A report for the internship on

Urban Health Center

Jorpati, ward no. 5

Submitted by
Awani Sigdel
Amita Poudel

Roll no 21140076

An internship report submitted towards partial fulfillment of the requirement of

Bachelor in Healthcare Management (BHCM)

(Affiliated by Pokhara University)

Atharva Business College

Maharajgunj, Kathmandu

2023

i
 Acknowledgement

I would like to especially show gratitude to Atharva Business College management and the

faculty members for offering such a great course with an objective to produce competent

health care managers inside our country Nepal. It is our pleasure to expand our knowledge

and creativity being the student of Health Care Management and preparing a practicum report

is not only a part of our curriculum and knowledge but also a subject of our university.

I would like to express my sincere gratitude to Principal, Mr. Manoj Thapa Magar,

Coordinator of Health Care Management Department, Mr. Subash Adhikari, Internship In

charge Mr. Pawan Prakash Dhami for the guidance and support for this internship.

Similarly, my gratitude goes to staffs of Urban Health Center, Jorpati and Gokarneshwor

municipality for providing an immense opportunity to undertake our internship in the Urban

Health Center and providing the necessary guidance and platform to explore our ideas,

generate the knowledge and develop the analytical skills regarding the management of the

health centers. I would like to thank department heads and all the staffs of the hospital for co-

operating and providing the useful set of data needed for the study.

I would also like to thank our friends for their support, assistance and made valuable

contribution during the practicum at Urban Health Center, Jorpati. Lastly my heartfelt

gratitude goes to them who directly or indirectly helped out to complete our work.

Sincerely yours,

Awani Sigdel, Amita Poudel

ii
BHCM V

iii
Certification by Authority

iv
v
 RECOMMENDATION

Faculty of Management Studies

Pokhara University

This is to certify that internship report titled

A report for the internship Urban Health Clinic

Jorpati, ward no. 5

Prepared by

Awani Sigdel

Has been prepared and submitted as approved by this college. This practical report is

forwarded to Pokhara University.

Place: ………...

Date: ………... BHCM Program

Atharva Business College

Maharajgunj, Kathmandu

vi
 APPROVAL

Faculty of Management Studies

Pokhara University

An internship report titled

A report for the internship on Urban Health Clinic

Jorpati, Ward no.5

Prepared by:

Awani Sigdel

Submitted towards partial fulfillment of the requirement for the

degree of Bachelor in Health Care Management has been approved

by the following panel:

S.N Date Name Designation Signature

1. Manoj Thapa Principle
Magar
2. Subash Adhikari Coordinator
3. Pawan Prakash Supervisor
Dhami

vii
 Abstract
The UHC of Jorpati was established in 2077 Falgun 30, with the motive to provide the OPD

and other basic health services to the local people of community. But with the changing time,

change in health needs of local people and changing pattern of disease its main focus is to

provide basic health service to people free of cost/ affordable cost especially promotive and

preventive health services.

The six weeks’ practicum was carried out in Urban Health Center, Jorpati, ward no.5. The

major focus of study was to gather information about the managerial activities and health care

delivery system of UHC. It was carried out to collect information about how the National

Health Programs are implemented, managed, reported and evaluated at local level. It also

aims to accumulate the information about the overall functioning of the UHC.

During the course of our internship primary as well as the secondary data were collected. The

primary data were collected with concerned body’s close observation. The secondary data

were collected through website; brochures published articles and internal reports.

The study in Urban Health Center shows that the health center is providing best health

services to the local people of community and its efforts has also shown positive impact to

reduce mortality and morbidity rate of the community. The study has provided valuable

insights regarding the role of local health bodies, community participation, National Health

Program to reduce the mortality and morbidity of population.

Hence the study became very beneficial for us as it has helped us to develop proficiency in

managerial field, develop more deep knowledge related to health programs operated by the

government. The benefit and outcome of these programs on local as well as national level. It

has also assisted us to gain knowledge regarding the procedure of program implementation,

monitoring and evaluation system, health communication channels and Management

Information System.

viii
The key words used in this report are UHC which means Urban Health Center, GoN which

means Government of Nepal, Atharva Business College, BHCM which means Bachelor in

Health Care Management.

Contents
ix
Acknowledgement...................................................................................................................ii

Certification by Authority.......................................................................................................iii

RECOMMENDATION...........................................................................................................v

APPROVAL..........................................................................................................................vi

Abstract................................................................................................................................vii

List of Illustration.................................................................................................................xiii

Abbreviations......................................................................................................................xvii

Chapter one.............................................................................................................................1

Introduction and Methodology..................................................................................................1

1.1Introduction........................................................................................................................1

1.1.1Pokhara University...........................................................................................................1

1.1.2 Atharva Business College................................................................................................2

1.1.3 Health Care Management................................................................................................2

1.1.4 Health.............................................................................................................................3

1.2 Background of the Study....................................................................................................6

1.4 Purpose and Objective........................................................................................................7

1.4.1 Purpose.......................................................................................................................7

1.4.2 Objective....................................................................................................................8

1.5 Definition of Terms............................................................................................................9

1.6 Methodology....................................................................................................................10

1.6.1 Study Design..............................................................................................................11

1.6.2 Study Site..................................................................................................................11

x
 1.6.3 Study Duration...........................................................................................................11

1.6.4 Data Collection Technique..........................................................................................11

1.7 Scope of Study.................................................................................................................12

1.7.1 Scope........................................................................................................................12

1.7.2 Limitation of Study....................................................................................................12

Chapter Two..........................................................................................................................13

Organization Under Study......................................................................................................13

2.1 History/ Introduction.....................................................................................................13

1.8 Organization of Paper...................................................................................................19

2.2 Management................................................................................................................20

2.3 Mission/ Vision/ Philosophy..........................................................................................21

2.3.1 Vision.......................................................................................................................21

2.3.2 Mission.....................................................................................................................21

2.3.3 Objective...................................................................................................................21

2.4 Location and Layout.....................................................................................................22

2.4.1 Location....................................................................................................................22

2.4.2 layout.......................................................................................................................23

2.5 Staffing........................................................................................................................24

2.5.1 Staffing Pattern.........................................................................................................24

2.5.2 Hiring and selection procedure...................................................................................24

2.5 Organogram.................................................................................................................26

2.6 Services Rendered........................................................................................................26

xi
 2.7 Future Plans.................................................................................................................30

Chapter 3..............................................................................................................................32

Programs...............................................................................................................................32

3.1 National Immunization Program.......................................................................................32

3.1.1 Magnitude of Health Problem........................................................................................35

3.1.2 Service Area including Outreach Activities....................................................................35

3.1.3 Target Population..........................................................................................................36

3.1.4 Program Objective........................................................................................................36

3.1.4.1 Vision....................................................................................................................36

3.1.4.2 Mission..................................................................................................................36

3.1.4.3 Goal.......................................................................................................................36

3.1.4.4 Strategic Objectives................................................................................................36

3.1.5 Implementation.............................................................................................................37

3.1.6 Monitoring and Evaluation............................................................................................38

3.1.7 Outcome.......................................................................................................................40

3.2.1 Safe motherhood Program.............................................................................................46

3.2.1 Magnitude of Health Problem........................................................................................47

3.2.2 Service area including outreach activities.......................................................................48

3.2.3 Target Population..........................................................................................................48

3.2.4 Program Objective........................................................................................................48

3.2.5 Implementation.............................................................................................................49

3.2.6 Monitoring and Evaluation of program activities.............................................................56

xii
3.2.7 Outcome.......................................................................................................................58

3.2.8 Analysis.......................................................................................................................62

3.3.1 Family Planning Program..............................................................................................63

3.3.2 Magnitude of Health Problem........................................................................................64

3.3.3 Service Area including outreach activities......................................................................64

3.3.4 Target Population..........................................................................................................64

3.3.4 Program Objective........................................................................................................65

3.3.5 Implementation.............................................................................................................65

3.3.6 Monitoring and Evaluation............................................................................................68

3.3.7 Outcome.......................................................................................................................69

3.3.8 Analysis........................................................................................................................72

3.4.1 Nutrition Program.........................................................................................................73

3.4.2 Magnitude of Health Problem........................................................................................74

3.4.3 Service area including outreach activities.......................................................................74

3.4.4 Target Population..........................................................................................................74

3.4.5 Program Objectives.......................................................................................................75

3.4.6 Implementation.............................................................................................................75

3.4.7 Monitoring and Evaluation.............................................................................................77

3.4.8 Outcome.......................................................................................................................77

3.4.9 Analysis........................................................................................................................81

Chapter Four.........................................................................................................................83

Administrations.....................................................................................................................83

xiii
4.1 Human Resource/ Personnel Management.........................................................................83

4.2 Finance (including accounting and materials management)................................................84

4.3 Health Communication, Planning and Management (Promotion and awareness).................85

4.4 Management Information System.....................................................................................87

4.5 Assessment......................................................................................................................91

Chapter Five..........................................................................................................................93

Analysis and Findings............................................................................................................93

5.1 Analysis..........................................................................................................................93

5.2 Findings..........................................................................................................................94

5.3 Critical Observation.........................................................................................................96

Chapter Six...........................................................................................................................98

Conclusion, Recommendation and lesson learnt......................................................................98

6.1 Conclusion......................................................................................................................98

6.2 Recommendation.............................................................................................................98

6.3 Lesson learnt...................................................................................................................99

6.4 References.......................................................................................................................99

6.5 Appendix.......................................................................................................................102

Internship Completion Form.............................................................................................102

Internship checklist..........................................................................................................104

APPENDIX A: INTERNSHIP WEEKLY REPORT ONE.................................................106

APPENDIX B: INTERNSHIP ACTIVITY LOG...............................................................107

APPENDIX A: INTERNSHIP WEEKLY REPORT TWO.................................................109

xiv
 APPENDIX B: INTERNSHIP ACTIVITY LOG...............................................................110

APPENDIX A: INTERNSHIP WEEKLY REPORT THREE..............................................113

APPENDIX B: INTERNSHIP ACTIVITY LOG................................................................115

APPENDIX A: INTERNSHIP WEEKLY REPORT FOUR................................................119

APPENDIX B: INTERNSHIP ACTIVITY LOG...............................................................120

APPENDIX A: INTERNSHIP WEEKLY REPORT FIVE.................................................123

APPENDIX B: INTERNSHIP ACTIVITY LOG...............................................................124

Appendix A: INTERNSHIP WEEKLY REPORT SIX.......................................................125

APPENDIX B: INTERNSHIP ACTIVITY LOG...............................................................126

List of Illustration

Figure 1 Structure of health system of Nepal.............................................................................5

xv
Figure 2 Location of UHC.......................................................................................................22

Figure 3 Layout of UHC..........................................................................................................23

Figure 4 organogram of UHC..................................................................................................26

Figure 5 Bar diagram of service rendered................................................................................30

Figure 6 Number of children who got vaccinated in 2079/80.................................................43

Figure 7: Bar diagram showing the immunization progress in percentage for two years........44

Figure 8 PNC Home Visits......................................................................................................55

Figure 9 Safe Motherhood Service provided in Three Years..................................................60

Figure 10 Bar diagram of family planning trend analysis........................................................71

Figure 11 Bar diagram showing the % of children served under Nutrition Program..............79

Figure 12 Bar diagram showing the Vitamin A and deworming tablets distributed...............80

xvi
List of Tables

Table 1: Gantt Chart.................................................................................................................20

Table 2:Table showing the management committee................................................................20

Table 3 Staffing pattern of UHC..............................................................................................24

Table 4 The staff that are in permanent job or contract...........................................................25

Table 5 Top ten disease of year 2079/80.................................................................................27

Table 6 Children served under CBIMNCI Program................................................................28

Table 7 Number of Geriatric services provided.......................................................................29

Table 8 NCD in year 2079/80..................................................................................................29

Table 9 Client Served in year 2077/78, 2078/79, 2079/80......................................................30

Table 10 Immunization Schedule.............................................................................................33

Table 11 Immunization Schedule for missed children.............................................................35

Table 12 Target Population of National Immunization Program In Jorpati, Ward 5..............36

Table 13 Number of children who got vaccinated each month of 2079/2080.........................41

Table 14 Target vs. Achievement of year 2079/80 for Immunization Program......................42

Table 15 Trend analysis of two years of data of immunization...............................................43

Table 16: Target Population of Safe Motherhood and Childhood Program............................48

Table 17 The table for reporting during pregnancy period......................................................57

Table 18 Trend analysis of three years of data........................................................................60

Table 19 Target Population for Family Planning Program in 2079/2080................................64

Table 20 Conditions when Pills, Depo-Provera, Implant and IUCD are not provided to clients

..................................................................................................................................................67

Table 21 Number of clients provided with Pills, Depo and Implant service each month of year

2079/80.....................................................................................................................................69

Table 22 Trend analysis of FP Programs of two years............................................................70

xvii
Table 23 Target Population of for Nutrition Program.............................................................75

Table 24 Trend analysis of Nutrition Program of two years....................................................78

Table 25 Table showing the Vitamin A and deworming tablets distributed...........................80

Table 26 Human Resource in UHC.........................................................................................83

Table 27 Financial Resource engaged in UHC........................................................................84

Table 28 Methods of Health Communication System.............................................................87

Table 29 Achievement of Health Indicator..............................................................................92

Table 30 Daily activities week one........................................................................................108

Table 31 Daily activities week two........................................................................................112

Table 32 Daily activities week three......................................................................................118

Table 33 Daily activities week four.......................................................................................122

Table 34 Daily activities week five........................................................................................124

Table 35 Daily activities week six.........................................................................................127

xviii
Abbreviations

UHC Urban Health Center

ART Antiretroviral therapy

AEFI Adverse following immunization event

EOC Essential obstetric care

EPI Expanded programme on immunization

IDA Iron deficiency anaemia

IHIMS Integrated health information management

system

NAHD National adolescent health and development

(strategy)

NCDR New case detection rate

NCP Integrated management of newborn care

programme

PCV Pneumococcal conjugate vaccine

TIMS Training information management system

TT Tetanus toxoid

UHC Universal health coverage

VAD Vitamin A deficiency

xix
WRA Women of reproductive age

NIP National Immunization Program

BCG Bacillus Calmette Guerin

Pentavalent Vaccine DPT-Hep B-Hib Diphtheria, Pertussis,

Tetanus, Hepatitis B and Hemophilus
influenza B

bOPV Bivalent Oral Polio Vaccine

fIPV Intradermal fractional-dose inactivated polio

vaccine

PCV Pneumococcal conjugate vaccine

JE Japanese encephalitis

TCV Typhoid conjugate vaccines

Td Tetanus and Diphtheria

ANC Antenatal care

PNC Postnatal care

SP Sulphurdoxine Pyrimethamine

xx
xxi
 Chapter I: Introduction and Methodology

1.1Introduction

1.1.1Pokhara University

Pokhara University was established in1997 as Nepal’s fifth university. Its central office

is in Pokhara, kaski district, Western Development Region. Along with Purbanchal

University, PU was formed as part of the government’s policy for the improved access to

higher education. The prime minister is the university chancellor and the minister for

education is the pro-chancellor. The vice chancellor is the principle administrator of the

university. (Pokhara University, 2021)

Pokhara University is located in Khudi-Dhungepatan, Pokhara Lekhnath Municipality, Kaski

District, 13 km east of Pokhara city (Prithvi Chowk). It also operates an academic complex in

Seven Lake City, Lekhnath, surrounded by several peaks of the Himalayan mountain

range. Begnas Lake and Rupa Lake are within walking distance of the university's central

office.

The School of Engineering, The School of Health & Allied Sciences, The School of

Business, and The School of Development and Social Engineering are housed in buildings

located on the bank of the Khudi river.

Pokhara University began offering degrees following the Pokhara University Act of 1997.

Pokhara University has four Constituent Schools where Bachelor's, Master's, and PhD degree

programs are offered. There are 57 academic institutions affiliated with PU, also offering

Bachelor's, Master's, M.Phil. and PhD. degree programs. Pokhara University manages its

expenditures mainly from three sources: Nepal

Government’s grants, revenue from students and affiliated institutions. PU has been

1
gradually reducing its dependence on government coffer in line with Nepal.

1.1.2 Atharva Business College

With the purpose of preparing management student adopt in the external environment

and unleashing their capacity by promoting innovativeness and creativity in a disciplined

manner, Atharva Business College was established in 2013AD. It was founded by

eminent academicians having rich educational experience. Apart from the university

curriculum. Atharva Business College has a distinct teaching module to succees in the

present day real world. (Athava Business College, 2020)

Vision:

Provide excellent learning environment and opportunity by applying latest learning models,

professional educators, business leaders and successful entrepreneurs.

Mission:

Central for Transformational Leaders, innovative Enterpreneurs and Multi Dynamic

Managers.

1.1.3 Health Care Management

Before the advent of rapidly-advancing medical technology, doctors didn’t have as much of a

need for healthcare managers. However, the near-continuous development of medical

technology (including changes in healthcare data systems) and regular changes in laws and

regulations surrounding healthcare mean that hospitals and other medical centers need

experts in these areas to ensure everything runs as it should. (Health Care Management

Degree Guide, 2023)

Healthcare management is exactly what the name implies. It’s the overall management of a

healthcare facility, such as a clinic or hospital. A healthcare manager is in charge of ensuring

a healthcare facility is running as it should in terms of budget, the goals of the facility’s
2
practitioners and the needs of the community. A person in charge of healthcare management

oversees the day-to-day operations of the facility. (Health Care Management Degree Guide,

2023)

This individual also acts as a spokesperson when providing information to the media. The

person in charge of healthcare management also collaborates with medical staff leaders on

issues such as medical equipment, department budgets, planning ways to ensure the facility

meets their goals and maintaining a good relationship with doctors, nurses, and all

department heads. The healthcare manager also makes decisions about performance

evaluations, staff expectations, budgeting, social media updates, and billing. (Health Care

Management Degree Guide, 2023)

1.1.4 Health

Health is a relative state in which one is able to function well physically, mentally, socially,

and spiritually to express the full range of one’s unique potentialities within the environment

in which one lives (Svalastog, Dohey, Kristoffesen, & Gajovic, 2017). Health is a state of

complete physical, mental and social well-being and not merely the absence of disease or

infirmity. (World Health Organization, 2020)

The enjoyment of the highest attainable standard of health is one of the fundamental rights of

every human being without distinction of race, religion, political belief, economic or social

condition. (World Health Organization, 2020) As the time is changing, the pattern of disease

is changing which has caused changing health needs of people. According to the changing

needs of people there are different concepts of health such as biomedical concept, ecological,

psychosocial, and holistic concept of health. These concept of health shows the overall

perception of health. Hence health is essence of life. Health is an integral part of

development.
3
Health is not only important to individual but also for society, community and nation. Only

the healthy individual is able to develop healthy society and country. So its immensely

important to focus in each aspect pertinent to health.

Health centres are community-based and patient directed organizations that provide

affordable, accessible, high-quality primary health care services to individuals and families,

including people experiencing homelessness, agricultural workers, residents of public

housing, and veterans.

Health centres integrate access to pharmacy, mental health, substance use disorder, and oral

health services in areas where economic, geographic, or cultural barriers limit access to

affordable health care. (Health resource and Service Administration, 2023) It mainly focuses

on providing various basic and health service to people at affordable or free cost and improve

health and living standard of people.

In context of Nepal, health care centers are established under Government of Nepal to

provide affordable, accessible, basic and primary health services to citizens of Nepal. Its

main objective is to provide promotive and preventive health service to people to decrease the

incidence of disease and reduce mortality and morbidity.

