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 Email: [email protected] District Public Health Office Rupandehi
Acknowledgement
It is my great pleasure to publish the Annual Report of District Public Health Office, Rupandehi of the year FY 2069/070. 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), PHC/ORC, EPI Clinic, NGO 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 Dr.Ashok Kumar Chaurasia, 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 and Mr Rajendra Paudel of WRHD; and Mr. Mukti Khanal,Section Chief and Mr. Surya Khadga 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. Deepak Tiwari, Project Manager of CARE Nepal and team, Mr. Om Prakash Gupta and Ramjanma Kurmi, 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. Peshal Kumar Pokhrel, 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 professional 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. Maheshwor Shrestha 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.
Sagar Dahal 1 Senior Public Health Administrator
Government of Nepal Ministry of Local Development Phone: 071-521423 071-523577 District Development Committee Fax: 071-520160 Email: [email protected] Rupandehi
Message from Local Development Officer
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 2069 70 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. 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 remotest areas of a district.
I appreciate the management skills of Mr. Sagar Dahal , Senior Public Health Administrator of Rupandehi district who through his leadership quality is able to bring Government and Non Government sectors in a common platform in order to achieve positive health indicators in the district. I also congratulate District Public Health Office, Rupandehi team for their achievement and wishing best in performing great task over the years to achieve new milestones in district health development that ultimately would contributes 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. Peshal Kumar Pokhrel Local Development Officer District Development Committee, Rupandehi. 2
Phone: 061-520390 Government of Nepal 061-520068 Ministry of Health & Population Fax: 061-520330 email: [email protected] Western Regional Health Directorate Pokhara
Few Words From Regional Director
It is my great pleasure to have Annual Report of the F/Y 2069/70 BS of the District Public Health Office, Rupandehi at expected time. I am pleased to know that the District Pulic Health Office, Rupandehi has been publishing the Annual Report regularly after completion of the district annual performance review workshop. I found this report to be very comprehensive. It covers most of the health services activities carried out in the last fiscal year 2069/70 including the activities of other national and international government and nongovernment partners. It also includes the contributions of priv ate sector. Regular progress reviewing is important not only for being satisfied in achieving the set targets but also identifying the gaps and actions to be taken for future improvement. This kind of report not only presents the past performance but also support for robust and evidence based planning exercise. I believe that the information provided in this report will be of immense help to planners, researchers, managers, service providers and concerned students. I am confident that a competent and effici ent health care delivery system is in place and all the relevant data from community to district level are included in this report. We should be aware that sustained efforts are needed to accelerate the progress of the programme. I deeply appreciate the ha rd work done by the team of District Public Health Office, Rupandehi including FCHVs working at the various levels of health institutions in a difficult situation. All the volunteers, health workers, personnel engaged in health sector and the stakeholders and partners deserve thanks and
congratulations too. To conclude, I extend my sincere thanks and congratulations to the Chief of District Public Health Office, his team and all concerned personnel for publication of the report.
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Table of Contents Acknowledgement ...... 1 Message from Local Development Officer...... 2 Few Words From Regional Director ...... 3 Table of Contents ...... 4 List of Tables ...... 6 List of Charts...... 7 Acronyms ...... 8 Health Service Coverage Fact - Sheet ...... 10 1. Rupandehi District: Brief Overview of the District ...... 12 2. Health Services ...... 13 3. Child Health Program ...... 15 3.1 National Immunization Programme (NIP) ...... 15 3.2 CB IMCI Programme ...... 20 Community Based Neo Natal Care Package (CB NCP) ...... 22 3.3 Nutrition Program ...... 22 4. Family Health...... 30 4.1 Safe Motherhood Programme ...... 30 4.2 Family Planning Program ...... 34 4.3 FCHV Programme ...... 37 4.4 PHC Outreach clinic Programme ...... 40 5. Disease Control Program ...... 41 5.1 Malaria Control Programme ...... 41 Malaria species ...... 42 5.2 Dengue Control Program ...... 49 5.3 Tuberculosis Control Program ...... 50 5.4 Leprosy Control Programme ...... 55 Objectives ...... 56 5.6 Filariasis Elimination Campaign ...... 60 5.7 Rabies ...... 60 5.8 Snake Bite ...... 60 5.9 HIV/AIDS Program ...... 61 6. Curative Services ...... 66 6.1 OPD Services ...... 66
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7. Supporting Program ...... 70 7.1 Health Education, Information and Communication ...... 70 7.2 Primary Health Care Revitalization Program ...... 73 7.3 Management Support ...... 77 7.4 Supervision and Monitoring Program ...... 78 7.5 Physical Infrastructure Development Program ...... 78 7.6 Maintenance Program ...... 79 7.7 Recommendation of private institution for approval and renewal ...... 79 7.8 Ambulance Services ...... 79 7.9 Blood Bank Services ...... 79 7.10 Population Management Program ...... 80 Annex I: Human Resources Situation ...... 81 Annex II : List of NGO/INGO & Private Health Intuition ...... 84 Annex III : Institutional Delivery by birthing center: ...... 85 Annex IV: Health facilities providing IUCD and Implants services & Chart Showing Birthing Centers ...... 86 Annex V : Estimated Target Population for 2069/70 ...... 87 Annex VI :MR Campaign 2069 Achievement...... 91 Annex VII : VDCs Categorized with Problems and Priority ...... 95 Annex VIII: VDC wise EPI Status ...... 96 Annex IX: List of Private Hospitals with Approval/Renewal Status ...... 101 Annex:X List of Programme Performance Evaluation ...... 104
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List of Tables Table 1: Average number of people served by level of health facilities per day ...... 14 Table 2: Service delivery points and reporting status in percent ...... 14 Table 3 : Progress status of targeted activities of EPI Program ...... 16 Table 4: EPI performance status by selected indicators ...... 17 Table 5 : ARI program performance status by selected indicators ...... 21 Table 6 : Nutrition program targeted activities of FY2069/70 ...... 24 Table 7 : Nutrition program performance status by selected indicators ...... 25 Table 8 : Progress of Baal Vita Distribution Program in 2069/70 ...... 29 Table 9: Safemotherhood program targeted activities of 2069/70 ...... 30 Table 10: Safemotherhood program performance status by selected indicators ...... 31 Table 11: Family planning program targeted activities of 2069/70 ...... 34 Table 12: Family planning program performance status by selected indicators ...... 35 Table 13 : FCHV program targeted activities of 2069/70 ...... 38 Table 14 :FCHV program performance by selected indicators ...... 39 Table 15: PHC/ORC targeted activities of 2069/70 ...... 41 Table 16; PHC/ORC performance status by selected indicators ...... 41 Table 17: Disease control program of 2069/70 ...... 43 Table 18: Malaria control program performance by selected indicators ...... 45 Table 19: PF cases reporting VDCs in 2069/70 ...... 47 Table 20: LLIN distribution status of three consecutive years ...... 48 Table 21: Trend of insecticide spraying ...... 48 Table 22: Larva of dengue mosquito search and destroy status ...... 49 Table 23: TB control program targeted activities of 2069/70 ...... 51 Table 24: TB control program performance by selected indicator ...... 54 Table 25: Leprosy control program targeted activities of 2069/70 ...... 56 Table 26: Leprosy control program performance by selected indicators ...... 57 Table 27: VDCs with leprosy prevalence more than 2 ...... 58 Table 28: Outbreak and disaster management Status ...... 59 Table 29: Outbreak Situation by disease categories ...... 60 Table 30: Animal bite and no. of vaccine use status ...... 60 Table 31: Snake bite situation 2069/70 ...... 61 Table 32: Service types of HIV/AIDS program ...... 62 Table 33: HIV/AIDS program targeted activities of 2069/70 ...... 62 Table 34: HIV/AIDS program performance by selected indicator ...... 63 Table 35 OPD service status by selelcted indicators ...... 67 Table 36: Top ten disease ...... 67 Table 37: Free health service targeted activities of 2069/70 ...... 68 Table 38: District recommended for Ultra poor Services by types ...... 69 Table 39: Laboratory services ...... 70 Table 40: NHEICC program targeted activities of 2069/70 ...... 71 Table 41: Client served in 2069/70 by urban health clinic ...... 75 Table 42: Urban Health program supported by DPHO and Municipality ...... 75 Table 43: Management support targeted activities of 2069/70 ...... 77 Table 44: Supervision and monitoring status of 2069/70 ...... 78 Table 45: Physical infrastructure development status 2069/70 ...... 78 Table 46: Maintenance program progress in 2069/70 ...... 79 Table 47: Recommendation of health facilities for approval or renewal in 2069/70 ...... 79 Table 48: Ambulance Services ...... 79 Table 49 Population management program targeted activities 2069/70 ...... 80
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List of Charts
Chart 1 Distribution of health facilities in rupandehi district ...... 13
Chart 2: Immunization Coverage ...... 18
Chart 3: Percent of New Growth Monitoring Visit by Under 5 Children ...... 26
Chart 4: Proportion of malnourished children as % of NGM (< 5 years) ...... 27
Chart 5 : ANC, Delivery and PNC Status ...... 32
Chart 6: Contraceptive Prevalence Rate and % of FP New Acceptor Method Mix ...... 36
Chart 7: Percent of new acceptors spacing method mix ...... 36
Chart 8 Annual Blood Slide Examination Rate 2069/70 ...... 45
Chart 9 Trend of Malaria Positive Cases in nos ...... 46
Chart 10 : Trend of Clinical Malaria Incidence ...... 46
Chart 11: Treatment Outcome and No. of MDR Cases in Three Consecutive Years .... 55
Chart 12: Trend of New Case Detection Rate and Prevalence fo Leprosy ...... 58
Chart 13: Distribution of VCT Centers at Rupandehi ...... 65
Chart 14: Top Ten Diseases in 2069/70 ...... 68
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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 Bbehaviour 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 IUCD Intra-uterine Contraceptive Device IYCF Infant and Young Child Feeding
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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 Fiscal Year 2067/68 - 2069/70 (2010/011 - 2012/13)
2067/68 Indicators 2068/69 (2011/2012) 2069/70 (2012/2013) (2010/2011)
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 81 100 99
IMMUNIZATION COVERAGE
BCG 115 121 113.42
DPT-Hep B-Hib 3 102 104 99.12
Measles 95 102 97.91
JE 83 97 95.61
Pregnant women receiving TT-2+ 67 83 74
Dropout Rate BCG Vs Measles 17 16 13.67
Dropout Rate DPT /hep/hib 1 Vs DPT/hep/hib 3 2 0 -2.09
NUTRITION
Proportion of malnourished children as % NGM 1.96 1.35 1.1
% of pregnant women receiving Iron tablets 100 100 76
% of postpartum Mother receiving Vitamin A 88 100 100
ACUTE RESPIRATORY INFECTION (ARI) Proportion of Severe Pneumonia among New Cases 0.18 0.02 0.02
DIARRHOEAL DISEASES
% of Severe Dehydration among Total New Cases 0.17 0.02 0
SAFE MOTHERHOOD Antenatal first visits as % of expected pregnancies 114 122 105.44
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2067/68 Indicators 2068/69 (2011/2012) 2069/70 (2012/2013) (2010/2011) ANC 4 th visit as % of ANC 1 st visit 60 65
Institutional delivery as % of expected live birth 78 92 93
PNC first visit as % of expected pregnancies 94 86 93
FAMILY PLANNING
Contraceptive Prevalence Rate (Modern Method)* 34 33 32.37
New Acceptor as % of MWRA 10.34 11.74 11.69
MALARIA
Annual Blood Slide Examination Rate (ABER) per 100 1.37 1.41 1.06
Proportion P.falciparum (PF %) 41.66 35.03 34
Clinical Malaria Incidence (CMI)/1000 3.70 4,49 2.60
TUBERCULOSIS
Case finding Rate 75 78 64
Treatment Success Rate on DOTS 90 92 91
No. of DR Cases 25 36 59
LEPROSY
New Case Detection Rate (NCDR) /10,000 1.87 1.9 1.64
Prevalence Rate (PR) /10,000 1.3 1.4 1.30
Disability rate Grade 2 among new cases 0.03 2 0
HIV/AIDS AND STI
Number of people counseling 1.9 4891 5575
Number of HIV +ve cases 1.4 191 144
Number of persons receiving ART 2 484 608
Number of ART sites 1 1 1
CURATIVE SERVICES
Total OPD new visits as % of total population 99.35 112 124 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 83 010’ to 83 030’ longitudes in the east and 27 010’ to 27 045’ 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 31 0 C. The highest temperature reaches up to 43.4 0 C around May June. However, the minimum mean temperature of the area is 18.2 0 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. Sixty one percent of the population holds agriculture as their prime source of income, thus agriculture is the life line of the district. 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.
Sixty six percent of the population is literate consisting 76% male and 56% female. The average life expectancy at birth in the district is remained 68.27% (HDI 2001). Out of the total population 79% have access to drinking water. The district has already declared open defecation free VDC into 15 VDCs and 2 wards (14 and 15) of Butwal Municipality.
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2. Health Services
District Public Health Offices provides a range of health services including preventive, curative and promotive into the district. Along with government health services, private sector and 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, NGOs, medical college, nursing home and private hospitals to improve health services. Similarly, some 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, 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 2067/68 2068/69 2069/70 1. Hospitals (GoN) 238 183 299 2. NGO/Private Hospitals and other 69 70 67 health institutions 3. PHCC 34 47 47 4. Health Post 83 53 40 5. Sub Health Post 30 32 33 6. EPI Clinic 39 49 45 7. PHC/ORC Clinic 14 22 32
Note: Private hospitals statistics does not include statistics from AMDA, UCMS and Devdaha Medical Colleges.
This shows that the case load at Government run hospitals are increasing considerably. In rural areas, PHCCs are providing better service so, getting more popular among the local people, however, some measures need to be taken at the Health Posts and EPI clinic to increase the service quality as found declining trend. The good things about the rural areas are PHC/ORC popularities jumped as the service utilization number has been found increased than the previous 2 years. The increasing 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 2067/68 2068/69 2069/70 1. Hospital (GoN) 100 100 100 2. Hospital/Medical College 100 100 100 (Other) 3. PHCC 100 100 100 4. Health Post 100 100 100 5. Sub Health Post 100 100 100 6. PHC/ORC Clinic 100 100 99 7. EPI Clinic 100 100 100 8. NGOs 100 100 100 9. Private HF 100 100 100
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.
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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 program (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 is 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 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 273 EPI Posts and 336 sessions per months are routinely running in the district. 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.
