GOVERNMENT OF NEPAL Ministry of Health & Population Department of Health Services Central Regional Health Directorate
District Health Office- Bara Kalaiya District Health Office, Bara
Date: - 2070/05/18 Acknowledgement
It is the eighth time endeavors to prepare this Annual Report on the basis of annual Performance Review of National Priority programs and Primary Health Services provided by the Health Facilities in F/Y 2069/70. This report comprises the achievements of Primary Health Care activities, major problems and issues related to the health program have been discussed here. This report will help for the future planning of Public Health Program.
I would like to extend my deep appreciation & special thanks to Mr. Ram Naresh Yadav. Statistical Officer DHO Bara for his hard work to prepare this report. I would also like to thank Miss Gunja Kumari Gupta (computer operator) whose hard work brought this report the shape of District Annual Report of Bara.
I would like to express my special thanks to DHO and Health Facilities staffs for their valuable contribution to produce this report. In addition, I would like to thank all FCHVs and individual who supported DHO directly or indirectly.
......
Dr. Sanjib Kumar Shingh DistrictHealth officer DHO, Bara
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District Health Office, Bara
Executive Summary
Government of Nepal, Ministry of Health and Population (MoHP) and Department of Health Services (DoHS) aims to provide Preventive, Promotive, Curative and Rehabilitative health services up to the community level, according to the National Health Policy 1991. The structure of Health System; Hospital, PHCCs, Health Posts, Sub-Health Posts, EPI Clinics and PHC/ORC provide those services mentioned in National Health Policy 1991, to bring improvement in the health conditions of the Nepalese people.
The annual performance of different Public Health Programs conducted by those health structures in Bara district during FY 2069/70 was collected timely through the HMIS system, reviewed and compiled in this Annual Report. The trend of three years annual performance is compared in this Annual Report.
The different national program activities' objectives, their targets and strategies adopted were analyzed on the basis of target vs. achievement and/or coverage. The latest public health scenario with major public health issues, problems and constraints faced during program implementation and suggestions gathered during review were identified and incorporated in this report.
This executive summary highlights and reflects key issues and observations emerging from the analysis of each Program. Further Program information is available in specific reports following this summary. The information and statistics used were based on Health Management Information System (HMIS) findings provided by health institution of Bara district.
There are 1 Hospital, 4+1 PHCs, 11+31 Health Posts, 51 Sub-Health Posts, 884 Female Community Health Volunteers (FCHV) in VDCs and 57 in Municipality, 492 EPI Clinics & 297 Primary Health Care Out Reach Clinics (PHC/ORC) in Bara district to support the existing systems. This report is a glance or the outcome of the annual performance of those structures in the existing health system.
Reporting Status:
Recording of the activities carried out in the health system program units and its reporting is the key activities carried out. It helps in tracking the program in all stages. On analyzing the reporting status of the 3 consecutive FYs 2067/68 to FY 2069/70; Hospital, PHCCs, HPs and SHPs have been reporting 100% for all three FYs. Reporting status of FCHV has decreased to 94% in FY 2069/70 from 98% in FY 2068/69.
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District Health Office, Bara
EPI Program:
The immunization coverage of all antigens was satisfactory. BCG coverage and DPT Hep B,Hib III were above 100% during FY 2069/70. As an indicator of fully immunized children, measles coverage was 91 percent if FY 2079/70 which was dropped from 100% in FY 2068/69). Similarly, there has been remarkably reduction in the coverage of TT2 from 93% during 2067/68 to 79% during FY 2069/70. Overall dropout rate of BCG vs Measles is 11% in FY 206/70 which is decreased by 1 point from 12% in last FY 2068/69. The dropout rate of Penta 1 Vs Penta 3 has been decreased from 9% to 2% from the FY 2068/69 to FY 2069/70.
School immunization program has been continued and Polio MOP UP Program has been continued in Bara district in this fiscal year too.
Nutrition:
Percentage of Growth Monitoring coverage hovered around 43% in FY 2069/70 from 42% in FY 2068/69. However, there has been slightly increase in average no. of growth monitoring visit to 2 in FY 2069/70 from 1.91 in 2068/69. There has been gradual reduction in the proportion of malnourished children among new visit in the last three years. Coverage of iron among pregnant women is declining. It was declined from 98% in FY 2067/68 to 87% in FY2068/69, and 88% during fiscal year 2069/70. Similar scenario was noticed to the % of Postpartum mother receiving Vitamin A which was dropped from 72% in FY 2067/68 to 67% and 58% during FY 2068/69 and FY 2069/70 respectively. Positive change is that proportion of Malnourished children as % of new growth monitoring of under 5 children has been decreased to 3.6 (FY 2069/70) from 6.3 (FY 2067/68).
Acute Respiratory Infection Program:
There was slightly increase in reported incidence of ARI/1000 <5 children i.e. 658 (FY 2069/70) which was 578 (FY 2068/69). Annual Reported Incidence of Pneumonia (Mild + Severe) / 1000 among <5 children New visits is in decreasing order showing 195 , 153 & 142 in Fiscal years 2067/68 , 2068/69 and 2069/70 respectively. Due to the active role of FCHV in ARI Program, the % of severe pneumonia was reported to be 0.44% during FY2068/69 which decreased to 0.17% during FY 2069/70 in the district.
Control of Diarrheal Diseases:
Both the Incidence of diarrhea among <5 children and % of severe dehydration among New Cases are in decreasing order. Incidence of diarrhea among <5 children is 451, 440,423 in respective fiscal years 2067/68, 2068/69 and 2069/70. Similarly, of severe dehydration among New Cases is 0.11, 0.22 and 0.09 in FYs 2067/68, 2068/69 and 2069/70 respectively.
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District Health Office, Bara
Safe Motherhood Program:
ANC First visit as % of expected pregnancies has decreasing trend, declined to 85% (FY 2069/70) from 92% (FY 2068/69) and 95 % (FY 2067/68). Similarly, ANC 4 th visit as % of ANC 1 st visit slightly dropped in those three consecutive years i.e. to 52% from 55%. Due to maternity scheme, increment of Birthing centers and available Skilled Birth Attendants, the institutional delivery and SBA delivery is in increasing trend. Institutional delivery has slightly dropped to 30% in FY 2069/70 from 31 % (FY 2068/69). CEOC is functional in Bara district in the district hospital. Altogether … CS was carried out in this fiscal year from the CEOC, Kalaiya. PNC visit as % of live birth has been decreased from 63% (FY 2067/68) to 44% during FY 2069/70.
Family Planning:
There is steady decrement in the current users of most of the Modern method except condom. The highest no of current user was VSC(31%) followed by Depo(5.94%). The total spacing methods of the district has increased from 6.68 in FY 2067/68 to 7.17 in FY 2068/69. Similarly, new acceptor of both Minilap and Vasectomy dropped remarkably during last three FY 2067/68 to FY 2069/70.
Primary Health Care Out Reach Center:
Conduction of PHC ORC has dropped to 73% in this fiscal year which was 83.73% in FY 2068/69. But the average number of clients served per clinic has raised to 18 (FY 2069/70) from 15 in FY 2068/69.
Vector Control Program:
Annual blood slide examination rate has again decreased to 0.37% in fiscal year 2069/70 which was dropped to 0.38 (FY 2068/69) from 0.62 (FY 2067/68). This may be due to Microscopic centers localized to PHCC and in the district. It needs to be extended to the entire Ilakas of Bara district. Percentage of PF among total positive cases increased dramatically 46.16 % in FY 2069/70 compared 7% in FY 2068/69. This shows high burden of +ve PF case compared to FY 2068/69.
Incidence of Kala-azar case per 10,000 Risk population is 0.07, 0.03 and 0.9 in Fiscal Years 2067/68, 2068/69 and 2069/70 respectively. Similarly Case Fatality Rate of Kala-azar maintained 0 from the FY 2066/67.
Tuberculosis Program:
Case finding Rate remarkably increased from 65% during fiscal 2068/69 to 76% in FY 2069/70. It is above national target. Similarly, Treatment success rate increased slightly from 92% in FY 2067/68 to 93% during FY 2069/70.
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District Health Office, Bara
Leprosy Program:
New case detection rate of leprosy has been slightly increased to 1.98 during FY 2069/70 compared to 1.7 in FY 68/69 and decreased from 2 per 10,000 populations in FY 67/68. Similarly, the prevalence rate per 10,000 has decreased to 1.31 (FY 2069/70) from 1.4 (FY 2068/69). But leprosy is eliminated from Nepal and Bara district has not met the national goal too. Due to early diagnosis and prompt treatment the disability grade has decreased to 0.7 in FY 2069/70 from 2 in FY 2067/68 .
Health Education Program:
IEC is the main cross cutting and supportive part of each health program and the achievement of IEC Program conducted during this Fiscal Year 2698/70 was 100%.
HIV & AIDS Program:
HIV in Nepal is characterized as concentrated epidemic, where majority of infections are transmitted through sexual transmission. Prevention of HIV among key population is the key programmatic strategies, while providing quality treatment, care and support for infected and affected is equally important strategic directions to achieve the end results of national response. In this fiscal year, altogether 2472 clients were counseled and tested in the 3 HTC centers in the district in which 16 new HIV positives were identified whose total count in the district sums up to 82. in this fiscal year 2069/70.
Curative Services:
In the curative service, total new OPD visits as % of total population has 72%to 75% in FY 2069/70 from 73 in FY 2067/68 and 70 in FY 2066/67 among which total new female OPD visits is 51% (FY 2068/69) compared to 48.3 (FY 2067/68) and 49 (FY 2066/67). The percentage of communicable disease among total OPD new visit is 21, 19.64 & 18.82 in 2066/67, 2067/68 & 2068/69 respectively. This concludes the trend of communicable disease decreasing which might be due to awareness and conscious about health.
Hospital Services:
Kalaiya District Hospital is the single hospital in Bara district for 7, 26,194 population. Data revealed that total OPD visits as % of total population has been decreased to 3% in FY 2069/70from 4 in FY 2068/69. But, the percentage of Emergency visits among total OPD visits has tapered down to 40% in FY 2069/70 from 58% in FY 2068/69. The important is that the bed occupancy rate has been increased to 60% in FY 2069/70 from the FY 2068/69 which proves the extension of bed of the hospital r. There is remarkable increment in hospital delivery conduction since last two fiscal years.
