Annual Health Report 2075 - 76

Annual
Report
Departm ent of Health Serv ices
2075/ 76 ( 2018/ 19)
K athm andu
Gov ernm ent of Nepal

Ministry of Health and Population
C O N T E N T S C O N T E N T S
ag m i it at a a
ag m tat i it at a a
a m ta at a a
F orew ord f rom Di rec tor G eneral, DoHS, M oHP
Ac k now led g em ent f rom Di rec tor of M anag em ent Di v i s i on, DoHS
g m t m i t g at at ma a ag m t
ia a m i
T rend of Health Serv i c es C ov erag e F ac t- s h eet iii
mma v
mma a a at i x x
mma a at t t at g x x x v iii
a t
Ba g
a tm t at i
i ma a ata a a i
t t am t t
a t
a t
a tm t g mi i t a
a tm t aa t a i i
a t
i at a mm i a
t g at a ag m t ata i i
ti
a t a at
ami a i ga at
t a a at
ima at a t a i i
a t
t B a g t i a i a
a a ia
aa a a
m a i a ia i
g
a
i a
i
a
mm i a i a ta at
i mi g a i a t a a ag m t
i a a a
a a i ga g t m
A
at a it i a
a t
i g a a it m t
iat i a Ba i
ia at it
Bi a a ag i a i a
ma mm it at t
a t
a t i
ma ga a a t
m at i i
a t
at ai i g
t B i a a ai i g
at a ma a mm i a
at i a ag m t
at ma a ag m t
at t m t
i m t at at a at a ag m t
gi a ag m t
i a t a at i
mi i t a a ag m t
i a ia a ag m t
i ga i
it i g a a a
a t
a i g i
a a i a i
a at a i
a i a i
a at i a i
a a ma i
a t
a t
at a ga i a
Bi at a ga i a
t a m t ga i a
m t ga i a
AN N E X E S
i a i ti g am
ag t g am
B
C
D
E
F
G
H
ABBREVIATIONS AND ACRONYMS
t i g imm ia DP T Di ph th eri a, P ertus s i s , T etanus

t ai m ata a it a m t
t a i aa i g m
t i i E DP E x ternal d ev elopm ent partners
t ga t t i a at a i
i imm i m a i a t iag i
mi ia i ta m m g t ti a
AN C Antenatal c are a t ti a
AP I Annual paras i te i nc i d enc e a g amm mm ia
t i at i t a a it a a
t ia t a a a i ga g t m
a i a i a a t ia ma mm it at t
B a i it a a t F SW F em ale s ex w ork er
t a a at a i a i it
a m m ga i i ma t m
B C B i rth i ng c entre ma a t i g a
B B a i a g mm i a G G B V G eri atri c and G end er B as ed V i olenc e
B M E AT B i om ed i c al eq ui pm ent as s i s tant trai ni ng at a i it a a ma ag m t
B M E T B i om ed i c al eq ui pm ent trai ni ng mmi
Bi a t a i a i HI B Health I ns uranc e B oard
B T SC B lood trans f us i on s erv i c e c entre a a ag m t ma t m
IM C I I nteg rated M anag em ent of C h i ld h ood I llnes s t g at at ma a ag m t
prog ram m e t m
IM N C I I nteg rated M anag em ent of N eonatal and ma imm i i
C h i ld h ood I llnes s t a a a i a i a
t g at a ag m t a IC T i m m unoc h rom atog raph i c tes t
P rog ram m e i a a mia
B mm it a ga i a i i i
t t i a mi i ma a a mm i a
C C E C om preh ens i v e c entres of ex c ellenc e m ta i i a i
C DD C ontrol of d i arrh eal d i s eas e t g at a ag m t t a ti
m i m g t ti a a at i a i
neonatal c are i a a i g
C HX C h lorh ex i d i ne i at ia ma g am aig
m i a a ta t i ta i
a a at a a ai
m i ami a i g agai t m i a a i
ta a at ga ga ma tm t
g ita a m ga g i ta
i i a a a a a g a gi i a t
T rai ni ng gi a ag m t ma t m
DAM A Di s c h arg ed ag ai ns t m ed i c al ad v i c e LT F L os t to f ollow - up
DHF Deng ue h aem orrh ag i c f ev er i a a
iti t at ma t m a ag m t t a ti
i t atm t t B a i a
DoHS, Annual Report 2075/76 (2018/19) i

M C H M aternal and c h i ld h ealth m a i i a iag
m ta a at P C V P neum oc oc c al c onj ug ate v ac c i ne
M C V M eas les - c ontai ni ng v ac c i ne P DR P renatal d eath rev i ew
M D M anag em ent Di v i s i on t i g ma ti
a g a mi i t a a ag a mm i a
M DG M i llenni um Dev elopm ent G oal Di s eas es
t i i i a a P f P las m od i um f alc i parum
a a ia i a ma t m ima at a t a i i
g i ta t P L HI V P eople li v i ng w i th HI V
gt a m t t i t a mi i
a i ia P N C P os tnatal c are
at a a t a g i ti i ga a
prog ram m e P P H P os tpartum h aem orrh ag e
at a a i at B i a t ia i
at a a at P v P las m od i um v i v ax
M N P M i c ro- N utri ent P ow d er P W ID P eople w h o i nj ec t d rug s
i it at a a a it im m t
M P DSR M aternal and peri natal d eath s urv ei llanc e and a i iag t t
res pons e t a ti
a a ta g i ta
M SM M en w h o h av e s ex w i th m en a t i at i
t ti a B i it a a ta a
a a a ma i a ia at it m t mmi
a a t at a m t a a at
t at g m a i
a a a m i a i a t a mi i
mm i a i a ai g ti
a t at B a a ga B g t t
a m ga i a at t m
a a t a a it a m T d T etanus and d i ph th eri a
a a at mm i a i ai i g ma a ag m t t m
N HSP - I P N epal Health Sec tor P rog ram m e- i a a i g at
m m ta a T T T etanus tox oi d
a at t t at g a i t a mi i i
a a mm ia g amm a a t a i a a it
a i at t itami i
a a i g amm a i ta i a
t ii a ag m t t ta gi a ta
t a t at a ita a gi
a i a i W P V W i ld poli ov i rus
a a m ag
a t at t i a ma ag m t
i a a t ma ag m t
B a i a i a
B m a a t i gi a m
ii DoHS, Annual Report 2075/76 (2018/19)

Trend of Health Serv ice Cov erage Fact Sheet
Fis cal y ear 2073/ 74 to 2075/ 76 ( 2016/ 17 to 2018/ 19)
National
National FY 2075/ 76 ( 2018/ 19) by Prov ince
Target
Program m e Indicators
2073/ 74 2074/ 75 2075/ 76 Bag Sudur
1 2 Gandaki 5 K arnali 2020 2030
( 2016/ 17) ( 2017/ 18) ( 2018/ 19) m ati Pas chim
NUMBER OF HEAL TH FACIL ITIES
P ub li c h os pi tals 123 125 125 19 13 3 5 16 17 12 13
P HC C s 200 198 196 4 0 3 2 4 1 23 3 0 14 16
HP s 3 808 3 808 3 806 64 7 74 5 64 1 4 91 570 3 3 5 3 77
N on- pub li c f ac i li ti es 1715 1822 2168 150 203 14 17 119 156 74 4 9
HEAL TH FACIL ITIES & FCHVs REPORTING STATUS ( % )
Public facilities :
P ub li c h os pi tals 93 96 88 100 97 64 91 94 99 100 100
P HC C s 98 98 99 100 100 97 100 100 100 100 100 100
HP s 100 98 99 100 100 99 99 100 100 100 100 100
Non- public facilities :
F C HV s 72 72 95 91 94 94 93 99 94 97 100 100
IMMUNIZ ATION STATUS ( % )
B C G c ov erag e 91 92 91 87 107 81 72 98 102 84
DP T - HepB - Hi b 3 c ov erag e 86 82 86 83 105 71 72 90 99 82 90 > 95%
M R2 c ov erag e
57 66 73 75 71 60 77 84 78 75
(12- 23 m onth s )
F ully I m m uni z ed c h i ld ren* 73 70 68 71 71 54 61 74 79 71 90 95
Dropout rate DP T - Hep B - < 10
4 .7 7. 4 4 .3 2. 9 7. 9 3 .2 2 4 2. 4 2. 7 < 5%
Hi b 1 v s 3 c ov erag e %
P reg nant w om en w h o
64 73 64 59 83 4 8 52 73 69 63
rec ei v ed T D2 and T D2+
NUTRITION STATUS ( % )
C h i ld ren ag ed 0- 11 m onth s
reg i s tered f or g row th 85 84 84 78 78 69 92 100 117 86 100 100
m oni tori ng
U nd erw ei g h t c h i ld ren
am ong new G M v i s i ts (0- 3 .5 3 .6 3 .0 1. 7 4 .2 2. 1 0. 9 3 .0 5. 0 4 .0
11m )
C h i ld ren ag ed 12- 23
m onth s reg i s tered f or 54 56 58 4 9 59 4 4 69 64 80 58 100 100
g row th m oni tori ng
U nd erw ei g h t c h i ld ren
am ong new G M v i s i ts (12- 5. 7 5. 7 4 .5 2. 9 5. 6 1. 8 1. 5 5. 4 8. 5 7. 2
23 m )
rec ei v ed 180 tab lets of 4 4 4 5 81 3 9 5. 7 3 0 62 61 61 68
I ron
P os tpartum m oth ers w h o
rec ei v ed v i tam i n A 72 66 65 57 91 4 1 4 6 65 98 68
s upplem ents
IMNCI STATUS
I nc i d enc e of pneum oni a
am ong c h i ld ren U 5 y ears
66 54 83 116 65 55 58 76 159 110
(per 1000) (* HF and
P HC /O RC only )
% of c h i ld ren U 5 y ears w i th
P neum oni a treated w i th 156 165 13 6 128 203 111 14 5 127 120 113
anti b i oti c s
% of c h i ld ren U 5 y ears w i th
P neum oni a treated w i th na 102 13 6 128 203 14 5 127 116 114 111 100 100
anti b i oti c s (Am ox i c i lli n)
I nc i d enc e of d i arrh ea per
1,000 und er f i v e y ears 4 00 3 85 3 75 3 51 3 4 7 24 0 268 4 04 683 624
c h i ld ren
% of c h i ld ren und er 5 w i th
d i arrh ea treated w i th O RS 92 95 95 90 102 93 97 94 99 94 100 100
and z i nc
SAFE MOTHERHOOD ( % )
attend ed f i rs t AN C v i s i t 102 103 110 114 118 106 108 110 127 90
(any ti m e)
attend ed f our AN C v i s i ts as 53 50 56 61 4 1 51 70 65 62 58 70 90
per protoc ol
DoHS, Annual Report 2075/76 (2018/19) iii

National
National FY 2075/ 76 ( 2018/ 19) by Prov ince
Target
Program m e Indicators
2073/ 74 2074/ 75 2075/ 76 Bag Sudur
1 2 Gandaki 5 K arnali 2020 2030
( 2016/ 17) ( 2017/ 18) ( 2018/ 19) m ati Pas chim
I ns ti tuti onal d eli v eri es * 55 54 63 62 53 62 4 8 79 73 71 70 90
Deli v eri es c ond uc ted b y
52 52 60 61 51 61 4 7 73 59 61 70 90
s k i lled b i rth attend ant*
M oth ers w h o h ad th ree
P N C c h ec k - ups as per 19 16 16 9 15 14 13 9 24 3 1 50 90
protoc ol*
FAMIL Y PL ANNING ( % )
C ontrac epti v e prev alenc e
4 3 .6 4 0. 0 4 0 4 1 4 7 3 3 3 4 4 3 3 5 3 9 56 60
rate (C P R- unad j us ted )*
C P R (Spac i ng m eth od s ) 21 18 19 19 9 17 17 28 21 23
FEMAL E COMMUNITY HEAL TH VOL UNTEERS ( FCHV)
4 108
N um b er of F C HV s 4 94 16 514 20 514 20 8990 753 4 9004 5709 8795 6060
% of m oth ers ' g roup
86 98 95 92 95 95 93 99 94 98 100 100
m eeti ng h eld
MAL ARIA AND K AL A- AZ AR
Annual b lood s li d e
ex am i nati on rate (AB E R) 0. 79 1. 3 1. 6 2. 6 1. 8 1. 2 1. 0 2. 6 1. 0 1. 6 4 .0
per 100
Annual paras i te i nc i d enc e
(AP I ) per 1,000 populati on 0. 08 0. 08 0. 09 0. 01 0. 03 0. 02 0. 03 0. 1 0. 2 0. 2 0. 05
at ri s k
% of P F am ong M alari a
13 . 1 7. 1 5. 4 26. 3 16. 7 3 0. 8 17. 2 4 .6 0. 4 3 .1
P os i ti v e c as e
N um b er of new K ala- az ar
225 23 9 216 3 4 19 25 4 4 2 50 3 9
c as es
TUBERCUL OSIS
C as e noti f i c ati on rate (all
111 112 109 89 112 123 90 127 78 110 N A N A
f orm s of T B )/100,000 pop.
T reatm ent s uc c es s rate 91 91 91 90 91 91 94 90 94 88 > 90 > 90
L EPROSY
N ew c as e d etec ti on rate
(N C DR) per 100,000 11 11 11 10 24 3 4 14 5 9 10 7
populati on
P rev alenc e rate (P R) per
0. 9 0. 9 0- 9 0. 9 1. 9 0. 5 0. 4 1. 1 0. 5 1. 1 0. 1 0. 4
10,000
HIV/ AIDS and STI
N um b er of new pos i ti v e
1781 2101 2298 287 3 73 583 165 552 25 3 13
c as es
CURATIVE SERVICES
% of populati on uti li z i ng
72 74 78 76 58 85 106 81 92 72
outpati ent (O P D) s erv i c es
Av erag e leng th of s tay at
3 4 4 3 2 4 4 5 3 3
h os pi tal
N ote: * N HSS RF and /or SDG i nd i c ators
Sourc e: HM I S, E DC D, N SSD, N C ASC & N T C /DoHS
iv DoHS, Annual Report 2075/76 (2018/19)

mma
EXECUTIVE SUMMARY
INTRODUCTION
a a t t a tm t at i a a
i t t t t it i i t t ta g t a
t at gi a t a at g amm a a a t i ma a i m t a
ig ig t t i i ag t a a i t a i i
m a t ai t a gg t a t ta at i t t
im m t
mai i t t at i ai at i i t i ita
i i g t mi i t i t i at a ii t ima at a
t a t at t ima at a i a i
ima at a t a i i it t ta a g amm
mm i a i i i imm i a i i t
ma mm it at t i ma t a i m t t
i at t m a i at at a ii t at
a ag m t ma t m
PROGRESS OF OTHER DEPARTMENTS UNDER MoHP
The Department of Drug Administration (DoA) G ov ernm ent of N epal h as prom ulg ated th e Drug
t t i it t mi a m i i a a i a ma a mat ia a
a t a mi a i g i ma a gt a a m i i a t g at
a t t ma g iti t im t t ag a ia t
m i i i a t a t t a i a ta a a it
a a it t t a a at i t a a g i
a a m at
im m t t ta i i g i a am g
g m t m t ag i at ga i a i i t a i at t
m i i im t t t ag a iti a it a m t
g at t a a a i ma i i g t aim a a a
g i i a t im ta t a a
Department of Ayurveda and Alternative Medicine (DoAA) ima i ma ag t i

a t a i i i a m t at i t t g it t
a ii a a t t t ma ag a at i a i g i t g
ta a ita a i i ia ita a g a a
i ai iti t a at t a a i ai a t
t aa t a i i it i t i it at a
i i m a g i i a g i i aa t ta i a m i a
t m
i a g m t a a g i a m t
a i a at at m at t at a m i i i a
it a t t a m t ita i a m
a a ai a m i i a mi a a ima igi m i i a ag m t g a
t at a m i i a ta a m ta i m t a ga
at at t a ia a m at t i m
DoHS, Annual Report 2075/76 (2018/19) v

mma
Department of Health Services under programs:

National Immunization Program (NIP)
a a g am mm i a a ta t i B a i a i it
g am t i t i at g am i i t at a a a
a a i a mi t ti g t i m i it a m ta it
a iat it a i ta i a a a ig it g a
gi a a a a g i i i i a mm a t g i t g am a
a i ti i t a t a a t at gi im m ta
a a g ta m g t ta g t t imi a a a i a
a i ta i a ma a m it t a i a i B
at a a ata t ta a imi at i a t imi a tat
a tai i t at a i i a a i a a g it t
ti t t a t ia gi a a i i i tat a
mai tai i t
g t a a a a i ga i t aa g ita a
m i a i t a a a tgi a ta g t a a a
a a t a
a ta g t t g m a a
m a
t t a a ta g t a i i g m a imi a a t
m t t m m m ti t a t ia gi i i g a
a t imi at t m a a a t t at a i a ii
a t ig i i i i a a i i t m t
i i a i i ig ag it t ta
imm i a m a a a i i mm it m i i a it iti t
i a a a i t imm it ga t m a a a a
a a i am aig m mi a t mi i i ag a ait a
i i g i t iti t ai
a a a i ga i a B t am g i t g
imm ia a t a t i a a B g t
t a am g a i
a i t t t i t t at ia gi t a mm i a t t g
a t gt i gt a a mm i a g am mm i a t a i i
t ia a a a Ba t t a a mm i a g a
i a i i t ia a g t
a a imm i a ag B a a i t i
t ag B i a a i a m a t i a g a
tag ta t m t a gi i t am a at
a a gi t a ma at a a a i a i t
t t ag i i ag a mai tai
at a ag a a i a i t m a t i a
ag a i a m a t i a a ag a i a
ig i a t i t m a t i a m a imi a ig ag
t a i i ag t a i t
a a t ag a i a a i t ag a -
i a i a i t m a t i a a tag at i i i
v i DoHS, Annual Report 2075/76 (2018/19)
mma
t a t i a tag at t t a a t t
a i B a t a t i a it i at t t
imm i a i i m t a tag at a t t ig a a
t at B B i t a a a a
m a t i a i g im m t a a t at a it i
g at imm i a ata t i a i it a
a m t at a i ag i a t a i ig t a t
Integrated Management of Neonatal and Childhood Illnesses (IMNCI)
i i t g at a ag i i a i t a t ma m i
a it a ia a t ia i a i t mia it ig t
i g a i g a a ma i i i m ia ia a
a a ia a a a ti am g a i i a i a
a t ta a gi t a t at at at a ii a
i i ig t a t at i a t t ta gi t a i
t a a i a i Ba t ia B i i
ig t t a t at i a
m
g t t ta gi t a at t a a a t a
a i a B ta a i a ta Bi t ig t B at
i g m B ig t i a t a t at i a t t
a i a B a m a t a t a m g t ta a t
a a t t a m at a ii a
i i a am g t m t t at it
am i i i a i a
i mat t a t ia a m t
m gt m t ta ia a a i at a
i i ia a a it a ata it at t
ia a a t at it i a a t gi i
imi a i mat t a ta t
i i t a i a a i a
m g t ta a i a t i a i g m ia
a t a m ia t m ia a t at
it a i i i t i a it a ata it at
B t t t ta a i a ma a i a m ma a ia
a m a a a i ma t i a a a mia a
i am g i i
Nutrition
a a ti g amm i i it g amm t g m t t aim t a i

t ti i g a t at t a mai tai a a t i a ti t t t
t i mi m t i a ig mmitm t t im t ti a
tat ia g a ta a ta g m t a i
t tag it it ig t g a a a i
t a a a ag m g t m it i g i it i m t i t
DoHS, Annual Report 2075/76 (2018/19) v ii
mma
t t i ag m t gi t g t m it i g mt
t i t a ig t
i gg t m it i g i i a m t gi t
g t m it i g i i mi i a
ta i m t t a it a mi i t a t a i a t
t a t m g i ag a t t a t
i a t a t imi a i a mi i ti
a i ita m t t i ma ma m gt
i i t a a m t a a t a
mt t ta i ag i
t t mi ti t m ta t m ia ta i g ta t t g t
t g a i ta a i g t at m i i ag t
i ag t m t a ta t i t i t g amm i t i t
i ga at i i i t itami m ta ag i a
a mi g ta t i t i ag i i i ag mi g i
t gi a t
a m g a i ai a a ta g m
i t igg i a i ga a i i t t iti t t
ti t t a i ti a m t m t i i g
ta ta a t i ag m t a t t m
i i a a t ma t i a i a
at t a ti a a t a ti i at
i it t a ti i t ig t a t iti t i m
i at i g i t g a t t t ami
i a t m ta i g g amm t i ag m t a
g a ta a ta g m
ti t B i gg i t m ag ti at a
i t a g ag ait i i B ia a i a ai t g a a i i
iti t ai ait i i B i i a a ia a a i
m
t ti t a i m t
a g a ta a ta g m i a t i t i t itami m t
i g at i ga m m ta i gt t a ta
m t i i g i t atm t
mi g m t i i a i a i ta t t
imi a i ag m t a a it a t m ta
i g a i ag m t it a m it a t
ma t i a it ag t m ta i g g amm
a at ig t ma i t m it t g i a it a a i t
i t i t Ba a a a i i g t a a mt t m at t i Ba a a
at i a a i t i t t i a a ig t i g a ig t mt i a a t
a a g m t a t mm iat a t i i a ti t
m m m tt g t a a t a mm iat iti t a ti
v iii DoHS, Annual Report 2075/76 (2018/19)
mma
t
a a m ii a g it t t am m a a iti t i at
f rom B ara, P ars a and Rautah at, M SN P v olunteers , h ealth w ork ers and F C HV s , th e f ollow i ng res pons e
a im m t
at ig t t a t a t Ba a i t i t a i t a a t
ai a a a ai a ita tai a at t Ba ia a at t i a
i a a a i at t ta a t t a a i at ta am at t
ta a am
at a t ta i it a t ma ti it a t a
a i ag a t a g i i g i m g i a a
g a t a a ta g m a a ti t a a at m a i
ta a a g ag
Safe Motherhood and Newborn Health
ami a i ii
a im m g a a a t g amm t
mat a a
ata m i it a m ta it a im mat a a ata a t
t g m a a i a a i ga i a a t t at a at
i g g a i it a t t at m i g a t m
a i g at a t i it a t t a i a m ti a
ti t ti tag m a at a t
i i at a a t a i i a tag t
i it a i a t ti m a ti a
t i t a i i t a
i m aai t at a a t a tag i ti a i t tag
i
B t ta i i i iti t a at g t
a t
i i g it a i imi a a t ta m i i ai
i t i t im m t it i i a a i g a m t i g g amm a
a i g m t i gg i i a t i a a ita a it im m t
i ita i iti t i t i a tag it a
B i a t ti m t t a
t m t a i gt i it a t t i m
ti t ti a m i a a
ma a a m a i a i ma a ai a i a iti t ita a
ma it i t i a
t ta it a it it t i a a i i
t ta m i a i gi a a i i
t i a a ta m i i a i
a m i a a am g t ta a a i a i a
t at a m ti t ti m
a a a a a t ta i a m ti t
ti
Family Planning and Reproductive Health
a a ami a i g g amm i i a t i ta ami

a i g i a a a i ia m a a m ta
a at m m at a a m ai i ig t a
DoHS, Annual Report 2075/76 (2018/19) ix
mma
aa a ag i a t ig t m i Bagma i t t
a a t a t m a m m t a a i
t a i i a m i t i t it m a a m
i t i i i a g a ma am g t m iti t
t t ma tm t a i a i gt i t at ga g
i ta t i a m t tag a t at a a t i i
i a i gt i i Bagma a a im i ma t i i a i
a i ai a ma t ii a i m a i tai a ii t a ai
ta im a t m a t m t m a am g m
ag i a gi a gi a ta a t a i i at ta
i a a ig i a t ta a i i gt
m t it t a t ta m t m a t ta g i
ta i a a a t at i a i
ta i a a i a i
i t
g at t a t t ta m t mi a m t
a t m im a t ma t ii a a
a t ma t ii a i a a a t a m m t
a t m a i a i a t a t m a m t
a t m a a mi a i a i im a t a t
ig i a t mi at i a i a gi a gi a mi a
i a i t a t m ta m t ta i agi g ta
ta am g t ta t a i i a i a m at a t
i t i t i i a g m a a a i g m t
Adolescent sexual and reproductive health
a i t t i t ia i a a t t a a
t at a m t t at g i a a t a a
at i t i it g am ami a i ii a
t m gi g i a t i t a gi g t t t t at g i i
i t mai aim ii t at g a t a t m a t a ti
a t ag t t t mi i t a i a a
a a t t at a m t ta i a at a
a t i m t a a t i t g i a i a t a
t i a a ag a iat i ma a tt i at a m ta
a i g i i a im t a t tat a t
a a g am a ga a a t t iti t ta g
ita a a a t im m t i t i t iti t at a ii t
t a a i a a t i m t a a i
ig i a t i a i i i m ai t i a a a i i mai t
ti t a t ata i ag a m am g t a i i i t
a t t m t ami a i g i ig t i i a
a ti i ta t i t a i am g m
a ag
m i i gt a a i a ig i a t a i t
i i i m ai it i a a a im i
a t t m a t m i i gt a a i i a a a
m a t t t i a t t ta m t m t a a
x DoHS, Annual Report 2075/76 (2018/19)
mma
i i gt a i i i i m ai t a
ig at ma iag i ta am g a t a a a
i agg gat ata ag a i t ga i mai tt g a g
t im m ta t g am i t a i i g t mi im m
t t ma im m a a it t i at i t a t a i it a a
t a it a a i i g ig t a tt a it a
a a t ig t t g i ma i ga at i it i t g a
t t t t
Primary Health Care Outreach Clinics

Ba t a a t m t at a t
i at a m i i a t it i a a a i g i ta t
a i i g i t at a a ima at a t a i i t ai at
a i t t mm it
mi i at t a i i a t ta
i i i t t ta g t m i i
i a a a ig t i a i i i a a
a ag i t a t a i i a aga a i m t
i t a m i t t at at
i i t a a a ag i t a t a i i
Malaria
a a a t i i m m t a i g ma a ia m i it a
m ta it at m t a i a m a t m t a
a ta ii a a ia a t a a a a ia t at gi a
a a t i mi g ma a ia i m
mi ta a aim i t a ai a a ia a
ta i a
ma a ia ig t a m i t i
a
a i ig a a a im t a t a i a
a i a mi i i ai gt a a i a
m a t t i a t i ig i ma t ig
m im t a i a m a t i ig ma a ia a a ai g
i im t a a i i a i gt t i i a t ma a ia a
i i it at a ma a ia a a ai g a a mai t i a
ag mi i a at i at i a ig ag i ig
a m at i t i t a i a i mi tat mm it
Kala-azar
aa a a i t ig i it i at m a t t iti t a
t a aa a a i t a t imi at a a a a
m a t at gi t im a t tat a a i a a ma
i g mi a a a i a t imi a a a a a a it g
m a i at m i i aa a a at a a a iti t a
t a a i t a a a i g ig i a t
t at a a t a ig t a i t a
aa a a a m a t i a
DoHS, Annual Report 2075/76 (2018/19) x i
mma
Lymphatic filariasis
m a i a ia i i a i at mi a g a a a m a i a ia i
g amm i t a g m m a a ia i
a t a t i iti t t i a i i at i iti t a
m i it ma ag m t a a i i at i a mi i t i t mi i t i t m t
t mm i i imi a g amm a a i i t
t i t t t gt i g at t mt g t ai i g a a a it i i ga i
t a mi i a m t i iti t i t at t a i
a ig i a t i m t a mi i m a a ia i g a
a mi i t at t at i a g i a m i
t
Dengue
g am it i a m g i a i i g a a a g
t g am i t t m i it a m ta it t g g
a m agi a g m m t g a
a a ig i a t i t a g i a i t a i g
g a t m iti t a ma it a
a t m ai a a a a g a a i
t m at t g a m a ia a g
L epros y
i g t t ta m a t t
a t g a a t atm ta i i g
at t t a a gi t a at a a at
a a a t t i a i i t t i tm a a
a a t ta a t a a i a i it
i a a ma a
i ai gt gi t a at a t imi a i i a
i t g am a a a a t a i
i a a ai a t a a t a i it m i i ai a
a a it i i g at a g i g t t am i t tai t g a
a
i
mi g a i a t i ii i t a it i it at a
a t i ta g t m i a ii i i ii i a i gt
m t a a a i ita t mi i ga i t g t
i i a g it a i ita i a a ia i i
i a i it ga i a a i t a a ag i t m t i a
g i i at t a i ita a i a i it
Z oonos es
a a a i a a i a i mi mi a a mi
t a a ma i at a m t a i a a
i am g i a t a i i a a m gi g a m gi g
i a i a i i a it t t a ai a i it a a i
a i a a m m m at a i a t t t a
x ii DoHS, Annual Report 2075/76 (2018/19)
mma
ma ag i mi a t a i t g a g am a
i t a m t a ma a i a a a it t ig t i a i t a ai
i gt ga t a ima it a a t t g tt
a a a a it a t
Tuberculosis
i B mai a ma i mi aa t t ta
B a gi t at m
i i g t
t B a
a a B a am m aga B a t t m
a t i gi a m i t ig t B a at ma
i t i ta a B a t B a mt i i
it ti i a i t a a t ta a i t m t ai i t i
ai t t m t a a a t a t i t
ag g ig t i a ag i Bi a i
m a m m t a m am g t t B a
a a at a m Bi a i i t B a
a a i a m ga a g i B a
gi t at a t m t at it a t atm t
at t atm t a a a mat a t a B
a a t B a a a a i a B a
a t ta B t atm t
a t a t Bi a Bi i ma gi a
t a t B a
B i i t g t atm t t ga i g iag i t
a i i t a t t t g tt t B i
i t g t atm t t a atm t t g t B i
a am at a i it a i a i t g t a m
HIV/ AIDS AND STI
a i g t t ta mat i i g it t a a t
mat i ag t a a i i g it i a i i t
a t ag a a a a t m t t ta mat i
am g a ag a B ma a t am t t t i
t i a t mai i gm t a t i i a i ma
a am g a ag g i i ta a
t atm t t
Non Communicable Diseases
mm i a i a a m gi g a t a i g a at i a t
a g i ia t mi a t i at i t a ia m ga i a mi
ta i at t a i a a i a ia t a a i at
i a a i a m a at i t i a t
a a a i i g m t a mm i a i a a a
a a t a t t ai t i t ima a i g
i mi mm i a i a i g i a a i
tai a m t a i at i a m t i g a at a ag
DoHS, Annual Report 2075/76 (2018/19) x iii

mma
t i g a ta g t t t i mat m ta it m t g
a t atm ta m t m ta at a i g m m ta a
a i i it t t a a a t
Mental Health
ta at a ta a i g i a at i i a a a i
tai a m t a it i t at g a t ta g t a i t at t
m ta at a ta a ag t t t at ti B
t i mat m ta it m mm i a i a t g a t atm t
a m t m ta at a i g ag t t t at ti t gt t
a t atm t ta a i i g a ga a am
a a a ig m ta i tt a imit i t t a t
i mi m ta i a
Surveillance and Research
i a i a a a i a i t ga at i mi g a i a t i ii
mi i t mm i a i a i a g am i t t t a im
t at a i ta i ga i gt t i a i t
a a t t a a i a it ta i a a
it t i m i a g a i ita t
a t i i i at g m it
imi a at a it i a ta mmi m g it ta a
ga i at a it i a at i t iti t i a ta
i a i i g a a i g i t g a g i ma
i i a
Nursing Capacity Development
a a a g am t i i t a a t a a
ai g amm a i g
Geriatric and Gender Based Violence
a ta i g iat i a i ig t a ita i i g g iat i i a

i i t ta i i g m i i t ita t i i g m i
a i a t t im i it a i i it
a m t a a a t a t B i i it t
a t i t a a B a i it t a a a t a B
i i a a i t a a ta i a ita Ba t ii
a ag m t t i t iti t a aim t i a i t g at
a ag i i g a i B t g a t m t at
t i i i i gt it a a t B i ii mai tai i g
a it a iii g t ig it ig t a i i at a m
g i i i g i t ita a a a a a
Ba t m t a a a a t i m i i
a m i a t atm t i g t m a t it i i g t ii
i a i ga a a i ita a a i a a a gi g
x iv DoHS, Annual Report 2075/76 (2018/19)
mma
i i a at t m
Bipanna Nagrik Aaushadi Upchar Programme
m i i i m ia at it i t i g
im i a i t t ati at i ii
m i a a t atm t t i a am a at i a a ma a
a a ma i a im i a a i a i a a mia
t t a t t it m a t ma ag
i t ii t atm t t im i i i m m t m
a t m a at i a i a ma i a
i a mia a ma a a m a i i a
a t i a a t t a t i m a t t
a m a t m im i a i a ti m
t ii t atm t t im i i i m
Fem ale Com m unity Health Volunteers
ma t ma mm it at t i m a
m t i a t ami a i g a t mm it a at i t m t
at a at a i m t a mm it it t m at
a at a ii t tt a a i ga t t
ti t ig i a t i t i ga i am iti a ta i
m a a a a t a i ga i gt m t i
t at a ii t i ia t m m t a i a g
i at m t g m g i a it t at iti t i
m a m i ta t i t i t i m ai t i
ta a t at a i t t imm i a agai t i i a
a a mm i a a t mm it a ma ag m t a t atm t a t
i at i a t ia a i a mm it ti g amm a
t i at a i
Inpatients/OPD services
a at i i t t a t i i g m g a t
a i a t i i g at i a t i i i t
ita i i g i at m i a g ita i g m a i at
ita t i a a t t ta a i t a t
i a t a mi ita i a a t i
m g i m ita
Health Training
a a a t ai i g t i t ta ma m ti a
at t a g a i t i at i a a ma ag ia a a it at
i i at a t i a it at a i t a a ai m t t
m m a t tat a a a t t ai i g t i at i ia
at ai i g t a ita a i i a t ai i g it t g tt t
DoHS, Annual Report 2075/76 (2018/19) x v

mma
Vector Borne Disease Research & Training
ima t B i a a a ai i g t i t t
g ga a g at i i i t t B i a B
t B t ai i g i ia iat i ia B a at
ai a a ma a ia mi i t ai i g t t a t i
g a i at it a t t i a t t g
t i g mi i mi g t aa a a ma i ma ia i a t m gi a
g t i aa t ita t a i a aa ai iti t a a i
ti t i a a
Health, Education, Information and Communication
a a at a ma a mm i a t i i at
m a i a i at i ma a m ag i gm m ia m t
a a t i i i a t ma a a i a a ai a at
i i it at a a
i a it i ii a t i a a a a
a g amm
a m at a im m t i i it t at i
a tai a
m tg a igita m ia a a i t a i i a a ia m ia a
i m g at a i i t a a mm i a a mm i a i a
a i a t m ta at it t ga a a i m ta
a ita ia a i a g mm i a a a a a i it ia m i i a
t g at t a mm i a a at
t t ta g t a i
at m a i a t m a t i g a t a a a a
ma gi a i a t g t g a g amm
Health Service Management
a ag m t i i i i i g a ma ag m t
im i i g it a t a i t i ma ma ag m t
a i g i a ii a t m it i g a a a at g amm
i ii i a i m it i g t a it ai at a t ta
m it t t a mai t a i at i t i i g a t t
mai t a m i a i m t a i a ig t t i i ii i i i g i
a a i g at t at i a t t a gi ma ag m t t a
t m a m t t ai i m t t t i i g
a at a it ga i g t mt m
at t ai a a t g g t it t
Logistics Management
mai gi a ag m t i t ti i i g a it at a i
i i g g am i i i a t t g gi a i m t
a i ami a i g mm i a at g t a gi a i t i t t a
at a ii ma i t at a t a iti t
at mm i i m t i t m t a ai i g mai tai i g t i m i a
i m t i t m t a ta ta i at a m t a
a a i itat i a gi i i ma i g a i i a i a a gi
a i g at a a i i i m g t a g at
x v i DoHS, Annual Report 2075/76 (2018/19)
mma
mm i a t im m ta t t m a maa t i m m
gi i g t ai i t it ta i ii
t g at a t ta a a i a a g
m ta ai at mm i a mat ia i t gi a iti t
Health Laboratory Services
a a i a t a at i t a t t a a it i i ga t
m t i a t a at t a iag at a at i t a
c ateg ori z ed as c entral, prov i nc i al, h os pi tals , P HC C s and Health pos ts
t a a i ai t ia i a at i it
i t a a i Bi mi t a mat g a a it g mm g i g
i i g
i g i t at g t g a mm it mi t t t a i t
i t i a a a im t t t t ai im m g a t mat g
t m it ma i t a at ma t m t mi imi ma t a a
ga i ai a i g i i g i a i a t a at i it
at t t g t a m i i ga g at a i at t a t a at
a a ta i t at i
Personnel Administration
mi i t a i i a g amm a mi i t a
t ma i ga i g at i t t ta at
ga i g at t t a a it i i ga a i t a ma ag m t
ma
Financial Management
a ia t t m i im a i t at i
ma ag m t
aa a a g t t m i m t g a g a
a i g a t mai a ia ma ag m t t t t im m ta
at g amm i a mi i t a i t a i t a ia ma ag -
m t a g amm t t ta a a B g t a m
a a at t at t i gt a a
t t ta at t g t a a at t
g am t a tm t at i
Monitoring and Evaluation
i a t i t g at at ma a ag m t t m
t
at a i i ma t a i ta at t iti t
t a i ii t a t iti t a ma i
t i a iti t a a a t ai i g t g amm
ma ag m t t im t i at
Eye care
a a g amm i a ta a g a i a am a
a g amm a i i a a at t t
DoHS, Annual Report 2075/76 (2018/19) x v ii
mma
m t a a a ita a t a t a i i i
t a t ta a m g i
Human Organ Transplant services
a a a a t t mai a t t gt a a ga t a a ta
i i ia i i ta a ta a g it ig a it a t a at
a i ta ig ma i i g t t t ai i g i
ai a t i t a t i a t t
a m t i a t a t a i a ma a i t
a t i t a t a tm t i t at a mi i a i ag
a m t imi a it a
mi g i a ma g i i t m i
ta a ta a at m t i m i ai ia i
a m i t i a a a a ig t a
a i t ia i i m i t i
Medico-legal Services
i ga i i i at g a t i i a i m i i a t i g
i t t mm a im i gm i ga i i a
g i i gt i at t i m i ga i t t ai i g i t i t m i a
a t at i a t i m i ga i i i g a ii
i i g i a m a a im i g i a t i ga g
a t i
im a m t g i m i ga a it i t a it
ta a aa m t a ai t ia i i t
i it i ig m a m t t a i itat t i m t t i
t t i m i ga i i g t i ia i t i t ai
Health Councils
i i a at i a i a i a i g i a
i i a i a at i a i a a ma i a a
at a i a it at at a t ai i g t a g at a
i
Health Insurance
at a g am i a ia it g am t m t a t at
aim t a it i t a t a it at a i mi imi i g a a ia
t m Bi i t a tt at i a g am i a t g g
g a ma im i ga m mai t at i a g am
i a ami a g am at i a g am i t am i ta t m
ai a i i t i t t ait a it i a t am a Bag g i t i t
t g am i im m t i iti t t t i t
t g am i im m t i iti t t t a t iti t a i i
i B i a i g t im m t t i g am a t t a
x v iii DoHS, Annual Report 2075/76 (2018/19)

mma
i i a i i a
i i t t ta
a a m m a a t i t at
i a g am at t m gt m a i t ai
ta at g ti i ai a m ti
Dev elopm ent Partners Support in health
m t at tt g m t at t mt g a t i a a
t t im m ta t a at t t at g
i t i a i g a g m t a ig ai at a
t g m t i i tai t a a g m t at a i g t
a at t i ga a g m ta aa a i g m a i m a i at a
ag t t g m ta t at i m t Ba a a at a
it mmitm t t g a g am t at i i agai t a i a t
t a i m t i t a a a i i g at t i
mmitm t agai t m i a ag it t i it at a a
DoHS, Annual Report 2075/76 (2018/19) x ix

a a at i
National Health Policy, 2019

1. Background
t a a ta i ai at a a a am t ig t it i
t t a m t a g a t m it i t i i it t tat t
t a a it at i a i a t t a m a t m
i a a at i a m at t ai t it i a
t a a tat a a a t t t
i i a g amm t m t a t i t a a mmitm t ma
a at i t m a t m a g a ai a a i i t
at t
2. Review
it t ta i m t i g a a a ai a a a i t t t t i
t atm t t m a i i at i a t a m t m m i a t m
ta t i a it t ta i m t Bi ita i a m ti t
at t ga it t ta t i i a i gi t a g t m at
a a i t i a t a g t m at a i
t i a a g i t a t a ia t a a at
i a i t t i i at t i a t i i ag m t
mmi at t i a a a t t a a a mi i t a it a ima at
t i a t a t ta i i t a ima at i t
t i ag i a m t t t a m ta a i a i m t
i at t t i ti t at t imi a t a a at i t
a i at ai at i i i it t i it t i t im t a
B g it t t a a ima at a ma ta i t g a
am aig ima at i a i t i i m m t a
a t tai a m t a i t a a mmitm t a ti t t t
m ta a i a at t m imi a a it mmitm t
t t g a am aig a i g a t a it ima at a i t a
ima at a t at t a i ta a a a ta i t t i
t a i m t ma ta
3. Current Situation
a a tat g m t a a ta t i i g ia i i i g at i
a t im m ta ai m i a t g t ta g m t a a
t ima at a t g tt t a t a t a t
a it i t a i i t iti t i t i a ma t a
i t a t im t i a it a t ta t t i at
t ita a t at i a a a a t i a a a i m it i g
a g a g t m ma i am t a at a a i g
it i t t it t i tm t i a i at t t i
agai a a it a m ta g a i t ma i t
a t a a it at i t g i t t i
x x DoHS, Annual Report 2075/76 (2018/19)

a a at i
i g i i t a i t i i t t i m a
a im t g it i a t t i a g at a i a m it t
iti a ma ag m t g imi a m ia i t atm t a i i
a gt at i g t i ga t a a t a g a a
a ta i i a t a a at i i a m t a
a i m t g i iag a a at i t t atm t
i gt a i at a i mat a a t ta
a t a ma a a i at imi a t ma at m i t at
a aa aa a ia i ma a ia t i m a i g g i t ia a a
ai ia a i at i t i a i g t a t m i it i
ai g i at a i t ma m a tai t im
mat a a t i a at
a g at i i a i i g i a ma i at i a
i i i a ia a a at a i a a i
i g a it a g a g ma at i a at
a ti a t g at i a ma t m m
it t i a i i a a a ta a t at a t atm t i
it i a t ma i a ta t t a a a at
i t ita a at i a a mi i a t m a ma t i it i
a t ma at i it g ti ag i a i t a a
ga i a t a a ta i t
imi a it i a t a at a i at it ag i t ta
g at i m ta a ai at
i a i t i i t a g i at a a i g i i a
i a t i im a t a it t m t t t t m it a g at t
t ag i t a g ai a ma g ma at
4. Problems, Challenges and Opportunities
4.1. Problems
ai m i m g a a ai i g a it at i at a i i a i it t
i t ta t a it at i a t t i a i it t
i a ma a ta t i at a i at t
m i tm t i t at i a ai a i it a m i m t a
ia i t i i at i t a at m at t
mm i a a mm i a i a ma t i a i t a iat a i a
i t mm i a i a a m ta at m g at m
g ai a a a g i a it a i t
t m i im a a t t a ma i
at i ma ita ia at m t mm mi a i it a at a
iat i a i t i i a mi ia i ta t i a iat
a i a a i mat a m ta it a a a at ti i m
t a t i i ag a m ag a a a a
at i it a g a t i at t i mm it at i

a a at i
4.2. Challenges
a g i at t i i g a a a i t a at t
i i g a it a i at i t g a a i i g at i it
i it t ta a a i i gt i g ig t t
it at a i gt i a ia ta i i g a a g
at i t i i it t a t m im m g at i a
i ma i g t at t i t a ma at ta mi g it m
t i ta t i i ta ma agi g i ma it a i
i at i a ia i i it i t at t mi g ia t g
i g at m a iat it imat a g a ia a a g i
i t ma agi g a g a gm i i a m i a t i a i gt
ata i m it i g a a i i ma i g a i i ma i g ma i g
t a t ma ag m t i ma t mm i t g at a t g i t
a t a i ga t mt t a at a a
g a t m a t mai tai g g a i a at a ti
t m a mi g a it at i a g a
4.3. Opportunities
i g t i i at t i ai g i ii i at i
am g t a tat a a a t t im m ta at i a
t g i i a a a at g amm tat a a g m t
i a i t a ai a i it i ma t gi g a i m t m t
i at t a i a i i a a a i at t t t
mm it t t at i i a g amm ma ag m t a a it
ta i i ma i g a i i ma i g a i i a at i
a t g m t
5. Relevance, Guiding Principles, Vision, Mission, Goal and Objectives
5.1. Relevance
t a i g m a a g a t t t a ig t
i t a it at i it i a t t am i g at i t at gi a
g amm a m at a a a at i i a a it t a t t ti
i i a t i g at i a t tai t i a i m t a a t
g i t m ta a i at i i at t a t a t t
gi ma at a i ii i i i a im a t a t a a a
i t a a mmitm t ma a a t a i t tai a m t a
i a g a i gt a i m t i i m m t a
5.2. Guiding Principles
t t a ig t i t at i t g a a at t m
a t i a a t a it at i t i i a m at t
ai t i gg i i g i i
a i a a t a ai a i it ta a a m i i
a it at i

a a at i
t a i m t a a a at i i at t mi a a
it t a t t
ia at i ta g t t t a ma gi a i a it a i ig mm i
at g a a a a a at a ia i tm t
i i a ita at i a
t t i gi t at i
g at a m t a i a a a a i a i i
i ai m t a a a t i i at i i
5.3. Vision
at a ta i i i t t a i
5.4. Mission
t am ta a t ig t i t g m ma
a a a at i
5.5. Goal
a a a at t m a i i t a t t a ia
a g g a a a t a ia a it at i
5.6. Objectives
at t i a i t t i t a ig t t at
a a im a t at t m a t a t t
im t a it at i i at i t a a t
a a t t i
t gt ia at t t m i t ga g t m t ma gi a i
m t m t a at i a a a t g m ta
g m ta a i at t a t m t mm it i m t a
ta mt at t m t i ta t i i ta
6. Policies
ai at i a m at i t a a i
ia i i a ma ai a i t g at i a
t ai m g at i a a i
at t m a t t im a a at a tat
a a a t a t t

a a at i
a a it t t i a at ag m a
a a i ita a a ia i a a a i a
i t g at ma
a a a at i am g g m ta g m ta a i at
t a m t ma ag a g at i t at t a i at
i t a a t a i tm t i at a i a a a
ag a t t
a at at ga a m at a a a i a
i t g at a
t ma at i a i a a ita i at ma
a a a a i gt t i a t ga
a a t t ma agi g a t i
t t at i a i a a a im t
ma at i i i i i a a i t a ta a
a ita
m a it g a t gi a a t mat ia a m t
a t i a a ia a t g g a a
ma ag m t i t t ag a iti
t g at a a m a a a t t m at
mm i a i a i t a a ima i a m at it
imat a g t i a i mi a iat
i i a ami i i a ag i a ma i
a t mm i a i a a i t g at at t m a
a a
t im ti a it a a t at a am a
i ag a m a a t a ita a at
a a
at a a ma i t a a ta a a t i g a a t
t a i i m a a i ga at t m
m t
at ma ag m t i ma t m a ma m a ita a
t g i a i t g at at i ma t m a
ig t t i ma at t at a ig t a ia t a t t
t atm t a
ta at a a a t at at i a a
a
a it at i i a at i t i i g ita a
i DoHS, Annual Report 2075/76 (2018/19)

a a at i
g a a im m t a i i at i t a a
ma ag ia t t i t at t t g m am m t
a a it t t at a t i at i a a
m t i at a a at a ta i i
a a a
a a ia a ia a a a g tai a
m t t at t
a ia i t a a t a mig a a ma ag a i at m
a iat it m a a
m ga i ta a ma ag a a a a t i t m it t
i ii a g amm ig i g
mi ia i ta a at i a a
a t t a ma ag m t mm i a i a i m ta
a ai a at a i a
g at a t
a a a g m t a ma t t i immig a i
at a t i at t t a ta i g a a
Strategies for each policy
Free basic health services shall be ensured from health institutions of all levels as specified
Ba i at i a i at i t t
g m t a a a a g a i ai at i t
t g t a tat a a g m t ma i a i a
i t t i a t it a i a
i a g m t
a i ga a i t a a a g m t a ma tat a a
g m t t ma ai at i
Specialized services shall be made easily accessible through health insurance
atm t i t at a ti i t ai at i a t gt
a i t g at i t t i a t m
Ba t i i ia a i i ta g t g a i
it t tat i i at i a t m
ma t a m i g t i t t at i a t m a
mat a i a t at i a t m
a t ia at i i t tat a ga a
DoHS, Annual Report 2075/76 (2018/19)

a a at i
Access to basic emergency health services shall be ensured for all citizens
i m g at i a g a i t g at i t
a i i g ai at i t a ima ita a a
t m a a a a g
ag g i a a i t i t mai ig a t a ma i t a
i t a ma a a imm iat t atm t i
t at am a it mi im m a i i a a a g a a a
am a i it i ta a a i a a m t gi a
a a g
Air ambulance shall be arranged with specified norms to rescue people from ultra-remote
areas with critical health conditions.
m g t atm t a a a g a m ii a i i t g i i
t ma t a it m g t atm t at a it t i t a a
ta a t ai i g t a t at a gi m
i t t ai i g
at t m a t t im a a at a tat
a a a t a t t
i g t t t at t a am a t a a
t t a ta i i i g a a i a t t i a
t i mi t a a
a ga a i t a a a g m t a ma t t gt t at
t mi i it t a t t
ita a at i t at i a ma at t a tat
a a a a a i a a it t m ga i
iti g g a i it a a Ba i at i t a
ta i a a t a ima ita a a
a ita a i ia ita t tat a ia i
ita t a a ta i imi a at a t t a ita
a at i a a m i a tat t a g m t a
ta i
a a t m m mm it t t ia i i i
a im m t t ma t t atm t i m t ma
at a i t ai a m t gi a m i at
t m i i a a a g at at i at
a m i a i a at t m a igita i
iag i a ma m a t g i a t a a
i a t a at a t gt t t i t a a ta a
a at a a iag t a ta i i a tat
a a at i
tim t a it at i i a g m ta
g m ta mm it a i at at i t a at i a t t
m t ta a a mi im m i ta a a im m t imi a
i ta a g m ta mm it a i at at i t a
a g a a im m t
at i a a t g m ta a g m ta t a
mm it a i a a m t a ta i i a
i t a a a t a tat a ima ita
it i i at at i a t g t a ai a i it a
a at it m a
ma ga ta a t ga a i a ga a ai a
a ma ag a a
i ga i a a a t a tat a ima ita
m at i at i a at i i ai
i t a ma ag a g at
a t m t g a m i t ma at i
a ita a t
In accordance with the concept of universal health coverage, promotional, preventive,

curative, rehabilitative and palliative services shall be developed and expanded in an
integrated manner
i i it t t m at a at i t a m t
t g at a a g amm
i a it t a t at g amm a at a a
am aig a ga a a t ig a i g t a ai a i it
at a t at i a
t m a a i a i a a t i g a i a
a t ig t ta g t g t i a i a a a
m a i a a im m t
t m t i at aa am g ai a g g a
at a a a g
i a a ita a t at i a it i it t
a ai ag g g a a gi
i at a g m ta ga i a a m t t ta i a i ita
a a ia i t it i t a i at a tat a a
t a a at a a i t a a ga
i mi a at at m ag a mat ia a ma i ma ag
a g at
DoHS, Annual Report 2075/76 (2018/19) ii
a a at i
i a t m a im m t i m t a ita i i g at
a it m t i i a it ta
ta a m a im a i ma at i a t im a t a m t
i i ti i t a t mi t i ta
mi imi t i a t i at
t a ia t mi a t at m t a at i a
a am g a i tat m a i m a ma m i
i i m t t i t at i i a a a ag a
a at
Collaboration and partnerships among governmental, non-governmental and private

sectors shall be promoted, managed and regulated in the health sector and private,
internal and external investments in health education, services and researches shall be
encouraged and protected
at i it i at a g m ta ga i a a a
i a am t t a t a t atm t a i i ta g t g a
a a
i ai m i t i t i a i a a ia t
i at t a i t m ta a i at i a
ia i i it a a m t
a am t a a ita a a a a a g m ta
g m
i at ta t imi a i at ita a ag t
ti t at ma a a i a mm i g a t m
ita a at i t t i i a ma ma at a
m it i g a g a a ti a
t a a it at i t a a t mi
i g t a i a ii t atm ta at i i a
a t ita a at i t
at t im a m t i g ia i a ia i at
i a t g at i t t g m ta i at a
g m ta t
t imi at i a m t a ma at t a
m ii a ma ag t g a
Ayurveda, naturopathy, Yoga and homeopathy shall be developed and expanded in an

integrated way
i it t a t t i i t at it i at a
a t ma a a a
t at a t m a ga a at at m at a i a t
a a a a t a t t
iii DoHS, Annual Report 2075/76 (2018/19)

a a at i
a a ai a m i i a mi a a a ima ta a i
t a m t it m a i i a
i at a a ia a m t
i ga ta i a at a t m a it ma ag a g at a
i a am t
a a a ga a a a a ma t it ia i i a
a a a a ma ga a at at a ta i t t at
t i ma i i a a ga a a a t a t t
a at i a a m a a i it a ta i a t i
t atm t a a a a i t a i a at at
t m
In order to make health services accessible, effective and qualitative, skilled health
human resources shall be developed and expanded according to the size of population,
topography and federal structure, hence managing health services
a at ma a tai a i a
tt ma gt m a t a t t
a a it ag i i t g at a a i m a
t a at ma at a
t t at i a at i t i i a t
a
at i a ta i g m t at i t a ga a
im m t i a g m t at i t t ma it m a t
a a t at i t ita i a im m t i
g m t ita it a ia a t i
t a ai a i it ai at i i a ai at t at a a
i t g at t atm t i a im m t i a i ima t atm t
m g i ima a i a t ai i
t a a t a at a a a g m g
t atm t a a ma i ga i at i a a ai at t ima
ita a a
a at a a t i t i a g t at ma
t g ig a i i t ai i g i a t ai i g i a
m t a ti a a i a a a ag a
m t
a g m t a ma t ia i ma i
t m a g a it at i g mi i ita ma ag m t
m i a a i at mi t
m aa t a m at a im m t t m ta a i
at i a a mi t t a i g iti t a im m t
t g tt t
a a at i
ma t g i m ta at i t a ma
a a t a mai tai a at
Structures of Health Professional Councils shall be developed, expanded and improved to

make health services provided by individuals and institutions effective, accountable and
qualitative
i t g at m aa t at at i a i a im m t
a a t t tat
t a a t i a a a it at at i a i a
t a t ma t i i i a a
a ta t t at ia i
ma a a a i a a a g t ma t at i a
i t t i a i
Domestic production of quality drugs and technological health materials shall be

promoted and their access and proper utilisation shall be ensured through regulation and
management of efficient production, supply, storage and distribution
a im a a t a t t t t mi i a a it
g i m ta t gi a a t mat ia a t g at t m i
i a ita a ma i it i t i ia a im m t
a a a g a t gi a at mat ia a
ag a ia a i a
i i a it m ma ag m t i i i a t at t a at
i it a t i it ia m t at t tat a t it
i a g a it a i t i a a ta a m a
a im t g a m i a i a a t t i
a it
m t ta ta a it t ag a iti t m a ma m
a t ma ai g i a g a m i a i
i i a ta a a t i a i m i i i m t
m i a i a t mi t a a a a a a g m t
g m ta i at
a a m i a i a a t t a a ma t ma ag
im ta t g
i a a a a t gt t a a mi ia i ta a
a t m a a a i i i a it i t ag i t
a t
g a a ti a t a it i m i i a
a t
x x x DoHS, Annual Report 2075/76 (2018/19)
a a at i
Integrated preparedness and response measures shall be adopted to combat
communicable diseases, insect-borne and animal-borne diseases, problems related with
climate change, other diseases, epidemics and disasters
g amm a im m t t a i a
t imi a a a i a mm i a i a i i gt i
a ma a ia
a t m a i i a a a im m t
a a it a m a i m a at a tat a a t ga a
t imi at a a i at i a a t t a a at g a
i m ta at i t gi a ag tat a a
a ma i ma ag m t g a a m it i g
at a m i a ga ag ita at i t a a at i
i a a a a a t m t m a mm it a t ma
ag m ta i m t a i
g amm t mi imi imat a g i at m a i a

i a a a i a it ta
a im a t at a t imm iat a iat a i mi

t i a a it m t a a a m i ita i
a a a g
i a mm it a i a a ti i a at i i i gi
i a t ma ag m t i a at m a ag
Individuals, families, societies and concerned agencies shall be made responsible for
prevention and control of non-communicable diseases and integrated health system shall
be developed and expanded
g amm t m t at i t a a t t g at
i t a
t a i a it i t at it i i g at i m ta
a i it a a a t gt t m t at
t a at i a im m t a a ta a a
a im m t t a t a i a m t i
a t ma a a at
t m a t ta t at ita i a
a a ma it m t at a am t ma at a
i ag a aa mi a i a t a i g t
t ag i ga a a t a g at
m a g g a a a i ag t g m t a
a a at i
i a a a a a t a t a g at
m a g amm a t t a a a g m t a im m t t t
a a i t a t iat ig t i g t i t
i a a a a it ta a t
a i a t t m t at i t a t a t
i m ta a m t i at
In order to improve nutritional situation, adulterated and harmful foods shall be

discouraged and promotion, production, use and access to qualitative and healthy foods
shall be expanded
t a ti i a g amm i i g it a at
a im m t it i it
t im mi t i t it a m i a i t ag
g i i a a aa i t a m ai a tt m
m i m t ma g t mm a at a a a t
at g amm a ti a g amm a t gt
a im m t
m ti a at it m a m t a m
a ag
Health researches shall be made of international standards and the findings and facts of
such reports shall be effectively used in policy formulation, planning and health system
development
t a t t a a it a a at a i a
at a a t a t t a ma a i t a a
ta a
a a it a a i at a a at a a
t i a ma a m at t a i i a it a a mi
a a a i t
t at a t a t a a i t g at a
t a t t a i a i m a i i a a a
at t m m ta a i
B g i i ig m i i a mi a a ima ta
a a ta i a at a a a a t t a
m t a i t t a t
The health management information system shall be made modern, qualitative and
technology-friendly and integrated health information system shall be developed
a t ma ag m t i ma t m a a a t t a
a ma ag i a i t g at ma
a a at i
a t ma ag m t i ma t m a ma i t g at t g i
t m a a g a a a a it a a a t t
i ma
a t a i
ma tai m at ma ag m t i ma t m
a a i a a i m it i g a a i
m a g amm m ta ii ma i g at a i
it at i ma a a at i ma ia i a
mai tai i i g t m
i g i a t mi t at t a t gt a a i t g at
i a t m a a im m t
Right to information related to health and right of a beneficiary to know about the
treatment shall be ensured
i i a ma i i at i ma at
i t a a i ma i a t ig t ia i t
i m t i a a i ma a
mm i a mat ia t at ma i t i i t a a t
at a i t a i ag a g at
Mental health, oral, eye, ENT (ear, nose and throat) health services shall be developed
and expanded
ima t atm t a i t g at i t ai at i
at i a a a it i i at at i a
a at it a t i t a i it at i a
at i a g a
a at i a t a t atm t ta i a a a
a at a i i g ai at t
a t at t atm t i a a a t a
a t m ta at a ia i a t g
ima ita m gt a g a i i i t i a
ia t ai i g
t ia i at i a a a a
Quality of health services provided by all health institutions including hospitals shall be
ensured
t a it at i a g at m a im a ita t
a ta i a at t a
i im m i ta a at i t a a a
a a at i
im m t a a am m t
i i a it ta a a ta a t atm t t atm t t a
a am t ii a it at i
a it t g g i i a t mat ia i i g a i m i i m i a
i m t i gi a ag t a at t m t iti a
at a im m t
i a a ma ag ia a it at i t a a i ta t a it
i a i t a a a it a t gt
a ta a ma ag m t at i t at a ia a
a a im m t
Good governance and improvement shall be ensured in policy-related, institutional and

managerial structures in the health sector through timely amendments
at g a a a im m t t ma at
i ta a t a ta a i
a m a im a a t a gi a m ai t a
gg ia i
ii i g a a am a im m t t it at
i i i gi i i a a i t
t g at m it i g a a a am a at a
im m t t a t at i a ma ag m t at i t a
i a i ga ia a it a a a g a tt at i i a
at i t
t a a a it a im ma ag m t at i at a
i mm it t t at i a ma ia i a
m ig t a
In accordance with the concept of health across the lifecycle, health services around safe
motherhood, child health, adolescence and reproductive health, adult and senior citizen
shall be developed and expanded
a m t a at i a ma g a it
a a a a i
at i
ta g t t a
ag g a mat a i a t a t i
at a t at a t
at a g iat i at a t gt a
i a mi i a i g i a a

a a at i
i ia t mi a t t at a t m at ia g amm a
im m t i i a it ta
t t gt a m t a at i it a a t
a a a g i a a
i a ma a ita a a t a
at i at it i it a ga a t t t tat
Necessary financial resources and special fund shall be arranged for sustainable
development of the health sector
t g at at a t at g a m at a im m t t
ita a a t at i t t t it at a
t m ii a ia i t at t i a t ma
tat it at a ga a i a a t it
i i i a a
a a at a t it a a a tai a i m it iti
a i t at t a a a i a i t
aa i i g amm a a
a im m g at mt a a a t a i
i at m g amm
mi t i mi t a a m t at a m ii
a t i it a it a i a i a
a i it at a a a g a ia m t a a ma gi a i
mm i tat a a g m t a a m am t i t a t
t a i i a i t g at ai at m i i
Urbanisation, internal and external migration shall be managed and public health
problems associated with such phenomena shall be resolved
m ga i i ma a a a t a a a m t t
m at t a t g amm
t mt ami t a at a a i it t ita
gi t a t m
t a a i t a mig a a a ia a ma ag a t
mi imi t t m ai i at a a t
i i a a a im m t t at it i g i g
ig m m t
Demographic statistics shall be managed, researched and analysed to link them with the
policy decisions and programme designing
a a at i
t a m ga i ata it ag iti a at t g t a
at i t a ta g t at g amm a ig ag i
g
Ba t t at a t i m ga i ata ma ag m t
a a a a a t i it t ii ma i g a
g amm ig i g
t a a i a a it i a i it t at i
i a i it i t t a m a im a at a
i a a ma it ag i t ta i i i a t
it i i at at i
Antimicrobial resistance shall be reduced, one-door health policy shall be developed and
expanded for the control and management of communicable diseases, environmental
pollution such as air pollution, sound pollution and water pollution shall be scientifically
regulated and controlled
t i a a g amm a a im m t i
at i it a t i t mi imi a t i m ta
i i g ai at a mi a
i at
a a a a im m t t g at a t
a a t a
t a mi ia i ta a a a a a
im m t t g at a t t mi a i
Necessary arrangements shall be made to reduce the risks of immigration process

on public health and to provide health protection to Nepalese staying abroad.
a a a g m t a ma t at i a t a
t t at t m t a t a at i
a m a im a a a t m t a
a t a at i a a a
at ami a ig a a t i g a a ma m
ig a at a ag m t ma t m a a im m t t
ma ag t mig a at i ma
7. Institutional Arrangement
i ga a g m t a ma t im m ta t i a a at i
i i a mai a a g i i g i t tat a a g m t t
t i i i it i t i ma at a at a i a
i
a a at i
im m ta t i i t t t t at i t i
a tat a a a t at at i t a i
im i a m t i ag i ii a t t
t g a ta a g i i a t a a
im m t a ii t i i
t a a a it a t gt a g a ta t a t
a t t
i g t m i i i i t at t a a am a
t ma m i t at gi a
tat a a a a a t t i a t i
a a at i
tai a a t i i a a a im m t
8. Financial Resources
m t g ta at a tat a a ig a a ga t i tm t
m i at a g m ta t a t a ia t im m t t i i
9. Monitoring and Evaluation
iat m a i m a ma ag a i t g a m it a a at
t at g amm im m t at a i t tat
t a m it i g a a a am a t a a
a i g mmi i a t m it i g a a a t m t i it
a ai a a mi i t a a ta i t a t i i ga
m it i g a a a t m t i i
a t ma ag m t i ma t m a at m it i g a a a
t m a ma ai a g a it t t i t m
10. Risks
t g t i a a at i a m at a t
t t at g a a t ai at i a i a a am ta ig t a
t i a g amm t m t a t at ii ita a t
a it at i t g t a t t a ai a i it a at g t ma
i t i t im m ta t i i a t at gi
at i ma a t t m i a iat it t m t
at i at t ga i a a m a t ma ag m t at ma
11. Repeal and Saving
a a at i a a i gt m i i i at t
a a t ma t at gi a m at
DoHS, Annual Report 2075/76 (2018/19) ii
Sum m ary of N epal Health Sec tor Strateg y 2015- 2020
Sum m ary of Nepal Health Sector Strategy 2015- 2020
t a i a a at i a at t t at g
i t ima i t m t t g i t at t t t a ta t t ii a
mi i t t t a a at i a a i t t t a ii
t g aa t a t ai at i a a am ta ig t i ta at
a mmitm t t a a i i g i a at ag a i t ai
ga i g i a i tm t a a t at t t
a i mi m t tg i t at t i ai i g g m t
i i t g a at a m at t t i m i g t
i it i t t t t i a a it at i a a
t at m ti a a i t t g m ta
it m t at B t t g m ta m t at mmit t a ig t i
t t i i a a i t a ta t a i t t a a
m t a a a t a ia t mi a t at t att a a
a ma ta g im i gt a at t m t i B t t
i a a im i m ta it a i a t
m ta it imi a a a a t mat a m ta it t t
i a i gt i i i i t a a i a a i i at
imi a tag i a t a ma t at a t t
t i a ma a ia m aa g a ma i i g ata
m ta it a ma t i
it t i g t t a ma at a g i i gi it a i
t a a ia i t a g ga i a a i t a a i i a i g at
i it t t g i a it t m a a ma gi a i
i i t i a t t i at a i g t g m t a i t
ia g amm a i a at a g amm a a i i
m t i it i at t at a t g m t a m ai
im i g a t at a i a i g at a ii a t gt i g
mm it a i t t i a t at a i a im i gt
a it at a mai a ma a g a i a at i i gt
a i a ia i a i g a g i i g i a a at a i a t i
at m i t a t a g i mm i a i a t
m t i a g i g a mm i a i a a a
i a i g t at at a i a t t imat a g i i t a i ai g m
at a i i t a a i t
a ta g a t a i a t a t i at
a ii i g a t t a mai t a t at a ii i a t
a g i a a t g t m g a a ma ag m t
t t t i i m t a a ma t a g t a
t t m a a m gi g a t a g i a t t i g i i
it t ai t t t a ii t t a ita iti
at a ii it t g ga a a at m t at tai m t
at t m t t gt i g t im t at t m t i
DoHS, Annual Report 2075/76 (2018/19) x x x v iii

tai t a i m t ma i t at t a a t a m a g
ta t at gi i i
ita a t at i
a it at i
at t m m
t a a a
tt at gi i i ii ita i ia t gt i g
i i a ma g a t a i i gt a
a g at at i it a i t a mm it g t m
m m t t a a a g a i i t i t
im i g t a it a at i t i i a a t a a
at i a a t m a ita i ta i i g i
a it a a at i i i a i at t m ai
t gt i g a a m gt i ta a i t ag m
t gi at i ma ma ag m t i a a t at i
ma ag m t m ta ai a m a i t t
at a ii
t gt t ai a a i ga g g i i t im m ta t
a a am t gt i g a at a i a a a
tat a tat at i i i gm t a ia a t i t t i
a i at t tt am m aim t t gt i t a a a it t
g at i a i at at t m
g i t im ta m t a a t a ia t mi a t at
i t t i t t a i g i at a g i g a g m
m ai m i t ai a g m t a a a t
t a m g at i t a at i m tt g
m t a a i i g ii g g a a ta g i t t m t at
i t agi g a t a i i a a a i g i m t at i t a a i
ta i g ma t i a m gt m at i gt ii g
at a i i t g a ta a i t a m g at i m ti i g
t imat a g at at i
ti t a t g a t im at tat a t g a ta a
ita at i i t m at t i g i t m t a i
t i g a
it a t gt at t m at t ma ag m t m ta
ai ma ag m t
m a it a at i t i
ita ia at a i
t gt t ai a i ga g g
m t ma ag m t a g a
m tai a i it at t a i g
m at i t a i m t
t gt ma ag m t i at m g i
x x x ix DoHS, Annual Report 2075/76 (2018/19)

m a ai a i it a i i i i ma i g at a
t m t a a tt a i i a a g m t t a
Ba i at i i i i ag t t i a t Ba i
a t a ag i t at a t ai at a ag a i t g
i t ia a t t a a g m t i i g at i a
g m t i a t a ia a i t ga t im m t t i
t at g m t a i g i t t im m ta t i
t at g m it i t a i a t t a t g m t i
a i t t ii Ba i at i mg m t i i
a g i t m t a i t a i a m ii
t a t ga
m ta m a a t a a a B g t B i
t a at t i t a i a t im m ta m it i g a a a
t i t at g it a i a i mi i t i m t at g m ta
ag i i i i t i at t a a a mm i t
am i t a i t m it t t ma t g a a i a a i
m i

Chapter 1
t
INTRODUCTION
1.1 Background
t a a a m at a am ta ig t t i
t i t t a at ii at a i ma a t at
a a a t at a a a t a i i g at a a ita t m it
a m ai ig t t i ma a ma i i t t i i t tt
i a t i a i i m t at a tm t
mit a a t i it t t a a a t a tm t
at i a i t i a t a a i
i t t t it i a it i t t i a ta t t i g
i it at a a
i t ma i a t t t ti i g
a a
g amm i tat m t i i gg a t at gi ma a i a
a i m t
g amm i i at
m i t ai t a mm a im i g ma a
a i i g ta g t
i ta i i ma t ti t a tm t aa
t a i i a tm t g mi i t a t at i
at a ta t m a i i t at t a a t g
ma g amm im m t a t i t at i i ia at
a at a ii
i ti a i a t t t a a a i t at a at
B B a ta iti t m a g i t t t m
a a i m t mi i t a tm t at i t at i ii
t a ta ita a ta t a m t
at a g m ta ga i a a
a i a t i t i tat m t a g amm a a a ata

g at t t g at at a ag m t ma t m a m t
t i i at ata i t t i g t t i a g am
ta a a i i
The objectives of National Annual Review Workshop were:
i t i t a a g a at t t at g
a ata a a ta i g g i t t
t t at gi i it a a t at t a t t gt at t mi
t a gi g t t
g t t at gi a t i i t t a a a a B g t
B
DoHS, Annual Report 2075/76 (2018/19) 1
 Ag ree on th e s trateg i c ac ti ons to b e i nc lud ed i n th e nex t y ear' s Annual W ork P lan and B ud g et
(AW P B ).
T h eM oHP prov i d es g ui d anc e to DoHS as w ell as prov i nc i al- and loc al- lev el g ov ernm ents to d eli v er
prom oti onal, prev enti v e, d i ag nos ti c , c urati v e, and palli ati v e h ealth c are s erv i c es and c arri es out related
poli c y , planni
t ng , h um an res ourc e, f i nanc i al m anag em ent and m oni tori ng and ev aluati on f unc ti ons . I n
new ly res truc tured M i oHPg org i a an tg ram , ai t h as af i v e d ii v i ia s i ons
a : T h ae P oli c gy , P lanni
m tng t & M i oni tori ng Di v i s i on;
th eHealth mC oord a i nati on Di v i iag s i on; th e aQ ualiaty As a ia s uranc ea t & a Reg ulati i on a Diav i is i on; t th e P opulati on
at i a i g ma a ia ma ag m t a m it i g a a a
M anag em ent Di v i s i on and tth et Ad m i ni s tratigaongDiam v i s iti on.a I n ad d i i iti ion, th e s i x i prof aes s i i onal
g c ounc i ls : N epal
M ed i c al C ouncit i i l,g N i epal
ii Nt urs i nga t C ounci i al, N epal
i i i Ay urvt ed ai c it M ed i c aal C ouncg i l,a N epal i i iHealth P rof es s i onal
t a a ag m t i i i a t mi i t a i ii a i t i
C ounc i l, N epali P ah arm aci y C ounc a
i l and
i a
N epali Health a
Resi earc
g
h C i ounc ai l) ac c red i i t h ealth i a
- related s c h ools
and trai ni ng c i entresa anda treg ulatei c are a prov i i d ers a. a ma i a a at a
i a it at at a t ai i g t a g at a i
Departm ent of Health Serv i c es (DoHS), th e Departm ent of Ay urv ed a and Alternati v e M ed i c i ne (DoAA)
a tm t
and th e Departm ent ofa tDrug Ad i
m i ni s tratit on (DDA)a tm t
c om e und era aM oHP t . T ah es e th ree i i
d epartm ents are
a t a tm t g mi i t a m t
res pons i b lea tmf or tf orm
a ulati ng i and i m mplem a genti
a ngim prog m ram g m esg, ammth e ust e of f i nanc a ia i al res ourc es and
ac c ountab i li ty , anda m a oni tori
ta ingit and
a m ev aluati
it i gon. a DDA a i as th e reg iulatory
t g auth
at oria ty t f or
it as s uri ng th e q uali ty
and reg aulati ingg t th e ai m it port,
a exg port,
a g t prod im uc tit on, s tale and d i s tria b auti oni t ofi d rug s . T gh e Departm ent of
Ay urv ed a and Alternati v e M ed i c i ne i s res pons i b le to c are w i ith Ayt urva ed i itc s erv i c es i and i m plem ents
a tm t a a t a i i i
i a im m t at m a a i ig
h ealth prom oti onal ac ti v i ti es (F i g ure1. 1).
Figure
Figure 1.1 1.1 Organogram
Organogram of Ministry
of Minis try ofofHealth
Health and andPopulation
Population (MoHP)
( MoHP)

B ud g et
o d eli v er
t related
ti ons . I n t
Di v i s i on; 1.2 Department of Health Services (DoHS)
pulati on
i gt t t t t ga g am ig a i at t m
: N epal a t i g t t at a a g a t m i a a ia
es s i onal ma ag m t a a at a ma a mm i a t
a a at ai i g t a a t a t
s c h ools a a i t a a i at a at
i at a t ai i g g amm t i ii a im m t t ai i g a i g mm
i t a i g t ta i g m a i i ma a a
e (DoAA) mm i a a a i a g mm i a B a i a i at
t tt i a at a i a i
ents are i a it t i ii
es and
e q uali ty i i i i g m iag a a at
i i t g a i t ga i a a a a i ii ma
ent of
i ii t i ii a mma i i a a ig
plem ents
Table 1.1: Summary responsibilities area of DoHS s five divisions
Division Areas of responsibility

t g at at ma a ag m t
1 a ag m t i ii at t m t i m ta at a
gi a ag m t
a g amm mm i a ti
a t g at a ag m t i
ami a i ii a a at a i i g
a t a ata at a ami
a i g
t a
a ag m t t i
mi a mi
a mi i a g t i a i a
t B i a a t
3 i mi g a i a mm i a i a mm i a i a
t i ii ta at t i a i it
i a a a i ga g
t m at a it a a
a i
ita i m it i g a t gt i g
a i i ii i i g m g a ai at a
a at
i ga ia it a a it i i g i g i a ia it
i ii iat i a g a i

t
Figure 1.2: Organogram of the Departm ent of Health Serv ices ( DoHS)
Figure 1.2: Organogram of the Departm ent of Health Serv ices ( DoHS)
Figure 1.3: Organogram of the health s y s tem at prov ince L ev el

Figure 1.3: Organogram of the health s y s tem at prov ince L ev el

t
DoHS s main functions are as follows:
i t m t a m a g at at i i a i g
a a i g at i t i i it t i i
t mi t i ma at i t a i gt m
a i g a im m g ta gt m a
a ag t m ta g i m t i t m t a t gi at
gi a i t i t a
i at a i a m ii t im m ta a
g amm
a ag t imm iat m a i i g m at a i a t a i mi
ta i a it ig ti a i t a a i t t a a
at i a a it i i i g a m ii i g ig
i i ga a a
ag t i at t a g
m t a ig i t t a i at i at i mai tai a a
i a a t t a it at i g a ii a
m it i g
a ag m i a a t atm t i a a at i a
im a i i a a i i i a i i a ai a i
a a miaa i ia i i a a t a i atm t im i
i
a ag i ma t m at t at a ii at i gi t ai i g
a a t tt a i g m it i g a a a at g amm
ai tai ata tat m t a i ma at i at i a
a t
a ia ma ag m t a t m t i g ai
i ia a t i t at i t i a a t i ga g amm m it i g
t iti t at t m a m i t i it ia m t i
gi a gi a a ita a iti t ita a a t at g i i t t
ita ima a a a a a t ai i g t a at i B
t a m i a t at t i ia
t m a i t a i t ta i at i iti t i a
i ia a t i t at ima at a t a a t ga
i t ima ita i i a a t it at t a t at a
i t a g t t t ai mm it at it a a at
i i a i g a i
at t a t ti t a ta t i t ai at i t
at a ii m it t a i ma mm it at t a t
mm it a a i ima at a t a i i a a
g amm mm i a i i a i t a t a t a
a mm it a a i a a i i a a
t at t i a a i ti a t m t ima a a
ita a a t t a ita i i a i ig t t at m t
t a a i i a t a mi t atm t i a i a t
t m a a gm a i m i i g gi a a ia m it
i a t i a t mt t t t i

t
1.3 Sources of Information and Data Analysis
t g at at ma a ag m t t m i t mai
i ma t i t ta i ma m t ma ag m t i ma
t m i a i a t m ita gi t a g
a i a m t a a mai at t i t t
gi a ag m t ma t m t i a ia a ag m t ma t m
t at a t t ma t m t a i g a a ag m t
t i at a t m t ma ma t m t
ai i g ma a ag m t t m t a g t m a t
g ma t
ata a a mt a a a a a ai t
i ii a t i a i gg mat ai a a a t
a a t
1.4 Structure of the Report
i t a a t a t t a g t a a t aa t
t t a i ma a at t a t g
agai t a at t t at g a t t t a tm t a
g a t t i t at a at a t
g amm a t t t g amm t at t i a t
t t g a a at i a i a t gi tai t at
t t a m t at a ti i t at t
a it t ata i a ta t m t g at at ma a ag m t t m
ata t a t g t m i a ti
a t m a a a a i i ta t ata i
t t i t ti m a
Annex 1 t t ta g t a i m t a a g amm ma
a i i gi t ma g amm ta g t t t a a t
t at a t i t at a a a a a ata a t
i at i t i t ma it a a a t t t i i a ata
a m i i ai a a i t it g

Chapter 2
g gai t
PROGRESS AGAINST
NHSS
C h apter 2
i m i t a at t t at g a a i ti
ag i t ta t t g i a t i a i g
m t i it at a a PROGRESS iAGAINST a NHSS
t a
i i a t at t i i i gt i gt
i aTb h y eaat
M i d - T erm Rev i ew (M T R) of th e N epal Health Sec tor Strateg y (N HSS) w as c arri ed out i n 2018/19
a a i i a m a i at t i ia a a
g roup of i nd epend ent c ons ultants und er th e g ui d anc e of th e T ec h ni c al W ork i ng G roup (T W G )
a
i af orm aed a b ity th e aM i niis try of Health
a a and iaP opulati
a on i(M oHPm ). T h tae revmi ewa tas s es s ed mth e trelev anc e,
ef f i c i enc y , ef f ec ti v enes s of N HSS i n relati on to h ealth s ec tor pri ori ti es us i ng th e f ollow i ng tools :
C ri ti c al P ath w ay Analy s i s (C P A); P oli ti c al E c onom y Analy s i s (P E A) at th e P rov i nc i al and L oc al lev els ; a
MajorC riFindings
ti c al C apac i ty Analy s i s (C C A) and a Soc i al and E nv i ronm ental I m pac t As s es s m ent (SE I A).
Maj or Findings
a M aj or if i ndg i nga s are ga i s ed aac c ord iing gtot th te N HSS outc om t es m
org ani a s uma m
and are ari s mma i .
ed b elow
S. N . O utc om e P rog res s G ap and P ri ori ti es

1 Reb ui ld and Streng th en Health
Sy s tem s • N epal Health I nf ras truc ture • I ns ti tuti onal s truc ture
• I nf ras truc ture Stand ard h as b een d ev eloped . and f unc ti on i n f ed eral
• Hum an Res ourc e f or Health • P repari ng Hum an Res ourc e f or c ontex t to b e f urth er
• P roc urem ent and Supply C h ai n Health Strateg i c Road m ap c lari f i ed .
M anag em ent • Draf ted Stand ard B i d d i ng • L ev el of ab s enteei s m i n
d oc um ent of th e h ealth s ec tor h ealth c are prov i d ers to
proc urem ent b e ad d res s ed .
• Delay s on proc urem ent
to b e ad d res s ed
2 • I m prov ed q uali ty of c are at • P repared N epal P ub li c Health • Roles b etw een q uali ty
poi nt of s erv i c e d eli v ery Ac t g ov ernanc e s truc tures
• P repared Saf e M oth erh ood and v ari ous autonom ous
and Reprod uc ti v e Health Ri g h t enti ti es to b e c lari f i ed .
Ac t. • P rac ti c e of analy z i ng
• Draf ted N ati onal ac ti on plan routi ne d ata to m eas ure
f or anti - m i c rob i al res i s tanc e q uali ty of c are to b e
and th e d rug poli c y 2074 i ns ti tuti onali z ed .
• Reporti ng li nk ag e
b etw een d i f f erent lev el
of g ov ernm ent s truc ture
to b e s treng th ened .
3 • E q ui tab le d i s tri b uti on and • Health c are uti li z ati on am ong • Serv i c e P rov i s i on i n
uti li z ati on of th e h ealth th e poores t q ui nti le h as b een rem ote areas to b e
s erv i c es i m prov ed . (E . g . C aes arean ex pand ed .
Sec ti on rate) • Ali g nm ent b etw een
• Ac c es s to reac h h ealth f ac i li ty h ealth i ns uranc e and
h as b een i m prov ed (E . g to m e f ree h ealth c are prog ram
to reac h h ealth f ac i li ty ) to b e s treng th ened .
• Dratted th e B as i c Health C are • N eg lec ted h ealth
P ac k ag e prob lem (e. g d i s ab i li ty ,
• Eg ui nd d ors
eli ne
ed f thoreI MN ati
N C onal
I • mA ental s trategh ealth y on h s ealtherv i c es ,
• Strateg
E nd ors ed y on ten reac h i ngac tith on
y ear e plan ad eq oles ui ty c b ent
as eds exon ual
locandal
unreacon Di s abh edi li ty. prev enti on and reprod
c ontex tucto ti v b ee h ealth ) to
• Erehnd aborsi liedtatirem on ote
(2073area - 2083 ) bs treng e h i g h th li ened
g h ted . .
4 • Streng th eni ng Dec entrali z ed • E nh anc ed c apac i ty of b ud g et • P lanni ng and B ud g eti ng
P lanni ng and B ud g eti ng and b ud g eti ng as per new i ns ti tuti onal
• Dev eloped P lanni ng and s truc ture to b e rev i ew ed
B ud g eti ng g ui d eli ne and upd ated .
• I m plem ented b ud g et planni ng • C ond i ti onal g rants need
as per loc al g ov ernm ent to c ov er pri ori ty
operati on ac t. prog ram m ati c need s .
• P rac ti c ed planni ng and • E v i d enc e b as ed planni ng
b ud g eti ng b as ed on f ed eral and b ud g eti ng s h ould b e
c ontex t. s treng th ened i n all th ree
s ph ere g ov ernm ent.
5 • Sec tor M anag em ent and • Dev eloped d i f f erent h ealth • Ac c ountab i li ty of loc al
G ov ernanc e s ec tor g ui d eli ne. lev el to prov i nc es need
• Roles of prov i nc es and loc al to b e c lari f i ed and
lev el b ei ng f urth er d ef i ned s treng th ened .
DoHS, Annual Report 2075/76 (2018/19) and c lari f i ed th roug h prac ti c e • M oti v ati on of th e h ealth
and c om m uni c ati on. c are prov i d ers to b e
m ai ntai ned .
• E nab le all h ealth f ac i li ti es
to prov i d e b as i c h ealth
s erv i c es .
• M od el
leg i s lature/reg ulatory
f ram ew ork f or prov i nc e
and loc al lev el to b e
• Dev eloped P lanni ng and s truc ture to b e rev i ew ed
B ud g eti ng g ui d eli ne and upd ated .
• I m plem ented b ud g et planni ng • C ond i ti onal g rants need
as per loc al g ov ernm ent to c ov er pri ori ty
operati on ac t. prog ram m ati c need s .
• P rac ti c ed planni ng and • E v i d enc e b as ed planni ng
b ud g eti ng b as ed on f ed eral and b ud g eti ng s h ould b e
c ontex t. s treng th ened i n all th ree
s ph ere g ov ernm ent.
5 g • gai
Sec tort M
anag em ent and • Dev eloped d i f f erent h ealth • Ac c ountab i li ty of loc al
G ov ernanc e s ec tor g ui d eli ne. lev el to prov i nc es need
• Roles of prov i nc es and loc al to b e c lari f i ed and
lev el b ei ng f urth er d ef i ned s treng th ened .
and c lari f i ed th roug h prac ti c e • M oti v ati on of th e h ealth
and c om m uni c ati on. c are prov i d ers to b e
m ai ntai ned .
• E nab le all h ealth f ac i li ti es
to prov i d e b as i c h ealth
s erv i c es .
• M od el
leg i s lature/reg ulatory
f ram ew ork f or prov i nc e
and loc al lev el to b e
d ev eloped and prac ti c ed .
• P ri v ate s ec tor reg ulari ty
f ram ew ork to b e
i ns ti tuti onali z ed .
• O ne h ealth s trateg y
am ong M i ni s try of
Health and P opulati on
(M oHP ) and Ag ri c ulture
and li v es toc k
d ev elopm ent f ores t and
env i ronm ent to b e
f orm ali z ed .
6 • I m prov ed s us tai nab i li ty of • I nc reas ed g ov ernm ent h ealth • E x ped i ti ng ex pend i ture
h ealth c are f i nanc i ng ex pend i ture. on h ealth to ac h i ev e
• I nc reas ed per- c api ta h ealth uni v ers al ac c es s to
ex pend i ture. pri m ary h ealth c are
• E x pand ed h ealth i ns uranc e s erv i c es .
prog ram • Strateg i es to red uc e out-
of - poc k et ex pend i ture to
b e s treng th ened .
• Health f i nanc i ng s trateg y
to b e d ev eloped .
• Health i ns uranc e
prog ram s h ould f oc us to
poor and i m prov e annual
renew al.
7 • I m prov ed h ealth li f e s ty le and • E nd ors ed and pi loted P ac k ag e • M ulti lateral c oord i nati on
env i ronm ent of E s s enti al N on- and c ollab orati on to b e
C om m uni c ab le Di s eas e s treng th ened .
protoc ol. • M ulti Sec toral ac ti on
• Rev i s ed M ental Health P oli c y plan f or prev enti on and
• E nd ors ed N ati onal Health c ontrol of non-
Ad aptati on P lan (H- N AP ) on c om m uni c ab le d i s eas e to
c li m ate c h ang e. b e d ev eloped and
i m plem ented .
• M ental Health I s s ue to
b e pri ori ti z ed b y all lev el.
• Serv i c e prov i s i on on non-
c om m uni c ab le d i s eas e to
b e ex pand ed .
• Soc i al m ob i li z ati on and
b eh av i or c h ang e
c om m uni c ati on ac ti v i ti es
to i m prov e li f es ty le to b e
i m prov ed .
8 • Streng th ened M anag em ent of • N ati onal protoc ol and • G ui d eli nes d ev elopm ent
P ub li c Health E m erg enc i es g ui d eli nes f or em erg enc y and alloc ati on of
s i tuati on h as b een d ev eloped . res ourc es f or h ealth
• E s tab li s h ed partners h i p w i th em erg enc i es t0o b e
non- g ov ernm ental and pri ori ti z ed .
s ec toral ag enc i es f or • I ns ti tuti onali z ed th e
em erg enc y m anag em ent. prog res s m ad e on pub li c
• I m plem entati on of N epal h ealth em erg enc i es .
N ati onal Ad aptati on P lan of • C apac i ty b ui ld i ng and
Ac ti on(N AP A) f or c li m ate m ob i li z ati on of h um an
c h ang e i nd uc ed d i s as ter res ourc es to ad d res s
i m pac t of h ealth
DoHS, Annual Report em erg 2075/76
enc i es . (2018/19)
9 • I m prov ed av ai lab i li ty of th e • Dev eloped nati onal e- h ealth • e- h ealth i ni ti ati v es at th e
and us e of ev i d enc e i n s trateg y . all lev els to b e
d ec i s i on m ak i ng proc es s at all • F unc ti onali z ed and upd ated d ev eloped , s tand ard i z ed
lev el. th e DHI S 2 platf orm f or HM I S and i ns ti tuti onali z ed .
reporti ng . • C entral d ata
• E s tab li s h ed g ri ev anc e repos i ti onary to b e
m anag em ent s y s tem . operati onali z ed .
• C ond uc ted m ulti ple analy ti c al • E f f ec ti v e i m plem entati on
8 • Streng th ened M anag em ent of • N ati onal protoc ol and • G ui d eli nes d ev elopm ent
P ub li c Health E m erg enc i es g ui d eli nes f or em erg enc y and alloc ati on of
s i tuati on h as b een d ev eloped . res ourc es f or h ealth
• E s tab li s h ed partners h i p w i th em erg enc i es t0o b e
non- g ov ernm ental and pri ori ti z ed .
s ec toral ag enc i es f or • I ns ti tuti onali z ed th e
em erg enc y m anag em ent. prog res s m ad e on pub li c
• I m plem entati on of N epal h ealth em erg enc i es .
N ati onal Ad aptati on P lan of • C apacg i ty b ui ldgaii ng andt
Ac ti on(N AP A) f or c li m ate m ob i li z ati on of h um an
c h ang e i nd uc ed d i s as ter res ourc es to ad d res s
i m pac t of h ealth
em erg enc i es .
9 • I m prov ed av ai lab i li ty of th e • Dev eloped nati onal e- h ealth • e- h ealth i ni ti ati v es at th e
and us e of ev i d enc e i n s trateg y . all lev els to b e
d ec i s i on m ak i ng proc es s at all • F unc ti onali z ed and upd ated d ev eloped , s tand ard i z ed
lev el. th e DHI S 2 platf orm f or HM I S and i ns ti tuti onali z ed .
reporti ng . • C entral d ata
• E s tab li s h ed g ri ev anc e repos i ti onary to b e
m anag em ent s y s tem . operati onali z ed .
• C ond uc ted m ulti ple analy ti c al • E f f ec ti v e i m plem entati on
s tud i es E . g N ati onal Health and g ui d eli nes and tools
Ac c ounti ng (N HA 2018), N epal at all lev el of
Health F ac i li ty Surv ey (N HF S)- g ov ernm ents to b e
2015, N epal Dem og raph i c prom oted .
Health Surv ey 2016, N epal
N ati onal m i c ronutri ent s urv ey
Key recommendations of the Mid Term Review
gi a g at am i g a ta i i a g m t t
t gt a g at t i mi a a a a ai i g t
am a i ii a a g m t
t a i a am g i mi i t i t t gt a m t a
a m g m t t ta i
ita iti i g a m a t
i a i a a g m t at it a t a
a at t at i i at a g m t
a i i t i ita i a a it i i g i a it
a a i g i g ga ata g amma
t t gt
m a ai a i it a at t ata i a ai a i gt
it t a t m t m a a a i a
a i ga g g
t t ai i g a a a it m t i t ma g g a ma ag m t
t m
i a iat m t mi a ia i t i
a a
a t at t t at g i a a t ta t a t at g
a t m a i ia t at gi a a t m t i
mt a t i ia t a
Overview of progress against NHSS results framework
at t g agai t a i i at t t am i a ai a t
it m g i a a i a a t m ia a a a i
i i at a g i t i t t at t i t t a i i gt t t a t m
a t t g a i i at it t i a i ata a a i m t agai t t
mi t a t ta g t

Bas eline Miles tone Miles tone 2017/ 18 Miles tone 2018/ 19 2020/ 21
g
Code Indicators
Data Year Source 2016/ 17 Data Year Source Data Year Source Target
M aternal m ortali ty rati o
G 1 190 2013 W HO 14 8 23 9 2016 N DHS 186 2019 W HO 125
(per 100,000 li v e b i rth s )
U nd er f i v e m ortali ty rate
gai t
G 2 3 8 2014 N M IC S 3 4 3 9 2016 N DHS 3 9 2016 N DHS 28

(per 1,000 li v e b i rth s )
N eonatal m ortali ty rate (per
G 3 23 2014 N M IC S 21 21 2016 N DHS 21 2016 N DHS 17. 5
1,000 li v e b i rth s )
T otal f erti li ty rate (b i rth s
G 4 per 1,000 w om en ag ed 15– 2. 3 2014 N M IC S 2. 2 2. 3 2016 N DHS 2. 3 2016 N DHS 2. 1
19 y ears )
% of c h i ld ren und er- 5 y ears
G 5 3 7. 4 2014 N M IC S 3 4 3 5 2016 N N M SS 3 5 2016 N N M SS 3 1
w h o are s tunted
% of w om en ag ed 15- 4 9
G 6 y ears w i th b od y m as s i nd ex 18. 2 2011 N M IC S 13 14 . 5 2016 N N M SS 14 . 5 2016 N N M SS 12
les s th an 18. 5
L i v es los t d ue to road traf f i c
N epal
G 7 ac c i d ents per 100,000 3 4 2013 23 7. 1 2016 N epal P oli c e 9. 5 2018 N epal P oli c e 17
P oli c e
populati on
Sui c i d e rate per 100,000 N epal
G 8 16. 5 2014 15 17. 8 2016 N epal P oli c e 19 2018 N epal P oli c e 14 . 5
populati on P oli c e
Di s ab i li ty ad j us ted li f e y ears
los t d ue to c om m uni c ab le,
G 9 m aternal and neonatal, 8,3 19,695 2013 B oD, I HM E 7,4 87,726 9. 015,3 20 2016 G B D Stud y 9. 015,3 20 2016 G B D Stud y 6,73 8,953
non- c om m uni c ab le
d i s eas es , and i nj uri es
I nc i d enc e of
i m pov eri s h m ent d ue to out- Red uc e b y
G 10 N A 2011 N L SS 20 N A N L SS N A N L SS
of - poc k et ex pend i ture i n 20%
h ealth
Refer to full NHSS Results Framework for means of verification of the targets and required data disaggregation
*Achievement against target- Green: 100%; Yellow: >50%; Red: <50%

