Government of Nepal Ministry of Health and Population Phone: 071-520260 Department of Health Services 071-520142 071-525331 Western Region Health Directorate Fax: 071-520840 District Public Health Office Email: [email protected] Rupandehi
Acknowledgement
It is my great pleasure to publish the Annual Report of District Public Health Office, Rupandehi of the year FY 2070/071. This report is the summary of performance of each program with trend analysis of last 3 fiscal years' services provided by the health facilities (SHPs, HPs, PHCs, and Hospitals), PHCs/ORCs, EPI Clinics, I/NGOs and Nursing homes and private and teaching hospitals. This report is prepared with untiring efforts and co-operation of many institution and individuals.
I would like to extend my sincere gratitude to Mr. Bal Krishna Bhusal, Director of Western Regional Health Directorate (WRHD), Pokhara for his valuable direction and guidance provided during district level monitoring visits in different time periods. My sincere thanks go to Mr. Rishi Ram Sigdel, Statistical Officer of WRHD and Mr. Mukti Khanal, Section Chief from Department of Health Services, Mgmt Division, HMIS section for their technical assistance on time and again and in particular during annual review meeting.
Additionally, I take this opportunity to express appreciation to all DPHO Supervisors including Admin and Finance staff, Health Workers, Local bodies, Volunteers (FCHVs), Health Facility Management Committees, District level partners working for the quality assurance and enhancement of health services. I would like to thank Mr. Prayash Khanal, Executive Director of Unity for Sustainable Community Development and SUAAHARA program (Rupandehi) team, Mr. Dinesh Poudyal, Team Leader of Namuna Integrated Development Council and Mr. Om Prakash Gupta, Stastistical Officer for their diligent efforts in making the publication of Annual Report a success. I express my sincere thanks to Mr. Bal Krishna Panthi, Chief District Officer for his continuous and valuable suggestion and guidance on health services delivery and also I am grateful to Mr. Bishow Prakash Aryal, Local Development Officer, DDC, Rupandehi and his team for timely releasing of budget, providing managerial guidance and support to DPHO. I am also thankful to Dr. Tara Nath Paudel, Medical Superintendent (MS) of Lumbini Zonal Hospital, Dr. Manohar Joshi, MS of Bhim Hospital and all Doctors and health professionals including all staffs for supporting us in delivering public health services at the district.
Finally, I hope that this profile would provide valid information to those who are interested to use the health indicators to plan, implement and evaluate health programs accordingly and also will be of enormous help to planners, researchers, managers, service providers and relevant students.
I sincerely thanks to all political parties, stakeholders, members of civil society, NGO and private partners and Media people for their valued participation, technical and moral support and suggestion in the delivery of health care services. I want to dedicate this achievement to all the stakeholder and partners. I would also like to thank Mr. Sagar Dahal for his strong leadership in bringing this result.
At last but not the least, my sincere thanks goes to the general population of the districts who are the beneficiaries of the service offered by the DPHO.
Rishi Prasad Lamichhane Senior Public Health Administrator
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Government of Nepal Ministry of Federal Affairs and Local Development Phone: 071-521423 071-523577 District Development Committee Fax: 071-520160 Email: [email protected] Rupandehi
Message
It has given me immense pleasure to know that District Public Health Office (DPHO), Rupandehi is preparing to publish its Annual Report for the year 2070-71 after reviewing its Public Health programs. I‟m confident that the DPHO, Rupandehi has achieved all its target set for the year and based on the lesson learned striving hard to deliver preventive, promotive and curative services to the people of Rupandehi from its various service outlets starting from PHC/ORC to immunization centers, Sub Health Posts, Health Posts and Primary Health Care centers respectively. Actually, the leadership always plays crucial role in achieving the target and winning the people confidence on the services delivered. The leadership flourishes motivation of the team members of an institution to deliver optimum service delivery. Concerning public health services I think that the FCHVs and health staff roles are very much important to bridge the gap between the government health service and the community need. This would increase access of the people in obtaining the services and once people started to enjoy free and quality health service this ultimately promote feeling of good governance presence at the doorsteps of the people who are living at remote areas of a district.
I appreciate & congratulate the DPHO team for efficient management of Public Health Program with a very good co-ordination with all stakeholders and wishing all the best in performing great task over the years to achieve new milestones in district health development that ultimately would contribute in Nepal‟s commitments towards achieving Millennium Development Goals by 2015.
On behalf of District Development Committee - Rupandehi, I would be happy in any way to support all the endeavors of the DPHO that ultimately contribute to enhance health of the people of Rupandehi district.
Thank you! ______Mr. Bishow Prakash Aryal Local Development Officer District Development Committee, Rupandehi
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Table of Contents
Acknowledgement ...... 1 Table of Contents ...... 4 List of Tables ...... 6 List of Charts...... 8 Acronyms ...... 9 Health Service Coverage Fact - Sheet ...... 11 Fiscal Year 2068/69 - 2070/71 (2011/12 - 2013/14) ...... 11 1. Rupandehi District: Brief Overview of the District ...... 14 2. Health Services ...... 15 3. Child Health Program ...... 17 3.1 National Immunization Programme (NIP) ...... 17 3.2 CB-IMCI Program ...... 23 3.3 Nutrition Program...... 25 4. Family Health...... 33 4.1 Safe Motherhood Programme ...... 33 4.2 Family Planning Program ...... 37 4.3 FCHV Programme ...... 41 4.4 PHC Outreach-clinic Programme ...... 43 5. Disease Control Programme ...... 45 5.1 Malaria Control Programme ...... 45 Malaria species ...... 45 5.2 Dengue Control Program ...... 53 5.3 Tuberculosis Control Program ...... 54 5.4 Leprosy Control Programme ...... 59 Objectives ...... 60 5.6 Filariasis Elimination Campaign ...... 64 5.7 Rabies ...... 64 5.8 Snake Bite...... 64 5.9 HIV/AIDS Program ...... 65 6. Curative Services ...... 70 6.1 OPD Services ...... 70 7. Supporting Program ...... 75 7.1 Health Education, Information and Communication ...... 75
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7.2 Primary Health Care Revitalization Program ...... 78 7.3 Management Support ...... 81 7.4 Supervision and Monitoring Program ...... 83 7.5 Physical Infrastructure Development Program ...... 83 7.6 Maintenance Program ...... 84 7.7 Recommendation of private institution for approval and renewal ...... 84 7.8 Ambulance Services ...... 84 7.9 Blood Bank Services ...... 85 7.10 Population Management Program ...... 85 7.11 Logistic Management ...... 86 Annex I: Human Resources Situation ...... 87 Annex II : List of NGO/INGO & Private Health Intuition ...... 90 Annex III : Institutional Delivery by birthing center: ...... 91 Annex IV: Health facilities providing IUCD and Implants services & Chart Showing Birthing Centers ...... 92 Annex V : VDCs Categorized with Problems and Priority ( FY 2070/71) ...... 93 Annex VI: VDC wise EPI Status ...... 94 Annex VII: List of Private Hospitals with Approval/Renewal Status ...... 99 Annex VIII: Health Tax Fund ...... 101 Annex IX National Health Training Program ...... 102 Annex X: Profile of I/NGOs implementing health and nutrition programs ...... 103 Annex XI: Areas of Improvement, Strengths and Way Forward ...... 107
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List of Tables
Table 1: Average number of people served by level of health facilities per day ...... 16 Table 2: Service delivery points and reporting status in percent ...... 16 Table 3: Progress status of targeted activities of EPI Program ...... 19 Table 4: EPI performance status by selected indicators ...... 20 Table 5 : ARI program performance status by selected indicators ...... 24 Table 6: ARI program performance status by selected indicators ...... 24 Table 7: Nutrition program targeted activities of FY2070/71 ...... 27 Table 8: Nutrition program performance status by selected indicators ...... 28 Table 9: Safemotherhood program targeted activities of 2070/71 ...... 34 Table 10: Safemotherhood program performance status by selected indicators ...... 35 Table 11: Family planning program targeted activities of 2070/71 ...... 38 Table 12: Family planning program performance status by selected indicators ...... 38 Table 13 : FCHV program targeted activities of 2070/71 ...... 42 Table 14 : FCHV program performance by selected indicators ...... 42 Table 15: PHC/ORC targeted activities of 2070/71 ...... 44 Table 16; PHC/ORC performance status by selected indicators ...... 44 Table 17: Disease control program of 2070/71 ...... 47 Table 18: Malaria control program performance by selected indicators ...... 48 Table 19: PF cases reporting VDCs in 2070/71 ...... 51 Table 20: LLIN distribution status of three consecutive years ...... 52 Table 21: Trend of insecticide spraying ...... 52 Table 22: Larva of dengue mosquito search and destroy status...... 53 Table 23: TB control program targeted activities of 2070/71 ...... 55 Table 24: TB control program performance by selected indicator ...... 58 Table 25: Leprosy control program targeted activities of 2070/71 ...... 60 Table 26: Leprosy control program performance by selected indicators ...... 61 Table 27: Registered Prevalence Rate scenario of the district ...... 62 Table 28: Outbreak and disaster management Status ...... 63 Table 29: Outbreak Situation by disease categories ...... 64 Table 30: Animal bite and no. of vaccine use status ...... 64 Table 31: Snake bite situation 2070/71 ...... 65 Table 32: Service types of HIV/AIDS program ...... 66 Table 33: HIV/AIDS program targeted activities of 2070/71 ...... 67 Table 34: HIV/AIDS program performance by selected indicator ...... 67 Table 35 OPD service status by selected indicators ...... 71 Table 36: Top ten disease ...... 71 Table 37: Free health service targeted activities of 2070/71 ...... 73 Table 38: District recommended for Ultra poor Services by types ...... 74 Table 39: Laboratory services ...... 74 Table 40: NHEICC program targeted activities of 2070/71 ...... 76 Table 41: Human resources at different UHCs of the district ...... 79 Table 42: Urban Health Center construction supported by DPHO ...... 80 Table 43: Management support targeted activities of 2070/71 ...... 81 Table 44: Supervision and monitoring status of 2070/71 ...... 83
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Table 45: Physical infrastructure development status 2070/71 ...... 83 Table 46: Maintenance program progress in 2070/71 ...... 84 Table 47: Recommendation of health facilities for approval or renewal in 2070/71 ...... 84 Table 48: Ambulance Services ...... 84 Table 49 Population management program targeted activities 2070/71 ...... 85 Table 50: Population management program targeted activities 2070/71 ...... 86
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List of Charts
Chart 1: Distribution of health facilities in Rupandehi district ...... 15 Chart 2: Immunization Coverage ...... 21 Chart 3: Percent of New Growth Monitoring Visit by Under 5 Children ...... 29 Chart 4: Proportion of malnourished children as % of NGM (< 5 years) ...... 29 Chart 5 : ANC, Delivery and PNC Status ...... 36 Chart 6: Contraceptive Prevalence Rate and % of FP New Acceptor Method Mix ...... 39 Chart 7: Percent of new acceptors spacing method mix ...... 39 Chart 8 Annual Blood Slide Examination Rate 2070/71 ...... 49 Chart 9 Trend of Malaria Positive Cases in nos ...... 49 Chart 10 : Trend of Clinical Malaria Incidence ...... 50 Chart 11: Treatment Outcome and No. of MDR Cases in Three Consecutive Years ..... 58 Chart 12: Trend of New Case Detection Rate and Prevalence fo Leprosy ...... 62 Chart 13: Distribution of VCT Centers at Rupandehi ...... 69 Chart 14: Top Ten Diseases in 2070/71 ...... 72
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Acronyms
AEFI Adverse Event Following Immunization AFP Acute Flaccid Paralysis AHW Auxiliary Health Worker AIDS Acquired Immuno-deficiency Syndrome ARI Acute Respiratory Infection ART Anti-Retroviral Therapy BCC Behaviour Change Communication BCG Bacille Calmette-Guerin BEOC Basic Emergency Obstetric Care BMI Body Mass Index CAC Comprehensive Abortion Care CB-IMCI Community Based Integrated Management of Childhood Illness CB-NCP Community Based Newborn Care Package CEOC Comprehensive Emergency Obstetric Care CLT Comprehensive Leprosy Training CPR Contraceptive Prevalence Rate DACC District AIDS Co-ordination Committee DDA Department of Drug Administration DDC District Development Committee DF Dengue Fever DFID Department for International Development DG Director General DHF Dengue Hemorrhagic Fever DHIB District Health Information Bank DHMC District Health Management Committee DHO District Health Office DOTS Directly Observed Treatment Short Course DPHO District Public Health Office EPI Expanded Program on Immunization EWARS Early Warning Reporting System FCHV Female Community Health Volunteer FPAN Family Planning Association of Nepal FY Fiscal Year GoN Government of Nepal HCT HIV Counselling and Testing HIV Human Immuno-deficiency Virus HMIS Health Management Information System HP Health Posts HSIS Health Sector Information System IDD Iodine Deficiency Disorder IEC Information, Education and Communication IMCI Integrated Management of Childhood Illness IPD Immunization Preventable Diseases
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IUCD Intra-uterine Contraceptive Device IYCF Infant and Young Child Feeding LEC Leprosy Elimination Campaign LMD Logistics Management Division LMIS Logistics Management Information System MA Medical Abortion MC Microscopy Centre MCHC Mother and Child Health Care MCHW Maternal and Child Health Worker MDT Multi Drug Therapy MG-H Mothers' Group for Health MNH Maternal and Neonatal Health MO Medical Officers MWRA Married Women of Reproductive Age NCASC National Centre for AIDS and STD Control NCD Non-Communicable Diseases NHEICC National Health Education, Information and Communication Centre NID National Immunization Day NIP National Immunization Program NTC National Tuberculosis Centre ORS Osmolar Oral Rehydration Solutions ORT Oral Rehydration Therapy PAL Practical Approach to Lung PEM Protein-Energy Malnutrition PHC/ORC Primary Health Care Outreach Clinics PHCC Primary Health Care Centre PHO Public Health Officer PME Planning, Monitoring, and Evaluation PMTCT Prevention of Mother to Child Transmission PPH Post-partum Haemorrhage PR Prevalence Rate RH Reproductive Health RHCC Reproductive Health Coordination Committee SAS Safe Abortion Services SBA Skilled Birth Attendants SHN School Health and Nutrition SHP Sub Health Posts TB Tuberculosis TFR Total Fertility Rate ToT Training of Trainers TT Tetanus Toxoid VAD Vitamin A Deficiency VBD Vector-Borne Diseases VCT Voluntary Counselling and Test VDC Village Development Committee VHW Village Health Worker VSC Voluntary Surgical Contraception
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Health Service Coverage Fact - Sheet
Rupandehi District
Fiscal Year 2068/69 - 2070/71 (2011/12 - 2013/14)
Indicators 2068/69 2069/70 2070/71 (2011/2012) (2012/2013) (2013/2014)
Reporting Status % Public Hospitals 100 100 100 Primary Health Care Center 100 100 100 Health Posts 100 100 100 Sub Health Posts 100 100 100 PHC-ORC clinics 100 100 100 EPI clinics 100 100 100 NGO and Private Health Institutions 100 99 99 IMMUNIZATION COVERAGE BCG 121 113.42 130 DPT-Hep B-Hib 3 104 99.12 105 Measles 102 97.91 104 JE 97 95.61 101 Pregnant women receiving TT-2&2+ 74 115.4 104 Dropout Rate BCG Vs Measles 16 13.67 20 Dropout Rate DPT /hep/hib 1 Vs DPT/hep/hib 3 0 -2.09 -1 NUTRITION Proportion of malnourished children as % NGM 1.35 1.1 0.58 % of pregnant women receiving Iron tablets 100 76 71 ACUTE RESPIRATORY INFECTION (ARI) Incidence Of ARI/1000 Risk Population 611 536 530
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Indicators 2068/69 2069/70 2070/71 (2011/2012) (2012/2013) (2013/2014)
Proportion of Severe Pneumonia among New Cases 0.02 0.02 DIARRHOEAL DISEASES % of Severe Dehydration among Total New Cases 0.17 0 0 SAFE MOTHERHOOD Antenatal first visits as % of expected pregnancies 122 105.44 129
ANC 4th visit as % of ELB 65 66.31 63.23 Institutional delivery as % of expected live birth 92 93 112 PNC first visit as % of expected pregnancies 86 93 106 FAMILY PLANNING Contraceptive Prevalence Rate (Modern Method)* 33 32.37 30 New Acceptor as % of MWRA 11.74 11.69 8.63 MALARIA Annual Blood Slide Examination Rate (ABER) per 100 1.41 1.06 1.81 Proportion P. Falciparum (PF %) 35.03 37 25.36 Clinical Malaria Incidence (CMI)/1000 4.49 2.26 1.64 TUBERCULOSIS Case finding Rate 78 64 66 Treatment Success Rate on DOTS 92 91 90 No. of DR Cases 36 59 63 LEPROSY New Case Detection Rate (NCDR) /10,000 1.9 1.64 1.78 Prevalence Rate (PR) /10,000 1.4 1.3 1.3 Disability rate Grade 2 among new cases 2 0 1.2
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Indicators 2068/69 2069/70 2070/71 (2011/2012) (2012/2013) (2013/2014)
HIV/AIDS AND STI Number of people counseling 4891 5575 Number of HIV +ve cases 191 144 Number of persons receiving ART 484 608 Number of ART sites 1 1 CURATIVE SERVICES Total OPD new visits as % of total population 112 123.72 116
Source: HF Reports
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1. Rupandehi District: Brief Overview of the District
Rupandehi is a district of Lumbini Zone comes under the western development region. Lumbini, the birth place of Lord Buddha, the light of Asia, falls under this district. Rupandehi district is situated in the lovely lap of the Chure range and bordered by Palpa on the north, India on the south, Kapilvastu on the west and Nawalparasi on the east. The total area of this district is 1172 square kilometer. The geographical position of the district is 83010‟ to 83030‟ longitudes in the east and 27010‟ to 27045‟ latitude in the north. The total surface area of the district is 141,340 ha with an altitude ranging from 95m to 1219m above the sea level. There are 6 major land use categories in Rupandehi district, of which the dominant land use category is cultivated land (68.03%) followed by forest (21.56%). Since the district is under the Terai region, very little amount of Mountain and Rocky cliff is available i.e. 0.29%.
Geographically, Rupandehi district is flat and formed from the alluvial deposits, the surface gradually slopes towards south, hence, the rivers and streams flow towards the same direction. Rupandehi is situated in the tropical bio-climatic zone therefore its climate is sub tropical. There are four distinct seasons occurring in this area namely, spring (pre monsoon) occurs from March-May, summer (monsoon) from June - August, fall (post-monsoon) from September –November, and winter season occurs from December - February. The spring or pre-monsoon season is hot and dry while monsoon or rainy season is hot and humid. In the post-monsoon season days are warm and nights are cool. The winter season is regarded cool and foggy.
The maximum mean temperature of the area is 310 C. The highest temperature reaches up to 43.40 C around May-June. However, the minimum mean temperature of the area is 18.20 C. The lowest temperature goes down below 6 0C in winter. The average annual rainfall recorded is 1174 mm, of which 80% precipitation occurred during the monsoon period.
Politically the district is divided into 7 electoral constituencies, 69 VDCs and 2 Municipalities. The district has good network of link roads and well connected with MRM, SRM and rest of the country and to Indian border. This has paved the way to flourish big factories and small cottage industries, thriving in the economy of the district.
