Annual Report
Depart ent of Health Ser ice 2075 76 2018 19
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Go ern ent of Nepal Ministry of Health and Population Depart ent of Health Ser ice S S
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ABBREVIATIONS AND ACRONYMS
t i g imm i a D D p t er a, ertu , etanu t a i m ata a it a m t t a i a a i g m t i i D ternal e elop ent partner t ga t t i a a t a i i imm i m a i a t iag i mi ia i ta m m g t t i a A Antenatal are a t t i a A Annual para te n en e a g amm mm i a t i at i t a a it a a t i a t a a a i g a g t m a i a i a a t i a ma mm it a t t B a i i t a a t S e ale e or er t a a a t a i a i it a m m g a i i ma t m rt n entre ma a t i g a B B a i a g mm i a er atr an en er a e olen e A o e al e u p ent a tant tra n n a t a i it a a ma ag m t o e al e u p ent tra n n mmi Bi a t a i a i H Healt n uran e oar S loo tran u on er e entre a a ag m t ma t m nte rate ana e ent o l oo llne t g at a t ma a ag m t pro ra e t m nte rate ana e ent o eonatal an ma imm i i l oo llne t a a a i a i a t g at a ag m t a uno ro ato rap te t ro ra e i a a mia B mm it a ga i a i i i t t i a mi i ma a a mm i a o pre en e entre o e ellen e m ta i i a i DD ontrol o arr eal ea e t g at a ag m t t a t i m i m g t t i a a at i a i neonatal are i a a i g H lor e ne i a t ia ma g am aig m i a a t a t i t a i a a at a a a i m i ami a i g agai t m i a a i t a a at g a g a ma t m t g ita a m g a g i t a i i a a a a a g a g i i a t ra n n gi a ag m t ma t m DA A D ar e a a n t e al a e o t to ollo up DH Den ue ae orr a e er i a a i t i t a t ma t m a ag m t t a t i i t atm t t B a i a
DoHS, Annual Report 2075/76 (2018/19) H aternal an l ealt m a i i a iag m t a a at neu o o al on u ate a ne ea le onta n n a ne DR renatal eat re e D ana e ent D on t i g ma t i a g a mi i t a a ag a mm i a D llenn u De elop ent oal D ea e t i i i a a la o u al paru a a ia i a ma t m ima a t a t a i i g i ta t H eople l n t H g t a m t t i t a mi i a i ia o tnatal are at a a t a g i t i i ga a pro ra e H o tpartu ae orr a e at a a i a t B i a t ia i at a a a t la o u a ro utr ent o er D eople o n e t ru i i t a t a a a it im m t DSR aternal an per natal eat ur e llan e an a i iag t t re pon e t a t i a a t a g i t a S en o a e e t en a t i at i t t i a B i i t a a t a a a a a m a i a ia a t it m t mmi a a t a t a m t a a a t t at g m a i a a a m i a i a t a mi i mm i a i a a i g t i a t at B a a g a B g t t a m g a i a a t t m a a t a a it a m etanu an p t er a a a a t mm i a i ai i g ma a ag m t t m HS epal Healt Se tor ro ra e i a a i g at m m ta a etanu to o a a t t t at g a i t a mi i i a a mm i a g amm a a t a i a a it a i at t itami i a a i g amm a i ta i a t i i a ag m t t ta gi a t a t a t at a ita a gi a i a i l pol o ru a a m ag a t at t i a ma ag m t i a a t ma ag m t B a i a i a B m a a t i gi a m
DoHS, Annual Report 2075/76 (2018/19) Depart ent of Health Ser ice Trend of Health Ser ice Co erage Fact Sheet Fi cal ear 2073 74 to 2075 76 2016 17 to 2018 19 National National FY 2075 76 2018 19 b Pro ince Target Progra e Indicator 2073 74 2074 75 2075 76 Bag Sudur 1 2 Gandaki 5 arnali 2020 2030 2016 17 2017 18 2018 19 ati Pa chi NUMBER OF HEA TH FACI ITIES u l o p tal 12 125 125 19 1 5 16 17 12 1 H 200 198 196 0 2 1 2 0 1 16 H 808 808 806 6 7 7 5 6 1 91 570 5 77 on pu l a l t e 1715 1822 2168 150 20 1 17 119 156 7 9 HEA TH FACI ITIES FCHV REPORTING STATUS Public facilitie : u l o p tal 9 96 88 100 97 6 91 9 99 100 100 H 98 98 99 100 100 97 100 100 100 100 100 100 H 100 98 99 100 100 99 99 100 100 100 100 100 Non public facilitie : H 72 72 95 91 9 9 9 99 9 97 100 100 IMMUNI ATION STATUS o era e 91 92 91 87 107 81 72 98 102 8 D Hep H o era e 86 82 86 8 105 71 72 90 99 82 90 95 R2 o era e 57 66 7 75 71 60 77 8 78 75 (12 2 ont ) ull un e l ren 7 70 68 71 71 5 61 7 79 71 90 95 Dropout rate D Hep 10 7 7 2 9 7 9 2 2 2 2 7 5 H 1 o era e re nant o en o 6 7 6 59 8 8 52 7 69 6 re e e D2 an D2 NUTRITION STATUS l ren a e 0 11 ont re tere or ro t 85 8 8 78 78 69 92 100 117 86 100 100 on tor n n er e t l ren a on ne t (0 5 6 0 1 7 2 2 1 0 9 0 5 0 0 11 ) l ren a e 12 2 ont re tere or 5 56 58 9 59 69 6 80 58 100 100 ro t on tor n n er e t l ren a on ne t (12 5 7 5 7 5 2 9 5 6 1 8 1 5 5 8 5 7 2 2 ) re nant o en o re e e 180 ta let o 5 81 9 5 7 0 62 61 61 68 ron o tpartu ot er o re e e ta n A 72 66 65 57 91 1 6 65 98 68 upple ent IMNCI STATUS n en e o pneu on a a on l ren 5 ear 66 5 8 116 65 55 58 76 159 110 (per 1000) ( H an H / R onl ) o l ren 5 ear t neu on a treate t 156 165 1 6 128 20 111 1 5 127 120 11 ant ot o l ren 5 ear t neu on a treate t na 102 1 6 128 20 1 5 127 116 11 111 100 100 ant ot (A o ll n) n en e o arr ea per 1,000 un er e ear 00 85 75 51 7 2 0 268 0 68 62 l ren o l ren un er 5 t arr ea treate t RS 92 95 95 90 102 9 97 9 99 9 100 100 an n SAFE MOTHERHOOD re nant o en o atten e r t A t 102 10 110 11 118 106 108 110 127 90 (an t e) re nant o en o atten e our A t a 5 50 56 61 1 51 70 65 62 58 70 90 per proto ol
DoHS, Annual Report 2075/76 (2018/19) National National FY 2075 76 2018 19 b Pro ince Target Progra e Indicator 2073 74 2074 75 2075 76 Bag Sudur 1 2 Gandaki 5 arnali 2020 2030 2016 17 2017 18 2018 19 ati Pa chi n t tut onal el er e 55 5 6 62 5 62 8 79 7 71 70 90 Del er e on u te 52 52 60 61 51 61 7 7 59 61 70 90 lle rt atten ant ot er o a t ree e up a per 19 16 16 9 15 1 1 9 2 1 50 90 proto ol FAMI Y P ANNING ontra ept e pre alen e 6 0 0 0 1 7 5 9 56 60 rate ( R una u te ) R (Spa n et o ) 21 18 19 19 9 17 17 28 21 2 FEMA E COMMUNITY HEA TH VO UNTEERS FCHV 108 u er o H 9 16 51 20 51 20 8990 75 900 5709 8795 6060 o ot er roup 86 98 95 92 95 95 9 99 9 98 100 100 eet n el MA ARIA AND A A A AR Annual loo l e e a nat on rate (A R) 0 79 1 1 6 2 6 1 8 1 2 1 0 2 6 1 0 1 6 0 per 100 Annual para te n en e (A ) per 1,000 populat on 0 08 0 08 0 09 0 01 0 0 0 02 0 0 0 1 0 2 0 2 0 05 at r o a on alar a 1 1 7 1 5 26 16 7 0 8 17 2 6 0 1 o t e a e u er o ne ala a ar 225 2 9 216 19 25 2 50 9 a e TUBERCU OSIS a e not at on rate (all 111 112 109 89 112 12 90 127 78 110 A A or o )/100,000 pop reat ent u e rate 91 91 91 90 91 91 9 90 9 88 90 90 EPROSY e a e ete t on rate ( DR) per 100,000 11 11 11 10 2 1 5 9 10 7 populat on re alen e rate ( R) per 0 9 0 9 0 9 0 9 1 9 0 5 0 1 1 0 5 1 1 0 1 0 10,000 HIV AIDS and STI u er o ne po t e 1781 2101 2298 287 7 58 165 552 25 1 a e CURATIVE SERVICES o populat on ut l n 72 7 78 76 58 85 106 81 92 72 outpat ent ( D) er e A era e len t o ta at 2 5 o p tal ote HSS R an /or SD n ator Sour e H S, D D, SSD, AS /DoHS
DoHS, Annual Report 2075/76 (2018/19) mma EXECUTIVE SUMMARY
INTRODUCTION
a a t t a tm t a t i a a i t t t t it i i t t ta g t a t at gi a t a a t g amm a a a t i ma a i m t a ig ig t t i i ag t a a i t a i i m a t ai t a gg t a t ta a t i t t im m t
mai i t t at i a i a t i i t i ita i i g t mi i t i t i a t a i i t ima a t a t a t a t t ima a t a i a i ima a t a t a i i it t ta a g amm mm i a i i i imm i a i i t ma mm it a t t i ma t a i m t t i a t t m a i at a t a i i t a t a ag m t ma t m
PROGRESS OF OTHER DEPARTMENTS UNDER MoHP
The Department of Drug Administration (DoA) o ern ent o epal a pro ul ate t e Dru t t i it t mi a m i i a a i a ma a mat ia a a t a mi a i g i ma a g t a a m i i a t g at a t t ma g i t i t im t t ag a i a t m i i i a t a t t a i a ta a a it
a a it t t a a a t i t a a g i a m at a im m t t ta i i g i a am g g m t g m t a i at ga i a i i t a i at t m i i im t t t ag a i t i a it a m t g at t a a a i ma i i g t aim a a a g i i a t im ta t a a
Department of Ayurveda and Alternative Medicine (DoAA) ima i ma ag t i a t a i i i a m t a t i t t g it t a i i a a t t t ma ag a a t i a i g i t g t a a ita a i i ia ita a g a a i a i i t i t a a t t a a i a i a t t a a t a i i it i t i i t a t a i i m a g i i a g i i a a t t a i a m i a t m
i a g m t a a g i a m t a i a at at m at t a t a m i i i a it a t t a m t ita i a m a a ai a m i i a mi a a ima igi m i i a ag m t g a t a t a m i i a ta a m ta i m t a ga at at t a i a a m a t t i m
DoHS, Annual Report 2075/76 (2018/19) mma Department of Health Services under programs:
National Immunization Program (NIP)
a a g am mm i a a ta t i B a i a i it g am t i t i a t g am i i t a t a a a a a i a mi t t i g t i m i it a m ta it a iat it a i ta i a a a ig it g a gi a a a a g i i i i a mm a t g i t g am a a i t i i t a t a a t at gi im m ta
a a g t a m g t ta g t t imi a a a i a a i ta i a ma a m i t t a i a i B at a a ata t ta a imi at i a t imi a tat a tai i t a t a i i a a i a a g it t t i t t a t ia gi a a i i i tat a mai tai i t
g t a a a a i g a i t a a g ita a m i a i t a a a t gi a ta g t a a a a a t a a ta g t t g m a a m a t t a a ta g t a i i g m a imi a a t m t t m m m t i t a t ia gi i i g a a t imi at t m a a a t t at a i a i i a t ig i i i i a a i i t m t i i a i i ig ag it t t a imm i a m a a a i i mm it m i i a it i t i t i a a a i t imm it ga t m a a a a a a i am aig m mi a t mi i i a g a ait a i i g i t i t i t ai
a a a i g a i a B t am g i t g imm i a a t a t i a a B g t t a am g a i
a i t t t i t t a t ia gi t a mm i a t t g a t gt i g t a a mm i a g am mm i a t a i i t ia a a a Ba t t a a mm i a g a i a i i t ia a g t
a a imm i a ag B a a i t i t ag B i a a i a m a t i a g a tag ta t m t a gi i t am a at a a gi t a ma at a a a i a i t t t ag i i ag a mai tai at a ag a a i a i t m a t i a ag a i a m a t i a a ag a i a ig i a t i t m a t i a m a imi a ig ag t a i i ag t a i t a a t ag a i a a i t ag a i a i a i t m a t i a a tag at i i i DoHS, Annual Report 2075/76 (2018/19) mma t a t i a tag at t t a a t t a i B a t a t i a it i at t t imm i a i i m t a tag at a t t ig a a t at B B i t a a a a m a t i a i g im m t a a t at a it i g at imm i a ata t i a i it a a m t at a i ag i a t a i ig t a t
Integrated Management of Neonatal and Childhood Illnesses (IMNCI)
i i t g at a ag i i a i t a t ma m i a i t a ia a t ia i a i t mia i t ig t i g a i g a a ma i i i m ia ia a a a ia a a a t i am g a i i a i a
a t ta a gi t a t at at a t a i i a i i ig t a t at i a t t ta gi t a i t a a i a i Ba t ia B i i ig t t a t at i a
m g t t ta gi t a at t a a a t a a i a B t a a i a t a Bi t ig t B a t i g m B ig t i a t a t at i a t t a i a B a m a t a t a m g t ta a t a a t t a m a t a i i a i i a am g t m t t at it am i i i a i a
i mat t a t ia a m t m g t m t ta ia a a i at a i i ia a a it a ata it at t ia a a t at it i a a t gi i
imi a i mat t a t ta i i t a i a a a i m g t ta a i a t i a i g m ia a t a m ia t m ia a t at it a i i i t i a it a ata it at B t t t ta a i a m a a i a m ma a ia a m a a a i ma t i a a a mia a i am g i i
Nutrition
a a t i g amm i i it g amm t g m t t aim t a i t t i i g a t at t a mai tai a a t i a t i t t t t i mi m t i a ig mmitm t t im t t i a tat ia g a t a a ta g m t a i
t tag it i t ig t g a a a i t a a a ag m g t m it i g i it i m t i t DoHS, Annual Report 2075/76 (2018/19) mma t t i ag m t gi t g t m it i g m t t i t a ig t
i g g t m it i g i i a m t gi t g t m it i g i i mi i a
ta i m t t a it a mi i t a t a i a t t a t m g i a g a t t a t i a t a t imi a i a mi i t i a i ita m t t i ma ma m g t i i t a a m t a a t a m t t ta i a g i
t t mi t i t m ta t m ia ta i g ta t t g t t g a i t a a i g t a t m i i ag t i ag t m t a ta t i t i t g amm i t i t
i g a at i i i t itami m ta ag i a a mi g ta t i t i ag i i i ag mi g i t gi a t
a m g a i ai a a ta g m i t igg i a i g a a i i t t i t i t t t i t t a i t i a m t m t i i g ta ta a t i ag m t a t t m i i a a t ma t i a i a at t a t i a a t a t i i at i it t a t i i t ig t a t i t i t i m
i at i g i t g a t t t ami i a t m ta i g g amm t i ag m t a g a t a a ta g m t i t B i g g i t m ag t i a t a i t a g ag ait i i B i a a i a ai t g a a i i i t i t a i ait i i B i i a a i a a a i m
t t i t a i m t a g a t a a ta g m i a t i t i t itami m t i g a t i g a m m ta i g t t a ta m t i i g i t atm t mi g m t i i a i a i ta t t imi a i ag m t a a it a t m ta i g a i ag m t it a m it a t ma t i a it a g t m ta i g g amm
a at ig t ma i t m it t g i a it a a i t i t i t Ba a a a i i g t a a m t t m at t i Ba a a at i a a i t i t t i a a ig t i g a ig t m t i a a t a a g m t a t mm iat a t i i a t i t m m m t t g t a a t a mm iat i t i t a t i DoHS, Annual Report 2075/76 (2018/19) mma t a a m i i a g it t t am m a a i t i t i at ro ara, ar a an Rauta at, S olunteer , ealt or er an H , t e ollo n re pon e a im m t
at ig t t a t a t Ba a i t i t a i t a a t a i a a a ai a ita tai a a t t Ba ia a a t t i a i a a a i a t t ta a t t a a i a t t a am a t t ta a am at a t ta i it a t ma t i it a t a a i ag a t a g i i g i m g i a a g a t a a ta g m a a t i t a a a t m a i ta a a g ag
Safe Motherhood and Newborn Health
ami a i i i a im m g a a a t g amm t mat a a ata m i it a m ta it a im mat a a ata a t t g a m a i a a i g a i a a t t at a at i g g a i i t a t t a t m i g a t m a i g at a t i it a t t a i a m t i a t i t t i tag m a at a t i i at a a t a i i a tag t i i t a i a t t i m a t i a t i t a i i t a i m a a i t a t a a t a tag i t i a i t tag i
B t i ta i i i t i t a a t g t a t t a i i g i i imi a a t ta m i i a i i t i t im m t it i i a a i g a m t i g g amm a a i g m t i g g i i a t i a a ita a it im m t i ita i i t i t i t i a tag i t a B i a t t i m t t a t m t a i g t i it a t t i m t i t t i a m i a a ma a a m a i a i ma a ai a i a i t i t ita a ma it i t i a
t ta it a it i t t i a a i i t ta m i a i gi a a i i t i a a ta m i i a i a m i a a am g t ta a a i a i a t a t a m t i t t i m a a a a a t t a i a m t i t t i
Family Planning and Reproductive Health
a a ami a i g g amm i i a t i ta ami a i g i a a a i ia m a a m t a a at m m at a a m ai i ig t a DoHS, Annual Report 2075/76 (2018/19) mma a a a ag i a t ig t m i Bagma i t t a a t a t m a m m t a a i t a i i a m i t i t it m a a m i t i i i a g a ma am g t m i t i t t t ma t m t a i a i g t i t at g a g i t a t i a m t tag a t at a a t i i i a i g t i i Bagma a a im i ma t i i a i a i ai a ma t i i a i m a i tai a ii t a ai t a im a t m a t m t m a am g m ag i a gi a gi a t a a t a i i at t a i a a ig i a t t a a i i g t m t it t a t t a m t m a t t a g i t a i a a a t at i a i t a i a a i a i
i t g at t a t t t a m t mi a m t a t m im a t ma t i i a a a t ma t i i a i a a a t a m m t a t m a i a i a t a t m a m t a t m a a mi a i a i im a t a t ig i a t mi at i a i a gi a gi a mi a i a i t a t m ta m t t a i agi g t a ta am g t ta t a i i a i a m a t a t i t i t i i a g m a a a i g m t
Adolescent sexual and reproductive health
a i t t i t ia i a a t t a a t a t a m t t at g i a a t a a a t i t i it g am ami a i i i a t m gi g i a t i t a gi g t t t t at g i i i t mai aim i i t at g a t a t m a t a t i a t ag t t t mi i t a i a a a a t t a t a m t t a i a at a a t i m t a a t i t g i a i a t a t i a a ag a iat i ma a t t i a t a m t a a i g i i a im t a t tat a t
a a g am a g a a a t t i t i t ta g ita a a a t im m t i t i t i t i t a t a i i t t a a i a a t i m t a a i ig i a t i a i i i m a i t i a a a i i mai t t i t a t ata i ag a m am g t a i i i t a t t m t ami a i g i ig t i i a a t i i t a t i t a i am g m a ag
m i i g t a a i a ig i a t a i t i i i m a i it i a a a im i a t t m a t m i i g t a a i i a a a m a t t t i a t t ta m t m t a a DoHS, Annual Report 2075/76 (2018/19) mma i i g t a i i i i m a i t a
ig at i ma iag t a am g a t a a a i agg gat ata ag a i t g a i mai t t g a g t im m ta t g am i t a i i g t mi im m t t ma im m a a it t i a t i t a t a i it a a t a it a a i i g ig t a t t a it a a a t ig t t g i ma i g a a t i it i t g a t t t t
Primary Health Care Outreach Clinics Ba t a a t m t at a t i at a m i i a t it i a a a i g i ta t a i i g i t at a a ima a t a t a i i t a i a t a i t t mm it
mi i at t a i i a t ta i i i t t ta g t m i i i a a a ig t i a i i i a a a ag i t a t a i i a a g a a i m t i t a m i t t a t a t i i t a a a ag i t a t a i i
Malaria
a a a t i i m m t a i g ma a ia m i it a m ta it at m t a i a m a t m t a a t a i i a a ia a t a a a a ia t at gi a a a t i mi g ma a ia i m mi t a a aim i t a ai a a ia a
ta i a ma a ia ig t a m i t i a a i ig a a a im t a t a i a a i a m i i i a i g t a a i a m a t t i a t i ig i ma t ig m im t a i a m a t i ig ma a ia a a a i g i im t a a i i a i g t t i i a t ma a ia a i i it at a ma a ia a a a i g a a mai t i a ag mi i a at i at i a ig ag i ig a m at i t i t a i a i mi tat mm it
Kala-azar
a a a a i t ig i it i a t m a t t i t i t a t a a a a a i t a t imi at a a a a m a t at gi t im a t tat a a i a a ma i g mi a a a i a t imi a a a a a a it g m a i a t m i i a a a a at a a a i t i t a t a a i t a a a i g ig i a t t a t a a t a ig t a i t a a a a a a m a t i a DoHS, Annual Report 2075/76 (2018/19) mma Lymphatic filariasis
m a i a ia i i a i a t m i a g a a a m a i a ia i g amm i t a g m m a a ia i a t a t i i t i t t i a i i at i i t i t a m i it ma ag m t a a i i at i a mi i t i t mi i t i t m t t mm i i imi a g amm a a i i t t i t t t gt i g a t t m t g t ai i g a a a it i i g a i t a mi i a m t i i t i t i t at t a i a ig i a t i m t a mi i m a a ia i g a a mi i t at t at i a g i a m i t
Dengue
g a m it i a m g i a i i g a a a g t g am i t t m i it a m ta it t g g a m agi a g m m t g a a a ig i a t i t a g i a i t a i g g a t m i t i t a ma it a a t m a i a a a a g a a i t m at t g a m a i a a g
epro
i g t t ta m a t t a t g a a t atm t a i i g at t t a a gi t a at a a at a a a t t i a i i t t i t m a a a a t ta a t a a i a i it i a a ma a i a i g t gi t a at a t imi a i i a i t g am a a a a t a i i a a a i a t a a t a i it m i i a i a a a it i i g a t a g i g t t am i t tai t g a a
i mi g a i a t i i i i t a it i i t a t a a t i t a g t m i a i i i i i i i a i g t m t a a a i ita t m i i g a i t g t i i a g it a i ita i a a ia i i i a i it ga i a a i t a a ag i t m t i a g i i at t a i ita a i a i it
oono e
a a a i a a i a i mi mi a a mi t a a ma i a t a m t a i a a i am g i a t a i i a a m gi g a m gi g i a i a i i a it t t a ai a i it a a i a i a a m m m a t a i a t t t a DoHS, Annual Report 2075/76 (2018/19) mma ma ag i mi a t a i t g a g am a i t a m t a ma a i a a a it t ig t i a i t a ai i g t g a t a ima it a a t t g t t a a a a it a t
Tuberculosis
i B mai a ma i m i a t t ta a B a gi t at m g t i i t B a a a am g a B a m a B a t t m a t i gi a m i t ig t B a at ma i t i t a a B a t B a m t i i it t i i a i t a a t ta a i t m t ai i t i ai t t m t a a a t a t i t ag g ig t i a ag i B i a i m a m m t a m am g t t B a
a a at a m B i a i i t B a a a i a m g a a g i B a gi t a t a t m t at it a t atm t at t atm t a a a mat a t a B a a t B a a a a i a B a a t ta B t atm t a t a t B i a B i i ma gi a t a t B a
B i i t g t atm t t ga i g iag i t a i i t a t t t g t t t B i i t g t atm t t a atm t t g t B i a am at a i it a i a i t g t a m
HIV AIDS AND STI
a i g t t ta mat i i g it t a a t mat i ag t a a i i g it i a i i t a t ag a a a a t m t t ta mat i am g a ag a B ma a t a m t t t i t i a t mai i g m t a t i i a i ma a am g a ag g i i ta a t atm t t
Non Communicable Diseases
mm i a i a a m gi g a t a i g a at i a t a g i ia t mi a t i a t i t a i a m g a i a mi t a i at t a i a a i a ia t a a i at i a a i a m a at i t i a t a a a i i g m t a mm i a i a a a a a t a t t a i t i t ima a i g i mi mm i a i a i g i a a i tai a m t a i a t i a m t i g a at a ag
DoHS, Annual Report 2075/76 (2018/19) mma t i g a ta g t t t i mat m ta it m t g a t atm t a m t m ta a t a i g m m ta a a i i it t t a a a t
Mental Health
ta a t a ta a i g i a a t i i a a a i tai a m t a it i t a t g a t ta g t a i t at t m ta a t a ta a a g t t t at t i B t i mat m ta it m mm i a i a t g a t atm t a m t m ta a t a i g a g t t t at t i t gt t a t atm t ta a i i g a g a a a m a a a ig m ta i t t a imit i t t a t i mi m ta i a
Surveillance and Research
i a i a a a i a i t g a a t i mi g a i a t i i i mi i t mm i a i a i a g am i t t t a im t a t a i t a i g a i g t t i a i t a a t t a a i a it ta i a a it t i m i a g a i ita t a t i i i at g m it
imi a at a it i a t a mmi m g it ta a ga i at a it i a at i t i t i t i a ta i a i i g a a i g i t g a g i ma i i a
Nursing Capacity Development
a a a g am t i i t a a t a a a i g amm a i g
Geriatric and Gender Based Violence
a ta i g iat i a i ig t a ita i i g g iat i i a i i t ta i i g m i i t ita t i i g m i a i a t t im i i t a i i i t a m t a a a t a t B i i it t a t i t a a B a i it t a a a t a B i i a a i t a a ta i a ita Ba t i i a ag m t t i t i t i t a aim t i a i t g at a ag i i g a i B t g a t m t at t i i i i g t it a a t B i ii mai tai i g a it a iii g t ig it ig t a i i at a m g i i i g i t ita a a a a a Ba t m t a a a a t i m i i a m i a t atm t i g t m a t it i i g t i i i a i ga a a i ita a a i a a a gi g
DoHS, Annual Report 2075/76 (2018/19) mma i i a a t t m
Bipanna Nagrik Aaushadi Upchar Programme
m i i i m ia a t it i t i g im i a i t t at i a t i i i m i a a t atm t t i a am a a t i a a ma a a a ma i a im i a a i a i a a mia t t a t t i t m a t ma ag i t i i t atm t t im i i i m m t m a t m a a t i a i a ma i a i a mia a ma a a m a i i a a t i a a t t a t i m a t t a m a t m im i a i a t i m t i i t atm t t im i i i m
Fe ale Co unit Health Volunteer
ma t ma mm it a t t i m a m t i a t ami a i g a t mm it a a t i t m t a t a a t a i m t a mm it it t m a t a a t a i i t t t a a i g a t t t i t ig i a t i t i g a i am i t i a t a i m a a a a t a i g a i g t m t i t a t a i i t i i a t m m t a i a g i a t m t g m g i a it t at i t i t i m a m i ta t i t i t i m a i t i ta a t at a i t t imm i a agai t i i a a a mm i a a t mm it a ma ag m t a t atm t a t i at i a t ia a i a mm it t i g amm a t i a t a i
Inpatients/OPD services
a a t i i t t a t i i g m g a t a i a t i i g a t i a t i i i t ita i i g i at m i a g ita i g m a i at ita t i a a t t ta a i t a t i a t a mi ita i a a t i m g i m ita
Health Training
a a a t ai i g t i t t a ma m t i a a t t a g a i t i a t i a a ma ag ia a a it a t i i at a t i a it a t a i t a a ai m t t m m a t tat a a a t t ai i g t i at i ia a t ai i g t a ita a i i a t ai i g it t g t t t
DoHS, Annual Report 2075/76 (2018/19) mma Vector Borne Disease Research & Training
ima t B i a a a ai i g t i t t g ga a g at i i i t t B i a B t B t ai i g i ia iat i ia B a a t a i a a ma a ia mi i t ai i g t t a t i g a i at it a t t i a t t g t i g mi i mi g t a a a a ma i ma ia i a t m gi a g t i a a t ita t a i a a a a i i t i t a a i t i t i a a
Health, Education, Information and Communication
a a a t a ma a mm i a t i i a t m a i a i a t i ma a m ag i g m m ia m t a a t i i i a t ma a a i a a ai a a t i i i t a t a a
i a it i i i a t i a a a a a g amm a m at a im m t i i it t a t i a tai a m t g a igita m ia a a i t a i i a a ia m ia a i m g a t a i i t a a mm i a a mm i a i a a i a t m ta a t i t t ga a a i m ta a ita ia a i a g mm i a a a a a i it ia m i i a t g a t t a mm i a a at t t ta g t a i a t m a i a t m a t i g a t a a a a ma gi a i a t g t g a g amm
Health Service Management
a ag m t i i i i i g a ma ag m t i m i i g it a t a i t i ma ma ag m t a i g i a i i a t m it i g a a a a t g amm i i i i a i m it i g t a it ai at a t t a m it t t a mai t a i a t i t i i g a t t mai t a m i a i m t a i a ig t t i i i i i i i g i a a i g at t a t i a t t a gi ma ag m t t a t m a m t t a i i m t t t i i g a at a it g a i g t m t m at t a i a a t g g t it t
Logistics Management
mai gi a ag m t i t t i i i g a it a t a i i i g g am i i i a t t g gi a i m t a i ami a i g mm i a a t g t a gi a i t i t t a a t a i i ma i t a t a t a i t i t a t mm i i m t i t m t a ai i g mai tai i g t i m i a i m t i t m t a t a ta i a t a m t a a a i itat i a gi i i ma i g a i i a i a a gi a i g a t a a i i i m g t a g a t DoHS, Annual Report 2075/76 (2018/19) mma mm i a t im m ta t t m a m a a t i m m gi i g t ai i t it ta i i i t g a t a t ta a a i a a g m t a ai a t mm i a mat ia i t gi a i t i t
Health Laboratory Services
a a i a t a at i t a t t a a it i i g a t m t i a t a at t a iag a t a at i t a ate or e a entral, pro n al, o p tal , H an Healt po t
t a a i a i t ia i a at i it i i t a a Bi mi t a mat g a a it g mm g i g i g i i g i t at g t g a mm i t mi t t t a i t i t i a a a im t t t t a i im m g a t mat g t m it ma i t a at ma t m t mi imi ma t a a ga i a i a i g i i g i a i a t a at i it at t t g t a m i i g a g at a i at t a t a at a a t a i t at i
Personnel Administration
mi i t a i i a g amm a mi i t a t ma i g a i g a t i t t t a a t g a i g a t t t a a it i i g a a i t a ma ag m t ma
Financial Management
a ia t t m i im a i t a t i ma ag m t a a a a g t t m i m t a g g a a i g a t mai a ia ma ag m t t t t im m ta a t g amm i a mi i t a i t a i t a ia ma ag m t a g amm t t ta a a B g t a m a a at t a t t i g t a a t t ta a t t g t a a at t g am t a tm t a t i
Monitoring and Evaluation
i i a t t g at a t ma a ag m t t m t at a i i ma t a i ta at t i t i t t a i i i t a t i t i t a ma i t i a i t i t a a a t ai i g t g amm ma ag m t t im t i a t
Eye care
a a g amm i a t a a g a i a am a a g amm a i i a a at t t DoHS, Annual Report 2075/76 (2018/19) mma m t a a a ita a t a t a i i i t a t ta a m g i
Human Organ Transplant services
a a a a t t mai a t t gt a a ga t a a ta i i ia i i t a a ta a g it ig a it a t a at a i t a ig ma i i g t t t ai i g i a i a t i t a t i a t t
m a t i a t a t a i a ma a i t a t i t a t a tm t i t at a mi i a i a g a m t imi a it a
mi g i a ma g i i t m i t a a ta a at m t i m i ai ia i a m i t i a a a a ig t a a i t ia i i m i t i
Medico-legal Services
i ga i i i at g a t i i a i m i i a t i g i t t mm a im i g m i ga i i a g i i g t i at t i m i ga i t t ai i g i t i t m i a a t a t i a t i m i ga i i i g a i i i i g i a m a a im i g i a t i ga g a t i im a m t g i m i ga a it i t a it ta a a a m t a a i t ia i i t i it i ig m a m t t a i itat t i m t t i t t i m i ga i i g t i ia i t i t a i
Health Councils
i i a a t i a i a i a i g i a i i a i a a t i a i a a ma i a a a t a i a it a t at a t ai i g t a g at a i
Health Insurance
a t a g am i a ia it g am t m t a t at aim t a it i t a t a it a t a i mi imi i g a a ia t m B i i t a t t a t i a g am i a t g g g a ma im i g a m mai t a t i a g am i a ami a g am a t i a g am i t am i ta t m ai a i i t i t t ait a it i a t am a Bag g i t i t t g am i im m t i i t i t t t i t t g am i im m t i i t i t t t a t i t i t a i i i B i a i g t im m t t i g am a t t a
DoHS, Annual Report 2075/76 (2018/19) mma i i a i i a i i t t ta a a m m a a t i t a t i a g am at t m g t m a i t a i t a at g t i i ai a m t i
De elop ent Partner Support in health
m t a t t t g m t a t t m t g a t i a a t t im m ta t a a t t t at g i t i a i g a g m t a ig a i a t a t g m t i i tai t a a g m t a t a i g t a at t i g a a g m t a a a a i g m a i m a i at a ag t t g m t a t a t i m t Ba a a at a it mmitm t t g a g am t a t i i agai t a i a t t a i m t i t a a a i i g a t t i mmitm t agai t m i a ag it t i i t a t a a
DoHS, Annual Report 2075/76 (2018/19) a a a t i National Health Policy, 2019
1. Background
t a a ta i a i a t a a a am t ig t it i t t a m t a g a t m it i t i i it t tat t t a a it a t i a i a t t a m a t m i a a a t i a m at t a i t i t i a t a a tat a a a t t t i i a g amm t m t a t i t a a mmitm t ma a at i t m a t m a g a ai a a i i t a t t
2. Review
it t ta i m t i g a a a ai a a a i t t t t i t atm t t m a i i at i a t a m t m m i a t m ta t i a it t ta i m t Bi ita i a m t i t a t t ga it t ta t i i a i g i t a g t m a t a a i t i a t a g t m a t a i
t i a a g i t a t a i a t a a a t i a i t t i i a t t i a t i i ag m t mmi a t t i a a a t t a a a mi i t a it a ima a t t i a t a t ta i i t a ima a t i t t i ag i a m t t t a m t a a i a i m t i at t t i t i t a t t imi a t a a a t i t a i at a i a t i i i it t i it t i t im t a
B g it t t a a ima a t a ma ta i t g a am aig ima a t i a i t i i m m t a a t tai a m t a i t a a mmitm t a t i t t t m t a a i a a t t m imi a a it mmitm t t t g a am aig a i g a t a it ima a t a i t a ima a t a t at t a i ta a a a ta i t t i t a i m t ma ta
3. Current Situation
a a tat g m t a a ta t i i g ia i i i g a t i a t im m ta a i m i a t g t t a g m t a a t ima a t a t g t t t a t a t a t a it i t a i i t i t i t i t i a ma t a i t a t im t i a it a t ta t t i at t ita a t at i a a a a t i a a a i m it i g a g a g t m ma i a m t a a t a a i g it i t t it t i tm t i a i at t t i agai a a it a m t a g a i t ma i t a t a a it a t i t g i t t i
DoHS, Annual Report 2075/76 (2018/19) a a a t i i g i i t a i t i i t t i m a a im t g it i a t t i a g at a i a m it t i t i a ma ag m t g imi a m ia i t atm t a i i a g t a t i g t i ga t a a t a g a a a ta i i a t a a a t i i a m t a a i m t g i iag a a at i t t atm t
i g t a i a t a i mat a a t ta a t a ma a a i at imi a t ma a t m i t a t a a a a a a ia i ma a ia t i m a i g g i t ia a a a i ia a i at i t i a i g t a t m i it i a i g i a t a i t ma m a tai t im mat a a t i a a t
a g at i i a i i g i a ma i a t i a i i i a i a a a a t a i a a i i g a it a g a g ma a t i a a t a t i a t g at i a ma t m m
it t i a i i a a a ta a t a t a t atm t i it i a t ma i a ta t t a a a a t i t ita a a t i a a mi i a t m a ma t i it i a t ma a t i it g t i ag i a i t a a ga i a t a a t a i t
imi a it i a t a at a i at it ag i t t a g at i m ta a ai at i a i t i i t a g i a t a a i g i i a i a t i im a t a it t m t t t t m it a g at t t ag i t a g ai a ma g ma a t
4. Problems, Challenges and Opportunities
4.1. Problems
ai m i m g a a ai i g a it a t i at a i i a i it t i t t a t a it a t i a t t i a i it t i a ma a ta t i a t a i at t m i tm t i t a t i a ai a i it a m i m t a ia i t i i a t i t a a t m at t mm i a a mm i a i a ma t i a i t a i a t a i a i t mm i a i a a m ta a t m g at m g a i a a a g i a it a i t
t m i im a a t t a ma i a t i ma ita ia a t m t mm m i a i it a at a i a t i a i t i i a mi ia i ta t i a iat a i a a i mat a m ta it a a a at t i i m t a t i i ag a m ag a a a a a t i it a g a t i at t i mm it a t i
DoHS, Annual Report 2075/76 (2018/19) i a a a t i 4.2. Challenges
a g i a t t i i g a a a i t a a t t i i g a it a i a t i t g a a i i g a t i it i it t t a a a i i g t i g ig t t it a t a i g t i a ia ta i i g a a g a t i t i i it t a t m im m g a t i a i ma i g t a t t i t a ma a t t a mi g it m t i ta t i i ta ma agi g i ma it a i i a t i a ia i i it i t a t t mi g ia t g i g a t m a iat it imat a g a i a a a g i i t ma agi g a g a g m i i a m i a t i a i g t ata i m it i g a a i i ma i g a i i ma i g ma i g t a t ma ag m t i ma t m m i t g at a t g i t a t a i g a t m t t a at a a g a t m a t mai tai g g a i a a t a t i t m a mi g a it a t i a g a
4.3. Opportunities
i g t i i a t t i a i g i i i i a t i am g t a tat a a a t t im m ta a t i a t g i i a a a a t g amm tat a a g m t i a i t a ai a i it i ma t gi g a i m t m t i a t t a i a i i a a a i a t t t t mm it t t a t i i a g amm ma ag m t a a it ta i i ma i g a i i ma i g a i i a a t i a t g m t
5. Relevance, Guiding Principles, Vision, Mission, Goal and Objectives
5.1. Relevance
t a i g m a a g a t t t a ig t i t a it a t i it i a t t am i g a t i t at gi a g amm a m at a a a a t i i a a it t a t t t i i i a t i g a t i a t tai t i a i m t a a t g i t m t a a i a t i i a t t a t a t t gi ma at a i i i i i i a im a t a t a a a i t a a mmitm t ma a a t a i t tai a m t a i a g a i g t a i m t i i m m t a
5.2. Guiding Principles
t t a ig t i t a t i t g a a a t t m a t i a a t a it a t i t i i a m at t a i t i g g i i g i i a i a a t a ai a i it t a a a m i i a it a t i
ii DoHS, Annual Report 2075/76 (2018/19) a a a t i t a i m t a a a a t i i a t t m i a a it t a t t ia a t i ta g t t t a ma gi a i a it a i ig mm i a t g a a a a a at a ia i tm t i i a ita a t i a t t i g i t a t i g a t a m t a i a a a a i a i i i a i m t a a a t i i a t i i
5.3. Vision
a t a t a i i i t t a i
5.4. Mission
t am ta a t ig t i t g m m a a a a a t i
5.5. Goal
a a a a t t m a i i t a t t a ia a g g a a a t a i a a it a t i
5.6. Objectives
at t i a i t t i t a ig t t a t
a a im a t a t t m a t a t t
im t a it a t i i a t i t a a t a a t t i
t gt ia a t t t m i t g a g t m t ma gi a i
m t m t a a t i a a a t g m ta g m ta a i at t a t m t mm it i m t a
t a m t a t t m t i ta t i i ta
6. Policies
a i a t i a m a t i t a a i
ia i i a ma a i a i t g a t i a
t a i m g a t i a a i
a t t m a t t im a a at a tat a a a t a t t
DoHS, Annual Report 2075/76 (2018/19) iii a a a t i a a it t t i a a t ag m a a a i ita a a ia i a a a i a i t g at ma
a a a a t i am g g m ta g m ta a i at t a m t ma ag a g at i t a t t a i at i t a a t a i tm t i a t a i a a a ag a t t
a at at ga a m at a a a i a i t g at a
t ma a t i a i a a ita i a t ma a a a a i g t t i a t g a a a t t ma agi g a t i
t t a t i a i a a a im t ma a t i i i i i a a i t a ta a a ita
m a it g a t gi a a t mat ia a m t a t i a a i a a t g g a a ma ag m t i t t ag a i t i
t g at a a m a a a t t m at mm i a i a i t a a ima i a m at it imat a g t i a i mi a i a t
i i a ami i i a ag i a ma i a t mm i a i a a i t g at a t t m a a a
t im t i a it a a t at a a m a i ag a m a a t a ita a a t a a
a t a a ma i t a a ta a a t i g a a t t a i i m a a i g a a t t m m t
a t ma ag m t i ma t m a ma m a ita a t g i a i t g at a t i ma t m a
ig t t i ma at t a t a ig t a ia t a t t t atm t a
ta a t a a a t at a t i a a a
a it a t i i a a t i t i i g ita a i DoHS, Annual Report 2075/76 (2018/19) a a a t i g a a im m t a i i at i t a a ma ag ia t t i t a t t t g m am m t
a a it t t a t a t i a t i a a m t i a t a a a t a t a i i a a a
a a ia a ia a a a g tai a m t t a t t
a i a i t a a t a mig a a ma ag a i a t m a iat it m a a
m g a i ta a ma ag a a a a t i t m it t i i i a g amm ig i g
mi ia i ta a a t i a a a t t a ma ag m t mm i a i a i m ta a ai a at a i a g at a t
a a a g m t a ma t t i immig a i a t a t i a t t t a ta i g a a
Strategies for each policy
Free basic health services shall be ensured from health institutions of all levels as specified
Ba i a t i a i a t i t t
g m t a a a a g a i a i a t i t t g t a tat a a g m t ma i a i a i t t i a t it a i a i a g m t
a i ga a i t a a a g m t a ma tat a a g m t t ma a i a t i
Specialized services shall be made easily accessible through health insurance
atm t i t at a t i i t a i a t i a t gt a i t g at i t t i a t m
Ba t i i ia a i i ta g t g a i it t tat i i a t i a t m
ma t a m i g t i t t a t i a t m a mat a i a t a t i a t m
a t ia a t i i t tat a g a a DoHS, Annual Report 2075/76 (2018/19) a a a t i Access to basic emergency health services shall be ensured for all citizens
i m g a t i a g a i t g a t i t a i i g a i a t i t a ima ita a a t m a a a a g
a g g i a a i t i t mai ig a t a ma i t a i t a ma a a imm iat t atm t i
t a t am a it mi im m a i i a a a g a a a am a i it i ta a a i a a m t gi a a a g
Air ambulance shall be arranged with specified norms to rescue people from ultra-remote areas with critical health conditions.
m g t atm t a a a g a m i i a i i t g i i
t ma t a it m g t atm t at a it t i t a a ta a t ai i g t a t a t a gi m i t t ai i g
a t t m a t t im a a at a tat a a a t a t t
i g t t t a t t a am a t a a t t a ta i i i g a a i a t t i a t i mi t a a
a ga a i t a a a g m t a ma t t gt t a t t m i i it t a t t
ita a a t i t a t i a ma at t a tat a a a a a i a a it t m g a i i t i g g a i it a a Ba i a t i t a ta i a a t a ima ita a a a ita a i ia ita t tat a ia i ita t a a ta i imi a at a t t a ita a a t i a a m i a tat t a g m t a ta i
a a t m m mm it t t ia i i i a im m t t ma t t atm t i m t ma
a t a i t a i a m t gi a m i a t t m i i a a a g at a t i a t a m i a i a a t t m a igita i
iag i a ma m a t g i a t a a i a t a at a t gt t t i t a a ta a a at a a iag t a ta i i a tat i DoHS, Annual Report 2075/76 (2018/19) a a a t i t im t a it a t i i a g m ta g m ta mm it a i at a t i t a a t i a t t m t ta a a mi im m i ta a a im m t imi a i ta a g m ta mm it a i at a t i t a a g a a im m t
a t i a a t g m ta a g m ta t a mm it a i a a m t a t a i i a i t a a a t a tat a ima ita
it i i at a t i a t g t a ai a i it a a at it m a
ma ga t a a t ga a i a ga a ai a a ma ag a a
i ga i a a a t a tat a ima ita
m a t i a t i a a t i i a i i t a ma ag a g at
a t m t g a m i t ma a t i a ita a t
In accordance with the concept of universal health coverage, promotional, preventive, curative, rehabilitative and palliative services shall be developed and expanded inan integrated manner
i i it t t m a t a a t i t a m t t g a t a a g amm
i a it t a t a t g amm a a t a a am aig a g a a a t ig a i g t a ai a i it at a t a t i a
t m a a i a i a a t i g a i a a t ig t ta g t g t i a i a a a m a i a a im m t
t m t i a t a a am g a i a g g a a t a a a g
i a a ita a t a t i a it i it t a a i ag g g a a gi
i at a g m ta ga i a a m t t ta i a i ita a a ia i t it i t a i at a tat a a
t a a a t a a i t a a g a i mi a a t at m ag a mat ia a ma i ma ag a g at DoHS, Annual Report 2075/76 (2018/19) ii a a a t i i a t m a im m t i m t a ita i i g at a it m t i i a it ta
ta a m a i m a i ma at i a t im a t a m t i i t i i t a t mi t i t a mi imi t i a t i a t
t a ia t mi a t a t m t a a t i a a am g a i tat m a i m a ma m i i i m t t i t a t i i a a a ag a a at
Collaboration and partnerships among governmental, non-governmental and private sectors shall be promoted, managed and regulated in the health sector and private, internal and external investments in health education, services and researches shall be encouraged and protected
a t i it i at a g m ta ga i a a a i a am t t a t a t atm t a i i ta g t g a a a
i a i m i t i t i a i a a ia t i at t a i t m t a a i a t i a ia i i it a a m t
a am t a a ita a a a a a g m ta g m ta i at t imi a i at ita a ag t t i t at ma a a i a mm i g a t m ita a a t i t t i i a ma ma at a m it i g a g a a t i a
t a a it a t i t a a t mi i g t a i a i i t atm t a a t i i a a t ita a a t i t
a t t i m a m t i g ia i a ia i a t i a t g a t i t t g m ta i at a g m ta t
t i m i a t i a m t a ma a t t a m i i a ma ag t g a
Ayurveda, naturopathy, Yoga and homeopathy shall be developed and expanded in an integrated way
i it t a t t i i t at it i a t a a t ma a a a
t a t a t m a ga a at at m at a i a t a a a a t a t t
iii DoHS, Annual Report 2075/76 (2018/19) a a a t i a a ai a m i i a mi a a a ima ta a i t a m t it m a i i a i a t a a ia a m t
i g a t a i a a t a t m a i t ma ag a g at a i a am t
a a a ga a a a a ma t it ia i i a a a a a ma ga a at at a ta i t t a t t i m a i i a a g a a a a t a t t
a a t i a a m a a i it a ta i a t i t atm t a a a a i t a i a at at t m
In order to make health services accessible, effective and qualitative, skilled health human resources shall be developed and expanded according to the size of population, topography and federal structure, hence managing health services
a a t ma a tai a i a t t m a g t m a t a t t
a a it ag i i t g at a a i m a t a a t ma at a
t t a t i a a t i t i i a t a a t i a ta i g m t a t i t a g a a im m t i a g m t a t i t t ma it m a t a a t a t i t ita i a im m t i g m t ita it a ia a t i
t a ai a i it a i a t i i a a i a t t at a a i t g at t atm t i a im m t i a i ima t atm t m g i ima a i a t a i i
t a a t a at a a a g m g t atm t a a ma i g a i a t i a a ai at t ima ita a a
a at a a t i t i a g t a t ma t g ig a i i t ai i g i a t ai i g i a m t a t i a a i a a a ag a m t
a g m t a ma t ia i ma i t m a g a it a t i g mi i ita ma ag m t m i a a i a t mi t
m a a t a m at a im m t t m t a a i a t i a a mi t t a i g i t i t a im m t t g t t t DoHS, Annual Report 2075/76 (2018/19) i a a a t i ma t g i m ta a t i t a ma a a t a mai tai a at
Structures of Health Professional Councils shall be developed, expanded and improved to make health services provided by individuals and institutions effective, accountable and qualitative
i t g at m a a t a t at i a i a im m t a a t t tat
t a a t i a a a it a t at i a i a
t a t ma t i i i a a a ta t t a t ia i
ma a a a i a a a g t ma t a t i a i t t i a i
Domestic production of quality drugs and technological health materials shallbe promoted and their access and proper utilisation shall be ensured through regulation and management of efficient production, supply, storage and distribution
a i m a a t a t t t t mi i a a it g i m t a t gi a a t mat ia a t g at t m i i a ita a ma i it i t i ia a im m t
a a a g a t gi a a t mat ia a ag a ia a i a
i i a it m ma ag m t i i i a t at t a at i i t a t i i t ia m t at t tat a t it i a g a it a i t i a a ta a m a a im t g a m i a i a a t t i a it
m t t a ta a it t ag a i t i t m a ma m a t ma a i g i a g a m i a i
i i a ta a a t i a i m i i i m t m i a i a t m i t a a a a a a g m t g m t a i at
a a m i a i a a t t a a ma t ma ag im t a t g
i a a a a t gt t a a mi ia i ta a a t m a a a i i i a it i t ag i t a t
g a a t i a t a it i m i i a a t DoHS, Annual Report 2075/76 (2018/19) a a a t i Integrated preparedness and response measures shall be adopted to combat communicable diseases, insect-borne and animal-borne diseases, problems related with climate change, other diseases, epidemics and disasters
g amm a im m t t a i a t imi a a a i a mm i a i a i i g t i a ma a ia
a t m a i i a a a im m t
a a it a m a i m a at a tat a a t g a a t imi at a a i at i a a t t a a a t g a
i m t a a t i t gi a ag tat a a a ma i ma ag m t g a a m it i g a t a m i a ga ag ita a t i t a a at i
i a a a a a t m t m a mm it a t ma ag m t a i m t a i
g amm t mi imi imat a g i a t m a i a i a a a i a it ta
a i m a t at a t imm iat a i a t a i mi t i a a it m t a a a m i ita i a a a g
i a mm it a i a a t i i a a t i i i g i i a t ma ag m t i a a t m a ag
Individuals, families, societies and concerned agencies shall be made responsible for prevention and control of non-communicable diseases and integrated health system shall be developed and expanded
g amm t m t a t i t a a t t g a t i t a
t a i a it i t at it i i g at i m ta a i it a a a t gt t m t a t
t a a t i a im m t a a ta a a a im m t t a t a i a m t i a t ma a a a t
t m a t t a t at ita i a
a a ma it m t at a a m t ma a t a i ag a a a mi a i a t a i g t t ag i g a a a t a g at
m a g g a a a i ag t g m t a DoHS, Annual Report 2075/76 (2018/19) i a a a t i i a a a a a t a t a g at
m a g amm a t t a a a g m t a im m t t t a a i t a t i a t ig t i g t i t
i a a a a it ta a t a i a t t m t a t i t a t a t i m ta a m t i a t
In order to improve nutritional situation, adulterated and harmful foods shall be discouraged and promotion, production, use and access to qualitative and healthy foods shall be expanded
t a t i i a g amm i i g it a at a im m t it i it
t im mi t i t it a m i a i t ag g i i a a a a i t a m a i a t t m m i m t m a g t m m a at a a a t
a t g amm a t i a g amm a t gt a im m t
m t i a a t it m a m t a m a ag
Health researches shall be made of international standards and the findings and facts of such reports shall be effectively used in policy formulation, planning and health system development
t a t t a a it a a a t a i a at a a t a t t a ma a i t a a ta a
a a it a a i a t a a a t a a t i a ma a m at t a i i a it a a mi a a a i t
t a t a t a t a a i t g at a t a t t a i a i m a i i a a a a t t m m t a a i
B g i i ig m i i a mi a a ima ta a a t a i a a t a a a a t t a m t a i t t a t
The health management information system shall be made modern, qualitative and technology-friendly and integrated health information system shall be developed
a t ma ag m t i ma t m a a a t t a a ma ag i a i t g at ma ii DoHS, Annual Report 2075/76 (2018/19) a a a t i a t ma ag m t i ma t m a ma i t g at t g i t m a a g a a a a it a a a t t i ma
a t a i ma tai m a t ma ag m t i ma t m a a i a a i m it i g a a i m a g amm m t a i i ma i g at a i
it a t i ma a a a t i ma ia i a mai tai i i g t m
i g i a t m i t a t t a t gt a a i t g at i a t m a a im m t
Right to information related to health and right of a beneficiary to know aboutthe treatment shall be ensured
i i a ma i i a t i ma a t i t a a i ma i a t ig t ia i t i m t i a a i ma a
mm i a mat ia t at ma i t i i t a a t a t a i t a i ag a g at
Mental health, oral, eye, ENT (ear, nose and throat) health services shall be developed and expanded
ima t atm t a i t g at i t a i a t i
a t i a a a it i i at a t i a a a t it a t i t a i i t a t i a a t i a g a
a a t i a t a t atm t ta i a a a a at a i i g a i a t t
a t at t atm t i a a a t a
a t m ta a t a ia i a t g ima ita m g t a g a i i i t i a ia t ai i g
t ia i a t i a a a a
Quality of health services provided by all health institutions including hospitals shall be ensured
t a it a t i a g at m a i m a ita t a ta i a at t a
i im m i ta a a t i t a a a DoHS, Annual Report 2075/76 (2018/19) iii a a a t i im m t a a am m t
i i a it ta a a ta a t atm t t atm t t a a am t i i a it a t i
a it t g g i i a t mat ia i i g a i m i i m i a i m t i gi a ag t a a t t m t i t i a at a im m t
i a a ma ag ia a it a t i t a a i t a t a it i a i t a a a it a t gt
a ta a ma ag m t a t i t at a ia a a a im m t
Good governance and improvement shall be ensured in policy-related, institutional and managerial structures in the health sector through timely amendments
a t g a a a im m t t ma a t i t a a t a ta a i
a m a i m a a t a g i a m ai t a gg ia i
i i i g a a am a im m t t it a t i i i g i i i a a i t
t g at m it i g a a a am a at a im m t t a t a t i a ma ag m t a t i t a
i a i g a ia a it a a a g a t t a t i i a a t i t
t a a a it a im ma ag m t a t i at a
i mm it t t a t i a ma ia i a m ig t a
In accordance with the concept of health across the lifecycle, health services around safe motherhood, child health, adolescence and reproductive health, adult and senior citizen shall be developed and expanded
a m t a a t i a ma g a it a a a a i
a t i ta g t t a ag g a mat a i a t a t i a t a t a t a t a t a g iat i a t a t gt a i a mi i a i g i a a
i DoHS, Annual Report 2075/76 (2018/19) a a a t i i ia t mi a t t at a t m a t ia g amm a im m t i i a it ta
t t gt a m t a a t i i t a a t a a a g i a a
i a ma a ita a a t a
a t i at it i it a g a a t t t tat
Necessary financial resources and special fund shall be arranged for sustainable development of the health sector
t g at a t a t at g a m at a im m t t ita a a t a t i t t t it a t a t m i i a ia i t a t t i a t ma
tat it a t a g a a i a a t it i i i a a
a a a t a t it a a a tai a i m it i t i a i t a t t a a a i a i t a a i i g amm a a
a im m g at m t a a a t a i i a t m g amm
mi t i m i t a a m t a t a m i i a t i it a it a i a i a
a i i t a t a a a g a ia m t a a ma gi a i mm i tat a a g m t a a m am t i t a t t a i i a i t g at a i a t m i i
Urbanisation, internal and external migration shall be managed and public health problems associated with such phenomena shall be resolved
m g a i i ma a a a t a a a m t t m at t a t g amm
t m t ami t a at a a i it t ita gi t a t m
t a a i t a mig a a a i a a ma ag a t mi imi t t m a i i a t a a t
i i a a a im m t t a t it i g i g ig m m t
Demographic statistics shall be managed, researched and analysed to link them with the policy decisions and programme designing DoHS, Annual Report 2075/76 (2018/19) a a a t i t a m g a i ata it ag i t i a at t g t a a t i t a ta g t a t g amm a ig ag i g
Ba t t a t a t i m g a i ata ma ag m t a a a a a t i it t i i ma i g a g amm ig i g
t a a i a a it i a i it t a t i i a i it i t t a m a i m a at a
i a a ma it ag i t ta i i i a t it i i at a t i
Antimicrobial resistance shall be reduced, one-door health policy shall be developed and expanded for the control and management of communicable diseases, environmental pollution such as air pollution, sound pollution and water pollution shall be scientifically regulated and controlled
t i a a g amm a a im m t i a t i it a t i t mi imi a t i m ta i i g ai at a mi a i a t
a a a a im m t t g at a t a a t a
t a mi ia i ta a a a a a im m t t g at a t t mi a i
Necessary arrangements shall be made to reduce the risks of immigration process on public health and to provide health protection to Nepalese staying abroad.
a a a g m t a ma t a t i a t a t t a t t m t a t a a t i
a m a i m a a a t m t a a t a a t i a a a
a t ami a ig a a t i g a a ma m
ig a a t a ag m t ma t m a a im m t t ma ag t mig a a t i ma
7. Institutional Arrangement
i g a a g m t a ma t im m ta t i a a a t i
i i a mai a a g i i g i t tat a a g m t t t i i i it i t i ma at a a t a i a i i DoHS, Annual Report 2075/76 (2018/19) a a a t i im m ta t i i t t t t a t i t i a tat a a a t a t at i t a i im i a m t i a g i i i a t t
t g a ta a g i i a t a a im m t a i i t i i
t a a a it a t gt a g a ta t a t a t t
i g t m i i i i t a t t a a am a t ma m i t at gi a
tat a a a a a t t i a t i a a a t i
tai a a t i i a a a im m t
8. Financial Resources
m t g t a at a tat a a ig a a g a t i tm t m i at a g m ta t a t a ia t im m t t i i
9. Monitoring and Evaluation
iat m a i m a ma ag a i t g a m it a a at t a t g amm im m t at a i t tat
t a m it i g a a a am a t a a a i g mmi i a t m it i g a a a t m t i i t a ai a a mi i t a a ta i t a t i i g a m it i g a a a t m t i i
a t ma ag m t i ma t m a at m it i g a a a t m a ma a i a g a it t t i t m
10. Risks
t g t i a a a t i a m at a t t t at g a a t a i a t i a i a a am ta ig t a t i a g amm t m t a t at i i ita a t a it a t i t g t a t t a ai a i it a at g t ma i t i t im m ta t i i a t at gi
a t i ma a t t m i a iat it t m t a t i a t t ga i a a m a t ma ag m t a t ma
11. Repeal and Saving
a a a t i a a i g t m i i i a t t a a t ma t at gi a m at DoHS, Annual Report 2075/76 (2018/19) ii Su ar o epal Healt Se tor Strate 2015 2020 Su ar of Nepal Health Sector Strateg 2015 2020
t a i a a a t i a a t t t at g i t ima i t m t t g i t a t t t t a t a t t i i a mi i t t t a a a t i a a i t t t a i i t g a a t a t a i a t i a a am ta ig t i t a at a mmitm t t a a i i g i a a t ag a i t a i ga i g i a i tm t a a t at t t a i mi m t t g i t a t t i a i i g g m t i i t g a at a m a t t t i m i g t
i it i t t t t i a a it a t i a a t a t m t i a a i t t g m t a it m t a t B t t g m t a m t a t mmit t a ig t i t t i i a a i t a ta t a i t t a a m t a a a t a ia t mi a t a t t a t t a a a ma ta g im i g t a a t t m t i B t t i a a im i m ta it a i a t m ta it imi a a a a t mat a m ta it t t i a i g t i i i i t a a i a a i i at imi a tag i a t a ma t a t a t t t i a ma a ia m a a g a ma i i g ata m ta it a ma t i
it t i g t t a ma a t a g i i g i it a i t a a ia i t a g g a i a a i t a a i i a i g a t i it t t g i a it t m a a ma gi a i i i t i a t t i a t a i g t g m t a i t ia g amm a i a a t a g amm a a i i m t i it i a t t a t a t g m t a m a i im i g a t a t a i a i g a t a i i a t gt i g mm it a i t t i a t a t a i a im i g t a it a t a mai a ma a g a i a a t i i g t a i a i a i a i g a g i i g i a a at a i a t i a t m i t a t a g i mm i a i a t m t i a g i g a mm i a i a a a i a i g t at at a i a t t imat a g i i t a i a i g m at a i i t a a i t
a ta g a t a i a t a t i a t a i i i g a t t a mai t a t a t a i i i a t a g i a a t g t m g a a ma ag m t t t t i i m t a a ma t a g t a t t m a a m gi g a t a g i a t t i g i i it t a i t t t a i i t t a ita i t i a t a i i it t g g a a a a t m t at tai m t a t t m t t gt i g t im t a t t m t i
DoHS, Annual Report 2075/76 (2018/19) Su ar o epal Healt Se tor Strate 2015 2020 tai t a i m t ma i t a t t a a t a m a g
ta t at gi i i ita a t a t i a it a t i a t t m m t a a a
t t at gi i i i i ita i i a t gt i g i i a ma g a t a i i g t a a g at a t i it a i t a mm it g t m m m t t a a a g a i i t i t im i g t a it a at i t i i a a t a a a t i a a t m a ita i ta i i g i a it a a a t i i i a i at t m a i t gt i g a a m g t i t a a i t ag m t gi a t i ma ma ag m t i a a t a t i ma ag m t m t a ai a m a i t t a t a i i
t gt t a i a a i g a g g i i t im m ta t a a am t gt i g a a t a i a a a tat a tat a t i i i g m t a ia a t i t t i a i at t t t am m aim t t gt i t a a a it t g at i a i at a t t m
g i t im ta m t a a t a ia t mi a t a t i t t i t t a i g i a t a g i g a g m m a i m i t a i a g m t a a a t t a m g a t i t a a t i m t t g m t a a i i g i i g g a a ta g i t t m t a t i t agi g a t a i i a a a i g i m t a t i t a a i ta i g ma t i a m g t m a t i g t i i g at a i i t g a t a a i t a m g a t i m t i i g t imat a g at a t i
t i t a t g a t im a t tat a t g a ta a ita a t i i t m at t i g i t m t a i t i g a
i t a t gt a t t m a t t ma ag m t m t a ai ma ag m t m a it a at i t i ita i a a t a i t gt t a i a i g a g g m t ma ag m t a g a m tai a i it a t t a i g m a t i t a i m t t gt ma ag m t i a t m g i
DoHS, Annual Report 2075/76 (2018/19) Su ar o epal Healt Se tor Strate 2015 2020 m a ai a i it a i i i i ma i g at a t m t a a t t a i i a a g m t t a Ba i a t i i i i a g t t i a t Ba i a t a ag i t at a t a i a t a ag a i t g i t ia a t t a a g m t i i g a t i a
g m t i a t a ia a i t ga t im m t t i t at g m t a i g i t t im m ta t i t at g m it i t a i a t t a t g m t i a i t t i i Ba i a t i m g m t i i a g i t m t a i t a i a m i i t a t ga
m m ta a a t a a a B g t B i t a at t i t a i a t im m ta m it i g a a a t i t at g it a i a i mi i t i m t a t g m ta ag i i i i t i at t a a a mm i t am i t a i t m it t t ma t g a a i a a i m i
DoHS, Annual Report 2075/76 (2018/19) t INTRODUCTION Chapter 1 Chapter
1.1 Background
t a a a m a t a am ta ig t t i t i t t a at i i a t a i ma a t a t a a a t a t a a a t a i i g at a a ita t m it a m a i ig t t i ma a ma i i t t i i t t t i a t i a i i m t at a tm t mit a a t i it t t a a a t a tm t a t i a i t i a t a a i i t t t it i a it i t t i a t a t t i g i i t a t a a
i t ma i a t t t t i i g a a g amm i tat m t i i g g a t at gi ma a i a a i m t g amm i i at m i t ai t a mm a im i g ma a a i i g ta g t
i t a i i ma t t i t a tm t a a t a i i a tm t g mi i t a t a t i a t a ta t m a i i t a t t a a t g ma g amm im m t a t i t at i i ia a t a a t a i i
i t i a i a t t t a a a i t at a at B B a ta i t i t m a g i t t t m a a i m t mi i t a tm t a t i t at i i i t a t a ita a ta t a m t a t a g m ta ga i a a
a i a t i t i tat m t a g amm a a a ata g at t t g at a t a ag m t ma t m a m t t i i at ata i t t i g t t i a g am ta a a i i
The objectives of National Annual Review Workshop were:
i t i t a a g a a t t t at g a a ta a a ta i g g i t t t t at gi i it a a t at t a t t gt a t t m i t a gi g t t g t t at gi a t i i t t a a a a B g t B
DoHS, Annual Report 2075/76 (2018/19) 1 . ent t e trate pr or t area t at nee to e a re e to tren t en ealt te n t e an n onte t
. A ree on t e trate a t on to e n lu e n t e ne t ear Annual or lan an u et (A )
e oH pro e u an e to DoHS a ell a pro n al an lo al le el o ern ent to el er pro ot onal, pre ent e, a no t , urat e, an pall at e ealt are er e an arr e out relate pol , plann t n , u an re our e, nan al ana e ent an on tor n an e aluat on un t on n ne l re i g i a t a a i ia a a g m t t i tru ture oH or an ra , t a e on e ol , lann n on tor n D on t eHealt m a oor nat on D iag on t a e ual a t a ia A uran a t e a Re i ulat on a D a i on t t e opulat on at i a i g ma a ia ma ag m t a m it i g a a a ana e ent D on an t t t e A n trat ga on g am D it on a n a i i i t on, t e i pro a i g e onal oun l epal e al it i g i i i t a t i a i i i t a it a g a i i i oun l, epal ur n oun l, epal A ur e e al oun l, epal Healt ro e onal t a a ag m t i i i a t mi i t a i i i a i t i oun l, i a epal ar i a a oun i a l an i epal Healt a i g Re ear i oun a l) i a re t i a ealt relate ool an tra n i a a t i a i a a ma i a a a t a n entre an re ulate are pro er i a it a t at a t ai i g t a g at a i Depart ent o Healt Ser e (DoHS), t e Depart ent o A ur e a an Alternat e e ne (DoAA) an t e a tm t Depart ent a t o Dru i A n trat t on a tm t (DDA) o e a un er a oH t a e e i i t ree epart ent are a t a tm t g mi i t a m t re pon a tm t a i m a g a im m g g amm t a ia le or or ulat n an ple ent n pro ra e , t e u e o nan al re our e an a ounta a a ta i it a m it i g a a a i t g at a t it l t , an on tor n an e aluat on DDA t e re ulator aut or t or a ur n t e ual t an re a i g t a it a g a g t im t t a a i t i g ulat n t e port, e port, pro u t on, ale an tr ut on o ru e Depart ent o A ur e a an a tm t Alternat a e e a ne t a re pon i i le to i are i t A t ur a e it i er e an ple ent i a im m t a t m a a i ig ealt pro ot onal a t t e ( ure1 1) Figure 1.1Figure Organogra 1.1 Organogram of Mini of Ministry tr of of Health Health and and Population Population (MoHP) MoHP
DoHS, Annual Report 2075/76 (2018/19) . ent t e trate pr or t area t at nee to e a re e to tren t en ealt te n t e an n onte t
. A ree on t e trate a t on to e n lu e n t e ne t ear Annual or lan an u et (A )
e oH pro e u an e to DoHS a ell a pro n al an lo al le el o ern ent to el er pro ot onal, pre ent e, a no t , urat e, an pall at e ealt are er e an arr e out relate pol , plann n , u an re our e, nan al ana e ent an on tor n an e aluat on un t on n t ne l re tru ture oH or an ra , t a e on e ol , lann n on tor n D on 1.2 Department of Health Services (DoHS) t eHealt oor nat on D on t e ual t A uran e Re ulat on D on t e opulat on i g t t t t t ga g am ig a i a t t m ana e ent D on an t e A n trat on D on n a t on, t e pro e onal oun l epal a t i g t t at a a g a t m i a a ia e al oun l, epal ur n oun l, epal A ur e e al oun l, epal Healt ro e onal ma ag m t a a a t a ma a mm i a t a a a t ai i g t a a t a t oun l, epal ar a oun l an epal Healt Re ear oun l) a re t ealt relate ool a a i t a a i a t a at an tra n n entre an re ulate are pro er i at a t ai i g g amm t i i i a im m t t ai i g a i g mm i t a i g t t a i g m a i i ma a a Depart ent o Healt Ser e (DoHS), t e Depart ent o A ur e a an Alternat e e ne (DoAA) mm i a a a i a g mm i a B a i a i at t t t i a a t a i a i an t e Depart ent o Dru A n trat on (DDA) o e un er oH e e t ree epart ent are i a it t i i i re pon le or or ulat n an ple ent n pro ra e , t e u e o nan al re our e an a ounta l t , an on tor n an e aluat on DDA t e re ulator aut or t or a ur n t e ual t i i i i g m iag a a a t an re ulat n t e port, e port, pro u t on, ale an tr ut on o ru e Depart ent o i i t g a i t ga i a a a a i i i ma i i i t i i i a mma i i a a ig A ur e a an Alternat e e ne re pon le to are t A ur e er e an ple ent ealt pro ot onal a t t e ( ure1 1) Table 1.1: Summary responsibilities area of DoHS s five divisions
Figure 1.1 Organogra of Mini tr of Health and Population MoHP Division Areas of responsibility t g at a t ma a ag m t 1 a ag m t i i i a t t m t i m ta a t a gi a ag m t
a g amm mm i a t i a t g at a ag m t i ami a i i i a a a t a i i g a t a ata a t a ami a i g
t a a ag m t t i mi a mi a mi i a g t i a i a t B i a a t i mi g a i a mm i a i a mm i a i a t i i i ta a t t i a i it i a a a i g a g t m at a it a a a i
ita i m it i g a t gt i g a i i i i i i g m g a a i a t a a a t
i g a ia it a a it i i g i g i a ia it i i i iat i a g a i
DoHS, Annual Report 2075/76 (2018/19) t Figure 1.2: Organogra of the Depart ent of Health Ser ice DoHS Figure 1.2: Organogra of the Depart ent of Health Ser ice DoHS
Figure 1.3: Organogra of the health te at pro ince e el Figure 1.3: Organogra of the health te at pro ince e el
DoHS, Annual Report 2075/76 (2018/19) t DoHS s main functions are as follows:
i t m t a m a g a t at i i a i g a a i g a t i t i i it t i i t mi t i ma a t i t a i g t m a i g a im m g t a g t m a a ag t m t a g i m t i t m t a t gi at gi a i t i t a i at a i a m i i t im m ta a g amm a ag t imm iat m a i i g m at a i a t a i mi ta i a it ig t i a i t a a i t t a a a t i a a i t i i i g a m i i i g ig i i g a a a ag t i at t a g m t a ig i t t a i at i a t i mai tai a a i a a t t a it a t i g a i i a m it i g a ag m i a a t atm t i a a a t i a im a i i a a i i i a i i a ai a i a a miaa i ia i i a a t a i atm t im i i a ag i ma t m at t a t a i i a t i gi t ai i g a a t t t a i g m it i g a a a a t g amm ai tai ata tat m t a i ma a t i at i a a t a ia ma ag m t a t m t i g a i
i ia a t i t at i t i a a t i g a g amm m it i g t i t i t a t t m a m i t i i t ia m t i gi a gi a a ita a i t i t ita a a t at g i i t t ita ima a a a a a t ai i g t a at i B t a m i a t at t i ia
t m a i t a i t ta i a t i i t i t i a i ia a t i t at ima a t a t a a t g a i t ima ita i i a a t it a t t a t at a i t a g t t t a i mm it a t it a a a t i i a i g a i
a t t a t t i t a ta t i t a i a t i t a t a i i m it t a i ma mm it a t t a t mm it a a i ima a t a t a i i a a g amm mm i a i i a i t a t a t a a mm it a a i a a i i a a t a t t i a a i t i a t m t ima a a ita a a t t a ita i i a i ig t t at m t t a a i i a t a mi t atm t i a i a t t m a a g m a i m i i g gi a a ia m it i a t i a t m t t t t i
DoHS, Annual Report 2075/76 (2018/19) t 1.3 Sources of Information and Data Analysis
t g at a t ma a ag m t t m i t mai i ma t i t t a i ma m t ma ag m t i ma t m i a i a t m ita gi t a g a i a m t a a mai a t t i t t gi a ag m t ma t m t i a ia a ag m t ma t m t a t a t t ma t m t a i g a a ag m t t i a t a t m t ma ma t m t ai i g ma a ag m t t m t a g t m a t g ma t
ata a a m t a a a a a ai t i i i a t i a i g g mat a i a a a t a a t
1.4 Structure of the Report
i t a a t a t t a g t a a t a a t t t a i ma a a t t a t g agai t a a t t t at g a t t t a tm t a g a t t i t a t a at a t g amm a t t t g amm t a t t i a t t t g a a a t i a i a t gi tai t a t t t a m t a t a t i i t a t t a it t ata i a t a t m t g at a t ma a ag m t t m ata t a t g t m i a t i a t m a a a a i i ta t ata i t t i t t i m a
Annex 1 t t ta g t a i m t a a g amm ma a i i gi t ma g amm ta g t t t a a t t at a t i t a t a a a a a ata a t i at i t i t ma it a a a t t t i i a ata a m i i a i a a i t it g
DoHS, Annual Report 2075/76 (2018/19) g gai t PROGRESS AGAINST Chapter 2 Chapter 2 NHSS i m i t a a t t t at g a a i t i a g i t ta t t g i a t i a i g m t i i t a t a a PROGRESS i AGAINST a NHSS t a apter i i a t a t t i i i g t i g t e er Re e ( R) o t e epal Healt Se tor Strate ( HSS) a arr e out n 2018/19 i a at a a i i a m a i at t i ia a a a a roup o n epen ent on ultant un er t e u an e o t e e n al or n roup ( ) i a a a it a i a a ia a i m ta m a t m t or e t e n tr o Healt an opulat on ( oH ) e re e a e e t e rele an e, e en , e e t ene o HSS n relat on to ealt e tor pr or t e u n t e ollo n tool r t al at a Anal ( A) ol t al ono Anal ( A) at t e ro n al an o al le el a Major r Findings t al apa t Anal ( A) an a So al an n ron ental pa t A e ent (S A)
Ma or Finding a i g a ga i a i g t t t m a a mma i a or n n are or an e a or n to t e HSS out o e an are u ar e elo
S ut o e ro re ap an r or t e 1 Re u l an Stren t en Healt S te • epal Healt n ra tru ture • n t tut onal tru ture • n ra tru ture Stan ar a een e elope an un t on n e eral • Hu an Re our e or Healt • repar n Hu an Re our e or onte t to e urt er • ro ure ent an Suppl a n Healt Strate Roa ap lar e ana e ent • Dra te Stan ar n • e el o a entee n o u ent o t e ealt e tor ealt are pro er to pro ure ent e a re e • Dela on pro ure ent to e a re e 2 • pro e ual t o are at • repare epal u l Healt • Role et een ual t po nt o er e el er A t o ernan e tru ture • repare Sa e ot er oo an ar ou autono ou an Repro u t e Healt R t ent t e to e lar e A t • ra t e o anal n • Dra te at onal a t on plan rout ne ata to ea ure or ant ro al re tan e ual t o are to e an t e ru pol 207 n t tut onal e • Report n l n a e et een erent le el o o ern ent tru ture to e tren t ene • u ta le tr ut on an • Healt are ut l at on a on • Ser e ro on n ut l at on o t e ealt t e poore t u nt le a een re ote area to e er e pro e ( ae arean e pan e Se t on rate) • Al n ent et een • A e to rea ealt a l t ealt n uran e an a een pro e ( to e ree ealt are pro ra to rea ealt a l t ) to e tren t ene • Dratte t e a Healt are • e le te ealt a a e pro le (e a l t , • u n or el ne e t or e at onal • A ental trate ealt on ealt er e , • Strate n or e on ten rea ear n a t on e plan a e ole u t ent a e e on ual lo an al unrea on D a e l t pre ent on an repro onte tu to t e e ealt ) to • re n a or l e tat re on ote(207 area 208 ) tren e t l ene te • Stren t en n De entral e • n an e apa t o u et • lann n an u et n lann n an u et n an u et n a per ne n t tut onal • De elope lann n an tru ture to e re e e u et n u el ne an up ate • ple ente u et plann n • on t onal rant nee a per lo al o ern ent to o er pr or t operat on a t pro ra at nee • ra t e plann n an • en e a e plann n u et n a e on e eral an u et n oul e onte t tren t ene n all t ree p ere o ern ent 5 • Se tor ana e ent an • De elope erent ealt • A ounta l t o lo al o ernan e e tor u el ne le el to pro n e nee • Role o pro n e an lo al to e lar e an le el e n urt er e ne tren t ene DoHS, Annual Report 2075/76 (2018/19) an lar e t rou pra t e • ot at on o t e ealt an o un at on are pro er to e a nta ne • na le all ealt a l t e to pro e a ealt er e • o el le lature/re ulator ra e or or pro n e an lo al le el to e e elope an pra t e • r ate e tor re ular t ra e or to e n t tut onal e • ne ealt trate a on n tr o Healt an opulat on ( oH ) an A r ulture an l e to e elop ent ore t an en ron ent to e or al e 6 • pro e u ta na l t o • n rea e o ern ent ealt • pe t n e pen ture ealt are nan n e pen ture on ealt to a e e • n rea e per ap ta ealt un er al a e to e pen ture pr ar ealt are • pan e ealt n uran e er e pro ra • Strate e to re u e out o po et e pen ture to e tren t ene • Healt nan n trate
u el ne or • A trate on ealt • n or e ten ear a t on plan e u t a e on lo al on D a l t pre ent on an onte t to e re a l tat on (207 208 ) tren t ene • Stren t en n De entral e • n an e apa t o u et • lann n an u et n lann n an u et n an u et n a per ne n t tut onal • De elope lann n an tru ture to e re e e u et n u el ne an up ate • ple ente u et plann n • on t onal rant nee a per lo al o ern ent to o er pr or t operat on a t pro ra at nee • ra t e plann n an • en e a e plann n u et n a e on e eral an u et n oul e onte t tren t ene n all t ree p ere o ern ent g gai t 5 • Se tor ana e ent an • De elope erent ealt • A ounta l t o lo al o ernan e e tor u el ne le el to pro n e nee • Role o pro n e an lo al to e lar e an le el e n urt er e ne tren t ene an lar e t rou pra t e • ot at on o t e ealt an o un at on are pro er to e a nta ne • na le all ealt a l t e to pro e a ealt er e • o el le lature/re ulator ra e or or pro n e an lo al le el to e e elope an pra t e • r ate e tor re ular t ra e or to e n t tut onal e • ne ealt trate a on n tr o Healt an opulat on ( oH ) an A r ulture an l e to e elop ent ore t an en ron ent to e or al e 6 • pro e u ta na l t o • n rea e o ern ent ealt • pe t n e pen ture ealt are nan n e pen ture on ealt to a e e • n rea e per ap ta ealt un er al a e to e pen ture pr ar ealt are • pan e ealt n uran e er e pro ra • Strate e to re u e out o po et e pen ture to e tren t ene • Healt nan n trate to e e elope • Healt n uran e
pro ra oul o u to poor an pro e annual rene al 7 • pro e ealt l e t le an • n or e an p lote a a e • ult lateral oor nat on en ron ent o ent al on an olla orat on to e o un a le D ea e tren t ene proto ol • ult Se toral a t on • Re e ental Healt ol plan or pre ent on an • n or e at onal Healt ontrol o non A aptat on lan (H A ) on o un a le ea e to l ate an e e e elope an ple ente • ental Healt ue to e pr or t e all le el • Ser e pro on on non o un a le ea e to e e pan e • So al o l at on an e a or an e o un at on a t t e to pro e l e t le to e pro e 8 • Stren t ene ana e ent o • at onal proto ol an • u el ne e elop ent u l Healt er en e u el ne or e er en an allo at on o tuat on a een e elope re our e or ealt • ta l e partner p t e er en e t0o e non o ern ental an pr or t e e toral a en e or • n t tut onal e t e e er en ana e ent pro re a e on pu l • ple entat on o epal ealt e er en e at onal A aptat on lan o • apa t u l n an A t on( A A) or l ate o l at on o u an an e n u e a ter re our e to a re pa t o ealt DoHS, Annual Reporte er 2075/76 en e (2018/19) 9 • pro e a a la l t o t e • De elope nat onal e ealt • e ealt n t at e at t e an u e o e en e n trate all le el to e e on a n pro e at all • un t onal e an up ate e elope , tan ar e le el t e DH S 2 plat or or H S an n t tut onal e report n • entral ata • ta l e r e an e repo t onar to e ana e ent te operat onal e • on u te ult ple anal t al • e t e ple entat on tu e at onal Healt an u el ne an tool A ount n ( HA 2018), epal at all le el o Healt a l t Sur e ( H S) o ern ent to e 2015, epal De o rap pro ote Healt Sur e 2016, epal at onal ronutr ent ur e
to e e elope • Healt n uran e pro ra oul o u to poor an pro e annual rene al 7 • pro e ealt l e t le an • n or e an p lote a a e • ult lateral oor nat on en ron ent o ent al on an olla orat on to e o un a le D ea e tren t ene proto ol • ult Se toral a t on • Re e ental Healt ol plan or pre ent on an • n or e at onal Healt ontrol o non A aptat on lan (H A ) on o un a le ea e to l ate an e e e elope an ple ente • ental Healt ue to e pr or t e all le el • Ser e pro on on non o un a le ea e to e e pan e • So al o l at on an e a or an e o un at on a t t e to pro e l e t le to e pro e 8 • Stren t ene ana e ent o • at onal proto ol an • u el ne e elop ent u l Healt er en e u el ne or e er en an allo at on o tuat on a een e elope re our e or ealt • ta l e partner p t e er en e t0o e non o ern ental an pr or t e e toral a en e or • n t tut onal e t e e er en ana e ent pro re a e on pu l • ple entat on o epal ealt e er en e at onal A aptat on lan o • g gai t apa t u l n an A t on( A A) or l ate o l at on o u an an e n u e a ter re our e to a re pa t o ealt e er en e 9 • pro e a a la l t o t e • De elope nat onal e ealt • e ealt n t at e at t e an u e o e en e n trate all le el to e e on a n pro e at all • un t onal e an up ate e elope , tan ar e le el t e DH S 2 plat or or H S an n t tut onal e report n • entral ata • ta l e r e an e repo t onar to e ana e ent te operat onal e • on u te ult ple anal t al • e t e ple entat on tu e at onal Healt an u el ne an tool A ount n ( HA 2018), epal at all le el o Healt a l t Sur e ( H S) o ern ent to e 2015, epal De o rap pro ote Healt Sur e 2016, epal at onal ronutr ent ur e Key recommendations of the Mid Term Review
gi a g at am i g a ta i i a g m t t t gt a g at t i mi a a a a ai i g t am a i i i a a g m t t a i a am g i mi i t i t t gt a m t a a m g m t t ta i ita i t i i g a m a t i a i a a g m t a t it a t a a at t a t i i at a g m t a i i t i ita i a a it i i g i a it a a i g i g g a ata g amma t t gt m a ai a i it a a t t ata i a ai a i g t it t a t m t m a a a i a a i g a g g t t ai i g a a a it m t i t ma g g a ma ag m t t m i a iat m t mi a ia i t i a a a t a t t t at g i a a t t a t a t at g a t m a i ia t at gi a a t m t i m t a t i ia t a
Overview of progress against NHSS results framework
at t g agai t a i i at t t am i a ai a t it m g i a a i a a t m i a a a a i i i at a g i t i t t at t i t t a i i g t t t a t m
a t t g a i i at it t i a i ata a a i m t agai t t mi t a t ta g t
DoHS, Annual Report 2075/76 (2018/19) g gai t
Target
2020 21
Re u e 20 28 17 5 2 1 1 17 1 5 6,7 8,95 125 12
Source SS H DHS DHS DHS SS epal ol e epal ol e D Stu SS
Year
2019 2016 2016 2016 2016 2018 2018 2016 2016 Mile 2018 tone 19
Data
A 186 9 21 2 5 1 5 9 5 19 9 015, 20
Source SS DHS epal ol e DHS epal ol e DHS SS D Stu SS DHS
Year
2016 2016 2016 2016 2016 2016 2016 2016 2016 Mile 2017 tone 18
Data
A 2 9 17 8 21 1 5 9 015, 20 7 1 5 2 9
2016 17
Mile tone
20 2 2 15 21 1 2 7, 87,726 1 8
Source SS S S epal ol e S S epal ol e oD, H H S
Year Ba eline 2011 201 201 201 201 2011 201 201 201 201
Data
8 A 16 5 2 2 18 2 8, 19,695 190 7
Green: 100%; Yellow: >50%; Red: Green: Red: Yellow:<50% >50%; 100%; 9 -
5 ear
Indicator o un a le po e et pen ture n aternal (per 100,000 l ortal t e rat o rt ) n er (per 1,000 l e e rt ortal t ) rate o l are o un ren tunte er n en o e po er ent ue to out o ealt eonatal l 1,000 ortal t e rate (per rt otal ert l ) per t 1,000 ( rate o rt 19 en a ear e ) 15 o ear o le en a e t t 15 an 18 5 o e a lo t a ue to roa populat on ent tra n 100,000 per e Su populat 100,000 per rate e on D a lo l t t a ue to o u te aternal an non l neonatal, un e ear a le, ea e an , n ur e
Code 1 2 5 6 7 8 9 10 Refer to full NHSS Results Framework for meansverification of the of targets and required data disaggregation *Achievement target against
DoHS, Annual Report 2075/76 (2018/19) g t a tm t PROGRESS OF OTHER
Chapter 3 Chapter DEPARTMENTS UNDER MoHP 3.1 Department of Drug Administration
3.1.1 BACKGROUND
m t a a m gat t g t t i it t mi a m i i a a i a ma a mat ia a a t a mi a i g i ma a g t a a m i i a t g at a t t ma g i t i t im t t ag a i a t m i i i a t a t t a i a ta a a it
im m t a t aim g t a a i g a it m t a ta i a tm t g mi i t a i
a a it t t a a a t i t a a g i a m at a im m t t ta i i g i a am g g m t g m t a i at ga i a i i t a i at t m i i im t t t ag a i t i a it a m t g at t a a a i ma i i g t aim a a a g i i a t im ta t a a
t g t t i g g a a a im m t a g t t a m t g t
g ta i a g i mmi B g gi t a B g ta a B i a B a a i t i g B g B
g a g i i a im m t t a it a a at m i i
3.1.2 OBJECTIVES
mai i t g at a a g m t i a a t a i a m i i i mi a a m i i a it a mat ia t t a a mi a i g a m t a ma a ai a a a i a a it m i i t t g a i t i g t ma g i t i a t im t t ag a m i i
3.1.3 STRATEGIES
a m i i t m t a a m i i ta i m t gi a at a gi t a i a
DoHS, Annual Report 2075/76 (2018/19) 11 g t a tm t t gt i g a a i i a at a a a a at m i i i i gi t a a i a t m a a m i i m t a i t g i ma t m t i mi at t a t i ma ag m t t m t a ta i a ma a i t i t a i ia i t a m i i i t t a it ma t m i i t mi a i t m at a mi ia i ta
3.1.4 FUNCTIONS OF DIVISION AND BRANCH OFFICES OF DEPARTMENT OF DRUG ADMINISTRATION
Drug Evaluation and Registration Division
Medicine and Biological Evaluation Section i a a m i i a a i t ma a t i g im t t a ma g i a a a i a i gi a ma a t i g t im t a ma g a a m t m i i a i i a t ia i at it t at t t a a m i i i mi i a a m t a i i a t ia
Import Section a ig ma a t im ta m i i gi t t t a im t a a a i t mm a im t t m i i t mm a im t t gi t a i a i gi a t a im t a a a i t mm a im t t a i a i gi a
Industry Section i mm a t ta i m t a ma a i t a i t a a t i g i a t m a a t a ma a i t gi t t a i ma g mi i t a a i t i mm a t im t a mat ia a t m gi t a i gi t a at t tai a a ma t t a t m a at a t i t a m i i at t a ma i a a a ia i t i
Planning, Co-ordination and Management Division
Training and Drug Information Section t t t ai i g t m i i i mi at i ma a t m i i a a i t t ai i a g i t a a t ag i a t a i ma ga i g m i i i g B a B a i t i t t a t i t i t i m i a t a t a ma i t a t a i t DoHS, Annual Report 2075/76 (2018/19) g t a tm t i a a i t a i i a a a a m a i i a mm im t a t i ta a iai it t a a a t B a t a i at t a ma igi a a g it i g g ag m t a g a m t t i g
Planning and Coordination section ga i a m t a i g g g ig ai t a a i ia g m t i a a ig i a a a a i g a i t a gi a i at it i i t t a tm t a t g m t a g m t ga i a g a i a mit t t t t a a a m t a t a a t
Pharmacovigilance section t ma g i a t i i a a i t a t a a a a a ma igi a t a i at a a at it gi a t a a a g t i t a a g it i g a a it i g t a i itat t i m t a ig g a a
Financial/Administration section t a i at a ag m t ma itm t g m t a t ma a a m a mai tai a m m m t at a i it i g a a a i a gi a a i a ag m t mi i i g a a i a t a a ia ma ag m t a a it a a a g t it m t a it ma ag m t i a ia i g a i ma ag m t B
Inspection, Evaluation and Law Enforcement Division
a ga a a mi i t a a a m ia a t i i g t a it g a g at a a i t i t i a a g i at a a t i g a it it i a t i t t
Inspection and Evaluation Section t im m ta g a t a t g a g t t g i t i a tai a ita a ma i g a a i i at i a a a a a a ta a i g t a a ma i t a a a ta g t i a a a i t i i a a a a i
DoHS, Annual Report 2075/76 (2018/19) 1 g t a tm t Law Enforcement Section a a m t gi t i g t a t agai t g t i t ga a t t a tm t ai i g t g t ga a a i g i a ga a t at t a ma a i t t am m t g a t g a a i i
GMP Audit and Certification Section m a a a at a i a ma a i t a a i at it gi a at i a a ig i t it i a a m ia
Branch Offices:
a it a at Bi at aga Bi g a a g a t t i i it i a a a ma gi t a a a
3.1.5 National Medicines Laboratory (NML)
a a i i a at i t i i a m t a t g a a a i g t a a i i mi a a a i mi i g a ma g a i t m ta a a i mai a t
t a a a t a it m i i a m a i g t t g t t a at a i t t ai i g a at a it a at i a a ma a i t i
3.1.6 ANALYSIS OF ACHIEVEMENTS BY MAJOR ACTIVITIES
Activities carried out in FY 2075/76 (2018-2019)
Major activities
a t a a m i i i t m ia g a i a g B a B it i m g i t i a a t i g a m ia tai a a ma i m ia t ma g a it a a i g a ai a i ma t ig a a t gi t a t g ami a t i a g t ai i g it m ma a t a at m ia a at a a ga a a mi i t a a i a g at ta a a m i i m ma t t ai t a it ta a
DoHS, Annual Report 2075/76 (2018/19) 5 o t ar et n ual t anal o ru a a la le n ar et 6 n pe t on o ore n anu a turer e ore re trat on o pro u t 7 on u t n e a nat on o eter nar ru eller tra n n 8 Au t o o e t anu a turer la orator or o pl an e o oo a orator ra t e ( ) 9 a e le al an a n trat e a t on or olat on o re ulator tan ar 10 Re all o e ne ro ar et t o e a le to ual t tan ar g t a tm t a le 1 ar et A e e ent, 2075/76 a a g t i m t S. Acti itie Unit Target Achie e ent N Nu i m t . 1 Dru i n or at on to t e pu l erent e a it u a g t 0 m 2 1 0 21 g i ma t t i i t m ia u l at on o Dru ullet n m 100 o epal 3 i a g B a on u t n e a nat on o eter nar ru eller tra n n 2 2 100 4 n pe t on o o e t 87 87 100 g ami a t i a g t ai i g ar a eut al n u tr e 5 m a ma a t i n pe t on to ru reta ler ole aler 291 0 117 6 Dru a ple Anal 1000 1018 102 t g tai a 7 Au t o ar a eut al 0 0 100 Anal g am a i t al a orator e 8 n pe t on o ore n e 5 5 100 it a ma a a a a at i o pan e ig m a i im
Table 2: Other acti itie S. N Acti itie Achie e ent 1 Re trat on o ne ore n p ar a eut al n u tr 9 2 Re trat on o ne e ne ( port) 2 Rene o port l en e 590 ue o ar et n l en e 787 5 ue o pro u t l en e 1 66 6 port l en e or ra ater al or o e t n u tr 1 21 7 Re trat on o ne p ar a 89 8 Rene o p ar a 571 9 Rene o pro e onal l en e 575 10 Dere trat on o p ar a 6 11 Re all o e ne ro ar et ue to n er or ual t 21 12 ra n n on S 17025 ert at on 1 1 Anal t al et o al at on or non p ar a opoe al pro u t 1 ntera t on pro ra t ta e ol er 5 15 ra n n on A/ D 2 16 De elop ent o S or ar a o llan e 1 17 Se nar on Rat onal e o e ne n erent ro n e 18 ra n n on le al pro e ure or Dru n pe tor 1
a le nan al allo at on an pen ture u et n t ou an (000) S u et ea n u et allo at on u et e pen ture 1 ap tal u et 7,25,00,000 00 ,68,15,221 01 6 57 2 Re urrent u et 9,57,96,8 9 50 7,28, ,2 5 25 76 0 otal 16,82,96,8 9 50 11,96,59, 66 26 71 10
1 7 Re enue enerate R otal re enue olle t on 8105599 9
1 8 allen e . r an at onal Stru ture or e eral, pro n al an lo al o ern ent . a n e an (le al an or an at onal or re ulat on o H ) DoHS, Annual Report 2075/76 (2018/19) . n or at on ana e ent , ran paren an la n o na an Re pon e n or at on te . lle al port o e ne ue to open or er an , S re ulat on an ontrol . a n o re our e ( u an, e nolo ) . Re onal ar on at on an un or t , RH an SRA olla orat on . ar a o lan e ,po t ar et n ur e llan e . oo o ernan e an a ounta l t . e ne S orta e ue . a o or an at on tru ture or pr e on tor n
g t a tm t 3.1.7 Revenue generated : NRs
ta
3.1.8 Challenges
ga i a a t t a i ia a a g m t a i g m a i m ga a ga i a a g a ma a ag m t a a a a i g ami a i ma t m ga im t m i i t a g a a t a i g ma g gi a a m i a a i mit a a a a ma igi a t ma g i a g a a a ta i it i i tag i a ga i a t t i m it i g
DoHS, Annual Report 2075/76 (2018/19) g t a tm t 3.2 Department of Ayurveda and Alternative Medicine
3.2.1 Background
a tm t a a t a i i ima i ma ag t i a t a i i i a m t a t i t t g it t a i i a a t t a tm t a t a i i t t a tm t t i i t a t a i i g ammi g ma ag m t i ma a i i m it i g a a a t a i g am
a i a a i t m i a t m a i ig t a it t i m i i a m i i a mi a a a ima t t m t g im a t a m a a g it m a a a i ita a t a a t i a i g i t g t a a ita a i i ia ita a g a a i a i i t i t a a t t a a i a i a t t a a t a i i it i t i i t a t a i i m a g i i a g i i a a t t a i a m i a t m
a i a a a i t a a i i a ig ig t t im ta a i i ima a t a a t a a a t t a m t a i a a m i i a g it at at a m at a a a t i a a a i i i a a t a a a a t i a a a a a t i
i a g m t a a g i a m t a i a at at m at t a t a m i i i a it a t t a m t ita i a m a a ai a m i i a mi a a ima igi m i i a ag m t g a t a t a m i i a ta a m ta i m t a ga at at t a i a a m a t t i m
DoHS, Annual Report 2075/76 (2018/19) 3.2 Depart ent of A ur eda and Alternati e Medicine
3.2.1 Background Depart ent o A ur e a an Alterna e e ne (DoAA) pr ar l ana e t e el er o A ur e a Alterna e e ne Ser e an pro ote ealt l e t le t rou t net or a l all a ro t e ountr e Depart ent o A ur e a Alterna e e ne, one o t e t ree epart ent o t e n tr o Healt opula on ( oH ) re pon le or pro ra n , ana e ent o n or a on, an uper on, on tor n an e alua on o t e A ur e a Ser e pro ra
A ur e a an an ent e al te an n enou to epal t eep root e our e o A ur e e ne are e nal er , neral an an al pro u t e te or t rou ple an t erapeu ea ure alon t pro o e, pre en e, ura e an re a l ta e ealt o people A ur e a ealt er e are e n el ere t rou one entral A ur e a Ho p tal ( ar e ), one ro n al Ho p tal (Dan ), 1 onal A ur e a D pen ar e , 61 D tr t A ur e a Healt enter an 05 A ur e a pen ar e a ro t e ountr e A ur e a an Alterna e e ne un t n t e n tr o Healt popula on ( oH ) re pon le or or ula pol e an u el ne or A ur e a an ot er tra onal e al te
ar ou na onal an nterna onal pol e a e l te t e portan e o A ur e a er e n pr ar ealt are an or pre en on o D e on tu on o epal a alle or t e prote on an pro o on o tra onal A ur e a e ne alon t naturopat an o eopat e a onal Healt ol (201 ) a alle or e pan on o A ur e er e a a e t e a onal A ur e a Healt ol (1995) an a onal r an Healt pol (2015)
een plan o o ern ent o epal (2019/20 202 /2 ) a u e planne e elop ent e pan on o A ur e a, aturopat , Ho eopat ot er alterna e e ne ore pe i all , t a 1) Stru tural e elop ent u ta le or en a on, pre en on, olle on pro o on o lo all a a la le e nal er , neral an al or n e ne 2) ana e ent re ula on o ot er alterna e e ne a e on tan ar nor ) ta l ent o A ur e a, o a aturopat enter an u i a on o A ur e a or pro o on o ealt tour g t a tm t OrgOrganizationani ation tructure structure
Federal e el Pro incial e el ocal e el
DoAA D tr t A ur e a Healt A ur e a D pen ar e 05 ar e Ho p tal enter 61 AR An al A ur e a S n a ur ar a a ana D pen ar e 1 A A ur e a an Alterna e e ne Se on ( oH )
Organi ation of Depart ent of A ur eda Alternati e Medicine:
Organization of Department of Ayurveda & Alternative Medicine:
Department of Ayurveda and Alternative Medicine
Herbs, Medicine Ayurveda and Research Alternative Administration Medicine Division Medicine Division Section Division
Homeopathy & Prakritik & Herbs & A ur eda Amchi Medicine Acupunture Medicine Health Section Medicine Section Pro otion Section Section
Monitoring, Ayurveda Research & Service Coordination Managemen Section t Section
3.2.2 Ob ecti e 3.2.2 Objectives • o e pan an e elop un onal, p al A ur e a ealt n ra tru ture • a a a i a a a t i a t t o pro e ual t ontrol e an or A ur e a ealt er e t rou out t e ountr • im o e elop a it an ana t e t e re m a i m u re u an re a our e a t i t g t t • t o o l e t e a e uate re our e or e nal plant • a ma ag t i ma o pro ote o un t par pa on n t e ana e ent o t e ealt a l t u a on m i i t a at m i i a a t o lo al er • m t mm it a i a i t ma ag m t t a t a i it i a o pro ote ealt tatu u ta na le e elop ent o A ur e a te u n lo all a a a la le e nal plant • m t o pro ote a t po tat e a tu e tai a to ar ealt m t are a arene a o ealt t m ue i g a a ai a m i i a a t 3.2.2 m t i a t t a a t a a a a t i Strategie • ro e pre en e, pro o e ura e ealt er e n t e rural area • ta l ent e elop ent o A ur e a n tu on • Stren t en e pan t e A ur e a ealt er e DoHS, Annual Report 2075/76 (2018/19) • De elop lle anpo er re u re or ar ou ealt a l • Stren t en n o on tor n uper on a • De elop ent o n or a on, e u a on o un a on enter n t e Depart ent • De elop nter e toral o or na on t u a on n tr , ore tr , lo al e elop ent • e tor ot er • ta l ent o re onal A ur e a Ho p tal A ur e a D pen ar e • Stren t en n e pan on o re ear tra n n enter o nterna onal le el • a onal nterna onal le el tra n n or t e apa t en an e ent o t u an re our e g t a tm t 3.2.2 Strategies
i m a a t i i t a a a ta i m t m t a i t t gt a t a a t i i ma i a i a t a i i t gt i g m it i g i i a i m t i ma a mm i a t i t a tm t t t a i a it a i i t t a m t t t ta i m t gi a a ita a i a i t gt i g a i a t ai i g t i t a a a a t a a t ai i g t a a it a m t it ma
3.2.3 Major Activities
Central level mm i a i a a t g am a a a t a a ga a a a ta i a g a i a i i t a a m t a a a ma a ga ta i m t a t i g g t i g t m a am g a i t ta i m t a a a a a a ma a ga t i B a i a t a ta i m t gi a a ita at a ga i a a t gt i g g am at at ga m at a i am i t a a ma at at ga a t am ga i t a a i a i it ai i g t a i ia a it m it i g i t a t a ai a i a ma t it i g i i i at a t a i a t m a i m g i it i i i a a m it i g a at i a t i a m t t i a a a m it i g a i a it i a a
Local Level ga a i t ma ag m t t ai gi g g am t gt i g a ga a i i it a t a i a a a a mat ia a a a t g am t m a i i t B i i g t a i t m a a a ma a a a ga g amm i i a g am m i i a a t g am a ta g m t i t i ga a t g g m i i m t t atm t i m t
DoHS, Annual Report 2075/76 (2018/19)
3.2.5 Service Statistics for fiscal year 2075/2076 g t a tm t Table 3.1: Table shows the number of people served by province wise in FY 2075/76 3.2.4 Analysis of Achievement Province Province Province Province Gandaki Province Karnali SudurPaschim Total No. 1 No. 2 No. 3 Province No. 5 Province Ba t t atm t t i t a i t i g i a a i a t t i a OPD 219232 127275 165924 221231 229558 149597 243885 1356702 m a i a a t i a g mi a i a Stanpayee 3151 2005 2195 3113 3309 2014 3597 19384 a a Bi a i at i a JesthaNagarik 5235 3456 4115 5136 5704 3591 6108 33345 ata a i t t i mat i t i t m a i a a ia Purvakarma 4697 3536 3811 4907 5183 3529 5784 31447 Ba ga iat i i a a a a a a a ta a t a g a ta i a GaunGhar 14121 10076 11143 14135 14320 9904 16125 89824 t i g gi a i a Clinic B a a t i i a SwasthyaSibir 7908 4943 5732 6910 7154 4168 8546 45361 a a a i ia a i a National 254344 151291 192920 255432 265228 172803 284045 1576063
3.2.6 Problems/Constraints Problems/Constraints Actions to be taken Responsibility Lack of experts and inadequate Production of Qualified Ayurvedic DoAA qualified manpower. manpower(BAMS, MD) MoHP MOE Inadequate financial support for Allocate sufficient Budget MoHP district level Ayurveda institutions to conduct monitoring supervision & publicity program. Poor storage & dispensing Provide good furniture & dispensing DoAA Practices of medicines in curative materials MoHP aspects of Ayurveda institutions. Training on storage & Good dispensing Practice. Lack of inter sectoral co-ordination. Co-ordination with related ministries, DoAA NGO's & INGO's MoHP Increase qualified manpower. Lack of community based program Increase manpower production.. DoAA for publicity of Ayurveda. Allocation of adequate budget. MoHP
Lack of Workshop, Training & Allocate adequate budget, DoAA Seminar ,Planning on Ayurveda. Develop policy & Long term, Mid term and MoHP Short term plan on Ayurveda
Lack of appropriate recording & Upgrading of Ayurveda Information DoAA reporting system. Management System(AIMS) MoHP Allocation of adequate budget. Training on AIMS For Ayurveda Personnel Inadequate Specialized Human Scholarship for higher studies,Recruitment MoGA Resources under &Placement . PSC Department of Ayurveda. Lack of Evidence Generation & Goal formation. DoAA
DoHS, Annual Report 2075/76 (2018/19)
3.2.5 Service Statistics for fiscal year 2075/2076 g t a tm t
Table 3.1: Table shows the number of people served by province wise in FY 2075/76 3.2.5 Service Statistics for fiscal year 2075/2076 Province Province Province Province Gandaki Province Karnali SudurPaschim Total Table 3.1: TableNo. shows 1 theNo. number 2 ofNo. people 3 Province served by provinceNo. 5 wise in FY 2075/76Province Province Province Province Province Gandaki Province Karnali SudurPaschim Total No. 1 No. 2 No. 3 Province No. 5 Province OPD 219232 127275 165924 221231 229558 149597 243885 1356702
StanpayeeOPD 2192323151 1272752005 2195165924 3113221231 3309229558 2014149597 3597243885 193841356702
JesthaNagarikStanpayee 52353151 34562005 41152195 51363113 57043309 35912014 61083597 3334519384
JesthaNagarik 5235 3456 4115 5136 5704 3591 6108 33345 Purvakarma 4697 3536 3811 4907 5183 3529 5784 31447 Purvakarma 4697 3536 3811 4907 5183 3529 5784 31447 GaunGhar 14121 10076 11143 14135 14320 9904 16125 89824 ClinicGaunGhar 14121 10076 11143 14135 14320 9904 16125 89824 Clinic SwasthyaSibir 7908 4943 5732 6910 7154 4168 8546 45361 SwasthyaSibir 7908 4943 5732 6910 7154 4168 8546 45361 National 254344 151291 192920 255432 265228 172803 284045 1576063 National 254344 151291 192920 255432 265228 172803 284045 1576063
3.2.6 Problems/Constraints 3.2.6 Problems/Constraints Problems/Constraints Actions to be taken Responsibility Problems/Constraints Actions to be taken Responsibility Lack of experts and inadequate Production of Qualified Ayurvedic DoAA Lack of experts and inadequate Production of Qualified Ayurvedic DoAA qualified manpower. manpower(BAMS, MD) MoHP qualified manpower. manpower(BAMS, MD) MoHP MOEMOE InadequateInadequate financial financial support support for for AllocateAllocate sufficient sufficient Budget Budget MoHPMoHP districtdistrict level level Ayurveda Ayurveda institutions institutions to to conductconduct monitoring monitoring supervision supervision & & publicitypublicity program. program. PoorPoor storage storage & & dispensing dispensing ProvideProvide good good furniture furniture & & dispensing dispensing DoAADoAA PracticesPractices of of medicines medicines in in curative curative materialsmaterials MoHPMoHP aspectsaspects of of Ayurveda Ayurveda institutions. institutions. TrainingTraining on on storage storage & & Good Good dispensing dispensing Practice.Practice. LackLack of of inter inter sectoral sectoral co-ordination. co-ordination. Co-ordinationCo-ordination with with related related ministries, ministries, DoAADoAA NGO'sNGO's & & INGO's INGO's MoHPMoHP IncreaseIncrease qualified qualified manpower. manpower. Lack of community based program Increase manpower production.. DoAA Lack of community based program Increase manpower production.. DoAA for publicity of Ayurveda. Allocation of adequate budget. MoHP for publicity of Ayurveda. Allocation of adequate budget. MoHP
Lack of Workshop, Training & Allocate adequate budget, DoAA LackSeminar of Workshop, ,Planning Trainingon Ayurveda. & AllocateDevelop adequate policy & budget,Long term, Mid term and DoAAMoHP Seminar ,Planning on Ayurveda. DevelopShort term policy plan & Long on Ayurveda term, Mid term and MoHP Short term plan on Ayurveda Lack of appropriate recording & Upgrading of Ayurveda Information DoAA Lackreporting of appropriate system. recording & UpgradingManagement of Ayurveda System(AIMS) Information DoAAMoHP reporting system. ManagementAllocation of System(AIMS) adequate budget. MoHP AllocationTraining ofon adequate AIMS For Ayurvedabudget. Personnel Inadequate Specialized Human TrainingScholarship on AIMS for higher For Ayurveda studies,Recruitment Personnel MoGA InadequateResources underSpecialized Human Scholarship&Placement for . higher studies,Recruitment MoGAPSC ResourcesDepartment under of Ayurveda. &Placement . PSC DepartmentLack of Evidence of Ayurveda. Generation & Goal formation. DoAA Lack of Evidence Generation & Goal formation. DoAA Documentation about the Allocate budget. MoHP successful treatment of certain incurable disease with Ayurveda therapy claimed by practitioners.
DoHS,3.2.6 Annual Programs Report formulated 2075/76 (2018/19) for the fiscal year 2076/77 Miscellaneous Programs: Ayurveda vibhagh (37003101) Improvement of Administrative building of Department and Budhanilkantha Panchakarma center. Construction of open gym center. Ayurveda Health promotion program. Skill development empowerment / program. Quality Medicinal Herbs & Medicine Management and Research program. Prevention, Reduction and management of NCD. Ayurveda Health Information management program . Study of effects of climate change on medicinal plants. Citizen health program. Grant for effectiveness study of Ayurveda Service Program NCDs Prevention & Management Ayurveda Services Guidelines, Manual, Protocol Traditional treatment related Policy, Standard & Management Yoga/Panchakarma TOT training for Ayurveda Physicians AHIMS upgrading Alternative Medicine Strengthening/Policy, Standards
Provincial Programs Lifestyle Management Program in PHC Training on “Operation & Management of Ayurveda Programs” for ayurveda personnel Procurement & Transportation of Ayurveda Medicines Free Health Camps National/International Yoga Day; National ArogyaDiwas&DhanwantariJayanti ICT materials development
g t a tm t 3.2.7 Programs formulated for the fiscal year 2076/77
Miscellaneous Programs: Ayurveda vibhagh (37003101)
P m m t mi i t a i i g a tm t a B a i a t a a a a ma t P t g m t P a a t m g am P i m t m m t g am P a it i i a i i a ag m t a a g am P a ma ag m t P a a t ma ma ag m t g am P t t imat a g m i i a a t P i a t g am P a t t a i g am P a ag m t P a i i i a a t P a i a t atm t at i ta a a ag m t P ga a a a ma t ai i g a i ia P g a i g P t a i i t gt i g i ta a
Provincial Programs
P i t a ag m t g am i P ai i g a a ag m t a g am a P m t a ta a i i P a t am P a a t a a ga a a a g a i a a a ta i a a P mat ia m t
DoHS, Annual Report 2075/76 (2018/19) ami a FAMILY WELFARE Chapter 4 Chapter
4.1 Child Health and Immunization Service
BACKGROUND
i a t a mm i a i i t ami a i i i i a t a m it a a i i a t a imm i a i gi a ag m t a ag m t i i i t a i t i t a i t g t t t a a i a t a mm i a i ami a i i i i a m ta i a t a imm i a a ia m i i a mat ia i i a it t i a a it i i g a t ta imm i a i i a it t i i t t g a a a t a i ia a t ai i g t mm i a a at i ma i t t g t g at a t ma a ag m t a ag m t i i i a i a a t i a a i a t a mm i a i ami a i i i i at it a ta imm i a a i a t t t a i t a a a
i a t g am a a mm i a g am a g am
4.1 National Immunization Program
a a mm i a g am a a g am mm i a a ta t i B a i a i it g am t i t i a t g am i i t a t a a a a a i a mi t t i g t i m i it a m ta it a iat it a i ta i a
it t i i i a tm t a t i a a a t i i t a t a a a i t a t i i g a g t a a mm i a g am t a t a i a i t a a i a i t i g t a a i m t a a i a ta g t i t i g a i a i i imm i a t t g am i a i a agai t a i ta i a a a a at i a i a i t i imm i a a it ma a i t m i a a mm i a a t a i i i g ta i a i a i a i a i a a i t i a mm i a i a i t g i i i t i a t a i i i t a i a m i i i
a a ig it g a gi a a a a g i i i i a mm a t g i t g am a a i t i i t a t a a t at gi im m ta a a g t a m g t ta g t t imi a a a i a a i ta i a ma a m i t t a i a i B at a a ata t ta a
DoHS, Annual Report 2075/76 (2018/19) ami a imi at i a t imi a tat a tai i t a t a i i a a i a a g it t t i t t a t ia gi a a i i i tat a mai tai i t a i t t t i i t t i t a i i imm i a i i i a a gi i mi i t i t a a a t t t t t i g t a t a a a i i a
g t a a a a i g a i t a a g ita a m i a i t a a a t gi a ta g t a a a a a t a a ta g t t g m a a m a t t a a ta g t a i i g m a imi a a t m t t m m m t i t a t ia gi i i g a a t imi at t m a a a t t at a i a i i a t ig i i i i a a i i t m t i i a i i ig ag it t t a imm i a m a a a i i mm it m i i a it i t i t i a a a i t imm it ga t m a a a a a a i am aig m mi a t mi i i a g a ait a i i g i t i t i t ai
a a a i g a i a B t am g i t g imm i a a t a t i a a B g t t a am g a i it t i a am t t t i a g it Ba g a B ta a ai a i t t a t ia gi t t a B am g i a t i i a t mai t i t t a i i a t a i m ta it a a t i i m m t a i a tat t a a a i g mmi i a a t i t ig i a t i a i i g a i g i m ta it
a i t t t i t t a t ia gi t a mm i a t t t i g a t gt i g t a a mm i a g am mm i a t a i i t ia a a a Ba t t a a mm i a g a i a i i t ia a g t mm i a t a a g i imm i a a a ig t a i i i a g i a t a mmi t i a a imm i a i t i t t a a mm i a mmi a a mm i a i mmi a i ga mmi a ma at t mm i a t it t t it a i imm i a a a i ta i a i a mmi a ta i a a it m it i g i t g am mmi i t g i a mmi mm i a a a a mmi i a i a a a i a mmi a a a imi a a a a a at tai m t i t i m mi i i ga mmi t
i a a i i at a im m t a i i i a a imm i a g am i g am a i ia i it i imm i a a i ga ia g g a i a a t it i a a mi i t a a a m a t t imm i t i g am t a a a it a i a a ta at a t a i imm i a t ta a i a a a t i t i t a a imm i
DoHS, Annual Report 2075/76 (2018/19) ami a a a i i a a a t i i a imm i i
i a i ta i a a im a t a i i t a i i a a t a i a a i i m a a a ata t ta a a t a i m a a a i i t t g t i a t it t i a t a i ta i a i a i a t ia i a ta i a g ita a m i t i a a it a a mia a a i t t
GUIDING DOCUMENTS OF NATIONAL IMMUNIZATION PROGRAM
a a g a gi a a a a g i i g m t t a a mm i a g am mai m t i a ta i a t a i at i a a a i a t a t ia gi a a i a a a mm i a t a a a t t t at g
4.1.1 Comprehensive Multi-Year Plan for Immunization (cMYP)
m i a a mm i a i a i i a i a a a t a i imm i a at g a t t t at gi a a i t t i t a i t am i t m t t g a i g i a t a i m ta it a m i it a iat it a i ta i a t m t i a a a g a a t i a i i g g i i i t a i a i a imi a a t ta g t a t gt i g imm i a
4.1.2 Vision
a a t a i ta i a
4.1.3 Mission
i i a m t ig a it a a a a a i a imm i a i m t a a mm i a g am i a ita ma
4.1.4 Goal
m i it m ta it a i a i it a iat it a i ta i a
4.1.5 Strategic Objectives
Objective 1 a i imm i a Objective 2 at a i a tai a i ta i a t imi a a a i a Objective 3 t gt imm i a ai a a i ma ag m t t m a it imm i a i Objective 4 a ia tai a i it imm i a g am Objective 5 m t i a a a ia m i i a a i t a t a
DoHS, Annual Report 2075/76 (2018/19) 4.1.4 Goal Re u t on o or t , ortal t an a l t a o ate t a ne pre enta le ea e
4.1.4 Goal Re u t on o or t , ortal t an a l t a o ate t a ne pre enta le ea e 4.1.5 Strategic Ob ecti e Ob ecti e 1 Rea e er l or ull un at on
Ob ecti 4.1.5 e 2 A Strategic elerate, Ob a ecti e e e an u ta n a ne pre enta le ea e ontrol, el nat on an era at on Rea e er l or ull un at on Ob ecti Ob e 3 ecti Stren e 1 t en un at on uppl a n an a ne ana e ent te or ual t un at on er e ami a A elerate, a e e an u ta n a ne pre enta le ea e ontrol, el nat on an era at on Ob ecti Ob e 4 ecti n e ure2 nan al u ta na l t or un at on pro ra Stren t en un at on uppl a n an a ne ana e ent te or ual t un at on er e Ob ecti 4.1.6Ob e 5 ecti TARGET ro e 3 ote nno POPULATION at on, re ear an o al o l at on a t t e to en an e e t pra t e Ob ecti e 4 n ure nan al u ta na l t or un at on pro ra Ob ecti e 5 ro ote nno at on, re ear an o al o l at on a t t e to en an e e t pra t e a a mm i a g am t i a i a t m t ag 4.1.6 TARGET POPU ATION ta g t a i gi a i t ta at onal4.1.6 TARGET un at on POPU ro ra ATION urrentl pro e rout ne a nat on up to 2 ont o a e e tar et populat on en a n t e ta le elo Table at onal 4.1.1: Target un at on population ro ra urrentl for FY pro 2075/76 e rout ne a nat on up to 2 ont o a e e tar et populat on Table 4.1.1: Target population for FY 2075 76 en a n t e ta le elo art ular opulat on Table 4.1.1: Target population for FY 2075 76 ( our e H S) art ular opulat on n er 1 ear l ren ( ur n n ant ) 621,565 ( our e H S) 12 2 ont populat on 611,91 n er 1 ear l ren ( ur n n ant ) 621,565 pe te pre nan 755,6 7 12 2 ont populat on 611,91 pe te pre nan 755,6 7 4.1.7 NATIONAL IMMUNIZATION SCHEDULE 4.1.7 NATIONA IMMUNI ATION SCHEDU E Table 44.1.7.1.2: NNATIONA ational I IMMUNI uni ation ATIONSchedule SCHEDU E SN Table 4.1.2: National ImmunizationNu ber of Schedule TableT 4.1.2 pe of: NVaccineational I uni ation Schedule Schedule Do e SN Nu ber of 1 T pe of Vaccine 1 At rt or on r t onta t Schedule t ealt n t tut on Do e 2 6, 10, an 1 ee o a e 1 1 At rt or on r t onta t t ealt n t tut on D Hep H 6, 10, an 1 ee o a e 2 6, 10, an 1 ee o a e Rota a ne 2 6 an 10 ee o a e D Hep H 6, 10, an 1 ee o a e 5 1 6 an 1 ee o a e Rota a ne 2 6 an 10 ee o a e 6 6,10 ee an 9 ont o a e 5 1 6 an 1 ee o a e 7 2 r t o e at 9 ont an e on o e at 15 6 ea le Ru ella 6,10 ee an 9 ont o a e ont o a e 7 2 r t o e at 9 ont an e on o e at 15 8 ea le Ru ella 1 12 ont o a e ont o a e 9 2 re nant o en 2 o e o one ont apart n 8 1 12 ont o a e r t pre nan , an 1 o e n ea u e uent 9 2 re nant o en 2 o e o one ont apart n pre nan r t pre nan , an 1 o e n ea u e uent pre nan
4.1.8 MAJOR4.1.8 MAJOR ACTIVITIES ACTIVITIES CONDUCTED CONDUCTED IN FY 2075 IN FY 76 2075/76 4.1.8 ro MAJOR n al le elACTIVITIES o a out CONDUCTED at onal un IN FY at 2075 on pro 76 ra an ro plann n or o al per on an ealt or i ia er a t a a imm i a g am a mi a i g a ro n al le el o a out at onal un at on pro ra an ro plann n or o al per on an ealt De a a t lare 5 ne ull un at on tr t n 2075/76 a on t e t (58) tr t or er A a o a eet n a out u imm i a ta na le nan i t i t al ana e i ent o un am g at on ro i ra ig t e t t e i t i t e er o De lare 5 ne ull un at on tr t n 2075/76 a on t e t (58) tr t t e a parl a ent, m g ol a a t er , an tai a er , n u tr a ia al t, u ne ma ag m t an, pr ate e tor mm i a an l o g amm et A o a eet n a out u ta na le nan al ana e ent o un at on ro ra e t t e e er o ra it n n a t out m m portan e o t l a iam t ealt ar / i un at ma on ar an a t retent i t ia i t on i ma i at t a i i i t t e parl a ent, ol a er , an er , n u tr al t, u ne an, pr ate e tor an l o et ai i g a t im ta i a t a imm i a a a it t ra n n a out portan e o l ealt ar / un at on ar an t retent on i a at a g i i a i mm i a a a i i g i i i a t i m a i ia i a i i a i a ai i mi a i g t m at a a t t ai i g mat ia t a t a t t ai i g a i itat g i a t ai i g mat ia i mit t ai i g a at a i at t imm i a ai i g a t it ag a it g i i t mm i a a i a a i a a i im m ta g i i a gi m g i i a it a ag DoHS, Annual Report 2075/76 (2018/19) ami a ta i ai t i a i a a i at i t t m t a a m t a i ai i m t m t a i g i t i t a t g t i m t m t g mi i a i a t a i t a i ia t a i t a t a t a a a am aig a t i t a i ta i it gi m g am i t imm i a t g t t a i imm i a at a i g t t imm i a t a i a a a a mm i a i mmi t a mm i a i ma m a t a a a a ag m t gi it t m a t t a a i ta m g it m m ia a mmi a a iam t m ia a a iam t a t imm i a a t imm i a i a a i t i imm i a gi t a t m im m ta t imm i a i i a m it i g m a i m t g g am ta a t t i t m it a imm i a a mmi m m at mi g a a i t i t a t t t a t m a i i t t t a a g i t a t m it i a m a t a i a mai tai t g t am t m t a mai t a ai a a a g ita a m t a i g a ta g i imm i a
4.1.9 VACCINATION TARGET vs. ACHIEVEMENT, FY 2075/76
a t t g a t i m ta it m i it a i a i it a iat it a i ta i a a t t at gi i t a i imm i a t at i a t a ig i a t i i a t a i m ta it ig a a mm i a g am a t i t ig i a t i i m ta it g a i ta i a
DoHS, Annual Report 2075/76 (2018/19) ami a Figure 4.1.1. Trend in earl childhood ortalit ig i a i m ta it Figure 4.1.1. Trend in earl childhood ortalit
Source: NDHS 2016 4.1.10 National accination co erage: Source: e NDHSta le an 2016 ap pre ente elo o t e rout ne un at on a nat on o era e an a e e ent tatu n 4.1.10 National vaccination coverage: 4.1.10207 5National/76 accination co erage:
e ta le an ap pre ente elo o t e rout ne un at on a nat on o era e an a e e ent tatu n ta a ma t t imm i a a i a ag a Table 4.1.3: National accination co erage b accine FY 2075 76 a i m t tat i 2075/76 Target SN Antigen Target Achie e ent Achie ed population TableTable 14.1.3: 4.1.3 National: National vaccination accination un co coverage er erage 1 ear b by accine vaccine,621565 FY 2075 FY 2075/76 76565029 91 2 D Hep H 1 un er 1 ear 621565 561 6 90 Target SN Antigen D Hep H 2 un er 1 ear 621565Target 5 8 8Achie e 88 ent Achie ed D Hep H un population er 1 ear 621565 5 7166 86 1 D Hep H un er 1 ear 621565 565029 91 n lu n ela e o e 2 5 D Hep H 1 un un er 1 er ear1 ear 621565621565 561675 561 6 90 en a ter 1 ear o D a Hep e H 2 un er 1 ear 621565 5 8 890 88 6 D Hep 1 H un un er 1 er ear1 ear 621565621565 5 579 5 716688 86 7 D Hep 2 H un er 1 ear 621565 5 01 85 8 n lu n ela e o e un er 1 ear 621565 5192 7 8 5 un er 1 ear 621565 561675 en a ter 1 ear o n lu n ela e o e 9 a e un er 1 ear 621565 5 75 90 en a ter 1 ear o 6 a 1 e un er 1 ear 621565 5 579 87 88 7 2 un er 1 ear 621565 0 665 ( n 5 01 85 8 10 1 un un er 1 er ear1 ear 621565621565 aroun 9 5 5192 7 8 ont ) 82 296066 ( n 11 n lu n 2 ela e o e un er 1 ear 621565 9 un er 1 ear 621565 aroun 9 5 5 75 60 en a ter 1 ear o a e 87 0 665 ( n 10 1 un er 1 ear 621565 aroun 9 5 ont ) 82 296066 ( n 11 2 un er 1 ear 621565 aroun 9 5 60
DoHS, Annual Report 2075/76 (2018/19) ami a
Target SN Antigen Target Achie e ent Achie ed population ont ) 10 1 un er 1 ear 621565 5 89 88 11 2 un er 1 ear 621565 5 5225 86 12 un er 1 ear 621565 50 075 81 1 R 1 un er 1 ear 621565 519676 8 1 R 2 15 ont 61191 5221 7 15 12 ont 61191 9 212 81 16 2 2 re nant o en 7556 7 862 0 6 Source: HMIS MD DoHS o era e or 9 5 ont tar et
Figure 4.1.2. National Routine Immunization Coverage ( ), Nepal, FY 2073/74 to 2075/76 Figure 4.1.2. National Routine I uni ation Co erage Nepal FY 2073 74 to 2075 76
Source: HMIS MD DoHS
D Hep H o era e n lu n ela e o e en a ter 1 ear o a e 207 /7 91 6 207 /75 86 2075/76 90
o era e n lu n ela e o e en a ter 1 ear o a e 207 /7 91 1 207 /75 86 8 2075/76 87 5 n 207 /7 , ur n t e lo al orta e o a alrea tarte , an a part all a a la le n epal ur n t e r t e ont onl a ter t e tart o o a ne n 207 /75 n 2075/76, a tarte , an t e en o era e a a n t 9 5 ont tar et n e a laun e a ter aroun 2 5 ont nto t e
ure 1 2 o nat onal o era e or ele te ant en or t ree ear , ro 207 /7 to 2075/76 o era e a e rea e 2 po nt n 2075/76 Ho e er, t e o era e o D Hep H an a n rea e o pare to pre ou ear lo al orta e tarte ro 207 /7 ere ore, t e o era e o onl 16 n 207 /7 ue to orta e o t e a ne n tea o ( en one o e ntra u ular at 1 ee ), ra t onal o e o ( en ntra er al at 6 an 1 ee ) a laun e n epal n to er 2018 or 2075/76, 2 o era e o n 60 ( o era e a u te or 9 5 ont tar et populat on a e on tart ate o t e a ne n t e al ear) 1 o era e a een a nta ne at 88 , erea o era e o 2 an a n rea e 1 po nt o pare to pre DoHS, ou Annual ear Report R 1 o era 2075/76 e a (2018/19) n rea e o pare to pre ou ear an R2 o era e a n rea e n antl 7 po nt o pare to pre ou ear or ea le el nat on, o era e o ot R 1 an 2 re u re ( 95 ) ere ore, o era e o ot R 1 an R 2 t ll not at a tor e o era e o a ne a al o n rea e l tl 1 po nt e report n rate or un at on ata et n H S a onl 80 n 2075/76 ere ore, t an e a u e t at a ne o era e n a tual er t an reporte ( H e t ate o nat onal un at on o era e or epal are a a la le on ttp // o nt/ un at on/ on tor n ur e llan e/ ata/npl p ami a DPT-HepB-Hib 3 coverage including delayed doses given after 1 year of age is:
OPV3 coverage including delayed doses given after 1 year of age is:
i i g i m g a tag a a a ta t a a a a a ai a i a i g t t m t a t ta t a i i a ta t a t gi ag i agai t m t ta g t i a a a a m t i t t
ig a a ag t a g t a m t B ag a a i t i t ag B i a a i a m a t i a g a tag ta t m t ag i i t tag t a i t a gi i t am a at a a gi i t a ma at a a a i a i t ag i i i ag a t m t ta g t a a ta t at t a i i t a a ag a mai tai at a ag a a i a i t m a t i a ag a i a m a t i a a ag a i a ig i a t i t m a t i a m a imi a ig ag t a i i ag t a i t a a t ag a i a a i a ig t i t g at imm i a ata t i a i it a a m t at a i ag i a t a i ig t a t mat a a imm i a ag a a a ai a i t imm i a m it i g i a ata
DoHS, Annual Report 2075/76 (2018/19) ami a 4.1.11 Vaccination coverage by Districts :
Figure4.1.11 Vaccination4.1.3 Percentage co erage of childrenb Di trict under : one year immunized with BCG Figure 4.1.34.1.4 Percentage Percentage of of children children under 12-23 one months year immunized immunized with with BCG measles/rubella 2 Figure 4.1.4 Percentage of children 12 2 ont un e t ea le /ru ella 2
DoHS, Annual Report 2075/76 (2018/19) 1 ami a ig a t ag B a i t i t i g t m a i t i it a a t i it ag B i ig t a i a a i B ag i ure 1 an 1 o t e o era e ( ) o an R 2 tr t, t o t e o par on o r t t an la t a t ag i imat i a t t m t ure t e 1 o an era e 1 o o t e er o era t an e ( R )2 o l e nat an onal R 2 e tr o t, era t e o a t o e e o 90 par ut on Ro 2 r o t era t ean onl la t t imm i a t at a t i g im 72 t Appro e o era atel e o 18 o l er ren t are an lo R t 2up l to e nat o onal plete t e un o era at on e So a t o at e 90 ealt ut or er R 2 oun o era ell n e onl oul 72 e pro Appro e atel 18 o l ren are lo t up to o plete t e un at on So t at ealt or er oun ell n oul 4.1.12 e pro Vaccination e coverage by province: 4.1.12 Vaccination co erage b pro ince: Figure 4.1.5. Pro ince wi e Three Year Trend of BCG co erage FY 2073 74 to FY 2075 76 Figure4.1.12 Vaccination4.1.5. Province co erage wise b Three pro Years ince: Trends of BCG coverage ( ), FY 2073/74 to FY 2075/76 Figure 4.1.5. Pro ince wi e Three Year Trend of BCG co erage FY 2073 74 to FY 2075 76
Figure 4.1.6.Pro ince wi e co erage of DPT HepB Hib 3 FY 2073 74 to FY 2075 76 FigureFigure 4 4.1.6.Province.1.6.Pro ince wi wise e co eragecoverage of ( ) DPT of HepB DPT-HepB-Hib Hib 3 FY 207 33, 7FY4 to 2073/74 FY 2075 to 76 FY 2075/76
Source: HMIS MD DoHS
S ource: HMIS MD DoHS
DoHS, Annual Report 2075/76 (2018/19) ami a 4.1.13. Province wise coverage ( ) of measles-rubella first and second dose FY 2073/74 to FY 2075/764.1.13. Pro ince wi e co erage of ea le rubella fir t and econd do e FY 2073 74 to FY 2075 76 Figure 4.1.7 MR 1 t Do e Figure 4.1.8 MR 2nd Do e
Source: HMIS MD DoHS
FigureFigure 4.1.9.4.1.9. Pro Province ince wi wise e co eragecoverage of ( ) Td 2of and Td Td 2 2 and FY Td 2074 2 , 75FY to 2074/75 FY 2075 76to FY 2075/76
Source: HMIS MD DoHS
ig t i i ag B B i a ure 1 5 to 1 9 o pro n e e o era e or ,D Hep H , R 1, R2, an 2/ 2 re pe t el n eneral, a nat on o era e n all pro n e a e pro e o pare to pre ou ear or , D Hep H , R 1 g a a i a ag i a i a im m a t an 2/ 2 , ro n e 2 a reporte t e e t o era e, erea or R 2, ro n e 5 a reporte t e e t i a B B i a i a t t ig t ag a i a t t ig t ag Bagma i a t a ag a t g at imm i a ata t i Bagma i i t t i t im
DoHS, Annual Report 2075/76 (2018/19) o era e a at ro n e a reporte relat el lo er o era e an t e report n rate or un at on ata et n ami a H S or a at ro n e t e lo e t (55 ), nee to e pro e 4.1.14 Droput rates of vaccination: 4.1.14 Droput rate of accination: Figure 4.1.104.1.10.. Dropout rate rates ( ) ofof differentdifferent accination vaccinations, FY 207FY 2073/743 74 to FYto 207FY 2075/765 76
Source: HMIS MD DoHS
ure 1 10 o t at nat onal ropout rate or R 1, D Hep H 1 an R 1 a e all e rea e o pare to pre ou ear o n pro e ent an all rop out rate are t n 10
4.1.15 Vaccine wa tage rate : Figure 2.1.11. Vaccine wa tage rate FY 2073 74 to FY 2075 76
Source: HMIS MD DoHS n 207 /7 an n 2075/76
DoHS, Annual Report 2075/76 (2018/19) ami a a t t a i B a t at t i a it i at t imm i a i i m t a tag at a t t ig t i a B a a i at a t ia i i i a ma i i a a a i i a m tai t ai a t a ig a tag at B a t a t a tag at B a a ig t a t i i a a tag at a t a tag at a im a i tai i a i t i i a a tag at i i a a a i t m i i i g a i i a i i ig a i g t a tag B i a t a a a tag at a t i i a a tag at t a i t a i a ig t m a t or all re on t tute a ne ( , R, an ) t at nee to e ar e t n 6 our (1 our onl or ) or at t e en o un at on e on e er o e r t, a ta e rate are e pe te to e er urt er, n epal, or , i a a i t a a a tag at i a t i i a a tag at R an a ne , at lea t one al per e on pol u e , an all e on e e au e o par e populat on n a i t t a tag at i i i i t a ll an ounta nou terra n a e to e allo e er a ta e rate e au e o t e e rea on , t e a ta e rate or i a tag at t t a an are er t an t e n at e a ta e rate o 50 an 10 re pe t el Ho e er, t e a ta e rate o R a pro e an u ta ne n 2075/76, an elo t e n at e a ta e rate o 50 pro a l e au e a ter ntro u t on o R 2, nu er o l ren re e n R a ne n a e on er lea n to le a ta e or 4.1.16D Access Hep H and an utilization , t e nat onal of immunization a ta e rate are elo services: t e n at e a ta e rate o 25 or ot a ne , ut a n rea e l tl o pare to pre ou ear or a ne , t e nat onal a ta e rate a o e t e n at e a a mm i a g am a at tat t i t i t a i i it a i a a ta e rate o 10 n 2075/76, a ntro u e , t e a ta e rate o 27 er lo t an pre ou a ta e rate o , ut oul e lo er t an 20 imm i a i i t i t a at g i i at g t a i B i ag 4.1.16 a Acce t and utili at ation of B i i uni ation er ice : B i t t a i i it a i a imm i a i at onal un at on ro ra e aluate tatu o t e tr t a e l t an ut l at on o un at on er e D tr t are ate or e n ate or 1 to on a o D Hep H 1 o era e an ropout rate o D Hep H 1 D Hep H to no t e a e l t an ut l at on o un at on er e re pe t el a i t i t at g i a a a B i ag a i a Table 4.1.4. Di trict categori ation ba ed on acce DPT HepB Hib 1 co erage and utili ation DPT HepB Hib 1 . DPT B i B i t HepB Hib 3 drop out FY 2075 76 Categor 1 Categor 2 Categor 3 Categor 4 le Proble Proble Proble Proble High Co erage ≥80 High Co erage ≥80 ow Co erage 80 ow Co erage 80 ow Drop Out 10 High Drop out ≥10 ow Drop out 10 High Drop out ≥10
aple un , S ra a an Rauta at al un a, D an uta, No di trict San u a a a, er at u , an t ar, Solu u u, otan , 2 di trict la , Dola a, o pur, apa, oran , S n upal o , D a n , Sun ar , a apur, u a ot, at an u, Saptar , S ra a, D anu a, al tpur, Ra e ap, a ottar , ara, ar a, ta an, or a, Ra u a, a tapur, anan , u tan , a repalan o , S n ul , a , a , a un , a anpur, a alpara ana u, S an a, ar at, a t, a lun , Ru u alpa, ar a an a t, Rolpa, ut an, an anpur ul , Ar a an , 25 di trict a alpara e t, Rupan e , ap l a tu, Dan , an e, Dolpa, u u, Hu la, u la, al ot, Da le , a ar ot, Ru u e t, Sal an, Sur et, a ura, a an , Dar ula, a ta , Da el ura, Dot , A a an a lal
50 di trict
Source: HMIS MD DoHS ote t e en D Hep H o era e u e n t e ta le a o e oe not n lu e ela e a ne en a ter 1 ear o a e
DoHS, Annual Report 2075/76 (2018/19) ami a a t at i t i t a i at g g a g i a i i a i a m i t i t i t i at g i t i a a i g im m t i imm i a a a i a at a a i t i t a i at g g a i a a i t i t a i at g a g i a a i t i t i i at g a i a
4.1.17 VACCINE PREVENTABLE DISEASES SURVEILLANCE
t t at gi i t a at a i a tai a i ta i a t imi a a a i a t at gi a a it i t i i t tai i tat t g a a i a t i a a i m a imi a a a t a at t tai imi a tat a at a B a i a a a i a t a i ta i a i ig ag it a i i i imm i a i im ta t t a i t i ig a it i a i im ta t t t tat t i a t g t a a i m t t i
t i a i a a i i a a t a i a a i i a ta t i a i m a a a a ata t ta i a a i t g at i t i i a t i a a t a i m a a a i a i t g at i t i i a t t i a t i a a t t g t t t t g g it a a m a i a it a i m t i a i a i a t ia i a ta i a g ita a m a a t i a
i a i a i a t ia i a m i a m i g a t at ata ita it t i imi a i a ta i i a a t at a i ita i i a it it t i i a ata m B i a it a ia i m i t a m i i a t a i i t i a m a gat a i i t i i imm i a a imi a ata m ta i i a it a ia i m mm a ta i a i i t i a a ta i i a it a a t t m it it g g a i a ta B i a a t t a t i a a g i a g t i a g ita a m i t t g it i at ma a a i ita i a i it a i g ita iat i a tm t ata a m a t i a i ga ga ita
i a ata gi a a at m mi t mi t a ig it t g m t a a
4.1.18 Acute flaccid paralysis surveillance, FY 2075/2076
a t a i i a a t i g t g it t t t i i t t a t ia gi a a i i i t a a mai tai t i tat i i a i t a t mai a i a i i at i at i at a t ta a a a a a at t at i m
DoHS, Annual Report 2075/76 (2018/19) ami a
FigureFigure 44.1.12..1.12. Reported Reported acute acute flaccid flaccid paral paralysisi AFP ca (AFP) e b di cases trict by FY district, 2075 2076 FY 2075/2076
Figure 4.1.12. Reported acute flaccid paral i AFP ca e b di trict FY 2075 2076
Source: FWD and WHO IPD Nepal
ure 1 12 o total reporte A a e tr t or 2075/2076 e total nu er o A a e reporte ere ig t ta t a i t i t t ta m 2 a e ro 6 tr t e re a n n 1 tr t (Dar ula, Hu la, Dolpa, Ru u , a , u tan , anan , a t a m i t i t mai i g i t i t a a m a Ra Source: e FWD ap, and otan WHO , IPD o Nepal pur, D an uta, erat u , aple un ) not report an A a e o t o t e e tr t are a m ag i ta g a a g am a ta g B a ta at m par ure el 1 populate 12 o total t relat reporte el le A nu a e er o un tr t er or15 ear 2075/2076 a e populat e total on At nu lea er t one o A A a a e e perreporte ear ro ere an a g i t t a a t t i t i t a a at it 2 tr a t e t ro 50,000 6 un tr er t 15 ear e re populat a n n 1 on e tr pe t te (Dar or ula, ual Hu t ur la, e Dolpa, llan eRu o A u , a , u tan , anan , a m a ag a t a t a a m a FigureRa e 4 ap,.1.13 . otan Non polio , o Acute pur, D Flaccid an uta, Paral erat i u NP , aple AFP un rate ) b di not trict report FY 2075 an A 2076 a e o t o t e e tr t are i t i t it a a i t a it i a par el populate t relat el le nu er o un er 15 ear a e populat on At lea t one A a e per ear ro an tr t t 50,000 un er 15 ear populat on e pe te or ual t ur e llan e o A FigureFigure 4 4.1.13..1.13. Non Non-polio polio Acute Acute Flaccid Flaccid Paral Paralysis i NP AFP (NPrate AFP)b di trict rate FYby 2075 district, 2076 FY 2075/2076
Source: FWD and WHO IPD Nepal
Source: FWD and WHO IPD Nepal
DoHS, Annual Report 2075/76 (2018/19)
ure 1 1 o non pol o A rate tr t at onal non pol o A rate 86 per 100,000 un er 15 ear populat on, a o e t e re u re rate o at lea t 2 ere are 6 tr t a e reporte A a e , out o 56 tr t a e et t e non pol o A tar et rate o 2 or ore, erea 7 tr t a e non pol o A rate ami a et een 1 1 9, an 1 tr t a non pol o A rate elo 1 per 100,000 un er 15 ear populat on ig i at i t i t a a i at i
a a i i a t i at at a t a i t i t Figure 4.1.14 Ade uate tool collection rate of AFP ca e b di trict FY 2075 2076 ure 1 1 o non pol o A rate tr t at onal non pol o A rate 86 per 100,000 un er 15 ear i a t a t i i t i t a m t t i ta g t at populat on, a o e t e re u re rate o at lea t 2 ere are 6 tr t a e reporte A a e , out o m a i t i t a i at t a i t i t a i 56 tr t a e et t e non pol o A tar et rate o 2 or ore, erea 7 tr t a e non pol o A rate at a a et een 1 1 9, an 1 tr t a non pol o A rate elo 1 per 100,000 un er 15 ear populat on
ig at t at a i t i t Figure 4.1.14 Ade uate tool collection rate of AFP ca e b di trict FY 2075 2076
Source: FWD and WHO IPD Nepal Source: FWD and WHO IPD Nepal
ig a at t at m t a a a t ure ure 1 1 1 1 o a o e uate a e tool uate olle tool t on rate olle ro t onreporte rate A ro a reporte e e nat A onal A a e tool olle e nat t on onal rate A 98 , tool olle t on rate 98 , at i i i a t ta g t m t i i i at t t a o a e t o e etar t et e o tar 80 et or o 80 ore or or t ore n ator or t ut o n t e ator 6 tr ut t o t e a 6 e reporte tr t A a e , t a e e reporte A a e , t e i t i t i a t a t ma it a a i a at t a or a t or t a e a a e e a e a e e e uate a tool e uate olle t tool on rate olle o at t or on a rate o e 80 o ate or ept a one o e tr 80 t e t t ept e rate one et een tr 60 t t t e rate et een 60 at at a t i t i t it t at t a i t i t it 79 , an one tr t t a e uate tool olle t on rate le t an 60 79 , an one tr t t a e uate tool olle t on rate le t an 60 a at t at t a Table 4.1.5. Non polio AFP rate and tool collection ade uac rate b pro ince FY 2075 2076 TableTablePro ince4.1.5. 4 .1.5. Non-polio Non polio AFPNP AFPAFP rate rate andNP andstool AFP toolcollectionStool collectionAde uac adequacy ade uac rate rateby province, b pro ince FY 2075/2076 FY 2075 2076 Ca e Rate Pro ince NP AFP NP AFP Stool Ade uac ro n e 1 1 2 77 98 Ca e Rate ro n e 2 85 72 100 a ro at n e 1 5 2 1 92 2 92 77 98 an ro a n e 2 27 85 6 95 72 100 ro a n e 5 at 62 5 22 2 98 92 92 arnal 26 98 100 an a 27 6 95 Su ur a 7 9 98 ro n e 5 Total 332 623.86 98 22 98 Source: arnal FWD and WHO IPD Nepal 26 98 100
Su ur a 7 9 98 Total 332 3.86 98 Source: FWD and WHO IPD Nepal
DoHS, Annual Report 2075/76 (2018/19) ami a a i a a at a a at t at i a i a a i i at a a a a a at t at a i a a i a a im a t i at a i a a a i a a i a at t at
4.1.19 e a Measles-rubella le 1 5 o non surveillance,pol o A a e FY an 2075/2076 rate, an a e uate tool olle t on rate pro n e a pro n e a a e e non pol o A rate a o e 2 per 100,000 un er 15 ear populat on, an a e uate tool olle t on rate a o e g t a a a a i g a i t a a g ita a 80 ro n e 2, 5, arnal an Su ur a a e reporte non pol o A rate a o e ro n e 2 an arnal a e m i a i t a a a t gi a ta g t a a a a e e 100 a e uate tool olle t on rate a a t a a ta g t t a a i a i i t i m i m a a m a a i i a4.1.19 Mea le rubella ur eillance FY 2075 2076 a n Au u i t 2018, epal a m a a ert e a t a n a e e ontrol o ru ella t g an on en tal ru i ella m n ro e m a a a i m a t m a a a t ert at on t o ear a ea o t e re onal tar et ear o 2020 an one ear a ea o t e nat onal tar et o 2019 t i i i m a imi a ig t at t a ontrol o ru ella an RS a e e t ere 95 or ore re u t on n nu er o ru ella a e ro 2008 le el a epal a e e 97 re i m a u t on n ru a ella a a e n a 2017 (22) i a a o pa m ta re to 2008 (786) imm i a Ho e er, e en t a i ou re u t on am aig i t a a i a a i m t ig ag m a a n nu er o ea le a e a een 98 n 2017 (99) o pare to 200 (5 19), ea le a e a e not een re u e t to ero i re u re or imm i a ea le el nat a on ure 2 1 t 1 mai o t a t at t ere a t i een a i m t ra t re u t on n ea le imi a an ru ella a e m a n epal ig Supple ag entar un t at on a t t e m a a ( a pa n ), ntro a i a u t on o ru i ella i a ne, an at a ag m a a i t a a t t i a e e ent o o era e o ea le ru ella r t o e n rout ne un at on a e een t e a n a tor or t a e i e ent or el nat on g o ea le , t a o era m a e o ot a o e a o ea imi a le a a i ati i i a t at all le el a i e o era e o m a ea le ru a i a ella e on am aig o e t ll not i i g at a tor t t onl i 7 n 2075/2076 o i i g t gt i g imm i a pro re to ar ea le an ru ella el nat on 202 a per t e re olut on, nat on e ea le a nat on a pa n e n on u te n 2076/2077 n lu n tren t en n o rout ne un at on Figure 4.1.15 Confirmed measles and rubella cases, Nepal, 2003- 2019 Figure 4.1.15 Confir ed ea le and rubella ca e Nepal 2003 2019
Source: FWD and WHO IPD Nepal MeaslesMea le accinationvaccination gi en ingiven Nepal in inceNepal the since tart of theEPI instart all di of trict EPI co in eredall districts 75 di trict (covered b 1988 75 districts by 1988) MRMR fir first t do edose tarted started in 2013 in MR 2013 econd MRdo second e tarted indose Septe started ber 2015 in September 2015
ure 1 15 an a le 2 1 6 o la orator on r e ea le an ru ella a e tr t an pro n e re pe t el n 2075/2076 ere a a total o 2 on r e ea le an 7 on r e ru ella a e ent e t rou DoHS, Annual Report 2075/76 (2018/19) ami a ig a a a at m m a a a a i t i t a i i a a t ta m m a a m u pe te ea le ur e llan e A on total on r e ea le a e n 2075/2076, t e a or t ro ro n e 2 a a i t g t m a i a m g t ta m m a ( 6 ), ollo e a at (2 6 ) an ro n e 5 (20 ) a i t ma it i m i Bagma a i u ne pe o te t e ea ar le nal ur n e llan ator e A or on total ea le on ru r ella e ur ea e le llan a e e n non 2075/2076, ea le non t e ru a ellaor t rate ro ( ro R n rate) e 2 oul ( e 6 at ),lea ollo t 2e per 100,000 a at (2 populat 6 ) an on ro atn e 5 , (20 at lea ) t 2 u pe te ea le /ru ella a e ( a ter la orator te t t a i a i i at m a a i a i m a a at
non ea at le an i non ru ella) per at 100,000 a t populat on a oul e reporte at i or at ual a t t ea t le ru ella ur e llan e All ne o t e ar nal n ator or ea le ru ella ur e llan e non ea le non ru ella rate ( R rate) oul m a a pro n e e ept a i a a at t t i Su ur a ro n e a e a e e m a a R rate a o e 2 a e nat onal R rate 7 per 100,000 e at lea t 2 per 100,000 populat on at , at lea t 2 u pe te ea le /ru ella a e ( a ter la orator te t a t a it m a a i a i t populat on non ea le an non ru ella) per 100,000 populat on oul e reporte or ual t ea le ru ella ur e llan e All a im i a a i at a a a at i pro n e e ept Su ur a ro n e a e a e e R rate a o e 2 e nat onal R rate 7 per 100,000 a populat Figure on 4.1.16 . Confir ed ea le and rubella ca e b di trict FY 2075 2076
Figure 4.1.16. Confirmed measles and rubella cases by district, FY 2075/2076 Figure 4.1.16. Confir ed ea le and rubella ca e b di trict FY 2075 2076
Source:Source: FWD FWD and and WHO WHO IPD IPD Nepal Ne pal
Table 4.1.6. NMNR rate, and confirmed measles and rubella cases by province, FY 2075/2076 TableTable 4 .1.6.4.1.6. NMNR NMNR rate rate and and confir confir ed ea ed le ea and le rubella and rubellaca e b ca pro e ince b pro FY 2075 ince 2076 FY 2075 2076 Pro ince NMNR NMNR Confir ed Confir ed Pro ince ca e NMNR rate NMNR Mea le Confir edRubella Confir ed ca e rate Mea le Rubella ro n e 1 27 5 62 1 8 ro ro n n e 2 e 1 228 27 7 5 62 185 ( 6 ) 1 8 a ro at n e 2 1 228 6 86 7 100 (2 185 6 ) ( 6 1 ) ( 5 ) an a a at 118 1 72 6 86 11 100 (2 6 ) 1 1 ( 5 ) ro an n a e 5 269 118 5 8 72 85 (20 ) 11 1 arnal ro n e 5 1 8 269 8 6 5 8 7 85 (20 ) 6 Su arnal ur a 5 1 8 1 88 8 6 5 7 6 Total 1522 3.73 424 37 Su ur a 5 1 88 5 Source: FWD and WHO IPD Nepal NMNR: non ea le non Total rubella 1522 3.73 424 37 Source: FWD and WHO IPD Nepal NMNR: non ea le non rubella
DoHS, Annual Report 2075/76 (2018/19)
ami a 4.1.20 Acute encephalitis syndrome (AES) surveillance, FY 2075/2076
a t at a a a i t m a a i ma a i a am aig ta t i a m t i ig i i t i t a i a i t i a i ma i t imm i a t i t i t 4.1.20 Acute encephaliti ndro e AES ur eillance FY 2075 2076 A a on t entrate m a apane e en ep ta al t ( ) ontrol ea ure, p a ig i a t e e a i a a nat on a pa n ere tarte t n a a i i a a t m t i t i t a a i g2006 an ere o plete n 1 r tr t 2011 a ne a ntro u e n p a e e anner n t e rout ne ma a i a un at on o t e am aig e 1 tr t i t 2012 mai i g A ter t e e i t i t ea ure i ere ta en, a i ur en a re u i t e n antl i nt epal Ho e er, imm i a o er t e ear , a a ent mai i g e ur e llan i t i t e, a i reporte ro ot er tr t i o ig epal a ell ollo n i a a ig i a t i m a t t i i a a i a a a nat on a pa n n t e re a n n tr t n 2016, a ne a ntro u e n t e rout ne un at on o a ta t all re a n n tr t n ul 2016 A o n n ure 2 1 16, ur en n epal a re u e n antl n 2019 o pare to t e n t al ear en ur e llan e a tarte
Figure 4.1.17. Reported AES and lab confirmed Japanese encephalitis cases, Nepal, 2004 – 2019 Figure 4.1.17. Reported AES and lab confir ed Japane e encephaliti ca e Nepal 2004 2019
Source: FWD and WHO IPD Nepal
ig t at i t i t a t a i t t ure 1 17 o t at 70 tr t a e reporte A S a e n 2075/2076 ut o t e e 70 tr t , e tr t i t i t i t i t a a a i i a a at ma a i a t ig m ( apa, Sun ar , S ra a, at an u, a ) a e reporte er nu er o A S a e ( et een 51 100), an oran a a t a a g a t t ig t t ta a reporte t e e t ( 100) n total, 12 1 a e o A S ere reporte ( a le 2 1 7) A on t e total reporte A S a e , t a m g t t ta t a onl 6 (2 9 ) ere la orator on r e or a a or re u t on o pare to t e ear e ore a nat on a at m i i a ma m a t t a a i a a tarte en aroun 50 o t e A S a e ere po t e or e a or t o la orator on r e a e (1 out a ta t a t a i ma it a at o 6 6 1 ) ere reporte ro ro n e 2 m a t t m i
DoHS, Annual Report 2075/76 (2018/19) ami a
Figure 2.1.18. Reported AES and laboratory confirmed Japanese encephalitis cases by district, FY
2075/2076 Figure 2.1.18 . Reported AES and laborator confir ed Japane e encephaliti ca e b di trict FY 2075 2076 Figure 2.1.18. Reported AES and laborator confir ed Japane e encephaliti ca e b di trict FY 2075 2076
Source: FWD and WHO IPD Nepal a a Source: FWD and WHO IPD Nepal Table 4.1.7. Reported AES ca e and confir ed JE ca e b pro ince FY 2075 2076 Table 4.1.7. Reported AES cases and confirmed JE cases by province, FY 2075/2076 Pro inceTable AES4.1.7. ca Reported e AEJE Sca ca e e and confir ed JE ca e b pro ince FY 2075 2076 Pro ince 1 Pro ince433 AES ca e 6 JE ca e Pro ince 2 Pro ince203 1 43313 36.1 6 Bag ati Pro ince329 2 203 3 13 36.1 Gandaki Bag ati138 329 2 3 Pro ince 5 Gandaki 75 138 8 2 arnali Pro ince 395 75 1 8 Sudur Pa chi arnali 24 39 3 1 Total Sudur Pa 1241 chi 24 36 3 Source: FWD and WHOTotal IPD Nepal 1241 36 Source: FWD and WHO IPD Nepal a a 4.1.21 Neonatal tetanu ur eillance FY 2075 2076 4.1.21 Neonatal tetanu ur eillance FY 2075 2076 n epal, neonatal4.1.21 Neonataltetanu ( tetanus ) el surveillance, nat on a a FY e 2075/2076 e n 2005 tatu a een a nta ne n e t en n 2075/76, n epal, a e neonatal ere reporte tetanu (one ( ea ) el ro nat ont ree a a tr e t e n2 2005 1 18) e n tatu at onal a n een en e a rate nta ne o n e t en n 0 012 per 1000 a ata t ta imi a a a i i i tat a mai tai 2075/76, l e rt a e ere reporte (one ea ro t ree tr t 2 1 18) e nat onal n en e rate o i t a t a m t i t i t ig 0 012 per 1000 l e rt a a i i at i i i t
DoHS, Annual Report 2075/76 (2018/19) ami a
FigureFigure 4.1.19. 4.1.19 Neonatal. Neonatal tetanus tetanu cases, ca e FYFY 2075/20762075 2076
Figure 4.1.19. Neonatal tetanu ca e FY 2075 2076
Source: a a FWD and WHO IPD Nepal
4.1.22 PROBLEMS/CONSTRAINTS AND ACTIONS TO BE TAKEN 4.1.22 PROBLEMS/CONSTRAINTS AND ACTIONS TO BE at onal a a a a i a i ia a i m g i t i g m Source: annual FWD andRe WHO e IPD an Nepal ro n al Annual Re e eet n ent e t e ollo n pro le an on tra nt an re o a t ai t a mm a t ta at i t imm i a i en e a t on to e ta en at erent le el o un at on el er te 4.1.22 PROBLEMS/CONSTRAINTS AND ACTIONS TO BE a le t m 1 8 ro at le onal / annual on tra Re nt e an ro n al AnnualA Re t on e to eet e ta n en ent e t e ollo n pro le an Re on pon tra nt l an t re o en e a t on to e ta en at erent le el o un at on el er te ateTable u 4.1.8: et relea Issues e an and len Recommendations t pro e from Provincial and National Review Meetings a le 1 8 u et to e relea e at t el / H /D HS or u u ro a, le / on tra nt A t on to e ta en Re pon l t n lear an too u t e on u n ate u et relea e an len t pro e a learan e an pro ure ent pro e pro e or ta learan e an u et to e relea e at t el / H /D H /D HS HS/ D or u u a, oul e a t, ea an tran parent pro ure n lear ent an too u t e on u n a learan e an pro ure ent pro e pro e or ta learan e an H /D HS/ D a o tra ne an l ul u an oul e a t, ea an tran parent re our pro e ure n ne ent l or e tru ture an All ne l appo nte an re oul e re u n a no tra e t ne onal an po t l ule en u on an D HS/ H re our e n ne l or e tru ture an tra ne a out an pro ra e t on ur n t e re tru tur n All ne l appo nte an re oul e re u n n e t onal po t e en on D HS/ H tra ne a out an pro e pro ra e t on ur n t e re tru tur n na e pro uate e HRH e pe all n etro/Su ro on or u ent a nator or t e oH/DoHS/DH , etropol na e tan, uate HRH H e / pe n t al tut l n onal etro/Su l n ro etro on / Su or u etropol ent a nator tan, or H t / e oH/DoHS/DH o al o , ern ent an ll e etropol ne tan, D o AH H / n t tut A onal ( or l n n etro t tut / Su onal etropol l n tan, H / o al o ern ent a nat an on ll ) e ne D o AH A ( or n n t orporate tut onal l re n pon l t o el er n a nat on ) n orporate un at re on pon er l e t o n o el De er n r pt on o all HA, un SAH at on , AH er /A e n o to De on r pt u on t o all HA, SAH , AH /A to on u t un un at at on on e e on on na e na uate e uate oor oor nat nat on, on, olla olla orat orat on on an ooperat an ooperat on non all n le all le el el oor ual oor t ual t un un at on at on ata ata n n er er o o nt nt upport upport e e uper uper on o on o un at un on at H on /H / H ro /H n e/ / ro n e/ an o an er repoo er report n rt n a a per per H H S S D/H S D/H S Stren Stren t t en en upport upport e uper e uper on at onall le at el all le el uarterl uarterl re re e e o per o per or or an e an o e ata o at ata at H /DH le el a H S 9 2, 9 an 2 5 H ro /DH on o le D el SA a to H t e RHDS S 9 2, an 9 an tr t 2 5 ro on o D SA to t e RHDS an tr t DoHS, Annual Report 2075/76 (2018/19) ami a
ro le / on tra nt A t on to e ta en Re pon l t ate u et relea e an len t pro e u et to e relea e at t el / H /D HS or u u a, n lear an too u t e on u n a learan e an pro ure ent pro e pro e or ta learan e an H /D HS/ D oul e a t, ea an tran parent pro ure ent a o tra ne an l ul u an re our e n ne l or e tru ture an All ne l appo nte an re oul e re u n n e t onal po t e en on D HS/ H tra ne a out an pro ra e t on ur n t e re tru tur n pro e o a e e ent o D a or n to r entat on, apa t u l n an oH , o A D, nat onal tar et e po er ent o lo al o ern ent DoHS/ D, A elerate o ull un at on e larat on at ro n e, un pal all le el oor nat on t nter e toral ta e ol er o pro n al a ne tore at arnal ta l ent o ne a ne tore at arnal H /D HS/ ro ro n e an pro n e o 2 ro n e an pro n e o 2 n e na e uate u p ent repa r, ro on o en neer an re r erator DoHS/ D/ D a ntenan e an repla e ent, la o te n an at pro n al le el te n an Suppl o ol a n pare part Repla e ent o a e n e u p ent re ular repa r o ol a n e u p ent na e uate a ne Store apa t Stren t en t e a ne tore t ne oH , DoHS, D, pe all entral le el u l n n entral tore D
DoHS, Annual Report 2075/76 (2018/19) ami a
DoHS, Annual Report 2075/76 (2018/19) ami a 4.2 Integrated Management of Neonatal and Childhood Illnesses (IMNCI)
4.2.1 Background
Chronological development: Community Based-Integrated Management of Childhood Illness (CB-IMCI)
a i i a i t ga t ia a i a g am a i i at i t t i at t g am a i i at i ma imi t at i at t a m a t atm t m at t mm it i t a a t i i t i a t at t atm t m a m a a i t mm it t a a m i t a m i it a am a B g am a at t m m t t i a imm i a a i at i t B g am g am a i t i a a i i t i t a a t t t mm it a i a t g m t i t m g t B i t i a am it a mm it Ba t g at a ag m t i B a it ta g t am a a i am a t B i t ma i i i a i m ia ia a ma a ia m a a ma t i t at gi a t i im i g g a a ma ag m t i a t i i a a t t m t gt i g a im i g mm it a a a i g m a a i m ta it a i at i B g am i a i im m ta B a m t i a i i i a g im ta t i t
Community-Based New Born Care Program (CBNCP)
t a a ma a g g i a i a t m ta it t ata m ta it a t ggi a t t a ta g t i t ia at mm it tat t t at ma a m ta it i at i a ia i t ig t a t mia m t a m at t a a ata a t t at g Ba t i mm it Ba a g am B a ig i a i t i B i at t at gi i t a i a g mm i a m i t a i t ata a ma ag m t ata i a i t ig t a ma ag m t t mia a g i a ita i t a ia t m i t m i i t a t a a i t im m t t i i ig at aimi g t t m i i a i t g m t i t a B a im ta t g am a a at i i t i t i t t B a im m t i i t i t i g t a
a t B g am t at g t a m ia a ia a a ig i a t t a t a a i g a a a a im B g am a m t m a mm it a g am a t i t i a a ig t i t t t ata i m ta it a i a a m ta itami g am a a g am imm i a t t a a a a im i B im m t i t i t
DoHS, Annual Report 2075/76 (2018/19) ami a t t g am B a B i a t i a t i i t a it a ag i B a B a imi a i i i t g am ma ag m t i i a ta g t ia i i a t g am a i at i t i ma ag m t ata i m a a a i a ma ag m t i t ig t g a i g g i m a t a i t a ma i i i t a it a a ma i i a agm t ma t am i it i a it i i a i a t ma a g i a i a t g am a t g a i a a a g i g t a t t m i i g t i i t i t g at B a i t a a ag t at i am a B
Community-Based Integrated Management of New-born and Childhood Illnesses (CB-IMNCI)
B i a i t g a B a B g am a t i i t i i t g at a ag i i a i t a t ma m i a i t a ia a t ia i a i t mia i t ig t a i g a i g t a mai tai it aim t a ma i i i m ia ia a a a ia a a a t i am g a i i a i a
B g am a t a t m a a i mat a a i a t a i i g a mm i i i t i i i i i i t i a m t a iag i a imm iat a i a a a g ig t at a a am g i a i a t i a i a t i i ma ag m t at i g a i t ig t a i mm i i a ma ag m t ata i t g am a i i t t ata i it t ai a t t g ima a t a t a i i
g am a i i t a t a t a it a a a m it i g t t B g am i i a t ai i g it a a t a ag t ai i g i t a t a i g t a i im m ta t g am it m it i g a i i t t gt t g am a it a i g t a t i i a i am g a t B g am a im m t i a i t i t
Facility-Based Integrated Management of Childhood and Neonatal Illnesses (FBIMNCI)
a i it Ba t g at a ag m t ata a i B a ag a ig ia t a i a m i a a t i t t ig i t a ag i i t g it t g i g mm it Ba t g at a ag m t ata a i B a ag i t t i g t i g ga i t ma ag m t m i at ata a i i a i it t g a a im m ta t i a ag t im m t i ata a i a t a t i a ag a t ma a i i i i g m g iag a atm t a t ma a a t mm i i t a iag i a t atm t ia a g ia a ma t i a a mia t aim t a a itat t am a t at i t i t ita it i g a i t ma ag m i at a ata a a t m a ma ag m t a a i t ai i g a ag i i t a am i DoHS, Annual Report 2075/76 (2018/19) ami a a i g ta a a t a at i t i t a gi a a gi a ita
Comprehensive New-Born Care Training package
i i at a i i t a t a a mi g a i t a at t i ata m ta it a t t t t a i g t at m i a ai i g a ag ita a a i t i t ai i g t a iat i ia i m i a a m i a i g i t ita i i g a i i i t gt a t t m t t ai a i a t i a a t a i i i i a a t ai i g a ag t t a t t a i i a g a ma ag m t ma a a i i a ag i g i a ma i g ata ita t ma t i ma ag m t i a a ma ag m t i at i ig t a g ta ata i a mm ata t ai i g a ta t m t m a a a m t gi
a a a t ai i g t a m i a ai i g a ag i a a g t ai i g i i a it ami a i i i
Free New-Born Care Services
m t a a ma i i t a g i t t g a it a t a i t t im t i g am i t t a t i a t a t a i t t t Ba t t atm t i t t i t i a a i i t a ag B a i a t t a a ag i t i t ita it ia a it a ag B a a ita a t t a ita ata t i a it i a ag g m t a ma i i i g t a i i t im m t t a a ag t g t a g a t a i a ag i t a i t tai a m t g a t m ta it t g i a i g a t a i g am ma t i i i i g t a t a t i t i i i g a t i a t i
Nepal Every Newborn Action Plan (NENAP)
it t i i a t t i ta at i t g a i a t i t at a m a i a i i t i a a t i t a a i i at t g t at gi i i a ita i a a t i a it a m t a a a a m a a a a a aim t a i t a at i i t a a i t at t a i t t ta i t t a
DoHS, Annual Report 2075/76 (2018/19) ami a 4.2.2 Goals, targets, objectives, strategies, interventions and activities of IMNCI program
Goal m a i i a a a t g t a m t • Targets of Nepal Health Sector Strategy (2015-2020) m ta it at i i t t ata m ta it at i i t t
• Targets of NENAP ata m ta it at i i t t i t t ta i t t
• Objectives ata m i it a m ta it m g a a i ata m i it a m ta it ma agi g ma a i m i it a m ta it ma agi g ma a i am g a i
• Strategies a it a t g t m t gt i g a a i ia i a i a a t a t a i a g i a t a a it i i g t i a t a t a i i a t g ma g a a i m t t a i a i a a i g a g ammi g
4.2.3 Major interventions
• Newborn Specific Interventions m i t a a m a a a a t ata a t m t a a a ma ag m t at i g a i at i t a a ma ag m t t m a i t ig t a i a ag m t i am g g i a t a i i g ia a
• Child Specific Interventions a ma ag m t i ag t m t ma i i i a m ia ia a a t i a a a a ia
• Cross-Cu ng Interventions B a i a a g mm i a a t g a a i a m a gi a a ita m g at t mm i a a t i a a i i m i t a mm i a i a
DoHS, Annual Report 2075/76 (2018/19) ami a Vision 90 by 20 Vision 90 by 20 Vision 90 by 20 Figure 4.2.1 CB IMNCI Program VisionInstitution al Delivery Institution al Delivery Under 5 children with Newborn To provide service Pneumoni who had Under 5 to 90% of targeted a treated CHX gel children group by 2020 with applied with Newborn Antibiotics To provide service Pneumoni who had to 90% of targeted a treated CHX gel group by 2020 with applied Antibiotics Under five children with Diarrhoea Under five treated children with ORS with and Zinc Diarrhoea treated with ORS Figure 4.2.1 CBa ndIMNCI Zinc Program Vision pro ra a a on to pro e tar ete er e to 90 o t e e mat popula B g am a a i i t i ta g t i t t mat a Figure 4.2.1 CB IMNCI Program Vision a i t iag am 2020 a o n n t e a ra elo pro ra a a on to pro e tar ete er e to 90 o t e e mat popula 4.2.4 Major activities 4.2.4 Major2020 activities a o n n t e a ra elo a a i a i t t g amm i a i ta a or a i e arr e out un er t e pro ra e n 2075/76 ere a o n n ta le 4.2.4 Major activities elo Capacity Building a or a i e arr e out un er t e pro ra e n 2075/76 ere a o n n ta le elo o pre en e e orn are ( e el ) 5 at e o tra n n one 95 e al o Capacity Building ra n n to e al er tra ne o pre en e e orn are ( e el ) 5 at e o tra n n one 95 e al o tra n n or e al er at e o tra n n one 57 e al o ra n n to e al er tra ne tra ne tra n n or e al er at e o tra n n one 57 e al o tra i g i g ta 6 at e o tra n n one 1 5 para e an para e tra ne tra ne tra i g i g ta 6 at e o tra n n one 1 5 para e Equipmentan para and supplies e tra ne ro ure ent o e u p ent or 0 et o p otot erap pro ure Equipment and supplies S / ro ure ent o e u p ent or 0 et o p otot erap pro ure ro ure ent o e u p ent an ar ou e u p ent an e ne or pro ra S / e ne or pro ra ( RS, n , A o ll n, enta n, loro e ne el) ro ure ent o e u p ent an ar ou e u p ent an e ne or pro ra ere pur a e e ne or pro ra ( RS, n , A o ll n, enta n, loro e ne el) Revision of Guidelines ere pur a e Re on o o pre en e e orn are ( e el ) ra n n a a e Revision of Guidelines Re on o o pre en e e orn are ( e el ) ra n n a a e DoHS, Annual Report 2075/76 (2018/19) ami a
Re on o ra n n a a e Vision 90 by 20 Re on o u t an A e u el ne Re on o ree ne orn are u el ne Institution al Establishing/strengthening SNCU Delivery otal e ta l e l ate 8 o p tal otal S e ta l l ate 21 o p tal Under 5 children Printing of training materials with Newborn To provide service Pneumoni who had to 90% of targeted a treated CHX gel i o , o pre en e e orn are ( e el ) ra n n ater al ( u el ne , group by 2020 with applied Antibiotics Han oo , art, le , et ) Implementation of newborn services and other programs Under five children with ro on o u et or ree e orn are Ser e n 68 o p tal n 2075/76 Diarrhoea treated with ORS ple enta on o Re ote area u el ne or and Zinc
Figure 4.2.1 CB IMNCI Program Vision 4.2.54.2.5 CB-IMNCI CB-IMNCI ProgramProgram MonitoringMonitoring Key Indicators pro ra a a on to pro e tar ete er e to 90 o t e e mat popula 2020 a o n n t e a ra elo g a m it i g i im ta t ma ag m t g am B g am Re ular on tor n portant or e er ana e ent o pro ra ere ore, pro ra a i ma i i at t m it t g am t at a i t 4.2.4 Major activities a en ma or n ator to on tor t e pro ra t at are l te elo
a or a i e arr e out un er t e pro ra e n 2075/76 ere a o n n ta le i t a i o n tu onal el er a a i i i g imm iat a i t it i elo i a t m t it B i i g m t tami i o ne orn o a appl e lor e ne el e atel a er rt ( t n one our) Capacity Building i it m ia t at it a i o n ant (0 2 ont ) t S re e n o plete o e o n n enta n i it ia a t at it a i o pre en e e orn are ( e el ) 5 at e o tra n n one 95 e al o t t o un t er 5 l ren B t pneu mm i on a treate at a t t a a i it o i tami i ra n n to e al er tra ne m i i i t im o un er 5 l ren t arr oea treate t RS an n tra n n or e al er at e o tra n n one 57 e al o i i at Sto t out o t t e a t 5 e a tai o m o e at t ealt i t a l t ( t at RS, i n t , enta i ig n, tra ne i t a i t g a a a imm iat ma ag m t A o ll n/ otr , H ) m i a i i t a ia t at i mat t i t i i g t ata m ta it tra i g i g ta 6 at e o tra n n one 1 5 para e tat B g amm m it i g i i at a mma i i a a All n ator e ept t e la t one are o ta ne ro H S. t e pe te t at t ere an para e tra ne i t onal el er , t ere oul e oo e en al ne orn are an e ate ana e ent o Equipment and supplies o pl a n l e rt a p a t at ll matel ontr ute n re u n t e neonatal ortal t ro ure ent o e u p ent or 0 et o p otot erap pro ure Statu o pro ra e on tor n n ator are u ar e elo n a ollo ( a le S / 2 1) ro ure ent o e u p ent an ar ou e u p ent an e ne or pro ra e ne or pro ra ( RS, n , A o ll n, enta n, loro e ne el) ere pur a e Revision of Guidelines Re on o o pre en e e orn are ( e el ) ra n n a a e DoHS, Annual Report 2075/76 (2018/19) ami a Table 4.2.1: Status of CB-IMNCI programme monitoring indicators by province (FY 2075/76) Table 4.2.2: CB-IMNCI Programme Monitoring Indicators by Province (FY 2075/76)
% of % of % of PSBI cases % of % diarrhoeal institutional newborns received pneumonia cases treated Province deliveries applied complete dose cases treated with ORS and chlorhexidine of inj. with zinc (CHX) gel Gentamicin antibiotics Province 1 62.0 53.2 30.9 128.0 89.5 Province 2 52..7 73.0 58.8 203.0 102.3 Bagmati 61.5 39.5 17.3 111.0 92.6 Gandaki 47.8 45.1 6.5 145.3 97.3 Province 5 78.8 64.1 50.8 127.3 94.4 Karnali 73.2 87.5 56.8 120.2 98.4 Sudur 71.0 74.5 55.1 113.6 93.9 Pachhim National 63.2 59.6 46.3 136.1 95.5 Source: HMIS, 2075/76 a a a ag t a i i i a t it t i a a i The i a ig t i i national average for Institutional deliveries in 2075/76 was 63.2 percent, with lowest in Gandaki province (47.8%) and highest in province 5 (78.8%). i i a a i i t m i i a am g t ta It t i i t i i i a ia a i it ig t i is interesting to note that the compliance of Chlorohexidine use and inj. Gentamicin for PSBI cases was a a i around 50% a only t whereas i use Bagma of antiobiotics i of pneumonia imi a t treatment and use i of tami i ORS and zinc at a a B a am g t m t i a t i for diarrhoeal cases was around 100%. a m t tami i i m t a t B a a t i a it i t a t a it t t i a a i i Chlorhexidine was applied in 59.6 percent of newborn’s umbilical stump (HF+ FCHV) among total expected a i m ia t atm t i g a m t a t i a live births. Province wise wide variation was observed in CHX use with highest use in Karnali i it (87.50%) and lowest a a in Bagmati a ag (39.5%). t ig t i g Similarly, compliance of inj. i Gentamicin at i national level a t i Bagma m ia a t t i for PSBI cases among under two months child was only 46.3%. Four provinces have used complete B t m t t i i at a i t at t m ia a dose of Gentamicin in more than 50% of PSBI cases and three provinces have used it in less t g t t g t atm t t than 30% of cases with lowest 6.5% use in Gandaki province. i a a i i a i t a i a t a i a Use of antibiotics for pneumonia treatment (excluding FCHVs) was more than 100 percent in all seven provinces, B with t atm t national t average of a 136.1 ia a %, highest a use was observed t at in it province 2 a (203%) i Ba ata i i g m ia a t at it a i at a a and lowest in Bagmati (111%). Pneumonia cases reported by FCHV were used to be included till a t i a ig t i i a t i i 2073/74. But, from the 2074/75, the indicator is in the process of revision and the cases of pneumonia4.2.6 Key Achievementsreported by FCHVs for Management are excluded. of 0-28The dayfigure newborn exceeded 100 percent because the treatment of cases by antibiotics other than pneumonia was also added like skin infection, ear infection i etc. which B is actually i a reporting ata error. a i m a t a i i a a i at i t m a i i Asat mm it a i i a mm it ata a t ta per CB-IMNCI treatment protocol, all diarrhoeal cases should be treated with ORS and Zinc. Based on i i m a t a i it i a i it mm it t t t a a HMIS data, U5 children suffering from diarrhoea treated with ORS and Zinc at National level was 95.5%,agg gat ata t i g am B g am a i i at m a m which was highest in province 2 (102.3%) and lowest in province 1 (89.5 %).