Chapter 3
g t a tm t
PROGRESS OF OTHER
DEPARTMENTS UNDER MoHP
3.1 Department of Drug Administration
3.1.1 BACKGROUND
m t a
a m gat t g t t i it t mi a
m i i a a i a ma a mat ia a a t a mi a i g i ma
a gt a a m i i a t g at a t t ma g
iti t im t t ag a ia t m i i i a t a t
t a i a ta a a it
im m ta t aim g t a ai g a it m t
a ta i a tm t g mi i t a i
a a it t
t a a at i t a a g i
a a m at
im m t t ta i i g i a am g
g m t m t a gi at ga i a i i t a i at t
m i i im t t t ag a iti a it a m t
g at t a a a i ma i i g t aim a a a
g i i a t im ta t a a
t g t t i g g a a a im m t a
gt t a m t g t
g ta i a g i mmi B
g gi t a B
g ta a B
i a B
a a iti g B
g B
g a g i i a im m t t a it a a at m i i
3.1.2 OBJECTIVES
mai i t g at a a
gm t i a a ta i a
m i i i mi a a m i i a it a mat ia t t a a mi a i g
a m t a ma a ai a a a i a a it m i i t t g a i
t i gt ma g iti a t im t t ag a m i
i
3.1.3 STRATEGIES
a m i i t m t a a m i i
ta i m t gi a at a gi t ai a

g t a tm t
t gt i g a a i i a at a a a a at
m i i
i i gi t a a i a t
m a a m i i
m t a i t gi ma t m t i mi at t a ti ma
ag m t t m t a ta i a ma a i ti t a i ia i
t a m i i
i t t a it ma t m i i
t mi a i t m at a mi ia i ta
3.1.4 FUNCTIONS OF DIVISION AND BRANCH OFFICES OF DEPARTMENT OF DRUG

ADMINISTRATION
Drug Evaluation and Registration Division
Medicine and Biological Evaluation Section

i a a m i i a a i t ma a t i g im t ta
ma g
i a a a i a i gi a ma a t i g t im t a
ma g
a a m t m i i a i i a t ia
i at it t at t t a a m i i
i mi i a a m ta i i a t ia
Import Section
a ig ma a t im ta m i i
gi t t t a im t a a a
i t mm a im t t m i i
t mm a im t t
gi t a i a i gi a t a im t a a a
i t mm a im t t a i a i gi a
Industry Section
i mm a t ta i m t a ma a i t a
i t a a t i g i a t m
a a t a ma a i t
gi t t a i ma g mi i t a a iti
mm a t im t a mat ia a t m
gi t a i gi t a at t tai a a ma t t a
t m
a at a t i t a m i i
at t a ma i a a a ia i t i
Planning, Co-ordination and Management Division
Training and Drug Information Section

tt t ai i g t m i i
i mi at i ma a t m i i a a i t t ai i a g
i t a a t ag i a t a i ma ga i g m i i
i gB a B a iti t t at i t i ti m i a
t at a ma i t a t a i t
g t a tm t
i a a it a i i a a a a m a i i a
mm im t a t i ta a iai it
t a a a t B a
ta i at t a ma igi a a g it i g g
ag m t a ga m t t i g
Planning and Coordination section

ga i a m t a i g g g ig ai
ta a i ia g m t i a a ig i a
a a a i g a i t a gi a
i at it i it t a tm t a t g m t a g m t
ga i a ga i a mit t tt
t a a a m t at a a t
Pharmacovigilance section
t ma g i a t i i a a i t
a ta a a a a ma igi a t a i at a a at it gi a
t a a a g t i t a a g it i g aa
it i g t
a i itat t i m ta ig g a a
Financial/Administration section
t a i at
a ag m t ma itm t g m ta t
ma a a m a mai tai am
m m t at a i
it i g a a a i a gi a a i
a ag m t mi i i g a a i a
t a a ia ma ag m t a a it
a a a g t it
m ta it ma ag m t
i a ia i g a i ma ag m t B
Inspection, Evaluation and Law Enforcement Division
a ga a a mi i t a a a m ia a t ii g t
a it g a
g at a a iti t i a a g
i at a a t i g a it it i a ti t t
Inspection and Evaluation Section

t im m ta ga t a t g a g
t
t gi ti a tai a ita a ma i g a
a i i at i a a a
a a a ta a i g t a a ma i
ta a a ta g t i a a a
it i i a a a a i

g t a tm t
Law Enforcement Section
a a m t gi t i g t a t agai t g t
it ga a tt a tm t
ai i g t g t ga a a i g
i a ga a t at t a ma a
it t am m t ga t g a a i i
GMP Audit and Certification Section

m a a a at a i
a ma a i t a a
i at it gi a at i
a a ig i t it i
a a m ia
Branch Offices:
a it a at Bi at aga Bi g a ag a t t
i i it i a a a ma gi t a a a
3.1.5 National Medicines Laboratory (NML)
a a i i a at i t i i a m t a t g a
a a i g t a ai i mi a a a i mi i g a ma g a
i t m ta a a i mai a t
ta a a t a it m i i a m a i gt t g t
t a at a i
t t ai i g a at a
it a at i a a ma a i ti
3.1.6 ANALYSIS OF ACHIEVEMENTS BY MAJOR ACTIVITIES
Activities carried out in FY 2075/76 (2018-2019)
Major activities
a t a a m i i i tm ia
g a i a gB a B
it i m gi ti a a t i g a
m ia
tai a a ma i m ia
t ma g
a it a a i g a ai a i ma t
ig a a t gi ta t
g ami a t i a g t ai i g
it m ma a t a at m ia a at a
a ga a a mi i t a a i a g at ta a
a m i i m ma t t ai t a it ta a

6. I ns pec ti on of F orei g n M anuf ac turers b ef ore reg i s trati on of prod uc ts .
7. C ond uc ti ng ex am i nati on of v eteri nary d rug s ellers ’ trai ni ng .
8. Aud i t of d om es ti c m anuf ac turer lab oratory f or c om pli anc e of G ood L ab oratory
P rac ti c e (G L P )
9. T ak e leg al and ad m i ni s trati v e ac ti on f or v i olati on of reg ulatory s tand ard s .
10. Rec all of m ed i c i ne f rom m ark et th os e f ai led to q uali ty s tand ard .
g t a tm t
T ab le 1: T arg et V s Ac h i ev em ent, F Y 2075/76
aS. Activ aities
g t i m t Unit Target Achiev em ent
N Num . i m% t
1 Drug i inf orm ati on to th e pub li c b y d i f f erent m ed i a N um . it 3 a0 g t 4 2m 14% 0
2 P ub ligc ati i on ma of Drug B ulleti
t tn i i t m ia m 3 3 100
1
of N epal
3 C ond iuc ati ng ex am i natigon B of v eteri nary d rug
a s ellers ’ trai ni ng 2 3 23 100
4 I ns pec ti on of d om es ti c 87 87 100
3 g ami a t i a g t ai i g
P h arm ac euti c al I nd us tri es
5 I ns pec ti on to d rug m retai lers & w ah ma
oles alers a ti 2913 3 4 04 117
6 Drug s am ple Analy s i s 1000 1018 102
t g tai a
7 Aud i t of P h arm ac euti c al 3 0 3 0 100
Analygti c am a i
al L ab oratori es
8 I ns pec ti on of F orei g n T i m es 5 5 100
it es a ma
C om pani a a a a at i
ig m a i im
Table 2: Other activ ities

S. N Activ ities Achiev em ent
1 Reg i s trati on of new f orei g n ph arm ac euti c al I nd us try 3 9
2 Reg i s trati on of new m ed i c i ne (i m port) 24 4
3 Renew of i m port li c ens e 3 590
4 I s s ue of m ark eti ng li c ens e 787
5 I s s ue of prod uc t li c ens e 13 66
6 I m port li c ens e f or raw m ateri al f or d om es ti c i nd us try 13 21
7 Reg i s trati on of new ph arm ac y 893
8 Renew of ph arm ac y 4 571
9 Renew of prof es s i onal li c ens e 575
10 Dereg i s trati on of ph arm ac y 3 3 6
11 Rec all of m ed i c i ne f rom m ark et d ue to i nf eri or q uali ty 21
12 T rai ni ng on I SO 17025 c erti f i c ati on 1
13 Analy ti c al M eth od V ali d ati on f or non- ph arm ac opoei al prod uc ts 3 4
14 I nterac ti on prog ram w i th s tak eh old ers 5
15 T rai ni ng on B A/B E & T DM 2
16 Dev elopm ent of SO P f or P h arm ac ov i g i llanc e 1
17 Sem i nar on Rati onal U s e of M ed i c i nes i n d i f f erent P rov i nc es 3
18 T rai ni ng on leg al proc ed ure f or Drug I ns pec tors 1
T ab le 3 : F i nanc i al alloc ati on and E x pend i ture

B ud g et i n th ous and s (000)
S. N B ud g et h ead i ng B ud g et alloc ati on B ud g et ex pend i ture %
1 C api tal b ud g et 7,25,00,000. 00 4 ,68,15,221. 01 64 . 57
2 Rec urrent b ud g et 9,57,96,83 9. 50 7,28,4 4 ,24 5. 25 76. 04
3 T otal 16,82,96,83 9. 50 11,96,59,4 66. 26 71. 10
3 . 1. 7 Rev enue g enerated : N Rs

T otal rev enue c ollec ti on: 4 8105599. 4 9
3 . 1. 8 C h alleng es
 O rg ani z ati onal Struc ture f or f ed eral, prov i nc i al and loc al g ov ernm ent.
 L ac k i ng m ec h ani s m (leg al and org ani z ati onal f or reg ulati on of HT P ).
 I nf orm ati on M anag em ent , T rans parenc y and lac k i ng of d y nam i c and Res pons i v e
I nf orm ati on s y s tem
 I lleg al i m port of m ed i c i ne d ue to open b ord er and , SF s reg ulati on and c ontrol.
 L ac k i ng of res ourc es (h um an, T ec h nolog y )
 Reg i onal h arm oni z ati on and uni f orm i ty , M RH and SRA c ollab orati on.
 P h arm ac ov i g i lanc e ,pos t m ark eti ng s urv ei llanc e
g t a tm t
3.1.7 Revenue generated : NRs
ta
3.1.8 Challenges
ga i a a t t a i ia a a g m t
a i g m a i m ga a ga i a a g a
ma a ag m t a a a a i g ami a i ma
t m
ga im t m i i t a g a a t
a i g ma g
gi a a m i a a i mit a a a
a ma igi a t ma g i a
g a a a ta i it
i i tag i
a ga i a t t i m it i g

g t a tm t
3.2 Department of Ayurveda and Alternative Medicine

3.2.1 Background
a tm t a a t a i i ima i ma ag t i
a t a i i i a m t at i t t g it t
a ii a a t t a tm t a t a i i t
t a tm t t i it at a i i g ammi g
ma ag m t i ma a ii m it i g a a a t a i
g am
ai a a i tm i a t m a i ig t a it t
i m i i a m i i a mi a a a ima t t m t g
im a t a m a a g it m a a a i ita
at a at i a i g i t g ta a
ita a i i ia ita a g a a i ai iti t
a at t a a i ai a t t aa
t a i i it i t i it at a i i
m a g i i a g i i aa t ta i a m i a t m
ai a
a a i t a a i i a ig ig t t im ta a i
i ima at a a t a a a t
t a m ta i a a m i i a g it at at a
m at a a at i a a a i i i a
a t a a a at i a a a a at i
i a g m t a a g i a m t
a i a at at m at t at a m i i i a
it a t t a m t ita i a m
a a ai a m i i a mi a a ima igi m i i a ag m t g a
t at a m i i a ta a m ta i m t a ga
at at t a ia a m at t i m

F i een plan of g ov ernm ent of N epal (2019/20- 2023 /24 ) h as g ui d ed planned d ev elopm ent &
ex pans i on of Ay urv ed a, N aturopath y , Hom eopath y & oth er alterna v e m ed i c i nes . M ore s pec i c ally ,
i t s ay s : 1) Struc tural d ev elopm ent s ui tab le f or i d en c a on, prev en on, c ollec on & prom o on of
loc ally av ai lab le m ed i c i nal h erb s , m i nerals & ani m al ori g i n m ed i c i nes . 2) M anag em ent & reg ula on of
oth er alterna v e m ed i c i nes b as ed on s tand ard s & norm s . 3 ) E s tab li s h m ent of Ay urv ed a, Y og a &
N aturopath y C enter and u iz a on of Ay urv ed a f or prom o on of h ealth touri s m .
g t a tm t
Organization
Organiz structure
ation s tructure
Federal L ev el Prov incial L ev el L ocal L ev el
• DoAA • Di s tri c t Ay urv ed a Health • Ay urv ed a Di s pens ari es - 3 05

• N ard ev i Hos pi tal C enters - 61
• N ART C • Anc h al Ay urv ed a
• Si ng h ad urv ar V ai d h y ak h ana Di s pens ari es - 14
• N AM C
• Ay urv ed a and Alterna v e
M ed i c i ne Sec on (M oHP )
Organiz ation of Departm ent of Ay urv eda & Alternativ e Medicine:
Organization of Department of Ayurveda & Alternative Medicine:
Department of Ayurveda and

Alternative Medicine
Herbs, Medicine
and Research Ayurveda Administration
Alternative
Division Medicine Section
Medicine Division
Division
Homeopathy & Prakritik &

Herbs & Ay urv eda Acupunture
Health Amchi Medicine
Medicine Medicine
Prom otion Section
Section Section
Section
Monitoring,
Ayurveda Research &
Service Coordination
Managemen Section
t Section
3.2.2 Obj ectiv es

3.2.2 Objectives
• T o ex pand and d ev elop f unc onal, ph y s i c al Ay urv ed a h ealth i nf ras truc ture;
• T o i am prov a e q uali ty c ontrol m eca h ani s m i af or Ay urv eda a h aealth t i s erva i tc es tht roug h out th e c ountry ;
• T imo d ev elop anda itm anag et th e req ui
m a im red h um an res ourc es ; a at i t g t t
• T ot m ob i li z e th e ad eq uate res ourc es f or m ed i c i nal plants ;
• T o prom aote c ma om m aguni tty par c i ipa on ma i n th e m anag em ent of th e h ealth f ac i li ty & u i z a on
of loc
m ii t a al h erb s ; at m i i a a t
• T o promm t ote h ealth
mm it a i a s tatus & s us tai nab
i tle d ma ev elopm
ag ment oft Ay t urv ed aa ts y s tem
a i itus i ng loc i ally
a
av aia lab le m ed i c i nal plants ;
• T o prom m t ote pos a ti v etat a tud es tow taiard as h ealth c are m & aw tarenes s of h ealth a i s ts uesm; i g a
a ai a m i i a a t
3.2.2 Strategies
m t i a t t a at a a a at i
• P rov i d e prev en v e, prom o v e& c ura v e h ealth s erv i c es i n th e rural areas ;
• E s tab li s h m ent & d ev elopm ent of Ay urv ed a i ns tu ons ;
• Streng th en & ex pand th e Ay urv ed a h ealth s erv i c es ; DoHS, Annual Report 2075/76 (2018/19)
• Dev elop s k i lled m anpow er req ui red f or v ari ous h ealth f ac i li s ;
• Streng th eni ng of m oni tori ng & s uperv i s i on ac v i s ;
• Dev elopm ent of i nf orm a on, ed uc a on & c om m uni c a on c enter i n th e Departm ent;
• Dev elop I nter s ec toral c o- ord i na on w i th E d uc a on M i ni s try , F ores try , loc al d ev elopm ent
• s ec tor & oth er N G O ' s & I N G O ' s ;
• E s tab li s h m ent of reg i onal Ay urv ed a Hos pi tals & Ay urv ed a Di s pens ari es ;
g t a tm t
3.2.2 Strategies
i m a at i i t a a a
ta i m t m t ai t
t gt a t a at i
i ma i ai at a ii
t gt i g m it i g ii a i
m t i ma a mm i a t i t a tm t
t t a i a it a i it t a m t
t t
ta i m t gi a a ita a i ai
t gt i g a i a t ai i g t i t a a
a a t a a t ai i g t a a it a m t it ma
3.2.3 Major Activities
Central level
mm i a i a a t g am
a a a t a a ga a a a ta i a g a i a
i i t a a m t
a a a ma a ga
ta i m t a t i g g t i g t m a am g a
i t
ta i m t a a a a a a ma a ga t i B a i a t a
ta i m t gi a a ita at a ga i a a
t gt i g g am at at ga m at a i am i t
a a ma at at ga a t am
ga i t a a i a i it ai i g t a i ia
a it m it i g i t a t a ai a i a ma t
it i g i i i at a t a i a t m
a i m g i it i
ii a a m it i g a at i at i a m t
t i
a a a m it i g a i a it i a a
Local Level
ga a i t ma ag m t t ai gi g g am
t gt i g a ga
a i i it a ta i a a
aa mat ia a
a at g am
t m a i i t
B i i g t a i t
m a a a ma a a a ga g amm i i
a g am m i i a a t
g am a ta g m t iti ga a t g g m i i
m t t atm t i m t

g t a tm t
3.2.4 Analysis of Achievement
Ba t t atm t t i t ai t i g i a a i
a t t i a
ma i a a t i
a g mi a i a
a a Bi a i at i a
ata a i t t i mat i t i t m a i a
a ia
Ba ga iat i i a
a a aa a a ta a t a g a ta i a
ti g gi a i a
Ba a t i i a
a a a i ia a i a

3.2.5 Service Statistics for fiscal year 2075/2076 g t a tm t
Table 3.1: Table shows the number of people served by province wise in FY 2075/76
3.2.5 Service Statistics for fiscal year 2075/2076
Province Province Province Province Gandaki Province Karnali SudurPaschim Total
Table 3.1: TableNo.
shows
1 the number
No. 2 of
No.people
3 served by province
Province No. 5 wise in FY 2075/76
Province
Province Province Province Province Gandaki Province Karnali SudurPaschim Total
No. 1 No. 2 No. 3 Province No. 5 Province
OPD 219232 127275 165924 221231 229558 149597 243885 1356702
Stanpayee
OPD 3151
219232 2005
127275 2195
165924 3113
221231 3309
229558 2014
149597 3597
243885 19384
1356702
Stanpayee
JesthaNagarik 3151
5235 2005
3456 2195
4115 3113
5136 3309
5704 2014
3591 3597
6108 19384
33345
JesthaNagarik 5235 3456 4115 5136 5704 3591 6108 33345
Purvakarma 4697 3536 3811 4907 5183 3529 5784 31447
Purvakarma 4697 3536 3811 4907 5183 3529 5784 31447
GaunGhar 14121 10076 11143 14135 14320 9904 16125 89824
Clinic
GaunGhar 14121 10076 11143 14135 14320 9904 16125 89824
Clinic
SwasthyaSibir 7908 4943 5732 6910 7154 4168 8546 45361
SwasthyaSibir 7908 4943 5732 6910 7154 4168 8546 45361
National 254344 151291 192920 255432 265228 172803 284045 1576063
National 254344 151291 192920 255432 265228 172803 284045 1576063
3.2.6 Problems/Constraints
3.2.6 Problems/Constraints
Problems/Constraints Actions to be taken Responsibility
Problems/Constraints Actions to be taken Responsibility
Lack of experts and inadequate Production of Qualified Ayurvedic DoAA
Lack of experts and inadequate Production of Qualified Ayurvedic DoAA
qualified manpower.
qualified manpower.
manpower(BAMS, MD)
manpower(BAMS, MD)
MoHP
MoHP
MOE
MOE
Inadequate
Inadequatefinancial
financialsupport
supportforfor Allocate
Allocatesufficient
sufficientBudget
Budget MoHP
MoHP
district
district level Ayurvedainstitutions
level Ayurveda institutionstoto
conduct
conductmonitoring
monitoringsupervision
supervision&&
publicity
publicityprogram.
program.
Poor
Poorstorage
storage&&dispensing
dispensing Provide
Providegood
goodfurniture
furniture&&dispensing
dispensing DoAA
DoAA
Practices
Practicesofofmedicines
medicinesinincurative
curative materials
materials MoHP
MoHP
aspects of Ayurveda institutions.
aspects of Ayurveda institutions. Trainingon
Training onstorage
storage&&Good
Gooddispensing
dispensing
Practice.
Practice.
Lackof
Lack ofinter
intersectoral
sectoralco-ordination.
co-ordination. Co-ordinationwith
Co-ordination withrelated
relatedministries,
ministries, DoAA
DoAA
NGO's & INGO's
NGO's & INGO's MoHP
MoHP
Increasequalified
Increase qualifiedmanpower.
manpower.
Lack of community based program Increase manpower production. DoAA
Lack of community based program Increase manpower production. DoAA
for publicity of Ayurveda. Allocation of adequate budget. MoHP
for publicity of Ayurveda. Allocation of adequate budget. MoHP
Lack of Workshop, Training & Allocate adequate budget, DoAA
Lack of Workshop,
Seminar ,Planning Training &
on Ayurveda. Allocate
Developadequate
policy & budget,
Long term, Mid term and DoAA
MoHP
Seminar ,Planning on Ayurveda. Develop policy & Long term, Mid term and MoHP
Short term plan on Ayurveda
Short term plan on Ayurveda
Lack of appropriate recording & Upgrading of Ayurveda Information DoAA
Lack of appropriate
reporting system. recording & Upgrading
Managementof Ayurveda Information
System(AIMS) DoAA
MoHP
reporting system. Management
Allocation ofSystem(AIMS)
adequate budget. MoHP
Training of
Allocation onadequate
AIMS For Ayurveda
budget. Personnel
Inadequate Specialized Human Scholarship
Training for higher
on AIMS studies,Recruitment
For Ayurveda Personnel MoGA
Resources under
Inadequate Specialized Human &Placement
Scholarship for. higher studies,Recruitment PSC
MoGA
Department
Resources of Ayurveda.
under &Placement . PSC
Lack of Evidence Generation &
Department of Ayurveda. Goal formation. DoAA
Lack of Evidence Generation & Goal formation. DoAA
Documentation about the Allocate budget. MoHP
successful treatment of certain
incurable disease with Ayurveda
therapy claimed by practitioners.
DoHS,
3.2.6Annual Reportformulated
Programs 2075/76 (2018/19)
for the fiscal year 2076/77
Miscellaneous Programs: Ayurveda vibhagh (37003101)
 Improvement of Administrative building of Department and Budhanilkantha Panchakarma
center.
 Construction of open gym center.
 Ayurveda Health promotion program.
 Skill development empowerment / program.
g t a tm t
3.2.7 Programs formulated for the fiscal year 2076/77
Miscellaneous Programs: Ayurveda vibhagh (37003101)
P m m t mi i t a i i g a tm ta B a i a t a a a a ma
t
P t g m t
P a at m g am
P i m t m m t g am
P a it i i a i i a ag m ta a g am
P a ma ag m t
P a at ma ma ag m t g am
P t t imat a g m i i a a t
P i at g am
P a t t a i g am
P a ag m t
P a i i i a a t
P a i a t atm t at i ta a a ag m t
P ga a a a ma t ai i g a i ia
P ga i g
P t a i i t gt i g i ta a
Provincial Programs
P i t a ag m t g am i
P ai i g a a ag m t a g am a
P m t a ta a i i
P a t am
P a a t a a ga a a a g a i a a a ta i a a
P mat ia m t

Chapter 4
ami a
FAMILY WELFARE
4.1 Child Health and Immunization Service

BACKGROUND
i at a mm i a i i t ami a
i ii i a t a m it a a i i a t a imm i a
i gi a ag m t a ag m t i i i t a iti t
a i t g tt t a a i at a mm i a i
ami a i ii i a m ta i at a
imm i a a ia m i i a mat ia i i a it t i
a a it i i g a t ta imm i a i i a it t i i
t t g a a at a i ia at ai i g t mm i a a
at i ma i t t g t g at at ma a ag m t
a ag m t i i i a i a at i a a i at a
mm i a i ami a i ii i at it a ta
imm i a a i at t t a i t a a a
i a t g am a a mm ia g am a g am
4.1 National Immunization Program
a a mm ia g am a a g am mm ia a ta t
i B a i a i it g am t i t i at g am
i it at a a a a a i a mi t ti gt i
m i it a m ta it a iat it a i ta i a
it t i ii a tm t at i a a a t
i it at a a a i t at i i g a g
t a a mm i a g am t a t a i a
i t a a i a i ti g t a a i m t
a a i a ta g t i t i g a i a i i
imm i a t t g am i a i a agai t a i ta
i a a a a at i a i a i t i
imm i a a it ma a i t m i a a
mm i a a t a i i i g ta i a i a
i a i a i a a i t i a mm i a i a i
t g i i i t i at a ii i t a i a
m i i i
a a ig it g a gi a a a a g i i i i a
mm a t g i t g am a a i ti i t a
t a a t at gi im m ta a a g ta m gt
ta g t t imi a a a i a a i ta i a ma a
m it t a i a i B at a a ata t ta a

ami a
imi at i a t imi a tat a tai i t at a i i
a a i a a g it t ti t t at ia gi a a
i i i tat a mai tai i t a i t t ti i
t t i t a i i imm ia i i i a a gi i
mi i t i t a a a t t t t ti gt a t
a a ai i a
g t a a a a i ga i t aa g ita a
m i a i t a a a t gi a ta g t a a a
a a t a a ta g t t g m a a
m a t t a a ta g t a i i gm a imi a a
t m t t m m m ti t a t ia gi i i g
a a t imi at t m a a a t t at a
i a ii a t ig i i i i a a i i
t m ti i a i i ig ag it t ta
imm i a m a a a i i mm it m i i a it i
ti t i a a a i t imm it ga t m a a a
a a a i am aig m mi a t mi i i ag a ait a
i i g i t iti t ai
a
a i ga i a a B t am g i t g
imm ia a t
t i a a a B g t
t a am g a i it t i a am t t
ti a g it Ba g a B ta a ai a i t t a t ia gi t
t a B am g i a t i i a t mai ti t t a
i i a ta i m ta it a a t i i m m t a i
a tat t a a a i g mmi i a a ti t ig i a t i
a i i g a i g i m ta it
a i t t t i t t a t ia gi t a mm i a t t t
i ga t gt i gt a a mm ia g am mm i a t a i
i t ia a a a Ba t t a a mm i a g a
i a i i t ia a g t mm i a t
a a g i imm i a a a ig t a i ii a g i a
t a mmi t i a a imm i a iti t t
a a mm i a mmi a a mm i a i mmi
a i ga mmi a ma at t mm i a t it t t
it ai imm i a a a i ta i a i a
mmi a ta i a a it m it i g i t g am
mmi i t g i a mmi mm i a a a
a mmi i a i a a a i a mmi a a
a imi a a a a a at tai m t i t i m
mi i i ga mmi t
i a a i i at a im m t a i i i a
a imm i a g am i g am a i ia i it i imm i a
a i ga ia g ga i a a t it i a a mi i t a a a
m a t t imm i t i g am t a a a it
a i a a ta at a t a i imm i a
t ta a i a a a t iti t a a imm i

ami a
a a i i a a a t i i a imm i i
i a i ta i a a im a t a i
i t a i i a a t a i aa i i m a a
a ata t ta a a t ai m a a ai i
t t g t i a t it t
i a t a i ta i a i ai a t ia i a ta i a
g ita a m i t i a a it a a mia a a i t t
GUIDING DOCUMENTS OF NATIONAL IMMUNIZATION PROGRAM
a a g a gi a a a a g i i g m t t a a mm i a
g am mai m t i a ta i a t a i at i
a a a i a t a t ia gi a a i a a a
mm ia t a a at t t at g
4.1.1 Comprehensive Multi-Year Plan for Immunization (cMYP)
m i a a mm i a i a
i i a i a a a t a i
imm i a at g a t t t at gi a a i t t i t
a i t am i t m tt g a i gi a ta i m ta it a
m i it a iat it a i ta i a t m t i a a
a g a a t i a i i gg i i i t
a i a i a imi a a t ta g t a t gt i g
imm i a
4.1.2 Vision
a a t a i ta i a
4.1.3 Mission
i i a m t ig a it a a a a a i a imm ia
i mt a a mm i a g am i a ita ma
4.1.4 Goal
m i it m ta it a i a i it a iat it a i ta i a
4.1.5 Strategic Objectives
Objective 1 a i imm i a
Objective 2 at a i a tai a i ta i a t imi a a
a i a
Objective 3 t gt imm i a ai a a i ma ag m t t m a it
imm i a i
Objective 4 a ia tai a i it imm i a g am
Objective 5 m t i a a a ia m i i a a i t a t
a

4.1.4 Goal
Red uc ti on of m orb i d i ty , m ortali ty and d i s ab i li ty as s oc i ated w i th v ac c i ne prev entab le d i s eas es .
4.1.4 Goal
Red uc ti on
4.1.5 Strategic Objofectiv
m orbes i d i ty , m ortali ty and d i s ab i li ty as s oc i ated w i th v ac c i ne prev entab le d i s eas es .
Obj ectiv e 1 Reac h ev ery c h i ld f or f ull i m m uni z ati on;
Obj ectiv4.1.5
e 2 AcStrategic
c elerate,Obj
ac ectiv
h i ev ees and s us tai n v ac c i ne prev entab le d i s eas es c ontrol, eli m i nati on and erad i c ati on;
Obj
Obj ectiv amiectiv e 1
e 3 Streng th aen i m m ery
Reac h ev uni z c ati
h i ldonf or f ull i m c h m ai uni
s upply z ati v on;
n and ac c i ne m anag em ent s y s tem f or q uali ty i m m uni z ati on s erv i c es ;
Obj ectiv e 2
Obj ectiv e 4 E ns ure f i nanc i al s us tai nab i li ty f or i m m uniacz ati
Ac c elerate, ac h i ev e and s us tai n v c i ne
onprev
prog entab
ram ; le d i s eas es c ontrol, eli m i nati on and erad i c ati on;
Obj ectiv
Obj ectiv4.1.6 e
e 5 P TARGET 3 Streng th ati on, res earc h and s oc i al m ob i li z ati on c aci ne
en
POPULATION
rom ote i nnov i m m uni z ati on s upply c h ai n and v ac ti v m i ti anag
es toemenhent
ancs ey s b temes t fprac
or q tiuali
c es ty i m m uni z ati on s erv i c es ;
Obj ectiv e 4 E ns ure f i nanc i al s us tai nab i li ty f or i m m uni z ati on prog ram ;
Obj ectiv e 5 P rom ote i nnov ati on, res earc h and s oc i al m ob i li z ati on ac ti v i ti es to enh anc e b es t prac ti c es
4.1.6 TARGET a aPOPUL
mm ATION ia g am t i a i a t m t ag
ta g t a i gi a i t ta
N ati onal I m m uni z ati on P rog ram c urrently prov i d es routi ne v ac c i nati on up to 23 m onth s of ag e. T h e targ et populati on i s
4.1.6 TARGET POPUL ATION
g i v en as i n th e tab le b elow .
N ati onal
Table I m m Target
4.1.1: uni z ati on P rog ram c urrently
population prov i d es routi ne v ac c i nati on up to 23 m onth s of ag e. T h e targ et populati on i s
for FY 2075/76
Table 4.1.1: Target population for FY 2075/ 76
g i v en as i n th e tab le b elow .
P arti c ulars P opulati on
Table 4.1.1: Target population for FY 2075/ 76
(s ourc e: HM I S)
P arti c ulars P opulati on
U nd er 1 y ear c h i ld ren (s urv i v i ng i nf ants ) 621,565
(s ourc e: HM I S)
12 – 23 m onth s populati on 611,914
U nd er 1 y ear c h i ld ren (s urv i v i ng i nf ants ) 621,565
E x pec ted preg nanc y 755,64 7
12 – 23 m onth s populati on 611,914
E x pec ted preg nanc y 755,64 7
4.1.7 NATIONAL
4.1.7 NATIONAL IMMUNIZATION
IMMUNIZ SCHEDULE
ATION SCHEDUL E
Table 4.1.2: National Im m uniz ation Schedule
4.1.7 NATIONAL IMMUNIZ ATION SCHEDUL E
SN Table 4.1.2: National Immunization Num ber of Schedule
TableTy4.1.2: National
pe of Vaccine Im m uniz ation Schedule Schedule
Dos es
SN Num ber of
1 B C G Ty pe of Vaccine 1 At b i rth or on f i rs t c ontac t w iSchedule
th h ealth i ns ti tuti on
Dos es
2 O P V 3 6, 10, and 14 w eek s of ag e
1 B C G 1 At b i rth or on f i rs t c ontac t w i th h ealth i ns ti tuti on
3 DP T - Hep B - Hi b 3 6, 10, and 14 w eek s of ag e
2 O P V 3 6, 10, and 14 w eek s of ag e
4 Rota v ac c i ne 2 6 and 10 w eek s of ag e
3 DP T - Hep B - Hi b 3 6, 10, and 14 w eek s of ag e
5 fIP V 1 6 and 14 w eek s of ag e
4 Rota v ac c i ne 2 6 and 10 w eek s of ag e
6 P C V 3 6,10 w eek s and 9 m onth s of ag e
5 fIP V 1 6 and 14 w eek s of ag e
7 2 F i rs t d os e at 9 m onth s and s ec ond d os e at 15
6M eas lesP - C Rub V ella 3 6,10 w eek s and 9 m onth s of ag e
m onth s of ag e
7 2 F i rs t d os e at 9 m onth s and s ec ond d os e at 15
8 JE M eas les - Rub ella 1 12 m onth s of ag e
m onth s of ag e
9 2 P reg nant w om en: 2 d os es of T d one m onth apart i n
8 JE 1 12 m onth s of ag e
T d f i rs t preg nanc y , and 1 d os e i n eac h s ub s eq uent
9 2 P reg nant w om en: 2 d os es of T d one m onth apart i n
preg nanc y
T d f i rs t preg nanc y , and 1 d os e i n eac h s ub s eq uent
preg nanc y
4.1.8 MAJOR ACTIVITIES

4.1.8 MAJOR CONDUCTED
ACTIVITIES IN FY 2075/
CONDUCTED IN FY76
2075/76
- P rov i nc i al lev el T oT ab out N ati onal i m m uni z ati on prog ram and m i c ro planni ng f or E P I f oc al pers on and h ealth
4.1.8 MAJOR ACTIVITIES CONDUCTED IN FY 2075/ 76
w ork er. i ia a t a a imm i a g am a mi a i g a
- P rov i nc i al lev el T oT ab out N ati onal i m m uni z ati on prog ram and m i c ro planni ng f or E P I f oc al pers on and h ealth
- a a t
Dec lared 5 new f ull i m m uni z ati on d i s tri c ts i n F . Y 2075/76 am ong F i f ty ei g h t (58) d i s tri c t
w ork er.
- Ad v oc ac ay m eeti ng ab out s usimm tai nab ileaf i nanc i al i tm ianag t emi ent of I m m uni am z ati ongP rogi ram m ige tw i th th e im temi tb ers of
- Dec lared 5 new f ull i m m uni z ati on d i s tri c ts i n F . Y 2075/76 am ong F i f ty ei g h t (58) d i s tri c t
a m g a t tai a a ia ma
th e parli am ent, P oli c y m ak ers , b ank ers , i nd us tri ali s t, b us i nes s m an, pri v ate s ec tors ag m t mmand ic ai v i l s oc i ety g amm
- Ad v oc ac y m eeti ng ab out s us tai nab le f i nanc i al m anag em ent of I m m uni z ati on P rog ram m e w i th th e m em b ers of
- T rai ni ng ab out i m portanc e of c h i ld h ealth c ard /i m m uni z ati on c ard and i ts retenti on t ia i t
it t m m t a iam t i ma a i i ma
th
i at e parli am
t a ent, P oli c
i i y m ak ers
i t , b ank ers , i nd us tri ali s t, b us i nes s m an, pri v ate s ec tors and c i v i l s oc i ety
- aiT rai i nig nga ab out
t imi m portanc
ta e of c h ii ld h ealth a t c arda /i m imm m uni z ati i aon c ard aand ai ts retenti it ton
i a at a g i i a i mm i a aa i i
g i i i a t i m a i ia i a i i a i a
ai i mi a i g t m at a at t ai i g mat ia
t at at t ai i g a i itat g i a
t ai i g mat ia i mit t ai i g a at a i at t imm i a
ai i g a t it ag a it g i i t mm i a a i
a ai a
a i im m ta g i i a gi m g i i a
it a ag
ami a
ta i ai t i ai a a i at i t t
m t a a m ta i ai i m t
m t a i g iti t a t g t i m t m t g
mi i a i a t a i t a i ia t a
i t at at
a a a am aig
a t i t a i ta i it gi m g am i t
imm i a t g t t
a i imm i a at a i g t t imm i a t
a i a a a a mm i a i mmi
t a mm i a i ma m a t a a a
a ag m t gi it t m at
t a a i ta m g it m m ia a mmi a
a iam t m ia a a iam t a t imm i a a t imm i a
i a a i t i imm i a gi t a t m
im m ta t imm i a ii a m it i g
m a im t g g am ta at t i t m it a
imm i a a mmi m m at mi g a a
i t i t at t t a t m ai i t t t a a g i
t a t m it i a ma t a i a mai tai
t g t am t mt a mai t a ai
a aa g ita a m t
a i ga ta g i imm i a
4.1.9 VACCINATION TARGET vs. ACHIEVEMENT, FY 2075/76
a tt g a t i m ta it m i it a i a i it a iat
it a i ta i a a t t at gi i t a i
imm i a t at i a t a ig i a t i
i a t a i m ta it ig a a mm i a g am a ti t
ig i a t i i m ta it g a i ta i a

ami a Trends in early childhood m ortality
Figure 4.1.1.
ig i a i m ta it
Figure 4.1.1. Trends in early childhood m ortality
Source: NDHS 2016
4.1.10 National v accination cov erage:

Source: NDHS 2016
T h e tab le and m aps pres ented b elow s h ow th e routi ne i m m uni z ati on v ac c i nati on c ov erag es and ac h i ev em ent s tatus i n F Y
4.1.102075/76.
National vaccination coverage:
4.1.10 National v accination cov erage:
T h etaTable
tab lea4.1.3:
and mam National
aps pres ented
t b elow
v accination
s h ow th et routi
cov erage by v accine,
ne i m m imm
FY 2075/ 76
uni z ati ion
a v ac c i nati
a oni ac ov erag es and
ag ac ah i ev em ent s tatus i n F Y
a 2075/76.
i m t tat i Target
SN Antigens Targets Achiev em ent % Achiev ed
population
Table
Table 14.1.3:
4.1.3: B National
C G Nationalvaccination v accination coverage
und
cov er 1 Y earby
erage by v vaccine, FY2075/
621565
accine, FY 2075/76
76565029 91
2 DP T - Hep B - Hi b 1 und er 1 y ear 621565 5613 4 6 90
3 DP T - Hep B - Hi b 2 und er Target
1 y ear 621565 54 84 3 8
SN Antigens Targets Achiev em 88ent % Achiev ed
4 DP T - Hep B - Hi b 3 und population
er 1 y ear 621565 53 7166 86
1 B C G DP T - Hep B - Hi b 3 und er 1 Y ear 621565 565029 91
2 5 DP T I nc- Hep lud i ngB - d Hielay
b 1ed d os e und er
und er 1 y ear 1 y ear 621565 621565 561675 5613 4 6 90
g i v en af ter 1 y ear of
3 DP T ag - Hep e B - Hi b 2 und er 1 y ear 621565 54 84 3 890 88
4 6 DP T O - P Hep V 1 B - Hi b 3 undund
er 1ery ear1 y ear 621565621565 54 5793 53 716688 86
7 DP T O - P Hep V 2 B - Hi b 3 und er 1 y ear 621565 53 014 4 85
8 I nc OludP V i ng3 d elay ed d os e und er 1 y ear 621565 51924 7 84
5 O P V 3 und er 1 y ear 621565 561675
I nc lud i ng d elay ed d os e
9 ag e und er 1 y ear 621565 54 3 754 90
6 O P Vag 1 e und er 1 y ear 621565 54 5793 87 88
7 O P V 2 und er 1 y ear 621565 4 03 665 (i n 53 014 4 85
8 10 O P Vf I P 3 V 1 undund
er 1ery ear1 y ear 621565621565around 9. 5 51924 7 84
m onth s ) 82*
O P V 3 296066 (i n
11 I nc flud I P V i ng 2 d elay ed d os e und er 1 y ear 621565
9 und er 1 y ear 621565around 9. 5 54 3 75460*
ag e 87
4 03 665 (i n
10 fIP V 1 und er 1 y ear 621565 around 9. 5
m onth s ) 82*
296066 (i n
11 fIP V 2 und er 1 y ear 621565
around 9. 5 60*

ami a
Target
SN Antigens Targets Achiev em ent % Achiev ed
population
m onth s )
10 P C V 1 und er 1 y ear 621565 54 894 4 88
11 P C V 2 und er 1 y ear 621565 53 5225 86
12 P C V 3 und er 1 y ear 621565 504 075 81
13 M R1 und er 1 y ear 621565 519676 84
14 M R2 15 M onth s 611914 4 4 5221 73
15 JE 12 m onth s 611914 4 94 212 81
16 T d 2& T d 2+ P reg nant w om en 75564 7 4 8623 0 64
Source: HMIS/ MD, DoHS; * f I P V c ov erag e f or 9. 5 m onth s targ et
Figure4.1.2.
Figure 4.1.2. National
National Routine
Routine Im m unizImmunization
ation Cov erage ( % Coverage
) , Nepal, FY( 2073/
), Nepal, FY 2073/74
74 to 2075/ 76 to 2075/76
Source: HMIS/ MD, DoHS
* DP T - HepB - Hi b 3 c ov erag e i nc lud i ng d elay ed d os es g i v en af ter 1 y ear of ag e i s :

F Y 2073 /74 : 91. 6%
F Y 2074 /75: 86. 3 %
F Y 2075/76: 90. 4 %
* * O P V 3 c ov erag e i nc lud i ng d elay ed d os es g i v en af ter 1 y ear of ag e i s :

F Y 2073 /74 : 91. 1%
F Y 2074 /75: 86. 8%
F Y 2075/76: 87. 5%
^ I P V i n F Y 2073 /74 , d uri ng w h i c h ti m e g lob al s h ortag e of I P V h ad alread y s tarted , and I P V w as parti ally av ai lab le i n N epal d uri ng th e f i rs t f ew m onth s
only af ter th e s tart of F Y . N o v ac c i ne i n F Y 2074 /75. I n F Y 2075/76, f I P V w as s tarted , and th e g i v en c ov erag e i s ag ai ns t 9. 5 m onth s targ et s i nc e f I P V
w as launc h ed af ter around 2. 5 m onth s i nto th e F Y .
F i g ure 4 . 1. 2. s h ow s nati onal c ov erag e f or s elec ted anti g ens f or th ree y ears , f rom F Y 2073 /74 to F Y 2075/76. B C G
c ov erag e h as d ec reas ed b y 2% poi nt i n F Y 2075/76. How ev er, th e c ov erag e of DT P - HepB - Hi b 3 and O P V 3 h as i nc reas ed
c om pared to prev i ous y ear. I P V g lob al s h ortag e s tarted f rom F Y 2073 /74 . T h eref ore, th e c ov erag e of I P V i s only 16% i n F Y
2073 /74 d ue to s h ortag e of th e v ac c i ne. I ns tead of I P V (g i v en one d os e i ntram us c ular at 14 w eek s ), f rac ti onal d os e of I P V
(g i v en i ntrad erm al at 6 and 14 w eek s ) w as launc h ed i n N epal i n O c tob er 2018. F or F Y 2075/76, f I P V 2 c ov erag e i s s h ow n
w h i c h i s 60% (c ov erag e ad j us ted f or 9. 5 m onth s targ et populati on b as ed on s tart d ate of th e v ac c i ne i n th e f i s c al y ear).
P C V 1 c ov erag e h as b een m ai ntai ned at 88% , w h ereas c ov erag e of P C V 2 and 3 h as i nc reas ed b y 1% poi nt c om pared to
prev
DoHS,i ous Annual
y ear. M Report
R 1 c ov erag e h as (2018/19)
2075/76 i nc reas ed c om pared to prev i ous y ear and M R2 c ov erag e h as i nc reas ed s i g ni f i c antly b y
7% poi nts c om pared to prev i ous y ear. F or m eas les eli m i nati on, h i g h c ov erag es of b oth M R 1 and 2 i s req ui red (> 95% ).
T h eref ore, c ov erag es of b oth M R 1 and M R 2 i s s ti ll not s ati s f ac tory . T h e c ov erag e of J E v ac c i ne h as als o i nc reas ed s li g h tly
b y 1% poi nt. T h e reporti ng rate f or i m m uni z ati on d atas et i n HM I S w as only 80% i n F Y 2075/76. T h eref ore, i t c an b e
as s um ed th at v ac c i ne c ov erag e i n ac tual i s h i g h er th an reported . (W HO - U N I C E F es ti m ates of nati onal i m m uni z ati on
c ov erag e f or N epal are av ai lab le on h ttps : //w w w . w h o. i nt/i m m uni z ati on/m oni tori ng _ s urv ei llanc e/d ata/npl. pd f
ami a
DPT-HepB-Hib 3 coverage including delayed doses given after 1 year of age is:
OPV3 coverage including delayed doses given after 1 year of age is:
i i g i m g a tag a a a ta t a a a a
a ai a i a i gt t m t a t ta t a i i
a ta t a t gi ag i agai t m t ta g t i a a a
a m t i t t
ig a a ag t a g t a m t
B ag a a i ti t ag
B i a a i a m a t i a g a tag ta t
m t ag i i t tag t
a i t a gi i t am a at a a gi
i ta ma at a a a i a i t
ag i i i ag a t m t ta g t a a
ta t at t a i i t a a ag a mai tai at a
ag a a i a i t m a t i a ag a
i a m a t i a a ag a i a ig i a t i t
m a t i a m a imi a ig ag t a i i
ag t a i t a a t ag
a i a a i a ig t i t g at imm i a ata t i
a i it a a m t at a i ag i a t a i ig
t a t mat a a imm i a ag a a a ai a
i t imm ia m it i g i a ata

ami a
4.1.11 Vaccination coverage by Districts :
4.1.11 Vaccination
Figure cov erage
4.1.3 Percentage by Dis tricts
of children : one year immunized with BCG
under
Figure 4.1.4 Percentage of children 12-23 months immunized with measles/rubella 2
Figure 4.1.3 Percentage of children under one year immunized with BCG
Figure 4.1.4 Percentage of children 12- 23 m onth s i m m uni z ed w i th m eas les /rub ella 2
DoHS, Annual Report 2075/76 (2018/19) 3 1

ami a
ig a t ag B a iti t i gt m ai
F i g uret 4 . i1. it a 4 . a1. 4t s hi owit s th e c ov eragage (% ) ofB B C G i andig M R t2 b ay d i s tri c t, iI ts s h aow th ea c om i pariBs on of f i rs tag
3 and v i s i ti and las t
aF v i i g s ure
i t . T 4h . e1. c 3 ovanderagt4 e. 1.of4 s B h C owG i s s thh ag ov erag e (% ) of B C G and M R 2 b y d i s tri c t, I ts s h ow th e c om pari s on of f i rs t v i s i tt eandi s only
i eg h c eri th an M R 2 li k e nati imat
onal w i s e B C G c ov erag e i i s ab ov a e 90% tb ut M t R 2 c m
ov erag las t
tv 72%i s i t . T h e c ov erag e of B C G i s h i g h ert th are
imm
. Approx i i m a ately 18 % t at
of c h i ld aren an M losRt 2upli k to i g w thi s ee i B m C m G uni
c om onal
e nati plete c ovim
z erag
ati on.e i Sos abth ovateh 90%
ealth b w utorkM erR 2c ouns elli nge i s s h only
c ov erag ould
b e i m . prov
72% Approx ed . i m ately 18 % of c h i ld ren are los t up to c om plete th e i m m uni z ati on. So th at h ealth w ork er c ouns elli ng s h ould
4.1.12 Vaccination
b e i m prov ed . coverage by province:
4.1.12 Vaccination cov erage by prov ince:
Figure 4.1.5. Prov ince wis e Three Years Trends of BCG cov erage ( % ) , FY 2073/ 74 to FY 2075/ 76
4.1.12 Vaccination cov erage
Figure 4.1.5. Province wise byThree
prov Years
ince: Trends of BCG coverage ( ), FY 2073/74 to FY 2075/76
Figure 4.1.5. Prov ince wis e Three Years Trends of BCG cov erage ( % ) , FY 2073/ 74 to FY 2075/ 76
Figure 4.1.6.Prov ince wis e cov erage ( % ) of DPT- HepB- Hib 3, FY 2073/ 74 to FY 2075/ 76
Figure 4.1.6.Province
Figure 4.1.6.Prov ince wis wise coverage
e cov erage ( % ) of(DPT-
) ofHepB-
DPT-HepB-Hib
Hib 3, FY 2073/3,74
FYto2073/74
FY 2075/ to
76 FY 2075/76


ami a
4.1.13. Province wise coverage ( ) of measles-rubella first and second dose FY 2073/74 to FY
2075/76
4.1.13. Prov ince wis e cov erage ( % ) of m eas les - rubella firs t and s econd dos e FY 2073/ 74 to FY 2075/ 76
Figure 4.1.7 MR 1s t Dos e Figure 4.1.8 MR 2nd Dos e
Figure
Figure4.1.9. Province
4.1.9. Prov ince wis wise coverage
e cov erage ( % ) of(Td)2of TdTd2 2+and
and , FYTd 2 ,75
2074/ FYto2074/75 to FY 2075/76
FY 2075/ 76
F i g ure 4 . 1. 5 to 4 . 1. 9 s h ow prov i nc e w i s e c ov erag e f or B C G ,DP T - HepB - Hi b 3 , M R 1, M R2, and T d 2/T d 2+ res pec ti v ely . I n
ig t i i ag B B i a
g eneral, v ac c i nati on c ov erag e i n all prov i nc es h av e i m prov ed c om pared to prev i ous y ear. F or B C G , DP T - HepB - Hi b 3 , M R 1
and T d 2/T d 2+ , P rov i nc e 2 h as reported th e h i g h es t c ov erag e, w h ereas f or M R 2, P rov i nc e 5 h as reporteda th e th i g h es t
g a a i a ag i a i a im m
i a B B i a i a t t ig t
ag a i a t t ig t ag Bagma i a
t a ag a t g at imm i a ata t i
Bagma i i t t i t im

c ov erag e. B ag m ati P rov i nc e h as reported relati v ely low er c ov erag es and th e reporti ng rate f or i m m uni z ati on d atas et i n
HMamiI S f or B aga m ati P rov i nc e i s th e low es t (55% ), w h i c h need s to b e i m prov ed .
4.1.14 Droput rates of vaccination:
4.1.14 Droput rates of v accination:
Figure 4.1.10. Dropout
Dropout rates
rates ( (% ) ) of
of different
differentv vaccinations, FY2073/
accinations , FY 2073/74 toFY
74 to FY2075/
2075/76
76
F i g ure 4 . 1. 10 s h ow s th at nati onal d ropout rates f or B C G v s M R 1, DP T - HepB - Hi b 1 v s 3 and M R 1 h av e all d ec reas ed

c om pared to prev i ous y ear s h ow i ng i m prov em ent and all d ropout rates are w i th i n 10% .
4.1.15 Vaccine was tage rates :

Figure 2.1.11. Vaccine was tage rates ( % ) , FY 2073/ 74 to FY 2075/ 76
Source: HMIS/ MD, DoHS; ^ I P V i n F Y 2073 /74 and f I P V i n F Y 2075/76

ami a
a t t a i B a t at t i a it i
at t imm i a i i m t a tag at a t
t ig t i a B a a i at a t ia i i i
a ma i i a a a i i a m tai t ai a t
a ig a tag at B a t a t a tag at B a a
ig t a t i i a a tag at a t a tag at
a im a i tai i a i t i i a a tag at
i i a a a i t m i i i g a i i a
i i ig a i gt a tag B i a t a a a tag at a
F or all re- c ons ti tuted v ac c i nes (B C G , M R, and J E ) th at need to b e d i s c ard ed w i th i n 6 h ours (1 h our only f or J E ) or at th e
t i i a a tag at t a i t a i a ig t m a t
end of i m m uni z ati on s es s i on w h i c h ev er c om es f i rs t, w as tag e rates are ex pec ted to b e h i g h er. F urth er, i n N epal, f or B C G ,
i M R and aJ E v ac c i nes , at leasa t ‘ ione v i alt per s esa s i on’ apoli c ay i s tag at s im alla s es s i onts i z es i b ec iausa e of s parsa etag
us ed , and aton i n
populati
h i lly and m ountai nous terrai nah avi etto b e allow ed t h i g h eraw tag at . B ec aus ie of ith es e reas ons i, thi e w as tag e ratest f aor
as tag e rates
i B C G anda J E tagare h i at
g h er th an th e i nd ti c ati v e w as tag e rates oft 50%a and 10% res pec ti v ely . How ev er, th e w as tag e rate of M R
h as i m prov ed and i s s us tai ned i n F Y 2075/76, and i s b elow th e i nd i c ati v e w as tag e rate of 50% . T h i s i s prob ab ly b ec aus e
af ter i ntrod uc ti on of M R 2, num b er of c h i ld ren rec ei v i ng M R v ac c i ne i n a s es s i on i s h i g h er lead i ng to les s w as tag e. F or
4.1.16DP Access
T - HepB - Hiand
b and utilization
O P V , th e natiof
onalimmunization
w as tag e rates are services:
b elow th e i nd i c ati v e w as tag e rate of 25% f or b oth v ac c i nes , b ut
h as i nc reas ed s li g h tly c om pared to prev i ous y ear. F or P C V v ac c i nes , th e nati onal w as tag e rate i s ab ov e th e i nd i c ati v e
a w asa tag mm e rate ofi 10%
a . I n F Y 2075/76,
g am f I P V a w asati ntrod tat
uc ed , th e w t as tag ei rate
t i oft w h i c h ai s 27% . iT h ii s iti s v aery low th ianaprev i ous
imm w asi taga e rate of I P iV , b ut s h ould
i t ib et lowa er th an
at20%g i i at g t ai B i
4.1.16
ag aAcces s and utiliz
t at ation of im m uniz ation
B is erv ices : B i t t a i i it a
i aN ati onal I m immm uni z ati on P rog ram ev aluates s tatus of th e d i s tri c ts b y ac c es s i b i li ty and uti li z ati on of i m m uni z ati on s erv i c es .
ia i
Di s tri c ts are c ateg ori z ed i n c ateg ory 1 to 4 on b as i s of DP T - HepB - Hi b 1 c ov erag e and d ropout rate of DP T - HepB - Hi b 1 v s
DP T - HepB - Hi b 3 to k now th e ac c es s i b i li ty and uti li z ati on of i m m uni z ati on s erv i c es res pec ti v ely .
a i t i t at g i a a a B i ag a ia
Table 4.1.4. Dis trict categoriz ation bas ed on acces s ( DPT- HepB- Hib 1 cov erage) and utiliz ation ( DPT- HepB- Hib 1 v s . DPT-
B i B i
HepB- Hib 3 dropout) , FY 2075/ 76
t
Category 1 Category 2 Category 3 Category 4
( les s Problem ) ( Problem ) ( Problem ) ( Problem )
High Cov erage ( ≥80% ) High Cov erage ( ≥80% ) L ow Cov erage ( < 80% ) L ow Cov erage ( < 80% )
L ow Drop- Out ( < 10% ) High Drop- out ( ≥10% ) L ow Drop- out ( < 10% ) High Drop- out ( ≥10% )
T aplej ung , Si rah a and Rautah at O k h ald h ung a, Dh ank uta, No dis trict
Sank h uw as ab h a, T erh ath um , P anc h th ar,
Soluk h um b u, K h otang , 2 dis tricts I lam , Dolak h a,
B h oj pur, J h apa, M orang , Si nd h upalc h ok , Dh ad i ng ,
Suns ari , U d ay apur, N uw ak ot, K ath m and u,
Saptari , Si rah a, Dh anus a, L ali tpur, Ram ec h h ap,
M ah ottari , B ara, P ars a, C h i taw an, G ork h a,
Ras uw a, B h ak tapur, M anang , M us tang ,
K av repalanc h ok , Si nd h uli , M y ag d i , K as k i , L am j ung ,
M ak w anpur, N aw alparas i T anah u, Sy ang j a, P arb at,
E as t, B ag lung , Ruk um P alpa, B ard i y a and
E as t, Rolpa, P y uth an, K anc h anpur
G ulm i , Arg h ak h anc h i , 25 dis tricts
N aw alparas i W es t,
Rupand eh i , K api lb as tu,
Dang , B ank e, Dolpa,
M ug u, Hum la, J um la,
K ali k ot, Dai lek h , J aj ark ot,
Ruk um W es t, Saly an,
Surk h et, B aj ura, B aj h ang ,
Darc h ula, B ai tad i ,
Dad eld h ura, Doti ,
Ac h h am and K ai lali
50 dis tricts

N ote: th e g i v en DP T - HepB - Hi b 3 c ov erag es us ed i n th e tab le ab ov e d oes not i nc lud ed d elay ed v ac c i nes g i v en af ter 1 y ear of ag e

ami a
a t at i t i t a i at g g a g ia i i a
i a m i t i t i t i at g i t i a a i g im m ti
imm i a a a ia at a a i t i t a i at g g
a ia a i t i t a i at g a g ia a
i t i t i i at g a ia
4.1.17 VACCINE PREVENTABLE DISEASES SURVEILLANCE
t t at gi i t a at a i a tai a i
ta i a t imi a a a i a t at gi a a it i t i
i t tai i tat t g a a i a t i a a i m a
imi a a a t a at t tai imi a tat
a at a B a i a a a i a t a i ta i a
i ig ag it a i i i imm i a i im ta t t a i t i
ig a it i a i im ta t t t tat t i a t g
t a a i m t t i
t i a i a a i i a a t a i aa i i a ta t
i a i m a a a a ata t ta i a a
i t g at i t i i a t i a a t ai
m a a ai a i t g at i t i i a t
t i a t i a a t t g tt t
t g g it a a m a i a it a
i m t i a i ai a t ia i a ta i a g ita
a m a a t i a
i a i ai a t ia i a m i a m i g a
t at ata ita it t i imi a i a
ta i i a a t at a i ita i i a it it t
i i a ata m B i a it a ia i m
i t a m i i a t a i i t i a m a
gat a i i t i i imm i a a imi a ata m
ta i i a it a ia i m mm a ta i a i
i t i a a ta i i a it a a
t t m it it g g a i a ta B i aa t t at i a
ag i a g t i a g ita a m i
t t g it i at ma a a i ita i a
i it a i g ita iat i a tm t ata a m at i a i ga ga
ita
i a ata gi a a at m mi t mi t a ig it t
g m t a a
4.1.18 Acute flaccid paralysis surveillance, FY 2075/2076
at a i i a a t i g t g it t t ti i t
t a t ia gi a a i i i t a a mai tai
t i tat i i a i t a t mai a i a i i at i
at i at a t ta a a a a
a at t at i m

ami a
Figure 4.1.12.Reported
Figure 4.1.12. Reported acute
acute flaccid
flaccid paraly paralysis
s is ( AFP) cas(AFP)
es by cases
dis trict,byFYdistrict, FY 2075/2076
2075/ 2076
Figure 4.1.12. Reported acute flaccid paraly s is ( AFP) cas es by dis trict, FY 2075/ 2076
Source: FWD and WHO- IPD, Nepal

F i g ure 4 . 1. 12 s h ow s total reported AF P c as es b y d i s tri c t f or F Y 2075/2076. T h e total num b er of AF P c as es reported w ere
3 ig3 2 c as es f rom 64 d i s tritc tsta. T h e rem tai ni ng 13 d ai s tri c ts (Darc i th ula,
i t Hum la, Dolpa, Ruk um - E , M ty agtad i , M usmtang , M anang ,
Ram
Source:
a
ec h FWD ap, K and t
h otang
WHO-, IPD, B h oj Nepal a m i t i t
pur, Dh ank uta, T erath um , T aplej ung ) d i d not maireporti g any AFi tP ic ast e. M aos t of ath es e m d i s atri c ts are
sF pars a m i th ag i v ely lestas num
g a ofa und g am a ag e populati ta g on. B a ta aty earmf rom any
i g ureely4 . 1.populated12 s h ow s w total relati
reported AF P c as esb er
b y d i s tri c terf or
15F y Y ears
2075/2076. T h e totalAtnumleasb ert one
of AFAF P P c c asas ese per
reported w ere
d3 a3i s 2tric c ast w es igthf rom50,000
i64 d und t er 15 y t a
ears populati ona i s ex pec tedt f or q t uali ty s i
urv tei i t
llanc a
e of AF P a
.
i s tri c ts . T h e rem ai ni ng 13 d i s tri c ts (Darc h ula, Hum la, Dolpa, Ruk um - E , M y ag d i , M us tang , M anang ,
at it
Figure a ap, K h otang
Ram ec h 4.1.13. Non- mpolio
, B h oj Acute
pur, Dh Flaccid
ank uta,Paraly
a ag, T aplej
T eraths isum ( NP AFP) ung a ) byd i d disnot
rate ttrict,a FY
report
t 2075/
any AF2076
a a ma
P c as e. M os t of th es e d i s tri c ts are
i t i t it a a i t a it
s pars ely populated w i th relati v ely les s num b er of und er 15 y ears ag e populati on. At leas t one AF P c as e per y ear f rom
i a any
d i s tri c t w i th 50,000 und er 15 y ears populati on i s ex pec ted f or q uali ty s urv ei llanc e of AF P .
Figure
Figure 4.1.13.4.1.13. Non-polio
Non- polio AcuteAcute
FlaccidFlaccid
Paraly s Paralysis
is ( NP AFP) (NP
rate AFP) rate FY
by dis trict, by2075/
district,
2076 FY 2075/2076

F i g ure 4 . 1. 13 s h ow s non- poli o AF P rate b y d i s tri c t. N ati onal non- poli o AF P rate i s 3 . 86 per 100,000 und er
populati on, w h i c h i s ab ov e th e req ui red rate of at leas t 2. T h ere are 64 d i s tri c ts w h i c h h av e reported AF P c as e
w h i c h 56 d i s tri c ts h av e m et th e non- poli o AF P targ et rate of 2 or m ore, w h ereas 7 d i s tri c ts h av e non- poli o
amib etw een a1 – 1. 9, and 1 d i s tri c t h as non- poli o AF P rate b elow 1 per 100,000 und er 15 y ears populati on.
ig i at iti t a a i at i
Figure 4.1.14 a Adeq auate s tool i collection
i a trate of AFP i casat es by atdis trict,
a t FY 2075/a 2076 i t i t
F i g ure 4 . 1. 13 s h ow s non- poli o AF P rate b y d i s tri c t. N ati onal non- poli o AF P rate i s 3 . 86 per 100,000 und er 15 y ears
i a t a t i i t i t a m tt i ta g t at
populati on, w h i c h i s ab ov e th e req ui red rate of at leas t 2. T h ere are 64 d i s tri c ts w h i c h h av e reported AF P c as es , out of
m a i t i t a i at t a i t i t a i
w h i c h 56 d i s tri c ts h av e m et th e non- poli o AF P targ et rate of 2 or m ore, w h ereas 7 d i s tri c ts h av e non- poli o AF P rate
at a a
b etw een 1 – 1. 9, and 1 d i s tri c t h as non- poli o AF P rate b elow 1 per 100,000 und er 15 y ears populati on.
ig at t at a iti t
Figure 4.1.14 Adeq uate s tool collection rate of AFP cas es by dis trict, FY 2075/ 2076

F ig
i g F ure
i g ure4 . 1. 144 . 1.s h 14ow s s h ad oweqa uate
s ad s eqat uate
tool c tollecs tool c ollec
ti on rate f rom tiat on rate
reported m fAFromP c as reported
tes . T h e natiaAFonal . aT h c ollec
P AFc asP ess tool e anati
ti ononalrate t AF P s ,tool c ollec ti on ra
i s 98%
at i
w h w i c h h i ci s h ab i s ov abe thove etargth et i i a
e oftarg80%etorof m 80% t ta
ore f ororth m i s ore g t
f or thO ut
i nd i c ator. m
i s ofi nd th i ceator. O ut
64 d i s tri t i
c ts of i i at
w h i thc h eh av64 e reported t t
d i s tri c ts AF w P h c i asc h es h, thav ee reported AF P c
m i ajtorii tyt h av eiac h i ev aed ad eq uate t s tool c olleca ti on rate t of ma at or abit ov ea80% aex c ept i one ad i s tri c t at w i th tht e rate b etw een 60% -
m aj ori ty h av e ac h i ev ed ad eq uate s tool c ollec ti on rate of at or ab ov e 80% ex c ept one d i s tri c t w i th th e rate b etw
at , and atone d ai s tri c t w i th ad eq uatet s tool c ollec
79% i t tii on
t rate it lest s th an at 60% . t a i t i t it
a 79% at
, and t one d i s tri c t w at
i th ad eq tuate
a s tool c ollec ti on rate les s th an 60% .
Table 4.1.5. Non- polio AFP rate and s tool collection adeq uacy rate by prov ince, FY 2075/ 2076
Table
Table4.1.5.
Prov ince Non-polio
4.1.5. AFP
Non- polio raterate
AFP
NP AFP and stool
NPand collection
AFP s tool adequacy
Stool collection
Adeq uacy adeq rate
uacy by province,
rate by prov FY 2075/2076
ince, FY 2075/ 2076
Cas es Rate
Prov ince NP AFP NP AFP Stool Adeq uacy
P rov i nc e 1 4 1 2. 77 98
Cas es Rate
P rov i nc e 2 85 4 . 72 100
B ag P m rov
ati i nc e 1 54 4 2.192 2. 92
77 98
G andP rov
ak i i nc e 2 27 85
3 . 64 4 . 95
72 100
P rovB i agnc em 5ati 62 544 . 22 2. 98
92 92
K arnali 26 4 . 98 100
G and ak i 27 3 . 64 95
Sud ur P as c h i m 3 7 4 .3 9 98
P rov i nc e 5
Total 332 62
3.86 4 . 98
22 98
Source: FWD
K arnali and WHO- IPD, Nepal 26 4 . 98 100
Sud ur P as c h i m 3 7 4 .3 9 98
Total 332 3.86 98

ami a
a i a a at a a at t at i
a i a a i i at a a a a
a at t at a i a aia a im a t
i at a i a a ai a a i a at t
at
T h e T ab Measles-rubella
4.1.19 le 4 . 1. 5 s h ow s non- surveillance,
poli o AF P c as es FY
and2075/2076
rate, and ad eq uate s tool c ollec ti on rate b y prov i nc e. E ac h prov i nc e h as
ac h i ev ed non- poli o AF P rate ab ov e 2 per 100,000 und er 15 y ears populati on, and ad eq uate s tool c ollec ti on rate ab ov e
80% . P grov ti nc e 2, 5, K arnali
a anda Sud ur P as c ah i m h aav ie greported
a i non- polito AF P rate ab ova ea4 . P rov i ncg e 2ita
and K arnalia h av e
ac h i ev edm100% adi eq uate s tool
a c ollec
i tti on rate.a a a t gi a ta g t a a a
a a t a a ta g t t aa i a i i t i m
4.1.19 Measi les - rubella
m s urv eillance,
a aFY 2075/m2076 a a i i a
I na Aug us i t 2018, N epala w as m c ertiaf i ed ast h av i ng ac h i ev ed c ontrol of rub ella t andg c ong eni tal rubi ella s m y nd rom e. T h i s
m c ertiaf i c ati ona i s tw oay ears ah ead of i th e reg i onal targ m et y aear of t 2020 and one y ear mah aead of ath e natiaonal targt et of 2019.
C ontrol of t rub ella and i C RSi i s ac h i iev ed i f th m ereai s 95% or imim ore
a red uc igti on i n num b er of rub tella at c tas es f roma 2008 lev els .
a ac h i ev ed 97% red
N epal i m a i n ruba ella c as es ai n 2017
uc ti on a (22) i as c om a pared to 2008 m (786).
ta imm How ev er, i aev en th aoug h i red uc ti on
i namnum aig b er of m ieast les c as es h as b een 98%a i an 2017 i (99)a c oma pared i m t (54 ig
to 2003 19), m eas les ag c as es mh avae not b een reda uc ed
to z tero w h i c h i i s req ui red f orimm
m eas lesi aeli m i nati aon. F i g ure 2. 1.t 14 s mai a tth ere h as b teen
h ow s th at i d aras ti ic red m t i n m eas les
uc ti on
andimirubaella c as es mi n aN epal. Supplem ig ag i m m uni ztati on ac ti v i ti es m(c ama pai g ns ), i ntrod
entary a auc tiiona of rubi ella v ac i c i ne, and
ac h i ev em atentaof h i g h c ov erag e of m ag eas les - rubm ella
a f i rs t d os e i an routi ne i m m uni iz ati on h av te b aeen tha et m ai n tf aci tors f or th i s
ac h i ev iem ent. F or eli m i nati on of m eas g les , ht i g h ac ov eragme aof b oth a d os es of m aeas lesimi - a a a i ati i a i t
at all lev els . T h ae c ov eragi e of mm eas a les - rub ella
a i a s ec ond d os e i
am aig is s ti ll not s ati s
i g f ac tory . I t i s t only i 73 % i n F Y 2075/2076. T o
iprog resi s gtow t ard sgtm eas ilesg and rub ella imm eli m i natii on
a b y 2023 as per th e res oluti on, nati on- w i d e m eas les v ac c i nati on
c am pai g n i s b ei ng c ond uc ted i n F Y 2076/2077 i nc lud i ng s treng th eni ng of routi ne i m m uni z ati on.
Figure 4.1.15 Confirmed measles and rubella cases, Nepal, 2003- 2019
Figure 4.1.15 Confirm ed m eas les and rubella cas es , Nepal, 2003- 2019

Meas les v accination
Measles vaccination giv engiven
in Nepal
ins Nepal
ince thesince
s tart ofthe
EPI start
in all disoftricts
EPI ( in
cov all
ered 75 dis tricts
districts by 1988) 75 districts by 1988)
(covered
MR firs t dos e s tarted in 2013; MR s econd dos e s tarted in Septem ber 2015
MR first dose started in 2013 MR second dose started in September 2015
F i g ure 4 . 1. 15 and T ab le 2. 1. 6 s h ow s lab oratory c onf i rm ed m eas les and rub ella c as es b y d i s tri c t and prov i nc e res pec ti v ely
i n F Y 2075/2076. T h ere w as a total of 4 24 c onf i rm ed m eas les and 3 7 c onf i rm ed rub ella c as es i d enti f i ed th roug h
ami a
ig a a a at m m a a a a i t i ta
s us peci ted m eas les s urvi ei llanc e. Am ong total c onf a iarm t edta m eas les c as esmi n F m a a
Y 2075/2076, m ty i s f rom
th e m aj ori P rov i nc e 2
a a i t g t m a
(4 3 . 6% ), f ollow ed b y B ag m ati (23 . 6% ) and P rov i nc e 5 (20% ). i a m g t ta m m a
a i t ma it i m i Bagma a
i
s O us ne
pec ofted th m eeas
c ardles i nal
s urv i nd i c ators
ei llanc e. Am f or
ongm total
eas lesc onf - rubi rm ella
ed ms urv
eas eilesllanc
c as ese i s i nnon- m eas les non-
F Y 2075/2076, th e rub
m aj ella
ori ty rate
i s f rom(N M P rov
N Ri ncrate)
e 2 w h i c h s h ould
(4b 3 e. 6%at ),leas t 2edper
f ollow b y 100,000
B ag m ati (23populati
. 6% ) andon.P rovT h i at
nc ei s 5, (20%
at leas
). t 2 s us pec ted m eas les /rub ella c as es (w h i c h af ter lab oratory tes t i s
t a i a i i at m a a i a i m a a at
non- m easatles and i non- rub ella) per at 100,000a t populati on s h ould b ae reportedat if or at q ualiaty t m eas les - rubt ella s urv ei llanc e. All
O prov
ne ofi ncth ese c exard c i ept
nal i Sud
nd i c ur
ators
P as f or
c h m i m easP rov
les - i rub
nc ella
e h s urv
av e ei llanc
ac h i ev eed i s N non-
M N m Reasrate
les abnon-
ov rub
e ella
2. T h rate
e (N onal
nati M N R N rate)
M N w Rh rate
i c h s h i s ould
3 . 73 per 100,000
m a a a i a a at t ti m a a a
b e at leas t 2 per 100,000 populati on. T h at i s , at leas t 2 s us pec ted m eas les /rub ella c as es (w h i c h af ter lab oratory tes t i s
populatia on. t a it m a a i a i t
non- m eas les and non- rub ella) per 100,000 populati on s h ould b e reported f or q uali ty m eas les - rub ella s urv ei llanc e. All
a im i a a i at a a a at i
prov i nc es ex c ept Sud ur P as c h i m P rov i nc e h av e ac h i ev ed N M N R rate ab ov e 2. T h e nati onal N M N R rate i s 3 . 73 per 100,000
Figure a 4.1.16. Confirm ed m eas les and rubella cas es by dis trict, FY 2075/ 2076
populati on.
Figure 4.1.16. Confirmed measles and rubella cases by district, FY 2075/2076

Figure 4.1.16. Confirm ed m eas les and rubella cas es by dis trict, FY 2075/ 2076
Source:
Source:FWD
FWDand WHO-
and IPD, IPD,
WHO- Nepal
Nepal
Table 4.1.6.NMNR
Table 4.1.6. NMNRrate,rate,
and and
confirmconfirmed
ed m eas lesmeasles andcasrubella
and rubella cases
es by prov ince,by
FYprovince,
2075/ 2076 FY 2075/2076
Table 4.1.6. NMNR rate, and confirm ed m eas les and rubella cas es by prov ince, FY 2075/ 2076
Prov ince NMNR NMNR Confirm ed Confirm ed
Prov ince cas esNMNR rate NMNR Meas lesConfirm ed
Rubella Confirm ed
cas es rate Meas les Rubella
P rov i nc e 1 274 5. 62 3 1 8
P P rovrovi nci nce 2e 1 228 274 5. 62 185 (4 3 . 6% ) 3 1
3 . 73 3 8
B P agrovm ati
i nc e 2 4 3 1 228 6. 86 3 . 73 100 (23 . 185
6% ) (4 3 . 6% 13 ) (3 5% ) 3
G B and
ag m ak ati
i 118 4 3 1 4 . 72 6. 86 11 100 (23 . 6% ) 1 13 (3 5% )
P G rovandi nc ake 5i 269 118 5. 3 8 4 . 72 85 (20% ) 11 3 1
K P arnali
rov i nc e 5 14 8 269 8. 3 6 5. 3 8 7 85 (20% ) 6 3
Sud ur P as c h i m 54 1. 88 5 3
K arnali 14 8 8. 3 6 7 6
Total 1522 3.73 424 37
Sud ur P as c h i m 54 1. 88 5 3
NMNR: non- m eas les non- Total
rubella 1522 3.73 424 37
NMNR: non- m eas les non- rubella

ami a
4.1.20 Acute encephalitis syndrome (AES) surveillance, FY 2075/2076
a t at a a ai t m a a i ma a i a
am aig ta t i a m t i ig i iti t a i
4.1.20
a i t Acute encephalitis
i a s y ndrom
i ma e ( AES) s urv
i t eillance, FY 2075/
imm i a 2076 t iti t
As a c onc t entrated m aJ apanes e enc ephtaali ti s (J E ) c ontrol m eas ure, ph asige- w i i s eam tas s iv ac c i natiaon c am pai g ns w ere s tarted t in
2006 a a iand w ere c om pleted i n 3 1 h i
i ag h - ri s k d i s tri c ats b y 2011.t J E v ac c i ne
m t w as i ntrod uc
iti t ed i n ph as e- w
a a i s e m anner i n th e routi
i g ne
i m m uni z ati on of th es e 3 1 d i s tri c ts b y 2012. Af ter th es e m eas ures w ere tak en, J E b urd en red uc ed s i g ni f i c antly i n N epal.
ma a i a am aig i t mai i g i t i t i a i a i t i t
How ev er, ov er th e y ears , as i d enti f i ed b y s urv ei llanc e, J E w as reported f rom oth er d i s tri c ts of N epal as w ell. F ollow i ng
imm i a a mai i g iti t i i ig
m as s - v ac c i nati on c am pai g n i n th e rem ai ni ng d i s tri c ts i n 2016, J E v ac c i ne w as i ntrod uc ed i n th e routi ne i m m uni z ati on of
i a a ig i a t i m a t t i i a a i a
all rem ai ni ng 4 4 d i s tri c ts i n J uly 2016. As s h ow n i n F i g ure 2. 1. 16, J E b urd en i n N epal h as red uc ed s i g ni f i c antly i n 2019
a ta t
c om pared to th e i ni ti al y ears w h en s urv ei llanc e w as s tarted .
Figure 4.1.17. Reported AES and lab confirmed Japanese encephalitis cases, Nepal, 2004 – 2019
Figure 4.1.17. Reported AES and lab confirm ed Japanes e encephalitis cas es , Nepal, 2004 – 2019
ig t at iti t a t a i t t
F i g ure 4 . 1. 17 s h ow s th at 70 d i s tri c ts h av e reported AE S c as es i n F Y 2075/2076. O ut of th es e 70 d i s tri c ts , f i v e d i s tri c ts
iti t iti t a a a i i a a at ma a i a t ig m
(J h apa, Suns ari , Si rah a, K ath m and u, K as k i ) h av e reported h i g h er num b er of AE S c as es (b etw een 51- 100), and M orang h as
a t a a g a t t ig t t ta a
reported th e h i g h es t (> 100). I n total, 124 1 c as es of AE S w ere reported (T ab le 2. 1. 7). Am ong th e total reported AE S c as es ,
t a m g t t ta t a
only 3 6 (2. 9% ) w ere lab oratory c onf i rm ed f or J E . T h i s i s a m aj or red uc ti on c om pared to th e y ears b ef ore J E v ac c i nati on
a at m i i a ma m a t t a a i a
w as s tarted w h en around 50% of th e AE S c as es w ere pos i ti v e f or J E . T h e m aj ori ty of lab oratory c onf i rm ed J E c as es (13 out
a ta t a
of 3 6; 3 6. 1% ) w ere reported f rom P rov i nc e 2.
t a i ma it a at
m a t t m i

ami a
Figure 2.1.18. Reported AES and laboratory confirmed Japanese encephalitis cases by district, FY
2075/2076
Figure 2.1.18. Reported AES and laboratory confirm ed Japanes e encephalitis cas es by dis trict, FY 2075/ 2076
Figure 2.1.18. Reported AES and laboratory confirm ed Japanes e encephalitis cas es by dis trict, FY 2075/ 2076

Source: FWD anda WHO- IPD, Nepal a
Table 4.1.7. Reported AES cas es and confirm ed JE cas es by prov ince, FY 2075/ 2076
Table 4.1.7. Reported AES cases and confirmed JE cases by province, FY 2075/2076
Prov inceTable AES
4.1.7.
cas Reported
es AES
JE cascases es and confirm ed JE cas es by prov ince, FY 2075/ 2076
Prov ince 1 Prov ince
433 AES cas es 6 JE cas es
Prov ince 2 Prov ince203
1 433
13 ( 36.1% ) 6
Bagm ati Prov ince329
2 203 3 13 ( 36.1% )
Gandaki Bagm ati138 329 2 3
Prov ince 5 Gandaki 75 138 8 2
K arnali Prov ince39
5 75 1 8
Sudur Pas chim K arnali 24 39 3 1
Total Sudur Pas chim
1241 24 36 3
TotalIPD, Nepal 1241
Source: FWD and WHO- 36
a a
4.1.21 Neonatal tetanus s urv eillance, FY 2075/ 2076
4.1.21 tetanus
I n N epal, neonatal Neonatal N tetanus
(N tetanus s urv on
eillance,
T ) eli m surveillance,
i nati h FY
w as ac FY 2075/ 2076 T h i s s tatus h as b een m ai ntai ned s i nc e th en. I n F Y
i ev2075/2076
ed i n 2005.
4.1.21 Neonatal
2075/76, 3 IN nN N T epal,
c as es neonatal
w ere reportedtetanus (one
(N N T eac
) elih m f rom
i nati on w as d i acs trih ci evts edF i g i n2. 2005.
th ree 1. 18). TT h h i es s nati
tatusonal
h asi ncb i een
d enc m e airate
ntai ned
of N N s i Tnc i es th en. I n F Y
2075/76,
0. 012 per 1000 3 N s . N ata
li v eab i rth T c as testaw ere reportedimi(one a eac h f rom
a a i th ree i tri c ts
d i s F i g i 2. 1.tat18). T ah e nati onal mai i nctaii d enc e rate of N N T i s
0.i 012 per t 1000 li v e b i rth s . a t a mt iti t ig
a a i i at i i it

ami a
Figure
Figure4.1.19.
4.1.19.Neonatal
Neonataltetanus
tetanus cases,
cas es , FY
FY 2075/2076
2075/ 2076
Figure 4.1.19. Neonatal tetanus cas es , FY 2075/ 2076
Source: FWD and WHO-

a IPD, Nepal a
4.1.22 PROBLEMS/CONSTRAINTS AND ACTIONS TO BE TAKEN
4.1.22 PROBLEMS/CONSTRAINTS AND ACTIONS TO BE
N ati onal a annual
Source: FWD
a aand Rev WHO- i aew IPD, andi Nepal P rova i nc i al Annual i ia Rev i ewa m eeti i ng mi d enti gf i edi th e f ollowt i ng prob ilemg s and cmons trai nts and
rec om am end ed act ai ti ont toa b e tak en mm at d i f f erent a lev els t of i m ta m uni z ati atoni d eli v eryt s y s tem . imm i a i
T ab le 4 4.1.22 . 1.t8 mPROBLEMS/CONSTRAINTS AND ACTIONS TO BE
P robN ati lem onal s /C annual
ons traiRev nts i ew and P rov i nc i al AnnualAcRevti on i ew to m beeti e tak ng en i d enti f i ed th e f ollow i ng prob lem s and Res c onspons
trai nts
i b i li and
ty
rec om m end ed ac ti on to b e tak en at d i f f erent lev els of i m m uni z ati on d eli v ery s y s tem .
L ateTable b ud g 4.1.8: et releas Issues e andandleng Recommendations
th y proc es s from Provincial and National Review Meetings
T ab le 4 . 1. 8 B ud g et to b e releas e at ti m ely M O F /M O HP /DO HS
f or f uk P uwrob a, lem s /C ons trai nts Ac ti on to b e tak en Res pons i b i li ty
U nc lear L ateand b ud g too et releas m uc eh andti m leng e c thonsy proc um i esng s
T ax c learanc e and proc urem ent procM esO F s /M O HP /DO HS
proc es f or s f uk f uwora, tax c learanc e and B ud g et to b e releas e at ti m ely M O HP /DO HS/M D
s h ould b e f as t, eas y and trans parent
proc urem U nc lear ent and too m uc h ti m e c ons um i ng
T ax c learanc e and proc urem ent proc es s
L ac k proc of es trai s ned f or and tax s c k learanc
i lf ul eh um and an s h ould b e f as t, eas y and trans parent M O HP /DO HS/M D
proc urem ent
rec ours es i n new ly f orm ed s truc ture and
red uc i L ngac k i nof s trai ec tinedonaland pos s tk i lf ul ev en h um on an All new ly appoi nted and f res h s h ould b e DO HS/N HT C
rec ours es i n new ly f orm ed s truc ture and trai ned ab out N I P and E V M .
prog ram s ec ti on d uri ng th e res truc turi ng All new ly appoi nted and f res h s h ould b e
red uc i ng i n s ec ti onal pos t ev en on DO HS/N HT C
proc es prog s . ram s ec ti on d uri ng th e res truc turi ng trai ned ab out N I P and E V M .
I nad eq proc uate es s HRH. es pec i ally i n M etro/Sub P rov i s i on f or s uf f i c i ent v ac c i nators f or th e M oH/DoHS/DHO ,
- M etropoli tan, M C H
I nad eq uate HRH es pec i ally i n M etro/Sub / I ns ti tuti onal c li ni c s M etro / Sub - M
P rov i s i on f or s uf f i c i ent v ac c i nators f or th eetropoli tan, M C H / M oH/DoHS/DHO L oc al G ov, ernm ent
and i ll-- d M efetropoli i ned Jtan, D ofM C AHW H / I ns & ti tuti AN onal
M (f c or li ni c s M I nsetro ti tuti/ Sub onal - M C etropolili ni c s tan, M C H / L oc al G ov ernm ent
v ac c i nati and ons i ll- d )ef i ned J D of AHW & AN M (f or I I nsnc tiorporate tuti onal C lires ni c s pons i b i li ty of d eli v eri ng
v ac c i nati ons ) I i ncm orporate m uni z ati onpons res s ervi b i i c li ety i ofn J d obeli v Des eri ngc ri pti on of all
i m m uni z ati on s erv i c e i n J ob Des c ri pti on of all
HA, SAHW , AHW /AN M to c ond uc t
HA, SAHW , AHW /AN M to c ond uc t
i i m m m m uni uniz atiz ationon s es s s esi onss i ons
I nad eq I nad uate c oord i nati on,
eq uate c oord i nati on, c ollab orati on c ollab orati on
and c ooperatiand c ooperati on i nonall i n lev
all level el
P oor q P uali oor tyq uali i m tym i uni
m m z uni atiz on
ati on d ata: d ata:U U ndnd er er J J oioint nts upporti
s upporti v ev s e s uperv
uperv i s i oni s ofi on I m ofm uni I m z m atiuni
on z ati HF on/HO /P HFrov/HO /P rov i nc e/
i nc e/
and ov ander reporti ov er reporti ng ng asas per perHMHM I S. I S. F W D/HM F IW S D/HM I S
Streng Strength thenen s upporti
s upporti v e s v uperv e s uperv i s i on i at s i on all lev
at elsall lev els
Q uarterly rev i ew of perf orm anc e of d ata at
Q uarterly rev i ew of perf orm anc e of d ata at
HF /DHO lev el as – HM I S 9. 2, 9. 3 and 2. 5
HF /DHO lev el as – HM I S 9. 2, 9. 3 and 2. 5
P rov i s i on of DQ SA to th e RHDS and d i s tri c ts
P rov i s i on of DQ SA to th e RHDS and d i s tri c ts
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P rob lem s /C ons trai nts Ac ti on to b e tak en Res pons i b i li ty
L ate b ud g et releas e and leng th y proc es s
B ud g et to b e releas e at ti m ely M O F /M O HP /DO HS
f or f uk uw a,
U nc lear and too m uc h ti m e c ons um i ng
T ax c learanc e and proc urem ent proc es s
proc es s f or tax c learanc e and M O HP /DO HS/M D
s h ould b e f as t, eas y and trans parent
proc urem ent
L ac k of trai ned and s k i lf ul h um an
rec ours es i n new ly f orm ed s truc ture and
All new ly appoi nted and f res h s h ould b e
red uc i ng i n s ec ti onal pos t ev en on DO HS/N HT C
trai ned ab out N I P and E V M .
prog ram s ec ti on d uri ng th e res truc turi ng
proc es s .
L ow ac h i ev em ent of F I D ac c ord i ng to O ri entati on, C apac i ty b ui ld i ng and M oHP , M oF AL D,
nati onal targ et em pow erm ent of loc al g ov ernm ent DoHS/F W D,
Ac c elerate of F ull I m m uni z ati on d ec larati on at P rov i nc e, m uni c i pal
all lev els
C oord i nati on w i th i nters ec toral s tak eh old ers
N o prov i nc i al v ac c i ne s tore at K arnali E s tab li s h m ent of new v ac c i ne s tore at k arnali M O HP /DO HS/P rov i
P rov i nc e and prov i nc e N o. 2 P rov i nc e and prov i nc e N o. 2 nc e
I nad eq uate C C E q ui pm ent repai r, P rov i s i on of eng i neer and ref ri g erator DoHS/ M D/F W D
m ai ntenanc e and replac em ent, lac k of tec h ni c i an at prov i nc i al lev el
tec h ni c i an Supply of c old c h ai n s pare parts
Replac em ent of ag ei ng eq ui pm ent
reg ular repai r of c old c h ai n eq ui pm ent
I nad eq uate V ac c i ne Store C apac i ty Streng th en th e v ac c i ne s tores w i th new M oHP , DoHS, M D,
s pec i ally c entral lev el b ui ld i ng s i n c entral s tore F W D
.

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4.2 Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

4.2.1 Background
Chronological development: Community Based-Integrated Management of Childhood Illness

(CB-IMCI)
a i i a i t ga t ia a i a g am a
i i at i t t i at t g am a i i at i
ma imi t at i at t a m a t atm t m at
t mm it i t a a t i i t i a t at
t atm t m a m a a i t mm it t a a m
i t a m i it a am a B g am a at t m
m t ti a imm i a a i at i t B g am
g am a i t i a a i i t i ta a t t t mm it a i a
t g m t i t m g t B i t i a am it a mm it Ba
t g at a ag m t i B a it ta g t am a a i
am at B i t ma i i i a i m ia
ia a ma a ia m a a ma t i t at gi a t i im i g
g a a ma ag m t i at i i a at t m
t gt i g a im i g mm it a a a i g
m a a i m ta it a i at i B g am i
a i im m ta B a m t i a i i i a g
im ta t i t
Community-Based New Born Care Program (CBNCP)
t a a ma a g g i a i a t m ta it
t ata m ta it a t ggi a t t
a ta g t i t ia at mm it tat t
t at ma a m ta it i at i a ia it ig t
a t mia m t a m at t a a ata a t t at g
Ba t i mm it Ba a g am B a ig i
a i t i B i at t at gi i t a i a g
mm i a m i t a i t ata a ma ag m t ata
i a it ig t a ma ag m t t mia a
g i a ita it a ia t m i t m i it at
a a i t im m t t i i ig at aimi g
t t m ii a i t g m t i t a B a
im ta t g am a a at i i t iti t t B a
im m t i iti t i g t a
a t B g am t at g t a m ia a ia a a
ig i a t t at a a i g a a a a
im B g am a m t m a mm it a
g am a t i t i a a ig ti t t
t ata i m ta it a ia a m ta itami g am a a
g am imm i a t t a a a a im i
B im m t iti t

ami a
t t g am B a B i a ti at i
i t a it a ag i B a B a imi a i
i i t g am ma ag m t i i a ta g t ia i i a t
g am a i at i t i ma ag m t ata i m a
a a i a ma ag m t it ig t g
a i g g i m at a i t a ma i i
i t a it a a ma i i a
agm t ma t am i it i a it i i a ia
t ma a g i a i at g am at g a i a
a a g i g t at t m i i gt i i t
i t g at B a i t a a ag t at i am a B
Community-Based Integrated Management of New-born and Childhood Illnesses (CB-IMNCI)
B i a i t ga B a B g am a t ii
t i i t g at a ag i i a i t a t
ma m i a it a ia a t ia i a i t mia
it ig t a i g a i g t a mai tai it aim t a ma
i i i m ia ia a a a ia a a a ti am g
a i i a i a
B g am a t at m a a i mat a
a iat a i i g a mm i i iti i i
i i i t i a m ta iag i a imm iat a i a
a a g ig t at a a am g i a i at i
a i at i i ma ag m t at i g a it ig t a i
mm i i a ma ag m t ata i t g am a
ii t t ata i it t ai at t g ima at a t a
i i
g am a ii t a ta t a it a a a m it i g t t
B g am i i a t ai i g it a a t a ag t ai i g i t a
t a i g t a i im m ta t g am it
m it i g a ii t t gt t g am a it a i g
t a t i i a i am g a t B g am a im m t i a
iti t
Facility-Based Integrated Management of Childhood and Neonatal Illnesses (FBIMNCI)
a i it Ba t g at a ag m t ata a i B a ag
a ig ia t a i a m i a at
i t t ig i t a ag i i t g it t g i g mm it Ba
t g at a ag m t ata a i B a ag i t t
i g t i g ga i t ma ag m t m i at ata a i i a
i it t g a a im m ta t i a ag t im m ti ata
a i at a t i a ag a t ma a i i
i i g m g iag a atm t a t ma a a t mm i
i t a iag i a t atm t ia a g ia a
ma t i a a mia t aim t a a itat t am at at i t i t ita it
i g a i t ma ag m i at a ata a a t
m a ma ag m t a a i t ai i g a ag i i t a am i
ami a
a i g ta a a t a at i t i t a gi a a gi a ita
Comprehensive New-Born Care Training package
i i at ai i ta t a a mi g a i t a at
t i ata m ta it a t t t t a i gt at
m i a ai i g a ag ita a a i
t i t ai i g t a iat i ia i m i a a m i a i g
i t ita i i g a i i i t gt at t m t
t ai a i at i a at a ii i i a a t ai i g
a ag t t at t ai i a g a
ma ag m t ma a a i i a ag i g i
a ma i g ata ita t ma t i
ma ag m t i a a ma ag m t i at i ig t a g ta
ata i a mm ata t ai i g a ta t m t m
a a a m t gi
a a at ai i g t a m i a ai i g
a ag i a a g t ai i g i i a it ami a
i ii
Free New-Born Care Services
m t a ii a ma t a g i tt g
a it at
a i im t i t t g am i t ta t i a
t at a i t t t Ba t t atm t i t
t i t i a a i i t a ag Ba i
at t a a ag iti t ita it ia a it
a ag B a a ita a t t a ita ata t i a it
i a ag g m t a ma ii i g ta i
i t im m t t a a ag t g t a g a t
a i a ag i t a i t tai a m tg a t
m ta it t g i a i ga t a i g am ma t i i
i i g t a t at i t i i i g a t
i a t i
Nepal Every Newborn Action Plan (NENAP)
it t ii a t t i ta at it
g a i a t it at a m a i a i i t i
a a t i t a a i i at t g t at gi i i
a ita ia at i a it a m t a a a a m
a a a a a aim t a i t a at
i i t a a it at t a it t ta i t t a

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4.2.2 Goals, targets, objectives, strategies, interventions and activities of IMNCI program
Goal
m a i i a a at g t a m t
• Targets of Nepal Health Sector Strategy (2015-2020)
m ta it at i it t
ata m ta it at i it t
• Targets of NENAP
ata m ta it at i it t
it t ta i t t
• Objectives
ata m i it a m ta it m g a a i
ata m i it a m ta it ma agi g ma a i
m i it a m ta it ma agi g ma a i am g
a i
• Strategies
a it a t g t m t gt i ga a i ia i a
i a a t at a i a gi a t
a a it i i g ti at a t
a i ia t g ma g a a i
m t t ai a i a a i ga g ammi g
4.2.3 Major interventions
• Newborn Specific Interventions

m it a a
m a a a a t ata a t m t a
a a ma ag m t at i g a i at i t
a a ma ag m t t ma it ig t a i
a ag m t i am g gi a t a i i g ia a
• Child Specific Interventions

a ma ag m t i ag t m t ma i i
i a m ia ia a a ti a a a a ia
• Cross-Cu ng Interventions
B a i a a g mm i a at g a a i a m
a gi a a ita
m g at t mm ia a ti a a i i
m i t a mm i a i a

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Vision 90 by 20
Vision 90 by 20
Vision 90 by 20
Figure 4.2.1 CB IMNCI Program Vision Institution
al
Delivery
Institution
al
Delivery
Under 5
children
with Newborn
To provide service
Pneumoni who had
Under 5 to 90% of targeted
a treated CHX gel
children group by 2020
with applied
with Newborn
Antibiotics To provide service
Pneumoni who had
to 90% of targeted
a treated CHX gel
group by 2020
with applied
Antibiotics Under five
children
with
Diarrhoea
Under five
treated
children
with ORS
with
and Zinc
Diarrhoea
treated
with ORS
Figure 4.2.1 CBand IMNCI
nd Zinc Program Vision
C BB - I M N C I progg am ram h aas aa vi i is i ont to provi i d etatargg eted t CBs erv i i c es tProgram
to 90% of t th e es mat mat popula a b y
Figure 4.2.1 IMNCI Vision
2020aas s h ow ni i ntth e d iag i ag ramam b elow .
C B - I M N C I prog ram h as a v i s i on to prov i d e targ eted s erv i c es to 90% of th e es mat popula b y
4.2.4 Major
4.2.4 Major activities2020 activities
as s h ow n i n th e d i ag ram b elow .
M aaj oraa i i es caarrii ed out t und ert th e I M N C I progg amm ram m e i i n F Y 2075/76 w ereaas s h ow ni i ntatab le
4.2.4 Major activities
b elow :
Capacity M Building aj or a i es c arri ed out und er th e I M N C I prog ram m e i n F Y 2075/76 w ere as s h ow n i n tab le
b elow :
C om preh ens i v e N ew b orn c are (L ev el I I ) 5 b atc h es of trai ni ng d one 95 M ed i c al o
Capacity Building
T rai ni ng to M ed i c al c er trai ned
C om preh ens i v e N ew b orn c are (L ev el I I ) 5 b atc h es of trai ni ng d one 95 M ed i c al o
F B I M N C I trai ni ng f or M ed i c al O c er 3 b atc h es of trai ni ng d one 57 M ed i c al o
T rai ni ng to M ed i c al c er trai ned
trai ned
F B I M N C I trai ni ng f or M ed i c al O c er 3 b atc h es of trai ni ng d one 57 M ed i c al o
F B I M N C I trai i g i g ta 6 b atc h es of trai ni ng d one 14 5 param ed i c s
and param ed i c s trai ned
trai ned
F B I M N C I trai i g i g ta 6 b atc h es of trai ni ng d one 14 5 param ed i c s
Equipment and supplies
and param ed i c s
trai ned
P roc urem ent of eq ui pm ent f or 4 0 s ets of ph ototh erapy proc ured
Equipment and supplies
SN C U /N I C U
P roc urem ent of eq ui pm ent f or 4 0 s ets of ph ototh erapy proc ured
P roc urem ent of eq ui pm ent and V ari ous eq ui pm ent and M ed i c i nes f or I M N C I prog ram s
SN C U /N I C U
m ed i c i nes f or I M N C I prog ram (O RS, Z i nc , Am ox i c i lli n, G entam y c i n, C h loroh ex i d i ne g el)
P roc urem ent of eq ui pm ent and V ari ous eq ui pm ent and M ed i c i nes f or I M N C I prog ram s
w ere purc h as ed
m ed i c i nes f or I M N C I prog ram (O RS, Z i nc , Am ox i c i lli n, G entam y c i n, C h loroh ex i d i ne g el)
Revision of Guidelines
w ere purc h as ed
Rev i s i on of C om preh ens i v e N ew b orn C are (L ev el I I ) T rai ni ng P ac k ag e
Revision of Guidelines
Rev i s i on of C om preh ens i v e N ew b orn C are (L ev el I I ) T rai ni ng P ac k ag e
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Rev i s i on of F B - I M N C I T rai ni ng P ac k ag e
Rev i s i on of E q ui ty and Ac c es s G ui d eli ne
Rev i s i on of F ree new b orn C are G ui d eli ne
Establishing/strengthening SNCU
T otal N I C U es tab li s h ed l d ate : 8 h os pi tals
T otal SN C U es tab li s l d ate: 21 h os pi tals
Printing of training materials
i g of C B - I M N C I , C om preh ens i v e N ew b orn C are (L ev el I I ) T rai ni ng M ateri als (G ui d eli nes ,
Hand b ook , C h art, F lex , etc . )
Implementation of newborn services and other programs
P rov i s i on of b ud g et f or F ree N ew b orn C are Serv i c es i n 68 h os pi tals i n F Y 2075/76.