4
 Figure 1 Structure of health system of Nepal

The Ministry of Health and Population department is the leading government of ministry for

health. It is responsible for overall policy formulation, planning, organization and

coordination of the health sector at national, province, district and community levels.

One of the branch of Ministry of Health and Population is DOHS; Department of Health

Service that is responsible for delivering preventive, promotive, diagnostic and curative

health services throughout Nepal. Under the DOHS, the municipality’s health branch

operates under which the Urban Health Clinic is operational.

5
1.1.5 Urban Health Center

Urban Health Center is the primary or basic health service providing center which includes

providing promotive, preventive health service to people at free cost or nominal cost. Its main

aim is to reach every community people of locality so that every citizen of country have equal

access to the health services.

1.2 Background of the Study

As many people in Nepal is suffering from minor health problem which in turn has caused

serious effects such as death of people so UHC are established to provide basic health service

at affordable cost and raise awareness among people about personal hygiene and healthy life

style.

Because people are suffering and dying from disease that can be managed with proper

exercise, healthy diet and lifestyle UHC are established in Nepal with an aim to provide

promotive, preventive and furthermore rehabilitative and curative health service to citizen of

Nepal.

Today the health institutions are facing challenges in delivering right care at right time, in

leadership task, communication, organizing, controlling, planning, decision making,

controlling and evaluation of health services and programs. This is mainly the outcome of

health institution managed by non -professional human resource.

This study has been carried out to gain the knowledge in managerial activities performed in:

 Determination of goals and objectives

 Program planning

 Financial management

 Personnel management

6
 Program review and evaluation

 Governmental related activities

 Educational development

In current scenario, most of the hospitals and health institutions are operated by medical

personnel so it’s necessary to increase the importance of hospital administration, so is the

study carried out. The local or national all the health context aspect are operated, planned and

decided by the medical personnel which may lack proper management of these health sector

including the environment hazards, poor HCWM, improper managerial activities, poor

communication and decision making ability at time of certainty, risk or uncertainty. So the

hospital and health institution management must be provided with proper managerial

personnel specialized and well informed in the field.

For the purpose of gaining and enhancing health care managerial knowledge, to behold how

the activities are applied in real world, to explore the capability and apply the theoretical

knowledge in real life situation, to understand the procedures of implementation of health

programs in the community the study is carried out.

1.3 Rationale of study

Undertaking an internship in Urban Health Center in Jorpati in the health program lies in its

unparalleled potential to bridge the gap between theoretical knowledge and practical

application.

Engaging with the health programs presents a unique opportunity for comprehensive

immersion in the practical aspects of healthcare delivery. By exclusively focusing on health

programs, we gain specialized knowledge and experience in critical areas of public health.

This focused involvement allows us, a deeper understanding of specific initiatives such as

7
immunization, safe motherhood, child health education, and disease control. Through active

participation in these programs, we contribute directly to the betterment of community health

outcomes. This internship also cultivates essential skills and expertise that are directly

transferable to careers in public health, healthcare administration, and related fields, making

it a pivotal learning experience for us seeking to make a meaningful impact in the healthcare

sector. Additionally, this internship affords invaluable insights into the specific healthcare

challenges and needs of the local community.

1.4 Purpose and Objective

1.4.1 Purpose

 The purpose of the health care management internship experience is to provide the

student with opportunities in an operational environment to:

 Acquire and demonstrate competencies expected in a professional managerial

environment within a health care organization as covered in theoretical course works.

 Integrate and apply the academic theory and knowledge acquired in the classroom to the

actual practice of health care management.

 Acquaint the student with various consumer, customer or client populations,

organizational activities, scope of services, and required personnel within the internship

organization.

 Assess the external environmental factors which affect the strategic ability of the health

care organization to operate such as: community organizations, advocacy organizations,

civil rights organizations, national and international policies and regulations.

8
 Acquaint the student with the interrelationships and interdependencies of the various

components of the health care delivery system and the interfaces to the internship

organization.

 Allow students to assess the suitability of his/her qualifications for and commitment to

the profession of health care management.

1.4.2 Objective

1.4.2.1 General Objective:

The prime focus of the study is to acquire knowledge about the planning, execution and

controlling system of health programs in the health center or health institution which involves

overview of all the managerial activities performed in the health institution to fulfill the

curriculum requirement of Pokhara University, BHCM 5th semester.

1.4.2.2 Specific Objective:

 To observe the managerial activities performed by UHC.

 To study the interrelationships between different departments of UHC.

 To fulfill the requirement of bachelor degree of health care management

 To study administration sector in detail.

 To study organization structure.

 To access MIS conducted in UHC.

 To observe the real scenario of conducting various health programs and obtained Targeted

results

 To collect and analyze information

 To find out existing problems in UHC.

9
1.5 Definition of Terms

Health: Health is a state of physical, mental and social wellbeing and not merely the absence

of disease.” (World Health Organization, 2020)

UHC:

Immunization: A process by which a person becomes protected against a disease through

vaccination. This term is often used interchangeably with vaccination or inoculation. (Centers

for Disease Control and prevention, 2021)

Vaccination: The act of introducing a vaccine into the body to produce protection from a

specific disease. (Centers for Disease Control and prevention, 2021)

Contraception means the measure to prevent pregnancy by obstructing the common process

of ovulation, expulsion of sperm, or implantation of the ovum. (Rights, 2075)

Contraceptive methods means hormone-based or other method of contraception (Rights,

2075)

Pregnancy means the term from first day of the last menstrual period before conception till

fetus remains in the woman’s uterus. (Rights, 2075)

Family planning means individual’s planning on the number or spacing of children by using

or not using the contraceptives. (Rights, 2075)

Reproductive health means the state of physical, mental and social wellbeing in all matters

related to the reproductive system, and to its functions and processes. (Rights, 2075)

Birth attendants means trained health worker who assist pregnant woman in childbirth

(Rights, 2075)

10
Safe motherhood means maternal services provided to women during antenatal, delivery and

post-partum periods, in accordance with this Act (Rights, 2075)

Health institution: means hospital, nursing home, medical college or health foundation

operated by government, non-government, community or private organization, and also refers

to primary health center, health post or the health institution operated under any other name

(Rights, 2075)

Newborn essential care: means the services, including newborn care to keep them clean and

warm, taking 2 care of the navel and eyes, breastfeeding, as well as administering necessary

vaccines. (Rights, 2075)

Nutrition: means the intake of essential nutrients from food that sustains bodily functions

and promotes health and well-being.

Antenatal care : (ANC) is a means to identify high-risk pregnancies and educate women so

that they might experience a healthier delivery and outcome. (McNellan, et al., 2019)

Postnatal care is defined as a care given to the mother and her newborn baby immediately

after the birth of the placenta and for the first six weeks of life. (Wudineh, 2018)

1.6 Methodology

A 6 weeks’ internship was conducted in the Urban Health Center, Jorpati, Kathmandu. The

health center is an institution which provides various OPD, family planning, maternity and

child health services free of cost.

1.6.1 Study Design

The study design is of descriptive in nature. It involves collection of data. The collective data

is as the basis for findings and findings are used to draw conclusion about the health

11
programs, the achievement of the program, its beneficiaries to the community, society and

nation.

All the data collected in this report is both primary as well as secondary data.

1.6.2 Study Site

The study is conducted in Urban Health Center, Jorpati, Gokarneshwar municipality.

1.6.3 Study Duration

The study duration is of 42 days. Time duration of 35 days is separated for study, UHC visit

and data collection and rest of the 7 days is for analysis and report writing. Internship is done

from Sep.26 to Nov.22 of 2023

1.6.4 Data Collection Technique

The study design is of descriptive and exploratory in nature. It involves collection of data.

The collective data is as the basis for findings and findings are used to draw conclusion.

All the data collected in this report of UHC is both primary as well as secondary data.

The data is collected through both primary and secondary methods.

Primary data

 Observation: the observation of the activities performed by the workers in the UHC can be

a means for data and information collection. The observation of their treatment,

counselling, communication and similar procedure can be the source of data.

 Interview: The Direct Personal Interview with the personnel working in the UHC can also

be a source of data collection. In this case we need to be involved personally in data

collection procedure.

 Questionnaire: The questionnaire can be prepared and requested to the Health worker of

UHC to be filled. It also provides relevant data necessary for the practicum.

12
 Discussion: Discussion with the health worker of UHC about the procedures used,

treatment protocol followed, activities performed can also assist in data collection.

Secondary data

 Annual report of UHC: the annual report of UHC prepared at the end of each fiscal year

can be an important sources of data. It provides information regarding the population

covered each year and helps in micro level planning.

 Brochures: The brochures of the UHC and Nepal Government can also provide valuable

insights regarding the implementation of program, services rendered.

1.7 Scope and Limitation of Study

1.7.1 Scope

 Essential to students for developing the managerial skills and practices.

 Helpful in the proper advertisement of the organization and study internal strength

and weakness and external opportunities and threats

 The study covers all medical and administrative aspect of the organization.

 This study report will help other student for understanding how the UHC functions.

 This type of study helps to provide feedback for the improvement in the organization

which ultimately helps in quality service delivery.

1.7.2 Limitation of Study

 Certain information is confidential or restricted, and some data are not readily

available. For example: budget detail is not provided.

 Most of the staffs in the UHC do not know about the Health care management course

and its scope. Therefore, it becomes very challenging to do internship. As the

managerial activities of UHC is even operated by health worker.

1.8 Organization of Paper

The paper in the report is arranged in total six chapters:

13
Chapter One is Introduction and Methodology, which includes Introduction, Background

of the Study, Rationale of the Study, Purposes and Objectives, Definition of Terms,

Methodology, Scope of the Study, Organization of the Paper, Gantt Chart.

Chapter Two includes Organization Under Study which includes History, Management,

Philosophy, Location and Layout, Staffing, Services Rendered, Future Plans.

Chapter Three is Programs which includes Magnitude of the Health Problem, Service area

including outreach activities, Target Population, Program Objectives, Implementation,

Monitoring and Evaluation of program activities, outcome, Overall analysis.

Chapter Four is Administration which includes Human Resources, Finance, Health

Communication, Planning and Management, Management Information System, Assessment.

Chapter Five is Analysis and Findings which includes Analysis, Findings, Critical

Observation.

Chapter Six is Conclusion, References and Lesson learnt.

1.9 Ghantt Chart

Week 1 Week 2 Week3 Week4 Week5 Week6

Table 1: Gantt Chart

14
 ACTIVITY 1 Program engagement

ACTIVITY 2 Finding literature

ACTIVITY 3 Data collection and analysis

ACTIVITY 4 Writing the report

Chapter II: Organization Under Study

2.1 History/ Introduction

15
Government of Nepal is committed to improve the health status of both rural and urban

people by delivering high quality health services throughout the country. In the past thrust of

concentration was towards health care delivery of rural population and it shadowed the

initiative of urban health services. Urban health centers were established through the joint

initiative of District Public Health Office and Municipality. UHCs were developed to

promote and prevent the health issues of people who lives in urban areas yet can’t afford to

pay for health interventions. (Kunwar, 2076)

The Urban Health Center in Jorpati, Ward 5 was established at 2077 B.S Falgun 30. Its was

establish after covid outbreak. As it is mentioned in the National Health Policy of Nepal,

2019 that health is the basic right of all citizens of Nepal so is the UHC established to provide

health service to the people. The government has established basic health care as a

fundamental right of its citizen. As country has moved to federal governance system, it is the

responsibility of the state to ensure the access of quality health services for all the citizens

based on contextual norms of federal system. To provide the basic health service to the

population of Jorpati ward no. 5 is the UHC established. But as the pattern of diseases is

changing, needs of people is changing it primarily aims to provide basic health services to

people free of cost or affordable cost.

Urban Health Center, Jorpati ward no 5 is located in Jorpati, Gokernaswor Municipality. It

runs multiple health programs under the supervision of Gokarneswor Municipality. The

programs like safe motherhood, family planning, immunization, nutrition, TB, CB-IMCI are

operated by it. It provides its services from 10 AM-5PM.

In current scenario, the UHC is providing OPD services free of cost six days a week from 10

Am – 12 Pm. Also OPD service is provided from 4:00 pm-6:00 pm every Tuesday a week. It

also provides basic and primary health services free of cost. It provides laboratory services

charging minimum cost which is affordable to all group of people.

16
 It also provides medicines specified by Government of Nepal free of cost.

The medicines provided by the UHC free of cost are as follows:

1. Acetylsalicylic acid (aspirin)

2. Adrenaline (epinephrine)

3. Albendazole

4. Aluminum hydroxide gel + Magnesium hydroxide (Antacid)

5. Amitriptyline

6. Amlodipine

7. Amoxicillin

8. Ampicillin

9. Artemether + Lumefantrine (AL) (Artemisinin-based Combination Therapy – ACT)

10. Artesunate

11. Atropine

12. Azithromycin

13. BCG Vaccine

14. Benzathine benzylpenicillin

15. Calamine

16. Calcium gluconate

17. Carbamazepine

18. Cefixime

19. Ceftriaxone

20. Cetirizine HCL

21. Charcoal, activated

22. Chlorhexidine (CHX)

17
23. Chloroquine (CQ)

24. Ciprofloxacin

25. Clotrimazole

26. Clove Oil

27. Cloxacillin

28. Combined Oral Contraceptive (COC)

29. Cotrimoxazole (Sulphamethoxazole and Trimethoprim 5:1)

30. Dapsone, Clofazimine, Rifampicin (MDT Combi Pack)

31. Dexamethasone

32. Dextrose (glucose)

33. Diazepam

34. Diclofenac Sodium

35. Doxycycline

36. Ferrous sulphate and folic acid

37. FIPV Vaccine

38. Fluconazole

39. Fluoxetine

40. Folic acid

41. Furosemide

42. Gentamicin

43. Gentian Violet

44. Glimepiride

45. HPV Vaccine

46. HRZE

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47. Hydrocortisone

48. Hyoscine butylbromide

49. Ibuprofen

50. Japanese Encephalitis Injection

51. Levonorgestrel (LNG)

52. Lignocaine hydrochloride

53. Lignocaine with adrenaline 1:10,000

54. Losartan

55. Magnesium sulphate

56. Measles-Rubella Vaccine

57. Medroxyprogesterone (Acetate DMPA)

58. Metformin

59. Methyldopa

60. Metoclopramide

61. Metronidazole

62. Mifepristone+ Misoprostol

63. Misoprostol

64. Neomycin Skin

65. Nifedipine

66. Nitrofurantion

67. Normal Saline (NS)

68. OPV (Oral Polio Vaccine)

69. Oral Rehydration Salts (ORS)

70. Oxygen

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71. Oxymetazoline

72. Oxytocin

73. Paracetamol

74. PCV Vaccine (Pneumococcal Conjugate Vaccine)

75. Pentavalent vaccine (DPT, Hep B and Hemophilius Influenza B)

76. Permethrin

77. Pheniramine

78. Phenobarbital

79. Povidone iodine

80. Pralidoxin Sodium

81. Prednisolone

82. Primaquine

83. Pyridoxine

84. Ranitidine

85. Ringer’s Lactate (RL)

86. Risperidone

87. Rotavirus Vaccine

88. Salbutamol

89. Silver Sulfadiazine

90. Tetanus diphtheria (Td) booster vaccine

91. Tetanus Toxoid (TT)

92. Tetracycline

93. Tinidazole

94. Sodium Valproate

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95. Vitamin A

96. Vitamin B complex

97. Vitamin K1

98. Zinc sulphate

The service sites of UHC are:

 Implant service site

 IUCD service site

 PMTCT service side

 DOTs service site

 Laboratory service site

 Microscopy service site

 VIA service site

The equipment used in UHC are:

 USG machine

 Autoclave machine

 Laboratory set

 ECG

 Nebulizer

 ICE lined frefrigelnator

 Washing machine

 Perilight

 Glucometer

 ENT set

 Fetal Dopple
21
  Desktop computer

 Canon printer

2.2 Management
S.N Management Committee Post

1. Dipak Kumar Rimal Chairman

2. Narayan Bahadur Upreti (Chairman)

3. Durga Ram Magar (Vice chairman)

4. Shatrudhan Bahadur (Member)

5. Kalpana Pandey (Member)

6. Jhalaknath Bhattrai (Member)

7. Uma Dhungel (Member)

8. Sarala Rai (Member Secretary)

Table 2:Table showing the management committee

2.3 Mission/ Vision/ Philosophy

To engage with Ministry of Health and Population (MoHP)/ Primary Health Care

Revitalization Division (PHCRD), Ministry of Urban Development (MoUD), Ministry of

Federal Affairs and Local Development (MoFALD), external development partners and

beneficiaries in developing the UHS to effectively deliver EHCS in urban areas in Nepal.

 To facilitate the process of developing the UHS;

 To document the overall process of the UHS development; and

 To facilitate in the scaling-up of the UHS

2.3.1 Vision

To provide quality health care services to the urban population, particularly to the urban poor,

women, children and marginalized groups.

22
2.3.2 Mission

To continuously improve the health of communities and the quality of life of the people by

providing affordable, comprehensive, quality, primary, and specialty health care.

2.3.3 Objective

 Ensure that all eligible children within the urban area receive timely and complete

 Vaccinations according to the recommended immunization schedule.

 Promote informed family planning choices to help individual couples plan their family in

a way that aligns with their preferences and circumstance.

 Promote safe delivery practices and skilled attendance during childbirth to reduce

maternal and neonatal mortality rates.

 Implement tuberculosis control programs, including early detection, diagnosis and

treatment of TB cases among urban residents.

 Educate the community about the causes of diarrhea and the importance of safe water,

sanitation, and hygiene practices.

2.4 Location and Layout

2.4.1 Location

The UHC is located in Jorpati, ward no. 05 near Jorpati Peepal bot.

North
Bouddha
Stupa
West East
South

23
 Jorpati, UHC
Peepalbot Jorpati

Figure 2 Location of UHC

From above it can be known that from Bouddha Stupa a bit to the east the Jorpati, Peepalbot

is located and adjescent to the Peepalbot the UHC of Jorpati is located.

24
2.4.2 layout

Entr
ance

Pharmacy

Family
Lab Planning
room

Office OPD

Immuniz
ation
Kitchen
room

Store

Figure 3 Layout of UHC

25
The Urban Health Center(UHC) is located in Jorpati, ward no 5 inside the ward. It is located

in the first floor. It is located at the eastern side of the building. When we enter the UHC we

can firstly find the pharmacy of the UHC where the general medicines and socio

demographic information of the patient is recorded. Then the patient is told to move to the

room according to the service they want.

When they move through the pharmacy they can view the lab in the right. Then they turn

opposite to the lab they can find Family Planning room in their left. Similarly, when they go

ahead they can find the office in their right and OPD in the left. Similarly, when they go

ahead they can find kitchen and just opposite to kitchen is the immunization room and a little

head is the store room.

2.5 Staffing

2.5.1 Staffing Pattern

S.N Staff Post

1. Dr. Santosh Gautam MD(HFOMC paid)

2. Dr. Amit Bista MGDP

3. Sarala Rai Incharge

4. Sita Bhattrai Sr. ANM

5. Khim Kumari Adhikari Sr. ANM

6. Sadhikshya Shrestha Sr. AHW

7. Salina Bista Lab Technician

8. Aadiathya Mahat Assistant. Computer

9. Krishna Maya Shrestha Ka. Sa(Karyalaya

Shahayogi)

10. Shanta Phyual Ka. Sa(Karyalaya Sahayogi)

26
 Table 3 Staffing pattern of UHC

2.5.2 Hiring and selection procedure

S.N Permanent Staff Contract Staff (Karrarr) No.

