Presentation on Health

Service Management

NAIHS- 4th Year

Group: B1
Neelkantha Municipality
INTRODUCTION:
• Nilkantha Municipality
• Established on 18th May 2014

• Total no of Ward :14

• Total Population :61762
Geography

• 90 kilometer west from

Kathmandu

• 16 km from Malekhu, a
point in Prithvi highway

• It occupies 10% of total

area of Dhading district.
 HOUSEHOLD BY ETHNICITY:

Total Brah Newar Chhetri Sarki Tamang Kaami Others

Households min Gurung   Magar  
     

14,145 2791 2594 2345 1592 1575 1006 805 516 921
 TYPE OF FOUNDATION OF HOUSE

Total Mud RCC Cement Wooden Others Not

households bonded with bonded pillar   stated
bricks/stone pillar bricks/ston    
e

14,145 76.1% 15.38% 7.5% 0.36% 0.04% 0.62%

MAIN SOURCE OF DRINKING WATER:

Total Tap /piped Spring Uncovered River/Stream Others

water well/kuwa   (Tube well, Covered
  Well)

14,14 90.67% 7.74% 0.89% 0.53% 0.17%

5
MAIN SOURCE OF FUEL FOR COOKING FOOD:

Total Wood kerosen LP Santhi Bioga Electricit Other Not

household / e gas / s y s State
s firewood Guith d
a

14145 69.72% 1.39% 24.17 0.007 4.14% 0.06% 0.20% 0.25%

% %
 TYPES OF TOILET:

Total Households Households Households Toilet facility

households with flush with ordinary without toilet not stated
toilet toilet facility

14,145 61.84% 21.56% 16.32% 0.26%

DEMOGRAPHIC PROFILE:
Total Population 61,762

Total female population 30,121

Total male population 31,641

Population Density 309.01 per sq km

Literate Population 82%

Female literacy 34%

Male literacy 66%

Total number of schools 103

Number of total households 14,145

Number of total disable population 114

MUNICIPALITY HEALTH PROFILE:
WARD 14

HEALTH POST 7

URBAN HEALTH CLINIC 2

COMMUNITY HEALTH UNIT 2

FCHVS 64

BASIC HEALTH CENTRES 5

BIRTHING CENTER 11

PHC-ORC 22

IMMUNIZATION CLINIC 30
 Neelakantha Municipality Health Section

Organization:
• Comprizes of MCH, BHC, HPs, CHUs, UHCs
• Consists of 4 Human Resources
- 7th level Public Health Officer
- 6th level Public Health Inspector
- 6th level Nursing Staffs and Paramedics
 Neelakantha Municipality Health Section
Logistics:

It consists of all the essential supplies needed for all health care facilities.
• Provides extra 65 medicines in addition to 35 medicines given by
government.
• Logistics for programs like HIV, CBIMNCI, Family Planning comes from
directly central level and are distributed through it.
• Logistics for TB program comes from TB centre
• Vaccines are stored in Cold Chain System of Health office and are
distributed to respective health care facilities. And as an allowance for the
transportation of vaccines, municipality provides an allowance of Rs. 2000.
 Neelakantha Municipality Health Section
Budgeting:
Budget comes from central, provincial and local level itself.
• From central level:
- Salary and allowance for government employees.
- FCHV and committee training.
- Purchasing essential medicines (35)
• From Provincial level – For programs like School Health Nursing Program, FCHV
training and communication budget and also for Basic Health Unit
• From Local level – It comes from Taxes from various places like Housing, Waste
management, etc.
 Neelakantha Municipality Health Section
Planning:

• Planning is done using POSDCORB Model.

