Human Resource For Health

BPH VIII SEMESTER
HUMAN RESOURCE FOR

HEALTH
HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA

BIRAT HEALTH COLLEGE
UNIT 1: INTRODUCTION TO HUMAN RESOURCE AND DEVELOPMENT
1.1: Concept and definition of HR and HRD
Human resources (HR)
Human resources is used to describe both the people who work for a company or organization
and the department responsible for managing resources related to employees. Human resources
are the people who make up the workforce of an organization business sector. The term human
resources was first coined in the 1960s when the value of labor relations began to garner attention
and when notions such as motivation, organizational behavior, and selection assessments began
to take shape.
Definition
William R. Tracey, in The Human Resources Glossary, defines Human Resources as: "The people
that staff and operate an organization," as contrasted with the financial and material resources of
an organization. A Human Resource is a single person or employee within your organization.
Human resources represent the most important asset of organizations. The achievement of the
organizational goals depends largely on the efforts and performance of people working in
organizations.
Functions of HR
 Effectively managing and utilizing people.

 Tying performance appraisal and compensation to competencies.
 Developing competencies that enhance individual and organizational performance.
 Increasing the innovation, creativity and flexibility necessary to enhance competitiveness.
 Applying new approaches to work process design, succession planning, career
development and inter organizational mobility.
 Managing the implementation and integration of technology through improved staffing,
training and communication with employees.
Human resource development (HRD)

Concept of HRD
Human resources represent the most important asset of organizations. The achievement of the
organizational goals depends largely on the efforts and performance of people working in
organizations. Human resource development is concerned with increasing the knowledge, skills,
attitudes and capabilities of people in organizations. Achieving HRD excellence leads to
organizational excellence.
People become human resources when they also acquire competencies, such as knowledge, skills,
attitude, experiences and growth potential. HRD is concerned with developing competencies of
people in organizational settings. It ensures that organizations have adequate human resources
with skills and capabilities needed to achieve goals effectively.
Definition
Human resource development is concerned with preparing employees to work effectively &
efficiently in the organization. (Decenzo & Robbins)
HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 1

HRD is organized learning experiences in a definite time period to increase the possibility of
improving job performance & growth. (Leonard Nadler)
HRD aims developing a variety of competencies of employees & developing a culture in the
organization to utilize these competencies & contribute to organizational growth. (T.V. Rao)
Hence from the above definition we can conclude that HRD is a set of inter-related activities, by
which human potentialities are assessed, selectively upgraded & appropriately deployed for
achievement of envisioned goals which foster human dignity.
Characteristics of HRD
The essential characteristics of human resource development
 Human Focus: It is concern with the human element in organization. It puts people first.
 Learning Experiences: It consists of organized learning experiences. New knowledge and
skills are acquired.
 Time-bound: It is time-bound. There is a definite time period for completing a particular
phase of learning.
 Competency Enhancement: It enhances employee competencies required to perform
current and future jobs. It is a continuous effort.
 Job Performance: It aims at improving job performance to achieve organizational goals
efficiently and effectively.
 Mechanisms: it consists of variety of mechanisms, such as training, management
development, career planning and development, performance appraisal and counseling,
employee welfare, organizational development and reward management.
 Culture: It develops an organization culture which provides opportunities for the use of
competencies by employees.
1.2: Function of HR and HRD

Function of HR/ HRM
 There are mainly 2 function of HR/ HRM

o Primary function
o Secondary function
Primary function:
 HR Planning: Predicting changes in management strategies and future HR needs.

 Equal Employment and Opportunities: To satisfy both the legal and moral
responsibilities of the organization through the prevention of discriminatory policies,
procedure and practice.
 Staffing: Activities designed for the timely identification of potential applicants for
current and future openings.
 Compensation and Benefits: Responsibility for establishing and maintaining an
equitable internal wages structure, a competitive benefit package, incentives tied to
individual, team or organization performance.
 Employee relations: Developing a communication system where employees can address
their problem and grievance. Else it leads to labor union, contract negotiation and
administration.

 Health, Safety and Security: Activities seek to promote a safe and healthy work
environment. This can include action such as safety training employees assistance
programs and health and wellness programs
 HRD: Activities intended to ensure organization members have the skills or competencies
to meet current and future job demands.
Secondary Function:
 Organizational/ Job design: Concerned with interdepartmental relations and

organizational and definition of jobs.
 PMS: Used for establishing and maintaining accountability throughout the organizations.
 Research and information system: Necessary to make enlightened HR decisions.
Function of HRD
1. Training and development
Training – improving the knowledge, skills and attitudes of employees for the short-term,
particular to a specific job or task – e.g.,
 Employee orientation
 Skills & technical training
 Coaching
 Counseling
Development – preparing for future responsibilities, while increasing the capacity to perform at
a current job
 Management training
 Supervisor development
2. Organization development
OD is the process of increasing the effectiveness of an organization along with the wellbeing of its
members with the help of planned interventions that use the concepts of behavioral science. Both
micro and macro changes are implemented to achieve organization development
3. Career Development
Ongoing process by which individual's progress through series of changes until they achieve their
personal level of maximum achievement.
 Career planning
 Career management
Challenges for HRD
 Changing workforce demographics

 Competing in global economy
 Eliminating the skills gap
 Need for lifelong learning
 Need for organizational learning

1.3: HRD in the context of organizational development.
 HRD is concerned with preparing employee to work effectively & efficiently in the
organization.
 HRD aims at developing a variety of competencies of employee & developing a culture in
the organization to utilize these competencies for & contribute to organizational growth.
 HRD in the context of organizational Development is expressed as the techniques for
bringing change in the entire aspect of organization rather than focusing on individual so
that change in easily observed.
 HRD brings change in organization environment where people work. It creates human
Responsive.
Facilitate
Environmental
adoption
Develop Managerial
competencies succession
Need for
HRD in
Increase Org. Dev. Future Growth
productivity & change
Increase Manage change

commitment & conflict.
Beside this:
 HRD programs impacts & effect on organizational efficiency.

 Efficient human resource design, develops & implement the program effectively and
efficiently.
 Manage the organizational learning system
 Support in planning, staffing, controlling & coordinating activities of the organizations.
 Support in strategic planning and integrating of HRD into the organization.
 Support to develop well defined and effective networks.
 Evaluate of carrier development programmes and OD activities
 Improve performance & productivity of organization through increased knowledge,
competencies, skill & attitudes.
 Helps in critical thinking and organizational decision making.
 Material development and management.

 Helps in everyday operations of the organization.
 Supports in staff recruitment, selection, evaluation and development.
 Environmental maintenance.
 Research activity.
From above diagram we can conclude HRD plays vital Role in organizational development.
1.4: Interrelationship among planning, production and utilization (management) cycle in

HRD
HRD is a complex task of identifying human resource needs and the action to be taken to satisfy
these needs. It is systematic approach to ensure that the right people will be in right place at the
right time so that organization can achieve its overall goals.
HEALTH SYSTEM EDUCATION SYSTEM
H. R. PLANNING H. R.
PRODUCTION
H. R.
UTILIZATION
Interrelationship between planning, production and utilization (management) cycle in HRD.
Human Resource Planning: HR planning is the process of estimating the numbers of persons
and the kind of knowledge, skill and attitudes they need to achieve predetermined health targets
and ultimately health status objectives.
Such planning also involves specifying who is going to do what, when, where, how and with what
resources for what population groups or individuals so that the knowledge and skills necessary
for adequate performance can be made available according to predetermined policies and time
schedule.
Human Resource Planning must be in a continuing process and continuous monitoring and
evaluation is required.
Human Resource Production: The justification for all the HR planning is the production and a
supply of health workers to meet identified needs.

This requires, among other things Planning, Implementing and evaluating educational
programmes. In carrying out this, human resource planners and educators (those who plan the
actual production process) have joint responsibilities and should coordinate their efforts.
Human Resource Utilization: Health services are planned for people & nonprofit making in
public sector similarly health professionals, are planed enrolled & utilized in a systematic manner.
Recruitment, staffing, performance appraisal, Reward/ compensation Employee benefit &
motivation are essential components in proper Human Resource Utilization.
HRD planning HRH production HRH utilization

* Job analysis * Academic Instruction * Recruitment
* Demography - Training * Stating
* Service target - Orientation * performance /Appraisal
* Service quality * Gov. Legislation.
* Reward
* Motivation.
Feedback
In HRD process, HR planning is also concerned with the production and utilization of health
workers. It is an essential part of National Health planning. These three are indeed interrelated
process.
1.5: Pre-requisites for HRD

The need for health manpower planning may be manifested, by among other thing , economic
concern about the financial implications of both training and the utilization of those trained ,
scientific concern about the quality of the service provided or social concern about the unequal
distribution of the services. Political and technical considerations may also enter into the picture.
Whatever the motive, for the embarking on health manpower planning certain pre-requisites are
required, conditions under which the process become feasible and the plans become easier to
implement.
The extent to which these conditions are fulfilled will indicate the changes of success in
establishing a health manpower planning process. The pre-requisites for HRD are as follows:
1. On the basis of statistical need
2. Leadership readiness
3. Enabling legislation
4. Administrative capacity
5. Political dimension

1. On the basis of statistical need: - The collection, analysis and management of the
statistical constitute a major responsibility of the manpower planner. Certain general
information of relevance to the statistical aspect of manpower planning should be
considered.
 Use briefly the information of potential relevance to planning.
 Suggest a way in which planner can quickly and economically test the validity of
their plan for the collection and use of data.
 Demographic data
 Economic Information’s
 Health status and need
 Health manpower supply
 Health care service utilization
 Health manpower utilization
 Health manpower in the national context etc.
2. Leadership readiness: - The preparation of a national health manpower plan must be

solidly based on clear and sustained directives by the relevant health education, and
manpower authorities. The degree of awareness among health and educational leaders in
relation to the quality distribution, utilization, functional imbalances between different
categories’ and other health manpower issues should be assessed, for with the whole
process of planning will at a late stage most probably end in defective, partial or perhaps
no plan implementation.
Leadership of an organization is a key determinant of HRD
planning. It ensures the right people are on right job with appropriate skills and motivated
to the level of high production. Leadership orientation, clear documented plan and
guidelines support to leaders for HRD. Periodical policy revisit and strategy are
supportive for HRD.
3. Enabling legislation:- First of all HRD planning depends on entry level knowledge, skills
and basic orientation of the workforce to technology and nature of job. Working hours,
weekly and annual leave system are also important enabling factors of HRD planning,
Similarly, it depends on leave in child birth,, sick leave and paid and unpaid holiday leave
in the organization. Health care facility on job and nature of the work etc are also the basic
enabling pre-requisites of HRD.
4. Administrative capacity:- Personal administrative division, recruitment system,

selection procedure, physical and medical examination capacity, orientation training,
basic and periodic refresher training, performance appraisal system, capacity span of
control, unity of command capacity, roles/responsibilities and authority are the essential
pre-requisites of the HRD planning.
5. Political dimension: - Political commitment, political stability, goals, mission, vision,

objectives and strategies of the originations are the pre-requisites of the HRD planning.
Similarly political dimension determines the long term & short term HRD planning.