1 Doctors 2

2 In charge(H.A) 1

3 Sr.ANM 2

4 Sr.AHW 1

5 Laboratory Technician 1

6 Assistant Computer 1

7 Housekeeping Staff 1

9 Housekeeping Staff 1

Table 4 The staff that are in permanent job or contract

The government (Health Ministry) notifies for citizens when there is vacancy in the post

through different media. Then the eligible candidate who are willing to participate fills the

form and gives exam. Those people who have passed the exam undergoes interview and most

competent candidate are selected for providing civil service to the population of country.

Then staff are allocated according to the need of the required place. The orientation is

provided to the selected candidates and allocated to the area where they need to do their job.

But not only through civil service exams the candidates may be selected on contract for

certain period of time which is known as “karaar” or “Door Hjir.”

27
2.5 Organogram

HA(Incharge)

S. ANM S. AHW
S. ANM

Lab Computer
Technician Operator

Ka. Sa (karyalaya Ka. Sa (Karyalaya

Sahayogi) Sahayogi)

Figure 4 organogram of UHC

The figure above shows the organogram of the Urban Health Center, Jorpati ward no. 05.

From above figure it is clearly seen that the head of UHC, Jorpati ward no. 05 is Incharge of

UHC who is a HA (Health Assistant). Under the incharge, three of the people works that is

Sr. AHW and two Sr. ANM. The lab technician and the computer works under the guidance

of both the UHC incharge and the Sr. AHW. The karyalaya Sahayogi are two in number who

works under the supervision of Sr. AHW.

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2.6 Services Rendered

 OPD services: The OPD services includes all the outpatient service which includes the

services for communicable disease, non-communicable disease, any illness like cough,

common cold, fever, etc.

The Top ten disease of year 2079/80

S.N Disease Number of client served

1. APD(Adenosine 227

Diphosphate)

2. Cough 203

3. Headache 190

4. HTN( Hypertension ) 187

5. Fever 175

6. Dm(Diabetes mellitus) 143

7. Rhinitis 120

8. URT1(Urinary Tract 118

Infection)

9. Diarrhoea 116

10. Worm infestation 112

Table 5 Top ten disease of year 2079/80

The top ten disease of year involves ADP (Adenosine Diphosphate) which is 227 in number.

In the same manner people suffering from cough was 203 in number. Similarly, the people

who had suffered from headache was 190 and HTN is 187. In addition to that the people

suffering from fever was 175 and from Dm (Diabetes mellitus) was 143 in year 2079/80.

Similarly, the people suffering from Rhinitis was 120 and diarrhoea was 116 and from worm

infestation was 112. It shows the number of people suffering from disease in year 2079/80.
29
 Family Planning: the family planning services includes counselling given to couples,

plls services, implant, Depo services and IUCD services provided to the clients.

 ANC/PNC Services: the ANC service is provided to the pregnant women where usually

four ANC visits are recommended (4,6,8,9 months) whereas the PNC visit includes

services provided to the post-partum women for about 45 days.

 RUSG Services: The RUSG is conducted every 16 th of month in UHC. The checkup of

pregnant women is done during this camp and necessary vitamin supplements like iron

folic acid, calcium is provided.

 Immunization Services: the vaccination is provided to the children abd pregnant

women to prevent maternal and neonatal illness and mortality rate. The immunization

program is conducted each Sunday in UHC.

 CBIMNCI Services: it is the one that focuses on under 5 children. It helaps to prevent

childhood illness and provide prompt service to the ill chidren like children suffering

from diarrhoea, ARI, pneumonia, etc.

Children served under CBIMNCI Program

S. Indicators 2078/79 2079/80

1. Incidence of ARI/ 1000 years children (new cases) 21 85

2. Incidence of pneumonia(pneumonia+severe 0 3

pneumonia )/1000 under 5 children (new cases)

3. Proportion of severe pneumonia among new ARI 0 0

cases

4. Number of dealths due to ARI (Under 5) 0 0

5 % of diarrhoeal cases treated with zinc and ORS 7 14

among under 5 years with diarrhoea

30
 Table 6 Children served under CBIMNCI Program
From above table it can be clearly interpreted that incidence of ARI/ 1000 years children

(new cases) was 21 in year 2078/79 which increased to 85 in year 2079/80. Similarly,

Incidence of pneumonia (pneumonia+severe pneumonia)/1000 under 5 children (new cases)

was 0 in year 2078/79 and 3 in year 2079/80. In the same way, Proportion of severe

pneumonia among new ARI cases was 0 in both year 2078/79 and 2079/80. The number of

death due to ARI was also 0 in both the year and % of diarrhoeal cases treated with zinc and

ORS among under 5 years with diarrhoea was 7 in year 2078/79 and 14 in year 2079/80.

From this it can be analysed that the UHC, Jorpati able to cover more population in fiscal

year in 2079/80 than in year 2078/798.

 Nutrition Service: It is the service which aims to improve the nutritional status of

children and adolescence to avoid malnutrition and nutritional deficiency. The nutrition

service primarily focuses on every month growth monitoring, distribution of vitamin A,

deworming tablets, etc.

 Consultant Service: The service involves providing information to the client regarding

any issues or condition they are facing. The consequences which may occur if untreated,

the procedures of treatment, follow up information.

 Geriatric Service: It involves the services provided to the population above 65. It

involves health counselling, distribution of calcium if necessary, etc.

The geriatric services provided in year 2079/80.

S.N Geriatric Service Number

1. Total 305

2. Female /Male 179/126

Table 7 Number of Geriatric services provided

31
From above table it can be interpreted that the total number of geriatric service provided was

305 among which 179 were female and 126 were male in year 2079/80.

 Promotional Health Service: it involves health education, health communication to

improve the health of population and assist in adopting healthy life style.

 NCDS service: The non-communicable services include the services provided to

different age group people regarding HTN, Uric Acid, Thyroid, CVD, Diabetes, COPD,

Asthma and so on.

The non-communicable diseases services provided in year 2079/80

S.N Disease Number of client served

1. HTN 173

2. CVD 9

3. Diabetes 110

4. COPD 6

5. Asthma 17

6. CKD 7

Table 8 NCD in year 2079/80

From above table it can be known that the UHC, Jorpati served 173 patient suffering from

HTN, 9 suffering from CVD, 110 from diabetes, 6 from COPD, 17 from asthma and 7 from

CKD.

The following includes the total number of clients served in fiscal year 2077/78, 2078/79 and

2079/80. (Also the consultant services provided to the clients)

32
S.N Fiscal Year Client Served

New Clients Served Total Clients Served

1. 2077/78 329 433

2. 2078/79 2181 2746

3. 2079/80 5938 9069

Table 9 Client Served in year 2077/78, 2078/79, 2079/80

Chart Title
10000
9069
9000
8000
7000
5938
6000
5000
4000
3000 2746
2181
2000
1000 329 433
0
2079/2080 2078/2079 2077/2078

New Client Served Total Client Served

Figure 5 Bar diagram of service rendered

This is the bar diagram that shows that the total service rendered in 2077/78 was 433 and

new client served was 329. In 2078/2079 total service rendered to new client is 2181 and

total client served is 2746. In 2079/2080 total service rendered to new client was 5938 total

client served is 9069.

This shows that the number of client being served is increasing every year at huge rate. It

shows that the UHC of Jorpati is able to cover more population each year since its operation.

The population coverage has also increased because people are more familiar about the
33
existence of UHC. Also the staff were only two during the time of operation but it has

consequently raised to 8 in number. Hence the service provided are also more.

2.7 Future Plans

 Safe abortion service will be started very soon.

 Emergency service is also planned for future.

 Also ambulance service will be provided in future.

 The UHC also plans to provide services like delivery service and extend the OPD

services.

Chapter III: Programs

34
3.1 National Immunization Program
The national immunization program is operated under the supervision of DOHs; Family

Welfare Division which falls on the Child Health and Immunization Service Section.

The National Immunization Program (NIP) of Nepal (Expanded Program on Immunization)

was started in 2034 BS and is a priority program of the Government of Nepal. It is one of the

successful public health programs of the Ministry of Health and Population and has achieved

several milestones contributing to reduction in morbidity, mortality and disability associated

with vaccine preventable diseases. (Department of Health Service, 2021/2022)

Nepal is the first country in the South-East Asia Region to have an Immunization Act, thus

supporting and strengthening the National Immunization Program. Immunization Act 2072

was published in the Official Gazette on 26 January 2016. Based on the Act, Nepal has

Immunization Regulation 2074, which was published in the Official Gazette on 6 August

2018. The Immunization Act of Nepal has recognized immunization as a right of all children.

In line with this, provinces of Nepal also have developed its own provincial Immunization

Act. (Department of Health Service, 2021/2022)

Since FY 2069/70 (2012/2013), Nepal has initiated and implemented a unique initiative

known as ‘full immunization program’. This program addresses issues of social inequity in

immunization as every child regardless of social or geographical aspect within an

administrative boundary are meant to be fully immunized under this program.

In case of UHC of Jorpati immunization program is conducted under supervision of

Municipality. The UHC conducts the NIP every Sunday from 10:00 am-2:00 pm. As the JE

35
vaccine cannot be provided after half an hour of opening it is provided from 12:00 pm-12:30

pm.

Immunization Schedule

S.N Type of Vaccine No. of Doses Schedule

1. BCG 1 At birth or on first contact with health

institution

2 bOPV 3 6, 10 and 14 weeks of age

3 DPT-Hep B-Hib 3 6, 10 and 14 weeks of age

4 Rotavirus Vaccine 2 6 and 10 weeks of age

5 fIPV 2 14 weeks and 9 months of age

6 PCV 3 6, 10 weeks and 9 months of age

7 Measles-Rubella 2 First dose at 9 months and second dose

at 15 months of age

8 JE 1 12 months of age

9 TCV 1 15 months of age

10 Td 1 Pregnant women: 2 doses of Td one

month apart in first pregnancy, and 1

dose in each subsequent pregnancy

Table 10 Immunization Schedule

Immunization Schedule for missed Children

Vaccine Up to 12 months if missed >12 months to 23 24 months to 5 years if

in routine schedule months if missed missed

1 dose - The standard dose of reconstituted vaccine is 0.05 mL for infants aged

BCG <1 year and 0.1 ml for children aged >1 year

36
 TST (Tuberculin Skin Test) not required before vaccination

Rotavirus 2 doses with 1-month interval Rotavirus vaccine should

not be given to children

above 2 years of age

bOPV 3 doses with interval of 1 month between dose

fIPV 2 doses with interval of 4 months between dose

PCV 3 doses with 1-month 2 doses with 2 months interval between doses

interval between doses

DPT-HepB- 3 doses with interval of 1 month between dose 3 doses interval of 1

Hib month between 1st &

(Pentavalent) 2nd dose, and 6

months between 2nd

& 3rd dose

MR > 9 months to < 15 months of age 1st dose at first ≥ 15 months to 5

contact, and 2nd dose at 15 months of age. There years of age 2 doses

should be at least 1-month interval between doses with 1-month interval

between doses

JE 1 dose

TCV ≥ 15 months to 5

years of age 1 dose

Table 11 Immunization Schedule for missed children

37
3.1.1 Magnitude of Health Problem

The national immunization program has reduced the people suffering from vaccine

preventable disease. The NIP (National Immunization Program) program has huge coverage

and success in Gokarneswor Municipality. It prevents the community from outbreak of

disease, provides quality of life to people, prevents children and community from suffering

from serious illness.

The consequence of not getting vaccinated may lead to poor immune system, lifelong

disability, paralysis, and even death. So one needs to be fully vaccinated.

Some problems that may occur while conducting immunization program includes high

vaccine dropout rate. Many people migrate due to which there is prevalence of high vaccine

dropout rate. Sometimes parents are unable to bring their child for vaccination in time

because of their personal reasons. Also the needle management becomes problem in case of

UHC in Jorpati as there is no instrument for waste disposal. Even when a HIV infected child

is immunized same needle cutter is used but there is no system for waste disposal which may

result outbreak of infectious disease.

3.1.2 Service Area including Outreach Activities

The service area of National Immunization Program in UHC of Jorpati ward no. 5 is the

community people of ward no. 05 and residents of the community including citizens of

Nepal.

The outreach activities include conducting immunization program every Sunday in UHC. It

also includes providing the awareness to people about need to be immunized, conducting

campaign at local level, conducting vaccination program at schools, home visits, etc.

38
3.1.3 Target Population

S.N Target Population No.

1. Under one year 338

2. Under two year 680

3. 2-59 month 1390

4. Under 5 year 1728

5. Expected pregnancy 418

Table 12 Target Population of National Immunization Program In Jorpati, Ward 5

3.1.4 Program Objective

3.1.4.1 Vision

A community free of vaccine-preventable diseases.

3.1.4.2 Mission

To provide every child and mother high-quality, safe and affordable vaccines and

immunization services from the National Immunization Program in an equitable manner.

3.1.4.3 Goal

Reduction of morbidity, mortality and disability associated with vaccine preventable diseases.

3.1.4.4 Strategic Objectives

Objective 1. Reach every child for full immunization

Objective 2. Accelerate, achieve and sustain vaccine preventable diseases control, elimination

and eradication

Objective 3. Strengthen immunization supply chain and vaccine management system for

quality immunization services

Objective 4. Ensure financial sustainability for immunization program

39
 Objective 5. Promote innovation, research and social mobilization activities to enhance best

practices.

3.1.5 Implementation

The program is implemented by medical professional especially Sr.ANM. It includes various

activities done by health workers. The activities include the following:

 Firstly, the vaccine is brought from the municipality by filling requisition form. The

vaccine is usually brought at end or start of month which consist of stock for a month.

Then it is stored in LR freeze certified by WHO.

 Then the vaccine is used opening the vail as per requirement.

 The BCG vaccine is vaccinated to the infant during the first day of birth or after some days

of birth.

 The Rota virus vaccine is vaccinated at 6th week and 10th week of birth of children.

 OPV vaccine is provided at 6th and 10th and 14th week of birth.

 FIPV is provided to children at 6th and 14th week of birth.

 PCV vaccine is provided at 6th and 10th week of birth.

 DPT vaccine id provided to children at 6th, 10th,14th week of birth.

 Measles-Rubella vaccine is provided at 9th and 15th month.

 JE vaccine is provided to children at 9th month.

 TCV vaccine is provided at 15th month to children.

 These vaccines are provided to the infants and children according to the guidance provided

by GON.

 The health care providers counsel the parent about the importance of getting vaccinated.

 The health worker performs the below mentioned activities and fills the card.

40
  Also the child health care card is provided to the parents which consists of

master registration number, vaccine service registration number.

 It also contains nutrition registration number, CB-IMNCI registration number.

 The card consists of name of child, date of birth, sex, birth weight, mothers name,

fathers name, address, municipality, ward no, tole, name of health institution, the name

of health worker, phone no., card issue date.

 The card consist of information about which vaccine has already been given, the date at

which the vaccine is provided, the date at which the child needs to be at health

institution for getting vaccinated in future.

 The immunization register (named as HIMS 2.2) is also filled which consists of name,

age, sex, registration number, ethnicity code, parents name, phone number, address and

birth of date. It also consists of information about the number of vaccine provided to

the children and infants.

 Later the information is filled in DHIS through online basis which can be accessed by

the DOHs, MOHP and respected municipality.

 The activities also include the training program that is carried out by DOHs, municipality to

upgrade the knowledge of health workers.

 The implementation also takes place by conducting campaigns, awareness program at school

and community level.

 It also focuses on providing TD vaccine to pregnant women side by side.

3.1.6 Monitoring and Evaluation

The monitoring is done primarily by the In charge of UHC. The monitoring is done at the end

of each month by In charge. The health workers are also required to fill the HIMS 9.1

manually as well as in software through online system. In case of immunization program, the

41
total number of children who have vaccinated are recorded, number of vaccines that were

brought to the UHC is recorded, the number of vaccine that were used during the month is

recorded and the number of vaccine that has been damaged, expired or went wastage due to

any reasons is recorded.

It also records the number of children who have been fully vaccinated within 23 months and

24-59 month.

Then it is firstly monitored by incharge of UHC. Then it is sent to municipality then it is

evaluated by the health section of municipality. At the same time, it is also accessible to

DOHs which also monitors and then evaluates either the activities are done effectively and

efficiently or not.

The monitoring and evaluation also takes place through MSS assessment which is conducted

4 times annually by the municipality. Through MSS evaluation is done by considering the

following point:

 The vaccination should be done in every work day from 10:00am-04:00pm.

 There must be one health worker allocated for vaccination and nutrition.

 There must be privacy of the client.

 The client’s parents must be informed counseled about the vaccine provided, nutrition

status and current health status of the client. Also it should include awareness to involve

proper health status of children.

 The type of vaccine, method used in vaccination, nutrition and IEC materials should be

available.

 The Standard Treatment Protocol should be followed.

 There should be adequate amount of equipment and furniture for operation.

 The negative consequences if any after being vaccinated is recorded.

 The mask and the gloves are available and utilized properly.
42
  The protocol for HCWM is followed in correct way.

 Also there must be proper work environment for the staff.

On the basis of above mentioned points it is determined whether the UHC is conducting the

Immunization Program within the certain standard or not.

 On the basis of report and records submitted to the DOHS and municipality monitoring

and evaluation takes place; if the targets are meet or not, infrastructure required to

conduct the program, efficiency of health worker, financial stability, medicines

consumed, drugs that wasted due to any reasons, satisfaction of locality people, maternal

and child health problem being solved, progress report, etc.