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Major Activities The major activities carried out during FY 2069/70 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 committee and 2 municipalities. Besides the immunization services are availed through seven 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. Measles Rubella campaign was completed with 93.7% coverage. 5. Conducted joint supervision and monitoring in poor performing VDCs in case of immunization low coverage 6. Celebrated "immunization month" during month of Baisakh. 7. Planning for full immunization VDC declaration: For the forthcoming year 21 VDCs of Rupandehi district viz; Karahaiya, Bodhwar, Shankarnagar, Manpakadi, Motipur, Chhodki Ramnagar, Sau. Farsatikar, Siktahan, Dudhraksha, Kha Bangai, Hati Bangai, Manmateria, Betkuiya, Gangoliya, Madhwaliya, Manjhgaunwa, Anandban, Tikuligadh, Chilhiya, Pa. Amuwa, and Devdaha VDCs has planned to declare as the full immunization VDCs. Management Committee, Political parties, FCHVs, NGOs and Schools of these VDCs has already sent their commitment in FY069/70.
Table 3 : Progress status of targeted activities of EPI Program Physical Financial (in’ 000)
Activities Units Target Achieve. % % % of of % Annual Budget Expenditure Expenditure Achievement Laptop Computer Purchase Pcs. 1 1 100 155 75 48 Repair and maintenance of Event 2 2 100 36 0 0 cold Chain Equipment Vaccine month conduction for strengthening of Pcs. 1 1 100 100 100 100 Vaccine program Declaration of complete Vaccine VDC with coordination of School, Pcs. 1 1 100 20 20 100 local government and health institution
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Physical Financial (in’ 000)
Activities Units Target Achieve. % % of Annual Budget Expenditure Expenditure Achievement Review of Vaccine program having low performance VDCs (Health Management committee, Pcs. 1 1 100 50 50 100 FCHV, teachers and other stakeholders) and update of micro planning of vaccine program Supply of vaccine and Pcs. 3 3 100 640 565 88 logistics World Pneumonia Day Pcs. 1 1 100 10 10 100 Integrated supervision and Pcs. 3 3 100 572 572 100 Monitoring Contract service of AHW and ANM for Vaccine Event 9 14 100 432 432 100 program Measles Rubella vaccine Event 1 1 100 3300 3171 96 campaign conduction Necessary Fuel to maintain Times 3 3 100 295 295 100 Vaccine temperature National Polio Vaccine Pcs. 1 0 0 2525 0 0 Campaign conduction cost
All the targeted interventions for the fiscal year 2069/70 have been accomplished 100% however budget expenditure has not been 100 percent as per allocation. Table 4: EPI performance status by selected indicators Indicators 2067/68 2068/69 2069/70 1. DPT Hep b Hib 3 coverage 102 104 99.12 2. Measles coverage 95 102 98 3. % of TT2+ (Pregnant women) coverage 67 83 74 4. Dropout rate DPT 1 Vs DPT 3 2 0 2.09
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Indicators 2067/68 2068/69 2069/70 5. Dropout rate BCG Vs Measles 17 16 13.67 6. Number and % of unimmunized children 939 425 228 (5%) (2%) (1%) 7. Wastage rate by antigen a. BCG 69 70.61 b. DPT Hep b Hib 3 0 12.43 c. Polio 18 13 d. Measles 46 41.49 e. JE 41 29 f. TT 30 12 8.No. of VDC with <90% DPT3 coverage 15 9.No. of AFP Cases 30 10.No. of Measles cases 14 11.No. of Neonatal tetanus Cases 0
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 even though slight decrease has been observed in this fiscal year. Percent of TT2 coverage depicts that the coverage trend was decreased in comparison to last year and yet to reach the national target. However, the coverage is fairly high and we believe that this can be improved in subsequent years.
Chart 2: Immunization Coverage
120 102 104 102 99.12 95 98 100 83 74 80 67 60 2067/68 40 2068/69 20 2069/70 0 DPT -Hep b -Hib 3 Measles coverage % of TT2+ (Pregnant coverage women) coverage
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Dropout rate of DPT 1 Vs DPT 3 for the current FY is 2%, which was reported 0% in last year. There are 1% of unimmunized children in the district in number which is 228. 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 increase to 12% from 0% in last year due to replacement of single dose vial by the 10 dose vial. The wastage rate of Measles, JE and TT is on the decreasing trend than last year. The wastage rate in case of DPT (Penta), Polio, Measles, JE and TT, it is less than the national norms for wastage rate though still suggested that if Polio, Penta and if TT followed in muti dose vial policies and refrigerator provided in each health facilities than wastage rate can be reduced to minimal.
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.
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
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S N Issues, Problem and constraints Recommended action Responsibility 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 and high drop out rate Two new Urban Health Clinics Immunization Officer of immunization into the has been added into the Butwal and Urban Health Clinic municipalities Municipality and need to In charge integrate regular Immunization program 4 Refrezerators are not working due to Budget for the transformer DPHO and Electricity low voltages of electricity supplied in replacement should be Office Manjgaun 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 Manjgaunwa HP)
3.2 CB-IMCI Programme 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. CBIMCI 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.
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• 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. • Contribute to improved growth and development.
Targeted Activities FY 2069/70: No targeted activities proposed for the fiscal year.
Table 5 : ARI program performance status by selected indicators Indicators 2067/68 2068/69 2069/70 1. % of pneumonia among new ARI cases 16.26 13.18 23.81 2. % of severe pneumonia or very severe disease 0.18 0.02 0.02 among total cases 3. Proportion of ARI cases treated at community by 20.74 72 70 FCHVs and CHWs. 4. Proportion of ARI cases treated by HF 32.69 28 38 5. Case fatality rate (pneumonia) 0 0 0 6. % of severe dehydration among total cases 0.17 0.02 0 7. Proportion of diarrhea cases treated at community by FCHVs and CHWs. 74.52 70 74
8. Proportion of diarrhea cases treated by HF 32.30 30 34.28 9. Proportion of diarrhea cases treated with zinc and NA NA NA ORS 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 increased substantially to 23.8% from 13.18%. Training given to the FCHV and VHW/MCHW over the previous year started to show the result as ARIs cases treated was found jumped from around 20 to 72 in proportions in FY 068/69 and remained consistent in FY 069/70 (70).
Similarly, incidence of CDD cases found increased to 74. It has direct impact that the case holding increased at community level and thus appearing less cases at the health institutions in comparison to previous years. The record concerning proportion of diarrhea cases treated with Zinc and ORS is not relevant as in HSIS system no such data are generated in the system at district level and similar is the case for proportion of under 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.
Community Based Neo-Natal Care Package (CB NCP) CBNCP is under the process of implementation in Rupandehi district. Three batches of CBNCP training of health workers have been completed and 67 health workers have been trained. The program is being rolled out with the technical and financial support of a NGO CNCP. The program is expected to bring positive changes in the status of maternal and newborn care program.
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 and 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
22 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 food insecurity, feeding behaviour 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 2069/70 (Amount Rs. in thousands) All the targeted activities for the fiscal year 2069/70 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 no budget was allocated so it is not applicable while others like balvita transport, neonatal ward improvement and iodine advocacy month have less than 50 percent financial progress.
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Table 6 : Nutrition program targeted activities of FY2069/70 Physical Financial
Activities Units Target Achieve. % % of Annual Budget Expenditure Expenditure Achievement Logistic for mass distribution of Vitamin A ( Pcs. 1 1 100 170 170 100 scissors, registers and pencil set) Breast feeding promotion Event 2 2 100 129 129 100 week program Albendazole distribution for the 1 5 children and Event 28000 27856 99 0 0 0 pregnant women Albendazole distribution program upto 10 grade students of government Event 207278 198986 96 0 0 0 and non government school Iron Tablet Distribution Event 5206 5103 98 0 0 0 Vitamin Capsule distribution for the Event 11155 10121 91 0 0 0 treatment of VAD Disorder. Vitamin A capsule mass distribution ( Kartik and Event 111548 109317 98 0 0 0 Baisakh month) FCHV mobilization cost for Vitamin A and Albendazole mass Event 1 1 100 580 580 100 distribution program ( 2 times) Iodine advocacy month for deficiency prevention and Pcs. 1 1 100 86 20 23 awareness
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Physical Financial
Activities Units Target Achieve. % % of of % Annual Budget Expenditure Expenditure Achievement Growth monitoring of Pcs. 21603 60831 100 0 0 0 under 5 children Supervision of Vitamin A Event 2 2 100 140 140 100 program Integrated supervision of Person 3 3 100 172 172 100 Nutrition Program Construction and Improvement of Pcs. 1 1 100 701 280 40 25neonatal care unit School Health and Nutrition week( Jestha 1 Pcs. 1 1 100 86 86 100 7) Bal Vitta Transportation Pcs. 1 1 0 42 0 0
Performance Status by selected indicators The growth monitoring services have been extended to children less than 5 years of age. There has been decrease in growth monitoring coverage to 59% from 75% of FY 68/069. In case of Iron compliance (% of mothers who received 180 iron tablets among ANC 1st visit) shows reduction in 2069/70 than the year 2068/69. Table 7 : Nutrition program performance status by selected indicators Indicators 2067/68 2068/69 2069/70 New growth monitoring visits as % of 5 years children 59.36 75.61 59 Proportion of malnourished children as % of new growth 1.96 1.35 1.1 monitoring (< 5 years) % of expected pregnant mothers supplemented with Iron 100 100 76 tablets % of pregnant mothers who received 180 iron tablets 88.24 91.23 98.84 % of pregnant mothers who were supplemented by 100 80 77 Antihelmentic tablet % of Postpartum mothers receiving Vitamin ‘A’ 88 100 104 Vitamin "A" Distribution Coverage (number and %) 1st 100 100 100
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Indicators 2067/68 2068/69 2069/70 (Kartik) round (6 month to < 5 years children) Vitamin "A" distribution coverage (number and %) 2nd 100 100 100 (Baishakha) round (6 month to <5 years children) Antihelmentic tablet distribution coverage (number and %) 100 100 100 1st (Kartik) round (1 <5 years children) Antihelmentic tablet distribution coverage (number and %) 100 100 100 2nd (Baishakha) round (6 month to <5 years children)
Less children were reported having malnutrition problem. The rest of performance status is achieved as 100% except in case of % of pregnant mothers supplemented with Anthelmintic tablet that shows 77% coverage that is less than previous 2 years status.
Chart 3: Percent of New Growth Monitoring Visit by Under 5 Children
80 75.61 70 59.36 59 60 50 40 New growth monitoring visits as % of 5 years 30 children 20 10 0 2067/68 2068/69 2069/70
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.
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Chart 4: Proportion of malnourished children as % of NGM (< 5 years)
2.5 2 1.96 Proportion of malnourished 1.5 1.35 children as % 1 1.1 of new growth monitoring (< 0.5 5 years) 0 2067/68 2068/69 2069/70
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. Now the district is not receiving additional supply. • Receiving supply of Baal vita at district store and subsequent supply to health Supply facilities. and • Supply of Baal vita to FCHVs on a month base. Logistics • Conducted 1 day orientation to the district supersupervvisorsisors • Conducted District Advocacy and Planning Meeting (D(Diistrictstrict level Govt. line agencies and Health post In -Charge) Capacity Building • Completed Ilaka level training to the Health Facility Staff • Community level training to the FCHVs and Mothers ggrroupsoups
• Social Mobilization – through Mothers groups, Social Mobilizers • Coordination at different Health Facility StructureStructuress Awaren • School Intervention ess • CBO/ I/ NGOs intervention • Media-FM intervention • Behavior Change Communication (BCC) and other Promotional Materials Supervis • Internal/ Surveillance was done by Max Pro before hahanhandoverndoverdover ion & Monitor • Supervision by Government officials ing • External Program Evaluation (baseline, endline , coverage surveys)
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Progress of MMNP Supplementation Program Table 8 : Progress of Baal Vita Distribution Program in 2069/70 Target (6 Total number of children receiving Baal Vita Achievement 23) months as or age groups in % HSIS 069/70 6 11 12 – 17 18 – 23 Total Months Months Months 29810 7992 4598 2834 15424 52
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 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
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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.
The detail indicators are given in Table Table 9: Safemotherhood program targeted activities of 2069/70 Physical Financial
Activities Units Achieve Target % %
. % of Annual Budget Expenditure Expenditure Achievement Screening of women with uterine prolapse and listing Pcs. 5 5 100 750 750 100 of women needing ring pessary and operation Meeting of Reproductive Perso 15 15 100 125 56 44.8 Health Coordination n
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Physical Financial
Activities Units Achieve Target %
. % of Annual Budget Expenditure Expenditure Achievement Committee Monitoring of AAMA SURKCHHA PROGRAM Pcs. 1 1 100 2 2 100 including population and Family Health Program Recruitment of ANMs into Health Post, PHCC for 24 Pcs. 30 30 100 190 190 100 hour services Recruitment of ANMs into Health Post, PHCC for 24 Pcs. 25 39 156 4419 2774 62.77 hour services Motivation of Pregnant and Perso 3740 575 15 1496 230 15.37 post partum mother n Incentives reimbursement Perso 2400 2312 of AAMA SURKCHHA 8850 8009 90 96.33 n 0 0 PROGRAM Printing of AAMA SURKCHHA PROGRAM Pcs. 1 1 100 20 20 100 formats, reports and partograph
Table 10: Safemotherhood program performance status by selected indicators Indicators 2067/68 2068/69 2069/70
1. No of functional BEOC sites 6 6 5 2. No of functional CEOC sites 7 6 8 3. No of Safe abortion sites ? 20 20 4. Ratio of BEOC/CEOC sites to Population 67,037 73,654 70,637 (Population/No. of sites) 5. No of birthing centers and Ratio to EP 10 12/2011 17/1474 (No.EP/No.BC) 6. ANC 1 st visit as % of expected pregnancy 114 122 105
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Indicators 2067/68 2068/69 2069/70
7. 4 ANC visits as % of 1 st ANC visit 60 65 66 8. Delivery conducted by SBA as % of expected live 78 92 93 births 9. % of institutional delivery among expected live births 78 92 93 10. PNC 1 st visit as % of expected live birth 94 86 93 11. No of CAC (Surgical and Medical Abortion, MA) 4427 4216 3342 12. No of PAC 104 783 817 13. % of women receiving maternity incentives among 72.72 81.39 73.75 total institutional deliveries 14. % of women receiving 4 ANC incentives among total 0.83 0.76 2.74 institutional deliveries 15. Met need of emergency obstetric care (need of EOC 2.09 2.11 1.98 is 15% of expected live birth) 16. Caesarian Section (CS) rate ( 5% of total expected 15.3 14.87 18.12 birth is the usual CS rate) 17. Number of Maternal Death NA 9 21 18. Number of Neonatal Death 19 5 166
Chart 5 : ANC, Delivery and PNC Status
140 122 114 120 105 92 9394 93 100 86 78 80 66 60 65 60 40 20 0 ANC 1st visit as % of 4 ANC visits as % of 1st Delivery conducted by PNC 1st visit as % of expected pregnancy ANC visit SBA as % of expected expected live birth live births
2067/68 2068/69 2069/70
Service statistics of the fiscal year 2069/70 shows the number of functional BEOC site remain the same as of 2068/69, however, functional CEOC site reduced to 6 as one CEOC site was found closed. ANC 1 st
32 visit as % of expected pregnancy has decreased by 17% in the fiscal year 2069/70. But 1 percent increase has been observed in 4 ANC visit as percent of 1 st ANC in the current fiscal year. SBA attendance at birth is increased to 93% and trend shows that mothers preferably liking institutional delivery. This can be taken as new sites started to attract more mothers for institutional delivery rather than delivering at home. The number of Birthing centers is increased in the district from 12 in 2068/69 to 17 in 2069/70 and hence, increased in mothers’ access to institutional delivery. EOC data shows that 1.98 met need of emergency obstetric care (need of EOC is 15% of expected live birth). Abortion services showing slight downwards trend as MA were found reduced. The reasons cited by majority of health workers as due to availability of emergency contraceptive pills in the market and attraction towards its use. Since the reasons showing, it is recommended to perform a micro research to explore further cause of the problem.
