to get recommendation for further improvement of the supply chain management. Logistics Management Division (LMD) began data quality assessment from 2073 (2017). Information required for the assessment was collected using RDQA tools developed by Measure Evaluation funded by USAID. The assessment was conducted in five provinces (1,2, 3, 6 and 7) covering five districts, each district including one health/public health offices, one PHCCs and two health posts. The assessment was carried out under the overall supervision of the senior members of the assessment team. Data collection was carried out during April – May 2018 and 2019 (FY 2075 and 2075) which lies in 2nd quarter of LMIS reporting period. A one-day debriefing workshop among the LMD's staff was organized at LMD premises to share experiences gained by the field teams during data collection. The workshop was instrumental for providing necessary feedback and guidance to the field team.
System Assessment Results by Level of the Reporting System
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00 Service Delivery District Site Cetral Level: Central Site Average Site Average Warehouse, Teku
I - M&E Structure, Functions and Capabilities III - Data-Collection and Reporting Forms and Tools
II - Indicator Definations and Reporting Guidelines IV - Data Management Processes
Gap analysis and action taken (RDQA): S. N GAPS ACTION TAKEN RESPONSIBILITY 1 Lack of M&E from all levels Regular M&E Federal, Province and Local Revive the feedback mechanism 2 No feedback mechanism Federal, Province and Local from all levels Need for LMIS training for all 3 Gaps on LMIS training Federal and Province SDP sites
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D. EFFECTIVE VACCINE MONITORING (EVM) National Immunization Program (NIP) is priority one and successful program in Nepal. It has a great role and responsibility of cold chain and vaccine management behind the success of Immunization program. Expanded Program of Immunization (EPI) was started in 1979 (2074- 75) after the eradication of Smallpox in Nepal. At the starting time, Vaccination program was introduced in three districts they are Dhanusha, Rupandehi and Sindhupalchok. There were only four antigens, which were BCG and DPT. Now, eleven antigens are in use and near future Nepal is going to introduce ROTA vaccine. At the starting period of Cold chain & Vaccine Management, there were only three cold rooms in Nepal. They are each in Kathmandu, Kailali and Biratnagar. Now, we have nine cold rooms in Central Vaccine Store, Teku and twenty are in other part of the country.
I. Goal Effective Vaccine Management has a great role for the success of NIP. Now, WHO & UNICEF has prepared Standard Operating Procedure (SOP) on Effective Vaccine Management (EVM). It has 9 indicators. They do EVM Assessment in every three years. Every country should have eighty percent in each indicator in EVM Assessment. Our main goal is to obtain more than eighty percent in EVM Assessment.
II. Objectives of Cold chain & Vaccine Management Main objective of the Cold chain & Vaccine Management is to store and distribution of vaccines in time with maintaining the quality of vaccines.
Overall goal is reduction of morbidity, mortality and disability associated with vaccine preventable diseases.
III. CMYP ▸ Ensure access to vaccine od assured quality and with appropriate waste management. ▸ Logistics Management under DoHS, is responsible for the procurement of vaccine and cold chain also has a section to handle the vaccine and cold chain. Under this division there are regional and district vaccine stores, reporting the status of vaccine and cold chain. ▸ Management Division Under DoHS responsible to collect information on administrative coverage.
IV. Vaccines Eleven antigens are in use in Nepal till Now. They are BCG, DPT-HepB-Hib, OPV, MR, JE, Td, PCV & IPV. ROTA vaccine is going to introduce in Nepal from Jun.-Jul. 2020.
V. Cold chain Equipment for Storage and Transportation WHO has advised to use only WHO prequalified cold chain equipment for the vaccine management of National Immunization Program (NIP) Nepal is following the WHO Guidelines and WHO PQS. The WHO PQS list is updating time by time. GON has advised to use only WHO prequalified cold chain equipment in NIP. This equipment is specially manufactured to store the vaccines and that kind of equipment has more holdover time.
VI. Progress and activities Cold chain and Vaccine Management Unit, Logistics Management Section, Management Division
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is doing all kind of management activities for vaccine management (shipment plan, pipeline monitoring, receiving, storing and distribution of vaccines, maintaining and monitoring of temperature by using the devices). This unit is coordinating with Child Health and Immunization Service Section under the Family Welfare, Division to do the forecasting and quantification of vaccines and EPI accessories.
Forecasted vs Supply Status of Vaccines in doses form (last three years) Forecasting methods for vaccines & syringes are based on no of EPI session, target population, coverage percentage, no of doses and wastage multiplication factor. We have a supply schedule and distribution quantities/list to supply the vaccines and syringes to PHLMC and Health Offices. Distribution quantities are calculated as per the stock status, estimated monthly consumption, minimum and maximum stock level of vaccines at the institution. We can compare the forested vs. supplied status of vaccines as follows:
4500000
4000000 4028340 4028340 4028340
3500000 3340000
3000000 3020000 2695370 2695370 2695370 2500000 2385400 2385400 2385400 2385400 2385400 2385400 2385400 2346350 2141320 2122600 2122600 2122600 2183500 2102650 2038732 1934150
2000000 1808990 1808990 1808990 1766800 1650800 1489000 1400000 1500000 1386000 1257105 1257105 1257105
1000000 942400 872500
500000
0 Items BCGDPT-HepB- bOPV MR JE Td PCV IPV Hib 2073-74 2074-75 2075-76
Forecasted vs Supply Status of Vaccines in doses form (current year) 4500000
4000000 3975040
3500000
3000000
2500000 2320000 2206810 2206810 2199400
2000000 1963692 1611900 1540750
1500000 1452405 1328510 1080000 1078000 990000 1055000 1000000 930190
500000 466000
0 BCG bOPVDPT-HepB- JE MR Td PCV4 IPV Hib 2076/77 Forecasted 2076/77 Supplied
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Prices of Vaccines in USD
8000000 7105500 7000000 6625500 6218132.6 6000000
5000000
4000000
3000000 1855975 1903150 1994397.5 2000000 1776248.83 1411129.88 1274604.85 1155560 546592 643278 1000000 540950 226500 295500 250500 423171 450670.5 397400.85 163790 168410 152460 0 Items BCGDPT-HepB- bOPV MR JE Td PCV IPV Hib 2073-75 2074-76 2075-77
Comparative Price of GoN vs GAVI Funded Vaccine in USD Government of Nepal is providing the budget to procure BCG, OPV, MR, JE, Td and syringes. Likewise, GAVI is supporting DPT-HepB-Hib, PCV, IPV with their syringe’s safety boxes. UNICEF is procuring and supplying the vaccines for GAVI supporting vaccines as per the MOU of GAVI & GON.
10000000 9368090.1
9000000 9008650 8481475
8000000
7000000
6000000
5000000
4000000 3306607.83
3000000 2763770.73 2650827.35
2000000
1000000
0 2073-75 2074-76 2075-77 GoN Procured-BCG, OPV, JE, MR I, Td GAVI funded-Penta, PCV, IPV
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VII. Wastage Rate of Vaccines - HMIS Government of Nepal / National Immunization Program (NIP) has policy for forecasting and quantification of vaccines and syringes as per the guideline of WHO. Forecasting for BCG is based on the EPI Session of the country. Nepal is following MDVP. As per the MDVP, 15 percent is acceptable for DPT-HepB-Hib, OPV, Td. Reconstitute vaccines MR has 40 and JE has 50 per- cent wastage on the basis of geographical and session size in Nepal.
Wastage minimization should be a priority action from each level. Which has direct effect on resource generation
100 90 84
80 80.5 74.8
60 51 50 49 48 45.8 48 45.7
40 34.5 26 25 23.4 23 22.4 22.5 12 20 10 13.6 27.4
0 BCGDPT-HepB-Hib bOPV MR JE Td PCV IPV
2073-74 2074-75 2075-76
VIII. Repair and Maintenance Status of Cold Chain Equipment Repair and Maintenance of Cold Chain Equipment is a main part in Vaccine Management. Quality of the vaccine cannot be maintained without cold chain. Therefore, regular tempera- ture monitoring and maintenance of cold chain equipment are very fundamental activities in NIP and Vaccine Management. We have Mechanical Engineers (ME) in CVS and Refrigerator Technicians (RT) in PHLMC. They are doing repair and maintenance of cold chain equipment at sanctioned office and districts as well as health facilities.
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E. REPAIR AND MAINTENANCE STATUS OF BIOMEDICAL EQUIPMENT Inventory of different Health facilities (HFs) which are under the Nationwide outsourcing Main- tenance Project are kept in the software called Planning and Management of Assets in Health Services (PLAMAHS). It contains the inventory details of Bill of Quantity (BoQ) items. In this proj- ect, Equipment Descriptor are limited to 86 type. In the software we have the detail equipment descriptor of 86 type depending upon the functionality with the particular equipment type. The inventory details are updated during every Maintenance Contractor (MC) intervention. According to the government structure Central, Provincial and Local level in different provinces. We have made the inventory of the BoQ type equipment. They are given below with the Health Facilities name.
Table below shows that involvement of Health Care Centres of different federal area maintained biomedical equipments (Detail inventory of biomedical equipments repaired and maintained with its categorized is mentioned in annex)
GOVERNMENT PROVINCE NAME OF HFS UNDER MAINTENACE PROJECT STRUCTURE Province 1 Koshi Hospital Province 2 Gajendra Narayan Singh Sagarmatha Hospital, Narayani Hospital Bagmati Bharatpur Hospital Federal Gandaki Pokhara Academy of Health Science Province 5 Rapti Academy of Health Science Karnali Karnali Academy of Health Science Sudurpashchim Dadeldhura Hospital Bhojpur Hospital, Dhankuta Hospital, IIam Hospital, Khotang Hospital, Mechi Hospital, Okhaldhunga Hospital, Panchthar Hospital, Province 1 Sankhuwasabha Hospital, Solukhumbu Hospital, Sunsari Hospital, Taplejung Hospital, Terhathum Hospital, Udayapur Hospital Bara Hospital, JanakpurHospital, Mahottari Hospital, Ram Kumar Province 2 Uma Prasad Memorial Hospital, Rautahat Hospital, Sarlahi Hospital, Siraha Hospital Dhading Hospital, Hetauda Hospital, Nuwakot Hospital, Ramechhap Bagmati Hospital, Rasuwa Hospital, Sindhuli Hospital, Sindhupalchok Hospital Dhaulagiri Hospital, Gorkha Hospital, Lamjung Community Hospital, Gandaki Manang Hospital, Mustang Hospital, Myagdi Hospital, Parbat Provincial level Hospital, Syangja Hospital, Tanahun Hospital Arghakhanchi Hospital, Bheri Hospital, Bhim Hospital, Gulariya Hospital Bardiya, Gulmi Hospital, Kapilvastu Hospital, Lumbini Province 5 Hospital, Palpa Hospital, Pipara Hospital, Prithvi Chandra Hospital, Pyuthan Hospital, Rampur Hospital, Rapti Hospital, Rolpa Hospital Dailekh Hospital, Dolpa Hospital, Humla Hospital, Jajarkot Hospital, Karnali Kalikot Hospital, Mehelkuna Hospital, Mugu Hospital, Rukum Hospital, Salyan Hospital, Surkhet Hospital Achham Hospital, Baitadi Hospital, Bajhang Hospital, Bajura Hospital, Sudurpashchim Darchula Hospital, Doti Hospital, Mahakali Hospital, Seti Hospital, Tikapur Hospital Province 1 Katari Hospital, Rangeli Hospital Bardibas Hospital, Bhardah Hospital, Chandranigahapur Hospital, Province 2 Pokhariya Hospital Baghauda Hospital, BakulaharRatnanagar Hospital, Jiri Hospital, Bagmati Local Level Methinkot Hospital Gandaki Bandipur Hospital Province 5 Shivraj Hospital Karnali Dullu Hospital Sudurpashchim Gokuleshwar Hospital, Jogbuda Hospital, Malakheti Hospital Biomedical equipment list of hospital is attached in Annex ….. 53 HEALTH LOGISTICS REPORT
F. EXPIRED DRUGS MANAGEMENT Expired drugs management is one of the major activities of health logistic and supply chain management. Expired drugs imply financial losses because they should no longer be distributed and must be discarded. WHO guideline for the safe disposal of expired drugs says expired drugs must be disposed of safely, without harming people and the environment.
There is gap on knowledge and practice of expired drugs management and proper disposal. High number of expiries shows gap on proper planning and quantification and mobilization in needy health facilities as well as data validity used for the planning. Provinces and district as well as community level health facilities are managing locally disposal of expired drugs with local resources and knowledge but not as the standard procedure.
SOME EXPIRED MEDICINES, ITEMS OF MNCH DRUGS IN FISCAL YEAR 2074/75 AND 2075/76 DRUGS STATE 1 STATE 2 STATE 3 STATE 4 STATE 5 STATE 6 STATE 7 TOTAL Oral Rehydration Salt 0 0 4300 0 0 20 0 4320 Powder Packet ORS + Zinc Packet 000024400244 Sulphamethoxazole 100 0000102000010200 mg + Trimethoprim 20 mg Dispersible Tablet Zinc Sulphate 20 mg Tablet 27000000229860 21159 0 278019 Ferrous Sulphate 60 mg 0 0 397890 0 26600 30061 0 454551 + Folic Acid Tab 0.4 mg Tablet Chlorhexidine Gel 4% (Navi 00001139 0 0 1139 Malam) Tube Oxytocin 10 IU / ml 0000050050 Injection Oxytocin 5 IU / ml Injection 0 0 710 0 2525 35 0 3270 Gentamycin 80 mg/ml 2ml 00001330 0 0 1330 Injection Amoxycillin 125 mg 000098980 0 0 98980 Dispersible Tablet Source: eLMIS
Data shows higher number of expiries of Zinc Tablet and ferrous sulphate among MNCH drugs in last two fiscal years. The expiry of Zinc is higher in province 5 in comparison to other provinces and Ferrous Sulphate expiry is higher in province 3. The number of expiries is higher in the group of tuberculosis, HIV and antihypertensive drugs as well. (detail list of expired drugs is attached in the annex) There are some items which is based on eLMIS but due to not updated record it may be not represent exact figure which should be updated timely and mobilization should be one of the activities for logistics management as per consumption.
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G. SUPPLY CHAIN MANAGEMENT WORKING GROUP (SCMWG) Supply Chain Management Working Group The SCMWG will be a group of logistics and supply chain expert from MoHP, development partners vand stakeholders working together to achieve specific goals. Its mandate will focus on improving the performance of the supply chain of all health commodities, with a focus on innovation, capacity, and stakeholder collaboration to enhance the health commodity supply chain management performance in Nepal.
Goal Round the year uninterrupted availability of quality essential drugs and health commodities at service delivery points.
Purpose • To identify gaps within the health logistics system. • To identify common interests and exchange views about health logistics issues. • To take timely action on critical logistics problems such as stock outs, overstock and distribution decisions. • To facilitate on plans, procure, store, distribute as required by federal, province and local level governments • To take way forward in the critical issues on logistics • To formulate SCMWG in federal, province and district Level • To facilitate on basic logistics capacity enhancements, LMIS, pipeline, forecasting, quantification in federal, province and local level • To monitor the ongoing logistics activities.
Task The working group will provide a platform for exchange of ideas / concept, good practices, and forge collaboration on the essential drugs and health commodities supply chain in Nepal. It will work toward ensuring efficient quality health commodities supply chain from central to province, province to district, district to health facilities and ultimately to client.
Specifically, the SCMWG works on following components:
Supply Chain Innovation • Identify issues, challenges and opportunities in health logistics system in Nepal. • Collaborate to introduce best practices and procedures in health logistics systems. • Oversight the overall logistics system. • Identify and come up with innovations that will improve supply chain performance and great impact on health outcomes
Capacity Building • Identify workforce requirements and continuous development, requisite tools, knowledge and expertise to build capacity that will enhance competitiveness within the health logistics system such as technology and change management.
Performance Measurement • Identify performance measurement gaps within the health logistics system and develop a performance measurement framework.
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• Identify common interests and exchange views about issues in support of the Essential Drugs and Health Commodity Supply Chain. • Share or exchange supply chain related success stories and lesson learnt
11.1 Rationale of SCMWG formation • Adapt supply chain related policies and strategies consistent with federal system of the country • Adapt new structure and functions within the given framework of MoHP/DoHS • Expand partners and stakeholders for supply chain management strengthening at different tiers of governance • Develop a more structured approach to tackle logistic issues. • Assess effectiveness and efficiency of present health logistics system • Bring improvement in the systems to increase availability of health commodities at all levels • Monitoring of logistics indicators including such as stockout, reporting rate, stock according to plan, on-time delivery, order fill rate and world bank DLI at all levels • Continuous monitoring and periodic evaluation of the logistics system for informed decision making • Facilitation on pipeline/forecasting and quantification in federal, province and local level • Advise and adopt right processes to manage, organized/cleaned, receive and distribute health commodities, batch management, adjustments, disposal and safety of warehouse/store at each level of supply chain • Update SOPs periodically based on learning and best international practices • Manage to provide knowledge and skill to all health professionals on basic health logistics, paper based LMIS and electronic LMIS • Supportive supervision/monitoring/onsite coaching/mentoring/facilitation as require strengthening supply chain management at all levels in coordination with supply chain partners • Formulate federal, province and district level logistics management working group to strengthen of supply chain management at all levels • Supply plan monitoring for uninterrupted availability of health commodities at federal, province, districts/local level • Establishment and operationalize of LMIS unit to analyze logistics data at Province Health Logistics Management Centre (PHLMC) • Upgrade eLMIS periodically based on the user experience and evolving needs to strengthen supply chain functions
11.2 Scope of Work (SOW) of SCMWG Specifically, this SCMWG would be responsible for following activities but not limiting to it: • Organize quarterly meeting to review performance management and improvement • Organize annual meeting on national consensus of health commodity forecasting • Organize quarterly national pipeline review meetings • Assist in preparing annual work plan • Coordination and cooperation with all development partners supporting health logistics management • Plan for the efficient management on procurement, storage, distribution and transportation of health commodities • Review policy and strategies • Periodic review of national guidelines on supply chain management • Review and update eLMIS as per requirement • Assess logistics gaps
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• Plan to prioritize supervision and monitoring the logistics activities in needed areas • Provide decision in logistics activities • Plan for supply chain workforce development and opportunity for internship to health personnel • Undertake periodic review and take immediate action on critical supply chain issues. • Constitute under SCMWG Task Force for governing regular activities
11.3 Provision of SCMWG Meeting Meeting should be arranged at least Quarterly or as per the need of the group.
11.4 Anticipated Outcomes • Provide a forum for a meaningful action, exchange of experiences and ideas to resolve supply chain management issues. • Timely and efficient decision making of procurement and distribution of health logistics operations • Ensure uninterrupted supply of health commodities at all levels of the supply chain to ensure uninterrupted quality health services
11.5 Proposed SCMWG Members Federal level: SCMWG will be chaired by Director of Management Division. The SCMWG will consist of 22 individuals and concern division and other key stakeholders will be invited as per need:
NO. OF S.N. MEMBERS ASSIGN POSITION PERSON 1. Director of Management Division Chairperson 1 2. Chief of Logistics Management Section Co-Chair 1 3. Chief Finance Controller, DoHS Member 1 4. Legal Officer, DoHS Member 1 5. MoHP Member 1 6. PPMO Member 1 7. FWD Member 1 8. EDCD Member 1 9. CSD Member 1 10. NCASC Member 1 11. NTC Member 1 12. NPHL Member 1 13. World Bank Nepal Member 1 14. WHO Nepal Member 1 15. GIZ Member 1 16. USAID Nepal Member 1 17. GHSC-PSM Nepal Member 1 18. UNICEF Nepal Member 1 19. UNFPA Nepal Member 1 20. ADRA Nepal Member 1 21. DFID Nepal Member 1 22. Officer – Supply management Member Secretary 1 Total 22
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* Partners directly supporting in logistic management will be member as well as partners without logistic support plan will not be as a member.
A focal person (Secretary), who is responsible for coordinating the activities of SCMWG such as: conducting meeting and necessary follow-up; follow-up action plan; preparing and circulating minutes.
Province level: Proposed SCMWG at provincial level will be chaired by Director of Province Health Logistics Management Centre. The SCMWG will consist of 13 individuals and concern division and other key stakeholders will be invited as per need:
S.N. MEMBERS ASSIGN POSITION NO. OF PERSON 1. Director of Province Health Logistics Management Centre Chairperson 1 Division/Section chief, Province Health Logistics 2. Co-Chairperson 1 Management Centre 3. Division chief Province health directorate Member 1 4. MoSD/Health Division Member 1 5. Chief Finance Comptroller, Province Finance Member 1 6. PPHLC, Section Chief Member 1 7. Section Chief, Province Health Training Center Member 1 8. Chief Health Office-local district Member 1 9. Health Logistics Related pharmacist (hospital) Member 1 10. Statistics officer Member 1 11. Representative of NGO/INGO Member 2 12. Focal Person Province HLM centers Member Secretary 1 Total 13
A focal person (Secretary), who is responsible for coordinating the activities of SCMWG such as: conducting meeting and necessary follow-up; follow-up action plan; preparing and circulating minutes.
District level: Proposed SCMWG at district level will be chaired by Chief of Health Office. The SCMWG will consist of 11 individuals and concern and other key stakeholders will be invited as per need:
S.N. MEMBERS ASSIGN POSITION NO. OF PERSON 1 Chief, Health Office Chairperson 1 2 Health Office Finance Section Member 1 3 Health Office Admin Section Member 1 4 Health Office Store In charge* Member 1 Health Logistics Related pharmacist 5 (Hospital - 1 and PHI/HO - 1) and Computer Assistant Member 4 (Hospital - 1 and PHI/HO - 1) 6 Health Section Coordinator Member 1 7 Representative of NGO/INGO Member 2 8 Focal Person Health Office LMIS Sections* Member Secretary TOTAL 12
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Local level: Proposed SCMWG at local level will be chaired by Chief Administrative Officer (CAO) of Local Level. The SCMWG will consist of 8 individuals and concern and other key stakeholders will be invited as per need:
S.N. MEMBERS ASSIGN POSITION NO. OF PERSON 1. Chief Administrative Officer Chairperson 1 2. Chief of Health Facilities (Senior Most Health Worker Co-Chair 1 among HF/Health Coordinator) 3. Health Coordinator Member 1 3. Chief, finance section Member 1 4. Store In charge Member 1 5. Health Sub Coordinator/Health worker Member 1 6. Health Logistics Related pharmacist and representative of Member 1 NGO/INGO 7. Health worker/storekeeper Secretary 1 Total 8
A focal person (Secretary), who is responsible for coordinating the activities of LMWG such as: conducting meeting and necessary follow-up; follow-up action plan; preparing and circulating minutes.
11.6 Standards of SCMWG Meeting • Meeting should be arranged at least quarterly or when necessary. • Set up the clear agenda of the meeting and ensure that its content is within the SOW. • Ensure that the agenda for the meeting are provided sufficiently in advance, presented in comprehensive way for effective discussion. • Minutes of each SCMWG meeting is circulated to all members within 5 working days after the meeting. • SCMWG can invite special expert- as deemed necessary upon the nature of the program or issues.
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CHAPTER 4 CAPACITY BUILDING AND SYSTEM ENHANCEMENT
CAPACITY ENHANCEMENT IS BASED ON TRAINING, WORKSHOP, ONSITE COACHING, FEEDBACK, MONITORING, MANUAL AND GUIDANCE
1. CAPACITY BUILDING: PROVINCIAL AND LOCAL LEVEL TRAINING ON BHL AND PPS To ensure continues knowledge management of the health service providers, various Provincial and local level training on LMIS/Basic logistics for HSPs is being provided. Three different types of trainings were conducted on Basic Health Logistics (BHL) and Public Procurement System (PPS). Training of Trainers, Basic Health Logistics and Public Procurement System for municipal level staff and Basic health logistics management training for health facility level staff.
1.1 CAPACITY BUILDING FOR PROCUREMENT Capacity to execute the plan and programs in all level is very crucial for results. However, capacity building program in both institutional and human resource level has been planned in PIP, but the execution progress is not very encouraging. PIP envisages standard procurement procedure, quality assurance, grievance handling, supply chain management and HR capacity building programs. Some of them are executed in FY 2073/74 and 2074/75 (2017/18 and 2018/19) as outlined below.
I. Workshop, Training and Technical Support LMS organized several workshops on TSB, CAPP, SOP on Procurement Management. Two SOPs on procurement management and eGP operation have been prepared, endorsed and distributed to local and provincial levels in FY 2073/74 (2017/18) with technical support through NHSSP and extensive technical support and capacity building program for Sub- National Governments (SNGs) level have been enhanced in FY 2074/75 (2018/19). Before eGP execution in LMD, 2 type of eGP training for DoHS staff have been conducted with the help of PPMO. After the completion of eGP training of DoHS staff, online eGP II system executed in DoHS since Mangsir 2074 (November 2017).
Some training module and its session plans are designed with the cooperation of PPMO. Logistic and Procurement Management Training Manual reviewed in FY 2074/75 (2018/19). In FY 2074/75 (2018/19) SNGs level capacity enhancement programs have launched several times in all provinces on the different topics like Forecasting and Quantification (7), Procurement Planning (7), eGP operation (7) and Trainers Training (TOT) in three provinces. Similarly, two eGP trainings in procurement were conducted at the central level; and four provincial/local level trainings were conducted in FY 2074/75 (2018/19).
II. Procurement Clinic Procurement Clinic is a troubleshooting approach applied in various cases of procurement
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occurred in all divisions of DoHS. Basically, it is an advisory function for decision makers on procurement. The Procurement Clinic services are provided to other health sector procurement entities in all spheres of governments.
III. Monitoring Management through Committee approach: LMS believes in participatory approach of planning and monitoring. In order to strengthen, monitor, and sustain the initiatives, in FY 2073/74 (2017/18) MoHP has formed CAPP Monitoring Committee (CMC) under the leadership of Director General of the DoHS and endorsed its TOR to monitor overall matters of procurement and supply chain management. The ToR of CMC have been endorsed by the secretary of the MoHP with the provision of submitting their progress report to the MoHP PFM committee. DoHS has formed and expanded the technical committees governing by CMC as Logistics Working Group (LWG), Logistics Management Information System Task Force and Technical Committee for the Technical Specification Bank in DoHS. These all institutional setup have been completed in FY 2073/74 (2017/18).
2. BASIC HEALTH LOGISTIC AND PUBLIC PROCUREMENT SYSTEM TRAINING METHOD The Basic Health Logistics Training Manual was first developed in 2056 (2000-2001 AD) to enhance the capacity of personnel involved in supply chain management of health commodities. Five years late in 2005-06 the manual was revised after the implementation of pull system. Since then the manuals were not revised and many changes in logistics management have had occurred. Realizing this LMD took lead to revise the manual incorporating many new components. Forecasting, data quality and pipeline monitoring were added in 2017. The country is already in federal structure; local bodies need to have capacity of supply chain management of health commodities. The new revised manual is expected to assist them for the capacity enhancement in supply chain management, procurement, recording/reporting and use of data for evidence-based decision making.
I. Training of Trainers (TOT) on Basic Health Logistics and Public Procurement System The main objective of the TOT was to train participants on basic logistic management and enable them to conduct and facilitate trainings in their respective district/Municipalities post the training. The participants were selected with close coordination with Logistic Management Section (LMS). Although, there were a total of 104 participants including trainers, experts, MD’s staff in 4 events organized in Biratnagar, Dhulikhel, Nepalgunj and Pokhara but 60 participants from provincial & HF level were certified as trainers on Basic health logistics management in FY 2074 (2018) and 61 trainers in FY 2075 (2019).
TABLE 7: TOT ON BASIC HEALTH LOGISTIC MANAGEMENT AND PUBLIC PROCUREMENT TRAINING CONDUCTED IN FY 2075 AND 2076 (2018 AND 2019) S. N VENUE PARTICIPANTS FROM # PARTICIPANTS 1 Nepalgunj Province 5 & Sudurpachim 23 2 Pokhara Province 5 & Bagmati 25 3 Biratnagar Province 1 & 2 12 Total in FY 2075 (2018) 60 4 Hetauda Province 1, 2 & Bagmati 16 5 Dhangadhi Sudurpachim 25 6 Biratnagar Province 1, 2 & Bagmati 20 Total in FY 2076 (2019) 61 Grand total in FY 2075 & FY 2076 (2018 & 2019) 121
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II. Training on Existing Package in 2075 A four-day ToT on Basic Logistic Management was conducted during 13 – 16 Ashad 2075 (27 - 30 June 2018) at Biratnagar with the purpose of facilitating the training to health workers at local level. Altogether, 40 participants (including 25 core trainees) from province one and two were attended the training. Basic Health Logistics trainer’s handbook was used to deliver all sessions which is designed by Logistics Management Division (LMD), Department of Health Services (DoHS). The training focused on logistics management system, storing medicine and supplies, physical inventory management, recording and reporting, authorized stock level (ASL), emergency order point (EOP), dispose and handover etc.
At the end of the training, reflection of the training has been obtained from the participants. There are few structural changes suggested in the new federal context. Similarly, experts and participants were agreed to include sessions like forecasting and procurement in humanitarian situation and proposed to revise the training module prior to the endorsement. After the training, LMD has formed a technical working group to incorporate all suggestions and compliments.
III. Training Package Revision in FY 2075 A three-day workshop on training package revision of Basic Health Logistics and Public Procurement System Training was successfully completed in Dhulikhel during Shrawan 4 – 6, 2075 (July 20-22, 2018). Feedbacks obtained in the workshop from the experts and support agencies on Participants Handbook and Trainers 'Guide for Basic Health Logistics and Public Procurement System were incorporated in the revised package and indorsed by Management Division and Department of Health Services.
A total of 19 experts participated in the workshop including Chief Procurement Section- Under Secretary Mr. Babu Ram Lamichhane, LMD, Chief Finance Controller Mr. Madhu Pokharel DoHS, Account Officer Mr. Tanka Prasad Paudyal LMD and legal Officer Mr. Shree Krishna Poudel from DoHS and representatives from NHSSP, GiZ, UNFPA, ADRA Nepal.
IV. Training of Trainers on Revised Package in FY 2075 Two events of training of trainers on Basic Health Logistics and Public Procurement System were organized in Nepalgunj and Pokhara. These ToT were conducted with the leadership of Management Division, Logistic Section with Technical Assistance and Financial Support from ADRA Nepal. The training sought to prepare trainers on Basic Health Logistics and Public Procurement Training for procurement of health commodities. Altogether 45 participants from Palikas, MoSD, UNFPA, JSI, PSM and ADRA attended the training successfully.
Basic Health Logistics trainer’s handbook was used to deliver all sessions which is designed by Logistics Management Division (LMD), Department of Health Services (DoHS). The training focused on logistics management system, storing medicine and supplies, physical inventory management, recording and reporting, authorized stock level (ASL), emergency order point (EOP), dispose and handover etc.
V. Training of Trainers on Revised Package in FY 2076 Three events of training of trainers on Basic Health Logistics and Public Procurement System were organized in Hetauda, Dhangadhi & Biratnagar. These ToT were conducted with the leadership of Management Division, Logistic Section with Technical Assistance and Financial
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Support from ADRA Nepal. The major objective of the TOT was to train participants on basic logistic management and enable them to conduct and facilitate trainings in their respective district/Municipalities post the training. A total 61 participants were attended from Palikas, MoSD of provinces 1,2, Bagmati & Sudurpachim, UNFPA and ADRA.
Additionally, in collaboration with Management Division/Logistic Management Section and GIZ/ Support to the Health Sector Programme (S2HSP) conducted 5 days ToT to Chief Administrative Officer, finance chief, health coordinator, sub coordinator and Social Development Officer of five municipalities (Nepalgunj SMC, Godawari Municipality, Nilkantha Municipality, Madhyapur Thimi Municipality and Bidur Municipality), altogether 24 participants were trained.
VI. Capacity strengthening on basic logistics to HSPs at Municipalities and health facilities in FY 2075 A 4-day training on Basic Health Logistics and Public Procurement System was organized in all targeted 14 districts. A letter from Management Division (MD) was circulated to the respective districts to invite the participants from Palika; such as Health Coordinators, Sub- health Coordinators and Health Store Focal Point. The main goal of the training is to improve knowledge and skill of the participants prior to work by the participants at Palika level. The trained personnel from respective Local Government who are responsible for logistic management and procurement system of health commodities including medicines and ensure the availability of adequate supply of medicine and health commodities in health facilities to provide effective health care service at Local level. A total of 25 batches of trainings were conducted which trained 591 government staff on Basic Health Logistic and Procurement system at municipality level. (see table 8)
TABLE 8 MUNICIPALITY LEVEL 4 DAYS TRAINING IN 2018 SN DISTRICT/ MUNICIPALITY BATCHES PARTICIPANTS 1 Bajura 126 2 Baitadi 237 3 Achham 131 4 Bajhang 244 5 Arghakhachi 1 21 6 Kapilbastu 1 33 7 Pyuthan 129 8 Rupandehi 2 52 9 Rukum 124 10 Rolpa 129 11 Rautahat 255 12 Sarlahi 256 13 Sunsari 233 14 Udaypur 126 15 Godawari Municipality 1 13 16 Nepalgunj SMC 2 29 17 Bidur Municipality 1 19 18 Nilkantha Municipality 1 20 19 Madhyapur Thimi Municipality 1 14 Total 25 591
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VII. Capacity strengthening on basic logistics to HSPs at health facilities A 2-day training on Basic Health Logistics was organized for health facility level staff. Invitation letter was sent by DPHOs/Palika to their respective health facilities to invite two participants from each health facilities. A total of 14 batches of trainings in FY 2075 (2018) were conducted which trained 391 government staff on Basic Health Logistic system at Health Facility Level. Likewise, 245 HSPs from 10 batches of training were trained in FY 2076 (2019). The details of the accomplished activities are shown in the table 9.
TABLE 9 HEALTH FACILITY LEVEL 2 DAYS TRAINING CONDUCTED IN 2018 & 2019 SN DISTRICT BATCHES PARTICIPANTS 1 Sunsari 2 60 2 Rolpa 2 52 3 Pyuthan 3 80 4 Rautahat 3 84 5 Sarlahi 4 115 Total in FY 2075 (2018) 14 391 1 Sunsari 2 56 2 Udaypur 2 43 3 Sarlahi 2 43 4 Rautahat 2 54 5 Arghakhachi 2 49 Total in FY 2076 (2019) 10 245 Grand Total in 2018 & 2019 24 636
a. Printing and distribution of Training Package in 2018 In the financial support of UNFPA and coordination of Management Division, the developed Basic logistic and procurement training manual and trainer’s guide (training package) was printed in 2018. The printed training package was distributed to all program implemented districts and municipalities in coordination with provinces for conducting the further training in their respective HFs. Rest of the manuals were handed over to Management Division/ DoHS in 2019.
b. Technical Support to Logistic Management to update training manual of BHLPPP in 2019 • Basic Health Logistic and Public Procurement Process training manual and trainer’s guide was updated by ADRA Nepal in coordination with Management Division. During the update meeting, 11 experts were participated from MD/DoHS. • Produced two volumes of Interactive Digital Visual (HD quality video) Training Manual on LMIS (15 minutes of each documentary): one for overall procurement process and another for logistics management. • Supported in publication of basic LMIS report • Supportive supervision/monitoring visits were conducted to monitor the ToT of BHLPPP by Director from management division, director form health directorate of province no.3, Chief of Health division from MoSD-3 & other staff of MD, UNFPA & ADRA Nepal in 2018 & 2019.
c. Health Commodities Supply Chain - Planning skills and data driven decision-making The activity encompasses formulation of terms of reference in the form of meeting facilitation guidelines in the conduct of quarterly supply chain management working group (SCMWG), a
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health commodities supply chain governance forum constituted of all relevant stakeholders and development partners. The federal terms of reference for SCMWG was approved and circulated as reference document for adaptation at the province, and local level government in their formation and conduct of health commodities SCMWG meetings. So far, formal meeting was conducted at federal level on Nov 12, 2019; Pradesh 5 on Jan 10, 2020 and March 13, 2020; Sudurpaschim Pradesh on Dec 30, 2019 and April 24, 2020 and in Pradesh 2 on May 15, 2020. The Ministry of Social Development (MoSD), Province 5 on 2076/10/26 has approved a term of reference of SCMWG for Province Health Logistics Management Center (PHLMC).