DoHS, Annual Report 2075/76 (2018/19) 4.2.6 Key Achievements for Management of 0-28 day newborn Since FY 2064/65, CB-IMCI services data (as received from Health Facilities, VHWs/MCHWs and FCHVs) has been incorporated into HMIS. Therefore, from FY 2064/65 onwards, service provided at community level (PHC/ORCs and FCHVs) is considered as community level data whereas total service provided from Health Facility level in addition with community level constitutes the national aggregate data for this program. CB-IMNCI program has been initiated from FY 2071/72 and from FY 2071/72 Health Facility Level and Primary Health Care/Out Reach Clinics (PHC/ORC) data has been ami a incorporated into HMIS. Consequently, the role of FCHV at community level has been redefined and a t a i it a ima a t a t a i i ata a i at i t t t at mm it a a limited to counselling service for newborn care. Obviously, the treatment protocol has also been imit t i g i a i t t atm t t a a changed and role of FCHVs at the community level has been assigned as health a g a at t mm it a a ig a a t m t at t a a t i i t g a i g t m t promoters/counsellors rather than health service providers. As per the new reporting and recording a i m t ma ag m t i a gi i t ta system, the achievements of management of under 5 children are given in the table below.
TableTable 4.2.3: 4.2.2: Classification Classification and and treatment Treatment of 0-28of 0-28 day newbornDay Newborn cases Cases by province by Province (FY 2075/76) (FY 2075/76) National
% Indicators among Year Sudur
Karnali No. Bagmati Gandaki Pachhim total Province 1 Province 2 Province 5 cases 2073/74 4,573 2,370 2,989 1,888 5,694 3,967 4,261 25,742 NA Total cases 2074/75 3,902 3,055 2,839 2,156 6,425 3,608 3,693 2,5678 NA (HF+ORC) 2075/76 5,233 3,935 3,270 2,479 6,536 3,133 4,520 29,106 NA
Possible 2073/74 578 217 246 124 1035 752 761 3,713 14.4 severe bacterial 2074/75 414 270 265 142 1,096 727 666 3,580 13.9 infections (PSBI) 2075/76 487 278 258 125 1,024 595 635 3,402 11.7 (HF+ORC) Local 2073/74 2,549 1,660 1,296 904 1,887 1,745 2,255 12,296 47.8 bacterial 2074/75 2,206 1,820 1,239 786 1,942 1,220 1,954 11,167 43.5 infections (HF+ORC) 2075/76 2595 2249 1400 821 2075 1235 2351 12,726 43.72
2073/74 298 122 320 296 339 181 184 1,740 6.8 Jaundice 2074/75 255 149 252 324 280 144 121 1,525 5.9 (HF+ORC) 2075/76 301 136 267 314 297 106 114 1535 5.3
% of Low 2073/74 3.98 5.23 5.16 7.40 6.06 8.55 10.55 1,605 6.8 weight or 2074/75 5.9 3.8 6.9 6.0 6.1 14.4 6.8 1838 7.2 feeding problem (HF 2075/76 4.7 4.9 6.7 4.5 4.2 9.5 6.9 1656 5.7 only)
2073/74 357 183 214 88 252 131 185 1,410 5.5 Referred 2074/75 215 258 214 98 259 288 186 5.9 (HF+ORC) 1518 2075/76 268 207 195 88 282 167 202 1409 4.8 2073/74 7 2 13 2 45 12 23 104 0.4 Deaths 2074/75 14 1 16 5 35 19 16 0.4 (HF+ORC) 106 2075/76 27 2 12 6 20 9 26 102 0.4 DoHS,FCHV Annual Report 2075/76 (2018/19) 2073/74 2,607 2,105 1,794 783 1,982 1,391 2,357 13,019 NA Sick baby 2074/75 2,671 2,285 1,862 653 2,469 1,535 1,782 13,257 NA 2075/76 2576 2982 1567 2649 1965 1087 1495 14321 NA
Treated with 2073/74 1656 1121 534 193 1118 865 855 6342 48.7 cotrim and 2074/75 1266 1007 314 95 1005 672 527 4886 36.9 referred 2075/76 1077 1002 228 119 687 459 436 4008 28 2073/74 168 70 155 52 204 145 249 1043 NA Death 2074/75 310 163 177 73 324 117 219 1383 NA 2075/76 524 93 139 63 151 68 216 1254 NA Source: HMIS A total of 29,106 new-born cases were registered and treated both in health facility and PHC/ORC clinic in FY 2075/76. The trend shows that the treatment of new-borns in HF and PHC/ORC clinic has increased by 3428 compared to last year. The highest of 6536 new-born cases in Province 5 and lowest of 2479 in Gandaki Province were treated. In total 3402 (11.7%) cases were classified as Possible Severe Bacterial Infection (PSBI) at national level which is 2% less than that of previous year (13.9 %). The proportion of PSBI was highest in Province 5 (30%) and lowest in Gandaki Province (3.6 %).
Likewise, 43.7% of total cases were classified as LBI, 5.3% as Jaundice, 5.7% as Low Birth Weight or Breast-Feeding Problem. Data shows there is not any significant change in classification and treatment of LBI and Jaundice however, there is slightly decreased in treatment of Low Birth Weight or Breast-Feeding Problem from 7.2 to 5.6 compared to last year. The proportion of LBI is highest in Province 1 (20.39%) and lowest in Gandaki province (6.4%). Similarly, in total 28% of the cases were treated by Paediatric Amoxicillin and 4.8% of total cases were referred from both HF and PHC/ORC weight or 2074/75 5.9 3.8 6.9 6.0 6.1 14.4 6.8 1838 7.2 feeding problem (HF 2075/76 4.7 4.9 6.7 4.5 4.2 9.5 6.9 1656 5.7 only)
2073/74 357 183 214 88 252 131 185 1,410 5.5 Referred 2074/75 215 258 214 98 259 288 186 5.9 (HF+ORC) 1518 2075/76 268 207 195 88 282 167 202 1409 4.8 2073/74 7 2 13 2 45 12 23 104 0.4 Deaths 2074/75 14 1 16 5 35 19 16 0.4 (HF+ORC) 106 ami a 2075/76 27 2 12 6 20 9 26 102 0.4 FCHV 2073/74 2,607 2,105 1,794 783 1,982 1,391 2,357 13,019 NA Sick baby 2074/75 2,671 2,285 1,862 653 2,469 1,535 1,782 13,257 NA 2075/76 2576 2982 1567 2649 1965 1087 1495 14321 NA
Treated with 2073/74 1656 1121 534 193 1118 865 855 6342 48.7 cotrim and 2074/75 1266 1007 314 95 1005 672 527 4886 36.9 referred 2075/76 1077 1002 228 119 687 459 436 4008 28 2073/74 168 70 155 52 204 145 249 1043 NA Death 2074/75 310 163 177 73 324 117 219 1383 NA 2075/76 524 93 139 63 151 68 216 1254 NA Source: HMIS t ta a gi t a t at t i a t a i it a A total of 29,106 new-born cases were registered and treated both in health facility and PHC/ORC i i i t t at t t atm t i a i i clinic in FY 2075/76. The trend shows that the treatment of new-borns in HF and PHC/ORC clinic has a i a m a t a t a ig t a i i a t i a a i i t at t ta a a i a increased by 3428 compared to last year. The highest of 6536 new-born cases in Province 5 and i Ba t ia B at a a i i t a t at i a lowest of 2479 in Gandaki Province were treated. In total 3402 (11.7%) cases were classified as B a ig t i i a t i a a i i Possible Severe Bacterial Infection (PSBI) at national level which is 2% less than that of previous year (13.9 %). The proportion of PSBI was highest in Province 5 (30%) and lowest in Gandaki Province (3.6 i i t ta a a i a B a a i a Bi t ig t %). B a t i g m ata t i t a ig i a t a g i a i a a t atm t B a a i t i ig t a i t atm t Bi t ig t B a t i g m m t m a t a t a B i ig t i Likewise, 43.7% of total cases were classified as LBI, 5.3% as Jaundice, 5.7% as Low Birth Weight or i a t i a a i i imi a i t ta t a Breast-Feeding Problem. Data shows there is not any significant change in classification and t at a iat i m i i i a t ta a m t a treatment of LBI and Jaundice however, there is slightly decreased in treatment of Low Birth Weight i i ig t i i m g a t at a i i i i at ig t m i a or Breast-Feeding Problem from 7.2 to 5.6 compared to last year. The proportion of LBI is highest in Province 1 (20.39%) and lowest in Gandaki province (6.4%). Similarly, in total 28% of the cases were t t i a i t at it t im a a t a i g t it a a m t a a it a i t a treated by Paediatric Amoxicillin and 4.8% of total cases were referred from both HF and PHC/ORC i i t at t t t a g t
4.2.7 Key achievement for Management of 2-59 months children
Diarrhoea
Classification of diarrhoeal cases by province 2075/76
B g am a at a i g i m t t a t i a a i a a t atm t ia a i a B a a t ia a a a i i t t at g i a m a a a t m a a i a t ta ia a a a t i ta
DoHS, Annual Report 2075/76 (2018/19) clinic, highest by Province 5 (20%) followed by Province 1 (19%). Among all treated cases, 0.35% died which indicates very slight reduction from previous year (0.4%).
The percent of the sick babies treated with cotrim and referred by FCHV has shown the decreasing trend. In FY 2073/74, it was almost half (48.7%) whereas it has been declined to 37% and 28% respectively. Likewise, the death reported by FCHV showed the fluctuating trend.
4.2.7 Key achievement for Management of 2-59 months children
Diarrhoea
Classification of diarrhoeal cases by province 2075/76
CB-IMNCI program has created enabling environment to health workers for better identification, classification and treatment of diarrhoeal diseases. As per CB-IMNCI national protocol, diarrhoea has been classified into three categories: 'No Dehydration', 'Some Dehydration', and ‘Severe Dehydration'. The reported number and classification of total new diarrhoeal cases has been presented in table 4.2.3 below. ami a TableTable 4.2.4: 4.2.3 :Classification Classification of of Diarrheal Diarrheal cases Cases by provinceby Province (FY (FY2075/76) 2075/76) (2-59 (2-59 months Months children) Children)
s 1 2 5 Year Sudur Karnali Bagmati Gandaki National Pachhim Province Province Province Indicator
200,17 186,090 205,477 181,071 76,889 206,359 128,064 1,184,120 0 2073/74 15.72% 17.35% 15.29% 6.49% 17.43% 10.82% 16.90% 100.0% 187,87 180,260 208,779 166,644 73,526 203,879 127,271 1,148,238 2074/75 9 15.70% 18.18% 14.51% 6.40% 17.76% 11.08% 16.36% 100%
(HF+ORC+FCHV) 182,32 1,1240,87
Total diarrhoeal cases 174,099 216,837 154,300 67,857 205,759 123,696 5 3 2075/76 15.48% !9.28% 13.72% 6.03% 18.29% 11.00% 16.21% 100%
2073/74 55,474 88,821 47,379 22,220 65,641 45,216 58,433 383,184
2074/75 51,792 94,447 43,143 22,088 67,989 42,918 54,183 376,560 Total 49,678 97,157 41,446 20,249 71,262 45,227 56,183 381,206 2075/76 42,643 69,566 40,920 19,288 56,679 35,058 49,793 313,947 2073/74 76.9% 78.3% 86.4% 86.8% 86.3% 77.5% 85.2% 81.9%
HF + ORC diarrhoeal cases 41201 74,202 37,366 19,570 58,791 33,716 47,160 31,2006 2074/75
No dehydration 79.6% 78.6% 86.6% 88.6% 86.5% 78.6% 87.0% 82.9%
41,225 77,587 36,937 18,438 62,322 36,578 49,288 322,375 2075/76 82.98% 79.86% 89.12% 91.06% 87.45% 80.88% 87.72% 84.57%
12,589 18,937 6,285 2,909 8,585 9,796 8,449 67,550 2073/74 22.7% 21.3% 13.3% 13.1% 13.1% 21.7% 14.5% 17.6% 10,397 19,858 5,690 2,475 8,696 8,801 6,891 62,808 2074/75 20.1% 21.0% 13.2% 11.2% 12.8% 20.5% 12.7% 16.7% 8,257 19,209 4,409 1.744 8,579 8,423 6,746 57,367 2075/76
Some dehydration 16.62% 19.77% 10.64% 8.61% 12.04% 18.62% 12.01% 15.05% 242 318 174 23 377 362 191 1,687 2073/74 0.4% 0.4% 0.4% 0.1% 0.6% 0.8% 0.3% 0.4% 194 387 87 43 502 401 132 1,746 2074/75 0.37% 0.41% 0.20% 0.19% 0.74% 0.93% 0.24% 0.46% 196 361 100 67 361 226 153 1,464 2075/76
Severe dehydration 0.39% 0.37% 0.24% 0.33% 0.51% 0.50% 0.27% 0.38% 141,73 DoHS, Annual Report 2075/76130,616 (2018/19) 116,656 133,692 54,669 140,718 82,848 800,936 7 2073/75 11.03% 9.85% 11.29% 4.62% 11.88% 7.00% 11.97% 67.64% FCHV 133,69 (diarr 128,468 114,332 123,501 51,438 135,890 84,353 771,678 hoeal 2074/75 6 cases 11.19% 9.96% 10.76% 4.48% 11.83% 7.35% 11.64% 67.21% 126,13 124,421 119,680 112,854 47,608 134,497 78,469 743,667 2075/76 8 11.06% 10.64% 10.03% 4.23% 11.96% 6.98% 11.21% 66.11% Source: HMIS In FY 2075/76, a total of 1,124,873 (population proportion of that age group is 38%) diarrhoeal cases were reported out of which more than one third (34%) were reported from health facilities and ORC and rest two third (66%) by FCHVs which showed similar trend like that of previous year. While there were decreasing trend in diarrhoeal cases among five provinces, those of Province 2 and 5 increased in comparison to FY 2074/75. Among registered cases in Health Facilities and PHC/ORC, more than three fourth (85%) were classified as having no dehydration, about one fifth (15.1%) some dehydration. Severe dehydration remained below 1% across all provinces and at national level as well. 41,225 77,587 36,937 18,438 62,322 36,578 49,288 322,375 2075/76 82.98% 79.86% 89.12% 91.06% 87.45% 80.88% 87.72% 84.57%
12,589 18,937 6,285 2,909 8,585 9,796 8,449 67,550 2073/74 22.7% 21.3% 13.3% 13.1% 13.1% 21.7% 14.5% 17.6% 10,397 19,858 5,690 2,475 8,696 8,801 6,891 62,808 2074/75 20.1% 21.0% 13.2% 11.2% 12.8% 20.5% 12.7% 16.7% 8,257 19,209 4,409 1.744 8,579 8,423 6,746 57,367 2075/76
Some dehydration 16.62% 19.77% 10.64% 8.61% 12.04% 18.62% 12.01% 15.05% 242 318 174 23 377 362 191 1,687 2073/74 0.4% 0.4% 0.4% 0.1% 0.6% 0.8% 0.3% 0.4% 194 387 87 43 502 401 132 1,746 2074/75 0.37% 0.41% 0.20% 0.19% 0.74% 0.93% 0.24% 0.46% 196 361 100 67 361 226 153 1,464 2075/76 ami a
Severe dehydration 0.39% 0.37% 0.24% 0.33% 0.51% 0.50% 0.27% 0.38% 141,73 130,616 116,656 133,692 54,669 140,718 82,848 800,936 7 2073/75 11.03% 9.85% 11.29% 4.62% 11.88% 7.00% 11.97% 67.64% FCHV 133,69 (diarr 128,468 114,332 123,501 51,438 135,890 84,353 771,678 hoeal 2074/75 6 cases 11.19% 9.96% 10.76% 4.48% 11.83% 7.35% 11.64% 67.21% 126,13 124,421 119,680 112,854 47,608 134,497 78,469 743,667 2075/76 8 11.06% 10.64% 10.03% 4.23% 11.96% 6.98% 11.21% 66.11% Source: HMIS In FY 2075/76, a total of 1,124,873 (population proportion of that age group is 38%) diarrhoeal a t ta a t at ag g i ia a a t t i m t a t i t m a t a i i cases were reported out of which more than one third (34%) were reported from health facilities a a t t t i i imi a t i t at i and ORC and rest two third (66%) by FCHVs which showed similar trend like that of previous year. a i t a i g t i ia a a am g i t i a i a i m a i t m g gi t a i a t a i i a While there were decreasing trend in diarrhoeal cases among five provinces, those of Province 2 m t a t t a i a a i g a a t and 5 increased in comparison to FY 2074/75. Among registered cases in Health Facilities and m a a mai t a a i a at a a a PHC/ORC, more than three fourth (85%) were classified as having no dehydration, about one fifth (15.1%) some dehydration. Severe dehydration remained below 1% across all provinces and at national level as well.
DoHS, Annual Report 2075/76 (2018/19) ami a ClassificationClassification ofof diarrhoeadiarrhoea disease disease incidenceincidence
TableTable 4.2.5: 4.2.5 Incidence: Incidence and and Case Case Fatality Fatality of of Diarrhea Diarrhea Among Among Children Children Under Under 5 Years5 Years of ofAge by Province (FYA ge2075/76) by Province (FY 2075/76)
Indicators National Year Sudur Karnali Bagmati Bagmati Gandaki Pashchim Province 1 Province 2 Province 5 Province
E stimated 207 3 / 7 4 4 94 , 3 01 6 1 3 , 3 6 1 6 29, 57 7 254 , 998 502, 21 6 1 7 7 , 3 8 9 28 7 , 24 4 2, 959, 08 6 < 5 years population 207 4 / 7 5 4 95, 6 7 1 6 1 9, 3 8 4 6 3 6 , 059 253 , 94 8 505, 950 1 7 9, 4 8 6 28 9, 7 3 9 2, 98 0, 23 7 that are prone to 207 5/ 7 6 4 92, 953 6 20, 4 8 9 6 3 7 , 58 0 251 , 3 3 1 505, 3 6 6 1 7 9, 6 94 28 9, 8 4 1 2, 97 7 , 254 diarrhoea Incidence of 207 3 / 7 4 3 7 6 3 3 5 28 8 3 02 4 1 1 7 22 6 97 4 00 diarrhoea/ 1 , 000 < 5 3 6 4 3 3 7 26 2 290 4 03 7 09 6 4 8 3 8 5 years 207 4 / 7 5 population 207 5/ 7 6 3 51 3 4 7 24 0 26 8 4 04 6 8 3 6 24 3 7 5
Diarrhoeal 207 3 / 7 4 7 1 6 4 1 1 2 2 3 3 deaths ( HF + ORC) 207 4 / 7 5 8 1 4 6 0 1 2 3 4 4 7 207 5/ 7 6 8 11 18 14 1 4 7 63 Diarrhoea 207 3 / 7 4 0. 1 3 0. 1 8 0. 08 0. 05 0. 02 0. 04 0. 03 0. 09 Case fatality rate per 207 4 / 7 5 0. 1 6 0. 1 5 0. 1 4 0. 00 0. 1 8 0. 07 0. 07 0. 1 3 1 000 207 5/ 7 6 ( HF + ORC) 0. 1 6 0. 1 1 0. 4 3 0. 6 9 0. 01 0. 09 0. 1 2 0. 1 7 Source: HM IS/ M D, DoHS As shown in table 4 . 2. 5, incidence of diarrhoea per thousand under 5 years children was 3 7 5 i ta i i ia a t a a i a i in F Y 207 5/ 7 6 , being highest at K arnali ( 6 8 3 ) followed by Sudur Pashchim ( 6 24 ) . Similar i g ig t at a a i a im imi a t a trend was seen in the previous fiscal year. M oreover, the lowest incidence was in B agmati i t i a a t t i i a i Bagma i ta Province ( 24 0) . Total diarrhoeal death in health facility and PHC/ ORC was 6 3 cases which ia a at i a t a i it a a a i i a t t a t a t a a a ata it at a a t i a t a i t i ag increased by 3 4 percent than the last fiscal year. Case fatality rate across all the provinces g was below 1 per thousand in this age group.
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DoHS, Annual Report 2075/76 (2018/19) ami a
TreatmentTreatment of diarrhoeaof diarrhoea
TableTable 4.2.6: 4.2.6 Treatment: Treatment of diarrhoea of Diarrhoea cases Cbyases province by Province (FY 2075/76) (FY 2075/76)
Indicators chim National sh Year Sudur Karnali Karnali Bagmati Bagmati Gandaki Gandaki Pa Province 1 Province 2 Province 5 Total cases 207 3 / 7 4 1 8 6 , 090 205, 4 7 7 1 8 1 , 07 1 7 6 , 8 8 9 206 , 3 59 1 28 , 06 4 200, 1 7 0 1 , 1 8 4 , 1 20 ( HF + ORC+ 207 4 / 7 5 1 8 0, 26 0 208 , 7 7 9 1 6 6 , 6 4 4 7 3 , 526 203 , 8 7 9 1 27 , 27 1 1 8 7 , 8 7 9 1 , 1 4 8 , 23 8 FCHV) 207 5/ 7 6 1 7 4 , 099 21 6 , 8 3 7 1 54 , 3 00 6 7 , 8 57 205, 7 59 1 23 , 6 96 1 8 2, 3 25 1 , 1 24 , 8 7 3
Diarrhoeal 1 6 0, 7 98 1 94 , 7 06 1 6 6 , 94 6 7 4 , 298 1 8 3 , 27 3 1 23 , 1 3 9 1 8 7 , 923 1 , 091 , 08 3 207 3 / 7 4 cases treated 8 6 . 4 1 % 94 . 7 6 % 92. 20% 96 . 6 3 % 8 8 . 8 1 % 96 . 1 5% 93 . 8 8 % 92. 1 4 % with ORS 1 6 1 , 7 94 202, 520 1 55, 7 4 9 7 2, 597 1 93 , 97 6 1 22, 6 7 8 1 8 3 , 7 92 1 , 093 , 1 06 and 207 4 / 7 5 z inc( HF + O 8 9. 7 6 % 97 . 00% 93 . 4 6 % 98 . 7 4 % 95. 7 4 % 96 . 3 9% 98 . 8 2% 95. 20% RC+ F CHV ) 207 5/ 7 6 1 55, 8 1 9 221 , 7 4 5 1 4 2, 8 8 4 6 6 , 056 1 94 , 3 3 0 1 21 , 98 3 1 7 1 , 28 1 1 , 07 4 , 098 8 9. 5% 1 02. 26 % 92. 6 0% 97 . 3 5% 94 . 4 5% 98 . 6 2% 93 . 94 % 95. 4 9% 1 , 1 1 3 2, 28 2 1 , 026 28 5 93 7 97 5 1 , 1 1 7 7 , 7 3 5 207 3 / 7 4 0. 6 0% 1 . 1 1 % 0. 57 % 0. 3 7 % 0. 4 5% 0. 7 6 % 0. 56 % 0. 6 5% Intravenous 6 3 3 1 , 4 58 3 51 1 4 8 1 , 3 6 9 7 27 1 , 029 5, 7 1 5 ( IV ) fluid 207 4 / 7 5 ( HF ) 0. 3 5% 0. 7 0% 0. 21 % 0. 20% 0. 6 7 % 0. 57 % 0. 55% 0. 50% 3 6 8 7 1 5 23 3 1 7 7 7 4 7 3 8 0 259 2, 8 7 9 207 5/ 7 6 0. 21 % 0. 3 3 % 0. 1 5% 0. 26 % 0. 3 6 % 0. 3 1 % 0. 1 4 % 0. 26 % Source: HMIS
t ia a a t at it a i a a a In F Y 207 5/ 7 6 , the proportion of diarrhoeal cases treated with ORS and Zinc as per IM NCI t at a a a t i a a m t imi a t t i a a ig t i am g i t a g it i t mai tai i g a m t t i a national protocol at national level was 95 percent which was almost similar to the previous i i i t a t ia a a t at it i t a year. There was slight difference among provinces treating with ORS & Zinc but i at a t a i i i a i maintaining almost 90 percent in all provinces. L ik ewise, less than 1 percent severe diarrhoeal cases were treated with intravenous ( IV ) fluid at health facilities level in all provinces. Acute Respiratory Infections
B t a t a a a i a Acute Respiratory Infections m ia m ia m ia a gi m t a t at it a iat a i t ig t a t i i a a As per CB - IM NCI protocol, every ARI cases should be correctly assessed and classified as no pneumonia, pneumonia or severe pneumonia; and given home therapy, treated with appropriate antibiotics or referred to higher centre as per the indications. ( See Table 4 . 2. 7 )
16 DoHS, Annual Report 2075/76 (2018/19) Table 4.2.7: Acute Respiratory Infection (ARI) and Pneumonia Cases by Provinces (FY 2075/76) ami a Table 4.2.7: Acute Respiratory Infection (ARI) and Pneumonia Cases by Provinces (FY 2075/76)
Indicators National Year Sudur Karnali Karnali Bagmati Bagmati Gandaki Gandaki Pashchim Province 1 Province 2 Province 5 Target 4 94 3 01 6 1 3 3 6 1 6 2957 7 254 998 50221 6 1 7 7 3 8 9 28 7 24 4 295908 6 population 207 3 / 7 4 ( < 5 years that 207 4 / 7 5 4 956 7 1 6 1 93 8 4 6 3 6 059 253 94 8 505950 1 7 94 8 6 28 97 3 9 298 023 7 are prone to 207 5/ 7 6 ARI) 4 92953 6 204 8 9 6 3 7 58 0 251 3 3 1 5053 6 6 1 7 96 94 28 98 4 1 297 7 254 207 3 / 7 4 1 55205 1 3 1 029 1 09550 6 004 4 1 1 7 4 3 0 7 2254 1 053 7 6 7 508 8 8 Total ARI 207 4 / 7 5 1 4 4 8 1 9 cases 1 3 08 7 4 98 3 96 57 01 4 1 1 7 6 7 5 7 4 97 0 1 01 6 7 8 7 254 26 ( HF + ORC) 207 5/ 7 6 1 56 6 8 2 1 53 7 00 1 0524 7 6 2907 1 298 7 2 7 94 3 2 1 01 93 7 7 8 97 7 7 ARI 207 3 / 7 4 7 1 7 4 7 2 4 3 9 597 57 6 927 992 6 1 2 incidence per 207 4 / 7 5 6 6 6 4 4 8 4 27 57 1 56 4 96 0 97 1 592 1 , 000< 5 year 207 5/ 7 6 6 93 child 4 98 4 3 1 6 1 0 57 9 94 1 93 0 6 08 Total 207 3 / 7 4 4 3 91 3 3 23 3 3 3 203 2 1 3 24 7 27 7 07 208 1 1 24 6 1 9 1 94 6 6 2 Pneumonia 207 4 / 7 5 3 3 93 8 25259 251 4 9 1 04 3 0 253 7 9 1 8 98 5 206 7 3 1 598 1 3 cases 207 5/ 7 6 ( HF + ORC) 3 3 009 23 990 23 8 99 91 94 23 6 3 4 1 7 503 1 96 58 1 508 8 7 Incidence of 207 3 / 7 4 8 9 53 51 52 55 1 1 7 8 6 6 6 pneumonia per 1 , 000 < 5 207 4 / 7 5 1 1 8 6 6 6 0 52 8 0 1 7 1 1 3 0 8 7 children 207 5/ 7 6 1 1 6 6 5 55 58 7 6 1 59 1 1 0 8 3 % of 207 3 / 7 4 28 . 3 24 . 7 29. 2 22. 1 23 . 6 28 . 8 23 . 4 25. 9 pneumonia among ARI 207 4 / 7 5 22. 0 23 . 4 1 9. 3 25. 6 1 8 . 3 21 . 6 25. 3 20. 3 cases 207 5/ 7 6 21 . 1 1 4 . 6 1 8 . 2 22. 0 1 9. 3 ( HF + ORC) 1 5. 6 22. 7 1 9. 1 % of severe 207 3 / 7 4 0. 25 0. 3 0 0. 3 0 0. 1 1 0. 22 0. 51 0. 3 3 0. 29 pneumonia among new 207 4 / 7 5 0. 24 0. 27 0. 1 6 0. 20 0. 1 9 0. 58 0. 23 0. 25 cases 207 5/ 7 6 0. 27 0. 3 4 0. 20 0. 1 9 0. 1 9 0. 52 0. 24 0. 27 % of 207 3 / 7 4 1 7 9. 7 26 4 . 4 1 6 2. 6 27 0. 7 24 4 . 2 1 6 7 . 3 21 0. 3 208 . 9 Pneumonia 207 4 / 7 5 Treated with 1 7 2. 7 296 . 5 1 4 7 . 8 21 8 . 6 1 93 . 0 1 7 3 . 8 1 6 0. 2 1 93 . 1 antibiotic 207 5/ 7 6 1 7 0. 4 28 5. 5 1 4 1 . 7 1 98 . 2 1 6 2. 4 1 3 1 . 8 1 4 7 . 7 1 7 7 . 2 ( HF & ORC) 207 3 / 7 4 1 1 58 7 6 2 1 3 5 20 1 7 6 Deaths due to ARI at 207 4 / 7 5 4 6 6 23 1 2 22 1 9 1 1 1 3 9 HF + ORC 207 5/ 7 6 6 0 41 31 18 15 2 11 178 ARI Case 207 3 / 7 4 0. 09 0. 6 3 0. 07 1 . 1 6 0. 1 2 0. 08 0. 22 0. 28 fatality rate 17 per 1 000 at 207 4 / 7 5 0. 09 0. 01 0. 04 0. 05 0. 04 0. 1 1 0. 04 0. 05 HF 207 5/ 7 6 0. 1 2 0. 07 0. 05 0. 07 0. 03 0. 01 0. 04 0. 06 F CHV 207 3 / 7 4 1 991 1 8 1 58 24 9 1 6 6 7 6 7 921 20 1 7 1 8 6 4 9221 9 1 7 94 97 1 0598 3 4 207 4 / 7 5 Total ARI 1 8 4 3 29 1 4 3 7 59 1 7 04 54 8 8 6 4 5 1 6 54 6 3 953 01 1 7 7 291 1 02524 2 207 5/ 7 6 1 8 7 1 4 5 1 57 6 3 0 1 7 1 3 95 91 53 7 1 6 4 8 22 91 001 1 6 9529 1 03 3 059 Source: HM IS/ M D, DoHS DoHS,In F YAnnual 2075/ Report 76, a total 2075/76 of 7 ,(2018/19) 89, 777 ARI cases were registered in HF and ORC, out of which 19. 1 percent were categoriz ed as pneumonia cases and 0. 27 percent were severe pneumonia cases. The incidence of pneumonia ( both pneumonia and severe pneumonia at HF and PHC/ ORC) at national level was 8 3 per 1 000 under five children. The incidence of pneumonia among under five children has decreased slightly compared to that of last F Y . L ik ewise, highest ARI incidence was seen at K arnali Province ( 94 1 / 1 000 U5 children) followed by Sudur Pashchim ( 93 0/ 1 000 U5 children) and least at B agmati Province ( 431 / 1000 U5 children) . Similarly, B agmati and K arnali Province had the highest percentage of pneumonia cases among ARI cases ( 22. 7 % and 22. 0%) and G andak i Province has the lowest ( 1 4 . 6 %) . ( Table 4. 2. 7 )
The total ARI- related deaths at health facilities were reported to be 1 7 8 which is slightly lower compared to previous F Y ( 13 9) . The ARI case fatality rate per thousand at health facility was increased to 0. 06 in F Y 207 5/ 7 6 compared to last fiscal year F Y 207 4 / 7 5 ( 0. 05) . ARI case fatality rate shows a wide variation in between the provinces ranging from the lowest 0. 01 per 1 000 in K arnali Province to the highest 0. 1 2 per 1 000 in Province 1 .
Other common childhood illnesses
CB - IM NCI Program also focuses on identifying and treating M alaria, M alnutrition, M easles, and other common illnesses among children under five. The interventions to address malnutrition among children are being led by Nutrition Program, interventions to address measles and other vaccine preventable diseases are being led by National Immuniz ation Program, and M alaria by disease control program. IM NCI program actively collaborated with respective programs to address these problems in an integrated approach.
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ami a a t ta a gi t i a t i t at g i a m ia a a t m ia a i i m ia t m ia a m ia at a at a a a i i i m ia am g i a a ig t m a t t at a t i i ig t i i a at a a i i i a im i a a t at Bagma i i imi a Bagma a a a i i a t ig t tag m ia a am g a a a a a i i a t t a
t ta at at at a t a i i t t i i ig t m a t i a ata it at t a at a t a i it a i a t i m a t a t a a a ata it at a i a ia i t t i a gi g m t t i a a i i t t ig t i i
Other common childhood illnesses
B g am a i i g a t a g a a ia a t i a a t mm i am g i i t t a ma t i am g i a i g t i g am i t t a m a a t a i ta i a a i g a a mm i a g am a a a ia i a t g am g am a a at it g am t a t m i a i t g at a a Table 4.2.8: Classification of Cases as Per CB-IMNCI Protocol by Province (FY Table 4.2.8:2075/76) Classification of Cases as Per CB-IMNCI Protocol by rovince (FY 2075/76) Malaria Very severe Falcipa Non- febrile Ear Severe rum falciparum disease Measles infection malnutrition Anaemia Province 1 1 4 1 1 0 1 97 1 5053 590 4 7 3 Province 2 4 9 3 3 2 0 3 1 2 29, 94 2 2, 4 1 1 1 , 94 3 B agmati 2 3 1 0 4 09 9, 7 3 1 4 20 58 2 G andak i 1 0 3 8 0 6 2 5, 6 6 1 4 6 8 3 53 Province 5 26 23 4 0 1 50 1 7 , 8 6 9 2, 28 8 1 , 3 28 K arnali 23 6 1 0 57 9205 1 , 1 8 5 51 4 Sudur Pashchim 1 6 6 7 0 7 5 1 0, 3 21 1 , 7 54 8 8 8 National 140 774 0 1,262 97,782 9,116 6,081 Source: HM IS/ M D, DoHS Under the CB - IM NCI programme, health work ers identified 1 4 0 falciparum malaria cases, t B g amm a t i a i a m ma a ia a 7 7 4 non a i a m - falciparum ma a ia malaria a cases; 1 , 26 2 m a measles a cases; 97 , 7 8 2 ear a infection i cases; a 9, 1 1 6 ma t i a a a a mia a i i a ag i severe malnutrition cases and 6 , 08 1 anaemia cases in children under five years of age in t a i i a i t i a a 207 5/ 7 6 . There were no reported cases of very severe febrile disease in this fiscal year.
4.2.8 Problem, constraints and actions to be taken and responsibility DoHS, Annual Report 2075/76 (2018/19) Table 4.2.9: Problem, constraints and actions to be taken Problem/Constrains Action to be taken Responsibility No sanctioned position for CB - • Policy level decision needed to M oHP, DoHS, IM NCI focal persons at allocate sanctioned position, and FWD municipal and provincial levels mak e necessary arrangements so that there is no void in implementation of Unclarity in roles of staffs in the the program and in service delivery new federal contex t during the transition period Unable to implement free • B etter coordination and collaboration Hospitals, newborn care guideline since last between related hospitals, Palik as, Palik as, HO, F Y as ex pected. D/ PHOs and CHD. B etter orientation FWD about the program and clarity in its implementation modality Insufficient Human Resource in • HR to be deployed by Contract M OHP, F W D, Hospital to implement • training to M O and nursing staff Province, SNCU/ NICU about NICU NHTC
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Table 4.2.8: Classification of Cases as Per CB-IMNCI Protocol by Province (FY 2075/76) Malaria Very severe Falcipa Non- febrile Ear Severe rum falciparum disease Measles infection malnutrition Anaemia Province 1 1 4 1 1 0 1 97 1 5053 590 4 7 3 Province 2 4 9 3 3 2 0 3 1 2 29, 94 2 2, 4 1 1 1 , 94 3 B agmati 2 3 1 0 4 09 9, 7 3 1 4 20 58 2 G andak i 1 0 3 8 0 6 2 5, 6 6 1 4 6 8 3 53 Province 5 26 23 4 0 1 50 1 7 , 8 6 9 2, 28 8 1 , 3 28 K arnali 23 6 1 0 57 9205 1 , 1 8 5 51 4 Sudur Pashchim 1 6 6 7 0 7 5 1 0, 3 21 1 , 7 54 8 8 8 National 140 774 0 1,262 97,782 9,116 6,081 Source: HM IS/ M D, DoHS Under the CB - IM NCI programme, health work ers identified 1 4 0 falciparum malaria cases, 7 7 4 non- falciparum malaria cases; 1 , 26 2 measles cases; 97 , 7 8 2 ear infection cases; 9, 1 1 6 severe malnutrition cases and 6 , 08 1 anaemia cases in children under five years of age in 207 5/ 7 6 . There were no reported cases of very severe febrile disease in this fiscal ami a year. 4.2.8 Problem, constraints and actions to be taken and responsibility 4.2.8 Problem, constraints and actions to be taken and responsibility Table 4.2.9: Problem, constraints and actions to be taken Table 4.2.9: Problem, constraints and actions to be taken Problem/Constrains Action to be taken Responsibility No sanctioned position for CB - • Policy level decision needed to M oHP, DoHS, IM NCI focal persons at allocate sanctioned position, and FWD municipal and provincial levels mak e necessary arrangements so that there is no void in implementation of Unclarity in roles of staffs in the the program and in service delivery new federal contex t during the transition period Unable to implement free • B etter coordination and collaboration Hospitals, newborn care guideline since last between related hospitals, Palik as, Palik as, HO, F Y as ex pected. D/ PHOs and CHD. B etter orientation FWD about the program and clarity in its implementation modality Insufficient Human Resource in • HR to be deployed by Contract M OHP, F W D, Hospital to implement • training to M O and nursing staff Province, SNCU/ NICU about NICU NHTC L imited IE C/ B CC interventions • M ore priority be given to the NHE ICC, as compared to the approved IE C/ B CC interventions so as to F W D, HO, program implementation improve19 the demand for CH services Palik as, HF by all concerned stak eholders guideline, so as to improve the demand of CH services F req uent stock outs of essential • Timely supply of commodities F W D, M D commodities in districts and communities L ack of eq uipment to deliver • Timely procurement and supply of M D, F W D newborn & child health services eq uipment at service delivery points Poor service data q uality • Carry out routine data q uality M D, F W D assessments • Strengthen regular feedback mechanisms Poor q uality of care • Strengthen q uality improvement M D, F W D, system Province, HO • E nhance the use of health facility q uality improvement tools • Onsite coaching • Supportive supervision Increase in percentage of severe • Targeted interventions ( B CC Province, HO pneumonia cases activities, and for early detection, treatment and referral) needs to be focused L imited engagement of private • E nsure better involvement of private DoHS, F W D DoHS,sectors Annual Report 2075/76 (2018/19) sector to ensure q uality services are provided with proper follow up of childhood treatment protocols. Poor referral mechanism • Strengthen the referral mechanism F W D, HO
20
L imited IE C/ B CC interventions • M ore priority be given to the NHE ICC, as compared to the approved IE C/ B CC interventions so as to F W D, HO, program implementation improve the demand for CH services Palik as, HF by all concerned stak eholders guideline, so as to improve the demand of CH services F req uent stock outs of essential • Timely supply of commodities F W D, M D commodities in districts and communities L ack of eq uipment to deliver • Timely procurement and supply of M D, F W D newborn & child health services eq uipment at service delivery points Poor service data q uality • Carry out routine data q uality M D, F W D assessments • Strengthen regular feedback mechanisms Poor q uality of care • Strengthen q uality improvement M D, F W D, system Province, HO • E nhance the use of health facility q uality improvement tools • Onsite coaching • Supportive supervision Increase in percentage of severe • Targeted interventions ( B CC Province, HO pneumonia cases activities, and for early detection, ami a treatment and referral) needs to be focused L imited engagement of private • E nsure better involvement of private DoHS, F W D sectors sector to ensure q uality services are provided with proper follow up of childhood treatment protocols. Poor referral mechanism • Strengthen the referral mechanism F W D, HO
20
DoHS, Annual Report 2075/76 (2018/19) ami a 4.3 Nutrition
4.3.1 Background
t i ami a i i i a tm t a t i i i t a t a a i i a a t i i i t t im t t i a tat i g a t a a ta g m a a t g a a a t i g amm t a i i g a t mai tai a a t i t t i t i t i mi m t t t t g im t i g am im m ta i a a it a t t t i i t a t ig a it a a i tm t a ai i g ma t tai a m t a it t a at a tai i tm t i t i t i t a i am i t g a i it a im t i a m t tai a ag i t i a t i at a t t tai i i at a ig a t t t i a ig m t it i t a a a a a a a ma t a a a i i i a a a t t i a a a a t i i a a a t t t at g a a a a g i t m t t at g t m t a i mmi a t at it i a a t t a at t i a t a t ia i t im a t t i t m t t ig t t a t a t i t a i g a t i t i t i i ma t i a i t at a t i a g i a i t t a m t it a m mi i mi m t
Focus on nutrition t i i a g a g i m t ag a i t a a g a m m t a a at t i m t t a t m a m i im m ta a mat a i a t a g i t i i i a t i g a t i ta g t t at aim t
a i a i t m i a t t a i a i t m i a t t a i a a a mia i m ag a i a i i t ig t t at t i i a i i ig t i a t at i a i g i t t m t t at a t a mai tai i a g t t a
a i g t i i i a a m t a a im t i i g t t a i t a a a i g t i a a i t m a a t t t i t m t a a a a i a t t t t i a i it a i i a a a t i t i i g t t a ag g imi a it a a m i ag a aimi g t a t i m t it t aim t i a a m a a am t at it i i g t t a a ai a t im m t t mmitm t ma at t a a t i a t g a tai a m t
Policy initiatives a a t i i a t at g a ia i t a a m ma t i im m g t i i a i i t
DoHS, Annual Report 2075/76 (2018/19) ami a t g t a t t t at i t t at gi a g amma i t i i t i a t g a t t imi a t t i a i i a a a a i am t i it i a t a t t i at t a a a i g mmi i i a a i g i a t i i a t i i i t a a a g a i g i m t t i i a i i t t g t t t a a a t i ig ig t t g t agai t ma t i a im t i t g m a it t i g at a t a t i i a mmi a t i t ami a i i i ma i a t i i i a ta i i it t m i t i a t m a t g m t i i t i a a tm t ag i a m t a t t at i t i a g i a t i i a i i t t g m t i a a i i ma i g
ig i g it t a ma a a a t i a a a t t t at g a a t g a i i a t i ami a i i i a a a t i t at gi a a im i g t mat a i a t a g i t i a i t t ag i a t i i a mmi a mm t a t i m t a a a i a g i i t a ga i a a a ag m t t a ta i i g a a a t i t a a t t i t i i t a t a a t i i i t
4.3.2 Malnutrition in Nepal
a a ma ig i a t g i i g t g i a i t g a m t i t t i imi a t a g i a g i a i t i a t i a mia am g i i t t t a t g t i mi t i t i t a a itami g amm a g a g i a a g amm a a mia am g m a t a i mai ig i a t a t t m ag a t g a t m a a a mi imi a t i ag m t a a a mi i t a a a mia am g a t m a i a m t i t t i i i t m t i g m i g i a g i t i a i g t ig t
4.3.3 Efforts to address under-nutrition
i i t a t a a a im m g a a i it i t i i i t t a mat a a t a i ma t i i a i ga it g t m it i g g i it m t a t a i i a i a t i a i g a a iat m m ta i g mm it a mi t i t m ta t t a ami a i i i a im m g i g g amm i t a m i B
DoHS, Annual Report 2075/76 (2018/19) ami a
Box 4.3.3.1: Nutrition programmes implemented by FWD Nutrition Section (1993–2018)
Nationwide programmes: Scale-up programmes: t m it i g a m a t g at a ag m t t a i g a t i a t i i i t i t a a mia i t i i t g a g it i a t a g i i g a a t a t atm t a t a t i itami i i g amm i i i i itami m ta t a t ag i m t t a a i i ta mi g a at a i a g mi m a t at a a t a g i t i
Small scale interventions: at a a i a t a t i g am i t i t
4.3.4 Objectives of National Nutrition Programme for health sector:
a t a a t i g amm m t a t t i t a t i a i g t i t t i a mat a m ta it a ita ma m t
i g t t a a t i i a t at g t i a a t i g amm a a
t i g ma t i i i a ag a ag m t a a a mia am g m a i imi at i i i i a tai t imi a imi at itami i a tai t imi a t i ta i t a m am g i a g a t m t a i t ig t im it t t at a a a a at a a ai a i it a i a a t i m t t a g i ta a it t im t t i a tat a t a t i i a t im t i a tat a i m ta it t t i i i t at i a a a t i a t i t a a m at i a a ia t i i a mia t im a t a t i a tat i t i a i ma t i a i i g a i t i m ta t gt t t m a a i g m it i g a a a g t t i it a
DoHS, Annual Report 2075/76 (2018/19) ami a 4.3.5 Targets
4.3.5.1 Current Global Nutrition Targets and Nepal s Status a. Sustainable Development Goal
a a tai a a a a a t t ta g t it t a at a tai i tm t i g t i t i t a i am i t g a i it a im t i a m t tai a ag i t i a t i at a t t a tai i i at t at a ig a t t t i imi a i t a t m a m i m m ta a at a a t a g i t i i i i g a t i ta g t Ba t a t i ta g t t m a a t m t i a a it t i ta g t t a i a
Table 4.3.5.1.1: Nepal s Nutrition Targets and Status Against WHA and SDG Targets Table 4.3.5.1.1: Nepal’s nutrition targetsand status against WHA and SDG targets SN Indicators Situation in Nepal SDGs Target (2030) 2011 2016 for Nepal 1 Reduction in the number of 40.5% 35.8% 15.0% children under - 5 who are stunted 2 (a) Reduction of anemia among 35.0% 40.8% 10.0% WRA (b) Reduction of anemia among 46.2% 52.7% 10.0% Children >5 3 Reduction in low birth weight 12.1% 12.3% <5%
4 Ensure that there is no increase in 1.4% 1.2% <1% childhood overweight 5 Increase rate of exclusive 69.6% 66.1% >90% breastfeeding in the first 6 months 6 Reduce and maintain childhood 10.9% 9.7% <5.0% wasting
4.3.5.2 National Nutritional Status and Targets 4.3.5.2 National Nutritional Status and Targets National Planning as the lead and coordinating agency for both nutrition specific and sensitive a a a i g a t a a i a g ag t t i i a i interventions of Nepal, collects, compiles and interprets the progress of the interventions against nutrition i t a t m i a i t t t g t i t agai t specific, sensitive interventions and enabling environment. MSNP-II has set the targets from 2018 to 2022 t i i i i t a a i g i m t a t t ta g t and making its links with WHA targets 2025 and SDG targets 2030. Therefore, the current nutrition status m t a ma i g it i it ta g t a ta g t as per the set targets for MSNP II, the status of nutrition in Nepal is as follows: t t t i tat a t t ta g t t tat t i i a i a Table 4.3.5.2.1: Nepal’s progress against the MSNP 2 targets (2001–2016)
Indicators Status (%) Target (%) NDHS NDHS NDHS NDHS MSNP WHA SDG 2001 2006 2011 2016 2022 2025 2030 Stunting among U5 children 57 49 41 36 28 24 15 DoHS, Annual Report 2075/76 (2018/19) Wasting among U5 children 11 13 11 10 7 <5 4 Underweight among U5 children 43 39 29 27 20 15 10 Percentage of LBW - 14 12 12 10 <1.4 <1.4 Exclusive breastfed - 53 70 66 80 85 90 Fed according to recommended IYCF - - 24 36 60 70 80 practices Over-weight and obesity among U5 - - - 2.1 1.4 1 <1 children Anaemia among U5 children - 48 46 53 28 20 <15 Anaemia among children under 6-23 - 78 69 68 - 60 <50 months Anaemia among women (15-49) - 36 35 41 24 20 <15 Table 4.3.5.1.1: Nepal nutrition target and tatu again t WHA and SDG target SN Indicator Situation in SDG Target 2030 Nepal for Nepal 2011 2016 1 Re u t on n t e nu er o 0 5 5 8 15 0 l ren un er 5 o are tunte 2 (a) Re u t on o ane a a on 5 0 0 8 10 0 RA ( ) Re u t on o ane a a on 6 2 52 7 10 0 l ren 5 Re u t on n lo rt e t 12 1 12 5
n ure t at t ere no n rea e n 1 1 2 1 l oo o er e t 5 n rea e rate o e lu e 69 6 66 1 90 rea t ee n n t e r t 6 ont 6 Re u e an a nta n l oo 10 9 9 7 5 0 a t n
4.3.5.2 National Nutritional Statu and Target
at onal lann n a t e lea an oor nat n a en or ot nutr t on pe an en t e nter ent on o epal, olle t , o p le an nterpret t e pro re o t e nter ent on a a n t nutr t on pe , en t e nter ent on an ena l n en ron ent S a et t e tar et ro 2018 to 2022 an a n t l n t HA tar et 2025 an SD tar et 20 0 ere ore, t e urrent nutr t on tatu a per t e et tar et or S , t e tatu o nutr t on n epal a ollo ami a
TableTable 4.3.5.2.1: 4.3.5.2.1: Nepal Nepal s progre Progress again Against t the MSNPthe MSNP 2 target 2 Targets 2001 (2001–2016)2016 Indicator Statu Target NDHS NDHS NDHS NDHS MSNP WHA SDG 2001 2006 2011 2016 2022 2025 2030 Stunt n a on 5 l ren 57 9 1 6 28 2 15 a t n a on 5 l ren 11 1 11 10 7 5 n er e t a on 5 l ren 9 29 27 20 15 10 er enta e o 1 12 12 10 1 1 lu e rea t e 5 70 66 80 85 90 e a or n to re o en e 2 6 60 70 80 pra t e er e t an o e t a on 5 2 1 1 1 1 l ren Anae a a on 5 l ren 8 6 5 28 20 15 Anae a a on l ren un er 6 2 78 69 68 60 50 ont Anae Anae a a a a on on o o en en (15 (15 9) 9) 6 6 5 5 1 1 2 2 20 20 15 15 Anae Anae a a a a on on pre pre nant nant o o en en 2 2 8 8 6 6 5 5 25 25 Anae Anae a a n n a a ole ole ent ent o o en en (15 (15 19) 19) 9 9 8 5 8 5 6 6 25 25 5 5 25 25 2 o o a a n n e e ( ( 18 18 5 5 / / ) a 2) a on on 26 26 2 2 18 2 18 2 17 17 12 12 8 8 5 5 o o en en 9 1 22 18 15 12 o o er er e e t tor or o o e e e ea a on on o o en en 9 1 22 18 15 12 Anae a n a ole ent o en or 10 19 8 5 6 15 Anae a n a ole ent o en or 10 19 8 5 6 15 ear a e ear a e 4.3.6 Progra e trategie 4.3.64.3.6 ProgrammeProgra strategies e trategie e o erall trate e or pro n nutr t on n epal are ) t e pro ot on o a oo a e approa , ) oo e a o ort erall at trate t at gi on, ) e t e or upple pro im i g entat n nutr on o t t i on oo n an epal i )are t e a pro ) t e ot pro a on o ot i pu on t o l a m ealt oo a ea e ure a pproa a e , ) a a a ii a iii t m ta a i t m pe oo ort nutr t at on on, trate ) t e e are upple l te entat n o on o 2 oo an ) t e pro ot on o pu l ealt ea ure e i a t m a i t i t at gi a i t i B pe nutr t on trate e are l te n o 2 Bo 4.3.6.1: Specific trategie to i pro e nutrition in Nepal Bo 4.3.6.1: Specific trategie to i pro e nutrition in Nepal Control of protein energ alnutrition PEM Hou ehold food ecurit Control• of ro protein ote rea energ t ee n alnutrition t n one PEM Hou • ehold ro ote food t enecurit ar en an a r ultural • our ro o ote rt rea an t a ee o n pre la t teal n one • ll ro ote t en ar en an a r ultural ee our n o rt an a o pre la teal • ro ote ll ra n o poultr , an l e to • r ee o ote n e lu e rea t ee n or • or ou ro e ote ol ra on n u o pt poultr on , an l e to • r ro t ote ont e lu an e t erea t t el ee n or • n or or o ou e un ol t people on u pt o on to tore an ntro u t on o o ple entar oo pre er e a l oo r t ont an t e t el • n or o un t people o to tore an • n ure ont nuat on o rea t ee n • pro e te n al no le e o oo ntro u t on o o ple entar oo pre er e a l oo or at lea t 2 ear an t e pro e n an pre er at on • n ure ont nuat on o rea t ee n • pro e te n al no le e o oo ntro u t on o appropr ate • ro ote o en roup or n o e or at lea t 2 ear an t e pro e n an pre er at on o ple entar ee n a ter 6 enerat n a t t e ntro ont u t on o appropr ate • ro ote o en roup or n o e DoHS, Annual Report 2075/76 (2018/19) I pro ed dietar practice • Stren o ple t en entar t e apa ee t n o a ealt ter 6 enerat n a t t e or ont er an e al pro e onal or • on u t a tu to lar t e pro le o I pro ed dietar practice • nutr Stren t on t an en t rea e apa t ee t n o ealt ulturall relate etar a t ana or er e entan an e oun al pro ell n e onal or • • ro ooten nutr u t a t on tu e u to at lar on an t a e pro o ate le o • nutr pro t e on no an le rea e an t ee ll n o or oo ulturall et an relate etar etar a t a t ealt ana e or ent er onan ro oun t ell on n tor n • •De elop ro an ote nutr tren t t on en e pro u at ra on an e or a o ate • an pro pro eot no on an le nutr e an t on ll o e a or our oo an et e to an pro etar e etar a t a t oun ealt ell n or er on ro t on tor n • •Stren De t elop en nutr an t onal tren e t u en at pro on an ra e or • Stren an pro t en ott e on an te nutr o ro t on t a o e a a a our t t e an to eel to nate pro oo e ta etar oo a t t at a e t nutr t onal tatu on oun tor ell n n an t uper on an • Stren t en nutr t onal e u at on an • ro ote t e ou e ol oo e ur t • Stren on tor t n en t e te o ro t a o a a t t e to el nate oo ta oo • ro ote to u e o appropr ate lo all pro ra e on tor n an t uper on an t at a e t nutr t onal tatu a a la le o ple entar oo on tor n Infectiou • di ro ea e ote pre t ention e ou and e ol control oo e ur t • n rea e a arene on t e portan e • ro ote to u e o appropr ate lo all • ro pro ote ra no le e e, att tu e an pra t e o appropr ate an a e uate nutr t on a a la le o ple entar oo t at ll pre ent n e t ou ea e or l ren an pre nant an Infectiou di ea e pre ention and control • n rea e a arene on t e portan e • n ure a e to appropr ate ealt • ro ote no le e, att tu e an pra t e o appropr ate an a e uate nutr t on t at ll pre ent n e t ou ea e or l ren an pre nant an • n ure a e to appropr ate ealt Anae a a on o en (15 9) 6 5 1 2 20 15 Anae a a on pre nant o en 2 8 6 5 25 Anae a n a ole ent o en (15 19) 9 8 5 6 25 5 25 o a n e ( 18 5 / 2) a on 26 2 18 2 17 12 8 5 o en o er e t or o e e a on o en 9 1 22 18 15 12 Anae a n a ole ent o en or 10 19 8 5 6 15 ear a e
4.3.6 Progra e trategie e o erall trate e or pro n nutr t on n epal are ) t e pro ot on o a oo a e approa , ) oo ort at on, ) t e upple entat on o oo an ) t e pro ot on o pu l ealt ea ure e pe nutr t on trate e are l te n o 2
Bo 4.3.6.1: Specific trategie to i pro e nutrition in Nepal
Control of protein energ alnutrition PEM Hou ehold food ecurit • ro ote rea t ee n t n one • ro ote t en ar en an a r ultural our o rt an a o pre la teal ll ee n • ro ote ra n o poultr , an l e to • ro ote e lu e rea t ee n or or ou e ol on u pt on r t ont an t e t el • n or o un t people o to tore an ntro u t on o o ple entar oo pre er e a l oo • n ure ont nuat on o rea t ee n • pro e te n al no le e o oo ami a or at lea t 2 ear an t e pro e n an pre er at on ntro u t on o appropr ate • ro ote o en roup or n o e o ple entar ee n a ter 6 enerat n a t t e ont I pro ed dietar practice • Stren t en t e apa t o ealt or er an e al pro e onal or • on u t a tu to lar t e pro le o nutr t on an rea t ee n ulturall relate etar a t ana e ent an oun ell n • ro ote nutr t on e u at on an a o ate • pro e no le e an ll o or oo et an etar a t ealt or er on ro t on tor n • De elop an tren t en pro ra e or an pro ot on an nutr t on e a our an e to pro e etar a t oun ell n • Stren t en nutr t onal e u at on an • Stren t en t e te o ro t a o a a t t e to el nate oo ta oo on tor n an t uper on an t at a e t nutr t onal tatu on tor n • ro ote t e ou e ol oo e ur t • ro ote to u e o appropr ate lo all pro ra e a a la le o ple entar oo Infectiou di ea e pre ention and control • n rea e a arene on t e portan e • ro ote no le e, att tu e an pra t e o appropr ate an a e uate nutr t on t at ll pre ent n e t ou ea e or l ren an pre nant an • n ure a e to appropr ate ealt la tat n ot er er e • Stren t en t e no le e o ealt • pro e nutr t onal tatu to n rea e per onnel on t e etar an l n al re tan e a a n t n e t ou ea e ana e ent o e erel • pro e a e ater uppl e , an tat on an alnour e l ren ou n on t on • D tr ute ort e oo to pre nant • pro e oo ene an la tat n o en an l ren School Health and Nutrition Progra e a e 6 to 2 ont n oo e ent area • u l apa t o pol an or n le el • pro e aternal an a ole ent ta e ol er nutr t on an lo rt e t t rou • e annual tr ut on o e or n pro e aternal nutr t on ta let to ra e 1 to 10 ool l ren • reate a arene o t e portan e • ele rate S ool Healt an utr t on (SH ) o a t onal etar nta e ur n ee n une e er ear to ra e a arene pre nan an la tat on on portan e nutr t on at t e o un t • Stren t en nutr t on e u at on an le el t rou ool l ren an ealt oun ell n e an or er • D tr ute r t a t to pu l ool Control of iron deficienc anae ia IDA • ntro u e l to l an l to parent • A o ate to pol a er to pro ote approa e etar er t Integrated anage ent of acute alnutrition • ron ol a upple entat on or pre nant an po t partu ot er • u l apa t o ealt or er or t e • ron ort at on o eat lour at ana e ent o a ute alnutr t on an roller ll H on reen n o un er e ear • nter ttent ron ol a l ren, re er t e l ren t e ere upple entat on or a ole ent rl a ute alnutr t on to appropr ate a l t or DoHS, Annual Report 2075/76 (2018/19) • ult ple ronutr ent t erapeut treat ent an are an upple entat on or l ren a e 6 oun ell n er e or t e pre ent on o 2 ont a ute alnutr t on • reate a arene o portan e o • ta l an ple entt e e part o t e ron n nutr t on, pro ote A pro ra e o un t o l at on, on u pt on o ron r oo an npat entt erapeut are, outpat ent pro ote er e a l et t erapeut are, ana e ent o o pl at on o e ere a ute alnutr t on • ontrol para t n e tat on a on an ana e ent o A nutr t onall ulnera le roup t rou e or n pre nant o en • ple entt e A pro ra e ollo n an l ren a e 12 2 ont our e pr n ple u a a u o era e a e , t el ne o er e Control of iodine deficienc di order pro on, appropr ate e al an • e un er al o at on o alt t erapeut are an are a lon a t • Stren t en ple entat on o t e nee e o e Salt A t, 2055 to en ure t at • nte rate t e ana e ent o a ute all e le alt o e alnutr t on a ro e tor to en ure t at • e o al ar et n o ert e t o treat ent l n e to upport or l lo o o e alt re a l tat n a e an to er alnutr t on pre ent on pro ra e an la tat n ot er er e • Stren t en t e no le e o ealt • pro e nutr t onal tatu to n rea e per onnel on t e etar an l n al re tan e a a n t n e t ou ea e ana e ent o e erel • pro e a e ater uppl e , an tat on an alnour e l ren ou n on t on • D tr ute ort e oo to pre nant • pro e oo ene an la tat n o en an l ren School Health and Nutrition Progra e a e 6 to 2 ont n oo e ent area • u l apa t o pol an or n le el • pro e aternal an a ole ent ta e ol er nutr t on an lo rt e t t rou • e annual tr ut on o e or n pro e aternal nutr t on ta let to ra e 1 to 10 ool l ren • reate a arene o t e portan e • ele rate S ool Healt an utr t on (SH ) o a t onal etar nta e ur n ee n une e er ear to ra e a arene pre nan an la tat on on portan e nutr t on at t e o un t • Stren t en nutr t on e u at on an le el t rou ool l ren an ealt oun ell n e an or er • D tr ute r t a t to pu l ool Control of iron deficienc anae ia IDA • ntro u e l to l an l to parent • A o ate to pol a er to pro ote approa e etar er t Integrated anage ent of acute alnutrition • ron ol a upple entat on or pre nant an po t partu ot er • u l apa t o ealt or er or t e • ron ort at on o eat lour at ana e ent o a ute alnutr t on an H on reen n o un er e ear roller ll ami a • nter ttent ron ol a l ren, re er t e l ren t e ere upple entat on or a ole ent rl a ute alnutr t on to appropr ate a l t or • ult ple ronutr ent t erapeut treat ent an are an upple entat on or l ren a e 6 oun ell n er e or t e pre ent on o 2 ont a ute alnutr t on • reate a arene o portan e o • ta l an ple entt e e part o t e ron n nutr t on, pro ote A pro ra e o un t o l at on, on u pt on o ron r oo an npat entt erapeut are, outpat ent pro ote er e a l et t erapeut are, ana e ent o o pl at on o e ere a ute alnutr t on • ontrol para t n e tat on a on an ana e ent o A nutr t onall ulnera le roup t rou e or n pre nant o en • ple entt e A pro ra e ollo n an l ren a e 12 2 ont our e pr n ple u a a u o era e a e , t el ne o er e Control of iodine deficienc di order pro on, appropr ate e al an • e un er al o at on o alt t erapeut are an are a lon a t • Stren t en ple entat on o t e nee e o e Salt A t, 2055 to en ure t at • nte rate t e ana e ent o a ute all e le alt o e alnutr t on a ro e tor to en ure t at • e o al ar et n o ert e t o treat ent l n e to upport or l lo o o e alt re a l tat n a e an to er alnutr t on pre ent on pro ra e an • n ure t e te at on tor n o er e o e alt • Support an pro ote , ater, an tat on • n rea e t e a e l t an ar et an ene ( ASH), earl l oo are o o e pa et alt t t e e elop ent, o al prote t on an l t o l lo o ealt an are alon t t e ana e ent • reate a arene a out t e o a ute alnutr t on portan e o u n o e alt to • ro ote t e A pro ra e a t e ontrol o ne e en or er r e et een e er en an ( DD) t rou o al ar et n e elop ent pro ra e a pa n • e upport e uper on an on tor n o A pro ra e a t t e Control of ita in A deficienc • Har on e t e o un t an a l t a e • e annual upple entat on o a e ana e ent o a ute alnutr t on o e ta n A ap ule to 6 59 • Stren t en t e oor nat on an apa t o ont ol nutr t on re a l tat on o e • o t partu ta n A upple entat on or ot er t n Nutrition in e ergencie 2 a o el er • ta l an tren t en e e t e • Stren t en ple entat on o ta n lea er p or nutr t on lu ter ntera en A treat ent proto ol or e ere oor nat on, t l n to ot er lu ter alnutr t on, per tent arr oea, oor nat on e an on r t al nter ea le an erop t al a e toral ue • utr t on e u at on to pro ote • n t ate nutr t onal a e ent an etar er at on an ur e llan e te an /or re n or e or on u pt on o ta n A r oo u an tar an a e ent an n or at on DoHS,• Annual n ur Report n t e2075/76 a a la (2018/19) l t o ta n, A ana e ent ap ule at ealt a l t e • u l a e uate apa t o nutr t on lu ter • n rea e a arene o portan e o e er , partner , ealt or er , H ta n A upple entat on an rele ant ta e ol er or nutr t on n • e annual tr ut on o ta n A e er en prepare ne an re pon e an ap ule to 6 to 59 ont ol re o er a t on t rou H • Support or appropr ate aternal, n ant • A o ate or n rea e o e an oun l ee n ( ) an are to pro u t on, on u pt on an e a e e a e te o en an pre er at on o ta n A r oo l ren • Stren t en t e u e o t e ta n A • n ure a e to appropr ate ana e ent reat ent proto ol an are er e or t e l ren an • ro ote t e on u pt on o ta n o en t a ute alnutr t on A r oo an a alan e et • n ure a e to ronutr ent ro t rou nutr t on e u at on ort e oo , upple ent or ult ple • ro e ta n A ap ule (200,000 ronutr ent or l ren an o en ) to po tpartu ot er t rou • n ure a e to rele ant n or at on a out ealt are a l t e an o un t nutr t on pro ra e a t t e or l ren olunteer an o en ami a
• n ure t e te at on tor n o er e o e alt • Support an pro ote , ater, an tat on • n rea e t e a e l t an ar et an ene ( ASH), earl l oo are o o e pa et alt t t e e elop ent, o al prote t on an l t o l lo o ealt an are alon t t e ana e ent • reate a arene a out t e o a ute alnutr t on portan e o u n o e alt to • ro ote t e A pro ra e a t e ontrol o ne e en or er r e et een e er en an ( DD) t rou o al ar et n e elop ent pro ra e a pa n • e upport e uper on an on tor n o A pro ra e a t t e Control of ita in A deficienc • Har on e t e o un t an a l t a e • e annual upple entat on o a e ana e ent o a ute alnutr t on o e ta n A ap ule to 6 59 • Stren t en t e oor nat on an apa t o ont ol nutr t on re a l tat on o e • o t partu ta n A upple entat on or ot er t n Nutrition in e ergencie 2 a o el er • ta l an tren t en e e t e • Stren t en ple entat on o ta n lea er p or nutr t on lu ter ntera en A treat ent proto ol or e ere oor nat on, t l n to ot er lu ter alnutr t on, per tent arr oea, oor nat on e an on r t al nter ea le an erop t al a e toral ue • utr t on e u at on to pro ote • n t ate nutr t onal a e ent an etar er at on an ur e llan e te an /or re n or e or on u pt on o ta n A r oo u an tar an a e ent an n or at on • n ur n t e a a la l t o ta n, A ana e ent ap ule at ealt a l t e • u l a e uate apa t o nutr t on lu ter • n rea e a arene o portan e o e er , partner , ealt or er , H ta n A upple entat on an rele ant ta e ol er or nutr t on n • e annual tr ut on o ta n A e er en prepare ne an re pon e an ap ule to 6 to 59 ont ol re o er a t on t rou H • Support or appropr ate aternal, n ant • A o ate or n rea e o e an oun l ee n ( ) an are to pro u t on, on u pt on an e a e e a e te o en an pre er at on o ta n A r oo l ren • Stren t en t e u e o t e ta n A • n ure a e to appropr ate ana e ent reat ent proto ol an are er e or t e l ren an • ro ote t e on u pt on o ta n o en t a ute alnutr t on A r oo an a alan e et • n ure a e to ronutr ent ro t rou nutr t on e u at on ort e oo , upple ent or ult ple • ro e ta n A ap ule (200,000 ronutr ent or l ren an o en ) to po tpartu ot er t rou • n ure a e to rele ant n or at on a out ealt are a l t e an o un t nutr t on pro ra e a t t e or l ren olunteer an o en
DoHS, Annual Report 2075/76 (2018/19) ami a
ow birth weight ife t le related di ea e • Re u e aternal alnutr t on • reate a arene a on a ult a out t e pre ent n , AD, DD an DA portan e o a nta n n oo etar ow birth• Re weight u e t e or loa o pre nant ife t le related a di t ea e • Re o u e en aternal alnutr t on • • reateDe a elop arene t e a apa on t a ult or nutr a out t onalt e • pre n ent rea n e a arene , AD, o DD t an e r DA o portan oun e ell o n a at nta ealt n n oo a l t etar e • Re u o e n t e an or al loa o ol o to pre pre nant nant • a t reate a arene a on a ole ent an o o en en • De elopa ult t e a apa out t t e or nutr portan t onal e o ontroll n • n rea e a arene o t e r o oun ell n at ealt a l t e • n rea e a arene o r o earl o n an o e t o n an al o ol to pre nant • reate a arene a on a ole ent an pre nan to n ant an aternal • reate a arene to n rea e p al o en a ult a out t e portan e o ontroll n ealt a t t an pro e tre ana e ent • n rea e a arene o r o earl o n an o e t • pre ro nan ote toa t n ant t e an or nutr aternal t on • reate a arene to n rea e p al ealt on tor n an oun ell n at a t t an pro e tre ana e ent • ro antenatal ote a t l t n e or nutr t on on tor n an oun ell n at 4.3.7 Ma or achie e ent antenatal l n 4.3.74.3.7.1 MajorGrowth achievements onitoring and pro otion 4.3.7 Ma or achie e ent 4.3.7.1 on tor Growth n t e monitoring ro t o and l ren promotion le t an t o ear o a e elp pre ent an ontrol prote n ener 4.3.7.1 Growth onitoring and pro otion alnutr t on an pro e t e opportun t or ta n pre ent e an urat e a t on Healt or er at all it i g pu on l tor n ealt t t e a ro l g t t t e o on l tor ren i t le e ro t an t t o o t a ear l ren t o on a e a e a elp ont pre ag u ent n an t e ontrol ro t t prote on a n tor ener n t ar t at t i g alnutr a e t onon an H pro ma t i ne e t ro e opportun t a tan i t ar or ta t n pre t it ent e an urat ta i g e a t on Healt or a er at a all a a t at a i a t a i i m it t g t i a m t pu l ealt a l t e on tor t e ro t o l ren on e a ont u n t e ro t on tor n ar t at i g t g t m it i g a t at i a g t ta a Gr a owth e on Monitoring H ne Statu ro t FY tan 2075 ar 76 2018 19
Growth Monitoring Statu FY 2075 76 2018 19 Figure 4.3.7.1.1: Percentage of children aged 0 23 Fig 4.3.7.1.2: Percentage of children 0 23 onth onth regi tered for growth onitoring regi tered for growth onitoring who were Figure 4.3.7.1.1: Percentage of children aged 0 23 Fig 4.3.7.1.2: Percentage of children 0 23 onth underweight onth regi tered for growth onitoring regi tered for growth onitoring who were underweight 110106 9 5 98 7 7 8 1 7982 797982 77 7 69 110 7 72 697071 9 5 6 2 6 666 6 6568 106 5 6 56 56 98 9 5 2 55 7 7 8 8 1 7982 797982 1 9 7 777 72 5 66 68 69 697071 6 2 6 6 6 65 2 52 2 2 5 65 2 565556 1 5 9 8 2 1 2 1 1 91 1 5 2 52 2 2 2 1 5 1 2 1 1 1
7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 Sour e H S/ D/DoHS Sour e H S/ D/DoHS Sour e H S/ D/DoHS Sour e H S/ D/DoHS n 2075/76, t e per enta e o l ren a e 0 2 ont re tere or ro t on tor n 71 per ent t tag i ag m t gi t g t m it i g i n 2075/76, t e per enta e o l ren a e 0 2 ont re tere or ro t on tor n 71 per ent t it i a i t m a t a a t ig t ag g t t t n n rea rea e e n 1 n per 1 per ent ent ro ro la t la t al ear al ear n n75/76 75/76, t e , t e e t o e era t o e on era ro e on t ro on t tor n on tor n m it i g i i a a i i i t a t ag i i Bagma i i n n arnal arnal pro pro n n e e e e98 98per per ent entan an lo e lo t e o t era o e era n e a n at a ro at n e ro e n 56 e per e 56 ent per n ent t e e n t e e t t t t ta i a g t m it i g i 75/7675/76, out, out o o total total l ren l ren o atten o atten e e or ro or t ro on t tor on n tor e n on, e 5 on, per ent 5 per ere ent u ere er n u ro er n ro t i g m ig t un un er er e e t t
n n 2075/76, 2075/76, a a on am g on 71 71per per ent, t ent, 5 per 5 per ent o ent t 0 o 2 0 2 ont ont l ren m t l ere ren reporte i ere reporte a un er a t e un er t at e a t at nat nat onal onal le le el el A A or or n n to t to et n e or n or at on, at t on, e t e e t proport e t proport on (6 on 2 )(6 o 2 un ) er o un e er t e l ren t are l ren n are n DoHS, Annual Report 2075/76 (2018/19) ami a ig t at a a i g t t i ma t ig t ig t i a i a a i i a im i i t a t i i a a i i arnal pro n e ollo e Su ur a ro n e 7 (6 2 ) le t e lea t n an a ro n e (1 1 ) ( ure 7 1 1 an 7 1 2) Figure 4.3.7.1.3: Percentage of new born with low Figure 4.3.7.1.4: A erage no. of growth birth weight 2.5 kg a ong total deli er b health onitoring i it per child 0 23 onth worker
5 15 9 8 1 9 6 1 2 2 1 1 5 2 1 1 1 12 6 12 5 2 9 2 9 2 9 11 9 2 7 11 7 11 8 11 2 5 11 11 2 2 1 10 5 10 1 9 1 9 9 5 9 9 8 8 8 8 7 9 8 6 9 6 7
7 /7 7 /75 75/76 7 /7 7 /75 75/76
Sour e H S Sour e H S
a a t tag it i t ig t g i i t at onall t e per enta e o ne orn t lo rt e t ( 2 5 ) 11 2 n t e e 2075/2076 le i i a t a a a it a i a a i a i t a n la t al ear al o t a 7 /75 11 9 A ar a pro n e a on erne n t e e al ear a at a pro n Bagma e a t e i e t per a enta t e ig t o ne tag orn t lo rt e t it e 1 2 per i t ent ig t an arnal i t a a a i i a t t i t it i t ig t ro n e a t e lo e t e 6 7 per ent o ne orn t lo rt e t at onall , t ere a an a era e o t per l n 207 /7 , 207 /75 ut n 2075/76, t e a a t a a a ag i it i i t i a era e t 1 A ar a pro n e are on erne n t e e 2075/76,t e ro n e nu er 2 a t e t a ag i it a a i a i t t i m lo e t a era e ro t on tor n t 2 1 an e t n Su urpa pro n e 2 a t t a ag g t m it i g i it i i a ig t i a im i ( ure 7 1 an 7 1 ) i i ig a 4.3.7.2 Infant and oung child feeding 4.3.7.2Appropr Infant ate ee and n youngan are child pra feeding t e or n ant an oun l ren are e ent al to en an e l ur al, ro t an e elop ent e n ant an oun l ee n ( ) an pra t e n lu e earl iat i g a a a i a t a g i a a t a i n t at on o rea t ee n t n an our o l rt , e lu e rea t ee n or ont an i a g t a m t i a t a g i i g a a i pro n nutr t onall a e uate an appropr ate o ple entar ee n tart n ro ont t a i i a a t i g it i a i i t i a i g i m t ont nue rea t ee n up to t o ear o a e or e on pro n are pra t e relate to a a pr or i i g t trate o t i a oH e a at pro ra a e a a iat een on o n m m ta to all 77 tr t i g ro 2072/7 ta g m i m t it a i g t t a ag m i g a a at al t o l n e i t a i it t e tr t at g ut on o ro nutr ent po er g amm ( aal ta) to 6 a 2 ont g i g l ren t n a 6 i t i t m tr t an l a rant ( ) n 1 tr t Ho e er, ore e e t e oun ell n an on tor n e an are nee e or t e e pro ra e i a i it t i t i mi t i t Baa ita t m t i i i t i t a i a g a t i i t i t m i g a m it i g m a i m a t g amm
DoHS, Annual Report 2075/76 (2018/19) ami a Figure 4.3.7.2.1: Percentage of children aged 0 6 Figure 4.3.7.2.2: Percentage of children aged 6 onth old regi tered for growth onitoring who onth old regi tered for growth onitoring were e clu i el brea tfed for their fir t i onth who had recei ed olid e i olid or oft food
65 5 2 5 60 6 9 5 6 52 5 2 5 0 8 7 7 5 5 5 1 0 2 1 7 0 29 6 5 26 1 1 25 1 29 2 1 27 28 27 21 20 9 20 2 21 15 5 18 1 1 16 12 7 1 7 1
7 /7 7 /75 75/76 7 /7 7 /75 75/76
Sour e H S Sour e H S
i a a g i ia i i t i ag m t gi t g t ere a lar e pro n al eren e n t e l ren a e 0 6 ont o re tere or ro t on tor n m it i g a i a i t i t i m t ag t an ere e lu el rea t e n t e r r t ont a e n 2075/76, per ent o t e e l ren t i a i i a i a i a i m a i t a t nat on e ere e lu el rea t e a n rea e n o par on to la t t o ear 5 per ent o t 0 6 a ont ol t l ren ere m t re tere or ro i t on tor n gi t ere e lu el g t rea t m it i g e or t e r r t i a t i t i m t i a t t imi a ag ont o pro n e 5 erea onl 15 per ent t e lar a e roup are e lu e rea t e n pro n e 2 g a i a i i ig a a a ag i t ( ure 7 2 1) e nat onal a era e per ent, u le er t an t e 2016 epal i i m t a t a m g a i a a t g i De o rap an Healt Sur e ( DHS) ure e 66 per ent t e proport on o 6 8 ont ol l ren re tere or ro t on tor n o re e e o ple entar oo ar e n 2075/76 A out 16 per ent o t e e l ren n t e pro n e 2 ere re tere or ro t on tor n o re m t e e o ple i entar gi t ee n erea g t 60 per ent m it i g o a e a e roup i n t e m m ta a i i t t t i i t i a at pro n e ( ure 7 2 2) at onall , onl per ent o t e e l ren re e e o ple entar gi t g t m it i g i m m ta i g a t oo u lo er t an t e DHS 2016 ure o 8 per ent a e a u e a le re or n am ag g i t Bagma i ig a a t t an report n ro pr ar report n entre el ntro u t on o o ple entar ee n an t e i on e uent i nee to m m ta pro e appropr ate i oun ell i n m to ot er t a an t are er pro e g t e ee n t pra t e i ma a m a i g a g m ima g t im i t m m ta i g a t t t i a iat 4.3.7.3 Integrated anage ent of acute alnutrition i g t m t a a gi im t i g a e nte rate ana e ent o A ute alnutr t on ( A ) ro ra e (pre ou l no n a o un t 4.3.7.3 a e Integrated ana e ent management o A ute alnutr of acute t on malnutrition A pro ra e) pro e t e treat ent o t e l ren t Se ere A ute alnutr t on (SA ) a e 0 59 ont t rou npat ent an outpat ent treat ent er t g at e at a l t a ag m t an o un t le t el a t i pro ra e a p lote g amm n 2009/010 i n e tr t na a el mm it A a , an a anpur, a ag m t u u, ar a an t a ar ot a t i A ter p lot e aluat on n 2011/012, g amm t pro i ra e t a t atm t te ro t A i to A it pro ra e an t ra uall a t i ale up t rou ag out t e ountr m t o er t g n an i a t a t a t t atm t i at a i it a mm it i g amm a ore tr t n t e r t p a e, A a ale up to 11 tr t n 201 ro 6 tr t na el i t i i i t i t am am a a g Ba i a a a a t A a , an anpur, ar a, a ar ot, u la, u u, ap l a tu, Sarla , D anu a, Saptar an i t a a i t i g amm a i m t g amm a al un a an n 2015, t a urt er ale up to 1 eart ua e a e te tr t u a a tapur, g a a a t g t t t i g ma m i t i t t t a D a n , Dola a, or a, at an u, a re, al tpur, a anpur, u a ot, o al un a, Ra e ap, a a t i t i t i m i t i t am am a a Ba i a a a t Ra u a, S n ul , S n upalan o ) n 2016, to a re t e nutr t on pa t o rou t e er en e , m a g a i a t a a i a a a ta i a a ga a i it a t a t a t a a t i t i t a B a ta a i g a a a DoHS, Annual Report 2075/76 (2018/19) ami a at ma a a it a a a t a ga am a a a i i i a a t e pro ra e a urt er ale t up a to 7 a t t onal t i tr t na im a t el al ot, g t Hu la, Dolpa, m g i a an , t g amm a t a t a i a i t i t am a i t m a a Ba a g a ura, a ta , Da el ura, ar a e e, n 2017, t e pro ra e a ale up to Dot , Ru u ea t Ba a Baita i a a a a i i i t g amm a a t m an e t, a alpara ea t an e t, a ottar , otan an an t ar tr t Due to a e loo n a t era a n 2017, t t a a a a a i a a n ale a t up to a apa, t oran a a i , Sun ar , ta ga S ra a, Rauta a t a at, ara, a lal i t i t , Dan an t ma i i ai i it a agai a t a a a g a i i a a a ta at an e tr t n t e eant e,t e pro ra a al o ple ente n a , San u a a a, Ba a Rupan ai a i e , otan a g , a a Ba pur, i t i t t an et n t t m a m t an, t e pro ra g am a a ple ente a im m t n onl e i ag i a a a a a i ta g a it a t it a t g am a pla e to a re t e ue o SA l ren n t e epan o un t e n runn n al ear t e im m t i a t a t i i i t a g mm i pro ra a een ale up n Dar ula tr t Alon t pro ot on an upport, A a to nte i g rate nutr a t on a upport t a g am ro ealt a , earl a l oo e elop i a a ent, ASH i t i t an o g al prote it t on m a t aim t i t g at t i t a a t a i e tor or t e ont nue re a l tat on o a e an to en alnutr t on pre ent on pro ra e an m t er e e pro ra a e al ia o a t t a a r t e et een t e er en an a i ita e elop ent nutr a t on a t i ma t i g amm a i g amm a a t a a i g nter ent on t m g a m t t i i t Figure 7 1: Pro ince wi e IMAM perfor ance FY 2075 76 ig i i ma
85 75 75 7 68 66 61 50 5 29 20 26 1 15 1 0 0 0 1 0 5 0 0 0
epal ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e
Re o ere Deat De aulter
Sour e H S n 2075/76, total 12,1 9 l ren o 0 ont to 5 ear t SA a tte n outpat ent an npat ent t ta i m t t a it a mi i t a t a t erapeut entre A on t e , 1 ,2 0 ere ar e A on all ar e SA a e , 75 per ent i a t t a t m g t m i a g m g a i a g ere re o ere , le t an 1 per ent e an 20 per ent ere e aulter e p ere tan ar or A a t t a t i a t a t pro ra (re o er rate 75 per ent, e aulter rate 15 per ent an eat rate 10 per ent) ure 7 ta a g am i at t a t at t a e pla n a out o erall per or an e o A pro ra e o epal at at t ig ai a t a ma g amm a 4.3.7.4 Nutrition rehabilitation ho e utr t on Re a l tat on Ho e ( RH) are t e a l t a e ana e o e ere a ute alnutr t on 4.3.7.4 Nutrition rehabilitation homes nte rat n t t e nte rat n t o p tal er e n epal, t e e RH are a o ate t pr ar , t i a i ita m a t a i it a ma ag a t ma t i e on ar an tert ar le el o p tal e r t utr t on Re a l tat on Ho e ( RH) a e ta l e n i t g a g 1998 n at it an u t a i t g a g n or t e re it u t on ita o l i ortal t au a e t alnutr t on t a rou a iat npat ent it ima a a t a ita t t i a i ita m a re a l tat on o e ere a ute alnutr t on a on t e l ren un er e ear o a e S n e t en, RH a ta i i i at ma aimi g t i m ta it a ma t i een ale up n erent pla e a ro epal e RH not onl treat an ana e e ere a ute t g i a t a i ita a t ma t i am g t i a alnutr t on t npat ent er e, ut al o pro e nutr t on e u at on an oun ell n to t e ag i t a a i i t a a a t t at uar an /parent or t e ana e ent o o erate a ute alnutr t on a ell a oo nutr t on an a ma ag a t ma t i it i a t i t a i t i a ealt are o t e r l ren n 2075/76, total 2,226 l ren un er e ear t e ere a ute a i g t t g a ia a t t ma ag m t m at a t ma t i a alnutr t on (SA ) ere a tte n t e 18 RH an a on t e 2,19 l ren ere re o ere a g t i a a t a t i i t ta i ar e o e not re o ere ere re erre to t e tert ar ealt a l t e or a an e treat ent a it a t ma t i a mi i t a am g t m Alon t t e treat ent o l ren, 0,626 ot er o a e to t e RH ere oun ele n t e RH i i a g t t t t a a t an n t e o p tal D n t e RH, ot er are e u ate an oun ele on t e etar ana e ent or a i i a a t atm t g it t t atm t i m t am t t i t a i t ita t m t a at a t i ta ma ag m t g i a mai tai t a t i
DoHS, Annual Report 2075/76 (2018/19) ami a
tat i at m i g ta t ma t i oun l ren an a nta n t e en an e nutr t on tatu o SA l ren at o e n 2075/76, oun l ren an a nta n t e en an e nutr t on tatu o SA l ren at o e n 2075/76, a i ita m i a ollo n ta le o t e per or an e o utr t on Re a l tat on Ho e n epal Table ollo 4.3.2: n ta Admission le o t and e per Discharge or an eStatus o utr of t Nutrition on Re a l Rehabilitation tat on Ho e n Homes, epal 2075/76 Province Wise Table 4.3.7.4.1: Ad i ion and di charge tatu of nutrition rehabilitation ho e 2075 76 pro ince wi e Table 4.3.7.4.1: Ad i ion and di charge tatu of nutrition rehabilitation ho e 2075 76 pro ince wi e More Coun eling e More Coun eling e than or to other Total than than or Total to other Total Male Fe ale than e ual Total inhou e ad i ion Male Fe ale fi e e ual Di charge inhou e ad i ion fi e to fi e Di charge and Ho p. ear to fi e and Ho p. Pro ince ear ear OPD Pro ince ear OPD ro n e 1 210 100 110 207 209 1001 ro n e 1 210 100 110 207 209 1001 ro n e 2 589 286 0 571 19 572 9951 ro n e 2 589 286 0 571 19 572 9951 a at ro n e 90 2 6 2 18 72 88 15516 a at ro n e 90 2 6 2 18 72 88 15516 ro n e 05 1 1 16 01 299 887 ro n e 05 1 1 16 01 299 887 an a ro n e 178 9 8 177 1 178 65 an a ro n e 178 9 8 177 1 178 65 arnal ro n e 16 9 70 157 62 157 70 arnal ro n e 16 9 70 157 62 157 70 Su urpa Su urpa ro n e 290 1 1 1 9 60 2 0 290 2 6 ro n e 290 1 1 1 9 60 2 0 290 2 6 epal 2226 1102 112 1891 91 219 0626 epal 2226 1102 112 1891 91 219 0626 Sour e epal out oun at on ( )/Re pe t e RH Sour e epal out oun at on ( )/Re pe t e RH Table 4.3.7.4.2: Ad i ion and di charge tatu of nutrition rehabilitation ho e 2075 76 Di trict Wi e TableTable 4.3.2: 4.3.7 .4.2Admission: Ad i and ion andDischarge di charge Status tatu of Nutritionof nutrition Rehabilitation rehabilitation ho Homes, e 2075 2075/76 76 Di District trict Wi Wise e More Coun eling e More Coun eling e than or to other Total than than or Total to other S.N NRH Total Male Fe ale than e ual to Total inhou e S.N NRH ad i ion Male Fe ale fi e e ual to Di charge inhou e ad i ion fi e fi e Di charge and Ho p. ear fi e and Ho p. ear ear OPD ear OPD 1 Sur et 10 6 0 99 10 270 1 Sur et 10 6 0 99 10 270 2 an anpur 1 66 77 5 108 1 2 1798 2 an anpur 1 66 77 5 108 1 2 1798 Ra ra 171 76 95 168 171 8851 Ra ra 171 76 95 168 171 8851 o ara 1 9 65 7 1 9 0 1 9 27 o ara 1 9 65 7 1 9 0 1 9 27 5 epal un 178 9 8 177 1 178 65 5 epal un 178 9 8 177 1 178 65 6 Da le 61 1 0 58 58 5 200 6 Da le 61 1 0 58 58 5 200 7 at an u 281 1 0 1 1 209 72 275 1101 7 at an u 281 1 0 1 1 209 72 275 1101 8 aratpur 15 80 7 15 0 157 1 1 5 8 aratpur 15 80 7 15 0 157 1 1 5 9 a rapur 119 5 6 119 0 118 8 1 9 a rapur 119 5 6 119 0 118 8 1 10 D an a 1 7 75 72 25 122 1 9 6 8 10 D an a 1 7 75 72 25 122 1 9 6 8 11 r un 215 109 106 20 11 207 890 11 r un 215 109 106 20 11 207 890 12 ana pur 20 101 102 199 5 19 210 12 ana pur 20 101 102 199 5 19 210 1 ut al 115 5 62 115 0 88 510 1 ut al 115 5 62 115 0 88 510 1 a lun 100 6 5 96 9 255 1 a lun 100 6 5 96 9 255 15 ratna ar 91 6 5 88 91 170 15 ratna ar 91 6 5 88 91 170 16 Da el ura 81 2 9 70 11 72 1 8 16 Da el ura 81 2 9 70 11 72 1 8 17 ar at 66 0 6 66 0 66 05 17 ar at 66 0 6 66 0 66 05 18 S n upalan o 56 26 0 56 0 56 270 18 S n upalan o 56 26 0 56 0 56 270 Sour e epal out oun at on ( )/Re pe t e RH Sour e epal out oun at on ( )/Re pe t e RH 4.3.7.5 Pre ention and control of iron deficienc anae ia 4.3.7.54.3.7.5 PreventionPre ention and and control control of ironof iron deficienc deficiency anae anaemia ia oH a een pro n ron ol a ( A) upple ent to pre nant an po t partu o en n e 1998 oH a een pro n ron ol a ( A) upple ent to pre nant an po t partu o en n e 1998 a i i g i i a i m t t g a t a t a t m m to re u e aternal anae a e proto ol to pro e 60 ele ental ronan 00 ro ra ol a i t mat a a a mia t i t i mg m ta i a to re u e aternal anae a e proto ol to pro e 60 ele ental ronan 00 ro ra ol a
DoHS, Annual Report 2075/76 (2018/19) ami a to pre nant o en or 225 a ro t e r e on tr e ter o pro e a e an ut l at on o A mi g am upple ent i , t e a i nten t g a t at on o m aternal an eonatal a m ronutr t i ent ro ra t im t im e ( ) tarte A a upple a entat i a on t rou e ale o m t un t Healt t olunteer t i a ( H ) n 200 at a pro a ra ata e o ere i t i t all 75 tr t g amm n e 201 an no 77 ta t tr t m ta e nten at on pro t g ra e ma pro e mm it o era e, a t t i i g amm a i t i t i a alt ou o pl an e t ta n 180 ta let ur n pre nan an 5 ta let po t partu re a n an i t i t i t i a g amm im ag a t g m ia it ta i g ue ta t i g g a a ta t t a t m mai a i Figure 4.3.7.5.1: Percentage of Pregnant and Figure 4.3.7.5.2: Percentage of Po t Partu Wo en actating Wo en recei ing 180 IFA tablet Recei ing 45 IFA tablet
68 70 62 66 66 61 59 61 57 58 58 57 56 51 50 52 51 55 56 5 6 52 5 6 9 1 7 9 0 0 0 2 8 9 28 0 2 2 28 28 26 27 2 2 22
7 /7 7 /75 75/76 7 /7 7 /75 75/76
Sour e H S Sour e H S
n 2075/2076, er tag enta e o pre g a t nant an la a tat a ta g n o en m re e n i i g 180 A ta let 51 ta t per ent i t i m t a i m a i t t i a a t m i t ee to e rea e n o par on to ot er al ear n ter o pro n e t e e t o era e ig t ag i i a im i i i t a t t i i Bagma n Su urpa ro n e 68 per ent erea t e lo e t n a at ro n e 0 i i i t a i t i a a tag t a t m m er ent erea n t e al ear 75/76, per enta e o po t partu o en re e n 5 A ta let i i g ta t i t i a m ig i t t g a t m i i g i i a i ta t a t a t m m i i g ta t t m 0 per ent onl al o ee eren e et een t e pre nant o en re e n 180 ron ol a i a t i g i ga i g g a t m a t a t m m ta let an po t partu o en re e n A ta let n ter o pro n e al o t ere u e eren e i i g i i a i ta t re ar n pre nant o en an po t partu o en re e n ron ol a ta let 4.3.7.6 Integrated Infant and Young Child Feeding and Micro Nutrient Powder Co unit Pro otion 4.3.7.6Progra Integrated e Infant and Young Child Feeding and Micro-Nutrient Powder Community Promotion Programme e DHS 2006 oun t at 78 per ent o 6 2 ont ol l ren ere anae , t a u e t at o t t at t m t i a a mi it i a m o t e are ue to poor pra t e oH u e uentl en or e a lan o A t on o ro nutr ent t at m t t m a t a t a a pr n le a t e e nter ent on to a re anae a n oun l ren nte rat n t pra t e n mi t i t i a t i t t a a a mia i g i i t g a g 2007, t e at onal utr t on r or t or op en or e a trate to p lot ult ple ro nutr ent it a t a a t i i it a t at g t i t pr n le upple entat on a a pre ent e ea ure a a n t erent ro nutr ent e en or er m mi t i t a on t e l ren a e i 6 2 ont m ta ol n une a 2009, a oH p lote m a t e o agai t e ort i t at on o mi t i t i i am g t i ag m t o ple entar oo t or 6 2 ont ol n tr t na el or a, Ra u a, a anpur, i t ar a, Sun t ar m an a oran nte rat m m ta n t t e o un it t ro ra e m t e u e ul i p i lot i t i t pro ra am e le to a oH e pan a a n t a a to an a t onal a a n ne a i tr t n a 2012 a g i t g a g it t mm it g amm i t g amm t a i g it t a a i a i i t i t i
DoHS, Annual Report 2075/76 (2018/19) ami a
e m pro ot on a an m ta upple entat on o l n i e i t it pro im i g n o ple m m ta entar ee n pra i g t e a t a a gi a t i t m m ta at i m t ot er an are er are oun elle to ntro u e o ple entar oo at ont o a e o u n on ag i g ag a iat i g im i g i ta a it m m ta a e pro e appropr ot on atean ee upple n entat re uen on o , pro n l n e etar t ual pro t o n o o ple ple entar entar oo ee n pra a t n e t e ot nutr er ent an ma i g an are alor er t m e are en t i t e, oun a elle ell a toa ntro an a i u ea o n ple t entar a oap oo e a ore at a an l a i g ont n t eo oo a it e an o u a n ee on n t e a i g a e a l ppropr ot t ate er ee an n a are re uen i g er are , tra pro t ne n i to etar prepare t ual t po o a lo o aulo ple a gi (pul entar e , oo a r e an t ai a reen n t t e e a eta le nutr ent an alor e en e, a ell a an a n t oap e ore an l n t e oo an ee n t e i oo e a n o l) an l to ( i ture a o g len e g ta an roa te ereal an i le i u a e lour it ) A mi t ea l t tu o t e l ot er an are er are tra ne to prepare po lo aulo (pul e , r e an reen e eta le a a t a a g m a i i it t t g amm i t gpro ra e n 2009 oun tron o un t a eptan e t a er o era e an o pl an e on t e mm it a ta it a ig ag a m ia t i t i t oo e n o l) an l to ( ture o len e an roa te ereal an le u e lour ) A ea l t tu o t e u e o n t e p lot tr t nte rat n o t a ontr ute to n ant pro e ent i t i t t g a g it a t i t t ig i a t im m t i a pro ra e n 2009 oun tron o un t a eptan e t a er o era e an o pl an e on t e n pra t e e pre alen e o ane a a on l ren a e 6 2 ont a e rea e to 68 ( DHS, a a mia am g i ag m t a a t u e o n t e p lot tr t nte rat n o t a ontr ute to n ant pro e ent 2016) ro 78 per ent ( DHS 2011) Ho e er, t t ll nee or ont nuou e ort a t e o era e o t e m t it t a t ag t n pra t e e pre alen e o ane a a on l ren a e 6 2 ont a e rea e to 68 ( DHS, pro ra not er pro n g am i t mi i g 2016) ro 78 per ent ( DHS 2011) Ho e er, t t ll nee or ont nuou e ort a t e o era e o t e pro Table ra 4.3. not7.6.1 er : Micronutrient pro n powder Baal Vita di tribution tatu 2073 74 2074 75 and 2075 2076 Table 4.3.7.6.1: Micronutrient Powder (Baal Vita) Distribution Status, 2073/74, 2074/75 and 2075/2076Table 4.3.7.6.1 : Micronutrient86 powder Baal Vita di tribution tatu 2073 74 2074 75 and 2075 2076 77 86
77
55 51 6 7 8 9 0 55 8 7 51 6 7 8 27 0 28 9 8 7 19 16 27 16 1 28 1 11 10 10 11 10 10 7 8 8 6 5 7 19 5 5 6 5 7 16 2 16 1 0 1 1 0 1 1 10 10 11 11 8 10 8 10 6 5 7 7 5 6 5 7 5 1 2 1 1 ro n e 1 0 ro n e 2 ro n e an a ro n e ro n e 5 0 arnal ro n e Su urpa ro n e epal
ro n e 1 ro n e 2 ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e epal o l ren a e 6 2 ont o re e e at lea t one le (60 Sa et ) aal ta ( ) o o l ren l a ren e a 6 e 2 6 2 ont ont o re oe re e e at e lea t one le (180 le (60 Sa Sa et et ) aal) aal ta ta( ( ) ) o o l ren l a ren e a 6 e 2 6 2 ont ont o re e o re e e e leat (180lea tSa one et ) le aal(60 Sa ta ( et ) ) aal ta ( ) o o l ren l rena e a 6 e 2 6 2 ont ont o re o e re e e at e lea t one le (180 le (60Sa Sa et ) et aal ) aal ta ( ta ( ) ) o o l ren l a ren e a 6 e 2 6 2 ont ont o re oe re e e e at le lea (180 t Sa one et ) le aal(60 Sa ta ( et ) ) aal ta ( ) o o l ren l a ren e a 6 e 2 6 2 ont ont o re oe re e e at e lea t one le (180 le (60 Sa Sa et et ) aal) aal ta ta( ( ) ) o l ren a e 6 2 ont o re e e le (180 Sa et ) aal ta ( ) Sour e H S/DoHS Sour e H S/DoHS t i ag t m t a ta t i t m n 2075/76, 51per ent o l ren a e 6 to 2 ont a ta en t e r r t o e o ult ple n ronutr 2075/76, ent 51po per er ent( o aal l ren ta) a an e onl 6 to 7 per 2 ent ont o t e a ta l ren en a t e e r 6 to r t2 o eont o ult a plere e e mi t i t Baa ita a t t i ag t m t a ronutr ent po er ( aal ta) an onl 7 per ent o t e l ren a e 6 to 2 ont a re e e i t aa ita i g amm i t i t m a t t t t ree le o aal ta n 6 pro ra e tr t o pare to t e r t le o nta e, t e t r t ree le o le nta o e aal n ta at n n 6 t pro e ra o pl e an e tr t ra o t pare all lo to att e7 per r t ent le o ere ore, nta t e, t e portantt r to i ta t t i i ta i i a g t m ia i a a at t le o nta e n at n t e o pl an e ra t all lo at 7 per ent ere ore, t portant to it i im ta t t m t at t ag t i ta i a at a t ta g t ent on t at t e o era e o r t le nta e al ulate a e on t e tar et populat on o 6 2 ont , ent on t at t e o era e o r t le nta e al ulate a e on t e tar et populat on o 6 2 ont , a m t i t at t i i a at am g t i ag le t at o t r le al ulate a on t e l ren a e 6 2 ont o a e e er ta en le t at o t r le al ulate a on t e l ren a e 6 2 ont o a e e er ta en m t a ta a t i a i g a erall, e e t e nutr t on e u at on, oun ell n an ollo up to t e ot er / areta er e ent al to erall, e e t e nutr t on e u at on, oun ell n an ollo up to t e ot er / areta er e ent al to t pro t e m t a ta o era e a ell a o pli an a e t t t e re im o en ag e o e o a a m ia it t pro e o era e a ell a o pl an e t t e re o en e o e o mm 7 7Pre ention and control of iodine deficienc di order 7 7Pre ention and control of iodine deficienc di order 4.3.7.7 oH Prevention a opte a pol and controlto ort of iodineall e ledeficiency alt n 197 disorder to a re o ne oH a opte a pol to ort all e le alt n 197 to a re o ne e en or er ( DD) t rou un er al alt o at on e Salt ra n e en or er ( DD) t rou un er al alt o at on e Salt ra n a t a i t a i a t i t a i i orporat on re pon le or t e o ne ort at on o all e le alt an t orporat on re pon le or t e o ne ort at on o all e le alt an t i tr ut on, i le n tr o t g Healt an i a opulat on a t ( oH i i a ) re pon le a t or tr ut on, le n tr o Healt an opulat on ( oH ) re pon le or a i g a i i t i i a a i pol pol r er an e an pro pro ot n ot n o o e e alt to alt n to rea n rea e on e u on pt u on pt A on per A t per e t e a t a it i t i i i i t a t a a i i i i a m g i i a t t i a DoHS, Annual Report 2075/76 (2018/19) ami a m t i m t a t i g a a t t a at i i a t a a m i i i g t t m ia ma g t im pol , o ern ent o epal u e t e o l o o pa e alt to ert a e uatel o e alt an a a DoHS a een it o l at n t t e te or o al a a ar et n to pro t e a arene at i t o t m u e at t e ou a e ol i a i t m i g a at i i a t m t i t le pol el , at o onalern ent ur o e epalreport u e at t e erent o l t o e o pa o e an alt n to rea ert e n a t e e uatel nu er o o e ou alt e an ol u n t i ig a DoHS e uatel a een o o e l alt n ro t e 55 te per or ent o n al 1998 ar to et n 95 toper pro ent e n a 2016 arene ( ureo t 1 u 2 e6 at 7 1t ) e ou e ol le el at onal ur e report at erent t e o an n rea e n t e nu er o ou e ol u n Figurea e uatel 4.3.7.7.14.3.7.7.1: o e : Percentage Percentage alt ro 55 ofper of hou Households ent ehold n 1998 u to Using ing95 per iodi Iodized ent ed n alt2016 Salt ( ure 1 2 6 7 1)
Figure 4.3.7.7.1: Percentage of hou ehold u ing iodi ed alt
Sour e D/ utr t on Se t on Sour e D/ utr t on Se t on a i a i i t i i a t t at t i m ere are, par t e n t e u e o o e alt e DHS 2016 oun t at t e ro n e nu er 2 a e t e ere are, par t e n t e u e o o e alt e DHS 2016 oun t at t e ro n e nu er 2 a e t e a t ig t ag t i t i a t t t t e e t t o o era era e e(99 (99 per per ent), ent), le t le e t ro e n ro e 6 n e a 6 t a e lo t e e tlo (85 e 1 t per (85 ent) 1 per t ent) ee , t t ee ere , at ere a m t i a t a i t ag i t ma it t nee to o er all ou e n t e lo o era e pro n e to a e t 90 per ent ou e ol ut l at on o i a a at i i a t m t i a a at i i a t at nee to o er all ou e n t e lo o era e pro n e to a e t 90 per ent ou e ol ut l at on o a e uatel o e alt o pro ote ut l at on o a e uatel o e alt at ou e ol le el, H at i i m t i a i a i t i t a a e uatel o e alt o pro ote ut l at on o a e uatel o e alt at ou e ol le el, H i i m t ai a a t t i g a t m m i i i ta t ele ele rate rate o o ne ne ont ont n n e ruar e ruar 201 2019 n9 all n 77all 77 tr t tr t e ele e rat ele on rat o on o neo o ont ne ra ont e ra e m at i i i i ig a arene onon t t e eu u e eo o t t o o l lo l olo alt o alt or opt or opt u o u ne o nta ne e nta to o e to at o o ne at e o ne en e en or or er er ( ( ure ure 1 1 2 2 6 7 6 27 ) 2 ) Figure 4.3.7.7.2: Percentage of Households Using Adequately Iodized Salt Figure 4.3.7.7.24.3.7.7.2: : PercentagePercentage of hou of hou ehold ehold u ing u ade ing uatel ade uatel iodi ed iodi alt ed alt
Sour e DHS, 2016 Sour4.3.7.8 e Control Control DHS, of2016 of ita vitamin in A deficienc A deficiency di order disorders e o ern ent n t ate t e at onal ta n A ro ra e n 199 to pre ent an ontrol o ta n A g m t i i at t a a itami g amm i t t a t 4.3.7.8 Control of ita in A deficienc di order e en or er o t e l ren a e 6 59 ont an re u e l ortal t a o ate t ta n A itami i i t i ag m t a i m ta it e e en o ern or ent er n t ate ta n t A e upple at onal entat ta on n n A epal ro ra a een e on n 199 o n a to pre annual ent an upple ontrol entat o on ta n A a iat it itami i i itami m ta i a a tar e et en n to all or 6 5 er 9 ont o t e l l ren ren an a e o era 6 59 e o ont upple an entat re u on e ore l t ortal an 80 t per a o ent ate e er t t e ta n A g i g a i a a m ta ta g g t a m t i a ag or e la en t e plu or ear er ta ere ore, n A t upple pro ra entat e on re no n epal e a a a eenlo al on pu o l n ealt a u annual e tor upple e entat on m ta i m t a t m a t a t i tar pro et ra n to e n all t all 6 5 9 o ere ont 8 tr l ren t an an a o era ale e up o to upple o er nat entat on on e to all ore 77 t an tr 8 0 t per n e ent2002 e er t e or la t e plu ear ere ore, t pro ra e re o n e DoHS,a a lo Annual al pu Report l ealt 2075/76 u (2018/19) e tor e pro ra e n t all o ere 8 tr t an a ale up to o er nat on e to all 77 tr t n e 2002 ami a g amm i g i a a g a i a t t g amm i i a i t i t a a a t a i t a i t i t i i t i t t a itami t t ta g t i t i a a t g a am aig a itami am aig i a t a Bai a i a H tr ute t e ap ule o ta n A to t e tar ete l ren t e a ear t rou a a pa n a ta n A a pa n n art ( to er) an a a (Apr l) e er ear Figure H 4.3.7.8.1: tr ute t Trend e ap & ule Coverage o ta of n VitaminA to t e Atar Supplementation ete l ren t to e aChildren ear t rou Aged a6-59 a pa Months n a Figure ta n A4.3. a 7.8.1 pa : nTrend n art co ( erage to er) of an ita a in a A (Apr upple l) e er entation ear to children aged 6 59 onth
Figure 4.3.7.8.1: Trend co erage of ita in A upple entation to children aged 6 59 onth 100 95 96 90 91 89 86 8 82 85 8 8 77 79 79 78 80 80 7 75 72 7 68 69 100 95 96 90 91 89 86 8 82 85 8 8 77 79 79 78 80 80 7 75 72 7 68 69
ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e epal
ro n e 1 ro n e 2 a at ro n e an 7 a /7 ro n e 7 /75 ro n e 5 75/76 arnal ro n e Su urpa ro n e epal
7 /7 7 /75 75/76 Sour e H S Sour a a a ag itami m ta i a t a am g e e o H erall S nat onal o era e o ta n A upple entat on aroun 80 per ent e er ear a on t e t i ag m t i i ag i a i it i l ren a e 6 59 ont le n 2075/2076 o era e pro n e ar e t pro n e nu er m it ig i i i g itami m ta i Bagma e o erall nat onal o era e o ta n A upple entat on aroun 80 per ent e er ear a on t e e t er proport on o l ren re e n ta n A upple entat on le a at ro n e a t e i a t t ag tag l ren a e 6 59 ont le n 2075/2076 o era e pro n e ar e t pro n e nu er lo e e t t o era er proport e o 69 onper o enta l e ren re e n ta n A upple entat on le a at ro n e a t e lo Figure e t o 4.3.7.8.2: era e o 69 Coverage per enta of e Vitamin A Supplementation to Children Aged 6-59 Months by Figure 4.3.7.8.2: Co erage of ita in A upple entation to children aged 6 59 onth b Di tribution Distribution Round Round Figure 4.3.7.8.2: Co erage of ita in A upple entation to children aged 6 59 onth b Di tribution Round 92 90 90 86 88 88 8 80 8 77 7 7 92 75 90 90 86 67 88 69 68 88 8 80 8 77 7 7 75 67 69 68
ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa epal ro n e ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa epal ro n e art 2075 a a 2076 art 2075 a a 2076 Sour e H S Sour e H S ro la t al ear, t e pro re on annual ta n A upple entat on pre ente n art ( to er) ro la t al ear, t e pro re on annual ta n A upple entat on pre ente n art ( to er) m a t a a t g ia a itami m ta i t i a t e r t Roun an n a a (Apr l) t e e on roun e o erall nat onal a e e ent a out 80 t t per e r ent t Roun a t on an t t e n l a ren a a a e (Apr 6 i 5 l)9 t Bai a e ont e on t i roun 8 per t ent e o eralln art nat an onal 7 a 7 per e e ent a ent n a a a a a out 80 per a i m t i a t t am g t i ag m t it t i a o ent e era on ert t e an l t ren at o a la e t 6 ear 59 or ont art t roun 8 per urt ent er n ore, art t an e o 77 era per e ent pro n a n a e ar e t a o ro e n er e t 5 er a t an i ert Bai a proport at o la t on i ear o or i l ren art re roun e ig n urt ta er t a n ore,A t at upple t e o entat a t era e a on an pro lo n a er e proport ar e on t o t m t ag i a i it i a ig i ro l n ren e 5 re a e n er t proport n a at on o ro n l e ren re e n ta n A upple entat on an lo er proport on o i i g l ren re itami e n t n m ta a at ro n e a i i i g it i Bagma i
DoHS, Annual Report 2075/76 (2018/19) ami a Figure 4.3.7.8.3: Coverage of Vitamin A Figure 4.3.7.8.4: Coverage of Vitamin A Supplementation by Age Groups for Kartik 2075 Supplementation by Age Groups for Baisakh 2076 Figure 4.3.7.8.3: Co erage of ita in A Figure 4.3.7.8.4: Co erage of ita in A upple entation Figure 4.3.7 .8.3: Co erage of ita in A Figure 4.3.7.8.4: Co erage of ita in A upple entation upple entation b age group for artik 2075 b age group for Bai akh 2076 upple entation b age group for artik 2075 b age group for Bai akh 2076
106 106 106 106 115 9 92 105 115 87 88 8 85 9 92 85 99 81 82 105 87 88 79 8 85 75 85 9988 81 82 8 85 67 69 79 80 80 75 88 76 6 7 8 75 85 69 70 71 67 66 67 80 68 80 6 7 75 76 70 71 66 67 68
6 11 ont 12 59 ont 6 11 ont 12 59 ont 6 11 ont 12 59 ont 6 11 ont 12 59 ont Sour e H S Sour e H S 4.3.7.94.3.7.9 Biannual Biannual Deworming Dewor ing Tablet Tablet Distribution Di tribution to to the the Children Children aged aged 12 5912-59 onth months 4.3.7.9 a Biannual l el are Dewor D on ing Tablet ple Di ent tribution n annual to the e Children or n agedta let 12 59 tr onth ut on to t e l ren ami a i i i i im m g ia a mi g ta t i t i t t i a e 12 59 ont a n to re u e l oo anae a t ontrol o para t n e tat on t rou a l el are D on ple ent n annual e or n ta let tr ut on to t e l ren ag m t aimi g t i a a mia it t a a i i ta t g pu l ealt ea ure a t t nte rate t annual ta n A upple entat on to t e a e 12 59 ont a n to re u e l oo anae a t ontrol o para t n e tat on t rou i a t m a i a it i i t g at it ia a itami m ta t t l ren a e 6 59 ont , ta e pla e nat onall n e er ar on r t ee o a a an pu l ealt ea ure a t t nte rate t annual ta n A upple entat on to t e i ag m t i ta a a a i a t Bai a a art ea ear De or n to t e tar et l ren a n t ate n e tr t ur n t e ear 2000 a a a mi g t t ta g t i a i i at i i t i t i g t a l ren a e 6 59 ont , ta e pla e nat onall n e er ar on r t ee o a a an nte rat n t annual ta n A upple entat on an t ra ual al n up, t e pro ra a i t g a g it ia a itami m ta a it g a a a i g t g am a art ea ear De or n to t e tar et l ren a n t ate n e tr t ur n t e ear 2000 u e ull ple ente nat on e t e ear 2010 nte rat n t ta n A a ta n A im m t a i t a i t g a g it itami a itami nte a rat pa n n t annual ta n A upple entat on an t ra ual al n up, t e pro ra a am aig u e ull ple ente nat on e t e ear 2010 nte rat n t ta n A a ta n A a Figure pa n 4.3. 7.9.1: Co erage of Dewor ing Tablet di tribution to the Children aged 12 59 onth Figure 4.3.7.9.1: Coverage of Deworming Tablets Distribution to the Children Aged 12-59 Months Figure 4.3.7.9.1: Co erage of Dewor ing Tablet di tribution to the Children aged 12 59 onth
96 94 93 89 89 86 85 83 82 81 79 76 76 76 77 78 78 75 73 75 71 96 72 68 69 94 93 89 89 86 85 81 83 82 79 78 78 76 76 75 76 75 77 71 73 72 68 69
ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e epal 7 /7 7 /75 75/76
Sour e H S ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e epal 7 /7 7 /75 75/76 A o n n ure 6 9 1, t e nat onal o era e o e or n ta let tr ut on 91 per ent Sour e H S n rea n tren or la t t o al ear or all t e pro n e , t e o era e er t an A o n n ure 6 9 1, t e nat onal o era e o e or n ta let tr ut on 91 per ent DoHS, Annual Report 2075/76 (2018/19) n rea n tren or la t t o al ear or all t e pro n e , t e o era e er t an ami a i g t a a ag mi g ta t i t i i t i i i a i g t a t t a a a t i t ag i ig t a Figure 4.3.7.8.3: Co erage of ita in A Figure 4.3.7.8.4: Co erage of ita in A upple entation t t i a im mi g ta t i t i i t i upple entation b age group for artik 2075 b age group for Bai akh 2076 m t i m a i it a t a a 80 per ent All t e pro n e a pro e e or n ta let tr ut on n t e l ren 12 59 ont n o par on t la t al ear Figure 4.3.7.9.2: Round Wise Coverage of Deworming Tablets Distribution to the Children Aged 106 106 Figure 4.3.7.9.2: Round wi e co erage of Dewor ing Tablet di tribution to the Children aged 12 115 12-59 Months 9 92 59 onth 88 105 87 85 85 8 82 99 79 81 75 88 8 85 69 67 80 80 106 6 7 75 76 70 71 66 67 68 9 86 86 8 85 8 82 79 82 82 76 7 7 69 68
ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e epal
art 2075 a a 2076
Sour e H S 6 11 ont 12 59 ont 6 11 ont 12 59 ont e report pre ente eparatel or a a (Apr l) an art ( to er) roun o 2075/076 t i t a at Bai a i a a t Sour e H S 4.3.7.10 School Health and Nutrition Progra e 4.3.7.10 School Health and Nutrition Programme 4.3.7.9 Biannual Dewor ing Tablet Di tribution to the Children aged 12 59 onth e S ool Healt an utr t on Strate (SH S) a e elope o ntl n 2006 n tr o Healt an opulat on ( oH ) an n tr o u at on ( o ) to a re t e ur en o ea e n a t a t i t at g a i t i i i t a t a l el are D on ple ent n annual e or n ta let tr ut on to t e l ren ool a e l ren n 2008, a e ear o nt A t on lan ( A ) a en or e to ple ent S ool a e 12 59 ont a n to re u e l oo anae a t ontrol o para t n e tat on t rou a a a i i t a t a t ig i a i ag i a a i t a a t im m t Healt an utr t on (SH ) ro ra e pro e u e o ool a e ealt an nutr t on er e , pu l ealt ea ure a t t nte rate t annual ta n A upple entat on to t e a t pro e a a t i e to a e r n g am n ater an an im tat on, ll a e a ealt e u at a t on, o a un t i t l ren a e 6 59 ont , ta e pla e nat onall n e er ar on r t ee o a a an i upport an im an pro a e pol t a en i i g ron ent are at t ea ore a ita ele ent o i a t e S ool a t Healt a an art ea ear De or n to t e tar et l ren a n t ate n e tr t ur n t e ear 2000 mm it t a a im i i m t a t m t t a t utr t on ro ra e nte rat n t annual ta n A upple entat on an t ra ual al n up, t e pro ra a a t i g amm Dur n 2008 2012, o ern ent a ple ente a p lot SH pro ra e n pr ar ool a e u e ull ple ente nat on e t e ear 2010 nte rat n t ta n A a ta n A on t e o nt A t on lan n S n upal o an S an a tr t p lot pro ra e a o e a pa n i g g m t a im m t a i t g amm i ima a pro n re ult re o en n to al n up o t e pro ra n ot er tr t t ra ual al n t i t a i i a a a g a i t i t i i t g amm a m Figure 4.3.7.9.1: Co erage of Dewor ing Tablet di tribution to the Children aged 12 59 onth mi i g up, t e pro t ra a mm i g o ere all 77 t a i g tr t n e t 207 g am /07 i e t urrent i t i t o nt A t it on lan g a a a i g t g am a a i t i t i t i t a (2071/072 to 2075/76) all or t a • Annual ealt reen n
96 94 93 • annual e or n o ra e 1 10 ool l ren 89 89 86 85 a a t i g 81 83 82 79 78 78 • A r t a t o t re ll n e an n all pr ar ool 76 76 75 76 75 77 71 73 72 Bia a mi g a i 68 69 • Han a n a l t e t oap n all ool t ai it it i g m a i m i a ima • a a i g a i i it a i a o let n all ool • i t i a e u e o t e ne atten an e re ter n all ool • t a a gi t i a r ent ool ana e ent o ttee on a l tat n ealt an nutr t on a t t e • i t ma ag m t mmi a i ita g a t a t i a i l lu o l at on on ealt an nutr t on ue i m i i a a t a t i i ne o t e a or a t t e un er SH ro ra annual S ool De or n to all S ool a e ro n e 1 ro n e 2 a at ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e epal 7 /7 7 /75 75/76 l ren (SA t ) t ma at on a i u te n r t ee o g am e t a an i an Bia a r e er ear nt mi g l 2072/07 , t a ag i t at i t i t t a a a g i a pro re n t re ar a not een reporte n t e annual report ue to t e er poor, al o t no Sour e H S g i t i ga a t t i t a a t t t report n to t e te Ho e er, t ou er lo , t ere o e report n t a pre ente n A o n n ure 6 9 1, t e nat onal o era e o e or n ta let tr ut on 91 per ent t e ure 18 elo A re le te , nat onal o era e o ool e or n or 207 /075 8 DoHS, Annual Report 2075/76 (2018/19) n rea n tren or la t t o al ear or all t e pro n e , t e o era e er t an ami a a m t g t t t m t g t i m g t i a t i t g t a a ag mi g i t gi a t a i i t gi per ent or rl an per ent or o ere a n 75/76 19 per ent or rl an 11 per ent a t or o
Figure 4.3.4.3.7.10.17.10.1 Co Coverage erage of of School School Dewor Deworming ing Tablet Tablet Di tributionDistribution
8 80
61 55 9
1 8 5 2 1 1 29 0 22 19 16 16 16 1 1 15 15 15 11 11 9 7 6 5
epal ro n e 1 ro n e 2 ro n e an a ro n e ro n e 5 arnal ro n e Su urpa ro n e
7 /75 7 /75 75/76 75/76
Sour e H S
4.3.7.11 AdAdolescentole cent Girl Girls Iron Iron Folic Folic Acid Acid Supple Supplementation entation
m t g am a i i at i i m ta ro 2072/07 , t e SH ro ra a n t ate ee l ron ol A ( A) upple entat on to t t a t gi ag a aimi g t t a t t ig t e a ole ent rl a e 10 19 ear a n to pre ent an ontrol t e ur en o ron i De en Ane mia a a on am g t part t i ular a a roup o g populat on a a t t i a p a it lote n a at i t an u, i at ma a a ta g a t a B a ta i t a a a i a t i Dola a, otan , an t ar, o pur, Saptar , ut an an ap l a tu n 2072/07 t g amm a a t i t i t am Ba a Ba a g B a ta a i n 207 /7 , t e pro a a g ra e t a ale a a i up to 17 a Ba a tr t na ami el a a ura, i i i a an , Do t , a m t t ai i g t t ia m a t i t i t t a tapur, Rupan e , anan , Sur et, a ottar , an ara a l el are D on o g am a im m t i i t i t t t a i a DoHS/ oH a o plete t e ra n n to t e on erne o al ro all t e e tr t Ho e er, t e pro ra a ple ente n e tr t ue to t e ar ou rea on t a i g t g am a i a i a i t i t am a a t m a t m t ai Ba i a a a a a i a t a a a a i t Baita i n 207 /075, urt er al n up o t e pro ra a one n a t onal 2 tr t na el am a ar ot, Ru a a u a t, Ru a u e a g t, Da a a le , ar a, a a a alpara a a i a t, a a ta at alpara a a e t, a a ta , a i t a m a g a m a i i ami a i i i a A a , Da el ura, Rolpa, Dan , an anpur, D anu a, Sarla , Rauta at, ar a, a pur, a i g t a t i g amm i a i a i t i t a it i t a t g amm al ot, Dolpa, u la, u u an Hu la e e, a l el are D on o DoHS/ oH a een i a t a i t i t plann n to ale up t pro ra e n a t onal 12 tr t an t n t ree ear , t e pro ra e t i m t a t a t gi ag a a m t it ll e ale up to all 77 tr t i i ta t ia a a i i a a a a ag ag iat a a t a i ta t ta t a a t gi g t n er t o ponent, all t e a ole ent rl a e 10 19 ear are upple ente t ee l ron a t ta ta t i a a ol A ta let annual a n S ra an (S r an A o ) an a ( a atra) roun n ea roun , t e are pro e A ta let one ta let e er ee or 1 ee So, ea a ole ent rl et 4.3.7.12a total o Nutrition26 A ta let in emergencies n a ear (NIE)
4.3.7.12 a i Nutrition t t in e g a ergencie t i NIE g am i t ami a i i i a i a a ig a it i t a t t i i i m g i a n a t on to t e re ular nutr t on pro ra nter ent on , a l el are D on al o m g it a a a at a i a t a t a g t t m pro e e ent al an ual t er e to a re t e nutr t on ue n er en e en an e er en t an rea on u a natural a ter (eart ua e, loo , rou t, et ), o ple DoHS, Annual Report 2075/76 (2018/19) ami a m g i i t a t a t at ig im a t ga a a t t i a i i t a a a t i t ami a i i i i t it a t i t a t t i t m m i t t i i m g i t t t i tat i g a t a a ta g m i i t t g a t a a ta g m a i a ag a t a t i a t m t a i g a t m g i i g i a i t a im m t i t a t a a t t
m t a t t a t i g i a t a g i ag m t m m m ta i g t t i a t a g i ag m t a ag m t m at a t ma t i am g t i ag m t a am g t g ta g t m ta i g g am a ag m t a t ma t i am g t i ag m t t g t a i g t i a i t i t m ta i a m i i g a itami i ag m t g a t a t ata m
(a) Small Scale Flood Emergency Response in FY 2075/076:
a i ai a a ta g m i t igg i a i g a a i i t t i t i t a ta g im a t m a a i a g t t i t i t ma a ma gi a m i i t a a i m mi i g m i m a t m t m a i i a m m t amag m a a amag m g t a t a a imat a i a ag a a g a t a a i g m it t ai a a a at a ita a gi i g at i ai a imit a t t i a a t i t it a
t t i t t a i t i a m t m t i i g ta ta a t i ag m t a t t m i i a a t ma t i a i a at t a t i a a t a t i i t it a a i a t ig g a a t ma t i a a a i g ma i agg a a g a t a a it a a a i g a a a iat t i i a t a g i g a t a a ta g m a imit a t i t a t atm t i i t t i ta a i a i i a a a t ma t i t i t a a a a t t i t m m i i at i t t a t t i i a
at i it t a t i i t ig t a t i t i t i m i at i g i t g a t t t ami 1 i i t m ai ta g
DoHS, Annual Report 2075/76 (2018/19) ami a i a t m ta i g g amm t i ag m t a g a t a a ta g m t i t B i g g i t m ag t i a t a i t a g ag ait i i B i a a i a ai t g a a i i i t i t a i ait i i B i i a a i a a a i m
(b) Bara and Parsa Tornado:
a at ig t ma i t m it t g i a it a a i t i t i t Ba a a a i i g t a a m t t m at t i Ba a a at i a a i t i t t i a a ig t i g a ig t m t i a a t a a g m t a t mm iat a t i i a t i t m m m t t g t a a t a mm iat i t i t a t i t a a m i i a g it t t am m a a i t i t i at m Ba a a a a a ta at t a t a t i g a im m t
at ig t t a t a t Ba a i t i t a at i t a a t a i a a a ai a ita tai a a t t Ba ia a a t t i a i a a a i a t t ta a t t a a i a t t a am a t t ta a am at a t ta i it a t ma t i it a t a a i ag a t a g i i g i m g i a a g a t a a ta g m a a t i t a a a t m a i ta a a g ag
(c) Nutrition Cluster preparedness actions:
t i t t a m t a m m ag i i i g m t a t i t m g ga i a i t g t t i t m g i g t i a i g g a m a a at t i t i a a i ta i t a t t i g amm i m g i
i g g i g g i t i t i g g ma ma ag m t i g g m t i g g B i g g
Similarly, following preparedness actions were conducted in FY 2075/076:
i a i m i t i i i t t ai i g ma a t t a t a a t t i t a a i t ai i g a i t i i m g m t a a t a a it i i g a t t t i i m g t ai i g t t i ia a a a ta i at ma t ai m i ia a t i t at ia m t mi i t i a t i t m m DoHS, Annual Report 2075/76 (2018/19) ami a i t i t a i t i t i g g i t i t a g g i i a i t g a t a t i t i i a t a a a m g i ma i g at t t i t t t g a
4.3.8: Issues and challenges:
tm t a t at a g m t t t m t t t ai a t t i g amm i ma a t a i i a t a ai a t im m t a i i a m t t i mm i m t a gi g t i t a i a i a m t t ma a t i i a g i i g a ta t i mm i a gi i a gi g gi t at i i i a i i i t t a i ia a a m t i a m a i m i mm it t a t a t t ta i it ig ag i t t a it t g amm im m ta i t a a t a it im m t m t i i i t a ai a t i i a ga i t g amm a t ta a t i i t ia i a a i m i t i g i i t t i g amm i t t i g amm
4.3.8: Lesson learned:
i at t i i a g m t m a i m t at a mmitm t a g m t t imi at a t mat a a i ma t i i a it i a ta i m t a i g m t m t t a t t a t i g a a a a t i g am g g a i a g amm ma ag a it i i i a i g t a i i g t t tai a t m t a t a g ig ga ig at a a t at i i g t i ma t i a t t i i a it ag i t a it t t a t t m t i ii it ig i a mmitm t at a t a a i i g t i a i g a g a im m ta t a i a ma m it i g a a a t t m iii a ia t a i g a it a a i i t i i a gi g a t t i tm t i ma a i a t t i i t t mat i a i i at i a i t m ata a a a i i i at t at a a ita t i t a a at m a i m t t it a t a a
4.3.8: Key Priorities for Next Fiscal Year (2077/078):
m t B i a a t a i i m i i a i a a t a a t
DoHS, Annual Report 2075/76 (2018/19) ami a a t t m i t i i g amm a ag t a m i i a i a it m m t m i t i t i g amm g t t i a ta t i t i t g a t m m t a a tai a t m i t g a g it i a t a g i i g a t a m t i m t t i i i ag i g t am t i i a a t m a g amm a i a a a t i t t atm t a a t a a t a a a g i t m t a a g amm m i t i t t i t i t m a t t i g amm m i t i t t i t i t ai tai a tai a a itami g amm a m t t i t a a itami g amm t g at a imat g a i m t it i am a i m i g t a a it i t a t i a i a a t ai t a a t a ta t t m i t i a it m i a i i a i t m t i t i a a t a a mi a a i a g m t t i t g at t i i t ma a a i t a m a i mat ia ta i a am t a a t a a t i t im t i g amm i t t a a i ia a iam ta ia t ma t i a ig ag a a a m t a
DoHS, Annual Report 2075/76 (2018/19) ami a 4.4 Safe Motherhood and Newborn Health
4.2.1 Background
g a t a a a t g amm i t mat a a ata m i it a m ta it a im mat a a ata a t t g a m a i a a i g a i a a t t at a at i g g a i i t a t t a t m i i gg t t at t a a im ta t a t mat a a m i it a m ta it i a a i i g a a i g a a i i g a
i g ma t at gi a a t t i i g g a a i i t a a a t a iat it m ta it a m i it
m g i t a a m i a a i i i g a a ai i g a im i g a t a t a t a i a i i t i g a i i a g i ama a a g amm m t m a m a t a a t t ata a a i m g t t i a i a i a m i at t a t a i i i a i t i t
a t g amm i i at i a ma ig i a t g it m a a m t i i i ag a g a g it t m t i i g amm a t i i i t a a t ig ig t t im ta i i t a a t B at a i t a m i t g m t mmitm t t t ai a t a it t i i a t t t ama g amm t i a ag m i t a i a im a t i t a i i a m g t t i a i m t t i a a B a i i a a t ig i a t t i g t a ai a i it a i m g a mai g amm t at gi a i t i B
a a t t t at g i it a a it a ga a a a a i i g t mat a a t tai a m t g a ta g t a gi g i a im i g a it a ita i t i a t i a i a a i a a t ag it a i g m a i m t a ia a i a t t it i a t
DoHS, Annual Report 2075/76 (2018/19) ami a
Box 4.4.1: Main strategies of the Safe Motherhood Programme 1. Promoting inter-sectoral coordination and collaboration at Federal, Provincial, district and Local levels to ensure commitment and action for promoting safe motherhood with a focus on poor and excluded groups. 2. Strengthening and expanding delivery by skilled birth attendants and providing basic and comprehensive obstetric care services at all levels. The interventions include: o developing the infrastructure for delivery and emergency obstetric care; o standardizing basic maternity care and emergency obstetric care at appropriate levels of the health care system; o strengthening human resource management —training and deployment of advanced skilled birth attendant (ASBA), SBA, anaesthesia assistant and contracting short-term human resources for expansion of services sites; o establishing a functional referral system with airlifting for emergency referrals from remote areas, the provision of stretchers in Palika wards and emergency referral funds in all remote districts; and 3. Strengthening community-based awareness on birth preparedness and complication readiness through FCHVs and increasing access to maternal health information and services. 4. Supporting activities that raise the status of women in society. 5. Promoting research on safe motherhood to contribute to improved planning, higher quality services and more cost-effective interventions.