% of women receiving 4 ANC incentives among total institutional deliveries has been marked increased to 15 percent with compared to 2 percent of the previous year.
No of maternal and neonatal death have gone up considerably with compared to the previous year and it needs further clarification and verification.
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
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 in safe abortion clandestine abortion practice in boarder area) 4 Less utilization of complete ANC Innovative approaches need Focal person and incentives compare to 4 th ANC to take concerned ANMs and institutional delivery 5 Alarming increase in reported Further exploration is needed Focal Person Maternal and newborn death
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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.
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 2069/70 Physical Financial
Activities Units Target Achieve. % % % of of % Expenditure Expenditure AnnualBudget Achievement Procurement of IUCD Pcs. 10 10 100 30 30 100 kit Procurement of Pcs 10 10 100 30 30 100 Implant kit IUCD Coaching to person 1 2 200 30 30 100
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Physical Financial
Activities Units Target Achieve. % % of of % Expenditure Expenditure AnnualBudget Achievement trained SBA/ANM Family Planning 800 655 82 1282 774 60.37 Sterilization person IUCD service person 1000 351 35 79 14.4 18.23 provision
Implan services person 800 696 87 60 17 29.00 Preparatory meeting Pcs 1 1 100 42 23 53.57 for sterilization Satellite clinics for person 1 1 100 14 4 28.57 long spacing methods Procurement of kits Pcs 4 4 100 65 65 100 for PHC/ORC
Table 12: Family planning program performance status by selected indicators Indicators 2067/68 2068/69 2069/70 1. No of IUCD service sites (functional) 12 16 13 2. No of implant service sites (functional) 8 10 8 3. No of functional satellite clinics for long acting spacing 0 0 2 methods 4. Contraceptive Prevalence Rate (CPR) 34 33 32.37 5. % of FP new acceptor method mix 10.34 11.74 11.69 6. VSC cases target versus achievement 69 78 83.26 7. % of new acceptors of spacing FP method CONDOM 3.32 3.52 4.36 PILLS 1.85 2.39 2.03 DEPO 3.88 4.60 3.84 IUCD 1.03 0.39 0.28 IMPLANT 0.23 0.14 0.52
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Chart 6: Contraceptive Prevalence Rate and % of FP New Acceptor Method Mix
Family Planing 40 35 30 25 20 Contraceptive Prevalence 15 Rate (CPR) Percentage 10 % of FP new acceptor 5 method mix 0 2067/68 2068/69 2069/70 FY
Chart 7: Percent of new acceptors spacing method mix
0.28 0.52
4.36 CONDOM PILLS DEPO 3.84 IUCD IMPLANT
2.03
The contraceptive prevalence rate (CPR) for modern family planning method is 32.3% 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. During the last year % of FP new acceptor as % of MWRA remained same.
VSC cases target achieved with 82 %, which is in increasing trend over the previous years. In case of achieving temporary methods of family planning shows that utilization rate is increased in case of Condom and Implant, Pills rema ined almost same. Whereas, DEPO and IUCD were found lower than the previous years.
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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 (data review as received from SHP, HP and PHC, pvt hospitals, nursing homes and pvt. clinics) 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 acing services centers Expansion of long acting DPHO service centers and need to trained service providers 2 No reporting from Private clinics, Channeling the reporting DPHO and Focal person nursing home and private medical system and strong colleges coordination with private nursing home and medical colleges 3 Improper running of satellite Mobilizing health workers and DPHO, focal person and clinics FCHVs for increasing clients Health Facility Incharge Awareness raising at community level 4 Less utilization of IUCD service Implant should be promoted DPHO from 17 BC in boarder area due to cultural practices into boarder area
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
37 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 • To develop FCHV as health motivator • To increase utilization of health care services through demand creation.
Table 13 : FCHV program targeted activities of 2069/70
Physical Financial Reasons
Unit for not Activities Achieve s Target achievin re re % % . of % Annual Budget g 100% Expenditu Expenditu
Female Community Achievement Health Volunteer Day Pcs. 69 69 100 278 278 100 celebration Dress allowances for Persn 1270 1270 100 5080 5080 100 FCHV Farewell program for Persn 7 7 100 70 60 85.71
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Physical Financial Reasons
Unit for not Activities Achieve s Target achievin re re %
. % of Annual Budget g 100% Expenditu Expenditu
FCHV who have Achievement served long
Table 14 :FCHV program performance by selected indicators
Indicators 2067/68 2068/69 2069/70
1. Proportion of Pills cycles distribution by FCHVs 57 56.28 49.15 among total distribution 2. Proportion of Condoms distribution by FCHVs 14.89 8.65 12.18 among total distribution 3. Proportion of ORS distribution by FCHVs among 21.62 31.46 21.89 total distribution 4. Number of maternal death reported by FCHV NA NA NA 5. Number of newborn death reported by FCHV NA NA NA 6. % of Mother's Group Meeting held 60.78 75.49 59.55 7. Total Loan Mobilized from FCHV Fund (Rs.) 5065199 6036675 9186963
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 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 49.15% of oral pills and 12.18% of condom out of total distribution. They have contributed in distribution of 21.89% of ORS packet, which is less than the previous year and also less than national achievement as 50% ORS packets at the national level found distributed by the FCHVs. Out of the total target, only 59.55% of Mother’s Group Meeting was organised by FCHV which has been reduced from the FY 2068/69.
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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.
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.
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Table 15: PHC/ORC targeted activities of 2069/70
Physical Financial
Unit Activities Achiev
s Target
re re t %
e. of % Annual Budget Expenditu Expenditu
Procurement kit of Achievemen Pcs. 4 4 100 65 65 100 PHC/ORC
Table 16; PHC/ORC performance status by selected indicators Indicators 2067/68 2068/69 2069/70 Number and % of PHC/ORC conducted wrt targeted 2748/100 2748/100 2748/100 Number of People Treated by First Aid 15 22 32 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. 100% of the targeted 2748 PHC/ORC was conducted in 2069/70 and this was equal with the previous year’s achievement. In an average, 32 clients were served per clinic per month during 2069/70, and is increasing in trend from 2067/68 to the current FY.
The data shows that popularity of PHC/ORC was increased during the FY 2069/70 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.
5. Disease Control Program
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.
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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 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).
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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 • 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 2069/70 Physical Financial
Activities Unit Target Achieve. % % % of of % Annual Budget Expenditure Expenditure Achievement Malaria control supervision & follow Event 3 3 100 82 82 100 up Campaign for control of Dengue and Chicken guinea epidemic by mobilizing health workers, FCHVs and Event 2 1 50 500 500 100 other volunteers by searching for mosquito habitat and destroying their larvae. Dengue & chicken guinea epidemic Event 1 1 100 3.25 3.25 100
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Physical Financial
Activities Unit Target Achieve. % % % of of % Annual Budget Expenditure Expenditure Achievement control Orientation & interaction programme for public awareness to Health workers, FCHV & stakeholders. Dengue and Chicken Guinea epidemic control and public Event 2 2 100 32 32 100 awareness by broadcasting and printing in electronic and print media. World Malaria Control Day Event 1 1 100 90 90 100 celebration Training for malaria control Person 3 1 33.3 464 116 25 Counseling Services for Malaria Event 3 1 25 100 75 75 control Supply of Drugs & Other Materials Event 3 3 100 32 32 100 received from the centre to field Unit Collection of blood slides and treatment of suspected malaria Pcs 5100 17714 100 85 85 100 patients in malaria prone areas. Malaria Spraying: Selection & Spraying of pesticides in malaria Event 2 2 100 220 220 100 epidemic likely malaria prone areas. Programs for malaria control like survey, quarterly review and other Event 0 0 0 0 0 0 related programs.
Most of the targeted activities has been achieved in fiscal years 2069/70. I.e. 100% achievement and 100% expenditure indicating the good performance in the vector borne control program, however the event "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" conducted only one time due to insufficient budget and counseling service for malaria could not be achieved due to finishing of contract of M& E Officer employed by EDCD ( GFATM support program).
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Table 18: Malaria control program performance by selected indicators Indicators 2067/68 2068/69 2069/70 1. No of confirmed malaria cases among total malaria 156 137 189 cases 2. Annual Blood Examination Rate (ABER) 1.37 1.41 1.06 3. % of PF among total positive cases 41.66 35.03 34 4. Clinical malaria incidence/1,000 risk population 3.70 4.49 2.6
5. Reported death due to malaria 0 0 0 6. Target versus achievement of blood slide collection 100 100 100 7. percentage of indigenous cases among total 76 82 69.31 positive cases
Regarding the malariomatric indicators of the Rupandehi district, the above table shows that number of positive cases of malaria has increased in comparison to the previous years I.e.189 cases. Annual Blood Examination Rate (ABER) is the operational efficiency of the malaria intervention. Chart 8 Annual Blood Slide Examination Rate 2069/70
2 1.9 1.8
1.6 1.41 1.37 1.4 1.2 1
0.8 ABER 0.6 0.4 0.2 0 2067/68 2068/69 2069/70
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Chart 9 Trend of Malaria Positive Cases in nos
200 189 180 160 156 137 140 120 100 Total positive casexs 80 60 40 20 0 2067/68 2068/69 2069/70
In case of Rupandehi district, 100% target has been achieved for Blood slide collection i.e. ABER is 1.41 (Greater than 1%) which is higher than previous 2 years. Proportion of P. Falciparum (PF) increased approximately 1% than FY 2068/69. Clinical Malaria incidence is 2.6 /1,000 risk population that is decreased by around 2 % 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 69.3% shows decreased than previous year however indigenous Falciparum case reporting indicates the outbreak of the malaria. No death cases have reported in the district due to Malaria in the FY2069/70.
Chart 10 : Trend of Clinical Malaria Incidence
5 4.5 4.49 4 3.7 3.5 3 2.5 2.6 Clinical Malaria incidence 2 1.5 1 0.5 0 2067/68 2068/69 2069/70
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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. In fiscal years 2069/70, 19 health facilities have reported Pf cases. 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. Table 19: PF cases reporting VDCs in 2069/70 Malaria PF case reporting VDCs in FY 2069/70 Name of the VDC No of PF and mixed case SN Indigenous Imported 1 Siddrthanagar N.P 9 1 2 Devdeha 4 1 3 Makraher 4 0 4 Aama 2 0 5 Aanandaban 2 0 6 Lumbini 2 1 7 Semara Bazzar 1 0 8 Madhavliya 1 0 9 Butwal N. P. 1 2 1o Dudhrakshya 1 1 11 Paroha 1 0 12 karahiya 1 0 13 Rudrapur 1 0 14 Tenuhawa 1 1 15 Kamahariya 1 0 16 Pajarkatti 1 0 17 Majhagawa 0 2 18 Siktahan 0 1 Total 33 10
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In fiscal years 2069/70, there are 18 institutions which have low performance in the Annual Blood Examination Rate (ABER) i.e. institutions which have not collected at least 50% of the total target.
LLIN distribution
LLIN has distributed in Rupandehi district in fiscal years 2069/70 with support from Nepal government and Global fund. The beneficiaries VDCs were Makraher, karahiya, Shankarnagar, Aanandaban, Devdeha, Paroha, Saljhandi, Bishnupura, Rudrapur, Madhubani, Lumbini, Sipawa and Padsari. The number of LLIN in ANC and free distribution were as follows; however LLIN are regularly distributed from the ANC clinic to prevent the pregnanat mother and fetus from the malaria transmission indigeneously.
Table 20: LLIN distribution status of three consecutive years Year 2067/68 2068/69 2069/70 ANC LLIN distributed 0 584 973 Free LLIN distributed 0 102807 14025
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 After conducting different training about the insecticide, precaution taken, preventive tools and publicize by different media; spraying program is conducted . it is completed in two cycle one in per monsoon and other post monsoon. In fiscal year 2069/70 spraying was done in 3 VDCs viz Lumbini, 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 on insecticide (in kg) No No of VDC
No of No Ward Hous Katera Populati Hous Kater No No villages of e on e a 2067/68 0 0 0 0 0 0 0 0 0 0
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2068/69 5 12 23 1959 1561 12180 1669 475 15143 337
2069/70 3 16 27 2340 1568 21122 2576 2354 22748 623
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 21 cases reported into the Rupandehi and no deaths were reported. Table 22: Larva of dengue mosquito search and destroy status
Place where mosquito hatch eggs Plastic Tin Drum/ Total Total Total Tire Container Container Tank Other no of no of Exa ward house mine Total FY s s d Found Found Found Found Found Found Found
examined examined examined examined examined 2067/6 1259 1913 1157 324 1480 8 15 16089 7 8952 4 9954 9448 5156 5 5 8 5857 67562 33164
2068/6 3594 1113 336 1840 9 15 20922 7529 5054 7 24322 11356 7127 4 5 0 12888 85257 52998
2069/7 1643 268 0 15 16654 5276 2803 2 6248 7910 2608 6696 9 6758 3960 42301 17730
In fiscal years 2069/70, 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.