UNIT 2: HUMAN RESOURCE FOR HEALTH (HRH) PLANNING
2.1: Conceptualizing planning in the context of health

2.2: Analysis of health care needs in the country
2.2.1: Demographic trends

Current health status indicators of Nepal are as given below (Demographic & health
survey2006):
o A very young( < 15 years) population: 41%,
o < five years Population 13%
o Above 65+years 4%
o Average household Population:4.9 person
o Women headed household 23%
o Improved source of drinking water uraban:90%, rural:80%
o No toilet household -50%(Improved toilet Urban 37%, 20% rural)
o TFR-3.1
o Median age for marriage 17.2years.
o married by age 18 years -60%
o Childbearing starts by median 19.9 years

One quarter of women have had their first child by age 18.
o
Unwanted birth is unwanted-16%
o
Birth intervals 33.6months
o
Knowledge on Family Planning- >90%
o
FP modern method using 44%
o
Female sterilization 18%
o
Injectable 10%
o
IMR-48/1000 live births
o
U5MR 61/1000 live births
o
Immunization coverage BCG-93%, DPT3rd89%,P3rd91%, Measles85%,
o
U5 children suffering from ARI-5%, taken for care 43%,
o
U5 children suffering from Diarrhoea -12%,, bloody diarrhea 2%,27% taken to Health
o
facility for care,
o ORS treated 41%,, 29% treated with ORS Sachet
o Diarrhoea case (34%) do not receive any treatment,
o Under five children with fever 17%, 34 % were taken to Health facility.
o ANC services received 44% by SBA,Four ANC visits -29%,
o TT 2 received during pregnancy 63%,
o Home delivery -81%,HF delivery 18%,19% delivery assisted by SBA,19 % delivery
assisted by Traditional BA,
o 50% delivery assisted by relatives,
o PNC care 31% received PNC care within two days of birth.
o MMR 281/100000 live births(3 deaths /1000 live births)
o Under five children are stunted ( Low Height for age)-50%,Wasted (Too thin for Ht)-
13%,Underweight -39%,
o Anemia under five children 48%
(Current Health services Facilities private)
Public sectors:
Types of facility No Total beds % of
Occupancy
1 Specialty Hospitals 5 275 95
2 Regional/ central & teaching 10 1860 95
hospital
3 Zonal Hospital 10 720 70
4 District Hospital 67 1030 60
5 Health Post 701
6 Sub health post 315g
7 PHCORC 1370
Private Sector:
Types of facility No Total beds % of
Occupancy
1 Specialty 123 3804 50
INGO/Missions
Source strategic plan for HR for health 2003 MOH.

2.2.2: Epidemiological trend:
Japanese encephalitis
Dengue fever
HIV and AIDS
Increasing in trend
Avian influenza
Pandemic A H1N1
2.2.3: Soio-economic trend:

1. Education Male
School enrollment rate
Adult literacy rate
Female
Dropout rate.
2. Gender disparity
3. Poverty
4. Geographical distribution of socio-economic classes
5. Cultural changes
6. Values system, norms, belief and attitude which all leads ultimately in
 Development
 Change in disease pattern
 Awareness
 Health service utilization
2.2.4: Development of scientific and technical capability:

Science and technology can make an important and vital contribution to health care needs.
 The use of simple, hand-held molecular diagnostic tools can help unskilled health workers
rapidly and accurately diagnose diseases, thus helping to reduce healthcare costs due to
delayed or incorrect diagnoses.
 Use of software like EPI-Info for forecasting epidemics.
 Appropriate Modern technology including teaching aids and resources are provided to
the National training center for improving the quality of training.
 Telemedicine, Tele health and linking of district hospitals with internet and emails is the
contribution of S & T.
 Training of Trainers is provided to upgrade the skill and technical capacity of the trainers.
 Modern technology like laparoscopic surgery, angiography etc. minimize human effort
and promote recovery

2.3: Estimating of HRH
The methods that can be used for human resource planning depends upon various factors like
availability of sufficient data, the political commitment, the organizational and funding for health
service delivery and so on.
Some of the methods that are commonly used are expressed below:
1. Market oriented method:-
Health personnel for the country are estimated on the basis of demand of country. This method
is based upon the assumption that investing scare resources is worthy where they are likely to
produce the highest return. This track is approached by comparing the cost of training different
manpower categories life time earning to their present value.
Alternatively employer surveys to obtain information on job vacancies, personnel turnover, and
the average time for which vacancies remain unfilled, the anticipated and desired number of new
positions in the coming years have frequently been used to estimate short term HRH
requirements.
2. Service target method/panel expert:-
In this method the primary focus is on setting targets for the production of health services. The
targets are established by the health authorities and may be used on a wide variety of inputs
including health needs, economic demands, consumer wants and manpower ratios. This method
usually pre suppose a healthy system that takes an active role in shaping sectoral development:
It seeks to disaggregate for analytical purpose the various component of the system, and it seeks
a good balance among what population needs, what it wants what medical technology can offer
and what society can deliver at a given point of time.
3. Economic (Health) demand function:-

This method is based on demand function that seeks to correlate the amount of care sought with
such variable as income. Costs, access, education, age, sex residence.
For most part of these function are based on concept of effective demand, this method asks what
number and kinds of health services people will actually use at the anticipated monetary and
other costs of obtaining those services.
4. Produce HRH in number exceeding the current supply:-
This method has two essential data inputs:-
 Population projection.
 Desired manpower/population ratio.
This method concerts population directly into human resources needed with little consideration
over how demand and supply forces acts/interact how the health system works and to what
extent given ratio contributor to health or satisfaction of perceived health wants.
5. Normative method (Standard setting):-
Normative method is required to calculate the human resources requirement they may be
derived from past or current experiments or from professional judgments or international
experiences. Following the methods for setting standards for HRH planning.

 Maintaining the existing situation: - If current manpower situation is generally satisfactory
and health services delivery isn't applied to undergo rapid change, maintaining the current
manpower/population ratio, staffing pattern etc.
 Experience and professional judgment: - Past and present pattern of HRH and utilization of
Health care pattern are considered.
 Setting Standards that are observed in the most successful region of the country.
 International Comparison and standards.
 Task analysis and functional analysis: - Identification of behavioral skills, resources and
organizational contexts that are efficient performance for specified tasks and functions.
6. Qualitative and Quantitative (statistical) methods:-
 Qualitative Methods:-
a) Delphi technique: - This technique utilizes and accumulates the expert’s

consensus on futures demand of human resources.
b) Managerial estimates :- Top managers estimate manpower demand for
coming years (top-down communication) or managerial estimate can be done
by lower level managers to estimate future manpower needs (bottom up
communication.)
 Quantitative methods / statistical methods :-
a) Regression analysis: - Estimates of HRH are obtained by establishing its relation with past
trend.
b) Markov analysis :- This technique derives transition rate foam analysis of past human
resources data concerning loss, promotion transfers, demotions and recruitment
Hence planning for human resources for health ensures the proactive approach to solve
the problems that may arise in the most sensitive field of health. It consists not merely in
projections number of personnel required but also in planning to provide properly
designed health of the personal they need planning for health manpower should be done
integration with overall health planning and choosing the method that best suits. The local
contexts and resources are adequate, authorities are willing and other prerequisites are
met.
2.4: Overview, objective, strategies, targets, challenges and critical appraisal on National
strategic plan for HRH.
Overview:
 The increasing limitations of public health sector resources to meet public demand are
leading not only to new forms of association between public and private health systems
and the public but also to an increased focus on achieving an efficient and effective, value-
for-money provision of health care in the public sector.
 At the core of this is the need to ensure that the health service has
o The right number of people,
o In the right place,

o At the right time,
o With the right skills,
o With the right motivation and attitudes,
o At the right cost,
o Doing the right work.
Purpose:
 The purpose of strategic human resource planning is to contribute towards the
achievement of this ideal.
 It does so by ensuring that the future needs for and supply of staff are identified and
prepared for in time for action, taking into account the needs of the health sector as a
whole, likely future staff productivity and projected availability of funding.
Strategies:
 The HR strategic plan is intended to accomplish three things. These are:
 To specify the direction of growth and development of human resources.
 To specify outline HR objectives for the medium term which provides a
framework for short-term plan development.
 To identify short-term actions and, in particular, policy actions which are needed
for the Ministry of Health (MOH) to proceed towards the medium term future.
Challenges:
 There are currently no mechanisms in place to manage the movement of staff into and
through the health service and between the public and private sectors.
 An HR planning unit exists but the capacity for HR planning and policy- making is limited
by a shortage of trained HR specialists and support staff.
 The HR unit should be a planning and policy unit and as such it should be directly linked
to the policy-making elements of the Ministry of Health. It is currently inappropriately
placed in the Ministry organizational structure and reporting to the director general.
 Staff attitudes towards their deployment are weakened by inconsistency in the
application of personnel regulations and policy.
 Jobs and roles are currently poorly defined and there are no mechanisms to provide
incentives for improved individual performance.
 The standard of training for many types of staff is not keeping pace with the need for
increased and changing skills within the health service as a whole.
 Staffing establishments are based on institutional staffing norms, which are not related to
the actual workload. This is leading to low levels of efficiency and underutilization of
many of the staff available.

 Recruitment in the absence of planned objectives is not matching needs and will lead to
increased distortion in skill mix.
 HR performance objectives are not established in most institutions.
 Training of high-level staff is not based on the need for these staff in the future in terms
of objectives for health and health care provision.
 A sound HR information system exists but is not adequately supported or used to create
improved planning and management processes.
2.5: Role of various institution in support to HRH planning

2.5.1: Role of National Planning Commission in HRH Planning
Coordination with
MOHP
Coordination to
Coordinati university
on with National Planning
MOF Coordination to
Commission CTEVT
Coordinati
Coordination to
on with HR Projection NHTC
MOGA
Estimation
HR Planning In corporate to LTHP, 5year plan
Creation of new Establish new

category of HRH Councils academic/training
institution
Strengthening the capacity of
existing academic training
intuition

2.5.2: Role of MOHP in HRH Planning
Information about vacant post from district

and regional level
DOHS, HR Development
Division
Target Vs HR for I/NGOs

Achievement MOHP
and Private
Demand estimation and projection
National planning
MOF
Commission MOGA
Permanent (Public Service Temporary

Commission) Add., selection
• Gazetted By MOHP
and proposed for • Non gazetted By
appointment to MOHP RHD/DHO
2.5.3: Universities/ Health science institution

1. National universities and its institutions:
 Tribhuvan University : Produced mid and higher level HRH
- Institute of Medicine
- Self-run college
- Affiliated colleges
 Kathmanduc University : Produced mid and higher level HRH
- Self-run college
 Mahendra Sanskirt University : Produced mid-level HRH
- Self-run college
 Purbanchal University : Produced mid-level HRH
- Self-run college
 Pokhara University : Produced mid-level HRH
- Self-run college
2. Institute and Academy : Produced mid and higher level HRH
 BP Koirala Institute of Health Sciences (BPKHS)
 National Academy of Medical Science (NAMS)

3. Council for Technical Education and Voc. Training (CTEVT): Basic and mid-level HRH
4. National/Regional Health Training Center (N/RHTC): - Basic and mid-level HRH
- In-service trainings to HRH
2.6: Critical analysis of the existing HRH planning process in the context of National Health
Service system of Nepal. HRH planning models from other countries.
 Lots of health professionals are produced every year in Nepal but still they are not enough.
 Coordination with other line agencies is poor
 Focus only in MOH
 Health professionals are centralized not regional distribution hence manpower is lacking
in PHC/HP/SHP.
 Many of the available health personnel are incompetent and not committed to their
professions due to no effective quality control mechanism and supervision.
 Unemployment is increasing but still there are people engaged in multiple jobs.
Strength
I. HRH has been discussed on the NHP 1991 with emphasizing in developing technically
competent human resources and health facilities.
a. Training contents and institutions are strengthening.
b. Equitable distribution of health professionals throughout the country is focused.
II. HRH has been included in SLTHP
a. Target is set to equip 100% health facilities with full staff to deliver essential
health service.
b. Mid-term plan
c. Clearly defined organogram
d. HR master plan developed
Weakness
 Mal-distribution of health professionals.
 Lack of quality assurance mechanism
 Many human resource products are not fully competent and committed.
 HRH productions are not need based but rather business oriented.
 Planning section is within DOHS rather than MOH.
Opportunity
 NHP focused on preventive and promotive services important for HRH planning.
 Interest of bilateral organizations agencies on health program in Nepal.
 NHP has opened the doorway for private sectors.
Threats
 Present political situation
 Poverty, disasters and re-emergence of the disease.
 Accessibility, availability and affordability of health services.