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2. Health Services
District Public Health Office provides a range of health services including preventive, curative and promotive into the district. Along with government health services, private sectors and I/NGOs are providing their services to boost up the health status of the people in the district. Reproductive Health Coordination Committee (RHCC) is playing reasonably key role in developing the cooperation among the health institutions, I/NGOs, medical college, nursing home and private hospitals to improve health services. Similarly, some I/NGOs in close coordination with District Public Health Office (DPHO) Rupandehi are playing key role in creating supportive environment for optimal utilization of the health services by the people. DACC Rupandehi has been successfully developed and well functional among the organizations and stakeholders in the district and able to coordinate the HIV/AIDS related activities in line with national strategies, priorities and goal. There are 1 Zonal Hospital, 1 District Hospital, 5 Primary Health Care Centers, 6 Health Posts, 20 Upgraded Health Post, 38 Sub-Health Posts, 18 Birthing Centers, 1 Ayurvedic Hospital and 4 Ayurvedic Health Posts catering health services in the district. District Development Committee (DDC) - Rupandehi is also supporting in developing the infrastructure in rural areas that ranges from construction of Birthing centers to SHP buildings in the district.
Chart 1: Distribution of health facilities in Rupandehi district
Legends Govt. Hospital -2
DPHO - 1 Regional Medical Store – 1 H Medical College -2 H PHCC- 5 HP Ilaka - 6 HP Upgrade – 20 SHP – 38 H H Birthing Center - 17 DR Hostel - 1 H DOTS Clinic - 2
Institutional Clinic -2
H
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2.1 Health Services utilization into the district
Table 1: Average number of people served by level of health facilities per day Type of Health Facilities 2068/69 2069/70 2070/71 1. Hospitals (GoN) 183 299 190 2. NGO/Private Hospitals and other 70 67 64 health institutions 3. PHCC 47 47 39 4. Health Post 53 40 32 5. Sub Health Post 32 33 28 6. EPI Clinic 49 45 51 7. PHC/ORC Clinic 22 32 37
The data indicates that the case load at PHC/ORC Clinics is increasing gradually with the improvement of service delivery. In rural areas, PHCs/ORCs are providing quality health services and getting more popular among the local people. The utilization of immunization services are also on increasing trend and with the quality routine immunization, 23 VDCs of the district achieved full immunization status during this FY. Due to increasing numbers of private health institutes, the utilization of service per day in the governmental hospitals has been in decreasing trend. Furthermore, strengthening the recording and reporting system in NGO/Private and other health institutes could depict clearer real world scenario of health service utilization in the district. There has been slight decrease in average people served per day in HP, SHP and PHCC. Moreover, the case load needs to be synchronized with the available human resources.
Table 2: Service delivery points and reporting status in percent Type of Health Facilities 2068/69 2069/70 2070/71 HF No. Reporting Status % 1. Hospital (GoN) 100 100 2 100 2. Hospital/Medical 100 100 2 100 College (Other) 3. PHCC 100 100 5 100 4. Health Post 100 100 26 100 5. Sub Health Post 100 100 38 100 6. PHC/ORC Clinic 100 99 229 99 7. EPI Clinic 100 100 274 100 8. FCHV 100 100 1511 84 9. NGOs 100 100 35 50
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10. Private HF 100 100 20 100 11. Urban Health 100 100 6 100 Clinic/Center 12. Community Health Unit - 100 1 100
Reporting status of the different service delivery points is quite satisfactory as depicted in above table however from the private hospitals and medical colleges only public health service data are collected. WRHD and DPHO, Rupandehi facilitated SUAAHARA program to conduct orientation on HMIS/LMIS system of D(P)HO to its field level staffs, considering the coverage of program throughout district, to further enhance the community level reporting mechanism. The involvement of stakeholders concerned with public health services in reporting is supportive in assuring accuracy, completeness and timeliness of the data inflow. Moreover, the training on HMIS related tools and templates could not be provided to FCHVs of Siddharthanagar Municipality due to time and budget constraint during FY 69/70. The training will be provided in coming FY and is expected to improve the reporting trend by FCHVs as well.
3. Child Health Program
3.1 National Immunization Programme (NIP)
Background
The National Immunization Program (NIP) is a high priority and one of the most cost effective programs (P1) of Government of Nepal. NIP has helped in reducing the burden of vaccine preventable diseases (VPDs) and child mortality and has contributed in achieving the Millennium Development Goal (MDG) on child mortality reduction (MDG4).
Currently NIP in Rupandehi provides vaccination against TB (BCG), diphtheria-pertussis-tetanus-hepatitis B and haemophilus influenza B (DPT-Hep B-Hib), poliomyelitis (OPV), measles-rubella and JE vaccine. TT vaccination is provided to all pregnant women and routine immunization services are provided through public health facilities, private hospitals, medical colleges, urban clinics, outreach session and mobile team. All vaccines under NIP are provided free of cost to the clients and DPHO, Rupandehi has been supplying the vaccines to both public and private sector outlets.
To implement the National Immunization Program in Rupandehi, DPHO has taken lead role in all immunization related activities. It works closely in coordination with Regional Health Directorates and Districts based health related organizations (Rotary Clubs, CBOs and I/NGOs) and local authorities including DDC, VDC and municipalities. It has a very comprehensive functional EPI session plan (micro plan) and vaccine movement plan. Currently there are 276 EPI Posts and 336 sessions per months are routinely running in the district.
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Goal
The goal of National immunization Program is to reduce child morbidity, mortality and disability associated with vaccine-preventable diseases.
Objectives
The objectives of the National Immunization Program are as follows: Achieve and sustain 90 percent coverage of DPT3 by and of all antigens Maintain polio free status Sustain MNT elimination status Initiate measles elimination Expand vaccine preventable disease (VPDs) surveillance Accelerate control of other vaccine preventable diseases through introduction of new vaccines Improve and sustain immunization quality Expand immunization services beyond infancy.
Major Activities
The major activities carried out during FY 2070/71 and their achievement status is presented below;
1. Provision of routine immunization services delivery through fixed sites and three to five outreach sessions as per micro plan in 69 village development committees and 2 municipalities. Besides the immunization services are availed through six private health institutions including 2 medical colleges. 2. Vaccinator recruitment for smooth conduction of immunization sessions. 3. Micro planning of immunization program was done in recent past in line with RED approach. 4. Conducted joint supervision and monitoring in poor performing VDCs in case of immunization low coverage 5. Celebrated "Immunization Month" during the month of Baisakh. 6. Conducted workshop at 2 VDCs (Pokharvindi and Patkhauli) with low indicators to update the micro plan for improving routine immunization. 7. Achieved Full Immunization status in 23 VDCs of the district. 8. Conducted Appreciative Inquiry (AI) workshop throughout district where the written commitment was ensured and deadline was set by HF Inchargers and VDC/MCP ward secretaries of the district for achieving full immunization status.
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Table 3: Progress status of targeted activities of EPI Program
Physical Financial S. N. Activities Unit Remarks Achievement Expenditure Target Achievement Budget Expenditure % %
Repair and maintenance 1 Piece 3 3 100 42 42 100 of Cold chain eqipment Full Immiunization VDC 2 Piece 1 1 100 300 300 100 announcement Immunization month 3 Piece 1 1 100 50 50 100 implementation (Baisakh) National Polio
4 Immunization movement Piece 1 1 100 2536 2536 100 implementation cost Review and update of
5 Micro planning of EPI Piece 1 1 100 35 35 100 service Fuel for temperature 6 maintenance of Fridge, Piece 3 3 100 255 255 100 Refridgeretor operation Training for health 7 workers involved in Piece 1 1 100 1310 1310 100 Vaccination Motivational workshop at 8 district level through Piece 1 1 100 80 80 100 Appreciative Inquiry Contract for AHW, ANM 9 for Vaccine program Person 9 9 100 432 396 91.67 conduction Transportation for the 10 vaccine and EPI Time 3 3 100 640 640 100 materials
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All the targeted interventions for the fiscal year 2070/71 have been accomplished 100% however budget expenditure has been slightly less than 100 percent as per allocation.
Table 4: EPI performance status by selected indicators Indicators 2068/69 2069/70 2070/71 1. BCG coverage 121 113 130 2. DPT-Hep b-Hib 3 coverage 104 99.12 105 3. Measles coverage 102 98 104 4. JE coverage 104 96 101 5. % of TT2 & 2+ (Pregnant women) coverage 74 115 104 6. Dropout rate DPT-1 Vs DPT-3 0 -2.09 -1 7. Dropout rate BCG Vs Measles 16 13.67 20 8. Number and % of unimmunized children 425 228 -982 (2%) (1%) (-4.89%) 9. Wastage rate by antigen a. BCG 69 70.61 71.65 b. DPT-Hep b-Hib 3 0 12.43 10.57 c. Polio 18 13 10.57 d. Measles 46 41.49 48.73 e. JE 41 29 36.72 f. TT 30 12 25.70 8.No. of VDC with <90% DPT3 coverage - 15 8 9.No. of AFP cases - 30 32 10.No. of Measles like cases - 14 10 11.No. of Neonatal tetanus cases - 0 2
Analysis of the immunization trend shows the coverage had been above the national target in case of DPT- Hep B - Hib 3 and Measles coverage and there has been gradual increase in this fiscal year. TT2 & 2+ (Pregnant women) coverage is also above the national target however the coverage has been slightly decreased as compared with the last FY.
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Chart 2: Immunization Coverage
Dropout rate of DPT- 1 Vs DPT-3 for the current FY is -1%, which was reported -2.09% in last FY. There are -4.89% of unimmunized children which is -982 in number. The negative value indicates that the growth rate is more than the estimated target population. Wastage rate shows that improvement needed for BCG vaccination and district need to further explore possible alternatives for curtailing the wastage rate observed but at the same time if the supply of BCG is made in 10 dose vial the problem will be resolved by greater extent. The wastage rate of DPT (Penta) has been decreased to 10.57% as compared with 12.43% in last FY. This decrease was achieved by assuring multi-dose vial policy in the EPI clinics. The wastage rate of Measles, JE and TT is on the increasing trend than last year. DPHO will lead to strictly follow multi-dose vial policy in coming FY and will focus on the maintenance of refrigerator provided to health facilities as some are not functioning well. The wastage rate will be reduced to minimal to the extent possible in coming FY.
Overall, it can be said that the team work from DPHO to SHPs and down to FCHVs has contributed well in national response achieving the high immunization coverage and at the same time like-minded organizations based in the district had contributed well in mobilizing the target population to increase their access to the immunization services.
Cold Chain Movement System:
The map below shows the cold chain movement system of the district. There are 9 supply centers with zero model freezers, one sub–center with deep freezer and one district center. Through this cold chain system DPHO is ensuring quality cold chain for immunization program.
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SC
SC SC SC
SC SC
SC DC
SC
DC = District center = 1 = Sub-center (with Deepfreeze) = 1
SC SC = Supply center (with zero Model Freezer) = 9
Problems and Constraints
S. N. Issues, Problem and constraints Recommended action Responsibility 1 In some of VDCs the immunization Strengthening MG and FCHVs HF in charge and coverage is low and drop-out rate is for immunization community health higher workers 2 25 posts of vaccinators is vacant into There has been deployment of DPHO the district 9 vaccinators into the district and need to find ways for 16 vaccinators 3 Low coverage/reach and high drop- Need to integrate regular Immunization Officer out rate of immunization into the Immunization program and and Urban Health Clinic municipalities strengthen the service delivery In charge by UHC 4 Refrigerators are not working due to Budget for the transformer DPHO and Electricity low voltages of electricity supplied in replacement should be Office Majhgawa and Rayapur PHC allocated. 5 No standard refrigerator in sub- Standard refrigerators for the Logistics Management centers and not working properly sub centers Division and CHD (Lumbini PHC and Majhgawa HP)
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3.2 CB-IMCI Program
Background
Community Based Integrated Management of Childhood Illness (CB-IMCI) Program is an integrated package of child-survival interventions and addresses major childhood killer diseases like Pneumonia, Diarrhoea, Malaria, Measles, and Malnutrition in 2 months to 5 year children in a holistic way. CB-IMCI also includes management of other problem such as Jaundice, Hyperthermia and counselling on breastfeeding for young infants having less than 2 months of age. With the implementation of this package children are diagnosed early and treated appropriately for major childhood diseases at the health facility and community level. At the community level FCHVs are the main vehicle of service delivery and plays key role to increase community participation.
The program envisaged community component, enabling mobilization of community health workers (VHWs and MCHWs) and FCHVs to provide CDD, ARI, Nutrition and Immunization services to the community. As a result the Community based ARI and CDD (CBAC) program was merged into IMCI and is now called the Community Based IMCI (CB-IMCI) and Newborn component was added to CB-IMCI.
Vision
Contribute to survival, healthy growth and development of < 5 children of Nepal. Achieve MDG Goal 4 by 2015.
Goal
To reduce morbidity and mortality among children <5 due to pneumonia, diarrhoea, malnutrition, measles and malaria.
Targets
To reduce neonatal mortality from the current rate of 33/1,000 live births to 17/1,000 live births by 2015. To reduce neonatal morbidity among infants less than 2 months of age.
Objectives
Reduce frequency and severity of illness and death related to ARI, Diarrhoea, Malnutrition, Measles and Malaria.
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Contribute to improved growth and development.
Targeted Activities and Achievements of FY 2070/71: DPHO has been successful in achieving the planned target under CB-IMCI. However, CBNCB program could not be implemented during this FY.
Table 5 : ARI program performance status by selected indicators
Physical Financial S. N. Activities Unit Remarks Achieve Achieve Expen Expend Target Budget ment ment % diture iture % Computer 1 purchase for Piece 1 1 100 40 40 100 IMCI World 2 Time 1 1 100 20 20 100 Pneumonia Day Integrated 3 Supervision and Time 3 3 100 611 611 100 follow up CBIMCI /CBNCP recording and 4 reporting form Piece 1 1 100 80 80 100 production and distribution Motivational allowances for 5 NA 1 0 0 2100 0 0 MCHW for CBNCB program
Table 6: ARI program performance status by selected indicators
Indicators 2068/69 2069/70 2070/71 1. % of pneumonia among new ARI cases 13.18 23.81 11.68 2. % of severe pneumonia or very severe disease among 0.02 0.02 0 total cases 3. Proportion of ARI cases treated by FCHVs 72 70 66 4. Proportion of ARI cases treated by HF 28 38 41 5. Case fatality rate (pneumonia) 0 0 0 6. % of severe dehydration among total cases 0.02 0 0 7. Proportion of diarrhea cases treated by FCHVs 70 74 80 8. Proportion of diarrhea cases treated by HF 30 34.28 32.47 9. Proportion of diarrhea cases treated with zinc and ORS NA NA NA 10. Case fatality rate (diarrhea) 0 0 0 11. Proportion of < 2 months case treated in HFs NA NA NA
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CB-IMCI program has been implemented up to the community level in the district and has shown positive results in management of childhood illnesses. The trend over the years shows that percentage of pneumonia among new cases has decreased substantially to 11.68% from 23.8%. Training given to the VHW/MCHW over the previous years started to show the result as ARIs cases treated by the HFs has been increased.
Similarly, incidence of diarrhea cases treated by FCHVs increased to 80. It signifies that the case holding has been increased at community level and thus appearing fewer cases at the health facilities. The record concerning proportion of diarrhea cases treated with Zinc and ORS is not relevant as in HSIS system so no such data are generated in the system at district level and similar is the case for proportion of children less than 2 months cases treated in health facilities. The report shows that no case fatality rate (diarrhea) reported during the last 3 years.
At a glance, the CB-IMCI reporting shows that the impact of the program is well received at the community level, which is possible due to efficient logistics system management, FCHVs‟ well mobilization, optimum management of HMIS information, monitoring and through well support supervision provided in the program from DPHO down to health services delivery level.
3.3 Nutrition Program
Background
The National Nutrition Program has laid the vision as “all Nepali people living with adequate nutrition, food safety and food security for adequate physical, mental and social growth and equitable human capital development and survival” with the mission to improve the overall nutritional status of children, women of child bearing age, pregnant women, and all ages through the control of general malnutrition and the prevention and control of micronutrient deficiency disorders. So, a broader inter/intra-sectoral collaboration and coordination, partnership among different stakeholders and high level of awareness and cooperation of population in general is necessary.
Malnutrition remains a serious obstacle to child survival, growth and development. The most common form of malnutrition is protein-energy malnutrition (PEM). The other forms of malnutrition are iodine, iron and vitamin A deficiency. Each type of malnutrition wrecks its own particular havoc on the human body, and to make matters worse, they often appear in combination. Even moderately acute and severely acute malnourished children are more likely to die from common childhood illnesses than those adequately nourished. In addition, malnutrition constitutes a serious threat especially to young child survival and is associated with about one third of child mortality. Major causes of PEM in Nepal is low birth weight of below 2.5 kg, due to poor maternal nutrition, inadequate dietary intake, frequent infections, household
DPHO, Rupandehi | Annual Report 2070/71 25 food insecurity, feeding behavior and poor care and practices leading to an intergenerational cycle of malnutrition.
Goal:
To achieve nutritional wellbeing of all people in Nepal to maintain a healthy life to contribute in the socio- economic development of the country, through improved nutrition program implementation in collaboration with relevant sectors.
The program aims to achieve the following targets:
Reduce IMR 36/1,000; <5 mortality rate 54/1,000 and MMR 250/100,000 live births by 2015 (MDGs) Reduce IMR 34.4/1,000 LB and <5 mortality rate to 62.5/1,000 LB by the end of 2017 (SLTHP).
General Objective
The general objective of the National Nutrition Program is to enhance nutritional well-being, reduce child and maternal mortality and is to contribute for equitable human development.
Specific Objectives:
Reduce general malnutrition among women and children Reduce Iron Deficiency Anaemia among children and pregnant mother Maintain and sustain Iodine Deficiency Disorder (IDD) and Vitamin A Deficiency Disorder (VAD) Improve maternal nutrition Align with Multi-sectoral Nutrition Initiative Improve Nutrition related behavior change and communication Improve Monitoring and Evaluation for Nutrition related Programs/Activities.
Targeted Activities FY 2070/71 (Amount NRs. in thousands)
All the targeted activities for the fiscal year 2070/71 has been accomplished by almost 100 percent as depicted in below table. As per the financial achievement is concerned for some of the activities like albendazole distribution, growth monitoring and iron tablet distribution, no budget was allocated so it is not applicable.