Neither maternal death nor hospital deaths have been recorded in these three fiscal years mentioned in above tables. Due to the fulfillment of the doctor's positions, v
District Health Office, Bara
Health Service Coverage Fact Sheet
FY 2067/68 (2010/2011) to 2069/70 (2012/2013)
Program/Activities/Health Indicators Fiscal Year
REPORTING STATUS 2067/68 2068/69 2069/70
Hospital 100 100 100
PHCC/HC 100 100 100
HP 100 100 100
Sub Health Post 100 100 100
PHC-ORC clinics 82 83.73 73.5
FCHV 97.6 98.14 93.98
EPI 98 97 96.7
EXPANDED PROGRAM ON IMMUNIZATION
1 BCG Coverage 113.4 114 102
2 Penta 3 Coverage 118 105 104
3 Polio-3 Coverage 118 105 104
4 Measles Coverage 98.8 100 91
5 % of Pregnant women receiving TT-2 & +2 93 89 79
NUTRITION PROGRAM
6 % of Growth Monitoring among <5 children 43 41 42
Proportion of malnourished children as % of new growth 7 6.3 3.71 3.57 monitoring (< 5 years)
8 % of Pregnant women receiving Iron tablets 98 87 98.69
9 % of Postpartum Mother receiving Vitamin A 72 66 58
ACUTE RESPIRATORY INFECTION (ARI)
10 Reported Incidence of ARI/1,000 <5 Children New Visits 704 711 658
Annual Reported Incidence of Pneumonia (Mild + 11 195 171 142 Severe)/1,000 among <5 Children New Visits
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District Health Office, Bara
Program/Activities/Health Indicators Fiscal Year
REPORTING STATUS 2067/68 2068/69 2069/70
12 Proportion of Severe Pneumonia among New Cases 0.44 0.25 0.17
CONTROL OF DIARRHOEAL DISEASES (CDD)
13 Incidence of Diarrhea/1,000 <5 Children New Cases 451 439 423
14 % of Severe Dehydration among Total New Cases .11 0.06 0.3
SAFE MOTHERHOOD PROGRAM
15 Antenatal First Visits as % of Expected Pregnancies 95.36 92 85.22
16 ANC 4 th Visit as % of ANC 1 st Visit 54.5 55 50
17 Delivery Conducted by SBA as % Live Birth 27 31.55 33
18 HF Delivery as % of Live Birth 29 30.71 31
Delivery Conducted by SBA at Health Facility as % of expected 19 20 23.75 25 pregnancy
Delivery Conducted by SBA at Home as % of expected 20 4 4.63 3.59 pregnancy
Delivery Conducted by Other than SBA at Health Facility as % of 21 5.6 3.88 1.45 expected pregnancy
Delivery Conducted by Other than SBA at Home as % of 22 28.26 24.45 15.33 expected pregnancy
23 PNC First Visits as % of Live birth 63.2 61.85 44
FAMILY PLANNING PROGRAM
24 Contraceptive Prevalence Rate (Modern Method)* 44.53 45 38
25 Pills 1.4 1.38 1.49
26 Depo Provera 6.51 5.99 5.94
27 IUCD 0.84 1.6 1.51
28 Implant 0.77 1.04 1
29 Sterilization 32.17 32.26 31
MALARIA / KALA-AZAR CONTROL PROGRAM
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District Health Office, Bara
Program/Activities/Health Indicators Fiscal Year
REPORTING STATUS 2067/68 2068/69 2069/70
30 Annual Blood Slide Examination Rate (ABER) per 100 0.62 0.38 0.37
31 % of PF among total positive cases 0.06 0.06 46.16
32 Clinical Malaria Incidence (CMI) /1,000 8.46 2.99 2.75
33 Incidence of Kala-azar /10,000 Risk Population 0.07 0.03 0.09
TUBERCULOSIS CONTROL PROGRAM
34 Case Finding Rate 70 65 76
35 Treatment Success Rate on DOTS 92 92 93
LEPROSY CONTROL PROGRAM
36 New Case Detection Rate (NCDR) /10,000 2.1 1.7 1.98
37 Prevalence Rate (PR) /10,000 1.9 1.4 1.31
38 Disability Rate Grade 2 Among New Cases 2 0.7 0.69
HIV/AIDS PROGRAM
39 Cumulative HIV/AIDS reported cases 44 60 82
40 Estimated HIV/AIDS cases
CURATIVE SERVICES
41 Total new OPD visits as % of total population 73 75 71.97
42 Total new female OPD visits as % of total OPD visit 48.3 51 52
43 % of communicable disease among total OPD new visit 19.64 18.82 48
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District Health Office, Bara
Contents
Executive Summary……………………………………………………………………………………………………………………….I
Fact Sheet……………………………………………………………………………………………………………………………………. VII
Introduction…………………………………………………………………………………………………………………………………….1
Reporting Status………………………………………………………………………………………………………………………………9
National Immunization Program…………………………………………………………………………………………………...12
Nutrition………………………………………………………………………………………………………………………………………..19
Community Based Integrated Management of Childhood Illness…………………………………………………..25
Safe Motherhood…………………………………………………………………………………………………………………………..30
Family Planning……………………………………………………………………………………………………………………..………34
FCHV Program…………………………………………………………………………………………………………………..……….. 38
Primary Health Care Outreach Clinic……………………………………………………………………………….…..……….40
Malaria………………………………………………………………………………………………………………………….……………..42
Kala-Azar……………………………………………………………………………………………………………………………………….45
National Tuberculosis Control Program…………………………………………………………………………………………47
Leprosy Control Program …………………………………………………………………………….……………………………….49
Health Education Program…………………………………………………………………………………………………………..53
HIV/AIDS and STI control Program………………………………………………………………………………….…………...55
Curative Services OPD Services……………………………………………………………………………………………….…..57
Hospital Service…………………………………………………………………………………………………………………………84
Logistic Management Information System……………………………………………………………………..…………86
Annexes………………………………………………………………………………………………………………………….….…….87
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District Health Office, Bara
Annual Review Performance Presentation Sheet……………………………………………………………….……1-35
ABBREVATIONS
ABER Annual Blood Examination Rate
AEFI Adverse Effect Following Immunization
AES Acute Encephalitis Syndrome
AFI Annual Falciparum Incidence
AFP Acute Flaccid Paralysis
AHW Auxiliary Health Worker
ANC Antenatal Care
ANM Auxiliary Nurse Midwife
API Annual Parasite Incidence
ARI Acute Respiratory Infection
BCG Bacilli Calmette-Guerin
BEOC Basic Essential Obstetric Care
CBIMCI Community-based Integrated Management of Childhood Illness
CDD Control of Diarrhoeal Diseases
CDR Central Development Region
CEOC Comprehensive Essential Obstetric Care
CFR Case Fatality Rate
CHD Child Health Division
CMI Clinical Malaria Incidence
CPR Contraceptive Prevalence Rate
CWS Child Welfare Society
CWC Community Welfare Center
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District Health Office, Bara
DDC District Development Committee
DHO District Health Office(r)
DHS District Health System
DoHS Department of Health Services
COFP Comprehensive Family Planning
DOTS Directly Observed Treatment, Short Course
DPT Diphtheria, Pertussis and Tetanus (Vaccine)
DTLA District Tuberculosis and Leprosy Assistant
EDCD Epidemiology and Disease Control Division
EDP External Development Partners
EHCS Essential Health Care Services
EPI Expanded Programme on Immunization
FCHV Female Community Health Volunteer
FHD Family Health Division
FP Family Planning
FY Fiscal Year
HA Health Assistant
HMC Health Management Committee
HMG His Majesty's Government
HMIS Health Management Information System
HP Health Post
HTR Hard to Reach
IMCI Integrated Management of Childhood Illness
INGO International Non-governmental Organisation
IUCD Intra-uterine Contraceptive Device
LCD Leprosy Control Division
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District Health Office, Bara
LMD Logistics Management Division
MB Multi-bacilli
MCHW Maternal and Child Health Worker
MMR Maternal Mortality Rate
MD Management Division
MoHP Ministry of Health and Population
MRA Medical Recorder Assistant
MToT Master Trainer of Trainers
MTSP Medium Term Strategic Plan
MWRA Married Women of Reproductive Age
MAP Male as Partner
NCDR New Case Detection Rate
NFHP Nepal Family Health Programme
NGO Non-Governmental Organisation
NHEICC National Health Education, Information and Communication Centre
NHTC National Health Training Centre
NFHP Nepal Family Health Program
NNT Neonatal Tetanus
NTC National Tuberculosis Centre
NTP National Tuberculosis Programme
OPD Out-Patient Department
OPV Oral Polio Vaccine
ORS Oral Rehydration Solution
PB Pauci Bacilli
PF Plasmodium falciparum
PHC/ORC Primary Health Care Outreach Clinic
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District Health Office, Bara
PHCC/HC Primary Health Care Centre/Health Center
PME Planning, Monitoring and Evaluation
PNC Postnatal Care
PR Prevalence Rate
RH Reproductive Health
RHD Regional Health Directorate
RTC Regional Training Centre
RTLA Regional Tuberculosis and Leprosy Assistant
SDC Swiss Agency for Development and Co-operation
SHP Sub Health Post
SLTHP Second Long Term Health Plan
SPR Slide Positivity Rate
TBA Traditional Birth Attendant
TT Tetanus Toxoid
UNFPA United Nations Population Fund
VHW Village Health Worker
VSC Voluntary Surgical Contraception
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District Health Office, Bara
Introduction
Bara, the district of famous temple of Goddess Gadhi Mai, lies in the Central Development Re- gion in which there are altogether 19 districts. It is bordered with Rautahat in the east, Parsa district in the west, Makwanpur district in the North and Eastern Champaran district of Bihar estate, India in the south. The northern part of Bara is mountainous that is Chure Bhavar and dense Char koshe Jhadi Jungle whereas the southern part is plain famous for agriculture. Administratively, Bara is divided into 6 electoral constituencies and 98 VDCs and a single muni- cipality Kalaiya which is the headquarter. In the Health System, there is a District Hospital, 5 Primary Health Care Centers (PHCCs), 40 Health Posts (HPs) and 54 Sub-Health Posts (SHPs) under District Health Office, Bara. In the concept of decentralization, these PHCCs & HPs are called Ilakas. Similarly, 492 Expanded Pro- gram on Immunization (EPI) clinics and 297 Primary Health Care Out Reach Clinics (PHC ORCs) are functional in the communities of Bara district. Altogether 884+57= 941 (VDC+Municipality) Female Community Health Volunteers (FCHVs), are the back-bone of Health System.
According to the HMIS section of DoHS, the total population of Bara district is 7,26,194, under 1 Year pop -n is 15,725; Adolescent pop -n (10-19 Yrs) is 1,42,455; expected pregnancies is 18,345 and expected Live birth is 16,509.
In this Fiscal Year 29 SHPs are upgraded to Health Posts whereas Kolbi SHP is upgraded to Pri- mary Health Care Center (PHCC).
