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Facility Based Assessment for Reproductive

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Facility Based Assessment for Reproductive August, 2014 Facility Based Assessment for Reproductive Health Commodities and Services Submitted to: United Nations Population Fund (UNFPA) Final Report Shanta Bhawan Road, Jhamsikhel This report is a product of research on "Facility Based Assessment for Reproductive Health Commodities and Services”carried out by Nepal Development Research Institute with the financial supportof United Nations Population Fund (UNFPA) from December 2013 to May 2014 StudyTeam Dr. Basu Dev Pandey, Team Leader Dr. Jaya Kumar Gurung, Project Coordinator Mr. Naveen Sherestha, Technical expert Mr. Suman Chandra Gurung, Technical expert Ms Sona Shakya , Researcher Ms. Apsara karki, Researcher Report By: Nepal Development Research Institute Shree Durbar Tole, Pulchowk, Lalitpur www.ndri.org.np i|Page Acknowledgement I extend my sincerest appreciation and thanks to Ms. Giulia Vallese, Country Representative of UNFPA Nepal for entrusting NDRI with the project and for her kind co-operation throughout the project duration. I owe profound gratitude towards Dr. Shilu Adhikari, SRH Specialist of UNFPA, for her regular and timely guidance throughout the research period. I would also like to take this opportunity to extend my appreciation to Mr. Phulgendra Singh for his paramount role in coordinating this research between UNFPA and NDRI. His continued efforts for the re-formulation of this study to match the desired objectives as well as his substantial inputs during training and data analyses are highly appreciated. Similarly, a very hearty thanks goes to Dr. Tara Pokharel, Chief of LMD for his kind suggestions regarding the research. I also appreciate the invaluable contribution of Mr. Dinesh Chapagai, Senior Health Administrator during training as well for his overall suggestions. I would also like to acknowledge Dr. Shilu Aryal from the Family Health Division, for her suggestions which were imperative in making our research more meaningful. Likewise, I am also grateful to Mr. Bhogendra Dotel from the Family Health Division, for his critical suggestions and continued feedback. A sincere note of thanks goes to Dr. Suresh Mehata, from NHSSPfor kind his suggestions and consultation during the data analysis phase; as well as to Mr Pradeep Poudel, from NHSSP and Mr. Susheel Chnadra Lekhak from WHO for their valuable feedback during the finalization of the report I also extend my benevolent gratitude to the members of our research team, Dr. Basu Dev Pandey (team leader), Mr. Naveen Shrestha, Mr. Suman Chandra Gurung and Ms. Sona Shakya, for their continued dedication towards this study. Their willingness and availability in conceptualizing the study framework and approach, developing research tools, accessing relevant documents, field works and later during data analysis with their helpful insights, is admirable. With great appreciation, I would particularly like to acknowledge the contribution of NDRI researchers, Ms. Anita Khadka, Mr. Dhiraj Raj Gyawali, Ms. Apsara Karki and Ms. Dina Pradhan for their praiseworthy efforts and perseverance right from the project design, to field survey, data analysis and synthesis, and report preparation. Hearty gratitude is also extended to the field supervisors and field researchers without whose dedicated efforts; this study wouldn't have been possible. All the key informants from Regional, district hospitals and other health facilities also deserve special mention for providing key information about the facilities as well as stock inventories. I am also thankful to all the respondents for their patience and their time during data collection. Similarly, I would like to acknowledge the NDRI administration, especially Ms. Roopa Bhandari, Finance and Admin Officer, for the overall logistics support and helps as per the need. Dr. Jaya Kumar Gurung Executive Director ii|Page Acronyms ANC Antenatal Care ASL Authorized Stock Level CI Confidence Interval DoHS Department of Health Services DRC Development Resource Centre EDPs External Development Partners EHCS Essential Health Care Services EOP Emergency Order Point FHD Family Health Division FP Family Planning GPRHCS Global Programme to enhance RHCS HFOMC Health Facility Operation and Management Committee HP Health Posts ICT Information and Communication Technology IUCD Intrauterine contraceptive devices ICPD International Conference on Population and Development LMD Logistics Management Division LMIS Logistics Management Information Systems MoHP Ministry of Health and Population NHSP Nepal Health Support Programme NHRC. Nepal Health Research Council NHTC National Health Training Centre OP Output PHCCs Primary Health Care Centers PPA Public Procurement Act RHDs Regional Health Directorates iii|Page RH Reproductive Health RHCS Reproductive Health Commodity Security RMS Regional Medical Stores SDPs Service Delivery Points SHPs Sub Health Posts SPSS Statistical Package for Social Scientists STI Sexually Transmitted Infections STS Service Tracking Survey iv|Page Table of Contents Acknowledgement ........................................................................................................................................................................... ii Acronyms ......................................................................................................................................................................................... iii Table of Contents ............................................................................................................................................................................ v List of Tables ................................................................................................................................................................................. viii List of Figures .................................................................................................................................................................................. x List of Annexes ................................................................................................................................................................................ x Executive Summary ...................................................................................................................................................................... xii PART 1: INTRODUCTION ....................................................................................................................................... 1 1.1. Background ...................................................................................................................................................................... 1 1.2. Rationale and Objective of the Study ........................................................................................................................ 1 1.3. Survey Organization and Management ..................................................................................................................... 1 1.4. Methodology and Limitations ........................................................................................................................................ 2 1.4.1. Survey Design and Sampling of Facilities ......................................................................................................... 2 Developing the List of Health Facilities by Category and Administrative Unit .............................................................. 2 Use of Recommended Sampling Procedure ......................................................................................................................... 2 1.4.2. Data Collection .................................................................................................................................................... 11 Recruit and train field staff enumerators and supervisors and data entry staff ......................................................... 11 Adapt and Pre-test Survey Questionnaires ........................................................................................................................ 11 Finalize the Survey Questionnaires ...................................................................................................................................... 12 Mobilization of the Field Staffs ............................................................................................................................................ 12 1.4.3. Data Analysis and Presentation ....................................................................................................................... 12 1.4.4. Limitation of the Survey ..................................................................................................................................... 13 PART 2: NATIONAL GUIDELINES, PROTOCOLS AND LAWS ...............................................................................15 2.1. Summary of Guidelines, Protocols and Laws for Provision of Modern Contraceptives .................................... 15 2.2. Summary of Guidelines, Protocols and Laws for Provision of Maternal/RH Medicines ................................... 16 PART 3: SURVEY FINDINGS FOR AVAILABILITY OF COMMODITIES AND SERVICES .........................................18 3.1. General Information about the Facilities .................................................................................................................. 18 3.1.1. Geographic Distribution of Facilities ..............................................................................................................
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