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Table 7: Nutrition program targeted activities of FY2070/71
Physical Financial S. N. Activities Unit Remarks
Achieve Achieve Expendi Expendi Target Budget ment ment % ture ture % MCHW mobilization 1 for Vit A and NA 2 2 100 1214 1214 100 dewormin program Distribution of medicine against worm and orientation 2 Person 1 1 100 1293 1023 79.12 on Primary treatment kit to the teachers of Government schools Distribution of Vit A capsule for the 3 Person 0 0 0 0 0 0 treatment of Vit A deficiency Breast feeding 4 prevention and Piece 1 1 100 69 69 100 promotin week Albendazole distribution from 1-10 5 class students of Piece 0 0 0 0 0 0 Government and Pvt schools Iron tablet distribution 6 to pregnant and Piece 0 0 0 0 0 0 delivered mothers School Health and 7 Nutrition week Piece 1 1 100 86 86 100 conduction Purchase and distribution of (Scissor, Register, 8 Piece 1 1 100 126 126 100 pencil -1 set) for Mass Vit A distribution Iodine month awareness organise 9 Piece 1 1 100 69 69 100 for the prevention of Iodine deficiency Growth monitoring of 10 Piece 0 0 0 0 0 0 <5yrs Children Suervision of Vit A 11 Piece 2 2 100 110 110 100 program
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Performance Status by selected indicators
The growth monitoring services have been extended to children less than 5 years of age. There has been considerable increament in growth monitoring coverage to 87% as compared with 87% during last FY. In case of Iron compliance (% of mothers who received 180 iron tablets among ANC 1st visit) is approximately same as in last FY and close to the target.
Table 8: Nutrition program performance status by selected indicators
Indicators 2068/69 2069/70 2070/71 New growth monitoring visits as % of 5 years children 75.61 69 87 Proportion of malnourished children as % of new growth 1.35 1.1 0.58 monitoring (< 5 years) % of expected pregnant mothers supplemented with Iron 100 76 71 tablets Iron Compliance (% of pregnant mothers who received 180 91.23 98.84 98 iron tablets among 1st ANC visit) % of pregnant mothers who were supplemented by 80 77 72 Antihelmentic tablet % of Postpartum mothers receiving Vitamin „A‟ 100 104 121 Vitamin "A" Distribution Coverage (number and %) 1st 100 100 124 (Kartik) round (6 month to < 5 years children) Vitamin "A" distribution coverage (number and %) 2nd 100 100 104 (Baishakha) round (6 month to <5 years children) Antihelmentic tablet distribution coverage (number and %) 100 100 109 1st (Kartik) round (1- <5 years children) Antihelmentic tablet distribution coverage (number and %) 100 100 103.2 2nd (Baishakha) round (6 month to <5 years children)
Less children were reported having malnutrition problem and were nearly half as compared with the last FY. Growth monitoring visit has been increased considerably during this FY which indicates the increase in awareness among the beneficiaries about its importance. DPHO has been leading to conduct various awareness program focusing VDCs with low indicators in last FY. 98% of the beneficiaries who received iron from the health facilities consumed full course of iron. Expected pregnant mothers supplemented with iron and antihelmentic tablets have been in decreasing trend which might be due to underreporting and service taken by beneficiaries from both private and governmental health institutes. Furthermore, DPHO has recently provided health and nutrition related orientation to the children of 1 to 10 grades of all the governmental schools of the district during school health nutrition week and then provided training to 1 teacher from each of the school about school health nutrition program that‟s going to be launched in full
DPHO, Rupandehi | Annual Report 2070/71 28 scale from Shrawan, 2071. The program will strengthen compliance of albendazole and mass distribution of other children related commodities at schools and ultimately raise the awareness on the importance of key commodities compliance in the communities through education sector. DPHO has been coordinating and collaborating with other governmental and private institutes to enhance the nutrition and health status of the beneficiaries in the district.
Chart 3: Percent of New Growth Monitoring Visit by Under 5 Children
At a glance, the Nutrition program shows that the impact of the program was reported well except few indicators at the community level, which is possible due to efficient logistics system management, well service delivered by health staff, FCHVs‟ well mobilization and optimum management of HSIS though some follow up are needed in anthelmintic tablet distribution to the pregnant women. Monitoring and supportive supervision provided in the program from DPHO down to health services delivery level responding well.
Chart 4: Proportion of malnourished children as % of NGM (< 5 years)
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Multiple Micronutrient Powder Program (Baal Vita)
Background:
Multiple Micronutrient Powder (MMNP) Supplementations started in 2009 when MoHP, with support from UNICEF, did a feasibility study in two districts Parsa and Makwanpur. The overall objective of the study was to reduce anemia and use the MNPs as a motivation to change infant, and especially, young child feeding practices i.e. complementary feeding practices. The outcome of the feasibility study was development of a local name for the MNP “Baal Vita”, agreement on the target age group of 6-23 months and agreement that MNPs should be „packaged‟ with IYCF counseling. MNP distribution program has currently been implemented in 6 districts of Nepal viz. Rupandehi, Parsa, Gorkha, Rasuwa, Palpa and Makwanpur. The plan is to scale up this program to all 75 districts by 2015. Following a pilot study undertaken in 3 districts in 2009, WFP started distributing MNPs with food/cash for assets (F/CA) programmes in 17 districts in the Mid and Far west, considered as food insecure regions. MNP distribution started in January 2010. When caregivers enrolled in the F/CA activities go to distribution points to collect the cash/food, those with children under 5 are counseled on IYCF and offered MNPs.
Goal:
• To improve the nutritional status of children aged 6 to 24 months by reducing prevalence of anemia and by improving complementary feeding and care practices.
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Distribution Models
UNICEF/DOHS/LMD Procurement Procurement Department/UNICEF Department/UNICEF
DHO/DPHO DHO/DPHO DHO/DPHO
PHC/HP/SH P HP/SHP/PHC Municipality Office
FCHV 6 to 24 months Ward Office Children
6 to 24 months FCHV HEALTH FACILITY (RURAL MODEL) Children 6 to 24 months FEMALE COMMUNITY HEALTH VOLUNTEERS (RURAL MODEL) Children MUNICIPALITY WARDS (URBAN MODEL)
Program Activities and Progress
Most of the preparatory activities mentioned below were accomplished in the fiscal year 2068/69. In the fiscal year 2069/70 the program was handed over to DPHO. Then onwards DPHO is maintaining regular supply of baal vita down to FCHVs till Chaitra during last FY. Now the district is not receiving additional supply.
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Problem and Constraints S N Issues, Problem and constraints Recommended action Responsibility 1 New growth monitoring not reported Uniformity in recording and reporting HFI according to protocol Orientation to health workers on new (even a single growth monitoring has growth monitoring approaches been reported as 100% for a child) 2 Some of health facilities lacks Salter Local action to make use of Salter HFI scale (weighing machine) scale if minor problem like cloth tearing etc Supply of new Salter scale into the DPHO selected HF where it is broken down completely 3 No importance realized by mothers Improving counseling to mother on Local health facility due to poor counseling by health importance of growth monitoring. workers about the importance of Grabbing the children when mother growth monitoring because of which comes to HF or ORC with baby there are missing of children 4 No malnourished reported Need to proper identification of Focal person malnourished cases and reporting Health facility
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5 Iron distribution among pregnant Data stratification and reanalysis and DPHO mother is reduced field assessment for the identification PHN and action of causes Nutrition focal person 6 No supply of program logistics on Need to strengthen supply of Baal CHD/ Nutrition Baal Vita program Vita Section
4. Family Health
4.1 Safe Motherhood Programme
Background
The goal of the National Safe Motherhood Program is to reduce maternal and neonatal mortalities by addressing factors related to various morbidities, death and disability caused by complications of pregnancy and childbirth. Global evidence shows that all pregnancies are at risk, and complications during pregnancy, delivery and the postnatal period are difficult to predict. Experience also shows that 3 key delays are of critical importance to the outcomes of an obstetric emergency: (i) delay in seeking care, (ii) delay in reaching care, and (iii) delay in receiving care. To reduce the risks associated with pregnancy and childbirth and address these delays, three major strategies have been adopted in Nepal:
Promoting birth preparedness and complication readiness including awareness raising and improving the availability of funds, transport and blood supplies. Encouraging for institutional delivery. Expansion of 24-hour emergency obstetric care services (basic and comprehensive) at selected public health facilities in every district.
Goal
Safe-motherhood and neonatal health aims at improving maternal and neonatal health and survival, especially of the poor and excluded. The main indicators for this include reduction in maternal mortality ratio and neonatal mortality rate.
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Table 9: Safemotherhood program targeted activities of 2070/71 Physical Financial S. Activities Unit Remarks N. Achieve Achieve Expendit Expend Target Budget ment ment % ure iture % Laptop purchase for PHN for recording 1 Piece 1 1 100.00 76 76 100 and reporting purpose Eqipment, instruments purchase 2 Piece 4 4 100.00 600 383 64 for Birthing center establishment IP for Family planning and Birthing 3 center program Piece 2 2 100.00 100 100 100 (autoclave, Drum, gas/kerosene, stove District level planning and review meeting 4 Piece 1 1 100.00 300 300 100 for Reproductive Health program Expansion of MPDR 5 Piece 2 2 100.00 106 106 100 program and training Listing of people who needs operation for 6 Piece 680 362 53.24 528 528 100 obstretics fistula and fitting ring pessaries Quarterly meeting of district level 7 Reproductive Health Piece 3 2 66.67 15 10 67 Coodination Committee Follow up of Reproductive Health 8 Piece 42 42 100.00 200 200 100 Programs from district to facility level ANM appointment on contract in HP and 9 Piece 25 38 152.00 4500 4500 100 PHC for 24 hrs delivery service Motivation for ANC 10 Person 5380 1836 34.13 2152 734.4 34 and Natal service Replace and Transportation cost 11 Person 8026 10318 128.56 22114 22065.75 100 for 'Aama Suraksha Service Program' Nyano Jhola (Warm 12 Bag) for delivered Person 6500 2383 36.66 5200 1874.4 36 women Replace and Transportation cost 13 Person 1774 0 0.00 4886 0 0 for 'Aama Suraksha Service Program'
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Report form and Partograph printing 14 Piece 1 1 100.00 20 20 100 for Aama Suraksha program Clinical updates for Nurses and ANMs 15 working at Birthing Piece 1 1 100.00 303 303 100 center and Health Institutions
Table 10: Safemotherhood program performance status by selected indicators Indicators 2068/69 2070/71 2070/71
1. No of functional BEOC sites 6 5 5 2. No of functional CEOC sites 6 8 8 3. No of Safe abortion sites 20 20 20 4. Ratio of BEOC/CEOC sites to Population 73,654 70,63 71,16 (Population/No. of sites) 5. No of birthing centers and Ratio to EP 12/2011 17/1474 18/1453 (No.BC/No.EP) 6. ANC 1st visit as % of expected pregnancy 122 105 129 7. 4 ANC visits as % of expected live birth 88 74 82 8. Delivery conducted by SBA as % of expected 92 93 112 live births 9. % of institutional delivery among expected live 92 93 99.07 births 10. PNC 1st visit as % of expected live birth 86 93 106 11. No of CAC (Surgical and Medical Abortion, 4216 3342 3184 MA) 12. No of PAC 783 817 466 13. % of women receiving maternity incentives 81.39 73.75 49.38 among total institutional deliveries 14. % of women receiving 4 ANC incentives 0.76 2.74 7.72 among total institutional deliveries 15. Met need for emergency obstetric care (need 2.11 1.98 0.59 of EOC is 15% of expected live birth) 16. Caesarian Section (CS) rate ( 5% of total 14.87 18.12 20.41 expected birth is the usual CS rate) 17. Number of Maternal Death 9 21 34 18. Number of Neonatal Death 5 166 171
Note: Number of Neonatal Death includes Gulmi-8, Kapilvastu-33, Rupandehi-66, Nawalparasi-31, Dang- 11, Pyuthan-10, Arghakhachi-4, Rolpa-4, India-1
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Chart 5 : ANC, Delivery and PNC Status
Service statistics of the fiscal year 2070/71 shows the number of functional BEOC and CEOC site remain the same as compared with last FY. ANC 1st visit as % of expected pregnancy has been increased by 24% margin in this FY. Also the increase in awareness of the beneficiaries and improvement in service delivery has been helpful in increasing the 4 ANC visits as % of expected live births.
SBA attendance at birth is increased to 112% and trend shows that mothers preferably accessing institutional delivery and is close to the target population. The expansion of Birthing centers over the last 2 FYs has considerably increased the mothers‟ access to institutional delivery and SBAs.
Abortion services showing slight downwards trend as MA were found reduced. The reasons cited by majority of health workers as due to easy availability of emergency contraceptive pills in the market and attraction towards its use.
The maternal death includes the referral from other districts as well. The neonatal death is also higher due the same reasons as in case of maternal death. The referral should be done at the right time before the critical condition. Also the focus should be done during ANC first visit and provide adequate counseling regarding maternal and child health. DPHO will focus to support health facilities showing low indicators in coming FY.
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Problems and Constraints S N Issues, Problem and Recommended action Responsibility constraints 1 4th ANC low due to less case Proper counseling during first ANM/focal person/FCHV holding and poor counseling visit /Appropriately maintain case record in private clinics
2 Error in recording (iron and ANC Data verification Stat./focal person first not matched) 3 Less utilization of safe abortion Awareness about the HF/FCHV/NGO working services into southern belt (high services /Extension of in safe abortion clandestine abortion practice in abortion site especially in boarder area) remote areas of the district 5 Alarming increase in reported Proper counselling during Focal Person Maternal and newborn death ANCl/Timely refer/Refresher training to birthing center health staffs
4.2 Family Planning Program
Background
The main thrust of the National Family Planning Program is to expand and sustain adequate quality family planning services to communities through the health service network such as hospitals, primary health care (PHC) centres, health posts (HP), sub health posts (SHP), primary health care outreach clinics (PHC/ORC) and mobile voluntary surgical contraception (VSC) camps. The policy also aims to encourage public private partnership. Female community health volunteers (FCHVs) are mobilized to promote condom distribution and re-supply of oral pills. Awareness on FP is to be increased through various IEC/BCC intervention as well as active involvement of FCHVs and Mothers Groups as envisaged by the revised National Strategy for FCHV program.
In this regard, family planning services are designed to provide a constellation of contraceptive methods/services that reduce fertility, enhance maternal and neonatal health, child survival, and contribute to bringing about a balance in population growth and socio-economic development, resulting in an environment that will help the Nepalese people improve their quality of life.
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Objectives
Within the context of reproductive health, the main objectives of the Family Planning Program are to assist individuals and couples to:
Space and/or limit their children Prevent unwanted pregnancies Improve their overall Reproductive Health.
Table 11: Family planning program targeted activities of 2070/71 Physical Financial S. N. Activities Unit Remarks Achieve Achieve Expend Expend Target Budget ment ment % iture iture % Motorcycle purchase for FP supervisor for 1 Piece 1 1 100 180 180 100 supervision and monitoring Computer and printer 2 Piece 1 1 100.00 85 70 82 purchase for FP supervisors IUCD coaching for 3 Person 6 0 0.00 56 0 0 SBA/ANM District level decision 4 Person 1 1 100.00 750 701 93 making tools program Permanent method of family 5 Person 1100 661 60.09 1919 748 39 Planning Permanent method of family 6 Person 0 0 0.00 689 0 0 Planning 7 IUCD service provide Person 700 377 53.86 95 27 28 8 Implant service Person 500 1369 100.00 58 0 0 Family Planning preparation 9 Piece 1 1 100.00 6 6 100 meeting Discussion with FCHV 10 before organising the FP Piece 15 15 100.00 79 73 92 mobile camp Sattelite service for long 11 Person 10 10 100.00 190 0 0 child spacing Degnified retirement of 12 MCHWs for their long Piece 10 5 50.00 100 50 50 service Revitalisation of Mothers 13 Piece 200 200 100.00 600 600 100 groups
Table 12: Family planning program performance status by selected indicators Indicators 2068/69 2069/70 2070/71 1. No of IUCD service sites (functional) 16 13 13 2. No of implant service sites (functional) 10 8 8
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3. No of functional satellite clinics for long acting spacing 0 2 2 methods 4. Contraceptive Prevalence Rate (CPR) 33 32.37 31 5. % of FP new acceptor method mix 11.74 11.69 8.63 6. VSC cases target versus achievement 78 83.26 104.46 7. % of new acceptors of spacing FP method CONDOM 3.52 4.36 2.13 PILLS 2.39 2.03 2.61 DEPO 4.60 3.84 5.81 IUCD 0.39 0.28 0.71 IMPLANT 0.14 0.52 0.44
Chart 6: Contraceptive Prevalence Rate and % of FP New Acceptor Method Mix
Chart 7: Percent of new acceptors spacing method mix
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The contraceptive prevalence rate (CPR) for modern family planning method is 31% and it is lower than 2011 NDHS (43%). District need to work hard as CPR trend shows some level of reduction over the last 2 FY. This is also as many people of reproductive ages have gone abroad for employment and there is no efficient system of recording and reporting by the private clinics.
VSC cases target achieved with 104.46%, which is in increasing trend over the previous years. But there are still spaces for improvement to increase VSC utilization by the beneficiaries. DPHO has been providing the service only on a seasonal basis and sufficient skilled human resource is not available throughout the year in governmental hospital. In case of achieving temporary methods of family planning shows that utilization rate is increased in case of Pills, DEPO and IUCD while Condom and Implant were found lower than the previous years.
Given the CPR estimated from the HMIS and NDHS, achieving NHSP-II goal of 67 percent by 2015 from the current level DPHO, Rupandehi deserve efforts on reviewing the reasons for lagging behind in achieving the target, hence, need to explore innovative approaches and appropriate strategies to perform well in achieving the target in line with the national level set target.
Problems and Constraints S N Issues, Problem and Recommended action Responsibility constraints 1 Fewer long acting services Expansion of long acting service DPHO centers/Only seasonal centers centers and need to trained in case of VSC service providers/Skilled doctors should be available in governmental hospitals throughout the year for VSC services 2 No reporting from Private Channeling the reporting system DPHO and Focal person clinics, nursing home and and strong coordination with private medical colleges private nursing home and medical colleges 4 Less utilization of IUCD Implant should be promoted due DPHO service from 17 BC in boarder to cultural practices into boarder area area/Launch various awareness program focusing VDCs with low indicators
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4.3 FCHV Programme
Background
Recognizing the importance of women's participation in promoting health of the people, GoN initiated the Female Community Health Volunteer (FCHV) Program in FY 2045/46 (1988/1989) in 27 districts and expanded to all 75 districts of the country in a phased manner. Initially, the approach was to select one FCHV per ward regardless of the population size. Later in 1993 population based approach was introduced in selected (28) districts. At present there are 48,541 FCHVs actively working in the country (FHD, Administrative record, 2010/11).
Various policy, strategy and guidelines have been developed to strengthen the program. Numerous factors influence the program including national health sector reform, decentralization and handing over of health facilities to VDCs, as well as the depth and breadth of experience gained from program implementation at the community level, and the recognition that community-based health programs are the key to reducing maternal and child mortality and fertility in Nepal
DPHO Rupandehi is committed to increase the high moral of FCHVs & participation in community health development. In FY 2064/65 MoHP established FCHVs fund by providing Rs. 50,000 to each VDC. The mobilization of this fund for income generating activities is expected to benefit the FCHVs and the community at large.
Goal
The goal of FCHV program is to support the national goal of health through community involvement in public health activities. This includes imparting knowledge and skills for empowerment of women, increasing awareness on health related issues and involvement of local institutions in promoting health care.
Objective
FCHV program has the following objectives: To activate the women for tackling common health problems by imparting relevant knowledge and skills To prepare a pool of self motivated volunteers as a focal person for bridging the health programs with community To prepare a pool of volunteers to provide services for community based health programs To increase the participation of community in improving health
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To develop FCHV as health motivator To increase utilization of health care services through demand creation.