3.1.7 Outcome

Number of children who got vaccinated each month of 2079/2080

Mont B O.P.V Rota F.I.P. P.C.V Penta M/R J Typh T.D

h C V E oid

1 1 2 3 1 2 1 2 1 2 3 1 2 3 1 2 1 1 1 2 3

Shra 4 1 2 7 1 2 1 7 1 2 2 1 2 7 2 3 4 1 6 1 0

wan

Bhad 3 1 2 3 1 2 1 3 1 2 2 1 2 3 2 4 2 1 3 2 1

ra 3 3 3 3 3

Asho 2 1 1 1 1 1 1 1 1 1 7 1 1 1 7 3 5 3 0 0 0

j 1 0 1 0 1 1 0 1 0

Karti 2 1 8 1 1 8 1 1 1 8 4 1 8 1 4 4 4 4 6 1 0

k 0 2 0 0 2 0 0 2

43
Mang 4 6 7 1 6 7 0 0 6 7 4 6 7 1 4 4 6 4 1 7 2

sir 0 0

Pous 1 1 1 1 1 6 0 0 1 1 7 1 1 6 7 5 5 5 5 1 2

h 2 0 2 0 2 0 2 0

Magh 5 6 1 1 6 1 6 1 6 1 4 6 1 1 4 6 5 6 3 2 2

3 3 3 3 3 3 3

Falgu 2 1 9 1 1 9 1 6 1 9 6 1 9 1 6 8 5 8 5 3 1

n 5 5 5 2 5 5 5

Chait 4 6 1 1 6 1 1 8 6 1 8 6 1 1 8 4 5 4 7 2 2

ra 3 1 3 1 3 3 1

Baish 3 1 1 1 1 1 1 2 1 1 2 1 1 1 2 1 1 19 1 3 1

akh 7 3 2 7 3 2 5 7 3 5 7 3 2 5 9 3 2

Jesth 4 1 1 8 1 1 8 1 1 1 1 1 1 8 1 5 0 5 7 8 4

a 5 2 5 2 1 5 2 1 5 2 1

Asha 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9 1 9 6 2 2

d 3 7 8 3 7 8 8 3 7 8 3 7 8 8 9

Total 37 1 1 1 1 1 1 9 1 1 9 1 1 1 9 7 8 74 6 3 1

2 1 0 2 1 0 1 2 1 8 2 1 0 8 4 1 2 4 7

5 6 3 5 6 3 5 6 5 6 3

Table 13 Number of children who got vaccinated each month of 2079/2080

Number of children who got vaccinated each month of 2079/2080

44
Target vs. Achievement

S.N Antigen Target population Target Achievement

1. BCG Under one year 338 37

2. OPV Under one year 338 241

3. Rota Under one year 338 344

4. FIPV Under one year 338 194

5. PCV Under one year 338 339

5. Penta Under two year 338 344

6. M/R Under one year 338 172

7. Typhoid Under two year 680 74

8. JE Under two year 680 81

9. TD2 and Expected pregnancy 418 113

TD2+

Table 14 Target vs. Achievement of year 2079/80 for Immunization Program

From above table it can be clearly analyzed that the target are not meet completely but it is in

its progressive phase to meet its target

45
 Number of children who got vaccinated during year
2079/2080
140
125 125 125 125
120 116 116 116 116
106
103 103
100 98 98 98
91

80 74 74

62
60

40 34
27

20 17

0
BCG OPV Rota FIPV PCV Penta Measles/ JE Typhoid TD
Rubella

1st dose 2nd dose 3rd dose

Figure 6 Number of children who got vaccinated in 2079/80

Achievement of Immunization Program in fiscal years of 2078/79 and 2079/80

Indicator 2078/2079 2079/2080

%of children under one year immunized 1.83% 10%

with BCG

%of children under one year immunized 3.82% 32%

with DPT-Hep-Hip3

% of children under one year 5% 30%

immunized with PVC3

% of children under one year 3.82% 31%

immunized with FIPV

46
% of children aged nine to eleven 5% 30%

month immunized with MIR 1st

%of children aged 12-23 months 4% 25%

immunized with JE

% of pregnant women immunized with 2% 6%

TD2 and TD2+

Table 15 Achievement of Immunization Program in fiscal years of 2078/79 and 2079/80

The above table is shown in graphical form as below:

47
 %of children and pregnant women who had been vac-
cinated in year 2078/2079 and 2079/2080
35.00%
32%
31%
30% 30%
30.00%

25%
25.00%

20.00%

15.00%

10%
10.00%
6%
5.00% 5.00%
5.00% 3.82% 3.82% 4.00%
1.83% 2.00%

0.00%

2078/2079 2079/2080

Figure 7: Bar diagram showing the immunization progress in percentage for two years
From above two years of data that is 2078/2079 and 2079/2080, it can be analysed that the

immunization program is fostering more in year 2079/2080 in comparison to previous year. It

can be noted that % of children under one year immunized with BCG was 1.83% in 2078/79

but next year it has covered about 10% of population under one year. Similarly, percentage of

children under one year immunized with DPT-Hep-Hib3 was 3.82% in 2-78/79 but it has

raised to 32% in 2079/80. Similar is with PCV3 vaccine where the immunization coverage
48
 has increased to 30% than in previous year which was 5%. The %of coverage of FIPV in

2078/79 was 3.82% whereas it has successfully increased to 31% in2079/80. In addition to

that the vaccination coverage was only 5% for M/R in year 2078/79 but it has reached 30%

the next year. Similarly, the JE vaccine coverage has significantly increased to 25% in

year2079/80 which is more than in previous year that is 4%. The next is TD2 and TD2+

vaccine whose coverage for pregnant women has reached 6% than in previous year 2%.

Hence from above explanation and bar diagram it is explicitly notable that the immunization

has covered higher rate in 2079/80 in comparison to 2078/79 which also shows that

immunization program in ward 5 is in progressive phase.

Finance:

The program is funded by government of Nepal. All the vaccines, vile, doses, syringes are

provided by the Nepal government with the help of Gokarneshwor Municipality. The certain

amount of budget is also allocated by the UHC to conduct immunization camp.

Beneficiaries:

The benefit of the immunization program is to the whole community, children and nation. It

helps to reduce the child and infant mortality rate in the nation and whole world and prevent

vaccine preventable disease in the population.

3.1.8 Analysis

Strength

 Trained Human Resource: the health workers are trained and proficient enough to

provide the vaccination service.

 Weekly vaccination: Every Sunday vaccination program is conducted in the UHC.

 LR freeze: there is presence of WHO certified LR freeze for storage of vaccines.

Weakness

49
 No regular onsite Coaching and Clinical updates: the clinical updates are not provided on

regular basis to the service providers.

 Regular problem from staff: If more number of health worker are absent then it becomes

difficult to provide immunization service to more number of clients.

Opportunity

 Location within ward office. The UHC Jorpati is located within the ward no 5 of Jorpati

so is the immunization program conducted so it becomes easier for the people to find the

location of UHC Jorpati.

 Free immunization: The immunization service is provided free of cost.

 Regular mothers group meeting, staff meeting, HFOMC meeting. HFOMC meeting. the

meeting with staff, mother group is conducted in monthly basis to understand the

need of improvement, services to be expanded.

 Health education to mother during sessions. When the mother visit UHC with child then

proper education regarding care of child is provided.

Threats

 Many of the migrant population don’t know about location of government health service

center and facility.

 High drop out of DPT1 and DPT3 due to migration. Many people migrate to other places

resulting high vaccine dropout rate.

 Other vaccine site within five minutes around health center.

3.2.1 Safe motherhood Program

Safe Motherhood means creating the circumstances within which a woman is able to choose

whether she becomes pregnant, and if she does, ensuring that she receives care for prevention

50
and treatment of pregnancy complications, that she has accessed to trained birth assistance,

and if she needs it to emergency obstetric care, and care after birth, to prevent death of

disability from complications of pregnancy and child birth. (Family and Welfare Division,

1998)

Safe Motherhood is concerned with maintaining the health of the woman/and her new-born

throughout the process of pre-conception, pregnancy, childbirth and the post-delivery period.

It means creating the circumstances within which a woman is enabled to choose whether she

will become pregnant or not, and if she does, ensure she receives optimum care for

prevention and treatment of pregnancy complications. It also mean having access to trained

birth assistants, emergency obstetric care if she needs it, and care after birth, so that death or

disability from complications of pregnancy and childbirth can be avoided for both mother and

baby. (World Health Organization, 2017)

The Family Welfare division (FWD) developed the Safe Motherhood and New-born Health

(SMNH) Roadmap (SMNH), 2030 which aims to ensure a healthy life for and the well-being

of, all mothers and newborns. Nepal’s SMNH Road Map 2030 is developed with a focus on

ending preventable maternal and newborn deaths, by building on the successes of the SMNH

Program and addressing the remaining challenges, especially around strengthening

community health system platforms and improving institutional quality of care in an

equitable manner.

(Depatment of Health Service, 2021/2022)

3.2.1 Magnitude of Health Problem

Many women are dying during prenatal and postnatal period due to lack of proper care,

hygiene, nutrition and proper health services. So it has become a problem in developing

countries especially in Nepal.

51
In case of Jorpati, Ward no. 05 expected number of pregnancy is 481 in numbers. So it is

necessary to manage the pregnancy in proper way to ensure healthy, happy population and

increase the quality of life of women of reproductive age group.

Sometimes the women are unknown about the necessity to visit the UHC after pregnancy.

They even have careless attitude towards going for ANC visit in time. Also unintended

pregnancy, lack of adequate spacing between child birth, family planning awareness after

pregnancy has become constraint to sound maternal health. It also becomes problem in case

of obstetric emergency services to be provided.

3.2.2 Service area including outreach activities

The service area of Safe Motherhood and Child health Program in UHC of Jorpati ward no. 5

is the community people of ward no. 05 and residents of the community including citizens of

Nepal.

The outreach activities include conducting Safe Motherhood program every Tuesday in UHC.

It also includes providing the awareness to people about necessity of maternal health,

conducting campaign at local level, conducting PNC home visits, etc. Also in 16 th of every

month RUSG program is conducted. The outreach activity includes providing home

deliveries to pregnant women by FCHW, awareness about the maternal care to women and

families of the community.

3.2.3 Target Population

S.N Target Population`

WRA 15-45 years 8330

MWRA 15-49 years 6331

Expected pregnancy 481

Table 16: Target Population of Safe Motherhood and Childhood Program

52
3.2.4 Program Objective

The goal of the safe motherhood program is to improve the health of women and their new-

born in general and specifically to contribute to the reduction in maternal and new-born

morbidity and mortality.

Components:

 Pre-conception care

 Antenatal care

 Postnatal care

 Family planning

 Health education and counselling

Pre-conception care is the counselling and care given to women planning to become

pregnant. It involves detecting and managing health problems that might affect the woman

and her baby later and ensuring that women with medical illnesses such as diabetes and

hypertension have these conditions controlled before becoming pregnant. It also involves

steps taken to reduce the risk of birth defects and other problems; for example, folic acid

supplements given to women to prevent neural tube defects.

Antenatal, labour/delivery and postnatal care are the services provided from the time

pregnancy is confirmed until six weeks following childbirth and these will be considered in

the ensuing sections of the document. Family planning and post-abortion care are dealt with

in separate management protocols.

Health education and counselling are important aspects of all the other components and

provide opportunities for promoting safe motherhood in formal settings such as health

facilities and schools and informal settings such as organized community groups as well as

faith-based gatherings. The mass media also provide cost-effective communication channels

for reaching policy makers, civil society and the general public.

53
3.2.5 Implementation
I. ANTENATAL CARE

Antenatal care (ANC) is the health care and education/counselling given during pregnancy.

Antenatal services are an important part of preventive and promotive health care.

A. OBJECTIVES

The objectives of ANC include:

 To promote and maintain the physical and mental health and social wellbeing of mother

and baby by providing information and education to the pregnant woman on nutrition,

rest, sleep, personal hygiene, family planning, immunization, sexually transmitted

infections (STIs) including HIV, danger signs, birth preparedness and complication

readiness.

 To detect and manage high-risk conditions arising during pregnancy, whether medical,

surgical or obstetric.

 To ensure the safe delivery of a full term healthy baby with minimal stress or injury to

mother and baby.

 To help prepare the mother physically, psychologically and socially to breastfeed

successfully, experience normal puerperium and to take good care of the baby.

In order to promote quality care, antenatal services must be organized in such a manner as to

provide comprehensive and individualized care. As much as possible, all care activities for

the pregnant woman e.g. history taking, physical examination and treatment, is done by the

same care provider.

The activities performed in ANC visit are:

Number and Timing of Visits: After pregnancy is confirmed, the number of times a client

needs to be seen during pregnancy may vary according to her needs. For the uncomplicated

pregnancy, the recommendation of at least 4 scheduled (16, 20-25, 32, 36 weeks) visits may

not be enough to ensure the pregnant woman receives the entire service package, especially
54
in view of the change in guidelines from a minimum of three doses of sulphurdoxine

pyrimethamine (SP) to five doses. The visits should therefore be scheduled with all the

various interventions in mind for uncomplicated pregnancy and for the pregnant woman with

complications, visits should be scheduled more frequently to ensure close monitoring and

timely management. Generally in the UHC at Jorpati 8 ANC visit is recommended.

 Assessing the Client

Take a Comprehensive History:

History includes the following information:

 Personal Information Name, age, home address, telephone number, educational status,

occupation, marital status, husband/partner’s information (name, address, telephone

number), next of kin (name, address, telephone number)

 Obstetric History Past obstetric history (including all pregnancies, deliveries, outcomes

and complications) History of the present pregnancy (record LMP and calculate EDD

and estimate the gestational age) Information on STIs is recorded

 Contraceptive history

 Medical and surgical history, including any known allergies to medication

 Family medical history

 Perform physical examination

 General Examination

 Examine of the woman from head to toe with emphasis on examination of the

conjunctiva and nail beds for pallor (anaemia) is done. Note of her gait for any sign of

pelvic deformity and check her feet for edema is taken. Check and record of the

following is done: - Temperature - Pulse - Blood Pressure - Weight and height

55
  Examine the breast is done for: - Discharge - Lumps - Nipple, whether everted or

inverted.

 Abdominal and Obstetric Examination is performed which includes: Inspection

abdomen for its shape and note for presence of any scars, palpate for tenderness, uterine

size, and other organ enlargements, Measurement of the symphysio-fundal height in

centimeters after 20 weeks, Check for fetal lie, presentation, and descent if at term,

Auscultate fetal heart tones after 20 weeks.

 Vulvo-vaginal Examination is performed which include Inspection of the vulva and

perineum for abnormal discharges, rashes, warty growths and ulcers.

Laboratory and Other Investigations Request/ perform the following:

 Urine for Protein and Sugar

 Midstream specimen of urine for bacteria, ova and pyuria (pus cells in urine)

 Stool for ova and parasites e.g. worms

 Blood for: - Haemoglobin level (Hb) - Sickling (Hb electrophoresis if positive) - Group and

Rhesus factor (Antibody titre if Rhesus negative) - Syphilis Test - HIV Testing and

Counselling - G6PD Deficiency - Hepatitis B Test

 Pelvic Ultrasound (for dating, fetal viability and abnormality, location of fetus and

placenta)

 Explaination about the purpose of antenatal care, as well as: - Timing of next visit - Total

number of visits - What to expect at subsequent visits is done.

 Briefly explanation about physiological changes and events in pregnancy is done (e.g.

changes in the breasts, growth of the fetus, onset of labour, etc.)

 Care of her health - Diet and nutrition: Use food charts in the maternal health record book

to educate woman is performed. Rest and exercise: Encourage woman to take between 6-10

hours of sleep each night, and try to rest for one hour during the day, undertake moderate
56
exercise regularly, if her daily activities do not entail much physical exercise. Personal

hygiene: -advice is given to woman to keep her body clean, especially the hands, genital area

and breasts, to minimize chances of infection. - Educate the woman on importance of family

planning and options of contraceptives available

Prescription and/or administration of the following is given to pregnant woman:

 Oral Iron daily (Non–anaemic clients) (Since second month of pregnancy to 45 days of

post-partum period; 60mg.)

 Folic acid daily (Since second month of pregnancy to 45 days of post-partum period;

0.4mg.)

 Anti-helminthic: Albendazole 500mg start after first trimester.

 Tetanus-toxoid immunization is given.

 Subsequent Visits

 At every subsequent visit, refer is done to previous antenatal notes, findings and

decisions made.

 History is taken which includes:

i. Asking about general health status since last visit.

ii. Asking about any new complaints or concerns, as well as the presence of any of the

danger signs.

iii. Asking about fetal movements if gestation is more than 20 weeks.

 Physical Examination is taken which includes:

i. Check blood pressure, and measure weight. (NB: in general, weight gain should not

exceed 0.5 kg weekly)

ii. Look for anaemia, goitre, fever, jaundice, swelling of face, feet and hands and signs

of physical abuse

57
  Obstetric Examination: measure symphysio-fundal height and compare with gestational

age.

 Laboratory Investigations is done which includes the test urine for sugar and albumin

check for Hb (at 28 weeks and 36 weeks, or more frequently if indicated)

 Administration of Drugs is done which includes: re-supply enough of iron and folic acid

to last till the next visit, giving Tetanus and Diphtheria immunization if indicated,

commence Anti-Retroviral Treatment where indicated

 Client education and counselling is given: continue with client education and counselling

as relevant to client’s needs and gestational age as follows: Discomforts of pregnancy,

birth preparedness and complication readiness, danger sign, sexual activity and safe sex,

signs and symptoms of labour, breastfeeding and breast care , infant feeding options for

HIV positive mothers, family planning methods, postnatal care (Importance and

schedule ), Newborn care, immunization schedule and danger signs in the newborn.

II POSTPARTUM CARE

OBJECTIVES

The postpartum period begins at the end of delivery and ends six weeks (42 Days) after

delivery.

The objectives of postpartum care are:

 To maintain the physical and psychological well-being of mother and baby

 To perform comprehensive screening for detection, treatment and /or referral of

complications of both mother and baby

 To detect and treat and/refer complications in the mother and the baby

 To provide health education on nutrition, danger signs, family planning, infant

feeding/breastfeeding and immunization of the baby

58
 Schedule of Postnatal visits for the mother and baby: There should be at least three review

visits:

 The first visit should be within the first 24 hours after delivery

 The second visit is on the 3rd day after delivery

 The last postnatal visit is at 7th day.

 Other visits may be done according to need.

Essential Activities at Postpartum Care

Examination of mother and baby

 Promotion of breastfeeding, including early initiation

 Micronutrient supplementation

 Immunization of the mother (where necessary)

 Health education and counselling

 Family planning motivation, and linkage with FP clinic for counselling and services

HIV testing and counselling (if not already done)

 Birth registration

 Iron tablets are provided to the mothers.

 Also vitamin A is provided to mothers.

 The iron tablet and calcium tablet along with folic acid is provided to the woman for 45

days after delivery.

After delivery of child the health worker visits the house of mother after 03:00 pm.

59
 PNC Home Visits Details

100 93
90
80
72
70
60
50
40
30
20
10 6
2
0
Normal Delivery LSCS Vacuum Home Delivery Total Service

Total Client Remarks

Figure 8 PNC Home Visits

3.2.6 Monitoring and Evaluation of program activities

The monitoring is done primarily by the In charge of UHC. The monitoring is done at the end

of each month by In charge. Then the monthly information is also filled at HIMS 9.3

manually and also in software HIMS through online process which is accessible to

Gokarneshwor Municipality and DOHs. Also minimum service standard is carried out three

times a year.

The following things are reported through Safe Motherhood and Child Health Program.

Obstetric Complication ICD11 Cases Referred out Death

Ectopic pregnancy JAO1

Abortion Complication JAO5

Pre-eclampsia JA24

Hyperemesis JA60.0

grivadarum
60
Antepartum JA41

haemorrage

Prolonged Labour JB03

Obstructed Labour JB06

Gestational JA23

Hypertension

Ruptured uterus JBOA.1

Postpartum JA43

haemorrhage

Retained placenta

JA43.0

Pueperal sepsis JB40.0

C-Section Wound JB40.1

Infection

Other complication JBOY

Table 17 The table for reporting during pregnancy period.

 The number of times pregnancy is examined for pregnant woman of <20 years and >20

years for first time, for within 12 weeks, at least four times (16, 20-24, 32, 36)

weeks/12, 16, 20-24, 28, 32, 34, 36 38-40 weeks (8 times according to protocol) is

reported to the municipality as well as DOHs.

 The examination of pregnant after birth is done which includes examination of

postnatal woman within 3 days after delivery, 7-24 days after birth, 42 days of birth, i

61
 vitamin A and iron tablet is provided to the pregnant woman after delivery and reported

to the respective authority.

 The UHC does not contain delivery service so is referred to the municipality hospital

but the number of deliveries of pregnant woman in ward no.5 of Jorpati is recorded by

the UHC and reported to the respected authority.

 The abortion service is not available but the reporting is done on the basis of data

available in patient card or obtained from patient.

 The weight of child during the time of birth is also reported either it is normal > 2.5 kg,

less that is 1.5 kg-2.5 kg or very less i.e <1.5 kg. Also reporting of condition of child

birth either normal or sophisticated case is also reported to the municipality and DOHS.

 On the basis of report and records submitted to the DOHS and municipality monitoring

and evaluation takes place; if the targets are meet or not, infrastructure required to

conduct the program, efficiency of health worker, financial stability, medicines

consumed, drugs that wasted due to any reasons, satisfaction of locality people,

maternal and child health problem being solved, progress report, etc.

