You are on page 1of 53

National Annual Review 

2074 

Chuda Mani Bhandari


Deputy Director General
Department of Health Services
Ministry of Health,Nepal
Child health …  70
58
60
160
139 50

Deaths per 1,000
140
Under five mortality 40
39 Neonatal mortality
120 33 33
100 91 30
21
80 18
Deaths per 1,000 livebirths

61 20 16 14
54 12
60
39 10
40 28 27 24 20 0
20
NDHS NDHS NDHS NDHS NDHS Target Target Target Target
0
1996 2001 2006 2011 2016 2020 2022 2025 2030
NDHS NDHS NDHS NDHS NDHS Target Target Target Target
1996 2001 2006 2011 2016 2020 2022 2025 2030 Neonatal mortality rate* (SDG 3 2 2 and NHSS RF G3)

Under five child mortality rate* (SDG 3.2.1 and NHSS RF G2)

120 Immunization coverage 60
48 51 49
100 90
95 97 99 50 Stunting
83 87 41
78 40 36
80 66 31
28
30

%
60 24
%

43 19
40 20
20 10
0
0
NDHS NDHS NDHS NDHS NDHS Target Target Target Target NDHS NDHS NDHS NDHS NDHS Target Target Target Target
1996 2001 2006 2011 2016 2020 2022 2025 2030 1996 2001 2006 2011 2016 2020 2022 2025 2030
Immunization coverage (all vaccines)***(NHSS RF OC3.2) Stunted children (height for age)^ (SDG 2.2.1 and NHSS RF G5)
Maternal health and family planning…
70
Institutional delivery 90 Contraceptive Prevalence Rate (CPR)
90 79 60
70 74 60
80 50 53 56
70 57 52
40 44 43
60 35 43

%
50 35 30
%

40 26
20
30 18
20 8 9 10
10 0
0
NDHS NDHS NDHS NDHS NDHS Target Target Target Target
NDHS NDHS NDHS NDHS NDHS Target Target Target Target
1996 2001 2006 2011 2016 2020 2022 2025 2030
1996 2001 2006 2011 2016 2020 2022 2025 2030
Contraceptive prevalence of any modern methods (SDG 3.7.2)
Institutional deliveries(SDG 3.8.2 and NHSS RF OC3.3)

35
31 Unmet need for family planning FP Unmet Need by Ecological Zone (1996‐2016)
30 28 27 40
25 24
25 21 35
20 19 18
15 30
%

15 25
10 20 Mountain

%
5 15 Hill

0 10 Terai
NDHS NDHS NDHS NDHS NDHS Target Target Target Target 5
1996 2001 2006 2011 2016 2020 2022 2025 2030 0
Unmet need of family planning NDHS NDHS NDHS NDHS NDHS
1996 2001 2006 2011 2016
Non‐communicable Disease …
Blood Pressure Status Prevalence of hypertension by wealth

Percent of women and men age 15 and above 
Percent of women and men age 15 and above
Health Offices at Different Level
Ministry of Health 1
Department 3
Regional Health Directorate 5
Regional Health Training Centers 5
Regional Medical Store  5
District Health Offices 50
District Public Health Offices  25
Health Service Delivery Networks
HFs type Number
Central Hospitals 6
Regional Hospitals 3
Sub Regional Hospitals 3
Zonal Hospitals 10
District Hospitals 52
District Level Hospitals 32
PHCs 198
HPs 3805
UHCs 235
CHUs 188
Private Health Facilities 1723

Source: HMIS
Reporting Status (%) FY 2073/74

Source: HMIS
Human Resources

Summary of Staffs under DoHS Department of Health Services

Total Officer 4205 Total Sectioned post  196


Total Sectioned post  38174 Total Full filled 180
Technical Staffs 31474 Total Vacant 16
Non‐Technical staffs 6700
HMIS Reporting Status (%) FY 2072/73
120

100 97 100 100 99 97


100
89 91 90 91
87
84 81
80
73 71
60 69
60

40

20
12

Source: HMIS
LMIS Reporting Status in 2073/74
100% 95 94
90% 88 87 88 87
81 79
80%
70%
60%
50%
40%
30%
20%
10%
0%
National Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7
Situation
Immunization coverage and drop out rate
Immunization coverage (DPT‐HepB‐Hib3) Drop out rate of DPT‐HepB‐Hib (1 vs 3)
100 95 98 95 95 97 93 15
89 8886 89 90 91
90 87 85 8584 8683
83 12
76 79 7778
13
80 71 11
70 11
60 9
50 7 6 6
40 5 55
5 44 4 4
30 3 3 3 3 3
20
3 22 2 2
111
10 1 0
0 ‐1

