Internship/Practicum Project Report

On
Pokhara Metropolitan Health Division

Prepared by-
Narayan Tripathi
PU Regd. No: 2017-4-70-0005
ng.babu28@gmail.com

Submitted to-
Master of Public Health Program
School of Health and Allied Sciences
Faculty of Health Sciences
Pokhara University
2019

1
 Internship/Practicum Project Report
On
Pokhara Metropolitan Health Division

Narayan Tripathi
PU Regd. No: 2017-4-70-0005
ng.babu28@gmail.com

Organization of Pokhara Metropolitan Health Division

Practicum Placement: Pokhara , NewRoad
061532301

Contact: Hemanta Sharma Poudel

Organization Head
9851189394

Faculty Advisor: Dr. Arun Kumar Koirala

Professor, Pokhara University
arunkoirala@gmail.com`
986903935

Master of Public Health Program

School of Health and Allied Sciences
Faculty of Health Sciences
Pokhara University
January, 2019

i
 Acknowledgement

I’m greatly thankful to Mr. Hemanta Sharma Poudel, Chief of Metropolis Health Division for
granting permission for practicum, participate in various activities of Health Division and his
guidance and suggestion during the stay in Health division.

I’m gratefully acknowledging the contributions of entire team of Health Division and Mr.
Chiranjivi Adhikari , Program Coordinator of MPH and supervisor of Practicum Professor Arun
Kumar Koirala and Dr. Deependra Kumar Yadav for their kind cooperation and guidance.

Also I would like to extend profound gratitude to Dr. Om Prakash kalouni, Nurisng incharge
Kabita Pudel , EPI officer Rajuraman Neupane, HA Phuldev Timsina and Dilliram Dahala
and Arjun Bahadur Chhettri for their continuous inspiration, valuable guidance and suggestions
during the entire Practicum.

I acknowledge Health division administration and management for necessary logistic

management. I want to impart vote of thanks to school administration of Gauri Shankar
Secondary School, Pokhara - 25 Hemja for providing approval to conduct our program.

Narayan Tripathi
MPH (HPE)

ii
 Table of Contents
Acknowledgement...........................................................................................................................ii
List of Tables...................................................................................................................................v
List of Figures..................................................................................................................................v
Abbreviations..................................................................................................................................vi
Executive Summary.......................................................................................................................vii
Chapter I: Introduction:...................................................................................................................8
1.1 Background of Metropolitan Health Division:......................................................................8
1.2 Objectives:.............................................................................................................................9
Chapter II: Methodology...............................................................................................................10
Chapter III: Information (Qualitative/Quantitative)......................................................................12
3 Organizational structures:.......................................................................................................12
3.1 Organaogram...................................................................................................................12
3.1.2 Staffing and Job description:........................................................................................13
3.1.3 Staffing pattern:............................................................................................................13
3.1.4 Management of the grievance:......................................................................................13
3.1.5 Supervision:..................................................................................................................14
3.1.6 Budget:..........................................................................................................................14
3.2 Monthly Review Meeting....................................................................................................14
3.3 Logistics Management Information System in Pokhara metropolitan:...............................14
3.5.1 Radio Message development.......................................................................................15
Chapter IV: Analyses/Results........................................................................................................17
4.4: Program Implementation status:.........................................................................................20
4.5 Mini action project...............................................................................................................24
Chapter V: Discussion...................................................................................................................27
Chapter VI: Conclusion and Recommendation.............................................................................29
6.1 Conclusions:.........................................................................................................................29
6.2 Recommendations:...............................................................................................................29
6.2.1 Recommendation for Pokhara Metropolitan (Health Division):..................................29
6.2.2 Recommendation for University...................................................................................30

iii
Chapter VII: Skills/Lesson Learned..............................................................................................31
References.................................................................................................................................xxxii
Appendices...............................................................................................................................xxxiv
Annex I: Placement Letter....................................................................................................xxxiv
Annex II: Approval letter mini action project.......................................................................xxxv
Annex III: Completion letter................................................................................................xxxvi
Annex IV: Approved Action Plan.......................................................................................xxxvii
Annex V: Pictures during practicum.................................................................................xxxviii
Annex VI: Pamphlet of Dengue Fever........................................................................................xl
Annex VII: Radio Message Script.............................................................................................xli
Annex VIII: Approval of Activities Conducted by Metropolis Health Division....................xlii
Annex IX: Different Reports...................................................................................................xliii

List of Table

iv
Table 1: Program Implementation Status......................................................................................20
Table 2: Detail schedule of intervention program.........................................................................25
Table 3 Contents of intervention program.....................................................................................25
Table 4: Knowledge Level on Adolescent Sexual and Reproductive Health................................26

