It is my great pleasure to publish the Annual Report of District Public Health Office, Rupandehi of the Fiscal Year 2071/072. 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/ORCs, EPI Clinics, I/NGOs and Nursing homes and private and teaching hospitals. This report is prepared with untiring efforts and co-operation of many institution and individuals. I would like to extend my sincere gratitude to Dr. Taranath Poudel, Director of Western Regional Health Directorate (WRHD), Pokhara for his valuable direction and guidance. My sincere thanks go to Mr. Mukti Khanal, Section Chief from Department of Health Services, Management Division, HMIS section for his valuable technical support and guidance. I express my sincere thanks to Mr. Bishnu Prasad Dhakal, Chief District Officer for his continuous and valuable suggestion and guidance on health services delivery and also I am grateful to Mr. Bishow Prakash Aryal, Local Development Officer, DDC, Rupandehi and his team for timely releasing of budget, providing managerial guidance and support to DPHO. I am also thankful to MS & their team of Lumbini Zonal Hospital & Bhim Hospital and all Doctors, Medical record Officers and health professionals including all staffs for supporting us in delivering public health services at the district. Additionally, I take this opportunity to express appreciation to all DPHO Supervisors including Admin and Finance staff, Health Workers, Local bodies, Volunteers (FCHVs), Health Facility Management Committees, District level partners working for the quality assurance and enhancement of health services. I would like to thank Mr. Prayash Khanal, Executive Director of USCD and Suaahara program (Rupandehi) team and Mr. Om Prakash Gupta, Statistical Officer for their diligent efforts in making the publication of Annual Report a success. I would like to thank Mrs. Shova GC, Computer Operator and Mr. Firoj Shresrtha, Mr. Anil Khadka, Mr. Deepak Gyawali, Mr. Prem Subedi and Mr. Khem Raj Pokhrel of HMIS online data entry points in PHCCs for their contribution. Similarly I would like to express sincere gratitude to Mr. Vardan Raj Karki, MNCH Officer, Plan International Nepal, Mr. Shankar Devkota, District Coordinator, Ipas Nepal and Mr. Gyan Dev Joshi, DPO, PSI Nepal for their support during report making process. 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. At last but not the least, my sincere thanks goes to the general population of the districts who are the beneficiaries of the service offered by the DPHO. Rishi Prasad Lamichhane Senior Public Health Administrator DPHO, Rupandehi | Annual Report 2071/72 i DPHO, Rupandehi | Annual Report 2071/72 ii TABLE OF CONTENTS ACKNOWLEDGEMENT………………...……………………………… i MESSAGE FROM WESTERN REGION HEALTH DIRECTORATE. ii TABLE OF CONTENTS…………………………………………………. iii LIST OF TABLES……………………...…………………………………. vi LIST OF FIGURES……………..………………………………………… viii LIST OF ABBREVIATIONS………………...……...………………..….. ix HEALTH COVERAGE FACT SHEET: RUPANDEHI DISTRICT..... xii 1. R1-6 UPANDEHI DISTRICT: A BRIEF OVERVIEW…...………….… 1.1 Introduction………………………………………………………….….. 2 1.2 Geo-Political Boarders………………………...…………………….….. 3 1.3 Social Status………………………………..…….……………………... 3 1.4 Major Natural Resources………………...………………………….….. 4 1.5 Major Business Centers…………………………...……………….…… 4 1.6 Major Religious and Tourist Areas………………......…………….…... 4 1.7 Major Religion…………………...…………………………………….. 4 1.8 Major Caste……………………...……………………………………... 4 1.9 Major Mother Tongue………………………………………………….. 5 1.10 Brief District Profile………………………..………………………… 5 2. D7-12 ISTRICT HEALTH SYSTEM…………………………..………… 2.1 Introduction………………………………...…………….……………... 8 2.2 Health Service Utilization in The District………………………………. 11 3. C13-28 HILD HEALTH PROGRAMME………...………………………... 3.1 National Immunization Programme……………..…………………….. 14 3.1.1 Background………………...………………………………………… 14 3.1.2 Cold Chain Movement System…………………...………………….. 18 3.1.3 Problems and Constraints of National Immunization Programme…... 18 3.2 CB-IMCI Program……………………………………………………... 19 3.2.1 Background…………………………...……………………………… 19 3.3 Nutrition Program……………………………………………………… 22 3.3.1 Background……………...…………………………………………… 22 3.3.2 Multiple Micronutrient Powder Programme (Baal Vita)……..……... 25 3.3.2.1 Background………………………..………………………………. 25 DPHO, Rupandehi | Annual Report 2071/72 iii 3.3.3 Problems and Constraints of Nutrition Programme…………………. 27 4. F29-40 AMILY HEALTH PROGRAMME……………...