Table 13 : FCHV program targeted activities of 2070/71
Physical Financial S. N. Activities Unit Remarks Achiev Achieve Expend Expend Target Budget ement ment % iture iture % 1 FCHVs' day Piece 69 69 100.00 262 262 100 Half Yearly review 2 Piece 2540 2544 100.16 2047 2047 100 meeting of FCHVs Collection and Publication of FCHVs 3 Person 1 0 0.00 150 0 0 personal information and its distribution Cloth allowances to 4 Person 1270 1270 100.00 5080 5080 100 FCHVs Prize distribution and 5 Person 1 1 100.00 73 73 100 respect to FCHVs Add Rs 10,000 in FCHV 6 NA 69 69 100.00 690 690 100 fund in each VDC
Table 14 : FCHV program performance by selected indicators
Indicators 2068/69 2069/70 2070/71
1. Proportion of Pills cycles distribution by 56.28 49.15 42.27 FCHVs among total distribution 2. Proportion of Condoms distribution by 8.65 12.18 7.44 FCHVs among total distribution 3. Proportion of ORS distribution by FCHVs 31.46 21.89 24.93 among total distribution 4. Number of maternal death reported by NA NA NA FCHV 5. Number of newborn death reported by NA NA NA FCHV 6. % of Mother's Group Meeting held 75.49 59.55 62
There are 1511 FCHV working in Rupandehi. Out of the total, 241 remain in the 2 municipalities and the rest remains in the VDCs. Their major role envisaged promotion of health and healthy behaviour of mothers and community people for safe motherhood, child health, family planning, and other community based health services with support of health personnel from the SHPs, HPs, and PHCCs. Besides the motivation and education, they re-supply pills and distribute condoms, ORS packets and vitamin A capsules; support in vaccination and treat pneumonia cases and refer more complicated cases to health
DPHO, Rupandehi | Annual Report 2070/71 42 institution. Similarly, they also distribute iron tablets to pregnant women in districts with Iron Intensification Programs.
In Rupandehi, status shows FCHVs have contributed in distribution of 42.27% of oral pills and 12.18% of condom out of total distribution. They have contributed in distribution of 24.93% of ORS packet, which has been increased during this FY. Out of the total target, only 62% of Mother‟s Group Meeting was organised by FCHV.
Though FCHVs role are important, enhancing and use of their full capacity could not be ignored to achieve the expected target. So, a review of their performance would enable in finding out their full potentialities by mobilising and get their contribution for improving performance status of certain indicators expected from them.
4.4 PHC Outreach-clinic Programme
Background
As envisaged in the national health policy 1991, health facilities were extended up to village level. However, utilization of services provided by health facilities, especially preventive and promotive services, has been found to be limited because of limited accessibility. Therefore it was felt that services should be closer to the community. Thus Primary Health Care Outreach (PHC/ORC) services was initiated and established.
Primary Health Care Outreach Clinic (PHC/ORC) program was established in 1994 (2051 BS) with an aim to improve access to some basic health services including family planning and safe motherhood services for rural households. PHC/ORC clinics are the extension of PHCCs, HPs and SHPs at the community level. The primary responsibility for conducting the PHC outreach clinics lies with MCHWs and VHWs. At PHCC and HP level, ANMs, AHW and VHWs are responsible for carrying out the PHC outreach services. AHWs and others staff of HP/PHCCs also help in conducting the PHC outreach clinics. Female Community Health Volunteers (FCHVs) and other local NGOs/CBOs support service providers in conducting PHC/ORC clinics and also for recording/reporting and other support activities. Currently, VHW and MCHWs have been promoted to AHW and ANM respectively.
Based on the local needs PHC outreach clinics are conducted every month at fixed locations of a VDC on specific dates and time. The clinics are held at locations not more than half an hour's walking distance for the population residing in that area.
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VHWs and MCHWs or ANMs/AHWs provide basic PHC services (FP and ANC services/Health Education/Minor Treatment) to a pre-arranged place close to communities on a predetermined day once in a month.
Table 15: PHC/ORC targeted activities of 2070/71
Physical Financial S. N. Activities Unit Remarks Achiev Achieve Expendi Expendi Target Budget ement ment % ture ture % Kit purchase for 1 Piece 20 20 100.00 300 300 100 PHC Outreach clinic
Table 16; PHC/ORC performance status by selected indicators Indicators 2068/69 2069/70 2070/71 Number and % of PHC/ORC conducted wrt targeted 2748/100 2748/100 2748/99
Number of People Treated by First Aid 22 32 48 No. of women who received ANC Services NA NA NA % of growth monitoring through ORC NA NA NA
Primary Health Care Outreach Clinics (PHC/ORC) are basically the extension of basic health services at the community level. 99% of the targeted 2748 PHC/ORC was conducted in 2070/71 however the number of people treated by First Aid kit has been increased considerable to 48.
The data shows that popularity of PHC/ORC was increased during the FY 2070/71 and was possible through team work of health staff, support received from like-minded organizations and well information dissemination of the clinics and its service provisions to the communities, proper logistics arrangement and support provided from DPHO team to the health facilities.
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5. Disease Control Programme
5.1 Malaria Control Programme
Background
The objective of Malaria Control Programme was to control malaria mainly in southern Terai belt of central Nepal. In 1958, national malaria eradication program, the first national public health program in the country was launched with the objective of eradicating malaria from the country within a limited time period. Due to various reasons the eradication concept was reverted to control program in 1978.
Malaria Epidemiology
Malaria cases are being reported from 65 out of the 75 districts of Nepal. Approximately 20.36 million populations (73% of Nepal population) are living in the malaria endemic areas. These 65 malaria endemic districts have been classified as 15 high risks, 18 moderate risks and 34 low risks (Micro stratification 2012). Rupandehi falls under the high risk district. The distribution of Malaria within the district itself is not homogenous. No malaria cases have been reported from 10 mountain districts including the capital Kathmandu.The high and moderate risk areas consist of foothills, forest fringe, forests in Terai and inner Terai valleys, where as the low risk area consist of southern planes and northern hills/ hill river valleys. Malaria disproportionately affects ethnic minorities, poor, mobile population groups, young adults and those living in border areas.
Malaria species
Among five human plasmodia, three species namely Plasmodium vivax, Plasmodium falciparum and Plasmodium malariae have been detected in Nepal till date. However, Plasmodium ovale has also been reported from private sector health care providers from the patients returning from Africa. P. malariae has not been detected since last two decades. During the last 5 years, percentage of P. falciparum remained between 17-26% of the total confirmed malaria cases, where as P.vivax has remained the predominant species. In malaria outbreaks P. falciparum is the dominant infection.
Malaria vectors
Mosquito fauna surveys done in 1968 have revealed presence of 42 Anopheles species in Nepal. Out of them, An. minimus, An. fluviatilis, An. maculatus, An. annularis are the vectors of malaria in Nepal. An. minimus disappeared after continuous insecticide spraying during malaria eradication era. An. fluviatilis has been incriminated from the pre-eradication period and also responsible for the perennial transmission
DPHO, Rupandehi | Annual Report 2070/71 45 in forest fringe, foothills and inner terai. This species has been found responsible for the transmission during epidemics. An. maculatus supports to maintain the transmission in these areas. An. annularis is found in outer Terai, cultivated plains and is a weak vector. An. minimus the principal vector has not been reported since its elimination during the eradication phase. An. culicifacies is a suspected vector in Terai region.
STRATEGIC PLAN 2011 - 2016
Vision
Malaria free Nepal by 2026
Mission
To provide free, efficient, equitable, accessible, and quality malaria interventions to all people in Nepal
Goal
By 2016, incidence of locally transmitted malaria will be reduced by 90% of current levels and number of VDCs having indigenous malaria cases will be reduced by 75% of current level (2010).
Objectives
1. To update the stratification of malaria endemic areas and align activities outlined in the strategic plan accordingly in different strata by 2012. 2. To achieve at least 90% vector control coverage of malaria risk population living in high and moderate risk areas by 2016. 3. To achieve 90 % screening of all suspected malaria cases for parasitological diagnosis and 100 % effective treatment of all confirmed malaria cases according to the national guidelines by 2016. 4. To intensify passive malaria surveillance, introduce weekly reporting including mandatory zero reporting system, case notification and case based active malaria surveillance and initiate early response to focal outbreaks by 2016. 5. To ensure that 90% of population at malaria risk adopt at least one preventive measure for malaria by combination of BCC approaches by 2015. 6. To develop and sustain the required program management capacity and structures at all levels to effectively and efficiently deliver a combination of targeted interventions by 2014.
Targets
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80 percent of people in high risk areas (stratum 1 VDCs) sleeping under LLIN (last night) by 2011. 80 percent of malaria cases reported by public sector health facilities in high risk areas (stratum 1) confirmed by microscopy or RDT by 2011. 80 percent of care providers at rural public sector health facilities providing appropriate treatment for malaria by 2011.
Table 17: Disease control program of 2070/71
Physical Financial S. N. Activities Unit Remarks Achiev Achieve Expen Expend Target Budget ement ment % diture iture % Mass movement for the against living areas for 1 Mosquito's larva distruction Piece 2 1 50 450 450 100 for the prevention of Dengue and Chiken guniya disease Orientation interaction with health workers, MCHWs and 2 other stakeholders for the Piece 2 2 100 450 450 100 prevention of Dengue and Chiken guniya disease Integrated Disease surviellance for the fast 3 Piece 3 3 100 71 71 100 information of epidemic diseases Outbreak and disaster preparedness workplan 4 Piece 2 2 100 70 70 100 workshop, supervision and monitoring Various level of training conduction in the distrcit (as 5 Piece 618 84 13.59 594.00 573.80 96.60 per fund approved from Global Fund) Hiring of expert for Malaria 6 Piece 2 0 0.00 357 0 0.00 control Identify the suspected cases of Malaria, collect blood 7 Piece 5100 0 0.00 360 0 0.00 smear and conduct surveillance Supervision, follow up and 8 evaluation of Malaria control Piece 2 2 100.00 120 67 55.83 program Collected medicine and 9 supplies from the center Piece 2 2 100.00 74 60 81.08 distibute up to the field level Purchase of medicine, 10 materials for the epidemic Piece 1 0 0.0 25 0 0.00 control of Malaria Insecticide spraying: Identify 11 the Malaria prone areas and Piece 2 2 100.00 500 500 100.00 spray insecticide
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Repair of pump for 12 Piece 2 2 100.00 30 30 100.00 insecticide spraying Multi-organisation interaction 13 for Malaria control and World Piece 1 1 100.0 78 60 76.92 Malaria Day celebration Various administrative work 14 Piece 3 3 100.00 120 75 62.08 in GFTM districts Keep buffer stock for emergency situation for 15 Piece 1 1 100 100 100 100.00 epidemic and disaster prevention
Table 18: Malaria control program performance by selected indicators Indicators 2068/69 2069/70 2070/2071 1. No of confirmed malaria cases among total 137 189 138 malaria cases 2. Annual Blood Examination Rate (ABER) 1.41 1.06 1.81 3. % of PF among total positive cases 35.03 34 25.36 4. Clinical malaria incidence/1,000 risk 4.49 2.6 1.64 population 5. Reported death due to malaria 0 0 0 6. Target versus achievement of blood slide 100 100 100 collection 7. % of indigenous cases among total positive 82 69.31 55.79 cases
Regarding the malariomatric indicators of the Rupandehi district, the above table shows that number of positive cases of malaria has decreased to 138 as compared with the last FY. Activities led by DPHO as street dramas, school health malaria program and distribution of insecticide treated bed nets has helped to raise the awareness against malaria and the relevant training to the health workers, FHCVs and private clinicians has been useful in building the capacity of health service provider. And as such there has been no reported death due to malaria. ABER has also been increased as people are aware to control the potential diseases in right time.
DPHO, Rupandehi | Annual Report 2070/71 48
Chart 8 Annual Blood Slide Examination Rate 2070/71
Chart 9 Trend of Malaria Positive Cases in nos
In case of Rupandehi district, 100% target has been achieved for Blood slide collection i.e. ABER is 1.81 (Greater than 1%) which is higher than previous 2 years. Clinical Malaria incidence is 1.64 /1,000 risk population that is decreased as compared with last FY which is the positive indicator because Nepal government has strategy to reduce the clinical malaria. Percentage of indigenous cases among total positive cases was found about 55.79% which has been decreased than previous year. No death cases have reported in the district due to Malaria in the FY2070/71.
DPHO, Rupandehi | Annual Report 2070/71 49
Chart 10 : Trend of Clinical Malaria Incidence
Performance Malaraia PF Case Reporting VDC
Since Falciparum malaria is severe type of malaria because it has high case fatality rate if is not treated on time. Even a single case of indigenous Falciparum malaria in the community, indicates the probability of outbreak of malaria. For the prevention of outbreak, blood slide should be taken around 2 KM radius supposing indigenous case as a centre. There is no proper mechanism to reconfirm whether the cases were indigenous. The prevention strategy should develop the system to reconfirm the indigenousity of the cases identified and from the all positive and about 10% of negative slides should be verified by strengthening cross checking mechanism. Annual Blood Examination Rate (ABER) is the operational efficiency of the malaria intervention program. According to WHO' standard guideline of the malaria, total blood slides of the risk population should be at least one percent of the total population. On the basis of this standard, annually and monthly target of the ABER is set up in the district and by the same process monthly and annually targets are distributed institution wise. It is mandatory that any fever case from the high risk malaria region, slide should be taken.
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Table 19: PF cases reporting VDCs in 2070/71 Malaria Control Program - FY 2070/71 ,Malaria positive cases in Month wise Report Slide Collection Examined Positive PV PF P Mix Slide Treat Clinical Month Micros Micros Death target ACD PCDH Total RDT Total RDT Total ment Ind Imp Ind Imp Ind Imp Malaria copy copy Shrawan 425 0 1028 1028 1041 1028 2069 9 5 14 14 5 3 0 5 0 1 269 0 Bhadra 425 0 685 685 954 685 1639 6 9 15 15 5 7 0 2 0 1 267 0 Aswin 425 0 691 691 1200 691 1891 10 1 11 11 6 1 0 4 0 0 262 0 Kartik 425 0 638 638 688 638 1326 9 1 10 10 2 1 0 6 0 1 63 0 Mansir 425 0 341 341 719 341 1060 9 2 11 11 3 3 4 1 0 0 11 0 Poush 425 0 344 344 372 344 716 6 0 6 6 2 0 2 1 0 1 60 0 Magh 425 0 380 380 412 380 792 11 2 13 13 7 2 1 2 0 1 109 0 Falgun 425 0 466 466 614 466 1080 8 1 9 9 3 3 3 0 0 0 111 0 Chaitra 425 0 847 847 629 847 1476 7 4 11 11 4 6 0 0 1 1 98 0 Baishakh 425 0 813 813 629 813 1442 5 5 10 10 6 4 0 0 0 0 29 0 Jestha 425 0 822 822 714 822 1536 14 1 15 15 14 1 0 0 0 0 121 0 Ashar 425 0 928 928 875 928 1803 13 0 13 13 6 3 3 1 0 0 121 0
Total 5100 0 7983 7983 8847 7983 16830 107 31 138 138 63 34 13 22 1 6 1521 0
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LLIN distribution
LLIN has been distributed in Rupandehi district with the support from Government of Nepal and Global fund. The beneficiaries' VDCs were Makraher, karahiya, Shankarnagar, Aanandaban, Devdeha, Paroha, Saljhandi, Bishnupura, Rudrapur, Madhubani, Lumbini, Sipawa & Padsari VDCs and Butwal municipality. The number of LLIN in ANC and free distribution are listed below. LLIN are regularly distributed from the ANC clinic to prevent the pregnant mother and fetus from the malaria transmission indigenously.
Table 20: LLIN distribution status of three consecutive years Year 2068/69 2069/70 2070/71 ANC LLIN 584 973 2014 distributed Free LLIN 102807 14025 61368 distributed
Spraying
Insecticide spraying is the main preventive measure of the mosquito control. First of all risk VDCs are selected on the basis of following criteria and municipalities are excluded for this process. 1. Not distributed LLIN 2. Case reporting every three fiscal years 3. High risk VDC felt by district malaria team 4. After conducting different training about the insecticide, precaution taken, preventive tools and dissemination by different media; spraying program is conducted. It is completed in two cycle one in per monsoon and other post monsoon. In fiscal year 2070/71 spraying was done in 3 VDCs i.e., Tenuhawa, Aama and Bhagawanpur. The detail about number of VDCs, ward villages the target population, achievement and insecticide expenditure is given in the following table.
Table 21: Trend of insecticide spraying
FY Target Achievement Saved Expenditur
populati e of ges on insecticide
(in kg) Noof VDC
Noof Ward Hous Katera Populati Hous Kater Noof villa e on e a 2068/69 5 12 23 1959 1561 12180 1669 475 15143 337
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2069/70 3 16 27 2340 1568 21122 2576 2354 22748 623
2070/71 3 16 27 2865 2655 25001 3106 2916 27094 616.4
5.2 Dengue Control Program
Dengue Fever is an illness caused by infection with a virus transmitted by the Aedes mosquito. In Nepal dengue has become a burning issue in epidemic control. First case reported in a foreigner in 2004. First outbreak of dengue occurs with molecular evidence (PCR) Sporadic cases from few districts of eastern Nepal but no outbreak (2007-2009). In 2010, outbreak was in Chitwan and Rupandehi few cases were reported from Nawalpasasi, Banke, Kailali, Parsa. At present, main intervention in dengue control program are advocacy, public awareness larva search and destroy and case surveillance and diagnosis and treatment of the cases. There were altogether 12 cases reported Butwal (10 cases), Makrahar (1 case), Devdaha (1 case) during FY 70/71 in Rupandehi and no deaths were reported.
Table 22: Larva of dengue mosquito search and destroy status
Place where mosquito hatch eggs
Total Total Plastic Tin Drum/ Total
no of no of Tire Container Container Tank Other Exa
ward house mine Total
FY s s d Found
Found Found Found Found Found
examined examined examined examined examined 752 505 3594 243 113 71 111 33 184 128 8525 2068/69 15 20922 9 4 7 22 56 27 34 65 00 88 7 52998 527 280 1643 624 791 26 669 26 675 396 4230 2069/70 15 16654 6 3 2 8 0 08 6 89 8 0 1 17730 769 329 2218 906 994 48 130 29 139 626 6626 2070/71 15 23269 7 4 1 6 1 60 09 87 82 5 5 26513
In fiscal year 2070/71, the programs Campaign for control of Dengue and Chicken guinea epidemic by mobilizing health workers, FCHVs and other volunteers by searching for mosquito habitat and destroying their larvae and Dengue & chicken-guinea epidemic control Orientation & interaction programme for public awareness to Health workers, FCHV & stakeholders have conducted. The details about the ward of municipality, no of houses, examination of the tire, plastic container and larva found in three fiscal years has given in above table.