3.2.7 Outcome

S.N Indicator 2077/ 2078/79 2079/ Target Achievem

78 80 ent in

number of

year

2079/80

1. % of women attending 1st ANC 8.7% 15% 47% 343 161

among expected live birth(Any

time 1st visit)

2. % of pregnant women 2.1% 14.4% 16% 343 69

62
 attending ANC among

expected live birth as a

protocol(4, 6, 8, 9)months

3. % of pregnant women who 3.3% 6.4% 30% 418 125

received anti helminthes

4. % of pregnant women who 2.1% 5.7% 16% 343 56

received Iron Folic Acid

tablets(new) among expected

live birth

5. % of deliveries attended by 24% 50% 343 172

health worker (HF and home)

among expected live birth

6. % of institutional delivery 24% 50% 343 172

among expected live birth

7. % of deliveries attended by 97.6% 100% 167 167

SBA at HFs among total

delivery at health facility

8. % of vacuum, forceps and C/S 41.6% 45% 173 78

deliveries among total

deliveries

9. % of postpartum mothers who 23.3% 46% 343 157

received vitamin A supplement

among expected live birth

10. % of women who had 4 24% 50% 343 172

postnatal care (PNC) visit as

63
 per protocol among expected

live birth

11. % of women receiving 24% 62% 173 107

maternity incentives among

institutional deliveries.

12. % of pregnancy terminated by 0 0 - -

induced procedure at HF

13. % of maternal death 0 0 - -

14. % of neonatal death 0 0 - -

15. % of pregnant women 4.6% 7.8% 30% 343 103

attending 1st ANC among

expected live birth as a

protocol(in four months)

Table 18 Safe Motherhood Achievement of Fiscal years of 2077/78, 2078/79 and 2079/80

Safe Motherhood Service Achievement of Fiscal years of 2078/79 and 2079/80

64
 120.00%

100%

100.00% 97.60%

80.00%

60.00%
50% 50% 50%
47%
45%
41.60%
40.00%
30% 30% 30%
24.00%
23.90%
23.90%
16%
20.00%15.10% 15.10% 16%
14.40%
7.80% 6.40% 5.70%

0.00%

2078/79 2079/80

Figure 9 Safe Motherhood Service Achievement of Fiscal years of 2078/79 and 2079/80

65
From the above graphs, it as clearly seen that the number of women receiving the ANC and

PNC service is increasing each year that is 2077/78<7078/79<2079/80.

In above diagram it is notable that the % of pregnant women visiting 1 st ANC among

expected live birth was 8.7 % in year 2077/78 but it raised to 15% next year and finally to

47% in year 2079/80. Similarly, the number of pregnant women attending ANC as in

protocol (in four month) has increased to 30% whereas it was just 4.6% in year 2077/78 and

7.8% in 2078/79. Also the number of women who received 180 days supply of iron folic acid

during pregnancy was 2.1% during 2077/78 which raised to 5.7% in year 2078/79 and 16% in

year 2079/80. Similarly, % of deliveries attended by SBA among expected live birth was

23.9% in year 2078/79 which successively raised to 50% next year. In addition to that, % of

postpartum mother who received vitamin A supplement among expected live birth was

23.3% inyear 2078/79 which raised to 46% in year 2079/80.

From above it can be analysed that the ANC/PNC services provided for good maternal and

child health has been fostering each year and the safe motherhood program conducted in

UHC is in progressive phase.

Finance:

The program is funded by government of Nepal. All the vaccines, doses of medicines,

syringes, equipment are provided by the municipality under the supervision of Government

of Nepal. The certain amount of budget is also allocated by the UHC to conduct RUSG camp.

Beneficiaries:

The benefit of the safe motherhood program is to the whole community, children and nation.

It helps to reduce the maternal and infant mortality rate in the nation and whole world and

improve the status of women in society in all aspects i.e. mentally, socially, physically and

economically.

66
3.2.8 Analysis

Strength

 Trained Human Resource the human resource mostly are trained to provided antenatal

and postnatal care and service to the clients.

 Timely and regular supply of FP devices. the FP devices are provided on regular basis to

the desired client.

Weakness

 All staff are not trained. Even though most of the human resource are trained not all are

trained to provide the safe motherhood service.

 No regular online coaching and clinical updates. The feedback and clinical updates are

not provided on regular basis.

Opportunity

 Location within ward office.

 Regular mother group meeting, staff meeting, HFOMC meeting. The meeting among

health worker, mothers group is conducted to understand the need of client, areas of

improvement.

 Manpower supported by FPAN one day per week. FPAN provides some manpower in

weekly basis to assist in ultrasound of pregnant women.

 Peer counseling among the client motivation. The clients and coupels are provided

counselling about the maternal and child health.

Threats

 Many populations don’t know about the location of government health service center and

facility.

 Migration of client resulting increase no of defaulter: many client migrate so they only

take half ANC PNC services resulting the increase number of defaulter.
67
 Less number of client using long term family planning method and permanent method.

 Prevalence of Emergency: many clients even visit UHC during the time of labour even

though delivery service is not provided in UHC.

3.3.1 Family Planning Program

Family Planning (FP) program is a long-standing program in Nepal. The aim of the

National FP program is to ensure individuals and couples fulfill their reproductive needs

and rights by using quality FP methods voluntarily based on informed choices.

Government of Nepal (GoN) is committed to equitable and right based access to

voluntary, quality FP services based for all individuals with special focus on hard-to-

reach communities such as adolescents and youths, migrants, slum dwellers, ethnic

minorities, sexual minorities, and other vulnerable groups ensuring no one is left behind.

To achieve this, GoN is committed and striving to strengthen policies and strategies

related to FP within the federal context, mobilize resources, improve enabling the

environment to engage effectively with supporting partners, promote public-private

partnerships, and involve health and non-health sectors. (Department of Health Service,

2021/2022)

Modern Family planning (FP) refers to female sterilization, male sterilization,

intrauterine contraceptive device (IUCD), implants, injectables, pills, condoms (male),

lactational amenorrhea method (LAM), emergency contraceptive (EC) and standard days

method (SDM). From program perspective, GoN through its subsidiary (FWD, PHD,

PHLMC, Health section MoSD, and municipalities) are trying to ensure access to and

utilization of client-centered quality FP services through improved contraceptive use

with special focus to underserved populations, broaden the access to range of modern

68
 contraceptives method mix including long acting reversible contraceptives (LARC) such

as IUCD and implant from service delivery points, reduce contraceptive discontinuation,

sustain and scale up successful innovations, evidence generation and linking with FP

service delivery and demand generation interventions. (Department of Health Service,

2021/2022)

3.3.2 Magnitude of Health Problem

The family planning devices is enabling people to have adequate spacing between birth. But

many people have misconception towards use of family planning devices which has lead to

maternal and child health. Similarly, there is prevalence of unintended pregnancy, teen age

pregnancy, prevalence of Sexually Transmitted Disease. Unsafe abortion and poor health of

women is the consequence of under use of family planning services. Some people even face

some kind of side effects related to use of contraceptive devices.

3.3.3 Service Area including outreach activities

The service is provided from UHC of Jorpati for people of ward no. 05. The services

provided includes implant, condoms, IUCD, Depo and pills, etc. These services are provided

from within the UHC. The outreach activities for family planning services includes

awareness program for men and women for related to birth spacing, maternal and child

health, school and college program related to family planning life, reproductive health.

Various camps are also conducted at local level at different service site.

3.3.4 Target Population

S.N Target Population Number

01 Adolescence 3978

02 WRA 15-45 years 8330

69
 03. MWRA 15-49 years 63310

Table 19 Target Population for Family Planning Program in 2079/2080

3.3.4 Program Objective

 To increase access to and the use of quality FP services that is safe, effective, and

acceptable to individuals and couples. A special focus is on increasing access in rural and

remote places with focus on marginalized people with high unmet need, postpartum and

post-abortion women and partner of labour migrants and adolescents.

 To increase contraceptive use, reduce unmet need for FP, unintended pregnancies, and

contraceptive discontinuation.

 To create an enabling environment for increasing access to quality FP services to men

and women including adolescents.

 To increase the demand for FP services by implementing strategic behaviour change

communication activities.

3.3.5 Implementation

The family planning program is implemented by ANM of UHC. The health worker of UHC

provides counselling services to the client who wants or needs family planning services. The

health worker provides information about various LARCs that is available in UHC like Dipo,

pills, condoms, IUCD and implant. Then according to the clients need and preferences the

services is provided to them.

The services are provided according to standard treatment protocol specified by Nepal

government. The implementation activities involve the following:

 Keeping the record of client taking pills or (COC) service, Depo-Provera, Implant and

IUCD is done which involves records in:

 Master Register (HMIS No. 1.1)

70
 Health Service Card (HMIS No. 1.2)

 Referral / Transfer Card (HMIS 1.4)

 Face Sheet (HMIS No. 3.1))

 Pills (HMIS 3.2)

 DMPA (HMIS 3.2)

 Implants service register (HMIS 3.3)

 IUCD Service Register (HMIS 3.3)

 Counselling about the advantage, disadvantage of taking pills, timing of taking pills,

Depo, implant and IUCD is provided to the clients and follow up time is provided.

 Then the client assessment is done and if following condition does not prevail

services are provided.

Pills Depo-Provera Implant IUCD

Known or suspected Known or cardiovascular Pregnancy

pregnancy suspected disease

pregnancy

Taking certain medications Unexplained ischemic heart Post-partum

(rifampicin fortuberculosis vaginal disease ≥48 hours to <

and medications for mental bleeding 4 weeks

disorders (e.g. epilepsy)

Thromboembolic disorders Breast cancer systemic lupus Post-abortion

(blood clots in the legs, erythematosus Immediate

lungs or eyes) post-septic

71
 abortion

Heavy smoker (if over 35 liver disease neurological Systemic

years of age) conditions lupus

erythematosus

High blood pressure Sensitivity to reproductive Reproductive

(systolic blood pressure any component tract infection Tract

between 140 and 159 of Depo- Infection and

mmHg or diastolic 90 and Provera Disorders

99 mmHg or history of

hypertension if blood

pressure not taken)

Active liver diseases (e.g. Risk factors for gastrointestinal Anatomical

jaundice) osteoporosis conditions abnormalities

A history of suspected or PID, Sexually

depression known transmitted

A history of pregnancy infections,

heart attack or Tuberculosis

stroke

Table 20 Conditions when Pills, Depo-Provera, Implant and IUCD are not provided to clients

 If none of the above condition is present, the it is provided to the client and called for

the follow up in time as per preference of the client.

72
3.3.6 Monitoring and Evaluation

The monitoring is initially performed by in charge of UHC. Then MSS is also performed

every four months a year. The recording of client served through family planning device is

sent to municipality through HIS 9.3 manually and through DHIS in online base which can be

monitored by both municipality and DOHS.

Then following information are filled by the UHC staff regarding family planning:

 The number of male and female users of family planning devices and the number of new

users of family planning devices. (For each FP device like condom, pills, implant, IUCD,

etc.)

 The number of client who has taken the services for implant, IUCD, pills, depo is

recorded along with their age either >20years or <20 years. The number of pills cycle

used, doses taken and set used is recorded.

 The number of women taking Family Planning service within 45 hours of delivery and

45 hours to within one year is also recorded manually and DHIS through online database.

 The evaluation is not only done by municipality but also by the DOHs. The evaluation

of DOHS is done without knowledge of UHC. On the basis of report and records

submitted to the DOHS and municipality monitoring and evaluation takes place; if the

targets are meet or not, infrastructure required to conduct the program, efficiency of

health worker, financial stability, medicines consumed, drugs that wasted due to any

reasons, satisfaction of locality people, maternal and child health problem being solved,

progress report, etc.

73
3.3.7 Outcome

Number of client in each month of fiscal year 2079/80 who received depo, pills and implant
services.

S.N Year Number of service provided

Depo Pills Implant

1. Shrawan 8 2 5

2 Bhadra 5 2 3

3 Ashoj 3 3 7

4 Kartik 8 1 6

5 Mangsir 7 1 3

6 Poush 8 1 1

7 Magh 6 0 2

8 Falgun 9 3 2

9 Chaitra 7 3 3

10 Baisakh 0 2 4

11 Jestha 0 3 2

12 ashad 0 3
0

Table 21 Number of clients provided with Pills, Depo and Implant service each month of year
2079/80
From above table it can be interpreted that in shrawan of year 2079/80 about 8 client visited

UHC Jorpati to take depo service, 2 for pills service and 5 for implant services. Similarly, in

the month of Bhadra 5, 2,3 patient visited UHC Jorpati to take depo, pills and implant service

respectively. Similarly, at the month of Ashoj 3,3,7 patient visited UHC Jorpati to take depo,

pills and implant service respectively. In the month of Kartik 8,1,6 patient visited the UHC

Jorpati to take depo, pills and implant services respectively. In the month Mangsir 7,1,3

74
patient visited UHC Jorpati for taking depo, pills and implant services respectively.in the

month of Poush 8, 1, 1 number of clients visited to take depo, pills and implant services

respectively. In the month of Magha, 6, 0, 2 number of clients visited to take depo, pills and

implant services respectively.

In the month of Falguna 9, 3, 2 number of clients visited to take depo, pills and implant

services respectively. In the month of Chaitra 7, 3,3 1 number of clients visited to take depo,

pills and implant services respectively. In the month of Baishakh 0,2,4 number of clients

visited to take depo, pills and implant services respectively. In the month of Jestha 0,3,2

number of clients visited to take depo, pills and implant services respectively. In the month of

Ashadh0,0,3 number of clients visited to take depo, pills and implant services respectively .

Number of clients who received FP Service in year 2078/79 and 2079/80

S.N Indicator 2078/79 2079/80

1 FP new acceptors – 0 7

IUCD

2. FP acceptors implant 5 25

3. Current user of 11 15

condom

4. Current user of pills 14 21

5. Current user of Depo 19 61

6. Current user of 0 7

IUCD

7. Current user of 11 41

implant

75
8. Current user of 0 0

sterilization

Table 22 FP Programs Achievement of fiscal years 2078/79 and 2079/80

family planning achievement in fiscal year 2078/79 and 2079/80

70

61
60

50

41
40

30

21
20 19

15
14
11 11
10
7 7

0 0 0 0
0
r
r

r
be
be

be

be

be
be

be
m
m

m
m

m
nu
nu

nu
nu

nu

nu

nu
in
In

in

n
in

in
i
si

CD
CD

po

n
nt
om

ll

tio
a
pi

De
-IU

IU
nd

pl

za
r-

m
r-
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or

r-

i
e

ril
e

r-i
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us
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us
us
r-

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e
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us

rs
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ac

rre

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w

Cu

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ne

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Cu
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FP

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2078/79 2079/80

Figure 10 Bar diagram of family planning achievement in fiscal year 2078/79 and 2079/80.

76
Hence from above diagram it can be known that the number of clients using the family

planning device is increasing each year. The number of clients using IUCD was 0 in year

2078/79 whereas it was 7 in year 2079/80. Similarly, the number of user of condom in year

2078/79 was 11 which raised to 15 the next year. The number of pills has successively

increased to 21 number in year 2079/80 which was 14 in year 2-78/79. In the same way the

number of people using the Depo was 19 in year 2078/79 which significantly raised to 61 in

year 2079/80. Hence from the given explanation it can be known that UHC is progressing

each year to provide better FP services to the clients and is able to reach more number of

people.

Finance:

The program is funded by government of Nepal. All the vaccines, vile, doses, syringes,

medicines are provided by the Nepal government with the help of Gokarneshwor

Municipality. The certain amount of budget is also allocated by the UHC to conduct FP

services.

Beneficiaries:

The benefit of the FP program is to the whole community, children, women and nation. It

helps to provide proper gaping between the two children and assist in planning the adequate

number of children. It also benefits for the maternal health of women and raises the

economic, social status of children

3.3.8 Analysis

Strength

 Trained human resources: The health worker in the UHC are trained and skilled enough

to provide family planning service to the clients.

77
 Timely and regular supply of FP device: The family planning device like IUCD, Implant,

Pills and condom are provided to the client on regular basis as per their their wish to use

them.

Weakness

 No regular onsite coaching and clinical updates: The clinical update and coaching

regarding use of FP devices is not provided.

 All staffs are not trained: A separate ANM is allocated to provide the FP services in the

UHC. So the other staff are not informed about the proper use of all FP devices.

Opportunities

 Location with in ward office.

 Regular mothers group meeting, staff meeting, HFOMC meeting. the meeting with

staff, mother group is conducted in monthly basis to understand the need of

improvement, services to be expanded.

 Peer counseling among the client motivation: the counseling of the client regarding

necessity to have proper gap between children, use FP device is provided to the couples.

Threat

 Many populations don’t know about location of government health service center and

facility.

 Migration of client resulting increase no of defaulter: the clients migrate to other place

due to which they leave to use the FP devices.

 Less number of client using long term family planning method and permanent method.

 Contraceptive pill as FP method among client: Contraceptive pills should not be used as

FP method for long period but instead it is used by many clients.

78
3.4.1 Nutrition Program

Nutrition is the intake of food, considered in relation to the body’s dietary needs and its

appropriate utilization. Good nutrition is essential for sound health and the prevention of

diseases. It involves consuming a varied and balanced diet that includes all essential

nutrients, such as carbohydrates, proteins, fats, vitamins, and minerals. Deviance from the

recommended dietary needs, i.e. insufficiency (undernutrition) or the excess (over nutrition)

of macro or micronutrients in our daily diet results in different manifestations of

malnutrition. The usual outcomes of undernutrition are stunting, underweight, wasting and

micronutrient deficiencies while the most notable form of over nutrition is obesity.

Inadequate nutrition, owing to factors such as the limited of access to nutritious food, poor

feeding practices, or certain health conditions that interfere with nutrient absorption, can lead

to a variety of health problems in children, adults, and the geriatric population, including

growth failure, weakened immune systems, and increased susceptibility to infections and

diseases. Over nutrition, on the other hand, resulting from the high intake of unhealthy,

calorie-rich foods, a lack of physical activity, or underlying health conditions that exacerbate

the body’s ability to regulate food intake can lead to weight gain (overweight) and obesity,

which multiples the risk of non-communicable diseases such as diabetes, heart disease, and

some types of cancer. (Department of Health Service, 2021/2022)

In case of UHC of Jorpati it provides various nutrition program which includes providing

vitamin A, deworming tablet, assessment of weight, providing balvita to children, etc.

3.4.2 Magnitude of Health Problem

The incidence of malnutrition, problem in breastfeeding, underweight of children are some of

the problem found in population. Also lack of proper nutrition among women during pre-

natal and postnatal period is found in UHC.

79
3.4.3 Service area including outreach activities

The primary service is provided from the UHC but various severe, camps are also organized

to provide nutritional services, assessment of nutritional status of children.

The vitamin A, deworming tablet are distributed to the children under 2 years of old in

schools. The deworming tablet are also provided to the adolescence from class 1-10 every 6

months.

Also schools are provided with iron folic acid to the female adolescence.

3.4.4 Target Population

S.N Target Population

1. Expected live birth 343

2. Under 1 year 338

3. 12-59 month 1390

4. Under 5 years 1728

5. Adolescence 10-19 years 3978

6. WRA-15-49 years 8330

Table 23 Target Population of for Nutrition Program

3.4.5 Program Objectives

 Improve the nutritional status of infant, young children, adolescent girls and women by

increasing access to nutrition specific and nutrition sensitive services.

 Improve the quality of nutrition specific and nutrition sensitive interventions and build

capacity of the service providers.

 Increase the demand of nutrition specific and nutrition sensitive interventions through

public awareness,

 promote good nutrition behaviors and inhibit harmful behaviors.

80
 To increase the scope of nutrition services in accordance with time.

3.4.6 Implementation

The nutrition program is implemented by performing the following activities:

 The sociodemographic information of the children is recorded.

 The birth weight of the children is recorded.