UNIT 3: HRH PRODUCTION
3.1: Concept and definition of HRH production
3.1.1: Demand and supply of human resource
One of the most important and difficult aspect of health manpower planning is the estimation of
demand. Without a clear understanding of the variables that influence the demand for health care
and of the ways they may change with time, even sophisticated analyses of manpower
characteristics, distribution, productivity and costs can contribute relatively little to policy
formulation.
The word demand, need and requirement of manpower make confusion regarding their meaning.
The definition and analysis of demand need, and requirement regarding manpower are given
below.
 Demand:
According to the market economist, demand is a measure of the quantities of goods or
services that buyers take at alternatives prices. Such factors as income, preference and
the relative price of other good are taken as constant. In other words demand refers to
the sum of the amounts of the various types of health services that the population of a
given area will seek and has the means to purchases at the prevailing prices within given
time period.
As applied to health sector, a demand curve shows how the use of a given health workers
services varies with the price of such services, for each price level there is different
utilization level of effective demand.
 Needs:
Need represents estimation based on professional judgment and current medical
technology of the number of workers or amount of services necessary to provide an
optimum stander of health care.
The humanistic ethic has often caused planners to regard health services as of such
positive value that they should be made available to all citizens regardless of their social
or economic situation. As a result much health planning has been based on professionally
determined estimates of the presumed need for health services. Need exceeds demand
when there are inefficient resources to produce or purchase services in accordance with
professionally determined need.
 Requirements:
Requirement refers to the amount of services, manpower etc. required to satisfy a given
sets of assumptions about how the health sector does, could, of should function. This
assumption may or may not be made explicit and may be premised in any one of a number
of different approaches to planning.
In recognition of the semantic confusion that sometimes arises through use of the word
demand, planner may find convenient to use the more neutral word requirement, which
does not carry with it implications about the underlying approaches and assumption used
in their determination.

A wide variety of factor influences the demand for health manpower. These factors are:
‫ ٭‬Demographic: Size, distribution, density, growth rate, age structure, sex ratio of the
population.
‫ ٭‬Economic: At any given price, a strong correlation usually exists between income and
the demand for health care. In the absence of a price variable, as in government
financed health care system, the waiting time for services and other such variables
will tend to replace the price between supply and demand.
‫٭‬ Social and cultural: Educational level, level of health consciousness, awareness
about availability of health care etc.
‫٭‬ Health status: morbidity, mortality, disease pattern etc.
‫٭‬ Accessibility: Travel time, waiting time, convenience of time for services, social and
cultural barriers to receiving services etc.
‫٭‬ Resource availability: Manpower, hospital beds, and other accessory resources.
‫٭‬ Resource productivity: Assuming a given availability of manpower, hospital beds
etc. if resources productivity is increased the output of services will be greater and a
higher level of demand can be satisfied.
‫٭‬ Health care technology: Availability of new and efficient technology.
Manpower Projection
The projection of manpower requirement in future is an essential component of human resource
development. There are varieties of manpower requirement projection method, these are:
1. Supply side projection:

This is done by cohort analysis and annual loss rate of manpower.
2. Demand side projection :
In this following methods are used:
 Health need method

 Health services target method
 Health ( or economic ) demand method
 The manpower/population ratio method
Health Need Method:
This method seeks to determine what health services people actually require to keep them
healthy. The determination are made by health professionals, with or without the involvement of
the consuming public, and are based primarily on medical and technological consideration. Other
issues, such as cost, the capacity to deliver the services needed, and the degree to which people
are seeking health services are may be important but are secondary concern.
It is especially useful in planning preventive and public health programmes and in countries with
a strong data base, a reasonably adequate health system infrastructure, and a strong commitment
to planned change.
Health services target method:
In this method the primary focus is on setting targets for the production and delivery of health
services. The targets are established by the health authorities and may be based on a wide variety
of inputs including health needs, economic demands, consumer wants and manpower ratios. This
method usually presupposes a health system that takes an active role in shaping sectoral
development.

Its advantages include flexibility, the potential for disaggregating the several components of
demand and less stringent data required than for the health need method. Its limitation includes
the risk that unrealistic targets will be set and that the degree of control over sectoral change will
be overestimated.
Health (or economic) demand method:
This method asks what number and kinds of health services people will actually use at the
anticipated monetary and other cost of obtaining these services. Current health service utilization
rates are a good measure of the met demand ( also termed the satisfied demand or effective
demand) for health services, and the planner may also want to take into account the unmet
demand for services, given certain assumption about their cost and accessibility.
It is chiefly applicable to private sector planning and to countries whose government policies are
more concerned with anticipating than with actively shaping future sectoral development and in
which there are no large inequalities in access to care.
The manpower/population relation method:

- Demographic trend
- National planning
commission
Current Projected Future

Population Population
Projected future HRH

-Affordability
-Demand Requirement
Current HRH/population Required future

ratio HRH/population ratio
- International comparison
- Recommended standard
- Ratios in favored areas
- Past trends
- Export opinion
Fig. Requirement Projection by the HRH/Population ratio method

This method uses an observed or desired manpower/population ratio as the basis for deriving
manpower requirement. This method has been a favorite method in many countries, primarily
because of its simplicity and easy to carry out.
Yet it is usually difficult to determine the appropriate population-to-health worker ratio for each
country’s situation, and this method usually gives aggregate figures. The appropriate population-
to-health workers ratio usually depends on the level of economic development and the type of
health care system management in each country.

Conclusion
Analysis of demand, need and requirement of health manpower is one of them must difficult task
confronting the health manpower planner, but an essential one. The demand refers to the sum of
the amount of the various types of health services that the population of the given area will seek
at prevailing price in a given time period. Need is an estimation based on professional judgment
whereas requirement refers to the amount of services, man power etc required to satisfy a given
set of assumption.
Projection of manpower is another important aspect of manpower production there are different
method used to project the manpower requirement. The selection of an appropriate method or
methods for requirement projection should takes into account:
 The degree of government involvement in planning and health care delivery
 The quality of available data base and of planning expertise
 The degree to which the assessment result will be consonant with the general political,
social and economic context of the country and
 Take into account past experiences in the production and utilization of health
manpower.
3.1.2: Role of Public and Private Sector in HRH production in Nepal
Equity, efficiency, and quality are three major targets not only for health care system
development but also for the development of human resources for health. Most human resources
for health in Nepal are produced by highly paid private institutes. Due to inequity in basic
education most health science students are from better off urban families. Thus they stay mainly
in the urban areas after graduation, creating inequitable distribution of health personnel.
At the same time the public education institutes are subject to strong bureaucratic inefficiency
and usually no systematic quality control system.
Role of Public Sector

 Sharing of knowledge and skills.
 Standard maintain.
 Support in training.
 Multiple approaches to achieve the target.
 Integrated monitoring and supervision.
 Sharing of resources.
 Mutual representation and responsibilities.
 Cost effective production.
 Control mechanism.
Role of Private Sector

 Appropriate design for equity and opportunity
 Generate strategies.

 Support for capacity building
1. Training needs assessment.
2. Gender analysis.
3. Estimating need for HR.
4. Seminar / workshop / meeting etc.
 Support in sustainable development and as a result advance human well beings and
development.
 Supporting in policy, strategy development.
I. Equity in education and distribution of health personnel

 Public Sector: Students from poor as well as rich families have better opportunities
in education. Thus equal subsidization results in inequity. However, low tuition fees,
and training in public institutes may increase chances of distribution to the
underserved areas.
 Private Sector: Students may come mainly from better-off families. High tuition fees,
and training in private institutes may increase chances of concentration of personnel
in the better-off areas.
II. Efficiency in education management

 Public Sector: Public institutes have less flexibility, strict regulations, no
competitiveness, and no financial motivation, thus they tend to operate on a less
efficient level.
 Private Sector: Private institutes are usually more flexible, competitive, and more
efficient.
III. Quality of education.

 Public Sector: Due to no need for licensing examination, and Limitation of
government resources, the quality of education may be hampered. However, the
public institutes usually recruit better quality students.
 Private Sector: The system may result in less competition in student recruitment, and
the quality of students may suffer. However, profit making private institutes may
minimize costs which will affect quality.
IV. Proper strategies to strengthen the policy options

Public Sector:
a. Mechanisms to allow more students from underprivileged groups should be
strengthened.
b. Decentralization of educational institutions or release from normal
bureaucratic system.
c. Establish efficient quality assurance system and requirement for licensing
examination for all graduates.
d. Develop efficient integrated mechanisms to support proper manpower
distribution.
 Private Sector:
a. Allow only nonprofit private institutions order to ensure better quality education.
b. Indirect subsidization reduce cost, e.g., tax break, and investment promotion.

c. Control tuition fees through approved maximum fee schedules with flexibility.
3.2: Analysis of manpower situation (Public and private sectors)

3.2.1: Mismatch among various categories and levels of HRH:-
Analysis mismatch problem in human resource planning:-
 In Nepal, public and private academic institutions are producing different categories of
Human Resources for Health.
 The public academic institutions are under Tribhuvan University (TU) and MoHP.
 The private sector should be licensed by the CTEVT or be affiliated to one or another
University.
 The categories of health workers include different levels and different specialties:
Paramedics in various disciplines, Undergraduate in Medical, Public Health, Nursing,
Pharmacy, Oral Health, and other para-clinical areas, post graduate in clinical, public
health, nursing and other different specialties.
 All the middle level health workers like Health Assistants, Staff Nurses, Auxiliary Nurse
Midwife (ANM), Community Medical Assistant (CMA), Dental Therapist, Lab Technician,
and Pharmacy Assistants are exclusively produced by private sector licensed and certified
by CTEVT.
 Graduates in Medicine, Public Health, Nursing and other disciplines are produced largely
by private academic, institutions affiliated to one or another University and in small
proportion by public academic institutions.
 Post graduates in clinical specialty, Public Health, Nursing, Pharmacy and other health
science disciplines are mainly produced by public sector. PhD programmes in public
health and Nursing are exclusively in public institutions.
 Thus, in Nepal, majority of health workers are produced by the private sector.
 For example, out of about 2,500 medical doctors produced in Nepal every year, public
academic institutions produce only slightly more than 200 medical graduates.
 Nonacademic public health institutions are not directly involved in the production of
health manpower but provide opportunities and space to medical doctors, nurses,
paramedics and lower level health workers to learn skills through internship and on the
job training programs.
This is the important step of human resource planning process. After projection of future supply
of manpower and manpower needs, the working group compares between the two. Such
comparison will reveal mismatch between supply and requirements. There may be too few or too
many of various categories of staff, needed skill may be lacking, productivity may be low, and
there may be a geographical distribution of staff other human resource problem will also be
identified at this stage mismatch problems can be of a number of different types, distribution,
skills and or productivity. Manpower problems are often country specific and their solution
should also be adopted to suit specific national circumstance.

If overstaffing is expected, the main options are transferring the extra employees, not replacing
an individual who quits encouraging early retirements and layoff. Downsizing should be done in
consultation to the employees union to avoid employee resistance for change in job size. If there
is shortage of human resource in the organization, there is necessity for planning about the
retention of existing of employees by improving the quality of work life. Such definition policy
includes providing training opportunities career bonus and other human incentives.
Hence, while solving mismatches, the planner should think about the nature of mismatch, their
constraints, obstacles, consequences and distribution. The necessary corrective action should be
taken by analyzing cost and benefit.
3.2.2: Gap between demand and supply:
Human resources are the crucial core of a health system, but they have been a neglected
component of health system development. The demands on health system have escalated in low
income countries. Human resources are in very short supply in health system in low and middle
countries compared to high income countries or to the skill requirements of a minimum package
of health interventions equally serious concerns exist about the quality and productivity of the
health workforce in low income countries. One of the most important and difficult aspects of
health in human resource planning is the estimation of demand. Demand is measure of the
qualities of goods that buyers take at alternative prices. Hence demand in health care is a more
restrictive and technical sense, refers to the sum of the services that the evaluation of a given area
will seek and has the means to purchase at the prevailing price within a given time period. If the
demand exceeds supply, the price will increase and vice versa until equilibrium established. The
demand can be estimated by the following approaches.
 Health need approach.