4.4.2 Major activities in 2075/76 4.2.2Community Major activitieslevel maternal in 2075/76and newborn health interventions Family Welfare Division (FWD) continued to expand and maintain MNH activities at community level Community level maternal and newborn health interventions including the Birth Preparedness Package (jeevansuraksha flipchart and card) and distribution of ami a i i i t a a mai tai a i at mm it matrisurakshachakki (misoprostol) to prevent postpartum haemorrhage (PPH) in home deliveries. i i g t Bi t a a ag a a a i a t a a a i t i Through FCHV, public health system promotes: mat i a a a i mi t t t t a t m a m ag i m i i birth preparedness and complication readiness (preparedness for money, place for delivery, g i a t t m m t transport and blood donors); self-care (food, rest, no smoking and no alcohol) in pregnancy and postpartum periods; i t ANC a (Iron supplementation, a m i a Td vaccination, a i deworming a tablets), institutional m a delivery (through i t a t a SBAs) and PNC (Iron and Vitamin A supplementation); a t m i g a a i g a a t a t m i essential newborn care; and m ta a i a mi g ta t i t a i t g identification of and timely care seeking for danger signs in the pregnancy, delivery, postpartum B a a itami m ta and newborn periods. a a a In 2066/67, i a a m a i g a g ig i t g a i t a t m the government approved PPH education and the distribution of the matrisurakshachakki (MSC) a i tablets through FCHVs to prevent PPH in home deliveries. For home deliveries, three misoprostol tablets (600 mcg) are handed over to pregnant women by FCHV at 8th month of pregnancy through t g m t a a a t i t i t proper counselling to take immediately after delivery and before the placenta is expelled. Fifty districts mat i a a a i ta t t g t t i m i i m i i t mi t ta t m g a a t g a t m at were implementing the programme up to 2075/76. Further four district Gorkha, Dolakha, Solukhumbu t m t g a t g i g t ta imm iat a i a and Parsa districts, started implementing this program in this fiscal year. Recent NDHS (2016) data t a ta i i i t i t im m g t g amm t t i t i t a a a m a a a i t i t ta t im m g t i g am i t i a a t ata t at t m ga i i t it t i a i ta t ta t t i a t im ta t gt i g t i g amm a m i at m a i t ig i t g amm i t t im m t a i m it i g i t t i t g at i
DoHS, Annual Report 2075/76 (2018/19) ami a Rural Ultrasound Programme
a t a g amm aim t m i a g a t m it i t t i m i a t t m i m g t t i a ata a t ai B a i t at a a i g ta t a m it t t a ma i a a ma i a ta t t a a ta ia a t a it t i i g amm i i g im m t i t m t i t i t t ta B t ai a t a a
Human Resources
ig i a t a g t g i g ma t ta t t m t a t t i at a i t a i t tag at ita it t ta t it t am t it ta a a i a g it t a a a t ai i g t a t a a a m i a i t i a i i t ai i g a t i t ai i g B B a t ia i ta t a at a ag m t ami a i g i i g m a t a a t ata t a g a B B t ai a B t a t ta B a B a t ai a m t t ai ta a B a a a t ia a i ta t a a a g t m it t m t t B B a a i m a a a a iat t a i a t i im a it i
Expansion and quality improvement of service delivery sites
t a i i it i i t i g t B a it at a ita a i i it i i m t t t i i t t a t t t m ta a B t i ta i i i t i t i t i t a t g t t a i g t a a i t i t i i t t i a i i i t g t i i a a g m t ta a t t a i i g i i i
Onsite clinical coaching and mentoring
a it i at t i i i t i t t m a it im m ta a it a i g a i i a i a m t i i i i t m t m a t im g i a a a t i i a ta t t im m t it i i a a i g m t i g g amm i m i t i t t a g a i B a B i g ta i i g i i at B B a i it i g amm a a i i t i t i a i t i t a a t t a t m a a a i t t t ta m i i a i i t i t im m t it i i a a i g a m t i g g amm a a i g m t i g g i i a t i g i i a i mai t a t i i a a i g m t i g i i B a B a a i a m t a ta t t i t i t m t t g DoHS, Annual Report 2075/76 (2018/19) ami a m t t ai i g i i t t ta i t i t B i i a m t t ai m a i g m t i g g amm im m t i t i t a t i i it a B B it a t it a i g m t i g a g it a i a m t t a a a it i i i ta a m m t ma i a i t m a m a a i g i i a a i g a g a t i t m i a at ia t B i i a m t t i t i t B t ta i i i it i i a m t i g m B m t i i a i m t ta a t a i i i i a i
MNH readiness Hospital and BC/BEONC Quality Improvement
m m t i a it i i t g a m t i m t a a a a im m ta i i a g am a t m i i g i t i t a g a ta a ita i t t a ita a it im m t i ita i i t i t a it im m t i a i g im m t i i t i g t i i t g a it it a i g m t i g i t ta t B B it i i a i
PNC home visit (microplanning for PNC)
t a i a t ata a i i a ma a g i t ma it mat a at i g t ata i t a i m i a i g t t t i t i i a a g t t a i a m i t i t a a i t a i a m i t i t i t t gt i m i i i g i i m a t a i i t i at m m
Emergency referral funds
t i mat t at t g a t m i i m i a i g t i g a i a i i a t t t m i a a a i i t a i at g t m m i it a i t g g a i a t ai a a ai a i it i ia t at t m a t a iat t a t i i a at m g a t i i i Bagma a a i i a a i a a im ai i i g m i imm iat t a t ig t t ta a a at t i i t t m i a a a at t ita i t i t i t t g i t t t a t a m t a a t ig a i it a a i i mai t i g amm i t t m g a t a t t m m a it a a a g g a i a i a a tag a ia a mi a i a a tag mm i
Safe abortion services
a a a a i t at ma m a a t g a i i g t imit a t ami a i g i ma a i m a t a a a i i a m a a at a ig i i g m i a t a a i t t a i i t ia a a at am g DoHS, Annual Report 2075/76 (2018/19) ami a i m ag m ig t i t a gi a t i a t gi t a t a t i ga at g m t a i it t i a t ma a a i a ai a a i a a a t a m it a t g a i a t m t m i a a a
a t i g a a m t a t a t a m t t mi a g a i a t a a t iag i a t atm t i g t a t i a i t a m t a i m i a t a m i a ma ag m t
m i a a ma a a m a i a i a a ai a i a i t i t ita a ma it i a t im t a i a a ai a i ita i a a a ai a i a a i a i g a i a t t t g t a i a t ai i g B i a a i a a t i t i t it t t a i a t a t ta it a it i t t i a a i i a t ta m i a i gi a a i i t i a a
Obstetric first aid orientations
ta t i g a am i t ai t ma ag t t i m i a at a t a i i it t i t i g t a t a a am i t t B a at m m g t ai t ai t i t i i t i t
Nyano Jhola Programme
a a g amm a a i t t t m t mia a i a t i a t i a a t a i i i t i g t t t t a a a i a a a m t a t a mat a a g m t a i m gi i t at i t i g t a i t i t ita g amm a i t t t a ia t ai t a at t a g t t a ma
Aama and Free New born Programme
g m t a i t ma i i t t ag m i t a i at it m i t a t i t m i t i a i i a t a i i m m a t i a i i t i t a a t a i t ama g amm i t a at i g amm a m g it t ama g amm t a g amm i t i a m g it t ama g amm i a agai a at i a t i t g amm it t i i i t i B
DoHS, Annual Report 2075/76 (2018/19) gown for mother are provided for women who give birth at birthing centres and district hospitals. The programme was interrupted due to financial constraints, however, MOHP allocated extra budget due to popular demand. Aama and Free New born Programme The government has introduced demand-side interventions to encourage women for institutional delivery. The Maternity Incentive Scheme, 2005 provided transport incentives to women who deliver their babies in health facilities. In 2006, user fees were removed from all types of delivery care in 25 low HDI districts and expanded to nationwide under the Aama Programme in 2009. In 2012, the separate 4 ANC incentives programme was merged with the Aama Programme. In 2073/74, the Free Newborn Care Programme (introduced in FY 2072/73 was merged with the Aama Programme which was again separated in FY 2074/75 as two different programmes with the provisions listed in Box 4.4.2. ami a
Box 4.4.2: Provisions of the Aama Programme and New born programme
Aama programme provision
a. For women delivering their babies in health institutions: Transport incentive for institutional delivery: Cash payment to women immediately after institutional delivery (NPR 3,000 in mountains, NPR 2,000 in hills and NPR 1000 in Tarai districts).
Incentive for 4 ANC visits: A cash payment of NPR 800 to women on completion of four ANC visits at 4, 6, 8 and 9 months of pregnancy, institutional delivery and postnatal care.
Free institutional delivery services: A payment to health facilities for providing free delivery care. For a normal delivery health facility with less than 25 beds receive NPR 1,000 and health facilities with 25 or more beds receive NPR 1,500. For complicated deliveries health facilities receive NPR 3,000 and for C- sections (surgery) NPR 7,000. Ten types of complications (antepartum haemorrhage (APH) requiring blood transfusion, postpartum haemorrhage (PPH) requiring blood transfusion or manual removal of placenta (MRP) or exploration, severe pre-eclampsia, eclampsia, MRP for retained placenta, puerperal sepsis, instrumental delivery, and management of abortion complications requiring blood transfusion) and admission longer than 24 hours with IV antibiotics for sepsis are included as complicated deliveries. Anti-D administration for RH negative is reimbursed NPR 5,000. Laparotomies for perforation due to abortion, elective or emergency C- sections, laparotomy for ectopic pregnancies and ruptured uterus are reimbursed NPR 7,000 to both public and private facilities.
b. Incentives to health service provider: For deliveries: A payment of NPR 300 to health workers for attending all types of deliveries to be arranged from health facility reimbursement amounts.
Newborn Care Programme Provision
a. For sick newborns: There are four different types of package (Package 0, Package A, B, and Package C) for sick newborns case management. Sick newborn care management cost is reimbursed to health facility. The cost of package of care include 0 Cost for Packages 0, and NPR 1000, NRP 2000 and NRP 5000 for package A, B and C respectively. Health facilities can claim a maximum of NPR 8,000 (packages A+B+C), depending on medicines, diagnostic and treatment services provided.
b. Incentives to health service provider: A payment of NPR 300 to health workers for providing all forms of packaged services to be arranged from health facility reimbursement amounts.
Antenatal care Antenatal care mm a mi im m a t ata at g a i t a t a g a t WHO recommends a minimum of four antenatal check-ups at regular intervals to all pregnant women m at t t i t ig t a i t m t g a i g t i it m i t i g i a g a a t (at the fourth, sixth, eighth and ninth months of pregnancy). During these visits women should receive the following services and general health check-ups: B ig t a ta a t at m it i g Blood pressure, weight and foetal heart rate monitoring. a B g a i i t a a a a ami a i g IEC and BCC on pregnancy, childbirth and early new born care and family planning. ma a g ig i g g a i i t a i t t a t m i a m a t a iat a t a i i Information on danger signs during pregnancy, childbirth and in the postpartum period, and timely a t a ma ag m t m i a i g g a referral to appropriate health facilities. i i Early detection t ta and management t i a of i t ia complications during imm i a pregnancy. i i a i ta t a mi g ta t t a g a t m a ma a ia a i a Provision of tetanus toxoid and diphtheria (Td) immunization, iron folic acid tablets and deworming tablets to all pregnant women, and malaria prophylaxis whereDoHS, necessary. Annual Report 2075/76 (2018/19)
Pregnant women are encouraged to receive at least four antenatal check-ups, give birth at a health institution and receive three post-natal check-ups, according to the national protocols. HMIS reported since 2066/67 to track the timing of ANC visits as per the protocol. The percentage of women who had at least one ANC check-up in FY 2075/76 is 110% at national level with 127% [HIGHEST] in Karnali Province and 90% [Lowest] in SUDURPASCHIM Province [Fig 4.4.3]. The proportion of pregnant women attending at least 4 ANC visits as per the protocol has increased from 53 percent in 2073/74 and 50 percent in 2074/75 to 56 percent in 2075/76 at the national level. All the provinces have shown some improvements as compared to last year in ANC visits as per protocol with highest [70%] achievement in Gandaki Province and lowest [41%] achievement in province 2. Figure 4.4.3
Percentage of pregnant women who had at least one ANC checkup
150 118 127 110 114 106 108 110 90 100
Percent 50
0
Provinces
b. Incentives to health service provider: A payment of NPR 300 to health workers for providing all forms of packaged services to be arranged from health facility reimbursement amounts.
Antenatal care WHO recommends a minimum of four antenatal check-ups at regular intervals to all pregnant women (at the fourth, sixth, eighth and ninth months of pregnancy). During these visits women should receive the following services and general health check-ups: Blood pressure, weight and foetal heart rate monitoring. IEC and BCC on pregnancy, childbirth and early new born care and family planning. Information on danger signs during pregnancy, childbirth and in the postpartum period, and timely referral to appropriate health facilities. Early detection and management of complications during pregnancy. Provision of tetanus toxoid and diphtheria (Td) immunization, iron folic acid tablets and deworming ami a tablets to all pregnant women, and malaria prophylaxis where necessary. g a t m a ag t i at a t a t ata gi i t at a a t Pregnanti t women a i are encouraged t t ata to receive at least four a i g antenatal t check t - a a ups, give t birth at a health institution t i t t a t mi g i it a t t tag and receive three post-natal check-ups, according to the national protocols. HMIS reported since m a at a t i i at a a it 2066/67 to track the timing of ANC visits as per the protocol. The percentage of women who had at least ig t one ANC i check a a i -up i in FY 2075/76 a is 110% t at national i level a im with 127% [HIGHEST] i in ig Karnali Province g a t m a i g at a t i it a t t a i a and 90% [Lowest] in SUDURPASCHIM Province [Fig 4.4.3]. The proportion of pregnant women attending m t i a t i t t i at t a a at t i a m im m t a m a t a t a i i it a least 4 ANC visits as per the protocol has increased from 53 percent in 2073/74 and 50 percent in 2074/75 t it ig t a i m t i a a i i a t a i m t i to 56 percent in 2075/76 at the national level. All the provinces have shown some improvements i as compared to last year in ANC visits as per protocol with highest [70%] achievement in Gandaki Province and lowest [41%] achievement in province 2. Figure ig 4.4.3
Percentage of pregnant women who had at least one ANC checkup
150 118 127 110 114 106 108 110 90 100
Percent 50
0
Provinces
Figure 4.4.4 Women having at least one ANC check-up Figure 4.4.4 Women having at least one ANC check-up
Percentage of women who had four ANC check-ups as per protocol
70 80 68 65 61 5960 61 62 70 53 56 58 5555 5558 50 47 4951 49 60 44 41 50 3734 40 30 20 10 0
2073/74 2074/75 2075/76
DoHS, Annual Report 2075/76 (2018/19)
ami a
Figure 4.4.5: Institutional deliveries by districts 2075/76 Figure 4.4.5: Institutional deliveries by districts 2075/76
Delivery care Delivery care services include: Delivery skilled care birth attendants (SBAs) at home and facility-based deliveries; Delivery early care detection services of complicated include: cases and management or referral (after providing obstetric first aid) to an appropriate health facility where 24 hours’ emergency obstetric services are available; and i i t a a t B at m a a i it a i i the registration of births and maternal and neonatal deaths. a t m i at a a ma ag m t a a i i g t t i t Although women are encouraged to deliver at a facility, home delivery using clean delivery kits with ai t a a iat a t a i it m g t t i i a provision of misoprostol to prevent post-partum haemorrhage and early identification danger a ai a a signs t gi t a i t a mat a a ata at and complications, are important components of delivery care in settings where institutional delivery services are not available or not used by the women.
t g m a ag t i at a a i it m i i g a i it it i i mi t t t t a t m a m ag a a i a a g Delivery attended by Skilled Birth Attendants (SBAs): ig a m i a a im ta t m t i a i g i t a Nepal is committed to achieving 70 percent of all deliveries attended by SBAs and at institutions by i i a t a ai a t t m 2020 (2076/77) to achieve the SDG target of 90 percent in 2030. At the national level, percentage of births attended by SBAs increased to 60 percent in FY 2075/76 from 52 percent for both FY 2073/74 and FY 2074/75. Similarly, SUDURPASCHIM province also remained at 60 percent for both years. DeliveryProvince fattendedive achieved by theSkilled highest Birth with Attendants 73 percent (SBAs):deliveries attended by SBA. The Gandaki province has the lowest percentage of delivery attended SBA at 47 percent which is stagnant from last fiscal a i mmi t a i i g t a i i a B a at i t year (Figure 4.4.6). t a i t ta g t t i t t a a tag i t a B i a t t i m t t a imi a i a mai at t t a i a i t ig t it t i i a B a a i i a t t tag i a B at t i i tag a t m a t a a ig
DoHS, Annual Report 2075/76 (2018/19) ami a
Figure 4.4.6 Percentage of births attended by a Skilled Birth Attendant (SBA)
7073 80 60 61 61 65 59 606061 70 5252 52 52 5156 60 48 45 51 49 464747 50 35 40 30 20 10 0
2073/74 2074/75 2075/76
IInstitutionalnstitutional delivery: delivery: In t a i i a tag t i i t a i a stitutional deliveries as percentage of expected live births have increased to 63 percentt t i m a t i a in 2075/76 from 54 and 55 percent in FY 2073/74 and FY 2074/75 respectively. As compared to 2074/75 m a t tag i t a i i i a i a i ig , percentage of institutional deliveries increased in all Provinces (Figure 4.4.7).
Figure4.4.7
Percentage of institutional deliveries 78.8 75 73.2 80 69 67 68 69 71 63.2 62 61.5 60 70 55 54 49 53 52.7 53 49 60 44 46 4747.8 50 34 40 30 20 10 0
2073/74 2074/75 2075/76
Institutional Deliveries by type of Health Facilities
Figure 4.4.8 Total institutional deliveries by type DoHS, Annual Report 2075/76 of(2018/19) health facilties
120000 108300 100000
80000
60000 36476 37035 40000 27047
20000 6331 8200 0 PHCCs General Health Posts Nursing Primary Teaching Hospital Home Hospital Hospital
Figure 4.4.8 Total institutional deliveries by type of health facilities The Health Posts had the highest contribution (108300) followed by teaching (37035) and general (36476) hospitals to conduct institutional deliveries in Nepal [Fig 4.4.8]. Figure4.4.7
Percentage of institutional deliveries 78.8 75 73.2 80 69 67 68 69 71 63.2 62 61.5 60 70 55 54 49 53 52.7 53 49 60 44 46 4747.8 50 34 40 30 20 10 0
2073/74 2074/75 2075/76
ami a Institutional Deliveries by typeby type of Health of Health Facilities Facilities
Figure 4.4.8 Total institutional deliveries by type of health facilties
120000 108300 100000
80000
60000 36476 37035 40000 27047
20000 6331 8200 0 PHCCs General Health Posts Nursing Primary Teaching Hospital Home Hospital Hospital
Figure 4.4.8 4.4.8 Total Total institutional institutional deliveries deliveries by type by of typehealth offacilities health facilities
The a t t a t ig t t i t a i g a g a Health Posts had the highest contribution (108300) followed by teaching (37035) and general (36476) ita t t i t a i i i a ig hospitals to conduct institutional deliveries in Nepal [Fig 4.4.8]. Emergency obstetric care: Ba i m g t t i a a B t ma ag m t g a m i a a i t agi a i a m t ma a m a a ta t m a tai t a ma a a m a i a a t a mi i t a a ta g t a t m a m ag i a am ia a am ia a t ita a a m i m g t t i a i g a a a a a t ia a t a i a g it B
t i t a i i a t m a t a t a a t i tag i t i a i t tag i ig i i Bagma i i a a a i i ig
DoHS, Annual Report 2075/76 (2018/19) Emergency obstetric care: Basic emergency obstetric and newborn care (BEONC) covers the management of pregnancy complications by assisted vaginal delivery (vacuum or forceps), the manual removal of placentas, the removal of retained products of abortion (manual vacuum aspiration), and the administration of parental drugs (for postpartum haemorrhage, infection and pre-eclampsia and eclampsia) and the resuscitation of newborns and referrals. Comprehensive emergency obstetric care (CEONC) includes surgery (caesarean section), anaesthesia and blood transfusions along with BEONC functions.
In FY2075/76, 18 percent of institutional deliveries are conducted by CS. Compared to last fiscal year there is one percentage point increase in the percentage of CS delivery. Very high CS delivery observed in Bagmati Province (31%), Province 1 (30%) and Gandaki Province (19%) (Figure 4.4.9).
Figure 4.4.9 Percentage of deliveries by caesarean section, by province ami a
Percentage of deliveries by caesarean section
35 30 3031 28 30 25 1919 1718 17 17 20 1515 15 10 9 10 9 7 10 5 5 5 7 4 3 4 5 0
2073/74 2074/75 2075/76
Postnatal care PostnatalPostnatal care care services include the following: Three postnatal check-ups, the first in 24 hours of delivery, the second on the third day and the Postnatal care services include the following: third on the seventh day after delivery. t ata t t i i t t t i a a t The identification and management of complications of mothers and newborns and referrals to t i t t a a i appropriate health facilities. i a a ma ag m t m i a m t a a a t The promotion of exclusive breastfeeding. a iat a t a i i m i a i g Personal hygiene and nutrition education, and postnatal vitamin A and iron supplementation for a gi a t i a a t ata itami a i m ta mothers. m t The immunization of newborns. imm i a Postnatal family planning counselling and services. t ata ami a i g i g a i
m m t i t i t t ata a at a a t a i it it i i i imi a t t m i t a i i i a m t a a t a i i a m t a t t t a i t ata a t t m t a a i i a g i i t t m it i g t i it a i g t a t i
m t a i g t i it a t t i m t i t t i a ig i i a a ig t i a im a a i i t i im ta t t t t at m a i g t a a a m a t t a m t i i at t a a g g a i a a t a g t m m t t ata m t a t ag i t i im ta a i g t t a t m i a ig i a t i a t a i i t t m t a t a t t ata i ia i g g a i a a gi g a a
DoHS, Annual Report 2075/76 (2018/19)
The number of mothers who received their first postnatal care at a health facility within 24 hours of delivery is similar to the number of institutional deliveries in almost all health facilities as most health workers reported to have provided post-natal care to both mothers and babies on discharge. The revised HMIS introduced the monitoring of three PNC visits according to a protocol since2071/72.
The proportion of mothers attending three PNC visits as per the protocol declined from 19 percent in 2073/74 to 16 percent in FY2074/75 and FY 2075/76 (Figure 4.4.10). The service utilization was found highest in Sudurpashim (31%) followed by Karnali Province (24%). It is important to note that proportion of women attending three PNC has always been low compared to other safe motherhood indicators. Cultural and geographical factors affecting the movement of postnatal mothers could be reasons for the low coverage while the perceived low importance of care during the postpartum period could also be significant. There is a need for culturally sensitive interventions to promote access to and the use of postnatal services, especially in geographically challenging areas. ami a
Figure 4.4.10: Provincial and national trends of percentage of women who had 3 PNC check-up as per protocol
Percentage of women who had PNC3 check-ups as per protocol 35 31 35 25 26 30 23 22 24 25 19 19 2019 1616 15 20 12 14 13 14 141313 15 9 9 10 10 5 0
2073/74 2074/75 2075/76
SafeSafe abortions abortions Women of reproductive age have been receiving safe abortion services (SAS) from certified sites since m ag a i i g a a i m it i t i ga i a m a i a t a t the service began in Nepal from 2060/61. The use of SAS has been increased over the last decade. Total a ta m i i a SAS users were 96,138 (12.7%) women in 2073/74; 98,625 (13%) in 2074/75 and 90,677 (12.6%) in i a m i a a am g t ta a a i g a a 2075/76. The share of medical abortion among total safe abortion service users gradually increased over i a t a t a m t i t i t the last few years, from 53 percent in 2072/73, 56 percent in 2073/74, 62 percent in 2074/75 and 66 i a t i a t a am g i m i a a a ig t i a gi a a i t i a a l tl n rea e (1 ) or ur al a ort on n t al ear otal reporte po t a ort on ta t t a m i a a i t a t t a o pl at on al o e l ne o er t e la t t ree ear
TableTable 4.4.11:4.2.4: ProportionProportion ofof safe afe abortionabortion er services ice u users, er b by age age Aged 20 ear a ong total Aged 20 ear a ong Fi cal ear Medical SAS u er total Surgical SAS u er
207 /7 12 17 207 /75 10 11 2075/76 9 1
o pare to al ear 207 /7 , t e proport on o o en o a a a e a ort on an t en u e t a ami a i g a ig t i a i a t t a i ontra ept e n rea e o er t e la t t ree ear , ro 75 per ent n 207 /75 an 76 per ent n a i i m a i t i a ta t a t a am g m i a a i a ig m a t am g gi a a 2075/76 ( ure 2 12) e a eptan e o po t a ort on ontra ept on a on e al a ort on er e m i a a gi a a a t a i ig u er a o pare to a on ur al a ort on u er ( e al a ort on 79 er u ur al am g m a gi a a t a am g m i a a a ort on 69 ) erall, po t a ort on AR u e er a on o en o a ur al a ort on (51 per ent) t an a on e al a ort on (26 per ent) I ple entation of Maternal and Perinatal Death Sur eillance and Re pon e MPDSR DoHS, Annual Report 2075/76 (2018/19) aternal an er natal Deat Sur e llan e an Re pon e ( DSR) a e ne to ea ure an tra all aternal eat n real t e, to un er tan t e un erl n a tor ontr ut n to ortal t an to pro e u an e or o to re pon to an pre ent uture eat a ont nuou ent at on, not at on, uant at on an eter nat on o au e an a o a l t o all aternal an per natal eat , a ell a t e u e o t n or at on to re pon t a t on t at ll pre ent uture eat o pr or t e an ple ente DSR n 207 /7 DSR t urt er tren t en n an e pan on
DSR a ale up n 21 tr t out o 7 tr t n t al ear ( a an , Da le , alpa, a , u a ot, aple un an Rauta at , an 99 Ho p tal ( ot pu l an pr ate) n 2075/76 o ern ent o epal ( o ) e elope DSR u el ne 2015 n t e e tr t , ot o un t aternal eat , o p tal aternal eat an o p tal per natal eat are re e e an re pon e planne
Co unit ba ed MPDSR: o un t a e DSR pro ra a ple ent n n 21 tr t 99 o p tal n o un t a e DSR pro ra o un t , aternal eat an per natal eat are re e e an re pon e planne
Ho pital ba ed MPDSR: Currentl 99 o p tal are ple ent n DSR pro ra n o p tal , ea aternal eat re e e n uall an per natal eat are re e e n a ont l a
For ation of MPDSR Co ittee at different le el A per t e DSR u el ne 2015, t ere a at onal DSR o ttee a re t e D re tor eneral, D re torate o Healt Ser e an DSR e n al or n roup ( ) a re D re tor, a l Healt D on n a t on, t ere are ealt a l t le el DSR o ttee an pal a le el o ttee t eparate A an au e o eat a n ent tea or o un t DSR pro ra or ea o p tal ple ent n DSR, t ere DSR o ttee or e a per t e le el o t e o p tal ami a Implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR)
at a a i ata at i a a a ig t m a a t a a mat a at i a m t ta t i g a t t i g t m ta it a t i g i a t t a t t at i i a i a a a a a t mi a a a a i a i it a mat a a i ata at a a t t i i ma t it a t at i t t at i i a im m t i it t t gt i g a a i
a a i i t i t t i i t i t i t i a a Ba a g ai a a ag i a t a g g a a ta a a ita t i a i at i m t a g i i t i t i t t mm it mat a at ita mat a at a ita i ata at a i a a
Community-based MPDSR: mm it a g am a im m g i i t i t ita mm it a g am mm it mat a at a i ata at a i a a
Hospital-based MPDSR: t ita a im m g g am ita a mat a at i i i i i a a i ata at a i i a m t a i
Formation of MPDSR Committees at different levels
t g i i t a a a mmi ai t i t a i t at a t i a i a i g ai i t ami a t i i i a i t a a t a i it mmi a a i a mmi it a at a a at a ig m t t am mm it g am a ita im m g t i mmi m a t t ita
MPDSR On-site coaching program
ami a t i i i t it a i g g am t t t i t i t a ita im m g g am it a i g g am a i i t i t mm it a a ita ita a i g t i g am a ai a ata m a m t i a i i a i mai t a t ta i
Review of MPDSR:
i g am a t i t i a a it a t i t at g i im m g ita i a t i Bi at aga B t a at ma a a ga i i a im m g ita i a m a ita i it m a ita t a i at i t i
One stop Crisis Management Centre (OCMC)
t i i ma ag m t i ta g am a m t i i t i t i t ita i a ta a i a i a a a a i a a DoHS, Annual Report 2075/76 (2018/19)
MPDSR On ite coaching progra a l Healt D on on u te on te oa n pro ra to upport t e tr t an o p tal or ple ent n DSR pro ra e on te oa n pro ra a one n tr t or o un t a e DSR an o p tal or o p tal a e DSR Dur n t pro ra a a la le ata, or an o u ent ere re e e an u on a one a nl o u e to a re t e pre enta le ue
Re iew of MPDSR: A re e o DSR pro ra a on u te n t al ear t an o e t e to re e t e up ate pro re on DSR n ple ent n o p tal Re e a on u te n ratna ar, ut al, at an u an D an a o ere all ple ent n o p tal n epal 2 per on ro ea o p tal ere n te ro ea o p tal to part pate n t e re e
ami a One top Cri i Manage ent Centre OCMC ne top r ana e ent oor entat on pro ra a u e ull o plete n e erent tr t ga a i a i a a a i a t a it i i a a a a a a i ita t o p tal e autara, S n upal o , D ul el, a repalan o , San ar a, Ar a a , g am a t a i i g a i ga i g a ma ag m t aul a al, ap l a tu an r t an ra ( a alpara ) o p tal e o e t e o t e pro ra a to en an e er e pro er no le e an ll re ar n a e ana e ent Issues, constraints and recommendations I ue con traint and reco endation Table 4.4.12.: Issues, constraints and recommendations— safe motherhood and newborn health Table 4.2.7: I ue con traint and reco endation afe otherhood and newborn health I ue and con traint Reco endation Re pon ibilitie • Re e o pro ra e ple entat on an e e t ene D, DoHS, H aternal ortal t rate • lan or roa ap to re u e R a e on lo al an oH epal e en e • Re e t e Aa a ro ra e to a l tate an appropr ate re erral e an an pro e a e to l e a n Re erral e an D er e • De elop Re erral u el ne • o u n on un t onal t an ual t o e t n te , rat er t an e ta l n ne te • on tor n er e pro on tatu an a a la l t o u an re our e • ro ote t e pro u t on o lle er e pro er (AA , D , D o n) an en ure appropr ate ll at te eplo ent an appropr ate tran er o lu tuat n un t onal t o lle u an re our e oH , DoHS, an rt n entre • ont nue allo at on o un or ontra t n out ort D, H er e ter er e pro er • ro e lo u o tor an anae t e a a tant n trate all lo ate re erral o p tal or ea pro n e • ntro u e a pe al pa a e to pro e er e n ounta n tr t • Support lo al o ern ent or tra n n o u an re our e n ne e ar ll A a la l t o ual t • ntro u e ual t pro e ent pro e or all atern t oH, DoHS atern I ue t and are con er traint e at are er e n lu Reco n endation el a e ent an on te Re pon ibilitie o p tal an rt n l n al oa n entre • ntro u e on tor n pro e n ator or ual t D( ual t o • 2 /7 a a la l t o atern t are n ealt a l t e are) er e • A e uate u et allo ate or e u p ent n rt n • ll an no le e o entre an te ta • Re ular H ll up ate pro ra e or nur e D • ena l n en ron ent o u n on ont nuu o are an ot at on • ntro u e on tru t on tan ar or rt n entre D, DH , • o er ro n at • Support rt n entre at trate lo at on onl D H re erral o p tal • ro e a t onal u etar upport or o er ro e D, DoHS o p tal • Ra e t e ual t o A oun ell n er e , o u n on lateau n o A u e an ont nuu o are DH , D H , t el r t A t , an • De elop a pe al pa a e to en oura e t el r t A D er lo o era e t • n t ate o e t n ele te oun l o u e o n t tut onal • ro u e a trate to rea unrea e u populat on el er an e t on • Rap l a e an e pan rural ultra ono rap ( S ) D, DH , er e n ounta n • pan er e n re ote an ult lo at on an D H tr t , an pro n e en ure ont nuou a a la l t o er e ( rt n nu er 2 an 6 entre an er e ) o er e n o e • D u on t lo al o ern ent on t e a anta e o re ote tr t Ra u a, a e , an allen e n a nta n n D anan an u tan un t onal t n lo populat on area e pu l e an or DoHS, Annual Report 2075/76 (2018/19) oH, HS, ree el er er e at • ple ent t e Aa a ro ra e at HS D, RHD HS • e trate up ra n o ealt a l t e nto rt n e na e uate u e o o e entre rt n entre an • p ra e trate all lo ate rt n entre to pro e n rea n t e nu er o D, DH o pre en e ual t pr ar ealt are er e an rt n entre , an D H a or o e el er ree D n rea n u e o re erral • Run nno at e pro ra e to en oura e el er at o p tal rt n entre H e an or ree • n rea e t e u et an tar et or re onal ealt ur er or uter ne prolap e D Ho p tal pro e re ular er e o ur er a e e eral tru ture an o ernan e o ealt • r entat on o lo al an pro n al le el o ern ent on n t tut on l te D/ H t e r role n ealt er e el er an o ernan e un er tan n o ealt er e el er
I ue and con traint Reco endation Re pon ibilitie o p tal an rt n l n al oa n entre • ntro u e on tor n pro e n ator or ual t D( ual t o • 2 /7 a a la l t o atern t are n ealt a l t e are) er e • A e uate u et allo ate or e u p ent n rt n • ll an no le e o entre an te ta • Re ular H ll up ate pro ra e or nur e D • ena l n en ron ent o u n on ont nuu o are an ot at on • ntro u e on tru t on tan ar or rt n entre D, DH , • o er ro n at • Support rt n entre at trate lo at on onl D H re erral o p tal • ro e a t onal u etar upport or o er ro e D, DoHS o p tal • Ra e t e ual t o A oun ell n er e , o u n on lateau n o A u e an ont nuu o are DH , D H , t el r t A t , an • De elop a pe al pa a e to en oura e t el r t A D er lo o era e t • n t ate o e t n ele te oun l o u e o n t tut onal • ro u e a trate to rea unrea e u populat on el er an e t on • Rap l a e an e pan rural ultra ono rap ( S ) D, DH , er e n ounta n • pan er e n re ote an ult lo at on an D H tr t , an pro n e en ure ont nuou a a la l t o er e ( rt n nu er 2 an 6 entre an er e ) o er e n o e • D u on t lo al o ern ent on t e a anta e o ami a re ote tr t Ra u a, a e , an allen e n a nta n n D anan an u tan un t onal t n lo populat on area e pu l e an or oH, HS, ree el er er e at • ple ent t e Aa a ro ra e at HS D, RHD HS • e trate up ra n o ealt a l t e nto rt n e na e uate u e o o e entre rt n entre an • p ra e trate all lo ate rt n entre to pro e n rea n t e nu er o D, DH o pre en e ual t pr ar ealt are er e an rt n entre , an D H a or o e el er ree D n rea n u e o re erral • Run nno at e pro ra e to en oura e el er at o p tal rt n entre H e an or ree • n rea e t e u et an tar et or re onal ealt ur er or uter ne prolap e D Ho p tal pro e re ular er e o ur er a e e eral tru ture an o ernan e o ealt • r entat on o lo al an pro n al le el o ern ent on n t tut on l te D/ H t e r role n ealt er e el er an o ernan e un er tan n o ealt er e el er
DoHS, Annual Report 2075/76 (2018/19) ami a 4.5 Family Planning and Reproductive Health
4.5.1 Background
ami a i g t ma t i i a g mi i a ma t i i a g a a t m i t a t i t a i ma t a im a t g a t m t i ta g a t a i m i a i m ma m a ta a am a m t m g t a i a ta a a m t
aim a a ami a i g g amm i t i i i a a t i a ig t i g a it m t ta i a i m i a i t i m t a i mmi t ita a ig t a a t ta a it i a i m i a i i i a a i g m a t a mm i a a a a t mig a t a t a ma gi a i g i g i i
m t mmit t t gt i i a t at gi at it i t a t t m i i im a i g i m t t gag it g a t m t i i at a t i a i a t t a a a i t a a mmitm t i t a im m t a t m m ta a a t
m g am t g it i ia a t a t a m i i a i a t i g t a t a i a i t t a it i t g im t a ia am g a t a mm i a a a t a t a g m t a m t mi i i g g a g i t a a a im a t m i i i t t a i a a i a i i m i i a ma g a i t
a i ma a a i a i t g t g m t ia ma g a t i at t i i g mm ia t g m t a t t m t a g i t a m t ma m a i a i ta a i t g a t t Ba i a t i t a a t it mm it a t it a i i ma a a t m a at mm it a i t i t ma m a a t a i i a a ai a i ita a a t t t at a t ai a i i t i i m t a a i i t g at it i i t i i g i i t i a a a i a m i am a a ma t i i a i g ta gi a t a a i at ta it t g a a a m i t a i
a it i a a i t g i at a mm ia t t a i i t i at i i a ma i g t ita i i g a a mi ita i a mm i a ma a ai a m ia ma g a imit ia a i i g ag i
i a a t a i a t a i a a i i a i t t t
DoHS, Annual Report 2075/76 (2018/19) ami a 4.5.2 Objectives, policies and strategies
a a g amm i t im t a t tat a t g i m i a i g a i i g i t t a it ta i i 4.5.2 Ob ecti e policie and trategie a a 4.5.2 e o erallOb ecti o e e t policie e o epal and trateg pro ie ra e to pro e t e ealt tatu o all people t rou 4.5.2 n or e o e Ob erall ecti o o e e on t policie ea o e epal and n an trateg ut pro ie l ra n l e ent to entre pro ual e t t e oluntar ealt tatu o er all e people e t pe rou o n or e i a a t a t a it i t at i a a a ta t t e e are o a e ollo on a e n an ut l n l ent entre ual t oluntar er e e pe e o erall o e t e o epal pro ra e to pro e t e ealt tatu o all people t rou o • i i i a a ia i i a i g a i a a m t a a t e t e o are n rea a ollo e a e to an t e u e o ual t er e t at a e, e e t e an a epta le to n or e o e on a e n an ut l n l ent entre ual t oluntar er e e pe • n o a it n rea ual a e an a t e ouple to ma gi a i an A t pe e u al e o o u ual t on it n rea er ig n e t a m t at e na rural e, e an e a t re e an t ote t a t m a pla epta e an le to to a o e t e are a ollo t a m t i a mig a t a a t poor, n Dal ual t an an ot ouple er ar A nal pe ale o people u on t n rea un n a et e nee n rural an toan po re tpartu ote pla an e po an t to • o n rea e a e to an t e u e o ual t er e t at a e, e e t e an a epta le to i a a poor, ort onDal a t o an en, tai ot t er e ar t a e nal o la e our people rant t a an a un ole et ent nee m t an to po tpartu an i t po t n ual an ouple A pe al o u on n rea n a e n rural an re ote pla e an to • g a i a t a i a a o ort n rea on e o an en, u t ta e n ontra e o la ept our e u e, rant an re an u a eole un ent et nee or , un nten e poor, Dal t an ot er ar nal e people t un et nee an to po tpartu an po t • pre o n nan rea e e ,an an u ontra ta n ept on ontra ept ont nuat on e u e, an re u e un et nee or , un nten e at a ort on a a i g o en, t e i m t e o la our i a i g rant an a a ole ent t a it i t m a • pre o reate nan e an, ena an l ontra n en ept on ron ent ont nuat on or n rea n a e to ual t er e to en an • m i i g a t o n rea e an u ta n ontra ept e u e, an re u e un et nee or , un nten e • o o reate en n an lu ena n a l n ole en ent ron ent or n rea n a e to ual t er e to en an i a pre nan e t , an ma ontra ept on i ont nuat on im m g t at gi a i a g • o o n en rea n e lu t e n e a an ole or ent er e ple ent n trate e a our an e • mm i a a i o reate an ena l n en ron ent or n rea n a e to ual t er e to en an • o o n rea un e at t on e a e t an t e or er e ple ent n trate e a our an e o en n lu n a ole ent o un at on a t t e i i a t at gi a a t a i t a a t i B e• e pol o n e rea an e t trate e e an area or to a er e e e t e a o ple e o ent e n t e trate are pre e ente a our n o an 5 e 1 e e pol o e un an at on trate a t t area e to a e e t e a o e o e t e are pre ente n o 5 1 Bo 4.5.1: Policie and Strategic Area for FP Bo e 4.5.1: e pol Policie e an and trate Strategic area A torea a for e FP e t e a o e o e t e are pre ente n o 5 1 1 Enabling environment Stren t en t e ena l n en ron ent or 2 Bo 1 DemandEnabling4.5.1: Policie generationenvironment and S n trategicStren rea e t A e ealt rea n t e for ena are FP l ee n en n ron e a ent our or a on populat on t un et 2 nee Demand or generation o ern ontra n ept rea on e ealt are ee n e a our a on populat on t un et 1 ServiceEnablingnee or delivery environment o ern ontra n an Stren e ept on t er e n t e e ena el er l n en n lu ron n ent o or o t e to re pon to t e nee o 2 DemandService ar nal delivery generation e people, n rural an n e rea people, e er ealt e rant are el , er a ee ole n n lu ent e n a an o our ot a o er on t pe e populat to al re roup pon on to t t e nee un o et Capacitynee ar nal or building e o people, ern Stren ontra rural t ept people, en on t e apa rant t o , a er ole e ent pro an er ot to ere pan pe al roup er e el er 5 ResearchServiceCapacity delivery buildingand innovation Stren n an e t Stren en t er e t apa en e t el t e o e er er en n lu e e pro n a e o er or topro o e ra t pan e to e re er ple pon e entat to el t er on e nee t rou o 5 re Research ar ear nal an and e people, nno innovation at onrural people,Stren t en rant t e e , a ole en e ent a ean or ot pro er ra pe al e roup ple entat on t rou Capacity building Stren t en t e apa t o er e pro er to e pan er e el er re ear an nno at on Target5 Research of Family and Planning innovation Stren t en t e e en e a e or pro ra e ple entat on t rou Target re of ear Fa an il Planning nno at on t g a a i i at t i a a t a a a t a Sele Target te of Fa oal il Planning an n ator to en ure un er al a e to e ual an repro u t e ealt are i i i g g am a a TargetSele er te e of , n Fa lu il oal n Planning oran /SRH n ator pro ra to en are ure a un ollo er al a e to e ual an repro u t e ealt are er e , n lu n or /SRH pro ra are a ollo Table 4.5.1: SDG Target and Indicator TableSele te 4.5.1: SDG oal Targets an n and ator Indicators to en ure un er al a e to e ual an repro u t e ealt are Target Table er e 4.5.1: and , n Indicator lu SDG n T arget or /SRH and pro Indicator ra are a ollo 2015 2019 2022 2025 2030 Source Target roport and on Indicator o o en o repro u t e a e (a e 15 9 66n2015 201971 20227 202576 203080 Source DHS, Table ear roport ) 4.5.1: on o o SDG a e o Tt arget e en r nee o and repro I ndicator or u a t l e plann a e (a n e at 15 e 9 66n 71 7 76 80 DHS, S t o ern et o Target ear ) and o Indicator a e t e r nee or a l plann n at e 2015 2019 2022 2025 2030 Source S ontra t o ept ern e pre et o alen e rate ( R) ( o ern et o ) ( ) 7 1 52 5 56 60 DHS, roport on o o en o repro u t e a e (a e 15 9 66n 71 7 76 80 DHS, S ear ontra ) ept o e a pre e t alen e r enee rate ( or R) a ( l o ernplann et n o at ) ( e ) 7 1 52 5 56 60 DHS, S otal ert l t Rate ( R) ( rt per o en a e 15 9 2 n 2 1 2 1 2 1 2 1 DHS, S ear t ) o ern et o S ontra otal ert ept l t e pre Rate alen ( R) e rate( rt ( R)per ( o o ern en et a e o 15 ) ( ) 9 2 7 n 1 2 52 1 2 5 1 2 56 1 2 60 1 DHS, DHS, A ear ole ) ent rt rate (a e 10 1 ear a e 15 19 ear ) 71n 56 51 0 DHS, S per 1,000 o en n t at a e roup S S A otal ole ert ent l t rt Rate rate ( (a R) e ( 10 rt 1 per ear o a e en 15a 19 e 15 ear 9 ) 71n2 n 562 1 512 1 2 1 2 0 1 DHS, DHS, per 1,000 o en n t at a e roup S ear ) S A ole ent rt rate (a e 10 1 ear a e 15 19 ear ) 71n 56 51 0 DHS, Tableper 1,000 4.5.2: o NHSS en I n t ple at a entation e roup Plan IP 2016 2021 Target of FP Progra : S S TableIndicator 4.5.2: NHSS I ple entation Plan IP 2016 2021Ba Target eline of FP Progra : Mile tone Target Table.S Indicator 4.5.2: NHSS Implementation Plan (IP)Data 2016-2021 Ba Year eline Target Source of FP2016 Program: 2017Mile 2018 tone 2019 2020Target NTable. 4.5.2: NHSS I ple entation Plan IP 2016Data 2021 Year Target ofSource FP Progra 2016 : 2017 2018 2019 2020 1 ontra ept e pre alen e rate ( o ern 7 1 201 S 50 55 SN Indicator Ba eline Mile tone Target 1 ontra et o ept ) R e pre alen e rate ( o ern 7 1 201 S 50 55 . Data Year Source 2016 2017 2018 2019 2020 N et o ) R 1 ontra ept e pre alen e rate ( o ern 7 1 201 S 50 55 et o ) R
DoHS, Annual Report 2075/76 (2018/19) ami a
2 et o o ale ter l at on 18 201 S 18 18 e ale ter l at on 0 9 201 S 29 9 27 D 5 201 S 8 5 7 plant 5 201 S 5 8 7 n e ta le 21 5 201 S 21 6 21 9 ll 9 7 201 S 9 7 9 7 on o 10 2 201 S 10 10 n et nee or a l plann n ( ) o e t u nt le 27 2 2015 S 22 19 5 H e t u nt le 2 2015 S 22 19 5 o o en o re e e po t 75 2015 A 80 80 a ort on 5 H (Healt o t) t AR A 2015 A 0 50 60 70 80 pro on
4.5.34.5.3 Ma Major or acti activities itie in 2075 in 2075/76 76 pro ra e are ple ente at ar ou le el ( entre, pro n e an un pal t e ) a ter t e e g amm eral at on a e im m t a t t e arr at e out a i n 2075/76are t a ollo i a m i i a i a t a i a a i a i t i a a • ro on o re ular o pre en e er e n lu n po t partu an po t a ort on er e • ro on o lon a t n re er le er e ( AR D an plant) • i i tren t en g a n pro m i ra t rou t e u i e o i i g e on a t a t m n tool (D a )an t H a e al i el l t or ontra ept e ( ) eel • i i g a g i i a m a t ro plann n or a re n un et nee o n ar to rea o un t e an un er er e t gt i g g am t g t i i ma i g t a m i a populat on • igi i it t a er anent et o or oluntar Sur al ontra ept on ( S ) • ple mi entat a i g on o pu l a i g pr ate partner m t p ( ) n pro i ra a at t populat a on mm i tr t a • a Stren t en n o n t tut onal e er e enter a a tra n n enter • ma t m t ta gi a t a ro on o ro n A (RA ) an S er e to n rea e er e u er • m m ta i i at a t i i g am at ig a i t i t nte rat on o an un at on er e • t gt i g i t a i i t a a t ai i g t Satell te l n er e or lon a t n re er le ontra ept e • i i i g a i t i a i ontra ept e up ate or tetr an/ ne olo t, nur e on erne e pla er • t g a a imm i a i ntera t on pro ra on an RH n lu n ASRH t p ar a t an ar nal e o un t e • at it i i i g a g i t a o un t ntera t on t at e l ent or pro ot n per anent et o an D • t a at t t i ia gi t a Stren t en n o ASRH er e • t a Strate , u g am el ne, proto ol an a tan ar i i g e elop ent an up it at n a ma i t relate to a , ASRH, ma gi a i mm i 4.5.4 mm it i t a it a i t m g ma t m t a Achie e ent 2075 76 t gt i g i Current t at g g i i t a ta a m t a a g at t u er e ale ter l at on ( 0 ) o up e t e reate t part o t e ontra ept e et o a on all urrent 4.5.4u er, ollo Achievements-2075/76 e Depo (1 8 ), plant (1 7 ), ale ter l at on (12 6 ), oral p ll (6 ) an la tl D (5 ) n 2075/76 ( ure 5 1) Current users
ma t i i a i t g at t a t t t a m t mi am g a t m a t ma t i i a a i a a t i ig
DoHS, Annual Report 2075/76 (2018/19) ami a
Figure 4.5.1: Proportion of FP Current Figure 4.5.2: Share of FP Current U er all U er Method Mi 2075 76 Method b Pro ince 2073 74 to 2075 2076
Figure 4.5.1: Proportion of FP Current Figure 4.5.2: Share of FP Current U er all U er Method Mi 2075 76 Method b Pro ince 2073 74 to 2075 2076
i a t ig t t i a a i i a t ro n e 2 a t e e t proport on (2 ) o urrent u er le arnal ro n e (5 ) a t e lo e t ( t ig i ta m ma t t t at a i g ure ro 5 n 2) e 2 n 207 a t 5 e/7 6 e otal t proport nu on er (2 o per ) o anent urrent u urrent er u le er arnal e ee ro n t e at (5 o ) pa a t n e lo et e t o at natm t at a a a i i a a t a t ta t onal( urele el 5 an 2) n n207 ro 5/7 6 n e otal 1 an nu 2 er ( o a per le anent 5 ) urrent e tren u er o e ee are t o at total o pa urrent n et u o er at ( n ) i a i a i i i a t a i i a ig o nat an onal n rea le el e an n 207 n 5 /7 ro 6 n n e ro 1 an n 2 e 2( an a le 5 t 5 an ) n epre tren ou o ear are ( o uretotal 5 urrent 2) at u er onall ( n , urrent ) u a a t a t m a m m t a i a i g t er (a o olute an n nu rea e er n 207 ) o 5/7 all6 n ro o ern n e 2 an et o 5 t anar e n pre n ou e rea ear n ( tren ure 5 2) A e at rea onall e , o urrent 26,000 o a i i t a i i a a a i i a i er u e er n(a 2075/76 olute nu t an er ) no pre all ou o ern ear et o an ar a e n ro e n rea e n an tren ro A n ee rea 5 e o o e 26,000 er o an n a i a i m t a i a a rea o e er n e nu n 2075/76 er t an pre t an ou n pre ear ou ( a ear le 5 an ) a ro n e an ro n e 5 o e er o an n rea e n nu er t an pre ou ear ( a le 5 )
TableTable Table4.5.3: 4.5.3: 4.5.3: FP C urrentFP FP C Currenturrent U er U Users er M odernM odern(Modern M Method ethod Methods) b Pro by ince ince Province, 2 073 2073 74 74 2073/74to2075 to2075 76 to2075/76 76 in 000 in 000 (in 000) MethodMethod Pro incePro 1ince 1 Pro Pro inceince 2 2 Bag Bag ati ati GandakiGandaki Pro Pro inceince 5 5 arnali arnali SudurSudur NationalNational pa hchi pa hchi
ear ear 7 /7 75/76 7 /7 7 /75 75/76 7 /7 7 /75 7 /7 7 /7 7 /75 75/76 7 /75 75/76 7 /75 75/76 7 /7 7 /75 7 /7 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 75/76 7 /7 7 /75 75/76 7 /7 7 /75 7 /7 7 /7 7 /75 75/76 7 /75 75/76 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76
Spa n Spa n et o et o 266 217266 207217 207126 126109 109 120 120 0 0 255 255 220220 9999 8686 100 295295 272272 10 10 80 807 7 82 821 9 1 1 95 1 9 5 1, 1 21 9 1, 1,161 21 1,1,161188 1,188 er anent er anent et o 2 9 2 7 2 0 86 8 70 22 218 206 10 101 97 176 176 169 57 55 52 100 99 95 1, 85 1, 71 1, 18 et o 2 9 2 7 2 0 86 8 70 22 218 206 10 101 97 176 176 169 57 55 52 100 99 95 1, 85 1, 71 1, 18 otal u er otal u er 505 5 7 612 592 590 527 7 26 202 188 196 71 8 79 1 7 129 1 2 9 2 2 2,707 2,5 2 2,506 505 5 7 612 592 590 527 7 26 202 188 196 71 8 79 1 7 129 1 2 9 2 2 2,707 2,5 2 2,506
e o ern ontra ept e pre alen e rate ( R) at nat onal le el 9 n 2075/76 ( ure 5 ) m t a a at m at a a i i ig e o ro ern n e 2 ontra a t ept e e e pre t alen R o e rate 6 ( le R) a at at nat onala t ele lo el e t ( 9 2 ) n 2075/76 e ro n ( e ure(1, , 5 ) ro n an e 2 a , a arnal t e an e Su t urpa R o 6 ) a e le R a le at t ana nat t e onal lo a e era t ( e 2 ( ) 9 ) e at ro onal n an e (1, , i a t ig t m i Bagma a t t i i ro n al (1, 2, a at an Su urpa ) R a e rea e n ear 2075/76 t an t at o pre ou a a i a a i a a im a m t a a a a ag a a a an a ear , ( arnal ure an 5 ) Su olo urpa al re on ) a e, e R o R le era ( t an ), alt nat ou onal na e era rea e n ( tren 9 ) , at onal er an i ia ro n al (1, 2, a Bagma at an a Su a im urpa ) m R a a e rea a e n ear i 2075/76 a t an t t a at o pre t at ou i a ig gi a gi i m ai a t g i a i g ear ( ure 5 ) olo al re on e, R o era ( ), alt ou n e rea n tren , er t i ig t a a a a ag i t at tai a i gi a gi mai t a a a ag ig
DoHS, Annual Report 2075/76 (2018/19) t an nat onal a era e ( 9 ) le t at o ounta n an H ll e olo al re on re a n elo t e nat onal a ami a era e ( ure 5 5)
Figure 4.5.4: CPR b Pro ince 2073 74 to Figure 4.5.5: CPR b Eco one 2073 43 to 2075 76 2075 76
D tr t e e H H S S ata ata n n ate ate t t at at n n 2075/762075/76 e e tr tr t t a a R R reater reater t t an an oror e e ual ual toto 50 50 , , 59 tr t a R et een een 0 0 50 an 1 tr t a R le t an 0 ( ure 5 5, 5 6) ar ar a a a a t e e t R (67 ) le at an u t e lo e t (20 ) ar ar a a tr tr t t a a atat t t e e toptop o o t e R l t pre ou ear al o at an u tr t repla e Solu u u t ear to e t e otto la t o t e R l t
i t i t i ata i i at t at i i t i t a m g at t a a t i t i t a m t a i t i t a m t a ig a a a t ig t m i at ma t t a a i t i t a at t t t m i t i a a at ma i t i t a m t i a t t m a t t m i t
DoHS, Annual Report 2075/76 (2018/19) e nu er o tr t t R elo 0 per ent e rea e ro 18 n 207 /75 to 1 ami a n 2075/76 n at n pro e per or an e a on t e lo R tr t ( ure 5 6 an 5 7) m i t i t it m t a m i t i i i a g im ma am g t m i t i t ig a Figure 4.5.6: CPR b Di trict 2075 76
Figure 4.5.7: S Cur e Pattern of CPR Growth 2075 76 Figure 4.5.8: Trend in CPR b Di trict FY 2073 74 2075 76
ma t m t ma a ma t i i a i t ma it a t am g a ma t m t i a i a m t mi t i i ig t ma t m t a i a i g t t at a a a i ia a t i i i a i g t i t i a a i i a a im ig i a t t tag t
DoHS, Annual Report 2075/76 (2018/19) er anent et o ( ale an e ale ter l at on) o up e t e a or t o are o urrent u er a on AR an per anent et o ( A ) n all pro n e an o t pro nent n ro n e 2 ( ure er 5 9) anent Ho e et er, o urrent ( u ale er an o per e ale anent ter l et at on) o o are up n e t e e rea a n or tren t o ot are o at nat urrent onal u an er a pro on n al AR le ean l per erea anent AR et urrent o ( A u ) er n all pro n n n rea e an n tren o t pro n t nent ree pro n ro n e n e( 2 an ( a ure , ro 5 9 ) n Ho e 5 an e er, Su urrent urpa u er ) ( o per ure anent 5 9) ro et n o e 2are a nt e e lo rea e n t per tren enta ot e o at AR nat onal urrent an ami a pro u er n al le el erea AR urrent u er n n rea n tren n t ree pro n e ( an a , ro n e 5 an Su urpa ) ( ure 5 9) ro n e 2 a t e lo e t per enta e o AR urrent Figureu er 4.5.9: Trend in APM Current U er a of MWRA 2073 74 to 2075 76
Figure 4.5.9: Trend in APM Current U er a of MWRA 2073 74 to 2075 76
e ale ter l at on ( / A) ontr ute a out 6 n ontra ept e et o n ro n e 2 ( ure ma t i i a t i t a t i t a m t mi i i ig t i i t t at ma t i i a mi i a a a a t ia i 5 10) t e ent t at e ale ter l at on ( n lap un er lo al anae t e a / A) popular n era ( e ure ale ter 5 1 l 1 ) at on ( a / e A) ontr ontr ute ute a n out antl 6 al no ontra n nat ept onal ea era et e o ale n ter ro l at n on e 2( ( S ) ureon a i ai ig i a t i t ig i a t a i a a a ag a t 5 e 10ot ) er t an e ent t ore at popular e ale ter n l ounta at on ( n an n lap H un ll t er an lo al era anae ( t ure e a 5 1 1 / ) A) o popular pare to n era D, t i i a t t a i m a i tai a i t a ai ig ( plant ure ee 5 11 ) to e a ore e popular ontr ute a on n o antl en o al repro o n nat u t onal e a a e era n all e e aleolo ter al l re at on on o ( S epal ) on m a t im a t m t m a am g m ag i a t A e ot ent er one an earl er, ore e popular ale ter nl at ounta on arr n e an t eH ll t e an t proport era ( on ure o urrent 5 11) u o er pare n era to re on D, gi a gi a m a i ma t i i a a i t ig t ( plant ure ee 5 11 ) to e ore popular a on o en o repro u t e a e n all e olo al re on o epal A ent one earl er, e ale ter l at on arr e t e e t proport on o urrent u er n era re on t i ai gi ig Figure 4.5.10: Sterili ation Current U er a of Figure 4.5.11: Trend APM Current U er a of MWRA ( ure 5 11) MWRA 2075 76 b Ecological Region 2073 74 to 2075 76 Figure 4.5.10: Sterili ation Current U er a of Figure 4.5.11: Trend APM Current U er a of MWRA MWRA 2075 76 b Ecological Region 2073 74 to 2075 76
t a a t a t m a m t i g m a i i at t a i a a at agai t t i ig i a t t a a i i g t m t ig m ma it t m t ma t a m t i i i a i g t i i t g a a it a a i i a i a a t at i a im i a t ig t ig m a t t a g i t a i a a a t at ig i a i a t m t a a m t t t a t a i a a i a i
DoHS, Annual Report 2075/76 (2018/19)
ontra ept e e aulter ( or all te porar et o e lu n on o ), a pro n ator or ontra ept e ont nuat on ( al ulate a a n t urrent u er ), n epal A out 59 o ontra ept e u er a e ont nue u n t e et o ( ure 5 12) e e o en a oo e
( t to) le e e t e et o or a not u e an et o ( ont nue le t ll n nee ) lea n to ontra r o ept un nten e e e aulter pre nan ( or an all te t porar on e uen et e o an e a lu ro n n on e ( o 7 ) ), an a pro ro n e n 5 ( ator ) a or lo ontra e ept aulter e rate ont nuat le Su on urpa ( al ulate ro a n a n e t a urrent t e u e er t ),(90 ) ( ure n epal 5 12 ) A outo pare 59 too SAR ontra ( ept ort e a u t er n re a er e le ont ontra nue ept u n e t p e ll et an o Depo), ( ure AR 5 1 2) a lo e e e aultero en rate a ( oo ure e ( 1 1 t ) to) n allle ro e e n t e e AR et o are or t e a not o t u e e e an t e a et o ell ( a ont o nue t o t e le e t t ll e n ontra ne ami a e ) ept lea e n to ren r o o un ontra nten ept e pre e nan ont an nuat t on on a e e uen n rea e e an n 2075/76 a ro ( n e ure ( 7 ) 5 an 12) n ro n at e n 5 ( ual t ) o a ig i i a g a it i i i a a m t a t lo er e aulter e el rate er ue le Su lo urpa all , AR ro are n pro e a ote t e a r e t l t ne(90 ontra ) ( ept ure e 5 1 or2) all o pro pare pe t to e i t a a i t ig i a a ta SAR l ent ( eort a t n ont re er nuat le on o ontra SAR ept an e lo p ll upta an e o Depo), AR AR n epal a n lo ate e aulter on ern rate o ( er an ure i a i i at a t g amma t a t 1 e 1nee ) n o all pro ro ra n e at AR o u are on t e ot o tuppl e e an t e a e an ell a a pe o t t u o ta t e n n e t t e pa ontra t a ept n an e ma a t tai i g t a t gai a i g m o ren u n o ore ontra on ept AR e ont nuat on a e n rea e n 2075/76 ( ure 5 12) n at n ual t o er e el er ue lo all , AR are pro ote a r t l ne ontra ept e or all pro pe t e Figure l ent 4.5.1 e2 : Percentage ont of nuat Contracepti on o SAR e M ethodan lo upta Figure e o 4.5.1 AR 3: Percentage n epal o n f Contracepti ate on e ern Method o er an Dt efaulter e nee o 2073 pro 74 ra to 2075 at 76 o u on ot uppl an Defaulter e an b Method a pe t 2073 u ta n 74 n to t 2074 e pa 75 t a n an o u n ore on AR
Figure 4.5.12: Percentage of Contracepti e Method Figure 4.5.13: Percentage of Contracepti e Method Defaulter 2073 74 to 2075 76 Defaulter b Method 2073 74 to 2074 75
New acceptor NewDepo acceptors ( 7 ) o up e t e reate t part o t e ontra ept e et o or all et o a on ne
a eptor , ollo e on o (2 ), p ll (19 ), plant (1 ), D ( ), e ale ter l at on ( ) i t g at t a t t t a m t mi a m t am g an la tl ale ter l at on ( S 1 ) n 2075/76 ( ure 5 1 ) ne a eptor (all et o ) a o New acceptor a t RA a talle at nat onal m le el le t i a n rea e im a t n ro n e 1 an 5 ( ure 5 ma 15) t i i a Depo ( 7 ) o up e t e reate t part o t e ontra ept e et o or all et o a on ne Figure 4.5.1 a 4: Share a t of ma FP Method t i i a Mi i Figure 4.5.1 5: Trend of ig FP New Acceptor a All Method a t a eptor , ollo e on o (2 ), p ll (19 ), plant (1 ), D ( ), e ale ter l at on ( ) a m t a a ta at a a i it a i a i i a A ong All New Acceptor 2075 76 of MWRA 2073 74 to 2075 76 ig an la tl ale ter l at on ( S 1 ) n 2075/76 ( ure 5 1 ) ne a eptor (all et o ) a o RA a talle at nat onal le el le t a n rea e n ro n e 1 an 5 ( ure 5 15) Figure 4.5.14: Share of FP Method Mi Figure 4.5.15: Trend of FP New Acceptor a All Method A ong All New Acceptor 2075 76 of MWRA 2073 74 to 2075 76
New acceptor VSC New acceptors VSCs ro n e 2 re or e t e e t nu er o S /per anent et o (12,562) le arnal ro n e i t e lo e t ( 827) ( a le t 5 ig t ) ote t m at t e pro e ma t te nu er o ne m t S a eptor a i n rea a a i e i t t a t t at t t m a t ro 0,000 n 207 /7 to 2, 00 n 207 /76 ( a le 5 5) e tren o are o ne a eptor (a olute nu er ) o an n rea e n 2075/76 t an n pre ou ear n all ro n e e ept t at o a i a m i t i a t a a at , ro n e 5 an Su urpa ro n e ( a le 5 ) at onall , ne a eptor o all o ern a t a t m a i a i t a i i a i a et o (a olute nu er ) a e n rea e 25,000 plu n 2075/76 t an n pre ou ear i t t at Bagma i a a im i a a a Table 4.5.4: New Acceptor All Modern Method b Pro ince 2073 74 to 2075 76 in 000 DoHS, Annual Report 2075/76 (2018/19) Sudur ar a le Pro ince 1 Pro ince 2 Bag ati Gandaki Pro ince 5 arnali National pa hchi
6 76
ear /7 5 7 /7 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /75 75/ 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 7
SAR 95 86 96 85 79 8 108 100 88 5 7 6 157 1 6 175 55 57 59 85 81 80 6 2 598 628
AR 21 25 2 12 1 15 5 2 25 10 11 10 25 27 29 7 7 9 15 1 1 129 1 2 125 er anent 5 6 9 8 1 2 1 1 2 1 1 1 2 2 0 25 27 et o otal ne 12 115 125 108 102 112 1 8 1 5 115 67 61 58 186 177 207 6 66 67 10 97 95 802 756 781 a eptor
er enta e o are o ter l at on ( ) ne a eptor a on total ne a eptor e t ( 6 ) n ro n e 2 an n n rea n tren ( ure 5 16) o en an en n an a ro n e an arnal ro n e a epte lea t nu er o S ( a le 5 ) ale a eptor o nate a at an arnal ro n e ( ure 5 16) e e, ro n e 2 a t e e t nu er (a olute nu er) o ter l at on n 2075/76 a n pre ou ear ( a le 5 , ure 5 16)
New acceptor VSC ro n e 2 re or e t e e t nu er o S /per anent et o (12,562) le arnal ro n e t e lo e t (827) ( a le 5 ) ote t at t e pro e te nu er o ne S a eptor a n rea e ami a ro 0,000 n 207 /7 to 2, 00 n 207 /76 ( a le 5 5) e tren o are o ne a eptor (a olute nu er ) o an n rea e n 2075/76 t an n pre ou ear n all ro n e e ept t at o a t a m m t a t m a i a i a at , ro n e 5 an Su urpa ro n e ( a le 5 ) at onall , ne a eptor o all o ern t a i i a et o (a olute nu er ) a e n rea e 25,000 plu n 2075/76 t an n pre ou ear Table 4.5.4: New Acceptor All Modern Method b Pro ince 2073 74 to 2075 76 in 000 Sudur ar a le Pro ince 1 Pro ince 2 Bag ati Gandaki Pro ince 5 arnali National pa hchi
6 76
ear /7 5 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/ 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 7
SAR 95 86 96 85 79 8 108 100 88 5 7 6 157 1 6 175 55 57 59 85 81 80 6 2 598 628
AR 21 25 2 12 1 15 5 2 25 10 11 10 25 27 29 7 7 9 15 1 1 129 1 2 125 er anent 5 6 9 8 1 2 1 1 2 1 1 1 2 2 0 25 27 et o otal ne 12 115 125 108 102 112 1 8 1 5 115 67 61 58 186 177 207 6 66 67 10 97 95 802 756 781 a eptor
er enta e o are o ter l at on ( ) ne a eptor a on total ne a eptor e t ( 6 ) n tag a t i i a a t am g t ta a t i ig t ro n e 2 an n n rea n tren ( ure 5 16) o en an en n an a ro n e an arnal i i a i i a i g t ig m a m i a a i i a ro n e a epte lea t nu er o S ( a le 5 ) ale a eptor o nate a at an arnal a a i i a t a t m a a a t mi at Bagma ro n e ( ure 5 16) e e, ro n e 2 a t e e t nu er (a olute nu er) o ter l at on a n 2075/76 a a i a i n pre ou ig ear ( a le 5 i i , ure 5 i 16) a t ig t m a t m t i i a i a i i a a ig
Figure 4.5.16: Share of M and NSV New Acceptor A ong Total Sterili ation New Acceptor 2073 74 to 2075 76
e ale S ne a eptor ere e t n era e olo al re on ollo e H ll ( ure 5 17) ale S a eptor e ee t at o e ale S n H ll e olo al re on ( ure 5 17)
Figure 4.5.17: Share of M and NSV new acceptor Figure 4.5.18: Share of te porar ethod of a ong total terili ation new acceptor 2073 74 to new acceptor a ong total new acceptor 2073 74 2075 76 to 2075 76
DoHS, Annual Report 2075/76 (2018/19)
A e e ent o n lap an a e to ne a eptor , a a n t t e pro e t on or 2075/76 6 Ho e er, nat on e, total nu er o S ne a eptor a e n rea e n 2075/76 ( 1,2 2) arnal ro n e a e n t e lo e t ( 7 ) le ro n e 1 an 2 t e e t (77 ) ( a le 5 5) Ho e er, n a olute nu er a e pe te , ro n e 2 outper or e ot er
Figure 4.5.16: Share of M and NSV New Acceptor A ong Total Sterili ation New Acceptor 2073 74 to 2075 76
ami a ma a t ig t i ai gi a gi i ig e ale S ne a eptor ere e t n era e olo al re on ollo e H ll ( ure 5 17) ale a a t t at ma i i gi a gi ig S a eptor e ee t at o e ale S n H ll e olo al re on ( ure 5 17)
Figure 4.5.17: Share of M and NSV new acceptor Figure 4.5.18: Share of te porar ethod of a ong total terili ation new acceptor 2073 74 to new acceptor a ong total new acceptor 2073 74 2075 76 to 2075 76
A e e ent o n lap an a e to ne a eptor , a a n t t e pro e t on or 2075/76 6 i m t mi i a a a t m a t agai t t i Ho e er, nat on e, total nu er o S ne a eptor a e n rea e n 2075/76 ( 1,2 2) a i t ta m a t a i a i arnal ro n e a e n t e lo e t ( 7 ) le ro n e 1 an 2 t e e t (77 ) ( a le 5 5) a a i i a i i g t t i i a t ig t a Ho e er, n a olute nu er a e pe te , ro n e 2 outper or e ot er i a t m a t i t m t
4.5.5:4.5.5: TrendTrend of VSCVSC New New Acceptor Acceptors Again Against t Pro ection Projection b Pro ince by 2073 Province, 74 to 2075 2073/74 76 to 2075/76
ro n e 1 ro n e 2 a at an a ro n e 5 arnal Su ur at onal pa
ar a le 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76
ro e te 6875 5 50 7950 11600 9 00 16 00 6100 775 250 2 00 2 00 2 50 6600 100 5225 2150 1950 2225 275 025 900 0000 0000 2 00
A e e ent 5989 9 0 6118 9988 8909 12562 955 020 1965 17 9 16 2 1552 617 1 5 2502 1880 1792 827 055 2 90 162 02 25918 27150
87 72 77 86 96 77 65 80 6 7 68 66 55 100 8 87 92 7 72 82 2 77 86 6 a e e ent
New acceptor of pacing ethod New acceptors of spacing methods at onall , ne a eptor o all te porar et o (a olute nu er ) a e n rea e n 2075/76 t an n pre ou ear H e t nu er o ne a eptor or pa n (te porar ) et o n 2075/76 are a a a t a t m a m t a t m a i a i reporte n ro n e 5 ( a le 5 6) t a i i a ig t m a t a i g t m a m t i a t i i a et o e plant, Depo an ll o e n rea n tren A on AR , plant n antl o nate D n all pro n e ( a le 5 6 an ure 5 19) e e, plant a eptor are er t an D n all e olo al re on ( ure 5 19) t i m a t a i i a i g t m g im a t ig i a t Table 4.5.6: New Acceptor All Te porar Method b Pro ince 2073 74 to 2075 76 in 000 mi at i a i a a ig i i im a t a t a Su ur at onal ro n e 1 ro n e 2 a at an a ro n e 5 arnal ig t a i a gi a gi ig pa total u er
ar a le 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76
D 9 7 2 5 1 5 10 7 9 2 5 5 2 7 2 6 6 6 7 5 9 0 8 0 6 0 9 2 1 1 9 9 1 6 22 6
plant 17 7 21 6 20 9 7 7 8 8 11 8 25 22 9 20 7 2 9 7 19 2 20 6 2 2 6 5 6 5 8 2 12 11 11 2 95 6 100 8 102 8
DoHS,Depo Annual Report 2075/76 (2018/19) 111 5 7 1 7 51 8 7 5 1 1 55 2 52 7 20 6 17 6 17 1 61 9 55 5 7 2 26 29 1 0 1 1 2 5 279 2 267 1 292 1
ll 2 21 7 21 8 21 8 18 8 22 2 2 5 19 9 1 6 10 9 11 2 8 7 11 12 7 1 6 16 1 8 1 1 2 7 1 6 1 8
on o 26 7 22 6 2 2 25 22 7 20 9 0 2 2 7 2 5 20 8 19 1 18 61 6 57 56 18 15 1 8 1 8 221 19 8 187 9
otal ne te p et o 117 0 111 119 6 98 2 9 2 99 5 1 1 1 2 6 11 5 65 7 59 56 2 182 8 17 5 20 6 62 6 68 1 100 6 95 1 92 7 772 7 7 0 7 75 8 a eptor
ept or plant, po t partu upta e o et o a e rea e n 2075/76 ( ure 5 19) plant 4.5.5: Trend of VSC New Acceptor Again t Pro ection b Pro ince 2073 74 to 2075 76
ro n e 1 ro n e 2 a at an a ro n e 5 arnal Su ur at onal pa
ar a le 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76
ro e te 6875 5 50 7950 11600 9 00 16 00 6100 775 250 2 00 2 00 2 50 6600 100 5225 2150 1950 2225 275 025 900 0000 0000 2 00
A e e ent 5989 9 0 6118 9988 8909 12562 955 020 1965 17 9 16 2 1552 617 1 5 2502 1880 1792 827 055 2 90 162 02 25918 27150
87 72 77 86 96 77 65 80 6 7 68 66 55 100 8 87 92 7 72 82 2 77 86 6 a e e ent
New acceptor of pacing ethod at onall , ne a eptor o all te porar et o (a olute nu er ) a e n rea e n 2075/76 t an n pre ou ear H e t nu er o ne a eptor or pa n (te porar ) et o n 2075/76 are reporte n ro n e 5 ( a le 5 6) et o e plant, Depo an ll o e n rea n tren A on AR , plant n antl ami a o nate D n all pro n e ( a le 5 6 an ure 5 19) e e, plant a eptor are er t an D n all e olo al re on ( ure 5 19) TableTable 4.5.6: 4.5.6: NewNew AAcceptorscceptor A ll(All Te Temporary porar Method Methods) b Pro by ince Province, 2073 74 to 2073/74 2075 76 to in 2075/76000 (in 000) Su ur at onal ro n e 1 ro n e 2 a at an a ro n e 5 arnal pa total u er
ar a le 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76 7 /7 7 /75 75/76
D 9 7 2 5 1 5 10 7 9 2 5 5 2 7 2 6 6 6 7 5 9 0 8 0 6 0 9 2 1 1 9 9 1 6 22 6
plant 17 7 21 6 20 9 7 7 8 8 11 8 25 22 9 20 7 2 9 7 19 2 20 6 2 2 6 5 6 5 8 2 12 11 11 2 95 6 100 8 102 8
Depo 5 7 1 7 51 8 7 5 1 1 55 2 52 7 20 6 17 6 17 1 61 9 55 5 7 2 26 29 1 0 1 1 2 5 279 2 267 1 292 1
ll 2 21 7 21 8 21 8 18 8 22 2 2 5 19 9 1 6 10 9 11 2 8 7 11 12 7 1 6 16 1 8 1 1 2 7 1 6 1 8
on o 26 7 22 6 2 2 25 22 7 20 9 0 2 2 7 2 5 20 8 19 1 18 61 6 57 56 18 15 1 8 1 8 221 19 8 187 9
otal ne te p et o 117 0 111 119 6 98 2 9 2 99 5 1 1 1 2 6 11 5 65 7 59 56 2 182 8 17 5 20 6 62 6 68 1 100 6 95 1 92 7 772 7 7 0 7 75 8 a eptor
ept or plant, po t partu upta e o et o a e rea e n 2075/76 ( ure 5 19) plant t im a t t a t m ta m t a a i ig m a t ta it i i a t i t t i a t upta e t n 8 our o el er a reporte n H S report nee to e er e a t e at onal a a ami a i g t a t t a t i a i a i a l lann n roto ol ( S ol 1, 2010) a et to appro e t pra t e n epal oul e g i a a a i g im a t t t a t m m report n error or pro er are alrea n ert n plant to po t partu o en e ore ar e ro i a g m ita i t i g t o p tal or rt n entre
Figure 4.5.19: Share of ARC Method of New Figure 4.5.20: Po t partu FP Method Acceptance Acceptor A ong Total New Acceptor 2073 74 to a Proportion A ong E pected i e Birth 2073 74 2075 76 to 2075 76
a a i agi g ig t a ta am g t ta t u e a ter a ort on en oura n ( ure 5 21) ontra ept e upta e a on total reporte a i i a i a m ig t i a ort on er e 75 9 , an n rea e ro 207 /7 (70 7 ) ( ure 5 21) ut onl 17 1 t i t i i a g m a a a i g m t ig ontr ute AR n at n o en a ter a ort on are rel n on le e e t e et o ( ure a a i i t t t a t a ta 5 21, 5 22, 5 2 ) arnal ro n e o t e lo e t po t a ort on ontra ept e upta e (65 ) ig ( ure 5 22) Figure 4.5.21: Proportion of Po t Abortion FP Method 4.5.22: Percentage Po t Abortion FP Uptake Uptake b Method T pe 2073 74 to 2075 76 2073 74 to 2075 76
DoHS, Annual Report 2075/76 (2018/19)
e t an 1 o un er 20 ear o a e populat on (a pro or a ole ent populat on) a epte o ern ontra ept e et o ( ure 5 2 ) ore t an al o t e et o ontr ute Depo (56 ure 5 2 ) A ole ent n arnal ro n e reporte to a ept er proport on o ontra ept e o pare to ot er ro n e ( ure 5 2 ) A ole ent a e un et nee le ontra ept e upta e t n 8 our o el er a reporte n H S report nee to e er e a t e at onal a l lann n roto ol ( S ol 1, 2010) a et to appro e t pra t e n epal oul e report n error or pro er are alrea n ert n plant to po t partu o en e ore ar e ro o p tal or rt n entre
Figure 4.5.19: Share of ARC Method of New Figure 4.5.20: Po t partu FP Method Acceptance Acceptor A ong Total New Acceptor 2073 74 to a Proportion A ong E pected i e Birth 2073 74 2075 76 to 2075 76
u e a ter a ort on en oura n ( ure 5 21) ontra ept e upta e a on total reporte a ort on er e 75 9 , an n rea e ro 207 /7 (70 7 ) ( ure 5 21) ut onl 17 1 ontr ute AR n at n o en a ter a ort on are rel n on le e e t e et o ( ure 5 21, 5 22, 5 2 ) arnal ro n e o t e lo e t po t a ort on ontra ept e upta e (65 ) ( ure 5 22) ami a
Figure 4.5.21: Proportion of Po t Abortion FP Method 4.5.22: Percentage Po t Abortion FP Uptake Uptake b Method T pe 2073 74 to 2075 76 2073 74 to 2075 76
e t an 1 o un er 20 ear o a e populat on (a pro or a ole ent populat on) a epte o ern t a a ag a a a t a a t ontra ept e et o ( ure 5 2 ) ore t an al o t e et o ontr ute Depo (56 m t a m t ig t a a t m t mi i t i t ure 5 2 ) A ole ent n arnal ro n e reporte to a ept er proport on o ontra ept e ig t i a a i i t t a t ig o pare to ot er ro n e ( ure 5 2 ) A ole ent a e un et nee le ontra ept e t a m a t t i ig t a ig m t i t a i t i i i i a im m ta a g m i a a a t g amma i g a a a t ami a i g g am i a a i a u e lo , t n at e o ple entat on allen e o o pre en e e ual an repro u t e ealt pro ra at n eneral an a ole ent a l plann n pro ra n part ular n epal
4.5.23: Share of Te porar Method Mi 4.5.24: Under 20 Year Te porar Method New E cluding Condo A ong Under 20 Acceptor a of MWRA 2073 74 to 2075 76 Total New Acceptor 2075 76
DoHS, Annual Report 2075/76 (2018/19) 11 ami a
4.5.5 Issues, constraints and recommendations 4.5.5 I ue con traint and reco endation Table 3.1.7: Issues and Constraints — Family Planning Table 3.1.7: I ue and Con traint Fa il Planning I ue and Reco endation Re pon ibilit con traint • Su opt u • ple ent ro plann n n lo ontra ept e D, HD, oSD, a e to an u e pre alen e ar / un pal t e un pal t e o er e • on u t tar ete o le outrea an atell te l n ar to rea o u n on AR o un t e an • o l e S ( or AR er e ) an RA un er er e • populat on n ure a a la l t o AR o o t e S/ D, D, HD, • • te ealt pro e ual t o er e el er oSD, HS, a l t e pro n un pal t e • e ontra ept e pro e e u at on, n or at on an er e or D, , HD, et o a ole ent n lu n S oSD, • • H S ale up ool ealt nur e pro ra e un pal t e • ontra ept e S ale up nte rate / l n an po tpartu an ont nuat on po t a ort on er e • n erut l e • Stren t en er e n ur an ealt an o un t D, HD, oSD, AR ealt l n un pal t e • na e uate • Stren t en an e pan t e apa t o tra n n te D, H , H , tra ne u an • plore AR oa entor p n t at e HD, un pal t e re our e on • pan an tren t en er e n pr ate o p tal oH , D, D, A HD, oSD • un t onal t o • p ate t e no le e o H on AR D, HD, S un pal t e • ta l t e role an re pon l t o S n t e oH , oSD, e eral onte t to en ure er e el er HD, un pal t
4.5.6 FAMILY PLANNING 2020 (FP 2020) 4.5.6 FAMI Y P ANNING 2020 FP 2020 ami a i g i a g a a t i t m m a gi i g a l lann n 2020 ( 2020) a lo al partner p to e po er o en an rl n e t n n i r ig t a t a e a ami l plann a i g n ( ) 2020 or it t g m t o ern ent , i i l o i t et , m at a ult lateral ga i a a t i at t t a mi i m m a gi t or an at on , onor , an t e pr ate e tor to ena le 120 ll on ore o en an rl to u e o ern m t a i i g t g a i a i a mi t t i a ontra ept e 2020 A e n t e 2020 oal a r t al le tone to en ure un er al a e to a e ual t an a repro a u t e ealt (SRH) a t an repro u a t e r t 20 ig t 0 a la out n a Su ai ta na t lei tai a m t a a De elop ent oal an 5 e o ern ent o epal ( o ) o ne t e 2020 o e ent n 2015 t o t ent to en ure m t a i t m m t i it mmitm t t e u ta le a e to oluntar er e a e on n or e o e or all n ual an ouple , n ita a t ta i a i m i a i i i a a part ular, t o e o are o t e lu e an ulnera le e o t ent a e o perta n to i a a t a m t a a mmitm t ma tai t ree o erar n t e e ol an pol t al en ron ent nan n an pro ra e an t t a i g t m i a i a i m t a i g a g amm er e el er e e o t ent ere urt er re tal e ur n t e on on Su t n 2017 ere o re terate t o t ent to n rea e t e o ern ent u et or a l lann n 7 ea ear a i i mmitm t t ita i i g t mmit i up to 2020 a elerate pro re n n rea n t e nu er o a t onal u er o o ern ontra ept e it at it mmitm t t i a t g m t g t ami a i g et o an e t ate 1 ll on 2020, an n rea n t e proport on o e an at e ( DS) a a t a at g i i a i g t m a i a to 71 2020 oreo er, t a pe al o u on eet n t e nee o a ole ent an out , m t a m t a mat mi i a i a i g t epal o tte t at t ll tr e to e pan t e ontra ept e et o t at re le t t e r ma a t it a ia m g t pre eren e a t a t a mmi t at it i t i t a t t a m t mi t at t t i ig a
a i t a t a a i i g mmitm t t g i a a a i i m t a i a a am ta ig t i t
DoHS, Annual Report 2075/76 (2018/19) epal ell on tra to ar a e n 2020 o t ent ol tere pro re e an a oura le pol en ron ent on a een en r ne a a un a ental r t n t e on t tut on, an n lu e n t e a ealt er e pa a e un er t e u l Healt A t 2018, t u pa n a a to ar un er al ealt o era e o er e e 15t at onal lan (2018/2019 2022/202 ) o t e o ern ent o epal a pu e or ar t e a en a o SRH/ n a t on to t e u l Healt A t2018, t e Repro u t e Healt A t2018, a ami a ell a t e Sa e ot er oo Roa ap (2020 20 0 e n t a i i t a i a t i a ag t i a t t t a i g a a t a i a a t ag i t a a a nal e ) e p a e t e a a la l t an a e l t o r t a e er e n ter o o era e, t m t a a a t ag a a i o elle e t ate o epal ell t n ran e o a e n t tar eto 9 o ern ontra ept e t t i a t t t a t t a a t a t a ma i g a i m a i t a ai a i it a a i i it ig t a pre alen e 2020 ( 1), an portant a e e ent t at pl e el er n er e to o er ll on i t m ag m mat a i it i a g a i i g it ta g t m t a a ig a im ta t a i m t t at o en n 2019 A a re ult o t le el o u e, 1 2 ll on un nten e pre nan e ere a erte an im i i i g i t mi i m i a t t i 79,000 un a e a ort on an 1,600 aternal eat ere a erte ( 2) mi i i t g a i a t a a a a mat a at a t ig epal ell on tra to ar a e n 2020 o t ent ol tere pro re e an a oura le pol en ron ent on a een en r ne a a un a ental r t n t e on t tut on, an n lu e n t e a ealt er e pa a e un er t e u l Healt A t 2018, t u pa n a a to ar un er al ealt o era e o er e e 15t at onal lan (2018/2019 2022/202 ) o t e o ern ent o epal a pu e or ar t e a en a o SRH/ n a t on to t e u l Healt A t2018, t e Repro u t e Healt A t2018, a ell a t e Sa e ot er oo Roa ap (2020 20 0 e n nal e ) e p a e t e a a la l t an a e l t o r t a e er e n ter o o era e, o elle e t ate o epal ell t n ran e o a e n t tar eto 9 o ern ontra ept e pre alen e 2020 ( 1), an portant a e e ent t at pl e el er n er e to o er ll on o en n 2019 A a re ult o t le el o u e, 1 2 ll on un nten e pre nan e ere a erte an 79,000 un a e a ort on an 1,600 aternal eat ere ure a erte 1 ra ( 20, 2) 2019 ure 2 ra 20, 2019
e o ern ent o epal a on tentl n rea e t e u et or a l lann n o er t e per o o la t e ear er la t e ear , t e o ern ent u et or a l plann n a n rea e t o t r ( R 296,107,000 n epal al ear 2072/7 (2015/16) R 96,687,000 n 2076/77) (2019/20) o a een u e ul n en a n an le era n upport ro e ternal e elop ent partner n t e area o er e el er an pro on o o o t e o n rea e t e ran e o ontra ept e , n tr o Healt an opulat on a pr or t e apa tat n ealt n t tut on an er e pro er t rou tra n n a ell a a re tat on o tra n n te on A ( on A t n an er anent et o ) n t e ne e eral e onte t, t ere are e en ro n al Healt o t ana e ent enter to en ure ore a t n , uant at on an uppl o ure 1 ra 20, 2019 o ure o 2 t e ra 20, 2019 oreo er, ar ou nter ent on are e n un erta en nat onall to roa en et o o e an a a la l t na el t e pro on o l ent entere , oluntar , ual t er e t rou e o ern ent o epal a on tentl DoHS, Annual Report 2075/76 (2018/19) e ate o le/outrea er e pro er to t e o t e lu e an ulnera le roup ta lore n rea e t e u et or a l lann n o er t e per o o la t e ear er la t e ear , t e e an enerat on a t t e to n rea e t e upta e o et o a on pe al roup t o ern ent u et or a l plann n a n rea e t o t r ( R 296,107,000 n epal al un et nee u a rel ou an et n nor t e , poor o en an o en ro re ote lo at on ear 2072/7 (2015/16) R 96,687,000 n 2076/77) (2019/20) o a een u e ul n o u on po t partu an po t a ort on n ele te ealt a l t e ea l t an a eptan e en a n an le era n upport ro e ternal e elop ent partner n t e area o er e el er operat onal re ear on Sa ana re n t o tr t ( t e pe tat on to nat onal ale up) un pal an pro on o o o t e le el ot pot app n o a ole ent ert l t or all 75 un pal t e to ent t e pr or t area or o n rea e t e ran e o ontra ept e , n tr o Healt nee an a e opulat nter ent on on a pr an or t e e elop apa n partner tat n p t t e l o et e or an at on le ar ou ealt n t tut on an er e pro er t rou tra n n roup a u ell a a peoplea re tat l n on o t tra n a n l t e te , out on a an n lea n no one e n A ( on A t n an er anent et o ) n t e ne e eral e onte t, t ere are e en ro n al Healt o t ana e ent enter to en ure ore a t n , uant at on an uppl o o o t e oreo er, ar ou nter ent on are e n un erta en nat onall to roa en et o o e an a a la l t na el t e pro on o l ent entere , oluntar , ual t er e t rou e ate o le/outrea er e pro er to t e o t e lu e an ulnera le roup ta lore e an enerat on a t t e to n rea e t e upta e o et o a on pe al roup t un et nee u a rel ou an et n nor t e , poor o en an o en ro re ote lo at on o u on po t partu an po t a ort on n ele te ealt a l t e ea l t an a eptan e operat onal re ear on Sa ana re n t o tr t ( t e pe tat on to nat onal ale up) un pal le el ot pot app n o a ole ent ert l t or all 75 un pal t e to ent t e pr or t area or nee a e nter ent on an e elop n partner p t t e l o et e or an at on le ar ou roup u a people l n t a l t e , out a an n lea n no one e n
ami a m t a a i t t i a t g t ami a i g t i a t a a t a t g m t g t ami a i g a i a t t i i a i a a i a i gagi g a agi g t m t a m t a t i t a a i i a i i mm i
i a t a g t a i i t a t a a a i i a a ita g a t i t a i i t g t ai i g a a a ita t ai i g it g g a ma t t t a i t t t a i ia a t gi a ag m t t t a g a a a mm i a i i t a i g ta a a t a m t i a a ai a i it am t i i i t t ta a it i t g i at m i t a i i t t m t a a g tai ma g a a i t i a t ta m t am g ia g it ig m t a igi a t i mi i m a m m m t a t a t m a t a i t a t a i i a i i it a a ta a a a a a a i t i t i t it ta t a a a i i a t t ma i g a t it a m i i a i t i t i it a a a i t a i g a t i it t i i i ga i a a i g a i i g it i a i i t a a i g a i g i
DoHS, Annual Report 2075/76 (2018/19) ami a 4.6 Adolescent Sexual and Reproductive Health
4.6.1. Background
a a t a a a t i t i it g am ami a i i i a tm t a t i a i t t i t ia i a a t t a a t a t a m t t at g i t i t i t a t ma ag t a a i t t at g a im m ta g i i t a a a t a i a i t i i a t a i i i t i t Ba i a t ai m a Baita i a i t i g i t ai t a g t a it a t i i a t a i i i a a i t i a i i t im m t i B a a t t m t gt i g a a it i i g a a it i i i ma a a a ai i g i t am g a t a ta a t m gi g i a t i t a gi g t t t t at g i i i t mai aim i i t at g a t a t m a t a t i a t ag t t t t a i a a i ig t t i i ma iag t g ga ag at ma iag i t t gi ag a a a a m t g a t it t i t i t ma i a t a m m t t a t it at i a i a i g t m i t i m a
4.6.2. Vision, Mission, Goal, objectives, target, strategic principle and direction
Vision: a a a t t a t a m t t a i
Mission: ma t a ai a m t a ta i i g t g t t a a i g t at g it t i i g t a t a m t a t
Goal: m t t a a a t a t
General Objective: B t a a a t i a i i t t a t m t a a t a i
Specific Objectives
at a a t i m t a a t i a a t a t i a a ag a iat i ma a t t i a t a m t a i i a im t a t tat a t i a a i i it a i a a t i a it a t a i g i Targets:
ma a a t a i i a a t i a t i i a a a t i a i a a t i a t a a t t t at g m m ta a aim t scale up dolescent riendly Service S to all DoHS, Annual Report 2075/76 (2018/19) ami a health facilities; behavioral skill focused ASRH training to 5,000 Health Service Providers and 3.2 Men trual H giene Manage ent MHM : more than 100 health facilities to be certified with quality AFS by 2021 en trual H ene ana e ent ple ente n 77 tr t t tr ut on o an tar pa ro lo al le el g amm aim t t a t it at im i g a t ami or l te ool e H tra n n pa a e a e elope o ntl n tr o Healt an n tr o a i g i a i ma u at on an e ne to u l apa t o tea er o t e A n ool an ealt or er o t e A ole ent r en l er e te e ool tea er o are tra ne on H are re ularl on u t n Strategic Principles and Direction en trual ana e ent e on n ool e ool t A are al o oor nat n t t e tra ne ealt a a i a a a i t er e pro er to on u t e on on H or tu ent a it a it ig t it i i it 4.6.3 ASRH er ice Utili ation t at gi a t i Fa il planning er ice t a i a a g m t e ure elo o t e tren o a l plann n er e ut l at on a on t e a ole ent e 4.6.2. Achievements in FY 2075-76 (FY 2018/2019) nu er o a ole ent ut l n a l plann n er e e t n t e pro n e 1 an t e lo e t n u ur pa pro n e e nu er o a ole ent a ep n a l plann n a e rea e n pro n e 1, 1. Scale-up of Adolescent Friendly Service: a a g am a a i arnal an u upa pro n e n 2075/76 o pare to 207 /75 t i t i t ta g ita a a a t im m t i t i t i t i t a t a i i t t a a
2. Strengthening Health facilities for AFS:
2.1 ASRH Clinical Training site development:
ta i i i a t ai i g it a ta i
2.2 Competency based ASRH training to the Health service providers:
ta a t i i t ai a i a a i m t a a t ai i g m t B t
3: Demand generation interventions on ASRH Program: i t a a ai i g a i a a i t i t i a i Safe otherhood er ice a a a t a ma a mm i a t a i t e ta le elo report t e nu er o a ole ent ee n a e ot er oo er e ro n e 2 a e t a a i i t Ba B a t a it t a t nu er o a ole ent o re e e a e ot er oo er e erea Su urpa a t e lo e t nu er g am im m t t ai a a am g a t a i o a ole ent a t t ta t m i g a t i mi ga a a a i a ai a at a i g t i 1 t ANC an ti e 1 t ANC a per 4 ANC a per protocol protocol 3.1 Establishment of AFICs in schools: at onal 118 08 77881 52226 ro n e 1 18261 12208 8557 t ta ta i i t ta i i t i a t a i i ro n e 2 25 1 18 97 971 a i i i it at B mat ia a t a at 1829 11926 870 t t a t a m t i a t mi t g an a 10657 7 19 57 9 i g t a ma iag a g ig i g g a it i ta t t ro n e 5 1688 12 7 8961 t a a t a t ma ag m t a a t i i m t i t arnal 1 09 8951 5826 mat ia t t a a a t gi a a a a t i Su urpa 8 6 65 716 a t a a t ta t a a t t t a a t i i i a t at a i g i m t i t mm it a m t t i a DoHS, Annual Report 2075/76 (2018/19) ami a 3.2 Menstrual Hygiene Management (MHM): 3.23.2 Men Men trual trual H H giene giene Manage Manage ent ent MHM MHM : : t a gi ma ag m t i im m t i i t i t it i t i a ita a m en en trual trual H H ene ene ana ana e e ent ent ple ple ente ente n 77 n 77 tr tr t t t t tr ut tr on ut o on an o tar an tar pa pa ro ro lo al lo le al el le el a imit t ai i g a ag a i t i i t a t or l te ool e H tra n n pa a e a e elope o ntl n tr o Healt an n tr o a i i t a a ig t i a a it t a t i a or l te ool e H tra n n pa a e a e elope o ntl n tr o Healt an n tr o u at on an e ne to u l apa t o tea er o t e A n ool an ealt or er o t e a t t t i i it t a a t ai u at on an e ne to u l apa t o tea er o t e A n ool an ealt or er o t e a g a g m t a ma ag m t i i it a A A ole ole ent ent r en r en l l er er e e te te e e ool ool tea tea er er o are o aretra ne tra ne on on H H are re are ularl re ularl on u on t n u t n en trual ana e ent e on n ool e ool t A are al o oor nat n t t e tra ne ealt a i a g it t t ai a t i i t t i t t en trual ana e ent e on n ool e ool t A are al o oor nat n t t e tra ne ealt er e pro er to on u t e on on H or tu ent er e pro er to on u t e on on H or tu ent 4.6.3 ASRH service Utilization 4.6.3 ASRH er ice Utili ation 4.6.3 ASRH er ice Utili ation FamilyFa il planning planning services er ice Fa il planning er ice g t t ami a i g i i a am g t a t e ure elo o t e tren o a l plann n er e ut l at on a on t e a ole ent e e ure elo o t e tren o a l plann n er e ut l at on a on t e a ole ent e m a t i i g ami a i g i i ig t i t i a t t nu er o a ole ent ut l n a l plann n er e e t n t e pro n e 1 an t e lo e t n i a im i m a t a i g ami a i g a a i u nu ur pa er o a pro ole n ent e ut e nu l n er a o l a plann ole ent n a er ep e n a l e plann t n t n e pro a e n rea e 1 e an n pro t e n lo e 1, e t n i a a i a a im i i m a t arnal u ur an pa u upa pro n e pro e n nu e n 2075/76 er o a o ole pare ent to a 207 ep /75 n a l plann n a e rea e n pro n e 1, arnal an u upa pro n e n 2075/76 o pare to 207 /75
SafeSafe motherhood otherhood services er ice Safe e ta le otherhood elo report er t ice e nu er o a ole ent ee n a e ot er oo er e ro n e 2 a e t ta t t m a t i g a m t i i nu e ta er o le a elo ole report ent t o re e nu e e er a o e a ot ole er ent oo ee er n e a e erea ot Su er urpa oo er e a t ro e lo n ee 2 t nu a er e t a ig t m a t i a m t i a a im o a ole ent a t t m a t nu er o a ole ent o re e e a e ot er oo er e erea Su urpa a t e lo e t nu er o a ole ent 1 t ANC an ti e 1 t ANC a per 4 ANC a per protocol protocol at onal 1 t ANC118 08 an ti e 1 77881 t ANC a per 522264 ANC a per ro n e 1 18261 12208protocol 8557protocol ro at n onal e 2 25118 1 08 18 9777881 971 52226 a ro at n e 1 1829 18261 1192612208 870 8557 an ro a n e 2 10657 25 1 7 1918 97 57 9971 ro a n at e 5 1688 1829 12 11926 7 8961870 arnal an a 1 10657 09 89517 19 582657 9 Su ro urpa n e 5 8 1688 6 65 12 7 7168961 arnal 1 09 8951 5826 Su urpa 8 6 65 716
DoHS, Annual Report 2075/76 (2018/19)
ami a Safe Abortion Ser ice Safe Abortion Ser ice Safe e Abortionproport on Services o a ole ent o re e e a e a ort on er e e t n pro n e 5 an t e lo e proport e t n Su on urpa o a ole ent pro n oe re o e pare e a eto a t ort e on 2075/75, er e proport e t on n o pro a n ole e 5 ent an t ee e n a t i a a i i ig t i i a t lo a e ort t on n Su er urpa e a pro n rea n e e o or pare re a ne to t at e a 2075/75, e le el proport n all pro on o n a e ole e ept ent a ee at n an a t i a im i m a t t a t i g ort on er e a n rea e or re a ne at a e le el n all pro n e e ept a at an a i a i a mai at am i a i t Bagma a Su urpa pro n e Su urpa pro n e a im i
4.6.44.6.4 i List i t of t of ofCertified Certified Certified AFS AFS ite AFS ite with withsites pre pre certification with certification pre- and andcertification certification certification core core andobtained obtained certification di aggregated di aggregated scoreobtained b disaggregatedb Pro Pro incial incial le le elel
S.S. N N Di Di trict trict AFSAFS ite ite PrePre core core CertificationCertification DateDate of of core core certificationcertification Pro Pro ince ince 1 1 1 1 Sun Sun ar ar Har Har na na ara ara H H 90 90 09 09 90 90 90 90 a 2018 a 2018 2 2 Sun Sun ar ar atra atra H H 90 90 09 09 91 5 91 5 a 2018 a 2018 Sun Sun ar ar S tapurS tapur H H 92 92 00 00 91 00 91 00 Apr Apr l 2016 l 2016 Sun Sun ar ar t ar t ar H H 91 91 0 0 9 00 9 00 Apr Apr l 2016 l 2016 5 5 a a pur pur Ha Ha a H a H 81 81 7 7 91 9 91 9 une une2018 2018 6 6 a a pur pur ape ape ar ar H H 89 89 6 6 88 2 88 2 une une2018 2018 7 7 a a pur pur o o a a H H 98 98 70 70 98 80 98 80 o e o e er 2017 er 2017 8 8 a a pur pur Sun Sun urpur urpur H H 9 9 70 70 9 70 9 70 o e o e er 2017 er 2017 9 9 a a pur pur Har Har en en H H 9 9 70 70 9 70 9 70 o e o e er 2017 er 2017 Pro Pro ince ince 2 2 1010 a a ottar ottar ar ar a a Ho Ho p tal p tal 90 90 70 70 9 9 0 0 o e o e er 2016 er 2016 1111 a a ottar ottar au au ala ala H H 89 89 0 0 9 00 9 00 o e o e er 2016 er 2016 1212 a a ottar ottar aratpur aratpur H H 9 9 60 60 81 00 81 00 o e o e er 2017 er 2017 1 1 Rauta Rauta atat a a antpatt antpatt H H 8 8 8 8 8 8 une une2018 2018 1 Rauta at ara a pur H 89 8 96 19 une 2018 15 Rauta at ana pur H 9 00 9 00 o e er 2016 16 Rauta at atura H 85 60 91 50 o e er 2016 17 Rauta at Sar u a H 90 00 96 80 o e er 2016 DoHS, Annual Report 2075/76 (2018/19) 18 Sarla S aut a H 90 00 96 19 une 2018 19 Sarla a t pur H 96 20 98 0 o e er 2016 20 Sarla A al a H 9 0 96 90 o e er 2016 21 Sarla par a H 95 50 98 0 o e er 2016 22 Saptar Hanu ana ar H 90 90 96 80 o e er 2017 2 Saptar or e ar a n H 91 50 9 10 o e er 2017 2 Saptar att a a a H 91 50 9 0 o e er 2017 Bag ati S l n , 25 at an u utal a a 100 00 92 60 Au u t 2017 26 S n ul S rt ual H 92 0 98 1 ar 2018 27 S n ul apaul H 9 12 9 07 ar 2018 28 S n ul el ar H 87 20 87 00 De e er 2015 29 S n ul e e or H 92 0 96 00 De e er 2015 0 S n ul S lapat H 90 70 97 00 De e er 2015 Gandaki 1 a S l n , o ara 95 00 87 80 Au u t 2017 Pro ince 5 2 Ar a an a a H 89 1 92 20 anuar 2017 Ar a an Han pur H 96 00 92 20 anuar 2017 Dan a u a H 92 26 91 1 ul 2018 5 Dan Sa an a H 95 00 9 70 ul 2017 6 Dan Sat ar a H 95 00 91 00 ul 2017 7 ap l a tu a na ar H 91 7 91 5 a 2018 8 ap l a tu ar alpur H 98 1 98 1 a 2018 9 ap l a tu aur H 8 00 92 00 Au u t 2016 0 ap l a tu laura ot H 90 00 98 00 Au u t 2016 1 ap l a tu S pur H 98 00 98 00 Au u t 2016 arnali 2 ut an a ra H 88 95 6 ul 2018 ut an Sotre 8 01 89 ul 2018 ut an urant ant H 92 00 95 00 De e er 2015 5 ut an ar ot H 92 00 95 00 De e er 2015 6 ut an n r H 92 80 95 60 ul 2017 7 ut an ot an H 9 0 89 70 75 ul 2017 1 Rauta at ara a pur H 89 8 96 19 une 2018 15 Rauta at ana pur H 9 00 9 00 o e er 2016 ami a Safe Abortion Ser ice 16 Rauta at atura H 85 60 91 50 o e er 2016 17 Rauta at Sar u a H 90 00 96 80 o e er 2016 e proport on o a ole ent o re e e a e a ort on er e e t n pro n e 5 an t e 18 Sarla S aut a H 90 00 96 19 une 2018 lo e t n Su urpa pro n e o pare to t e 2075/75, proport on o a ole ent ee n 19 Sarla a t pur H 96 20 98 0 o e er 2016 a ort on er e a n rea e or re a ne at a e le el n all pro n e e ept a at an Su urpa pro n e 20 Sarla A al a H 9 0 96 90 o e er 2016 21 Sarla par a H 95 50 98 0 o e er 2016 22 Saptar Hanu ana ar H 90 90 96 80 o e er 2017 2 Saptar or e ar a n H 91 50 9 10 o e er 2017 2 Saptar att a a a H 91 50 9 0 o e er 2017 Bag ati S l n , 25 at an u utal a a 100 00 92 60 Au u t 2017 26 S n ul S rt ual H 92 0 98 1 ar 2018 27 S n ul apaul H 9 12 9 07 ar 2018 28 S n ul el ar H 87 20 87 00 De e er 2015 29 S n ul e e or H 92 0 96 00 De e er 2015 0 S n ul S lapat H 90 70 97 00 De e er 2015 Gandaki 1 a S l n , o ara 95 00 87 80 Au u t 2017 Pro ince 5 4.6.4 i t of Certified AFS ite with pre certification and certification core obtained di aggregated b Pro incial le el 2 Ar a an a a H 89 1 92 20 anuar 2017 Ar a an Han pur H 96 00 92 20 anuar 2017 S. N Di trict AFS ite Pre core Certification Date of core certification Dan a u a H 92 26 91 1 ul 2018 Pro ince 1 5 Dan Sa an a H 95 00 9 70 ul 2017 1 Sun ar Har na ara H 90 09 90 90 a 2018 6 Dan Sat ar a H 95 00 91 00 ul 2017 2 Sun ar atra H 90 09 91 5 a 2018 7 ap l a tu a na ar H 91 7 91 5 a 2018 Sun ar S tapur H 92 00 91 00 Apr l 2016 8 ap l a tu ar alpur H 98 1 98 1 a 2018 Sun ar t ar H 91 0 9 00 Apr l 2016 9 ap l a tu aur H 8 00 92 00 Au u t 2016 5 a pur Ha a H 81 7 91 9 une 2018 0 ap l a tu laura ot H 90 00 98 00 Au u t 2016 6 a pur ape ar H 89 6 88 2 une 2018 1 ap l a tu S pur H 98 00 98 00 Au u t 2016 7 a pur o a H 98 70 98 80 o e er 2017 arnali 8 a pur Sun urpur H 9 70 9 70 o e er 2017 2 ut an a ra H 88 95 6 ul 2018 9 a pur Har en H 9 70 9 70 o e er 2017 ut an Sotre 8 01 89 ul 2018 Pro ince 2 ut an urant ant H 92 00 95 00 De e er 2015 10 a ottar ar a Ho p tal 90 70 9 0 o e er 2016 5 ut an ar ot H 92 00 95 00 De e er 2015 11 a ottar au ala H 89 0 9 00 o e er 2016 6 ut an n r H 92 80 95 60 ul 2017 12 a ottar aratpur H 9 60 81 00 o e er 2017 7 ut an ot an H 9 0 89 70 75 ul 2017 1 Rauta at a antpatt H 8 8 8 une 2018 8 Rolpa ot aun H 9 60 9 01 ul 2018 9 Rolpa u el H 92 60 96 20 o e er 2017 50 Rolpa an H 9 70 9 70 De e er 2017 51 Ru u S la ap a H 9 70 96 80 Septe er 2016 52 Ru u a ot H 96 00 96 20 Septe er 2016 DoHS,5 Annual Ru Report u 2075/76S (2018/19) rut H 96 00 96 20 Septe er 2016 Sudurpa chi 5 A a Dun H 91 80 96 00 De e er 2015 55 A a al a H 85 10 8 00 De e er 2015 56 a ta u a ot 96 80 96 82 Apr l 2018 57 a ta S ar al 98 0 98 1 Apr l 2018 58 a ta S an arpur H 8 70 9 97 ul 2018 59 a ta e arpur H 86 70 90 08 ul 2018 60 a ta unal H 88 00 97 00 De e er 2016 61 a ta S e or H 86 80 90 60 De e er 2016 62 a an Sun u a H 8 77 95 6 ul 2018 6 a an a ra t an H 81 0 85 00 De e er 2015 6 a an Deule H 9 00 97 20 De e er 2015 65 a an ar ta 91 50 98 00 De e er 2016 66 a an ana H 8 70 90 00 De e er 2016 67 a ura ate H 92 06 92 06 Apr l 2018 68 a ura a le an u H 86 00 98 0 a 2017 69 a ura a u a H 90 00 95 00 a 2017 70 Da el ura Sa a H 80 00 92 19 ul 2018 71 Da el ura a ur a 80 00 9 10 a 2017 72 Da el ura a ar ot H 87 00 9 10 a 2017 7 Da el ura Aal tal H 91 00 87 80 une 2017
4.6.5. I ue and reco endation Adole cent Se ual and Reproducti e Health ue an pro le ra e at re ent re onal an nat onal re e eet n an ur n o nt on tor n o t e ert at on pro e are u ar e n a le 6 6
a le 6 6 ue an Re o en at on ro Re onal an at onal Re e eet n an o nt on tor n I ue Reco endation Re pon ibilit H pre alen e o earl nten o un t a arene a t t e an H , D, oH , arr a e an teena e e e t el ple ent t e la l ne n tr e pre nan pro n e, lo al le el an partner o R an un et nee Run nno at e a t t e to n rea e a e to a l D, DoHS, oH , or ontra ept on a on plann n er e an n or at on n ar to rea pro n e, lo al le el 8 Rolpa ot aun H 9 60 9 01 ul 2018 9 Rolpa u el H 92 60 96 20 o e er 2017 50 8 Rolpa ot an aun H H 9 9 60 70 9 01 9 70 ul De 2018 e er 2017 ami a Rolpa 51 Ru u S la ap a H 9 70 96 80 Septe er 2016 9 Rolpa u el H 92 60 96 20 o e er 2017 5052 RolpaRu u a an otH H 9 96 70 00 9 70 96 20 De e Septe er 2017 er 2016 515 Ru Ru u u S S la ap rut aH H 9 96 70 00 96 80 96 20 Septe Septe er 2016 er 2016 52 Ru u a ot H Sudurpa 96 00 chi 96 20 Septe er 2016 5 5 Ru A u a S Dun rut H H 96 91 00 80 96 20 96 00 Septe De e er 2016 er 2015 55 A a al a H Sudurpa chi 85 10 8 00 De e er 2015 5 56 A a ta a Dun u H a ot 91 96 80 80 96 00 96 82 De e Apr er 2015 l 2018 55 57 A a ta a al S ar a H al 85 98 10 0 8 00 98 1 De e Apr er 2015 l 2018 56 58 a a ta ta u S an a ot arpur H 96 8 80 70 96 82 9 97 Apr l 2018 ul 2018 57 a ta S ar al 98 0 98 1 Apr l 2018 59 a ta e arpur H 86 70 90 08 ul 2018 58 a ta S an arpur H 8 70 9 97 ul 2018 60 a ta unal H 88 00 97 00 De e er 2016 59 a ta e arpur H 86 70 90 08 ul 2018 61 a ta S e or H 86 80 90 60 De e er 2016 60 a ta unal H 88 00 97 00 De e er 2016 62 a an Sun u a H 8 77 95 6 ul 2018 61 a ta S e or H 86 80 90 60 De e er 2016 6 a an a ra t an H 81 0 85 00 De e er 2015 62 a an Sun u a H 8 77 95 6 ul 2018 6 a an Deule H 9 00 97 20 De e er 2015 6 a an a ra t an H 81 0 85 00 De e er 2015 65 a an ar ta 91 50 98 00 De e er 2016 6 a an Deule H 9 00 97 20 De e er 2015 66 65 a a an an ar ta ana H 91 8 50 70 98 00 90 00 De e De ere 2016 er 2016 67 66 a a ura an ate ana H H 8 92 70 06 90 00 92 06 De e Apr er 2016 l 2018 68 67 a a ura ura ate a le H an u H 92 86 06 00 92 06 98 0 Apr l 2018 a 2017 69 68 a a ura ura a a le u a an H u H 86 90 00 00 98 95 0 00 a 2017 a 2017 6970 Da a ura el ura a Sa u a a H H 90 80 00 00 95 00 92 19 a 2017 ul 2018 7071 Da Da el el ura ura Sa a a ur H a 80 80 00 00 92 19 9 10 ul 2018 a 2017 7172 Da Da el el ura ura a a ar ur ot a H 80 87 00 00 9 10 9 10 a 2017 a 2017 727 Da Da el el ura ura a Aal ar tal ot H H 87 91 00 00 9 10 87 80 a une2017 2017 7 Da el ura Aal tal H 91 00 87 80 une 2017 4.6.5. Issues and recommendations — Adolescent Sexual and Reproductive Health
4.6.5. I ue and reco endation Adole cent Se ual and Reproducti e Health a m ai at t gi a a a a i m g a i g i t m i 4.6.5. I ue and reco endation Adole cent Se ual and Reproducti e Health t i g t a a mma i i a ue an pro le ra e at re ent re onal an nat onal re e eet n an ur n o nt on tor n o t e ert ue an at on pro pro le e ra are e u at re ar ent e re n onal a lean 6 nat 6 onal re e eet n an ur n o nt on tor n o t e ert at on pro e are u ar e n a le 6 6 Table a le 3.6.6: 6 6 Issues ue an and Re Recommendations o en at on ro from Re onalRegional an and at onalNational Re e Review eet n Meetingsan o nt and on Joint tor n Monitoring a le 6 6 ue an Re o en at on ro Re onal an at onal Re e eet n an o nt on tor n I ue Reco endation Re pon ibilit H pre alen I ue e o earl nten o Reco un t a endation arene a t t e an Re H pon ibilit , D, oH , H arr pre a e alen an teena e o earl e nten e e t el o un ple t a ent arene t e la a t t e an H l ne , n D, tr oH e , pre arr nan a e an teena e e e t el ple ent t e la l ne pro n tr n e e, lo al le el pre nan pro an n e, partner lo al le el an partner o R an un et nee Run nno at e a t t e to n rea e a e to a l D, DoHS, oH , o R an un et nee Run nno at e a t t e to n rea e a e to a l D, DoHS, oH , or ontra ept on a on plann n er e an n or at on n ar to rea pro n e, lo al le el or ontra ept I on ue a on plann n er e Reco an n or endation at on n ar to rea pro Re n pon e, lo ibilit al le el ulnera le populat on area an a on ulnera le populat on n lu n n lu n a ole ent a ole ent ual t a uran e o ASRH ert ealt a l t e u n t e ual t D pro n e, lo al ro ra e pro e ent an ert at on tool or A S 2015 to le el an ASRH pro ote t e el er o a ole ent r en l ual t partner er e na e uate tra ne u an Stren t en ASRH l n al tra n n te an e elop H pro n e, lo al re our e on ASRH n ealt t e apa t o er e pro er t e a oural le el an ASRH a l t e an ll o u e o peten a e DoHS,5 a AnnualASRH Report artner 2075/76 (2018/19) tra n n at all ealt a l t e an pe all A S te na e uate on tor n n rea e t e nu er o o nt on tor n t to A S D, D, H te at erent le el pro n e, lo al le el an ASRH partner na e uate re our e Allo ate u ent re our e at entral, tr t an D, DH pro n e, allo ate to t e pro ra e lo al le el lo al le el na e uate l n t ot er A o ate or t e un t onal nte rat on o ASRH D pro n e, lo al pro ra e ( a l plann n , ue an er e n ot er t e at le el an ASRH a e ot er oo , H ) area /pro ra e partner na e uate / ater al n ure t e uppl o ASRH relate / ater al D, H , H to ealt a l t e pro n e, lo al le el an ASRH partner a o a re ate ASRH Re e t e ont l /annual report n or at (Anne D, D, H , ata ( a e/ e ) an 5 ASRH ro ra e ple entat on u el ne , pro n e, lo al le el nte rat on n H S 2011) an a o ate to n orporate n H S an ASRH partner
I ue Reco endation Re pon ibilit ulnera le populat on area an a on ulnera le populat on n lu n n lu n a ole ent a ole ent ual t a uran e o ASRH ert ealt a l t e u n t e ual t D pro n e, lo al ro ra e pro e ent an ert at on tool or A S 2015 to le el an ASRH pro ote t e el er o a ole ent r en l ual t partner er e ami a na e uate tra ne u an Stren t en ASRH l n al tra n n te an e elop H pro n e, lo al re our e on ASRH n ealt t e apa t o er e pro er t e a oural le el an ASRH a l t e an ll o u e o peten a e 5 a ASRH artner tra n n at all ealt a l t e an pe all A S te na e uate on tor n n rea e t e nu er o o nt on tor n t to A S D, D, H te at erent le el pro n e, lo al le el an ASRH partner na e uate re our e Allo ate u ent re our e at entral, tr t an D, DH pro n e, allo ate to t e pro ra e lo al le el lo al le el na e uate l n t ot er A o ate or t e un t onal nte rat on o ASRH D pro n e, lo al pro ra e ( a l plann n , ue an er e n ot er t e at le el an ASRH a e ot er oo , H ) area /pro ra e partner na e uate / ater al n ure t e uppl o ASRH relate / ater al D, H , H to ealt a l t e pro n e, lo al le el an ASRH partner a o a re ate ASRH Re e t e ont l /annual report n or at (Anne D, D, H , ata ( a e/ e ) an 5 ASRH ro ra e ple entat on u el ne , pro n e, lo al le el nte rat on n H S 2011) an a o ate to n orporate n H S an ASRH partner
DoHS, Annual Report 2075/76 (2018/19)
ami a ReproductiveReproductive hhealthealth mmorbidityorbidit y preventionprevention aandnd mmanagementanagemen tprogram program Manage ent of pel ic organ prolap e and Ob tetric Fi tula Management of pelvic organ prolapse and Obstetric Fistula el or an prolap e ( ) o on repro u t e ealt or t n epal t ne at e ealt an i ga a i mm a t m i it i a it ga a t o al on e uen e ult par t , aternal alnutr t on, too re uent pre nan e an ea or a ter a ia a it mat a ma t i t t g a i a a el er are t e a n r a tor or a ear t e o ern ent allo ate un or t e ana e ent a i a t mai i a t a a t g m t a at t ma ag m t t at i i g i i g i i i g a i g o t at n lu e ree reen n , pro n l on r n pe ar e , e el e er e tra n n an ree i t ai i g a gi a i at ig at ita ur al er e at e nate o p tal Cer ical cancer creening and pre ention Cervical cancer screening and prevention er al an er t e o t o on an er a on o en n epal, a ount n or 21 per ent o all i a a i t m t mm a am g m i a a g t an er a on o en e nat onal u el ne on er al an er reen n an pre ent on (2010) all or a a am g m a a g i i i a a i g a reen n at lea t 50 per ent o o en a e 0 60 ear an re u n t e ortal t ue to er al a i g at a t t m ag a a i g t m ta it t i a a t it mm i g am g t i g an er 10 per ent t re o en e reen n a on t roup e er e ear er al an er a i a a i g i i a i t i t ai a t reen n one ual n pe t on o t e er tra ne ealt or er u n a et a an n i g o a pre a an erou a i le a on are ig een, a o a en are re erre i or r ot a erap to m ure t e a le on approa t a t t i i a a i t a t a t i a o t e e t e a t e earl ete t on o le on an earl ana e ent r ot erap ll u uall a ma ag m t t a i a t g i t i a a a t t pre ent pro re on to er al an er, an t e o t o al n up t a t t relat el lo u et a a i g t i a it i a B g t a a at i a a i a t t t allo ate n all 75 al a to on u t t e er al an er reen n an pre ent on pro ra Ho e er, i a a i g a g am t imit t ai a t it ue to l te tra ne ealt or er, t ult to en ure t at er e n ull le e n t report n i i t t t at i i i g t i g a t ta a t t ai i a i it a a i a t a ear 2075/76, total 51 ealt or er ere tra ne on ual n pe t on t a et a an r ot erap Utilization of health services for selected reproductive health morbidity in Nepal Utili ation of health er ice for elected reproducti e health orbidit in Nepal e g a rap elo o t e t tren t o l ent i t ee n i g D er e i or ele te repro t u t e or t e n m i i i a g a t i a i g t a i i a t t a epal e rap o t e n rea n tren or all er e n la t t ree ear
Sour e H S/ D, DoHS
DoHS, Annual Report 2075/76 (2018/19)
4.7 Pri ar Health Care Outreach ami a Reproductive health morbidity prevention and management program 4.74.7.1 Primary Background Health Care Outreach
Manage ent of pel ic organ prolap e and Ob tetric Fi tula 4.7.1Healt Background a l t e ere e ten e to t e lla e le el un er t e at onal Healt ol (1991) Ho e er, t e u e o er e pro e t e e a l t e , e pe all pre ent e an pro ot e er e , a el or an prolap e ( ) o on repro u t e ealt or t n epal t ne at e ealt an a t l te a i i ue to a e t l t a tor t r t ar i ag ealt are outrea t l a a n ( H a t R ) i ere t ere ore o al on e uen e ult par t , aternal alnutr t on, too re uent pre nan e an ea or a ter n t ate nt 199 (2051 i S) to r i n ealt er t e lo a i i er to t e ia o un t e a m el er are t e a n r a tor or a ear t e o ern ent allo ate un or t e ana e ent i a imit t a i i it a t ima a t a t a i i o t at n lu e ree reen n , pro n l on r n pe ar e , e el e er e tra n n an ree t i i at i B t i g a t i t t mm i e a o t e e l n to pro e a e to a ealt er e n lu n a l plann n , l ur al er e at e nate o p tal ealt an a e ot er oo e e l n are er e e ten on te o H an ealt po t e aim t i i i t im a t a i a t i i i g ami a i g i pr ar re pon l t or on u t n outrea l n o A an para e H an lo al Cer ical cancer creening and pre ention a t a a m t i i a i t i it a a t t an o un t a e or an at on ( ) upport ealt or er to on u t l n ima i i it g t a i i i a a am i a er al an er t e o t o on an er a on o en n epal, a ount n or 21 per ent o all n lu n re or n an report n a a mm it a ga i a B t a t t t i i an er a on o en e nat onal u el ne on er al an er reen n an pre ent on (2010) all or i i g i g a g a e on lo al nee , t e e l n are on u te e er ont at e lo at on , ate an t e reen n at lea t 50 per ent o o en a e 0 60 ear an re u n t e ortal t ue to er al e are on u te t n al an our al n tan e or t e r at ent populat on an er 10 per ent t re o en e reen n a on t roup e er e ear er al an er Ba a t i i a t m t at a at a m A /AH pro e t e a pr ar ealt are er e l te n o 7 1 reen n one ual n pe t on o t e er tra ne ealt or er u n a et a an n a t it i a a a i g i ta t i at m t a o a pre an erou le on are een, o en are re erre or r ot erap to ure t e le on approa i t a i ima a t a i i t i B o t e e t e a t e earl ete t on o le on an earl ana e ent r ot erap ll u uall pre ent pro re on to er al an er, an t e o t o al n up t a t t relat el lo u et a Bo 4.7.1: Ser ice to be Pro ided b PHC ORC According to PHC ORC Strateg allo ate n all 75 al a to on u t t e er al an er reen n an pre ent on pro ra Ho e er, ue to l te tra ne ealt or er, t ult to en ure t at er e n ull le e n t report n Safe otherhood and newborn care: Child health: ear 2075/76, total 51 ealt or er ere tra ne on ual n pe t on t a et a an • Antenatal, po tnatal, an ne orn are • ro t on tor n o un er ear l ren r ot erap • ron upple ent tr ut on • reat ent o pneu on a an arr oea • Re erral an er n ent e Utili ation of health er ice for elected reproducti e health orbidit in Nepal Health education and coun elling: Fa il planning: • a l plann n e rap elo o t e tren o l ent ee n D er e or ele te repro u t e or t e n • aternal an ne orn are epal e rap o t e n rea n tren or all er e n la t t ree ear • D A (Depo ro era) p ll an on o • on tor n o ont nuou u e • l ealt • u at on an oun ell n on a l plann n • S , H /A DS et o an e er en ontra ept on • A ole ent e ual an repro u t e ealt
• oun ell n an re erral or D , plant Fir t aid: an S er e • • ra n e aulter nor treat ent an re erral o o pl ate a e
4.7.2 Service coverage 4.7.2 Ser ice co erage
mi i at t a i i a t ta n 2075/76, 2 8 ll on people ere er e at 1 8,125 outrea l n ( a le 7 1) A total o i i i t t ta g t m i i i a 1 8,125 l n ere run repre ent 92 o t e tar ete nu er (1 8,125 l n 12 a ta t ta m t i ig t m i i a t i i a t ig t a i i 1,657,500 n a ear) e ta le elo o total nu er o H R on u te pro n e e e t nu er o l n a on u te n pro n e 2 an t e e t people a er e n
pro n e 5 Sour e H S/ D, DoHS
DoHS, Annual Report 2075/76 (2018/19)
ami a Table 4.7.1: PHC ORC Conducted and People Ser ed in 2075 76 b Pro ince Table 4.7.1: PHC ORC Conducted and People Ser ed in 2075 76 b Pro ince ro n e otal no l n Ser e pro e to l ent (ne ol ) Table ro ro n n 4.7.1: e e 1 PHC ORC Conducted 25 otal,6 no 2 and l n P eople Ser edSer in 5 2079, 0 e 5 8 pro 7 7 66 b b Pro Pro e to ince ince l ent (ne ol ) ro ro n n e e 1 2 2525,,6 87 22 5999,0 , 8 8 ro ro n n e e otal otal no no l l n n Ser e pro e e toto l l ent ent (ne (ne ol ol ) ) ro a n at e 2 2205,,879 28 9980, ,108 0 ro ro n n e e 1 25,6 2 59,0 8 a an a at 20,9 8 80,100 ro ro n n e e 2 215,5,879652 99 , , 018 ,0 1 an a 15,965 01,01 ro a a n at at e 5 2022,9,0 08 8 80529,,100,0 97 ro n e 5 arnal an an a a 15,2121,965,000 8 8 01 015292,0,05 1 ,0, 97 98 arnal Su ro ro ur n n pa e e 5 2116,21,,006620 88 5292 5 ,0,09997, ,27 9 8 Su National arnal arnal urpa 116,113,08662 18 2 5 25 2 99,, 821 9 9,27 8 303 NationalSu Su urpa 16,138662 12 5 992 ,82127 303 Sour e H S/ D, DoHS 16,662 99,27 Sour National e H S / D, DoHS 138 125 2 821 303 e ta le elo o t at nu er o people pro e t e or n ta let , ron ta let an ta t at m i it mi g ta t i ta t a Sour Sour e H S/ D, DoHS ta e ta n leA or elo po tpartu o t at enu er e to nu people er o pro l ent e er t e e or H n R ta a let n , ronro ta n e let 2 an itami t a t m ig t m i t a i i ta e e ta ta n A le or elo elo po tpartu o o t t at at nu e er e o t nu people er o pro l ent e er t e e e or or H n n ta R ta let let a , , ron n ron ro ta ta n let let e 2 an an Table ta ta 4.7.2: n n AA or or PHC po po tpartu tpartu ORC Clinic e e D i tributed e e t t nu nu M er eredicine o o l l ent ent S er er er ed e e P eople H H R b R P ro a a nince n ro ro in n n FY e e 2072 2 5 76 Table 4.7.2: PHC ORC Clinic Di tributed Medicine Ser ed People b Pro ince in FY 2075 76 Table ro n 4.7.2: e PHC ORC Clinic De DDi tributed or n M a edicine let Ser ron ed P a eople let bb PPro ro ince ince t A inin or FYFY 207o 207 tpartu 55 7 766 ro ro n n e e 1 De 11199 or n a let ron 80 a let 5 t A 90 or o tpartu ro ro n n e e De or n a let ron ron a a let let t t AA or or o o tpartu tpartu ro ro n n e 12 11199 20 10 80 512 5 20 90 09 ro ro ro n n n e e e 21 11199 20 10 80 80 512 5 5 90 9020 09 a ro at n e 2 562 22709 1 8 a ro at n e 2 562 20 20 10 22709 512 20 20 09 09 1 8 an a a at 562 18 22709152 0 1 81769 an a a at 562 18 22709152 0 1 1769 8 ro an an n a a e 5 1 18 112 152 59797 0 1769 67 ro n e 5 1 18 112 152 59797 0 1769 67 arnal ro ro n n e e 5 1 7 112 5979715706 67 67 55 arnal 7 15706 55 Su arnal arnal urpa 7 089 15706182 55 55 1 7 Su urpa 089 182 1 7 Su Su at urpa onal 76752 089 089 182 279011 1 1 7 7 9 17 at onal 76752 279011 9 17 at at onal onal 76752 279011 9 9 17 17 e ta le elo 7 o t e la t ear tren o er e pro e H R l n n e ta le elo 7 o t e la t ear tren o er e pro e H R l n n ta t a t a t i i i i o e e par ta ta le le on to elo elo la t 7 7 207 o o /75, t t e ela t er ear e el tren er o er er H e e R pp ro ro l n e e n n H H rea R R n l l n tren n n ne ept o o par par on on toto la la t t 207 207 /75, /75, t t e e er er e e el el er er o o H H R R l n l n n n n rea n rea n tren n tren e ept e ept m a i t a t t i i i i i i i a i g t t Depo o par n on 207to la 5/7 t 6 pr 207 ar /75, treat t e er ent e a el een er n o rea H e R n l o n par non n to rea la t n tren ( a lee ept 7 ) ima t atm t a i a i m a i t a t a Depo Depo n n n 2072072075/76 pr pr ar ar treat treat ent ent a a een een n n rea rea e e n n o o par par par on on to onto la la to t t la t ( ( a a ( le le a le 7 7 ) ) 7 ) Table 4.7.3: Trend of Ser ice Pro ided b PHC ORC TableTable 4.7.3:4.7.3: TrendTrend of SSer er ice ice P Pro ro ided ided b b PHC PHC ORC ORC Ser e pe 207 /7 207 /75 2075/76 Ser Ser e e pe pe 207 207 /7 /7 207 207 /75 /75 /75 2075/762075/762075/76 r ar treat ent 817,7 8 89 , 77 1,26 , 99 r r r ar ar ar treat treat treat ent ent ent 817,7 817,7 8 8 89 89 , 77 77 , 77 11,,26 26 1,,26 , 99 99, 99 Depo ( u er) 189,686 175,555 166,655 DepoDepo ( ( u u u er er er)) 189,686189,686 175,555175,555 166,655166,655166,655 A (t e ) 2 9,525 2 6,2 8 2 6, 02 A A (t (t e e ) ) 2 2 9,525 9,525 2 6,2 2 6,2 8 8 8 2 2 6, 6, 2 02 02 6, 02 (t e ) ,752 7,707 9, 0 (t (t (t e e e ) ) ) ,752 ,752 ,752 7,707 7,707 7,707 9, 9, 9, 0 0 0 ro ro t t on on tor tor n n (0(0 1111 ont ont ) ) 85 85,076,076 929,851929,851 1,5891,88 ,589 ,88 ro ro t t on on tor tor n n (0(0 1111 ont ont ) ) 85 85,076,076 929,851929,851 1,5891,589,88 , 88 Sour Sour e e H H S S/ / D, DoHSDoHS Sour Sour e e H H S S/ / D, DoHS
4.7.34.74.7.3.3.3 Issues, I I I ue ue ue constraints con con traint traint and and and recommendations reco reco endation endation 4.7 .3 I ue con traint and reco endation
Table 4.7.4: I ue Con traint and Reco endation PPri ri ar ar HHealthealth CCareare OOutreachutreach Table 4.7.4: I I ue ue CCon on traint traint and and R Reco eco endation endation P Pri ri ar ar H Healthealth C Careare O Outreachutreach I I ue ue con traint Reco endation Re Re pon pon ibilit ibilit I I ue ue con con traint traint Reco Reco endation endation Re Re pon pon ibilit ibilit All t e H R R areare notnot u un t onal un un t t onal onal e e allall H H R R re re ol ol n n allall D,D, H H All t e H R R areare notnot u un n t t onal onal un un t t onal onal e e all all H H R R re re ol ol n n all all D,D, H H ue ue atat e e er er le le el el ue ue at at e e er er le le el el
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t EPIDEMIOLOGY AND DISEASE CONTROL Chapter 5 Chapter
5.1.1 Malaria
5.1.1.1 Background
a ma a ia t g amm ga i mai i t a ai t t a a it t m t it tat t a a a a ia a i a g amm a i i at a i t t t t a t g amm t Ba a a ia B i i a a a t i a t t i t i a ai a i i a i a t m t a t ma a ia a i a a a ia i a g at i i a a it a a a t m it am g t m i a a a i a i a i a a a i g m tai t m at
a a ia i t a a a tai t it t a gi g i mi g ma a ia i t t a t a iat ig tag i a t t mi a t ma a ia t a mi i a mm t a ma a ia g am i a a ia ata m a t t a a t at it i a i i a i i i a i ma a ia i t at it i m a i t a mai a ma a ia t g t a mi i i t i a i t a a a t g t a a t a mat ma a ia i at a mm it t a t t i t a a at t mm it a t t t ta a at i ma a ia ma a ia i mi t a a a t at t a a i i a it i i a i
m t g t ma a ia ata m t i ma t a a i t i t mi a t t a mi i i i i g imat g a t a a t i a a i it i t m ma a m m t m t a a a mi t a a t a it a mm i mi g a i a t i i i a a a ia i a i g i t a ig t t t
i a g g t m gi a i a a i it gi a ig t a a a i a ig tag t t t mi a t m ia a a a a at a a a t a t a t t ma a ia ata t a a a m a a i m t a m ia ta a ia a a at a m a a ta a a ig i a a a t a a a t ta i a ig t imi a m at a i a a i a a t i ig tag it a a a t ta ig t i a t i i i t i m t a t a i it a a a t ta ig t i a t i i a ig tag a a a ig m i it a a a m at t m i it a a ig tag a t mi a t a a a a at a t mma t t t mi a t a t i t tag t tag m a ag a t it ia t a ig i a DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t Ba t i m t mi t a a a at a t a ig at a ig m at a i a ig i a i i a a a i t i t t t ig i a a i i a i i a i districts. Out of these high-risk wards, 6 wards in Province 2, 1 ward in Province 3, 3 wards in Province i a i a a i i a a i a im i i ig i 5, 7 wards in Karnali Province and 30 wards in Sudurpashchim Province while no high-risk ward was a a t t i i a a a i i t m m at i a detected in Province 1 and Gandaki Province. Furthermore, moderate risk wards were identified in 151 i i a i i t i t a i a i t i t t t i t i t t at tai ig wards in 18 districts (5 additional districts to the 15 districts that contained high risk wards) of these i a t m at i a a i i a i a a i i moderate risk wards, , 6 wards in Province 2, , 1 ward in Gandaki Province, 22 wards in Province 5, 18 a i i a i a a i i a a i a im i i wards in Karnali Province and 104 wards in Sudurpashchim Province while no even moderate risk ward m at i a a i i was in Province 1.
a a ia t a mi i i t at i t a im a a a i i it t t Malaria transmission is concentrated in the Sudurpashchim and Karnali Province with these two i provinces a g accounting for approx. a 79 % high ig risk i burden and around a a 83% moderate m at risk burden. i Malaria a a ia t a mi i a a mi it i m t t a ai gi ai transmission has reached low level of endemicity in most of the Tarai regions (plain lands) but malaria a t ma a ia i i i a i g i g t t i i i a i a infection is increasingly being detected in upper hilly river valleys, which was traditionally classified as t a i a a i a a a ia i a i i a a i ma a ia i i “No Malaria” risk. A relative incidence analysis of malaria infection in upper hilly river valleys suggest i i a gg t t at ma a ia i a mi i t a a it a t that malaria infection was endemic in the area, with adults developing immunity with repeated i g imm it it at a t g a i a i g t t exposures as they grow older and children bearing the brunt of the infection due to immature t i t immat imm it i i i ig i a t ig i i t a immunity (incidence is significantly higher in children less than 14 years as compared to adolescents a a m a t a t a a t and adults 15+).
Figure 5.1.1.1: Ward Level Risk Classification Map (MS 2019)
Source: Malaria micro stratification report 2019
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t Nepal’s National Malaria Strategic Plan (NMSP, 2014–2025) has shown in Box 5.1.1.1.
Box 5.1.1.1: National Malaria Strategic Plan (2014–2025 Revised) National Malaria Strategic Plan (NMSP 2014 – 2025) was revised since it was developed in 2013 and targeted Pre-elimination, and is as a result out of step with the latest normative guidance on malaria elimination from the World Health Organization (WHO) ( “Global Technical Strategy 2016 – 2030” and ‘A framework for malaria elimination, 2017’), current country structure, disease epidemiology, 2017 mid term malaria program review. This plan has inherent Government of Nepal’s commitment and seeks appraisal of external development partners, including the Global Fund, for possible external funding and technical assistance. The aim of NMSP is to attain “Malaria Free Nepal by 2025”.. National Malaria Strategic Plan (2014 – 2025, Revised) are phased malaria elimination by province: • Achieve Malaria Elimination (zero indigenous cases) throughout the country by 2022; - Province 1, Bagmati & Gandaki “get to zero indigenous case” by 2020, - Province 2 & 5 “get to zero indigenous case” by 2021, - Province Karnali & 7 “get to zero indigenous case” by 2022, and • Sustain malaria – free status and prevent re-introduction of malaria in provinces after getting to zero indigenous case.
Goal: In line with the WHO Global Technical Strategy for Malaria 2016–2030 (GTS) and the Asia Pacific Leaders Malaria Alliance Malaria Elimination Roadmap, the goals of the National Malaria Strategic Plan 2014 – 2025 are: • Achieve Malaria Elimination (zero indigenous cases) throughout the country by 2022; and • Sustain malaria – free status and prevent re-introduction of malaria.
The specific objectives of NMSP (2014 -2025, Revised) are as follows: Strengthen surveillance and strategic information on malaria for effective decision making. Ensure effective coverage of vector control intervention in the targeted malaria risk areas. Ensure universal access to quality assured diagnosis and effective treatment for malaria. Develop and sustain support from leadership and communities towards malaria elimination. Strengthen programmatic technical and managerial capacities towards malaria elimination. Current Achievement By 2018, National Malaria Program had achieved 55% reduction in indigenous malaria cases compared to 2013, In 2016, 3 deaths were recorded in an imported case of malaria, and foci investigation activity also got momentum in this year. In 2075/76, there were altogether 121 foci which were gone through the investigation.
Rationale for amending the NMSP Nepal is primarily a low malaria endemic country with around 80% of malaria cases due to P. vivax and the remaining burden due to P falciparum with occasional case reports of P. ovale or P. malariae mostly imported from Africa. Vivax parasites have unique biological and epidemiological characteristics that pose challenges to control strategies that have been principally targeted against lasmo ium falciparum. Infection with i a typically results in a low blood-stage parasitemia
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
with gametocytes emerging before illness manifests, and dormant liver stages causing relapses. As a consequence of low parasitemia, high prevalence of asymptomatic infection and difficulty in detection of the parasites, ability to infect mosquitoes before development of clinical symptoms, and appearance of relapse within months to years of the primary infection; P. vivax pose a great challenge to malaria elimination. Radical cure with at least 2 weeks of Primaquine is required to clear the hypnozoites but the drug can only be given after a normal G6PD test. Besides, current point of care rapid tests may not identify heterozygotes G6PD deficient female despite a normal rapid test and such a case may hemolyze on exposure to Primaquine. i a tolerates a wider range of environmental conditions and is more likely to lead to geographical expansion. Conventional control methods of minimizing human contact with mosquito vectors through insecticide-treated mosquito nets and indoor residual spraying – may be less effective against i a . This is because, in many areas where i a predominates, vectors bite early in the evening, obtain blood meals outdoors and rest outdoors. In addition, vector control has no impact on the human reservoir of latent hypnozoite stage parasites residing in the liver, which are responsible for an appreciable proportion of morbidity.
To recollect, National Malaria Strategic Plan has to address the following issues:
1. P. vivax is the overwhelmingly predominant parasite species in Nepal and strategy should reflect the importance of P. vivax in elimination programme and it should target P. vivax with novel and innovative interventions.
2. Traditional conventional interventions are neither effective for P vivax control nor elimination.
3. Novel interventions based on strong evidence are required to clear hypnozoites in the liver and prevent relapse, point of care tests to detect asymptomatic and sub–microscopic infections, and new community based testing and treatment methods to increase access to quality assured and quality controlled diagnosis and prompt effective treatment. Ensure G6PD point of care test and roll out radical cure treatment for P. vivax infection.
4. Without interrupting P. vivax (reduction will not be sufficient) transmission, achieving malaria elimination is unlikely.
5.1.1.2 Major activities in 2075/76 5.1.1.2 Major activities in 2075/76 2,76,225 LLIN was distributed as mass distribution and 81,133 LLINs were distributed through a i t i t a ma i t i a i t i t t g continuous distribution to people leaving in risk areas, army police, pregnant women at their i t i t a i g i i a a a m i g a t m at t i t i it first ANC visits. t t a mi t a a ma a ia a i i t i t Conducted the ward-level micro-stratification of malaria cases in 77 districts. a Continuation a a of case-based i a surveillance t m system a as key i t intervention, i i g including a web-based i g a g t m i t i t i a a recording and reporting system for districts. The MDIS is now fully operational. i tat i t i t a i a a t a a i a a Orientated district and peripheral level health workers on case based surveillance and a i t tai i i ga at m t a it response. ita i t ma a ia mi a it a a t m it a a t t Carried out detailed foci investigation at more than 100 sites. i mi g a i a t i i i a B it t i a a i ta m i tat i t i t a t a t g m t ma a ia imi a i i a a t i i t g a a a i ita g a t atm t DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t i tat m t g a i ma a ia a t a iag i a m t t atm t t a t a a a i m g i t i t a t a ta a i a t i ata m i a a i i a i it a gg t a a a ma a ia t a i a i i i ta t g a t t i i a a i g ia a a ig a m at i i t i t t tai a a i ga a a i i a t i t g at t m gi a i a a t i t it t g t t t t at a a ia a i
Achievements
a a i a a m i g ma a ia m i it a m ta it at m t a t i it i a i ta i it a ma a ia g amm a im m t a i t t imi at t mai i g a ma a ia i it t m it a im m t a t g ma a ia t g amm t a i im i g t ag a a it i i a a i g i t i g g a g i i t at t a i a i g a t a i ma a ia iag i a a t mi i i a m i a t atm t
ata g at i a t a a i i i t t a a i g a g t m a m t i i i g ma a ia mi t a a a ta a i t a t i a i i i a a a at m a m i m a i a m a i a a i g t mi t a a i t m ig a m at i i t i t m t a i t a g a i t a g ma a ia mi t a a a t a t i at a t a i
t t ma a ia i mi gi a it a t a a ig t i a i g t t a t a a t a i t i a a a
m ma a ia a i a m i t i i a i a m i i a a a t t a a i t a i g t a a a a it i i mai ta a t i a t a g a a i t t t i t t a m i i t i i at i a a at a mi at t a mi t a a t i i a t ma a ia a i a a i g mai t t i a ag mi i a at i at i a a g a i ta a it a i g i i t ta a i i a t ma a ia a t at i t g t i a a a i t m i ig a i a m a a i ig i a a B t a i g i i a a ia i m tai i a t ai gg t t at i a ma a ia mai a a g t imi a ma a ia i a i ai t t i imi a t at gi
DoHS, Annual Report 2075/76 (2018/19) 1 1 onsite coaching of service providers. A total of 695 probable/clinical suspected malaria cases treated by chloroquine through OPD were reported in 2075/76. There was a decrease in the number of indigenous P. falciparum as well as indigenous P.vivax cases. But cases being identified in new areas, especially in mountain, hilly and terain, suggest that P.vivax malaria remains a challenge for the elimination of malaria in Nepal. This raises the need for new country specific elimination strategies. i mi g a i a t Table 5.1.1.1: Malaria epidemiological information (FY 2073/74–2075/76) Items /indicators 2073/74 2074/75 2075/76 Total population at Risk 14944174 15177434 12,224,703 Slide Collection Target 150,000 150,000 150,000 Total slide examined 118165 207581 199927 Total positive cases 1128 1187 1065 Total indigenous cases 492 557 444 Total imported cases 636 630 621 Total P. falciparum (Pf) cases 148 82 57 % of Pf of total cases 13.1 6.9 5.4 Total indigenous Pf cases 52 10 7 % indigenous Pf cases 35 12 12 Total imported Pf cases 96 72 50 % imported Pf cases 65 88 88 Total P. vivax (Pv)cases 980 1105 1008 Total indigenous Pv cases 440 547 437 % indigenous Pv cases 44.9 49.5 43.3 Total imported Pv cases 540 558 571 % imported Pv cases 55.1 50.5 57.6 Annual blood examination rate 0.79 1.4 1.64 Annual parasite incidence 0.08 0.08 0.09 Annual Pf incidence 0.01 0.01 0.005 Slide positivity rate 0.95 0.57 0.53 Slide Pf positivity rate 0.13 0.04 0.03 Probable/clinical suspected malaria cases (not 3904 3282 695 tested but treated by chloroquine) Source: M S o S The trend of the national malariometric indicators (Table 5.1.1.1) indicates that Nepal has entered in t t a a ma a i m t i i i at a i i at t at a a t the elimination phase. Despite district variance including on number of cases, the API and slide i t imi a a it i t i t a ia i i g m a t a i positivity rates (SPR) and the zero indigenous cases from districts such as Kavre and Sindhupalchok over i it at a t i ig a m i t i t a a a i a the last four years suggests a paradigm shift. The highest number of confirmed cases were reported t a t a gg t a a a igm i ig t m m a from Kailali district (206), followed by Mugu (173), Bajura (85), Kanchanpur (77 ), Banke 61) and t m ai a i i t i t g Ba a a a Ba Kapilbastu (61). In is including private sector as well, which shows substantial progress towards a a i a t i i i g i at t a i ta a g elimination targets, however it requires continuous attention for further improvement. t a imi a ta g t it i a t im m t
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t Table 5.1.1.2: Province wise Malaria epidemiological information of 2073/74 to 2075/76 Percentage of Annual Blood Malaria annual Percentage of Plasmodium a i i a a ia i mi gi a i ma t Examination rate parasite incidence imported cases Slide positivity rate falciparum cases (ABER) of malaria at per 1000 among positive of malaria among the total Province risk population population cases of malaria malaria cases 2073 2074 207 2073 2074 2075 2073 2074 2075 2073 2074 2075 2073 2074 2075 /74 /75 5/76 /74 /75 /76 /74 /75 /76 /74 /75 /76 /74 /75 /76 Province 20.8 21.0 45.8 78.9 0.44 0.56 2.64 0.02 0.01 0.01 24.5 77.6 0.39 0.15 0.06 1 3 5 3 5 Province 17.7 68.1 85.4 0.51 0.49 1.57 0.04 0.02 0.03 19.9 6.06 28.1 0.83 0.39 0.2 2 4 8 8 38.4 37.0 92.3 85.1 Bagmati 0.42 0.55 1.17 0.03 0.02 0.02 28.9 37.8 0.63 0.27 0.13 6 4 1 9 21.8 66.6 96.8 Gandaki 0.87 0.63 0.56 0.03 0.03 0.03 10.3 25 72.4 0.32 0.54 0.48 8 7 8 Province 16.1 12.1 68.6 80.1 1.07 1.68 2.59 0.08 0.07 0.1 4.95 74.5 0.77 0.41 0.39 5 9 3 2 8 17.2 Karnali 0.7 1.19 0.78 0.13 0.35 0.18 5.3 0.48 0.42 74.7 21.9 1.7 2.9 2.35 3 Sudhurp 53.9 61.0 1.6 4.64 1.61 0.3 0.29 0.18 8.3 4.1 3.01 50.6 1.6 0.63 1.11 achim 2 8
Source: M S o S
In 2073/74 and 2074/76, the confirmed malaria is slightly increased due to active surveillance, a t m ma a ia i ig t i a t a i a availability of RDT kits upto peripheral level and others many factors that may have contributed to the a ai a i it it t i a a t ma a t t at ma a t i t decline of clinical and the decline of the number of endemic districts (and probably of the number of t t i i i a a t i t m mi i t i t a a t active foci): m a i Overall improvements in the social determinants of health (for example, less than 20% of Nepalese people now live below the poverty line against more than 40% in 2000). a im m t Increased access i to t simple ia diagnostic t mi a t tools like (combo) a t RDTs. am t a a i t t i agai t m t a i The availability of powerful antimalarial medicine (ACTs) in all public health facilities. a a t im iag t i m The distribution of around 0.65 million LLINs in FY 2074/75 in endemic areas (Mass and ANC). a ai a i it a ma a ia m i i i a i a t a i i The large financial support from the GFATM since 2004 has played a major role by allowing the i t i a mi i i i mi a a a a programme and partners to scale up essential interventions and malaria control tools to the a g a ia t m t i a a a ma a i g t most peripheral level. Data reported by the districts via HMIS and reports received by the g amm a a t t a a i t a ma a ia t t t t programme may differ for various reasons such as lack of orientation of staff who generate m t i a data and statistical ata officers t who enter the t data i t i t as per the ia suggestion a of vector t control i officers t g amm ma i a i a a a i ta ta g at ata at district and regional levels. The involvement of the vector control inspector (VCI), statistical officers and lab personnel from districts and regions on data quality coupled with rigorous on- a ta a t t ata a t gg t t at site coaching and support by the central EDCD team (comprising government and contracted i t i t a staff gi a from Save the Children i m t working at the programme t t management t unit) i t have paid dividends ta a a in helping a decrease errors. m i t i t a gi ata a it it ig it a i g a t t t a t am m i i g g m t a t a t ta m a t i i g at t g amm ma ag m t it a ai i i i i g a
DoHS, Annual Report 2075/76 (2018/19) 1 i mi g a i a t mm a m i ia a a a i a a ta i Recommendations from Provincial and national reviews and actions taken in 2075/76
Problems and constraints Action to be taken Action taken Increased number of malaria microscopy trainings run at VBDRTC and in other regions including lab Malaria microscopy trainings personnel from across the country of all untrained lab personnel Database created that lists untrained Availability of RDT at non and trained personnel since 2004. It microscopic sites aims to reduce repetition before two Confirmation of Orientation of service years of basic malaria microscopy suspected and probable providers, clinicians, health training to provide equal opportunities malaria cases workers and private Regular periodic validation of HMIS practitioners data by EDCD in coordination with Validation of probable DPHOs malaria case through cases Decentralized training centres investigation established in mid and far west to train more lab personnel on malaria microscopy Low blood slide Train health workers on RDT Supplied RDT at community level examination rates for and microscopy in malaria Trained health workers from malaria malaria elimination reported districts reported districts programme Ongoing basic and refresher trainings on malaria microscopy for lab Orientation on malaria technicians and assistants at Run training programmes programme to health peripheral facilities with GFATM support workers Oriented PHD and DHO finance and store persons on malaria programme Oriented FCHVs on malaria District and peripheral level staff Orient district and peripheral Malaria case reporting oriented on case investigation, staff on case investigation and case investigation surveillance, foci investigation and and reporting reporting Unnecessary variables in EDCD to address to variables Discussed with HMIS section and HMIS tool (for status of during HMIS tools revision agreed to rectify at next revision patients) Malaria cases increasing Programme should address Programme will be added next year to in non-endemic district non-endemic districts also target non-endemic districts.