• Starts with the meetings in respective toles then
towards the wards.
• Discussed by the committee in municipality and finally
implemented by Municipality Parishad.
 Neelakantha Municipality Health Section

Reporting
• Done by both manually and online.
• The HMIS forms are filled by respective health care facilities and
personnel.
• The FCHVs fill the form HMIS 9.1 and conduct meetings on the last day of
the month and submit to health posts.
• The Health Posts fill 9.3 HMIS forms
• The meeting is held on Municipality office from all health care facilities for
discussion and correction.
• Then reporting is done through online by DHIS 2 software which can be
assessed from local, provincial and central level.
 HEALTH SYSTEM OF NEELKANTH
MUNICIPALITY
WARD 14 The various services provided by
these Health care facilities are:
HEALTH POST 7
• Immunization services
• Safe motherhood services
URBAN HEALTH CLINIC 2 • Family planning services
COMMUNITY HEALTH UNIT 2 • Nutrition
• PHC-ORC services and attending
mother’s group meetings
• CBIMNCI
BASIC HEALTH CENTRES 5
They contribute to preventive,
MCH-CLINIC 1 promotive and curative services.
The various services provided by these Health
care facilities are:
• Immunization services
• Safe motherhood services
• Family planning services
• Nutrition
• PHC-ORC services and attending mother’s group meetings
• CBIMNCI
They contribute to preventive, promotive and curative services.
 HEALTH SYSTEM OF NEELKANTH
MUNICIPALITY

Services:
• Recommendation letter services for the allowance upto Rs.
1,00,000 for people with Heart diseases, Kidney problems,
Parkinsonism, etc. and upto Rs.5,00,000 for dialysis as
provided by the government.
• The additional transportation allowance of Rs. 5,000 is given
by the Municipality.
• One way ambulance free service for the delivery in Health
Care Facility.
 HEALTH SYSTEM OF NEELKANTH
Programs:
MUNICIPALITY
A) Immunization:
It is provided by 2 categories:
• Less than 15 months children
• Pregnant women

- Immunization schedule- 12th to 16th of each month.

- A child should receive vaccine for 7 times for 11 different diseases to be labelled as
complete immunization
- Verification of complete immunization- Magh, Falgun and Chaitra
- Similarly vaccine wastage rate and dropout rates are calculated for the analysis of
vaccination as per National Immunization Program.
For pregnant women, vaccines for Tetanus and Diphtheria
are given as Td. They are given as ;

• For primigravida – 2 times , 4 weeks apart and once for

succive pregnancy <5 years gap.
• If 5 years gap for next pregnancy- 2 times , 4 weeks apart.
For partially vaccinated children (<5 years old), vaccines are
given under delayed schedule.
B) Nutrition:
The nutrition program is focused for following groups:
• <2 year children
• Pregnant/Lactating women
- Mainly focused on children <2 years

- They are weighed every month upto 2 years for growth monitoring and
graded as following growth card:
• Green – Normal
• Yellow – Moderate malnutrition
• Red – Sever malnutrition
C) CBIMNCI

It is focused for <5 years children who are categorized as :

• <2 months
• 2-59 months

- <2 months infants are looked for Possible Severe Bacterial Infections(PSBI),
Local Bacterial Infections(LBI) and Non Bacterial Infections(NBI)
- 2 – 59 months children are looked for possible general danger signs, ARIs,
Fever, Ear infection and Nutritional status for which they are treated
accordingly.
D) Safe Motherhood
Safer Motherhood Program is focused to the women from pregnancy to Post
Partum period of 45 days. There are different sub programs under this as:

• “Sunaulo Hajar Din” – which is dedicated from pregnancy upto when the
child is 2 years old. Various services like, Pregnancy test, Iron tablets,
Vitamin A and exclusive breastfeeding techniques are given. This is
available in all birthing centres where Rs.2000 is provided for
transportation cost and Rs. 800 as ANC incentives.
• “Nyano Jhola Program” – It is also available in every Health Post where
for birth both pregnant woman and baby are given necessary after
delivery.
• Chlorhexidine gel is also provided for umbilical cord.
• For prevention of Post Partum Haemorrhage
Oxytocin- Institutional delivery
Misoprostol Tablet – Home delivery
• Further, Municipality provides fees for emergency
services.
E) Family Planning
The 5 temporary methods (Condoms, Pills, DePo Implants and IUCD) are all
provided to the Health Post by the government as a National Family Program.