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District Health Office, Bara
Amlekhganj Ratanpuri MAKWANPUR
Nijgadh
PiparaSimara BharatganjSigaul 01 05 Every Month
Dumarwana 10 14 Every Month
Karaiya Kakadi Sapahi PARSA JitpurBhawanipur Fatepur 17 21 Every Month Manaharwa Haraiya Chhatapipra Inarwasira KaraiyaRaghunathpur Prastoka Bhodaha RampurTokani Parsauna Kakadi Kolhabi Banjariya Jhitakaiya(Uttar)Jhitakaiya(Uttar) Lipanimal Buniyad Dohari Tetariya g Bachhanpurwa Rampurwa Prastoka Karaiya Umarjan Avab Bahuari Khutwajabdi Sihorwa Rampurwa Avab BanjariyaBhatauda Bachhanpurwa Maheshpur KalaiyaN.P. Bachhanpurwa Prasauni Motisar Ganjbhawanipur Bachhanpurwa Sinhasani yar BhaluyeeArwaliyaRaghunathpur Dahi GadhahalKhopawaBachhanpurwa Itiyahi Pheta Sisahaniya Bhagwanpur Kabahijabdi Bishunpurwa PipraBasantapur Purainiya Bariyarpur Madhurijabdi Batara Balirampur Bishrampur Bara Dharmanagar Babuain Narahi iniya Raghunathpur RAUTAHAT Patharhati Patharhati MahendraAdarsha Chhatawa Rauwahi Pathera Matiarwa Prasurmpur Tedhakatti Piparpati Jabadi Telkuwa Kabahijabdi Bhaganpur Majhariya I Piparabirta Amarpatti Inarwamal PipradhiGoth MahendraAdarsha Jhitakaiya(Dakshin) Hardiya Kudawa Paterwa Hardiya Rampurwa N BadakiFulbariyaPrasurmpur Dewapur Bagahi Bhaganpur Hariharpur Kabahigoth Benauli Bishunpur Uchidiha Hardiya ShreenagarBairiya BishunpurAmritgang Kachorwa Golaganj D Bishunpur PakadiyaChikani Beldari PiparpatiParchrouwa *Total EPI Clinics: I A dhoBara
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District Health Office, Bara
Amlekhganj Ratanpuri MAKWANPUR
Nijgadh DC = District center = 1
PiparaSimara BharatganjSigaul = Sub center (with freezer) = 6
Dumarwana SC = Supply center (without freezer) = 8 Karaiya Kakadi PARSA Sapahi JitpurBhawanipur Fatepur
Manaharwa Chhatapipra Haraiya Inarwasira SC KaraiyaRaghunathpur Prastoka Bhodaha RampurTokaniSC Kakadi Kolhabi Banjariya Jhitakaiya(Uttar)Jhitakaiya(Uttar) Lipanimal Buniyad Dohari Tetariya Raghunathpur Bachhanpurwa Rampurwa Prastoka Karaiya Umarjan Avab Bahuari Khutwajabdi Sihorwa Rampurwa Avab BanjariyaBhatauda DC Bachhanpurwa KalaiyaN.P. Maheshpur PrasauniSC Bachhanpurwa Bachhanpurwa Motisar Ganjbhawanipur Sinhasani BhaluyeeArwaliya Dahiyar Raghunathpur Gadhahal Bachhanpurwa Itiyahi Pheta SC Khopawa Sisahaniya Kabahijabdi Bishunpurwa Bhagwanpur PipraBasantapur SC Purainiya BariyarpurSC Madhurijabdi Bishrampur Batara Balirampur RAUTAHAT Dharmanagar Babuain Barainiya Raghunathpur Narahi Patharhati Patharhati MahendraAdarsha Chhatawa Rauwahi Pathera Matiarwa Prasurmpur Tedhakatti Piparpati JabadiTelkuwa I MajhariyaKabahijabdi Bhaganpur Piparabirta AmarpattiSC Inarwamal PipradhiGoth MahendraAdarsha N Kudawa Jhitakaiya(Dakshin) Hardiya Paterwa HardiyaSC Badaki FulbariyaPrasurmpur RampurwaDewapur Bagahi Bhaganpur Kabahigoth Benauli Hariharpur Bishunpur Uchidiha D Hardiya ShreenagarBairiya BishunpurAmritgang Kachorwa Golaganj Bishunpur PakadiyaChikani Beldari I PiparpatiParchrouwa A District Health office Bara
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District Health Office, Bara
Organizational Structure of DHO
DHO
Public Health Section District Hospital
Administration Administration Account Section Account Section Statistics Section Store Section
Store Section OPD Section Health Promotion Section Indoor Section
Emergency Section Child Health Section X Ray Section Disease Control Section Lab Section Lab Section PAC Section
Obstetric Care
Organizational Structure of Primary Health Care Center
PHCC In charge Medical Officer
Technical Unit Administration Unit
HA/Sr AHW =1, Staff Nurse= 1, AHW=2, Office assistant 2 ANM=3, Lab Assistant= 1, AHW (VHW) = 1
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District Health Office, Bara
Organizational Structure of Health Posts
HP In Charge HA/S r AHW
Technical Section Administration Sec
tion
AHW=2 Kharidar =1 Of ANM=1 fice assistant 1 AHW (VHW) = 1
Organizational Structure of Sub-Health Post
SHP In charge AHW
ANM AHW (VHW) (MCHW) =1 =1
5
District Health Office, Bara Estimated Target Population FY 2069/70
Growt ARI/CD ti- Popula- <2Year h Mon- Popula- D/Nutri FP/MWR Ex- Adoles- mate Total EPI tion Women Female s itoring 6-59 tion tion A pected cent Pop d Popula- (<1Yea (6- (15-44 (15-49 live birth Popu- (<36 months (25- (Under (15-49 Preg- (10- TB tion rs Old) 35)Mont Years) Years) lation Month 59)Months 5 Years) nancies 19)Years +pve hs Hospital/PHCC//HP s) Years) cas- Name es Simara PHC 71815 1566 3357 5257 4487 8514 5928 9285 16630 18228 13669 1827 14082 1644 72 Nijgadh PHC 39951 891 1887 2943 2506 4730 3281 5168 9456 10364 7773 1039 7832 935 40 Ganjabhawanipur PHC 37036 805 1727 2704 2310 4392 3060 4787 8537 9354 7017 938 7265 841 37 Rampur HP 56983 1228 2648 4154 3548 6759 4717 7365 13062 14312 10734 1436 11183 1291 57 Rampuruwa HP 48807 1091 2313 3600 3063 5773 4000 6311 11613 12729 9545 1276 9563 1147 49 Gadahal HP 35126 772 1647 2570 2190 4162 2893 4541 8193 8983 6737 898 6888 811 35 Simraungadh HP 55516 1186 2568 4032 3449 6589 4603 7172 12619 13830 10374 1385 10893 1245 56 Hardiya HP 27875 585 1277 2015 1728 3312 2321 3599 6216 6814 5108 681 5473 614 28 Bhodaha HP 39257 861 1839 2876 2453 4653 3237 5075 9142 10021 7516 1003 7697 902 39 Pheta HP 55957 1194 2588 4065 3478 6645 4645 7233 12702 13925 10444 1396 10987 1253 56 Bariyarpur HP 53259 1150 2479 3884 3321 6318 4406 6883 12212 13385 10038 1340 10450 1206 53 Prasauni HP 41489 888 1919 3013 2577 4927 3443 5362 9445 10352 7763 1034 8138 934 41 Haraiya HP 33736 751 1589 2478 2108 3993 2772 4362 8004 8772 6582 879 6610 790 34 Chutaha HP 54046 1162 2506 3931 3359 6411 4480 6981 12335 13522 10142 1353 10605 1218 54
Hardiya PHC 33357 705 1535 2415 2067 3962 2775 4310 7508 8230 6171 822 6547 743 33 MCH(District clin- ic) 41984 890 1938 3048 2610 4987 3487 5425 9441 10348 7761 1038 8242 935 42 5298 District Total : 726194 15725 33817 5 45254 86127 60048 93859 167115 183169 137374 18345 142455 16509 726
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km]6f al/of/k'/ xlb{of x]=kf]= Ro"6fxf u9xn ss8L sjxL uf]7 ax'c/L k|;f}gf v'6'jf t]tl/of dgxjf{ dl6cjf{ etf}8f lr=ksl8of ;kxL 6]8fs§L vf]kjf l;xf]jf{ lkk|flatf{ b=lem6s}of df]lt;/ lkkf|a;tk'/ bf]x/L wd{gu/ k|i6f]sf xl/x/k'/ a5gk'jf{ srf]jf{ s/}of p=lem6s}of 5tjf lnklgdfn kqx§L plrl8x a=km'nal/of s'8\jf /3'gfyk'/ ky/f l;xf;gL l;;xlgof dx]zk'/ j/}lgof a'lgofb t]ns'jf‘ >Lgu/a}l/of auxL k6]jf{ u9xn jt/f a+hl/of aa'cfO{g cd[tu+h cdfj Ogjf{dfn e=e/jlnof pdhg lj>fdk'/ O{gjf{l;/f /f}jfxL a]nbf/L la;'gk'jf{ eujfgk'/ cd/k§L O{l6ofxL lkk/kflthAbL la;'gk'/ sf]tjfnL k'/}lgof a]gf}nL b]jfk'/ lk=kr/f}6f 7
District Health Office, Bara
Existing Health Facility and Human Resources for Health
Hospital 1 PHCC 5 Health Post 40 Sub Health Post 54 PHC ORC 283 EPI Clinic 498 Ayurvedic Centers 2 Medicine Shops 161 Doctors 10 Nurses( including ANM) 172 Paramedicals 308 Private Health Facilities 7 FCHV VDC +Municipality Kalaiya 884+57=941
8 ANNUAL REPORT 2069/70 District Health Office, Bara
Reporting Status
Timely and complete reporting is very necessary for proper program planning. It supports regular program monitoring and provides adequate time to improve program implementation.
Hospital/PHCC/HP SUB HEATH POST FCHV HFs % Received %Received %Received 67/68 68/69 69/070 67/68 68/69 69/070 067/68 068/69 69/070 Kalaiya Hospital 100 100 100 0 0 0 0
Simara PHC 100 100 100 100 100 100 96 86 95 Nijgadh PHC 100 100 100 100 100 100 100 94 93 Ganjabhawanipur 100 100 100 100 100 100 98 98 98 PHC
Rampur HP 100 100 100 100 100 100 98 98 100 Rampuruwa HP 100 100 100 100 100 100 100 100 100 Gadahal HP 100 100 100 100 100 100 100 100 96 Simraungadh HP 100 100 100 100 100 100 90 100 99 Hardiya KB HP 100 100 100 100 100 100 100 100 100 Bhodaha HP 100 100 100 100 100 100 87 96 96 Pheta HP 100 100 100 100 100 100 100 100 98 Bariyarpur HP 100 100 100 100 100 100 100 100 100 Prasauni HP 100 100 100 100 100 100 96 98 98 Haraiya HP 100 100 100 100 100 100 100 97 100 Chutaha HP 100 100 100 100 100 100 100 100 99 Hardiya PHC 100 100 100 100 100 100 98 100 98 District Total 100 100 100 100 100 100 97.6 98 94
The above table shows reporting status of hospital, PHCC, HP, SHP and FCHV. The reporting status of Hospital, PHCC, HP and SHP has been constant & universal for last three consecutive Fiscal Years. Reporting status of FCHV has decreased to 94% in FY 2069/70 from 98% in FY 2068/69.
9 ANNUAL REPORT 2069/70 District Health Office, Bara Fig 1.1
Fig 1.1 shows three years trend of reporting status of PHCC & HP in Bara district. It shows that reporting status of all PHCC & HPs is timely, continuously and 100% in all three consecutive years from FY 2067/68 to FY 2069/70.
Fig: 1.2
10 ANNUAL REPORT 2069/70 District Health Office, Bara Fig 1.2 shows three years trend of reporting status of SHP in Bara district. It shows that reporting status of all SHPs is almost timely, continuously and 100% in all three consecutive years from FY 2067/68 to FY 2069/70.
Fig: 1.3
Fig. 1.3 presents trend of reporting status of FCHV. It has revealed that reporting status of FCHV has been decreasing over the last two consecutive fiscal year. It has decreased to 94% in FY 2069/70 from 98% in FY 2067/68. The figure indicates that more focus should be given to FCHV program
Problem/Constraints:
Problem/Constraints Action to be taken Responsibility Delay supply of HMIS tools and Timely and adequate supply of all HMIS tools MD/LMD inadequate supply of some tools No specified budget for supply of Specific budget should be allocated for the MD HMIS tools supply of HMIS tools to all HFs Technical problem of Software Provide technically sound software MD/HMIS section and power supply Allocate budget for regular power supply dur ing load shading and high speed internate `
11 ANNUAL REPORT 2069/70 District Health Office, Bara National Immunization Program
The National Immunization Program (NIP) is a high priority program (P 1) of Government of Nepal. Immunization is considered as one of the most cost effective health interventions. Since its introduction in 1979, it has significantly contributed to reduce the burden of targeted vaccine pre ventable diseases, ultimately contributing to reduction in child mortality. Nepal is one of the countries on track to achieve the Millennium Development Goal on Child Mortality reduction. Successful immunization program has a crucial role to achieve this goal. National immunization program is guided by its Multi Year Plan of Action (MYPA 2007 2011). The program covers all the districts and Village Development Committees (VDCs) of the country.
The service of Immunization is provided free of cost. NIP under Child Health Division has a lead role in all immunization related activities at the national level. It includes coordinated actions with other Divisions of the DoHS and all other partners of the program. The Regional Health Directo rate (RHD) acts as a facilitator between the Central and the District levels. It is the responsibility of the D(P)HO to ensure that a successful immunization program is implemented at the district level and below. Primary Health Centers (PHCs), Health Posts (HPs), and Sub Health Posts (SHPs) implement immunization programs in their respective Village Development Committees (VDCs). Regular monitoring of the National Immunization Program is continuing with the use of data collected through the Health Management Information System (HMIS). Data generated at the service level are reported to the district, region and the central level on monthly basis. On the ba sis of HMIS data, NIP monitors the coverage, drop out, vaccine wastage and the number of un vaccinated children against Penta 3 and measles in every district and village Development Com mittee and sends its feedback to the area of concern. Thus the information received are analyzed at different levels and used for corrective action. In addition to HMIS, vaccine preventable diseas es are reported through integrated .Acute Flaccid Paralysis (AFP) surveillance system supported by WHO/IPD. In AFP surveillance, data related to VPD are collected through the sentinel sites. Similarly any outbreak of vaccine preventable disease is reported through both the HMIS and in tegrated AFP network.
The NIP is determined to achieve and sustain high coverage of all vaccines in all the districts and VDCs. Fluctuating immunization coverage at national and district level is a concern. There are still some districts (and VDCs within districts) with low coverage. These low performing VDCs or pockets within the VDCs have been identified during district micro planning and performance review. Appropriate local interventions have been planned jointly with the community and local NGOs during micro planning and performance review.
To ensure equity and high vaccine coverage, NIP is focusing in municipalities to strengthen im munization network. NIP is focusing to create an uniform strategy to address urban population needs. Immunization section has initiated coordination with D(P)HO and municipalities of the respective district. Establishment of adequate service outlet will be ensured through micro plan ning workshops based on RED strategy. The micro planning is jointly conducted with municipali ties, district health office and all local NGOs and INGOs including private sectors.