 Programmatic approach.
 Economic demand approach
 Normative approach.
Among available strategies to address the problems, expansion of the numbers of doctor and
nurses through training is highly constrained. This is a difficult issue involving the interplay of
multiple factors.
There are some factors that affect demand which ultimately affects the gap between demand
supplies.
 Demographic situation.
 Economic development.
 Social and cultural milieu.
 Health status of the people.
 Accessibility of services.
 Resource availability.
 Resource productivity.
 Health care technology.
Supply usually refers to the availability and characteristics of resources or services at a given time
according to specified assumptions about production, losses and use supply is affected by the
following situation:
 Current supply: current stock of qualified health manpower.

 Future increments: New graduates, employee transferred from the other
occupations.

While analyzing the manpower situation the estimation demand and supply should be taken as
simultaneously so that the major gap can be ruled out. The following are the major gaps that are
facing by our country itself.
1. Past planning efforts were of short term vision, crisis oriented, and lack of accurate data
regarding human resource.
2. Due to high population growth, rapid socio economic development and rising social
expectation has escalated the demand that hasn’t been satiated with the scare supply.
3. Demand for the poor and the marginalized is less due to ignorance. More supply is
concentrated on the few segment of the people that resides on the well facilitated areas
4. The co-ordination mechanism between health care delivery and the health manpower
development is inadequate.
5. Centralization on health manpower planning.
6. Lack of synchrony between health policy and HRH policies.
7. Past HRH plan were highly restricted on producing medical doctors other health
professionals were neglected.
8. Supply is done according to the sanctioned post basis but not with the health service
demand basis.
9. Distribution problems: geographical, occupation, institutional and public, private sectors.
10. Changes in the foci of health institutions like IOM. CTEVT, BPKIHS, NHTC.
11. Growth of private sectors.

Distribution Analysis
Distribution of Staff by Type of Staff
Seventy seven percent of all health care workers work in the public sector (see Table 3).
Table 3. Base Year (2003) Health Workforce Supply
OCCUPATIONS Supply in % FTE * in FTEs by sector Population

2003 public sector Public Private per worker
Medical specialist 1,544 24 363 1,181 14,994
Medical officer 1,186 63 753 433 19,521
Integrated Medical Officer 30 98 29 1 771,714
Dental surgeon/Dentist 236 16 37 199 98,099
Pharmacist 38 37 14 24 609,248
Asst. Pharmacist 69 58 40 29 335,528
Nurse(certificate) 1,585 61 967 618 14,607
ANM 1,820 75 1,358 462 12,721
Graduate nurse 264 73 193 71 87,695
Medical Technologist 42 83 35 7 551,224
Lab technician/Assist. 543 65 353 190 42,636
Radiographer 48 29 14 34 482,321
Asst. radiographer 158 39 61 97 146,528
VHW/MCHW 5,221 98 5,132 89 4,434
AAW/AHW 4,334 98 4,231 103 5,342
HealthAsst./Kaviraj/Hakim 1,558 90 1,397 161 14,860
Allied health occup. 556 64 358 198 41,639
Allied non-med. prof. 594 70 414 180 38,975
Manager 240 99 238 2 95,425
Skilled support staff 2,384 57 1,367 1,017 9,711
Other support staff 12,462 75 9,362 3,100 1,858
Totals 34,912 77% 26,716 8,196 694

*FTE = Full Time Equivalent staff
(Source: Nepal strategic plan for human resources for health 2003-2017, ministry of health and
population, 2003)
The total numbers of staff (34,912) in proportion to the population is low (1 health staff to 694
people). There are, unusually, more specialists than medical officers, reflecting the effects of
previous policies. Specialists in this presentation also include qualified general practitioners.
The overall distribution of staff in terms of the mix of skills shows a significant deficiency in the
middle technical grades. There is currently a high number of unskilled support staff (35% of the
total workforce). These staff, together with semi-skilled staff, constitutes 55% of the workforce
.As the Ministry seeks to raise the skill level of its human resources and its efficiency, it will need
to explore opportunities to reduce the volume of unskilled and semi-skilled labor as a percentage
of the total workforce.

3.2.4: Preventive, promotive, curative and rehabilitative HRH

3.3: Interrelationship between health services system and education system
3.3.1: Co-ordination between MOH and MOE in HRH production:
 Recent development of the all educational institutions for medical, dental, nursing and
allied courses necessitates better co-ordination between the Ministry of Education (MoE)
and MoH.
 MoH through its human resource policy and skilled personnel projection models will
recommend the MoE in the decision of prioritizing the type of educational institutions'
approval process.
 The MoH will collaborate with the MoE, Universities', health science programmes and
CTEVT for improving the quality of education and also the health priorities to be reflected
in the curriculum for these courses.

 The overall process will be coordinated in consultation with the NPC.
Nature of Training Institution of HRH Production
3.3.2: Critical Analysis of Private Public Mix OF HRH Production

Strength:-
 Sharing of knowledge and skills.
 Standard maintain.
 Support in training.
 Multiple approaches to achieve the target.
 Integrated monitoring and supervision.
 Sharing of resources.
 Mutual representation and responsibilities.
 Cost effective production.
 Control mechanism.
 National health policy 1991.
Weakness:-
 No transparency and poor coordination between agencies.
 Ego/ Domination.

 Internal planning/ separate target.
 MOH not addressed the main problem.
 Lack of well qualified and well managed staff (professionals).
 No proper monitoring and supervision system.
 No review and changes in educational/ training program as per present context for
competent manpower production.
 No proper information of health work force distributions and requirement.
 No clear and upto date national human resources policies at the highest level.
 No proper evaluation system of the human resources in health.
Opportunity:-
 Various private agencies of same objectives.
 Emerging quality control mechanism of the government.
 Competitive market.
 Political change.
 Health sector reform gradually shifting government focus form planning for MOH to
planning for HRH.
 Decentralization of HRH planning in the broad national guidelines.
 Master plan for HRH planning and production.
Threat:-
 Political instability and interference.
 Unemployment is increasing but some in Multiple jobs.
 Immigration of HRH.
 Frequent change the position, Sector of the staff and partners.
3.4: Role of NHPC, NMC, NNC, NPC, NAMC

Nepal Health Professional Council (NHPC)
Introduction
• Nepal Health Professional Council (NHPC) was established under the Nepal Health
Professional Council Act 2053 with an aim to register all "health professionals" other than

medical doctors and nurses according to their qualification; and bring them into a system
as to make their services effective, timely and in a scientific manner.
• According to NHPC Act Clause 4 a thirteen member council is formed as follows:
1. Chairman: Health professional with five years of experience after Bachelor Degree
nominated by the government.
2. Member: Chairman or representative of PAN.
3. Member: Chairman or representative of Nepal Pharmaceutical Association.
4. Member: Chairman or representative of Radiological Society.
5. Member: Chairman or representative of PAN.
6. Members (3): Three members representing each of the Pathology, Physiotherapy
and Public Health nominated by the government on recommendation of PAN.
7. Members (4): Four elected members.
8. Member: Dean or representative of Institute of Medicine, Tribhuvan University.
9. Member: Representative of Nepal Medical Council.
History:
• Nepal does not have a long history of health training and production. for the first
time1991(In 1 9 34) BS Civil Medical School established compounder and hairdresser to
the training of health has started production.
• And 2013 (In 1 9 56) BS Civil Medical School Health Assistant Training School said the
same year the school nurse is also done up. 9 and 6 years 201 (in 1 9 62), BS, Assistant
Health Worker School in Kathmandu and Biratnagar and Bharatpur (Chitwan) in anami
Training School was established. After 2024 (In 1 9 67) in Nepalganj anami school was
expanded.
• The health personnel training Home Saving, even among organized and formal training
(teaching) to start the new education system by Tribhuvan university medical study
Institute Foundation and the above mentioned operation of all the training centers was
only later started and needs of the country.
• According to Health Medium level of health science also other casual products was
initiated in which the intermediate level certificate in general medicine ,pharmacy ,
radiography , nursing, Ayurveda, physiotherapy .
• Of these, the idea of nursing teaching hospital in Bir Bouddhi Nursing Campus and the
campus by installing ayurveda to renovate the hospital and general medical operation,
other programs Maharajgun brought under central campus (all in Kathmandu) were
operating. In the days other parts of the country by the various campuses, programs were
established.
• After 2034 (In 1 9 77) BS Nursing graduate and thereafter Maharajgun 2035 (In 1 9 78)
BS M. B. B. s study was initiated. In this process, after the establishment of the Universities
Kathmandu University, purbancala University, Pokhara University, b. P. Koirala Institute
of Health science also brought a variety of programs.

Functions:
 To make necessary policies for smoothly operating the health profession related
activities.
 To determine the curriculum terms of admission and policies on examination system of
educational institutions imparting teaching and learning on health profession and
evaluate and review the related matters.
 To determine the qualifications of health professionals and to provide the registration of
the names of health professionals having required qualifications.
Roles
1. To make necessary policies for smoothly operating the health profession related
activities.
2. To determine the curricula, terms of admission and policies on examination system of
educational institutions imparting teaching and learning on health profession and
evaluate and review the related matters.
3. To determine the qualifications of health professionals and to provide for the registration
of the names of health professionals having required qualifications.
Meeting and Decision of Council:
1. The Council shall meet as prescribed by the chairperson.
2. The Council shall normally hold its meeting three times a year; and the
chairperson may, if he/she considers necessary, call meetings more
times.
3. The meeting of the Council shall be presided over by the chairperson;
and in the absence of the chairperson, it shall be presided over by the
person selected by the members present at the meeting from amongst
themselves.
4. The presence of fifty percent members of the total number of
members of the Council shall be deemed to constitute a quorum for a
meeting of the Council.
5. A majority opinion shall prevail at the meeting of the Council. In the
event of a tie, the person presiding over the meeting may exercise the
casting vote.
6. The decisions of the Council shall be authenticated by the registrar.
7. The allowances and other facilities receivable by the members for
attending the meeting shall be as prescribed.
8. Other procedures relating to the meeting of the Council shall be as
determined by the Council itself.
Nepal Medical Council (NMC)

Introduction:
 It was at the time of the First All Nepal Medical Conference in 1963 that the Nepal Medical
Association (NMA) requested by way of a resolution to HMG/N that a Nepal Medical
Council Act and a Drug Control Act be passed.

 The Nepal Medical Council Act was ultimately passed in February, 1964. A notification
which appeared in the Nepal Gazette of Bhadra 28th, 2022 BS stated.
Objective & Function:
 To determine the qualification of doctors and to provide registration certificate by

taking licensing examination for new doctors.
 To give recognition to medical institutions for providing formal studies in medical
science and training.
 To formulate policies related to curriculum, admission, term and examination system of
teaching institute of medical education and to make recommendation for cancellation of
registration and approved by renewing and evaluating such system/procedure.
 To formulate necessary policies and to make Code of Conduct to run doctors profession
smoothly.
Nepal nursing council (NNC)

 Date of authentication and publication 2052/12/07(march 20/1996)
 The Nepal Nursing Council(1st amendment) act,2058.(2058/10/04)
 However initially the office of council was located within the premises of ministry of
health at present it is located in Dhumbarahi.
Objectives:
 To Promote Protect and Develop professional code of conduct, Right and Interest of all
the nurses in the country.
 To rise the health status of people and undertake various activity necessary to avail the
basic health service throughout the country.
 To facilitate and conduct relevant nursing research.
 To strengthen the nursing service by upgrading its standard by continual education.
 To remain effortful to develop and extend a scientific nursing system.
 To establish the nursing standard for the scope of practice and safe care delivery.
Functions Duty and Power of council
 To prepare such policies as may be required to smoothly operate the nursing business.
 To give recognition to education institution
 To have evaluation and review of the curriculum, Terms of admission, Examination
system and other necessary terms and infrastructure of the educational institutions.
 To fix qualifications of nursing professionals enter the names of a nursing professional
having possessed the qualification in the register and issue the certificate of registration.
 To fix work limitation of nursing professionals.