I m plem enta on of Rem ote area g ui d eli ne f or C B - I M N C I
4.2.5 CB-IMNCI Program Monitoring Key Indicators

4.2.5 CB-IMNCI Program Monitoring Key Indicators
g ular
Reg a mm oniit torii ngg i i s im ta t f or b e erma
i m portant ag emm ent
m anag t of prog
g am
ram . T h eref ore, CBB - I M N C I progg am
ram
a i ma i i at t m it t g am t at a i t
h as i d en ma or i nd i c ators to m oni tor th e prog ram s th at are li s ted b elow :
i % oft I ns atu onal i d eli v ery
a a i i i g imm iat a it it i
i % a oft new b orn
m w t h o h adit appliBed C h ilorhi gex i d m i ne g tel i m m ed i ately a er b i rth tami
(w i th i i n one h our)
i (0- 2 m itonth s ) w mi th ia
% of i nf ants P SBt I rec
at ei v i ngit c aom plete
i d os e of I n n G entam i c i n
i it ia a t at it a i
t % oft und ter 5 c h i ld renBw i th pneum mm oni a treated
i atw i th aa t i oa ic its i tami i
m i % i ofi und terim5 c h i ld ren w i th d i arrh oea treated w i th O RS and Z i nc
i i at Stoc k outt oft th ea 5t k ey C aB - I M N C tai I c om m od mi es at h ealth

t i f ac i li tyt (O tRS,at Z ii nct , G entam
i igi c i n,
i t aAm ox ii c i lli n/Ct otri m , C HX ) g a a a imm iat ma ag m t
m i a i it a ia t at i mat ti t i i gt ata m ta it
All
tat i nd i c ators
B ex c ept th e las t one are
g amm m it i g i i atob tai ned f rom a HM I S. I
mma i t i s ex pec ted th
i a i f th ere i s ah i g h
at
i t onal d eli v ery , th ere w ould b e g ood es s en al new b orn c are and i m m ed i ate m anag em ent of
c om pli a ns li k e b i rth as ph y x i a th at w i ll mately c ontri b ute i n red uc i ng th e neonatal m ortali ty .
Status of C B - I M N C I prog ram m e m oni tori ng i nd i c ators are s um m ari z ed b elow i n as f ollow s (T ab le
4 . 2. 1).

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Table 4.2.1: Status of CB-IMNCI programme monitoring indicators by province (FY 2075/76)
Table 4.2.2: CB-IMNCI Programme Monitoring Indicators by Province (FY 2075/76)
% of % of % of PSBI cases % of % diarrhoeal

institutional newborns received pneumonia cases treated
Province
deliveries applied complete dose cases treated with ORS and
chlorhexidine of inj. with zinc
(CHX) gel Gentamicin antibiotics
Province 1 62.0 53.2 30.9 128.0 89.5
Province 2 52..7 73.0 58.8 203.0 102.3
Bagmati 61.5 39.5 17.3 111.0 92.6
Gandaki 47.8 45.1 6.5 145.3 97.3
Province 5 78.8 64.1 50.8 127.3 94.4
Karnali 73.2 87.5 56.8 120.2 98.4
Sudur
71.0 74.5 55.1 113.6 93.9
Pachhim
National 63.2 59.6 46.3 136.1 95.5
Source: HMIS, 2075/76
a a a ag t a i i i a t it ti a a i
i a ig t i i
The national average for Institutional deliveries in 2075/76 was 63.2 percent, with lowest in Gandaki
province (47.8%) and highest in province 5 (78.8%).
i i a a i i t m ii a am g t ta
t i i t i i i a ia a
It is interesting to note that the compliance of Chlorohexidine use and inj. Gentamicin for PSBI i it ig t casesi
a ai a t i Bagma i
was around 50% only whereas use of antiobiotics of pneumonia treatment and use of ORS and zinc
imi a t i tami i at
a a B a am g t m t i a t i
for diarrhoeal cases was around 100%.
a m t tami i i m t a t B a a t i
a it i t a t a it t t i a a i i
Chlorhexidine was applied in 59.6 percent of newborn’s umbilical stump (HF+ FCHV) among total
expected a livei births. Province m wise ia t wideatm variation
t wasi gobserved in a CHX
m use t awith highest use t i in a
Karnali (87.50%) i anditlowest a inaBagmati a ag (39.5%). Similarly, tcompliance ig t ofi inj. g Gentamicin i at national i
level fora PSBI cases t i among
Bagma under two months m iachild a was only t 46.3%. Four provinces t have i used
complete dose B of
t Gentamicin
mt in moret than i 50% i at of PSBI a cases i t atthree provinces
and t have m used ia ita in
t g
less than 30% of cases with lowest 6.5% use in Gandaki province. t t g t atm t t
i a a i i a i t a i a t a i a
Use of antibiotics for pneumonia treatment (excluding FCHVs) was more than 100 percent in all
B
seven provinces, t atm
with national t average t a 136.1
of ia %, ahighest a use was observed t at in province
it 2a (203%) i
Ba ata i i g m ia a t at it a i at a a
and lowest in Bagmati (111%). Pneumonia cases reported by FCHV were used to be included till
a t i a ig t i i a ti i
2073/74. But, from the 2074/75, the indicator is in the process of revision and the cases of
pneumonia reported by FCHVs
4.2.6 Key Achievements are excluded.
for Management of 0-28The day figurenewbornexceeded 100 percent because the
treatment of cases by antibiotics other than pneumonia was also added like skin infection, ear
i
infection etc. which isBactually a reporting i ataerror.
a i m at a ii a
a i at i t m a i i
at permm
As it treatment protocol,
CB-IMNCI a all diarrhoeal i i should
cases a bemm treated it with ORS ataand Zinc.aBased t ta
on HMIS data, U5 children suffering from diarrhoea treated with ORS and Zinc at National level wasa
i i m a t a i it i a i it mm it t t t a
agg gat
95.5%, whichata t i
was highest ing province
am B 2 (102.3%)g and am lowesta in iprovince
i at 1 (89.5 m %). a m

FCHVs) has been incorporated into HMIS. Therefore, from FY 2064/65 onwards, service provided at
community level (PHC/ORCs and FCHVs) is considered as community level data whereas total service
provided from Health Facility level in addition with community level constitutes the national
aggregate data for this program. CB-IMNCI program has been initiated from FY 2071/72 and from FY
2071/72 Health Facility Level and Primary Health Care/Out Reach Clinics (PHC/ORC) data has been
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incorporated into HMIS. Consequently, the role of FCHV at community level has been redefined and
a t a i it a ima at a t a i i ata a
i limited at
to counselling
i t service for newborn
t t care. Obviously,
at themmtreatment
it protocol
a has also been
a
imit t i g i a i t t atm
changed and role of FCHVs at the community level has been assigned as health t t a a
a g a at t mm it a a ig a at m t
promoters/counsellors rather than health service providers. As per the new reporting and recording
at t a at i i t ga i g t m t
asystem,
i mthetachievements
ma ag mof management
t of iunder a5 children
gi iaret given
ta in the table below.
Table
Table 4.2.3:
4.2.2:Classification and treatment
Classification and Treatmentofof0-28
0-28day
Daynewborn
Newborn Cases
cases by Province
by province (FY 2075/76)
(FY 2075/76)
Province 1 National
Province 2
Province 5
Pachhim
%
Bagmati
Gandaki
Karnali
Sudur
Year
Indicators among
No.
total
cases
2073/74 4,573 2,370 2,989 1,888 5,694 3,967 4,261 25,742 NA
Total cases
2074/75 3,902 3,055 2,839 2,156 6,425 3,608 3,693 2,5678 NA
(HF+ORC)
2075/76 5,233 3,935 3,270 2,479 6,536 3,133 4,520 29,106 NA
Possible 2073/74 578 217 246 124 1035 752 761 3,713 14.4
severe
bacterial 2074/75 414 270 265 142 1,096 727 666 3,580 13.9
infections
(PSBI) 487 278 258 125 1,024 595 635 3,402 11.7
2075/76
(HF+ORC)
Local 2073/74 2,549 1,660 1,296 904 1,887 1,745 2,255 12,296 47.8
bacterial
2074/75 2,206 1,820 1,239 786 1,942 1,220 1,954 11,167 43.5
infections
(HF+ORC) 2075/76 2595 2249 1400 821 2075 1235 2351 12,726 43.72
2073/74 298 122 320 296 339 181 184 1,740 6.8
Jaundice
2074/75 255 149 252 324 280 144 121 1,525 5.9
(HF+ORC)
2075/76 301 136 267 314 297 106 114 1535 5.3
% of Low 2073/74 3.98 5.23 5.16 7.40 6.06 8.55 10.55 1,605 6.8
weight or 2074/75 5.9 3.8 6.9 6.0 6.1 14.4 6.8 1838 7.2
feeding
problem (HF 2075/76
4.7 4.9 6.7 4.5 4.2 9.5 6.9 1656 5.7
only)
2073/74 357 183 214 88 252 131 185 1,410 5.5
Referred
2074/75 215 258 214 98 259 288 186 1518 5.9
(HF+ORC)
2075/76 268 207 195 88 282 167 202 1409 4.8
2073/74 7 2 13 2 45 12 23 104 0.4
Deaths
2074/75 14 1 16 5 35 19 16 106 0.4
(HF+ORC)
2075/76 27 2 12 6 20 9 26 102 0.4
DoHS,FCHV
Annual Report 2075/76 (2018/19)
2073/74 2,607 2,105 1,794 783 1,982 1,391 2,357 13,019 NA
Sick baby 2074/75 2,671 2,285 1,862 653 2,469 1,535 1,782 13,257 NA
2075/76 2576 2982 1567 2649 1965 1087 1495 14321 NA
Treated with 2073/74 1656 1121 534 193 1118 865 855 6342 48.7
1,410
Referred
2074/75 215 258 214 98 259 288 186 1518 5.9
(HF+ORC)
2075/76 268 207 195 88 282 167 202 1409 4.8
2073/74 7 2 13 2 45 12 23 104 0.4
Deaths
2074/75 14 1 16 5 35 19 16 106 0.4
(HF+ORC)
ami a
2075/76 27 2 12 6 20 9 26 102 0.4
FCHV
2073/74 2,607 2,105 1,794 783 1,982 1,391 2,357 13,019 NA
Sick baby 2074/75 2,671 2,285 1,862 653 2,469 1,535 1,782 13,257 NA
2075/76 2576 2982 1567 2649 1965 1087 1495 14321 NA
Treated with 2073/74 1656 1121 534 193 1118 865 855 6342 48.7
cotrim and 2074/75 1266 1007 314 95 1005 672 527 4886 36.9
referred
2075/76 1077 1002 228 119 687 459 436 4008 28
2073/74 168 70 155 52 204 145 249 1043 NA
Death 2074/75 310 163 177 73 324 117 219 1383 NA
2075/76 524 93 139 63 151 68 216 1254 NA
Source: HMIS
At total
ta of 29,106 new-born cases
a were registered
gi t aand treated
t at both
t in
i health
a t facility
a i it and
a PHC/ORC
i i i in FY 2075/76. The trend
clinic t t atthe
shows that t treatment
t atm oft new-borns in HF
i and aPHC/ORC clinic has
i i
a i a m a t at a ig t a i i a
increased
t by 3428
i compared
a a i toi last year. tTheathighest tofta6536 new-born cases
a in Province
a i5 anda
i of 2479Ba
lowest in tGandaki
ia Province B at treated.
were a a In total i3402
i (11.7%) tcases
a t were
at classified
i asa
B a ig ti i a ti a a i i
Possible Severe Bacterial Infection (PSBI) at national level which is 2% less than that of previous year
(13.9 %). The proportion of PSBI was highest in Province 5 (30%) and lowest in Gandaki Province (3.6
i i t ta a a i a B a a i a Bi t ig t
%).
B at i g m ata t i ta ig i a t a g i a i a a
t atm t B a a i t i ig t a i t atm t Bi t ig t
Likewise,
B a t 43.7% i gof total m
cases mwere classified
t as aLBI, 5.3%
m t aast Jaundice,
a 5.7% as Low Birth
B i Weight
ig orti
i
Breast-Feeding a
Problem. Datat i shows
a athere
i isi not any significant
imi a ichange
t ta in classification
t a and
t at a iat i m i i i a t ta a m t a
treatment of LBI and Jaundice however, there is slightly decreased in treatment of Low Birth Weight
i i ig t i i m g a t at a
i Breast-Feeding
or i i i at Problem ig t 7.2 to 5.6 compared
from m i to lastayear. The proportion of LBI is highest in
Province 1 (20.39%) and lowest in Gandaki province (6.4%). Similarly, in total 28% of the cases were
t t i a i t at it t im a a t ai g
t treated by Paediatric Amoxicillin
it a a mandt 4.8%
a of total cases were
a it referred
a from both
i HF
t and PHC/ORC
a
i i t at t t t a gt
4.2.7 Key achievement for Management of 2-59 months children
Diarrhoea
Classification of diarrhoeal cases by province 2075/76
B g am a at a i g i m tt at i a
a i a a t atm t ia a i a B a a t ia a
a a i i t t at g i a m a a
a t m a a i a t ta ia a a a t
i ta

Classification of diarrhoeal cases by province 2075/76
CB-IMNCI program has created enabling environment to health workers for better identification,
classification and treatment of diarrhoeal diseases. As per CB-IMNCI national protocol, diarrhoea has
been classified into three categories: 'No Dehydration', 'Some Dehydration', and ‘Severe
Dehydration'. The reported number and classification of total new diarrhoeal cases has been
presented in table 4.2.3 below.
ami a
Table 4.2.3: Classification of Diarrheal cases by province (FY 2075/76) (2-59 months children)
Table 4.2.4: Classification of Diarrheal Cases by Province (FY 2075/76) (2-59 Months Children)
Indicator
Province
Province
Province
Pachhim
National
Bagmati
Gandaki
Karnali
Sudur
Year
5
s
200,17
186,090 205,477 181,071 76,889 206,359 128,064 1,184,120
0
2073/74
15.72% 17.35% 15.29% 6.49% 17.43% 10.82% 16.90% 100.0%
Total diarrhoeal cases
(HF+ORC+FCHV)
187,87
180,260 208,779 166,644 73,526 203,879 127,271 1,148,238
2074/75 9
15.70% 18.18% 14.51% 6.40% 17.76% 11.08% 16.36% 100%
182,32 1,1240,87
174,099 216,837 154,300 67,857 205,759 123,696
5 3
2075/76
15.48% !9.28% 13.72% 6.03% 18.29% 11.00% 16.21% 100%
2073/74 55,474 88,821 47,379 22,220 65,641 45,216 58,433 383,184
HF + ORC diarrhoeal cases
2074/75 51,792 94,447 43,143 22,088 67,989 42,918 54,183 376,560

Total
49,678 97,157 41,446 20,249 71,262 45,227 56,183 381,206

2075/76
42,643 69,566 40,920 19,288 56,679 35,058 49,793 313,947

No dehydration
2073/74
76.9% 78.3% 86.4% 86.8% 86.3% 77.5% 85.2% 81.9%
41201 74,202 37,366 19,570 58,791 33,716 47,160 31,2006
2074/75
79.6% 78.6% 86.6% 88.6% 86.5% 78.6% 87.0% 82.9%
41,225 77,587 36,937 18,438 62,322 36,578 49,288 322,375

2075/76
82.98% 79.86% 89.12% 91.06% 87.45% 80.88% 87.72% 84.57%
12,589 18,937 6,285 2,909 8,585 9,796 8,449 67,550

2073/74
22.7% 21.3% 13.3% 13.1% 13.1% 21.7% 14.5% 17.6%
Some dehydration
10,397 19,858 5,690 2,475 8,696 8,801 6,891 62,808

2074/75 20.1% 21.0% 13.2% 11.2% 12.8% 20.5% 12.7% 16.7%
8,257 19,209 4,409 1.744 8,579 8,423 6,746 57,367
2075/76
16.62% 19.77% 10.64% 8.61% 12.04% 18.62% 12.01% 15.05%
242 318 174 23 377 362 191 1,687
2073/74
0.4% 0.4% 0.4% 0.1% 0.6% 0.8% 0.3% 0.4%
Severe dehydration
194 387 87 43 502 401 132 1,746

2074/75 0.37% 0.41% 0.20% 0.19% 0.74% 0.93% 0.24% 0.46%
196 361 100 67 361 226 153 1,464
2075/76
0.39% 0.37% 0.24% 0.33% 0.51% 0.50% 0.27% 0.38%
DoHS, Annual Report 2075/76 (2018/19) 141,73

130,616 116,656 133,692 54,669 140,718 82,848 800,936
7
2073/75
11.03% 9.85% 11.29% 4.62% 11.88% 7.00% 11.97% 67.64%
FCHV
(diarr 133,69
128,468 114,332 123,501 51,438 135,890 84,353 771,678
hoeal 2074/75 6
cases 11.19% 9.96% 10.76% 4.48% 11.83% 7.35% 11.64% 67.21%
318 174 23 377 362 191 1,687
2073/74
0.4% 0.4% 0.4% 0.1% 0.6% 0.8% 0.3% 0.4%
Severe dehydration
194 387 87 43 502 401 132 1,746
2074/75 0.37% 0.41% 0.20% 0.19% 0.74% 0.93% 0.24% 0.46%
196 361 100 67 361 226 153 1,464
2075/76
ami a
0.39% 0.37% 0.24% 0.33% 0.51% 0.50% 0.27% 0.38%
141,73
130,616 116,656 133,692 54,669 140,718 82,848 800,936
7
2073/75
11.03% 9.85% 11.29% 4.62% 11.88% 7.00% 11.97% 67.64%
FCHV
(diarr 133,69
128,468 114,332 123,501 51,438 135,890 84,353 771,678
hoeal 2074/75 6
cases 11.19% 9.96% 10.76% 4.48% 11.83% 7.35% 11.64% 67.21%
126,13
124,421 119,680 112,854 47,608 134,497 78,469 743,667
2075/76 8
11.06% 10.64% 10.03% 4.23% 11.96% 6.98% 11.21% 66.11%
Source: HMIS
In FY 2075/76, a total of 1,124,873 (population proportion of that age group is 38%) diarrhoeal
a t ta a t at ag g i ia a
acases were reported
t outt of which
i more
m than
t a one third
t i (34%) were reportedt from health
m afacilities
t a ii
aand ORC andarest twot tthirdt(66%)
i by FCHVs which showedi imi alike
similar trend t that iof previous
t at year.i
a i t a i gt i ia a a am g i t i
While
a there
i were
a decreasing
i m ai trend t in diarrhoeal cases among
m g gi t five provinces,
a i those of Province
at a ii 2 a
m
and 5 increasedt ina comparison
t tto FY 2074/75. Among
a i registered
a a i g cases in Healtha a t and
Facilities
m a a mai ta a i a
PHC/ORC, more than three fourth (85%) were classified as having no dehydration, about one fifth
at a a a
(15.1%) some dehydration. Severe dehydration remained below 1% across all provinces and at
national level as well.

ami a
Classification of of
Classification diarrhoea disease
diarrhoea incidence
disease incidence
Table 4.2.5:
Table 4.2.5:Incidence
Incidenceand
andCase
CaseFatality
FatalityofofDiarrhea
DiarrheaAmong
AmongChildren
ChildrenUnder 5 Years
Under of of
5 Years Age by
Province (FY
Age2075/76)
by Province (FY 2075/76)
Province 1
Province 2
Province 5
Pashchim
Gandaki
Bagmati
Karnali
Sudur
Year
Indicators National
E stimated 207 3 / 7 4 4 94 , 3 01 6 1 3 ,3 6 1 6 29, 57 7 254 , 998 502, 21 6 1 7 7 ,3 8 9 28 7 , 24 4 2, 959, 08 6

< 5 years
population 207 4 / 7 5 4 95, 6 7 1 6 1 9, 3 8 4 6 3 6 , 059 253 , 94 8 505, 950 1 7 9, 4 8 6 28 9, 7 3 9 2, 98 0, 23 7
that are
prone to 207 5/ 7 6
4 92, 953 6 20, 4 8 9 6 3 7 , 58 0 251 , 3 3 1 505, 3 6 6 1 7 9, 6 94 28 9, 8 4 1 2, 97 7 , 254
diarrhoea
Incidence of
207 3 / 7 4 3 7 6 3 3 5 28 8 3 02 4 1 1 7 22 6 97 4 00
diarrhoea/ 1 ,
000 < 5
3 6 4 3 3 7 26 2 290 4 03 7 09 6 4 8 3 8 5
years 207 4 / 7 5
population
207 5/ 7 6 3 51 3 4 7 24 0 26 8 4 04 6 8 3 6 24 3 7 5
Diarrhoeal 207 3 / 7 4 7 1 6 4 1 1 2 2 3 3
deaths
( HF + ORC) 207 4 / 7 5 8 1 4 6 0 1 2 3 4 4 7
207 5/ 7 6 8 1 1 1 8 1 4 1 4 7 6 3
Diarrhoea 207 3 / 7 4 0. 1 3 0. 1 8 0. 08 0. 05 0. 02 0. 04 0. 03 0. 09
Case fatality
rate per 207 4 / 7 5 0. 1 6 0. 1 5 0. 1 4 0. 00 0. 1 8 0. 07 0. 07 0. 1 3
1 000
207 5/ 7 6 0. 1 6 0. 1 1 0. 4 3 0. 6 9 0. 01 0. 09 0. 1 2 0. 1 7
( HF + ORC)
Source: HM IS/ M D, DoHS
As shown in table 4 . 2. 5, incidence of diarrhoea per thousand under 5 years children was 3 7 5
in F Y 207i 5/ta7 6 , being highest
i i ia ( 6 8 a3 ) followed
at K arnali t a by Sudur Pashchim
a i( 6 24 ) . Similar
a i
i g ig t at a a i a im imi a t a
trend was seen in the previous fiscal year. M oreover, the lowest incidence was in B agmati
i t i a a t ti i a i Bagma i ta
Province ( 24 0) . Total diarrhoeal death in health facility and PHC/ ORC was 6 3 cases which
ia a at i a t a i it a a a i i a tt a
t increased
at aby 3 a4 percent
a atathan
it the
at last
a fiscal
a year.
t Casei fatality
a rate across allt the provinces
a i t i ag
g was below 1 per thousand in this age group.
15

ami a
Treatment of diarrhoea
Treatment of diarrhoea
Table 4.2.6:
Table Treatment
4.2.6: of diarrhoea
Treatment cases Cases
of Diarrhoea by province (FY 2075/76)
by Province (FY 2075/76)
Province 1
Province 2
Province 5
Pashchim
Gandaki
Bagmati
Karnali
Sudur
Year
Indicators National
Total cases 207 3 / 7 4 1 8 6 , 090 205, 4 7 7 1 8 1 , 07 1 7 6 ,8 8 9 206 , 3 59 1 28 , 06 4 200, 1 7 0 1 , 1 8 4 , 1 20

( HF + ORC+ 207 4 / 7 5 1 8 0, 26 0 208 , 7 7 9 1 6 6 ,6 4 4 7 3 , 526 203 , 8 7 9 1 27 , 27 1 1 8 7 ,8 7 9 1 , 1 4 8 , 23 8
F CHV ) 207 5/ 7 6 1 7 4 , 099 21 6 , 8 3 7 1 54 , 3 00 6 7 , 8 57 205, 7 59 1 23 , 6 96 1 8 2, 3 25 1 , 1 24 , 8 7 3
Diarrhoeal 1 6 0, 7 98 1 94 , 7 06 1 6 6 , 94 6 7 4 , 298 1 8 3 , 27 3 1 23 , 1 3 9 1 8 7 , 923 1 , 091 , 08 3

cases treated 207 3 / 7 4
8 6 .4 1 % 94 . 7 6 % 92. 20% 96 . 6 3 % 8 8 .8 1 % 96 . 1 5% 93 . 8 8 % 92. 1 4 %
with ORS
1 6 1 , 7 94 202, 520 1 55, 7 4 9 7 2, 597 1 93 , 97 6 1 22, 6 7 8 1 8 3 , 7 92 1 , 093 , 1 06
and
207 4 / 7 5 8 9. 7 6 % 97 . 00% 93 . 4 6 % 98 . 7 4 % 95. 7 4 % 96 . 3 9% 98 . 8 2% 95. 20%
z inc( HF + O
RC+ F CHV ) 207 5/ 7 6 1 55, 8 1 9 221 , 7 4 5 1 4 2, 8 8 4 6 6 , 056 1 94 , 3 3 0 1 21 , 98 3 1 7 1 , 28 1 1 , 07 4 , 098
8 9. 5% 1 02. 26 % 92. 6 0% 97 . 3 5% 94 . 4 5% 98 . 6 2% 93 . 94 % 95. 4 9%
1 ,1 1 3 2, 28 2 1 , 026 28 5 93 7 97 5 1 ,1 1 7 7 ,7 3 5
207 3 / 7 4 0. 6 0% 1 .1 1 % 0. 57 % 0. 3 7 % 0. 4 5% 0. 7 6 % 0. 56 % 0. 6 5%
Intravenous 6 3 3 1 , 4 58 3 51 1 4 8 1 ,3 6 9 7 27 1 , 029 5, 7 1 5
( IV ) fluid 207 4 / 7 5 0. 3 5% 0. 7 0% 0. 21 % 0. 20% 0. 6 7 % 0. 57 % 0. 55% 0. 50%
( HF )
3 6 8 7 1 5 23 3 1 7 7 7 4 7 3 8 0 259 2, 8 7 9
207 5/ 7 6 0. 21 % 0. 3 3 % 0. 1 5% 0. 26 % 0. 3 6 % 0. 3 1 % 0. 1 4 % 0. 26 %
Source: HMIS
t ia a a t at it a i a a a
In
t
F Y 207
at a
5/ 7 6 , a
the proportion
a
of diarrhoeal
t i
cases treated with
a a m t imi a t t
ORS and Zinc
i
as a
per IM NCI
a
ignational
t i protocol
am atg nationali level
t a was g 95
it percent which
i twas
maialmost
tai i gsimilar
a m tto the previous ti a
i
year. i
There i was slight
t a difference t amongia provinces
a a treatingt withat ORS it i & t a Zinc but
imaintaining
at a t aalmost ii 90 ipercent
a ini all provinces. L ik ewise, less than 1 percent severe
diarrhoeal cases were treated with intravenous ( IV ) fluid at health facilities level in all
provinces.
Acute Respiratory Infections
B Respiratory
Acute t Infectionsa t a a a i a
m ia m ia m ia a gi m t a t at it a iat a i
As per CB - IM t NCI
ig protocol,
t a every ARI cases
t i i a should be correctly
a assessed and classified as
no pneumonia, pneumonia or severe pneumonia; and given home therapy, treated with
appropriate antibiotics or referred to higher centre as per the indications. ( See Table 4 . 2. 7 )
16
Table 4.2.7: Acute Respiratory Infection (ARI) and Pneumonia Cases by Provinces (FY
2075/76) ami a
Table 4.2.7: Acute Respiratory Infection (ARI) and Pneumonia Cases by Provinces (FY 2075/76)
Province 1
Province 2
Province 5
Pashchim
Gandaki
Bagmati
Karnali
Sudur
Year
Indicators National
Target 4 94 3 01
207 3 / 7 4 6 1 3 3 6 1 6 2957 7 254 998 50221 6 1 7 7 3 8 9 28 7 24 4 295908 6
population
( < 5 years that 207 4 / 7 5 4 956 7 1 6 1 93 8 4 6 3 6 059 253 94 8 505950 1 7 94 8 6 28 97 3 9 298 023 7
are prone to
207 5/ 7 6 4 92953 6 204 8 9 6 3 7 58 0 251 3 3 1 5053 6 6 1 7 96 94 28 98 4 1 297 7 254
ARI)
207 3 / 7 4 1 55205 1 3 1 029 1 09550 6 004 4 1 1 7 4 3 0 7 2254 1 053 7 6 7 508 8 8
Total ARI
207 4 / 7 5 1 4 4 8 1 9 1 3 08 7 4 98 3 96 57 01 4 1 1 7 6 7 5 7 4 97 0 1 01 6 7 8 7 254 26
cases
( HF + ORC) 207 5/ 7 6 1 56 6 8 2 1 53 7 00 1 0524 7 6 2907 1 298 7 2 7 94 3 2 1 01 93 7 7 8 97 7 7
ARI 207 3 / 7 4 7 1 7 4 7 2 4 3 9 597 57 6 927 992 6 1 2
incidence per 207 4 / 7 5 6 6 6 4 4 8 4 27 57 1 56 4 96 0 97 1 592
1 , 000< 5 year 207 5/ 7 6
6 93 4 98 4 3 1 6 1 0 57 9 94 1 93 0 6 08
child
Total 207 3 / 7 4
4 3 91 3 3 23 3 3 3 203 2 1 3 24 7 27 7 07 208 1 1 24 6 1 9 1 94 6 6 2
Pneumonia
207 4 / 7 5 3 3 93 8 25259 251 4 9 1 04 3 0 253 7 9 1 8 98 5 206 7 3 1 598 1 3
cases
207 5/ 7 6
( HF + ORC) 3 3 009 23 990 23 8 99 91 94 23 6 3 4 1 7 503 1 96 58 1 508 8 7
Incidence of 207 3 / 7 4
8 9 53 51 52 55 1 1 7 8 6 6 6
pneumonia
per 1 , 000 < 5 207 4 / 7 5 1 1 8 6 6 6 0 52 8 0 1 7 1 1 3 0 8 7
children 207 5/ 7 6 1 1 6 6 5 55 58 7 6 1 59 1 1 0 8 3
% of 207 3 / 7 4 22. 1 23 . 6 28 . 8 23 . 4
28 . 3 24 . 7 29. 2 25. 9
pneumonia
among ARI 207 4 / 7 5 22. 0 23 . 4 1 9. 3 25. 6 1 8 .3 21 . 6 25. 3 20. 3
cases 207 5/ 7 6
21 . 1 1 5. 6 22. 7 1 4 .6 1 8 .2 22. 0 1 9. 3 1 9. 1
( HF + ORC)
% of severe 207 3 / 7 4 0. 25 0. 3 0 0. 3 0 0. 1 1 0. 22 0. 51 0. 3 3 0. 29
pneumonia
among new 207 4 / 7 5 0. 24 0. 27 0. 1 6 0. 20 0. 1 9 0. 58 0. 23 0. 25
cases 207 5/ 7 6 0. 27 0. 3 4 0. 20 0. 1 9 0. 1 9 0. 52 0. 24 0. 27
% of 207 3 / 7 4 1 7 9. 7 26 4 . 4 1 6 2. 6 27 0. 7 24 4 . 2 1 6 7 .3 21 0. 3 208 . 9
Pneumonia
207 4 / 7 5 1 7 2. 7 296 . 5 1 4 7 .8 21 8 . 6 1 93 . 0 1 7 3 .8 1 6 0. 2 1 93 . 1
Treated with
antibiotic 207 5/ 7 6
1 7 0. 4 28 5. 5 1 4 1 .7 1 98 . 2 1 6 2. 4 1 3 1 .8 1 4 7 .7 1 7 7 .2
( HF & ORC)
207 3 / 7 4 1 1 58 7 6 2 1 3 5 20 1 7 6
Deaths due to
ARI at 207 4 / 7 5 4 6 6 23 1 2 22 1 9 1 1 1 3 9
HF + ORC 207 5/ 7 6 6 0 4 1 3 1 1 8 1 5 2 1 1 1 7 8
ARI Case 207 3 / 7 4 0. 09 1 .1 6
0. 6 3 0. 07 0. 1 2 0. 08 0. 22 0. 28
fatality rate 17
per 1 000 at 207 4 / 7 5 0. 09 0. 01 0. 04 0. 05 0. 04 0. 1 1 0. 04 0. 05
HF
207 5/ 7 6 0. 1 2 0. 07 0. 05 0. 07 0. 03 0. 01 0. 04 0. 06
F CHV
207 3 / 7 4 1 991 1 8 1 58 24 9 1 6 6 7 6 7 921 20 1 7 1 8 6 4 9221 9 1 7 94 97 1 0598 3 4
207 4 / 7 5 1 8 4 3 29 1 4 3 7 59 1 7 04 54 8 8 6 4 5 1 6 54 6 3 953 01 1 7 7 291 1 02524 2
Total ARI
207 5/ 7 6 1 8 7 1 4 5 1 57 6 3 0 1 7 1 3 95 91 53 7 1 6 4 8 22 91 001 1 6 9529 1 03 3 059
DoHS,
In F Y Annual
2075/ Report
76, 2075/76
a total of 7 ,(2018/19)
89, 7 ARI cases were registered in HF and ORC, out of which
19. 1 percent were categoriz ed as pneumonia cases and 0. 27 percent were severe pneumonia
cases. The incidence of pneumonia ( both pneumonia and severe pneumonia at HF and
PHC/ ORC) at national level was 8 3 per 1 000 under five children. The incidence of
pneumonia among under five children has decreased slightly compared to that of last F Y .
ami a
a t ta a gi t i a t i
t at g i a ia a a m t m ia a
i i m ia t m ia a m ia at a at a a
a i i i m ia am g i
a a ig t m a t t at at i i ig t i i a at
a ai i i a im i a
a t at Bagma i i imi a Bagma a a ai i a t
ig t tag m ia a am g a a a a a i i
a t t a
t ta at at at at
a ii t t i i ig t
m a t i a ata it at t a at a t a i it a
i a t i m a t at a a a ata it at
a i a ia i t t i a gi g m t t i a ai
i t t ig t i i
Other common childhood illnesses
B g am a i i g a t a g a a ia a t i a a
t mm i am g i i t t a ma t i
am g i a i g ti g am i t t a m a a t
a i ta i a a i g a a mm i a g am a a a ia
i a t g am g am a a at it g am t a
t m i a i t g at a a
Table 4.2.8: Classification of Cases as Per CB-IMNCI Protocol by Province (FY
Table 4.2.8:2075/76)
Classification of Cases as Per CB-IMNCI Protocol by rovince (FY 2075/76)
Malaria Very
severe
Falcipa Non- febrile Ear Severe
rum falciparum disease Measles infection malnutrition Anaemia
Province 1 1 4 1 1 0 1 97 1 5053 590 4 7 3
Province 2 4 9 3 3 2 0 3 1 2 29, 94 2 2, 4 1 1 1 , 94 3
B agmati 2 3 1 0 4 09 9, 7 3 1 4 20 58 2
G andak i 1 0 3 8 0 6 2 5, 6 6 1 4 6 8 3 53
Province 5 26 23 4 0 1 50 1 7 ,8 6 9 2, 28 8 1 , 3 28
K arnali 23 6 1 0 57 9205 1 ,1 8 5 51 4
Sudur
Pashchim 1 6 6 7 0 7 5 1 0, 3 21 1 , 7 54 8 8 8
National 140 774 0 1,262 97,782 9,116 6,081
Under the CB - IM NCI programme, health work ers identified 1 4 0 falciparum malaria cases,
t B g amm at i a i a m ma a ia a
7 7 4 non-a ifalciparum
a m ma malaria
a ia a cases; 1 , 26 2mmeasles
a a
cases; a infection
97 , 7 8 2 ear i a 9, 1 1 6
cases;
ma
severe tmalnutrition
i a acases and a6 , 08a 1 mia a
anaemia i
casesi in children under fivea yearsag ofi age in
t a i i a i t i a a
207 5/ 7 6 . There were no reported cases of very severe febrile disease in this fiscal year.
4.2.8 Problem, constraints and actions to be taken and responsibility

Table 4.2.9: Problem, constraints and actions to be taken
Problem/Constrains Action to be taken Responsibility
No sanctioned position for CB - • Policy level decision needed to M oHP, DoHS,
IM NCI focal persons at allocate sanctioned position, and F W D
municipal and provincial levels mak e necessary arrangements so that
Under the CB - IM NCI programme, health work ers identified 1 4 0 falciparum malaria cases,
7 7 4 non- falciparum malaria cases; 1 , 26 2 measles cases; 97 , 7 8 2 ear infection cases; 9, 1 1 6
severe malnutrition cases and 6 , 08 1 anaemia cases in children under five years of age in
ami
207 5/ 7 6 . There were no reported cases of very severe febrile disease in this fiscal year. a
Problem/Constrains Action to be taken Responsibility
No sanctioned position for CB - • Policy level decision needed to M oHP, DoHS,
IM NCI focal persons at allocate sanctioned position, and F W D
municipal and provincial levels mak e necessary arrangements so that
there is no void in implementation of
Unclarity in roles of staffs in the the program and in service delivery
new federal contex t during the transition period
Unable to implement free • B etter coordination and collaboration Hospitals,
newborn care guideline since last between related hospitals, Palik as, Palik as, HO,
F Y as ex pected. D/ PHOs and CHD. B etter orientation F W D
about the program and clarity in its
implementation modality
Insufficient Human Resource in • HR to be deployed by Contract M OHP, F W D,
Hospital to implement • training to M O and nursing staff Province,
SNCU/ NICU about NICU NHTC
L imited IE C/ B CC interventions • M ore priority be given to the NHE ICC,
as compared to the approved IE C/ B CC interventions so as to F W D, HO,
improve 19 the demand for CH services
program implementation Palik as, HF
by all concerned stak eholders
guideline, so as to improve the
demand of CH services
F req uent stock outs of essential • Timely supply of commodities F W D, M D
commodities in districts and
communities
L ack of eq uipment to deliver • Timely procurement and supply of M D, F W D
newborn & child health services eq uipment
at service delivery points
Poor service data q uality • Carry out routine data q uality M D, F W D
assessments
• Strengthen regular feedback
mechanisms
Poor q uality of care • Strengthen q uality improvement M D, F W D,
system Province, HO
• E nhance the use of health facility
q uality improvement tools
• Onsite coaching
• Supportive supervision
Increase in percentage of severe • Targeted interventions ( B CC Province, HO
pneumonia cases activities, and for early detection,
treatment and referral) needs to be
focused
L imited engagement of private • E nsure better involvement of private DoHS, F W D
sectors sector to ensure q uality services are
provided with proper follow up of
childhood treatment protocols.
Poor referral mechanism • Strengthen the referral mechanism F W D, HO
q uality improvement tools
• Onsite coaching
• Supportive supervision
Increase in percentage of severe • Targeted interventions ( B CC Province, HO
pneumonia cases activities, and for early detection,
ami a treatment and referral) needs to be
focused
L imited engagement of private • E nsure better involvement of private DoHS, F W D
sectors sector to ensure q uality services are
provided with proper follow up of
childhood treatment protocols.
Poor referral mechanism • Strengthen the referral mechanism F W D, HO
20

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4.3 Nutrition
4.3.1 Background
ti ami a i ii a tm t at i i it
at a a i i a a ti i i t t
im t ti a tat i g a ta a ta g m a a t
g a a a ti g amm t a i i g a t mai tai a a t
i t ti t i t i mi m t t t t g im ti
g am im m ta i a a it a t t ti i t a t
ig a it a a i tm t a ai i g ma t tai a m t
a it ta at a tai i tm t i ti t i t ai
am i t g a i it a im ti a m t tai a
ag i t i a t i at a t t tai i i at a
ig a t t ti a ig m t it i t a a a a a a
a ma t a a a i i i a a a
t ti a a a at i i a a at t t at g a
a a a gi t m t t at g t m t a
i mmi a t at it i a a t t a at ti at a
t ia i t im a t t i t m t t ig t t
at a ti t a i g a ti ti t i i
ma t i a i t at a t i a g i a i t t a m t
it a m mi i mi m t
Focus on nutrition ti i ag a g i m t ag a i t a
a g a m m t a a at ti m t t at
m a m i im m ta a mat a i a t a
g i ti i i a t i g a ti ta g t t at aim t
a i a i t m i a t t
a i a i t m i a t t
a i a a a mia i m ag
a i a i it ig t t at t i i a i i
ig t
i a t at i a i gi t t m t t at a t
a mai tai i a gt t a
ai g ti i i a a m t a a im ti
i gt t a i t a a ai g ti a a i
t m a a t t t i t m t a a a a
i a t t t ti a i it a ii a
a a t i ti i gt t a ag g
imi a it a a m i ag a aimi g
t a ti m t it t aim t i a a
m a a am t at it i i g t t a a ai a t
im m t t mmitm t ma at t a a ti a t
g a tai a m t
Policy initiatives a a ti i a t at g a ia i t
a a m ma ti im m g ti i a i i t

ami a
t g t at t t at i t t at gi a g amma i ti
i t i a t g at t imi a t ti a
i i a a a a i am ti it i a t at
t i at t a a a i g mmi i i a a i g i a
ti i a ti i i t a a a g a i g i m t
ti i a i i t t g tt t a a at i
ig ig t t g t agai t ma t i a im ti t g m
a it ti g at a t a ti i a mmi
a t i t ami a i ii ma i at i ii a
ta i i it t m i t i a t m a tg m t i iti a
a tm t ag i a m t at t at i t i a g i a ti
i a i i t t g m t i a a i i ma i g
ig i g it t
a ma a a at
i a a at t t at g
a a t g a i i a t i ami a i ii a
a a ti t at gi a a im i g t mat a i a t a g
i ti a it t ag i a ti i a mmi
a mm t a ti m ta a a i
a g i i t a ga i a a a ag m t
t a ta i i g a a a ti t a a t ti t i it
at a a ti i i t
4.3.2 Malnutrition in Nepal
a a ma ig i a t g i i g t gi a i t g
a m ti t ti imi a t a gi
a g i a i t i a t i a mia
am g i i t t t a t g ti
mi ti t i t a a itami g amm a g a g i a a
g amm a a mia am g m a t a i mai
ig i at a t t m ag a
t g a t m a a a mi imi a t i ag
m t a a a mi i t a a a mia am g a t m a
i a m ti t ti i i t
m t i g m i g i a gi t i ai gt ig t
4.3.3 Efforts to address under-nutrition
i it at a a a m im
g a a i it i ti
i i t t a mat a a ta i ma t i i a i ga
it g t m it i g g i it m t a t a
i i a i a t i a i g a a iat m m ta i g
mm it a mi ti t m ta t t a ami a
i ii a im m g i g g amm i t a m
i B

ami a
Box 4.3.3.1: Nutrition programmes implemented by FWD Nutrition Section (1993–2018)
Nationwide programmes: Scale-up programmes:

t m it i g a m a t g at a ag m t t
a i g a ti
a t i i i ti t
a a mia iti i t g a g it i a t a
g i i g a a
t a t atm t at a ti
itami i i g amm
i i i i itami m ta t a
t ag i m t
t aai i ta
mi g
a at a i ag
mi
m a t at a a t
a g i ti
Small scale interventions: at a a i at a ti g am iti t
4.3.4 Objectives of National Nutrition Programme for health sector:
a t a a ti g amm mt at t i t a
ti a i g ti t t i a mat a m ta it a ita ma
m t
i gt t a a ti i a t at g t i a a
ti g amm a a
t i g ma ti i i a ag a ag
m
t a a a mia am g m a i
imi at i i i i a tai t imi a
imi at itami i a tai t imi a
t i ta i t a m am g i a g a t m
t a it ig t
im it t t at a a a a at a
a ai a i it a ia at i
m t t a g i ta a it t im t ti a tat a
t a t i i a t im ti a tat a i
m ta it
t t i i i t at i a a at i a t i
t a a m at i a a ia t i i a mia t
im at a t i a tat i
t i a i ma t i a i i g a i t i m ta
t gt t t m a a i g m it i g a a a gt ti it a

ami a
4.3.5 Targets
4.3.5.1 Current Global Nutrition Targets and Nepal s Status
a. Sustainable Development Goal
a a tai a a a a a t t ta g t it ta at a
tai i tm t i g ti t i t ai am i t g
a i it a im ti a m t tai a ag i t i a t i
at a t t a tai i i at t at a ig a tt ti
imi a i t at m a m i m
m ta a at a a ta g i ti i i i g a ti
ta g t Ba t a ti ta g t t m a at m ti
a a it ti ta g t t a i a
Table 4.3.5.1.1: Nepal s Nutrition Targets and Status Against WHA and SDG Targets
Table 4.3.5.1.1: Nepal’s nutrition targetsand status against WHA and SDG targets
SN Indicators Situation in Nepal SDGs Target (2030)
2011 2016 for Nepal
1 Reduction in the number of 40.5% 35.8% 15.0%
children under - 5 who are stunted
2 (a) Reduction of anemia among 35.0% 40.8% 10.0%
WRA
(b) Reduction of anemia among 46.2% 52.7% 10.0%
Children >5
3 Reduction in low birth weight 12.1% 12.3% <5%
4 Ensure that there is no increase in 1.4% 1.2% <1%

childhood overweight
5 Increase rate of exclusive 69.6% 66.1% >90%
breastfeeding in the first 6 months
6 Reduce and maintain childhood 10.9% 9.7% <5.0%
wasting
4.3.5.2 National Nutritional Status and Targets

National Planning as the lead and coordinating agency for both nutrition specific and sensitive
a a a i ga t a a i a g ag t ti i a i
interventions of Nepal, collects, compiles and interprets the progress of the interventions against nutrition
i specific,
t a t m i a i t t t g t i t agai
sensitive interventions and enabling environment. MSNP-II has set the targets from 2018 to 2022
t
t i i i i t a a i g i m t a t t
and making its links with WHA targets 2025 and SDG targets 2030. Therefore, the current nutrition statusta g t
asm t targets
per the set a forma i g II,
MSNP it thei status
it of nutrition
ta g int Nepal isa as follows:
ta g t
t t ti tat a t t ta g t t tat ti i a i a
Table 4.3.5.2.1: Nepal’s progress against the MSNP 2 targets (2001–2016)
Indicators Status (%) Target (%)

NDHS NDHS NDHS NDHS MSNP WHA SDG
2001 2006 2011 2016 2022 2025 2030
Stunting among U5 children 57 49 41 36 28 24 15
Wasting among U5 children 11 13 11 10 7 <5 4
Underweight among U5 children 43 39 29 27 20 15 10
Percentage of LBW - 14 12 12 10 <1.4 <1.4
Exclusive breastfed - 53 70 66 80 85 90
N ati onal P lanni ng as th e lead and c oord i nati ng ag enc y f or b oth nutri ti on s pec i f i c and s ens i ti v e
i nterv enti ons of N epal, c ollec ts , c om pi les and i nterprets th e prog res s of th e i nterv enti ons ag ai ns t nutri ti on
s pec i f i c , s ens i ti v e i nterv enti ons and enab li ng env i ronm ent. M SN P - I I h as s et th e targ ets f rom 2018 to 2022
and m ak i ng i ts li nk s w i th W HA targ ets 2025 and SDG targ ets 203 0. T h eref ore, th e c urrent nutri ti on s tatus
as per th e s et targ ets f or M SN P I I , th e s tatus of nutri ti on i n N epal i s as f ollow s : ami a
Table
Table4.3.5.2.1: Nepals progres
4.3.5.2.1: Nepal’ s Progress Against
s agains the MSNP
t the MSNP 2 Targets
2 targets ( 2001– (2001–2016)
2016)
Indicators Status ( % ) Target ( % )

NDHS NDHS NDHS NDHS MSNP WHA SDG
2001 2006 2011 2016 2022 2025 2030
Stunti ng am ong U 5 c h i ld ren 57 4 9 4 1 3 6 28 24 15
W as ti ng am ong U 5 c h i ld ren 11 13 11 10 7 < 5 4
U nd erw ei g h t am ong U 5 c h i ld ren 4 3 3 9 29 27 20 15 10
P erc entag e of L B W - 14 12 12 10 < 1. 4 < 1. 4
E x c lus i v e b reas tf ed - 53 70 66 80 85 90
F ed ac c ord i ng to rec om m end ed I Y C F
- - 24 3 6 60 70 80
prac ti c es
O v er- w ei g h t and ob es i ty am ong U 5 - - - 2. 1 1. 4 1 < 1
c h i ld ren
Anaem i a am ong U 5 c h i ld ren - 4 8 4 6 53 28 20 < 15
Anaem i a am ong c h i ld ren und er 6- 23 - 78 69 68 - 60 < 50
m onth s
Anaem i ai aamam ong
Anaem ong w w om om enen (15-
(15- 4 9)4 9) - - 3 6 3 6 3 5 3 5 4 1 4 1 24 24 20 20< 15 < 15
Anaem
Anaem i ai aamam ong
ong preg
pregnant
nantw omw omenen - - 4 2 4 2 4 8 4 8 4 6 4 6 - - 3 5 3 5< 25 < 25
Anaem
Anaem i ai ai ni nadad oles
olesc ent
c entw omw omenen
(15-(15-
19)19) - - 3 9 3 9 3 8. 53 8. 5 4 3 . 6 4 3 . 6 25* 25* 3 5 3 5< 25 < 25
BB odod y y m m asass s i ndi nd exex (< (<18.18.5k 5kg /mg /m2) am2) amongong 26 26 24 24 18. 218. 2 17 17 12 12 8 8 < 5 < 5
ww omom en en
- 9 14 22
ov erw ei g h t or ob es e am ong w om en
ov erw ei g h t or ob es e am ong w om en - 9 14 22 18 18 15 15< 12 < 12
Anaem i a i n ad oles c ent w om en f or 10- 19 3 8. 5 4 3 .6 - - < 15
Anaem i a i n ad oles c ent w om en f or 10- 19 3 8. 5 4 3 .6 - - < 15
y ears ag ed
y ears ag ed
4.3.6 Program m e s trategies
4.3.6
4.3.6Programme
Program m strategies
e s trategies
T h e ov erall s trateg i es f or i m prov i ng nutri ti on i n N epal are i ) th e prom oti on of a f ood b as ed - approac h , i i )
f T ood
h e ovf orti erall
f ai c atis trateg
on,t ati i i )i gi
esth ef or i m prov
s upplem i ng nutri
imentati oni gofti fon
oodti ns i N andepal
i v i)are
th ei prom
) th ae oti
prom
a on ofoti on
t ofli c ah ealth
i pub f oodm m b aseased ures
- approac
. T ah e h , i i )
f pec
sa ood i f if caorti
nutri f i c tiati
aonon, iii i i ) th i ese s are
s trateg upplem
li s tedaentati
i n B oxon
iii4 . of3 t . 2.f ood s and mi v ) thtae prom oti on of apub liic h ealth t m eas
m ures . T h e
s peci i f i c nutri
a t timonas trateg i es are li s ted
i i n B t oxi 4 . 3 . 2.t at gi a it i B
Box 4.3.6.1: Specific s trategies to im prov e nutrition in Nepal
Box 4.3.6.1: Specific s trategies to im prov e nutrition in Nepal
Control of protein energy m alnutrition ( PEM) Hous ehold food s ecurity
Control
• P of
rom protein energy
ote b reas tf eed i m ng alnutrition
w i th i n one ( PEM) Hous
• P ehold
rom otefood
k i tc h s en
ecurity
g ard en and ag ri c ultural
• h P our rom ofote b i rthb reas
and tf aveedoi d i ngpre-w lac i th teal
i n one •s k i lls P . rom ote k i tc h en g ard en and ag ri c ultural
f eed i ng .
h our of b i rth and av oi d pre- lac teal • P rom s k otei lls . rai s i ng of poultry , f i s h and li v es toc k
• P f rom eed ote
i ng . ex c lus i v e b reas tf eed i ng f or •f or h P ous rom eh ote old rai
c ons
s i ngum ofptipoultry
on. , f i s h and li v es toc k
f i rs t s i x m onth s and th e ti m ely • I nf orm f or h ous eh old c ons um h pti
c om m uni ty people ow on. to s tore and
• P rom ote ex c lus i v e b reas tf eed i ng f or
i ntrod uc ti on of c om plem entary f ood . pres erv e f am i ly f ood .
f i rs t s i x m onth s and th e ti m ely • I nf orm c om m uni ty people h ow to s tore and
• E ns ure c onti nuati on of b reas tf eed i ng • I m prov e tec h ni c al k now led g e of f ood
f or at leas t 2 y ears and th e proc es s i ng and pres erv ati on.
i ntrod uc ti on of appropri ate • P rom ote w om en’ s g roup f or i nc om e
c om plem entary f eed i ng af ter 6 g enerati ng ac ti v i ti es .
im ntrod onth s . uc ti on of appropri ate • P rom ote w om en’ s g roup f or i nc om e
DoHS, Annual c om Report
plem 2075/76
entary f eed (2018/19)
i ng af ter 6 Im prov ed dietary g enerati practices
ng ac ti v i ti es .
• Streng th en th e c apac i ty of h ealth
w m orkonth ers s and . m ed i c al prof es s i onals f or • C ond uc t a s tud y to c lari f y th e prob lem s of
Im prov ed dietary practices
• nutri Streng th en th e c
ti on and b reas tf eed i ng apac i ty of h ealth c ulturally - related d i etary h ab i ts
m w anag ork ersem ent and and m ed c ounsi c al prof elli nges . s i onals f or • P rom C ond
• ote nutriuc t ati s on
tud edy uctoatic lari
on f and
y th ade prob lem s of
v oc ate
• I m nutri provti eon k now and ledb reas
g e and tf eeds k i llsng of f or g c ood ulturally
d i ets - and
related d i etary
d i etary h ab i tsh ab. i ts
h m ealth anag w emork ent ers on and g row c ouns th elli
m oni ng tori
. ng • •Dev elop P rom and otes nutri
treng tith onenedprog uc ati
ram on m andes f orad v oc ate
h our of b i rth and av oi d pre- lac teal s k i lls .
f eed i ng . • P rom ote rai s i ng of poultry , f i s h and li v es toc k
• P rom ote ex c lus i v e b reas tf eed i ng f or f or h ous eh old c ons um pti on.
f i rs t s i x m onth s and th e ti m ely • I nf orm c om m uni ty people h ow to s tore and
ami a
i ntrod uc ti on of appropri ate • P rom ote w om en’ s g roup f or i nc om e
c om plem entary f eed i ng af ter 6 g enerati ng ac ti v i ti es .
m onth s .
Im prov ed dietary practices
• Streng th en th e c apac i ty of h ealth
w ork ers and m ed i c al prof es s i onals f or • C ond uc t a s tud y to c lari f y th e prob lem s of
nutri ti on and b reas tf eed i ng c ulturally - related d i etary h ab i ts
m anag em ent and c ouns elli ng . • P rom ote nutri ti on ed uc ati on and ad v oc ate
• I m prov e k now led g e and s k i lls of f or g ood d i ets and d i etary h ab i ts .
h ealth w ork ers on g row th m oni tori ng • Dev elop and s treng th en prog ram m es f or
and prom oti on and nutri ti on b eh av i our c h ang e to i m prov e d i etary h ab i ts .
c ouns elli ng • Streng th en nutri ti onal ed uc ati on and
• Streng th en th e s y s tem of g row th ad v oc ac y ac ti v i ti es to eli m i nate f ood tab oos
m oni tori ng and i ts s uperv i s i on and th at af f ec t nutri ti onal s tatus .
m oni tori ng . • P rom ote th e h ous eh old f ood s ec uri ty
• P rom ote to us e of appropri ate loc ally prog ram m e.
av ai lab le c om plem entary f ood s . Infectious dis eas e prev ention and control
• I nc reas e aw arenes s on th e i m portanc e
• P rom ote k now led g e, atti tud es and prac ti c es
of appropri ate and ad eq uate nutri ti on
th at w i ll prev ent i nf ec ti ous d i s eas es .
f or c h i ld ren and preg nant and
• E ns ure ac c es s to appropri ate h ealth
lac tati ng m oth ers . s erv i c es .
• Streng th en th e k now led g e of h ealth • I m prov e nutri ti onal s tatus to i nc reas e
pers onnel on th e d i etary and c li ni c al res i s tanc e ag ai ns t i nf ec ti ous d i s eas e
m anag em ent of s ev erely • I m prov e s af e w ater s uppli es , s ani tati on and
m alnouri s h ed c h i ld ren. h ous i ng c ond i ti ons .
• Di s tri b ute f orti f i ed f ood s to preg nant • I m prov e f ood h y g i ene.
and lac tati ng w om en and c h i ld ren
School Health and Nutrition Program m e
ag ed 6 to 23 m onth s i n f ood d ef i c i ent
areas . • B ui ld c apac i ty of poli c y and w ork i ng lev el
• I m prov e m aternal and ad oles c ent s tak eh old ers .
nutri ti on and low b i rth w ei g h t th roug h • T h e b i annual d i s tri b uti on of d ew orm i ng
i m prov ed m aternal nutri ti on. tab lets to g rad e 1 to 10 s c h ool c h i ld ren.
• C reate aw arenes s of th e i m portanc e • C eleb rate Sc h ool Health and N utri ti on (SHN )
of ad d i ti onal d i etary i ntak e d uri ng w eek i n J une ev ery y ear to rai s e aw arenes s
preg nanc y and lac tati on. on i m portanc e nutri ti on at th e c om m uni ty
• Streng th en nutri ti on ed uc ati on and lev el th roug h s c h ool c h i ld ren and h ealth
c ouns elli ng m ec h ani s m . w ork ers .
• Di s tri b utef i rs t ai d k i ts to pub li c s c h ools .
Control of iron deficiency anaem ia ( IDA) • I ntrod uc e c h i ld - to- c h i ld and c h i ld - to- parent
• Ad v oc ate to poli c y m ak ers to prom ote approac h es .
d i etary d i v ers i ty .
Integrated m anagem ent of acute m alnutrition
• I ron f oli c ac i d s upplem entati on f or
preg nant and pos t- partum m oth ers . • B ui ld c apac i ty of h ealth w ork ers f or th e
• I ron f orti f i c ati on of w h eat f lour at m anag em ent of ac ute m alnutri ti on and
roller m i lls . F C HV s on s c reeni ng of und er f i v e y ears
• I nterm i ttent i ron f oli c ac i d c h i ld ren, ref er th e c h i ld ren w i th s ev ere
s upplem entati on f or ad oles c ent g i rls . ac ute m alnutri ti on to appropri ate f ac i li ty f or
th erapeuti DoHS, Annualent
c treatm Report
and c 2075/76
are and (2018/19)
• M ulti ple m i c ronutri ent
s upplem entati on f or c h i ld ren ag ed 6- c ouns elli ng s erv i c es f or th e prev enti on of
23 m onth s . ac ute m alnutri ti on.
• C reate aw arenes s of i m portanc e of • E s tab li s h and i m plem entth ek ey parts of th e
i ron i n nutri ti on, prom ote I M AM prog ram m e: c om m uni ty m ob i li z ati on,
c ons um pti on of i ron ri c h f ood s and i npati entth erapeuti c c are, outpati ent
• I ntrod uc e c h i ld - to- c h i ld and c h i ld - to- parent
• Ad v oc ate to poli c y m ak ers to prom ote approac h es .
d i etary d i v ers i ty .
Integrated m anagem ent of acute m alnutrition
• I ron f oli c ac i d s upplem entati on f or
preg nant and pos t- partum m oth ers . • B ui ld c apac i ty of h ealth w ork ers f or th e
• I ron f orti f i c ati on of w h eat f lour at m anag em ent of ac ute m alnutri ti on and
roller m i lls . F C HV s on s c reeni ng of und er f i v e y ears
ami a
• I nterm i ttent i ron f oli c ac i d c h i ld ren, ref er th e c h i ld ren w i th s ev ere
s upplem entati on f or ad oles c ent g i rls . ac ute m alnutri ti on to appropri ate f ac i li ty f or
• M ulti ple m i c ronutri ent th erapeuti c treatm ent and c are and
s upplem entati on f or c h i ld ren ag ed 6- c ouns elli ng s erv i c es f or th e prev enti on of
23 m onth s . ac ute m alnutri ti on.
• C reate aw arenes s of i m portanc e of • E s tab li s h and i m plem entth ek ey parts of th e
i ron i n nutri ti on, prom ote I M AM prog ram m e: c om m uni ty m ob i li z ati on,
c ons um pti on of i ron ri c h f ood s and i npati entth erapeuti c c are, outpati ent
prom ote d i v ers e d ai ly d i ets . th erapeuti c c are, m anag em ent of
c om pli c ati ons of s ev ere ac ute m alnutri ti on
• C ontrol paras i ti c i nf es tati on am ong
and m anag em ent of M AM .
nutri ti onally v ulnerab le g roups
th roug h d ew orm i ng preg nant w om en • I m plem entth eI M AM prog ram m e f ollow i ng
and c h i ld ren ag ed 12- 23 m onth s . f our k ey pri nc i ples s uc h as ; m ax i m um
c ov erag e & ac c es s , ti m eli nes s of s erv i c e
Control of iodine deficiency dis orders prov i s i on, appropri ate m ed i c al and
• T h e uni v ers al i od i z ati on of s alt. th erapeuti c c are and c are as long as i t i s
• Streng th en i m plem entati on of th e need ed .
I od i z ed Salt Ac t, 2055 to ens ure th at • I nteg rate th e m anag em ent of ac ute
all ed i b le s alt i s i od i z ed . m alnutri ti on ac ros s s ec tors to ens ure th at
• T h e s oc i al m ark eti ng of c erti f i ed tw o- treatm ent i s li nk ed to s upport f or
c h i ld log o i od i z ed s alt. reh ab i li tati ng c as es and to w i d er
m alnutri ti on prev enti on prog ram m e and
• E ns ure th e s y s tem ati c m oni tori ng of s erv i c es .
i od i z ed s alt. • Support and prom ote I Y C F , w ater, s ani tati on
• I nc reas e th e ac c es s i b i li ty and m ark et and h y g i ene (W ASH), early c h i ld h ood
s h are of i od i z ed pac k et s alt w i th th e d ev elopm ent, s oc i al protec ti on and c h i ld
tw o- c h i ld log o. h ealth and c are along w i th th e m anag em ent
• C reate aw arenes s ab out th e of ac ute m alnutri ti on.
i m portanc e of us i ng i od i z ed s alt to • P rom ote th e I M AM prog ram m e as th e
c ontrol i od i ne d ef i c i enc y d i s ord er b ri d g e b etw een em erg enc y and
(I DD) th roug h s oc i al m ark eti ng d ev elopm ent prog ram m es .
c am pai g n. • T h e s upporti v e s uperv i s i on and m oni tori ng
of I M AM prog ram m e ac ti v i ti es .
Control of v itam in A deficiency
• Harm oni z e th e c om m uni ty and f ac i li ty - b as ed
• T h e b i annual s upplem entati on of h i g h b as ed m anag em ent of ac ute m alnutri ti on.
d os e v i tam i n A c aps ules to 6- 59- • Streng th en th e c oord i nati on and c apac i ty of
m onth old s . nutri ti on reh ab i li tati on h om es .
• P os t- partum v i tam i n A
s upplem entati on f or m oth ers w i th i n Nutrition in em ergencies
4 2 d ay s of d eli v ery . • E s tab li s h and s treng th en ef f ec ti v e
• Streng th en i m plem entati on of v i tam i n lead ers h i p f or nutri ti on c lus ter i nterag enc y
A treatm ent protoc ol f or s ev ere c oord i nati on, w i th li nk s to oth er c lus ters
m alnutri ti on, pers i s tent d i arrh oea, c oord i nati on m ec h ani s m s on c ri ti c al i nter-
m eas les and x eroph th alm i a. s ec toral i s s ues .
• N utri ti on ed uc ati on to prom ote • I ni ti ate nutri ti onal as s es s m ent and
d i etary d i v ers i f i c ati on and s urv ei llanc e s y s tem s and /or rei nf orc ed f or
c ons um pti on of v i tam i n A ri c h f ood s . h um ani tari an as s es s m ent and i nf orm ati on
E ns uriReport
DoHS,• Annual ng th e2075/76
av ai lab i (2018/19)
li ty of v i tam i n, A m anag em ent.
c aps ules at h ealth f ac i li ti es . • B ui ld ad eq uate c apac i ty of nutri ti on c lus ter
• I nc reas e aw arenes s of i m portanc e of m em b ers , partners , h ealth w ork ers , F C HV s
v i tam i n A s upplem entati on. and relev ant s tak eh old ers f or nutri ti on i n
• T h e b i annual d i s tri b uti on of v i tam i n A em erg enc y prepared nes s and res pons e and
c aps ules to 6 to 59- m onth old s rec ov ery ac ti ons
ami a
• E ns ure th e s y s tem ati c m oni tori ng of s erv i c es .

i od i z ed s alt. • Support and prom ote I Y C F , w ater, s ani tati on
• I nc reas e th e ac c es s i b i li ty and m ark et and h y g i ene (W ASH), early c h i ld h ood
s h are of i od i z ed pac k et s alt w i th th e d ev elopm ent, s oc i al protec ti on and c h i ld
tw o- c h i ld log o. h ealth and c are along w i th th e m anag em ent
• C reate aw arenes s ab out th e of ac ute m alnutri ti on.
i m portanc e of us i ng i od i z ed s alt to • P rom ote th e I M AM prog ram m e as th e
c ontrol i od i ne d ef i c i enc y d i s ord er b ri d g e b etw een em erg enc y and
(I DD) th roug h s oc i al m ark eti ng d ev elopm ent prog ram m es .
c am pai g n. • T h e s upporti v e s uperv i s i on and m oni tori ng
of I M AM prog ram m e ac ti v i ti es .
Control of v itam in A deficiency
• Harm oni z e th e c om m uni ty and f ac i li ty - b as ed
• T h e b i annual s upplem entati on of h i g h b as ed m anag em ent of ac ute m alnutri ti on.
d os e v i tam i n A c aps ules to 6- 59- • Streng th en th e c oord i nati on and c apac i ty of
m onth old s . nutri ti on reh ab i li tati on h om es .
• P os t- partum v i tam i n A
s upplem entati on f or m oth ers w i th i n Nutrition in em ergencies
4 2 d ay s of d eli v ery . • E s tab li s h and s treng th en ef f ec ti v e
• Streng th en i m plem entati on of v i tam i n lead ers h i p f or nutri ti on c lus ter i nterag enc y
A treatm ent protoc ol f or s ev ere c oord i nati on, w i th li nk s to oth er c lus ters
m alnutri ti on, pers i s tent d i arrh oea, c oord i nati on m ec h ani s m s on c ri ti c al i nter-
m eas les and x eroph th alm i a. s ec toral i s s ues .
• N utri ti on ed uc ati on to prom ote • I ni ti ate nutri ti onal as s es s m ent and
d i etary d i v ers i f i c ati on and s urv ei llanc e s y s tem s and /or rei nf orc ed f or
c ons um pti on of v i tam i n A ri c h f ood s . h um ani tari an as s es s m ent and i nf orm ati on
• E ns uri ng th e av ai lab i li ty of v i tam i n, A m anag em ent.
c aps ules at h ealth f ac i li ti es . • B ui ld ad eq uate c apac i ty of nutri ti on c lus ter
• I nc reas e aw arenes s of i m portanc e of m em b ers , partners , h ealth w ork ers , F C HV s
v i tam i n A s upplem entati on. and relev ant s tak eh old ers f or nutri ti on i n
• T h e b i annual d i s tri b uti on of v i tam i n A em erg enc y prepared nes s and res pons e and
c aps ules to 6 to 59- m onth old s rec ov ery ac ti ons
th roug h F C HV s . • Support f or appropri ate m aternal, i nf ant
• Ad v oc ate f or i nc reas ed h om e and y oung c h i ld f eed i ng (I Y C F ) and c are to
prod uc ti on, c ons um pti on and b e ac c es s ed b y af f ec ted w om en and
pres erv ati on of v i tam i n A ri c h f ood s . c h i ld ren.
• Streng th en th e us e of th e v i tam i n A • E ns ure ac c es s to appropri ate m anag em ent
T reatm ent protoc ol. and c are s erv i c es f or th e c h i ld ren and
• P rom ote th e c ons um pti on of v i tam i n w om en w i th ac ute m alnutri ti on.
A ri c h f ood s and a b alanc ed d i et • E ns ure ac c es s to m i c ronutri ents f rom
th roug h nutri ti on ed uc ati on. f orti f i ed f ood s , s upplem ents or m ulti ple-
• P rov i d e v i tam i n A c aps ules (200,000 m i c ronutri ent f or c h i ld ren and w om en.
I U ) to pos tpartum m oth ers th roug h • E ns ure ac c es s to relev ant i nf orm ati on ab out
h ealth c are f ac i li ti es and c om m uni ty nutri ti on prog ram m e ac ti v i ti es f or C h i ld ren
v olunteers . and w om en.

ami a
L ow birth weight L ifes ty le related dis eas es

• Red uc e m aternal m alnutri ti on b y • C reate aw arenes s am ong ad ults ab out th e
prev enti ng P E M , V AD, I DD and I DA. i m portanc e of m ai ntai ni ng g ood d i etary
L ow birth
• Red uc e th e w ork load s of preg nant L ifes ty
weight le related h ab dis
i ts .eas es
• Redw omuc een. m aternal m alnutri ti on b y • C •reate Devaw eloparenes th se amc apac
ong i tyad fults ab outti onal
or nutri th e
• prev I nc enti
reas nge awP E M arenes
, V AD,s I of DDthande riI sDA.
k s of i m portanc c ounseelli of ng
m aiatntaih ealth
ni ng g f ood
ac i li d tii etary
es .
• Reds m ucokei ng th eand
w orkalcloadoh s olof topreg pregnant nant h •ab i tsC . reate aw arenes s am ong ad oles c ents and
w om en. • Dev elop th e c apac i ty f or nutri ti onal
w om en. ad ults ab out th e i m portanc e of c ontrolli ng
• I nc reas e aw arenes s of th e ri s k s of c ouns elli ng at h ealth f ac i li ti es .
• I nc reas e aw arenes s of ri s k s of early s m ok i ng and b od y w ei g h t.
s m ok i ng and alc oh ol to preg nant • C reate aw arenes s am ong ad oles c ents and
preg nanc y to i nf ant and m aternal • C reate aw arenes s to i nc reas e ph y s i c al
w om en. ad ults ab out th e i m portanc e of c ontrolli ng
h ealth . ac ti v i ty and i m prov e s tres s m anag em ent.
• I nc reas e aw arenes s of ri s k s of early s m ok i ng and b od y w ei g h t.
• preg P romnancote ac i tinfv ant
y to i ti es andf orm nutri
aternalti on • C reate aw arenes s to i nc reas e ph y s i c al
m
h ealth . oni tori ng and c ouns elli ng at ac ti v i ty and i m prov e s tres s m anag em ent.
• P rom antenatal
ote ac ti c v lii tiniesc s f . or nutri ti on
m oni tori ng and c ouns elli ng at
4.3.7 Maj or achiev em ents
antenatal c li ni c s .
4.3.7 Major achievements
4.3.7.1 Growth m onitoring and prom otion
4.3.7 Maj or achiev em ents
M oni tori
4.3.7.1 ng th e monitoring
Growth g row th of c and
h i ld ren les s th an tw o y ears of ag e h elps prev ent and c ontrol protei n- energ y
promotion
4.3.7.1 Growth m onitoring and prom otion
m alnutri ti on and prov i d es th e opportuni ty f or tak i ng prev enti v e and c urati v e ac ti ons . Health w ork ers at all
M pub oni itlitori
c h ngiealth
gth te f gacrowi ligtithes ofm t oni
c h i ldtor
renth iles
e g s row
th an th twof otc h y a
ears tof onc
i ld ren ag ee h aaelps
m onthprevagusent
i ng andth ec ontrol
g row th protei
m tonian-tori
energ
ng y c ard
t th at
tb asi ed ti on
m i s alnutri g
and ma
prov i d es t i
th e
on W HO ’ s new g row th s tand ard s . a
opportuni ty f i
or tak i t
ng prev enti v te andit c urati v ta
e i
ac g
ti ons . Health w a
ork ers at alla
apub li c h ealth af act i li ti es m oni at torath e g row i th ofac th i ld a reni ionc e m a m onthit ust i ng gth e g trow th m oni i tori ng c ard ath mat t
b i asgedt on
i s Growth gW HO t’ s new
Monitoring m Status g itrow ith, gFY a2075/
s tand ardt s76
at . i( 2018/
a 19) g t ta a
Growth Monitoring Status , FY 2075/ 76 ( 2018/ 19)
Figure 4.3.7.1.1: Percentage of children aged 0- 23 Fig 4.3.7.1.2: Percentage of children 0- 23 m onths
m onths regis tered for growth m onitoring regis tered for growth m onitoring who were
Figure 4.3.7.1.1: Percentage of children aged 0- 23 Fig 4.3.7.1.2: Percentage of children 0- 23 m onths
underweight
m onths regis tered for growth m onitoring regis tered for growth m onitoring who were
110106
underweight
9. 5
98
7. 7 8. 1
79 82 79 79 82 77 73 72 7. 3
69 110106 69 70 71 9. 5 6. 2
64 66 64 63 65 68 98 5. 65. 2
56 55 56 4 .9 4 .8
7. 7 4 8.. 41
4 . 13 . 9 7. 3 4 .4 4 .4
79 82 79 79 82 77 73 72 3 .3 3 .5
69 69 70 71 6. 2
64 66 64 63 65 68 2. 52. 2 2. 4 2 5. 65. 2
56 55 56 1.4 5. 9 4 . 8 4 . 1.
4 4 2. 131. 91. 1 4 .4 4 .4
3 .3 3 .5
2. 52. 2 2. 4 2
1. 5 1. 2 1 1. 1
F Y 73 /74 F Y 74 /75 F Y 75/76 F Y 73 /74 F Y 74 /75 F Y 75/76

F Y 73 /74 F Y 74 /75 F Y 75/76 F Y 73 /74 F Y 74 /75 F Y 75/76
Sourc e: HM I S/M D/DoHS
Sourc e: HM I S/M D/DoHS Sourc e: HM I S/M D/DoHS
Sourc e: HM I S/M D/DoHS
I nI nF YF Y 2075/76,
2075/76, th tthe perc
e perc entag entag etag ofe c ofh i ldc h ren i ld ren
i ag e 0-ag
ag 23e 0-m 23onthm s onth s reg i s tered f or g row th m oni tori ng i s 71 perc ent
mreg i ts tered gif ort g row th m goni toritng mi s 71itperci ent gi
ww i thi th i nci nctreas
reas
it i
ed ed i n i n
1 1a
perc perc ent i ent
f rom f romlas t lasf i t
t m at
s c f
al i s y c al y
ear. ear.
I n F Y I n
a aF
75/76,Y 75/76,
th e h i th
g h e
es h ti g c h
ov est t
erag c ov
e erag
ig t
on g e
row on
th g m row
ag
oni th
tori m ng g i s torit ng i s
oni
mi ni nK K arnali
itarnali gprov
i prov i i nci i nce i ae. e.i . e.98
a i98 percperc i ent
ent and i and low eslowt c esov terag c ovt eierag
a s i neiB s ag i nm B ati
tag P m rovatii ag ncP erovii . e.i inc 56
eBagma
i perc
. e. 56ent.percI n ent.
thi es eI n iF Y th es e F Y
75/76,out
75/76, t outof ofttotal total c h i c ldh reni ld ren w h o w h attend
ot attend ted taf edor g f rowor
i g throwm oni th m toriaoning tori
s es ngs i on,
s es 3 s . gi 5on,
perc3 t. ent 5m perc w ereent
it s ufiw f ere
geri ng s uff rom
if eri ng f rom
undund erwerw tei eig h g t.h t. i g m ig t
I nI nF YF Y 2075/76,
2075/76,am among ong71 g71 percperc
ent,ent, 3 . 5 3 perc ent ofent0- of23 0-m 23onthm s onth
. t5 perc c h i ld s ren
c h i ldw tere
ren reported
w ere as und erw ei g h t at ei g h t at
am t m i reported as und erw t a
nati
nationalonallevlevel.el.Ac Acc ordc ordi ng i ngto thtoeth i nfeorm ati on,
i nf orm ati thon,
e h th i g eh esh i tg h proporti on (6. on
es t proporti 2% )(6.of 2%und) erw ei g h erw
of und t c h eii ld g ren
h t c are
h i ld i ren
n are i n
ami a
ig t at a a i gt t i ma t ig t
ig t i a i a ai i a im i i t a ti
i a a i i
K arnali prov i nc e f ollow ed b y Sud ur P as c h i m P rov i nc e 7 (6. 2% ) w h i le th e leas t i s i nG and ak i P rov i nc e (1. 1% )
(F i g ure 4 . 3 . 7. 1. 1 and 4 . 3 . 7. 1. 2).
Figure 4.3.7.1.3: Percentage of newborns with low Figure 4.3.7.1.4: Av erage no. of growth
birth weight ( < 2.5 kg) am ong total deliv ery by health m onitoring v is its per child ( 0– 23 m onths )
workers
4 .5
4
15. 144 . 9 3 .9 3 .8
3 .6
14 . 3 3 .3 3 .3 3 .4 3 .4
13 . 135 . 2 13 . 3 3 .1 3 .2 3 .2 3 .1
2. 9 2. 9 2. 9 3 3 3
12. 6 12. 5 2. 7
11. 7 11. 8 11. 9 2. 5
11 11. 3 11. 2
10. 5 10. 4 2. 1
9. 9 1. 9 1. 9
9. 5
8. 8 8. 4 8. 8
7. 9
6. 9 6. 7
73 /74 74 /75 75/76 F Y 73 /74 F Y 74 /75 F Y 75/76
Sourc e: HM I S Sourc e: HM I S
N ati
a onally a th te perc entag tag e of new - b orn w i th lowit b i rth w iei tg h t (< ig
2. 5tk g ) i s 11. g2 i ni th es e iF Y t2075/2076 w h i le
i n lasi t fii s c al
a y tear alsa o i taw asa F Y it74 /75a i s 11. 9. As f iar as prov i nc aes a w as c onci erned i na th es e f i s c al y earB
i tag m ati a
prova i ncBagma
e h as th e h i g ih es t perc a t e igof newt - b orn
entag w tagi th low b i rth w ei g h t i . ite. 13 . 2 perci ent t and igK arnali
t i
P rov i nc et h aas th ealow aesi t i . e. 6.i 7 perc aentt of new - b orn
ti w i th low b i rth tw ei g h t. it it ig t
N ati onally , th ere w as an av erag e of 3 v i s i ts per c h i ld i n F Y 2073 /74 ,F Y 2074 /75 b ut i n F Y 2075/76, th e
av aerag eav i s i tt3 . 1. As af araas aprov ag i iterned i n ith esi e F Y 2075/76,th e P rov i nc e num b teri 2 h as th e
i nc es are c onc
tlow esa t av ag erag e g row th m oni tori ng v i s i ts w h i c h a i s 2. 1 and h i g h esi tti n Sud urpas c h i m prov
i it a a i t i nc e w ih i c h i s 4 m
. 2.
a t t a ag g
(F i g ure 4 . 3 . 7. 1. 3 and 4 . 3 . 7. 1. 4 ).
t m it i g i it i i a ig t i a im i
i i ig a
4.3.7.2 Infant and y oung child feeding
4.3.7.2
Appropri Infant
ate f eedand
i ng young child
and c are pracfeeding
ti c es f or i nf ant and y oung c h i ld ren are es s enti al to enh anc e c h i ld
s urv i v al, g row th and d ev elopm ent. T h e i nf ant and y oung c h i ld f eed i ng (I Y C F ) and prac ti c es i nc lud e early
i ni ti ati on iat
of b reas ti f g
eeda i ng w a i th i n aan h our of i c h ai ld tb ai rth , ex c lusgi v e i b reas tf aeed i ng f or as i x t m onth as and i
i a g t a m t i a t a g i i g
prov i d i ng nutri ti onally ad eq uate and appropri ate c om plem entary f eed i ng s tarti ng f rom s i x m onth s w i th a a i
a nued
c onti i i ab reas tf eed i nga up
t to twi og y earsit i of aag e or b ey ond i . I m iprov t i ng c arei prac ti c aes relatedi gto I Y C iF im s a t
apri ori ty s trateg
i i gy of M t oHPi . T ah e I Y aC F prog at a a iat m m ta i
ram m e h as b een ong oi ng to all 77 d i s tri c ts f rom F Y 2072/73 . g ta g m i
m t it a i g t t a ag m i g a a
I Y C at
F i s als to li nk ed iw i tha th ei d i its tri b uti
t at on gof m i c ronutri ent pow d er (B aal
g V amm
i ta) to 6- a
23 m onth s c h gi ld iren
g i tn 4 a6
d iis tri
t ic tst and mc h i ld c as h g rants (C C G ) i n 14 d i s tri c ts . How ev er, m ore ef f ec ti v e I Y C F c ouns elli ng and
m oni tori ng m ec h ani s m s are need ed f or th es e prog ram m es .
i a i it t iti mi ti t Baa ita t m t i
i iti t a i a ga t i iti t m i g
a m it i g m a i m a t g amm

ami a
Figure 4.3.7.2.1: Percentage of children aged 0– 6- Figure 4.3.7.2.2: Percentage of children aged 6–
m onths olds regis tered for growth m onitoring who m onths old regis tered for growth m onitoring
were ex clus iv ely breas tfed for their firs t s ix m onths who had receiv ed s olid, s em i- s olid or s oft foods
65
53 . 2 53
60
4 6. 9
4 5. 3 4 4 .6 52 53
4 2. 5
4 0. 8 4 7
3 7. 3 4 5
3 5. 5 4 1
3 4 3 3 .3 4 0
3 2. 1 3 7
3 0. 4 29. 6 3 5
3 3
26. 4 3 13 1
25. 1 29 28
23 . 1 27 27
20. 21.
9 3 20 24
21
15. 5 18
14 . 1 16
12
7. 1 7
3 .1 3
F Y 73 /74 F Y 74 /75 F Y 75/76 F Y 73 /74 F Y 74 /75 F Y 75/76
Sourc e HM I S Sourc e HM I S
T h ere i s i aalarga egprov i nc ii al ia i e i n th ie c th i ld reni ag ed 0-ag6 m onth s mw h otreg i s tered f gi

d i f f erenc or tg row th m oni g toritng
m and w iterei exg calus i v ely b reas tf edi i n th ei raf i rs t s i ix m t onthi s ag te. i I nmF Y 2075/76,
t ag 3 3 . 3 perc ent of th es e c h i ld ren t
natit onw i d e wi ere ex c alus i v ely i b reas tf ed w h i c h i h ad i nc reasa ed i n c iom pari a s on
i to alas t tw i o y earsm .a53i perct enta oft
t0– 6- m onth a old c h i ld ren tw ere reg i s mteredt f or g row ith m oni tori ng w gi eret ex c lus i v elyg b reast tf m
ed f orit th iei rg f i rs t s i x
m onth i of prov i nca e 5 w h ereas t ionly 15 t ipercm entt th e s i m i lar i ag e g roupw aare ex c lus i v e b reas ttf ted i nimi prova i ncage 2
g(F i g ure a4 . 3 . 7. 2. 1). i T h e nati
a onal i av erag ei i s 3 3 . 3 igperc ent, w h i c h i s m uca h lesa s aer thagan ith e 2016 N epal t
Dem i og raphi m i c and Health Surv
t a t ey (N DHS)f i g ure a i . e. 66 perc
m ga i aent. at g i
T h e proportit on of 6- 8 m onth s old c h i ld ren reg i s tered f or g row th m oni tori ng w h o rec ei v ed c om plem entary
f ood s v ari ed i n F Y 2075/76. Ab out 16 perc ent of th es e c h i ld ren i n th e prov i nc e 2 w ere reg i s tered f or
g row th m oni tori ng w h o recmei v edt c om plem entary i f eedgii ngt w h ereas g60 perc t ent
m of its am i eg ag e g roup i ni th e
B ag m ati prov i nc e (F i g ure 4 . 3 . 7. 2. 2). N ati onally , only 3 3 perc ent of th es e c h i ld reni rec ei v ied tc om plem i entary
m m ta a i i t t t
f ood w h igi c h ti s m uc h lowg er tht anmth e itN DHS
i g2016 f i g urei of 84 perc m ent.m T h ta
i s m ay b e ias gs um ed asa les s rec ord i ngt
and am agng gf rom ipri tm ary Bagma
reporti i
reporti ng c entres . T igi m ely i ntrod uc ti onaof c oma plem entary f eed i ngt andt th e
c onsi eq uent need i m i d me appropri
to prov ta ate c ounsi ellii ng m to m oth ers tanda c tareg i v ers i m prov e gth e f eed i ng
prac ti c est . i ma a m a i ga g m ima g t
im Integrated
4.3.7.3 i t m anagem ment of
m acute
ta m alnutrition
i ga t t t i a iat
i gt m t a a gi im t i g a
T h e I nteg rated M anag em ent of Ac ute M alnutri ti on (I M AM ) P rog ram m e (prev i ous ly k now n as C om m uni ty
b as ed M Integrated
4.3.7.3 anag em entmanagement of Ac ute M alnutri ti on [ malnutrition
of acute C M AM ] prog ram m e) prov i d es th e treatm ent of th e c h i ld ren
w i th Sev ere Ac ute M alnutri ti on (SAM ) ag ed 0- 59 m onth s th roug h i npati ent and outpati ent treatm ent
s erv i c es t atg f atac i li ty anda agc om mm unit ty lev els .t T h i s aprog trami m e w as pi loted i ng 2009/010
amm i n f i iv e d i s tri c ts nam aely
Ac h h am , K anc h anpur, M ug u, B ard i y a and J aj ark ot. Af ter pi lot ev aluati on i n 2011/012, th i s prog rami m e tw as
mm it a a ag m t t a t i g amm
ts h i f atm
ted f romt C M tAM to iI M AM prog it ram m e and g rad t uallya s c aledt i up th roug h ag
out th e c ountry m c tov eritng m any g
im ore a d i s ttriac ts . I n tth ae f i rs tt tph atm
as e, I M AM w as s c aled up to 11 d i s tri c ts i n 2013 f rom 6 d i s tri c ts nam aely
t i at a i it a mm it i g amm
Ac h h am , K anc h anpur, B ard i y a,t i J ajt ark am
i t i i i ot, J um la, am M ug u,a K api a lb as tu, Sarlah
g Bai , Dhi aanus
a h a,a aSaptari t and
i t a a i t i g amm a i m t
O k h ald h ung a and i n 2015, i t w as f urth er s c aled up to 14 earth q uak e af f ec ted d i s tri c ts s uc h as ; B h ak tapur,
g amm a
ga a a t g tt t i g ma m iti t t t a
Dh ad i ng , Dolak h a, G ork h a, K ath m and u, K av re, L ali tpur, M ak w anpur, N uw ak ot, ok h ald ung a, Ram ec h h ap,
a a t iti t i m i t i t am am a a Ba i a a a t
Ras uw a, Si nd h uli , Si nd h upalanc h ow k ). I n 2016, to ad d res s th e nutri ti on i m pac ts of d roug h ts em erg enc i es ,
ma g a i at a a i a a a ta i a a ga a i it a t
a t at a a t iti t a B a ta a i g a a a
ami a
at ma a a it a a a t a ga am a a a i i
th i e prog ram a a m e w as f urth er s c aled t upato 7 ad d itti onal d ti s tri i c ts nam
im elya ; t K ali k ot, Humg la, t Dolpa,m gB aj h angi , t
B aj ura, g amm B ai tad i , aDad eld th ura, P aars a. L i k ewt i s e,ai n 2017,
i ath ei prog
t i ram
t m ame w as s c aaled i tup tomDoti a , Ruk uma Ba eas t a g
Baand W aes Baita i a i eas t and
t, N aw alparas a w aes t, a M iah ottari i , Ki h otang andt P anc h gth amm
ar d i s tri c tsa. Duea to m as s ti v e f lood i n m
T eraia t ai n 2017, i ttw as aag aai n as c aaledi up a ttoaJ h apa, M toranga, Sunsaarii , Si rah taa, Rautah ga a B ara,
at, t aK ai lalii ,tDang
i t and t
ma B ank e d i s tri c ts . I n th e m eanti m e,th e prog ram w as als o i m plem ented i n M y ag d i , Sank h uw aas abah a,
i i ai i it a agai a t a a a g a i i a ta at
Ba a ai a i a g a Ba i t i t t m a m t g am
Rupand eh i , K h otang , U d ay pur, C h i tw an etc . I n C h i tw an, th e prog ram w as i m plem ented i n only f ew a a im m t i
plac ag es toi ad ad res s th ae ai s s uesa of SAM a c h i ild ren ta i n thg e C h aepang c om itm uni
a ti est . I n runni it nga f i s tc al y earsg am
th e a
im prog ram h as b een s c aled up i n Darc h ula d i s tri c t. Along w i th M I Y C N prom oti on and s upport, I M AM ai m s toi
m t i a t a t i i i t a g mm
i nteg ratei nutri g ti on a s upport
a t ac ros s g h am ealth ,aearly c h i ld h aood d ev elopm i aent, W a ASH i t and
i t s oc i al gprotec it ti on
m f or th ae c onti nued t reh ab i li tatiaim
s ec tors on oft c asi est gandat to w ti d ien m alnutri ti on t aprev enti ona tprog ram a m e andi
s erv i c es . T h e prog ram m e als o ac ts as a b ri d g e b etw een em erg enc y and d ev elopm ent nutri ti on a
m t a ia t t t a i ita a
ti nterv i enti ons ma. ti g amm a i g amm a a t a a i g
t m g a m t ti i t
Figure 4 . 3 . 7. 3 . 1: Prov ince wis e IMAM perform ance, FY 2075/ 76
ig i i ma
85
75 73 75
66 68
61
50
3 5 29
20 26
14 15 14
0 0 0 1 0 5 0 0 0
N epal P rov i nc e 1 P rov i nc e 2 B ag m ati P rov i nc e G and ak i P rov i nc e P rov i nc e 5 K arnali P rov i nc e Sud urpas h c h i m
P rov i nc e
Rec ov ered Death Def aulter
Sourc e HM I S
I n F Y 2075/76, total 12,13 9 c h i ld ren of 0 m onth s to 5 y ears w i th SAM ad m i tted i n outpati ent and i npati ent
th erapeuti c c entres t ta. Am ong th em ,i 14 ,24 0 w eremd i s c th arg ted . Am ong
a allitd i s c h arg eda mi
SAM c as ies , 75t perc
a entt a
iw ere a rec ovt tered a, les s th an 1 perc
t entm d i ed and 20 perc ent w ere d ef aulter. T h e s ph ere s tand ard f or I M g AM
g t m i a g m g a i a
a ram i s (rec ov eryt rate > 75 perc ent, d ef aulter
prog t arate < 15 perc ent t and
i d aeath rate < 10 perc t ent). F i g ure
a 4 t. 3 . 7
ta a g am i
ex plai ns ab out ov erall perf orm anc e of I M AM prog ram m e of N epal. at t a t at ta
at at t ig ai a t a ma g amm
4.3.7.4
a Nutrition rehabilitation hom es
N utri ti on Reh ab i li tati on Hom es (N RH) are th e f ac i li ty b as ed m anag ed of s ev ere ac ute m alnutri ti on
4.3.7.4 Nutrition rehabilitation homes
i nteg rati ng w i th th e i nteg rati ng w i th h os pi tal s erv i c es . I n N epal, th es e N RH are as s oc i ated w i th pri m ary ,
s ec tondi ary and aterti ary lev el h os
i ita mpi tals . T h ea f i rs tt N utria ti ion it Rehaab i li tati maonag Hom e (N RH) w asa es ttab ma li s h ed ti ni
1998 i n K ath
i t g a g it t i t g a g it m and u ai m i ng f or th e red uc ti on of c
itah i ld m ortali
i ty c aus ed b
a t y m alnutri ti on th
a a npati
roug h i iat ent it
reh ima
ab i li tati on of s eva erea ac ute t m alnutri
a ti on am ongitath e c h i ld ren und t ert f ii v e y ears ofa agi e.itaSi nc e th en, m N RH h as a
b een ta i s c aled - up
i i n d i f f
i at maerent plac es ac ros
aimi g s N epal. t T h e N RH not only treat
i m ta it a and m anag e s ev ere
maac ute ti
tm alnutri g ti ion aw i th t i npatiaent i itas erv i c e, b ut als oa prov t i ma d e nutri t iti on edamuc atigont and i c ouns elli ng to th e a
g uard ag i ans i/parents t f or th e m aanag em enta of m od ieratei ac utet m alnutri a ati on as w ellaas g ood nutri ti ton and t at
ha ealthmac are ag of th ei r c a t ma t i
h i ld ren. I n F Y 2075/76, it i a
total 2,226 tc h i ld i
ren und tera f i v e y earsi w i th ts evi ere ac utea
am alnutri ti on (SAM i g t) w t ere gad am i tted ia i n ath e t18 N RH t andmaam agong mth emt 2,193 m c h at a w teremarec ov tered
i ld ren i a
d i s c h arga edg . T h os et not i recaov ered aw terearef erredt toi th ei terti ary h ealth f ac i li ti es tf orta ad v anc e treatm i ent.
Along w ai th th eit treatm ent aof c th i ld ma ren, 3 0,626 t i m oth ers w h o c am a emi to th e N i RHt w ere c ouns eled a i nam th e N gRHt m
and i n th ei h os pi tal O P D. I n th e N RH,i m otha ers g are ed uc ated t and c ouns eled on th e d i etaryt m tanagt em ent a f or a t
a ii a a t atm t g it t t atm t i m t am
t t i t a i t ita t m t a at
a t i ta ma ag m t g i a mai tai t a ti

ami a
tat
y oung c h i ld ren and i m aiatntai nmth e enh anc ed nutri ti on s tatusi g taof SAM c h i tld ren at h ommae. I n F Y 2075/76,
ti
y oung c h i ld ren and m ai ntai n th e enh anc ed nutri ti on s tatus of SAM c h i ld ren at h om e. I n F Y 2075/76,
a ii ngita tab le s h m
f ollow ow s thi e perf aorm anc e of N utri ti on Reh ab i li tati on Hom es i n N epal:
f ollow 4.3.2:
Table i ng tabAdmission
le s h ow s thand
e perf orm anc eStatus
Discharge of N utri
oftiNutrition
on Reh ab iRehabilitation
li tati on Hom es Homes,
i n N epal:2075/76 Province Wise
Table 4.3.7.4.1: Adm is s ion and dis charge s tatus of nutrition rehabilitation hom es , 2075/ 76 prov ince wis e
Table 4.3.7.4.1: Adm is s ion and dis charge s tatus of nutrition rehabilitation hom es , 2075/ 76 prov ince wis e
More Couns eling
L es s More Couns eling
L es s than or to m other
Total than than or Total to m other
Total Male Fem ale than eq ual Total ( inhous e
adm is s ion Male Fem ale fiv e eq ual Dis charge ( inhous e
adm is s ion fiv e to fiv e Dis charge and Hos p.
y ears to fiv e and Hos p.
Prov ince y ears y ears OPD)
Prov ince y ears OPD)
P rov i nc e 1 210 100 110 207 3 209 1001