List of Figures
Figure 1: Map of Health Facilities under Pokhara Metropolitan Health Division........................9
Figure 2: Structure Of Metropolitan Health Division...................................................................12
Figure 3: Staffing pattern..............................................................................................................13
Figure 4: BMI classification..........................................................................................................18
Figure 5: Smoking and Alcohol status..........................................................................................19

v
 Abbreviations

AHW Auxiliary Health Workers

ASRH Adolescent Sexual and Reproductive Health
BCC Behaviour Change communication
CB-IMNCI Community-Based Integrated Management of Neonatal and Childhood
Illnesses
DHIS District Health information System
EDPs External Development Partners
EHCS Essential Health Care Services
EPI Expanded Programme on Immunization
FCHV Female community Health Voluntree
FY Fiscal Year
HA Health Assistant
HF Health Facility
HMIS Health Management Information System
IEC Information Education and communication
LMIS Logistic Management Information System
LMD Logestic Management Division
NCD Non Communicable Disease
NGOs Non Governmental Organization
PHCC Primary Health Care center
UHC Urban Health Center
USG Ultrasonography
WHO World Health Organization

vi
 Executive Summary

This is a report of a graduate internship program instituted by Pokhara University with the aim of
exposing Masters Students of employment world to gain experience and sharpen their
employability skills before the completion of their studies. The internship was undertaken at
Pokhara Metropolitan Health Division, According Local Government Operation Act, 2074 local
bodies have responsibility of basic health and sanitation for fulfilling this responsibility of
Pokhara Metropolitan Executive formed Health Division from the beginning of FY2074/74.
(Rewrite the sentence). The Division has direct control over 39 Health Facilities (HFs) under it
and the division is under the Metropolitan Executive Office.

The purpose of Practicum/internship was to observe, participate and engage in various activities,
to critically appraise the present state and mode of the Health promotion, education and
communication status of Metropolitan health Division and to prepare and carry out the prototype
mini project following the systematic step of a project preparation and implementation. During
the practicum period different methods were used for conduction of various activities and fulfill
the objectives. Discussion, Record and Literature review, observation and participation were the
major methods applied.

The major activities conducted during internship were participation in monthly reporting of HF,
Involve in HMIS reporting and Data entry, study and involve in logistic management and LMIS,
Review Annual Program Implementation Status, Involvement in HP activity /program
conducted by municipality (Swasthya jeevan program, yoga and screening program), participate
in the HPEC materials (Dengue Fever pamphlet ) and Radio Message development in Health
Division and Cconduct mini action project on Adolescents Sexual And Reproductive Health
and Mobile app “Khulduli ” after situation analysis. (It would be better if you break the sentence
in 2 or 3 segments.)

Apart from various national level programs, various new programs (Swasthya jeewan program
for NCD, uterine and Brest cancer screening and female reproductive health awareness and
camps, free USG service ) are being planned and conducted . Various health promotional
programs are being implemented with exciting results buts still some health promotional
programs are not being started as we are near of accomplishing 1st six month of this fiscal Year.

The Division at its own also develops different IEC/BBC materials and also broadcast health
messages through various methods and media. HMIS and LMIs Reporting quality has been
questionable sometimes, but the overall activities conducted by Health Divisions are striving to
improve the health of the inhabitants.

vii
 Chapter I: Introduction:
1.1 Background of Metropolitan Health Division:

Pokhara a provincial capital of Gandaki Pradesh is beautiful city in western Nepal. In Mmay
2017, Pokhara was declared as metropolitan; It is the largest in terms of area and 2nd largest in
terms of Population after country’s capital Kathmandu.

Country moved from centralized political system to Federal system, through the constitution of
Nepal 2072,. the Health (Public) system is in the phase of transition to federal context. In this
federal structure local bodies, provincial and central government has responsibility to provide
Right to health of citizen abide by the constitution. Health policy may need to be readjusted by
segregating programs to be included in the domain of center and federation after the country is
transformed into the federal structure.

According Local Government Operation Act, 2074, local bodies have responsibility of basic
health and sanitation (13 different roles). Ffor fulfilling this responsibility, the of Pokhara
Metropolitan Executives formed Health Division from the beginning of FY2074/74.

Along with government health services, private sectors and NGOs are providing their services to
boost up the health status of the people by coordinating with health office. It is playing key role
in creating supportive environment for optimal utilization of the health services by the people.

The overall purpose of the Metropolitan Health Division is to deliver preventive, promotive and
curative health services throughout Pokhara Metropolitan. According to the institutional
framework of the Health Division , the health post/urban health Center (from an institutional
perspective) is the first contact point for basic health services. However, in reality, the HP/UHC
is the referral centre of the volunteer cadres of FCHVs as well as a venue for community-based
activities such as PHC outreach clinics and EPI clinics. The system works as a supporting
mechanism for lower levels by providing logistical, financial, supervisory, and technical support
from the Division to ward UHC/HP/PHC.

8
 Figure 1: Map of Health Facilities under Pokhara Metropolitan Health Division
The Division has direct control over 39 HFs under it and the division is under the Metropolitan
Executive Office. It closely collaborates with Health Office Gandaki province and Provincial
Health Directorate of Gandaki province under Ministry of Social Development.

The report is a requirement for the partial fulfillment of Pokhara University ??. It focuses
primarily on the responsibilities given, observations, project implementation processes,
Delivering the project and mini-project on integrated health promotion, education and
communication based on the needs and on-going programs of Metropolitan Health Division.