In the meeting, key decisions were made to improve supply chain performance, facilitate use of eLMIS data for decision-making on pipeline, quantification, procurement and distribution and inventory management as well as good practice in storage. The Division in support of USAID has deployed contractual pharmacist in bringing about improvement in health commodities supply chain performance at central, provincial and a few health offices. As a result, there is ample improvement at functionally indicating clearly a need for review of organizational structure and creating opportunity for their integration.
SCMWG has also advocated for measures to ensure regulatory compliance for Oxytocin Injection storage condition at 2 to 8 degrees by suppliers and procurement entities (mainly at local level) and birthing centers at all levels of supply chain. conceptually, there is stakeholders (MoHP system, and partners mainly UNICEF – country, region and HQ consensus in integrating a few key life-saving commodities like ARV, ASV, Oxytocin, Mag Sulfate, and Insulin in the EPI system in the course of drawing National iSC Roadmap Design (First consultative meeting on developing road-map for iSC design at national level, 27-29 Dec 2019).
The meeting has always emphasized for generation of real-time LMIS data for evidence- based decision making, and monitoring key supply chain indicators like availability of stock according to plan, order fill rate, supply plan reviews aiming to eliminate stock-outs, near expiries or expiries, poor inventory management and processes that prevent effective supply chain operation.
In this direction, LMS, MD would like to draw attention of all stakeholders and partners for their necessary coordination and advocacy, and contribution for eLMIS implementation and monitoring of the impact at all levels of supply chain. At this stage, eLMIS is in use at all central and provincial warehouses, health offices and a few local level and health facility store in Karnali and Pradesh 5, CCMC / HEOC / MoHP, Office of DG / DoHS, and many COVID-19 treatment hospitals, and is in verge of scale-up nationally following MoHP decision on eLMIS scale up on May 14 2020 (MD letter ref no 1780 dated May 20 2020), and thus paving way for eLMIS official launch.
Until the real-time transaction and/or reporting system reaches at all types of health facilities, we would sincerely request all also for improving LMIS reporting rate as well as monitoring data quality and timeliness of reporting. Ultimately, timely availability of quality data matters in taking timely decision on intervention measures.
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d. Role and responsibilities of different level of supply chain for adequate capacity and performance Aiming to improve performance of health care delivery system overall - health workforce, organization, and delivery of patient-centered service, structural reforms were implemented In the Federal health system. Accordingly, roles and responsibilities have been redefined and implemented to bring about desired improvement in behaviors and competencies of health workers and organization, and finally to generate system capability, and sustain gains in the service delivery performance.
There is separate role and responsibilities for different level in consistence with the constitutional mandate and function of different level of federal health system - Logistic Management Section, DoHS, procurement and logistics management section of Province health directorate, PHLMC, Health Office, Local levels and the health facilities. The detail of all these roles and responsibilities is produced in the Logistics report.
A desk review on existing roles and responsibilities of supply chain organization and work force, and survey-based review of performance and capability is under way. Both these activities are expected to provide a comprehensive view of province supply chain system, current performance, processes, technologies, and human capacity, and serve as guiding document on priority activities based on key supply chain functional areas to improve supply chain performance at the province. The approach is to develop capability, measure performance, innovate intervention until gain of performance at acceptable level. Capability for system learning and improvement as long-standing practice, and emergence of new collective norms on the supply chain mandate are necessary conditions for uninterrupted availability of health commodities at all service delivery points, and therefore the patient-centered care directed towards universal health care.
3. LMIS TOOLS UPDATED Logistics Management Information System (LMIS) is key function of the Logistics Management Section. LMIS tools are using since from 1997 all districts and SDPs. It was revised LMIS tools time to time as required. In the Federal context, need to update the LMIS tools in 2075 with the supported by Save the Children Nepal. MD organized and one day workshop to update the tools with the participation of core teams represents from DoHS/Divisions/Centres/Sections, EDPs partner and Stakeholders with following objective, output and process. Objective: Update of LMIS tools according to procurement and supply commodities Output: Uniformity of reporting system Process: Meeting with program division/centres, Collection of feedback, finalization of commodities, finalization of tools, printing and distribution
TABLE 10: NUMBER OF ITEMS IN REVISED LMIS BY LEVEL REVISED UPDATED OLD TOOLS TOOLS IN 2072 TOOLS IN 2075 LMIS TOOLS FOR COMMODITY REMARKS COMMODITY COMMODITY ITEMS ITEMS ITEMS District Store 232 232 Before 2075 there was separate District Hospital 232 232 tools for institutional wise but 203 after updated new tools used PHC 193 193 integrated one form for all HP 132 132 SDPs NGO 5 5 5 No change in NGO tools
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4. NEW MAA.LE.PA FORMS AND FORMATS The tools are important for storage, distribution and recording/reporting as Ma.Le.Pa Form and LMIS for Medicines, Vaccines, Family Planning Commodities and others more. We should update the manual as changed the Ma.Le.Pa Form and other important area. Management Division will print the updated manual and will distribution and supply of manual as requirement basis. Government of Nepal (FCGO) has been circulated to replace all new Ma.Le.Pa. Forms and Formats as used in Organization. Management Division had organized a meeting for replace the new forms and formats which are used in inventory management with the participation of concern division/section and stakeholders and decided to replace all forms and formats in LMIS/ eLMIS as soon as possible.
5. CAPACITY DEVELOPMENT ON eLMIS IMPLEMENTATION (JOURNEY) eLMIS journey began on Ashwin 2074 with selection of the off-the-shelf software solution for the Electronic Logistics Management Information System (eLMIS). The eLMIS project initiation meeting was held on Kartik 2074.
I. Software Customization: Software customization preparation began with the first requirement gap analysis workshop in Kartik 2074 to validate the selected software application against the business requirements by end-users themselves.
II. Master Dataset Finalization: Master health facility, health commodity and equipment, manufacturer, supplier and donor datasets were gathered, compiled and finalized in consultation with MD using authorized data sources. The final datasets were presented to MoHP eHealth unit who praised the work for facilitating the interoperability of the different health information systems. The master data was signed off by MD in Magh 2074 and migrated onto the eLMIS after the data was reviewed for quality assurance.
III. eLMIS Familiarization Workshop: A pre user acceptance test workshop was organized to familiarize users to eLMIS on Magh 2074. During this workshop eLMIS was demonstrated to all stakeholders on the configuration and customization done based on their requirements agreed on Ashar 2074 and requirement gap analysis workshop held on Kartik 2074.
IV. eLMIS Training Curriculum Finalization: The eLMIS training of trainers’ and user training curricula were developed by curriculum development sub-committee under LMIS Taskforce for the online, offline and mobile modules in English and Nepali in consultation with MD and NHTC. The curriculum was finalized and approved by NHTC on Falgun 2074.
V. Training of Trainers: The training of 24 eLMIS master trainers were produced on Falgun 2074 as a cadre of government trainers from DoHS; LMD/Management Division; central, regional and district stores; the Province 6 Regional Health Training Centre, the National Health Training Centre (NHTC) and the National Health Education, Information and Communication Centre (NHEICC).
VI. User Acceptance Tests (UAT): System was validated on UAT held on Chaitra 2074 for system endorsement by LMD at which master trainers, and MoHP, regional and district health office and service delivery point representatives ran test scenarios at all levels of the supply chain.
VII. User Trainings: eLMIS user trainings were started on Chaitra 2074 after endorsement of
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solution on UAT. The training was conducted by master trainers from MD and Bileeta to equip participants to roll out the eLMIS online module.
VIII. Develop Support Mechanism and Helpdesk: A support structure for eLMIS users became operational from Chaitra 2074 before any site goes live on eLMIS. The establishment of a helpdesk, staffed by support engineers and support manager, located at the Management Division, provides user support through a toll-free helpline, trouble-shooting guidelines, support personnel and training. The helpdesk receives calls and emails from eLMIS users, which are logged and given support tickets. In addition, LMIS support officers were deployed at the larger sites including the Central Medical Store (Teku and Pathlaiya), RMS Butwal, RMS Nepalgunj, and Bardiya and Surkhet district stores. IX. eLMIS Standard operating procedures: The standard operating procedures for the functionality of the eLMIS was developed to address user difficulties. The SOPs was reviewed by Management Division.
X. Software updates: The eLMIS continues to get feedback for improving existing features and adding new requirements. eLMIS introduced software updates from Ashadh 2075 and has been continuously making improvements based on user feedbacks and suggestions since then to make the software more user-friendly.
XI. eLMIS monitoring and data utility for decision making: eLMIS performance dashboards were developed and updated weekly to monitor and show the use of the eLMIS at the live sites.
XII. eLMIS operational monitoring: In Ashoj 2075, senior personnel from the Management Division, USAID, GHSC-PSM, GIZ, and UNICEF visited four Banke and Bardiya eLMIS rollout sites and confirmed that eLMIS was operational at all visited sites. The team suggested the sites to utilize the information that the eLMIS generates by developing a culture of information- based decision making for inventory management. The team also recommended adequate government human resources are the key for the long-term success of the eLMIS.
XIII. eLMIS implementation assessment and adjustments based on lesson learnt: Management Division assessed eLMIS operational sites in Mangsir through support from GHSC- PSM project in Mangsir 2075. Assessments was conducted at representative eLMIS operational sites, this included all level of supply chain (i.e. CMS, PMS, district, LLGs and SDPs) and all types of eLMIS modules (i.e. online, offline and mobile modules of eLMIS). The recommendations of assessment were adopted into eLMIS as lesson learnt.
XIV. eLMIS review workshop: eLMIS workshop was organized by logistic management on Magh 3-4, 2076 (17-18 January 2020) in Dhulikhel, Kavre to share a lesson learn and experience by the users and figure out the best approach and way forward to eLMIS scale-up in remaining sites. Field level staffs, Provincial Staffs and decision level staffs from Ministry and DoHS were participated in the workshop. The purpose of this eLMIS evaluation workshop was also to assess the progress, acceptability and the effectiveness supply chain performance from the eLMIS user in the province, district, and local levels. In the workshop, the users from the district and palika expressed how eLMIS system helped them to improve inventory management and supply chain decisions making. The user recommended to scale up eLMIS as quickly as possible for the complete supply chain information. In addition, the users also expressed their concerned regarding the timely response of their eLMIS issues and suggested developing a calendar of
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Participants taking photographs after the workshop. operation to address the issue raised by the province, palika, and districts. Based on the eLMIS user feedback, Chuda Mani Bhandari, Chief HCWM/Logistic Management Information System shared the findings during field level assessment and monitoring visit and Bhogendra Raj Dotel, Director of Management Division concluded the eLMIS review workshop by saying eLMIS is a policy-level decision and Management Division will forward eLMIS scale-up plan to the Ministry with all the suggestions and feedback provided by the users during these two days of the workshop with positive recommendations for eLMIS scale-up.
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CHAPTER 5 TRENDS OF LOGISTIC INDICATOR
1. PROCUREMENT AND SUPPLY CHAIN MANAGEMENT OF ESSENTIAL DRUGS AND COMMODITIES IN FEDERAL CONTEXT The Constitution of Nepal promulgated in 2015 confers high level of functions to the local governments. The local level restructuring and unbundling of functions between different levels of government also reiterate the fact that health service delivery will be a key function of local governments. The functions of local governments relate to their role in basic health service delivery and in leading local development. Procurement and logistics management of drugs and medical items is a key task for ensuring basic health service.
Local government has responsibility to provide quality, easily access health service to every citizen which is directly associates with the procurement and logistics management practices. Public procurement act 2063 and public procurement regulation 2064 has shown roadmap to standardize procurement practices in three level of government.
Right quantities, quality, appropriate price, date of delivery, storage environment is the major variable that has to be address while doing procurement of drugs and medical items from concern authorities. Proper procurement helps to maintain required number of medical items and drugs and helps to reduce stock out, drug expiry and ultimately reduce total cost in health sector.
The objective of proper logistic management practice is to ensure continue supply of drugs and to prevent drugs wastage in health facilities. Inadequate supply of medical item and drugs in health facilities are leading cause in deteriorating quality health service. Thus, local level government needs to highly focus and should be serious on proper procurement and logistics management of drugs and medical items.
Before federalism of Nepal- Logistics Management Division (LMD) was the major unit to quality assurance, forecast, quantify, procure, store and distribute drugs and essential commodities. Basically, the system was, Logistics Management Division sends the procure drugs and commodities to Regional Medical Store and regional medical store distribute the drugs and commodities to District Public/ Health offices. Later, D/PHO distributes the drugs and commodities to service delivery units within the district. Moreover, procurement was done by all three levels LMD (70%), D/PHO (20%), and Regional Health Directorate (10%) respectively.
It is challenging and completely new job for local government to ensure smooth and effective procurement and logistics management practice. One of the major challenges in this regard is the lack of capacity among the elected representative and municipal health unit staff. Considering this gap, capacity development of municipality staff was deemed on procurement and logistics management practice and considering the fact, logistics management unit of Management Division
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has developed a local level standard guideline on procurement and supply chain management to capacitate the local government. The functional analysis assignment has defined the key functions of federal, provincial and local government for procurement and supply of key commodities thus Ministry of Health and Population and Department of Health Service has clarified the list of commodities to be procured and supplied by these three tires of government to ensure the effective health service delivery. Drugs, commodities and medical equipment are supplied to local government from central medical store and provincial medical store based on the pull and push system approach.
2. AVAILABILITY OF KEY COMMODITIES The concerned authorities aim to make year-round availability of health commodities in all health facilities. National stock out of health commodities has been steadily decreasing in last two fiscal years. The average availability of contraceptives and key MCH commodities has increased in HFs in comparison with previous fiscal years.
Though the demand and consumption of essential drugs has increased drastically after implementation of free basic health service policy up to hospital level, the stock out of the selected drugs has been reduced. The availability of health commodities is increased in health facilities is because of scale-up of Pull System, monitoring of LMIS and inventory management, health institution level logistics orientation, and other capacity building activities at various levels. There is a need to decrease the stock-outs % of essential drugs in the health facilities, for this there is need to strengthen the supply chain system from local level to health facilities and effective implementation of Pull system.
Stock situation of FP commodities
100%
90% 7.60% 8.55% 16.71% 22.27% 11.35% 80%
70%
60% 9.91%
18.76% 11.09% 50% 9.96% 19.68%
40%
30%
20% 12.93% 12.28% 8.45% 18.54% 21.71%
10%
0% Condom Depo Implant IUD Pills Cycle
2074/75 2075/76 2076/77 (half-yearly)
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Stock situation of MNH commodities
100%
24.96% 90% 5.69% 16.28% 18.20% 18.07% 10.10% 31.11% 80%
70% 59.96% 60% 12.21% 21.80% 25.48% 50% 24.74% 30.30% 15.80% 40%
30% 79.60% 20% 23.07% 14.73% 22.90% 25.24% 16.98% 8.19% 10%
0% Amoxycillin Chlorhexidine Gentamycin Magnesium ORS Oxytocin Zinc Sulphate Gel 4% Tube Injection Sulphate
2074/75 2075/76 2076/77 (half-yearly)
The chart gives the stockout percentage of MNH commodities in HFs in FY 2074/75 to 2076/77 health facility wise. There is distinct stockout situation seen among all key MNH commodities where dramatic difference is seen in oxytocin followed by Gentamycin, Chlorohexidine and Zinc Sulphate.
3. REPORTING STATUS 3.1 LMIS REPORTING STATUS The LMIS has helped to generate accurate and reliable feedback reports, thereby contributing to improved logistics functions like budgeting, quantifying, forecasting, procurement, storage, transportation and distribution of MCH commodities and essential drugs to be procured by the federal, province and local governments. With closely monitoring LMIS information, it has played a key role in reducing stock-out rates and increasing year-round availability of key health commodities.
% of LMIS reporting status 100% 90%
90.50% 83.31% 80.56% 96.92% 80% 89.35% 95.65% 96.22% 87.46% 70% 60% 50% 70.55% 81.81% 40% 72.15% 76.89% 66.61% 60.25% 79.13% 72.02% 30% 20% 54.60% 55.25% 50.75% 56.43% 60.62% 10% 54.38% 56.48% 50.22% 0% National Province 1 Province 2 Bagmati Gandaki Province 5 Karnali Sudhur Province Province Province Paschim Province 2074/75 2075/76 2076/77 (half-yearly)
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LMIS is a credible information system in the MoHP and is being used in Health Sector Reform document defining procurement indicators and reporting on stock situations. LMIS, at Federal, Provincial and Local is used extensively for key logistics decision making such as forecasting, quantification, procurement and distribution of health commodities. Moreover, LMIS is being used at all levels for evidence-based logistics decision making.
Over the years, LMIS reporting trend is improving as compared to 2075/75 to 2076/77, thus National reporting status has also increased in over the years by 2076/77. After the federalism, all the functions monitoring and reporting responsibility was assigned to local government, and with the limited human resource and capacity of municipal health unit staff as well as frequent transfer of health facility and municipality human resource, due to this HF could not compile and send the reports in time.
Analyzing the Province wise reporting percentage, there has been sharp increase in Sudhurpaschim Province in over the years latest FY 2076/77 is 96.92 % reporting. Each province has shown a remarkable progress over the years with dramatic change in figures. It is the big achievement in the short period of time. MD/LMS take actions to all 77 districts to entry data on eLMIS with facilitation of training to staffs within one months supported by partner.
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CHAPTER 6 PLANNING, MONITORING AND EVALUATION
PLANNING: Logistic management Section (LMS) had adopted mainly 2 types of Planning System 1. Annual Work plan and Budgeting system 2. Five years Plan.
Along with these plans LMS reviews the list of health commodities annually to be finalized for upcoming period to plan the commodities supply and reporting of them.
MONITORING: Periodic movement by the team of LMS in the ground level provide the actual information of the field which will be compiled as a field report and been shared with the team. All these movements will be as per annual plan and activities, its goals and objectives, target vs achievement etc.
EVALUATION: Based on the report of field visit and quarterly LMS report differences analysis will be done based on plan and activities and progress report on target vs achievements as monthly, bimonthly, trimester, biannual and annual. These evaluations will support to plan/modify the further activities of LMS.
1. MAJOR ACTIVITIES CONDUCTED 1.1 MAJOR ACTIVITIES CARRIED OUT DURING FY 2074/75 • Construction of central medical warehouse in Pathalaiya • Procurement and distribution of Hospital Equipment, Materials • Procurement and distribution of Ambulance and Vehicles to the Hospitals and Regional Offices • Procurement and distribution of Desktop, Laptop to the Regional and District Health Offices • Quantification, forecasting, procurement and distribution of essential drugs and program commodities • Printing and distribution of LMIS tools • Pipeline monitoring of the essential drugs and program commodities • Maintenance and repair of vehicles, biomedical/cold chain equipment and materials • Publication of 2nd 3yrs Logistics Report • Capacity building on Basic Health Logistics/LMIS • eLMIS piloting on 57 sites
1.2 MAJOR ACTIVITIES CARRIED OUT DURING FY 2075/76 • Construction of Central Medical Warehouse in Teku • Procurement and distribution of Hospital Equipment, Materials, ambulance, vehicles, computers to the Provinces and Local levels • Quantification, forecasting, procurement and distribution of essential drugs, program commodities
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• Pipeline monitoring of the essential drugs and program commodities • Maintenance and repair of vehicles, biomedical/cold chain equipment and materials • Printing and distribution of new updated LMIS tools • Updated of training materials: Basic Health Logistics and Public Procurement System • Publication and distribution of facilitation handbook on procurement and e-procurement system • Publication and distribution of facilitation and workbook on Quantification • Established grievance handling and redressal mechanism by online through website • Rollout and capacity building on Basic Health Logistics/LMIS/eLMIS • Training of Trainers on Basic Health Logistics and Public Procurement to the Provinces and Local Level Staffs
1.3 MAJOR ACTIVITIES CARRIED OUT DURING 2076/77 (HALF YEAR) • Continue construction of Central Medical Warehouse and National Vaccine warehouse in Teku • Procurement and distribution of Hospital Equipment, Materials to the Provinces and Local levels • Quantification, forecasting, procurement and distribution of essential drugs, program commodities • Pipeline monitoring of the essential drugs and program commodities • Maintenance and repair of vehicles, biomedical/cold chain equipment and materials • Training of Trainers on Basic Health Logistics and Public Procurement to the Provinces and Local Level Staffs • Data entry training on eLMIS to the Province and local level staffs • Standard building design of provincial and local level warehouses • Development and distribution of LMIS tools writing instruction visual through website: www. dohslmd.gov.np • Emergency supplies of commodities for COVID-19 prevention, control and treatment • eLMIS Scale-up process to all level health institutions focused on COVID-19 Commodities. • eLMIS Scale-up plan approved by Ministry.
2. BUDGET CONTRIBUTION IN RED BOOK CONTRIBUTION IN AMOUNT NRS in Thousand FISCAL YEAR GON UNICEF USAID UNFPA POOL FUND TOTAL 2074/75 224400 45050 20000 500 202050 492000 2075/76 138600 5200 25300 0 145500 314600 2076/77 218385 10250 16800 0 0 245435 Source: LMD/MD Budgeting and Planning
500000 492000
400000 314600 300000 245435 224400 218385 202050
200000 138600 145500
100000 45050 10250 25300 20000 5200 16800 500 0 GoN UNICEFUSAID UNFPA Pool Fund Total
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B. CONTRIBUTION IN PERCENTAGE FISCAL YEAR GON UNICEF USAID UNFPA POOL FUND TOTAL 2074/75 45.90% 9% 4% 0.10% 41% 100% 2075/76 44% 1.65% 8% 0% 46% 100% 2076/77 89% 4.15% 6.85% 0% 0% 100%
Table shows that govrernment contributed about 45% budget in 2074/75 and 2075/76 fiscal year whearas all partners contributed about 55% budget in two fiscal year. Similarly, GoN contributed almost 90% budget and remaining 10% budget contributed by all partners in 2076/77 fiscal year in red book.
100% 100% 100% 100%
90% 89%
80%
70%
60%
50% 45.90% 46% 44% 41% 40%
30%
20% 9% 8% 6.85% 10% 6.85% 4 % 1.65% 0% % 0.10 GoN UNICEFUSAID UNFPA Pool Fund Total 2074/75 2075/76 2076/77
C. PHYSICAL VS FINANCIAL FISCAL YEAR PHYSICAL FINANCIAL 2074/75 80% 74% 2075/76 95% 75% 2076/77 (Half Year ) 70% 55%
100% 95%
90% 80% 80% 74% 75% 70% 70%
60% 55%
50%
40%
30%
20%
10%
0% 2074/75 2075/76 2076/77 (Half Year) Physical Financial
Comparing the physical vs financial achievements for the FY 2074/75, 2075/76 & half year of FY 2076/77 the physical achievement shows progress from 80 to 90 % similarly, the financial achievemnts shows progress from 74 to 75 % respectively.
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Table shows that almost AWPB activities were done in 2074/75 and 2075/76 fiscal year and more than 50% achieved in half year of 2076/77 fiscal year
3. EVM ACTIVITY EVM ACTIVITIES VS BUDGET 2074/75 2075/76 2076/77
ALLOCATED EXPENDITURE ALLOCATED EXPENDITURE ALLOCATED EXPENDITURE Workshop with Stakeholders 300,000 236,612 - - 253,000 303,000 Onsite coaching & PPM 800,000 769,395 - - 1,068,750 200,000 Workshop on Policy Guideline 300,000 - - - - EVM Implementation Plan (Base - - 273,000 - line survey)
Technical Assistant on CCEOP & - - 2,266,750 750,000 Orientation
Capacity building & Review & - - 4,919,200 2,750,000 Planning Total 1,400,000 1,006,007 - - 8,780,700 4,003,000
5000000
4500000
4000000
3500000
3000000
2500000
2000000
1500000
1000000
500000
0 Workshop with Onsite coaching Workshop on EVM Implementation Technical Assistant Capacity building Stakeholders & PPM Policy Guideline Plan (Base line survey) on CCEOP & Review & Planning & Orientation
2074/75 Allocated 2074/75 Expenditure 2075/76 Allocated 2075/76 Expenditure 2076/77 Allocated 2076/77 Expenditure
This program was supported from UNICEF to accomplish the logistic activities through logistic management section.
FINANCIAL IRREGULARITIES NRS in Thousand FISCAL YEAR TOTAL IRREGULARITY CLEARED BALANCE 2074/75 (LMD) 324049 169321 225723 2075/76 (LMD) 225723 131773 77851 2076/77 (Half Year) MD 77851 766 77085 Source: DoHS Finance Section
Table shows that, reduced financial irregularities of MD gradually from Fiscal Year 2074/75 to 2076/77. The financial irregularities seem high in FY 74.77 in comparison to 75/76. In FY 76/77 as well seems very low clearance and high balance. But the report is up to second quarter of this FY so large amount of expended costs are in the clearance process. So, we hope we will have better performance in terms of financial clearance in this fiscal year.
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Monitoring and Supervision: It extends technical support and onsite coaching on procurement, storage, inventory, recording reporting, LMIS to Province, District and Local level for improvement on procurement and supply chain management in Health Sector.
4. PHLMC PROGRESS MAJOR LOGISTICS ACTIVITIES DONE BY PHLMC
PROVINCE DISTRIBUTION S.NO PROCUREMENT DONE TRAINING WAREHOUSE CHALLENGES NAME/NO ACTIVITY
1. Province # 1 Essential & ayurvedic drugs, Essential Basic Health logistics Well equipped with Inadequate rooms for hospital equipments, cold medicines management & appropriate inventory employee as well as chain equipments, PPE & lab Programmed public procurement management via eLMIS. storage. equipments for COVID 19 for items & surgical training to Health Lack of manpower Corona epidemic. items. Regular Coordinators. with the reference to Vaccines. eLMIS data entry the GoN sanctioned training. positions. No proper guidelines for new assemblies.
2. Province # 2 Essential drugs, ayurvedic Vaccine & Quantification Provincial rented Scarce HR. drugs, hospital equipments, medicines for & forecasting of warehouse is functional No office vehicle for cold chain equipments, PPE & MR camping, essential medicine with limited storage transportation. lab equipments for COVID 19. regular supplies workshop to district & capacity. Procurement authority of medicines hospital managers. District warehouses is not clear at all levels. and vaccines eLMIS training to need support for Lack of coordination as per routine district & hospital strengthening. in between district & supplies. storekeepers Land purchase for Palikas. provincial warehouse is Unable to do timely in process. reporting due to lack of trained staffs. Delayed in budget release from MoSD.
3. Bagmati Double cab pickup, 4WD SUV, Vaccine and Provincial level Lack of sufficient Unreliable data from Province 32-seater minibus, essential medicine for quantification and storage space. districts and LLG. and ayurvedic medicine, MR camping’s, forecasting workshop. District level store needs Necessity of SOP. hospital equipment, LLIN, regular supplies further support. Lack of Lack of skilled HMIS tools and COVID-19 of essential sufficient manpower. manpower. related equipments. drugs and other commodities. COVID-19 management equipments.
4. Gandaki Haemodialysis machine, Regular eLMIS training to All districts warehouses Difficult to get land Province essential and ayurvedic drugs. essential drugs, storekeeper. are strengthened. for office building & Hospital equipments. vaccine, medical Quantification & Hospital warehouse yet warehouse construction. equipments & forecasting workshop to be supported. Difficult to manage commodities to district & hospital Insufficient space at damaged equipment managers. province warehouse. and furniture. No clear guidelines for all level. Delayed budget release.
5. Province # 5 Essential drugs, ayurvedic Essential & Basic Health Logistic Well-equipped but not Lack of knowledge drugs, hospital equipments, ayurvedic Management and sufficient space. on forecasting and cold chain equipments, PPE & medicine, public procurement Well maintained quantification. lab equipments for epidemic distribution of training, Basic Health warehouses at districts. Difficult to estimate COVID 19. medical & lab Logistic Management Need to strengthen actual supply. equipments. and public capacity at local level Lack of monitoring and COVID19 procurement training, by monitoring and supervision. related PPE and EVM training, Basic coaching. Warehouse at Rukum regular supplies. logistic and public is not satisfactory and procurement & same with LLG. Onsite coaching and Duplication in mentoring for smooth procurement. e-LMIS reporting.
6. Karnali Procurement of essential Distribution Provincial level Low storage capacity, Problem being faced in Province (in process) and ayurvedic of regular quantification and all district’s warehouses supply chain. medicines, HMIS tools, COVID medicines & forecasting workshop. are functional further -19 related equipment and commodities support needed. Lack of medicine and buffer stock vaccine and skilled manpower. medicines. medicine for MR camping, medical equipments and equipment for COVID-19 management.
7. Sudurpaschim Ayurvedic medicine, portable Essential drugs LMIS data entry. Does not have own Difficulty in forecasting Province lab & oxygen concentrator, & program ToT for logistic building. commodity as per real IMNCI drugs, isolation beds, commodities, management & Difficult to follow need. COVID-19 health commodities. vaccines. procurement up to scientific logistic Lack of availability local level. management of store space & technologies. manpower. Lack of updates on LMIS & store management.
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5. COVID-19 LOGISTICS MANAGEMENT ACTIVITIES Supply Chain Management on Disaster and Health Emergency Management is one of the key actions of the Logistics Management Section. Nepal has been faced many of disaster and health problems such as Earthquake, Flood, Landslide, Hot & Cold and epidemic/outbreak of diseases as Bird flu/Seasonal flu, Measles, Cholera, snake bite, animal bite etc.
Now, most of the countries are facing health problem of fast spreading and fatal pandemic Corona Virus Disease (COVID-19). Nepal is not absence of this disease (COVID -19). Nepal is aware and prepared all health institutions in staring time on January 2020. All provinces are prepared quarantine places as well as isolation wards in major hospitals and establishment of labs and procurement and supply chain management of essential lab equipments, reagents, kits, protective equipments, IR thermometer, disinfectants, sanitizers as demands and required side by side MD/ LMS leads to connect eLMIS software to all Provinces (PHLMC), COVID Hospitals/Clinics and Health Offices for real time information of health materials and equipments for the prevention, treatment and control of COVID-19 for the regulation of demand and supply. The system focused mainly on received, distributed and stock on hand of commodities on the site.
Major Activities: • Procurement of equipments/ materials (COVID -19 Items): Thermal scanner, PPE, Gown, Face Shield, Gaggles, N95 Mask, Face Mask, Sanitizers, IR Thermometer, PCR machines, PCR Kits, RDT Kits RNA extraction Kits VTM etc • Received COVID-19 items from Donor Partners and others • Storage of COVID-19 items • Distribution and transportation of COVID items to all PHLMC and COVID Hospitals as per requirement basis, districts and in some affected palikas as well as laboratories. • Recording and reporting of COVID items as daily, weekly, monthly to concern authorities. • As a new learning, at the district & palika level supply was possible/easy due to initiation of social leader, political leaders including Hon. Parliament members ad LLG chiefs for the transportation of materials up to the sites but, needs one door supply. Detail of Received and Supplied of COVID-19 items is in Annex …
Lesson learned, Issues and Recommendations • Guidelines for direct procurement is must to overcome such emergency • Health emergency logistics with assurance of recording and reporting is compulsory • Clear role of federal, province and local government should be in place with action plan. • Health emergency logistics management of Federal Hospital vs logistic Management Section/ DoHS to be defined prior to any emergency/disaster • One door system to be followed from government & partners at all level. • In any disaster or emergency information system to be followed one door from HEOC.
Great lesson learned during this period to be addressed as per recommended job & responsibility.
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6. ISSUES IN LOGISTICS MANAGEMENT • Procurement: Quantification, Cost estimation, Specifications, bidding documents, procurement methods of the health commodities/equipment’s and timely procurement. • Storage/Warehousing: Central medical and vaccine store and modern warehouse design and construction-inadequate in all level cold chain as a major issue during campaign. • Distribution/Transportation: Distribution and transportation of drugs, vaccines, health commodities, tools and equipments throughout country-push n pull system both are using but not information based as well as maintenance is an issue. • LMIS/eLMIS: Tools and electronic systems not being utilized by SDPs. • HRD/Training: HR and training on Procurement and SCM-trained but not in place or low confidence. • Budget: Insufficient budget for procurement of drugs, vaccines, health commodities and equipments • Disposal/Auctioning: Expired medicines disposal and guidelines not in place. • Quality: Quality is always has been an issue. • M&E: Standard tools for M&E for SCM at least for 5 yrs.-frequent changes made difficult.
ISSUES/CHALLENGES AND RECOMMENDATIONS (LMS) S. NO LMS SUBTITLE ISSUES/CHALLENGES RECOMMENDATIONS RESPONSIBILITY 1 Procurement Quantification, Cost Coordination with DoHS/MD/LMS estimation, Integrated Divisions, centres, plan & planning follow CAPP. 2 Storage/ Central Vaccine and Design and construction DoHS/MD Warehousing Medical Warehouse at federal and provincial Province level & local level LLGs 3 Distribution/ Distribution and Timely distribution DoHS/MD/Venders Transportation transportation of and transportation Province vaccines, drugs and on demand through health commodities, PPP model and equipment’s, tools & refrigerator Vans. Timely Issue of maintenance. maintenance. Maintenance plan & implement efficiently. 4 LMIS/eLMIS Tools and electronic Revise tools and Scale- MD/Partner system up the systems Fix for at Province, Palika least 4- 5 years 5 HRD/Training Package design, BHL Package design, To and MD/Partner, training and Trainers onsite coaching Province on SCM 6 Disposal/Auctioning Guidelines for disposal Need to incorporate in MD/Partner, of expired medicines auctioning guidelines as Province well as make separate LLGs. guidelines & followed. 7 Budget Insufficient annual Need to increase budget MoHP/DoHS budget for procurement for PSCM Province of health commodities LLGs. and equipments 8 Quality Quality is always has To be followed in every MoHP/DoHS/LMS been an issue. steps. Province Quality assurance mechanism has to be strengthened. 9 M&E Tools for M&E Need to develop a M&E MD/Partner tools and responsibilities for SCM 10 Mobilization & Mobilization of Medicine Mobilize in needful place At all level Expiry of Medicine & reducing Expiry
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7. NEPAL HEALTH SECTOR STRATEGY 2015-2020, OUTPUT AND KEY INTERVENTION FOR PROCUREMENT AND SUPPLY CHAIN MANAGEMENT The output envisions reforming procurement and logistics systems responsible for forecasting, tendering, contracting, and supply chain processes. Establishment of a procurement center staffed with procurement experts will be initiated, including further capacity enhancement in supply chain management and implementation of innovative approaches to improve supply chain management.
KEY ACHIEVEMENTS OUTPUTS KEY INTERVENTIONS 2074/75 AND 2075/76 1. Improved 1. Build capacities in procurement and quality 1. Published the Standard Operating procurement assurance at central and decentralized levels Procedural Handbook for Health- system related Procurement. 2. Implement Consolidated Annual Procurement Plan. 2. Conducted procurement training in 3. Widen the scope of Multi-year contracts in health provincial level. products and services. 3. Maintained the specification bank 4. Pilot central bidding and local ordering approach centrally and update it periodically. and scale-up as appropriate
5. Lay foundations for the establishment of procurement center 2. Improved supply 1. Develop capacity in operational planning and 1. Capacity development activities chain management logistics management systems in order to develop conducted for store and a cost effective and timely distribution system. supply chain management for seven provincial health logistic 2. Expand warehouse capacities, including upgrading management center (PHLMC). of storage facilities at regional and district levels. 2. Support provided with the 3. Explore innovative approaches (e.g. PPP) and coordination of partners for the technologies to improve supply chain management infrastructure of warehouses at between the district store and health facilities for regional, district and local level. supply management at the district level. 3. Extension of the eLMIS system in 4. Improve management to prevent expiry of drugs the SDPs and warehouse which and handling of expired drugs and non-functional is good in notifying the expiry of equipment drugs priory is going on.
5. Improve supply chain of Ayurvedic drugs/medicines
8. DLI INDICATORS RELATED TO PSCM DLI 1: Systems and organizational reforms at MoH carried out, based on Procurement Reform Action Plan. DLI 2: Production and submission of Annual Report on grievances and received and addressed through a web-based grievance mechanism DLI 3: Percentage of procurements done by LMD using standard specifications DLI 4: Percentage of districts stores reporting based on LMIS DLI indicators are maintained and in the process of improvements.