• Provided by Health Post and MCH clinics

• PHC-ORC also provides Family Planning Services once in a month.
• Minilap and Vasectomy are conducted via mobile camps 2 times a year.
• Similarly, CPR and CYP are calculated to analyze the effectiveness of
family planning
Peripheral Institutions
Includes NGOs and INGOs.
• Red cross society
• Suaahara program
• Shanti Nepal
• HERD for Tuberculosis
• Eye centre
• Action Nepal
• Utthan Nepal
• Sunaulo Bazar Health Post
• Salyantaar PHC

These are established for better health care facilities to the people.
WHO six building blocks of
health systems
Contents

• Introduction
• Health Service Delivery
• Health workforce
• Health Information System
• Access to Essential Medicine
• Health System Financing
• Leadership and Governance
Health Workforce

Health Information Systems

Financing

Access to Essential Medicines

Leadership/Governance

Health Service Delivery

Introduction
• Health System consists of all the organizations, institutions, resources and
people whose primary purpose is to improve health.
• This includes efforts to influence determinants of health as well as more
direct health improvement activities.
• It delivers preventive, promotive, curative and rehabilitative interventions
through a combination of public health actions and health care facilities.
• A health system needs staff, funds, information, supplies, transport,
communications and overall guidance and direction to function.
• Common monitoring and evaluation framework was stimulated as a result
of the international health partnership + in 2007
1.Health service delivery

Service provision or delivery is an immediate output of the inputs into health

system, such as
i. The health workforce
ii. Procurement and supplies
iii. Financing
Sources of information on health service delivery-
• Routine health facility reporting
Indicators to monitor service delivery-
• Number and distribution of health facilities/10,000 population
 2.Health worforce
Can be defined as all people engaged in actions whose primary intent is to
enhance health.
Includes :
• Clinical staffs (physicians , nurses, pharmacists and dentists)
• Management and support staffs like managers, ambulance drivers accountants.

Data for monitoring health workforce :

Health facility assessment
Civil service payroll registries
Indicators of health workforce

• Health worker density

• Distribution of health workers
• Number of entrants into community health training programmes
in past 12 months
 3.Health information system

It collects data from health and other relevant sectors, analyses the data and
ensures their overall quality ,relevance and timeliness and converts the data
into information for health related decision making

SOURCES OF INFORMATION
• Different sectors and agencies that are responsible for generation, synthesis,
analysis and use of data
INDICATORS TO ACCESS DATA SOURCE
Two or more data points for child mortality in past 5 years
Two or more population based data points for maternal mortality in past 10 years
Number of institutional deliveries

INDICATORS TO ACCESS CAPACITY FOR ANALYSIS OF HEALTH DATA

A burden of disease study conducted within the past 5 years
A health system performance assessment carried out within past 5 years
 4.Access to essential medicines
A well functioning health system ensures equitable access to essential medical products ,
vaccines and technologies of assured quality , safety, efficacy and cost effectiveness.

SOURCE OF INFORMATION ON ACCESS TO ESSENTIAL MEDICINES

Facility surveys
Key informant surveys

CORE INDICATORS
Average availability of essential medicines in health facilities
Access to essential medicines/technologies as part of the fulfillment of the right to health
recognized in the constitution or national legislation
 5. Health systems financing
Refers to the function of health system concerned with the mobilization , accumulation and
allocation of money to cover the health needs of the people , individually and collectively in the
health system .