 The nutrition status of the children is assessed and in children nutrition card it is

recorded, also in nutrition register it is recorded.

 The children nutrition status is assessed every month and recorded weather it falls in

normal, risky or riskier situation.

 Weather the children under 6 months are breastfeed or not, breastfed after 6 months,

other foods that are provided along with milk to the children during, after or before 6

month.

 The distribution of balvita to the children from 6-11 month,12-17 and 18-23 is done.

 The distribution of vitamin A, deworming tablet take place.

 Vitamin A is distributed to children from 6-11 month and 12-59 months.

 The deworming tablet is distributed to children from 12-59 month every 6 month.

 The female adolescence of school are provided with iron folic acid in the 1 week, 13 th

and 26th week.

 The deworming tablet is also distributed to the children in school aged 10-19 (from

class1-class 10)

 The FCHV also provides vitamin A, deworming tablet, iron folic acid and balvita to the

locality people and is recorded in nutrition register and DHIS.

 The counselling is provided to every mother about the nutrition to be provided to

children, vitamins, etc.

81
 The awareness is also provided through mobilization of FCHV, radio, tv and other mass

media.

 The health worker of UHC also provides classes to students and teacher regarding need

of healthy diet, good eating behavior, etc.

 The teachers of school also provide this knowledge to the parents during the meeting.

 The importance of nutrition for children, women and adolescence is also included in

school syllabus.

 The schools also conduct various drama, debate, awareness program regarding the

importance of nutrition, consequences of under nutrition, etc.

3.4.7 Monitoring and Evaluation

The monitoring and evaluation is initially performed by the UHC Incharge. It is then done by

the municipality and DOHS. Also MSS is carried out thrice a year by health department of

UHC. The inspection is also carried out by the DOHS.

The records, reports made by UHC and submitted to municipality and DOHS is evaluated

and their progress is assessed.

Whether the targets are meet or not, infrastructure required to conduct the program are

utilized effectively or not, efficiency of health worker, financial stability, medicines

consumed, drugs that wasted due to any reasons, satisfaction of locality people, maternal and

child health problem being solved, progress report, etc. are being analysed for evaluation and

monitoring.

3.4.8 Outcome
Achievement of fiscal year 2078/79 and 2079/80

S.N Indicator Unit 2078/79 2079/80 Target Achievement

of in Number
82
 2079/89 of 2079/80

1. % of children aged 0-11 % 15.8% 51% 338 172

month for growth

monitoring new visits

2. Proportion of % 2.1% 0.8% 680 5

malnourished children as

% of new growth

monitoring (<2 years)

3. Average number of % 2.67% 680

growth monitoring

visits( under 2 years)

4. Number of children aged Numbe 11 25 - 25

0-6 months registered for r

growth monitoring visits

(under 2 years)

5. Number of children aged Numbe 11 25 - 25

6-8 month registered for r

growth monitoring ,

brestfeed for 6 month

6. Number of children aged Numbe 11 25 - 25

6-8 month registered for r

growth monitoring who

received solid semi solid

or soft food.

7. % of children aged from Numbe 42.02% 95% 683 648

83
 0-23 months registered for r

growth monitoring

Table 24 Nutrition Program Achievement of fiscal years 2078/79 and 2079/80

100.00%
95%

90.00%

80.00%

70.00%

60.00%

51%
50.00%

42.02%
40.00%

30.00%

20.00%
15.80%

10.00%

2.10% 2.67%
1%
0.00%

2078/2079 2079/2080

Figure 11 Bar diagram showing the % of children served under Nutrition Program in fiscal
year 2078/79 and 2079/80.
84
 From above diagram it can be clearly known that the number of children getting the

nutritious food, nutrition service is increasing. The UHC is able to cover more number of

children in year 2079/80 in comparison to year 2078/79. In year 2078/79 only 15.80% of

children aged 0-11 month for growth monitoring visited UHC Jorpati but in year

2079/80 51% of the children aged 0-11 month for growth monitoring visited UHC

Jorpati. The % of children aged 0-23 months visiting UHC Jorpati in year 2078/79 was

only 42.02% where as it was 95% in year 2079/80. Similarly, the percentage of

malnourished children among growth monitoring was 2.10% in year 2078/79 which

decreased to 0.80% the next year which reveals that the nutrition program is able to

cover more and more children each year.

Vitamin A and Deworming Tablets distributed in fiscal year 2079/80

Vitamin A distributed Vitamin A Deworming tablet Deworming tablet

in 1st round distributed in 2nd distributed in 1st distributed in 2nd

round round round

2078/79 2079/80 2078/79 2079/80 2078/79 2079/80 2078/79 2079/80

27.36% 60% 44.50% 105% 30.64% 56% 46.26% 95%

Table 25 Table showing the Vitamin A and deworming tablets distributed in fiscal year
2079/80

85
 Vitamin A and Deworming Tablets distributed
in fiscal year 2079/80

120.00%
105%
100.00% 95%

80.00%
60% 56%
60.00%
44.50% 46.26%
40.00% 30.64%
27.36%
20.00%

0.00%
Vitamin A 1st round Vitamin A 2nd round Deworming tablet mass Deworming tablet mass
distribution coverage distribution coverage
1st round 2nd round

2078/2079 2079/2080

Figure 12 Bar diagram showing the Vitamin A and deworming tablets distributed in fiscal
year 2079/80
From above figure, it is known that the vitamin A distributed to children has increased to

60% in year 2079/80 in comparison to year 2078/79. Similarly, in second round the vitamin

A coverage was only 30% in year 2078/79 but in year 2079/80 the coverage has raised to

105%. Similar is with deworming tablet. The deworming tablet coverage was only 30.64%

in year 2078/79 but the coverage has raised to 56% in year 2079/80. Similarly, in second

round the coverage in year 2078/79 was 46.26% but in year 2079/80 it was 95%.

Hence the coverage of vitamin A and deworming tablet has significantly increased in year

2079/80 in comparison to previous year. Hence the UHC is progressing each year in

covering the maximum population.

Finance:

The program is funded by government of Nepal. All the vitamin supplements, balvita, iron

folic acid, medicines are provided by the Nepal government with the help of Gokarneshwor

Municipality. The certain amount of budget is also allocated by the UHC to conduct vitamin

A and deworming severe in community.

86
Beneficiaries:

The benefit of the nutrition program is to the whole community, children, women and nation.

It helps to raise the nutritional status of children, women, adolescence in the community and

the nation which promotes healthy society.

3.4.9 Analysis

Strength

 Trained Human Resource: The health workers are trained and skilled enough to provide

nutrition service to the clients.

 FCHVW mobilized: Female Community Health Volunteers are also mobilized in the

community to distribute vitamin A, deworming tablet, iron folic acid, etc. they are also

mobilized to provide awareness about the nutrition facilities provided, information

regarding necessity of nutritious food to mother, adolescence and children.

 Daily growth monitoring: Daily growth monitoring of the child is done for every child

who visits the UHC.

Weakness

 No regular onsite coaching and clinical updates: The clinical updates regarding new

health problem related to nutrition or other upgraded counselling that can be provided is

not updated regularly.

 A separate focal person for nutrition is not recruited.

Opportunities

 Regular mothers group meeting, staff meeting, HFOMC meeting: the meeting with staff,

mother group is conducted in monthly basis to understand the need of improvement,

services to be expanded.

87
 Location within ward office: The UHC is located within the ward of Jorpati.

Threats

 Malpractice of pediatrician: Some pediatrician of private clinics recommend the vitamin

supplements which are not recommended by Nepal Government.

 Trends of bottle feeding: It is better to feed mother milk to the children through breast

rather than bottle.

 Many in-migrants don’t know about the location of heath institute: even though

awareness are provided about the current services provided by the UHC, many people

are not conscious and aware enough to use it.

Chapter IV: Administrations

4.1 Human Resource/ Personnel Management

Human resource management is the process of planning, acquisition, development, utilization

and maintenance of human energies and competencies for achieving organizational

objectives. It is concerned with managing people in organizations. It is concerned with

philosophy, principle, practices related to human aspects of management. It aims at achieving

organizational objectives through productive contribution of people. It creates harmony

between the objectives of organization and the individuals.

SN Human Resource Post Level

1 Sarala Rai HA and incharge 6th

2 Sita Neupane Sr. ANM 5th

3 Khim kumari Adhikari Sr.ANM 5th

4 Sadhikshya Shrestha AHW 5th

5 Krishna Maya Devi Ka.Sa 5th

6 Salina Bista Lab technician 5th (Karar)

88
 7 Shanti Phuyal Ka.Sa Karar

8 Aadiathya Mahat Computer Operator Karar

Table 26 Human Resource in UHC

There are total eight number of personnel engaged in providing health related services to the

community people. The head of UHC Jorpati or incharge is Sarala Rai. She is a health worker

specialized as HA (Health Assistant). She is the one who is primarily responsible for the

overall activities of the UHC Jorpati. She is also the focal person for TB program. She is the

one who provides recording and reporting of all the activities in the UHC to the municipality

and DOHS. She is also responsible for providing counseling service, consultation service to

the client who visits UHC, Jorpati. Also she is responsible to provide the dressing services to

the patient, and keep tract of the other worker in the UHC.

The next personnel engaged in UHC is Ms. Sita Bhattrai who is a Sr. ANM. She is the focal

person for Family Planning Program, Safe Motherhood Program. She provides FP services to

all the clients intended to use them and ANC/PNC services to the prenatal and post-partum

mother. She is also responsible to keep track of all the FP services and safe motherhood

services in the UHC Jorpati. She also maintains records of these activities in Family Planning

Card, Register, Mother and child health card and register and provides reports to both the

UHC Incharge and municipality and DOHS.

The other Sr. ANM is Ms. Khim Kumari Adhikari who is focal person for immunization

program. She is responsible to carry out all the immunization services in the UHC

Jorpati. Also responsible for keeping records and reports of the immunization program

in the UHC Jorpati.

The next personnel is the ASW Ms. Sadikshya Shrestha who is responsible to take the

socio demographic information of the patient vising UHC Jorpati, keeping their record

in master register, OPD register. She is also responsible to fill the Nutrition register and
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immunization register including the child health card and patient card and provides

basic counseling to the patient and distributes medicine to the as required.

Miss Salina Bista is the lab technician of the UHC Jorpati who is responsible for

performing all the laboratory activities of UHC Jorpati and keeping records of them and

reporting to the UHC head.

The next is the Computer Operator Mr. Aditya Mahat who is responsible to perform

computer related activities which involves preparing certain report formats, printing,

preparing documents.

The last two personnel are Karyalaya Sahayogi Miss. Santi Phuyal and Krishna Maya

Devi who is responsible for performing all the housekeeping activities of the UHC

including autoclaving of instruments.

4.2 Finance (including accounting and materials management)

Material management is concerned with planning, organizing and controlling the flow of

materials from their initial purchase through internal operations to the service point

through distribution. Material management is a scientific technique, concerned with

Planning, Organizing, Control of flow of materials, from their initial purchase to

destination.

To procure the materials organization need to fill the requisition form and materials and

drugs required are ordered through online system. After the delivery of stock required the

number of materials brought are counted to assure that exact amount of stock is delivered

or not. After this if the materials are brought in adequate number than signature of

authorized personnel is taken manually and also in digital online system authorized

personnel ensures that the material delivered is right amount. Also the organization fills

the HLIMS (Health Information Logistic Management System) in which the amount of

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 materials that were ordered and brought are recorded and sent to municipality. Also the

materials used that were damaged and expired are recorded and sent to municipality. The

expired drugs and other inventories are sent back to municipality.

Financial resources

Source Budget Received Budget Balance at the end of the Fiscal

Expenditure Year

Balance of 748135 748722 223540( the amount is obtained

previous year by adding budget of nagarpalika

and lab i.e.

100000+123540=223540)

which was not used in fiscal

year 2079/80.)

Nagarkpalika 100000

Lab. 123540

Table 27 Financial Resource engaged in UHC

From above table it can be known that the UHC had received Rs. 748135 in year 2079/80

among which about Rs.748722 was spent in conducting different program and Rs. 100000

was received in year 2079/80 and approximately Rs. 123540 was collected in fiscal year

2079/80. These amount is spent on different programs and camps as per need and

requirement. Hence the balance left at the end of fiscal year 2079/80 is Rs.223540

4.3 Health Communication, Planning and Management (Promotion and awareness)

Planning involves micro level planning. The report of previous year is assessed and

shortcomings, threats, weakness are identified and analysed. Then plans for the next year is

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made in such a way to overcome the shortcomings and achieve the targets and provide

equitable health service to all the locality people.

Need
Controlling
assessment
phase
phase

Implementation
phase

Planning involves assessment phase, implementation and controlling phase

 The unmet need of the locality people is assessed, unmet targets are discussed and plan is

made to overcome the shortcomings.

 Then the implementation of action plan is done to achieve the objective.

 After certain period of time the actual performance is compared with the standard

objective and necessary actions are taken to improve it.

Health communication is the process of exchanging information between managerial

personnel of the organization, outside the organization and with the community people.

Health communication should be the one that should be able to improve health and

wellbeing of people. It can take place through following channels and tools used:

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Channels Tools Used on the channels Materials/Activities

Interpersonal Peer Counselling Training, support materials

Communication

(IPC) Provider Counselling Training, support materials

Health Clinic Enhancement Posters, pamphlets, videos

used by client without personal

interaction with provider.

Community Community Participation Group meetings, guides,

Channels rallies, advocacy activities,

speaker kits, press kits.

Community Media Community newspaper, local

radio, hoardings, criers,

miking.

Community Activities Folk drama, road shows, health

fairs

Mass Media, TV, Advertising Print advertisements, TV spots,

Radio, Radio spots, outdoor posters,

Newspapers, transit cards.

Magazines.

Mass Media, TV, Publicity Press release, video release,

Radio, articles, radio press release,

Newspapers, press conferences and public

Magazines. service announcement.

Media Community Event Creation and Sponsored News conferences, celebrity

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 appearances, grand openings,

concert awards, research

presentation.

Media Community Entertainment Education Vehicles TV programs, radio programs,

folk dramas, songs, games.

Table 28 Methods of Health Communication System

The health communication can take place through above mentioned ways to assist in public

awareness.

The health communication can take place directly in the form of interpersonal communication

which includes providing consultation services to the clients, counseling services which

includes providing them knowledge about the medicine they need to take, dietary plans they

need to follow, exercises they need to perform, etc. It also includes the use of posture,

pamphlets which provides awareness to the locality people regarding their health, symptoms

of diseases, preventive measures that can be taken to prevent disease or unhealthy practices,

etc.

The community channels like community participation, communication media can also help

in health communication. It involves meeting in group, guides, rallies advocacy activities and

soon. It also involves dissemination of health related information through local newspapers,

radios and miking in the junction of community. The others are conducting folk drama, road

shows and health fair.

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 The other involves the use of mass media, TV, Radio and newspapers for the purpose of

advertising related to the health services, awareness, and soon for the purpose of promotion

of health and prevention of disease and help people to adopt healthy life style . The use of

celebrity, conducting news conferences, grand openings, concert awards and research

presentation can be helpful for health communication.

4.4 Management Information System

Management Information System includes HMIS, ETB, ELIMS.

Register, Card and Reporting Formats are given below:

Common Tools

 Master Register: the master register includes the registration of all patient visiting UHC for

different health service to be taken. It includes all the socio-demographic information of the

client like age, sex, name, address and ethnicity code and type of service taken.

 Health Service Card: the card which is provided to every patient visiting UHC to take any

kind of health service which consist of history of patient about the service he had taken

before, last time when he visited the health institution, diagnosis and ongoing medicine he is

taking.

 Outpatient Register: The register consists of information of all the patient who have visited

UHC to take the OPD services. It records all the information regarding the patient which

includes the name, age, sex, ethnicity code, the diagnosis, etc.

 Referral/Transfer Slip: It is the slip that is provided to patient in case the patient needs to be

transferred to municipality hospital or other PHC.

 Defaulter/Discontinuation Tracking Slip: The slip that helps to identify the service which the

client might have stopped taking due to improvement or any other reason like for pills, depo

service that client have stopped taking, etc.

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 Tally Sheet: In tally sheet the number of patient vising UHC to take different service is

recorded on the basis of their age like from age 0-1 year, 20-59 year, 60-6

 Infant and Child Health: in case of infant and child health different type of register is mainted

to keep the record of children and infant which includes the following:

 Child Health Card: the child health card consists of immunization record of child and

nutritional status of children each month which is provided to the parents of children which

helps them to visit the UHC for follow up and assess the current nutritional status of the

children.

 Immunization Register: in immunization register the name, age, sex, ethnicity of children,

name of parents, contact number is basically recorded along with the main focus on the

vaccination provided to the children each time and date and type of vaccination provided.

 Children’s Nutrition Register: It also involves the socio-demographic information of the

children under two years and vitamin A, deworming tablets and iron folic acid distributed to

adolescence in school and camps. It consists of date of birth of children, weight at the time of

birth and each month growth of weight of children and suggests the parents whether they are

under nutritioned state or normal or obesity state.

 CBIMNCI Register: In case of CBIMCI register the children under 5 vising due to health

problem like problem in breast feeding, ARI, fever, pneumonia are recorded and reported.

 Family Health register: This register includes the socio-demographic information of mother

and couples who need maternal and family planning services

 Face Sheet: the face sheet is the card that is provided to client taking FP service or Safe

motherhood service. It may be either FP card or ANC/PNC card that is provided to the client

which consists of the service taken by client, ongoing treatment and soon

 Pills, Depo Register: The Pills, Depo register consists of the socio demographic information

of the women who are taking either Pills or Depo dervice. It consist of socio-demographic

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 data, the date when the service is taken, number of times the service is taken and records of

clients who have terminated to use the service.

 IUCD/Implant Service Register: It also consists of the socio demographic information of

women who have taken the service, date when they have taken the service, follow up if

necessary.

 Sterilization Service Register: It also consists of the socio demographic information of

women who have taken the service, date when they have taken the service, follow up if

necessary

 Maternal and Newborn Health Card: It is the card that is provided to the pregnant women

which consists of the socio demographic information of mother, ANC/PNC visits, the

information about past pregnancy, TD1, TD2 and TD2+ vaccine taken the date when the

pregnant women is provided the ANC service for at least 4 times, iron tablet provided,

deworming tablet provided, the sate of child in mother womb, the situation of mother and

child during labour, condition of mother and child after delivery, the delivery type(C/S,

forcep/vacuum, normal etc. the condition of newborn infant PNC service taken by the mother

is recorded.

 Maternal and Newborn Health Service Register: It is the register that is provided to the

pregnant women which consists of the socio demographic information of mother, ANC/PNC

visits, the information about past pregnancy, TD1, TD2 and TD2+ vaccine taken the date

when the pregnant women is provided the ANC service for at least 4 times, iron tablet

provided, deworming tablet provided, the state of child in mother womb, the situation of

mother and child during labour, condition of mother and child after delivery, the delivery

type(C/S, forcep/vacuum, normal etc. the condition of newborn infant PNC service taken by

the mother is recorded. The abortion if done is also recorded.

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 Community Services Register: It includes the record of services provided by the FCHV in

community like Vitamin A register, FCHV register, Deworming tablets distributed in

community

 Similarly, Tuberculosis Sample Collection Form, Tuberculosis Laboratory Register,

Tuberculosis Treatment Card (Health Facility), Tuberculosis Treatment Card (Patient),

Tuberculosis Treatment Register, Smoking cessation Register, Tuberculosis Laboratory

Register, Tuberculosis Treatment Register is maintained to provide service to the TB patient.