12 ANNUAL REPORT 2069/70 District Health Office, Bara GOAL
The overall goal of the NIP Program is to reduce child morbidity, mortality and disability asso ciated with vaccine preventable diseases.
OBJECTIVES/STRATEGIES/ACTIVITIES The objectives, strategies and key acivities are as follows: Objective 1: Achieve and maintain at least 90% vaccination coverage for all antigens at nation and district level by 2016. Proposed Key Strategies: Increase access to vaccination by implementing RED strategies in every district Enhance human resources capacity for immunization management Review program performance at all levels Strengthen communication, social mobilization, and advocacy activities Strengthen immunization data analysis, monitoring and use at all levels Strengthen immunization services in the municipalities Strengthen supportive supervision and monitoring activities Ensure adequate and sustainable financing for the immunization program
Objective 2: Ensure access to vaccines of assured quality and with appropriate waste management Proposed Key Strategies: Strengthen the vaccine management system Strengthening cold chain systems at all levels Increase the capacity of cold chain staff Explore various methods of waste disposal
Objective 3: Achieve and maintain polio free status Proposed Key Strategies: Achieve and maintain immunity levels to stop transmission of poliomyelitis Respond adequately and timely to outbreak of poliomyelitis with appropriate vaccine Achieve and maintain certification standard AFP surveillance at district level Develop post eradication strategic guideline
Objective 4: Maintain maternal and neonatal tetanus elimination status Proposed Key Strategies: Achieve and maintain at least >80% TT 2+ coverage for pregnant women in every dis tricts Conduct TT follow up campaigns in high risk districts Expand school based immunization program Continue integrated VPD surveillance including NT
Objective 5: Achieve measles elimination status by 2016 Proposed Key Strategies: Achieve and sustain immunity level to reduce measles incidence to elimination level Investigate all suspected measles outbreaks with program response Continue expansion of case based measles surveillance
13 ANNUAL REPORT 2069/70 District Health Office, Bara Objective 6: Accelerate control of vaccine preventable diseases through introduction of new and under used vaccines Proposed Key Strategies: Introduction of new and under used vaccines (rubella, pneumo, typhoid, rota) based on disease burden and financial sustainability in the country. Expansion of cold chain capacity at all levels for introduction of new vaccines.
Objective 7: Strengthen and expand VPD surveillance Proposed Key Strategies: Expand VPD surveillance Strengthen staff capacity to accommodate additional laboratory surveillance procedures Control of JE, CRS/Rubella and other VPDs.
Objective 8: Continue to expand immunization beyond infancy Proposed Key Strategies: Increasing government fiscal space the immunization program will get increased share Accelerating the potential improvements in program efficiency. Reviewing objectives and possibly reducing the speed in which improvements are planned for introduction Exploring various additional funding resources (domestic private and public as well as ex ternal partners). Establishment of immunization Trust Fund as directed by the parliament.
TARGET POPULATION
• All infants (under one year/under 12 months) for BCG, Pentavalent, OPV, and Measles vaccines. • Children 1 to 2 years for JE Vaccine. • All pregnant women for TT vaccine. • All 1, 2 and 3 grade students for School Immunization Program.
Table 2.1 Immunization Schedule of National Immunization Program
Type of Vaccine Number of Doses Recommended Age BCG At birth or on first contact with health insti 1 tution OPV 3 6, 10, and 14 weeks of age Pentavalent (Combo) 3 6, 10, and 14 weeks of age Measles 1 9 months of age JE 1 1 to 2 years TT 2 Pregnant women TT 3 Grade 1,2, 3 students
14 ANNUAL REPORT 2069/70 District Health Office, Bara Major activities carried out during FY 2068/69 1. Regular Immunization services through immunization session per month 2. Active surveillance of AFP cases 3. Sub NID program 4. Polio MOP UP Program 5. Supervision and monitoring
Service Analysis . Fig: 2.1
The above fig. shows that BCG coverage has decreased in majority of the Ilakas. The overall Dis trict average of BCG stood at 102% which has decrease from 113% in FY 2067/68. Although the coverage is above 100%, eye should be kept on BCG coverage.
Fig: 2.2
15 ANNUAL REPORT 2069/70 District Health Office, Bara
The trend of coverage of Pentavalent III antigen shows fluctuation in almost all Ilakas over the last three consecutive years. The figure 2.2 shows the decreasing trend of pentavalent 3 vaccina tion in Bara though the coverage is above 100%. In almost all Ilakas, the Penta 3 coverage has declined in all facilities compared to last fiscal year except Gadahal and Bariyarpur. Nijgadh, Ganjbhawanipur, Rampur, and Bariyarpur ilakas are still struggling to reach 100% coverage. This scenario may be due to irregular conduction of EPI clinic & lack of vaccine supply.
Fig: 2.3
The above figure 2.3 shows the trend of measles coverage which shows lack of consistency in the coverage as well as reduction in the average district coverage to 91% in FY 2069/70 from 100% in FY 2068/69.
Fig: 2.4
16 ANNUAL REPORT 2069/70 District Health Office, Bara Fig.2.4 shows the three years trend of TT 2 & TT +2 coverage. TT 2 and 2 + coverage in most of the Illaka have decreased over the last three FYs. The overall TT2 coverage has also declined tremendously from 93% in FY 2067/68 to 79% in FY 2069/70. All Ilakas should take more atten tion for the better coverage of TT vaccine.
Drop Out Rate
Fig: 2.5
Dropout rate of BCG vs Measles vaccine varies greatly among ilakas and it ranges from 78% of MCH clinic to 12% in Rampurwa & 5% in Simraungadh HP. Overall dropout rate of BCG vs Measles is 11% in FY 206/70 which is decreased by 1 point from 12% in last FY 2068/69 as shown in figure 2.5.
Fig:2.6
17 ANNUAL REPORT 2069/70 District Health Office, Bara The graph 2.6 shows the situation of Dropout rate of Penta 1 Vs Penta 3 from FY 2067/68 to FY 69/70. Droupout rate ranges from 18% of Hardiya Kabhigoth HP to 10% of Rampurwa HP. The district total dropout rate of Penta 1 Vs Penta 3 has been decreased from 9% to 2% from the FY 2068/69 to FY 2069/70.
Problem /Constraints and action to be taken Problem/Constraints Action to be taken Responsibility Irregular conduction of Vacant posts should be fulfilled permanently and on MoHP EPI session. time. Difficult in maintaining Non functioning freezes at Ilaka level and need CHD, LMD, CRHD cold chain system in the maintenance of the freezes and for regular electric periphery Ilakas supply facility of generator should be provided. Irregular & inadequate Vaccines and syringes should be supplied adequate LMD, supply of vaccines & ly on time.. syringes. EPI register not recorded Vaccinators should be sincere, at least two staffs MoHP, CHD, DHO according to the guide should be provided for efficient EPI session conduc line. tion, supervision should be supportive and quarterly review should be done. Inadequate monitoring & Monitoring & supervision Work plan should be pre DHO supportive supervision pared and provided to the periphery too & health workers should be responsible for their duties.
18 ANNUAL REPORT 2069/70 District Health Office, Bara Nutrition
Nutrition is the basic requirement for the human beings. Good nutrition makes people healthy and helps to fight against the diseases by enhancing the immune mechanism. Malnutrition is the major public health problem of Nepal. It has affected all age groups, but children of under five and pregnant women are at high risk. Therefore, Nutrition intervention has been a priority program of essential health care services. The main interventions include nutritional supplementation, nutri tional enrichment, Growth monitoring, nutrition education and BCC activities.
Goal The overall goal of national nutrition program is to achieve nutritional well being of all people in Nepal to maintain a healthy life to contribute in the socio -economic development of the country, through improved nutrition program implementation in collaboration with relevant sectors. The program aims to achieve the following targets: • Reduce IMR 36/1,000; <5 mortality rate 54/1,000 and MMR 250/100,000 live births by 2015 (MDGs) • Reduce IMR 34.4/1,000 LB and <5 mortality rate to 62.5/1,000 LB by the end of 2017 (SLTHP)
Nutrition Specific MDGs Goal The following Nutrition Specific Goals are to be achieved by the end of 2015 (MDGs): • Reduce sub -clinical VAD to 7 pecent • Reduce anaemia in pregnant women to 43 percent Child Health: Nutrition DoHS, Annual Report 2067/68 (2010/11) 26 • Reduce anaemia in all age women to 42 percent • Reduce anaemia in children to 43 percent • Increase consumption of adequately iodized salt (≥ 15 PPM) at HHs level to 88 percent • Reduce prevalence of night blindness in pregnant women to 1 percent • Reduce prevalence of underweight in <5 years children to 27 percent • Reduce prevalence of stunting in <5 years children to 28 percent • Reduce prevalence of wasting in <5 years children to 5 percent • Increase exclusive breast -feeding in <6 months children to 88 percent • Reduce prevalence of thinness (BMI 18.5 – below 25) in women to 15 percent • Reduce worm infestation rate in children (Pre -school) to less than 15 percent
Objectives
General Objective The general objective of the National Nutrition Program is to enhance nutritional well -being, re duce child and maternal mortality and is to contribute for equitable human development.
Specific Objectives: • Reduce general malnutrition among women and children • Reduce Iron Deficiency Anaemia among children and pregnant mother
19 ANNUAL REPORT 2069/70 District Health Office, Bara • Maintain and sustain Iodine Deficiency Disorder (IDD) and Vitamin A Deficiency Disorder (VAD) • Improve maternal nutrition • Align with Multi -sectoral Nutrition Initiative • Improve Nutrition related Behaviour change and communication • Improve Monitoring and Evaluation for Nutrition related Programs/Activities
Targets In order to improve the overall nutritional status of children and pregnant women, the national Nutrition program has set the following targets: • To reduce PEM in children under 5 years of age and reproductive aged women to half of the 2000 level by the year 2017. • To reduce the prevalence of anaemia among women and children to less than 40 percent by 2017. • To virtually eliminate IDD and sustain the elimination by 2017. • To virtually eliminate vitamin A deficiency and sustain the elimination by 2017. • To reduce the infestation of intestinal worms among children and pregnant women to less than 10 percent by 2017. • To reduce the prevalence of low birth weight to 12 percent by the year 2017. • To improve household food security to ensure that all people can have adequate access, availability and utilization of food needed for healthy life in order to reduce the percentage of people with inadequate energy intake to 25 percent by 2017. • To improve health and overall nutritional status of school children through the implementation of School Health and Nutrition Program. • To reduce the critical risk of malnutrition and life during exceptionally difficult circumstances. • To strengthen the system for analyzing, monitoring and evaluating the nutrition situation. Child Health: Nutrition DoHS, Annual Report 2067/68 (2010/11) 27 • To promote exclusive breastfeeding till the age of six completed months. Thereafter, introduce complementary foods along with breast milk till the child completes 2 years or more. • To reduce the Infestation of intestinal worm among Children and Pregnant Women to less than 10 percent by 2017.
Strategies The following general strategies have been pursued to address the nutritional situation in Nepal: • To reduce protein -energy malnutrition (PEM) in children less than five years of age and Reproductive aged Women to half of the 2000 level by the year 2017 through a multi -sectoral approach. • Promote, facilitate and utilize community participation and involvement for all nutrition activities. • Develop understanding and effective co -ordination between various concerned Sections, Divisions and Centres within the Department of Health Services. • Maintain and strengthen co -ordination among other agencies involved in nutrition activities, i.e.,the Ministries of Agriculture, Education, Local Development and the National Planning Commission, as well as with EDPs, NGOs, INGOs and private sector. • Decentralise authority to the region, district, Health Post, Sub Health Post and community for needs assessment, planning, implementation, and monitoring. • Conduct national advocacy and social mobilization campaigns; Integrate/incorporate activities
20 ANNUAL REPORT 2069/70 District Health Office, Bara (such as Expanded Program on Immunization, Integrated Management of Childhood Illness, Maternal and Family Health and other concern program, etc.) into nutrition plans. • Develop a systematic approach for Monitoring and Evaluation of all nutrition program activi ties. • Celebrate different events related to nutrition program like School Health and Nutrition Week (Jestha 1 to 7), Breast feeding week (August 1 -7), Iodine month (February) to raise awareness about the importance of Nutrition. • Implement School Health and Nutrition Program as per National Strategy. • Growth monitoring will be used as a screening tool to assess the general malnutrition status of children under less than five years.