DPHO, Rupandehi | Annual Report 2070/71 53
Problems and Constraints
S N Issues, Problem and Constraints Recommended action Responsibility 1 Shortage of malaria diagnostic kit and To coordinate with Regional DPHO antimalarial drugs in peripheral health Health Directorate and DOHS to facility time to time. minimize the stock out of the medicine and commodities. 2 Lack of knowledge in health workers To supervise and monitor the EDCD/GFATM, in malaria indicators and its formula peripheral health facilities having DPHO low performance of the malaria indicators 3 Delay in program approval; vector Timely approval and EDCD borne disease must be controlled in implementation of control program the right time helps to reduce the prevalence to the greater extent
5.3 Tuberculosis Control Program
Background
Tuberculosis (TB) is a major public health problem in Nepal. About 45 percent of the total population is infected with TB, of which 60 percent are adult. Every year 40,000 people develop active TB, of whom 20,000 have infectious pulmonary disease. These 20,000 are able to spread the disease to others. Treatment by Directly Observed Treatment Short course (DOTS) has reduced the number of deaths; however 5,000-7,000 people still die per year from TB. Expansion of this cost effective and highly successful treatment strategy has proven its efficacy in reducing the mortality and morbidity in Nepal. By achieving the global targets of diagnosing 70 percent of new infectious cases and curing 85 percent of these patients will prevent 30,000 deaths over the next five years. High cure rates and Sputum conversion rate will reduce the transmission of TB and lead to a decline in the incidence of this disease, which will ultimately help to achieve the goal and objectives of TB control.
DOTS have been successfully implemented throughout the country since April 2001 has coordinated well with the public sectors, private sectors, local government bodies, I/NGOs, social workers, educational sectors and other sectors of society in order to expand DOTS and sustain the present significant results.
Vision
The NTP‟s vision is TB free Nepal.
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Mission
To ensure that every TB patient has access to effective diagnosis, treatment and cure To stop transmission of TB To prevent development of multi drug resistant TB To reduce the social and economic toll of TB
Goal
To reduce the mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem in Nepal.
Objectives
Achieve universal access to high-quality diagnosis and patient-centered treatment Reduce the human suffering and socioeconomic burden associated with TB Protect poor and vulnerable populations from TB, TB/HIV and multi-drug-resistant TB Support development of new tools and enable their timely and effective use.
Targets
The NTP targets for TB control are: To find at least 82% if sputum positive TB Patient To Cure at least 90% of sputum positive TB Patient
Table 23: TB control program targeted activities of 2070/71
Physical Financial S. Activities Unit Remarks N.
Achiev Achieve Expen Expend Target Budget ement ment % diture iture % Purchase of steel drawyer, 1 filter etc for Piece 1 1 100 10 10 100 treatment centers TB orientation to 2 Piece 4 34 100 Mothers groups 4 100 34
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Physical Financial S. Activities Unit Remarks N.
Achiev Achieve Expen Expend Target Budget ement ment % diture iture % Basic TB 3 Piece 1 110 100 Modular training 1 100 110 I day HMIS data cross check 4 Piece 1 209 100 training in DOTS 1 100 209 center Case detection (Microscopic
5 camp) in Piece 4 171 100 6 150 171 remaining population Case detection (Microscopic
6 camp) increasing Piece 5 138 100 5 100 138 in factories and Prison At household level TB examination Pers 7 through Mothers 1288 644 38.51 on 497 39 248 Groups and FCHVs mobilization Sputm examination of Pers 8 7340 0 - - suspected on 6,055 82 patients New sputum Pers 9 examination 22020 0 - - on 15,253 69 slide Follow-up Pers 10 sputum 3266 0 - - on 2,575 79 examination New sputum Pers 11 positive patient 734 0 - - on 625 85 no. New sputum Pers 12 negative patient 440 0 - - on 445 101 no. Extra pulmonary Pers 13 294 0 - - patient no. on 295 100 Re treatment Pers 14 110 0 - - patient number on 115 105 Information 15 dissemination Piece 8 - - 539 - - program through
DPHO, Rupandehi | Annual Report 2070/71 56
Physical Financial S. Activities Unit Remarks N.
Achiev Achieve Expen Expend Target Budget ement ment % diture iture % media and communication in the district IEC production
16 and distribution Piece 1 15 100 1 100 15 at district level Celebration of 17 Piece 1 20 100 World TB day 1 100 20 Regular follow up and
18 supervision from Piece 27 108 67 27 100 72 treatment center to sub center Quartely program follow
19 up and HMIS Piece 10 440 100 10 100 440 cross check workshop for TB TB HIV PAL related district
20 level quarterly Piece 6 180 100 6 100 180 follow up meeting Internet and motorbike repair 21 Piece 1 12 100 and mobilisation 1 100 12 in the district From disrict to treatment center and sub center level follow up and evaluation
22 (including Piece 30 150 33 30 100 50 program of DOTS PPM PAL Microscopic center's program) Defaulter cases of TB patients who come for re treatment and 23 NA 117 468 67 their nutrition 78 67 312 cost during entire treatment period
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Proper management, good coordination, sound monitoring & supervision and good team work has helped to reach close to the planned target of the TB control programs.
3.4.1.2 Performance by selected indicators (FY 2068/69 – 2070/71)
In context of Nepal, TB program is a high priority public Health program and is also considered as a successful and cost effective program. Tuberculosis is one of the major public health problems in Rupandehi. Treatment by Directly Observed Treatment Short (DOTS) course has been implemented and TB clients are being treated with DOTS at 15 treatment centers, 73 sub centers and 2 urban DOTS center (Bhim and Zonal hospital). DPHO has succeeded to achieve the treatment success rate (TSR) of 90% which is in line with the national rate (90%). The case finding rate (CFR) has been slightly increased 66% than previous years. Active case finding program and routine supportive supervision by DPHO at low performing centers is expected to increase the CFR in coming FYs.
Table 24: TB control program performance by selected indicator Indicators 2068/69 2069/70 2070/71 1. Case Finding Rate 78 64 66 2. Treatment Success 92 91 90 Rate 3. No of DR Cases 36 59 63
A comparison trend of 3 years shows that the number of DR Cases reached are gradually increased that shows the gradual success of Tuberculosis Control Program in the district.
Chart 11: Treatment Outcome and No. of MDR Cases in Three Consecutive Years
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DR Service provided through 2 DR Treatment Centers and through establishing of 15 bedded 1 DR Hostel. This has immensely contributed in increasing access of services for poor and vulnerable clients and successfully serving the clients referred from adjacent 6 districts to Rupandehi. Due to awareness about DR Hostel the DR cases has increased significantly. This provision is helpful in reducing DR cases.
5.4 Leprosy Control Programme
Background
Leprosy has existed in Nepal since time immemorial and was recognized as a major Public Health problem as early as 1950. For ages, leprosy has been a disease causing public health problem and has been a priority of the government of Nepal. Thousands of people have been affected by this disease and many of them had to live with physical deformities and disabilities.
The program was integrated into the general health services in 1987. By 1996 MDT was expanded to all 75 districts. The country conducted Leprosy Elimination Campaign in 1999 (LEC-1) and again in 2001 (LEC-2) which was an active case detection activity. In high endemic pockets special interventions were undertaken for case finding. Community mobilization and participation during LEC contributed to voluntary case reporting due to reduction of stigma and discrimination against leprosy affected persons.
In Rupandehi, MDT service is being delivered through all the public health facilities (PHCs, HPs and SHPs). Health care providers serving at community based health facilities had undergone Comprehensive Leprosy Training (CLT) and are effectively providing MDT service over the years. FCHVs have received orientation on leprosy and are capable in suspecting and referring cases to the nearest HF for confirmation of diagnosis and treatment.
Vision
To usher in a leprosy free society where there are no new Leprosy cases and all the needs of existing Leprosy affected persons having been fully met.
Mission
To provide accessible and acceptable cost effective quality leprosy services including rehabilitation and continue to provide such services as long as and wherever needed.
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Goal
Reduce further the burden of leprosy and to break channel of transmission of leprosy from person to persons by providing quality service to all affected community.
Objectives
To eliminate leprosy (Prevalence Rate below 1 per 10,000 population) and further reduce disease burden at district level; To reduce disability due to leprosy; To reduce stigma in the community against leprosy; and Provide high quality service for all persons affected by leprosy.
Table 25: Leprosy control program targeted activities of 2070/71
Physical Financial S. Activities Unit Remarks N. Achi Tar Achievem Expen Expendi evem Budget get ent % diture ture % ent 1 Laptop / computer Piece 1 1 100 35 35 100 Family examination 2 of sick and Person 2380 4800 100 120 120 100 neighbours 3 Skin disease camp Event 1 1 100 70 70 100 Message dissemination in 4 Piece 39 39 100 24 24 100 local language from local FM 5 Flex board Piece 4 4 100 2 2 100 Excluded groups, dalit, janjati groups and Gender 6 Piece 4 4 100 88 88 100 inclusiveness (access inclusion in Leprosy program) School Health 7 Piece 30 30 100 15 15 100 Education Secure Human Rights of disabled person due to Leprosy in leprosy 8 Piece 1 1 100 25 25 100 affected districts with conduction of orientation in Community Based
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Rehabilitation program and follow up as per provision of United Nations guidelines Collective income generation and saving increase 9 Piece 1 1 100 60 60 100 program for the Leprosy affected person Interaction among stakeholders for 10 Piece 1 1 100 14 14 100 Leprosy affected MCBR Program on the 11 accasion of World Piece 1 1 100 30 30 100 Leprosy Day Information dissemination for 12 district, PHC and HP Piece 3 3 100 307 292 95.11 level review and report Program supervision 13 observation and Piece 44 44 100 133 133 100 follow up Transportation cost 14 for regular treatment NA 137 137 100 137 137 100 completed patients
Although, there are not so much activities in the district for the control of leprosy since its prevalence is low in comparison to other diseases however all the targeted activities about the leprosy control program has been completed getting almost hundred percent achievement which indicates the good performance in the leprosy control program.
Table 26: Leprosy control program performance by selected indicators Indicators 2068/69 2069/70 2070/71 1. New case Detection Rate (per 1.9 1.64 1.78 10000) 2. Registered Prevalence Rate (per 1.4 1.30 1.3 10000) 3. Disability Grade 2 % 2 0 1.2
Even though Nepal has already achieved the status elimination at national level, it has still remained a challenge to achieve the same at district level. In Rupandehi, New case detection rate has slightly increased to 1.78% as compared with the last FY. Registered prevalence rate is the same as last FY and Disability Grade has been increased to 1.2 due to low early case diagnosis in the disadvantaged VDCs of
DPHO, Rupandehi | Annual Report 2070/71 61 the district. DPHO will focus to implement various awareness campaigns to ensure early case diagnosis focusing areas with higher disability grade in coming FY.
Chart 12: Trend of New Case Detection Rate and Prevalence fo Leprosy
Leprosy cases are scattered in the district, hence, reaching regularly to them are part of the problem. However, health staffs are regularly mobilized and motivated in reaching them to increase access to the services. We have further analyzed the prevalence rate of leprosy and following 5 VDCs have reported more than 3 PR. There are 25 VDCs which has reported zero prevalence rate of leprosy.
Table 27: Registered Prevalence Rate scenario of the district Rate Number of VDCs/NPs 0 25 <1 11 1-2 20 2-3 10 >3 5
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Problems and Constraints S N Issues, Problem and constraints of Recommended action Responsibility TB and Leprosy Program 1 CFR is fairly low in comparison to Launch active case finding HF in charge, Focal national target program with focus on person and DPHO, NTC disadvantaged VDCs of the district 2 Lack of drug supply for children as per Drug supply for children NTC and WRHD the recent WHO guideline according to WHO guideline 3 Low budget allocation for quarterly Allocate proper budget for NTC and WRHD monitoring workshop quarterly monitoring workshop according to the need of district 4 Still PR is high in district Specific program has to HF in charge, Focal conducted into high case load person and DPHO/ VDCs related partners 5 No specific program for RFT patient Developing model health HFI/related partners care facility for RFT patient management care
Outbreak and Disaster Management
Table 28: Outbreak and disaster management Status Indicators 2068/69 2069/70 2070/71 1. Number of outbreaks reported 4 4 1 2. Number of outbreaks investigated and 4 4 1 managed by RRT within two weeks of onset 3. Number of disasters reported 0 0 0 4. Proportions of disasters responded by RRT 4 4 1 5. Outbreak/disaster categories, number of 252/4 0 0 affected and death 6. Budget allocated for outbreak and disaster 121,000 211,000 241,000 management
In the past, Rupandehi experienced of outbreaks like diarrhoea, JE, Malaria, Measeles, Rubella, Dengue but in the fiscal year 2070/71 no such has been reported. But 1 outbreaks reported in 2070/71 was of avian influenza (bird flu) epidemic. The district RRT was mobilized to respond and control in coordination with district Vetenerary Office, Rupandehi. In the culling operation 332 chickens were destroyed.
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Table 29: Outbreak Situation by disease categories Outbreak/Disaste 2068/69 2069/70 2070/71 rs Categories * No of No of Cases/ Deat No of Cases/ Dea No of Cases/inju events event injured h events injured th events red s Diarrhoea 5 2 64 0 0 0 0 0 0 Flood 0 0 0 0 0 0 Faciolopsis 0 0 0 0 0 0 Cholera 1 0 0 0 0 0 Dengue 1 0 0 0 0 0 Measles/Rubella 2 188 4 0 0 0 0 0 Avian influenza 4 695* 0 1 332 *chicken were culled
5.6 Filariasis Elimination Campaign
Elimination campaign has been completed.
5.7 Rabies
An acute virus disease of the nervous system of mammals that is caused by a rhabdovirus (species Rabies virus of the genus Lyssavirus) usually transmitted through the bite of rabid animal and that is characterized typically by increased salivation, abnormal behavior, and eventual paralysis and death when untreated. in FY 2070/71, total number of animal bite case were 4336. For the post exposure prophylaxis, vaccine (vials) expenditure were 20009. There was no death case reported in the Rupendehi district from the hydrophobia.
Table 30: Animal bite and no. of vaccine use status
1. Total number of animal bites (species wise) 4336 2. Vaccine (vial) expenditure 20009 3. Number of deaths due to rabies (hydrophobia) 0
5.8 Snake Bite
The condition resulting from the bite of a venomous snake and characterized by variable symptoms (a pain and swelling at the puncture site, blurred vision, difficulty in breathing, or internal bleeding). Records shows that 1957 cases of snake bites registered, whereas 148 cases had been treated for poisonous snake bite. A total 3115 dose of anti-snake venom serum expenditure recorded. Eight cases of Snake bite deaths has been recorded during the FY 2070/71.
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Table 31: Snake bite situation 2070/71 1. Total Number of snake bite 1957 2. number of persons treated for poisonous snakebite 148 3. Anti snake venom serum expenditure 3115 4. Number of deaths due to snake bite 8
5.9 HIV/AIDS Program
Background
History of Nepal‟s response against HIV/AIDS begun with the launching of first National AIDS Prevention and Control Program in 1988. In 1995, a National HIV/AIDS Policy with 12 key policy statements and supportive structures like National AIDS Coordination Committee (NACC) and District AIDS coordination Committee to guide and coordinate the response at central and district level was endorsed. As directed by the National HIV/AIDS Policy, a multi-sector National AIDS Coordinating Committee (NACC) chaired by the Minister of Health, with representation from different ministries, civil society, and private sector was established at centre to build the coordination mechanism to support and monitor the activities implemented through NCASC. Similarly, DACC was established to coordinate and monitor the activities at district level.
Vision
Nepal will become a place where new HIV infection are rare and when they do occur, every person will have access to high quality, life extending care without any form of discrimination.
Goal
To achieve universal access to HIV prevention, treatment, care and support.
Objectives
Reduce new HIV infections by 50 percent by 2016, compared to 2010; Reduce HIV-related deaths by 25 percent by 2016 (compared with a 2010 baseline) through universal access on treatment and care services; and Reduce new HIV infections in children by 90 percent by 2016 (compared with a 2010 baseline)
DPHO, Rupandehi | Annual Report 2070/71 65
The National HIV/AIDS Strategy is a national guiding document and a road map for the next five years for all sectors, institutions and partners involved in the response to HIV and AIDS in Nepal to meet the national goal; to achieve universal access to HIV prevention, treatment, care and support with two major programmatic objectives (i) reduce new HIV infections by 50 percent, and (ii) reduce HIV related deaths by 25 percent, by 2016. The strategy delineates the central role of the health sector and the essential roles the other sectors play, in response to the HIV epidemic.
District AIDS Coordination Committee (DACC) is formed in the district and operates its office from DPHO, Rupandehi. The district is following current national HIV/AIDS Strategy, therefore, builds on two critical program strategies: (i) HIV prevention, and (ii) treatment care and support of infected and affected. To ensure the achievements of program outcomes, cross-cutting strategies are devised to supports (i) creating enabling environment: health system strengthening, legal reform and human rights and community system strengthening (ii) strategic information (HIV and STI surveillance, program monitoring and evaluation and research).
Annual performance
Total of 22 organizations are working in HIV/AIDS sector in Rupandehi and all the VDCs and municipalities have been covered by at least few HIV/AIDS related intervention.
Table 32: Service types of HIV/AIDS program Service type Number of sites VCT Service 7 STI treatment 16 ART 1 PMTCT 1 Community Care Center 1 Treatment care and support 8 Drug Treatment and Rehab 9 Post rehabilitation center 1
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Table 33: HIV/AIDS program targeted activities of 2070/71
Physical Financial S. N. Activities Unit Remarks Achieve Achieve Expen Expendi Target Budget ment ment % diture ture % Development and Publication of 1 Time 1 1 100 1 1 100 Communication materials for DACC Communication cost 2 Time 12 12 100 38 38 100 of DACC Day celebration by 3 Time 1 1 100 44 44 100 DACC Supporting 4 Time 3 3 100 12 12 100 supervision by DACC Tri-monthly review 5 Time 4 4 100 31 31 100 meeting by DACC Office operation cost 6 Time 12 12 74 91 67 74 of DACC Preparation of District 7 Time 1 1 100 45 45 100 AIDS profile and use Bimonthly planning and admin meeting cost of DACC 8 Time 6 1 100 50 50 100 (including stationary, transportation and fuel) Remuneration of 9 Time 13 13 100 322 322 100 DACC Coordinator
The activities targeted for the fiscal year 2070/71 and their status is presented in the above table. Most of targeted activities have been achieved by 100 percent and this applies to the financial progress as well. All these activities were conducted in a coordinated approach under the umbrella of district AIDS coordination committee chaired by Local Development Officer. Due to already available logistic that was remained from the previous year, expenditure for office operation cost could not reach 100% as per the target.
Table 34: HIV/AIDS program performance by selected indicator Indicators 2068/69 2069/70 2070/71 1. Number of people counseled and tested 4891 5575 5461 2. Number of HIV +ve cases 191 144 179 3. Number of persons receiving ART 484 608 702 (cumulative) 4. Number of ART sites 1 1 1 5. Number of Counseling centres 22 22 22
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HIV in Nepal is characterized as concentrated epidemic, where majority of infections are transmitted through sexual transmission. Prevention of HIV among Most At Risk Populations (MARPs) is the key programmatic strategies adopted by the district in line with the national strategies.
Reported data shows that a total of 5461 HIV counselling performed in the district during FY 2070/71, which is slightly lower than the last FY data. A total of 179 new HIV cases reported in the district in FY 2070/71 which is in decreasing trend than previous years. One ART site is functional in the district and 702 PLHA are receiving treatment from the centres furthermore the number of persons receiving ART services is in increasing trend due to awareness about the services . The estimated national prevalence of HIV in the adult population is about 0.25%, however, no district specific study conducted so far to find out the district specific HIV prevalence rate.