1.2 Objectives:

To observe, participate and engage in various activities of Pokhara Metropolitian Health

Division during the practicum or internship?? period.

To critically appraise the present state and mode of the Health promotion, education and
communication status of Metropolitan health Division, Gandaki Province

To prepare and carry out the prototype mini project following the systematic step of a project
preparation and implementation

To involve in the activities assigned by the institutional supervisor

9
 Chapter II: Methodology

During the practicum period different methods were used for conduction of various activities.
Discussion, Record and Literature review, observation and participation were the major methods
applied.
Observation: Organization and various Health promotion program observation along with
IEC/BCC materials produced by Health Division and the logistics management was observed.

Record and Literature Review: various documents of the Organization as well as some
literatures were reviewed to understand the HPEC programs conducted by Division; Design and
Implement for Mini action project. (Rewrite)

Discussion: Discussion with Organization staffs, Supervisor was done to understand the various
programs and aspects of the organization, as well as for mini action project finalization and for
its implementation.

Participation: Involvement in various HPEC activities and Radio Message development.

Participation was made HMIsS data entry training and data entry.

Activities and Approaches applied:

Activities
Review of various activities of Pokhara
metropolitan Health Division
Observing and understanding the organogram
and office administration
Monthly review meeting of HF at municipality
Preparation of action plan
Observe, study and involve in HMIS reporting
and Data entry
Observe, study and involve in logistic
management and LMIS
Observe identify and participate in various
community oriented and environment
(multisectoral ) oriented activities and its
implementation
Observe and study and participate in the HPEC
materials (Dengue Fever pamphlet ) and Radio
Message development in Health Division
Participate in HMIS data entry orientation /
training
Report preparation of HMIS data entry
orientation program
Involvement in HP activity /program conducted
Approaches
Discussion with organizational staffs
How you observed the organogram and other
program??
Participatory observation
Discussion with organizational staffs
Discussion ,observation and data entry
Discussion ,observation and in-depth study
Did you monitor or enter any form??
Observation, Discussion ,study and
participation
Observation, Participation in the
development of health message
Participation
Record review
Discussion participation and measurement

10
by municipality (Swasthya jeevan program, (BMI)
yoga and screening program conducted by
metropolitan
Review Annual Program Implementation Status Review of annual Plan and Discussion with
Organization staffs
Co-ordination with Hemja Health Post and Gauri Rapport and Discussion about the Program
Shankar School for Mini action Project
Conduct mini action project on Adolescents Situation analysis
Sexual And Reproductive Health and Mobile Mini lecture
app “Khulduli ” Discussion

Report writing of Mini action project Consultation With Metropolis Health

Division Chief
Presentation of The practicum in the Health
Division

11
 Chapter III: Information (Qualitative/Quantitative)
3.1 Organizational structures:

3.1.1 Organaogram
The organogram of Pokhara metropolitan is mentioned below:

Pokhara Metropolitan City (Mayor)

City(nagar) Executive Office

Health Division

Urban Health Health Post Health Hospital-1

Ayurvedic
aushadhalaya Centers-15 -19 promotion
PHC-2
-1 center -1

PHC/ORC 88 FCHVs-654 EPI clinics 112

Figure 2: Structure Of Metropolitan Health Division

To fulfill the local bodies responsibility of basic health and sanitation According Local
Government Operation Act 2074, Pokhara metropolies Health division have 39 hHealth
fFacilities under it for delivery of Preventive, promotive and curative services, (Make two
sentences)

12
3.1.2 Staffing and Job description:
The job description of all positions is not well mentioned as well as the created posts are not
permanent so there is a lot of dilemma in the employees. The posts created in Health Division are
not sufficient to describe job as previously done in the DPHOs. There is shortage of Human
resources to implement its annual pPlan and function the statistical and logistics section.
(Discussion with organization chief)

3.1.3 Staffing pattern:

Altogether there are fourteen staffs. The staffing pattern is mentioned below:

Total -14 staffs

Health section-9 Administration -5

• Organization Head -1 • General Administration -2

(Officer 10th level)
• Office Helper-2
• Ayurvedic Doctor -1
• Driver-1
• Nursing Incharge-1

• EPI supervisor-1

• HA (officer ) – 2

• Sr.AHW-1

Support: 2 from HERD International

Medical Doctor: 1, Public Health Expert: 1

Figure 3: Staffing pattern

3.1.4 Management of the grievance:
Grievance is managed by reporting to the higher authority and the authority provides
management options based on the issue or problem. The problems that could be solved by the
Chief of health division is solved at division and those that couldn’t solved are reported to
metropolitan executive office.

13
3.1.5 Supervision:
Supportive supervision is practicing to promote the quality of service delivery. The division
staffs are visiting the service delivery sites (HFs) and fields. Supervision checklist, JD, working
plans, supervision guideline also in HR policy, registers and reports, attendance sheet and action
plan are used. Supervision is done at least twice a year but also according to the need of
programs. and HFs the supervisions are made at regular interval.