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CHAPTER 7 CASE STORY
A. IMPROVING INVENTORY MANAGEMENT AND WAREHOUSE BEST PRACTICES Proper warehouse storage and practices are key for maintaining quality health commodities and a functional supply chain system and is a priority area for GHSC-PSM in Nepal. Effective and efficient management of racking and shelving simplifies the warehouse operation. A competent, motivated, skill-mixed workforce is required to ensure good storage practices, operations and that health commodities reach where they are needed most. Achham District store after reorganization and inventory support by GHSC-PSM. Photo credit: GHSC-PSM
GHSC-PSM collaborated with the MD, Provincial Health Directorate, and Health Office mobilized FSO, LMIS Officers and pharmacist in all the districts of Sudurpaschim, Gandaki and province-2 to organize all medical DHO stores to ensure effective inventory management. This included arranging appropriate stores based on warehouse best practices, conducting a physical count, removing expired commodities, updating inventory records, building overall capacity of staff with an emphasis on inventory management, supportive supervision, teamwork, dedication, hard work and cooperation with the local government institutions can improve the storage condition and practices in sustainable approach.
During a site visit the following tasks are performed with supportive supervision as part of inventory management and warehouse best practices: • Cleaning of the storage area • Organizing of stores based on FEFO/FIFO and separation of none usable health commodities from usable products; • Performing physical count of all health commodities in a store; • Verifying and reconciling counted stock with stock registers; • Signing and stamping reconciled quantities by relevant authority; • Updating all inventory records and tools (registers and eLMIS) • On-the job-training on inventory management and any relevant supply chain management function.
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“we know the store should be cleaned and arranged but today we understood the real meaning of good storage practice and why it is important for the supply chain management. This is a good learning experience for us and thank you to GHSC-PSM, Provincial Heath Directorate and Management Division” – Karishma Bhatt, Storekeeper, Health Office, Dadeldhura
District Health Store Before District Health Store After Reorganization Reorganization All the district stores of all three provinces were successfully reorganized with an updated stock balance in the system as well as segregation and record in the separate register of expired and damaged commodities. The event was highly appreciated by the district and provincial health directorates.
B. PROCUREMENT AND SUPPLY CHAIN MANAGEMENT (PSCM) OF NEPALGUNJ SUB METROPOLITAN CITY What we did: • Smooth supply of drugs and health commodities is the responsibility of local government. Nepalgunj SMC realizing this fact started scientific process of PSCM such as developing procurement plan, drug forecasting, quantification and timely procurement and supply of drugs to the health facilities. • Next, storing of drugs and supplies at right place was the major challenge addressed. SMC initiated its own medical store for smooth functioning. Medical store of Nepalgunj Sub Metropolitan City With this startup, the process such as First Expiry First Out (FEFO), physical count was adopted to minimize expiry, wastage and stockout of these supplies. • Having procurement plan, own medical store and following scientific approach of procurement system, drugs expiry and stockout problem is minimized as a result zero stockout of essential drugs.
Approaches that worked: • Rapid assessment was conducted in each health facilities to identify the major gaps and challenges, where, observation of inventory and storeroom, structured questionnaire and discussion was adopted.
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• Participated in 5 days Training of Trainers (ToT) on Basic health logistics and public procurement system. • Health facilities in charge and storekeeper were trained on two days’ package of basic health logistics management. • Study visit to observe medical store of Bailpata Hospital, Accham. • coordination with health office, Banke and province medical store for timely supply of vaccine.
What next: • Digitalizing proper logistic management with connection to health facilities and municipal medical store. • Monitoring mechanism for strengthening health facilities store management and timely reporting with assurance of drug quality.
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CHAPTER 8 MONITORING/SUPERVISION/WORKSHOP/SEMINAR
A. JOINT MONITORING VISIT AND ASSESSMENT OF ELMIS PROGRAM EFFECTIVENESS IN SURKHET AND BARDIYA DISTRICTS. It was planned to have a workshop in Bardiya with greater participation of province, local level including partners but because of important events of Ministry it was post ponded and planned to visit at the sites and quick assessment of LMIS system in field with the leadership of logistic management section and partners.
Propose of the visit: Chief Logistic Management Section, Management Division along with Acting HSS Team Manager, GHSC-PSM visited eLMIS piloted districts Surkhet and Bardiya for the assessment of field reality, its effectiveness and gaps for the improvement on January 12- 13, 2020. The visit planned to interact with the eLMIS users working at field level and suggest to the central team about strength and gap of the system while deciding for the scale up approval. System observation by LMS Chief at District Health Store Surkhet
Findings of the visit: Observation HO Surkhet Briefing of user: • eLMIS system was functioning well • Reminds to take action for near expiry and stock out highlighted in the dashboard • System is supporting for procurement actions by analyzing the stocks
“In overall eLMIS system has become one of the major tools to guide us in supply chain management and decision making” -Chetan Nidhi Wagle, Chief, Health Office Surkhet
Observation Mobile Site Uttarganga Health Post Surkhet Briefing of user: • The system was functioning well • Focal person eLMIS said the requisition, stock update and overall management has become easy and accurate because of the real time data. • The focal person was just transferred at that site and coached by Pharmacy Officer to use
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mobile based eLMIS system. • Only 2 hours onsite coaching was enough to the new staffs to orient about mobile based eLMIS system. • The focal person operated and showed all the system to the team perfectly
eLMIS is helping a lot, its very good tool and it’s a kind of lifeline in supply chain sector “Raju Basnet HC Barahatal, RM Briefing of mobile application by user to LMS Chief at Uttarganga Health Post, Surkhet Observation at Rajapur Municipality, Badaiyatal Rural Municipality and Jamuni Health Post, Bardiya Briefing of user: • eLMIS system has visibility and real time data which is supporting to municipality for the procurement process, forecasting and quantification said Health Coordinator. • Municipality is managing stock out, near expiry on time because of alert in the dashboard. • Store was well managed now because of the system update and timely information • eLMIS supported for quantification and forecasting based on stock analysis with real Discussion with Mayor and team at Rajapur Municipality, Bardiya with Team Lead Chuda Mani Bhandari time data. • eLMIS supported to manage the distribution and prevented misdistribution because of stock status visibility • There were not any system related issues in Rajapur, Badaiyatal and Jamuni Health Post
“eLMIS supported us for good governance in our procurement process and financial management” -Mayor, Badaiyatal Rural Municipality
Overall Feedback received from eLMIS users in the field: • System support to address the Supply Chain Issues on time • Inventory Management has improved where the system is being well utilized • Real data available to support for the decision making related to supply chain and inventory management • Help Desk L1, L2 was very effective and useful to the users
Recommendations • Recommended to provide authority to edit from province level authorized person • Need to provide continuous capacity building and supportive supervision • Scale up eLMIS system to other health facilities • The trained staffs from LLGS are transferred so need some training package to enhance skill of eLMIS sites and requested to support from GHSC-PSM • eLMIS operation needs high bandwidth internet capacity so hard to operate smoothly in remote so suggested to improve system to run in available internet capacity at field level.
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B. JOINT VISIT OF MANAGEMENT DIVISION AND GHSC-PSM IN SRI LANKA, 30 JAN-4FEB, 2020
Propose of the visit: Management Division officials Mr. Bhogendra Dotel, Director and Mr. Gyan Bahadur BC, GHSC-PSM Ananta Bhadra Lamichhane jointly as a team to have a joint discussion with eLMIS vendor on technical and managerial issues of eLMIS from 29th January 2020 to 3rd February 2020. These discussions were expected to strengthen collaboration Field visit findings sharing workshop at Dhulikhel, Kabhre between eLMIS vendor Bileeta, and Logistic Management of DoHS through in-person meetings in anticipation of the eLMIS scale- up in Nepal. After this visit, the parties will reach a consensus on eLMIS process standardization expectations and identify, understand and narrow down the difficulties of each side and mutually establish a common beneficial way forward for eLMIS service management to prepare for further scale-up implementation and operationalization.
1. Support eLMIS Service Quality Management. Technical leads from both parties shall come to a common understanding of eLMIS support service management, change management, and quality management.
2. Detailed discussions on technical, managerial, implementation and operationalization issues of eLMIS Team on Bileeta Office, Sri Lanka modules. Tasks include: a. Modular discussion of the Online, Offline and Mobile modules for technical issues, synchronization and data integrity b. System performance assurance to host at least 2,000 users and c. Meeting with technical teams to streamline the rollout issues for all parties, Bileeta, GHSC- PSM and Management Division. d. Process standardization discussions, particularly focusing on estimation methods, root cause analysis, impact analysis, corrective action plan and preventive action plan.
3. Detailed discussion on eLMIS sustainability aspects. Detailed discussion with Bileeta management on eLMIS server hosting in Nepal, local partner pool creation, compliance with local governance rules of Nepal (Procurement Act, Cyber Law and Information Act of Nepal), and data warehousing.
Following were expected outcomes from the visit: • Service quality management structure agreed • eLMIS sustainability expectations and policies of Nepal are shared with Bileeta • eLMIS technical and operationalization issues shared and way ahead explored
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Achievements a. Source code of eLMIS Bileeta has agreed to provide source code of eLMIS to Ministry of Health and Population (MoHP) of Nepal Government with assurance of Nepal Government that eLMIS source code would be utilized only for the propose of eLMIS in Nepal by MoHP.
b. eLMIS hosting to shift to Nepal eLMIS hosting would be shifted to Nepal immediately.
c. eLMIS Data Ownership to remain on GON and Bileeta’s access on eLMIS data As provisioned on contract of eLMIS, Bileeta assured MD that all data gathered in eLMIS are owned by Nepal Government itself and it hasn’t been used anywhere else. Bileeta also assured that it will never be used without MoHP consent.
d. Local Support Partner Pool Creation and Support Service Procurement by GON Bileeta will train additional local IT companies to develop as eLMIS local support pool within 2020.MoHP will procure all eLMIS support services through local partners complying with Public Procurement Act of Nepal and the support service provider would subscribe or procure essential services from Bileeta.
e. eLMIS License Ceiling Bileeta has offered 20% reduction ($212,600) on existing licensing ceiling ($1,063,000). MD is clear on its stand that GoN would not bear any licensing liability for eLMIS.
f. eLMIS Software Issues and Concerns A detailed discussion was held on technical issues and concerns of eLMIS software including load test for 6000+ users. Bileeta committed to evaluate the issues and concerns that has been raised and would take necessary measures to streamline and assure that software services are received as per the agreed Service Level Agreement (SLA) and agreed Standard Operating Procedure (SOP).
g. Joint Annual Review Meetings The teams agreed to hold joint annual review meetings each year in participation of Logistic Management of DoHS, to review the software service performance of a year and to plan way- ahead for next year.
h. User License Management Bileeta would issue user license certificates for all procured licenses that would certify to Management Division that all procured licenses are perpetual and can be used for its lifetime.
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CHAPTER 9 PARTNER CONTRIBUTION FOR LOGISTICS MANAGEMENT
A. GHSC-PSM The purpose of the United States Agency for International Development (USAID) Global Health Supply Chain Program - Procurement and Supply Management (GHSC-PSM) project is to ensure the uninterrupted supply of health commodities to patients. In Nepal, the project contributes to achieving USAID/Nepal’s Country Development and Cooperation Strategy, Development Objective 3: Increased human capital and Intermediate Result: A healthier and well-nourished population by ensuring the availability of health commodities at the last mile. The project primarily works with the Management Division (MD) providing technical assistance (TA) across various foundational supply chain activities integrated across Task Orders 3 and 4.
GHSC-PSM has been working on improving supply chain functional areas such as inventory management, forecasting and supply planning, supported procurement of family planning products for social marketing, capacity building and strategies to improve supply chain performance, with a particular focus on the scale-up of eLMIS. During the implementation, GHSC-PSM worked closely with stakeholders such as MD, provincial health directorates (PHDs), district public health offices (DPHOs), local level governments (LLGs), Red Book funded supply chain pharmacists (supported by USAID at various levels of supply chain) and the USAID funded project System Strengthening for Better Health.
The project conducted a performance assessment of the Electronic Logistics Management Information System (eLMIS) operating sites in December 2018 and based on the findings of the site assessments, GHSC-PSM made enhancements to improve the system and processes, ensuring effective system utilization and supply chain best practices. The project continues to provide support through the help desk addressing and resolving issues reported by the eLMIS users. The eLMIS scale-up plan, though presented and shared with the Ministry of Health and Population (MoHP) and external development partners (EDPs), it is approved by the ministry level decision for a broader roll out to cover all provinces, districts, LLGs and SDP level gradually.
To institutionalize capacity for evidence-based and coordinated forecasting and supply planning of health commodities at all levels of the supply chain in the federal structure, GHSC-PSM developed a forecasting and supply plan guidebook and workbook endorsed by Department of Health Services (DoHS). GHSC-PSM has been providing quantification support to center and provinces to build the capacity of LLGs health staff of five provinces, as well as conducting pipeline review meetings as well.
Warehouse and inventory management activities included, delivering new storage racks and safety equipment such as trolley, pallets, fire extinguishers to five PMSs. GHSC-PSM also worked closely with Save the Children (SC) and USAID Nepal Reconstruction Engineering Services (NRES)
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Project implemented by CDM Smith on designing the new construct warehouse in CMS Pathlaiya, to rebuild the warehouse floor to improve its’ strength to accommodate modern racking and movement of folk lift or stacker and new construction at different provinces.
The project supports the MD in managing expired commodities by collecting the list of expired and damaged commodities from PMSs and district stores through GHSC-PSM field support officers (FSOs). GHSC-PSM has been working closely with Contraceptive Retail Services (CRS) to facilitate the importation of family planning commodities for social marketing. GHSC-PSM is proud to confirm that all scheduled shipments for FY 18&19 were procured and delivered on time.
B. NHSSP NHSSP as embedded team in procurement, the majority of the activities were in continuity with the NHSS (2016-2021). It includes advisory, technical and policy implementation support for standardization of procurement with capacity enhancement by transferring of knowledge to the officials engaged in procurement. The specific contributions, but not limited to, acts of NHSSP are as follows:
• Institutionalization of the procurement planning assurance mechanism in health sector through Consolidated Annual Procurement Plan (CAPP). A new initiation for the online CAPP (e-CAPP) preparation is also designed and piloted. • Establishment of CAPP Monitoring Committee at DoHS under the chairmanship of the Director General. A TOR of CAPP Monitoring Committee prepared and endorsed by the Secretary of MoHP. • Preparation of Procurement Improvement Plan (PIP, 2017-2022) which is prepared and endorsed by MoHP in FY 2017/18. CAPP Monitoring Committee of DoHS are continuously monitoring the progress of the implementation of PIP. • In FY 2018/19, a new concept has been agreed in 2018 NAR, to transform PIP into Nepal Health Sector Public Procurement Strategic Framework (PPSF) as an umbrella strategic policy document on procurement and supply chain management by including all spheres of governments. So, the PIP is reviewed to cover all spheres of health governance and prepared a comprehensive PPSF. • The Technical Specifications Bank (TSB) was restructured with coding of specifications and systematizes in the website of DoHS in FY 2017/18 and is opened to use for all stakeholders. Prepared SOP for operation and updating of TSB. • Coordinated e-GP II training to DoHS staffs and facilitated in implementation of e-GP II system in all bids of LMD/LMS. • Preparation of Concept Note, design specification and technical support to prepare web-based Grievance Handling and Redressal Mechanism (GHRM) in LMS. • Two Standard Operating Procedures (SOPs) as Procurement and supply chain handbook and facilitation handbook for electronic Government Procurement (e-GP) have been prepared, endorsed and distributed to local and provincial levels in FY 2017/18 and extensive technical support and capacity building program for SNGs level have been enhanced in FY 2018/19. • New Standard Bidding Documents for Medical Goods prepared and sent to PPMO and MoHP for endorsement. • A Framework Arrangement (FA) for procurement of medicines has been developed and agreed to implement in MDAC meetings. Draft Standard Bidding documents for FA prepared and sent to PPMO for review and endorsement. • Technical support and monitoring of DLI indicators and its achievements. • Preparation of drug disposal mechanism and executed by LMD in 2017/18.
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• Training session plan have been developed for PGs and LGs capacity building in procurement management in 2017/18. • Training sessions conducted in various procurement and supply chain management trainings conducted by LMD/LMS and other EDPS at all levels of governments. Similarly, inputs provided in revision of Logistic and Procurement Management Training Manual in FY 2017/18 and 2019/19. Facilitated to the TOT sessions on Procurement and Logistics Management. • Procurement Clinics have been operating in DoHS and MoHP for troubleshooting in procurement management. Basically, it is an advisory function for decision makers on procurement. • Coordination for organization of Suppliers’ Conference annually. • Market Analysis of pharmaceutical products has been done in Nepalese market to assess the production cycle and availability of essential medicines manufactured by the domestic pharmaceutical industries in Nepal.
C. UNFPA From the beginning of its UNFPA’s seventh country program cycle (2013-2017), UNFPA through its global UNFPA Supplies Thematic Trust Funds (TTF) has been working in Nepal to ensure a secure, steady and reliable supply of quality contraceptives, and its improved access and use by strengthening the national health system.
Strengthening FP Supply Chain Management (SCM) and Ensuring Commodity Security: In 2018, UNFPA through its global UNFPA Supplies Thematic Trust Funds (TTF) provided USD 964,220 worth of commodities including 102,000 units of LARC (Implant: 86,000 and IUCD: 16,000 units); 550,000 vials of DMPA; 2.5 million condoms; 169,920 Oral Contraceptive Pills to the MoHP and key FP actors including Marie Stopes International (MSI) and Family Planning Association of Nepal. Likewise, UNFPA provided FP commodities equivalent to USD 2.1 million in 2019 in support of the National FP Program. The support for 2019 included 1,998,864 pieces of Male Condoms, 9,545 Female Condoms, 141,700 Implant, 51,000 IUDs, 6,588 ECP, 349,800 vials of DMPA; 1,759,968 cycle of Oral Contraceptive Pills & 100 k Solo shot to the MOHP and FP partners (MSI and FPAN).
UNFPA is actively engaged in the Logistics Working Group led by the Logistic Management Unit, MoHP, and the External Development Partners (EDP) SCM group and contributes towards advocating for an efficient SCM system. UNFPA has its provincial offices in Province 2, Province 5 and Sudurpaschim Province where UNFPA works closely with the Provincial health logistics management center (PHLMC) to support the provincial efforts on forecasting/quantification and capacity development at local levels in SCM. Likewise, with support from UNFPA Supplies, the piloting for Sayana Press has been initiated in two districts of Nepal from October 2019 to expand the choice of FP methods available (implemented through MSI’s DFID-funded project).
ADRA Nepal has been supporting and working in the field of Basic Logistics and supply chain management of health sector in close coordination with Management Division (MD/DoHS/ MoHP) funded under UNFPA supplies with the time frame of 2018 to December 2020. In an effort to decentralize logistics decision making at the peripheral level health facilities and transfer of technology below district level, ADRA Nepal supported in “strengthening the logistics management information system” in 16 districts of provinces 1, 2, Bagmati province, 5 and SudurPachim.
This helps for real time information on stock status of key health commodities and other essential drugs at peripheral level HFs and can make evidence based logistics decision by making
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commodities available uninterruptedly and ultimately contributing to increase health services utilization by the hard-to reach population. Therefore, ADRA Nepal has contributed to strengthen Basic Health Logistics, Public Procurement System, commodity and essential drugs forecasting through capacity building activities with the support from UNFPA’s programme team.
Summary of performance achieved through this project in 2018 & 2019 are revision of the both logistics and procurement packages, three different types of trainings such as Training of Trainers, Basic Health Logistics and Public Procurement System for municipal level staff and Basic health logistics management training for health facility level staff. Altogether 121 HSPs were capacitated on ToT related to Basic Health Logistics and Public Procurement system at province level covering 1, 2, Bagmati, 5 & SudurPachim followed by 496 HSPs at municipality level and 636 HSPs at Health Facility Level. Moreover, Program Review and Planning meeting was conducted at provincial level, developed, printed & distributed the Basic logistic and procurement training manual and trainer’s guide (training package) along with monitoring & technical support visits.
D. WHO • WHO with UNICEF provides technical support for immunization and vaccine logistics which includes technical support for preparation and submission of vaccine support yearly renewal to Gavi, the Vaccine Alliance, including projection/forecasting of Gavi-supported vaccines need; technical support for Gavi supported Cold Chain Equipment Optimization Platform application and roll-out; technical support for Effective Vaccine Management and related assessments and monitoring. • WHO provides technical support for communicable diseases and related logistics. WHO supported coordination with other partners and NCASC to offset HIV drug shortages during the initial lockdown period in the current COVID-19 pandemic situation, donated Leprosy and Kala-azar drugs and ensures no stockout situation in the country, supported procurement of 10,000 Dengue test kits for Dengue outbreak preparedness as the procurement of Dengue test kits in the current year was impacted due to COVID-19 impact on supply chain, and collaborated with NTCC and Save the Children on supply of GeneXpert cartridge for TB. WHO coordinated with Global Fund to enable funding and coordinated shipment of Xpert Xpress CoV-2 cartridges which enabled introduction of Xpert Xperss CoV-2 test in Nepal. • WHO provides technical support on emergencies related logistics. WHO has provided logistics technical support for emergencies such as in the major earthquake in 2015 which included about 41 WHO Medical Camp Kits, several Inter Agency Medical, Surgical and Diarrhoeal Kits, establishment of Emergency Medical Logistics Warehouses with emergency medical stockpiles, temporary hospital tents and trauma back packs in four hub hospitals; tents to set up 17 birthing centers, Inter agency Emergency Health and Diarrhoeal kits for flood related emergencies; PPE, Viral Transport Media and Oseltamivir tablets to manage disease outbreaks including influenza, etc. WHO has also provided technical support for responding to the current COVID-19 pandemic, including for national forecasting, quantification, costing, distribution plan of COVID-19 logistics including PPE, medicines, ICU items, and other items critical for various pillars of the response. WHO has also donated PPE items; laboratory diagnostic kits and oxygen concentrators. In addition, WHO has also supported the establishment of the toll-free call center; ICT and tele-conferencing facilities for four different divisions and centers of the MoHP/DoHS and completed the establishment of fully functional permanent (4) and temporary (3) Health Emergency Operations Centers (HEOC) covering all seven provinces and complete expansion and re-furbishment of the National HEOC; establishment of Emergency Medical Logistics Warehouses with emergency medical stockpiles, temporary hospital tents and trauma back
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packs in six additional hub hospitals and established the Health Desk at the arrivals terminal of the Tribhuvan International Airport – and IHR Point of Entry.
E. UNICEF “UNICEF is one of the program partners supporting to government for National Immunization Program right from the beginning when he immunization program was initiated in Nepal. The main UNICEF support in the area of vaccine and cold chain equipments. UNICEF mainly supports government in following areas:
Regular supply of vaccines: UNICEF in government and GAVI, UNICEF prepared a vaccine forecast and shipment plan every year based on which vaccine including devises are supplied for both routine immunization and campaign when planned. Support in emergency: UNICEF is always upfront to support government in any emergency. During the current COVID pandemic, UNICE has supplied vaccines and syringes through chartered flight to ensure the country should not face any shortfall of vaccines.
Technical support in effective vaccine management: UNICEF provide support in cold chain management to ensure vaccine’s quality. Also, provides technical support for strengthening effective vaccine management (EVM) which is conducted every three years.
Supply of cold chain equipment: UNICEF with support from GAVI supporting government in the deployment high quality cold chain equipment. Currently under the Cold Chain Equipment Optimization Platform (CCEOP) initiatives, 1200 new equipments are deploying to increase the cold chain capacity in the country”
F. GIZ GIZ is a public benefit federal enterprise providing services worldwide in the field of international cooperation for sustainable development. Since 1994, GIZ has been working in the health sector in Nepal. The German Federal Ministry for Economic Cooperation and Development (BMZ) is the main commissioning party. The current phase of GIZ- Support to the Health Sector Programme (S2HSP) is commissioned for the period of January 2016 to June 2021. The programme is aligned with Nepal Health Sector Strategy 2015 to 2020. It provides technical advice to government actors responsible for sectoral management the national level on planning reforms and assists in their implementation in selected districts and municipalities in the newly created provinces 3, 5, and in Sudur Paschim. The TC module concentrates on five thematic areas: (1) Social Health Protection; (2) Improved availability of qualified human resources in health; (3) Strengthening governance in health;(4) Digitalization of information systems and work processes, including improved monitoring of health-related SDGs ;and (5) promotion of adolescent health and development.
GIZ- S2HSP is providing technical assistance on individual and organizational capacity development and strengthening health governance mechanism of local, provincial and federal government. Specifically, improving the capacities of local government and its health facilities for basic health service delivery and better procurement and supply chain management for quality of health service delivery. S2HSP has provided TA in the process of development of logistic and supply chain management guideline, capacity development of local government and its health facility and establishment of their own Municipal Medical Store