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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 Confirmed malaria positive cases in To reduce the case load of In charge of HF, increasing trend and more over PF malaria by collecting slides of VCI, DPHO case also is in increasing trend malaria and quickly treatment of the cases 3 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 4 Increase in clinical malaria incidence To reduce the clinical malaria In charge of HF, incidence "0" by regular supply of VCI, DPHO RDT and supplying monthly and annually slide collection target
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
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The NTP’s vision is TB free Nepal.
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 target 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 2069/70 Physical Financial
Activities Units Target Achieve. % % of of % Annual Budget Expenditure Expenditure Achievement Procurement of steel cupboard filter for the Pcs. 4 4 100 28000 28000 100 treatment centre Infrastructure Development Pcs. of the Lab which have not 1 1 100 224000 224000 100 completed in Fy 2068/69 TB orientation for the Pcs. 1 1 100 11000 11000 100 Proporiter of Private Clinic DOT Training for VHW and Pcs. 6 6 100 287000 287000 100
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Physical Financial
Activities Units Target Achieve. % % % of of % Annual Budget Expenditure Expenditure Achievement MCHW Basic Refresher training for Pcs. 6 6 100 235000 235000 100 VHW and MCHW PPM working group Pcs. formatiom and regular 2 2 100 12000 12000 100 meeting in district level Sputum examination of Pcs. suspected patient no of 7740 5948 76.85 0 0 0 patients New sputum Examination Pcs. 23220 16786 72.29 0 0 0 slides Sputum Examination of Pcs. 3442 2728 79.26 0 0 0 Follow up patients Number of new sputum Pcs. 774 582 75.19 0 0 0 positive slides Number of new negative Pcs. 464 368 79.31 0 0 0 slides patients Number of Extra Pulmonary Pcs. 309 319 103.24 0 0 0 TB patients Number of patients for re Pcs. 116 118 101.72 0 0 0 treatment ACSM Program in District Pcs. 2 2 100 22000 22000 100 Level TB message flow by school Pcs. 3 3 100 45000 45000 100 students Orientation about DOTS for Pcs. 2 2 100 20000 20000 100 factory's workres Increase awareness about Pcs. TB for FCHV and Mother,s 5 5 100 60000 60000 100 group Awareness program about Pcs. 7 7 100 84000 84000 100
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Physical Financial
Activities Units Target Achieve. % % % of of % Annual Budget Expenditure Expenditure Achievement TB for Mother,s group and women,s group Awareness program about Pcs. 2 2 100 20000 20000 100 the TB for Factory,s worker Orientation about the TB for Pcs. 3 3 100 36000 36000 100 jailer Pal orientation about the Pcs. 2 2 100 22000 22000 100 FCHV Special program for Dalit and Pcs. 3 3 100 40000 40000 100 Aadhibasi School Health Program Pcs. 6 6 100 3000 3000 100 TB orientation for NGOs and Pcs. 2 2 100 33000 33000 100 CBOs World TB Day celebration Pcs. 1 1 100 20000 20000 100 Internet connection in District Pcs. 1 1 100 12000 12000 100 Refresher about the TB for Pcs. Health Management 15 15 100 75000 75000 100 Committee Quarterly Meeting for every Pcs. 15 15 100 628000 628000 100 DOTS centre Regular monitoring and Pcs. Evaluation to the Treatment centre and sub centre for 4 4 100 172000 172000 100 MDR TB and HIV treatment centre from the district Supervision from the District Pcs. in treatment and sub centre 15 15 100 54000 54000 100 (Including DOTS PPm pal Microscopic centre) Supervision from treatment Pcs. 22 22 100 62000 62000 100 centre to sub centre
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Physical Financial
Activities Units Target Achieve. % % % of of % Annual Budget Expenditure Expenditure Achievement Quarterly monitoring meeting Pcs. 3 3 100 189000 189000 100 in District about the Pal Intensive case finding from FCHV where low case finding Person 90 90 100 33000 33000 100 VDCs Lodging and fooding cost for the relapsing TB and ultra N/A 80 80 100 320000 320000 100 poor TB patient during treatment
All the targeted activities in the district have hundred percent achievement indicating the good performance in the TB control program such as proper management, good coordination and sound monitoring and supervision skill and good team work.
3.4.1.2 Performance by selected indicators (FY 2067/68 – 2069/70) 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 course (DOTS) 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 91% which is above the national rate (90%). The case finding rate (CFR) of 64% which has been reduced than previous years this is due to low case finding rate from 4 Ilakas (Chhapiya, Raypur, Basantpur, Manjgaun). Table 24: TB control program performance by selected indicator Indicators 2067/68 2068/69 2069/70 1. Case Finding Rate 75 78 64 2. Treatment Success Rate 90 92 91 3. No of DR Cases 25 36 59
DPHO has further analysed CFR at VDC level also and found that Harnaiya has 0%, Hartifarsatikar 19%, Masina 16%, Pokharvindi 15%, Tumapiprahawa 20%, Kamariya 10%, Dhamauli 15%, have below the 20% CFR. DPHO is planning to strengthen CFR into these VDCs in coming FY. A comparison trend of 3
54 years shows that the TSR and no 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
100 90 92 91 75 78 80 64 59 60 Case Finding Rate 36 Treatment Success Rate 40 25 No of MDR Cases 20
0 2067/68 2068/69 2069/70
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 significan tly. This provision is helpful in reducing DR cases.
5.4 Leprosy Control Programme
Background Leprosy has existed in Nepal since tim e 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 Elimina tion 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 redu ction 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 55 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.
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 2069/70 Physical Financial
Activities Units Target Achieve. e e % % % of of % Annual Budget Expenditur Expenditur
Examination of patient and Achievement Person 3720 3720 100 124 124 100 neghbouring family Transportation cost for the patient who completes regular treatment Person 184 184 100 184 154 100 (per patient one thousands rupees) Flex Board Pcs. 4 4 100 2 2 100 School Health Education Number 10 10 100 5 5 100 World Leprosy Day Pcs. 1 1 100 17 17 100
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Physical Financial
Activities Units Target Achieve. e e e e % % of Annual Budget Expenditur Expenditur
Program supervision and Achievement Monitoring in to the HF where Event 45 45 100 124 124 100 patient prevalent from the district Camp for the Skin Disease Event 1 1 100 50 50 100 Review Program in district, PHC Pcs. and HP level to the helath worker for the improvement of the 2 2 100 202 202 100 patients recording and reporting and updating
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 and achieved hundred percent achievement which indicates the good performance in the leprosy control program also. Table 26: Leprosy control program performance by selected indicators Indicators 2067/68 2068/69 2069/70 1. New case Detection Rate 1.87 1.9 1.64 2. Registered Prevalence Rate 1.3 1.4 1.30 3. Disability Grade 2 % 0.03 2 0
Even though Nepal has already achieved a 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 decreased to 1.9% than last previous 2 years. Registered prevalence rate is also slightly reduced to 1.3% from 1.4% in last FY and Disability Grade has been rated as 0 as was found reduced than previous 2 years. The New Case Detection rate in comparison to national figure, the registered Prevalence rate is higher in Rupandehi.
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Chart 12 : Trend of New Case Detection Rate and Prevalence fo Leprosy
1.87 1.9 2 1.69 1.4 1.5 1.3 1.03 New case Detection Rate 1 Registered Prevalence Rate
0.5
0 2066/67 2067/68 2068/69
Leprosy cases are scattered in t he 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 11 VDCs have reported more than 2 PR. There are 27 VDCs which has reported zero prevalence rate of leprosy.
Table 27 : VDCs with leprosy prevalence more than 2 VDCs with higher than 2 prevalence rate Basantapur – 2.32 Aama – 3.29 Pokharvindi – 2.67 Kamhariya – 2.45 Gajedy – 4.06 Paroha – 2.42 Karahaiya – 2.74 Tikulighad – 2.04 Gonaha – 2.83 Motipur – 3.03 Makrahar – 2.66
Problems and Constraints S N Issues, Problem and constraints of Recommended action Responsibility TB and Leprosy Program
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1 CFR is fairly low in comparison to VDC wise specific awareness HF in charge, Focal national target program has to be conducted person and DPHO Karmahawa and Chhapiya HP need to establish microscopic services 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 2067/68 2068/69 2069/70 1. Number of outbreaks reported 3 4 4 2. Number of outbreaks investigated and managed by 3 4 4 RRT within two weeks of onset 3. Number of disasters reported 0 0 0 4. Proportions of disasters responded by RRT 3 4 4 5. Outbreak/disaster categories, number of affected 290/9 252/4 0 and death 6. Budget allocated for outbreak and disaster 150,000 121,000 211,000 management
In the past Rupandehi has the experience of outbreaks like diarrhoea, JE, Malaria, Measeles, Rubella, Dengue but in the fiscal year 2069/70 no such has been reported. But 4 outbreaks reported in 069/70 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 operatin 695 chikens were destroyed.
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Table 29: Outbreak Situation by disease categories Outbreak/Disaste 2067/68 2068/69 2069/70 rs Categories * No of Cases Deat No of Cases/ Deat No of Cases Deat events / h event injured h events / h Injure s injure d d Diarrhoea 5 70 5 2 64 0 0 Flood 0 0 0 0 Faciolopsis 0 0 0 0 Cholera 1 16 0 0 Dengue 1 290 4 0 Measles/Rubella 2 188 4 0 Avian influenza 4 695* 0 *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 2069/70, total number of animal bite case were 3192. for the post exposure prophylaxis, vaccine (vials) expenditure were 14245. 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) 3192 2. Vaccine (vial) expenditure 14245 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 1,844 cases of snake bites registered, whereas 184 cases had been treated for poisonous snake bite. A total 4635 dose of anti snake venom serum expenditure recorded. Fourteen cases of Snake bite death has been recorded during the FY 2069/070.
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Table 31: Snake bite situation 2069/70 1. Total Number of snake bite 1844 2. number of persons treated for poisonous snakebite 184 3. Anti snake venom serum expenditure 4635 4. Number of deaths due to snake bite 14
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)
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.
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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/PMTCT 1 Community Care Center 1 Treatment care and support 8 Drug Treatment and Rehab 9 Post rehabilitation r 1
Table 33: HIV/AIDS program targeted activities of 2069/70 Physical Financial
Activities Units Target Achieve. % % % of % of Annual Budget Expenditure Expenditure Achievement Communication material development and publication Event 1 1 100 1 1 100 cost for DACC Communication cost for DACC Class 12 12 100 38 38 100 Celebration of DACC day Event 1 1 100 44 44 100 Supportive supervision from Event 3 3 100 12 12 100 DACC Quarterly Review meeting of Event 4 4 100 31 31 100 DACC ( stationery,
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Physical Financial
Activities Units Target Achieve. % % % of of % Annual Budget Expenditure Expenditure Achievement transportation, lunch) Office running cost for DACC Event 12 12 100 91 91 100 Preparation and use of district Event 1 1 100 45 45 100 AIDS profile Bimonthly meeting on Planning Event 6 6 100 50 50 100 or administration of DACC Salary of DACC Coordinator 13 13 100 322 322 100 Orientation program about the HIV, STI test, condom, TB and Number 150 150 100 141 141 100 HIV referral to the FCHV and Community worker. Development of the IEC meterial about the HIV/AIDS in Event 1 1 100 20 20 100 community level
The activities targeted for the fiscal year 2069/70 and their status is presented in the above table. All the 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 apporach under the umbrella of district AIDS coordination committee chaired by Local Development Officer. Table 34: HIV/AIDS program performance by selected indicator Indicators 2067/68 2068/69 2069/70 1. Number of people counseling 7010 4891 5575 2. Number of HIV +ve cases 198 191 144 3. Number of persons receiving ART 358 484 608 4. Number of ART sites 1 1 1 5. Number of Counseling centres 22 22 22
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.
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Reported data shows that a total of 5575 HIV counselling performed in the district during FY 2069/70, which is higher than the last FY data. A total of 144 new HIV cases reported in the district in FY 2069/70 which is in decreasing trend than previous years. One ART site is functional in the district and 608 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 0.33%, however, no district specific study conducted so far to find out the district specific HIV prevalence rate.
VDCs ownership is growing towards HIV/AIDS related activities, as 19 Village AIDS Coordination Committees (VACC) has been formed in the district and regular meeting was held. 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.
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 NAMUNA -2 Kerbani
ManMateriya Amuwa Suryapura Tikuligadh Sadi Madhbaliya Nagarjun -2 Bisunpura Dayanagar Gangoliya Sikatahan Chilhiya Harnaiya Jogada Dhamauli 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%. This rate can be reduced to levels below 5% with effective interventions. 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 . in case of rupendehi district,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.
.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
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Problems/ Issues Recommended Actions Responsibility
rural areas also Other stakeholders
No special package for CABA Special CABA programs NCASC programs should be conducted in DACC/DPHO the 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
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, 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.
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Table 35 OPD service status by selelcted indicators
Indicators 2067/68 2068/69 2069/70 1. Total new OPD visits as % of total population 99.35 112 123.72 2. Total new female OPD visits as % of total OPD visit 59.18 53.24 46.19 3. % of communicable disease among total OPD new 13.99 12.83 12.22 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 increased than the previous years, which indicates that frequency of visit and health care utilization has been increased. 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 client has visited the OPD due to communicable diseases. . Table 36: Top ten disease
Disease % Disease % 1 APD 15.1 6 Scabies 8.64 2 LRTI 14.36 7 Other superficial mycoses 8.61 3 URTI 13.22 8 Dermatitis 8.03 4 Impetigo boils 10.79 9 Other noninfective 7.65 gastroenteritis and colitis 5 Amoebiasis 10.38 10 AGE 7.38
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Chart 14: Top Ten Diseases in 2069/70
9- Other 10 - AGE 1- APD noninfective 7% 15% gastroenteritis and colitis 7% 8- Dermatitis 8% 2- LRTI 14%
7- Other superficial mycoses 8%
3- URTI 13% 6- Scabies 8%
5- Amoebiasis 4- Impetigo/Boils 10% 10%
In Rupandehi district, no 1 disease reported was APD followed by LRTI, URTI and so on. However in FY 2068/69, the no 1 disease was "unspecified acute lower respiratory infection". Table 37: Free health service targeted activities of 2069/70 Physical Financial Reasons for not Activities Units Achie
Target achievin
re re re t %
ve. of % Annual Budget g 100% Expenditu Expenditu
Fund support for the Achievemen NA 1 1 100 42 42 100 Municipality FCHV Human Resource Counseling Perso services for free health care, 6 6 100 236 236 100 n urban health or community Drug Procurement for District Hospital and Health Facility Pcs. 2 2 100 2600 2600 100 under the DPHO Referral program for patient NA 2 0 0 0 90 0 from targeted group Printing of Program activity run Times 1 1 100 90 90 100 by division
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Physical Financial Reasons for not Activities Units Achie
Target achievin
re re t %
ve. % of Annual Budget g 100% Expenditu Expenditu
Grant on OPD registration fee Achievemen District Hospital, PHCC, HP, NA 1 1 100 1304 1304 100 SHP Public Hearing or Social audit Pcs. 1 1 100 250 250 100 Conracting with local NGO for NGO 2 2 100 716 716 100 equity and access program FCHV Day celebration Pcs. 1 1 100 72 72 100 Dress distribution for Pcs. 1 1 100 964 964 100 Municipality FCHV Meeting of Urban Health Times 2 2 100 34 34 100 Monitoring committee Grant for established or Event 12 12 100 1872 1872 100 functional Urban Health Clinic
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 district hospital PHCC, HP SHP, Grant for established for functional Urban Health Clinic and so on. But referral program for patient from targeted group has zero progress.