 To fix the professionals code of conduct of nursing professionals and take action against
the nursing professionals who violates such code of conducts.
Nepal Pharmacy Council (NPC)

Overview of NPC
 Nepal Pharmaceutical Association (NPA) has played a pivotal role in the formation of
Nepal Pharmacy Council (NPC).
 The NPA’s exercise for preparation of draft of NPC Act took momentum after
implementation of National Drug Policy 1995 (B.S. 2051) that clearly spelled out for the
policy strategy (Section 4.4c) aiming to promulgate legislative measures to register
pharmacy manpower engaged in the pharmacy profession.
 The draft prepared by NPA was discussed in the national seminar entitled “Need of
Pharmacy Council for the Development of Pharmacy Services in Nepal” on 10 April 1997
(28 Chaitra 2053) on the auspicious occasion of NPA’s silver jubilee.
 The draft recommended by the seminar was submitted to the Ministry of Health and
Population for further action.
 Based on these discussions NPA submitted a justification document for the NPC Act, the
summary points of which as reported by the Gorkha Patra on 2 Shrawan 2057 were:
o National Drug Policy was in favor of a legislative measure for registration of
pharmacy manpower engaged in pharmaceutical field.
o The draft NPC document was recommended by the national seminar.
o The theme carried by the document was oriented to community welfare and
pharmacy service development.
o Broad base nature of the profession encompassing policy, manpower
development and regulation, inter-sectoral collaboration and coordination for
public health, quality assurance, logistic and supply management, information
and rational use, and other specific sub-discipline like community and social,
hospital, industrial pharmacy aspects.
o Health Professional Council Act 1997 did make NPA’s representation in its
council but the measures were not sufficient enough for pharmacy discipline.
o Promotion by WHO document on Pharmacy Council (Pharm/94 272 1994).
o Availability of example of separate pharmacy council legislation of which
references of Act of India, Singapore, Canada, UK, Denmark, Jamika, Namibia
were provided.
o In addition to these efforts NPA defended and clarified queries raised by
different ministries, council and other organization on various aspects of draft
NPC Act throughout the period between B.S.2054 until the Act was finally
approved by the Parliament in 2000 (B.S. 2057) and enacted from January 2001.
Functions, duties, objectives and powers of Council
 To prepare & review such policies, plans and programs as may be required to operate
the pharmacy business in a managed and systematic manner and implement these
policies.
 To give recognition to educational institutes teaching the pharmacy profession and the
certificates granted by such institutes.
 To require details of the curricula, terms of admission, examination system of the
educational institute teaching the pharmacy profession and other necessary details as to

whether such institute has maintained the fixed standards; and, by fulfilling the
procedures as prescribed, to withdraw recognition granted to the certificate and degree
granted by the educational institute failing to maintain the standards.
 To fix qualifications required to carry on pharmacy profession, enter the name of a
pharmacist and pharmacy assistant having possessed the fixed qualification in the
register of the Council, as prescribed.
 By fulfilling the procedures as prescribed, to delete from the register the name of a
registered pharmacist and pharmacy assistant who violates or fails to observe the
prescribed professional code of conduct.
Nepal Ayurvedic Medical Council (NAMC)
Introduction:
 Nepal Ayurvedic Medical Council (NAMC), the autonomous body, it is established
ayurveda medical council act- 2045, to make more effective the ayurvedic system of
medicine & make provision on the registration of ayurvedic doctors , it has lots of
functions, we need help of entire people to fulfill these purposes.
 Council has already developed code of ethics for ayurveda doctors, minimum
requirements for educational institutions & also started registration process of Ayurvedic
practitioner in Nepal.
Function & Objectives
 To make necessary arrangements for smoothly operating the Ayurveda medical
treatment by strengthening the provisions of medical treatment of diseases from
the Ayurveda medical science.
 To make necessary arrangements for developing the system of uses of Ayurvedic
medicines.
 To determine the qualifications of doctors and to provide for the registration of the names
of doctors having required qualifications.
 To give advice to the Government of Nepal on the production, sale and distribution of
Ayurvedic medicines.
 To give suggestions to the Government of Nepal for making necessary arrangements on
research of Ayurveda.
 To give suggestion to the concerned body on the standards of Ayurveda education.
 To give recognition, any educational institutions established within Nepal with objectives
of imparting teaching and learning on Ayurveda related subjects and other institutions
established with similar objectives.
 To determine the curriculum, terms of admission and policies on examination system and
other essential infrastructures of educational institutions established within Nepal with
objectives of imparting teaching and learning on Ayurveda related subjects and other
institutions established with similar objectives and evaluate and review the related
matters.
 To give recognition, the educational qualifications and degrees granted on the subjects of
Ayurveda, modern medicine, surgery and auxiliary medical science.

 To determine such policies as may be required to smoothly operate the business of
Ayurveda medical treatment.
 To prepare a code of conduct of doctors and delete the name of a doctor who fails to
observe the code of conduct from the register by taking action against
him/her.
Role in Quality Assurance in HRH Production
 Strengthen the provisions of medical treatment of diseases from the Ayurveda medical
science.
 Determine the qualifications of doctors.
 Prepare a code of conduct of doctors.
 Give advice to the Government of Nepal on the production, sale and distribution of
Ayurvedic medicines.

UNIT 4: HRH UTILIZATION
4.1: Concept on HRH Management and utilization
4.1.1: Methods of Recruitment/procedure:-
 Once the requirement of manpower is known, the process of recruitment starts.

Recruitment can be defined as the process of identifying the sources for prospective
candidates and to stimulate them to apply for the jobs. In other words, recruitment is the
generating of applications or applicants for specific positions. According to Dalton E.
Mcfarland, it is the process of attracting potential employees to the company.
 Thus, recruitment process is concerned with the identification of possible sources of

human supply and tapping those sources. In the total process of acquiring and placing
human resources in the organization, recruitment falls in between different sub
approaches.
Methods stimulate the prospective candidates to apply for the job. The method of recruitment
can be
1. Internal method.
2. External methods.
1. Internal method:
 Job posting,
 employee referral,
 Human resource inventory search.
2. External method:
 Advertising,
 educational institution placement,
 employee referrals,
 Internet search.
 Contact.
Internal methods of recruitments

Methods:
1. Job posting method.

a. Bulletin boards.
b. In house newsletters/ newspapers
c. Circulars.
D. electronic mails.
i) Job posting methods: involves announcing job openings to all current employees. Position,
location, pay scale and qualifications are described. Interested employees are asked to apply for
the jobs. The means used for announcing job vacancies are:
a. In house newsletters/ newspaper: Job vacancies are published in home newsletter and
newspapers.
b. Circulars: Job vacancies are announced in circular or memos sent to supervisors.
c. Electronic mail: Employees receive information about job vacancies on their computer
screens through E-mail. Employees can submit application by E-mail. Job posting method
provides equal opportunities to employees get aware about the importance of better
performance. However, favoritism and strained superior subordinate relations may happen.
ii.) Employee referral method:

This nomination by superiors candidates are located within the organization supervisors
generally recommended best qualified candidates for the vacant jobs. Informal communication
among managers can also lead to the discovery of qualified candidates within the organization.
This is recruitment by world of health.
 Retrenched or retired employees and their dependents can also be recommended by

existing employees. Temporary or causal employees working in the organization can also
be referred by permanent employees.
 This method may confuse friendship to competence for job performance superior may
recommend friendly subordinates.
iii) Human resource inventory search method:
It is a search of human resource inventory currently employed in the organization. It tells
management what individual’s employee can do. The information included in the inventory about
each employee is:
a. Personal name, age, sex, marital status.
b. Educational qualifications/ professional qualifications.
c. Training undertaken/ special skills.
d. Employment experience/ current position held/ seniority.
e. Performance rating.
f. Salary level/ benefit plans.
g. Languages spoken.
h. Capabilities.
i. Job and location preferences.
 Human resource inventory can be manual or computerized. It is searched to quickly identify

qualified employees within the organization to fill up the vacancies.
 Succession plan server as a useful tool for locating candidates for managerial vacancies.
2. External methods for recruitments:-

The common methods used are;
1. Advertising

2. Education.
3. Employee referral.
4. Internet search.
5. Contact.
1. Advertising method: This is the most common method for external recruiting. It reaches a
much wider audience through various media. The media selection and the design of the
advertisement should be given careful thought. It should encourage qualified candidates.
Advertising media can be:

a. Print: newspaper, magazines, trade journal, internet.
b. Visual: Billboard, poster, point of recruitment materials.
c. Audio –Visual: Radio, television, cinema etc.
2. Educational institution placement method: Most educational institutions operate placement

services. Prospective employers to be “for entry level positions from such institutions for
technical and professional posts.
3. Employee referrals method: current employee recommends their friends and relatives from
outside the organization. Such candidates tend to the better informed about the job and the
organization. This is word of mouth recruiting.
4. Internet search: Bio data by prospective candidates made available through internet is
searched. Such database becomes a method for recruiting prospective candidates. It is cost
effective for high tech employees.
5. Contract: Employees are hired on contact. Labor contractors supply workers. They charge
commission for their services. Recruitment procedure adopted in the health sectors through
public.
Service commissions:
When there is a vacant post in any health institution the district will first notify to the regional
health directorate. The regional health directorate then forwards the message to the ministry of
health via department of health service. The ministry of health informs to the public service
commission about the vacant and additional (if needed). Post of the different levels, for the
different health institution of the country The central office of the public service commission
announces the vacancy for the officer level of health personnel white regional offices of the public
service commission’s announces vacancy for the post of assistant level ( non gazette) for the
respective region.
The vacancy announcement is published in the national daily newspaper Gorkha patra, and Nepal
T.V Generally the notice about the vacancy is published on wed only. The selection procedure of
the candidate’s so the written examination and interview. The passed candidates in the written
examination will only be short listed for the interview those candidates who are selected from
both written examination and interview will be posted in the needed health institution. Thus the
health employee is recruited in our government health services.