3.1.6 Budget:
Apart from administration cost the Metropolitan has sanctioned 210,000,000 (twenty one Two
hundred and ten million rupees) for its programs from its total budget of 6,179,258,000 (six
billion one hundred and seventeen 17 million rupees)

3.2 Monthly Review Meeting

Monthly review meeting is organized by Metropolis health division every month for situation
analysis of Hhealth situation with in the Metropolis and discussion on health program
implementation and progress update.

The health institutions (HP/PHCC/UHCs) Under Metropolitan Health Division monthly gather
monthly in ever 3rd day of next month for monthly review meeting. (Rewrite)

In the meeting monthly report from health facilities are also collected by division and
Ddiscussion on HMIS 9.5 reporting is conducted for improving the data quality and data
enhancement.
Major issues discussed:
 HMIs Reporting and its quality
 Quality improvement of Health services.
 Case notification status for outbreak identification.
 HMIs Reporting and its quality (Repeated sentence)
Monthly reporting of Health facility were cross tallied by other participants for each HFs HMIS
report. The major entry mistake was made on
- Immunization
- CB-IMNCI
- Population by ethnicity
3.3 Logistics Management Information System in Pokhara metropolitan:

Essential medicine is supplied by LMD through Health office (Medical store) and the
unavailable and urgent medicines and equipment are procured through the municipality.

There is procurement unit in the municipality for procurement, Health division provides the
technical support to the procurement unit .The procurement is done according to the public
procurement aAct.

14
At present a hybrid ‘push-pull’ system has been in place with a provision of procurement budget
at local levels. It collects and analyses quarterly (three monthly) LMIS reports from all of the
health facilities across the Municipality

3.4 Data entry of Health facilities:

HMIs 9.3 collected at monthly review meetings by division from each HFs in filled HMIs file
form. No online reporting at HFs level through each HFs has their own. User account, HFs
monthly reporting are reported to Online by Health Division Staffs in HMIS system through
Divisions user account regularly. (Rewrite) Due to limitation of Human resources specified to
statistics timely online reporting has been sometime problem. Data reporting from private
institutions are in dilemma where to submit report, either to former DPHO or at metropolis
Health Division

3.5 HEIC material development:

The municipality at its own also develops different IEC/BBC materials and also broadcast health
messages through various methods and media.

IN FY 2075/76 the health division developed the Pamphlets on Dengue, Health message
broadcasting through radio and Published through print media on Dengue, and vitamin A. It had
also conducted miking on various issues at different places of Metropolitan. The metropolis
health Division though new in its structure in operation has initiated and conducted various
activities in IEC/BCC material development.

3.5.1 Radio Message development

With guidance and supervision from metropolis Health division chief Mr Hemanta Sharma
Poudel and other staffs of Health division a radio message script was developed.

Relevancy of Topic: Cold waves along with suffocation with carbon monoxide in between
2001-2010 affected 1793 people and associated to 376 deaths. Each year multiple death occur in
Nepal by carbon monoxide poisoning being left coal and gas heater on throughout night.

The radio Message script is Placed in Annex VII:

3.6 Metropolitan initiation in Health Promotional programs:

Apart from various national level programs various new programs are being planned and
conducted, they are :food and water quality monitoring, tobacco product control monitoring and
regulation, healthy mother healthy child program, uterine and Breast cancer screening and
female reproductive health awareness and camps, free USG service for pregnant women and
NCD control and awareness program (including trainings) adolescent target program, school

15
Eye and Oral health program, School First aid training and program,  Healthy life “swasthya
jeewan” Ayurveda program and yoga camp.

The division is also starting a Health Promotion center in Pokhara-8, and has announced
vacancy for its staff recruitment. Apart from regular health Services as usual from the HPs the
Health promoting center will be conducting various health promotional activities( as described
by metropolitan chief; it will be conducting Youga classes, screening programs for NCDs,
cancelling and Behaviour change awareness programs )

16
 Chapter IV: Analyses/Results

4.1 Critical analysis of Dengue fever Pamphlet (IEC material Developed by metropolitian):

The pamphlet is attached on Annex VI:

4.1.1 Strength of dengue fever pamphlet:

Use of the theme:

Theme was well developed and was properly reflected throughout the pamphlet

Simplicity of the statements:

Words of the messages were simple

Typography (font):

Font size was well fitted for viewing along with the boldness in the headings.

Less use of jargon and technical word:

The pamphlet has less used the jargon and technical words

 4.1.2 Weakness of the dengue fever pamphlet:

Lack of color variation:

It lacks the color variation which is most effective way for making the pamphlet eye catching
and more appealing.

Lack of picture or image:

A good ideal of the information in the brochure can be presented along with the attractive
images but the pamphlet is not comprised of that.

No generation of fear:

People should somehow made to arise the fear so that they would increase their intention to
reduce the risk of dengue. But it lacks that property.

