TABLE OF CONTENTS

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TABLE OF CONTENTS……………………………………………………............................viii
CHAPTER ONE
INTRODUCTION...........................................................................................................................1
1.1 Background and Context...................................................................................................1
1.2 Provincial Health Service System.....................................................................................1
1.3 Municipality Health Service System.................................................................................1
1.4 Objectives..........................................................................................................................4
1.5 Methodology.....................................................................................................................4
1.6 Data processing, analysis..................................................................................................6
1.7 Validity and Reliability of study.......................................................................................7
1.8 Ethical Consideration........................................................................................................8
1.9 Logistics Management......................................................................................................8

CHAPTER TWO
DISTRICT PROFILE......................................................................................................................9
2.1 Introduction and Historical background................................................................................9
2.2 Geographical features and Topography...............................................................................10
2.3 Political and Administrative division...................................................................................10
2.4 Location...............................................................................................................................10
2.5 Climate.................................................................................................................................10
2.6 Geographical Profile............................................................................................................11
2.7 Demography of Makwanpur District.......................................................................................11

YCHAPTER THREE
HOSPITAL PROFILE...................................................................................................................17
3.1 Hetauda Hospital Profile......................................................................................................17
3.1.1 Introduction...............................................................................................................17

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 3.1.2 Hospital Development Service Committee..............................................................18
3.1.3 Existing Manpower in Hospital................................................................................18
3.1.4 Infrastructures...........................................................................................................21
3.1.5 Services Provided:....................................................................................................25
3.1.6 Fund Sources............................................................................................................38
3.1.7 Management Process................................................................................................39
3.1.8 Outcome....................................................................................................................44
3.2 Makwanpur Co-operative Hospital......................................................................................48
3.2.1 Introduction...............................................................................................................48
3.2.2 Mission.....................................................................................................................48
3.2.3 Hospital Management………………………………………………............................. 49

YCHAPTER FOUR
HEALTH SERVICE MANAGEMENT AT MUNICIPAL LEVEL.............................................55
4.1 Hetauda Sub-Metropolitan City Profile...............................................................................55
4.1.1 Introduction...............................................................................................................55
4.1.2 History......................................................................................................................56
4.1.3 Area and Boundaries.................................................................................................56
4.1.4 Geography and Climate............................................................................................56
4.1.5 Political and administrative divisons........................................................................56
4.1.6 Religious and tourist area.........................................................................................57
4.1.7 Rivers........................................................................................................................58
4.1.8 Physical Infrastructures............................................................................................58
4.1.9 Natural Resources.....................................................................................................60
4.1.10 Demography...........................................................................................................60

4.2 SUB- METROPOLITAN CITY ADMINISTRATION PROFILE.....................................64

4.2.1 Municipal House (Nagar Sabha)..............................................................................64
4.2.2 Members of Municipal House..................................................................................64
4.3 SUB-METROPOLITAN HEALTH PROFILE...................................................................65
4.3.1 Health Care Delivery System...................................................................................65

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 4.3.2 Health Care System..................................................................................................65
4.3.3 Governmental Line Agencies...................................................................................67
4.3.4 Health Systems in Input, Process and Output Model..............................................67

CHAPTER FIVE
PERIPHERAL HEALTH INSTITUTIONS................................................................................108
5.1 Urban Health Promotion Center (UHPC)..........................................................................108
5.2 Hetauda Health Post...........................................................................................................115
5.3 MOHAN BAJRACHARYA Urbhan Health Center..........................................................123
5.4 Nawalpur Urban Health Center.........................................................................................130

CHAPTER SIX
SUPPORTING ORGANISATIONS...........................................................................................131
6.1 IPAS...................................................................................................................................131
6.2 Marie Stopes......................................................................................................................131
6.3 Green Tara Nepal...............................................................................................................132
6.4 Sunaulo Bhabishya.............................................................................................................133

CHAPTER SEVENY
CRITICAL ANALYSIS ON EMERGENCY SERVICE OF HETAUDA PROVINCE
HOSPITAL..................................................................................................................................134
7.1 Introduction........................................................................................................................134
7.2 Rationale............................................................................................................................134
7.3 Objectives...........................................................................................................................135
7.4 Conceptual framework for critical analysis.......................................................................135
7.5 Methodology......................................................................................................................136
7.6 Analysis Matrix..................................................................................................................137
7.7 Conclusion.........................................................................................................................148
7.8 Recommendation...............................................................................................................148