Table 38: District recommended for Ultra poor Services by types Diseases Female Male Total Heart disease 12 21 33 Kidney Disease 34 55 89 Cancer 42 20 62 Alzhiemer’s Disease 0 0 0 Total 88 96 184
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
69 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 2069/70, number of people supported by the government of nepal were maximum in kidney disease (Total 89, F 34, M 55) and followed by cancer ( total no of people 62,F 42, M 20) but district committee has not recommended in Alzheimer/parkinsonism.
Laboratory Services by District: FY 2068/69 – 2069/70 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 2069/70 is outlined in table below.
Table 39: Laboratory services
Other Paracitology/ Virol Hemato Microbi Histopath Bioche Immunology/ Tests FY Bacteriology ogy logy ology ology mistry Serology 2067/68 195874 8292 55637 33932 17833 18382 2067/68 195874 9 2068/69 202711 9249 62542 39054 14337 8900 2068/69 202711 4 2069/70 95964 6956 370260 27032 1877 239912 86994 25277
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
70 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.
Goal
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.
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 2069/70
Physical Financial
Activities Units
Target Achieve. re re t % % of of % Annual Budget Expenditu Expenditu health education and PCS. 1 2 100Achievemen 50 50 100
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Physical Financial
Activities Units
Target Achieve. re re t % % of % of Annual Budget Expenditu Expenditu awareness program for Achievemen prevention of communicable diseases and epidemics Distribution of health education (IEC) material into PCS. 2 2 100 20 20 100 Health Facilities FM Broadcasting on Sterilization camp, Nutrition PCS. 600 2 100 60 60 100 and massage related to elimination of filariasis Health program development PCS. 7 7 100 21 21 100 and broadcasting through FM Health related messages PCS. 600 600 100 60 60 100 broadcasting through FM Health related messages PCS. 500 500 100 50 50 100 broadcasting through FM Awareness raising message dissemination through local PCS. 130 130 100 65 65 100 printed media Community Health promotion interaction program (places PCS. 10 10 100 130 130 100 with low access to services) Operating health education corners into health facilities PCS. 2 2 100 5 5 100 and hospitals Interaction program for effective implementation of tobacco control act and for PCS. 3 3 100 39 39 100 the prevention of non communicable diseases Celebration of public health PCS. 3 3 100 110 110 100 days (WHO day and
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Physical Financial
Activities Units
Target Achieve. re re t % % of % of Annual Budget Expenditu Expenditu handwashing day) and health Achievemen and hygience promotion program Supervision and monioring of PCS. 5 5 100 25 25 100 health education program
Problems and Constraints SN Issues, problem and constraints Recommended Action Responsibility 1 Fewer budgets in FY than previous Budget need to NHEICC, WRHD years increased 2 School health education program Need to include this NHEICC, WRHD program as this is effective program 3 Community health education display Need to include this DPHO/WRHD and exhibition program program as this is effective program 4 Health education corner only 5000 Became very less and NHEICC, WRHD NPRS no use of such a less budget better not to provide
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. The division has 3 thematic focuses. • National Free health Care
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• 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 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, 5 PHCs, 26 HPs, 38 SHPs, one district hospital and one zonal hospital are catering free health services to the 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.
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Staffing Pattern S.N Name of Health Center HA AHW ANM Office assistant Total 1 Urban Health Center SNM 1 1 1 1 4 Ward no. 9 2 Urban Health Center SNM 2 2 1 1 5 Ward no. 4 3 Urban Health Center BM 1 1 1 4 Ward no. 14 4 Urban Health Center BM Ward 1 2 2 5 no. 13 5 Urban Health Center BM 1 1 1 3 Ward no. 9 6 Urban Health Center BM Ward 1 1 1 3 no. 3 Total 7 8 7 2 24
A total of 24 staffs are working in six urban health centers at Rupandehi, in the fiscal year a total of 25028 people have been served through these clinics.
Table 41: Client served in 2069/70 by urban health clinic S.N Name of Health Centre Total 1 Urban Health centre BM ward 14 4225 2 Urban Health centre BM ward 13 6141 3 Urban Health centre SNM ward 10 6464 4 Urban Health centre SNM ward 9 653 Total 25028
Urban FCHVs Program There are 241 FCHVs in urban area. In Butawal Municipality there are 140 and in Siddharthanagar municipality 101. They have received dress and FCHVs fund have been established. The FCHVs were also provided kit box from DPHO. Municipality supported exposure visit and empowerment program of FCHVs.
Table 42: Urban Health program supported by DPHO and Municipality SN Activities Support of DPHO Support of Municipality 1 Building Construction of urban health clinic 95,00000.00 500000.00 in both municipality
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SN Activities Support of DPHO Support of Municipality
2 Rent and renovation into two municipality 920,000.00 3 FCHV dress support - 4000 5000 per FCHV
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 Bhaganwanpur VDC has been 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, the same was supplied with the essential drugs and medicine. The office support staff was also supported from the same program. DDC is approaching for the construction of health facility building and wants to support for the model health village program.
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 furniture, instrument, logistics and essential drugs for the smooth running of 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. 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.
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7.3 Management Support
Table 43: Management support targeted activities of 2069/70 Physical Financial
Activities Unit Achiev Target % %
e. % of Annual Budget Expenditure Expenditure Achievement Purchase of furniture for newly Even 1 100 100 300 300 100 constructed & other health t facilities Public Health Office & other Even 1 100 100 750 750 100 PHC/HP/SHP Repair and t maintenance Construction of placenta pit Even 3 100 100 180 180 100 t Integrated Supervision Even 65 100 100 326 326 100 t Conduct Review and Reporting Even 2 100 100 365 365 100 within district at Ilaka level t Preparation & printing of district Even 1 100 100 25 25 100 level annual report t Human Resource for computer Even 1 100 100 120 120 100 assistance and consultation on t contract (for 1 years) Update for health GIS work Even 1 100 100 20 20 100 t Micro teaching and analysis for Even 1 100 100 50 50 100 monitoring and evaluation t Operate E mail, Internet in the Even 1 100 100 26 26 100 district t Continuity of HSIS programme Even 2 100 100 1253 1251.64 99.89 t Recording reporting interaction Even 1 100 100 50 50 100 for NGOs,pvt. Hospital,GOs t
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DPHO Rupandehi was able to perform the targeted activities as per the plan shown in above table. The achievement status was 100% in all activities. Despite of the task performed, specific program wise problem and issues was reviewed and recommendation made to deal with them efficiently.
7.4 Supervision and Monitoring Program
Table 44: Supervision and monitoring status of 2069/70 Target Achieve - % Achieve - Description ment ment PHCC (Number of PHCC 5) 60 60 100 HP (Number of HP 6) 72 72 100 UP HP (Number of HP 20) 40 40 100 SHP (Number of SHP 38) 76 76 100 Total 248 248 100 A total of 248 supervisory visits have been planned and performed. Joint team supervision initiative has been continued in this fiscal year.
7.5 Physical Infrastructure Development Program
Table 45: Physical infrastructure development status 2069/70 Construction Status (FY 2069/70) Ownership of Total Under Description Building Complet Under No. Constructio Remarks e Process Own Rental n 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 2 1 17 Birthing Center 17 17 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 2069/70 Allocated Expenditure Type of Maintenance and Site (HF) Budget Budget District Public Health Office 190000 190000 Lumbini PHCC 250000 250000 Basantapur PHCC 25000 25000 Chhapiya HP 750000 750000 Chiliya HP 25000 25000
7.7 Recommendation of private institution for approval and renewal
Table 47: Recommendation of health facilities for approval or renewal in 2069/70 Total up to FY FY 2069/70 Type of HF 2069/70 New Renew Remarks Private Hospital 9 9 5 Poly clinic 3 3 2 Nursing Home 1 1 1 X ray / City scan clinic 2 2 1 Pathology Lab 7 7 7 Dental Clinic 46 46 42
7.8 Ambulance Services
Table 48: Ambulance Services Private / Public NGO/ Other No. of ambulance available in District Registered Functional Registered Functional 4 4 40 35
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.
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7.10 Population Management Program Table 49 Population management program targeted activities 2069/70
Physical Financial
Activities Units Target Achieve. % of% % % Annual Budget Budget Expenditure Expenditure Expenditure Achievement Orientation to District Population Event 1 100 100 73 73 100 Coordination Committee DTOT on Population Event 1 100 100 100 100 100 Population related message broadcasting through the local School 1 100 100 25 25 100 FM Interaction Program of Youths going for foreign employment, Event 1 100 100 25 25 100 sending agencie and government officails Wolrd Populationi Day Event 1 100 100 25 25 100 celebraion Preparation and publication of Event 1 100 100 60 60 100 district population Profile Preparation and publication of Event 1 100 100 60 60 100 district population Profile Review meeting of district Event 2 100 100 40 40 100 coordination committee Updating disrict population Event 1 100 100 75 75 100 information Centre Awareness and sensitization program for possible migrants Event 1 100 100 50 50 100 and migrants youths TOT for school centered Peer Event 1 100 100 160 100 62.5 educators Peer education program for Event 1 100 100 133 133 100 school adolescents Interaction program for youths School 1 100 100 50 50 100 and adolescents from school