17
4.2 Swasthya Jeevan program:

Swastha Jeevan Program is one of the pioneer programs for NCD reduction conducted by
Pokhara Metropolotian Health Division.The program is funded by Pokhara metropolitan and
conducted at Gandaki Zonal Ayurvedic Ausadhalaye through Metropolitan Health Division at
pokhara 26 Sundaribazzar.
The Yoga classes are usually conducted from 6-7 am and then individuals are screened for NCDs
like diabetes, hypertension, overweight, CVD risk and COPD. After the screening herbal tea and
Silajeet is offered to the individuals. Individuals are also counseled for healthy life styles and
healthy eating. The municipality has sanctioned Rs 300000 (three lakhs hundred thousand ) for
this program in its annual Budget. During the visit of swathya jeevan program : following was
the situational observation of screening program ;

4.2.1 BMI classification:

Among 300 participants 20 were underweight, 70 had normal weight,150 were overweight ,40
fall under class I obese whereas remaining 20 fall under class ii obese.

BMI classification

150

70
40
20 20

Underweight Normal weight Overweight Class I obese Class II obese

Figure 4: BMI classification

These shoes the scenario of overweight and obesity as well as there is increase of other risk
factor for NCDs like Smoking and Alcohol and sedentary life style. So the Division Has to
intensify the programs for NCDs prevention and awareness for behavior change.

18
4.2.2 Smoking and alcohol status of the participants:

Smoking and alcohol status

83
90

17
10
Smoking Alcohol

Figure 5: Smoking and Alcohol status

During the interview with the participants in screening program 10% were found to be smoker
and 17% were alcoholic.

4.3: Orientation program on online data entry to private health facility pokhara
metropolitan city

With the objective to build the capacity of statistical officers of private Health Facility (HF) on
data management and data quality and to orient on the private health facility staffs on
DHIS/HMIS 9.5 for online reporting was conducted by Mmetroplitian health Division on 27th
December 2017 in division’s seminar Hall where 10 private health facility statistical personals
including me myself were the participants; the orientation program was helpful in (Break the
sentence)

• Understanding of DHIS and HMIS, its aim and its importance by private hospital
participants.

• Understanding of role of private health facilities in HMIS reporting.

• Data entry of Hospitals data in HMIS 9.5

19
 • Identification of major areas where data entry mistakes occurs and its minimization skills
as well as complete data entry.

4.4: Program Implementation status:

Health Sector Programs of Metropolitan Health Division for FY 2075/76

Table 1: Program Implementation Status

Partly Fully
Starte Not imple implem
Program list d stared mented ented Remarks
1)      Work plan and Policy
s
Health policy tarting from
implementation plan Friday 6th of
development poush
    Community audit  
   Monthly Report
collection and Review  
   Meeting  
2)      Quality improvement and monitoring
  Food and water quality water started/ food quality
monitoring     not started

Tobacco product control

monitoring and regulation  
  Private HF monitoring
and meetings  
3)      Child Health Program
Healthy mother healthy
child program   primary phase going
Full immunization
continuity and continued but major
sustainability function from Baishak
Immunization month
(Baisakh ) program  
Rota Virus Immunization
program   central level/ not fixed
Building a Immunization 3 center development in
center   progress
Vitamin A and
Dewaorming tablet
Distribution program  
  Guideline not approved

20
Nutraition program
(Including golden
thousand days)
Continuity of CB-IMNCI
program  
4)      Family Health program
Operate FP satellite clinic  
Outreach (gaunghar
clinic ) and EPI clinic
transport cost  
VIEA materials
procurement and form
print and monitoring  
Uterine and Brest cancer
screening and Female
reproductive health
awareness and camps   3 completed
Family panning service  
ANM recruitment in
birthing center  
Nyano jhola procurement
and Distribution  
Free USG service for
pregnanent women  
Orientation prior 6 camps completed/ pre
sterilization camp   orientation
Emergency blood supply
Service for pregnant In collaboration with Rakta
women   sanchar Red croos
5)      FCHV program
FCHV day  
FCHV basic training and planning phase and location
kit   identification
FCHV respectful leave
package  
Bag and umbrella or
FCHV materials   FCHVs
FCHV monthly transport
expenditure   Each HF conduct

6)      Disease control program

NCD control and some area covered/
awareness program especially in Lekhnath in
(including trainings) collaboration with Nepal
  Bikas samaj

21
TB center DOTS
sahayaogi
recruitment/continuity  
STI and OI management
program  
7)      School health program
Adolescent target
program  
School Eye and Oral
health program  
School health education
program   Dengue and others ongoing
School First aid training
and program  
8)      Mental Health program
Mental health program
(training and Counseling)  
9)      Health education information and communication
IEC/BCC materials
production
(development), print and Dengue done 60 thousand
publish   pieces
Health message from
radio  
Ward health campaign     3 wards
Health days celebration
10)  Epidemic management
 
Epidemic management   dengue and seasonal flue
11)  Ayurveda and optional health program
Continuity of ayurveda
service from HF center
17  
Procurement of
Aryuvedic medicine  
Extend and upgrade
ayurveda service and
Celebrate ayurveda days  
Data enhancement internal resource
management in regular
  meetings
Health employee
ayurveda program   Hw training on Ayurveda
Healthy life “swasthya  
jeewan” ayurveda