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YCHAPTER EIGHT
AN EPIDEMIOLOGICAL STUDY ON TUBERCULOSIS OF............................................149
8.1 Introduction........................................................................................................................149
8.2 Clinical Features................................................................................................................149
8.3 Global and national Scenario.............................................................................................150
8.4 Epidemiological Triad of Tuberculosis..............................................................................152
8.5 Epidemiological determinants............................................................................................152
8.6 Mode of transmission.........................................................................................................153
8.7 Rationale............................................................................................................................154
8.8 Objectives...........................................................................................................................155
8.9 Methodology......................................................................................................................155
8.10 Operational definitions.....................................................................................................156
8.11 Finding and Discussion:...................................................................................................156
8.11.8 Recommendations:.......................................................................................................165

YCHAPTER NINE
FIVE YEAR PLAN ON HEALTH CARE WASTE MANAGEMENT IN................................166
HETAUDA HOSPITAL..............................................................................................................166
9.1 Introduction........................................................................................................................166
9.2 Effect on Human Health and Environment........................................................................166
9.3 Global scenario:.................................................................................................................167
9.4 National Scenario...............................................................................................................167
9.5 Rationale............................................................................................................................169
9.6 Methodology......................................................................................................................169
9.7 Process of planning............................................................................................................169
9.8 Vision.................................................................................................................................173
9.9 Mission...............................................................................................................................173
9.10 Goal..................................................................................................................................173
9.11 Strategic points.................................................................................................................174

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 9.12 Objectives.........................................................................................................................174
9.13 Targets..............................................................................................................................174
9.14 Logical framework...........................................................................................................175
9.15 Phase wise action plan.....................................................................................................179
9.16 Budgeting on five year plan.............................................................................................184
9.17 Resources.........................................................................................................................185
9.18 Hospital Waste management Committee.........................................................................186
9.19 Monitoring.......................................................................................................................189
9.20 Evaluation........................................................................................................................190
9.21 Conclusion.......................................................................................................................190

LEARNING REFLECTIONS………………………………………………………………….191

RECOMMENDATIONS………………………………………………………………………192

BIBLIOGRAPHY……………………………………………………………………………...193

PHOTO GALLERY……………………………………………………………………………194

LIST OF ABBREVIATIONS
AFB Acid Fast Bacillus

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 AGE Acute Gastro Enteritis

AHW Auxiliary Health Worker

AIDS Acquired Immune Deficiency Syndrome

ANC Antenatal Care

ANM Auxiliary Nurse Midwife

APD Acid Peptic Acid Peptic Disease

ARI Acute Respiratory Infection

Anti-Retro Viral Therapy

BCC Behavioral Change Communication

BCG Bacillus Calamette Guerin

BEOC Basic Emergency Obstetric Care

BP Blood Pressure

BPP Birth Preparedness Package

CAC Comprehensive Abortion Care

CAT-I Category-I

CBC Complete Blood Count

CBIMNCI Community Based Integrated Management of Neonatal

and ChildhoodIllnesses

CBO Community Based Organization

CDD Control of Diarrheal Diseases

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 CDP Community Drug Program

CEOC Comprehensive Emergency Obstetric Care

CMC Chitwan Medical College

CMA Community Medical Assistant

COPD Chronic Obstructive Pulmonary Diseases

CPR Contraceptive Prevalence Rate

DCMPH Department of Community Medicine and Public Health

DDA Department of Drug Administration

DCC District Coordination Committee

DHIS District Health Information System

DoHS Department of Health Services

DOTS Directly Observed Treatment Short Course

DPT Diphtheria Pertusis Tetanus

Hb Hemoglobin

HDI Human Development Index

HDC Hospital Development Committee

Hep-B Hepatitis B

HFMC Health Facility Management Committee

HFs Health Facilities

HIV Human Immunno-deficiency Virus

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 HMIS Health Management Information System

HO Health Office

HP Health Post

HSM Hetauda Sub-Metropolitan

HWs Health Workers

IDUs Intravenous Drug Users

IPD Indoor Patient Department

IUCD Intra Uterine Contraceptive Device

KAP Knowledge Attitude Practice

LA Lab Assistant

LMD Logistics Management Division

LMIS Logistics Management Information System

MNH Maternal and Neonatal Health

MO Medical Officer

MoHP Ministry Of Health and Population

Me.Su. Medical Superintendent

NA. Su. Nayab Subba

NDHS Nepal Demographic Health Survey

NGO Non-Governmental Organization

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NHEICC National Health Education Information and
Communication Centre