P rov i nc e 1 210 100 110 207 3 209 1001
P rov i nc e 2 589 286 3 03 571 19 572 9951
P rov i nc e 2 589 286 3 03 571 19 572 9951
B ag m ati P rov i nc e 4 90 24 6 24 4 4 18 72 4 88 15516
B ag m ati P rov i nc e 4 90 24 6 24 4 4 18 72 4 88 15516
P rov i nc e 4 3 05 14 1 164 3 01 4 299 887
P rov i nc e 4 3 05 14 1 164 3 01 4 299 887
G and ak i P rov i nc e 178 94 84 177 1 178 3 65
G and ak i P rov i nc e 178 94 84 177 1 178 3 65
K arnali P rov i nc e 164 94 70 157 62 157 4 70
K arnali P rov i nc e 164 94 70 157 62 157 4 70
Sud urpas c h i m
Sud urpas c h i m
P rov i nc e 290 14 1 14 9 60 23 0 290 24 3 6
P rov i nc e 290 14 1 14 9 60 23 0 290 24 3 6
N epal 2226 1102 1124 1891 3 91 2193 3 0626
N epal 2226 1102 1124 1891 3 91 2193 3 0626
Sourc e: N epal Y outh F ound ati on (N Y F )/Res pec ti v e N RH
Table4.3.2:
Table 4.3.7.4.2: Adm is s and
Admission ion and dis charge
Discharge s tatus
Status of nutrition
of Nutrition rehabilitationHomes,
Rehabilitation hom es , 2075/ 76 District
Dis trict Wis e
Table 4.3.7.4.2: Adm is s ion and dis charge s tatus of nutrition rehabilitation hom es , 2075/76 Wise
2075/ 76 Dis trict Wis e
More Couns eling
L es s More Couns eling
L es s than or to m other
Total than than or Total to m other
S.N NRH Total Male Fem ale than eq ual to Total ( inhous e
S.N NRH adm is s ion Male Fem ale fiv e eq ual to Dis charge ( inhous e
adm is s ion fiv e fiv e Dis charge and Hos p.
y ears fiv e and Hos p.
y ears y ears OPD)
y ears OPD)
1 Surk h et 103 63 4 0 99 4 103 270
1 Surk h et 103 63 4 0 99 4 103 270
2 K anc h anpur 14 3 66 77 3 5 108 14 2 1798
2 K anc h anpur 14 3 66 77 3 5 108 14 2 1798
3 Raj b i raj 171 76 95 168 3 171 8851
3 Raj b i raj 171 76 95 168 3 171 8851
4 P ok h ara 13 9 65 74 13 9 0 13 9 3 27
4 P ok h ara 13 9 65 74 13 9 0 13 9 3 27
5 N epalg unj 178 94 84 177 1 178 3 65
5 N epalg unj 178 94 84 177 1 178 3 65
6 Dai lek h 61 3 1 3 0 58 58 54 200
6 Dai lek h 61 3 1 3 0 58 58 54 200
7 K ath m and u 281 14 0 14 1 209 72 275 1101
7 K ath m and u 281 14 0 14 1 209 72 275 1101
8 B h aratpur 153 80 73 153 0 157 14 14 5
8 B h aratpur 153 80 73 153 0 157 14 14 5
9 B h ad rapur 119 54 64 119 0 118 83 1
9 B h ad rapur 119 54 64 119 0 118 83 1
10 Dh ang ad i 14 7 75 72 25 122 14 9 63 8
10 Dh ang ad i 14 7 75 72 25 122 14 9 63 8
11 B i rg unj 215 109 106 204 11 207 890
11 B i rg unj 215 109 106 204 11 207 890
12 J anak pur 203 101 102 199 5 194 210
12 J anak pur 203 101 102 199 5 194 210
13 B utw al 115 53 62 115 0 88 510
13 B utw al 115 53 62 115 0 88 510
14 B ag lung 100 4 6 54 96 4 94 255
14 B ag lung 100 4 6 54 96 4 94 255
15 B i ratnag ar
91 4 6 4 5 88 3 91 170
15 B i ratnag ar
91 4 6 4 5 88 3 91 170
16 Dad eld h ura
81 4 2 3 9 70 11 72 14 8
16 Dad eld h ura
81 4 2 3 9 70 11 72 14 8
17 P arb at66 3 0 3 6 66 0 66 3 05
17 P arb at
66 3 0 3 6 66 0 66 3 05
18 Si nd h upalanc h ow k 56 26 3 0 56 0 56 270
18 Si nd h upalanc h ow k 56 26 3 0 56 0 56 270
4.3.7.5
4.3.7.5 Prev ention and control ofof
iron deficiency anaem ia
4.3.7.5Prevention
Prev ention andandcontrol
controlof iron
iron deficiency deficiencyanaem anaemia
ia
M oHP h as b een prov i d i ng i ron f oli c ac i d (I F A) s upplem ent to preg nant and pos t- partum w om en s i nc e 1998
M oHP h aas b een prov i d ii ngi igron f oli c aci i d a(I iF A) s upplem ent m to preg t nant and post at- partum tw oma tenms i nc em 1998
to red uc e m aternal anaem i a.i T h e protoc ol i s to prov i d e 60 m g telem g ai ronand
ental 4 00 m i c rog ram f oli c ac i d
to
i red uc e m t aternal anaem i a. T
mat a a a mia h e protoc ol i s to prov i d
t e 60 m
i tg elem ental
i i ronand
mg 4 00mm i c rog
ta i a ac i d
ram f oli c

ami a
to preg nant w om en f or 225 d ay s f rom th ei r s ec ond tri m es ter. T o i m prov e ac c es s and uti li z ati on of I F A
mis upplemg am ents , th i e aI ntens
i ti f i c ati on
g aof tM aternal
m and N eonatal a M i c ronutri
m t ent
i P rog ram mt im e (I M tN M P ) s tarted
im I F A
as upplem aentati on thi aroug h F em ale C om m unimty Health t t V olunteers
t i (F C aHV s )i n 2003 . at a aram m e c ov ered
T h i s prog ata
all 75 d i s tri c ts s i nc e 2014 and now 77 d i s tri c ts . T h e i ntens i f i c ati on prog ram m e i m prov ed c ov eragite,
i t i t g amm ta t m ta t g ma mm
alth aougt h c om tpli anc e w i th tak i i ng 180 tabi lets gd uri
ammng preg nanc y aand 4 5 i tabt ilets
t pos i t- partum a rem ai ns an
i s is ue.
ti t i t i a g amm im ag a t g m ia it ta i g
ta t i g g a a ta t t at m mai a i
Figure 4.3.7.5.1: Percentage of Pregnant and Figure 4.3.7.5.2: Percentage of Pos t- Partum Wom en
L actating Wom en receiv ing 180 IFA tablets Receiv ing 45 IFA tablets
68 70
62 66 66
58 58 57
61 59 61
57
51 50 52 51 55 56 54 56
4 6 4 6 52
4 4 4 5 4 3 4 9
4 1
3 73 9 4 4
4 0 4 04 0
3 2 3 83 9
28 3 0
3 2 3 2
28
26 27 28
24 24
22
F Y 73 /74 F Y 74 /75 F Y 75/76 F Y 73 /74 F Y 74 /75 F Y 75/76
Sourc e HM I S Sourc e HM I S
I n F Y 2075/2076, P erc entag tag e of preg nant g and

a t laca tati nga ta
w om gen recmei v i ng 180i iI F Ag tab lets i s 51 ta perct ent i
t i m t a i m a i t t i a a t m
w h i c h s eem s to d ec reas e i n c om pari s on to oth er F i s c al y ears . I n term s of prov i nc e th e h i g h es t c ov erag e i s
i t
ig t ag i i a im i i i t a t t i i Bagma
i n Sud urpas c h i m P rov i nc e w h i c h i s 68 perc ent w h ereas th e low es t i s i n B ag m ati P rov i nc e w h i c h i s 3 0
i i i t a i t i a a tag t at m m
P erc ent. W h ereas i n th e F i s c al y ears 75/76, perc entag e of pos t- partum w om en rec ei v i ng 4 5 I F A tab lets i s
i i g ta t i t i a m ig i t t g a t
4 0m perc ent only i i w gh i c h alsi o s eem i h ai g ih d tai f f erenc
t ae b etw een t ath te preg
m nant m w om eni reci gei v i ng ta180 i tron f olit c acmi d
tab lets iand pos a t- partum
t i w om gen rec i ei v i ng I F A ga tab lets
i g. I n term
g a s tof prov
m i nc ae als o th terea i ts h m
ug e d m
i f f erenc es
reg ardi ii ngg ipreg nant i w a omi en ta and t pos t- partum w om en rec ei v i ng i ron f oli c ac i d tab lets .
4.3.7.6 Integrated Infant and Young Child Feeding and Micro- Nutrient Powder Com m unity Prom otion
4.3.7.6
Program Integrated
m e Infant and Young Child Feeding and Micro-Nutrient Powder Community
Promotion Programme
T h e N DHS 2006 f ound th at 78 perc ent of 6- 23 m onth s old c h i ld ren w ere anaem i c , i t i s as s um ed th at m os t
of th em are d ue to poortI Y at C F prac ti c es . M t oHP s ub s m
eq uently
t end orsi ed a P lan of aAc ati onmi of itm ii c ro-a nutri
ment
st priatnkmles tas th te k m
ey ai nterv entit ons to ad d res s aanaem i a i n y oung c h i ld ren ti nteg rati ng w i ath I YaC F prac ti c es . I n
2007, th et iN atit onali N utri ati ont P ri ori ty i tW ork s h op end
mi t orsa ed a as trateg a miay to
i pi lot gm ultii plem i ic ro-t nutri
g a ent g
s priit nk les s upplem
a entati on as at prev entia v ea m east urei ag ai nsi t itd i f f erent m i c ronutri ent d aef i tc i at
enc gy d ti s ord i erst
m am ong thmie c h i ld ren
t i ag t ed 6-i 23 m onth s oldm. I nta J une a2009, a M oHP pi lotedm tha e h om agai e f ortit f i c ati
i on oft
mi t i t f ood iw i th M N i P s f or 6- am
c om plem entary g t s old is i n s i x ag
23 m onth d i s tri c ts nammely tG ork h a, Ras uw a, M ak w anpur,
P ars a, Suns ari and M orang i nteg rati ng w i th th e C om m uni tyit I Y C F P rog ram m e. m
i t t m a m m ta T h e ts uc c es s f uli pi lot i
i t i t am a a a a a a a a
prog ram m e led to M oHP ex pand i ng i t to an ad d i ti onal ni ne d i s tri c ts i n 2012. i a a g i t g a g it t
mm it g amm i t g amm t a i g it t a
a i a i iti t i

ami a
T h e prom m oti on aand s upplem m entatitaon of M N P s i s li nki ed i w i th i m prov it im i ng c om iplem g entary m m f eed i ta ng prac ti c esi .g
aM oth ers and tc areg i av ers are a c gi ouns elled a to i ntrod uc e c tom iplem t entary f ood m s atms i x m taonth s of ag ate f oci usmi ng ton
T h ageagprome- approprioti on i ate
g f s eed
and ag i nga f entati
upplem req uenc iaty of, i M m N prov
on P is i g
i s ngli nkd iedetary i m im
w i th q uali ty ofi ngic omc gom plem
prov iplemta entary
entarya fitf ood
eed s i ngb y prac mm akti ci m
nges . th ta
em
M oth ma i g t m ounst ielled t a to i ntrod a uc i
nutri ent and c alori e d ens e, as w ell as h and w as h i ng w i th s oap b ef ore h and li ng th e f ood and f eed on
ers and c areg i v ers are c e c om plem a
entary f a
ood s at a
s i x m a
onth s iof g ag e it
f oc us i a
ng i ng th e
ag ae-c h appropri
i ld i . gM otht ate and i ng c aareg
ers f eed f req i uenc i, i gm trai
v ers y are t ned
prov i ng to d ii etary
prepare t “ typosofh ai c lojom aulo”
q uali a (puls
plem gi es ,f ood
entary ari c es andb t y aim g akreeni ng t vth egem etab ales
c ook ied i na oi l) and ‘ li to’ (m i ix ture a ofas b h glend
and w as h gi ng taw i th s oap b ef ore
ed and roas ted c ereal andi leg ium ae f loursit). A f mi
nutri ent and c alori e d ens e, as w ell h and li ng th e f ood and tf eed i ng th e
eas i b i li ty s tud y of th e
ac h i prog ld . M aotht ers and ac areg
ram m e i n 2009 f ound s trong c om m uni ty ac c eptanc e w i th a v ery h i g h c ov erag e and c om pli anc e on th eg
a i v ersg are m trai ned to prepare a i i it
“ pos h t i loj aulo” t (puls es ,griamm c e and ig reen v eg etab les t
c ookmm ed i n it oi l) aand ‘ li to’ta (m i x ture it ofa b lend ed igand roas tedagc ereal a and mleg umia e f lours ).t A f eas i b i li ty s tud y iof tth e i t
us e of M N P i n th e pi lot d i s tri c ts . I nteg rati ng of I Y C F w i th M N P s h as c ontri b uted to s i g ni f i c ant i m prov em ent
progi t ram i t m e itn g2009 a f oundg s trong itc om m uni ty aca c eptanc t i e w ti th at v eryig h ii g h ac ov terag im e and m c om pli t ianc e on th ae
i n I Y C F prac ti c es . T h e prev alenc e of anem i a am ong c h i ld ren ag e 6- 23 m onth s h as d ec reas ed to 68% (N DHS,
us e of M N aP i n th e pi lot a d i s miatri c ts am
. I nteg g rati ng i of I Y C F agw i th M N P m s h as tc ontriab uted to as i g ni f i c tant i m prov em ent
2016) f rom 78 perc ent (N DHS 2011). How ev er, i t s ti ll need f or c onti nuous ef f ort as th e c ov erag e of th e
i n I Ym C F prac ti c es . T th e prev alenc e of anem i a am ong it c h i ld ren ag e 6- 23 m onth s h as d ec reas t a edt to 68% (N ag DHS, t
prog ram i s not v ery prom i s i ng .
2016) g am f rom i 78 perc t ent (N DHS mi i2011). g How ev er, i t s ti ll need f or c onti nuous ef f ort as th e c ov erag e of th e
progTable
ram 4.3.7.6.1:
i s not v ery Micronutrient
prom i s i ng . powder ( Baal Vita) dis tribution s tatus , 2073/ 74, 2074/ 75 and 2075/ 2076
Table 4.3.7.6.1: Micronutrient Powder (Baal Vita) Distribution Status, 2073/74, 2074/75 and
Table 4.3.7.6.1: Micronutrient
2075/2076 86 powder ( Baal Vita) dis tribution s tatus , 2073/ 74, 2074/ 75 and 2075/ 2076
77
86
77
55
51
4 6 4 7 4 8
4 0 55
3 9 3 8 3 7 51
3 34 6 4 7 4 8 3 4
27 4 0 28
3 9 3 8 3 7
3 3 19 3 4
16 16 14 28
13 27
10 10 11 11 10
8 10 8
6 5 7 7 19 5 6 5 7
3 16 4 16 4 4 5
1 2 3 1 14 1
13 0 11 0
10 10 11 10 10
7 8 8
6 5 7 5 5 6 5 7
3 4 2 3 4 4
P rov i nc e 1 0 1
P rov i nc e 2 P rov i nc e 3 G and ak i P rov i nc e P rov i nc e 5
1 0K arnali 1P rov i nc e Sud urpas h c h i m P rov i nc e N epal
P rov i nc e 1 P rov i nc e 2 P rov i nc e 3 G and ak i P rov i nc e P rov i nc e 5 K arnali P rov i nc e Sud urpas h c h i m P rov i nc e N epal
% of c h i ld ren ag ed 6- 23 m onth s w h o rec ei v ed at leas t one c y c le (60 Sac h ets ) B aal V i ta (M N P )
% of % c h ofi ld c ren
h i ld agrened ag6-ed23 6-m 23onthm onth
s w h os w rech oei rec
v ed eiatv edleas 3 t c one
y c lec y(180
c le (60
Sac Sac
h etsh ets ) B aal
) B aal V i ta
V i ta (M (MN P N ) P )
h i ld agren
ed ag6- ed23 6-m 23onthm s onth
w h os rec
w h eiov rec
ed ei3 v c edy c le
at (180
leas tSac
oneh ets
c y c) le
B aal
(60V Sac
i ta (Mh etsN P ) )B aal V i ta (M N P )
% of% c ofh i ldc h ren ag edag 6-ed 23 6-m 23onth
i ld ren s w h s ow rech oeirec
m onth v ed ei at
v edleas3 tc one
y c le c (180
y c le (60
Sac h Sacets h )etsB aal
) B aal
V i taV i(Mta N (M P )N P )
v ed ei 3 v edc y c at
le leas
(180t Sac
oneh ets
c y c )leB aal
(60V Sac
i ta h (M etsN )P B ) aal V i ta (M N P )
v ed eiatv edleas 3 t c one
y c lec y(180
c le (60
Sac Sac
h etsh ets ) B aal
) B aal V i ta
V i ta (M (MN P N ) P )
% of c h i ld ren ag ed 6- 23 m onth s w h o rec ei v ed 3 c y c le (180 Sac h ets ) B aal V i ta (M N P )
Sourc e: HM I S/DoHS
Sourc e: HM I S/DoHS
I n F Y 2075/76, 51perc ent of c h i ld ren ag ed 6 to 23 m onth s h ad tak en th ei r f i rs t d os e of m ulti ple
I n m F Y i c ronutri 2075/76,
t h i ld iren ag edag 6 to t23 m onth m t a en ta t rsi t d os te of m ulti ple m
ent 51perc
pow er ent (M N ofP - B c aal V i ta) and only 7 perc ent of s th h eadc h i tak ld ren agth edei r 6f i to 23 m onth s h ad rec ei v ed
mi m i thc ronutri
t i t Baa ita a t t i ag t m t a
ree
i c y ent
c les powof er
t b aalv (M iN taP - i B naal 4 6V prog
aa
i ta) and
ita rami
only
m e d 7i s perc tri amm
g c tsent
. C ofom th pared
e c h i ld to
i t i t
renth age edf i rs 6t to
m a c y c23le
t
m ofonth
t M N s P h adi tntakrec e,ei vth ede th i rd
th ree c y c lec y tc ofles i ntak of b aalv i ta i n 4 6 prog ram omi mpli e d i s tri sc ts d . rasC omti c pared to atth e f i perc
rs t c ent.
y c le of eref M N P ore,
i ntak e,i s th i m e portant
th i rd
ic y ta c m leenti of oni ntak
t ei i nde i i ndc atii c ngati ngth iethtac eom c pli anc
i aeanci s egd i ras
t ti c allymally low
ia lowat 7
i perc7 aent. aT h erefT h ore, at i t i s i i m t portant
t to
toonth s ,
it i im ta t t m th at th e c ov erag e of f
t at t i rs t c y c le i ntak e
ag i s c alc ulated
t b as ed on
i ta i a atth e targ et populati aon of 6- 23 m
t ta g t
m enti on th at th e c ov erag e of f i rs t c y c le i ntak e i s c alc ulated b as ed on th e targ et populati on of 6- 23 m onth s ,
w h i le a th at of th i rd c m y c le i ts c alc ulated i t am atong tth ei c h i ld reni ag eda 6- at 23 m onth am s w gh to h av e i ev er takagen M N P .
w h i le th at of th i rd c y c le i s c alc ulated am ong th e c h i ld ren ag ed 6- 23 m onth s w h o h av e ev er tak en M N P .
m O v terall, ef f ec tiav e nutri ti on ta ed uc ati on, c ouns aelli ng and f ollow tupi to th e m oth a ers /c aretak ersi i gs esa s enti al to
O v erall, ef f ec ti v e nutri ti on ed uc ati on, c ouns elli ng and f ollow up to th e m oth ers /c aretak ers i s es s enti al to
i m tprovt e c m ov erag
t e as w ell
a ta as c om pli
i anc e w i th th
a t im e rec om m end ed d os
ag a N P s . a
es of M m ia it t
i m prov e c ov erag e as w ell as c om pli anc e w i th th e rec om m end ed d os es of M N P s .
mm
4 . 3 . 7. 7Prev ention and control of iodine deficiency dis order
4 . 3 . 7. 7Prev ention and control of iodine deficiency dis order
4.3.7.7 M oHP Prevention
ad opted a and poli c ycontrol to f ortiof f y iodine all ed i b deficiency
le s alt i n 1973 disorder to ad d res s i od i ne
M oHP ad opted a poli c y to f orti f y all ed i b le s alt i n 1973 to ad d res s i od i ne
d ef i c i enc y d i s ord ers (I DD) th roug h uni v ers al s alt i od i z ati on. T h e Salt T rad i ng
d ef i c i enc y d i s ord ers (I DD) th roug h uni v ers al s alt i od i z ati on. T h e Salt T rad i ng
C orporati a ont i s res a ponsi i b tle f or th e ai od i nei f orti f ai c ati t ion of allt ed ai b le s alt and i i i ts
C orporati on i s res pons i b le f or th e i od i ne f orti f i c ati on of all ed i b le s alt and i ts
i b uti on,i w h i le M i ni s try of t Healthg and P i opulati
d i s tri a ona (Mt oHP i i) ai s res pons i b le faort
d i s tri b uti on, w h i le M i ni s try of Health and P opulati on (M oHP ) i s res pons i b le f or
a i c gy d ri v e anda promi oti ng i od ii z ed s altt to i inc reas i e c ons um a pti on. Asa per ith e
polipoli c y d ri v e and prom oti ng i od i z ed s alt to i nc reas e c ons um pti on. As per th e
ata it iti i i it at a a
i i i i a m g i i at t i a
ami a
m t i m t a t i g a att
apoli c y ,atG ov ernm i i ent ofa tN aepal us es th ae T w o- C m h i ld - L i ogi iogpac t k ed s taltmto c erti f ia y adma eq uatelyg ti od im i z ed s alt and
aDoHSa h as b eenitm ob i li z iat ng tth e s y s tem f or s oc i al m aark etiang to i m prov e awt arenes at i s of i tst us me at th eh ousa eh old
ilev c y a, N G ati
poliel. ovi onal
t ent
ernm s urvm ofey N epal reports o- C h i i ldg
us es atth ed i fT f w erent ti - m aL oges o s pac
h atow k ed anis alti nci toreas ae tf i y n adthm
c erti eqe uately
num b ier od i ofz tedi h s ous t s us i ng
alt ehandold
adDoHS h ast i b een
eq uately i od m i z obed i ig
lis z alt
i ng f rom
th e s y 55s tempercf orent s oc i n
i al1998
m ark to eti ng95to perci m prov
ent i enaw2016 arenes (F i g s ure
of i ts1. us2. e6. at th eh ous eh old
7. 1).
lev el. N ati onal s urv ey reports at d i f f erent ti m es s h ow an i nc reas e i n th e num b er of h ous eh old s us i ng
Figure
Figure 4.3.7.7.1:
ad eq uately
4.3.7.7.1: Percentage
i od i z ed Percentage ofhous
s alt f rom 55 of
perc Households
i n 1998 ustoUsing
ent eholds Iodized
95 perc
ing iodizent Salt(F i g ure 1. 2. 6. 7. 1).
edi ns alt
2016
Figure 4.3.7.7.1: Percentage of hous eholds us ing iodiz ed s alt
Sourc e: F W D/ N utri ti on Sec ti on

Sourc e: F W D/ N utri ti on Sec ti on
T h ere are, a d i s i paria tii es i ni th te us e of i od ii z edi s alt. aT th e N DHS 2016 f ound th at tht eatP rov t i nc e num i b er 2mh av e th e
T h ere are, d i s pari ti es i n th e us e of i od i z ed s alt. T h e N DHS 2016 f ound th at th e P rov i nc e num b er 2 h av e th e
a t
h h ii gg h h eses tt c c ovov erag ig
erage e(99. t
(99.3 3 percperc ag ent), t i t i a t t t t
ent), w h iw leh thi lee thP rov e P i ncrove i 6nc h ead 6 thh ade lowth ese tlow(85.es1t perc (85. ent).
1 percI t ent).
s eem s I ,t ths eem
ere i s s , ath ere i s a
need m t i
to c c ovov ererallallh ous a t a
h ouses esi n i thn eth lowe lowc ov cerag ov erag i
e prov t ag i t ma it t
need to e prov i nc es i nctoesm aktoe m i tak< 90 e i pert < 90 perh ous
c ent c ent eh oldh ousutiehli z old
ati onutiofli z ati on of
ia a at i i at m t ia a at i i a t at
adad eqeq uatelyuately i odi od i s i eds ed s alt. s alt.T oT oprompromoteote uti li z ati ofonad ofeq aduately eq uately i od i s ed s alt at h ous eh old lev el, M O HP
at iuti li iz ati on m t i a i od i s ed s ialta at h ousi teh ioldt lev el, M O HP a
c eleb rated
i rated i mi odi od i ne ti nem m onth
aionth i nai F nebaF ruary
eb ruary2019 2019
t i n alli n77alld 77 i ts tri cd tsi s . triiT c h tse . c geleb
T h erati
ac telebon rati
of i on
od mi neof m i odonthi nes mraionth
m i i i s ta ed s trai s ed
aw m arenes
arenes at is s on ionth the eus usie eof oftw itwo- c o-h i ldc h - ilogld - ologigs alt
o s f altor opti f or m opti um m i odum i nei odi ntak i nee i ntakto c ome tob atc omi od i b ne
at d i efod i c i i ne
enc y d ef i c i enc y
d d ii ss ord
ord ers ers . . (F (F i g i g ure
ure1. 1.2. 2.6. 7.6. 2).
7. 2).
Figure
Figure 4.3.7.7.2:
4.3.7.7.2: Percentage Percentage
of Households
of hous eholds
Using
us ingusadeq
Adequately Iodized Salt
Figure 4.3.7.7.2: Percentage of hous eholds ing uately adeq uately iodiz ediodiz s alt ed s alt
Sourc e: N DHS, 2016

4.3.7.8e: Control
4.3.7.8
Sourc N DHS,of
Control v itam
of
2016 in A deficiency
vitamin dis orders
A deficiency disorders
T h e g ov ernm
4.3.7.8 ent i ni ti ated in th e N ati onal V i tamdis i norders A P rog ram m e i n 1993 to prev ent and c ontrol of v i tam i n A
g Control m oft iv itam i at Atdeficiency a a itami g amm i t ta t
d ef i c i enc y d i s ord ers of th e c h i ld ren ag ed 6- 59 m onth s and red uc e c h i ld m ortali ty as s oc i ated w i th v i tam i n A
itami
T d h efei c g i enc
ov ernm i
entersi ni. V ti i ated i t i ag m t a i m ta it
y d i s ord tam i nth Aes upplem N ati onal V i tamon i i nn N Aepal
entati P rogh ram m e ong
as b een i n 1993
oi ng asto b prev ent and
i - annual s upplem c ontrol entatiofonv i tam i n A
ad ef i c i enc iat y d i s ord it ersitami of th s ec hc h i ld i ldren i i
renandag c edov erag
6- 59em of onth itami
s andentati red uconei s c m h i ore m
ld m th ortalita i a a
targ eti ng to all 6- 59 m onth s upplem an 80ty per as sc ocenti atedev ery w tii thm ev i tam i n A
g i g a ia a m ta ta g g t a m t i a ag
d f or
ef i lasc i enc
t f i v y e d plus
i s ordy ears
ers . T V h i tam i n A ths upplem
eref ore, i s prog ramentatim e on i s reci nogN niepal
z ed h asas a b g een
lob along pub oili c ngh ealth
as b i s - ucannual
c es s s tory s upplem
. T h e entati on
m ta i m t a t m at a t i
targ
prog eti ram ng m to e i niallti ally
6- 59c ovm ered onth 8s d c ih s i trild c ren and w c asov s erag
ts and c aled eup of tos upplem entati
c ov er nati onw on i d ei s tom all ore77th d an
i s tri80c ts per
s i nc ec ent
2002.ev ery ti m e
f or las t f i v e plus y ears . T h eref ore, th i s prog ram m e i s rec og ni z ed DoHS, as a g lob Annualal pubReportli c h ealth2075/76 s uc c (2018/19)
es s s tory . T h e
prog ram m e i ni ti ally c ov ered 8 d i s tri c ts and w as s c aled up to c ov er nati onw i d e to all 77 d i s tri c ts s i nc e 2002.
ami a
g amm i g i a ag a i at t g amm i i a
iti t a a a t a i
t a iti t i iti t t
a itami t t ta g t i t i a a t g a am aig a itami am
F C HV s d i s tri b ute th te
aig i a c aps ules of v i tam i n Ai to
a Bai a a
th e targ eted c h i ld ren tw i c e a y ear th roug h a c am pai g n- as
v i tam i n A c am pai g n i n K arti k (O c tob er) and B ai s ak h (Apri l) ev ery y ear.
F Figure
C HV s d 4.3.7.8.1:
i s tri b ute th Trend
e c aps &
ulesCoverage
of v i tam of
i n Vitamin
A to th e Atarg Supplementation
eted c h i ld ren tw ito
c e Children
a y ear th Aged
roug h 6-59
a c am Months
pai g n- as
v iFigure
tam i n A c am pai g nTrend
4.3.7.8.1: i n K arti& k cov
(O c erage
tob er)of andv itam
B ai s in
ak A
h (Apri l) ev ery
s upplem y ear. to children aged 6- 59 m onths
entation
Figure 4.3.7.8.1: Trend & cov erage of v itam in A s upplem entation to children aged 6- 59 m onths
100
95 96
90 91 89
83 85 86 84 83
82 79 79 80 80
77 75 78
74 72 74
68 69 100
95 96
90 91 89
83 85 86 84 83
82 79 79 80 80
77 75 78
74 72 74
68 69
P rov i nc e 1 P rov i nc e 2 B ag m ati P rov i nc e G and ak i P rov i nc e P rov i nc e 5 K arnali P rov i nc e Sud urpas h c h i m P rov i nc e N epal
P rov i nc e 1 P rov i nc e 2 B ag m ati P rov i nc e F G Y and73 ak /74

i P rov i nc e F Y 74 /75
P rov i nc e 5 F Y 75/76
K arnali P rov i nc e Sud urpas h c h i m P rov i nc e N epal
F Y 73 /74 F Y 74 /75 F Y 75/76

Sourc e: HM I S
Sourc
T h e e:ov HM a I S nati
erall a onala c ov eragage of v itami i tam i n A s upplemmentati ta on i is aaround 80 perc entt ev ery y ear a am am ong g th e
t i ag m t i i ag i ai it i
T ch h ei m ldov ren
erallag nati
ed onal
6- 59 c m ov onth s . W h i le i n F Y 2075/2076 c ov on
it ig erag e of v i tam i n A s iupplem entati
erag earound
b y prov80i ncperc
i i g i sitami
es v ent ari esev ery
m ta
w i th y ear
provami nc ong
i Bagmath e
e num b er
c h f i i v ld ewren i th h i g h er proporti on of c h i lei ld i ren
i ag eda 6-t 59 m ontht s . W h ag n F Y rec2075/2076
ei v i ng v i tamc ovi nerag
tag
A s upplem
e b y proventati
i nc esonv w arih esi le w B agi th m prov
ati P i ncrovei ncnume h b aserth e
f i low
v ew esi th t c h ovi g h erag e of 69 on
er proporti percof entag
c h i ld e.ren rec ei v i ng v i tam i n A s upplem entati on w h i le B ag m ati P rov i nc e h as th e
lowFigure
es t c ov4.3.7.8.2: Coverage
erag e of 69 perc entag of
e. Vitamin A Supplementation to Children Aged 6-59 Months by
Figure 4.3.7.8.2: Cov erage of v itam in A s upplem entation to children aged 6- 59 m onths by Dis tribution
Distribution Round
Round4.3.7.8.2: Cov erage of v itam in A s upplem entation to children aged 6- 59 m onths by Dis tribution
Figure
Round
92 90
88 90 88
86
83 83
80
75 77
74 74 92
88 69 68 90 90 88
86 67
83 83
80
75 77
74 74
67 69 68
P rov i nc e 1 P rov i nc e 2 B ag m ati P rov i nc e G and ak i P rov i nc e P rov i nc e 5 K arnali P rov i nc e Sud urpas h c h i m N epal
P rov i nc e
P rov i nc e 1 P rov i nc e 2 B ag m ati P rov i nc e G and ak i P rov i nc e P rov i nc e 5 K arnali P rov i nc e Sud urpas h c h i m N epal
P rov i nc e
K arti k 2075 B ai s ak h 2076
Sourc e: HM I S
Sourc e: HM I S
F rom las t f i s c al y ear, th e prog res s on b i annual V i tam i n A s upplem entati on i s pres ented i n K arti k (O c tob er)
F rom th emf las i rs at f tRound
i s c al y ear, th e prog res s on b i annual V i tam i n round A s upplem . T h eentati on i s pres ented i n K arti k (O c tob er)
a and a i nt B ai s h ak gh (Apri l) th iae s ec aond itami ov erall
m nati ta onali ac h i ev em t enti i s aba out 80
th perce f i rsent t Round and i n B ai
am tong th e tc h i ld ren ag aed 6- i59 Bai s h ak h (Apri l) th e s ec ond round . T h e
m onthas w i th 83 i perct ent i n K arti k and 77 perc ov erall nati onal ac h i ev ementent i na B i s ai abs aakout h . T a80h is is
t
perc ent am
ah ow i ev ermh i g h t er ong th e c h i ld ren
i tha an tht at of las t y tear ag ed 6- 59 m onth
amf or gK arti s w
t k roundi th 83
i . F urth perc ag erm ore,mth e tc ov eragit e b y prov i nc tesi v aria es i w s i th
ent i n K arti k and 77 perc ent i n B ai s ak h . T h i s
h aP owrovev i ncereh 5i g hh er as thh ti gan h i er th Bai at ofa las ton
proporti y ear
ofi c f or hi i ld K ren
arti k recround ei v i ng.igF urth
v i tam erm t i na ore, thate c oventati
A s tupplem erag
a t eon b ay and
provlowi nc eraes proporti
v ari es w ons i th of
P c rov i nc e 5 h as h i g h er proporti
h i ldt renmrec ei v itng i t i n B agagm ati P rov i nci e. on of c h i ld ren rec ai ei v i ng v
it i tam i n A
i s upplem entati
a ig on and low er proporti i ons of
c h i ld ren i i rec g eiitami v i ng i t i n B ag m ati mP rov ta i nc e. a i i i g it i Bagma
i

ami a
Figure 4.3.7.8.3: Coverage of Vitamin A Figure 4.3.7.8.4: Coverage of Vitamin A
Supplementation by Age Groups for Kartik 2075 Supplementation by Age
Figure 4.3.7.8.4: Cov Groups
erage of v itamforinBaisakh 2076entation
A s upplem
Figure 4.3.7.8.3: Cov erage of v itam in A Figure 4.3.7.8.4: Cov erage of v itam in A s upplem entation
Figure 4.3.7.8.3: Cov erage of v itam in A by age groups for Bais akh 2076
s upplem entation by age groups for K artik 2075 by age groups for Bais akh 2076
s upplem entation by age groups for K artik 2075
106 106
106 106 115
93 92
88 105 115
87 85 85 99
84 93 92 82
87 88 79 81 105
84 85 75 85 9988
82 84 85
67 69 79 81 80 80
7564 74 88 75 76
70 68 71 84 85
67 69 66 67 80 80
76
64 74 75
70 68 71
66 67
6- 11 m onth s 12- 59 m onth s 6- 11 m onth s 12- 59 m onth s
6- 11 m onth s 12- 59 m onth s 6- 11 m onth s 12- 59 m onth s

Sourc e: HM I S
Sourc e:4.3.7.9 HM I S Biannual Deworm ing Tablet Dis tribution to the Children aged 12- 59 m onths
4.3.7.9 Biannual Deworming Tablet Distribution to the Children aged 12-59 months
4.3.7.9 F am i Biannual
ly W elf areDeworm Di v i s i oning
i s Tablet
i m plem Dis
entitribution to the
ng b i annual d ew Children
orm i ng aged tab lets12-d 59
i s trim b onths
uti on to th e c h i ld ren
ami ag ed 12- 59 a m onth i i s i ai m ii ngimto redmuc e c h gi ld h iaood anaem
a i a w mii th c gontrol
ta oft paras i t ii ti c i nf es tati
t ton th roug i h
F am i ly W elf are Di v i s i on i s i m plem enti ng b i annual d ew orm i ng tab lets d i s tri b uti on to th e c h i ld ren
ag pub li c h ealth m eas ures . T h i s ac ti v i ty i s i nteg rated w i th b i annual V i tam i n A s upplem entati on to th eg
m t aimi g t i a a mia it t a a i i ta t
ag ed i 12- 59 a tagm onth s ai m i ng to red uc e c i h i ild th ood anaem it i a w iai th c ontrol of paras i ti c i nf es tati on th roug h
c h i ld ren edm 6-a 59 m onth is , aw h i c it h tak es plac g at
e nati onally i n ev erya w itami
ard on f i rs t w eek mof B taai s ak h tandt
pubi li c h ealth ag m eas ures m . t T h i s ac iti v i tyta i s i ntega rateda w i tha b ii annual V i tam a i n A s upplem t entati
Baiona to ath e
K arti k eac h y ear. Dew orm i ng to th e targ et c h i ld ren w as i ni ti ated i n f ew d i s tri c ts d uri ng th e y ear 2000
c ah i ld rena ag ed a6- 59 m onthmis ,gw th i tc h takta esg plac t ie nati onally
a i i in at ev ery i w ard on i t f ii rs tt w eeki goft B ai s aka h and
i nteg rati ng w i th b i annual V i tam i n A s upplem entati on and w i th g rad ual s c ali ng - up, th e prog ram w as
iK arti t gk aeac gh y ear. it Dew ia orma i ngitami m ta a it g a a
to th e targ et c h i ld ren w as i ni ti ated i n f ew d i s tri a ic tsg d uri tng th e y gear am2000 a
s uc c es s f ully i m plem ented nati onw i d e b y th e y ear 2010 i nteg rati ng w i th V i tam i n - A as V i tam i n - A
i ntegc amratipaing g n.w im i th b i m annual t V i tama i n Ai s upplemt entatia on and i w ti th g g arad gual its c ali ngitami - up, th e aprog itami
ram w as
am aig
s uc c es s f ully i m plem ented nati onw i d e b y th e y ear 2010 i nteg rati ng w i th V i tam i n - A as V i tam i n - A
c am Figure pai g n.4.3.7.9.1: Cov erage of Deworm ing Tablets dis tribution to the Children aged 12- 59 m onths
Figure 4.3.7.9.1: Coverage of Deworming Tablets Distribution to the Children Aged 12-59 Months
Figure 4.3.7.9.1: Cov erage of Deworm ing Tablets dis tribution to the Children aged 12- 59 m onths
96 94 93
89 89
86 85
81 83 82
79 78 78
76 76 75 76 75 77
71 73 72
96 68 69 94 93
89 89
86 85
81 83 82
79 78 78
76 76 75 76 75 77
71 73 72
68 69
F Y 73 /74 F Y 74 /75 F Y 75/76
Sourc e: HM I S
F Y 73 /74 F Y 74 /75 F Y 75/76
As s h ow n i n f i g ure 4 . 3 . 6. 9. 1, th e nati onal c ov erag e of d ew orm i ng tab let d i s tri b uti on i s 91 perc ent
Sourcw e:h i cHMh i I sS i nc reas i ng trend s f or las t tw o f i s c al y ears . F or all th e prov i nc es , th e c ov erag e i s h i g h er th an
As s h ow n i n f i g ure 4 . 3 . 6. 9. 1, th e nati onal c ov erag e of d ew orm i ng tab let d i s tri b uti on i s 91 perc ent
w h i c h i s i nc reas i ng trend s f or las t tw o f i s c al y ears . F or all th e prov i nc es , th e c ov erag e i s h i g h er th an
ami a
g i t a a ag mi g ta t i t i i t
i i i
a i gt a tt a a a t i t ag i ig t a
t t i a im mi g ta t i t i i t i
80 perc
m t ent.
i All
m th aei prov i ncites ah adt i m aprov eda d ew orm i ng tab lets d i s tri b uti on i n th e c h i ld ren 12- 59
m onth s i n c om pari s on w i th las t f i s c al y ears .
Figure 4.3.7.9.2:Round
Figure 4.3.7.9.2: RoundwisWise
e cov Coverage of Deworming
erage of Deworm ing TabletsTablets Distribution
dis tribution to the Children
to the Children aged 12- Aged
12-59 Months
59 m onths
106
93
86 84 85 86
82 83 82 82
79
76 74 74
69 68
Sourc e: HM I S
T h e report i s pres ented s eparately f or B ai s ak h (Apri l) and K arti k (O c tob er) round of F Y 2075/076.
ti t a at Bai a i a a t
4.3.7.10 School Health and Nutrition Program m e
4.3.7.10 School Health and Nutrition Programme
T h e Sc h ool Health and N utri ti on Strateg y (SHN S) w as d ev eloped j oi ntly i n 2006 b y M i ni s try of Health
and P opulati on (M oHP ) and M i ni s try of E d uc ati on (M oE ) to ad d res s th e h i g h b urd en of d i s eas es i n
at a ti t at g a i t i i it at
s c h ool ag e c h i ld ren. I n 2008, a f i v e- y ear J oi nt Ac ti on P lan (J AP ) w as end ors ed to i m plem ent Sc h ool
a a a i it a t a t ig i a i
Health and N utri ti on (SHN ) P rog ram . T h e i m prov ed us e of s c h ool- b as ed h ealth and nutri ti on s erv i c es ,
ag i a a i t a a t im m t
i m prov a t eda ac c es s t to i s af e d ri nk i ng w g ater
am and s ani imtati on, s k i ll- b as ed h ealth aed uc ati on,
a tc om a m uni ty t i
s upport i andim an i m prov
a ed poli
t a c y env i ronm ent
i i g at aare th e c ore elem
a ita ents of th
i ae Sc h ool Health
a t and a
N utrimm ti on it
P rog ram m e.t a a im i i m ta t m t t at
aDuri ng 2008-
t i 2012,gg ovamm
ernm ent h ad i m plem ented a pi lot SHN prog ram m e i n pri m ary s c h ools b as ed
on th e J oi nt Ac ti on P lan i n Si nd h upalc h ow k and Sy ang j a d i s tri c ts . T h i s pi lot prog ram m e h as s om e
i g g m t a im m t a i t g amm i ima a
prom i s i ng res ults rec om m end i ng to s c ali ng up of th e prog ram i n oth er d i s tri c ts . W i th g rad ual s c ali ng -
t i t a i i a a a ga i t i t i i t g amm a m
up, th e prog ram h as c ov ered all 77 d i s tri c ts s i nc e F Y 2073 /074 . T h e c urrent J oi nt Ac ti on P lan
mi i g t mm i g t ai g t g am i t iti t it g a a
(2071/072
a i g tot 2075/76) g amc alls af or: a iti t i t i t a
• Annual t h ealth s c reeni a ng
• B i annual d ew orm i ng of G rad e 1– 10 s c h ool c h i ld ren
a at i g
• A f i rs t ai d k i t b ox w i th ref i lli ng m ec h ani s m i n all pri m ary s c h ools
Bia a mi g a i
• Hand w as h i ng f ac i li ti es w i th s oap i n all s c h ools
t ai it it i gm a i mi a ima
• a T oi letsa i ni all
g s ac h iools
i it a i a
• i T h t e ius ea of th e new attend anc e reg i s ters i n all s c h ools
• O ri ent s c th ool m anag a em enta c om m gii ttees
t oni f aac i li tati ng h ealth and nutri ti on ac ti v i ti es
• i C h ti ld c lub m maob i li ag m ont h ealth
z ati on mmiand nutri ti on a iis itas ues . g a t a ti a i
i m ii a at a ti i
O ne of th e m aj or ac ti v i ti es und er SHN P rog ram i s B i annual Sc h ool Dew orm i ng to all Sc h ool- ag ed -
t ) thma
c h i ld ren (SAC a uc ited i n f i rs t w eek of J es th ga am
at i s c ond and M i angBia a y ear. U nti l F Y 2072/073
s i r ev ery mi g ,t a
ag i t at i t i t t a a a
prog res s i n th i s reg ard h as not b een reported i n th e annual report d ue to th e v ery poor, alm os t no g i a
reporti ng to th e s y gs tem . i Howt iev er,ga th oug h a v ery tlow , th ere i s s tom ei reporti
t ang th ai s F Y as tpres ented
t ti n
th e f i g ure 4 . 3 . 18 b elow . As ref lec ted , nati onal c ov erag e of s c h ool d ew orm i ng f or F Y 2074 /075 i s 3 8
ami a
am t gt t t m t g t i m gt i
a t i t g t a a ag mi g
perc ent f ori g i rls and 3 4 t perc gi a b oy s w h ere ast i n F Y 75/76 i s 19a perc
ent f or i ent f or g i rlsi and 11 perct ent gi
af or b oy s . t
Figure 4.3.7.10.1Cov
Figure 4.3.7.10.1 Coverage
erage ofof School
School Deworming
Deworm Tablet
ing Tablet Distribution
Dis tribution
83
80
61
55
4 9
4 3 4 1
3 8
3 4 3 5
3 2 3 1 3 1 3 0
29
22
19
16 16 15 15 15 16
13 14
11 11
9
6 5 7
4
N epal P rov i nc e 1 P rov i nc e 2 P rov i nc e 3 G and ak i P rov i nc e P rov i nc e 5 K arnali P rov i nc e Sud urpas h c h i m P rov i nc e
F Y 74 /75 F Y 74 /75 F Y 75/76 F Y 75/76
Sourc e: HM I S
4.3.7.11 Adolescent
4.3.7.11 Adoles GirlsIron
cent Girls Iron Folic
Folic Acid
Acid Supplementation
Supplem entation
F rom m F Y 2072/073 , th te SHN P rog ramg am h as i ani ti iated

i atW eek ly I ron F oli c Ac i id (I F A)
i s upplem entatimon tota
tth et ad olesa c ent g i rls
t giag edag10- 19 y ears aai m iaimi g t t a t t ig
ng to prev ent and c ontrol th e h i g h b urd en of I ron
Def i c i enc y Anem i a am ong th i s parti c ular g roup ofg populati on. T h i s aac ti v i ty w asi pialotedit i n K ath
i mia am g t i a a a m and
i tu, i
at ma a a ta g a t a B a ta i t a a a i at i
Dolak h a, K h otang , P anc h th ar, B h oj pur, Saptari , P y uth an and K api lv as tu i n F Y 2072/073 .
t g amm a a t iti t am Ba a Ba a g
I n F Y 2073 /74 , th e prog ram m e w as s c aled up to 17 d i s tri c ts nam ely ; B aj ura, B aj h ang , Doti ,
B a ta a i a a g t a a i a Ba a ami a i ii
B h ak tapur,
a Rupand
m t eh i ,t M anang
ai i , g Surk
t t h et, M ah ottari , andia B ara. mF aam ti ly W elfi are t i t Di v i s i on of t
DoHS/M
g amoHP a h im
as c om mpleted
t thi e T rai ni ingt itot th e c onc
t erned
t aofi f i c i als f arom all th es e d i s tri c ts . How ev er,
th e prog ram w as i m plem ented i n f ew d i s tri c ts d ue to th e v ari ous reas on.
t ai g t g am a i a i a iti t am
I na aF Y 2074
t /075, m f urth
a t er s c alimng upt of aith e progBaram i aw as ad one a ai na adi d ai ti tonala 24a d ai s tri
a c i ts namt Baita
ely ; i
J aj ark am
ot, Ruk aum E as t,aRuk um aW es at, Dai g leka h , B aard i y a, N awa alparas
a i E aas t,
a N i aw aalparas
ta ati W esa t, aB ai tad ai ,
a i t a m a g a m a i i ami a i i i
Ac h h am , Dad eld h ura, Rolpa, Dang , K anc h anpur, Dh anus h a, Sarlah i , Rautah at, P ars a, U d ay pur, a
a i g t a t i g amm i a i a i t i t a it i t
K ali k ot, Dolpa, J um la, M ug u and Hum la. L i k ew i s e, f am i ly W elf are Di v i s i on of DoHS/M oHP h as b eena t g amm
i a t a i t i t
planni ng to s c ale up th i s prog ram m e i n ad d i ti onal 12 d i s tri c ts and w i th i n th ree y ears , th e prog ram m e
w i ll b e s tc aled
i upm to all 77
t ad i s ttri c tsa. t gi ag a a m t it
i i ta t ia a ai i a a a a ag ag iat a a
U nd er tht i s c oma ponent, i all th e ta ad olest c entta
g i rls tag ed 10- 19 y ears are s upplem ented a w ai th w eek ly t I gi
rong t
aF olit c taAc i d tab let b tai annual
t i b asa i s i an Sh raw an (Sh rw an- As oj ) and M ag h (M ag h - C h i atra) round s . I n eac h
round , th ey are prov i d ed I F A tab let one tab let ev ery w eek f or 13 w eek s . So, eac h ad oles c ent g i rl g ets
4.3.7.12
a total of Nutrition in emergencies
26 I F A tab lets i n a y ear. (NIE)
4.3.7.12
a i Nutrition t tin em ergencies
g a ( NIE) ti g am i t ami a i ii a
I n adi d i ti on to a th ae regigular anutri it ti on i progt rama i ntervt enti onst i, F am i i ly W i elf are
m gDi v i s ii on als o a
prov i d es es s enti al and h i g h - q uali ty s erv i c es to ad d res s th e nutri ti on i s s ues i n E m erg encg i est . Wt h en an
m g it a a a at a i a t a t a m
em erg enc y h i ts b y any reas ons s uc h as ; natural d i s as ters (earth q uak e, f lood , d roug h t, etc . ), c om plex
ami a
m g i i t a t a t at ig im a t ga a at
ti a i i t a a a ti t ami a
i ii i t it a ti t a t ti
t m m i t ti i m g i t t ti tat
i g a t a a ta g m i i t t g a t a a ta g
m a i a ag a t a ti a t m t a
i ga t m g i i g i a i t a im m t i t
a t a a t t
m t a tt at i g i a ta g i ag
m t
m m m ta i g t t i a t a g i ag
m t
a ag m t m at a t ma t i am gt i ag m t
a am g t g ta g t m ta i g g am
a ag m t a t ma t i am g t i ag m t t g
t a i g
t i a i ti t m ta i a m i i g a
itami i ag m t g a ta t ata m
(a) Small Scale Flood Emergency Response in FY 2075/076:
a i ai a a ta g m i t igg
i a
a i i ga
i t t iti t a ta g im a t m
a a g ti a t iti t ma a ma
gi a m i i t a a i m
mi i g m i m a t
m t m ai i a m m t amag
m a a amag m g t a t a
a imat a i a ag a a g a t a
a i g m it t ai a a a at a ita a gi
i g at i ai a imit a t ti a at i t
it a
t ti t a i t ti a m t m t
i i g ta ta t a i ag m t a
t m t i i a a t ma t i a i
a at t a ti a a t a ti i t
it a a i a t ig g a a t ma t i a a a i g ma
i agg a a g a t a a it a a ai g a
a a iat ti i a ta g i g a ta a ta g m
a imit at i t a t atm t i i t t i
ta a i a i i a a a t ma t i ti t a
a a a t ti t m m i i at i t t
a t ti i a
at i it t a ti i t ig t a t iti t
i m
i at i g i t g a t t t ami
1
i it m ai ta g

ami a
i a t m ta i g g amm t i ag m t a
g a ta a ta g m
ti t B i gg i t m ag ti at a
i t a g ag ait i i B ia a i a ai t g a a i i
iti t ai ait i i B i i a a ia a a i
m
(b) Bara and Parsa Tornado:
a at ig t ma i t m it t g i a it a a i t
iti t Ba a a a i i g t a a mt t m at t i Ba a a
at i a a iti t t i a a ig t i g a ig t mt i a a t
a a g m t a t mm iat a t i i a ti t
m m m tt g t a a t a mm iat iti t a ti
t a a m ii a g it t t am m a a iti t i at
m Ba a a aa a ta at t at a t i g
a im m t
at ig t t a t a t Ba a i t i t a at i t a
a t ai a a a ai a ita tai a at t Ba ia a at t
i a i a a a i at t ta a t t a a i at ta am
at t ta a am
at a t ta i it a t ma ti it a t a
a i ag a ta g i i gi m g i a a
g a ta a ta g m a a ti t a a at m
a i ta a a g ag
(c) Nutrition Cluster preparedness actions:
ti t t a m t a m m ag i i i g m t
a ti t m g ga i a
i t g t ti t m g i gt i a i gg a
m a a at t i t i a a i ta i ta t ti g amm
i m g i
i gg
i gg
i ti t i gg
ma ma ag m t i gg
m t i gg
B i gg
Similarly, following preparedness actions were conducted in FY 2075/076:
i ai m i ti i i t t ai i g ma a t t at
a a t t i t a a i t ai i g a i
ti i m g m t a at a a it i i ga
t t ti i m g t ai i g t t i ia a a a ta i
at ma t ai m i ia at i t at ia
m t mi i t i a ti t m m
ami a
i ti t
a i ti t i gg
i ti t a gg i i
a i t g a t a t i ti i
at a a a m g i
ma i g
at t ti t t
t g a
4.3.8: Issues and challenges:
tm t at at a g m t t t m t
t t ai at ti g amm i ma at a ii a t a ai a t
im m t a i
i a m t ti mm i m t a gi g
t i t a i ai a m t t ma a t i i a g i i g
a ta ti mm i a gi i a gi g gi t at i ii
a i i i t t a i ia a a m t i a
m a i mi mm it t a t a tt ta i
it ig ag i t t a it t g amm im m ta i t
a a t
a it im m t m ti i i t a ai a t i i a ga
i t g amm a t ta a
t i i t ia i a a i mi t i g i i t ti g amm
i t ti g amm
4.3.8: Lesson learned:
i at ti i a g m t m a i m t at a mmitm t
a g m t t imi at a t mat a a i ma t i i a it i
a
ta i m t a i g m t m t ta t t at i g
a a a at i g am g g a i a
g amm ma ag a it i i i a i gt
a i i g t t tai a t mt
a t a g ig ga ig at a a t at i i g t i
ma t i at t i i a it ag i t a it t t
a t t m ti ii it ig i a mmitm t at a t
a a ii g t i a i g a g a im m ta t a
i a ma m it i g a a at t m iii a ia t a i g
a it a a i i ti i a gi g a t t i tm t i
ma a i at t i i tt mat i a
i i at i a i t m ata a a a i
i i at t at a a ita t i t a a at m a i m t t it a t
a a
4.3.8: Key Priorities for Next Fiscal Year (2077/078):
m t B i a at a ii m i i ai a a t a at

ami a
a t
t m i ti i g amm a ag t a
m i i ai
a it m m t m i t i ti g amm g
t ti a ta t i t i t g a t m
m t a a tai a t m i t g a g it i a t a g i i g
a ta m ti
m t ti i i ag i gt am ti i a a
t m
a g amm a i a a at i t t atm t
a a t a at a a a g it
m t a
a g amm m iti t t iti t m
a t ti g amm m iti t t iti t
ai tai a tai a a itami g amm a m t t i t a
a itami g amm
t g at a imat g a i m t it i am a i
m i gt a a it it a ti a i
a a t ai t a a t a ta t t m i ti
a
it m i a i i a i t m t i ti a at
a a mi a a i a gm t t i t g at ti i
t ma a a i t a m a i mat ia
ta i a am t a a t a at i t im ti
g amm
i tt a a i ia a iam ta ia t ma ti a ig ag a a a
m t a

ami a
4.4 Safe Motherhood and Newborn Health

4.2.1 Background
g a t a a a t g amm i t mat a a ata

m i it a m ta it a im mat a a ata at t g a
m a i a a i g a i a a t t at a at i g g a
i it a t t at m i i gg t t at t a a im ta t a t
mat a a m i it a m ta it i a a i i g a a i g a a
i i g a
i g ma t at gi a a t t i i g g a a i it
a a a t a iat it m ta it a m i it
m g it a a m i a a i i i g a a ai i g a
im i g a ta ta ta i
a i i t i g a ii a gi ama a a g amm m t
m a ma t a a t t ata a
a i m g t ti a i ai a m i at
t at a ii i a iti t
a t g amm i i at i a ma ig i a t g it m a
a m t i i i ag a g a g it t m t
i i g amm a t i i it a a t ig ig t t
im ta i it a a t B at a it a m i t g m t
mmitm t t t ai a t a it t i i a t
t t ama g amm t i a ag m
i t a i a im a t i t a i i a m g t ti a
i m t t i a a B a i i a a t
ig i a t t i g t a ai a i it a i m g a mai
g amm t at gi a i t i B
a at t t at g i it a a it a ga a a a
a i i g t mat a at tai a m tg a ta g t a gi
g i a im i g a it a ita iti at i a ia a
i a at ag it a i gm a i mt a ia a i a t
t it i at

ami a
Box 4.4.1: Main strategies of the Safe Motherhood Programme

1. Promoting inter-sectoral coordination and collaboration at Federal, Provincial, district and Local levels to
ensure commitment and action for promoting safe motherhood with a focus on poor and excluded groups.
2. Strengthening and expanding delivery by skilled birth attendants and providing basic and comprehensive
obstetric care services at all levels. The interventions include:
o developing the infrastructure for delivery and emergency obstetric care;
o standardizing basic maternity care and emergency obstetric care at appropriate levels of the
health care system;
o strengthening human resource management —training and deployment of advanced skilled birth
attendant (ASBA), SBA, anaesthesia assistant and contracting short-term human resources for
expansion of services sites;
o establishing a functional referral system with airlifting for emergency referrals from remote areas,
the provision of stretchers in Palika wards and emergency referral funds in all remote districts; and
3. Strengthening community-based awareness on birth preparedness and complication readiness through
FCHVs and increasing access to maternal health information and services.
4. Supporting activities that raise the status of women in society.
5. Promoting research on safe motherhood to contribute to improved planning, higher quality services and
more cost-effective interventions.
4.4.2 Major activities in 2075/76

Community
4.2.2 level maternal
Major activities and newborn health interventions
in 2075/76
Family Welfare Division (FWD) continued to expand and maintain MNH activities at community level
Community level maternal and newborn health interventions
including the Birth Preparedness Package (jeevansuraksha flipchart and card) and distribution of
matrisurakshachakki
ami a i i i (misoprostol) to prevent
t postpartum
a a mai haemorrhage
tai (PPH)
a iin home
at deliveries.
mm it
i Through
i g FCHV,
t Bipublic
t a system apromotes:
health ag a a a i ata a a iti
mat i a a a i mi t t t t at m a m ag i m i i
 birth preparedness and complication readiness (preparedness for money, place for delivery,
transport
g and blood
i adonors);
t t m m t
 self-care (food, rest, no smoking and no alcohol) in pregnancy and postpartum periods;
 iANC
t (Ironasupplementation,
a mTd ivaccination,
a a deworming
i a
tablets), m
institutional a (through
delivery i
t SBAs)
a t a
and PNC (Iron and Vitamin A supplementation);
 a
essential newbornt care; and
m i ga a i g a a t at m i

m ta a i a mi g ta t i t a i t
identification of and timely care seeking for danger signs in the pregnancy, delivery, postpartum
g
B a a itami m ta
and newborn periods.
a a a
i
In 2066/67,athe government
a m approved
a i geducation
PPH a g andig thei distribution
t g aof the matrisurakshachakki
i t at m
a i
(MSC) tablets through FCHVs to prevent PPH in home deliveries. For home deliveries, three misoprostol
tablets (600 mcg) are handed over to pregnant women by FCHV at 8th month of pregnancy through
t g m t a a a t iti t
proper counselling to take immediately after delivery and before the placenta is expelled. Fifty districts
mat i a a a i ta t t g t t i m i i m
were implementing the programme up to 2075/76. Further four district Gorkha, Dolakha, Solukhumbu
i i t mi t ta t m g a a t g a t m at
and
t mParsat districts,
g astarted
t implementing
g this program in this
i g t ta immfiscaliatyear. aRecent NDHS
i a(2016) data
t a ta i i iti t im m gt g amm t t
iti t a a a m a a a i t i t ta t im m gt i g am
i t i a a t ata t at t m ga
i i t it t i a i ta t ta t t i a t im ta t gt i gt i
g amm a m i at m a i t ig i t g amm i t
t im m t a i m it i g i t t i t g at i

ami a
Rural Ultrasound Programme
a ta g amm aim t m i a g a t m it i
t ti m i a t t m i m g t ti a ata a
t ai B a i t at a a i g ta ta
m it t t a ma i a a ma i a ta t t a
a ta ia a t a it t i i g amm i i g
im m t i t m t iti t t ta B t ai a ta
a
Human Resources
ig i a t a g tg i g ma t ta
tt m ta t t i at a
i t a i t tag at ita it t ta
t it t am t it ta a
a i a g it t a a at ai i g t a t a a
a m i a i t i a i i t ai i g at
i t ai i g B B a t ia i ta t a at
a ag m t ami a i g i i g m a t a a t ata t a ga
B B t ai a B t a t ta
B a B a t ai a m t t ai ta a B
a a a t ia a i ta t a a a g t m it t
m t t B B a a i m a a a
a iat t a i a t i im a it i
Expansion and quality improvement of service delivery sites
t a i i it i it i g t B a it
at a ita a i i it i i m t t t ii
t ta t t t m ta a B t i ta i
i iti t iti t a t g tt a i gt a a
i ti t i i t t i a i i i t g
t i i a a g m t ta a t t a i i g
i i i
Onsite clinical coaching and mentoring
a it i at t i i i t i t t m a it
im m ta a it a i g a i i a i a
m t i
i i i t m t m a t im g i a a
at i i a ta t t im m t it i i a
a i g m t i g g amm i m iti t t a g a
i B a B i g ta i i g i i at B B a
i it i g amm a a i iti t i a iti t
a a t t at ma a a i tt t ta
m i i ai i t i t im m t it i i a a i ga m t i g g amm
a a i g m t i gg i i a t i g i i a i mai t at
i i a a i g m t i g i i B a B
a a i a m t a ta t t i t i tm t t g
ami a
m t t ai i g i i t t ta iti t B i i a
m t t ai m a i g m t i g g amm im m t iti t a t
i i it a B B it a t it a i g m t i g a g it
a i a m t t a a a it i i i ta
a m m t ma i a i t m a m a
a i g i i a a i g a g at i t m i a
at ia t B i i a m t t iti t B t ta i
i i it i i a m t i g m B m t i i
a i m t ta at a ii i i a
i
MNH readiness Hospital and BC/BEONC Quality Improvement
m m t i a it i i t g a m t i
m ta a a a im m ta i i a g am a
t m i i g iti t a g a ta a ita i t t
a ita a it im m t i
ita i iti t a it im m ti a i g im m t i it i g
t i i t ga it it a i g m t i g i t ta t
B B it i i a i
PNC home visit (microplanning for PNC)
t a ia t ata a i i a ma a g i
ma it t
mat a at i g t ata i t a i m
i a i gt t t i ti i
a a g tt ai a m iti t a a i t ai a m iti t i
t t gt i m ii i g i i m at a ii t
i at m m
Emergency referral funds
ti mat t at t g a t m i i m i a i gt i
g a i a i i a t t t m i a a a i i
t a i at g t m m i it a i t g g a i a t ai a
a ai a i it i ia t at t m a t a iat t
a t i i a at m g a t i i i Bagma
a a i i a ai a a im ai i i g m i imm iat
ta t ig t t ta a a at t i i t t m
i a a a at t ita i t iti t t g
i t tta t a m ta a t ig a i it a
a ii mai t i g amm i t t m g a ta t
t m m a it a a a g g a i a i a a tag a ia a mi a
i a a tag mm i
Safe abortion services
a a a a i t at ma m a a t g a i i g
t imit a t ami a i gi ma a i m a ta
a a i i a m a a at a ig i i g m i a t a
a i t t a i i t ia a a at am g
ami a
i m ag m ig ti ta gi a
ti a t gi t a t a t i ga at
g m ta i it t i a t ma a a
i a ai a a i a a a t a m it a t g a i a
t m t m i a a a
a t i g a a m t a ta ta m t
t mi a g a i a t a a t
iag i a t atm t i g t a ti a
i ta m t a i m i a ta
m i a ma ag m t
m i a a ma a a m a ia i a a ai a i a
iti t ita a ma it i a t im t a i a
a ai a i ita i a a a ai a i a a i
a i g a i at t t g t a i a t ai i g B i a a
i a a t i t i t it t t ai at a
t ta it a it it t i a a i i a
t ta m i a i gi a a i i t i a
a
Obstetric first aid orientations
ta t i g a am i t ai t ma ag t ti m i a at
at a ii it t it i g t a t a a am i t t B a at
m m g t ai t ai t i ti iti t
Nyano Jhola Programme
a
a g amm a a i tt t m mia t
a i a t i a t i a at a ii it i g t t
t t a a a i a a a m t a t a mat
a a g m t a i m gi i t at i t i g t a iti t
ita g amm a i t t t a ia t ai t a at
ta g t t a ma
Aama and Free New born Programme
g m t a mai ti i t t ag m
i t a i at it m i ta t i t
m i
t i a i i at a ii m ma t
i a i iti t a a t a i t ama g amm i
t a at i g amm a m g it t ama g amm
t a g amm i t i a m g it t
ama g amm i a agai a at i a t i t g amm it t
ii it i B

The Maternity Incentive Scheme, 2005 provided transport incentives to women who deliver their babies in
health facilities. In 2006, user fees were removed from all types of delivery care in 25 low HDI districts and
expanded to nationwide under the Aama Programme in 2009. In 2012, the separate 4 ANC incentives
programme was merged with the Aama Programme. In 2073/74, the Free Newborn Care Programme
(introduced in FY 2072/73 was merged with the Aama Programme which was again separated in FY
2074/75 as two different programmes with the provisions listed in Box 4.4.2.
ami a
Box 4.4.2: Provisions of the Aama Programme and New born programme
Aama programme provision
a. For women delivering their babies in health institutions:

Transport incentive for institutional delivery: Cash payment to women immediately after
institutional delivery (NPR 3,000 in mountains, NPR 2,000 in hills and NPR 1000 in Tarai districts).
Incentive for 4 ANC visits: A cash payment of NPR 800 to women on completion of four ANC visits
at 4, 6, 8 and 9 months of pregnancy, institutional delivery and postnatal care.
Free institutional delivery services: A payment to health facilities for providing free delivery care.
For a normal delivery health facility with less than 25 beds receive NPR 1,000 and health facilities
with 25 or more beds receive NPR 1,500. For complicated deliveries health facilities receive NPR
3,000 and for C- sections (surgery) NPR 7,000. Ten types of complications (antepartum
haemorrhage (APH) requiring blood transfusion, postpartum haemorrhage (PPH) requiring blood
transfusion or manual removal of placenta (MRP) or exploration, severe pre-eclampsia, eclampsia,
MRP for retained placenta, puerperal sepsis, instrumental delivery, and management of abortion
complications requiring blood transfusion) and admission longer than 24 hours with IV antibiotics
for sepsis are included as complicated deliveries. Anti-D administration for RH negative is
reimbursed NPR 5,000. Laparotomies for perforation due to abortion, elective or emergency C-
sections, laparotomy for ectopic pregnancies and ruptured uterus are reimbursed NPR 7,000 to
both public and private facilities.
b. Incentives to health service provider:

For deliveries: A payment of NPR 300 to health workers for attending all types of deliveries to be
arranged from health facility reimbursement amounts.
Newborn Care Programme Provision
a. For sick newborns:

There are four different types of package (Package 0, Package A, B, and Package C) for sick
newborns case management. Sick newborn care management cost is reimbursed to health facility.
The cost of package of care include 0 Cost for Packages 0, and NPR 1000, NRP 2000 and NRP 5000
for package A, B and C respectively. Health facilities can claim a maximum of NPR 8,000 (packages
A+B+C), depending on medicines, diagnostic and treatment services provided.
b. Incentives to health service provider:

A payment of NPR 300 to health workers for providing all forms of packaged services to be
arranged from health facility reimbursement amounts.
Antenatal care
Antenatal care
mm a mi im m a t ata at g a i t a t a g a t
WHO recommends a minimum of four antenatal check-ups at regular intervals to all pregnant women
m at t t i t ig t a i t m t g a i gt i it m
(at the fourth,
i t sixth, eighth
i g and inintha months
g of
a pregnancy).
at During these visits women should receive
the following services and general health check-ups:
 B Blood pressure, weightig t aand foetal
ta heart
a t rate
at m it i g
monitoring.
a B g a i it a a a a ami a i g
 IEC and BCC on pregnancy, childbirth and early new born care and family planning.
ma a g ig i g g a i it a i t t at m i a
 m Informationa ont danger
a signs
iat during
a t pregnancy,
a ii childbirth and in the postpartum period, and timely
areferralt to appropriate
a ma health
ag m facilities.
t m i a i g g a
 Early i i detection
t taand management
t i a ofi complications
t ia during
imm pregnancy.
ia i i a i ta t a
 Provision mi goftatetanus
t t toxoid
a gand
a diphtheria
t m a(Td) ma a ia
immunization, a i folic acid tablets
iron a and deworming
tablets to all pregnant women, and malaria prophylaxis where DoHS,necessary.
Annual Report 2075/76 (2018/19)
Pregnant women are encouraged to receive at least four antenatal check-ups, give birth at a health
institution and receive three post-natal check-ups, according to the national protocols. HMIS reported
since 2066/67 to track the timing of ANC visits as per the protocol. The percentage of women who had at
least one ANC check-up in FY 2075/76 is 110% at national level with 127% [HIGHEST] in Karnali Province
 Blood pressure, weight and foetal heart rate monitoring.
 IEC and BCC on pregnancy, childbirth and early new born care and family planning.
 Information on danger signs during pregnancy, childbirth and in the postpartum period, and timely
referral to appropriate health facilities.
 Early detection and management of complications during pregnancy.
 Provision of tetanus toxoid and diphtheria (Td) immunization, iron folic acid tablets and deworming
ami a
tablets to all pregnant women, and malaria prophylaxis where necessary.
g a t m a ag t i at a t a t ata gi i t at a at
i t
Pregnant a
women are iencouraged
t tot receive
ata at least four a antenatal
i g t check-ups,
t a give
a birtht at a health
t i t t a t mi g i it a t t
institution and receive three post-natal check-ups, according to the national protocols. HMIS reported tag
m a at a t i i at a a
since 2066/67 to track the timing of ANC visits as per the protocol. The percentage of women who had at it
ig t i a ai i a t i a im i ig
least one ANC check-up in FY 2075/76 is 110% at national level with 127% [HIGHEST] in Karnali Province
g a t m a i g at a t i it a t t a i a
and 90% [Lowest] in SUDURPASCHIM Province [Fig 4.4.3]. The proportion of pregnant women attending
m ti a ti t ti at t a a
at least 4 tANC visits
i as pera the protocol has
m im increased from
m t a 53 percent
m a in 2073/74
t at a i and 50 percent
i it ain
2074/75t to 56 itpercent
ig in t 2075/76 a i at them national
t i a level.
a i Alli thea provinces t havea showni msome ti
improvements
i as compared to last year in ANC visits as per protocol with highest [70%]
achievement in Gandaki Province and lowest [41%] achievement in province 2.
ig 4.4.3
Figure
Percentage of pregnant women who had at least one ANC checkup
150 118 127

110 114 106 108 110
90
100
Percent
50
Provinces
Figure 4.4.4 Women having at least one ANC check-up

Figure 4.4.4 Women having at least one ANC check-up
Percentage of women who had four ANC check-ups as per

protocol
80 68 70
61 65 62
70 535056
5960 5861 55 555558
60 4447 4951 49
50 373441
40
30
20
10
0
2073/74 2074/75 2075/76

ami a
Figure 4.4.5: Institutional deliveries by districts 2075/76
Figure 4.4.5: Institutional deliveries by districts 2075/76
Delivery care
Delivery care services include:
Delivery
 skilledcare
birth attendants (SBAs) at home and facility-based deliveries;
 earlycare
Delivery detection of complicated
services include: cases and management or referral (after providing obstetric first aid)
to an appropriate health facility where 24 hours’ emergency obstetric services are available; and
 the
i registration
i t a of births
a t andB maternal
at m and aneonatal
a i itdeaths.
a i i
a t m i at a a ma ag m t a a i i g t ti t
Although women are encouraged to deliver at a facility, home delivery using clean delivery kits with
ai t a a iat a t a i it m g t ti i a
provision of misoprostol to prevent post-partum haemorrhage and early identification danger
a ai a a
signs
t andgicomplications,
ta i are
t important
a mat components
a a ofata
delivery
at care in settings where institutional
delivery services are not available or not used by the women.
t g m a ag t i at a a i it m i i g a i it
Delivery
it attended
ii by Skilled tBirth
mi t Attendants
t (SBAs):
t at m a m ag a a i a a g
ig a m i a a im ta t m t i a i g i t a
Nepal is committed to achieving 70 percent of all deliveries attended by SBAs and at institutions by
i i a t a ai a t t m
2020 (2076/77) to achieve the SDG target of 90 percent in 2030. At the national level, percentage of
births attended by SBAs increased to 60 percent in FY 2075/76 from 52 percent for both FY 2073/74
and FY 2074/75. Similarly, SUDURPASCHIM province also remained at 60 percent for both years.
Delivery attended by Skilled Birth Attendants (SBAs):
Province five achieved the highest with 73 percent deliveries attended by SBA. The Gandaki province
has the lowest percentage of delivery attended SBA at 47 percent which is stagnant from last fiscal
a i mmi
year (Figure 4.4.6).
t a i i g t a i i a B a at i t
t a i t ta g t t i t t a a
tag it a B i a t ti m t
t a imi a i a mai at t
t a i a i t ig t it t i i a B
a a i i a t t tag i a B at t i i
tag a t m at a a ig

ami a
Figure 4.4.6 Percentage of births attended by a Skilled Birth Attendant

(SBA)
73
80 60 61 61 6570 59 606061
70 5252 4852 45 51
5249 464747 5156
60
50 35
40
30
20
10
0
2073/74 2074/75 2075/76
Institutional
Institutional delivery:
delivery:Institutional
t a deliveries
i i asa percentage
tag of expectedt livei birthsi t havea increased
i a to 63
t
percent ti
in 2075/76 from 54 and m 55 percent
a ti
in FY 2073/74 a
and FY 2074/75 respectively. As compared to
m a percentage
2074/75, t tag deliveries
of institutional i t increased
a i ini alli Provinces
a i (Figure
a i
4.4.7). ig
Figure4.4.7
Percentage of institutional deliveries

7578.8 73.2
80 69 67 68 69 71
63.2 62 61.5 60
70 55 54
60 49 53 52.7 53 49
46 4747.8
44
50 34
40
30
20
10
0
2073/74 2074/75 2075/76
Institutional Deliveries by type of Health Facilities
Figure 4.4.8 Total institutional deliveries by type

DoHS, Annual Report 2075/76 of health facilties
(2018/19)
120000 108300
100000
80000
60000
2073/74 2074/75 2075/76
ami a
Institutional Deliveries
Institutional Deliveries by of
by type type of Facilities
Health Health Facilities
Figure 4.4.8 Total institutional deliveries by type

of health facilties
120000 108300
100000
80000
60000
36476 37035
40000 27047
20000 6331 8200
0
PHCCs General Health Posts Nursing Primary Teaching
Hospital Home Hospital Hospital
Figure 4.4.8
Figure 4.4.8 Total
Total institutional
institutional deliveries
deliveries by type ofby typefacilities
health of health facilities
The Health
at tPosts
a t hadigthet highest
ti contribution (108300)t a followed
i g bya teaching
g a (37035) and ge
ita t ti t a i i i a ig
(36476) hospitals to conduct institutional deliveries in Nepal [Fig 4.4.8].
Emergency obstetric care: Ba i m g t ti a a B t
ma ag m t g a m i a a it agi a i a m t
ma a m a a ta t m a tai t a ma a a m
a ia a t a mi i t a a ta g t at m a m ag i a
am ia a am ia a t ita a a m i
m g t ti a i g a a a a a t ia a
ta i a g it B
t i t a i i a t m a t at a
a t i tag i ti a i t tag i ig i
i Bagma i i a a a i i ig

In FY2075/76, 18 percent of institutional deliveries are conducted by CS. Compared to last fiscal
year there is one percentage point increase in the percentage of CS delivery. Very high CS delivery
observed in Bagmati Province (31%), Province 1 (30%) and Gandaki Province (19%) (Figure 4.4.9).
Figure 4.4.9 Percentage of deliveries by caesarean section, by province ami a
Percentage of deliveries by caesarean section
35 30 3031
28
30
25 1919
20 1718 17 17
1515
15 10 9 9 10
10 7 7
4 5 5 5 4
3
5
0
2073/74 2074/75 2075/76
Postnatal care
Postnatal
Postnatalcare
care services include the following:
 Three postnatal check-ups, the first in 24 hours of delivery, the second on the third day and the
Postnatal care services include the following:
third on the seventh day after delivery.
 The identification
t ata and management
t ti of complications
i oft mothers andt newborns
t i a and
a referrals
t to
t appropriate
i t t afacilities.
health a i
 i a a ma ag m t
The promotion of exclusive breastfeeding. m i a m t a a a t
a iat at a ii
 Personal
m hygiene andi nutritiona education,
i g and postnatal vitamin A and iron supplementation for
mothers.
a gi a ti a a t ata itami a i m ta
 m t
The immunization of newborns.
imm i a
 Postnatal family planning counselling and services.
t ata ami a i g i ga i
m m t i t i t t ata a at a a t a i it it i
i i imi a t t m i t a i i i a m ta at a ii a m t at
t t a i t ata a t t m t a a i i ag
i i t t m it i g t i it a i gt a t i
m t a i gt i it a t t i m t
i t ti a ig iai a
ig ti a im a ai i t i im ta t t t t at
m a i g t a a a m a t t a
m t i i at t a a g ga i a a t a g t m m t t ata
m t a t ag i t i im ta a i g
t t at m i a ig i a t i a t a i i t
t m t a t a t t ata i ia i g g a i a a gi g
a a

2073/74 to 16 percent in FY2074/75 and FY 2075/76 (Figure 4.4.10). The service utilization was found
highest in Sudurpashim (31%) followed by Karnali Province (24%). It is important to note that proportion
of women attending three PNC has always been low compared to other safe motherhood indicators.
Cultural and geographical factors affecting the movement of postnatal mothers could be reasons for the low
coverage while the perceived low importance of care during the postpartum period could also be significant.
There is a need for culturally sensitive interventions to promote access to and the use of postnatal services,
especially in geographically challenging areas.
ami a
Figure 4.4.10: Provincial and national trends of percentage of women who had 3 PNC check-up as per protocol
Percentage of women who had PNC3 check-ups as per

protocol
35
31
35
30 25 24 26
23 22
25 19 19 2019
20 1616 1415 141313
12 13 14
15 9 9 10
10
5
0
2073/74 2074/75 2075/76
Safe
Safeabortions
abortions
Women of reproductive age have been receiving safe abortion services (SAS) from certified sites since
m ag a i i g a a i m it
i service
the t began
i ingaNepal
i from a 2060/61.
m The use of SAS has beenaincreased i overa the last decade.
t a t Total
aSAS users
ta were 96,138 (12.7%) women in 2073/74;m i 98,625 (13%) in 2074/75 i and 90,677 a (12.6%) in
2075/76.
i The share of medical
a abortion
m i a aamong total safe abortion
am g t ta a a service users gradually
i increased
g a aover
i the alast few years,
t from
a t 53 percent
a inm2072/73, 56t percent
i in 2073/74, 62 tpercent
i in 2074/75 and 66t
i a ti a t a am g
s li g h tly i nc reas ed (13 % ) f or s aurg i c al
i m i a a ig tab orti
i ona i n th i s gi a a i t i
f i s c al y ear. T otal reported a t- aab orti on
pos
ta t ta m i a a i t a tt a
c om pli c ati on als o d ec li ne ov er th e las t th ree y ears .
Table
Table4.4.11:
4.2.4: Proportion
Proportion of
of safe
s afe abortion
abortionservices
s erv ices users,
us ers , by
by age
age
Aged < 20 y ears am ong total Aged < 20 y ears am ong
Fis cal y ear Medical SAS us ers total Surgical SAS us ers
2073 /74 12% 17%