Major Activities carried out in FY 2069/70 1. Growth monitoring at MCH Clinic, PHCCs, Health posts, Sub Health Posts and Outreach Clinics. 2. Celebration of Breast feeding week (August 1 7 )with various promotional activities 3. IDD month Celebrated throughout the month of February with promotional activities. 4. Mass distribution of high dose Vitamin A capsule to children between 6 months to 59 months throughout the district in Baishak and Kartik. 5. Supplemented postpartum mothers with Vitamin A capsule through the network of HFs, FCHVs and PHC outreach clinics including District hospital. 6. Distribution of Iron tablets to pregnant and lactating mother. 7. Biannual deworming of children of 1 5 years of age. 8. Quarterly review meeting of Nutrition program in Ilaka Health Facility with SHP incharges. 9. Observed Nutrition week with various promotional activities throughout the district on 10 th 17 th of Paush.
Performance Status: FY 2067/68 – 2069/70 Indicators 2067/68 2068/69 2069/70
1. Proportion of malnourished children as % of new growth monitor- 6.31 3.71 3.57 ing (< 5 years) 2. % of expected pregnant mothers supplemented with Iron tablets 98.31 87 87.91 3. Iron compliance (% of mothers who received 225 iron tablets 47.72(180Tab) 47.78 49 among ANC 1st visit) 4. % of pregnants supplemented by Antihelmentic tablet 83 79.7 76.65 5. % of Postpartum mothers receiving Vitamin ‘A’ 71.67 66.73 56.39
6. Vitamin "A" Distribution Coverage (number and %) 1st (Kartik) 109156 106557 105901 round (6 month to < 5 years children) 100% 100% 123% 7. Vitamin "A" distribution coverage (number and %) 2nd (Baishak- 160350 103438 105586 ha) round (6 month to <5 years children) 100% 100% 99% 8. Antihelmentic tablet distribution coverage (number and %) 1st 95924 90391 90784 (Kartik) round (1- <5 years children) 100% 100% 116% 9. Antihelmentic tablet distribution coverage (number and %) 2nd 25701 86590 87981 (Baishakha) round (6 month to <5 years children) 33% (2< 100% 96% years)
21 ANNUAL REPORT 2069/70 District Health Office, Bara Service Statistics
Fig. 3.1
Figure 3.1 shows the illaka wise three years trend of growth monitoring coverage. The coverage has increased in Rampurwa, Simraungadh, Prasauni, Nijgadh and Bariyarpur Ilakas whereas cov erage decreased in rest of illaka as compared last FY. As a whole, trend of growth monitoring coverage is in stagnant stage over the last three years.
Fig: 3.2
Fig. 3.2 shows that there has been slightly increase in average no. of growth monitoring visit to 2 in FY 2069/70 from 1.91 in 2068/69. It shows that growth monitoring program has been perform ing good in the district. The average no of growth monitoring visits increased nine Ilakas and de creased or constant in rest of the illakas.
22 ANNUAL REPORT 2069/70 District Health Office, Bara Fig: 3.3
In the above figure 3.3 shows the proportion of malnourished children among new visit in the last three years by illaka. The district average is 3.6% during FY 2069/70 which is low than previous FYs. The proportion of malnourished children has decreased in most of the illakas except in Rampuruwa, Haraiya during FY 2069/70 compared to FY 2067/68.
Fig. 3.4
Anemia is the major public health problem among pregnant women in Nepal. To address the problem, MoHP distribute Iron tablet to pregnant women through HF and FCHV. Coverage of iron among pregnant women is declining year by year i.e. from 98% in FY 2067/68 to 87% in FY2068/69, and 88% during fiscal year 2069/70. This is due to interruption of iron tablet supply in few months.
23 ANNUAL REPORT 2069/70 District Health Office, Bara Fig: 3.5
Fig: 3.5 shows the trend of Vitamin A coverage among post partum mothers and it is seen that it has been declining over the past three FYs from72% in FY 2067/68 to 67% and 58% during FY 2068/69 and FY 2069/70 respectively. The highest coverage was noticed in Gpur PHC( 84%) and least coverage was reported in Pheta Ilaka(only 25%).
Problem/constraint and Action to be taken Problem /Constraint Action to be taken Responsibility Poor supply and use of salter Improve supply system up to Health facility DHO, HF scale level Increase and improve number of supervi sion and feedback
The flow of Under 5 yrs ba Number of PHC/ORC should be increased and DHO bies to HF for growth moni functional with regular supportive supervision toring is least. and monitoring. Motivation of the Health Health Facilities Incharges should be sensi DHO/CHD Workers for weighing the ba tized in Ilaka /District review bies under 5yrs.is low. Lack of monitoring & super Prepare Monitoring & supervision Work plan DHO/CHD vision as per plan and follow schedule
Lack of feed back Provide feedback regularly by higher level& DHO/CHD/Fo lower level cal person
24 ANNUAL REPORT 2069/70 District Health Office, Bara Community Based Integrated Management of Childhood Illness (CB-IMCI)
The Global burden of diseases analysis of1996 indicated that acute respiratory infections, diarr hea, measles, malaria and malnutrition and often a combination of them continue to be the major contributors to child morbidity and mortality. These five problems account for 70% of under five mortality. Integrated Management of childhood Illness (IMCI) program has been introduced in Nepal since 1997 in phase wise manner, with the objectives to reduce mortality, frequency and severity of illness and disability and to promote the growth and development in children under five. CB IMCI aims to improve the health status of children under five at all level involving health facilities as well as families and communities through the promotion of quality preventive as well as curative services.
IMCI was introduced in FY 2059/60 in Bara district. Before IMCI it was CBAC district.
Acute Respiratory Infection (ARI)
Fig: 4.1 ARI Cases at different level
The above fig. 5.1 is regarding reported ARI cases of under 5 year children treated at different level, in community by FCHV, VHW/MCHW and HWs at HF. Out of total ARI cases, 60% were handled in community level by FCHV followed by one quarter at HF and remaining by VHW/MCHW. The treatment done by FCHV is at community which is in the early stage of the infection. Hence it reduces the severity of the infection.
25 ANNUAL REPORT 2069/70 District Health Office, Bara Fig: 4.2
The above fig.4.2 presents three years trend of reported incidence of ARI by Ilaka and district. The trend of ARI incidence is in fluctuating state, first declined to 574 per 1000 during FY 2068/69 and increased(658) during FY 2069/70.The highest incidence was reported at Rampuru wa (961) and lowest at Simara (449) during the FY 2069/70. It was increased in most of the HFs during FY 2069/70 compared to FY 2068/69.
Fig: 4.3
Fig 4.3 reflects decreasing trend of Incidence of Pnemonia in 1000 under 5 children in during last three fiscal years. The incidence rate of Pneumonia vary Ilakawise. The incidence was reported to highest in Hardiya (240) and lowest in Simara(80) during FY 2069/70.
26 ANNUAL REPORT 2069/70 District Health Office, Bara Fig: 4.4
Since the implementation of CB IMCI program in Bara, the % of severe pneumonia dropped gradually over the past three FYs. The % of severe pneumonia was reported to be 0.44% during FY2068/69 which decreased to 0.17% during FY 2069/70 in the district. % of severe proportion has decreased in most of the Hfs during FY 2069/70 compared to FY 2068/69.
27 ANNUAL REPORT 2069/70 District Health Office, Bara DIARRHOEA CONTROL PROGRAM Diarrhea has become the leading cause of morbidity and mortality in under five children. CB IMCI program is one of the effective public health programs to address child mortality and mor bidity. Fig: 4.5
Graph 4.5 shows the reported incidence of diarrhea during the period of FY 2066/67 to FY 2068/69 among health institutions. Incidence of Diarrhoea among under 5 children is in decreas- ing trend at district level. It was 451 during 2067/68 and declined to 440 and 423 per 1000 U-5 child during FY 2068/69 and 2069/70 respectively. The incidence has increased in Rampuruwa, Pheta, Hardiya during FY 2069/70. Highest incidence was reported in Prasauni and lowest in sa- mara during FY 2069/70.
Fig 4.6
Fig 4.6 shows the trend of proportion of severe dehydration during the period of FY 2067/68 to FY 2069/70 by health institutions. Only eight Ilakas out of 15 ilakas has reported severe dehydra- tion in which Nijgadh Ilaka has the highest 0.5% followed by Haraiya Ilaka 0.11. The % of severe dehydration has dropped to 0.09% during FY 2069/70 from 0.11% and 0.22% during FY 2067/68 and FY 2068/69 respectively.
28 ANNUAL REPORT 2069/70 District Health Office, Bara
Problem/constraints and action to be taken
Problem/Constraints Action to be taken Responsibility
Poor use of IMCI protocol, reg- Provide onsite coaching to service providers Local HFs and ister and recording of service staffs Unavailability of Cotrim Pd PULL system should be followed. District Store and ORS to the HF and Com- Availability of Key commodities upto commu- LMD munity all the months. nity level should be at all the time. Few Health Workers have not IMCI training should be managed for them. CHD taken training due to newly selection by PSC and transfer- in of the staffs CB-IMCI related reports are Proper recording and reporting should be CB-IMCI Unit and inconsistent done with proper monitoring and supervision DHO Inadequate monitoring & su- Provide adequate monitoring and supervi- DHO/CHD pervision sion as well as budgetary provision Improve capacity of all supervisors on IMCI supervision Poor use of IMCI protocol, reg- Provide onsite coaching to service providers Local HFs and ister and recording of service staffs
Less recording/reporting of <2 On site coaching and encouragement during DHO/Focal Per- months cases Joint supervision and monitoring son/NFHP II
Lack of feed back Provide feedback regularly DHO/CHD/Focal person
29 ANNUAL REPORT 2069/70 District Health Office, Bara Safe Motherhood
The main challenges of health of Nepal are high maternal mortality rate and infant mortality rate. So, main focused of National Safe Motherhood program is to reduce maternal mortality and neo natal mortality which comprises 60% among the infant mortality rate by addressing the high rates of death and disability caused by the complication if pregnancy, child birth and postnatal period. This is because every pregnancy recognized at risk. Experiences showed that there is need to avoid three delay i.e. delay in seeking care , delay in reaching care /facilities and delay in receiv ing care due to unavailability of skilled person, timely decision etc. The major strategies have been taken: 1. Providing essential obstetric, care emergency and comprehensive obstetric care. 2. Ensuring the presence of skilled attendants focusing in home setting. 3. Promoting birth preparedness and complication readiness.
Major Activities carried out in FY 2068/69
Regular Provision of Antenatal services, delivery services and postnatal services through Hospital, MCH clinic, PHCC, HP, SHP and outreach Clinic. DRHCC meeting conducted. MNH Update and Review/Follow up workshop Expansion of birthing sites.
Service analysis
Fig: 5.1
Above figure 5.1 presents the trend of ANC first visit as % of expected pregnancy by ilaka and district over the three FYs. The first ANC coverage has declined gradually from 95% during 2067/68 to 92% and 85% during FY 2068/69 and FY 2069/70 respectively. The coverage was dropped in most of the HFs durinf FY 2069/70 compared to FY 2067/68.ancy have been in creased but the remaining Ilakas have decreased. Even the district total ANC first visit as % of expected pregnancy has trend of declining which need some extra efforts by the district and HFs to increase the coverage. It has been reduced to 92 by 99 in FY 2068/69 from FY 2066/67.
Fig: 5.2
30 ANNUAL REPORT 2069/70 District Health Office, Bara
Fig: 5.2 shows the coverage of pregnant women receiving 4 th ANC visit as % of ANC 1 st visit. Over last three FYs. The coverage dropped slightly(52%) during FY 2069/70 compared to pre vious two FYs which stood at 55%. However, it was elevated in Simra, Nijgadh, Rampur, Har diya and MCH clinic during FY 2069/70 compared to FY 2068/69. The coverage was highest in Hardiya and lowest was reported in Gadahal illaka. The figure stress that focus should be made on awareness to the community and birthing centers should be strengthened.