NHP National Health Policy

NHTC National Health Training Center

PHC/ORC Primary Health Care/ Outreach Clinic

PHCC Primary Health Care Center

PMTCT Prevention of Mother to Child Transmission

PNC Post Natal Care

PUO Pyrexia of Unknown Origin

RH Reproductive Health

RHCC Reproductive Health Co-ordination

Committee

RHD Regional Health Directorate

RM Rural Municipality

RMS Regional Medical Store

RRT Rapid Response Team

RTI Respiratory Tract Infection

SM/FP Safe Motherhood/ Family Planning

SMNH Safe Motherhood and Neonatal Health

SMP Safe Motherhood Program

SN Staff Nurse

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SWOT Strength, Weakness, Opportunity, Threats

TB Tuberculosis

TT Tetanus Toxoid

WHO World Health Organisation

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 LIST OF TABLES

Table 1.1: Tools and Techniques of Data Collection......................................................................6

Table 2.1: Boundaries of the district..............................................................................................10
Table 2.2: Demographic information of the district......................................................................11
Table 2.3: Caste and Ethnicity of Makwanpur district..................................................................12
Table 2.4: Languages spoken in Makwanpur district....................................................................13
Table 2.5: Religion followed in Makwanpur district.....................................................................13
Table 2.6: Educational institutions in Makwanpur district............................................................14
Table 2.7:Means of Communication in Makwanpur district.........................................................14
Table 2.8: Source of drinking water..............................................................................................15
Table 2.9: Sanitation Status in Makwanpur district.......................................................................15
Table 3.1: Menbers of Hospital Development Service Committee..............................................18
Table 3.2: Human Resources in Hetauda Hospital........................................................................20
Table 3.3: Infrastructures of Hetauda Hospital..............................................................................21
Table 3.4:List of instrument present in IPD..................................................................................23
Table 3.5:No. of bed in IPD...........................................................................................................23
Table 3.6: Services provided in Hetauda Hospital.......................................................................26
Table 3. 7: Equipments available in Emergency Department.......................................................29
Table 3.8:Emergency drugs available in Hetauda Hospital...........................................................30
Table 3.9 : Equipments available in Hetauda Hospital Laboratory...............................................31
Table 3.10 : Laboratory Services provided in Hetauda Hospital...................................................31
Table 3.11: Duration of pregnancy and abortion...........................................................................34
Table 3.12: Service consumers......................................................................................................36
Table 3.13: Cases recorded at OCMC...........................................................................................36
Table 3. 14: Indicators of Hetauda Hospital..................................................................................37
Table 3. 15 : Sources of Fund for Hetauda Hospital.....................................................................38
Table 3.16: Hospital Performance Indicators................................................................................44
Table 3. 17:Top Ten Causes of Morbidity and Mortality among In-patients FY 2075/76...........44
Table 3.18:Top 10 Emergency and Elective number of operation FY 2075/076..........................45
Table 3.19:Rabies Record 3yr data 73/74, 75/76and 2075/76.......................................................45
Table 3.20:Safe Abortion Indicators FY 2075/76.........................................................................46
Table 3. 21:Medico Legal Cases performed in FY 2073/74-2074/75...........................................46
Table 3.22 : Information regarding the infrastructure...................................................................49
Table 3.23 :Human resources Makwanpur co-operative Hospital………….……………………49
Table 4.1: Reconstructed wards after federalism..........................................................................57
Table 4.2: Types of Roads.............................................................................................................58
Table 4.3:List of Government Schools providing +2 course.........................................................59
Table 4. 4:List of institutes providing +2 and above cours...........................................................59
Table 4.5: Population Distribution according to Ward (Population Census 2068 BS)................61
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Table 4.6: Population distribution according to age group............................................................61
Table 4.7: Population distribution according to Religion................………………….….....…..62

YTable 4.8: Literacy rate in the city...................................................................................................