22
program
Ayurved and yoga camp  
12)  Logistic management

Essential medicine
procurement and
transport
Procurement and supply of Health
equipment in newly established
HFs  
Tools print
Procure, supply and
repair Health equipment
Store management and Estimation
of Health materials workshop  
13)  Capacity Building program
Report writing and
financial management
training  
DMT and other trainings to new
Health workers and those who
haven’t received  
Training and materials
procurement for infection
prevention  
Programs related to GBV   conducted in collaboration
14)  Supervision and monitoring
HF monitoring    
Travel allowance for HF    
15)  Waste management
Waste management of
HFc  
Health program in landfill
site  
16)  HF function and grant
Hospital, Health centers
and health sector grant   Starts with in one weeks
17)  Institutional development and extension
Establish and run Health
Ffacility with Doctor , lab
and x-ray   guideline in progress
Community nursing
program   guideline in progress
Establish Urban Health

23
centers ( wards not
having HFs)
Blood transfusion
Institutionalization
management and in progress at discussion
improvement   level
Metropolitan Health
structure development  

4.5 Mini action project

Physiological risk factors depends largely on the initiation of health compromising behaviors.
The metropolitan health division has planned the program Adolescent target program in School
Health program for this FY program but it hasn’t been started yet.

The mini action project (Adolescents targeted school Health Program) was Designed and
Implemented as the metropolitan had sanctioned budget for Adolescents targeted program in its
annual plan, but adolescent related concrete plan was not developed. so I developed the school
health program on adolescent Sexual reproductive health and a Mobile app “Khulduli” for
adolescent Knowledge and Practice enhancement and meet the Divisions annual program and
also for the modification of behaviors or the risk factors before behavioral patterns are more fully
established and resistant to change. (Break the sentence)

Intervention Program

Date 3rd January 2019

Time 12:00 Pm - 1:00 pm

Venue Gauri Shankar Secondary School, Pokhara - 25 Hemja

Table 2: Detail schedule of intervention program

S.N Programme Facilitator Time Remarks

1 Inauguration/ Introduction Narayan Tripathi 12:00Pm-12:10 pm  

2 Pre- Test Narayan Tripathi  

24
 Intervention

• Mini lecture

• Power point
presentation

• Key messages sharing Narayan Tripathi

3 • Group discussion 12:10-12:45 pm  

Narayan Tripathi

4 Documentary show 12:45-12:55 pm  

5 Closing Narayan Tripathi 12:55-1:15 pm

IEC/BBC materials Hand

6 Over to School Library

Table 3 Contents of intervention program

Contents of intervention program

SN Contents Methods and Media Responsible Person  Remarks

Introduction about • Mini lecture

adolescents and
changes during • Power point
1. adolescent presentation Narayan Tripathi

• Mini lecture
Adolescent
sex/sexuality and • Power point
2. menstruation presentation Bijaya Parajuli

• Mini lecture

• Power point
STIs and presentation

3. Life Skills • Group discussion Narayan Tripathi

• Group discussion
4. Adolescent Narayan Tripathi
friendly health • And Mobile

25
 services and
ASRH knowledge
through internet
(Khulduli Mobile
app) application show

Table 4: Knowledge Level on Adolescent Sexual and Reproductive Health

Total score of knowledge on Adolescent Sexual and Pre test post test
Reproductive Health
Frequenc Percent Frequenc Percen
y y t
Poor knowledge (<60%) 21 67.7  1 3.2

Moderate knowledge (60 -80%) 10 32.3 10 32.3

Good knowledge (>80%) 0 0 20 64.5

Total 31 100 31 100

The study revealed that more than two third of the adolescents (67.7%) had the poor knowledge
on Sexual and Reproductive Health after the intervention nearly two third had acquired good
knowledge (64.5%) on it.

Chapter V: Discussion

No any record was made for Dispatch of HPEC materials and its demand collection.
Ciprofloxacin ophthalmic is was not in stock. In Medicine supplied by health office Kaski,
medical store, if any deficit fulfilled by procurement by Health division through executive office
of municipality Health facilities not properly filling ASL and Demand order correctly in
trimester LMIS form. (Rewrite) No specific mechanism for collection of need of medical
equipment needed, which was similar with the national Scenario of Low stock of essential Drugs
and Inadequate of HMIS/LMIS tools and late supply (annual report 2073/74). HMIS 9.3 report
of HFs has been questionable at different points in the data quality and seen not responsibly
reporting.?? (There is mechanism but may be not followed properly where as in present context
may not be proper mechanism. Think and write again.)

26
Therefore with the one day orientation program on HMIS form fill up data entry and data entry
was conducted to improve the data quality and coverage of HFs in HMIs online reporting. (Make
more clear)

Various health promotional programs are being implemented with exciting results buts still as
similar with the other developmental sectors program implementation , some health promotional
programs are not being started as we are near of accomplishing 1st six month of this fiscal Year.

Some health promotional programs have been planned by other sectors (e.g Social Development
sector, waste management etc ) needs close collaboration with Health Division. ButThe
programs is being conducted without collaboration with Health Division, without studying and
understanding the health impact of these sectors has not been well studied and understood. As
seen in the national scenario the lack of coordination between the governmental bodies has also
been seen in developing and implementing the cross cutting isssues of Health like waste
management, air quality in Pokhara metropolitan Health division.