Factors that satisfy employee/Employment Satisfaction:
Human resource management (HRM) is a major determinant of any system’s performance. It has
been overlooked in the health sector has defined and evaluated the effects of HRH interventions,
the particular nature of the health sector makes difficult to apply lessons learned from elsewhere.
However one lesion that can be applied to HRM in health is that single or uncoordinated
interventions are less likely to achieve performances improvements than strategic packages.
Global context considers the importance of HRM in improving overall health care services. The
authors argue that proper management of human resources is critical in providing a high quality
of health critical in providing a high quality of health care.
Good human resource management means putting the knowledge, skill and talents of employee
to the best use. The effective use of people depends upon the human resource manager’s ability
to recognize the diversity of workers and provide them to opportunities for participating in
decisions and design of job requirements.
With the increasing diversity of workforce, any organization needs to accommodate the resulting
diversity of individual needs of health workforce. This will necessitate the development of
organizational system management, planning and control functions which are responsive to
diversity in gender lifestyle, age and ethnic background.
For the achievement of the organizational goal and achievement of target, retention of employee
is crucial and which is affected grossly by the employee satisfaction. Broadly it includes the
affecting factors such as salary, organizational culture training, career paths and recruitment
techniques.
Apart from these factors, there are many factors for employee satisfaction which can be studied
broadly used the following headings:-
1. Education and training
2. Individual and social factors.
3. Organizational and structural context.
4. Financial aspects
5. Political.
 Education and training:

Proposed specific actions include ensuring a mandatory services period in national health
services as an obligatory condition for scholarship, effective and enforceable bounding
means and improve local and in country training and continuing education, this may
include intermittent, continuous or distance learning.
The training and education which the employee has should be matched to the job
condition.
 Individual and social factors:

The aspirations of skilled health personnel for better living conditions and opportunities
for self and families should be recognized and taken into account, including supportive
working environment. Personal developments plans for the employee should be included
in the organizational policy. Governments can work together to professional association
and unions to improve working conditions for the workers and their families.
 Financial aspects: -

Compensation and benefits should be fair and reliable. Salaries should meet the expenses
is regulations, law, policies, and partners
 Political:
Political leadership should be able to assess future threats and opportunities react to
changes in regulations, laws, policies, and partnership
 organizational and structural contexts:-
Weakness is governance and management in the public sector, civil service and health sector
reforms that result in limiting posts for the health sectors were issues raised. Recommended
actions to satisfy employee include:-
1. transparency and fair governance structures and procedures in promotions and
incentives such as training
2. Professional associations involvement flexible career structures and professional
development of their members
3. Better incentives for rural and remote posting which include monetary incentives
and non-monetary ones such as equipment, supplies, and benefits for dependents
and family
4. Transparent and proper leadership
5. Performance based appraisal and its transparency made compulsory.
6. Adequate supportive supervision
7. Appropriate flexibility at mid-level management
8. Employee involvements in decision making in the organization
9. Ensure open communication.
10. Proper recruitment policy based on gender, ethnicity and geography
11. Retirement policy on ageing should be elderly friendly
12. Adequate managerial and organizational infrastructure
13. Vision- goals- objectives should be clear
4.1.2: Selection:
Selection can be conceptualized in terms of either choosing the fit candidates or rejecting
the unfit candidates, or a combination of both.
“Selection is the process of differentiating between applicants in order to identify

those with a greater likelihood of success in job”
Steps in selection Process
a) Application evaluation:
Applications of prospective candidates provide personal data about age, qualification,

experience etc. They are evaluated.
b) Screening
c) Selection tests:
 Aptitude test: Measures aptitude for the job.
 Intelligence test: Measures intelligence quotient (IQ)

 Personality test: Measures personality characteristics
 Achievement test: Measures theoretical and/or practical knowledge

and skills etc.
d) Reference check:
 Information about character and background of the candidate is checked from

referees provided in the application.
e) Final interview:
It is generally done by a panel of experts.

f) Medical test:
It checks medical fitness for the job.
Difference between Recruitment and Selection
Recruitment Selection
The major objective of recruitment is to Major objective of selection is to

attract maximum candidates choose best alternative candidates
Adopts process of creating application Adopts the process through which

pool. So it is a positive process more candidates rejected from
selected. So it is a negative process
Not very intensive , requiring high skills Highly specialized techniques are
required.
Outcome of recruitment is application The outcome of process is in the form

pool which becomes the input for of finalizing candidates.
selection
Placement:
This step involves placing the right candidate in the right job. Proper placement builds a
competent and satisfied work force. Not only the person should be suitable to job but also
the job should be suitable to the person. Initially, the placement may be on probation, the
period of which may range from six months to one year. After successful completion of this
period, the candidate is offered permanent employment.

After placement, her needs orientation regarding the organizational policies, purposes,
practices, terms and conditions of works, salary and other benefits. This process is known as
induction.
4.1.3: Employment motivation

Employee motivation is the level of energy, commitment, and creativity that a company's workers
bring to their jobs. Whether the economy is growing or shrinking, finding ways to motivate
employees is always a management concern. Competing theories stress either incentives or
employee involvement (empowerment). Employee motivation can sometimes be particularly
problematic for small businesses. The owner has often spent years building a company hands-on
and therefore finds it difficult to delegate meaningful responsibilities to others. But
entrepreneurs should be mindful of such pitfalls: the effects of low employee motivation on small
businesses can be harmful. Such problems include complacency, disinterest, and even
widespread discouragement. Such attitudes can cumulate into crises.
But the small business can also provide an ideal atmosphere for employee motivation: employees
see the results of their contributions directly; feedback is swift and visible. A smoothly working
and motivated work force also frees the owner from day-to-day chores for thinking of long-term
development. Furthermore, tangible and emotional reward can mean retention of desirable
employees. People thrive in creative work environments and want to make a difference. Ideally
the work result itself will give them a feeling of accomplishment—but well-structured reward
and recognition programs can underline this consequence.
What motivates?
One approach to employee motivation has been to view "add-ins" to an individual's job as the
primary factors in improving performance. Endless mixes of employee benefits—such as health
care, life insurance, profit sharing, employee stock ownership plans, exercise facilities, subsidized
meal plans, child care availability, company cars, and more—have been used by companies in
their efforts to maintain happy employees in the belief that happy employees are motivated
employees.
Many modern theorists, however, propose that the motivation an employee feels toward his or
her job has less to do with material rewards than with the design of the job itself. Studies as far
back as 1950 have shown that highly segmented and simplified jobs resulted in lower employee
morale and output. Other consequences of low employee motivation include absenteeism and

high turnover, both of which are very costly for any company. As a result, "job enlargement"
initiatives began to crop up in major companies in the 1950s.
While terminology changes, the tenets of employee motivation remain relatively unchanged from
findings over half a century ago. Today's buzzwords include "empowerment," "quality circles,"
and "teamwork." Empowerment gives autonomy and allows an employee to have ownership of
ideas and accomplishments, whether acting alone or in teams. Quality circles and the increasing
occurrence of teams in today's work environments give employees opportunities to reinforce the
importance of the work accomplished by members as well as receive feedback on the efficacy of
that work.
In small businesses, which may lack the resources to enact formal employee motivation
programs, managers can nonetheless accomplish the same basic principles. In order to help
employees feel that their jobs are meaningful and that their contributions are valuable to the
company, the small business owner needs to communicate the company's purpose to employees.
This communication should take the form of words as well as actions. In addition, the small
business owner should set high standards for employees, but also remain supportive of their
efforts when goals cannot be reached. It may also be helpful to allow employees as much
autonomy and flexibility as possible in how their jobs are performed. Creativity will be
encouraged if honest mistakes are corrected but not punished. Finally, the small business owner
should take steps to incorporate the vision of employees for the company with his or her own
vision. This will motivate employees to contribute to the small business's goals, as well as help
prevent stagnation in its direction and purpose.
Motivation Methods
There are as many different methods of motivating employees today as there are companies
operating in the global business environment. Still, some strategies are prevalent across all
organizations striving to improve employee motivation. The best employee motivation efforts
will focus on what the employees deem to be important. It may be that employees within the same
department of the same organization will have different motivators. Many organizations today
find that flexibility in job design and reward systems has resulted in employees' increased
longevity with the company, improved productivity, and better morale.

Empowerment
Giving employees more responsibility and decision-making authority increases their realm of
control over the tasks for which they are held responsible and better equips them to carry out
those tasks. As a result, feelings of frustration arising from being held accountable for something
one does not have the resources to carry out are diminished. Energy is diverted from self-
preservation to improved task accomplishment.
Creativity and Innovation
At many companies, employees with creative ideas do not express them to management for fear
that their input will be ignored or ridiculed. Company approval and toeing the company line have
become so ingrained in some working environments that both the employee and the organization
suffer. When the power to create in the organization is pushed down from the top to line
personnel, employees who know a job, product, or service best are given the opportunity to use
their ideas to improve it. The power to create motivates employees and benefits the organization
in having a more flexible work force, using more wisely the experience of its employees, and
increasing the exchange of ideas and information among employees and departments. These
improvements also create an openness to change that can give a company the ability to respond
quickly to market changes and sustain a first mover advantage in the marketplace.
Learning
If employees are given the tools and the opportunities to accomplish more, most will take on the
challenge. Companies can motivate employees to achieve more by committing to perpetual
enhancement of employee skills. Accreditation and licensing programs for employees are an
increasingly popular and effective way to bring about growth in employee knowledge and
motivation. Often, these programs improve employees' attitudes toward the client and the
company, while bolstering self-confidence. Supporting this assertion, an analysis of factors which
influence motivation-to-learn found that it is directly related to the extent to which training
participants believe that such participation will affect their job or career utility. In other words, if
the body of knowledge gained can be applied to the work to be accomplished, then the acquisition
of that knowledge will be a worthwhile event for the employee and employer.

Quality of Life
The number of hours worked each week by American workers is on the rise, and many families
have two adults working those increased hours. Under these circumstances, many workers are
left wondering how to meet the demands of their lives beyond the workplace. Often, this concern
occurs while at work and may reduce an employee's productivity and morale. Companies that
have instituted flexible employee arrangements have gained motivated employees whose
productivity has increased. Programs incorporating flex-time, condensed workweeks, or job
sharing, for example, have been successful in focusing overwhelmed employees toward the work
to be done and away from the demands of their private lives.
Monetary Incentive
For all the championing of alternative motivators, money still occupies a major place in the mix
of motivators. The sharing of a company's profits gives incentive to employees to produce a
quality product, perform a quality service, or improve the quality of a process within the
company. What benefits the company directly benefits the employee. Monetary and other
rewards are being given to employees for generating cost-savings or process-improving ideas, to
boost productivity and reduce absenteeism. Money is effective when it is directly tied to an
employee's ideas or accomplishments. Nevertheless, if not coupled with other, non-monetary
motivators, its motivating effects are short-lived. Further, monetary incentives can prove
counterproductive if not made available to all members of the organization.
Other Incentives
Study after study has found that the most effective motivators of workers are non-monetary.
Monetary systems are insufficient motivators, in part because expectations often exceed results
and because disparity between salaried individuals may divide rather than unite employees.
Proven non-monetary positive motivators foster team spirit and include recognition,
responsibility, and advancement. Managers who recognize the "small wins" of employees,
promote participatory environments, and treat employees with fairness and respect will find
their employees to be more highly motivated. One company's managers brainstormed to come
up with 30 powerful rewards that cost little or nothing to implement. The most effective rewards,
such as letters of commendation and time off from work, enhanced personal fulfillment and self-
respect. Over the longer term, sincere praise and personal gestures are far more effective and
more economical than awards of money alone. In the end, a program that combines monetary

reward systems and satisfies intrinsic, self-actualizing needs may be the most potent employee
motivator.
Others method of employment motivation

 Promotion and gratitude
 Reward / Punishment
 Job security
 Staff career development
Promotion and gratitude

 In terms of a career, a promotion refers to the advancement of an employee's rank or
position in a hierarchical structure.
 A job promotion is usually handed to an employee who has displayed exceptional
performance or has developed the appropriate skills and knowledge necessary to take on
the higher job responsibility. In the latter case, the employee may have been with the
company for a required amount of time to be eligible for the promotion.
 For example, an individual who starts off as an analyst in an investment bank may have
to do time for three years in this role, before he gets considered for the next step up, which
is the associate position. A promotion is usually accompanied by a higher salary and
increased job responsibilities. It might also include an expansion of benefits and
managerial authority over other employees.
Reward/ Punishment
Reward
 Something given in exchange for good behaviour or good work, etc