VDCs and municipalities ownership is growing towards HIV/AIDS related activities, as 3 Village AIDS Coordination Committees (VACC) has been formed in the district during this FY and altogether there are 22 VACC in the district. A total of 20 NGOs are working in the district targeting to Most At Risk Population (MARPs). Regular reporting to the DACC shows that NGOs and DPHO have better working relations and working jointly on various matters related to HIV prevention program. Practices of day commemorations including WAD, Candle Light Day, and Condom day, International Day against Drug Abuse prevention and International TB Day were jointly organized by the stakeholders for effectiveness and mass awareness of public and related advocacy done for reducing Stigma and Discriminations associated with HIV and AIDS. DPHO is leading Children Affected By Aids (CABA) program being implemented from this FY to reduce stigma and discrimination to the infected children and supporting them in their education, health and nutrition. In coordination with line stakeholders, DPHO is supporting affected children in event basis.
Voluntary Counseling and Testing Centers (VCT)
Voluntary Counseling and Testing (VCT) for HIV usually involves two counseling sessions: one prior to taking the test known as "pre-test counseling" and one following the HIV test when the results are given, often referred to as "post-test counseling". Counseling focuses on the infection (HIV), the disease (AIDS), the test, and positive behavior change. There are all together seven VCT centers in the district. Among them two are from government of Nepal and other five are from non-governmental organizations. All of them except one are urban centered.
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Chart 13: Distribution of VCT Centers at Rupandehi
Saljhundi
Dudharakchhe ButawalN.P. Parroha
Dev adaha VCT Centers Semalar
Shankarnagar Rudrapur Gajedi Motipur KhadawaBangai LZH - 1
Manpakadi SourahaPharsatikar Aanandaban Makrahar Karahiya Kerbani NAMUNA -2
ManMateriya Amuwa Suryapura Sadi Tikuligadh Madhbaliya Nagarjun -2 Bisunpura Dayanagar Gangoliya Sikatahan Chilhiya Harnaiya Dhamauli Jogada Mainahiya Padsari HatiPharsatikar Patekhouli ChhotakiRamnagar FPAN - 1 HatiBangai Basantapur Dhakadhai Chhipagada Masina Ekala Kamahariya Pokharvindi Khudabagar Bhim Hospital -1 Bagaha nuhawa SiddharthNagarN.P. Lumbini Development PakadiS Pajarkatti Madhuwani Te Gonaha Bodabar akron Maryadpur
Bairghat Lumbini Sipawa Bhaganpur Betakuiya Majhagawa
Bogadi
Aama Farena Silautiya Roinihawa Bagauli Asurena
ThumhawaPiprahawa Rayapur
Karauta SameraMarchwar
ART Center
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs in an attempt to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. In Rupendehi district, there is only one ART center in Lumbini Zonal hospital Butwal. This is a referral center for other districts also. In this center there is also CD4 cell count service.
PMTCT Center The transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery or breastfeeding is called mother-to-child transmission. In the absence of any interventions transmission rates range from 15-45%. Currently, the beneficiaries utilizing PMTCT services are 12% as compared with the expected pregnancy. This has to be increased to maximum to meet the national target of reducing 90% transmission from mothers to children. DPHO along with line agencies will be leading various awareness program to disseminate its importance to the beneficiaries. Moreover, there is only one PMTCT center in Lumbini Zonal hospital Butwal. This is a referral center for other districts also. This is mainly related to pregnant women issues. The service sites extension is very necessary for ensuring easy access to the services provided by the mothers. The global community has committed itself to accelerate progress for the prevention of mother-to-child HIV transmission (PMTCT) through an initiative with the goal to eliminate new paediatric HIV infections by 2015 and improve maternal, newborn and child survival and health in the context of HIV.
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.Problem and Constraints
Problems/Issues Recommended Actions Responsibility
VCT/HTC services are centered HTC/VCT services . NCASC mainly in urban areas should be established in . DACC/DPHO rural areas also . Other stakeholders
No special package for children Special CABA package . NCASC affected by AIDS should be provided in the . DACC/DPHO district . Other stakeholders
Establish emergency fund for Emergency fund should . Ministry of local treatment , care and support be established in the development district . Ministry of health . NCASC . DDC/DACC/DPHO . Other stakeholders
Strengthening of DACC and Adequate human . DACC mobilization of local resources resources and budget is . DPHO required to extend the . DDC service sites and reach . Municipalities the remote areas . Line stakeholders
6. Curative Services
6.1 OPD Services
Government of Nepal is committed to improving the health status of rural and urban people by delivering high-quality health services throughout the country. Curative (out-patient, in-patient and emergency) services are highly demanded component of health services by the people. The policy is aimed at providing prompt diagnosis and treatment, and referral of cases through the health network from PHC outreach clinics to the specialized hospitals.
The Interim Constitution of Nepal 2063 has emphasized that every citizen shall have the rights to basic health services free of costs as provided by the law. Ultimately, government of Nepal decided to provide essential health care services (emergency and inpatient services) free of charge to poor, destitute,
DPHO, Rupandehi | Annual Report 2070/71 70 disabled, senior citizens and FCHVs up to 25 bedded district hospitals and PHCCs (December 15, 2006) and all citizens at SHP/HP level (8 October, 2007).
Objectives
The overall objectives of curative services is to reduce morbidity, mortality and to provide quality health services by means of early diagnosis, adequate as well as prompt treatment and appropriate referral, if necessary.
Target Group
All patients attending at health facilities.
Table 35 OPD service status by selected indicators
Indicators 2068/69 2069/70 2070/71 1. Total new OPD visits as % of total population 112 123.72 116 2. Total new female OPD visits as % of total OPD 53.24 46.19 55.61 visit 3. % of communicable disease among total OPD 12.83 12.22 11.97 new visit
Free charge in registration fee, medicine supplied free of cost are systematized in the HF, logistics supply is well maintained and HSIS system has been functional in the district. OPD visits slightly decreased than last FY but still above the target. However caution should be made that all the old cases should not be registered as new cases. Proportion of female who have visited health facilities as new case is decreased with compared to the previous year but the figure shows that health facilities remain friendly even for women. Almost equal proportion of male and female visited the OPD to get the services. . Table 36: Top ten disease
Disease % Disease % 1- Unknown and unspecified 22.84 6 - Impetigo 8.02 causes of morbidity 2- Gastritis and duodenitis 11.66 7 - Fever of other and unknown 7.93 origin (com) 3- Unspecified acute lower 10.28 8- Amoebiasis (com) 6.81 respiratory infection (com) 4- Acute upper respiratory 10.09 9 - Other superficial mycoses 6.66
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infections of multiple and unspecified sites (com) 5- Headache 9.11 10 - Other dermatitis 6.57
Chart 14: Top Ten Diseases in 2070/71
In Rupandehi district, no 1 disease reported is unknown and unspecified causes of morbidity followed by Gastritis and duodenitis, unspecified acute lower respiratory infection and so on.
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Table 37: Free health service targeted activities of 2070/71
Physical Financial S. N. Activities Unit Remarks Achievement Expenditure Target Achievement Budget Expenditure % % Allocation of fund for Municipality Health Building 1 Center Building Construction 1 1 100 1500 1500 100 Consutation service for Human Resource for 2 Person 3 3 100 300 300 100 National free health service Medicine purchase for District 3 Hospital/District Health/ for institutions Piece 1 1 100 3500 3500 100 working under Publci Health Office 4 Special Health program for excluded VDCs NA 1 1 100 125 125 100 Printing materials for Department 5 Piece 1 1 100 150 150 100 implemented program 6 District level follow up for free health service Piece 1 1 100 10 10 100 Fund contribution for the patients registered 7 NA 1 1 100 3521 3500 99.40 in district hospital, PHC, HP, SHP Referral program for patients from target 8 NA 1 1 0 180 0 0.00 groups 9 Elderly citzen program NA 1 1 100 125 125 100.00 10 Equity and access program NA 1 1 100 925 800 86.49 11 Social audit program Piece 1 1 100 660 549.9 83.32 12 Urban women FCHV day Event 1 1 100 46 46 100.00 13 Annual Review of Urban FCHV Time 1 1 100 205 205 100.00 14 Urban FCHV dress allowances Person 1 1 100 964 964 100.00 14 Urban health follow up meeting Piece 1 1 100 28 28 100.00 Fund contribution for established Urban Time 1 1 100 1872 1800 96.15 15 health centers
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Regarding the activities conducted by the government of Nepal about the free Health service, most of the activities have completed according to their target such as fund support and dress distribution for FCHV, drug procurement for HF, Grant on OPD registration fee for PHCC, HP, SHP, grant for establishment for functional Urban Health Clinic and so on. But referral program for patient from targeted group has shown no progress as yet.
Table 38: District recommended for Ultra poor Services by types Diseases Female Male Total Heart disease 42 47 99 Kidney Disease 23 41 64 Cancer 159 81 240 Alzhiemer’s Disease 0 0 0 Total 224 169 403
Nepal is in epidemiological transition phase and also facing the double burden of disease i.e there are more prevalence of communicable disease and on the other hand many types of non communicable disease have been increasing day by day burdening the Nepalese people to invest the money for such type of disease because cost for the treatment of non communicable disease are comparatively higher than communicable disease. Moreover poor and ultra poor people are inaccessible to expend the money to cure this disease. So government of Nepal has decided to support up to one hundred thousands ruppes for those people for the treatment of Heart disease, Kidney disease, Cancer and Alzheimer/parkinsonism. In FY 2070/71, majority of people supported by the government of Nepal had Cancer followed by heart and kidney disease but district committee has not recommended in Alzheimer/parkinsonism.
Laboratory Services by District: FY 2068/69 – 2070/71
Laboratory services are the main diagnostic tools for the clinicians or health facility. Laboratory services are provided for the people in different categorical such as Paracitology, Bacteriology, Virology, Microbiology Hematology, Histopathology, Biochemistry, Immunology/ Serology and so on. Details of the services provided in the fiscal year 2070/71 are outlined in table below.
Table 39: Laboratory services
Other Paracitology/ Virolo Hemat Microbi Histopat Bioche Immunology/ Tests FY Bacteriology gy ology ology hology mistry Serology 2068/69 202711 92494 62542 39054 14337 8900 2068/69 202711
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2069/70 95964 6956 370260 27032 1877 239912 86994 25277 2070/71 171628 4408 305844 15407 16140 151886 64499 1858
7. Supporting Program
7.1 Health Education, Information and Communication
In 1991, Ministry of Health and Population had formulated new health policy. Following this policy, National Health Education, information and Communication Centre (NHEICC) was established under the Ministry of Health and population in 1993. MoHP improved its structure in 2002 with giving mandate to support for health promotion, education and communication to Department of Drug Administration and Department of Ayurveda. So, NHEICC is under the direct supervision of MoHP. Similarly, recently cabinet endorsed "National Health Communication Policy, 2012" is the milestone for health promotion, education and communication program under MoHP/GoN. It shows high priority of government to health promotion, education and communication program in the health sector.
NHEICC is responsible for planning, implementation, monitoring and evaluation of health promotion, education and communication program of all health services and program under the ministry of health and population. It, also, regulates the health messages produced and disseminated by other organizations. Developing, producing and disseminating messages and materials to promote and support health programs and services in an integrated manner is part of the responsibility. For this purpose, all of the districts have Health education, information and communication programs since FY 2051/52. The health education and communication section in the regional health directorates and training and health information section in the district Health/Public Health Offices implement health promotion, education and communication activities utilizing various media and methods according to the needs of the local people in the district. Local media and languages are used in the district for the dissemination of health messages so that people can understand health messages clearly in their local context.
Objectives
The general objective of National Health Education, information and Communication program is to raise the health awareness of the people as a means to promote improved health status and to prevent disease through the efforts of the people themselves and through full utilization of available resources.
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The specific objectives of the IEC/BCC programs are to:
To increase knowledge, improve skills and promote desired behaviour change on EHCS and beyond To create a demand for quality EHCS among all castes and ethnic groups, and disadvantaged and hard to reach populations To advocate for required resources (human and financial) and capacity development for effective communication programmes and interventions to achieve the NSHP-2 goals To increase access to new information and technology on health programmes To raise awareness among the public on communicable and Non communicable diseases and to encourage all to seek preventive measures To intensify and strengthen action against tobacco use, both smoked and smokeless, excessive use of alcohol, unhealthy diets, and physical inactivity To mitigate public panic and respond to communication needs during emergency situations. To promote environment health, hygiene and sanitation.
Table 40: NHEICC program targeted activities of 2070/71
Physical Financial S. N. Activities Unit Remarks Achiev Achieve Expendit Expend Target Budget ement ment % ure iture % Strengthening of district health education service center by providing 1 electrical devices Piece 1 1 100 75 75 100 Health education materials 2 production Copy 15000 15000 100 45 45 100 based on the local needs Distribution of health education Time 2 2 100 20 20 100 materials to 3 health facilities Production and broadcasting of 4 health related Time 6600 6600 100 660 660 100 messages through FM/radio
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Community health promotion Time 5 5 100 85 85 100 5 campaign Interaction on health service 6 Time 25 25 100 425 425 100 promotion in the communities Printing of health related Time 200 200 100 200 200 100 awareness 7 messages School health 8 education Time 300 300 100 150 150 100 program Awareness program for controlling non- Time 5 5 100 85 85 100 communicable 9 program Awareness program on environmental and professional health & hygiene 10 (water Time 5 5 100 85 85 100 purification and food handling, hand washing promotion and climate change) Supervision and monitoring of Time 15 15 100 75 75 100 health education 11 program
Problems and Constraints S. N. Issues, problem and constraints Recommended Action Responsibility
1 School health education program Need to include this NHEICC, WRHD program as this is effective program 2 Community health education display Need to include this DPHO/WRHD and exhibition program program as this is effective program
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7.2 Primary Health Care Revitalization Program
Background:
In 2009 ministry of health and population embedded in principles of essential care and equity constituted a new division Primary Health Care Revitalization (PHCRD) under the Department of health services. The new division is envisaged to revitalize PHC in Nepal by addressing emerging health challenges in close collaboration with other DOHS divisions and relevant actors. Division works towards reducing poverty by providing equal opportunity for all to receive quality and affordable health care services this division is envisaged to revitalize PHC in Nepal by addressing emerging health challenges in close collaboration with concerned stakeholders.
The division has 3 thematic focuses. National Free health Care Social Health Protection Urban and Environmental Health
Vision:
To contribute in improving the health status of Nepal Population, especially of the poor and excluded. It will support MOHP to contribute to poverty reduction by providing equal opportunity for all to receive high quality and afford able health care services.
Goal:
To reduce morbidity and mortality especially of poor marginalized and vulnerable people by severing the right of the citizens to quality essential health care services.
Objectives:
The overall objectives of free health and urban health program is to reduce morbidiy, mortality especially of poor marginalized and vulnerable people by serving the right of the citizens to quality essential health services.
Free Health Services:
Interim constitution of Nepal 2063 has emphasized that every citizen shall have the right to basic health services free of cost as provided by the law. After a long discussion and preparation the government of
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Nepal ultimately decided to provide essential health care services free of charge to the entire citizen up to 25 bedded hospitals run by public sector. Besides poor, destitute, disabled, senior citizens and FCHVs have been provisioned to have access to free health care services from hospital having more than 25 beds. In Rupandehi, district hospital and zonal hospital are catering free health services to the targeted people.
Urban Health Services Program
Government of Nepal is committed to improve the health status of both rural and urban people by delivering high quality health services throughout the country. In the past, thrust of concentration was towards health care delivery of the rural population and it shadowed the initiative of urban health services. Establishment of Urban health centers through the joint initiative of DPHO and Municipality is being progressed as a new initiative.
In Rupandehi district, a total of six urban health centers are established and functions. Four of these are in Butwal Municipality and 2 at Siddharthanagar municipality. Three urban health centers were established in fiscal year 67/68, one urban health Centre in FY 68/69 and two urban health Center in 69/70. In Rupandehi district there are two municipalities and six urban health centre four in Butawal and two in Bhairahawa. Three in urban health centre establish in fiscal year 67/68 one urban health Centre in FY 68/69 and two urban health Center in 69/70.
Table 41: Human resources at different UHCs of the district
S.N Name of Urban Health Center HA AHW ANM Office assistant Total 1 UHC SNM Ward no. 9 1 1 1 1 4 2 UHC SNM Ward no. 4 1 2 1 1 5 3 UHC BM Ward no. 14 1 1 1 - 3 4 UHC BM Ward no. 13 1 2 2 - 5 5 UHC BM Ward no. 9 1 1 1 - 3 6 UHC BM Ward no. 3 1 1 1 - 3 Total 6 8 7 2 23
A total of 23 staffs are working in six urban health centers at Rupandehi. In the FY 2070/71, altogether 17895 people utilized the services provided by UCHs.
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Urban FCHVs Program
There are 241 FCHVs in urban area. In Butwal Municipality there are 140 and in Siddharthanagar municipality 101. The FCHVs were provided dress support from DPHO. Municipality supported in the exposure visit and empowerment program of FCHVs.
Table 42: Urban Health Center construction supported by DPHO
S. N. Activities Amount Remarks 1 Building Construction of urban health clinic 1500000.00 in both municipalities 2 Rent and renovation into two municipality - Support provided by municipality 3 FCHV dress support 964000.00
Both Municipality and DPHO have provided support to establish and strengthen the urban health clinics. The huge support from Municipality depicts the local ownership is increasing into the urban health program.
Model Health Village Program
During FY 2069/70, Bhaganwanpur VDC was selected and developed as the Model Health Village. With the support of this model health village program the health facility building was repaired and maintained and was supplied the essential drugs. The office support staff was also provided to the health facility from the same program. DDC is approaching for the construction of health facility building and wants to support for the model health village program. However, DPHO did not receive the budget to continue the program in FY 2070/71.
Community health unit program
In order to increase the access to health care services, a community health unit was established at Charange of Devdaha VDC. With this community health unit program DPHO supported logistics, essential drugs and staffs for ensuring quality of the program.
Problems and Constraints
Land in municipality area is very expensive and very difficult to find out for the construction and establishment of urban health clinics. In urban health centers there is a demand for laboratory services.
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For the sustainability and further expansion of the services at the urban health centers, community drug program needs to be run for medicines and supplies beyond free health care services. Also there is no continuation of budget release to prolongation and scale up the model health village, community health unit and urban health center.