In a mini action project, our school health education program targeted for adolescent has got
good results in increasing good enhancing knowledge on Sexual and Reproductive Health.
Similarly in a school- based intervention study carried out in Chetla, Kolkata showed that twenty
to fifty per cent of the students answered all the questions about reproductive health correctly
before the course, and 70 – 100% of them at the end of four months. Mean knowledge score
increase in post intervention (Das and Pal,2010). The similar Health Education program was
planned for at least one school in each ward of Pokhara metropolitan.

27
 Chapter VI: Conclusion and Recommendation
6.1 Conclusions:

This report has compiled my as per experiences and engagement with gained in Pokhara
Metropolitan Health Division. This report shows my the findings of observation and analysis in
their daily activities as well as in variouss programs implementation.

The Metropolitan Health Division conducts various HPEC programs and activities, for health
promotion. ; it develops and distributes HPEC (IEC/BBC) materials to HFs under it and through
different programs it reaches to the community people. In the context of IEC/BCC reference
materials, library of the Division has very limited spaces and not all the IEC materials could be
displayed. This has limits the choices for Local HF staffs to detect new and required IEC
materials and update on existing IEC/BBC materials.

It (what?) conducts various national level programs and Its own annual programs for the
betterment of Peoples’ health and visualize the concept of Healthy City. “Swastha Jeevan
Program” is one of the pioneer programs for NCD reduction. It has to be scaled up at each HF
level in a phase wise manner. The Division has been working in data quality improvement and
increases the online HMIs reporting through the HFs at local level. Similar school Health
education programs targeted to Adolescents could increase the ASRH knowledge and has to be
scaled up.

In this federal structure local bodies have responsibility of basic health and sanitation. and
Pokhara Metropolitain executive office is striving to fulfill its responsibility towards the citizens
Health.

6.2 Recommendations:

In spite of considerable achievement in the health sector of Pokhara metropolitan and country
progressing towards positive direction, there are still many problems and challenges that need to
be addressed. Some recommendations for Pokhara Metropolitan Health Division and University
are

6.2.1 Recommendation for Pokhara Metropolitan (Health Division):

 Pokhara Metropolitan has to create a permanent staffs positions at Health Divisions.
 The division has to establish a IEC/BCC material development section under it through
enrollment of specified manpower for IEC materials development.

28
  The division has to establish and strengthen the IEC/BBC materials logistics and
information and has to build a well-equipped and specious metropolitan reference library
for IEC/BCC materials through collaboration with Metropolitan and NHEICC and other
related sectors.
 The division has to concentrate on digital IEC/BCC materials development in this
Digitalized world with close collaboration with multiple sectors for NCD awareness and
prevention.
 HMIS and LMIs Reporting quality enhancement training should be conducted to
minimize the faults and increase the data quality.
 The division has to develop specific targets for program implementation in time.

6.2.2 Recommendation for University

 The university has to develop an agreement (MOoU) with organizations so that it would
be easier for its students to fully participate in the organization.
 The supervisor has to be assigned prior moving to the internship so that better
coordination could be made.
 The university has to made provisions for some allowances for students and payments for
organizational supervisors.
 The supervisor has to better coordinate with respective Organizations and has to be
present in final presentation at the organization.

29
 Chapter VII: Skills/Lesson Learned

“We might have an idea about what a job is like but we won't know until we actually perform
or view deeply it if it's what we thought it was.” As explained by this saying during the 21 days
internship in Pokhara Metropolitan Health Division and being engaged in above mentioned
various activities. I had and great opportunity to apply the theoretically learned exercises in to
the real field. The major Skills that has been acquired during the internship are :

• Real field experience of Health sector program implementation

• Enhancement the professional communications

• Skills in message designing and message delivery mechanisms.

• Coordination skills

• Health promotional program planning and implementation skills

• HMIS and DHIS reporting and data quality enhancement skills

30
 References

Adhikari P, Kadel B, Dhungel SI, Mandal A, 20017.Knowledge and practice regarding

menstrual hygiene in rural adolescent girls of Nepal. Kathmandu University medical journal
2007; 5(3): 382-6.

Alim, A., Nahar, A. and Khatoon, F.Z., 2012. How the Adolescents Applied their Learning in
their Lives: An Evaluation of the Adolescent Development Programme of BRAC. Dhaka:
BRAC.

Bangladesh ARH Strategy, 2006.Bangladesh Adolescent Reproductive Health Strategy.

Center Bureau of Statistics, 2012. National Population and Housing Census.

Dahal G, Hennink M and Hinde A ; 2005. Risky sexual behaviour among Young Men in Nepal,
Applications and Policy Working Paper A05/01 England: Southhampton University

Edmeades, J., Hayes, R., Hollingworth, G. and Warner, A., 2012. The girl effect: What do boys
have to do with it? Meeting report.