2073/74 2072/73 2071/72 2073/74 2072/73 2071/72


Treatment of children for pneumonia and diarrhea

% of children under 5 years with pneumonia treated with 
% of children under 5 years treated with zinc and ORS
antibiotics
196 197 197 100.0
200
188
182184 184 181
178 175172
180 95.8 96.2
95.6 95.4
165 94.9
162164 159 94.7 94.5
155 95.0 93.8 93.9
160 152153152 150 151 93.1
144 92.2 92.2
140 91.2
90.5
90.0 89.5 89.3
120 88.8
88.2
87.6 87.3 87.4
100 86.2
85.2
85.0 84.5
80

60

40 80.0

20

0 75.0
Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National

2073/74 2072/73 2071/72 2073/74 2072/73 2071/72


Institutional delivery
Percentage of women aged 15‐49 year giving birth in a health facility
80
70.7
70 68.3 66.4
62.2
59.4 57.4
60

50 44.6
40 35.6

30

20

10

0
Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National
Use of contraception
Current use of contraception (any method)
70
60.6
60 57.3
55.1
51.1 52.6
50 47.7 48.5 48

40

30

20

10

0
Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National
Disease Control: Malaria
Annual malaria parasite incidence/1000 at  Annual blood examination rate at risk 
risk population, 2073/74 population (ABER), 2073/74
0.30 0.28 2.00
1.78
0.25 1.80
1.60
0.20 1.40
0.15 1.20 1.08
0.11
0.10 1.00
0.08 0.07 0.79
0.80 0.74
0.04 0.63
0.05 0.02 0.02 0.03 0.60 0.51
0.44
0.37
0.00 0.40
0.20
0.00
Lymphatic Filariasis: Year‐wise MDA Coverage (2003‐2017)
120

100
82.5 82.6 85.5 81.3
81.2 83.1
80 76.8 79.1 73.8 72.7
Coverage %

69.6

68.8 71.4
60 67.7

40

20

0
2003 2004 2005 2006 2007 2009 2010 2011 2012 2013 2014 2015 2016 2017
No of people treated for HIV and on ART
Number of people (‘000) tested and  Number of people on ART
counseled for HIV

4082
92.5
100.0 4500
90.0 4000

3440
70.9

3036
80.0 3500

2824
59.3
70.0

2466

2421
3000

2467
53.3
52.9

2113

2158
60.0 2500

1897
1785
41.4

1560
50.0

1428
2000
32.7
32.2
31.5
31.3

1197

1248
40.0

1044
27.2

1500
22.2

21.6

974
20.9

826
30.0
14.8

13.3 1000
11.9

434
10.6

20.0

374
305
8.5

500
4.3

10.0
1.8

0.0 0

2073/74 2072/73 2071/72 2073/74 2072/73 2071/72


HIV testing and positive cases

Description Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National

Number of people 
tested  for HIV (in  31.3 20.9 32.2 10.6 59.3 4.3 53.3 211.8
'000)

% of positive cases 0.8 1.9 2.2 1.2 0.8 1.0 0.5 1.0


Leprosy Elimination
Regional/Province/District wise PR (2072/73)
6
Province 2:
7 1268(42%)

3
1
5

2
TB case finding and treatment success rate
Trend of Annual DR TB case Finding
Delivery of Free Basic Health Services

% of free health outpatient services among  % of targeted group received free health services 
estimated  total population among total  hospital (new) OPD visits
84 60.0 55.5
82.3
82 47.9
50.0
80 42.9
78.0 40.0
78

76 30.0

74 73.4
20.0
72
10.0
70

68 0.0
2073/74 2072/73 2071/72 2073/74 2072/73 2071/72
Free treatment services for Bipanna Nagrik

Free treatment to Bippna Nagrik for selected diseases 


25000  140,000
127,280  125,305 
20480  120,000
20000
Year Exp (million)
 100,000
2073/74 1330.8
15000
2072/73 1019.9  80,000