7.3 Management Support
Table 43: Management support targeted activities of 2070/71 Physical Financial S. Activities Unit Expen Remarks N. Achiev Achieve Expend Target Budget diture ement ment % iture % Purchase desk top computer and other computer 1 accessories, repair for Time 2 2 100 140 126.0 90.01 information center strengthening Solar power back up and 2 fixing for online reporting Time 1 1 100 100 100.0 100.00 coverage Computer set, power back up purchase and fixing for 3 Time 1 1 100 100 100.0 100.00 'TABUSH' program conduction Expansion of online HMIS reporting service to PHC, 4 computer purchase with Time 1 1 100 670 541.6 80.83 printer, modem, UPS and pen drive Laptop 1 pcs purchase for 5 information center Time 1 1 100 60 60.0 100.00 strengthening Repair maintenance of 6 Time 1 1 100 500 500.0 100.00 Health institutions HMIS training to staff of Health Institutions on 7 improved recording reporting Time 1 1 100 510 508.77 99.76 format (including Private and NGOs) Annual report of district health its preparation, 8 Time 1 1 100 105 105.00 100.00 printing with Health Institutions ranking Orientation on disposal of health institutions related 9 Time 1 1 100 300 191.48 63.83 materials to health workers - Hospital, PHC, HP, SHP
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HMIS training to staff of Health Institutions on 10 improved recording reporting Time 1 1 100 2060 1895.00 91.99 format (including Private and NGOs) Hiring of computer related 11 Human Resource on Time 1 1 100 180 180.00 100.00 contract (consulting service) Health service expansion for minorities, janjatis, Gender 12 Time 1 1 100 600 379.24 63.21 and identification of geographic areas Activities in Health Institutions for quality system establishment 13 Time 1 1 100 500 246.34 49.27 (Waste dust bin, quality visit, Virex purchase including others) Distriict level planning, follow up and review: a) Last FY, 14 Time 3 3 100 1270 1228.29 96.72 b) 1st qtr and planning meeting, c) 2nd quarter In district DATA quality 15 Time 1 1 100 495 318.56 64.36 strengthening program Review and reporting in the 16 Time 1 1 100 980 790.97 80.71 district Micro level follow up and evaluation (Public Health 17 Time 1 1 100 125 73.06 58.44 analysis) for planning, follow up and evaluation Program continuation as per 18 Time 3 3 100 2520 977.45 38.79 HMIS strategy Activities for Health GIS 19 update, Atlas preparation Time 1 0 0 76 0.00 0.00 and its use For HMIS email, internet, 20 web hosting conduction and Time 1 1 100 100 100.00 100.00 its management Internet installation for 21 information management at Time 1 1 100 183 150.30 82.13 the PHCs 22 Printing of HMIS forms Time 1 1 100 70 70.00 100.00 23 Integrated supervision Time 51 51 100 390 390.00 100.00
DPHO Rupandehi was able to perform the targeted activities as per the plan shown in above table. The achievement status was 100% in most of the activities. Despite of the task performed, specific program wise problem and issues was reviewed and recommendation made to deal with them efficiently.
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7.4 Supervision and Monitoring Program
Table 44: Supervision and monitoring status of 2070/71 Target Achieve- % Achieve- Description ment ment PHCC (Number of PHCC-5) 60 50 83.33 HP (Number of Illaka HP-6, Upgrade HP-20) 132 120 90.90 SHP (Number of SHP-38) 76 68 89.47 Total 268 238 88.80 A total of 238 supervisory visits have been made during this FY.
7.5 Physical Infrastructure Development Program
Table 45: Physical infrastructure development status 2070/71 Construction Status (FY 2070/71) Ownership of Total Under Description Building Under No. Complete Constructi Remarks Process Own Rental on Hospital 2 2 - 2 0 0 PHC 5 5 - 2 1 2 HP (Ilaka-6 ) 6 6 - 6 0 0 Up grated( HP-20) 20 19 1 (VDC) 2 1 17 Birthing Center 18 18 - 8 3 6 BEOC/CEOC Site 5/5 5/5 - - - - Placenta Pit 7 7 - 7 - - Boundary Wall (all GoN 5 - - 11 11 - HFs)
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7.6 Maintenance Program
Table 46: Maintenance program progress in 2070/71 Allocated Expenditure Type of Maintenance and Site (HF) Budget Budget District Public Health Office 500000 500000 Majhgawa HP, Chhapiya HP, Karmahawa HP 946264 946264 Basantapur PHCC, Lumbini PHCC, Anandaban HP 897509 87509
7.7 Recommendation of private institution for approval and renewal
Table 47: Recommendation of health facilities for approval or renewal in 2070/71 Total up to FY FY 2070/71 Type of HF 2070/71 New Renew Remarks Private Hospital 10 1 0 Poly clinic 3 0 0 Nursing Home 1 0 0 X-ray / City scan clinic 2 0 0 Pathology Lab 7 0 0 Dental Clinic 47 1 2
7.8 Ambulance Services
Table 48: Ambulance Services Private / Public NGO/ Other No. of ambulance available in District Registered Functional Registered Functional 6 4 46 41
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7.9 Blood Bank Services
Rupandehi district has one functional blood bank run by Nepal Red Cross Society at Butwal. It is supplying the required blood need at different health institutions like Lumbini Zonal Hospital, AMDA, UCMS etc.
7.10 Population Management Program
Table 49 Population management program targeted activities 2070/71
Physical Financial S. N. Activities Unit Remarks Achieve Achieve Expen Expend Target Budget ment ment % diture iture % Vital events registration strengthening program 1 (cooperation with Federal Time 1 1 100 600 298.54 49.76 matters and Local Development Ministry) Orientation program for 2 the district population Time 1 0 0.00 40 0 0.00 cooordination members Population related 3 message broadcasting for Time 1 1 100 43 37.7 87.67 local FM 4 Follow up and supervision Time 1 1 100 25 25 100.00 Audion/video preparation 5 Time 1 1 100 75 69.6 92.80 of district population World population day (July 6 Time 1 1 100 25 23.32 93.30 11) Preparation and 7 publication of District Time 1 1 100 80 60.5 75.63 Population profile SESI working group 8 meeting and half-yearlty Time 2 0 0 50 0 0.00 review Problem solving program as identified by the District 9 Time 1 1 100 150 147.66 98.44 Population Cooordination Committee Awareness program for 10 the care and cooperation Time 1 1 100 100 100 100.00 for the elderly people ToT for school focused 11 Time 1 1 100 150 125.06 83.37 peer education program Service providers (Gender 12 related violation related Time 1 1 100 75 72.18 96.25 program for Health
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workers) Population Management 13 training for the Health Time 1 1 100 150 115.59 77.07 Institutions incharges Meeting and review in 14 District Coordination Time 3 2 66.7 50 31.32 62.65 Committee Preparation, printing of 15 Population information Time 1 0 0 50 0 0.00 educational materials Update of district 16 population and Gender NA 1 1 100 60 31.04 51.74 information center Awareness program for 17 youth going abroad for Time 1 1 100 75 68.48 91.31 work School level adolescent 18 focused peer education NA 1 1 100 210 118.30 56.33 program
7.11 Logistic Management
Table 50: Population management program targeted activities 2070/71
Physical Financial S. N. Activities Unit Remarks Achiev Expen Achiev Expend Target ement Budget diture ement iture % % Medicine, Instruments equipments, Vaccine and 1 Time 3 3 100 225 225 100 other materials integrated transport Service purchase for 75 2 districts store for LMIES Piece 1 1 100 43 7.5 17.44 system conduction Logistics system related 3 Time 3 0 0 50 0 0 quarterly review Supervision of Logistics 4 Time 6 6 100 50 50 100 program
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Annex I: Human Resources Situation
District Health Office/District Public Health Office
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) Technical Staffs 1 Public Health Administrator 1 1 1 2 Statistical Assistant/Officer 1 1 1 3 HA/SAHW/PHI 2 3 2 (stay order-1) 4 Immunization supervisor 1 1 1 5 supervisorSupervisor/OfficerDTLA/O/I 1 1 1 6 PHN 0 0 0 7 Family Planning Supervisor 1 1 1 8 Cold Chain Assistant/Officer 1 2 1(fajil) 9 Lab Technician 1 1 10 Vector Control Asst./Officer 1 1 11 HET Officer 0 0 0 12 Computer Asistant 0 0 0 1 Administrative (Non-Technical) 1 Section Officer/Nayab Subba 1 1 1 2 Account Officer 1 1 1 3 Typist Na. Su./ Section 1 1 1 4 OfficerKharidar 1 1 1 5 Driver 1 1 1 1 6 Office Assistant 3 3 3 2
PHC
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) Technical Staffs 1 Medical Officer 5 4 5 2 HA/SAHW/PHI/PHO 5 4 5 3 Staff Nurse 5 4 4 1 4 AHW/SAHW 15 15 15 4 5 ANM 15 14 14 6 6 Lab Assistant 5 5 5 7 VHW/AHW (Padnam) 5 4 4 Administrative (Non-Technical)
DPHO, Rupandehi | Annual Report 2070/71 87
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) 1 Office Asistant 9 10 10 HP
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) Technical Staffs 1 HA/SAHW/PHI/PHO 26 11 12(stay order-1) 0 3 AHW/SAHW 78 73 78 0 4 ANM 52 50 50 22
Administrative (Non-Technical) 1 Kharidar 0 4 4(Fajil) 0 2 Office Assistant 0 21 21(fajil) 5+1(Other) SHP
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) Technical Staffs 1 AHW/SAHW 76 71 76 2 3 MCHW/ANM 38 36 36 2 + 5 (Vaccinator)
Administrative (Non-Technical) 1 Office Assistant 0 25 25 7
SHP
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) Technical Staffs 1 AHW/SAHW 76 71 76 2 3 MCHW/ANM 38 36 36 2 + 5 (Vaccinator)
Administrative (Non-Technical) 1 Office Assistant 0 25 25 7
Urban Health Center + DR Hostel
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) Technical Staffs 0 0 0 0 1 HA 0 0 0 6+1 2 AHW 0 0 0 8 3 MCHW/ANM 0 0 0 7+1
Administrative (Non-Technical)
DPHO, Rupandehi | Annual Report 2070/71 88
GOVERNMENT CURRENTLY AVAILABLE SN POSTS Sanctioned post Fulfilled Among government Local and other resources (in number) (in number) sanction (in number) (in number) 1 Office Assistant 0 0 0 2 + 3 (Other)
Contract Staff under DPHO SN Designation No. Employee For 1 HA 7 Urban health centre (6), DR hostel (1) 2 AHW 8 Urban health centre 3 ANM 8 Urban health centre (7), DR hostel (1) 4 ANM 38 Birthing centre 5 Staff Nurse 1 Raypur PHC 6 AHW 6 PHC (4), SHP (2) 7 VHW/Vaccinator 13 HP, SHP 8 Office Assistant 14 DPHO, HP, SHP TOTAL 95
DPHO, Rupandehi | Annual Report 2070/71 89
Annex II : List of NGO/INGO & Private Health Intuition
Name Reporting Status Y/N
UCMS& Teaching Hospital, Bhairahawa Yes Devdaha Medical College, Bhaluhi Yes Lumbini Ran Ambika Eye Hospital Yes Lumbini Netralaya Yes Shree Krishna Netralaya Yes Marchawar Poli Clinic Yes Ale Dental, Butwal No City imagine N0 Siddhartha City Hospital Yes Bhairahawa Hospital Pvt. Yes Butwal Hospital Pvt. Ltd. Yes Meditech Hospital Yes Crymson Hospital , Manigram Yes Admond City Hospital Yes AMDA Hospital Yes Khatri Nursing home Yes Lumbini Hospital & Technical College, Butwal Yes FPAN Yes IBS , Mahilwar Yes Merrie Stopes Clinic Yes Namuna Integrated Development Council Yes Unity for Sustainable Community Development (SUAAHARA Program) Yes AMDA Minds Yes UMN Yes CARE International Yes Save the Children Nepal Yes Terai Bikash Manch Yes Sungava Vikash Sanstha Yes IPAS Nepal Yes Population Service International Yes
DPHO, Rupandehi | Annual Report 2070/71 90
Annex III : Institutional Delivery by birthing center:
Institution Name Normal Complicated Lumbini 366 3 Dhakdhai 382 20 Basantapur 175 1 Motipur 422 31 Rayapur 338 15 Anandban 94 1 Chhapiya 326 26 Parroha 441 8 Karmahawa 199 14 Majhgawa 495 6 Semarabazar 260 2 Rudrapur 231 11 Kerwani 227 0 Devadaha 180 4 Suryapura 271 16 Farena 309 28 Bodwar 151 21 Asuraina 102 1 TOTAL 4969 208
DPHO, Rupandehi | Annual Report 2070/71 91
Annex IV: Health facilities providing IUCD and Implants services &
Chart Showing Birthing Centers
IUCD Implants Lumbini PHC Lumbini PHC Motipur PHC Motipur PHC Basantapur PHC Basantapur PHC Dhakdhai PHC Rayapur PHC Paroyha HP Paroyha HP Chhapiya HP Chhapiya HP Manjhgaunwa HP Manjhgaunwa HP Karmahawa HP Semarabazar Kerwani SHP Lumbini Zonal Hospital Devdaha SHP Bhim Hospital, Bhairahawa Rudrapur SHP Suryapura SHP Lumbini Zonal Hospital Bhim Hospital, Bhairahawa
DPHO, Rupandehi | Annual Report 2070/71 92
Annex V : VDCs Categorized with Problems and Priority ( FY 2070/71)
Category 1 Category 2 (Problem) Category 3 Category 4 (No Problem) (>10)High Drop-out (Problem) (Problem) (<10) Low Drop-Out (>90)HighCoverage (<10) Low Drop- (>10) High Drop-out (>90) High Coverage out (<90) Low Coverage (<90) Low Coverage
Dhakdhai,Bodawar,Cho.Ramnagar,Paja Thu.Piprahawa Basantpur,Motip Patkhauli rkatti Farena, Masina ur, Semlar, = 1 VDCs Chhipagad,Pokharbhindi,Siktahan, Aama,TenuhawaBog Anandban,Tikuli Padsari Bagaha,Hati pharshataker, Hati adi, gadh Bangai Rayapur, Bagauli, Asuraina, =6 VDCs Shankarnagar,C Silautiya Karauta,Semera, Rohinihawa, hhiliya Lumbini Madhubani, Khudabagar, = 7 VDCs Bhagawanpur Sipawa,Sau.Pharsatikar, Kha.Bangai Pa.Amuwa, Manpakadi, Madhawaliya, Majhagawa Gonaha,Betkuiya, Maryadpur, Bayarghat Sa.Pakadi, Parroha, Dudraksha, Salghandi Gajedi, Dayanagar, Mainahiya, Kamhariya Dhamauli, Manmateriya, Hernaiya, Ekala Bishnupura,Sandi, Suryapura, Rudrapur Jogada, Makrahar, Devdha, Karwani Karahiya, Gangoliya, Butwal NP, Siddharathanagar NP
= 55 VDCs + 2 NP = 57 •District
DPHO, Rupandehi | Annual Report 2070/71 93
Annex VI: VDC wise EPI Status
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wswO{k|f=:jf=s]= 220 248 118 106 130 106 19 150 169 -11 8 13 kf]v/le)*L 134 130 108 91 216 252 97 94 78 65 20 121 141 19 6 22 l;S^xg 263 237 257 194 220 271 112 101 109 94 17 72 88 2 0 -8 hDdf 1282 1280 1270 989 1931 2411 107 107 106 93 31 124 155 1 -2 -1
a;Gtk'/ 157 160 149 106 218 277 84 86 80 70 24 90 114 5 -1 6
- 185 220 220 197 k*;/L 234 318 79 94 94 135 28 77 105 -19 -14 14 - 100 121 112 107 xf=km;f{l^s/ 254 323 90 109 101 120 48 176 224 -12 -19 10 - xf=agufO{ 145 205 195 148
a;Gtk"/k|f=:jf=s]= 276 344 81 114 108 98 29 117 146 -34 -22 16 aufxf 165 164 138 96 314 333 142 141 119 96 13 208 220 16 -1 15
DPHO, Rupandehi | Annual Report 2070/71 94
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aL;LhL= k])^f1 hDdf 752 870 814 654 1296 1595 91 105 98 103 28 120 148 -8 -11 -4 /fok'/ 368 365 369 342 365 518 135 134 135 134 43 103 146 0 2 1 s/f}tf 471 306 320 250 341 476 180 117 123 110 40 100 140 32 2 -2 y'=lkk|xjf 147 147 123 111 310 343 135 135 113 101 23 218 242 16 10 25 - 247 253 266 152 auf}nL 268 428 112 115 121 71 56 93 149 -8 -6 11 l;nf}^Lof 234 242 248 219 264 336 113 116 119 136 27 97 124 -6 0 -3 c;'/}gf 186 192 187 194 266 340 113 117 114 111 35 124 159 -1 -9 -6
/fok"/k|f=:jf=s]= km/]gf 132 111 99 94 230 257 132 111 99 84 21 178 199 25 10 20 /f]Olgxjf 185 192 150 149 382 496 150 156 122 123 72 240 312 19 -6 17 ;]d/f 189 182 194 135 258 416 103 99 106 92 66 108 175 -3 3 -4 hDdf 2159 1990 1956 1646 2683 3609 132 121 119 108 43 126 169 9 0 2 n'lDjgL 327 344 349 132 389 560 137 145 147 48 55 125 181 -7 3 2
dl;gf 186 164 145 83 324 387 143 126 112 56 37 192 229 22 20 30 - 141 148 170 107 dw'jgL 200 245 88 92 106 75 21 95 117 -21 2 13 cfdf 293 242 244 128 258 326 114 94 95 48 20 77 97 17 12 11 v"bfjfu/ 155 152 129 106 276 334 130 128 108 102 38 179 217 17 3 17 n'lDagLk|f=:jf=s]= t]g"xjf 331 290 259 183 276 336 137 120 107 63 19 88 107 22 16 25 l;kjf 183 190 183 133 253 349 108 112 108 76 43 115 158 0 0 4
DPHO, Rupandehi | Annual Report 2070/71 95
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aL;LhL= k])^f1 eujfgk"/ 309 279 267 136 276 488 119 107 103 50 63 82 144 14 6 10 hDdf 1925 1809 1746 1008 2253 3026 122 115 111 60 38 110 147 9 8 12 ;f}=km;f{l^s/ 237 222 215 166 282 429 108 101 98 125 51 98 149 9 0 3 df]tLk'/ 186 205 183 202 209 250 78 86 77 125 13 67 81 2 -18 -5 v=agufO{ 185 189 198 132 228 320 94 96 101 92 36 89 125 -7 -4 -9 dfgks*L 127 140 138 124 249 300 83 92 90 102 26 125 151 -9 -4 -2 - 132 202 232 235 ;]dnf/ 254 364 57 88 101 197 37 85 122 -76 -28 47
df]ltk"/k|f= :jf=s]= k=cd'jf 222 236 216 205 222 307 88 93 85 104 26 67 93 3 1 9 hDdf 1089 1194 1182 1064 1443 1969 84 93 92 122 31 86 117 -9 -8 -7
cfgGbjg 220 258 263 206 203 339 76 90 91 110 36 54 90 -20 -2 -4
dwjlnof 209 215 216 223 229 325 89 92 92 166 31 75 106 -3 -6 -7 - 139 229 256 243 l^s"nLu( 208 361 46 77 86 136 39 53 93 -84 -17 31 lrlNxof 99 111 100 89 210 269 79 88 79 102 36 128 164 -1 5 15
cfgGbjg :jf=rf}= z+s/gu/ 316 449 430 371 167 257 57 80 77 116 12 23 35 -36 -11 -6 hDdf 983 1262 1265 1132 1017 1551 65 84 84 125 27 52 79 -29 -7 -8
demufjf 195 177 167 142 345 460 155 140 133 109 71 212 282 14 4 10
uf]gfxf 318 329 329 194 245 338 100 104 104 64 23 59 82 -3 -2 -2 :jf=rf}= demu+fjf a]ts"Oof 162 156 143 110 337 424 145 139 128 86 60 231 290 12 -11 -1
DPHO, Rupandehi | Annual Report 2070/71 96
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aL;LhL= k])^f1 ao/#f^ 169 164 154 142 317 426 123 120 112 123 61 178 240 9 6 12 ;=ks*L 172 174 152 100 322 470 137 138 121 95 91 197 288 12 0 13 af]u*L 304 269 289 196 264 353 126 112 120 89 28 84 112 5 12 5 dof{bk"/ 132 126 131 117 242 282 104 99 103 105 24 146 171 1 7 4 hDdf 1452 1395 1365 1001 2072 2753 122 118 115 90 44 134 179 6 3 5
k/f]{xf 587 600 599 431 322 655 98 100 100 110 43 41 84 -2 -4 -4
b'w/fIf 456 465 464 368 286 604 102 104 104 114 55 49 104 -2 -1 -1 ;fnem)*L 338 309 345 301 323 498 141 129 144 191 56 104 160 -2 8 -2 - uh]*L 270 277 301 196
k/f]{xf :jf=rf}= 216 299 98 100 109 89 23 60 83 -11 -8 17 hDdf 1651 1651 1709 1296 1146 2055 106 106 110 119 45 56 101 -4 -1 -5 bofgu/ 228 255 233 148 283 405 111 124 113 83 46 106 151 -2 -16 -6