Fig: 5.4
Due to the maternity incentive scheme and the high focus on SBA, the delivery conducted by skilled birth attendant is in increasing trend and this was noticed in Simara Ilaka, Ganjabhawani pur and Simraungadh Ilaka and district hospital during FY 2069/70 compared to FY 2067/68 and FY 2068/69. The district average is also in increasing gradually from 27% during FY 2067/68 to 33% during FY 2069/70. This is due to more no. of training provided to nursing staff of district and expansion of Birthing centers. The district hospital has significant contribution as shown in figure above as shown in Fig: 6.4. In district hospital this may due to implementation of AMMA Suraksha Program and CEOC service.
31 ANNUAL REPORT 2069/70 District Health Office, Bara
Fig: 5.5
Safe Motherhood policy has emphasized HF delivery to reduce maternal mortality and has im plemented AMMA Suraksha program to increase HF delivery and SBA delivery. HF delivery has decreased nominally to 30% in FY 069/70 from 31% during FY 2068/69 despite the great effort. And it is very low compared to national and regional level. Though number of delivery con ducted in HF is very low, it has been increasing in majority of HFs. District Hospital and Simara, Nijgadh PHCC and Simraunghadh Ilakas have great contribution on district achievement as shown in Fig: 6.5. The number of birthing centers should be increased for the availability and in crease the percentage of HF delivery. Fig: 5.6
32 ANNUAL REPORT 2069/70 District Health Office, Bara The Fig. 5.6 shows the coverage of PNC 1 st visit during last three FYs. It was sharply reduced to 44% during FY 2069/70 from 63% during FY 2067/68. The coverage dropped in most of the Hfs during FY 2069/70 compared to FY 2067/68 except Ganjabhawanipur. Great effort should made to increase PNC visit. Problem/constraints and action to be taken
Problems/constraints Action to be taken Responsibilities Vacant of key health personnel re Recruitment process for fulfilling vacant posts as soon as MoHP/ Public Service lated to safe motherhood program possible. Commission (Doctors, SN, ANM, MCHWs)
Safe delivery directive is not im Orientation should be provided and ensuring its effective FHD/RHD/DHO plemented by the district execution Percentage of HF delivery has not Advertisement of the birthing centers in respective locality Birthing centers, been increased as expected. should be done. DHO, FHD. More birthing centers should be established to increase the availability of the service and presence of female trained staff is must. ANC 4 th Visit has not been in Mothers group meeting should be strengthened and FCHVs MCHW/VHW/HF creased as expected should be encouraged to carry the task. Efforts to be made to get more cases to be check up 4 or more times Inadequate supervision and moni Necessary budget should be manage DHS/FHD toring Follow supervision plan
33 ANNUAL REPORT 2069/70 District Health Office, Bara
Family Planning
The main thrust of Family Planning (RH/FP) Program is to expand and sustain adequate quality of family planning services to the community level through all existing health facilities and clinics and mobile voluntary surgical contraception (VSC) camps. This Program also aims to encourage NGOs, social marketing organisations, and private practitioners to complement and supplement on government efforts. Community level volunteers FCHVs are mobilised to promote condom distribution and re supply of oral pills contraceptive. In this regard, family planning services are designed to provide a constellation of methods that reduce the fertility, enhance the maternal and neonatal health, child survival and bring about a balance in population growth and socio economic development.
Objectives The main objectives of the Family Planning Program are to assist individuals and couples to: • Space and/or limit their children; • Prevent unwanted pregnancies; • Manage infertility and • Improve their overall reproductive health.
Targets The main target of Family Planning Program is as follows: • To reduce TFR from 4.1 per women in 2001 to 3.5 per women by the end of the 10th Five Year Plan and to 2.5 by the year 2017. • To raise the Contraceptive Prevalence Rate (CPR) to 47% by the end of 10th Five Year Plan period and to 65% by 2017
Indicators Main Indicators Description 1.Contraceptive Prevalence Rate Number of current users of modern FP methods = x100 (CPR) Married Women of Reproductive Age (MWRA) 2.Method specific new acceptors Method Specific New Acceptors x100 as a % of MWRA = Married Women of Reproductive Age (MWRA)
Major Activities carried out in FY 2068/69 1. Provision of Family Planning services through Hospitals, MCH Clinic, PHC, HP SHP, PHC ORC and FCHVs. 2. Conduction of VSC Camps. 3. Satellite clinic conduction
Service analysis
Fig 6.1 shows the trend of current users of different family planning method. The fig. 6.1 shows decreasing trend of current users in all methods except Condom. VSC has highest contribution (31%) followed by Depo (5.94%) among different methods during FY 2069/70.
34 ANNUAL REPORT 2069/70 District Health Office, Bara Figure: 6.1
Fig 6.2 below presents trend of new accepter of various FP method. The numbers of new accepter have increased in condom, Pills and implant during FY 2069/70 compared to FY 2067/68. The number of new accepter of VSC has been gradually dropped from 3019 during FY 2067/68 to 2158 and 917 during FY 2068/69 and FY 2069/70 respectivelly.
Fig: 6.2
35 ANNUAL REPORT 2069/70 District Health Office, Bara Fig 6.3 presents the trend of new acceptor of permanent method of family planning. New acceptor of both Minilap and Vasectomy dropped remarkably during last three FY 2067/68 to FY 2069/70.
Fig: 6.3
Figure 6.4 shows the trend of VSC Expected Vs Achievement of three FYs. District has achieved more than 100% achievement in VSC during FY 2067/68 and FY 2068/69 where as it met just above 50% target during FY 2069/70.
Fig6.4
36 ANNUAL REPORT 2069/70 District Health Office, Bara Problem/constraints and action to be taken
Problems/Constraints Action To be taken Responsi- bilities Poor counseling in periphery HF Ensure about counseling about all method in regarding long term spacing me DHO periphery HF. thod. Adequate counseling and defaulter training High discontinuation of pills and should be applied to bring the dropout client in HFI /DHO Depo users. contact.
Under reporting in Pills users due Ensure to bring the data in service register to VHW/MCHW/ to not updating the service register those client who were taking from FCHVs. ANM/HFI as FCHV were providing method.
Regular supply of commodities Regular supply of commodities as per demand. HF/DHO could not take place in time
Inadequate monitoring, supervision Provide adequate monitoring visit and feedback DHO/FHD and lack of feedback to the health workers
37 ANNUAL REPORT 2069/70 District Health Office, Bara
FCHV Program
High infant and maternal mortality, high population growth rate, low coverage in immunization, poor nutritional status, poor sanitation and lack of awareness on health matters are causing ad verse effect in the health of the people. Unless and until the local people perceive these health problems as their own concern no health program will get success whatever efforts will be made from government sector alone. To combat these problems the government established health insti tutions in all parts of the country and also initiated the Community Health Leader Program in or der to increase community participation in the health sector in 1977. As these health problems are mainly related to women and children, it become necessary to involve female volunteer to assist female population in health promotion activities at community level. Therefore in FY 2045/46 (1988/89) the Government initiated the Female Community Health Volunteer (FCHV) Program. FCHVs are the pillar of community based health program and they are referred as bridge between community and health institution. There are 884 Female community health volunteers working in Bara district.
Objectives The objectives of the Female Community Health Volunteer Program are : To develop self help mechanism among rural women by providing basic knowledge to them on primary health care with special focus on mothers and child health contents. To enhance Community self help mechanism in primary health care through mobilization of local women and other resources To promote community participation for the best utilization of available Maternal, Child Health and Family Planning Services in order to reduce infant child and maternal mortality and fertility rates.
Service Analysis Fig.7.1 FCHV reporting status
38 ANNUAL REPORT 2069/70 District Health Office, Bara
The above figure 7.1 presents trend of FCHV reporting status over the three years. Reporting sta tus was constant at 98% during past two FYs and dropped to 94% FY 2069/70. Rampurwa, Har diya and Bariyarpur had 100% reporting in all three consecutive FYs.
Mother group meeting Mother group meeting is the forum for FCHVs through which they can disseminate the health in formation to their target group. Each month each FCHV conducts at least one mother group meet ing and provide health information on various topics as well as teach the positive health beha viors.
Fig 7.2
Fig 7.2 presents the trend of mother’s group meeting held during three fiscal years. % of mother’s group meeting held dropped to 91% during FY 2069/70 from 95% in FY 2067/68. FCHVs of Nij gadh, , Rampurwa Ilakas conducted 100% MGM in FY 2069/70 but FCHVs of Hardiya Kawahi goth,Simra,Gnjbhawanipur Ilaka conducted least MGM i.e. 71%,73%&78% in the same Year.
Problems/Constraints and Action to be taken
Problems/Constraints Action to be taken Responsible person
Mothers Groups' meetings District Health Office should encourage DHO/PHO were not conducted regularly. VHW/MCHW and FCHV to conduct mother's group meetings. Mother's group meetings are Mother's group meetings should be linked with Coordination with not conducted effectively. some monetary performance for their regular other stakeholders and effective meeting. Inadequate monitoring & su Provide adequate supervision to FCHV from HF/DHO pervision health facility and district
39 ANNUAL REPORT 2069/70 District Health Office, Bara
Primary Health Care Outreach Clinic
Within the framework of National Health Policy 1991, PHC ORC program was established in 2051 BS so as to increase access to health services to those living in remote areas of country. PHC ORC deliver a basic minimum health service package that contain FP services, basic mater nity, services(ANC/PNC), minor treatment, referral, health education etc. that are run by VHWs, MCHWs or ANMs in predetermined three to five places of each VDCs. Regarding Bara, there are 300 ORCs.
Objective To improve the accessibility and coverage of basic primary health care services through develop ing a network of three to five outreach clinic per VDC per months.
Service analysis Figure no 8.1
Figure No: 8.1 shows the decreasing trend of conduction of PHC ORC in the district. It has dropped to 73% during FY 2069/70 from 83.73 % in FY 2068/69. PHC ORC should be super vised and monitored from all the levels to reach up to 100%.
Fig. 8.2
40 ANNUAL REPORT 2069/70 District Health Office, Bara
Fig. 8.2 presents the trend of client served per PHC ORC. It has raised to 16 per clinic during FY 2067/68 to 18 in FY 2069/70,
PROBLEMS/CONSTRAINTS AND ACTION TO BE TAKEN
Problems/Constraints Action to be taken Responsibility
Communities/Management Conduct orientation program for FHD/NHTC/PHO, Committee are not aware on community and Mgmt. HPI/SHIP PHC/ORC program Lack of monitoring & supervi Prepared Monitoring & supervision DHO/FHD/ Focal sion Work plan & lack of responsible for person their duties Lack of feed back Regular provide Feedback by DHO/FHD/Focal per higher level& lower level son
41 ANNUAL REPORT 2069/70 District Health Office, Bara
MALARIA
Malaria in its various forms has been the cause of morbidity and mortality in Nepal throughout the ages. Malaria has constituted one of the most important causes of economic misfortune engendering poverty and intellectual standards of the nation and hampering prosperity and economic progress in every way. The first attempt to control malaria in Nepal was initiated in 1954 through the Insect Borne Disease Control Program. In 1958, the malaria eradication program, the first national public health program in the country, was launched with an objective of eradicating malaria from the country within a limited time period. Due to various reasons this objective could not be achieved and consequently the malaria eradication program reverted to malaria control in 1978. OBJECTIVES Prevention of mortality due to malaria; Reduction in malaria morbidity; Prevention and control of epidemics with particular reference to P. falciparum (PF); Community mobilization and community partnership in malaria control.
TARGETS • Reduce or contain the Annual Parasite Incidence (API) at the level of 3/1000 population in malaria risk areas.
INDICATORS
Main Indicators Calculation Total no of slides examined Annual Blood Examination Rate = x100 (ABER) Total Population at risk Total no of positive cases Slide Positivity Rate (SPR = x100 Total slides examined Total no of positive cases Annual Parasite Incidence (API) = x1000 Total population at risk Total no of P.falciparum cases Proportion of P. falciparum (PF%) = x100 Total positive cases Total no of clinical malaria cases Clinical Malaria Incidence (CMI) = x1000 Total population at risk
Target vs. Achievements, FY 2069/70
Program/activities Unit Target Achievement % Achieved Collection and Examination Slides 3900 3779 99 Kala azar Spray times 2 2 100%
42 ANNUAL REPORT 2069/70 District Health Office, Bara
Service analysis Fig. 9.1 Trend of Annual Blood slide Examination Rate(ABER)
Fig: 9.1 shows the trend of annual blood slide examination rate of district which decreased to 0.37% in FY 2069/70 compared to 0.62% in FY year 2067/68.