64,978  2071/72 763.7  60,000


10000 8013
6095  40,000
5000
 20,000

0  ‐

2073/74 2072/73 2071/72


No of cases Per case expenses (NPR)
Building Construction by DUDBC
Progress Status Summary (FY 2061/062 – 2073/74)
Total HFs:  2022
Under Construction:  693
Near Completion:  177
Completed/Handed over:  1152
Sick Projects 100 (reduced from 181)
Financial Progress
Allocation Budget (000) FY  Expenditure % of Expenditure
2073/74 (000)
3,88,60,55,000 3,65,2073,000 93.98%
(3 arab, 88 crore) (3 arab, 65 crore)
Source: DUDBC
Fixing the Basics: Bio‐Medical Equipment
Rapid Inventory Assessments 2014

Operational
MC intervention
Out of Order
Stock Out Situation of Key 
Commodities in 2073/74
16.0% 14.92%

14.0%
12.03%
12.0%
Condom
10.0% Depo
8.0% Pills
6.46%
ORS
6.0% 5.49%
4.6% 4.78% Zinc
4.0% 3.11% Iron
2.0% Vitamin A

0.0%
Condom Depo Pills ORS Zinc Iron Vitamin
A
Budget Expenditure and Irregularity 
Clearance
Key Innovation/Initiatives
Child Health Program
• Expansion EIRS (Electronic Immunization registration) in Chitawan, 
Kaski and Bhaktapur 
• Establishment of SNCU/NICU and Expansion

• Quality improvement in perinatal care  program at 12 hospitals

• Establishment of IMNCI clinical training sites

• Fully nourished ward/village declaration

National Annual Health Review 2073/74                            
Key Innovation/Initiatives
EDCD
• Regular Water quality Surveillance at district level
• Food quality surveillance at highway restaurants to minimize food borne 
diseases
• Budget allocation for Sickle cell anemia and thalassemia affected 
districts for treatment and management.
• Allocated budget for purchase of Wag tech machine for district to 
support water quality surveillance and monitoring.
• Budget allocation for Stockpiling of Medicine and other equipment for  
outbreak and disaster management at district level.

National Annual Health Review 2073/74                            
Key Innovation/Initiatives
LCD
• Mini Leprosy Campaign in Banke and Bardiya.
• Sustained elimination at the national level as the prevalence rate has remained intact this 
year
• Increased proportion of female cases and child cases as the result of early/active case 
detection activities
• Functional Disability Unit
• Policy, Strategy and 10 year action plan
• Early Case detection, referral and management 

National Annual Health Review 2073/74                            
Key Innovation/Initiatives
LMD
• Logistics starts Online Inventory Management System in 1 Centre 
Store Pathalaiya, 5 RMS and 75 Districts
• Logistics just starting e‐Government Procurement (e‐GP) portal 

MD
• PHC strengthening program initiated (073/74)
074/75
• Hospital Management Officer –contract (20 Hospitals)
• DHIS 2 roll out in 459 HPs
• Budget provision for HFs for Waste Management
National Annual Health Review 2073/74                            
Key Innovation/Initiatives
NHTC
• Blended learning approach ( NSV,IUCD, 2nd tri abortion)
• Structured OJT
• Trauma Management Trainings
• Revision of NHT strategy (amendments in according to the federal 
situation)
• District level Coach and Mentor Development
• Training on Non Communicable Disease [PEN Protocol]
• Web based Access to training related documents (manuals and
references etc)
• Development of Comprehensive Reproductive Health Training sites
[Seti, Bheri, Paropakar Maternity, West Regional Hospitals]

National Annual Health Review 2073/74                            
Key Innovation/Initiatives
PHCRD NHEICC
• Budget provisioned for additional  • Development of Golden 1000 
drug availability days communication campaign 
• Drug Specification‐Bank  directives.
developed • Information technology hub 
• Urban Health Promotion Center  established and commenced
established and conducted. • Development of mobile & mobile 
• PEN program initiated in 10  apps initiated 
districts. • Awareness program for Sickle 
Cell disease prevention
• Approved FCTC 2030 Party 
Project 
National Annual Health Review 2073/74                            
Key Innovation/Initiatives
FHD
• To announce all facilities with at least 5 FP methods available (in 5 
districts)  
• Interaction with newly married couple for fertility planning & 
• Micro planning in low PNC districts  
• Birth defect plan implementation
• EOC Monitoring and Micro Planning in Remote VDC
• Declaration of no more home delivery VDC
• Obstetric First Aid training for paramedics
• Establishment of one stop crisis management center 
Key Innovation/Initiatives
NCASC
• IRRTTR ‐ Identify, Reach, Recommendation, Test, Treat & Retain
• mHealth‐Mobile Health Technologies (SMS reminders)
• Biometric and Auto dispensing tool (ADT) 
• Community  approach        
‐ Out reach                         ‐ In reach
Budget Allocation FY 2074/75 (in billion)
S.N Program Allocation