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Annex I: Human Resources Situation District Health Office/District Public Health Office GOVERNMENT CURRENTLY AVAILABLE Among Sanctioned Local and other SN POSTS Fulfilled government post resources (in number) sanction (in (in number) (in number) number) Technical Staffs 1 Sr.Public Health Administrator 1 1 1 2 Statistical Assistant/Officer 1 1+1 St.O. 1 3 HA/SAHW/PHI 2 2+1 St.O. 2 4 Immunization supervisor 1 1 1 5 Medical Recorder/Officer 0 0 0 6 DTLA/O/I 1 1 1 7 PHN 0 0 0 8 Family Planning Supervisor 1 1 1 9 Cold Chain Assistant/Officer 2 1+1(fajil) 1 10 Malaria Assistant 2 0 0 11 Lab Technician 1 1 1 12 Vector Control Asst./Officer 1 1(fajil) 0 13 Computer Assistant 0 0 0 14 HET Officer 1 1(fajil) 0 Administrative (Non -Technical) 1 Section Officer/Nayab Subba 1 1 1 2 Account Officer 1 1 1 3 Typist Na. Su./ Section Officer 2 2 2 4 Kharidar 1 1 1 5 Driver 1 1 1 6 Office Assistant 3 3 3 Primary Health Care Center- GOVERNMENT CURRENTLY AVAILABLE Among Sanctioned Fulfilled Local and other SN POSTS government post (in resources sanction (in (in number) number) (in number) number) Technical Staffs 1 Medical Officer 5 5 5 2 HA/SAHW/PHI/PHO 5 5 5
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GOVERNMENT CURRENTLY AVAILABLE Among Sanctioned Fulfilled Local and other SN POSTS government post (in resources sanction (in (in number) number) (in number) number) 3 Staff Nurse 5 3 5 4 AHW/SAHW 10 10 10 5 ANM 14 13 14 6 Lab Assistant 5 5 5 7 VHW/AHW (Padnam) 5 4 5 Administrative (Non -Technical) 1 Office Assistant 9 10 9 Health Post- GOVERNMENT CURRENTLY AVAILABLE Among S Sanctioned Local and other POSTS Fulfilled governmen N post resources (in number) t sanction (in number) (in number) (in number) Technical Staffs 1 HA/SAHW/PHI/PHO 26 12+1 St.O. 26 2 Staff Nurse 0 0 0 3 AHW/SAHW 52 48 52 4 ANM 52 48 52 5 VHW 26 20 26 Administrative (Non -Technical) 1 Kharidar 0 4(Fajil) 2 Office Assistant 0 21(fajil) Sub Health Post- GOVERNMENT CURRENTLY AVAILABLE Among Sanctioned Fulfilled Local and other SN POSTS government post (in resources sanction (in (in number) number) (in number) number) Technical Staffs 1 AHW/SAHW 38 38 38 2 VHW 38 25 38 3 MCHW/ANM 38 36 36 Administrative (Non -Technical)
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GOVERNMENT CURRENTLY AVAILABLE Among Sanctioned Fulfilled Local and other SN POSTS government post (in resources sanction (in (in number) number) (in number) number) 1 Office Assistant 0 25 25 Contract Staff under DPHO- SN Designation No. Employee For 1 HA 7 Urban health centre 2 AHW 8 Urban health centre 3 ANM 7 Urban health centre 4 ANM 38 Birthing centre 5 Staff Nurse 1 Raypurphc 6 AHW 4 PHC 7 VHW 13 HP&SHP 8 Office Assistant 11 HP&SHP TOTAL 89 Contract Staff under VDC/LHFOMC- SN Designation No. Employee For 1 Lab Asst. 7 PHC/HP/SHP
2 VHW 3 SHP
3 Office Assistant 23 Birthing centre 4 TOTAL 33
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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 SUAHARA 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
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Annex III : Institutional Delivery by birthing center:
Institution Name Normal Complicated Lumbini 273 3 Dhakdhai 425 19 Basantapur 138 4 Motipur 405 42 Rayapur 276 19 Anandban 55 2 Chhapiya 258 25 Parroha 450 9 Karmahawa 145 0 Majhgawa 400 25 Semarabazar 206 0 Rudrapur 233 10 Kerwani 193 6 Devadaha 206 11 Suryapura 220 6 Farena 195 9 Bodwar 91 13 TOTAL 4169 203
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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
86
Annex V : Estimated Target Population for 2069/70
Under 5 Married Under 1 Female Female Adolescent Total 6-59 years ARI/ Female Expected Expected S.N. Name year Pop 15-44 Pop 15-49 Population Population months CDD/ Pop 15-49 Pregnancies live birth EPI years years 10-19 years Nutrition years
1 BASANTAPUR PHC 8634 199 883 981 2065 2248 1686 233 1878 209
2 PADSARI 10115 241 1029 1147 2498 2719 2039 282 2198 252 3 HATIPHARSATIKAR 5562 128 567 631 1329 1446 1085 150 1209 134
4 HATIBANGAI HP 8753 201 895 993 2080 2264 1698 234 1903 211 5 BAGAHA HP 6291 143 643 714 1486 1618 1214 167 1368 151 39,355 912 4,017 4,466 9,458 10,295 7,722 1,066 8,556 957 TOTAL
6 DHAKADHAI PHC 7713 176 790 876 1821 1982 1487 205 1678 185 7 PAJARKATTI 5963 137 609 676 1419 1545 1158 160 1297 143
8 BODABAR 9794 223 1003 1113 2314 2518 1889 261 2131 235 9 PATAKHAULI 6383 144 655 725 1498 1631 1224 168 1389 152
10 CHHOTAKI RAMNAGAR 6124 142 625 695 1476 1607 1205 166 1331 150 11 SIKATAHAN 12326 287 1258 1399 2969 3232 2424 335 2682 301
12 POKHARVINDI 7482 167 768 850 1734 1888 1416 195 1628 176 13 CHHIPAGADA 6260 144 640 711 1495 1627 1220 168 1361 152 62,045 1,420 6,348 7,045 14,726 16,030 12,023 1,658 13,497 1,494 TOTAL
14 LUMBINI PHC 11007 249 1127 1250 2589 2818 2113 292 2395 262 15 MASINA 6071 138 622 690 1431 1557 1168 161 1321 144
16 MADHUBANI 7185 165 735 816 1711 1863 1397 192 1564 174 17 AAMA 12170 273 1249 1383 2832 3083 2312 319 2650 287
18 KHUDABAGAR 5985 140 611 679 1455 1583 1188 164 1301 148
87
Under 5 Married Under 1 Female Female Adolescent Total 6-59 years ARI/ Female Expected Expected S.N. Name year Pop 15-44 Pop 15-49 Population Population months CDD/ Pop 15-49 Pregnancies live birth EPI years years 10-19 years Nutrition years
19 TENUHAWA 12045 279 1230 1367 2897 3152 2365 326 2619 294
20 BHAGAWANPUR 13104 299 1342 1489 3095 3369 2527 349 2852 314 21 SIPAWA 8234 182 847 936 1885 2052 1539 212 1792 191 75,801 1,725 7,763 8,610 17,895 19,477 14,609 2,015 16,494 1,814 TOTAL
22 RAYAPUR PHC 12017 267 1234 1365 2769 3013 2260 312 2616 281 23 KARAUTA 12370 282 1266 1405 2925 3183 2388 329 2692 296
24 THU. PIPRAHAWA 5037 116 514 571 1206 1313 985 136 1095 123 25 BAGAULI 10947 244 1122 1243 2534 2758 2069 286 2382 257
26 SILAUTIYA 10234 234 1046 1162 2427 2642 1981 273 2225 245 27 ASURENA 7855 174 808 894 1798 1957 1468 203 1710 182
28 FARENA 4738 106 485 537 1105 1203 902 125 1032 112 29 ROINIHAWA HP 5840 132 598 664 1376 1497 1123 155 1271 139
30 SAMERA MARCHWAR HP 8177 182 839 929 1889 2056 1542 212 1778 191 77,215 1,737 7,912 8,770 18,029 19,622 14,718 2,031 16,801 1,826 TOTAL SOU - PHARSATIKAR PHC 31 (Motipur) 10378 256 1051 1177 2652 2887 2165 299 2255 269
32 MOTIPUR 9902 240 1005 1123 2495 2715 2036 281 2153 252 33 KHADAWABANGAI 10139 241 1032 1150 2495 2716 2036 281 2204 252
34 MANPAKADI HP 7522 177 767 854 1835 1997 1498 207 1635 186 35 SEMALAR HP 10757 262 1092 1221 2717 2957 2217 306 2337 275
36 AMUWA 12621 299 1285 1433 3102 3377 2533 350 2744 315 61,319 1,475 6,232 6,958 15,296 16,649 12,485 1,724 13,328 1,549 TOTAL 37 AANANDABAN HP 12278 293 1249 1393 3040 3309 2482 343 2668 309
88
Under 5 Married Under 1 Female Female Adolescent Total 6-59 years ARI/ Female Expected Expected S.N. Name year Pop 15-44 Pop 15-49 Population Population months CDD/ Pop 15-49 Pregnancies live birth EPI years years 10-19 years Nutrition years
38 MADHWALIYA 11374 265 1162 1291 2745 2987 2240 309 2474 278 39 TIKULIGADH 14698 357 1492 1668 3706 4034 3025 418 3194 376
40 CHILHIYA 5816 140 592 661 1451 1580 1185 163 1263 148 41 SHANKARNAGAR 16979 415 1722 1925 4292 4672 3504 484 3689 435 61,145 1,470 6,217 6,938 15,234 16,582 12,436 1,717 13,288 1,546 TOTAL Bisunpura (Karmahawa HP) 42 15693 354 1607 1782 3672 3997 2997 414 3415 372 43 SURYAPURA 23682 541 2423 2689 5603 6100 4575 632 5153 568
44 SADI 6829 154 700 776 1600 1741 1306 180 1487 162 45 RUDRAPUR 24855 616 2516 2820 6384 6950 5212 719 5398 647
46 JOGADA 7015 163 716 796 1695 1845 1384 190 1525 171 47 EKALA 12064 275 1235 1370 2855 3108 2330 321 2624 289 90,138 2,103 9,197 10,233 21,809 23,741 17,804 2,456 19,602 2,209 TOTAL
48 PARROHA HP 24807 606 2516 2815 6280 6835 5126 708 5390 637 49 DUDHARAKCHHE 21103 509 2143 2394 5273 5739 4304 594 4586 535
50 SALJHANDI HP 12140 302 1228 1377 3130 3408 2556 353 2637 317 51 GAJEDI 14765 351 1503 1676 3637 3959 2969 410 3209 369 72,815 1,768 7,390 8,262 18,320 19,941 14,955 2,065 15,822 1,858 TOTAL MAKRAHAR HP (Semara 52 Bazar) 18769 465 1900 2129 4816 5242 3931 542 4077 488 53 KERBANI 16989 417 1723 1927 4310 4691 3518 485 3690 437
54 KARAHIYA 18247 450 1848 2070 4663 5075 3807 526 3963 473 55 DEVADAHA 28802 703 2923 3269 7289 7935 5951 822 6258 740
56 GANGOLIYA 8532 199 872 969 2065 2248 1686 233 1856 209
89
Under 5 Married Under 1 Female Female Adolescent Total 6-59 years ARI/ Female Expected Expected S.N. Name year Pop 15-44 Pop 15-49 Population Population months CDD/ Pop 15-49 Pregnancies live birth EPI years years 10-19 years Nutrition years
91,339 2,234 9,266 10,364 23,143 25,191 18,893 2,608 19,844 2,347 TO TAL 57 DAYANAGAR( Chapiya) HP 10669 255 1085 1210 2645 2879 2159 298 2319 268
58 MAINAHIYA 8735 202 892 992 2092 2277 1708 236 1899 212 59 KAMAHARIYA 20391 475 2082 2315 4912 5348 4010 554 4434 499
60 DHAMAULI 7063 163 722 802 1691 1841 1381 190 1537 171 61 HARNAIYA 5465 126 558 620 1306 1421 1066 146 1189 132
62 MANMATERIYA 10886 247 1115 1236 2560 2787 2090 289 2368 260 63,209 1,468 6,454 7,175 15,206 16,553 12,414 1,713 13,746 1,542 TOTAL 63 MAJHAGAWA HP 6374 144 652 724 1500 1633 1225 169 1387 152
64 GONAHA 14110 322 1445 1603 3334 3629 2722 376 3070 338 65 BETAKUIYA 6031 137 617 685 1422 1548 1162 160 1313 144
66 BAIRGHAT 6719 150 690 764 1549 1686 1264 175 1462 157 67 PAKADISAKRON 6010 135 616 683 1406 1530 1148 158 1308 142
68 BOGADI 11591 263 1186 1316 2729 2970 2228 308 2524 276 69 MARYADPUR 6470 149 662 735 1537 1673 1255 172 1408 156 57,305 1,300 5,868 6,510 13,477 14,669 11,004 1,518 12,472 1,365 TOTAL BUTAWAL MUNICIPALITY 70 98150 2269 10026 11143 23499 25579 19184 2648 21352 2383
71 SIDDHARTH NAGAR 68446 1586 6991 7771 16426 17880 13410 1851 14888 1666 918,282 21,467 93,681 104,245 222,518 242,209 181,657 25,070 199,690 22,556 ALL TOTAL
90
Annex VI :MR Campaign 2069 Achievement
nlIft hg;+Vof k|utL ---bfn'/f-bfn'/f -?a]nf nufPsf afnaflnsf_ k|utL ---kf]lnof]-kf]lnof] yf]kf vfPsf afnaflnsf_ EofS;Lg tyf cGo ;fdfu|Lsf] laa/0f AEFI laa/0flaa/0f :jf:Yo ;+:yfsf] vf]k s]Gb| l;=g+ gfdgfdgfd ;+Vof ( dlxgf b]lv !% % aif{ d'lgsf ( dlxgf b]lv ^ b]lv !%aif{ bfb'/f ?a]nf bfb'/f ?a]nf P=l8= aif{ d'lgsf %aif{ ;Ddsf ;Ddsf hDdf ! aif{ d'lgsf hDdf EofS;Lg vr{ EofS;Lg vr{ EofS;L 3f]ns l;l/~h P=l8= l;l/~hl;l/~h l;l/~hl;l/~h v]/v]/ ;]km;]km;]km\;]km \\6L\6L aS; s8f ;fdfGo lgsf]lgsf] k|]if0f afn aflnsf hDdf k|utL % ! aif{ d'lgsf -% aif{sf hDdf k|utL % EofS;Lg vr{ EofS;Lg vr{ g v]/ b/ 3f]ns l;l/~h vr{ l;l/~hl;l/~h v]/v]/ vr{ s8f ;fdfGo ePsf u/]sf] afnaflnsf afnaflnsf afnaflnsf efondf 8f]hdf g v]/ b/ vr{ b/b/b/ vr{ ePsf u/]sf]
1 wswO{ 10 2699 1206 694 2396 3090 114 187 742 929 77 310 3100 0 315 3100 0 33 0 2 2 0
2 jf]wjf/ 9 3427 1688 736 2545 3281 96 284 1296 1580 94 330 3300 1 330 3350 2 39 0 0 0 0
3 l%kfu( 9 2189 977 496 1538 2034 93 122 479 601 62 211 2110 4 220 2150 5 24 0 0 0 0