2074 /75 10% 11%
2075/76 9% 13 %
C om pared to f i s c al y ear 2073 /74 , th e proporti on of w om en w h o h ad a s af e ab orti on and th en us ed

ta ami a i g a ig t i a i att a i
c ontrac epti v es i nc reas ed ov er th e las t th ree y ears , f rom 75 perc ent i n 2074 /75 and 76 perc ent i n
a i i m ai t i a ta ta
2075/76
t a (F i g ure am4 . 2.g12).
m T ih ea aca c eptanc e of i pos t ab ortiaon ig c ontracm epti
a ont am am ong gm ed gi
i c alaaba orti on s erv i c e
us ers mw as i h ai g ah c om pared to am ong gis urg a a i c al ab orti on us ers a (m ed i
tac al ab orti on 79% v i ers igus s urg i c al
am
ab ortigon 69%
m ). O v erall, a pos git- aba orti
a on L ARC us eti s ah i g am h er amg mong i w aoma en w h o h ad s urg i c al ab orti on (51
perc ent) th an am ong m ed i c al ab orti on (26 perc ent).
Im plem entation of Maternal and Perinatal Death Surv eillance and Res pons e ( MPDSR)
M aternal and P eri natal Death Surv ei llanc e and Res pons e (M P DSR) w as d es i g ned to m eas ure and trac k
all m aternal d eath s i n real ti m e, to und ers tand th e und erly i ng f ac tors c ontri b uti ng to m ortali ty and to
prov i d e g ui d anc e f or h ow to res pond to and prev ent f uture d eath s . T h i s i s a c onti nuous i d enti f i c ati on,
noti f i c ati on, q uanti f i c ati on and d eterm i nati on of c aus es and av oi d ab i li ty of all m aternal and peri natal
d eath s , as w ell as th e us e of th i s i nf orm ati on to res pond w i th ac ti ons th at w i ll prev ent f uture d eath s .
G oN pri ori ti z ed and i m plem ented M P DSR i n F Y 2073 /74 M P DSR w i th f urth er s treng th eni ng and
ami a
Implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR)
at a a i ata at i a a a ig t m a
a t a a mat a at i a m t ta t i g a t ti gt
m ta it a t i g i a t t a t t at i i a
i a a a a a t mi a a a a i a i it
a mat a a i ata at a a t t i i ma t it a
t at i t t at i i a im m t i
it t t gt i ga a i
a a i iti t t i iti t i t i a a Ba a g ai
a a ag i a t a g ga a ta a a ita t i a i at i
m t a g i i t iti t t
mm it mat a at ita mat a at a ita i ata at a i
a a
Community-based MPDSR: mm it a g am a im m gi iti t

ita mm it a g am mm it mat a at a i ata at
a i a a
Hospital-based MPDSR: t ita a im m g g am ita

a mat a at i i i i i a a i ata at a i i am t ai
Formation of MPDSR Committees at different levels
t g i i t a a a mmi ai t
i t a
i t at at i a i a i g ai
i t ami at i i i a i t a a t a i it mmi a
ai a mmi it a at a a at a ig m t t am mm it
g am a ita im m g t i mmi m a
t t ita
MPDSR On-site coaching program
ami at i i i t it a i g g am t tt iti t a ita

im m g g am it a i g g am a i iti t mm it
a a ita ita a i gt i g am a ai a ata m
a m t i a i i a i mai t a t
ta i
Review of MPDSR:
i g am a t i t i a a it a t i t at
g i im m g ita i a t i Bi at aga B t a
at ma a a ga i i a im m g ita i a m
a ita i it m a ita t a i at i t i
One stop Crisis Management Centre (OCMC)
t i i ma ag m t i ta g am a m t i i t
iti t ita i a ta a i a i a aa a i a a
Rev iew of MPDSR:
A rev i ew of M P DSR prog ram w as c ond uc ted i n th i s f i s c al y ear w i th an ob j ec ti v e to rev i ew th e upd ate
prog res s on M P DSR i n i m plem enti ng h os pi tals . Rev i ew w as c ond uc ted i n B i ratnag ar, B utw al, K ath m and u
and Dh ang ad h i w h i c h c ov ered all i m plem enti ng h os pi tals i n N epal. 2- 3 pers on f rom eac h h os pi tal w ere
i nv i ted f rom eac h h os pi tal to parti c i pate i n th e rev i ew .
One
ami s top Crisa is Managem ent Centre ( OCMC)
O ne s top c ri s i s m anag em ent oori entati on prog ram w as s uc c es s f ully c om pleted i n f i v e d i f f erent d i s tri c t
ga a i a i a a a i a t a it i i a a a a a ai ita t
h os pi tal i . e. C h autara, Si nd h upalc h ow k , Dh uli k h el, K av repalanc h ow k , Sand h i k h ark a, Arg ak h ac h i ,
g am a t a i i g a i ga i g a ma ag m t
T auli h aw al, K api lb as tu and P ri th i v i c h and ra (N aw alparas i ) h os pi tals . T h e ob j ec ti v e of th e prog ram w as to
enh anc e s erv i c e prov i d er' s k now led g e and s k i ll reg ard i ng c as e m anag em ent.
Issues, constraints and recommendations
Is s ues , cons traints and recom m endations
Table 4.4.12.: Issues, constraints and recommendations— safe motherhood and newborn health
Table 4.2.7: Is s ues , cons traints and recom m endations — s afe m otherhood and newborn health
Is s ues and cons traints Recom m endations Res pons ibilities
• Rev i ew of prog ram m e i m plem entati on and ef f ec ti v enes s
F W D, DoHS,
Hi g h m aternal m ortali ty rate • P lan f or road m ap to red uc e M M R b as ed on g lob al and
M oH
N epal ev i d enc es
• Rev i s e th e Aam a P rog ram m e to f ac i li tate an appropri ate
ref erral m ec h ani s m and i m prov e ac c es s to li f e- s av i ng
Ref erral m ec h ani s m F W D
s erv i c es .
• Dev elop Ref erral G ui d eli ne.
• F oc us i ng on f unc ti onali ty and q uali ty of ex i s ti ng C E O N C
s i tes , rath er th an es tab li s h i ng new s i tes .
• M oni tori ng s erv i c e prov i s i on s tatus and av ai lab i li ty of
h um an res ourc e
• P rom ote th e prod uc ti on of s k i lled s erv i c e prov i d ers (AAs ,
M DG P s , M D ob g y n) and ens ure appropri ate s k i ll m i x at
C E O N C s i tes b y d eploy m ent and appropri ate trans f er of
F luc tuati ng f unc ti onali ty of
s k i lled h um an res ourc es M oH , DoHS,
C E O N C and b i rth i ng c entre
• C onti nue alloc ati on of f und f or c ontrac ti ng out s h ort – F W D, N HT C
s erv i c es
term s erv i c e prov i d ers
• P rov i d e loc um d oc tors and anaes th es i a as s i s tants i n
s trateg i c ally loc ated ref erral h os pi tals f or eac h prov i nc e
• I ntrod uc e a s pec i al pac k ag e to prov i d e C E O N C s erv i c es i n
m ountai n d i s tri c ts
• Support loc al g ov ernm ent f or trai ni ng of h um an
res ourc es i n nec es s ary s k i lls
Av ai lab i li ty of q uali ty • I ntrod uc e q uali ty i m prov em ent proc es s f or all m aterni ty M oH, DoHS
Is s uesty and
m aterni c arecons
s erv traints
i c es at c are s erv i c es i nc ludRecom i ng Q m I P endations
s elf - as s es s m ent and on- s i te Res pons ibilities
h os pi tals and b i rth i ng c li ni c al c oac h i ng
c entres : • I ntrod uc e m oni tori ng proc es s i nd i c ator f or q uali ty F W D(q uali ty of
• 24 /7 av ai lab i li ty of m aterni ty c are i n h ealth f ac i li ti es c are)
s erv i c es • Ad eq uate b ud g ets alloc ated f or eq ui pm ent i n b i rth i ng
• s k i lls and k now led g e of c entres and C E O N C s i tes
s taf f • Reg ular M N H s k i lls upd ate prog ram m es f or nurs es F W D
• enab li ng env i ronm ent f oc us i ng on c onti nuum of c are
and m oti v ati on • I ntrod uc e c ons truc ti on s tand ard s f or b i rth i ng c entres F W D, DHO s ,
• ov erc row d i ng at • Support b i rth i ng c entres at s trateg i c loc ati ons only DP HO s
ref erral h os pi tals . • P rov i d e ad d i ti onal b ud g etary s upport f or ov erc row d ed F W D, DoHS
h os pi tals
• Rai s e th e q uali ty of AN C c ouns elli ng s erv i c es , f oc us i ng on
P lateaui ng of 4 AN C us e and c onti nuum of c are
DHO s , DP HO s ,
ti m ely f i rs t AN C v i s i ts , and • Dev elop a s pec i al pac k ag e to enc ourag e ti m ely f i rs t AN C
F W D
v ery low P N C c ov erag e v i s i ts .
• I ni ti ate P N C h om e v i s i t i n s elec ted c ounc i ls
L ow us e of i ns ti tuti onal • P rod uc e a s trateg y to reac h unreac h ed s ub - populati ons
d eli v ery and C - s ec ti on • Rapi d ly as s es s and ex pand rural ultras onog raph y (U SG )
F W D, DHO s ,
s erv i c es i n m ountai n • E x pand s erv i c es i n rem ote and d i f f i c ult loc ati ons and
DP HO s
d i s tri c ts , and prov i nc e ens ure c onti nuous av ai lab i li ty of s erv i c es (b i rth i ng
num b er 2 and 6 c entres and C E O N C s erv i c es )
N o C E O N C s erv i c es i n s om e • Di s c us s i on w i th loc al g ov ernm ent on th e ad v antag es of
rem ote d i s tri c ts : Ras uw a, h av e C E O N C , and c h alleng es i n m ai ntai ni ng C E O N C F W D
M anang and M us tang f unc ti onali ty i n low populati on areas
T h e h i g h pub li c d em and f or DoHS, Annual Report 2075/76 (2018/19)
M oH, B P K I HS,
f ree d eli v ery s erv i c es at • I m plem ent th e Aam a P rog ram m e at B P K I HS
F W D, RHDs
B P K I HS
• T h e s trateg i c upg rad i ng of h ealth f ac i li ti es i nto b i rth i ng
T h e i nad eq uate us e of s om e
c entres
b i rth i ng c entres and
• U pg rad e s trateg i c ally loc ated b i rth i ng c entres to prov i d e
i nc reas i ng th e num b er of F W D, DHO s
c om preh ens i v e q uali ty pri m ary h ealth c are s erv i c es and
b i rth i ng c entres , and DP HO s
ai m f or ‘ h om e d eli v ery f ree’ V DC s
F W D
v ery low P N C c ov erag e v i s i ts .
• I ni ti ate P N C h om e v i s i t i n s elec ted c ounc i ls
L ow us e of i ns ti tuti onal • P rod uc e a s trateg y to reac h unreac h ed s ub - populati ons
d eli v ery and C - s ec ti on • Rapi d ly as s es s and ex pand rural ultras onog raph y (U SG )
F W D, DHO s ,
s erv i c es i n m ountai n • E x pand s erv i c es i n rem ote and d i f f i c ult loc ati ons and
DP HO s
d i s tri c ts , and prov i nc e ens ure c onti nuous av ai lab i li ty of s erv i c es (b i rth i ng
num b er 2 and 6 c entres and C E O N C s erv i c es )
N o C E O N C s erv i c es i n s om e • Di s c us s i on w i th loc al g ov ernm ent on th e ad v antag es of ami a
rem ote d i s tri c ts : Ras uw a, h av e C E O N C , and c h alleng es i n m ai ntai ni ng C E O N C F W D
M anang and M us tang f unc ti onali ty i n low populati on areas
T h e h i g h pub li c d em and f or
M oH, B P K I HS,
f ree d eli v ery s erv i c es at • I m plem ent th e Aam a P rog ram m e at B P K I HS
F W D, RHDs
B P K I HS
• T h e s trateg i c upg rad i ng of h ealth f ac i li ti es i nto b i rth i ng
T h e i nad eq uate us e of s om e
c entres
b i rth i ng c entres and
• U pg rad e s trateg i c ally loc ated b i rth i ng c entres to prov i d e
i nc reas i ng th e num b er of F W D, DHO s
c om preh ens i v e q uali ty pri m ary h ealth c are s erv i c es and
b i rth i ng c entres , and DP HO s
ai m f or ‘ h om e d eli v ery f ree’ V DC s
i nc reas i ng us e of ref erral
• Run i nnov ati v e prog ram m es to enc ourag e d eli v ery at
h os pi tals
b i rth i ng c entres
Hi g h d em and f or f ree
• I nc reas e th e b ud g et and targ et f or reg i onal h ealth
s urg ery f or uteri ne prolaps e F W D
Hos pi tals prov i d es reg ular s erv i c es of P O P s urg ery .
c as es
F ed eral s truc ture and
g ov ernanc e of h ealth
• O ri entati on of loc al and prov i nc i al lev el g ov ernm ent on
i ns ti tuti ons ; li m i ted F W D/M O HP
th ei r roles i n h ealth s erv i c es d eli v ery and g ov ernanc e
und ers tand i ng of h ealth
s erv i c e d eli v ery

ami a
4.5 Family Planning and Reproductive Health

4.5.1 Background
ami a i g t ma t ii a g mi i a ma t ii a g
a a t m i ta t i ta i ma ta
im a t g a t m t i ta g a t a i m i a
i m ma m a ta a am am t m g ta
i a ta a a m t
aim a a ami a i g g amm i t i i i a a t i

a ig t i g a it m t ta i a i m i
a i t i m t a i mmi t ita a ig t a a t
ta a it i a i m i a i i i a a i g
m a t a mm i a a a a t mig a t
a t a ma gi a i g i g i i
m t mmit t t gt i i a t at gi at it i t a
t t m ii im a i g i m tt gag it g
at m t i i at at i a i at t a a a
i t a a mmitm t i t a im m t a t
m m ta a a t
m g am t g it i ia at at
a
m i i ai a t i gt a t a ia i t t
a it
i
t g im ta ia am g a t a mm i a
a a t a t a g m ta m t mi
i i g g a g i ta a a im a t m i
i i t ta i a a i a i
i m i i a ma g a i t
a i ma a a a i i t g t g m t ia
ma g a t i at t i i g mm ia t g m t at
t m t a g i ta m t ma m a i a
i ta a i t g at t Ba i at i t a at
it mm it at it a i i ma a
a t m a at mm it a i t i t ma m a a
ta i i a a ai a i ita a at t t at a
t ai a i i t i i m t a a i i t g at it
i i t ii g i i t i a a a i
a m i am a a ma t i i a i g ta gi a ta
a i at ta it t g a a a m i t a i
a it i a a i t g i at a mm ia t t a
i i t i at i i a ma i g t ita i i g a a mi ita
i a mm i a ma a ai a m ia ma g a imit ia
a i i g ag i
i a at ai at a i a a i i a i t t t

ami a
4.5.2 Objectives, policies and strategies
a a g amm i t im t a t tat a t g
i 4.5.2m Obj ectivi es , policies a i g as trategiesi i g i t
and t a it ta i i
T 4.5.2 Obj aectiv
h e ov erall ob aj eces ti, vpolicies and s s trategies
e of N epal’ F P prog ram m e i s to i m prov e th e h ealth s tatus of all people th roug h
i4.5.2 T nfh orm
e ov edObj erall c ectiv
h oboi c j eesec on v eacofc esN s epal’
, ti policies i ng s and
and F P uti
trategies progli z i ram ng cm li eent- i s c to entredi m provq uali e th ty e vh oluntary
ealth s tatus F P s ofervall i c espeople . T h e ths pec rougi f i hc
obi nf j orm ec tiiv edes c are h aoi asc eaf ollow on ac s tc : es as i ng t and uti li z i ng ac liitent- c entredi q uali t at ty iv oluntary a F P s erv ai c es . a T h e ta s pec i f i tc
T h ei ov ierall ob j aec ti v e of N epal’ s F P ia prog ram m i e i s i to i m aprov e th e h ealth s tatus of m all tpeople a thlearoug h
ob j •ec ti v T esi o are i nca reas as f ollow e ac c ess : s to and th e us e of q uali ty F P s erv i ic esg ath at i s s iaf e, efaf eca ti v e and ac c eptab to t
i nf orm ed c h aoiitc ea on act c es s i ma ng and uti li z i ng c li ent- c entred q uali ty v oluntary F P s erv i c es . T h e s pec ac
i f i
• i T ndo i v nci d reas uals eand ac c esc ouples s to and. Agiths pec ae iusi ale f ofoc q usualii s tyonF i P ncits reas erv i ig c i nges thac at cmes i s s ts i naf rural e, ef f and ec ati v rem t oteac plac
e and c teptab aes tand lemtoto
ob j ec ti v tesa are as f ollow ms : t
poor, i nd i v i d Dali ualst and and oth c ouples er m arg . A iis nali pec z i al ed f aocpeople us i s mig w i thi ncah reas
on i g t h aunm i ng acaetc esneed s i ns rural andt to andposremtpartum ote placandes pos and t-to
• T oorti i nc on reasw eomac en, c es s th to andi v esth ofe uslabeour of q m uali ty F P and s erv adi c esolesth c atents i s s . af e, ef f ec ti v e and ac c eptab le to
i poor,a Dali at and oth tai
ab e w
er m arg i nali t az ed people w i th ah i g h unm et need mi g rants s andt to pos tpartum and i pos t t-
i nd i v i d uals and c ouples . A s pec i al f oc us i s on i nc reas i ng ac c es s i n rural and rem ote plac es and to
• gT aboaorti i nc ireas on w aeomanden, s ustht taiae wn i c v ontraces of labepti i our v e m us i g e,rants aand red and ucad eoles unm c ents et need . f or F P , uni ntend ed
poor,nanc Dalii tesand oth er m argepti i nalionz epti dedi ts c people w i th h i g h unm et need s and to pos tpartum and pos t-
• preg T oati nc reas a e ,and aand is usc gontrac tai n c iontrac m v onti
e us inuati e, andon. a red i gucae unm et t need a f itor F P , uni ntend i ed t m a
ab orti on w om en, th e w i v es of lab our m i g rants and ad oles c ents .
• mT preg o c ireate nanc i an esi ,genab and a c li ontrac
ng env epti i ronmonent
t d i s c f onti or i ncnuati reas on. i ng ac c es s to q uali ty F P s erv i c es to m en and
• T o i ncen reas eludandi ng s usad tai n c ontrac. epti v e us e, and red uc e unm et need f or F P , uni ntend ed
• iw T oom c reate a i nci estan enab li ngolesenvc ents i ronm ent f or i nc reas i ng ac c es s to q ualigty F tP at s erv gii c es to m aeni and
preg nanc , and c ma ontrac epti on d i s c ontiinuati on. im m a g
• mm T w oomi ncien reas
a i nc e th
lud a ei d
ng em ad
i and
oles c f or
ents F P . s erv i c es b y i m plem enti ng s trateg i c b eh av i our c h ang e
• T o c reate uni c an enabac liti ngv i ti env i ronm ent f or i nc reas i ng ac c es s to q uali ty F P s erv i c es to m en and
• c T omo i ncm reas eatith on e d em andes f . or F P s erv i c es b y i m plem enti ng s trateg i c b eh av i our c h ang e
w om en i nc lud i ng ad oles c ents .
T h e•f i v e T c poli om i c m ii esuniand
o i nc reasa e ths trateg
c ati on ac ti i v c i tiareas
et d atem gi
es .
and a f orato F P tacs erv hai evi c iees th b ey tabi m ovplem a e obenti j ec ngti v ess trateg are pres i ac b ehented av i our i ntB c oxh ang i4 . 5.Be 1.
T h e f i v ec poli om mc i esuniand c ati s on trateg ac ti v i c i tiareas
es . to ac h i ev e th e ab ov e ob j ec ti v es are pres ented i n B ox 4 . 5. 1.
Box 4.5.1: Policies and Strategic Areas for FP
T Box h e f 4.5.1:
i v e poli c Policies i es and s and trategStrategic i c areas Areas to ac h for i ev FP e th e ab ov e ob j ec ti v es are pres ented i n B ox 4 . 5. 1.
1. Enabling environment: Streng th en th e enab li ng env i ronm ent f or F P
2.Box 1. Demand 4.5.1: Policies
Enabling generation:
environment: and Strategic reas eth h Areas
I ncStreng en ealth th efor c enab are FPs li eek ng env i ng i ronm b eh av ent i ourf oram F P ong populati ons w i th h i g h unm et
need f or m od ern c ontrac epti on
2. Demand generation: I nc reas e h ealth c are s eek i ng b eh av i our am ong populati ons w i th h i g h unm et
31.. Service need f ordelivery:
Enabling od ern E c ontrac
m environment: nh ancStreng eeptiF P on ths erven i thc ee d enab eli v ery li ng i env nc ludi ronm i ng cent om f m orodF P i ti es to res pond to th e need s of
2.3 . mDemand arg i nalidelivery:
Service z generation:
ed people, E nh rural ancI nc ereas people,
F P e s h ervealth m i c ei g rants cd are eli v ,ery s adeekoles i nci ng ludc ents
b iehng avand c i omourothm amoderi ong s tipec i to
al g res
es populati roups pondons wtoi thth eh i g need h unms ofet
4 . Capacity need
m arg i f nali or mbuilding: ern c Streng
z edod people, ontrac rural thepti
enon
people, th e c apac m i g rants i ty of, ads ervolesi c ec ents prov and i d ers othto er ex s pand pec i alF P g roups s erv i c e d eli v ery
5.3 4 . Research
Service
Capacitydelivery: and innovation:
building: nh anc eth Streng
E Streng F P ths erv
en e thc iapaccen e d thi eli ty e v ofeverys i erv d enci nci c lud ee provb i ngas ei d c f omers or m to prog
odex i ram tipand es m toF eP res i s m ervplem
i c eentati
pond d to on
eli v thery th rougs h of
e need
5. res argearci nali
m Research h and ed i people,
z and nnov
innovation: ati on rural people, Streng th m en i g rants th e ev, adi d oles enc ec ents b as eandf orothprog er srampec m i ale g i roups m plem entati on th roug h
4 . Capacityres earc h building: and i nnov Streng ati on th en th e c apac i ty of s erv i c e prov i d ers to ex pand F P s erv i c e d eli v ery
Target 5. Research of Family andPlanning innovation: Streng th en th e ev i d enc e b as e f or prog ram m e i m plem entati on th roug h
Target res of earcFamh and i nnov ati on
ily Planning
Selec Target tted of F Fam P gg oals ilya Planningaand i i nd ii c at ators tto ens ure unii v ers al a aac c es s to t s ex ual a and a reprod uc ti v e h ealth a t- c are a
sTarget erv i i c ted
Selec es of , ii ncFFam
P ludg ilyoals i ing Planning
gf or and F P i /SRH prog ram
nd i c ators gtoam areaure
ens as af uniollowv erss : al ac c es s to s ex ual and reprod uc ti v e h ealth - c are
sTable erv i c es4.5.1: , i nc ludSDG i ng Targets f or F P /SRH prog ram are as f ollow s :
TableSelec ted 4.5.1: F P SDG g oalsTargets and i ndand Indicators
i c ators
and Indicatorsto ens ure uni v ers al ac c es s to s ex ual and reprod uc ti v e h ealth - c are
s Table
Target erv i c es4.5.1:and
, i nc Indicators ludSDG i ng Targets f or F P /SRH and prog Indicators
ram are as f ollow s : 2015 2019 2022 2025 2030 Source
P Target roportiand on Indicators of w om en of reprod uc ti v e ag e (ag ed 15- 4 9 66n 2015 2019 71 202274 76 2030
2025 80 N Source DHS,
yTable P ears
roporti ) 4.5.1:
w on h o ofh SDG av w e omTargets th eienr need ofand Indicators
reprodf or f ucam ti i v ly e planni
ag e (ag ng eds ati15- s f i ed4 9 66n 71 74 76 80 N N M DHS, IC S
w y ears i th m ) odw h ern m eth od s
CTarget ontrac andoIndicators h av e th ei r need f or f am i ly planni ng s ati s f i ed
(C P R) (m od ern m eth od s ) (% ) 4 2015 7. 1 2019 52 2022 2025
56 2030
N M IC S
60 N Source
P w roporti i th m odepti onernofm eth
v e prev odalenc
w om en s eofrate reprod uc ti v e ag e (ag ed 15- 4 9 66n 71 74
53
76 80 N N M DHS,
DHS,
Cy ears ontrac epti v e prev alenc e rate (C P R) (m od ern m eth od s ) (% ) 4 7. 1 52 53 56 60 N IC S
DHS,
T otal ) F w ertih oli tyh avRate e th ei(T rF R) need(b i rthf ors f per am i lyw omplanni en agng ed s ati15-s f i4 ed9 2. 3 n 2. 1 2. 1 2. 1 2. 1 N N N DHS, M IC S
M IC S
yw T ears i th m od ern m eth od s
otal ) F erti 2.4 7.3 n1 2.521 2.53 1 2.561 2.601 N N N M DHS, IC S
Ad C ontrac oles c eptili v b tyei rthprev
ent
Ratealenc
rate
(T F R)
(ag
(b i rth(C Ps R)per
eedrate 10- 14 y (m odw ; omagern
ears
enm eth
ed
ag edod s 15-
15- 19 y ) (% 4 )9) 71n
ears 56 51 4 3 3 0 N DHS,
DHS,
y ears ) N N M M I I C C SS
per 1,000 w omb i rthen rate i n th at aged e 10- g roup y ears ; ag ed 15- 19 y ears ) 71n 56 51 4 3 N M IC S
T Adotal oles F c erti
ent li ty Rate (T (ag F R) (b i rth 14s per w om en ag ed 15- 4 9 2. 3 n 2. 1 2. 1 2. 1 3 2.01 N N DHS, DHS,
per
y ears ) 1,000 w om en i n th at ag e g roup N N M M I I C C SS
Ad oles c ent b i rth rate (ag ed 10- 14 y ears ; ag ed 15- 19 y ears ) 71n 56 51 4 3 3 0 N DHS,
Table per 1,000 4.5.2: w omNHSS en i Imn thplem at agentation
e g roupPlan ( IP) 2016- 2021 Target of FP Program : N M IC S
Table
S Indicator 4.5.2: NHSS Im plem entation Plan ( IP) 2016- 2021 Target
Bas eline of FP Program : Miles tone Target
.S Indicator
Table 4.5.2: NHSS Implementation Plan (IP) Data
2016-2021 Yeareline
Bas Target Sourceof FP2016
Program:2017
Miles 2018
tone 2019 2020 Target
N Table
. 4.5.2: NHSS Im plem entation Plan ( IP) 2016- Data2021 YearTarget of FP Program
Source 2016 : 2017 2018 2019 2020
1N C ontrac epti v e prev alenc e rate (m od ern 4 7. 1 2014 N M IC S 50 55
S1 mIndicatorC eth
ontrac od s )
epti C P v Re prev alenc e rate (m od ern 4 7. 1 Bas 2014eline N M IC S
Miles
50 tone Target
55
. Data Year Source 2016 2017 2018 2019 2020
N m eth od s ) C P R
1 C ontrac epti v e prev alenc e rate (m od ern 4 7. 1 2014 N M IC S 50 55
m eth od s ) C P R

ami a
2 M eth od m i x of F P
M ale s teri li z ati on 18 2014 N M IC S 18 18
F em ale s teri li z ati on 3 0. 9 2014 N M IC S 29. 9 27
IU C D 4 .5 2014 N M IC S 4 .8 5. 7
I m plant 5. 3 2014 N M IC S 5. 8 7. 3
I nj ec tab le 21. 5 2014 N M IC S 21. 6 21. 9
P i lls 9. 7 2014 N M IC S 9. 7 9. 7
C ond om 10. 2 2014 N M IC S 10. 3 10. 4
3 U nm et need f or f am i ly planni ng (% )
L ow es t q ui nti le 27. 2 2015 N M IC S 22. 4 19. 5
Hi g h es t q ui nti le 24 . 3 2015 N M IC S 22. 4 19. 5
4 % of w om en w h o rec ei v ed pos t 75 2015 N A 80 80
ab orti on F P
5 % HP s (Health P os t) w i th L ARC N A 2015 N A 4 0 50 60 70 80
prov i s i on
4.5.3 Maj
4.5.3 or activ
Major ities in 2075/
activities 76
in 2075/76
F P prog ram m e are i m plem ented at v ari ous lev el (c entre, prov i nc e and m uni c i pali ti es ) af ter th e
g s amm
f ed erali ati on. K aey F P imac ti v m
i ti es tc arri at a ii n 2075/76are ast f ollow s : i
ed out a i i ai a m t
•
a i a a i a i t i a a
P rov i s i on of reg ular c om preh ens i v e F P s erv i c e i nc lud i ng pos t- partum and pos t ab orti on F P s erv i c es
• P rov i s i on of long ac ti ng rev ers i b le s erv i c es (L ARC s - I U C D and I m plant)
• F P is treng i th eni ngg aprog ram m th roug ih th e us e iof d i ec i s i on-i m g ak i ng t tool at m (DM a T )and W t HO a m ed i c al
i
eli g i b i li ty f or c ontrac epti v e (M E C ) w h eel
• F P m i i ic ro planni gng af or adg d res s i ngi unm eti need of F P i n h ard ato reac m h ac omt m uni ti es and und ers erv ed
populati t gt ons i g g am t g t i i ma i g t a m i a
• P igi erm ianent
it t aod s or V oluntary Surg i c al C ontrac epti on (V SC )
F P m eth
• I m plem mi entatiaon iof gpub li c apri v ate partners i g mh i pt(P P P ) i n F P prog iram at a h i g th populati
a on mm d i s tri c ti a
• a
Streng th eni ng of i ns ti tuti onali z ed F P s erv i c e c enter as a trai ni ng c enter
• P rovma i s i on oft rov mi ng t AN M (RAN M ) and ta V SP s gi erv ai c e to i tncareas e F P s erv i c e us ers
• m I nteg m taof F P and i m m i uni zi atiaton s aervt i c es i
rati on i g am at ig a iti t
• t gtte c li nii c gs erv i i c es tf or longa iac ti ng rev ers ii b le c ontrac
Satelli t aepti a tv esai i g t
• C ontrac i i epti v e upd i gate f or O b s tetri c i aan/G y nec olog ii s t, tnursi es & ac onc erned ik ey F P play ers
• t g a ti on prog rama onimm
I nterac F P and i RH
a i nc lud i ngi ASRH w i th ph arm ac i s t and m arg i nali z ed c om m uni ti es
• C atom m it uni tyi ii nterac iti on w i th s atig s af i ed c gli ents f ori prom otit nga perm anent m eth od and I U C D
• t a th eni ng of ASRH
Streng at s erv i c es t t i ia gi t a
• Strateg
t a y , g ui d eli gne,am protoc ol and as tand ard di ev elopm i g ent and upd itati ng relateda ma itot F P a, ASRH, maP PgiP a i
mm i
4.5.4 mm
Achiev it
em ents
i t - a2075/ 76 it a i t m g ma tm t a
t gt i g i
Currentt at usgers g i i t a ta a m ta a g at t
F em ale s teri li z ati on (4 0% ) oc c upi es th e g reates t part of th e c ontrac epti v e m eth od m i x am ong all c urrent
4.5.4 Achievements-2075/76
us er, f ollow ed b y Depo (14 . 8% ), I m plant (13 . 7% ), m ale s teri li z ati on (12. 6% ), oral pi lls (6. 4 % ) and las tly
I U C D (5% ) i n 2075/76 (F i g ure 4 . 5. 1).
Current users
ma t ii a i t g at t a t t ta m t mi am ga
t m a t ma t ii a a i
a at i ig

ami a
Figure 4.5.1: Proportion of FP Current Figure 4.5.2: Share of FP Current Us ers ( % ) , all
Us er— Method Mix , 2075/ 76 Methods , by Prov ince, 2073/ 74 to 2075/ 2076
Figure 4.5.1: Proportion of FP Current Figure 4.5.2: Share of FP Current Us ers ( % ) , all
Us er— Method Mix , 2075/ 76 Methods , by Prov ince, 2073/ 74 to 2075/ 2076
P rov i nci e 2 h as a th te h i g h iges t proporti t on (24 % ) of c urrent us ers t w h i le K arnali i a P rov a i i nc e (5% i ) h as th ealow t es t
(F i g ure t ig
P rov4 . 5.i nc2)
e 2i nh 2075/76.
i
as th e h i g h T esotal num b on
t proporti
ta m
er (24of % perm) of c anent
urrent cusurrent
ma ers w h us
t
i leers
K arnali
t
ex c eedP rov s i ncth eat(5%of ) sh pac
t at
as thi nge lowm eth
a i g
es t od at
m t
nati onal at
lev el
(F i g ure a
4 . 5.and a
2) i ni n2075/76. a
P rov i nc T eotal i
1 and i
num b 2er(T ofab perm a
le 4 . anent a
5. 3 ). cT urrenth e trend us ersof ex s c h eed t
ares thof attotal of s pac a i ng m ethus oders at(i n % t )
c urrent t ta
s h ow s nati ani onal
i nc reas n a2075/76
lev ele iand i ni P rov ai nci neP irov
1 andi nc 2 ab ile 54 . th5. 3 an
e 2(T and i). T i nh eprev a i ousof ty s ear
trend h aare(Fi ofi g ure
totali4 . c 5.urrent
2). N a ati ig (i n ,% c urrent
onally
us ers )
a s (ab
us ers h owa s s olute
an i nc numreast eb i ers ) ofa alli nm tP rov
n 2075/76 od erni ncme 2m and eth od 5 thas an mi n prev
are ecmreas
i n d i ous y teari ng(F i g trend
aure 4 i . .5. 2).
A d N ecatiareas i get, ofc urrent
onally 26,000 i s
a useders i n(ab 2075/76
ob s erv s olutei num th b an ers )i nof previ all m i ous
od ern m t etha G odand
y ear. i s are ak i i nP i rov d ec i nc
reasea i ngand a trend
P rov a. iAi ncd eec reas
5i h eow aof ev 26,000
er s h owii s s an
ob s erv ed i n 2075/76
a i ath an ii n
i nc reas ed i n num b er th an prev i ous y ear (T ab le 4 . 5. 3 ). prev m i ous y
t ear.
a G and i ak i P rova i nc e a and P rov i nc e 5 h ow ev er s h ow s an
i nc reas ed i n num b er th an prev i ous y ear (T ab le 4 . 5. 3 ).
Table 4.5.3:
TableTable
4.5.3: FP Current
4.5.3: FP
Us ers
FPCurrent
Current ( Modern
Us Users (Modern
ers ( Modern
Methods ) ) byby Prov
Methods)
Methods
Provbyince, 2073/ 74
Province,
ince,
to2075/ ( 76
2073/ 74 2073/74
( in ‘ 000)(in 000)
to2075/ 76to2075/76
in ‘ 000)
Method
MethodProv ince
Prov 1ince 1 Prov Prov
inceince
2 2 Bagm
Bagmatiati Gandaki
Gandaki Province
Prov ince
5 5 K arnali
K arnali SudurSudur National National
pas hchim
pas hchim
Y ear Y ear
75/76
7473 /75
75/76
74 /75
7473 /75
75/76
75/76
/75
7474 /75
75/76
74 /75
75/76
/75
75/76
/75
75/76
7375/76
74 /75
75/76
74 /75
74 /75
75/76
75/76
/75
75/76
74 /75
7475/76
/75
7475/76
/75
7475/76
73 /74
/74
/74
73 /74
/74
73 /74
7373 /74
7374 /74
7373 /74
/74
73 /74
7374 /74
7374 /74
/74
73 /74
73 /74
Spac i ng Spac i ng
m eth od m s eth od 266
s 266 217 207 126 109 120 3 04 255 220 99 86 100 295 272 3 10 80 74
217 207 126 109 120 3 04 255 220 99 86 100 295 272 3 10 80 74
82 14 9 14 5 14 9 1,3 21 1,161 1,188
82 14 9 14 5 14 9 1,3 21 1,161 1,188
P erm anent
P erm anent
m eth od s 23 9 23 7 23 0 4 86 4 83 4 70 223 218 206 103 101 97 176 176 169 57 55 52 100 99 95 1,3 85 1,3 71 1,3 18
m eth od s 23 9 23 7 23 0 4 86 4 83 4 70 223 218 206 103 101 97 176 176 169 57 55 52 100 99 95 1,3 85 1,3 71 1,3 18
T otal us ers
T otal us ers 505 4 54 4 3 7 612 592 590 527 4 73 4 26 202 188 196 4 71 4 4 8 4 79 13 7 129 13 4 24 9 24 4 24 4 2,707 2,53 2 2,506
505 4 54 4 3 7 612 592 590 527 4 73 4 26 202 188 196 4 71 4 4 8 4 79 13 7 129 13 4 24 9 24 4 24 4 2,707 2,53 2 2,506
T h e m od ern c ontrac epti v e prev alenc e rate (m C P R) at nati onal lev el i s 3 9% i n 2075/76 (F i g ure 4 . 5. 4 ).
P odrov ern
i nc ec 2ontrac
h as thepti
T h e mm t a e h v i g eh esprevt m alenc
aC P R ofe rate 4 6% (mw h C i leP R)
at m B ag at m ati
at a h onal
nati as th elevlowel esi s t 3 (3 9%2% ).i nF 2075/76
a i i i v e P rov i nc(Fig esi g ure
(1, 3 4 , . 5. 4 ).
G and ak i , K arnali and Sud urpas h c h i m ) h av e m C P R les s th an nati onal av erag e (3 9% ). N ati onal and
P rov i nci e 2 h asa tht e h i ig g h es t m C P R of 4 6% w h i le B ag m ati h aas tth e low es tt (3 2% ). F i i v e P rov i i nc es (1, 3 ,
P rov i nc i al (1, 2, B ag m ati tandm Sud urpas c h i m ) m iC P RBagma h as d ec reas ed i n y ear 2075/76 th an th at of prev i ous
G and
a y aeari (F i ag urea 4 i . 5.a 4 ). Sud
ak i , K arnali and urpas
E c olog alh reg
ic a c h ii on
m im)w h i s ave,
a em C m m
P CR P ofR T les
erais (4tth3 a
% an), alth
nati onal
a oug ah i naavd ecerag reasei ng(3 trend
ag 9% ). , N i as ati
h i g onal
h aer a and
P rov i nci i al
ia (1, 2, B agBagma
m ati and a Sud urpas c h ai m ) im m C Pm R h as d eca reas ed ian y eari 2075/76a th an th tataof prev
t ati ous
y ear (Fi i g ure 4 a. 5. 4 ).ig E c olog i c al reg i on gi
w i sae, m giC P R of i T eraim (4 3 % ), alth ai
oug h i n d eca treas i ng
g trend
i , i s ah i g i h ger
t i ig t a a a a ag i t at tai a i gi a gi
mai t a a a ag ig

th an nati onal av erag e (3 9% ) w h i le th at of M ountai n and Hi ll ec olog i c al reg i on rem ai n b elow th e nati onal
avami
erag e (F i g ure
a 4 . 5. 5).
Figure 4.5.4: m CPR by Prov ince, 2073/ 74 to Figure 4.5.5: m CPR by Eco- z ones , 2073/ 43 to
2075/ 76 2075/ 76
Di s tri c t- w i s e HM I S d ata i nd i c ates th at i n 2075/76 f i v e d i s tri c ts h ad m C P R g reater th an or eq ual to 50% ,

59 d i s tri c ts h ad m C P R b etw een 3 0- 50% and 13 d i s tri c ts h ad m C P R les s th an 3 0% (F i g ure 4 . 5. 5, 4 . 5. 6).
P ars a h as th e h i g h es t m C P R (67% ) w h i le K ath m and u th e low es t (20% ). P ars a d i s tri c t w as at th e top of
th e m C P R li s t prev i ous y ear als o. K ath m and u d i s tri c t replac ed Soluk h um b u th i s y ear to b e th e b ottom
las t of th e m C P R li s t.
iti t i ata i i at t at i iti t a m g at t a a t

iti t a m t a iti t a m t a ig
a a a t ig tm i at ma t t a a i t i t a at
t t t m it i a a at ma iti t a m t i a t
t m at t m it

T h e num b er of d i s tri c ts w i th m C P R b elow 3 0 perc ent d ec reas ed f rom 18 i n 2074 /75 to 13 ami a
i n 2075/76
i nd i c ati ng i m prov ed perf orm anc e am ong th e low m C P R d i s tri c ts (F i g ure 4 . 5. 6 and 4 . 5. 7).
m iti t it m t a m i t i
i i a g im ma am gt m iti t ig a
Figure 4.5.6: m CPR by Dis tricts 2075/ 76
Figure 4.5.7: S- Curv e Pattern of CPR Growth, 2075/ 76 Figure 4.5.8: Trends in m CPR by
Dis tricts , FY 2073/ 74- 2075/ 76
ma t m t ma a ma t i i a i t mait a t
am g a ma t m t i a i a m t mi t i
i ig t ma tm t a i ai gt
t at a a a i ia a t i i i a i gt i t
i a a i i a a im ig i a t t
tag t

P erm anent m eth od (P M - m ale and f em ale s teri li z ati on) oc c upi es th e m aj ori ty of s h are of c urrent us ers
am ong L ARC s and perm anent m eth od (L AP M ) i n all prov i nc es and m os t prom i nent i n P rov i nc e 2 (F i g ure
P4 .erm
5. 9).anentHow mev eth er, odc urrent
(P M - m usaleers andof perm
f em ale s teri lim z eth
anent ati on)
od s ocare c upii nes d thec ereasm aji ngori trend
ty of s bh othare ofat c nati
urrent onalus and ers
amprovongi nc i L alARClevs el.
and W perm anent m eth od (L AP M ) i n all prov i nc es and m os t
h ereas L ARC c urrents us ers i s i n i nc reas i ng trend i n th ree prov i nc es (G and ak i , prom i nent i n P rov i nc e 2 (F i g ure
P4 .rov 5. 9).i nc How
e 5 and ev er,Sudc urrent
urpas c ush i ers
m ) (Fof i g perm
ure 4 anent
. 5. 9). P m rovethi ncod es 2are h as i nth d eec low
reasesi ngt perc
trendentagb othe ofatL ARC nati s onal
c urrentand
ami prov
us ers . i nc i al lev
a el. W h ereas L ARC c urrents us ers i s i n i nc reas i ng trend i n th ree prov i nc es (G and ak i ,
P rov i nc e 5 and Sud urpas c h i m ) (F i g ure 4 . 5. 9). P rov i nc e 2 h as th e low es t perc entag e of L ARC s c urrent
us ers . 4.5.9: Trends in L APM Current Us ers as of % MWRA 2073/ 74 to 2075/ 76
Figure
Figure 4.5.9: Trends in L APM Current Us ers as of % MWRA 2073/ 74 to 2075/ 76
`
F emmaale s tterii lii z aati on (M L /L A) c ontri tb utes ab out 3 6% i n c ontrac eptiav e m eth odm m t i x i n mi P rov i inc e 2 (F ii g ure
`4 . 5. 10). I t i s ev i d ent th at f em ale s teri ili z atit ona(m i ni tlap und ier loc alt anaes th es i a- - M L /L A) i s popular i n T erai
F(Fig emi g ure
ale 4 s . teri li z ati
5. 11)
t i (M L i/L A)tc tontri
w h on
at b utes
i c h h av e c ontri b uted
ma ab out t i3 i6% a i n c ontrac
s i g ni f i c antly
mi i a v e m eth od am ai x ai n P trov i nciae 2 (F i g urei
als o i n nati epti onal av erag e. M ale s teri li z ati on (N SV ) on
a iI t i s ev aii d ent
4th . 5.e 10). ig at f em ale s terii li z ati aon (m i ni tlap i t er loc ig i anaes a t aes i a- i- M L /La A) i s apopular a ag a
oth er h and i s m thore popular i n M ountai n and Hiund ll th an T al erai (F i g thure 4 . 5. 11). C om pared toi nI TU erai C D,
t(Fi m i g plant
i ure
i a 4 s . eem
5. 11)s w toh b i c eh m th avoree tcpopular
ontri b auted i s m
i g ni f i c antly a
als oi i n nati tai
onal ava erag i
e.
am ong w om en of reprod uc ti v e ag e i n all ec olog i c al reg i on of N epal. M t a
ale s teri ai
li z ig
ati on (N SV ) on
thAsm em oth aentieroned ht and earlii s mer,im ore aale t s terim
f em popular in M t ountai
li z ati on c arri mn esandth eHi h lli g thhaesanam eraig (F i on
t T proporti mof 4 c . urrent
g ure 5. 11). C usomerpared ag I U i C i on
to reg
i n T erai a
D,
i(Fm i g plant
gi a s eem
ure 4 . 5. 11). gi s to b e m ore
a popular
m am ong w om
a ien of reprod
ma uc
t ti
i v i eaag e i n all
a i ec olog
t i c al
ig reg i on
t of N epal.
As m entitoned earli i er, aif em Current
giale s teri li z ati on c arri es th e h i g h es t proporti on of c urrent us er i n T erai reg i on
Figure 4.5.10: Steriliz ation Usigers as % of Figure 4.5.11: Trend, L APM Current Us ers as % of MWRA
(F i g ure 4 . 5. 11).
MWRA, 2075/ 76 by Ecological Region, 2073/ 74 to 2075/ 76
Figure 4.5.10: Steriliz ation Current Us ers as % of Figure 4.5.11: Trend, L APM Current Us ers as % of MWRA
MWRA, 2075/ 76 by Ecological Region, 2073/ 74 to 2075/ 76
ta a t a t m a m t i g m a i
i at
ta i aa at agai t t i ig i a t
ta a i i gt m t ig m ma
it t m t ma t a m t i i i
a i gt i i t g a a it a a i i a i
a a t at i a im i a t ig t ig
m a t t a g i ta i a a
a t at ig i a i a t m t a a m t
t ta ta i a a i a i

C ontrac epti v e d ef aulters (f or all tem porary m eth od s ex c lud i ng c ond om ), a prox y i nd i c ator f or
c ontrac epti v e d i s c onti nuati on (c alc ulated ag ai ns t c urrent us ers ), i s h i g h i n N epal. Ab out 59% of
c ontrac epti v e us ers h av e d i s c onti nued us i ng th e m eth od (F i g ure 4 . 5. 12). T h es e w om en m ay c h oos e
(s w i tc h to) les s ef f ec ti v e m eth od s or m ay not us e any m eth od (d i s c onti nued w h i le s ti ll i n need ) lead i ng
toC ontrac ri s k ofepti univ ntend
e d ef edaulters preg nanc (f ory and all tem i ts c porary
ons eq uenc m ethes .odG s andex akc lud i P rovi ng i ncc ond e (4 om 7% )),anda P prox rov i y nc ei nd5 i (4c ator
3 % ) h f asor
lowc ontrac d ef epti
aulter v e rate d i s c onti
w h i nuatile Sudonurpas (c alcc h ulated
i m P rovag i ncai nse th asc urrent
th e h i g ush eserst ),(90% i s h) i (Fg h i g ure
i n N 4 epal.
. 5. 12).Ab C out om pared 59% to of
SARCc ontracs (septi h ort v e acus tiers ng hrevav ers e d i b i s le
c onti nued epti
c ontrac us i v nges — th pie llsm ethand od Depo),
(F i g ureL ARC 4 . 5.s 12).
h as T low h es ed efw aulter
om en mrate ay (Fc h i oos
g uree
3(s . w 1. i 13tc h ) to) i n all les sP rov ef f eci nc tiesv e. m L ARC eth sod are s orthm eay m not os t usef ef ecanyti v em aseth w od ell(d asi s c onti m os nuedt c os t-w efh i f le ec s titiv lle i nc ontrac
need ami)epti lead v esi ng . a
Ttorend ri s k s ofof uni ntend epti
c ontrac ed preg v e d inancs c ontiy and nuatii tsonc ons h av eqe i uenc
nc reases ed. G and ak i P rov i (Fnc i g eure
i n 2075/76 (4 7% 4 . )5.and 12) P i ndrov i c i ncati eng 5 q (4 uali
3 % ty) h ofas
Flowig P s erv d ef i aulter
c e d eli v rate iery ii w s as h ues
i leg. Sud a ally
G loburpasit ,c h L ARC arei incprom
i m P s rov e h asotedi th easih i f g i rsh est lit ne a) (F i g epti
(90%c ontrac ure v 4 es. 5.af 12).or allC omprosm pared tpec tiav to e t
icSARC li entss . (stT hh aeorth i g ach tid ngi s c onti
rev a ers
nuati i b le onc ofontrac
SARCepti iv es tlow
s and — pi llsuptak andig L iARC s L ARC
e ofDepo), i n N s aepal h as i ndlowi c ates d ef aulter
c onc a erns ta
rateov (Feri g andure
th3 . 1.e 13need )i i n ofall prog aP rovi ram i nci esat
m . atiL ARC
c f ocs usareonth b eothm osas tupply ef tf ec and
ti v e d asem w and ell asasg pec m amma
ost ts cusostait- efni ngf ec tith v ee pas c ontrac
tt g aieptins vand es . a
fT ocrend maus i sng ofam c oreontrac t epti
on L ARC taiv es . id i gs c tonti nuati a t on gaih av ae i nc reas edi gi nm2075/76 (F i g ure 4 . 5. 12) i nd i c ati ng q uali ty of
F P s erv i c e d eli v ery i s s ues . G lob ally , L ARC s are prom oted as f i rs t li ne c ontrac epti v es f or all pros pec ti v e
Figurec li ents 4.5.12:
. T h e h Percentage
i g h d i s c ontiof nuati on of SARC
Contraceptiv s and low uptak
e Method Figure e of4.5.13:
L ARC Percentage
s i n N epal of i nd Contraceptiv
i c ates c onc eerns Method ov er and
th e need , of2073/
Defaulters prog74ramto 2075/ m ati c 76f oc us on b oth s upply and d em and
Defaulters by Methodsas pec t , s 2073/ us tai ni74ng toth2074/ e pas75t g ai ns and
f oc us i ng m ore on L ARC s .
Figure 4.5.12: Percentage of Contraceptiv e Method Figure 4.5.13: Percentage of Contraceptiv e Method
Defaulters , 2073/ 74 to 2075/ 76 Defaulters by Methods , 2073/ 74 to 2074/ 75
New acceptors
New acceptors
Depo (3 7% ) oc c upi es th e g reates t part of th e c ontrac epti v e m eth od m i x f or all m eth od am ong new
ac c eptors , f ollow ed b y c ond om (24 % ), pi ll (19% ), i m plant (13 % ), I U C D (3 % ), f em ale s teri li z ati on (M L 3 % )
and tly m ale s terii li z tati ong (N at
Newlasacceptors SV 1% t )i na 2075/76
t t (F i g ure t a 4 . 5. 14 ). m F P new t acmi c eptors a(allmm teth od am ) as % gof
aM W RA t h as s talled at nati onal lev m i im a t
el w h i le i t h as i nc reas ed i n P rov i nc e 1 and 5 (F i g ure 4 . 5. 15) ma t ii a
Depo (3 7%a ) oc c aupit es ma th e g reates t
t i iMixa part of th e c ontrac i epti v e m eth od m i x f or all m
ig New Acceptors as ( All Method) eth od am ong a new % t
Figure 4.5.14: Share of FP Method Figure 4.5.15: Trend of FP
aca c eptors ,
m tAll New f ollow ed b y c ond
a Acceptor, 2075/ a76 ta om (24 % ), pi ll (19% ),
at ofaMWRA, i m plant (13 %
a 2073/ 74ito it ), I U C D (3 %
a 76 ), i f em ale
a s teri
i li z ati on
i (M L 3 %a )
Am ong 2075/
and
ig las tly m ale s teri li z ati on (N SV 1% )i n 2075/76 (F i g ure 4 . 5. 14 ). F P new ac c eptors (all m eth od ) as % of
M W RA h as s talled at nati onal lev el w h i le i t h as i nc reas ed i n P rov i nc e 1 and 5 (F i g ure 4 . 5. 15)
Figure 4.5.14: Share of FP Method Mix Figure 4.5.15: Trend of FP New Acceptors as ( All Method) %
Am ong All New Acceptor, 2075/ 76 of MWRA, 2073/ 74 to 2075/ 76
New acceptors VSCs

New acceptors VSCs
P rov i nc e 2 rec ord ed th e h i g h es t num b er of V SC s /perm anent m eth od s (12,562) w h i le K arnali P rov i nc e
th e ilow es t (827) (T ab let 4 . 5. 4 ).igN otet th atmth e proj ec ted num ma b ers of tnewm Vt SC ac c eptors w as i nci reas aed a i
f rom 4 0,000 i n 2073 /74 to 4 2,3 00 i n 2074 /76 (T ab le 4 . 5. 5). T h e trend of s h are of new ac c eptors
i t t a t t at t t m a t
(ab s olute num b ers ) s h ow s an i nc reas e i n 2075/76 th an i n prev i ous y ear i n all P rov i nc es ex c ept th at of
a i a m i t i a t
B ag m ati , P rov i nc e 5 and Sud urpas c h i m P rov i nc e (T ab le 4 . 5. 4 ). N ati onally , new ac c eptors of all m od ern
a
m eth aod s (abt s olute a num tb ers ) h mav e i nc reas ed b ay 25,000
i aplus i i n 2075/76 tht an a i ni prev i ousi y ear. a i a
i t t at Bagma i a a im i a a a
Table 4.5.4: New Acceptors ( All Modern Methods ) by Prov ince, 2073/ 74 to 2075/ 76 ( in ‘ 000)
DoHS, Annual Report 2075/76 (2018/19) Sudur
V ari ab les Prov ince 1 Prov ince 2 Bagm ati Gandaki Prov ince 5 K arnali
pas hchim
National
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
Y ear
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
SARC s 95 86 96 85 79 84 108 100 88 54 4 7 4 6 157 14 6 175 55 57 59 85 81 80 64 2 598 628

New acceptors VSCs
P rov i nc e 2 rec ord ed th e h i g h es t num b er of V SC s /perm anent m eth od s (12,562) w h i le K arnali P rov i nc e
th e low es t (827) (T ab le 4 . 5. 4 ). N ote th at th e proj ec ted num b ers of new V SC ac c eptors w as i nc reas ed
ami f rom 4 0,000 a i n 2073 /74 to 4 2,3 00 i n 2074 /76 (T ab le 4 . 5. 5). T h e trend of s h are of new ac c eptors
(ab s olute num b ers ) s h ow s an i nc reas e i n 2075/76 th an i n prev i ous y ear i n all P rov i nc es ex c ept th at of
a B ag m t ati , P rovai nc me 5 and Sud
m urpast c h i m a P rov i nct e (T abmle 4 . 5. 4 ).a N atii onallya, new ac c eptors of all m i od ern
m
t a i eth od s (ab i s olute num
a b ers ) h av e i nc reas ed b y 25,000 plus i n 2075/76 th an i n prev i ous y ear.
Table 4.5.4: New Acceptors ( All Modern Methods ) by Prov ince, 2073/ 74 to 2075/ 76 ( in ‘ 000)
Sudur
V ari ab les Prov ince 1 Prov ince 2 Bagm ati Gandaki Prov ince 5 K arnali
pas hchim
National
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
Y ear
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
SARC s 95 86 96 85 79 84 108 100 88 54 4 7 4 6 157 14 6 175 55 57 59 85 81 80 64 2 598 628
L ARC s 21 25 23 12 14 15 3 5 3 2 25 10 11 10 25 27 29 7 7 9 15 14 13 129 13 2 125
P erm anent
5 3 6 9 8 13 3 3 2 1 1 2 3 4 3 1 1 1 3 2 2 3 0 25 27
m eth od s
T otal new
123 115 125 108 102 112 14 8 13 5 115 67 61 58 186 177 207 64 66 67 103 97 95 802 756 781
ac c eptors
P erc entag e of s h are of s teri li z ati on (M L ) new ac c eptors am ong total new ac c eptors i s h i g h es t (4 6% ) i n
tag a t ii a a t am g t ta a t i ig t
P rov i nc e 2 and i n i nc reas i ng trend (F i g ure 4 . 5. 16). W om en and m en i n G and ak i P rov i nc e and K arnali
i P rov i nci e ac c epteda ileasi t num a b iergoft V SC s (T abig le 4 . 5. 4 ). M ale ac m c eptorsa d om mi natedi B aga m ati
a iand K arnali
i a
aP rova i inc e (F i ig ure 4a. 5. 16).t L i k ew ai s e,
t P rovmi nc e 2 h as th e h i ag h es t num b ers (ab
a s olute
a num t b er) mi at Bagma
of s teri li z ati on
a i n 2075/76
a a i as i n prev i i ous ig y ears (T ab le 4 . 5. 4 ,iF i g ure
i 4 . 5. 16) i a t ig t m a t
m t ii a i a i i a a ig
Figure 4.5.16: Share of ML and NSV New Acceptors Am ong Total Steriliz ation New Acceptors , 2073/ 74 to
2075/ 76
F em ale V SC new ac c eptors w ere h i g h es t i n T erai ec olog i c al reg i on f ollow ed b y Hi ll (F i g ure 4 . 5. 17). M ale
V SC ac c eptors ex c eed s th at of f em ale V SC i n Hi ll ec olog i c al reg i on (F i g ure 4 . 5. 17)
Figure 4.5.17: Share of ML and NSV new acceptors Figure 4.5.18: Share ( % ) of tem porary m ethods of
am ong total s teriliz ation new acceptors , 2073/ 74 to new acceptors am ong total new acceptors , 2073/ 74
2075/ 76 to 2075/ 76

ami a
F emmaale V SC new acac eptorst w ere h i g h esigt i n T t erai
i ec olog
ai i c al reggi i ona f ollow gi ed b y Hi ll (F i g urei4 . 5. 17).
ig M ale
V aSC ac c eptors
a ex tc eed s th at of f emt at
ale V SC mai n Hi ll ec ologi i c ali reg i on (Fgii g aure 4 gi
. 5. 17) ig
Figure 4.5.17: Share of ML and NSV new acceptors Figure 4.5.18: Share ( % ) of tem porary m ethods of
am ong total s teriliz ation new acceptors , 2073/ 74 to new acceptors am ong total new acceptors , 2073/ 74
2075/ 76 to 2075/ 76
Ac h i ev em ent of m i ni lap and V as ec tom y new ac c eptors , ag ai ns t th e proj ec ti on f or 2075/76 i s 64 % .

How i ev er,
m natit on mi i atotal
w i s e, a num a b erst ofm V SC newa ac c eptors
t agai
h av e ti nct reas ed i n 2075/76 (b y 1,23 2).i
K arnali P rov ai nc e ac h ii ev i ngt ta
th e lowmes t (3 7% ) w h i le P rova i nc e t1 and a2 th ie h i g haes t (77%
i ) (T ab le 4 . 5. 5).
a aev i er, i n iab s olute
How a num i i b gerst as ex pec ted
t , P rov i nc ei 2 outperfi orm ed a oth erst . ig t a
i a t m a t i t m t
4.5.5:
4.5.5: Trend of VSC
Trend of VSCNew
New Acceptors
Acceptors Against
Agains Projection
t Proj ection by Province,
by Prov ince, 2073/ 74 to2073/74
2075/ 76 to 2075/76
P rov i nc e 1 P rov i nc e 2 B ag m ati G and ak i P rov i nc e 5 K arnali Sud ur N ati onal

pas h c h i m
V ari ab les
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
P roj ec ted 6875 54 50 7950 11600 93 00 164 00 6100 3 775 4 250 24 00 24 00 23 50 6600 4 100 5225 2150 1950 2225 4 275 3 025 3 900 4 0000 3 0000 4 23 00
Ac h i ev em ent 5989 3 93 0 6118 9988 8909 12562 3 955 3 020 1965 174 9 164 2 1552 3 617 4 13 5 2502 1880 1792 827 3 055 24 90 1624 3 023 3 25918 27150
%
87% 72% 77% 86% 96% 77% 65% 80% 4 6% 73 % 68% 66% 55% 100% 4 8% 87% 92% 3 7% 72% 82% 4 2% 77% 86% 64 %
ac h i ev em ent
New acceptors of s pacing m ethods

New acceptors of spacing methods
N ati onally , new ac c eptors of all tem porary m eth od s (ab s olute num b ers ) h av e i nc reas ed i n 2075/76 th an
i n prev i ous y ear. Hi g h es t num b ers of new ac c eptors f or s pac i ng (tem porary ) m eth od s i n 2075/76 are
areported
a i n P rov ianc e 5 (Tt ab le 4 . 5.a 6).t m a m t a t m a i a i
t a i i a ig t m a t a i g t m a m t i
M eth od w i s e I m plant, Depo and P i lls s h ow ed i nc reas i ng trend . Am ong L ARC s , i m plant s i g ni f i c antly
a t i i a
d om i nated I U C D i n all prov i nc es (T ab le 4 . 5. 6 and F i g ure 4 . 5. 19). L i k ew i s e, i m plant ac c eptors are h i g h er
th an I U C D i n all ec olog i c al reg i ons (F i g ure 4 . 5. 19).
t i m a t a i i a i gt m g im a t ig i a t
Table 4.5.6: New Acceptors ( All Tem porary Methods ) by Prov ince, 2073/ 74 to 2075/ 76 ( in ‘ 000)
mi at i a i a a ig i i im a t a t a
Sud ur N ati onal
ig t a P rov i nc e i1 a P rov i nc e 2 gi a gi B ag m ati ig G and ak i P rov i nc e 5 K arnali
pas h c h i m total us ers
V ari ab les
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
IU C D
3 .9 3 .7 2. 4 5. 1 5. 4 3 .4 10. 7 9. 2 5. 4 3 .5 2. 7 2. 6 6. 3 6. 7 5. 9 0. 8 0. 6 0. 9 3 .2 3 .1 1. 9 3 3 . 9 3 1. 6 22. 6
I m plant
17. 7 21. 6 20. 9 7. 7 8. 8 11. 8 25 22. 9 20. 7. 2 9 7. 3 19. 2 20. 6 23 . 2 6. 5 6. 5 8. 2 12 11 11. 2 95. 6 100. 8 102. 8
DoHS,
Depo Annual Report 2075/76 (2018/19) 111
4 5. 7 4 1. 7 51. 3 3 8. 3 3 7. 5 4 1. 1 55. 2 52. 3 4 4 .7 20. 6 17. 6 17. 1 61. 9 55. 5 74 . 2 26 29. 1 3 0. 3 1. 1 3 3 . 2 3 3 . 5 279. 2 267. 1 292. 1
P i lls
23 21. 7 21. 8 21. 8 18. 8 22. 3 23 23 . 5 19. 9 13 . 6 10. 9 11. 2 3 3 .8 3 3 .7 4 4 .3 11 12. 7 14 . 6 16 14 . 8 14 . 3 14 2. 7 13 6. 4 14 8. 4
C ond om
26. 7 22. 6 23 . 2 25. 3 22. 7 20. 9 3 0. 2 24 . 7 23 . 5 20. 8 19. 1 18. 61. 6 57 56. 18 15. 4 14 . 4 3 8. 3 3 3 3 1. 8 221. 3 194 . 8 187. 9
T otal new
New acceptors of s pacing m ethods
N ati onally , new ac c eptors of all tem porary m eth od s (ab s olute num b ers ) h av e i nc reas ed i n 2075/76 th an
i n prev i ous y ear. Hi g h es t num b ers of new ac c eptors f or s pac i ng (tem porary ) m eth od s i n 2075/76 are
reported i n P rov i nc e 5 (T ab le 4 . 5. 6).
M eth od w i s e I m plant, Depo and P i lls s h ow ed i nc reas i ng trend . Am ong L ARC s , i m plant s i g ni f i c antly
d om i nated a
ami I U C D i n all prov i nc es (T ab le 4 . 5. 6 and F i g ure 4 . 5. 19). L i k ew i s e, i m plant ac c eptors are h i g h er
th an I U C D i n all ec olog i c al reg i ons (F i g ure 4 . 5. 19).
Table
Table4.5.6:
4.5.6: New Acceptors
New Acceptors ( All(All
Tem Temporary Methods)
porary Methods ) by Prov by
ince,Province,
2073/ 74 to2073/74
2075/ 76 ( to
in ‘ 2075/76
000) (in 000)
Sud ur N ati onal
P rov i nc e 1 P rov i nc e 2 B ag m ati G and ak i P rov i nc e 5 K arnali
pas h c h i m total us ers
V ari ab les
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
74 /75
75/76
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
73 /74
IU C D
3 .9 3 .7 2. 4 5. 1 5. 4 3 .4 10. 7 9. 2 5. 4 3 .5 2. 7 2. 6 6. 3 6. 7 5. 9 0. 8 0. 6 0. 9 3 .2 3 .1 1. 9 3 3 . 9 3 1. 6 22. 6
I m plant
17. 7 21. 6 20. 9 7. 7 8. 8 11. 8 25 22. 9 20. 7. 2 9 7. 3 19. 2 20. 6 23 . 2 6. 5 6. 5 8. 2 12 11 11. 2 95. 6 100. 8 102. 8
Depo
4 5. 7 4 1. 7 51. 3 3 8. 3 3 7. 5 4 1. 1 55. 2 52. 3 4 4 .7 20. 6 17. 6 17. 1 61. 9 55. 5 74 . 2 26 29. 1 3 0. 3 1. 1 3 3 . 2 3 3 . 5 279. 2 267. 1 292. 1
P i lls
23 21. 7 21. 8 21. 8 18. 8 22. 3 23 23 . 5 19. 9 13 . 6 10. 9 11. 2 3 3 .8 3 3 .7 4 4 .3 11 12. 7 14 . 6 16 14 . 8 14 . 3 14 2. 7 13 6. 4 14 8. 4
C ond om
26. 7 22. 6 23 . 2 25. 3 22. 7 20. 9 3 0. 2 24 . 7 23 . 5 20. 8 19. 1 18. 61. 6 57 56. 18 15. 4 14 . 4 3 8. 3 3 3 3 1. 8 221. 3 194 . 8 187. 9
T otal new
tem p.
117. 0 111. 3 119. 6 98. 2 93 . 2 99. 5 14 4 . 1 13 2. 6 113 . 5 65. 7 59. 3 56. 2 182. 8 173 . 5 203 . 6 62. 3 64 . 3 68. 1 100. 6 95. 1 92. 7 772. 7 73 0. 7 753 . 8
m eth od s
ac c eptors
E x c ept f or i m plant, pos t- partum uptak e of F P m eth od h as d ec reas ed i n 2075/76 (F i g ure 4 . 5. 19). I m plant
t im a t t a t m ta m t a a i ig
m a t ta it i i a t i t t i a t
uptak e w i th i n 4 8 h ours of d eli v ery as reported i n HM I S reports need s to b e v eri f i ed as th e N ati onal
F aam i ly a P lanni ng P rotoc ol (N M S V ol 1, 2010) h as y et to approv e th i s prac ti c e i n N epal. T h i s c ould b ei
ami a i g t a t t a t i a i a
reporti ng error orgprov i d ers are alread i y ai ns erti
a nga i m plants
i togposimt- partum
a t t w om en
t b aeftore
md i s c m
h arg e f rom
ih os pia tals
g or b mi rth i ng ita
c entres i t i g t
Figure 4.5.19: Share ( % ) of L ARCs Methods of New Figure 4.5.20: Pos t- partum FP Method Acceptance
Acceptors Am ong Total New Acceptors , 2073/ 74 to as Proportion Am ong Ex pected L iv e Births , 2073/ 74
2075/ 76 to 2075/ 76
F P us ea af tera ab orti oni i s enc ourag agi i ngg (F igi g ure 4 . 5. 21). C ontrac
t a epti v e uptak ta e amamong g total
t ta reportedt
a ab orti on s ervi i c es i i s 75. 9% a, an i i nc areas e f m rom 2073 /74 (70. 7% ) ig(F i g ure 4 . 5. 21) tb ut only 17. 1%i i s
t c i ontrit b uted b y L ARCi s ii nda i c ati
g ng wmom en a af ter a ab orti ona are relyi i ngg on les s ef f ec ti v e m m etht od s (F i g igure
4 . 5. 21, 4 . 5. 22, 4 . 5. 23 ). K aarnali
ai P rov ii nc e s h ow s th
t e low es t
t pos t
ta ab orti on c ontrac
ta epti v e uptaktae (65% )
(Figi g ure 4 . 5. 22).
Figure 4.5.21: Proportion of Pos t Abortion FP Method 4.5.22: Percentage Pos t Abortion FP Uptake
Uptake by Method Ty pe, 2073/ 74 to 2075/ 76 2073/ 74 to 2075/ 76

F P us e af ter ab orti on i s enc ourag i ng (F i g ure 4 . 5. 21). C ontrac epti v e uptak e am ong total reported
ab orti on s erv i c es i s 75. 9% , an i nc reas e f rom 2073 /74 (70. 7% ) (F i g ure 4 . 5. 21) b ut only 17. 1% i s
c ontri b uted b y L ARC s i nd i c ati ng w om en af ter ab orti on are rely i ng on les s ef f ec ti v e m eth od s (F i g ure
4 . 5. 21, 4 . 5. 22, 4 . 5. 23 ). K arnali P rov i nc e s h ow s th e low es t pos t ab orti on c ontrac epti v e uptak e (65% )
(F i g ure 4 . 5. 22). ami a
Figure 4.5.21: Proportion of Pos t Abortion FP Method 4.5.22: Percentage Pos t Abortion FP Uptake
Uptake by Method Ty pe, 2073/ 74 to 2075/ 76 2073/ 74 to 2075/ 76
L es s th an 1% of und er 20 y ears of ag e populati on (a prox y f or ad oles c ent populati on) ac c epted m od ern
t a a ag a a a t a a t
c ontrac epti v e m eth od s (F i g ure 4 . 5. 24 ). M ore th an h alf of th e m eth od m i x i s c ontri b uted b y Depo (56% - -
m ta m t ig t a a t m t mi i ti t
F i g ure 4 . 5. 23 ). Ad oles c ents i n K arnali P rov i nc e reported to ac c ept h i g h er proporti on of c ontrac epti v es
ig t i a ai i t t a t ig
c om pared to oth er P rov i nc es (F i g ure 4 . 5. 24 ). Ad oles c ents h av e h i g h unm et need w h i le c ontrac epti v e
ta m a t t i ig t a ig m t
i ta i t i i i i a im m ta a g m i
a a at g amma i g a a a t ami a i g g am
i us ea i s low a, ith i s i s ai nd i c ati v e of i m plem entati on c h alleng es of c om preh ens i v e s ex ual and reprod uc ti v e
h ealth prog ram m ati c i n g eneral and ad oles c ent’ s f am i ly planni ng prog ram i n parti c ular i n N epal.
4.5.23: Share of Tem porary Method Mix 4.5.24: Under 20 Years Tem porary Method New
( Ex cluding Condom ) Am ong Under 20 Acceptors as % of MWRA, 2073/ 74 to 2075/ 76
Total New Acceptors , 2075/ 76

ami a
4.5.5 Issues, constraints and recommendations
4.5.5 Is s ues , cons traints and recom m endations
Table 3.1.7: Issues and Constraints — Family Planning
Table 3.1.7: Is s ues and Cons traints — Fam ily Planning
Is s ues and Recom m endations Res pons ibility
cons traints
• Sub opti m um • I m plem ent F P m i c ro- planni ng i n low c ontrac epti v e F W D, P HD, M oSD,
ac c es s to and us e prev alenc e w ard s /m uni c i pali ti es m uni c i pali ti es
of F P s erv i c es b y • C ond uc t targ eted m ob i le outreac h and s atelli te c li ni c s
h ard to reac h f oc us i ng on L ARC s
c om m uni ti es and • M ob i li z e V SP s (f or L ARC s erv i c es ) and RAN M s
und ers erv ed
populati ons • E ns ure av ai lab i li ty of L ARC s c om m od i ti es L S/M D, F W D, P HD,
• L i m i ted h ealth • I m prov e q uali ty of F P s erv i c es d eli v ery M oSD, P HS,
f ac i li ti es prov i d i ng m uni c i pali ti es
f i v e c ontrac epti v e • I m prov e F P ed uc ati on, i nf orm ati on and s erv i c es f or F W D, M O E , P HD,
m eth od s ad oles c ents i nc lud i ng C SE M oSD,
• Hi g h • Sc ale up s c h ool h ealth nurs e prog ram m e m uni c i pali ti es
c ontrac epti v e • Sc ale up i nteg rated F P /E P I c li ni c s and pos tpartum and
d i s c onti nuati on pos t- ab orti on s erv i c es
• U nd eruti li z ed • Streng th en F P s erv i c es i n urb an h ealth and c om m uni ty F W D, P HD, M oSD,
L ARC s h ealth c li ni c s m uni c i pali ti es
• I nad eq uate • Streng th en and ex pand th e c apac i ty of F P trai ni ng s i tes F W D, N HT C , P HT C ,
trai ned h um an • E x plore L ARC s c oac h - m entors h i p i ni ti ati v e P HD, m uni c i pali ti es
res ourc es on • E x pand and s treng th en F P s erv i c es i n pri v ate h os pi tal M oHP , F W D, M D,
L AP M P HD, M oSD
• F unc ti onali ty of • U pd ate th e k now led g e of F C HV s on L ARC F W D, P HD,
I F P SC s m uni c i pali ti es
• E s tab li s h th e role and res pons i b i li ty of I F P SC i n th e M oHP , M oSD,
f ed eral c ontex t to ens ure F P s erv i c e d eli v ery P HD, m uni c i pali ty
4.5.6 FAMILY PLANNING 2020 (FP 2020)

4.5.6 FAMIL Y PL ANNING 2020 ( FP 2020)
amiF am i ly P alannii ngg 2020 (F P 2020) i si aa g glob ala partners a t h i pi tot em pow m er w om en m and ag i rls gib y i nv esi ti ng i n g
ri
i ig t ag h ts - b as ed f am i
amily plannia i g ng (F P ). F P 2020 w ork s w i th it g g ov ernm m t c i v ii l i s oc i etyi t, m multi lateral
ents , at a
org ga i a ani z ati ons , d onors , and
a t th e pri v ate
i ats ec tor to
t tenab le 120
a m i lli on mi i w mom en and mg i rls ato us gie m odt ern
m ore
mc ontrac epti vt esa b y 2020. Ac h i ev i ng th ei F P i 2020 g t g oal i s a c gri ti ac ali m ai les i tone a mi to enst ure unit v ers al ac c esi s toa
a s ex ual t and reprod a a uc ti v e h ealth (SRH) and
at reprod uca ti v e ri g h ts b y 203 0ig tas lai d out i na Susaitai nab tlei
Dev elopm ent G oals 3 and 5.
tai a m t a a
T h e G ov ernm ent of N epal (G oN ) j oi ned th e F P 2020 m ov em ent i n 2015 w i th c om m i tm ents to ens ure
eq ui tab le acmc es st to v oluntary a F P s erv i i c es t b as ed on i nfmorm edm c h toii c e f or all iti nd i v i dmmitm uals and ctouples t , in
parti
itac ular, a th os e t w h o are m
ta os t ex c lud ied and
a v ulnerab i le. T mh e c om m i i tm ent m ad e
a i i i a a b y G oN pertai ns to
i ath ree ov erarc
a t h i ng th em es
a m t - P oli c y and poli ti
a c al env i ronm a ent; F P f i nanc i ng
mmitm t ma ; and F P prog ram m e and
tai
t s ervt i c e d eli v ery
a . T ih esg et c ommm i tm entsi w ere a f urth ier rev a i tali iz ed d muri ngt th e L onda oni Sum g am i t i n 2017gw amm h ere
G oN rei terated i ts c om m i tm ent to i nc reas e th e g ov ernm ent b ud g et f or F am i ly P lanni ng b y 7% eac h y ear
a i i mmitm t t ita i i gt mmit i
up to 2020; ac c elerate prog res s i n i nc reas i ng th e num b er of ad d i ti onal us ers of m od ern c ontrac epti v e
m eth od s b y an es ti m ated 1 m i lli on b y 2020, and i nc reas i ng th e proporti on of F P d em and s ati s f i ed (F aP DS)
it at it mmitm t t i a t g m t g t ami i g
a a t a at g i i a
to 71% b y 2020. M oreov er, w i th a s pec i al f oc us on m eeti ng th e F P need s of ad oles c ents and y outh s ,i g t m a i a
mN epal c om tm ai tted th atmi tt w i ll s tri v ae to exmat pand th mi e c iontrac epti v e am ethi od ma i ix gth tat ref lec t th ei r
ma es . a
pref erenc t it a ia m gt
a t a t a mmi t at it i ti t a t ta m t
mi t at tt i
ig a
a i ta t a a i i g mmitm t t g i a
a a i i m t a i a a am ta ig t i t

poli c y env i ronm ent on F P . F P h as b een ens h ri ned as a f und am
i nc lud ed i n th e b as i c h ealth s erv i c e pac k ag e und er th e P ub li c H
tow ard s uni v ers al h ealth c ov erag e of F P s erv i c es . T h e 15th N ati ona
G ov ernm ent of N epal h as pus h ed f orw ard th e ag end a of SRH/
Ac t2018, th e Reprod uc ti v e Health Ac t2018, as amiw ell asa th e Saf e M o
t
f i nalia z ied ) emi i taph aasa it i z ea t thag ei av aai aglab
a i ga a t a i
i li ty t tanda i acaac t esa s t i b i li tty of ri g h ts - b as
m od elled
t es mti m t ates a s h a ow N epala i s t w agell aw i th i n ranga ei of ac h i ev i ng i t
t t i at t t at t a a t a t
a ma prev alenc e b
i g ai y 2020 (F i g 1), an
m a i t a ai a i it a a i m portant ac
i i it h ig t ema ent th at i m pli e
i ev
i
it ta g t
w omt men
m
i n 2019.
ag m
ta
As aa res mat
ult of thiga i is a levim el of us e,a 1.i 2i gm i lli on uni nte
it i a g
ta t a i m t t at
im i 4 79,000 i i g uns
i taf e ab mi ortii onsm andi 1,600a m aternal t t i d eath s w ere av erted
mi i i t g a i a t a a a a mat a
at a t ig
ng F P 2020 c om m i tm ents b ols tered b y prog res s i v e and f av ourab le

een ens h ri ned as a f und am ental ri g h t i n th e c ons ti tuti on, and
pac k ag e und er th e P ub li c Health Ac t 2018, th us pav i ng a w ay
P s erv i c es . T h e 15th N ati onal P lan (2018/2019- 2022/2023 ) of th e
orw ard th e ag end a of SRH/F P . I n ad d i ti on to th e P ub li c Health
2018, as w ell as th e Saf e M oth erh ood Road m ap (2020- 203 0b ei ng
nd ac c es s i b i li ty of ri g h ts - b as ed F P s erv i c es . I n term s of c ov erag e,
l w i th i n rang e of ac h i ev i ng i ts targ etof 4 9% m od ern c ontrac epti v e
ant ac h i ev em ent th at i m pli es d eli v eri ng s erv i c es to ov er 3 m i lli on
el of us e, 1. 2 m i lli on uni ntend ed preg nanc i es w ere av erted and
aternal d eath s w ere av erted
F i g ure: 1 T rac (Fk 20,
i g 2).2019
F i g ure : 2 T ra
T h e G ov ernm ent of N epal h as c ons i s tently
i nc reas ed th e b ud g et f or F am i ly P lanni ng ov er th e peri od of las t
g ov ernm ent b ud g et f or f am i ly planni ng h as i nc reas ed b y tw o- th i
y ear 2072/73 (2015/16) v s . N P R 4 96,687,000 i n 2076/77) (201
eng ag i ng and lev erag i ng s upport f rom ex ternal d ev elopm ent part
and prov i s i on of F P c om m od i ti es .
T o i nc reas e th e rang e of c ontrac epti v es , M i ni s try of Health and P
h ealth i ns ti tuti ons and s erv i c e prov i d ers th roug h trai ni ng as w ell
L AP M (L ong Ac ti ng and P erm anent M eth od ). I n th e new f ed erali z e
Health L og i s ti c s M anag em ent C enters to ens ure f orec as ti ng ,
Fc iomg ure m :od2 T i tiraces k . 20,
M 2019
oreov er, v ari ous i nterv enti ons are b ei ng und ert
c h oi c e and av ai lab i li ty nam ely th e prov i s i on of c li ent- c entered , v
c ons i s tently DoHS, Annual Report 2075/76 (2018/19)
d ed i c ated m ob i le/outreac h F P s erv i c e prov i d ers to th e m os t ex c lu
ni ng ov er th e peri od of las t f i v e y ears . O v er las t f i v e y ears , th e
d em and g enerati on ac ti v i ti es to i nc reas e th e uptak e of F P m eth
ng h as i nc reas ed b y tw o- th i rd (N P R 296,107,000 i n N epali f i s c al
unm et need s uc h as reli g i ous and eth ni c m i nori ti es , poor w om en
6,687,000 i n 2076/77) (2019/20). G oN h as b een s uc c es s f ul i n
f oc us on pos t- partum and pos t- ab orti on F P i n s elec ted h ealth
ami a
m t a a it t i a t g t ami a i g t i
at a at a t g m t g t ami a i g a i a
t t i i ai a a i
a i gagi g a agi g t m t a m t
at i t a a i i a ii mm i
i a t a g ta i it at a a a i i
a a ita g a t i t a i i t g t ai i g a a a ita
t ai i g it g ga ma t t t ai t t t
a i ia at gi a ag m t t t a g a a
a mm i ai i t a i g ta a a t
a m t i a a ai a i it am t ii i t t ta a it
i t g i at m i t a i i t t m t a
a g tai ma g a a i t i a t ta m t
am g ia g it ig m t a igi a t i mi i m
a m m m t a t at ma ta i t at
a ii a i i it a a ta a a a a a a i t iti t it
ta t a a a i i a t t ma i g a t it
a m i i ai t i t i it a a a i t a i g
at i it t i i i ga i a ai g a i i g it
i a ii t a a i g a i g i

ami a
4.6 Adolescent Sexual and Reproductive Health

4.6.1. Background
a a t a a at i t i it g am
ami a i ii a tm t at i a i t t i t
ia i a a t t a a t at a m t
t at g i t i t i t a t ma ag t a ai t t at g a
im m ta g i i t a a at a i
a i t i i at a ii i t i t Ba i a t ai m a Baita i
a i t i g i t ai t a gt a it a t i
i a t a i i ia a i ti a i
i t im m t i B a at t m t gt i g a a it
i i g a a it i i i ma a a a ai i g
i t am g a t a ta a t m gi g i
a t i t a gi g t t t t at g i i i t mai aim ii
t at g a t a t m a t a ti a t ag t
t t t a i a a i ig t t i i ma iag t g
ga ag at ma iag i t t gi ag a a a a m t
g a t it t i t i t ma i a t am m t
ta t it at i a i a i gt m i t i
m a
4.6.2. Vision, Mission, Goal, objectives, target, strategic principle and direction
Vision: a a a t t at a m t ta i
Mission: ma t a ai a m t a ta i i g t g t t
a a i g t at g it t i i gt at a m t
a t
Goal: m t t a a at a t
General Objective: B t a a a t i a i i t t a t mt
a at a i
Specific Objectives
at a a t i m t a a t
i a a t a t i a a ag a iat i ma a t
t i at a m t
a i i a im t at tat a t
i a a i i it a ia a t i a it at a i g
i
Targets:
ma a at a ii a a t i a t ii a a at i
a
i a a t i a t a at t t at g
m m ta a aim t scale up A dolescent F riendly Service ( A F S) to all
ami a
health facilities; behavioral skill focused ASRH training to 5,000 Health Service Providers and
more than 100 health facilities to be certified with quality AFS by 2021
g amm aim t t a t it at im i ga t ami

a i g i a i ma
Strategic Principles and Direction
a a i a a a i t
a it a it
ig t it i i it
t at gi at i
ta i a a g m t
4.6.2. Achievements in FY 2075-76 (FY 2018/2019)
1. Scale-up of Adolescent Friendly Service: a a g am a a i

t iti t ta g ita a a a t im m t i t i t iti t at
a ii t t a a
2. Strengthening Health facilities for AFS:
2.1 ASRH Clinical Training site development:
ta i i i a t ai i g it a ta i
2.2 Competency based ASRH training to the Health service providers:
ta at i i t ai a i a a i m t a
a t ai i g m t B t
3: Demand generation interventions on ASRH Program:
i t a a ai i g a i a a i t i t i a i
a a at a ma a mm i a t a i t
a a i i t Ba B at a it t at
g am im m t t ai a a am g a t a i
a t t ta t m i g a t i mi ga a a a
i a ai a at a i gt i
3.1 Establishment of AFICs in schools:
t ta ta i i t ta i i t i at a ii
a i i i it at B mat ia a t
t t at a m t i a t mi t g
i gt a ma iag a g ig i g g a it i ta t t
t a a t a t ma ag m t a at i i m t i t
mat ia t t a a a t gi a a a a t i
a t a a t ta t a a t t t a at i
i i a t at a i g i m ti t mm it
a m t t ia
ami a
3.2 Menstrual Hygiene Management (MHM):
3.2
3.2Mens
Menstrual
trualHy Hygiene Managem
giene Managementent
( MHM) : :
( MHM)
M M ens t a Hy gi ma agem mentti is i im m t i ni 77 d i s i trit c i t tw i thit d i s itrit b i uti on of s ania tary ita pad a f rom mloc al lev el
enstrual trual Hyg i g ene i enem m anag anag em ent i m s i plem m plemented ented i n 77 d i s tri c t w i th d i s tri b uti on of s ani tary pad f rom loc al lev el
f or ali m i ted s c h imit
ool. T h e M HM trai ni ng t
pac aik i
ag g
e w a
as ag
d ev a
eloped j oi ntly b y M i t
i ni s try i
of iHealth
t and a Mt i ni s try of
a f or li m i it i ted s c h ool. T a h e M a HM trai ni
ig ng pac
t k ag e w
i a a it as d ev eloped
t a j oi ntly b y
t M i ni s try i of Health a and M i ni s try of
E Ed d ucucatiationonandand d esd esi g ned i g ned totob uib ldui ld c apac
c apac i ty i tyof ofteacteac h ersh ersof of th eth AFe I C AF i I nC s i c nh ools s c h and and
ools h ealthh ealth
w ork w ersork ofers th ofe th e
at t t i i it t a a t ai
Ad oles ac ent gF ri end
Ad oles c ent F riaendly ly s ervs ervi c ei c es gi tes sm . T th eas cma
i tes . T h e h s ool c h agool teac h erst w h io are
mteac h ers w h o i aretrai ned on M HM are reg
trai ned on M HM are it ularly a c ond c ucondti nguc ti ng
reg ularly
am m ens trual im aanagg em itentt s est s ai
ens trual
i on i n s c h ools . T h e s c h oolsi w i th t AF I C are als
m anag em ent s es s i on i n sac th ools . iT h e s c h ools w i th AF I C are t oalsc oord i o c oord i nati ng w i th tht e traitned h ealth
i nati ng w i th th e trai ned h ealth
s erv i c e prov i d ers to c ond uc t s es s i on on M HM f or s tud ents .
s erv i c e prov i d ers to c ond uc t s es s i on on M HM f or s tud ents .
4.6.3 ASRH service Utilization
4.6.3 ASRH s erv ice Utiliz ation
4.6.3 ASRH s erv ice Utiliz ation
Family
Fam ily planning
planningservices s erv ices
Fam ily planning s erv ices
T h e f gi g ure b elow s h ow ts th t e trend ami of f am i aly planni i g ng i s erv i c iea uti li z am ati ongamt ong a th e ad toles c ents . T h e
T m
h e f i g ure b elow s h ow s th e trend of f am i ly planni ng s erv i c e uti li z ati i i nc aeong1 tand
on am th e ad oles c ents . T h e
num b er of aad oles c ents t utiili iz i ngg ami f am i ly aplanni i gng s ervi i c ie i s igh i g h tesi t ti n th e prov th e tlow es t i n
i num b er aof adimoles c ents i li z i ng b m a ng s actervc aepi
i c eng i s i f amgh i g i ami t i n athng eih prov
g a e 1 aand i th e low es t i n
s ud urs pac h i m prov i nc e. T h uti e num erf am of i lyad planni
oles c ents hly es planni as d eci nc reas e i n prov i nc e 1,
i a a i a a im i i m a t
K s arnali
ud urs and
pac h s udi m upas
provc h i nci m e.prov
T h ienc num b er of adc omolespared
e i n 2075/76 c ents toac2074 c epi/75.ng f am i ly planni ng h as d ec reas e i n prov i nc e 1,
K arnali and s ud upas c h i m prov i nc e i n 2075/76 c om pared to 2074 /75.
Safe motherhood
Safe m otherhood s services erv ices
T Safeh e tab m leotherhood

b elow reports s erv thicese num b er of ad oles c ents s eek i ng s af e m oth erh ood s erv i c es . P rov i nc e 2 h ad h i g h es t
num ta ents tw h t tho rec eimv edb ers afofeaadm oth t s erv ii c ges wa h ereas
m t h i m ii c h esas. P th rove low
i es t num
aT h eb ig
er ofle adb elow
tab t
oles c reports
m a e num t oles
i
erhc ents
ood
a eek ti ng s af e m oth Sud
sm erh urpas
i ood s c erva a i nc eim
2 h ad h b i er
g h es t
of ad oles c ents .
anumt b er of adt olesmc ents w ah o rec ei v edt s af e m oth erh ood s erv i c es w h ereas Sud urpas c h i m h as th e low es t num b er
of ad oles c ents . 1s t ANC ( any tim e ) 1s t ANC ( as per 4 ANC as per
protocol) protocol
N ati onal 1s t ANC 1184 ( 08
any tim e ) 1s 77881
t ANC ( as per 4 ANC as per
52226
P rov i nc e 1 18261 protocol)
12208 8557 protocol
P Nrovatii nconal e2 11841 08
3 254 183 9777881 9714 52226
B P agrovm ati i nc e 1 1829418261 11926 12208 8703 8557
G P androv aki nci e 2 106573 254 1 74 19183 97 574 99714
BP rovag i mnc ati
e5 16883 18294 124 3 11926
7 89618703
K Garnali
and ak i 13 4 10657
09 895174 19 5826574 9
SudP rovurpasi nc ec h 5i m 83 16883
63 654 124
3 3 7 4 7168961
K arnali 13 4 09 8951 5826
Sud urpas c h i m 83 63 654 3 4 716

Safe Abortion
ami a Serv ices
Safe Abortion Serv ices
Safe
T h eAbortion
proporti on Services
of ad oles c ents w h o rec ei v ed s af e ab orti on s erv i c es i s h i g h es t i n prov i nc e 5 and th e
T hlowe proporti
es t i n Sud urpasad c oles
on of h i m c ents
prov w i nch oe. rec
C omei v pared
ed s af etoabth orti
e F on s erv i c es i s proporti
Y 2075/75, h i g h es toni n ofprovad i ncolese 5c ents
and s theek
e i ng
lowab esortit on
i n Sud a t i a a i i ig t i i a t
s ervurpasi c es c h h i asm prov i nc e.ed C om
i nc reas or pared
rem ai nedto th at
e F s Y am 2075/75,
e lev el proporti
i n all prov on ofi nc ade oles c ents B ags eek
ex c ept i ng and
m ati
t
abSudortiurpasi a im i m a t t
on s cervh i m i c esprovh asi nc i e.nc reas ed or rem ai ned at s am e lev el i n all prov i nc e ex c ept B ag m ati and a t i g
a i a i a mai at am i a i t Bagma a
Sud urpas c h i m prov i nc e.
a im i
4.6.4L isList
4.6.4 L ist of
t of
ofCertified AFS
Certified
Certified AFS s iteswith
s AFS
ites with
sites pre-certification
with
pre- certification
andand
pre- certificationcertification s core
and certification
certification s core obtained
score
obtained dis aggregated
obtained
dis aggregated
by Prov
disaggregated
by incial lev
Prov incial lev el el
S.S.NN DisDistrict
trict AFS
AFS s ites
s ites Pre-Pre- s core
s core Certification
Certification DateDate
of of
s core
s core certification
certification
ProvProv ince
ince 1 1
1 1 Suns
Sunsariari Hari Harinagnagaraara
P HCP HCC C 90. 90.
09% 09% 90. 90%
90. 90% M ay M 2018
ay 2018
2 2 Suns
Sunsariari C h C atra
h atraP HCP HCC C 90. 90.
09% 09% 91. 5391.% 53 % M ay M 2018
ay 2018
3 3 Suns
Sunsariari Si tapur
Si tapur HP HP 92. 92.
00% 00% 91. 00%
91. 00% Apri Apri l 2016
l 2016
4 4 Sunsariari
Suns I th I ari
th ariP HCP HCC C C C 91. 91.
3 0% 3 0% 93 . 00%
93 . 00% Apri Apri l 2016
l 2016
5 5 U Ud ayd aypur
pur HadHadi y ai y HPa HP 81. 81.
3 7% 3 7% 91. 9391.% 93 % J uneJ une
20182018
6 6 U Ud ayd aypur
pur T apesh w h ari
T apes w ari
HP HP 89. 89.
63 % 63 % 88. 2388.% 23 % J uneJ une
20182018
7 7 U Ud ayd aypur
pur J ogJ ogi d ahi d ahHP HP 98. 98.
70% 70% 98. 80%
98. 80% N ov N em ov b emer 2017
b er 2017
8 8 U Ud ayd aypur
pur Sund
Sundurpur HP HP
urpur 94 . 9470%. 70% 94 . 70%
94 . 70% N ov N em ov b emer 2017
b er 2017
9 9 U Ud ayd aypur
pur Hard
HardenieniHP HP 94 . 9470%. 70% 94 . 70%
94 . 70% N ov N em ov b emer 2017
b er 2017
ProvProv
inceince 2 2
1010 M M ah ahottari
ottari B ard
B ardi b asi b asHosHos
pi tal
pi tal 90. 90.
70% 70% 93 . 3 930% . 3 0% N ov N em ov b emer 2016
b er 2016
ottari G aus h ala P
G aus h ala P HC CHC C 89. 89.
4 0% 4 0% 94 . 00%
94 . 00% N ov N em ov b er 2016
em b er 2016
ottari B h B aratpur
h aratpurHP HP 93 . 9360%. 60% 81. 00%
81. 00% N ov N em ov b emer 2017
b er 2017
13 13 Rautah
Rautahatat B asB asantpatti HP HP
antpatti 83 . 834 3 . % 4 3 % 83 . 3 838% . 3 8% J uneJ une 20182018
14 Rautah at B arah am puri HP 89. 83 % 96. 19% J une 2018