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t 5.1.2 Kala-azar
5.1.2.1 Background 5.1.2 Kala-azar
a a a a i a t i a a t a a it i ma ia a i i i t a mi t it ma a t m a g i a i a a t i 5.1.2.1 Background m t a t it m ga a a mia g i ig t a m m a i g t i mi a a i a g a t a t i i a i m Kala-azar is a vector-borne disease caused by the parasite Leishmaniadonovani, which is transmitted by i a i ata i t t at m a a a a a B i a m g i t the bite of female sandflyPhlebotomusargentipes. The disease is characterized by fever of more than a two weeks with splenomegaly, anaemia, progressive weight loss and sometimes darkening of the skin. In endemic areas, children and young adults are the principal victims. The disease is fatal if not treated g m t a i mmi t t gi a t at g t imi at a a a a a ig on time. Kala-azar and HIV/TB co-infections have emerged in recent years. t m m a m ta i g t at a ma i at t a t m i The government of Nepal is committed to the regional strategy to eliminate Kala-azar and signed the m at a a a a a a a a imi a i a a a a memorandum of understanding that was formalized at the World Health Assembly in 2005. In 2005, a i i a a a a t at gi i i a a a a imi a i a i mm EDCD formulated a National a a a i Plan iag for Kala-azar t t elimina it a tion i t i in Nepal. The a national t t plan i was t atm t revised in a a a a 2010 as a i National m t it a Strategic Guideline on Kala g i i -azar elimination a at in Nepal i which recommended t i t i ma rK39 as a am t i i B a m i a t a i t a a t atm t g i i a a rapid diagnostic test kit and Miltefosine as the first line treatment of Kala-azar in most situations. The g i i a i agai i i mm i g i ma am t i i B a 2010 guideline was updated in 2014 to introduce liposomal amphotericin B and combination therapy in t t i t atm t ima a a a a the national treatment guideline. The 2014 national guideline was revised again in 2019 which recommended single dose liposomal amphotericin B as the first line treatment for primary kala-azar. 5.1.2.2 Goal, objectives and strategies 5.1.2.2 Goal, objectives and strategies Box:Box: 5.1.2.2 5.1.2.2 Goal . The goal of Kala-azar elimination program is to contribute to mitigation of poverty in Kala-azar endemic districts of Nepal by reducing the morbidity and mortality of the disease and assisting in the development of equitable health systems. Target . Reduce the incidence of Kala-azar to less than 1 case per 10,000 populations at district level. Objectives . Reduce the incidence of Kala-azar in endemic communities with special emphasis on poor, vulnerable and unreached populations. . Reduce case fatality rates from Kala-azar to ZERO. . Detect and treat Post-Kala-azar dermal leishmaniasis (PKDL) to reduce the parasite reservoir. . Prevent and manage Kala-azar HIV–TB co-infections. Strategies Based on the regional strategy proposed by the South East Asia Kala-azar Technical Advisory group (RTAG) and the adjustments proposed by the Nepal expert group, Government of Nepal, MoHP has adopted the following strategies for the elimination of Kala-azar. . Early diagnosis and complete treatment . Integrated vector management . Effective disease and vector surveillance . Social mobilization and partnerships . Improve programme management . Clinical and implementation research
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t t a t a t a ig i a t a a i t iag i a t atm t a a a a a a a g amm ma t i t t it a a i a a i a i a gi a t t a ai a t i a t i t i t i i g a a a a a i ma am t i i B mi t i a a m m i a ma a ai a t a t a a a a t atm t t a a a a iag a g a i t t t a t
5.1.2.3 Major activities in 2075/76
Case detection and treatment: a a t a m t a m t atm t i t mai ta imi a g a a a a a a a a at iag a i at a iag t atm t i a i at i t i t a a a t a i i i a a a t a i a a a t a a a at a t t
RDT scaling up: i t im t t t at a at a a t a i t t ig i a at ta a t t t it t i i a t atm t i ta a a i a a t t t a ai a iag t a a a a iag i a a i a g i a iag t at g t at a a t t i a ai a at a a a a a t i t i t m a a a t i t i i i ma t a a t a i it i ig g i i a i i
Use of liposomal amphotericin-Bas first line treatment regimen: t mmi i ma ia i i a t gi a i a i t a a a a imi a g amm i mm i ma m t i i B mB a t t i gim i g t a a a i t ia t a i g i t i a it ig a a t a a a m ia t t a a t ia a a g t gim m i a t a t a a a t a a t gim m i a gim a mm a i gim t ia t i t a a a t g t m m i a gim a t t a t t t i i i a g m i g i ta t a it i t i a m m i i a t i a m t i i B i t t mmi mm a
mB a i t i a i m a t ai i g a t t a m mi i t i t t a i t a a t ita i t a t t a mB a ai i t ag a t ma a ai a i ita t ag i i a a a a a a g i i a mm i g i ma am t i i B a t t i t a ima a a a a
Indoor residual spraying in priority affected areas: t i i a a i g a i t i i i a a a a a t a a mi i t i t a t a a g i i i a i t i i ag a a a a a i t i a i a a it a t a i t t a t a a a a g amm a t m t ma a ia
Orientation on updated national guidelines on KA Elimination Program: i a a at ta a t a am i t ai t i a a a a a a g i i a t atm t t i i g t at i a t m
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t Kala-azarnational review meeting: a a a a a a a a i m g a t i i g a i a a a a a t i t i t a t i ia t am
National Kala-azar Technical Working Group Meeting: t a a a a a a i a i g g a t i at ma a i i ga i g a a a a i
Disease surveillance: a a a a t t t a m t ata i tai t g a i a t ia m g m t ita i g a a t a a i t i mi a mi a m i i a i i a t g a a a am a a a it t a t m a t i t i a i g a a mm it a t a a i t i t i t t am a a t a i it ta a t a a a a a a t a t i i a i ia a a i iag it at a t a i i a at a t a t i a t i t i t a ita a t t ma a ma ag m t
Multi-disciplinary Kala-azar Vector Surveillance: t a t a t a a a a a m i t mi i t i t a i a i i g i at t at t a a t m mi i t i t t a g ta a m ta i ma ia i i t a t a i i a a a a a a a t m a t a t a t i g t i a a t i t i t i t a
5.1.2.4 Trend of Kala-azar cases
m a a a a a a a i g ig i a t i t a g g a i a a i t a a i t a
2073/74 a t ta a a a a a t t i a ig a t a a m t a a a a g am i t i t a m g am a a a a i t i t
2074/75 a t ta a a a a a t m a i a t t t i i a ig t i a a m a t t i a t a a a m a a a a g am i t i t a a m g am a a a a i t i t a t m a a i a t g i g a g am i t i t
2075/76 t a a a i t m t a a m a t t i a t ta a a a a a t t i a ig a t t a a m t a a a a g am i t i t a m g am a a a a i t i t t a a t m a a a a g am i t i t ig t m a t m t a a a g a i a a i t g amm i t i t Ba a a a a a ta at t a t i a
t a a a i i a i a a a a a m a t i a am g g amm i t i t g amm i t i t t a i Province 1 a ta ta g a a a a a Bagmati Province i i am a a a B a ta it a at ma a it a a Gandaki Province a g a a a a a a i a t Province 5 g a a i Ba Ba i a a g t a a a i a i a t a m a t Karnali Province ai a m a a a t a i t g a a a m DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t t Sudurpashim Province am Baita i Ba a Ba a g a a a a a a a
imi a S larl , i n 75/76, a a e o t o t a a a a ala a ar i ma ia i e an a ( D ) a a een t reporte m ro a a i a o ar S a i un ar , Sarla a a i an a S ra i a a a e i i e, 10 a a e o utaneou ta e i ma ia i an a ( ) a a een t m i t i t i t i t a am Ba a a g a m a reporte ro 8 erent tr t n t e ear 2075/76 na el a ura, Dan , or a, Hu la, a ar ot, a a t a a a a m t an anpur, alpa, Ru u e t
Table: Trend of ala a ar Ca e FY 2073 74 to 2075 76
Pro ince Di trict FY 2073 74 FY 2074 75 FY 2075 76 o pur 6 7 1 apa 6 6 10 oran 21 16 10 1 al un a 2 Sun ar 6 7 2 a apur 2 1 ara 1 1 0 D anu a 15 2 a o ar 11 8 ar a 1 0 0 2 Rauta at 1 2 0 Saptar 6 Sarla 2 17 1 S ra a 15 11 8 a anpur 5 6 5 alpa 16 19 6 arnal Sur et 11 10 16 Su urpa a lal 2 7 18 Progra e di trict 151 122 83 Total Ca e Other di trict 74 117 130 Foreign ca e 6 0 3 Grand Total Ca e 231 239 216 Source EDCD Do S
i i a a a a at a a a i t i t a t a a i e n en e o ala a ar at na onal an tr t le el a een le t an 1/10,000 popula on n e i a t a a a a g am i t i t i i a at i t i t i 201 n all t e ala a ar pro ra tr t e n en e per 10,000 popula onat tr t le el n a g m i a a t i a ta ata Ba a i i a g m 2073 74 ran e ro 0 6 n alpa to 0 01 n Rauta atan ara n 2074 75 n en e ran e ro 0 75 i a a t i Ba a i t i t t i t i t i i n alpa to 0 01 n ara tr t n 2075 76, t e tr t le el n en e per 10,000 people ran e ro a g m i t a a a a ga t i a a i it 0 9, 0 2 , 0 20, n Sur et, alpa an al un are pe el to 0 01 n Sarla t an a era e a a ag i i i t g amm i t i t a at t a a n en e o 0 07 per 10,000 n t e 18 pro ra e tr t an 0 07 at t e na onal le el
t t at t a a a a a t m ia t a a t i t ote t at t e ala a ar a e reporte ro H a t e H S an a e report re e e t e g amm m m a a i agg gat ata m ita a t pro ra e o e e ar e H S u uall re e e a re ate ata ro o p tal an ot er ealt a l e le t e pro ra e proa el olle t ata ro en nel te t rou ARS D D a t a i i i t g amm a t ata m it t g er e ata t t e elp o l ne l n report o all t e a e i ata it t i i g t a t a
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
Table: ala a ar Ca e and Incidence 2073 74 to 2075 76 Ca e Incidence Di trict 2073 74 2074 75 2075 76 2073 74 2074 75 2075 76 o pur 6 7 1 0 6 0 0 06 apa 6 6 10 0 07 0 07 0 11 oran 21 16 10 0 20 0 15 0 09 al un a 2 0 1 0 27 0 20 Sun ar 6 7 2 0 07 0 08 0 02 a pur 2 1 0 06 0 0 0 09 ara 1 1 0 0 01 0 01 0 00 D anu a 15 2 0 19 0 02 0 0 a o ar 11 8 0 16 0 12 0 06 ar a 1 0 0 0 01 0 00 0 00 Rauta at 1 2 0 0 01 0 0 0 00 Saptar 6 0 09 0 06 0 0 Sarla 2 17 1 0 28 0 20 0 01 S ra a 15 11 8 0 22 0 16 0 12 a anpur 5 6 0 11 0 07 0 1 alpa 16 19 6 0 6 0 75 0 2 Sur et 11 10 16 0 28 0 25 0 9 a lal 2 7 0 02 0 0 0 08 t er D tr t 7 117 1 0 0 0 0 06 0 07 Total 225 239 213 0.07 0.08 0.07 Source EDCD Do S 5.1.2.5 Strengths, issues/challenges and recommendations of Kala-azar Elimination Program 5.1.2.5 Strength i ue challenge and reco endation of ala a ar Eli ination Progra Strengths Strength ai a i it t g a iag a a t a m t atm t . A a la l t o ree o o t ru an a no or earl a e ete on an el treat ent a a a a a o ala a ar a e ai a i it t i ta a a a g i i a a a a imi a g am i . A a la l t o re entl re e tan ar na onal u el ne or ala a ar el na on pro ra n a epal m i i i a a a t m t a g imi a a a a a . e o ul pl nar approa to o er o e t e allen e or el na on o ala a ar . m m ta ple enta on o a t Healt a ag m t ana e ent ma n or a on S t m te (H S) an a arl a arn a i g n an a g t m i a a a a a Repor n S te ( ARS) or ur e llan e o ala a ar . e o erent approa e o a e a e ete on o ala a ar u a a p a e approa i t a a a a t a a a a a am a a a an n e a e a e approa a i a a a a . e e partner p an olla ora on t a a e , re ear er an ot er ta e ol er a t i a a a it a a mi a a t ta I ue Challenge a g . At pre ent ea e, ur e llan e o tl pa e an o e o t e a e o pr ate e tor t t i a i a i m t a i a m t a i at t i n erel o ere t e ur e llan e te mi i g i i m t i a t m . a o re ularl tra ne ta to on tor out rea n e a on an re pon e e ort n non a en e g a tr t t ai ta t m it t a i ga a t i mi i t i t . na e uate a arene a out ea e a on t e o un e Reco a at a a a t i a am g t mm i endation . er a on o en e t tatu o ala a ar n tr t on tentl repor n ne a e o Recommendations ala a ar . pan ala a ar relate trate e an a e to all tr t n t e ountr ere a e are i a een or ere mi it t ere pro tat a l t o a a a a i tran on i t i t i t t g a a a a a . pro e t e ea e an e tor ur e llan e a a a a a at t at gi a a i t a i t i t i t t a a DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t t i a i it t a mi i m t i a a t i a i mi a a a m ag t i i a t i a a i ma at t a a a a m i g a i ga a ma ag m t t a
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t 5.1.3 Lymphatic Filariasis 5.1.3 Lymphatic Filariasis 5.1.3.1 Background 5.1.3.1 Background Lymphatic Filariasis (LF) is a public health problem in Nepal. Mapping of the disease in 2001 using ICT (immune- m a i a ia i i a i a t m i a a i g t i a i i g chromatography test card) revealed 13 percent average prevalence of lymphatic filariasis infection imm mat g a in Nepal’s districts, ranging t t a from a <1 percent to t 39 percent. a ag Based a on the ICT m a survey, a ia i i i a i t i t a gi g m t t t Ba t morbidity reporting and geo-ecological comparability, 61(63) districts were identified as endemic for m i it g a g gi a m a a i it i t i t i a the mi t i a ig i a a t t m t a a disease (Figure 5.1.3.1). The disease has been detected from 300 feet above sea level in the Terai to i t ai t t a a i t mi i m a a m a a i 5,800 feet above sea level in the mid hills. Comparatively more cases are seen in the Terai than thet ai t a t i t i a a i a i a a ig i a i a hills, but hill valleys and river basins also have high disease burdens. The disease is more prevalenti m a t i a a a mi a t a g ia a i i t in rural areas, predominantly affecting poorer people. Wuchereriabancrofti is the only recorded a a it i a m it i a iat a i t t t parasite in Nepal, The mosquito Culexquinquefasciatus, an efficient vector of the disease, has i a a i a mi a a t t been recorded in all endemic areas of the country.
Figure 5.1.3.1:5.1.3.1: Lymphatic Lymphatic filariasisendemicity, filariasisendemicity, Nepal Nepal
Progress towardstowards elimination elimination
The m at a a a a t imi a m a i a ia i i a EDCD formulated a National Plan of Action for the Elimination of Lymphatic Filariasis in Nepal (2003 B ta i i g a a a a i i i i i at ma g –2020) (Box 5.1.3.1) by establishing a National Task Force. The division initiated mass drug administrationa mi i t a m a a i t i t i i a a t a mi i t i t (MDA) fromParsa district in 2003, which was scaled up to all endemic districts by 2069/70 (2013). As of 2075/76 , MDA has a been stopped t (phased a out) t in i 50 districts, i t i t post t -MDA surveillance i a i i at i i t i t a m i it ma ag m t a a i i at i a mi initiated in 50 districts and morbidity management partially initiated in all endemic districts. i t i t mi i t i t a m t t mm i All endemic districts have completed the recommended six rounds of MDA by 2018. The eliminati imi a g amm a i i t t i t t t gt i g t t m t g t ai i g on programme has indirectly contributed to strengthening the system through trainings and a a a it i i g i a a i t i i g ma i g a i capacity building. Since 2003, surveys have been carried out including mapping, baseline, follow up, t ag a t a mi i a m t t a mi i a m t i i t i t i t at t a i a ig i a t i DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t post MDA coverage and transmission assessment surveys. The transmission assessment survey in 50 m t a mi i m a a ia i g a a mi i t at t at i districts in 2018 found that the prevalence of infection had significantly reduced. Since 2003 more a than 111 million doses of lymphatic filariasis drugs have been administrated to at-risk population.
5.1.3.25.1.3.2 Goal, objectives, strategies strategies and and targets targets
Box 5.1.3.1: Goal, objectives, strategies and targets of lymphatic filariasis elimination programme
oal The people of Nepal no longer suffer from lymphatic filariasis
b ecti es: To eliminate lymphatic filariasisasas a public health problem by 2020 To interrupt the transmission of lymphatic filariasis To reduce and prevent morbidity To provide deworming through albendazole to endemic communities especially to children To reduce mosquito vectors by the application of suitable available vector control measures (integrated vector management).
trate ies: Interrupt transmission by yearly mass drug administration using two drug regimens (diethylcarbamazine citrate and albendazole) for six years Morbidity management by self-care and support using intensive simple, effective and local hygienic techniques.
ar ets: To scale up MDA to all endemic districts by 2014 Achieve <1% prevalence (microfilaraemia rate) in endemic districts after six years of MDA by 2018.
5.1.3.35.1.3.3 Major Major activitiesactivities in inFY FY2075/76 2075/76 Mass drug administration Mass drug administration MDA was continued in 15 districts in 2075/76. 2 districts completed seven, 6 districts completed a i i t i t i i t i t m t i t i t m t eight, 2 districts completed nine, 3 districts completed ten and 1 district completed eleven rounds ig t i t i t m t i i t i t m t t a i t i t m t and 1 district completed first rounds of re-MDA in this year. A total of 52,28,247(66.6%) of the a i t i t m t t i t i a t ta t targeted 78,49,070people in 15 districts were treated this year. The campaign was conducted in ta g t i i t i t t at t i a am aig a t i February-March 2019. The campaign mobilized around 6,500 health workers and 10,000trained a a am aig m i i a a t a t ai female community health volunteers to reach the target populations and for monitoring campaign ma mm it a t t t a t ta g t a a m it i g am aig a i mai at a i a i t i B activities. The main MDA-related activities are listed in Box 5.1.3.2. More than 4,700 adverse events (mostly mild headaches, dizziness and stomach aches) were reported t a after MD a A. Health t workers m t and FCHV mi mobilized a a for the i i campaign a reported t ma nearly a 2,500 t a a t a m i i t am aig t a cases of morbidity due to or suspected to be due to lymphatic filariasis. More than 30,000 cases of a m i it t t t t m a a ia i t a a m ma t a im a t i g a t m lymphedema of the lower and upper limbs, breast swelling and hydrocele were reported from mi i t i t i g i am aig endemic districts during previous MDA campaigns.
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
The progress and coverage of the MDA campaign is shown in Table 5.1.3.1. The progress and coverage of the MDA campaign is shown in Table 5.1.3.1.
Table 5.1.3.1: Scaling-up Scaling-up and and coverage coverage of of MDA MDA campaigns campaigns MDA MDA At risk Treated Epidemiological Remarks Year districts population population coverage % 2003 1 505,000 412,923 81.8
2004 3 1,541,200 1,258,113 81.6
2005 5 3,008,131 2,509,306 83.4
2006 3 2,075,812 1,729,259 83.3
2007 21 10,906,869 8,778,196 80.5
2009 21 10,907,690 8,690,789 80.0
2010 30 14,162,850 11,508,311 81.3 MDA stopped in 1 district 2011 36 15,505,463 12,276,826 79.2 MDA stopped in 4 more districts 2012 46 20,017,508 13,546,889 67.7
2013 56 21,852,201 16,116,207 73.8
2014 41 15,874,069 10,929,305 68.9 MDA stopped in 15 more districts 2015 41 15,981,384 11,117,624 69.6 2016 35 12,470,213 8,887,666 71.3 MDA stopped in 5 more districts 2017 30 10,827,093 7,870,784 72.7 MDA stopped in 6 more districts 2018 24 91,26,506 64,24,332 70.4 MDA stopped in 6 more districts 2019 15 78,49,070 52,28,247 66.61 MDA stopped in more 9 districts Source: EDCD/DoHS
Box 5.1.3.2: MDA related major activities
National level activities — National task force committee meetings; interactions with the media, professionals, organizations and civil society; monitoring and supervision; procurement and supply; and advocacy and IEC/BCC activities.
Provincial level activities — Provincial level planning meetings in Biratnagar, Nepalgunj, Dhangadhi and Pokhara; Provincial coordination meetings and monitoring and supervision.
Implementation unit and local level activities — Planning meetings, training of health workers, advocacy, social mobilization, IEC/BCC, monitoring and supervision, interactions with the media, interactions with multi-sector stakeholders including newly elected local body and logistics supply.
Community level activities — Volunteers orientations, advocacy, social mobilization, IEC/BCC, implementation of MDA activities and monitoring and supervision.
Social mobilization activities — The production of revised IEC materials, checklists, reporting,
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
recording, and guidelines for MDA campaign; media mobilization and advertisement of MDA; coordination and collaboration with stakeholders and school health programmes and interactions in schools on the LF disease and MDA.
Monitoring — Monitoring and management of post-MDA complications and adverse events.
Transmission Assessment Survey (TAS)—Panchthar, Ilam, Jhapa, Dhankuta, Morang, Lamjung, Parbat, Baglun and Bardiya performed pre-TAS and only Panchthar and Ilam Passed the survey.After completion of six round of MDA with pre-TAS passed, 10 districts(Bhojpur, Udayapur, Dailekh, Bajura, Bajhang, Achham, Doti, Darchula, Baitadi and Dadeldhura) carried out TAS I, thirteen districts (Saptari, Siraha, Okhaldhunga, Kathmandu, Lalitpur Urban, Bhaktapur, Kaski, Arghakhachi, Pyuthan, Rukum east, Rukum west, Rolpa and Salyan) carried out TAS II and fourteen districts (Dhanusha, Mahottari, Sarlahi, Rautahat, Sindhuli, Ramechhap, Sindhupalchok, Kavre, Nuwakot, Dhading, Gorkha, Tanahun, Syangjha and Palpa) completed TAS III with supported of RTI/ENVISION. All the districts passed TAS I and TAS II but 2 evaluation units (Dhanusha, Mahottari, Sarlahi, Rautahat, Sindhuli) failed the TAS III.
MorbidityMorbidity management management andand disability preventionprevention
i it Morbidity ma ag m t management and a disability i a i it prevention is the i second t strategy t at g adopted a t by the national t a a imi a g amm t i g i i t i i g it i a m i elimination programme to reduce suffering in infected people living with chronic and morbid i conditions including i i g elephantiasis, a a i lymphedema m ma and hydrocele. a This strategy i includes t at g activities i and a i a i t a gi g m m a a i i g it m ma a interventions ranging from home-based self-care by people living with lymphedema and a a i t ita a ma ag m t a gi a elephantiasis to hospital-based management and surgical corrections of hydroceles.
i g a i a i t i The following activities were carried out in 2075/76: 1753hydrocele surgeries have been performed in year 2075/076. This surgery is included in the g i a m i a i g i i i t Red Book and is regularly done in hospitals in endemic districts. B a i g a i ita i mi i t i t Morbidity mapping activities done in Terhathum, Udayapur, Sunsari, Rautahat, Sindhuli, i it ma i g a i i at m a a a i a ta at i i at ma B a ta Kathmandu,Bhaktapur, Nuwakot, a t Tanahun, a a Syangjha, a g a Arghakhachi, g a a i Surkhet, t Salyan and a a a am i t i t Achhamdistricts. a t a i at m a a a i a ta at i i at ma All health workers and FCHVs in Terhathum, Udayapur, Sunsari, Rautahat, Sindhuli, Kathmandu, B a ta Bhaktapur, Nuwakot, a t Tanahun, a a Syangjha, a g a Arghakhachi, g a a i Surkhet, Salyan t and a a a am i t i t t ai a t a Achhamdistrictswere trained on patient self-care.
Challenges and ways forward Challenges and ways forward The major challenges that remain that need addressing to consolidate the achievements are ensuring ma quality a g MDA t at including mai achieving t at high a i g coverage t in i at urban areas t and a i m t some specific a i g communities, a it and adverse i i g event a i i g management, ig sustaining ag low i a prevalence a a in a MDA m phased i out mm i districts, expanding a a morbidity t management ma ag m t and disability tai i g prevention, a and post i MDA surveillance. a t i t i t a i g m i it ma ag m t a i a i it a t i a The biggest challenge is the persistent high prevalence in some districts despite completing the igg t a g i t i t t ig a i m i t i t it m g t mm recommended rounds of MDA. The following are the major programme recommendations: The followingContinue are MDA the for major Pre TAS programme un-success recommendations: districts, and carry out transmission assessment, periodic surveillance and follow up surveys to monitor progress towards elimination. i t i t a a t t a mi i a m t i i Strengthen the capacity of the health system and service providers on morbidity management i a a t m it g t a imi a and disability prevention and post-MDA surveillance.
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t t gt t a a it t a t t m a i i m i it ma ag m t a i a i it a t i a a t a a a t i a g amm i Carry out operational research, studies and programme reviews. i at a m t at t t g amm i a i t at a i a a Consolidate all documents related to the programme in a dossier for the later validation and i a imi a verification of elimination. Lymphatic Filariasis Elimination Status Lymphatic Filariasis Elimination Status Status of Province 1 Districts LF MDA Status Survey Status Up-coming Activity Remarks Taplejung Non Endemic
Panchthar MDA TAS Pass 2019 TAS II 2022 Mapped
Ilam MDA TAS Pass2019 Mapping 2020
Jhapa MDA Re-Pre TAS Fail 2018 Re-Pre TAS 2020
Shankhuwasava Non Endemic
Terhathum MDA Stooped TAS I Pass 2017 TAS II 2020 Mapped
Bhojpur MDA Stooped TAS I Pass 2018 Mapping 2020
Morang MDA Re-Pre TAS Fail 2018 Re-Pre TAS 2020
Sunsari MDA Stooped TAS I Pass 2017 Mapping 2019/2020
Dhankuta MDA Re-Pre TAS Fail 2018 Re-Pre TAS 2020
Udaypur MDA Stooped TAS I Pass 2018 TAS II 2021 Mapped
Solukhumbu Non Endemic
Okhaldhunga MDA Stooped TAS II Pass 2019 TAS III 2022 Mapped
Khotang Non Endemic
Status of Province 2 Districts LF MDA Status Survey Status Up-coming Activity Remarks Saptari MDA Stooped TAS II Pass 2019 TAS III 2022 Mapped
Siraha MDA Stooped TAS II Pass 2019 TAS III 2022
Dhanusha MDA Stooped TAS III Fail 2019
Mahottari MDA Stooped TAS III Fail 2019 Mapping 2020
Sarlahi MDA Stooped TAS III Fail 2019
Rautahat MDA Stooped TAS III Fail 2019 Mapped
Re-MDA, Bara MDA TAS II Fail 2016 TAS 2020 Mapped
Parsa MDA Stooped TAS III Pass 2018
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
Status of Bagmati Province Districts LF MDA Status Survey Status Up-coming Activity Remarks Dolakha Non Endemic
Ramechhap MDA Stooped TAS III Pass 2019 Mapping 2020
Sindhuli MDA Stooped TAS III Fail 2020 Mapped
Sindhupalchok MDA Stooped TAS III Pass 2020 Mapping 2020
Rasuwa Non Endemic
Nuwakot MDA Stooped TAS III Pass 2020 Mapped
Kavre MDA Stooped TAS II Pass 2016 TAS III 2019
Dhading MDA Stooped TAS III Pass 2019 Mapped
Kathmandu MDA Stooped TAS II Pass 2019 TAS III 2022 Mapped
Lalitpur Urban MDA Stooped TAS II Pass 2019 TAS III 2022
Lalitpur Rural MDA Stooped TAS I Pass 2017 TAS II 2020
Bhaktapur MDA Stooped TAS II Pass 2019 TAS II 2022 Mapped
Chitwan MDA Stooped TAS III Pass 2018 Mapping 2020
Makawanpur MDA Stooped TAS III Pass 2018
Status of Gandaki province Districts LF MDA Status Survey Status Up-coming Activity Remarks Manang Non Endemic
Gorkha MDA Stooped TAS III Pass 2019 Mapped
Lamjung MDA Re-Pre TAS Fail 2018 Re-Pre-TAS 2020 Mapped
Tanahun MDA Stooped TAS III Pass 2019 Mapping 2020
Mustang Non Endemic
Kaski MDA Stooped TAS II Pass 2019 Mapping 2020
Parbat MDA Re-Pre TAS Fail 2018 Re-Pre-TAS 2020
Baglung MDA Re-Pre TAS Fail 2018 Re-Pre-TAS 2020
Myagdi MDA Stooped TAS I Pass 2017 TAS II and Mapping 2020
Nawalpur MDA Stooped TAS III Pass 2018 Mapped
Syangja MDA Stooped TAS III Pass 2019 Mapped
DoHS, Annual Report 2075/76 (2018/19) Status of province 5 i mi g a i a t Up-coming Districts LF MDA Status Survey Status Remarks Activity
Nawalparasi MDA Stooped TAS III Pass 2018 Mapped
Rupandehi MDA Stooped TAS III Pass 2017 Mapping 2020
Palpa MDA Stooped TAS III Pass 2019 Mapped
Arghakhanchi MDA Stooped TAS II Pass 2019 TAS II 2022 Mapped
Pyuthan MDA Stooped TAS II Pass 2019 Mapping 2020
Gulmi Non Endemic
Pre-Re-TAS Fail Kapilbastu MDA Pre-Re-TAS 2020 2018
Dang MDA Pre-TAS Fail 2019 Re-Pre TAS 2021 Mapped
Banke MDA Pre-TAS Fail 2019 Re-Pre TAS 2021
Bardiya MDA Re-Pre-TAS Fail 2018 Re-Pre TAS 2020
Rolpa MDA Stooped TAS II Pass 2019 Mapping 2020
Rukum East MDA Stooped TAS II Pass 2019 TAS III 2022
Status of Karnali Province Districts LF MDA Status Survey Status Up-coming Activity Remarks
Mapping, Surkhet MDA Stooped TAS I Pass 2019 TAS II 2020
Mapping, TAS II Jajarkot MDA Stooped TAS I Pass 2017 2020
Salyan MDA Stooped TAS II Pass 2019 TAS II 2022
Rukum West MDA Stooped TAS II Pass 2019 TAS III 2022
Kalikot Non Endemic
Mugu Non Endemic
Jumla Non Endemic
Humla Non Endemic
Dolpa Non Endemic
Status of Sudurpashchim Province Districts LF MDA Status Survey Status Up-coming Activity Remarks Bajhang MDA Stooped TAS I Pass 2018 TAS II 2021
Bajura MDA Stooped TAS I Pass 2018 TAS II 2021
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
Districts LF MDA Status Survey Status Up-coming Activity Remarks
Achham MDA Stooped TAS I Pass 2018 TAS II 2021 Mapped
Doti MDA Stooped TAS I Pass 2018 Mapping 2020
Darchula MDA Stooped TAS I Pass 2018 TAS II 2021
Baitadi MDA Stooped TAS I Pass 2018 TAS II 2021 Mapped
Dadeldhura MDA Stooped TAS I Pass 2018 Mapping 2020
Kailali MDA Pre-TAS I Fail 2019 Re-Pre TAS II 2019
Kanchanpur MDA Pre-TAS Pass 2019 TAS I 2020 Mapped
DoHS, Annual Report 2075/76 (2018/19)
5.1.4 Den e
5.1.4.1 ack ro nd i mi g a i a t 5.1.4Dengue Dengue is a mosquito-borne disease that is transmitted by mosquitoes (Aedesaegypti and Aedesalbopictus) and occurs in most of the districts of Nepal.WHO (2009) classified dengue as: i) 5.1.4.1Dengue Background without warning signs, ii) Dengue with warning signs, iii) Severe Dengue. The first dengue case was reported from Chitwan district in a foreigner. The earliest cases were detected in 2005.Since 2010, g dengue i epidemics a m it have continued i a to affect t at lowland i t a mi districts as m it well as mid-hill areas. a g This trend a of increased a i t magnitude a has since i continued m t t with i t i t number of a outbreaks reported a i each year g in many a i g it t a i g ig ii g it a i g ig iii g districts- Chitwan, Jhapa, Parsa (2012-2013), Jhapa, Chitwan (2016-2016), Rupandehi, Jhapa, t g a a t m it a i t i t i a ig a i t a t t Mahottari(2017), i i Kaski (2018) and g Sunsari, i mi Kaski, Chitwan a (2019). t a t a i t i t a The a mi i mostly affected a a districts i t are Chitwan, i a Kanchanpur, mag it Kailali, a Banke, i Bardiya, Dang, it Kapilbastu, m Parsa, t a t a a i ma i t i t it a a a a a a a it a Rupandehi, Rautahat, Sarlahi, Saptari and Jhapa, reflecting the spread of the disease throughout the a i a a a a i a i a a i a i it a Tarai plains from west to east. In 2011, 79 confirmed cases were reported from 15 districts with the m t a t i t i t a it a a a ai a i Ba Ba i a a g a i a t highest number a a in a i Chitwan (55). a ta at During 2012 a a i -15, the a ta i dengue a cases a a still g continued t to be a reported t from i a t g t t a ai ai m t t a t m a t several districts but the number fluctuated between the years. In 2019, we experienced the outbreak at m i t i t it t ig t m i it a i g t g a Sunsari (Dharan), Chitwan (Bharatpur) and Kaski (Pokhara). t t m a i t i t t t m t at t t a i t t a at a i a a it a B a at a a i a a Aedesaegypti (the mosquito-vector) was identified in five peri-urban areas of the Terai (Kailali, Dang, a g Chitwan, Parsa t and Jhapa) m it t during entomological a i surveillance i by EDCD i a during 2006 a a –2010, indicating t ai the ai a i local transmission a g it a of dengue. a a However, a a a recent i g study t m gi a carried out by VBDRTC i a has shown that i g both the mosquitoes have i i a g found t to be a transmitting t a mi i the disease g in Nepal. t t a i t B a t at t t m it a t t a mi g t i a i a t i Studies carried a i out t in collaboration i a a with the it Walter t Reed/AFRIMS a t Research Unit (WARUN)in a 2006 it by EDCD and i the National Public Health a Laboratory t a a (NPHL)found i a t that all a at four sub-types of the Dengue t at viruses a (DEN- 1, t DEN-2, DEN -3 and t DEN g - i a i a g i a tai a g t g amm a gi i B Programme are given in Box 5.1.4.1.
5.1.4.2:Goal, 5.1.4.2:Goa Objectives jectives andand trate Strategy o of Den e Dengue ontro Control Pro ra e Programme
o 5.1.4.1: Nepal’s Dengue Control Programme
Goal To reduce the morbidity and mortality due to dengue fever, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS).
Objectives: To develop an integrated vector management (IVM) approach for prevention and control. To develop capacity on diagnosis and case management of dengue fever, DHF and DSS. To intensify health education and IEC activities. To strengthen the surveillance system for prediction, early detection, preparedness and early response to dengue outbreaks.
Strategies: Early case detection, diagnosis, management and reporting of dengue fever Regular monitoring of dengue fever surveillance through the EWARS Mosquito vector surveillance in municipalities The integrated vector control approach where a combination of several approaches are directed to wards containment and source reduction
5.1.4.3: Major activities in 2075/76 Trained physicians, nurses, paramedics and laboratory technicians on dengue case detection, DoHS, Annual Report 2075/76 (2018/19) diagnosis, management and reporting. Orientated municipality stakeholders in 34 districts. Supplied rapid diagnostic test kits (IgM). Dengue case monitoring and vector surveillance. Search and destruction of dengue vector larvae in 34 districts in different local levels. Developed IEC materials and disseminated health education messages engaging various stakeholders including the media and youth.
Achievements Development of national guidelines on prevention, management and control of dengue in Nepal Conducted ToT by international experts on dengue and created a pool of master trainers in all the provinces Developed the IEC materials and disseminated the awareness messages through media and other relevant means of communications. Table 5.1.4.1: Dengue cases (2073/74–2075/76) District 2073/74 2074/75 2075/76 District 2073/74 2074/75 2075/76 Jhapa 54 3 5 29 Gorkha 1 2 0
Morang 0 2 8 1 Syangja 1 4 1
Sunsari 0 8 3 025 Kaski 1 553 21
Bhojpur 0 0 4 Baglung 4 4 1
Udaypur 0 0 1 Tanahu 0 1 1
Dhankuta 0 2 5 Parbat 0 2 2
Illam 0 1 2 Mustang 0 1 0
Taplejung 0 1 2 Myagdi 0 1 0
Shankhuwashbha 0 0 1 24 568 26 Gandaki Province Panchthar 0 0 2 Arghakhanchi 21 4 5 Province -1 543 19 3152 Palpa 1 4 7 7
Saptari 0 2 4 Nawalparasi West 3 7 1 5 1 1
Siraha 0 1 1 Rupandehi 6 7 7 6 1 55
Dhanusa 27 0 0 Kapilbastu 57 8 6 Mahottari 4 3 8 3 3 Pyuthan 1 2 3 2 Sarlahi 1 3 0 2 0 Rolpa 4 0 0 Bara 2 1 0 Rukum East 0 0 0 Parsa 0 2 4 Dang 1 3 2 2 Rautahat 1 2 1 0 Banke 1 6 5 Province -2 609 12 12 Gulmi 0 1 0 0 Kavre 0 1 1 Bardiya 0 4 3 Lalitpur 0 1 2 Province- 5 836 120 96 Bhaktapur 1 0 3 Surkhet 2 0 0
Kathmandu 1 1 6 6 Dailekh 1 0 0 Dhading 6 7 7 5 Salyan 0 1 1
Regular monitoring of dengue fever surveillance through the EWARS i mi g a i a t Mosquito vector surveillance in municipalities 5.1.4.3: The integratedMajor activities vector control in 2075/76 approach where a combination of several approaches are directed to wards containment and source reduction ai i ia a am i a a at t i ia g a t 5.1.4.3: iag i ma ag m t a g Major activities in 2075/76 i tat m i i a it ta i i t i t Trained physicians, nurses, paramedics and laboratory technicians on dengue case detection, i a i iag t t it g diagnosis, management and reporting. g a m it i g a t i a Orientated municipality stakeholders in 34 districts. a a t g t a a i i t i t i i t a Supplied rapid diagnostic test kits (IgM). Dengue case monitoring mat ia and a vector i mi at surveillance. a t a m ag gagi g a i ta i i g t m ia a t Search and destruction of dengue vector larvae in 34 districts in different local levels. Developed IEC materials and disseminated health education messages engaging various Achievements stakeholders including the media and youth.
Achievements m t a a g i i ma ag m t a t g i a Development of national guidelines on prevention, management and control of dengue in t i t a a t g a at a ma t t ai i a Nepal t i Conducted ToT by international experts on dengue and created a pool of master trainers in all t mat ia a i mi at t a a m ag t g m ia a the provinces t a t m a mm i a Developed the IEC materials and disseminated the awareness messages through media and other relevant means of communications. Table 5.1.4.1: Dengue cases (2073/74–2075/76) District 2073/74 2074/75 2075/76 District 2073/74 2074/75 2075/76 Jhapa 54 3 5 29 Gorkha 1 2 0
Morang 0 2 8 1 Syangja 1 4 1
Sunsari 0 8 3 025 Kaski 1 553 21
Bhojpur 0 0 4 Baglung 4 4 1
Udaypur 0 0 1 Tanahu 0 1 1
Dhankuta 0 2 5 Parbat 0 2 2
Illam 0 1 2 Mustang 0 1 0
Taplejung 0 1 2 Myagdi 0 1 0
Shankhuwashbha 0 0 1 24 568 26 Gandaki Province Panchthar 0 0 2 Arghakhanchi 21 4 5 Province -1 543 19 3152 Palpa 1 4 7 7
Saptari 0 2 4 Nawalparasi West 3 7 1 5 1 1
Siraha 0 1 1 Rupandehi 6 7 7 6 1 55
Dhanusa 27 0 0 Kapilbastu 57 8 6 Mahottari 4 3 8 3 3 Pyuthan 1 2 3 2 Sarlahi 1 3 0 2 0 Rolpa 4 0 0 Bara 2 1 0 Rukum East 0 0 0 Parsa 0 2 4 Dang 1 3 2 2 Rautahat 1 2 1 0 Banke 1 6 5 Province -2 609 12 12 Gulmi 0 1 0 0 Kavre 0 1 1 Bardiya 0 4 3 Lalitpur 0 1 2 Province- 5 836 120 96 Bhaktapur 1 0 3 Surkhet 2 0 0
Kathmandu 1 1 6 6 Dailekh 1 0 0 Dhading 6 7 7 5 Salyan 0 1 1 Makwanpur 3 9 8 3 arna i Province 3 1 1
Chitwan 23 28 23 Kailali 0 2 3 Nuwakot 0 0 1 Kanchanpur 0 1 4 2 Sindhuli 0 0 1 Dadeldhura 0 2 2 Dolkha 0 2 0 Achham 1 0 1 a ati Province 95 64 125 Darchula 0 9 4 d r as i DoHS, Annual1 Report 2075/7627 (2018/19)12 Province Grand ota 2111 811 3424
Source: EDCD/DoHS The number of reported dengue cases has significantly increased from 2111 in FY 2073/74, 811 in FY 2074/75 to 3424 in FY 2075/76. The major cause of increasing the reported case is the impact of global dengue outbreak.During FY 2075/76, 3424 dengue cases were reported from 44 districts (Table 5.1.4.1). The majority of cases have been reported from Sunsari (88%), Makawanpur (2.4%), Morang (2.3%) and Rupandehi (1.6%). As well there were 2 confirmed deaths due to Dengue one each from Sunsari and Morang.
Note that Dengue cases reported from Hospitals, HOs and PHCCs via the Early warning and Reporting System (EWARS), HMIS/DHIS2 and case reports received by the programme sometimes vary. The HMIS usually receives aggregate data from hospitals and other health facilities while the programme proactively collects data from Hospitals through EWARS. EDCD verifies data with the help of line listing report of all cases.
Makwanpur 3 9 8 3 arna i Province 3 1 1 Chitwan 23 28 23 Kailali 0 2 3 Nuwakot 0 0 1 Kanchanpur 0 1 4 2 Sindhuli 0 0 1 Dadeldhura i mi g a i a t 0 2 2 Dolkha 0 2 0 Achham 1 0 1 a ati Province 95 64 125 Darchula 0 9 4 d r as i 1 27 12 Province Grand ota 2111 811 3424
Source: EDCD/DoHS m t g a a ig i a t i a m i i The number of reported dengue cases has significantly increased from 2111 in FY 2073/74, 811 in FY t i ma a i a i g t t a i t im a t 2074/75 to 3424 in FY 2075/76. The major cause of increasing the reported case is the impact of global g a g t a i g g a t m i t i t dengue outbreak.During FY 2075/76, 3424 dengue cases were reported from 44 districts (Table a ma it a a t m a i a a a 5.1.4.1). The majority of cases have been reported from Sunsari (88%), Makawanpur (2.4%), Morang a g a a i t m at t g (2.3%) and Rupandehi (1.6%). As well there were 2 confirmed deaths due to Dengue one each from a m a i a a g Sunsari and Morang.
t Note that t at Dengue g cases a reported t from Hospitals, m ita HOs and PHCCs a via the Early ia warning t a and Reporting a i g a g t m a a t i t g amm m m System (EWARS), HMIS/DHIS2 and case reports received by the programme sometimes vary. The HMIS a a i agg gat ata m ita a t a t a i i i t usually receives aggregate data from hospitals and other health facilities while the programme g amm a t ata m ita t g i ata it t proactively collects data from Hospitals through EWARS. EDCD verifies data with the help of line listing i i g t a a report of all cases.
DoHS, Annual Report 2075/76 (2018/19)
i mi g a i a t 5.1.5 Leprosy 5.1.5 epro 5.1.5.1 Background 5.1.5.1 Background e e ta l ent o t e o ana epro ar u n t e n neteent entur a t e e nn n o ta i m t t a a a i m i t i t t t a t gi i g ga i or an e lepro i er e n i a epal e lepro ontrol t le mi t tone n e i 1960 an t a e oal, t o g a e t e a t at gi t a a t g amm a an trate e o t e nat onal epro ontrol ro ra e are
E olution and ile tone of lepro control progra e in Nepal
Year and ark 1960 epro ur e o ern ent o epal n olla orat on t H 1966 lot pro e t to ontrol lepro laun e t Dap one onot erap 1982 ntro u t on o ult ru t erap ( D ) n lepro ontrol pro ra e 1987 nte rat on o ert al lepro ontrol pro ra e nto eneral a ealt er e 1991 at onal lepro el nat on oal et 1995 o al per on ( an lepro a tant A ) appo nte or tr t an re on 1996 All 75 tr t ere rou t nto D pro ra e 1999/2000 2001/02 o roun o at onal epro l nat on a pa n ( ) ple ente 2008 nten e e ort a e or a e n el nat on at t e nat onal le el 2009 an 2010 epro el nat on a e e an e lare at t e nat onal le el 2011 at onal epro Strate (2011 2015) 2012 201 l nat on u ta ne at nat onal le el an nat onal u el ne , 201 (2070) re e 201 201 ter e aluat on o ple entat on o at onal epro Strate (2011 2015) 201 2015 n tr o Healt e nate D a t e D a l t o al n t ol , Strate an 10 ear A t on lan on D a l t ana e ent ( re ent on, reat ent 2017 an Re a l tat on) 207 2082 e elope an e nate
at onal epro Strate 2016 2020 (207 2077) e elop an en or e Re e lepro 2018 u e l ne n l ne t nat onal lepro trate an lo al lepro trate
2019 n ept Re e o at onal epro ro ra e an n on n Roa ap to ero epro
5.1.5.25.1.5.2 Goal, Goal objectives, ob ecti e strategies trategie and and targets target of theof the leprosy lepro control control programme progra e epro ree epal Vision:Vi ion: a Goal : n t e on e uen e o lepro n lu n a l t an t a Goal : t i i g i a i it a gma Guiding principle Guiding• principlesSte ar p an te tren t en n • pe te t e el nat on pro e n pre alen e tr t t a i a t m t gt i g• olla orat on, oor nat on an partner p it t imi a i ig a i t i t a a i a a a t i mm it i m t t g a it a ia i i i ag it i a a t ag a tai a m t a
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t Objectives:
i imi a tat i a i t i t a i a t a at a t a i it ia i ig a i t i t t g a i g t i a a i at t a i t ami m m a ig i t i a ma i i at
Strategies
a a a a a t t g t i a a t i t a i t i a ma i i at i a i t i t i i at a i g a it i ig t t a a a a t i a a t m a i m i t a a t
5.1.5.3 Activities and achievements in 2075/76
i i a t t a t m g t a a a t atm t at t t a a i g t a a t m t t gim a a m t atm t a a t a a i i t a a t a t t g t i g t a t it a t t g t at a ma a ai a t a a t g a a a g a ai a g t a i a a ma ag m t t g t t a
Capacity building — i g a a it i i g a i a t i g a a it i i g g amm i
a m i ai i g t at a t i ta t t a t i at a am aig a i am ai i g t i a a ta at Ba a a a it a a a a a i a a i a t ai i g a ta i ma ia i t i t mat gi t at ma
imi a a t a a t a i itat a t i ia t i t a t ai m a ga ita a i t i ta a t ai i g a t a a a ita
IEC and advocacy — t a mm it a a a i a t ta a g a t gma a i g a ta i g t i a i t m ia t ig ig g t iag i a t atm t a i a i t i t i a at a t a i i i a i t i t a ai i g i a a m ag a a a t i i a it a a a i g amm ig ig g t a
World Leprosy Day— a i i at t a t a i t m t a a i a mm m at t ag t a a i a a t t a g a i a i at a a i a i t i t t am a a m ia i t a g amm a a a g at i t i t DoHS, Annual Report 2075/76 (2018/19)
repro u e an tr ute or pla at ealt a l t e n all 77 tr t an or ra n pu l a arene epro e a e ere al o roa a te n oor nat on t epal an ra o pro ra e l t n t e orl epro Da
orld e ros a orl epro Da ele rate on t e la t Sun a n t e ont o anuar orl e a o e orate on 1 t a 2075 (27t anuar 2019) n epal a t e 66t orl epro Da on u t n ar ou a t t e at nat onal, pro n e an tr t le el n t e a e a a i mi g a i a t e a ntera t on pro ra e a arran e at DoHS n pre en e o t e D re tor eneral, lan et a a t i t i g amm a t a ga i at a a tr ut on pro ra e or 55 lepro a e te people a or an e at apa tr t n oor nat on i t i t i i a a t a a a a t i t at i a at a ga o Healt e apa an Healt D re torate o ro n e 1 an at al a epro Ho p tal an er e ita a i t entre Reviews Re ular tr e ter re e eet n ere el at tr t an pro n al le el ere Reviews — g a t im t i m g at i t i t a i ia a re ate ata, a n trat e ue an a o pl ent ere pre ente an u e an uture agg gat ata a mi i t a i a a m i m t t a i a t a i t a t im t i t a t t m plan u e o entral tr e ter re e or op ere el to a e t e out o e an a m it i g t g amm B m t i a t i t at on tor n o t e pro ra e epro er ( ) ro t e pro n e ealt re torate t pre ente a an a are n i ma or at on an a ue i on t e lepro t pro ra g amm e n t e r i pro t i n e i ro n e i o t gi ana e ent ma ag m t entre e t al o pre i ente a t e t to an t uppl t o D a ru an n or e g a i m t at a ma ag t a t at D uppl a een properl ana e o er t e ear arl case detection An a t e a e ete t on a arr e out n Sarla tr t t t e upport ro Early case detection— a a t a a i t i a a i i t i t it t t m a ga ita a i t i a t i t at i H , al a epro Ho p tal an Ser e entre, ro n e Healt D re torate o ro n e an So al a De ia elop ent m t n tr o i i t ro n e 2 762 i ealt or er a t , 1 6 H an 9 lepro a a e te people a t i t mi g t a a t ere or ente on per or n ou e to ou e ear e e ear e ere t en arr e out epro a i t i a a t t t a t a i i t o er , uper or an partner per onnel t en upporte ealt a l t e to a no e an ana e iag a ma ag i a ent e a e Table 5.1.5.1 Su ar Finding Acti e Ca e Detection in Sarlahi Di trict
Di trict Screened No. of No. of confir ed new ca e Population u pect otal e e ale l ra e 2 ca e a e D a l t Sarlahi 1,88,129 55 7 51 58 16 0
Source CD S EDCD
a ta t ami a g amm a a i t a i t i a a n an e onta t e a nat on pro ra e a arr e out arr e out n D anu a ere 6,08 people t t ta g t a i g i i g ere reene out o t e tar ete 10, 08 populat on o er n ou e urroun n 220 n e i a a B B t t am g t t a a e 19 ne a e (2 17 ) ere ete te a on t e re erre 15 u pe t a e n t e i t a t a i i ta t ami a t am a t a a re pe t e ealt a l t e e onta t e a nat on tea al o ent ol lepro a e a u pe t t a ma a a t i a i a a ata m i i ent at on, on r at on o lepro a e an t e r al at on an ata ere o p le n t ole t i g amm a t i a ia it a a ga ita a i t
Continued medical education— a m i a a t a mat gi t i t a t m i a at ma i t i t i t at i g a i a t i t ta t ig ig t t i i a ia i t i t i g i a a gma a i t at i ma at t ma ag m t a
Transport support to released-from-treatment cases — g amm i g a t t a t a m t atm t t t i t a t t a m g t atm t t atm t g a it at a t i i a i g a t t t i i t i i
Recording, reporting, update and leprosy case validation— i g g at a a a i a a a i t i a a a g a a a i t i t t i ata a a i a t a i i t a i at a iag a t a i i a t t gt i g a
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t g a t a a m t atm t
Supervision and monitoring — g a i i it ta ta t g i a t at i a a t a i i a t a
Coordination with partners — ga i i a m g am g t a t i g i t t a i a i it ma ag m t t m g i t i a m g a ta m i i a a t t a a a i B a a t i i a i a i ia a a a a i a a i ita m m t a m t a a a t a g a at a i t a mm a a t at a a t g amm g i i imi a i a m g it a t i g i a i it a ag m t a a i ita t a im ta
Post exposure prophylaxis— t a i i i t i g i am i i i gi t ta t iag a t t a t i i i g i t t ai a i a a a i a t a a i i t i t m t i i a i t i t i t a a a g a a a i g amm i i g im m t i g m t a a a t i i a t a i a t t
Grant to leprosy affected persons— a a g a t i i t t a t i t i t a a a a a a am t g t a i ia g a t a t t mi i a i a t t i a t a i t a imat a t
In-depth Review of National Leprosy Programme and Envisioning Roadmap to Zero Leprosy— i t i a a g amm a t m it a t am t m a a a t i Bi ita a a a a ita t a t t t t g amm a g t a g t i a mm a t a ai t am it t a t a ta g amm a a a ma t a i m t i a
Priority Assistive Product List(PAPL) 2075— i t a i a a i t a i i it i t i t a i i a t a i i a it a i a t a a t a t i t a a ta i g i a i it ma ag m t a a i ita i t tai a a i t i i g m i it ai t t a a i t g i a a i ia a a i i t i i i ta a a i t a i a i g i g i m i it i i a i g mm i a g i a i m t
Distribution of Assistive Product— g a t mi i a g a t t a a i a i t i a t i i a i t i a i t t it i a i i m i t i t t g t i m a i i i t i t t it i a i i i i t i t i m i it ai a a a ai a t i it i i t a i t i g a t a a i a g a t mi i a a t
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t 1.1.1 ACTIVITIES SUPPORTED BY PARTNERS
t t g i t i a t t t a i a i it ma ag m t g amm a i t i i i a m it i g a t a a it i i g a a t a t mm it a a g amm
The partners: i i a a t t a a a i ami a t a i a t t i g a i i ig mi i t i t
mm it a a a a i a g amm i ta mm it m m i i ima a a t a a at a t a a it i i g a i g m t a t i a t t g i t i i a m it i g i a i it i a a i ita i ma im m ta a t a a g at a t a i i g it i a i i t t t a i g amm
imi a g a i a a a a a i t it a t a ta i g i a i it ma ag m t a a i ita t a t a ta a a a i a a a a i a at t t ma i a i i a i a t a a a m a t ita a a i ita t i a i i a a t i a ga i a i a i t a ia a a a a ia t a t i t t a i t i g a t a t a a a a i i i a i it ma ag m t a a i i i a i it i a t i t ai i g i mi a t a t ai i g t g m t a t a ma mm it a t t t t a a t a i ita a t im ai m t i i i a a t a a i i a m t t a t t m i Ba a a a a
Prevalence
Overall prevalence
t t a i i g i a i ma a gi t a at a a at t a a i at i t t i t a a t t i i at t imi a a a i a t m i t at a imi a tat m i i g tai a at a am a t i a t i t i t i t i t t a i t i t a a a at a i t i t a a at m t a
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
Figure 5.1.5.1: Leprosy Prevalence in Nepal, 2075/76 (2018/19)
Source Source EDCD S S e e t nu er o lepro a e un er treat ent a reporte ro ro n e 2 (1177 a e , 0 o ig t m a t atm t a t m i a e e t nu er o lepro a e un er treat ent a reporte ro ro n e 2 (1177 a e , 0 o total) an lo e t an a ro n e an arnal ro n e ( ea ) e re tere pre alen e rate total) t ta a t a a i i a a a i i a gi t an lo e t an a ro n e an arnal ro n e ( ea ) e re tere pre alen e rate a t e e t n ro n e 2 (1 9 a e per 10,000 populat on) ollo e ro n e 5 an lo e t a a at a t ig t i i a a i t e e t n ro n e 2 (1 9 a e per 10,000 populat on) ollo e ro n e 5 an lo e t pre alen e a reporte at an a ro n e (0 0 a e per 10,000 populat on) pre a t a a t at a a i i a a alen e a reporte at an a ro n e (0 0 a e per 10,000 populat on) Table: 5.1.5.3 Di tribution of Regi tered Ca e and Pre alence Rate in 2075 76 2018 2019 Table:Table: 5.1.5.3 5.1.5.3 Di Distribution tribution of Regi of Registered tered Ca e Cases and and Pre Prevalence alence Rate Rate in 2075 in 2075/76 76 2018 (2018/2019) 2019 No. of regi tered pre alence ca e at the end of the ear No. of regi tered pre alence ca e at the end of the ear Pro ince Pre alence rate Total ca e Percentage Pro ince Per 10 000P re population alence rate Total ca e Percentage ro n e 1 26 1 58 Per0 10 87 000 population ro ro n n e e 21 1177 26 0 29 1 58 1 9 0 87 ro a n at e 2 ro n e 29 1177 10 06 0 29 0 7 1 9 a an a at ro ro n n e e 10129 56 10 06 0 0 0 7 an ro n a e 5 ro n e 527101 18 0 56 1 05 0 0 ro arnal n e ro 5 n e 95527 25 18 0 0 5 1 05 Su ur a ro n e arnal ro n e 0195 10 0 25 1 05 0 5 Su National ur a ro n e 2921 01 100 10 0 0.99 1 05 Source National EDCD S 2921 100 0.99
Source EDCD S
m i t i t g a a at m t a a a t m i t i a ig i i t i t a i t ai t a a i t i t t t ig t a at a am g a i t i t it DoHS, Annual Report 2075/76 (2018/19)
e nu er o tr t report n a pre alen e rate o ore t an 1 per 10,000 populat on e rea e to 17 ro 21 n t e pre ou ear ( ure) teen tr t are n t e era elt D anu a tr t reporte t e e t pre alen e rate o 9 per 10,000 populat on a on all 17 tr t t i mi g a i a t R 1 FigureFigure:: 5.1.5.25.1.5.2 Di Districts trict withwith Leprosy epro Pre Prevalence alence RateRate Abo Above e 11 perper 10 10,000 000 PPopulationopulation Uda pur 1.11 Rupandehi 1.28 Mahottari 1.38 Bardi a 1.40 Rautahat 1.43 Morang 1.45 Nawalpara i We t 1.46 Siraha 1.56 apil a tu 1.56 Achha 1.80 ailali 1.91 Jhapa 1.95 Sarlahi 1.96 Par a 2.05 Banke 2.17 Bara 2.36 Dhanu ha 3.49 0 50 1 00 1 50 2 00 2 50 00 50 00
NEWNEW CASECASE DETECTION DETECTION
e t ete t on o ne a a e ig i n e g i g on o n t a mi i tran on it t t t at e rate m a ea ure per 100,000 p a t ta a t t i it a opulat on A total o 282 ne lepro a e ere ete te n 2075/76 t 5 22 o ne a e n i i a a i a a i i a t t a t a ro n e 2 (1 8 a e ) ean le, an a ro n e a t e lo e t ne a e ete t on (a o n n i t g a t at a t a a a e ure) e ne a e ete t on rate ( DR) per 100,000 populat on or 2075/76 a 11 16 nat onall ig t i t i t a ta am a a it i a a a a a g ta g a m a t t a t i a i i t i t a a t at m t a t tr t (D an uta, Ra e ap, al tpur, S n upal o , Ra u a, anan , u tan an Ru u ig i Ba i t i t a t ig t at a a a t) reporte no ne a e t ear le 17 tr t a a e ete t on rate ore t an 10 ( ure) o an e tr t a t e e t rate ( 70) ollo e D anu a ( 2) ig i i a Figure 5.1.5.3: Pro ince wi e New epro Ca e 2075 76 2018 2019
89 266 71 8 1 ro n e 1 719 ro n e 2 22 a at ro n e an a ro n e 1 8 ro n e 5 5 arnal ro n e 88 165 Su ur a ro n e 5
Figure 5.1.5.4: Di trict with More than 10 New Ca e DetectionDoHS, Rate Annual per Report100 000 2075/76 Population (2018/19) 2075 76 2018 2019
Banke 44.70 Dhanu ha 44.42 Sarlahi 35.79 Mahottari 23.40 Rautahat 23.36 Par a 19.37 ailali 18.78 Bara 18.61 Jhapa 18.60 apilba tu 18.06 Morang 16.40 Rupandehi 14.97 Bardi a 13.74 Siraha 13.41 Nawalpara i We t 13.06 Achha 12.01 Uda pur 11.42 5 00 10 00 15 00 20 00 25 00 0 00 5 00 0 00 5 00 50 00
t our per ent o ne a e ere ult a llar ( ) an t e re t ere pau a llar ( ) proport on a re a ne aroun t per ent or t e la t e ear ore t an one t r ( 1 9 ) o
Figure 5.1.5.3: Pro ince wi e New epro Ca e 2075 76 2018 2019
89 266 71 8 1 ro n e 1 719 ro n e 2 22 a at ro n e an a ro n e 1 8 5 ro n e 5
arnal ro n e 88 e nu er o tr t report n a pre alen e rate o ore t an 1 per 10,000 populat on 165 Su ur a ro n e e rea e to 17 ro 21 n t e pre ou ear ( ure) teen tr t are n t e era elt D anu a 5 tr t reporte t e e t pre alen e rate o 9 per 10,000 populat on a on all 17 tr t t R 1 i mi g a i a t
Figure: 5.1.5.2 Di trict with epro Pre alence Rate Abo e 1 per 10 000 Population Figure 5.1.5.4: Districts with More than 10 New Case Detection Rate per 100,000 Population, Figure2075/76 5.1.5.4: (2018/2019) Di trict with More than 10 New Ca e Detection Rate per 100 000 Population 2075 76 2018 2019 Uda pur 1.11 Rupandehi 1.28 Mahottari 1.38 Banke 44.70 Bardi a 1.40 Dhanu ha 44.42 Rautahat 1.43 Sarlahi 35.79 Morang 1.45 Mahottari 23.40 Nawalpara i We t 1.46 Rautahat 23.36 Siraha 1.56 Par a 19.37 apil a tu 1.56 ailali 18.78 Achha 1.80 Bara ailali 1.91 18.61 Jhapa 1.95 Jhapa 18.60 Sarlahi 1.96 apilba tu 18.06 Par a 2.05 Morang 16.40 Banke 2.17 Rupandehi 14.97 Bara 2.36 Bardi a 13.74 Dhanu ha 3.49 Siraha 13.41 0 50 1 00 1 50 2 00 2 50 00 50 00 Nawalpara i We t 13.06 Achha 12.01 NEW CASE DETECTION Uda pur 11.42 5 00 10 00 15 00 20 00 25 00 0 00 5 00 0 00 5 00 50 00 e ete t on o ne a e n e on o n tran on t t e rate ea ure per 100,000 populat on A total o 282 ne lepro a e ere ete te n 2075/76 t 5 22 o ne a e n t our per ent o ne a e ere ult a llar ( ) an t e re t ere pau a llar ( ) ro n e 2 (1 8 a e ) ean le, an a ro n e a t e lo e t ne a e ete t on (a o n n i t a m a i a B a t t a i a i a B i proport on a re a ne aroun t per ent or t e la t e ear ore t an one t r ( 1 9 ) o t e ure) e ne a e ete t on rate ( DR) per 100,000 populat on or 2075/76 a 11 16 a mai a t t a t a t a t i t e ne a e ere e ale e e ale proport on a re a ne n t e ran e o 0 0 per ent or t e nat onall t a ma ma a mai i t a g t la t a t a t e ear t tr t (D an uta, Ra e ap, al tpur, S n upal o , Ra u a, anan , u tan an Ru u a t) reporte no ne a e t ear le 17 tr t a a e ete t on rate ore t an 10 ( ure) TableTable 5.1.5.4:5.1.5.4: Di Distribution tribution of of Newnew leprosy epro casesCa e 2075/762075 76 (2018/2019) 2018 2019 o an e tr t a t e e t rate ( 70) ollo e D anu a ( 2) Pro ince Total New Ca e NCDR
ro n e 1 71 9 66 ro n e 2 1 8 2 28 a at ro n e 165 2 6
an a ro n e 88 52 719 1 8 ro n e 5 arnal ro n e 89 5 0
Su ur a ro n e 266 9 28 National 3282 11.16 Source D D/H S TREND IN PREVA ENCE CASE DETECTION AND RE APSE CASES ere tren o ne a e ete t on an t e nu er o re tere a e n t e la t e t ear a re a ne ta nant e pre alen e e rea e n 2066/67 (2009/2010) en el nat on tatu a DoHS, e lare Annual an Report a een 2075/76 un er (2018/19) t e el nat on rate t ll ate an a een r n n e t en e n rea e n t e pre alen e rate t e ue to a e ol n , rre ular t o nta e o D an ue n re or n an report n Ho e er, t e ne a e ete t on rate a re a ne et een 10 11 n e t e el nat on e nu er o relap e a e n rea e ro 21 a e n t e pre ou ear to 6 n 2075/76 (2018/2019)
i mi g a i a t TREND IN PREVALENCE, CASE DETECTION AND RELAPSE CASES
t a t a t m gi t a i t a t ig t a a mai tag a t a a i imi a ta t a a a a t imi a at at a a i i g i t i a i t a at mig t t a i g i g a it i ta a i i i g a g t a t at a mai t i t imi a m a a i a m a i t i a t i
Figure 5.1.5.5: 5.1.5.5: Trend Trend in Newin New epro Leprosy Ca e DetectionCase Detection Rate and Rate Pre alenceand Prevalence Rate fro 2067 Rate 68from 2075 2067/68- 76 Figure2075/76 5.1.5.5: (2010/11-2018/19) Trend in New epro Ca e Detection 2010 Rate 11 a2018 nd Pre 19 alence Rate fro 2067 68 2075 76 1 2010 11 2018 19 25 1 0.99 0.99 25 0.92 0.89 0.89 0.99 0.99 20 0 75 0.85 0.84 0.83 0.92 0.79 0.89 0.89 20 0 75 0.85 0.84 0.83 0.79 15 0 5 15
0 5 12.2 11.9 11.8 10 11.2 11.01 10.67 11.23 11.19 11.23 12.2 11.9 11.8 10 0 25 11.2 11.01 10.67 11.23 11.19 11.23
PR 10 000 POPU ATION 5 0 25 NCDR 100 000 POPU ATION
PR 10 000 POPU ATION PR NCDR 5 NCDR 100 000 POPU ATION 0 PR NCDR 0 0 2067/68 2068/69 2069/70 2070/71 2071/72 2072/7 207 /7 207 /75 2075/76 0 2067/68(2010/11) 2068/69(2011/12) 2069/70(2012/1 ) 2070/71(201 /1 ) 2071/72(201 /15) 2072/7 (2015/16) 207 (2016/17) /7 207 (2017/18) /75 2075/76(2018/19) (2010/11) (2011/12) (2012/1 ) (201 /1 ) (201 /15) (2015/16) (2016/17) (2017/18) (2018/19) Source D D/H S Source D D/H S Figure 5.1.5.6: Trend in Relap e Ca e fro 2067 68 2074 75 2010 2011 2018 19 FigureFigure 5.1.5.6: 5.1.5.6: Trend Trend in Rinelap Relapse e Ca e Cases fro from 2067 2067/68 68 2074 - 752074/75 2010 2011(2010/2011-2018/19) 2018 19 0 6 0 5 6 5 0 27 0 27 25 20 21 25 20 20 21 15 20 15 11 12 15 15 8 12 10 11 5 8 10 5 5 5 0 0 2067/68 2068/69 2069/70 2070/71 2071/72 2072/7 207 /7 207 /75 2075/76 2067/68(2010/11) 2068/69(2011/12) 2069/70(2012/1 ) 2070/71(201 /1 ) 2071/72(201 /15) 2072/7 (2015/16) 207 (2016/17) /7 207 (2017/18) /75 2075/76(2018/19) (2010/11) (2011/12) (2012/1 ) (201 /1 ) (201 /15) (2015/16) (2016/17) (2017/18) (2018/19) Source D D/H S Source D D/H S DISABI ITY CASES DISABI ITY CASES epro a e t at are not ete te earl on or n a t el an o plete a re ult n a l t e arl epro ete t on a an e t t at are el notan ete o plete te earl treat on entor n a t ru el al an or pre o ent n plete a a re l t e ult n e a roport on l t e arl o ete ra t on e 2 D an a t l t el ( 2D)an a o on plete ne treat a e ent an t e ru rate al per or pre 100,000 ent n populat a l t e on are e a or roport on on tor o n ra e 2 D a l t ( 2D) a on ne a e an t e rate per 100,000DoHS, populat Annual on areReport a 2075/76 or on tor (2018/19) n
i mi g a i a t DISABILITY CASES
a t at a t t t a i a m a m t ma t i i a i i a t a m a m t t atm t i ia g i a i i a i a i it am g a a t at a a ma m it i g i i at a a t i g a n ator o earl a e ete t on Dur n 2075/76 (2018/2019), 156 a e o le a l t ( 2D) ere re i i i a i it it a am g a a a or e t a proport on a on ne a e o 5 0 nat onall
Figure ig i a i a i it a m t 5.1.5.7: Trend in Grade 2 Di abilit Ca e fro 2067 068 to 2075 076 2010 11 2018 2019
5 00 75 2 09 00 00 7 57 7 8 16 2 89 00 2 71
2 00
1 00
0 00 2067/68 2068/69 2069/70 2070/71 2071/72 2072/7 207 /7 207 /75 2075/76 (2010/11) (2011/12) (2012/1 ) (201 /1 ) (201 /15) (2015/16) (2016/17) (2017/18) (2018/19)
Figure 5.1.5.8:5.1.5.8: Trend Trend in in C hildChild Ca Cases e fro from 2067 2067/068 068 to 2075 to 2075/076 076 2010 (2010/11-2018/19) 11 2018 19 10 00
7.92 7.73 7.92 8 00 7.20 6.84 6.26 6.33 6.22 6 00 5.19 4.18 00
2 00
0 00 2067/68 2068/69 2069/70 2070/71 2071/72 2072/7 207 /7 207 /75 207 /75 (2010/11) (2011/12) (2012/1 ) (201 /1 ) (201 /15) (2015/16) (2016/17) (2017/18) (2018/19)
Source D D/H S
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t t ta i a iag i g t a i a a a m t i a a t g t t i t a g
ConclusionsA total o 260 ne l a e ere a no e n 2075/76 (2018/2019) re ult n to 6 22 o ne a e a a e rea e ro t e pre ou ear alt ou t e tren lu tuat n imi a tat a mai tai at t a a a t a at mai Conclu ion a a t i a a t g t i at a ig i i t i t i a e el nat ma on tatu a a i a nta a ne at t e nat a onal t le el a t m e pre a alen e a ratea re a ne a elo t 1 a i a g i a a a t i it a t t im m ta a e per 10,000 populat on t ear alt ou t rate a t ll n 17 tr t e n rea e g amm proport on o e ale an l a e oul e a re ult o ore earl an a t e a e ete t on a t t e ere a oo oor nat on an partner p t partner or t e ple entat on o pro ra e
g t mai i i at t t a t i a a mma i i a e ure or t e a n n ator o lepro ontrol or t e la t n ne ear are u ar e n a le i t mai t gt a a a g t t g amm a i t le t e a n tren t , ea ne an allen e o t e lepro ontrol pro ra e are l te
Table 5.1.5.5: Comparison of Leprosy Indicators - 2066/67–2075/76 (2009/10 – 2018/19) Table 5.1.5.5: Co pari on of epro Indicator 2066 67 2075 76 2009 10 2018 19
Indicator 018 19 2066 67 2067 68 2068 69 2069 70 2070 71 2071 72 2072 73 2073 74 2074 75 2009 10 2010 11 2011 12 2012 13 2013 14 2014 15 2015 16 2016 17 2017 18 2075 76 2
e a e ,157 ,1 2 , 81 ,25 ,22 ,05 ,05 215 2 9 282 e a e ete t on rate 11 5 11 2 12 2 11 9 11 18 11 01 10 67 11 2 11 19 11 16 n er reat ent a e at t e en 2,10 2,210 2, 0 2,228 2,271 2, 61 2,559 2626 2882 2921 R/10,000 populat on 0 77 0 79 0 85 0 82 0 8 0 89 0 89 0 92 0 99 0 99 o ne l a e 212 16 218 1 6 20 2 6 220 220 202 260 roport on l a e 6 71 5 19 6 26 2 6 7 7 7 20 6 8 6 22 7 92 e 2D a e 86 109 110 9 109 1 5 109 87 1 156 roport on 2D a e 2 72 7 16 2 89 8 2 57 2 71 09 75 2D rate/100,0000 1 9 9 5 0 9 8 1 5 0 e 2D l a e /A /A /A /A /A /A /A /A 2 2 roport on 2D l a e /A /A /A /A /A /A /A /A 0 06 0 06 e e ale a e 1,0 0 892 1,100 1,00 1,1 1,100 1,169 1 61 1 75 1 76 roport on e ale a e 2 6 28 1 6 0 8 5 6 6 0 8 28 2 2 2 1 9 Relea e ro treat ent ,8 2,979 ,190 , 7 187 2,800 2,902 0 0 2852 221 1 2 o De aulter 25 1 2 2 8 57 9 o relap e a e 18 20 25 1 11 8 12 15 21 6
Source EDCD S
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
Table 5.1.5.6: Strengths, Weakness and Challenges for the Leprosy Control Programme Table 5.1.5.6: Strength Weakne and Challenge for the epro Control Progra e Strength Weakne e Challenge • o t ent ro pol t al le el • o pr or t or lepro • o u ta n t e el nat on o ern ent o t ent to pro ra e at per p er a e e at nat onal le el an an o De larat on or epro • o ot at on o ealt el nat on at tr t le el • A e le o lepro er e or er • o a nta n a e an ual t o • ree D , tran port er e or • er e re a l tat on er e n lo en e ounta n relea e ro treat ent a e a t t e an ll tr t an ot er er e or treat n • na e uate tra n n an • o tren t en ur e llan e, o pl at on or entat on or ne l lo t , n or at on, an o • n nterrupte uppl o D re ru te ealt or er an or ente apa t u l n or • oo o un at on an re re er tra n n or o al eneral ealt or er , an an olla orat on a on upport n per on an ana er e ent re erral net or partner • oor n t tut onal et up an • o a e t e a n tu e o • pro n part pat on o na e uate u an re our e a l t ue to lepro lepro a e te people n • ro le or rea t on an • o urt er re u e t a an nat onal pro ra e o pl at on ana e ent at r nat on a a n t a e te • Steer n , oor nat on an per p er le el per on an t e r a l e te n al o ttee or e • oor re ult a e output, • n u ent a t t e n lo an on u t n eet n n re or n an report n o en e tr t or re u n t e re ular a onta t e a nat on a t t e ea e ur en • onta t e a nat on/ • oor o era e an on tor n • o a nta n a e an ual t ur e llan e o pat ent, a l o n ple ent n er e at H le el e er an ne our tr t • Stren t en n o n e a e • ntro u t on o epro o t • n er an o er report n o onta t ur e llan e, re or n po ure rop la n 7 o t e lepro ata n H S an report n te • Str t u e o H S ata n pro ra on tor n
Future cour e of action and opportunitie Future• course ple ent of t action e nat onal and trate opportunities 2016 2020 t n oH an t rou partner • e an ollo nat onal operat onal u el ne a per t e ne trate m m t t a a t at g it i a t g a t • nten a t t e to ra e o un t a arene on earl a no an treat ent, t e a a a a a g i i a t t at g t i a i t ai mm it a a a iag i a t atm t t pre ent on o a l t , re a l tat on an o al ene t • i a i it a i ita a ia t Stren t en earl a e ete t on o u n on po et area o en e tr t • t gt a a t i g t a a ig mi i t i t De elop an nten e a e ear a t t or t e tr t le el el nat on • a i t i a a a it t i t i t imi a ro ote o un t part pat on n t e at onal epro l nat on ro ra e • m t mm it a i a i t a a imi a g amm pro e t e a e o unrea e , ar nal e an ulnera le roup to lepro er e • m t a a ma gi a i a a g t i Stren t en t e n ol e ent o people a e te lepro n lepro er e an pro ra e • t gt t i m t a t i i a g amm u l t e apa t o ealt or er or earl a e ete t on, ana e ent an o un t a e B i re a t a a it l tat on a t a a t ma ag m t a mm it a a i ita • arr out operat onal re ear n en e tr t an po et on pe ue or ual t a t a a a i ig mi i t i t a t i i er e a it i • a m a i t t t ta t a t t a mi i pan e oprop la to prote t onta t an ut lepro tran on • t i a a a a i m g a a i a t nten o at onal e u at on an n o e enerat on a t t e or people a e te lepro m i i a a t i a a i a a g m t a a a it a t i t a i i i a i a a i ita t gt t a a it im m g a a i i a t at gi t gt i a i mi i t i t a a a t gt t i a a at m g a a i
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t tai t i i at g amm a i g at it i i t a it m i a g ita i t m it i g t ai i g a a i a t i a a t gt a ita i a it i i a a ita a a m a i m
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t 5.2 Eye Care
Background
a at a t i i a a i i im ai m t i m at a t i i a a i i im ai m t t at a t a t t a ia ata t m t a m t a a i a i g t i a i i im ai m t i t a t t g at i a mi i m t i a a a m mig a t i ig it tai i i a i it a i a mm i a g t a ag i g a g it a i a a i t a g a a i a i ama a i a t m it i i i im ai m t a i i t mi g a
i a g a ma i t a i g t i t i g t i i a a i g a ma i t i a t t m t i a i ma m t m i i a a t t i t a i i t t
a i t t t i i t ia t a ig t t ig t a g a am aig i i at a t ga i a i m a i g i i t g amm am m a i g t t g i i a ta g t i t i i t at gi a a i i a a i i t a t B a t m i a t at gi a t a a i a g amm ata a t a ma t a mia a a i i a mi t m a a t i i i a a a t i mi t m a a ig ig t t at a a ma a i a g i t a i i a t a g t m a t a a a t t t at g t t i i at a t i i a t i a i i t a t ta t t a at m a i
a a ig i a t i a i t m ia i ma a a t a m gi t t m t i t a t a mi i ta t a a a mi i t a i g ma i a a i i g i i it a a it t t ai it ma it a i t ai i g t t g t a a mi i t a i g t a m gi t a a i t a i g t m t i t a i i a i t a i g t a mi i ta t a t t a m gi t i t t i m a a t t t i t a m gi t a mat a t a t t m t i t i a t a t m t i t i t t m t a mi a i ta t a a a m t i t i a t a a a a a t m a ma ag a i m t mai t a i a i a i g g a a m a ma ma ag m t a i i a a g
ig i a t m t i a i t m i a t t m t i t i i a m t a t i t i t a it ima a t ita t g a t i a a i t t i g a at a i t a a a t ta a
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t a ma a a i g a i i a i a t i i t a t a a a t a a a ma g amm it t imi a g t a ma m a t mi i t i t i a g t at g imi a t i i a g t i ia i i t a i a ia a i a i m ta im m t t imit t a mi i a i a t t at gi t im m t t a i t i g a t g am im m ta t a ma a imi at m a a a i a t m a i imi a g t a ma a a i a t m a a m t t i t at a g a i g t t a ma a t a i g a imi a t a ma a
a i a ig at t a a t a t i t i t a t m i a a t it t ma t g it a i a t t t i a im ai m t a t gt a i ita t i i mm i
i t t t gt i i t a i t g a ta g t a a i a i a im ai m t m t a i a a a a a i t a a i a Ba t t a a a i mm a a ma t m t a t a a a t t t gt i i t a i t g a ta g t
m t a a a i a a a a t i i i it t ig t t a t g a a t t t i t t a i t a t g m t a t i i a g i a t t a a i m t ma a i a t i i g a t i t i
i aim t a a a a ia i a t i t a t a i t i g m t a a t i t g at t ima a i t t a i g m t a t a t m a a i i t a a a t i i at a t i i a t it i ta i at a i i t a t t i at at a g at t t a g am i t t
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t ita ata
Total Total Surgery Nepali Other S.No OPD Outreach Nepali OPD Other (OPD) (Surg Eye Hospital Name (OPD) (Outreach) Surgery Surgery (Eyecarecenter ery) + CAMP) NNJS/Hiralal Santu Devi Pradhan Eye 214656 6961 1 Institute 69077 139756 5823 2871 3941 149 2 NNJS/Biratnagar Eye Hospital 275353 54507 245755 575615 833 10411 58571 69815 3 NNJS/Butwal Lions Eye Hospital 44123 85826 475 130424 1034 1820 25 2879
4 NNJS/ChhandaKBN Eye Hospital 0 23326 50748 74074 0 1470 6802 8272 NNJS/Dr.Binod Neeta Kandel Eye 2471 5 Hospital 13518 32727 14255 60500 943 865 663 NNJS/Dr.Ram Prasad Pokharel Eye 13644 13644 667 667 6 Hospital 0 0 0 0
7 NNJS/Fateh Bal Eye Hospital 32362 65806 42598 140766 201 4760 4610 9571
8 NNJS/Gaur Eye Hospital 23093 40777 52973 116843 1379 1460 4382 7221 9 NNJS/Geta Eye Hospital 0 187355 38660 226015 0 11698 19871 31569 10 NNJS/Himalaya Eye Hospital 259835 152013 0 411848 1548 4218 0 5766 11 NNJS/ R M Kedia Eye Hospital 124115 43336 53891 97227 1031 2965 8414 12410 12 NNJS/Kirtipur Eye Hospital 0 24677 0 24677 0 695 0 695
13 NNJS/Lamahi Eye Hospital 0 47650 104 47754 0 1739 7 1746 14 NNJS/Lumbini Eye Institute 268285 109367 153300 530952 6524 8786 23756 39066 15 NNJS/Mahendranagar Eye Hospital 0 21226 3746 24972 0 515 128 643 16 NNJS/Palpa Lions Lacoul Eye Hospital 0 30509 0 30509 463 1030 0 1493 17 NNJS/Rapti Eye Hospital 88578 80947 0 169525 2414 3299 0 5713 NNJS/Sagarmatha Choudhary Eye 226,491 96255 110297 433043 3886 14712 40422 59020 18 Hospital 19 Birat Eye Hospital Pvt. Ltd 5369 15165 55735 76269 808 1575 10792 13175 20 Birtamode Eye Hospital 0 39964 13565 53529 0 1725 1005 2730 21 BPKLCOS 0 93221 0 93221 1789 3653 0 5442 22 BPEF-CHEERS 0 77485 0 77485 395 2141 0 2536 Dhangadhi Netralaya Pvt. Ltd. 23 Dhangadhi, Kailali 0 22640 3306 25946 0 2811 353 3164 Dibyajyoti eye and ear care center pvt 24 ltd 1460 2086 4987 7073 0 0 0 0 Kathmandu Medical 25 college,sinamangal 1649 12646 0 14295 0 429 0 429 26 Lions Eye Hospital 693 39482 0 40175 0 559 0 559 27 Manipal Teaching Hospital, Pokhara 0 11311 212 11523 - 208 5 213 Mechi Drishti Eye Hospital & Research 28 Centre 0 12658 5032 17690 0 3030 3504 6534 29 Mechi Eye Hospital 0 89668 114363 204031 0 5986 22024 28010 30 Mechi Netralaya Eye Hospital 0 13940 35871 49811 0 1174 2050 3224 31 Nepal Eye Hospital 0 107793 0 107793 0 4357 803 5160 Nepal Red Cross Society Surkhet Eye 0 38779 0 1324 1707 0 3031 32 Hosptial 38779 33 Reiyukai Eiko Masunaga Eye Hospital 15170 42813 0 57983 921 1038 0 1959 34 Shreekrishna Netralaya, Bhairahawa 0 6040 0 6040 0 325 1006 1331 35 Tilganga Inst. Of Ophthalmology 139139 492891 12095 644125 8368 26593 930 35891 DoHS, Annual Report 2075/76 (2018/19)
i mi g a i a t 5.3 Zoonotic disease
5.3.1 Background 5.3 Zoonotic disease
5.3.1 i mi g a i a t i i i i i i g t i t Background The i a i a t i i i a i a a B i Epidemiology and Disease Control Division (EDCD) is responsible for responding to different zoonotic t i i a i i a m i t i a t a i a diseases of public health concern. Priorities zoonotic diseases in Nepal are Brucellosis, Leptospirosis,t i Hydatidosis, a it Cysticercosis, a g it Toxoplasmosis i i i i etc. Our a public health i g activities i i a are focused to a a poisonous a snake ta bites and it dog g m ta bites. This division i t has i i been working ag i t in co i m t-ordination, collabor t g a i a t g m ta t ation and consultation with governmental livestock, wildlife, agriculture, environment sectors, general public and other non-governmental sectors. 5.3.5.3.22 GGoalsoals andand objectives objectives of ofthe the national national zoonosis zoonosis control control programme. programme.
Box 5.3.1: Goals and objectives of national zoonosis control programme Goals: No people dies of rabies or poisonous snake bites due to the unavailability of anti-rabies vaccine (ARV) or anti-snake venom serum or timely health care services. To prevent, control and manage outbreaks and epidemics of zoonosis.
Objectives:
To strengthen the response and capacity of health care service providers for preventing and controlling zoonoses. To improve coordination among and between stakeholders for preventing and controlling zoonoses. To enhance the judicious use of ARV and ASVS in health facilities. To reduce the burden of zoonotic diseases (especially rabies and other priority zoonoses) through public awareness programmes. To provide cell culture ARV as a post-exposure treatment to all victims bitten by suspicious or rabid animals. To reduce the mortality rate in humans by providing ASVS and ARV. To train health workers on snake bite management and the effective use of ARV and immunoglobulins. To reduce the number of rabid and other suspicious animal bites.
a i a i i ima i a i a a m a ima i g a a g Rabies i at t a i a a a m t a ata t it i ta a i a a a -Rabies is primarily a disease of warm-blooded animals like Dogs, Jackals, Wolfs, Mongoose a t ma a a ima i t a t t a t a i t a a m t at wild cats etc. Rabies cases are almost all fatal but it is 100% preventable by vaccination, awareness a m t a a a a at ig i a a a t at m at i a i t i about mat t at a a i t a m t a ma a i a a a human and animal interaction. Most of the affected are children. It has been assumed that almost it t ig t i a i t ai at t i a t i g a at half of Nepal’s population are at high risk and a quarter at moderate risk of rabies. It is estimated a t ta a i imm g i t a i m t a ma a that around 30,000 cases in pets and more than 100 human rabies cases occur each year with a i a t g it a i a g g a a i t a mi i i a a a the highest risk are in the Terai. Latent infections have been reported in dogs and cats. Very few patientsat i a g it t g a a ima a t a t i a m take rabies immune globulin (post-exposure prophylaxis). Almost all of human cases (99%) oft imi at it a i a t m rabies are result of dog bites.Vaccinating 70% of dogs break rabies transmission cycle in an area at risk. So, along with the EDCD, every dog owner and animal health authorities are more concerned to eliminate it as public health problem.
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t
Activities and achievements in 2075/76 in Rabies control Programme TheActivities following activitiesand achievements were carried in 2075/76 out in 2075 in Rabies/76 for control the control Programme of rabies cases:
Awareness programs about Rabies for school students and general public. The following activities were carried out in 2075/76 for the control of rabies cases: Celebration of Work Rabies day on 28th September and co-ordination with province and local level a g am a t a i t t a g a i health officials for its effective implementations. Epidemiological a a i a t t m a i a it i a a study on the active dog bite cases. a t ia it im m ta Surveillance about Rabies on outbreak area. i mi gi a t t a g it a Orientation i a a t a i t a a a program about the benefit of Intradermal (ID) delivery of Anti Rabies Vaccine (ARV) for i ta g am a t t t t a ma i a i a i health workers. Procurement a t of cell culture ARV vaccine and immunoglobulin. m t t a i a imm g i In 2075/76, 35,250 cases animal bites were reported (Table 5.3.1). The number of reported animal bite a a ima it t a m t a ima cases has fluctuated in recent years but the number of rabies deaths has increased four times as compared it a a t at i t a t t m a i at a i a m to last year. a m a t a t a
DoHS, Annual Report 2075/76 (2018/19)
i mi g a i a t Table 5.3.1: Status of reported animal bites and rabies in Nepal TableTable 5.3.1: 5.3.1: Status Status of of reported reported animal animal bites bites and and rabies rabies in in Nepal Nepal
NumberNumber of of No.No. of of cases cases of of NumberNumber of of casescases of of dog dog animalanimal bites bites NumberofARVNumberofARV FiscalFiscal year year casescases of of other other DeathsDeaths bitesbites (dog+(dog+ Other Other vialsvials cons consumedumed animalanimal bites bites animal)animal) 31,976 195,868 10 2070/712070/71 31,976 2,5402,540 34,51634,516 195,868 10 2071/722071/72 17,32017,320 3,2903,290 20,61020,610 273,000273,000 1313 2072/732072/73 20,13320,133 2,4942,494 22,62722,627 320,139320,139 6 6 2073/742073/74 37,22637,226 2,5182,518 39,74439,744 227,639227,639 8 8 2074/752074/75 33,20433,204 2,4772,477 35,68135,681 281,718281,718 3232 2075/762075/76 32,88232,882 2,3682,368 35,25035,250 236022236022 1818 o ce: o ce:
Issues,Issues, recommendations recommendations from from reviews reviews and and actions actions taken-Rabies taken-Rabies
IssuesIssues RecommendationsRecommendations ActionAction taken taken TheThe under under reporting reporting of of cases cases and and DevelopDevelop a aregular regular reporting reporting mechanism mechanism IncreasedIncreased supervisory supervisory deathsdeaths from from dog, dog, Monkey, Monkey, Jackal, Jackal, Bear Bear toto medical medical stores stores and and EDCD EDCD visitvisit to to reporting reporting sites sites CollaborateCollaborate with with different different local local CoordinationCoordination with with ProperProper awareness awareness about about animal animal bites bites stakeholdersstakeholders livestockslivestocks TrainingTraining and and Availability Availability of of ARV ARV in in all all ProvideProvide regular regular supply supply and and service service at at TrainingTraining and and availability availability healthhealth care care facilities facilities leastleast to to PHC PHC level level isis being being increased increased TrainingTraining followed followed by by IntraIntra dermal dermal vaccination vaccination not not started started to to TrainingTraining to to health health worker worker and and proper proper guidanceguidance to to start start is isbeing being allall sites sites supervisionsupervision expandedexpanded CoCoordinateordinate with with animal animal health health and and ProperProper Coordination& Coordination& MassMass dog dog vaccination vaccination locallocal other other stakeholders stakeholders for for at at least least collaborationcollaboration not not started started 70%70% dog dog vaccination vaccination inin reality reality
SnakeSnake bites bites Snake bites oiso o s oiso o s s a e s a e bites bites — — Twenty-one Twenty-one of of the the 79 79 species species of of snakes snakes found found in in Nepal Nepal are are poisonous poisonous (11 (11 Poisonouspitpit viper viper species, species, snake 5 bites 5krait krait —species, species, t t i a i a a i 3 3cobra cobra species species and and 1 1each each coral coral and and Russel’s Russel’s viper viper species). species). Around Around it i i ait i a i a a a a i i 15,00015,000 snake snake bite bite cases cases estimated estimated annually annually of of which which about about 10 10 percent percent are are poisonous poisonous bites. bites. The The a it a mat a a i a t t a i it mortalitymortality rate rate is is about about 10 10 percent percent among among poisonous poisonous bite bite cases. cases. The The 26 26 Terai Terai districts districts are are highly highly m ta it at i a t t am g i it a ai i t i t a ig affected.affected. In In the the last last eight eight years years between between 1 1and and 131 131 deaths deaths have have been been reported reported from from poisonous poisonous a t t a t ig t a t a at a t m i snake bites each year. The free distribution of anti-snake venom serum (ASVS) began in 1999/2000. a it a a i t i a a m m ga i snake bites each year. The free distribution of anti-snake venom serum (ASVS) began in 1999/2000. ia a i a t i i g a a it t atm t t a i t IndianIndian quadrivalent quadrivalent ASVS ASVS is is being being used used now. now. There There are are 85 85 snake snake bite bite treatment treatment centres centres are are in in the the t countrycountry for for a it snakebite snakebite management ma ag m t management in i in collaboration a a collaboration with it with Nepal a Nepal army, a m army, Nepal a Nepal Red Red Cross Cross Society, i t Society, mm it m m a i t t t ita i at ma a a g g communitycommunity members. members. In In addition addition to to these, these, other other hospitals hospitals in in Kathmandu Kathmandu valley valley has has been been getting getting a i a t ma ag ASVSASVS on on basis basis of of cases cases they they manage.The manage.The following following activities activities were were carried carried out out in in 2075/76for 2075/76for the the i g a i a i t i t t a ma ag m t i controlcontrol and and management management of of poisonous poisonous snake snake bites: bites: a it OrientationOrientation program program to to Medical Medical officers, officers, nurses nurses and and paramedics paramedics was was conducted conducted on on the the proper proper i ta g am t i a a a am i a t t useuse of of Anti Anti snake snake venom venom a mProcurementProcurement and and supply supply of of ASVS ASVS for for respective respective centres. centres.
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t m t a t
a t g t a it a t at a a t ta a i a mma i g agai t i a ata
In 2075/76, altogether 4,567snake bite cases were reported at national level. A total of 696 In 2075/76, altogether 4,567snake bite cases were reported at national level. A total of 696 caseswere poisonous. Table 5.3.2 summarises progress against previous years' data. caseswere poisonous. Table 5.3.2 summarises progress against previous years' data.
Table 5.3.2:5.3.2: Snake Snake bite bite cases cases and and deaths, deaths, Nepal Nepal (2070/71 (2070/71–2075–2075/7/76) 6)
Fiscal yearyear TotalTotal cases cases NonNon-poisonous-poisonous PoisonousPoisonous CureCure DeathsDeaths % deaths% deaths 2070/71 5,1435,143 4,1454,145 998998 988988 10 10 1.0 1.0 2071/72 4,1284,128 3,4613,461 667667 666666 1 1 0.1 0.1 2072/73 3,2683,268 2,6052,605 663663 643643 20 20 3.0 3.0 2073/74 6,1216,121 5,2095,209 912912 879879 33 33 3.6 3.6 2074/75 5,6065,606 4,8124,812 794794 362362 20 20 2.5 2.5 2075/76 4,5674,567 3,8713,871 696696 o ce:
Issues, recommendationsrecommendations from from reviews reviews and and actions actions taken-Snake taken-Snake bite bite management management IssuesIssues RecommendationsRecommendations ActionAction taken taken The under reportingreporting of of cases cases and and DevelopDevelop a aregular regular reporting reporting mechanism mechanism to to IncreasedIncreased supervisory supervisory visit visit to to deaths fromfrom SnakeSnake bites bites medicalmedical stores stores and and EDCD EDCD reportingreporting sites sites AwarenessAwareness about about impor importancetance CoordinationCoordination with with local local regarding regarding quick quick Public beingbeing dieddied in in community community of coof -coordination-ordination and and transportation,transportation, awareness awareness etc etc transportationtransportation TimelyTimely procurement, procurement, supply, supply, training training and and SnakeSnake bite bite management management Use of ASVSASVS vialvial treatmenttreatment availability availability trainingtraining for forhealth health worker worker The snake bite treatment centres should be Training and orientation Not included in regular health The snake bite treatment centres should be Training and orientation Not included in regular health in collaboration with health facilities with at started up to treatment service in collaboration with health facilities with at started up to treatment service least trained physician centres least trained physician centres Prepare at least one equipped snake bite ICU and ventilator Prepare at least one equipped snake bite No action is taken ICU and ventilator management centre in each province No action is taken management centre in each province Motivation, security and All snake bite management centres should Motivation, security and All snake bite management centres should Inclusive management by local sustainability to provide snake be ensured with security, motivation of HR Inclusive management by local sustainability to provide snake be ensured with security, motivation of HR and security personnel bite management and sustainability of service and security personnel bite management and sustainability of service
DoHS, Annual Report 2075/76 (2018/19)
i mi g a i a t
Snake Bite Treatment Centres in Nepal
Snake Bite Treatment Centres in Nepal
Table 5.3.3: Province wise Animal Bite cases in Nepal 2075-76 .
S/N Animal Bite Province Province Bagmati Gandaki Province Karnali Sudurpashchim Tablecases 5.3.3: Province wiseNo. Animal1 No.2Bite cases inProvince Nepal 2075-76Province . No.5 Province Province S/N Animal Bite Province Province Bagmati Gandaki Province Karnali Sudurpashchim 1 Dog Bite 4838 7335 6550 3591 4781 1984 3803 cases No. 1 No.2 Province Province No.5 Province Province Other rabies 1 Dog Bite 4838 7335 6550 3591 4781 1984 3803 2 susceptible 429 407 474 489 243 122 204 animalOther Bite rabies 2 susceptible 429 407 474 489 243 122 204 Snake bite- Non 3 animal Bite 727 763 477 940 668 145 151 Poisonous Snake bite- Non 3 Snake bite 727 763 477 940 668 145 151 4 Poisonous 81 195 95 91 77 20 137 Poisonous Snake bite 4 Insects/Wasp 81 195 95 91 77 20 137 5 Poisonous 5696 7101 6359 4364 7265 2825 3377 Bite Insects/Wasp 5 5696 7101 6359 4364 7265 2825 3377 Bite
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t 5.4 Tuberculosis
5.4.1 Background
i B i a i a t m i a t at a t t a a a a i t a i g a at i t t mat t at a i i at a B a i a a tag t m a mat t a i m a i a
i g t i g a a a i g amm gi t a m B a i i i i t B a a a m g a m i i t B a a a a t i gi a m B i i t B a m a i i a iag i i t B a a t a m a i i t B a t i g t g a t t ta gi t a i t ma a ma
i g t a B t i ta it at a a i B t a B t t a i g a m B i a B at am g gi t B a t a am g gi t B a i B m ta it i ig gi t at m t at a ta i a a t i a iag i a t t t atm t i i a a a t t g a B t at g a t B t t at g t t
i t atm t t a im m t t g t t t i i a i at it t i t i at t a g m t ia a a i t a t t t a a tai t g g a i t a B t atm t t i a a t a a t t g a B t at g a t a i m t t a t t B t t at g
5.4.2 Vision, goal, objectives of the National TB Programme
Vision: TB Free Nepal
Goal
t B i i t a m a t a i a a a a m a t ta m t m a t t a
Objectives
Objective 1: a a a t g im a t a i it a iag i i a iag i am g i m at a i t t ta a ami a ta t a a iag i am g a g it i t a t i a m a at a i t a i a t it ia t m it
Objective 2: ai tai t t atm t at at a t a m B t g t
DoHS, Annual Report 2075/76 (2018/19) Objective 5: Strengthen community systems for management, advocacy, support and rights for TB patients in order to create an enabling environment to detect & manage TB cases in 60% of all districts by 2018 and 100% by 2021 Objective 6: Contribute to health system strengthening through HR management and capacity development, financial management, infrastructures, procurements and supply management in TB Objective 7: Develop a comprehensive TB Surveillance, Monitoring, and Evaluation system Objectives 8: To develop a plan for continuation of NTP services in the event of natural disaster or public health emergency
Box 5.4.1: The End TB Strategy VISION: A world free of TB Zero deaths, disease and suffering due to TB
GOAL: End the Global TB Epidemic MILESTONES FOR 2025: 1. 75% reduction in TB deaths (compared with 2015)
2. 50% reduction in TB incidence rate (less than 55 TB cases per 100,000 population)
3. No affected families facing catastrophic costs due to TB
TARGETS FOR 2035: 1. 95% reduction in TB deaths (compared with 2015)
2. 90% reduction in TB incidence rate (less than 10 TB cases per 100,000 population) No affected families facing catastrophic costs due to TB The End TB Strategy was unanimously endorsed by the World Health Assembly in 2014. Its three overarching indicators are i) the number of TB deaths per year, ii) TB incidence rate per year, and iii) the percentage of TB-affected households that experience catastrophic costs as a result of TB. These indicators have related targets for 2030 and 2035.
The main principles for implementing the strategy are: government stewardship and accountability, with monitoring and evaluation; strong coalitions with civil society organizations and communities; the protection and promotion of human rights, ethics and equity; and The adaptation of the strategy and targets at country levels, with global collaboration.
The strategy’s components (three pillars) and related strategies are as follows: i mi g a i a t 1. Integrated, patient- entered care and prevention: Objective 3: i iag i it m B a Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening t at at a t t iag a t of contacts and high-risk groups. Treatment of all people with TB including drug-resistant TB. Objective 4: t a a i g gagi g i B a m t i t m i a g t a i at t t g t a a i g Collaborative TB/HIV activities and the management of co-morbidities. m it ma gag m t ig t B a The preventive treatment of persons at high risk, and vaccination against TB. 2. Bold policies and supportive systems: Objective 5: t gt mm it t m ma ag m t a a t a ig t B Political commitment with adequate resources for TB care and prevention. a t i t at a a i g i m t t t t ma ag B a i a Objective 5: Strengthen community systems for management, advocacy, support and rights for TB The engagement of communities, civil society organizations, and public and private care patients in order to create an enabling environment to detect & manage TB cases in 60% of all districts by i t i t a providers. 2018 and 100% by 2021 Universal health coverage policy and regulatory frameworks for case notification, vital Objective 6: t i t t a t t m t gt i g t g ma ag m t a a a it Objective 6: Contribute to health system strengthening through HR management and capacity registration, quality and rational use of medicines, and infection control. m t a ia ma ag m t i a t t m t a ma ag m t i Bdevelopment, financial management, infrastructures, procurements and supply management in TB Social protection, poverty alleviation and actions on other determinants of TB. Objective 7: Develop a comprehensive TB Surveillance, Monitoring, and Evaluation system Objective 7: a m i B i a it i g a a a t m 3. Intensified research and innovation: Objectives 8: To develop a plan for continuation of NTP services in the event of natural disaster or public The discovery, development and rapid uptake of new tools, interventions and strategies. Objectiveshealth emergency 8: a a a i i t t at a i a t Research to optimize implementation and impact and promote innovations. i a t m g 5.4.3 Major activities in fiscal year 2075/76 Box 5.4.1: The End TB Strategy Provided effective chemotherapy to all patients in accordance with national treatment policies. Promote early diagnosis of people with infectious pulmonary TB by sputum smear examination and VISION: A world free of TB GeneXpert. Zero deaths, disease and suffering due to TB Implemented active case finding interventions across high burden districts to identify missing GOAL: End the Global TB Epidemic tuberculosis cases among high risk groups through sub recipients of Global Fund grant. MILESTONES FOR 2025: Provided continuous drugs supply to all treatment centres. Maintained a standard system for recording and reporting 1. 75% reduction in TB deaths (compared with 2015) Monitored the result of treatment and evaluate progress of the programme 2. 50% reduction in TB incidence rate (less than 55 TB cases per 100,000 population) Strengthened cooperation between NGOs, bilateral aid agencies and donors involved in the NTP. 3. No affected families facing catastrophic costs due to TB Coordinate and collaborate NTP activities with and HIV /AIDS programmes. E-TB Orientation to private practitioner to notify the TB patients diagnosed at private health facilities. TARGETS FOR 2035: Roll out of DR TB Tracking and Laboratory System at all the DR and GX sites. 1. 95% reduction in TB deaths (compared with 2015) Linkage of DOTS centres to Microscopic centre through courier. 2. 90% reduction in TB incidence rate (less than 10 TB cases per 100,000 population) Provided training to health personnel. No affected families facing catastrophic costs due to TB Training to medical doctors for childhood TB diagnosis.
The End TB Strategy was unanimously endorsed by the World Health Assembly in 2014. Its three 5.4.4 Progress and epidemiology of TB
overarching indicators are i) the number of TB deaths per year, ii) TB incidence rate per year, and iii) Institutional coverage and estimation of TB burden the percentage of TB-affected households that experience catastrophic costs as a result of TB. These Nepal adopted the DOTS strategy in 1996 and achieved nationwide coverage in 2001. All DOTS sites are indicators have related targets for 2030 and 2035. integrated in public health services or run through NTP partner organizations in public and private sectors. The main principles for implementing the strategy are: In 2075/76, 4,382 institutions were offering TB diagnosis and treatment DOTS-based TB control services. Among them, 4,204 are government health institutions. To increase access to treatment services, NTP has government stewardship and accountability, with monitoring and evaluation; developed partnership with different organizations including private nursing homes, polyclinics, I/NGO strong coalitions with civil society organizations and communities; health clinics, prisons, refugee camps, police hospitals, medical colleges and municipalities. the protection and promotion of human rights, ethics and equity; and The adaptation of the strategy and targets at country levels, with global collaboration. The burden of TB can be measured in terms of incidence (defined as the number of new and relapse cases), prevalence and mortality. WHO estimates the current prevalence of all types of TB cases for Nepal The strategy’s components (three pillars) and related strategies are as follows: at 60,000 (241/100,000) while the number of all forms of incidence cases (newly notified cases) is 1. Integrated, patient- entered care and prevention: estimated at 42,000 (151/100,000). Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening DoHS, Annual Report 2075/76 (2018/19) Case notification of contacts and high-risk groups. Reported case notification rate (CNR) of all forms of TB is 109/100,000 whereas CNR for incident TB cases Treatment of all people with TB including drug-resistant TB. (new and relapse) is 107/100000 population. In Fiscal Year 2075/76, a total of 32,043 cases of TB was Collaborative TB/HIV activities and the management of co-morbidities. notified and registered at NTP. There were 97.98 % incident TB cases registered (New and Relapse) among The preventive treatment of persons at high risk, and vaccination against TB. all TB cases. Among the notified TB cases, 71 % of all TB cases were pulmonary cases and out of notified 2. Bold policies and supportive systems: Objective 5: Strengthen community systems for management, advocacy, support and rights for TB patients in order to create an enabling environment to detect & manage TB cases in 60% of all districts by 2018 and 100% by 2021 Objective 6: Contribute to health system strengthening through HR management and capacity development, financial management, infrastructures, procurements and supply management in TB Objective 7: Develop a comprehensive TB Surveillance, Monitoring, and Evaluation system Objectives 8: To develop a plan for continuation of NTP services in the event of natural disaster or public health emergency
Box 5.4.1: The End TB Strategy VISION: A world free of TB Zero deaths, disease and suffering due to TB
GOAL: End the Global TB Epidemic MILESTONES FOR 2025: 1. 75% reduction in TB deaths (compared with 2015)
2. 50% reduction in TB incidence rate (less than 55 TB cases per 100,000 population)
3. No affected families facing catastrophic costs due to TB
TARGETS FOR 2035: 1. 95% reduction in TB deaths (compared with 2015)
2. 90% reduction in TB incidence rate (less than 10 TB cases per 100,000 population) No affected families facing catastrophic costs due to TB The End TB Strategy was unanimously endorsed by the World Health Assembly in 2014. Its three overarching indicators are i) the number of TB deaths per year, ii) TB incidence rate per year, and iii) the percentage of TB-affected households that experience catastrophic costs as a result of TB. These indicators have related targets for 2030 and 2035.
The main principles for implementing the strategy are: government stewardship and accountability, with monitoring and evaluation; strong coalitions with civil society organizations and communities; the protection and promotion of human rights, ethics and equity; and The adaptation of the strategy and targets at country levels, with global collaboration.
The strategy’s components (three pillars) and related strategies are as follows: i mi g a i a t 1. Integrated, patient- entered care and prevention: Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups. Treatment of all people with TB including drug-resistant TB. Collaborative TB/HIV activities and the management of co-morbidities. The preventive treatment of persons at high risk, and vaccination against TB. 2. Bold policies and supportive systems: Political commitment with adequate resources for TB care and prevention. Objective 5: Strengthen community systems for management, advocacy, support and rights for TB The engagement of communities, civil society organizations, and public and private care patients in order to create an enabling environment to detect & manage TB cases in 60% of all districts by providers. 2018 and 100% by 2021 Universal health coverage policy and regulatory frameworks for case notification, vital Objective 6: Contribute to health system strengthening through HR management and capacity registration, quality and rational use of medicines, and infection control. development, financial management, infrastructures, procurements and supply management in TB Social protection, poverty alleviation and actions on other determinants of TB. Objective 7: Develop a comprehensive TB Surveillance, Monitoring, and Evaluation system 3. Intensified research and innovation: Objectives 8: To develop a plan for continuation of NTP services in the event of natural disaster or public The discovery, development and rapid uptake of new tools, interventions and strategies. health emergency Research to optimize implementation and impact and promote innovations.
5.4.35.4.3 Major Major activitiesactivities in infiscal fiscal year year 207 52075/76/76 Box 5.4.1: The End TB Strategy Provided effective chemotherapy to all patients in accordance with national treatment policies. i m t a t a a t i a a it a a t atm t i i Promote early diagnosis of people with infectious pulmonary TB by sputum smear examination and VISION: A world free of TB m t a iag i it i m a B t m m a ami a GeneXpert. Zero deaths, disease and suffering due to TB a t Implemented active case finding interventions across high burden districts to identify missing m m t a a i g i t a ig i t i t t i mi i g GOAL: End the Global TB Epidemic tuberculosis cases among high risk groups through sub recipients of Global Fund grant. t i a am g ig i g t g i i t a g a t Provided continuous drugs supply to all treatment centres. MILESTONES FOR 2025: i g t a t atm t t Maintained a standard system for recording and reporting 1. 75% reduction in TB deaths (compared with 2015) ai tai a ta a t m i g a g it t t t atm t a a at g t g amm Monitored the result of treatment and evaluate progress of the programme 2. 50% reduction in TB incidence rate (less than 55 TB cases per 100,000 population) t gt a t i at a ai ag i a i i t Strengthened cooperation between NGOs, bilateral aid agencies and donors involved in the NTP. 3. No affected families facing catastrophic costs due to TB i at a a at a i it a g amm Coordinate and collaborate NTP activities with and HIV /AIDS programmes. B i ta t i at a t t B a t iag at i at a t E-TB Orientation to private practitioner to notify the TB patients diagnosed at private health facilities. TARGETS FOR 2035: a i i Roll out of DR TB Tracking and Laboratory System at all the DR and GX sites. 1. 95% reduction in TB deaths (compared with 2015) t B a i g a a at t m at a t a it Linkage of DOTS centres to Microscopic centre through courier. i ag t t i i t t g i 2. 90% reduction in TB incidence rate (less than 10 TB cases per 100,000 population) i t ai i g t a t Provided training to health personnel. No affected families facing catastrophic costs due to TB ai i g t m i a t i B iag i Training to medical doctors for childhood TB diagnosis.
The End TB Strategy was unanimously endorsed by the World Health Assembly in 2014. Its three 5.4.4 Progress and epidemiology of TB 5.4.4 Progress and epidemiology of TB overarching indicators are i) the number of TB deaths per year, ii) TB incidence rate per year, and iii) Institutional coverage and estimation of TB burden the percentage of TB-affected households that experience catastrophic costs as a result of TB. These InstitutionalNepal adopted coverage the DOTS andstrategy estimation in 1996 andof TB achieved burden nationwide coverage in 2001. All DOTS sites are indicators have related targets for 2030 and 2035. integrated in public health services or run through NTP partner organizations in public and private sectors. a a t t t at g i a a i a i ag i The main principles for implementing the strategy are: In 2075/76, 4,382 institutions were offering TB diagnosis and treatment DOTS-based TB control services. it a i t g at i i a t i t g a t ga i a i i a Among them, 4,204 are government health institutions. To increase access to treatment services, NTP has government stewardship and accountability, with monitoring and evaluation; i at t i t i g B iag i a t atm t a developed partnership with different organizations including private nursing homes, polyclinics, I/NGO strong coalitions with civil society organizations and communities; B t i m g t m a g m t a t i t i a a t health clinics, prisons, refugee camps, police hospitals, medical colleges and municipalities. the protection and promotion of human rights, ethics and equity; and t atm t i a a t i it i t ga i a i i g i at The adaptation of the strategy and targets at country levels, with global collaboration. i g m i i a t i i i g am i ita m i a The burden of TB can be measured in terms of incidence (defined as the number of new and relapse g a m i i a i cases), prevalence and mortality. WHO estimates the current prevalence of all types of TB cases for Nepal The strategy’s components (three pillars) and related strategies are as follows: at 60,000 (241/100,000) while the number of all forms of incidence cases (newly notified cases) is B a m a i t m i i a t m a a 1. Integrated, patient- entered care and prevention: estimated at 42,000 (151/100,000). Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening DoHS,Case Annualnotification Report 2075/76 (2018/19) of contacts and high-risk groups. Reported case notification rate (CNR) of all forms of TB is 109/100,000 whereas CNR for incident TB cases Treatment of all people with TB including drug-resistant TB. (new and relapse) is 107/100000 population. In Fiscal Year 2075/76, a total of 32,043 cases of TB was Collaborative TB/HIV activities and the management of co-morbidities. notified and registered at NTP. There were 97.98 % incident TB cases registered (New and Relapse) among The preventive treatment of persons at high risk, and vaccination against TB. all TB cases. Among the notified TB cases, 71 % of all TB cases were pulmonary cases and out of notified 2. Bold policies and supportive systems: i mi g a i a t a a a m ta it mat t t a a t B a a at i t m a m i i a a i mat at
Case notification
t a a at a m B i a i i t B a a a i a i a a a t ta a B a a gi t at i i t B a gi t a a am g a B a m g t B a a B a m a pul a a t m a B a a t i gi a m m g t onar a e , 82 ere a ter olo all on r e A on t o e a ter olo all on r e an not a t i gi a m a m i g t B t g e , 9 (12520) ere on r e u n pert /R te t n
ore t a t a B a t m i i a t an t ree t o all a e (20928, 65 ) ere reporte ro ro n e 2, ro n e an ro i t B a t m i at ma i t i t a n e 5 Aroun 2 o t e a e ere reporte ro ro n e at an u tr t alone ol aroun a B a t B a m t i i it t i 8 (29 0 a e ) o t e a e not e ro t e ro n e le t ontr ut on aroun 9 i a i t a a t ta a i t m t ai i t i ai t t n t e nat onal total erea n ter o e o terra n tr ut on, era elt reporte ore t an al o a m t a a a t a t i t mi ag g it t e (18,815, 59 ) o t a e ere reporte n t e le a e roup t t e e t o 8 n 15 ear ig t i a ag i B i a i m a m o a e e l oo aroun 5 5 le en ere nearl 2 t e ore t an o en a on t e reporte m t a m am g t t B a a e
FigureFigure 5.4.1: 5.4.1: Tuberculo Tuberculosis i Ca Case e Notification Notification Rate Rate,2075 2075/76 76
Figure 5.4.1: Tuberculosis case notification rate, 2075/76
a a a a at m i a Ba t t ea i t i t it m t a i i t i t a t a mai i g at onal a e ot at on Rate (All or ) 109 / 100,000 populat on a e on t e R, t ere are 20 i t i t a m g ig i t i t i t i t a m t ai t tr t t R ore t an 120, le 2 tr t a R et een 75 120 an re a n n i mai i g a m t i gi t m t a t B a t tr t a elo 75 R A on 20 ur en tr t , 1 tr t are ro t e era elt le re a n n 6 are ro t e H ll re on urt er, ore t an t ree t o a e (66 ) o t e a e ere reporte ro ro n e 2, ro n e , an ro n e 5 re pe DoHS, t el Annual erea Report n2075/76 ter (2018/19)o e o terra n tr ut on, era elt el ore t an al o a e (57 ) n t e report n ear
i mi g a i a t a t m i i a i a i t m t ai i t i ai t m t a a B a i t g a
FigureFigure 5.4.2: 5.4.2: Notified Notified TB TB C a Case e and and Ca Case e Notification Notification Rate CNR Rate b (CNR)Pro ince by Provinces, FY 2075 7 6FY 2075/76
Figure 5.4.2: Notified TB Ca e and Ca e Notification Rate CNR b Pro ince FY 2075 76
Sou e ure 5 2 o t e pro n e e a e not at on rate e ro n e 5 a t e e t R (127 per ig t i i a a at i a t ig t 100,000 populat on) ollo e a at ro n e, ro n e 2 an Su urpa ra e (12 ,112 an
a Bagma i i a a im a 110 per 100,000 populat on) re pe t el R a er lo at arnal ro n e (78 per 100,000 Sou e a a a at a a i i populat on) a ure 5 2 o t e pro n e e a e not at on rate e ro n e 5 a t e e t R (127 per Di tribution b age and e 100,000 populat on) ollo e a at ro n e, ro n e 2 an Su urpa ra e (12 ,112 an n 2075/76, aroun 5 5 o a e ere re tere a l a e le t e re a n n 9 5 ere Distribution1 10by perage 100,000 and sex populat on) re pe t el R a er lo at arnal ro n e (78 per 100,000 re tere populat a on) a ult a a gi t a i B a i t mai i g A on t e , ale gi t a a t B m g t m ma B a t a m m t a Di tribution b age and e a e n ere 207 5reporte /76, aroun 5 5 o a e ere re tere a l a e le t e re a n n 9 5 ere ma m g t i B a m t t m t a ag g nearl re 2 tere t e a a ore ult t t t i a t an A e on ale t e A , on ale a t a t i t e l a e a ere e , reporte o t i a ig a g a o t e nearl (6 2 )t e ere ore it i mat t at a et eent an (5 1 e ) ale ear A o on a a i g a e t roup e l n ountr a e , o t mi t o iag t e (6 ) m ere onte t l e epal, t mm it a t et een (5 1 ) ear o ere a e to ealt mat B i i a e roup n ountr t er e onte t a t t lll ea epal, i t allen e ere an a e ere to t ealt i a i g e t er ate t e t at nearl t ll a 20 25 allen o i e a an B e am g are ere t a e n B e t e a ate to et at a nearl no e ro t e o un t e er ear, t e e t ate n l ren oul not e le t 20 an 25 10 i 15 o , B a en e e a are re u re to o u on n rea n urrent (5 5 ) proport on o l a on gg t t ig i t B t a mi i t at i m a a iag i a all not e e n a e e to e e lo a no proport e ro on t eo o l un t e a er e u ear, e t te e e t e ate e n ten l rene o oul tran not e on t atm t i B a m a t i a m t t a B t a m le t an 10 15 , en e re u re to o u on n rea n urrent (5 5 ) proport on o l a on i a t am i t gi a g a t t all not e a e e lo proport on o l a e u e te t e e ten e o tran on DoHS, Annual Report 2075/76 (2018/19) Figure 5.4.4: TB treatment success trend (FY 2071/72– FY 2075/76)
t at re u re ea ure o earl a no an treat ent o l n epal, en ere nearl t e a ore reporte to a e t an o en ere nearl t e a e n t e re on an lo al onte t Source: NTC i mi g a i a t Table 5.4.1 shows the treatment outcomes of the TB patients across different provinces. Among the 7 Annual trend Annual trends provinces, Karnali province has achieved highest treatment success rate (i.e. 94%). The treatment failure ure 5 o t e tren o a e not at on ro 2071/72 to 2075/76 t a e rea e ra uall rate was constant across all the provinces. Meanwhile, around 4% of registered TB patients died at ig t t B a a m t t a a ro 12 per 100,000 populat on n 2071/72 to 109 per 100,000 populat on n 2075/76 Gandaki province, province 5 and Sudurpaschim province during the course of TB treatment. Similarly, g a a m a i t a i Sudurpaschim and Province-2 experienced high lost to follow up (around 4%) in comparison to other Figure 5.4.3: TB Ca e Notification Rate 2071 72 2075 76 Figure 5.4.3: TB Case Notification Rate (2071/72–2075/76) provinces.
Table 5.4.1: Province wise TB treatment outcomes (2075/76) P rov i nce S ucce s s % F ai l ure % D i e d % L F U % N ot E v al uat e d % Province 1 9 0 1 3 3 3 Province 2 9 1 0 3 4 1 Bagmati Province 9 1 1 2 2 5 Gandaki Province 9 4 0 3 2 1 Province 5 9 0 1 4 3 2 Karnali Province 9 4 1 3 2 1 Sudurpashim Province 8 8 1 4 4 3 N at i onal T ot al 9 1 1 3 3 2
Source: NTC
Drug resistant tuberculosis (DR TB) Drug-resistant TB (DRTB) has become a great challenge for the NTP and a major public health concern in Nepal. Innovative approaches and more funding are urgently needed for the programmatic management of drug resistance TB nationally to detect and enrol more patients on multi-drug resistant (MDR) TB Sour e treatment, and to improve outcomes.
TreatmentTrea outcomest ent outco e of diagnostic services, case finding among new cases has remarkably increased in recent years i.e; new Burden of MDR-TB e a a e e e ellent treat ent u e rate, t or a o e 90 per ent u e rate u ta ne MDR-TB contribution in registration category has increased rapidly in the last 4 years (14.6% in 2071/72, a a i t t atm t at it a t at The Drug Resistance Survey (2011-12) found that burden of drug resistant forms of TB was increasing, with n e t e ntro u t on o D S n 1996 S n e t en, a al a e ee e t e lo al tar et o 85 15.3% in 2072/73, 18.8% in 2073/74 and 32% in 2074/75). It signifies that RR/MDR-TB cases are diagnosed tai i t i t i i t a a a t g a early9.3 andpercent are ofenrolled new patient in DR were TB treatment found resistant. Likewise, to at least the contributionone anti-tuberculosis of “Category drug. WithII failure the expansion after first line ta g t t t atm t per ent treat ent u e treatment” has been declining (i.e. 30.8% in 2071/72, 28.0% in 2072/73, 24.0% in 2073/74, and 11% in 2074/75) for consecutive year suggesting that the early case diagnosis and treatment is improving t e tren B t atm t o treat ent u at e rate B or a a i t t een on tentl a a o e i 90 t n e a t t e la t e ear a a t B t atm t at at a a a a Annual tren o treat ent u e rate at nat onal le el or ne er a e ( e an Relap e) treatment outcomes before the cases reach to category II failure. a i ta t ig at a t i it i t t on tantl at aroun 91 , or t 2075/76 t 91 Ho e er, t e tren o u e rate a on There are estimated around 1500 (0.84 to 2.4) cases of DR TB annually. However, 350 to 450 MDR TB at am g t t atm t a ai t a t i t e retreat ent a e (Su e , a lure, o to ollo up an t er pre ou l treate ) a een t at a ta t i m a i t t atm t am g a on tantl le er ( n o par on to treat ent u e a on ne er a e ) cases are notified annually. This year 635 MDR TB cases were notified. In 2075/76, a total of 392 RR/MDR TB were enrolled for treatment. TSR of RR/MDR patients was 72%. .Among them, 62 cases (16%) were on Figure 5.4.4: TB treatment success trend (FY 2071/72– FY 2075/76) Figure 5.4.4: TB Treatment Success Trend (FY 2071/72– FY 2075/76) treatment at DR centers of province 1, 60 cases (16%) at province 2, 89 cases (23%) at Bagmati province, 36 cases (9%) at Gandaki province, 95 cases (24 %) at province 5 and remaining 50 cases (13%) were on DR treatment at Sudurpaschim province respectively. However, there were no patients on treatment at DR centers of Karnali province during the period.
Box 5.4.2 Drug Resistant TB Types Rifampicin resistant TB (RR-TB) is resistant to rifampicin (detected using rapid diagnostic tests), with or without resistance to other anti-TB drugs and covers any resistance to rifampicin.
Pre-extensively drug resistant TB (Pre-XDR TB) is a multi-drug resistant strain of TB that is also
resistant to either one of the fluoroquinolones and all the second line injectable drugs. Extensively drug resistant TB (XDR TB) is a severe form of MDR-TB that is multidrug-resistant (MDR-TB) to all the fluoroquinolones and second line injectable drugs.
Source: NTC DoHS, Annual Report 2075/76 (2018/19) Case finding Table 5.4.1 shows the treatment outcomes of the TB patients across different provinces. Among the 7 The national MDR TB Treatment Guideline defines three types of MDR-TB (RR TB, Pre-XDR TB and XDR TB) provinces, Karnali province has achieved highest treatment success rate (i.e. 94%). The treatment failure cases which are further classified in six different categories. Drug resistant forms of TB are detected rate was constant across all the provinces. Meanwhile, around 4% of registered TB patients died at through GeneXpert, Culture/DST and LPA methods in Nepal. In this reporting period, 376 MDR TB cases Gandaki province, province 5 and Sudurpaschim province during the course of TB treatment. Similarly, were reported to have enroll in the DR treatment. Sudurpaschim and Province-2 experienced high lost to follow up (around 4%) in comparison to other provinces. Figure 5.4.5 shows the burden of MDR TB across the different provinces in this fiscal year 2074/75. In terms of number of RR/MDR TB patients notified, province 2 and province 3 were found to have equal Table 5.4.1: Province wise TB treatment outcomes (2075/76) burden followed by province 5, Sudurpaschim province and province 1 respectively. Similarly, the burden P rov i nce S ucce s s % F ai l ure % D i e d % L F U % N ot E v al uat e d % of Pre-XDR and XDR TB patients was found more at province 5 followed by province 3, Gandaki province, P rov i nce 1 9 0 1 3 3 3 Sudurpaschim province, and Province 1 respectively. P rov i nce 2 9 1 0 3 4 1 Bagm at i P rov i nce 9 1 1 2 2 5 G andaki P rov i nce 9 4 0 3 2 1 P rov i nce 5 9 0 1 4 3 2 K arnal i P rov i nce 9 4 1 3 2 1 S udurp as h i m P rov i nce 8 8 1 4 4 3 N at i onal T ot al 9 1 1 3 3 2
Source: NTC
Drug resistant tuberculosis (DR TB)
Drug-resistant TB (DRTB) has become a great challenge for the NTP and a major public health concern in Nepal. Innovative approaches and more funding are urgently needed for the programmatic management of drug resistance TB nationally to detect and enrol more patients on multi-drug resistant (MDR) TB treatment, and to improve outcomes.
Burden of MDR-TB The Drug Resistance Survey (2011-12) found that burden of drug resistant forms of TB was increasing, with 9.3 percent of new patient were found resistant to at least one anti-tuberculosis drug. With the expansion Figure 5.4.4: TB treatment success trend (FY 2071/72– FY 2075/76)
Source: NTC i mi g a i a t Table 5.4.1 shows the treatment outcomes of the TB patients across different provinces. Among the 7 a t t atm t t m t B a t a i t i m g t provinces, Karnali province has achieved highest treatment success rate (i.e. 94%). The treatment failure i a a i i a a i ig t t atm t at i t atm t rate was constant across all the provinces. Meanwhile, around 4% of registered TB patients died at ai at a ta t a a t i a i a gi t B a t i at a a i i i a a im i i g t B t atm t Gandaki province, province 5 and Sudurpaschim province during the course of TB treatment. Similarly, imi a Sudurpaschim a im and Province-2 a experienced i high i lost to follow ig up t (around t 4%) in comparison a to other i m a i t t i provinces.
Table 5.45.4.1:.1: Province wise wise TB TB treatment treatment outcomes outcomes (2075 (2075/76)/76) P rov i nce S ucce s s % F ai l ure % D i e d % L F U % N ot E v al uat e d % Province 1 9 0 1 3 3 3 Province 2 9 1 0 3 4 1 Bagmati Province 9 1 1 2 2 5 Gandaki Province 9 4 0 3 2 1 Province 5 9 0 1 4 3 2 Karnali Province 9 4 1 3 2 1 Sudurpashim Province 8 8 1 4 4 3 N at i onal T ot al 9 1 1 3 3 2
Source: NTC Drug resistant tuberculosis (DR TB)
g i ta t Drug resistant tuberculosis B B (DR a TB) m a g at a g t a a ma i a t Drug-resistant i a TB (DRTB) a has become a a a great challenge a m for the i g NTP and a a major g t public health concern t in g amma ma ag m t g i ta B a a t t t a m a t Nepal. Innovative approaches and more funding are urgently needed for the programmatic management m g i ta t B t atm t a t im t m of drug resistance TB nationally to detect and enrol more patients on multi-drug resistant (MDR) TB Burdentreatment, of andMDR-TB to improve outcomes. of diagnostic services, case finding among new cases has remarkably increased in recent years i.e; new Burden g of MDR-TB i ta t at g i ta t m B a MDRi a i g it t a t i ta t t at a t a t i -TB contribution in registration category has increased rapidly in the last 4 years (14.6% in 2071/72, 15.3% g The Drugin it 2072/73, Resistance t a i 18.8% Survey in 2073/74 (2011-12) iag and found 32% i that in 2074/75).burden a of drug i g It signifies resistant am g that forms RR/MDR-TB of a TB was a casesincreasing, ma a are diagnosed with earlyi a 9.3 andpercent are i ofenrolled t new patient in a DR were TB i treatment found resistant B . Likewise, to t i at least the contributionone anti-tuberculosis i gi t a of “Category at g drug. WithII failure a the i a expansionafter first line treatment” a i i has t been a t declining a (i.e. 30.8% i in 2071/72, 28.0% i in 2072/73, 24.0% i in 2073/74, a and 11% in i t ig i t at B a a iag a a a i B 2074/75) for consecutive year suggesting that the early case diagnosis and treatment is improving t atm t i i t t i at g ai a t i t atm t a treatment i i g i i i i a i outcomes before the cases reach to category II failure. a gg g t at t a a iag i a t atm t i im i g t atm t There t m t a a t at g ai are estimated around 1500 (0.84 to 2.4) cases of DR TB annually. However, 350 to 450 MDR TB cases are notified annually. This year 635 MDR TB cases were notified. In 2075/76, a total of 392 RR/MDR a mat a t a B a a t TB were enrolled for treatment. TSR of RR/MDR patients was 72%. .Among them, 62 cases (16%) were on B a a a a i a B a a t ta treatment B t atm t a t a m g t m a at DR centers of province 1, 60 cases (16%) at province 2, 89 cases (23%) at Bagmati province, 36 t atm t at t i a at i a cases (9%) at Gandaki province, 95 cases (24 %) at province 5 and remaining 50 cases (13%) were on DR treatmentat Bagma i a at a a i i a at i a mai i g at Sudurpaschim province respectively. However, there were no patients on treatment at DR centers a t atm t at a im i t of Karnali province during the period. a t t atm t at t a a i i i g t i
Box 5.4.2 Drug Resistant TB Types Rifampicin resistant TB (RR-TB) is resistant to rifampicin (detected using rapid diagnostic tests), with or without resistance to other anti-TB drugs and covers any resistance to rifampicin. Pre-extensively drug resistant TB (Pre-XDR TB) is a multi-drug resistant strain of TB that is also resistant to either one of the fluoroquinolones and all the second line injectable drugs. Extensively drug resistant TB (XDR TB) is a severe form of MDR-TB that is multidrug-resistant (MDR-TB) to all the fluoroquinolones and second line injectable drugs.
DoHS, Annual Report 2075/76 (2018/19) Case finding The national MDR TB Treatment Guideline defines three types of MDR-TB (RR TB, Pre-XDR TB and XDR TB) cases which are further classified in six different categories. Drug resistant forms of TB are detected through GeneXpert, Culture/DST and LPA methods in Nepal. In this reporting period, 376 MDR TB cases were reported to have enroll in the DR treatment.
Figure 5.4.5 shows the burden of MDR TB across the different provinces in this fiscal year 2074/75. In terms of number of RR/MDR TB patients notified, province 2 and province 3 were found to have equal burden followed by province 5, Sudurpaschim province and province 1 respectively. Similarly, the burden of Pre-XDR and XDR TB patients was found more at province 5 followed by province 3, Gandaki province, Sudurpaschim province, and Province 1 respectively.
i mi g a i a t Case finding a a B atm t i i t t B B B a B a i a t a i i i i t at g i g i ta t m B a t t t g t t a m t i a t i g i B a t t a i t t atm t run by the government health facilities while few are operated by NGOs and private instructions (Table ig t B a t i t i i t i a a 5.4.2).There are well established networks between the microscopy centres (MCs) at PHCCs, DHOs and t m m B a t i a i t a DPHO, the five regional TB quality control centres (RTQCCs) and with the National TB Centre (NTC). The a i a im i a i imi a microscopy centres send examined slides to their RTQCCs via DHOs according to the Lot Quality Assurance Figure 5.4.5: MDR-TB cases notified by provinces t a B a t a m at i i Sampling/System (LQAS) method. At the federal structure, NTP has already initiated coordination and a a i i a im i a i communication with respective provinces to provide technical and financial support to establish provincial Figure 5.4.5: MDR-TB cases notified by provinces Figure 5.4.5: MDR-TB cases notified by provinces structure for the external quality assurance of smear microscopy slides. The overall agreement rate or the concordance of sputum slide examinations between microscopy centres and RTQCCs has been more than 95% in this reporting year 2074/75. The agreement rate has improved in recent years. The external quality assurance (EQA) for sputum microscopy is carried out provincial health directorates (previously regional health directorates) at seven provinces and at the National TB centre in Kathmandu.
Table 5.4.2: NTP laboratory network (no. of institutions) by province
Center Province 1 Province 2 Province 3 Gandaki Province 5 Karnali Sudurpaschim Total MC 102 79 136 58 99 33 97 604 GX sites 7 10 15 4 11 4 5 56
Source: NTC
A lot quality assurance sampling/system (LQAS) has been implemented throughout Nepal. At each Source: NTC microscopy centre, examined slides for EQA are collected and selected according to the LQAS. Previously FigureSource: NTC5.4.6 shows treatment outcome of DRTB case registered in NTP. The Treatment success rate of NTP used to collect all positive and 10 percent negative slides for EQA. In LQAS, slides are collected and ig t atm t t m B a gi t i atm t at MDRFigure TB 5.4.6 has showsslightly treatment increase tooutcome 72% in of this DRTB reporting case registered period from in NTP. that The of previousTreatment year success. But ratethere of was a selected using standard procedures to give a statistically significant sample size. LQAS is a systematic B a ig t i a t i t i g i m t at i a B t t fluctuationMDR TB has in s lightlythe treatment increase tosuccess 72% in rate this ofreporting MDR TB. period The fromfluctuation that of inprevious treatment year .success But there rate was is amainly sampling technique that helps maintain good quality sputum results between microscopy centres and a a t a i t t atm t at B t a i t atm t at affectedfluctuation by inthe the proportion treatment of success death asrate well of MDRas holding TB. The of fluctuationthe MDR patients in treatment at treatment. success rate is mainly quality control centres. The two means of testing for MDR-TB are given in i mai a t t at a a i g t a t at t atm t affected by the proportion of death as well as holding of the MDR patients at treatment. Figure 5.4.6: Percentages of Treatment outcomes of MDR TB cases Figure 5.4.6: Percentages of Treatment outcomes of MDR TB cases Box 5.4.3 Means of testing for MDR-TB in use in Nepal Figure 5.4.6: Percentages of Treatment outcomes of MDR TB cases The GeneXpert MTB/RIF is a cartridge-based technological platform that integrates sputum processing, DNA extraction and amplification, TB and MDR-TB diagnosis. It has a similar sensitivity to culture, targets specifically and enables the simultaneous detection of rifampicin resistance. The Xpert MTB/RIF test is a valuable, sensitive, and specific new tool for early TB detection and for determining rifampicin resistance. While mono-resistance to rifampicin occurs in approximately 5% of rifampicin resistant strains, a high proportion of rifampicin resistance is associated with concurrent resistance to isoniazid. Thus, detecting resistance to rifampicin can be used as a marker for MDR-TB with a high level of accuracy. The use of Xpert MTB/RIF started in Nepal in 2011/2012 and there are 74 Xpert MTB/RIF centres throughout the country.
The culture of remains the gold standard for both diagnosis and drug susceptibility testing, and also the method of choice to monitor drug resistant TB treatment. Conventional culture methods using Lowenstein-Jensen (LJ) has the major disadvantage of being very slow. LJ cultures take eight weeks for negative results and four to six weeks after initial culture for drug susceptibility testing. National TB Reference Laboratories (NRL), NTC and GENETUP, are providing culture and drug susceptibility test (DST) services and NTP has envisioned to establish Provincial TB Reference Source:Source: NTC NTC Laboratories in all the seven provinces by 2021. DoHS, Annual Report 2075/76 (2018/19) NTP’sNTP’s laboratorylaboratory networknetwork The diagnosis and treatment monitoring of TB patients relies on sputum smear microscopy because of its The diagnosis and treatment monitoring of TB patients relies on sputum smear microscopy because of its low cost and ease of administration. It is also the worldwide diagnostic tool of choice worldwide. Nepal low cost and ease of administration. It is also the worldwide diagnostic tool of choice worldwide. Nepal has 603 microscopy centers (MCs) that carry out sputum microscopy examinations. Most of the MCs are has 603 microscopy centers (MCs) that carry out sputum microscopy examinations. Most of the MCs are i mi g a i a t NTP s laboratory network iag i a t atm t m it i g B a t i t m m a mi a it t a a a mi i t a t i a t i iag t i i a a mi t t at a t t m mi run ami a t t a t g m t a t a i i i a at run by by the the government government healthhealth facilitiesfacilities whilewhile few are operated by NGOs andand privateprivate instructionsinstructions (Table(Table 5.4.2 a i at i t a a ta i t t t 5.4.2).).ThereThere areare wellwell establishedestablished networksnetworks between the microscopy centrescentres (MCs)(MCs) atat PHCCs,PHCCs, DHOsDHOs andand mi t at a t gi a B a it t t DPHO,DPHO, the the five five regionalregional TBTB qualityquality controlcontrol centres (RTQCCs) and with thethe NationalNational TBTB CentreCentre (NTC).(NTC). The The a it t a a B t mi t ami i t microscopy centres send examined slides to their RTQCCs via DHOs according to the Lot Quality Assurance microscopyt i ia a i g t t t a it a am i g t m m t t centres send examined slides to their RTQCCs via DHOs according to the Lot Quality Assurance Sampling/System (LQAS) method. At the federal structure, NTP has already initiated coordination and Sampling/Systemt a t t a a a i i at i a a mm i a it (LQAS) method. At the federal structure, NTP has already initiated coordination and communication i communication t i with with respective respective t i a provincesprovinces a a ia toto provideprovide t technical t and ta i financial i ia supportsupport toto establish t t establish provincial provincial t structure t a structure for for a it the the external external a a qualityquality assuranceassurance m a mi ofof smear microscopy i slides. a TheThe overalloverall ag m t agreementagreement at rat rate e or or t the the concordance of sputum slide examinations between microscopy centres and RTQCCs has been more than concordance a of sputum t m slide i examinations ami a between t microscopy mi centres t and RTQCCs a has been a more than m t a i t i g a ag m t at a im i t a 95% in this reporting year 2074/75. The agreement rate has improved in recent years. The external quality 95% in this reporting year 2074/75. The agreement rate has improved in recent years. The external quality assurance t a (EQA) a it for sputum a a microscopy is carried t m out provincial mi health i directorates a i t (previously i ia regional a t assurance (EQA) for sputum microscopy is carried out provincial health directorates (previously regional i t at health directorates) i at seven gi a provinces a t and at i t at the National TB at centre in i Kathmandu. a at t a a B health t i at ma directorates) at seven provinces and at the National TB centre in Kathmandu. Table 5.4.2: NTP laboratory network (no. of institutions) by province Table a 5.4.2: NTP laboratory a at t i t i network (no. of institutions) by province Center Province 1 Province 2 Province 3 Gandaki Province 5 Karnali Sudurpaschim Total Center Province 1 Province 2 Province 3 Gandaki Province 5 Karnali Sudurpaschim Total MC 102 79 136 58 99 33 97 604 MC 102 79 136 58 99 33 97 604 GX sites 7 10 15 4 11 4 5 56 GX sites 7 10 15 4 11 4 5 56 Source: NTC Source: NTC A lot quality assurance sampling/system (LQAS) has been implemented throughout Nepal. At each A t a it a a am i g t m a im m t t g t a t a lot quality assurance sampling/system (LQAS) has been implemented throughout Nepal. At each mi microscopy centre, t examined ami slides i for EQA are collected a t and selected a t according a i g to the LQAS. t t Previously microscopy i t t a i a t ga i i NTP used to centre, collect examined all positive slides and for10 EQApercent are negativecollected slides and selectedfor EQA. accordingIn LQAS, slidesto the are LQAS. collected Previously and NTPa t a t i g ta a t gi a ta a ig i a t am i selected used usingto collect standard all positive procedures and 10 to percent give a statisticallynegative slides significant for EQA. sample In LQAS, size. slides LQAS are is collecteda systematic and selected i a t ma am i g t i t at mai tai g a it t m t t sampling using technique standard that procedures helps maintain to give good a statisticallyquality sputum significant results samplebetween size. microscopy LQAS is centresa systematic and samplingmi t a a it t t t m a t g B a gi i quality control technique centres. that The helps two maintainmeans of goodtesting quality for MDR-TB sputum are results given in between microscopy centres and quality control centres. The two means of testing for MDR-TB are given in Box 5.4.3 Means of testing for MDR-TB in use in Nepal Box 5.4.3 Means of testing for MDR-TB in use in Nepal The GeneXpert MTB/RIF is a cartridge-based technological platform that integrates sputum processing, TheDNA GeneXpe extractionrt MTB/RIF and amplification, is a cartridge TB-based and MDR technological-TB diagnosis. platform It has that a integratessimilar sensitivity sputum toprocessing, culture, DNAtargets extraction and amplification, specifically andTB enablesand MDR the-TB simultaneous diagnosis. Itdetection has a similar of rifampicin sensitivity resistance. to culture, The targetsXpert MTB/RIF test is specifically a valuable, and sensitive, enables andthe simultaneousspecific new detectiontool for earlyof rifampicin TB detection resistance. and forThe Xpertdetermining MTB/RIF rifampicin test is aresistance. valuable, Whilesensitive, mono and-resistance specific to new rifampicin tool for occurs early in TB approximately detection and 5% forof determiningrifampicin resist rifampicinant strains, resistance. a high While proportion mono -ofresistance rifampicin to rifampicinresistance occursis associated in approximately with concurrent 5% of rifampicinresistance resistto isoniazid.ant strains, Thus, a detectinghigh proportion resistance of rifampicinto rifampicin resistance can be usedis associated as a marker with for concurrent MDR-TB resistancewith a high to level isoniazid. of accuracy. Thus, Thedetecting use of resistanceXpert MTB/RIF to rifampicin started in can Nepal be inused 2011/2012 as a marker and there for MDR are 74-TB withXpert a MTB/RIFhigh level centres of accuracy. throughout The use the of country. Xpert MTB/RIF started in Nepal in 2011/2012 and there are 74 XpertThe cultureMTB/RIF of centres throughout remains the country. the gold standard for both diagnosis and drug susceptibility Thetesting, culture and of also the method of remains choice tothe monitor gold standard drug resistant for both TB diagnosistreatmen t.and Conventional drug susceptibility culture testing,methods and using also Lowenstein the method-Jensen of choice (LJ) has to themonitor major drug disadvantage resistant TBof beingtreatmen veryt. slow. Conventional LJ cultures culture take methodseight weeks using for Lowenstein negative results-Jensen and (LJ) four has to the six majorweeks disadvantageafter initial culture of being for drugvery slow.susceptibility LJ cultures testing. take eightNational weeks TB for Reference negative resultsLaboratories and four (NRL), to six NTCweeks and after GENETUP, initial culture are forproviding drug susceptibility culture and testing. drug Nationalsusceptibility TB Referencetest (DST) Laboratories services and (NRL), NTP NTChas envisionedand GENETUP, to establish are providing Provincial culture TB Referenceand drug Laboratories in all the seven provinces by 2021. susceptibility test (DST) services and NTP has envisioned to establish Provincial TB Reference Laboratories in all the seven provinces by 2021. DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t TB/HIV co-infection
TB/HIV B a t it a m t t t t co-infection TB/HIV co-infection InInFigure FY FY 207 207 5.4.755/7/76 ,:, 22029TB/HIV22029 TB TB Co-infection patients patients with with ascreening documented a documented and HIV treatment test HIV result. test status. result. FigureFigure 5.4. 5.4.77 : TB/HIVTB/HIV Co Co-infection-infection screening screening and treatment and treatment status. status. ig Figure 5.4.7 Figure shows 5.4.7 the t shows the B TB /HIV TBco-infection i /HIV co-infection tat status .Out t status of total t ta .Out of total screened for screened TB, B 0.7 %for TB, 0.7% were diagnosed to have iag t a HIV. In thosewere diagnosed diagnosed to have t iag with TB-HIVHIV. co-infection, In those diagnosed it 97% were withenrolled TB B -HIV in co-infection, i ART. 97% were enrolled in i As per the ART.data received t ata i from NCASCAs out per of thetotal data received m t t ta estimated 31,020 mat estimated PLHIVfrom NCASC19,702 out of total mat knew theirestimated status and 31,020 15,260 t i wereestimated under tat ART. a PLHIV 19,702 I In FY 2074/75,totalknew their of status and 15,260 t ta B PLHIV were screened for TB. 15,260 were under ART. Planning, Monitoring & Evaluation I In FY 2074/75,total of 15,260NationalPlanning, PLHIV Tuberculosis Monitoring were screened Centre & Evaluation is responsiblefor TB. for formulating long and short terms strategy and plans to fight against Tuberculosis throughout the country Planning and implementation of National Tuberculosis Planning,Programme a a i t i i m a g g a t t m t at g a a Monitoring (NTP) is guided & Evaluation by National Strategy Plan (NSP). Currently, NTP is implementing its activities as Nationalpert g t the strategy, Tuberculosis agai t objectives, i Centre and is targets t g t responsible of NSP t 2016-21. for t formulating NTC a i g also develops long a and and im m ta short revise terms its annual strategy work a a and plan plans to fight againstbased i onTuberculosis strategic g amm information throughout and recommendations i the g i country a a ofPlanning Palika and t at g and Province. implementation a t of National i Tuberculosis Programmeim m g it a i a t t at g a ta g t a (NTP) is guided by National Strategy Plan (NSP). Currently, NTP is implementing its activities as per a i it a a a a t at gi i ma a mm a the strategy, objectives, and targets of NSP 2016-21. NTC also develops and revise its annual work plan a i a a i based on strategic information and recommendations of Palika and Province.
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t Supervision and monitoring
Supervision and monitoring TB/HIV co-infection i i a m it i g B a t a i i a i t g a i it t a
t g amm ig a a i t a t g a i The supervision and monitoring of TB health care services is carried out by regular visits to all levels of the In FY 2075/76, 22029 TB patients with a documented HIV test result. i a i t at t im t a i g m it i g a a a at a t programme (Figures 5.6.9 and 5.4.10). In addition, the quarterly reporting of activities is carried out at Figure 5.4.7 : TB/HIV Co-infection screening and treatment status. g amm trimester planning, monitoring and evaluation (PME) workshops at all levels of the programme. Figure 5.4.7 shows the TB /HIV co-infection The NTP g a regularly monitors m it case a notification a , smear m a conversion, i treatment t atm t outcomes t m and programme a status .Out of total g amm ma ag m t t m a t g amm ata i i i a a a B management reports from all levels of the programme. Data is initially analysed by TB focal persons of screened for TB, 0.7% a t a a t i at a i g g a DOTS center and Health Coordinator of respective local level during reporting and planning workshops. were diagnosed to have a i g a B a m t a t t at i Thereafter, TB focal person from the respective health office report at province level planning, monitoring HIV. In those diagnosed a i g m it i g a a a i a B a m i ia a t and evaluation workshop. Finally, TB focal persons from provincial health directorates report at national i t at t at a a ta a m t at with TB-HIV co-infection, PME workshops. These workshop take place every four months at the Local level province and national t a i a a a 97% were enrolled in level. ART. As per the data received Figure 5.4.9: TB supervision system Figure 5.4.10: TB monitoring system from NCASC out of total International International Review Annual estimated 31,020 estimated PLHIV 19,702 National Reporting & National 4 monthly knew their status and Planning Workshop
15,260 were under ART. Provincial Reporting & Provincial 4 monthly I In FY 2074/75,total of Planning Workshop
15,260 PLHIV were screened for TB. Palika level Local Level Reporting & 4 monthly (Local body) Planning Workshop
Planning, Monitoring & Evaluation Treatment Center Treatment Reporting & Planning 4 monthly National Tuberculosis Centre is responsible for formulating long and short terms strategy and plans to fight Centre Workshop against Tuberculosis throughout the country Planning and implementation of National Tuberculosis Programme (NTP) is guided by National Strategy Plan (NSP). Currently, NTP is implementing its activities as per the strategy, objectives, and targets of NSP 2016-21. NTC also develops and revise its annual work plan LogisticsLogistics supply managementmanagement The NTP’s logistics management system supplies anti-TB drugs and other essentials every four months to based on strategic information and recommendations of Palika and Province. service delivery gi sites ma ag m t based on the t m number i of new cases a B notified g in a the t previous a quarter and the number m t t i i it a t m a i t i a t of cases under treatment (Figure 5.4.11). Prior to procurement of Anti TB Drugs, forecasting and a t m a t atm t ig i t m t B g quantification is done considering all available data. NTC follows rules and regulations of PPMO to procure a g a a a i i i g a a ai a ata a drugs from GoN Budget while Pooled Procurement Mechanism (PPM) is adopted to import medicines from g a t g m B g t i m t a i m the Global Drug Facility (GDF), Switzerland. All the drugs from procurements are received in the central i a t t im t m i i m t a g a i it it a t g m m t a i i t t a t a t a g t ag NTC Store and stored by adopting proper storage methods. Drugs are supplied every 4 months to District m t g a i m t t i t i t i a t ia gi a i a t Medical Store via Regional Medical Store (RMS) after receiving order as a result of workshops in each a i i g a a t i a gi a i t i g Region. In case of First Line Drugs buffer of 4 months is added in the order while supplying but no such m t i a i t i i g t a t i gi i a buffer quantity is given in case of DR Drugs. Supply of DR drugs is done directly to DR Centers and to some g g i i t t t a t m t DR Sub Centers.
PhysicalPhysical and and Financial Financial ProgressProgress status In Fiscal year 2075/76, NTC made 72.76 percent physical progress. Financial progress was 53.56 i a a ma t i a g i a ia g a t at m t m t at t t a i percent(Allocated Amount 695,200,,000, Expended Amount 344,225,000) at the central level. Till the date, t at a t a ia i g a i i t a NTC cleared 9.26 percent of financial irregularities ( ) in the year .
DoHS, Annual Report 2075/76 (2018/19) i mi g a i a t 5.4.5 Key Constraint & Challenges
a a g a a i g a a g a t ai t i i t i a i it t a a tai t i i t g amm i g a t a g a t ai t a t i t a t i t g a a ta g t t g amm i t a t a a
Challenges:
a a B g am at a a i i t i m g a g am t a t a t i ami m m a at B ma ag m t t ai i g t m i a t i im m i t t gt i g m t a a a a ga i g i a i g t atm t a a t m t a ta i at a i t i t ai a i it B mat ia at a t a i i i t t i at it gi a a i ia ita
Action to be taken:
a i B g amm t g t t t m t g i i t t gt i i at i a a t gt t mm it t t m g amm a a a a a B t atm t a a a i t i t a t t B mat ia
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol 5.5 HIV AIDS and STI 5.5 HIV/AIDS and STI
1:1: Background Background With it t t a i a i a ta t it i t t i mi the first case of HIV identification in 1988, Nepal started its policy response to the epidemic of HIV t g it t a a i i mm i m a a through its firstNational Policy on Acquired Immunodeficiency Syndrome (AIDS) and Sexually Transmitted a mi Diseases i a (STDs) Control, t 1995 (2052 BS). Taking B the dynamic a i g t nature ami of the epidemic at of HIV t into i mi i t i a a i it it t a a i a consideration, Nepal revisited its first national policy on 1995 and endorsed theupdated version: Nationalt at Policy i on Human a a Immunodeficiency i Virus ma (HIV) mm i and Sexually Transmitted i Infections a (STIs) a in 2011 a mi i a a t at gi a i a t a i .National HIV Strategic Plan 2016-2021 is launched to achieve ambitious global goals of 90-90- 90am i g a g a B a i i g it i .By July 2021, 90% of all people living with HIV (PLHIV) will know their HIV status, 90% of all people witht i tat a it iag i i i tai a t i a diagnosed HIV infection will receive sustained antiretroviral therapy (ART),and90% of all people receivingt a a a i i g a t i a t a i a i a i antiretroviral therapy will have viral suppression.
1.1. O er iew of the Epide ic 1.1. Overview of the Epidemic Starting ta g m a i mi t i m i i a it t from a ‘low-level epidemic’ over the period of time HIV infection in Nepal evolved itself to become m a t at i mi am g a ta it t a ‘concentrated epidemic’ among key populations (KPs), notably with People who Inject Drugs (PWID), g ma a it a a g Female sex workers (FSW), Men who have Sex with Men (MSM) and Transgender (TG) People i a i t at t i mi gi a ata i i at t at t in Nepal. A review of the latest epidemiological data, however, indicates that the epidemic i mi t a mi i a a t i a t i i ta i g a i g transmissiont a t a i g it a i g i mi t at a i it a m t of HIV has halted in Nepal. The trend of new infections is taking a descending trajectory, reaching a i a a a a a i t i a i i i t its peak during 2002-2003.The epidemic that peaked in 2000 with almost 4,455 new cases in a calendara m a i t a i g t a i a a i t g year has declined to 873 in 2018 (81% decrease). This declineis further accompanied bythedecreasing trend of prevalence of HIV in Nepal, as shown in the figures below.
0.4 Figure 1.1: Estimated HIV prevalence among adult population (15-49 Year) 2018 (1985-2020)
0.3
0.2 0.16
Percentage 0.14 0.1 0.12
0
Male Female Total
Figure 1.2: Estimated Trend of New HIV Infections and Deaths 2018 (1985-2020) 5000
4000
3000
Number 2000 873 1000 895 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 New Infection Death
DoHS, Annual Report 2075/76 (2018/19) 185 p e olo an D ea e ontrol
i a a m ig t t i t i a i This prevalence has dropped from 0.24% (highest level projected in 2005) to 0.14% in 2018 and is t t mai tai a at a at t g it t t t expected to maintain a plateau at 0.13% through 2020 with thecurrent level of efforts.