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G. SAVE THE CHILDREN Save the Children has been working together with Ministry of Health to fight against Aids, Tuberculosis and Malaria as a sole principal recipient (PR) of the Global Fund grant in Nepal since 16 July 2015 for these three diseases. Under the leadership of Save the Children, Global Fund grant is implemented in all the 75 districts of Nepal. It works for the case detection, cure management and drugs supply for Aids, Tuberculosis and Malaria.
Some of the activities enrolled by Save the Children in the procurement and supply chain are as below: • National drug consumption analysis and forecasting for Malaria, Tuberculosis and Aids. • Procurement and distribution support for these diseases. • Contribute in annual plan and budget preparation for MoHP and health division. • Partial support to expand the coverage areas of eLMIS. • Contributed to prepare the national warehouse management guideline, this guideline is under process with other partners. • Coordinate to bring the logistic reporting system of Malaria, Tuberculosis and Aids under LMIS of management division. • Preparation of product specification of health commodities and laboratories items. • Support SDPs with the health and laboratories commodities in all province. • Printing and distribution of IEC material for SDPs. • Warehouse management done by deploying human resources in National Centre for AIDS & STD Control (NCASC), National Tuberculosis Centre (NTC) and Epidemiology and Disease Control Division (EDCD)
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BIBLIOGRAPHY
Chemonics. (2018/19). Annual Progress Report. Kathmandu: USAID GHSC-PSM Nepal Project. DFID/NHSSP. (2018/19). Progress Report. Kathmandu: NHSSP Nepal. DoHS. (2074/75-2075/76). Annual Report. Kathmandu: MD. DoHS. (2077). Annual Report. Retrieved 2074/75 and 2075/76, from Department of Health Services: www.dohs.gov.np DoHS. (2016-2017). Basic Health Logistics Management Training Manual. Kathmandu: LMD. DoHS. (2077, Jestha 10). COVID-19 Logistics Report. Retrieved from DoHS/Management Division: www.elmis.dohslmd.gov.np DoHS. (2074/75-2076/77 (2nd Quarter)). LMIS Progress Report. Kathmandu: MD. DoHS. (2067). National Disposal and Auctioning Guideline. Kathmandu: LMD. DoHS. (2019). National Pipeline Report. Kathmandu: MD. DoHS. (2019). National Quantification Gudeline. Kathmandu: MD. DoHS. (2014). National Supply Chain Management Guideline. Kathmandu: LMD. DoHS. (2016-2017). Public Procurement System Training Manual. Kathmandu: LMD. DoHS. (2072 & 2075). Three Years Logistics Report. Kathmandu: LMD. GoN. (2076). Inventory Management New Forms & Formats. Retrieved from Financial Controller General Office: www.fcgo.gov.np GoN. (2077). Public Procurement Act 2064/Regulation 2067. Retrieved from Public Procurement Monitoring Office: www.ppmo.gov.np GoN. (2077). Reports and Guidelines. Retrieved from DoHS Management Division: www,dohslmd. gov.np MoHP. (2077). COVID-19 Report and Guidelines. Retrieved Baishak 2077, from Ministry of Health and Population: www.covid19.mohp.np MoHP. (2015). NHSS 2015-2020. Kathmandu: MoHP. MoHP. (2075/76). Finance Progress Report. Kathmandu: MoHP-Finance. MoHP. (2019). Joint Annual Report. Kathmandu: MoHP. UNFPA/ADRA. (2018/19). Progress Report. Kathmandu: ADRA Nepal. WB. (2019). World Bank Report. Kathmandu: WB. WHO. (2015). Pharmaceutical Waste Management Guideline. Kathmandu: WHO
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ANNEXES
96 HEALTH LOGISTICS REPORT
1. COVID-19 LOGISTICS INFORMATION
नेपालसरकार वा यतथाजनसं याम ालय वा यसेवा वभाग यव थापनमहाशाखा आप तू यव थापनशाखा :jf:Yo ;]jf ljefu, Joj:yfkg dxfzfvfdf COVID-19 ;fdu|Lx?sf] k|fKt tyf ljt/0fsf] ljj/0f ldltM @)&&.#.!% ut] %M)) ah] ;Dd -xfn ;Ddsf] hDdf_ अ दानी खच देश . अ पतालर सामानकोनाम इकाई वा यह ज मा बाक प रमाण सं. ख रदप रमाण सहयोग व प ज मा ा त अ य थानमा माभएको नकासा भएको नकासा नकासा 1 lklkO ;]^ ;]^ 625 5,768 6,393 1,425 4,471 5,896 497 2 ufpg yfg 1,90,900 58,621 2,49,521 50,530 43,537 94,067 1,55,454 3 ufpg -s]_ yfg 10,000 0 10,000 7,740 2,098 9,838 162 4 df:s -;lh{sn_ yfg 18,58,745 16,55,630 35,14,375 13,20,575 12,61,869 25,82,444 9,31,931
5 k+hf -;lh{sn Unf]A;_ -s]_ hf]/ 1,00,000 15,000 1,15,000 91,370 23,630 1,15,000 0 6 k+hf hf]/ 1,19,160 4,34,350 5,53,510 1,38,485 2,65,375 4,03,860 1,49,650 7 Pg 95 df:s yfg 47,500 2,03,795 2,51,295 20,475 75,695 96,170 1,55,125 8 Sofk - ;lh{sn Sofk yfg 39,400 11,220 50,620 13,290 28,226 41,516 9,104 9 rZdf -;]km\^L_ yfg 21,550 49,599 71,149 9,159 14,166 23,325 47,824 10 km]; df:s yfg 0 3,600 3,600 580 3,020 3,600 0 11 km]; l;N* lk; 8,540 22,650 31,190 3,045 13,502 16,547 14,643 12 ;' se/ hf]/ 55,600 24,650 80,250 6,290 29,960 36,250 44,000 13 ud a'^ hf]/ 18,540 300 18,840 4,680 2,680 7,360 11,480 14 k+hf x]eL *\o'^L hf]/ 5,200 0 5,200 2,280 1,112 3,392 1,808 15 ;]lg^fOh/ 100 Pd Pn jf]tn 0 140 140 0 43 43 97 16 ;]lg^fO{h/ 300 Pd Pn af]^n 0 3,600 3,600 1 3,187 3,188 412 17 ;]lg^fOh/ 500 PdPn jf]tn 5,500 8,698 14,198 8,063 3,294 11,357 2,841 18 ;]lg^fOh/ -ln^/_ ln^/ 440 3,000 3,440 520 2,920 3,440 0 19 ;lh{sn x'* lk; 0 2,000 2,000 0 0 0 2,000 20 cfO=cf/ ydf]{ld^/ yfg 10 2,573 2,583 885 895 1,780 803 21 Oo/ yd{ld^/ -sfgaf^ yfg 0 100 100 0 11 11 89 hfRg]_ 22 j*L Jofu lk; 0 2,400 2,400 590 785 1,375 1,025 23 jo^ jfO{k Kofs]^ 0 3,480 3,480 492 369 861 2,619
24 :k|]o/ kDk yfg 84 2 86 57 29 86 0 25 Snf]/f]SjLg kmf]:km]^ a§f 0 400 400 0 0 0 400 26 Snf]l/g PgPl*l;l; 45 . s]=lh= 4,000 0 4,000 2,500 900 3,400 600 55 27 ;f]l*Pd xfOkf]Snf]/fO* ln^/ 0 300 300 15 285 300 0 ;f]n';g 28 l*; OGkm]S^]G^ ^\ofa= uf]^f 0 490 490 140 215 355 135 29 kf]^{]an e]G^Ln]^/ yfg 0 1 1 1 0 1 0 30 kf]^{]an lkl;cf/ d]lzg yfg 5 2 7 0 7 7 0
97 HEALTH LOGISTICS REPORT 1 7 3 4 1 8 6 0 8 6 4 7 6 2 8 7 0 1 4 3 4 4 8 0 0 3 4 4 3 0 , 0 0 0 0 0 0 , , 0 4 0 0 4 0 , 1 0 4 0 4 , , 0 , , 2 , , , 2 0 4 2 ;lxt_ 5 1 0 1 2 5 1 0 , 1 1 , , 1 5 1 6 Koflsª 4 lel^Pd - lel^Pd d]^]l/on d]^]l/on 1 3 4 2 6 0 0 0 5 5 5 5 0 0 0 0 0 0 0 0 0 0 0 0 2 5 9 2 6 2 2 2 2 2 2 2 5 1 3 2 l*; 5 0 0 0 0 0 4 ^\ofa= OGkm]S^]G^ 2 2 1 2 4 2 2 0 0 0 5 0 5 5 5 5 5 0 0 0 0 0 0 0 1 9 0 2 6 1 1 3 fO* fO* ;f]n';g 5 0 0 ;f]l*Pd xfOkf]Snf]/ 0 6 2 5 1 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 3 3 , , 1 1 1 2 2 5 . 55 4 4 4 4 0 0 0 3 3 0 0 0 0 ; 45 ; 45 Snf]l/g Snf]l/g PgPl*l;l 4 5 6 4 6 4 5 6 3 2 0 4 3 1 1 7 7 7 5 0 0 8 8 4 1 1 1 8 7 kDk 0 7 3 0 :k|]o/ :k|]o/ 1 1 1 9 1 7 8 1 7 8 4 6 6 6 6 6 6 8 4 6 9 2 4 6 2 3 0 0 0 0 0 3 9 9 9 6 9 9 9 6 2 0 9 4 9 3 4 8 8 jfO{k 1 jo^ 1 1 6 0 2 9 1 5 5 5 0 0 0 0 7 7 0 0 0 0 8 8 8 8 8 8 3 8 0 0 1 7 8 8 0 0 0 0 3 3 5 5 5 5 9 9 9 9 9 , , 1 Jofu 1 2 1 1 0 0 0 9 9 4 2 j*L 1 1 2 2 3 1 1 1 1 1 1 7 2 2 0 0 0 0 0 0 0 0 0 0 0 0 - 1 1 Oo/ sfgaf^ hfRg]_ yd{ld^/ yd{ld^/ 0 0 7 2 2 0 0 6 0 5 5 6 0 5 9 5 0 9 4 7 8 5 5 5 0 4 1 6 5
1 7 5 0 4 7 7 1 6 1 7 7 6 3 8 0 0 4 0 4 1 , 1 2 1 , 3 1 1 1 1 7 4 5 7 6 1 7 7 1 cfO=cf/ ydf]{ld^/ 2 2 3 1 3 1 1 0 5 7 0 6 0 6 5 1 5 6 8 0 4 0 0 0 0 7 1 2 0 0 0 2 9 5 0 3 6 3 1 6 2 0 6 5 , 4 4 3 6 1 3 1 3 1 , 0 , 2 4 3 0 0 1 2 3 3 , 4 3 7 ;]lg^fOh / -ln^/_ 5 4 1 2 3 1 4 7 7 2 8 1 8 2 0 0 2 1 2 2 1 5 1 5 8 3 9 6 3 3 4 4 8 1 3 9 2 3 3 3 1 8 9 9 0 6 4 4 6 , 1 , 1 1 5 2 0 8 , 4 , , 5 , 1 4 1 3 5 8 1 3 , , 3 3 4 1 9 , 1 0 PdPn 1 1 1 1 6 6 3 2 9 1 2 1 1 1 1 1 , , , , , , , 500 500 ;]lg^fOh/ 1 1 1 1 1 1 1 3 8 5 5 5 5 5 5 2 4 7 8 4 9 5 7 6 0 0 0 0 0 0 0 2 9 3 3 8 1 2 , 5 , 3 7 3 , 2 1 1 5 5 4 5 4 1 2 3 3 9 Pd Pn 7 4 , 9 3 300 2 ;]lg^fO{h/ 3 2 1 1 4 1 2 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 Pd Pn ;]lg^fOh / 100 0 0 0 0 0 0 0 2 4 0 4 0 0 0 0 0 0 0 5 0 9 5 0 0 8 5 0 1 2 6 8 9 9 9 4 0 8 4 4 3 5 5 0 6 3 0 2 2 0 , 1 , 1 5 2 1 5 2 2 3 1 *\o'^L 4 x]eL 5 6 8 6 k+hf k+hf 6 5 1 3 3 5 4 6 3 6 3 3 9 0 2 0 7 8 8 2 0 6 2 0 7 2 2 2 2 2 1 8 6 1 8 8 8 1 6 3 1 1 2 5 1 0 8 9 0 8 4 2 3 1 0 0 7 2 2 6 0 , , 3 , 1 6 1 , 2 5 7 2 7 0 3 4 5 5 4 0 6 0 1 , , , , 7 1 7 ud a'^ 1 1 1 6 1 7 6 6 3 0 7 2 6 3 5 5 8 9 5 0 0 0 0 0 5 5 0 0 8 2 2 8 5 4 5 5 7 2 2 5 5 7 9 2 1 2 5 6 7 , 8 4 2 3 4 , 1 6 7 2 , 0 0 3 0 8 9 , 3 9 , , , , , , , 6 7 2 4 6 5 9 5 6 0 8 6 6 7 3 6 2 3 1 1 2 , 1 1 , 9 , , , , 3 3 ;' se/ 1 2 3 1 1 5 1 1 7 8 9 9 5 3 7 0 9 2 4 7 0 5 6 0 9 5 0 0 2 7 0 5 3 6 6 6 0 5 9 3 1 5 5 1 4 , 6 0 8 , 3 , 3 2 5 8 3 1 , 9 3 6 7 0 5 1 8 5 1 6 l;N* 4 8 4 0 km]; km]; 5 6 2 4 9 7 1 1 , 0 , 1 1 1 1 9 1 6 1 4 5 2 8 0 0 2 0 0 0 0 5 5 3 5 7 4 9 0 0 3 1 1 0 0 0 0 0 5 0 0 2 1 2 4 6 0 6 9 8 0 4 5 , , , 1 1 , 2 1 1 1 4 df:s km]; km]; 9 0 , 5 6 1 0 1 3 1 2 3 9 1 1 2 1 1 1 5 6 5 6 0 0 0 0 0 4 5 5 5 5 5 2 0 1 4 6 5 3 5 3 5 4 0 1 5 6 5 0 0 3 0 1 0 8 0 9 5 7 1 , 1 2 0 3 5 1 , 9 0 6 0 9 7 9 0 , , 3 , , , , , , , 5 2 2 5 2 3 3 8 3 8 5 1 5 4 1 1 1 ;]km\^L_ 1 2 1 1 9 1 1 , , , , , , , 2 2 rZdf - 2 2 9 2 3 1 1 2 6 6 5 5 9 4 0 0 0 4 0 0 1 1 1 6 5 0 8 2 0 4 9 6 3 5 0 9 2 6 0 5 5 8 5 5 5 1 5 3 , 2 , 0 , 2 1 4 0 3 1 5 4 3 6 7 8 5 0 3 0 , , 4 , 8 4 , , , , , , , 1 2 , Sofk 0 9 8 5 8 2 4 1 6 4 2 1 2 1 , , 1 3 1 1 2 4 1 , , , , 1 8 4 4 Sofk - - Sofk ;lh{sn 4 4 1 2 6 2 2 2 0 8 0 0 9 0 5 0 0 0 0 0 0 0 8 0 0 4 6 9 7 0 6 3 6 0 6 5 0 0 1 0 9 2 2 0 9 9 8 1 4 6 7 1 1 3 5 4 , 5 , , 1 1 , 2 1 6 2 1 7 , 6 0 8 4 9 4 , , 3 , , 0 , 5 , , , , , , 6 df:s 8 , , 6 , 6 0 0 2 4 7 7 1 3 6 5 1 3 , 3 2 3 2 4 , , , 3 3 6 7 9 1 1 9 Pg 95 9 1 3 4 1 5 5 0 9 8 8 9 9 0 1 5 0 0 0 6 0 8 3 0 0 5 0 0 3 7 9 8 5 9 0 0 0 6 9 8 0 9 5 0 7 5 0 8 9 9 8 , 5 , 5 , 6 3 6 1 6 6 3 9 7 1 , , , 7 , 5 3 , 7 , , , 7 3 3 2 , 0 , , 4 8 8 2 k+hf , , , , 7 2 1 7 3 9 7 5 4 6 9 7 4 8 5 7 0 , , 7 7 4 , 1 , 5 5 , , , 9 3 , , 2 3 1 1 1 1 2 2 2 4 2 7 2 9 3 3 , 8 1 4 4 4 1 2 6 2 1 1 0 0 0 0 0 0 0 0 0 0 1 0 9 0 0 0 0 0 2 5 0 0 0 0 0 0 5 5 7 1 0 9 0 7 4 0 0 0 9 , , 5 0 5 5 0 0 0 5 8 0 1 9 , 7 9 5 , 7 , 7 1 2 5 7 , 5 , , , , 3 , , , , 5 , 2 1 0 2 7 3 3 2 6 9 1 5 2 4 1 , , k+hf - k+hf 4 6 1 2 2 1 5 , , , , 4 , , , 1 1 1 1 1 1 1 ;lh{sn 7 7 7 4 9 2 4 1 1 Unf]A;_ -s]_ 1 1 1 1 1 1 1 4 9 0 4 0 0 5 0 0 5 0 0 3 5 0 0 4 5 7 0 6 9 0 4 4 0 0 1 5 4 0 4 5 4 0 0 , 0 0 4 4 5 5 0 7 0 5 6 , 5 0 7 2 0 7 , 8 , , , , 4 0 3 8 4 7 6 , , , , , 0 3 6 4 , , 2 1 , 3 5 , 6 1 8 5 6 0 0 6 6 , 3 9 8 9 9 , 6 6 , , 6 , , 9 , 1 , , 2 8 0 1 1 1 3 9 2 5 9 9 0 , 6 , , df:s - df:s , , 9 8 , , , , 0 5 , 2 ;lh{sn_ 8 2 , 8 4 9 4 6 2 5 2 2 1 2 1 1 2 2 6 1 9 1 5
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98 HEALTH LOGISTICS REPORT ] ^ ] S m f ] / k
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99 HEALTH LOGISTICS REPORT
2. eLMIS PILOTING AND SCALE-UP LIVE SITES
eLMIS PILOTING SITES S.N. PROVINCE HF TYPE HF NAME ELMIS MODULE LIVE DATE 1 Bagmati Province Central Store CW-FPED Online 2018-04-11 2 Bagmati Province Central Store CW-VCC Online 2018-06-16 3 Bagmati Province Central Store CW-NCASC Online 2018-04-16 4 Bagmati Province Central Store CW-NTCC Online 2018-04-12 5 Province 2 Central Store CW-Pathalaiya Online 2018-04-16 6 Bagmati Province Central Store CW-EDCD Online 2019-06-23 7 Bagmati Province Central Store CW- ETS Online 2019-06-24 Province Health Logistics 8 Karnali Province RMS-Nepalgunj Online 2018-04-16 Management Center Province Health Logistics 9 Province 5 RMS-Butwal Online 2018-04-13 Management Center District Health 10 Province 5 Dhs-Rupandehi Online 2018-05-17 Office District Health 11 Province 5 Dhs-Kapilbastu Online 2018-06-10 Office District Health 12 Province 5 Dhs-Nawalparasi Online 2018-05-25 Office District Health 13 Province 5 Dhs-Palpa Online 2018-06-04 Office District Health 14 Province 5 Dhs-Arghakhanchi Online 2018-05-27 Office District Health 15 Province 5 Dhs-Gulmi Online 2018-05-16 Office District Health 16 Province 5 Dwh-Dang Online 2018-06-06 Office District Health 17 Province 5 Dhs-Pyuthan Online 2018-05-30 Office District Health 18 Province 5 Dhs-Rolpa Online 2018-05-25 Office District Health 19 Province 5 Dhs-Rukum East Online 2018-06-13 Office District Health 20 Province 5 Dhs-Rukum West Online 2018-06-13 Office District Health 21 Province 5 Dwh-Banke Online 2018-06-18 Office District Health 22 Province 5 Dwh-Bardiya Online 2018-04-13 Office District Health 23 Karnali Province Dwh-Surkhet Online 2018-04-12 Office District Health 24 Karnali Province Dhs-Dailekh Online 2018-05-30 Office District Health 25 Karnali Province Dhs-Jajarkot Online 2018-05-18 Office District Health 26 Karnali Province Dhs-Salyan Online 2018-06-08 Office District Health 27 Karnali Province Dhs-Dolpa Offline 2018-07-20 Office
100 HEALTH LOGISTICS REPORT
District Health 28 Karnali Province Dhs-Kalikot Offline 2018-07-21 Office District Health 29 Karnali Province Dhs-Jumla Offline 2018-07-17 Office District Health 30 Karnali Province Dhs-Mugu Offline 2018-07-19 Office District Health 31 Karnali Province Dhs-Humla Offline 2018-07-17 Office Local Level 32 Province 5 LLG-Rajapur Online 2018-08-24 Govenment Office Local Level 33 Province 5 LLG-Badaiyatal Online 2018-08-23 Govenment Office Local Level LLG- 34 Karnali Province Online 2018-08-27 Govenment Office Birendranagar Local Level 35 Karnali Province LLG-Barahatal Online 2018-08-28 Govenment Office Primary Health Rajapur Primary 36 Province 5 Mobile 2018-09-02 Center Health Mainapokhar 37 Province 5 Health Post Mobile 2018-08-23 Health Post 38 Province 5 Health Post Kalika Health Post Mobile 2018-08-30 39 Province 5 Health Post Manpur Tapara Mobile 2018-08-27 40 Province 5 Health Post Khairi chandanpur Mobile 2018-09-04 41 Province 5 Health Post Bhimapur Mobile 2018-09-02 42 Province 5 Health Post Daulatpur Mobile 2018-08-27 43 Province 5 Health Post Badalpur Mobile 2018-08-30 44 Province 5 Health Post Naya Gaun Mobile 2018-08-29 45 Province 5 Health Post Jamuni HP Offline 2018-09-05 46 Karnali Province Health Post Jarbuta Mobile 2018-08-31 47 Karnali Province Health Post Ratu Mobile 2018-09-04 48 Karnali Province Health Post Sanilekh Mobile 2018-09-05 49 Karnali Province Health Post Lekhgaun Mobile 2018-08-31 50 Karnali Province Health Post Gadi (Bayalkanda) Mobile 2018-09-04 51 Karnali Province Health Post Katkuwa Mobile 2018-09-04 52 Karnali Province Health Post Uttarganga Mobile 2018-09-07 53 Karnali Province Health Post Latikoili Mobile 2018-09-07 54 Karnali Province Health Post Hariharpur Online 2018-08-30 55 Karnali Province Health Post Pokharikanda Mobile 2018-09-07 56 Karnali Province Health Post Taranga Mobile 2018-09-03 57 Karnali Province Health Post Kunathari Mobile 2018-09-03
101 HEALTH LOGISTICS REPORT
eLMIS SCALE-UP REPORTING PERIOD 21 JUNE TO JUNE 27, 2020 Site Summary TOTAL LIVE S.NO SITE TYPE NUMBER THIS WEEK NUMBER 1 Health Office (HO) 55 21 5 2 Hospital 61 22 4 3 Medical College 14 9 - 4 Provincial Public Health Laboratories (PPHL) 7 2 - TOTAL 137 54 9
LIVE SITES SUMMARY LIVE DATE S.NO PROVINCE NAME OF THE SITE SITE TYPE DISTRICT LIVE DATE (B.S.) 1 1 Birat Medical College Medical College Morang 6/7/2020 2/25/2077 2 1 Health Office Morang Health Office Morang 6/5/2020 2/23/2077 Provincial Public Provincial 31Health Laboratory, Morang 6/7/2020 2/25/2077 Laboratory Biratnagar Charikot PHC, Primary Health 4 Bagmati Dolakha 6/10/2020 2/28/2077 Dolakha Care Center District 5 Bagmati Dhading Hospital Dhading 6/5/2020 2/23/2077 Hospital College of Medical 6 Bagmati Medical College Chitwan 6/2/2020 2/20/2077 Science Kathmandu Medical 7 Bagmati Medical College Kathmandu 5/26/2020 2/13/2077 College 8 Bagmati Nepal Medical College Medical College Kathmandu 5/24/2020 2/11/2077 9 Bagmati Kist Medical College Medical College Lalitpur 5/22/2020 2/9/2077 Health Office 10 Bagmati Health Office Kavrepalanchok 5/22/2020 2/9/2077 Kavrepalanchok Health Office 11 Bagmati Health Office Bhaktapur 5/19/2020 2/6/2077 Bhaktapur 12 Bagmati Health Office Dhading Health Office Dhading 6/1/2020 2/19/2077 13 Bagmati Health Office Dolakha Health Office Dolakha 6/10/2020 2/28/2077 14 Bagmati Health Office Lalitpur Health Office Lalitpur 5/22/2020 2/9/2077 Health Office 15 Bagmati Health Office Sindhupalchowk 6/4/2020 2/22/2077 Sindhupalchowk Sindhupalchowk District 16 Bagmati Sindhupalchowk 6/4/2020 2/22/2077 Hospital Hospital Gandaki Medical 17 Gandaki Medical College Pokhara 5/31/2020 2/18/2077 College Manipal Medical 18 Gandaki Medical College Pokhara 6/4/2020 2/22/2077 College Bhim Hospital, District 19 5 Rupandehi 6/4/2020 2/22/2077 Rupandehi Hospital District 20 5 Pyuthan Hospital Pyuthan 6/9/2020 2/27/2077 Hospital District 21 5 Rolpa Hospital Rolpa 5/20/2020 2/7/2077 Hospital Devdaha Medical 22 5 Medical College Rupandehi 5/28/2020 2/15/2077 College
102 HEALTH LOGISTICS REPORT
Universal College of 23 5 Medical College Rupandehi 6/4/2020 2/22/2077 Medical Science District 24 Karnali Rukum West Hospital Rukum West 6/5/2020 2/23/2077 Hospital 25 1 Health Office Jhapa Health Office Jhapa 6/11/2020 2/29/2077 District 26 Bagmati Trisuli Hospital Nuwakot 6/11/2020 2/29/2077 Hospital District 27 5 Kapilbastu Hospital Kapilbastu 6/11/2020 2/29/2077 Hospital 28 Gandaki Health Office Gorkha Health Office Gorkha 6/12/2020 2/30/2077 District 29 Gandaki Gorkha Hospital Gorkha 6/12/2020 2/30/2077 Hospital Health Office 30 Bagmati Health Office Kathmandu 6/14/2020 2/32/2077 Kathmandu Health Office 31 Bagmati Health Office Nuwakot 6/14/2020 2/32/2077 Nuwakot District 32 Bagmati Ramechhap Hospital Ramechhap 6/15/2020 3/1/2077 Hospital Health Office 33 Bagmati Health Office Ramechhap 6/15/2020 3/1/2077 Ramechhap Sudur Tikapur Hospital, District 34 Kailali 6/15/2020 3/1/2077 Pachim Kailali Hospital Privthvi Chandra District Nawalparasi 35 5 6/16/2020 3/2/2077 Hospital Hospital West 36 Gandaki Health Office Tanahu Health Office Tanahu 6/17/2020 3/3/2077 37 1 Health Office Illam Health Office Illam 6/18/2020 3/4/2077 District 38 Gandaki Damauli Hospital Tanahu 6/18/2020 3/4/2077 Hospital Sudur District 39 Health Office Kailali Kailali 6/18/2020 3/4/2077 Pachim Hospital District 40 Bagmati Sindhuli Hospital Sindhuli 6/18/2020 3/4/2077 Hospital District 41 1 Illam District Hospital Illam 6/18/2020 3/4/2077 Hospital 42 Bagmati Health Office Rasuwa Health Office Rasuwa 6/19/2020 3/5/2077 43 Bagmati Health Office Sindhuli Health Office Sindhuli 6/19/2020 3/5/2077 Provincial Public Sudur Provincial 44 Health Laboratory, Kailali 6/20/2020 3/6/2077 Pachim Laboratory Dhangadi District 45 Bagmati Rasuwa Hospital Rasuwa 6/20/2020 3/6/2077 Hospital District Nawalparasi 46 Gandaki Madhyabindi Hospital 6/21/2020 3/7/2077 Hospital East 47 Gandaki Health Office Lamjung Health Office Lamjung 6/22/2020 3/8/2077 48 1 Health Office Khotang Health Office Khotang 6/23/2020 3/9/2077 District Hospital District 49 1 Khotang 6/23/2020 3/9/2077 Khotang Hospital Sudur Health Office 50 Health Office Kanchanpur 6/23/2020 3/9/2077 Pachim Kanchanpur District District District 51 Gandaki Lamjung 6/24/2020 3/10/2077 Community Hospital Hospital District Hospital District 52 1 Panchthar 6/24/2020 3/10/2077 Panchthar Hospital Health Office Nawalparasi 53 Gandaki Health Office 6/24/2020 3/10/2077 Nawalparasi East East Health Office 54 1 Health Office Panchthar 6/25/2020 3/11/2077 Panchthar 103 HEALTH LOGISTICS REPORT
LIVE SITES SUMMARY (21 JUNE TO 27 JUNE) LIVE DATE S.NO PROVINCE SITE NAME SITE TYPE DISTRICT LIVE DATE (BS) District Nawalparasi 1 Gandaki Madhyabindi Hospital 6/21/2020 3/7/2077 Hospital East 2 Gandaki Health Office Lamjung Health Office Lamjung 6/22/2020 3/8/2077 3 1 Health Office Khotang Health Office Khotang 6/23/2020 3/9/2077 District Hospital District 41 Khotang 6/23/2020 3/9/2077 Khotang Hospital Sudur Health Office 5 Health Office Kanchanpur 6/23/2020 3/9/2077 Pachim Kanchanpur District District District 6 Gandaki Lamjung 6/24/2020 3/10/2077 Community Hospital Hospital District Hospital District 71 Panchthar 6/24/2020 3/10/2077 Panchthar Hospital Health Office Nawalparasi 8 Gandaki Health Office 6/24/2020 3/10/2077 Nawalparasi East East Health Office 91 Health Office Panchthar 6/25/2020 3/11/2077 Panchthar
ROLLOUT ACTIVITIES ONGOING SITES START START DATE END DATE S.NO PROVINCE SITE NAME SITE TYPE END DATE DATE (BS) (BS) Health 1 Gandaki Health Office Kaski 6/25/2020 6/28/2020 3/11/2077 3/14/2077 Office District Hospital District 21 6//27/2020 6/30/2020 3/13/2077 3/16/2077 Okhaldhunga Hospital Health Office Health 31 6/26/2020 6/29/2020 3/12/2077 3/15/2077 Okhaldhunga Office Health Office Health 42 6/23/2020 6/28/2020 3/9/2077 3/14/2077 Mahottari Office District 5 2 Jaleshowr Hospital 6/25/2020 6/30/2020 3/11/2077 3/16/2077 Hospital Health Office Health 6 Bagmati 6/25/2020 6/28/2020 3/11/2077 3/14/2077 Chitwan Office Sudur Health Office Health 7 6/25/2020 6/29/2020 3/11/2077 3/15/2077 Pachim Darchula Office Health Office Health 81 6/26/2020 6/30/2020 3/12/2077 3/16/2077 Taplejung Office
104 HEALTH LOGISTICS REPORT
PLAN ( 21 JUNE TO 27 JUNE) START START DATE END DATE S.NO PROVINCE SITE NAME SITE TYPE END DATE DATE (BS) (BS) Health Office Health 1 Gandaki 6/30/2020 7/2/2020 3/16/2077 3/18/2077 Syangja Office Provincial Provincial Public Public 2 Gandaki Health Laboratories Health 6/29/2020 6/29/2020 3/15/2077 3/15/2077 (PPHL)- Pokhara Laboratories (PPHL) Health Office Health 32 7/1/2020 7/4/2020 3/17/2077 3/20/2077 Dhanusa Office Provincial Provincial Public Public 45 Health Laboratories Health 6/29/2020 6/30/2020 3/15/2077 3/16/2077 (PPHL)- Butwal Laboratories (PPHL) District 5 Gandaki Syangja Hospital 7/3/2020 7/6/2020 3/19/2077 3/22/2077 Hospital Health Office Health 61 7/1/2020 7/3/2020 3/17/2077 3/19/2077 Solukhumbu Office District 7 1 Taplejung Hospital 6/28/2020 7/1/2020 3/14/2077 3/17/2077 Hospital Sudur District Hospital District 8 6/28/2020 6/30/2020 3/14/2077 3/16/2077 Pachim Darchula Hospital
Note: Start date and end date of rollout may differ because of the pandemic situation. Also, It may be fluctuate based on the current running sites rollout end date.
105 HEALTH LOGISTICS REPORT DROPPED CANCELLED SIGNED CONTRACT CONTRACT LOI ISSUED LOI COMPLETED EVALUATION EVALUATION 2 3 2 3 2 3 UNDER PROCESS EVALUATION EVALUATION 19/20 AS OF JULY 15, 2020 JULY OF AS 19/20 BID OPENED NOTICE NOTICE PUBLISHED DEPARTMENT OF HEALTH SERVICES OF HEALTH DEPARTMENT MINISTRY OF HEALTH AND POPULATION OF HEALTH MINISTRY BIDDING NUMBER STARTED STARTED 3. PROCUREMENT STATUS FY 2076/77 FY STATUS 3. PROCUREMENT PROCESSES PROCUREMENT STATUS OF F/Y 20 OF F/Y STATUS PROCUREMENT PROC. TOTAL TOTAL PACKAGE NUMBER OF PROCUREMENT METHOD PROCUREMENT Direct Procurement (DP) Procurement Direct (DC) Contract Direct NCB (Works)SQ (Works) ServiceNon Consulting (NCB) ServiceNon Consulting (SQ) ServiceConsulting (QCBS) 5 1 1 3 1 1 2 3 1 1 2 3 1 1 2 - 1 1 2 1 1 1 1 1 1 1 2 ICB (Goods)NCB (Goods)SQ (Goods)Total 22 total CAPP) (of Percentage 31 started) number (of Percentage published) notice (of Percentage 3 21 19 21 2 19 20 2 19 72.06% 72.06% 3 2 100.00% 70.59% 2 68 97.96% 7.35% 17 - 10.20% 49 17 60.29% 83.67% 13 48.53% 97.96% 49 13 67.35% 48.53% 10.20% 13 67.35% 16.18% 13 48 83.67% 22.45% 0.00% 67.35% 5 0.00% 67.35% 4 5 22.45% 0.00% 41 33 33 11 -
106
HEALTH LOGISTICS REPORT
VALUE (MIL.) VALUE
ACTUAL ACTUAL
VALUE (MIL.) VALUE
PLANNED PLANNED
NUMBER
VALUE (MIL.) VALUE
ACTUAL ACTUAL
VALUE (MIL.) VALUE
PLANNED PLANNED
NUMBER
WORKS SERVICES
CONTRACT SIGNED CONTRACT (MIL.) VALUE
ACTUAL ACTUAL
VALUE (MIL.) VALUE
GOODS PLANNED
NUMBER
VALUE (MIL.) VALUE
PLANNED NUMBER SERVICES
19/20 AS OF JULY 15, 2020 JULY OF AS 19/20
VALUE (MIL.) VALUE
PLANNED
WORKS NUMBER
VALUE (MIL.) VALUE PLANNED PLANNED DEPARTMENT OF HEALTH SERVICES OF HEALTH DEPARTMENT MINISTRY OF HEALTH AND POPULATION OF HEALTH MINISTRY
GOODS
NUMBER STARTED BIDDING PROCESSES NUMBER STARTED NUMBER
PROCUREMENT STATUS OF F/Y 20 OF F/Y STATUS PROCUREMENT
VALUE (MIL.) VALUE PLANNED
SERVICES NUMBER
VALUE (MIL.) VALUE PLANNED PLANNED
WORKS NUMBER
VALUE (MIL.) VALUE PLANNED PLANNED
GOODS
TOTAL PLANNED PROCUREMENT PACKAGE PLANNED PROCUREMENT TOTAL NUMBER DIVISION FWDEDCD 23MD 1,676.83 15CSD 311.45 NSSD 6 13Total 74.46 5 677.69 2 62 2,745.33 2 4.90 2 4.10 2 8.50 4.10 21 4 37.20 1,665.83 2 45.70 45 13 10.00 2,484.68 1 305.50 1 8 1.71 2 1.71 1 8.50 3 1 502.95 18 2.20 10.70 31 1,641.40 1 0.40 1,531.94 1,963.48 1,782.81 7.00 1 1.71 5.21 0.99 6 1 1 2.20 1.71 58.33 1.68 0.99 5 1 51.02 2.20 256.35 1.68 1 194.38 0.40 0.26
107 HEALTH LOGISTICS REPORT
DIVISION WISE PROCUREMENT PROGRESS AS OF JULY 15, 2020 TOTAL NUMBER OF PROC. NUMBER STARTED BIDDING CONTRACT SIGNED PROCUREMENT PACKAGE PROCESSES METHOD PLANNED PLANNED PLANNED ACTUAL NUMBER NUMBER NUMBER VALUE (MIL.) VALUE (MIL.) VALUE (MIL.) VALUE (MIL.) FWD Goods 23 1,676.83 21 1,665.83 18 1,641.40 1,531.94 Works Services 2 8.50 2 8.50 0 - - EDCD Goods 15 311.45 13 305.50 6 58.33 51.02 Works Services MD Goods 6 74.46 2 10.00 1 7.00 5.21 Works 2 4.10 1 1.71 1 1.71 0.99 Services 2 37.20 1 2.20 1 2.20 1.68 CSD Goods 13 677.69 8 502.95 5 256.35 194.38 Works Services NSSD Goods 5 4.90 1 0.40 1 0.40 0.26 Works Services Total 68 2,795.13 49 2,497.09 33 1,967.39 1,785.48
108 HEALTH LOGISTICS REPORT
PROCUREMENT FOR COVID-19 RESPONSE IN FY 2019/20 PROCUREMENT OF MEDICAL GOODS AND COST ESTIMATE CONTRACT METHOD OF S.N. REMARKS LOGISTICS (NPR) AMOUNT (NPR) PROCUREMENT Thermal Scanner and Infrared Non Touch 1 15051000.00 6,396,430.54 RFQ Hand Thermometer Essential Logistics For N-Corona Virus 2 15051000.00 7,222,962.00 RFQ Management Essential Logistics For COVID-19 3 280000000.00 276,549,430.00 RFQ Cancelled Response Procurement of ICU Equipment & others 4 48474700.00 37,267,225.80 RFQ for COVID-19 General Bed and Accessories For Isolation 5 51415000.00 35,482,000.00 RFQ Ward 6 Procurement of Hand Sanitizer 1842000.00 2,034,000.00 DP 7 Hand Sanitizer 1044000.00 1,152,600.00 DP 8 Gum Boot for PPE 2320000.00 1,999,139.50 DP PPE items For COVID -19 Control and 9 402297145.72 S-NCB Prevention 338,051,630.55 10 Laboratory items For COVID -19 56488706.00 45,216,950.00 S-NCB Different items For COVID -19 Control 11 58507919.60 27,461,373.00 S-NCB and Prevention 12 RDT Kit for COVID-19 115418000.00 63,873,250.00 RFQ 13 Drugs for COVID-19 75000000.00 45,418,140.00 S-NCB 14 RT-PCR & RNA and VTM For COVID -19 102039101.04 311,089,000.00 S-NCB 15 RDT Kit for COVID-19 102039101.04 77,536,560.20 DP 16 ICU Consumables for COVID-19 78050000.00 29,496,479.50 S-NCB Automated RNA Extraction Machine and 17 252500000.00 146,822,030.00 S-NCB RNA Extraction Kit 18 RDT Kit for COVID-19 9600000.00 94,500,000.00 DP Total NPR Value 1,667,137,673.40 1,547,569,201.09
109 HEALTH LOGISTICS REPORT ACHIEVEMENT OF YEAR 3 OF ACHIEVEMENT Achieved contract of (97.8% 3 initiated Year of value online e-GP II) through 2019) YEAR 3 (JULY 16, 2018 – JULY 15, JULY 16, 2018 – (JULY DLI Target 1.4 70% of of 1.4 70% Target DLI total contracts of value LMD managed by online done through e-procurement 3 Year of rule: (WB disbursement for USD 3,000,000 total contracts 60% of LMD done managed by e-procurement through and US$100,000 percentage every for to a 60% up over point Year 70% maximum of 3) YEAR 2 ACHIEVEMENT UPDATED UP TO JULY 17, 2019 17, JULY TO UP UPDATED ACHIEVEMENT ACHIEVEMENT OF ACHIEVEMENT Achieved contract of (63.92% 2 Year of value initiated through online e-GP II) 2018) YEAR 2 (JULY 16, 2017 – JULY 15, JULY 16, 2017 – (JULY DLI Target 1.3 At least At 1.3 Target DLI total of value 60% of managed by contracts online through LMD done 2 Year of e-procurement ACHIEVEMENT OF YEAR 1 OF ACHIEVEMENT Achieved trained 25 DoHS Staff Achieved in Y3 in Achieved on (Trainings and procurement to e-procurement staff provencial with conducted are PFM-SP support from is and NHSSP STTA to on-site coaching institutions in provincial procedures) procuremnt DISBURSEMENT LINKED INDICATOR (DLI TARGET VS PROGRESS) VS TARGET (DLI LINKED INDICATOR DISBURSEMENT YEAR 1 – JULY 15, 2017) JULY – ([INSERT DATE OF DATE ([INSERT RETROACTIVE FINANCING] FINANCING] RETROACTIVE DLI Target 1.1 (i) Training Training (i) 1.1 Target DLI PPMO’s the use of on online e-procurement at least for completed 20 MoH staff; DLI Target 1.2 (ii) Target DLI bidding standard drugs and for documents for developed equipment online e-procurement as: Revised on procurement/ Training and use e-procurement bidding standard of to documents province completed 4. DISBURSEMENT LINKED INDICATOR (DLI TARGET VS PROGRESS) VS TARGET (DLI LINKED INDICATOR 4. DISBURSEMENT DISBURSEMENT LINKED INDICATORS DISBURSEMENT BASELINE Procurement Reform Reform Procurement Action Plan not implemented DFID £450,000 £600,000 DFID £400,000 £400,000 INDICATORS DISBURSEMENT- DLI 1: Systems DLI 1: Systems and organizational at MoH reforms out,carried based on Procurement Action Reform Plan. DLI ValueDLI WB $1,000,000 DLI Value WB $1,000,000 $3,000,000 $4,000,000
110 HEALTH LOGISTICS REPORT Achieved produced (Annual report the system on from and received grievances addressed) Achieved procurement (100% health commodities of standard with approved TSB) using specifications DLI Target 2.3 DLI Target on Annual report and received grievances addressed DLI Target 3.4 DLI Target of procurement 80% of free of basic package drugs and essential based on equipment standard the use of specifications as: Revised of procurement 80% of as health comodities, the list of specified in with healthcommodities specifications standard MD, by and procured the use of is based on specifications standard (WB Disbursement rule: US$1,500,000 the achievement for for 80% of target a of a of the procurement drugs; free of package for US$1,500,000 a of the achievement the for 80% of target essential of procurement equipment; DFID Disbursement for rule: £300,000 of the achievement for 80% of target a of the procurement free of a package for drugs; £300,000 a of the achievement the for 80% of target essential of procurement equipment) Achieved based Web- Grievance Redressal Mechanism use established for to Orientation handling the staff are grievances done Achieved floated Tender 100% using approved TSB for standard drugs and free done procurement standard from only specifications DLI Target 2.2 DLI Target based (i) Web- Redressal Grievance Mechanism established and functioning; completed (ii) training staff of all levels for grievance for responsible handling rule: (Disbursement for US$1,500,000 the of establishment GRM and US$1,500,000 of completion for training) DLI Target 3.2 1 Target DLI procurement of 70% of basic package of drugs based on free standard the use of specifications[2] Achieved not on GHRM Concept endorsed System Achieved Specifications Standard Drugs Essential Feree of and published endorsed DLI Target 2.1 2.1 DLI Target Grievance Guidelines for Mechanism Redressal MoH by endorsed DLI Target 3.1 MoH 3.1 Target DLI standard endorses basic for specifications to drugs free of package LMD by be procured Web-based Grievance Grievance Web-based Mechanism Redressal is not procurement for established DFID not Procurement based on standard specifications £- £- £- DLI 2: Production DLI 2: Production and submission Annual of Report on grievances and received and addressed web- a through based grievenace mechanism DLI ValueDLI WB $2,000,000 $3,000,000 $2,000,000 DLI 3: Percentage DLI 3: Percentage procurements of LMD done by using standard specifications