 Monthly Reporting Forms: Monthly reporting form is the bundle of forms in which all the

activities conducted by the UHC, number of clients served, types of service provided is

recorded and reported to the municipality each month. It records all the information

mentioned above.

The Management Information System of Government includes the above mentioned registers

and software where the data are entered as per service rendered and sent to the municipality and

DOHS, MOPH.

4.5 Assessment

Achievement of Health Indicator

S.N Indicator Unit 2077/78 2078/79 2079/80

1. Number of monthly report of HF Number 12 12 12

reporting

2. % of PHC-ORC clinics reporting to % 0 0 0

HF

3. % of FCHV reporting to HF % 100 100 100

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 4. Average number of people served by Number 8 25

HF(per day)

5. Average number of people served by Number 188 199

FCHV per month

6. % of new clients attempts for health % 79 81

care service

7. Average number of people served by Number - 0 0

PHCORC

8. Average number of people served by Number - 20 22

immunization clinic

9. % of senior citizen (new) among % 11.21 21

total(new) client served

10. Average visit of client for health Time 1.25 36

service

Table 29 Achievement of Health Indicator

Assessment is done on the basis of achievement of health indicator. The above table shows

the achievement of health indicator and its progress in two fiscal years. From above table it is

clearly known that number of monthly report to HF reporting is 12 in both year 2078/79 and

2079/80 which shows that monthly report is always submitted to the required authority.

Similarly, % of immunization clinics reporting to health care facility is 100% each year in

2077/78, 2078/79 and 2079/80 which shows that the clinics have been reporting

immunization update each year. Similarly, % of FCHV reporting to HF is 100% in all three

years. Similarly, the average number of people served by FCHV per month has increased in

99
 year 2079/80 to 199 from 188 in 2078/79. In the same way, the % of new clients attempts for

health care service has increased to 81% from 71% in year 2079/80 from 2078/79. Similarly,

average number of people served by immunization clinic has raised 22 in year 2079/80 from

20 in year 2078/79. Also % of senior citizens (new) among total(new) client served has

increased to 21 in year 2079/80 from year 2078/79.

From above explanation it can be known that the UHC has been progressing each year to

cover more population and serve more people of the locality.

For the assessment MSS is also conducted in every three months in UHC according to which

the UHC performance is evaluated by the health department of UHC.

Chapter V: Analysis and Findings

5.1 Analysis

For overall analysis

Strength

 Trained health worker: All the health worker are trained enough to provide the basic

health services to the Clients visiting UHC.

 Basic health services are provided free of cost: Even though the basic health services like

FP services, Nutrition services are provided at free cost some people go to private clinics

and hospitals by paying the money. So as UHC provides this services at free cost it

becomes the strength of UHC.

 Nominal amount of price is charged for laboratory services: The laboratory charge in

case of private clinics and private hospital is more but it provides those lab services at

nominal cost.

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 Effective counseling is provided to the clients who visits UHC: All the clients who

requires the specific or particular counseling in any health related topic are provided

with adequate amount of the consultation services.

 Proper recording and reporting system: The records of each and every client vising UHC

is kept in the UHC. Also the records are reported to the municipality on monthly and

annual basis.

 Coordination and cooperation among human resource: There is well coordination and

communication among the staff of the UHC. All of the staff work together to solve health

related or managerial problems in UHC.

 96 types of services are provided free of cost: In case of private hospitals and clinics even

though these medicines are provided at free cost enough amount of money is charged by

them but UHC provides them at free cost.

 Monitoring and evaluation is carried out effectively: The monitoring and evaluation is done

both by the UHC incharge, municipality and DOHS. The monitoring and evaluation of works

and performance done by the UHC worker is evaluated on timely basis.

Weakness

 The health worker leaves the organization early than in time. Mostly many health worker

leaves the UHC before their duty hour is finished for their personal reasons.

 The space is not sufficient for providing the services. The space is less and the patient volume

is more so it becomes difficult to provide services in proper manner.

 The doctors are not available for all time for all those who needs consultation from doctor.

The doctors are only available fom 10:00 AM-12:00 PM so due to mismatched timing clients

are able to take the doctors consultation in their time.

Opportunities

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 Mobilization of FCHV worker: The FCHV are mobilized to provide health related awareness

program to the community people.

 Awareness and Mass campaigns is provided to the community people: The awareness

program at school, locality is conducted related to FP services, proper care for mother and

children, necessity of nutritious food.

 Camps and severe are conducted which includes the blood donation camp, Vitamin A,

deworming tablet camp and soon.

 OPD service is provided free of cost.

Threats

 Other health care facility near the UHC. The other hospitals who provides more sophisticated

services are present near the UHC of Jorpati.

 The organization is not operational during holidays while other health organizations are

operational. So more number of clients are attracted to the other health organization.

Financial Stability

The financing is usually done by the municipality and the amount collected by UHC from lab

service. The budget is allocated for the different programs conducted by the UHC under the

supervision of municipality and Government of Nepal.

Work Flow

The work is divided among the staff of the UHC according to their skill, capacity and ability.

There is separate person allocated for immunization, FP and safe motherhood program and

soon. So is the coordination, cooperation maintained among the worker of UHC. Also the

work is proportionally divided among the health workers.

Productivity

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 Of course the productivity is in increasing phase. Each year the UHC is showing progression

since its operation. The population covered has been increasing each year, service rendered to

people has been increasing each year and the morbidity rate of the locality is decreasing.

Quality

Of course the quality is maintained as per requirement. The treatment is provided to the

clients as per Standard Treatment Protocol. The minimum service standard must be

maintained for operation of UHC.

5.2 Findings

 The basic services are provided at free cost, only some lab charges are taken. The basic health

service like primary OPD services, FP services, Immunization to mother and children, ANC

and PNC services are provided at free cost but the nominal price is charged in case of

laboratory services taken by the clients.

 The UHC runs for six days a week. The UHC is closed during Saturday of a week and the

remaining days of a week it is operational except in government holidays.

 96 medicines specified by the government is provided at free cost. The 96 medicines that are

guided by WHO are provided free of cost which includes medicine like cetamol, iron tablets,

calcium tablets, pain killers, deworming tablets and soon.

 The budget to UHC is provided by ward and municipality. The budget necessary for

conducting any camp, mobilizing FCHV is provided by the municipality or ward.

 Work is divided among people according to the proficiency of staff. The skills of staff

depends as the laboratory technician has ability to conduct blood, urine test and soon so is the

activity divided according to the capability of staff.

 The HCW is collected by the municipality and taken at the place of disposal by the

municipality.

 VIA, ECO and Ultrasound service is provided at nominal cost.

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 The UHC contains WHO certified LR freeze (which meets the national and international

standard).

 The awareness program conducted in school and locality. The awareness program like good

eating habits, importance to intake nutritious food, necessity of routine checkups and soon are

provided to locality mother and school children.

 FCHW of the ward also are mobilized to provide the awareness, counselling service to the

community people.

 For TB cases to be referred as the referral information ETB is used when the clients migrate

in any case.

 The micro level planning is conducted at UHC on the basis of standard performance set and

the actual performance done.

 MSS is carried out thrice a year. It is conducted by the UHC staff in the presence of

personnel of health department of municipality of Gokarneshwor.

 There is PNC home visits at the days of cases of delivery after 03:00 pm every day.

 The women for delivery are referred to municipality hospital but ANC and PNC service are

provided to pregnant women in UHC.

 The medicines are brought to the UHC from municipality which is ordered by filling

requisition form.

 The autoclave is done every Monday for Tuesday to deliver service that is for ANC PNC

visit.

 The immunization program is conducted once a weak in UHC i.e every Sunday.

 If there is holiday during Sunday, then Immunization program is conducted next day.

 The safe motherhood program is also conducted once a week on Tuesday.

 During the first pregnancy 2 TD vaccine is vaccinated to women but during second time only

one vaccine is provided to women.

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 There are three types of TB that is PBC, PCD, EP.

 All the medicines that are damaged or expired is returned back to the municipality.

 At the end of every monthly progress report is prepared and sent to the municipality.

 The geriatric service is also provided to the old aged people of community.

 Every 16th of the month rural USG program is conducted.

 The TB patient are even called for follow up when they don’t arrive for follow up at right

time.

 The OPD runs from 10:00 AM – 05:00 PM for 5 days from Sunday to Thursday but its

operational only till 03:00 pm in Friday.

 The lab service operates from 07:30-02:00PM. The lab service is closed after 02:00 PM.

 The amount received from the lab is deposited every day in the Jyoti Bikash Bank at the time

after lab is closed by the computer operator.

 There is one staff designated specially to provide the Immunization service to children.

 The UHC incharge is responsible to look after the managerial activities of the UHC.

5.3 Critical Observation

 There is no sufficient amount of water supply in the UHC. Sometimes there is shortage of

water in toilets. It would also be better if toilet was a bit clean.

 The toilets are less in number; resulting shortage of toilet. The toilet is only one for whole

ward and personnel working there and even the client vising the UHC and ward.

 There is no precaution in case the infected patient visits the UHC. There is no any safety

measures taken by the health worker incase a infected person visits UHC.

 The all type of wastes Sis kept together which has resulted improper HCWM. It may resuld

into spread of disease.

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 The number of clients visiting UHC are more so is the space required but there is shortage of

space.

 The UHC runs from 10;00 am- 05pm, but some staff show unprofessionalism and leaves

early most of the time to complete their household chores.

 Due to negligence rarely expired medicines are distributed.

 The UHC needs to pay some attention towards waste (cotton buds) to be disposed in the trash

by the clients rather than throwing around the floor.

 The UHC is at first floor and no lift is available. All the patient must go through ladder to

visit UHC. It creates problem for handicapped clients who need access of wheelchair.

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 Chapter VI: Conclusion, Recommendation and lesson learnt

6.1 Conclusion

We are very thankful for the Urban Health Center in Jorpati for providing this immense

opportunity to observe and experience the real life situation of UHC. The UHC has provided

us valuable insights regarding the operation, administrative and clinical part of UHC. It has

also helped us to develop the managerial skills and knowledge regarding health program, to

become conversant with the beneficiaries of health program, to understand the multifaceted

relationship between primary health center and hospitals, its role in prevention and promotion

of health of the population including the role of community participation to build a healthy

locality.

It has made us conscious about the role of Universal Health Coverage approach to provide

affordable, accessible, quality of basic health services to the people. The procedure of the

approach being implemented. It has also provided us a medium to apply our theoretical

knowledge in practical life and learn by doing to develop proficiency in managerial field in

regard to aspect of health care facility.

The six week of practicum has been helpful for us to delve more knowledge about the health

programs, the policy applied by the government, health related incentives provided to the

mother and children. It has enlightened us about the importance of health program like FP

Program, Immunization Program, CB-IMNCI Program in reducing the mortality and

107
morbidity of the nation. It has provided us deep insight regarding the role of local health

bodies like UHC, PHC in promotion of health and prevention of disease. It has also helped us

to know about various health services and facilities that are provided at free or nominal cost

to the citizen of our nation. It has helped us to be more conversant regarding the effort of our

Nepal Government towards developing healthy and prosperous society and nation.

The six week of internship practicum that was conducted basically to fulfill the curriculum of

BHCM 5th semester, Pokhara University has been very helpful for us to become well

acquainted with the health policy and programs conducted by the Nepal Government and the

interviews, questionnaires, observation and participation made in the Urban Health Center,

Jorpati camp and severs along with different programs has been very effective for us to

develop some practical skill that is required in our upcoming days and career to achieve a

success in the field of Health Care Management.

6.2 Recommendation

 It would be better if there was a bit more number of toilets as the patient flow is

increasing.

 It is more desirable to expand the UHC as the current space is not enough to provide

services to the increasing number of clients.

 It would be more appropriate if HCWM system is developed within the UHC. Because

all the wastes are kept together and sent to the municipality but there must be proper

segregation of waste. The negligence in HCWM may lead to spread of infectable

diseases.

 It would also be better if there is appropriate method to provide more precautions for

staff in case of infected case arrives. There is no separate room or service site, specific

precaution taken when a infected person arrives.

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 It would be better if the services are user friendly for even the handicapped clients. It is

because the handicapped cannot walk through ladder to take the health service from

UHC and there is no lift.

 It would be better if the emergency services are expanded in the UHC as many patient

visit UHC even at severe cases. The ambulance if present at service site would assist in

providing even the transportation service to people during the arrival of severe cases.

Also if there was a separate room for the case of emergency, it would be better.

6.3 Lesson learnt

From this six weeks of internship we are not only able to enhance our managerial skill but

also communication skills, presentation, negotiation skills. It has helped us to apply our

theoretical knowledge in real life situation and understand the operational, practical part of

UHC. It has helped us to gain valuable insights regarding the role of preventive and

promotive health service in developing health and wellbeing of community people. In

addition to this, we are able to gain clear understanding regarding the micro level planning,

activities carried out at local level, method of implementation of health programs, evaluation

system of government, HIMS, health communication, promotion and awareness activities,

prevalence of health problem with in community people, ways to mitigate them and soon

6.4 References

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Centers for Disease Control and prevention. (n.d.). Retrieved from Immunization Basis/CDC:

https://www.cdc.gov/vaccines/vac-gen/imz-basics.htm
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Immunizatiion Service Section. Retrieved 10 17, 2023, from

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78-date-5-July-2022-2022_FINAL.pdf

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Health Care Management Degree Guide. (n.d.). Retrieved 10 17, 2023, from

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Kunwar, A. (2076). visit to urban health care center. Urban Health care-Nepal, 2.

McNellan, C. R., Dansereau, E., Wallace, M. C., V, D., Colombara, B, E., . . . Mokdad, A. H.

(2019, Feburary 19). antenatal care as a means to increase participation in the

continuum of maternal and child healthcare. Retrieved 12 22, 2023, from

mcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2207-

9#:~:text=Antenatal%20care%20(ANC)%20is%20a,a%20healthier%20delivery

%20and%20outcome.

Pokhara University. (n.d.). Retrieved from Pokhara University:

https://pu.edu.np/about-us/general-information/

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Rights, C. f. (2075, 06 02). Retrieved 12 22, 2023, from

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%20Reproductive%20Health%20Rights%20Act%20in%20English.pdf

Svalastog, A. L., Dohey, D., Kristoffesen, N. J., & Gajovic, S. (2017, Dec). Modern concepts

of health – from individual to societal risks and back to the individual. Concepts and

definitions of health and health-related values in the knowledge landscapes of the

digital society, 431-435. doi:10.3325/cmj.2017.58.431

World Health Organization. (n.d.). Retrieved from

https://www.who.int/about/governance/constitution

World Health Organization. (n.d.). Retrieved from Constitutiion of World Health

Organization: https://www.who.int/about/accountability/governance/constitution

World Health Organization. (n.d.). i iNational Safe Motherhood Protocoli. Retrieved from

https://platform.who.int/docs/default-source/mca-documents/policy-documents/

operational-guidance/GHA-CC-10-02-OPERATIONALGUIDANCE-eng-National-

Safe-Motherhood-Protocol.pdf

Wudineh, K. N. (2018, December 27). Postnatal care service utilization and associated

factors among women who gave birth in Debretabour town, North West Ethiopia: a

community- based cross-sectional study. doi:https://doi.org/10.1186/s12884-018-

2138-x

111
6.5 Appendix

Internship Completion Form

112
113
Internship checklist
Internship checklist
Urban Health Clinic
Jorpati, Ward no 5

Awani Sigdel
Amita Poudel
(BHCM V)

Preceptor: Pawan Dhami Mahat

 Internship plan : Duration is 6 week of internship

 Gantt Chart

Week 1 Week 2 Week3 Week4 Week5 Week6

ACTIVITY 1: Two days of Orientation Program by our Internship supervisor Mr. Pawan

Prakash Dhami

ACTIVITY 2: Preparation of checklist and mini proposal for internship along with our

college provide us with guidelines and request letter for internship

ACTIVITY 3: Submission of request letter along with guidelines to the respected

Gokarneswor Municipality.

ACTIVITY 4: With the acceptance of our request letter, we grant permission from them to

accept and go through our checklist and proposal (2 to 3 days after the submission of request

letter from college)

ACTIVITY 5: Program engagement

ACTIVITY 6: Finding literature

ACTIVITY 7: Submitting weekly progress report to Mr. Pawan Prakash Dhami and

Coordinator Mr. Subash Adhikari.

114
ACTIVITY 8: Data collection and analysis

ACTIVITY 9: Writing the (report draft)

ACTIVITY 10: Acceptance of draft as a final report by our supervisor.

ACTIVITY 11: Submission, Oral Presentation and report interpretation.

Checklist for UHC, Jorpati

S. Activities Prep. Week Week Week Week 4 Week 5 Week 6 Activities

N activities for 1 2 3 after the
internship completion of
internship
premiership
1 Orientation
2 Checklist+
proposal and
guidelines
preparation
3 Subm. of
request letter
4 Acceptance of
checklist and
proposal
5 Program
engagement
6 Finding
literature
7 Submitting
weekly
progress
8 Data
collection and
analysis

9 Writing the
(report draft)
10 Acceptance of
draft
11 Submission,
Presentation
and report
interpretation

APPENDIX A: INTERNSHIP WEEKLY REPORT ONE

115
Awani Sigdel For the dates of: 26 Sept.-__ Oct 2____________

1. What new knowledge or skill did you learn this week?

I learned about the staffing of UHC of Jorpati, ward number 5. There are about 8 staffs in

UHC. The UHC operates under the guidelines set by Gokarneshwor municipality. The staff

consists of in charge, two nurses, one paramedics, two housekeeping staff and one lab

personnel. The UHC is established to provide basic health services to the residents and all

citizens of Nepal visiting UHC.

2. What did you learn, either from readings or classroom discussions, that you applied on the

job this week? (Do not give course numbers or classes.)

I have learned about the process by which procurement is done in the organization. The

requisition form is filled and materials and drugs required are ordered through online

system. After the delivery of stock required the number of materials brought are counted to

assure that exact amount of stock is delivered or not. After this if the materials are brought

in adequate number than signature of authorized personnel is taken manually and also in

digital online system authorized personnel ensures that the material delivered is right

amount.

Also the organization fills the HLIMS (Health Information Logistic Management System)

in which the amount of materials that were ordered and brought are recorded and sent to

municipality. Also the materials used that were damaged and expired are recorded and sent

to municipality. The expired drugs and other inventories are sent back to municipality.

3. Which courses/subjects helped you most this week? Please give course numbers or topics?

The courses like Hospital Administration and Health Policy and Program Management helped

me this week.
116
4. Which courses/subjects you feel could be expanded or added that would have helped you

perform your job better this week?

Health information system used by government could be expanded as it helps us to gain

in depth knowledge about the information system.

APPENDIX B: INTERNSHIP ACTIVITY LOG

Student: ___Awani Sigdel____________________________ for the dates of: Sept 26- Oct 2

Day of Activities or assignments Time

Week spent in

each

activity

During Monday I came to know that the UHC provides temporary 1:00-5:00

Monday as well as LARC services to the patients with every effort to

provide healthy and enabling environment to the residents of ward

no.5.

We started since 26 septs. Tuesday. Even though all services are 1:00-5:00

Tuesday provided during all week but Tuesday is especially focused to

provide ANC/PNC care to the clients.

This day I learned about the process through which the information 1:00-5:00

Wednesd is recorded in master register than in other register like

ay immunization register, nutrition register, CB IMNCI register ,OPD

register.

I learned about how the drugs which are recommended by 1:00-5:00

government are provided free of cost registered their name in

117
 Thursday master register and OPD register.

This day I learned about the Information that every day free OPD 10:00-

Friday services are provided to the clients who require consultation with 3:00

GP. The opd services are provided from 10 a.m. to 12 p.m.