Figure 1.3: Estimated HIV infections by age group, 2018 Male 12,000 11,059 Female 10,000 8,975
8,000
6,000 5,373 Number 4,000 1,868 2,000 661 635 639 734 - 0-14 years 15-24years 25-49 years 50+ years
F i gure 1.4 : A nnual H I V i nf e ct i ons am ong adul t s ( 15 + ) b y rout e of t rans m i s s i on : 19 9 0 - 20 20 5 , 0 0 0 4, 5 0 0 4, 0 0 0 3, 5 0 0 3, 0 0 0 2 , 5 0 0
Number 2 , 0 0 0 1, 5 0 0 1, 0 0 0 5 0 0 0 19 9 0 19 9 1 19 9 2 19 9 3 19 9 4 19 9 5 19 9 6 19 9 7 19 9 8 19 9 9 2 0 02 0 0 02 1 0 02 2 0 02 3 0 02 4 0 02 5 0 02 6 0 02 7 0 02 8 0 02 9 0 10 2 0 11 2 0 12 2 0 13 2 0 14 2 0 15 2 0 16 2 0 17 2 0 18 2 0 19 2 0 2 0
Clients MSW MSM TG FS W L ow- ris k males L ow- ris k females IDU
a t i mi i ima i i a a t a mi i t at a t m t a t t ta i a i g t t ta mat t a Overall, the epidemic is primarily driven bya sexual transmission that accounts for more than 76% of a t i ag t a a i i g it i a i i t a t the total new HIV infections.Making up 4.3% of the total estimated PLHIV(29,944), there are about ag a a a a t it a i mi t at a i t m t a t 1,296children aged up to 14 years who are living with HIV in Nepal in 2018, while the adults aged 15 a t a i mat am g t a ag a a a years and above account for 95.7%. With an epidemic that has existed for more than two decades, am g t ta mat B ma a t t t i t i a t there are 7,241infections estimated among thepopulation aged 50 years and above (24%) among total mai i g m t a t i i a i ma t i a a i estimated PLHIV. By sex, males account for two-thirds (59.2%) of the infections and the remaining t ag g a am g t ta mat more than one-third (40.8%) of infections are in females, out of which around 71% are in the reproductive age group of 15-49 years among total estimated PLHIV. t a t a mi i i t ma t a mi i i t t ta i i a t i m a a i imi a i t i Heterosexual transmission is the major routine of transmission in the total pool of HIV infection in t i a i g m Nepal.The contribution from all bands of KPs is similar in the period of projection 1995-2020, only the level is varying over time. t t ta i a i t i t am g t a a i g ag g a a a mat i am g a a a a a a i t a a t i ma In 2018, 95.7% of the total infection was distributed among the population having age group 15 years i i g a t a i ma a t t mai i g i and above. The estimate infections amongkey populations are as follows: PWIDs (Male) (3%), MSWs(2%), MSM and TG (9%), FSWs (2%) and Client of FSWs (9%). These apart, low-risk males, DoHS, Annual Report 2075/76 (2018/19) including MLM account for 36%andlow-risk females account for 39% of the remaining infections.The estimated number of annual AIDS deaths of all ages is estimated to be around 895 for 2018.
Similarly, subnational HIV estimates of Nepal according to key population is reflected in table below. p e olo an D ea e ontrol
This prevalence has dropped from 0.24% (highest level projected in 2005) to 0.14% in 2018 and is mat m a a at a ag i mat t a expected to maintain a plateau at 0.13% through 2020 with thecurrent level of efforts.
imi a a a mat a a i g t a i t i ta Figure 1.5: Distribution of People Living with HIV (15 years and above), 2018. Note: LR, Low risk. Figure 1.5: Distribution of People Living with HIV (15 years and above), 2018. S , 2 Figure 1.3: Estimated HIV infections by age group, 2018 S , 2 Male D ( ale), N e r MSW, 2% 12,000 11,059 FSW, 2% Female PWID (Male), 3% 10,000 8,975 l ent , 9 Clients, 9% R o en, 8,000 S / , 9 9 LR 5,373 MSM/TG, 9% 6,000 Table 1.1 People living with HIV by key Women, 39% Number populations and Province, 2018. 4,000 1,868 2,000 PW MS MS FS Migr Clie 661 635 639 734 Province ID W M W ants nts - R ale , 6 0-14 years 15-24years 25-49 years 50+ years Province 18 15 65 74 609 401 LR I Table 1.1 People4 i ing4 with HIV b e Population Males, and 36% Pro ince 2018. F i gure 1.4 : A nnual H I V i nf e ct i ons am ong adul t s ( 15 + ) b y rout e of t rans m i s s i on : 19 9 0 - 20 20 5 , 0 0 0 ProvincePro ince 13 PWID67 MSW MSM FSW Migrant Client 76 44 1063 386 4, 5 0 0 2 4 4 4, 0 0 0 i 18 65 15 7 609 01 3, 5 0 0 Province 33 25 90 20 i 76 9981 917 67 106 86 3, 0 0 0 3 5 4 8 1 2 , 5 0 0 Bagmati 5 25 908 201 998 917 Number 11 2 , 0 0 0 Gandaki 76 75 25 846 127 1, 5 0 0 a a i 767 75 117 25 8 6 127 1, 0 0 0 Province i 22 15 22753 13 155 5 5 1 108 5 8 5 0 0 1083 548 0 5 7 5 5 4 a a i 5 16 219 12
19 9 0 19 9 1 19 9 2 19 9 3 19 9 4 19 9 5 19 9 6 19 9 7 19 9 8 19 9 9 2 0 02 0 0 02 1 0 02 2 0 02 3 0 02 4 0 02 5 0 02 6 0 02 7 0 02 8 0 02 9 0 10 2 0 11 2 0 12 2 0 13 2 0 14 2 0 15 2 0 16 2 0 17 2 0 18 2 0 19 2 0 2 0 Karnali a im 5 4 1627 3 219 6 12 2 52 1868 1 7 Clients MSW MSM TG FS W L ow- ris k males L ow- ris k females IDU Sudurpa 24 D eople27 46 o n e t Dru 52 1868 S ale137 Se or er S en o a e Se t en S schim e ale Se or er 3 Overall, the epidemic is primarily driven bya sexual transmission that accounts for more than 76% of t g a a it the total new HIV infections.Making up 4.3% of the total estimated PLHIV(29,944), there are about PWID: ma l People o et e who a Inject e al oDrugs; pla e MSW: p otal Male role Sex n Workers;t e nat onal MSM: re Men pon e who have l o Sex et e with , t rou Men; t FSW: e 1,296children aged up to 14 years who are living with HIV in Nepal in 2018, while the adults aged 15 Femalee po Sex er Workers ent o , a e een pla n n tru ental role n pre ent on, treat ent, are an upport years and above account for 95.7%. With an epidemic that has existed for more than two decades, i i er i e a ell a a r n a n a a out i ta an e n le al i an t pol a a en ron ent t rou i i a i o a t g there are 7,241infections estimated among thepopulation aged 50 years and above (24%) among total Civil m m t societies have also a played pivotal a i g roles i t m ta in the national i response. Civil t atm t societies, a through a ternal De elop ent artner ( D ) e uall upport t e nat onal re pon e to H n epal pro n estimated PLHIV. By sex, males account for two-thirds (59.2%) of the infections and the remaining empowerment t i of KPs, a have been a i gi g playing instrumental a t a g roles i in ga prevention, a i treatment, i m t care and t g support a u tant al a ount o re our e re u re or o at n H e lo al un to t A DS, an more than one-third (40.8%) of infections are in females, out of which around 71% are in the servicesa a as well as bringing about changes in legal and policy environment through advocacy. alar a ( A ), re ent er en lan or A DS Rel e ( AR), n te State A en or reproductive age group of 15-49 years among total estimated PLHIV. External t a m t a t a t t a a t i a nternat Development onal De elop Partners ent ( SA (EDPs) D), equally e n te support at on the national l ren un response ( to ),HIV orl in NepalHealt by Heterosexual transmission is the major routine of transmission in the total pool of HIV infection in providing i i g a ta a am t i m a g a t ig t r an a at substantial on ( H ), A amount DS Healt of resources are oun required at on (AH for ) acombatingre t e e ternal HIV. The our Global e t at Fund are to ontr Fight ut AIDS, n Nepal.The contribution from all bands of KPs is similar in the period of projection 1995-2020, only the TB B a a a ia i t m g a i it tat toand t eMalaria nat onal (GFATM), H re pon President's e Emergency Plan For AIDS Relief (PEPFAR), United States Agency level is varying over time. for g t a a m t it a i International Development (USAID),The United Nations Children’s Fund (UNICEF),World Health a t ga i a a t a a a t t a t at a Organization2: Polic (En WHO iron ),AIDSent Health and Care Progre Foundation in National (AHF)are theHIV external Re pon sources e that are contributing t i g t t a a In 2018, 95.7% of the total infection was distributed among the population having age group 15 years to the national HIV response. and above. The estimate infections amongkey populations are as follows: PWIDs (Male) (3%), 2.1 Introduction MSWs(2%), MSM and TG (9%), FSWs (2%) and Client of FSWs (9%). These apart, low-risk males, 2: DoHS, Policy ore t Annual anEnvironment t Report o e a 2075/76 e o andt (2018/19) e H Progress ep e in a National t ulate HIV epal Responseto re pon t a nu er o pol including MLM account for 36%andlow-risk females account for 39% of the remaining infections.The n t at e e e pol re pon e a e o e ro utt n l ro t e ealt e tor a ell a ot er estimated number of annual AIDS deaths of all ages is estimated to be around 895 for 2018. 2.1 Introduction e elop ent e tor a n at reat n an ena l n pol en ron ent or t e onta n ent o H a ell a t at on o t e ep e ota le pol e elop ent ta en or u n t e nat onal re pon e Similarly, subnational HIV estimates of Nepal according to key population is reflected in table below. More than two decades of the HIV epidemic has stimulatedNepal to respond with a number ofpolicy initiatives.to H are These pelt policyout ere responses have come cross-cuttingly from the health sector as well as other development sectors aiming at creating an enabling policy environment for the containment of HIV as well as mitigation of the epidemic. Notable policy developments taken for guiding the national response to HIV are spelt out here. p e olo an D ea e ontrol 2: Policy Environment and Progress in National HIV Response
2.1 Introduction
t a t a t i mi a m at a t it a m i i i a i a m g m t a t t a a t m t t aimi g at a g a a i g i i m t t tai m t a a mi ga t i mi ta i m t ta g i i g t a a t a t t
The National Health Sector Strategy Implementation Plan (NHSS-IP 2016-2021)
a a g i a a i it g amm m t a i g i t a a t at gi a t tai a m t a a t a a a t t t at g a a a t t t at g m m ta a a a i a t a i g t a i am i ta g t a a t at gi a a i g t i mi a a i a t t at
National HIV Strategic Plan 2016-2021
a a t at gi a t a a t at g it t aim m g t g a g a a a t at gi a t i i a t i i m t at gi i i g i at i ig t a a t a i g amm it i t at a i t g at i t t g a a t i t t t i a m im m ta t a a t at g it mi t m i a t a tm t a a it a i mm a m t t m i mi i a t t at gi i ma m t i a a m t
National Health Sector Strategy (2015-2020)
i i t a t a a a a t a t i a ta t im m ta t a a t at gi a t g t i a t i i a t t at a i ia a a t im m ta ta a i i a it t i a t i at t i i g i t at a i i i i t a t g m t t a ga i a B a a i g t i a i a i t a i g t at i a i i i g it i im a t at i i at a t i mai tai a i i m i tm t i a ma
mmitm t a t t g a t at g a t tai a m t a a t t a m i mmitm t t a t a i g i g t i mi a a i a t t at
2.2 Policy related activities/highlights from FY 2075/076 it t aim im m ta t a a t a i t a a g a a m a a g i i a a t i t a i a a g a atm t i i a a i at i i t at gi ma g i i a a a i i i at m t t i t a mi i ai i g a a atm t it a ai i g a a iat i i i i a a a i i mm it g i a a
188 DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol 3: HIV Testing Services and STI Management
3.1 Introduction
a t t it g a a i i g i a a t t atm t a a t g i a a t at gi i t a a t i a ta t it t t ga i it t a a ta i t i at g a i g i g t m it i a a ta t a a t g a i g g am a at i t i i i at g a i g a a a ia m t t a g t agai t it t a i g a i g it a t t t a a a m t a a i i a m at i a at i a a at t a at g i i i m g a a m i g i i t a g a g i mm it Ba g B a a a a i i at i a a a gg t a a g a atm t i i a i a m i g a t im m t t mm it g a a i t ma imi t g am g a t i a a a a i i mm it g i a i a a t i a im m t i i t i t imi a ta g t i t g am am g a a a i a i t i t
ma a t ai i a t a i i a a it g it t a ma ag m t a a mi a a a t at gi a i t g a a t t a a t i a ta t it t t a i i a a g a t t mai tai i g t i i ag t t a i t a a a a ag m t g i i i a i a a i i a
3.2 Key strategies and activities
HIV Testing Services
a a t at gi a i i a i a i g t g i mm it a t g i a i at ma i ta g t a i a t a t ma im m i a it t g a i ag t a ig t atm t a a t a a t at g t i i t at t i a t t m i g a a ta t g i a a i t g a a t t g m t a t a i
m t a i m g t ta t g am g t g ta g t mm i a a i ag t mm it t a a i i i i at g a i g a ta t i i t ata i i i i t ma i i i t a t m ami a i g a B i i t i t t t a a t a a a a i g ag a a t i t t
a a t m i a a i i g t atm t t i i t a t i a t a t a mi i i a i i g m t t i t a mi i m a a i i i a a ami a t ia t a t m i g a a i g t t ma i a i i t gma a i imi a DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol ami a i g a t a i a a agi g B i
Detection and Management of Sexually Transmitted infections (STI)
t t t t a ma ag m t t ta a i a a it iag i a t atm t t a t t a a t t a a a t ima a t a i a a t at g i t a a t i t at g t ta a i a mi a a it t a gi a t atm t
t gt i g m t i ag a m a i m t a i a a g mm i a B i a t ga i g i i g t t gt i g i ag t a i a t a i t t t t t at i mi a
33.3.3 Progre Progre and and Achie Achie e e ent ent 3.3 Progre and Achie e ent HIV Te Testing ting Ser Services ice HIV ere Te are ting 17 Ser 5 H ice e t n an oun el n te n epal t at n lu e 8 non o ern ent te an 1 7 a g a i g it i a t at i g m t it a o ere ern are ent 17 5 te H operat e t n n an n t oun e ountr el n al te o na nta epal n t n at t n e r lu l n e a 8 e non t o ern a ent ell te a an t AR 1 7 g m t it a g i t t a mai tai i g t i i ag it a a o te ern a ent ell a te operat te n n et tren e ountr o p ro al o ra a nta at n n ata t o e people r l n a e o t ere te a te ellan a oun t ele AR o it it a a it t g amma ata t t te er t a e la ellt a t ree ear te o e e tren n a leo p ro 1 ra at ata o people o ere te te an oun ele o a t a t t a i i a er t e la t t ree ear o e n a le 1 Table3.1: Ser ice Stati tic HIV Te ting and Coun eling for the Period of BS 2073 074 2075 076 Table3.1: Ser iceIndicator Stati tic HIV Te ting and Coun 207 / eling07 for the Period207 of /0 BS75 2073 074 2075 2075/ 076076 otal te te orIndicator H 207 210,525 /07 207 0, /0 6075 2075/2 7, 0 9676 otal otal te H te o or t H e reporte 210,5251,85 2,152 0, 60 2 2,298 7, 96 otal u ulat H e o H t reporte e reporte a e 1,85 0,612 2,152 2,76 2,298 5,062 Source u ulat C SC e H routine reporte programme a e data i S 0,612 2,76 5,062 Source C SC routine programme data i S
t g i ig t i i a t i a a i i a t e H te t n e t n a at (76,920), an lo e t n arnal pro n e ( ,100) erea t e per tag i it i i ig t i a a i i a im i e H enta te e t o n po t t e t el n a at e ( 76,920 t n an ), an a lo ro e n t e n ollo arnal e p ro Su n e urpa ( ,100 ) erea ro n t e e e i i tai i a i a pro per enta n e e o e po eta t l t al o el o n n e a t n le an 2 a ro n e ollo e Su urpa ro n e e pro n e e eta l al o o n n a le 2 Table3.2: Pro ince wi e Ser ice Stati tic HIV Te ting and Coun eling in 2075 76 TablePro 3.2: ince Pro ince wi e Ser ice Stati Te tic ted forHIV HIV Te ting andPo Coun iti e reported eling in 2075 76 of po iti it ield Pro ro ince n e 1 Te ted 6,527 for HIV Po iti e287 reported of po 0 iti 8 it ield ro ro n n e e 12 6,527 2,0 2 287 7 0 8 9 ro a n at e 2 76,920 2,0 2 58 7 0 9 8 a an a at 76,92010,588 58 165 0 1 8 6 ro an n a e 5 10,588 6,977 165552 1 6 2 arnal ro n e 5 6,977 ,100 55225 1 0 2 8 Su arnal urpa 21, ,100 2 25 1 0 1 8 5 Su otal urpa 237 21, 496 2 2 298 1 1.0 1 5 Source otal C SC routine programme data i 237 S496 2 298 1.0 Source C SC routine programme data i S 3.3 e Challenge I ue and Reco endation 3.3 e Challenge I ue and Reco endation I ue Reco endation I ue Reco endation D ata ap oun n t e H pro ra e pe all ra n n pro DoHS, ra Annual o u Report n on 2075/76 a or(2018/19) non Dt ata e report ap ro oun an n t e te H ( pro a or ra Ho e p pe tal all report ra n n n pro o ern ra ent an o u pr n ateon o p a tal or non oul an t e report ) are ro et an to e te o ( ere a or n Ho t e p tal report e one n o ern AS ent an an H pr Sate n or o erp tal to en oul ure ele an tron ) H are S et to te e o ere n t e report e one n to H AS S an urt H er S ore, n or an er up to en ate ureo ele tron H S te report n ator n to n H H S S report urt er ne ore, e ar an toup a ate re o n urrent ator ata n H S repan report e ne n e a ar t on to a to t re , urrent or op ata to tren repan t en t e e apa n a t t o on ata to entr t , u or er o op H to S tren at all t enle t el e apa ne t e o ar ata or entr t e u up er ate o , H on S tentat all an le el al ne ata e report ar or n t e n up H ate S , on tent an al ata report n n e pre ent on o ponent n lu n All H t S e or n u t e enl te n t e H S o e pre un ent on t a e o / ponente H te n t lu n n er e All t te e So or t n at, t e total u te t t e n enl nu te er n t e oul H eS a o on un e t populat a e / one H a te nl t n run er t rou e n orporate te So t , at, nto t e nat total onal te t n te nu an er nat oul onal e a on an e H populat S ata on a e a nl te run oe t rou not ull n ure orporate o te t , n nto an nat e onal enerate te ro an t nat e H onal S o er an H ett S n ata e a report e te n ro oe t not e ull urete o te t n an e enerate ro t e H S o or er n ett et n to e e report o ere n n ro t e t e te ele or tron n H S et to te e o ere n t e ele tron H S te 3.3 Progress and Achievement HIV Testing Services There are 175HIV Testing and Counseling sitesin Nepalthat include38non-government sites and 137 government sites operating in the country also maintaining their linkages with KPs as well as with ART sites as well as PMTCT sites.The trends of programmatic data of people who were tested and counseled over the last three yearsis showed in Table 3.1.
Table3.1: Service Statistics HIV Testing and Counseling for the period of BS 2073/074-2075/076 Indicators 2073/074 2074/075 2075/076 Total tested for HIV 210,525 330,460 237,496 Total HIV Positive reported 1,854 2,152 2,298 Cumulative HIV reported cases 30,612 32,764 35,062 Source: NCASC routine programme data/ iHMIS
The HIV testing is highest in Province 3(76,920),andlowest in Karnaliprovince (3,100) whereas the percentage of positivity yield is highest in Gandaki Provincefollowed bySudurpaschimProvince. The province-wise detail is also shown in Table 3.2.
Table3.2: Province wise Service Statistics HIV Testing and Counseling in 2075/76 Provinces Tested for HIV Positive reported % of positivity yield Province 1 36,527 287 0.8% Province 2 42,042 373 0.9% Bagmati 76,920 583 0.8% Gandaki 10,588 165 1.6% Province 5 46,977 552 1.2% Karnali 3,100 25 0.8% Sudurpaschim 21,342 313 1.5% Total 237,496 2,298 1.0% Source: NCASC routine programme data/ iHMIS p e olo an D ea e ontrol 3.3 Key challenges/Issues and recommendations Issues Recommendations Huge data gap is found in the HIV program Training programs focusing on major non-reporting especially the report from many sites(major government and private hospitals should be done HospitalsandNGOs) are yet to be covered in the by NCASC and iHMIS in order to ensure reporting electronic iHMIS system. to iHMIS. Furthermore, an update of indicators in HMIS reports is necessary to address current data discrepancies. In addition to this, workshops to strengthen the capacity of data entry users of iHMIS at all levels is necessary for the updated, consistent and valid data reporting in iHMIS. The Community-Based/Led HIV testing service All the working NGOs must be enlisted in the iHMIS among key population is mainly run through system. So that, the total testing numbers could be NGOsandiHMIS database system does not fully incorporated, into national system andnational cover NGO setting. The reporting from the figure of testing can be generatedfrom the iHMIS working NGO yet to be covered in the electronic system. HMIS system. Low HIV testing coverage among key populations Effectiveroll-out of Community-led HIV Testing and (KPs) has beenalong-standing challenge in Treatment Competence in Communities (TCC) response to HIV. The problem of low coverage is approach with active monitoring should be in most prominent for the returning labor migrants. place. Provide testing facilities at transit points as well as destinations of migrant population. Gap in HIV positivity coverage along with HIV The number of HIV testing sites should be testing coverage as per 90-90-90 target. expanded in order to achieve 90-90-90 targets, whereas decreasing funding trend remains a
challenge. Additionally, in response to loss to follow-up of HIV positive cases, referral linkage of HIV positive cases between Community Based Testing sites and HIV Testing Services should be strengthened to achieve the target for first 90.
4: Prevention of Mother to Child Transmission for elimination of vertical transmission (eVT) 4: Prevention of Mother to Child Transmission for elimination of vertical 4.1transmission Introduction (eVT)
a ta t it t t i a mi i g am i a 4.1 Introduction it Nepal g started its t Prevention it of at Mother B to i a a Child Transmission t t (PMTCT) a t program i in B February a a 2005 with at it ita at ma a B i a ita Ba a t setting up three sites at 1) B. P. Koirala Institute of Health Science (BPKIHS), Dharan; 2) Maternity a t a a a i t i t g amm i ma Hospital, Kathmandu and; 3) Bheri Zonal Hospital, Banke. In early 2007, the NCASC and UNICEF i g mm a i t g a a i it mm it a mat a a ata a t i i a t i m t ma mm it a t t undertook an operational Review of the pilot PMTCT programme. The review made following a t mm it a a t i g t i i m recommendation: integration of PMTCT activities with community-based maternal and neonatal health services; increase ag the a involvement g of t Female i t Community Health g a Volunteers i i (FCHVs) and m other a i a a g t m t t i t a mi i a g community-based health workers in “Prong 1: Prevent HIV infection in women of reproductive age” i a t atm t a t t i t a t i a t a ami i i i and “Prong 2: Prevent unintended pregnancy in HIV-positive women” activities, and referral for “Prong a 3: Prevent im m g mother-to a t -child transmission a i i of i t HIV” and ga i a “Prong 4: Provide i ma agi g care, treatment a g and support to i a t gt t t i a g amm ma ag m t a g a HIV-infected parents, infants and families” services; involve local implementing partners and civil mm it a g am i i at i a i t i t i a gi i g i society organisations in managing and supporting PMTCT services, and strengthen the role of the DoHS,NCASC Annual in overall Report programme 2075/76 (2018/19) management and governance. Community-based PMTCT programs were initiated in several districts in Nepal beginning in 2009, based on recommendations from the 2007 PMTCT National Review and the knowledge that current facility-only based PMTCT models were not reaching the majority of pregnant HIV infected women in the county and made several important recommendations notably, train and utilize female community health volunteers (FCHV) and other community-level workers to raise awareness on HIV and PMTCT and educated pregnant mothers on the need to test for HIV in pregnancy; decentralize HIV testing of ANC mothers to lower-level health facilities; Make some antiretroviral (ARVs) available at lower-level health facilities for decentralization of PMTCT services and enable women to “take-home” ARVs for themselves and their babies to use at the time of labour and delivery, in the circumstances where they are unable to reach a PMTCT site for delivery.
Moving further in this direction, apart from the free provision of maternal ART and prophylaxis for infants, the National Guidelines on PMTCT have been developed and integrated intoNational HIV Testing and Treatment Guidelines in Nepal, 2017. Human resources, especially from maternal and child health care, have been trained in alignment with PMTCT services. Apart from it, HIV testinghas been incorporated into maternal and child health care in the form of PITC. Tailoring to the needs of HIV- infected infants as well as HIV exposed babies; counselling and information on infant feeding have been adjusted accordingly. p e olo an D ea e ontrol a mm a m t a a i a t g t at t a i it a m t a i g t ma it g a t i t m i t t a ma a im ta t mm a ta t ai a i ma mm it a t t a t mm it t ai a a a a at g a t m t t t t t i g a t a i t g m t t a t a i i a m a t i a a ai a at a t a i i t a i a i a a m t ta m t m a t i a i t at t m a a i i t i m ta t a a t a a it i
i g t i t i i a a t m t i i mat a a a i i a t t a a i i a a i t g at i t a a g a atm t i i i a ma ia m mat a a i a t a a t ai i a ig m t it i a t m it t g a i at i t mat a a i a t a i t m ai i g t t i t i a t a a a i i g a i ma i a t i g a a t a i g Table 4.1:Service Statistics on PMTCT in Nepal for the period of BS 2073/74-2075/76 4.2 Key strategies and activities Indicators 2073/74 2074/75 2075/76 a i g t t i a mi i i a t a ig i a t i Tested for HIV (ANC &Labour) 382,887 439,225 440,709 i i i a i t i a a a t at g aim t imi at t a mi i HIV Positive Pregnant women 128 70 79 t g i a i g t g ag agai t t ta a a mat Total Deliveries by HIV +ve mothers 126 127 129 g a i i t t a a t at g i ag t g amm Mothers received ART 175 158 133 t i t g at a i t g a t a i a t i Babies received prophylaxis 112 123 130 a a t at g a t i t g a i t g amm a i g it t a gi ami a i i i a a t at g a t t t g amm Source: NCASC routine programme data/ iHMIS a t i g m i a i t g at g a a The HIV testing among pregnant women is higher in Province 3 (97,461),and Province 5 (88,595) i ima t a mi i whereas the percentage of positivity yield among pregnant women is higher in Province 5, than ii i t g a i am g m i i g it national average. The province-wise detailis also shown in Table 4.2. iii t a mi i m m i i g it t t i i a i i i atm t a a t m i i g it a t i i a Table 4.2: Province wise Service Statistics on PMTCT in Nepal 2075/76 ami i Pregnant women tested Positive pregnant Provinces Positivity Yield (%) a t t t a t t m t t g a a a a ag it t tai m t t for HIV women identified i g i i i g i t g a t m Province 1 6 9 , 8 9 2 15 0.021462 Province 2 6 0 , 48 2 14 0.023147 t g a i g i g a a i a t a t m Bagmati 9 7 , 46 1 2 6 0.026677 g t m t i t it i Gandaki 47 , 2 2 9 6 0.012704 a i a Province 5 8 8 , 5 9 5 17 0.019188 a t i g i ma i g a t Karnali 2 5 , 2 43 0 0 a a t iag i a i at i t a it i a Susurpaschim 0.00193 a t m i t atm t a a ia t m t a ami i it 5 1, 8 0 7 1 i Total 440,709 79 0.00018 Source: NCASCroutine programme data/ iHMIS i i a a i t g at i t mat a a ata a t i i i t i t i t it B i a t g am a a i a i t i t Aiming at the elimination of mother to child transmission, Nepal adheres to Option B+ and embarks for a i g a i g i am g m i g i it at t a t providing lifelong ART for all identified pregnant women and breastfeeding mothers with HIV, a i i it t a a t a t a i i at mm it t g m t a regardless of CD4 along with prophylaxis treatment for their infants as well. The rollout of the lifelong a mm it Ba t t i a mi i B g am treatment adds the benefits of the triple reinforcing effectivenessof the HIV response: (a) help improve DoHS, Annual Report 2075/76 (2018/19) maternal health (b) prevent vertical transmission, and (c) reduce sexual transmission of HIV to sexual partners.
Early Infant Diagnosis (EID) Initiatives for Early Infant Diagnosis (EID) of HIV in infants and children below 18 months of age have been takenwith the goals a) of identifying infants early in order to provide them life-saving ART; and b) of facilitating early access to care and treatment in order to reduce morbidity. In this context, a Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) testing facility has been set up at National Public Health Laboratory in Kathmandu. Early Infant Diagnosis (EID) coverage has significantly increased within two months of birth (6.4% in 2014 to 42% in 2018 July) in last four years due to widely scale-up of sample collection in all ART centers and lab staff widely trained to collect the sample for EID. After the revision of National HIV Testing and Treatment Guideline in 2017, and implementation of EID testing at birth, by the end of 2017 the EID testing within 2 months of age increased. However, still,18 % of EID cases are being reached after 2 months of age due to home delivery, diagnosis of HIV mother during the post-natal period and breastfeeding with the support of trained lab personnel at the site. p e olo an D ea e ontrol i ta i g i ita a ma i g t i a i t g a t m i i g i m t a a B g am a i g t ag mm it t a t a i a ag a a ta am g g a t m B g amm a a t g t t t
a t m B g am a i g t t a i ag t a a t at g t t i a i g i i i g it a i i g a t a m a a t g a t m it t m i ag a ta i t it a a ta g t i t ami a i g a a a t a i g i
4.3 Progre and Achie e ent
a t t it mmitm t t imi at a t a mi i am g i a a a it i i t a a t t i a it t m m a i g a a t t a i t a i a t a it t i a i a i ta t ag i agai t t mat g a i t a t i ta i i a Table 4.1:Service Statistics on PMTCT in Nepal for the period of BS 2073/74-2075/76
Indicators 2073/74 2074/75 2075/76 Tested for HIV (ANC &Labour) 382,887 439,225 440,709 HIV Positive Pregnant women 128 70 79 Total Deliveries by HIV +ve mothers 126 127 129 Mothers received ART 175 158 133 Babies received prophylaxis 112 123 130 Source: NCASC routine programme data/ iHMIS
The HIV testing among pregnant women is higher in Province 3 (97,461),and Province 5 (88,595) The HIV testing t g among am g pregnant g a t women m is higher i ig in Province i Bagma 3 (97,461 i ),and Province 5 ( a 88,595 i ) whereas the percentage of positivity yield among pregnant women is higher in Province 5, than i i tai i a i a whereas the percentage of positivity yield among pregnant women is higher in Province 5, than national average. The province-wise detailis also shown in Table 4.2.
Table 4.2: Province wise Service Statistics on PMTCT in Nepal 2075/76
Provinces Pregnant women tested Positive pregnant Provinces Positivity Yield (%) for HIV women identified Province 1 66 9 9 , , 8 8 9 9 2 2 15 0.021462 Province 2 66 0 0 , , 48 48 2 2 14 0.023147 Bagmati 99 7 7 , , 46 46 1 1 22 6 6 0.026677 Gandaki 47 , 2 2 9 66 0.012704 Province 5 88 8 8 , , 5 5 9 9 5 5 17 0.019188 Karnali 22 5 5 , , 2 2 43 43 00 0 Susurpaschim 55 1, 1, 8 8 0 0 7 7 1 0.00193 Total 440,709 79 0.00018 Source: NCASCroutine programme data/ iHMIS
Aiming at the elimination of mother to child transmission, Nepal adheres to Option B+ and embarks for imi g at t imi a m t t i t a mi i a a t B a m a providing lifelong ART for all identified pregnant women and breastfeeding mothers with HIV, i i g i g a i g a t m a a i g m t it regardless of CD4 along with prophylaxis treatment for their infants as well. The rollout of the lifelong ga regardless of CD4 along a g with it prophylaxis a i treatment t atm t for their t i infants i a t as well. a The rollout of t the lifelong t treatment adds the benefits of the triple reinforcing effectivenessof the HIV response: (a) help improve DoHS, Annual Report 2075/76 (2018/19) maternal health (b) prevent vertical transmission, and (c) reduce sexual transmission of HIV to sexual partners.
Early Infant Diagnosis (EID) Initiatives for Early Infant Diagnosis (EID) of HIV in infants and children below 18 months of age have been takenwith the goals a) of identifying infants early in order to provide them life-saving ART; and b) of facilitating early access to care and treatment in order to reduce morbidity. In this context, a Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) testing facility has been set up at National Public Health Laboratory in Kathmandu. Early Infant Diagnosis (EID) coverage has significantly increased within two months of birth (6.4% in 2014 to 42% in 2018 July) in last four years due to widely scale-up of sample collection in all ART centers and lab staff widely trained to collect the sample for EID. After the revision of National HIV Testing and Treatment Guideline in 2017, and implementation of EID testing at birth, by the end of 2017 the EID testing within 2 months of age increased. However, still,18 % of EID cases are being reached after 2 months of age due to home delivery, diagnosis of HIV mother during the post-natal period and breastfeeding with the support of trained lab personnel at the site. p e olo an D ea e ontrol i g t atm t a t t t t i i i g t a im mat a a t t a t a mi i a a t a mi i t a a t
Early Infant Diagnosis (EID)
i a a a t iag i i i a t a i m t ag a ta it t g a a i i g i a t a i t i t m i a i g a a i ita g a a t a a t atm t i t m i it t i t t a i i i m a ai a t g a i it a t at a a i a t a at i at ma a a t iag i ag a ig i a t i a it i t m t i t i t i i a t a t i a am i a t a a ta i t ai t t t am t i i a a g a atm t i i i a im m ta t g at i t t t t g it i m t ag i a a a i g a a m t ag t m i iag i m t i g t t ata i a a i g it t t t ai a at t it Table 4.3. EID Service Statistics in Nepal Table 4.3. EID Service Statistics in Nepal Indicators 2073/74 2074/75 2075/76 Tested (within 2 months)Indicators 2073/7499 2074/75204 2075/76243 Tested (within 2 months) 99 204 243 HIV Positive (Within 2 months) 5 12 12 HIV Positive (Within 2 months) 5 12 12 Tested (within 2-18 months) 56 106 64 Tested (within 2-18 months) 56 106 64 HIV Positive (Within 2-18 months) 9 16 12 HIV Positive (Within 2-18 months) 9 16 12
FigureFigure 4.1 4.1: :CB CB PMTCT PMTCT districts districts andand EID SitesSites
4.4 Key challenges/Issues and recommendations DoHS, Annual Report 2075/76 (2018/19) 4.4 Key challenges/IssuesIssues and recommendations Recommendations Availability of HIV test kits with the limited expiry date. Ensure timely procurement and supply of Issues Recommendations test kits to service sites. Availability of HIV test kits with the limited expiry date. Ensure timely procurement and supply of Tracking of HIV-positive mothers and exposed baby for The robust tracking system to track the HIV- EID. positivetest kits women to service should sites. be developed and Tracking of HIV-positive mothers and exposed baby for implementedThe robust tracking in all sites system, and to home track- basedthe HIV - EID. bloodpositive sample women for shouldEID test be of developedan exposed and babyimplemented can be recommended in all sites., and home-based Mainstreaming the private hospital in the national Theblood district sample should for strengthen EID test ofcoo anrdination exposed reporting system for PMTCT test. withbaby privatecan be recommendedhospitals to .regularize the Mainstreaming the private hospital in the national reportingThe district to district should. strengthen coordination reportingSupportive system monitoring for PMTCT visit test at .service delivery points Frequentwith private monitoring hospitals visit to regularizeshould be the from the Province and centre. performedreporting toto district intensify. the services at bairthing centre and beyond birthing centre. Supportive monitoring visit at service delivery points Frequent monitoring visit should be fromInadequate the Province supply and of HIV centre test. kit. Regularperformed and consistentto intensify supply the of HIVservice test kits at shouldbairthing be done centre to andall ANC beyond sites .birthing centre. Inadequate supply of HIV test kit. Regular and consistent supply of HIV test kit should be done to all ANC sites.
Table 4.3. EID Service Statistics in Nepal
Indicators 2073/74 2074/75 2075/76 Tested (within 2 months) 99 204 243 HIV Positive (Within 2 months) 5 12 12 Tested (within 2-18 months) 56 106 64 HIV Positive (Within 2-18 months) 9 16 12
Figure 4.1: CB PMTCT districts and EID Sites
p e olo an D ea e ontrol 4.4 Key challenges/Issues and recommendations Issues Recommendations Availability of HIV test kits with the limited expiry date. Ensure timely procurement and supply of test kits to service sites. Tracking of HIV-positive mothers and exposed baby for The robust tracking system to track the HIV- EID. positive women should be developed and implemented in all sites, and home-based blood sample for EID test of an exposed baby can be recommended. Mainstreaming the private hospital in the national The district should strengthen coordination reporting system for PMTCT test. with private hospitals to regularize the reporting to district. Supportive monitoring visit at service delivery points Frequent monitoring visit should be from the Province and centre. performed to intensify the services at bairthing centre and beyond birthing centre. Inadequate supply of HIV test kit. Regular and consistent supply of HIV test kit should be done to all ANC sites.
5: HIV Treatment, Care and Support Services
5.1 Introduction
it a ima aim t m ta it am g i t a t t g m t i ta t gi i g g i a i ita a t at a t m t t a a g i i t atm t i t a i a a a i a a i t it t aim i i g atm t a a t i t i i g it Ba a a g a atm t i i t im m t t t a t at t at g m a a iag a t atm t at i a t t a ma i a i a a ma i a t i i t a t t t m g ma ag m t g am ma a t ai atm t a a t i a a it t a a a a g t ai i g g i i i i g it a m aimi g at a i g t i m ta i atm t a a t
5.2 Progre and Achie e ent
B t t t m m g t t ta t t a m t it t i i a a t ta m a m i i g t a a a a t g t a t a g a a i a i t m i g t m a a i i g a
DoHS, Annual Report 2075/76 (2018/19) Figure 5.1 HIV Treatment Cascade in Nepal, 2018
Sitewise distribution of VL Suppression among Total VL Test 100% 91% 93% 90% 87%
80%
5: HIV Treatment, Care and Support Services 70%
5.1 Introduction 60% With a primary aim to reduce mortality among HIV-infected patients, the government, in 2004, started 50% giving free ARV drugs in a public hospital and that was followed by the development of first-ever 40% national guidelines on ARV treatment. Since then, a wide array of activities has been carried out with the aim of providing Treatment, Care and Support services to People Living with HIV (PLHIV). Based on 30% National HIV Testing and Treatment Guidelines 2017 county implemented ‘test and treat’ strategy 20%
from February 2017. Necessary diagnostic and treatment-related infrastructures such as CD4 machines 10% and viral load machines have been set up in different parts of the country for supplementing ART management program. Human resources have been trained for Treatment, Care and Support in 0% parallel with the preparation and updating of training guidelines. People Living with HIV have been National Public Health Laboratory Seti Zonal Hospital Bir Hospital empowered aiming at enhancing their supplementary roles in Treatment, Care and Support. Figure 5.2 Proportion of Viral Load (VL) Suppression among Total VL Tests according to test sites.
5.2 Progress and Achievement Among total 8,357 VL tests conducted in 2018, NPHL conducted 7248 tests with 6604 (91%) suppressed results, Seti Zonal Hospital Conducted 574 with 502 (87%) suppressed results, and Bir Hospital By the end of 2018, out of 21,388 PLHIV, only 16,913 of them were on ART. Among the total tested conducted 535 with 479 (93%) suppressed results (Figure 5.2). (8,357) almost 91%(7,603) ofPLHIV were with their viral load suppressed. The total cumulative number p of e PLHIV olo receiving an D ART ea eby the ontrol end of fiscal year 2075/76 has reached the figure of 17,987 (July 2019). Out of those who are currently on ART, 93% are adults and remaining 7% are children, while male FigureOver 5.1 the HIV years, Treatment there have Cascade been gradualin Nepal, increases 2018 in the number of people enrolling themselves on population makes 51.3%, female population 48.1%, and remaining 0.6% are of thethird gender.
Number of ART sites in Nepal by establishment year 20000 17987 140 18000 16913 16000 15260 120
14000 13069 100 11922 12000 78 10407 74 70 80 10000 8866 65 61 8000 7719 53 60 44
39 Number of ART sites 6000 35 36
Number of PLHIV on ART 40 25 4000 23 9 17 3 20 2 10 9 ART as well as receiving ARVs (Table5.1). 2000 6 8 6 5 8 5 2 1 2 1 3 4 4 4 0 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Figure 5.1 HIV Treatment Cascade in Nepal, 2018 Jul Figure 5.2 Proportion of Viral Load (VL) Suppression among Total VL Tests according to test sites. # of ART Sites on ART Cummulative number of ART sites
Sitewise distribution of VL Suppression among Total VL Test Figure 5.3 Trend of PLHIV on ART and number of ART sites. 100% 93% 91% 90% 87%
80%
70% 60%
50% 40%
30%
20%
10%
0% National Public Health Laboratory Seti Zonal Hospital Bir Hospital
Figure 5.2 Proportion of Viral Load (VL) Suppression among Total VL Tests according to test sites. m g t ta t t t i t t t it t i ia ita t it t a Among total 8,357 VL tests conducted in 2018, NPHL conducted 7248 tests with 6604 (91%) suppressed Bi ita t it t ig results, Seti Zonal Hospital Conducted 574 with 502 (87%) suppressed results, and Bir Hospital conducted 535 with 479 (93%) suppressed results (Figure 5.2). t t a t a a t a mai i g a i i ma a ma ma a a mai i g a t t i g Out of those who are currently on ART, 93% are adults and remaining 7% are children, while male population makes 51.3%, female population 48.1%, and remaining 0.6% are of thethird gender.
Number of ART sites in Nepal by establishment year 20000 17987 140 18000 DoHS, Annual Report 2075/76 (2018/19) 16913 16000 15260 120
14000 13069 100 11922 12000 78 10407 74 70 80 10000 8866 65 61 8000 7719 53 60 44
39 Number of ART sites 6000 35 36
Number of PLHIV on ART 40 25 4000 23 9 17 3 20 2 10 9 2000 6 8 6 5 8 5 2 1 2 1 3 4 4 4 0 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Jul # of ART Sites on ART Cummulative number of ART sites
Figure 5.3 Trend of PLHIV on ART and number of ART sites.
Figure 5.1 HIV Treatment Cascade in Nepal, 2018
Sitewise distribution of VL Suppression among Total VL Test 100% 91% 93% 90% 87%
80%
70%
60%
50%
40%
30%
20%
10%
0% National Public Health Laboratory Seti Zonal Hospital Bir Hospital
Figure 5.2 Proportion of Viral Load (VL) Suppression among Total VL Tests according to test sites.
Among total 8,357 VL tests conducted in 2018, NPHL conducted 7248 tests with 6604 (91%) suppressed results, Seti Zonal Hospital Conducted 574 with 502 (87%) suppressed results, and Bir Hospital conducted 535 with 479 (93%) suppressed results (Figure 5.2).
Out of those who are currently on ART, 93% are adults and remaining p e 7% olo are an children, D ea while e ontrol male Figurepopulation 5.3 Trend makes of 51.3%, PLHIV female on ART population and Number 48.1 %,of andART remaining Sites 0.6% are of thethird gender.
Number of ART sites in Nepal by establishment year 20000 17987 140 18000 16913 16000 15260 120
14000 13069 100 11922 12000 78 10407 74 70 80 10000 8866 65 61 8000 7719 53 60 44
39 Number of ART sites 6000 35 36
Number of PLHIV on ART 40 25 4000 23 9 17 3 20 2 10 9 2000 6 8 6 5 8 5 2 1 2 1 3 4 4 4 0 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Jul # of ART Sites on ART Cummulative number of ART sites
Figure 5.3 Trend of PLHIV on ART and number of ART sites. a g t t a ta i m t it a
TableTable 5.1:5.15.1:: ARTART ProfileProfile ofof of thethe the PP erioderiodPeriod ofof FYofFY 2073 2073 FY2073/74-FY 74 74 FYFY 2075 2075 2075/76 76 76
Indicator Indicator 2073 2073 74 74 2074 2074 75 75 2075 2075 76 76 eople eople l l n n t t H H e e er er enrolle enrolle onon AR AR ( ( u u ulat ulat e) e) 19, 19, 88 88 22,0 22,0 8 8 2, 2, 1 1 eople eople l l n n t t H H enrolle enrolle n n AR AR ( ( u u ulat ulat e) e) 1 1 ,5 ,5 16, 16, 28 28 17,98717,987 eople eople lo lo t t toto ollo ollo upup ( ( u u ulat ulat e) e) 2,0 2,0 9 9 2, 2, 88 88 2,6792,679 eople eople toppe toppe treat treat ent ent 2525 2222 2525 otal otal eat eat ( ( u u ulat ulat e) e) 2,7702,770 ,201 ,201 ,617 ,617 Source Source C C SC SC
m i ig i Bagma i a i e e nu nu er er o o peoplepeople onon AR AR er er n n a a at at pro pro n n e e (( ,919 ,919)) an an ro ro n n e e 55 ( ( , , 92 92) ) e e i i tai a i a pro pro n n e e e e eta eta l l al al o o o o n n n n a a le le 5 5 2 2
TableTable 5.2:5.25.2:: Pro ProvincePro ince ince W WWisei i e e PP Peopleeopleeople onon on ARTART ART FYFY FY 2075 2075 2075/76 76 76
Pro Pro ince ince PeoplPeoplee onon ARTART ro ro n n e e 11 1,5811,581 ro ro n n e e 22 21762176 a a at at 919 919 an an a a 21652165 ro ro n n e e 55 92 92 arnal arnal 551515 Su Su urpa urpa 2 2 9 9 TotalTotal 17 17 987 987 Source Source C C SC SC DoHS, Annual Report 2075/76 (2018/19)
ere ere areare totaltotal 7878 AR AR te te a a ro ro 6060 tr tr t t t t ll ll t t e e en en o o t t e e al al ear ear 2075/762075/76 an an t t o o t t at at 1111 o o t t o o e e e e er er enrolle enrolle onon AR AR e e an an 88 a a e e een een lo lo t t toto ollo ollo up,up, le le 8181 areare al al e e an an onon treat treat ent ent
e e ro ro ra ra ata ata (( 22075/76075/76)) o o e e t t at at o o allall t t e e pat pat ent ent re re tere tere onon AR AR ur ur n n t t e e per per o o ,, 9191 ere ere t t ll ll a a t t el el onon AR AR a a ter ter 1212 ont ont le le 8585 ere ere t t ll ll a a t t el el onon AR AR a a ter ter 2 2 ont ont o o treat treat ent ent t t t t e e a a o o upple upple ent ent nn t t e e AR AR ana ana e e ent ent pro pro ra ra , , D D ount ount te te t t n n er er e e areare a a a a la la le le onon 2 2 erent erent te te So So e e o o t t e e porta porta le le D D ount ount n n a a ne ne a a e e een een pla pla e e n n t t e e ll ll tr tr t t o o epal epal toto pro pro e e t t el el D D ount ount er er e e toto on on tor tor AR AR e e e e t t ene ene t t at at lea lea toto upport upport H H toto u u ta ta n n ual ual t t an an o o orta orta le le l l e e o o on on tor tor AR AR re re pon pon e e an an a a no no n n treat treat ent ent a a lure lure,, ral ral loa loa te te t t n n re re o o en en e e or or peoplepeople re re e e n n AR AR
at at onal onal u u l l Healt Healt a a orator orator at at an an u, u, Set Set ro ro n n al al Ho Ho p p tal tal a a lal lal , , Su Su rara rara rop rop al al an an n n e e t t ou ou D D ea ea e e Ho Ho p p tal tal at at an an u, u, r r Ho Ho p p tal tal at at an an u, u, o o ara ara A A a a e e o o Healt Healt S S en en e e o o ara, ara, o o Ho Ho p p tal tal ratna ratna ar ar an an t t o o te te arnal arnal ro ro n n al al Ho Ho p p tal tal an an a a alpata alpata Ho Ho p p tal tal u u n n ene ene pert pert a a ne ne o o er er ralral loa loa te te t t er er e e toto t t e e peoplepeople onon AR AR treat treat ent ent
t t t t e e purpo purpo e e o o earl earl a a no no n n o o H H n n e e t t on on a a on on l l ren ren orn orn toto H H n n e e te te ot ot er er earl earl Deo Deo r r onu onu le le A A (D (D A) A) ol ol era era e e a a n n Rea Rea t t on on ( ( R) R) te te t t one one atat t t e e at at onal onal u u l l Healt Healt a a orator orator n n at at an an u u e e D D A A R R te te t t one one atat rt rt an an 66 ee ee te te t t re re o o en en e e or or a a no no n n H H tatu tatu o o l l ren ren elo elo 1818 ont ont an an or or t t o o e e o o e e te te t t re re ult ult n n on on lu lu e e rap rap te te t t
p e olo an D ea e ontrol a t ta it a i t i t t t a a a it t at t i a a t t i a a i a t atm t
g am ata t at a t a t gi t i g t i a a m t i a a m t t atm t it t aim m g t ma ag m t g am t t g i a a ai a i t it m t ta g ma i a a i t i i t i t a t i m t i t m it t at a t t t tai a it a m ta i m it a iag i g t atm t ai i a a t g i mm i i g
a a i a t a at at ma i ia ita ai a i a a i a a i a ita at ma Bi ita at ma a a a m a t i a a i ita Bi at aga a t it a a i i ia ita a Ba a ata ita i g t a i i a a t t i t t t atm t
it t a iag i g i am g i t i t m t a i i i m a ai a t t i at t a a i a t a at i at ma t t i at i t a i t t i mm iag i g tat i m t a t t t t i i i a i t t recommended for diagnosing HIV status of children below 18 months and for those whose test result is t ta a i B i m i g i t i t a t inconclusive by rapid test. am t t i t i t a a t t i a i i g t i i t a As of 2075/76, total 9,787 has received CHBC services from 52 covering districts (Table 8). In the same context 52 districts have CCCs across the country which have been delivering their services to PLHIV 6: Integrated Biological and Behavioral Surveillance (IBBS) Survey (Table 5.3). Nepal has been conducting HIV and STI surveillance particularly among key populations, namely: Table 5.3: Service Statistics on CHBC Services in Nepal, as of the end of FY 2075/76 people who inject drugs, FSW and their clients, MSM and TG, and Male Labor Migrants for more than a decade mainly to track changes in HIV and STI prevalence along with behavioral components such as Indicators Numbers condom use etc. Hepatitis-B and C screening among PWID have been started in the IBBS surveys form Number of PLHIV (new and old) received CHBC services 9,787 2015. From this year, national-level surveillance survey is planned among people who inject drugs and Number of PLHIV (new) received CHBC services 4,747 male labor migrants. The table below depicts HIV prevalence according to the survey population (Table 6.1).
Table 5.4:Service Statistics on CCC Services in Nepal as of the end of FY 2075/76 Table 6.1 HIV prevalence according to survey population.
Indicators Numbers Survey Population HIV Prevalence Survey Location Number of new PLHIV receiving services from CCC 5,350 Female Sex Workers 0.7 22 Highway Districts 2018 Number of PLHIV receiving Follow-up services from CCC 3,280 Number of PLHIV admitted to CCC to start ART 997 Male Labor Migrants 0.3 Eastern Districts 2018 Number of PLHIV received counselling service 5,350 MSM and TG 8.2 Terai Highway 2018
Wives of Migrants 0.5 Far-West Districts 2018 5.5 Key challenges/Issues and recommendations Source: Integrated Bio-Behavioural Surveillance (IBBS) Survey, 2018. Issues Recommendation Placement of point of care CD4 machine and implementing viral load Low access to CD4 Count and testing by GenXpert and using DBS would enhance the accessibility of Viral Load testing services 6.1 HIV Co-infection services among PLHIV. DoHS, Annual Report 2075/76 (2018/19) The robust, unique identifier system has been developed to track the Because of the shared modes of transmission of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Client duplication in the individual client within and across the service sites but it needs to be HIV, people at risk for HIV infection are also at risk for HBV and HCV infection. HIV-positive persons service implemented at all service sites for its functioning. who become infected with HBV or HCV are at increased risk for developing chronic hepatitis. In Start an electronic record keeping system with backup capability. In addition, persons who are co-infected with HIV and hepatitis can have serious medical complications, Lost or incomplete medical addition, creating a client coding system would facilitate improved including an increased risk for liver-related morbidity and mortality. records(Recording and record keeping and continuity when clients are transferredin or Reporting) transferredout. TB is the most common illness among people living with HIV. Fatal if undetected or untreated, TB is the Poorsupply of OIs medicines Provide consistent supply of OIs medicines that are supposed to be leading cause of death among people with HIV, responsible for nearly 1 in 3 HIV-associated deaths. as per demand provided according to the program. Early detection of TB and prompt linkage to TB treatment and ART can prevent these deaths.TB The PLHIVs face financial problems to treat other comorbidities, but screening offered routinely at ART sites, and routine HIV testing is also offered to all patients with Inadequate financial support there is not sufficient government support to pay for medical care and presumptive and diagnosed TB. TB preventive therapy should be offered to all people living with HIV for the clients treatment. So, the government should establish a mechanism to share who do not have active TB in Nepal. In 2018, the total proportion of PLHIV having TB among newly the financial burden facing by PLHIV. enrolled in HIV care in Nepal accounts for 12.8%. CHBC services coverage is The government should invest in such an essential service in declining over time due to coordination with NGOs. limited support from donors. Capacitating and strengthening of ART dispensing centres (ADC) sites Expansion of ART sites to ART is necessary for additional support to increase PLHIV treatment coverage (Second 90).
A o 2075/76, total 9,787 a re e e H er e ro 52 o er n tr t ( a le 8) n t e a e onte t, 52 tr t a e a ro t e ountr a e een el er n t e r er e to H ( a le 5 )
Table 5.3: Ser ice Stati tic on CHBC Ser ice in Nepal a of the end of FY 2075 76
Indicator Nu ber u er o H (ne an ol ) re e e H er e 9,787 u er o H (ne ) re e e H er e ,7 7
Table 5.4: Ser ice Stati tic on CCC Ser ice in Nepal a of the end of FY 2075 76
Indicator Nu ber u er o ne H re e n er e ro 5, 50 u er o H re e n ollo up er e ro ,280 u er o H a tte to to tart AR 997 u er o H re e e oun ell n er e 5, 50 p e olo an D ea e ontrol 5.5 e Challenge I ue and Reco endation
I ue Reco endation o a e to D ount la e ent o po nt o are D a ne an ple ent n ral loa an ral oa te t n te t n en pert an u n D S oul en an e t e a e l t er e o er e a on H e ro u t, un ue ent er te a een e elope to tra t e l ent upl at on n t e n ual l ent t n an a ro t e er e te , ut t nee to e er e ple ente at all er e te or t un t on n Start an ele tron re or eep n te t a up apa l t n o t or n o plete e al a t on, reat n a l ent o n te oul a l tate pro e re or (Re or n an re or eep n an ont nu t en l ent are tran erre n or Report n ) tran erre out oor uppl o e ne ro e on tent uppl o e ne t at are uppo e to e a per e an pro e a or n to t e pro ra e H a e nan al pro le to treat ot er o or t e , ut na e uate nan al upport t ere not u ent o ern ent upport to pa or e al are or t e l ent an treat ent So, t e o ern ent oul e ta l a e an to are t e nan al ur en a n H H er e o era e e o ern ent oul n e t n u an e ent al er e n e l n n o er t e ue to oor nat on t l te upport ro onor apa tat n an tren t en n o AR pen n entre (AD ) te pan on o AR te to AR ne e ar or a t onal upport to n rea e H treat ent o era e (Se on 90)
6:6: Integrated Integrated Biological Biological and Behavioral and Behavioral Surveillance Surveillance (IBBS) Survey (IBBS) Survey
6: a a g a i a a a am g a am Nepal Integrated has been Biological conducting andHIV and Beha STI surveillance ioral Sur eillanceparticularly IBBS among Sur key populations, e namely: i t g a t i i t a a a a ig a t m people who inject drugs, FSW and their clients, MSM and TG, and Male Labor Migrants for more than a epal a een on u t n H an S ur e llan e part ularl a on e populat on , na el people t a a a mai t t a a g i a a a g it a i a m t decade mainly to track changes in HIV and STI prevalence along with behavioral components such as o n e t ru , S an t e r l ent , S an , an ale a or rant or ore t an a e a e a m t a B a i g am g a ta t i t BB condom use etc. Hepatitis-B and C screening among PWID have been started in the IBBS surveys form m m t i a a a i a i a am g 2015. a nl toFrom tra this year, an e national-level n H an S surveillance pre alen survey e alon is planned t e a among oral people o ponent who inject u drugsa on and o u i t male e et g labor Hepat migrants. a t ma an The a table reen mig a t below n a depicts on HIV ta D prevalence a e een i t tarte according n t to e a the Ssurvey ur e population a i g or 2015 (Table t ro t a a 6.1).
Table 6.1 HIV prevalence according to survey population.
Survey Population HIV Prevalence Survey Location
Female Sex Workers 0.7 22 Highway Districts 2018
Male Labor Migrants 0.3 Eastern Districts 2018
MSM and TG 8.2 Terai Highway 2018
Wives of Migrants 0.5 Far-West Districts 2018
Source: Integrated Bio-Behavioural Surveillance (IBBS) Survey, 2018.
6.1 HIV Co-infection DoHS, Annual Report 2075/76 (2018/19) Because of the shared modes of transmission of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV, people at risk for HIV infection are also at risk for HBV and HCV infection. HIV-positive persons who become infected with HBV or HCV are at increased risk for developing chronic hepatitis. In addition, persons who are co-infected with HIV and hepatitis can have serious medical complications, including an increased risk for liver-related morbidity and mortality.
TB is the most common illness among people living with HIV. Fatal if undetected or untreated, TB is the leading cause of death among people with HIV, responsible for nearly 1 in 3 HIV-associated deaths. Early detection of TB and prompt linkage to TB treatment and ART can prevent these deaths.TB screening offered routinely at ART sites, and routine HIV testing is also offered to all patients with presumptive and diagnosed TB. TB preventive therapy should be offered to all people living with HIV who do not have active TB in Nepal. In 2018, the total proportion of PLHIV having TB among newly enrolled in HIV care in Nepal accounts for 12.8%.
Survey Location Hep B Hep C Coinfection (Hep C & HIV) PWID-Male Eastern Terai 0.8 38.0 2.5 Western to Far Western Terai 2.7 24.0 3.7 Pokhara 2.6 22.0 3.8 Kathmandu Valley 1.0 21.0 7.4 t ear, nat onal le el ur e llan e ur e planne a on people o n e t ru an ale la or PWID-Female rant e ta le elo ep t H pre alen e a or n to t e ur e populat on ( a le 6 1) Pokhara 1.3 3.0 0.6 Table 6.2 Hepatitis Prevalence and HIV, HBV, HCV co-infection among People who Inject Drugs in Table 6.1 HIV pre alence according to ur e population. 2017 Sur e Population HIV Pre alence Sur e ocation
ma 0 7 22 H a D tr t 2018 7: Province level HIV related Services and Indicators a a ig a t 0 a tern D tr t 2018 In the early 1990s, a national HIV surveillance system was established in Nepal to monitor the HIV a 8 2 era H a 2018 epidemic and to inform evidence-based HIV prevention efforts. Since then, integrated biological and i ig a t 0 5 ar e t D tr t 2018 behavioral surveillance (IBBS) survey surveys have been conducted every two/three years among key populations at higher risk of HIV (PWID, MSM and TG, FSW and migrants) in identified three epidemic Source ntegrated io ehavioural Surveillance S Survey zones (Figure 7.1) to collect information on socio-demographics and biological markers to assess the prevalence of HIV and other sexually transmitted infections (STI), behavioural information (condom use, number of sex partners, needle sharing behaviours). The epidemic zones are based on different 6. p 1 HIV e Co olo infection an D ea e ontrol 6.1 e au HIV e Co-infection o t e are o e o tran on o Hepat t ru (H ), Hepat t ru (H ) an H , people at r or H n e t on are al o at r or H an H n e t on H po t e per on o B a t a m t a mi i a B i B a i a e o e n e te t H or H are at n rea e r or e elop n ron epat t n a t on, at i i a a at i B a i i per on o are o n e te t H an epat t an a e er ou e al o pl at on , n lu n an m i t it B a at i a i i g i a n rea e r or l er relate or t an ortal t a i a i t it a a a a i m i a m i a i i g a i a i i at m i it a m ta it t e o t o on llne a on people l n t H atal un ete te or untreate , t e B i t m t mm i am g i i g it ata i t t t at B lea n au e o eat a on people t H , re pon le or nearl 1 n H a o ate eat arl i t a i g a at am g it i a i a iat ete t on o an pro pt l n a e to treat ent an AR an pre ent t e e eat reen n at a t B a m t i ag t B t atm t a a t t at o ere rout nel at AR te , an rout ne H te t n al o o ere to all pat ent t pre u pt e an B i g at it a t g i a t a a t it a no e pre ent e t erap oul e o ere to all people l n t H o o not a e m a iag B B t a t a i i g it a t e n epal n 2018, t e total proport on o H a n a on ne l enrolle n H are n t a a B i a t t ta a i g B am g epal a ounte or 12 8 i a i a a t Table 6.2 Hepatiti Pre alence and HIV HBV HCV co infection a ong People who In ect Drug in 2017 distributions of key populations at risk, mobility links and HIV risk behaviour (Figure 7.1). Sur e ocation Hep B Hep C Coinfection Hep C HIV Survey Location Hep B Hep C Coinfection (Hep C & HIV) PWID - Malea Eastern a t Terai ai 0.80 8 38.0 8 0 2 2.5 5 Western t tto Fara t Western Terai ai 2.72 7 2 24.0 0 3.7 7
Pokhara a a 2.62 6 22 22.0 0 3.8 8 Kathmandu at ma a Valley 1.01 0 21 21.0 0 7 7.4 PWID - Female ma Pokhara a a 1.31 3.0 0 0 0.6 6 Table 6.2 Hepatitis Prevalence and HIV, HBV, HCV co-infection among People who Inject Drugs in 7: Province level HIV related Services and Indicators 2017 7: Pro ince le el HIV related Ser ice and Indicator t a a a a i a t m a ta i i a t m it t i mi a t i m i a t i t i t g at i gi a a n t e earl 1990 , a nat onal H ur e llan e te a e ta l e n epal to on tor t e H a i a i a BB a t t t a am g ep 7: Province e an to level n or HIV e related en e a e Services H pre and ent on Indicators e ort S n e t en, nte rate olo al an a at ig i a a mig a t i i t e a oral ur e llan e ( S) ur e a e een on u te e er t o/t ree ear a on e i mi ig t t i ma i m g a i a i gi a ma t populat In the early on at1990s, era national r o H HIV ( surveillance D, S an system ,was S established an rant in Nepal ) n ent to monitor e t ree the ep HIV e a t a a t a t a mi i a i a i ma one epidemic ( ureand 7 to 1 )inform to olle evidence-based t n or at on onHIV prevention o o e o efforts. rap Since an then, olo integrated al ar er biological to a e and t e m m a t a i g a i i mi a a pre behavioral alen e o surveillance H an ot (IBBS) er e survey uall tran surveys tte have n been e t on conducted (S ), e every a ouraltwo/three n or years at on among ( on o key i t i t i a at i m i it i a i a i ig populations at higher risk of HIV (PWID, MSM and TG, FSW and migrants) in identified three epidemic zones (Figure 7.1) to collect information on socio-demographics and biological markers to assess the prevalence of HIV and other sexually transmitted infections (STI), behavioural information (condom use, number of sex partners, needle sharing behaviours). The epidemic zones are based on different
DoHS, Annual Report 2075/76 (2018/19)
distributions of key populations at risk, mobility links and HIV risk behaviour (Figure 7.1).
Survey Location Hep B Hep C Coinfection (Hep C & HIV) PWID-Male Eastern Terai 0.8 38.0 2.5 Western to Far Western Terai 2.7 24.0 3.7 Pokhara 2.6 22.0 3.8 Kathmandu Valley 1.0 21.0 7.4 PWID-Female Pokhara 1.3 3.0 0.6 Table 6.2 Hepatitis Prevalence and HIV, HBV, HCV co-infection among People who Inject Drugs in 2017
7: Province level HIV related Services and Indicators
In the early 1990s, a national HIV surveillance system was established in Nepal to monitor the HIV epidemic and to inform evidence-based HIV prevention efforts. Since then, integrated biological and behavioral surveillance (IBBS) survey surveys have been conducted every two/three years among key populations at higher risk of HIV (PWID, MSM and TG, FSW and migrants) in identified three epidemic zones (Figure 7.1) to collect information on socio-demographics and biological markers to assess the prevalence of HIV and other sexually transmitted infections (STI), behavioural information (condom use, number of sex partners, needle sharing behaviours). The epidemic zones are based on different p e olo an D ea e ontrol
distributions of key populations at risk, mobility links and HIV risk behaviour (Figure 7.1). Figure 7.1: HIV epidemic zones in Nepal
Table 7.1 Province-wise distribution of HIV services in Nepal
No. No. of No. of No. of CBPMTCT of Treatment and CLT Organization unit/Data HTS Dispensing ART Sites Services OST Care Services Implemented Sites Sites Sites Province - 1 23 9 6 14 2 6 6 3
TAPLEJUNG 1 - 1 Available - - - - SANKHUWASABHA 1 1 - Available - CCC CHBC - SOLUKHUMBU 1 - 1 Available - - - - OKHALDHUNGA 1 1 - Available - - - - KHOTANG 1 - 1 Available - - - - BHOJPUR - - 1 Available - - - - DHANKUTA 1 1 - Available - - - - TERHATHUM 1 - 1 Available - - - - PANCHTHAR 1 - 1 Available - - - - ILAM 1 1 - Available - CCC CHBC - JHAPA 5 1 - Available 1 CCC CHBC Yes MORANG 3 1 - Available 1 CCC CHBC Yes SUNSARI 4 2 - Available - CCC CHBC Yes UDAYAPUR 1 1 - Available - CCC CHBC - Province - 2 14 8 0 8 1 7 8 8 SAPTARI 1 1 - Available - CCC CHBC Yes SIRAHA 1 1 - Available - CCC CHBC Yes DHANUSA 5 1 - Available - CCC CHBC Yes MAHOTTARI 2 1 - Available - CCC CHBC Yes SARLAHI 2 1 - Available - CCC CHBC Yes RAUTAHAT 1 1 - Available - CCC CHBC Yes BARA 1 1 - Available - - CHBC Yes PARSA 1 1 - Available - CCC CHBC Yes DoHS,Bagmati Annual Province Report 2075/7643 (2018/19) 15 3 13 - 9 10 4 DOLAKHA 1 - 1 Available - - - - SINDHUPALCHOK 3 1 - Available - CCC CHBC - RASUWA 1 - 1 Available - - - - DHADING 1 1 - Available - CCC CHBC - NUWAKOT 4 1 - Available - CCC CHBC - KATHMANDU 12 6 - Available 3 CCC CHBC Yes BHAKTAPUR 2 1 - Available 1 CCC CHBC - LALITPUR 3 1 - Available 3 CCC CHBC Yes KAVREPALANCHOK 3 1 - Available - CCC CHBC - RAMECHHAP 1 - 1 Available - - - - SINDHULI 1 1 - Available - - CHBC - MAKWANPUR 4 1 - Available - CCC CHBC Yes CHITAWAN 7 1 - Available 1 CCC CHBC Yes Gandaki Province 26 10 4 11 1 8 9 2 GORKHA 4 1 - Available - CCC CHBC - MANANG 1 - 1 Available - - - - MUSTANG 1 - 1 Available - - - - MYAGDI 2 1 - Available - CCC CHBC - Figure 7.1: HIV epidemic zones in Nepal
Table 7.1 Province-wise distribution of HIV services in Nepal
No. No. of No. of No. of CBPMTCT of Treatment and CLT Organization unit/Data HTS Dispensing ART Sites Services OST Care Services Implemented Sites Sites Sites Province - 1 23 9 6 14 2 6 6 3 TAPLEJUNG 1 - 1 Available - - - - SANKHUWASABHA 1 1 - Available - CCC CHBC - SOLUKHUMBU 1 - 1 Available - - - - OKHALDHUNGA 1 1 - Available - - - - KHOTANG 1 - 1 Available - - - - BHOJPUR - - 1 Available - - - - DHANKUTA 1 1 - Available - - - - TERHATHUM 1 - 1 Available - - - - PANCHTHAR 1 - 1 Available - - - - ILAM 1 1 - Available - CCC CHBC - JHAPA 5 1 - Available 1 CCC CHBC Yes MORANG 3 1 - Available 1 CCC CHBC Yes SUNSARI 4 2 - Available - CCC CHBC Yes UDAYAPUR 1 1 - Available - CCC CHBC - Province - 2 14 8 0 8 1 7 8 8 SAPTARI 1 1 - Available - CCC CHBC Yes SIRAHA 1 1 - Available - CCC CHBC Yes DHANUSA 5 1 - Available - CCC CHBC Yes MAHOTTARI 2 1 - Available - CCC CHBC Yes SARLAHI 2 1 - Available - CCC CHBC Yes RAUTAHAT p e olo an D ea e 1 ontrol 1 - Available - CCC CHBC Yes BARA 1 1 - Available - - CHBC Yes PARSA 1 1 - Available - CCC CHBC Yes Bagmati Province 43 15 3 13 - 9 10 4 DOLAKHA 1 - 1 Available - - - - SINDHUPALCHOK 3 1 - Available - CCC CHBC - RASUWA 1 - 1 Available - - - - DHADING 1 1 - Available - CCC CHBC - NUWAKOT 4 1 - Available - CCC CHBC - KATHMANDU 12 6 - Available 3 CCC CHBC Yes BHAKTAPUR 2 1 - Available 1 CCC CHBC - LALITPUR 3 1 - Available 3 CCC CHBC Yes KAVREPALANCHOK 3 1 - Available - CCC CHBC - RAMECHHAP 1 - 1 Available - - - - SINDHULI 1 1 - Available - - CHBC - MAKWANPUR 4 1 - Available - CCC CHBC Yes CHITAWAN 7 1 - Available 1 CCC CHBC Yes Gandaki Province 26 10 4 11 1 8 9 2 GORKHA 4 1 - Available - CCC CHBC - MANANG 1 - 1 Available - - - - MUSTANG 1 - 1 Available - - - - MYAGDI 2 1 - Available - CCC CHBC - KASKI 6 1 1 Available 1 CCC CHBC - LAMJUNG 2 1 - Available - CCC CHBC - TANAHU 2 1 - Available - CCC CHBC Yes NAWALPARASI EAST 2 1 - Available - - CHBC Yes SYANGJA 2 2 - Available - CCC CHBC - PARBAT 1 1 - Available - CCC CHBC - BAGLUNG 3 1 1 Available - CCC CHBC - Province - 5 33 14 1 12 2 11 11 6 RUKUM EAST - - - Available - - - - ROLPA 1 1 - Available - CCC CHBC - PYUTHAN 1 1 - Available - CCC CHBC - GULMI 1 1 - Available - CCC CHBC - ARGHAKHANCHI 2 1 - Available - CCC CHBC - PALPA 4 1 - Available - CCC CHBC - NAWALPARASI WEST 4 1 - Available - CCC CHBC Yes RUPANDEHI 4 2 - Available - CCC CHBC Yes KAPILVASTU 5 2 1 Available - CCC CHBC Yes DANG 6 2 - Available - CCC CHBC Yes BANKE 4 1 - Available - CCC CHBC Yes BARDIYA 1 1 - Available - CCC CHBC Yes Karnali Province 16 6 6 10 0 2 4 1 DOLPA 1 - 1 Available - - - - MUGU 1 - 1 Available - - - - HUMLA 1 - 1 Available - - - - JUMLA 1 - 1 Available - - - - KALIKOT 1 1 - Available - - CHBC - DAILEKH 4 2 1 Available - - - - DoHS, Annual Report 2075/76 (2018/19) JAJARKOT 1 - 1 Available - - - - RUKUM WEST 1 1 - Available - CCC CHBC - SALYAN 1 1 - Available - - CHBC - SURKHET 4 1 - Available - CCC CHBC Yes Sudurpaschim Province 20 16 2 9 0 8 9 2 BAJURA 2 1 - Available - CCC CHBC - BAJHANG 1 1 - Available - CCC CHBC - DARCHULA 1 1 - Available - - CHBC - BAITADI 3 2 - Available - CCC CHBC - DADELDHURA 1 1 1 Available - CCC CHBC - DOTI 3 1 1 Available - CCC CHBC - ACHHAM 2 4 - Available - CCC CHBC - KAILALI 4 3 - Available - CCC CHBC Yes KANCHANPUR 3 2 - Available - CCC CHBC Yes Note: HTS: HIV Testing Services; CCC: Community Care Centre; CHBC: Community Home-based Care; CLT: Community Led Testing.
7.1 List of Possible Indicators for Province One, Two, Three, Four, Five and Seven The following indicators might be useful to track HIV response in a particular province considering the drivers of HIV epidemic in that province and HIV services being provided. However, the province can select indicators that are deemed necessary to track HIV response. NCASC will provide any required support to the provinces as and when needed. For detail (numerator, denominator and data source) regarding indicators, refer to 2017 National Consolidated Guidelines on Strategic Information for HIV Response in Nepal. KASKI 6 1 1 Available 1 CCC CHBC - LAMJUNG 2 1 - Available - CCC CHBC - TANAHU 2 1 - Available - CCC CHBC Yes NAWALPARASI EAST 2 1 - Available - - CHBC Yes SYANGJA 2 2 - Available - CCC CHBC - PARBAT 1 1 - Available - CCC CHBC - BAGLUNG 3 1 1 Available - CCC CHBC - Province - 5 33 14 1 12 2 11 11 6 RUKUM EAST - - - Available - - - - ROLPA 1 1 - Available - CCC CHBC - PYUTHAN 1 1 - Available - CCC CHBC - GULMI 1 1 - Available - CCC CHBC - ARGHAKHANCHI 2 1 - Available - CCC CHBC - PALPA 4 1 - Available - CCC CHBC - NAWALPARASI WEST 4 1 - Available - CCC CHBC Yes RUPANDEHI 4 2 - Available - CCC CHBC Yes KAPILVASTU 5 2 1 Available - CCC CHBC Yes DANG 6 2 - Available - CCC CHBC Yes BANKE 4 1 - Available - CCC CHBC Yes BARDIYA 1 1 - Available - CCC CHBC Yes Karnali Province 16 6 6 10 0 2 4 1 DOLPA 1 - 1 Available - - - - MUGU 1 - 1 Available - - - - HUMLA 1 - 1 Available p - e olo - an - D ea e - ontrol JUMLA 1 - 1 Available - - - - KALIKOT 1 1 - Available - - CHBC - DAILEKH 4 2 1 Available - - - - JAJARKOT 1 - 1 Available - - - - RUKUM WEST 1 1 - Available - CCC CHBC - SALYAN 1 1 - Available - - CHBC - SURKHET 4 1 - Available - CCC CHBC Yes Sudurpaschim Province 20 16 2 9 0 8 9 2 BAJURA 2 1 - Available - CCC CHBC - BAJHANG 1 1 - Available - CCC CHBC - DARCHULA 1 1 - Available - - CHBC - BAITADI 3 2 - Available - CCC CHBC - DADELDHURA 1 1 1 Available - CCC CHBC - DOTI 3 1 1 Available - CCC CHBC - ACHHAM 2 4 - Available - CCC CHBC - KAILALI 4 3 - Available - CCC CHBC Yes KANCHANPUR 3 2 - Available - CCC CHBC Yes Note: HTS: HIV Testing Services; CCC: Community Care Centre; CHBC: Community Home-based Care; CLT: Community Led Testing.
7.17.1 List List of of PossiblePossible Indicators for for Province Province One, One, Two, Two, Three, Three, Four, Four, Five Five and and Seven Seven The following indicators might be useful to track HIV response in a particular province considering the i g i i at mig t t t a i a a a i i i g drivers of HIV epidemic in that province and HIV services being provided. However, the province can t i i mi i t at i a i i g i t i select indicators that are deemed necessary to track HIV response. NCASC will provide any required a t i i at t at a m a t t a i support to the provinces as and when needed. For detail (numerator, denominator and data i a source) i t t t i a a tai m at mi at a regarding indicators, refer to 2017 National Consolidated Guidelines on Strategic Information for HIV ata Response in Nepal. ga i g i i at t a a i at i i t at gi ma i a
I pact le el Indicator a i i m a tag i a am g a a B a am g i t g a i g t t i t a mi i mat tag i i t it m
Outco e le el indicator
tag g m it m t t i t g tag i t g g a i g a m t a t m t a a a i t tag m g t m t a t m t a a a it a ma partner i tag mig a t ag g t m t a t m t a it g a a a t
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol Output le el indicator
a i g i t i t i t g tag i i i a i i g i i t a i t atm t at a t i m t m a tag a a a t t i t a t m t a t i t m tag a a g amm B i t m a i t i m a t ai a tag g a t m it tat tag g a t m i i g it i a t i a t a t imi at a t a mi i tag t g ita i i a i i t a i t m a tag i i g it a i i g a i g tag a m a t a i a t i a t a am g a a t a i i i g it at t t g i t tag i i g it a tai a a m t a i i a a t i a t a tag a t a i i i i g a t i a t a t at i a t t at a t i a t i a g i t a t m t m a tag a t a i i i g it t i i g a a t i m t i a i i tag i a t B i a t atm t g tag B a t a a t t t i t B gi t
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol 5.6 Non Communicable Diseases
a t a a i mi gi a t a i m mm i a i a t mm i a i a a t ma a i i a i a i it a at i i g im i m t m g t m t atm t a t a i g t it t at t at i m a a t it i i i a a t i ami i a t t m t a at t a i a a i a ia t a a i at i a a i a m a at i t i a t im ta a t a t i a i g t t a g i ma a a i t im a t t a i m t t i t a a ag tai a m t a i a t i a m t B i g t g t i g a ta g t t t i mat m ta it m t g a t atm t a m t m ta a t a i g
B a t t m m a a i m m a i a i t t a g m t i i g i i i i t i ag i t mm i a a m m t g i m t a i t a t t a t a t a a i g a ia a mi m t t a ma i g a g i a t i a
m m ta a a i i it t t a a a t
Multi-Sectoral Action Plan (MSAP) for the Prevention and Control of NCD (2014-2020 AD)
• Vi ion: a t ig t a ai a tat a t i g a a it i at ag ta a i a i a i it a mat at • Goal: g a t m t a a a i t ta m i it a i a i a i it a mat m ta it t i a
Strategic objectives for MSAP 2014-2020 AD
ai t i it a t t a t mm i a i a i t a a ag a a i i t gt a a a a it a i g a m t a a a a t i t a at t t a t m i a i a t a i g ia t mi a t t g a a t m g i m t t gt a i t a t t m t a t a t a i g ia t mi a t t g t a m t a t a a a a it ig a it a a m t t a t a m ta a t it t t a t mi a t a a at g i t i a t m i g a i mi im m a m ta a t i at t mm it a im i g m t a i a a i i a g a at ima a
Targets (At the end of 2025 AD
a i a m ta it m a ia t
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol a i t a m a a i a t t a i ag a a i t i g i a t ima i g a i m a a i ta a t i m i a ai a t t i i it a ia t a i a i i t i a a it igi i g t a a i g i i g g mi t t t a t a a a t a ai a i it a a a i t gi a a m i i i i g g i i t t at ma i t i a i at a i i
Nepal PEN progra
t a i a a a
a ig i it ig m t m i g t m i i t a i m t m t i g t g i t m i a a
i g am i a i t a g a i i a t ma a a a t atm t a ma ag m t
The PEN Intervention has Four protocols:
Protocol I : a t a a t a i i a t g i t g at ma ag m t ia t a t i Protocol II: a t a a i g a t B a i Protocol III: a ag m t i t m a i a a t ma Protocol IV: m t a a m it t a B a t i
Goal
i i a a t ig a it iag i a t t a i g i mi ma t t a a m ma i a a t atm t t g a a t a t mm it gag m t a a
Objectives
m iag t at a ma ag m t t a t i a t i g i mit i t atm t i a i a t a t a i it a mm it i a a i i it i a a t ag
a t a t t a a i a t g am ta t i t i t i t i t am a ai a i t a i a t a a a t g am a a i t i t i t a a ag i DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol The Nepal PEN protocol I, II and concept note was developed and endorsed in June, 2016 and the Bag g am Ba i a t a a a a ta at i a a program started in two pilot districts (Ilam and Kailali) on October, 2016. In addition, Nepal PEN protocol t i a a g am a a i a i a i t i t it a m a III and IV was endorsed and the program was scaled-up in the 8 districts (Palpa, Myagdi, Baglung, Achham, Bardiya, Surkhet, Makwanpur and Rautahat) for Fiscal Year 2073/74. a a t a i g a t a a i a a g am a a i a i a i t i t a a a m a a i a a i i B a ta a i a a For the Fiscal Year 2074/75 PEN program was scaled up in additional 6 districts (Chitwan, Jumla, a i a t a a m a Baita i Ba a Jajarkot, Dhading, Nuwakot, and Gorkha). For Fiscal Year 2075/76 PEN PEN program was scaled up in additional 14 districts (Jhapa ,Solakhumbu, Mohattari ,Parsa,Sindhuli,Bhaktapur,Kaski , Tanahun, t Kapi i a lbastu,Rolpa,Dolpa,Humla, a Baitadi g am , Bajura). i i g a i i t i t a g at m a a a i a ta i a a a a i a a a g a a at a a a a i For the Fiscal a t Year a g 2076/77 t a PEN Program g a a i is being scaled up a a in 21 districts ai (Morang, t Terathum, Ba a g Udaypur, a a Sarlahi, Saptari, Dhanusha, Rasuwa, Sindhupalchowk, Dolkha, Syangja, Parbat, Nawalparasi (East), Dang, a a Pyuthan, Arghakhanchi, Salyan, Dailekh, Surkhet, Bajhang, Darchula, Dadeldhura)
B t i a a g am i a t g t a By the end of Fiscal Year 2077/78 PEN Program will be scaled up throughout Nepal.
Major activities, achievement and target Major activities, achievement and target Key Achievements Key Achievements Key Achievements Key Achievements Target ( FY 2073/74) ( FY 2074/75) ( FY 2075/76) ( FY 2076/77) ( FY 2077/78) ● Concept note on ● Implementation of ● Development of ● Expansion of PEN ● Expansion & PEN developed and NepalPEN Program in NCD & Mental Health Program in additional Implementation PEN Protocol additional 6 districts Section in EDCD under 21 Districts of PEN Program endorsed • Update in recording DoHS ●Expansion of ● Development of throughout Nepal ● Implementation of andreporting tools PEN Program in Community in all 77 districts NepalPEN Program in ●Protocol revision additional14 Districts Invervention ● Implementing 10 districts after consultation • Revision/update of Framework to tackle Community ●Initial Steps in from the experts PEN trainer’s guide NCDs and piloting in 2 Intervention Management of NCDs ● HEARTS Tool kit also and Trainee ‘s manual districts by the end of Framework at PHC level taken endorsed ● Allocation of budget the FY. Throughout Nepal ● Drugs related to to each provinces and ● Increase the PEN Program enlisted governance level for ● Allocation of budget amount of budget in Essential Drug List proper management to each provinces and for NCDs of NCDs governance level for ● Work up to ●Provincial based tot proper management integrate PEN for increasing trainers of NCDs Program at provincial level Recording & Reporting Tools in HMIS & DHIS ●Develop Country’s as well as Province’s NCDs Profile
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol m Trend of o e NCD
Pro ince Pro ince Bag ati Gandaki Pro ince arnali Su. Pa. Di ea e Period Nepal 1 2 Pro ince Pro ince 5 Pro ince Pro ince 2072/7 21817 1 590 60 85 5978 960 1 1 6 2026 201229 207 /7 2 01 128 8 7 78 68 281 8 1 652 2166 210171 COPDTrend of o e NCD 207 /75 2 901 1 2 8 8 2 1 550 2 0 1696 2 5 5 2 1685 2075/76 Pro 2 ince Pro 18805 ince Bag 78 50 ati Gandaki 20 9 Pro 8705 ince 198 arnali Su.2 802 Pa. 2 5768 Di ea e Period Nepal 2072/7 80 1 7 281822 Pro 870 ince 5 Pro 56569 ince 1 5 9 Pro 5 69 ince Pro 9125 ince 275886 207 2072/7 /7 58 21817 95 29 1 590 56 12 60 897 85 579 5978 7 0000 960 1 7919 1 6 117 2026 9 201229 29 207 /7 2 01 128 8 7 78 68 281 8 1 652 2166 210171 H perten COPD ion 207 /75 65126 70 5 1600 6 6 587 5 161 8828 1 162 0 9 5 207 /75 2 901 1 2 8 8 2 1 550 2 0 1696 2 5 5 2 1685 2075/76 9 2 1 8 18805 78 8 16218778 50 7521 20 9 86 8705 76 198 1 8 0 2 18827 802 2 99 5768 0 2072/7 18700 80 7 281825 10 870 906 5 5656926860 17599 1 9 5 977 69 9125276 275886116116 Diabete 207 /7 58 258 95 7 29 106 56 7 12 7 5 897 1 579 28128 7 172 0000 6 79191098 117 862 9 161 29 9 Mellitu H perten DM ion 207 /75 65126 2127 9 70 6 5 1600 95781 6 6 2287 587 228515 161 19728828 1 659 162 19911 0 9 5 2075/76 55 9 1 61 8 15520 78 8 16218790 19 7521 890 86 8922 76 1 5859 8 0 188276512 251596 99 0 2072/7 18700 5 12 10 6 906 268607 8 175996 9776 276 28 11611615 5 Diabete 207 /7 258 7 106 7 7 5 1 28128 172 6 1098 862 161 9 207 /7 6 16 1 5 90 7 5 1 186 Mellitu DM 207 /75 2127 9 6 95781 2287 22851 1972 659 19911 Brea t Cancer 2075/76207 /75 55 11 61 1552029 90 1 19 5 890 278 8922 7 58592 65126 2515961808 2072/7 2075/76 9 125 15 6 7 7 57 8 6 0 65 2821 15 20 5 2072/7 207 /7 2 6 16 1 62 5 710 90 188 7 15 1 2 1299186 Brea Cer t Cancer ical 207 /7 /75 8211 292 1 92 5 267278 1 7 8 52 6 1 1808 21 Cancer 207 2075/76 /75 629 5 0 176715 7 20 57 0 25 2821 2 20 07 2072/7 2 62 710 188 1 2 1299 2075/76 91 21 8 2 7 80 0 286 Cer ical 207 /7 82 2 92 267 1 8 5 1 21 Cancer 207 /75 62 0 1767 20 2 28 2 07 Strength Weakne 2075/76 and Challenge 91 21 8 2 7 80 0 286 t gt a a a g Strength Weakne Challenge A Strength e le at W o eakne un t and C hallenge nl o u e on H le el • o proport onal u et allo at on le el ( H Strength an H ) o tl o u e Weakne on treat ent approa to ar D Challenge A De e ate le atan o un un t onal t o nl e o eru t e e on H le pu el l ealt • o oor a proport arene onal an u et on allo ept at on on le el ( H an H ) o tl o u e on treat ent approa to ar D at onal D ental approa a out t e ur en an on e uen e o De ate an un t onal o e er t e pu l ealt • oor a arene an on ept on Healt at onal n t D ental approa o u e on R o r people a out D , a t e on ur t en e pol an on a e er uen , e ealt o Healt m i n t ealt ( o o u e per e on on o te R o n r H people t pro D e , a onal on an t e t pol e eneral a er pu , l ealt m i n uran e un ealt er al r ( o populat e per on on ot u te pe te n H o t ea e) • pro n e ealt onal l e an t le t e ee eneral n e pu a l or an n ealt uran e o era e un n lu er n al r na populat e uate on re or t n u , pe report te o n an ea e) • lo n er ealt alue l e o t e lealt ee a n on e t e a pu or l an ealt o era e n lu n na e uate re or n , report n an or D pre ent on an on tor n te • lo S orta er alue e o o e e alt al a e on u p t e ent pu ,an l treat or ent D pre er ent e on an on o tor le n el o te o un t a arene • S orta e o e al e u p ent ,an treat ent er e o le el o o un t a arene uppl e nee e or a no t or ra e or ult o ple RR tool re erral a n uppl e nee e or a no t or ra e or ult o ple RR tool re erral a n t erapeut are o pat ent t D e toral approa e toral approa Se eral pol e to o D R • S orta e o ealt or er n pu l a tor are n erent ra t ta e ealt ealt a a l l t t e e i at g t i part ular or pro ot on, pre ent on, an re ear
Mental Health
ta a t a ta a i g i a a t i i a a a tai a m t a it i t a t g a t ta g t a i t at t ta a t a ta a a g t t t at t i B t i mat m ta it m mm i a i a t g a t atm t a m t m ta a t a i g a g t t t at t i t gt t a t atm t ta a i i g a g a a a m a a a ig m ta i t t a imit i t t a
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol t i mi m ta i a i t a i t i a a t a t m ta a t at i a t ai a a a t t m a i a a ai i g a a it i i g a t a i ma t g t g t i ma ga i g m ta a t a a i ita i mm it a ta a t g am a ta t at i t i t a t a a a i a a am g a i a t a a
mm i a i a a ta a t a a ig a t a it im m ta m ta a t g am i a a i im m t m ta a t g am m
Community Mental Health Care Package, Nepal, 2074
a ag i ta a i a a i mit i a a it i i g ia i m ta a t i a i g t a ai a i it a a i i it i t g at m ta a t a ia t i it i t ima a t a t m t t a ag a t m ta a t a a ag at t a t a i it a mm it a g it t im m ta m a i m
Aims and Objectives of Mental Health Care Package
aim t ta a t a a ag i t a i itat im m ta a a ta a t i t i g t a ai a i it a a i i it a i m ta a t a ia t i a t a a
g a t i a ag i t a i itat i t g a m ta a t i i t t ima a t a i t m t t
The specific objectives include:
t m ta a t a ia t i a ag at i t a ima a t a t m t mi im m ta a t i at i t a ima a t are te t t ta a t t ai i g a ag a ma a t ai i g a i i a t a mm it t i
B t i a a ag a it t a a i t it a ta a t at i a a t a i m i it
t gt a a a g Strength, weakness and challenges Strength Weakness Challenges Community Mental Health Program coverage Recording and reporting Care Package, Nepal, 2074 couldn’tbe achieved as • Clinical supervision and developed targeted mentoring • Community mental health • Training was not topped • Availability of psychotropic program at six districts with availability of medicine around thecalendar • Drugs procurement and medicine • Limited budget allocation supply. to cover the programdistrict • Turnover of trained health professional
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol 5.7 Epidemiology and Disease Outbreak Management
5.7.1 Introduction
i mi g a t a a ag m t i i t a a a a t t a i mi a t a t m g i i g i i t a t t t a ig it t ga i a a t t mm i a i a a a t a t t t g a a i g t a a i mi it a i g t i g a t a t m
5.7.2 Major Responsibilities of Epidemiology and Outbreak Management:
i t t i i t a t a a a i g a a a i i a t at gi at t i mi g a t a ma ag m t i t t i i t a t a a a i g a a a i i a t at gi at t a a ma ag m t t a i mi a t a t m g it a a ta a t a g i i ga i g i mi g a t a i mi ma ag m t i at it i ia a a i mi a t a ma ag m t i t a a a im m ta a a a at a at t i mi a t a ma ag m t i at a a at it a t i at a i mi a t a ma ag m t i at a i t i i ma ma ag m t t ai i g a t a g am at t i mi g i mi a t m g it a ma ag m t i at it m t a a t i i mi imi i g t im a t at a i a t i a t t t a i a t i mi a i itat a i at i i i g a a i t g i ia a a t t t a i a a at a i a t i i a mm i it i g a i i i a t a a ma ag m t a i i i a it i a i a t t a t i a i g a t t a t a ma ag m t m i i a a i am i t t i mi i a i at a a i itat ma ag m t t a m i i a t gi i t t t a i mi it i g a i i i a i mi t a a a t a i a i a a i g
5.7.3 Rapid Response Teams (RRTs)
t a i am a i t a B t m t i mi a a t m t g t t t i t t gt t i ma ma ag m t a i a mm i a i a a a a i a t a t a a i ga a m t i g t t a a m at t a gi a i t i t a mm it a t i m i i a i g t a a i mi a a i g t im g i i a i t t a t t t i a t m a
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol Roles and responsibilities of RRTs are as follows:
a a i a t a ga i a t a i g t i a t a t g a a a a i a ma ag m t mm it m i i a a t i a ta m it i g t a i a t a ma a ia a a a a g t a t ga t t i a a t i at i i a t at it a i a i a t a it a i mm i a ami i t i g a m ma ag m t i at it t i a a a t i i a t a ma ag m t g it a it ma a gi a t i a t a i g t t i a t m g t a mm m a t at t t i a t t t t i a m i t
5.7.4 Major activities carried out in fiscal year 2075/76:
t i i g m g g a a t gi at t at gi a t i i t i t a a ta i a t at ma i t t i i i a t a a i t a at g t gt t a i t a g amm t at i t i t i t a i it a a i g a i t ta g a t a i mi a a a t t a i a t a a i mi i t i t a mm i a t i i ata i t m i i t g t t t i ga t a a a i ita m g a a a a at at i t ita
5.7.55.7.5 Major OutbreaksOutbreaks in in fiscal fiscal year year 207 2075/765/76 Acute Gastro-Enteritis (AGE)/Cholera: Acute Gastro-Enteritis (AGE)/Cholera: Outbreak of diarrhoeal diseases occurs throughout the country mostly in the monsoon season but t a ia a i a t g t t t m t i t m a t most of them with low case morbidity is under reported. In fiscal year 2075/76, eight events of AGE m t t m it a m i it i t a a ig t t outbreaks were reported to EDCD from 8 different districts affecting 648 people in total with four t a t t m i t i t i t a g i t ta it mortality. m ta it Table 5.7.4.1: Status of AGE/Cholera outbreak in fiscal year 2075/76 S.N. District Location Total Cases Deaths 1 Mugu Soru RM-3; Purumuru 15 2 2 Mohattari Jaleshwor MN-12 Nanhi 253 1 3 Kapilbastu Taulihawa 10 0 4 Gulmi Musikot MN-4, Dajakot 185 1 5 Jajarkot Rani Gaun Jail 55 0 6 Kathmandu KMC-13, Tahachal 1* 0 7 Sindhupalchok Balefi RM-5 120 0 8 Lalitpur Nakhu 9 0 *Confirmed Cholera Source: EDCD/DoHS
DoHS,Influenza Annual Like Report Illness 2075/76 (ILI): (2018/19)
ILI cases are commonly seen in winter and during seasonal changes. The high risk group for severe disease includes pregnant women, children under 5 years, elderly people, immune-compromised people and those with medical morbidity eg. Heart disease, cardiovascular disease and COPD.
A total of 2 outbreaks of ILI were reported in FY 2075/76 with 3,386 cases throughout the country including 13 deaths. Circulating strains of Influenza have been found to be Influenza A (H1N1) pdm09, Influenza A H3 and Influenza B.
Table 5.7.4.2: Status of ILI outbreak in fiscal year 2075/76
S.N. District Location Total cases Deaths
1 Saptari Kanchanrup MN, Saptari 3147 4
2 Humla Tajakot 239 9
Source: EDCD/DoHS
Food Poisoning/Water contamination: One event of food poisoning was reported to EDCD in FY 2075/76 from Bheriganga municipality Surkhet. Thirty-three people were affected with no death. Similarly, twenty-five people were ill due to contaminated drinking water in Letang Municipality Morang in this fiscal year.
5.7.5 Major Outbreaks in fiscal year 2075/76 Acute Gastro-Enteritis (AGE)/Cholera:
Outbreak of diarrhoeal diseases occurs throughout the country mostly in the monsoon season but most of them with low case morbidity is under reported. In fiscal year 2075/76, eight events of AGE outbreaks were reported to EDCD from 8 different districts affecting 648 people in total with four mortality.
Table 5.7.4.1: Status of AGE/Cholera outbreak in fiscal year 2075/76 S.N. District Location Total Cases Deaths 1 Mugu Soru RM-3; Purumuru 15 2 2 Mohattari Jaleshwor MN-12 Nanhi 253 1 3 Kapilbastu Taulihawa 10 0 4 Gulmi Musikot MN-4, Dajakot 185 1 5 Jajarkot Rani Gaun Jail 55 0 6 Kathmandu KMC-13, Tahachal 1* 0 7 Sindhupalchok Balefi RM-5 120 0 8 Lalitpur Nakhu 9 0 *Confirmed p e olo Cholera an D ea e ontrol Source: EDCD/DoHS InfluenzaInfluenza LikeLike IllnessIllness (ILI): (ILI): ILI cases are commonly seen in winter and during seasonal changes. The high risk group for severe a a mm i i t a i g a a a g ig i g i a i g a t m i a imm m mi disease includes pregnant women, children under 5 years, elderly people, immune-compromised a t it m i a m i it g a t i a a i a a i a a people and those with medical morbidity eg. Heart disease, cardiovascular disease and COPD. A total of 2 outbreaks of ILI were reported in FY 2075/76 with 3,386 cases throughout the country t ta t a t i it a t g t t t i i g at i a g t ai a a t a including 13 deaths. Circulating strains of Influenza have been found to be Influenza A (H1N1) m a a a B pdm09, Influenza A H3 and Influenza B. Table 5.7.4.2: Status of ILI outbreak in fiscal year 2075/76
S.N. District Location Total cases Deaths
1 Saptari Kanchanrup MN, Saptari 3147 4
2 Humla Tajakot 239 9
Source: EDCD/DoHS
i i g at tami a t i i g a t t i Food Poisoning/Water contamination: One event of food poisoning was reported to EDCD in FY m B iga ga m i i a it t i t t a t it at 2075/76 from Bheriganga municipality Surkhet. Thirty-three people were affected with no death. imi a t t i t tami at i i g at i ta g i i a it Similarly, twenty-five people were ill due to contaminated drinking water in Letang Municipality a g i t i a a Morang in this fiscal year.
DoHS, Annual Report 2075/76 (2018/19) Viral Fever: In the month of Baisakh there were a viral fever outbreak in Tatopani RM Jumla and Himali RM Bajura. One hundred fifty cases were in Jumla whereas three p e hundred olo an twenty D ea cases e ontrolwere in i a t m t Bai a t a i a t a i at a i m a a Bajura. No deaths. ima i Ba a a i m a a t t t a Issuesi Ba a at actions taken & recommendations: Issues Actions taken Recommendations Outbreaks of food and Coordination with the Department Improve water supplies, hygiene water borne disease of Water Supply and Sanitation for and sanitation. effective interventions Coordination with the Department Food-borne disease surveillance of Food Technology and Quality should be initiated (active) Control (DFTQC) for food borne disease surveillance Field epidemiologists Outbreak investigations being Organization and management to perform thorough conducted with available health survey to identify gaps in technical outbreak investigation workers and support from human resources at EDCD external partners Train and retain adequate field epidemiologists Investigation of Mobilization of a comprehensive Capacity building outbreaks team for outbreak investigation Guideline toinvestigate outbreak in Collaborating with WHO and other a more scientific way sectors/agencies Deploying trained field epidemiologists to investigate outbreaks The threat of Risk Assessments done for Zika Orientation programme at district emerging and re- and Ebola at central level level emerging diseases Enhance the capacity of response teams through regular capacity development and logistic arrangements Strengthening of IHR Established health desk at TIA and Guideline for the function of PoEs core capacities 8 ground crossings and role of health workers Permanent structural arrangement at designated PoE sites RRT structure and Interim guideline sent to Update & Revise RRT guideline functioning in provincial and local levels according to federal structure federalism
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol 5.8 Surveillance and Research
Background
i a i a a a a ta i i g t a a m i a i g t a t t i i a t mai a i i a i a t g a a i g a g t m a at a it i a
Major responsibilities of the section are:
i t a a i a i a a a at a a a t g a a t at gi a a ta a t a g i i at t i a i a a a a i i at a a i t i a a i a i a a a a i a a a a a a i a i a a a a i i at it a ta i a i a a a a i ma ma ag m t i a i a ta i m t a a i at a a i ia ita i i a it g m t a ag m it i g a a i a a a a i i a t a a m g ma ag m t at a a t i a i a i i m it i g a a a a i a t a t i i i a it i
5.8.1 Early Warning and Reporting System(EWARS)
i a ita a i a t m t t ita imm iat a t i i g t i i it i a a t a a i a t i ig t i m t t i mi t at a i a t a t t a
t a ta i i t i it a a t it i it i it i it i a it i a a i a it i at ita a m i a g a a a a it t t t ta m t it i it i a t t a i ia i t i t ita m i a g i i g t i at ita
mai i t t gt t i ma t a i i a a t i a m t i t i t a t a i itat m t t a t a i t a i t am at a i ia a a t i ig t i m t t a t t t at a i a it t a t a
Main Objectives: a m i a m t i ata a i i a i a t im ta m it a i t i i a t g a i a t ita i a t a a a i a a i g ig a i a i a a t t t t a
DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol i i at a t a a t t a a i ga a t g i t i mi at ata i ma i i a t g a a iat a t m
The four basic elements of surveillance that were the cornerstones of EWARS development:
a i m ita i a t a a a t a at i i i g a a a t i i g mi ta t i ma t m a mm iat i ma a a m i i a i ga a t t
Information flow mechanism and control room responsibilities:
it t imm iat t g t t a t t m a a t i t at m t a m a at t t a t i t at i i at t a i a it i a at a i i i a at i t t a i a a i i g m t it a a t i t at i t a t it
A control room is functioning regularly under disease surveillance and research section of EDCD. Main activities of control room are:
ai t a a it a a m i a m t ata i m it a i ata m it m it i g i a t a i g a t i t a a t i t i a t i a i mi at a t a i ia a t a t i a it a t a t ta i a a t t it
g i t a a i g a g t m a at a i mi at i i a a at it
5.8.2 Water quality monitoring and surveillance
Background
a a i i g at a it ta a i m t a t i i at t a t t ta g t t a i t i a a a i i g at ta a a t i i i i t ta t a i t ta g t
tat i t ta a i i t a t a a a it i ag i a i t t at a it i a a i t t at a it i a i i i g t t g i i at a it i a mmi t i t a m t i i a i a a a i i g a m m ta g i i tat t at t i i t t t at a it i a t g i i t ia m t at a i ia DoHS, Annual Report 2075/76 (2018/19) p e olo an D ea e ontrol a a a g m t m ta t t i a i i t i t i t Ba t a a i a t am at i t i t a t t g a i a it i i t i t
i i g at i a t t a igi a t i a t a m t a i t a t a a ta i it i i g at i i i a t i t t t t i a t m g im m t t a it a i i it ag a a i it a it at i a i m m ta t t a it t t i i g at i
Main objectives of Water quality surveillance:
at a it i a m t g a im m t at a it i a a i a i t a i i i at a it i a t a t ta i a t m t g a t at a it i a a at a t a i g a a t ta a t at a it i a a at a t plan
i a ta iat at a it i a mmi a i i i mmi a
g a m it i g i i g at a it m a i a i t i it g a i a at i a a i at it i t ta a it i a a a a it ma t g t ai i g m g a t g amm t i a at a it t i t i t a i itat t g at a it t at i t i t i t a a a a i a at i a i mi i t at i t i t i t a a a a i i g at i t i t m t t a i g a i a ma t m a i a t t i ga i a
IssuesIssues and and Recommendation Recommendation
SN Issues Recommendation Vacant post of medical recorder should be fulfilled Create posts for medical recorder in hospitals with Inadequate resources for sentinel no/lack of sanctioned posts 1 sites operation Allocation of necessary budget for EWARSorientation, data verification and strengthening of infrastructures of sentinel sites Limited prompt response for disease Disease investigation guideline should be prepared and case 2 control and prevention after base investigation should be done reporting Regular and immediate feedback/supportto sentinel Limited feedback/support to 3 sitesfrom EDCD as well as Health Directorate sentinels sites Regular onsite coaching to sites Including retrospective data analysis and 4 Retrospectives data analysis publish/disseminate its major findings 5 Inconsistency of data Data from EWARS may not match with HMIS data
DoHS, Annual Report 2075/76 (2018/19)
i g a ia it 6. NURSING AND
Chapter 6 Chapter SOCIAL SECURITY 6.1 Background
i g a ia it i i i a ta i i B a i i i a it a t i t g a a it m t i g a it i a i m i i g a i g i a i i m it i g a a i ita a i a t i g mi i a t a mm it i g i a t a a g iat i a g a i g amm a g it t atm t a ma ag m t a i i t i a t im i a i at i t ita i i i i a i m t a i i a t a t at ia m i i i t at g ta a t a g i i
6.2 Organizational Arrangements
i g a ia it i i i a t B i a it a gi
Box 6.2.1: Sections under the Nursing and Social Security Division i g a a it m t iat i a Ba i a ag m t ia a t it
6.2.1. Nursing Capacity Development Section:-
i at a at a a i itat t ag i t m t a im m ta i t at g ta a t a g i i t mai tai a it i i g i i at a a i itat t ag i t m t a ta a t a g i i t a m i i a i a m t t ma i i g i a a it i g i a t a m i i i g ta a a a it i i g i i at a a at t i g a a g i i ga i g ia i a i i g a i t a t ag i i i g a a a t at i i t at gi ta a t a g i i t t a at a i t a it i i g a a i g i i i g ia i i g a a a i i at a a i itat i t a i t a aim t a m t a it mm it a mi i a a a i i at mm i at a at a a i itat t ag i t m t a m i g i i a t i at a a i itat t ag i t m t a m mm it i g a i i at a a i itat t ag i t m t a m
DoHS, Annual Report 2075/76 (2018/19) i g a ia it mi i a a it a i a at a i at it t ag i i i g i g a mi i ma a i g a a it i i g m t ma ag m t t t i a t i g a mi i i g a i
6.2.2 Geriatric and Gender Based Violence Management Section :-
i at a at a a i itat t ag i t m t i t at g ta a t a g i i t m a i g a i at a a i itat t ag i t m t a m i g a i i t g iat i a t at a i i at a a i itat i a it a t i t a t m g a i t ta a t a g i i t t atm t a ma ag m t g a i it a a i itat i ta i i at it a ag i ta ga i a t at i t g iat i a g a i t t mat ia t i a it a t i it m a i g iat i i i m a t a t i t i i i at t t t a i t i a t i m g a a it a t a i g iat i a t a a ma ag m t g a i
6.2.3 Social Health Security Section:-
t i t at g ta a t a g i i t ga i g a a a i i ita a i t t ta g t a a ma ag m t Bi a a ag i a a i g amm t atm t i a t i i ia it it a t i i a ag m t t a a i a at t i ta a a t a t at ia m i i
DoHS, Annual Report 2075/76 (2018/19) i g a ia it 6. 1 Nursing Capacity Development Section
6.1 Background
i g a ia it i i i a t i t i a gi
i at a at a a i itat t ag i t m t a im m ta i t at g ta a t a g i i t mai tai a it i i g i i at a a i itat t ag i t m t a ta a t a g i i t a m i i a i a m t t ma i i g i a a it i g i a t a m i i i g ta a a a it i i g i i at a a at t i g a a g i i ga i g ia i a i i g a i t a t ag i i i g a a a t at i i t at gi ta a t a g i i t t a at a i t a it i i g a a i g i i i g ia i i g a a a i i at a a i itat i t a i t a aim t a m t a it mm it a mi i a a a i i at mm i at a at a a i itat t ag i t m t a m i g i i a t i at a a i itat t ag i t m t a m mm it i g a i i at a a i itat t ag i t m t a m mi i a a it a i a at a i at it t ag i i i g i g a mi i ma a i g a a it i i g m t ma ag m t t t i a t i g a mi i i g a i
ote eacuse of new section, no rogram is carried out in the F 20 5 However, rogram will be ro osed and run smoothly in F 20
DoHS, Annual Report 2075/76 (2018/19) i g a ia it 6.2 Geriatric and Gender Based Violence
6.2.1 Background
The specific functions of this section are given below:
i at a at a a i itat t ag i t m t i t at g ta a t a g i i m a i g a t a i at a a i itat t ag i t m t a m i g a i i t g iat i a t at a i i at a a i itat i a it a t i t a t m g a i t ta a t a g i i t t atm t a ma ag m t g a i it a a i itat i t ta i i at it a ag i ta ga i a t at i t g iat i a g a i t mat ia t i a it a t i it m a i g iat i i i m a t a t i t i i i at t t t a i t i a t a g i a m g a a it a t a i g iat i a t a a ma ag m t g a i
A. Geriatric
Geriatric Ward Establishment Program
Background:
a ta i g iat i a i t a ita i i g g iat i i i i t ita a t t t ita a a t m t ita i B ata B a at a a t a t i t g iat i i a i i t tat a i i it i t i imit a a it a
iat i it imit a a it imit a a ai a i it t a t g iat i i m t i i g a at g iat i ma a ma a a t ta a a a ig a g i ita i i g g iat i i i i i t t a g iat i a t ig i i at ita a a g ma g iat i i i a a i g iat i i t t a a tm t i ita i i g ma at g iat i i i i at a t a i g ita t i i i a a a a a ma a g i t t ma ag gi a m i a g a g t a i t a mi a iat i a t t am it a ia i a t a i t a g iat i a t a ta t t g iat i m i i mm a ma ita i i g g iat i i a a it t ai ma g iat i i a a ma a g m t ma g iat i m i i i g t ai i g a ia i t ai i g i it i a m t
1 ata ita ata a m a t a i a a a i g ita i B a at ita t gi a ita a a a m a t a i B i ita a g ita a ga i B i a a t t a t a i m i i ita B t a
DoHS, Annual Report 2075/76 (2018/19) i g a ia it i i g iat i a t a i a gi g a i im a t g i t t i a t i g iat i i i at i t i i i g i a ma ag m t m a a ia i am imm i a ig ma g iat i i i ita B ata a a a B a at t a t t i m m a t t a t imit i a i t t a t i i ag it ia g iat i i i
B. Gender Based Violence Management Program
Background:
a i B i a g a ma ig t i a a i a t i im a t t i a a m ta a t t i i i a i a i a a i a ia a mi t t i t B i a t a a t t i it igi a i mi tat a i a t i a g g a i a g it a a a t imi a i gai t m B a i t at i i t agai t a ma a i a ma i t at a t m i at t i a t t at i i t i a m ta a a m i g t at a t i a t i a i t B i i at a i a t i i t i a i t t g m a a a t g i i t i gai t m a i i t ma i ta t i g i a it
m t a a ta ig i a t t i mi g a a i i t m at B i t t t ia m t at i gai t m a i i t i i t a t a a a ta it a t a a a gai t B t i i t g at i t i B ta i i g ita a t i i a ag m t t
i i at t ta i m t i B t a ta i i i t i t t m i ta i i a t i t t m t a a t t i a i m ta i i g i t t t gt t t m a a a it i t i i t a i t mi t a a a i a i i a i t g i t m t gt i g i ita a a t i i i g i a i t atm t ia i g a m i ga i a i at it m t a ag i t at i i a t a m ga t a it a a i ita a i t ia i t a t i a i a ma at t i i t B i B a i m a at i a t t i a ai a m t t a t i i
DoHS, Annual Report 2075/76 (2018/19) i g a ia it
Services OCMCs are mandated to provide
The ‘Hospital-based OCMC Operational Manual’ (MoHP 2011) says that OCMCs shall provide the following seven kinds of services through multi-faceted coordination with other agencies: Health services – Immediate treatment of physical and mental health needs of GBV survivors with OCMCs having to stock the equipment and the free health service medicines to provide these services. Medico-legal examination and reporting. Psycho-social counselling to survivors and perpetrators. Legal service- counselling and support to survivors through district attorneys and legal counsellors. Safe homes — by directing survivors to safe shelter homes. Security – by working with the police and district administration offices to provide security to survivors in hospitals, safe houses, and in their communities. Rehabilitation – by providing further counselling, education, vocational skills training and other livelihoods support.
B GBV t cuts a across a t t i it caste-ethnicity, igi religion a and i mi socioeconomic status tat and a is i prevalent a t in i all a g g a i a g t g i i t m a mag it ma i g a geographical settings, though in different forms and magnitude, making prevention and response ia a i a m g a i a a t t at t crucial nationwide2. The Nepal Demographic and Health Survey (NDHS, 2016) found that 22 percent of m women ag aged 15–49 a had i experienced i a physical violence i at at some m point i t since i age ag 15, while i 7 t percent a had i experienced sexual a violence. i The main mai perpetrator t at of physical i a or sexual a violence i was a their t i husband. a Women’s m experience i of spousal a violence i varies a i by ecological gi a zone. Close to one t - t i m i t ai i i a a m a i m a third of women in the Terai (32%) experienced physical, sexual or emotional violence compared to t i i a tai a a i a at i m a one-fifth in Hill (20%) and Mountain (19%) areas. Divorced, separated or widowed women are more m i t a i a i t a t ma i m a likely to have experienced t a spousal a t violence m (48%) i than a currently i married t women (26%). t The m education level a of the husband a affects a women’s a i risk of spousal a violence. i Forty-four m a percent t of t m a a m t t a i g at ig g women whose husband has no education had experienced spousal violence compared to 14 i percent of i g women whose i t husband mm had a completed i the a school ta t leaving t t certificate i i t or higher. t t a t i a gma a i g t i a a t i t i Reporting violence or seeking help is not common as survivors are reluctant to report incidents to the m authorities for a fear i of stigmatisation, a i a fuelling the a violence i and lack a of t support i m services. a Two- g t thirds of women who have experienced any physical or sexual violence have not informed anyone 6.2.2or sought Major help. Achievements in fiscal year 2075/76 6.2.2 Major Achievements in fiscal year 2075/76 ata t a t i a g t at t t ta a a m i t a MoHP data extracted in Falgun 2076 shows that the total annual number of OCMC clients has a m i a g a i i t i a g a i i m ma t i t Ba increased from 187 in 2069/70 (2011/12) (based on seven reporting facilities) to 6,992 in 2075/76 ata i a a a t a a a t a a ma t a a (2018/19) based on 45 reporting facilities. Women make up over 90 percent of clients. Based on a a a a a t t g t a t a a a i a a a t i t 2075/76 (2018/19) data, physical assault, sexual assault and rape make up 72 percent of all cases. Rape and sexual assault together are 38 percent of all cases, and physical assault is 34 percent. m a i a a a i t at a t t a i i i a The number i a ma of cases of physical a t a and sexual violence that mat are reported to any service a provider m in Nepal is a small proportion of actual occurrence. To estimate how well OCMCs reach women i i t a t a a a m g a i a a t at ma a i i t a t a 2Ministry of Health, Nepal; New ERA; and ICF. 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health, Nepal. DoHS, Annual Report 2075/76 (2018/19) seeking help for physical or sexual violence, we calculated the number of OCMC clients in one year as a percentage of the estimated number of women seeking help i g a ia it using census data and estimates of i g i a a i a at t m i t i a physical and sexual violence from the Nepal Demographic and Health Survey (NDHS, 2016). The crudea a tag t mat m m i g i g ata a mat estimation is that OCMCs served between 3–4 percent of women who sought help for i a a a i m t a m g a i a a t physical ma i t at t t m g t or sexual violence in 2075/76 (2018/19). Coverage varies by province but the headline message i a is that a coverage i is i extremely low and ag there is much a i more i for the t government t a i to do to improvem ag i t at ag i t m a t i m m t g m t t t survivors’ access to services. im i a t i 6.2.3 Analysis of OCMC utilisation data 6.2.3 Analysis of OCMC utilisation data The number of OCMCs has increased from seven in 2011/12 to the planned 69 by the end of FY 2075/76 m a i a m i t t a t (2019/20). MoHP data extracted in March 2020 shows that the total annual number of ata t a t i a t at t t ta a a m OCMC i t a i a m i a g a i i t i clients has increased from 187 in 2011/12 (based on seven reporting facilities) to 6,992 in 2018/19 a g a i i a (based on 45 reporting facilities). (see Table 1).
Table 1:
Table 1: Total number of Clients by year and number of reporting hospitals Year Total # clients # hospitals reported data 2011/12 187 7 2012/13 545 12 2013/14 1,049 14 2014/15 1,730 15 2015/16 2,004 17 2016/17 2,924 22
2017/18 4,372 37
2018/19 (2075/76) 6,992 45
Source: GESI/MoHP
Women make up the overwhelming majority of OCMC clients, representing over 90 percent of m ma t mi g ma it i t g t clients. i t a ag m i t a i a m g i The average number of clients served per OCMC has increased over time (see figure 1). This reflects t i a i g a a it it t i t t B i i a t i increasing capacity of OCMCs with the introduction of the GBV Clinical Protocol in 2015, revision i i t a a a a i a t i t ia i g of the OCMC Operational Manual in 2016 and the introduction of psychosocial counselling t ai i g i a m i ga t ai i g i training in 2012/13 and medico-legal training in 2018/19.
DoHS, Annual Report 2075/76 (2018/19)
i g a ia it Figure 1: Average number of clients per OCMC by fiscal year 2011-12 to 2018-19
180
160
140
120
100
80
60
40
20
0 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Source: GESI/MoHP
ig i a t i it i t a i a i ig t a a i Significant diversity in the readiness and use of OCMCs is well known. Figure 2 presents annual t at t at a a a i a t t i i it a a client use at five OCMCs that have been operational since 2011/12 and reflects this diversity. a a a i g ita a ta i i t i t a ta a ita a a a i t i t t a ig at i t i t m a t t i t i t a a a a a ita i at i ai a Gajendra Narayan Singh hospital (Saptari district) and Hetauda hospital (Makawanpur district) both ta a ita i at at i a ia t a i t t a i t a are highly populated districts compared to other 3 districts. Gajendra Narayan hospital is located in a t m a t i g B i a a i a i i a ta t Terai and Hetauda hospital is located at hill. The variation of the cases is due to the population, a a ita i ta a a a a a a a ita a a a i socio-cultural factor, number of partners working on GBV issues and leadership and initiatives taken i a m t a i a it a t a a i at a by the OCMC focal and hospital chief. OCMCs of Hetauda and Gajendra Narayan hospitals are very ita i a i i g i a it i t ita i a i im active and visible. They possess active multi-sectoral coordination with partners, focal persons are a t a a a t imi a a dedicated and hospital chiefs are supportive including effective coordination within the hospital. Initially, Phidim (Panchthar) was active due to similar reasons.
DoHS, Annual Report 2075/76 (2018/19)
i g a ia it Figure Figure 2:2: TotalTotal number ofof clientsclients by by year year at at five five OCMCs OCMCs operational operational since since FY 2011/12 FY 2011/12 to 2018/19 to 2018/19 Figure 2: Total number of clients by year at five OCMCs operational since FY 2011/12 to 2018/19 600 600 Hetauda Hospital Hetauda Hospital 542 542 500 District Hospital Fidim, Panchthar 500 District Hospital Fidim, Panchthar Gajendra Narayan Singh 400 411 GajendraSagarmatha Narayan Zonal HospitalSingh 400 411 SagarmathaDamauli Hospital Zonal Hospital 321 300 Damauli Hospital 321 300 Dhaulagiri Regional Hospital Dhaulagiri Regional Hospital 200 199 200 199
100 95 83 76 100 62 95 69 58 8347 51 50 49 69 76 62 5821 51 50 0 47 49 21 0 2068/69 2069/70 2070/71 2071/72 2072/73 2073/74 2074/75 2075/76 2068/69 2069/70 2070/71 2071/72 2072/73 2073/74 2074/75 2075/76
Source: GESI/MoHP
Source: GESI/MoHP 6.2.4 Type of violence 6.2.4Recording Type ofof violencethe type of violence experienced by clients was introduced during the OCMC pilot Recordingperiod. Using of the2075/76 type of(2018/19) violence asexperienced the fullest by year clients of reporting was introduced to date, during we see the that OCMC physical pilot i g t t i i i t a i t i g t i tperiod.assault, Usingsexual 2075/76assault and (2018/19) rape make as theup 72fullest percent year of of all reporting cases. Rape to anddate, sexual we see assault that togetherphysical i assault,are 38 percent i g sexual ofassault all cases, and andrape physical make a up t assault 72 t percent is 34 a percent. of all g cases. Rape t and at sexual assault t at together i a a a t a a a t a a ma t a a a a a a a t t g t areFigure 38 percent3: Type ofof violenceall cases, recorded and physical for all assault OCMC is cases 34 percent. in FY 2018/19 a t a a a i a a a t i t Figure 3: Type of violence recorded for all OCMC cases in FY 2018/19 Figure 3: Type of violence recorded for all OCMC cases in FY 2018/19
Rape Rape 960 Sexual assault 960 1660 Sexual assault 1660 Physical assault 732 Physical assault 732 101 Forced marriage (child marriage) 101 Forcedand traficking marriage (child marriage) 1017 andDenial traficking of resources 1017 Denial of resources Emotional abuse 2355 Emotional abuse 2355
Source: GESI/MoHP Source: GESI/MoHP DoHS, Annual Report 2075/76 (2018/19)
i g a ia it a ig g a g m i a a a i at t a m a a i t i i g ai i g ia m gi mi ma t a a ta i it a i g i agai t i a t m ag t at a i a t i a a i a g t t a i a t gg t it i i i a i i i m i a a t at m i a i g t t at i i it i ma ig ami a t i at t a t i a i t a i g a a i t
6.2.5 Enabling Factors
ma t a a i i t at t i g g a a t a
ita a i mmitm t t i a a i g a t t i a i t g at mmitm t t B a t ita m at ta a im t a it a ita i a i t t i B t i a a ia m t i i it t ita t i i a i a a i t t i i a i a t a ita t a i g t t a B a t a t a ag i ita a tm t a m i ga ai mmi i a a a i ita t a it a i ta a t ai i g ta a ta t i i a a i t mai t a i t a it a it a i a m a i ita t a a i t a g a t t m t g t i mi a i ma a t i a B i t g a i a t m ia a i i g i g i a am aig agai t B i a mm i g a m it i g a i 6.2.6 Issues and Constraints
a i a g a a t t at gi g a i t at a im a g t i g i t a i m a a g t g a i m t it im ta t im i a ig t a t it i g a i a a g t t m a t at i t i t i t ita mai a a i a t i a i at m t a i t at a a ai a at t i g i i ga ga i a m a m a i m i i t a a a g m t it i t it t a i at i g a
t at gi i at t i t a m i t i i t m i a i i a t m a t i i i i g a m a a i ita i a t a ita i i g i t m i t i a g a t t a t ia t i a a m i t i g t
t at t m a t m i t at a a i i a g i i i at a t i it a
DoHS, Annual Report 2075/76 (2018/19) i g a ia it i a a a a a i m t t m i a t t g t i a ga i a m a a i ita i a ma it t t a mm a a a i ita a t i t a i t a i m it i a i i a t m ta i i a a a a g ma a ai a i it i a ma t a ta a i B a at t ai i g a t a t a i i it t a a a t t ta a tm t i it a a t g a i it ta ia t a t ta a i im i a a a it a i i ta a a it a m t ta a a g i i a at t ai i g t i i a t a a a a a m i ga t ai i g t t ta i ami a a i m a t a m i ga t at ta i t a ia i g t ai i g a i a i tm t i a a ta t t a a it a m t i i a t ta i i g i i a m i ga t ai i g a B a ia i g t ai i g ig ta t i ita it i a at a a a g m t a a i t a a a ga im a t i i g a i g i ia i a i g B i m m m i a at a a i at m a i t a a g i i ma i g it i t t mai tai i a i i i g i a a a i ita m a t i g m m ta a g i a t igg t a g a a m t a t
i i t a t a a Ba i i i a t i i t a t a a t i i a ag m t t a a a a
DoHS, Annual Report 2075/76 (2018/19) i g a ia it 6.3 Social Health Security
6.3.1 Background
ia a t it a ta i i B a i i t atm t a ma ag m t a i i ig t t i a t im i a i at i t ita t i m i a a a m t a i i a t a t at t i t at g ta a t a g i i i t i B a gi
B ia a t it
t i t at g ta a t a g i i t ga i g a a a i i ita a i t t ta g t a a ma ag m t Bi a a ag i a a i g amm t atm t i a t i i a a i a at t i ta a a t a t at t
DoHS, Annual Report 2075/76 (2018/19) i g a ia it 6.3.1 Bipanna Nagrik Aaushadi Upchar Programme
6.3.1.1 Background
g a a t i B a gi
B a a t g amm
Goal a ag t i i t atm t t im i i
Objectives — i t i t t ita m i a a t atm t ii i a at t i ta a g i i a t Bi a a ag i a a i g amm
Major ongoing activities
m i i i m ia a t it i t i g i g im i a i t t at i a t i
t atm t t a t ia i t ita i a i i g a a t i a t a ma a i i t a ma i a i i im i a a i a i a a mia i a i a t t t a t a a t a ia i i t a a t mat t t t t a a t a a ta t t a t a m i a t atm t tai i i a t
i g a i t a g a a a i i a g i t a m g a
i t t a t t i t m a t ma ag i t i i t atm t t im i i i m m t m a t m a a t i a i a ma i a i a mia a ma a a m a i i a a t i a a t t a t i m a t t a m a t m im i a i a t i m t i i t atm t t im i i i m tai a i a m a t i t i t a a t m i a t
DoHS, Annual Report 2075/76 (2018/19)
i g a ia it Table 6.3.1.1: Total nu ber of i po eri hed patient both new and old pro ided with treat ent upport for eriou di ea e 2075 76
idne
Na e of Ane ia Head In Head ur Spinal In ur
S.N. ell Total Ho pital particular Heart C Cancer ial i Parkin on Al hei er ial i idne d Sickle ae od Trau atic Trau atic H idne Peritoneal idne Treat ent idne Tran plant at onal a a e o 1 ealt en e , r o p tal, at an u 66 0 188 1 0 25 0 0 2812 r u an un er t , 2 tea n o p tal a ara un 12 11 19 55 0 502 7 9 209 1 0 9 7 atan a a e o ealt en e, patan 99 0 1 8 0 o p tal 9 1681 2 2 80 69 0 2186 o rala n t tute o ealt en e, D aran 1 8 9 25 0 621 2 129 0 188 0 0 157 rop ar atern t 5 o en Ho p tal, 0 0 0 0 0 apat al 16 0 0 0 0 0 16 Sa an alal 6 Heart entre, 0 0 0 0 2709 an ar 0 0 0 0 0 0 2709 l er e Ho p tal, 7 0 n a an 0 0 0 0 2275 0 0 0 0 95 2 70 an o an ar o 8 ora , a ular 0 0 0 0 879 0 0 0 0 0 0 879 o rala 9 e or al an er 0 0 0 0 0 Ho p tal, aratpur 1555 0 0 0 0 1555 Sa D ar a a ta 10 ran plant entre, a tapur 197 6 0 18 0 0 0 0 0 0 0 o ara A a e o 11 Healt S en e, 10 0 0 0 0 o ara 0 0 0 0 0 10 ara an 12 8 0 0 0 0 o p tal, r un 0 0 0 0 0 0 8 Rapt A a e o 1 Healt S en e, Dan 0 0 0 0 0 0 0 0 0 89 122 e Ho p tal, 1 1 0 0 0 0 a rapur, apa 0 0 0 0 0 0 1 o Ho p tal, 15 oran 0 0 0 0 17 0 0 0 0 0 208
DoHS, Annual Report 2075/76 (2018/19) i g a ia it
idne
Na e of Ane ia Head In Head ur Spinal In ur
S.N. ell Total Ho pital particular Heart C Cancer ial i Parkin on Al hei er ial i idne d Sickle ae od Trau atic Trau atic H idne Peritoneal idne Treat ent idne Tran plant ara e or al 6 Ho p tal t, a po ara 8 10 0 0 0 0 0 0 0 0 0 58 H al Hop tal t, 7 ane ar, t 0 0 0 0 0 0 0 0 0 0 a o a Ho p tal t, 8 al u 0 0 0 0 5 0 0 0 0 0 0 5 at an u an er 9 enter, at al , a tapur 0 0 0 0 0 652 0 0 0 0 0 652 enu o p tal 0 p t lt , ane or, at an u 0 0 0 0 0 0 0 0 0 0 at onal ra a 1 enter, a a au a, t 0 0 0 0 0 0 0 1 1 61 0 0 502 o el e al olle e 2 ea n Ho p tal, ratna ar 85 10 0 0 895 0 202 20 8 15 0 1610 epal an er Ho p tal rear enter, al tpur 0 0 0 0 0 0 8 0 0 0 0 0 0 8 ran nternat onal Ho p tal t, D apa 2 0 0 0 0 0 0 0 0 0 0 2 r on Ho p tal , 5 an ra Rupan e 6 0 0 0 79 0 0 9 0 0 177 reen t Ho p tal 6 p t t , D apa , at an u 5 0 0 0 0 0 0 0 0 0 0 5 o p tal an 7 Re ear enter 8 0 0 0 0 0 0 0 0 0 8 euro ar o 8 ult pe al t Ho p tal, ratna ar 0 0 0 0 0 0 121 2 0 0 166 urna un rta t 9 Ho p tal, apa 0 0 0 0 0 0 0 0 0 0 ana Healt are 50 an Re ear enter t t 9 0 0 0 0 0 0 0 0 0 0 9 D ul el Ho p tal, 51 a re 1 0 0 0 10 122 0 0 0 0 0 176 a at ara 52 Ho p tal, apa 66 0 0 0 0 0 0 0 0 0 0 66 t e al olle e, 5 ea n Ho p tal, al tpur 57 0 0 0 0 0 0 0 0 0 0 57 5 a e t an r t al 8 0 0 0 0 0 0 0 0 0 0 8
DoHS, Annual Report 2075/76 (2018/19) i g a ia it
idne
Na e of Ane ia Head In Head ur Spinal In ur
S.N. ell Total Ho pital particular Heart C Cancer ial i Parkin on Al hei er ial i idne d Sickle ae od Trau atic Trau atic H idne Peritoneal idne Treat ent idne Tran plant ana pur Ho p tal, 16 ana pur 0 0 0 0 0 0 0 0 0 0 er Ho pp tal, 17 an e 12 0 0 0 0 0 0 0 0 0 167 179 Set onal o p tal, 18 a lal 62 0 0 0 0 0 0 0 0 0 270 2 epal e al 19 18 0 0 0 0 0 0 0 0 0 olle e orpat 126 1 an a e al 20 0 0 0 0 0 0 0 0 0 olle e, o ara 1 7 8 n er al olle eo 21 e al S en e , 10 0 0 0 0 0 0 0 0 0 0 a ra a a 10 t al e al 22 olle e ea n 0 0 0 Ho p tal, t an 88 22 50 0 2 16 0 512 olle e e al 2 0 0 0 S en e , t an 99 16 0 12 2 2 0 20 epal un e al 2 95 0 0 0 0 olle e, an e 0 0 0 0 0 95 an pal e al 25 olle e, ea n Hop tal po ara 7 20 0 0 90 127 0 12 6 0 0 292 a tapur an er 26 0 0 0 0 0 Ho p tal, a tapur 8829 0 0 0 0 0 8829 at onal n e 27 entre, ana t al 6 5 12 0 0 0 0 0 0 0 0 0 657 ol en Ho p tal 28 5 0 0 0 0 p t t , ratna ar 0 0 5 0 0 8 Ho p tal, 29 0 0 0 0 ar o 17 5 0 0 0 0 0 62 Aaro a ealt 0 2 6 61 0 0 0 prat t an, ul o 0 0 0 0 0 0 07 at onal al 1 1 8 0 0 0 0 enter, a un ara 0 0 0 0 0 0 1 8 an er are nepal, 2 0 0 0 0 0 a ala el 727 0 0 0 0 0 727 S arat a t Ho p tal t, ut al 8 0 0 0 0 0 0 0 0 0 0 8 Al a Ho p tal t, a ala el 50 0 0 0 0 0 0 0 0 0 0 50 auta u a Sa u a e Heart 5 Ho p tal, ut al, Rupan e 267 0 0 0 1066 0 0 0 0 0 0 1
DoHS, Annual Report 2075/76 (2018/19)
i g a ia it
idne
Ane ia Na e of Head In Head ur
Spinal In ur
S.N. ell Total Ho pital particular Heart C Cancer ial i
idne
Parkin on
Al hei er
ial i Ane ia idne Na e of d Sickle Head In Head ur Spinal In ur
S.N. ell ae od Trau atic Total Heart Ho pital particular Trau atic C Cancer H ial i idne Peritoneal idne Treat ent idne Tran plant Parkin on Al hei er ial i idne are Ho p tal, d Sickle ae od Trau atic Trau atic
po ara H idne Peritoneal idne Treat ent Sp nal n ur idne Tran plant 55 are Ho p tal, Re a l tat on entre 0 0 0 0 0 0 0 0 6 0 0 6 po ara Sp nal aratpur n ur Ho p tal, 5556 67 Re a aratpur l tat on entre 0 0 0 0 0 0 00 0 0 0 0 0 6 0 0 60 0 0 6 0 127 aratpur lue ro Ho Ho p tal, p tal 5657 67 aratpur t t 0 0 0 0 0 0 00 0 0 0 0 0 600 0 0 0 0 127 0 0 lueS ree ro ren Ho p ra tal 5758 108 Ho t t p tal, aun , t 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 108 S ree at onal ren ra t Ho p tal 5859 108 0 0 0 0 0 Ho p t tal, t , aun aratpur , t 0 0 0 0 0 1620 0 0 0 0 0 0 0 0 108 0 162 at onal t Ho p tal 59 epal ol e Ho p tal, 0 0 0 0 0 60 t t , aratpur 162 0 0 0 0 0 162 t 0 0 0 0 0 0 0 0 0 0 epal ol e Ho p tal, 60 o a o Ho p tal 61 t 0 0 0 0 0 0 0 0 0 0 o t a o t Ho p tal 0 0 0 0 0 0 0 0 0 0 05 05 61 ant l ren 62 t t 0 0 0 0 0 9 0 00 0 0 0 0 0 0 05 05 ant Ho p tal, l ren t 1 9 0 0 0 0 0 2 62 0 0 9 0 0 Ho Su p tal, eru t o un t 1 9 0 0 0 0 0 2 6 Su Ho eru p tal o t un t t 1 0 72 0 0 0 0 0 0 0 0 50 6 Ho Rapt p tal Ho t p t tal, 1 0 72 0 0 0 0 0 0 0 0 50 6 Rapt Ho p tal, 17 6 ul pur 17 0 0 0 0 0 0 0 0 0 0 17 ul D pur aula r Ho p tal, 0 0 0 0 0 0 0 0 0 0 17 65 D aula r Ho p tal, 6 65 a lun 6 0 0 0 0 0 0 0 0 0 0 6 a lun 0 0 0 0 0 0 0 0 0 0 6 Sur et ro n al 66 Sur et ro n al 2 66 2 Ho Ho p tal, p tal, Sur Sur et et 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 2 0 2 at at onal onal e e al al 6767 olle olle e, e, r un r un 79 79 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 79 0 79 Su Su l lo rala o rala an an er er 6868 Ho Ho p tal, p tal, an an e e 0 0 0 0 0 0 0 00 071 710 0 0 0 0 0 0 0 0 71 0 71 a en a en ra ra ara ara an an S n S n Ho Ho p tal, p tal, 6969 Ra Ra ra ra 11 11 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 11 0 11 Total 1 0 221 9 6 252 6828 7121 77 761 15 7 121 1026 5 0 Total 1 0 221 9 6 252 6828 7121 77 761 15 7 121 1026 5 0 Source: SSD, DoHS Source: SSD, DoHS Table 6.3.1.2: I ue challenge and reco endation Bipanna Nagrik Aau hadi Upchar Progra Table 6.3 e.1. 2: I ue challenge and reco endation Bipanna Nagrik Aau hadi Upchar Progra e I ue and challenge General reco endation n u ent u et/I un ue and or challenge po er e ro e a e uate un General or n orporate reco t endation pro ra e epale n u e ent t en u to et/ treat un er or ou ealt po er on e t on t ealt ro n e uran a e e uate un or n orporate t pro ra e e epale on tor e n t o en pu to l treat an pr er ate ou ealt ealt on t on ta l t a ta ealt or e n t uran at uper e e re ularl to t e a l e t e on tor n o pu l an pr ate ealt pu l an ta pr l ate a ta ealt or a e l t t e at uper e re ularl to t e a l t e pu l an pr ate ealt a l t e
DoHS, Annual Report 2075/76 (2018/19) i g a ia it 6.3.2 FCHV Programme 6.3.2 FCHV Programme
6.3.2.1 Background 6.3.2.1 Background g m t i i at t ma mm it a t t g amm i The government initiated the Female Community Health Volunteer (FCHV) Programme in 2045/46 (1988/1989) i in 27 i t i t districts a and a expanded it it to t all a 77 districts i t i t thereafter. t a i a Initially one FCHV was a a i t a a a a a a a t at a i t i appointed per ward and followed by a population-based approach that was introduced in 28 districts i t i t i a t i g i a g a a in 2050 (1993/94). There are currently 51,420 FCHVs working in Nepal. The goal and objectives of t g amm a i t i B the programme are listed in Box 6.3.2.1
Box 6.3.2.1: Goal and objectives of the FCHV Programme
Goal — Improve the health of local community peoples by promoting public health. This includes imparting knowledge and skills for empowering women, increasing awareness on health related issues and involving local institutions in promoting health care.
Objectives — i) Mobilise a pool of motivated volunteers to connect health programmes with communities and to provide community-based health services, ii) activate women to tackle common health problems by imparting relevant knowledge and skills; iii) increase community participation in improving health, iv) develop FCHVs as health motivators and v) increase the demand of health care services among community people.
a t a t m t g a i it a a i t ai i g a FCHVs are selected by health mothers' groups. FCHVs are provided with 9 days basic training and 9 a t ai i g i g i t i m i i it ma a i a t a days refresher training following which they receive medicine kit boxes, manuals, flipcharts, ward gi t mat ia a a ag ig a a i t a ami a i g i i registers, IEC materials, and an FCHV bag, signboard and identity card. Family planning devices (pills a m i ta t itami a a a i t t m t g a t and condoms only), iron tablets, vitamin A capsules, and ORS are supplied to them through health a i i facilities.
ma i t a at a t a i am g m t a mm it t The major role of FCHVs is to advocate healthy behaviour among mothers and community people to m t a m t i a t ami a i g a t mm it a a t i promote safe motherhood, child health, family planning and other community based health issues a i i i t i t m a i a t a itami a t at and service delivery. FCHVs distribute condoms and pills, ORS packets and vitamin A capsules, treat m ia a i a t a t i t a m at a at a pneumonia cases, refer serious cases to health institution and motivate and educate local people on a t a i at a i a i t i t i ta t t g a t m healthy behaviour related activities. They also distribute iron tablets to pregnant women.
The g m t government is i committed mmi to increase t i a the morale t m a and participation a a i a of FCHVs for community mm it health. Policies, a t strategies i i and t at gi guidelines a have g i i been developed a and updated accordingly a at to a i g strengthen the t t gt programme. t The g amm FCHV programme strategy g amm was revised t at g in 2067 a (2010) i to promote i a t m t a t gt a a g amm a a ta i strengthened national programme. In fiscal year 2064/65 MoH established FCHV funds of NPR i a mai t m t i m g a a i a 50,000 in each VDC mainly to promote income generation activities. FCHVs are recognised for having g i a i g a a ma i i g mat a a i m ta it a g a played a major role in reducing maternal and child mortality and general fertility through it t g mm it a a t g amm community-based health programmes.
6.3.2.26.3.2.2 Major Major activities activities in 2075/762075/76 Dress allowance for FCHVs increased from NPR 7,500 to NPR 10,000. a a i a m t i t g m t a a at g t a t a Since 2071/72 the government has allocated budget for farewell to FCHVs over 60 years of age ag a mm a t m t g as recommended by health mothers’ groups. t ai i g i ta a m i i a a a a t g amm The training, orientation and mobilization of FCHVs for national health programmes. Bia a i m g a a a at t m
DoHS, Annual Report 2075/76 (2018/19) Biannual FCHV review meeting was held and FCHV Day celebrated on 5th December. • annual H re e eet n a el an H Da ele rate on i g a ia it 5t De e er 6.3.2.36.3.2.3 Major Major achievements achievements in 2075/76in 2075/76 th 6.3.2.3Biannual Ma orFCHV achie review e meeting ent in 2075 was held 76 and FCHV Day celebrated on 5 December. 1. Progress reports, which provide the basis for the following analysis, that in fiscal year 2075/76,the 6.3.2.3 g t i i t a i t i g a a i t at i a a t 1 ro Major re report achievements , pro in 2075/76 e t e a or t e ollo n anal , t at n al ear 2075/76,t e number of mothers participating in health mother's group meetings were increased, despite of that m nu er o m t ot er part a i a g pat n n i ealt a t m t ot er roup g eet m g n ere n rea i a e , e p it te o t at 1.t at i t i t i m i m a i t a a FCHVs Progress distributed reports, whichfewer provide pills, condoms the basis in for comparisons the following to analysis, fiscal year that 2074/75.in fiscal year However, 2075/76,the FCHVs H tr ute e er p ll , on o n o par on to al ear 207 /75 Ho e er, H number i t i t m i ta t i m a i t a a a a ig distributed of mothers more iron participating tablet in comparisons in health mother's to fiscal group year 2074/75.meetings (Table were increased,6.3.2.1 and despite Figure 6.3.2.1)of that tr ute ore ron ta let n o par on to al ear 207 /75 ( a le 6 2 1 an ure 6 2 1) FCHVs distributed fewer pills, condoms in comparisons to fiscal year 2074/75. However, FCHVs Table 6.3.2.1: Trend of services provided by FCHVs distributed a le 6 2 more1 iron ren tablet o er in comparisons e pro e to fiscal H year 2074/75. (Table 6.3.2.1 and Figure 6.3.2.1) Services 2073/2074 2074/2075 2075/2076 Table 6.3.2.1: Ser Trend e of services provided by207 FCHVs /207 207 /2075 2075/2076 Pills distribution (no. cycles) 808,138 697,852 692,010 ll tr ut Services on (no le ) 2073/808,1 2074 8 2074/2075697,852 2075/2076692,010
Pills distribution (no. cycles) 808,138 697,852 692,010 Condom distribution (pieces) 9,983,379 9,006,248 8,759,624 on o tr ut on (p e e ) 9,98 , 79 9,006,2 8 8,759,62
Condom distribution (pieces) 9,983,379 9,006,248 8,759,624 Iron tablet distribution 717,267 664,162 718,285 ron ta let tr ut on 717,267 66 ,162 718,285
Iron tablet distribution 717,267 664,162 718,285 ealth mother’s group meetings 506,909 517,285 520,101 Healt ot er roup eet n 506,909 517,285 520,101
ealth mother’s group meetings 506,909 517,285 520,101 Source:Sour e HMIS/DoHS H S/DoHS Figure 6.3.2.1: FCHV contribution on selected health services in FY 2073/74 2075/76 (,000) Source: ure HMIS/DoHS6 2 1 H ontr ut on on ele te ealt er e n 207 /7 2075/76 (,000)
Figure 6.3.2.1: FCHV contribution on selected health services in FY 2073/74 2075/76 (,000)
2075/20762075/2076 207 2074/2075 /2075 207 2073/74 /7
2075/2076 2074/2075 2073/74 ealth mother’s group meet ngs Healt ot er roup eet n
ealth mother’s group meet ngs Iron tablet distribution ron ta let tr ut on
Iron tablet distribution Condom distribution (pieces) on o tr ut on (p e e )
Condom distribution (pieces) Pills distribution (no. cycles) ll tr ut on (no le ) 0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000 Pills distribution (no. cycles) 0 2,000,000 ,000,000 6,000,000 8,000,000 10,000,000 12,000,000
Source:Sour e HMIS/DoHS H S/DoHS 0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000
Source: HMIS/DoHS
DoHS, Annual Report 2075/76 (2018/19) i g a ia it 2. In 2075/76 t they i i at initiated a baby t to m t mother i t i skin-to-skin ta t contact a after i delivery i in 85,223 a cases, a i i i t t m i i a i a a t ta i g applied2. In 2075/76 chlorhexidine they initiated to the umbilicusbaby to mother after delivery skin-to -skinfor 74,977contact cases after anddelivery ensured in 85,223 the taking cases, of mi t t i a a misoprostolapplied chlorhexidine for prevent to PPH the in umbilicus 16,561cases after (Table delivery 6.3.2 for.2). 74,977 cases and ensured the taking of misoprostol for prevent PPH in 16,561cases (Table 6.3.2.2). Table 6.3.2.2: Support provided byFCHVs for home deliveries, 2075/76 Table 6.3.2.2: Support provided byFCHVs for home deliveries, 2075/76 Initiating skin-to-skin Chlorhexidine applied Ensured Province Initiatingcontact afterskin-to birth-skin Chlorhexidineon umbilicus applied misoprostolEnsured tablets Province contact after birth on umbilicus misoprostoltaken tablets taken Province 1 13,735 13,243 3,873 Province 1 13,735 13,243 3,873 Province 2 40,780 34,726 4,243 Province 2 40,780 34,726 4,243 Bagmati i 6,922 5,275 2,612 Bagmati i 5,275 2,612 Gandaki Province 2,8516,922 2,796 772 ProvinceGandaki 5Province 10,8232,851 2,7969,199 2,243772 KarnaliProvince Province 5 10,8236,231 9,1996,185 2,2432,047 SudurpashchimKarnali Province Province 3,8816,231 6,1853,553 2,047771 Sudurpashchim Province 3,881 3,553 771 National 85,223 74,977 16,561 National 85,223 74,977 16,561 Source: HMIS/DoHS Source: HMIS/DoHS SupportSupport for ho home e deliveriesdeli erie Support for home deliveries FCHVs t supported i in m home i i deliveries t too. In 2075/76 a (Table 6.3.2.3), FCHVs i it visit-newborn & PP t Bi t a Bi t a t a Bi t a Mothers-FCHVs supported hours in o home rth ,deliveries on 3rd day too. of InBirth 2075/76 and on (Table 7th day 6.3. of2. 3),Birth FCHVs were visit-newborn 75,522, 84,009 & andPP 84,202Mothers- respectively. hours o rth, on 3rd day of Birth and on 7th day of Birth were 75,522, 84,009 and 84,202 respectively. Table 6.3.2.3: FCHVs support for home deliveries Table 6.3.2.3: FCHVs support for home deliveries Home Delivery-visit- Home Delivery-visit- Home Delivery-visit- Homenewborn& Delivery PP-visit - Homenewborn& Delivery -PPvisit - Homenewborn& Delivery -PPvisit - Mothersnewborn&- hours PP o Mothersnewborn&- 3rd dayPP of Mothersnewborn&-7th dayPP of Province Mothers-Birth hours o Mothers-Birth 3rd day of Mothers-7thBirth day of Province Birth Birth Birth Province 1 10,887 13,048 13,154 Province 1 10,887 13,048 13,154 Province 2 37,400 37,572 37,767 Province 2 37,400 37,572 37,767 Bagmati i 6,025 6,173 6,221 Bagmati i 6,025 6,173 6,221 GandakiProvince 2,605 3,176 3,741 GandakiProvince 2,605 3,176 3,741 Province 5 8,478 12,967 12,301 Province 5 8,478 12,967 12,301 Karnali Province 6,074 5,778 5,289 Karnali Province 6,074 5,778 5,289 Sudurpashchim Province 4,053 5,295 5,729 Sudurpashchim Province 4,053 5,295 5,729 National 75,522 84,009 84,202 National 75,522 84,009 84,202 Source: HMIS/DoHS Source: HMIS/DoHS
DoHS, Annual Report 2075/76 (2018/19) i g a ia it NutritionNutrition servicesservices providedprovided by by FCHVs FCHVs at at the the Household Household level level
t i i i i a B a t i g Nutrition services were provided by FCHVs in 2075/76 (Table 6.3.2.4). Breast Feeding<1 hour of Birth Nutrition services provided by FCHVs at the Household level Bi t a i t i it a and distribution of PP Vit A were 89897 and 161499 respectively.