Fig. 9.2
The figure 9.2 shows the trend of clinical malaria incidence of the district. It decreased to 2.75 in FY 2069/70 from 8.46% in FY 2067/68. This may be due to confirmation of those suspected case of clinical malaria cases.
43 ANNUAL REPORT 2069/70 District Health Office, Bara
Fig: 9.3
The fig 9.3 shows three year trend of confirmed malaria cases among total malaria cases. The above fig shows increasing trend which increased to 39 in FY 2069/70 compared to 15 in FY 2068/69.
Fig: 9.4
Fig 9.4 shows three year trend for percentage of PF among total malaria Positive cases. The % of PF among total malaria positive cases increased to 46.16 % in FY 2069/70 compared 7% in FY 2068/69. This shows high burden of +ve PF case compared to FY 2068/69.
Problems/Constraints and Action to be taken Responsible per- Problems/Constraints Action to be taken son ABER is decreased Needs microscopic centers to be in EDCD creased with their full requirements Lack of recording and reporting Sensitization to Health Workers for DHO proper recording and reporting. Inadequate supervision and monitor Proper supervision and monitoring. DHO/ EDCD ing.
44 ANNUAL REPORT 2069/70 District Health Office, Bara Kala-azar
BACKGROUND Kala azar (Visceral Leishmaniasis) is an endemic disease in 12 Terai districts of Nepal including Bara dis trict. It is mainly confined to the southern plains of Eastern and Central regions of the country bordering Kala azar endemic districts of Bihar and West Bengal States of India. However, a few sporadic cases are reported from other parts of the country every year
OBJECTIVES 1. To progressively reduce morbidity and prevent mortality; 2. To determine the efficacy of the drugs used in the treatment of Kala azar; and 3. To prevent epidemics due to Kala azar.
TARGET Reduction of Kala azar incidence by 1case Per10000 by the yearAD 2018 INDICATORS Main Indicators Numerator and Denominator 1 Kala azar incidence (KAI) Total Kala azar cases x 10,000 Total population in area at risk 2 Kala azar treatment failure rate Total number of cases not responding to SAG x 100 (KATFR) Total Kala azar cases 3 Case Fatality Rate (CFR) Total death cases x 100 Total Kala azar cases
Achievement trend of Three years
Indicators 2067/68 2068/69 2069/70 1. Incidence of kala azar/10,00 population 0.07 0.03 0.09 2. Reported number of death due to Kala azar 0 0 0
Fig. 10.1
The above fig. 10.1 reflects the trend of Incidence of Kala azar which decreased to 03% during FY 2068/69 & increased to 0.09% in FY 2069/70.
45 ANNUAL REPORT 2069/70 District Health Office, Bara National Tuberculosis Control Program
Tuberculosis is one of the major public health problems in Nepal. About 45% of the total popula tion is infected with TB, out of which 60% are in the productive age group. Every year, 44,000 people develop active TB, of whom 20,000 have infectious pulmonary disease. These 20,000 people are able to spread the disease to others. Introduction of treatment by Directly Observed Treatment Short course (DOTS) has already reduced the numbers of deaths; however 5,000 7,000 people continue to die every year from this disease. By achieving the global targets of diagnosing 70% of new infectious cases and curing 85% of these patients we will save up to 30,000 deaths over the next five years. High cure rates will reduce the transmission of TB and lead to a decline in the incidence of this disease, which will ultimately help us to achieve our objectives of TB con trol
OBJECTIVES • To ensure that every TB patient has access to effective diagnosis, treatment and cure • To stop transmission of TB • To prevent development of multi drug resistant TB • To reduce the social and economic toll of TB
TARGETS Targets linked to the MDGs and endorsed by the Stop TB Partnership: • by 2005: detect at least 70 percent of new sputum smear ‐positive TB cases and cure at least 85 percent of these cases • by 2015: reduce prevalence of and death due to TB by 50 percent relative to 1990 • by 2050: eliminate TB as a public health problem (<1 case per million population)
Service analysis
Case finding rate Fig: 12.1
The above fig. 12.1 reflects the trend of TB case finding rate of Bara district. It shows increasing trend. It has been decreased to 65% in FY 2068/69 from 70% in FY 2067/68 and increased to 76% in FY 2069/70. This rate is above the national target of case finding rate i.e. 70%
46 ANNUAL REPORT 2069/70 District Health Office, Bara Fig. 12.2
Fig 12.2 shows the three years trend of case treatment success rate of TB. Being a successful pub lic health program in Nepal, CTSR for FY 2068/69 is unchanged from previous fiscal year 2067/68 at 92% which has slightly raised to 93% in FY 2066/67. Treatment success rate of TB program of district is above the specified minimum rate of program.
Problems/Constraints and Action to be taken
Problem/Constraints Action to be taken Responsibility Microscopic centers are few in numbers. Only PHCC and district lab has this facility. DoHS, NTC, DHO. So should be extended up to Ilaka at least with its full package. Sanctioned posts of lab personnel not Fulfill vacant post of lab personnel DoHS/RHD fulfilled Cross border issues NTC/MoHP initiated to solve this problem MoHP/ NTC/CRHD
Achievement of sputum examination Microscopic centers should be expanded. DHO/NTC cases & new smear examination is lower than expected.
Lack of feed back Regular provide Feedback by higher level& DHO/NTC/Focal per lower level son Monitoring /Supervision lack of responsible for their duties DHO/NTC/Focal per son Lack of basic training updated Should be provide Basic training of NTC AHW/ANM AHW/ANM (Updated staff)
Leprosy Control Program
47 ANNUAL REPORT 2069/70 District Health Office, Bara Leprosy has existed in Nepal since time immemorial and was recognized as a major Public Health problem as early as 1950. Khokana Leprosarium near Kathmandu was established more than 150 years ago to provide services to the leprosy patients. Organized leprosy control activities and le prosy survey commenced in 1960.
Nepal is committed to the cause of elimination of leprosy in line with the global program and is an active member of the global alliance for elimination of leprosy as a public health problem. A six year plan was developed in 1995 for strengthening the program. According to that plan, an estimation of the annual prevalence was done and all Basic Health Staff (BHS) were provided with training in leprosy. Health education was intensified to improve community awareness and to facilitate case detections.
Objectives • To eliminate leprosy (Prevalence Rate below 1 per 10,000 population) and further reduce disease burden at district level; • To reduce disability due to leprosy; • To reduce stigma in the community against leprosy; and • Provide high quality service for all persons affected by leprosy.
Strategies • Early case detection and prompt treatment of cases. • Enable all general health facilities to diagnose and treat leprosy. • Ensure high MDT treatment completion rate. • Prevent and limit disability by early diagnosis and correct treatment. • Reducing stigma through information, education, and advocacy by achieving community empowerment through partnership with media and community. • Sustain quality of leprosy service in the integrated set up.
Targets • Reduce NCDR by 25 percent at national level by the end of 2015 in comparison to 2010. Disease Control: Leprosy DoHS, Annual Report 2067/68 (2010/2011) 123
48 ANNUAL REPORT 2069/70 District Health Office, Bara • Reduce PR by 35 percent at national level by the end of 2015 in comparison to 2010. • Reduce by 35 percent GII disability amongst newly detected cases per 100,000 population by the end of 2015 in comparison to 2010. • Additional deformity during treatment <5 percent by EHF score. • 80 percent health workers are able to recognize and manage /refer reaction/complications. • Promote POD and Self care.
Target Vs. Achievements, FY 2069/70 ah]^ pkzLif{s g+= 3708043 s'i&/f]u sfo{s|d jflif{s nIo jflif{s k|ult jflif{s vr{ qm=;+= sfo{qmd÷lqmofsnfkx? O{sfO k|ult kl/df)f ah]^ kl/df)f /sd k|ltzt k|ltzt ! lj/fld tyf l5d]sLsf] kl/jfl/s hgf 3000 83 3000 100 83 100 kl/rfng @ :s"n :jf:Yo lzIff :s"n 12 6 35 100 35 100 # ;'kl/j]If0f÷dlg6l/ª k6s 45 122 54 100 110 100 $ df]lg6f]l/ª sfo{zfnf k6s 2 236 2 100 236 100 % pk]lIft ju{sf] sfo{qmd k6s 0 0 0 0 0 ^ kmNofS; jf]8{ yfg 4 2 4 100 2 100
& lgoldt pkrf/ k'/f ug]{ la/fdLsf] hfgf 148 148 148 100 148 100 oftfot vr{ * ljZj s'i7/f]u lbjz 1 17 1 100 17 100 ( s'i7/f]u k|efljt lhNnfx?df uf]6f 1 60 1 100 60 100 s'i7/f]usf] sf/0fn] c;dy{tf ePsfx?nfO{ ;d"xut ?kdf cfo cfh{g tyf art s"n hDdf vr{ 674 674
Service statistics New Case Detection Rate Table: 11.1
49 ANNUAL REPORT 2069/70 District Health Office, Bara
Service statistics of district revealed that new case detection rate of leprosy has been slightly in creased to 1.98 during FY 2069/70 compared to 1.7 in FY 68/69 from 2 per 10,000 populations in FY 67/68. However, nationally Leprosy is eliminated from Nepal in the FY 2067/68 but Bara dis trict has not still not met the goal of elimination of Leprosy.
Fig: 11.2
Fig 11.2 above shows that registered prevalence rate of leprosy is also in declining trend. It has been reached to 1.31 in fiscal year 69/70 from 1.4 of fiscal year 68/69.
Fig: 11.3
50 ANNUAL REPORT 2069/70 District Health Office, Bara
Along with increased of case detection rate and declining prevalence rate of leprosy in fiscal year 69/70 compared to last fiscal year, disability grade has also remarkable decline to 0.69 during FY 2069/70 from 2 in fiscal year 67/68 as shown in fig: 11.3
Problems/Constraints and Action to be taken
Problem/Constraints Action to be taken Responsibility Lack of Public Awareness Awareness program should be imple LCD/RHD/DHO mented Monitoring /Supervision lack of responsible for their duties DHO/Focal per son
Lack of feed back Regular provide Feedback by higher DHO/FHD/Focal level& lower level person
51 ANNUAL REPORT 2069/70 District Health Office, Bara
Health Education Program
Background: Information Education Communication is one of the components for the supporting health Pro gram. Since 1994, IEC activities have been decentralized and district are involved in preparing work plan and developing IEC materials locally as per guideline of NHEICC.
Objectives: To raise health awareness of the people as to promote improve health status. To prevent disease through the effort of people themselves and through utilization availa ble resources.
Strategies: Promotion of IEC activities in all government and non government agencies. Dissemination of information, education and communication on health issues through health and health related workers. Use of individual group and mass media in health education, information and communi cation.