4 k^\vf}nL 9 2235 1294 961 1193 2154 96 95 1018 1113 86 215 2150 0 220 2160 0 25 0 2 2 0
5 %f]=/fdgu/ 9 2141 1242 586 1420 2006 94 147 581 728 59 200 2000 0 205 2050 2 23 0 0 0 0
6 kh/s§L 9 2086 982 578 1227 1805 87 175 558 733 75 180 1800 0 180 1805 0 20 0 0 0 0
7 kf]v/le)*L 10 2621 1318 1043 1522 2565 98 192 1027 1219 92 260 2600 1 265 2575 0 30 0 0 0 0
8 l;S^xg 11 4308 1863 840 3061 3901 91 326 948 1274 68 390 3900 0 400 4200 7 48 0 1 1 0
76 21706 10570 5934 14902 20836 96 1528 6649 8177 77 2096 20960 1 2135 21390 3 242 0 5 5 0 hDdf
9 a;Gtk'/ 11 3019 1500 805 2040 2845 94 158 1059 1217 81 285 2850 0 289 2985 5 34 0 1 1 0
10 k*;/L 14 3531 1289 1019 2808 3827 108 249 834 1083 84 385 3850 1 385 3900 2 43 0 0 0 0
11 xf=km;f{l^s/ 9 1945 867 492 1386 1878 97 110 608 718 83 190 1900 1 190 1890 1 23 0 0 0 0
12 xf=agufO{ 12 3062 1787 1142 2178 3320 108 232 1106 1338 75 354 3540 6 354 3550 6 40 0 0 0 0
13 aufxf 9 2202 1142 495 1418 1913 87 169 478 647 57 192 1920 0 192 1925 1 25 0 0 0 0
55 13759 6585 3953 9830 13783 100 918 4085 5003 76 1406 14060 2 1410 14250 3 165 0 1 1 0 hDdhDdffff
14 15 6539 2241 1297 4657 5954 91 447 1709 2156 96 595 5950 0 600 6100 2 70 0 6 6 0 dqmx/ 15 16 5922 2000 1251 4357 5608 95 297 1537 1834 92 565 5650 1 570 5650 1 65 0 5 5 0 s]/jfgL 16 18 6359 2218 1414 4738 6152 97 270 1714 1984 89 615 6150 0 620 6200 1 75 0 7 7 0 s/xLof 17 20 10043 3089 2444 8854 11298 112 397 2739 3136 102 1125 11250 0 1125 11500 2 130 0 0 0 0 b]]jbx 18 11 2982 1265 990 1893 2883 97 189 949 1138 90 290 2900 1 290 2900 1 35 0 0 0 0 u+uf]lnof 80 31845 10813 7396 24499 31895 100 1600 8648 10248 95 3190 31900 0 3205 32350 1 375 0 18 18 0 hDdf 91
19 cfgGbjg 9 4286 1608 882 3894 4776 111 221 1210 1431 89 480 4800 1 480 4800 1 60 0 1 1 0
20 dwjlnof 12 3976 1344 899 2568 3467 87 173 1102 1275 95 350 3500 1 350 3500 1 45 0 0 0 0
21 l^s"nLu( 14 5126 1476 1446 2619 4065 79 225 1221 1446 98 410 4100 1 410 4100 1 48 0 1 1 0
22 lrlNxof 9 2029 707 499 1401 1900 94 192 478 670 95 190 1900 0 190 1920 1 25 0 0 0 0
23 z+s/gu/ 22 5922 2119 2510 8322 10832 183 310 2364 2674 126 1090 10900 1 1100 11000 2 150 0 7 7 0
66 21339 7254 6236 18804 25040 117 1121 6375 7496 103 2520 25200 1 2530 25320 1 328 0 9 9 0 hDdf
24 n'lDjgL 9 3853 2350 1087 2451 3538 92 444 1682 2126 90 355 3550 0 260 3610 2 45 0 0 0 0
25 dl;gf 12 2125 1329 732 1985 2717 128 420 915 1335 100 275 2750 1 280 2750 1 35 0 0 0 0
26 dw'jgL 9 2513 1375 502 1892 2394 95 192 1016 1208 88 240 2400 0 244 2450 2 30 0 0 0 0
27 cfdf 10 4262 2067 1790 2420 4210 99 200 1620 1820 88 425 4250 1 425 4225 0 55 0 0 0 0
28 10 2091 1246 443 1645 2088 100 168 972 1140 91 210 2100 1 210 2100 1 25 0 0 0 0 v"bfjfu/
29 t]g"xjf 11 4211 2463 1456 3011 4467 106 288 1384 1672 68 450 4500 1 450 4475 0 50 0 0 0 0
30 l;kjf 10 2885 1835 714 1970 2684 93 149 1347 1496 82 270 2700 1 270 2700 1 35 0 0 0 0
31 eujfgk"/ 9 4585 2595 1114 3493 4607 100 544 1864 2408 93 465 4650 1 465 4650 1 60 0 0 0 0
hDdf 26525 15260 7838 18867 26705 101 2405 10800 13205 87 2690 26900 1 2604 26960 1 335 0 0 0 0 hDdf 80 klxnf] r/)f klxnf] r/)f 357 115174 50482 31357 86902 118259 103 7572 36557 44129 87 11902 119020 1 11884 120270 2 1445 0 33 33 0 hDdf
;f}=km;f{l^s/ 14 3617 1346 675 2688 3363 93 171 789 960 71 337 3370 0 340 3375 0 40 0 7 7 0 32
df]tLk'/ 15 3454 1284 894 2758 3652 106 173 788 961 75 370 3700 1 370 3700 1 45 0 3 3 0 33
v=agufO{ 10 3540 1371 628 2609 3237 91 206 939 1145 84 325 3250 0 325 3275 1 40 0 0 0 0 34
dfgks*L 12 2628 919 541 2101 2642 101 117 592 709 77 265 2650 0 265 2700 2 30 0 0 0 0 35
;]dnf/ 12 3751 1212 762 2747 3509 94 246 780 1026 85 355 3550 1 355 3530 1 40 0 0 0 0 36
k=cd'jf 12 4408 1552 955 3038 3993 91 209 1078 1287 83 400 4000 0 400 4050 1 50 0 0 0 0 37
hDdf 75 21398 7684 4455 15941 20396 95 1122 4966 6088 79 2052 20520 1 2055 20630 1 245 0 10 10 0
/fok'/ 14 4210 2115 1049 3840 4889 116 370 1516 1886 89 490 4900 0 490 5000 2 60 0 0 0 0 38
s/f}tf 14 4328 1466 1772 2576 4348 100 404 1699 2103 143 435 4350 0 440 4380 1 50 0 0 0 0 39
92
y'=lkk|xjf 9 1762 946 769 887 1656 94 134 733 867 92 165 1650 0 165 1670 1 25 0 0 0 0 40
auf}nL 9 3835 1834 1051 2688 3739 97 330 1463 1793 98 375 3750 0 375 3750 0 45 0 1 1 0 41
l;nf}^Lof 14 3580 1641 1277 2730 4007 112 414 1227 1641 100 400 4000 0 400 4100 2 50 0 0 0 0 42
c;'/}gf 11 2752 1392 1159 1510 2669 97 171 1114 1285 92 270 2700 1 270 2675 0 35 0 0 0 0 43
km/]gf 9 1659 1011 772 1107 1879 113 113 749 862 85 190 1900 1 190 1900 1 25 0 0 0 0 44
/f]Olgxjf 12 2044 1253 569 1326 1895 93 177 724 901 72 190 1900 0 190 1950 3 25 0 0 0 0 45
;]d/f 9 2864 1485 780 1943 2723 95 238 1269 1507 101 272 2720 0 275 2807 3 35 0 0 0 0 46
hDdf 101 27034 13143 9198 18607 27805 103 2351 10494 12845 98 2787 27870 0 2795 28232 2 350 0 1 1 0
demufjf 11 2231 1215 562 2204 2766 124 243 1078 1321 109 278 2780 1 280 2795 1 35 0 0 0 0 47
uf]gfxf 14 4937 2819 1551 3671 5222 106 373 1451 1824 65 520 5200 0 525 5300 1 60 0 0 0 0 48
a]ts"Oof 9 2111 1292 795 1917 2712 128 161 927 1088 84 270 2700 0 272 2750 1 35 0 0 0 0 49
ao/#f^ 9 2353 1127 341 1742 2083 89 162 1248 1410 125 208 2080 0 210 2100 1 30 0 5 5 0 50
;=ks*L 9 2104 1153 666 1346 2012 96 210 822 1032 90 203 2030 1 203 2050 2 25 0 0 0 0 51
af]u*L 12 4057 2111 1144 2734 3878 96 269 1651 1920 91 390 3900 1 390 3900 1 45 0 0 0 0 52
dof{bk"/ 9 2263 1024 734 1820 2554 113 170 837 1007 98 255 2550 0 255 2600 2 30 0 0 0 0 53
hDdf 73 20056 10741 5793 15434 21227 106 1588 8014 9602 89 2124 21240 0 2135 21495 1 260 0 5 5 0
k/f]{xf 16 8650 3078 1125 6631 7756 90 416 2639 3055 99 780 7800 1 780 7800 1 90 0 7 7 0 54
b'w/fIf 17 7363 2727 1225 5895 7120 97 554 2339 2893 106 720 7200 1 720 7150 0 90 0 0 0 0 55
;fnem)*L 10 4229 1455 627 3398 4025 95 295 1430 1725 119 405 4050 1 405 4050 1 45 0 9 9 0 56
uh]*L 9 5156 2001 730 4290 5020 97 334 1535 1869 93 505 5050 1 505 5050 1 515 0 0 0 0 57
hDdf 52 25398 9261 3707 20214 23921 94 1599 7943 9542 103 2410 24100 1 2410 24050 1 740 0 16 16 0
bofgu/ 9 3724 1425 549 3227 3776 101 311 1018 1329 93 377 3770 0 380 3800 1 45 0 2 2 0 58
d}glxof 9 3054 1471 454 2763 3217 105 200 1221 1421 97 325 3250 1 325 3250 1 40 0 0 0 0 59
sDxl/of 9 7127 4035 1672 6251 7923 111 473 3191 3664 91 800 8000 1 800 8000 1 100 0 0 0 0 60
wdf}nL 9 2470 1303 675 1935 2610 106 246 950 1196 92 260 2600 0 260 2650 2 35 0 3 3 0 61
xg]{of 9 1911 890 607 1157 1764 92 130 598 728 82 176 1760 0 178 1800 2 25 0 0 0 0 62 93
dfgd^]/Lof 10 3810 1637 1340 2371 3711 97 255 1252 1507 92 375 3750 1 375 3750 1 45 0 2 2 0 63 55 22096 10761 5297 17704 23001 104 1615 8230 9845 91 2313 23130 1 2318 23250 1 290 0 7 7 0 hDdf 12 5494 2781 1295 4112 5407 98 406 2294 2700 97 544 5440 1 545 5450 1 65 0 5 5 0 64 lai)f'k'/f 13 8286 3838 3143 5322 8465 102 550 3087 3637 95 850 8500 0 850 8500 0 100 0 0 0 0 65 ;'o{k'/f 9 2391 1189 764 1267 2031 85 205 817 1022 86 203 2030 0 205 2050 1 30 0 0 0 0 66 ;f*L 20 8660 3370 1667 5900 7567 87 296 2438 2734 81 760 7600 0 765 7600 0 100 0 0 0 0 67 ?b|k'/ 12 2452 1536 706 1992 2698 110 219 1237 1456 95 270 2700 0 272 2750 2 35 0 0 0 0 68 hf]u*f 15 4221 2039 1651 2370 4021 95 310 1576 1886 92 407 4070 1 410 4100 2 50 0 0 0 0 69 Psnf 81 31504 14753 9226 20963 30189 96 1986 11449 13435 91 3034 30340 0 3047 30450 1 380 0 5 5 0 hDdf bf]>f] r/)f 437 147486 66343 37676 108863 146539 99 10261 51096 61357 92 14720 147200 0 14760 148107 1 2265 0 44 44 0 hDdf 10548 794 262660 116825 69033 195765 264798 101 17833 87653 90 26622 266220 1 26644 268377 1 3710 0 77 77 0 uf=la=;=hDdf 6
34319 13027 3006 14611 17617 51 1111 5505 6616 51 1765 17650 0 1770 18233 3 233 2 66 66 0 70 a'^jn g=kf= 190 23930 9914 3516 14674 18190 76 1086 4733 5819 59 1825 18250 0 1830 18621 2 220 0 54 54 0 71 l;=g=kf= 120 58249 22941 6522 29285 35807 61 2197 10238 12435 54 3590 35900 0 3600 36854 3 453 2 120 120 0 hDdf 310 11792 1104 320909 139766 75555 225050 300605 93.7 20030 97891 84 30212 302120 0.5 30244 305231 2 4163 2 197 197 0 s"n hDdf 1
94
Annex VII : VDCs Categorized with Problems and Priority ( FY 2069/70) 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-out (>10) High Drop-out (>90) High Coverage (<90) Low Coverage (<90) Low Coverage
Dhakdhai,Bodawar,Cho.Ramnagar,P Siddharathanagar NP Chhipagad,Patkhauli, Pa.Amuwa ajarkatti, Hati pharshataker,Hati = 1 NP Pokharbhindi,Siktahan, = 1 VDCs Bangai, Rayapur, Thu.Piprahawa Basantpur,Padsari,BagahaMotipur, ,Bagauli, Asuraina, Silautiya, Manpakadi, Madhawaliya,Chhiliya, Priority 1 Karauta,Semera, Farena Gonaha,Chhapiya, Rohinihawa, Lumbini, Masina, Hernaiya,Rudrapur, Makrahar, Aama, Madhubani, Khudabagar, Devdha, Bhagawanpur, Sipawa, Tenuhawa, Priority 3 = 17 VDCs Sau.Pharsatikar, Kha.Bangai, Semlar, Anandban, Tikuligadh, Priority 2 Shankarnagar, Majhagawa, Betkuiya, Maryadpur, Bayarghat, Bogadi, Sa.Pakadi, Parroha, Dudraksha, Salghandi, Gajedi, Mainahiya, Kamhariya, Dhamauli, Manmateriya, Bishnupura, Ekala, Sandi, Suryapura, Jogada, Karwani,Karahiya, Gangoliya,Butwal NP, = 51 VDCs + 1 NP = 52
95
Annex VIII: VDC wise EPI Status
se/]h % *«k cfp^ %
+ + + 2
Onfsf 2 + l;= :j:Yo ;:yf tyf & & :jf:Yo 3 _ bfb"/f h]=O{= g+= uf=la=; bfb"/f _ aL=;L=hL= bfb'/f l^=l^= l^=l^= 2 ;:yf l^=l^=2 h]=O{= bfb"/f − − k])^f÷kf]lnof]3 k])^F 3k])^F l^=l^=2 l^=l^=2 aL=;L=hL= l^=l^= 2 k])^f 1 aL;LhL= k])^f 1 1 wswO{ 170 170 154 145 269 483 97 97 88 86 104 131 236 9 0 9 2 jf]wjf/ 212 211 241 227 210 280 95 95 108 106 27 80 107 -14 -8 -24 3 l%kfu( 101 124 110 129 176 219 70 86 76 93 26 105 130 -9 -8 4
4 k^\vf}nL 121 123 132 128 225 289 84 85 92 91 38 134 172 -9 -3 -10 5 %f]=/fdgu/ 125 146 170 189 222 290 88 103 120 141 41 134 175 -36 -12 -31 6 kh/s§L 128 137 103 90 218 241 93 100 75 69 14 wswO{ k|f=:jf=s]= wswO{ k|f=:jf=s]= wswO{ k|f=:jf=s]= wswO{ k|f=:jf=s]= 136 151 20 -17 12 7 kf]v/le)*L 119 124 111 100 160 192 71 74 66 61 16 82 99 7 0 10 8 l;S^xg 251 258 251 190 198 321 87 90 87 70 37 59 96 0 -14 -11 hDdf 1227 1293 1272 1198 1679 2316 86 91 90 88 38 101 140 -4 -8 -6 9 a;Gtk'/ 156 137 154 143 181 267 78 69 77 75 37 78 115 1 6 -6 175 214 220 183
10 k*;/L 226 301 73 89 91 82 27 80 107 -26 -22 -25 11 xf=km;f{l^s/ 106 138 115 130 266 336 83 108 90 107 47 178 224 -8 -20 0 12 xf=agufO{ 166 217 227 268 247 308 83 108 113 140 26 106 132 -37 6 1 a;Gtk"/k|f=:jf=s]= a;Gtk"/ k|f=:jf=s]= 13 a;Gtk"/k|f=:jf=s]= a;Gtk"/ k|f=:jf=s]= aufxf 154 128 151 92 226 242 108 90 106 66 10 135 145 2 10 -6 hDdf 757 834 867 816 1147 1455 83 91 95 94 29 108 136 -15 -3 -7
14 /fok'/ 379 398 404 361 360 501 142 149 151 137 45 115 161 -7 -3 -5 15 s/f}tf 318 307 302 299 293 492 113 109 107 110 60 89 150 5 4 6 16 y'=lkk|xjf 117 130 113 121 255 284 101 112 97 110 21 /fok"/k|f=:jf=s]= /fok"/k|f=:jf=s]= /fok"/k|f=:jf=s]= /fok"/k|f=:jf=s]= 188 209 3 -5 9
96
se/]h % *«k cfp^ %
+ + + 2