GIZ/GFA, 2012. Sexual and reproductive health status and health service utilisation of
adolescents in four districts in Nepal: baseline report. Kathmandu: GIZ/GFA, Health Sector
Support Programme, Ministry of Health and Population, Government of Nepal.

Igras, S.M., Macieira, M., Murphy, E. and Lundgren, R., 2014. Investing in very young
adolescents' sexual and reproductive health. Global public health, 9(5), pp.555-569.

Khatiwada, N., Silwal, P.R., Bhadra, R. and Tamang, T.M., 2013. Sexual and reproductive
health of adolescents and youth in Nepal: Trends and determinants. Further analysis of the 2011
Nepal Demographic and Health Survey.

Kothari, P., 1994. The need of sex education for adolescents in India.

xxxii
Lewis J., 2016. The Physiological and Psychological Development of the Adolescent: Yale-New
Haven Teachers Institute; [04/07/2017]. Available from:
www.teachersinstitute.yale.edu/curriculum/units/1991/5/91.05.07.x.html.

Mandal, K., 1998. Teaching adolescent school girls about menstrual hygiene. Indian J nursing
midwifery, 1, pp.19-26.

Ministry of Health and Population, 2012. Nepal Adolescents and Youth Survey 2010/11.
Kathmandu: Ministry of Health and Population, Government of Nepal.

MOHP, 2010. National adolescent’s health and development strategy;

NCASC, 2008. Cumulative Data of HIV and AIDS. Kathmandu: National Centre for AIDS and
STD Control.

NDHS, 2011. Nepal Demographic Health Survey. Kathmandu: New Era/Ministry of Health.

NDHS, 2016. Nepal Demographic Health Survey. Kathmandu: New Era/Ministry of Health

PIP-HPNSDP, 2011.Health, Population and Nutrition Sector Development Program (2011-

2016): Program Implementation Plan, Volume -I. 2011 p. 40–1.

Sanzero L and Mahat G., 2003. Psychological Factors in Nepali Former Commercial Sex
Workers with HIV. Journal of Nursing Scholarship, 2003:53-60.

World Health Organization, 1997. Adolescence the critical phase: the challenges and the
potential.

World Health Organization, 1997. Coming of age: from facts to action for adolescent sexual and
reproductive health.

Appendices

xxxiii
Annex I: Placement Letter

xxxiv
Annex II: Approval letter mini action project

xxxv
Annex III: Completion letter

xxxvi
Annex IV: Approved Action Plan

xxxvii
xxxviii
Annex V: Pictures during practicum

During Monthly review meetings

xxxix
 Supervisor sir from university at work place

During School health education “Mini action project ”

xl
Annex VI: Pamphlet of Dengue Fever

xli
Annex VII: Radio Message Script

lr;f] df};ddf :jf:Yo ;d:ofaf6 hf]lug

ckgfpg' kg]{ ;fjwfgLx? !!!!!!
 lr;f] df};dn] ;a}nfO{ c;/ ug]{ ePtfklg gjhft lzz',
jfnjflnsf, ;'Ts]/L,j[4,bL3{/f]uL, czSt JolQmx?nfO{ lr;f]n] jl9 c;/
ug]{ xF'bf pgLx?sf] ljif]z x]/rfx ug'{kb{5 .
 hf8f] df};ddf ljif]ztMGofgf] sk8f nufpg],tftf] u/L a:g], tftf] vfg]s'/f
vfg] / k|z:t emf]lnnf] kbfy{ vfg] ug'{kb{5 .
 w]/} lr;f] a9]sf] ;dodf 3/leq} j:g'kb{5,cTofjZos sfdn] 3/jflx/ jf
v]tjf/Ldf hfg'k/]df Gofgf] sk8f nufO{ jf cf]8]/ hfg'k5{ .
 /ftL ;'Tbf cfuf], sf]O{nf jf Uof; lx6/ jfn]/ ‰ofn 9f]sf aGbul/ ;'Tg'
x'Fb}g .
 sf]7f tftf] kfg{ cfuf], sf]O{nf jf Uof; lx6/ jfNbf ‰ofn 9f]sf af6
xfjf k:g ;Sg] Joj:yf ldnfpg' kb{5, xfjf gk;]sf] cj:yfdf cS;Lhgsf] sdL
eO{ Hofg klg hfg ;S5 .
 lr;f] jf6 hf]lug] ljZjf;df dfbs kbfy{ h:t} /S;L ;]jg ug{ x'Fb}g . dfbs
kbfy{ ;]jg ugf{n] zl//sf] tfks|ddf sdL cfpg ;S5 / :jf:Yodf ulDe/
;d:of cfO{ Hofg klg hfg ;Sb5 .
 lr;f] df};ddf ;d'bfo jf kl/jf/sf s'g} JolQm lj/fdL eP tTsfn} glhssf]
:jf:Yo ;+:yfdf ;Dks{ /fVg'kb{5 .

पोखरा विश्वविद्यालय
स्कूल अफ हे ल्थ एण्ड एलाइड सऐन्सेज

xlii
Annex VIII: Approval of Activities Conducted by Metropolis Health Division

xliii
Annex IX: Different Reports

xliv