111 HEALTH LOGISTICS REPORT Achieved DLI Target 4.2 Training 4.2 Training DLI Target on, and installation LMIS of, and operation all central for completed and district warehouses two at least of stores and baseline regions; for data generated tracer of stock-outs drugs. Achieved (Year 2) (Year Achieved standard Endorsed specifications essential for are equipment TSB of published in MD website, Achieved Online LMIS is installed and in functional all regional warehouses, and district stores medical central stores DLI Target 3.3 DLI Target standard MoH endorses for specifications to equipment essential LMD[3] by be procured $1,000,000 £250,000 LMIS installed in all the of warehouses and district stores center two of regions $3,000,000 £300,000 $3,000,000 £350,000 DFID £500,000 DFID LMIS not in placeDFID £300,000 4.1 Target DLI £500,000 DLI Value DLI 4: Percentage districtsof stores WB based on reporting LMIS DLI Value WB DLI ValueDLI WB $4,000,000 $2,000,000 $3,000,000
112 HEALTH LOGISTICS REPORT
5. AVAILABLE COLD CHAIN EQUIPMENT
1. COLD BOX Model: RCW 25 Vaccine storage capacity: 20 Litres Cool Life: 34.4Hours No. of Ice Pack required: 24 Units (0.6 L) Purpose: Transportation of vaccines from vaccine store todistribution centre Manufactured by: B Medical, Luxembourg Available: CVS, PVS, DVS, HF
2. ICE LINING REFRIGERATOR Model: TCW 1152 Vaccine storage capacity: 169 Litres Refrigerant: R134a Temperature Range: 2 to 8 deg. Celsius. Holdover time: 42 Hours. Purpose: Storage of vaccines Manufactured by: Electrolux,Luxembourg Available: CVS, PVS, DVS
3. ICE PACK FREEZER Model: TFW 800 Capacity: 209 Litres Refrigerant: R134a Temperature Range: -15 to - 25 deg. Celsius. Purpose: Preparation of Ice packs at CVS, PVS & DVS Manufactured by: Electrolux, Luxembourg Available: CVS, PVS, DVS
4. ICE LINED REFRIGERATOR Model: TCW 4000 AC* Vaccine storage Capacity: 240 Litres Refrigerant: R600a Temperature Range:2 to 8 deg. Celsius. Holdover time: 77.3 Hours Purpose: Storage of Vaccines at PVS & DVS Manufactured by: B Medical, Luxemburg
*Various models like TCW 2000, TCW3000 & TCW2000DC are available Available: DVS
113 HEALTH LOGISTICS REPORT
5. DEEP FREEZER Model: HBD 286 Ice Pack Storage Capacity: 310 x 0.6 L Ice pack Refrigerant: R134a Temperature Range: -15 to -25 deg. Celsius. Holdover time: 4.9 Hours Purpose: Preparation and Storage of Ice Pack at PVS & DVS Manufactured by: Haier-Qingdao, China Available: CVS, PVS, DVS
6. ICE LINED REFRIGERATOR Model: HBC 80 Vaccine storage Capacity: 61 Litres Refrigerant: R600a Temperature Range:2 to 8 deg. Celsius. Holdover time: 59.51 Hrs. Purpose: Storage of Vaccines at Distribution Centre Manufactured by: Haier-Qingdao, China Available: Municipality, HF
7. ICE LINED REFRIGERATOR Model: HBD 116 Ice Pack Storage Capacity: 136 X 0.6 Litres Refrigerant: R134a Temperature:2 to 8 deg. Celsius. Holdover time: 59.51 Hrs. Purpose: Preparation and Storage of Ice Pack at distribution centre Manufactured by: Haier- Qingdao,China Available:Municipality, HF
8. ICE LINED REFRIGERATOR Model: HBD 116 Types of Appliance: Solar Direct drive Combined Refrigerator/freezer Vaccine Storage Capacity: 37.5 Litres Ice Pack Storage Capacity: 12 X 0.6 Litres Refrigerant: R600a Temperature Range:Freezer < -5 °C & Refrigerator (2 to 8) °C. Holdover time: 59.51 Hrs. Purpose: Storage of Vaccines and preparation of Ice Pack Manufactured by: Haier, Qingdao,China Available: Municipality, HF
114 HEALTH LOGISTICS REPORT
9. ICE LINED REFRIGERATOR Model: TCW 3000 AC Vaccine storage Capacity: 150 Litres Refrigerant: R134a Temperature:2 to 8 deg. Celsius. Holdover time: 53.10 Hrs. (fridge) and 3.55 Hrs. (Freezer) Purpose: Storage of Vaccines Manufactured by: B Medical, Luxemburg Available: DVS, HF
10. ICE LINED REFRIGERATOR Model: TCW 2000 DC Types of Appliance: Battery solar Powered Combined refrigeratorand freezer Vaccine storage Capacity: 76 Litres Freezer Capacity: 30 Litres Refrigerant: R134a Temperature:2 to 8 deg. Celsius. Holdover time: 13.6 Hours Purpose: Storage of Vaccines and Preparation of Ice Packs Manufactured by: B Medical, Luxemburg Available: DVS, HF
11. VACCINE CARRIER Model No: BDVC 46 Vaccine Storage Volume: 3.36 Litres Cool Life: 13.26 Hrs. at 43°C with 4 Ice Packs No. of Ice Pack required: 4 Units (0.6 L) Purpose: Transportation of vaccines from distribution centre to EPI session. Manufactured by: Nilkamal, India Available: DVS, HF, Session
12. VACCINE CARRIER Model No: BDVC 44 Vaccine Storage Volume: 1.7 Litres Cool Life: 7 Hrs. at 43°C with 4 Ice Packs No. of Ice Pack required: 4 Units (0.4 L) Purpose: Transportation of vaccines from distribution centre to EPI session. Manufactured by: Nilkamal, India Available: DVS, HF, Session
115 HEALTH LOGISTICS REPORT
13. WALK IN COOLER Model:Huurre* GrossCapacity: 41cm3 Refrigerant: R404a Temperature Range:2 to 8 deg. Celsius. Purpose: Storage of Vaccines at CVS & PVS Manufactured by: Finland Available: CVS *Cooling unit changed with Danfoss Denmark
14. WALK IN COOLER Model: EMB2009MIZ Gross Capacity: 15 m3 Refrigerant: R404a Temperature:2 to 8 deg. Celsius. Holdover time: not available Purpose:Storage of vaccines at CVS & PVS Manufactured by: Haier, Qingdao China Available: CVS, PVS
15. WALK IN FREEZER Model:Coldbank Gross capacity: 30 m3, Refrigerant: R404a Temperature:- 15 to - 25 deg. Celsius. Purpose: Storage of Heat sensitive vaccines eg. OPV Manufactured by:China Available: CVS
16. ALCOHOL THERMOMETER Temperature Range: -40 to + 50 deg. Celsius. Uses: Temperature Monitoring of Vaccines Manufactured by: China Available: CVS, PVS, DVS, HF
17. FRIDGE- TAG TYPE 2 Description:30 Days Electronic Temperature Logger Power source: Non- Replaceable Battery Battery Shelf Life: 42 months from manufacture date Uses: Use in WIC,ILR, Cold Boxes to monitor Temperature Manufacture By:Berlinger and Co. AG, Switzerland Available: CVS, PVS, DVS, HF
116 HEALTH LOGISTICS REPORT
18.FREEZE TAG Description: Electronic Freeze Indicator Product Type: Irreversible freeze Indicator Temperature Range: Min. -20°C and Max. +50°C Power source: Non- Replaceable Battery Battery Shelf Life: 60 months from manufacture date Alarm Condition: Below -0.5°C for 60 min. Uses: Use in WIC,ILR, Cold Boxes and Vaccine carrier to monitor freezing temperature Manufacture By:Berlinger and Co. AG, Malaysia Available: CVS, PVS
19. LOG TAG Model:TRIX-8 Description: Interface and the freely available companion software Log Tag Analyzer Temperature Range:- 40°C to +85°C Power source: Non- Replaceable Battery Battery Shelf Life: 10 Years Uses: Use in WIC,ILR, Cold Boxes to monitor Temperature Manufacture By: Log Tag Recorders Ltd., China Available: Available: CVS, PVS
20. MULTI-LOG Model: 30252 – 2C Description: PC Interface with Multi-log Software Measuring Range: - 30°C to +70°C Power source: In-Built Battery Uses: Use in WIC, WIF Manufacture By:RemonsysLimited ,UK Available: Available: CVS, PVS
21. BACK- UP GENERATOR Model:KDF60SS3 Capacity: 50 KVA, 15 KVA Fuel consumption: 10 lit. per hour Purpose: Power back- up at the time of power cut-off Manufactured by: Wuxi Kipor Power CO.LTD. CHINA Available: CVS - 50 KVA, PVS-15 KVA
117 HEALTH LOGISTICS REPORT
22. REFRIGERATED VAN Model:Cooling Unit: Carrier-XARIOS500 Capacity: Gross capacity 19 m3 Refrigerant: R404a Temperature:2 to 8 deg. Celsius. Holdover time: not available Purpose:Transportation of vaccines from CVS to PVS Manufactured by: Cooling Unit: Carrier, USA Body & engine: JAC, China Available: Provincial Vaccine Store (PHLMC)
23. REFRIGERATED VAN Model:Cooling Unit: HT-500ESC Body & engine:1109H-EX2 Capacity:Gross capacity 20 m3 Refrigerant: R404a Temperature: 2 to 8 deg. Celsius. Holdover time: not available Purpose: to transport the vaccines from CVS to PVS & DVS Manufactured by: Cooling Unit: HWASUNG THERMO S. Korea Body & engine: TATA, India Available: Provincial Vaccine Store (PHLMC)
24. REFRIGERATED VAN Model: Cooling Unit: HT-250ESC Body & engine: TATA 407 Capacity: Gross capacity:10 m3 Refrigerant: R404a Temperature: 2 to 8 deg. Celsius. Holdover time: not available Purpose: Transport the vaccines from CVS to PVS & DVS Manufactured by: Cooling Unit: HWASUNG THERMO S. Korea Body & engine: TATA, India Available: Provincial Vaccine Store (PHLMC)
118 HEALTH LOGISTICS REPORT
6. EXPIRED MEDICINES LIST
PROVINCE WISE TOTAL QUANTITIES EXPIRED LIST OF FY 2074/75 AND 2075/76 6) STATE 1 STATE 2 STATE 3 STATE 5 STATE 4 KARNALI (STATE 7) PRADESH S.NO PRODUCTS SUDURPASHCHIM SUDURPASHCHIM PROVINCE (STATE (STATE PROVINCE TOTAL EXPIRED TOTAL AL SUBTOT SUBTOTAL SUBTOTAL SUBTOTAL SUBTOTAL SUBTOTAL SUBTOTAL
COLD CHAIN ACCESSORIES AND SYRINGES 1 Insulin Syringe 0 0 48550 0 64235 16410 0 129195 2 Syringe 2 ml 000024608867300128476 NCASC PROGRAM Determine HIV Test Kits 3 0 0 299600 0 1640 20 0 301260 (PMTCT) Determine HIV-1 / 2 4 0 0 119940 0 4290 0 0 124230 (Complete set) Lopinavir/Ritonavir Oral 5 0 0 12120 000012120 Pellets 40mg/10/mg 6RPR 004848500000484850 7 TPHA Syphilis 0 0 36200000036200 Vacutainer (K3E 7.5 % 8 0 0 35000000035000 0.072 ml ) 3 ml I.V. SOLUTION Compound Sodium Lactate 9 Solution 500 ml (Ringers 0 8270 24 0 748 104 0 9146 Lactate) IMNCI PROGRAM 10 Zinc Sulphate 20 mg Tablet 27000000229860 21159 0 278019 INJECTIONS 11 Water for Injection 5 ml 0 0 88700 0 6345 842 0 95887 LEPROSY PROGRAM 12 Rifampicin 150 mg Capsule 0 0 3300 0 8000 0 0 11300 LIQUID SOLUTION AND POWDER (TOP/DER/EXT USE) Ciprofloxacin 0.3% w / v 13 000085692295 0 10864 Eye / Ear Drops Povidone Iodine Solution 14 00001395 108 0 1503 5% 500 ml MALARIA/KALA-AZAR PROGRAM Diethylcarbamzipine 100 15 000090800 3600 0 94400 mg (DEC) Tablet NIP/VACCINES/IMMUNOLOGICAL AGENTS 16PCV 10 -2 Dose 0000400149204493 NUTRITION PROGRAM Ferrous Sulphate 60 mg 17 + Folic Acid Tab 0.4 mg 0 0 397890 0 26600 30061 0 454551 Tablet RUTF (Ezee Paste Nut) 18 000043161 23748 0 66909 Packet OINTMENT CREAM AND DROP Chloramphenicol Eye 19 00001973001973 Applicab 1% Applicab
119 HEALTH LOGISTICS REPORT
ORAL SOLIDS : TABLETS/CAPSULES 20 Acyclovir 200 mg Tablet 0 0 68440 0 11740 49 0 80229 21 Allopurinol 100 mg Tablet 0000157002300 0 18000 22 Amitriptyline 25 mg Tablet 000019300 4840 0 24140 23 Amlodipine 5 mg Tablet 0 0 22740 0 56660 26000 0 105400 24 Anti Cold Tab 0000203300020330 25 Atenolol 50 mg Tablet 0 0 3900 0 30456 80241 0 114597 Azithromycin 500 mg 26 0 0 1370 0 3463 10 0 4843 Tablet Carbamazepine 400 mg 27 0000134003900 0 17300 Tablet Chlorpromazine 100 mg 28 00009400009400 Tablet Ciprofloxacin Hydrochloride 29 0 0 8100 0 2200 0 0 10300 500 mg Tablet Doxycycline 100 mg 30 0 0 18400 0 750 1200 0 20350 Capsule 31 Doxycycline 100 mg Tablet 0 0 12500 0 2600 3550 0 18650 32 Frusemide 40 mg Tablet 000021270100021370 33 Metformin 500 mg Tablet 000017590108500 0 126090 34 Omeprazole 20 mg capsule 0 0 48000048 35 Oseltamivir 30 mg Capsule 0 0 11710 0 345 0 0 12055 36 Oseltamivir 45 mg Capsule 0 0 10480 0 1495 0 0 11975 37 Pyridoxine 25 mg Tablet 0 0 26280 000026280 38 Tinidazole 500 mg Tablet 0 0 72800 0 6470 0 0 79270 39 Vitamin B Complex Tablets 0 0 14540 0 4120 15000 0 33660 Tuberculosis Program Cycloserine 250 mg 40 0 0 2831000000283100 Capsule 41 Isoniazid 100 mg Tablet 0 0 50900 0 18750 150 0 69800 42 PASER 5.2 g Sachet 0 0 97725000097725 Pyrazinamide 400 mg 43 0 0 33600000033600 Tablet
120 HEALTH LOGISTICS REPORT
7. BIOMEDICAL EQUIPMENTS MAINTENANCE
FEDERAL LEVEL HOSPITAL INVENTORY TILL 4TH PPM PROVINCE
EQUIPMENT DESCRIPTOR SN (ACC. PLAMAHS SYSTEM) 1 2 5 TOTAL SUDUR GRAND KARNALI BAGMATI BAGMATI GANDAKI GANDAKI PASHCHIM PASHCHIM
1 Air conditioner, split type, ceiling mounted 1 1 2 2 Air conditioner, split type, wall mounted 34 41 52 49 8 1 10 195 3 Air conditioner, window type 8 1 2 11 4 Anaesthesia apparatus, Boyle’s 1 4 5 5 Anaesthesia apparatus, EMO, with OMV vaporizer 1 1 6 Anaesthesia apparatus, ventilator 7 7 7 5 4 2 2 34 7 Analyser, biochemistry 5 6 4 6 6 5 3 35 8 Analyser, blood culture 1 1 2 2 6 9 Analyser, blood gas 1 1 4 1 7 10 Analyser, electrolyte 6 5 3 10 2 26 11 Analyser, haematology 4 2 1 9 2 1 3 22 12 Analyser, immunoassay 1 1 2 1 5 13 Analyser, MTB/RIF 1 1 14 Analyser, Na/K 3126 15 Audiometer 3 2 2 7 16 Bilirubinometer 11 17 Bio-safety cabinet 1 2 3 18 Cardiotocography (CTG) machine 2 2 1 5 19 CD4 counter 21111 6 20 Centrifuge, bench type, electric 10 8 8 11 8 4 7 56 21 Coagulometer 11112 6 22 Colonoscope (fiber optic) 1 1 23 Colorimeter 8 7 3 6 6 2 1 33 24 Colposcope 1 1 2 25 CT scanner 1 1 1 3 26 Defibrillator 2 2 6 7 2 1 20 27 Dental chair, electric 1 1 2 4 28 Dental unit, complete 4 4 6 3 2 1 2 22 29 Dialysis machine 5 5 11 21 30 Dialysis water treatment unit 1 1 2 31 Diathermy unit, short wave 1111 15 32 Drill, surgical 3 3 3 1 10 33 Electrocardiograph (ECG), multi-channel 17 12 23 12 8 6 1 79 34 Electrocardiograph (ECG), single-channel 1 2 1 2 6 35 Electroconvulsive therapy (ECT) machine 1 1 2 36 Electroencephalograph (EEG) 1 1 2 37 Electrosurgical unit, argon beamer 2 2 38 Electrosurgical unit, general purpose 10 9 14 10 5 4 2 54 39 ELISA reader 1 1 1 3 40 Endoscope (fiber optic) 2 2 4 4 1 13 41 Endoscopy unit (light source) 5 4 5 7 1 22 42 Endoscopy unit ENT, with monitor 2111 5 43 ENT treatment unit 2 2 4 44 Freezer, electric, chest 1 1
121 HEALTH LOGISTICS REPORT
45 Haemoglobinometer 2 2 46 Incubator, infant, with sensors 1 1 3 1 2 1 9 47 Incubator, laboratory 4 7 3 6 2 2 24 48 Insufflator, endoscopy / laparoscopy 2 2 2 4 1 1 12 49 Interferential therapy apparatus 3 1 1 5 50 Laparoscope (fiber optic) 1 1 1 1 4 51 Laparoscopy unit (light source) 1 2 3 1 1 8 52 Light, dental resin curing 2 2 1 5 53 Light, operating, ceiling mounted 5 7 9 8 2 2 1 34 54 Light, operating, mobile 1 1 6 3 4 15 55 Light, operating, mobile, with battery backup 6 4 2 12 56 Light, operating, mobile, with transformer 6 6 2 2 16 57 Lithotripter, intracorporeal 1 1 2 58 Microscope, binocular 13 8 5 14 6 2 6 54 59 Microscope, ENT 11 60 Microscope, operating 1 3 1 3 8 61 Microscope, ophthalmic 1 1 62 Monitor, fetal heart, ultrasonic, portable 1 1 2 63 Monitor, multiparameter 28 36 101 62 14 10 9 260 64 Monitor, multiparameter, centralized 1 2 3 65 Oven, drying 3 3 1 5 1 3 16 66 Oxygen concentrator 9 15 12 7 6 13 14 76 67 Phototherapy unit 4 8 12 16 2 2 4 48 68 Printer, thermal, for ultrasound scanner 3 7 8 12 4 4 3 41 69 Pulmonary function test unit 1 1 70 Pulse oximeter, with monitor 8 11 4 12 2 3 1 41 71 Pump, infusion 5 5 16 9 2 7 3 47 72 Pump, syringe 9 6 21 11 4 6 1 58 Refrigerator, double door, electric, medium 73 5 6 10 8 2 4 1 36 (150 - 400 liters) 74 Refrigerator, kerosene / electric 1 1 75 Refrigerator, mortuary 2 1 2 5 Refrigerator, single door, electric, medium 76 20 18 8 8 3 1 6 64 (150 - 400 liters) Refrigerator, single door, electric, small 77 15582 122 (below 150 litres) 78 Scaler, ultrasonic 3 3 2 1 1 10 79 Scanner, ultrasonic, colour Doppler 1 1 2 1 5 80 Scanner, ultrasonic, general 1 5 3 8 2 4 2 25 81 Scanner, ultrasonic, portable 1 2 2 1 2 2 10 82 Shaker, mixer 1 1 2 2 6 83 Shaker, roller 1 1 2 84 Shaker, vortex 2 3 6 4 15 85 Sterilizing unit, dry heat 2 2 4 Sterilizing unit, steam, non-vacuum, automatic, M 86 21 3 6 (21 - 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 87 22 2 6 L (above 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 88 1124211324 M (21 - 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 89 3101 11 16 S (up to 20 ltr)
122 HEALTH LOGISTICS REPORT
Sterilizing unit, steam, vacuum, automatic, 90 122 16 L (above 80 ltr) Sterilizing unit, steam, vacuum, automatic, 91 11 M (21 - 80 ltr) Sterilizing unit, steam, vacuum, automatic, 92 22 S (up to 20 ltr) Sterilizing unit, steam, vacuum, basic, 93 31 3 7 L (above 80 ltr) Sterilizing unit, steam, vacuum, basic, 94 32 5 M (21 - 80 ltr) 95 Stimulator, muscle 1 2 1 1 2 7 96 Stimulator, neuromuscular (TENS) 1 4 1 6 97 Suction apparatus, electric 44 39 47 60 25 12 5 232 98 Table, operating, electric 4 2 7 4 1 3 21 99 Table, operating, hydraulic 7 12 1 4 2 1 2 29 100 Therapy unit, ultrasonic 1 2 2 3 4 3 15 101 Tissue processor 1 2 3 102 Traction machine, digital 1111 15 103 Treadmill test (TMT) machine 1 1 104 Tympanometer 1 1 2 105 Ventilator, for emergencies and transport 3 3 1 7 106 Ventilator, intensive care 4 4 12 15 2 3 3 43 107 Warmer, infant, with sensor 9 24 18 19 2 2 11 85 108 X-ray cassette reader, incl. PC 3 21111211 109 X-ray film dryer, automatic 1 1 2 110 X-ray film printer 4 2 1 1 2 1 1 12 111 X-ray film processor, automatic 2 3 1 6 112 X-ray unit, dental 1 1 3 3 1 1 10 113 X-ray unit, dental, panoramic 3 3 114 X-ray unit, mobile 2 3 5 3 3 1 17 115 X-ray unit, mobile, C-arm, image intensifier 2 2 3 2 2 1 1 13 116 X-ray unit, stationary, 300 mA and above 3 3 1 3 3 2 1 16 117 X-ray unit, stationary, below 300 mA 1 1 118 X-ray unit, stationary, DR system 1 1 Total 382 459 538 547 187 130 144 2387 Note: Yellow Highlight are those equipment descriptor which was removed from BoQ after the 1st PPM cycle
123 HEALTH LOGISTICS REPORT
PROVINCIAL LEVEL HOSPITAL INVENTORY TILL 4TH PPM PROVINCE
EQUIPMENT DESCRIPTOR SN (ACC. PLAMAHS SYSTEM) 1 2 5 TOTAL SUDUR GRAND KARNALI BAGMATI BAGMATI GANDAKI GANDAKI PASHCHIM PASHCHIM
1 Air conditioner, split type, wall mounted 31 45 40 22 142 16 75 371 2 Air conditioner, window type 3 1 5 9 3 Anaesthesia apparatus, Boyle's 3 2 2 2 1 10 4 Anaesthesia apparatus, EMO, with OMV vaporizer 1 1 1 1 4 5 Anaesthesia apparatus, ventilator 7 3 5 6 13 4 11 49 6 Analyser, biochemistry 38 10 18 26 50 30 25 197 7 Analyser, blood culture 44 8 Analyser, blood gas 1 2 4 1 8 9 Analyser, electrolyte 16 4 4 11 11 8 8 62 10 Analyser, haematology 13 9 6 10 19 10 11 78 11 Analyser, immunoassay 1 1 4 1 7 12 Analyser, MTB/RIF 1 2 1 4 13 Analyser, Na/K 2 16 2 4 24 14 Arthroscope (fiber optic) 1 1 15 Audiometer 42 6 16 Bilirubinometer 2 1 3 17 Bio-safety cabinet 2 2 18 Cardiotocography (CTG) machine 2 2 2 6 19 CD4 counter 1 1 1 2 3 2 5 15 20 Centrifuge, bench type, electric 50 21 26 31 63 37 39 267 21 Centrifuge, haematocrit 3 3 6 22 Coagulometer 1 2 4 1 8 23 Colonoscope (fiber optic) 1 1 1 3 24 Colorimeter 39 18 9 22 42 32 23 185 25 CT scanner 1 1 26 Defibrillator 4 1 2 3 7 4 5 26 27 Dental chair, electric 1 1 2 1 4 1 10 28 Dental chair, hydraulic 1 2 1 4 29 Dental unit, complete 13 5 9 8 12 6 7 60 30 Dialysis machine 4 2 6 4 4 20 31 Dialysis water treatment unit 1 1 2 4 32 Diathermy unit, short wave 1 1 1 2 5 33 Drill, surgical 1 1 5 1 8 34 Electrocardiograph (ECG), multi-channel 53 19 24 31 57 42 30 256 35 Electrocardiograph (ECG), single-channel 3 3 2 8 36 Electrosurgical unit, general purpose 28 10 7 13 32 21 22 133 37 Electrosurgical unit, ophthalmology 1 1 38 ELISA reader 2 1 3 39 Endoscope (fiber optic) 111113 8 40 Endoscopy unit (light source) 2 1 1 2 12 7 2 27 41 Endoscopy unit ENT, with monitor 1 1 2 42 ENT treatment unit 11 43 Freezer, electric, chest 2 2 3 7 4 18 44 Freezer, electric, upright 2 1 1 4
124 HEALTH LOGISTICS REPORT
45 Haemoglobinometer 11 46 Incubator, infant, transport 1 1 21117 47 Incubator, infant, with sensors 8 1 3 2 6 3 6 29 48 Incubator, laboratory 27 9 12 16 23 13 17 117 49 Insufflator, endoscopy / laparoscopy 1 1 3 2 1 8 50 Interferential therapy apparatus 2 3 2 7 51 Laparoscope (fiber optic) 1 1 52 Laparoscopy unit (light source) 1 2 3 53 Light, dental resin curing 2 3 3 1 9 54 Light, operating, ceiling mounted 14 4 7 6 27 5 6 69 55 Light, operating, mobile 7 5 11 4 30 21 25 103 56 Light, operating, mobile, with battery backup 30 11 3 10 23 27 11 115 57 Light, operating, mobile, with transformer 20 1 1 15 5 1 43 58 Microscope, binocular 48 23 24 26 69 44 31 265 59 Microscope, ENT 314 60 Microscope, operating 1 1 2 61 Microscope, ophthalmic 2 3 1 6 62 Monitor, cardiac pulse rate, mobile 1 1 2 63 Monitor, fetal heart, ultrasonic, portable 2 3 2 19 2 4 32 64 Monitor, multiparameter 60 75 45 41 146 60 66 493 65 Monitor, multiparameter, centralized 1 2 3 66 Oven, drying 31 6 16 17 23 21 21 135 67 Oxygen concentrator 99 40 40 58 94 85 42 458 68 Phototherapy unit 28 12 11 16 34 10 7 118 69 Printer, thermal, for ultrasound scanner 28 14 15 17 35 24 15 148 70 Pulmonary function test unit 1 1 2 71 Pulse oximeter, with monitor 14 11 7 6 30 8 20 96 72 Pump, infusion 6 9 5 7 28 9 9 73 73 Pump, syringe 9 16 5 2 35 3 12 82 Refrigerator / freezer, solar powered 74 213 (complete system) Refrigerator, double door, electric, 75 22 4 large (above 400 liters) Refrigerator, double door, electric, 76 11 8 3 11 19 10 12 74 medium (150 - 400 liters) 77 Refrigerator, kerosene / electric 2 2 1 1 6 78 Refrigerator, mortuary 213 Refrigerator, single door, electric, 79 45 21 24 17 74 20 35 236 medium (150 - 400 liters) Refrigerator, single door, electric, 80 18 15 16 18 22 15 15 119 small (below 150 litres) 81 Scaler, ultrasonic 11 5 7 7 3 3 36 82 Scanner, ultrasonic, colour Doppler 1 1 1 2 1 2 8 83 Scanner, ultrasonic, general 27 11 11 14 19 17 13 112 84 Scanner, ultrasonic, portable 7 4 3 6 18 8 6 52 85 Shaker, mixer 6 1 3 5 15 4 7 41 86 Shaker, roller 1 2 9 1 5 18 87 Shaker, vortex 13 4 3 3 1 4 2 30 88 Sterilizing unit, dry heat 11 3 1 2 17 Sterilizing unit, steam, non-vacuum, automatic, 89 212510 L (above 80 ltr) Sterilizing unit, steam, non-vacuum, automatic, 90 62510241957 M (21 - 80 ltr)
125 HEALTH LOGISTICS REPORT
Sterilizing unit, steam, non-vacuum, basic, 91 133 13 1 113 L (above 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 92 36 19 20 19 19 27 15 155 M (21 - 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 93 30 12 10 13 34 14 10 123 S (up to 20 ltr) Sterilizing unit, steam, vacuum, automatic, 94 11417 L (above 80 ltr) Sterilizing unit, steam, vacuum, automatic, 95 1 1211 6 M (21 - 80 ltr) Sterilizing unit, steam, vacuum, automatic, 96 11125 S (up to 20 ltr) Sterilizing unit, steam, vacuum, basic, 97 22 L (above 80 ltr) 98 Sterilizing unit, steam, vacuum, basic, M (21 - 80 ltr) 1 2 3 99 Stimulator, muscle 2 8 4 4 2 20 100 Stimulator, neuromuscular (TENS) 1 2 3 101 Suction apparatus, electric 110 51 56 70 176 72 66 601 102 Table, operating, electric 1 2 2 4 11 2 2 24 103 Table, operating, hydraulic 18 12 10 8 32 24 27 131 104 Therapy unit, ultrasonic 2 2 3 7 105 Tissue processor 11 106 Traction machine, digital 2 1 2 2 1 8 107 Treadmill test (TMT) machine 1 1 108 Tympanometer 11 109 Ventilator, for emergencies and transport 1 1 1 2 1 6 110 Ventilator, infant 2 2 1 5 111 Ventilator, intensive care 1 4 4 3 28 7 6 53 112 Warmer, infant, with sensor 47 50 28 34 76 35 42 312 113 X-ray cassette reader, incl. PC 7 3 5 3 12 6 3 39 114 X-ray film dryer, automatic 1 2 3 115 X-ray film printer 7 3 3 5 11 9 3 41 116 X-ray film processor, automatic 7 2 2 6 5 2 3 27 117 X-ray unit, dental 10 5 6 7 9 4 4 45 118 X-ray unit, mobile 15 9 5 12 23 15 8 87 119 X-ray unit, mobile, C-arm, image intensifier 122252216 120 X-ray unit, stationary, 300 mA and above 15 9 7 6 19 10 11 77 121 X-ray unit, stationary, below 300 mA 5 1 6 6 4 5 3 30 122 X-ray unit, stationary, DR system 1 1 1 3 Total 1223 682 639 769 1884 928 915 7040 Note: Yellow Highlight are those equipment descriptor which was removed from BoQ after the 1st PPM cycle
126 HEALTH LOGISTICS REPORT
LOCAL LEVEL HOSPITAL INVENTORY TILL 4TH PPM PROVINCE
EQUIPMENT DESCRIPTOR SN (ACC. PLAMAHS SYSTEM) 1 2 5 TOTAL SUDUR GRAND KARNALI BAGMATI BAGMATI GANDAKI GANDAKI PASHCHIM PASHCHIM
1 Air conditioner, split type, wall mounted 12 1 6 1 20 2 Anaesthesia apparatus, EMO, with OMV vaporizer 1 1 3 Anaesthesia apparatus, ventilator 1 1 4 Analyser, biochemistry 4 3 8 3 1 2 4 25 5 Analyser, electrolyte 1 2 4 1 8 6 Analyser, haematology 2 3 4 9 7 Analyser, MTB/RIF 1 1 8 Analyser, Na/K 11 9 Centrifuge, bench type, electric 8 6 12 4 1 3 7 41 10 Centrifuge, haematocrit 1 1 11 Colorimeter 4 7 5 3 2 5 8 34 12 Defibrillator 1 1 13 Dental chair, electric 3 2 5 14 Dental unit, complete 3 1 4 15 Electrocardiograph (ECG), multi-channel 7 5 12 3 2 2 4 35 16 Electrocardiograph (ECG), single-channel 1 1 2 17 Electrosurgical unit, general purpose 3 3 1 7 18 ELISA reader 1 1 19 Endoscopy unit (light source) 1 1 20 Freezer, electric, chest 2 2 1 1 5 11 21 Freezer, electric, upright 1 1 22 Freezer, kerosene / electric, chest 1 1 23 Incubator, infant, with sensors 1 1 2 24 Incubator, laboratory 2 2 3 1 1 2 11 25 Light, operating, ceiling mounted 2 2 4 26 Light, operating, mobile 1 1 4 1 3 10 27 Light, operating, mobile, with battery backup 2 1 3 28 Light, operating, mobile, with transformer 1 2 1 3 7 29 Microscope, binocular 7 9 12 1 3 2 10 44 30 Monitor, fetal heart, ultrasonic, portable 1 2 3 1 7 31 Monitor, multiparameter 7 2 13111833 32 Oven, drying 2 2 5 1 1 2 3 16 33 Oxygen concentrator 5 5 14 3 3 2 8 40 34 Phototherapy unit 1 3 5 1 1 1 12 35 Printer, thermal, for ultrasound scanner 3 1 3 1 1 3 12 36 Pulmonary function test unit 1 1 37 Pulse oximeter, with monitor 1 2 3 4 1 11 Refrigerator, double door, electric, 38 13 2 39 medium (150 - 400 liters) 39 Refrigerator, kerosene / electric 2 2 4 Refrigerator, single door, electric, 40 433 13317 medium (150 - 400 liters) Refrigerator, single door, electric, 41 2 3 12 1 3 21 small (below 150 litres) 42 Scaler, ultrasonic 3 1 4 43 Scanner, ultrasonic, general 3 1 5 1 2 3 15
127 HEALTH LOGISTICS REPORT
44 Scanner, ultrasonic, portable 2 1 2 5 45 Shaker, mixer 1 1 3 2 1 8 46 Shaker, roller 1 1 2 47 Shaker, vortex 1 1 2 48 Sterilizing unit, dry heat 2 4 3 9 Sterilizing unit, steam, non-vacuum, automatic, 49 11 M (21 - 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 50 33 L (above 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 51 4644 321 M (21 - 80 ltr) Sterilizing unit, steam, non-vacuum, basic, 52 1584422 S (up to 20 ltr) Sterilizing unit, steam, vacuum, automatic, 53 11 L (above 80 ltr) 54 Sterilizing unit, steam, vacuum, basic, M (21 - 80 ltr) 1 1 55 Suction apparatus, electric 11 18 18 5 4 2 4 62 56 Table, operating, electric 1 1 2 57 Table, operating, hydraulic 1 3 1 5 58 Ventilator, intensive care 1 1 59 Warmer, infant, with sensor 6 4 10111831 60 X-ray cassette reader, incl. PC 1 3 2 1 1 8 61 X-ray film dryer, automatic 11 62 X-ray film printer 2 2 2 1 1 8 63 X-ray film processor, automatic 1 2 3 64 X-ray unit, dental 1 3 1 5 65 X-ray unit, mobile 12221 513 66 X-ray unit, mobile, C-arm, image intensifier 1 1 67 X-ray unit, stationary, 300 mA and above 2 1 4 2 1 2 12 68 X-ray unit, stationary, below 300 mA 4 3 1 8 69 X-ray unit, stationary, DR system 1 1 Total 131 126 231 53 39 36 114 730 Note: Yellow Highlight are those equipment descriptor which was removed from BoQ after the 1st PPM cycle
128 HEALTH LOGISTICS REPORT
8. GAZZETE NOTICE FOR DRUG PRICE
g]kfn /fhkq v08 ^%_ ;+Vof !@ g]kfn /fhkq efu % ldlt @)&@.$.!* ;"rgf @ g]kfn;/sf/,dlGqkl/ifb\sf@ ldlt@)&@.)#.@!sf@ lg0f{on@ cf}iflwP]g,@)#%sf@bkmf@^n@lbPsf@clwsf/k|of]uu/Lb]xfosf tflnsf !/@dfpNn]vePadf]lhdsfcf}iflwsfclwstdv'b|f d"No tf]s]sf]n of@;"rgf;j{;fwf/0fsf hfgsf/Lsfnflu ksfzg| ul/Psf@ 5. tflnsf! jl9k|rngdf/x]sf!*pTkfbgx?sftf]lsPsfclwstdv'b|fd"No l;=g= cf}iflw PsfO d"No÷PsfO -g]=?=_ ! Cefpodoxime 200 mg Tablet/Capsule @%.– @ Amoxycillin 500 mg Tablet/Capsule *.– # Amoxycillin 250 mg Tablet/Capsule %.– $ Azithromycin 500 mg Tablet/Capsule #).– % Azithromycin 250 mg Tablet/Capsule !&.$% ^ Cefixime 200 mg Tablet/Capsule @).– & Ceftriaxone 1g Inj Vial/Ampoule ().– * Ceftriaxone 500 mg Inj Vial/Ampoule ^).– ( Ciprofloxacin 500 mg Tablet/Capsule *.–
Fluconazole 150 mg Tablet/Capsule !) @$.– 129 HEALTH LOGISTICS REPORT
v08 ^%_ ;+Vof !@ g]kfn /fhkq efu % ldlt @)&@.$.!*
!! Levonorgestrol 150 mcg Tablet/Capsule *).– tab or 2 tablets of levonorgestrol 75 mg
!@ Nimesulide 100 mg Tablet/Capsule #.– !# Ofloxacin 400 mg Tablet/Capsule *.– !$ Omeprazole 20 mg Tablet/Capsule $.– !% Pantoprazole 40 mg Tablet/Capsule *.– !^ Tinidazole 500 mg Tablet/Capsule %.– !& Levofloxacin 750 mg Tablet/Capsule !%.– !* Combination of Paracetamol Tablet/Capsule with Chlorpheniramine, and
Phenylepherine or pseudoephedrine (Anticold Tablets/Capsules) #.– tflnsf @ SofG;/ nufot lbw{/f]u pkrf/df k|of]udf /x]sf &* pTkfbgx?sf tf]lsPsf clwstd v'b|fd"No l;=g= cf}iflw PsfO d"No÷PsfO-g]=?=_
! Amlodipine 2.5 mg Tablet/capsule @.#) @ Amlodipinne 5 mg Tablet/capsule %.– # Amlodipine 10 mg Tablet/capsule *.– $ Losartan 25 mg Tablet/capsule $.$! % Losartan 50 mg Tablet/capsule &.^) ^ Atorvastatin 5 mg Tablet/capsule ^.&%
130 HEALTH LOGISTICS REPORT v08 ^%_ ;+Vof !@ g]kfn /fhkq efu % ldlt @)&@.$.!*
& Atorvastatin 10 mg Tablet/capsule !).&* * Atorvastatin 20 mg Tablet/capsule @).^) ( Enalapril 2.5 mg Tablet/capsule @.#) !) Enalapril 5 mg Tablet/capsule $.– !! Enalapril 10 mg Tablet/capsule &.– !@ Metoprolol 12.5 mg Tablet/capsule @.() !# Metoprolol 25 mg Tablet/capsule $.– !$ Metoprolol 50 mg Tablet/capsule %.#) !% Metformin 500 mg Tablet/capsule @.–
!^ Metformin 1000 mg tab Tablet/capsule ^.– !& Glimepride 1 mg Tablet/capsule %.#) !* Glimepride 2 mg Tablet/capsule *.^) !( Glimepride 3 mg Tablet/capsule !!.@) @) Pioglitazone 15 mg tab Tablet/capsule ^.%) @! Pioglitazone 30 mg tab Tablet/capsule !).*) @@ Amityptalline 10 mg Tablet/capsule @.$) @# Amityptalline 25 mg Tablet/capsule #.*) @$ Imipramine 25 mg tab Tablet/capsule !.#@ @% Imipramine 75 mg Tablet/capsule #.– @^ Lorazepam 1 mg Tablet/capsule @.–
131 HEALTH LOGISTICS REPORT
v08 ^%_ ;+Vof !@ g]kfn /fhkq efu % ldlt @)&@.$.!*
@& Lorazepam 2 mg Tablet/capsule @.*) @* Alprazolam 0.25mg tab Tablet/capsule !.&) @( Alprazolam 0. 5mg Tablet/capsule #.$)
#) Carboplatin 150 mg injection !#(#.*&
#! Carboplatin 450 mg injection $!#).&&
#@ Chlorabucil 2 mg tablet &(.*(
## Cisplatin 10 mg injection !$(.*&
#$ Cisplatin 50 mg injection %#@.@! #% Cyclophosphamaide 50 mg tablet ^.^@
#^ Cyclophosphamaide 500 mg injection !)%.@#
#& Cytosine Arabinoside 100 mg /vial injection $@!.@#
#* Cytosine Arabinoside 500 mg /vial injection (!).&$ #( Cytosine Arabinoside 1000 mg /vial injection @)^*.–
$) Dacarbazine 500 mg injection !*!&.(*
$! Danazol 50 mg capsule !^.%$
$@ Danazol 100 mg capsule #%.()
$# Daunorubicin 20 mg injection %(@.!*
$$ Doxorubicin 10 mg injection #@*.–
132 HEALTH LOGISTICS REPORT v08 ^%_ ;+Vof !@ g]kfn /fhkq efu % ldlt @)&@.$.!*
$% Doxorubicin 50 mg injection !$!^.@*
$^ Etoposide 100 mg capsule (@.$)
$& Etoposide 100 mg/5 ml injection #@).@&
$* Flutamide 250 mg table !%.@@
$( 5 flurouracil 250 mg/ 5 ml Injection / ml #.^*
%) Gemcitabin 200 mg injection !&)^.(#
%! Gemcitabin 1000 mg injection ((*).–
%@ L- asparginase 500 KU injection !(@!.#*
%# Mercaptopurine 50 mg tablet !%.&*
%$ Imatinib 100 tablet !%$.&$
%% Imatinib 400 tablet $&$.)#
%^ Ifosamide 1 gm/2ml injection ^)(.@^
%& Methotraxate 50 mg/ml Injection/ml %*.^@
%* Methtraxate 2.5 mg tablet *.#$
%( Mensa 200 mg Injection/ml $#.$!