1 Hospital Construction, Strengthening, Maintenance and Management


Information System 6.55
2 Integrated Child Health and Nutrition Program 4.61
3 Integrated Reproductive Health and Women's Health Program 4.15
4 Primary Health Revitalization Program 2.3
5 Epidemiology, Malaria and Kala-azar Control and Natural Disaster
Management Program 1.38
6 National Tuberculosis Control Program 1.25
7 National AIDS and STD Control Program 0.97
8 Logistic Management 0.49
9 NHEICC 0.33
10 NPHL 0.27
11 NHTC 0.24
12 Leprosy Control 0.23
Total (Approx) 22
Budget through Local Level (conditional grant)
(total 14.90 Billion)

60%
54
50%

40%
Percentage

30
30%

20%

10%
9
5
1 1% 0.3
0%
Primary Health Integrated District Hospitals Ayurbed Health Tuberculosis Ayurved Services Health Education,
Centre, Health Health Program Center and Control Program Program Information and
Post Aushadhalaya Communication
Programs
Program Issues
CHD: 
 Declining coverage of DPT 3 compare to 2071/2072
 Distribution of vaccine and  logistics as per stock requirement
 Trained HR in HMIS‐ specially in Nutrition
 Irregular ORC Services

EDCD: 
• Malaria case increasing in non endemic district
• Confirmation of suspected and probable malaria cases
• Low blood slide examination rates for Malaria elimination program
• Malaria case reporting (including private sector) and case investigation
• KA Cases Increasing in Non‐endemic district
• Inadequate Vector Surveillance of dengue & dengue control investigation including other VBDs & NTDs
• TAS and TAS failure
• Poor MDA coverage in Urban Settings
• Integrated vector management(vector control)
• Threat of emerging and reemerging diseases such as sickle cell anemia and thalassemia
• Disaster management‐Availability of resources,role responsibility,guidelines,structure
Program Issues
LCD
• Quality Services & Capacity building of health Institutions &  Health 
workers 
• Focus/Pocket Area Mapping & Planning, Identify Unreached areas & 
plan
Surveillance: Endemic and Low Endemic(Case based, Policy and 
Strategy on follow‐up, including record and report)
• Early case detection Vs Disability, Stop  transmission, Medical 
Rehabilitation & Community  based Rehab
• LCD as a disability focal point 
• Need to develop capacity 
• Extend services up to palika and province level
Program Issues
LMD
• LMIS
• Functioning and reporting on the Online IMS 
• Data Quality 
• Telemedicine : Not  well functioning
• Condition and space of the cold room & warehouse (small ware house, warehouse 
with Zinc sheet)
• Drug Management: Procurement, mobilization, redistribution and disposal
• Quality assurance mechanism
• Technical human resource in the store (need for pharmacist)
• Planned supply & management,maintenance.
Program Issues

MD
• Lack of Policy on Physical Assets Management (PAM) including Maintenance.
• Sick project (building construction): 6.5 %, and ownership 
• MSS of HP (Need to develop) and PHC (to be approved by MoH)
• No provision for treatment support other than 8 listed diseases
• Difficult procedure for recommendation to treatment of 8 listed diseases
• Need simplicity in procedure regarding kidney transplantation.
• Repetition  in program (in heart disease MoH and DoHS both release fund)
• Guideline for HFOMC approval
• Monitoring is an issue
• Effective use of evidences‐HMIS,Data quality.
Program Issues
NHTC
• Unplanned selection of participants
• Training plan for programme and service (district and respective division)
• Training as incentives rather than need based
• Preparedness of logistics for the utilization of trained human resources
• Multi‐door trainings/ Integration of training
• Selection process and criteria of Snr. AHW, Snr. ANM(age and level)
• Rostering of resource person and appropriate use
• Integrated package
Program Issues
NTC
• Low TB Case Notification (Decreasing)
• Proper Management of MDR Cases‐ specially in GoN hospitals
• Rapid expansion of gene‐xpert sites & digital‐xray in major TB diagnostic 
facilities
• Expand/Strengthen community based DOTS 
Program Issues