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:jf:Yo lzIff ;fdfu|Lx? :jf:Yo ;+:yfdf ljt/)f uf]6f 2 20 2 100 20 100 3
52 ANNUAL REPORT 2069/70 District Health Office, Bara kl/jf/ lgof]hgsf] aGWofs/)f ;DaGwL ;Gb]z uf]6f 600 60 600 100 60 100 4 /]l*of]] jf^ k|;f/)f :jf:Yo Pkm =Pd= /]l*of] sfo{amd / ;Gb]z uf]6f 7 21 7 100 21 100 5 pTkfbg tyf k|;f/)f s=:jf:Yo ;DalGw Pkm =Pd= /]l*of] ;Gb]z uf]6f 600 60 600 100 60 100 6 k|zf/)f v=:jf:Yo ;DalGw Pkm =Pd= /]l*of] ;Gb]z uf]6f 500 50 500 100 50 100 7 k|zf/)f %fkf dfWoddf hgr]tgfd"ns :jf:Yo uf]6f 130 65 130 100 65 100 8 ;Gb]zx? K|fsfzg ;fd"bflos :jf:Yo ;]jf k|j¢{g cGt/ls|of uf]6f 10 130 10 100 130 100 9 sfo{s|d - :jf:Yo ;]jf k+x"r sd ePsf :yfgx?_ :jf:Yo ;+:Yff tyf c:ktfnx?df :jf:Yo uf]6f 2 5 2 100 5 100 10 lzIff sg{/ ;+rfng ;"tLhGo kbfy{ lgoGq)f / lgodg ug]{ Pg] tyf lgodfjnL sfof{Gjog / g;g]{ /f]u uf]^f 3 39 3 100 39 100 11 /f]syfd ug{ cGt/lqmof sfo{qmd ljZj :jf:Yo lbj;,ljZj xft w'g] lbj; / uf]^f 3 110 3 100 110 100 12 :jf:Yo / ;/;kmfO{ ;DaGwL k|aw{g sfo{qmd :jf:Yo lzIff sfo{s|dsf] ;'k/Lj]If)f tyf uf]6f 5 25 5 100 25 100 13 cg'udg 585 585 :jf:Yo lzIff hDdf
rfn" vr{ cGtu{tsf sfo{qmdx? hDdf 635 635
u= pkefu vr{ 0 0
4 #=sfof{no ;~rfng vr{ 0 0 705 100 705 s"n hDdf vr{ -s₊v₊u₊#_
53 ANNUAL REPORT 2069/70 District Health Office, Bara s|=; sfo{s|d÷ s[ofsnfkx? OsfO{ jflif{s nIo aflif{s k|ult aflif{s k|ult ljj/)f ljj/)f vr{ jh]^ k|ult k|ltzt kl/df)f kl/df)f k|ltzt ! @ # $ ^ & ( !) !!
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;"tLhGo kbfy{ lgoGq)f / lgodg ug]{ sfg"g sfof{Gjog af/] ;xfos k|d"v lhNnf 2 k^s 2 6 2 100 6 100 clwsf/Lsf] ;+of]hsTjdf lhNnf :t/Lo lg/LIf)f ;DalGw a}&s k|d"v lhNnf clwsf/L jf ;xfos k|d"v lhNnf clwsf/Lsf] k|d"v cfltYo / 3 ;dGjodf lhNnf l:yt ;fj{hlgs :ynx?sf k^s 2 20 2 100 20 100 Joj:yfksx? ;xefuL x"g] cGt/s[of sfo{qmd lhNnf :jf:Yo sfof{no :jon] ;+rfng ug]{
sfo{qmd g;g]{ /f]u /f]]syfd tyf ;"tLhGo kbfy{ lgoGq)f / lgodg ug]{ sfg"g sfof{Gjog 4 k^s 4 56 4 100 56 100 af/] r]tgf clea[l$ ug{ ;d"bfo :t/df cGt/s[of sfo{qmd s k|zf;lgs vr{ k^s 2 2 2 100 2 100 v OGwg vr{ k^s 2 2 2 100 2 100 3 u= pkefu vr{ 0 0 4 #=sfof{no ;~rfng vr{ 0 0 5 s"n hDdf vr{ -s₊v₊u₊#_ 111 100 111
HIV/AIDS and STI control program
54 ANNUAL REPORT 2069/70 District Health Office, Bara BACKGROUND Since the detection of the first AIDS case in 1988, the HIV epidemic in Nepal has evolved from a low prevalence to concentrated epidemic. As of 2007, national estimates indicate that approx imately 70,000 adults and children are infected with the HIV virus in Nepal, with an estimated prevalence of about 0.49% in the adult population. As of Ashadh 2064, a total of 9756 cases of HIV, 1454 AIDS cases and 423 AIDS deaths had been reported to the National Centre for AIDS and STD control (NCASC). The sex ratio among HIV positive cases is 2:1. Nepal is categorized as a “Concentrated” epidemic country as some of the sub population groups (IDUs, migrants) are having more than 5% of prevalence. As in other countries in the region, IDUs, MSM and FSW are the groups most at risk with highest HIV prevalence. Most cases of HIV occur among labour migrants (46%) and increasing number occurs among their wives (a combined 21% of HIV cases in low risk women in rural and urban areas). Of all adults estimated to be living with HIV, a major proportion of HIV infections has consistently been among migrant workers travelling to India for work. In 2005, 46% of estimated HIV infections in Nepal were among seasonal labour migrants and similar pattern is found in 2007. Clients of sex workers account for 19% of HIV infections in 2005 and 16% in 2007. Spous es or female partners of migrant workers and clients of sex workers, now account for 21% of all adult infections.
Performance Indicators: FY 2067/68– 2069/70 Indicators 2067/68 2068/69 2069/70
1. Number of people counseling 2510 1749 2472 2. Number of HIV +ve cases 44 60 82 3. Number of persons receiving ART 30 35 47
Major Activities carried out during 2069/70
a=lz=g+= 3708023 . 3708024 a=lz=g+= 3708023 . 3708024 /fli^«o P*; tyf of}g/f]u lgoGq)f
55 ANNUAL REPORT 2069/70 District Health Office, Bara
jflif{s nIo jflif{s k|ult jflif{s vr{ qm.;+. sfo{qmd÷lqmofsnfkx? O{sfO k|ult k|ltz kl/df)f ah]^ kl/df)f /sd k|ltzt t
1 VCT ;+rfng vr{ k6s 12 52 12 100 52 100 VCT df 2}dfl;s a}7s 6 27 6 100 27 100 2 df ;+rf/ ;fdu|L lasf; 3 DACC 1 1 1 100 1 100 ;+rf/ vr{ 4 DACC 3 12 3 100 12 100 DACC df lbj; dgfpg] 1 44 1 100 44 100 5 DACC af6 ;xof]uL ;'k/lehg 3 12 3 100 12 100 6 DACC sf] rf}dfl;s a}7s 4 31 4 100 31 100 7 DACC sf] sfof{no ;+rfnf vr{ 12 91 12 100 91 100 8 DACC Profile 1 45 1 100 45 100 9 DACC sf] 2}dfl;s a}7s 6 51 6 100 51 100 10 d=:j=:jo+=;]= tflnd 150 150 94 100 94 100 11 hgf hgf :yflgo :t/df Pr=cfO{=eL=sf] 1 20 1 20 100 12 hgr]tgf lasf; lzIff 100 38 388 hDdf 8
Curative Services OPD Services
1. Background:
56 ANNUAL REPORT 2069/70 District Health Office, Bara Curative health services aims to provide appropriate diagnosis, treatment and referral through the network of PHC outreach to specialized hospitals. It is one of the important and highly demanded services. These services are provided through all health facilities. Due to free health care services in Govt. Health Institution the number of patients has increased drastically in the district. 2. Objectives: • To provide curative services from all level health facilities to reduce morbidity, mortality and improved quality of life by early diagnosis prompt treatment and referral to appropriate place as required. 3. Targets: • To provide service to all clients attending health facilities with appropriate diagnosis, treatment and/or referral to specialized facilities. 4. Strategies: • Establishment and service delivery through of SHP in all the VDCs. • Establishment and service delivery through HPs in ilaka & PHCs in all electoral constituencies.
Performance Indicators: FY 2066/67-2068/69
Indicators 2067/68 2068/69 2069/70
1. Total new OPD visits as % of total population 73 75 72 2. Total new female OPD visits as % of total OPD visit 48 51 52 3. % of communicable disease among total OPD new visit 19.64 18.82 48
Top Ten Diseases: FY 2068/69 Disease % Disease %
Impetigo/boils/furunculosis Ameobic Dysentry /Amoebiasis 7.88 4.25 Scabies Presumed non infectious diarrhoea 7.80 (Persistant) 4.06 Intestinal Worms Not mentioned above and other dis- 5.41 eases 4.06 Headache Upper respiratory tract infection 5.08 3.92 Gastritis (APD) ARI/Lower respiratory tract infection 4.562 3.63
Hospital Service
Kalaiya Hospital
57 ANNUAL REPORT 2069/70 District Health Office, Bara Background Kalaiya Hospital is the district hospital of Bara. It is located at centre of Kalaiya Municipality. The services provided by the hospital were OPD, Indoor, Emergency, Lab, X-Ray, Minor Operation, Obstetric care including post abortion care and medico legal services and includes also CEOC service.
Hospital Related Information
S. Indicators 2067/68 2068/069 2069/070 Trend No ( - or + ) 1 Number of Sanction Beds 25 25 25
2 Number of Available Beds 25 25 25
3 Total Number of OPD Cases 21111 25444 22815 - 4 Total Number of Emergency Cases 14245 14631 17353 + 5 Total Number of OPD (OPD + Emergency) Cases 35356 40075 43603 + 6 Total Number of Inpatients Discharged 2929 2941 3435 + 7 Total Number of Preventative Services Provided 8 Total Number of Lab Services Provided 9412 10078 12158 + 9 Total Number of Hospital Services Provided 38285 43016 55761 + 10 Total Number of Delivery Conducted 2183 2185 2564 + 11 Referral Cases ( In ) Total 55 59 86 ( +) 12 Referral Cases ( Out ) Total 13 Total Maternal Deaths 0 0 - 14 Total Hospital Deaths 0 0 - 15 Number (%) of Hospital Development Com- 4 4 4 - mittee Meeting Held in FY 2067/68
Major indicators Table: Selected indicator of Hospital services .
SN Indicators 2067/68 2068/069 2069/070 Trend ( - or+ )
58 ANNUAL REPORT 2069/70 District Health Office, Bara 1 Total OPD Visits as % of Total Population 3.07 4 3 - 2 % of Emergency Visits Among Total OPD Visits 68 58 40 - 3 Bed Occupancy Rate 38.91 49 60 + 4 Delivery Conducted as a % of Expected Pregnancy 12.3 13 16 + 5 Proportion of Non-communicable Disease among Inpatients 6 Number of CAC Services Provided 22 7 Death Rate among Surgery (%) 8 Death Rate among In-patients 0 ( - ) 9 % of Major Surgery among Total Surgery Cases 10 % of Intermediate surgery among Total Surgery Cases 11 Percentage of Minor surgery among Total Surgery Cases 12 Doctor: In-patient Ratio 977 491 429 - 13 Doctor: OPD Ratio 5277 6361 2851 - 14 Nurse: In-patient Ratio 488 490 572 -
The above tables show the information of Kalaiya District Hospital which is the single hospital in Bara district for 6, 97,812 population. Data revealed that total OPD visits as % of Total popula- tion has been increased to 4% in FY 2068/69 from 3.07 in FY 2067/68. But, the percentage of Emergency visits among total OPD visits has tapered down to 58% in FY 2068/69 from 68% in FY 2067/68. The important is that the bed occupancy rate has been increased to 49% in FY 2068/69 from the FY 2067/68 which proves the extension of bed of the hospital. Number of CAC services achieved is 22 which was not previously reported. There is remarkable increment in hospital de- livery conduction since last two fiscal years. Neither maternal death nor hospital deaths have been recorded in these three fiscal years men- tioned in above tables. Due to the fulfillment of the doctor's positions, the Doctor: In-patient ration has been drastically declined to 42.41 in FY 2068/69 from 88.39 in FY 2067/68. Similarly, Nurse : In-patient ratio has been declined 7.47 in FY 2067/68 to 4.94 in FY 2068/69.
Logistic Management Information System
Background:
59 ANNUAL REPORT 2069/70 District Health Office, Bara In Bara district Pull system is implemented for the supply of drugs and medicine in all HFs. All HFs have to report LMIS on each quarter of essential drugs. This is submitted to LMD through District Medical Store.
LMIS: Reporting % 2067/68 2068/69 2069/70 100 100 100
Activities in FY 2068/69: • Drugs and medicines are supplied to all HFs during each quarter on the basis of Pull Sys- tem. • Vitamin A Capsules and Albendazole for National Vitamin A supplementation program supplied to all Ilaka during this Champaign. • HMIS tools were supplied to all 98 HFs as VDCwise. • Medicine of Filariasis was supplied to all Ilakas during this Campaign. • Supported medicine, equipments for Free Health Campaign.
60 ANNUAL REPORT 2069/70 District Health Office, Bara
ANNEXES
61 ANNUAL REPORT 2069/70