SOURCES OF INFORMATION
• Part of total budget allocated to health

CORE INDICATORS
• Total expenditure on health
• General government expenditure (GGE)on health as a proportion of GGE
• Ratio of household out of pocket payments for health to total expenditure on health
 6.Leadership and governance

Involves ensuring that strategic policy framework exists and are combined with
regulation and accountability

CORE INDICATORS
• Existence of an up to date national health strategy linked to national needs and
priorities
• Existence of national strategic plan for national tuberculosis
• Existence of national malaria strategy
Five year plan on family
planning
• Family planning refers to a conscious effort by a couple to limit or space the number of children
through the use of contraceptive methods.
• Modern methods of family planning include:

Temporary method Permanent method

Condoms Female sterilization (Minilap)

Pill Male sterilization (Vasectomy)
Injectable (e.g. Depo Provera)
Intrauterine contraceptives device (IUCD)
Implants (Norplant)
Aims of National Family Planning Program
To ensure the individuals and couples can fulfill their reproductive needs by using the appropriate
family planning methods voluntarily based on informed choices.
 
Commitment of Government of Nepal
• Equitable and right based access
• Quality family planning services based on the choice of individuals and couples
• Strengthen the policy and strategies related to family planning
• Mobilize resources of family planning
• Improve enabling environment to engage external development and supporting partners
• Promote public private partnership and involve non-health sector
Situation analysis of family planning
Analysis of family planning can be done based on the indicators such as
CPR, CYP, Percentage of Contracepptive method defaulters. For
situation analysis of Family planning in Nilkantha Municipality,
Contracetive Prevalence Rate (CPR) and Couple Years of Protection
(CYP) is taken due to availability and adequacy of data. Comparing with
the national CPR (43%) of fiscal year 2075/76, the existing CPR of fiscal
year 2075/76 in Nilkantha Municipality is low.
Rationale for selecting five-year plan on family planning

• Prioritized program of government of Nepal.

• Least concern and discuss areas among public health due to Nepalese culture ,
values,illiteracy etc
• Hesitation among health workers to deliver effective information and education
to public.
• Least focus areas in education system of Nepal
• The CRP of family planning in Nilkantha municipality is less in comparison to
national data and target.
• Inadequate recording and reporting.
 National data
S. Indicators 2072/73 2073/74 2074/75 2075/76
N
1 CPR 43 44 40 41

2 Temporary methods      
of FP among new
acceptors
Condom 32% 29% 27.7% 27.3%

Pills 17% 19% 19% 18.4%

IUCD 4% 4% 4.3% 4.7%

Implant 12% 12% 12.5% 12.1%

Depo 35% 36% 36.5% 37.5%

Family Planning Program:
Temporary New users Currently Follow up Device distributed
methods <20 yrs >_ 20 yrs using not done Unit Quantity
Condom Numbers 5010
Pills 3 35 187 33 Cycle 134
Depo 0 90 770 58 Dose 235
IUCD 0 2 564 0 Set 2
Implants 0 7 1112 2 Set 7
Permanent New Users Currently Using
Methods Health Organizations Sibir(Camps)
Female Male Male Female Female Male
Governmenta 0 0 0 0 0 0
l
Non- 0 0 0 0
Governmenta
l
After Delivery Contraceptive Users (within 48 hours) IUCD Implants Tubectomy
0 0 0

Table: showing distribution of Family Planning Methods in the FY 2076/77

Goal:
Accessible and affordable quality family planning service to all married couple of
reproductive age group
 
General objectives:
To decrease high risk, early and unwanted pregnancy.
 
 
Specific objective :

•To increase the use of temporary method of family planning among newly married
couple
•To increase use of long acting reversible contraceptive among married couple after
first baby
•To identify hard to reach,disadvantaged and vulnerable groups and areas.
•To increase use of long acting reversible contraceptives such as IUCD and implants
especially to outreach groups or areas
•To increase use of permanent method of family planning among couples who
complete their family
•To increase awareness regarding family planning and increase number of new
individuals using family planning methods
•To decrease the percentage of contraceptive method defaulters
•To decrease the teenage pregnancy
 
Targets:
Phase 1:
To increase CPR to 40% by fiscal year 2077/78
 Phase 2:
To increase CPR to 52% by fiscal year 2079/80
 Phase 3:
To increase CPR to 60% by fiscal year 2081/82
 