15 Rautah at K anak pur HP 93 . 00% 93 . 00% N ov em b er 2016
16 Rautah at P atura P HC C 85. 60% 91. 50% N ov em b er 2016
17 Rautah at Sarm uj w a HP 90. 00% 96. 80% N ov em b er 2016
18 Sarlah i Si s auti y a HP 90. 00% 96. 19% J une 2018
19 Sarlah i B h ak ti pur HP 96. 20% 98. 4 0% N ov em b er 2016
20 Sarlah i Ac h alg ad P HC C 94 . 4 0% 96. 90% N ov em b er 2016
21 Sarlah i P i pari y a HP 95. 50% 98. 4 0% N ov em b er 2016
22 Saptari Hanum anag ar HP 90. 90% 96. 80% N ov em b er 2017
14 Rautah at B arah am puri HP 89. 83 % 96. 19% J une 2018
15 Rautah at K anak pur HP 93 . 00% 93 . 00% N ov em b er 2016
ami a
16 Rautah at P atura P HC C 85. 60% 91. 50% N ov em b er 2016
17 Rautah at Sarm uj w a HP 90. 00% 96. 80% N ov em b er 2016
18 Sarlah i Si s auti y a HP 90. 00% 96. 19% J une 2018
19 Sarlah i B h ak ti pur HP 96. 20% 98. 4 0% N ov em b er 2016
20 Sarlah i Ac h alg ad P HC C 94 . 4 0% 96. 90% N ov em b er 2016
21 Sarlah i P i pari y a HP 95. 50% 98. 4 0% N ov em b er 2016
22 Saptari Hanum anag ar HP 90. 90% 96. 80% N ov em b er 2017
23 Saptari B ord h eb ars ai n HP 91. 50% 93 . 10% N ov em b er 2017
24 Saptari P atth ag ad a HP 91. 50% 93 . 4 0% N ov em b er 2017
Bagm ati
SP N C li ni c ,
25 K ath m and u P utali s ad ak 100. 00% 92. 60% Aug us t 2017
26 Si nd h uli Si rth uali P HC C 92. 3 0% 98. 4 1% M arc h 2018
27 Si nd h uli C h apauli HP 93 . 12% 94 . 07% M arc h 2018
28 Si nd h uli B elg h ari P HC C 87. 20% 87. 00% Dec em b er 2015
29 Si nd h uli B es es h w or HP 92. 3 0% 96. 00% Dec em b er 2015
3 0 Si nd h uli Sh i lapati HP 90. 70% 97. 00% Dec em b er 2015
Gandaki
3 1 K as k i SP N C li ni c , P ok h ara 95. 00% 87. 80% Aug us t 2017
Prov ince 5
3 2 Arg h ak anc h i T h ad a P HC C 89. 13 % 92. 20% J anuary 2017
3 3 Arg h ak anc h i Hans pur HP 96. 00% 92. 20% J anuary 2017
3 4 Dang G ad uw a HP 92. 26% 91. 4 1% J uly 2018
3 5 Dang Sas h ani y a HP 95. 00% 94 . 70% J uly 2017
3 6 Dang Satb ari y a HP 95. 00% 91. 00% J uly 2017
3 7 K api lv as tu J ay nag ar HP 91. 73 % 91. 53 % M ay 2018
3 8 K api lv as tu B ark alpur HP 98. 4 1% 98. 4 1% M ay 2018
3 9 K api lv as tu G auri HP 83 . 00% 92. 00% Aug us t 2016
4 0 K api lv as tu T i laurak ot HP 90. 00% 98. 00% Aug us t 2016
4 1 K api lv as tu Sh i v pur HP 98. 00% 98. 00% Aug us t 2016
K arnali
4 2 P y uth an K h ai ra HP 88. % 95. 63 % J uly 2018
4 3 P y uth an Sotre 83 . 01% 89. 4 3 % J uly 2018
4 4 P y uth an P uranth anti HP 92. 00% 95. 00% Dec em b er 2015
4 5 P y uth an O k h ark ot HP 92. 00% 95. 00% Dec em b er 2015
4 6 P y uth an B h i ng ri P HC C 92. 80% 95. 60% J uly 2017
4 7 P y uth an G oth i w ang HP 93 . 4 0% 89. 70% 75 J uly 2017
4 8 Rolpa K otg aun HP 94 . 60% 93 . 01% J uly 2018
4 9 Rolpa K h um el HP 92. 60% 96. 20% N ov em b er 2017
50 Rolpa L i b ang HP 94 . 70% 94 . 70% Dec em b er 2017
51 Ruk um Sy lak aph a HP 94 . 70% 96. 80% Septem b er 2016
52 Ruk um B af i k ot HP 96. 00% 96. 20% Septem b er 2016
DoHS,53 Annual Report
Ruk um 2075/76
Sm (2018/19)
i ruti HP 96. 00% 96. 20% Septem b er 2016
Sudurpas chim
54 Ac h h am Duni HP 91. 80% 96. 00% Dec em b er 2015
55 Ac h h am K ali k a HP 85. 10% 83 . 00% Dec em b er 2015
56 B ai tad i K uw ak ot 96. 80% 96. 82% Apri l 2018
4 8 Rolpa K otg aun HP 94 . 60% 93 . 01% J uly 2018
4 9 Rolpa K h um el HP 92. 60% 96. 20% N ov em b er 2017
4 50
8 Rolpa
Rolpa
L i b ang
K otg HP
aun HP 94 . 9460%. 70% 94 . 70%
93 . 01% Dec 2018
J uly em b er 2017
ami a
4 51
9 Ruk um
Rolpa K h Syumlak elaph
HP a HP 92. 9460%. 70% 96. 80%
96. 20% N ov emSeptem b er 2016
b er 2017
52
50 Ruk um
Rolpa L i B b afangi k ot
HP HP 94 . 96.
70% 00% 96. 20%
94 . 70% Dec emSeptem b er 2016
b er 2017
53
51 Ruk umum
Ruk Sy Smlak i aph
ruti aHPHP 94 . 96.
70% 00% 96. 20%
96. 80% SeptemSeptem b er 2016
b er 2016
52 Ruk um B af i k ot HP Sudurpas
96. 00%chim 96. 20% Septem b er 2016
5354 Ruk
Ac h umh am Sm Duni
i ruti HPHP 96. 91.
00% 80% 96. 20%
96. 00% SeptemDecb emer 2016
b er 2015
55 Sudurpas chim
Ac h h am K ali k a HP 85. 10% 83 . 00% Dec em b er 2015
5456 AcB aih h tadam i Duni
K uw HPak ot 91. 96.
80% 80% 96. 00%
96. 82% Dec em b Apri
er 2015
l 2018
55
57 AcB aih h tadam i K ali
Sh k arm
a HP ali 85. 98.
10% 4 0% 83 . 00%
98. 4 1% Dec em b Apri
er 2015
l 2018
56
58 B B aiaitadtad i i K uwSh ank
ak otarpur HP 96. 8480%. 70% 96. 82% Apri l J 2018
94 . 97% uly 2018
57 B ai tad i Sh arm ali 98. 4 0% 98. 4 1% Apri l 2018
59 B ai tad i K es h arpur P HC C 86. 70% 90. 08% J uly 2018
58 B ai tad i Sh ank arpur HP 84 . 70% 94 . 97% J uly 2018
60 B ai tad i B h unali HP 88. 00% 97. 00% Dec em b er 2016
59 B ai tad i K es h arpur P HC C 86. 70% 90. 08% J uly 2018
61 B ai tad i Si d d h es w or HP 86. 80% 90. 60% Dec em b er 2016
60 B ai tad i B h unali HP 88. 00% 97. 00% Dec em b er 2016
62 B aj h ang Sunk ud a HP 84 . 77% 95. 63 % J uly 2018
61 B ai tad i Si d d h es w or HP 86. 80% 90. 60% Dec em b er 2016
63 B aj h ang B h ai rav s th an HP 81. 3 0% 85. 00% Dec em b er 2015
62 B aj h ang Sunk ud a HP 84 . 77% 95. 63 % J uly 2018
64 B aj h ang Deulek h P HC C 94 . 00% 97. 20% Dec em b er 2015
63 B aj h ang B h ai rav s th an HP 81. 3 0% 85. 00% Dec em b er 2015
65 B aj h ang K h ari tad i 91. 50% 98. 00% Dec em b er 2016
64 B aj h ang Deulek h P HC C 94 . 00% 97. 20% Dec em b er 2015
66
65 B B ajajh h ang ang K h C ari h h tad
anai HP 91. 8350%. 70% 90. 00%
98. 00% Dec emDecb er
em 2016
b er 2016
67
66 B B ajajh ura
ang C h T h ate
anaHPHP 83 . 92.
70% 06% 92. 06%
90. 00% Dec em b Apri l 2018
er 2016
68
67 B B ajajura
ura K ai les
T ate HP h m and u HP 92. 86.
06% 00% 98. 3 0%
92. 06% Apri l M 2018
ay 2017
69
68 B B ajajura
ura K aiJ aglesudh m a and
HP u HP 86. 90.
00% 00% 98. 3 95.
0% 00% M ay M 2017
ay 2017
70
69 B Dad eld h ura
aj ura J agSamud aai HPj i HP 90. 80.
00% 00% 92. 19%
95. 00% J uly 2018
M ay 2017
71
70 Dad eldeld h h ura
Dad ura SamN awai j d i urg
HP a 80. 80.
00% 00% 93 . 10%
92. 19% M ay 2017
J uly 2018
72
71 Dad eldeld h h ura
Dad ura N B aw ag d ark
urg ot
a HP 80. 87.
00% 00% 93 . 10%
93 . 10% M ay M 2017
ay 2017
72
73 Dad
Dad eldeld h h ura
ura B agAaliarktal
otHPHP 87. 91.
00% 00% 93 . 10%
87. 80% M ay J une
20172017
73 Dad eld h ura Aali tal HP 91. 00% 87. 80% J une 2017
4.6.5. Issues and recommendations — Adolescent Sexual and Reproductive Health
4.6.5. Is s ues and recom m endations — Adoles cent Sex ual and Reproductiv e Health
4.6.5. aIs s ues and m recomai m endations
at t— Adoles
gi a cent
a Sexa ualaand Reproductiv
i m ge Health
a i g i tm i
It s s iuesg andt prob lem s arai s ed at rec ent
a reg i onal
mma iand nati
i aonal rev i ew m eeti ng s and d uri ng j oi nt m oni tori ng of th e
I c s erti
s uesf i c and probproclem es s s rai
ati on ares eds umat m recarient
z edregi ni onal and3 . 6.nati
T ab le 6. onal rev i ew m eeti ng s and d uri ng j oi nt m oni tori ng of th e
c erti f i c ati on proc es s are s um m ari z ed i n T ab le 3 . 6. 6.
Table
T ab le3.6.6:
3 . 6. 6: Issues andRec
I s s ues and Recommendations
om m end ati ons f romfrom
Reg Regional
i onal and and National
N ati onal Rev i ewReview
M eeti ngMeetings
s and J oi and
nt M Joint
oni tori ng
Monitoring
T ab le 3 . 6. 6: I s s ues and Rec om m end ati ons f rom Reg i onal and N ati onal Rev i ew M eeti ng s and J oi nt M oni tori ng
Is s ues Recom m endations Res pons ibility
Is s ues
Hi g h prev alenc e of early I ntens i f y c om m Recomuni ty m aw endations Res N HEpons
arenes s ac ti v i ti es and I C C ibility
, F W D, M oHP ,
Hi g h prev alenc
m arri ag e and teenage of earlye I ntens
ef f ec i f tiy v c ely
om mi m uni
plem ent th e laws ac ti v i ti es and
ty aw arenes N HE I liC neC , F m W i niD,s Mtri oHP
es ,
m preg
arrinanc
ag e and
y teenag e ef f ec ti v ely i m plem ent th e law li ne m prov
i ni s i trinc ese, loc al lev el
preg nanc y prov i nc e, loc al lev el
and partners
and partners
L ow C P R and h i g h unm et need Run i nnov ati v e ac ti v i ti es to i nc reas e ac c es s to f am i ly F W D, DoHS, M oHP ,
L ow C P R and h i g h unm et need Run i nnov ati v e ac ti v i ti es to i nc reas e ac c es s to f am i ly F W D, DoHS, M oHP ,
f or c ontrac epti on am ong planni ng s erv i c es and i nf orm ati on i n h ard to reac h prov i nc e, loc al lev el
f or c ontrac epti Is s on
ues am ong planni ng s erv i c es Recom and i nfm ormendations
ati on i n h ard to reac h prov Resi nc pons
e, loc ibility
al lev el
v ulnerab le populati ons areas and am ong v ulnerab le populati ons i nc lud i ng
i nc lud i ng ad oles c ents ad oles c ents
Q uali ty as s uranc e of ASRH C erti f y h ealth f ac i li ti es us i ng “ th e q uali ty F W D prov i nc e, loc al
P rog ram m e i m prov em ent and c erti f i c ati on tool f or AF S 2015” to lev el and ASRH
prom ote th e d eli v ery of ad oles c ent f ri end ly q uali ty partners
s erv i c es .
I nad eq uate trai ned h um an Streng th en ASRH c li ni c al trai ni ng s i tes and d ev elop N HT C prov i nc e, loc al
res ourc es on ASRH i n h ealth th e c apac i ty of s erv i c e prov i d ers w i th “ b eh av i oural lev el and ASRH
f ac i li ti es and s k i ll f oc us ed c om petenc y b as ed DoHS, 5 d ay s Annual
ASRH Report 2075/76 (2018/19)
P artners
trai ni ng ” at all h ealth f ac i li ti es and s pec i ally AF S
s i tes
I nad eq uate m oni tori ng I nc reas e th e num b er of j oi nt m oni tori ng v i s i ts to AF S W D, M D, HO s
s i tes at d i f f erent lev els prov i nc e, loc al lev el
and ASRH partners
I nad eq uate res ourc es Alloc ate s uf f i c i ent res ourc es at c entral, d i s tri c t and F W D, DHO s prov i nc e,
Is s ues Recom m endations Res pons ibility
v ulnerab le populati ons areas and am ong v ulnerab le populati ons i nc lud i ng
i nc lud i ng ad oles c ents ad oles c ents
Q uali ty as s uranc e of ASRH C erti f y h ealth f ac i li ti es us i ng “ th e q uali ty F W D prov i nc e, loc al
P rog ram m e i m prov em ent and c erti f i c ati on tool f or AF S 2015” to lev el and ASRH
prom ote th e d eli v ery of ad oles c ent f ri end ly q uali ty partners
s erv i c es . ami a
I nad eq uate trai ned h um an Streng th en ASRH c li ni c al trai ni ng s i tes and d ev elop N HT C prov i nc e, loc al
res ourc es on ASRH i n h ealth th e c apac i ty of s erv i c e prov i d ers w i th “ b eh av i oural lev el and ASRH
f ac i li ti es and s k i ll f oc us ed c om petenc y b as ed 5 d ay s ASRH P artners
trai ni ng ” at all h ealth f ac i li ti es and s pec i ally AF S
s i tes
I nad eq uate m oni tori ng I nc reas e th e num b er of j oi nt m oni tori ng v i s i ts to AF S
W D, M D, HO s
s i tes at d i f f erent lev els prov i nc e, loc al lev el
and ASRH partners
I nad eq uate res ourc es Alloc ate s uf f i c i ent res ourc es at c entral, d i s tri c t and F W D, DHO s prov i nc e,
alloc ated to th e prog ram m e loc al lev els loc al lev el
I nad eq uate li nk s w i th oth er Ad v oc ate f or th e f unc ti onal i nteg rati on of ASRH F W D prov i nc e, loc al
prog ram m es (f am i ly planni ng , i s s ues and s erv i c es i n oth er th em ati c lev el and ASRH
s af e m oth erh ood , HI V ) areas /prog ram m es partners
I nad eq uate I E C /B C C m ateri als E ns ure th e s upply of ASRH related I E C /B C C m ateri als F W D, N HE I C C , HO s
to h ealth f ac i li ti es prov i nc e, loc al lev el
and ASRH partners
L ac k of d i s ag g reg ated ASRH Rev i s e th e m onth ly /annual reporti ng f orm at (Annex F W D,M D, N HT C ,
d ata (b y ag e/s ex ) and 5: ASRH P rog ram m e I m plem entati on G ui d eli nes , prov i nc e, loc al lev el
i nteg rati on i n HM I S 2011) and ad v oc ate to i nc orporate i n HM I S and ASRH partners

ami a
Reproductivehealth
Reproductive healthmorbidity
morbidityprevention
prevention and
and management
management program
program
Managem ent of pelv ic organ prolaps e and Obs tetric Fis tula
Management of pelvic organ prolapse and Obstetric Fistula
P elv i c org an prolaps e (P O P ) i s c om m on reprod uc ti v e h ealth m orb i d i ty i n N epal w i th neg ati v e h ealth and
i ga a i mm a t m i it i a it
s oc i al c ons eq uenc es . M ulti pari ty , m aternal m alnutri ti on, too f req uent preg nanc i es and h eav y w ork af ter
ga at
a ia a it mat a ma t i t t g a i a a
d eli v ery are th e m ai n ri s k f ac tors f or P O P . E ac h y ear th e g ov ernm ent alloc ates f und s f or th e m anag em ent
a i a t mai i a t a a t g m t a at
of P tO P ma th at ag i nc lud
m es t f ree s c reeni
t atngi , prov i d i ng s i li c on rii ngg pes s ari
i ies g, K i egi el’ s iex gerc i s e atrai
i ni ng gand f ree
s urg i c i al s tervai i c ies g at
a d es i g nated gih osa pi tals i . at ig at ita
Cerv ical cancer s creening and prev ention
Cervical cancer screening and prevention
C erv i c al c anc er i s th e m os t c om m on c anc er am ong w om en i n N epal, ac c ounti ng f or 21. 4 perc ent of all
c anc ieraam aong w iom t en. mT h etnatimm onal g ui ad eli nes am on c erv g i c almc anc i er s c reeni
a ang and prev g enti on (2010) c all t f or
a a am g m a a g i i i a a i ga
s c reeni ng at leas t 50 perc ent of w om en ag ed 3 0– 60 y ears and red uc i ng th e m ortali ty d ue to c erv i c al
a i g at a t t m ag a a i g t m ta it
c anc er
t b y 10i apercaent w i th rec om m endt edit s c reenimm ng am ong th i s g roup i g am ev eryg fti v ie y gears . C erv i c al c anc er
s c reeni
a ng i s i d aonea b y v i s ual i ns i pec
g i ti on of th e c ierv ai x i b y trai ned h ealtht w orki ers ust ai i ng ac eti c aact i d . I f any s i g ns
of ia gpre- a c anc erous a i les i aon areigs een, w aom en are a ref erred f ori c ry oth a erapy to c ure m th eales i on. T h i s approac h
i s c ost t- efaf ec tit v e as tht e earlyi d eteci tiaon of a les ii ons and t early m a anag t em a ent b ty c ry oth erapy i w i lla us ually
prev ent prog res s i on to c erv i c al c anc er, and th e c os t of s c ali ng up th i s tac ti v i ty i i as relati
a ma ag m t t a i a t g i a v ely alow t. B ud g ett w as
alloc ated i n all 753 P ali k a to c ond uc t th e c erv i c al c anc er s c reeni ng and prev entii on
a i g t i a it i a B g t a a at i a a a tprog ram . tHow t ev er,
i a a i ga g am t imit t ai at it
d ue to li m i ted trai ned h ealth w ork er, i t i s d i f f i c ult to ens ure th at s erv i c e i s i n f ull- f led g ed . I n th i s reporti ng
i i tt t at i i i g t i g a t ta at
y ear F Y 2075/76, t ai total 51 i h aealthi w ork ers it w ere
a traia ned i a on v i s ual t i ans pec ti on w i th ac eti c ac i d and
c ry oth erapy .
Utilization of health services for selected reproductive health morbidity in Nepal
Utiliz ation of health s erv ices for s elected reproductiv e health m orbidity in Nepal
T h e g graph
a b elow s h ow s th ettrendt of c li ents is eekt i ng O P iD gs erv i c es f or s i elec ted reprod t uc ti v e m orb i d i ti es i n
Nmepal.i T i h e g iraph s h aow s th ge ai nc reas i ng trend
t i f or all
a is erv
g ti c es i n las at th reei y earsi . a t t a
Sourc e: HM I S/M D, DoHS

4.7 Prim ary Health Care Outreach
ami a
4.7
4.7.1Primary Health Care Outreach
Background
4.7.1 Health Background

f ac i li ti es w ere ex tend ed to th e v i llag e lev el und er th e N ati onal Health P oli c y (1991). How ev er,
th e us e of s erv i c es prov i d ed b y th es e f ac i li ti es , es pec i ally prev enti v e and prom oti v e s erv i c es , w as
li m ai tedt d auei ito ac c es s i b i li ty t f ac tors t. P ritm ary i h agealth c are outreac th c li niac s (P aHC - O RCa t) w erei th eref ore
i ni ti ated i nt1994 (2051 B S) to i b ri ng h ealth
i s erv ti c es c losaeri ito th e c om m iauni ti es . a m
i a imit t a i i it a t ima at a t a i i
T h e ai tm of th es ei c i li at ni c s i si to i m prov e ac Bc es ts to b i asgi c h aealth
t s ervi i c es i nc lud ti ng t f am i lymmplannii ng , c h i ld
h ealth and s af e m oth erh ood . T h es e c li ni c s are s erv i c e ex tens i on s i tes of P HC s and h ealth pos ts . T h e
pri m aim ary res tpons i b i lii ty i f ori tc ondimuc ti ng aoutreac th c lianiic s i s aoft AN M i and i param i edg i ami c s . F C HVa s and
i g loc ial
N G O s and c om m uni ty b as ed org ani s ati ons (C B O s ) s upport h ealth w ork ers to c ond uc tt c li ni tc s
a t a a m t i i a i t i it a a
ima i i it g t a i i i a a am i a
i nc lud i ng rec ord i ng and reporti ng .
a a mm it a ga i a B t at t t i i
iB as ed iong loc al need i g as , th es e c li ni gc s are c ond uc ted ev ery m onth at f i x ed loc ati ons , d ates and ti m es .
T h ey are c ond uc ted w i th i n h alf an h our' s w alk i ng d i s tanc e f or th ei r c atc h m ent populati ons .
Ba a t i i a t m t at a at a m
AN M s /AHW s prov i d e th e b as i c pri m ary h ealth c are s erv i c es li s ted i n B ox 4 . 7. 1.
a t it i a a a i g i ta t i at m t a
i t ai ima at a i it i B
Box 4.7.1: Serv ices to be Prov ided by PHC- ORCs According to PHC- ORC Strategy
Safe m otherhood and newborn care: Child health:

• Antenatal, pos tnatal, and new b orn c are • G row th m oni tori ng of und er 3 y ears c h i ld ren
• I ron s upplem ent d i s tri b uti on • T reatm ent of pneum oni a and d i arrh oea.
• Ref erral i f d ang er s i g ns i d enti f i ed .
Health education and couns elling:
Fam ily planning: • F am i ly planni ng
• DM P A (Depo- P rov era) pi lls and c ond om s • M aternal and new b orn c are
• M oni tori ng of c onti nuous us e • C h i ld h ealth
• E d uc ati on and c ouns elli ng on f am i ly planni ng • ST I , HI V /AI DS
m eth od s and em erg enc y c ontrac epti on • Ad oles c ent s ex ual and reprod uc ti v e h ealth .
• C ouns elli ng and ref erral f or I U C Ds , i m plants
Firs t aid:
and V SC s erv i c es
• T rac i ng d ef aulters . • M i nor treatm ent and ref erral of c om pli c ated
c as es .
4.7.2 Service coverage

4.7.2 Serv ice cov erage
I n 2075/76, 2. 8mim i illi on people w ere s erv at ed at 13 8,125t outreac
a i h i c li niac s (T ab le 4 . 7.t 1).
ta A total of
i i i t t ta g t m i i i a
13 8,125 c li ni c s w ere run w h i c h repres ents 92% of th e targ eted num b er (13 8,125 c li ni c s x 12 =
a ta t ta m t i ig t m
1,657,500
i i in
a a y ear). tT h ei tab le b i elow s ah ow ts total
ig num t b er of P HC a O RC c ond i uc ted ib y prov i nc e. T h e
h i g h es t num b er of c li ni c s w as c ond uc ted i n prov i nc e 2 and th e h i g h es t peoples w as s erv ed i n
prov i nc e 5.

ami a
Table 4.7.1: PHC- ORCs Conducted and People Serv ed in 2075/ 76 by Prov ince
Table 4.7.1: PHC- ORCs Conducted and People Serv ed in 2075/ 76 by Prov ince
P rov i nc e T otal no. c li ni c s Serv i c es prov i d ed to c li ents (new + old )
PTable rov i i ncnc4.7.1:
ee1 PHC- ORCs Conducted T 25,64
otal no. 2 c and li ni c People
s Serv ed in Serv 4 59,03 i c es 8prov
2075/ 76 byby i d Prov Prov ed to ince
ince c li ents (new + old )
P rov i nc e 12 25,64
25,872 2 4 4 59,03 99,3 848
P rov i nci ncee2 T otal no. c li ni c s Serv i c es prov i d eded to to c c lili ents ents (new (new + + old old ))
P B rov ag m ati 25,872
20,93 8 4 3 99,3 80,100 84
P rov i nc e 1 25,64 2 4 59,03 8
B G agandm akati i 20,93
15,965 8 3 3 80,100
01,013
P rov i nc e 2 25,872 4 99,3 84
G P rov and i nc ak i e 5 15,965
22,008 3 01,013
529,097
B ag m ati 20,93 8 3 80,100
P K rov
G arnali
i nc e 5
and ak i 22,008
15,965 11,03 8 3 01,013 529,097
253 ,3 98
K Sud arnali
P rovurpas i nc e h 5c h i m 11,03
22,008 16,662 8 529,097 2533 99,273,3 98
Sud National
K arnali urpas h c h i m 16,662
11,03 138, 125 8 2533 2,99,273 ,3 821,
98 303
Sourc National Sud e:urpas HM I h S/M c h i m D, DoHS 138,
16,662 125 3 99,273 303 2, 821,
Sourc National e: HM I S/M D, DoHS 138, 125 2, 821, 303
T Sourc
hSourc e tab le
e: HM I S/M D, DoHS
b elow s h ow s th at num b er of people prov i d ed w i th d ew orm i ng tab lets , i ron tab lets and
Tv hi tam e ta
tabi n le t thatat num m b er of people prov
A f or pos tpartum . T h e h i g h es t num b er of c li ents s erv ed b y P ormHC i O ng RC tabw asletsi n, iP ron
b elow s h ow s i i d ed itw i th d ew mi g ta t i ta tabt lets
rov i nc e 2. and
a
itami
v T i tam h e tab inA le f borelow t a t
s h ow s th . at
pos tpartum m T h num ig
e h i g b h er t
es oft numpeople m b er ofprovc li i ents i d ed w s ervt i th edd ewewb y orm ormP HCi i ngng O tab tab lets
RC a i
w as,, i i ron
lets nron P rov i
tab
tab i nc lets
letse 2.and and
vTable i tam 4.7.2:i n A f orPHC- ORC Clinics Dis tributed Medicines / Serv ed Peoples
pos tpartum . T h e h i g h es t num b er of c li ents s erv ed b y P P HC O byRC Prov
HC O RC w w as i ince
as i n n P rovini ncFYe2075/
P rov i nc e 2.
2. 76
Table 4.7.2: PHC- ORC Clinics Dis tributed Medicines / Serv ed Peoples by Prov ince in FY 2075/ 76
Table P rov i nc4.7.2: e PHC- ORC Clinics Dew Dis tributed orm i ng Medicines T ab lets / ServI ron ed T Peoplesab lets byby Prov
Peoples Prov V ince i t Ain
ince f orFY
in FYP 2075/ os2075/tpartum 7676
P P rov rov i i ncnc ee1 Dew11199 orm i ng T ab lets I ron 4 3 803T ab lets V 53i t A90f or P os tpartum
P P P rov rov i nc e Dew 11199 orm i ng T ab lets I ron 4 103 3 T803 ab lets V V i i tt 53AA f f 90 or
or P P osos tpartum tpartum
rov i i ncnc ee 12 3 3 203 512 204 09
PP rov rov i nc
i nc ee 21 111993 3 203 4 3 803
103 512 53 53 90
90 204
B ag m ati 3 5623 3 203 103 22709 512 204 204 093 1409
09
8
B G P agand rovm i atinc e 2 5623 22709 3 14 8
B ag m akatii 5623 3 183 22709 1524 0 3 3 1414 881769
G P rov and i nc ak i e 5 3 13183112 1524 59797 0 1769 3 674
G and ak i 3 13183112 1524 0 1769 1769
P rov i nc e 5 59797 3 674
K P arnali rov i nc e 5 1373 112 4 3 59797 15706 3 3 674 674 3 553
K arnali 73 4 3 15706 3 553
Sud urpas h c h i m
K arnali 733 089 4 3 15706 1824 4 3 3 553553 13 74
Sud urpas h c h i m 3 089 1824 18244 4 1313 7474133 93 74
N Sudati urpas onal h c h i m 3 76752 089 279011 17
N N atiational onal 7675276752 279011 279011 3 3 9393 17 3 93 17
17
T h e tab les b elow 4 . 7. 3 s h ow s th e las t 3 y ears trend of s erv i c es prov i d ed b y P HC - O RC c li ni c s . I n
T T T h h h eee tab tab les b elowelowlas t4 44 . .F . 7.7.7.Y 33 3 2074 ss s hh h owowow/75, ss s tththth theeeealas
laslass tttervt33 3 i y y c ears
y ears trend trend of ervs erv i c esprovprov i d ed b yHC P - - O HC O RCRC- i O ngc c RCliliinitrend
niic cc s lis . . niI I ncnexs . c I ept
n
c om ta tab
pari s lesonb b to
les elow ea d elittrend
ears v ery ofofof sP s erv HC ii i- c c O esesRC prov c li niii i d d c ededs i s b b y i y nP P i HC nc reas
c c comomm om pari a I ins s s Fon
pari ontto to alas
last ttt F F F YY Y 2074 2074 /75,
2074 /75,tththth eeess erv s erviii cc i eec ed d eli d eliv v ery v eryofof ofP P HC HCP HC- ed
- O O RC-RCO i nRCc cc liliom
i ninic ilic c pari
s nis ii i c s s s ii i nni s ii i nci ncnreas i nca reas i ng trend i ng trend exex c c ept ex c ept
Depo.pari on Y 2075/76 to las pri m ary/75,treatm ent h as elib i een
erv ery i nc reas s on toreas las ii tngFgY ttrend (T ab le 4 .ept 7. t3 ).
Depo. Depo. I I n
Depo. I nnF F F Y Y Y 2075/76 2075/76 pri
2075/76 priima
pri mm m ary ary ttreatm
ary treatm
treatm atment entent t hh ashasaas b b een b een
een i i ncreas
i i ncnc reas reasaeded edi i nni c i c nomom c m ompari
pariapari ions to
s s on on totlas toattlas
las F F tY Y t(T(TF abY ab (Tale
leab4 4 . . le
7.7. 3 3 4 ).).. 7. 3 ).
Table 4.7.3: Trend of Serv ices Prov ided by PHC- ORCs
Table Table4.7.3:
Table 4.7.3: Trend
4.7.3: Trend of
Trend Serv ices
of Serv
Serv ices Prov
ices Prov ided
Prov idedbybyby PHC-
ided PHC-ORCs
PHC- ORCs
ORCs
Serv i c e T y pes
Serv i ic i c c eeeT T T y y y pes
pes 2073
2073 /74 2074 /75 2075/76
Serv Serv pes 2073/74
2073 /74/74 2074 2074
2074 /75
/75/75 2075/76 2075/76
2075/76
P P ririm m ary ary treatm
treatm ent
ent 817,74 817,748 8 894 894 ,3 77 1,263 ,4 99
P P ririm m ary ary treatmtreatm ent 817,748 8
817,74 894894,3 77
,3 ,3 77
77 1,263
1,2631,263 ,4,4 99
99,4 99
DepoDepo (N(N umum b b er) er) 189,686 189,686 175,555 175,555 166,655 166,655
Depo Depo(N(N umum b er) 189,686
189,686 175,555
175,555 166,655
166,655
AN C (ti(tim m m eseses ))) 242424249,5259,525 23 6,2388 88 6,4242402 6,4 02
ANANAN C C C (ti(ti m es ) 9,525
9,525 2323 6,23
236,236,23 2424 6,4 026,4 02
P N C (ti(tim m m eseses )) 44 343 4 ,752
3 ,752 3 7,707 3 009,3 3 0
P P P N N N C C C (ti(ti m es ) ,752
3 ,752 3 3 7,707
7,707
3 7,707 3 3 9,3
9,3 3 3 3 9,3 3 0
G G rowrow ththth m m m oni tori ngngng (0-
(0- 11
(0- 11M M onth
onths )s ) 3 85,076 3 85,076 929,851 929,851 1,589,883 1,589,883
G G row row th m oni oni tori
tori ng (0- 11 11M M onth
onth s s ) ) 3 385,076 85,076 929,851929,851 1,589,883 1,589,883
Sourc e:e:e: HM
Sourc
Sourc HM I I S/M
S/M D,
D, DoHS
DoHS
DoHS
Sourc e: HMHM I I S/M
S/M D, DoHS
4.7.3Issues,
4.7.3 Is s uesues constraints
, cons
cons traints and recom
recom mm m m endations
4.7.3
4.7.3
4.7.3 IsIsIs s s ues cons traints
, , cons traints
and
traints and
and recom
recommendations
and recom endations
endations
endations
Table 4.7.4:
4.7.4: IsIs s s ues
ues , , Cons
Table
Table
Table 4.7.4:
4.7.4: Is s ues , , Cons
ues Cons
traints and
Cons traints
traints andRecom
traints and
and Recomm m m endations
Recom
Recom
endations — — Prim
m endations
endations —
Prim
— Primary
Prim Health
ary ary
Health
ary
Care
Health
Health
Outreach
CareCare
Outreach
Care Outreach
Outreach
Is s ues / cons traints Is s ues
ues / / cons Recom m endation Res pons ibility
IsIs s s ues / cons cons traints
traints
traints Recom m endation
Recom
Recomm endation
m endation Res pons ibility
ResRespons
ponsibility
ibility
All thth ee P P HC
HC - O RC ss are
are not
not ff unc
unc titi onal
onal FF uncunc ti onali z z ee all P P HC - O RC s b y
res olv olvresi i ngngolvall F F W W D,
D,F HOHOW D, HO
All
All
All HC - - - O OO RCRCRC
thth ee P P HC s s are
are not
not f f unc
unc titional
onal uncti onali
Fi s s F unc ti onaliz z eall
tionali eall allHCP P HC- HCO - RCO - O RCs RCb s y
s b resb y y res all
olv i ngi ng allall F W D, HO
i s s ues
ues at at evev ery
ery levlev elsels
i s i s s s ues
ues atatevev eryery levlev elsels

i mi g a i a t
Chapter 5 EPIDEMIOLOGY AND DISEASE CONTROL
5.1.1 Malaria
5.1.1.1 Background
a ma a ia t g amm ga i mai i t a ai t ta a it
t mt it tat t a a a a ia a i a g amm a i i at
a i t t t t a t g amm t Ba a a ia B
i i a a a t i a t t i t i a ai a i i
a i a t m t a t ma a ia a i a a a ia i a g at
i i a a it a a a t m it am g t m i a a a
i a i a i a a a i g m tai t m at
a a ia i ta a a tai t it t a gi g i mi g ma a ia i t
t a t a iat ig tag i a t t mi a t ma a ia
t a mi i a mm t a ma a ia g am i a a ia ata m a t t
a a t at it i a i i ai i i ai ma a ia i t at it i
m a i t a mai a ma a ia t g t a mi i i
t i a i t a a a t g t a a ta mat ma a ia i
at a mm it t a t t i ta a at t mm it a
t t t ta a at i ma a ia ma a ia i mi ta a a
t at t a a i i a it i i ai
m t g t ma a ia ata m t i ma t a a
iti t mi a t t a mi i i i i g imat g a t
a a t i a a i it i t m ma a m m t
m t a a a mi ta a t a it a mm
i mi g a i a t i ii a a a ia i a i g
i t a ig t t t
i a g g t m gi a i a a i it gi a ig t
a a a i a ig tag t t t mi a t m ia a a a
a at a a a t at a t t ma a ia
ata t a a am a a i mt a m ia ta a ia
a a at a m a a ta a a ig i a a a t a a
a t ta i a ig t imi a m at a i a
a i a a t i ig tag it a a a t ta
ig t i a t i i i t i m t a t
a i it a a a t ta ig t i a t i i a ig tag
a a a ig m i it a a a m at t m i it a a
ig tag a t mi a t a a a a at a t mma t t
t mi a t a t i t tag t tag m a ag a t
it ia t a ig i a
i mi g a i a t
Ba t i m t mi ta a a at a t a ig at a
ig m at a i a ig i a i i a a a
i t i tOut oft these
districts. t high-risk
ig wards,
i a6 wards ina Provincei 2, i1 ward in Province
a i 3, 3 iwards in Province a i
i a i a a i i a a i a im
5, 7 wards in Karnali Province and 30 wards in Sudurpashchim Province while no high-risk ward was i i ig i
a
detected a in Province
t t i 1 and Gandaki
i aProvince.
a aFurthermore,
i i t mrisk wards
moderate m were at identified
i a in 151
i wards in 18 i districtsa (5 additional
i i t districts
i t ato the
i 15 a districts
i t i t that
t tcontained i thigh
i t risk
t atwards) taiof these
ig
imoderate
a t m at i a a i i a i a
risk wards, , 6 wards in Province 2, , 1 ward in Gandaki Province, 22 wards in Province 5, 18 a i i
a
wards i in Karnali
i Province anda 104i wards
a a iin Sudurpashchim
i a a
Province iwhile no even
a moderate
im irisk wardi
m
was in Province 1. at i a a i i
a a ia t transmission
Malaria a mi i iis concentrated
t at iin tthe Sudurpashchim
a im and
a Karnali
a a i Province
i with it these
t t
two
i a g a ig i a a m at
provinces accounting for approx. 79% high risk burden and around 83% moderate risk burden. Malaria i
a a ia t a mi i a a mi it i m t t a ai gi
transmission has reached low level of endemicity in most of the Tarai regions (plain lands) but malaria
ai
a t ma a ia i i i ai g i g t t i i i a i a
infection is increasingly being detected in upper hilly river valleys, which was traditionally classified as
ta i a a i a a a ia i a i i a a i ma a ia i i
“No Malaria” risk. A relative incidence analysis of malaria infection in upper hilly river valleys suggest
i i a gg t t at ma a ia i a mi i t a a it a t
that malaria infection was endemic in the area, with adults developing immunity with repeated
i g imm it it at a t g a i ai gt t
exposures as they grow older and children bearing the brunt of the infection due to immature
t i t immat imm it i i i ig i a t ig i i t a
immunity (incidence is significantly higher in children less than 14 years as compared to adolescents
a a m a t a t a a t
and adults 15+).
Figure 5.1.1.1: Ward Level Risk Classification Map (MS 2019)
Source: Malaria micro stratification report 2019

i mi g a i a t
Nepal’s National Malaria Strategic Plan (NMSP, 2014–2025) has shown in Box 5.1.1.1.
Box 5.1.1.1: National Malaria Strategic Plan (2014–2025 Revised)

National Malaria Strategic Plan (NMSP 2014 – 2025) was revised since it was developed in 2013 and
targeted Pre-elimination, and is as a result out of step with the latest normative guidance on malaria
elimination from the World Health Organization (WHO) ( “Global Technical Strategy 2016 – 2030”
and ‘A framework for malaria elimination, 2017’), current country structure, disease epidemiology,
2017 mid term malaria program review. This plan has inherent Government of Nepal’s commitment
and seeks appraisal of external development partners, including the Global Fund, for possible
external funding and technical assistance. The aim of NMSP is to attain “Malaria Free Nepal by
2025”..
National Malaria Strategic Plan (2014 – 2025, Revised) are phased malaria elimination by province:
• Achieve Malaria Elimination (zero indigenous cases) throughout the country by 2022;
- Province 1, Bagmati & Gandaki “get to zero indigenous case” by 2020,
- Province 2 & 5 “get to zero indigenous case” by 2021,
- Province Karnali & 7 “get to zero indigenous case” by 2022, and
• Sustain malaria – free status and prevent re-introduction of malaria in provinces after getting to
zero indigenous case.
Goal: In line with the WHO Global Technical Strategy for Malaria 2016–2030 (GTS) and the Asia
Pacific Leaders Malaria Alliance Malaria Elimination Roadmap, the goals of the National Malaria
Strategic Plan 2014 – 2025 are:
• Achieve Malaria Elimination (zero indigenous cases) throughout the country by 2022; and
• Sustain malaria – free status and prevent re-introduction of malaria.
The specific objectives of NMSP (2014 -2025, Revised) are as follows:

 Strengthen surveillance and strategic information on malaria for effective decision making.
 Ensure effective coverage of vector control intervention in the targeted malaria risk areas.
 Ensure universal access to quality assured diagnosis and effective treatment for malaria.
 Develop and sustain support from leadership and communities towards malaria elimination.
 Strengthen programmatic technical and managerial capacities towards malaria elimination.
Current Achievement
By 2018, National Malaria Program had achieved 55% reduction in indigenous malaria cases
compared to 2013, In 2016, 3 deaths were recorded in an imported case of malaria, and foci
investigation activity also got momentum in this year. In 2075/76, there were altogether 121 foci
which were gone through the investigation.
Rationale for amending the NMSP
Nepal is primarily a low malaria endemic country with around 80% of malaria cases due to P. vivax
and the remaining burden due to P falciparum with occasional case reports of P. ovale or P. malariae
mostly imported from Africa. Vivax parasites have unique biological and epidemiological
characteristics that pose challenges to control strategies that have been principally targeted against
lasmo ium falciparum. Infection with i a typically results in a low blood-stage parasitemia

i mi g a i a t
with gametocytes emerging before illness manifests, and dormant liver stages causing relapses. As a
consequence of low parasitemia, high prevalence of asymptomatic infection and difficulty in
detection of the parasites, ability to infect mosquitoes before development of clinical symptoms, and
appearance of relapse within months to years of the primary infection; P. vivax pose a great challenge
to malaria elimination. Radical cure with at least 2 weeks of Primaquine is required to clear the
hypnozoites but the drug can only be given after a normal G6PD test. Besides, current point of care
rapid tests may not identify heterozygotes G6PD deficient female despite a normal rapid test and
such a case may hemolyze on exposure to Primaquine. i a tolerates a wider range of
environmental conditions and is more likely to lead to geographical expansion. Conventional control
methods of minimizing human contact with mosquito vectors through insecticide-treated mosquito
nets and indoor residual spraying – may be less effective against i a . This is because, in many
areas where i a predominates, vectors bite early in the evening, obtain blood meals outdoors
and rest outdoors. In addition, vector control has no impact on the human reservoir of latent
hypnozoite stage parasites residing in the liver, which are responsible for an appreciable proportion
of morbidity.
To recollect, National Malaria Strategic Plan has to address the following issues:
1. P. vivax is the overwhelmingly predominant parasite species in Nepal and strategy should reflect
the importance of P. vivax in elimination programme and it should target P. vivax with novel and
innovative interventions.
2. Traditional conventional interventions are neither effective for P vivax control nor elimination.
3. Novel interventions based on strong evidence are required to clear hypnozoites in the liver and
prevent relapse, point of care tests to detect asymptomatic and sub–microscopic infections, and
new community based testing and treatment methods to increase access to quality assured and
quality controlled diagnosis and prompt effective treatment. Ensure G6PD point of care test and
roll out radical cure treatment for P. vivax infection.
4. Without interrupting P. vivax (reduction will not be sufficient) transmission, achieving malaria
elimination is unlikely.
5.1.1.2 Major activities in 2075/76

 2,76,225 LLIN was distributed as mass distribution and 81,133 LLINs were distributed through
a i t i t a ma iti a iti t t g
continuous distribution to people leaving in risk areas, army police, pregnant women at their
iti t a i gi i a a am i g a t m at t i
t first ANC
i it visits.
 Conducted
t t the
a ward-levelmi micro-stratification
ta a of malaria
ma a ia a casesi in 77idistricts.
ti t
 Continuation
a aof case-based
a surveillance
i a tsystem
m a as key i tintervention,i including
i g web-based
a
i ga
recording g t system
and reporting m i t districts.
for i t The MDISi is now fully operational.
a a
i tat i t i district
Orientated ta i peripheral
and a a t health workers
level a a case based
on i a surveillance
a and
a i response.
t tai ii ga at m t a it
 itaCarried
i t outma a ia mi
detailed a itat more
foci investigation a athan 100tsites.
m it a a t t
i mi g a i a t i ii a B it t i a a i ta m
i tat i t i t at a t g m t ma a ia imi a i i a
a t i i t g a a a i ita g a t atm t
i mi g a i a t
i tat m t g a i ma a ia a t a
iag i a m t t atm t
t at a a a i m g i t i ta ta ta a i a t
i ata m i a a ii a i it a gg
t a a a ma a ia t a i a i i i ta
t g a t t i i a a i g ia a a ig a
m at i iti t
t tai a a i ga a a i i a
t i t g at t m gi a i a a t i t it t g t t
t t
at a a ia a i
Achievements
a a i a a m i g ma a ia m i it a m ta it at m
t a ti it i a i ta i it a ma a ia g amm a
im m t a i t t imi at t mai i g a ma a ia i
it t m it a im m t a t g ma a ia t g amm t a i
im i g t ag a a it i i a a i g i t i g g a g
i i t at t a i ai g a t a i ma a ia iag i a
a t mi i i a m i a t atm t
ata g at i at a a ii i t t a a i ga g t m
a m t i i i g ma a ia mi ta a a ta a i t
at i a i i i a a a at m am i m a i a ma i a a
i g t mi ta a i t m ig a m at i
iti t m t a i t a ga i ta g
ma a ia mi ta a a t a t i at a t
a i
t t ma a ia i mi gi a it a t a a ig t
i a i gt t at a a t a i t i a a a
m ma a ia a i a m i t i i
a i a mi i a a a t t
a a i t a
i g t a a a a it i i mai ta
a t i a t a ga a i t t t
i t t a m i i t i
i at i a a at a mi at t a
mi ta a
t i i a t ma a ia a i a a i g mai t t i a
ag mi i a at i at i a a g a i ta a
it a i g i i t ta a i i a t ma a ia a
t at i t g t i
a a a i t m i ig a i a ma a i ig i a
a B t a i gi i a a ia i m tai i a t ai gg t
t at i a ma a ia mai a a g t imi a ma a ia i a i ai t
t i imi a t at gi

onsite coaching of service providers. A total of 695 probable/clinical suspected malaria cases
treated by chloroquine through OPD were reported in 2075/76.
 There was a decrease in the number of indigenous P. falciparum as well as indigenous P.vivax
cases. But cases being identified in new areas, especially in mountain, hilly and terain, suggest
that P.vivax malaria remains a challenge for the elimination of malaria in Nepal. This raises the
need for new country specific elimination strategies.
i mi g a i a t
Table 5.1.1.1: Malaria epidemiological information (FY 2073/74–2075/76)
Items /indicators 2073/74 2074/75 2075/76
Total population at Risk 14944174 15177434 12,224,703
Slide Collection Target 150,000 150,000 150,000
Total slide examined 118165 207581 199927
Total positive cases 1128 1187 1065
Total indigenous cases 492 557 444
Total imported cases 636 630 621
Total P. falciparum (Pf) cases 148 82 57
% of Pf of total cases 13.1 6.9 5.4
Total indigenous Pf cases 52 10 7
% indigenous Pf cases 35 12 12
Total imported Pf cases 96 72 50
% imported Pf cases 65 88 88
Total P. vivax (Pv)cases 980 1105 1008
Total indigenous Pv cases 440 547 437
% indigenous Pv cases 44.9 49.5 43.3
Total imported Pv cases 540 558 571
% imported Pv cases 55.1 50.5 57.6
Annual blood examination rate 0.79 1.4 1.64
Annual parasite incidence 0.08 0.08 0.09
Annual Pf incidence 0.01 0.01 0.005
Slide positivity rate 0.95 0.57 0.53
Slide Pf positivity rate 0.13 0.04 0.03
Probable/clinical suspected malaria cases (not
3904 3282 695
tested but treated by chloroquine)
Source: M S o S
The trend of the national malariometric indicators (Table 5.1.1.1) indicates that Nepal has entered in
the teliminationt phase.
a a Despite
ma a i district
m t i i variance
i at including
a on number
i i at of t cases,
at the
a aAPI and
t slide
ipositivity
t rates
imi a (SPR) aand the zero it indigenous
i t i t a iacases ifrom districts
i g such
m as Kavrea andt Sindhupalchok
a i over
thei last
it four
at years suggests
a t a paradigm i ig shift. The a highestm i number
t i t of confirmed
a a a cases
i wereareported
fromt Kailali
a t district a(206), gg t a abya Mugu
followed igm (173),
i ig (85),
Bajura t m Kanchanpur (77m ), Banke
a 61) and
t m ai a i i t i t g Ba a a a
Kapilbastu (61). In is including private sector as well, which shows substantial progress towards Ba
a a i at i i i g i at t a i ta a g
elimination targets, however it requires continuous attention for further improvement.
t a imi a ta g t it i a t im m t

i mi g a i a t
Table 5.1.1.2: Province wise Malaria epidemiological information of 2073/74 to 2075/76
Percentage of
Annual Blood Malaria annual Percentage of
a i rate i
Examination a a iaincidence
parasite i mi giPlasmodium
a i ma imported casest Slide positivity rate
falciparum cases
(ABER) of malaria at per 1000 among positive of malaria
Province among the total
risk population population cases of malaria
malaria cases
2073 2074 207 2073 2074 2075 2073 2074 2075 2073 2074 2075 2073 2074 2075
/74 /75 5/76 /74 /75 /76 /74 /75 /76 /74 /75 /76 /74 /75 /76
Province 20.8 21.0 45.8 78.9
0.44 0.56 2.64 0.02 0.01 0.01 24.5 77.6 0.39 0.15 0.06
1 3 5 3 5
Province 17.7 68.1 85.4
0.51 0.49 1.57 0.04 0.02 0.03 19.9 6.06 28.1 0.83 0.39 0.2
2 4 8 8
38.4 37.0 92.3 85.1
Bagmati 0.42 0.55 1.17 0.03 0.02 0.02 28.9 37.8 0.63 0.27 0.13
6 4 1 9
21.8 66.6 96.8
Gandaki 0.87 0.63 0.56 0.03 0.03 0.03 10.3 25 72.4 0.32 0.54 0.48
8 7 8
Province 16.1 12.1 68.6 80.1
1.07 1.68 2.59 0.08 0.07 0.1 4.95 74.5 0.77 0.41 0.39
5 9 3 2 8
17.2
Karnali 0.7 1.19 0.78 0.13 0.35 0.18 5.3 0.48 0.42 74.7 21.9 1.7 2.9 2.35
3
Sudhurp 53.9 61.0
1.6 4.64 1.61 0.3 0.29 0.18 8.3 4.1 3.01 50.6 1.6 0.63 1.11
achim 2 8
Source: M S o S
In 2073/74 and 2074/76, the confirmed malaria is slightly increased due to active surveillance,
a t m ma a ia i ig t i a t a
availability of RDT kits upto peripheral level and others many factors that may have contributed to the
i a
a ai a i itdecline of clinical
it and tthe decline
i of athe number a of endemic
t ma a t t at ma a
districts (and probably of the number of ti t
t t i
active foci): i i a a t i t m mi i t i t a a t
m a i
Overall improvements in the social determinants of health (for example, less than 20% of
Nepalese people now live below the poverty line against more than 40% in 2000).
a im Increased m access
t i to tsimple diagnostic
ia ttools
milikea (combo)
t RDTs.at am t a
a  The availabilityiof powerful antimalarial
t tmedicine
i agai t m t a i
(ACTs) in all public health facilities.
a  aThe distribution
t im of around iag 0.65 million
t LLINs i in FY m 2074/75 in endemic areas (Mass and ANC).
a aia The
i it large financial support
a ma from a the
ia GFATM
m i since i 2004 hasi played
a a major i role a t by aallowing
i i the
i t i programmea and partners mi i up essential
to scale i interventionsi and malaria mi control
a a toolsa to athe
a g most a peripheral
ia t Data
level. m t reported by the i districts viaa HMISa and areportsma received byathe i g t
g amm a programme at may differ
t for
a various reasons such
a i t as lack of orientation
a ma of astaff
ia who tgeneratet t t
m t i data aand statistical officers
ata whot enter the
t data as per the
i t i t ia suggestion aof vector control
t officersi t
g amm atma district and regional levels. The involvement of the vector control inspector (VCI), statistical
i ai a a a i ta ta g at ata
officers and lab personnel from districts and regions on data quality coupled with rigorous on-
a ta a t t ata a t gg t t at
site coaching and support by the central EDCD team (comprising government and contracted
i t i t a staffgi a i m t t t t i
from Save the Children working at the programme management unit) have paid dividends
t ta a
a in helping
a decrease errors.m i t i t a gi ata a it it ig
it a i ga t t ta t am m i i g g m ta ta t
ta m a t i i g at t g amm ma ag m t it a ai i i
i i g a

i mi g a i a t
Recommendations
mm a frommProvincial
i ia anda national
a reviews
a i and aactions
a takentain 2075/76
i
Problems and constraints Action to be taken Action taken
 Increased number of malaria
microscopy trainings run at VBDRTC
and in other regions including lab
 Malaria microscopy trainings
personnel from across the country
of all untrained lab personnel
 Database created that lists untrained
 Availability of RDT at non
and trained personnel since 2004. It
microscopic sites
aims to reduce repetition before two
 Confirmation of  Orientation of service
years of basic malaria microscopy
suspected and probable providers, clinicians, health
training to provide equal opportunities
malaria cases workers and private
 Regular periodic validation of HMIS
practitioners
data by EDCD in coordination with
 Validation of probable
DPHOs
malaria case through cases
 Decentralized training centres
investigation
established in mid and far west to train
more lab personnel on malaria
microscopy
 Low blood slide
 Train health workers on RDT  Supplied RDT at community level
examination rates for
and microscopy in malaria  Trained health workers from malaria
malaria elimination
reported districts reported districts
programme
 Ongoing basic and refresher trainings
on malaria microscopy for lab
 Orientation on malaria technicians and assistants at
 Run training programmes
programme to health peripheral facilities
with GFATM support
workers  Oriented PHD and DHO finance and
store persons on malaria programme
 Oriented FCHVs on malaria
 District and peripheral level staff
 Orient district and peripheral
 Malaria case reporting oriented on case investigation,
staff on case investigation
and case investigation surveillance, foci investigation and
and reporting
reporting
 Unnecessary variables in
 EDCD to address to variables  Discussed with HMIS section and
HMIS tool (for status of
during HMIS tools revision agreed to rectify at next revision
patients)
 Malaria cases increasing  Programme should address  Programme will be added next year to
in non-endemic district non-endemic districts also target non-endemic districts.

i mi g a i a t
5.1.2 Kala-azar
5.1.2.1 Background 5.1.2 Kala-azar

aa a a i a t i a a t a a it i ma ia a i i i
t 5.1.2.1
a mi Background t it ma a t m ag i a i aa t i
m t a t it m ga a a mia g i ig t a m m
aKala-azar
i g tis a vector-borne
i disease caused
mi a a by the
i parasite
a Leishmaniadonovani,
ga t a t which
i i a i m by
is transmitted
itheabitei ofata
female
i sandflyPhlebotomusargentipes.
t t at m a a a a aThe disease B is characterized
i aby fever
m of g more
i than t
two
a weeks with splenomegaly, anaemia, progressive weight loss and sometimes darkening of the skin.
In endemic areas, children and young adults are the principal victims. The disease is fatal if not treated
g
on time. m t and HIV/TB
Kala-azar a i co-infections
mmi t have
t emerged
gi a int recent
at g years.
t imi at a a a a a ig
t m m a m ta i g t at a ma i at t at m i
The government of Nepal is committed to the regional strategy to eliminate Kala-azar and signed the
m at a a a a a a a a imi a i a a a a
memorandum of understanding that was formalized at the World Health Assembly in 2005. In 2005,
a i i a a a a t at gi i i a a a a imi a i a i
EDCD
mmformulated a National
a a a Plan for Kala-azarelimination
i iag t t it a ini tNepal.i Thea national
t tplan
i was revisedt in
t atm
a2010
a a as
a aiNational
m t Strategic
it a Guideline on Kala-azar
g i i elimination
a in Nepal
at i which recommended
t i t rK39
i asmaa
am rapid diagnostic
t i i B atest kitmandi Miltefosine
a t aas the i tfirst line
a treatment
a t atmof Kala-azar
t g i iin most situations. a Thea
g 2010
i iguideline
a was i updated
agai ini 2014 to introduce
i liposomal amphotericin
mm i g Bi and combination
ma am ttherapy
i i B ina
t the national
t i t treatment
atm t guideline.
ima Thea a a2014
a national guideline was revised again in 2019 which
recommended single dose liposomal amphotericin B as the first line treatment for primary kala-azar.
5.1.2.2 Goal, objectives and strategies
5.1.2.2 Goal, objectives and strategies
Box:
Box:5.1.2.2
5.1.2.2
Goal
 The goal of Kala-azar elimination program is to contribute to mitigation of poverty in Kala-azar
endemic districts of Nepal by reducing the morbidity and mortality of the disease and assisting
in the development of equitable health systems.
Target
 Reduce the incidence of Kala-azar to less than 1 case per 10,000 populations at district level.
Objectives
 Reduce the incidence of Kala-azar in endemic communities with special emphasis on poor,
vulnerable and unreached populations.
 Reduce case fatality rates from Kala-azar to ZERO.
 Detect and treat Post-Kala-azar dermal leishmaniasis (PKDL) to reduce the parasite reservoir.
 Prevent and manage Kala-azar HIV–TB co-infections.
Strategies
Based on the regional strategy proposed by the South East Asia Kala-azar Technical Advisory group
(RTAG) and the adjustments proposed by the Nepal expert group, Government of Nepal, MoHP has
adopted the following strategies for the elimination of Kala-azar.
 Early diagnosis and complete treatment
 Integrated vector management
 Effective disease and vector surveillance
 Social mobilization and partnerships
 Improve programme management
 Clinical and implementation research

i mi g a i a t
t at a t a ig i a t a a i t iag i a t atm t
aa a a a a a g amm ma t i t t it a a i a ai a i a
gi a t t a ai a t i a t iti t i i g aa a a a
i ma am t i i B mi t i a a m m i a ma a ai a t a t aa a a
t atm t t a a a a iag a g a i t t t a t
Case detection and treatment: a a t a m t a m t atm ti t

mai ta imi a g a a a a a a a a at iag a i at a
iag t atm t i a i at i t i t a a at a ii i
a a at a i a a a t a a a at at
t
RDT scaling up: i t im t t t at a at a at a i t t

ig i a at ta a t t t it t i i a t atm t i
ta a a i a a t t t a ai a iag t
a a a a iag i a a i a g i a iag t
at gt at a a t t i a ai a at
aa a a a t iti t m a a at i t i ii
ma t a a t a i it i ig g i i a i i
Use of liposomal amphotericin-Bas first line treatment regimen: t mmi

i ma ia i i a t gi a i a i t aa a a
imi a g amm i mm i ma m t i i B mB a t t
i gim i gt a a a i t ia t a i gi t i a it ig
a a t a a a m ia t t a a t ia a a g
t gim m i a t a t a a a t a a t
gim m i a gim a mm a i gim t
ia ti t a a a t gt m m i a gim a t t
a t t t i i i a g m i g i ta t a it it i
a m m i i a t i a m t i i B i t t mmi mm a
mB a i t i a i m a t ai i g a t t a m
mi i t i t t a i t a a t ita i
t a t t a mB a ai i t ag a t
ma a ai a i ita t ag i i a a
aa a a g i i a mm i g i ma am t i i Ba t t i
t a ima a a a a
Indoor residual spraying in priority affected areas: t i

i a a i g a i ti i i aa a a a t a a mi iti t a
t a a g i i i a i t i i ag aa a a a
i t i a i a a it a t a i t t at aa a a g amm a
t m t ma a ia
Orientation on updated national guidelines on KA Elimination Program: i a

a at ta a t a am i t ai t i a a aa a a g i i
a t atm t t i i gt at i a t m

i mi g a i a t
Kala-azarnational review meeting: a a aa a a a a i m g a t
i i g ai aa a a a t iti t a t i ia t am
National Kala-azar Technical Working Group Meeting: t a a aa a a i a

i g g a t i at ma ai i ga i g a a a a
i
Disease surveillance: a a a a t t t a m t ata i tai t g a i

a t ia mg m t ita i g a a t a
a i ti mi a mi a m i i ai i a t g a a
a am a a a it t a t m a t
i t i a i g a a mm it a t a a i
t i t i t t am a a t a i it ta a t aa a a a a
t a t i i a i ia a a i iag it at
at a ii a at a t at i a
t iti t a ita a t t ma a ma ag m t
Multi-disciplinary Kala-azar Vector Surveillance: t a t a t a

aa a a m i t mi i t i t a i a i i g i at
t at t a a t m mi i t i t t a g
ta a m ta i ma ia i i t at a i i a
a aa a a a t m at at a t i g
t i a a t i t iti t a
5.1.2.4 Trend of Kala-azar cases
m aa a a a a a i g ig i a t i t a
g ga i a a i t a a i t a
2073/74 a t ta aa a a a t t i a ig a
t a a mt aa a a g am i t i t a m
g am a a a a iti t
2074/75 a t ta aa a a a t m ai at t t i i
a ig t i a a m a t t i a t a a a
m aa a a g am i t i t a a m g am a a a a i t i t a
t m a ai at g i ga g am i t i t
2075/76 t a a a i t m t a a m a t t
i a t ta aa a a a t t i a ig a
t t a a mt aa a a g am i t i t a
m g am a a a a i t i t t a a t m aa a a g am
i t i t ig t m a t m t a a a g a
ia a i t g amm i t i t Ba a a a a a ta at t a t i a
t a a a i i a i aa a a a m a t i a
am g
g amm i t i t g amm i t i t t a i Province
1 a ta ta g a a a a a Bagmati Province i i am a a a
B a ta it a at ma a it a a Gandaki Province a g a a a a aai
a t Province 5 g a a i Ba Ba i a a g t a a a i a i at a
m a t Karnali Province ai a ma aa t ai t g a a a m
i mi g a i a t
t Sudurpashim Province am Baita i Ba a Ba a g a a a a a
a a
Si m ialarly , i i n F Y 75/76, 4 ac as es of P ost t aK aala-a aza arL eii s h ma

imi m aniiaas i is (P K DL ) h asa b een reported t f rom m-
M aah o aarii Suns aria , i Sarlah i and
a a i a Si rah a.
ia a i L i k ew i s e,
i 10 c as es
a of C utaneousta L ei s h m i ma ia i h as b een
ani as i s (C L ) a
reported f rom t 8dm i erent
i d i s tritc ts i itni th t e iy ear t 2075/76
a nam ely - am B aj ura, Ba
Dang a, G orka h ga, Hum la, a J aj arkm ot,
a
aK anc
a h tanpur, a P alpa,
a Ruk aum aW es t. m t
Table: Trend of K ala- az ar Cas es ( FY 2073/ 74 to 2075/ 76)
Prov ince Dis tricts FY 2073/ 74 FY 2074/ 75 FY 2075/ 76

B h oj pur 6 7 1
J h apa 6 6 10
M orang 21 16 10
1
O k h ald h ung a 2 4 3
Suns ari 6 7 2
U d ay apur 2 1 3
B ara 1 1 0
Dh anus h a 15 2 3
M ah o ari 11 8 4
P ars a 1 0 0
2
Rautah at 1 2 0
Saptari 6 4 3
Sarlah i 24 17 1
Si rah a 15 11 8
3 M ak w anpur 5 3 6
5 P alpa 16 19 6
K arnali Surk h et 11 10 16
Sud urpas c h h i m K ai lali 2 4 7
18 Program m e dis tricts 151 122 83
Total Cas es Other dis tricts 74 117 130
Foreign cas es 6 0 3
Grand Total Cas es 231 239 216
Source: EDCD/ DoH S
T h ei i nci i d enc e of ak ala-

a aazaaratat na a onal a aand d i i ts trii c tt lev el h aas b een les s t thaan 1/10,000 popula a on s ii nc e
2013 i i na allt th e ak ala-
aaa az ar prog ram d
g am i t i t i s tri c ts . T h ei ii nc i d enc e per 10,000 popula
a onat
at i t i c t lev el ii n
d i s tri
2073/ 74 rang a g ed f romm 0. 63 i in P alpa a ato t 0. 01 i ni Rautah a taatand Ba Ian 2074/ 75i nc i id enci e rang eda gf rom 0. 75
ata B ara. m
i n P alpa i ato 0.a 01 i s tri ac t. I int2075/
t i n B arai d Ba i t 76, th e d i s tri tc t lev el i ti nci ti d enc e per
i i 10,000 people rang ed f rom
a0. 3 g9, 0. 24 m , 0. 20, i n Surk h et, iP alpa and t O k ah alda ah ung ares apec v elyga to 0. 01 i n Sarlah t i w ii th aanaav i eragit e
i nc i
a a ag i i d enc e of 0. 07 per 10,000 i n th e 18 progi t ram m e d i s tri c ts and
g amm i t i t a 0. 07 at th e na onalat t el. a
lev a
N ote
t t th atatt th e ak ala-
a aazaar ac as es reportedt f romm HO s v iai a t th e HM I S aand c aas e reports t rec eii v ed b y tth e
progg amm
ram m e s omm e m m es v ary
a . T h e HM I S us uallya rec ei v esi ag g reg ate d ata
agg gat ata m f rom h os pi tals and
ita otha er h ealth
t
f ac i li es w h i le th e prog ram m e proac v ely c ollec ts d ata f rom s en nel s i tes th roug h E W ARS. E DC D
at a ii i t g amm a t ata m it t g
v eri es d ata w i th th e h elp of li ne li s ng report of all th e c as es .
i ata it t i i g t a t a

i mi g a i a t
Table: K ala- az ar Cas es and Incidence ( 2073/ 74 to 2075/ 76)
Cas es Incidence
Dis tricts
2073/ 74 2074/ 75 2075/ 76 2073/ 74 2074/ 75 2075/ 76
B h oj pur 6 7 1 0. 3 6 0. 4 3 0. 06
J h apa 6 6 10 0. 07 0. 07 0. 11
M orang 21 16 10 0. 20 0. 15 0. 09
O k h ald h ung a 2 4 3 0. 13 0. 27 0. 20
Suns ari 6 7 2 0. 07 0. 08 0. 02
U d ay pur 2 1 3 0. 06 0. 03 0. 09
B ara 1 1 0 0. 01 0. 01 0. 00
Dh anus h a 15 2 3 0. 19 0. 02 0. 04
M ah o ari 11 8 4 0. 16 0. 12 0. 06
P ars a 1 0 0 0. 01 0. 00 0. 00
Rautah at 1 2 0 0. 01 0. 03 0. 00
Saptari 6 4 3 0. 09 0. 06 0. 04
Sarlah i 24 17 1 0. 28 0. 20 0. 01
Si rah a 15 11 8 0. 22 0. 16 0. 12
M ak w anpur 5 3 6 0. 11 0. 07 0. 13
P alpa 16 19 6 0. 63 0. 75 0. 24
Surk h et 11 10 16 0. 28 0. 25 0. 3 9
K ai lali 2 4 7 0. 02 0. 04 0. 08
O th er Di s tri c ts 74 117 13 0 0. 03 0. 06 0. 07
Total 225 239 213 0.07 0.08 0.07
Source: EDCD/ DoH S
5.1.2.5 Strengths, issues/challenges and recommendations of Kala-azar Elimination Program
5.1.2.5 Strengths , is s ues / challenges and recom m endations of K ala- az ar Elim ination Program
Strengths
Strengths
 aiAva aii lab it i li ty of f ree of c tos ts d grug as and iag d i ag nos c s f or aearly ac as e d etec t on aand m m ely treatm
t atmentt
of k
aa a a a ala- az ar c as es .
 aiAva aii lab it i li ty of rec tently rev i i s ed tas tanda ard ana onal a g g iui d eli
i nes f or ak ala-
a aazaar eliimim i na a on progg ram am iin
N aepal.
 U s emof m ul i - d ii s c ii plia narya approac a th to ov erc m om et th e c h aallengg es f or eliimim i na
a on of K ala- a a aza ar.
a
m I m m plem taenta on of Health at M anag
a ag m t em ent I nf orm ma a on Sy s tem
t m(HM I S) and a E arly a W arni ang and
i ga
Reporg ng tSy m s tem (E W ARS) f or s urvi eiallanc e of aK aala-a aza ar.
 U s e of d i erent approac h es of ac v e c as e d etec on of K ala- az ars uc h as c am p b as ed approac h
i ta a a a t aa a a a am a a a
and i nd ex c as e- b as ed approac h .
a i a a a a
 E ec v e partners h i ps and c ollab ora on w i th ac ad em i c s , res earc h ers and oth er s tak eh old ers .
at i a a a it a a mi a a t ta
Is s ues / Challenges
a g
 At pres ent d i s eas e, s urv ei llanc e i s m os tly pas s i v e and s om e of th e c as es of pri v ate s ec tor i s
t m i s s i ngt w ih i c ah i s m erely i c aov eredi b m y th te s urvaei llanci ae s y s temm. t a i at t i
mi i g i i m t i a t m
 L ac k of reg ularly trai ned s ta s to m oni tor outb reak i nv es g a on and res pons e e orts i n non-
a end em i gc d ias tri c tst . ai ta t m it t a i ga a t i
 I nad eq mi uate iaw t arenes
i t s ab out d i s eas e am ong th e c om m uni es .
a
Recom m endations at a a a t i a am g t mm i
 V eri c a on of end em i c i ty s tatus of K ala- az ari n d i s tri c ts c ons i s tently repor ng new c as es of
Recommendations
k ala- az ar.
 E x pand K ala- az ar related s trateg i es and ac v i es to all d i s tri c ts i n th e c ountry w h ere c as es are
is een a or w h ere th ere mi i its probtatab i li ty of atrans
a a m a i s i s i on.i t i t it t g a
a a a a
 I m prov e th e d i s eas e and v ec tor s urv ei llanc e.
a aa a a at t at gi a a i t a iti t i t t a a
i mi g a i a t
t i a i it t a mi i
m t i a a t i a
i mi a a a m ag t i i at i a a i ma
at t a a a a
m i g a i ga a ma ag m t t a

i mi g a i a t
5.1.3 Lymphatic Filariasis 5.1.3 Lymphatic Filariasis
5.1.3.1 Background
5.1.3.1 Background
Lymphatic Filariasis (LF) is a public health problem in Nepal. Mapping of the disease in 2001 using ICT
m a i a ia i
(immune-chromatography i test
a card)i revealed
at mi
13 percent a
average a prevalence
i g t of ilymphatic
a i filariasis i g
imm mat g a t t a a t a ag
infection in Nepal’s districts, ranging from <1 percent to 39 percent. Based on the ICT survey,
a m a
a ia i i i a i t i t a gi g m tt t Ba t
morbidity reporting and geo-ecological comparability, 61(63) districts were identified as endemic for
m i it ga g gi a m a a i it iti t i a
the disease
mi (Figure
t i5.1.3.1).
a The disease has beenidetected
ig a a from 300 feet
t t abovem sea level int the
a Terai a
to 5,800i t feet aboveai t sea level tina the mida hills. Comparatively
i t mi i moremcases a a are seen
m in athe Terai
a thani
the
t hills, but
ai t a t hill valleys
i and river
t i a basins
a also
i have
ai ahigh disease
a burdens.
ig i a The disease is more
i a
i m
prevalent in aruralt iareas,a predominantly
a a miaffecting
a t a poorer g people. Wuchereriabancrofti ia a is the i only
i t
a a it i a m it i a iat a
recorded parasite in Nepal, The mosquito Culexquinquefasciatus, an efficient vector of the disease, i t t t
i a a i a
has been recorded in all endemic areas of the country.mi a a t t
Figure 5.1.3.1:
Figure 5.1.3.1: Lymphatic
Lymphaticfilariasisendemicity,
filariasisendemicity,Nepal
Nepal
Progress towards
Progress towardselimination
elimination
The EDCD formulated a National Plan of Action for the Elimination of Lymphatic Filariasis in Nepal
m at a a a a t imi a m a i a ia i i a
(2003–2020) (Box B 5.1.3.1) by establishing
ta i i gaaNational
a a Task
a Force. The division
i i i initiated
i i at massma drug g
administration
a mi i t a (MDA) fromParsa
m a adistrict i t i tini 2003, which i wasa scaled
a up tot alla endemic mi districts
i t i t by
2069/70 (2013). As of 2075/76, MDA has a been stopped
t (phased
a out)t ini 50 districts,
i t i t post-MDA
t
i a
surveillance i i at in
initiated i 50 districts
i t i t and
a morbidity
m i it management
ma ag m tpartially
a a initiated
i i at ini alla endemic mi
i t i t All endemic
districts. mi districts
i t i t havea completed
m t the t recommended
mm sixi rounds of MDA by 2018. The
imi a g amm a i i t t i t t
elimination programme has indirectly contributed to strengthening thet gt i g system
t t m t trainings
through g t aiand i g
a a a it i i g i a a i t i i g ma i g a i
capacity building. Since 2003, surveys have been carried out including mapping, baseline, follow up,
t ag a t a mi i a m t t a mi i a m t
i iti t i t at t a i a ig i a t i
i mi g a i a t
post MDA coverage and transmission assessment surveys. The transmission assessment survey in 50
m in t2018
districts a foundmithat
i the prevalence m ofa infection
a ia had
i significantly
g a a mi Since
reduced. i t at2003
t more
at i
than a111 million doses of lymphatic filariasis drugs have been administrated to at-risk population.
5.1.3.2 Goal, objectives,

5.1.3.2Goal, objectives,strategies
strategiesand
andtargets
targets
Box 5.1.3.1: Goal, objectives, strategies and targets of lymphatic filariasis elimination programme
oal The people of Nepal no longer suffer from lymphatic filariasis
b ecti es:
 To eliminate lymphatic filariasisasas a public health problem by 2020
 To interrupt the transmission of lymphatic filariasis
 To reduce and prevent morbidity
 To provide deworming through albendazole to endemic communities especially to children
 To reduce mosquito vectors by the application of suitable available vector control measures (integrated
vector management).
trate ies:
 Interrupt transmission by yearly mass drug administration using two drug regimens (diethylcarbamazine
citrate and albendazole) for six years
 Morbidity management by self-care and support using intensive simple, effective and local hygienic
techniques.
ar ets:
 To scale up MDA to all endemic districts by 2014
 Achieve <1% prevalence (microfilaraemia rate) in endemic districts after six years of MDA by 2018.
5.1.3.3Major
5.1.3.3 Major activities
activities in
in FY
FY2075/76
2075/76
Mass drug administration
Mass drug administration
MDA was continued in 15 districts in 2075/76. 2 districts completed seven, 6 districts completed
eight, 2a districts completed
i i t i t3 districts
nine, i i t iten
completed t andm1 district
t i t eleven
completed i t m t
rounds
ig t i t i t m t i i t i t m t t a i t i t m t
and 1 district completed first rounds of re-MDA in this year. A total of 52,28,247(66.6%) of the
atargetedi t78,49,070people
i t m t in t15 districts were treated i t this
i year.
a t tacampaign was conducted in
The t
taFebruary-March
g t 2019. The campaign mobilized around 6,500 health workers and 10,000trainedi
i i t i t t at t i a am aig a t
a a am aig m i i a at a t ai
female community health volunteers to reach the target populations and for monitoring campaign
ma mm it at t t a t ta g t a a m it i g am aig
activities. The main MDA-related activities are listed in Box 5.1.3.2.
a i mai at a i a it i B
More than 4,700 adverse events (mostly mild headaches, dizziness and stomach aches) were
t a after MDA.
reported a Health workerst mandt FCHV
mi mobilized
a a for thei campaign
i a reported
t ma nearly
a 2,500
t a at a m ii t am aig t a
cases of morbidity due to or suspected to be due to lymphatic filariasis. More than 30,000 cases of
a m i it t t t t m a a ia i t a a
lymphedema of the lower and upper limbs, breast swelling and hydrocele were reported from
m ma t a im at i ga t m
endemic districts
mi i t i t during
i g previous
i MDA campaigns.
am aig

i mi g a i a t
The progress and coverage of the MDA campaign is shown in Table 5.1.3.1.
The progress and coverage of the MDA campaign is shown in Table 5.1.3.1.
Table 5.1.3.1: Scaling-up and coverage of MDA campaigns
Table 5.1.3.1: Scaling-up and coverage of MDA campaigns
MDA MDA At risk Treated Epidemiological
Remarks
Year districts population population coverage %
2003 1 505,000 412,923 81.8
2004 3 1,541,200 1,258,113 81.6
2005 5 3,008,131 2,509,306 83.4
2006 3 2,075,812 1,729,259 83.3
2007 21 10,906,869 8,778,196 80.5
2009 21 10,907,690 8,690,789 80.0
2010 30 14,162,850 11,508,311 81.3 MDA stopped in 1 district
2011 36 15,505,463 12,276,826 79.2 MDA stopped in 4 more districts
2012 46 20,017,508 13,546,889 67.7
2013 56 21,852,201 16,116,207 73.8
2015 41 15,981,384 11,117,624 69.6
2019 15 78,49,070 52,28,247 66.61 MDA stopped in more 9 districts
Source: EDCD/DoHS
Box 5.1.3.2: MDA related major activities
National level activities — National task force committee meetings; interactions with the media,
professionals, organizations and civil society; monitoring and supervision; procurement and supply;
and advocacy and IEC/BCC activities.
Provincial level activities — Provincial level planning meetings in Biratnagar, Nepalgunj, Dhangadhi
and Pokhara; Provincial coordination meetings and monitoring and supervision.
Implementation unit and local level activities — Planning meetings, training of health workers,
advocacy, social mobilization, IEC/BCC, monitoring and supervision, interactions with the media,
interactions with multi-sector stakeholders including newly elected local body and logistics supply.
Community level activities — Volunteers orientations, advocacy, social mobilization, IEC/BCC,

implementation of MDA activities and monitoring and supervision.
Social mobilization activities — The production of revised IEC materials, checklists, reporting,

i mi g a i a t
recording, and guidelines for MDA campaign; media mobilization and advertisement of MDA;
coordination and collaboration with stakeholders and school health programmes and interactions in
schools on the LF disease and MDA.
Monitoring — Monitoring and management of post-MDA complications and adverse events.
Transmission Assessment Survey (TAS)—Panchthar, Ilam, Jhapa, Dhankuta, Morang, Lamjung,

Parbat, Baglun and Bardiya performed pre-TAS and only Panchthar and Ilam Passed the survey.After
completion of six round of MDA with pre-TAS passed, 10 districts(Bhojpur, Udayapur, Dailekh,
Bajura, Bajhang, Achham, Doti, Darchula, Baitadi and Dadeldhura) carried out TAS I, thirteen
districts (Saptari, Siraha, Okhaldhunga, Kathmandu, Lalitpur Urban, Bhaktapur, Kaski, Arghakhachi,
Pyuthan, Rukum east, Rukum west, Rolpa and Salyan) carried out TAS II and fourteen districts
(Dhanusha, Mahottari, Sarlahi, Rautahat, Sindhuli, Ramechhap, Sindhupalchok, Kavre, Nuwakot,
Dhading, Gorkha, Tanahun, Syangjha and Palpa) completed TAS III with supported of RTI/ENVISION.
All the districts passed TAS I and TAS II but 2 evaluation units (Dhanusha, Mahottari, Sarlahi,
Rautahat, Sindhuli) failed the TAS III.
Morbidity
Morbiditymanagement
management and
and disability prevention
disability prevention
Morbidity management
i it ma ag m t and a disability
i a i itprevention is the i second
t strategyt adopted
at g a by the t nationalt
elimination
a a imiprogramme
a to reduce
g amm t suffering ini ginfected
i i tpeople living
i i with
g it chronici and
a morbid
m i
conditions
i including
i i gelephantiasis,
a a lymphedema
i m and
mahydrocele.
a This strategy iincludes
t at activities
g i and
ainterventions
i a i tranging from a gihome-based
g m m self-care a by a people livingi i with
g it lymphedema
m ma and
a
a a i tto hospital-based
elephantiasis ita a ma ag m t and
management a surgicalgi a corrections of hydroceles.
The following
i g aactivities
i were carried
a i outt in
i 2075/76:
 1753hydrocele surgeries have been performed in year 2075/076. This surgery is included in the
g i
Red Book and is regularly adone in hospitalsmin endemic
i a districts. i g i i i t
B a i g a i ita i mi i t i t
 Morbidity mapping activities done in Terhathum, Udayapur, Sunsari, Rautahat, Sindhuli,
i it ma i g a i i at m a a a i a ta at i i
Kathmandu,Bhaktapur,
at ma B a ta Nuwakot,
a t Tanahun,
a a Syangjha,a g Arghakhachi,
a g a aSurkhet,
i Salyan
t anda a a
Achhamdistricts.
am i t i t
 All health
a t workersa and FCHVsi in Terhathum,
at m Udayapur,
a a Sunsari,
a i Rautahat,
a ta at Sindhuli,
i i Kathmandu,
at ma
B Bhaktapur,
a ta a tTanahun,
Nuwakot, a a Syangjha, Arghakhachi,
a g a gSurkhet,
a a Salyan
i and t a a a
am i t i t t ai a t
Achhamdistrictswere trained on patient self-care. a
Challengesand
Challenges andways
waysforward
forward
The major challenges that remain that need addressing to consolidate the achievements are
ma quality
ensuring a gMDAt including
at mai achieving
t at a coverage
high i g t in urban i atareas
t and a isome
m specific
t a
i g
communities, a itand adversei i g amanagement,
event i i g ig sustaining ag low
i prevalence
a a a ina MDA m i
phased out
districts, expanding morbidity management and disability prevention, and post MDA surveillance.t
mm i a a t ma ag m t tai i g a i a
iti t a i g m i it ma ag m t a i a i it a t i a
The biggest challenge is the persistent high prevalence in some districts despite completing the
igg t a g i t i t t ig a i m iti t it m gt
recommended rounds of MDA.
mm
The following are the major programme recommendations:
Continueare
 following
The MDA theformajor
Pre TAS un-successrecommendations:
programme districts, and carry out transmission assessment, periodic
surveillance and follow up surveys to monitor progress towards elimination.
 Strengthen the capacity of the health system i t i t and
a service
a providers
t t a mi i a
on morbidity m t
managementi i
i a a t m it
and disability prevention and post-MDA surveillance. g t a imi a

i mi g a i a t
t gt t a a it t at t ma i i m i it ma ag m t
a i a i it a t i a
 a outtoperational
Carry a aresearch,
a studies
t i anda programme
g amm
reviews.i
 i at a m t at t t g amm i a fori the later
Consolidate all documents related to the programme in a dossier t validation
at a and
i a a
i a imi a
verification of elimination.
Lymphatic Filariasis Elimination Status
Lymphatic Filariasis Elimination Status
Status of Province 1
Districts LF MDA Status Survey Status Up-coming Activity Remarks
Taplejung Non Endemic
Panchthar MDA TAS Pass 2019 TAS II 2022 Mapped
Ilam MDA TAS Pass2019 Mapping 2020
Jhapa MDA Re-Pre TAS Fail 2018 Re-Pre TAS 2020
Shankhuwasava Non Endemic
Terhathum MDA Stooped TAS I Pass 2017 TAS II 2020 Mapped
Bhojpur MDA Stooped TAS I Pass 2018 Mapping 2020
Morang MDA Re-Pre TAS Fail 2018 Re-Pre TAS 2020
Sunsari MDA Stooped TAS I Pass 2017 Mapping 2019/2020
Dhankuta MDA Re-Pre TAS Fail 2018 Re-Pre TAS 2020
Udaypur MDA Stooped TAS I Pass 2018 TAS II 2021 Mapped
Solukhumbu Non Endemic
Okhaldhunga MDA Stooped TAS II Pass 2019 TAS III 2022 Mapped
Khotang Non Endemic
Status of Province 2
Saptari MDA Stooped TAS II Pass 2019 TAS III 2022 Mapped
Siraha MDA Stooped TAS II Pass 2019 TAS III 2022
Dhanusha MDA Stooped TAS III Fail 2019
Mahottari MDA Stooped TAS III Fail 2019 Mapping 2020
Sarlahi MDA Stooped TAS III Fail 2019
Rautahat MDA Stooped TAS III Fail 2019 Mapped
Re-MDA,
Bara MDA TAS II Fail 2016 TAS 2020
Mapped
Parsa MDA Stooped TAS III Pass 2018

i mi g a i a t
Status of Bagmati Province
Dolakha Non Endemic
Ramechhap MDA Stooped TAS III Pass 2019 Mapping 2020
Sindhuli MDA Stooped TAS III Fail 2020 Mapped
Sindhupalchok MDA Stooped TAS III Pass 2020 Mapping 2020
Rasuwa Non Endemic
Nuwakot MDA Stooped TAS III Pass 2020 Mapped
Kavre MDA Stooped TAS II Pass 2016 TAS III 2019
Dhading MDA Stooped TAS III Pass 2019 Mapped
Kathmandu MDA Stooped TAS II Pass 2019 TAS III 2022 Mapped
Lalitpur Urban MDA Stooped TAS II Pass 2019 TAS III 2022
Lalitpur Rural MDA Stooped TAS I Pass 2017 TAS II 2020
Bhaktapur MDA Stooped TAS II Pass 2019 TAS II 2022 Mapped
Chitwan MDA Stooped TAS III Pass 2018 Mapping 2020
Makawanpur MDA Stooped TAS III Pass 2018
Status of Gandaki province

Manang Non Endemic
Gorkha MDA Stooped TAS III Pass 2019 Mapped
Lamjung MDA Re-Pre TAS Fail 2018 Re-Pre-TAS 2020 Mapped
Tanahun MDA Stooped TAS III Pass 2019 Mapping 2020
Mustang Non Endemic
Kaski MDA Stooped TAS II Pass 2019 Mapping 2020
Parbat MDA Re-Pre TAS Fail 2018 Re-Pre-TAS 2020
Baglung MDA Re-Pre TAS Fail 2018 Re-Pre-TAS 2020
Myagdi MDA Stooped TAS I Pass 2017 TAS II and Mapping

2020
Nawalpur MDA Stooped TAS III Pass 2018 Mapped
Syangja MDA Stooped TAS III Pass 2019 Mapped

Status of province 5
i mi g a
Up-coming i a t
Districts LF MDA Status Survey Status Remarks
Activity
Nawalparasi MDA Stooped TAS III Pass 2018 Mapped
Rupandehi MDA Stooped TAS III Pass 2017 Mapping 2020
Palpa MDA Stooped TAS III Pass 2019 Mapped
Arghakhanchi MDA Stooped TAS II Pass 2019 TAS II 2022 Mapped
Pyuthan MDA Stooped TAS II Pass 2019 Mapping 2020
Gulmi Non Endemic
Pre-Re-TAS Fail
Kapilbastu MDA Pre-Re-TAS 2020
2018
Dang MDA Pre-TAS Fail 2019 Re-Pre TAS 2021 Mapped
Banke MDA Pre-TAS Fail 2019 Re-Pre TAS 2021
Bardiya MDA Re-Pre-TAS Fail 2018 Re-Pre TAS 2020
Rolpa MDA Stooped TAS II Pass 2019 Mapping 2020
Rukum East MDA Stooped TAS II Pass 2019 TAS III 2022
Status of Karnali Province

Mapping,
Surkhet MDA Stooped TAS I Pass 2019
TAS II 2020
Mapping, TAS II
Jajarkot MDA Stooped TAS I Pass 2017
2020
Salyan MDA Stooped TAS II Pass 2019 TAS II 2022
Rukum West MDA Stooped TAS II Pass 2019 TAS III 2022
Kalikot Non Endemic
Mugu Non Endemic
Jumla Non Endemic
Humla Non Endemic
Dolpa Non Endemic
Status of Sudurpashchim Province

Bajhang MDA Stooped TAS I Pass 2018 TAS II 2021
Bajura MDA Stooped TAS I Pass 2018 TAS II 2021

i mi g a i a t
Achham MDA Stooped TAS I Pass 2018 TAS II 2021 Mapped
Doti MDA Stooped TAS I Pass 2018 Mapping 2020
Darchula MDA Stooped TAS I Pass 2018 TAS II 2021
Baitadi MDA Stooped TAS I Pass 2018 TAS II 2021 Mapped
Dadeldhura MDA Stooped TAS I Pass 2018 Mapping 2020
Kailali MDA Pre-TAS I Fail 2019 Re-Pre TAS II 2019
Kanchanpur MDA Pre-TAS Pass 2019 TAS I 2020 Mapped

5.1.4 Den e
5.1.4.1 ack ro nd
i mi g a i a t
Dengue
5.1.4 is a mosquito-borne disease that is transmitted by mosquitoes (Aedesaegypti and
Dengue
Aedesalbopictus) and occurs in most of the districts of Nepal.WHO (2009) classified dengue as: i)
5.1.4.1
DengueBackground
without warning signs, ii) Dengue with warning signs, iii) Severe Dengue. The first dengue case
was reported from Chitwan district in a foreigner. The earliest cases were detected in 2005.Since 2010,
g
dengue iepidemics
a m have it continuedi ato affect
t at lowland
i t a mi districts as m
well asitmid-hill areas.a This
g trend
a of
increased magnitude has since continued with number of outbreaks reported each year in gmany
a i t a i m t t i t i t a a i
a i g it t a i g ig ii g it a i g ig iii g
districts- Chitwan, Jhapa, Parsa (2012-2013), Jhapa, Chitwan (2016-2016), Rupandehi, Jhapa,
t g a a t m it a iti t i a ig a i t a
Mahottari(2017),
t t i Kaski
i (2018) and Sunsari,
g Kaski,
i mi Chitwana (2019). t a t a iti t a
The amostly
mi affected
i a a districts i t are Chitwan,i a mag itKailali, aBanke,
Kanchanpur, i Bardiya, Dang, Kapilbastu,
it m Parsa,
t a t a a i ma iti t it a a a a a a a it a
Rupandehi, Rautahat, Sarlahi, Saptari and Jhapa, reflecting the spread of the disease throughout the
a i a a a ai a i a ai a i it a
Tarai plains from west to east. In 2011, 79 confirmed cases were reported from 15 districts with the
m t a t iti t a it a a a ai a i Ba Ba i a a g
highest
a i a tnumber a ain Chitwan a (55).
i aDuring
ta at2012 a -15,
a i the a dengue
ta i a cases a still
a continued g t to be reported
a tfrom
several
i a tdistricts g butt tthe number
a ai aifluctuated m betweent t athe t years. In 2019, wem experienced
a the outbreak t at
Sunsari
m (Dharan),
i t i t Chitwan
it t (Bharatpur)
ig t mand Kaski i (Pokhara).
it a i g t g a
t t m a iti t tt m t at t t a
Aedesaegypti (the i mosquito-vector)
t t a at was identified
ai aain five peri-urban
it a B a at areas of the
a Terai
a i (Kailali,aDang,
a
Chitwan,
a g Parsa tand Jhapa)m during
it entomological
t a i surveillance i by EDCD duringi a 2006–2010,
a a indicating
t aithe
local
ai a itransmission
a g itof adengue.a aHowever,
a arecent
a study
i g carried
t m out gi by
a VBDRTC i ahas shown that bothi gthe
mosquitoes havei i afound g tto be transmitting
a t a mi the i disease ing Nepal. t t a i t
B a t at t t m it a t t a mi g t i a i a
Studies
t i carried
a i out int collaboration
i a witha the Walter it t Reed/AFRIMS
at Research Unit (WARUN)in a 2006itby
EDCD and ithe National Public Health a Laboratory
t a (NPHL)found
a i that a t all four
a sub-types
at of the Dengue
t viruses
at a (DEN-1, DEN-2, t DEN-3 and t DEN-g i a
iProgramme
a g i are given a intaiBox 5.1.4.1. a g t g amm a gi i B
5.1.4.2:Goa Objectives
5.1.4.2:Goal, jectives and Strategy
trate oof Den e Control
Dengue ontro Pro ra e
Programme
o 5.1.4.1: Nepal’s Dengue Control Programme
Goal To reduce the morbidity and mortality due to dengue fever, dengue haemorrhagic fever
(DHF) and dengue shock syndrome (DSS).
Objectives:
 To develop an integrated vector management (IVM) approach for prevention and control.
 To develop capacity on diagnosis and case management of dengue fever, DHF and DSS.
 To intensify health education and IEC activities.
 To strengthen the surveillance system for prediction, early detection, preparedness and early
response to dengue outbreaks.
Strategies:
 Early case detection, diagnosis, management and reporting of dengue fever
 Regular monitoring of dengue fever surveillance through the EWARS
 Mosquito vector surveillance in municipalities
 The integrated vector control approach where a combination of several approaches are
directed to wards containment and source reduction
5.1.4.3: Major activities in 2075/76

 Trained physicians, nurses, paramedics and laboratory technicians on dengue case detection,
diagnosis, management and reporting.
 Orientated municipality stakeholders in 34 districts.
 Supplied rapid diagnostic test kits (IgM).
 Dengue case monitoring and vector surveillance.
 Search and destruction of dengue vector larvae in 34 districts in different local levels.
 Developed IEC materials and disseminated health education messages engaging various
 Regular monitoring of dengue fever surveillance through the EWARS
i mi g a i a t
 Mosquito vector surveillance in municipalities
5.1.4.3:
 Major activities
The integrated in 2075/76
vector control approach where a combination of several approaches are
directed to wards containment and source reduction
ai i ia a am i a a at t i ia g a t
iagMajori activities
5.1.4.3: ma ag in m2075/76
ta g
 iTrained
tat physicians,
m i i a nurses,
it ta paramedicsi and laboratory
i t i t technicians on dengue case detection,
i a imanagement
diagnosis, iag t treporting.
and it g
g
 Orientateda m it i g astakeholders
municipality t in 34idistricts.
a
 aSupplied
a rapidt diagnostic test gkits (IgM).
t a a i iti t i i t a
mat ia a i mi
 Dengue case monitoring and vector surveillance.
at a t a m ag gagi g a i
ta i i g t m ia a t
 Search and destruction of dengue vector larvae in 34 districts in different local levels.
 Developed IEC materials and disseminated health education messages engaging various
Achievements
stakeholders including the media and youth.
Achievementsm t a a g i i ma ag m t a t g i
a
 Development of national guidelines on prevention, management and control of dengue in
Nepalt i t a a t g a at a ma t t ai i a
t i
 Conducted ToT by international experts on dengue and created a pool of master trainers in all
t
the provinces mat ia a i mi at t a a m ag t g m ia a
 t Developeda the
t mIEC
a materials
mm i a
and disseminated the awareness messages through media and
other relevant means of communications.
Table 5.1.4.1: Dengue cases (2073/74–2075/76)
District 2073/74 2074/75 2075/76 District 2073/74 2074/75 2075/76
Jhapa 54 3 5 29 Gorkha 1 2 0
Morang 0 2 8 1 Syangja 1 4 1
Sunsari 0 8 3 025 Kaski 1 553 21
Bhojpur 0 0 4 Baglung 4 4 1
Udaypur 0 0 1 Tanahu 0 1 1
Dhankuta 0 2 5 Parbat 0 2 2
Illam 0 1 2 Mustang 0 1 0
Taplejung 0 1 2 Myagdi 0 1 0
Shankhuwashbha 0 0 1 Gandaki Province 24 568 26
Panchthar 0 0 2 Arghakhanchi 21 4 5
Province -1 543 19 3152 Palpa 1 4 7 7
Saptari 0 2 4 Nawalparasi West 3 7 1 5 1 1
Siraha 0 1 1 Rupandehi 6 7 7 6 1 55
Dhanusa 27 0 0 Kapilbastu 57 8 6
Mahottari 4 3 8 3 3 Pyuthan 1 2 3 2
Sarlahi 1 3 0 2 0 Rolpa 4 0 0
Bara 2 1 0 Rukum East 0 0 0
Parsa 0 2 4 Dang 1 3 2 2
Rautahat 1 2 1 0 Banke 1 6 5
Province -2 609 12 12 Gulmi 0 1 0 0
Kavre 0 1 1 Bardiya 0 4 3
Lalitpur 0 1 2 Province- 5 836 120 96
Bhaktapur 1 0 3 Surkhet 2 0 0
Kathmandu 1 1 6 6 Dailekh 1 0 0
Dhading 6 7 7 5 Salyan 0 1 1
Makwanpur 3 9 8 3 arna i Province 3 1 1
Chitwan 23 28 23 Kailali 0 2 3
Nuwakot 0 0 1 Kanchanpur 0 1 4 2
Sindhuli 0 0 1 Dadeldhura 0 2 2
Dolkha 0 2 0 Achham 1 0 1
a ati Province 95 64 125 Darchula 0 9 4
d r as i
DoHS, Annual1 Report 2075/76 27 (2018/19)
12
Province
Grand ota 2111 811 3424
Source: EDCD/DoHS
The number of reported dengue cases has significantly increased from 2111 in FY 2073/74, 811 in FY
Makwanpur 3 9 8 3 arna i Province 3 1 1
Chitwan 23 28 23 Kailali 0 2 3
Nuwakot 0 0 1 Kanchanpur 0 1 4 2
Sindhuli 0 0 1 Dadeldhura i mi 0 g a 2i a 2 t
Dolkha 0 2 0 Achham 1 0 1
a ati Province 95 64 125 Darchula 0 9 4
d r as i
1 27 12
Province
Grand ota 2111 811 3424
Source: EDCD/DoHS
m of reported
The number t dengueg casesa has significantly
a ig i a increased
t i afrom 2111
m in FY 2073/74,
i 811 in FY i
t in FY i2075/76. The major cause
2074/75 to 3424 ma of increasing
a i the reported
a i g t case is the
t impact
a ioftglobal
im a t
g a g t a i g g a t
dengue outbreak.During FY 2075/76, 3424 dengue cases were reported from 44 districts (Table m iti t
a
5.1.4.1). The majorityma it havea beenareported from Sunsari
of cases t m ai
(88%), Makawanpur a a a Morang
(2.4%),
a g a a i t m at
(2.3%) and Rupandehi (1.6%). As well there were 2 confirmed deaths due to Dengue one t eachg from
a m a
Sunsari and Morang.i a a g
t that
Note t atDengue g casesa reported from
t Hospitals,
m ita and PHCCs
HOs a via the Earlyiawarning
t aand Reporting
a i g a
g
System (EWARS), t m a received
HMIS/DHIS2 and case reports a t programme
by the i t
sometimes g vary.
ammThe HMIS m m
a a i agg gat ata m ita a t a t
usually receives aggregate data from hospitals and other health facilities while the programmea i i i t
g amm collects
proactively a data from Hospitals
t atathrough
m EWARS. ita EDCD
t verifies
g data with the help i of line
atalisting
it t
i i
report of all cases. g t a a

i mi g a i a t
5.1.5 Leprosy
5.1.5 L epros y
5.1.5.1 Background
5.1.5.1 Background
T h e es tab li s h m ent of th e K h ok ana L epros ari um i n th e ni neteenth c entury w as th e b eg i nni ng of
ta i m t t a a ai mi t i t t t a t gi i g
org
ga ani
i z ed lepros y s erv i ic es i ni N epal.a K ey lepros y c ontroltm i lesmi
tonest s i nc e 1960
i and th ae g oal,
t ob gj ecati v es
and s tratega i es oft at
th eginati onal
t L epros
a y C aontrol P rog ram t m e are:g amm a
Ev olution and m iles tones of lepros y control program m e in Nepal
Year L andm arks
1960 L epros y s urv ey b y G ov ernm ent of N epal i n c ollab orati on w i th W HO
1966 P i lot proj ec t to c ontrol lepros y launc h ed w i th Daps one m onoth erapy
1982 I ntrod uc ti on of m ulti - d rug th erapy (M DT ) i n lepros y c ontrol prog ram m e
1987 I nteg rati on of v erti c al lepros y c ontrol prog ram m e i nto g eneral b as i c h ealth s erv i c es
1991 N ati onal lepros y eli m i nati on g oal s et
1995 F oc al pers ons (T B and lepros y as s i s tants [ T L As ] ) appoi nted f or d i s tri c ts and reg i ons
1996 All 75 d i s tri c ts w ere b roug h t i nto M DT prog ram m e
1999/2000– 2001/02 T w o round s of N ati onal L epros y E li m i nati on C am pai g n (N L E C ) i m plem ented
2008 I ntens i v e ef f orts m ad e f or ac h i ev i ng eli m i nati on at th e nati onal lev el
2009 and 2010 L epros y eli m i nati on ac h i ev ed and d ec lared at th e nati onal lev el
2011 N ati onal L epros y Strateg y (2011– 2015)
2012- 2013 E li m i nati on s us tai ned at nati onal lev el and nati onal g ui d eli nes , 2013 (2070) rev i s ed
2013 - 2014 M i d - term ev aluati on of i m plem entati on of N ati onal L epros y Strateg y (2011- 2015)
2014 - 2015 M i ni s try of Health d es i g nated L C D as th e Di s ab i li ty F oc al U ni t

