District Public Health Office, Bara
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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 i 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. ii 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. iii 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. iv 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%.