^) Mitomycin c 10 mg injection &)@.#%
^! Oxaliplatin 50 mg /vial injection $)#%.*^
^@ Paclitaxel 30 mg/5 ml injection %!^.!*
^# Procarbazine 50 mg capsule %%.*(
^$ Tamoxifen 10 mg tablet &.^*
^% Tamoxifen 20 mg tablet $.()
133 HEALTH LOGISTICS REPORT
v08 ^%_ ;+Vof !@ g]kfn /fhkq efu % ldlt @)&@.$.!*
^^ Vinblastin 10 mg/ pack injection %)#.#!
^& Vincristin 1 mg / ml injection *(.#(
^* Melphalan 2 mg tablet !(!.&#
^( Melphalan 5mg tablet #@!.^#
&) Azathioprine 50 mg tablet !&.$&
&! Cyclosporine 25 mg capsule $#.&!
&@ Cyclosporine 50 mg capsule *%.@%
&# Cyclosporine 100 mg capsule !*&.&*
&$ Cyclosporine 100 mg/ml Injection/ml @)(.^)
&% Actinomycin D 0.5 mg injection (#%.$$
&^ Alpha Interferon 3 MIU injection !#$@.)*
Bleomycin 15 mg Injection/ml && !)**.#@
&* Busulphan 2 mg tablet ^.)#
cf1fn], /3'/fd lji6 g]kfn ;/sf/sf lg= ;lrj
134 HEALTH LOGISTICS REPORT
9. STORE MANAGEMENT INSTRUCTION
135 HEALTH LOGISTICS REPORT
10. GREIVANCE HANDLING AND READDRESSAL MECHANISM REPORT
GOVERNMENT OF NEPAL
MINISTRY OF HEALTH & POPULATION DEPARTMENT OF HEALTH SERVICES
MANAGEMENT DIVISION
LOGISTIC MANAGEMENT SECTION
ANNUAL REPORT ON GRIEVANCES RECEIVED AND RESOLVED VIA THE WEB BASED
GRIEVANCE HANDLING AND REDRESSAL MECHANISM (GHRM)
136 HEALTH LOGISTICS REPORT
Yearly Report from 2018/07/1717 to 2019/07/16
S. NO RECEIVING OFFICE DETAILS NO.
1. Grievances received within the report period
Web 5
Written Letter 32
Walk-in-verbal 16
2. Grievances received based on Office Category
Head Office 5
3. Received Grievance and its Category
Free medicine is not available 2
Irregularities in procurement 49
Overstock and Expired Medicine 1
Unavailability and poor status of Equipment 1
4. Resolved Grievance and its Category
Free medicine is not available 2
Irregularities in Procurement 49
Overstock and Expired Medicine 1
Unavailability and poor status of Equipment 1
5. Average Time Taken to Resolve the Grievance {Category wise}
Free medicine is not available 4
Irregularities in procurement 37
Overstock and Expired Medicine 2
Unavailability and poor status of Equipment 2
6. Cumulative No of Public Users Accessing the GHRM webpage 7
Note: The average no. of days taken to resolve the grievances registered under irregularities in procurement and corruption as shown is 37. As, all of the grievances received under above category were via written letter (which were resolved manually on time) but were registered and maintained in GHRM system latter on, so the average time taken to accomplish grievances under irregularities in procurement is shown high by the GHRM system.
137 HEALTH LOGISTICS REPORT
TYPE REGISTRATION NO. DETAILS REG. DATE Amendment requested for point 2019-06-07 no.3.11, 3.16 and 3.13 of original requirements of tender published for Apheresis Machine. Amendment requested are that The instrument should have a support of a sealer to close and Grievance in 07-2019-RPKIQM separate the product bag, the instrument 2019-06-07 procurement should have built-in centrifuge temperature sensor (important to maintain hematocrit)/ adjustable and The instrument should have a printing facility to get procedure data respectively for point no.3.11, 3.16 and 3.13. Amendment requested for point Original no.1.1, 3.5(b), 3.5(e), 3.7 of requirements of tender published for Apheresis Machine. Amendment requested is that the instrument should be based on continuous Flow Blood Cell Separator Grievance in for platelet both single/double needle 07-2019-AOPP5K 2019-06-07 procurement technique, RBC exchange with automated fluid balance controlled system, Bone marrow processing and The system should have built in CCD camera for high interphase detection respectively for point no. 1.1, 3. 5 (b), 3.5(e) and 3.7. Amendment requested for point no.15 of 2019- 06-07 tender published for Water Management Grievance in System. Amendment requested is that Water 07-2019-WMPMYJ 2019-06-07 procurement Shredder required integrated or non integrated system in one or two separate vessel for shredding and sterilization Amendment requested in point no.5 & 24 of original requirements of tender published for Grievance in Water Management System. Amendment 07-2019 WSGX4O 2019-06-07 procurement requested are Load Capacity higher than 20kg/ hr and with water recycling system respectively for point no.5 & 24 Amendment requested in point no.4 of 2019- 06-07 original requirements of tender published Grievance in 07-2019- OQIZRO for Water Management System. Amendment 2019-06-07 procurement requested is that Sterilization temperature should be higher than 721 degree celsius or more The bid accepted for the Tender of Phototherapy Machine (DOHS/G/ICB8.6lcHDl2075-76), Grievance in 07-2019-2UMUN7 whose rate was 37,60,000.00 is lacking Valid 2019-06-07 procurement European CE. So, the request is made to revise the decision of acceptance of bid Grievance in Clarification on the CE Certificate submitted 07-2019-ZBCBMZ 2019-06-07 procurement by IWs Medi Waves Inc., Delhi. Amendment requested in the point no.47 of original requirements of tender published for High end Ultrasound with Real Time Shear Elastography Contrast Wave Imaging, which says and that Transducers: Following Grievance in 07-2019-VTKYDM transducers sholuld be offered with transducers 2019-06-07 procurement must have Shear wave Elastography imaging mode the system (All available): Curved Array 1-6 MHzllllMlcroconvex Probe 3-I2 MHz. Amendment requested here is that Micro Convex Probe 4-8 MHz.
138 HEALTH LOGISTICS REPORT
Amendment requested in the point no.35 of original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast Imaging equipment, which says that System should Grievance in have real time simultaneous imaging mode 07-2019-SRP5QF 2019-06-07 procurement that combines three modes- B-mode, SWE and rrr-micro vascular Color flow imaging modes- to visualize anatomy, tissue stiffness and blood flow simultaneously to improve the workflow. Amendment requested is that Micro vascular color mode should be removed. Amendment requested in the point no.33 of original requirements of tender published for: High end Ultrasound with Real Time Shear Elastography and Contrast Imaging, (during: the pre-bid meeting held on 7th June 2019,). The respective point in original requirements says Grievance in 07-20I9-TSQJAS that Shear wave Elastography Quantification 2019-06-07 procurement tool (Elllipse and trace) should be able to provide Mean, Max & Min; elasticity values of the tissues in both m/s and kPA(KiloPascal) on all transducers and the amendment requested is that should be allowed in shear wave transducer only Amendment requested in point no.30 of original requirements of tender published for High End Ultrasound with Real Time Shear Wave Elastography and Contrast Imaging Grievance in 07-209-IJHORD Equipment, during pre-bid meeting held on 7th 2019-06-07 procurement jun of 2019, which states that system should be able to generate a color coded shear wave elastogram with a reference Adjustable Numerical elasticity scale for all the applications Amendment requested in point no.28 of 2019-06-07 original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast Grievance in Imaging equipment, which says that Real time 07-2019-URZLPl 2019-06-07 procurement Shear Wave tissue elastography imaging with Convex, Linear, Micro convex, Hockey Stick, Endo cavitary & 3D transducers wherein Only convex probe for real time shear wave should be amended. Amendment requested in point no.25 of original requirement of tender published for High end Ultrasound with Real Time Shear wave Grievance in 07-2019-6ZRKQC procurement Elastography And Contrast Imaging, which Grievance in 07-2019-6ZRKQC says the system should have facility of direct 2019-06-07 procurement storage and retrieval of B/W' and color images in both frozen and cine loops in the inbuilt hard disk drive. In-built hard disk storage capacity of 1TB or more to be changed to In-built hard disk storage of storage capacity of 500G8 or more.
139 HEALTH LOGISTICS REPORT
Amendment requested in point No.13 of original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast system should have Imaging, which says Panoramic Imaging Grievance in with at least 60cm of scanning length. It should 07-2019-WD6YD6 2019-06-07 procurement have skin line scaling markers, cuwed distance measurement tool and Zoom, pan, Rotate & Trim Facility to trim panoramic images from start or end of the panoramic capture to be changed to system should have panoramic imaging with at least 25-30 cm. Amendment requested in point no.11 of 2019- 06-07 original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast Imaging, which says the system should have advanced Grievance in color Doppler facility to position at least three 07-2019-FRJT9M 2019-06-07 procurement spectrograms (online or offline) on a single image within the same cardiac cycle to simplify the workflow and reduce the examination time should be changed to system should have advance color Doppler position at least two spectrogram. Amendment requested regarding the point no.10 of original requirements of tender published for High end Ultrasound with Real Grievance in 07-2019-VFTR8V Time Shear wave Eastography and Contrast 2019-06-07 procurement Imaging, which says the system should have a frame rate on receive of over 5000 frames per second or more should be 250125001400. Amendment requested during the Pre-bid meeting held on 7th June of 2019 requesting Grievance in point no.6 original amendment requirement O7-2019-SCCVUJ 2019-06-07 procurement (which says system should have 60000 or more digital processing channels) to be made to be above 4500000 and Massive parallel beaming. Amendment requested during Pre-bid meeting held on 7th of June 2019 regarding the removal Grievance in of 3D imaging mode mentioned in the point no.4 07-2019-LAPBTC 2019-06-07 procurement of original requirements of Tender Published for High end Ultrasound Real Time Shear wave Elastography and Contrast Imaging Grievance in O4-2OI9-TKLDER Biasness in specification. 2019-04-28 procurement Request for amendment of technical 2419-02-21 specifications of portable ultrasound machine Grievance in (amendment of the clauses, mentioned in the 03-2O19-KACVAI 2019-02-27 procurement attachment below, in the technical specification of slice no.44. Portable USG Machine for more participation and benefit of the hospital. Request for amendment of some technical Grievance in 03-2O19-VZKBNK specification so some equipment which details 2019-03-05 procurement are as provided in. the attachment below. Clarifications to be provided regarding some specifications related to Request for Grievance in 03-2019-AXJLlS tender enquiry vide(ICB) IFB No: DOHS/ 2019-03-05 procurement GACB.44ILMDI2O75-76. As mentioned in the attatchment below.
140 HEALTH LOGISTICS REPORT
Grievance in Request for amendment of the clauses in IFB 03-2019-CZQDWF 2019-03-05 procurement No : DOHS?G?ICB-44 /LMD/2075-76 Request for amendment of specifications to be Grievance in 03-2019-ECZ4BY made in order for Konica Minolta DR Systems 2019-03-05 procurement be able to bid. Grievance in Request to amend some points in specification 03-2019-ENIG6E 2019-02-28 procurement regarding tender of Electro Convulsive Therapy. Grievance in Request to amend specifications regarding the 03-2019-2ZOVEF 2019-03-05 procurement tender No: IBF No DOHS/G/ICB/44.1/LMD Request regarding amendment in specification Grievance in 03-2019-BMSVQI of Platelets Aheresis (DOHS/G/ICB -44.7 ILI|/.D 2019-03-05 procurement I 207 5 -7 6) Pre-bid amendment request regarding the Grievance in tender No: DOHS/G/ICB-44.1/LMD/ 2075-76 03-2019-GRXTYI 2019-02-27 procurement FOR USG Machine Portable Color Doppler27 Nos. Request for amendment of specifications regarding the tender published on date ebruary-1 2019 of International Competitive Grievance in Bidding (ICB),IFB No: DOHS/G/ICB/44.1/ 03-2019-U2NQKF 2019-03-05 procurement LMD/2075-76 for procurement of medical equipment, some points in the compliance of needs to be revised so that most of the bidder can participate in the bidding process. Request to make some revision in some points of compliance sheet of following mentioned slices of International Competitive Bidding Grievance in 03-2019-EOKTSK (ICB), IFB No: DOHS/G/ICB/44/LMD/2075- 2019-03-05 procurement 76 for procurement for medical Equipment so that most of the bidder can participate in the bidding process. Grievance in Amendment Request for Monitor Tender 03-2019-PMB6L1 2019-03-05 procurement Specification. Grievance in Amendment Request UCG Machine Portable 03-2019-OKJR46 2019-03-05 procurement Color Doppler. Request for change in the specifications Grievance in 03-2019-XXXAQO Ref: DOHS/G/I CB-44.1/LMD/2076-76 USG 2019-03-05 procurement MACHINE COLOR DOPPLER-27) Request for change in the specifications Ref: Grievance in 03-2019-HIUZJW DOHS/G/ICB-44.9/LMD / 2075 -76 (F1at Panel 2019-03-05 procurement Detector Systems-5)
141 HEALTH LOGISTICS REPORT
11. AUCTIONING REPORT + = %) } lkmot s ] =kmf=g lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL d=n ] ] ] ] ] ] ] ] ] ] ] ] ] ] { sf/0f ] udf gcfpg ] udf gcfpg ] udf gcfpg ' { kg { x? ] udf gcfpg ] udf gcfpg ] udf gcfpg | of | of | of ' g g;Sg ' g g;Sg ' g g;Sg ' g g;Sg ' g g;Sg ' g g;Sg ' g g;Sg " hf | of | of | of { k { t x { t x { t x { t x { t x { t x { t x { dd { t u/L k { t u/L k { t u/L k ] dd ] dd ] dd ] dd ] dd ] dd { t u/L k { t u/L k { t u/L k { ÷ldgfxf ug ' /fgf ' /fgf ' /fgf ' /fgf ' /fgf ' /fgf l/Psf kf6 ] l/Psf ] , dd ] , dd ] , dd { dd { dd { dd km } k } k } k } k } k } k { 6gf eO ] / ] / ] / ] / ] / ] / ' 3 ] eO ] eO ] eO w w w w w w b { ePsf { ePsf { ePsf lhG;L lg;u ' /fgf ' /fgf ' /fgf k k k hL0f hL0f hL0f 0 0 . 0 ' dflgt 7 200.00 200.00 200.00 200.00 " No 4 , ] cg d 96,140.00 96,140.00 55,000.00 55,000.00 55,000.00 55,000.00 96,140.00 55,000.00 55,000.00 30,250.00 7 5 6 xfnsf 2, 2, 2, 2,
] ] ] ] ] ] ] ] ] ] ] ] ] " No ] sf ] sf ] sf ] sf ] sf ] sf ] sf ] sf ] sf ] sf ] sf ] sf ] sf ' n ' n ' n ' n ' n ' n ' n ' n ' n ' n ' n ' n ' n gv gv gv gv gv gv gv gv gv gv gv gv gv k/n d - 1 1 1 1 1 1 1 1 1 1 1 kl/df0f { ] ] ] ] ] ] ] { ' /fgf ' /fgf ] / tkm ' /fgf ' /fgf ' /fgf ' /fgf ' /fgf ] jif ] ] ] sf ] sf { ÷ldGxf kmf/fd ' n ' n ,, { eGbf k { eGbf k { eGbf k { eGbf k { eGbf k gv gv { eGbf k { eGbf k ] u ePsf hg/n :6f | of cf=j= @)&#÷)&$ k @) jif @) jif @) jif @) jif @) jif ] ] ] ] lhG;L lg;u ] sf + :yfaf6 ' n ,, ,, ,, @) jif ,, ,, @) jif | fKt ldlt { cfPsf { cfPsf [ ; 2043 29 1 gv | fKt ePsf ' ? k eO eO k bft z @)^@ df cNof @)^@ df cNof @)^@ df cNof { { ] ] w eO ' /fgf ' /f | fKt_ ] kl/;/df ] k « s ] 6/;fOsn ' g g;ls lkmtf { 5fl8Psf ] ;g « lksn { t x } + 8faf6 cg { sn ] 6f } ifwfnosf ' h/ hLk ' jx? cf=j= fKt uf8Lsf k | fKt uf8Lsf ' o ] cj:yfsf fKt 6f6f 6 | fKt 6f6f { k ] l;lkms H2SJPWX | ] af6 dd ' qm/fh 6 ] 6/ ;fO :k ' /fgf ' jfaf6 NofO F S; jfOug ' gfgL cf ] G; ] { zgfno x \ lkmtf df ' n { sn ] 6f Nof08qm / lj/f6gu/af6 lnnfdL ] / lj/f6gu/af6 DT ] of { x?, 6fo/ 6 « s « s ] a; e ] tyf o | f hLk ^^–!–!!%@ ofdfxf df ] ^^–!–!!%@ " hf | f PDa 6f hLk -z ] 6f ] = :6f ] hgsf nflu k { k { t kZrft ] Gb ] Gb ] sf ] 6/ ;fO ] of 08f PS;=Pn=!@% ] 08f ] = :jf= lgb ] =d | of | fKt 6f cfPsf @)&@÷&# ;Ddsf k /x kf6 xf 6f6f 6 6f6f 6 df ofdfxf dx dfOqmf hLk hLK;L 6f c:ktfnaf6 k If lh=:jf=sf= /; lh=:jf=sf= sfe k If dd dx L(HJGK HJPKXH2SJPWX L(HJGK HJPKX hDdf hDdf ] gfd ^^–!–!!%@ 66-1-1106 af ! Em ##^^ af ! Em *#^$ af EJY EJY EJY EJE EJE EJE EJIQ EJIQ dfn ;fdfgsf EJIQ + = -- + = g ORH2SZ RAWJAXOQ_ ; ORH2SKZ RAWJAXOQ_ lhG;L a= = + g lh=vf=kf= + = qm=;
142 HEALTH LOGISTICS REPORT + = %) } lkmot ] =kmf=g s lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL d=n ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ] { sf/0f { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx ' { kg { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu ÷ldgfxf ug { ÷ldgfxf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf | of | of | of | of | of | of | of | of | of | of | of | of | of | of | of | of k k k k k k k k k k k k k k k k " No lhG;L lg;u ' dflgt d ] cg " No xfnsf { kl/df0f ] ] / tkm { jif ] u ePsf | of hg/n :6f k cf=j= @)&#÷)&$ | fKt ldlt ' ? k z ] ;g k/n d ] l;lkms ] gfd :k V dfn ;fdfgsf + = + = g lhG;L a= ; + = =g lh=vf=kf + = A7V0 B@SJ OQ@SJK OQJABJAWO0HA^0K W(/S B I_ N0 W 0_ GJ3_/SJ 9SJ V 2\JA JAOQJ AB O`JALA7B 7SJK W(/SBPO`+B )SJW HP7RK W(/S BBAE R 47L WAB0IBAE R W(/S BHPKB 47L WAB0IPEJAP2IVAS
qm=; 143 HEALTH LOGISTICS REPORT } lkmot s lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL lnnfd laqmL ] ] ] ] ] ] ] ] ] ] ] ] ] ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ' g ] { sf/0f { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx { t gx ' { kg { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd { dd | O | O | O | O | O | O | O | O | O | O | O | O | O { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu { lalu ÷ldgfxf ug { ÷ldgfxf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf ] u ubf | of | of | of | of | of | of | of | of | of | of | of | of | of k k k k k k k k k k k k k lhG;L lg;u " No ' dflgt d 31,977.00 ] cg xfnsf " No k/n d kl/df0f ] { jif ] u ePsf | of k | fKt ldlt ' ? k z ] ;g ] l;lkms :k ] gfd hDdf dfn ;fdfgsf + = + = g ORH2SZ RAWJAXOQ_L(HJGK HJPKXH2SJPWX lhG;L a= ; ORH2SKZ RAWJAXOQ_L(HJGK HJPKXH2SJPWX + = =g lh=vf=kf + = 9SJ P\B NJROQ@SJK W(/S BHA^0K B RWJ WJA B R \ARJALKP\B 7SJHJ 2SJOBOW(/SB PIRPNVASRJA%SJWC BAE RWJ WJA VAWJ3B KJABE W W PV_W K P\XWJA 144 qm=; HEALTH LOGISTICS REPORT + = %) } lkmot ] =kmf=g s d=n
] { sf/0f ' { kg ÷ldgfxf ug { ÷ldgfxf lhG;L lg;u " No ' dflgt d 75 20 175 120 500 500 500 500 ] cg xfnsf " No 825.00 277.00 230.00 320.00 1,257.00 1,050.00 6,300.00 k/n d ] t_
18,200.00 2, 3, ] an km08 ;d kl/df0f + :yf, Unf ] { ÷ldGxf kmf/fd [ ; { jif ] u ePsf { -bft cf=j= @)&#÷)&$ | of k ] / tkm lhG;L lg;u | fKt ldlt hg/n :6f ' ? k z ] ;g ] l;lkms :k ] gfd HP ] S6/ HP ] h | f ' 6/ [ ' 6/ hDdf ] 6 dfn ;fdfgsf ] 6 lk06/ ] g ; { ' ;L ] h/ h ] S;6k sDKo ] lnkmf Nofk 6k sDKo 8 k dlN6 ldl8of n 6 s UPS APC UPS + = + = g ORH2SZ RAWJAXOQ_L(HJGK HJPKXH2SJPWX lhG;L a= ; ORH2SKZ RAWJAXOQ_L(HJGK HJPKXH2SJPWX + = =g lh=vf=kf + = qm=; 145 HEALTH LOGISTICS REPORT { ] ' { kg + = %) } lkmot ] =kmf=g s d=n lnnfd laqmL ug ] { sf/0f ] ' { kg | Psf ] lalu ÷ldgfxf ug { ÷ldgfxf F lrPsf ef lhG;L lg;u " No ' dflgt d 4,800.00 ] cg xfnsf " No k/n d { t kl/df0f ] / cGtu ] { ÷ldGxf kmf/fd { jif ] u ePsf | of k cf=j= @)&#÷)&$ } hf/ pks/0f :6f cf lhG;L lg;u | fKt ldlt ' ? k z ] ;g ] l;lkms :k ] gfd hDdf dfn ;fdfgsf + = + = g ORH2SZ RAWJAXOQ_L(HJGK HJPKXH2SJPWX lhG;L a= ; ORH2SKZ RAWJAXOQ_L(HJGK HJPKXH2SJPWX + = =g lh=vf=kf + = /SJ A+BEA KZ RAWJA qm=; 146 HEALTH LOGISTICS REPORT
d=n]=kmf=g+= %) g]kfn ;/sf/ :jf:Yo dGqfno :jf:Yo ;]jf ljefu cfk"lt{ Joj:yf dxfzfvf 6]s' 6]s', sf7df08f}+ . lhG;L lg;u{÷ldGxf kmf/fd cf=j= @)&#÷)&$ hg/n :6f]/ tkm{ lh=vf=kf lhG;L a= ;+= qm=;+= dfn ;fdfgsf] gfd :k]l;lkms];g kl/df0f s}lkmot =g+= g+= A7V0 lnnfd laqmL W(/S B I_ N0V lnnfd laqmL B@SJ OQ@SJK lnnfd laqmL O`JALA7B lnnfd laqmL GJ3_/SJ lnnfd laqmL OQJABJAWO0HA^0K lnnfd laqmL W 0_ lnnfd laqmL JAOQJ AB lnnfd laqmL 9SJ V 2\JA lnnfd laqmL W(/S BHPKB lnnfd laqmL W(/SBPO`+B lnnfd laqmL W(/S BBAE R lnnfd laqmL 7SJK lnnfd laqmL 47L WAB0IPEJAP2IVAS lnnfd laqmL 47L WAB0IBAE R lnnfd laqmL )SJW HP7RK lnnfd laqmL 9SJ P\B lnnfd laqmL PIRPNVASRJA%SJWC lnnfd laqmL B R lnnfd laqmL VAWJ3B lnnfd laqmL NJROQ@SJK lnnfd laqmL \ARJALKP\B lnnfd laqmL W(/S BHA^0K lnnfd laqmL W PV_W K P\XWJA lnnfd laqmL 2SJOBOW(/SB lnnfd laqmL B RWJ WJA lnnfd laqmL 7SJHJ lnnfd laqmL KJABE W lnnfd laqmL BAE RWJ WJA lnnfd laqmL Nofk 6k sDKo'6/ HP lnnfd laqmL
147 HEALTH LOGISTICS REPORT
8]S;6k sDKo['6/ lnnfd laqmL UPS APC lnnfd laqmL dlN6 ldl8of k|f]h]S6/ lnnfd laqmL n]h/ h]6 lk06/ HP lnnfd laqmL UPS lnnfd laqmL 6]lnkmf]g ;]6 lnnfd laqmL s';L{ lnnfd laqmL
lh=vf=kf lhG;L a= ;+= qm=;+= dfn ;fdfgsf] gfd :k]l;lkms];g kl/df0f s}lkmot =g+= g+= /SJ A+BEA lnnfd laqmL ug'{ kg{]
d=n]=kmf=g+= %) g]kfn ;/sf/ :jf:Yo dGqfno :jf:Yo ;]jf ljefu cfk"lt{ Joj:yf dxfzfvf, 6]s' lhG;L lg;u{÷ldGxf kmf/fd cf=j= @)&#÷)&$ hg/n :6f]/ tkm{ lh=vf=kf= lhG;L a= qm=;+= dfn ;fdfgsf] gfd :k]l;lkms];g kl/df0f s}lkmot g+= ;+= g+= EJE xf]08f PS;=Pn=!@% 1 lnnfd laqmL EJY 6f6f 6«s 1 lnnfd laqmL EJY 6f6f 6«s 1 lnnfd laqmL EJE df]6/ ;fO{sn 1 lnnfd laqmL EJE ofdfxf DT df]6/ ;fO{sn 1 lnnfd laqmL 66-1-1106 dx]Gb|f hLk 1 lnnfd laqmL EJIQ dfOqmf] a; eFS; jfOug lnnfd laqmL EJIQ hLk hLK;L 1 lnnfd laqmL EJIQ 6f]of]6f hLk -z'qm/fh 6«lksn c:ktfnaf6 lnnfd laqmL k'/fgf] cj:yfsf] k|fKt_ 1 EJY If]=d]= :6f]/ lj/f6gu/af6 lnnfdL k|of]hgsf lnnfd laqmL nflu k|fKt 6f6f 6«s 1 lh=:jf=sf= /;'jfaf6 NofO{ 5fl8Psf] dx]Gb|f af ! Em *#^$ lnnfd laqmL PDa'n]G; 1 lh=:jf=sf= sfe|]af6 dd{t x'g g;ls lkmtf{ af ! Em ##^^ lnnfd laqmL k|fKt 6f]of]6f Nof08qm'h/ hLk 1 If]= :jf= lgb]{zgfno x]6f}+8faf6 cg'/f]w eO{ ^^–!–!!%@ cfPsf] tyf o'gfgL cf}ifwfnosf] kl/;/df 1 lnnfd laqmL /x]sf] ^^–!–!!%@ ofdfxf df]6/;fOsn dd{t kZrft\ lkmtf{ k|fKt uf8Lsf k'/fgf --kf6{k"hf{x?, 6fo/ 6'o'jx? cf=j= @)&@÷&# - lnnfd laqmL ;Ddsf
148 HEALTH LOGISTICS REPORT
12. GUIDELINES FOR USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)
Developed by expert Team of NMC and Government of Nepal with reference from WHO A. For Aerosol Generating procedures: Dental procedures, bronchoscopy, Upper GI Endoscopy, ENT procedures, Nebulization, Intubation of a patient, CPR, Non-invasive ventilation, endotracheal, suctioning, when obtaining nasopharyngeal or oropharyngeal swab, etc. In Covid-19 suspected or confirmed cases health personnel need to use the following protective equipment. Category I PPE: a. N-95 mask b. Goggles or visor c. Gloves (loose gloves acceptable) d. Water resistant OR standard disposable gowns. e. Cap: Regular Disposable B. For Non aerosol generating covid-19 suspected or confirmed patients: Health personnel need to use the following protective equipment: Category II PPE: a. Surgical mask (seal the top edge with tape) b. Goggles or visor c. Gloves (loose gloves acceptable) d. Water resistant or standard disposable gowns e. Cap: Regular disposable C. For Physicians examining the patients in the fever/screening clinics the following PPE is recommended. Category II PPE a. Surgical mask, (seal the top edge with a tape) b. Goggles or visor c. Water resistant or standard disposable gowns d. Regular disposable Cap e. Gloves (loose globes acceptable) Note: For staff involved in preliminary screening not involving direct contact, maintain spatial distance of at least 1meter, no PPE required, Use surgical mask if maintaining distance not always possible. D. For escorts or drivers, the following PPE is recommended. Category III PPE: a. Surgical masks b. Gloves c. Gowns (if physical contact expected) Follow hand hygiene and keep minimum 3 to 6 feet from the patient. E. For Laboratory staff: category II or III PPE; depending upon the chance of splash: d. surgical mask e. Gown f. loose Gloves g. Eye protection (if risk of splash) F. For staff, including health care workers involved in any activity that does not involve contact with COVID-19 patients and working in other areas of patient transit (e.g. wards, corridors). NO PPE required. For Everyone: • Maintain 3-6 feet distance while visiting patients, if no need to touch the patients. • Mandatory hand-hygiene after each use of PPE and between patients. • Mandatory surface cleaning of bed or furniture with 0.5% Chlorine disinfectant (Virex* or similar) between each patient in OPD or in an inpatient setting.
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13. PROCUREMENT ON SEPCIAL CONDITION - PPA
THE PUBLIC PROCUREMENT ACT, 2063 (2007) Date of certification and publication 30 paush 2063 (14 January 2007) ACT NUMBER 36 OF THE YEAR 2007 AN ACT MADE TO PROVIDE FOR PUBLIC PROCUREMENT Preamble: Whereas, it is expedient to make legal provisions in order to make the procedures, processes and decisions relating to public procurement much more open, transparent, objective and reliable, obtain the maximum returns of public expenditures in an economical and rational manner by promoting competition, fairness, honesty, accountability and reliability in public procurement processes, and; ensure good governance by enhancing the managerial capacity of procurement of public entities in procuring, or causing to be procured, construction work and procuring goods, consultancy services and other services by such entities and by ensuring the equal opportunity for producers, sellers, suppliers, construction entrepreneurs or service providers to participate in public procurement processes without any discrimination;
Now, therefore, the House of Representatives has enacted this Act in the First Year of the issuance of the Proclamation of the House of Representatives, 2007.
MISCELLANEOUS 66. Provision Concerning Procurement to be Made in Special Circumstances: (1) Notwithstanding anything contained elsewhere in this Act, where the occurrence of special circumstance has created a situation in which, if a procurement is not made immediately, the public entity will sustain further loss, the Public Entity may procure or cause to be procured immediately.
(2) The chief of the Public Entity shall have to give information of the circumstances under Sub-section (1) and the detailed description concerning the procurement to be made immediately to one level higher authority.
(3) Other provision concerning procurement to be made in special circumstances shall be as prescribed.
67. Procurement Process under this Act not to be Applied: (1) Notwithstanding anything contained elsewhere in this Act, the procurement process under this Act need not be applied in the following conditions:- (a) If the Government of Nepal decides that procurement relating to security, strategic or defense by application of the process in accordance with this Act is not appropriate for the interest of national security or defense , or
(b) If as per the agreement between government of Nepal and donor party, procurement is to be made in accordance with the Procurement Guidelines of a donor party.
(2) In making a decision pursuant to clause (a) of Sub-section (1), Government of Nepal shall have to state reasons for procurement and determine separate procedure related thereto as well.
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68. Method of Communication: (1) Any document, notice, decision or other information as referred to in this Act and Regulations made thereunder, bidding documents, documents relating to request for proposal or procurement contract as to be given by the Public Entity to a bidder, consultant or by a bidder or consultant to the Public Entity shall, unless otherwise provided for in this Act, be given in writing.
(2) In case where a notice transmitted pursuant to Sub-section (1) could not be served due to failure to trace out the address of the recipient bidder or consultant or for any other reason, a public notice shall be published in a newspaper of national circulation stating therein brief description thereof and where a notice is so published such person shall be deemed to have received the notice.
69. Procurement Transaction May be Carried Out Through Electronic Communications Means: (1) Notwithstanding anything contained elsewhere in this Act, Government of Nepal may, by publication of a notice in the Nepal Gazette, provide a mechanism that the Public Entity may arrange, through the means of electronic communications, invite a pre-qualification proposal, issue notice of bid invitation, prepare a short list by inviting expression of interest, invite a proposal of consultancy service, transmit bidding or pre-qualifying documents, receive bids, proposals for pre-qualification or consultancy services, conclude the procurement contract, make payment and give and receive other notices.
(2) The means of communications under Sub-section (1) shall be used in the following manner:- (a) That the content of communications in such means of communications is legally valid and preserved,
(b) That the security of such communications means is adequate,
(c) That bidder's access to the procurement proceeding is notinappropriately restricted,
(d) That it is not in contravention of this Act and rule made thereunder and other prevailing law.
70. Legal Documents to be kept in Website: For information and convenience of general public, this Act and Regulations and Procurement Manuals made thereunder shall be kept in the website of the Public Procurement Monitoring Office.
71. Evaluation Committee to be Formed: (1) The Public Entity shall have to form an evaluation committee as prescribed for examination and evaluation of the pre-qualification proposals, bids, expression of interest or proposals of consultancy services or sealed quotation.
(2) The functions, duties and powers of the committee formed pursuant to Sub-section (1) shall be as prescribed.
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72. Records of Procurement Proceedings: The Public Entity shall have to keep safely the records of the documents of the procurement proceedings for a prescribed period.