P oli c y , Strateg y and 10 Y ears Ac ti on P lan on Di s ab i li ty M anag em ent (P rev enti on, T reatm ent
2017
and Reh ab i li tati on) 2073 - 2082 d ev eloped and d i s s em i nated
N ati onal L epros y Strateg y 2016- 2020 (2073 - 2077) d ev elop and end ors ed . Rev i s ed lepros y
2018
g ui d e li ne i n li ne w i th nati onal lepros y s trateg y and g lob al lepros y s trateg y .
2019 I n- d epth Rev i ew of N ati onal L epros y P rog ram m e and E nv i s i oni ng Road m ap to Z ero L epros y
5.1.5.2
5.1.5.2Goal,
Goal,objectives,
obj ectiv esstrategies andand
, s trategies targets of the
targets leprosy
of the control
lepros programme
y control program m e
Vis ion: L epros y f ree N epal
Vision: a
Goal : E nd th e c ons eq uenc es of lepros y i nc lud i ng d i s ab i li ty and s ti g m a
Goal : t i i g i a i it a gma
Guiding principles
Guiding
• principles
Stew ard s h i p and s y s tem s treng th eni ng
• E x ped i te th e eli m i nati on proc es s i n h i g h prev alenc e d i s tri c ts
•t Ca ollab iorati
a on, c oord
t m i nati
t on gtand ipartners
g h ip
it t imi a i ig a iti t
a a i a a at i
mm it i m t
t ga it a ia i i
i ag it i a at ag a tai a m t a

i mi g a i a t
Objectives:
i imi a tat i a i t i t
a i a t a at at a i it ia i ig
a iti t t g a i g t i a a
i at t a i t ami m m a ig
i t i a ma i i at
Strategies
a a a a a t t g t i a a
ti t a i t i a ma i i at
i a i t i t i i at a i g a it i
ig t t a a a at i a
a tm a i m i t a a t
5.1.5.3 Activities and achievements in 2075/76
i i a t t a t
m gt a a a t atm t at t t a a i gt
a a t m t t gim a a mt atm t a a
t a a i i t a a t a t t g t i g
t a t it at t g t at a ma a ai a t
a a t g a a a g a ai a
gt a i a a ma ag m t t g tt a
Capacity building — i g a a it i i ga i a t i g a a it
i i g g amm i
a m i ai i g t at at
i ta t t at i at a am aig a i am
ai i g t i a a ta at Ba a a a it a a a a a i
a a i at
ai i g a ta i ma ia i t i t mat gi t
at ma
imi a at a at a i itat a t i ia t i t
a t ai m a ga ita a i t i ta a t ai i g a
t a a a ita
IEC and advocacy — t a mm it a a a i a t

ta a g a t gma a i g a ta i g
t i a i t m ia t ig ig gt iag i a t atm t a
i a iti t i a at a t a i i i a iti t a
ai i g i a a m ag a a at i i a it
a a a i g amm ig ig gt a
World Leprosy Day— a i i at t at a i t m t

a a i a mm m at t ag t a a i a a t
t a g ai a i at a a i a iti t
t am a a m ia i t a g amm a a a g at i t i t
aw arenes s . L epros y m es s ag es w ere als o b road c as ted i n c oord i nati on w i th N epal T V and F M rad i o
prog ram m es h i g h li g h ti ng th e W orld L epros y Day .
W orld L ep rosy D ay — W orld L epros y Day w h i c h i s c eleb rated on th e las t Sund ay i n th e m onth of J anuary
w orld w i d e w as c om m em orated on 13 th M ag h 2075 (27th J anuary 2019) i n N epal as th e 66th W orld
L epros y Day b y c ond uc ti ng v ari ous ac ti v i ti es at nati onal, prov i nc e and d i s tri c t lev els . O n th e s am e d ay a
m i ed mi g ati on prog
i a i nterac i aram m e tw as arrang ed at DoHS i n pres enc e of th e Di rec tor G eneral, b lank ets
d i s tri b auti ona progt ram i tm ie f or 55 lepros y af f ec ted people w as org
g amm a anit z ed at J h apa ad i s tri c ga
t i ni c oordati natiaona
ofi tHealth
i t i O f f i c e:i J ah apa and Health
a t Di rec torate a ofa aP rov i nc ae t1 andi attL algatad h L epros iy Hos piatal and at s aervgai c e
c entre. . ita a i t
Reviews — Reg ular tri m es ter rev i ew m eeti ng s w ere h eld at d i s tri c t and prov i nc i al lev els w h ere
Reviews — g a t im t i m g at i t i t a i ia
ag g reg ated d ata, ad m i ni s trati v e i s s ues and ac c om pli s h m ents w ere pres ented and d i s c us s ed and f uture
agg gat ata a mi i t a i a a m i m t t a i a
plans d i s c us s ed . T w o c entral tri m es ter rev i ew w ork s h ops w ere h eld to as s es s th e outc om e and
t a i t a t im t i t a t t m
am onimtori itng iof g th et prog ramg amm m e. T B - LBepros y O f f i c ers (T L O s ) f rom mtht e prov i inc e h ealth a t d ii rec ttorates
at
pres ented t and
a s h ared
a i nf
i orm ati
ma on and a i s s uesi on th e lepros
t y prog ram m g amm i t i nci es . P rovi i nc e
e i n th ei r prov
L og i is ti c m anag gi em ent ma c entres
ag m ’ c ht i ef s alst o pres ented i a th e s toc k s and
t s tupply tof M DTa d rug s and i nf orm ed
th atga i M DT s upply h
m t at ad b een properly m anaga ed ov er th e y ear.
ma ag t a
E arly case detection— An ac ti v e c as e d etec ti on w as c arri ed out i n Sarlah i d i s tri c t w i th th e s upport f rom
Early case detection— a a t a a i t i a a i i t i t it t t
W m HO , L alg ad ah ga L epros y Hos pi tal anditaServa i c e C entre,
i P rov ti nc e Health i Di rec atorate
t i of P t rovati nc e and Soci i al
aDev elopmia ent M i ni s m try oft P rovi ii nct e 2. 762 h ealth
i w ork ers , 14a 63t F C HV s and 4 9 lepros y afaf ec ted peoples
a t w ere ori ented on perf orm i
i tng h ous e- to- h ous
mi g h es . tT h e s earc h esa w ere th en c arri
e s earc a ed out. L epros t y
aof f i ic ers , s tuperv i s ors and partner persi onnel a th ena s tupported h ealth t f ac i li ti es to td i ag nosa et anda im i anag te
i iag
d enti f i ed ac as esma. ag i a
Table 5.1.5.1 Sum m ary Findings ( Activ e Cas e Detection in Sarlahi Dis trict)
Dis trict Screened No. of No. of confirm ed new cas es

Population s us pect
M B P B T otal N ew F em ale C h i ld G rad e 2
cas es
c as es Di s ab i li ty
Sarlahi 1,88,129 553 7 51 58 3 4 16 0
Source: L CDM S/ EDCD
E nh aanc ed c ontac ta tt ex amami

i natia on prog ramg ammm e w as ac arri aed iout c arrit eda out
i i n Dht anusi h aa w h ere a 6,083 people
w ere s c reened out of th et targ teted ta10,4 g t 08 populati on b y c
a ov eri ng s i x h ous es
i g i s urround i ng 220 i nd iex g
c as esi . 19 new a c as es (2 M aB + 17 P BB ) w ereBd etec ted amt ong t am th e refg erred
t 154 s us pec t c as es ti n ath e
i rest pec ti v e h ealth f acai litti es a. T i h i e c ontac t ex amta i nati
t on amiteama als to am a
s ent 4 old lepros t y c as es as s aus pec at.
I d enti f ti c ati on, c onf
a i rm ati on of ma lepros y c as es and tha ei r vaali d tati on
i anda i d aata w aere c omatapi led i n th mi s wi h ole
i
t i g amm a t i a ia it a a ga
ita a i t
Continued medical education— a m i a a t a mat gi t

i t a t m i a at ma i t i ti t at i g a i a t
i t ta t ig ig t t i i a ia i t i t i g i a
a gma a i t at i ma at t ma ag m t
a
Transport support to released-from-treatment cases — g amm i ga t

t a t a m t atm t t t i ta t t a m g
t atm t t atm t g a it at a t i i ai g at t t ii t i
i
Recording, reporting, update and leprosy case validation— i g g at a a

ai a a a i ti a a a ga a a iti t t i ata a a
i at a ii t a i at a iag at a ii a t t gt i ga

i mi g a i a t
ga t a a m t atm t
Supervision and monitoring — g a i i it ta ta t g i

at at i a at a ii a t a
Coordination with partners — ga i i a m g am g t at

i gi t t a i a i it ma ag m t t m g i t i
a m g a ta m i i a
a t t a a a i B a at i
i a i a i ia a
a a a i a a i ita m m ta m t a a
a t a g a at a i t a mm a a t at
a a t g amm g i i imi a i a m g it a t i g
i a i it a ag m t a a i ita t a im ta
Post exposure prophylaxis— t a i i i i g t

i am i i i gi t ta t iag a t t a
t i i
i g i t t ai a i a a a i at a a i iti t m
t i i a i t iti t a a a g a a a i g amm i i g im m t i
g m ta a at i i a t a i a
t t
Grant to leprosy affected persons— a aga ti i t t a t

i t i t a aa aa a am t g t a i ia
ga t a tt mi i a i a t t i
a t a i t a imat a t
In-depth Review of National Leprosy Programme and Envisioning Roadmap to Zero Leprosy—
i t i a a g amm a t m it a
t am t m a a at i Bi ita
a a a a ita t a t t t t g amm
a gt a g t i a mm a t a ai
t am it t at a ta g amm a a a ma
t a i m t i a
Priority Assistive Product List(PAPL) 2075— it a i a a i t a

i i it i t ita i i a t a
i i a it a i a t a a t a t i t a a
ta i g i a i it ma ag m t a a i ita it tai a
a i t i i g m i it ai t t a a i t g i
a a i ia a a i i t i ii ta a a i t a i
a i g i g i m i it i i a i g mm i a g i a i m t
Distribution of Assistive Product— ga t mi i a ga t t a a ia

i t i a t ii a i ti a i t t it i a i i m
iti t t g t i m a i i iti t t
it i a i i i i t i t i m i it ai a
a a ai a t i it i i t a i
t i ga t a a i a ga t mi i a a t

i mi g a i a t
1.1.1 ACTIVITIES SUPPORTED BY PARTNERS
t t g i t i a t t
t a i a i it ma ag m t g amm a i t i ii a m it i g a
t a a it i i g a a t a t mm it a a g amm
The partners: i i a a t t a a a i
ami a t a i a t t i g
a i i ig mi i t i t
mm it a a a a i a g amm
i ta mm it m m
ii ima a a t a a at a t
a a it i i ga i g m t at
i a tt g i t i i a m it i g
i a i it i a a i ita i
ma im m ta a t a a g at
a t a i i g it i a i i t
t t a i g amm
imi a g a i a a a a a i tat it a ta
i g i a i it ma ag m t a a i ita t at a ta
a a a ia a a a ia at t t ma
i a ii a i a t a a a m a t ita a a i ita t
ia i i a a t i a ga i a i a
i t a ia a a a a ia t a t
i t t a i t i g a ta t a a a a i i
i a i it ma ag m t a a i i ia i it i at i
t ai i g i mi a t a t ai i g t g m t at
a ma mm it at t t t a a t a i ita a
t im ai m t i i i aa t a a ii a m t t
a t t m i Ba a a a a
Prevalence
Overall prevalence
tt a i i g i a i ma
a gi t a at a a at t a a i at i
t t i t a a t t i i at t imi a
a a i at m i t at a imi a tat m i i g
tai a at a am a t i a t iti t iti t
t a iti t a a a at a i t i t a a at m
t a

i mi g a i a t
Figure 5.1.5.1: Leprosy Prevalence in Nepal, 2075/76 (2018/19)
Source: EDCD/
Source: EDCD/ H H M M I ISS
T T h h ee h h i i g g h h igeses tt num
num b er of lepros y c as es und er treatm entent
t b mer of lepros y c as esa und er treatm
w as reported f rom f P rom
t atm w ast reported a t
rov i ncP rove- 2 (1177 c as es , 4 0% of
m i nc e- i2 (1177 c as es ,a4 0% of
total) and low es t b
total) and t lowta es at b y G and tak i P rov y G and ak i P rov i nc e and K arnali P rov i nc e (3 % eac h ). T h e reg i s tered prev alenc e rate
a i nca ei and iK arnalia P rova i nca ei (3 % i eac h ). T h ea reg i s tered giprevt alenc e rate
w as th e h i g h es t i n P rov i nc e- 2 (1. 93 c as e per 10,000 populati on) f ollow ed b y P rov i nc e- 5 and low es t
w asa th e h at i g h es at i nt P rovigi nc e-t2i (1. 93 i c as e per 10,000 a populati on) f ollowa ed b y P rov i nc e- 5 and i low es t
prev alenc e w as reported at G and ak i P rov i nc e- 3 (0. 4 0 c as e per 10,000 populati on).
prev a alenc e w t as reported a ataG and ak ti P rovati nc ae- 3 a(0.i 4 0 c asi e per 10,000apopulati on). a
Table: 5.1.5.3 Dis tribution of Regis tered Cas es and Prev alence Rate in 2075/ 76 ( 2018/ 2019)
Table: 5.1.5.3
Table: DisDistribution
5.1.5.3 tribution of of
Regis tered CasCases
Registered es and PrevPrevalence
and alence Rate in 2075/
Rate 76 ( 2018/
in 2075/76 2019)
(2018/2019)
No. of regis tered prev alence cas es at the end of the y ear
Prov inces No. of regis tered prev alence cas es at the end of the y ear
Prev alence rate
Prov inces Total cas es Percentage
( Per 10, 000Prev alence rate
population)
Total cas es Percentage
P rov i nc e- 1 4 26 14 . 58% ( Per0. 10,
87 000 population)
P P rov
rov i nc e-e- 21 4 26
1177 14 . 58%
4 0. 29% 1. 93 0. 87
P B rov
ag m i ncatie-P 2rov i nc e 2941177 4 0. 29%
10. 06% 0. 4 7 1. 93
B G agandm akatii P P rov
rov i nci nc ee 101294 3 . 56%10. 06% 0. 4 0 0. 4 7
G P and
rov i ncak e-i P 5rov i nc e 527101 18. 04 3 % . 56% 1. 05 0. 4 0
P K rov
arnali
i nc P e-rov5 i nc e 95527 3 . 25%18. 04 % 0. 54 1. 05
K Sud urP asP rov
arnali c h i m i nc P erov i nc e 3 0195 10. 3 0%3 . 25% 1. 05 0. 54
National
Sud urP as c h i m P rov i nc e 2921
3 01 100%10. 3 0% 0.99 1. 05
National
Source: EDCD/ H M I S 2921 100% 0.99
Source: EDCD/ H M I S
m iti t g a a at m t a a
a t m i t i a ig i iti t a i t ai t a a
iti t t t ig t a at a am g a iti t
it
T h e num b er of d i s tri c ts reporti ng a prev alenc e rate of m ore th an 1 per 10,000 populati ons
d ec reas ed to 17 f rom 21 i n th e prev i ous y ear (F i g ure). F i f teen d i s tri c ts are i n th e T erai b elt. Dh anus h a
d i s tri c t reported th e h i g h es t prev alenc e rate of 3 . 4 9 per 10,000 populati on am ong all 17 d i s tri c ts w i th
P R>i 1. mi g a i a t
Figure:
Figure:5.1.5.2
5.1.5.2 Dis tricts with
Districts withL Leprosy
epros y Prev alence Rate
Prevalence Rate Abov
Above e 11 per
per 10,
10,000000 Population
Population
Uday pur 1.11

Rupandehi 1.28
Mahottari 1.38
Bardiy a 1.40
Rautahat 1.43
Morang 1.45
Nawalparas i Wes t 1.46
Siraha 1.56
K apilv as tu 1.56
Achham 1.80
K ailali 1.91
Jhapa 1.95
Sarlahi 1.96
Pars a 2.05
Banke 2.17
Bara 2.36
Dhanus ha 3.49
- 0. 50 1. 00 1. 50 2. 00 2. 50 3 . 00 3 . 50 4 . 00
NEWCASE
NEW CASEDETECTION
DETECTION
T h e d etec t ti on of new ac as es igs i g ini f i es ong g i oigngt atrans mi m ii s s i onit w i tth th ate rate
m a m eas ured per 100,000
populati ons . A total of 3 282 new lepros y c as es w ere d etec ted i n 2075/76 w i th 4 5. 22% of new a c as es i n
a t ta a t t i it
i i a a i a a i i a t t a t a
P rov i nc e- 2 (14 84 c as es ). M eanw h i le, G and ak i P rov i nc e h as th e low es t new c as e d etec ti on (as s h ow n i n
i t g a t at a
th ea f i g ure). aT h e new a c as e d etec ti on rate (N C DR) per 100,000 populati ons f or F Y 2075/76 w as 11. 16
nati onally .
ig t i t i t a ta am a a it i a a a a a g ta g a
E ig h tm d i s tria c tts (Dh ankt uta, Ram ecah h ap, t iL ali tpur,
a Sii nd h upalc i t ih okt , Ras
a uwa a, M tanang , M atus tang
m andt aRuk um
E as t) ig
reported noi newBac as es itht i is ty ear a w t h i le ig17 d i ts triatc ts h ad c as e d etec ti on rates a m aore th an 10 (F i g ure)
ofFigure
w h i c h 5.1.5.3:
B ank e Prov
d i s tri ince-
c t h adwisth eeNew
h i g h esL epros
t ratey (4Cas4 . es70), 2075/
f ollow 76ed ( b 2018/
y Dh anus
2019) h a (4 4 . 4 2).
ig i i a
89
3 %
266 4 71
8% 14 % P rov i nc e- 1
719 P rov i nc e- 2
22%
B ag m ati P rov i nc e
G and ak i P rov i nc e
14 84
4 5% P rov i nc e- 5
K arnali P rov i nc e
88
3 % 165 Sud ur P as h c h i m P rov i nc e
5%
DoHS,
Figure 5.1.5.4: Dis tricts with More than 10 New Cas e Detection Annual
Rate per Report 2075/76
100, 000 (2018/19)
Population, 2075/ 76
( 2018/ 2019)
Banke 44.70
Dhanus ha 44.42
Sarlahi 35.79
4 5% P rov i nc e- 5
K arnali P rov i nc e
88
3 % 165 Sud ur P as h c h i m P rov i nc e
5%
i mi g a i a t
Figure 5.1.5.4: Districts with More than 10 New Case Detection Rate per 100,000 Population,
Figure
2075/765.1.5.4: Dis tricts with More than 10 New Cas e Detection Rate per 100, 000 Population, 2075/ 76
(2018/2019)
( 2018/ 2019)
Banke 44.70
Dhanus ha 44.42
Sarlahi 35.79
Mahottari 23.40
Rautahat 23.36
Pars a 19.37
K ailali 18.78
Bara 18.61
Jhapa 18.60
K apilbas tu 18.06
Morang 16.40
Rupandehi 14.97
Bardiy a 13.74
Siraha 13.41
Nawalparas i Wes t 13.06
Achham 12.01
Uday pur 11.42
- 5. 00 10. 00 15. 00 20. 00 25. 00 3 0. 00 3 5. 00 4 0. 00 4 5. 00 50. 00
F i f ty f our perc ent of new c as es w ere m ulti b ac i llary (M B ) and th e res t w ere pauc i b ac i llary (P B ). T h i s
i
proporti on h as remt ai ned around
a f i f tymperc ent
a i af or th eBlasa t f ewt y earst . M oreath ani aone
i a th i rd B (4 1. 93i % ) of
a mai a t t at a t a t i
th e tnew c as esa w ere f em ales ma . T h e f em ale
ma proporti on h as rem
a mai ai ned i n th
i t e rang
a ge of 3 0- 4 0 perc entt f or th e
las t f ti v e y aears
t . a
Table5.1.5.4:
Table 5.1.5.4: Dis
Distribution
tribution of new
Newleprosy
L epros y cases
Cas es2075/76 (2018/2019)
2075/ 76 ( 2018/ 2019)
Prov inces Total New Cas es NCDR
P rov i nc e- 1 4 71 9. 66
P rov i nc e- 2 14 84 24 . 28
B ag m ati P rov i nc e 165 2. 63
G and ak i P rov i nc e 88 3 . 52
P rov i nc e- 5 719 14 . 3 8
K arnali P rov i nc e 89 5. 03
Sud ur P as c h i m P rov i nc e 266 9. 28
National 3282 11.16

Source: E DC D/HM I S
TREND IN PREVAL ENCE, CASE DETECTION AND REL APSE CASES

T h ere trend of new c as e d etec ti on and th e num b er of reg i s tered c as es i n th e las t ei g h t y ears h ad
rem ai ned s tag nant. T h e prev alenc e d ec reas ed i n 2066/67 (2009/2010) w h en eli m i nati on s tatus w as
d DoHS,
ec laredAnnual
and Report 2075/76
h as b een und er(2018/19)
th e eli m i nati on rate ti ll d ate and h as b een ri s i ng s i nc e th en. T h e i nc reas e i n
th e prev alenc e rate m i g h t b e d ue to c as e h old i ng , i rreg ulari ty of i ntak e of M DT and i s s ues i n rec ord i ng
and reporti ng . How ev er, th e new c as e d etec ti on rate h as rem ai ned b etw een 10 & 11 s i nc e th e
eli m i nati on. T h e num b er of relaps e c as es i nc reas ed f rom 21 c as es i n th e prev i ous y ear to 3 6 i n 2075/76
(2018/2019).
i mi g a i a t
TREND IN PREVALENCE, CASE DETECTION AND RELAPSE CASES
t a t a t m gi t a i t a t ig t a a
mai tag a t a a i imi a ta
t a a a a t imi a at at a a ii gi t
i a i t a at mig t t a i g i g a it i ta a
i i i ga g t a t at a mai t
i t imi a m a a i a m a i t i a
t i
Figure 5.1.5.5:Trend
Figure 5.1.5.5: Trend in New
in New Leprosy
L epros Case Detection
y Cas e Detection Rate andRate
Prev and Prevalence
alence Rate from Rate
2067/ from 2067/68-
68- 2075/ 76
2075/76 (2010/11-2018/19) ( 2010/ 11- 2018/ 19)
Figure 5.1.5.5: Trend in New L epros y Cas e Detection Rate and Prev alence Rate from 2067/ 68- 2075/ 76
1 ( 2010/ 11- 2018/ 19) 25
ATION
1 0.99 0.99 25
ATION
0.92 0.99 0.99
0.89 0.89 20
ATION
0. 75 0.85 0.84 0.83 0.92

0.89 0.89 20
POPUL
0.79
ATION
0. 75 0.85 0.84 0.83
POPUL
0.79 15
POPUL
000000
0. 5 15
POPUL
10, 000
0. 5 12.2 11.9 10
100,100,
11.2 11.8 11.23 11.19 11.23
11.01 10.67
10, 000
12.2 11.9 11.8 10

11.2 11.01 10.67 11.23 11.19 11.23
NCDR/
0. 25
PR/ PR/
NCDR/
0. 25
PR NCDR 5
0 PR NCDR 0
0 2067/68 2068/69 2069/70 2070/71 2071/72 2072/73 2073 /74 2074 /75 2075/76 0
(2010/11) 2068/69
2067/68 (2011/12) 2069/70
(2012/13 ) 2070/71
(2013 /14 ) 2071/72
(2014 /15) 2072/73
(2015/16) 2073
(2016/17)
/74 (2017/18)
2074 (2018/19)
/75 2075/76
(2010/11) (2011/12) (2012/13 ) (2013 /14 ) (2014 /15) (2015/16) (2016/17) (2017/18) (2018/19)
Figure 5.1.5.6: Trend in Relaps e Cas es from 2067/ 68 - 2074/ 75 ( 2010/ 2011- 2018/ 19)
Figure5.1.5.6:
Figure 5.1.5.6: Trend
Trend in Relapse
in Relaps e Cas esCases
from from
2067/ 2067/68
68 - 2074/- 75
2074/75 (2010/2011-2018/19)
( 2010/ 2011- 2018/ 19)
4 0 3 6
4 0 3 6
3 5
3 5 27
3 0
3 0 27
25 21
20
25 21
20 20
15
20 12
15 11 15
15 11 8 12
10
5 8
10
5 5
5
0
2067/68
0 2068/69 2069/70 2070/71 2071/72 2072/73 2073 /74 2074 /75 2075/76
(2010/11)
2067/68 (2011/12)
2068/69 (2012/13
2069/70 ) (2013 /14
2070/71 ) (2014 /15)
2071/72 (2015/16)
2072/73 (2016/17)
2073 /74 (2017/18)
2074 /75 (2018/19)
2075/76
(2010/11) (2011/12) (2012/13 ) (2013 /14 ) (2014 /15) (2015/16) (2016/17) (2017/18) (2018/19)
Source:
DISABILE DCITY
D/HMCASES
IS
DISABIL ITY CASES

L epros y c as es th at are not d etec ted early on or i n a ti m ely and c om plete m ay res ults i n d i s ab i li ti es . E arly
L d epros
etec tiy on
c as and
es th tiatm are ely not
and d c etec ted early
om plete treatmon ent
or i ni s a c tiruc
m elyi al and c om enti
f or prev pleteng m d ayi s abresi liults
ti es .i nT d h i es abP roporti
i li ti es . E on
arlyof
d G etec
rad tieon2 Diands ab tii lim ty ely(G 2D)
and amc om ongplete
new treatm
c as es ent
and i s th c erucrate
i al f per
or prev enti ngpopulati
100,000 d i s ab i lion ti esare
. T h m eajP or roporti
m oni on tori ofng
G rad e 2 Di s ab i li ty (G 2D) am ong new c as es and th e rate per 100,000 DoHS,
populatiAnnual on are Report m aj 2075/76
or m oni tori (2018/19)
ng
i mi g a i a t
DISABILITY CASES
a t at a t t t a i a m a m t ma t i
i a ii a t a m a m t t atm t i ia g i a ii
a i a i it am g a a t at a
i and i c ma
ators of early c as e d etec ti on. Duri nga
m it i g i i at a t i g a
2075/76 (2018/2019), 156 c as es of v i s i b le d i s ab i li ty (G 2D) w ere
reci iord ed i w ai th i ita proporti on am ong new c asites aof 5. 3 0% nati onally
am . g a a a
ig 5.1.5.7: Trend ini Grade

Figure a 2 Dis iability
a i it Cas aes from m
2067/ 068 to t2075/ 076 ( 2010/ 11- 2018/ 2019)
5.5. 00
00 44 .. 75
75
44 .. 44 2
2
44 .. 09
09
44 .. 00
00
33 .. 44 7 33 .. 57
57
7 33 .. 33 8
8
33 .. 16
16
2.
2. 89
89
33 .. 00
00 2.2. 71
71
2.2. 00
00
1.1. 00
00
0.0. 00
00
2067/68
2067/68 2068/69
2068/69 2069/70
2069/70 2070/71
2070/71 2071/72
2071/72 2072/73
2072/73 2073 /74
2073 /74 2074 /75
2074 /75 2075/76
2075/76
(2010/11)
(2010/11) (2011/12)
(2011/12) (2012/13 ))
(2012/13 (2013 /14
(2013 /14 )) (2014 /15)
(2014 /15) (2015/16)
(2015/16) (2016/17)
(2016/17) (2017/18)
(2017/18) (2018/19)
(2018/19)
Figure
Figure5.1.5.8:
5.1.5.8:Trend
TrendininChild
ChildCasCases
es fromfrom
2067/ 068 to 2075/
2067/068 076 ( 2010/
to 2075/076 11- 2018/ 19)
(2010/11-2018/19)
10. 00
10. 00
7.73 7.92
7.92
7.73
8.8. 00
00 7.20
7.20 6.84
6.84
6.26
6.26 6.33
6.33 6.22
6.22
6.6. 00
00 5.19
5.19
4.18
4.18
44 .. 00
00
2.2. 00
00
0.0. 00
00
2067/68
2067/68 2068/69
2068/69 2069/70
2069/70 2070/71
2070/71 2071/72
2071/72 2072/73
2072/73 2073 /74
2073 /74 2074 /75
2074 /75 2074 /75
2074 /75
(2010/11)
(2010/11) (2011/12)
(2011/12) (2012/13 ))
(2012/13 (2013 /14
(2013 /14 )) (2014 /15)
(2014 /15) (2015/16)
(2015/16) (2016/17)
(2016/17) (2017/18)
(2017/18) (2018/19)
(2018/19)
Source:
Source: EE DC
DC D/HM
D/HM II SS

i mi g a i a t
t ta i a iag i gt
a i a a a mt i a at g t t i t a g
Conclusions
A total of 260 new c h i ld c as es w ere d i ag nos ed i n 2075/76 (2018/2019) res ulti ng to 6. 22% of new c as es .
T h i s w as a d ec reas e f rom th e prev i ous y ear alth oug h th e trend i s f luc tuati ng .
imi a
Conclus ions
tat a mai tai at t a a a t a at mai
a a t i a at g t i at a ig i iti t i a
T h e eli m i nati ma
on s tatus
a w as m i ai ntai
a ned at th e nati aonal lev el t as thme prev alenc a ea ratearem ai neda b elow t 1
a i c as e per 10,000a populati
g on th i is y aear altha oug h ath t i s ratei w as s itti ll h ai g h t i n 17 d i s tri
t c ts im
. T h e im
nc reastaed
proporti on of f em ale and c h i ld c as es c ould b e a res ult of m ore early and ac ti v e c as e d etec ti on ac ti v i ti es .
g amm
T h ere w as g ood c oord i nati on and partners h i ps w i th partners f or th e i m plem entati on of prog ram m es .
T gh e f i g ures tf or mai
th e m aii n i ind at t f or tht e lasat tni ne
i c ators of lepros y c ontrol i y ears a area s um m mma
ari s ed ii n T abi le a
i w t h i lemaith e m ai n s treng th s , w eak nes s and c h alleng es of th e lepros y c ontrol prog ram m e are li s ted . a
t gt a a a g t t g amm it
Table 5.1.5.5: Comparison of Leprosy Indicators - 2066/67–2075/76 (2009/10 – 2018/19)

Table 5.1.5.5: Com paris on of L epros y Indicators - 2066/ 67– 2075/ 76 ( 2009/ 10 – 2018/ 19)
2075/ 76( 2
2066/ 67
2067/ 68
2068/ 69
2069/ 70
2070/ 71
2071/ 72
( 2009/ 10)
2072/ 73
( 2010/ 11)
2073/ 74
( 2011/ 12)
2074/ 75
( 2012/ 13)
( 2013/ 14)
( 2014/ 15)
( 2015/ 16)
( 2016/ 17)
( 2017/ 18)
018/ 19)
Indicators
N ew c as es 3 ,157 3 ,14 2 3 ,4 81 3 ,253 3 ,223 3 ,053 3 ,054 3 215 3 24 9 3 282
N ew c as e d etec ti on rate 11. 5 11. 2 12. 2 11. 9 11. 18 11. 01 10. 67 11. 23 11. 19 11. 16
U nd er T reatm ent c as es at th e end 2,104 2,210 2,4 3 0 2,228 2,271 2,4 61 2,559 2626 2882 2921
P R/10,000 populati on 0. 77 0. 79 0. 85 0. 82 0. 83 0. 89 0. 89 0. 92 0. 99 0. 99
N o. new c h i ld c as es 212 163 218 13 6 204 23 6 220 220 202 260
P roporti on c h i ld c as es 6. 71 5. 19 6. 26 4 . 24 6. 3 3 7. 73 7. 20 6. 84 6. 22 7. 92
N ew G 2D c as es 86 109 110 94 109 13 5 109 87 13 3 156
P roporti onG 2D c as es 2. 72 3 .4 7 3 . 16 2. 89 3 .3 8 4 .4 2 3 . 57 2. 71 4 . 09 4 . 75
G 2D rate/100,0000 3 .1 3 .9 3 .9 3 .5 4 .0 4 .9 3 .8 3 .3 4 .1 5. 3 0
N ew G 2D C h i ld c as es N /A N /A N /A N /A N /A N /A N /A N /A 2 2
P roporti onG 2D C h i ld c as es N /A N /A N /A N /A N /A N /A N /A N /A 0. 06 0. 06
N ew f em ale c as es 1,03 0 892 1,100 1,004 1,14 3 1,100 1,169 13 61 13 75 13 76
P roporti on f em ale c as es 3 2. 6 28. 4 3 1. 6 3 0. 8 3 5. 4 6 3 6. 03 3 8. 28 4 2. 3 3 4 2. 3 2 4 1. 93
Releas ed f rom treatm ent 3 ,84 4 2,979 3 ,190 3 ,3 74 3 187 2,800 2,902 3 04 0 2852 3 221
N o. Def aulters 25 3 1 24 4 3 24 3 8 4 4 57 93 14 2
N o. relaps e c as es 18 20 25 14 11 8 12 15 21 3 6
Source: EDCD/ H M I S

i mi g a i a t
Table 5.1.5.6: Strengths, Weakness and Challenges for the Leprosy Control Programme
Table 5.1.5.6: Strengths , Weaknes s and Challenges for the L epros y Control Program m e
Strengths Weaknes s es Challenges
• C om m i tm ent f rom poli ti c al lev el • L ow pri ori ty f or lepros y • T o s us tai n th e eli m i nati on
– g ov ernm ent' s c om m i tm ent to prog ram m e at peri ph ery ac h i ev ed at nati onal lev el and
B ang k ok Dec larati on f or L epros y • L ow m oti v ati on of h ealth eli m i nati on at d i s tri c t lev el
• Ac c es s i b le of lepros y s erv i c e w ork ers • T o m ai ntai n ac c es s and q uali ty of
• F ree M DT , trans port s erv i c e f or • V ery f ew reh ab i li tati on s erv i c es i n low end em i c m ountai n
releas ed f rom treatm ent c as es ac ti v i ti es and h i ll d i s tri c ts
and oth er s erv i c es f or treati ng • I nad eq uate trai ni ng and • T o s treng th en s urv ei llanc e,
c om pli c ati ons ori entati on f or new ly log i s ti c , i nf orm ati on, and j ob
• U ni nterrupted s upply of M DT rec rui ted h ealth w ork ers and ori ented c apac i ty - b ui ld i ng f or
• G ood c om m uni c ati on and ref res h er trai ni ng s f or f oc al g eneral h ealth w ork ers , and an
c ollab orati on am ong s upporti ng pers ons and m anag ers ef f i c i ent ref erral netw ork
partners • P oor i ns ti tuti onal s et- up and • T o as s es s th e m ag ni tud e of
• I m prov i ng parti c i pati on of i nad eq uate h um an res ourc es d i s ab i li ty d ue to lepros y
lepros y af f ec ted people i n • P rob lem f or reac ti on and • T o f urth er red uc e s ti g m a and
nati onal prog ram m e c om pli c ati on m anag em ent at d i s c ri m i nati on ag ai ns t af f ec ted
• Steeri ng , c oord i nati on and peri ph ery lev el pers ons and th ei r f am i li es
tec h ni c al c om m i ttees f orm ed • P oor res ult- b as ed output, • I ns uf f i c i ent ac ti v i ti es i n low
and c ond uc ti ng m eeti ng i n rec ord i ng and reporti ng of end em i c d i s tri c ts f or red uc i ng th e
reg ular b as i s c ontac t ex am i nati on ac ti v i ti es d i s eas e b urd en
• C ontac t ex am i nati on/ • P oor c ov erag e and m oni tori ng • T o m ai ntai n ac c es s and q uali ty
s urv ei llanc e of pati ent, f am i ly of L P E P i n i m plem enti ng s erv i c e at HF lev el
m em b ers and nei g h b ours d i s tri c ts . • Streng th eni ng of i nd ex c as e
• I ntrod uc ti on of L epros y P os t- • U nd er and ov er reporti ng of & c ontac t s urv ei llanc e, rec ord i ng
E x pos ure P roph y lax i s i n 7 of th e lepros y d ata i n I HI M S. and reporti ng s y s tem
h ig h • Stri c t us e of I HI M S d ata i n prog ram
m oni tori ng .
Future cours e of action and opportunities

Future
• I m course
plem entofth action ands trateg
e nati onal opportunities
y 2016- 2020 w i th i n M oHP and th roug h partners .
• U s e and f ollow nati onal operati onal g ui d eli ne as per th e new s trateg y .
m m tt a a t at g it i a t g at
• I ntens i f y I E C ac ti v i ti es to rai s e c om m uni ty aw arenes s on early d i ag nos i s and treatm ent, th e
a a a a a g i i a t t at g
prev t enti i on of ad i s ab ii li ty , treh abaii li tati on
mm and s itoc i al
a b enef
a i ts . a iag i a t atm t t
• Streng th en early i c aas ieitd etec ti aonib ita y f oc us a
i ng on pocia k et areast of h i g h end em i c d i s tri c ts .
• Dev
t elop gt an i ntens
a i f ai ed c as te s earc h ac ti v i ty f iorgth e d i s tri c ttleva elaeli m i nati ig on mi i t i t
• P rom oteac om i m t uni ity partiac i pati on a i n tha e N itati onaltL eprosi y t E i li tm i nati onimi
P rog aram m e.
• Im mprov t e th emm ac c es s itof unreac
a i h aed , m arg i ti nali z eda and av ulnerab le g roups imi ato lepros gy s ammerv i c es .
• m Streng th en th e i nv olv em ent of people af f ec ted b y lepros y i n lepros y s erv i c es and prog ram m ies .
t a a ma gi a i a a g t
• B t ui ld gtth e c apac
t i tyi of h ealth m w tork ers f or early a c tas e d etec ti on, m ianag em ent and i c om am uni ty b gasamm ed
Brehi ab ti li tati on. a a it at a a t ma ag m t a mm it
a a i ita
• C arry out operati onal res earc h i n h i g h end em i c d i s tri c ts and poc k ets on s pec i f i c i s s ues f or q uali ty
a t a a a i ig mi i t i t a t i i
s erv i c es .
a it i
• E x pand c h em oproph y lax i s to protec t c ontac ts and c ut lepros y trans m i s s i on.
a m a i t t t ta t a t t a mi i
• I ntenst ii f y v oc ati a onala ed uc atia on anda i nc i om emg enerati g on
a ac ti v ai ti es if or people af f ec teda b y tlepros y .
m ii a at i a a i a a g m t a
a a it at i t a i i i a i a
a i ita
t gt t a a it im m g a a i i a t at gi
t gt i a i mi i t i t a a a
t gt t i a a at m g a a
i

i mi g a i a t
tai t i i at g amm a i g at it i i t a it
m i a g itai t m it i g t ai i g a a i at i a a
t gt a ita i a it i i a a ita a
a m a im

i mi g a i a t
5.2 Eye Care

Background
a at a t i i a a i i im ai m t i m at a t i i
a a i i im ai m t t at a t a tt a ia
ata t m ta m t a a i a i g t
i a i i im ai m t i t a t t g at i
a mi i m ti a a a m mig a t
i ig it tai i i a i it a i a mm i a
g t a ag i g a g it a i a a i t a g a a ia i ama a
i a t m it i i i im ai m t a i i t mi g
a
i a g a ma i t a i gt i t i g
t i i a a i g a ma i t i at t m t i a i
ma m t m ii a a t t i t a i i t
t
a i t t ti i t ia t a ig t t ig t a g a
am aig i i at at ga i a i m a i g ii
t g amm am m a i g t t g i i a ta g t i
t ii t at gi a a i i a a i it at
B at m i a t at gi a t a ai
a g amm ata a t a ma t a mia a a ii
a mi t m a a t i i i a a a t i mi t m
a a ig ig t t at a a ma a i a g i t a i
i at a g t m at a a at t t at g
t t i i at a t i i at i a i it a t ta t t
a at m a i
a a ig i a t i a i t m ia i ma a
a t a m gi t t m tit a t a mi i ta t a a a mi i t
a i g ma i a a ii g i i it a a it t t ai it
ma it a i t ai i g t t g t a a mi i t a
i g t a m gi t a a i t a i g t m ti t
a i i a i t a i g t a mi i ta t a
t t a m gi t i t t i m a a t
tt i t a m gi t a mat a t a t
t m titi a t a t m tit i t t m
t a mi a i ta t a a a m t i t i at
a a a a a t m a ma ag a i m t
mai t a i a i a i gg a a m a ma
ma ag m t a i i a a g
ig i a t m ti a i t m i at t m ti t i i
am ta t iti t a it ima a t ita t g a t
i a a i t t i g a at a i t a a a t ta a

i mi g a i a t
a ma a a i g a i i a i a t i it
at a a a t a a a ma g amm it t
imi a g t a ma m a t mi i t i t i a g t at g
imi a t i i a g t i ia i i t a i a ia
a i a i m ta im m t t imit t a mi i a i a t
t at gi t im m t t a i t i g a t g am im m ta
t a ma a imi at m a a a i at m a i imi a g
t a ma a a i at m a am t t i t at a g a i g
t t a ma a t a i g a imi a ta ma a
a i a ig at t a at a t i t i t at
m i a a t it t ma t g it a i a t t
t i a im ai m t a t gt a i ita t i i mm i
i t t t gt i i t a i
t g a ta g t
a a i a i a im ai m t mt a i a
a a a ai t a a i a Ba t t a
a ai mm a a ma t m t a
t a a at t t gt i i t a i t g a ta g t
m t a a a i a a a at i i i
it t ig t t
at g a a t t t it t a i ta t
g m t a t i i a g i at t a a i m t ma a i a
t i i g at i t i
iaim t a a a a ia i at i t a
t a i t i g m t a a t i t g at t ima a i t t ai
g m t at a t ma a i i t a a a
t i i at a t i i at it i ta i at a i it at
t i at at a g at t t a g am i t t

i mi g a i a t
ita ata
Total
Total Surgery Nepali Other
S.No Eye Hospital Name OPD Outreach Nepali OPD Other (OPD)
(OPD) (Outreach) Surgery Surgery
(Surg
(Eyecarecenter ery)
+ CAMP)
NNJS/Hiralal Santu Devi Pradhan Eye
214656 6961
1 Institute 69077 139756 5823 2871 3941 149
2 NNJS/Biratnagar Eye Hospital 275353 54507 245755 575615 833 10411 58571 69815
3 NNJS/Butwal Lions Eye Hospital 44123 85826 475 130424 1034 1820 25 2879
4 NNJS/ChhandaKBN Eye Hospital 0 23326 50748 74074 0 1470 6802 8272

NNJS/Dr.Binod Neeta Kandel Eye
2471
5 Hospital 13518 32727 14255 60500 943 865 663
NNJS/Dr.Ram Prasad Pokharel Eye 13644
13644 667 667
6 Hospital 0 0 0 0
7 NNJS/Fateh Bal Eye Hospital 32362 65806 42598 140766 201 4760 4610 9571
8 NNJS/Gaur Eye Hospital 23093 40777 52973 116843 1379 1460 4382 7221
9 NNJS/Geta Eye Hospital 0 187355 38660 226015 0 11698 19871 31569
10 NNJS/Himalaya Eye Hospital 259835 152013 0 411848 1548 4218 0 5766
11 NNJS/ R M Kedia Eye Hospital 124115 43336 53891 97227 1031 2965 8414 12410
12 NNJS/Kirtipur Eye Hospital 0 24677 0 24677 0 695 0 695
13 NNJS/Lamahi Eye Hospital 0 47650 104 47754 0 1739 7 1746
14 NNJS/Lumbini Eye Institute 268285 109367 153300 530952 6524 8786 23756 39066
15 NNJS/Mahendranagar Eye Hospital 0 21226 3746 24972 0 515 128 643
16 NNJS/Palpa Lions Lacoul Eye Hospital 0 30509 0 30509 463 1030 0 1493
17 NNJS/Rapti Eye Hospital 88578 80947 0 169525 2414 3299 0 5713

NNJS/Sagarmatha Choudhary Eye
226,491 96255 110297 433043 3886 14712 40422 59020
18 Hospital
19 Birat Eye Hospital Pvt. Ltd 5369 15165 55735 76269 808 1575 10792 13175
20 Birtamode Eye Hospital 0 39964 13565 53529 0 1725 1005 2730
21 BPKLCOS 0 93221 0 93221 1789 3653 0 5442
22 BPEF-CHEERS 0 77485 0 77485 395 2141 0 2536
Dhangadhi Netralaya Pvt. Ltd.
23 Dhangadhi, Kailali 0 22640 3306 25946 0 2811 353 3164
Dibyajyoti eye and ear care center pvt
24 ltd 1460 2086 4987 7073 0 0 0 0
Kathmandu Medical
25 college,sinamangal 1649 12646 0 14295 0 429 0 429
26 Lions Eye Hospital 693 39482 0 40175 0 559 0 559
27 Manipal Teaching Hospital, Pokhara 0 11311 212 11523 - 208 5 213
Mechi Drishti Eye Hospital & Research
28 Centre 0 12658 5032 17690 0 3030 3504 6534
29 Mechi Eye Hospital 0 89668 114363 204031 0 5986 22024 28010
30 Mechi Netralaya Eye Hospital 0 13940 35871 49811 0 1174 2050 3224
31 Nepal Eye Hospital 0 107793 0 107793 0 4357 803 5160
Nepal Red Cross Society Surkhet Eye
0 38779 0 1324 1707 0 3031
32 Hosptial 38779
33 Reiyukai Eiko Masunaga Eye Hospital 15170 42813 0 57983 921 1038 0 1959
34 Shreekrishna Netralaya, Bhairahawa 0 6040 0 6040 0 325 1006 1331
35 Tilganga Inst. Of Ophthalmology 139139 492891 12095 644125 8368 26593 930 35891

i mi g a i a t
5.3 Zoonotic disease
5.3.1 Background 5.3 Zoonotic disease

5.3.1 Background
i mi g a i a t i ii i i i gt i t
The Epidemiology
i a and Disease
i aControl
t Division i (EDCD)
i is responsible
i a for iresponding
a a toB differenti
zoonotic
t i diseases
i aof public
i health concern.i Priorities
a m i zoonotict diseases
i in
a t Nepal
a iare Brucellosis,
a
Leptospirosis,
t i Hydatidosis,
a it aCysticercosis,
g itToxoplasmosis
i i ii etc. Our
a public health activities
i g i are focused
i a
to apoisonous
a asnake bites
ta and dog
it g bites. This
m ta i t division has been
i i working
ag i t in co-ordination,
i m t
collaboration
t g aand consultation
i a t with ggovernmental m ta livestock,
t wildlife, agriculture, environment
sectors, general public and other non-governmental sectors.
5.3.2 Goals
5.3.2 Goals and
andobjectives
objectivesofofthe
thenational
nationalzoonosis
zoonosiscontrol
control programme.
programme.
Box 5.3.1: Goals and objectives of national zoonosis control programme
Goals:
 No people dies of rabies or poisonous snake bites due to the unavailability of anti-rabies vaccine (ARV)
or anti-snake venom serum or timely health care services.
 To prevent, control and manage outbreaks and epidemics of zoonosis.
Objectives:
 To strengthen the response and capacity of health care service providers for preventing and controlling
zoonoses.
 To improve coordination among and between stakeholders for preventing and controlling zoonoses.
 To enhance the judicious use of ARV and ASVS in health facilities.
 To reduce the burden of zoonotic diseases (especially rabies and other priority zoonoses) through
public awareness programmes.
 To provide cell culture ARV as a post-exposure treatment to all victims bitten by suspicious or rabid
animals.
 To reduce the mortality rate in humans by providing ASVS and ARV.
 To train health workers on snake bite management and the effective use of ARV and immunoglobulins.
 To reduce the number of rabid and other suspicious animal bites.
a i a i i ima i a i a am a ima i g a a g
i at t a i a a a m t a ata t it i ta
Rabies-Rabies is primarily a disease of warm-blooded animals like Dogs, Jackals, Wolfs, Mongoosea i a a a
a t ma a a ima i t a t t a t a i t a a m t at
wild cats etc. Rabies cases are almost all fatal but it is 100% preventable by vaccination, awareness
am t a a a a at ig i a a a t at m at i a i ti
about
mathuman t atand
a animal interaction. a i Most t aof the
m affected
t a are children.
ma aIti has abeen assumed a thata
almost
it t halfig of Nepal’s
t i a population
i t aiareatat high
t i risk andaa quarter at moderate
t i grisk
a of at
rabies. It is
estimated
a that around
t ta a i imm 30,000 gcases i in petst and more than 100 human
a i rabies
m ta cases ma aeach year
occur
witha the
i highest
a riskt are ing theit Terai.
a Latent
i a ginfections have g been
a reported
a i t ain dogsmi iand cats. iVerya few
a a
at i a g it t g a a ima a t a t i
patients take rabies immune globulin (post-exposure prophylaxis). Almost all of human cases (99%) a m
t rabies
of imi at
are it a of dog
result i bites.Vaccinating
at m 70% of dogs break rabies transmission cycle in an area at
risk. So, along with the EDCD, every dog owner and animal health authorities are more concerned to
eliminate it as public health problem.

i mi g a i a t
Activities and achievements in 2075/76 in Rabies control Programme

TheActivities
following and achievements
activities in 2075/76
were carried out inin Rabies control
2075/76 Programme
for the control of rabies cases:
 The Awareness
followingprograms aboutcarried
activities were Rabiesout
for in
school students
2075/76 and
for the general
control of public.
rabies cases:
 Celebration of Work Rabies day on 28 September and co-ordination with province and local
th
level ahealth officials

g amforaits effective
t a i implementations. t t a g a i
 Epidemiologicala study on a the
i active
a dogt bite cases.
t m a i a it i a a
at ia it im m ta
 Surveillance about Rabies on outbreak area.
i mi gi a t t a g it a
 Orientation i a program
a t about
a i the benefitt a of a Intradermal
a (ID) delivery of Anti Rabies Vaccine (ARV)
for health
i ta workers. g am a tt t t a ma i a i a i
a t
 Procurement of cell culture ARV vaccine and immunoglobulin.
m t t a i a imm g i
In 2075/76, 35,250 cases animal bites were reported (Table 5.3.1). The number of reported animal
bite cases has fluctuated a in arecent
ima years
it but the number t aof rabies deaths hasm increased four t atimes
ima as
it a a
compared to last year. t at i t a t t m a i at a i a m
a m a t at a

i mi g a i a t
Table
Table5.3.1: Status
5.3.1:Status
Status of reported animal bites and rabies in Nepal
Table 5.3.1: ofofreported
reported animal
animal bites
bites andrabies
and rabiesininNepal
Nepal
Numberofof
Number No.ofofcases
No. casesofof
Numberofof
Number
Fiscalyear
year cases ofofdog
cases dog animal bites
animal bites NumberofARV
NumberofARV
Fiscal bites cases ofofother
cases other
(dog+Other
Other vialsconsumed
consumed
Deaths
Deaths
bites animal bites (dog+ vials
animal bites animal)
animal)
2070/71
2070/71 31,976
31,976 2,540 34,516 195,868
195,868 1010
2,540 34,516
2071/72
2071/72 17,320
17,320 3,290
3,290 20,610
20,610 273,000
273,000 1313
2072/73
2072/73 20,133
20,133 2,494
2,494 22,627
22,627 320,139
320,139 66
2073/74
2073/74 37,226
37,226 2,518
2,518 39,744
39,744 227,639
227,639 88
2074/75
2074/75 33,204
33,204 2,477
2,477 35,681
35,681 281,718
281,718 3232
2075/76
2075/76 32,882
32,882 2,368
2,368 35,250
35,250 236022
236022 1818
o o ce:ce:
Issues,recommendations
Issues, recommendationsfrom
fromreviews
reviewsand
andactions
actionstaken-Rabies
taken-Rabies
Issues
Issues Recommendations
Recommendations Actiontaken
Action taken
Theunder
The underreporting
reportingofofcases
casesand
and Developa aregular
Develop regularreporting
reportingmechanism
mechanism Increasedsupervisory
Increased supervisory
deaths from dog, Monkey, Jackal, Bear to medical stores
deaths from dog, Monkey, Jackal, Bear to medical stores and EDCD and EDCD visit to reporting sites
visit to reporting sites
Collaborate with different local Coordinationwith
with
Properawareness
Proper awarenessabout
aboutanimal bites Collaborate with different local
animalbites Coordination
stakeholders
stakeholders livestocks
livestocks
Trainingand
Training andAvailability
AvailabilityofofARV
ARVininallall Provideregular
Provide regularsupply
supplyand
andservice
serviceatat Trainingand
Training andavailability
availability
health care facilities
health care facilities least to PHC level
least to PHC level is being increased
is being increased
Trainingfollowed
Training followedbyby
Intradermal
Intra dermalvaccination
vaccinationnot
notstarted
startedtoto Training
Trainingtotohealth
healthworker
workerand
andproper
proper
guidancetotostart
guidance startisisbeing
being
all sites
all sites supervision
supervision expanded
expanded
Coordinatewith
Coordinate withanimal
animalhealth
healthand and ProperCoordination&
Proper Coordination&
Massdog
Mass dogvaccination
vaccination localother
local otherstakeholders
stakeholdersfor
foratatleast
least collaborationnot
collaboration notstarted
started
70%dog
70% dogvaccination
vaccination ininreality
reality
Snakebites
Snake bites
Snake bites
oisoo os ss sa ae ebites
oiso bites——Twenty-one
Twenty-oneofofthe the7979species
speciesofofsnakes
snakesfound foundininNepal
Nepalare arepoisonous
poisonous(11 (11
Poisonous
pitviper
pit snake5bites
viperspecies,
species, krait—
5krait species,3t 3cobra
species, cobraspecies
species
t and1 1each
and ieachcoral
coral aandandRussel’s
Russel’s viperspecies).
i viper aspecies).
a i Around
Around
it i
15,000snake
15,000 snakebite i
bitecases ait
casesestimated i
estimatedannually a
annuallyofofwhich i a
whichabout a
about1010percent a a
percentarearepoisonous i
poisonousbites. i The
bites.The
mortalityrate aabout
rateisisabout it 10a percentmat amongapoisonous a
poisonous i cases.
bite a t The 26 Terait a districts
i it
arehighly
highly
mortality 10 percent among bite cases. The 26 Terai districts are
m ta it
affected.InInthe at
thelast i a
lasteight t
eightyears
yearsbetween t am
between1 1and g i
and131
131deaths it
deathshave a
havebeen beenreportedai i
reportedfromt i t a
frompoisonous ig
poisonous
affected.
a t t a t ig t a t a at a t m i
snakebites
snake bites eachyear. year.The Thefreefreedistribution
distributionofofanti-snake
anti-snakevenom
venomserum serum(ASVS)
(ASVS)began
beganinin1999/2000.
1999/2000.
a it each a a iti a a m m ga i
Indian
Indian quadrivalent
ia quadrivalent
a i a t ASVS ASVSisi isbeing
being usednow.
i g used now.ThereThereare
aare8585snake
snake
a bite bite ttreatment
it treatment centres
atm tcentres t are aareiniinthe
tthe
country
country for
t for snakebitesnakebite
a it management management
ma ag m t in in collaboration
i collaboration
a a with
with Nepal
it Nepala army, army, Nepal Red Cross
a m Nepala Red Cross Society, Society,
i t
community
mm it m members.
m Ina addition
i t to t these, other
t hospitals
community members. In addition to these, other hospitals in Kathmandu valley has been gettingg
ita i in Kathmandu
at ma valley
a has
a been getting
g
ASVSononbasis
ASVS abasis
i ofofacases casest they
theyma ag
manage.The
manage.The followingactivities
following activitieswere werecarried
carriedoutoutinin2075/76for
2075/76forthe the
control andi g a
managementi of a i
poisonous
control and management of poisonous snake bites: t i
snake bites: t t a ma ag m t i
a it
Orientationprogram
  Orientation programtotoMedical Medicalofficers,
officers,nurses
nursesandandparamedics
paramedicswas wasconducted
conductedononthe theproper
proper
use
usei ofof Antisnake
taAnti snake venom
g venom
am t i a a a am i a t t
Procurementand
  Procurement a andsupply
supply
m ofofASVS
ASVSfor forrespective
respectivecentres.
centres.

i mi g a i a t
m ta t
at g t a it a t at a a t ta a
i a mma i g agai t i a ata
In 2075/76, altogether 4,567snake bite cases were reported at national level. A total of 696
In 2075/76, altogether 4,567snake bite cases were reported at national level. A total of 696
caseswere poisonous. Table 5.3.2 summarises progress against previous years' data.
caseswere poisonous. Table 5.3.2 summarises progress against previous years' data.
Table 5.3.2:
Table 5.3.2: Snake
Snakebite
bitecases
casesand
anddeaths,
deaths,Nepal
Nepal(2070/71–2075/76)
(2070/71–2075/76)
Fiscal year
Fiscal year Totalcases
Total cases Non-poisonous
Non-poisonous Poisonous
Poisonous Cure
Cure Deaths
Deaths % deaths
% deaths
2070/71
2070/71 5,143
5,143 4,145
4,145 998
998 988
988 10 10 1.0 1.0
2071/72
2071/72 4,128
4,128 3,461
3,461 667
667 666
666 1 1 0.1 0.1
2072/73
2072/73 3,268
3,268 2,605
2,605 663
663 643
643 20 20 3.0 3.0
2073/74
2073/74 6,121
6,121 5,209
5,209 912
912 879
879 33 33 3.6 3.6
2074/75
2074/75 5,606
5,606 4,812
4,812 794
794 362
362 20 20 2.5 2.5
2075/76
2075/76 4,567
4,567 3,871
3,871 696
696
ce:
o ce:
Issues,
Issues, recommendations
recommendationsfrom
fromreviews
reviewsand
andactions
actionstaken-Snake bite
taken-Snake management
bite management
Issues
Recommendations Action taken
Action taken
The under
under reporting
reportingofofcases
casesand
and Develop
Developa aregular
regularreporting mechanism
reporting to to
mechanism Increased supervisory
Increased visitvisit
supervisory to to
deaths from Snake bites
deaths from Snake bites medical stores and EDCD
medical stores and EDCD reporting sites
reporting sites
Awareness about
Awareness importance
about importance
Coordination
Coordinationwith local
with regarding
local quick
regarding quick
Public
Public being
beingdied
diedinincommunity
community of co-ordination and
of co-ordination and
transportation,
transportation,awareness
awareness etcetc
transportation
transportation
Timely
Timelyprocurement,
procurement, supply, training
supply, and
training and Snake bitebite
Snake management
management
Use
Use of
of ASVS
ASVS vial
vial treatment availability
treatment availability training for health
training for worker
health worker
The snake bite treatment centres should be Training and orientation
Not included in regular health The snake bite treatment centres should be Training and orientation
Not included in regular health in collaboration with health facilities with at started up to treatment
service in collaboration with health facilities with at started up to treatment
service least trained physician centres
least trained physician centres
Prepare at least one equipped snake bite
ICU and ventilator Prepare at least one equipped snake bite No action is taken
ICU and ventilator management centre in each province No action is taken
management centre in each province
Motivation, security and All snake bite management centres should
Motivation, security and All snake bite management centres should Inclusive management by local
sustainability to provide snake be ensured with security, motivation of HR Inclusive management by local
sustainability to provide snake be ensured with security, motivation of HR and security personnel
bite management and sustainability of service and security personnel
bite management and sustainability of service

i mi g a i a t
Snake Bite Treatment Centres in Nepal
Snake Bite Treatment Centres in Nepal
Table 5.3.3: Province wise Animal Bite cases in Nepal 2075-76 .

S/N Animal Bite Province Province Bagmati Gandaki Province Karnali Sudurpashchim
Tablecases
5.3.3: Province wise
No. Animal
1 Bite cases in
No.2 Nepal 2075-76
Province .
Province No.5 Province Province
S/N Animal Bite Province Province Bagmati Gandaki Province Karnali Sudurpashchim
1 Dog Bite 4838 7335 6550 3591 4781 1984 3803
cases No. 1 No.2 Province Province No.5 Province Province
Other rabies
1 Dog Bite 4838 7335 6550 3591 4781 1984 3803
2 susceptible 429 407 474 489 243 122 204
animal
OtherBite
rabies
2 susceptible 429 407 474 489 243 122 204
Snake bite-
animal BiteNon
3 727 763 477 940 668 145 151
Poisonous
Snake bite- Non
3 Snake bite 727 763 477 940 668 145 151
4 Poisonous 81 195 95 91 77 20 137
Poisonous
Snake bite
4 Insects/Wasp 81 195 95 91 77 20 137
5 Poisonous 5696 7101 6359 4364 7265 2825 3377
Bite
Insects/Wasp
5 5696 7101 6359 4364 7265 2825 3377
Bite

i mi g a i a t
5.4 Tuberculosis
5.4.1 Background
i B i a i at mi a t at a t t a a a a
i t a i g a at i t t mat t at a i i
at a B a i a a tag
t ma mat t a i m a i a
i gt i g a a a g amm i gi t a m
B a i i i i t B a a a m ga m i i t
B a a a a t i gi a m B i i t B a
m a i i a iag i i t B a a ta
m a i i t B a t i gt g a t t ta gi t a i
t ma a ma
i g t a B t i ta it at a
a i B t a B t t a i g
a m B i a B at am g gi t B a t a am g
gi t B a i B m ta it i ig gi t at m t at a
ta i a a t i a iag i a t t t atm t i
i a a a t t g a B t at g a t B t t at g
t t
i t atm t t a im m t t g tt
t i i a i at it t i t i at t a
g m t ia a a i t a t t t a a
tai t g g a i t a B t atm t t i a a
t a a t t g a B t at g a t a i m t t a t t
B t t at g
5.4.2 Vision, goal, objectives of the National TB Programme
Vision: TB Free Nepal
Goal
t B i i t a m a t a i a a
a a m a t ta m t m a t t a
Objectives
Objective 1: a a a t g im a t a i it a iag i i a
iag i am g i m at a i t t ta a ami a
ta t a a iag i am g a g it i t at i
a m a at a i t a i a t it ia t
m it
Objective 2: ai tai t t atm t at at a t a m B t g t

i mi g a i a t
Objective 3: i iag i it m B a
t at at a t t iag a t
Objective 4: t a a i g gagi g i B a mt i t
m i a g t a i at t t g t a a i g
m it ma gag m t ig t B a
Objective 5: t gt mm it t m ma ag m t a a ta ig t B
Objective
a t i 5: Strengthen
t community
at a a systems
i g for
i management,
m tt tadvocacy,
t ma support
ag Band a rights
i for TB a
patients
i t i t in orderato create an enabling environment to detect & manage TB cases in 60% of all districts by
2018 and 100% by 2021
Objective
Objective 6: t i t tot health
6: Contribute a tsystemt strengthening
m t gt throughi g t HRg management
ma ag and
m capacity
ta a a it
m t financial
development, a ia ma ag m t infrastructures,
management, i at t m tand
procurements a supply management
ma ag m in tTBi B
Objective 7: Develop a comprehensive TB Surveillance, Monitoring, and Evaluation system
Objective 7: a m i B i a it i g a a a t m
Objectives 8: To develop a plan for continuation of NTP services in the event of natural disaster or public
Objectives 8:
health emergency a a a i i t t at a i a t
i at m g
Box 5.4.1: The End TB Strategy

VISION: A world free of TB
Zero deaths, disease and suffering due to TB
GOAL: End the Global TB Epidemic
MILESTONES FOR 2025:
1. 75% reduction in TB deaths (compared with 2015)
2. 50% reduction in TB incidence rate (less than 55 TB cases per 100,000 population)
3. No affected families facing catastrophic costs due to TB

TARGETS FOR 2035:
1. 95% reduction in TB deaths (compared with 2015)
2. 90% reduction in TB incidence rate (less than 10 TB cases per 100,000 population)
No affected families facing catastrophic costs due to TB
The End TB Strategy was unanimously endorsed by the World Health Assembly in 2014. Its three
overarching indicators are i) the number of TB deaths per year, ii) TB incidence rate per year, and iii)
the percentage of TB-affected households that experience catastrophic costs as a result of TB. These
indicators have related targets for 2030 and 2035.
The main principles for implementing the strategy are:

 government stewardship and accountability, with monitoring and evaluation;
 strong coalitions with civil society organizations and communities;
 the protection and promotion of human rights, ethics and equity; and
 The adaptation of the strategy and targets at country levels, with global collaboration.
The strategy’s components (three pillars) and related strategies are as follows:
1. Integrated, patient- entered care and prevention:
 Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening
of contacts and high-risk groups.
 Treatment of all people with TB including drug-resistant TB.
 Collaborative TB/HIV activities and the management of co-morbidities.
 The preventive treatment of persons at high risk, and vaccination against TB.
2. Bold policies and supportive systems:
 government stewardship and accountability, with monitoring and evaluation;
 strong coalitions with civil society organizations and communities;
 the protection and promotion of human rights, ethics and equity; and
 The adaptation of the strategy and targets at country levels, with global collaboration.
The strategy’s components (three pillars) and related strategies are as follows:
i mi g a i a t
1. Integrated, patient- entered care and prevention:
 Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening
of contacts and high-risk groups.
 Treatment of all people with TB including drug-resistant TB.
 Collaborative TB/HIV activities and the management of co-morbidities.
 The preventive treatment of persons at high risk, and vaccination against TB.
2. Bold policies and supportive systems:
 Political commitment with adequate resources for TB care and prevention.
 The engagement of communities, civil society organizations, and public and private care
providers.
 Universal health coverage policy and regulatory frameworks for case notification, vital
registration, quality and rational use of medicines, and infection control.
 Social protection, poverty alleviation and actions on other determinants of TB.
3. Intensified research and innovation:
 The discovery, development and rapid uptake of new tools, interventions and strategies.
 Research to optimize implementation and impact and promote innovations.
5.4.3Major
5.4.3 Majoractivities
activities in
in fiscal
fiscalyear
year2075/76
2075/76
 Provided effective chemotherapy to all patients in accordance with national treatment policies.
 i
Promote early diagnosis m oft people
a twith a infectious
a t ipulmonary
a a TB byitsputum
a smear
a t atm t
examination i and
i
m t a
GeneXpert. iag i it i m a B t m m a ami a
 aImplemented tactive case finding interventions across high burden districts to identify missing
m m t a a i gi t a ig iti t t i mi i g
tuberculosis cases among high risk groups through sub recipients of Global Fund grant.
t i a am g ig i g t g i i t a ga t
 Provided continuous drugs supply to all treatment centres.
i g t a t atm t t
 Maintained
ai tai aa standard
ta a system t m for recording i ganda reporting g
 Monitored
it tthe resultt of treatment
t atm tand a evaluate a at progress g of thet programme
g amm
 tStrengthened
gt a
cooperation t
between i at aaid
NGOs, bilateral ai agencies
ag i and a donors involved
i i t NTP.
in the
 i at a a at a i it a
Coordinate and collaborate NTP activities with and HIV /AIDS programmes. g amm
 B Orientation
E-TB i ta t private
to i at practitioner
a to tnotify the tTB patients
B a diagnosed
t iag at private
at health
i at facilities.
at

aRoll
i i out of DR TB Tracking and Laboratory System at all the DR and GX sites.
t B a i ga a at t m at a t a it
 Linkage of DOTS centres to Microscopic centre through courier.
i ag t t i i t t g i
 Provided
i ttraining
ai i g tto health
a t personnel.
 Training
ai i g ttom medical
i a doctorst for childhood
i TBBdiagnosis.
iag i
5.4.4 Progress and epidemiology of TB
5.4.4 Progress and epidemiology of TB
Institutional coverage and estimation of TB burden
Institutional
Nepal adoptedcoverage andstrategy
the DOTS estimation of TB
in 1996 burden
and achieved nationwide coverage in 2001. All DOTS sites are
integrated in public health services or run through NTP partner organizations in public and private sectors.
a a
In 2075/76, t 4,382
t institutions
t atwere
g ioffering TB
a diagnosis
a i andatreatment
i ag i TB control services.
DOTS-based
itAmong
a them,
i t g at i i a t i t g a t ga ia
4,204 are government health institutions. To increase access to treatment iservices,
i NTP
a has
i at t i t i g B iag i a t atm t a
developed partnership with different organizations including private nursing homes, polyclinics, I/NGO
B t i m gt m a g m t at i t i a a t
health clinics, prisons, refugee camps, police hospitals, medical colleges and municipalities.
t atm t i a at i it i t ga i a i i g i at
i g m i i a t i i i g am i ita
The burden of TB can be measured in terms of incidence (defined as the number of new and m relapse
i a
g prevalence
cases), a m i ianda i mortality. WHO estimates the current prevalence of all types of TB cases for Nepal
at 60,000 (241/100,000) while the number of all forms of incidence cases (newly notified cases) is
B a m a i t m i i a t m a a
estimated at 42,000 (151/100,000).
Case Annual
DoHS, notification
Report 2075/76 (2018/19)
Reported case notification rate (CNR) of all forms of TB is 109/100,000 whereas CNR for incident TB cases
(new and relapse) is 107/100000 population. In Fiscal Year 2075/76, a total of 32,043 cases of TB was
notified and registered at NTP. There were 97.98 % incident TB cases registered (New and Relapse) among
all TB cases. Among the notified TB cases, 71 % of all TB cases were pulmonary cases and out of notified
i mi g a i a t
a a a m ta it mat t t a a t B a
a at i t m a m i i a
a i mat at
Case notification
t a a at a m Bi a i i t B
a a a i a i a a a t ta a
B a a gi t at i i t B a gi t a
a am g a B a m gt B a a B a m a
pulm a onary a T B c tas es , 82% w erem ateri olog
b ac B ai c ally c onf i rm ed . aAm t ong
i thgiosae b ac teri m
olog i c ally
m c onf
g t i rm ed and
noti af i edt , i3 9% gi(12520)
a w ere
m c onfa i rm ed us i ng X pert M T B /RI F tes ti ng . m i g t B t g
M ore th tana th tree- f i f th s of all a T BB c aas es (20928, 65% ) w ere reported t m f rom P i rov i nc e 2, iP rov i nca e 3 and
P rov i nc ie 5. Around 24 % of th te T B Bc as aes w ere reportedt f rom mP rov i nci e 3 . K ath at m ma and u d i is tri t ic tt alone
a h old s
around 3 a8% (293 0 T B c as es )Bof ath e T B tc as es B noti a f i ed f rom th e mt P rov i nc e 3 i w h i le i ts i it c ontri b uti
ti on i s around
9% i i na th e nati onal i ttotal. a W h ereas
a t ta i n term s of ec
a i t m o- terrai n d i s tri b uti
t ai i t ion, T erai b elt reported ai t m ore th ant h alf of
c as m
es (18,815,
t a a 59% ). M a os t c as es w ere reported t ai n th e m i d d le ag e g roup
t i t mi w i th th e h
ag gi g h es t of 4 8
it t i n 15- 4 4
%
y earigof ag t e. T h e c h i i ld h ood T B a i s around ag 5. 5% i w h i le m en
Bi a w ere nearly 2 ti m es
i m m ore th an w om
a en amm ong th e
reported
m t T aB c as e.m am g t t B a
Figure 5.4.1:
Figure Tuberculos
5.4.1: is CasCase
Tuberculosis e Notification Rate,
Notification 2075/
Rate, 76
2075/76
Figure 5.4.1: Tuberculosis case notification rate, 2075/76

a a a a at m i a Ba t t
T h ea N ati onal i t iC ast e N itoti f i c atimon Rate
t a (All f orm s i ) i s 109i t/ i100,000 t a populati t on. B as ed ona th e C maiN R, thi ere
g are
20 d i s trii tc tsi tw i tha C N R m ore th an m120,g w h i le ig 24 d i s tri c ts
iti t h ad C N R b etw
iti t a een 75- 120
mt and rem
ai ai ni
t ng 3 3
d i s tri c its h admaib elow
i g a 75 C N R.
mt Am ong
i 20 h
gi i g h b urd t en d i
m s tri c ts ,
t a t1 4 d i s tri c ts are f rom
B a th e T erai b t w h i le
elt
rem ai ni ng 6 are f rom th e Hi lly reg i on. F urth er, m ore th an th ree- f i f th s of T B c as es (66% ) of th e c as es w ere
reported f rom P rov i nc e 2, P rov i nc e 3 , and P rov i nc e 5 res pecDoHS, ti v elyAnnual Reporti n2075/76
w h ereas term s (2018/19)
of ec o- terrai n
d i s tri b uti on, T erai b elt h eld m ore th an h alf of T B c as es (57% ) i n th e reporti ng y ear.
i mi g a i a t
a t m i i a i a i t m
t ai iti ai t m t a a B a i t g a
FigureFigure
5.4.2:5.4.2:
Notified
NotifiedTB
TBCase
Cas e and Case
and Cas Notification
e Notification Rate
Rate (CNR)
( CNR) by Provinces,
by Prov FY 2075/76
inces , FY 2075/ 76
Figure 5.4.2: Notified TB Cas e and Cas e Notification Rate ( CNR) by Prov inces , FY 2075/ 76
Souc e: N T C
F i g ure 5. 4 . 2 s h ow s th e prov i nc e w i s e c as e noti f i c ati on rate. T h e P rov i nc e 5 h ad th e h i g h es t C N R (127 per

ig 100,000 populati t on) f ollowi ed b iy B ag am ati P rov i nca e, P rovati nc e 2 and Sudi urpas c h ai m tP rad esigh (123t ,112 and
110 per 100,000 apopulati on) res pec tiBagma v ely . C N R w asi v ery low i at K arnali a P rov i nca e im per
(78 a 100,000
a Souc e: N T C
populati on). a a at a ai i
F i g ure 5.a4 . 2 s h ow s th e prov i nc e w i s e c as e noti f i c ati on rate. T h e P rov i nc e 5 h ad th e h i g h es t C N R (127 per
Dis tribution by age and s ex
100,000 populati on) f ollow ed b y B ag m ati P rov i nc e, P rov i nc e 2 and Sud urpas c h i m P rad es h (123 ,112 and
Distribution I n F Y 2075/76,by age
110 per 100,000
around
and 5. 5% of on)
sexpopulati c as res
es pec
w ere reg i s tered as c h i ld T B c as es w h i le th e rem ai ni ng 94 . 5% w ere
ti v ely . C N R w as v ery low at K arnali P rov i nc e (78 per 100,000
reg i s tered populati as on). ad ult T B .
Am ong Dis thtribution aem , m ale T B a gi t a i B a i t mai i g
by age and s ex
c asgies t I nw F ere a areported
Y 2075/76,
t B m g t m ma B a t a m m
around 5. 5% of c as es w ere reg i s tered as c h i ld T B c as es w h i le th e rem ai ni ng 94 . 5% w ere
t a
ma nearlym 2g tti m es im oreB a m t t m t a ag g
reg i s tered as ad ult T B .
t t t i
th an Amf em ongale.th em Am , m ongale T B
a
a t a t i
th e c h ic ldas esT B c w as ere es , m reported
os t
i a ig nearly a g2 ati m es m ore
of th em (63 % ) w ere
it i mat th an(5- 14f emt) y ale. at Am aong
b etw een ears of
th e c h i ld T B c as es , m ios gt
a a
ag e g roup. I n- c ountry
mi t of th iag em (63 % ) w ere m
t c mm ontex tit li k e N epal,
b etw een (5- 14 ) a y earst of
mat w h ereB ac c es s i to h I ealth
ag ie g roup. n- c ountry
t s erv i c esc ontex i s t ts ati llli k ea b N i g epal,
c h allengw h eere and
i ac c w tes h s ere to h i tealth
i ai s i esgti m s ervatedi c es th i at s t nearly
s ti ll a b i g
20- 25% c h alleng of i c eas and esB w am h ere g
are it
a b ei ng m B i s es ti m ated th at nearly
i s s eda to b e d i ag nos ed f rom th e c om m uni ty ev ery y ear, th e es ti m ated T B i n c h i ld ren s h ould not b e
les s th 20- an 25% 10- 15% iof , c h asenc Bes e aare N T P req ui res to f oc us on i nc reas i ng c urrent (5. 5% ) proporti on of c h i ld T B am ong
gg b ei ng m i s s ed to b et d i ag nos ed f Bromt ath emic om m uni ty ev ery y ear, th e es ti m ated T B i n c ah i ld reniag
s h ould i not
am b i es s i on
all noti f i ed T B c as es . T h e low proporti on of c h i ild T B t c at
t t ig i as es s ug ig es tedm tha e h i g h ex i s tenc e of T B trans
t atm t les s thi an 10-
B 15% , h enca e N mT P req ui res to faoc us tonii nc reas
a i ng c urrent (5. 5% ) proporti on of c h i ld T B am ong
m t t a Bt a m
all noti f i ed T B c as es . T h e low proporti on of c h i ld T B c as es s ug g es ted th e h i g h ex i s tenc e of T B trans m i s s i on
i a t am i t gi a g a t t
th at req ui res m eas ures of early d i ag nos i s and treatm ent of c h i ld T B . I n N epal, m en w ere nearly tw i c e as
m ore reported to h av e T B th an w om en w h i c h w ere nearly th e s am e i n th e reg i on and g lob al c ontex t.
i mi g a i a t
Annual trends
Annual trends
F i g ure 5. 4 . 3 s h ow s th e trend of T B c as es noti f i c ati on f rom 2071/72 to 2075/76. I t h as d ec reas ed g rad ually
ig f rom 123 per t 100,000
t B a on i n 2071/72
populati a to 109 m per 100,000t populati ont i an 2075/76.
a
ga a m a i t a i
Figure 5.4.3: TB Cas e Notification Rate ( 2071/ 72– 2075/ 76)
Figure 5.4.3: TB Case Notification Rate (2071/72–2075/76)
Sourc e: N T C
Treatment outcomes
Treatm ent outcom es
T h e N T P h as ac h i ev ed ex c ellent treatm ent s uc c es s rate, w i th or ab ov e 90 perc ent s uc c es s rate s us tai ned
a a i t t atm t at it a t at
s i nc e th e i ntrod uc ti on of DO T S i n 1996. Si nc e th en, N T P h as alw ay s ex c eed ed th e g lob al targ et of 85
tai i t i t i i t a a a t g a
ta g t perc ent treatm ent s uct c es s .
t t atm
t
T h e trendB t ofatm t ent s uc at
T B treatm c es s rates Bf oraT B h as b een i c tons ti s tently
a i s ti nc e ath te las t f ew y ears .
ab ov e 90%
a Annual atrend t of T B B treatm
t atmentt s uc c es s ratesat atat anati onal a lev el f or new er a c as es (N aew and Relaps e) i s
a c ions tantly
ta th i g h ig at a 91% , f or th i s tF Y i 2075/76 i t i s 91%
at around it i . How ev er, th e trend
t t of s uc c es s rates am ong
thate retreatm
am g t ent tc as atm es (Suct c aes s , F ai lure, L osai s to F ollowt - up and O ath er tprev i ous ily treated ) h ad b een
t at a tantly les s ta
c ons er (it n c om parii s onm ai
to treatm tentt s ucatm
c es s tam ong newamer c gas es ). a
Figure 5.4.4: TB treatment success trend (FY 2071/72– FY 2075/76)
Figure 5.4.4: TB Treatment Success Trend (FY 2071/72– FY 2075/76)
Source: NTC DoHS, Annual Report 2075/76 (2018/19)
Table 5.4.1 shows the treatment outcomes of the TB patients across different provinces. Among the 7
provinces, Karnali province has achieved highest treatment success rate (i.e. 94%). The treatment failure
rate was constant across all the provinces. Meanwhile, around 4% of registered TB patients died at
Gandaki province, province 5 and Sudurpaschim province during the course of TB treatment. Similarly,
Sudurpaschim and Province-2 experienced high lost to follow up (around 4%) in comparison to other
Source: NTC
i mi g a i a t
Table 5.4.1 shows the treatment outcomes of the TB patients across different provinces. Among the 7
a
provinces, t t atm
Karnali province t t m
has achieved highestttreatment
B a success
t a rate (i.e.
i 94%).t Thei treatment
m failure
gt
i a ai i a a i ig t t atm t at i t atm t
rate was constant across all the provinces. Meanwhile, around 4% of registered TB patients died at
ai at a ta t a a t i a i a gi t B a t
Gandaki
i at province,
a a i province
i 5 and
i Sudurpaschim
a province
a im during i the course
i g t of TB treatment.
B t Similarly,
atm t
Sudurpaschim
imi a andaProvince-2
im a experienced
i high lost
i to follow
ig up (around
t t 4%) in comparison
a to other
i
m ai
provinces. t t i
5.4.1: Province
Table 5.4.1: Provincewise
wiseTBTBtreatment
treatment outcomes
outcomes (2075/76)
(2075/76)
P rov i nce S ucce s s % F ai l ure % D ie d% L F U % N ot E v al uat e d %
Province 1 9 0 1 3 3 3
Province 2 9 1 0 3 4 1
Bagmati Province 9 1 1 2 2 5
Gandaki Province 9 4 0 3 2 1
Province 5 9 0 1 4 3 2
Karnali Province 9 4 1 3 2 1
Sudurpashim Province 8 8 1 4 4 3
N at i onal T ot al 9 1 1 3 3 2
Source: NTC
Drug resistant tuberculosis (DR TB)
Drugg resistant
i ta ttuberculosis
B B (DR
a TB) m a g at a g t a a ma i at
i
Drug-resistant a
TB (DRTB) hasa become
a a great
a challenge
a mfor the NTPi and
g aa majorg public
t health concernt in
g amma
Nepal. maapproaches
Innovative ag m t and more g funding
i ta areBurgently
a aneeded
t for t the
t a programmatic
m management
a t
m g i ta t B t atm t a t im t m
of drug resistance TB nationally to detect and enrol more patients on multi-drug resistant (MDR) TB
treatment,
Burden of and to improve outcomes.
MDR-TB
of diagnostic services, case finding among new cases has remarkably increased in recent years i.e; new
ofgMDR-TB
Burdencontribution
MDR-TB
i ta
in registration category
t at g i ta t m B a
i a i g it t a thas increased rapidly
i ta t int the
at last
a t4 years
a (14.6%
t in 2071/72,
i
The Drug
15.3% itResistance
gin 2072/73,t 18.8% Survey
a in (2011-12)and
i 2073/74iag found
32% that burden of drug
in i2074/75). iresistant
a It signifies
g amthat forms of TB was cases
g RR/MDR-TB
a increasing,
a awith
are diagnosed
ma
i9.3 and
early percent
a areiof new patient
enrolled a were
t in DR found resistant
i treatment.
TB B to at tleast
Likewise, one anti-tuberculosis
i contribution
the i drug.
at g With
gi tofa “Category the
a iexpansion
II failure aftera first line
a i i t a t a i i i
treatment” has been declining (i.e. 30.8% in 2071/72, 28.0% in 2072/73, 24.0% in 2073/74, and 11% in a
i t ig i t at B a a iag a a a
2074/75) for consecutive year suggesting that the early case diagnosis and treatment is improving
i B
t atm t i i t ti at g ai a t i t atm t a
treatmenti i goutcomes
i before
i the cases reachito category II failure. i a i
a gg g t at t a a iag i a t atm t i im i g t atm t
Theret are
m estimatedt around
a 1500 a (0.84
t attog 2.4) cases
ai of DR TB annually. However, 350 to 450 MDR TB
cases are notified annually. This year 635 MDR TB cases were notified. In 2075/76, a total of 392 RR/MDR
a mat a t a Ba a t
TB were enrolled for treatment. TSR of RR/MDR patients was 72%. .Among them, 62 cases (16%) were on
B a a a a i a B a a t ta
treatment atBDR centers of province
t atm1, 60t cases (16%) at province
a t 2, 89
a cases (23%)
m gatt Bagmati
m province,
a
36 cases (9%) at Gandaki
t atm province,
t at 95 tcases (24 %)i at province
a 5 and remaining
at i50 cases (13%)
a were on DR
at Bagmaat Sudurpaschim
treatment i a provinceatrespectively.
a a i i
However, a
there were at i
no patients a treatment
on mai i gat DR
a t atm t at
centers of Karnali province during the period. a im i t
a t t atm t at t a ai i i gt i
Box 5.4.2 Drug Resistant TB Types

Rifampicin resistant TB (RR-TB) is resistant to rifampicin (detected using rapid diagnostic tests),
with or without resistance to other anti-TB drugs and covers any resistance to rifampicin.
Pre-extensively drug resistant TB (Pre-XDR TB) is a multi-drug resistant strain of TB that is also
resistant to either one of the fluoroquinolones and all the second line injectable drugs.
Extensively drug resistant TB (XDR TB) is a severe form of MDR-TB that is multidrug-resistant
(MDR-TB) to all the fluoroquinolones and second line injectable drugs.