TableNutritionTable 6.3.2.4:6.3. services2.4: Nutrition were providedservice service provided byprovided FCHVs by in byFCHVs 2075/76FCHVs at theat (Table the Household Household6.3.2.4). level Breast level Feeding<1 hour of Birth and distribution of PP Vit A were 89897 and 161499 respectively. Province Breast Feeding<1 hour of Birth Distribution of PP Vit A Table 6.3.2.4: Nutrition service provided by FCHVs at the Household level Province 1 14,672 31,484 Province 2 43,158 63,323.2 Province Breast Feeding<1 hour of Birth Distribution of PP Vit A Bagmati i 7,613 18,610 Province 1 14,672 31,484 Gandaki Province 3,065 8,232 Province 2 43,158 63,323.2 Province 5 10,322 20,232 Bagmati i 7,613 18,610 Karnali Province 6,787 11,116 Gandaki Province 3,065 8,232 Sudurpashchim Province 4,280 8,502 Province 5 10,322 20,232 Nepal 89,897 161,499 Karnali Province 6,787 11,116 Source: HMIS/DoHS Sudurpashchim Province 4,280 8,502 IMAM servicesNepal provided by FCHVs at the Household89,897 level 161,499 IMAMSource: services HMIS/DoHS provided by FCHVs at the Household level IMAM services were provided by FCHVs in 2075/76 (Table 6.3.2.5). Screening of children through IMAM services provided by FCHVs at the Household level i i i a i g i t g MUAC and categorized their nutritional status as follows, 9,334 are SAM, 86,475 are MAM while 247 a at g i t i t i a tat a a a i screened as oedema where as 2,935,281 are normal children as well by FCHVs. a ma a a ma i IMAM services were provided by FCHVs in 2075/76 (Table 6.3.2.5). Screening of children through MUACTable 6.3.2.5: and categorized IMAM service their providednutritional by status FCHVs as at follows, the Household 9,334 are level SAM, 86,475 are MAM while 247 screened as oedema where as 2,935,281 are normal children as well by FCHVs. MUAC- MUAC- MUAC- Table 6.3.2.5: IMAM service provided by FCHVs at the Household level MUAC-Screening- Screening-Red- Screening- Screening- Table 6.3.2.5: IMAM service provided by FCHVs at the Household level Green-Normal Province SAM Yellow-MAM Oedema MUAC- MUAC- MUAC- Province 1 591 6,201 27 MUAC-Screening-239,311 Screening-Red- Screening- Screening- Province 2 3,059 20,358 127 Green-Normal541,516 Province SAM Yellow-MAM Oedema Bagmati i 688 6,276 10 828,528 Province 1 591 6,201 27 239,311 Gandaki Province 118 417 0 86,832 Province 2 3,059 20,358 127 541,516 Province 5 559 2,394 2 189,443 Bagmati i 688 6,276 10 828,528 Karnali Province 1,656 17,244 25 393,687 Gandaki Province 118 417 0 86,832 Sudurpashchim 559725 2,3948,320 292 189,443110,890 ProvinceProvince 5 Karnali Province 1,656 17,244 25 393,687 Nepal 9,334 86,475 247 2,935,281 Sudurpashchim Source: HMIS/DoHS 725 8,320 29 110,890 Province Nepal 9,334 86,475 247 2,935,281 Source: HMIS/DoHS
DoHS, Annual Report 2075/76 (2018/19) a i
6.3.46.3.4 Issues Issues andand constraints
TableTable 6.3.4.1: 6.3.4.1: Issues Issues and constraintsconstraints — — FCHVs FCHVs Issues and constraints Recommendations Responsibility Low utilization of FCHV Fund Strictly implement guidelines and audit NSSD, DHOs, HFs, FCHV fund every year Health Section of local level, rural municipalities, municipalities, sub-metro and metro municipalities FCHV are not interested in farewell Rethink the farewell package NSSD, DHOs, programmes Implement revised FCHV strategy (1st Health Section of amendment_2076) local level, rural, municipalities, sub-metro and metro municipalities Decreasing work performance of Motivate FCHV through FCHV Review NSSD, DHOs, HFs, FCHV meeting and orientation for FCHV on Health Section of related program local level, rural, municipalities, sub-metro and metro municipalities
DoHS, Annual Report 2075/76 (2018/19) a i CURATIVE SERVICE Chapter 7 Chapter
A.Background a i i i i i i i i a tm t a t i t t t i g a i t a m i i t a t a a g i t a i i g a t m it i mi i t it a m i t t t a i itat t t i t t i t gi i g a a a i i i i a ta i it i a tm t a t i i a i i i i a i i t t i t a gi g t t t at i a ta i a t g t a i i i a t am a i i i t
i g t t i t a am t a t a t t m a i t a i t t ta t i t a i a a t i a a i t i a t m t t i t i t a a gi a gi a ita a a t ia i t a ita i a i a a ig t t at t ma it a i i mi t ia i t atm t i a a i t t m a at a i t a a t t m a a g m a i m i i g gi a ia i a t i a t m t t t t i
ma i i it i t i t a i a t i t g a a t t a a g at a i at t ta i at a g a ia i t a ita a i at a i a a a t i
a t i i i i i t a a a t i a i t g it t i t am ita i it i g a t gt i g Ba i a t a m g a ag m t a a a a t
B.Sections under Curative Service Division and their key functions 1. Hospital Service Monitoring and Strengthening Section a i t a i g i a a it ta a t m a ga i g ita t gt a i t m t a t i at a i a t i t a t a i m a g a i t at g a it ia a i itat t gi t a a a g a t ia i a t a ita a i t m t a a i t at gi a g i i ga i g gi t a g a a m it i g i at a g m ta ita i g m i i i i i i a m it i g t ita m m a it i a ag m t a ia i a t a t a a a a i t a a ta a a i itat t m t a i t a i a t t m i i i t m
DoHS, Annual Report 2075/76 (2018/19) a i a i t t m t a t t i m m a g a i t at gi it ia t i at m t a ma ag m t a a t a a t ai i g t m at ta a t atm t t a g i t a i a i g t t i g a m it i g g i i t ita a ma a a t a i i m a ta a a mi ia i ta a a a t ai i g mat ia a a g a t t ai i g a t a i
2. Basic Health and Emergency Management Section a ma ag m t Ba i a t i a i g t a t m a i it at t t mi i g t a it ia a i a t i i i m it i g a a a t a it a i a t i a a t a i a t i a i at t a a t t im m t i i g a i a a t i a i a t a i a t m g i a a ai a i it a ia a a t t a a a t a i a t i a i itat ma a i it ia t a g i i t ma m g a t a i a i itat ma a i it ia t a g i i ga i g a t m a a i t t im m ta m it i g a g a m g i a a i
3. Eye, ENT and Oral Health Section a i itat m a a a i ta a t a g i i at t a t a i itat m a a a i ta a t a g i i at t i a i itat m a a a i ta a t a g i i at t a a t i a a t a a a t a i at t a a t t im m t i i g a a i ita a i a i t g a it a t a a a t i t a a a t i t m a t a at t a a a t i
C. Minimum Service Standards for Hospitals i im m i ta a ita i t i a i a a ai a i it t ma i m t t ita t i mi im m i t at a t m t m i t tai a a i i i a m t i i a t at a t mi i t a a it ita t a i g i m t i a i a it a t i i i ita t t ma mi im m it ia i t i t i it i t a i a i t t ma im m ta a i i t i i t t a a g am i a it im m t t a it i t i t i m t i it ma i a i g t i t t tai t t ta a a g DoHS, Annual Report 2075/76 (2018/19) a i a i
t a a t a i it t at am g t a t a i i t at a t t m a a a i i m t it m a t ig i g a i ig i g a i a t ig i g a t m m t t t a a at a a ig t i i i a ai a i it a i a i m t ta a a t a a a a a i a at i i a a i i a i t a m a i m i a i a a a a mi g it a i g t at i mi im m i ta a a t i i t i t ita a a i t t t i t i a it i i ita it i ta im g a ma ag m t i i a a t i i ag t t it t g t mi im m i ta a ita a a t a a at t am m t t a i i i t i t ita t t ima ita i i a m t t t t i t i t gi i g it m a i a i g a t t a t i a i at a ta a m g ig i i a m t g i i g m t a t a a a a t i i a it a i a t a i i a t i t a t g at a t a t t m t ta a a a t t t at g a i i a t t ta i m t a a g a i g ta a t t imit t t m
a i a m i t ma a a t ita t mi im m i t at a t i t a t a i i a a t a t i g a i a g a t t a ami a i i t i a ta a i i a i at i i ita i a t a m i a ta g t g m t ita t i at t a i g a a a t t m t t t m gi g t t
t a ga i i t ma a a a ag m t i i a i a ag m t a ita t i a ag m t t a a i t m i t t at t i t a a i a t at a am ta t ta i i t a a it ima ita it g a i t a t ta t ta a it t ta t i ta a m a i g g a a ma ag m t a a ig tag ta a m a i g i i a i ma ag m t a a ig tag a ta a m a i g t i ma ag m t a a ig tag a a ma ag m t i t mi im m ta a i i i a i ma ag m t a t i t a ita t i ma ag m t a
a m t a t t ta a a i g a i t ig t g a a ma ag m t i ig i t at i i a i ma ag m t i ig i a t at ita t i ma ag m t i ig i m t ig tag t gi t a t ita a a it i i i ita m a t i g it a a a t i t ga a a t at a t a t g t m t t a a t at ma t t i a a a ia i t a ma ag ia mmitm t a i g i it im m ta g i i t at i a m t a a ga i a a a m t a t i i g ma DoHS, Annual Report 2075/76 (2018/19) service management and has weightage of 60%, and 124 standards for measuring support service management and has weightage of 20%. Governance and management section includes the minimum standards for six subsections, clinical Service management has thirteen sub sections and hospital support service management has eleven subsections. After assessment of all the sections of the standards, for overall scoring, each section is then weighed. The section of the governance and management (Section I) is weighed in 20%, that of clinical service management (Section II) is weighed in 60% and that of hospital support service management (Section III) is weighed in 20%. The sum of these weighed percentage of the subsections give the overall MSS score of the hospitals and based on it colour code will be provided. This MSS Score for hospitals measure the existing situation and enables to identify the gap areas that are to be addressed through the development of the actions plan that demands both technical and financial inputs and managerial commitments. The overall process is guided by its implementation guideline that describes on sequences of self-assessment and follow up a i workshops and gap identification for action plan development and striving for optimal MSS Score. i i t Ministry of a t Health a and a Population strives t i to t implement im m t MSS in hospitals i ita for establishing ta i i g a i g i m t at i i i t t g a a a ai a i it a it enabling environment at service delivery point through preparedness and availability for quality i i i t t t i g a a i t a i i a i ita a service provision to the users. Not being an exhaustive list of facilities and services, hospitals are ag encouraged t to t i strive for m t betterment and a go g beyond the t defined set of t minimum mi im m standards ta a t i t whenever their resources support. Minimum Service Standards (MSS) for hospitals were previously lead by Curative Service i im m i ta a ita i a a i Division, Ministry of Health and Population. Now in changing context, as per ToR of Division the i i i i i t a t a a i a gi g t t a i i i t programme will run by Curative Service Division, DoHS. Following is the progress data regarding g amm i a i i i i i g i t g ata ga i g Minimum Service Standards (MSS) score of 84 district level hospitals of F/Y 2075/76. i im m i ta a i t i t ita 7.2.4 MSS Score of Hospitals fiscal year 2075/76 by province i im m i ta a ita i i a a
SN Clus ter H os p ital 1 1 2 3 1 2 4 5 Follow upFollow e. Follow upe. Follow d. Follow upd. Follow upg. Follow h. c. W ork s hop a. W ork s hop b . W ork s hop f. Follow upf. Follow 3 1 C1 Gaur H os p ital ( R autahat) 2 7 % 34% 47 % 46 % 5 1% 45 % 44% 48 %
2 J ales hwor D is trict H os p ital 2 8 % 42 % 45 % 35 % 6 2 % 39 % 47 % 6 8 % ( M ahottari) 3 K alaiya H os p ital ( Bara) 2 7 % 5 3% 6 3% 6 5 % 6 7 % 7 7 % 6 2 % 6 4%
4 M alangwa H os p ital ( S arlahi) 2 9 % 2 7 % 43% 2 6 % 32 % 30 % 5 1% 0 %
5 C2 J iri H os p ital ( D olk ha) 7 5 % 8 6 % 9 0 % 7 9 % 8 8 % 8 1% 0 % 0 %
6 R amechhap D is trict H os p ital 5 4% 6 9 % 7 3% 6 6 % 7 7 % 7 1% 0 % 0 %
7 S indhuli D is trict H os p ital 6 2 % 8 1% 8 5 % 8 0 % 8 2 % 9 6 % 0 % 0 %
8 C3 Bardib as H os p ital, M ahottari 34% 5 9 % 7 1% 5 2 % 47 % 45 % 0 % 0 %
9 Chandranigap ur H os p ital 31% 6 1% 7 7 % 41% 6 7 % 0 % 0 % 0 % ( R autahat) 10 Pok hariya H os p ital ( Pars a) 47 % 40 % 6 2 % 6 2 % 48 % 5 5 % 0 % 0 %
11 C4 D hading H os p ital 6 9 % 8 7 % 9 3% 8 9 % 0 % 0 % 0 % 0 % 12 R as uwa D is trict H os p ital 37 % 5 4% 7 0 % 6 8 % 0 % 0 % 0 % 0 %
13 T ris huli H os p ital ( N uwak ot) 7 2 % 7 7 % 7 9 % 6 8 % 0 % 0 % 0 % 0 %
14 C5 Bagauda H os p ital ( Chitwan) 41% 5 7 % 6 5 % 5 0 % 0 % 0 % 0 % 0 %
15 Bak ulaharR atnanagar H os p ital 5 2 % 5 5 % 7 1% 7 6 % 0 % 0 % 0 % 0 % ( Chitwan)
16 H etauda H os p ital 49 % 7 0 % 7 2 % 6 7 % 0 % 0 % 0 % 0 % 17 C6 Chautara H os p ital 45 % 7 6 % 8 2 % 6 6 % 0 % 0 % 0 % 0 % ( S indhup alchowk ) 18 M ethink ot H os p ital 6 1% 6 3% 7 3% 6 1% 0 % 0 % 0 % 0 % 19 E 1 I lam D is trict H os p ital 6 0 % 7 2 % 7 5 % 5 5 % 5 9 % 6 1% 7 3% 7 2 %
20 Panchthar D is trict H os p ital 47 % 6 2 % 7 2 % 5 7 % 5 9 % 6 0 % 6 8 % 7 9 %
2 1 T ap lej ung D is trict H os p ital 36 % 5 3% 6 9 % 5 1% 7 5 % 7 5 % 7 5 % 7 2 %
22 E 2 Bhoj p ur D is trict H os p ital 48 % 5 5 % 8 4% 6 0 % 6 3% 6 6 % 0 % 0 %
2 3 S ank huwas ab ha D is trict 5 2 % 6 5 % 7 8 % 6 8 % 7 0 % 8 1% 0 % 0 % H os p ital 24 T erhathum D is trict H os p ital 42 % 6 1% 6 1% 7 7 % 7 2 % 7 4% 0 % 0 % DoHS, Annual Report 2075/76 (2018/19) 2 5 E 3 Gaighat H os p ital, U dayap ur 5 7 % 7 2 % 8 5 % 6 5 % 6 2 % 0 % 0 % 0 %
26 K atari H os p ital ( U dayap ur) 40 % 6 0 % 6 7 % 5 3% 7 3% 0 % 0 % 0 %
2 7 K hotang D is trict H os p ital 40 % 7 5 % 8 7 % 6 0 % 6 3% 7 0 % 0 % 0 %
28 E 4 Phap lu H os p ital, S oluk humb u 6 0 % 6 6 % 8 2 % 7 5 % 0 % 0 % 0 % 0 %
2 9 R umj atar H os p ital, 48 % 6 4% 7 5 % 8 0 % 0 % 0 % 0 % 0 % O k haldhunga 30 E 5 D hank uta D is trict H os p ital 7 6 % 8 9 % 9 4% 9 0 % 0 % 0 % 0 % 0 %
31 I naruwa H os p ital, S uns ari 40 % 5 9 % 6 9 % 5 1% 0 % 0 % 0 % 0 %
32 R angeli H os p ital, M orang 40 % 7 6 % 8 2 % 6 1% 0 % 0 % 0 % 0 %
33 E 6 Bhardaha H os p ital ( S ap tari) 42 % 6 0 % 6 9 % 5 7 % 0 % 0 % 0 % 0 %
34 L ahan D is trict H os p ital ( S iraha) 5 9 % 6 9 % 8 1% 6 8 % 0 % 0 % 0 % 0 %
35 S iraha D is trict H os p ital ( S iraha) 41% 7 6 % 8 1% 5 1% 0 % 0 % 0 % 0 % 8 C3 Bardib as H os p ital, M ahottari 34% 5 9 % 7 1% 5 2 % 47 % 45 % 0 % 0 %
9 Chandranigap ur H os p ital 31% 6 1% 7 7 % 41% 6 7 % 0 % 0 % 0 % ( R autahat) 10 Pok hariya H os p ital ( Pars a) 47 % 40 % 6 2 % 6 2 % 48 % 5 5 % 0 % 0 %
11 C4 D hading H os p ital 6 9 % 8 7 % 9 3% 8 9 % 0 % 0 % 0 % 0 % 12 R as uwa D is trict H os p ital 37 % 5 4% 7 0 % 6 8 % 0 % 0 % 0 % 0 %
13 T ris huli H os p ital ( N uwak ot) 7 2 % 7 7 % 7 9 % 6 8 % 0 % 0 % 0 % 0 %
14 C5 Bagauda H os p ital ( Chitwan) 41% 5 7 % 6 5 % 5 0 % 0 % 0 % 0 % 0 %
15 Bak ulaharR atnanagar H os p ital 5 2 % 5 5 % 7 1% 7 6 % 0 % 0 % 0 % 0 % ( Chitwan)
16 H etauda H os p ital 49 % 7 0 % 7 2 % 6 7 % 0 % 0 % 0 % 0 % 17 C6 Chautara H os p ital 45 % 7 6 % 8 2 % 6 6 % 0 % 0 % 0 % 0 % ( S indhup alchowk ) 18 M ethink ot H os p ital 6 1% 6 3% 7 3% 6 1% 0 % 0 % 0 % 0 % 19 E 1 I lam D is trict H os p ital 6 0 % 7 2 % 7 5 % 5 5 % 5 9 % 6 1% 7 3% 7 2 %
20 Panchthar D is trict H os p ital 47 % 6 2 % 7 2 % 5 7 % 5 9 % 6 0 % 6 8 % 7 9 %
2 1 T ap lej ung D is trict H os p ital 36 % 5 3% 6 9 % 5 1% 7 5 % 7 5 % 7 5 % 7 2 %
22 E 2 Bhoj p ur D is trict H os p ital 48 % 5 5 % 8 4% 6 0 % 6 3% 6 6 % 0 % 0 %
2 3 S ank huwas ab ha D is trict 5 2 % 6 5 % 7 8 % 6 8 % 7 0 % 8 1% a i 0 % 0 % H os p ital 24 T erhathum D is trict H os p ital 42 % 6 1% 6 1% 7 7 % 7 2 % 7 4% 0 % 0 %
2 5 E 3 Gaighat H os p ital, U dayap ur 5 7 % 7 2 % 8 5 % 6 5 % 6 2 % 0 % 0 % 0 %
26 K atari H os p ital ( U dayap ur) 40 % 6 0 % 6 7 % 5 3% 7 3% 0 % 0 % 0 %
2 7 K hotang D is trict H os p ital 40 % 7 5 % 8 7 % 6 0 % 6 3% 7 0 % 0 % 0 %
28 E 4 Phap lu H os p ital, S oluk humb u 6 0 % 6 6 % 8 2 % 7 5 % 0 % 0 % 0 % 0 %
2 9 R umj atar H os p ital, 48 % 6 4% 7 5 % 8 0 % 0 % 0 % 0 % 0 % O k haldhunga 30 E 5 D hank uta D is trict H os p ital 7 6 % 8 9 % 9 4% 9 0 % 0 % 0 % 0 % 0 %
31 I naruwa H os p ital, S uns ari 40 % 5 9 % 6 9 % 5 1% 0 % 0 % 0 % 0 %
32 R angeli H os p ital, M orang 40 % 7 6 % 8 2 % 6 1% 0 % 0 % 0 % 0 %
33 E 6 Bhardaha H os p ital ( S ap tari) 42 % 6 0 % 6 9 % 5 7 % 0 % 0 % 0 % 0 %
34 L ahan D is trict H os p ital ( S iraha) 5 9 % 6 9 % 8 1% 6 8 % 0 % 0 % 0 % 0 %
35 S iraha D is trict H os p ital ( S iraha) 41% 7 6 % 8 1% 5 1% 0 % 0 % 0 % 0 %
36 E 7 D amak H os p ital, J hap a 48 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
37 M angalb are H os p ital, M orang 49 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
38 F1 A chham D is trict H os p ital 45 % 6 0 % 7 5 % 7 2 % 7 0 % 8 8 % 9 0 % 8 9 %
39 Baj ura D is trict H os p ital 47 % 45 % 7 0 % 5 6 % 5 3% 6 7 % 6 5 % 6 7 %
40 D oti D is trict H os p ital 45 % 7 5 % 7 6 % 5 3% 47 % 5 9 % 6 8 % 7 3%
41 F2 Baitadi D is trict H os p ital 48 % 7 2 % 7 4% 7 0 % 6 1% 6 5 % 0 % 0 %
42 Baj hang D is trict H os p ital 5 3% 7 7 % 8 3% 8 7 % 8 4% 8 1% 8 0 % 0 %
43 D archula D is trict H os p ital 35 % 5 7 % 6 7 % 7 3% 7 5 % 7 5 % 8 2 % 0 %
44 Gok ules hwor H os p ital 39 % 5 9 % 6 8 % 7 0 % 5 8 % 6 6 % 8 2 % 0 %
45 F3 J ogb udha H os p ital 5 0 % 7 3% 7 7 % 8 2 % 0 % 0 % 0 % 0 % ( D adeldhura) 46 M alak het H os p ital 2 8 % 39 % 5 1% 49 % 0 % 0 % 0 % 0 % 47 T ik ap ur H os p ital ( K ailali) 48 % 8 4% 8 8 % 8 2 % 0 % 0 % 0 % 0 %
48 M 1 Pyuthan D is trict H os p ital 48 % 6 1% 6 9 % 6 4% 5 9 % 7 6 % 7 2 % 6 4%
49 R olp a D is trict H os p ital 43% 5 9 % 6 3% 6 7 % 6 7 % 6 6 % 7 3% 7 0 %
50 R uk um D is trict H os p ital 5 6 % 5 2 % 7 5 % 43% 5 0 % 32 % 5 7 % 7 1%
5 1 S alyan D is trict H os p ital 49 % 7 2 % 7 8 % 5 7 % 6 4% 6 7 % 7 8 % 7 5 %
52 M 2 D ailek h D is trict H os p ital 6 0 % 7 3% 7 1% 6 9 % 8 2 % 8 7 % 9 1% 0 %
5 3 D ullu H os p ital 38 % 42 % 6 5 % 6 9 % 7 2 % 5 8 % 6 5 % 0 % 54 Gulariya D is trict H os p ital, 5 8 % 8 1% 8 5 % 7 6 % 7 3% 8 0 % 8 8 % 0 % Bardiya 5 5 M ehelk una H os p ital, S urk het 36 % 47 % 5 5 % 5 9 % 48 % 6 2 % 7 6 % 0 %
56 M 3 K alik ot D is trict H os p ital 35 % 7 1% 8 9 % 8 0 % 6 5 % 6 7 % 0 % 0 %
5 7 M ugu D is trict H os p ital 2 4% 40 % 7 5 % 5 9 % 47 % 0 % 0 % 0 %
58 M 4 D olp a D is trict H os p ital 6 9 % 0 % 5 9 % 7 3% 0 % 0 % 0 % 0 % DoHS, Annual Report 2075/76 (2018/19) 5 9 M 5 H umla D is trict H os p ital 39 % 0 % 5 2 % 6 5 % 0 % 0 % 0 % 0 %
60 M 6 J aj ark ot D is trict H os p ital 38 % 48 % 6 8 % 5 8 % 0 % 0 % 0 % 0 %
6 1 M 7 L amahi H os p ital, D ang 42 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
62 W 1 A rgak hanchi D is trict H os p ital 5 8 % 7 6 % 8 5 % 7 6 % 5 9 % 5 9 % 6 8 % 0 %
6 3 Bhim H os p ital, R up andehi 5 9 % 6 9 % 6 3% 5 9 % 6 0 % 7 6 % 7 8 % 0 % ( Bhairawa) 36 E 7 D amak H os p ital, J hap a 48 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
37 M angalb are H os p ital, M orang 49 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
38 F1 A chham D is trict H os p ital 45 % 6 0 % 7 5 % 7 2 % 7 0 % 8 8 % 9 0 % 8 9 %
39 Baj ura D is trict H os p ital 47 % 45 % 7 0 % 5 6 % 5 3% 6 7 % 6 5 % 6 7 %
40 D oti D is trict H os p ital 45 % 7 5 % 7 6 % 5 3% 47 % 5 9 % 6 8 % 7 3%
41 F2 Baitadi D is trict H os p ital 48 % 7 2 % 7 4% 7 0 % 6 1% 6 5 % 0 % 0 %
42 Baj hang D is trict H os p ital 5 3% 7 7 % 8 3% 8 7 % 8 4% 8 1% 8 0 % 0 %
43 D archula D is trict H os p ital 35 % 5 7 % 6 7 % 7 3% 7 5 % 7 5 % 8 2 % 0 %
44 Gok ules hwor H os p ital 39 % 5 9 % 6 8 % 7 0 % 5 8 % 6 6 % 8 2 % 0 %
45 F3 J ogb udha H os p ital 5 0 % 7 3% 7 7 % 8 2 % 0 % 0 % 0 % 0 % ( D adeldhura) 46 M alak het H os p ital 2 8 % 39 % 5 1% 49 % 0 % 0 % 0 % 0 % 47 T ik ap ur H os p ital ( K ailali) 48 % 8 4% 8 8 % 8 2 % 0 % 0 % 0 % 0 %
48 M 1 Pyuthan D is trict H os p ital 48 % 6 1% 6 9 % 6 4% 5 9 % 7 6 % 7 2 % 6 4%
49 R olp a D is trict H os p ital 43% 5 9 % 6 3% 6 7 % 6 7 % 6 6 % 7 3% 7 0 %
50 R uk um D is trict H os p ital 5 6 % 5 2 % 7 5 % 43% 5 0 % 32 % 5 7 % 7 1%
5 1 S alyan D is trict H os p ital 49 % 7 2 % 7 8 % 5 7 % 6 4% 6 7 % 7 8 % 7 5 %
52 M 2 D ailek h D is trict H os p ital 6 0 % 7 3% 7 1% 6 9 % 8 2 % 8 7 % 9 1% 0 %
5 3 D ullu H os p ital 38 % 42 % 6 5 % 6 9 % 7 2 % 5 8 % 6 5 % 0 % 54 Gulariya D is trict H os p ital, 5 8 % 8 1% 8 5 % 7 6 % 7 3% 8 0 % 8 8 % 0 % Bardiya 5 5 M ehelk una H os p ital, S urk het 36 % 47 % 5 5 % 5 9 % 48 % 6 2 % 7 6 % 0 %
56 M 3 K alik ot D is trict H os p ital 35 % 7 1% 8 9 % 8 0 % 6 5 % 6 7 % 0 % 0 %
a i 5 7 M ugu D is trict H os p ital 2 4% 40 % 7 5 % 5 9 % 47 % 0 % 0 % 0 %
58 M 4 D olp a D is trict H os p ital 6 9 % 0 % 5 9 % 7 3% 0 % 0 % 0 % 0 %
5 9 M 5 H umla D is trict H os p ital 39 % 0 % 5 2 % 6 5 % 0 % 0 % 0 % 0 %
60 M 6 J aj ark ot D is trict H os p ital 38 % 48 % 6 8 % 5 8 % 0 % 0 % 0 % 0 %
6 1 M 7 L amahi H os p ital, D ang 42 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
62 W 1 A rgak hanchi D is trict H os p ital 5 8 % 7 6 % 8 5 % 7 6 % 5 9 % 5 9 % 6 8 % 0 %
6 3 Bhim H os p ital, R up andehi 5 9 % 6 9 % 6 3% 5 9 % 6 0 % 7 6 % 7 8 % 0 % ( Bhairawa)
64 T amghas D is trict H os p ital 5 7 % 7 2 % 7 8 % 6 9 % 7 3% 6 9 % 7 1% 0 % ( Gulmi) 6 5 T aulihawa D is trict H os p ital 46 % 5 7 % 7 4% 5 3% 5 7 % 7 6 % 7 8 % 7 4% ( K ap ilv as tu)
66 W 2 M us tang D is trict H os p ital 5 8 % 6 4% 7 2 % 5 2 % 5 8 % 6 1% 0 % 0 %
6 7 M yagdi D is trict H os p ital 7 5 % 8 9 % 9 1% 8 5 % 8 2 % 8 4% 0 % 0 %
68 Parb at D is trict H os p ital 5 3% 8 4% 9 1% 5 9 % 5 6 % 6 4% 0 % 0 %
6 9 W 3 Bandip ur H os p ital 45 % 5 2 % 5 5 % 6 6 % 6 9 % 7 2 % 0 % 0 % 70 D amauli H os p ital 44% 7 8 % 6 9 % 7 1% 7 2 % 7 5 % 0 % 0 % 7 1 W 4 Gork ha D is trict H os p ital 7 1% 7 5 % 7 8 % 8 0 % 0 % 0 % 0 % 0 %
72 M anang D is trict H os p ital 39 % 5 7 % 6 5 % 6 2 % 0 % 0 % 0 % 0 %
7 3 W 5 Pip ara H os p ital, K ap ilv as tu 5 0 % 5 1% 5 5 % 5 4% 0 % 0 % 0 % 0 %
74 Prithiv i Chandra H os p ital, 6 1% 5 7 % 7 4% 6 0 % 0 % 0 % 0 % 0 % N awalParas i
7 5 S hiv araj H os p ital ( K ap ilv as tu) 5 2 % 6 0 % 7 5 % 7 9 % 0 % 0 % 0 % 0 %
76 W 6 Palp a D is trict H os p ital 47 % 6 5 % 7 1% 6 0 % 0 % 0 % 0 % 0 %
7 7 R amp ur H os p ital, Palp a 5 9 % 7 3% 6 8 % 7 3% 0 % 0 % 0 % 0 %
78 S yangj a D is trict H os p ital 5 9 % 7 4% 7 8 % 7 5 % 0 % 0 % 0 % 0 %
7 9 W 7 Chap ak ot H os p ital, S yangj a 2 9 % 42 % 0 % 0 % 0 % 0 % 0 % 0 %
80 Chis ap ani H os p ital, Bardaghat, 38 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % N awalp aras i
8 1 M atriS is huM iteri H os p ital, 6 9 % 9 0 % 0 % 0 % 0 % 0 % 0 % 0 % Batalichaur, K as k i
82 S is uwa H os p ital, K as k i 41% 6 5 % 0 % 0 % 0 % 0 % 0 % 0 %
8 3 S undar Bazar H os p ital, 38 % 6 3% 0 % 0 % 0 % 0 % 0 % 0 % L amj ung A v e rage s core 4 8 % 6 4 % 7 3% 6 5 % 6 4 % 6 7 % 7 1% 7 2% T otal numb er of hos p ital where the ev ents 8 3 7 7 7 5 7 5 45 41 2 5 13 was conducted
Source: CSD, DoHS
DoHS, Annual Report 2075/76 (2018/19) a i 7.1 Inpatients/OPD Services
Background 7.1 Inpatients/ OPD services m t a i mmi t im i g t a t tat a a a i i g Background ig a it a t i i aim t i m t iag i a t atm t a t a m a a t t t ita iag i a a m a i m a ta i at i t t t a iag i a t The Government of Nepal is committed to improving the health status of rural and urban people by delivering high- m quality health services. The policy aims to provide prompt diagnosis and treatment, and to refer cases from PHCCs and health posts to hospitals. Diagnostic services and referral mechanisms have been established at different levels to m t g m t ga i i g a a t a i m g a support early diagnosis of health problems. i a t i a g t t t i a i i i m g i a t i t i t i t ita a a a i at a t In December 2006 the government began providing essential health care services (emergency and inpatient services) t i t t im t a ai t at i a t ig t free of charge to destitute, poor, disabled, senior citizens, FCHVs, victims of gender violence and others in up to 25- t a i a t i t a i t a bed district hospitals and PHCCs and for all citizens at health posts in October 2007.The Interim Constitution of Nepal, 2007said that every citizen has the right to basic health services free of costs as provided by the law. a a i i t m i it m ta it i g t a iag i i a a i i g a iat a m t t atm t mai t at gi t The overall objective of DoHS on curative services is to reduce morbidity, mortality by ensuring the early diagnosis of a i t i a i t i B diseases and providing appropriate and prompt treatment. The main strategies to achieve this are listed in Box 5.1.
Box 7.1.1: Curative service strategies To make curative health services available in an integrated way in rural areas through health posts and PHCCs. To establish hospitals on the basis of population density and patient load with at least one hospital per district. To establish zonal and regional hospitals to provide specialized services related to paediatrics, gynaecology, general surgery, general medicine, eye care, dermatology, orthopaedics and psychiatry. To equip central hospitals with sophisticated diagnostic and other facilities to provide specialised and super-specialty services. Specialist curative care services will be extended to remote areas, as and when required, through mobile teams. To extend referral systems to provide rural people with access to services from modern well equipped hospitals. To strengthen diagnostic services such as laboratories and X-ray services at hospitals. To extend service provision through more outreach clinics and by considering the relocation of existing facilities. To provide basic curative services free in up to 25 bed hospitals. To promote private medical colleges, hospitals, nursing homes and hospitals run by INGOs, NGOs and private practitioners to complement public health care provision.
MajorMajor Activities Activities and and Achievements Achievements in inthe the fiscal fiscal year year2075 2075/76/76 a a t i i at a a t a i i i i g t a t m g a Curative health services were provided at all health facilities including outpatient, emergency and inpatient care and i a t a a a t i a t i i at a ita free health services. Inpatient services were provided at all levels of hospitals including INGO and NGO run hospitals, i i g a ita i at m i a g ita i g m a i at private medical college hospitals, nursing homes and private hospitals. Medical camps were organised mainly in ita i a am ga i mai i m t a a remote areas.
DoHS, Annual Report 2075/76 (2018/19) a i 1. Hospital reporting
i a i t ig t ita i t i t i i Hospital i ita a i ita a reporting Hospital reporting Five hundred a t i a t i ita mi i m t and sixty Eight hospitals were listed in the HMIS under DoHS in 2075/76, of which 125 (6.5%) were public hospitalsFive hundred and and1796 sixty (93.49%) Eight hospitalsnon-public were hospitals listed (Tablein the HMIS1). under DoHS in 2075/76, of which 125 (6.5%) were public hospitals t a and 1796 (93.49%) non-public hospitals (Table 1). 88 i a m t g t m t i ita a percent of public and 34.1 percent of non-public hospitals submission of monthly reports (Table 1); 88 percent of public and 34.1 percent of non-public hospitals submission of monthly reports (Table 1); The t i ita a HMIS received all 12 monthly progress reports from 77.6 percent of public hospitals and 14.4 percent of The HMIS received all 12 monthly progress reports from 77.6 percent of public hospitals and 14.4 percent of non-public a t t t a ita mi a m t g t it hospitals respectively (Table 2); non-public hospitals respectively (Table 2); half a ita a i g t a i m t t mi i a m t (7) out of the 13 tertiary level hospitals submitted all 12 monthly progress reports, with secondary A half (7) out of the 13 tertiary level hospitals submitted all 12 monthly progress reports, with secondary A hospitals g t a a B ita t t mi a m t having 56 out of 60 achievement , 93.3 % report submission all 12 month progress report and hospitals having 56 out of 60 achievement , 93.3 % report submission all 12 month progress report and secondary g t t mi am g a t a Bl hospitals 100% ( 7 out of 7)report submitted all 12 month progress report only 87.9% report submittedsecondary amongBl hospitals all report 100% (Table ( 7 out 3). of 7)report submitted all 12 month progress report only 87.9% report submitted among all report (Table 3). TableTable 1: 1: Hospital Hospital reportingreporting status, status, FY 2075/76FY 2075/76 Table 1: Hospital reporting status, FY 2075/76 Submission of Monthly Report No. of Hospital Submission of Monthly Report No. of Hospital Non Public Public Total Province Non Public Public Total Province Non PublicNon Public Total No. % No. % No. % 1 Province 1 Public96 Public19 Total115 No.587 %51.0 No.228 %100.0 No.815 % 59.1 21 ProvincProvincee 21 14896 1319 161115 475587 26.951.0 152228 100.097.4 627815 32.659.1 32 Bagmati ProvinceProvince 2 1301148 3513 1336161 4759475 30.526.9 271152 64.597.4 5030627 31.432.6 43 GandakiBagmati Province 130165 1635 133681 4759476 61.030.5 176271 91.764.5 5030652 67.131.4 54 ProvinceGandaki Province5 11165 1716 12881 466476 35.061.0 192176 94.191.7 658652 42.867.1 65 KarnaliProvince Province 5 11143 1217 12855 350466 70.935.0 144192 100.094.1 494658 77.442.8 76 SudurpashchimKarnali Province 43 12 55 350 70.9 144 100.0 494 77.4 Province7 Sudurpashchim 32 13 45 215 56.0 155 99.4 370 68.5 Province Total 179632 12513 192145 7328215 34.156.0 1318155 87.8799.4 8646370 37.668.5 Total 1796 125 1921 7328 34.1 1318 87.87 8646 37.6 Source: HMIS, DoHS Source: HMIS, DoHS Table 2: Hospital submitting all 12 monthly progress reports, FY 2075/76 TableTable 2: 2: Hospital Hospital submi ng submitting all all 12 12 monthly monthly progress progress reports, reports, FY 2075 /7FY6 2075/76 Hospital Reporting 12 months a year No. of Hospital Hospital Reporting 12 months a year No. of Hospital Non Public Public Total Province Non Public Public Total Province Non PublicNon Public Total No. % No. % No. % 1 Province 1 Public96 Public19 Total115 No.35 36.5% No.19 100.0% No.54 47.0% 21 Province 21 14896 1319 161115 2135 14.236.5 1119 100.084.6 3254 19.947.0 Bagmati i 2 Province 2 1301148 3513 1336161 14021 10.814.2 1511 42.984.6 15532 11.619.9 4 Bagmati i Gandaki Province 130165 1635 133681 14023 35.410.8 1215 75.042.9 15535 43.211.6 54 ProvinceGandaki Province5 11165 1716 12881 2223 19.835.4 1612 94.175.0 3835 29.743.2 65 KarnaliProvince Province 5 11143 1217 12855 1422 32.619.8 1216 100.094.1 2638 47.329.7 76 SudurpashchimKarnali Province 43 12 55 14 32.6 12 100.0 26 47.3 Province7 Sudurpashchim 32 13 45 4 12.5 12 92.3 16 35.6 Province Total 179632 12513 192145 2594 14.412.5 9712 77.692.3 35616 18.535.6 Source: HMIS, DoHSTotal 1796 125 1921 259 14.4 97 77.6 356 18.5 Source: HMIS, DoHS
DoHS, Annual Report 2075/76 (2018/19) a i
TableTable 3:3: Status Status of ofdifferent different levelslevels of of hospitals hospitals submitting submi ng all 12 all monthly 12 monthly reports, reports, FY 2075/76 FY 2075/76 No. of 12 months reporting No. of Reports Type of Hospital Hospital No. % Expected Received % ACADEMY 6 5 83.3 72 61 84.7 GENERAL HOSPITAL 6 0 0.0 72 21 29.2 LABORATORY 1 0 0.0 12 0 0.0 OTHER HEALTH FACILITY 1 0 0.0 12 0 0.0 PRIMARY HOSPITAL 27 21 77.8 324 303 93.5 SECONDARY A HOSPITAL 60 56 93.3 720 715 99.3 SECONDARY B HOSPITAL 7 7 100.0 84 84 100.0 SPECIALIZED HOSPITAL 4 1 25.0 48 12 25.0 TERTIARY HOSPITAL 13 7 53.8 156 122 78.2 Total 125 97 77.6 1500 1318 87.9 Source: HMIS, DoHS
2.Inpatient Inpatient services services Inpatient services are provided through inpatient departments at public and non-public hospitals. Note that the a t i a i t g i a t a tm t at i a i ita following findings should be interpreted with caution because of incomplete progress reporting (see above). t t at t i g i g i t t it a a i m t g g a Bed Occupancy Rates, FY 2075/76 Federal -level government hospitals that submitted all 12 monthly reports ranged from bed occupancy rate 20.0 3. Bedpercent Occupancy in Karnali Rates, Academy FY 2075/76 of Health Science to 218.0 percent in Koshi Hospital, Biratnagar, 11 federal level hospital no reporting (Figure 1); a g m t ita t at mi a m t t a g m Province level hospitals ranged from (110.0%) in Humla District Hospital to 0.03 percent in Lumbini provincial a at t i a a i a m a t i t t i i Hospital due to incomplete report and 5 provincial hospital has no report (Figure 2). ita Bi at aga a ita g ig Primary level hospitals ranged from 69.3 percent at Bhardaha hospital , Saptari to 0.92 percent at Lamahi i Hospital, Dang Due ita to incomplete a g report) m (Figure 3). i m a i t i t ita t t i m i i i ia ita t i m t t a i ia ita a t ig Figure ima ita a g m t at B a a a ita a ta i t t 1: Bed occupancy rate (in %) of Federal -level public hospitals, FY 2075/76 at ama i ita a g t i m t t ig
DoHS, Annual Report 2075/76 (2018/19) a i Figure 1: Bed occupancy rate (in ) of Federal -level public hospitals, FY 2075/76
KOSHI HOSPITAL 218.8 SHAHID GANGALAL NATIONAL HEART… 97.2 MENTAL HOSPITAL_ LALITPUR 85.9 PAROPAKAR MATERNITY & WOMEN'S… 83.3 BHERI HOSPITAL BANKE 77.3 BHARATPUR HOSPITAL_ CHITWAN 70.7 POKHARA ACADAMY OF HEALTH… 70.4 PAHS (PATAN HOSPITAL) LALITPUR 69.2 KANTI CHILDREN… 67.6 ARMED POLICE FORCE (APF)… 67.6 NAMS (BIR HOSPITAL) KATHMANDU 62.5 NATIONAL TRAUMA… 61.6 Ram Raja Prasad Singh Academy of… 52.2 DADELDHURA HOSPITAL 46.1 RAPTI ACADEMY OF HEALTH SCIENCE 45.8 SUKRARAJ TROPICAL… 34.1 SHAHID DHARMABHAKTA NATIONAL… 33.5 TEACHING HOSPITAL (TRIBHUVAN… 28.9 KARNALI ACADEMY OF HEALTH… 20 TU Manmohan Cardiovascular… 0
PATAN ACADEMY OF HEALTH… 0 NEPAL POLICE HOSPITAL_KATHMANDU 0 NATIONAL TUBERCULOSIS… 0 NATIONAL PUBLIC HEALTH… 0 GP KOIRALA NATIONAL CENTER FOR… 0 CHHETRAPATI PARIBAR KALYAN… 0 BP KOIRALA CANCER… 0 BIRENDRA ARMY… 0 NARAYANI HOSPITAL 0 CIVIL SERVICES HOSPITAL_KATHMANDU 0 0 50 100 150 200 250
DoHS, Annual Report 2075/76 (2018/19) a i Figure 2: Bed occupancy for Provincial hospitals, FY 2075/76
Figure 2: Bed occupancy for Provincial hospitals, FY 2075/76
DISTRICT HOSPITAL_ DOTI 35.7 GULMI HOSPITAL 35 PRITHIV CHANDRA HOSPITAL_… 34.7 DISTRICT HOSPITAL_ KHOTANG 34.7 GAUR HOSPITAL_ RAUTAHAT 34.4 DISTRICT HOSPITAL_ ILAM 34.2 BARDIBAS HOSPITAL_ MAHOTTARI 33.7 MATRI SHISHU MITERI (Bataulechaur)… 33.6 MAHAKALI ZONAL… 32.9 RAM UMA SMARAK… 32.6 DISTRICT HOSPITAL_ DARCHULA 32.5 BHAKTAPUR HOSPITAL _BHAKTAPUR 32.5 MEHELKUNA HOSPITAL_SURKHET 32.4 DISTRICT HOSPITAL_ UDAYAPUR 31.8 KALAIYA DISTRICT HOSPITAL_ BARA 31.3 DISTRICT HOSPITAL_ DHANKUTA 31.1 DISTRICT HOSPITAL_ DHADING 30.5 DISTRICT HOSPITAL_ GORKHA 29.7 POKHARIYA HOSPITAL_PARSA 27.3 DISTRICT HOSPITAL_ JAJARKOT 26.5 DISTRICT HOSPITAL_ SIRAHA 25.8 DISTRICT HOSPITAL_ SOLUKHUMBU 23.3 BARDIYA HOSPITAL GULARIYA 23.3 JOGBUDA HOSPITAL_DADELDHURA 22.6 DISTRICT HOSPITAL_ PARBAT 20.9 GOKULESHWOR HOSPITAL_DARCHAULA 19.5 DISTRICT HOSPITAL_ DOLPA 17.8 MALAKHETI HOSPITAL_KAILALI 14.2 DAMAULI DISTRICT HOSPITAL_ TANAHU 14 DISTRICT HOSPITAL_ BAITADI 12.8 DISTRICT HOSPITAL _ RASUWA 11.4 DISTRICT HOSPITAL_MUSTANG 9.5 DISTRICT HOSPITAL_ MANANG 1.7 MALANGAWA DISTRICT HOSPITAL_… 0.33 PROVINCIAL HOSPITAL LUMBINI… 0.03 DISTRICT HOSPITAL_ SYANGJA 0 BHIM HOSPITAL_ RUPANDEHI 0 0 5 10 15 20 25 30 35 40
DoHS, Annual Report 2075/76 (2018/19) a i
SIMIKOT DISTRICT HOSPITAL_ HUMLA 110 106.2 PROVINCIAL HOSPITAL SURKHET… 83.5 72.9 HEATUDA HOSPITAL_ MAKWANPUR 70.8 70.3 BHARADAH HOSPITAL_SAPTARI 69.3 68.1 ROLPA HOSPITAL REUGHA 67.6 66.5 DISTRICT HOSPITAL_ ACHHAM 66.1 64.3 DISTRICT HOSPITAL_ SALYAN 62.7 61.4 PROVINCIAL HOSPITAL JANAKPUR 57.7 56.5 SETI ZONAL HOSPITAL_ KAILALI 54.1 53.8 DISTRICT HOSPITAL_ PANCHATHAR 52.8 49.9 DISTRICT HOSPITAL_ DAILEKH 47.5 46.7 DISTRICT TRISULI HOSPITAL_ NUWAKOT 46.5 46.2 DISTRICT HOSPITAL_MYAGDI 45.4 44.7 DISTRICT HOSPITAL_ KALIKOT 44.6 41.1 DISTRICT HOSPITAL_ BAJHANG 40.6 40.4 TIKAPUR HOSPITAL_ KAILALI 39 37.5 DHAULAGIRI ZONAL… 37.1 36.7 RUMJATAR HOSPITAL_ OKHALDHUNGA 0 0 CHANDRANIGAHAPUR HOSPTIAL_… 0 0 20 40 60 80 100 120
DoHS, Annual Report 2075/76 (2018/19)
Figure 3: Bed occupancy in Primary level hospitals , FY 2075/76 a i Figure 3: Bed occupancy in Primary level hospitals , FY 2075/76
BHARADAH HOSPITAL_SAPTARI 69.3 DULLU HOSPITAL_DAILEKH 44.3 BARDIBAS HOSPITAL_ MAHOTTARI 33.7 MATRI SHISHU MITERI (Bataulechaur)… 33.6 AANPPIPAL HOSPITAL_GORKHA 32.7 BANDIPUR HOSPITAL_ TANAHU 32.4 DISTRICT HOSPITAL_ DHANKUTA 31.1 BAGHAUDA HOSPTIAL_CHITAWAN 30.8 POKHARIYA HOSPITAL_PARSA 27.3 JOGBUDA HOSPITAL_DADELDHURA 22.6 KATARI HOSPITAL_ UDAYPUR 22.2 GOKULESHWOR HOSPITAL_DARCHAULA 19.5 BAKULAHAR HOSPITAL_CHITAWAN 17.9 Chisapani Hospital, Nawalparasi 15 MALAKHETI HOSPITAL_KAILALI 14.2 MANGALBARE Hospital MORANG 13 DAMAK HOSPITAL_JHAPA 10.6 Sundarbazar_hospital_Lamjung 9.4 METHINKOT HOSPITAL_KAVRE 9 PIPARA HOSPITAL_KAPILBASTU 4.1 SHISHUWA HOSPITAL_KASKI 2.7 LAMAHI HOSPITAL_DANG 0.92 CHAPAKOT HOSPITAL_SYANGJA 0 CHANDRANIGAHAPUR HOSPTIAL_… 0 SHIVRAJ HOSPITAL_ BAHADURGANJ_… 0
0 10 20 30 40 50 60 70 80
Average length of stay — In fiscal year 2075/76, the average length of stay by inpatients: at Federal-level government hospitals ranged from 3.2 days at Bheri Hospital to 28.6 days at the Sahid Gangalag National Heart Center. 14 Federal hospital are no reporting (Figure 4); at provincial hospitals ranged from 0.73 day at Bardibas hospitals to 9.8 days at Pyuthan District hospital (Figure 5); and DoHS, Annualin other Report district 2075/76 level (2018/19) hospitals ranged from 0.14 day at, Lamahi hospital to 6.8 days in Chisapani hospital Figure 6). a i 4. Average length of stay — In fiscal year 2075/76, the average length of stay by inpatients:
at a g m t ita a g m a at B i ita t a at t a i a ga ag a a a t t a ita a g ig at i ia ita a g m a at Ba i a ita t a at t a i t i t ita ig a i t i t i t ita a g m a at ama i ita t a i i a a i ita ig Figure 4: Average length of stay by Figure 4: inpatientsAverage length in of stayFederal by inpatients -level in hospitals, Federal -level FYhospitals, 2075 FY/7 2075/766
28.6 MENTAL HOSPITAL_ … 21.1 11.4 NATIONAL TRAUMA … 11.2 8.7 Figure 5: Average length of stay by inpatients NAMS (BIR HOSPITAL) … 6.9 in Province level hospitals, FY 2075/76 6.8 SUKRARAJ TROPICAL … 6.3 6.1 KOSHI HOSPITAL 5.1 4.3 BHAKTAPUR HOSPITAL … 4.9 BHARATPUR HOSPITAL_ … 4.3 3.7 4.2 DISTRICT HOSPITAL_ … 3.5 PAROPAKAR … 3.8 3.3 3.3 BHARADAH … 3.3 3 BHERI HOSPITAL BANKE 3.2 DISTRICT HOSPITAL _ … 2.9 0 2.8 TEACHING HOSPITAL … 0 DISTRICT HOSPITAL_ … 2.8 2.8 0 DISTRICT HOSPITAL_ … 2.8 PATAN ACADEMY OF … 0 2.8 0 DHAULAGIRI ZONAL … 2.8 NEPAL POLICE … 0 2.8 DISTRICT HOSPITAL_ … 2.7 0 2.6 NATIONAL PUBLIC … 0 DISTRICT HOSPITAL_ … 2.6 0 2.6 GP KOIRALA NATIONAL … DISTRICT HOSPITAL_ … 2.5 0 2.5 0 SETI ZONAL HOSPITAL_ … 2.4 CHHETRAPATI PARIBAR … 0 2.3 0 DISTRICT HOSPITAL_ … 2.3 2.3 BIRENDRA ARMY … 0 DISTRICT HOSPITAL_ … 2.3 2.3 0 10 20 30 40 DISTRICT HOSPITAL_ … 2.2 2.1 DISTRICT HOSPITAL_ … 2.1 2.1 TIKAPUR HOSPITAL_ … 2 1.9 BARDIYA HOSPITAL … 1.9 1.4 BARDIBAS HOSPITAL_ … 0.73 0 DoHS, Annual Report 2075/76 (2018/19)BHIM HOSPITAL_ … 0
0 2 4 6
Figure 4: Average length of stay by inpatients in Federal -level hospitals, FY 2075/76
28.6 MENTAL HOSPITAL_ … 21.1 11.4 NATIONAL TRAUMA … 11.2 8.7 Figure 5: Average length of stay by inpatients NAMS (BIR HOSPITAL) … 6.9 in Province level hospitals, FY 2075/76 6.8 a i SUKRARAJ TROPICAL … 6.3 Figure 5: Average length of stay by inpatients in Province level hospitals, FY 2075/76 6.1 KOSHI HOSPITAL 5.1 4.3 BHAKTAPUR HOSPITAL … 4.9 BHARATPUR HOSPITAL_ … 4.3 3.7 4.2 DISTRICT HOSPITAL_ … 3.5 PAROPAKAR … 3.8 3.3 3.3 BHARADAH … 3.3 3 BHERI HOSPITAL BANKE 3.2 DISTRICT HOSPITAL _ … 2.9 0 2.8 TEACHING HOSPITAL … 0 DISTRICT HOSPITAL_ … 2.8 2.8 0 DISTRICT HOSPITAL_ … 2.8 PATAN ACADEMY OF … 0 2.8 0 DHAULAGIRI ZONAL … 2.8 NEPAL POLICE … 0 2.8 DISTRICT HOSPITAL_ … 2.7 0 2.6 NATIONAL PUBLIC … 0 DISTRICT HOSPITAL_ … 2.6 0 2.6 GP KOIRALA NATIONAL … DISTRICT HOSPITAL_ … 2.5 0 2.5 0 SETI ZONAL HOSPITAL_ … 2.4 CHHETRAPATI PARIBAR … 0 2.3 0 DISTRICT HOSPITAL_ … 2.3 2.3 BIRENDRA ARMY … 0 DISTRICT HOSPITAL_ … 2.3 2.3 0 10 20 30 40 DISTRICT HOSPITAL_ … 2.2 2.1 DISTRICT HOSPITAL_ … 2.1 2.1 TIKAPUR HOSPITAL_ … 2 1.9 BARDIYA HOSPITAL … 1.9 1.4 BARDIBAS HOSPITAL_ … 0.73 0 BHIM HOSPITAL_ … 0
0 2 4 6
DoHS, Annual Report 2075/76 (2018/19) a i
PYUTHAN HOSPITAL 9.8 4.4 DISTRICT HOSPITAL_MUSTANG 3.8 3.6 PROVINCIAL HOSPITAL JANAKPUR 3.4 3.3 DISTRICT HOSPITAL_ TERHATHUM 3.2 3.1 DISTRICT HOSPITAL_ TAPLEJUNG 3.1 3 HEATUDA HOSPITAL_ MAKWANPUR 3 2.9 DISTRICT HOSPITAL_ SIRAHA 2.9 2.8 DISTRICT HOSPITAL_ UDAYAPUR 2.7 2.7 ROLPA HOSPITAL REUGHA 2.6 2.6 PROVINCIAL HOSPITAL SURKHET… 2.5 2.4 MATRI SHISHU MITERI (Bataulechaur)… 2.3 2.3 DISTRICT TRISULI HOSPITAL_ NUWAKOT 2.3 2.2 PRITHIV BIR HOSPITAL_ KAPILBASTU 2.2 2.2 DISTRICT HOSPITAL_ SUNSARI 2 1.8 JOGBUDA HOSPITAL_DADELDHURA 1.8 1.3 POKHARIYA HOSPITAL_PARSA 1.2 1.2 KALAIYA DISTRICT HOSPITAL_ BARA 1.1 0 MALANGAWA DISTRICT HOSPITAL_… 0 0 DISTRICT HOSPITAL_ SYANGJA 0 0 2 4 6 8 10 12
Figure 6: Average length of stay by inpatients in other Primary level hospitals, FY 2075/76
DoHS, Annual Report 2075/76 (2018/19) a i Figure 6: Average length of stay by inpatients in other Primary level hospitals, FY 2075/76
Chisapani Hospital, Nawalparasi 6.8
BHARADAH HOSPITAL_SAPTARI 3.3
BAGHAUDA HOSPTIAL_CHITAWAN 3.3
BAKULAHAR HOSPITAL_CHITAWAN 3.2
AANPPIPAL HOSPITAL_GORKHA 2.9
BANDIPUR HOSPITAL_ TANAHU 2.8
KATARI HOSPITAL_ UDAYPUR 2.5
DAMAK HOSPITAL_JHAPA 2.5
MATRI SHISHU MITERI (Bataulechaur)… 2.3
GOKULESHWOR HOSPITAL_DARCHAULA 2.3
DISTRICT HOSPITAL_ DHANKUTA 2.3
DULLU HOSPITAL_DAILEKH 2.2
Sundarbazar_hospital_Lamjung 2
METHINKOT HOSPITAL_KAVRE 2
MANGALBARE Hospital MORANG 2
JOGBUDA HOSPITAL_DADELDHURA 1.8
POKHARIYA HOSPITAL_PARSA 1.2
BARDIBAS HOSPITAL_ MAHOTTARI 0.73
PIPARA HOSPITAL_KAPILBASTU 0.43
SHISHUWA HOSPITAL_KASKI 0.21
LAMAHI HOSPITAL_DANG 0.14
SHIVRAJ HOSPITAL_ BAHADURGANJ_… 0
MALAKHETI HOSPITAL_KAILALI 0
CHAPAKOT HOSPITAL_SYANGJA 0
CHANDRANIGAHAPUR HOSPTIAL_… 0
0 1 2 3 4 5 6 7 8
Hospital use The use of hospitals is measured in this section according to emergency room attendance and total outpatient and inpatient admissions
DoHS, Annual Report 2075/76 (2018/19) a i 5. Ho pital u e
ita i m a i t i a i g t m g m a a a t ta t a t a i a t a mi i
ita m g a a a at ita it g g i a a
m g a ita Bi ia t ig t a a at it m g a i ta ita t t ig m g i ia ita i ia ita a t ig t a a at it m g it i a a ita a t t ig m g ima ita a ta ita a t ig t a a at it m g a i a a iga a ita a ta at a t a t ig
Figure 7: Emergency ward attendance in Federal level hospitals, FY 2075/76
NAMS (BIR HOSPITAL) KATHMANDU 56840 KANTI CHILDREN HOSPITAL_KATHMANDU 55514 BHARATPUR HOSPITAL_ CHITWAN 46775 PAHS (PATAN HOSPITAL) LALITPUR 46364 NARAYANI HOSPITAL 41584 POKHARA ACADAMY OF HEALTH SCIENCE 39704 KOSHI HOSPITAL 28499 PAROPAKAR MATERNITY & WOMEN'S… 27911 CIVIL SERVICES HOSPITAL_KATHMANDU 19872 NATIONAL TRAUMA CENTER_KATHMANDU 19269 BHERI HOSPITAL BANKE 16198 RAPTI ACADEMY OF HEALTH SCIENCE 13325 Ram Raja Prasad Singh Academy of Health… 10581 SUKRARAJ TROPICAL HOSPITAL_KATHMANDU 8487 DADELDHURA HOSPITAL 5712 KARNALI ACADEMY OF HEALTH… 5400 ARMED POLICE FORCE (APF)… 1861 MENTAL HOSPITAL_ LALITPUR 655 TU Manmohan Cardiovascular Transplant… 0 TEACHING HOSPITAL (TRIBHUVAN… 0 SHAHID GANGALAL NATIONAL HEART… 0 SHAHID DHARMABHAKTA NATIONAL… 0 PATAN ACADEMY OF HEALTH… 0 NEPAL POLICE HOSPITAL_KATHMANDU 0 NATIONAL TUBERCULOSIS… 0 NATIONAL PUBLIC HEALTH… 0 GP KOIRALA NATIONAL CENTER FOR… 0 CHHETRAPATI PARIBAR KALYAN… 0 BP KOIRALA CANCER HOSPITAL_CHITAWAN 0 BIRENDRA ARMY HOSPITAL_KATHMANDU 0 0 10000 20000 30000 40000 50000 60000
Figure 8: Emergency ward attendance at provincial hospitals,DoHS, AnnualFY 207 5Report/76 2075/76 (2018/19) a i Figure 8: Emergency ward attendance at provincial hospitals, FY 2075/76
PROVINCIAL HOSPITAL LUMBINI RUPANDEHI 53729 34739 PROVINCIAL HOSPITAL JANAKPUR 27566 23877 MECHI ZONAL HOSPITAL_ JHAPA 20005 19537 HEATUDA HOSPITAL_ MAKWANPUR 19127 18311 DISTRICT HOSPITAL_ SUNSARI 11990 11101 PROVINCIAL HOSPITAL SURKHET KARNALI 9913 8594 DISTRICT HOSPITAL_MYAGDI 7905 7856 DISTRICT HOSPITAL_ UDAYAPUR 7346 7292 PRITHIV CHANDRA HOSPITAL_… 7123 6952 GULMI HOSPITAL 6885 5703 DISTRICT HOSPITAL_ SYANGJA 5680 4954 MEHELKUNA HOSPITAL_SURKHET 4610 4507 DISTRICT HOSPITAL_ TERHATHUM 3928 3612 ROLPA HOSPITAL REUGHA 3591 3579 PALPA HOSPITAL TANSEN 3224 3092 GOKULESHWOR HOSPITAL_DARCHAULA 2791 1733 JOGBUDA HOSPITAL_DADELDHURA 1599 1054 RUMJATAR HOSPITAL_ OKHALDHUNGA 906 655 MALAKHETI HOSPITAL_KAILALI 175 0 10000 20000 30000 40000 50000 60000
DoHS, Annual Report 2075/76 (2018/19) a i
DISTRICT HOSPITAL_ PANCHATHAR 17124 16471 DHAULAGIRI ZONAL… 12342 11818 DISTRICT HOSPITAL_ DHADING 10730 9229 DISTRICT HOSPITAL_… 8754 8577 BARDIYA HOSPITAL GULARIYA 7165 7017 DISTRICT HOSPITAL_… 6765 6361 ARGHAKHANCHI HOSPITAL… 6331 5993 DISTRICT HOSPITAL_ KHOTANG 5649 5470 BARDIBAS HOSPITAL_ MAHOTTARI 5118 3530 DISTRICT HOSPITAL_ BAJHANG 3401 3105 DISTRICT HOSPITAL_ PARBAT 3027 3015 DISTRICT HOSPITAL_… 2922 2622 DISTRICT HOSPITAL_ BHOJPUR 2343 2336 DISTRICT HOSPITAL_ DOTI 2074 2061 DISTRICT HOSPITAL_ SALYAN 1909 1566 BHARADAH HOSPITAL_SAPTARI 1329 1304 DISTRICT HOSPITAL_ MUGU 1261 937 DISTRICT HOSPITAL _ RASUWA 933 391 CHANDRANIGAHAPUR HOSPTIAL_… 25 0 5000 10000 15000 20000
Figure 9: Emergency ward attendances at primary level hospitals, FY 2075/76
DoHS, Annual Report 2075/76 (2018/19) a i Figure 9: Emergency ward attendances at primary level hospitals, FY 2075/76
DISTRICT HOSPITAL_ DHANKUTA 9229 KATARI HOSPITAL_ UDAYPUR 6730 BAKULAHAR HOSPITAL_CHITAWAN 5291 BARDIBAS HOSPITAL_ MAHOTTARI 5118 Chisapani Hospital, Nawalparasi 4143 LAMAHI HOSPITAL_DANG 3762 POKHARIYA HOSPITAL_PARSA 3612 MATRI SHISHU MITERI (Bataulechaur)… 3579 MANGALBARE Hospital MORANG 3079 GOKULESHWOR… 2791 SHIVRAJ HOSPITAL_ BAHADURGANJ_… 2223 BANDIPUR HOSPITAL_ TANAHU 2189 BAGHAUDA HOSPTIAL_CHITAWAN 1863 JOGBUDA HOSPITAL_DADELDHURA 1599 CHAPAKOT HOSPITAL_SYANGJA 1555 DAMAK HOSPITAL_JHAPA 1534 BHARADAH HOSPITAL_SAPTARI 1329 DULLU HOSPITAL_DAILEKH 1255 METHINKOT HOSPITAL_KAVRE 1185 AANPPIPAL HOSPITAL_GORKHA 719 Sundarbazar_hospital_Lamjung 692 PIPARA HOSPITAL_KAPILBASTU 676 MALAKHETI HOSPITAL_KAILALI 175 SHISHUWA HOSPITAL_KASKI 153 CHANDRANIGAHAPUR HOSPTIAL_… 25 0 2000 4000 6000 8000 10000
u e 6. Outpatient e ce attendance in in the the fiscalfiscal uear uear 20752075/76/7 at6 at hospitals hospitals with withfull progress full progress reporting reporting was was as follows: a follow : Outpatient attendance at Federal level hospitals ranged from 44317 at Karnali Academy of Health t a t a a at a ita a g m at a a i a m Science , Jumla to 22 at Civil Service Hospital most of federal hospitals are no reporting of OPD a t i m a t at i i i ita m t a ita a g m i it ig morbidity (Figure 10). t a t a a at i ia ita a g m a t at a a ita Outpatient attendance at Provincial hospitals ranged from 54403 patients at Palpa Hospital Tansen a t at i ia ita ig t a t a a at ima ita a g m at Ba a a ita to 227 at Seti provincial Hospital (Figure 11). ita a t at i a ita a i a t ig Outpatient attendance at Primary level hospitals ranged from 89600 at Bakulahar Hospital, t a t i it a t a a i g a g t t ta i t a a ig Chitawan to 13 at Shivraj hospital, Kapilbastu (Figure 12). New outpatient visits accounted for a varying range of the proportion of total clients across Nepal DoHS, Annual Report 2075/76 (2018/19) (Figure 13).
Figure 10: Outpatient attendance at Federal level hospitals, FY 2075/76 a i Figure 10: Outpatient attendance at Federal level hospitals, FY 2075/76
44317 DADELDHURA HOSPITAL 22802 8452 MENTAL HOSPITAL_ LALITPUR 6626 203 CIVIL SERVICES… 22 0 TEACHING HOSPITAL (TRIBHUVAN… 0 0 SHAHID GANGALAL NATIONAL HEART… 0 0 RAPTI ACADEMY OF HEALTH SCIENCE 0 0 POKHARA ACADAMY OF HEALTH… 0 0 PAROPAKAR MATERNITY & WOMEN'S… 0 0 NEPAL POLICE HOSPITAL_KATHMANDU 0 0 NATIONAL TRAUMA… 0 0 NARAYANI HOSPITAL 0 0 KOSHI HOSPITAL 0 0 GP KOIRALA NATIONAL CENTER FOR… 0 0 BIRENDRA ARMY… 0 0 BHARATPUR HOSPITAL_ CHITWAN 0 0 10000 20000 30000 40000 50000
Figure 11: Outpatient attendance at provincial hospitals, FY 2075/76
DoHS, Annual Report 2075/76 (2018/19) a i Figure 11: Outpatient attendance at provincial hospitals, FY 2075/76
CHANDRANIGAHAPUR HOSPTIAL_… 42930 DISTRICT HOSPITAL_ ILAM 38460 DISTRICT HOSPITAL_ DHADING 34788 BARDIYA HOSPITAL GULARIYA 33875 DISTRICT HOSPITAL_ GORKHA 31949 DISTRICT HOSPITAL_… 30638 BARDIBAS HOSPITAL_ MAHOTTARI 28836 DISTRICT HOSPITAL_ SALYAN 21234 DISTRICT HOSPITAL_ KHOTANG 17751 DISTRICT HOSPITAL_ RUKUM 16821 DISTRICT HOSPITAL_ PARBAT 16490 DISTRICT HOSPITAL_… 16451 DISTRICT HOSPITAL_ BAJURA 16330 DISTRICT HOSPITAL_ DARCHULA 16224 DISTRICT HOSPITAL_ BAJHANG 14318 DISTRICT HOSPITAL_ ACHHAM 14154 DISTRICT HOSPITAL_ KALIKOT 13668 DISTRICT HOSPITAL_ DAILEKH 13135 BHARADAH HOSPITAL_SAPTARI 12901 DISTRICT HOSPITAL_ MUGU 12215 DISTRICT HOSPITAL_ BAITADI 11920 DISTRICT HOSPITAL_ DOLPA 11065 DISTRICT HOSPITAL_ DOTI 9911 DISTRICT HOSPITAL_ BHOJPUR 8799 DISTRICT HOSPITAL_ RAMECHHAP 8572 DISTRICT HOSPITAL_ JAJARKOT 7801 ARGHAKHANCHI HOSPITAL… 4432 DISTRICT HOSPITAL _ RASUWA 4306 DISTRICT HOSPITAL_ DHANKUTA 3934 DISTRICT HOSPITAL_ MANANG 2094 DISTRICT HOSPITAL_ PANCHATHAR 0 DHAULAGIRI ZONAL… 0 DAMAULI DISTRICT HOSPITAL_… 0 BHIM HOSPITAL_ RUPANDEHI 0 BHAKTAPUR HOSPITAL _BHAKTAPUR 0 0 10000 20000 30000 40000 50000
DoHS, Annual Report 2075/76 (2018/19) a i
PALPA HOSPITAL TANSEN 54403 51221 DISTRICT HOSPITAL_ SINDHULI 34249 32874 GULMI HOSPITAL 31952 28419 MEHELKUNA HOSPITAL_SURKHET 25846 24149 DISTRICT HOSPITAL_MYAGDI 22584 19897 DISTRICT HOSPITAL_ SIRAHA 19613 19229 DISTRICT HOSPITAL_ TAPLEJUNG 18534 15648 RAM UMA SMARAK HOSPITAL_LAHAN_ SIRAHA 15167 14293 PRITHIV CHANDRA HOSPITAL_ NAWALPARASI 13990 13290 JOGBUDA HOSPITAL_DADELDHURA 13256 12396 SIMIKOT DISTRICT HOSPITAL_ HUMLA 11175 10127 DISTRICT HOSPITAL_MUSTANG 6370 5946 DISTRICT HOSPITAL_ SOLUKHUMBU 4262 2378 PRITHIV BIR HOSPITAL_ KAPILBASTU 2274 430 TIKAPUR HOSPITAL_ KAILALI 305 227 RAPTI ZONAL HOSPITAL_DANG 1 0 PROVINCIAL HOSPITAL JANAKPUR 0 0 MALANGAWA DISTRICT HOSPITAL_ SARLAHI 0 0 HEATUDA HOSPITAL_ MAKWANPUR 0 0 DISTRICT HOSPITAL_ SUNSARI 0 0 10000 20000 30000 40000 50000 60000
Figure 12: Outpatient attendance at primary level hospitals, FY 2075/76
DoHS, Annual Report 2075/76 (2018/19) a i Figure 12: Outpatient attendance at primary level hospitals, FY 2075/76
BAKULAHAR HOSPITAL_CHITAWAN 89600 DAMAK HOSPITAL_JHAPA 47488 CHANDRANIGAHAPUR HOSPTIAL_… 42930 BARDIBAS HOSPITAL_ MAHOTTARI 28836 BAGHAUDA HOSPTIAL_CHITAWAN 27143 KATARI HOSPITAL_ UDAYPUR 22579 PIPARA HOSPITAL_KAPILBASTU 22137 AANPPIPAL HOSPITAL_GORKHA 16354 MALAKHETI HOSPITAL_KAILALI 15648 MATRI SHISHU MITERI… 13290 JOGBUDA HOSPITAL_DADELDHURA 13256 BHARADAH HOSPITAL_SAPTARI 12901 CHAPAKOT HOSPITAL_SYANGJA 12091 Chisapani Hospital, Nawalparasi 11010 GOKULESHWOR… 10127 DULLU HOSPITAL_DAILEKH 9514 BANDIPUR HOSPITAL_ TANAHU 9271 LAMAHI HOSPITAL_DANG 8847 METHINKOT HOSPITAL_KAVRE 8694 Sundarbazar_hospital_Lamjung 7141 MANGALBARE Hospital MORANG 6624 SHISHUWA HOSPITAL_KASKI 5482 DISTRICT HOSPITAL_ DHANKUTA 3934 POKHARIYA HOSPITAL_PARSA 2378 SHIVRAJ HOSPITAL_ BAHADURGANJ_… 13 0 20000 40000 60000 80000 100000
Figure 13: Percentage of new outpatient visits among total population, FY 2075/76
Commented [SJK1]: Layout: remove title from above/within chart.
DoHS, Annual Report 2075/76 (2018/19) a i Figure 13: Percentage of new outpatient visits among total population, FY 2075/76
Inpatient attendance in 2075/76 at hospitals with full progress reporting was as follows: 7. InpatientBharatpur attendanceHospital, Chitawan in 2075/76 had the at mosthospitals inpatient with admissionsfull progress 40562 reporting with the Mentalwas as follows: Hospital, Patan having the fewest (508) some federal hospital had no report (Figure 14) Among B a at public ita provincial ita a hospitals, a Janakpur t m t Provincial i a t Hospital a mi i had the most inpatient it admissions t ta ita ata a i g t t m a ita a t ig (20397), while Malangawa District Hospital, sarlahi had the fewest (76) some provincial hospital m g i i ia ita a a i ia ita a t m t i a t had a mi i no reported (Figure i 15). a a ga a i t i t ita a a i a t t m Among i ia ita a t ig primary hospitals Bardibas Hospital, Mahotary recorded the most inpatient admissions (2355) m g ima ita Ba i a ita a ta t m t i a t a mi i while Chapakot Hospital syangja recorded the fewest (6) (Figure 16). i a a t ita a g a t t ig
DoHS, Annual Report 2075/76 (2018/19) a i
Figure 14: Inpatient admissions at Federal Figure 15: Inpatient admissions at provincial level hospitals, FY 2075/76 hospitals, FY 2075/76
BHARATPUR HOSPITAL_ CHITWAN CHANDRANIGAHAPUR40562 HOSPTIAL_… PAROPAKAR MATERNITY & WOMEN'S… 28092 3557 BHARATPUR HOSPITAL_ CHITWANDISTRICT HOSPITAL_ SALYAN 40562 3487 PAHS (PATAN HOSPITAL) LALITPUR 21966.5 PAROPAKAR MATERNITY & WOMEN'S … 28092 3404 POKHARA ACADAMY OF HEALTH… DISTRICT20669 HOSPITAL_ PANCHATHAR 3134 PAHSKOSHI (PATAN HOSPITAL HOSPITAL) LALITPUR20171 21966.5 3062 BHIM HOSPITAL_ RUPANDEHI 2784 NARAYANIPOKHARA HOSPITAL ACADAMY OF HEALTH18545 … 20669 2638 BHERI HOSPITAL BANKE KOSHI HOSPITAL13574BARDIBAS HOSPITAL_ MAHOTTARI20171 2355 NAMS (BIR HOSPITAL) KATHMANDU 12068 2326 NARAYANI HOSPITAL 18545 KANTI CHILDREN… 10083 BARDIYA HOSPITAL GULARIYA 2310 BHERI HOSPITAL BANKE 2218 CIVIL SERVICES… 9285 13574 DISTRICT HOSPITAL_ DHADING 2014 Ram Raja PrasadNAMS Singh (BIR Academy HOSPITAL) of… KATHMANDU8372 12068 1940 RAPTI ACADEMY OF HEALTH SCIENCE KANTI6525 CHILDREN … DISTRICT10083 HOSPITAL_… 1935 SHAHID GANGALAL NATIONAL HEART… 6232 1864 CIVIL SERVICESDISTRICT … HOSPITAL_9285 ACHHAM 1743 NATIONAL TRAUMA… 4016 Ram Raja Prasad Singh Academy of … 8372 1597 KARNALI ACADEMY OF HEALTH… 3307 DISTRICT HOSPITAL_… 1522 DADELDHURARAPTI ACADEMY HOSPITAL OF HEALTH2973 SCIENCE 6525 1520 DISTRICT HOSPITAL_ KHOTANG 1493 TEACHING HOSPITALSHAHID (TRIBHUVAN…GANGALAL NATIONAL2311 HEART … 6232 1327 SUKRARAJ TROPICAL…NATIONAL2073 TRAUMADISTRICT … 4016HOSPITAL_ PARBAT 1219 SHAHID DHARMABHAKTAKARNALI NATIONAL… ACADEMY1793 OF HEALTH … 3307 1215 ARMED POLICE FORCE (APF)… 734 BHARADAH HOSPITAL_SAPTARI 1154 DADELDHURA HOSPITAL 2973 1113 MENTAL HOSPITAL_ LALITPUR 508 TEACHING HOSPITAL (TRIBHUVANDAMAULI … DISTRICT HOSPITAL_… 1110 TU Manmohan Cardiovascular… 0 2311 1044 PATAN ACADEMY OF HEALTH…SUKRARAJ0 TROPICAL …DISTRICT2073 HOSPITAL_ MUGU 1004 965 NEPAL POLICE HOSPITAL_KATHMANDU 0 SHAHID DHARMABHAKTA NATIONAL …DISTRICT1793 HOSPITAL_ DOTI 807 NATIONAL TUBERCULOSIS…ARMED POLICE0 FORCE (APF) … 734 567 NATIONAL PUBLIC HEALTH… 0 DISTRICT HOSPITAL_ DOLPA 296 MENTAL HOSPITAL_ LALITPUR 508 GP KOIRALA NATIONAL CENTER FOR… 0 224 DISTRICT HOSPITAL_ MANANG 29 CHHETRAPATI PARIBARTU Manmohan KALYAN… 0 Cardiovascular … 0 BP KOIRALAPATAN CANCER… ACADEMY0 OF HEALTH … 0 0 500 1000 1500 2000 2500 3000 3500 4000 NEPALBIRENDRA POLICE HOSPITAL_KATHMANDU ARMY… 0 0 NATIONAL0 TUBERCULOSIS10000 20000 30000 … 0 40000 50000 NATIONAL PUBLIC HEALTH … 0 GP KOIRALA NATIONAL CENTER FOR … 0 CHHETRAPATI PARIBAR KALYAN … 0 BP KOIRALA CANCER … 0 BIRENDRA ARMY … 0
0 10000 20000 30000 40000 50000
Figure 14: Inpat ient admissions at Federal level hospitals, FY 2075/76 DoHS, Annual Report 2075/76 (2018/19) a i
Figure 14: Inpatient admissions at Federal Figure 15: Inpatient admissions at provincial level hospitals, FY 2075/76 hospitals, FY 2075/76
BHARATPUR HOSPITAL_ CHITWAN CHANDRANIGAHAPUR40562 HOSPTIAL_… PAROPAKAR MATERNITY & WOMEN'S… 28092 3557 DISTRICTCHANDRANIGAHAPUR HOSPITAL_ SALYAN HOSPTIAL_ … 3487 PAHS (PATAN HOSPITAL) LALITPUR 21966.5 3404 3557 POKHARA ACADAMY OF HEALTH… DISTRICT20669 HOSPITAL_ PANCHATHAR 3134 DISTRICT HOSPITAL_ SALYAN 3487 KOSHI HOSPITAL 20171 3062 BHIM HOSPITAL_ RUPANDEHI 2784 3404 NARAYANI HOSPITAL 18545 DISTRICT HOSPITAL_ PANCHATHAR 2638 3134 BHERI HOSPITAL BANKE 13574 BARDIBAS HOSPITAL_ MAHOTTARI 2355 3062 NAMS (BIR HOSPITAL) KATHMANDU 12068 BHIM HOSPITAL_ RUPANDEHI 2326 2784 KANTI CHILDREN… 10083 BARDIYA HOSPITAL GULARIYA 2310 2218 2638 CIVIL SERVICES… 9285 DISTRICTBARDIBAS HOSPITAL_ HOSPITAL_ DHADING MAHOTTARI 2014 2355 Ram Raja Prasad Singh Academy of… 8372 1940 2326 RAPTI ACADEMY OF HEALTH SCIENCE 6525 DISTRICTBARDIYA HOSPITAL_… HOSPITAL GULARIYA 1935 2310 SHAHID GANGALAL NATIONAL HEART… 6232 1864 DISTRICT HOSPITAL_ ACHHAM 1743 2218 NATIONAL TRAUMA… 4016 DISTRICT HOSPITAL_ DHADING 1597 2014 KARNALI ACADEMY OF HEALTH… 3307 DISTRICT HOSPITAL_… 1522 1940 DADELDHURA HOSPITAL 2973 DISTRICT HOSPITAL_ …1520 1935 DISTRICT HOSPITAL_ KHOTANG 1493 TEACHING HOSPITAL (TRIBHUVAN… 2311 1327 1864 SUKRARAJ TROPICAL… 2073 DISTRICT HOSPITAL_DISTRICT PARBAT HOSPITAL_ ACHHAM1219 1743 SHAHID DHARMABHAKTA NATIONAL… 1793 1215 1597 ARMED POLICE FORCE (APF)… 734 BHARADAH HOSPITAL_SAPTARIDISTRICT HOSPITAL_1154 … 1522 1113 MENTAL HOSPITAL_ LALITPUR 1520 508 DAMAULI DISTRICT HOSPITAL_… 1110 TU Manmohan Cardiovascular… 0 DISTRICT HOSPITAL_ KHOTANG1044 1493 PATAN ACADEMY OF HEALTH… 0 DISTRICT HOSPITAL_ MUGU 1004 1327 965 NEPAL POLICE HOSPITAL_KATHMANDU 0 DISTRICT HOSPITAL_ PARBAT 1219 DISTRICT HOSPITAL_ DOTI 807 1215 NATIONAL TUBERCULOSIS… 0 567 NATIONAL PUBLIC HEALTH… 0 DISTRICTBHARADAH HOSPITAL_ DOLPA HOSPITAL_SAPTARI296 1154 GP KOIRALA NATIONAL CENTER FOR… 0 224 1113 DISTRICT HOSPITAL_DAMAULI MANANG DISTRICT29 HOSPITAL_ … 1110 CHHETRAPATI PARIBAR KALYAN… 0 1044 BP KOIRALA CANCER… 0 0 500 1000 1500 2000 2500 3000 3500 4000 DISTRICT HOSPITAL_ MUGU 1004 BIRENDRA ARMY… 0 965 0 10000 20000 30000 40000 50000DISTRICT HOSPITAL_ DOTI 807 567 DISTRICT HOSPITAL_ DOLPA 296 224 DISTRICT HOSPITAL_ MANANG 29
0 500 1000 1500 2000 2500 3000 3500 4000
DoHS, Annual Report 2075/76 (2018/19) a i
PROVINCIAL HOSPITAL JANAKPUR 20395 20082 PROVINCIAL HOSPITAL LUMBINI RUPANDEHI 19309 13865 HEATUDA HOSPITAL_ MAKWANPUR 9533 7508 KALAIYA DISTRICT HOSPITAL_ BARA 4635 4414 RAPTI ZONAL HOSPITAL_DANG 4376 4284 PYUTHAN HOSPITAL 3919 3622 PRITHIV BIR HOSPITAL_ KAPILBASTU 2975 2781 DISTRICT TRISULI HOSPITAL_ NUWAKOT 2757 2718 DISTRICT HOSPITAL_MYAGDI 2666 2611 DISTRICT HOSPITAL_ SINDHULI 2183 2159 DISTRICT HOSPITAL_ TAPLEJUNG 1689 1607 GULMI HOSPITAL 1522 1450 POKHARIYA HOSPITAL_PARSA 1225 1134 DISTRICT HOSPITAL_ TERHATHUM 1084 1058 MEHELKUNA HOSPITAL_SURKHET 1041 901 DISTRICT HOSPITAL_ SOLUKHUMBU 829 783 SIMIKOT DISTRICT HOSPITAL_ HUMLA 714 696 RUMJATAR HOSPITAL_ OKHALDHUNGA 559 360 PALPA HOSPITAL TANSEN 181 157 MALANGAWA DISTRICT HOSPITAL_ SARLAHI 76 0 5000 10000 15000 20000 25000
DoHS, Annual Report 2075/76 (2018/19) a i FigureFigure 16: Inpatient 16: Inpatient admissions admissions at primary at level primary hospitals, level FY hospitals, 2075/76 FY 2075/76
BARDIBAS HOSPITAL_ MAHOTTARI 2355 DISTRICT HOSPITAL_ DHANKUTA 1520 AANPPIPAL HOSPITAL_GORKHA 1354 POKHARIYA HOSPITAL_PARSA 1225 BHARADAH HOSPITAL_SAPTARI 1154 MATRI SHISHU MITERI (Bataulechaur)… 901 GOKULESHWOR… 783 JOGBUDA HOSPITAL_DADELDHURA 696 BANDIPUR HOSPITAL_ TANAHU 659 BAGHAUDA HOSPTIAL_CHITAWAN 546 BAKULAHAR HOSPITAL_CHITAWAN 492 KATARI HOSPITAL_ UDAYPUR 474 DULLU HOSPITAL_DAILEKH 457 MALAKHETI HOSPITAL_KAILALI 360 METHINKOT HOSPITAL_KAVRE 352 MANGALBARE Hospital MORANG 269 Chisapani Hospital, Nawalparasi 249 DAMAK HOSPITAL_JHAPA 231 PIPARA HOSPITAL_KAPILBASTU 167 LAMAHI HOSPITAL_DANG 132 Sundarbazar_hospital_Lamjung 108 SHISHUWA HOSPITAL_KASKI 65 CHAPAKOT HOSPITAL_SYANGJA 6 SHIVRAJ HOSPITAL_ BAHADURGANJ_… 0 CHANDRANIGAHAPUR HOSPTIAL_… 0 0 500 1000 1500 2000 2500
Commented [SJK ]: Layout: remove title from within chart. Only put one title
DoHS, Annual Report 2075/76 (2018/19) a i Disease8. Disease analysis analysis o t m i i am g i a t a a t i t m a e or e o e — In fiscal year 2075/76other chronic obstructive pulmonary disease i a a t m i a t a mi i i a t at is the number one reason for inpatient admission (13,412) followed by Cholelithothiasis disease a m t t a it t ia i (7191 i a ig ) (Figure 18).
FigureFigure 5.18: 5.18: Top tenTop inpatient ten inpatient morbidities morbidities in FY in 2075/76 FY 2075/76
J44 Other chronic obstructive pulmonary… 13412 A09 Diarrhoea and gastroenteritis of… 12839 J18 Pneumonia, organism unspecified 12281 N39 Other disorders of urinary system 11569 T14 Injury of unspecified body region 11089 I10 Essential (primary) hypertension 8633 A010 Typhoid fever 8553 J22 Unspecified acute lower respiratory… 7932 K37 Unspecified appendicitis 7352 K80 Cholelithiasis 7191
0 2000 4000 6000 8000 10000 12000 14000 16000
Source: HMIS
Total9. Total patients patients — In— a t a t ma ma 2075/76 Nepal’s the HMIS recorded 1045062 patients (female 62.47%–male 37.53%) i g i a g m a t ita a t i m being a i i t i i a im m t t ta discharged from all types of hospitals (Table 5).Of this number 995414 (91.22%) were recorded as cured a t i it i a mi i i a a t i or recovered, while 19756 (1.81%) did not show clinical improvement A total of 5659 (0.51%) m t a a a mi i t a t ag t a patientst a a a t i a t ag a died within 48 hours of admission while , whereas 6228(0.57%) patients died more than 48 hours after admission. Most patients were aged between 20-29 years (25.75%), More than a half of the inpatients a a t m i it ag a a ita were aged 15-49 years (59%). Table 5: Inpatient morbidity by age and sex, all hospitals, FY 2075/76
Table 5: Inpatient morbidity by age and sex, all hospitals, FY 2075/76 Years
Age Group 29 Total Total
- 04 Years - 14 Years - 19 Years - - 39 Years - 49 Years - 59 Years
≥ 60 Years
01 05 15 20 30 40 50 29 Days -29 Days 1 Year
1 Year
AgeFemale Group 25514 15841 20752 28994 59400- 214059 95718 54229 48755 70765 634027 04 Years 14 Years 19 Years 29 Years 39 Years 49 Years 59 Years
Recovered/Cure Male 31318 23581 29573 40218 30201 53220 49555 47671 48501 7549 361387 Total ------
Female 325 391 334 28 ≤ days 632 700 1260 1218 1158 1293 2392 9703 ≥ 60 Years 60 ≥ Not Improved Male 463 565 401 692 608 1083 01 1032 05 1104 123115 287420 1005330 40 50 29 Days Female 545 473 407 806 1004 2640 1223 1346 855 1972 11271 Referred Out Male 810Female 760 25514607 879 15841563 20752971 90228994 955 594001061 2140592227 957189735 54229 48755 70765 634027 Female 1166 725 799 1008 1572 4060 2350 1748 2006 4771 20205 DOR/LAMA/DAMARecovered/Cure Male 1577Male 1058 122131318 1340 235811211 234829573 209040218 2026 302012097 532205101 4955520069 47671 48501 7549 361387 Female 58Female 67 60325 98 39191 377334 190 632 120 700104 1260188 12181353 1158 1293 2392 9703 Absconded Male 59 69 105 124 377 163 145 124 99 173 1438 463 565 401 692 608 1083 1032 1104 1231 2874 Deaths Not in Source: HMIS, DoHS Note: LAMA = left against medical advice , DAMA discharged against medical advice Outpatient consultations The top-most reason for outpatient consultations in 2075/76 was for Gastritis (APD) (5.84%), followed by upper respiratory tract infection (5.81%) (Figure 5.19). Figure 19: Top ten reasons (%) for outpatient consultations, FY 2075/76 Male 810 760 607 879 563 971 902 955 1061 2227 9735 Female 1166 725 799 1008 1572 4060 2350 1748 2006 4771 20205 DOR/LAMA/DAMA Male 1577 1058 1221 1340 1211 2348 2090 2026 2097 5101 20069 Female 58 67 60 98 91 377 190 120 104 188 1353 Table 5: AbscondedInpatient morbidity by age andMale sex, all hospitals,59 FY 2075/76 69 105 124 377 163 145 124 99 173 1438 253 70 37 65 73 195 195 227 347 955 Female1 Year 2417 Deaths in < 48 Years Age Group - 04 Years 14 Years 19 Years 29 39 Years 49 Years 59 Years Total - 387- - 123- - 47 - 66- 96 199 267 380 438 1239 Hours Male 3242 ≥ 60 Years 01 05 15 20 30 40 50 Female 29 Days 176 77 53 93 93 184 204 267 384 1170 2701 Deaths inFemale 48 25514 15841 20752 28994 59400 214059 95718 54229 48755 70765 634027 Recovered/CureHours Male 31318 Male23581 29573 40218287 30201 14153220 4955576 47671 9148501 7549102 361387215 292 397 480 1446 3527 Female 325 391 334 632 700 1260 1218 1158 1293 2392 9703 Not Improved Male 463 Female565 401 28037692 608 176441083 103222442 1104 316961231 629332874 22277510053 101098 59095 53744 82213 681677 Female 545 473 407 806 1004 2640 1223 1346 855 1972 11271 Referred Out Male 810 %760 607 55.45879 563 59.85971 90258.80 955 57.801061 34.512227 20.719735 34.94 47.12 50.08 20.04 37.53 Female 1166 Male725 799 349011008 1572 262974060 235032030 1748 434102006 331584771 5819920205 54283 52657 53907 20609 409451 DOR/LAMA/DAMATotal Male 1577 1058 1221 1340 1211 2348 2090 2026 2097 5101 20069 Female 58 %67 60 55.4598 91 59.85377 19058.80 120 57.80104 34.51188 20.711353 34.94 47.12 50.08 20.04 37.53 Absconded Male 59 69 105 124 377 163 145 124 99 173 1438 Deaths in < 48 Female 253 Total70 37 6293865 73 43941195 19554472 227 75106347 96091955 2809742417 155381 111752 107651 102822 1091128 387 123 47 66 96 199 267 380 438 1239 Hours Male % 5.77 4.03 4.99 6.88 8.81 25.753242 14.24 10.24 9.87 9.42 100.00 a i Female 176 77 53 93 93 184 204 267 384 1170 2701 Hours Male 287 141 76 91 102 215 292 397 480 1446 3527 Female 28037 17644 22442 31696 62933 222775 101098 59095 53744 82213 681677 Source: HMIS, %DoHS 55.45 59.85 58.80 57.80 34.51 20.71 34.94 47.12 50.08 20.04 37.53 Male 34901 26297 32030 43410 33158 58199 54283 52657 53907 20609 409451 Total o e: LAMA = %left against55.45 59.85 medical 58.80 advice57.80 34.51 , DAMA 20.71 discharged34.94 47.12 against50.08 medical20.04 advice37.53 Total 62938 43941 54472 75106 96091 280974 155381 111752 107651 102822 1091128 Outpatient consultations% 5.77 4.03— The4.99 top-most 6.88 8.81 reason 25.75 for14.24 outpatient 10.24 9.87 consultations 9.42 in100.00 2075 /76 was for Gastritis (APD) Source: HMIS, (5. 84DoHS%), followed by upper respiratory tract infection (5.81%) (Figure 5.19). Note: t agai t m i a a i i a g agai t m i a a i LAMA = left against medical advice , DAMA discharged against medical advice t a t ta t m t a t a t ta i a Outpatient consultations The top-most reason for outpatient consultations in 2075/76 was for Gastritis (APD) (5.84%), followed by upper respiratory tract infection (5.81%) (Figure 5.19). a t i i at t a t i ig Figure 19: Top ten reasons (%) for outpatient consultations, FY 2075/76 FigureFigure 19: 19: Top Top ten reasonsten reasons (%) for outpatient ( ) for consultations, outpatient FY 2075 consultations,/76 FY 2075/76 Gastritis (APD) 1341855 Upper Respiratory Tract Infection… 1335016 Headache 1142177 ARI/Lower Respiratory Tract… 948830 OPD-Morbidity-Orthopaedic… 912091 PUO 687103 Communicable-Water/Food Borne-… 609256 Skin Diseases-Fungal Infection… 566337 Orthopaedic Problems-… 558172 Skin Diseases-Scabies Cases 557645 0 500000 1000000 1500000 10. Disease types — t m i a t am g i a t a t a t i i t m ai i a a m ia ga i m i a m ia i a a t t i i a a am g t a t i a t ta at a am g a at t m i a a i a ia a a ga t t i a t a i g a i a t at i a a t i a a mi i mm i a a mm i a i a t t a t i mm i a mm i a a DoHS, Annual Report 2075/76 (2018/19) D e e e — In terms of disease types among inpatients and outpatient services in FY 2075/76: the number one airborne disease was pneumonia (organism unspecified) (12,281 cases) followed by pneumonia (unspecified) (5,222 cases) and Acute tonsillitis (2,8808 cases) (Table 6); among the 144 cases of vector borne diseases total death case 3, among 61 cases 2 death reported from Viral Encephalitis (Table 7); diarrhoea and gastroenteritis was the leading cause of inpatient waterborne disease (A09 :12839 cases), followed by typhoid fever (A010: 8553 cases) (Table 8); 22.9million communicable and non-communicable diseases were reported by outpatients in 2075/76 (communicable 11.46%, non-communicable 88.58%) (Table 9) a i TableTable 6: Breakdown Breakdown of ofairborne airborne disease disease cases cases among inpatients, inpatients, FY 2074/75FY 2074/75 Inpatient Morbidity Cases Inpatient Morbidity Deaths ICD Code and Name Female Male Total Female Male Total A15 Respiratory tuberculosis, bacteriologically and histologically confirmed 97 197 294 1 4 5 A150 Tuberculosis of lung, confirmed by sputum microscopy with or without culture 45 83 128 4 7 11 A151 Tuberculosis of lung, confirmed by culture only 8 17 25 1 1 A152 Tuberculosis of lung, confirmed histologically 4 0 4 0 0 A153 Tuberculosis of lung, confirmed by unspecified means 2 3 5 0 A154 Tuberculosis of intrathoracic lymph nodes, confirmed bacteriologically and histologically 1 0 1 0 A155 Tuberculosis of larynx, trachea and bronchus, confirmed bacteriologically and histologically 0 1 1 0 A156 Tuberculous pleurisy, confirmed bacteriologically and histologically 3 3 6 0 A157 Primary respiratory tuberculosis, confirmed bacteriologically and histologically 1 1 2 0 0 A158 Other respiratory tuberculosis, confirmed bacteriologically and histologically 1 3 4 1 1 A159 Respiratory tuberculosis unspecified, confirmed bacteriologically and histologically 9 5 14 0 A16 Respiratory tuberculosis, not confirmed bacteriologically or histologically 49 109 158 2 1 3 A160 Tuberculosis of lung, bacteriologically and histologically negative 21 30 51 3 3 6 A161 Tuberculosis of lung, bacteriological and histological examination not done 6 5 11 0 0 0 A162 Tuberculosis of lung, without mention of bacteriological or histological confirmation 46 55 101 0 4 4 A164 Tuberculosis of larynx, trachea and bronchus, without mention of bacteriological or histological DoHS,confirmation Annual Report 2075/76 (2018/19) 2 1 3 0 0 A165 Tuberculous pleurisy, without mention of bacteriological or histological confirmation 9 10 19 0 0 0 A168 Other respiratory tuberculosis, without mention of bacteriological or histological confirmation 17 22 39 0 A169 Respiratory tuberculosis unspecified, without mention of bacteriological or histological confirmation 144 237 381 3 9 12 A17 Tuberculosis of nervous system 3 3 6 0 A170 Tuberculous meningitis 16 26 42 2 3 5 A171 Meningeal tuberculoma 0 1 1 0 0 0 A178 Other tuberculosis of nervous system 3 3 6 0 A18 Tuberculosis of other organs 44 93 137 0 4 4 A180 Tuberculosis of bones and joints 15 14 29 0 0 0 A181 Tuberculosis of genitourinary system 3 0 3 0 A158 Other respiratory tuberculosis, confirmed bacteriologically and histologically 1 3 4 1 1 A159 Respiratory tuberculosis unspecified, confirmed bacteriologically and histologically 9 5 14 0 A16 Respiratory tuberculosis, not confirmed bacteriologically or histologically 49 109 158 2 1 3 A160 Tuberculosis of lung, bacteriologically and histologically negative 21 30 51 3 3 6 A161 Tuberculosis of lung, bacteriological and histological examination not done 6 5 11 0 0 0 A162 Tuberculosis of lung, without mention of bacteriological or histological confirmation 46 55 101 0 4 4 a i A164 Tuberculosis of larynx, trachea and bronchus, without mention of bacteriological or histological confirmation 2 1 3 0 0 A165 Tuberculous pleurisy, without mention of bacteriological or histological confirmation 9 10 19 0 0 0 A168 Other respiratory tuberculosis, without mention of bacteriological or histological confirmation 17 22 39 0 A169 Respiratory tuberculosis unspecified, without mention of bacteriological or histological confirmation 144 237 381 3 9 12 A17 Tuberculosis of nervous system 3 3 6 0 A170 Tuberculous meningitis 16 26 42 2 3 5 A171 Meningeal tuberculoma 0 1 1 0 0 0 A178 Other tuberculosis of nervous system 3 3 6 0 A18 Tuberculosis of other organs 44 93 137 0 4 4 A182A180 TuberculousTuberculosis peripheralof bones and joints 15 14 29 0 0 0 lymphadenopathyA181 Tuberculosis of genitourinary 8 8 16 0 0 A183system Tuberculosis of intestines, 3 0 3 0 peritoneum and mesenteric glands 28 37 65 0 1 1 A187 Tuberculosis of adrenal glands 0 1 1 0 A188 Tuberculosis of other specified organs 3 8 11 0 A19 Miliary tuberculosis 8 14 22 1 2 3 A190 Acute miliary tuberculosis of a single specified site 1 0 1 0 A191 Acute miliary tuberculosis of multiple sites 1 0 1 0 A192 Acute miliary tuberculosis, unspecified 0 1 1 0 0 A199 Miliary tuberculosis, unspecified 5 16 21 0 0 0 G03 Meningitis due to other and unspecified causes 85 115 200 2 3 5 G030 Nonpyogenic meningitis 1 4 5 0 1 1 G031 Chronic meningitis 0 2 2 1 1 G038 Meningitis due to other specified causes 0 1 1 0 G039 Meningitis, unspecified 134 170 304 4 11 15 J02 Acute pharyngitis 206 215 421 6 7 13 J020 Streptococcal pharyngitis 2 5 7 2 2 J029 Acute pharyngitis, unspecified 28 45 73 0 0 0 J03 Acute tonsillitis 1498 1382 2880 48 38 86 J030 Streptococcal tonsillitis 24 11 35 0 0 J038 Acute tonsillitis due to other specified organisms 10 12 22 0 0 0 J039 Acute tonsillitis, unspecified 304 272 576 2 1 3 J18 Pneumonia, organism unspecified 5668 6613 12281 397 335 732 J180 Bronchopneumonia, unspecified 74 110 DoHS,184 Annual0 Report 2075/760 (2018/19)0 J181 Lobar pneumonia, unspecified 79 70 149 7 6 13 J182 Hypostatic pneumonia, unspecified 61 34 95 46 25 71 J188 Other pneumonia, organism unspecified 19 14 33 0 0 J189 Pneumonia, unspecified 2380 2842 5222 68 90 158 J40 Bronchitis, not specified as acute or chronic 739 917 1656 49 47 96 Total 11915 13841 25756 647 605 1252 A182 Tuberculous peripheral lymphadenopathy 8 8 16 0 0 A183 Tuberculosis of intestines, peritoneum and mesenteric glands 28 37 65 0 1 1 A187 Tuberculosis of adrenal glands 0 1 1 0 A188 Tuberculosis of other specified organs 3 8 11 0 A19 Miliary tuberculosis 8 14 22 1 2 3 A190 Acute miliary tuberculosis of a single specified site 1 0 1 0 A191 Acute miliary tuberculosis of multiple sites 1 0 1 0 A192 Acute miliary tuberculosis, unspecified 0 1 1 0 0 A199 Miliary tuberculosis, unspecified 5 16 21 0 0 0 G03 Meningitis due to other and unspecified causes 85 115 200 2 3 5 G030 Nonpyogenic meningitis 1 4 5 0 1 1 G031 Chronic meningitis 0 2 2 1 1 G038 Meningitis due to other specified causes 0 1 1 0 G039 Meningitis, unspecified 134 170 304 4 11 15 J02 Acute pharyngitis 206 215 421 6 7 13 J020 Streptococcal pharyngitis 2 5 7 2 2 J029 Acute pharyngitis, unspecified 28 45 73 0 0 0 J03 Acute tonsillitis 1498 1382 2880 48 38 86 J030 Streptococcal tonsillitis 24 11 35 0 0 J038 Acute tonsillitis due to other specified organisms 10 12 22 0 a i 0 0 J039 Acute tonsillitis, unspecified 304 272 576 2 1 3 J18 Pneumonia, organism unspecified 5668 6613 12281 397 335 732 J180 Bronchopneumonia, unspecified 74 110 184 0 0 0 J181 Lobar pneumonia, unspecified 79 70 149 7 6 13 J182 Hypostatic pneumonia, unspecified 61 34 95 46 25 71 J188 Other pneumonia, organism unspecified 19 14 33 0 0 J189 Pneumonia, unspecified 2380 2842 5222 68 90 158 J40 Bronchitis, not specified as acute or chronic 739 917 1656 49 47 96 Total 11915 13841 25756 647 605 1252 TableTable 7: 7: Breakdown Breakdown of vector of v borneector bornediseases diseases among amonginpatients, inpatients, FY 2074/75 FY 2074/75 Inpatient Morbidity Cases Inpatient Morbidity Deaths ICD Code and Name Female Male Total Female Male Total A50 Congenital syphilis 1 2 3 0 A86 Unspecified viral encephalitis 27 34 61 2 0 2 B50 Plasmodium falciparum malaria 0 2 2 1 1 B500 Plasmodium falciparum malaria with cerebral complications 1 1 2 0 0 B509 Plasmodium falciparum malaria, unspecified 3 10 13 0 0 B51 Plasmodium vivax malaria 5 7 12 0 B519 Plasmodium vivax malaria without complication 7 8 15 0 0 B54 Unspecified malaria 13 14 27 0 0 0 B559 Leishmaniasis, unspecified 5 4 9 0 Total 62 82 144 2 1 3 Table 8: Water borne diseases among inpatients, FY 2075/76 Inpatients Inpatients Death ICD 10 Case Total Total Female Male Female Male A00 Cholera 43 34 77 0 1 1 DoHS,A00.0 Annual Cholera Report due 2075/76 to Vibrio (2018/19) cholerae 01, biovar cholerae 28 13 41 2 1 3 A00.1 Cholera due to Vibrio cholerae 01, biovar eltor 10 8 18 0 0 0 a i TableTable 8: 8: WaterWater borne borne diseases diseases among inpatients, among FY inpatients, 2075/76 FY 2075/76 Inpatients Case Inpatients Death ICD 10 Total Total Female Male Female Male A00 Cholera 43 34 77 0 1 1 A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae 28 13 41 2 1 3 A00.1 Cholera due to Vibrio cholerae 01, biovar eltor 10 8 18 0 0 0 A00.9 Cholera, unspecified 64 35 99 29 20 49 A01 Typhoid and paratyphoid fevers 1960 1969 3929 43 46 89 A010 Typhoid fever 4432 4121 8553 45 61 106 A011 Paratyphoid fever A 53 74 127 0 0 0 A014 Paratyphoid fever, unspecified 40 37 77 0 A03 Shigellosis 35 27 62 0 0 0 A030 Shigellosis due to Shigella dysenteriae 3 6 9 0 A038 Other shigellosis 16 24 40 0 0 0 A039 Shigellosis, unspecified 108 82 190 0 2 2 A06 Amoebiasis 133 112 245 0 2 2 A060 Acute amoebic dysentery 53 53 106 1 2 3 A061 Chronic intestinal amoebiasis 5 7 12 0 0 0 A062 Amoebic nondysenteric colitis 1 0 1 0 A064 Amoebic liver abscess 0 5 5 0 0 A065 Amoebic lung abscess 16 3 19 0 A066 Amoebic brain abscess 6 5 11 0 A067 Cutaneous amoebiasis 4 6 10 1 1 A068 Amoebic infection of other sites 0 3 3 0 A069 Amoebiasis, unspecified 114 97 211 3 1 4 A09 Diarrhoea and gastroenteritis of presumed infectious origin 6543 6296 12839 113 84 197 B15 Acute hepatitis A 48 56 104 1 1 2 B150 Hepatitis A with hepatic coma 12 13 25 1 1 B159 Hepatitis A without hepatic coma 40 77 117 2 1 3 B16 Acute hepatitis B 11 27 38 0 2 2 B161 Acute hepatitis B with delta-agent (coinfection) without hepatic coma 1 0 1 0 B169 Acute hepatitis B without delta- agent and without hepatic coma 24 48 72 1 0 1 B17 Other acute viral hepatitis 36 61 97 1 0 1 B170 Acute delta-(super)infection of hepatitis B carrier 2 0 2 0 B172 Acute hepatitis E 5 12 17 1 0 1 E86 Volume depletion 162 151 313 0 2 2 K52 Other noninfective gastroenteritis and colitis 80 72 152 4 2 6 K520 Gastroenteritis and colitis due to radiation 3 0 3 0 K521 Toxic gastroenteritis and colitis 2 2 4 0 K522 Allergic and dietetic gastroenteritis and colitis 1 0 1 0 K528 Other specified noninfective gastroenteritis and colitis 6 4 10 0 0 0 K529 Noninfective gastroenteritis and colitis, unspecified 247 250 497 0 0 R17 Unspecified jaundice 352 397 749 45 44 89 Total 14699 14187 28886 291 274 565 Table 9: Communicable and non-communicable diseases among outpatients by province, FY 2075/76 Communicable Non-Communicable Province Total Cases % Cases % 366901 9.92 3329450 90.07 3696351 Province 1 686147 19.34 2861653 80.66 3547800 Province 2 DoHS, Annual Report 2075/76 (2018/19) 440359 8.2 4892851 91.74 5333210 Province 3 230585 8.70 2418414 91.29 2648999 Province 4 449280 11.14 3580429 88.85 4029709 Province 5 223966 13.75 1403883 86.24 1627849 Province 6 233895 11.30 1834345 88.69 2068240 Province 7 11.46 88.53 22952158 Nepal 2631133 20321025 and colitis K528and colitisOther specified noninfective gastroenteritis and colitis 6 4 10 0 0 0 K528 Other specified noninfective K529gastroenteritis Noninfective and gastroenteritis colitis and 6 4 10 0 0 0 colitis, unspecified 247 250 497 0 0 K529 Noninfective gastroenteritis and R17 Unspecified jaundice 352 397 a i 749 45 44 89 colitis, unspecified 247 250 497 0 0 Total 14699 14187 28886 291 274 565 TableR17 9:Unspecified Communicable jaundice and non-communicable diseases among352 outpatients 397 by province, 749 45 44 89 Table 9: Communicable and non-communicable diseases among outpatients by province, FY 2075/76 Total 14699 14187 28886 291 274 565 FYTable 2075/ 9: Communicable76 and non-communicable diseases among outpatients by province, Communicable Non-Communicable FY 2075/Province76 Total Cases % Cases % Communicable Non-Communicable Province Total Province 1 366901Cases 9.92% 3329450Cases 90.07% 3696351 366901 9.92 3329450 90.07 3696351 ProvinceProvince 2 1 686147 19.34 2861653 80.66 3547800 Bagmati ProvinceProvince 2 440359686147 19.348.2 4892851 2861653 91.7480.66 53332103547800 a a i Bagmati ProvinceProvince 230585440359 8.708.2 24184144892851 91.29 91.74 26489995333210 a a i Province 230585 8.70 2418414 91.29 2648999 Province 5 449280 11.14 3580429 88.85 4029709 a a i ProvinceProvince 5 223966449280 13.75 11.14 1403883 3580429 86.24 88.85 16278494029709 a a i Province 223966 13.75 1403883 86.24 1627849 a im Province 233895 11.30 1834345 88.69 2068240 233895 11.30 1834345 88.69 2068240 a a a im Province 11.46 88.53 22952158 Nepal 2631133 11.46 20321025 88.53 22952158 Nepal 2631133 20321025 11. Communicable and non-communicable diseases (inpatients) Communicable and non-communicable diseases (inpatients) a ta a t ita i t e Communicable — In 2075/76 and non-communicable, 446811 cases were diseases discharged (inpatients) to hospital, of which 92.1 percent were non- mm i a i a a a a m t a m a ma communicable disease cases (Table 5.10). There were nearly five times as many non-communicable mm i a i a at a mm i a i a at e — In 2075/76, 446811 cases were discharged to hospital, of which 92.1 percent were non- diseasecommunicable deaths as disease communicable cases (Table disease 5.10). deaths. There were nearly five times as many non-communicable disease deaths as communicable disease deaths. TableTable 10:10: Communicable Communicable and and non-communicable non-communicable disease cases cases and and deaths deaths (inpatients), (inpatients), FY 207 FY 5/76 2075/76 Table 10: CommunicableDiseases and non-communicable diseaseCases cases and deaths% (inpatients),Deaths FY 2075/76% Diseases 35281Cases % Deaths % Communicable 7.89 716 6.67 35281 Communicable 411530 7.89 716 6.67 Non-communicable 92.1 10010 93.32 411530 TotalNon- communicable 446811 92.1100 1072610010 93.32100 Total 446811 100 10726 100 DoHS, Annual Report 2075/76 (2018/19) Male Female 120000 99930 100000 80000 63495 60000 36869 37456 40000 35774 35051 23936 18951 20000 0 Major Surgeries Outpatients Minor Inpatients Minor Emergency Minor Surgeries Surgeries Surgeries Cause a i of death — Regarding the causes of death (and morbidity) among inpatients in FY 2075/76: De er e —333,218 deliveries were conducted in Health Facilities in 2075/76 of which 79.5 percent 12. CauseThe leading of death cause — ga i g t a at a m i it am g i a t i of death among inpatients was ‘Unknown and unspecified cause of morbidity happened through spontaneous labour, 18.2 percent through caesarean sections and 2.3 percent were (1332) (Figure 22). vacuum assisted (Figure 24). a i g a at am g i a t a a i a m i it ig Figure 24: Deliveries in hospitals, FY 2075/76 C/S Vaccum or Forceps normal FigureFigure 22: 22: Top Top10 causes 10 causes of death of death among among inpatients, inpatients, FY 2075/76 FY 2075/76 R69 Unknown and unspecified causes of… 1332 J18 Pneumonia, organism unspecified 732 18.2 O80 Single spontaneous delivery 405 2.3 J44 Other chronic obstructive pulmonary… 393 J22 Unspecified acute lower respiratory… 238 R50 Fever of unknown origin 215 N39 Other disorders of urinary system 207 Normal A09 Diarrhoea and gastroenteritis of… 197 79.5 Delivery: T14 Injury of unspecified body region 173 333218 J189 Pneumonia, unspecified 158 0 200 400 600 800 1000 1200 1400 Note: Please see Annex 3 for more details. Surgeries — 163425 major surgeries were performed in the reporting period (combined inpatient and 13. Surgeries — ma g i m i t g i m i Hospital Brought deaths and Post-mortem cases — In FY 2075/76: outpatienti a t a surgeries) t a t of which g i 61.14 percent i were female t cases (Figure ma 23). A a total ig of 72643 minor surgical procedurest ta were mi performed gi a on hospital outpatients m while 72507 ita were t a t performed i on an inpatient basis. 3417 brought dead to hospital cases (60% male–40% female) and 7547 hospital post-mortem cases Females m accounted for a 49.02 i a t percent a i of all ma minor surgeries. a t More of the minor t emergency a mi surgery cases (64% males–37% females) were reported to the HMIS (Table 11). were g i t mi m g g a ma t a ma males than females Table 11: Hospital brought dead and post-mortem cases, FY 2075/76 Figure 23: Surgeries in hospitals, FY 2075/76 Figure 23: Surgeries in hospitals, FY 2075/76 Male Female 120000 99930 100000 80000 63495 60000 36869 37456 40000 35774 35051 23936 18951 20000 0 Major Surgeries Outpatients Minor Inpatients Minor Emergency Minor Surgeries Surgeries Surgeries De er e —333,218 deliveries were conducted in Health FacilitiesDoHS, in 2075 Annual/76 Reportof which 2075/76 79.5 percent (2018/19) happened through spontaneous labour, 18.2 percent through caesarean sections and 2.3 percent were vacuum assisted (Figure 24). Figure 24: Deliveries in hospitals, FY 2075/76 C/S Vaccum or Forceps normal 18.2 2.3 79.5 Normal Delivery: 333218 Note: Please see Annex 3 for more details. Hospital Brought deaths and Post-mortem cases — In FY 2075/76: 3417 brought dead to hospital cases (60% male–40% female) and 7547 hospital post-mortem cases (64% males–37% females) were reported to the HMIS (Table 11). Table 11: Hospital brought dead and post-mortem cases, FY 2075/76 Male Female 120000 99930 100000 80000 63495 60000 36869 37456 40000 35774 35051 23936 18951 20000 0 Major Surgeries Outpatients Minor Inpatients Minor Emergency Minor Surgeries Surgeries Surgeries a i De er e —333,218 deliveries were conducted in Health Facilities in 2075/76 of which 79.5 percent 14. Deliveries — i i t i a t a i i i i happened t a t g ta a t t g a a a a through spontaneous labour, 18.2 percent through caesarean sections and 2.3 percent were vacuum t a m a i t ig assisted (Figure 24). FigureFigure 24: 2 4:Deliveries Deliveries in hospitals, in hospitals, FY 2075/76 FY 2075/76 C/S Vaccum or Forceps normal 18.2 2.3 79.5 Normal Delivery: 333218 Note: t a m tai Please see Annex 3 for more details. Hospital15. Hospital Brought Brought deaths deaths andand Post-mortemPost-mortem cases cases — In — FY In 2075/76: FY 2075/76: g t a a t ita ma ma a ita t m t m 3417 brought dead to hospital cases (60% male–40% female) and 7547 hospital post-mortem cases a ma ma t t t a (64% males–37% females) were reported to the HMIS (Table 11). TableTable 11:11: Hospital Hospital brought brought dead and dead post-mortem and post-mortem cases, FY 2075/76 cases, FY 2075/76 Female % Male % Total Brought dead 1359 40 2058 60 3417 Post-mortem done 2724 36 4823 64 7547 Total 4083 37 6881 63 10964 DoHS, Annual Report 2075/76 (2018/19) a i 7.2 Human Organ Transplant Services 7.2.1 Introduction a i a ma B a ta a a a a t t B a ta i i t i i t a t a a t t gt a a ga t a a ta i i t t i t tat it i m it t i t it i a a it ta i m t it a t it i ga t a a ta t a i i a a i a a t g a i t a a a t a 7.2.2 Major Milestones of Shahid Dharmabhakta National Transplant Center (SDNTC) ta i m t a i a ia i i m i t a a ta ta t m a a m ia i i tat m a ma ga a a ta t a t ai a g i a a ta i a a ia g m ma ga a a t g a m i t i a a ta m i a a ta i i a a ta a a ta m a ai a a i i a a ta t a a i i t a a ta i a a a t i a a t a i t a a t t at i a g m a t g 7.2.3 Objectives t gt a a ga t a a ta i i t t i a a ia i i t a a ta i ig a it a t a at a i t ta a at t ma ga t a a t t ta t tat i a t ga ai i a a at i i t ga i a t am a a t a i i a t a a a i t ai a a ga i g ga ai ga t a a ta a ga a ig ma i i g t t t ai i g i a i a t i t a t i a t t 7.2.4 Major achievements of FY 2075/76 i gat t a a i i t a a ta i a t i t a a ta m a ai a t i m i a a i t i t a a t i t ma t a m t i a ma Status of health care services, fiscal year 2075/76 m a t i a t a t a i a ma a i t a t i t a t a tm t i t at a mi i a i a g a m t imi a it a DoHS, Annual Report 2075/76 (2018/19) a i mi g i a ma g i i t m i t a a ta a at m t i m i ai ia i a m i t i a a a a ig t a a i t ia i i m i t i 7.2.5 Status of specialized diagnostic services m a t t i a m t a t t a a a a i t a a imi a t m a i t at t a i g a a a t ta m B a a t at B a tat ma at B a a t i a a a t t a t ta ta i t i a a t i a ta t m a ig t a t at i a 7.2.6 Status of Financial Resources, t ta g t it i t a 7.2.7 Physical infrastructures at SDNTC- FY 2075/76 ita a a i B i i g ita m a at t a t t a ai a ta a t t a ai a m a i g a i a i m t a ma i a at i m t Bi mi t mat g mi t a a a t mat imm a a a a a t mat ta mi t m a t mat ag a a a t a t mat mat g a a ia i a i a i m t at it i g m i m i at a a i a at a i t a m at a a t g B a ag t m m B B a t DoHS, Annual Report 2075/76 (2018/19) There were 799 minor surgeries and 652 major surgeries in the FY 2075/76. The number of kidney transplantation escalated from 152 to 179 in FY 2075/76. The number of sessions of paid dialysis decreased from 2826 in FY 2075/76 to 3,229 in fiscal year 2074/75. There has been a slight decrease also in the free dialysis sessions from 26,051 in FY 2074/75 to 21,202 in FY 2075/76. 7.2.5 Status of specialized diagnostic services The number of lab tests done in FY 2075/76 was 129,186. The number of ultrasound tests and X-ray and CT scan in the FY 2075/76 was 42,823,115 and 787 respectively. Similarly, the number of ECG done was 2013 while that of the echocardiograph was 1,274 followed by 654 endoscopy and colonoscopy. The total number of BCM done was 99 and that of ABG was 205. The status of human resources at SDBNTC shows an upward trend in each fiscal year. In the FY 2075/76, there were a total of 200 staffs of which 167 were technical and 33 were non-technical staffs. These both numbers are higher than that of previous years. 7.2.6 Status of Financial Resources, The total budget expenditure in the FY 2075/76 was 192,814,516.40 7.2.7 Physical infrastructures at SDNTC- FY 2075/76 Hospital owned land: 0 Ropani Building: Hospital Room: Inadequate Doctor quarter: Not available Staff quarter:Not available Ambulance : Functioning - 1 Major Medical Equipment: X-Ray machine – 1, USG – 3 Laboratory Equipment : Biochemistry, Hematology , dry chemistry analyzer, automated immunoassay analyzer, automated tissue presser, rotary microtome, automated coagulation analyzer, 6 port fully automated hematology analyzer, Dialysis Machine : 60 OT/ICU Major Equipment's : Ventilator – 4 , Monitor – 15 , Syringe Pump - 10 , Infusion Pump – 10, Defibrillator- 6, Laparoscopy – 1, Endoscopy 256 Slice CT Scan Cath Lab Endoscopic Ultrasound, CUSA Low Temperature Analyzer TEG Analyzer Autologous Blood Salvage System TEE Probe PCA Pump EBUS ECMO ABP Halter a i TMT 7.2.8 Status of House Keeping at SDBNTC, FY 2075/76 7.2.8 Status of House Keeping at SDBNTC, FY 2075/76 SN Activities Remarks 1 Cleanliness of the hospital Satisfactory 2 Maintenance of hospital premises Satisfactory 3 Sanitation Satisfactory 4 Health care waste management Satisfactory 5 Safe drinking water Satisfactory 6 Canteen Satisfactory 7 Triage system Satisfactory 8 Hospital parking Poor 9 Hospital garden Poor 7.2.9 Challenges: a a a a a at a 7.2.9 Aims of SDBNTC in FY 2075/76 t ma i a a g am ga ai ga a a t a a ta a t a m t t ma i i a t g i t g t i t ai i g a t i a t t at a t i t a a t a t at a t i t a a t a a t g m t a t a a it t t t a a m ia t a a t i i t 7.2.10 Available Services of Shahid Dharmabhakta National Transplant Center i a a t i a a t g m i i a ma a g g i t a a ma t at t i g i i B t a t t g at g a t i t a a a i t t m B a t B a Bi t a i g a i g a i t a i a a g g a t g B g ita a t a g a a t g B a i g am B g Bi a i iag i a t a at g ga a i t a a ma DoHS, Annual Report 2075/76 (2018/19) a i 7.3 Homoeopathic Services 7.3.1 BACKGROUND 7.3 Homoeopathic Services am 7.3.1 BACKGROUND a ma ma a i m at i t m t a a t i i i a i i a imi ia imi i a t i i i i Dr. amuel H ahnemann of ermany had discovered omoeopathic system before two and half t a i ig a m t m i it a t centuries. This is based on fi ed principals of imilia imilibus urantur . edicine is provided on the basis of sign and symptom e hibited by patients. i t ita i i g m at i i t t a i t i t m at i t m i mi a a a i g i t a is the only one hospital providing homoeopathic services to the people of Nepal in the public sector. The ita i i homoeopathic system is economic, easy and effective having ero side effect as well. The hospital provides PD service only. 7.3.27.3.2 STRATEGIES STRATEGIES ADOPTED ADOPTED This is the only one hospital of omeopathy in Nepal. This system is economic, easy and i i t ita m at i a i t m i mi a a i t convenient, covering most of the diseases with no side effect from the medicine being used. i g m t t i a it i t m t m i i i g a t a t m B t t a ma a at g a i t i a t atm t PD patients are outnumbered. But, due to lack of manpower and pathology lab IPD is not in i i t action. The treatment provided here is free of cost. 7.3.3 SUMMARY OF ACHIEVEMENT 7.3.3 SUMMARY OF ACHIEVEMENT m a t i i a i g a a m t a a a t at i The number of patients is increasing day by day. ome of the referred cases are also treated a gi i i a ia a g a a i ma a t i i a ta i i here like allergic rhinitis, urticaria, laryngeal papilloma, P D and other skin diseases. Total i a mma i i a service provided in FY 2075/76 are summari ed in Table 7.1 TableTable 7.1: 7.1: Description Description ofof patientspatients visited visited inin Hospital, Hospital, fiscal fiscal year year 2075/76 2075/76 Particular Number of Patients eneral edicine 5,302 kin 21,125 .N.T 3,135 ye 2,025 Dental 1, 06 yn/ bs. 2,530 ther ,525 Total Patients 84,448 7.3.47.3.4 HEALTH HEALTH CAMP CAMP SERVICES: SERVICES: FISCAL FISCAL YEAR YEAR 2075/76 2075/76 1. Bethan chowk Gaupalika ,Dhunkharka {Health post}, Kavre B t a a a i a a a a t t a Total number of patients 600 ta m a t ale 350 a Female 250 ma 2. Kakani Gaupalika { Kakani PHC }, Nuwakot a a i a a i a a a i a tTotal number of patients 05 ta m a t ale 225 a Female 1 0 ma DoHS, Annual Report 2075/76 (2018/19) a i 7.3.5.3.5 Summary of Financial Allocation andand ExpenditureExpenditure SummarySummary of of Financial Financial Allocation Allocation and Expenditure Fiscal Year Regular Budget in Rs Development Budget in Rs Total Budget in Rs (in thousand) (in thousand) (in thousand) 2075/76 13,600 2,000 15,600 7.3.6 Constraints 7.3.6 Constraints i. Lack of doctors, paramedics and other staffs made ineffectiveness in its services. i a t a am i a t ta ma i i it i ii. Doctors and other staff are not provided with higher training and education. ii t a t ta a t i it ig t ai i g a a iii. There is high need of pathology lab. iii i ig at g a 7.3.7 Conclusion: 7.3.7 Conclusion: This homeopathy hospital is central level hospital. It needs to be ungraded. People of i m at ita i t a ita t t g a at ma Kathmandu valley and nearby districts can take free and convenient service of the hospital. a a a i t i t a ta a i t i t ita a m People far from Kathmandu valley are not able to take the benefits provided by this hospital. It at ma a a t a t ta t t i t i ita t i a t i is essential to provide service at all the 7 provinces of Nepal i at a t i a DoHS, Annual Report 2075/76 (2018/19) g g am SUPPORTING PROGRAMS Chapter 8 Chapter 8.1 Health Training 8.1.1 Background: a a a t ai i g t a ta i i a t a a i a g a g a t ai i g a i t a a t it t ai i g a i i i it t a a a t ai i g t at g a a i g t t t i t i i i a t g a i t i t t i a a ma ag ia a a it a t i i at a t i a it a t a i t a ai t ig t a t tat a i i a i ia t ai i g t a ta at a i a at ma a a B t a t a a ga i a i i a t ai i g it t at t t ai i g a a tm t i i i a t t i i t a t a a a i at a t t i ia a t t ai i g t t t i g t m t t ta g t i i i t a a a t i B a a a t t t at g a tai a m t a 8.1.2 Goal: a g a i t i a t i a a ma ag ia a a it a t i i at a t i a it a t a i t a a ai m t t m m a t tat 8.1.3 Objectives: ta a i t t ai i g a i g a ag i ai i a i a t a a a a i t t ai i g ga i a t i i t ai i g t a t t t a t t t a it a a i g t i i m t t a it t ai i g a i i t m a i m i a t a a ta a a t a t a a it i t t ai i g it a t a m t i a t ai i g a a t gt m a i m a a a it t t ai i g a t 8.1.4 Strategies: i g ta a i i g a a i g t ai i g a i a i i a t ai i g it i g a ta a i i g t ai i g a ag t a a a it m t t ai i g it g i i i t t m a g t m t ai i g a a a i m t t g a g a i t a i i g t ai i g a i i g i it i a a m t ga i a t gt i g ai i g ma a ag m t t m a t ai at a i ia a a DoHS, Annual Report 2075/76 (2018/19) 28 8.1.5 Training Netw ork of NH TC: g g am National health training network co- ordinates and supports seven Provincial Health Training 8.1.5 TrainingCenter Network( previous of RegionalNHTC: Health Training Centers/ Sub- Regional Health Training Center) currently established under M inistry of Social development ( M OSD) of each Province and 4 9 a a a t t ai i g t i at a t i ia a t ai i g t i clinical gi a training a t sites ( Figure ai i g 8 . 1 . 2 t ) . The hospital- gi a based training a t sites ai i g conduct F t amily Planning, t ta i i i t ia m t a i a i i a t ai i g Sk illed B irth Attendance, M id- L evel Practicum, Safe Abortion Services, Rural USG , Anesthesia it ig ita a t ai i g it t ami a i g i Bi t Assistant, Pediatric Nursing, M edico- L egal and other types of training program. The new a i a m a i a t ia i ta t iat i i g i ga a t t t ai i g g am ga i a a t t a organiz ational structure and training network are as shown in below. t ai i g t a a i Figure 8.1.1 New O rganiz ational Structure of NH TC: Figure 8.1.1 New OrganizationalNational Structure H ealthof NHTC: Training Center Training Skill Development Training Administration MaterialDevelopmen Section Accreditation and Section t Section Regulation Section Figure 8.1.1Training co-ordination W ings: Training Netw ork i a a a a i t NH TC DoHS, Annual Report 2075/76 (2018/19) g g am 8.1.68.1.6 Different Different ClinicalClinical Training TrainingSites Sites accredited accredited by byNHTC: NH TC: National Health Training Centre provides following training through different training sites as a a a t ai i g t i i g t ai i g t g i t t ai i g it a i t listed below. Clinical i i a t ai i g it training sites S.N Number Name of the training site site accredited for Province 1 1 1 F PAN, Charali, J hapa Implant, IUCD, M inilap, NSV 2 2 AM DA Hospital, Damak , J hapa SB A, RUSG , M L P, AAC 3 3 M echi Provincial Hospital, B hadrapur, J hapa MLP 4 4 F PAN, Itahari G B V , PoP, SB A, ASB A, B RH, V IA Cryo, CAC, M A 5 5 B PK IHS, Dharan PNC, V IA 6 6 K oshi Hospital, B iratnagar RH, PPIUCD, SB A, SAS, G B V , IP, COPF Counseling, ASRH, G B V 7 7 Nobel M edical College, B iratnagar PPIUCD 8 8 Udayapur Hospital, G aighat GBV 9 9 Inaruwa Hospital, Sunsari GBV 1 0 1 0 Ok haldhunga Community Hospital M L P, G B V Province 2 1 1 1 G aj endra Narayan Singh Hospital, Raj biraj RH 1 2 2 Province Hospital, J anak pur RH 1 3 3 Narayani Hospital, B irgunj SB A, PPIUCD 1 4 4 F PAN, J hanak pur, Dhanusa Implant, IUCD, M inilap Bagmati province 1 5 1 Paropak ar M aternity and W omen' s Hospital, ASB A, SB A, Implant, IUCD, PPIUCD, K athmandu ASRH, G B V , AAC, RUSG , CNC( SNCU) , V IA/ CRY O, STI, SAS ( CAC, M A, 2nd Trimester Abortion Care) , M inilap 1 6 2 CF W C, Chhetrapati, K athmandu F P, ASRH 1 7 3 B hak tapur Hospital, B hak tapur ASRH 1 8 4 F PAN, Pulchowk F P, SAS 1 9 5 M SS, Satdobato F P, SAS 20 6 F PAN, Chitwan F P, SAS 21 7 M SS, Narayanghat F P, SAS 22 8 B haratpur Hospital, Chitwan ASB A, SB A, M L P, SAS, OTTM , G B V 23 9 PHE CT Nepal K irtipur Hospital, K athmandu SB A, F P, V IA 24 1 0 PHE CT Nepal M odel Hospital, K athmandu SAS, V IA, AAC 25 1 1 Nepal M edical College, K athmandu 2nd Trimester Abortion Care, SAS 26 1 2 Army Hospital, Chhauni, K athmandu SB A, F P 27 1 3 TUTH, M aharaj gunj , K athmandu NICU, ICU, OTTM , PNM , M edicolegal 28 1 4 K anti Children Hospital, K athmandu Pediatric Nursing care 29 1 5 Nepal Cancer Care F oundation, L alitpur V IA/ CRY O Gandaki province 3 0 1 Pok hara Academy of Health Science, RH, G B V , AAC Pok hara 3 1 2 Community Hospital, L amj ung SB A, M L P 3 2 3 Dhaulagiri Provincial Hospital, B aglung SB A, M L P Province 5 3 3 1 L umbiniProvince Hospital, B utwal SB A, SAS, G B V 3 4 2 B him Hospital, B hairahawa SBA 3 5 3 AM DA Hospital, B utwal OTTM 3 6 4 F PAN, B utwal F P, SAS 3 7 5 M SS, Chandrauta, K apilvastu F P, SAS 3 8 6 L umbini M edical college, Palpa F P, RH 3 9 7 F PAN, Dang FP 4 0 8 B heri Hospital, Nepalgunj RH, G B V 4 1 9 M ission Hospital, Palpa SB A, M L P Karnali province DoHS,4 2 Annual1 Report 2075/76K arnali Provincial(2018/19) Hospital, Surk het SB A, F P ( Implant, IUCD, NSV , M inilap) 4 3 2 K arnali Academic of Health Science, J umla SB A, IP Sudurpaschhim province 4 4 1 Seti Provincial Hospital, Dhangadhi RH, G B V , M L P 4 5 2 M ahak ali Provincial Hospital, K anchanpur SBA 4 6 3 F PAN, K anchanpur FP 4 7 4 Dadeldhura Hospital SB A, M L P 4 8 5 B ayalpata Hospital, Achham MLP 4 9 6 AchhamHospital, M angalsen MA 3 6 4 F PAN, B utwal F P, SAS 3 7 5 M SS, Chandrauta, K apilvastu F P, SAS 3 8 6 L umbini M edical college, Palpa F P, RH 3 9 7 F PAN, Dang FP g g am 4 0 8 B heri Hospital, Nepalgunj RH, G B V 4 1 9 M ission Hospital, Palpa SB A, M L P Karnali province 4 2 1 K arnali Provincial Hospital, Surk het SB A, F P ( Implant, IUCD, NSV , M inilap) 4 3 2 K arnali Academic of Health Science, J umla SB A, IP Sudurpaschhim province 4 4 1 Seti Provincial Hospital, Dhangadhi RH, G B V , M L P 4 5 2 M ahak ali Provincial Hospital, K anchanpur SBA 4 6 3 F PAN, K anchanpur FP 4 7 4 Dadeldhura Hospital SB A, M L P 4 8 5 B ayalpata Hospital, Achham MLP 4 9 6 AchhamHospital, M angalsen MA Figure 8.1.2: Province level training sites : 1. Seti Province Hospital, Dhangadi 2. Mahakali province Hospital, Mahendranagar 1. PMWH, Kathmandu 3. FPAN, Kanchanpur 2. CFWC, Chhetrapati, Kathmandu 4. Dadeldhura Hospital 3. FPAN, Pulchok 5. Bayalpata Hospital, Achham 4. Bhaktapur Hospital, Bhaktapur 6. Achham hospital, Mangalsen 1. Karnali province Hospital,Surkhet 5. MSS Satdobato 2. Karnali Academy of Health 6. FPAN, Chitwan Sciences, Jumla 7. MSS, Narayanghat 8.Bharatpur Hospital, Chitwan 1. Pokhara Academy of 9. PHECT Nepal kritipur Hospital Health science, Pokhara 10. PHECT Nepal Model Hospital 2. Dhaulagiri province 11. Nepal Medical College (NMC) Hospital, Baglung 12. Army Hospital, Chauni 3. Community Hospital, 13. TUTH, Maharajgunj lamjung 14.Kanti Children's Hospital Sudurpaschhim 15. Nepal cancer care Foundation, Karnali Gandaki Bagmati 1. Lumbini Province Hospital, Butwal 2. Bhim Hospital, Bhairahawa 3. AMDA Hospital, Butwal 4. FPAN Butwal 5. MSS, Chandrauta, kapilvastu 6. Lumbini Medical College, Palpa 7. FPAN, Dang 1. Gajendra Narayan singh 8. Bheri Hospital, Nepalgunj Hospital, Rajbiraj, 9. Mission Hospital, Palpa 2. Province Hospital, Janakpur 1. BPKIHS, Dharan 3. Narayani Hospital, Birgunj 2. Mechi provincial Hospital,Jhapa 4. FPAN, Janakpurdham, 3. Koshi Hospital, Biratnagar Dhanusa 4. AMDA Hospital, Damak, Jhapa 5. Novel Medical College, Biratnagar 6. Okhaldhunga community Hospital 7. Udayapur Hospital, Gaighat 8. Inaruwa Hospital, Sunsari 9. FPAN, Itahari 10. F PAN, Charali, J hapa F igure 8 . 1 . 2: Province level training sites DoHS, Annual Report 2075/76 (2018/19) g g am 8.1.7 MAJOR ACTIVITIES CONDUCTED BY NHTC 8.1.7.1 Training Material Development i g t ai i g at ia m t i t t ai i g ma a i t i a it t m t a m t a t i i a i ma ag m t ima a ma a a ag a am i a ta imat a g a a t m a t a ia a B a ma ag m t iat i i g a a a i t Ba i i t a i ia i a ag i ta i a t a a i g at a i ta a t a i it a a ma ag m t mmi i t a i g a ag a t i i a m t i a m t m a i ia i ta : a a a t a a t Ba i i t B t a gi a ag m t ia i g a t i ai i g a t t g at 1. Seti Province Hospital, Dhangadi a t a a t ma ag m t a t Ba B at a t t i i m ta 2. Mahakali province Hospital, Mahendranagar 1. PMWH, Kathmandu 3. FPAN, Kanchanpur 2. CFWC, Chhetrapati, Kathmandu a t a t a a t ma ag m t a ga i a a a a it m t 4. Dadeldhura Hospital 3. FPAN, Pulchok a i ga t ai i g t 5. Bayalpata Hospital, Achham 4. Bhaktapur Hospital, Bhaktapur 6. Achham hospital, Mangalsen 1. Karnali province Hospital,Surkhet 5. MSS Satdobato 2. Karnali Academy of Health 6. FPAN, Chitwan 8.1.7.2. Skill Development Sciences, Jumla 7. MSS, Narayanghat 8.Bharatpur Hospital, Chitwan t a i a ma t ai i g g am at i ia a a i i t ia 1. Pokhara Academy of 9. PHECT Nepal kritipur Hospital Health science, Pokhara 10. PHECT Nepal Model Hospital m t i i t i ta i g t mai i t a i g 2. Dhaulagiri province 11. Nepal Medical College (NMC) i i t ai i g g am t i ia a t ai i g t t a Hospital, Baglung 12. Army Hospital, Chauni 3. Community Hospital, 13. TUTH, Maharajgunj i m a t ai i g ai ia i i a t ai i g lamjung 14.Kanti Children's Hospital i ga a t m t t ai i g g am ma ag m t g i i Sudurpaschhim 15. Nepal cancer care Foundation, it g i i t ai i g ma a m t a i i m it i g g am a Karnali t a i itat t i ia g t ai i g g am The Skill Development Section of NHTC conducted the following types of training: Gandaki a re-service training: i t t i t ai i g t i ma i Bi m i a i m t gi i g m t a t ia i ta t a a it B t ai i g i ta g t t t i g a at i a i m i a i m t t i ia a t ai i g m t m a ai Bagmati mai t a a t a i m t a a a m i a i i i a i a a i i t ai i g i i ig a a ta 1. Lumbini Province Hospital, Butwal 2. Bhim Hospital, Bhairahawa i i g t t ta a a t i ta t a t a i at t i 3. AMDA Hospital, Butwal a a g a a t a i t a i m g g i 4. FPAN Butwal 5. MSS, Chandrauta, kapilvastu ia t a a a i i a ita i t a a t i gi t 6. Lumbini Medical College, Palpa 7. FPAN, Dang 1. Gajendra Narayan singh n service trainings: i g a t i t t i i t ai i g t 8. Bheri Hospital, Nepalgunj Hospital, Rajbiraj, 9. Mission Hospital, Palpa 2. Province Hospital, Janakpur 1. BPKIHS, Dharan 3. Narayani Hospital, Birgunj 2. Mechi provincial Hospital,Jhapa 1 grading raining: i g a i g t ai i g a ig a t a t 4. FPAN, Janakpurdham, 3. Koshi Hospital, Biratnagar i i i a t t ai i g a ag aim t t i t im m t Dhanusa 4. AMDA Hospital, Damak, Jhapa 5. Novel Medical College, Biratnagar g am a im ma a g a i g t ai i g a 6. Okhaldhunga community Hospital a at 7. Udayapur Hospital, Gaighat 8. Inaruwa Hospital, Sunsari 9. FPAN, Itahari om etenc and clinical- ased training: ga i a i m t a i i a a 10. F PAN, Charali, J hapa t ai i g i g g m t a t i i a it m i i a t ai i g it t g a t g a i t i i i m i i a a a F igure 8 . 1 . 2: Province level training sites DoHS, Annual Report 2075/76 (2018/19) repair maintenance of healthcare eq uipment. The AA course under National Academy of M edical Sciences ( NAM S) is considered as pre- service as well as in service training course which is designed as a task shifting to produce non- doctor AA. Staff Nurses and Health Assistant are the candidates for this course and after graduation; they can help in the conduction of various emergency surgeries, especially the caesarean section in peripheral hospitals in the absence of anesthesiologists. b. I n serv ice training s: F ollowings are the different types of in- service trainings conducted by NHTC 1 . U p g rading Training : In- service upgrading trainings are designed and conducted as per the needs of M OHP, divisions and centers. The training pack ages aim to develop the sk ills to implement new programs and improve j ob performance. In F Y 207 4 / 7 5 no any upgrading training were planned and held at NHTC. 2 . C omp etency and clinical- b ased training : NHTC organiz e various competency and clinical based training for ex isting government health work ers in coordination with multiple clinical training sites to upgrade the k nowledge and sk ills of the service g g am providers in multiple clinical areas. These in- service trainings are based on local need and i i t ai i g demand a and a are supported, a developed, a ma and updated a a according t to the national a and at a i g international t t practice a a and a scientific i t a a evidence. a Twenty a courses i are offered i which t are listed a i a i t i in box below: Types of Upgrading and Competency and Clinical-based Training Courses U p g rading C omp etency and clinical b ased cou rses cou rses Senior aux iliary Sk illed birth attendance M id- level practicum ( M L P) health Advanced sk illed birth Palliative care work er training attendance Pediatric nursing care ( 6 months) Rural ultrasonography ( USG ) G ender based training Senior aux iliary for nurses Clinical training sk ills nurse- midwife M edico- legal Training ( CTS) ( 6 months) Non- scalpel vasectomy Operation theatre techniq ue Aux iliary Intrauterine Contraceptive and management ( OTTM ) nurse- midwife Device ( IUCD) Infection prevention ( IP) Padnam ( P) ( 6 Postpartum intrauterine M ental health months) contraceptive device Comprehensive family Aux iliary ( PPIUCD) planning ( CoF P) counseling health work er-P M inilaps Primary trauma care ( PTC) ( 6 months) Implants and emergency trauma Aux iliary Safe abortion services management ( E TM ) health Comprehensive abortion care Adolescent and sex ual work er( 1 5 M edical abortion reproductive health ( ASRH) months) Pack ages of E ssential Non- Aux iliary communicable Diseases nurse- midwife ( 1 8 months) 3 . R efresher training : A range of refresher trainings are conducted as per the needs of Refresherdivisions training: and a g t ai i g a t a t i i i centers to develop the sk ills for implementing new programs and to a t t t i im m g g am a t im ma improve j ob performance. In this fiscal year 207 5/ 7 6 , the refresher training courses t i a a t t ai i g i i i t a a t B ami a i g a a ia a include for sk illed birth attendants ( SB As) , V IA/ CRY O, F amily planning and Palliative care. . Orientation programs: t t i i i a t t i ta 4 . Orientation p rog rams: NHTC supports the divisions and centers to develop orientation a ag a a t ai g i ta a t a a t i i g a t a i it a a a ag m t mmi m m pack ages and prepare pools of trainers for conducting orientations for health and non- a i ta g am a i g at a health work ers including for Health F acility Operation and M anagement Committee 288 DoHS, Annual Report 2075/76 (2018/19) ( HF OM C) members and orientation program on planning at local levels. 5 . B asic training : B asic trainings are organiz ed for F emale Community Health V olunteers (FCHVs) who are newly recruited by the local mother’s group among the member. The duration of this course is 1 8 days. This training is not being conducted 6 . S erv ice I ndu ction training : NHTC has begun providing induction training for newly PSC recruited all gaz ette 7 / 8 th level Health Officers of all health service groups from 207 2/ 7 3 . The one month courses ( 24 days work ing day) are provided for all health service disciplines. 7 . Others: g g am 5 asic training: Ba i t ai i g a ga i ma mm it a t t a it t a m t g am g t m m a t i i a i t ai i g i t i g t . Service Induction training: a g i i g i t ai i g it a ga t a t a a t i g m m t a i g a a i a a t i i i i thers: t t ai i g i ai i g t a a g a B g ta t t m B Bi m i a i m t a i ta t t ai i g B Bi m i a i m t t ai i g ai a at a 8.1.7.3. Training Accreditation and Regulation ita a g a i i a i g a iat i i a a m t a t ai i g a t ai i g it t m t a it i i g t ai i g i i i t m it a g at a i g mat ia i i m a t ai i g g am t t i i i a t a t g a t t a i m a g i i t a ta a i mai tai i g a it t ai i g i i a i t m t ai i g g am i a m t t ai i g m it i g a a t i t a it it a i t i ta 8.1.7.4. Institutional Capacity Development t i g a i t i t a a a it m t t ai i g • Physical facilities: t a i itat i a t t m t ita a t ai i g it a t a ma g it t i it i a t a at i a a i i a i m t • Training program development: t t ai i g g am a t a t ta a a i itat i a t i i i t i a t ai i g it a a im m t a ma ag i t t ai i g a t t ai i g im m t i i a a a a it t a m t a t i at i a m i a g • Capacity building: t a a it t a a i ia ta i i t t ai i g a m t ia i a a t t gt a a g a i ta i i g a t it t a i at i i t a a a i t a a mi a t ai i g a i t g am DoHS, Annual Report 2075/76 (2018/19) g g am • Training Working Group: ig ai i g i g i m i t a i i m i t m m i g m t a t a m t a t i m t g a a i t i t ai i g a it im m t i m m t a a t ai i g a ita • Training Information Management System (TIMS) ai i g ma a ag m t t m i a a i a t ma ag t t ai i g i g g a a at a t a i a i t ai i g it a i i t i a a i a i t a i ma ag a t ai i g at ata i i g t ai a a i a t t ai i g i ma t ai i g g a a i a i i it i t a it a i i i a ta a ga i a t a a t a it t ai i g it a a it im m t i t t ai i g t m a i i i t i a a a i t mai tai t a i gi t a t m it i 8.1.7.5. Follow –up Enhancement (FEP): a a a t ai i g t a i i g a i i i t ai i g t im a t i i i it a t a i t a t a tai i g a i i g t i t at t a at t i it i i t at t tai t g a i a t a a m t i a t i ga a a i i a a it i im t t i i at a a a m t g am i a a i g t g a i t ai t t ga a i it a i g a it a a t a i g i m t i t m g i m t t am t t am a i a t t ai a t a i it a a a ag m t mmi i a t a ta t at t a t ga g am a a t t g a i t t ai i it a i g a ga i g a t a i g i m t a it a a i g t a t ta Bi t i g t i a t a 8.1.9 Annual target and achievements a. Program activities a a i m t it a a t ai i g ta g t i a t a i a t am g i ma a ma t ai i t a i g t ai i g a i a m ma a a i i g m t a t t ai i g ta g t i a ia a B iat i i g a t ai i g a i a g a a a ia g a i t DoHS, Annual Report 2075/76 (2018/19) F E P allows assessing the k nowledge and sk ill of trainees to find the gaps and provide on- site coaching and it also assesses the enabling environment in terms of drugs supply, eq uipment, team support. The F E P team also provides feedback to trainees Health F acility Operation and M anagement Committee ( HF OM C) , province and central level stak eholders so that they can be fulfill the gaps. The obj ectives of F E P programs are: To assess the retention of k nowledge and sk ills of the trainees To provide onsite coaching based on gap findings To assess the enabling environment of each site To feedback / share findings to all the concern stak eholders ( B irthing Centers, province and Central level) 8.1.9 Annual target and achievements a. Program activities In F Y 207 5/ 7 6 NHTC has achieved most of its annual training target i. e. about 4 597 participants among which 1 4 8 1 male and 3 1 1 5 female were trained. . Under different headings of training activities, NHTC has performed remark ably by achieving more than 1 00% of the training target in V IA/ CRY O, CoF P, ASRH, Palliative Care, SB A, NICU, PPIUCD, PE N, Pediatric Nursing and Infection prevention training. The overall physical progress was 1 04 . 1 0 and financial progress was 91 . 23 in the F Y 207 5/ 7 6 . g g am b. Budget and Ex penditure B g t a it The data shows thepercentage of budget spent with respect to budget allocation in F Y 207 5/ 7 6 ata t tag g t t it t t g t a a i m a t i compared to previous F Y s. tat g t a a a a ia g i t a a Status of budget allocation and financial progress in three consecutive fiscal years Budget FY 2073/074 FY 2074/075 FY 2075/076 (in NRs ‘000) (in NRs ‘000) (in NRs ‘000)FY A l l oca t ed E x p en d i t ure A l l oca t ed E x p en d i t ure A l l oca t ed E x p en d i t ure B ud g et (%) B ud g et (%) B ud g et (%) Central level 1 8 8 , 4 50 8 0. 6 2 204 , 1 4 9 90. 3 1 0, 3 7 , 00 91 . 23 8.1.10.8.1.10. ISSUES ISSUES AND AND RECOMMENDATIONS: RECO MMENDATIO NS: a M aj or i issues, m problems raised ai at at this t i year’s a national a a and a regional gi a review i meetings m g are listed a i t in i a a a mm a Table. Ma j or Is s ues a n d R ecom m en d a t i on s Issues Recommendations M anage a separate pool of trainers from Consolidate the overall training needs of health different disciplines service providers Unplanned selection of participants: Consolidate all training program run by – Training plan for program and service divisions and centers through NHTC. ( district and respective division) Improve the q uality of training by regularly – Training as incentives rather than need updating trainers, by post- training follow- up, by based and carrier development preparing a roster of master trainers and by Multi‐door trainings ensuring training q uality as per guidelines L ack of strategic and uncoordinated Recogniz e competency based training for career approach to training, e. g. staff may be development trained but lack the eq uipment req uired or Design and develop practical training which opportunities to practice their sk ills. encourages ‘learning by doing’ and links F ocus of training on transfer of k nowledge directly to an individual’s job/ tasks ( theory) rather than developing practical E stablish a national health resource unit at sk ills NHTC Inadeq uate training follow up mechanism Rapidly assess the needs of NHTC, RHTCs and training sites including infrastructure and human resources. M ak e transfer policies and guidelines Revise the selection criteria for upgrading training Develop regulating bodies to ensure q uality and standard of training DoHS, Annual Report 2075/76 (2018/19) g g am 8.2 Vector Borne Disease Research and Training 8.2.1 Introduction t B i a a a ai i g t B a ta i i t a it t am a a ia a a ai i g t t a a a ia a i a ga i a i a am a B i ma it t i g it i g a a i t i i a a t ai i g B i i g a a ia a a a a g i g a a m a a ia i t a a a a i 8.2.2 Major activities carried out in fiscal year 2075/76 Training: 8.2.2.1. VBDs training for health workers t i t ai i g i t at t g i a t gt ma ag m t a a it a t B i a a B t ai i g a t i mi a i a a i a t i t i t m t gi t a i i a ai i t ta g a i i t ta i i g a t ai B 8.2.2.2 VBDs training for physicians, pediatricians and medical officers t i t ai i g i t i t t a i a t t atm t t B a t a i itat a iag i a a iat t atm t B t ai i g a t i i g ita a ta i a ita a ama ita a a i ia iat i ia m i a g a i t a a i itat t ta t i t i t a a 8.2.2.3 Malaria microscopy training ig t mi i m a a a ia i i t g ta a t i ma a ia iag i B i i i g a i a ma a ia mi t ai i g t a at t i ia a i ta t i g i t ma a ia mi a a t m t t ma at mi i t 8.2.2.3.1 The basic malaria microscopic training i t ai i g i i t t i t a at a t ma a ia mi a a i i ma a ia iag i t i a it t a t i i i g m a a a tai i g a mi i ami a ma a ia a a it t t m t i t ai i g i t i a i ma a ia mi a it iag i a t a i i i i a iag i a i a m i m a a it t ta t ai i a i ma a ia mi at B 8.2.2.3.2 The refresher malaria microscopy training i a t ai i g i i t t i t t a i tai a i DoHS, Annual Report 2075/76 (2018/19) g g am mi t ai i g t at a g a t i i ma a ia mi a t t gt t ma a ia mi a at i i ma a ia mi i t i t t ta t ai 8.3. Early warning and reporting system on-site coaching programme a a i g a g t m it a i g i t im i g g t m t gt i a t m B a t i mi t a i a a ag m a m t g g amm a t i ita t ta a i at i i g m i a i t t m i a a m i a im i a m t t g a im i t i t ita 8.4. Molecular diagnosis of Malaria and dengue using PCR at VBDRTC B i iag i a it a a i a a t a i ga ma a ia a t i g g i a t ta m am i ga t t m g i am g g a mai i g mi it g g 8.5 Research activities 8.5.1 Serotyping of dengue virus and entomological survey of its vectors in Gandaki province Introduction a g t a a it a a mi g im a t t ma a t a t a a mi m i t i i g imm it t t i t t ma i a t i i g g g t i a g t t i ma agi g a a a t t mi g t a a i g a iat t t m t 8.5.2 Methods i ita a a t a a i t m g t t a i g g a am g a i a t i g t atm t i i t ita m i a g i g m i at a mm it g m t ita i g ta a ai B am t t m g g a g a i a m am a t i g g i i g 8.5.3 Results t ta g a a t i m g a i i i a t i ma t a t a t g i m am t i am t t i g g i i g a m m g i am g g a mai i g mi it g g i g t g i i a ima t g t a mi i i a a g it i t ig i a t i ig it DoHS, Annual Report 2075/76 (2018/19) g g am 8.5.4 Conclusion and Recommendation t g a t t t i g a mi a t i a g t i t a i a a t ita t a it i g i t i t a g it a g t t i ma i a a i a t t t i i g i mi g g i it a i g it ma m a ai t m tai t t t gt t g t a i a t a a i a a it at a im i g B i a t m 8.6 Study on Microepidemiology of PKDL 8.6.1 Introduction i i a a im ta t i a i i t i t a t atm t a im ta t imi a t t m t t a at i a t t at a a a a a t i i a t i g m t t a i ma ia a i i am g a t ta t i i g t g t a i g a a m t t a t tat it i a a t i i g it a 8.6.2 Methods t t t a t m a t i a a a g a i a ta i a i a a i t i t i a t ig mi a a a a a am g t a t t at a 8.6.3 Results 8.6.3.1 Prevalence and risk of PKDL in previously treated Kala-azar cases t t a a i t at a a a a it i t i it m t i i B a t a gim i ma m t i i B a a i i t i t atm t a i t atm t gim i m t i i B t atm t a i i ma m t i i B t atm t t ta m a t t at g a t t a at a a i t i t at g t a at a t i a iat a a i a ig i a t a iat it i a at i t i t atm t i t a t a a a a B t i g mai i t ig i a t i t m gi g i m a t i t a it i t a a a a a a t atm t it i a a it i a g i a im ta t a g a t a t t a ig i a t t i t a t a t ag g 8.6.3.2 Leishmania donovani infection in healthy individuals t a t i i i a i i g t g t it a a i g t t it a a a a i g t a DoHS, Annual Report 2075/76 (2018/19) g g am 8.6.3.3 Entomological findings t i ag it m a t a i i a a i t i t i t t a i g t a i a g i i a i g t a t t mi a i i a ata i a g t m ia i a t m t a a t a a a a a a t i t m a g i a a t a i a t g i a a i at t a mi i t a a a a i t a a 8.7 Entomological activities 8.7.1 Insecticide susceptibility status of Anopheles fluviatilis against different insecticides a t ma ia i m it it a m t i m ta it imi a t t i a t ma ia i m it it am a a t i a m ta it i t i a t ma ia i m it t m ta it m ta it a i i it t t m t a t ma ia i m it it a at i a i t it B i a t m it t m i ata i ag a a i t i t a i it t t m at B 8.7.2 Insecticide susceptibility status of malaria vector Anopheles annularis agains Alphacypermethrin and Lambdacyhalothrin t t a t ma a a i m it t m a a i i ag a m a a i t i t agai t a m t i m ta it a t agai t am a a t i m ta it t tai t i t it i ta a i a t a t ma a a i m it t agai t ig t a a m t i a m ta it a 8.7.3 Entomological survey of dengue vectors in different localities of Pokhara metropolitan city during Pre and post monsoon priod. t t m gi a a t t mi t i g a itat a a m it i i g a t m a m it a a i t i i t a i a a a t ita it a i i t i t i g t m i t a at i g tai i t i i i a a a t a i t ag i t a ag ga t t t t t m it i g a itat m g t i a a m g t at i g tai i t i t it m it a a a tai B t a a i a m g a t at i g tai i t ig t i it tag m it a a a i a m a t m i t m ta m ai t t a t t ta a t m i t t at i g tai t a m g a t tag DoHS, Annual Report 2075/76 (2018/19) g g am a i t a a g i m t m gi a breeding habitats. Among these surveyed houses, 4 9 ( 4 6 . 6 %) houses were found positive for A ed es larvae. Among these 4 3 6 water- holding containers inspected, 1 03 ( 23 . 6 %) were found infested with A ed es mosq a uito a larvae. The t at overall t House hold, m it Container, i B ruto and Pupal a g Indicesa were 4 6 . 6 6 , 23 a i t . 6 2, i t 98 . 09. 00 and i 3 t 04 . 7 6 respectively. a i Among all t ta the water- holding at i g containers inspected, tai highest i t positivity am g percentage of A ed es mosq uito larvae was recorded in i t plastic drums it ( 8 . 8 %) , followed m it by automobile a a i g tyres t m a t t t t m it i g a itat m ( 7 . 4 %) , metal drums ( 2. 3 %) , paint buck et ( 1 . 9%) , plastic buck et ( 1 . 4 %) respectively. A total of 3 20 pupae t m g t i m it a a were collected from different types of water- holding containers. All collected pupae were emerged adult a t m gi a i i B a a stage. 1 8 2 ( 56 . 9%) were A ed es a l b op i ct us and 1 3 8 ( 4 3 . 1 %) A ed es a eg y p t i . This pre- monsoon entomological survey also revealed that both A ed es mosq uito species A ed es a eg y p t i and A ed es a l b op i ct us m g a t at i g tai i t ig t i it tag m it co- ex isted in the surveyed localities. A total of 21 1 water- holding containers inspected among surveyed a a a i a m t m ta m a 6 0 houses, 96 ( 4 5. 5%) were found infested with A ed es mosq uito larvae during post m on s oon s ea s on to t a a i g a a mi at detect the presence of A ed es mosq uito breeding habitats from 207 5/ 07 / 1 5 to 207 5/ 07 / 1 7 . Among these houses, 4 2 ( 7 0. 00%) t ta were found t positive for a A ed a es mosq a uito larvae. m g The overall i t entomological a t tag indices a g a a i t HI, CI, B I and PI were 7 0. 00, 4 5. 5, 1 6 0. 00 and 3 6 3 . 3 3 respectively. Among all the water- holding containers inspected, highest positivity percentage of A ed es mosq uito larvae was recorded in plastic drums ( 23 . 2%) , followed by tyres ( 9. 9%) , metal drums ( 5. 2%) , plastic pots ( 3 . 3 %) , plastic j ars ( 1 . 4 %) , 8.7.4fridge Entomological vessels ( 1 . 0%) , surveyplastic bottlesof dengue ( 1 . 0%) vectors and milk of crateDharan ( 0. 5%) respectively. A total of 1 3 4 collected and rared pupae were emerged into adult stage were 7 0 ( 52. 2%) A ed es a eg y p t i and 6 4 ( 4 7 . 7 %) A ed es a l b t mi op i ct us . t i g a itat a a m it i a t ta i i t a i a a a m t ita it a i 8.7.4 Entomological survey of dengue vectors of Dharan i t i t m t m g i m it a a a at i g tai i t m g To determine the breeding habitats and prevalence of A ed es mosq uito species, a total of 1 02 houses were surveyed in different localities of ward no. 1 5 of Dharan sub- metropolitan city, Sunsari district from t at i g tai i t it m it a a 207 6 / 03 / 1 0 to 207 6 / 03 / 1 6 . Among surveyed houses, 6 5 ( 6 3 . 7 %) houses were found positive for A ed es ig t m gi a i i i g t i a B a mosq uito larvae. Overall, 3 6 1 water- holding containers were inspected. Among these 3 6 1 water- holding a m g a t at i g tai i t containers, 1 1 8 ( 3 2. 6 %) were found infested with A ed es mosq uito larvae. High levels of entomological ig t tag m it a a a i a m indices were observed during this survey. The overall HI, CI, B I and PI were 6 3 . 7 , 3 2. 6 , 1 1 5. 6 and 1 28 . 4 t a t a t m i t a m ta m respectively. Among all the water- holding containers inspected, highest percentage of A ed es mosq uito t ta a t m i t t at i g tai m g larvae was recorded in plastic drums ( 1 3 . 5%) , followed by flower pot ( 4 . 1 4 %) , plastic pot ( 3 . 6 %) , automobile tyre ( 2. 7 %) and metal drum ( 1 . 6 %) respectively. A total of 1 3 1 pupae were collected from i t a t tag m g t a g a a i t tdifferent types of water- holding containers emerged into adults stage. Among these, 1 24 ( 94 . 6 %) were a t at a g i t m t a t m it i i t a i A ed es a eg y p t i and 7 ( 5. 3 %) A ed es a l b op i ct us . It revealed that A ed es a eg y p t i is the most prevalent A ed es mosq uito species in the surveyed localities. 8.8. Financial Achievement 8.8. Financial Achievement Fiscal Allocated Total Expen Remaining Irregularity Irregularity to year budget Expenses ses % Regulated be regulated (cumulative) 22,600,000.00 16,366,998.55 72 6,233,001.45 0 29,700.00 30,030,000.00 15,235,068.58 51 14,794,931.42 0 1015973.10 23260000 20459136.09 87.9 2800863.91 1015973.10 0 8.9. Problems/ constrains S. N Problems/ constrains Action to be taken Responsibility VBDRTC’s Office & dormaory for trainees is Health office & Educational Directorate VBDRTC & MoHP occupied by health office Makawanpur and to be managed in other place. /MoSD educational directorate, Hetauda. Old infrastructure: dormitory, office building and Hostels, office and staff quarters to be VBDRTC/MOHP quarters. renovated. Vacant post: parasitologist, entomologist & VCO Vacant post needs to be filled VBDRTC/MOHP Lack of vehicles for training, research, surveys and At least one vechicle should be provided VBDRTC/MOHP outbreak investigation of VBDs. for field program. Lack of sanctioned post for microbiologist, O & M survey to be done to revitalize VBDRTC/MOHP epidemiologist, research officer and statistical VBDRTC. officer. DoHS, Annual Report 2075/76 (2018/19) g g am 8.3 Health Education Information and Communication 8.3.1 Background a a a t a ma a mm i a t i t a t i i t a t a a a i g im m g m it i g a a a g a a t m a a mm i a g amm i i g i i a a t t i g i t a a a t mm i a i a t a a a t i mm i a t at gi a t a t at a a i i t t t a t g amm a i t a i a a a t g a a t g a t m a i ma a mm i a a a t i t a a a t m a a mm i a g amm i i g m t a a t i i a t a a ia m i i a a ma g a i a g a mm it a ia a g t at gi t im m t it g amm 8.3.2 Vision: a i i a t a i a g a i 8.3.3 Goal: g a i t t i t t t a ai m t t ig t a t t t a 8.3.4 Objectives: g a a i ma a mm i a a t i t ai a t a a t a a m a t m t im a t tat a t t i a t g t t t t m a t g i a a ai a The specific objectives of NHEICC are listed below: m i i a m a t a i a mm i a m m ia a m t t ai a t a a g a m t a t a i am g t g a i t gt a a im m t a t mm i a g amm at a g at t a m i i t im m t a t mm i a g amm t t a t i i mi a a i a a t at m ag i ma a mat ia i t i a a a it a t mm i a t a i mi at a it t a t i i m a a iat m ag a i ma i a it a t m ag a i ma t g a iat m ia a m t t t i t i a i a t m ag a i ma DoHS, Annual Report 2075/76 (2018/19) g g am 8.3.5 Strategies: a ia m i i a a a i a g mm i a a t ma t at gi a t m a a mm i a i t at gi a a a g it a t i i g a t i i a a t i a i i m m g a i t g at a a a a t mm i a g amm i g a at g t a t mm i a g amm i a g a a a g it a ta t g t i a mmi a t m a i g im m ta a t mm i a g am t g a t i a t t at a a g m t i a i ia a a i a t a i ma i i i g mm i a m ia m t a mat ia t i a a m a t ta a i i g a t m ag a i ma i mit a a iat i g tai m t a a it a a mat i mi a g a t m ag a i ma i g t at a ta i mi at a t m ag a i ma a ta i g t m a t i agi g t m ia t i mi at m ag a i ma a t i agi g t i mi a a t m ag a i ma t g i i at a t i i agi g m ag a i ma t at i a m t a t i i i g i t i a m ag a i ma i mi a B i i g t a a it a t t a a im m t a t mm i a g amm i g t a it i mit a ta a i a a t m ag a mat ia t g t i a mmi t i g mm i a t gi a t m a a t mm i a i a g it a a mia i i g t a a it a t a t m a a t mm i a t gt i g m it i g a i i a i t t mi t ga i g a t a a am g ta g t a i a i i 8.3.6 Major activities and achievement by federal, province and district level in 2075/76 a t a i ma a mm i a a t m a i t at a i t a i t g i a i t i t i g ta ta DoHS, Annual Report 2075/76 (2018/19) Implementing a one-door integrated approach for all health communication programmes under MoHP. Ensuring adequate budget for health communication programmes. Coordinating and collaborating with all levels of stakeholders through technical committees and other means. Ensuring implementation of health communication programs through health infrastructure at all tiers of federal government i.e. federal, provincial and local levels in a decentralized manner. Mobilizing communication media, methods and materials for the prevention of diseases and promotion of health. Standardizing health messages and information for uniformity and appropriateness. Using edutainment approach with an education format for disseminating health messages and information. Ensuring that all stakeholders disseminate health messages and information after taking consent from concerned MoHP authorities. Encouraging the media to disseminate messages and information on health issues. Encouraging the dissemination of health messages and information through public-private partnerships. Discouraging messages and information that is harmful to health. Prioritizing lifestyle diseases prevention messages and information dissemination. Building the capacity of health workers to plan and implement health communication programmes. Ensuring the quality, uniformity and standardisation of health messages and materials through technical committees. Introducing new communication technologies for health promotion and health communication. Coordinating with academia for building the capacity of health workers on health promotion and health communication. Strengthening monitoring and supervision activities to determine the gaps in knowledge, attitudes and practices among target audiences and service providers. 8.3.6 Major activities and achievement by federal, province and district level in 2075/76 Health education, information and communication (health promotion) activities that were carried out by federal level in the reporting period are listed in the following table (table g g am 8.3.1). Table 8.3.1: Major activities carried out by federal level in 2075/76 Development, production and distribution of IEC Health awareness and communication materials to stakeholders, regional medical stores, program on mental health and birth DHOs and DPHOs. defect Development, production and broadcasting of Pen-package promotion regarding the health messages through radio, television, and Control of non-communicable newspapers (printed and electronic). diseases. Golden 1000 days promotion communication Communication programme on campaign tobacco control and regulation. Communication programme on IMNCI, Communication programme on immunization, nutrition. communicable disease and epidemic prevention. Health promotion program’s national commitment School and adolescent friendly service message dissemination on Merobarsha centre, safe motherhood, delay pratibaddhata; swasthya prati jimmewar : marriage and family planning related pratibaddhata; swasthya prati jimmewar : marriage and family planning related samriddhiko aadhar inter-personal, social mobilization and samriddhiko aadhar inter-personal, social mobilization and mass communication programme mass communication programme Health promotion, reproductive and child health, Dissemination of messages and Healthfree hea promotion,lth, communicable reproductive and non and-communicable child health, informationDissemination through of messages popular and online freedisease hea preventionlth, communicable related IEC and materials non-communicable printing mediainformation through popular online diseaseand distribution preventi on related IEC materials printing media and distribution Broadcasting of health messages through Radio Communication programme on risk BroadcastingNepal and Nepal of health television messages in packages through including Radio factorsCommunication of non-communicable programme diseaseson risk NepalJeevanchakra, and Nepal Janaswasthya television in radio packages program, including throughfactors ofsocial non mobilization,-communicable diseases Jeevanchakra,Janaswasthya BJahas.anaswasthya radio program, interpersonalthrough social communication, mobilization, Janaswasthya Bahas. electronicinterpersonal and printcommunication, media. Source: NHEICC electronic and print media. Source: NHEICC Health education, information and communication (health promotion) activities that were carried a t a i ma a mm i a a t m a i t at a i Healthout by provincialeducation, and information district level and in communication the reporting period (health are promotion) listed in the activities following that table we (tablere carried t i ia a i t i t i t g i a i t i t i g ta ta out8.3.2). by provincial and district level in the reporting period are listed in the following table (table 8.3.2). Table 8.3.2: Major activities carried out by Province and District level in 2075/76 Table Hygiene 8.3.2: Major and sanitation activities programmescarried out by for Province and DistrictPublication level of inhealth 2075/76 messages in print Hygienepreventing and and sanitation controlling programmes epidemics. for media.Publication of health messages in print preventing and controlling epidemics. media. Production of need-based IEC materials. Community interaction programmes for Production of need-based IEC materials. promotingCommunity health interaction services. programmes for Distribution of IEC materials to health Celebrationpromoting healthof world services. health day and other Distributionfacilities. of IEC materials to health healthCelebration related of days, world week health and day months and other. facilities.Production and airing of health programmes health related days, week and months. Productionand messages and through airing of local health FM programmesradio on anddifferent messages health through issues. local FM radio on Source:different NHEICC health issues. Source: NHEICC 8.3.78.3. 7Trend rend program pro ram analysis analysis by byfederal, federal, provincial provincial and and district district level level 8.3.7 rend pro ram analysis by federal, provincial and district level The physical and financial achievement in the year 2075/76 regarding Health education, information i a a a ia a i m t i t a ga i g a t a Theand physicalcommunication and financial (health achievement promotion in) programmethe year 2075/76 by federal regarding level Health was 95 education, percent informationand 76.41 i ma a mm i a a t m g amm a a t a t i ia a i t i t a i m t t a t tai i andpercent communication respectively. (healthProvincial promotion and district) programme level achievement by federal reportlevel waswas 95not percent obtained and in 76.41the t g a t i i t i g ta a percentreporting respectively. year. The trend Provincial is shown and in the district following level table achievement (Table 8.3.3 report) was not obtained in the reporting year. The trend is shown in the following table (Table 8.3.3) DoHS,Table Annual 8.3.3: PercentageReport 2075/76 trend (2018/19) of physical and financial achievement by federal, provincial and Tabledistrict 8.3.3 level: Percentagein 2073/74 totrend 2075/76 of physical. and financial achievement by federal, provincial and districtProgramme level in 2073/74 to 2075/762073/74. 2074/75 2075/76 Programme Physical2073/74 Financial Physical2074/75 Financial Physical207 5/Financial76 Federal Level Physical90.13 Financial69.55 Physical56.04 Financial79.12 Physical95 Financial76.41 Provincial and District Federal Level 73.0090.13 72.9269.55 56.0485 79.1283 NA95 NA76.41 ProvincialLevel and District 73.00 72.92 85 83 NA NA LevelSource: NHEICC Source: NHEICC pratibaddhata; swasthya prati jimmewar : marriage and family planning related samriddhiko aadhar inter-personal, social mobilization and mass communication programme Health promotion, reproductive and child health, Dissemination of messages and free health, communicable and non-communicable information through popular online disease prevention related IEC materials printing media and distribution Broadcasting of health messages through Radio Communication programme on risk Nepal and Nepal television in packages including factors of non-communicable diseases Jeevanchakra, Janaswasthya radio program, through social mobilization, Janaswasthya Bahas. interpersonal communication, electronic and print media. Source: NHEICC Health education, information and communication (health promotion) activities that were carried out by provincial and district level in the reporting period are listed in the following table (table 8.3.2). Table 8.3.2: Major activities carried out by Province and District level in 2075/76 Hygiene and sanitation programmes for Publication of health messages in print preventing and controlling epidemics. media. Production of need-based IEC materials. Community interaction programmes for promoting health services. Distribution of IEC materials to health Celebration of world health day and other facilities. health related days, week and months. Production and airing of health programmes and messages through local FM radio on different health issues. Source: NHEICC 8.3.7 rend pro ram analysis by federal, provincial and district level The physical and financial achievement in the year 2075/76 regarding Health education, information and communication (health promotion) programme by federal level was 95 percent and 76.41 percent respectively. Provincial and district level achievement report was not obtained in the g g am reporting year. The trend is shown in the following table (Table 8.3.3) Table 8.3.3: Percentage trend of physical and financial achievement by federal, provincial and district level in 2073/74 to 2075/76. Programme 2073/74 2074/75 2075/76 Physical Financial Physical Financial Physical Financial Federal Level 90.13 69.55 56.04 79.12 95 76.41 Provincial and District 73.00 72.92 85 83 NA NA Level Source: NHEICC 8.3.8 Strength, Weakness and Challenges: 8.3.8 tren th, ea ness and hallen es t gt a a a g a t a i ma a mm i a a t The strength, weakness and challenges of Health education, information and communication (health m g amm i t g a a i t i g ta promotion) programme in the reporting year are shown in the following table. Table 8.3.4: Strength, Weakness and Challenges tren th ea ness hallen es National health Limited human resource for Inadequate compliance communication policy, health promotion at federal with National Health strategy and directive are in and province level. Communication Policy place. No human resource for health (NHCP), guidelines and Good organizational promotion at local level. directives. structure at No organizational structure for Less emphasis in health federal/province level for health promotion program at promotion activities health promotion program. local level. according to changing Behaviour change disease pattern. communication for health Inadequate allocation of approach has been budget on the basis of developed in line with planned programs. national health communication policy 2012. Programmes flow from federal to province and local level. DoHS, Annual Report 2075/76 (2018/19) g g am 8.4 Health Service Management Background The Management Division(MD) is responsible for DoHS’s general management functions. DoHS’s a ag m t i i i i i g a ma ag m t i revised m Terms of References (ToR) of MD i i g describing it it a as t the focal a point i t for information i ma ma ag m t management, a i g planning, i a coordination, i i supervision, forecast, a t quantify, a procure, distribute i t i t health a t mm i t a t a i i a t m it i g a a a a t g amm commodities for the health facilities and the monitoring and evaluation of health programmes. The i i i i a i m it i g t a it ai i m t a t a t a a t division is also responsible for monitoring the quality of air, environment health, health care waste ma ag m t at a a ita t a m it t t a mai t a i management, water and sanitation. It also monitors the construction and maintenance of public a t i t i i g a t t mai t a m i a i m t t a i health institution buildings and supports the maintenance of medical equipment. It also involved ai a mai t a i m i a i m t i t m t a t t a ta i repair and maintenance of bio-medical equipment, instruments and the transportation vehicles. a i a ig t t i i i i i i i g i a a i g at t a t More activities assigned to this division include including policy and planning related to health i a t t a gi ma ag m t a t at gi t a ag m t i i i a i t i B infrastructure and logistic management. The objectives and strategies of the Management Division are listed in Box 8.4.1 Objectives — The Management Division aims to support health programmes and DoHS to deliver health services through the following specific objectives: Facilitate and coordinate among concerned divisions and centres to prepare annual plans, programmes and to make necessary arrangements to get approval from the National Planning Commission (NPC) and Ministry of Finance. Make arrangements for the preparation and compilation of annual budgets and programmes of province and local levels. Monitor programme implementation status and carryout periodic performance reviews. Manage integrated health information system. Manage and coordinate the construction and maintenance of buildings and other public health infrastructure including the maintenance of biomedical equipment. Support MoHP to develop and implement environmental health, health care waste management and drinking water-related policies, directives and guidelines Support MoHP to develop and update national-level specification bank for drugs and health equipment's. To plan and carry out the logistics activities for the uninterrupted supply of essential medicines, vaccines, contraceptives, equipment, HMIS/LMIS forms and allied commodities for the efficient delivery of healthcare services from the health institutions of government of Nepal in the country. Strategies Make arrangements to collect and analyse health information and use it to support the planning, monitoring, and evaluation of health programmes Strengthen bottom-up planning from community to central levels via the optimum use of available resources including health service information. Support MoHP to Conduct and expand regular periodic performance reviews and use outcomes for improvements down to community level. DoHS, Annual Report 2075/76 (2018/19) g g am Strengthen and guide the monitoring and supervision system at all levels. Establish a central data bank linking HMIS with the Human Resources Management StrengthenInformation and System guide (HURIS), the monitoring health facility and supervision and work force system registry, at all levels. surveillan ces, HIIS, EstablishLMIS, finance, a central surveys, data censusesbank linking and HMIS other with sources the Humanof information. Resources Management InformationExpand computerized System (HURIS), information health systems facility andat all work levels. force registry, surveillances, HIIS, LMIS,Monitor finance, the health surveys, services censuses provided and other by state sources and non of information.-state health institutions. ExpandDevelop computerized and implement information construction, systems repair at and all levels.maintenance plans for public health Monitorfacilities theand health for biomedical services providedequipment. by state and non-state health institutions. DevelopThe routine and management implement construction, of integrated repair health and service maintenance Information. plans for public health facilitiesDevelop andand forimplement biomedical integrated equipment. supervision and monitoring plans. TheEstablish routine and management develop required of integrated infrastructure, health humanservice resourceInformation. and guidelines to conduct Developother assigned and implement designated integrated and non -supervisionroutine works. and monitoring plans. EstablishLogistics planningand develop for forecasting,required infrastruct quantification,ure, human procurement, resource andstorage guidelines and distribution to conduct of otherhealth assigned commodities. designated and non-routine works. LogisticsIntroduce planning effective for and forecasting, efficient procurement quantification, mechanisms procurement, like storagee-Bidding, and e distributionSubmission. of healthUse of commodities.LMIS information and real-time data in the decision making. IntroduceStrengthen effective physical and facilities efficient at the procurement Federal, Provincial, mechanisms District like and e-Bidding, Local level e Submission. for the Usestorage of LMIS and informationdistribution ofand health real- timecommodities. data in the decision making. StrengthenPromote On physicalline Inventory facilities Management at the Federal, System Provinc andial, Non District-Expendable/Expendable and Local level for the Items storageInventory and System distribution in Federal, of health Provinc commodities.ial, District and Local level warehouses. PromoteAuctioning On ofline non Inventory-functional Management cold chain equipment's/furniture, System and Non-Expendable/Expendable vehicle etc. Items InventoryRepair and System maintenance in Federal, of bio Provinc-medical,ial, District cold chain and equipment's/instruments Local level warehouses. and Auctioningtransportation of non vehicles.