73. Delegation of Power: Out of the powers conferred on him/her by this Act or rule made thereunder, a competent authority may delegate the powers other than the prescribed one, to any staff.
74. Power to Make Rules: (1) The Government of Nepal may make Rules required for implementation of the objective of this Act. (2) Notwithstanding any thing contained in Sub-section (1), the Public Entity other than the one as referred to in sub-clause (1) of clause (b) of Section 2 may make necessary Rules subject to the Act, Rules or Formation Order relating to such entity.
75. Repeal and Amendment: (1) The provision to Section 168 of the Traffic and Transportation Management Act, 1992 is hereby repealed.
(2) Notwithstanding anything contained in prevailing law, legal provision relating to the procurement of the Public Entity under clause (b) of Section 2 shall be deemed to have ipso facto been so amended as to be compatible to this Act to the extent of their inconsistency with this Act.
(3) Instead of Section 7 of Financial Procedure Act, 1998, the following Section 7 has been substituted:- "7 Procedure of Making Expenditure: Provision concerning financial administration relating to operation of government transactions and project implementation, deposit, charges, service fee, taking advance and settlement thereof, preservation of government's cash and goods-in-and property, auction, remission, and other miscellaneous provision and procedure related thereto shall be as prescribed."
76. Saving: All the acts and proceedings relating to procurement carried out under the Financial Procedure Act, 1998 and the Financial Administrations Regulations, 1999 made thereunder and the provisions of the Act, Rule or Formation Order related to procurement of the Public Entity as referred to in sub-clause (2), (3), (4), (5) and (6) of Clause (b) of Section 2 shall be deemed to have been carried out under this Act.
152 HEALTH LOGISTICS REPORT त िफय ै क टवाला ँ फा ला ै शाखा ÷ ) ख ु शाखा म िव शाखा िव शाखा िव शाखा िव शाखा िव शाखा ु ु ु ु ु खोप प प आ शाखा आ शाखा ( आ शाखा वा तथा ा ज फोहरम शाखा आ शाखा आ शाखा प आ शाखा प प आ शाखा GoN GoN GoN GoN ोत GoN GoN GoN GoN GoN GoN GoN GoN GoN ो े त चौमािसक २०० २०० १००० १००० १५०० ३००० दो ो चौमािसक म २०० ५०० १००० २२०० थम म चौमािसक क त काय त ृ रकम १७३३०० ७२१०० ३९९०० ६१३०० बािष ा म ालय ं ट५०० े वा िवभाग े इकाइ पाल सरकार े न ३पटक६०० २पटक६७०० ६ पटक ३००० क बािष ल ा स ा व थापन महाशाखा क ा तथा ा जनस तथा ३७००११०७ ा व थापन काय ा व थापन ३७००११०७ ं िशष ३१११२ १ भवन ४०००० १५००० ५००० २०००० ३१११२ १ भवन १५००० १५००० ३११२२ ५ स ३११२२ ५ बटा३११२२ २ ५००३११२२ थान २०० १ ४००० २०० पटक३११२२ १०० २००० ३ २००० पटक २००० ८५००० २००० ३०००० २०००० ३५००० ३११७१ ३११७१ ३११२३ आ ब २०७७।०७८ को ीक त ) , ब उ िश न त े ल ३११७१ १ थान ३००० ३००० - फोटोकिप रा पखा े पी पी एम एम पी पी ं , ानी सम ु टर ू रानो स झौताको ु _ रचनाह को मम ं एव े प ै ण िनर रता वािक भ क सह ख रद ३११२२ १ पटक ३००० ३००० ( ( पानी ट े 14. FY 2077/78 ACTIVITIES AND BUDGET : MANAGEMENT DIVISION : MANAGEMENT AND BUDGET ACTIVITIES 2077/78 14. FY ) त े याको उपकरणह लािग ै यर पाट े वाका साम ीह ख रद ३११२२ १ पटक १०००० ५००० ५००० े ण मागत ) ि याकलापको नाम खच टपाथ र ढल िनकाश र ढल टपाथ ु याको लािग तारवार तथा घ ै ानी सम ु फ िनमा तथा पथल ु ु , मह क क े े मह ट आदी जडान आदी ट े य ा न ोर िनमा े ढलान , े ानीह पिन ु ला तथा खान व थापन न साम ीह को साम ीह को न ै े ाल ापटप आदी तका काय मको ज ा िवभाग प रसर िभ का भौितक स िवभाग प रसर िभ का बाटोह को रो ती , े े , लय योजनका उपकरणह चर तथा िफ स िनक क ु तका काय य ोर ट य ोर ट य ोर पथल धार ु े े े मागत वािक भ काय अ ग स क आध काया को च क फोहरम आपतकािलन ा स अ ताल औजार उपकरण ख रद साथ क बटा ख रद १ र ि र ४ बटा ापटप ा स ा स फिन ( वािक भ कालोप रयाक स ी साम ी ख रद स ी ि र अ ग खच ु 11.1.2.62 11.1.2.66 11.3.7.39 11.3.9.87 11.3.9.88 11.3.7.50 11.5.22.8 11.5.22.9 जीगत खच ु ँ 11.3.9.156 11.3.9.193 11.3.9.195 11.5.22.10 11.6.13.10 जीगत खच ु ँ चाल प प ं C ) C १ २ ३ ९ ४ ८ ५ ६ न ७ ११ १० १२ १३ िस अ आ क
153 HEALTH LOGISTICS REPORT ) ) ) ) ) ) ) ) ) खोप खोप खोप खोप खोप खोप खोप खोप खोप आ शाखा आ शाखा आ शाखा आ शाखा आ शाखा ( आ शाखा ( आ शाखा ( आ शाखा ( आ शाखा ( आ शाखा ( आ शाखा ( आ शाखा ( आ शाखा ( आ शाखा आ शाखा आ शाखा GoN USAID USAID USAID USAID USAID UNICEF UNICEF UNICEF UNICEF UNICEF UNICEF UNICEF UNICEF UNICEF GoN 2004 GoN USAID 1356 USAID २२४११ २५ जना२२४११ १०८०० ६ जना ४१०० २३४० २०१६ ४३६० ७०० ७०० ६१६ २२२१३ ३ पटक ४००० १००० १००० २००० २२५२२ ३ पटक२२५२२ ३३०० १ पटक२२५२२ ११०० १ ११०० ५५०२२५२२ पटक ११०० ३२२५२२ ५५० पटक ३२२५२२ ५५० १६५० पटक १ ५५० पटक २२०० ५५० ५५० ८०० ११००२२५२२ ५५० ८०० ३ ६०० पटक ११०० २२५२२ ११०० २ ाच ३०० १८०० ३०० ९०० ५०० ९०० ी ृ त ृ टर ू , िज ा त , मताको न े श े क र १ , सी सी इ ओ , ( चालन २२५२२ २ पटक २००० ५०० १५०० ं को ान योजनाको योजनाको खीकरण ु े धार योजनाको ु गमा द ं िडकल अिधक े र उपकरण र उपकरण ू
गमन काय ु म ढ २२५२२ १ पटक ५५० ५५० ु , को ािविधक अिभम ट तथा स तथा ट टर जना २ े MIS े
रण गोि २२५२२ १ पटक ५०० ५०० ट े सवारी साधन मम चारीको मता अिभब , न इ न े ची ू लोडर ाकर ६ जना गमन २२५२२ ३ पटक १००० ३०० ३०० ४०० ु SOP वा करार २२४११ १२ जना ३३६० ११०० ११०० ११६० े : त क खोप तथा को च तथा खोप क टर अपर ू को मता स न व थापन काय व थापन न े
को च र ा स ु े न ब थापन काय ब थापन न े तथा ई भी एम ए स ामस अपड
ब प ीय बज क ) डीकल इ जिनयर २ जना े , , , एल एम आई एस आई एम एल सको मम ् वानीका साधन ु इ वा करार े ढ (NLWG) न व थापन र ा िल र व थापन न व थापन तथा ा व थापन साम ी ख रद े , , को समी ा सिहत अनसाइट कोिचग तथा े न उपकरणको स उपकरणको न े बायोम ित यन ू श रमा वािष े , त ा न ा त जी जी ू िस यनको लािग ािविधक सहयोग िसयन प रचालन यर पाट े े िसयन जना १ वा े न े क थापना क ई भी एम ए ई भी एम ( वा िवभागको स े े त आप त ू टर ट े काया ै त १ जना स जना १ त ण र े ृ फ माफ फ े इल कन ं , य खोप तथा को च तथा खोप य द तथा य भ म े को योजना जडान ब थापन र अन ब थापन जडान को योजना
) धार ु ा ू िनस ण र खोप तथा कोड च ु ू ोज े लािग ािविधक सहयोग ि भ र स ािविधक स अिधक जना २ सवारीचालक जना िवकास र काया औजार उपकरण ोरमा फामा जनश व थापन करारमा ा स भावकारी ा न ब थापन काय य खोप तथा को च अनाइन को च राि राि एन एल ड र अन िश ण एस आई एम एच ग ाटलग ब आधारभ णाली स ी तािलम ा साम ीह को प रमाण िनधा म िवकास र र नगरपािलका व थापकीय कम र िनमा ब थापन काय पी समयम 2.3.1.11 2.5.3.54 2.5.3.55 2.5.3.56 2.7.25.11 2.7.25.12 2.7.22.743 2.7.22.744 2.7.22.745 2.7.22.747 2.7.22.748 2.7.22.749 2.7.22.750 2.7.22.751 2.7.22.800 2.7.22.853 २१ १९ १४ १८ १५ १६ २० २३ २२ १७ २८ २९ २४ २५ २६ 154 २७ HEALTH LOGISTICS REPORT
ु ु ु ------) म म म म म म िव शाखा ु खोप महाशाखा महाशाखा महाशाखा महाशाखा महाशाखा महाशाखा आ शाखा आ शाखा आ शाखा ( आ शाखा आ शाखा आ शाखा ा काय ा काय ा काय ा स ए ा काय ा काय ा काय प ा स ए ा स ए शाखा शाखा शाखा GoN GoN GoN GoN GoN GoN GoN GoN GoN GoN USAID USAID USAID USAID USAID GoN 3501 GoN USAID 6466 USAID १पटक९५० ९००५० १ पटक१पटक५०० ५०० ६५०११ ३३०००१ पटक ३००० २९०११ ४००० ५०० ३५०० ६ पटक६पटक३५०१००१००१५० ४०० १०० १०० २०० १२ पटक ९०० ३०० ३०० ३०० ७० पटक ७०० २०० २०० ३०० १०० पटक ७०० २०० २०० ३०० २२१११ २२३११ २२११२ २२११२ २२५२२ २२२५२२ पटक १००२२५२२ पटक ८०० १२२५२२ १५०० पटक ३०० ८६ १५० वटा२२५२२ ५०० ९०० ४९९० ३ ५०० पटक ५०० ४५० १५०० ९९६७ १५०० ३३०० १९९० ३३०० ३३६७ २२४११ २२४११ २२४११ २२२१३ २२२१२ वा े ठक ै , िसस िशका , त े त े िनद ै साधन , वाको रकम े पणका स लािग े साथ िडकल औजार े ट स ट े ानी सम ु ो प िवमा े त नः िवतरणनः सम र ू ु , टा डाटा एनालाइ े ा ं की भ ं ह का आव क लािग सार बायोम ु तथा न गन तथा न े वा द े को बा वानी र प वानी ु निवकरण मको म , ण र प र ण २२५२२ ३ पटक ५००० १५०० १५०० २००० ु ल ु त े ाउन ु तथा ढ ध त े . , धार काय ु त भिन मािणत भएका औषिध र अ र अ औषिध मािणतभएका भिन े सार लि त जनस ु सम ली महश ु त स त एस शाखामा जडीत इ रन जडीत शाखामा एस ल ु चालन खच र ा स ी काय ं ु ा स झौता अन े इ न सम इ न ं ाकन सिमित लगयतका सिमितह को ब ु निम न ा न तथा ा न ज साम ी खको खोप काय े य ठ य ण सम य र ािबिधक सहयोग २२६११ १०० पटक ४००० १००० १००० २००० े , लय स प रव चार सहस तथाचालन मम ानी चालन खच ु ं ं ु ं तयारी र छपाइ साम ीह िललाम ख रद योगगन बोलप म ा न स सवारी साधनह को दता औषिध तथा ग उपकरण औषिध स तथापानी वज स एच एम आइ इ न तथा अ इ न स काया ब बिष थानीय तह अन २०५१ द साम ी एव सामा ी र ािकड सवारीकर स ी िविवध स भ उपकरण मम स 2.8.1.40 2.7.25.14 2.7.25.19 2.7.25.20 2.7.25.21 2.7.25.23 2.7.25.24 2.1.5.3 2.1.6.3 2.1.7.6 2.2.2.6 2.3.1.5 2.4.1.1 2.5.3.45 2.5.3.46 2.5.3.47 ३१ ३० ४१ ३२ ३३ ३९ ३४ ३८ ४० ४३ ३५ ३६ ४२ ३७ ४४ ४५
155 HEALTH LOGISTICS REPORT
ु ु ु ु ु ु ु ु िव शाखा िव शाखा िव शाखा ु ु ु आ शाखा आ शाखा आ शाखा आ शाखा आ शाखा प ा स ए ा स ए ा स ए ा स ए ा स ए ा स ए ा स ए प प ा स ए शाखा शाखा शाखा शाखा शाखा शाखा शाखा शाखा GoN GoN GoN GoN USAID USAID USAID USAID USAID USAID USAID USAID USAID USAID USAID GoN 1885 GoN USAID 4400 USAID १ पटक २४०० ८०० ८०० ८०० १ पटक १५०० १५०० १ पटक ५००० ५००० १पटक८०० ८०० ३ पटक ५०० १५० १५० २०० २ जना ८८८ २९६ २९६ २९६ २ पटक १२०० ६०० ६०० २ पटक १०००२ पटक १००० २००० ६००२पटक५०० २५०२५० ४०० १००० २ पटक १००० ३०० २०० ५०० ४ पटक २००० १००० १००० ४ जना १४४० ४८० ४८० ४८० २० जना ६२८५ १५०० ३२८५ १५०० १५ पटक ९०० ३०० ३०० ३०० १५ पटक १३३४ ६१० ३२४ ४०० २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२५२२ २२४११ २२४११ २२४११ २२४११
, - गमन ु टर ू , एस र एस क , तको े क शासन शासन क िडकल य स झौतामा स झौतामा य े दन फाराम े त १ जना करार करार जना १ त धार स नतम मापद ु ू ृ स ी तािलम ोर सहायक १ एच एम आइ एम एच चना व थापन र ू त े ला तथा व थापन ै M _ गी ३ जना े र म सम म र त स त खकरण ु वाबाट े ण रका लािग अनसाइट ु चना व थापन तथा िड एच ू ख तथा ितव े एस टा टा ग िश ण अ ताल लगायत नीजी नीजी लगायत िश ण अ ताल ा स लय सहय / सको स त अ तालह लाइ ं गमन ु , चारीह लाइ धारह को षण तथा योग स तािलम े धार स ब बिष ु वा ु यनका लािग बायोम एस चकह अ ाविधक ू काया माइ ो िटिचङ ं त स त , क शासन स ि याकलाप िव यर पाट े , चारी शासन शाखा र आिथ चारी शाखा शासन न ा स ा न सवारी चालक ५ जना सवारीचालक कािनकल र आइ टी इ जिनयर गरी ३ जना े , जी आइ / म दन तयारी तथा छपाइ े , एस को अिभल एस ो प बाट िनर रता सम े एस तािलम अिभम _ य अ ताल ानी ु े आर ो रङ एव ं - क भ , य स झौता काया स झौता य त अनलाइ त िडकल औजार उपकरण मम े लगायत आिथ ु िवभाग कम िवभाग प रशर िभ को फोहरम े े ृ िसिभल षण े ख नभएका े क व थापकह लाइ ं क ितव क िनिककरण ु एस २ स ी िफ काय िफ स ी २ एस , िशका र ा स तका अ तालका कम े श र थानीय तहका सिम ाह मा सहयोग तथा अन े वामा व थापन े ज े आध इ जिनयर १० जना र जन ा अिधक स जना सहायक १ जना उ शोधभना आइ िनद जनश व थापन करार स बायोम ा स ा स ब मम औजार उपकरण त ा व थापन द बािष एिकक ित ान अ तालमा ा त ाक एच एम आइ भवन लगायत भौितक प सभ लगायत शाखा एस आई एम एच त ा ब बिष व थापन जनश ी शाखामा कोिचङ म तथा अन फलोअप स ी िव डाटा एनािल १ जना सरसफाइ त पी एच ए टी सम डी एच आइ 2.5.3.50 2.5.3.51 2.5.3.52 2.5.3.53 2.7.22.530 2.7.22.531 2.7.22.538 2.7.22.539 2.7.22.540 2.7.22.541 2.7.22.543 2.7.22.544 2.7.22.545 2.7.22.547 2.7.22.548 2.7.22.550 ५१ ६१ ५० ५३ ६० ४८ ४९ ५२ ५८ ५९ ४६ ५४ ४७ ५५ ५६ ५७
156 HEALTH LOGISTICS REPORT
ु - - म म महाशाखा महाशाखा ए ा स ए ा काय ा काय शाखा GoN GoN USAID १७००९१ ५९५९६३४३३९१ १३१६९६ ३९४७५ ७९३७५ ७१०२० १३२३२० १पटक२००६०५०९० २ पटक १४०० ७०० ७०० ३० पटक ३००० १००० १००० १००० २२५२२ २२६११ २२७११ , एच एम एम एच ण े खकरण ु प रव ु ) ु चारीह लाइ त स त ृ ह को िनरी ण मण खच एस तािलम अिभम जीगत र चाल जीगत ु ँ ितका काय प रत ा कम ृ ( मह को एिकक ष क ष े िवश ल ज ा ल ज ा वा काय े ु , क एस र डी एच आइ एच र डी एस गमन ु मको ज ा आइ कारागारह मा काय ा स अन िविवध खच काय खच ु 2.7.22.555 2.8.1.39 2.9.9.3 चाल ) ६३ ६२ ६४ क
157 HEALTH LOGISTICS REPORT पि म ज ा िज ाह मा ु ली स दश ५ कणा े बागमती ग की ३ १ श े २ ५ म ४ द ६ २
ग ६०० ५०० ७०० ६०० ६०० ८०० ७०० ४५०० श े ११०० ७००२५०० १२०० २००० ९०० २४००६९०० ९९० २५५० ७५८५ २४०० ८९० ६९०८ २८००५०९५ ५१२५ ७५० ५०६० ५९८२ २२५० ६५३० ४४२५ १६९०० ३५५०१२७० ३१६० ७०० ४०५२ ३९५० १२०० ४०००० २९३७१९१५ १०५० १८०० १०५० ३२७१२२२० १६६५ २८००० १२०० ११९० ९३०१००० २१३० १५३० ८०० १८०० ९०० ११५० १००० १९५० ७१०० ९०० १२५० १७८० १०५०० ९०० १५०० ११०० १२५८० १००० ६७०० १ ा ल द
ो क , ह ह त िड िड त त
खकरण ु य त सिम ा त ृ न
ं ा सामा ी ख तथा तथा ख े , थ ा ं
ा शनालय माफ लय एव थ साधन त क समी ा क ,
मह को योजना मा एस एल एम आइ शनालयबाट ा
श े ) त े द बािष ं योजक एव ं आ ब २०७७।०७८ को ािवत काय ािवत को २०७७।०७८ ब आ लय सह स श ा िनद ा श े का थानीय तह स को लागी ु , त ा काया ा त ा काय द नः िवतरण सम नः िवतरण ू योजक ं गमन प ु त चौमािसक एव ृ िड एच आइ एस एच िड २ स ी आइ एिकक ह लाइ ÷ एल एम आइ एसएल एम स ीआइ अिभल धारकालािग ा िनद ु शनालयबाट थानीय तहह का ा शनालय माफ वानी र प व थापन तथा ा साम ी ख रद णाली / ु योजकह लाइ ं ित ू ो रङ े म ÷ अ ताल तथा ा काया सह स ण र स ( ु 15. FY 2077/78 ACTIVITIES AND BUDGET : PROVINCE AND LOCAL LEVEL AND LOCAL : PROVINCE AND BUDGET ACTIVITIES 2077/78 15. FY ÷ त आप त ू ा न तथा ा न ज साम ी , एव िवतरण दन फाराम एव अन े क ग क ं रण गोि मा स ी ि याकलाप ु श ा िनद ा श िनद ा श श तथा थािनयतहह को ा साम ीह को प रमाण े े े थाका ा किम थाह योजक ं ं ं एल एम आई एस एम एल आई एच एस एम आई एस र िड एच आई स ी थलगत सहिजकरण अ तालह को एिकक तज स िनधा इ औषिध र ािकङ तथा ढ एसएच एम आइ छपाइ थानीय तहका ा स त ा स द स द आधारभ स ी तािलम द ितव एस एस एच२ र एल एम आई स ी आइ तािलम अिभम े े े े क क क क
ू ू ू ू त त त त शनालय शनालय शनालय शनालय शनालय आप आप आप आप नद नद नद नद नद कोड थान ि याकलापह 6.1.2.440 6.1.2.441 6.1.2.442 6.1.2.443 6.1.2.445 6.1.2.446 6.1.2.447 6.1.2.449 6.1.2.450 ं १ २ ३ ४ ५ ६ ७ ८ ९ िस न
158 HEALTH LOGISTICS REPORT ::?;@ ० ० ० ० ० २८८६३ ० २८८६३ 1421 842 14 32 13 28 11 43 16 12 26 19 30 10 14 14 9 16 16 77 128 203 137 136652 119 740 85 645 109 489 571 79 340 88 378 753 3815 २४० ०५२० ० ० ० ० ० ० ० ० ० २४० ४८० ५२० १०४० २३३६० २०३४५ २१६२८ १७२७५ १९४५४ ४४८०० १६३३१ १६३१९३ े िज ा ा चौ पािलका अ ताल ा ा क िविभ , वामा े चारी करार स घर टहरा भाडा घर टहरा कम क शासन तथा आ रक िनय ण सरसफाइ ं अ योजनाथ ं लय एव श रमा आिथ रमा श े कारका िनकल तािलम लगायतका अ ि याकलापह द ोर एव काया शनालय शनालय सामािजक नद नद 6.1.2.451 6.1.2.558 6.1.2.559 १० ११ १२
159 HEALTH LOGISTICS REPORT
देश अ ग तका ा काया लयह मा पठाएको रकमह २०७७।०७८ त ाक गुण र सुधारकालािग ा काया लय माफ त ा काया लयबाट थानीय तह थानीय तहह को मािसक एवं ा सं थाह मा एल एम आइ सूचना संकलनभे रिफके शन P !K! 2RJW A PL2RJ OJPRWJ\# एसएच एम आई एस र िड एच एवं गुण र सुधार आई एस एस स ी थलगत चौमािसकबािष क सिम ा सहिजकरणमे ो रङ !!! !!! XJ/RAL Y ९ OJV] ८ 3RJH १० IQJOJ १५ Z NJ IJ १० XA\`] H ६ [KW BJ ७ IJALO ९ K 0 १२ HJAY १७ JAR Z (E ८ ZJABJY १० GJAZR YJ ८ TFSO ८ /X0 १८ P J\J १७ [K MJJ १८ H\JA50 १५ RJ_\0 २० JaX\B १८ EJJ १६ O J_ १४ P +[ R0 ९ JHA JH ८ FJARZJ ९ P +[ OJ2VJAW १२ NJ ५ [JPFY १३ K NJWJAB १२ WJ HJ Ja ११ RPRXO ६ I5QO ४ WJI`AORJbVJAW १३ HWNJKO १० PVXNK ७ YJAZJ ११ XK\ १० RHL Y ८
160 HEALTH LOGISTICS REPORT
HKJY ४ WJ W0 ५ H XJY ५ EJ9R Y १० ON_X ७ (SJ9F0 ६ SJYLJ ११ ON_KNROJ 0 ८ KNROJ 0O! ७ #O+FA\0 १६ WPORE X १० OJ2OJ १० Y 2H0 १२ GJ_ZJV0 ६ /S JK ९ JA2OJ १० FJY १० EJWA ८ EPF_SJ ८ #W HON_ ३ ZA_X ९ FaRAZ ११ 2SJK १० LJLWJAB ७ #W HOP>VH ६ JA2OJ ८ H Y ४ \ (RJ ७ L (RJ ८ WJPRWJAB ९ WaRJR0 १३ JAB0 ९ G JH १० EJL J ९ EIQJY १२ FJV _RJ ९ EaX0 १० AR[ J ७ WbVKO ९
161 HEALTH LOGISTICS REPORT
sfo{qmdsf] gfdM kflnsf :t/df :jf:Yo ;+:yfx?sf] dfl;s ;"rgf ;+sng, e]l/lkms]zg Pj+ u'0f:t/ ;'wf/ ;fy} rf}dfl;s Pj+ aflif{s ;ldIff 26332 6.2.2.323 lhNnf M ता ेजु Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 फु ङलीङ नगरपािलका 125 6 मैवाखोला गाउँपािलका 149 2 आठराई ि वेणी गाउँपािलका 197 7 पािथभरा याङवरक गाउँपािलका 173 3 फ ाङलुङ गाउँपािलका 197 8 िसिदङ् वा गाउँपािलका 197 4 िम ाखोला गाउँपािलका 104 9 िसरीज ा गाउँपािलका 221 5 मे रङदेन गाउँपािलका 173
lhNnf M पाँचथर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 िफिदम नगरपािलका 221 5 फा ुन गाउँपािलका 173 2 कु ायक गाउँपािलका 125 6 िम ाजुङ गाउँपािलका 173 3 तु ेवा गाउँपािलका 125 7 याङवरक गाउँपािलका 149 4 फालेलुङ गाउँपािलका 125 8 िहिलहाङ गाउँपािलका 149
lhNnf M इलाम Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ईलाम नगरपािलका 197 6 फाकफोकथुम गाउँपािलका 149 2 देउमाई नगरपािलका 173 7 माईजोगमाई गाउँपािलका 149 3 माई नगरपािलका 104 8 माङसेबुङ गाउँपािलका 104 4 सुय दय नगरपािलका 221 9 रोङ गाउँपािलका 125 5 चुलाचुली गाउँपािलका 104 10 स कपुर गाउँपािलका 149
lhNnf M संखुवासभा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 खाँदवारी नगरपािलका 149 6 िचिचला गाउँपािलका 104 2 चैनपुर नगरपािलका 173 7 भोटखोला गाउँपािलका 104 3 धम देवी नगरपािलका 104 8 मकालु गाउँपािलका 149 4 पाँचखपन नगरपािलका 149 9 सभापोखरी गाउँपािलका 104 5 मादी नगरपािलका 104 10 िसलीचोङ गाउँपािलका 149
lhNnf M ते थुम Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ाङलुङ नगरपािलका 149 4 छथर गाउँपािलका 173 2 लालीगुराँस नगरपािलका 149 5 फे दाप गाउँपािलका 149 3 आठराई गाउँपािलका 197 6 मे छयायेम गाउँपािलका 104
lhNnf M धनकु टा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 धनकु टा नगरपािलका 104 5 चौिबसे गाउँपािलका 197 2 पाि वास नगरपािलका 173 6 छथर जोरपाटी गाउँपािलका 125 3 महाल ी नगरपािलका 173 7 साँगुरीगढी गाउँपािलका 221 4 सिहद भूिम गाउँपािलका 125
162 HEALTH LOGISTICS REPORT
lhNnf M भोजपुर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 भोजपुर नगरपािलका 197 6 पौवादु ा गाउँपािलका 173 2 षडान नगरपािलका 269 7 राम साद राई गाउँपािलका 197 3 अ ण गाउँपािलका 173 8 सा ािसिलछो गाउँपािलका 125 4 आमचोक गाउँपािलका 221 9 हतुवागढी गाउँपािलका 173 5 ा के मैयुङ गाउँपािलका 245
lhNnf M खोटा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 पाकोट मझुवागढी नगरपािलका 317 6 ज ेढुंगा गाउँपािलका 173 2 हलेसीतुवाचुङ नगरपािलका 293 7 िद ुङ चुइचु ा गाउँपािलका 197 3 ऐसेलुखक गाउँपािलका 197 8 रावाबेसी गाउँपािलका 197 4 के िपलासगढी गाउँपािलका 197 9 वराहपोखरी गाउँपािलका 173 5 खोटेहाङ गाउँपािलका 245 10 साके ला गाउँपािलका 104
lhNnf M सोलुख ु Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 सोलुदुधकु नगरपािलका 245 5 नेचास ान गाउँपािलका 149 2 खु ु पासाङ ामु गाउँपािलका 125 6 माहाकु लुङ गाउँपािलका 104 3 मा दुधकोशी गाउँपािलका 104 7 िलखु िपके गाउँपािलका 104 4 थुलुङ दुधकोशी गाउँपािलका 173 8 सोताङ गाउँपािलका 104
lhNnf M ओखलढु ा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 िस चरण नगरपािलका 269 5 मानेभ याङ गाउँपािलका 221 2 खजीदे ा गाउँपािलका 173 6 मोलुङ गाउँपािलका 197 3 च ादेवी गाउँपािलका 173 7 िलखु गाउँपािलका 173 4 िचशंखुगढी गाउँपािलका 197 8 सुनकोशी गाउँपािलका 149
lhNnf M उदयपुर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 कटारी नगरपािलका 245 5 उदयपुरगढी गाउँपािलका 149 2 चौद ीगढी नगरपािलका 173 6 ता ी गाउँपािलका 149 3 ि युगा नगरपािलका 173 7 रौतामाई गाउँपािलका 173 4 वेलका नगरपािलका 125 8 िल चुङबुङ गाउँपािलका 149
lhNnf M झापा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 अजु नधारा नगरपािलका 104 9 कचनकवल गाउँपािलका 173 2 क ाई नगरपािलका 104 10 कमल गाउँपािलका 104 3 गौरादह नगरपािलका 149 11 गौ रगंज गाउँपािलका 125 4 दमक नगरपािलका 104 12 झापा गाउँपािलका 104 5 िवता मोड नगरपािलका 104 13 बा दशी गाउँपािलका 104 6 भ पुर नगरपािलका 104 14 बु शा गाउँपािलका 104 7 मेचीनगर नगरपािलका 173 15 ह बारी गाउँपािलका 104 8 िशवसता ी नगरपािलका 125
163 HEALTH LOGISTICS REPORT
lhNnf M मोर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 िवराटनगर उपमहानगरपािलका 104 10 कटहरी गाउँपािलका 104 2 उला बारी नगरपािलका 104 11 कानेपोखरी गाउँपािलका 104 3 पथरी शिन रे नगरपािलका 104 12 के राबारी गाउँपािलका 125 4 बेलवारी नगरपािलका 125 13 ामथान गाउँपािलका 173 5 रंगेली नगरपािलका 125 14 जहदा गाउँपािलका 149 6 रतुवामाई नगरपािलका 149 15 धनपालथान गाउँपािलका 173 7 लेटाङ नगरपािलका 125 16 बुढीगंगा गाउँपािलका 125 8 सुनवष नगरपािलका 125 17 िम ाजुङ गाउँपािलका 125 9 सु र हरैचा नगरपािलका 149
lhNnf M सुनसरी Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 इटहरी उप-महानगरपािलका 149 7 कोशी गाउँपािलका 125 2 धरान उप-महानगरपािलका 104 8 गढी गाउँपािलका 125 3 इन वा नगरपािलका 125 9 देवानग गाउँपािलका 149 4 दुहवी नगरपािलका 173 10 बजु गाउँपािलका 125 5 बराह े नगरपािलका 149 11 भो ाहा नरिसंह गाउँपािलका 104 6 रामधुनी नगरपािलका 125 12 ह रनगरा गाउँपािलका 149
lhNnf M स री Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 क न प नगरपािलका 269 10 िछ म ा गाउँपािलका 125 2 खडक नगरपािलका 221 11 ितर त गाउंपािलका 149 3 डा े री नगरपािलका 245 12 ितलाठीकोईलाडी गाउंपािलका 173 4 राजिवराज नगरपािलका 197 13 िब ुपुर गाउँपािलका 104 5 बोदेबरसाईन नगरपािलका 269 14 राजगढ गाउँपािलका 173 6 श ुनाथ नगरपािलका 245 15 महादेवा गाउँपािलका 149 7 सु गां नगरपािलका 269 16 पनी गाउँपािलका 104 8 हनुमाननगर कं कािलनी नगरपािलका 245 17 स कोशी नगरपािलका 104 9 अ ीसाइर कृ ासवरन गाउँपािलका 149 18 बलान िव ल गाउँपािलका 125
lhNnf M िसराहा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 क ाणपुर नगरपािलका 293 10 कज ा नगरपािलका 125 2 गोलबजार नगरपािलका 245 11 नरहा गाउँपािलका 125 3 धनगढीमाई नगरपािलका 149 12 नवराजपुर गाउँपािलका 104 4 िमच या नगरपािलका 221 13 ब रयारप ी गाउँपािलका 149 5 लहान नगरपािलका 341 14 भगवानपुर गाउँपािलका 104 6 िसरहा नगरपािलका 341 15 ल ीपुर पतारी गाउँपािलका 173 7 सुखीपुर नगरपािलका 197 16 िव ुपुर गाउँपािलका 125 8 अन मा गाउँपािलका 125 17 सखुवाना ारक ी गाउँपािलका 149 9 औरही गाउँपािलका 149
164 HEALTH LOGISTICS REPORT
lhNnf M धनुषा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 जनकपुर उपमहानगरपािलका 269 10 औरही गाउँपािलका 149 2 ि रे रनाथ नगरपािलका 125 11 कमला नगरपािलका 173 3 गणेशमान–चारनाथ नगरपािलका 149 12 जनकन नी गाउँपािलका 173 4 धनुषाधाम नगरपािलका 125 13 बटे र गाउँपािलका 125 5 नगराइन नगरपािलका 149 14 िमिथला िवहारी नगरपािलका 149 6 िमिथला नगरपािलका 197 15 मु खयापि मुसहरिमया गाउँपािलक 125 7 िवदेह नगरपािलका 173 16 ल ीिनया गाउँपािलका 125 8 सबैला नगरपािलका 221 17 हंसपुर नगरपािलका 197 9 शिहदनगर नगरपािलका 245 18 धनौजी गाउँपािलका 125
lhNnf M महो री Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 गौशाला नगरपािलका 197 9 मिटहानी नगरपािलका 149 2 जले र नगरपािलका 173 10 मनरा िससवा नगरपािलका 173 3 बिद बास नगरपािलका 221 11 महो री गाउँपािलका 104 4 एकडारा गाउँपािलका 149 12 रामगोपालपुर नगरपािलका 149 5 औरही नगरपािलका 104 13 लोहरप ी नगरपािलका 173 6 िपपरा गाउँपािलका 149 14 सा ी गाउँपािलका 149 7 बलवा नगरपािलका 125 15 सोनमा गाउँपािलका 125 8 भँगाहा नगरपािलका 173
lhNnf M सला ही Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ई रपुर नगरपािलका 149 11 किबलासी नगरपािलका 125 2 गोडैटा नगरपािलका 221 12 च घ ा गाउँपािलका 245 3 मलंगवा नगरपािलका 125 13 च नगर गाउँपािलका 125 4 लालब ी नगरपािलका 197 14 धनकौल गाउँपािलका 173 5 बरहथवा नगरपािलका 173 15 पुरी गाउँपािलका 125 6 बलरा नगरपािलका 245 16 रामनगर गाउँपािलका 173 7 बागमती नगरपािलका 125 17 िव ु गाउँपािलका 197 8 ह रपुर नगरपािलका 245 18 बसव रया गाउँपािलका 100 9 ह रवन नगरपािलका 125 19 पसा गाउँपािलका 100 10 ह रपुवा नगरपािलका 104 20 कौडेना गाउँपािलका 100
lhNnf M रौतहट Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ग डा नगरपािलका 269 10 परोहा नगरपािलका 173 2 गौर नगरपािलका 104 11 फतुवा िवजयपुर नगरपािलका 149 3 च पुर नगरपािलका 149 12 बौधीमाई नगरपािलका 149 4 ईशनाथ नगरपािलका 173 13 माधवनारायण नगरपािलका 221 5 कटहरीया नगरपािलका 173 14 मौलापुर नगरपािलका 104 6 गढीमाई नगरपािलका 173 15 राजपुर नगरपािलका 149 7 गजुरा नगरपािलका 149 16 वृ ावन नगरपािलका 149 8 दुगा भगवती गाउँपािलका 149 17 यमुनामाइ गाउँपािलक 125 9 देवाही गोनाही नगरपािलका 149 18 राजदेवी नगरपािलका 173
165 HEALTH LOGISTICS REPORT
lhNnf M बारा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 कलैया उपमहानगरपािलका 317 9 देवताल गाउँपािलका 149 2 िजतपुर-िसमरा उपमहानगरपािलका 269 10 पचरौता नगरपािलका 221 3 को वी नगरपािलका 197 11 परवानीपुर गाउँपािलका 104 4 िनजगढ नगरपािलका 125 12 सौनी गाउँपािलका 104 5 महागढीमाई नगरपािलका 245 13 फे टा गाउँपािलका 149 6 िस ौनगढ नगरपािलका 221 14 बारागढी गाउँपािलका 173 7 आदश कोतवाल गाउँपािलका 149 15 सुवण गाँउपािलका 125 8 करैयामाई गाउँपािलका 173 16 िव ामबुर गाउँपािलका 125
lhNnf M पसा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 वीरग महानगरपािलका 437 8 पसा गढी नगरपािलका 149 2 पोख रया नगरपािलका 173 9 ब दरमाई नगरपािलका 293 3 िछपहरमाई गाउँपािलका 149 10 िब बािसनी गाउँपािलका 125 4 जगरनाथपुर गाउँपािलका 197 11 सखुवा सौनी गाउँपािलका 173 5 धोबीनी गाउँपािलका 125 12 ठोरी (सुवण पुर) गाउँपािलका 104 6 पकाहा मैनपुर गाउँपािलका 149 13 कािलकामाइ गाउँपािलका 149 7 पटेवा सुगौली गाउँपािलका 125 14 जीराभवानी गाउँपािलका 125