I learned about the immunization program which is conducted 1:00-5:00

Sunday every Tuesday a week. I learned about the immunization card

which is provided to the client after providing vaccine.

Table 30 Daily activities week one

Signature of Supervisor:

APPENDIX A: INTERNSHIP WEEKLY REPORT TWO

Name: ________Awani Sigdel_____________________ For the dates of: _____Oct.3 –

Oct.9__________
118
 5. What new knowledge or skill did you learn this week?

I learned how the information of patient are recorded in master register and OPD register. Also

I learned about the details of patient that are included in master register and OPD register. I

learned that the S.N is filled first of all then the patient registration number which is classified

on the basis of either they are newly visited or old clients who have visited earlier. The master

register consists of name, caste, sex, ethnicity code, district, municipality, ward no. phone no,

type of services taken, medication taken, etc. The services like normal treatment, IMNCI,

Nutrition, Safe motherhood, Family Planning, Tuberculosis, Leprosy, bacterial disease, NCD,

and others are provided. Then I learned that the clients of different age group are focused

especially children, mothers and all population of reproductive age group. Also geriatric

population is focused for providing different types of services. I also learned that usually old

aged people suffer from disease like HTN, diabetes, fever, respiratory disease and heart disease.

6. What did you learn, either from readings or classroom discussions, that you applied on the job

this week? (Do not give course numbers or classes.)

I applied about the Dots program that the TB patients are provided with medicine in front of

them in daily basis. So is it called Directly Observed Treatment Short course.

7. Which courses/subjects helped you most this week? Please give course numbers or topics?

The subject that helped me this week is Health Policy and Program Management. I had learned

only about their plan, activities conducted at national level but after this internship I am able to

learn about their implementation in local level.

8. Which courses/subjects you feel could be expanded or added that would have helped you

perform your job better this week?

119
 The knowledge about the logistic management process, program management, inventory

management would be helpful if expanded as would provide more depth knowledge about

their implementation in local and national level,

APPENDIX B: INTERNSHIP ACTIVITY LOG

Awani Sigdel
Student: _______________________________ for the dates of: _____Oct.3 –
Oct.9__________

Day of Activities or assignments Time spent

Week in each
activity
Every month 16 day RUSG is conducted to provide more care for 1:00-5:00

Monday mother reduce the infant mortality rate, maternal mortality rate. The

delivery services are not provided and referred to municipality

hospital.

People tsking services are categorized into different age group : 1:00-5:00

Tuesday 0-9

10-14

15-19

20-59

60-69

>70

According to my observation, mostly client from age 0-9 visit UHC

to take immunization, nutrition services. The children of age

group10-14 visit hospital due to fever, cold, tonsillitis, etc. the

children of age group 15-29 visit hospital to take FP services.

120
 Similary the clients of 20-59 visits UHC for safe motherhood and

other OPD services. other remaining population visit UHC for

mostly OPD services.

The CB- IMNCI program basically focuses to children of 0-59 1:00-5:00

Wednesda months and under 5 years children. The CB IMNCI register

y consists of SN, master register no, SRN, date, name, caste, address,

sex, age, weight, temperature, GDS, drinking capability of child,

vomiting, convulsion, lethargic, ARI, respiratory rate, chest in

drawing, stridor, wheezing, diarrhoea. Presence of blood in stool,

lethargic signs, irritable, sunken eyes, unable to drink, skin pinch

slowly, fever, malaria risk, ROT positive/negative information. The

presence or absence of general rash, oral ulcer pus from eyes,

falciparum and non-falciparum is included in the register. Many

other thing or condition that a child may suffer from is included in

the register.

The nutrition register consist of records of programs carried out like 1:00-5:00

Thursday providing albendazole to children in every 6 months, vitamin A to

children, keeping records of birth weight of the infant, weight after

28D, 1M, 2M,3M, 4M, 5M, 6M. Records of breast feeding and

other food providing from 6 months to 23 months. It also includes

program like Bal vita distribution.

The pregnant woman is provided with TD vaccine, calcium and 10:00-3:00

Friday iron capsule is provided at each ANC visit. The estimated date of

birth of child, last time of mensuration, number of child born, alive

child, dead child, number of abortion, heartbeat of child every

121
 details are recorded in ANC visit. The UHC provides 8 ANC visit

on 12, 20, 26, 30, 34, 36, 38, 40 weeks.

Sunday The vaccines are stored in refrigerator and at the time of providing 1:00-5:00

vaccine it is kept in cold chain. The JE is the vaccine which cannot

be provided after its seal is opened for more than half an hour. So

JE is usually provided from 12:00 p.m-12:00 pm

Table 31 Daily activities week two

Signature of Supervisor:

APPENDIX A: INTERNSHIP WEEKLY REPORT THREE

Name: ______Awani Sigdel_______________________ For the dates of: _______________

9. What new knowledge or skill did you learn this week?

122
 The fact that about 100000 rupees of budget is provided to the UHC for performing various

other activities and providing some emergency medicine as far as possible which is not

available in the UHC. This week as an intern, I learned about different health programs. We

focused on vaccinations and how they're recorded. I also got to understand the importance of

keeping vaccines at the right temperature. We also covered important topics like taking care of

pregnant women and making sure they get the right information and check-ups.

I also got hands-on experience in handling iron supplements and learned how to keep proper

records. Plus, I took part in a program for managing tuberculosis/DOTS. Overall, it's been a

really practical and educational week for me.

10. What did you learn, either from readings or classroom discussions, that you applied on the job

this week? (Do not give course numbers or classes.)

The socio-demographic information about the client is recorded on master register,

immunization register, CBIMNCI register, nutrition register, OPD register, ETB, etc.

11. Which courses/subjects helped you most this week? Please give course numbers or topics?

This week, the courses on Communication, Safe Motherhood, Family Planning, DOTS, Cold

Chain Management, Hospital Administration, Medical Record Management, and Health Policy

were paramount in my internship experience. They equipped me with essential practical

knowledge directly applicable to my healthcare responsibilities. Effective communication

proved indispensable in conveying information accurately and empathetically to patients and

colleagues. Additionally, understanding concepts like safe motherhood and family planning

enabled me to provide valuable support to expectant mothers and families. Knowledge of

logistics, particularly in Cold Chain Management, ensured the safe handling and storage of

vital medical supplies. This combined with insights into Hospital Administration and Health

123
 Policy empowered me to navigate operational aspects of the healthcare facility with confidence

and responsibility.

Moreover, these courses enhanced my efficiency and responsibility in executing tasks.

Familiarity with Medical Record Management enabled me to maintain organized patient

records, ensuring timely access to crucial information for healthcare providers. Understanding

Health Policy enabled me to make well-informed decisions in adherence to regulatory

guidelines, ultimately elevating the quality of care provided. The comprehensive education I

received this week directly translated into tangible benefits for both me and the healthcare

facility, fundamentally shaping my approach as an intern.

12. Which courses/subjects you feel could be expanded or added that would have helped you

perform your job better this week?

As an intern, I believe that expanding or adding courses in Inventory Control,

Communication, Planning, Logistics Management, Health Policy, and Hospital

Administration would have significantly enhanced my performance this week. These subjects

are crucial for seamless operations in a healthcare setting. A deeper understanding of

inventory management and logistics would have improved efficiency in handling supplies.

Enhanced communication skills would have facilitated better interactions with patients and

staff. Moreover, a broader grasp of planning and health policy would have provided a more

comprehensive view of the healthcare system, enabling me to contribute more effectively.

APPENDIX B: INTERNSHIP ACTIVITY LOG

Student: ___Awani Sigdel____________________________ for the dates of:

___________________________
124
Day of Week Activities or assignments Time spent
in each
activity
th
Every 16 of the month the campaign is provided 12:00-5:00
Monday
for pregnant woman. The necessary capsules,

RUSG is done. Also the health worker from the

UHC visits the post-natal woman after 3:00 pm in

evening.

During Tuesday I filled the safe motherhood HIMS, 12:00-5:00

Tuesday
which consists prenatal care which includes of

number of birth, no of abortion, time of birth, last

date of mensuration, heartbeat of child, no of times

the pregnant women are distributed with iron tablet,

TD vaccinated and albendazole, etc. The services

include time of delivery, delivery place, delivery

date, the presentation of fetal which includes either

cephalic, breech, shoulder, etc. the birth of child

may include normal, or vacuum or forceps or C/S.

The complication during the time of birth either

more bleeding, more than 12 hours of labor,

whether the umbilical cord falls or not, other

problems.

After delivery care like birth weight, sex of child,

immediately cried or not, breathing complication,

125
 other treatment or suggestion.

The PNC includes care within 24 hours, care at

third day of birth, care at 7 days, other treatment.

It also includes the examination of Hb, Albumin,

Urine, Blood Sugar, HBsAg, VDRL, Retro –virus.

The delivery service is not provided at UHC, so if a 12:00-5:00

Wednesday
patient is required to be referred for advance care

then a separate referral form should be filled. Also

for TB patients if referral is required then one need

to use referral form or done through ETB.

The family planning service is provided to the 12:00-5:00

Thursday
people of age group 15-59. It includes the services

like pills, Dipo, IUCD, implant, sayana press,

condom. Its aim is to provide proper gap between

two child.

The TB services is provided to the patient who 10:3:00

Friday
require it. Especially DOTS program is conducted

to provide healthy life to the citizen of the country.

In case of DOTs program TB medicine is provided

to the patient according their weight and sputum.

The TB may be of different type like PCB, PCD,

EP.

Sunday Every Sunday immunization program is carried out 12:00-5:00

which includes providing 9 kinds of vaccine to

children according to their age group.

126
 BCG: at the time of birth

Rota: 6 weeks 10 weeks

O.P.V: 6, 10, 14 weeks

F.I.P.V: 6,14 weeks

P.C.V: 6, 10 weeks

DPT: 6,10, 14 weeks

Measles rubella: 9, 15 month

JE: 10 month

TCV: 15 month

Also nutrition program is carried out at same time

which includes taking weight of child every month,

if the growth is according to weight or not, its taken

for 2 years, the feeding of vitamin capsule,

albendazole, etc. the information about the breast

feeding is also recorded. Also Balvita is distributed

to the child during the campaign. The information

and awareness is provided to parent about necessity

of breast feeding, providing other foods that is

necessary for children growth.

The information about necessity for feeding ghee,

milk, fruits, green leafy vegetables, meat, grains,

rice is also provided to all the parents and other

personnel.

Table 32 Daily activities week three

Supervisors Sign:
127
 APPENDIX A: INTERNSHIP WEEKLY REPORT FOUR

Name: _______Awani Sigdel______________________ For the dates of: 19 Oct.-31

Oct._______________

13. What new knowledge or skill did you learn this week?

128
 The new knowledge that I gained this week is about the fact that iron tablet are not only

provided to mothers but also to the children. It is distributed to the children in school in ward

no 5 and to the children who may require it. Also the women are provided with knowledge

about the breast feeding when visit UHC. The children must be feed about 8-10 times a day.

The children should also be provided with vitamin A and albendazole twice a year for at least 5

years i.e 10 times. The information about the breast feed by mother to children for 1 month and

times the children is feed is recorded, also for month 2, month 3, month 4, month 5 and

month6. The the information about the food feed to the child before 6 month, at 6 month and

after 6 month is recorded. The balvita is distributed to the children for three times and the date

of time when it is provided is recorded. The mothers are counseled about the nutrition the

children should be provided.

14. What did you learn, either from readings or classroom discussions, that you applied on the job

this week? (Do not give course numbers or classes.)

This week, I applied my knowledge about various aspects of healthcare, particularly in the

health program. This included understanding patient records, health programs, patient

satisfaction, hospitality, and identifying and addressing patient needs. Additionally, I learned

about the range of health services provided and the various health programs conducted in

Urban Health Clinics, Jorpati. This knowledge was instrumental in my imternship this week,

enabling me to better contribute to the health programs in place.

15. Which courses/subjects helped you most this week? Please give course numbers or topics?

This week as an intern, courses in Hospital Administration, Medical Record Management, and

Health Policy proved to be incredibly beneficial. They equipped me with practical knowledge

and skills that directly applied to my responsibilities in the CMPH. Understanding how

program are run, managing medical records effectively, and being familiar with health policies

129
 were instrumental in carrying out my tasks efficiently and responsibly. These courses

significantly contributed to my effectiveness during this week’s internship activity.

16. Which courses/subjects you feel could be expanded or added that would have helped you

perform your job better this week?

As an intern, I believe that expanding or adding courses in Health Policy and Hospital

Administration would have significantly enhanced my performance this week. These subjects

provide critical insights into the broader healthcare system and the management of healthcare

facilities. A more in-depth understanding of health policy and hospital administration would

have better equipped me to navigate complex administrative tasks and make informed

decisions in the healthcare setting

APPENDIX B: INTERNSHIP ACTIVITY LOG

Student: ____Awani Sigdel ___________________________ for the dates of: ______17

Oct.-28 Oct.

Time spent
Day of Week Activities or assignments

Observe the staff providing ARV vaccine to the patient ,visit 12:00-5:00

Monday the administration room and consult and discuss with the

admin staff about the activities to be performed , about the

required data that is required for report writing , manage the

patient coming for health check-up , observe the distribution of

the medicine ( iron-chakki) to the pregnant women.

observe the ANC/ PNC services received to the patient , 12:00-5:00

Tuesday observe how their visit is recorded and education related to

pregnancy care provided by the staff member , Questioned a

series of question prepared to Staff member , Discuss with the

130
 nursing staff about tomorrow program

Got knowledge about how the DOTs program is carried out 12:00-5:00

Wednesday and how the medicines are prescribed to the patients. I also

came to know that patient are provided medicine according to

their weight.

The information about the staffing pattern and management 12:00-5:00

Thursday team was taken. The history of organization was also taken in

more detail.

Asking the admin staff about the health program ( date and day 11:00-03:00

Friday it is provided, the program benefits , and target population )

Gathering the information on the health program , Helping the

nursing staff to manage the patient , making the observation on

the services that is provided , learning about the DOTS

program that is being conducted and its related stuff .

First I go to the immunization room, then I observe the 12:00-5:00

Sunday preparation of the vaccination set up , then after when the

people come for the vaccination of babies I send them orderly

in line and help them to take the weight of the babies and also

provided them the information about the vaccine days , After

that I help the staff to take the vital signs , and collect the card

of the patient came for check-up . After the break time I ask a

series of questionaries to the staff members about today

vaccination.

Table 33 Daily activities week four

131
APPENDIX A: INTERNSHIP WEEKLY REPORT FIVE

Name: ____Awani Sigdel

For the dates of: 1Nov-7Nov

17. What new knowledge or skill did you learn this week?

132
 As an intern I learned about the fact that vaccines which are used for immunization purpose

are kept at refrigerator and is stored at 5.8 C. The vaccine is brought for about a month but

maximally it can be stored for 3 months if remains unused. Syringe are disposed in proper

manner with the help of needle cutter. The vaccine is provided to the children and the next

date of administration is provided. The next time of administration is provided. Also heath

education counselling is provided to the child parents like he/she may undergo through fever

or similar effects and one should not apply oil at the area of vaccination.

18. What did you learn, either from readings or classroom discussions, that you applied on the

job this week? (Do not give course numbers or classes.)

I learned about the way of vaccination and learned about the vaccine schedule, doses of

to apply. Also about the medicine are distributed to the clients. The medicines are provided

to the clients at least for 15 days.

19. Which courses/subjects helped you most this week? Please give course numbers or topics?

The courses like POM, Organization behavior, Health Policy and Program Management,

Hospital Administration I, Hospital Administration II, etc helped me to understand the

operation of UHC in proper way.

20. Which courses/subjects you feel could be expanded or added that would have helped you

perform your job better this week?

The courses like PHC if would be expanded the it would have helped us to understand the

operation of health care system at local level. Also HIMS would also help us to understand

the Health Information Management System of Government of Nepal in proper way

APPENDIX B: INTERNSHIP ACTIVITY LOG

Weeks Activity Time

Sunday The TB program is conducted every day. The patients come and 12AM-

according to the sputum taken and weight of patient people are 5PM

133
 provided with medicine. The TB can be different types i.e. PBC,

PCD, EP. The people are provided different doses of medicine

according to the type of TB. In case of medicines Isoniazid(H),

Rifampicin (R), Pyrazinamide(Z), Ethambutol (E),

Levofloxacin(Lfx) are used.

Monday The more is the weight of the patient more is the doses of tablets 12AM-

provided. 5PM

Tuesday Vitamin A and albendazole was provided to the children of Ward 12AM-

no: 05 and other people residing in that area. 5PM

Wednesda The record of weight of children till under 2 years is taken every 12AM-

y method. 5PM

Thursday The inspection of medicine weather the medicines are maintained 12AM-

according to date or not. The expired medicines are returned back 5PM

to the municipality and recorded in LIMS.

Friday The autoclave is done timely so that infection can be removed. 10AM-

3PM

Table 34 Daily activities week five

Signature

Appendix A: INTERNSHIP WEEKLY REPORT SIX

Name: ____Awani Sigdel _________________________ For the dates of: 1Nov-

7Nov_______________

21. What new knowledge or skill did you learn this week?

134
 I learned about how the total number of patient is counted from master register on the basis of

their age. Also I learned about the fact that TB patient can be referred by using ETB. Besides

this I also got knowledge about the camps conducted by FCHV in the UHC i.e. of vitamin A

and deworming tablets. I also gained knowledge that the iron folic acid is distributed to the

the adolescence of school in 13th week and 23rd week.

22. What did you learn, either from readings or classroom discussions, that you applied on the job

this week? (Do not give course numbers or classes.)

I learned about the nutrition program in Health Policy and Program Management. I had

learned about the importance of nutritious food for children, women and adolescence which I

applied in the UHC. I provided some of the mothers about the necessity to have good, clean,

healthy food for themselves and their children. I also informed them about good eating habits

and bad eating habits.

23. Which courses/subjects helped you most this week? Please give course numbers or

topics?

The courses that helped me this includes Health Information Management System, Health Policy

and Program Management, Healthcare Inventory and Biomedical Equipment, Hospital planning

and administration. Principal of health care management also helped me to understand about the

aim of government to establish UHC in Nepal.

24. Which courses/subjects you feel could be expanded or added that would have helped you

perform your job better this week?

The courses like Health Policy and Program Management, Health care Inventory and

Biomedical Equipment, Health Information Management System would help to understand

the Healthcare system in a depth way, if expanded.

APPENDIX B: INTERNSHIP ACTIVITY LOG

135
Student: ____Awani Sigdel ___________________________ for the dates of: ______17
Oct.-28 Oct.

Days Activities Time spent in

each activity

Sunday During Sunday, we asked the UHC staff about the data 12:00-05:00

necessary for us for preparing the report.

Monday This day we collected the data from UHC which includes 12:00-05:00

collecting data of FP Program, Safe motherhood Program,

Nutrition Program, TB program, CBIMNCI Program,

Immunization Program.

Tuesday The activities involves helping the health worker to fill the child 12:00-05:00

heath card, counting the number of patients of different ages

visiting the UHC.

Wednesda We distributed the deworming tablets to the children, vitamin A 12:00-05:00

y
to children and providing counseling regarding the nutritious

food to be provided to the children. We also distributed Balvita

to the children during the camp.

Thursday We counted the data / number of different ethnicity people 12:00-05:00

visiting UHC to help to make the monthly report. We also filled

the safe motherhood program information in the software that is

DHIS.

Friday This day I collected data about montly visit of patient for 11:00-03:00

immunization, FP service, Nutrition service and Safe

motherhood program.

Table 35 Daily activities week six

136
Signature:

137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154