-functional cold chain equipment's/furniture, vehicle etc. RepairCapacity and building maintenance of required of bio human-medical, resources cold chain on logistics equipment's/instruments management regarding and public transportationprocurement, e vehicles.-bidding, e-procurement, and online Inventory Management System at all Capacitylevels. building of required human resources on logistics management regarding public procurement,Implement effective e-bidding, Pull eSystem-procurement, for year -andround online availability Inventory of Essential Management Drugs System and other at all levels.health commodities at all levels (Federal, Provincial, District and Local level Health ImplemFacilities).ent effective Pull System for year-round availability of Essential Drugs and other healthImprovement commodities in procurement at all levels and (Federal, supply Pchainrovincial of health, District commodities, and Local level worki Healthng on Facilities).procurement reform and restructuring of federal, provincial and district stores. ImprovementFormation of IHIMSin procurement Working Group and supply at Federal chain and of health Provincial commodities, levels. working on procurement reform and restructuring of federal, provincial and district stores. Formation of IHIMS Working Group at Federal and Provincial levels. OrganizationalThe Management arrangements Division has four sections and one unit for the overall management of functions and service delivery (Box 8.4.2 ). The specific functions of sections and units are given below: a ag m t i i i a a it t a ma ag m t The Management Division has four sections and one unit for the overall management of functions a i i B i a it a gi and service Integrated delivery health (Box 8.4.2 information ). The specific Section functions of sections and units are given below: Environmental health and health related waste management Section IntegratedHealth Infrastructure health information Development Section Section EnvironmentalLogistic Management health andSection health related waste management Section Health Infrastructure Development Section Logistic Management Section DoHS, Annual Report 2075/76 (2018/19) g g am 8.4.1. The Integrated Health Information Management Section a ag a t i i ma m mm it t t i t m i t manages health service information from community to the DoHS level. This system provides the a i i ma a i g m it i g a a a t a t t m at a basic information for planning, monitoring and evaluation of the health system at all levels. The ma t a i t i B major functions of the HMIS are listed in Box 8.4.3 Facilitate MoHP to develop national level policies, plans, regulation, guidelines, standards and protocols related to integrated information system. Timely update and making information digital friendly for effective management and health information. Develop, expand and institutionalize existing health sector information system such as HMIS, LMIS, HIIS etc as an integrated information system. Identification and revision of sector wise health indication for national level health information. Develop periodic and annual health reports and disseminate the funding based on rigorous analysis and existing health information. Facilitate for capacity building and health personnel for institutionalization of integrated information system at different level. Coordination and cooperation with provincial and local level government for health-related information management system development and implementation. Facilitate division of DoHS for developing annual work plan and budget. Prepare and document monthly, trimester and annual progress and various activities conducting by divisions under DoHS and need based reporting to MoHP. Provide support to MoHP on behalf of DoHS for development of overall plan. Improve online data entry mechanisms in all districts and hospitals and gradually extend online data entry to below districts level health facilities. Online data entry mechanism will be established in provinces and local levels. Establish a uniform and continuous reporting system from government and non- government health service providers so that all health services provided by government and non-government providers are reported and published. Verify, process and analyse collected data and operate a databank. Provide feedback on achievements, coverage, continuity and quality of health services to programme divisions and centres, RHDs, hospitals, DHOs and DPHOs. Databased feedback will be provided to provinces. Disseminate health information through efficient methods and technologies. Improve the information management system using modern information technology. Update HMIS tools as per the needs of programme divisions and centres. Update geo-information of health facilities. Provide HMIS and DHIS 2 tracking as per needed. a Nepal’s a t health t sector needs a at accurate, m i comprehensive and a disaggregated i agg gat data ata to t gauge ga g its it ma t i i a i t ia g a g g a i a a t a t performance, to identify inequalities between social groups and geographic areas, to plan future i t a t a t m it i g a ta g t t i i t interventions, and to enable the monitoring of NHSP-2 and NHSS targets to provide evidence to i m t at gi a i i i inform strategic and policy level decisions. DoHS, Annual Report 2075/76 (2018/19) The g g am current HMIS software systemsystem (DHIS 2 software) meet the basic requirements of the recently revised HMIS. Existing software related errors have been resolved with upgrading of System to dHIS revised t a t m a m t t a i i m t t t HMIS. Existing software related errors have been resolved with upgrading of System to dHIS 2.3. i i g a at a it g a i g t m t Few problems related to Nepali Calender are on the progress of sorting out with the help of DHIS m at t a i a a t g g t it t 2 developers. New Dashboards for different level governments have been developed which will a a i t g m t a i facilitate program managers and policy managers to monitor real time health situation. There is will i a i itat g am ma ag a i ma ag t m it a m a t it a i facilitate program managers and policy managers to monitor real time health situation. There is still a at i a ai t a a a t i software related errors seen which are raised due to calendar and other issue. 8.4.2. Health Infrastructure Development Section cti s t e ea t i rastr ct re eve e t Secti are iste i Functions of the health infrastructure Development Section are listed in Box 8.4.4 Support MoHP for development of national level policy, regulation and standards related to physical structure of health facilities and health equipment's. Maintain the updated record and upgradation of physical infrastructure and health equipment. Facilitate health facilities to develop national plan for need based infrastructure development. Coordination with concerned authorities for basic infrastructure management of health facilities. Facilitate for development update and monitoring of hospital code of conduct. Facilitate for supervision, monitoring and quality control of health infrastructure and equipment. Identifying the status of and maintaining medical equipment; Rolling out the out sourcing of maintenance contract nationwide. Coordinating with government agencies and other stakeholders for the maintenance of health facility and hospital medical equipment. Manage and mobilize biomedical engineer and other human resources. 8.4.3. Environment health and health related waste management section As t i a m i mi i t a g mt i i per the work description approved from council of ministers federal gvernemtn is responsible for development m t a m it i g a a a g i i gi a am a it ta a and monitoring and evaluation guideline, logical framework, quality standard for i i g at a ai a it i a ta i t im m t t a drinking water, food and air quality. This section was establish to implement the above function of t a g m t tai t m t i i i i B the federal governement. Detail terms of reference of this section isis includedincluded inin BoxBox 8.4.58.4.5 Support and facilitate MoHP to develop environmental mental health related policy, guideline, directions and standards. Facilitate for carrying out regular surveillance and studies related to impact and drinking water, air and overall environmental on health status and support for environmental pollution control. Support MoHP for development of national laws, policies, plans, standards and protocols for health-related waste management. Facilitate for scientific management of health-related wastages released for different health facilitiesilities underunder federal,federal, provincialprovincial andand locallocal levellevel government.government. DoHS, Annual Report 2075/76 (2018/19) g g am Carry out monitoring and central activities for scientific management of health-related Carry Carry out outmonitoring monitoring and and central central activities activities for for scientific scientific management management of of health health-related-related wastages released from health facilities under federal government. wastageswastages released released from from health health facilities facilities under under federal federal government. government. 8.4.4. Logistic Management Section e cti t e gistic a age e t secti are iste i e cti t e gistic a ag t gi a ag m t a i t i B e cti t e gistic a age e t secti are iste i e e t secti are iste i Major functions of the Logistic Management Section MajorMajor functions functions of theof the Logistic Logistic Management Management Section Section Support MoHP for development of procurement and supply related national laws, policies, Support Support MoHP MoHP for fordevelopment development of procurementof procurement and and supply supply related related national national laws, laws, policies, policies, guidelines, quality standards, protocols. guidelines,guidelines, quality quality standards, standards, protocols. protocols. Support MoHP to prepare national level standard and specification bank for drugs, health Support Support MoHP MoHP to prepare to prepare national national level level standard standard and and specification specification bank bank for for drugs, drugs, health health related tools and equipment. relatedrelated tools tools and and equipment. equipment. Procurement of vaccine, family planning commodities and other essential health commodities Procurement Procurement of vaccine, of vaccine, family family planning planning commodities commodities and and other other essential essential health health commodities commodities to the province. to theto theprovince. province. Facilitate federal and local level government for procurement and supply of the essential Facilitate federal and local level government for procurement and supply of the essential Facilitatemedicines federal and and equipment. local level government for procurement and supply of the essential medicines and equipment. medicinesCoordination and equipment. and facilitation to develop and institutionalize logistic information system at the Coordination and facilitation to develop and institutionalize logistic information system at the Coordinationnational level. and facilitation to develop and institutionalize logistic information system at the national level. nationalManagement level. of essential commodities at the health facilities under DoHS. Management of essential commodities at the health facilities under DoHS. Management of essential commodities at the health facilities under DoHS. Major ongoing activities The following innovative activities were conducted on a regular or ad-hoc basis in 2075/76 The following innovative activities were conducted on a regular or ad-hoc basis in 2075/76 The alongside following i g the innovative above i a -mentioned activities a i regular were functions. conducted t on a a regular g a or ad a -hoc basis a i in i 207 5/76 alongside the above-mentioned regular functions. alongsidea g i t a m g a the above-mentioned regular functions. a ea t rastr ct re r ati S ste — The HIIS is expected to provide the basis for decision a)a ea t rastr ct re r ati S ste ealth Infrastructure Information System— The — HIIS is expected i t to provide t i the basis t for decision a i a ea t rastr ct re r ati S ste making on building construction and maintenance— The HIIS as iswell ex pectedas for resource to provide allocation. the basis The for system decision is i i ma i g i i g t a mai t a a a a a making on building construction and maintenance as well as for resource allocation. The system is makingin process on building of completion construction after whichand maintenance it will be regularly as well updated. as for resource allocation. The system is t m i i m a i it i g a at in process of completion after which it will be regularly updated. in process of completion after which it will be regularly updated. b i i g c str cti a ai te a ce— The Management Division oversees the construction b)b i i g c str cti a ai te a ce Building construction and maintenance—— The Mana gement a ag m t Division oversees i i i the construction t and maintenance of health facility buildings and other infrastructure in partnership with the b t a mai t a a t a i it i i g a t i a t t i a t i it t i i g c str cti a ai te a ceand maintenance of health facility buildings— The Manaand othergement infrastructure Division oversees in partnership the construction with the Department of Urban Development and Building Construction (DUDBC). All maintenance within and a tm t a m t a B i i g t B mai t a it i Departmentmaintenance of ofUrban health Development facility buildings and Building and otherConstruction infrastructure (DUDBC). in Allpartnership maintenance with within the a t a i i mi a t a mai t a g t a mi i health facilities premises and construction and maintenance works costing less than one million Departmenthealth facilities of Urban premises Development and construction and Building and maintenanceConstruction works(DUDBC). costing All lessmaintenance than one withinmillion were i disbursed t g through t the a ag m t Management Division i i i till 2074/075 . All other t construction t works healthwere facilities disbursed premises through and the construction Management and Division maintenance till 2074/075 works .costing All other less construction than one million works g m t a mi i i t g B i a i i a costing more than one million is done through DUDBC. Since 2061/062, 2031 facilities have been werecosting disbursed more throughthan one the million Management is done through Division DUDBC. till 2074/075 Since 2061/. All062 other, 2031 construction facilities have works been i t i i i i a t a t i i g t t g B built while in 2075/076 NPR 4,871 billion was spent on health building construction through DUDBC costing a mmi m it t buil tmore while than in 207 one5/076 million NPR 4,is 871done billion through was spentDUDBC. on Sincehealth 2061/ building062 construction, 2031 facilities through have DUDBC been (Table 8.4.1). An MoHP committee monitors these works. built(Table while 8.4 in .1).207 An5/076 MoH NPRP committee 4,871 billion monitors was spent these on works. health building construction through DUDBC Table 8.4.1: Summary of building construction by DUDBC (2061/062 – 2075/076) (Table 8.4.1). An MoHP committee monitors these works. Detail Number Detail Number Total number of health facilities built 2031 Total number of health facilitiesDetail built Number2031 Number of facilities under construction 342 TotalNumber number of o facilitiesf health underfacilities construction built 2034231 Near to completion facilities 158 NumberNear ofto facilitiescompletion under facilities construction 342158 Completed/handed over facilities 1689* NearCompleted/handed to completion facilities over facilities 1689158 * Budget allocated (in NPR) in 2075/076 6,11,34,00,000 Completed/handedBudget allocated over (in NPR) facilities in 2075 /076 6,111689,34,00* ,000 Expenditure (in NPR) in 2075/076 4,87,16,00,000 (79.69%) BudgetExpenditure allocated (in (in NPR) NPR) in in 207 20755/07/076 6 4,876,,1611,,0034,000,00,000 (79. 69%) ExpenditureDoHS, Annual (in ReportNPR) in 2075/76 2075/07 (2018/19)6 4,87,16,00,000 (79.69%) g g am t m t a a i i a i i a m t t a a m t i Table 8.4.2: Building construction scenario in previous five years from DUDBC. Health posts with birthing centres 200 101 275 - - Doctors’quarters - - 20 - 1 Staff quarters - - 36 - - PHCCs 7 2 6 - - Birthing centres 20 5 8 - - District health stores - - - - - BEOC buildings - - - - - CEOC buildings - - - - - Public health office buildings 3 2 - - - District hospital buildings 6 5 3 - 6 Regional hospital buildings 1 - - - 15 bedded hospital building 3 2 - - Zonal hospital buildings 2 2 - - Sub-regional hospital buildings 2 - - Maternity units in zonal hospitals 1 - - Emergency blocks in district hospitals 1 - - Block A buildings in districts - - - d) Health facility upgrading— a ag m t i i i a ta t t g a i g a i t i t ita t ita i it t g a i g a ea t aci it gra i g— The Management Division has started the process of upgrading PHCCs and a t t t a t t a ig a i i t at a t ita i g below 15 bed district hospitals up to 15 bed hospitals. In line with the upgrading of all sub- health tai i i i t ma a mm a m ag i a posts to health posts and higher level facilities to at least 15 bed hospitals following certain procedures, a a division collects demand and recommendations from concerned agencies and process for approval. e) Logistics Management Information System (LMIS) - i it a ta i i e) it gistics a age t ta t i e t r ati S ste S t a ag m t t m This unit i was t a established a in 1994. i ia LMIS unit just a started Online a Inventory i t i t a Management System t t t in 2 Central a Warehouses, g a 5 i provincial a warehouses t t t and gi 77 District ma ag m t Warehouses. i i i After a the m i restructure a of it Nepal's governance a i g in federa a i l structure, t t g gi ma ag m t a ag m t i i i a tm t a t the logistic management division was demolished and its functions are being carried out through i a gi a ag m t a a a a i a t logistic management section under Management Division of Department of Health Services. t m t Major Functions t of Logistic m Management a t a t section a i i are collection a t and t analysis a a of quarterly (three g a i mi a i ma t monthly) LMIS reports from all of the health facilities across the country; preparation, reporting and dissemination of information to: Forecast a t annual a a requirements i m t of commodities mm i for public i health a t program g am including i i g ami family planning, a i g maternal, mat a neonatal ata and a child i health, a t HIV and a AIDS commodities, mm i vaccines, a i and a Essential a g Drugs; Help t ma a g a i t a a m i a a to ensure demand and supply of drugs, vaccines, contraceptives, essential medical and cold ai i at a chain supplies at all levels; Quarterly monitor the national pipeline and stock level of keyDoHS, health Annual commodities. Report 2075/76 (2018/19) g g am a t m it t a a i i a t a t mm i The following are the major activities conducted by the Management Division in 2075/76: t t a a a ma i g a i g t m a a a i t at ma i i at a a i a ag t i t a i t i t m t a i t m i a a t i t a m t i a i t a i t i t t a t t a t t ai i g it a t a a i a a t i a g t g t t t a g t i g a i g a g t i tat a t ai a t a t a a t ma ag m t i ta a t ai i g a t a a t ma ag m t t i a a ta a t i t ma ag m t a g a a m t t ag i t i a t a ta a t mm i t a a t a i i t i a t a i a t m t a i m t a g a a a m i i a i t a i m t i t m i i g a a i mm i t a a i t i t m i i a i t a i m t a a i mm i t im m ta a i g Ba a i m i a t i t i t a ag m t t m at a i ia a a t a a it i i g i i t a ag m t t m t a t m t i ta t i g t g t t it i a t a a it i i g i m t t a g a it i a i m t it i g t i ia a a ma ag a t a a it i i g a t a a i ta t t a i ia a a ta a a g i a i a ag m t i a i g a a i g a i m t mat ia a t a t mm i i a it a t a t gt i g ai a a it t g t i i a t i i t ai i m t a a ai a mai t a ig at a a ag t mai tai t i m i a i m t ma i i a t a t i m m t a m it t m t a a i a a g i t i t i t i at it a m t a t g a t gi ma ag m t i a m it t gi a i a m i a t t ata a it m t DoHS, Annual Report 2075/76 (2018/19) g g am Issues, challenges and recommendations Table 8.4.5: Issues, challenges and recommendations — health service management — Inadequate quality human resources Produce and appoint skilled human resources Individualized planning in divisions and Ensure strategic joint central annual planning and budgeting centres (due partly to time constraints)and under the Management Division for one-door planning from negligible bottom-up planning DoHS and promote bottom up planning to address district specific issues Insufficient budget for building health Provide funds and human resource support for upgraded facility and hospital buildings. health facilities. Health facility buildings construction Mandatory supervision and approval by concerned health delayed and obstructed (around 2% sick facilities before payment for building construction. projects). Self-dependence for health facility building construction in the long term. The standardization of public hospitals Strategic planning to bring public hospitals to design standard as per guidelines The lack of WASH guidelines for health Develop WASH guidelines facilities and hospitals Insufficient and poor implementation of Expand programme and budget for health care waste waste management guidelines by health management as per guidelines facilities and hospitals Information flow from lower level health Provide more budgetary support for data quality and its timely facilities and data quality issues flow from lower level health facilities to DHOs and DPHOs and make reporting to DoHS’s information system mandatory for all hospitals The monitoring of private health care Establish a task force or outsource the supervision of private health facilities Low Budget in Drug Procurement and Budget will be revised as demand in next year. supply in local level Capacity building in procurement, LMS has planned to conduct that training at all provinces. forecasting, quantification and LMIS Management of Expired, Wastage and LMS will collect those materials from all provinces and unused materials destroy or disposed as process. Inadequate of HMIS/LMIS tools and late Tools will be supplied in time and adequately supply High demand of required equipments LMS will demand budget for equipment procurement. Table 6.8.6: Specific recommendations — health service management Endorse proposed Central Coordination Committee and Technical Committee MoH, DoHS- Form joint taskforce representing MoH, DoHS-MD, RHDs and DUDBC officials to MD,PPICD,RHDs, assess delayed and ongoing infrastructure projects and make planDoHS, to address Annual issues Report 2075/76 (2018/19) — Inadequate quality human resources Produce and appoint skilled human resources Individualized planning in divisions and Ensure strategic joint central annual planning and budgeting centres (due partly to time constraints)and under the Management Division for one-door planning from negligible bottom-up planning DoHS and promote bottom up planning to address district specific issues Insufficient budget for building health Provide funds and human resource support for upgraded facility and hospital buildings. health facilities. Health facility buildings construction Mandatory supervision and approval by concerned health delayed and obstructed (around 2% sick facilities before payment for building construction. projects). Self-dependence for health facility building construction in the long term. The standardization of public hospitals Strategic planning to bring public hospitals to design standard as per guidelines The lack of WASH guidelines for health Develop WASH guidelines facilities and hospitals Insufficient and poor implementation of Expand programme and budget for health care waste waste management guidelines by health management as per guidelines facilities and hospitals Information flow from lower level health Provide more budgetary support for data quality and its timely facilities and data quality issues flow from lower level health facilities to DHOs and DPHOs and make reporting to DoHS’s information system mandatory for all hospitals The monitoring of private health care Establish a task force or outsource the supervision of private health facilities Low Budget in Drug Procurement and Budget will be revised as demand in next year. supply in local level Capacity building in procurement, LMS has planned to conduct that training at all provinces. forecasting, quantification and LMIS Management of Expired, Wastage and LMS will collect those materials from all provinces and unused materials destroy or disposed as process. Inadequate of HMIS/LMIS tools and late Tools will be supplied in time and adequately supply High demand of required equipments LMS will demand budget for equipment g g am procurement. Table 6.8.6: Specific recommendations — health service management Table 6.8.6: Specific recommendations — health service management Endorse proposed Central Coordination Committee and Technical Committee MoH, DoHS- Form joint taskforce representing MoH, DoHS-MD, RHDs and DUDBC officials to MD,PPICD,RHDs, assess delayed and ongoing infrastructure projects and make plan to address issues Operationalise joint monitoring team for the field monitoring of construction projects DHOs, DPHOs Endorse standard building design and guidelines Develop a building planning cycle Establish/strengthen a health infrastructure section with adequate capacity at central and regional levels to be responsible for construction related planning and budgeting. Update and strictly implement land development criteria considering geographical variation, urban/rural settings (guidelines have been endorsed by MoH with ministerial decision). Assess regional, sub-regional, and zonal hospitals against standard guidelines and develop standardization plan. Develop mechanism to standardise PHC-ORC structures in coordination with communities. Initiate and continue measures to functionalise and regularize all routine information MoH, DoHS- systems including TABUCS. MD,PPICD,RHDs, Roll-out routine data quality assessment mechanisms at all levels. DHOs, DPHOs The monthly generation of data from all data platforms; sharing and review with concerned programmes, divisions, RHDs, DHOs, DPHOs, and hospitals. Provide data access through public portal, including meta-data and resources. Ensure interoperability among all existing management information systems. Develop and implement a long-term survey plan. Update and implement integrated supervision checklist, supervision plan and All levels feedback tools. Deploy functional feedback mechanism with provision of coaching and mentoring services. Develop monthly integrated online supervision calendar and submit to higher authority to monitor effective execution at all levels. DoHS, Annual Report 2075/76 (2018/19) g g am 8.4.4 Logistic Management 8.4.4.1 Background i t ma ag m t gi i ia a a i t i a t i a a i g ig t i a i g a it a t a i gi a ag m t i i i a ta i t a tm t a t i i it a t t a a gi a m i a t a a i t i t t ma a t a t a t a i t i t a t mm i t a t a i i g m t a t a i ai a mai t a i m i a i m t i t m t a t t a ta i t t ma t ma ag m t gi t gi a ag m t ma t m it a ta i i i it t ta t i t a ag m t t m i t a a gi a a a i t i t a i t t t a g a i a t t t gi ma ag m t i i i a m i a it a i g a i t t g gi ma ag m t a ag m t i i i a tm t a t i a gi a ag m t a a a a i a t t m t t m a t a t a i i a t t a a g a i mi a i ma t a t a a i m t mm i i a t g am i i g ami a i g mat a ata a i a t a mm i a i a a g t ma a g a i t a a m i a a ai i at a a t m it t a a i i a t a t mm i Goal a it a t mm i a ai a at a t a i i a mm it t a Overall Objective a a a t t gi a i t i t t a m i i a i t a i m t m a a i mm i i i g ai a mai t a i m i a i m t t i t i a t a i m t a t i t g m t a i t t Strategies gi a i g a g a a m t t ag a i t i a t mm i t a i t m t m a i m i Bi i g mi i i ma a a m ata i t i i ma i g t g ata i i i it i t i gi ma ag m t i ma t m t gt i a a i i at t t a gi a gi a a i t i t t t ag a i t i a t mm i m t i t a ag m t t m a a a t m t t m i t a gi a a i t i t a DoHS, Annual Report 2075/76 (2018/19) g g am i g a ai i m t it i t ai a mai t a i m i a ai i m t i t m t a t a ta i a a it i i g i ma gi ma ag m t ga i g i m t i i g m t a i t a ag m t t m at t a gi a a i t i t m m t t m a a ai a i it a g a t a t mm i at a t a gi a i t i t a a t a i i m m t i m t a ai a t mm i i g m t m a t t i g a i ia a i t i t t ma gi i g at t a a i ia 8.4.4.2 Major Activities a t i t ma ag m t a g a a m t t ag i t i a t a ta a t mm i t a a t a i i t i a t a i a t m t a i m t a g a a a m i i a i t a i m t i t m i i g a a i mm i t a a i t i t m i i a i t a i m t a a i mm i ma m m gi i g at t a t gi i a ag t i t a i t i t m t a i t m i a a t i t t im m ta a i g Ba a i m i a t i t i t a ag m t t m at t i ia a a t a a it i i g i i t a ag m t t m t a t m t i ta t i g t g t t it i a t a a it i i g i m t t a g a it i a i m t it i g t i ia a a ma ag a t a a it i i g a t a a i ta t t a i ia a a ta a a g i a i a ag m t i a i g a a i g a i m t mat ia a t a t mm i i a it a t a i i i a t gt i g ai a a it t g t i i a t i i t ai i m t a a ai a mai t a ig at a a ag t mai tai t i m i a i m t ma i i a t a t i m m t a m it t m t a a i a a g i t i t i t i at it a m t a t g a t gi ma ag m t i a m it t gi a i a m i a t t ata a it m t m m t m i i g am i t i a m tai i t i t DoHS, Annual Report 2075/76 (2018/19) g g am 8.4.4.3 Analysis of Achievement 8.4.4.3 Analysis of Achievement 8.4.4.3 Analysis of Achievement LMIS Reporting Status LMIS Reporting Status Review LMIS Reporting and optimization Status of information flow for the LMIS reports Review and optimization of information flow for the LMIS reports With new i a mi a i ma t t Federal structures in place, information flow acrossWith the new supply Federal chain structures levels was in unclearplace, informationresulting in flow it a t t i a i ma a LMIS Reporting Rate across the supply chain levels was unclear resulting in LMIS Reporting Rate difficultiest ai a a g i i i in decision-making on supply quantities. To difficulties in decision-making on supply quantities. To resolve i i ma i g the challenges, MD together a in technical assistance t In FY 2074-75 Q4, the In FY 2074-75 Q4, the with a g resolve GHSC-PSM the reviewedchallenges, t g t existing MD together i SOPs t i a and in the technical information a i ta assistance it reporting rate was only 30%, flow with process GHSC-PSM and i advocated reviewed i g with existing the MoHPSOPs a t and to i ma streamlinethe information whereas, reporting in FY 20 rate75- 76was Q4, only 30%, the a a at it t t t am i t LMISflow processreporting and processes advocated. MoHP with issuedthe MoHP letters to to streamline the the reportingwhereas, rate in FYincreased 2075-76 Q4, Ministry g i t t i i t the LMISof Federalreporting Affairs processes and . General MoHP issuedAdministration letters to themore thanthe reporting two-fold torate 76%. increased a ai a a mi i t a a t (MoFAGA)Ministry and of the Federal office ofAffairs the provincialand General Chief AdministrationMinister more than two-fold to 76%. t i ia i i i t gg g a t In FY 2074-75, the quarterly suggesting(MoFAGA) a process and the to office streamline of the theprovincial LMIS reportingChief Minister t am i t g t m a a averageIn reportingFY 2074-75, rate the was quarterly system.a i a a t a it it it a suggesting MoFAGA a processhas uploaded to streamline a new theSOP LMIS circular reporting 65%, whereas,average reportingin FY 2075 rate-76, wasit addressed t t t im i i t ta a system. to allMoFAGA LLGs on itshas website uploaded with a acopy new to theSOP office circular increased 65%, to whereas, 78%. in FY 2075-76, it of the addressed Prime Minister. to all LLGs GHSC-PSM t on its website staff t and with FSOs a a copyfollowed a to t the up t office t increased to 78%. to ensure i ia i of the the Prime letter Minister. was also GHSC-PSM sent to the staff Provincial and FSOs Chiefs. followed up to ensure the letter was also sent to the Provincial Chiefs. Improving trend in reporting rate Improving trend in reporting rate Improving trend in reporting2075/76 rate Q1 2075/7690 Q2 2075/76 Q3 2075/76 Q4 75 75 76 2075/76 Q1 802075/7690 Q2 712075/7672 Q3 2075/76 Q4 65 75 75 76 70 80 71 72 60 70 65 45 50 60 40 50 45 30 40 20 30 5 10 20 0 10 5 Oct-18 Dec-18 Feb-19 Mar-19 May-19 Jul-19 Aug-19 Oct-19 Dec-19 Jan-20 Mar-20 LMIS REPORTING PERCENTAGE 0 These efforts to review the SOPs and follow-up on application implementation have resulted in Oct-18 Dec-18 Feb-19 Mar-19 May-19 Jul-19 Aug-19 Oct-19 Dec-19 Jan-20 Mar-20 LMIS REPORTING PERCENTAGE improved t t i t a a i a im m ta a t i reporting rates. The reporting rate for FY 2074/75 Q4 was only 30% whereas the These efforts to review the SOPs and follow-up on application implementation have resulted in reportingim g at g at a a t g rate for FY 2075/76 Q4 has increased more than two-fold to 76%. The quarterly improved reporting rates. The reporting rate for FY 2074/75 Q4 was only 30% whereas the average at a i a m t a t t a t a ag g reporting rate of FY 2074/75 was 65%, whereas, in FY 2075/76, it increased to at a a i it i a t im i g reporting rate for FY 2075/76 Q4 has increased more than two-fold to 76%. The quarterly 78%.,Timeliness of reporting improved significantly after the implementation of data entry in im ig i a t a t im m ta ata t i a t i t i t i t average reporting rate of FY 2074/75 was 65%, whereas, in FY 2075/76, it increased to health office in the district. 78%.,Timeliness of reporting improved significantly after the implementation of data entry in •health GHSC-PSM office in theproviding district. training to 371 LLGs in conjunction with the DHIS2 training GHSC-PSM providing training to 371 LLGs in conjunction with the DHIS2 training 1. eLMIS implementation in Province 5 & 6: 1. GHSC-PSMeLMIS implementation providing training in Province to 371 5 LLGs & 6: in conjunction with the DHIS2 training MD/LMS a im m t t t i gi a ag m t ma t m has successfully implemented the Electronic Logistics Management Information System 1. i a i t a m i a t t i ia m i a t i t i t t it i eLMIS implementation in Province 5 & 6: (eLMIS) in all six central medical stores, two provincial medical stores (PMS), 22 district stores within ProvincesMD/LMS i a i t t t i t i 5 and has 6 insuccessfully the support implemented of USAID GHSC-PSM the Electronic project in Logistics this FY. Management Information System (eLMIS) in all six central medical stores, two provincial medical stores (PMS), 22 district stores within Provinces 5 and 6 in the support of USAID GHSC-PSM project in thisDoHS, FY. Annual Report 2075/76 (2018/19) g g am im m ta at a g m t a a t a i i t a i t t a t mat a g m t a t i a t a i i i tag a a t t g a t t gi i g a g i i i t i a a g m t a t mm it m t a a t a m i i a i t m Ba i a a t i t i t a t ma t i a t mm it ma ag m t i m a t mi a a ta i at t a g m t a t i a t a i i a a t it a a a i a i a i im m t t a t a i i i a i t t a t mat t i ai a i a a a a t m a i m a ta i m t a ta t t gi a t ma ag at at t a ag m t i i i i t t g a t i t g g i i t a t ai i g i a a mai m i a gg a gi t t a i t a i t t am a a ta a a g t ta a a g t a it t t a i a mi a a t a ag m t i i i a t a a tm t a a i g i g t im m ta i a m t t im m ta a t i a t m a t t i it t t t tag t g a a m t a t a i t a m im m g tag a a t a a ta t t t am i at a a i t t a a a a i g m it i g a ata it i i ma i g ma a a a at t m it a t t at t i it t ga t t a i it a t m ata a a t i t t m at t t a a a t t a t a t m ata i t t t t a a tm t a im m ta a i g i m t a i amma a t i t a i a a it ia t t a t a a it at a t ai i i t i t a a t m i i i a m i m t a m t t mi t t t mi t a a ta a a ig m t t i a a at t t m t t a m t t t Ba t a ta a a im m t DoHS, Annual Report 2075/76 (2018/19) g g am 2. 2. PradeshPradesh Reporting Reporting Status, Status, fiscal fiscal year year 2075/76 2075/76 2. Pradesh Reporting Status, fiscal year 2075/76 Figure Figure 8.4.2. 8.4.2. Reporting Reporting Status Status Figure 8.4.2. Reporting Status Reporting Percentage Reporting Percentage93.58% 90.64% 100.00% 86.54% 82.09% 93.58% 90.64% 100.00%90.00% 86.54% 73.68% 80.00% 64.36% 82.09% 90.00%70.00% 73.68% 80.00%60.00% 64.36% 50.28% 70.00% 50.00% 50.28% 60.00%40.00% 50.00%30.00% 40.00%20.00% 30.00%10.00% 20.00%0.00% 10.00% 0.00% 3. 3. AvailabilityAvailability of Key of Health Key Health Commodities Commodities ig mm it t t tat a a 3. Availability of Key FigureHealth 8.4.3 Commodities : Commodity Stockout Status, fiscal year 2075/76 LMIS report provides data 20% 26% visibility t of stock i status ata at Figure 8.4.3 : Commodity Stockout Status, fiscal year 2075/76 i i i it LMISthe healthreport t facility provides tat level data of at 15% 11% 13% 26%6% t visibilitykey a t health of a i it stock commodities status at 20% 9% 10% 11% 10% 17% 9% thelike a t healthCondom, mm i facility Depo, level Pills, i of 15% 11% 13% 5% m ORS, Zinc, Vitamin i A, 6% key health commodities 5% 11% 9% Ferrous Sulfate, 10% 10% 17% 9% i like itami Condom, Depo, Pills, 5% Albendazole, Paracetamol 0% at ORS, a Zinc, Vitamin a a A, 5% Pills tam and Metronidazole a t i a 400 mg ORS Ferrous Sulfate, Depo in and essential drugs for 0% Ferrous mg i a a g Condom Albendazole, Paracetamol Sulphate 500mg Vitamin A Zinc 20mg fre e health a t services i on a 400mg le Pills ORS Albendazole and Metronidazole 400 mg Paracetamol Metronidazo quarterly basis. The figure Depo a in a t and essential a i drugs for g Ferrous Condom shows among three FP commodities, Condom and Pills have stockout of 11% whereasSulphate Depo is 500mg Vitamin A am g t mm i m a i a t t a i Zinc 20mg free health services on a 400mg le slightly lower (10%). Out of MNCH and essential commodities, Paracetamol has the lowersAlbendazole stockout Paracetamol ig t t a a mm i a a tam a t t t Metronidazo quarterlyat 5% whereas basis Vitamin. The figure A shows the stockout of 26%. at a itami t t t shows among three FP commodities, Condom and Pills have stockout of 11% whereas Depo is slightly lower (10%). Out of MNCH and essential commodities, Paracetamol has the lowers stockout 8.4.4.4at8.4.4.4 5% whereas Major Major Logistics VitaminLogistics AActivities Activities shows the to stockout Strengthen of 26%. HealthHealth CareCare Services Services a. Procurement a. MD/LMSProcurement continued and added more commodities in the multi-year procurement. Condom, 8.4.4.4Injectable, Major ORS, Logistics Iron Tablets, Activities Essential to Strengthen Drugs are Health now Carebeing Servicesprocured through multi-year a.mechanism. Procurement Multi-year a mechanism a m saves mm i every year bidding i t m a and evaluation m t time for tender. m LMS ta MD/LMSalso completed continued the LICBand a t (limitedadded a internationalmore commodities g competitive a in the i g bidding) multi-year process procurement. in t g coordination m a Condom,with m a i m Injectable,World Bank ORS, a in theIron procurement m a i m Tablets, Essential of a Implants, Drugs a which are i i g nowresults being a in procuring a a procured directly m through from t multi-year the a m t t B imit i t a a m i i g i i a mechanism.manufacturer Multi-year in much lower mechanism cost. saves every year bidding and evaluation time for tender. LMS it also completed Ba the i t LICB m t (limited international m a t competitive i t bidding) i i g process i t in coordination m t with ma a t i m t World Bank in the procurement of Implants, which results in procuring directly from the manufacturer in much lower cost. DoHS, Annual Report 2075/76 (2018/19) g g am i t i t i a i t a g a a t at t i t i t a a t a a i t a g t t t a i t i t t ima a t a ita i a i i i imi a t m t i i g a t t m g i i a i a t t i t i i a a ai i g i m t t i a i t i t a i it t a ia t a t i a t b. Forecasting and Supply Planning a t i ia i i i g g t m a i g i m t a t mm i a t i g g a t mi g t a i it i i i g i t ta m a i i i i i t i t ia ma g ga i a a a a a i a ta t g ga i i g i t a t i t i a a ga i i t t g am it a i a m i t ia ma g t a The main purpose of the workshop is outlined below: . mat t mm it a a t tat i t i i a t i a t im a a . i ata i mm it i m t a a g m t g t a a . t t ma mm it m t t . i m a t i g i m t a a at mm it m t . g m t mmitm t i ig t i i i g a t a i a g a a a a g mm i mm i a i i g a mm i a i t t mi g a t a a i ata i i m g a i ata m a m i it i a m ia g amma i a a i at t a t g a g i i g a i g g a t m i g g a i a a i a i g i a t a a a a t mm i a am t it mm a a t a a a i a mi t i gi ma ag m t t t i a a m im m t imi a a a i at a m t a ga i i a a it a i i i a t it t i a a i ta a a ia t m m t it gi a ag m t t a a t a Quantification Guidebook i t a i a a it i a a i at a g a a i g a t mm i at a t ai i t a t t a at a i ita a a t i a i t a a i a a it t m a a t ai m t a ag m t t a a t B t a i i a DoHS, Annual Report 2075/76 (2018/19) g g am t ai i g a a a at t i Consensus Forecasting Consensus Forecasting MD organized 2-days workshop on national quantification ga i of program a drugs and EPI vaccines a for the FY ona April a a 4-5, 2019 with g am the support g of a GHSC - PSM. Participants a i t i it conducted data analysis, assumptiont t building, forecasting and a i a t supply t ata a a i a m planning exercises. The team produced a national i i g a g a a i g forecast i and supply plan t am for 700 items a a a for FY 2076/77 a t (2019/2020) a for all a divisions and it m centers. The estimated budget for this forecast is a NPR. i i i 4.60 billion. a t mat g t t i a t i i i Establish Quantification Capacity at Provinces Establish Quantification Capacity at Provinces MD with support of GHSC-PSM project provided technical assistance to three provinces in quantification it of health t commodities in Province t 5, Province i 1 t i a and Sudhurpaschim a i ta Prades t t h based i on i data generated a a a t mm i i i i a a im a a from eLMIS and HMIS data. The forecast on commodity requirements and cost estimate ata g at m a ata a t mm it i m t a t helped provinces to procure the medicine. mat i t t m i i Develop Quantification Capacity for Local Level Governments Develop Quantification Capacity for Local Level Governments The quantification of health commodities at the central level has been effective to determine the quantities a a a t mm i at t t a a t t mi t for the next fiscal year. Considering federal context of the country, MD organized the trainings a t t a a i i g a t t t t ga i t on quantification for province and local level health personnel. Quantification guidebook and workbookt ai i g a a i a a a t a a g i were used as resource material in all the seven provinces. Skills and knowledge from a a mat ia i a t i i a g m the training enabled health personnel realize the importance of forecasting in procurement and t t ai i g a a t a i t im ta a g i m t a supply planning a i g a t mm i i t i t t of health commodities in their respective context. c. Quarterlyc. Quarterly National National Pipeline Pipeline Review Review Meetings Meetings Pipeline monitoring of FP commodities was started since 1997/98. It now covers FP, MNCH, EPI Vaccines, i i m it i g mm i a ta t i t Syringes, selected Essential Drugs and HIV/AIDS commodities as well. National pipeline reports are a i i g t a g a mm i a a a i i now used to monitor the availability of the stock at service delivery points (SDPs) and to monitor the t a t m it t a ai a i it t t at i i i t a t procurement status of key health commodities. m it t m t tat a t mm i In each quarter, a national pipeline meeting takes place at the Logistic management section to review, monitor, a a t a and evaluate a a the procurement, i i m g shipment, ta a distribution, at t gi transportation ma ag m t and stock t status of i m it a a at t m t i m t i t i t a ta a t family planning and other health commodities. tat ami a i g a t a t mm i Quarterly Pipeline Review meetings was conducted where program Divisions of DOHS, External Donor Partners a t and i i stakeholders i m g like Social a Marketing t agency participated. g am i i i In the meetings t a shipment schedules, a t shipment a ta status (planned, i ia ordered a g and received), ag actual a i at consumption t and m g months-of i m t -stock-on -hand of 32 i m t health commodities tat a were discussed. a i a t a m a m t t a a t mm i i In FY 2018/19 MD organized three quarterly pipeline monitoring meetings on Aug 9, 2018; Nov 26, 2018 and ga i t a t i i m it i g m g g Feb 22, 2019 to share the stock status of the 37 key commodities including FP, EPI Vaccines a t a t t tat t mm i i i g a i and some program commodities. Based on evidence, decisions were taken to cancel or postpone or prepone or even relocation / redistribution of the stock averting a situation of stockout or overstock and expiry. DoHS, Annual Report 2075/76 (2018/19) Achham District store after reorganization g g am and inventory support by GHSC- PSM. Photo credit: GHSC-PSM a m g am mm i Ba i i i ta t a t a i t i t t a g a it a t t t a i d. d. Strengthen Strengthen Storage Storage Capacity Capacity Ideal storage conditions for essential drugs and commodities are required to deliver quality health services a t ag i a g a mm i a i t i a it a t from any service delivery sites and ensure optimal health service utilization by consumers. Numerous i m a i i it a ma a t i i a m districts seriously lacked ideal storage space for handling health and other allied commodities m including i t i t vaccines. i Earlier a assessment i a t ag shown a that storage a i g space a t was inadequate, a t and a i security mm i was poor, i i g sore space a i scattered a i in two a m t or more rooms with t at none t ag specifically a a designed i a at for storagea it a a a i t m m it i a ig and many were in rented buildings. Most of the storerooms were filled with unusable commodities t ag a ma i t i i g t t t m it a and junk. Every year huge quantities of drugs and other health commodities went missing, mm i a a g a g a t a t mm i t damaged or had to be destroyed. mi i g amag a t t Logistics Management Section in technical assistance with USAID GHSC-PSM enhanced warehouse capacity gi a ag m t i t i a a i ta it a a at the central and province 5 and 6 warehouse with installation of storage equipment, and induction a a it at t t a a i a a it i ta a t ag i m t a of good warehouse practices. Health Commodities store at the health office of Provinces 2, 6, andi g a a a t mm i t at t a t i 7 were reorganized making it possible to institute supportive supervision and good practices. In the reporting a period, ga i GHSC-PSM worked ma i g closely it i with t stakeholders i t t – DoHS Divisions i i mainly a the g MD, a provincial health directorates (PHDs) and Logistics Management Centers (PHLMCs), districthealth offices (DPHOs), local level governments (LLGs). The purpose is to ensure availability t g i it ta i i i mai t of uninterrupted i ia supply a t of health i t at commodities to patients. a gi a ag m t t i t i t a t a g m t i t a ai a i it In the i t t a t mm i t a t reporting period, in coordination with MD, GHSC-PSM delivered new storage and safety equipment – racks, trolley, pallets, fire extinguishers to five PMSs. GHSC-PSM also worked closely with Save t the g Children i (SC) and i i a USAID Nepal it Reconstruction Engineering i Services t ag (NRES) a Project a t implemented i m t a t a t g i t a by CDM Smith on designing the new construct warehouse in CMS Pathlaiya, to rebuild the warehouse it a t i a a t gi i g i t floor to improve its’ strength to accommodate modern racking and movement of folk im m t mit ig i g t t t a i at ai a t i lift or stacker and new construction at different provinces. t a t im it t gt t a mm at m a i g a m m t Data on i ta a t at i t i expired commodities was built by collecting the list of expired and damaged commodities from PMSs and health office stores through GHSC-PSM field support officers (FSOs). In the process of ata i mm i a i t g t i t i a amag mm i importation m a a t t t g t t of family planning commodities for social marketing GHSC-PSM has facilitated Contraceptive im ta Retail Services ami (CRS). a i g All scheduled mm i shipments ia for ma g FY 18 & 19 were procured a a i itat and delivered t a tai i i m t a on time. i m a. Improving Inventory Management and Warehouse Best Practices Propera. warehouse Improving storage Inventory and Management practices are andkey for maintainingWarehouse quality Best Practices health commodities and a functional supply chain system Effective and a t ag a efficient management of racking and shelving a a mai tai i g a it a t simplifies mm i the a warehouse a a operation. ai A competent, t m motivated, a skill-mixed i t ma ag m t workforce is required a i g to ensure a good i g storage im i practices, t operations a and that a health commodities m t t reach wherem at i mi i i they are needed most. t g t ag a a MD ina collaboration t at a t with mm i GHSC-PSM a supported Provincial Health Directorate, and Health Office through mobilizationDoHS, Annual of FSO, Report LMIS 2075/76 Officers (2018/19) and pharmacist in all the districts of Sudurpaschim, Gandaki and Province-2 to organize all health office stores aligning the process for effective inventory management. This included arranging stores basedon warehouse best practices, conducting a physical count, removing expired commodities, updating inventory records, building overall capacity of staff with an emphasis on g g am t a m t i a a it t i ia a t i t at a a t t g m i i a a a ma i t i a t i t i t a im a a i a i t ga i a a t t a ig i g t i t ma ag m t i i a a gi g t a a t a g a i a t m i g i mm i a g i t i i g a a a it ta it a m a i i t ma ag m t i i t am i a a a a it t a g m t i t inventory management, supportive supervision, teamwork, dedication, hard work and cooperation with the local government institutions. i g a it i it t i g ta a m it i i a a t i t inventory management, supportive supervision, teamwork, dedication, hard work and cooperation with During a site visit the following tasks are performed with supportive supervision as part of inventory ma ag m t a a t a the local government institutions. management and warehouse best practices: During a i g t t ag a a a site visit the following tasks are performed with supportive supervision as part of inventory Cleaning of the storage area management and warehouse best practices: ga i i g t a a a a a a t mm i Organizing of stores based on FEFO/FIFO and separation of none usable health commodities from m a t usable products; Cleaning of the storage area mi g i a t a a t mm i i a t Performing physical count of all health commodities in a store; Organizing of stores based on FEFO/FIFO and separation of none usable health commodities from e o usable the tore products; ho d e c e ed d rr ed t tod e der tood the re e i o ood tor e r ctice d h it i Performing i ort t or physical the count ch i of e e t all health commodities hi i ood in e r i a store; e erie ce or d th o to GHSC-PSM Pro i ci He th irector te d M e e t i i io ri h h tt Store ee er He th ice de dh r e o the tore ho d e c e ed d rr ed t tod e der tood the re e i o ood tor e r ctice d h i i g a i i g t t it t gi t it i Verifying i ort t and or reconciling the ch i counted e e t stock with hi stock i registers; ood e r i e erie ce or d th o to GHSC-PSM Pro i ci ig i g a tam i g i a a t a t it Signing He t hand irector te stamping d reconciled M e e t quantities i i io by relevant ri h authority; h tt Store ee er He th ice de dh r Updating all inventory records and tools (registers and eLMIS) a g a i t a t gi t a Verifying and reconciling counted stock with stock registers; On-the job-training on inventory management and any relevant supply chain management function. t t ai i g i t ma ag m t a a a t ai ma ag m t ReorganizationSigning and of stamping Mustang reconciled Health Office quantities Store by relevant authority; Updating all inventory records and tools (registers and eLMIS) On-the job-training on inventory management and any relevant supply chain management function. ReorganizationReorganization of MustangMustang Health Health Office Office Store Store Before After All the district stores of all three provinces were successfully reorganized with an updated stock balance in the system Before as well as segregation and record in the separate registerAfter of expired and damaged commodities. The event was highly appreciated by the district and provincial health directorates. t i t i t t a t i ga i it a at t All the district stores of all three provinces were successfully reorganized with an updated stock balance in a a i t t m a a g ga a i t a at gi t i a Effectivethe system Vaccine as well Management as segregation is one and of therecord cores in workingthe separate areas registerof LMS. ofEffectiveness expired and of damagedvaccine amag managementcommodities. mm i widely The event depends was highly t on the appreciated a effective ig and by the a iat proper district storage and provincial of t vaccine i t i t health as well directorates. a as i ia cold chain and a t i t at supply chain management. To ensure proper cold chain, LMS has mobilized Mechanical Engineers and RefrigeratorEffective Vaccine Technician Management for immediate is one repair of the of damagedcores working refrigerators areas ofand LMS. freezer Effectiveness to ensure ofeffective vaccine vaccinemanagement management. a i widely a ag m t dependsLMShad repaired on the i effectiveand maintenance t and proper of refrigerators i g storage of a a vaccineand freezers as well whenever as cold required. chain and a i ma ag m t i t a t ag a i a a Bysupply far, 107chain cold management. chain equipment To ensure has been proper repaired cold inchain, 50 districts. LMS has Currently mobilized one Mechanical Refrigerator Engineers Technician and hasRefrigerator been mobilized Technician in Biratnagar for immediate for CCE repairrepair and of maintenancedamaged refrigerators in Province and 1. freezer to ensure effective ai a ai ma ag m t ai a m i i a i a vaccine management. LMShad repaired and maintenance of refrigerators and freezers whenever required. gi a ig at i ia imm iat ai amag ig at a Similarly,By far, 107 storage cold chaincapacity equipment in 45 districts has been were repaired strengthened in 50 districts. by transportation Currently one of Refrigerator96 Godrej Sure Technician chill refrigerators enabling the districts and their sub-stores to store vaccine in proper temperature to provide has been mobilized in Biratnagar for CCE repair and maintenance in DoHS,Province Annual 1. Report 2075/76 (2018/19) quality immunization service. Lifeline Nepal supported in distribution, installation and preventive maintenanceSimilarly, storage of refrigerators capacity insupported 45 districts by UNICEF were strengthenedNepal. by transportation of 96 Godrej Sure chill refrigerators enabling the districts and their sub-stores to store vaccine in proper temperature to provide quality immunization service. Lifeline Nepal supported in distribution, installation and preventive maintenance of refrigerators supported by UNICEF Nepal. g g am t a i ma ag m t a ai a mai t a ig at a i B a ai i m t a ai i i t i t t ig at i ia a m i i i Bi at aga ai a mai t a i i imi a t ag a a it i i t i t t gt t a ta i ig at a i g t i t i t a t i t t t a i i t m at t i a it imm i a i i i a t i i t i i ta a a mai t a ig at t a e. Capacity Building in Logistics Management New Intervention Quality assurance of Inj Oxytocin t i i g i t i m ta a t i t g a i i t a t m at i t a i at a it a a i t i i a at a ai ig t m m t a i g i t i a t a tmi i g t ag i i a a a t i it t i i a i g t t ma a ai a at t i t i g t at a m t i i a a it i a i t i a t i g mat a m ta it a i t i t i it t ag i i t i t i m ia it a i t at i t i g g a ig at i t a ai a it t t i ai it a a i i g a mi it a i t Real Time Inventory Management System (IMS) Ba a i t i a t a t a a g t m t m t it i t i t a m i ma t ma a ai i i ma i g a i i g t a m i ma at mm i gi a ag m t t a i i a t ma a m i t ma ag m t t m t t i t i t it t mi a a a i a i i i g i t m gi a m i ma t tat a t mm i at i t t i a t ma ai i i ma i g ai i g a i t a i ia m i a t a i t i t t it t a ia t a a a i t im m t t i t m m t i a a Manual Revision and Pull System Training ai i g ma a a i i i t t t a a g i a a ai i g i t ga i it a aim im i g g i a a t t t a a t at i t a t t a ai a i it a at m i i a a t mm i i a t a i i ia t m t i a t a i Conduction of basic level logistics training t a i gi t ai i g a t it t m i a i a t i i a a imi a t i a t i a a m t a ai ma ag m t a a t it t m i a i t i t DoHS, Annual Report 2075/76 (2018/19) g g am Development of Basic Logistics Training Manual a ai g i a a i a t a Ba i gi ai i g Conduction of eLMIS training: t a t t ai i g i a i i i t i t i a i a t a i i t a Ba i a i t i t t ata a it a m t a i t t i t i t i t at a a i a a a mai ata a it a m t i t m it a it ata at a i it ata a a Disposal of Unusable Health Equipment and Commodities: A Best Practice Disposal of Unusable Health Equipment and Commodities: A Best Practice a Unusable and/or a expired i health a t commodities mm i are a a major a ma problem m for Nepal’s a health a t system. t m Safe a t ag i a g a mm i a i t i a it a t storage conditions for essential drugs and commodities are required to deliver quality health i t i i it a i i g a mm i a services to service delivery sites. In addition, “de-junking” of unusable commodities helps clear the t a a mm i am a ma i g i i m way for usable commodities. For example, a major de-junking drive in 1994-97 freed up more than t a 125,000 square a feet t of free space a and a generated g at 25 million mi i Nepali a i Rupees (NRs.) for the t m t a t a Government of Nepal’s treasury. ta t a a t i a a t i a a i t it m LMS started several actions to disposal of unused, unwanted or expired have been carried out items. a i i t i i t i a t i a i g a mm i These activities include the provision of technical support in auctioning of unusable commodities for t i t i t a i g a t t a a i a i g g the District for saving space to store valuable lifesaving drugs. f.f. FormationFormation andand action action taken taken of ofLogistics Logistics Working Working Group Group (LWG) (LWG) a t a ma it m m i ai i t a ag m t i i i An authentic Group was formation with 9 memberships chaired by Director of Management Division it ta i i i t a t a m t a t at t with representation of Divisions, Centers and External Development Partners at center level. The LWG addressed a major ma issues i regarding ga i g procurement m t and a supply chain management ai ma ag m t of health- a t at mm i m m i t t a i a a a a related commodities. The LWG members will be extend on the basis of area and necessary and also a a a t t t gi a plan to extend the Regional level LWG. 8.4.4.58.4.4.5 Issues and ActionAction Taken Taken : : Issues Action Taken Responsibility Low Budget in Drug Procurement Budget will be revised as demand MoHP/DoHS and supply in local level in next year. Capacity building in procurement, LMS has planned to conduct that DoHS/MD/LMS forecasting, quantification and training at all provinces. LMIS Not functioning of telemedicine LMS will coordinate to start the DoHS/MD/LMS program in rural areas well-functioning of telemedicine program Management of Expired, Wastage LMS will collect those materials DoHS/MD/LMS and unused materials from all provinces and destroy or disposed as process. Inadequate of HMIS/LMIS tools Tools will be supplied in time and DoHS/MD/LMS/IHIMS and late supply adequately High demand of required LMS will demand budget for DoHS/MD/LMS equipments equipment procurement. DoHS, Annual Report 2075/76 (2018/19) g g am 8.5 National Public Health Laboratory 8.5.1 Introduction a at m i i i a ita m t a t a i a a t a t m i t a i a at i i i iag i a a t i i i a t a i i a a t a a i a t a at i a t t i i t a t a a a i i i a t i t at a a a a a i g at t a at i i t t t a ta i i B a t a a t a at a ga it a a a i a t a at i B a a a t i a a a t a at i a t i i a t a at ta i m t a i t a a i a t a at a t t a ia i a a a i a t a at t t a t g at t i i a i at a i a a a i t a t t g it a a B a B a i i BB i a gi t i i it a a i a t m it a at i it i t t t g it t a a it a a a i a t a it t t g am a i i i i t g m t a g m t a at i t t t a a t a a it a m g amm t m it t g a it i i i i g a m t ag t i i i a t t at i i g t i ma a i a t m g i i t a a g it iag a i i t a at a i a a a a ia i g t t a a i m gi g a m gi g i a a at ma t a t a at a a a it a a i gi t a a i i g i at t a at i a t a a B a B a i i BB at ig at a a a i t a t a a a i t a a i mi t at g a a t i i iag i g m gi g a m gi g i i a a a ta i t a a a t i i a it Bi a t a i a a a a a t t g t a a a i a t t g t a i a t iag i a a B a t i i i g i at a i a ta a im a g a m agi g i g a i a t i a a t a ma t i it a ai a t i a m a i g i a a a B i a a a a i g t a t g t i g 8.5.2 OBJECTIVES: a a a a a at a a i g i i a m a i m m t ta a a at i m t ag t a mi a a m t g m t mmitm t a t t ga i a a ma ag m t i t t a tai a a t a at i t gt a at i g t iag i t atm t i a a t i a i i g i B a DoHS, Annual Report 2075/76 (2018/19) g g am ta i a a ta a a at a it t m t a it a t a at i t g a a it t m m t ta i m t im m ta a m it i g t a a a t a at g amm a t a a g at m a i m g a g a t a at i a at a ia a ma a t a at i m it a t t i a a i a at a i i g a t a it a t i a t a t i a a a ag a a a a t i m a im t a it a t a at i a t a a a a a at a a t a a i t a t im i a a t a a t ma ag m t a im a t a t i ia a a t gt a t i t i i g a t m t gt ia a t t m a i m t a a t i i i it a a i i g t t mi a a a i g i a a a B i a a a a i g t a t g t i g 8.5.3 NON-COMMUNICABLE DISEASE DEPARTMENT a mat g Bi mi t i g a i t t at g a i g mm i a i a a tm t B t a ia i i a i g i m t a tm t t a mia a t m t i t i a m g i t i a m g i at i g t a a mia i i a t ag a a t a a a i i it a a it a a t i m a i i g a a t g i a m t ia i i i g i B i iag a i i m a t t at t a mat g i B B i g a t i m ta a a tm t i a m it it m g i at i t at a it at i a g B a at a ga i a B t a a i a a i a a i g a i t i t 8.5.4 QUALITY CONTROL AND TRAINING SECTION: a it t a t ai i g a i t a it at a i a t t ai i g a ai i g it a a t i g t ai i g a a a i a t ai i g a t ai i g a m t g a t ai i g t i i a i i i i a m it i g t g m t a g m t a at i Ba i i a m it i g i i i a at a a t at g i t a a t a a it a m t m i a i g t m t i i i t t t a i mi a t t a mat gi a t t a g am tai a a a i at t a i a g a at i a i i a t t am a t t m a a a a i t i g am a t m i i a i g i i i a i g B t a i i it i g t t B g a it a i t g am t t B 22 DoHS, Annual Report 2075/76 (2018/19) g g am i t m t a t t i a t 8.5.5 NATIONAL BUREAU FOR BLOOD TRANSFUSION SERVICES: a a B a B a i i BB i i a at i t a a a t it im m g t a a B g amm B BB t t a a at a m a t t m t t a i i g i i g i i t ta a a g a at a i t a a a at i g t a i t a mi i i a i i a a g ma a t g a i g i a t t a i i t B t a a a it a m t i a i t ai i g B ta a i i g m it i g i i g B a m a a g am i i m t t t B t i i at a t at i 8.5.6 HIV/HEPATITIS REFERENCE LABORATORY a a a at i it at at i a B i a a i a t a at a i mai t g a m it i g t a a at g am a t t t mai m i a it a mm g it a a m a t t m a a a m a t a t t i i a a a B i a a a i a a a a a a t iag i a i t a i mm g t g t m t g m i B g a t t a i iag it a B g B B B i a m i a at a B m i B a ma a t g m a a a i B a i a B t g a ma i a a it t a a i a g i i g g am i a a a i g i im t a a t B a i a a m t a ia t t m i i a ita Ba g a g m t a ia t a a g am i a t a m it t i a tm t i i t g t am m i t it a a a a a a g a at t t a g am a a it i a g at ai i g a a a a i g a a i i BB a a i g i g g i ta a g t i g i mi g t t i a a t t B a a i g DoHS, Annual Report 2075/76 (2018/19) 2 g g am FigureFigure 8.5.1: HIV 8.5. Reference1: HIV Reference Unit (Viral load Unit tests (Viral on HBV, load HCV tests and HIV)on HBV, HCV and HIV) Figure 8.5.150001: HIV Reference Unit (Viral load tests on HBV, HCV and HIV) 10171 8603 15000 7573 10000 10171 8603 10000 7573 5000 372202 633217 644240 5000 0 372202 633217 644240 0 2073/74 2074/75 2075/76 2073/74 2074/75 2075/76 HBVHBVHCV HCVHIV HIV 8.5.7 NATIONAL8.5.7 NATIONAL INFLUENZA INFLUENZA CENTRE CENTRE 8.5.7 NATIONAL INFLUENZA CENTRE National Influenza Centre is one of the newly established and highly equipped departments of a a a t i t ta i a ig i a tm t NationalNational Influenza Public Health Centre Laboratory is one (NPHL) of designatedthe newly by Ministryestablished of Health and and highly Population equipped (MoHP) anddepartments of a a i a t a at ig at i i t a t a a Nationalrecognized Publica g i a t ga i a t a i a g i a by Health World LaboratoryHealth Organization (NPHL) (WHO)designated for the by purpose Ministry of participatingof Health and in WHO Population Global (MoHP) and recognizedInfluenza a g amm g i a m m m t a by Programme. World Health Upon such Organization recognition by (WHO) WHO, NICfor has the become purpose member of ofparticipating the WHO Global in WHO Global Influenza a i a t Surveillance Network. Influenza Programme. Upon such recognition by WHO, NIC has become member of the WHO Global InfluenzaInfluenza Surveillance a i a a ta t i m a a a t a t a it t aim t Surveillance Network. was started since 2004 from Jhapa, eastern part of Nepal with the aim to identify the influenzai viruses t i a from suspected i m cases t of influenza a like illness i a (ILI) i and i immediate a response imm iat to Influenzaminimize Surveillance t mi imi t i a i i g t a i a im t m the circulation was of started viruses during since outbreak. 2004 from Initially, Jhapa, specimens eastern collected part of from Nepal suspected with thecases aim to identify the influenzaof ILI were t a m a i iag t i a i a virusesperformed from by Rapid suspected Diagnostic cases Test (RDT)of influenza for identification like illness of influenza (ILI) andviruses. immediate Later on, response to i at m a iag a a a i a i a a ta t it t molecular diagnostic assay based influenza surveillance was started with the introduction of Real-Time minimize thei t a im at a a i a t a at m circulation of viruses during outbreak. Initially, specimens collected from suspected cases PCR (RT-PCR) at National Public Health Laboratory (NPHL) from 2009. During pandemic influenza of ILI were i g performed a mi by i a Rapid Diagnostic t a i Test (RDT) a for a identification a ia of influenza t g t viruses. it Later on, outbreak i mi g in 2009, NPHL a had i a played t a key crucial i i i role together a tm t with Epidemiology a t and i Disease i i g Control molecularDivision diagnostic i t a a ga i a a ig at a a a a t (EDCD), Department assay based of Health influenza Services surveillance including international was started organizations with the (WHO, introduction WARUN). of Real-Time PCR NPHL(RT-PCR) has t i a i i a i a a a a t i a gi a beenat Nationaldesignated Public as National Health Influenza Laboratory Centre (NIC)(NPHL) on 19fromth April, 2009. 2010. During Influenza pandemic virus influenza m a iag a a ta t it i a a i at i isolation, identification and characterization by serological molecular diagnostic assay were successfully outbreak in t a a g t mma t a t t i a i g a 2009, NPHL had played a key crucial role together with Epidemiology and Disease Control Divisionstarted (EDCD), within g a Departmentone year and 28of isolates Health were Services shipped including to WHO Collaboratinginternational Centre organizations Summary of (WHO,the WARUN). Influeza test done is as shown in figure 8.5.2 and figure 8.5.3 for 2017 and 2018 respectivelyth NPHL has beenFigure 8.5.2:designated Total Influeza as National Tests done Influenzain 2017 Figure Centre 8.5.3: (NIC) Total Influezaon 19 Tests April, done 2010. in 2019 Influenza virus isolation, identificationFigure 8.5.2: Total and Influeza characterization Tests done in 2017 by serologicalFigure 8.5.3: molecular Total Influeza diagnostic Tests done in 2019assay were successfully started within oneTotal year Sample and Collected 28 isolates in 2018 were= shippedTotal to Sample WHO CollectedCollaborating in 2019 =Centre 5786 Summary of the 1821 Influeza test done is as shown in figure 8.5.21381 and figure4000 8.5.3 for 2017 and 2018 respectively3208 1500 3000 1000 2000 1183 Figure 8.5.2: Total Influeza Tests done in 2017 Figure 8.5.3:498 Total Influeza869 Tests done in 2019 500 35 187 218 1000 0Total Sample Collected in 2018 = 0 Total Sample Collected in 2019 = 5786 A/H1N1 A/H3 Influenza Influeza A/H1N1 A/H3 Influenza Influeza A 1821 pdm09 Positive B A & B 4000pdm09 Positive B Positive & B 3208 positive Positive Negative1381 positive Negative 1500 3000 1000 2000 1183 869 DoHS, Annual Report498 2075/76 (2018/19) 500 35 187 218 1000 0 0 A/H1N1 A/H3 Influenza Influeza A/H1N1 A/H3 Influenza Influeza A pdm09 Positive B A & B pdm09 Positive B Positive & B positive Positive Negative positive Negative g g am 8.5.8 JAPANESE ENCEPHALITIS, MEASLES AND RUBELLA LABORATORY i a mm i a i a a g i g a t a ma i a t m i m g t m a i ta i a a t m t m ta it at i am g t i a t a t t m ta it a m i it a i ta i a a a a i a a t mm i a ta i a a a t i t a t ga i a a m t a i i g i a a it a a i a t a at t a tm t a t i i i t a t a a a i t g a i g m i it a m ta it t a i ta i a i a a t i a i a t a it t ma im m i a it a at a t t at i a i m t a i t a ma am a i g m ta a t ag a i a i a a a t t at a at g at i a t a imit t a a t t a m t ma t a t it t i a i g a i t i i a g am a t t i a i i gi t a a at i ia i a a i a t a at a at iag i i a m ma i g t m t t t i i i i a t i a t mi i gi t i a i t g a a t t a t a at t am t mai i i it i t mm i at i ma m t ga i g t a it a t a t t a i im i a at a g it t a ma ga i g i i g im a t g t ag im t g a m ta t m i t g amm i a a a i t i a i a a at it a i ma i a t m g a t a a t t a a a a it agai i g t 8.5.9 MAJOR ROUTINE ACTIVITIES OF NPHL: a ia i iag i i i g i a a at i a t at a i a at a i a a a a i m a a i a mi ia i ta i a it a a a t B a at a t a i ga ai i g a gi m t a a a at i m t i i a m it i g i i g a B a a t a a it a m a mat g i mi t g am tai mi i g t a t ia at g a i tai m t a it a ita i g a i g m i a a at at i gi a a g i i m t ia t it a ag t a i m t i ia a a g m t a at i a a mi i t a DoHS, Annual Report 2075/76 (2018/19) g g am 8.5.10 AMR (Antimicrobial Resistance) SURVEILLANCE ACTIVITIES 8.5.10 AMR (Antimicrobial Resistance) SURVEILLANCE ACTIVITIES t a at i a a i i a at g i i g m a a NPHL8.5.10 conductsAMR (Antimicrobial laboratory surveillance Resistance) SURVEILLANCEon various disease ACTIVITIES pathogens including on measles-rubella, Japanese a a a i i a a a mi ia i ta i a t m it t encephalitis, influenza and antimicrobial resistance surveillance to monitor the burden of NPHLt i a a t i m i a t t at gi t t i a a conducts laboratory surveillance on various disease pathogens including on measles-rubella, these diseases and to inform disease control strategies. Trend of the enteric fever cause and AMR are as Japanesea a i g encephalitis, influenza and antimicrobial resistance surveillance to monitor the burden of shownthese diseases in figure and 8.5.4 to inform disease control strategies. Trend of the enteric fever cause and AMR are as shown in figure 8.5.4 Figure 8.5.4: Trend of enteric fever (cause and AMR) Figure 8.5.4: Trend of enteric fever (cause and AMR) 100 84 848388 S.Typhi S.ParatyphiFigure 8.5.4: A Trend of enteric fever (cause75 and81 AMR) 80 100 8184 848388 500 S.Typhi S.Paratyphi A 60 75 401 80 400 40 400500 60 401 20 9 10 6 5 5 400 40 2 2 2 2 1 4 4 400 300 250 0 9 10 20 6 2 5 5 2 2 2 1 4 4 200300 250 0 101 200 100 39 39 101 1000 39 39 2073/74 2074/75 2075/76 2073/74 2074/75 2075/76 0 2073/74 2074/75 2075/76 2073/74 2074/75 2075/76 Salmonella Salmonella • S.Typhi s predominant than S.Paratyphi A till date however, the prevalence of S. Paratyphi A is Salmonella i mi a t t a a at i at t a a at i i increasing annually indicating changing epidemiology. • S.Typhi s predominant than S.Paratyphi A till date however, the prevalence of S. Paratyphi A is • i a i g a a i i a g a gi g i mi g Infection is higher in 20-29 years age group in both sexes. increasing annually indicating changing epidemiology. • i ig i a ag g i t Resistance to fluoroquinolones and third generation cephalosporin is increasing • Infection is higher in 20-29 years age group in both sexes. • i ta t i a t i g a a i i i a i gMDR trend is decreasing from 8% in2012 to 1% by 2019. • Resistance to fluoroquinolones and third generation cephalosporin is increasing t i a i g m i t • MDR trend is decreasing from 8% in2012 to 1% by 2019. Figure 8.5.5: Trend of AMR in bacterial diarrhea FigureFigure 8.5.5: 8.5.5: TrendTrend ofof AMR AMR in in bacterial bacterial diarrhea diarrhea 2073/2074 2074/2075 2073/2074 2074/2075 2075/2076 100 2073/2074 2074/2075 2073/2074 2074/2075 2075/2076 85 74 74 75 80 68 6868 69 63 100 54 54 5757 85 60 4850485050 74 74 75 80 42 4242 68 6868 69 5757 63 40 50 5050 54 54 25 60 48 48 42 4242 20 6 4 4 40 250 0 0 20 6 4 4 0 0 0 Shigellaspp i i t a t g a B ig a t ia a a t t ig a i mi at a a ig a i at a t m t mm i ta t t a im ta i ta t t B ta a tam i a t a i DoHS, Annual Report 2075/76 (2018/19) Shigellaspp g g am • Shifts in the prevalent serogroups have been observed i at a i t am i tami i a im • Before 2005 Shigelladysenteriae was prevalent but Shigellaflexneri predominated afterwards. • In 2018, 31% Shigella isolates were MDR and the most common resistant type was Vibrio sppsimultaneuosly resistant to Beta lactams/Fluoroquinolones and Tetracyclines. • All isolates are sensitive to Chloramphenicol, Gentamicin and Cefixime. i i t Vibrio spp a ga a • a a aShift in serotype observed. t a t ga a a a i ima• 2003-2004: V. cholerae O1 Ogawa i a ga a • 2005-2006: V. cholerae O1 Inaba • 2007: All serotypes V. cholerae O1 Eltor Ogawa, Inaba&Hikojima t a a i a i at a t t m a it • Since 2008-2015 : V. cholerae O1 Ogawa i t i t i t a a t a ga a t • In 2016 outbreak 169 cholera positive cases were isolated and reported (Mostly from lalitpur a a t i a t a district) of which only two were O1 Inaba rest all were of Ogawa serotype. • Only 2 V.cholerae was reported in past year. Figure 8.5.6 : AMR in respiratory infections Figure68.5.6 : AMR in respiratory infections 2073/74 2074/75 2075/76 2073/74 2074/75 2075/76 70 61 61 61 61 60 4847.5 4847.5 50 41 41 40 30 22 22 20 10 10 8 8 9 10 4 4 5 5 5 5 5 4.5 5 4.5 3 3 0 0 2 2 0 2 2 0 Ampicillin ciprofloxacin Chloramphenicol Cotrimoxazole Erythromycin Penicillin G Ceftriaxone 70 60 50 40 2073/74 66 66 30 2074/75 43 2075/2076 20 38 29 29 33 10 20 16 17 0 0 0 0 0 0 Ampicillin Ciprofloxacin Ceftriaxone Cotrimoxizole Erythromycin StreptococcusStreptococcus pneumonia • Infection is higher in elderly patients (above 60 years of age) i ig i a t a a ag • 2 % isolates were resistant also to third generation Cephalosporin (ceftriaxone) i at i ta t a t t i g a a i ia • All the isolates are sensitive to doxycycline. t i at a i t i Haemophilusinfluenzae a t i at t it a i at t im a i ta i i a i g m i t i a m t mm a t m a t a DoHS, Annual Report 2075/76 (2018/19) Haemophilusinfluenzae Haemophilusinfluenzae• Least isolated due to its fastidious nature •• CotrimoxazoleLeast isolated due resistance to its fastidious is increasing nature from 2% in 2005 to 42% in 2018. •• ElderlyCotrimoxazole are most resistance commonly is increasingaffected (50% from from 2% in patients 2005 to above 42% in 60 2018. yrs) g g am • Elderly are most commonly affected (50% from patients above 60 yrs) Figure8.5.7:Figure8.5.7: AMR AMR in MRSA Figure8.5.7: AMR in MRSA 120 120 99 9896 100 8891 85 99 9896 87 100 79 8891 80 85 7474 73 87 79 64 64 80 7474 73 60 52 64 555464 2073/74 60 52 5554 2073/74 40 2831 2074/75 40 2831 2074/75 20 13 12 2075/76 8 8 7 20 0 0 0 13 12 0 2075/76 8 8 7 0 0 0 0 0 0 Methicillin Methicillin resistant resistant S.aureus S.aureus Methicillin• Resistance resistant to S.aureus Gentamicin increased from 41% in 2013 to 64 % by 2018 . •• i ta t tami i i a m i t ResistanceResistance toto chloramphenicolGentamicin increased fluctuated from 41% between in 2013 9%-15% to 64 % in by recent 2018 years.. •• i ta t am i t at t i t a VancomycinResistance to is chloramphenicol the drug of choice fluctuated between 9%-15% in recent years. • a m i i t g i Vancomycin is the drug of choice Figure8.5.8: AMR in ESBL producing E.coli Figure8.5.8: AMR in ESBL producing E.coli Figure8.5.8: AMR in ESBL producing E.coli Chart Title Chart Title 100 92 91 92 10090 92 91 92 90 80 72 71 72 71 69 70 67 69 70 80 72 70 66 66 71 72 70 71 70 69 66 66 67 69 70 60 60 50 50 40 31 2074/75 2074/75 40 2331 25 30 20 19 25 2075/76 30 20 16 23 20 13 16 19 11 11 13 14 2075/76 20 7 9 13 8 11 11 913 14 10 7 9 8 2 9 2075/762 10 2 2075/762 0 0 ESBL E.coli ESBLESBL E.coli E.coli IncreasingIncreasing resistanceresistance against carbapenemscarbapenems (Imipenem,meropenem)(Imipenem,meropenem) is is of of major major concern. concern. a i g i ta agai t a a m mi m m m i ma BetaBeta lactamlactam--Beta lactamase Inhibitor CombinationCombination drugs drugs are are also also becoming becoming less less effective. effective. B ta a tam B ta a tama i it m i a g a a mi g AmongAmong thethe commonly used drugs, nitrofurantoinnitrofurantoin shows shows less less resistance. resistance. m g t mm g it a t i i ta 8.5.11 REVENUE GENERATION g at m i t a at t g i i i a i g t g a a a at i i i m a i it i a 28 DoHS, Annual Report 2075/76 (2018/19) 8.5.11 REVENUE GENERATION NPHL generates revenue from different laboratory testing services. There is increasing trend on revenue generation and laboratory services provided in comparison with previous years. g g am Figure 8.5.9: Total number of laboratory testing services provided by NPHL Figure 8.5.9: Total number of laboratory testing services provided by NPHL 600000 501693 500000 400000 305849 300000 200000 174761 100000 0 2073/74 2074/75 2075/76 Total Tests Done Net Revenue 120000000 105130726 100000000 80000000 76127355 60000000 56696637 Net Revenue 40000000 20000000 0 2073/74 2074/75 2075/76 FigureFigure 8.5.10: 8.5.10 Trend: Trend of ofrevenue revenue generation generation fromfrom laboratory laboratory service service at NPHLat NPHL (amount in Nrs.) Source: NPHL/DoHS DoHS, Annual Report 2075/76 (2018/19) g g am 8.5.12 Working Working StructureStructure of of NPHL NPHL SECTION 1: SECTION 2: SECTION 3: SECTION 4: SECTION 5: Non Infectious Blood Bank and Quality Administrative Communicable Diseases lab Laboratory Control and Disease lab Licensing and Training Unit Section Microbiology Monitoring Unit (AMR) Director's NEQAS Blood Safety Office Program Diagnostic JE/Measles/Rubell a (National -Routine Bureau for Training and Polio/Dengue Data surveillance Lab Blood section Specialize Transfusion Management d National Influenza services(NBBTS and IT Section Center HIV/Hepatitis Licensing, Account Reference Lab Supervision and Section Monitoring of Immunolo Laboratories Store and logistic gy Lab management section BSL 3 Lab 8.5.13 CHALLENGES 8.5.13 ma a g a a t a at i a a a iat a a a CHALLENGES m t a at ta a i a a a ita The major challenges for Nepal's health laboratories are lack of appropriate laws and bylaws i t g t a a a it a a a i m i a a at i i i most needed for laboratory standardization and accreditation. a i g a it a at i i g m t a a at i Insufficient budget allocation for quality assurance activities of medical laboratories which is a a i ig a a a a t ai i g a at a causing a low quality laboratory i m t services a in i a at government m based laboratories. a i ma Lack of scholarships for higher education and advance level trainings for laboratory personnel, m m ta a t a at i i lack of pro-research environment and inadequate number of functional skilled human t i g i i a am t i t resources. ta i m t i ia i a t a a t a i a i a t a Implementation of Health Laboratory Guideline 2073. iag i Prevention of out sourcing clinical sample outside country. t gt i g iag i Establishment of PPHL (Provincial Public Health Lab.) and Decentralization of public health and t gt i g diagnostic services. i i g i m t Strengthening of Diagnostic Service. a ag t a i a Strengthening NEQAS. g a i m i a i m t Vendor licensing for equipment. t gt i g a a i KIT and reagent validation. Regulation of biomedical equipment. Strengthening research activities. DoHS, Annual Report 2075/76 (2018/19) g g am 8.6 Personnel Administration 8.6 Personnel Administration 8.6.18.6.1 Background Background ma a t i ta a t a i ma ma ag m t Human resources are the pivotal resource for health care delivery. Human resource management i involves t the planning, a i g motivation, m a use, training, t ai i g development, m t promotion, m transfer t a and training a t ai i g of m a m t a ma i ia a it employees. The proper placement and use of human resources is crucial for effective quality health a t a i mi i t a i i a care delivery. DoHS’s Personnel Administration Section (PAS) is responsible for routine and g amm a mi i t a i i g g a i g a t i t t t a a t programme administrative functions including upgrading health institutions, the transfer of health t g a i g a t t t t i g t gat t it workers, the upgrading of health workers up to the 7th level. According to delegated Authority of i i t a a it i i g a t i t a ma ag m t ma Ministry capacity building and the internal management of human resources. The objectives of PAS a i t i B are listed in Box 8.6.1. Box 8.6.1: Objectives of the Personnel Administration Section The main objective of the section is to mobilize human resource to deliver quality health services. The specific objectives are as follows: To transfer and manage all posts up to 7th level according to the delegated authority o ministry. To place health staff at sanctioned posts under DoHS. To manage human resources at the different levels under DoHS. To take disciplinary action according to the law. To manage and update personnel information of all levels and institutions under DoHS. To manage the posting and transfer of medical officers who completed their studies under government scholarships. To execute organisation and management (O&M) surveys to establish and extend the structure of health institutions and organizations under DoHS. To recommend to MoHP for approval special leave and education leave requests by health workers. 8.6.2 Routine activities 8.6.2 Routine activities The number of sanctioned and fulfilled posts under DoHS of fiscal year 2075/76 is given in Table 8.6.2.1 m a a t a a i gi i a The routine responsibilities for personnel administration are as follows: According to the Health Service Regulations, 2055 and MoHP policy, DoHS is responsible for The routinethe transfer responsibilities of the health workforcefor personnel up to theadministration 7th level. are as follows: DoHS manage the upgrading of its employees to the 7th level twice a year. i g t t a t i g a a i i i t DoHS work to maintain the professional discipline of its employees. t a t a t t t t DoHS approve house leave, sick leave, delivery leave and other types of leave. It recommends ma ag t g a i g it m t t t t i a a to MoHP for the approval of special and education request by up to 7th level employees. t mai tai t i a i i i it m DoHS manage the retirement of staff. a a i a i a a t t a t mm th t t a a ia a a t t t m The approval of resignations of staff above the 6 level is made through MoHP. ma ag t m t ta a a ig a ta a t t i ma t g DoHS, Annual Report 2075/76 (2018/19) g g am Table 8.6.2.1: Type and number of DoHS workforce, fiscal year 2075/76 Table 8.6.2.1: Type and number of DoHS workforce, fiscal year 2075/76 SN Types of human resources Grade/level Sanctioned Fulfilled 1 Director General (DG) 12th 1 1 2 Director 11th (PHA) 2 2 3 Director 11th (PHA/HI) 1 0 4 Senior Health Administrator 9/10th 3 3 5 Senior Computer Officer Gazetted II 1 1 6 Senior Community Nursing Administrator 9/10th 2 2 7 Senior Public Health Administrator 9/10th 8 3 8 Chief and Deputy Chief Medical Officer 9/10th 1 2 9 Senior Consultant Dermatologist 9/10th 1 1 10 Senior Consultant Gynaecology/Obstetrics 9/10th 1 1 11 Director and Deputy Director Senior Demographer Gazetted II 1 1 12 Under Secretary Gazetted II 1 1 13 Under-Secretary (Finance) Gazetted II 1 1 14 Section Officer Gazetted III 7 7 15 Account Officer Gazetted III 2 2 16 Legal Officer Gazetted III 1 1 17 Pharmacist 7/8th 2 2 18 Senior Public Health Officer 7/8th 9 9 19 Medical Officer 8th 7 7 20 Electrical Engineer Gazetted III 1 0 21 Senior Community Nursing Officer 7/8th 7 5 22 Senior Nursing Officer 7/8th 5 5 23 Entomologist 7/8th 1 0 24 Statistics Officer Demographer Gazetted III 5 5 25 Veterinary Doctor Gazetted III 1 1 26 Computer Officer Gazetted III 3 3 27 Mechanical Engineer Gazetted III 1 1 28 Nayab Subba (Clerk) Non gazetted I 8 7 29 Health Assistant /Public Health Inspector 5/6th 6 6 th 30 Biomedical Engineer 7/8 2 0 th 31 Architect Engineer 7/8 1 0 32 TB/leprosy Assistant 5/8th 1 0 33 Cold Chain Assistant 4/5th 3 3 34 2Lab Assistant 4/5DoHS,th Annual Report2 2075/76 (2018/19)2 Table 8.6.2.1: Type and number of DoHS workforce, fiscal year 2075/76 SN Types of human resources Grade/level Sanctioned Fulfilled 1 Director General (DG) 12th 1 1 2 Director 11th (PHA) 2 2 3 Director 11th (PHA/HI) 1 0 4 Senior Health Administrator 9/10th 3 3 5 Senior Computer Officer Gazetted II 1 1 6 Senior Community Nursing Administrator 9/10th 2 2 7 Senior Public Health Administrator 9/10th 8 3 8 Chief and Deputy Chief Medical Officer 9/10th 1 2 9 Senior Consultant Dermatologist 9/10th 1 1 10 Senior Consultant Gynaecology/Obstetrics 9/10th 1 1 11 Director and Deputy Director Senior Demographer Gazetted II 1 1 12 Under Secretary Gazetted II 1 1 13 Under-Secretary (Finance) Gazetted II 1 1 14 Section Officer Gazetted III 7 7 15 Account Officer Gazetted III 2 2 16 Legal Officer Gazetted III 1 1 17 Pharmacist 7/8th 2 2 18 Senior Public Health Officer 7/8th 9 9 19 Medical Officer 8th 7 7 20 Electrical Engineer Gazetted III 1 0 21 Senior Community Nursing Officer 7/8th 7 5 22 Senior Nursing Officer 7/8th 5 5 23 Entomologist 7/8th 1 0 24 Statistics Officer Demographer Gazetted III 5 5 25 Veterinary Doctor Gazetted III 1 1 26 Computer Officer Gazetted III 3 3 27 Mechanical Engineer Gazetted III 1 1 28 Nayab Subba (Clerk) Non gazetted I 8 7 29 Health Assistant /Public Health Inspector 5/6th 6 6 th 30 Biomedical Engineer 7/8 2 0 th 31 Architect Engineer 7/8 1 0 g g am 32 TB/leprosy Assistant 5/8th 1 0 33 Cold Chain Assistant 4/5th 3 3 34SN Lab AssistantTypes of human resources Grade/level4/5th Sanctioned2 Fulfilled 2 35 Light Vehicle Driver Not classified 7 7 36 Office Assistant (Peon) Not classified 8 8 SN Types of human resources Grade/level Sanctioned Fulfilled Source: PAS, DoHS 7 7 35 Light Vehicle Driver Not classified 368.6.38.6.3 Office NewNew Assistant initiativesinitiatives (Peon) Not classified 8 8 The following new initiatives were taken from the fiscal year 2072/73: Source: PAS, DoHS File tracking system. i g i i a ta m t a a 8.6.3 NewDigital initiatives attendance introduced within DoHS. The following i t a i g t m An online new calendar initiatives of operations were taken (online from actionthe fiscal plan) year of divisions2072/73: and DoHS introduced. igita a a i t it i File tracking system. i a a a i a a i i i a i t 8.6.4Digital Issues attendance and recommendations introduced within DoHS. Table 8.6.4.1: Issues and Recommendations. 8.6.4An Issues online and calendar recommendations of operations (online action plan) of divisions and DoHS introduced. Issues Recommendations 8.6.4TableInsufficient Issues 8.6.4.1: andinformation Issuesrecommendations andfor strategic Recommendations. Develop a scientific health workforce transfer criteria and a Tableplacement 8.6.4.1 and: transfers Issues and Recommendations.time- bound transfer management system from district to Issues central level with the Recommendationsdecentralization of authority. InsufficientLack of functional information database for strategic of DoHS DevelopDevelop aa scientificmechanism health for theworkforce timely recruitment transfer criteria of contract and a - placementpersonnel and transfers time-basedbound health transfer workers management (ANMs and SBAs) system to fromensure district 24/7 to centralservices. level with the decentralization of authority. LackWeak of managementfunctional database of staff of on DoHS long leave DevelopFunctionalise a mechanism coordination for the mechanisms timely recruitment between ofagencies contract - personnel basedconcerned health with workers producing (ANMs and and deploying SBAs) to human ensure resources 24/7 services.including induction training (academia, councils, training centres, MoHP) Weak management of staff on long leave Functionalise coordination mechanisms between agencies Placement of scholarship doctors in Tarai concernedAuthorize DoHSwith producing to place doctors and deploying at PHCCs. human resources and mountain districts including induction training (academia, councils, training The one-door placement of medical officers centres,Develop MoHP) and implement an incentive package to retain Placement of scholarship doctors in Tarai Authorizedoctors at DoHS PHCCs to and place in remotedoctors areas.at PHCCs. andHuman mountain resource districts placement in rural and Effectively implement the time-bound transfer of personnel Theremote one- facilitiesdoor placement of medical officers Developstarting fromand implement district to centralan incentive level with package the decentralizationto retain doctorsof authority. at PHCCs and in remote areas. HumanMonitoring resource of doctors placement in PHCCs in rural and and district EffectivelyInitiate an implemente-attendance the system time-bound in PHCCs transfer and 50 of bed personnel hospitals remotehospitals facilities startingand then from scale district-up to toall centralfacilities level and with institutions the decentralization Weak coordination between MoHP, ofMoHP authority. and MoFALD to work together to fill health worker Monitoringdepartment of and doctors districts in PHCCs for personnel and district Initiateposts in an urban e-attendance health clinics system in PHCCs and 50 bed hospitals hospitalsmanagement and then scale-up to all facilities and institutions Weak coordination between MoHP, MoHP and MoFALD to work together to fill health worker department and districts for personnel posts in urban health clinics management DoHS, Annual Report 2075/76 (2018/19) g g am 8.78.7 Financial Financial Management Management 8.7 Financial Management 8.7.18.7.1 Background Background 8.7.1 Background a ia t t m i im a i t a t i ma ag m t An effective financial support system is imperative for efficient health service management. The An effective financial support system is imperative for efficient health service management. The a a preparation of a a annual g t budgets, t the m timely i m t disbursement of funds, accounting, a g reporting, g and a preparation of annual budgets, the timely disbursement of funds, accounting, reporting, and a i g a t mai a ia ma ag m t t t t im m ta auditing are the main financial management functions needed to support the implementation of auditing are the main financial management functions needed to support the implementation of a t health g amm programmes. DoHS’s i a Finance mi i t a Administration Section (FAS) is i the t focal a point i t for financial a ia ma ag m t a g amm a ia ma ag m t a ta g t a gi health programmes. DoHS’s Finance Administration Section (FAS) is the focal point for financial management for all DoHS programmes. The financial management objectives and targets are given i B management for all DoHS programmes. The financial management objectives and targets are given in Box 8.7.1. in Box 8.7.1. Box 8.7.1: Health financial management objectives and targets Box 8.7.1: Health financial management objectives and targets : : To support all programmes, divisions and centres for preparing their annual budgets To support all programmes, divisions and centres for preparing their annual budgets To obtain and disburse programme budgets To obtain and disburse programme budgets To keep books of accounts and collect financial reports from all public health institutions To keep books of accounts and collect financial reports from all public health institutions To prepare and submit financial reports To prepare and submit financial reports To facilitate internal and external auditing To facilitate internal and external auditing To provide financial consultations. To provide financial consultations. —To achieve 100 percent expenditure of all budgets in accordance with programme work —To achieve 100 percent expenditure of all budgets in accordance with programme work plans within a specified times as per financial rules and regulations of the government and to plans within a specified times as per financial rules and regulations of the government and to maintain the recording and reporting system accurately and on time. maintain the recording and reporting system accurately and on time. 8.7.28.7.2 Achievements Achievements in inthe the fiscal fiscal year year 2075/76 2075/76 8.7.2 Out ofAchievements total National in Budget the fiscal of Rs. year 1,315,161,7 2075/7600 ,000 a sum of Rs. 34,082,300,000 (2.59%) was Out of total National Budget of Rs. 1,315,161,700,000 a sum of Rs. 34,082,300,000 (2.59%) was t t ta a a B g t a m a allocated for the health sector during the fiscal year 2075/76. Of the total health sector budget, Rs. allocated for the health sector during the fiscal year 2075/76. Of the total health sector budget, Rs. a at t a t t i g t a a t t ta a t t g t 7,639,936,209 (22.42%) was allocated for the execution of programs under the Department of 7,639,936,209 (22.42%) was allocated for the execution of programs under the Department of a a at t g am t a tm t Health Services Network (Table 8.7.1). Health Services Network (Table 8.7.1). a t i t a Table 8.7.1: Health budget details, FY 2075/76 (NPR) TableTable 8.7.1:8.7.1: Health Health budget budget details, details, FY 2075/76 FY 2075/76 (NPR) (NPR) Budget Total Recurrent % Capital % Financing % Budget Total Recurrent % Capital % Financing % National National 1,315,161,700,000 845,447,500,000 64.28 313,998,200,000 23.88 155,716,000,000 11.84 budget 1,315,161,700,000 845,447,500,000 64.28 313,998,200,000 23.88 155,716,000,000 11.84 budget Health Health 34,082,300,000 25,511,200,000 74.85 8,571,100,000 25.15 0 0.00 budget 34,082,300,000 25,511,200,000 74.85 8,571,100,000 25.15 0 0.00 budget Province 4,184,700,000 4,184,700,000 100.00 0 0.00 0 0.00 Provincebudget 4,184,700,000 4,184,700,000 100.00 0 0.00 0 0.00 budget Local Level 18,152,700,000 18,152,700,000 100.00 0 0.00 0 0.00 Localbudget Level 18,152,700,000 18,152,700,000 100.00 0 0.00 0 0.00 budgetHealth Healthbudget 7,639,936,209 6,797,436,209 88.97 842,500,000 11.03 0 0.00 budgetunder DoHS 7,639,936,209 6,797,436,209 88.97 842,500,000 11.03 0 0.00 under DoHS DoHS, Annual Report 2075/76 (2018/19) g g am Table 88.7..7..7.2:2:2: Allocation Allocation Allocation of of of health health health budget budget budget by by bysource, source, source, FY FY 2075/76FY 2075/76 2075/76 BudgetBudget TotalTotalTotal GoNGoNGoN % %% DonorDonorDonor % % % HealthHealth budget budgetbudget 7,639,936,2097,639,936,2097,639,936,209 4,528,836,2094,528,836,2094,528,836,209 59.2859.2859.28 3,111,100,0003,111,100,0003,111,100,000 40.7240.72 40.72 underunder DoHS DoHSDoHS Table 88.7..7..7.3:3:3: Regular Regular Regular programme programme programme recurrent recurrent recurrent budget, budget, budget, releases releases releases and and and expenditure expenditure expenditure by byprogramme by programme programme activities,activities,activities, FY FY FY 2075/76 2075/76 2075/76 ProgrammeProgrammeProgramme budget budget budget ReleaseReleaseRelease budget budget budget (in (in (in TotalTotalTotal budget budget budget (in (in NPR)(in NPR) NPR) NPR)NPR)NPR) ExpenditureExpenditureExpenditure (in NPR) (in (in NPR) NPR) BudgetBudget Code CodeCode NoNo AmountAmountAmount % %% AmountAmountAmount % %% AmountAmountAmount % (a)% %(a) (a) 37001233700123 DepartmentDepartmentDepartment of of of Health Health Health 167,954,975167,954,975167,954,975 22.7822.7822.78 153,903,938 153,903,938153,903,938 28.03 28.0328.03 153,903,938 153,903,938153,903,938 28.0328.03 28.03 37001243700124 DepartmentDepartmentDepartment of of of Health Health Health 255,000,000255,000,000255,000,000 34.5834.5834.58 122,825,740 122,825,740122,825,740 22.37 22.3722.37 122,825,740 122,825,740122,825,740 22.3722.37 22.37 37001433700143 DistrictDistrictDistrict Health Health Health Offices Offices Offices 258,478,000258,478,000258,478,000 35.0635.0635.06 255,230,277 255,230,277255,230,277 46.49 46.4946.49 255,230,277 255,230,277255,230,277 46.4946.49 46.49 HealthHealthHealth Training Training Training Centres Centres Centres 37002133700213 programmesprogrammesprogrammes 55,902,00055,902,00055,902,000 7.587.587.58 17,035,71117,035,71117,035,711 3.103.10 3.10 17,035,71117,035,71117,035,711 3.10 3.103.10 TotalTotalTotal 737,334,975737,334,975737,334,975 100100 100 548,995,666548,995,666548,995,666 100100 100 548,995,666548,995,666548,995,666 100 100100 TableTable 8.7.8.7.4:4:4: Central Central Central level level level recurrent recurrent recurrent budget budget budget allocation allocation allocation by by sourceby source source and and and programme programme programme activities, activities, activities, FY 2075/76FY FY 2075/76 2075/76 BudgetBudget ProgrammeProgrammeProgramme budget budget budget TotalTotalTotal budget budget budget allocation allocation allocation by sourcesby by sources sources CodeCode No NoNo headingheadingheading GoNGoNGoN % %% DonorDonorDonor % % % TotalTotal Total % % % TuberculosisTuberculosisTuberculosis Control Control Control 37011333701133 ProgrammesProgrammesProgrammes 437,401,234.00437,401,234.00437,401,234.00 11.8911.8911.89 117,300,000.00117,300,000.00117,300,000.00 4.454.45 4.45 554,701,234 554,701,234554,701,234 8.78 8.788.78 NationalNationalNational HIV/AIDS HIV/AIDS HIV/AIDS 37011433701143 ControlControlControl Programmes Programmes Programmes 164,800,000.00164,800,000.00164,800,000.00 4.484.484.48 359,300,000.00359,300,000.00359,300,000.00 13.62 13.6213.62 524,100,000 524,100,000524,100,000 8.30 8.308.30 37011533701153 FP/MCHFP/MCHFP/MCH Programmes Programmes Programmes 54,100,000.0054,100,000.0054,100,000.00 1.471.471.47 425,700,000.00425,700,000.00425,700,000.00 16.14 16.1416.14 479,800,000 479,800,000479,800,000 7.60 7.607.60 IntegratedIntegratedIntegrated CHD CHD CHD 37011633701163 ProgrammeProgrammeProgramme 561,700,000561,700,000561,700,000 15.2715.2715.27 1,427,700,000.00 1,427,700,000.001,427,700,000.00 54.13 54.1354.13 1,989,400,000 1,989,400,0001,989,400,000 31.5031.50 31.50 EpidemiologyEpidemiologyEpidemiology 37011933701193 ProgrammeProgrammeProgramme 352,700,000.00352,700,000.00352,700,000.00 9.599.599.59 65,900,000.0065,900,000.0065,900,000.00 2.502.50 2.50 418,600,000 418,600,000418,600,000 6.63 6.636.63 LeprosyLeprosyLeprosy Control Control Control 37013701203203203 ProgrammeProgrammeProgramme 27,000,000.0027,000,000.0027,000,000.00 0.730.730.73 0.000.00 0.00 0.000.00 0.00 27,000,00027,000,00027,000,000 0.43 0.430.43 37012133701213 IndentIndentIndent Procurement Procurement Procurement 107,500,000.00107,500,000.00107,500,000.00 2.922.922.92 36,000,000.0036,000,000.0036,000,000.00 1.361.36 1.36 143,500,000 143,500,000143,500,000 2.27 2.272.27 HospitalHospitalHospital Construction Construction Construction /Management/Management/Management 37012233701223 InformationInformationInformation System System System 1,171,900,000.001,171,900,000.001,171,900,000.00 31.8731.8731.87 141,500,000.141,500,000.141,500,000.00 0000 5.375.37 5.37 1,313,400,000 1,313,400,0001,313,400,000 20.8020.80 20.80 37012333701233 NHEICCNHEICCNHEICC programmes programmes programmes 83,800,000.0083,800,000.0083,800,000.00 2.282.282.28 29,800,000.0029,800,000.0029,800,000.00 1.131.13 1.13 113,600,000 113,600,000113,600,000 1.80 1.801.80 HealthHealthHealth Laboratory Laboratory Laboratory 37012633701263 ServicesServicesServices 163,300,000.00163,300,000.00163,300,000.00 4.444.444.44 0.000.00 0.00 0.000.00 0.00 163,300,000 163,300,000163,300,000 2.59 2.592.59 37013633701363 PHCRDPHCRDPHCRD programmes programmes programmes 481,100,000.00481,100,000.00481,100,000.00 13.0813.0813.08 5,000,000.005,000,000.005,000,000.00 0.190. 0.1919 486,100,000 486,100,000486,100,000 7.70 7.707.70 NationalNationalNational Health Health Health Training Training Training 37012433701243 CentreCentreCentre programmes programmes programmes 72,400,000.0072,400,000.0072,400,000.00 1.971.971.97 29,200,000.0029,200,000.0029,200,000.00 1.111.11 1.11 101,600,000 101,600,000101,600,000 1.61 1.611.61 TotalTotalTotal 3,677,701,2343,677,701,2343,677,701,234 100100 100 2,637,400,0002,637,400,0002,637,400,000 100100 100 6,315,101,234 6,315,101,2346,315,101,234 100 100100 DoHS, Annual Report 2075/76 (2018/19) g g am Table 8.7.5: Central level recurrent budget released by source and programme, FY 2075/76 Programme budget Released Budget By Source Budget heading Code No GoN % Donor % Total % Tuberculosis Control 3701133 Programmes 310,396,679.45 6.73 0.00 0.00 310,396,679 5.78 National HIV/AIDS 3701143 Control Programmes 158,743,517.07 3.44 265,130,002.40 35.06 423,873,519 7.89 3701153 FP/MCH Programmes 50,290,415.00 1.09 280,876,390.00 37.14 331,166,805 6.17 Integrated CHD 3701163 Programme 524,206,592.21 11.36 58,304,438.97 7.71 582,511,031 10.84 3701193 Epidemiology Programme 237,488,637.93 5.15 11,601,761.00 1.53 249,090,399 4.64 Leprosy Control 3701203 Programme 15,690,346.00 0.34 0.00 0.00 15,690,346 0.29 3701213 Indent Procurement 82,341,012.77 1.78 14,894,968.00 1.97 97,235,981 1.81 Hospital Construction /Management 3701223 Information System 2,494,254,630.00 54.05 87,888,790.81 11.62 2,582,143,421 48.07 3701233 NHEICC programmes 71,723,000.58 1.55 11,872,566.00 1.57 83,595,567 1.56 Health Laboratory 3701263 Services 160,394,255.10 3.48 0.00 0.00 160,394,255 2.99 3701363 PHCRD programmes 442,799,230.00 9.59 0.00 0.00 442,799,230 8.24 National Health Training 3701243 Centre programmes 66,764,517.38 1.45 25,743,782.00 3.40 92,508,299 1.72 Total 4,615,092,833 100 756,312,699 100 5,371,405,533 100 Table 8.7.6: Central level recurrent budget expenditure by source and programme, FY 2075/76 Programme budget Released Budget By Source Budget heading Code No GoN % Donor % Total % Tuberculosis Control 3701133 Programmes 310,396,679.45 6.73 0.00 0.00 310,396,679 5.78 National HIV/AIDS 3701143 Control Programmes 158,743,517.07 3.44 265,130,002.40 35.06 423,873,519 7.89 3701153 FP/MCH Programmes 50,290,415.00 1.09 280,876,390.00 37.14 331,166,805 6.17 Integrated CHD 3701163 Programme 524,206,592.21 11.36 58,304,438.97 7.71 582,511,031 10.84 3701193 Epidemiology Programme 237,488,637.93 5.15 11,601,761.00 1.53 249,090,399 4.64 Leprosy Control 3701203 Programme 15,690,346.00 0.34 0.00 0.00 15,690,346 0.29 3701213 Indent Procurement 82,341,012.77 1.78 14,894,968.00 1.97 97,235,981 1.81 Hospital Construction /Management 3701223 Information System 2,494,254,630.00 54.05 87,888,790.81 11.62 2,582,143,421 48.07 3701233 NHEICC programmes 71,723,000.58 1.55 11,872,566.00 1.57 83,595,567 1.56 Health Laboratory 3701263 Services 160,394,255.10 3.48 0.00 0.00 160,394,255 2.99 3701363 PHCRD programmes 442,799,230.00 9.59 0.00 0.00 442,799,230 8.24 National Health Training 3701243 Centre programmes 66,764,517.38 1.45 25,743,782.00 3.40 92,508,299 1.72 Total 4,615,092,833 100 756,312,699 100 5,371,405,533 100 DoHS, Annual Report 2075/76 (2018/19) g g am Table 8.7.7: Central level capitalcapital budgetbudget allocationallocation byby sourcesource andand programme, programme, FY FY 2075/76 2075/76 Budget Programme budget TotalTotal budget budget allocation allocation by by source source Code No heading GoNGoN %% DonorDonor %% TotalTotal %% Tuberculosis Control 3701134 Programmes 110,400,000110,400,000 39.8439.84 35,100,00035,100,000 11.8311.83 145,500,000145,500,000 25.3625.36 National HIV/AIDS Control 3701144 Programmes 00 0.000.00 13,000,00013,000,000 4.384.38 13,000,00013,000,000 2.272.27 3701154 FP/MCH Programmes 5,200,0005,200,000 1.881.88 00 00 5,200,0005,200,000 0.910.91 Integrated ChildChild HealthHealth 3701164 Programme 58,000,58,000,000000 20.9320.93 108,500,000108,500,000 36.5836.58 166,500,000166,500,000 29.0229.02 3701194 Epidemiology Programme 2,600,0002,600,000 0.940.94 00 00 2,600,0002,600,000 0.450.45 Leprosy Control 3701204 Programme 1,300,0001,300,000 0.470.47 00 00 1,300,0001,300,000 0.230.23 3701214 Indent Procurement 31,100,00031,100,000 11.2211.22 140,000,000140,000,000 47.2047.20 171,100,000171,100,000 29.8229.82 Hospital Construction /Management 3701224 Information SystemSystem 5,600,0005,600,000 2.022.02 00 00 5,600,0005,600,000 0.980.98 3701234 NHEICC programmes 500,000.00500,000.00 0.180.18 0.000.00 00 500,000500,000 0.090.09 National Health Training 3701244 Centre 2,100,0002,100,000 0.760.76 00 00 2,100,0002,100,000 0.370.37 Health Laboratory 3701264 Services 34,800,00034,800,000 12.5612.56 00 00 34,800,00034,800,000 6.076.07 Primary Health Care 3701364 Division programmes 25,500,00025,500,000 9.209.20 00 0.000.00 25,500,00025,500,000 4.444.44 Total 277,100,000277,100,000 100100 296,600,000296,600,000 100100 573,700,000573,700,000 100100 Table 8.7.8: Central level capitalcapital budgetbudget releasedreleased byby sourcesource andand programme, programme, FY FY 2075/76 2075/76 Budget Programme budget heading ReleasedReleased budget budget by by source source Code No GoNGoN %% DonorDonor %% TotalTotal %% Tuberculosis Control 3701134 Programmes 78,575,471.0078,575,471.00 53.6653.66 0.000.00 00 78,575,47178,575,471 27.3527.35 National HIV/AIDS Control 3701144 Programmes 00.00.00 0.000.00 13,000,000.0013,000,000.00 9.239.23 13,000,00013,000,000 4.534.53 3701154 FP/MCH Programmes 4,989,831.004,989,831.00 3.413.41 0.000.00 00 4,989,8314,989,831 1.741.74 Integrated Child HealthHealth 3701164 Programme 4,444,606.004,444,606.00 3.043.04 7,062,500.007,062,500.00 5.015.01 11,507,10611,507,106 4.014.01 3701194 Epidemiology Programme 199,520.00199,520.00 0.140.14 0.0.0000 00 199,520199,520 0.070.07 3701204 Leprosy Control Programme 498,552498,552 0.340.34 0.000.00 00 498,552498,552 0.170.17 3701214 Indent Procurement 15,246,836.5015,246,836.50 10.4110.41 120,796,387.96120,796,387.96 85.7685.76 136,043,224136,043,224 47.3547.35 Hospital Construction /Management Information 3701224 System 4,787,934.004,787,934.00 3.273.27 0.00.000 0.000.00 4,787,9344,787,934 1.671.67 3701234 NHEICC programmes 375,900.00375,900.00 0.260.26 0.000.00 00 375,900375,900 0.130.13 3701264 Health Laboratory Services 32,623,028.0032,623,028.00 22.2822.28 0.000.00 00 32,623,02832,623,028 11.3611.36 Primary Health Care Division 3701364 programmes 4,689,984.604,689,984.60 3.203.20 0.000.00 0.000.00 4,689,9854,689,985 1.631.63 Total 146,431,663.10146,431,663.10 100.00100.00 140,858,887.96140,858,887.96 100.00100.00 287,290,551.06287,290,551.06 100.00100.00 DoHS, Annual Report 2075/76 (2018/19) g g am Table 8.7..7.9: Central Central levellevel capitalcapital budgetbudget expenditureexpenditure by by source source and and programme, programme, FY FY 2075/76 2075/76 Budget Programme budgetbudget headingheading ReleasedReleased budget budget by by source source Code No GoNGoN %% DonorDonor %% TotalTotal %% TuberculosisTuberculosis ControlControl 3701134 ProgrammesProgrammes 78,575,471.0078,575,471.00 53.6653.66 0.000.00 00 78,575,47178,575,471 27.3527.35 National HIV/AIDSHIV/AIDS ControlControl 3701144 ProgrammesProgrammes 0.000.00 0.000.00 13,000,000.0013,000,000.00 9.239.23 13,000,00013,000,000 4.534.53 3701154 FP/MCHFP/MCH ProgrammesProgrammes 4,989,831.004,989,831.00 3.413.41 0.000.00 00 4,989,8314,989,831 1.741.74 IIntegratedntegrated ChildChild HealthHealth 3701164 ProgrammeProgramme 4,444,606.004,444,606.00 3.043.04 7,062,500.007,062,500.00 5.015.01 11,507,10611,507,106 4.014.01 3701194 EpidemiologyEpidemiology ProgrammeProgramme 199,520.00199,520.00 0.140.14 0.000.00 00 199,520199,520 0.070.07 3701204 LeprosyLeprosy ControlControl ProgrammeProgramme 498,552498,552 0.340.34 0.000.00 00 498,552498,552 0.170.17 3701214 IndentIndent ProcurementProcurement 15,246,15,246,836.50836.50 10.4110.41 120,796,387.96120,796,387.96 85.7685.76 136,043,224136,043,224 47.3547.35 Hospital ConstructionConstruction /Management/Management InformationInformation 3701224 SystemSystem 4,787,934.004,787,934.00 3.273.27 0.000.00 0.000.00 4,787,9344,787,934 1.671.67 3701234 NHEICC programmesprogrammes 375,900.00375,900.00 0.260.26 0.000.00 00 375,900375,900 0.130.13 3701264 Health LaboratoryLaboratory ServicesServices 32,623,028.0032,623,028.00 22.2822.28 0.000.00 00 32,623,02832,623,028 11.3611.36 PrimaryPrimary HealthHealth CareCare DivisionDivision 3701364 programmes 4,689,984.604,689,984.60 3.203.20 0.000.00 0.000.00 4,689,9854,689,985 1.631.63 TotalTotal 146,431,663.10146,431,663.10 100.00100.00 140,858,887.96140,858,887.96 100.00100.00 287,290,551.06287,290,551.06 100.00100.00 Table 8.7..7.10:: Cumulative Cumulative financialfinancial irregularitiesirregularities up up to to 2075/76 2075/76 (NPR (NPR In,000) In,000) IrregularityIrregularity Irregularity clearanceIrregularity clearance PercentPercent amount to bebe regularized 2,,18,,01,,50,,000 11,44,44,53,53,16,16,000,000 66.2966.29 Table 88.7..7.11:: IrregularityIrregularity clearanceclearance statusstatus ofof last last three three years years FY FY 2073/74 2073/74 - -2075/76 2075/76 ( NPR(NPR In In ,000) ,000) Fiscal YearYear Total irregularityTotal amount irregularity amount IrregularityIrregularity ClearanceClearance % % clearanceclearance 2075/76 22,18,18,01,01,50,50,000,000 11,44,44,53,53,16,16,000,000 66.2966.29 2074/75 35273213527321 1414,39,39,096,096 40.8040.80 2073/74 4,25,95,144,25,95,14 1,92,02,951,92,02,95 45.0845.08 Source: FinanceFinance Section,Section, DoHSDoHS 8 DoHS, Annual Report 2075/76 (2018/19) g g am 8.7.3 Issues of financial management Following major Issues of financial management are given below table: Problems and constraints Delay in approval of organizational structure and functionality has affected in the health budget allocation, release and disbursement to the local level health institutions. Still remain to ensure the rational allocation of health budget to the Provinces and local level programs and availability of human resources. Mismatch in the allocation of health budget to the LGs in the certain levels. No single platform for the planning and budgeting to ensure harmonization of budget planning and program implementation across the three layers of government. Due to newly formed federal structure the health facility capacity remain limited to improvement of the planed budget activities and utilization of allocated budget. Lack of clarity "On and Off" health budget reporting mechanism in the changed context including expendityre reporting at the local level. Non-release of committed EDPs budgets in time. Difficulty in keeping books of accounts and reporting according to differing software e.g. GGAS, TABUCUS, LMBIS and RMIS Difficulty in financial reporting procedures and reimbursement from External Development Partners (EDPs) due to lack of trained manpower and physical facilities DoHS, Annual Report 2075/76 (2018/19) g g am 8.8 Medico-Legal Services i ga i i i i a i ai g it i t i a g at i t g i ma a t a a t i a i a t i ig g i g i i t a im a i a at m i ga i t a i i t i i t tat i t ig t a t a at g i a mai g m a a i g i t a t im i m t a i a i a i i t i i g i t a a a a a a i g i i t a m t a g am a a im i m t a i t a a a a a imi a i t a at it im agai t ma t a i it a g a a t ig t t a t a a i i a i a a ig t t ig t i m im a ig t agai t t g a a t a i i a am ta ig t t a i i m m a a t a i a ig t t ia a ig t m i a a a m t at it m i ga t i im m ta i a i it a a i a a t a ig t m i ga t i a m t i a tat im a m t g i m i ga a it i t a it ta a a a m t a a i t ia i i t i it i ig m a m t t a i itat t i m t t i t t i m i ga i i g t i ia i t i t a i i i t a mi g it t t a a a i ga i t a a gi t i a i t a i g a i i i i ia i t i t i t m t i t m a i t a i i t a t a at t ta t i t i at ita t t i t i a t a a i ga a t i a at at ma i a ga i i i t a t i t m i ga ami a a g mat a a a i a m t it i i a i i t a a a t a a a a t ai i g t m a tm t a t t t t a i a i t ta a a g a a a ai i g a a ta a m i ga ami a a g i ta a m t a i g a a i i t a t a a a a ma a a t a ma a i ami a a ma a a a ami a a ma a ag ma a ma a ami a i m t t a ma a i i a ta mai a i i a m a i m i a g t a mi i m i ga i t i m t i ita t mi i i ga i m t m i a g a i ta i i t a a i a t DoHS, Annual Report 2075/76 (2018/19) g g am i g a t a a a i t i i t i a a a a i ga i a i i i i ai g it im m ta i g t g i i m i ga i a t a i ga i a mmi i m at a t t m g a ta t i i a i i t a at i im m ta a a t a i it i t i m t at it m i ga i i a t t a i at t m i ga i a i g i a t g a i it a i g a a t i g t a at m a t a i m i ga i t g t a ma m i a t a i i t m i t t t m i ga i t i i i at i m t a t mi im m ta a a gg i m t a a i ga a a i a mi im m a i i m i i t im m ta t i i gi ga i i g i i a ta a m t im m t t t i t imi a i g ma a a ta a i m i ga i t t t t i i a im m t t t it ma ta g t a i mi im m ta a i t i i a at i i i it t g at i i t a imi a t t at a i m t a ta i m t t ta i i it t im m ta m g a a t g t a i a i m t m i ga i ta a DoHS, Annual Report 2075/76 (2018/19) g g am 8.9 Monitoring and Evaluation 8.9.1 Background a a t a t i ma i im t g t ma mm i a g a i i a a t t t t a t a i t a a t i ma t m i i a a i g it a im a i t g at a t t i at i t t at i t t a i g a g g t i a m i i g i a a t ag t a t tai a m t a m a i m it i g a i g t it ga i t a t t m at i t a g tai a tai m t am a a a t t t at g t t i t t tat t m a a t g at i ma ma ag m t a a a a a t i t i i it a a m a t t i it a i ag t a i g 8.9.2 Major Progress in FY 2075/76 (2018/19) Development of Guideline i it t a a a t t at g t a a a a a t i i t i a am ta a i a a t t m i a g i i t a t a ta a t i g t ig im m ta m it i g a i a t t m Integrated information management it ga t t i ma ma ag m t i t a t t t a i t a i t ta i a i t a m a i m i g m t g t a t a i i i t a a ata a t a i ia a a m t t t m a i m i a i g g a m a m t g t i ma m a t a i i t t a m t m a m t t a t m a t t a t i t at a m t i t at t t a tm t a t i a t t i a t t i t it i g a a a g i i t t g m t a a a t a t a a g i i g m t i ia a a g m t t g at a a t a t t ata t i i i g t a t t m t at a i a t i ma t m a i t a a t a i it gi t a t t at t a a a t a i i it i t t i a i at a i i ma i i a a at gi t a a i t a t at a t i ma t m t t t it i t t i i i i a i t a t a i i t at a i it t t a t t i g i ata m a t a i i i a i a t a i i mi m t t t i a a t t a ima a t a t a i g ma ag t a g m t t DoHS, Annual Report 2075/76 (2018/19) g g am i i g a i g t i a a i a t i ma ma ag m t i i g t t a m a a a g m t t t a t a i it a i ta t i a t t a a ata a i a a mi t t ata m a g m t t t a a t m a i g m t i ta a t ta ia m t at a g amm ma ag a a a a ai a t it g a ata a it m t t a t a i g a ag a at i a g a m t a i ma a ai a t it a m g t m i t mai i ata i a a t m a m t i g ata m t t t i a t a at a it m t i i i g t ata t ata i a mai a t a a a it i g a a t m a a t t m a m t mai a i a tai m a i g a it a ata i a mai a i i at t i a a i a t ma a a i i g g at m i ata i a mai m a t a i i a t at m t a a t a t a i it a t m t t ma i mai gi t m it i g t a t a t a i it m t t i t i gi t ta a m it i g t ta a a ag t t m a m t a i t a a i ma i t t i ta t m t m a m t mai a t at t t a t a i it a t m t t a i ata ma ag m t m t a a m t t ma i a ai a i it i i at i a g g i i a t ata i i ma i g m it i g a a a a a a i i mai t a a im m t m t t a t a i i a igita a a a t m it ma a t i i at i i g t t am a a t at i i at Electronic Health Records a a a g i i im m ta t i a t at a t a i i a g i t at t i ia a i i at ita at t i g ita a ta t i i am a t a a ta B a g ita i a a a a a i g ita Bagma i a t ita a a a i t ita a a i i a agi i ita a a a m a t i i mi a a m a t i a a i i a a a ai ita a im i a Ba a ata ita Surveillance systems at a a i ata at i a a a i it a a a m ita i t a a i a ita i mm it a a a m i t i t t a a i a i t i t a g a ta at a t ag i a a ai a Ba a g i Bagma i i i at t i t i t am a a a a a mm it a i m t i g t i a g t a i g a g t a DoHS, Annual Report 2075/76 (2018/19) g g am a i g t a m i a i a t t at m t mm it ta g t i t a mm it a i i t i t a a i it a i a i ita Early Warning and Reporting System (EWARS) i a ita a i a t m t it ita t i i g t i i mi t at a i a i t t t t a ta t i it it a a t it i it i it i it i it i a it i t ta i at ita a m i a g i a it a a i it a g a a g i t a m i i t i t t i i g i ag it t 8.9.3 Survey, research and studies i a i g t t t a a t a i it i i i a ta it g a t a i i at a t a a ta a i a a i i i a ata i a a a a t t i t t a i i m a a t a i a t a m a t i i t a i g a mma i Studies Key Findings Policy Recommendations 28.9 % of the adults aged 15 to 69 years As the prevalence of NCD risk factors is were currently using tobacco found high, there should be effective (smoked/smokeless). enforcement of NCDs risk factor 24.2% of the adults aged 15 to 69 years prevention and control programmes were using tobacco on daily basis. Average age at initiation of smoking (years) among those who smoke daily was 17.1 years (17.7 years in male and 18.4 years in female). 21% prevalence of alcohol user. Only 3% of the sample population met the intake of WHO recommended fruits and vegetables per day. Salt intake was found to be 9.1 grams per day which is almost twice the WHO recommendation 6% of women of age 30-49 had done the NCD STEPS survey 2019 cervical test in the last five years. Mean BMI: 22.7 (22.6 for men and 22.8 for women), Overweight: 24% and Obese: 4%. Raised BP: 25% (Males-30%, females- 20%) 10% measured to have raised BP and/ or on treatment /medication 21% of people measured to have raised blood glucose and/ or on medications Among the surveyed population only 7% are member of health insurance scheme DoHS, Annual Report 2075/76 (2018/19) g g am From January to May 2019 a total of 702 cancer cases from Kathmandu Valley. 256 new cases of cancer from Siraha, Saptari, Dhanusha and Mahottari and 23 new cases from East and West Rukum were identified. In 702 cases from Kathmandu Valley, cancer incidence is higher among females comparing to the males (379 Vs 323). The higher incidence is found among the age group of 70-74 years. In male the top leading cancer site is Population based cancer registry lungs followed by lip and oral cavity. In females, breast followed by lungs, cervix uteri. The prevalence of Sickle Cell disorder is There is need of counselling to unmarried found 11.3% among 1 to 29 years Tharu people for their marriage to avoid Sickle of population (Sickle cell trait 10.7% and cell in their future generation district Bardiya Bardiya Sickle Cell disorder in Municipalit Sickle cell diseases 0.7%) Most of the government institution Create national level information of T&CM in Nepal were Ayurvedic Centres different types of T&CM practices that can Acupuncture was commonly practiced in in Nepal be available to the public would be useful combination with Ayurveda or in bringing all traditional system under Naturopathy as an adjuvant therapy in most centres. single umbrella where they could be T&CM were commonly practiced by recognized, regulated and connected with qualified and registered doctors in their each other to deliver better impact on respective system. There were also population health in Nepal. practices done by the registered There is a need to develop conceptual assistants with diploma or certificate models or frameworks for each system, degrees. create definite regulations policies, planning, and building network infrastructure required for the overall developments of all the existing T&CM in Nepal. Further, there is a growing demand for complementary medicine with the expanding morbidity and mortality of Non- Communicable Diseases. Many patients seek complementary medicine along with the conventional medicine for the treatment of Non-Communicable Diseases. In this scenario research on identifying the main scientific, policy, and practice issues related to CAM research and explores and translates of validated therapies into conventional medical practice to reduce burden of Disease due to Chronic Non- Mapping the availability of Ayurveda and other complementary medicineservice centres Communicable disease is very crucial DoHS, Annual Report 2075/76 (2018/19) g g am High prevalence of non-communicable Effective health promotion and chronic High prevalence of non-communicable Effective health promotion and chronic diseasesdiseases (COPD:(COPD: 11.7%,11.7%, Diabetes:Diabetes: 8.5%, 8.5%, diseasedisease prevention prevention program program CKD: 6.0% and CAD: 2.9%). CKD: 6.0% and CAD: 2.9%). EffectiveEffective rehabilitation rehabilitation programs programs to tolessen lessen MostMost ofof thethe behavioralbehavioral and and biological biological risk risk thethe effecteffect for for those those who who are are already already factors were more prevalent among men alcohol dependent and effective awareness factors were more prevalent among men alcohol dependent and effective awareness thanthan women.women. OtherOther factorsfactors such such as as high high andand prevention prevention programs programs should should be be started started LDLLDL cholesterol,cholesterol, lowlow HDLHDL cholesterocholesterol, l, andand strengthened strengthened to to advocate advocate the the risks risks overweight,overweight, obesity,obesity, waistwaist-hip-hip ratio ratio and and associatedassociated abdominalabdominal obesityobesity werewere notednoted highhigh BPBP screening screening programs programs should should be be deployed deployed disease in Nepal especially among females. in larger numbers catering to a greater disease in Nepal especially among females. in larger numbers catering to a greater coverage.coverage. SpecialSpecial interventions interventions need need to tobe be designed designed forfor women women to to help help counter counter issues issues related related Population basedstudy on selected chronic Population basedstudy on selected chronic toto body body mass mass which which have have long long term term health health implications.implications. Out of 244 batches of 20 generic Out of 244 batches of 20 generic TemperatureTemperature and and humidity humidity records records collected,collected, 3737 batchesbatches werewere foundfound exceededexceeded the the recommended recommended range range in in Nepal substandard.substandard. bothboth healthhealth facilities facilities and and Regional Regional OutOut ofof identifiedidentified substandardsubstandard MedicalMedical Stores. Stores. medicines,medicines, 2323 (62.16%)(62.16%) batchesbatches ofof ThereThere should should be be provision provision to toassess assess medicinesmedicines werewere suppliedsupplied byby thethe qualityquality ofof essentialessential medicines medicines GovernmentGovernment ofof NepalNepal andand 1414 suppliedsupplied in in health health facilities. facilities. (37.83%)(37.83%) batchesbatches ofof medicinemedicine StringentStringent rules rules and and regulations regulations should should samples were purchased from local samples were purchased from local bebe made made along along with with their their effective effective resources resources implementationimplementation toto preventprevent Among 62 health facilities, only 13% Among 62 health facilities, only 13% substandard/counterfeitsubstandard/counterfeit medicinesmedicines were found to follow the medicine were found to follow the medicine fromfrom enteringentering intointo pharmaceutical pharmaceutical storage guidelines storage guidelines supply chain. supply chain. AllAll thethe infrastructures infrastructures required required for for storagestorage ofof medicinesmedicines shouldshould bebe establishedestablished andand maintainedmaintained in inall all Regional medical stores and health Regional medical stores and health facilities. facilities. DDA should strengthen its resources DDA should strengthen its resources to ensure quality of medicines that to ensure quality of medicines that are widely being used in are widely being used in Quality ofQuality essential medicines in public facilitieshealth care of pharmaceutical market of Nepal. Quality ofQuality essential medicines in public health facilities care ofNepal pharmaceutical market of Nepal. NHRC has plan to conduct the following studies in the coming months of FY 2019/20: mm it a t a t mm i a i a i a t Ba i i i mm it a t a t mm i a i a i a t i i a ta a am i t i t i g t tat t a a t a gi a ag m t am g a t gi i DoHS, Annual Report 2075/76 (2018/19) g g am a a Ba a gi t i a a a ta a t a i i a ia gi t B i a B t i a m t i a i i mm m it a g ta a t i a t i i at ma a m t i a i i mm m it a g ta a t i a t i i at ma a m t im a t ai ma a t i t a a a a i g t imat a g a t m a i t i t i a i a NHRC has provided ethical approval for the following major studies in FY 2018/19 a mi i m t i i t i t a a t a iat it i i g t a ia a t it m am g t i t Bag g i i a it i g a i t a i i it a a ai a i it a i am g g m i a a a t a a i iag i a t atm t t a at a i t ita a 8.9.4 Policy / Technical Briefs it t t a a g t i i t a i i a i g i g a ata i g i a a i a i a t a a t i ma ag m t i i g i i i ami a i g ga i a a a a it a m t a it i a i a i im m i ta a a t a i i a i i t g t a m i t i t i i i at m i g a it a t ma ag m t i ma t m t g a ata a it a m t t i a i g a it a g i a t i i a t a ag m t ma t m ata t ta a t i ma ma ag m t a i t t t g a i i t at gi a a i t i i 8.9.5 Health sector reviews with functional linkages with the planning processes Ba t a t a a t a a g i i a t t a t t i at a t g m t a t ta a i t i at t a a i ia a i t i at t a a it t a i a a i g g i i a t a i t i t a a t g t it g i i a i t m ta t t ta a i t i t a i a i g m t a a i i g i t t a i a a i g 8.9.6 Challenges imit a ai a i it a it ata t m t t a t t ata at a i a DoHS, Annual Report 2075/76 (2018/19) g g am a imit i a i i ma i g at a imit i t g at i ma ma ag m t agi g t at a t tai t g a a a i m t t a t t 8.9.7 Way Forward m ia m g m a t a i i m t a i igi i g gi t t a i itat m g im i g ata a it a ata at t i t ata g a ta a i t i ta a ag i t ai i g t i t a t a a t i a i a a a t i i a g i i it ta t a i itat ta a i a a i t a i it it t a a ata a igi a i t g at a ma a ag m t t m it t a a ata a a a ia ata a t a i i at im m ta t g i i a t t i a t t m m ta a t a i it gi t at a a a a i t t a ta a ata it ta a i t gt a i t a i a t i i a at a t a i a g a i i g a a a t a t DoHS, Annual Report 2075/76 (2018/19) 9 a t i 9.1 Ne al Nursing Council HEALTH COUNCILS Chapter Chapter 9 Chapter 9.1 Nepal Nursing Council 9.1.1 ntroduction Nepal9.1.1 Nursing Introduction Council (NNC) is established under Nepal Nursing Council Act 2052 (1996). It came into force on 2053-03-02 (16 June 1996). NNC is an autonomous body formed to maintain quality nursing a i g i i ta i a i g i t t am and i t i a a t m m t mai tai a it midwifery education for the provision of quality nursing and midwifery services to the public. i g a mi i a t i i a it i g a mi i i t t 9.1.2 i T e ain functions of t e council are: Register the nurse and midwife through licensing examination and manage the registration of 9.1.2qualified The main nursing/midwiferyfunctions of the council professionals. are: Formulate policy required to operate the nursing and midwifery profession smoothly and to gi t t a mi i t g i i g ami a a ma ag t gi t a a i i g mi i i a provide better care to the public. m at i i t at t i g a mi i i m t a t Inspect, monitor and recognition to nursing and midwifery academic institutions and monitor i a t t i the quality of nursing and midwifery services for better nursing care. t m it a g i t i g a mi i a a mi i t a m it Maintain the standardization in nursing and midwifery education through evaluating and t a it i g a mi i i i g a reviewing the nursing and midwifery curriculum, the terms and conditions of admission and ai tai t ta a i a i i g a mi i a t g a a g a i i g t i g a mi i i m t t m a i a mi i a examination systems. ami a t m Formulate professional code of conduct of the nursing and midwifery professionals and to take m at i a t t i g a mi i i a a t ta action against those professionals who violate such code of conduct. a agai t t i a i at t Develop the scope of practice for nursing and midwifery professionals to determine the work t a i g a mi i i a t t mi t limit of nursing and midwifery professionals. imit i g a mi i i a i t a a a t a i g i Publish the annual Journal of the Nepal Nursing Council. As of t i g a mi i i g i a am g i g June 2019 there were 277 nursing and 3 midwifery courses running in Nepal among nursing college g i i g B i g Ba i i g ma t , Proficiency level nursing 121, B. Sc. nursing 50, Bachelor in nursing 45, master level 12 and 49 Auxiliarya i ia mi i nurse-midwife (ANM) . TableTable 9.1: 9.1: Nursing Nursing and and Midwifery Midwifery education education programs rogra s .N. Nursing education rogra s Nu ber 1 Auxiliary nurse Midwife (ANM) 49 2 Proficiency certificate level (PCL) 121 3 B.Sc. nursing 50 4 Bachelor in nursing science (BNS) 45 5 Master in nursing (MN/MSC) 12 Total 277 1 Bachelor in midwifery 3 DoHS, Annual Report 2075/76 (2018/19) a t i The a gi t a i a a ig NNC had registered 88,675 Nepali nurses (PCL 55,534 and 33,141 ANM) and 843 foreign nurses till 2019 June. TableTable 9.2: 9.2: Categories Categories ofof registered Nurses Nurses SN Categories of nurses Number 1 Nurses 55,534 2 ANM 33,141 Total 88,675 1 Foreign nurses 843 9.1.3.9.1.3. Major Major activities activities carried carried out out byby NNCNNC in in fiscal fiscal year year 2075/76 2075/76 • Completed “midwifery educators’ training” for two batch 14 participants in each batch with m t mi i at t ai i g t at a i a t i a at it help of UNFPA and GIZ. a • Develop the code of conduct for nurses and midwives. t t a mi i • Started specialized online registration for master level of nursing. ta t ia i i gi t a ma t i g Expansion of bachelor level of midwifery education. a i a mi i a • Initiation bachelor level nursing education (oncology major subject). i a a i g a g ma t • i m mi i a a • Approved curriculum for PCl midwifery prepared by CTEVT and MoHP. i g t t i t a a i i g ami a i g g a at • During the 2076 the council held three national licensing examinations for nursing a t a a t a i g a t m a t m m t graduates. i t i t t a a ita m it i g a i i it a m t t t • Prepared the proposed draft of NNC act according federal system and sent for Amendment. a a • Revised the different tools such as accreditation, monitoring, feasibility, self assessment to t a mi i the all level of education. i g a mi i g a • Developed the scope of practice for midwife. • Developed of nursing and midwife regulation. 9.1.49.1.4 Ways Ways forward forward a a Preparation t for gi t a the Registration a i and ami a license examination a of bachelor mi i level a midwives and a g i i i i g am prepares guideline for licensing exams. i Revised mi im m minimum i m t requirements i t for different i g level of nursing course a i such as proficiency at i g a i i g ma t i g certificate level of nursing, bachelor in nursing, masters of nursing. m m t a t a m t g a mi i a a a a i g t t a Amendment of NNC act as per. m a i a Development of rules regulations of midwifery education and practice according to the ai tai t i a t at i ma i gi t federal democratic republic of Nepal. m t t a i t Maintain the online and up to date information of previously registered nurses a at t i i g t m a a i g g am Development the scope of practice for different level of nurse. Separate the licensing system for PCL and bachelor level nursing program. DoHS, Annual Report 2075/76 (2018/19) a t i 9.2 Nepal Ayurvedic Medical Council 9.2.1 Introduction a i i a i i t a t m t g at a t i m i i i a t a ta i t a i a i t i i t g at a gi a i ma i t a a t a i a a i a a a a a a i t a t gi t it t i i a a t i i t a mi im m i m t i a a i t i mai mmi i t a i t mi at t g m t a ai t t mi at t g m t t i t t t t gi t t am i mi at t g m t a gi t a mi at t g m t i gi t igi a i a ig a t t a a m i i i a i i a gi t it t i a at a m it i t i ig t gi t t ta i i at i i i a mai a t i a i t 9.2.2 Functions and objectives of the council a g t m t i i a t atm t t t m i m i i t mi t a i a t a t gi t t m i t g m t t a a i t i i m i i gg t t t g m t ma i g a a gi g a a g i a iat a a a i t i a t mi t i m t m a mi i a ami a t m i i a a i a t t a a i t g i t a a a i a g a t a m m i i a g a a am i a a t i t a t m it it im m ta 9.2.3 The number of registered members, institutions and courses are given below: MD & Bachelor Level Programme i a i it a am i it it i a a g a t a a a a iat a a i a g Bi g a a iat B a a it i it i a a i a t Bi a i a g ata a i a i a g a t i a iat B Certificate Level Programme (AHA) a ta i a a t Bi a i a g a a ta i ig a a a t a Ba a at ma iat ima a a a g Ba at ma iat DoHS, Annual Report 2075/76 (2018/19) a t i Under CTEVT, Ayurveda Health Worker (AAHW) ai a a a a it i a t t i a i a g aga am a i a t t a i a a ta i t t a t i aig at a a i i a t t a a am a a a a i a ai i g t a a a a a a t t i g B a at it a Ba i a i a t t a i a Ba i a t t mm it i i ta t a ga i ai a i Dadeldhura a a a am i a am a a Paramedical Campus, Dadeldhura. it a g a a White a t i a a i i i a a a t Park College, Dadeldhura. Rastriya i ga a a a a m a a aig at Prabidhik Sikhsalaya, Surkhet. Triyuga am i a t t am National Education Academy, Udayapur, Gaighat. Ilam Baga am i i a t t ta a i Technical Institute, Ilam. Bagalamukhi Technical Institute, Itahari. a i i a i a t i i B Ba a (NAMC- Nepal Ayurvedic Medical Council , MD - Master of Medicine, BAMMS- Bachelor of Ayurveda & i i g B Ba a i i g Modern a t i ta t i ia a a t Medicine & Surgery , BAMS- Bachelor of Ayurveda Medicine & Surgery, AHA- Ayurved Health Assistant; AAHW- Auxiliary Ayurveda Health Worker) 9.2.4 Statistics of registration persons (up to date 2075/12/26) 9.2.4 Statistics of registration persons (up to date 2075/12/26) SN Subject Number 1 MD/MS/PG 97 2 BAMS/equivalent 708 3 Ayurveda B. Pharmacy 5 4 AHA/Equivalent 1,515 5 AAHW /TSLC 2,272 6 Traditional healers 19 7 Academic institutions 22 8 Foreigner practitioners 4 Source: NAMC DoHS, Annual Report 2075/76 (2018/19) a t i 9.3 Nepal Health Research Council 9.3.1 Introduction a a t a i i t a a a i a m g a t a a t t a ta i i a t a iam t a a gi t i i it t m t a i at a t a im m t t a t tat a ma i a g a i g a t a a i i t i a a a a a it i i g a a i t i t a a a t a a i a t mai a a i t i Dadeldhura Paramedical Campus, Dadeldhura. t i a a t i a i a mi i i i a a t a a a White Park College, Dadeldhura. a t i a i i a iat i t i a i B a B a t a it g a g i a i t a Rastriya Prabidhik Sikhsalaya, Surkhet. it a a a t i a ig i g it t a a a t i i a a it i i g Triyuga National Education Academy, Udayapur, Gaighat. m a i i g a ga i i g t ai i g a i a t a t Ilam Technical Institute, Ilam. t m a t a a i t it ia m a i m g t a m t Bagalamukhi Technical Institute, Itahari. g a a i i g a t a g a t t t a i t (NAMC- Nepal Ayurvedic Medical Council , MD - Master of Medicine, BAMMS- Bachelor of Ayurveda & a t a a i t g t t t a t a i mi a g am t a i itat ta a i g t i ma i t a t Modern Medicine & Surgery , BAMS- Bachelor of Ayurveda Medicine & Surgery, AHA- Ayurved Health t m i i a a imi a a i itat a t a i g m i t Assistant; AAHW- Auxiliary Ayurveda Health Worker) a t a maga i t t g t i a igita ata a a t a 9.2.4 Statistics of registration persons (up to date 2075/12/26) SN Subject Number 9.3.2 Major Activities in the fiscal year 2075/76 1 MD/MS/PG 97 9.3.2.1 Research Project/Activities 2 BAMS/equivalent 708 3 Ayurveda B. Pharmacy 5 a a t a i t i t a a i it t m t 4 AHA/Equivalent 1,515 a a t ag i i a t a a a a i t i g t 5 AAHW /TSLC 2,272 a i t 6 Traditional healers 19 7 Academic institutions 22 a Ba a t mm i a i a i a a Ba a gi t a 8 Foreigner practitioners 4 a Ba i g i i i a mm it Ba i a i t i t Source: NAMC a a ta a t a i a i m t i i at mm i a i a i a t a a it a i i i i a t a a i i a Bi ia i t t a g a ima g a i t i a a i a t a t i g a g t a t i i i i a a ita i a i g t t i a g a a i i i i i t g a g t m m ta a t a i i i a ta i i g a i i a ia gi t i i g i a i a t m i a m imat a g a i g a a it i Ba g ammi g a t i g t ia t mi a t t a a t t i i a m t i a i i it a g ta t a m t i a a t i a t i DoHS, Annual Report 2075/76 (2018/19) a t i mm it Ba t a t mm i a i m m ta t t m gi a a a it B i i g t a t B i a i a 9.3.2.2 Publication i a m t i g t a t a a a a t m t i i a a a a t a i i t mma i ma i a t i g t t a a ai a i g t a a a a ima B a B a a a t i t t a a m ta a t a at ma a a t a i t im t a Ba a gi t i a at ma a a t a i a i ima a a a a t i i a i g t m i i i i t i t ita a a t a i ima a i B a a a a a im i a aB Bi ta B a a Ba a t i a g i Ba i i a i g at ma a a t a i a i a t at ma a a t a i t a t B i a a mmit a t a a i t i a at ma a a t a i a a t a i i i t a t a a a it i g a a a a a a a B i a t t a t a B i a t at ma a a a a a t a i m m a a a t a i m m a a a t a i m m a a a t a i m m 9.3.2.3 Training and Workshop t t ai i g t i t t i i t a t a a t g t t ai i g a t a a m t i a a i t ai i g ata a ag m t a a a i a a a imi a t ai i g i i g a a ga i i i i g ta t ai i i t ga i i i a a 9.3.2.4 Fifth National Summit i a a mmit a t a a i t i a i t t m a it a m t i t a t t mmit a t t a a a t i it a a a B i t i it a a t i mmit a i gi g i i at a t i i a t a m a igita a t a ig ata m a i a a m t a t a a i t a a a ig i a t t i t g at i i i t i a i ig t i t t a it a i t t it i t t t a gi g a t t m i i a t a i g t a ai a i m imm i DoHS, Annual Report 2075/76 (2018/19) a t i i g a m g t a ga i i g a tai a a t t m at t a i ia a t a g m t 9.3.2.5 Ethical Clearance of Research Proposals t i a i B a B i a t a a t i a a a i t t i B m g t i t i a a a t mi a i t ta a a g t t i a a a i a t a a it a i a t i i i g a it a a t i m it am g a a a a g it m it i g a t imi a a t a a i a a mi t i a i i a i tag i a a a t i a i i a t a i a a a 9.3.2.6 Institutional Review Committees (IRCs) a ta i t a t a a a t t t m t a t a at i t a ia i m i a g a t i i i a g a t am i t t t a i mmi a i g t t m it i g a a ta t i gi t a m a t a a 9.3.2.7 Knowledge Management g a ag m t t t aim t a i itat t a a a i i t a t i a a g a ag m t a i t i g t a a a t a i it a a a t a a a i a a t t g ig a i i t a a m t t a t t t at gi g a a a g a t at gi a t a i i a a t a t a i i a i t t i t a t a a a i a a i t g ta m g a a t m g a a t t i ma m g t a i a t a i m t a t a tm t i i i t a ita it i t i i g i t a t ta a a ta m a i ita a i i i t mat t i g a a a m t a a i t a Priority Health Research Areas 2019 a t t m a mm i a i a mm i a i a a i a t at a a a t ta a t a ta a i i t a i t i a a t i m ta a a a a t a a t a i i iat i a t i a a t a t DoHS, Annual Report 2075/76 (2018/19) a t i 9.3.2 Financing Research 9.3.2 Financing Research Figure 1: Total Research Budget of NHRC between 2063/64 to 2075/76 (NPR in Million) Figure 1: Total Research Budget of NHRC between 2063/64 to 2075/76 (NPR in Million) 120 114 100 110.46 80 60 55.1 56 40 37 41 27.5 Budget(NRS. inmillions) 23.98 23.128 20 19 20 17.73 11 0 The above figure illustrates the total research budget of NHRC between 2063/64 to 2075/76. The a g i t at t t ta a g t t t Government of Nepal (GoN) covered the major source of research budget. In addition to this, External m t a t ma a g t a i t t i Development t a m t a t a t im a g t a i Partners are other imperative sources of budget for research in NHRC. 9.3.4 National Dissemination Workshops NHRC9.3.4 Nationalorganized nationalDissemination dissemination Workshops workshop of the published studies on 08 April 2019 at NHRC training hall Kathmandu. There were more than 70 participants from Ministry of Health and Population, Government ga i Departments, a a i mi a Non-Government Organizations, t i Academic t i Institutions i and individual at researchers. t ai i g a at ma m t a a i a t m i i t a t a The program was held in the presence of Chief Guest Honorable Deputy Prime Minister and Minister a m t a tm t m t ga i a a mi t a of Health and Population Mr. Upendra Yadav. The purpose of the dissemination workshop was toi i i a a g am a i t i t a t inform policymakers, researchers and community with the evidence obtained from the studies conducted im i i t by NHRC. a Ten i i t research reports a t were a a produced and a distributed to a a the participants. t i mi a a t i m i ma a a mm it it t i tai m t t i t a t a i t i t t t a i a t DoHS, Annual Report 2075/76 (2018/19) a t i a i a i t a i a i i a g at ga i a ta i a t a iam t t t at m i m m i m t t t a m t t a t a a t t i i g ta a i t t ai i g a a m m i i gi t i g t a g at t i a a i g t at i i i a i a a a ai a ia a i g at a i i i a i i mm it a a t a m i i t t it m 9.4 Nepal Medical Council 9.4.2 Progress of Nepal Medical Council: 9.4.1 Introduction Nepal9.4.2.1 Medical Licensing Council Examination (NMC) is a regulatory organization established by an Act of Parliament (NMC Act 2020) that comprises 19 members. NMC is empowered to protect and promote the health and safety of the public a by i a ensuring i proper standards t in i i g the training ami a and practice of modern g a at medicine, registering BB doctors B and a regulate their practice and ensuring that individual professionals have a fair and unbiased hearing at any ia ami a tg a at m t t a t disciplinary inquiry. The community and patients occupy a supreme position in the conduct of its multiple duties.m i a a ta a 9.4.29.4.2.2 Progress Registration of Nepal StatusMedical Council: 9.4.2.1 Licensing Examination Nepal Medical Council conducts Licensing Examination for undergraduates (MBBS & BDS) and Special ma a i a i i t gi t a mai tai a i Examination for postgraduates (MD, MS & MDS) every four months round the year to certify medical m i a ta and dental practitioners. a a gi t t a g a at i BB i ma m a a a 9.4.2.2 Registration Status The major function of Nepal Medical Council is to register and maintain proper archives of 9.4.2.2.1medical/dental National practitioners Doctors as NMC Registered doctors, who have duly graduated in MBBS/ Diploma from Nepal or abroad. ata gi t a a t B i a i a i a 9.4.2.2 .1 National Doctors The data of registered national doctors till 2076 B.S. (2019 A.D.) in Nepal Medical Council were as follows: UNDERGRADUATE POSTGRADUATE Program Number of Number of Total Program Number of Number of Total Male Female Number Male Female Number MBBS 15,485 7,661 23,146 MD/MS 5,530 2,228 7,758 BDS 1,118 2,082 3,200 Total 16,603 9,743 26,346 Source: NMC 9.4.2.2.2 Foreign National Doctors (FND) 9.4.2.2.2The provision Foreign ofNational temporary Doctors registration (FND) to foreign doctors is on the basis of recommendation of Government of Nepal, Medical Colleges or organizations related with healthcare and their academic qualification. i i In t m a fiscal year 2075/76, gi t a total number t ig of 185 t foreign i doctors t has a i been registered mm a at Nepal Medical Council to provide health services in various parts of the country. m t a i a g ga i a at it a t a a t i 9.4.2.2a a mi .3 Eligibility a i a Certificate Issuance a a t ta m ig t a gi t at a i a i t i a t i i a i a t t t Eligibility Certificates were provided as per the NMC regulations to those who possess minimum qualification to pursue Medical Degree/ Diploma from abroad. NMC has granted Eligibility Certificates as 9.4.2.2.3below Eligibilitymentioned Certificate data: Issuance SN Country UG Eligibility PG Eligibility SN Country UG PG Eligibility Eligibility igi i it at i a t g a t t mi im m 1 Australia 1 2 9 Pakistan 10 37 a i a 2 Bangladesh t i a 361 g 9 i ma m 10 a a Philippines a 60 g a t igi i it 2 at a m ata 3 China 75 45 11 Russia 7 0 4 Egypt 0 5 12 Thailand 0 1 5 Germany 2 1 13 Ukraine 2 2 6 India 35 65 14 UK 1 1 DoHS, Annual Report 2075/76 (2018/19) 7 Japan 0 4 15 USA 1 66 8 Kyrgyz 2 0 Total 557 240 Source: NMC 9.4 Nepal Medical Council 9.4.1 Introduction Nepal Medical Council (NMC) is a regulatory organization established by an Act of Parliament (NMC Act 2020) that comprises 19 members. NMC is empowered to protect and promote the health and safety of the public by ensuring proper standards in the training and practice of modern medicine, registering doctors and regulate their practice and ensuring that individual professionals have a fair and unbiased hearing at any disciplinary inquiry. The community and patients occupy a supreme position in the conduct of its multiple duties. 