lhNnf M दोलखा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 िजरी नगरपािलका 125 6 वैते र गाउँपािलका 149 2 िभमे र नगरपािलका 197 7 मेलु गाउँपािलका 149 3 कािल ोक गाउँपािलका 197 8 िवगु गाउँपािलका 221 4 गौरीश र गाउँपािलका 197 9 शैलु गाउँपािलका 173 5 तामाकोशी गाउँपािलका 197
lhNnf M रामेछाप Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 म ली नगरपािलका 341 5 गोकु लग ा गाउँपािलका 173 2 रामेछाप नगरपािलका 197 6 दोर ा गाउँपािलका 173 3 उमाकु गाउँपािलका 149 7 िलखु तामाकोशी गाउँपािलका 173 4 खाँडादेवी गाउँपािलका 221 8 सुनापित गाउँपािलका 149
lhNnf M िस ुली Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 कमलामाई नगरपािलका 197 6 िफ ल गाउँपािलका 173 2 दुधौली नगरपािलका 269 7 म रण गाउँपािलका 104 3 गोल जोर गाउँपािलका 197 8 सुनकोशी गाउँपािलका 149 4 ाङलेख गाउँपािलका 149 9 ह रहरपुरगढी गाउँपािलका 125 5 तीनपाटन गाउँपािलका 221
166 HEALTH LOGISTICS REPORT
lhNnf M का ेपला ोक Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 धुिलखेल नगरपािलका 173 8 चौरीदं ेउराली गाउँपािलका 245 2 नमोबु नगरपािलका 221 9 तेमाल गाउँपािलका 197 3 पनौती नगरपािलका 293 10 बेथानचोक गाउँपािलका 149 4 पांचखाल नगरपािलका 221 11 भु ु गाउँपािलका 245 5 बनेपा नगरपािलका 149 12 महाभारत गाउँपािलका 149 6 म नदेउपुर नगरपािलका 173 13 रोशी गाउँपािलका 269 7 खानीखोला गाउँपािलका 149
lhNnf M िस ुपा चोक Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 चौतारा सागाचोकगढी नगरपािलका 245 7 पाँचपोखरी थाङपाल गाउँपािलका 221 2 मेल ची नगरपािलका 293 8 बलेफी गाउँपािलका 125 3 वा िवसे नगरपािलका 173 9 भोटेकोशी गाउँपािलका 125 4 ई ावती गाउँपािलका 197 10 िलसंखुपाखर गाउँपािलका 149 5 जुगल गाउँपािलका 173 11 सुनकोशी गाउँपािलका 197 6 ि पुरासु री गाउँपािलका 173 12 हेल ु गाउँपािलका 149
lhNnf M रसुवा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 उ रगया गाउँपािलका 104 4 नौकु गाउँपािलका 104 2 कािलका गाउँपािलका 104 5 आमाछोिदङमो गाउँपािलका 125 3 गोसाईंकु गाउँपािलका 173
lhNnf M नुवाकोट Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 िवदुर नगरपािलका 173 7 दु चे र गाउँपािलका 197 2 बेलकोटगढी नगरपािलका 197 8 प क ा गाउँपािलका 125 3 ककनी गाउँपािलका 173 9 ागङ गाउँपािलका 173 4 िक ाङ गाउँपािलका 173 10 िलखु गाउँपािलका 104 5 तादीगाउँ गाउँपािलका 149 11 िशवपुरी गाउँपािलका 221 6 तारके र गाउँपािलका 149 12 सुय गढी गाउँपािलका 125
lhNnf M धािद Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 धुनीब सी नगरपािलका 104 8 ि पुरासु री गाउँपािलका 149 2 नीलक नगरपािलका 197 9 था े गाउँपािलका 149 3 खिनयाबास गाउँपािलका 104 10 ने ावती गाउँपािलका 104 4 ग ाजमुना गाउँपािलका 149 11 बेनीघाट रोरा गाउँपािलका 125 5 गजुरी गाउँपािलका 104 12 वी ाली गाउँपािलका 104 6 ग छी गाउँपािलका 104 13 िस लेक गाउँपािलका 104 7 ालामूखी गाउँपािलका 125
167 HEALTH LOGISTICS REPORT
lhNnf M िचतवन Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 भरतपुर महानगरपािलका 365 5 र नगर नगरपािलका 125 2 कािलका नगरपािलका 125 6 रा ी नगरपािलका 173 3 खैरहनी नगरपािलका 125 7 इ ाकामना गाउँपािलका 149 4 माडी नगरपािलका 125
lhNnf M मकवानपुर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 हेटौडां उप-महानगरपािलका 173 6 बा ती गाउँपािलका 104 2 थाहा नगरपािलका 173 7 िभमफे दी गाउँपािलका 173 3 ई सरोवर गाउँपािलका 125 8 मकवानपुरगढी गाउँपािलका 125 4 कै लाश गाउँपािलका 125 9 मनहरी गाउँपािलका 104 5 बकै या गाउँपािलका 149 10 रा रा गाउँपािलका 125
lhNnf M भ पुर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 चाँगुनारायण नगरपािलका 221 3 म पुर िथमी नगरपािलका 149 2 भ पुर नगरपािलका 104 4 सूय िवनायक नगरपािलका 173
lhNnf M लिलतपुर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 लिलतपुर महानगरपािलका 173 4 को ोसोम गाउँपािलका 173 2 गोदावरी नगरपािलका 341 5 बा ती गाउँपािलका 197 3 महाल ी नगरपािलका 149 6 महा ाल गाउँपािलका 149
lhNnf M काठमा ौं Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 काठमा ौं महानगरपािलका 104 7 तारके र नगरपािलका 197 2 कागे री–मनोहरा नगरपािलका 173 8 दि णकाली नगरपािलका 173 3 कीित पुर नगरपािलका 221 9 नागाजु न नगरपािलका 149 4 गोकण र नगरपािलका 149 10 बुढािनलक नगरपािलका 173 5 च ािगरी नगरपािलका 293 11 शंखरापुर नगरपािलका 173 6 टोखा नगरपािलका 149
lhNnf M गोरखा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 गोरखा नगरपािलका 173 7 धाच गाउँपािलका 197 2 पालुङटार नगरपािलका 221 8 िभमसेन गाउँपािलका 173 3 अिजरकोट गाउँपािलका 149 9 शिहद लखन गाउँपािलका 173 4 आ घाट गाउँपािलका 149 10 िसरानचोक गाउँपािलका 197 5 ग की गाउँपािलका 173 11 बारपाक सुलीकोट गाउँपािलका 197 6 चुमनु ी गाउँपािलका 197
168 HEALTH LOGISTICS REPORT
lhNnf M ल जु Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 बेसीशहर नगरपािलका 197 5 ोलासोथार गाउँपािलका 197 2 म नेपाल नगरपािलका 269 6 दू धपोखरी गाउँपािलका 149 3 राईनास नगरपािलका 173 7 दोद गाउँपािलका 245 4 सु रबजार नगरपािलका 269 8 म ा ङदी गाउँपािलका 197
lhNnf M तन ँ Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 भानु नगरपािलका 221 6 ऋिष गाउँपािलका 149 2 िभमाद नगरपािलका 173 7 िघ रङ गाउँपािलका 104 3 ास नगरपािलका 245 8 देवघाट गाउँपािलका 149 4 शु ाग की नगरपािलका 173 9 ा े गाउँपािलका 104 5 आँबुखैरेनी गाउँपािलका 104 10 ब पुर गाउँपािलका 104
lhNnf M का ी Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 पोखरा लेखनाथ महानगरपािलका 581 4 मादी गाउँपािलका 221 2 अ पूण गाउँपािलका 149 5 पा गाउँपािलका 149 3 माछापुछ े गाउँपािलका 221
lhNnf M माना Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 चामे गाउँपािलका 104 3 नाशो ं गाउँपािलका 104 2 नापा भूिम गाउँपािलका 104 4 मनाङ िद ाङ गाउँपािलका 197
lhNnf M मु ा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 घरपझोङ गाउँपािलका 104 4 लोम ाङ गाउँपािलका 104 2 थासाङ गाउँपािलका 125 5 वा गाउँ मु े गाउँपािलका 125 3 लो घेकर दामोदरकु गाउँपािलका 104
lhNnf M ka{t Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 कु ा नगरपािलका 269 5 महािशला गाउँपािलका 173 2 फलेवास नगरपािलका 293 6 मोदी गाउँपािलका 221 3 जलजला गाउँपािलका 197 7 िवहादी गाउँपािलका 173 4 पैयूं गाउँपािलका 173
lhNnf M ा जा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ग ाङ नगरपािलका 245 7 आँिधखोला गाउँपािलका 173 2 चापाकोट नगरपािलका 173 8 कालीग की गाउँपािलका 125 3 पुतलीबजार नगरपािलका 269 9 फे दीखोला गाउँपािलका 125 4 भीरकोट नगरपािलका 149 10 िब वा गाउँपािलका 173 5 वािलङ नगरपािलका 269 11 ह रनास गाउँपािलका 104 6 अजु नचौपारी गाउँपािलका 149
169 HEALTH LOGISTICS REPORT
lhNnf M ा ी Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 बेनी नगरपािलका 197 4 मंगला गाउँपािलका 125 2 अ पूण गाउँपािलका 221 5 मािलका गाउँपािलका 173 3 धवलािगरी गाउँपािलका 197 6 रघुगंगा गाउँपािलका 221
lhNnf M बा ु Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ग ोट नगरपािलका 221 6 तमानखोला गाउँपािलका 104 2 जैिमनी नगरपािलका 245 7 ताराखोला गाउँपािलका 125 3 ढोरपाटन नगरपािलका 125 8 िनसीखोला गाउँपािलका 125 4 बा ुङ नगरपािलका 269 9 विडगाड गाउँपािलका 197 5 काठे खोला गाउँपािलका 197 10 वरेङ गाउँपािलका 149
lhNnf M नवलपरासी बद घाट सु ा पूव Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 कावासोती नगरपािलका 149 5 बौिदकाली गाउँपािलका 173 2 ग डाकोट नगरपािलका 125 6 बुिलङटार गाउँपािलका 173 3 देवचुली नगरपािलका 125 7 िवनयी ि वेणी गाउँपािलका 125 4 म िव दु नगरपािलका 241 8 ेकोट गाउँपािलका 104
lhNnf M नवलपरासी Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 बद घाट नगरपािलका 149 5 पा ीन न गाउँपािलका 173 2 राम ाम नगरपािलका 245 6 तापपुर गाउँपािलका 221 3 सुनवल नगरपािलका 104 7 सरावल गाउँपािलका 173 4 सु ा गाउँपािलका 125
lhNnf M प ेही Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 बुटवल उपमहानगरपािलका 104 9 कोटहीमाई गाउँपािलका 173 2 ितलो मा नगरपािलका 197 10 गैडहवा गाउँपािलका 125 3 देवदह नगरपािलका 104 11 मच वारी गाउँपािलका 125 4 लु नी सां ृ ितक नगरपािलका 221 12 मायादेवी गाउँपािलका 125 5 िस ाथ नगर नगरपािलका 104 13 रोिहणी गाउँपािलका 173 6 सैनामैना नगरपािलका 104 14 शु ोधन गाउँपािलका 125 7 ओमसितया गाउँपािलका 149 15 स रीमाई गाउँपािलका 173 8 क न गाउँपािलका 104 16 िसयारी गाउँपािलका 149
lhNnf M किपलव ु Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 किपलव ु नगरपािलका 221 6 िशवराज नगरपािलका 221 2 कृ नगर नगरपािलका 269 7 मायादेवी गाउँपािलका 221 3 बाणगंगा नगरपािलका 197 8 यसोधरा गाउँपािलका 221 4 बु भुमी नगरपािलका 269 9 िवजयनगर गाउँपािलका 125 5 महाराजग नगरपािलका 245 10 शु ोधन गाउँपािलका 149
170 HEALTH LOGISTICS REPORT
lhNnf M kfNkf Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 तानसेन नगरपािलका 173 6 बगनासकाली गाउँपािलका 245 2 रामपुर नगरपािलका 149 7 माथागढी गाउँपािलका 197 3 ितनाउ गाउँपािलका 125 8 र ा गाउँपािलका 125 4 िन ी गाउँपािलका 197 9 र ीकोट गाउँपािलका 221 5 पूव खोला गाउँपािलका 173 10 रैनादेवी छहरा गाउँपािलका 221
lhNnf M अघा खाँची Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 भुिमका थान नगरपािलका 197 4 छ देव गाउँपािलका 197 2 िशतगंगा नगरपािलका 197 5 पािणनी गाउँपािलका 221 3 स खक नगरपािलका 173 6 मालारानी गाउँपािलका 173
lhNnf M गु ी Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 मुिसकोट नगरपािलका 197 7 छ कोट गाउँपािलका 173 2 रेसुंगा नगरपािलका 125 8 धुक ट गाउँपािलका 197 3 इ ा गाउँपािलका 149 9 मदाने गाउँपािलका 197 4 कालीग की गाउँपािलका 197 10 मािलका गाउँपािलका 221 5 गु ीदरबार गाउँपािलका 173 11 गाउँपािलका 197 6 च कोट गाउँपािलका 221 12 स वती गाउँपािलका 221
lhNnf M कु म पूव Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 पुथा उ रगंगा गाउँपािलका 173 3 िस े गाउँपािलका 148 2 भूमे गाउँपािलका 148
lhNnf M रो ा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 रो ा नगरपािलका 197 6 ीगढी गाउँपािलका 173 2 ि वेणी गाउँपािलका 149 7 लुङ ी गाउँपािलका 149 3 थवाङ गाउँपािलका 104 8 गंगादेव गाउँपािलका 125 4 प रवत न गाउँपािलका 149 9 सुनछहरी गाउँपािलका 173 5 माडी गाउँपािलका 125 10 सुिनल ृित गाउँपािलका 173
lhNnf M ूठान Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ूठान नगरपािलका 173 6 नौबिहनी गाउँपािलका 173 2 ग ारी नगरपािलका 197 7 म रानी गाउँपािलका 125 3 ऐरावती गाउँपािलका 173 8 मा वी गाउँपािलका 149 4 गौमुखी गाउँपािलका 173 9 स मारानी गाउँपािलका 104 5 िझम क गाउँपािलका 149
171 HEALTH LOGISTICS REPORT
lhNnf M दा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 घोराही उपमहानगरपािलका 221 6 बंगलाचुली गाउँपािलका 125 2 तु ीपुर उपमहानगरपािलका 221 7 बबई गाउँपािलका 100 3 लमही नगरपािलका 104 8 राजपुर गाउँपािलका 100 4 गढवा गाउँपािलका 125 9 रा ी गाउँपािलका 100 5 दंगीशरण गाउँपािलका 104 10 शा नगर गाउँपािलका 100
lhNnf M बाँके Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 नेपालग उपमहानगरपािलका 289 5 डुडुवा गाउँपािलका 149 2 कोहलपुर नगरपािलका 104 6 नरैनापुर गाउँपािलका 173 3 खजुरा गाउँपािलका 173 7 बैजनाथ गाउँपािलका 125 4 जानकी गाउँपािलका 173 8 रा ीसोनारी गाउँपािलका 173
lhNnf M alb{of Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 गुल रया नगरपािलका 104 5 राजापुर नगरपािलका 197 2 ठाकु रबाबा नगरपािलका 125 6 बारबिद या नगरपािलका 125 3 बाँसगढी नगरपािलका 104 7 गे वा गाउँपािलका 125 4 मधुवन नगरपािलका 125 8 बढैयाताल गाउँपािलका 149
lhNnf M?s'd Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 आठिबसकोट नगरपािलका 149 4 ि वेणी गाउँपािलका 125 2 चौरजहारी नगरपािलका 149 5 बाँिफकोट गाउँपािलका 125 3 मुिसकोट नगरपािलका 149 6 सानीभेरी गाउँपािलका 125
lhNnf M स ान Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 बागचौर नगरपािलका 173 6 कु माख गाउँपािलका 149 2 बनगाँड कु िप े नगरपािलका 197 7 छ े री गाउँपािलका 149 3 शारदा नगरपािलका 197 8 िस कु माख गाउँपािलका 104 4 कपुरकोट गाउँपािलका 125 9 ि वेणी गाउँपािलका 125 5 कािलमाटी गाउँपािलका 125 10 दामा गाउँपािलका 104
lhNnf M डो ा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ठू लीभेरी नगरपािलका 104 5 जगदु ा गाउँपािलका 104 2 ि पुरासु री नगरपािलका 149 6 डो ो बु गाउँपािलका 104 3 काईके गाउँपािलका 104 7 मुड्के चुला गाउँपािलका 104 4 छाका ताङसोङ गाउँपािलका 104 8 शे फो ु ो गाउँपािलका 104
172 HEALTH LOGISTICS REPORT
lhNnf M जु ा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 च ननाथ नगरपािलका 104 5 ितला गाउँपािलका 149 2 कनकासु री गाउँपािलका 149 6 पातारासी गाउँपािलका 125 3 गुिठचौर गाउँपािलका 104 7 िसंजा गाउँपािलका 104 4 तातोपानी गाउँपािलका 125 8 िहमा गाउँपािलका 104
lhNnf M मुगु Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ख ाड गाउँपािलका 197 3 सो गाउँपािलका 197 2 मुगुमकामा रोगं गाउँपािलका 149
lhNnf M ा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 अदानचुली गाउँपािलका 104 5 ना खा गाउँपािलका 125 2 खापु नाथ गाउँपािलका 125 6 सक गाड गाउँपािलका 197 3 चंखेली गाउँपािलका 125 7 िसमकोट गाउँपािलका 125 4 ताँजाकोट गाउँपािलका 104
lhNnf M कािलकोट Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 खाँडाच नगरपािलका 104 6 पचालझरना गाउँपिलका 100 2 ितलागुफा नगरपािलका 149 7 पलाता गाउँपािलका 100 3 रा ोट नगरपािलका 100 8 महावै गाउँपािलका 100 4 कािलका गाउँपािलका 100 9 सा ी ि वेणी गाउँपािलका 100 5 नरह रनाथ गाउँपािलका 149
lhNnf M जाजरकोट Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 छे डागाड नगरपािलका 197 5 जुनीचाँदे गाउँपािलका 125 2 नलगाड नगरपािलका 173 6 बारेकोट गाउँपािलका 125 3 भेरी मािलका नगरपािलका 149 7 िशवालय गाउँपािलका 104 4 कु से गाउँपािलका 149
lhNnf M दैलेख Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 आठबीस नगरपािलका 173 7 डुंगे र गाउँपािलका 125 2 चामु ा िब ासैनी नगरपािलका 104 8 नौमुले गाउँपािलका 197 3 दु ु नगरपािलका 265 9 भगवतीमाई गाउँपािलका 173 4 नारायण नगरपािलका 173 10 भैरवी गाउँपािलका 104 5 गुराँस गाउँपािलका 173 11 महाबु गाउँपािलका 149 6 ठाँटीकाँध गाउँपािलका 104
173 HEALTH LOGISTICS REPORT
lhNnf M सुख त Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 गुभा कोट नगरपािलका 197 6 िच ाड गाउँपािलका 149 2 प पुरी नगरपािलका 149 7 चौकु ने गाउँपािलका 149 3 भेरीगंगा नगरपािलका 125 8 बराहताल गाउँपािलका 149 4 लेकबेसी नगरपािलका 197 9 िस ा गाउँपािलका 221 5 बीरे नगर नगरपािलका 197
lhNnf M बाजुरा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 ि वेणी नगरपािलका 104 6 ख ड छे डेदह गाउँपािलका 149 2 बिडमािलका नगरपािलका 104 7 पा व गुफा गाउँपािलका 104 3 बुढीगंगा नगरपािलका 104 8 ामीकाित क गाउँपािलका 104 4 बुढीन ा नगरपािलका 125 9 िहमाली गाउँपािलका 104 5 गौमुल गाउँपािलका 104
lhNnf M बझा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 जयपृ ी नगरपािलका 149 7 तालकोट गाँउपािलका 125 2 बुंगल नगरपािलका 149 8 थलारा गाँउपािलका 149 3 साइ पाल गाउँपािलका 104 9 दुगा थली गाँउपािलका 104 4 के दार ुँ गाँउपािलका 125 10 म ा गाउँपािलका 125 5 ख डछा ा गाँउपािलका 173 11 िव डिचर गाँउपािलका 104 6 छिबसपािथभेरा गाँउपािलका 149 12 सूमा गाउँपािलका 104
lhNnf M डोटी Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 िदपायल िसलगढी नगरपािलका 125 6 पूव चौकी गाउँपािलका 197 2 िशखर नगरपािलका 245 7 बडीके दार गाउँपािलका 125 3 आदश गाउँपािलका 173 8 बोगटान गाउँपािलका 197 4 के .आई.िसं. गाउँपािलका 149 9 सायल गाउँपािलका 104 5 जोरायल गाउँपािलका 173
lhNnf M आछाम Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 कमलबजार नगरपािलका 221 6 ढकारी गाउँपािलका 125 2 पंचदेवल िवनायक नगरपािलका 221 7 तुमा खाँद गाउँपािलका 197 3 मंगलसेन नगरपािलका 221 8 बा ीगढी जयगढ गाउँपािलका 173 4 साँफे वगर नगरपािलका 341 9 मे ेख गाउँपािलका 197 5 चौरपाटी गाउँपािलका 173 10 रामारोशन गाउँपािलका 197
lhNnf M दाचु ला Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 महाकाली नगरपािलका 149 6 ाँस गाउँपािलका 149 2 शै िशखर नगरपािलका 173 7 मामा गाउँपािलका 149 3 अिपिहमाल गाउँपािलका 104 8 मािलकाजु न गाउँपािलका 173 4 दु ँ गाउँपािलका 125 9 लेकम गाउँपािलका 125 5 नौगाड गाउँपािलका 125
174 HEALTH LOGISTICS REPORT
lhNnf M बैतडी Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 दशरथच नगरपािलका 265 6 दोगडाके दार गाउँपािलका 217 2 पाटन नगरपािलका 245 7 पंचे र गाउँपािलका 149 3 पुच डी नगरपािलका 269 8 िशवनाथ गाउँपािलका 104 4 मेलौली नगरपािलका 173 9 िसगास गाउँपािलका 149 5 डीलासैनी गाउँपािलका 125 10 सुन या गाउँपािलका 197
lhNnf M डडेलधुरा Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 अमरगढी नगरपािलका 125 5 ग ापधुरा गाउँपािलका 125 2 परशुराम नगरपािलका 104 6 नवदुगा गाउँपािलका 125 3 अजयमे गाउँपािलका 149 7 भागे र गाउँपािलका 100 4 आिलताल गाउँपािलका 104
lhNnf M कं चनपुर Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 कृ पुर नगरपािलका 100 6 माहाकाली नगरपािलका 104 2 पुनवा स नगरपािलका 100 7 शु ाफाँट नगरपािलका 104 3 बेदकोट नगरपािलका 100 8 बेलडाँडी गाउँपािलका 104 4 बेलौरी नगरपािलका 100 9 लालझाडी गाउँपािलका 104 5 िभमद नगरपािलका 104
lhNnf M कै लाली Budget Budget SN Palika SN Palika NPR(000) NPR(000) 1 धनगढी उपमहानगरपािलका 104 8 कै लारी गाउँपािलका 173 2 गोदावरी नगरपािलका 149 9 चुरे गाउँपािलका 104 3 गौरीगंगा नगरपािलका 104 10 जानकी गाउँपािलका 125 4 घोडाघोडी नगरपािलका 125 11 जोशीपुर गाउँपािलका 104 5 िटकापुर नगरपािलका 104 12 बद गो रया गाउँपािलका 104 6 भजनी नगरपािलका 125 13 मोह ाल गाउँपािलका 104 7 ल कचुहा नगरपािलका 104
Total Budget 120992
175 HEALTH LOGISTICS REPORT
16. ToR OF MD SECTIONS g]kfn ;/sf/ :jf:Yo tyf hg;+Vof dGqfno :jf:Yo ;]jf ljefu Joj:yfkg dxfzfvf
Zffvfx?sf] sfo{ ljj/0f
!= cfk"lt{ Joj:yfkg zfvf • vl/b tyf cfk"lt{ ;DaGwL /fli6«o sfg'g, gLlt, lgb]{lzsf, u'0f:t/ dfkb08, k|f]6f]snx? lgdf{0f ug{ :jf:Yo tyf hg;+Vof dGqfnonfO{ ;xof]u ug]{ . • /fli6«o:t/df cf}iflw, :jf:Yo pks/0f tyf cf}hf/x?sf] dfkb08 Pjd\ :k]lzlkms]zg a}+s tof/ tyf cWofjlws ug{ :jf:Yo tyf hg;+Vof dGqfnonfO{ ;xof]u ug]{ . • vf]k tyf kl/jf/ lgof]hgsf ;fwg h:tf clt cfjZos :jf:Yo ;fdfu|Lx?sf] v/Lb tyf k|b]z:t/df cfk"lt{ ug]{ . • k|b]z tyf :yfgLo :t/df cfjZos cf}hf/, pks/0f tyf cf}iflwx?sf] vl/b tyf cfk"lt{ ug{ ;xlhs/0f ug]{ . • /fli6«o:t/df cfk"lt{ Joj:yfkg ;"rgf k|0fflnnfO{ ;+:yfut ug{ ;dGjo tyf ;xlhs/0f ug]{ . • ljefu cGQu{tsf lgsfox?df cfjZos ;dfu|Lsf] Joj:yfkg ug]{ .
@= k"jf{wf/ ljsf; zfvf • :jf:Yo ;+:yfx?sf] ef}lts ;+/rgf tyf pks/0f ;DaGwL /fli6«o gLlt, lgod tyf dfkb08 lgdf{0f ug{ :jf:Yo tyf hg;+Vof dGqfnonfO{ ;xlhs/0f ug]{ . • :jf:Yo ;+:yfx?sf] ef}lts k"jf{wf/x¿ tyf pks/0fx?sf] :t/Ls/0f ul/ nut /fVg ] . • :jf:Yo ;+:yfx?nfO{ cfjZos k"jf{wf/ ljsf;sf] /fli6«o of]hgf th{'df ug{ ;xlhs/0f ug]{ . • :jf:Yo ;+:yfx?sf] cfjZos k"jf{wf/sf] Joj:yfkgsf] nflu ;/f]sf/jfnfx?;+u ;dGjo ug]{ . • c:ktfn ejg ;+lxtf ljsf;, cWofjlws tyf lgodgsf nflu ;xlhs/0f ug]{ • :jf:Yo k'jf{wf/ tyf pks/0fsf] lgl/If0f, cg'udg tyf u'0f:t/ lgoGq0fsf nflu ;xlhs/0f ug]{ .
#= jftfj/l0fo :jf:Yo tyf :jf:YohGo kmf]x/d}nf Joj:yfkg zfvf ;+3, k|b]z tyf :yfgLo ;/sf/sf] sfo{ lhDd]jf/L ;DaGwdf >L dGqLk/Lifbn] :jLs[t u/]sf] ;+3sf] sfo{ la:t[tLs/0fdf vfg]kfgL, vfWo kbfy{ / xfjfsf] u'0f:t/Lotf cg'udg tyf n]vfhf]vf 9fFrf Pj+ u'0f:t/sf] dfkb08 lgwf{/0f ug]{ pNn]v eP cg';f/ ;f] sfo{ ;+rfng ug{ of] zfvf :yfkgf u/LPsf] xf] . o; zfvfsf] sfo{ljj/0f lgDgfg';f/ 5M • jftfj/l0fo :jf:Yo ;DaGwL gLlt, lgb]{lzsf, dfu{bz{g, dfkb08 nufotsf b:tfj]hx? lgdf{0f ug{ ;xof]u tyf ;xhLs/0f ug]{ . • vfg]kfgL, xfjf tyf ;du| jftfj/0fn] :jf:Yodf kf/]sf] c;/ ;DaGwdf lgu/fgL, cWoog, cg';Gwfg tyf lgodgdf ;xhLs/0f ug{ ] . • :jf:Yo ;]jfhGo kmf]x/d}nf Joj:yfkg ;DaGwL /fli6«o sfg'g, gLlt, lgod, dfkb08, k|f]6f]sn tof/ ug{ :jf:Yo tyf hg;+Vof dGqfnonfO{ ;xof]u ug]{ • ;+3, k|b]{z tyf :yfgLo tx cGQu{tsf :jf:Yo ;+:yfx?af6 lg:sg] kmf]x/d}nfsf] j}1flgs 9Ën] Joj:yfkg ug{ ;xlhs/0f ug]{ . • ;+3 cGQu{tsf :jf:Yo ;+:yfx?af6 lg:sg] kmf]x/d}nf j}1flgs 9Ën] Joj:yfkg ug{ cg'udg tyf lgodgsf sfo{x? ug]{ .
$= Plss[t :jf:Yo ;"rgf Joj:yfkg zfvf • /fli6«o:t/df :jf:Yo Joj:yfkg ;"rgf k|0ffnL ;DaGwL gLlt, lgod, lgb]{lzsf, dfkb08 tyf k|f]6f]snx? lgdf{0f ug{ :jf:Yo tyf hg;+Vof dGqfnonfO{ ;xlhs/0f ug]{ . • :jf:Yo ;"rgfx? k|efjsf/L Joj:yfkgsf nflu ;dofg's'n cWofjlws tyf k|ljlwd}qL agfpg] . • :jf:Yo If]qdf Pr=Pd=cfO{=P;=, Pn=Pd=cfO{=P;=, Pr=cfO{=cfO{=P;= h:tf laWodfg ;"rgf k|0ffnLnfO{ Plss[t k|0ffnLsf] ?kdf ljsf;, lj:tf/ / ;+:yfut ug]{ . • /fli6«o:t/sf] :jf:Yo ;"rgfsf] nflu txut ;"rsx? lgwf{/0f Pjd\ kl/dfh{g ug{ ] . • :jf:Yo ;+u ;DalGwt ;"rgfsf] ljZn]if0f u/L jflif{s tyf cfjlws ?kdf k|ltj]bg tof/ tyf ;fj{hlgs/0f ug]{ . • Plss[t :jf:Yo ;"rgf k|0ffnLnfO{ ljleGg txdf ;+:yfut ug{ Ifdtf clea[lbsf nflu ;xlhs/0f ug]{ . • :jf:Yo ;]jf ;DjGwL ;"rgf Joj:yfkg tyf sfof{Gjogsf nflu k|fb]{lzs tyf :yfgLo tx;Fu ;dGjo tyf ;xsfo{ ug]{ . • ljefu cGtu{t dxfzfvfx¿sf] of]hgf tof/ ug{ ;dGjo tyf ;xhLs/0f ug]{ . • ljefusf] df;Ls rf}df;Ls tyf afifL{s k|utL ceLn]vLs/0f ug]{ tyf k|ltj]bg tof/ ug]{ . • ljefusf tkm{af6 dGqfnosf] ;du| of]hgf th{'dfdf cfjZos ;xof]u ug]{ .
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16.PHOTO GALLERY
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Banke HFL Training Bardiya Hospital Visit
Bardiya Rajapur Store Bardiya Rollout
BHLTraining Sarlahi BNM Surkhet Store
BRT ToT 2 Cerificate Dist Hetauda
178 HEALTH LOGISTICS REPORT
COVID-19 item recieved from US Army at MD Dhangadhi ToT
EDPs Contribution Meeting on SCM EDPs Meeting on COVID-19
eLMIS Site Visit at Surkhet eLMIS Review Workshop Dhulikhel 1
eLMIS Review Workshop Dhulikhel 2 eLMIS Review Workshop Dhulikhel 3
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eLMIS Study Trip Sri Lanka 1 New Ware House Construction at Teku, Kathmandu
eLMIS Study Trip Sri Lanka 3 eLMIS Study Trip Sri Lanka 4
eLMIS Visit Bardiya eLMIS Visit Surkhet
Expert Consultative Meeting Kathmandu GIDC Visit
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Health Logistics Report Development Meeting Hetauda ToT
HO Arghakhachi Visit LWG Meeting at MD
Quantification Workshop Hetauda Mugu Hospital
Rajapur Meeting National Quantification Workshop Nagarkot
181 HEALTH LOGISTICS REPORT
Covid-19 Commodities Recieved at TIA, Kathmandu Covid-19 Commodities Recieved at TIA, Kathmandu
Covid-19 Commodities Repacking at MD Covid-19 Partners Meeting at MD
Quantification Training Biratnagar 1 Quantification Training Lalgadh 1
Quantification Workshop Lalgadh 2 LMIS Training at Dupcheshowor Gaun Palika, Nuwakot
182 HEALTH LOGISTICS REPORT
Rautahat BHL1 Repacking and Distribution of PPE Set for COVID-19
Quantification Biratnagar ToT at Biratnagar
ToT at Dhangadhi 2 ToT at Hetauda
ToT at Hetauda Biratnagar Quantification Training
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International Training on FP/RH Commodity Security at International Training on FP/RH Commodity Security at Jaipur, india Jaipur, india
eLMIS Site Visit at Surkhet Covid-19 Quarantine Visit at Kharipati, Bhaktapur
COVID-19 Logistics Management Operations Monitoring at COVID-19 Logistics Management Operations Monitoring at TIA Kathmandu 1 TIA Kathmandu 2
eLMIS Joint Monitoring Visit at Sindhupalchok Partners Meeting at MD
184 HEALTH LOGISTICS REPORT
LOGISTICS MANAGEMENT SECTION Systems Being Monitored an d Managed by Logistics Management Information Resource Center: 1. Website of Department of Health Services. Url: https://dohs.gov.np
2. Official Email Server/Email ID of Department of Health Services. Mail server Url: https://mail.nepal.gov.np Email ID: [email protected]
3. Website of Logistics Management Section, Management Division. Url: https://dohslmd.gov.np
4. Official Email Server/Email ID of Management Division. Mail Server Url: https://mail.nepal.gov.np Email ID: [email protected]
5. Electronic Logistics Management Information System (eLMIS ,web based application hosted under domain dohslmd.gov.np ) System & Server Management with support & coordination from GHSC-PSM Url: https://elmis.dohslmd.gov.np
6. Technical Specification Bank (web based application hosted under the domain dohslmd.gov. np). It contains the DoHS approved specifications of health services related commodities, i.e medicine & medical equipments, based on which procurement is to be done. The system can be accessed via the website of LMS (https://dohslmd.gov.np)
7. Grievance Handling & Redressal Mechanism (web based application hosted under domain dohslmd.gov.np). The system can be accessed via the website of LMS or by the following web address: Url: https://dohslmd.gov.np/ghrm
185 HEALTH LOGISTICS REPORT
SUPPORTED BY
UNFPA/ADRA NEPAL
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