………………… 4.1 Safe Motherhood Programme…………………...……………………... 30 4.1.1 Background……...…………………………………………………… 30 4.1.2 Problems and Constraints of Safe Motherhood Programme…………. 33 4.2 Family Planning programme.………. ………………………………… 33 4.2.1 Background………………...………………………………………… 33 4.2.2 Objectives……..……………………………………………………... 33 4.2.3 Problems and Constraints of Family Planning Programme………….. 34 4.3 Female Community Health Volunteer (FCHV) Programme…………... 35 4.3.1 Background……………………………….………………………..… 35 4.4 PHC Outreach-clinic Programme………………………...……………. 37 4.4.1 Background…………………...……………………………………… 37 5. D41-66 ISEASE CONTROL PROGRAMME…………..………………… 5.1 Malaria Control Programme………………...…………………………. 42 5.1.1 Background………………………...………………………………… 42 5.1.12 Malaria Epidemiology……………………………………………… 42 5.1.3 Malaria Species…………..………………………………………….. 43 5.1.4 Malaria Vectors…………….……………………………………...... 43 5.1.5 Strategic Plan 2011-2016……………….…………………………... 43 5.1.6 Performance Malaria PF Case Reporting………………………..….. 45 5.1.7 LLIN Distribution……….………………………………………….. 45 5.1.8 Spraying…………………….………………………………………. 46 5.2 Dengue Control Programme……………….…………………………. 47 5.3 Tuberculosis Control Programme……………….……………………. 49 5.3.1 Background………………….……………………………………… 49 5.4 Leprosy Control Programme………………….………………………. 51 5.4.1 Background…………….…………………………………………… 51 5.5 Outbreak and Disaster Management…………….……………………. 54 5.6 Filariasis Elimination Campaign………….…………………………... 55 5.7 Rabies………….……………………………………………………… 55 5.8 Snake Bite…………………………………………………………….. ……………………….55 ………………………………………. 5.9 HIV and AIDS Programme……………….…………………………... 56 5.9.1 Background………………………………….……………………… 56 DPHO, Rupandehi | Annual Report 2071/72 iv 5.9.2 HIV Testing and Counseling Centers…………………………….… 59 5.9.3 ART Center………………………………….……………………… 60 5.9.4 PMTCT Centers……………………………….……………………. 60 5.9.5 Problems and Constraints of HIV and AIDS Control Programme.... 60 6. CURATIVE 69-73 SERVICES………………..……………...…….….…… 6.1 OPD Services………………………………………..……….………… 68 6.2 Laboratory Services by District…………………………………...…… 71 7. SUPPORTING 74-90 PROGRAMME………………………………..…… 7.1 Health Education, Information and Communication Programme…….. 75 7.1.1 Background………………………...………………………………… 75 7.1.2 Problems and Constraints of ICCC/BCC Programme…….………… 77 7.2 Primary Health Care Revitalization Programme…………..…………... 77 7.2.1 Background…………………...……………………………………… 77 7.2.2 Free Health Services………………………………………………….. 78 7.2.3 Urban Health Services Programme……………………...…………… 78 7.2.4 Urban FCHVs Programme…………………..………………………. 79 7.2.5 Model Health Village Programme…………...………………………. 79 7.2.6 Community Health Unit Programme…………….……..……………. 79 7.2.7 Problems and Constraints of PHCRD Programme………..………… 79 7.3 Management Support Programme……...……………………………… 79 7.4 Supervision and Monitoring Programme…………..…...…………….. 79 7.5 Physical Infrastructure Development Programme...……………..…… 80 7.6 Maintenance Programme…………......……………………………….. 80 7.7 Recommendation of Private Institution for Approval and Renewal...... 81 7.8 Ambulance Services……………..…………………………………….. 81 7.9 Blood Bank Services…………………...………………………………. 81 7.10 Population Management Programme………..……………………….. 81 7.11 Medicine Procurement……………………...…………...…………… 82 7.12 Financial Resource Management…………………………......……… 82 8. STRENGHTS, AREAS OF IMPROVEMENT AND WAY 91-93 FORWAD.. 8.1 Strengths…………………..…………………………………………… 92 8.2 Areas of Improvement……………………..………………………….. 92 8.3 Way Forward………………………..…………………………………. 92 DPHO, Rupandehi | Annual Report 2071/72 v ANNEX………………………………………………………………….... 94-131 DPHO, Rupandehi | Annual Report 2071/72 vi LIST OF TABLES Table 1.1 Number of health service delivery points and health service intervention related I/NGOs……………………….....…….……………………………...…….... 11 Table 2.2 Average no. of people served by level of health facilities per day………. 11 Table 2.3 Service delivery points and reporting status in percentage………………. 12 Table 3.1 EPI performance status by selected indicators…………………………… 15 Table 3.2 VDC categorized with problems and priority, FY 2071/72……………… 17 Table 3.3 ARI performance status by selected indicators…………………………... 20 Table 3.4 Nutrition programme performance status by selected indicators………… 23 Table 3.5 Progress status of targeted activities of child health (FY2071/72)……….. 28 Table 4.1 Safe motherhood programme performance by selected indicators……... 30 Table 4.2 Family planning programme performance by selected