9.4.2 Progress of Nepal Medical Council: 9.4.2.1 Licensing Examination Nepal Medical Council conducts Licensing Examination for undergraduates (MBBS & BDS) and Special Examination for postgraduates (MD, MS & MDS) every four months round the year to certify medical and dental practitioners. 9.4.2.2 Registration Status The major function of Nepal Medical Council is to register and maintain proper archives of medical/dental practitioners as NMC Registered doctors, who have duly graduated in MBBS/ Diploma from Nepal or abroad. 9.4.2.2.1 National Doctors The data of registered national doctors till 2076 B.S. (2019 A.D.) in Nepal Medical Council were as follows: UNDERGRADUATE POSTGRADUATE Program Number of Number of Total Program Number of Number of Total Male Female Number Male Female Number MBBS 15,485 7,661 23,146 MD/MS 5,530 2,228 7,758 BDS 1,118 2,082 3,200 Total 16,603 9,743 26,346 Source: NMC 9.4.2.2.2 Foreign National Doctors (FND) The provision of temporary registration to foreign doctors is on the basis of recommendation of Government of Nepal, Medical Colleges or organizations related with healthcare and their academic qualification. In fiscal year 2075/76, total number of 185 foreign doctors has been registered at Nepal Medical Council to provide health services in various parts of the country. 9.4.2.2.3 Eligibility Certificate Issuance Eligibility Certificates were provided as per the NMC regulations to those who possess minimum qualification a t i to pursue Medical Degree/ Diploma from abroad. NMC has granted Eligibility Certificates as below mentioned data: SN Country UG Eligibility PG Eligibility SN Country UG PG Eligibility Eligibility 1 Australia 1 2 9 Pakistan 10 37 2 Bangladesh 361 9 10 Philippines 60 2 3 China 75 45 11 Russia 7 0 4 Egypt 0 5 12 Thailand 0 1 5 Germany 2 1 13 Ukraine 2 2 6 India 35 65 14 UK 1 1 7 Japan 0 4 15 USA 1 66 8 Kyrgyz 2 0 Total 557 240 Source: NMC 9.4.2.2.4 Ethical Cases a i a i a a i g ia i i g t a i g g i i a t at it m i a a ta i t mai tai 9.4.2.2.49.4.2.2.4 ta a t i a t i t i i a t a a Ethical Ethical Cases Cases NepalNepalim m t MedicalMedical CouncilCouncil hashas beenbeen playingplaying crucialcrucial rolerole inin enforcingenforcing codecode ofof conductconduct andand developingdeveloping guidelinesguidelines andand protocolsprotocols relatedrelated withwith medicalmedical andand dentaldental professions.professions. InIn orderorder toto maintainmaintain standardstandard ofof conductconduct ga g inin healthhealth m ai t services,services, gi t CodeCode ofof EthicsEthics agai t && t ProfessionalProfessional m i a ConductConduct i 20172017 t waswas developeddeveloped a i i andand implemented.implemented. a g a t mm i g i ga a i a a InvestigatingInvestigating i i complaints,complaints, a t registeredregistered againstagainst a i thethe medicalmedical t services/services/ doctorsdoctors a andand i a provisionprovision i ofof enactingenacting penaltypenalty m ai t agai t t mi t at it m i a i a a g i oror recommendingrecommending concernedconcerned bodiesbodies forfor legallegal actionsactions inin casecase ofof anyany disobedience/disobedience/ fraudulentfraudulent found,found, i g alsoalso lieslies underunder thethe spheresphere ofof NepalNepal MedicalMedical Council.Council. TheThe complaintscomplaints filedfiled againstagainst thethe misconductmisconduct relatedrelated with with medical medical profession profession have have been been operating operating in in following following procedure: procedure: No.No. of of complaints complaints ProcessedProcessed & & finalized finalized WithheldWithheld UnderUnder process process 5151 2727 1212 1212 Source:Source: NMC NMC 9.4.2.2.59.4.2.2.59.4.2.2.5 Accreditation Accreditation Accreditation Standards: Standards: Standards: FollowingFollowing accreditation accreditation standards standards has has been been formulated formulated and and being being implemented: implemented: FollowingAccreditationAccreditation accreditation Standards Standards standards for for MBBS MBBS (Bachelor (Bachelorhas been ininformulated Medicine Medicine & & andBachelor Bachelor being in inimplemented: Surgery) Surgery) - - 2017 2017 AccreditationAccreditation Standards Standards for for Bachelor Bachelor of of Dental Dental Surgery Surgery (BDS) (BDS) – – 2 2017017 RegulationsRegulations ita ta a BB Ba i i i Ba i g for for Postgraduate Postgraduate Medical Medical Education Education (MD/ (MD/ MS) MS) - - 2017 2017 RegulationsRegulations ita ta a Ba ta g B for for Postgraduate Postgraduate Dental Dental Education Education (MDS (MDS Program) Program) – – 2017 2017 RegulationsRegulations for for Subspecialty Subspecialty Postgraduate Postgraduate Medical Medical Education Education (DM, (DM, MCh) MCh) – – 2017 2017 g a tg a at i a a 9.4.2.2.69.4.2.2.6 g a tg a at ta a g am Continuing Continuing Professional Professional Development Development (CPD): (CPD): NepalNepal g a ia t tg a at i a a MedicalMedical CouncilCouncil hashas beenbeen emphasizingemphasizing onon upgradingupgrading medicalmedical educationeducation andand skillsskills ofof NMCNMC registeredregistered doctorsdoctors andand makingmaking strategicstrategic plansplans forfor itsits implementation,implementation, therefore,therefore, NMCNMC successfullysuccessfully 9.4.2.2.6conductedconducted Continuing andand completedcompleted Professional firstfirst phasephase Development ofof TrainingTraining (CPD): ofof TrainersTrainers (TOT)(TOT) programprogram toto produceproduce competentcompetent HumanHuman ResourcesResources forfor thethe effectiveeffective implementationimplementation ofof ContinuingContinuing ProfessionalProfessional DevelopmentDevelopment (CPD)(CPD) programprogram a i a i a m a i i g g a i g m i a a a i and and has has planned planned to to conduct conduct TOT TOT programs programs in in every every Provinces Provinces of of the the country. country. gi t t a ma i g t at gi a it im m ta t InIn orderorder toto pilotpilot t thethe CPDCPD a program,program, m t NepalNepal Medical t Medical a CouncilCouncil ai i g havehave startedstarted ai accreditingaccrediting CPDCPD g am activitiesactivities t conductedconducted byby differentdifferent organizationorganization andand grantinggranting creditcredit pointspoints toto participantsparticipants ofof suchsuch accreditedaccredited m t t ma t im m ta i g programs.programs. i a m t g am a a a t t g am i CouncilCouncil i t t hashas developeddeveloped andand launchedlaunched softwaresoftware toto enrollenroll differentdifferent organizationsorganizations andand NMCNMC registeredregistered doctorsdoctors in in the the online online system system and and make make CPD CPD accreditation accreditation system system accessible accessible in in the the country. country. 9.4.2.2.79.4.2.2.7 e ision e ision of of irecti es: irecti es: DoHS, Annual Report 2075/76 (2018/19) TheThe provisionsprovisions mentionedmentioned underunder ClauseClause No.No. 1414 ofof AccreditationAccreditation StandardsStandards forfor MBBSMBBS ProgramProgram 20172017 andand ClauseClause No.No. 1313 ofof AccreditationAccreditation StandardsStandards forfor thethe BDSBDS ProgramProgram hashas beenbeen amendedamended asas 'candidates'candidates enrolledenrolled asas medicalmedical graduatesgraduates andand havehave completedcompleted sixsix monthsmonths ofof theirtheir mandatorymandatory internshipinternship from from Nepal Nepal as as well well as as from from abroad abroad both both can can appear appear in in the the licensing licensing examination. examination. TheThe councilcouncil hashas fixedfixed thethe ageage ofof thethe facultiesfaculties teachingteaching clinical,clinical, dentaldental andand basicbasic sciences.sciences. TheThe maximummaximum ageage limitlimit forfor clinicalclinical subjectssubjects isis 7373 yearsyears andand thethe maximummaximum ageage limitlimit forfor dentaldental andand basicbasic sciencescience is is 75 75 years years NMCNMC hashas revisedrevised itsits serviceservice feesfees withwith thethe approvalapproval fromfrom MinistryMinistry ofof HealthHealth && PopulationPopulation andand isis inin implementation.implementation. a t i t i t t g am a i a i a ta t a i g a i t i t ga i a a g a g it i t t a i a t a it g am i a a a a t i t ga i a a gi t t i t i t m a ma a ita t m a i i t t 9.4.2.2.7 Revision of Directives: i i m a ita ta a BB g am a a ita ta a t B g am a am a a i at a m i a g a at a a m t i m t t i ma at i t i m a a a m a a t a a a i t i i g ami a i a t ag t a t a i g i i a ta a a i i ma im m ag imit i i a t i a a t ma im m ag imit ta a a i i i a a i it i it t a a m i i t a t a a i i im m ta 9.4.2.2.7 Recent Activities: it a ma g t m i a i i i i t m a i ta it a a iat a a a i a i a tai m m i t a a ia i a g at t i i a i t i i a a t it ta a i g a a g am a i a i a i a g it m t a a mi i i g a t ta t it i i i DoHS, Annual Report 2075/76 (2018/19) a t i 9.5 Nepal Health Professional Council 9.5.1 Introduction a a t i a i a a ta i t ma m t 9.5 Nepal Health Professional Council a t i i a t m i i t i a t i a t t a i t a t gi t it t i a i i a ma ag a i ma a ma 9.5.1 i i t gi t a t i am a i g t t i a i a a i g t a Introduction Nepal Health Professional Council (NHPC), Nepal has been established to make more effective the health services in a t i a i t t m t a a i a t Nepal, to mobilize the services of health professionals except the qualified doctors and nurses to be registered with t a iam t i t t t a ig i a t i g Bi a Bi Bi am a the Medical Council in a managed and scientific manner and make provisions on the registration of their names according to their qualifications, according to “Nepal Health Professional Council Act 2053” by the Government of Nepal i g t a t t a t mm m t t i t and is enacted on 2053/11/3 by the Parliament in the twenty fifth year of reign of His Majesty King Birendra Bir t t a a gi t a t i a a t t a t a t Bikram Shah Dev. i i t i i t a a t i a a t t gi t i Accordingt i a it a a i g t t a a t i a to article 20 of the Act, “After one year of the commencement of this Act, no person other than a i g a registered health professional shall be entitled to carry on the health profession, directly or indirectly”. Therefore all health professionals are requested to register in the Council and renew it on every five years according9.5.2 Functions, to the rule duties36 of “Nepal and Healthpowers Professional of Council Council” regulation. 9.5.2 i g t t a t t Functions, duties and powers of Council According to the article 4(1) of the Act i ta i a t t a a i t t m m a The Council established pursuant to article 3 shall consist of the members as follows: A person nominated by the Government of Nepal from amongst the persons - Chairperson who, having obtained at least bachelor degree in a subject related with health profession, have been involved in the health service for at least five years Chairperson of Paramedicals' Association of Nepal (PAN) or a representative - Member designated by him/her Chairperson of Nepal Pharmaceuticals Association or a representative designated - Member by him/her Chairperson of Nepal Radiological Society or a representative designated by - Member him/her Three registered health professionals nominated by the Government of Nepal - Member from the pathology, physiotherapy and public health, on recommendation of the Paramedicals' Association of Nepal (PAN) . Four health professionals elected by the registered health professionals from - Member amongst themselves, as prescribed Dean of the Institute of Medicine or a representative designated by him/her - Member Representative, Nepal Medical Council - Member All together there will be 13 council t g t t i i According to the article 9 of the Act, the functions, duties and powers of the Council shall be as follows: AccordingTo make to the necessary article policies 9 of the for smoothlyAct, the functions, operating the duties health professionand powers related of the activities. Council shall be as To determine the curriculum, terms of admission and policies on examination system of educational follows: institutions imparting teaching and learning on health profession and evaluate and review the related matters. ma a i i m t a g t a t i at a i To determine the qualifications of health professionals and to provide for the registration of the names of health t mi professionals t i m having required t m qualifications. a mi i a i i ami a t m a a i t im a g t a i g a a i g a t i a a at a 9.5.3 Registration i t at ma levels and its qualification requirements According t mi t a i a a t i a a t i t gi t a t the qualification of health professionals, the NHPC will register into respective groups. am a t i a a i g i a i a The health professional with Master degree will be registered into “Specialization” category of the related subject. The health professional with Bachelor degree will be registered into “First Class” (A) category of the related subject. DoHS, Annual Report 2075/76 (2018/19) The health professional with proficiency certificate level or equivalent will be registered into “Second Class” (B) category of the related subject. The health professional with only one year study or course on health education or related field will be registered into “Third Class” (C) category of the related subject. a t i 9.5.3 Registration levels and its qualification requirements i g t a i a a t i a t i gi t i t g a t i a it a t g i gi t i t ia i a at g 9.5 Nepal Health Professional Council t at t a t i a it Ba g i gi t i t i t a at g 9.5.1 Introduction t at t Nepal Health Professional Council (NHPC), Nepal has been established to make more effective the health services in a t i a it i at i a t i gi t i t Nepal, to mobilize the services of health professionals except the qualified doctors and nurses to be registered with a B at g t at t the Medical Council in a managed and scientific manner and make provisions on the registration of their names a t i a it a t a t a at according to their qualifications, according to “Nepal Health Professional Council Act 2053” by the Government of i gi t i t i a at g t at t Nepal and is enacted on 2053/11/3 by the Parliament in the twenty fifth year of reign of His Majesty King Birendra Bir Bikram Shah Dev. t According to article 20 of the Act, “After one year of the commencement of this Act, no person other than a t t Ba a t g t i ig t i a a registered health professional shall be entitled to carry on the health profession, directly or indirectly”. a t at t i t g t a t Ba a t t Therefore all health professionals are requested to register in the Council and renew it on every five years t a a a a t t a ami a a i it t according to the rule 36 of “Nepal Health Professional Council” regulation. a t t a Ba g t t t i m t t a ami a 9.5.2 Functions, duties and powers of Council 9.5.4 Subject committees of the Council According to the article 4(1) of the Act The Council established pursuant to article 3 shall consist of the members as follows: t gi t a a t i a t i a i t t mmi A person nominated by the Government of Nepal from amongst the persons - Chairperson who, having obtained at least bachelor degree in a subject related with health i a t t mmi profession, have been involved in the health service for at least five years i i t mmi Chairperson of Paramedicals' Association of Nepal (PAN) or a representative - Member designated by him/her a at i i t mmi Chairperson of Nepal Pharmaceuticals Association or a representative designated - Member a i g t mmi by him/her i t a a a i ita t mmi Chairperson of Nepal Radiological Society or a representative designated by - Member a t mmi him/her ta t mmi Three registered health professionals nominated by the Government of Nepal - Member t m t i t mmi from the pathology, physiotherapy and public health, on recommendation of the i a t mi a i at at t mmi Paramedicals' Association of Nepal (PAN) . Four health professionals elected by the registered health professionals from - Member Registration process amongst themselves, as prescribed Dean of the Institute of Medicine or a representative designated by him/her - Member a i i i a i t a a iat gi t a m a mit t a i a Representative, Nepal Medical Council - Member t t i a g it g m t a a i i a t i All together there will be 13 council a i a t t t mmi a a t a i a t t mmi i a t a i a t t i it it mm a i According to the article 9 of the Act, the functions, duties and powers of the Council shall be as follows: m g i ma a i i a a a a t gi t a at a To make necessary policies for smoothly operating the health profession related activities. ta t i a i a t m gi t a a a ta t a t a am t To determine the curriculum, terms of admission and policies on examination system of educational a i a t i i a a t gi t a at a a i g t i am institutions imparting teaching and learning on health profession and evaluate and review the related matters. To determine the qualifications of health professionals and to provide for the registration of the names of health professionals having required qualifications. 9.5.3 Registration levels and its qualification requirements According the qualification of health professionals, the NHPC will register into respective groups. The health professional with Master degree will be registered into “Specialization” category of the related subject. The health professional with Bachelor degree will be registered into “First Class” (A) category of the related subject. DoHS, Annual Report 2075/76 (2018/19) The health professional with proficiency certificate level or equivalent will be registered into “Second Class” (B) category of the related subject. The health professional with only one year study or course on health education or related field will be registered into “Third Class” (C) category of the related subject. Note: All persons who want to persue Bachelor or Master degree study in foreign countries should apply for a letter of consent at the Council. In order to get a letter of consent for Bachelor/Master study, the person should already have passed the entrance examination of any university. All those, who have not yet any Bachelor degree need not to fulfil the requirement of entrance examination. 9.5.4 Subject committees of the Council For the registration of health professional, the council has 9 different subject committes: Public Health subject committee, Medicine subject committee, Laboratory Medicine subject Committee, Radiology subject committee, Physiotherapy and Rehabilitation subject committee, Ayurveda subject committee, Dental subject committee Optometry Science Subject committee Miscellaneous subject (Homiyo, Yunani, Naturopathy etc.) committee\ Registration process Each individual or institution shall fill appropriate registration form and submit the application to the Council along with supporting documents and bank voucher. The Council will forward this application to the respective subject committee. After evaluation of the application, the subject committee will forward the application to the Council with its recommendation. The Council meeting will make a decision and finally award the registration certificate. The NHPC has now started online application system for registration and also started an entrance exam of the applicant. The Council will now award the registration a t i certificate only after passing of this exam. TableTable 9.5.5 9.5.5 Total Total number number of Health of Health Professionals Professionals Permanent Permanent Registered Registered Table 9.5.5.1 Summary of registration in NHPC up to 2076 Ashadh 31. TableS.No. 9.5.5.1Subject Summary of registration in NHPC up toSpecialization 2076 Ashadh 31.First Second Third 1 Public Health 1112 3866 2 Health Education 30 76 16 3 Primary Health Care 1 4 Medicine 15297 57942 5 Medical Microbiology 138 139 6 Health Lab 34 2627 7053 16962 7 Radiography 619 1761 8 Radiotherapy 1 7 9 9 Cytrology 1 3 10 Hematology 20 8 11 Biochemistry 194 83 12 virology 10 13 Nuclear Medicine 1 14 Ayurved 181 1159 15 Homeopath 151 44 16 Unani) 13 17 Acupuncture 3 10 91 51 18 Physiotherapy 183 1337 104 75 19 Community Base Rehabilitation 1 20 Prosthetic & Arthritic 12 1 21 Dental Science 1248 779 22 Naturopathy 1 48 23 Yoga 3 9 1 24 Ophthalmic Science 12 709 1060 25 Operation Theater and Allied Health Sciences 13 55 26 Clinical Psychology 20 27 Speech and Hearing 9 69 1 28 Forensic Medicine 3 29 Perfusion Technology 3 7 30 Anaesthesia 1 62 31 Cardiology Tech. 4 32 TCM AMT 3 33 Occupational Therapy 1 34 Renal Dialysis 4 Sub Total 1778 9880 26923 76970 Total 1,15,551 Note: Registration procedure in online system. Licensing examination on the process. Note: Description collection of institutes in online on the process. Table 9.5.5.2 gi t a i i t m Summary of Student Intake number 2076 Ashadh 31 S.No. i i g ami a t Programme Student intake S.No. Programme Student intake No. No. i i t t i i t 1 MPH 20 10 B.Sc. Medical Biochemistry 20 2 BPH 40 11 B. Optometry 20 3 B.Sc. MLT 20 12 PCL GM/ CMA 40 4 BPT 30 13 CMLT 30 5 CPT 40 14 PCL Radiography 30 DoHS, Annual Report 2075/76 (2018/19) 6 M.Sc.MLT 5 15 PCL Dental Science 40 7 M.Sc. Medical Microbiology 5 16 PCL Ophthalmology 40 8 B.Sc. Medical Microbiology 20 17 TSLC MLT 40 9 M.Sc. Medical Biochemistry 5 Source: NHPC 24 Ophthalmic Science 12 709 1060 25 Operation Theater and Allied Health Sciences 13 55 26 Clinical Psychology 20 27 Speech and Hearing 9 69 1 28 Forensic Medicine 3 29 Perfusion Technology 3 7 30 Anaesthesia 1 62 31 Cardiology Tech. 4 32 TCM AMT 3 33 Occupational Therapy 1 34 Renal Dialysis 4 Sub Total 1778 9880 26923 76970 Total 1,15,551 Note: Registration procedure in online system. Licensing examination on the process. Description collection of institutes in online on the process. a t i Table 9.5.5.2 Summary of Student Intake number 2076 Ashadh 31 a mma t t ta m a S.No. Programme Student intake S.No. Programme Student intake No. No. 1 MPH 20 10 B.Sc. Medical Biochemistry 20 2 BPH 40 11 B. Optometry 20 3 B.Sc. MLT 20 12 PCL GM/ CMA 40 4 BPT 30 13 CMLT 30 5 CPT 40 14 PCL Radiography 30 6 M.Sc.MLT 5 15 PCL Dental Science 40 7 M.Sc. Medical Microbiology 5 16 PCL Ophthalmology 40 8 B.Sc. Medical Microbiology 20 17 TSLC MLT 40 9 M.Sc. Medical Biochemistry 5 Source: NHPC DoHS, Annual Report 2075/76 (2018/19) a t i 9.6 Nepal Pharmacy Council 9.6.1 Introduction a a ma i i ta i i t ma t a ma i ma agi g a a g it i a i ma a a i t gi t a am a i g t t a i a a ma i t a a ma a i ta t a a a 9.6.2 Functions and Duties: ta i i a a it a a ma i i t a it a a a a ita a ma i t t a it a ma ma a t t i m m mmi a a gi t a a i t i i gi t a a ma i t a a ma i ta t 9.6.3 Infrastructure and Facilities: a a i a a i i a at a t a ag a ia g t a a m t g m t 9.6.4 Regular Activities: i ami a t m a a gi t a a ma i t a a ma i ta t a a i g t t i ami a a ma t a i g i t ita a ma t a i g i t mi i ta g a g a m i i a it i g a i i a ma g 9.6.5 Specific Activities: i i t i g g i i g i im m t i a t t a a i i t i i i g a ma t t i g ig t i it a ma i t t ma at a i m ta 9.6.6 Approved Collegesof fiscal year 2074/75 a t g am g Ba g am g i ma g am g DoHS, Annual Report 2075/76 (2018/19) a a a t a NATIONAL HEALTH Chapter 10 Chapter INSURANCE 10.1 Introduction a t a g am i a ia it g am t m t a t at aim t a it i t a t a it a t a i mi imi i g a a ia t m a t a B a B i i t a t t a t i a g am i a t g g g a ma im i g a m mai t t t it t a at i ata t i i g a t t m m i g i a t i a g am i a ami a g am ami a t a t i am t t i t g am m t i ta mm i a g m t a i t i i t i g am t t m a i g i t t t a t a t i ata t i it t a i t i a m i i g a m t a i i g it m t a t i g am a a at t a a it a t i i g am a m t t a a i i a t i i a a it a a a i a a tag g a a m a t a i i a a t ag i ta t t m ai a i i t i t t ait a a t a i t a t t i a i ma 10.2 Objectives: a t a it a t i it a a it t t m a ia a i a t t a m t t t t i a a t ag 10.3 Main features of Health Insurance t i a ta g am a ami t i ami i t m m a t t i t a a a i a m m m t a t i am t t a B a i a ami i a i g a t i t a a a a t t i m m i t g a a t i B t t a a a ai a ami i t m m it a a i a a a i a m m ma im m am t a ai a a i m t a t i am t t a i a B t t a a t t i t i i t a a ia i i t at a t a ai a at t t i i t a a i m t i t ta t i t t i a t m m m i g a t i g am i a it m t a i ta t i g ma t B a t a t i a i g m t a i t i at ita i t i DoHS, Annual Report 2075/76 (2018/19) a a a t a HIB acts as the service purchaser while government and listed private hospitals provide the 10.4 Programservices. Implementation Status a t i a g am i t am i ta t m ai a i i t i t t ait a 10.4 Program Implementation Status it i a t am a Bag g i t i t t The healthHIB insurance acts as the program service in purchaser present frameworkwhile government is started and from listed Kailali private district hospitals on 25th, provide Chaitra, the g am i im m t i i t i t t t i t t g am i 2072. Thenservices. it is expanded to Illam and Baglung district on FY 2073/74. The end of FY 2074/75 the im m t i i t i t t t a t i t i t a i i i B i a i g t program is implemented in 36 districts of the country. Till the end of FY 2075/76 the program is im m t t i g am a t t a i t B g am a i t i t i a implemented10.4 Program in Implementation 46 districts of Statusthe country and next 7 districts are in pipe line. HIB is planning to i a implementThe health this insurance program program all over in the present country framework as well. isThe started list of from HIB Kailaliprogram district launched on 25th, districts Chaitra, is as shown2072. inThen Table it 10.1.is expanded to Illam and Baglung district on FY 2073/74. The end of FY 2074/75 the Tableprogram 10.1: is Listimplemented of districts in implementing 36 districts of theNational country. Health Till theInsurance end of programFY 2075/76 till the FY program2075/76 is Tableimplemented 10.1: List in of 46 districts districts implementing of the country National and next Health 7 districts Insurance are program in pipe tillline. FY HIB2075/76 is planning to SNimplement Name this of program Province all over the country as well. The listDistricts of HIB program launched districts is as 1shown in TableProvince 10.1. 1 Ilam, Jhapa, Sunsari, Bhojpur, Khotang, Solukhumbu, Sankhuwasabha 2 Province 2 Rautahat, Mahottari, Parsa, Dhanusa, Siraha 3Table 10.1: Bagmati List of districts implementingBhaktapur, Makawanpur, National Health Chitawan, Insurance Sindhuli, program Ramechhap till FY 2075/76 4 SN NameGandaki of Province Baglung, Myagdi, Kaski, Gorkha,Districts Tanahun,Syanja 5 1 ProvinceProvince 5 1 Palpa,Ilam, Jhapa, Bardiya, Sunsari, Arghakhanchi, Bhojpur, Khotang, Kapilvastu, Solukhumbu, Rolpa, Sankhuwasabha Rukum east, 2 Province 2 Pyuthan,BankeRautahat, Mahottari, Parsa, Dhanusa, Siraha 6 3 ProvinceKarnali 3 Jajarkot,Bhaktapur, Surkhet, Makawanpur, Rukum west,Chitawan, Jumla, Sindhuli, Kalikot, Ramechhap Mugu, Humla,Dolpa 7 4 SudurPaschimGandaki Kailai,Baglung, Achham, Myagdi, Baitadi, Kaski, Gorkha,Bajura, Bajhang, Tanahun,Syanja Kanchanpur, Darchula 5 Province 5 Palpa, Bardiya, Arghakhanchi, Kapilvastu, Rolpa, Rukum east, Pyuthan,Banke 10.5 Enrollment and Health service utilization Status of fiscal year 2075/76 10.56 EnrollmentKarnali and Health serviceJajarkot, utilization Surkhet, Rukum Status west, of Jumla,fiscal Kalikot,year 2075/76 Mugu, Humla,Dolpa There were 13,507 people insured in FY 2072/73 and 228,113 people were insured in FY 2073/74 and 7 SudurPaschim Kailai, Achham, Baitadi, Bajura, Bajhang, Kanchanpur, Darchula 1,130,575 people were insured in the FY 2074/75. A total of 147,938 peoples reenrolled 16,40,879 i i a i i a peoples are active members and 507,059 peoples are drop out of Insurees respectively in the health i i t t ta 10.5 Enrollment and Health service utilization Status of fiscal year 2075/76 insurance program at the end of FY 2075/76 . Among them 293,958 people are insured on the basis of a a m m a a t i t a t There were 13,507 people insured in FY 2072/73 and 228,113 people were insured in FY 2073/74 and ultra-poor category whose contribution is paid solely by Nepal Government in FY 2075/76. The i a g am at t m g t m a i t a i 1,130,575 people were insured in the FY 2074/75. A total of 147,938 peoples reenrolled 16,40,879 population coverage in health insurance seemed to be around 14 percent of total population among t a at g t i i ai a m t i peoples are active members and 507,059 peoples are drop out of Insurees respectively in the health implemented districts. Among the total insures, about 708,406 people have taken health services from a ag i a t i a m t a t t ta a am g insurance program at the end of FY 2075/76 . Among them 293,958 people are insured on the basis of listed health facilities in health insurance program in FY 2075/76. Based on the number of enrollments im m t i t i t m g t t ta i a t a ta a t i ultra-poor category whose contribution is paid solely by Nepal Government in FY 2075/76. The Jhapa , Chitwan , Palpa and Sunsari are leading top four districts, followed by Kaski and Kailali, present m i t a t a i i i a t i a g am i Ba t m population coverage in health insurance seemed to be around 14 percent of total population among the enrollment status as shown in Table 10.2. m t a a it a a a a a i a a i g t i t i t a i a implemented districts. Among the total insures, about 708,406 people have taken health services from ai a i t t m t tat a i a Tablelisted 10.2 health: Summary facilities ofin numbershealth insurance of enrollment program by in district FY 2075/76. by province Based on the number of enrollments S.Jhapa N. ,Province Chitwan , PalpaName and of Sunsari District are leadingNos. of top fourDrop districts, out of followedActive byMembers Kaski and of Kailali,No. servicepresent the enrollment status as shown in Table 10.2.Insurees Insurees Insurees takers a mma m m t i t i t i 1 Table 10.2Province: Summary 1 Ilam of numbers of enrollment67073 by district17556 by province 49517 25198 2 S. N. Province JhapaName of District 243061Nos. of Drop51962 out of Active 191099Members of No. 89851service 3 Sunsari Insurees151621 Insurees24343 Insurees127278 takers48203 4 1 Province 1 BhojpurIlam 1977667073 175566295 4951713481 251982928 5 2 KhotangJhapa 24306123907 519628019 19109915888 898512169 6 3 SolukhumbuSunsari 1516215201 243432825 1272782376 48203640 7 4 SankhuwasabhaBhojpur 197766883 62950 134816883 2928113 8 5 i RautahatKhotang 239079870 80193256 158886614 21692728 9 6 MahottariSolukhumbu 108215201 28253747 23767074 6401059 107 ParsaSankhuwasabha 139386883 31820 688310756 1131838 8 Province 2 Rautahat 9870 3256 6614 2728 9 Mahottari 10821 3747 7074 1059 2 10 Parsa 13938 3182 10756 1838 11 Dhanusa 3483 11 3472 304 12 Siraha 6839 11 6828 288 2 13 Bagmati Bhaktapur 90512 16041 74471 43802 14 Makawanpur 95832 16252 79580 40308 15 Chitawan 214103 55110 DoHS, Annual158993 Report 2075/76110228 (2018/19) 16 Sindhuli 52743 12889 39854 11070 17 Ramechhap 22882 5672 17210 4428 18 Gandaki Baglung 48934 12548 36386 16129 19 Myagdi 16545 4553 11992 7362 20 Kaski 120730 32412 88318 56848 21 Gorkha 40970 12877 28093 12879 22 Tanahun 65132 16495 48637 22794 23 Syanja 34034 12 34022 3659 24 Province 5 Palpa 147817 17766 130051 73835 25 Bardiya 78813 22742 56071 16205 26 Arghakhanchi 37057 10735 26322 8658 27 Kapilvastu 41391 8220 33171 6483 28 Rolpa 20395 8780 11615 2053 29 Rukum east 4815 2355 2460 223 30 Pyuthan 33142 9269 23873 6952 31 Banke 18183 81 18102 1870 32 Karnali Jajarkot 34400 11735 22665 6655 33 Surkhet 39743 13623 26120 15766 34 Rukum west 41972 14543 27429 16400 35 Jumla 32445 10755 21690 9258 36 Kalikot 29546 14866 14680 3678 37 Humla 2843 0 2843 1 38 Dolpa 1253 0 1253 2 39 Mugu 1383 0 1383 1 40 SudurPasc Kailali 122494 24333 98161 27971 41 him Achham 23682 9183 14499 1394 42 Baitadi 9523 4326 5197 1695 43 Bajura 24686 11042 13644 2117 44 Bajhang 27654 6637 21017 1934 45 Kanchanpur 5682 0 5682 295 46 Darchula 4129 0 4129 134 Total 2147938 507059 1640879 708406 Gender wise Insurees Trend since FY 2072/073- 2075/076 serial no. Fiscal year No. of Total Insurees Gender wise distribution Male Female Others 1 2072/73 12623 5972 6647 4 2 2073/74 228113 107804 120277 32 3 2074/75 1130575 533829 596633 113 4 2075/76 1640879 782143 858449 287 Source: IMIS 2075/76 Ashadha 31 3 11 Dhanusa 3483 11 3472 304 12 Siraha 6839 11 6828 a a a t a 288 13 Province 3 Bhaktapur 90512 16041 74471 43802 14 Makawanpur 95832 16252 79580 40308 15 Chitawan 214103 55110 158993 110228 16 Sindhuli 52743 12889 39854 11070 17 Ramechhap 22882 5672 17210 4428 18 Gandaki Baglung 48934 12548 36386 16129 19 Myagdi 16545 4553 11992 7362 20 Kaski 120730 32412 88318 56848 21 Gorkha 40970 12877 28093 12879 22 Tanahun 65132 16495 48637 22794 23 Syanja 34034 12 34022 3659 24 Province 5 Palpa 147817 17766 130051 73835 25 Bardiya 78813 22742 56071 16205 26 Arghakhanchi 37057 10735 26322 8658 27 Kapilvastu 41391 8220 33171 6483 28 Rolpa 20395 8780 11615 2053 29 Rukum east 4815 2355 2460 223 30 Pyuthan 33142 9269 23873 6952 31 Banke 18183 81 18102 1870 32 Karnali Jajarkot 34400 11735 22665 6655 33 Surkhet 39743 13623 26120 15766 34 Rukum west 41972 14543 27429 16400 35 Jumla 32445 10755 21690 9258 36 Kalikot 29546 14866 14680 3678 37 Humla 2843 0 2843 1 38 Dolpa 1253 0 1253 2 39 Mugu 1383 0 1383 1 40 SudurPasc Kailali 122494 24333 98161 27971 41 him Achham 23682 9183 14499 1394 42 Baitadi 9523 4326 5197 1695 43 Bajura 24686 11042 13644 2117 44 Bajhang 27654 6637 21017 1934 45 Kanchanpur 5682 0 5682 295 46 Darchula 4129 0 4129 134 Total 2147938 507059 1640879 708406 Gender wise Insurees Trend since FY 2072/073- 2075/076 serial no. Fiscal year No. of Total Insurees Gender wise distribution Male Female Others 1 2072/73 12623 5972 6647 4 2 2073/74 228113 107804 120277 32 3 2074/75 1130575 533829 596633 113 4 2075/76 1640879 782143 858449 287 Source: IMIS 2075/76 Ashadha 31 3 DoHS, Annual Report 2075/76 (2018/19) a a a t a 10.6 Opportunities in HIP program g am i a i t a i t tat g i i i i a t a t a i i t m m t i g i ma t ig i a mmitm t ig a t i i g ita a a it a t i a t t m t gt i g g i i i g ita a ma gat i g t m tai a a a t i ia a t it t a 10.7 Challenges in HIP program g t ta i ai i g t m m t a a ai a i it a a i i it a it a t i t gt i g i a ma ag m t i ma t m a ta g t g a t i m t t a t t a at i agm t ia a t it g am it i a DoHS, Annual Report 2075/76 (2018/19) m t a t t DEVELOPMENT Chapter 11 Chapter PARTNERS SUPPORT t m i i t i a t a t t m i t t i i t a t a it m t a t m at a i at a a i t a a ga i a a a a a tm t a t i a g it a t i it t ga i a a t i a g t i t a a t t i a t i t t g amm t ga i a a t i ta t tai a t a a i t i a a i ta i t i a a m t a t t t g m t a t t m t g a t i a a t t im m ta t a a t t t at g i t i a i g a g m t a ig a i a t a t g m t i i tai t a a g m t a t a i g t a at t i g a a g m t a a a a i g m a i m a i at a ag t t g m t a t a t i m t Ba a a at a it mmitm t t g a g am t a t i i agai t a i a t t a i m t i t a a a i i g a t t i mmitm t agai t m i a ag it t i i t a t a a mat i i t i a i a t g t DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details details Contact Fax: Fax: + 977-1-5527756 Office address: Office Nepal UNFPA Lalitpur Sanepa, Jhamsikhel, Tel: +977 1 5523880 1 Fax: +977 5523985 Email: [email protected] [email protected] http://nepal.unfpa.org/ address: Office UN House, UNICEF Nepal, Lalitpur Pulchowk, Tel:5523200 Fax: 5527280 Email: [email protected] Web: http://www.unicef.org/nepal Web: Dr Jos Vandelaer Representative WHO Nepal for Office Country WHO UN House, Lalitpur Pulchowk, Email: [email protected] Phone: + 977-1-552199 FY for 9 1 20 budget / 8 201 ealth sector sector ealth H $ 5,319,000 5,319,000 $ 3,405,554 $ purchase of amount amount of purchase US$ 1,756,000 Total allocated budget of all of all budget allocated Total activities: programs 4,896,000 US$ programs of all expenses Total activities: US additional the includes The amount of all budget allocated Total activities: programs US programs of all expenses Total activities: US $ 3,405,554 Allocation (Award): 8.1m (Award): Allocation 6.65 Expenditure: m 19 districts, districts, 19 of 5 and Sudur Paschim Paschim Sudur 5 and Provincial presence: 2, 2, presence: Provincial Geographical Geographical coverage 18 number: District 77 number: District 18 number: District 18 number: District 41 number: District National – l networks with adequate with adequate l networks Major program Major program focus RGANIZATIONS O Vaccine preventable disease Vaccine preventable support technical and surveillance immunization to strengthen coverage hospita Strengthen public health emergency emergency health public Strengthen and preparedness response health to establish support centers operation emergency hub- and strengthening (HEOCs) Sexual Reproductive Health andReproductive SexualHealth Right, Education, Midwifery , Family Planning Sexual Adolescent RH morbidities, Response , Health Health Reproductive and (GBV) Violence Based to Gender & response. preparedness Emergency health and newborn Maternal 1) immunization including 2) Health Child Health 3) Adolescent Strengthening System 4) Health response including emergency 5) Nutrition ULTILATERAL Organization Organization Development Partners to Health Contributing Sector in Nepal 11 .1 M UNFPA UNICEF Nepal WHO DoHS, Annual Report 2075/76 (2018/19) m t a t t -5260607 01 -5260607 - Contact details details Contact 977 Office address: Office Group Bank The World Complex Yeti Yak and Kathmandu Durbar Marg, Tel:977-1-4236000 Email: [email protected] Web: https://www.worldbank.or g/en/country/nepal address: Office Road Chakupat- Patandhoka 44600 Lalitpur 10, Tel: Fax: 977-1-5260607 Fax: 977-1-4225112 Fax: 977-1-4225112 Email:[email protected] rg FY for 9 1 20 budget / 8 201 ealth sector sector ealth H Total disbursed disbursed Total Budget million US$29.5 expenses Total US $ 701091 Geographical Geographical coverage Nationwide Nutrition Emergency Programme Response in implemented was of districts five (Rautahat, 2 Province Sarlahi, Mahottari, Saptari) Siraha and and Child Maternal Health Nutrition and being is Programme five in implemented 59 – - 59 months. 59 Major program Major program focus limination and control targets targets control and limination stockpiles stockpiles Tuberculosis Technical support to achieve and to achieve support Technical disease communicable sustain e filariasis, Lymphatic Malaria, and Leprosy Kala-azar, Trachoma, Support implementation of package of package implementation Support noncommunicable of essential and interventions diseases (PEN) update of and development national protocols and frameworks To prevent malnutrition among among malnutrition prevent To pregnant lactating women and and 6- aged children MAM of deterioration prevent To 6 children between aged public resource in efficiency To improve health of the systems management sector in Nepal Nutrition Response 1. Emergency Programme: Response Nutrition The Emergency the with implemented was Program objectives. key following Organization Organization The World The World Group Bank United Nations World Food Programme DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details details Contact Web: www.wfp.org FY for 9 1 20 budget / 8 201 ealth sector sector ealth H icts of Province 6 6 icts of Province Geographical Geographical coverage distr Humla, Jumla, (Mugu, Kalikot) Dolpa and women (PLW) (PLW) women rogramme: rogramme: Major program Major program focus months into SAM. months into among To the create awareness and malnutrition, regarding public maternal, on knowledge To enhance feeding young child infant and practices. Feeding Supplementary Blanket Programme MUAC through Nutrition screening Nutrition education education Nutrition The major activities implemented were: were: implemented activities The major 2. Maternal and Child Health and Health Child and 2. Maternal P Nutrition Worldis Food UnitedNation Programme of government supported continuously the of implementation the Nepal in Nutrition and Health Child and Maternal focused program major The Program. of status the nutrition to improve was Lactating and Pregnant and the children and the of age children 6 23 to months. to enhance focus is major The program child young and infant maternal, to and support practices nutrition servicesalong health basic the enhance for cereals of super distribution the with the children 6 PLW of and age to 59 months. Organization Organization DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact Office address: DFID British Nepal, Embassy, Lainchaur, Kathmandu, PO Box 106, Nepal Email: nepal- [email protected] k government/world/o rganisations/dfid- nepal address: Office Sanepa, Road, Milap Ward Lalitpur SMC, 3, Nepal no.2, Province 1 5013088 Tel: +977 1 Fax: +977 5013078 Email:paul.rueckert@gi z.de Web: https://www.gov.uk/ 9 1 of all /20 financial financial aidfinancial FY 2018 of budget allocated Total activities: programs all US $2,854,332 of all expenses Total activities: programs US $2,636,592 Health sector budget budget for Health sector Total Allocated budget of all programme activities: £12,350,000 aid and £10,200,000 Technical assistance Total Expenses programme activities: £5,000,000 disbursed, and is £8,100,000 FA planned to disburse by Nov 2019 (subject to achievement ofDisbursement Linked Indicators) and £8,500,000 technical assistance Geographical coverage Geographical Nationwide District number:Nationwide(43 already of 77 districts NHI) implemented (6 5 number: District municipalities: Thimi, Madhyapur Bidur, Nilkantha, SMC, Nepalgunj Dhangadi) and Godawari Major program focusMajor program professionals professionals Strengthening the health management of of management health the Strengthening a part as units government national sub selected of health system federal sector health selected of capacity the Improve Health system strengthening, including health policy, planningand budgeting, health governance and devolution (federalism), improving evidence science and accountability on health including monitoring, evaluation, surveillance and research, and socialaccountability in the health sector; Health of National implementation Nationwide Insurance procurement and public financial management; accessimproving to medicines including safe motherhood and family planning, gender, equity and socialinclusion; and health infrastructure and hospital retrofitting (Nepal Health Sector Programme 3 and Nepal Family PlanningProject) RGANIZATIONS O ILATERAL Organization Organization 11 .2 B for Department International Development (DFID) Technical German GIZ - Cooperation the to Support Sector Health Programme (S2HSP) DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact 535693 shanker.pandey@kf w.de kfw.kathmandu@kfw Web: www.giz.de/nepal Office address: KfW Kathmandu Büro Office of German Development Cooperation Sanepa, Lalitpur, Tel: 00977 1 5523228 Fax: 00977 1 5 Email: .de Web: www.kfw.de address: Office USAID/Nepal Embassy c/0 U.S. Maharajgunj Building, 295 Box: G.P.O 01-4234000 Tel: Fax: 01-4007285 http://nepal.usaid.gov 9 1 /20 FY 2018 Disbursement Euro 4.77 million or USD 5.34 million Health sector budget budget for Health sector of Budget Allocated Total activities: programs all US $43,082,322 of all Expenses Total activities: programs US $43,082,322 Province 7 National level National level National level Gorkha, Ramechhapp, Dolakha Geographical coverage Geographical Number: District Nationwide 10 number: District at support (Major level) federal 2 number: District Nuwakot) (Kailali, and 47 number: District districtsthrough projects different SSBH II, and (Suaahara project) 75 :all number District through districts projects different (GGMS,GHSC-PSM, project) BA Redbook and Suaahara II, SSBH, FACT, FACT, SSBH, II, Suaahara Nepal CRS — 19 years) 19on years) Child Care in Major program focusMajor program Procurement of OC and EC Construction, medical equipment and e- health components, particularly to strengtheningthe referral system in and Multiyear contract outsourcing of maintenance Budget Support national through systems around Dadheldhura Harmonization of various health information information health of various Harmonization national of a future element first as the system platform health information topics health reproductive Implementation ofrelevant approaches and and approaches ofrelevant Implementation promotion health on dissemination for strategies (10- adolescents for targeting o Reconstruction of 3 earthquake damaged District Hospitals Remote Areas o Maintenance of medical equipment o Sector Support/Pool Fund o Support Social to Marketing Improvement of Mother Health Child and Newborn Maternal Family Planning & Reproductive Health Health Reproductive & Family Planning Organization Organization German Financial Cooperation - KfW USAID DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact 5555913, 5555914 5555913, - Contact details Contact -5554251 01 -5554251 Office address: Office Sanepa, Nirbhawan, 3 Lalitpur - 01 Tel: Fax: [email protected] Email: Web: www.adranepal.org 9 9 1 201 / /20 FY 2018 FY 2018 for Total allocated allocated Total of budget all activities: programs US $3117,445.00 of all expenses Total activities: programs US $2423,472.00 Health sector budget budget Health sector Health sector budget budget for Health sector number: 42 number: Geographical coverage Geographical 17 number: District (Linkages districts project) District through districts projects different SafaaPani, (SUAAHARA, project) Swachchta Stores number: District and Lumbini at central, level Pradesh Karnali and the health offices 4 districts, (22 there in and23 health LLGs GHSC- through facilities) PSM Project coverage Geographical 9 number: District 1 District number: 4 number: District 1 number: District RGANIZATIONS O Major program focusMajor program focusMajor program OVERNMENT -G HIV/AIDS and STI HIV/AIDS ON Family Planning and Adolescent Sexual and Sexual Adolescent and Planning Family FPSSP) and (UNFPP Health Reproductive Strengthening Health System Strengthening System Health and Women's Project Child and Neonatal of Management Integrated Health Water Sanitation and Hygiene program and Hygiene Sanitation Water program Supply Chain Health Global N NTERNATIONAL I Organization Organization Organization 11 .3 Adventists and Development Agency Relief Nepal (ADRA) DoHS, Annual Report 2075/76 (2018/19) m t a t t -5521202 -5521202 -5522800 -5522800 2, Kathmandu, 2, Kathmandu, 01 01 – - - -4420787 -4420787 Contact details Contact Web: http://nepal.ipas.org/ Nepal. Nepal. Tel: 977 1 4436434, 4428240 1 4439108 Fax: 977 Email: Office address: Office Do Kathmandu Baluwatar, 4 No: Ward Cha Marg, 01 Tel: Fax: 01-4425378 Email:[email protected] address: Office Lazimpat [email protected] address: Office Samata Bhawan Lalitpur Dhobighat, +977 Tel: Fax: +977 Gopal Bhawan, Anamika Galli, Baluwatar, Kathmandu -4, Nepal www.fhi360.org/countries/nepal Web: Email: [email protected] Web: WWW.carenepal.org Tel: +977.1.4437173 Fax: +977.1.4417475 Email: [email protected] 9 201 / 1,820,409 1,820,409 1,820,409 FY 2018 2,055,028 for of all expenses Total activities: programs 1,086,066.40 US $ Total allocated allocated Total of budget all activities: programs US $: of all expenses Total activities: programs US $: allocated Total of budget all activities: programs 1,179,555.02 US $ allocated Total of budget all activities: programs 00 US $: 870820. of all expenses Total activities: programs US $: 842252.00 Health sector budget budget Health sector Total allocated budget: US$ 3.6 million Total Expenditure: US$ a an s, n a s and a n a s Geographical coverage Geographical number:28 District 17 number: District 1 number: District 1 number: District 1 number: District 7 number: District 17 districts, 131 d s an s, s (STI) -quality abortion abortion -quality -efficacy to access access to -efficacy -offline, HIV self- to and distribution led testing, enhanced led testing, - funded LINKAGES Nepal transmitted infection transmitted - -quality abortion and and abortion -quality Major program focusMajor program community and PEPFAR - Condom promotion HIV testing and counseling (HTC)services HIV testing and(HTC)services counseling online- (index testing, through online platforms and offline prevention education, and referral follow-up HIV and sexually HIV and sexually testing, To create an enabling environment that supports supports that environment an enabling To create high to access girls’ and women Tuberculosis (SRHR) Rights Health Reproductive Sexual and Health including Menstrual SupportServices and Mental Health Psychosocial (MHPSS) and Hygiene Sanitation Water system Health and building 1)Capacity strengthening and contraceptive care. and contraceptive To ensure high and accessible, available, care are contraceptive of Nepal. girls and women to acceptable 2)Maternal, newborn, child health, family family health, child newborn, 2)Maternal, planning accountability and governance 3)Health to support and equipment 4)Infrastructure center birthing To ensure women and girls have the social social the have girls and To ensure women self and knowledge, support, safe abortion contraception. safe and abortion USAID Organization Organization Ipas Nepal Ipas Nepal Nepal Birat Trust Medical Nepal) (BNMT CARE Nepal/ NURTURE FHI 360 Nepal DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact 9 201 / FY 2018 for Health sector budget budget Health sector Total allocated budget: US$ 1.8 million US$ 174,685 Total Expenditure: Geographical coverage Geographical Lalitpur district National level 16 laboratories/surveillanc (12e sites human health and 4 animal health sector) testing - for AIDS for -basedon skill National Center National treatment services treatment discrimination reduction discrimination Major program focusMajor program exposure prophylaxis (PrEP) exposure (ART) services (ART) - funded Fleming Fund Country Grant Fleming for funded - Referral to and linkages with with to linkages antiretroviral Referral and therapy adherence Care, support and for counseling and retention and (GBV) screening violence Gender-based preventionmitigation for and referral services trainings and onsite andcoaching/mentoringtrainings onsite for from AMR sentinel lab professionals laboratories with laboratories Linking reference national in the Externalimproving Quality Assurance performance Procurement and of equipmentsupply and STI examination and examination STI Resistance Support to Antimicrobial ContainmentMultispectralSteering Committee Technical (AMRCSC), National and Working (NTWC) Committee-AMR Technical (TWGs) Working Groups Action Develop/Update AMR National Plan/Protocols/Guidelines/Standard Operating Procedures Capacity building: hands- peer outreach) and Stigma Demonstration/piloton HIV self study and pre Technical support to and Nationaland Public STD Control(NCASC) Health (NPHL) Laboratory Support to networks of key national populations with and living people HIV supplies UK aid Nepal Organization Organization DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact www.hki.org Office address: Office No. 10, Ward Block, Green Lalitpur, Patan, Chakupat, Nepal 5260247 Tel: Fax: 5260245 Web: Office address: 304 Surya Bikram Gyawali Marg,Baneswor,Kathma ndu Tel: 4115636 Fax: 4115515 E-mail: [email protected] Web:www.inrud- nepal.org.np 126 PO Box: Kathmandu Thapathali, 4268900 Tel: 4228118, Fax: 4225559 9 201 / FY 2018 for Total allocated allocated Total of budget all activities: programs US $16,834,102. of all expenses Total activities: programs US $14,509,827. allocated Total of budget all activities: programs US $521517 Health sector budget budget Health sector Allocated Budget: Budget: Allocated MoHP/DoHS Geographical coverage Geographical 42 number: District 6 number: District number:1 District number:1 District Different districts. 10 number: District 2 number: District 5 number: District anning) Community Resilience Resilience Community Major program focusMajor program Recording andRecording reporting, Analysis and Suaahara II (Good Nutrition) Program Nutrition) (Good II Suaahara maternal between relationship Study on on birth Mycotoxins to exposure Program Program 3.0 ARCH Feeding Child Nutrition - SABAL - Nutrition - Nutrition SABAL - Renovation of selected Renovation of selected laboratories andof AMR/AMU Establishment functioning laboratories in AMR surveillance sentinel ( based policy and pl Dissemination of the results for evidence- Monitoring prescribing practices and availability of free drugs at PHC outlets to improve rational use of medicines / Standard TreatmentProtocol adherence. Provides support technical to DoHS/MoHP to the set activities since 2009- 10. Community Health: Integrated components on components Integrated Health: Community health and HIV FP,ASRH, WASH, Nutrition, MCH, strengthening system and child Maternal Health Mental health Mission to Mission Organization Organization Helen Keller Keller Helen International (HKI) International for Network Rational Use of Drugs ( INRUD,Nepal) United Nepal (UMN) DoHS, Annual Report 2075/76 (2018/19) m t a t t Nepal Nepal -1- -1- -1- Contact details Contact Web:www.plan- international.org/nepal Email: Email: [email protected] umn.org.npWeb: Box address:PO Office 496, No. House 3764, Dhara Maharajgunj, Marg, Nepal Kathmandu, +977 Tel: 4416191/4417547 Email:ohwnepal@oneheartworld wide.org g address: Office Bakhundole, Maitri Marga, Sub-metropolitan Lalitpur Shanti.Upadhyaya@plan -international.org Web:www.oneheartworldwide.or City Ward City Ward no. 3, +977 Tel: 5535580,5535560 Email; : 9 201 / FY 2018 for Total expenses of all of all expenses Total activities: programs US $580087 allocated Total of all budget program’s activities: 1,458,960 US $ of all expenses Total program’s activities Allocated Total all Budget of activities: programs Rs. 41,576,403 of all Expenses Total activities: programs Rs. 40,867,663 Health sector budget budget Health sector US $1,158,000 US $1,158,000 Geographical coverage Geographical 2 number: District number:13 District Panchthar, (Taplejung, Terhathum, Ilam, Sankhuwasabha, Khotang, Bhojpur, Okhaldhunga, Solukhumbu, Sindhupalchok, Nuwakot, Ramechhap, Dhading) number:5 District Sindhuli, (Sunsari, Makawanpur,Bardiya, Jumla) g g ECD Caucus. Major program focusMajor program ASRH and HIV ASRH and Health and Neonatal 1)Maternal and of nutrition establishment demonstration, level to address social determinants on early early on determinants social to address level development. childhood Strategy at national Childhood Development and strengthenin level Community based nutrition program- program- nutrition based Community less of children nutritional ofstatus Assessment food competition, baby healthy years, than five Maternal and Newborn Health: Repair & Repair Health: Newborn and Maternal & equipment centres, birthing of maintenance strengthen centre; birthing to support furniture clinics. outreach Parenting a) Development: Early Childhood of less mothers women, pregnant to Education of takers care and other of children years than five for stimulation early care and on responsive family security and safety development; childhood early corner. play child of including establishment a) Reflection Dialogue and Action at community at community Action and Dialogue a) Reflection b) Support on development of National Early Early of National on development b) Support - Organization Organization One Heart World Wide (OHW) International Plan Country Nepal, Office DoHS, Annual Report 2075/76 (2018/19) m t a t t . Contact details Contact www.fairmed.ch 5013180 Office address: Office Krishnagali, Pulchowk, Nepal Lalitpur, 5550620 Tel: 5553190. Fax: 5550619 [email protected] Email: Web:www.psi.org Office address: FAIRMED Nepal, Kalika 2 Marg, Sanepa 10047 Box P O Lalitpur, Tel: Web: Email:[email protected] 9 201 / : : llocated llocated a FY 2018 $509,778 for udget udget of all US all of Total expenses programs Total allocated allocated Total of budget all activities: programs US $3,965,796 of all expenses Total activities: programs US $3,635,712 Total b programs: Health sector budget budget Health sector US $435,107 : 3 Province: 1, 2, 3, 4, 5 & 4, 5 3, 1, 2, Province: Geographical coverage Geographical 7 30 number: District 5, 7 Province: 7 number: District 6 Province: 5 number: District 4, 2, 3, 1, Province: Total 6 & 7 35 (7 Number: District in overlapping districts WHP AYP) and number District (Kapilvastu, and Sindhupalchowk Baglung) for personal WASH for personal Diseases Activity (HHA) (HHA) Activity Major program focusMajor program Health Project (WHP) Project Health Support infection prevention at public facilities facilities at public prevention infection Support related change behavior provider through counseling and activities public among change behavior hygiene related clients. facility Improve knowledge and access to Long Acting Acting to Long access and knowledge Improve and Safe (LARC) Contraception Reversible and public private through Services abortion quality onsite training, sector: Provider and commodities of distribution assurance, through sharing and infor equipment, mation media. mass and mobilization level community and family use of knowledge Increase planning and adolescents among services products and sites service sector private from (15-24) youth WASH corners. Women’s Women’s 1) Tropical Neglected Health New Born and Maternal 2) behavior and strengthening, system 3) Health level community at change Inclusiveness Disability 4) Adolescent Youth Project (AYP) Project Youth Adolescent Health Hygiene and Organization Organization Population Population Services International Nepal (PSI Nepal) FAIRMED Nepal Foundation DoHS, Annual Report 2075/76 (2018/19) m t a t t , , Contact details Contact Contact details Contact -1-4224884/ - 4419376 4419376 - 4223477/4221133 Office address: address: Office 1813 EPC Box 8975, 2, Laltipur Sanepa 5550318 Tel: 5520322, Fax: 977-1-5554250 Email: [email protected] Web: nsi.edu.np Fax: 01- 4420416 4420416 Fax: 01- Email: Lancelot Anne [email protected] Web: http://www.ntag.org.np Office address: Marga, Ukti Maitighar Kathmandu, Nepal GPO Box 7518 Tel: 977 Email:[email protected]/ address: Office Kathmandu Baluwatar, 01 Tel: [email protected] 9 201 / s: 9 FY 1 r r 20 / FY 2018 dget of alldget for 2018 Total allocated allocated Total bu activities: programs US $ 3,396,420.00 of all expenses Total activities: programs US $ 2,436,401.00 Health sector budget budget Health sector sector fo Budget for health health Budget for Total expenses of all programs activities: NRS. 66,564,558 US $581,705 Total allocated budget of all programs activities: NRS. 101,316,364 US $885,400 budget allocated Total of all program activities: NPR 467,111,428 program activitie Total expenses of all of all expenses Total (NV A 42 districts (Suaahara-II) 77 districts Program) 6 districts 3 districts Province # 2 and # 6 Geographical coverage Geographical District number: 18 18 number: District 12 number: District 77 number: District 77 number: District Geographical coverage Geographical 31 Center: Static Districts steri Steri Outreach:9 team 13 LARC Outreach: LARC team Major program focusMajor program Major program focusMajor program Maternal and child nutrition Multi-sectoral training to health workers, FCHVs and others Promotion and advocacy of National VitaminA Program Research and surveys Family planning (staticand outreach services which includes full range of FP methods) Safe Abortion Services Training on reproductive health Contraceptive social marketing Sexual reproductive Health Training (AAC, DBEE, MLP, SBA, ASBA, OTTM, ASBA, SBA, MLP, DBEE, (AAC, Training Hospital Support Program - Rural Staff Support Staff Rural - Program Support Hospital Program Support Staff Rural - Program Support Hospital Program Partnership Hospital - Program Support Hospital Program Management Strengthening PEC) Nepali - Organization Organization Organization Organization Nick Simons Nick Simons Foundation International (NSFI) 11 .4 Organizations Non-Governmental NTAG Technical Assistance Group Stopes Marie International implementing through partner Sunaulo Parivar Nepal DoHS, Annual Report 2075/76 (2018/19) m t a t t -1-5010240, 977-1- -1-5010240, 5010248 Contact details Contact -1- KP Upadhyay KP Upadhyay org.np kp.upadhyay@mariestopes. address: Office National Society, Cross Red Nepal Kathmandu, Kalimati, Headquarters, Nepal Tel: +977 1 4270650 1 Fax: +977 4271915 / [email protected] Email: Address: Office Nepal of Association Planning Family Central Office, Pulchowk, Lalitpur Nepal Kathmandu, 486, P. O. Box Phone : 977 address: Office National Society, Cross Red Nepal Kathmandu, Kalimati, Headquarters, Nepal [email protected] [email protected] Web: www.nrcs.org Web:www.mariestopes.org.np Web:www.mariestopes.org.np 5010104 5010104 Fax : 977 Email :[email protected] :[email protected] Email http://fpan.org Website 9 FY 1 r r 20 / 2018 sector fo Budget for health health Budget for Total allocated allocated Total FY budgetfor all of 2018/2019 programs: health US $ 2,860,289 of all expenses Total activities: programs US $ 2288231.2 allocated Total of budget program activities US $ 4461844 of expenses Total program activities US $ 4350298 allocated Total of all budgetfor health programs: NPR 448,919,597 Geographical coverage Geographical MS Ladies: 19 districts 19 MS Ladies: number:11 District 77 number: District District based number:77(Need in emergency) 33 Number District 33 Number District 27 Number District 28 Number District number:11 District WASH and Emergency WASH Emergency and Major program focusMajor program Adolescent Sexual Reproductive Health Preventive health(Major focused: focused: health(Major Preventive and community building of capacity through institutions based community Community WASH,NCD, RMNCAH, Aid) First and BASED Health focused: services(Major health Curative Janaki and Surkhet through health Eye nationwide and CareHospitals, Eye Services) Blood Ambulance and including services SRH Integrated contraceptives, sexuality counseling, safe STIs, HIV, gynecological, obstetrics, -based abortion and sexual/gender violence. Sexuality Comprehensive and Equality Education/Gender Women. and of Youth Empowerment area. Emergency Health services (Major services Health Emergency Emergency Cross Red focused: System Trauma Emergency Clinic,Rural E- Strengthening, response and preparedness health Comprehensive abortion Care (Safe abortion Service). Provide Initial Minimum Service Package (MISP) in disaster effected Preventive health(Major focused: focused: health(Major Preventive and community building of capacity through institutions based community BASED Community WASH,NCD, RMNCAH, Organization Organization Nepal Red Cross Society Society Cross Red Nepal (NRCS) Planning Family of Nepal Association (FPAN) Society Cross Red Nepal (NRCS) 82 DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact address: [email protected] / Tel: +977 1 4270650 1 Fax: +977 4271915 Email: address: Office Nepal PHASE Bhatkapur Dadhikot, 016634038/89/11 Tel: [email protected] Email: Web: www.phasenepal.org Office Ltd. Pvt Inc. Mobile Medic Lalitpur Chakupat, 9802024110 +977 Tel: Email: [email protected] www.medicmobile.org [email protected] [email protected] Web: www.nrcs.org 9 FY 1 r r 20 / 2018 sector fo Budget for health health Budget for US $ 2,860,289 of all expenses Total activities: programs US $ 2288231.2 of all Expenses Total : activities programs US $ 571,502.00 allocated Total of budget all activities: programs US $617,392 of all expenses Total activities: programs US $528,021 Geographical coverage Geographical 77 number: District District based number:77(Need in emergency) District:7 District:7 District:7 District:7 14 number: District cy -source -source WASH Emergen and al care Major program focusMajor program Essential Primary Health care. Health Primary Essential Postnatal care Postnatal where districts (in those MPDSR been has MPDSR based Community implemented) Design, configuration and configuration Design, Health Health First Aid) and Basic of an open implementation mHealth toolkit for community-based for community-based toolkit mHealth care health child and maternal currently are cases that Use coordination. with partnership in Nepal in deployed include: partners NGO and municipalities a) Antenat c) Maternal and Child Maternal Health Community awareness program program awareness Community Training healers Traditional Curative health services(Major focused: focused: services(Major health Curative Janaki and Surkhet through health Eye Blood nationwide and CareHospitals, Eye Services) and Ambulance (Major services Health Emergency Emergency Cross Red focused: System Trauma Emergency Clinic,Rural E- Strengthening, response and preparedness health b) Organization Organization PHASE Nepal PHASE Mobile Medic DoHS, Annual Report 2075/76 (2018/19) 8 m t a t t - Contact details Contact [email protected] [email protected] mail: email: email: [email protected] Himalaya Dev Sigdel Dev Himalaya Director Country Phone: 4784296 01 Mobile: 9846024430 http://www.nlrnepal.org.np web: Tikabhairab address: office Country 01 (977) Satdobato,Lalitpur Road, 5151371 Director: Country Kandel Shovakhar Website: www.tlmnepal.org E- 9 FY 1 r r 20 / nses for for all nses Nepali Nepali 2018 225,000 USD225,000 sector fosector ( Rs. 2,47,50,000 Budget for health health for Budget Total Expenditure for for Expenditure Total activities program all for 2018: Rs.212,142,438 Expe Total for activities program 2019: NRs. 182,166,300 – - spital in Morang, Morang, Geographical coverage Geographical Green Pasture’s Pasture’s Green Hospital) 18 groups: help Self districts other and CBID Butwal, projects: Dhading, Kapilvastu, Banke, Two provinces provinces Two and 1 Province no Pachhim Pradesh Sudur districts) (23 provinces Both of these and high both include in districts lowendemic burden to of relation by caused disease disability. and leprosy ho Care Tertiary Anandaban,Lele:1 (2): clinics Satellite Butwal and Biratnagar 3 sites: Partner’s (Banke, districts Pokhara Surkhet, Biratnagar, and PRF), - demonstration demonstration programs through Major program focus Major program Reducing disease burden due to due to burden disease Reducing & promotion leprosy, of preventive effectiveness on measure in PEP leprosy through interventions. and prevention Disability management. through Development Inclusive approach. integrated 1. 2. 3. complication (reaction and neuritis) neuritis) and (reaction complication relapse referral (WHO) management, services physiotherapy confirmation, Anandaban Hospital, Lele and Satellite Satellite and Lele Hospital, Anandaban Clinics. leprosy fixing surgery 2.Reconstructive (L therapy regenerative deformities, including appliances supportive provides orthosis/prosthesis clinical recognized 3. Internationally Microbacterium research through and Hospital Anandaban in Laboratory through activities research social Development Inclusive based Community projects leprosy on training technical Essential 4. NLR has adopted the three zero strategies strategies zero three the adopted has NLR and zero disabilities, (zero transmission, the set and pillars major as exclusion) zero period. project this of targets main on; focuses NLR technical and care tertiary 1.Specialist and filariasis leprosy/Lymphatic for support control disability Sri (Bangladesh, global to disability and (NLR Nepal) Organization Organization Netherlands Leprosy Leprosy Netherlands Relief Leprosy Mission The Nepal DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact -1-4374609 | | -1-4374609 W eb: www. hi. org Office address Office International Handicap 233 Marg, Sallaghari Bansbari, Kathmandu. person: Contact Bergogne Willy Director Country +977 Tel: E-mail: [email protected] 9 FY 1 r r 20 / oject Budget 2018 sector fo Budget for health health Budget for - Budget: Total NPR.38,200,880 Expenses: Total NPR.41,701,088 Pr Total £.150,000 Expenses: Total £.150,000 Geographical coverage Geographical Sunsari, Rautahat, Rautahat, Sunsari, Chitwan, Bare, Parsa, Bardiya, Rupandehi, Morang, Lalitpur,Parasi, and Rupandehi Kathmandu. with Nepal over All on specific focus Pradesh Karnali Province: Bagmati Dolakha, Sindhupalchowk, and Nuwakot Rasuwa, Dhading Gandaki Province: Gorkha and Dang 5: Province Banke Sudurpashchim Dadeldhura Province: and Kailali 2: No. Province Dhanusha Province: Bagmati Dolakha and Dhading Basic Physiotherapy and and Physiotherapy Basic Major program focusMajor program Health Health Rehabilitation and Disaster Health Sector Preparedness Health Rehabilitation and velopment (CBID) projects with a focus a focus with projects (CBID) velopment 5. Community based Inclusive Inclusive based 5. Community De livelihood empowerment, on economic and discrimination stigma support, of people integration social and reduction and disabilities other by leprosy, affected Lanka, Netherlands, Mozambique etc.) and and etc.) Mozambique Netherlands, Lanka, non-and governmental national level health through professionals governmental Lele Training Unit, districts. several in people marginalized Activity(PRA) Physical Rehabilitation Health Preparedness Sector Strengthening Capacity and in Earthquake Response in Districts Prone Disaster and Affected Nepal Shifting of Task Integration Through Services Rehabilitation into Mid- Skills Physiotherapy of Basic in Paramedics for Training Providers Level Nepal International Organization Organization Handicap Handicap DoHS, Annual Report 2075/76 (2018/19) m t a t t Contact details Contact 9 FY 1 r r 20 / 2018 sector fo Budget for health health Budget for Total Total Project Budget NPR.62754689.00 Geographical coverage Geographical Six of the most 2015 2015 most Six of the affected earthquake districts: Sindhupalchowk: Chautara Sangachokgadhi Municipality Dhading: Nilkantha Municipality Bhimeswor Dolakha: (Charikot) Municipality Municipality(Jiri) and Jiri Bidur Nuwakot: Municipality Gosainkunda Rasuwa: Rural Municipality Gorkha Gorkha: Municipality Major program focusMajor program Health Health Rehabilitation and Livelihood Inclusive Education Inclusive Preparedness Disaster Facilitate for access of Women and Women of access Facilitate for to Disabilities/Impairments with Children Protection and Social Healthcare EDPs, INGOs and NGOs EDPs, Organization Organization DoHS, Annual Report 2075/76 (2018/19) ANNEXES DoHS, Annual Report 2075/76 (2018/19) a i a i t i 88 DoHS, Annual Report 2075/76 (2018/19) a i a i t i ANNEX 1 Major activities carried out in FY 2075/76 Family Welfare Division Immunization and Child health sections program activities: SN Activities Unit Targets Achieved % 1 Provincial level ToT about National immunization program No. of 7 7 100 and micro planning for EPI focal person and health worker. times 2 FIPV launching and starting in routine immunization No. of 1 1 100 times 3 Training about Importance Child health Card/Immunization No. of 1 1 100 card and its retentioin times 4 Workshop to review and update injection safety policy, No. of 1 1 100 Multi-dose Vial vaccine policy, school td, Rota Vaccine Usage times guideline, vaccine disposal policy and cod chain policy, DQSA Guideline 6 Training about "Khop Kit Bag "and its guideline to No. of 2 2 100 immunization focal person of province and palika level. times 7 Planned and announced for MR-SIA campaign . No. of 1 1 100 times Produced and supplied full immunization certificate No. of 1 100 8 according to the immunization Act.. times 9 Conduction of Outbreak Response Immunization in major No. of 1 1 100 measles outbreak area times 10 Advocacy meeting about sustainable Immunization times 1 1 100 Programme with the members of the parliament, Policy makers, private sectors and civil society 11 Certification of Rubella and Congenital Rubella syndrome No. of 1 1 100 control by WHO SEARO. times 12 Ventilator tranining for staff working in NICU No. of 3 times 13 Provincial level workshop on CBIMNCI program Orientation No. of 7 7 100 and planning times 14 Facility based IMNCI training to health workers of district No. of 4 5 120 hospital times 15 NePeriQIP onsite mentoring for programmed implemented No. of 3 3 100 hospital times 16 SNCU level 2 training for Medical officer and No. of 7 7 100 paramedics/nursing times 17 FBIMNCI training to Medical officer No. of 3 3 100 times 18 Work shop about Early Childhood Development No. of 1 1 100 times 19 Workshop with TU/CTEVT/PU/ curriculum committee about No. of 1 1 100 inclusion and revised CBIMNCI/FBIMNCI content in times respected curriculum IMNCI Program S.No. Activities Unit Targeted Completed % 1 Comprehensive Newborn Care (Level II) Training for batches 6 5 83 Medical Officers 2 FBIMNCI Training for Medical Officers batches 3 3 100 3 FBIMNCI Training for Nursing staffs and Paramedics batches 6 6 100 4 Ventilator training for NICU staffs batches 3 0 0 5 CBIMNCI related guideline revision times 1 1 100 DoHS, Annual Report 2075/76 (2018/19) a i a i t i 6 Workshop with curriculum development center to times 1 1 100 include/ revise IMNCI protocol 7 Early Childhood Development Workshop times 1 1 100 8 CBIMNCI orientation and planning to provinces times 7 0 0 9 Free Newborn Care Program Times 1 1 100 10 Development of IMNCI Training Manuals (Guidelines, Times 1 1 100 Handbooks etc.) 11 Quality Improvement Mentorship Times 20 0 0 12 Procurement of CBIMNCI medicines Times 1 1 100 13 Procurement of SNCU/ NICU equipment Times 1 1 100 14 Monitoring and supervision Times - - 100 Nutrition SN Activities Unit Targets Achieved % 1 National Nutrition Review, Advocacy and workshop with No. of 1 1 100 participation of health workers and allied representatives of times all provinces 2 Regular operation of nutrition technical committee (NUTEC) No. of 1 1 100 meeting (SUAAHARA 1) times 3 Operation of Nutrition Rehabilitation Home for management No. of 1 1 100 of malnourished children (through 8 hospitals: Bheri, Seti, times Mahakali, Dhaulagiri, Lumbini Zonal Hospital, Rapti Sub Regional, MP Surkhet and Kanti Children Hospital). 4 Formation of Province level Multi-sector nutrition and food batch 1 0 - security steering committee and training, orientation to the stakeholders on it 5 Update on National nutrition policy (as per data of National No. of 1 1 100 micronutrient survey status) times 6 Review of Multi-Sector Nutrition Program (15 District - No. of 1 1 100 Taplejung, Sankhuwasabha, Solukhumbu, Bhojpur, Dolakha, times Sindhupalchok, Rasuwa, Rupandehi, Nawalparasi, Gorkha, Lamjung, Syangja, Myagdi, Baglung and Nuwakot) 7 Training to social development/Administrative officer and No. of 1 1 100 local health cordinator (15 District - Taplejung, times Sankhuwasabha, Solukhumbu, Bhojpur, Dolakha, Sindhupalchok, Rasuwa, Rupandehi, Nawalparasi, Gorkha, Lamjung, Lamjung, and Njungu). 8 Nutrition lobby program(Breastfeeding, up to 6 weeks No. of 1 1 100 maternal safety benefits, etc.) times 9 Training and Monitoring to Center-level concerned No. of 1 1 100 Government, Inspectors, private sector stakeholders times regarding the sale and distribution of breast milk substitute act 10 Guideline preparation, updating and printing No. of 1 1 100 National Guidelines on Nutrition Fortification, Child times Nutrition Week, Nutrition Campaign, Day and Special Programs and School Health and Nutrition, Adolescent Nutrition Guideline 11 Comprehensive Nutrition Specific Intervention package and No. of 1 1 100 integrated nutrition-related behavior change communication times and training materials, guideline preparation, printing and distribution (UNICEF) 12 Training of trainers for Comprehensive Nutrition Specific No. of 1 1 100 Intervention (IYCF-MNP, IMAM, Adolescent IFA, SBCC etc.) - times Center level DoHS, Annual Report 2075/76 (2018/19) a i a i t i 13 Monitoring and Supervision of Nutrition Program No. of 1 1 100 times 14 Capacity building for nutrition related stakeholders regarding No. of 1 1 100 disaster risk reduction times Family Planning SN Activities Unit Targets Achieved % 1 Family Planning (FP) current users Couple 3010000 2505645 83 2 VSC expected new acceptors Couple 42300 27150 64 3 IUCD expected new acceptors Couple 48000 22615 47 4 Implant expected new acceptors Couple 95000 100896 100 5 FP program strengthening through DMT, EC, MEC wheel District 15 13 87 6 Micro-planning and response actions implementation in District 3 3 100 low CPR districts 7 Support to satellite clinic for LARC methods Time 306 306 100 Printing of DMT, MEC WHEEL, Time 3 3 100 PARTOGRAPH 10 Support to Institutional Clinic District 24 24 100 Epidemiology and Disease Control Division of all sections program activities: Annual S N Activity Unit Achieve % Target Epidemic Disease Control HR and travel costs for Health team of 4 including 2 1 No. of times 1 1 100 doctors at Tribhuwan International Airport 2 Hiring of staff for official work on agreement No. of times 1 1 100 Cost for RRT mobilization and intra sect oral coordination 3 No. of times 3 3 100 for outbreak control and disaster management Supervision and monitoring for prep Preparedness of 4 No of times 3 3 100 disaster management activities Monitoring of food quality of restaurants located in 5 No. of times 3 3 100 highway Planning meeting at regional level on vector borne 6 disease control, disaster and epidemic and surveillance No of times 5 5 100 activities. 7 Emergency preparedness plan meeting for hospital No. of times 3 3 100 Orientation to health workers on scrub typhus, malaria, 8 No of times 5 5 100 kalaazar including other vector borne diseases Interaction program and health message promotion 9 No. of times 1 1 100 regarding cold and its effects in Terai areas Interaction program with related stakeholders on effect 10 and management of radio nuclear and biochemical No. of times 1 1 100 disaster 11 Purchase of RRT deployment kits No. of times 1 1 100 purchase and deployment of medicine and necessary 12 equipment for epidemic and disaster management in No of times 1 1 100 related district 13 Purchase of diphtheria antitoxin, ARV and other vaccine No. of times 1 1 100 Activities to manage sickle cell anemia in affected 14 No. of times 1 1 100 districts 1 day regional level interaction program to RHD, chiefs of Medical Colleges, chiefs of Regional/Sub-Regional/Zonal 15 No. of times 1 1 100 Hospitals, NPHL, directors of various divisions of DoHS on sickle cell anemia and thalassemia DoHS, Annual Report 2075/76 (2018/19) a i a i t i Annual S N Activity Unit Achieve % Target Various activities to strengthen the implementation of 16 No of times 3 3 100 IHR Form Highway RRT to rescue the casualties in accidents 17 in major highways, orient the highway RRT and prepare No of times 1 1 100 Highway RRT mobilization guidelines Malaria control 1 Evaluation of surveillance conducted by EDCD No. of times 1 1 100 2 Conduct annual national review meetings No. of times 1 1 100 Capacity Building orientation for medical recorders of 3 new and existing sentinel sites and people from EDCD to No. of times 1 1 100 strengthening the reporting system Quality control of 5000 pcs of malaria slides at central 4 level & monitoring of the blood slide samples examined No of times 12 10 83 at districts for quality assurance Multi-sector advocacy meetings at national levels to 5 No. of times 1 1 100 secure support for Malaria elimination 6 Strengthen Malaria technical working group (TWG) No. of times 3 3 100 VAT and other tax for GF/SCI funded capital items and 7 No of times 3 3 100 activities Procurement of Insecticide for Indoor residual spraying 8 No. of times 1 1 100 for malaria control in endemic districts 9 Procurement of LLIN for malaria endemic districts No. of piece 1 1 100 Procurement of medicines and medical goods for malaria 10 No. of times 1 1 100 diagnosis and control Procurement and supply of spare parts for Hudson pump 11 No of times 1 1 100 repairmen 12 Procurement of microscopy for diagnosis of malaria 1 1 100 Kala azar control 1 National review meeting on Kalaazar No. of times 1 1 100 Orientation to medical college, private hospitals, 2 teaching hospitals on treatment procedure and on active No. of times 1 1 100 case detection orientation to district with kalaazar case. Case base surveillance and active case finding of Kala- 3 No of times 1 1 100 azar in districts Procurement and supply of medicines and medical goods 4 No of times 1 1 100 for Kala-azar control Procurement of Insecticide for Indoor residual spraying 5 No of times 1 1 100 in Kala-azar affected districts Natural disaster management Orient RRT on RH promotion in emergency and natural 1 disaster for preparation of district level contingency No. of times 4 4 100 planning Lymphatic Filariasis elimination 1 Printing of IEC material for LF program No. of times 1 1 100 2 Surveillance of LF No. of times 1 1 100 Technical support from central level to districts regions 3 No. of times 1 1 100 in LF elimination programme 4 preparation of documentary on LF No of times 1 1 100 Technical & financial support by LSTM/DFID in LF 5 No. of times 1 1 100 elimination DoHS, Annual Report 2075/76 (2018/19) a i a i t i Annual S N Activity Unit Achieve % Target Financial and technical support from RTI/USAID on LF 6 No. of times 1 1 100 elimination 7 Procurement of DEC Tablet for LF MDA No of Piece 1 1 100 Zoonotic Disease Surveillance in districts having zoonotic disease 1 No. of times 5 5 100 outbreaks Orientation to the medical officers and paramedics on 2 rational use of ARV and case management of dog bites No. of times 5 5 100 and poisonous snakebites Training and orientation to health workers regarding 3 No. of times 5 5 100 snake bites Procurement and supply of ASVS for around 2000 4 No of item 1 1 100 persons to districts Procurement of ARV (Cell culture vaccine) for approx 5 No of item 1 1 100 50,000 persons. Dengue Control Orientation on Dengue and chikungunya fever and 1 No. of times 3 3 100 mosquito larva search and destroy campaign 2 National review meeting on dengue No. of times 1 1 100 Orientation to medical college, private hospitals, 3 No. of times 1 1 100 teaching hospitals on management of dengue case Procurement of RDT including G6PD for diagnosis of 4 No. of times 1 1 100 vector borne diseases Disease Surveillance and EWARS Orientation on EWARS to doctors, health workers and 1 No. of times 3 3 100 medical recorders of sentinel sites Technical review on EWARS for medical recorders of 2 No. of times 2 2 100 sentinel sites 3 Revision of EWARS guideline 2009 No. of times 1 1 100 Evaluation of different disease surveillance activities 4 No of times 3 2 66 being conducted by EDCD Water quality surveillance Preparation of documentary for activities conducted 1 No of times 2 2 100 according to Surveillance guideline 2070 2 Workshop on water safety surveillance at Provincial level No of times 5 5 100 Leprosy Control and Disability Management Section program activities: Annual S N Activity Unit Achieve % Target 1 Purchase of dermatoscope and camera Set 2 2 100 2 Contract of driver and office Assistant Persons 2 2 100 Cooperation with Ayurveda & other medical system for leprosy 3 Times 1 1 100 control program Coordination meeting of Steering, Technical and coordination 4 Times 3 3 100 committees with leprosy and disability related partners 5 Celebration of World Leprosy Day Times 1 1 100 Printing of annual report, program implementation guideline 6 Times 4 4 100 and bulletins 7 Technical monitoring and case validation Times 10 10 100 8 Trimester review meeting Times 2 2 100 DoHS, Annual Report 2075/76 (2018/19) a i a i t i Annual S N Activity Unit Achieve % Target Strengthening & monitoring of Prevention of Impairment and 9 Times 7 7 100 Disability (POID) 10 Surveillance for leprosy and disability prevention Times 2 2 100 11 In depth review of national leprosy program Times 1 1 100 Leprosy orientation for health workers of mini leprosy 12 Times 24 16 66 elimination campaign and skin camp. Conduct reconstructive surgery camp in coordination with 13 Times 5 5 100 supporting partners. 14 Transportation for the distribution/management of MDT Times 3 3 100 Grant to National Disable Fund ( Purchase and distribution of 15 Times 1 1 100 assistive devices) 16 Cooperative grant for national seminar of dermatologists Times 1 1 100 17 Grant for leprosy affected of KhokanaArogya Ashram Times 3 3 100 Nursing and Social Security Division of all Sections program activities: S.N. Activities Unit Targets Achieve % 1. Bi-Annual FCHV Review District 77 77 100.00 district 2 Provincial level Health Orientation for Cooperative Times 7 7 100.00 representatives and it’s members Provinces 3 Provision of free treatment to impoverished citizens as Times 3 0 0 “Bipanna Nagrik Aaushadi Programme”, release of budget as per quarterly 4 Provision of free treatment to “Jaan Andolan Gaite” Times 3 Budget 100.00 citizens, release of budget as per quarterly released as per in 3 quarter Source: NSSD, DoHS Curative Service Division of all sections program activities: 1. NCD program MTOT Places 1 1 50 2. Social Audit TOT Times 1 1 100 Conduct reconstructive surgery camp in coordination with 3. Times 7 7 100 supporting partners in the Centre and province level Coordination meeting of Steering, Technical and 4. coordination committees with leprosy and disability related Times 3 3 100 partners 5. Mental Health TOT Times 1 1 100 6. Celebration of World Leprosy Day Times 1 1 100 7. Surveillance for leprosy and disability prevention Times 2 0 0 8. Peer group Discussion for STP Times 1 1 100 Strengthening & monitoring of Prevention of Impairment 9. Times 5 4 80 and Disability (POID) 10. Monitoring and technical support for disability programs Times 15 12 80 Development and distribution of disability related IEC 11. Times 1 1 100 materials Preparation, printing and distribution National Guideline on 12. Times 1 1 100 disability & rehabilitation 13. National Workshop on Disability Management Times 1 1 100 14. Technical monitoring and case validation Places 10 10 100 15. Continue medical education for doctors on leprosy program Times 2 2 100 16. Purchase of drugs for leprosy complication management Times 1 1 100 DoHS, Annual Report 2075/76 (2018/19) a i a i t i 17. Program monitoring and supervision Places 10 10 100 17.Grant Program for strengthening monitoring of and referral supervision Centre for specialized Places 10 10 100 18. Grant for strengthening of referral Centre for specialized Places 3 3 100 18.service Places 3 3 100 service Curative Service Division renewed 60 hospitals of 51-100 Bedded Curative Service Division renewed 60 hospitals of 51-100 Bedded National Tuberculosis Control Center program activities: National Tuberculosis Control Center program activities: Achieved Achieved SNSN ActivitiesActivities Unit UnitTarget TargetAchievement Achievement % % 1 1 ProcuremetProcuremet of equipments of equipments for Cultrue for Cultrue DST lab DST expansion lab expansion Pieces Pieces3 3 2 266.67 66.67 2 2 ProcuremnetProcuremnet of GeneXpert of GeneXpert machine machine Pieces Pieces18 18 13 1372.22 72.22 3 3 ConstructionConstruction of Chest of Chest Hospital Hospital percent percent60 60 60 60100.00 100.00 4 4 ProcuremnetProcuremnet of Equipment of Equipment for Prevalance for Prevalance Survey Survey Pieces Pieces 1 1 1 1100.00 100.00 5 5 PMEPME workshop workshop of NTP of NTPat national at national level level Times Times3 3 1 133.33 33.33 Basic ZN MicroscpoyTraininng Times 4 100.00 6 6 Basic ZN MicroscpoyTraininng Times 4 4 4100.00 7 Procurement of N95 Mask and personelproctectionutilitise Pieces 11044 3000 27.16 7 Procurement of N95 Mask and personelproctectionutilitise Pieces 11044 3000 27.16 8 Nutritional support to MDR patients person 60 12 20.00 8 Nutritional support to MDR patients person 60 12 20.00 9 Cultrue DST lab Training Times 1 1 100.00 9 Cultrue DST lab Training Times 1 1 100.00 10 Supply ofTB Drug to Medical Store and District Times 3 3 100.00 10 Supply ofTB Drug to Medical Store and District Times 3 3 100.00 11 Broadcasting of TB Related message by National level Television Times 200 100 50.00 Broadcasting of TB Related message by National level Television Times 200 50.00 1112 Revision of Guideline and Recording and Reporting form Times 2 100 2 100.00 1213 RevisionCommomeration of Guideline andof World Recording TB day and Reporting form Times Times2 1 2 1100.00 100.00 1314 CommomerationConditional grant of World to Kalimati TB day Chest hospital Times Times1 3 1 3100.00 100.00 Procurement of Consumable and Chemical for sputum 14 Conditional grant to Kalimati Chest hospital Times Times3 1 3 100.00 100.00 15 Microscopy 1 Procurement of Consumable and Chemical for sputum Times 1 100.00 1516 MicroscopyProcurement of Second Line Drug Times 1 1 1 100.00 Procurement of Falcon Tube Times 1 100.00 1617 Procurement of Second Line Drug Times 1 1 1100.00 18 Precurement of HR for National Referance Laboratory Times 6 6 100.00 17 Procurement of Falcon Tube Times 1 1 100.00 19 GeneXpert Management Training Times 9 6 66.67 18 Precurement of HR for National Referance Laboratory Times 6 6 100.00 20 Procurement of Consumable and Chemical for C/DST Times 1 1 100.00 19 GeneXpert Management Training Times 9 6 66.67 21 Procurement of Digital Xray Film Pieces 1200 1600 133.33 20 Procurement of Consumable and Chemical for C/DST Times 1 1 100.00 22 Internet Installation to DR/GeneXpert Center Institut 60 23 38.33 21 Procurement of Digital Xray Film Pieces 1200 1600 133.33 23 Procurement of First Line Drug TB Times 1 1 100.00 Internet Installation to DR/GeneXpert Center Institut 60 38.33 2224 LQS Training to Lab Personnel Times 4 23 4 100.00 2325 ProcurementClinical Management of First Line DrugTrainig TB to Medical Officer Times Times 1 5 1 3100.00 60.00 2426 LQSProcurement Training to Lab of Personnel Cartidge for GeneXpert Machine Times Pieces 4 470004 21500100.00 45.74 2526 ClinicalTransportation Management ofTB Trainig Drug to to Medical Medical Officer store and District StoreTimes Times5 20 3 2060.00 100.00 2628 ProcurementCourier service of Cartidge for Culture for GeneXpert /DST test Machine Pieces Times47000 500021500 315045.74 63.00 Supervision to TB Teatmet Center Times 90 66.67 2629 Transportation ofTB Drug to Medical store and District Store Times 20 20 60100.00 30 Precurement of Liquid media Times 1 1 100.00 28 Courier service for Culture /DST test Times 5000 3150 63.00 31 Intraction with Stakeholder on TB Program Times 10 2 20.00 29 Supervision to TB Teatmet Center Times 90 60 66.67 32 TB Program monotoring from Province Times 30 30 100.00 30 Precurement of Liquid media Times 1 1 100.00 33 National PME workshop on TB Program Times 2 1 50.00 Intraction with Stakeholder on TB Program Times 10 20.00 3134 DR TB Basic Training Times 4 2 1 25.00 32 TB Program monotoring from Province Times 30 30 100.00 33 National PME workshop on TB Program Times 2 1 50.00 34 DR TB Basic Training Times 4 1 25.00 DoHS, Annual Report 2075/76 (2018/19) a i a i t i National AIDS and STI Control Center program activities: SN Activities Unit Targets Achievement % 1 Procurement of viral load machine, reagents Time 1/2 50 and accessories 1 2 IBBS study among male labor migrants event 1 0 0 throughout the country 3 DHIS -2 tracker training to ART counselor lot 2 2 100 4 Early warning indicator workshop for capacity lot 0 0 building to ART counselor 2 5 Procurement of HIV test kits event 1 1 100 6 Procurement of the ART drugs event 1 1 100 7 Procurement of STI/OIs drugs event 1 1 100 8 Procurement of nutrition pitho event 1 0 0 9 Procurement of the CD4 reagents event 1 1 100 10 Capacity building training on HIV recording and lot 1 100 reporting to ART counselor 1 11 HIV guideline update and print event 1 0 0 12 AIDS conference event 1 0 0 13 PMTCT guideline update and print event 1 1 100 14 STI syndromic case management training lot 4 4 100 15 Training to medical officer on Hepatitis c lot 1 0 0 16 CMT training manual print event 1 0 0 17 DHIS-2 strengthening training lot 1 1 100 18 AIDS day celebration event 1 1 100 19 CMT training to MO, and ART counselor lot 3 3 100 20 Meta analysis on MSM/TG event 1 1 100 21 Meta analysis on PWIDs event 1 1 100 22 Logistic data review lot 1 1 100 23 PMTCT TOT lot 3 3 100 24 Monitoring and supervision for HIV program event 12 12 100 Source: NCASC National Health Training Center program activities: SN Activities Unit Targets Achieved % 1 Pediatric Nursing Care Training Person 70 73 104 2 X-ray User Maintenance Training Person 10 10 100 3 Anesthesia Assistant Training (HA, SN) Person 10 10 100 4 Palliative Care Training (Doctors, Nurses) Person 58 67 115 5 Induction Training for newly appointed health officers Person 160 180 112 6 Medico-legal Training (Doctors) Person 100 75 75 7 Safe Abortion Training Person 40 39 97.5 8 Basic IUCD Training Person 30 30 100 9 Transaction Accounting and Budget Control System Training Person 100 40 40 10 Screening of pre-cancer/lesion VIA/CRAYO for HW training Person 50 51 102 11 Gender Based Violence Training for Health Service Providers Person 100 100 100 12 Lab users maintenance Training Person 10 10 100 13 Cold chain users maintenance training Person 10 10 100 14 ICU training (nurses) Person 30 30 100 15 Trainer's review and refresher meetings Batch 5 5 100 16 Mental Health training for MO/HA( Prescriber) Person 25 25 100 17 Training Need Assessment (TNA) Batch 5 5 100 18 Trainer's pool preparation for different training Batch 5 5 100 19 TOT for Infection prevention and control (central and Person 25 42 168 provincial) 20 CTS Training Person 32 50 156 DoHS, Annual Report 2075/76 (2018/19) a i a i t i 21 Operation Theater Technique and Management(OTTM) Person 40 33 83 (nurse) 22 Diploma Training in Biomedical 24 and continuation of Person 48 48 100 2073/74 (24) 23 Rural Ultrasound training (SN) Batch 3 3 100 24 SBA Person 100 117 117 25 NICU management training (MO, SN) level 2 Person 50 52 104 26 ASBA Training Person 20 16 80 27 PPIUCD Training (Nursing staff) Person 20 31 155 28 NSV Self Paced Learning Approach Person 10 0 0 29 Vasectomy Training (MO, Group wise) 12+5 days Person 50 46 92 30 Minilab Training (MO/SN) 12 / 5 days Person 60 48 80 31 Implant Training (Nursing staff / paramedics) Person 100 90 90 32 CoFP (FP service provider) Person 48 51 106 33 ASRH Training Person 90 95 105 34 Printing training materials of different training Times 6 6 100 35 Transportation of training materials of different training in Times 5 5 100 training sites 36 Follow up Enhancement Program Times 7 5 71 37 Training materials development and revision Times 10 15 150 38 To Ton NCDs (PEN Package) for MO/HW Person 75 124 165 National Health Education Information and Communication Center program activities: SN Activities Unit Targets Achieved % 1 Communication program for Control of risk factors of NCDs times 12578 7270 58 including tobacco control 2 Health promotion program’s national commitment message times 2250 2250 100 dissemination on Merobarsha pratibaddhata; swasthya prati jimmewar : samriddhiko aadhar 3 Communication program and daily monitoring of newspaper times 4500 4500 100 about epidemic disease control and prevention. 4 Broadcasting of Jeevan chakra and public health debate times 820 820 100 through NTV. 5 Airing of health messages and public health radio program times 2032 2032 100 through Radio Nepal 6 Continuation and implementation of Health news desks times 1 1 100 7 Conduction of health literacy campaign program times 10 10 100 8 Dissemination of messages and information through popular times 30 30 100 online media 9 Publication of health related messages and notices through times 35 35 100 national newspapers 10 SMS, Apps and IVR services through information technology times 3 1 33 center 11 IEC/BCC material development technical assistance, times 1000 10 1 coordination, supervision and template development and distribution in provincial and local level 12 Awareness communication program for FP, SM and neonatal times 50000 50000 100 health 13 Awareness and orientation package development on anti- times 7000 5775 83 microbial resistance 14 Communication programme on child health nutrition promotion times 5000 4996 100 15 Dissemination of public health messages through nepal television times 865 570 66 and radio nepal during epidemic outbreak and disaster. 16 Risk communication program during epidemic outbreak and times 1000 986 99 disaster. DoHS, Annual Report 2075/76 (2018/19) a i a i t i 17 Production and dissemination of maternal service communication times 100000 97935 98 program 18 Health promotion brain death, kidney and organ donation related times 6000 4969 83 communication program with the coordination of organ transplant centre. 19 Health awareness and communication program on mental health times 3000 3000 100 and birth defect 20 Broadcasting of health messages and information through national times 2300 2300 100 private televisions 21 Hiring of communication officer, secretariat assistant and driver times 3 3 100 for golden 1000 days promotion program. 22 Communication program for golden 1000 days promotion. times 5000 4767 95 23 Supervision and facilitation of health promotion program in times 139 114 82 provincial and local level National Public Health Laboratory program activities: SN Activities Unit Targets Achieved % 1. Procurement of Real Time PCR machine for Non- Piece 1 1 100 communicable diseases 2. Procurement of barcode machine and PVC card printer Piece 2 2 0 3. Construction of waiting room for patients Site 1 1 96.88 4. Procurement of server for National Blood Program software Piece 1 1 49.5 5. Procurement of fully automated biochemistry analyzer and Piece 2 2 76.46 haematology analyzer machine 6. Procurement of equipment for establishment of molecular Piece 1 1 75.37 bacteriology lab 7. Training on equipment application for equipment Person 30 30 96.58 distribution those were procured on FY 2074/75 8. Hiring microbiologists to operate regional based labs in Person 5 20 96.33 Koshi, Janakpur, Seti, Bheri and Pokhara 9. Training on bacteriology for Medical laboratory Technicians person 20 20 98.43 to operate bacteriology lab in District Hospitals. 10. Quality control management for all laboratories and BTSCs number 3 3 99.96 in Nepal. 11. Procurement of equipments and kits chemicals for National time 3 3 99.71 Influenza Centre 12. Publication of guidelines and brochures Time 1 1 91.76 13. Development of Health Laboratory Registry System software Time 1 1 88.14 14. Accreditation of laboratory time 1 1 34.49 15. Barcode management for laboratory service security and Piece 3 3 44.28 quality 16. Transportation of laboratory related equipment and Piece 3 3 100 chemicals to Health Post, District Hospitals, Zonal Hospital and Regional and Sub-regional Hospitals 17. Training program on accreditation related biosafety and time 3 3 47.28 biosecurity for laboratory staffs 18. ToT training on operating specialized laboratory services for Person 14 14 99.67 Provincial Laboratory based staffs 19. Operation of diagnostic services in epidemic situation Time 3 3 93.34 DoHS, Annual Report 2075/76 (2018/19) a i a i t i 20. Operation expenses for NBBTS and for quality improvement time 3 3 97.99 in blood transfusion services 21. Research programs in NPHL time 3 3 56.27 22. Participation of International Quality Control Program Time 3 3 61.89 23. Management of sickle cell disease surveillance Time 3 3 95.89 24. Monitoring and evaluation of government based hospitals, Times 600 600 99.85 private hospitals and blood transfusion service centres 25. SMO contract of Medical Lab Technologist for sickle cell Time 5 5 87.22 program in Koshi, Lumbini, Seti, Bheri Hospitals and NPHL 26. Viral load test for Hep B and C Time 3 3 100 Management Division of all Sections program activities: SN Activities Unit Targets Achieved % 1 Repair and maintenance of physical infrastructure under the Times 8 8 100 department of health services 2 Arrangements of spare parts not listed in repair and Times 3 3 100 maintenance of tools and equipment as per the need 3 Repair and maintenance of Medical and cold chain tools Times 3 3 100 and equipment including reimbursement of remaining expenses 4 Human resource Management: Store Assistant- 2, Civil and Person 16 16 100 Mechanical Enginee-r 2, Data Analyst- 1, Office Assistant- 3, Computer Assistant -1, Driver -4, Sweeper (part-time) - 3 5 Human Resource Management for PAM Unit, 9-Biomedical Person 10 10 100 Engineers and 1-Public Health Officer 6 Financial administration and Irrugulatation including Times 2 2 100 conduction of staff capacity building programs 7 Monitoring and supervision of repair and maintenance of Times 3 3 100 tools and instruments/equipment by biomedical engineer and PAM unit 8 Inquiry and admission into the hospitals for treatment of Times 3 3 100 injured in people's movement 9 Follow-up and monitoring of minimum service standards of Times 3 3 100 district level hospital and mutual fund matching 10 Development and modification including publication of new Times 3 3 100 policies, rules, directives and other documents 11 Monitoring, inspection and interaction with private, Times 3 3 100 government as well as non-government hospitals 12 Central level assistance and coordination visit to state and Times 3 3 100 local level review meetings 13 Package development and follow-up for oral health care Times 3 3 100 services under PHC settings 14 Basic / Refresher Training of Medical Recording related to Times 1 1 100 ICD-10 15 Printing of annual report of the DoHS, HMIS records, reports, Times 3 3 100 monitoring forms and monitoring booklets as well as reimbursement of past dues. 16 Expenses for conduction of coordination meetings with Times 15 15 100 committees , divisions and sections as specified by different directives DoHS, Annual Report 2075/76 (2018/19) a i a i t i 17 Conduction of activties related to federal, provincial and Times 3 3 100 local level throgh PPP model 18 Training including material development related to Server Times 3 3 100 Management, DHIS 2, HMIS, PHAT 19 Monthly, bi-monthly and quarterly review and planning Times 3 3 100 activities of the Department of Health Services 20 Integrated supervision of health care programs Times 200 200 100 21 Fund availability and reimbursement of remaining dues of Times 3 3 100 last FY to listed hospitals to provide services for poor citizen DoHS, Annual Report 2075/76 (2018/19) g am a g t Annex 2: Program Targets for FY 2076/77 Family Welfare Division: (1) Child Health and Immunization section program activities: SN Activities Unit Target 1 MR Guidelines and IEC materials preparation and printing times 1 2 Procurement of vaccine and vaccine related materials, Vaccine carrier, icepack, times 1 refrigerator, cold box, 3 Advocacy meeting about sustainable financial management of Immunization times 1 Programme with the members of the parliament, Policy makers, bankers, industrialist, businessman, private sectors and civil society 4 Provincial level ToT about National immunization program and micro planning for Batch 7 EPI focal person and health worker. 5 1 days orientation to media person about NIP and AEFI central and province times 2 6 MR campaign Launching times 1 7 High level personal and media orientation about MR campaign on central level times 1 8 Development of immunization fund for sustainable immunization program times 1 9 DQSA training for Low coverage and high dropout districts times 1 10 Briefing High level officers, MoHP and national Immun. Committee, Stake batch 1 holders and partners about Rota vaccine and hygiene promotion program introduction 11 Rota vaccine and hygiene promotion program launching times 1 12 2 days orientation to Medical officer, Medias and paediatrician about A.E.F.I in all batch 13 province 13 Media, Doctors, trade union and health workers Orientation about MR Campaign batch 7 2076 to all 7 province 14 4 days Health workers training for private institutions/palikas ( 200 no.) about batch 8 NIP, immunization session management ,EVM and vaccine and cold management. 15 Orientation training on utilization and retention of Child health card/ Full batch 2 immunization card for some districts of province 3 and 2. 16 Introduction of HPV vaccine times 1 17 KMC strategy and guidelines Preparation times 1 18 KMC corner establishment Place 5 19 IMNCI RDQA Training 20 FBIMNCI Training batch 3 21 SNCU training for Medical Officer batch 9 22 SNCU reporting recording training batch 7 23 TOT on POCQI times 1 24 Early Child hood Development workshop times 1 25 Research on New born and Child health times 1 Family Welfare Division: (2) Nutrition section program activities: SN Activities Unit Targets 1 National Nutrition Program Review (Two Days) – with participation of Nutrition No. of 3 Representative of all provinces times 2 Two-day capacity enhancement program of staff employed in the nutrition No. of 1 rehabilitation house times 3 Review and plan formulation of Multi-Sector Nutrition and Food security No. of 1 Directive Committee and stake holders All provinces times 4 MToT on Comprehensive Nutrition Specific Intervention package for Health No. of 9 Cordinator and Focal person of Social Development Ministry Basic Health times Nutrition Package (18 District-Taplejung, Bhojpur, Sangja, Magdie, Palpa, Rupandehi, Gulmi, Arghakhanchi, Banke, Puthanjan, Dang, Salan, Kailali, etc.) 5 MToT on Comprehensive Nutrition Specific Intervention package for Health No. of 15 DoHS, Annual Report 2075/76 (2018/19) g am a g t Cordinator of 30 MSNP districts times 6 capacity building with concerned stakeholders on the sale and distribution of times 6 breast milk products. 7 Celebrate National Day / Month on nutrition related Programs (Breastfeeding No. of 4 Week, School Health and Nutrition Week, Iodine Month etc.) times 8 Preparation, refinement and printing of training directory for nutrition programs, No. of 1 preparation, modification and updating of micronutrient guidelines based on times nutrition strategies. 9 Monitoring and Supervision of Nutrition Programs times 2 10 Orientation, capacity building and Planning of Disaster Risk Reduction batch 1 11 Operation of Nutrition Rehabilitation Home for malnutrition management No. of 1 (through hospital: Bheri, Koshi, Narayani, Bharatpur, Sagarmatha, Pokhara Health times Sciences Foundation, Rapti Health Sciences Academy, Dadeldhura Hospital and Kanti Children Hospital). 12 Purchase of Laptop and LCD for Nutriton Section times 1 13 Purchase and distribution of nutritional materials (Vit A, RUTF / RUSF, f75, F100, No. of 1 Resomal, Albendazole, MNP, Rapid Test Kit, Height / weight Machine, Shakir's times Tape (MUAC), dummy baby and mother for breast feeding) 14 Orientation to social development Ministers team about nutrition program and No. of 1 intervention to all provinces times 15 Mother Baby Friendly Hospital (MBFHI)- 5 hospital times 1 16 Program for the Health and Education Parliamentary Committee for No. of 1 breastfeeding / nutrition promotion times 17 Production and promotion of audio-visual material to enhance nutritional No. of 1 capacity of health workers times Family Welfare Division :(3) Newborn and IMNCI program activities: SN Activities Unit Target 1 Procurement of equipment for CBIMNCI program times 1 2 Procurement of SNCU/ NICU equipment times 1 3 Procurement of equipment for KMC units and KMC corners times 1 4 Development of Prematurity ( KMC) Guideline times 1 5 Development of FBIMNCI/ Newborn Coaching/ Mentoring Guideline times 1 6 Facility Based IMNCI (FB-IMNCI) ToT batch 3 7 Revision of national newborn health strategy and plans batch 2 8 FBIMNCI/Newborn Care Coaching/ Mentoring Training times 2 9 Development of Early Childhood Development Guideline times 1 10 Mentoring for SNCU/ NICU staffs times - 11 IMNCI Training for health workers in province and health offices times 7 12 Comprehensive Newborn Care (Level II) Training for MOs times 9 13 Free Newborn Care Program No. of Hosp 107 14 Research on Newborn and IMNCI related program times 2 15 ToT on Point of Care Quality Improvement (POCQI) batch 1 16 IMNCI Routine Data Quality Assessment (RDQA) ToT batch 1 Epidemiology and Disease Control program activities: Annual S N Activity Unit Target Establishment of health desk at international airport and strengthen existing 1 No. of times 1 health desk 2 Procurement of microscopy for diagnosis of malaria Quantity 11 3 Deployment of health worker team at Tribhuwan International Airport No. of times 3 DoHS, Annual Report 2075/76 (2018/19) g am a g t Annual S N Activity Unit Target 4 Hiring of staff for official work on agreement No. of times 3 5 Conduct national annual review on Malaria, dendue and kalaazar No. of times 3 6 Conduct national workshop on free hydrocele surgery and planning meeting No. of times 1 conduction of orientation, review and planning meeting with provincial 7 No. of times 1 authorities and medical colleges on NCD and mental health 8 conduction of various activities based on IHR-2002 No of times 1 Review and revision of RRT, outbreak response and control of communicable 9 No of times 1 disease guideline based on federal context Review and planning on zoonotic diseases focus on sankebite and rabies 10 No of times 1 treatment center. 11 Multisectoral workshop on Onehealth No of times 1 12 Mapping and prioritization of zoonotic diseases No of times 1 13 Formation of TWG on Zoonotic diseases and conduction of meetings No of times 1 orientation to different health institutions including medical colleges(doctors 14 No of times 1 and paramedics) for influenza management preparation and demonstration to hospitals on epidemic disaster and 15 No of times 3 response 16 Review meeting on Early Warning and Reporting System (EWARS) No of times 2 17 Formation of TWG on EWARS and conduction of meetings No of times 1 18 Study and improvement on EWARS No of times 1 19 Integrated vector surveillance on malaria, kalaazar, dengue, JE etc No of times 3 20 Conduction of Mass Drug Administration (MDA) for Lymphatic Filarisis No of times 1 Interaction program with related stakeholders on effect and management of 21 No. of times 1 radio nuclear and biochemical disaster 22 Purchase of RRT deployment kits No. of times 1 23 Purchase of diphtheria antitoxin, ARV and other vaccine No. of times 1 24 Activities to manage sickle cell anemia in affected districts No. of times 1 Procurement of Insecticide for Indoor residual spraying for malaria control in 25 No. of times 1 endemic districts 26 Procurement of LLIN for malaria endemic districts No. of piece 1 Procurement of medicines and medical goods for malaria diagnosis and 27 No. of times 1 control Technical support from central level to lower levels in LF elimination 28 No. of times 1 programme 29 Procurement of DEC Tablet for LF MDA No of Piece 1 30 Procurement and supply of ASVS for around 2000 persons to districts No of item 1 31 Procurement of ARV (Cell culture vaccine) for approx 50,000 persons. No of item 1 Leprosy Control and Disability Management activities: Annual S N Activity Unit Target 1 Trimester review on leprosy Times 3 DoHS, Annual Report 2075/76 (2018/19) g am a g t Annual S N Activity Unit Target 2 Transportation for the distribution/management of MDT Times 3 3 Celebration of World Leprosy Day Times 1 4 Printing of annual report, program implementation guideline and bulletins Times 4 Development of information system for disability, skin disease, injury and 5 Times 1 leprosy 6 Technical monitoring and case validation Times 7 Surveillance for leprosy and disability prevention Times 2 8 Orientation, planning, monitoring on post exposure prophylaxis in province Times 3 Leprosy orientation for health workers of mini leprosy elimination campaign 9 Times 24 and skin camp Conduct reconstructive surgery camp in coordination with supporting 10 Times 5 partners. Grant for leprosy affected of Khokana, Pokhara, Kapan and 11 Times 3 BudhanilkanthaArogya Ashram Nursing and Social Security Division program activities: S.N. Activities Unit Targets 1. Develop nirdesika for deployment of one nurse in every school for the management Times 1 of school health program 2. Develop guideline and standard regarding home based health care services Times 1 3. Develop e-based training package on geriatric care for health workers Times 1 4. Develop clinical protocols on chemotherapy preparation and administration, fistula Times 3 puncture and hemodialysis, ventilator care 5. Deploy nine midwives in hospitals and provide safe motherhood and midwifery Times 9 services 6. Provision of scholarship to PCL and bachelor midwives to prepare midwife as Times 30 required by Nepal 7. Develop ten continue professional development module and piloting of it in two Times 12 federal hospitals 8. Development of action plan and implementation of clinical audit program Times 1 9. Revise and update the job description of all level health workers Times 1 10. Health and nursing care service support program in government secondary schools Times 30 for school children and adolescents including menstrual hygiene management 11. Capacity assessment of nurses working in safe motherhood area and develop Times 2 standard bridge course to develop professional midwives 12. Conduct policy dialogue in Federal and Province level for nursing and midwifery Times 4 services 13. Capacity development of nurses working in hospitals running geriatric ward and Times 1 geriatric homes on geriatric care 14. Develop infection prevention and control web based training package and develop Times 2 capacity of nurses on IPC 15. Celebrate, advocate and interact on Nursing and FCHV day Times 2 16. Revision of Gender based violence clinical protocol Times 1 17. Facilitation, review, orientation and onsite mentorship for hospital and it’s staff Times 8 especially providing geriatric and GBV service 18. Regular supervision and monitoring of hospitals for quality nursing service Times 40 19. Integrated supervision of health institutions that providing SSU, OCMC, Geriatric care Times 30 and reaching the unreached program 20. Reimbursement and payment of fund quarterly to the hospitals that is listed under Times 3 impoverished citizen treatment scheme (including previous Fiscal Year due) Source : NSSD, DoHS DoHS, Annual Report 2075/76 (2018/19) g am a g t Curative Service Division: (1) Hospital Services monitoring and strengthening program activities: SN Activities Unit Targets 1 Continuous supervision and monitoring of the hospitals for optimum quality number 95 service 2 Minimum Service Standards (MSS) implementation and follow-up in hospitals number 94 3 Formulate standard treatment protocol (STP) of diseases number 2 4 Telemedicine service extension number 1 5 registration, renewal and regulation of the specialized and tertiary level number 90 hospitals 6 Pharmacy Service strengthening in federal hospitals number 10 7 Digitalization of MSS recording and reporting system Times 1 Curative Service Division: (2) Basic & Emergency Management Section program activities: SN Activities Unit Targets 1 Modification and extension of basic health care services based on the emergence Time 1 of diseases, availability of financial resources and local needs 2 Supervision, monitoring and evaluation of the quality of basic health services Time 1 3 Formulation of Protocol for strengthening the Emergency services. Time 1 4 Develop and implementation of Basic Health Service Package Time 1 5 Develop and implementation Emergency Service Package Time 1 Curative Services Division: (3) IENT and Oral Health Section program activities: SN Activities Unit Targets 1 Establishment of Eye OPD in federal hospitals number 10 2 MTOT to Dental surgeons about oral health times 5 3 Training on Oral health and facial injuries to dentist working in federal hospitals times 5 National Tuberculosis Control Center program activities: SN Activities Unit Target 1 Procuremet of equipments for Cultrue DST lab expansion Pieces 3 2 Procuremnet of GeneXpert machine Pieces 18 3 Construction of Chest Hospital person 60 4 Procuremnet of LPA machine Pieces 2 5 PME workshop of NTP at national level Times 3 7 Basic ZN MicroscpoyTraininng Times 4 8 Procurement of N95 Mask and personelproctectionutilitise Pieces 11044 9 Nutritional support to MDR patients person 60 10 Cultrue DST lab Training Times 1 11 Supply ofTB Drug to Medical Store and District Times 3 12 Broadcasting of TB Related message by National level Television Times 200 13 Revision of Guideline and Recording and Reporting form Times 2 14 Active Case Finding Program Times 3 15 Conditional grant to Kalimati Chest hospital Times 3 16 Procurement of Consumable and Chemical and Regent for sputum Microscopy Times 1 17 Procurement of Second Line Drug Times 1 18 Procurement of Falcon Tube Times 1 19 Extension of Warranty of GeneXpert Machine Times 10 20 GeneXpert Management Training Times 9 21 Income Generation Training to DRTB Patient Times 1 22 Procurement of Digital Xray Film Pieces 1200 23 Internet Installation to DR/GeneXpert Center Institut 60 24 Procurement of First Line Drug TB Times 1 25 Establishment of Quality Control Center in Province 2 and Province 5 Place 2 26 LQS Training to Lab Personnel Times 4 27 Clinical Management Trainig to Medical Officer Times 5 DoHS, Annual Report 2075/76 (2018/19) g am a g t SN Activities Unit Target 28SN Procurement of Cartidge for GeneXpertActivities Machine PiecesUnit 47000Target SN Activities Unit Target 2928 TransportationProcurement of ofTB Cartidge Drug tofor Medical GeneXpert store Machine and District Store TimesPieces 4700020 28 Procurement of Cartidge for GeneXpert Machine Pieces 47000 3029 CourierTransportation service forofTB Culture Drug to/DST Medical test store and District Store TimesTimes 500020 29 Transportation ofTB Drug to Medical store and District Store Times 20 3130 SupervisionCourier service to TB for Teatmet Culture Center/DST test TimesTimes 500090 30 Courier service for Culture /DST test Times 5000 3231 NationalSupervision PME to workshop TB Teatmet on CenterTB Program TimesTimes 290 31 Supervision to TB Teatmet Center Times 90 3332 IntractionNational PME with workshop Stakeholder on onTB TBProgram Program TimesTimes 102 32 National PME workshop on TB Program Times 2 3433 DRIntraction TB Basic with Training Stakeholder on TB Program TimesTimes 410 33 Intraction with Stakeholder on TB Program Times 10 34 DR TB Basic Training Times 4 34 DR TB Basic Training Times 4 National AIDS and STI Control Center program activities: National SN AIDS and STI Control Center programActivities activities: Unit Target National AIDS and STI Control Center program activities: SN 1 Procurement ofXene Export machineActivities , Refrigerator van , reagents and eventUnit Target SN Activities Unit Target 1 accessoriesProcurement ofXene Export machine , Refrigerator van , reagents and event 1 1 Procurement ofXene Export machine , Refrigerator van , reagents and event 2 IBBSaccessories survey among male labor migrants throughout the country event 11 accessories 1 32 DHISIBBS survey-2 tracker among training male for labor counselors migrants and throughout others the country timesevent 71 2 IBBS survey among male labor migrants throughout the country event 1 43 ProcurementDHIS -2 tracker of trainingHIV test forkits counselors and others eventtimes 17 3 DHIS -2 tracker training for counselors and others times 7 54 Procurement ofof theHIV ARV test drugskits eventevent 11 4 Procurement of HIV test kits event 1 65 Procurement ofof theSTI/OIs ARV drugs drugs eventevent 11 5 Procurement of the ARV drugs event 1 76 Procurement ofof the STI/OIs CD4 drugsreagents eventevent 11 6 Procurement of STI/OIs drugs event 1 87 ToTProcurement on STI of the CD4 reagents eventevent 21 7 Procurement of the CD4 reagents event 1 98 STIToT syndromic on STI case management training eventlot 42 8 ToT on STI event 2 109 TrainingSTI syndromic to medical case officermanagement on Hepatitis training B and c lotlot 24 9 STI syndromic case management training lot 4 1110 CMTTraining training to medical manual officer print on Hepatitis B and c eventlot 12 10 Training to medical officer on Hepatitis B and c lot 2 1211 AIDSCMT daytraining celebration manual print eventevent 11 11 CMT training manual print event 1 1312 CMTAIDS ToTday forcelebration provincial facilitators eventlot 31 12 AIDS day celebration event 1 1413 LogisticCMT ToT data for reviewprovincial facilitators lotlot 13 13 CMT ToT for provincial facilitators lot 3 1514 PMTCTLogistic TOT data review lotlot 31 14 Logistic data review lot 1 1615 MonitoringPMTCT TOT and supervision for HIV program eventlot 123 15 PMTCT TOT lot 3 1716 DevelopmentMonitoring and of supervisionHepatitis Strategy for HIV program eventevent 112 16 Monitoring and supervision for HIV program event 12 1817 NationalDevelopment Program of Hepatitis review on Strategy HIV,STD including HEP c for health workers eventlot 11 17 Development of Hepatitis Strategy event 1 19`18 DevelopmentNational Program of guideline review onof HIVHIV,STD an STD including HEP c for health workers eventlot 11 18 National Program review on HIV,STD including HEP c for health workers lot 1 2019` DataDevelopment Quality assessment of guideline of HIV an STD eventevent 11 19` Development of guideline of HIV an STD event 1 2120 StudyData Quality on Identification assessment of discrimination of PLHIV eventevent 11 20 Data Quality assessment event 1 2221 ReviewStudy on of Identification National HIV strategyof discrimination of PLHIV eventevent 11 21 Study on Identification of discrimination of PLHIV event 1 2322 EstablishmentReview of National of IT platformHIV strategy using social media for PLHIV eventevent 11 22 Review of National HIV strategy event 1 23 Establishment of IT platform using social media for PLHIV event 1 23 Establishment of IT platform using social media for PLHIV event 1 National Health Training Center program activities: NationalSN Health Training Center program activities:Activities Unit Target National Health Training Center program activities: SN Training Material Development SectionActivities Unit Target SN Activities Unit Target 1 LearningTraining MaterialResource DevelopmentPackages (LRP) Section Development and revision Times 7 Training Material Development Section 1 SkillLearning Development Resource SectionPackages (LRP) Development and revision Times 7 1 Learning Resource Packages (LRP) Development and revision Times 7 1 AdvancedSkill Development Skilled Birth Section Attendants Training for doctors (ASBA Training) Person 16 Skill Development Section 21 RuralAdvanced Ultrasound Skilled TrainingBirth Attendants (Staff Nurse) Training for doctors (ASBA Training) PersonPerson 2016 1 Advanced Skilled Birth Attendants Training for doctors (ASBA Training) Person 16 32 PediatricRural Ultrasound Nursing CareTraining Training (Staff (Staff Nurse) Nurse) PersonPerson 7020 2 Rural Ultrasound Training (Staff Nurse) Person 20 43 DiplomaPediatric in Nursing Biomedical Care EquipmentTraining (Staff Engineering Nurse) (DBEE) training for 24 persons and PersonPerson 2470 3 Pediatric Nursing Care Training (Staff Nurse) Person 70 4 continuationDiploma in Biomedical of 24 persons Equipment from FY Engineering 2074/75 (DBEE) training for 24 persons and Person 24 4 Diploma in Biomedical Equipment Engineering (DBEE) training for 24 persons and Person 24 5 Inductioncontinuation training of 24 for persons newly fromappointed FY 2074/75 health officers Person 55 continuation of 24 persons from FY 2074/75 65 MedicoInduction-legal training training for fornewly Doctors appointed health officers PersonPerson 12055 5 Induction training for newly appointed health officers Person 55 76 OperationMedico-legal Theater training Management for Doctors Training (OTTM) for Nurses PersonPerson 40120 6 Medico-legal training for Doctors Person 120 87 NewOperation Born IntensiveTheater ManagementCare Unit (NICU) Training Management (OTTM) forTraining Nurses (Staff Nurse/Nursing PersonPerson 10040 7 Operation Theater Management Training (OTTM) for Nurses Person 40 8 Officers)New Born Level Intensive 2 Care Unit (NICU) Management Training (Staff Nurse/Nursing Person 100 8 New Born Intensive Care Unit (NICU) Management Training (Staff Nurse/Nursing Person 100 9 IntensiveOfficers) LevelCare Unit2 (ICU) Training for Nurses Person 30 Officers) Level 2 109 ToTIntensive on screening Care Unit for (ICU) pre- Training cancer lesion for Nurses of Cervix/ VIA/CRAYO for Medical and PersonPerson 6030 9 Intensive Care Unit (ICU) Training for Nurses Person 30 10 NursingToT on screening staffs for pre- cancer lesion of Cervix/ VIA/CRAYO for Medical and Person 60 10 ToT on screening for pre- cancer lesion of Cervix/ VIA/CRAYO for Medical and Person 60 11 Trainer'sNursing staffs pool preparation by enhancing competency of different clinical trainers Batch 5 11 Trainer'sNursing staffs pool preparation by enhancing competency of different clinical trainers Batch 5 11 Trainer's pool preparation by enhancing competency of differentDoHS, clinical Annual trainers Report 2075/76Batch (2018/19)5 g am a g t SNSN ActivitiesActivities UnitUnit TargetTarget 1212 MTOTMTOT on on Road Road Traffic Traffic Accident Accident (RTA) (RTA) and and Safety Safety TimesTimes 33 1313 MTOTMTOT on on Occupational Occupational Health Health and and Safety Safety TimesTimes 22 1414 MTOTMTOT on on Climate Climate Change Change and and Health Health Impact Impact TimesTimes 33 1515 TOTTOT for for health health workers workers to to orient orient members members of of Health Health Facility Facility Operation Operation and and TimesTimes 77 ManagementManagement Committee Committee (HFOMC)/Province (HFOMC)/Province level level 1616 TOTTOT on on Anti Anti-Microbial-Microbial Resistance Resistance (AMR) (AMR) prevention prevention TimesTimes 77 1717 ClinicalClinical Training Training Skills Skills (CTS) (CTS) training training PersonPerson 6464 1818 AnesthesiaAnesthesia Assistant Assistant (AA) (AA) Training Training for for HA/SN HA/SN PersonPerson 1010 1919 PalliativePalliative care care training training for for doctors doctors and and nurses nurses PersonPerson 6464 2020 TrainingTraining on on accounting/ accounting/ online online recording recording reporting/ reporting/ TABUCS TABUCS for for account account staffs staffs PersonPerson 5050 21 21 TOTTOT on on Mental Mental Health Health for for Medical Medical Officers/Health Officers/Health Workers Workers TimesTimes 33 22 22 TOTTOT on on Package Package of of Essential Essential Non Non-communicable-communicable diseases diseases (PEN) (PEN) TimesTimes 66 2323 TOTTOT on on role role of of health health workers workers to to response response Gender Gender Based Based Violence Violence (GBV) (GBV) BatchBatch 22 2424 TrainingTraining for for health health workers workers on on Burn Burn Care Care Management Management BatchBatch 77 2525 Advocacy/OrientationAdvocacy/Orientation meetings meetings on on climate climate change change and and health health impacts impacts with with policy policy TimesTimes 77 makersmakers of of all all 7 7 provinc provincee TrainingTraining Accreditation Accreditation and and Regulation Regulation Section Section 11 ReviewReview and and Refresher Refresher workshop/meetings workshop/meetings with with trainers trainers of of different different trainings trainings TimesTimes 77 22 PreparationPreparation of of training training accreditation accreditation and and regulation regulation guideline/protocol guideline/protocol TimesTimes 55 33 InformationInformation collection collection for for trainer's trainer's pool pool update update TimesTimes 55 44 QualityQuality Improvement Improvement (QI) (QI) tools tools preparation/revision preparation/revision TimesTimes 33 55 FollowFollow up up and and Enhancement Enhancement Program Program (FEP) (FEP) for for SBA, SBA, FP, FP, MLP MLP and and others others TimesTimes 77 66 Accreditation,Accreditation, renew renew and and regulation regulation meetings meetings with with different different training training sites sites TimesTimes 77 77 PlanningPlanning and and review review meetings meetings for for regulation regulation of of quality quality of of training training materials materials and and TimesTimes 77 trainingstrainings 88 Accreditation/regulationAccreditation/regulation meetings meetings with with different different institutions institutions that that prepare prepare training training TimesTimes 66 materialmaterial and and conduct conduct trainings trainings NationalNational Health Health Education Education Information Information and and Communication Communication Center Center program program activities: activities: SNSN ActivitiesActivities UnitUnit TargetsTargets 11 BroadcastingBroadcasting and and Airing Airing of of the the messages messages regarding regarding Smoking Smoking and and Tobacco Tobacco product product TimesTimes 11 controlcontrol through through private private television television and and FM FM . . 22 AiringAiring of of health health messages messages and and public public health health radio radio program program through through Radio Radio Nepal. Nepal. TimesTimes 21002100 33 PublicationPublication of of health health messages, messages, information information and and press press release release in in national national TimesTimes 4040 newspapers.newspapers. 44 DisseminationDissemination of of health health news,information,or news,information,or messages messages through through TimesTimes 33 website,Facebook,website,Facebook, you you tube,twitter,aps tube,twitter,aps etc. etc. 55 CommunicableCommunicable and and epidemic epidemic disease disease control control related related communication communication program program TimesTimes 66 andand daily daily newspaper newspaper monitoring monitoring program. program. 66 HealthHealth awareness awareness and and communication communication program program for for disable disable people people TimesTimes 33 77 Ear/Nose/ThroatEar/Nose/Throat related related health health awareness awareness and and communication communication program. program. TimesTimes 44 88 DisseminationDissemination of of information information and and messages messages through through online online media media TimesTimes 33 99 DevelopmentDevelopment and and distribution distribution of of federal federal health health communication communication policy, policy, strategy strategy TimesTimes 11 1010 BroadcastingBroadcasting of of health health related related message, message, information information through through national national private private TimesTimes 27882788 televisiontelevision 1111 HealthHealth literacy literacy campaign campaign program program mobilization mobilization TimesTimes 11 1212 CommunicationCommunication program program on on smoking smoking and and tobacco tobacco control control and and regulation. regulation. TimesTimes 2424 1313 CommunicationCommunication program program on on non non-communicable-communicable disease disease prevention prevention and and control. control. TimesTimes 1717 1414 HealthHealth promoting promoting school school campaign campaign framework framework or or strategy strategy development development and and TimesTimes 88 campaigncampaign conduction conduction 1515 SocialSocial media, media, sms, sms, aps aps and and IVR IVR service service from from information information technology technology center center TimesTimes 33 1616 AdvocacyAdvocacy and and strategic strategic communication communication on on occupational, occupational, environmental environmental health health TimesTimes 1212 andand Air Air pollution, pollution, climate climate change change 1717 SamriddhaSamriddha Nepal Nepal shukhi shukhi Nepali Nepali Promotion Promotion Program Program TimesTimes 55 DoHS, Annual Report 2075/76 (2018/19) g am a g t SN Activities Unit Targets 18 Broadcasting of health messages, public health dialogue (Janaswasthya bahas) Times 2827 and jivan chakra through Nepal television 19 AMR awareness and orientation health promotion program Times 7 20 Communication program on brain death, kidney and organ donation Times 3 21 Communication program on fuel emission and air pollution Times 3 22 Development of print and visual materials on obstetric fistula Times 2 23 Adolescent reproductive health (8 set booklet) printing. Piece 5000 24 Health message exhibition on assembly, event, sports, health camp musical and Times 3 cultural program 25 Organization of assembly, event, sports, health camp musical and cultural Times 1 program 26 Publication and dissemination of public health related press release, information Times 12 and messages 27 Coordination program among federal, provincial and local level for the Times 3 development and expansion of health promotion activities. Awareness and communication program on mental health Times 24 28 Awareness and communication program on IMNCI, Immunization, Diarrheal Times 12 diseases pneumonia etc. 29 Awareness and communication program on birth defect. Times 3 30 Awareness and communication program on family planning, safe motherhood Times 3 and neonatal health. 31 Awareness and communication program on family planning, safe motherhood, Times 12 neonatal and adolescent health. 32 Family planning, PPIUCD promotion and social behavioral change through inter Times 3 personal communication for hard to reach group. 33 Airing and broadcasting of messages relating to risk factors of NCDs through Times 1 Radio Nepal and Nepal Television. 34 Monitoring and facilitation at provincial and local level. Times 100 National Public Health Laboratory program activities: SN Activities Unit Target 1. Distribution and publicity of management, requirement and transportation of Time 3 cold chain 2. Management of quality control in government and private hospitals time 3 3. Participation in international quality control program Time 3 4. Development of NEQAS Software Time 1 5. Research activities of NPHL Time 3 6. Sickle cell surveillance management Time 3 7. Laboratory service security management Time 3 8. Management of BSL 3 Laboratory operation Time 3 9. Operational expenses for NBBTS to improve blood transfusion services time 3 10. Management of NIC, HIV, Microbiology, JE, Measles, Rubella, Hep B & C, Polio time 3 operation programs 11. Laboratory Accreditation time 1 12. Barcode management for laboratory service reliability and security number 3 13. Providing diagnostic services during epidemic outbreak time 3 14. Management of constructing infrastructures and human resources to operating time 1 Provincial Public Health Laboratory 15. Monitoring and evaluation of government hospitals, private hospitals and blood Time 50 transfusion service centre 16. Procurement of fully automated barcode labeling machine Piece 1 17. Procurement of real time PCR, HLA Machine and Extraction machine and Set 1 initiation of service for communicable disease 18. Procurement of ECLIA and ELISA machine for virology and immunology unit Set 1 DoHS, Annual Report 2075/76 (2018/19) g am a g t SN Activities Unit Target 19.SN Construction of 2 to 8 degree cold storeActivities room UnitPiece Target1 20.19. ConstructionConstruction of 2molecular to 8 degree lab cold for nostore communicable room diseases PieceTime 1 1 21.20. PreparationConstruction and of molecular planning onlab upgradation for no communicable of NPHL to diseases National Diagnostic Centre Timetime 1 4 21. withPreparation latest technology and planning on upgradation of NPHL to National Diagnostic Centre time 4 with latest technology Management Division: (1) Integrated Health Information Management Section program activities: ManagementS N Division: (1) Integrated HealthActivity Information Management Section program activities:Unit Target S N Conduction of coordination meetingsActivity of committees, divisions and sections as Unit Target 1 Times 10 specifiedConduction by ofvarious coordination directives meetings of committees, divisions and sections as 1 Times 10 specifiedMonthly, by bivarious-monthly, directives quarterly review, planning and infrastructure related 2 Times 6 developmentMonthly, bi programs-monthly, quarterly review, planning and infrastructure related 2 Times 6 developmentPrinting and programs distribution of HIMS records, reports, monthly monitoring 3 Times 1 bookletsPrinting and distribution of HIMS records, reports, monthly monitoring 3 Times 1 bookletsTraining for Data Managers on Health Information Management and 4 Times 2 AnalysisTraining (GIS for / DataSTATA) Managers (SO/ SA on and Health Medical Information Recorder Management Assistant) and 4 Times 2 5 AnalysisTraining (GIS on / dataSTATA) management, (SO/ SA and analysisMedical andRecorder use (PHAT) Assistant) Times 3 65 AssistanceTraining on for data and management, monitoring ofanalysis state andand localuse (PHAT) level reviews TimesTimes 3 3 76 PreparationAssistance for and and printing monitoring of annual of state report and local level reviews TimesTimes 3 2 Development of Demography Dynamic model for projection of target 87 Preparation and printing of annual report TimesTimes 2 2 populationDevelopment and healthof Demography education Dynamic material model according for projection to local level of target 8 Payment of internet service connected to HMIS branch, server Times 2 9 population and health education material according to local level Times 1 management,Payment of internetnetwork serviceoptimization, connected procurement to HMIS branch, of firewall server 9 Procurement of Statistical Packages for Health Information Management, Times 1 10 management, network optimization, procurement of firewall Times 1 WordProcurement Processing of Software Statistical and Packages Antivirus for Health Information Management, 10 Transfer and upgrade of old database to DHIS 2as per the report from Times 1 11 Word Processing Software and Antivirus Times 2 HealthTransfer Facility and upgrade of old database to DHIS 2as per the report from 11 Development (customization) and use of digital recording information Times 2 12 Health Facility Times 3 systemsDevelopment at health (customization) facilities and use of digital recording information 12 HMIS and DHIS training to staff of Central Hospital, Teaching Hospital and Times 3 13 systems at health facilities Times 3 other hospitals (including private ones) HMIS and DHIS training to staff of Central Hospital, Teaching Hospital and 13 Times 3 14 otherOnsite hospitals coaching (including and mentoring private ones) to improve health data quality in hospitals Times 3 1514 UpdateOnsite coaching HMIS records and mentoring and report to forms, improve guidelines health data and quality health in indicators hospitals TimesTimes 3 2 Training for doctors including medical recorders from Central Hospital, 1615 Update HMIS records and report forms, guidelines and health indicators TimesTimes 2 3 Teaching Hospital and other hospitals (private) Mortality Statistics Training for doctors including medical recorders from Central Hospital, Management16 Division: (2) Infrastructure Development Section program activities: Times 3 Teaching Hospital and other hospitals (private) Mortality Statistics S N Activity Unit Target Management Division: (2) Infrastructure Development Section program activities: Maintenance and improvement of physical structures within the S1 N Activity UnitTimes Target 2 Department of health premises Maintenance and improvement of physical structures within the 1 Construction of damaged boundary wall behind the National Health Times 2 2 Department of health premises Times 1 Training Center Construction of damaged boundary wall behind the National Health 32 Procurement of Laptop-5 and Projector-1 for HIMS section TimesSet 1 6 Training Center 4 Furniture and fixtures Times 3 3 Procurement of Laptop-5 and Projector-1 for HIMS section Set 6 Biomedical tools and equipment maintenance including payments of 5 Times 1 4 previousFurniture remaining and fixtures expenses Times 3 Biomedical tools and equipment maintenance including payments of 5 From Human Resource Management Contract Services: Store Assistant 1, Times 1 6 Civilprevious and Mechanicalremaining expenses Engineer 2, Data Analyst 1, Office Assistant 3, Computer Person 16 AssistantFrom Human 1, Driver Resource 5, Sweeper Management Part-time Contract-3 Services: Store Assistant 1, 6 CivilHuman and Mechanical Resource Management Engineer 2, Data under Analyst Staff 1, Administration Office Assistant section 3, Computer and Person 16 7 Person 6 FinancialAssistant Administration1, Driver 5, Sweeper section Part of- timeDoHS-3 HumanHuman Resource Management underfor PAM Staff Unit, Administration 10-Biomedical section Engineers and and 87 PersonPerson 6 11 1Financial-Public Health Administration Officer section of DoHS Human Resource Management for PAM Unit, 10-Biomedical Engineers and 98 Activities related to financial administration and disallownaces PersonTimes 11 1 1-Public Health Officer DoHS,9 AnnualActivities Report related2075/76 to (2018/19)financial administration and disallownaces Times 1 g am a g t Waste management and sanitation within the premises of DoHS 10 Times 1 (from third party included) Repair and maintenance of spare parts not included in the multi-year 11 Times 1 agreement after inquiry with concerned hospitals and payment 12 Monitoring of biomedical equipment maintenance work Times 3 Development of new policies, rules, directives and other documents 13 Times 2 including Revision and printing Follow-up and monitoring of minimum standards of physical infrastructures 14 Times 3 including buildings 15 Integrated supervision of health care programs Times 100 Management Division: (3) Environment Health and Health Care Waste Management Section program activities: S N Activity Unit Target 1 MTOT on Strengthening of Health Facility generated Waste Management Times 2 Onsite coaching and follow-up of solid waste management for health 2 Times 24 organization 3 Review and priting of Guidelines on Health Care Waste Management Times 1 Strengthening of programs including drinking water and sanitation WASHFIT 4 Times 2 tools Management Division: (4) Logistic Management Section program activities: S N Activity Unit Target 1 Continuous construction of modern central vaccine stores Building 1 2 Continuous construction of Central Store Teku Building 1 3 Reconstruction of Pathlaiya Store Building continues Pcs 1 4 Procurement of office equipment Set 12 5 Purchase of Hospital Equipment (including payment of old contract) Times 3 6 Purchase of servers for expansion and operation of LMIS program Times 1 7 Purchase of spare parts for vaccination and cold chain management Times 1 8 Fuel and other fuels for vaccine safety and transportation Times 20 9 Pharmacist, LMIS technical service contract in store Person 25 10 To be taken in staff service consultation Person 20 11 Review and discussion with all the states about LMIS, HMIS. Times 2 12 Seminar on quantification of health products in the Union Times 1 Meetings of various committees and sub-committees related to supply 13 Times 3 management in the association 14 LMIS program expansion and operating costs Times 3 15 Management Division Website Updates Times 1 16 LMIS Forms, Stock Book Printing Times 1 17 Tools, means of transportation, maintenance of vehicles Times 3 18 Drug and equipment quality testing Times 3 Preparation of tender documents, publication of bill notice, third party 19 Times 3 insurance, vehicle tax and supply services. Repacking, transportation, and redistribution of drugs, vaccines, and 20 Times 3 vaccines Washing and disposing of old, expired, broken medicines and other 21 Times 7 unusable health related items 22 Capacity building for effective vaccine management Times 4 Vaccination and Coldchain Management Plan Onsite Coaching with 23 Times 50 Preventive Maintenance 24 Pre-evaluation activities for effective vaccine management Times 1 Connection and management of Coldchain Equipment Sub Centers received 25 Times 2 through UNICEF 26 Seminar on Vaccination and Cold Chain Management with Stakeholders Times 2 27 Technical evaluation of effective vaccine management work Times 3 28 Health in All Policy 13.1 Workshop Times 2 29 Technical Specification Bank Enhancement Program Times 2 30 TOT on Procurement and Basic Supply Management Times 2 31 Supervision, coordination and technical Support Times 70 DoHS, Annual Report 2075/76 (2018/19)