d}glxof 186 200 186 158 303 508 109 117 109 115 92 137 229 0 -10 -2 sDxl/of 483 499 448 410 363 643 111 114 103 99 49 64 113 7 1 11 wdf}nL 160 161 158 137 258 328 113 113 111 99 38 140 178 1 9 11
xg]{of 111 105 104 102 227 263 102 96 95 94 25 160 186 6 5 6 %lkof :jf=rf}= dfgd^]/Lof 215 210 213 208 237 341 101 99 100 121 38 86 123 1 5 4
hDdf 1383 1430 1342 1163 1672 2489 108 112 105 101 49 101 150 3 -1 5
lai)f'k'/f 388 352 334 214 278 391 119 108 102 70 27 65 92 14 6 11 sd{xjf :jf=rf}= ;'o{k'/f 498 468 461 252 266 562 107 100 99 57 49 44 92 7 6 7
DPHO, Rupandehi | Annual Report 2070/71 97
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aL;LhL= k])^f1 ;f*L 161 160 180 97 258 318 113 112 126 68 32 139 171 -12 8 -4 ?b|k'/ 471 450 515 372 272 424 103 98 113 122 26 46 71 -9 7 -6 hf]u*f 237 227 216 170 378 540 173 166 158 118 91 212 303 9 4 9 Psnf 312 330 316 184 361 514 133 141 135 76 50 118 168 -1 1 5 hDdf 2067 1987 2022 1289 1812 2748 117 113 115 82 41 79 120 2 5 4 dqmx/ 384 407 385 375 266 397 104 110 104 150 27 55 82 0 -4 2 - 286 360 389 317 s]/jfgL 263 395 87 109 118 146 31 61 92 -36 -13 22 - 318 419 425 325 s/xLof 274 467 75 99 100 126 35 49 84 -34 -14 15 b]]jbx 547 640 633 520 289 505 84 98 97 107 25 34 59 -16 -5 -4 148 151 161 112 ;]d/fahf/ :jf=rf}= u+uf]lnof 207 264 96 98 105 111 29 103 132 -9 -2 -9 hDdf 1683 1977 1993 1649 1299 2028 87 102 103 126 29 52 81 -18 -8 -9 - 6803 2828 2926 1896 a'^jn g=kf= 1176 3300 236 98 101 107 56 31 88 57 -7 10 l;=g=kf= 2851 1370 1153 987 598 1711 200 96 81 103 60 32 92 60 9.6 24 s'n hDdf 26080 21043 20743 15774 20399 31246 130 105 103 101 41 78 119 20 -1 1
DPHO, Rupandehi | Annual Report 2070/71 98
Annex VII: List of Private Hospitals with Approval/Renewal Status
Name of Health Facilities Address Number of Approval Status Beds Medical Colleges Universal College of Medical Ranigaun Not informed Not informed Sciences Bhairahawa Devdaha Medical College Devdaha 100 Registered Private Hospitals Medicare Hospital Butwal 51 Not Informed Crimson Hospital Manigram 50 Yes Lumbini Hospital and Technical Butwal 50 Not Informed College Admond City Hospital Butwal 50 Not Informed Butwal Hospital Private Ltd. Butwal 50 Not Informed Khatri Nursing Home Pvt. Ltd. Butwal 15 Yes Siddhartha City Hopsital Bhairahawa 15 Yes Bhairahawa Hospital Pvt. Ltd. Bhairahawa 15 Yes Parroha Model Hospital Parroha 15 Yes Unified Public Hopsital Basgadi 15 Yes Tilottama Hospital Butwal 15 Yes Landmark Hospital Butwal 15 Yes Poly Clinic Marchawar Polyclinic Bhairahawa - Yes Janakalyan Polyclinic Butwal - Yes Ayush Polyclinic and diagnostic Butwal - No Informed center Ossisara paramarsa Sewa Kendra Butwal - Yes Homeopathic Homeopathic Hospitals Kalika Homioathy Butwal 15 Yes Malika Homiopathy Butwal 15 Yes X-ray Lumbini X-Ray and diagnositc center Butwal City and Imaging Center Butwal -- Yes Pathology Dhakal Pathology Bhairahawa - Yes Om Pathology Bhairahawa - Yes Diagnostic and Pathology Centers Indreni Pathology Butwal - Yes Joshi Pathology Bhairahawa - Yes Siddhartha Pathology Bhairahawa - Yes National Path Lab. Butwal - Yes Eye Hospital/Clinic Eye Clinic and Hospital Srikrishna Netralaya Bhairahawa - Yes Lumbini Netralaya Bhairahawa - Yes Lumbini Eye Hospital -- Yes
DPHO, Rupandehi | Annual Report 2070/71 99
Dental Clinic Dental Clinics Palpa Dental Clinic Butwal - Yes Ale Dental Clinic Butwal - Yes Smile Dental Clinic Butwal - Yes Doctors Dental Home Butwal - Yes Dhaulagiri Dental Clinic Manigram - Yes Dibyashree Dental Clinic Bhalwari - Yes Butwal Dental Pvt. Ltd. Butwal - Yes Ashish Dental Clinic Butwal - Yes Alina Dental Clinic Butwal - Yes New Adhunik Samaj Dental Butwal - Yes Siddhartha dental clinic Butwal - Yes Tinau Dental Clinic Butwal - Yes Kantipur Dental clinic Butwal - Yes The Dental Home Butwal - Yes Om Dental Clinic Butwal - Yes Astha Dental Clinic Butwal - Yes Krishna Buddha Dental Clinic Bhairahawa - Yes Buddha Dental Clinic Bhairahawa - Yes Ale Dental Clinic Bhairahawa - Yes Lumbini Dental Clinic Bhairahawa - Yes Doctors Dental Clinc Bhairahawa - Yes Smile Profile Dental Clinic Bhairahawa - Yes Deep Dental Clinic Bhairahawa - No informed Khima Devi Dental clinic Parrohoa - No Informed
Name of Health Facilities Address Number of Approval Status Beds Smile Dental Clinic Butwal - Yes Doctors Dental Home Butwal - Yes Dhaulagiri Dental Clinic Manigram - Yes Dibyashree Dental Clinic Bhalwari - Yes Butwal Dental Pvt. Ltd. Butwal - Yes Ashish Dental Clinic Butwal - Yes Alina Dental Clinic Butwal - Yes New Adhunik Samaj Dental Butwal - Yes Siddhartha dental clinic Butwal - Yes Tinau Dental Clinic Butwal - Yes Kantipur Dental clinic Butwal - Yes The Dental Home Butwal - Yes Om Dental Clinic Butwal - Yes Astha Dental Clinic Butwal - Yes Krishna Buddha Dental Clinic Bhairahawa - Yes Buddha Dental Clinic Bhairahawa - Yes Ale Dental Clinic Bhairahawa - Yes Lumbini Dental Clinic Bhairahawa - Yes Doctors Dental Clinc Bhairahawa - Yes Smile Profile Dental Clinic Bhairahawa - Yes Deep Dental Clinic Bhairahawa - No informed Khima Devi Dental Clinic Parrohoa - No Informed
DPHO, Rupandehi | Annual Report 2070/71 100
Annex VIII: Health Tax Fund
Physical Financial S. Activities Unit Remarks N. Achiev Achieve Expen Expendit Target Budget ement ment % diture ure % Follow up of the Tobacco 1 prevention act 2068 and its Time 5 5 100 35 35 100 implementation Meeting with Assistant CDO about strategy for the Tobacco 2 Time 3 3 100 16 16 100 control and implementation of its provision Program Review with coordination of CDO or 3 Time 3 1 100 30 30 100 Assistant CDO and with the Managers of Public places Administration cost of Assistant CDO monitoring visit 4 Time 4 4 100 4 4 100 (Stationaries, post office cost and others) Awareness program of non communicable disease, Tobacco control and 5 Time 11 10 100 170 170 100 implementation of its provision through VDC level interaction program Increasing general awarness against Non communicable disease and tobacco product 6 Time 120 120 100 12 12 100 control and implementation of its provision through Local FM radio
DPHO, Rupandehi | Annual Report 2070/71 101
Annex IX National Health Training Program
Physical Financial S. N. Activities Unit Remarks Achiev Achieve Expen Expendi Target Budget ement ment % diture ture % Updates of training records and office Person 1 0 0 10 0 0 running cost (training 1 profile) MCHW selecion through Mothers Piece 135 31 22.96 108 37 34.26 2 groups meeting Supervision and follow Time 2 0 0 10 0 0.00 3 up 4 basic MCHW training Person 135 31 22.96 1215 459.65 37.83 Kit box purchase for basic Piece 5 MCHW training 135 31 22.96 270 46.5 17.22
DPHO, Rupandehi | Annual Report 2070/71 102
Annex X: Profile of I/NGOs implementing health and nutrition programs
1. Name of the Organization: Unity for Sustainable Community Development (USCD)
Works in 2070/71 Donor Target Population Working Areas SUAAHARA Program USAID 1000 days mothers and Whole district coverage children under 2 years
Contact Address and location: USCD, Annapurna Path - 8, Siddharthanagar, Rupandehi Name of contact person: Ganesh Aryal Post: Chairperson Telephone Landline: (Off.) +977 071 520707
Program Overview
Geographical Coverage 25 districts of Nepal Goal The health and well-being of Nepalese is improved and sustained Strategic Objective Improve the nutrition status of 1000 days mothers and children under 2 years Nutrition Specific Essential Nutrition Actions Essential Hygiene Actions Program Components Nutrition Sensitive Homestead Food Production Maternal new born and child heath services Family Planning Water, Sanitation and Hygiene Cross Cutting Themes Social behavior change communication and governance Gender and Social Inclusion Capacity Building Monitoring & Evaluation
USAID/Suaahara Program's Nutrition and Health Specific Interventions and Outputs in Rupandehi during FY 2070/071
Intermediate Result 1: Household Health and Nutrition Behaviors are improved Intermediate Result 2: Women and children increase their use of quality nutrition and health • 2 modules of peer facilitation training to 73 persons services • 2 days INP refresher training to1460 FCHVs • 93 traditional healers/religious leaders oriented on INP • Supported to formulate action plans of 74 • 33136 persons (1000 days mothers, key household Health Facilities (HFs) to strengthen decision makers and social leaders) participated in nutrition related services Ward Level Interaction on INP • Partnership Defined Quality (PDQ) • 2119 food demonstration sessions through FCHVs – training at 12 HFs recipes of nutritious and diversified locally available • Follow up review workshop of PDQ with foods shared with 87261 persons HFOMC and HF staffs • Interaction on integrated nutrition with 127 male • 15 health facilities provided with essential members of 5 VDCs equipments/materials to improve quality • Directly reached 12816 beneficiaries during nutrition nutrtition services related events celebration • Supportive supervision of key • Wall painting with key health and nutrition messages commodities in 38 HFs including HTSP at 23 places • HTSP/FP DToT to 21 district supervisors • 2580 households (HHs) of 1000 days mothers visited – • 7 events of 3 days orientation on delivered/reinforced the key messages of INP using HTSP/FP to 145 health service providers integrated home visit checklist
DPHO, Rupandehi | Annual Report 2070/71 103
2. Name of the Organization: CARE International in Nepal
Works in 2070/071 Target population Working areas Remarks VDCs/Municipality Saving Mothers‟ and Under 5 yrs Children and Selected VDCs in Infants‟ Lives Project pregnant and lactating Rupandehi mother
Contact Address and location: CARE Nepal, Siddhartha Nagar Municipality, Ward no -8 (NAMUNA integrated Development Council) Name of contact person: Induka Karki Post: Project Officer, SMILE project Telephone Landline: 056 533093, 533097 Fax No: 056 533098
Project Introduction:
Geographical Coverage Western Region of Nepal Nawalparasi and Rupandehi districts Project Goal To contribute to MDGs on Child Health (4) and Maternal Health (5) at district level. Overall Objective To create an enabling environment for sustained outcomes in community health.
Achievements of FY 2070/071
Objective 1: Improve community awareness and response to maternal health
Implemented Self Applied Technique for Quality Health (SATH) into 8 VDCs in this process we oriented 630 participants. Conducted 81 events Mother‟s in Law Interaction program in which 2225 women participated. SMILE project is providing technical as well as minimum financial support in celebration of various national and international public health days. We have supported the celebration of FCHVs Day/SMH Day/ Iodine month and breast feeding weeks. Strengthening Mother Health Groups into selected 17 VDCs Objective 2: Improve the quality of pregnancy and delivery care services at local health facilities Provided Essential Supplies and Equipment to Birthing Centers 6 fully and partially 12 Birth Preparedness training to Health workers event 4 participants 101 Birth preparedness training to FCHVS 21 event participants 396 Liaison meetings to establish/ improve referral systems between communities, local health facilities and district service providers 1 event participants 25 Partner Defined Quality ( PDQ) 5 event Participants 195 Objective 3: Promote and strengthen health governance, accountability systems, advocacy and resource mobilization Conduction Training to Health Facility Operational Management Committee into 3 HF Review of Community Score Board Technique into 3 HF Conducted and support 1 batch VDC secretary workshop covering 61 participants.
DPHO, Rupandehi | Annual Report 2070/71 104
3. Name of the Organization: NAMUNA Integrated Development Council (NAMUNA)
1. Organizational background and objectives:
- Background: A groups of professional &social activists in Western Development Region gathered together and reflected their contemplated idea of servicing the nation and public through social work and activities, which gave rise to establishment of NAMUNA Integrated Development Council (NAMUNA) on October 2002. NAMUNA is an NGO, with aim to conduct various social and health related activities for the general and marginalized people in consultation with the stakeholders.
- Objectives: i) Addressing the specific needs of the Poor, Vulnerable and Socially Excluded sections of the society to enhance their capability in taking rational decisions to enjoy a respectable life, ii) Focusing on Gender and Equity as cross-cutting issues, iii) Fostering collaboration and partnership for joint initiation.
2. Areas of specialization in health sector :
- Reproductive Health. - Drug Harm Reduction among the vulnerable groups. - Prevention of communicable and non-communicable diseases. - Social mobilization in Health.
3. Target groups:
- Reproductive Health – Poor, vulnerable and socially excluded communities, mothers and infants - HIV/AIDS – Female Sex workers and their clients, Migrant workers and their spouse, People living with HIV/AIDS.
4. Geographical Coverage:
- In Western Development Region – 4 districts. Project wise geographic coverage are mentioned below:
SN Districts/Municipalities Projects 1 Rupandehi/28 VDCs and 2 municipalities Rupandehi Safe Motherhood Project (RSMP 2 Rupandehi/7 VDCs Saving Mothers and Infants Life (SMILE). 3 Rupandehi – 44 VDCs and 2 Municipalities USAID Funded Saath-Saath Project.
5. Summary of the program achievement in fiscal year 2070/2071:
Major achievement mentioned as per below -
- Rupandehi Safe Motherhood Project – i) Mobilisation of 303 Women Dialogue Groups (WDG) on regular basis (twice in a month), ii) Formation and mobilization of ward level Pregnant Women Groups (PWG) on a regular basis (once in a month), iii) Emergency fund management training to 240 new WDGs followed by support of Emergency fund, iii) Equipment and instrument support to HFs and Birthing centers, iii) Facilitation and support to HFOMC meetings.
- SMILE project –i) Regular interaction with pregnant women and Mother-in-Law, iii) Emergency fund established iii) Equipment support to Birthing centers.
- USAID Saath-Saath project(Rupandehi &Kapilvastu)–i)New FSW reached – 19191, ii) Client of New client reached – 14,935, iii) No. of STIs test performed – 2748, iv/No. of condom distributed – 458,011 , v)Total HIV +ve case identified – 46, vi) No. of PLHIV received CHBC service – 398, vi) No. of people receivedFP counseling – 1932.
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6. Name of Supporting Agencies/Donors:
- Kidasha-UK and Big Lottery Fund-UK - Care Nepal - USAID funded Saath – Saath Project
7. Issues and Challenges: In General
- Non-flexibility remain in logical transfer of fund from one to another heading - Reaching the unreached people is tiresome work with project deliverables.
8. Problem faced: In General
- Non addressing vested interest of the stakeholders created setback in the work. - Client harassment by security personnel (especially to FSWs. Hence, hiding of clients leading to non-access to the available services). - High staff turnover due to low salary allocation by the donors.
9. Work plan and budget for fiscal year 2071/72: (Key activities only)
- Rupandehi Safe Motherhood Project – Women and Pregnant women groups mobilization, Fund mobilization capacity building events, Equipment support to birthing center and District Hospital. Budget NRs.– 8,630,014.25 - SMILE – Women group mobilization, Data Board establishment at health facilities. Budget NRs– 935,000.00 - USAID Funded Saath-Saath Project –Continuation of regular activities, review and further activities design to carry forward the project activities. Budget - Approx. NRs. 9,000,000.
10. Contact person and number : - Ms. Gyanu Poudyal (Chairperson), Cell – 98570 22135 - Email: [email protected]
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Annex XI: Areas of Improvement, Strengths and Way Forward
Areas of improvement: Infrastructures Low CPR Low TB case finding Inadequate supervision and monitoring Contract staffs ; 1.Birthing centre staff 2.computer Assistant 3.Office Assistant 4.Municipality staff
Strengths: Good coverage of SMP Good coverage of Immunization Full immunization, progressive Most of programs performance indicators are in positive trend Functional birthing centre(18), good achievment Sustained achievment Availability of essential commodities and free medicine Regular program performance review Good support from gov &. non government stake holders GESI focused intervention Good co-ordination co-operation and collaberation with local government institutions and stake holders Almost posts are fullfilled.
Way Forward: Effective Supervision, monitoring and review Sustaining existing performance GESI focused intervention Effective HMIS/LMIS Updating citizen charter Infrastructure repair and development Improve responsibility and accountability Improve urban health services Full suport to open defaecation compaign Strengthening free health services Strenghtening particeptory management strengthening integrated health service delivery Improvement and strenghtening co-ordination,co-operation among stake holders Strengtening and expand birthing centres Prepareness for disaster and epidemic Improve PBMS Mean streaming private sectors reporting. Heading toward model district
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