Punishment
 Punishment is the imposition of an undesirable or unpleasant outcome upon a group or

individual, meted out by an authority.
Job security
 Job security is the probability that an individual will keep his/her job; a job with a high
level of job security is such that a person with the job would have a small chance of losing
it.
Staff career development
Career development is about making sure your employees fulfil their potential, so they can
make a long-term difference to your organization.
Why priorities career development?
Career development therefore, gives you a greater ROI from employees. But there are also
short-term benefits of employee development: employees are more engaged and committed
when they see a path of career development and progression ahead of them.
This can mean better performance in the short term, as well as positive effects on staff
turnover and recruitment. With more than three-quarters of UK organisations finding it
difficult to retain staff in a recent survey, effective career development can be a

differentiator. 74% of companies have plans to develop more talent in -house in future
(CIPD, 2015).
Because career development also nurtures internal talent, it can help you reduce the costs
of external hiring. You can also retain valuable knowledge held by staff, who might choose
to leave if development opportunities are scarce.
Employee career development plans
Career development needs clear structure and outcomes, and HR should take the lead in
developing them.
At the organisational level, once you’ve decided to prioritise career development, the next
step is to build a system that defines:
 Criteria for identifying employees with the talent and potential for development
 Career development initiatives such as career counselling, coaching and

mentoring, and learning and development programmes
 A progression structure for employees participating in development initiatives
 Metrics for career development outcomes, so initiatives can be evaluated and

improved
Individual employee career development should also be planned and recorded, using
personal plans. Plans can be discussed with employees during appraisals, or in career
counselling sessions with HR.
Individual career development plans should include:
 Long-term and short-term goals for career progression, agreed between HR or line
managers and the employee
 Identification of skills and experience needed to achieve the goals
 The employee’s next career development steps, such as completing training and
improving performance in key areas
Career development as part of succession planning
Succession planning is a process of developing a pool internal talent as potential successors

to key current staff. It originated in blue chip companies and has recently become popular
again, offering:
 The possibility of recruiting for key roles from within, thus appointing employees
who already know your company well.
 A wider pool of candidates for roles that are difficult to recruit. Technical and
management roles are among the most difficult to fill (CIPD 2015).
 Exciting career development paths for employees with potential.
Succession planning isn’t just for the most senior roles. HR and line managers can work to
identify employees with potential for development. Initiatives to develop employees for

succession can include shadowing, and receiving coaching and mentoring from, their
superiors.
4.1.4: Concept, component and importance of job description, JD OF DPHO
Job description is the overall summary of the task requirements. It is an outcome of job analysis,
which is written statement of what the jobholder does.
Job description provides the following information’s:
 Title of job, level of job

 Location of job- department, geography
 Relationship- responsible to whom, responsible for what
 Job summary
 Duties and responsibilities
 Authority- right to make decision and give order to subordinates
 Accountability
 Working condition
 Machine/materials used etc.
Job summary is the statement of personnel characteristics and qualifications need to perform the
job. It states the minimum acceptable qualifications that the job holder must possess to perform
the tasks. It identifies the knowledge, skills and abilities need to get the job done effectively.
Job summary contains:
 Education and training year of schooling, type of training.

 Experience-previous job experience in terms of duration and nature.
 Physical health.
 Skills-inter personnel communication, computer facilities, report writing etc.
 Abilities-in terms of physical and mental.
 Management authority and responsibilities.

Job description of District/ Public Health Officer
Job Description of DHO
Post Senior Public Health Officer
Level Gazetted Second Class
Service Health
Group Health Inspection
Minimum Educational Graduate/Post Graduate in Public Health

Qualification
Answerable to Regional Director
Relation Employees of hospitals, medical officers, governmental and

non-governmental institutions in the district, members of the
district development committee and people’s representatives
Direct supervision of District Public Health Office/all employees of the district health
office, chief of the PHCs and all employees of HPs and SHPs
and maternity health workers and midwives
Carry out the following duties to prepare work plan of all promotional, preventive and
treatment related services provided in the district, implement, coordinate, supervise and
monitor and evaluate them:
1. Planning
 Prepare the structure of the district level health development plan within the
budget ceiling as per national policy and directions
 Get the annual district level health plan and programme approved by the district
assembly and make arrangements to send it to the regional center and the national
center
 Prepare detailed work plan and work calendar for the chief of PHCs, HPs, SHPs and
technicians of the public health offices
 Present timely recommended proposals for other programs, if necessary, in addition

to the regular annual programs of the district along with rationales for such
programs.

Division of targets
Make arrangements to hand over responsibilities of conducting programs for the fulfillment
of various objectives of the district health services to PHCs, HPs and SHPs within the district
on the basis of population.
Collection of information and analysis
 Ensure the regular dissemination of information from various health institutions

within the district.
 Prepare graphs and charts on the basis district health profile and display them
 Identify and prioritize the main health problems of the district on the basis of the
analysis of the information collected
 Identify district level health indicators
 Evaluate the effectiveness of health programs in the district according to the progress
towards fulfillment of objectives and on this basis recommend employees involved
in these programs for opportunities for career development.
 Disseminate information regularly, send progress reports and provide feedback as

directed by the district public health office
2. Family Planning Programme
 Ensure the family planning services are always available in the district through the
health institutions, health workers and volunteers in the district
 Make arrangements to provide family planning consultancy services through health

institutions, PHC outreach and health workers
 Make arrangements to provide vasectomy and laparoscopy services through

institutional clinics on a regular basis
 Make arrangements to have in stock contraceptives for four months for regular
supply
 Make arrangements for the follow up on those availing of family planning services
and defaulters
 Make necessary arrangements to increase the number of those availing of family

planning services in the district and various health institutions
3. Safe Motherhood
 Ensure that safe motherhood services are being provided by PHCs, HPs, SHPs, PHC
outreach, rural health program, mother and child health program midwives

4. Vaccination Programme
 Ensure the quality vaccination services are regularly being provided by vaccination
centers and health institutions
 Make arrangements for the regular supply of vaccines and managements of cold
chain
 In case of epidemics like polio, measles and hepatitis make immediate

arrangements for the prevention of their spread and report to the center
5. Nutrition Programme
 Conduct a survey on nutrition in the community and study or have others study the
nutrition situation of the community
 Make arrangements for growth monitoring through health institutions and PHC
outreach
 Make necessary arrangements for giving Vitamin A capsule to children and

distribution of iron tablets
 Make arrangements to give iron tablets to pregnant women
 Make arrangements for the supply of iodized salt
6. Diarrheal diseases
 Monitor the work at all levels for the control of diarrhoeal diseases
 Make arrangements for the prevention of epidemic of diarrhoeal diseases in the

district
 Make arrangements to set up ORT corners in all health institutions
 Make arrangements for the regular supply of oral dehydration solution at all levels
in the district
7. Emergency Respiratory Diseases
 Make arrangements for the prevention and treatment of respiratory diseases by

various health institutions in the district
 Make arrangements for the supply of medication for respiratory diseases at health
institutions
 Monitor the work being carried out at all levels for the control of respiratory
diseases

8. Malaria and Kala-azar
 Make arrangements for the control of malaria in the district on clinical basis
 Make arrangements for the collection of slides of those with fever through the field
visit of rural health worker, outreach clinic and health posts and test them at the
district public health office or in the field as necessary
 Make arrangements for the complete treatment of all positive cases
 Send proposals with the rationale for the spraying of insecticides in areas with
malaria and kala-azar epidemic on the basis of the case load and intensity of the
epidemic to the Epidemiology Division through the Regional Directorate of Health
Services
9. Tuberculosis
 Make arrangement for the collection of sample of the sputum of the suspected TB
patient, its testing and treatment of patient with confirmed cases of the disease.
 Make arrangements to look for defaulter patients and treat them again
 Make arrangements to provide information on the prevention of TB
10. Leprosy
 Make arrangements for the collection of skin smear of suspected leprosy patient, its
testing and find out if arrangements have been made for the treatment of patients
with leprosy
 Make arrangements for the follow-up on patients being treated, tracing of defaulter
patients
 Make arrangements to provide information on the prevention of leprosy
11. HIV/AIDS Prevention Programme
 Identify target groups and make arrangements for the prevention of HIV/AIDS
 Make arrangements for the promotion of condom use
 Make arrangements for the treatment of sexual diseases
12. Epidemic Control

 Collect information on the spread of epidemic in the district and if confirmed
immediately inform the Regional Directorate of Health Services and Epidemiology
Division in Kathmandu
 Make necessary arrangements for the control of the epidemic, supply of medicines,
deputation of health teams, dissemination of information and mobilization of
resources
 Carry out or have others carry out preventive measures for possible seasonal
epidemics and make arrangements to stock medicines
13. Health Education Programme
 Find out if public awareness programs about all public health programs being carried
out in the district is being carried out as necessary and if it is not ensure that such
awareness programs are being carried out School Health Education Program
 Make arrangements to conduct school health education programs regularly in all

the schools of the district
14. Female Community Health Volunteer Programme
 Make arrangements for FCHV and midwives selection training and refresher review
meeting and conducting of supervision meeting in the district on the basis of
population
 Find out if there are FCHV and midwives training conducted by various NGOs in the
district and coordinate them and make arrangements for the collection of reports and
maintaining of standards
 Make arrangements to conduct district level review meeting of FCHV and midwives
programs in the district
 Participate in regional meetings with suggestions on making periodic reports of

FCHV and midwives programs and strengthening the programs
 Prepare plans to make mothers’ group active and help in the implementation of the
plans by various organizations
 Ascertain if the PHC outreach programs are being run
 Make arrangements to conduct district level and VDC level orientation programs
 Collect monthly progress reports from health posts, and send them to the HMIS
section with analysis and reaction

15. Simple treatment and referral service
 Assist in the referral of patients who cannot be treated in health institutions and in
the process ascertain if s/he is being treated with priority.
16. Community Medicine Programme
 Run the community medicine programme with the participation of health

committees in the district
17. Budget and supply of provisions
 Mobilize budget allocated for various programs
 Ascertain amount of medicines and equipment/instruments needed to run

programs and make arrangements to supply medicines and equipment/instruments
requested
 Make arrangements for the maintenance and utilization of various equipment in the
district
 Ensure that accounts, inventories and records of goods in the store are maintained
 Ascertain if the allocated budget is being spent and ensure that records are kept
 Public health officer should ascertain if the public health programs are being run
and if they are not assist the chief of district health office to run them.
18. Monitoring and Supervision
 Monitor all health programs in the district on the monitoring checklist. Prepare or
have others prepare the district profile periodically.
 Have the chiefs of the PHCs, HPs and SHPs and technical assistants prepare field
supervision work plan and approve them.
 Make arrangements to conduct district level review meeting of FCHV and midwives
programs in the district
 Participate in regional meetings with suggestions on making periodic reports of

FCHV and midwives programs and strengthening the programs
 Prepare plans to make mothers’ group active and help in the implementation of the
plans by various organizations
 Ascertain if the PHC outreach programs are being run
 Make arrangements to conduct district level and VDC level orientation programs

 Collect monthly progress reports from health posts, and send them to the HMIS
section with analysis and reaction
19. Simple treatment and referral service
 Assist in the referral of patients who cannot be treated in health institutions and in
the process ascertain if s/he is being treated with priority.
20. Community Medicine Programme
 Run the community medicine programme with the participation of health

committees in the district
21. Budget and supply of provisions
 Mobilize budget allocated for various programs
 Ascertain amount of medicines and equipment/instruments needed to run

programs and make arrangements to supply medicines and equipment/instruments
requested
 Make arrangements for the maintenance and utilization of various equipment in the
district
 Ensure that accounts, inventories and records of goods in the store are maintained
 Ascertain if the allocated budget is being spent and ensure that records are kept
 Public health officer should ascertain if the public health programs are being run
and if they are not assist the chief of district health office to run them.
22. Monitoring and Supervision
 Monitor all health programs in the district on the monitoring checklist. Prepare or
have others prepare the district profile periodically.
 Have the chiefs of the PHCs, HPs and SHPs and technical assistants prepare field
supervision work plan and approve them.
 Prepare annual plan for the integrated supervision and monitoring of the various
health services in the district, get it approved from the district health chief and make
arrangements for the regular monitoring and supervision of HPs and SHPs by the
assistants in the district

 Study the supervision reports, inform the concerned department on the contents
and take action against employees if necessary.
23. Administrative duties
 Make necessary arrangements for day to day administrative work of the public
health office to be carried out smoothly
 Act as the supervisor and evaluate the performance of subordinates
 Evaluate the performance of the employees and reward or punish them
 Be an active participant in the monthly staff meeting
24. People’s participation and community mobilization
 Make arrangement for regular contact with members of the district health and
population committee to establish a relationship with them and make the committee
active
 Make arrangement to mobilize the health committees of PHCs, HPs, SHPs and
management committee of PHC/ORC clinic.
25. Coordination
 Establish cordial relationships with all governmental and non-governmental

organizations and people’s representatives in the district
 Make or have others make necessary arrangements against natural calamities and
control of epidemics.