NPHL
• Implementation of health laboratory guideline 2073

• Establish, strengthen & expand  public health laboratory at all levels

• Functional blood transfusion service in all districts

• Vendor licensing, reagent and kit validation

• Role of central Agency : Super special vs routine services
Program Issues…
PHCRD
• Free essential drugs‐ Lengthy and complex Procurement 
process
• High demand for establishment of UHC and CHU but limited 
budget allocation
• Use of regular stock during emergency and no support to 
fulfill regular stock. 
• Policy framework on Central Bidding and Local Purchasing
Issues
Personnel Management:
• Lack of functional database 
• Insufficient information for strategic placement/transfer
• Influence of pressure group over the system
• HR placement in rural and remote area
• Placement of scholarship doctors in Terai/ mountainous districts
• One door placement of medical officers
• Weak coordination between ministry ,department , region and district for 
administration/management
• Poor management of  staff on long leave/ no departmental action
• New appointment/promotion/Upgrading/padnam/posting  like overlapping issues
Issues
Finance Management:
• Delay in releasing budget & Program
• Inadequate IT friendly A/C staff
• TABUCS vs LMBIS implementation 
• Delay in release of donors fund 
• Capacity building for budget absorption
• Lack of trained H/R for procurement
• Huge burden of audit issues/ irregularities clearance (Improving)
DISASTER:Quick action & mobilization of MoH-District,Partners
1.An Incident management system (IMS) is needed, with SOPs, to help
defining roles and responsibilities between all central bodies,revise update
guidelines,provision of proviencial RRT,EWARS
2.Any outbreak including zoonotic diseases should be considered in priority for
preparedness and response
3.Provision of emergency fund at district, province and Central levels
4.Sufficient stock of essential/life saving medicines prepositioned at various
levels
5.Provision of MRRT/MDRC,Surge teams for response support
6.WASH and Health clusters need to work jointly for preparedness activities
and distribution of WASH items during response phase
7.Immediate release of budget to the flood affected districts.
General issues
Issues Issues

Private Sector‐ Reporting, Case Notification, Using  Ownership of programs  (Utilization of Trained HR 


Standard protocol, kit. (mechanism – transfer system‐)Darchula,Dadeldhura.

Strengthening  operational research activities
Involvement of stakeholders in dengue vector 
search and destroy‐EDCD Structure of major priority program in the federal 
context. 
Sustaining the achievements (Full immunization,  Budget Entry in LMBIS for Region and Districts
Leprosy elimiated, NT, Polio) No need as previous, Entry in TABUCS

Surveillance (LCD, VBD, TB,) Stigma associated with different disease conditions like 


leprosy, HIV etc.
Resource Constraints: (Building, Equipment, 
Impoverished, Training, Surveillance) Development of Pharmacy Guideline  for Primary Health 
Care
Capacity Building: Procurement, 
Guideline changing every year, Norms and Standards Not 
Budget Constraints Uniform
General issues
Insurance program implementation versus health services
Continuation of emergency services in every settings‐eg:Birthing Center
Continuation Performance based management system
Evidence based decision planning
Updated website : Documentation and institutional memory,transparency
Integrated system vs vertical orientation
Mapping‐ planning and implementation (
CHU, UHC, Equipment, Ambulances, district selection for new program)

GESI : FHD, PHCRD,MoH

Integrated/Joint Monitoring
GOVERNANCE:‘Issues/Information that are to be confidential are
transparent whereas things that are to be transparent are confidential’
Some issues related to federalization
• Internalization of federal Context
• Facilitating role : MoH, DoHS, RHD and Districts-up to the Palika level
• Guidelines to be circulated to districts-Palika guideline either through
MOFALD or MOF & guidelines/request from ministry.
• Salary of all staff ,Contract Staff
• Immediate action based on the experiences , observation and issues
shared in the first day plenary session
• Identify the role of DoHS-DoHS will plan accordingly.

Lets discuss,work together,more COMMUNICATION & coordination is required-


Your commitment and positive support made all success..
THANKS FOR Your Attention..
THANKS FOR your hard works
REVIEW FEDERALIZATION
DREAM DREAM
Discovery DISCOVERY

Personal view
Design Design
DESTINY DESTINY