Strategy:
• Strengthen the recording and reporting system and feedback mechanism
• Engagement of local community
• Enhance the Information Education and Communication(IEC) and
Behavioral Change Communication(BCC) activities
• Capacity building of health workers
• Building the motivated and competent health workers, FCHVs
• Quality delivery of family planning services along with adequate supply of
necessary commodities
• Coordination with developmental partners ( INGOs, NGOs ) and private
sector
Activities:
• Proper recording and reporting training to the health workers of government institution and private
health institution
• Establishment of proper feedback mechanism being municipality as a central body regarding information
system
• Participation of local, political and religious leaders in family planning campaign, meetings
• Active participation of FCHVs and their effective mobilization
• Active participation of school and colleges through launching at least 1 program in school of the
municipality
• Celebration of family planning day by engagement of community members, conducting different
program regarding awareness ( drama, rally, seminar, debate competition..)
• Awareness through pamphlets and posters related to family planning at health posts and public
places should be initiated
• Awareness through media like local FMs, newspaper and social media (YouTube, Facebook) in
coordination with health office of Dhading
• Awareness to be conducted by renowned people of the society/nation to increase the impact of the
campaign
• Co ordinate with Health office regarding training of health workers and necessary refresher program
• Coordinate with Dhading hospital in providing permanent method of family planning service by recruiting
trained doctor and in providing required additional infrastructure
• Development of two way feedback system regarding service
• Separate counselling and information section in every health institution regarding family planning
• Top up incentive to the health workers who participate in training session of family planning
• Top up incentive to the health workers, FCHVs helping and bringing clients for permanent family planning
method
• Incentive to trained health workers for providing Implant and IUCD service
• Rewards the health institution and health worker for providing best performance in family planning
service yearly during family planning day
• Rewards to the client who adapt permanent method of family planning despite having daughters only
• Satellite campaign and mobile clinics at remote areas 6 monthly.
• Home delivery of family planning materials through FCHV and health workers.
• Proper storage , distribution and timely demand of family planing devices
• Coordinate with private sector and developmental partners for financial, technical and functional support
 
Activities
Program will be conducted in 3 phases
Phase Year 1 Year 2 Year 3 Year 4 Year 5

1          

2          

3          
Budget plan
Sources of budget
Local government (Nilkantha municipality)
 

Budget distribution
•1 st
phase : NRs. 22,00,000
•2 nd
phase: NRs. 39,00,000
•3 rd
phase: NRs. 39,00,000
 Activities 1st phase budget in NRs. 2nd phase budget in NRs. 3rd phase budget NRs.
1.Recording
  and reporting training to health workers 2,10,000 2,10,000 2,10,000
    (on-site coaching ) (on-site coaching)
2,Awareness
  program in school 1,30,000 1,10,000 1,10,000
3,Celebration
  of family planning day 1,70,000 3,80,000 3,80,000
4. Awareness of family planning through advertisement 3,90,000 9,10,000 9,10,000
5.Training
  for effective FP service delivery 4,00,000 5,30,000 ( refresher 1 5,30,000
( 4 day) day) ( refresher 1 day)
6.Doctor
  providing permanent methods of FP 90,000 2,00,000 2,00,000
7.Incentives
  to permanent family planning users 80,000 2,50,000 2,50,000
8.Top
  up incentive to the health workers, FCHVs 90,000 2,30,000 2,30,000
9. Rewards to the health institution and health worker 70,000 1,30,000 1,30,000
10.  Rewards to the client who adapt permanent method 70,000 1,75,000 1,75,000
of family planning despite having daughters only
 

11.Satellite
  campaign and mobile clinics at remote 4,30,000 9,10,000 9,10,000
areas 6 monthly
12.Miscellaneous
  70,000 1,65,000 1,65,000
Total
  22,00,000 39,00,000 39,00,000