Table 4.9: Sources of Drinking water............................................................................................62
Table 4.10: Types of waste in the city...........................................................................................63
Table 4.11: HMIS..........................................................................................................................78
Table 4. 12: Immunization Schedule of Nepal..............................................................................81
Table 4. 13 : Vaccination coverage...............................................................................................82
Table 4. 14: IMNCI Performance status in Hetauda Sub-Meetropolitan city...............................84
Table 4. 15: IMNCI Performance status in different HPs in FY 2075/76.....................................86
Table 4. 16: IMNCI Performance status in different UHCs FY 2075/76......................................87
Table 4.17: Nutrition Programme Performance Status in HSM...................................................88
Table 4.18: Nutrition Programme Performance Status(HPs): FY 2075/76...................................90
Table 4.19:Nutrition Programme Performance Status(UHC): FY 2075/76..................................91
Table 4. 20: National family planning programme indicators.......................................................97
Table 4. 21 : Current family planning method users of health posts of Hetauda..........................98
Table 4. 22: Current family planning method users of urban health clinic...................................98
Table 4. 23: New acceptors of family planning devices in HSM.................................................99
Table 4. 24: New acceptors of family planning devices (HPs)...................................................100
Table 4. 25 : New acceptors of family planning devices (UHCs)...............................................101
Table 4.26: FCHV programme Indicators...................................................................................101
Table 4.27: Number of mothers group meeting held(HPs).........................................................103
Table 4.28: Number of mothers group meeting held (UHCs).....................................................103
Table 4.29: Malaria Control Programme Performance Indicators..............................................104
Table 4. 30: Service Statistics HIV Testing in Hetauda Sub-Metropolitan City.........................104
Table 4.31: Service Statistics HIV Testing in Health Post..........................................................105
Table 4. 32: Service Statistics HIV Testing in Urban Health Clinic..........................................105
Table 4. 33: Service Statistics on PMTCT in Hetauda Sub-Metropolitan City...........................106
Table 4. 34: Service Statistics on PMTCT in Health Post...........................................................106
Table 4. 35: Service Statistics on PMTCT in UHC.....................................................................107
Table 5. 1: Equipment available in UHPC.................................................................................109
Table 5. 2: Table: Human Resource of the UHPC......................................................................113
Table 5. 3: Human resources of HP.............................................................................................116
Table 5. 4: Formation of Primary Health Centre Management Committee................................119
Table 5. 5: Human resources of UHC.........................................................................................124
Table 5. 6: Formation of Urban Health Centre management committee..................................126
Table 7. 1 : Tools and techniques used for Critical Analysis Study............................................136
Table 7. 2: SWOT Analysis and TOWS Matrix of Physical Infrastructure................................138
Table 7. 3: SWOT Analysis and TOWS Matrix of Human Resources.......................................139
Table 7. 4:: SWOT Analysis and TOWS Matrix of Command and Control..............................140

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Table 7. 5 : SWOT Analysis and TOWS Matrix of Communication.........................................141
Table 7. 6: SWOT Analysis and TOWS Matrix of Safety and Security....................................144
Table 7. 7: SWOT Analysis and TOWS Matrix of Triage.........................................................145
Table 7. 8: SWOT Analysis of Surge capacity...........................................................................145
Table 7. 9: SWOT Analysis of Continuity of essential services................................................146
Table 7. 10: SWOT Analysis and TOWS Matrix of Logistics and Supply Mansgement...........147
Table 7. 11: SWOT Analysis and TOWS Matrix of Recording and Reporting........................148
Table 9. 1: Logical framework matrix.........................................................................................179
Table 9. 2: Phase wise Action Plan.............................................................................................184
Table 9. 3: Sources of Budgeting................................................................................................185
Table 9. 4: Hospital Waste management Committee Members..................................................187

YY

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 LIST OF FIGURES

Figure 1. 1: Determinants Municipality health service...................................................................3

Figure 1. 2: Process of data collection, analysis and presentation...................................................7
Figure 3.9 : Management process of Co-operative Hospital …...……………....................……

Figure 8. 1: Epidemiological triad of TB.....................................................................................152

Figure 8. 2: Mode of transmission of Tuberculosis.....................................................................154
Figure 8. 3: TB case notification rate..........................................................................................157
Figure 8. 4: Graph showing yearly trend of Tuberculosis over 3 years......................................158
Figure 8. 5: Monthly trend of Tuberculosis in fiscal year 2074/75.............................................159
Figure 8. 6: Quarterly Fig: Quarterly trend of Tuberculosis in fiscal year 2075/76....................159
Figure 8. 7: Place wise Distribution of confirmed cases of Tuberculosis...................................160
Figure 8. 8: Sex wise distribution of Tuberculosis......................................................................161
Figure 8. 9 At the time of TB Diagnosis-Patients tested for HIV Cases,....................................161
Figure 8. 10: At the time of TB Diagnosis-With Known HIV Status Cases...............................162
Figure 8. 11: TB performance indicators F/Y 2073/74, 2074/75, 2075/76.................................162
Figure 8. 12: Treatment success rate (New PBC).......................................................................163
YFigure 9. 1; Classification of waste in context of Nepal............................................................168
Figure 9. 2: Process of planning followed for development of five year plan............................170
Figure 9. 3: Stakeholder Analysis................................................................................................171
Figure 9. 4: Problem analysis for development of five-year plan...............................................172
Figure 9. 5: Objective analysis for development of five-year plan.............................................173

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