Onfsf 2 + l;= :j:Yo ;:yf tyf & & :jf:Yo 3 _ bfb"/f h]=O{= g+= uf=la=; bfb"/f _ aL=;L=hL= bfb'/f l^=l^= l^=l^= 2 ;:yf l^=l^=2 h]=O{= bfb"/f − − k])^f÷kf]lnof]3 k])^F 3k])^F l^=l^=2 l^=l^=2 aL=;L=hL= l^=l^= l^=l^= 2 k])^f 1 aL;LhL= k])^f k])^f 1 17 auf}nL 267 274 263 225 264 474 109 112 108 94 73 92 166 1 -2 2 18 l;nf}^Lof 245 255 245 269 251 317 105 109 105 120 24 92 116 0 -1 3 19 c;'/}gf 195 186 193 177 248 305 112 107 111 103 28 122 150 1 5 1 20 km/]gf 111 118 121 106 223 240 105 111 114 103 14 178 192 -9 -6 -9 21 /f]Olgxjf 154 154 145 138 286 427 117 117 110 108 91 185 276 6 -8 -2 22 ;]d/f 181 184 171 159 271 415 99 101 94 88 68 128 196 6 -1 7 hDdf 1967 2006 1957 1855 2452 3456 113 115 113 110 49 121 170 1 -1 1 23 n'lDjgL 273 306 264 192 359 518 110 123 106 79 54 123 177 3 -10 5 24 dl;gf 171 212 156 168 354 484 124 154 113 126 81 220 301 9 -5 23 25 dw'jgL 176 186 180 132 253 312 107 113 109 84 31 132 163 -2 -9 -5
26 cfdf 273 275 218 192 250 333 100 101 80 72 26 78 104 20 -7 15 27 v"bfjfu/ 120 141 134 141 201 250 86 101 96 107 30 122 152 -12 -7 -2 28 t]g"xjf 323 289 291 229 258 309 116 104 104 87 16 79 95 10 5 4 n'lDagLn'lDagLk|f=:jf=s]= k|f=:jf=s]= n'lDagLn'lDagLk|f=:jf=s]= k|f=:jf=s]= 29 l;kjf 193 190 183 181 222 302 106 104 101 100 38 105 142 5 2 5 30 eujfgk"/ 256 295 300 168 252 455 86 99 100 58 58 72 130 -17 -7 -9 hDdf 1785 1894 1726 1403 2149 2963 103 110 100 84 40 107 147 3 -5 5 31 ;f}=km;f{l^s/ 261 253 282 279 254 377 102 99 110 123 41 85 126 -8 -6 -18
32 df]tLk'/ 188 215 206 173 212 258 78 90 86 80 16 75 92 -10 -11 -6 :jf=s]= :jf=s]= :jf=s]= :jf=s]= df]ltk"/ df]ltk"/k|f= k|f= 33 df]ltk"/ df]ltk"/k|f= k|f= v=agufO{ 198 230 223 213 218 293 82 95 93 96 27 77 104 -13 -12 -9
97
se/]h % *«k cfp^ %
+ + + 2
Onfsf 2 + l;= :j:Yo ;:yf tyf & & :jf:Yo 3 _ bfb"/f h]=O{= g+= uf=la=; bfb"/f _ aL=;L=hL= bfb'/f l^=l^= l^=l^= 2 ;:yf l^=l^=2 h]=O{= bfb"/f − − k])^f÷kf]lnof]3 k])^F 3k])^F l^=l^=2 l^=l^=2 aL=;L=hL= l^=l^= l^=l^= 2 k])^f 1 aL;LhL= k])^f k])^f 1 34 dfgks*L 122 139 137 123 190 231 69 79 77 75 20 92 112 -12 -3 -1 35 ;]dnf/ 253 237 240 208 228 286 97 90 92 88 19 74 93 5 7 6 36 k=cd'jf 198 178 197 230 146 279 66 60 66 83 38 42 80 1 12 2 hDdf 1220 1252 1285 1226 1248 1724 83 85 87 91 28 72 100 -5 -2 -4 37 cfgGbjg 257 266 266 217 191 320 88 91 91 81 38 56 93 -4 1 1 203 214 209 192
38 dwjlnof 187 298 77 81 79 77 36 60 96 -3 -6 -3 39 l^s"nLu( 292 330 343 374 248 476 82 92 96 116 55 59 114 -17 -2 -7 40 lrlNxof 84 112 123 118 174 217 60 80 88 93 26 107 133 -46 -8 -18 cfgGbjg:jf=rf}= cfgGbjg :jf=rf}= 41 cfgGbjg:jf=rf}= cfgGbjg :jf=rf}= z+s/gu/ 325 449 444 525 213 323 78 108 107 141 23 44 67 -37 -5 -4 hDdf 1161 1371 1385 1426 1013 1634 79 93 94 106 36 59 95 -19 -4 -5 42 demufjf 171 188 183 198 318 388 119 131 127 141 41 188 229 -7 -13 -10 43 uf]gfxf 306 288 241 159 206 286 95 89 75 51 21 55 76 21 -13 5 44 a]ts"Oof 147 146 147 144 222 343 107 107 107 109 76
139 215 0 1 0 45 ao/#f^ 163 166 152 151 298 466 109 111 101 103 96 170 266 7 -2 6 46 ;=ks*L 141 142 136 121 248 392 104 105 101 92 91 157 248 4 -1 4 demu+fjfdemu+fjf:jf=rf}= :jf=rf}= 47 demu+fjfdemu+fjf:jf=rf}= :jf=rf}= af]u*L 259 266 253 246 232 291 98 101 96 97 19 75 95 2 -2 3 48 dof{bk"/ 144 147 142 135 231 322 97 99 95 96 53 134 187 1 1 5 hDdf 1331 1343 1254 1154 1756 2489 102 103 96 92 48 116 164 6 -5 2
49 k/f]{xf 567 598 528 499 290 539 94 99 87 92 35 f}= f}= f}= f}= k/f]{xf k/f]{xf k/f]{xf k/f]{xf
:jf=r :jf=r 41 76 7 1 12 :jf=r :jf=r
98
se/]h % *«k cfp^ %
+ + + 2
Onfsf 2 + l;= :j:Yo ;:yf tyf & & :jf:Yo 3 _ bfb"/f h]=O{= g+= uf=la=; bfb"/f _ aL=;L=hL= bfb'/f l^=l^= l^=l^= 2 ;:yf l^=l^=2 h]=O{= bfb"/f − − k])^f÷kf]lnof]3 k])^F 3k])^F l^=l^=2 l^=l^=2 aL=;L=hL= l^=l^= l^=l^= 2 k])^f 1 aL;LhL= k])^f k])^f 1 50 b'w/fIf 487 494 484 451 300 609 96 97 95 98 52 50 102 1 -2 0 51 ;fnem)*L 342 312 337 335 244 339 113 103 112 126 27 69 96 1 4 -4 52 uh]*L 324 336 343 302 231 352 92 96 98 93 30 56 86 -6 -10 -12 hDdf 1720 1740 1692 1587 1064 1838 97 98 96 99 37 52 89 2 -1 1 53 bofgu/ 217 219 221 214 218 341 85 86 87 92 41 73 114 -2 -4 -5 54 d}glxof 205 232 204 191 295 482 101 115 101 99 79 125 204 0 -6 6
55 sDxl/of 450 439 438 476 306 598 95 92 92 106 53 55 108 3 0 0 56 wdf}nL 164 168 181 129 246 301 101 103 111 83 29 130 159 -10 -4 -12 57 xg]{of 111 111 125 111 187 219 88 88 99 93 22 %lkof:jf=rf}= %lkof:jf=rf}= %lkof:jf=rf}= %lkof:jf=rf}= 128 150 -13 -2 -15 58 dfgd^]/Lof 239 243 247 248 209 424 97 98 100 104 74 72 147 -3 -6 -7 hDdf 1386 1412 1416 1369 1461 2365 94 96 96 99 53 85 138 -2 -3 -4 59 lai)f'k'/f 344 366 350 339 268 395 97 103 99 98 31 65 96 -2 0 4 60 ;'o{k'/f 468 498 455 349 271 549 87 92 84 67 44 43 87 3 -2 7
61 ;f*L 156 176 174 143 265 335 101 114 113 95 39 147 186 -12 -5 -4 62 ?b|k'/ 496 503 542 487 226 422 81 82 88 89 27 31 59 -9 8 0 63 hf]u*f 192 174 172 131 241 405 118 107 106 85 86 sd{xjf:jf=rf}= sd{xjf:jf=rf}= sd{xjf:jf=rf}= sd{xjf:jf=rf}= 127 213 10 8 9 64 Psnf 286 313 298 272 330 488 104 114 108 103 49 103 152 -4 1 5 hDdf 1942 2030 1991 1721 1601 2594 92 97 95 87 40 65 106 -3 2 4
65 dqmx/ 411 399 403 359 233 409 88 86 87 87 32 f}= f}= f}= f}= ahf/ ahf/ ahf/ ahf/
:jf=r :jf=r 43 75 2 1 0 :jf=r :jf=r
99
se/]h % *«k cfp^ %
+ + + 2
Onfsf 2 + l;= :j:Yo ;:yf tyf & & :jf:Yo 3 _ bfb"/f h]=O{= g+= uf=la=; bfb"/f _ aL=;L=hL= bfb'/f l^=l^= l^=l^= 2 ;:yf l^=l^=2 h]=O{= bfb"/f − − k])^f÷kf]lnof]3 k])^F 3k])^F l^=l^=2 l^=l^=2 aL=;L=hL= l^=l^= l^=l^= 2 k])^f 1 aL;LhL= k])^f k])^f 1 66 s]/jfgL 295 380 384 381 228 354 71 91 92 102 26 47 73 -30 -7 -8 67 s/xLof 407 466 486 494 280 523 90 104 108 123 46 53 99 -19 1 -3 68 b]]jbx 579 631 580 546 289 484 82 89.8 83 86 24 35 59 0 -14 -5 69 u+uf]lnof 182 180 191 199 216 283 91 90 96 105 29 93 122 -5 1 -6 hDdf 1874 2056 2044 1979 1246 2053 84 92 91 99 31 48 79 -9 -5 -4 70 a'^jn g=kf= 5845 2458 2664 2243 1140 3565 258 108 117 104 92 43 135 54 -5 -14 71 l;=g=kf= 2112 1550 1421 1272 701 1994 133 98 90 85 70 38 108 33 10.5 18 s'n hDdf 24327 21239 20974 19249 18657 30446 113 99 98 96 47 74 121 14 -2 -1
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Annex IX: List of Private Hospitals with Approval/Renewal Status
Name of Health Facilities Address Number of Beds Approval Status Medical Colleges Universal College of Medical Sciences Ranigaun Bhairahawa Not informed Not informed Devdaha Medical College Devdaha 100 Registered Private Hospitals Medicare Hospital Butwal 51 Not Informed Crimson Hospital Manigram 50 Yes Lumbini Hospital and Technical College Butwal 50 Not Informed 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 center Butwal No Informed 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
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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 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
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Name of Health Facilities Address Number of Beds Approval Status 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 C linic Parrohoa No Informed
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Annex:X List of Programme Performance Evaluation (FY- 2069/070)
Objective of evaluation To increase responsibility and motivate health workers at implementation level To maintain high morale and encourage for further improvement To provide appropriate feedback for furter improvement Background of evaluation DPHO, Rupandehi started evalution system since 2067/68 in its own initiation All Health Facilities are evaluated by using key program indicators Top performer Health Facilities are awarded and appreciated Evaluation result disseminated in district annual review in each year Source of information HSIS LMIS HF profile Audit report Management skill evaluated by a committee of DPHO
Administrative record of DPHO
Methodology of evaluation Formation of evaluation committee Selection of key indicators
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Analysis and weight given to the indicator value Total mark is 100 If some indicators are not applicable to particular Health Facility then the full mark for this indicator is eliminated and remaining mark is supposed to 100 Some information is based on the monitoring report of DPHO during regular supervision monitoring Selected Performance Evaluation Indicators Reporting and Response Timely Reporting & complete Reporting (5) Social Audit (Financial Auditing) (4) Attendance and response (5) HF Profile (Fill up, Use, Maintain ) (10) LMIS Reporting Status throughout the FY (3) New Management initiation (5) Immunization DPT III Coverage (3) JE Coverage (3) TT2 and 2+ coverage (3) Measles Coverage (3) Dropout Rate (DPT-Hep B I vs III) (3)
CB-IMCI • % of severe dehydration among new (4)
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% of severe pneumonia & very severe disease among total cases (4) NUTRITION New Growth Monitoring (5) Proportion of malnourished children as % of new growth monitoring (< 5 years) (5) SaferMotherhood ANC 1 st Visit as % of EP (5) 4th ANC visit as % of 1 st ANC visit (5) Family Planning New Accepter as % of MWRA (5) Current User (CPR) (5) Disease Control (TB) Case Finding (5) (TB) Treatment Success Rate (5) (Malaria ) Slide collection and Blood Examination Rate (5) Basis of evaluation Most of the indicators are selected similar to the indicators that have been using by MoHP for the district evaluation Total 22 key indicators are used for evaluation Management related indicators are further divided into 5 sub indicators Positive indicators = 18
Negative indicators =4 Classification of evaluation ( Out of total 69 Health Facilities ) Determination of Health Facilities who secured first, second, third, fourth and fifth position
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Top ten and lowest ten Health Facilities are determined Marks obtained and rank of all Health Facilities are listed Top ten VDCs FY- 068/069 FY- 069/070 Health Institution Mark Rank Health Institution Mark Rank EKALA 79.26 1 Majhagawa HP 91.2 1 BETKUIYA 78.79 2 Motipur PHC 90.1 2 Karmahawa HP 78.62 3 EKALA 89.7 3 GANGOLIYA 77.67 4 Karmahawa HP 88.9 4 Anandaban HP 77.39 5 ASURAINA 88.7 5 CHHILIYA 77.36 6 BETKUIYA 88.5 6 Basantapur PHC 77.22 7 PHARENA 87.7 7 TIKULIGADH 76.72 8 MANMATERIYA 86.8 8 SHPHATTI PHARSATIKAR 76.47 9 MAINAHIYA 85.6 9 ASURAINA 76.34 10 Chhapiya HP 85.5 10 Least ten VDCs FY - 068/069 FY - 069/070 Health Institution Mark Rank Health Institution Mark Rank SIKTAHAN 65.99 1 THUMUWA PIPRAHAWA 72.2 1 POKHARBHINDI 65.62 2 MASINA 72.0 2 AAMA 65.57 3 PATAKHAULI 71.9 3 JOGADA 65.29 4 AAMA 71.2 4 KAMAHARIYA 65.10 5 MANPAKADI 70.5 5 PA. AMUWA 64.50 6 KHADWA BANAGAI 69.8 6 GAJEDI 64.07 7 BHAGAWANPUR 66.6 7 MADHUBANI 63.26 8 PA. AMUWA 66.4 8 BHAGAWANPUR 62.66 9 POKHARBHINDI 66.3 9 CHO RAMNAGAR 59.85 10 CHHIPAGADHA 65.3 10
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