4.2: Role of health care service system in HRH utilization:
Health care system
Preventive / promotive curative

-Extensive promitive / preventive method. -District hospital and Zonal Hospital
-Outreach clinics in each ward -Regional / sub regional hospital.
-PHCC, HP/SHP at lower level - Central hospital.
4.2.1: National Health Service System – Primary, Secondary, Tertiary Levels
 Primary: HPs, PHCCs

 Secondary: District hospitals, Zonal hospitals, Regional hospitals
 Tertiary: Central hospitals, Teaching hospitals
Primary:
Health Posts
 Health post is the first institutional contact point for basic health services as well as
birthing centers in the respective VDC.
 Referral center of the volunteer cadres of TBAs and FCHVs as well as a venue for
community-based activities such as PHC outreach clinics and EPI clinics.
 HPs monitor the activities of FCHVs as well as community‐based activities by PHC
outreach clinics and
 EPI clinics.
 From Health Post (HP) to Primary Health Care Centre (PHCC), on to district, zonal sub
regional and regional hospitals, and finally to tertiary level hospitals
PHC
 Highest center among the primary level health center
 Cases from health Post is referred to PHC.
Services provided by PHC

 Safe motherhood and newborn care
 Family planning
 Child Health
 Immunization
 Nutrition
 Health Education and Counseling
 First aid treatment

Secondary:
Zonal hospital – 10
District hospitals – 75
 Referral centers for the primary health centers

 Provide acute care: necessary treatment for a short period of time for a brief but serious
illness, injury or other health condition, such as in a hospital emergency department.
 Also provide skilled attendance during childbirth, intensive care, and medical imaging
services.
Tertiary Level Health Center
 Highest level of health centre in referal system of health services

 Central hospitals and regional hospital serve as the tertiary referral centers
 Here, patients are referred from smaller hospitals for major operations, consultations
with sub-specialists and when sophisticated intensive care facilities are required.
Central Hospitals- 8
1. Bir hospital
2. Thapathali maternity hospital
3. Kanti children hospital
4. Sukraraj tropical hospital
5. Gangalal heart center
6. Bharatpur cancer hospital
7. Human body transplant center
8. TUTH
Factors affecting HRH utilization:

1. Geography: lack of HRH of different level in remote and difficult geographical area leads
low utilization of human resource in health.
2. Infrastructure: institutions, buildings, machinery, technology etc well equipped adequate
infrastructure leads to high utilization of HRH.
3. Effect at recruitment, training and dev.
4. Presence of INGO affects HRH utilizations.
Characteristics of existing health system:
 Focus on PHC concept.

 Community participation e.g. preventive/ promotive health services.
 Equity: equitable distribution of health services, but due to the gap between supply and
demand of HRH the achievement in health sector has not been seen as per desired
objectives.
Role of professional bodies and council in quality assurance in health and practice:
 Nepal medical council (NHPC)

- Register professional doctors.
- Register Institution.
- Take action / code of ethics.
 Nepal nursing council (NHC)
-Register nurse / code of ethics and guidelines.
 Nepal health professional council (WHPC)

- Register the professional other than those registered to NMC.
 Nepal pharmacy council (NPC)
-Register pharmacist.
 Nepal Ayurvedic professional.

- Creating awareness about health of general population by means of HE.
- International college of surgeon (ICS)
- Education activities and training in country of aspiring surgeon.
 Nepal Medical association (NMA)
- Guidelines.
 Nepal health association (NHA)
- Help in growth and development of public health professional.
 Nepal association of Nepal (NAN)
- Encourage development of high standard of nursing education.
- Promote the advancement of missing.
 Pharmaceutical association of Nepal.
- Deal to common problems and various health clinics in districts.
 Psychiatric Association of Nepal.
- Encourage the increase in knowledge and research in mental health.
- Take steps in timely change of mental health service.
 Society of internal medicine of Nepal.
- Promote, continue medical education holding conference and discussing matters of
common practice of medicine.
SWOT analysis:
Strength
 Registration of professionals is strictly followed

 Councils approve syllabus.
 Curriculum design.
Weakness:
 No regular monitoring and supervision of educational institution.

 Not much co-ordination for quality assurance of health.
 Code of conduct not conducts fully.
Opportunity:
 Integrated monitoring mechanism of institute producing HRH

 Council can make quality assurance team and can monitor.
 MOH can expand its existing quality assurance network.

Threat:
 Overproduction of nonproductive HRH.

 Utilization of nonproductive professionals.
 Might put at risk goal of National health policy.
Recommendation:
 Finance monitoring.
 Enhance co-ordination between different sectors and stakeholders in HRH
production and utilization.
 Monitoring council – while appointing member of council only competent members
should be appointed
 Mandatory, provision of registration of all the alive health services ( also should
include sections) and monitor them.
 Services provided by NGO and INGOs monitor the quality.
Critically analyze regional distribution of HRH in Nepal.
1. Distribution of total health work force by urban and rural setting:
Setting HRH Target population

Urban 20% 10%
Rural 72% 90%
Development Total Target Doctors Indigenous Nursing Paramedic Public health

region work population health staff
force professionals
Central 36 % 95 % 50 % 34 % 36 % 33 % 31 %
Eastern 20 % 23 % 17 % 17 % 21 % 22 % 22 %
western 20 % 20 % 17 % 24 % 20 % 21 % 22 %
Mid western 14 % 13 % 9% 13 % 13 % 15 % 15 %
Far west 9.5 % 9% 7% 12 % 10 % 10 % 10 %
Strength:-
- Equitable distribution of HRH.

- Different policies addressed by health plans for proper distribution of HRH.
- Support form bilateral agencies.
- MOH provides career development and training opportunities and facilities to its
employees for enhancing decentralization mechanism based upon the concept the
equity.
- Sanctioned post created in accordance to the target population to be focused need
based demand based.

Weakness:
- Inadequate production of HRH in related field.
- Unscientific system of manpower projection.
- Gap between demand and supply analysis.
- Unscientific system of distribution analysis.
- Mismatch among various categories and level of HRH.
- Unclear job requirement.
- Sanctioned post partially fulfilled.
- Weak reporting and recording system
- Inadequate monitoring and supervision system.
- Weak performance analysis and lack of adequate encouraging working environment.
- Less study on dynamic environment.
Threat:
- Political instability.
- Socioeconomic factors.
- Individual variation choices of health services
- Health care operated as price market mechanism.
Opportunity:
- Good interplay and analysis of demand and supply distribution must be made by
competent manpower.
- Planning should be done by HRH expertise.
- Data bank of employee should be strongly managed and recorded (HURDDIS) should
be strengthen)
- HRH Nepal government should encourage public private sector for the production
required HRH.
- Opportunity for career development of HRH should be made.
4.2.2: Role of private sectors

 Please see role of private sector in HRH production
4.3: Concept, Objective, role, function, importance and critical appraisal application
4.3.1: Human Resource Development Information System (HuRDIS)
HURDIS is a powerful mix tool developed and supported by PHCP-GTZ upon request of DOHS in
1994. It is a computerized system for collecting, storing, updating, analyzing, and retrieving
information or health personnel and health institution data base device and is designed to store
information about employee and their jobs. Database includes comprehensive bio-data of health
workers (30000) health organization (4500+), demographic data (4000) and many others. The
information system contained following data about each.
Personal data, skill data, compensation data, position data, performance record etc. the system is
developed and supported by PHCP, GTZ, since 1994. Upon a request from DOHS.
Objective:

- To facilitate the decision making process in planning and HRD management at all
level.
- To enhance the management capacity at central, regional and district level health
institution.
- To acquire accurate reliable and update information in time which is not only
essential for effective HRM but also for use of HURDIS.
1. Make the information processing faster easier and reliable.
2. Facilitates the decision making process in planning and HRD management at
all level.
3. Enhance the maximum capacity of central regional and district level health
information.
4. Provides the reliable and updated information in health mix which is required
not only for human resources development mix but also for rational planning.
5. It provides the information about the person requiring training, transfer or
promotion.
6. Can be used in succession planning.
7. Forms the basis for conducting job analysis.
4.3.2: Personnel Information System (PIS)
 Major component of national human resources management system.

 Integral part of whole HRIS under ministry of general administration.
 Managed by department of civil personnel records.
 Database of personnel information of all government employees along with all
government offices and institutions including civil, police, military, health workers,
teachers etc.
 Information acquired and updated from appointment to retirement.
Uses of PIS:
 Database of all government employees.

 Information is acquired, stored, manipulated, analyzed, retrieved and distributed for
pertinent information of concerned employees for different purpose.
 Information is used for different purposes from appointment to retirement like
promotion, leave, transfer, retirement
 Used in calculation of pension , gratuity
Conclusion
 HuRDIS is one of the four information system of ministry of health

 There are four component of HuRDIS viz. Personnel information, Health facilities,
Demographic data and Human Resources.
 HuRIC (Human Resource Information Centre) under HRFMD, DoHS is focal point of
HuRDIS.
 The objective of HuRDIS is to facilitate the decision making process in planning and HRD
management at all level.

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BPH VIII SEMESTER

HUMAN RESOURCE FOR

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA

 Effectively managing and utilizing people.

Human resource development (HRD)

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 1

1.2: Function of HR and HRD

 There are mainly 2 function of HR/ HRM

 HR Planning: Predicting changes in management strategies and future HR needs.

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 2

 Organizational/ Job design: Concerned with interdepartmental relations and

Challenges for HRD

 Changing workforce demographics

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 3

Increase Manage change

 HRD programs impacts & effect on organizational efficiency.

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 4

1.4: Interrelationship among planning, production and utilization (management) cycle in

HEALTH SYSTEM EDUCATION SYSTEM

Interrelationship between planning, production and utilization (management) cycle in HRD.

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 5

HRD planning HRH production HRH utilization

1.5: Pre-requisites for HRD

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 6

2. Leadership readiness: - The preparation of a national health manpower plan must be

4. Administrative capacity:- Personal administrative division, recruitment system,

5. Political dimension: - Political commitment, political stability, goals, mission, vision,

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 7

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 8

2.2.1: Demographic trends

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 10

Source strategic plan for HR for health 2003 MOH.

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 11

2.2.3: Soio-economic trend:

2.2.4: Development of scientific and technical capability:

 Use of software like EPI-Info for forecasting epidemics.

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 12

1. Market oriented method:-

3. Economic (Health) demand function:-

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 13

6. Qualitative and Quantitative (statistical) methods:-

a) Delphi technique: - This technique utilizes and accumulates the expert’s

 Quantitative methods / statistical methods :-

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 14

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 15

2.5: Role of various institution in support to HRH planning

Creation of new Establish new

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 16

Information about vacant post from district

Target Vs HR for I/NGOs

Demand estimation and projection

Permanent (Public Service Temporary

2.5.3: Universities/ Health science institution

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 17

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 18

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 19

1. Supply side projection:

 Health need method

HUMAN RESOURCE FOR HEALTH COMPILED BY ANIL SHRESTHA 20

The manpower/population relation method:

Current Projected Future

Projected future HRH

Current HRH/population Required future