Case finding
The national MDR TB Treatment Guideline defines three types of MDR-TB (RR TB, Pre-XDR TB and XDR TB)
cases which are further classified in six different categories. Drug resistant forms of TB are detected
through GeneXpert, Culture/DST and LPA methods in Nepal. In this reporting period, 376 MDR TB cases
were reported to have enroll in the DR treatment.
Figure 5.4.5 shows the burden of MDR TB across the different provinces in this fiscal year 2074/75. In
i mi g a i a t
Case finding
a a B atm t i i t t B B Ba
B a i a t a i i i i t at g i g i ta t m Ba
t t t g t t a m t i a t i g i
B a t t a i t t atm t
ig t Ba t i t i i t i a a
t m m B a t i a i t a
a i a im i a i imi a
t Figure 5.4.5: MDR-TB cases
a notified
B by
a provinces
t a m at i i
a a i i a im i a i
Figure 5.4.5: MDR-TB cases notified by provinces
Figure 5.4.5: MDR-TB cases notified by provinces
Source: NTC
Figure 5.4.6 shows treatment outcome of DRTB case registered in NTP. The Treatment success rate of
Source: NTC
igMDR
FigureTB5.4.6
has shows
slightly increase
atm t to
t treatment t72%minofthis
outcome DRTBreporting
Bcase period
gi t from
a registered thatThe
in iNTP. of previous
atmyear.
Treatment t But rate
success there atwas a
of
B
fluctuation a ig t i a t i t i g i m t at i a
MDR TB has slightly increase to 72% in this reporting period from that of previous year. But there was amainly
in the treatment success rate of MDR TB. The fluctuation in treatment success B
ratet tis
aaffected
a tbya in
fluctuation thethei treatment
t t atm
proportion t as
ofsuccess
death ratewell at holding
as
of MDR B MDR patients
of fluctuation
TB. The the int treatment
a ati treatment.
t success
atm rate
t is mainlyat
i mai
affectedaby the
t proportion
t atholding
of death as well as a a MDRi patients
of the g t at treatment.
a t at t atm t
Figure 5.4.6: Percentages of Treatment outcomes of MDR TB cases
Source:NTC
Source: NTC
NTP’slaboratory
laboratory network DoHS, Annual Report 2075/76 (2018/19)
NTP’s network
The diagnosis and treatment monitoring of TB patients relies on sputum smear microscopy because of its
The diagnosis and treatment monitoring of TB patients relies on sputum smear microscopy because of its
low cost and ease of administration. It is also the worldwide diagnostic tool of choice worldwide. Nepal
low cost and ease of administration. It is also the worldwide diagnostic tool of choice worldwide. Nepal
has 603 microscopy centers (MCs) that carry out sputum microscopy examinations. Most of the MCs are
has 603 microscopy centers (MCs) that carry out sputum microscopy examinations. Most of the MCs are
i mi g a i a t
NTP s laboratory network
iag i a t atm t m it i g B a t i t m m a mi a
it t a a a mi i t a t i a t i iag t i
i a a mi t t at a t t m mi
run
run ami a government
bythe
by the government t health
t
health a
facilities
facilities whiletfew
while fewgare m t by
are operated
operated bya NGOs
tNGOs a iand i private
and i instructions
private a
instructions at
(Table
(Table
5.4.2).There a
5.4.2).Thereare are welli at i
well establishedt
established networks a
networks betweenbetween the a
the microscopy ta
microscopy centres i
centres (MCs) t
(MCs) at at PHCCs, t
PHCCs, DHOs DHOsand tand
mi
DPHO,the thefive t
fiveregional
regional TB at
TB quality
quality control
control centres a
centres (RTQCCs) t
(RTQCCs) and gi a B a it t t
DPHO, and with
with thethe National
National TB TB Centre
Centre (NTC).
(NTC).The The
microscopy a centres it t
send a
examined a B
slides tot their RTQCCs mi
via DHOs according t to the Lot ami
Quality i
Assurance t
microscopy
t i centres
ia send examineda i gslides
t t to their t RTQCCs
a it via aDHOs according
am i g to the t mLot Quality m Assurance
t t
Sampling/System (LQAS)
Sampling/System (LQAS) method.
method. At At the federal structure,
structure, NTP has already initiated coordination and
t a t t a a athe ifederal i at i aNTP has a already mm initiated
i a coordination
it and
communication
i
communication t with withirespective
respective
t provinces
i provinces
a a toaprovide
to provide technical
ia technical t t and financial
and ta i
financial support
i iato
support to establish
t t provincial
establish t
provincial
structure
t a for athe
it external
a a quality assurance
m a of
mi smear microscopy
i slides. The a overall
ag agreement
m t at rate or tthe
structure for the external quality assurance of smear microscopy slides. The overall agreement rate or the
concordancea ofofsputum
sputum slidei examinations
t slide
m betweent microscopy
ami a between mi centres and RTQCCs a has been more a than
concordance examinations microscopy centres andt RTQCCs has been more than
m
95% int thisa reporting i t year i 2074/75. g The a agreement rate has ag improved
m t at in recent a imyears. Thei externalt quality a
95% in this reporting year 2074/75. The agreement rate has improved in recent years. The external quality
assurancet (EQA)a a itsputum
for a a
microscopy is carried toutmprovincial
mi healthi directorates
a i t(previously
i ia regional at
assurance (EQA)
i t directorates)
at for sputum
i at seven gi microscopy
a is
aand carried out
t atithe tNational
at provincial health directorates
at centre in Kathmandu.i a at t (previously a regional
a B
health provinces TB
healtht directorates)
i at ma at seven provinces and at the National TB centre in Kathmandu.
Table 5.4.2: NTP laboratory network (no. of institutions) by province
a 5.4.2: NTP laboratory
Table a at networkt(no. of institutions)
i t by province i
Center Province 1 Province 2 Province 3 Gandaki Province 5 Karnali Sudurpaschim Total
Center Province 1 Province 2 Province 3 Gandaki Province 5 Karnali Sudurpaschim Total
MC 102 79 136 58 99 33 97 604
MC 102 79 136 58 99 33 97 604
GX sites 7 10 15 4 11 4 5 56
GX sites 7 10 15 4 11 4 5 56
Source: NTC
Source: NTC
A lot quality assurance sampling/system (LQAS) has a been implemented
m t tthroughout t Nepal. a At t each
lott quality
Amicroscopya it aassurance
centre,
a am i g
sampling/system t m (LQAS) has been im
implemented g
throughout Nepal. At a
each
mi t examined
ami slidesi for EQA are collected a andt selected
a according
t a to thei LQAS.g t tPreviously
microscopy
NTP iused tocentre,
collectexamined
alltpositiveslides for EQA arenegative
collectedslides
and selected according to the LQAS. Previously
tand
a 10 percent
i a t forgaEQA. In iLQAS, slides are collected iand
NTP used using
aselected to
t collect all positive
astandard iand
tprocedures g 10
tatopercent negative slides
a a statistically
give gi foraEQA.
t significant In LQAS,
tasample slides
a size.ig i aare
LQAS ist collected
aam iand
systematic
selected i ausing
sampling t standard
ma that
technique amprocedures t toi give
i g maintain
helps t aatstatistically
good quality mai
sputumsignificant
tai results
g sample
a it size.
between t LQAS
m is centres
microscopy ta systematic
t and
mi
sampling technique t a
that a
helps itmaintaint good t quality t
sputum
quality control centres. The two means of testing for MDR-TB are given in m a
results t
betweeng microscopy B a gi
centres i
and
quality control centres. The two means of testing for MDR-TB are given in
Box 5.4.3 Means of testing for MDR-TB in use in Nepal
Box 5.4.3 Means of testing for MDR-TB in use in Nepal
The GeneXpert MTB/RIF is a cartridge-based technological platform that integrates sputum processing,
The
DNAGeneXpert
extractionMTB/RIF is a cartridge-based
and amplification, technological
TB and MDR-TB platform
diagnosis. that
It has a integrates sputum to
similar sensitivity processing,
culture,
DNA extraction and amplification,
targets specifically andTB enables
and MDR-TB diagnosis. Itdetection
the simultaneous has a similar sensitivity
of rifampicin to culture,
resistance. The
targets
Xpert MTB/RIF test isspecifically
a valuable,and enables and
sensitive, the simultaneous
specific new detection of rifampicin
tool for early resistance.
TB detection and forThe
determining
Xpert MTB/RIF rifampicin
test is aresistance.
valuable,While mono-resistance
sensitive, and specifictonew rifampicin
tool for occurs
earlyinTBapproximately
detection and 5% for
of
rifampicin resistant
determining rifampicin strains, a highWhile
resistance. proportion of rifampicin
mono-resistance resistance occurs
to rifampicin is associated with concurrent
in approximately 5% of
resistance to isoniazid. Thus, detecting resistance to rifampicin can be used
rifampicin resistant strains, a high proportion of rifampicin resistance is associated with concurrentas a marker for MDR-TB
with a hightolevel
resistance of accuracy.
isoniazid. Thus, The use of resistance
detecting Xpert MTB/RIF started incan
to rifampicin Nepalbe in 2011/2012
used and there
as a marker are 74
for MDR-TB
Xpert MTB/RIF centres throughout the country.
with a high level of accuracy. The use of Xpert MTB/RIF started in Nepal in 2011/2012 and there are 74
Xpert MTB/RIFofcentres throughout
The culture the country.
remains the gold standard for both diagnosis and drug susceptibility
testing, and
The culture of also the method ofremains themonitor
choice to drug resistant
gold standard for bothTB diagnosis
treatment.andConventional culture
drug susceptibility
methods
testing, using
and alsoLowenstein-Jensen
the method of choice (LJ) has
to the majordrug
monitor disadvantage
resistant TBof being very slow.
treatment. LJ culturesculture
Conventional take
eight weeks for negative results and four to six weeks after initial culture for drug susceptibility
methods using Lowenstein-Jensen (LJ) has the major disadvantage of being very slow. LJ cultures take testing.
National
eight weeksTBforReference Laboratories
negative results and four(NRL),
to six NTC
weeksand GENETUP,
after are for
initial culture providing culture andtesting.
drug susceptibility drug
susceptibility test (DST) services and NTP has envisioned to establish
National TB Reference Laboratories (NRL), NTC and GENETUP, are providing culture and drugProvincial TB Reference
Laboratories in all the seven provinces by 2021.
susceptibility test (DST) services and NTP has envisioned to establish Provincial TB Reference
Laboratories in all the seven provinces by 2021.
i mi g a i a t
TB/HIV co-infection
TB/HIV co-infection B a t it a m t t t t
TB/HIV co-infection
InIn
FYFY2075/76,
Figure 22029TBTB
5.4.7 : 22029
2075/76, TB/HIV patients
withwith
Co-infection
patients a documented
screening andHIV
a documented testHIV
treatment test result.
status.
result.
Figure 5.4.7 : TB/HIV Co-infection screening and treatment
Figure 5.4.7 : TB/HIV Co-infection screening and treatment status. status.
Figure
ig Figure
5.4.7 shows5.4.7 the
t shows the
TB
B /HIV TBco-infection
i /HIV co-infection
status
tat .Out t of total
status t.Out
ta of total
screened for TB, 0.7%
screenedB for TB, 0.7%
were diagnosed to have
iag were tdiagnosed a to have
HIV. In those diagnosed
t HIV. iagIn
with TB-HIV co-infection, those diagnosed
it were with
97% B in co-infection,
TB-HIV
enrolled
ART.i 97% were enrolled in
As per thei ART.
data received
t
from NCASC ata of totali
Asout
per the data received
m
estimated t 31,020
t ta
estimated from NCASC out of total
mat PLHIV 19,702
knew mattheirestimated
status and 31,020
15,260 twere estimated
i under
tat ART. a PLHIV 19,702
knew their
I In FY 2074/75,total of status and
15,260 PLHIV were
t screened
ta for TB. B 15,260 were under ART.
Planning, Monitoring & Evaluation I In FY 2074/75,total of
Planning,
15,260 PLHIV
National Monitoring & Evaluation
were screened
Tuberculosis Centre for TB. for formulating long and short terms strategy and plans to fight
is responsible
against Tuberculosis throughout the country Planning and implementation of National Tuberculosis
Planning,
a a Monitoring
Programme i & Evaluation
(NTP) is guided t National
by i i
Strategy m a Currently,
Plan (NSP). g g aNTP is implementing
t t m t atitsgactivities
a aas
t g
National t agai t
Tuberculosis
per the strategy, Centre
objectives, i t
andistargets g
responsible t t t
for formulating
of NSP 2016-21. a i g a
long andand
NTC also develops im
short mterms
revise ta strategy
its annual a planaplans to fight
workand
i
based onTuberculosis
against strategic g amm
information
throughout i theg i country of
and recommendations a Palika
a and
Planning t and
atProvince.
g implementation
a of tNational i Tuberculosis
Programme (NTP) is guided by National Strategy Plan (NSP). Currently, NTP is implementinga its activities as
im m g it a i a t t at g a ta g t
a i it a a a a t at gi i ma a
per the strategy, objectives, and targets of NSP 2016-21. NTC also develops andmmrevise aits annual work plan
ai aa i
based on strategic information and recommendations of Palika and Province.

i mi g a i a t
Supervision and monitoring
Supervision and monitoring
i i a m it i g B at a i i a i t g a i it t a
The supervision
t gand
amm monitoring
ig of TB health
a care services
a is i carried
t outabyt regular visitsgto all
a levels
i of the
i programme
a i t (Figures
at t im 5.6.9
t a i5.4.10).
and g m In it addition,
i g a thea quarterly
a at a is carried
reporting of activities t out at
g amm planning, monitoring and evaluation (PME) workshops at all levels of the programme.
trimester
he
on The NTP regularly
g a monitors
m it case a notification,
a smear m conversion,
a itreatment
t atmoutcomes
t t andm programme
a
tal management
g amm mareportsag m from t all levels
t mofathe programme.
t Data is initially
g amm ataanalysed
i i i a byaTBa focal persons
B of
7% a center and Health Coordinator
DOTS t a a of
t respective
i at local level during reporting
a i gplanning workshops.
and ga
ve a i g
Thereafter, TB focal persona from B a
the respective m t office report at province
health at t at
level planning, i
monitoring
ed and evaluation workshop. Finally, TB focal persons from provincial health directorates report atanational
a i g m it i g a a a i a B a m i ia t
n, iPMEt workshops.
at tThese
at aworkshop
a ta a m t
take place every four months at the Local level province and national
at
in t a i a a a
level.
ed Figure 5.4.9: TB supervision system Figure 5.4.10: TB monitoring system

tal
20 International International Review Annual
02 National Reporting &
National 4 monthly
nd Planning Workshop
T. Provincial Reporting &

Provincial 4 monthly
of Planning Workshop
Palika level Local Level Reporting &

4 monthly
(Local body) Planning Workshop
Treatment Center
Treatment
ht Centre
Reporting & Planning 4 monthly
Workshop
sis
as
Logistics
Logisticssupply
supplymanagement
management
an
The NTP’s logistics management system supplies anti-TB drugs and other essentials every four months to
gi sites
service delivery mabased ag m t number
on the t m of new i cases
a B
notified g ina the previous
t a and the number
quarter
mof tcasest underi treatment
i it(Figure
a 5.4.11).t Prior m to procurement a of Anti TB Drugs,i forecasting
i t a t and
a quantification
t m is done a considering t all
atmavailable data. NTC follows rules and regulations of PPMO to gprocure
t ig i t m t B
a g a a a i i i g a a ai a ata a
drugs from GoN Budget while Pooled Procurement Mechanism (PPM) is adopted to import medicines from
g a t g m B g t i m t a im
the Global Drug Facility (GDF), Switzerland. All the drugs from procurements are received in the central
i a t t im t m i i mt a g a i it it a t g
NTC
m Store and stored
m t a by adopting
i proper
i t storage
ta methods.
t aDrugs t are supplied
a every
g 4 monthst agDistrict
to
Medical
m t Store via
g a Regional i Medical Store (RMS)
m t t iti t after receiving
i a torder as a result
ia gi a of workshops
i a t in each
Region.
a In casei ofi gFirst Linea Drugs
a buffer
t of 4 months
i isa added gi in the order
a while
i t supplying
i g but no such
m quantity
buffer t i a is given i tin case of DR iDrugs. Supply i g oftDR drugs is done directlya t itogiDR Centers i a and to some
DRgSub Centers. g i i t t t a t m t
Physicaland
Physical andFinancial
FinancialProgress
Progress status
In Fiscal year 2075/76, NTC made 72.76 percent physical progress. Financial progress was 53.56
i a a ma t i a g i a ia g a
percent(Allocated
t at Amount
m t 695,200,,000, Expended Amount
m 344,225,000)
t at the
at t centraltlevel.
a Till the
i date,
t NTCat
cleared 9.26apercent of financial
t irregularities
a ia i (g a i ) in the year i. t a

i mi g a i a t
5.4.5 Key Constraint & Challenges
a a g a a i g a a g a t ai t i i t
i a i it t a a tai t ii t g amm i ga t a g a
t ai t a t i t a t i t g a a ta g t t g amm i
t at a a
Challenges:
a a B g am at a a i
i tim g a g am t a t a t i ami m m
a at B ma ag m t t ai i g t m i a t
i im m i t t gt i g m t
a a a a ga i g i a i g t atm t a
a t mt a ta i at a i t i t
ai a i it B mat ia at a t a i i
i tt i at it gi a a i ia ita
Action to be taken:
a i B g amm t g tt t
m tg i i t t gt i i at i a a
t gt t mm it t t m g amm
a a a a a B t atm t a a
a iti t a t t B mat ia

E pi d em i olog y and Di s eas e C ontrol
5.5 HIV/ AIDS and STI 5.5 HIV/AIDS and STI

1:1:Background
Background
Withit the
t first case
t a of HIV identification
i a in i1988, Nepal started a ta tits policy
it response
i to the
t epidemic
t i of
mi
t
HIV through g it
its t a
firstNational a
Policy i on Acquired i mm
Immunodeficiency i Syndrome m(AIDS) and a Sexuallya
a mi Diseases
Transmitted i a (STDs) Control, 1995 t (2052 BS). TakingBthe dynamic a i g tnature ofami at
the epidemic t
of HIV
intoi consideration,
mi iNepal
t i a its first national
revisited a i itpolicy
it on 1995
t a andaendorsed i a version:
theupdated
t
National at i
Policy on Human aImmunodeficiency
a i Virusma (HIV) mm
and Sexually iTransmitted i a (STIs) in
Infections a
a mi
2011.National HIV Strategic Plan i 2016-2021 a is alaunched t atto giachieve
a ambitious globali a goals of t 90-90-
a i
am iJuly 2021,
90.By g a90% g of
a all people livingB with HIV (PLHIV) will a know their i iHIVg status,
it i
90% of all people
t i tat a it iag i i i
with diagnosed HIV infection will receive sustained antiretroviral therapy (ART),and90% of all people tai a t ia
t a antiretroviral
receiving a a will have viral
therapy i isuppression.
ga t ia t a i a ia i
1.1. Ov erv iew of the Epidem ic

1.1. Overview of the Epidemic
ta gfromma a‘low-level epidemic’
Starting i mi over thet periodi of timem HIV infection
i ini Nepal aevolved itself
it tot
become a ‘concentrated epidemic’ among key populations (KPs), notably with People who Inject Drugs t
m a t at i mi am g a ta it
g Female sexma
(PWID), workers (FSW), Men who have Sex with a Men (MSM)
it a
and Transgender a (TG)
g People
i a i t at t i mi gi a ata i i at t at t
in Nepal. A review of the latest epidemiological data, however, indicates that the epidemic
i mi t a mi i a at i a t i i ta i g a i g
transmission of HIV has halted in Nepal. The trend of new infections is taking a descending trajectory,
ta t a i g it a i g i mi t at a i it a m t
reachinga its peak
i a during
a 2002-2003.The
a a a epidemic
i t that peaked
i in 2000 with almost
a 4,455
i newi cases
i int a
calendar
a m a i year hast declined to
a i gt873 in 2018 (81%
a decrease).
i This declineis
a a further
i t accompanied
g
bythedecreasing trend of prevalence of HIV in Nepal, as shown in the figures below.
0.4
Figure 1.1: Estimated HIV prevalence among adult population (15-49 Year) 2018 (1985-2020)
0.3
Percentage
0.2
0.16
0.14
0.1 0.12
Male Female Total
Figure 1.2: Estimated Trend of New HIV Infections and Deaths 2018 (1985-2020)
5000
4000
3000
Number
2000
873
1000
895
0
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
New Infection Death

i prevalence
This a a dropped from
has m 0.24% (highest
ig t level projected
t i in 2005)t to 0.14%i in 2018a andi is
t t tomai
expected tai aa plateau
maintain at a at t g 2020 with
at 0.13% through it thecurrent
t t
level of efforts.t
Figure 1.3: Estimated HIV infections by age group, 2018

Male
12,000 11,059
Female
10,000 8,975
8,000
Number
6,000 5,373
4,000
1,868
2,000 734
661 635 639
-
0-14 years 15-24years 25-49 years 50+ years
F i gure 1.4 : A nnual H I V i nf e ct i ons am ong adul t s ( 15 + ) b y rout e of t rans m i s s i on : 19 9 0 - 20 20

5 ,0 0 0
4, 5 0 0
4, 0 0 0
3, 5 0 0
3, 0 0 0
Number
2 ,5 0 0
2 ,0 0 0
1, 5 0 0
1, 0 0 0
5 0 0
0
19 9 1
19 9 3
19 9 4
2 0 0 1
2 0 0 3
2 0 0 4
2 0 11
2 0 13
2 0 14
19 9 0
19 9 2
19 9 5
19 9 6
19 9 7
19 9 8
19 9 9
2 0 0 0
2 0 0 2
2 0 0 5
2 0 0 6
2 0 0 7
2 0 0 8
2 0 0 9
2 0 10
2 0 12
2 0 15
2 0 16
2 0 17
2 0 18
2 0 19
2 0 2 0
Clients M S W M S M T G FS W L ow- ris k males L ow- ris k females ID U
a t i mi i ima i i a a t a mi i t at a t m t a
Overall,
t t ta the epidemici is primarily driven
a i g bya sexual transmission
t t ta that
mataccounts for more than
t 76% a of
a the ttotal newi HIV infections.Making
ag t aup 4.3% aof the
i i total
g itestimated
i PLHIV(29,944),
a i there
i t area about
t
ag1,296children
a aageda up toa14 yearst who are livingit with
a HIV i inmiNepal
t atin a2018,i while
t m adults
the t aaged
t 15
a and
years t above
a account i for 95.7%. With
mat anam g t that has
epidemic a existed
ag for more a than
a atwo decades,
amthereg are
t ta7,241infections
mat B
estimated ma athepopulation
among t t aged
t i 50 years and above
t i (24%) among
a ttotal
mai i g mPLHIV.
estimated t aBy sex, tmales
i i two-thirds
account for a i(59.2%)
ma of thet infections
i aand the remaining
a i
t ag g a am g t ta mat
more than one-third (40.8%) of infections are in females, out of which around 71% are in the
reproductive age group of 15-49 years among total estimated PLHIV.
t a t a mi i i t ma t a mi i i t t ta i i
a t i m a a i imi a i t i
Heterosexual transmission is the major routine of transmission in the total pool of HIV infection in
t Nepal.The
i contribution
a i g m all bands of KPs is similar in the period of projection 1995-2020, only the
from
level is varying over time.
t
i t i t am g t t ta ia a i g ag g a
a a a am g a a amat i a
In 2018, 95.7% ofathe total infection was distributed
a i among
t the population having
a a tage group
i 15
mayears
i and iabove.
g The
a estimate
t infections
a amongkey
i ma populations
a t are as follows:
t PWIDs
mai i g(Male)
i (3%),
MSWs(2%), MSM and TG (9%), FSWs (2%) and Client of FSWs (9%). These apart, low-risk males,
including MLM account for 36%andlow-risk females account for 39% of the remaining infections.The
estimated number of annual AIDS deaths of all ages is estimated to be around 895 for 2018.
Similarly, subnational HIV estimates of Nepal according to key population is reflected in table below.
mat m a a at a ag i mat t a
imi a a a mat a a i gFigure

t 1.5: Distribution
a of People
i Livingtwith iHIVta
(15
years and above), 2018. Note: LR, Low risk.
Figure 1.5: Distribution of People Living with HIV (15
years and above), 2018. N e r
M SW , 2%
F SW , 2%
P W I D (M ale),
MSW, 2%
3 % FSW, 2%
PWID
C li ents , 9% (Male), 3%
Clients, 9%
L R W om en,
M SM /T G , 9%
3 9%
LR
Table 1.1 People living with HIV by key MSM/TG, 9%
Women, 39%
populations and Province, 2018.
PW MS MS FS Migr Clie
Province
ID W M W ants nts
L R M ales ,
3 6%
Province 18 15
65 74 609 401 LR
I Table 1.1 People
4 L iv ing4with HIV by K ey PopulationsMales,
and36%Prov ince, 2018.
Province
Prov ince 13 PWID
67 MSW MSM FSW Migrants Clients
76 44 1063 386
2 4 4
i 184 65 154 74 609 4 01
Province 33 25 90 20
i 76 998
13 4 917 674 4 4 1063 3 86
3 5 4 8 1
Bagmati 3 3 5 254 908 201 998 917
11
Gandaki 76 75 25 846 127
a a i 76
7 75 117 25 84 6 127
Provincei 22 15 227
53 13 155 53 5 13 4 1083 54 8
1083 548
5 7 5 5 4
a ai 5 4 16 3 219 12
Karnali a 5 im 4 16
27 3 219
4 6 12 24 3 52 1868 13 7
Sudurpa P W I D: P eople h o I nj ec24t Drug52s ; M 1868
27 w 46 SW : M ale 137Sex W ork ers ; M SM : M en w h o h av e Sex w i th M en; F SW :
schim F em ale Sex W ork ers 3
t g a a it
PWID: i l People
C i v ma s oc i eti eswhoh av Inject
e als oDrugs;
play ed MSW:
pi v otal Male
rolesSexi n Workers;
th e nati onal MSM: res Men
pons e.who C i v ihave
l s oc i Sex
eti es with Men;
, th roug h thFSW: e
Female em powSex ermWorkers
ent of K P s , h av e b een play i ng i ns trum ental roles i n prev enti on, treatm ent, c are and s upport
s erv i i i c es asi w ell asa b ri nga i ng ab aout c h ang i esta i n leg al iand t poli c ay env ai ronm ent th roug i h i ad v oci ac y . t g
Civilmsocieties m have t also played
a pivotala i roles
g i t inmthetanationali response. Civil t atm societies,t a through a
E x ternalt Dev elopm
empowerment of
i KPs, ent P artners
a have a (E playing
been DPi gi
s ) eqg instrumental
ually
a s tupport a gthroles
e nati
i inonalga resa pons e treatment,
prevention, to
i HI V i ni N epal m b y tand
care prov i d i gng
t support
aa s ub s as
services atanti
wellal amas bringing
ount of resabout ourc eschanges
req ui redin legal
f or c omandb ati ng HIenvironment
policy V . T h e G lob althrough
F und to advocacy.
F i g h t AI DS, T B and
M alari a (G F AT M ), P res i d ent' s E m erg enc y P lan F or AI DS Reli ef (P E P F AR), U ni ted States Ag enc y f or
External
I nternati t aDevelopment
onal Dev m elopmPartners
t ent (EDPs)
a t (U SAI D), T h equally
e U nia tedsupport
N ati onst the
t C h i national response
ld aren’ s a F und (U N I C tto
E F ),HIV in Nepal
W iorld a by
Health
providing
O rg ani a substantial
i iz atig on amount
a (W HOta ), AIa DS of resources required
amHealtht C are F ound ati on (AHF for combating
i )are th emex aternal HIV.The
g s ourc es th at aare c ontrit b utiigAIDS,
Global Fund to Fight ng t
TB to and B
Malariaa a a
(GFATM), ia
th e nati onal HI V res pons e. President's i t
Emergency m g
Plan For aAIDS Relief i
(PEPFAR), United it
States tat
Agency
g
for International t Development
a a m t
(USAID),The United Nations it aChildren’si Fund (UNICEF),World Health
Organization2: aPolicyt gaEnvi aironm ent and Progres
(WHO),AIDS Health Care Foundation
a t s a in National a
(AHF)are the HIVexternala pons
Res t et athat are contributing
sources
t at a
ti gt t a a
to the national HIV response.
2.1 Introduction
2: DoHS,
M Policy Environment
ore thAnnual
an tw Report es of and
o d ec ad2075/76 e HI Progress
V epi d em i c h in
th (2018/19) as National
s ti m ulated N HIV
epal Response
to res pond w i th a num b er of poli c y
i ni ti ati v es . T h es e poli c y res pons es h av e c om e c ros s - c utti ng ly f rom th e h ealth s ec tor as w ell as oth er
2.1d Introduction
ev elopm ent s ec tors ai m i ng at c reati ng an enab li ng poli c y env i ronm ent f or th e c ontai nm ent of HI V as
Moreellthan
w as m twoi ti g atidecades
on of th eof
epithe
d em HIV
i c . N epidemic
otab le polihas
c y d stimulatedNepal
ev elopm ents tak en
tof or g ui d i ng with
respond th e nati onal res pons
a number e
ofpolicy
to HI V are
initiatives. Theses pelt policy
out h ere.
responses have come cross-cuttingly from the health sector as well as other
development sectors aiming at creating an enabling policy environment for the containment of HIV as
2: Policy Environment and Progress in National HIV Response
2.1 Introduction
t a t a mi a t m at i a t it a m
i i i a a i m g mt at t a a
t m t t aimi g at a g a a i g i i m t t tai m t
a a mi ga t i mi ta i m t ta g i i gt
a a t a t t
The National Health Sector Strategy Implementation Plan (NHSS-IP 2016-2021)
a a g i a a i it g amm m t a i
g i t a
t at gi a a t tai a m t a a t
a a at t t at g a a at t t at g m m ta a
a ai at a i g t a i am i
ta g t a a t at gi a a i gt i mi a a
i a t t at
National HIV Strategic Plan 2016-2021
a a t at gi a t a
a t at g it t aim m gt
g a g a a a t at gi a t i i
a t i i m t at gi i i g i at i ig t a
a t ai g amm it i t at a i t g at i t t g a at i
t t t i a m im m ta t a a t at g
it mi t m i a t a tm t a a it a i
mm a m t t m i mi i a t t at gi
i ma m t i a a m t
National Health Sector Strategy (2015-2020)
i it at a a a a t a t i a ta
t im m ta t a a t at gi a t g t i at i
i at t at a i ia a a t im m ta ta a i i a
it t i a t i at t i i g i t at a i i i
i t a t g m t t a ga i a B a a i gt
i a i a i t a i g t at i a i i i g it i im a t at
i i at a t i mai tai a i i m i tm t i a ma
mmitm t a t t g a t at g a t tai a
m t a a t t a m i mmitm t t at a i g
i gt i mi a a i at t at
2.2 Policy related activities/highlights from FY 2075/076
it t aim im m ta t a a t a i t a a g a
a m a a g i i a a ti t a i
a a g a atm t i i a a i at i i
t at gi ma g i i a a a i
i i at m t t i t a mi i ai i g a a
atm t it a ai i g a a iat i i i i a a a
i i mm it gi a a
188 DoHS, Annual Report 2075/76 (2018/19)

3: HIV Testing Services and STI Management
3.1 Introduction
a t t it g a a i i g i a a t t atm t a a t
g i a a t at gi i t a a t i
a ta t it t t ga i it t a a ta
i t i at g a i g i g t m it i a a
ta t a a t g a i g g am a at i t
i i i at ga i g a a a ia m t t
a g t agai t it t a i ga i g it a t
t t a aa m t a a i i a m at i
a at i a a at t a at g i i i m g a a m i
g i i t a ga g i mm it Ba g B a a
a a i i at i a a a gg t a a ga atm t
i i a i a m i g a t im m t t mm it g
a a i t ma imi t g am g a t i a a a a
i i mm it gi a i a a t i
a im m t i i t i t imi a ta g t i t g am am g a
a a i a iti t
ma a t ai i at
a ii a a
it g it t a ma ag m t aa mi a a
a t at gi a i t ga at t a a t i a ta t it
t t a i i a a ga t t mai tai i g t i
i ag t t ai t a a a a ag m t g i i i a i
a a i i a
3.2 Key strategies and activities
HIV Testing Services
a a t at gi a ii a i ai g t g i
mm it a t gi a i at ma i ta g t a i a t
a t ma im m ia it t g a i ag t a ig t atm t a
a t a a t at g t i i t at t i at t m i ga a
ta t g i a a i t ga at t g m t at a i
m t a i m gt ta t g am g t g ta g t
mm i a a i ag t mm it t a a i i i i at
g a i g a ta t i i t ata i i i it
ma i i i t a t m ami a i g a B i i t i t t t
a a t a a a a i g ag a a t i tt
a a t m i a a i i g t atm t t i i
a t t i a t a
t a mi i i a i i gm t t i t a mi i
m a a i i i a a ami
a t ia ta t
m i ga a i g t t
ma i a i i t gma a i imi a
ami a i ga ta i a
a agi g B i
Detection and Management of Sexually Transmitted infections (STI)
t t t t a ma ag m t t ta a i a a it iag i a
t atm t t at ta at t a a at ima at a i a
a t at g i t a a t i t at g t ta a i a
mi a a it t a gi a t atm t
t gt i g m t i ag a m a im t a i a a g
mm i a B i a t ga i g i i g t t gt i g i ag
t a i a t a i t t t t t at
i mi a
3.3 Progres
3.3 Progres s s and andAchiev Achievemem ent ent
3.3 Progres s and Achiev em ent
HIV
HIV Tes ting Serv
Testing Services ices
HIV Tes ting Serv ices
T h ere are 175 HI V T es ti ng and C ouns eli ng s i tes i n N epal th at i nc lud e3 8 non- g ov ernm ent s i tes and 13 7
Tg hovere ernmarea ent 175s i tesHI V operati
T es ti ng nggandai n thC ouns eli ngi s galsi tesoit m i naiiN ntai
e c ountry epalni thnga at i ncei irludli nke3 ag8 esnon-
t th at w i gth ov K gernm
P s as entw mells i tes
ast w itandi th 13 7
aART
gs i ovtesernm gas w ell m
ent as P M t T itC T s i tes . T ah e trend
s i tes operati ng i n th g i ts of prog ram
e c ountry als o t am ati cmai
m ai ntai d atatai
ni ng th ei i g t w i h oi w ag
r
of people li nk ag es w i th K P s
ere tes ted it and ac ouns
as w ell as w i th ARTa
eled
sovi tes iter thas ew lasellittasth P reeaM T y C ears
T s ai tes
s h ow i nitT abs le
. T h ede trend . 1.t ram m ati c d ata
of 3 prog g amma of people ata w h o w ere tes ted and c ouns t t
eled
a t
ov er th e las t th ree y ears s h ow ed i n T ab le 3 . 1. a t t a i i a
Table3.1: Serv ice Statis tics HIV Tes ting and Couns eling for the Period of BS 2073/ 074- 2075/ 076
Table3.1: Serv ice Statis tics HIV Tes ting and Couns
Indicators 2073 /074 eling for the Period 2074 of /075BS 2073/ 074- 2075/ 2075/076 076
T otal tes ted f or HI V Indicators 2073
210,525 /074 2074 /075
3 3 0,4 60 2075/076
23 7,4 96
TT otal
otal tesHI V tedP os f or i ti v HIe Vreported 210,525
1,854 3 32,152
0,4 60 232,298
7,4 96
TC otal
um ulatiHI V v P eosHIi tiV v reported
e reportedc as es 3 1,854
0,612 3 2,152
2,764 3 2,298
5,062
C um ulati v e HI V reported
Source: N CA SC routine programme data/ iH M I S c as es 3 0,612 3 2,764 3 5,062
Source: N CA SC routine programme data/ iH M I S
T h e HI V tes t ti ng gi s i h i g ig h es t i tniB ag m atii (76,920), and low a es t i n K tarnali i a prov a i i nc e i(3 ,100) w h ereas th ea t
T h e HI
perc entag
tag i it i
V tesetiofng posi s h i tii g v h i tyes y ti i eld i ig
n B iags h m i g atih es(76,920), t i
t i n G and and
a a i i
ak i Plowrov esi nct i enf K ollow
arnalied prov i nc eurpas
b y Sud (3 ,100)a imrov i nc thie. eT h e
c h i m w h P ereas
perc entag i i tai i a i a
prov i nc e- w ei sofe pos
d etaii ti lv i i s ty alsy i oelds h i ows h ni g i h nesT abt i nleG 3 and. 2. ak i P rov i nc e f ollow ed b y Sud urpas c h i m P rov i nc e. T h e
prov i nc e- w i s e d etai l i s als o s h ow n i n T ab le 3 . 2.
Table3.2: Prov ince wis e Serv ice Statis tics HIV Tes ting and Couns eling in 2075/ 76
Table3.2:
Prov incesProv ince wis e Serv ice Statis Tes tics
ted for HIVHIV Tes ting and Pos Couns eling in 2075/ 76
itiv e reported % of pos itiv ity y ield
Prov
P rov i inces
nc e 1 Tes ted 3 6,527 for HIV Pos itiv e287 reported % of pos0.itiv8% ity y ield
PP rov
rov ii nc
nc ee 1
2 34 6,5272,04 2 287
3 73 0.0. 8%9%
PB rov
ag m i ncatie 2 476,920 2,04 2 358373 0.0. 9%8%
BG agandm akatii 76,920
10,588 583
165 0.1. 8%6%
GP rov
and i ncak ei 5 10,588
4 6,977 165
552 1.1. 6%2%
PK arnali
rov i nc e 5 4 3 6,977,100 552 25 1.0. 2%8%
KSudarnaliurpas c h i m 3 ,100
21,3 4 2 25
3 13 0.1. 8%5%
SudT otal urpas c h i m 21,3 496
237, 4 2 2,3 298
13 1. 5%
1.0%
T otal N CA SC routine programme data/ iH237,
Source: M I S496 2, 298 1.0%
Source: N CA SC routine programme data/ iH M I S
3.3 K ey Challenges / Is s ues and Recom m endations
Is s ues Recom m endations
Data g ap i s f ound i n thIs es ues HI V prog ram es pec i ally T rai ni ng progDoHS, Recom
ram s Annual f m oc endations
usReport
i ng on 2075/76 m aj or non-
(2018/19)
Data
th e report f rom m any s i tes V (m prog
g ap i s f ound i n th e HI aj orramHos espi pec
tals i ally Treporti
rai ni ngng g prog ram s f oc us i ng
ov ernm ent and pri v ate h os pi tals s h ould on m aj or non-
th e report
and N G O s )f are
rom y m etany to b s ei tes
c ov (meredaj ori nHos
th epi tals reporti
b e d one b y N ernm
ng g ov C ASC ent andandi HMpriI v Sate h os er
i n ord pi tals s h ould
to ens ure
and troni
elec N G O c s )i HM
are I y Set
s y to
s temb e. c ov ered i n th e breporti
e d one ng b ytoN i C HMASC I S. andF urthi HM ermI S ore, i n ordaner upd to ens
ateure of
elec troni c i HM I S s y s tem . reporti ng to i HM I S. F urth erm
i nd i c ators i n HM I S reports i s nec es s ary to ad d res s ore, an upd ate of
ic ndurrent
i c atorsd ata
i n HMd i s I c Srepancreportsi es i s . nec I n esad s d aryi ti on
to adto d thresi s s ,
cw urrent
ork s h opsd ata to s d treng
i s c repanc th en ithes e. c I apac n ad i tyd i tiofon to entry
d ata th i s ,
Gandaki 10,588 165 1.6%
Province 5 46,977 552 1.2%
Karnali 3,100 25 0.8%
Sudurpaschim 21,342 313 1.5%
Total 237,496 2,298 1.0%
Source: NCASC routine programme data/ iHMIS
3.3 Key challenges/Issues and recommendations
Huge data gap is found in the HIV program Training programs focusing on major non-reporting
especially the report from many sites(major government and private hospitals should be done
HospitalsandNGOs) are yet to be covered in the by NCASC and iHMIS in order to ensure reporting
electronic iHMIS system. to iHMIS. Furthermore, an update of indicators in
HMIS reports is necessary to address current data
discrepancies. In addition to this, workshops to
strengthen the capacity of data entry users of
iHMIS at all levels is necessary for the updated,
consistent and valid data reporting in iHMIS.
The Community-Based/Led HIV testing service All the working NGOs must be enlisted in the iHMIS
among key population is mainly run through system. So that, the total testing numbers could be
NGOsandiHMIS database system does not fully incorporated, into national system andnational
cover NGO setting. The reporting from the figure of testing can be generatedfrom the iHMIS
working NGO yet to be covered in the electronic system.
HMIS system.
Low HIV testing coverage among key populations Effectiveroll-out of Community-led HIV Testing and
(KPs) has beenalong-standing challenge in Treatment Competence in Communities (TCC)
response to HIV. The problem of low coverage is approach with active monitoring should be in
most prominent for the returning labor migrants. place. Provide testing facilities at transit points as
well as destinations of migrant population.
Gap in HIV positivity coverage along with HIV The number of HIV testing sites should be
testing coverage as per 90-90-90 target. expanded in order to achieve 90-90-90 targets,
whereas decreasing funding trend remains a
challenge. Additionally, in response to loss to
follow-up of HIV positive cases, referral linkage of
HIV positive cases between Community Based
Testing sites and HIV Testing Services should be
strengthened to achieve the target for first 90.
4: Prevention of Mother to Child Transmission for elimination of vertical transmission (eVT)

4: Prevention of Mother to Child Transmission for elimination of vertical
transmission
4.1 Introduction (eVT)
4.1 aIntroduction
ta t it t t i a mi i g am i a
it g t it at B i a a t t a t
Nepal started its Prevention of Mother to Child Transmission (PMTCT) program in February 2005 with
i B aa
at it ita at ma a B i a ita Ba a t
setting up three sites at 1) B. P. Koirala Institute of Health Science (BPKIHS), Dharan; 2) Maternity
a t a a a i t i t g amm i ma
Hospital, Kathmandu and; 3) Bheri Zonal Hospital, Banke. In early 2007, the NCASC and UNICEF
i g mm a i t ga a i it mm it a mat a
aundertookataan operational
at i Review
i aof the
t piloti PMTCT
m t programme. ma The
mmreview it made a t following t
recommendation:
a t integration
mm it of PMTCTa activities
at with community-based
i g maternal
t i and neonatal
i health
m
services; increase
ag the a involvement g of Female t Community
i t Health
g aVolunteersi (FCHVs) i and other m
community-based
a i a health
a workers gin “Prong 1: Prevent
tm t HIV
t infection
i t a mi i in women of reproductive
a age”
g
andi “Prong
a 2:t Prevent
atm unintended
ta tt
pregnancy i HIV-positive
in t a women”t i a tactivities,
a ami
andi referrali for “Prong
i
3:aPrevent
im m g a t transmission
mother-to-child a i i of HIV”
i t andga“Prong i a 4: Provide
i ma care,agi gtreatment
a g
and support to
i a t gt t t i a g amm ma
HIV-infected parents, infants and families” services; involve local implementing partners and civil ag m t a g a
mm organisations
society it a g amand supporting
in managing i i at PMTCT i a i t iand
services, t istrengthena gi i g i of the
the role
NCASC
DoHS, in overall
Annual programme
Report management and governance. Community-based PMTCT programs were
2075/76 (2018/19)
initiated in several districts in Nepal beginning in 2009, based on recommendations from the 2007
PMTCT National Review and the knowledge that current facility-only based PMTCT models were not
reaching the majority of pregnant HIV infected women in the county and made several important
recommendations notably, train and utilize female community health volunteers (FCHV) and other
community-level workers to raise awareness on HIV and PMTCT and educated pregnant mothers on
the need to test for HIV in pregnancy; decentralize HIV testing of ANC mothers to lower-level health
a mm a mt a a i a t g t at t
a i it a m t a i g t ma it g a t i t m
i t t a ma a im ta t mm a ta t ai a i ma
mm it at t a t mm it t ai a a
a a at g a tm t t t t t i g a t ai
t g m t t at a ii a m a t ia
a ai a at at a ii t ai a i a a m t
ta m t m a t i a i t at t m a a i i t
i m ta t a a t a a it i
i g t i t i i a a t mt ii mat a a a i
i a t t a a i i a a i t g at i t a a
ga atm t i i i a ma ia m mat a a
i at a a t ai i a ig m t it i a t m it t g a
i at i t mat a a i at a i t m ai i g t t
i t i a t a a a i i ga i ma i a t i g
a a t a i g
4.2 Key strategies and activities
a i g t t i a mi i i a t a ig i a t i
i i i a i t i a a a t at g aim t imi at t a mi i
t g ia i gt g ag agai t t ta a a mat
g a i i t t a a t at g i ag t g amm
t i t g at a i t g at a i at i
a a t at g a t i t ga i t g amm a i g it t
a gi ami a i ii a a t at g a t t t g amm
a t i g m i a i t g at ga a
i ima t a mi i
ii i t g a i am g m i i g it
iii t a mi i m m i i g it t t i i a
i ii atm t a a t m i i g it a t i i a
ami i
a tt t a tt m t t ga a a a ag it t tai m t t
i g i i i g i t g a t m
t ga i g i g a a i a t at m
g t m t i t it i
a i a
a t i gi ma i ga t
a a t iag i a i at i t a it i a
a t m i t atm t a a ia t m t a ami i it
i
i i a a i t g at i t mat a a ata at i i
i t i t i t it B i a t g am a a i a iti t
a i ga i gi am g m i g i it at t at
a ii it t a a t at a ii at mm it t g m t a
a mm it Ba t t i a mi i B g am
i ta i g i ita a ma i g t i a i t g a t
m i i g i m t a a B g am a i g t ag mm it
t a t a i a ag a a ta am g g a t m
B g amm a a t g tt t
atm B g am a i gt t a i ag t a a t at g
t t i ai g i i i g it a i
i g a t a m a a t g a t m it t m
i ag a ta i t it a a ta g t i t
ami a i g a a at a i g i
a t t it mmitm t t imi at a t a mi i am g i a
a a it i i t a a t t i a it t
m m a i g a a t t a i t a i a
t a it t i a i a i ta t ag i
agai
Tablet t4.1:Service
matStatistics
g on
a PMTCT
i intNepal fora the
t period of BSi 2073/74-2075/76
ta i i a
Table 4.1:Service Statistics on PMTCT in Nepal for the period of BS 2073/74-2075/76
Indicators
Indicators 2073/74
2073/74 2074/75
2074/75 2075/76
2075/76
Tested
Tested for HIV (ANC &Labour)
for HIV (ANC &Labour) 382,887
382,887 439,225
439,225 440,709
440,709
HIV
HIV Positive
Positive Pregnant
Pregnant women
women 128
128 70
70 79
79
Total
Total Deliveries by HIV +ve
Deliveries by HIV +ve mothers
mothers 126
126 127
127 129
129
Mothers received
Mothers received ARTART 175
175 158
158 133
133
Babies
Babies received
received prophylaxis
prophylaxis 112
112 123
123 130
130
Source:
Source: NCASC routine programme
NCASC routine programme data/
data/ iHMIS
iHMIS
The
The HIV
HIV testing
testing among pregnant women is higher in Province 33 (97,461),and Province 5 (88,595)
t gamong
am gpregnant
g a women
t mis higher
i igin Province
i Bagma (97,461),and
i Province 5 (88,595)
a i
whereas
whereas the
the percentage
percentage of
of positivity
positivity yield
yield among
among pregnant
pregnant women
women is
is higher
higher in
in Province
Province 5,
5, than
than
i i tai i a i a
national
national average.
average. The
The province-wise
province-wise detailis
detailis also
also shown
shown in
in Table
Table 4.2.
4.2.
Table
Table 4.2:
4.2: Province
Province wise
wise Service
Service Statistics
Statistics on
on PMTCT
PMTCT in
in Nepal
Nepal 2075/76
2075/76
Provinces Pregnant
Pregnant women
women tested
tested Positive
Positive pregnant
pregnant
Provinces Positivity
Positivity Yield
Yield (%)
(%)
for
for HIV
HIV women
women identified
identified
Province
Province 11 66 99 ,, 88 99 22 1515 0.021462
0.021462
Province 2
Province 2 66 00 ,, 48 48 22 1414 0.023147
0.023147
Bagmati
Bagmati 9 9 7 , 46 1
7 , 46 1 22 66 0.026677
0.026677
Gandaki
Gandaki 47 ,
47 , 2 2 9 2 2 9 66 0.012704
0.012704
Province 5
Province 5 8 8 88 ,, 55 99 55 1717 0.019188
0.019188
Karnali
Karnali 2 2 55 ,, 22 43 43 00 00
Susurpaschim
Susurpaschim 5 5 1, 8 0 77
1, 8 0 1 1 0.00193
0.00193
Total
Total 440,709
440,709 79
79 0.00018
0.00018
Source: NCASCroutine programme data/ iHMIS
Source: NCASCroutine programme data/ iHMIS
Aiming
Aiming at
at the
the elimination
elimination of
of mother
mother toto child
child transmission,
transmission, Nepal
Nepal adheres
adheres to
to Option
Option B+B+ and
and embarks
embarks forfor
imi g at
providing t imi a m t t i t a mi i a a t B a m a
providing lifelong
lifelong ART
ART for
for all
all identified
identified pregnant
pregnant women
women and and breastfeeding
breastfeeding mothers
mothers with
with HIV,
HIV,
i i of
regardless g CD4
i along g with prophylaxis
a i treatmentg afort their
m infants
a as well.a The irollout
g m tof the lifelong
it
regardless
ga of CD4 along with
a g it prophylaxis treatment
a i t atm t for their infants as
t i i a t a well. The rollout of the lifelong
t t
treatment
treatment adds
adds the
the benefits
benefits of
of the
the triple
triple reinforcing
reinforcing effectivenessof
effectivenessof the the HIV
HIV response:
response: (a)
(a) help
help improve
improve
DoHS, Annual Report
maternal 2075/76 (2018/19)
maternal health
health (b)
(b) prevent
prevent vertical
vertical transmission,
transmission, andand (c)
(c) reduce
reduce sexual
sexual transmission
transmission of of HIV
HIV to
to sexual
sexual
partners.
partners.
Early
Early Infant
Infant Diagnosis
Diagnosis (EID)
(EID)
Initiatives
Initiatives for Early
for Early Infant
Infant Diagnosis
Diagnosis (EID)
(EID) of
of HIV
HIV in
in infants
infants and
and children
children below
below 18
18 months
months ofof age
age have
have
been
been takenwith the goals a) of identifying infants early in order to provide them life-saving ART; and b)
takenwith the goals a) of identifying infants early in order to provide them life-saving ART; and b)
i g t atm t a t t t ti i i g t a
im mat a a t t a t a mi i a a t a mi i
t a at
Early Infant Diagnosis (EID)
i a a a t iag i i i a t a i m t ag
a ta it t g a a i i gi a t a i t i t m i a i g
a a i ita g a a t a a t atm t i t m i it t i
t t a i i i m a ai a t g a i it a
t at a a i a t a at i at ma a a t iag i ag a
ig i a t i a it i t m t it i t i i at
a t i a am i a t a a ta i t ai t
tt am t ii a a ga atm t i i i
a im m ta t g at i t t t t g it i m t
ag i a a a i g a a m t ag t
m i iag i m t i gt t ata i a a i g it t
t t ai a at t it
Table 4.3. EID Service Statistics in Nepal
Table 4.3. EID Service Statistics in Nepal
Indicators 2073/74 2074/75 2075/76
Indicators 2073/74 2074/75 2075/76
Tested (within 2 months) 99 204 243
Tested (within 2 months) 99 204 243
HIV Positive (Within 2 months) 5 12 12
HIV Positive (Within 2 months) 5 12 12
Tested (within 2-18 months) 56 106 64
Tested (within 2-18 months) 56 106 64
HIV Positive (Within 2-18 months) 9 16 12
HIV Positive (Within 2-18 months) 9 16 12
Figure
Figure4.1:
4.1:CB
CBPMTCT
PMTCTdistricts
districts and
and EID Sites
EID Sites
4.4 Key challenges/Issues and recommendations DoHS, Annual Report 2075/76 (2018/19)
4.4 Key challenges/IssuesIssues
and recommendations Recommendations
Availability of HIV test kits with the limited expiry date. Ensure timely procurement and supply of
test kits to service sites.
Availability of HIV test kits with the limited expiry date. Ensure timely procurement and supply of
Tracking of HIV-positive mothers and exposed baby for The robust tracking system to track the HIV-
EID. test kitswomen
positive to service sites.be developed and
should
Availability of HIV test kits with the limited expiry date.
Ensure timely procurement and supply of
test kits to service sites.
EID. positive women should be developed and
implemented in all sites, and home-based
blood sample for EID test of an exposed
baby can be recommended.
Mainstreaming the private hospital in the national The district should strengthen coordination
reporting system for PMTCT test. with private hospitals to regularize the
reporting to district.
Supportive monitoring visit at service delivery points Frequent monitoring visit should be
from the Province and centre. performed to intensify the services at
bairthing centre and beyond birthing centre.
Inadequate supply of HIV test kit. Regular and consistent supply of HIV test kit
should be done to all ANC sites.
5: HIV Treatment, Care and Support Services
5.1 Introduction
it a ima aim t m ta it am g i t a t t g m t i
ta t gi i g g i a i ita a t at a t m t
t a a g i i t atm t i t a i a a a i a
a i t it t aim i i g atm t a a t i t i i g it
Ba a a ga atm t i i t im m t t t
a t at t at g m a a iag a t atm t at i at t
a ma i a i a a ma i a t i i t at t t
m g ma ag m t g am ma a t ai atm t
a a ti a a it t aa a a g t ai i g g i i i i g
it a m aimi g at a i gt i m ta i atm t a
a t
B t t t m m gt t ta t t
am t it t i i a a t ta m a
m i i g t a a a a t g
t a t a ga a i a i t m i g
t m a a i i g a

parallel with the preparation and updating of training guidelines. People Living with HIV have been
empowered aiming at enhancing their supplementary roles in Treatment, Care and Support.
5.2 Progress and Achievement
By the end of 2018, out of 21,388 PLHIV, only 16,913 of them were on ART. Among the total tested
(8,357) almost 91%(7,603) ofPLHIV were with their viral load suppressed. The total cumulative number
E pi d ofem PLHIV
i olog receiving
y and Di s ART
eas ebyC the
ontrol
end of fiscal year 2075/76 has reached the figure of 17,987 (July 2019).
Figure 5.1 HIV Treatment Cascade gradual
Over the years, there have been in Nepal,increases
2018 in the number of people enrolling themselves on
ART as well as receiving ARVs (Table5.1).
Figure 5.1
Figure 5.2 HIV Treatment
Proportion Cascade
of Viral in (VL)
Load Nepal, 2018
Suppression among Total VL Tests according to test sites.
Sitewise distribution of VL Suppression among Total VL Test

100% 93%
91%
90% 87%
80%
70%
60%
50%
40%
30%
20%
10%
0%
National Public Health Laboratory Seti Zonal Hospital Bir Hospital
Figure 5.2 Proportion of Viral Load (VL) Suppression among Total VL Tests according to test sites.
m g t ta t t t i t t t it
Among total 8,357t VL tests conducted
i ia in 2018,
ita NPHL conducted
t it7248 tests with 6604 (91%) suppressed
t a
Bi ita t it t ig
results, Seti Zonal Hospital Conducted 574 with 502 (87%) suppressed results, and Bir Hospital
conducted 535 with 479 (93%) suppressed results (Figure 5.2).
t t a t a a t a mai i g a i i ma
Out ofa thosemawho are currently
ma on ART,a 93% are adults
a and remaining
mai i g 7%
a are children,
t t i while
g male
population makes 51.3%, female population 48.1%, and remaining 0.6% are of thethird gender.
Number of ART sites in Nepal by establishment year

20000
17987
140
18000
16913
16000 15260 120
13069
PLHIV on ART
14000
of ART sites
100
11922
12000 78
10407 74
70 80
10000 8866 65
National Public Health Laboratory Seti Zonal Hospital Bir Hospital
Figure 5.2 Proportion of Viral Load (VL) Suppression among Total VL Tests according to test sites.
Among total 8,357 VL tests conducted in 2018, NPHL conducted 7248 tests with 6604 (91%) suppressed
results, Seti Zonal Hospital Conducted 574 with 502 (87%) suppressed results, and Bir Hospital
conducted 535 with 479 (93%) suppressed results (Figure 5.2).
E pi d em 7%
Out of those who are currently on ART, 93% are adults and remaining i ologarey and Di s easwhile
children, e C ontrol
male
population
Figure makesof
5.3 Trend 51.3%,
PLHIVfemale population
on ART 48.1%,
and Number of and
ARTremaining
Sites 0.6% are of thethird gender.
Number of ART sites in Nepal by establishment year

20000
17987 140
18000
16913
16000 15260 120
13069
Number of PLHIV on ART
14000
Number of ART sites

100
11922
12000 78
10407 74
70 80
10000 8866 65
61
8000
7719 53 60
44
36 39
6000 35
40
23 25
4000
9 17
2 3 20
2000 8 10 9 8
6 6 3 5 4 5 4 4
2 1 2 1
0 0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Jul
# of ART Sites on ART Cummulative number of ART sites
Figure
a 5.3 Trend
g of PLHIVt on tART and number of ARTa sites.ta i m t it a
Table 5.1:
Table 5.1: ART
ART Profile
ART Profile of
Profileof the
ofthe Period
thePeriod ofofFY2073/
Periodof FY2073/ 74- FY
74- FY 2075/
FY2073/74-FY 2075/ 76
76
2075/76
Indicators
Indicators 2073/ 74
2073/ 74 2074/ 75
2074/ 75 2075/ 76
2075/ 76
P P eople
eople lili v v i i ngng w w i i thth HI
HI V V evev er
er enrolled
enrolled on on ART
ART (c(c umum ulati v v e)
ulati e) 19,3 88
19,3 88 22,04 88
22,04 3 3 2,42,4 4 4 11
P P eople
eople lili v v i i ngng w w i i thth HI
HI V V enrolled
enrolled i i nn ART ART (c(c umum ulati v v
ulati e)
e) 1414 ,54
,54 4 4 16,4 28
16,4 28 17,987
17,987
P P eople
eople los los tt to to f f ollow
ollow up up (c(c umum ulati
ulati v v e)
e) 2,04 99
2,04 2,32,3 88
88 2,679
2,679
P P eople
eople s s topped
topped treatm treatm ent ent 25
25 22
22 25
25
T T otal
otal d d eath
eath s s (c(c umum ulati ulati v v e)
e) 2,770
2,770 3 3 ,201
,201 3 3 ,617
,617
Source:
Source: N CA SC N CA SC
num mb b er
T T h h ee num er ofof people people on on ARTART i i s s h h ii i g g h h ig
er i i nn B B agiag m m Bagma
er prov i i ncnc ee (4(4i ,919)
ati prov
ati ,919) and a i i ncnc ee 55 (3(3i ,3,3 92).
and P P rov
rov 92). T T h h ee
i i tai
prov i i ncnc ee w w i i s s ee d d etai
prov als oo s s h h owow nn i i nni T T
a
etai lsls als a
abab le
le 5.5. 22
Table 5.2:
Table 5.2: Prov
Prov ince
ince Wis
Province Wis
Wiseee People
People on
Peopleon ART
onART FYFY
ARTFY 2075/ 76
2075/76
2075/ 76
Prov Prov ince

ince People on
People on ART
ART
P P rov rov i i ncnc ee 11 1,581
1,581
P P rovrov i i ncnc ee 22 21762176
BB agag m m ati ati 4 4 919 919
G G and
and akak i i 2165
2165
P P rov
rov i i ncnc ee 55 3 3 3 3 92
92
K K arnali
arnali 515
515
Sud urpas c c h h i i m m
Sud urpas 33 2323 99
Total
Total 17, 987
17, 987
Source: N N CACA SC
Source: SC
T T h h ere
ere are
are total
total 78 78 ART
ART s s i i tes
tes acac ros
ros s s 60
60 d d i i s s tri
tri c c tsts titi llll thth ee end
end ofof thth ee f f i i s s c c al
al y y ear
ear 2075/76
2075/76 and and i i tt s s h h owow s s thth at
at
11% ofof thth osos ee evev er
11% er enrolled
enrolled on on ART
ART d d i i eded and
and 8%8% h h avav ee b b een een los
los tt toto f f ollow
ollow - - up, up, w w h h i i le
le 81%
81% are
are ali ali v v ee and
and on on
treatm
treatm ent. ent.
T T h h ee P P rog
rog ram
ram d d ata
ata (F(F Y Y 2075/76)
2075/76) s s h h owow eded thth at
at ofof all
all thth ee pati
pati ents
ents reg
reg i i s s tered
tered on
on ART
ART d d uri
uri ngng thth ee peri
peri odod ,, 91%
91%
w ere s ti ll ac ti v ely on ART af ter 12 m onth s w h i le 85% w ere s ti ll ac ti v ely on ART af ter 24 m onth s of
a t ta it a iti t t t a a a it
t at t i a a tt i a ai
a t atm t
g am ata t at a t a t gi t i gt i
a a m t i a a m t
t atm t it t aim m gt ma ag m t g am t t g
i a a ai a i t it m t ta g ma i a
a i t i iti t a t i m t i t m it
t at a t t t tai a it a m ta i m it
a iag i g t atm t ai ia a t gi mm i i g
a a i
a t a at at ma i ia ita ai a i aa i a
a i a ita at ma Bi ita at ma aa a m at
i aa i ita Bi at aga a t it a ai i ia ita a Ba a ata
ita i g t a i ia a t t i t t t atm t
it t a iag i g i am g i t i t m t
a i i i m a ai a t ti at t a a
i at a at i at ma t ti at i t a i t t
i mm iag i g tat i m t a t t t
ti i i a i t t
recommended for diagnosing HIV status of children below 18 months and for those whose test result is
inconclusive by trapid
ta test. a i B i m i g iti t a t
am t t iti t a a t t i a i i gt i i
t As of 2075/76,
a total 9,787 has received CHBC services from 52 covering districts (Table 8). In the same
context 52 districts have CCCs across the country which have been delivering their services to PLHIV
(Table 5.3).
Table 5.3: Service Statistics on CHBC Services in Nepal, as of the end of FY 2075/76
Indicators Numbers
Number of PLHIV (new and old) received CHBC services 9,787
Number of PLHIV (new) received CHBC services 4,747
Table 5.4:Service Statistics on CCC Services in Nepal as of the end of FY 2075/76
Indicators Numbers
Number of new PLHIV receiving services from CCC 5,350
Number of PLHIV receiving Follow-up services from CCC 3,280
Number of PLHIV admitted to CCC to start ART 997
Number of PLHIV received counselling service 5,350
Issues Recommendation
Placement of point of care CD4 machine and implementing viral load
Low access to CD4 Count and
testing by GenXpert and using DBS would enhance the accessibility of
Viral Load testing services
services among PLHIV.
The robust, unique identifier system has been developed to track the
Client duplication in the
individual client within and across the service sites but it needs to be
service
implemented at all service sites for its functioning.
Start an electronic record keeping system with backup capability. In
Lost or incomplete medical
addition, creating a client coding system would facilitate improved
records(Recording and
record keeping and continuity when clients are transferredin or
Reporting)
Indicators Num bers
N um b er of new P L HI V rec ei v i ng s erv i c es f rom C C C 5,3 50
N um b er of P L HI V rec ei v i ng F ollow - up s erv i c es f rom C C C 3 ,280
N um b er of P L HI V ad m i tted to C C C to s tart ART 997
N um b er of P L HI V rec ei v ed c ouns elli ng s erv i c e 5,3 50
Is s ues Recom m endation

L ow ac c es s to C D4 C ount P lac em ent of poi nt of c are C D4 m ac h i ne and i m plem enti ng v i ral load
and V i ral L oad tes ti ng tes ti ng b y G enX pert and us i ng DB S w ould enh anc e th e ac c es s i b i li ty
s erv i c es of s erv i c es am ong P L HI V .
T h e rob us t, uni q ue i d enti f i er s y s tem h as b een d ev eloped to trac k th e
C li ent d upli c ati on i n th e
i nd i v i d ual c li ent w i th i n and ac ros s th e s erv i c e s i tes , b ut i t need s to b e
s erv i c e
i m plem ented at all s erv i c e s i tes f or i ts f unc ti oni ng .
Start an elec troni c rec ord k eepi ng s y s tem w i th b ac k up c apab i li ty . I n
L os t or i nc om plete m ed i c al
ad d i ti on, c reati ng a c li ent c od i ng s y s tem w ould f ac i li tate i m prov ed
rec ord s (Rec ord i ng and
rec ord k eepi ng and c onti nui ty w h en c li ents are trans f erred i n or
Reporti ng )
trans f erred out.
P oor s upply of O I s m ed i c i nes P rov i d e c ons i s tent s upply of O I s m ed i c i nes th at are s uppos ed to b e
as per d em and prov i d ed ac c ord i ng to th e prog ram .
T h e P L HI V s f ac e f i nanc i al prob lem s to treat oth er c om orb i d i ti es , b ut
I nad eq uate f i nanc i al s upport th ere i s not s uf f i c i ent g ov ernm ent s upport to pay f or m ed i c al c are
f or th e c li ents and treatm ent. So, th e g ov ernm ent s h ould es tab li s h a m ec h ani s m to
s h are th e f i nanc i al b urd en f ac i ng b y P L HI V .
C HB C s erv i c es c ov erag e i s T h e g ov ernm ent s h ould i nv es t i n s uc h an es s enti al s erv i c e i n
d ec li ni ng ov er ti m e d ue to c oord i nati on w i th N G O s .
li m i ted s upport f rom d onors .
C apac i tati ng and s treng th eni ng of ART d i s pens i ng c entres (ADC ) s i tes
E x pans i on of ART s i tes to ART i s nec es s ary f or ad d i ti onal s upport to i nc reas e P L HI V
treatm ent c ov erag e (Sec ond 90).
6:6: Integrated
Integrated Biological
Biological and Behavioral
and Behavioral Surveillance
Surveillance (IBBS) Survey
(IBBS) Survey
6:Nepal
Integrated
a ahas beenBiological
g and
conducting Behav
HIV aand iorali aSurv eillance
STI surveillance a ( IBBS)
particularly
a am gSurv
among ey a
key populations, namely:
am
people who iinjectt drugs, g FSW and their
a t i i t clients, MSM and aTG, and Male
a Labor a a Migrants for
ig a t more than
m a
N epal h as b een c ond uc ti ng HI V and ST I s urv ei llanc e parti c ularly am ong k ey populati ons , nam ely : people
t decade
a a mainly a mai to track t changes
ta a HIV
in g and i STIaprevalence along a a behavioral
with g it a i a msuch ast
components
w condom
h o i nja ec tuse
d rugetc.
ms , F Hepatitis-B
SW andt th eiand rac li Cents B ,aM SM and
screening
T G , and
among iPWID g amM havealegL been
ab or Mstartedi ag rantsin f the
or m IBBS
taore t thsurveys
an
i ta d form
ec BB
ad e
m 2015.
ai nly to trac
From k c h year,
mthis ang esnational-level
i ntHIi V anda STsurveillance
m aI prev aalenc survey
e along isiw planned
ai th b eh avamong
i oral i c peopleoma ponentsaminject
who s ucg h drugs
as c ondand
om
usi male
e etct labor
. Hepati ti s
g migrants. - B and
a ma Thea tablemig C s c reeni ng
below am ong P
a tdepicts HIV W I D h av e b een
ta prevalence accordings tarted
i t i n th e I B B S s urv ey
to the asurvey population s a f orm 2015. F rom
i g (Table
t t
6.1). a a
Table 6.1 HIV prevalence according to survey population.
Survey Population HIV Prevalence Survey Location
Female Sex Workers 0.7 22 Highway Districts 2018
Male Labor Migrants 0.3 Eastern Districts 2018
MSM and TG 8.2 Terai Highway 2018
Wives of Migrants 0.5 Far-West Districts 2018
Source: Integrated Bio-Behavioural Surveillance (IBBS) Survey, 2018.
6.1 HIV Co-infection

Because of the shared modes of transmission of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and
HIV, people at risk for HIV infection are also at risk for HBV and HCV infection. HIV-positive persons
who become infected with HBV or HCV are at increased risk for developing chronic hepatitis. In
addition, persons who are co-infected with HIV and hepatitis can have serious medical complications,
including an increased risk for liver-related morbidity and mortality.
a 8. 2 T erai Hi g h w ay 2018
i ig a t 0. 5 F ar- W es t Di s tri c ts 2018
Source: I ntegrated B io- B ehavioural Surveillance ( I B B S) Survey, 2 0 1 8 .
E6.1
pi d HIV
em Co-
i ologinfection
y and Di s eas e C ontrol
B ec aus
6.1 HIVeCo-infection
of th e s h ared m od es of trans m i s s i on of Hepati ti s B v i rus (HB V ), Hepati ti s C v i rus (HC V ) and HI V ,
people at ri s k f or HI V i nf ec ti on are als o at ri s k f or HB V and HC V i nf ec ti on. HI V - pos i ti v e pers ons w h o
Bb ec oma e i nf ect ted w a i th HBm V or HC tV aaremi i reas ed ri as k f orBd evi elopi B
at i nc ng c h roniac h epati iti s . I n ad d i tiaon,
pers ons w h o are c o- i nf ec ted w i th HI V and h epati ti s c an h av e s eri ous m ed i i c al c om pli c ati ons i, i nc lud i ng an
at i i a a at i B a
i nc reas ed rims k f ior li v ter- related
it m Borb i d i ty anda m ortali
at i ty . a i i g i a
a i a i t it a a a a i m i a
m i a i i ga i a i i at m i it a m ta it
T B i s th e m os t c om m on i llnes s am ong people li v i ng w i th HI V . F atal i f und etec ted or untreated , T B i s th e
lead i ng c aus e of d eath am ong people w i th HI V , res pons i b le f or nearly 1 i n 3 HI V - as s oc i ated d eath s . E arly
B i t m t mm i am g i i g it ata i t t t at B
di etec t ti on a ofi gT B aand prom pt atli nkam
ag e to
g T B treatm itent and ART c ani prev ent tha es e d ieath s . T B a s c reeni iat ng
of f atered routi
a nely t at ART s i tes B, anda routimnetHIi V tes ag ti ngt i s Balst o atm
of f ered t ato all pati entsa w i th pres t t um pti v eatand
d Bi ag nos ed i T gB . T B prev enti v e th at erapy s h itould ab e of f ered to allt people g i li av i ng w i th HI V t w ah o ad o not
t h avit e
ac ti v em T B i n N aepal. I iag
n 2018, th eBtotal B proporti on tof P L aHI V h av i ng T B am ong new t aly enrolled i i in HI g V itc are i n
t a f aor 12. 8% B. i
N epal ac c ounted a t t ta a i g B am g
i a i a a t
Table 6.2 Hepatitis Prev alence and HIV, HBV, HCV co- infection am ong People who Inj ect Drugs in
2017
Surv ey Location
Survey L ocation Hep B
Hep B Hep C
Hep C Coinfection
Coinfection ((Hep
Hep C
C&& HIV)
HIV)
PWID-Male a
a t Terai
Eastern ai 0. 8
0.8 3 38.0
8. 0 2.2.5 5
t to
Western t Far
a Western
t ai
Terai 2. 7
2.7 2424.0
.0 3 3.7.7
a
Pokhara a 2. 6
2.6 22.
22.0 0 3 3.8
.8
at ma
Kathmandu a
Valley 1. 0
1.0 21.
21.0 0 7.7.4
4
PWID-Femalema
aa
Pokhara 1. 3
1.3 3 3.0
.0 0.0.6
6
Table 6.2 Hepatitis Prevalence and HIV, HBV, HCV co-infection among People who Inject Drugs in
7: Province level HIV related Services and Indicators
2017
7: Prov ince lev el HIV related Serv ices and Indicators
t a a a a i a t m a ta i i a t m it t
I n thi emiearlya 1990st i , a nati
m ional HI V s urv
a ei llanc e s y s tem w as es tab li
t i s h ed i ntN epal i t m g oni
to at tor thi e HIgi V a a
7:d aProvince
epi em i i c aand tolevel
i nfi aorm HIV i d related
ev BB enc e- b as edServices
HI V prev and a onIndicators
enti ef f orts . Si nc te th en, i ntegt ratedt b i olog ai c al am and g
b eh av i oralas urv ei llanc at ig e (I B B S)i s urv ey s h av e b een c ond uca ted ev ery tw ao/th ree migy aearst ami ong i k ey t
In the early 1990s, a national HIV surveillance system was established in Nepal
populati ons at h i g h er ri s k of HI V (P W I D, M SM and T G , F SW and m i g rants ) i n i d enti f i ed th ree epi d em i c t
i mi ig t t i ma i m g a i a to monitor
i gi the
a HIV
ma
az ones
epidemic (Ft i g ure a1)inform
and7.to t i nfaorm ati
to c ollecevidence-based t on on oca i o- td aem ogmiefforts.
HIVs prevention raph i ci s Since
and b then, c al m arka ers
i olog i integrated i biological
toaasi s es s and
ma
th e
behavioral m m a t a i g a i i mi a a
prev alenc e ofsurveillance
HI V and oth(IBBS) er s exsurvey surveys
ually trans havei nfbeen
m i tted conducted
ec ti ons (ST I ), b ehevery two/three
av i oural i nf orm years
ati onamong
(c ond omkey
i
populations t i tati higher risk of HIV (PWID, a MSM at and i TG, m FSW i it and i migrants)
a iniidentified a i three epidemic
ig
zones (Figure 7.1) to collect information on socio-demographics and biological markers to assess the
prevalence of HIV and other sexually transmitted infections (STI), behavioural information (condom
use, number of sex partners, needle sharing behaviours). The epidemic zones are based on different

epidemic and to inform evidence-based HIV prevention efforts. Since then, integrated biological and
behavioral surveillance (IBBS) survey surveys have been conducted every two/three years among key
populations at higher risk of HIV (PWID, MSM and TG, FSW and migrants) in identified three epidemic
zones (Figure 7.1) to collect information on socio-demographics and biological markers to assess the
prevalence of HIV and other sexually transmitted infections (STI), behavioural information (condom
use, number of sex partners, needle sharing behaviours). The epidemic zones are based on different
distributions of key populations at risk, mobility links and HIV risk behaviour (Figure 7.1).
Figure 7.1: HIV epidemic zones in Nepal
Table 7.1 Province-wise distribution of HIV services in Nepal
No.
No. of No. of
No. of CBPMTCT of Treatment and CLT
Organization unit/Data HTS Dispensing
ART Sites Services OST Care Services Implemented
Sites Sites
Sites
Province - 1 23 9 6 14 2 6 6 3
TAPLEJUNG 1 - 1 Available - - - -
SANKHUWASABHA 1 1 - Available - CCC CHBC -
SOLUKHUMBU 1 - 1 Available - - - -
OKHALDHUNGA 1 1 - Available - - - -
KHOTANG 1 - 1 Available - - - -
BHOJPUR - - 1 Available - - - -
DHANKUTA 1 1 - Available - - - -
TERHATHUM 1 - 1 Available - - - -
PANCHTHAR 1 - 1 Available - - - -
ILAM 1 1 - Available - CCC CHBC -
JHAPA 5 1 - Available 1 CCC CHBC Yes
MORANG 3 1 - Available 1 CCC CHBC Yes
SUNSARI 4 2 - Available - CCC CHBC Yes
UDAYAPUR 1 1 - Available - CCC CHBC -
Province - 2 14 8 0 8 1 7 8 8
SAPTARI 1 1 - Available - CCC CHBC Yes
SIRAHA 1 1 - Available - CCC CHBC Yes
DHANUSA 5 1 - Available - CCC CHBC Yes
MAHOTTARI 2 1 - Available - CCC CHBC Yes
SARLAHI 2 1 - Available - CCC CHBC Yes
RAUTAHAT 1 1 - Available - CCC CHBC Yes
BARA 1 1 - Available - - CHBC Yes
PARSA 1 1 - Available - CCC CHBC Yes
DoHS, Annual
Bagmati Report 2075/7643
Province (2018/19)15 3 13 - 9 10 4
DOLAKHA 1 - 1 Available - - - -
SINDHUPALCHOK 3 1 - Available - CCC CHBC -
RASUWA 1 - 1 Available - - - -
DHADING 1 1 - Available - CCC CHBC -
NUWAKOT 4 1 - Available - CCC CHBC -
Province - 2 14 8 0 8 1 7 8 8
SAPTARI 1 1 - Available - CCC CHBC Yes
SIRAHA 1 1 - Available - CCC CHBC Yes
DHANUSA 5 1 - Available - CCC CHBC Yes
MAHOTTARI 2 1 - Available - CCC CHBC Yes
SARLAHI 2 1 - Available - CCC CHBC Yes
RAUTAHAT 1 1 - Available - CCC CHBC Yes
BARA 1 1 - Available - - CHBC Yes
PARSA 1 1 - Available - CCC CHBC Yes
Bagmati Province 43 15 3 13 - 9 10 4
DOLAKHA 1 - 1 Available - - - -
SINDHUPALCHOK 3 1 - Available - CCC CHBC -
RASUWA 1 - 1 Available - - - -
DHADING 1 1 - Available - CCC CHBC -
NUWAKOT 4 1 - Available - CCC CHBC -
KATHMANDU 12 6 - Available 3 CCC CHBC Yes
BHAKTAPUR 2 1 - Available 1 CCC CHBC -
LALITPUR 3 1 - Available 3 CCC CHBC Yes
KAVREPALANCHOK 3 1 - Available - CCC CHBC -
RAMECHHAP 1 - 1 Available - - - -
SINDHULI 1 1 - Available - - CHBC -
MAKWANPUR 4 1 - Available - CCC CHBC Yes
CHITAWAN 7 1 - Available 1 CCC CHBC Yes
Gandaki Province 26 10 4 11 1 8 9 2
GORKHA 4 1 - Available - CCC CHBC -
MANANG 1 - 1 Available - - - -
MUSTANG 1 - 1 Available - - - -
MYAGDI 2 1 - Available - CCC CHBC -
KASKI 6 1 1 Available 1 CCC CHBC -
LAMJUNG 2 1 - Available - CCC CHBC -
TANAHU 2 1 - Available - CCC CHBC Yes
NAWALPARASI EAST 2 1 - Available - - CHBC Yes
SYANGJA 2 2 - Available - CCC CHBC -
PARBAT 1 1 - Available - CCC CHBC -
BAGLUNG 3 1 1 Available - CCC CHBC -
Province - 5 33 14 1 12 2 11 11 6
RUKUM EAST - - - Available - - - -
ROLPA 1 1 - Available - CCC CHBC -
PYUTHAN 1 1 - Available - CCC CHBC -
GULMI 1 1 - Available - CCC CHBC -
ARGHAKHANCHI 2 1 - Available - CCC CHBC -
PALPA 4 1 - Available - CCC CHBC -
NAWALPARASI WEST 4 1 - Available - CCC CHBC Yes
RUPANDEHI 4 2 - Available - CCC CHBC Yes
KAPILVASTU 5 2 1 Available - CCC CHBC Yes
DANG 6 2 - Available - CCC CHBC Yes
BANKE 4 1 - Available - CCC CHBC Yes
BARDIYA 1 1 - Available - CCC CHBC Yes
Karnali Province 16 6 6 10 0 2 4 1
DOLPA 1 - 1 Available - - - -
MUGU 1 - 1 Available - - - -
HUMLA 1 - 1 Available - - - -
JUMLA 1 - 1 Available - - - -
KALIKOT 1 1 - Available - - CHBC -
DAILEKH 4 2 1 Available - - - -
JAJARKOT
1 - 1 Available - - - -
RUKUM WEST 1 1 - Available - CCC CHBC -
SALYAN 1 1 - Available - - CHBC -
SURKHET 4 1 - Available - CCC CHBC Yes
Sudurpaschim Province 20 16 2 9 0 8 9 2
BAJURA 2 1 - Available - CCC CHBC -
6 2 - Available - CCC CHBC Yes
BANKE 4 1 - Available - CCC CHBC Yes
BARDIYA 1 1 - Available - CCC CHBC Yes
Karnali Province 16 6 6 10 0 2 4 1
DOLPA 1 - 1 Available - - - -
MUGU 1 - 1 Available - - - -
HUMLA 1 - 1 Available
E pi d em i olog y and Di s eas e C -ontrol
- - -
JUMLA 1 - 1 Available - - - -
KALIKOT 1 1 - Available - - CHBC -
DAILEKH 4 2 1 Available - - - -
JAJARKOT 1 - 1 Available - - - -
RUKUM WEST 1 1 - Available - CCC CHBC -
SALYAN 1 1 - Available - - CHBC -
SURKHET 4 1 - Available - CCC CHBC Yes
Sudurpaschim Province 20 16 2 9 0 8 9 2
BAJURA 2 1 - Available - CCC CHBC -
BAJHANG 1 1 - Available - CCC CHBC -
DARCHULA 1 1 - Available - - CHBC -
BAITADI 3 2 - Available - CCC CHBC -
DADELDHURA 1 1 1 Available - CCC CHBC -
DOTI 3 1 1 Available - CCC CHBC -
ACHHAM 2 4 - Available - CCC CHBC -
KAILALI 4 3 - Available - CCC CHBC Yes
KANCHANPUR 3 2 - Available - CCC CHBC Yes
Note: HTS: HIV Testing Services; CCC: Community Care Centre; CHBC: Community Home-based Care; CLT:
Community Led Testing.
7.1
7.1List
Listof
of Possible Indicatorsfor
Possible Indicators forProvince
ProvinceOne,
One, Two,
Two, Three,
Three, Four,
Four, FiveFive
andand Seven
Seven
The following indicators might be useful to track HIV response in a particular province considering the
drivers of iHIV
g i epidemic
i at in mig
thatt province and
t tHIV
a services being provided.
i a a However,
a i province
the i cani g
t selecti indicators thati are mideemed
i t at necessary
i ato track HIV iresponse.
i g NCASC i will provide any
t required
i
asupport to
t i thei provinces
at t atasa and when
m needed. For a detail
t t a(numerator, denominator andi data source)
i a
i t t t i a a tai m at mi
regarding indicators, refer to 2017 National Consolidated Guidelines on Strategic Information for HIVat a
ata
Response in Nepal. ga i g i i at t a a i at i i t at gi
ma i a
Im pact lev el Indicators
a i i m a tag i
a am g a
a B a am g i t g
a i g
t t i t a mi i mat tag i i t
it m
Outcom e lev el indicators
tag g m it m t t i t
g tag i t g g a i g a mt at m t a
a a i t
tag m gt mt at m t a a a it a ma
partner
i tag mig a t ag gt mt at m t a it
g a a at

Output lev el indicators
a i g iti t i t g
tag i i i a i i g i i t a i t atm t at
at i m t
m a tag a a a t ti t at m t a
t i t
m tag a a g amm B i t
ma iti
m a t ai a
tag g a t m it tat
tag g a t m i i g it i a t ia t a t imi at
a t a mi i
tag t g ita ii a i it a it
m a tag i i g it a i i g a i g
tag a m a t a i a t ia t a am ga a t a
i i i g it at t t g i
t tag i i g it a tai a a m t
a i i a a t ia t a
tag at a ii i i ga t ia t a t at i a t t
at a t i a t ia gi t at m t
m a tag a t a i i i g it t i i g a a
t i m ti a ii
tag i a t Bi a t atm t g
tag B a t a a t t t i t B gi t

5.6 Non Communicable Diseases

a t a a i mi gi a t a i m mm i a i a t
mm i a i a a t ma a i i a i a i it a at i i g
im i m t m g t m t atm t a t a i gt it t at t at
i m a a t it i i i a a t i ami i a t t
m t a at t a i a a i a ia t a a
i at i a a i a m a at i t i a
t im ta a t at i a i gt t
a g i ma a a i t im a t t a i m t t i t a a ag
tai a m t a i at i a m t B i g t
g t i g a ta g t t t i mat m ta it m t g
a t atm t a m t m ta a t a i g
B at t m m a a i m a i m a i t
t a g m t i i g i i i i t i
ag i t
mm i a a m m t g i m t a i t a t
ta ta t a a i g a ia a mi m tt a ma i g a g i
at i a
m m ta a a i i it t t a
a a t
Multi-Sectoral Action Plan (MSAP) for the Prevention and Control of NCD (2014-2020 AD)
• Vis ion: a t ig t a ai a tat at i ga a it

i at ag ta a i a i a i it a mat at
• Goal: g a t m t a a a i t ta m i it a i a
i a i it a mat m ta it t i a
Strategic objectives for MSAP 2014-2020 AD
ai t i it a t t a t mm i a i a i t
a a ag a a i i
t gt a a a a it a i g a m ta a a at i t
a at t t a t
m i a i a t a i g ia t mi a t t g a
at m g i m t
t gt a i t at t m t a t a t a
i g ia t mi a t t g t a
m t a t a a a a it ig a it a a m t t
a t a m ta at
it t t a t mi a t a a at g i t i a
t
m i g a i mi im m a m ta at i at t mm it a im i g
m t a i a a i i a g a at ima a
Targets (At the end of 2025 AD
a i a m ta it m a ia t

a i t am a
a i a tt a i ag a
a i t i g i a t ima
i g
a i m a a i ta at i m
ia ai
att i i it a ia t
a i a i i t i a a it
igi i gt a a i g i i gg mi t t
t a ta a a t
a ai a i it a a ai t gi a a m i i i i gg i
i t t at ma i t i a i at a i i
Nepal PEN program
t a i a a a
a ig i it ig m t m i g tm i i t
a i m t m t i g t g i t
m i a a
i g am i a i ta ga i i at ma a
a a t atm t a ma ag m t
The PEN Intervention has Four protocols:
• Protocol I : at a a t a i i a t g i t g at
ma ag m t ia t a t i
• Protocol II: a t a a i g at B a i
• Protocol III: a ag m t i t m a i a a t ma
• Protocol IV: m ta a m it t a B at i
Goals
i i a a t ig a it iagi a t t a
i g i mi ma
t t a a m ma
i a a t atm t t g a a
t a t mm it gag m t a a
Objectives
m iag t at a ma ag m t
ta t i a t
i g i mit i t atm t
i a i a t a t a i it a mm it
i a a i i it i a at ag
a t a t t a a i a t
g am ta t i t i t i t i t am a ai a i t a i a
t a a a t g am a a i t iti t a a ag i
The Nepal PEN protocol I, II and concept note was developed and endorsed in June, 2016 and the
Bag g
program am Ba
started i apilot districts
in two t (Ilam
a and
a Kailali)aon October,
a ta 2016.
at In addition,
i a Nepala PEN protocol
t III and IV
i a a was endorsed and the program
g am awas scaled-up
a in the 8
i a idistrictsa(Palpa,
i tMyagdi,
i t Baglung,
it a ma
Achham, Bardiya, Surkhet, Makwanpur and Rautahat) for Fiscal Year 2073/74.
aa t a i g a t a a i a a g am a a
i a iFor thea Fiscal i Year
t i t2074/75
a aPEN program
a m was scaleda up
a iin additional
a a i 6 districts
i B a (Chitwan,
ta a Jumla,
i a a
a i at
Jajarkot, a
Dhading, a m aandBaita
Nuwakot, i Ba
Gorkha). a Year 2075/76 PEN PEN program was scaled up in
For Fiscal
additional 14 districts (Jhapa ,Solakhumbu, Mohattari ,Parsa,Sindhuli,Bhaktapur,Kaski , Tanahun,
t Kapilbastu,Rolpa,Dolpa,Humla,
i a a Baitadi ,gBajura).
am i i g a i iti t a g at m
a a a i a ta i a a a a i a a a ga a at
For the Fiscal Year 2076/77 PEN Program is being scaled up in 21 districts (Morang, Terathum, Udaypur,
a a aai at a g t a g a a i a a ai t Ba a g a a
Sarlahi, Saptari, Dhanusha, Rasuwa, Sindhupalchowk, Dolkha, Syangja, Parbat, Nawalparasi (East), Dang,
a a
Pyuthan, Arghakhanchi, Salyan, Dailekh, Surkhet, Bajhang, Darchula, Dadeldhura)
B t By the end of
i Fiscal
a Yeara 2077/78 PEN Program
g am
will bei scaled up
a throughout
t Nepal.
g t a
Major activities, achievement and target
Major activities, achievement and target
Key Achievements Key Achievements Key Achievements Key Achievements Target
( FY 2073/74) ( FY 2074/75) ( FY 2075/76) ( FY 2076/77) ( FY 2077/78)
● Concept note on ● Implementation of ● Development of ● Expansion of PEN ● Expansion &
PEN developed and NepalPEN Program in NCD & Mental Health Program in additional Implementation
PEN Protocol additional 6 districts Section in EDCD under 21 Districts of PEN Program
endorsed • Update in recording DoHS ●Expansion of ● Development of throughout Nepal
● Implementation of andreporting tools PEN Program in Community in all 77 districts
NepalPEN Program in ●Protocol revision additional14 Districts Invervention ● Implementing
10 districts after consultation • Revision/update of Framework to tackle Community
●Initial Steps in from the experts PEN trainer’s guide NCDs and piloting in 2 Intervention
Management of NCDs ● HEARTS Tool kit also and Trainee ‘s manual districts by the end of Framework
at PHC level taken endorsed ● Allocation of budget the FY. Throughout Nepal
● Drugs related to to each provinces and ● Increase the
PEN Program enlisted governance level for ● Allocation of budget amount of budget
in Essential Drug List proper management to each provinces and for NCDs
of NCDs governance level for ● Work up to
●Provincial based tot proper management integrate PEN
for increasing trainers of NCDs Program
at provincial level Recording &
Reporting Tools in
HMIS & DHIS
●Develop
Country’s as well
as Province’s
NCDs Profile

Trend of s om e NCDs
m
Prov ince Prov ince Bagm ati Gandaki Prov ince K arnali Su. Pa.
Dis eas e Period Nepal
1 2 Prov ince Prov ince 5 Prov ince Prov ince
2072/73 21817 14 590 604 85 3 5978 3 3 960 14 13 6 20263 201229
2073 /74
Trend of s om e NCDs
24 014 1284 8 74 4 78 3 4 3 68 2814 8 14 652 21663 210171
COPD
2074 /75 24 901 14 24 8 83 23 1 3 5503 3 23 04 16963 24 53 5 23 1685
2075/76 3 3 23ince
Prov 4 18805
Prov ince 783 50
Bagm ati 3 203 9
Gandaki 3 8705
Prov ince K 1983
arnali 3 24 802
Su. Pa. 24 5768
Dis eas e Period Nepal
2072/73 4 8041 7 28182 2 Prov
8704ince 5 Prov 56569 ince 4 1454 9 Prov54 69 ince Prov
9125 ince 275886
2072/73
2073 /74 21817
584 95 14293590 56 604
123 897 85 35793 5978 7 34 30000 960 14791913 6 20263
1173 9 201229
3 293 4 3
2073 /74 24 014 1284 8 74 4 78 3 4 3 68 2814 8 14 652 21663 210171
Hy pertens
COPD ion 2074 /75 65126 3 704 5 16003 6 64 587 54 161 8828 14 162 4 03 94 5
2074 /75 24 901 14 24 8 83 23 1 3 5503 3 23 04 16963 24 53 5 23 1685
2075/76
2075/76
943 3 1423 84 418805
784 8 162187
783 50
75214
3 203 9
863
3 8705
76 14198384 03 18827
24 802
4249945768 4 0
2072/73
2072/73 18700
4 804 7 53
28182 10 48704
3 9065 26860
56569 17599
4 14 4 9 54977 69 2764
9125 116116
275886
Diabetes 2073
2073 /74
/74 2584
584 95 7 1063
293 56 7 123 54897
74 1 28128
5793 7 1723
4 0000 6 1098
7919 3 8629
1173 1613
3 293 44 9 3
Mellitus ( DM) 2074 /75
Hy pertens ion 3 2127
65126 3 947043 65 957816
16003 3 2287
64 587 22851
54 161 1972
8828 144 659 162 4199113
03 94 5
2075/76
2075/76 945541461 8 415520
784 8 162187
904 19 75214
3 8903 863
3 8922 76 14585984 0 18827
6512 4251596
994 4 0
2072/73
2072/73 18700 4 3 5312 10 4 633 906 4 26860
74 8 17599
64 977
6 2764
28 116116
153 5
Diabetes 2073 /74 2584 7 1063 7 74 54 1 28128 1723 6 1098 3 862 1613 4 9
Mellitus ( DM)
2073 /74
2074 /75 3 2127
4 6 16
94 3 6
13
95781
4 5 3 90
3 2287
4 7
22851 1972
5 14
4 659
1863
199113
Breas t Cancer 2074 /75
2075/76 5541161 29
15520 14
904 19 3 5 278
3 8903 4 7
3 8922 58592 6
6512 1808
251596
2075/76
2072/73 4 93 5412 154
63 4 7 3 578
74 4 0
64 56 21
28 203 53
153
2072/73
2073 /74 4 26 16 4 133 62 4 5 710
3 90 188 4 7 15 3 2
14 1299
1863
Breas
Cervt Cancer
ical 2074
2073 /75
/74 11
82 29 2 149243 5 278
267 134 78 2
5 6
3 1808
14 21
Cancer 2075/76
2074 /75 3 962 540 154
17677 3204
57 44 0
4 5
2 21
28 203
24 073
2072/73 2 4 3 62 710 188 1 3 2 1299
2075/76 3 91 3 214 8 23 7 80 0 4 2863
Cerv ical 2073 /74 82 2 924 267 13 8 5 3 14 21
Cancer 2074 /75 3 62 0 1767 204 4 4 2 28 24 07
Strength, Weaknes s and Challenges
2075/76 3 91 3 214 8 23 7 80 0 4 2863
t gt Strength
a a a g Weaknes s Challenges
Ac c Strength,
es s i b le atWeaknes
c om m unis tyand Challenges O nly f oc us ed on HF lev el • L ow proporti onal b ud g et alloc ati on
lev el (P HC Strength C and HP ) M os tly f oc us ed Weaknes on treatms ent approac h tow ard s N C DsChallenges
AcDedc esi c s ated
i b le atandc om f unc m uni ti onal h ow ev er th e P E N i s lev
ty O nly f oc us ed on HF pub elli c h ealth L ow
•
• P oor awproporti arenes onal s and b ud m g et i s c oncalloceptiations on
lev el (P HC C and HP ) M os tly f oc us ed on treatm ent approac h tow ard s N C Ds
N ati onal N C Ds & M ental approac h ab out th e b urd en and c ons eq uenc es of
Ded i c ated and f unc ti onal h ow ev er th e P E N i s pub li c h ealth • P oor aw arenes s and m i s c onc epti ons
Health
N ati onal U ni tN C Ds & M ental approac F oc us edh on T I P I C E B E RG of ri s k people Nab C out Ds , amth eong b urdth en e poli
and c y c ons
m ak eqersuenc , h esealthof
Health U ni t m i h ealth (T F h ocos use persed ononT w I P h I oC E v B i s E i ted
RG ofi n riHFs k w people
i th h i g h Nprof C Dses, s ami onals
ong and th e thpoli e g c eneral
y m ak ers pub ,li h c ealth
i ns uranc m e &i uni h v ealth ers al (Tri s h k ospopulati e pers on onw w h i oth v s i s usi tedpec i ted
n HF ofw d i thi s eas h i g e)
h • U nh esealth
prof y li f esandty leth s eeekg eneral
s i onals i ng b ehpubav lii or c and
ih nsealth uranc ec ov erag & e uni v
i nc lud i ng ers al ri s k populati on w
I nad eq uate rec ord i ng , reporti ng andi th s us pec ted of d i s eas e) • Ulownh er
ealth
v alue y li of
f es h ty ealth
le s eek am i ngong b ehth eav pub
i or liand c
hf or ealthN C Dsc ov prev erag enti
e on i nc lud and i ng m I oni nad torieq ng
uate s y rec
s temord i ng , reporti ng and low er v alue
f or N C Ds prev enti on and m oni tori ng s y s tem
• Sh ortag e ofof m h ealth ed i c alam eqongui pmth eent pub ,andli c
treatm ent s erv i c es L ow lev el of c om m uni ty aw arenes s • Sh ortag e of m ed i c al eq ui pm ent ,and
treatm ent s erv i c es L ow lev el of c om m uni ty aw arenes s s uppli es need ed f or d i ag nos ti c or
s uppli es need ed f or d i ag nos ti c or
FF ram ew ork & m ulti - CC omom plex
plex RRRR tools
tools && ref ref erral
erral cc hh aiai n thth erapeuti
ram ew ork & m ulti - n erapeuti cc cc are are of of pati
pati ents
ents ww ii thth NN CC Ds Ds
ss ecec toral
toral approacapproac hh Sev
Sev eral
eral polipoli cc ii eses to to mm od od ii ff yy NN CC D D Ri Ri ss kk •• ShSh ortag
ortag ee ofof hh ealth ealth ww ork ork ers
ers ii nn pub pub lili cc
FF acac tors tors areare ii nn dd ii ff ff erent
erent dd raf raf tt ss tag
tag eses .. h ealth f ac i li ti es
i at g t i
parti cc ular
parti ular ff or
or promprom oti oti on, on, prev
prev enti enti on,on, and and
res earc h
res earc h
Mental Health
ta at a ta a i g i a at i i a a a
tai a m t a it i t at g a t ta g t a i t at
t ta at a ta a ag t t t at ti B
t i mat m ta it m mm i a i a t g a t atm t
a m t m ta at a i g ag t t t at ti t gt t
a t atm t ta a i i g a ga a am
a a a ig m ta i tt a imit i t t a

t i mi m ta i a i ta i t i a a
t a t m ta atat i a t ai a a a tt m
a i a a ai i g a a it i i g at a
i ma t g t g t i ma ga i g m ta at a a i ita
i mm it a ta at g am a ta t at iti t a t a
a ai a a am g a i at a a
mm i a i a a ta at a a ig a t a
it im m ta m ta at g am i a a i im m t m ta at
g am m
Community Mental Health Care Package, Nepal, 2074
a ag i a ia a i mit i ta a a it i i g ia i
m ta ati a i g t a ai a i it a a i i it i t g at m ta at
a ia t i it i t ima at a t m t t
a ag a t m ta at a a ag at t a t a i it a
mm it a g it t im m ta m a im
Aims and Objectives of Mental Health Care Package
aim t ta at a a ag i t a i itat im m ta a a ta at
i t i g t a ai a i it a a i i it a i m ta at a ia
t i a t a a
g a t i a ag i t a i itat i t g a m ta at i i t t
ima at a i t m t t
The specific objectives include:
t m ta at a ia t i a ag at i t a
ima at a t m
t mi im m ta a t i at i t a ima at
C are s y s tem
tt ta a t t ai i g a ag a ma a t ai i g a ii
at a mm it t i
B t i a a ag a it t a a i t it a ta at at i a
a t a i m i it
t gt a a a g
Strength, weakness and challenges
Strength Weakness Challenges
 Community Mental Health  Program coverage  Recording and reporting
Care Package, Nepal, 2074 couldn’tbe achieved as • Clinical supervision and
developed targeted mentoring
• Community mental health • Training was not topped • Availability of psychotropic
program at six districts with availability of medicine around thecalendar
• Drugs procurement and medicine • Limited budget allocation
supply. to cover the programdistrict
• Turnover of trained health
professional

5.7 Epidemiology and Disease Outbreak Management

5.7.1 Introduction
i mi g a t a a ag m t i i t a a a a
t t a i mi a t at m g i i gi i t at t
t a ig it t ga i a a t t mm i a
i a a a t at t t g a a i g t a a
i mi it a i gt i g at a t m
5.7.2 Major Responsibilities of Epidemiology and Outbreak Management:
i t t i it at a a a i g a a a
i i a t at gi at t i mi g a t a ma ag m t
i tt i it at a a a i g a a a i i
a t at gi at t a a ma ag m t t a i mi a t
at m g it a
a ta a t a g i i ga i g i mi g a t a i mi
ma ag m t
i at it i ia a a i mi a t a ma ag m t
i t aa a im m ta a a a at a
at t i mi a t a ma ag m t
i at a a at it a t i at a i mi a
t a ma ag m t
i at a i ti i ma ma ag m t t ai i g a t
a g am at t i mi g i mi a t m g it a
ma ag m t
i at it m t a a t i i mi imi i g t im a t at a i a t i at
t t a i a t i mi
a i itat a i at i i i g a a i t g i ia a
a t tt a i a a at a i a t i i a mm i
it i g a ii iat a a ma ag m t a i i
i a it i a i a t t a t i a i g
a t t a t a ma ag m t m i i a a i am i
t t i mi i a
i at a a i itat ma ag m t t a m i i a t
gi i t t t a i mi
it i g a ii i a i mi t a a a
t a i a i a a i g
5.7.3 Rapid Response Teams (RRTs)
t a i am a i t a B t
m t i mi a a t mt g tt t i t
t gt t i ma ma ag m t a i a mm i a i a a
a a i a t a t a a i ga a m t i gt
t a a m at ta gi a i t i t a mm it a t i
m ii a i g t a a i mi a a i g t im g i i
a i t t a t t t i a t m a

Roles and responsibilities of RRTs are as follows:
a a i a t a
ga i a t a
i g t i a t a t g a a a a i a ma ag m t
mm it m i i a a t i a ta
m it i g t a i a t a ma a ia a a a a g t a t
ga t t i a a t i at i i a t at it
a i a i a t a it a
i mm i a ami i t i g a m ma ag m t
i at it t i a a a t i i a t a ma ag m t g
it a it ma a gi a
t i a t a i g t t i at m g t a mm
m a t at t t i a t t t t
i a m i t
5.7.4 Major activities carried out in fiscal year 2075/76:
t ii g m g g a at gi at t at gi a t i
iti t a a
ta i at at ma i t ti i i a t a a i t
a at g t gt
t a i t a g amm t at i t iti t a i it a
a i g ai t ta g a t a i mi a a
at t
a i a t a a i mi iti t a mm i a t
i i ata
i t m ii t g tt t i ga t a a
a i
ita m g a a a a at at i t ita
5.7.5 Major
5.7.5 Major Outbreaks
Outbreaksininfiscal
fiscalyear
year2075/76
2075/76
Acute Gastro-Enteritis (AGE)/Cholera:
Acute Gastro-Enteritis (AGE)/Cholera:
Outbreak of diarrhoeal diseases occurs throughout the country mostly in the monsoon season but
t ofathem with
most ia lowa case
i amorbidity is tundergreported.
t t In fiscal
t m yeart2075/76,
i t m eight eventsaof AGE t
m t t m it a m i it i t a a
outbreaks were reported to EDCD from 8 different districts affecting 648 people in ig total
t t four
with
t a
mortality. t t m i t iti t a g i t ta it
m ta it
Table 5.7.4.1: Status of AGE/Cholera outbreak in fiscal year 2075/76
S.N. District Location Total Cases Deaths
1 Mugu Soru RM-3; Purumuru 15 2
2 Mohattari Jaleshwor MN-12 Nanhi 253 1
3 Kapilbastu Taulihawa 10 0
4 Gulmi Musikot MN-4, Dajakot 185 1
5 Jajarkot Rani Gaun Jail 55 0
6 Kathmandu KMC-13, Tahachal 1* 0
7 Sindhupalchok Balefi RM-5 120 0
8 Lalitpur Nakhu 9 0
*Confirmed Cholera Source: EDCD/DoHS
DoHS, Annual
Influenza LikeReport
Illness2075/76
(ILI): (2018/19)
ILI cases are commonly seen in winter and during seasonal changes. The high risk group for severe
disease includes pregnant women, children under 5 years, elderly people, immune-compromised
people and those with medical morbidity eg. Heart disease, cardiovascular disease and COPD.
A total of 2 outbreaks of ILI were reported in FY 2075/76 with 3,386 cases throughout the country
3 Kapilbastu Taulihawa 10 0
4 Gulmi Musikot MN-4, Dajakot 185 1
5 Jajarkot Rani Gaun Jail 55 0
6 Kathmandu KMC-13, Tahachal 1* 0
7 Sindhupalchok Balefi RM-5 120 0
8 Lalitpur Nakhu 9 0
*Confirmed Cholera Source: EDCD/DoHS
Influenza Like
Influenza Like Illness
Illness (ILI):
(ILI):
ILI cases are commonly seen in winter and during seasonal changes. The high risk group for severe
a a mm i i t a i g a a a g ig i g
disease
i a iincludes pregnant
g a t women,
m children
i under 5 years,
a elderly people,imm
immune-compromised
m mi
people aand tthose with medical morbidity
it m i a m i it g eg. Heart disease,
at i a cardiovascular
a i a disease
a i a a and COPD.
A total of 2 outbreaks of ILI were reported in FY 2075/76 with 3,386 cases throughout the country
t ta t a t i it a t g t t
including
t i 13 deaths.
i g Circulating
at i strains
a g t ai of Influenza have
a a been found tot be Influenzaa (H1N1)
A
pdm09,
m Influenzaa A H3 and
a Influenza aBB.
Table 5.7.4.2: Status of ILI outbreak in fiscal year 2075/76
S.N. District Location Total cases Deaths
1 Saptari Kanchanrup MN, Saptari 3147 4
2 Humla Tajakot 239 9

Source: EDCD/DoHS
Food Poisoning/Water
i i g at contamination:
tami a One eventt of food poisoning
i i g was
a reportedt tto EDCD i in FY
2075/76 from m BBheriganga
iga ga m i i a it Surkhet.
municipality t Thirty-three
it t people were aaffected
t it no death.
with at
imi a
Similarly, ttwenty-five
t people were iill due tto contaminated
tami at i i g water
drinking at i in Letang
ta g Municipality
i i a it
a g iin tthis
Morang i fiscal
a year.
a

Viral Fever: In the month of Baisakh there were a viral fever outbreak in Tatopani RM Jumla and
Himali RM Bajura. One hundred fifty cases were in Jumla whereas E three
pi d em hundred
i olog y and Di s eas
twenty e C ontrol
cases were
ini Bajura.
a No deaths.
t m t Bai a t a ia t a i at a i ma a
ima i Ba a a i ma a t t t a
Issues
i Ba actions
a taken
at & recommendations:
Issues Actions taken Recommendations
Outbreaks of food and Coordination with the Department Improve water supplies, hygiene
water borne disease of Water Supply and Sanitation for and sanitation.
effective interventions
Coordination with the Department Food-borne disease surveillance
of Food Technology and Quality should be initiated (active)
Control (DFTQC) for food borne
disease surveillance
Field epidemiologists Outbreak investigations being Organization and management
to perform thorough conducted with available health survey to identify gaps in technical
outbreak investigation workers and support from human resources at EDCD
external partners Train and retain adequate field
epidemiologists
Investigation of Mobilization of a comprehensive Capacity building
outbreaks team for outbreak investigation Guideline toinvestigate outbreak in
Collaborating with WHO and other a more scientific way
sectors/agencies Deploying trained field
epidemiologists to investigate
outbreaks
The threat of Risk Assessments done for Zika Orientation programme at district
emerging and re- and Ebola at central level level
emerging diseases Enhance the capacity of response
teams through regular capacity
development and logistic
arrangements
Strengthening of IHR Established health desk at TIA and Guideline for the function of PoEs
core capacities 8 ground crossings and role of health workers
Permanent structural arrangement
at designated PoE sites
RRT structure and
Interim guideline sent to Update & Revise RRT guideline
functioning in
provincial and local levels according to federal structure
federalism

5.8 Surveillance and Research

Background
i a i a a a a ta i i g t a a m i
a i gt a t t i i a t mai a i i a i a
t g a a i ga g t m a at a it i a
Major responsibilities of the section are:
it aa i a i a a a at a a a t
g a a t at gi
aa ta a t a g i i at t i a i a a a
a i
i at a a it a i a i a i a a a a i
aa a a a a i a i a a a a i
i at it a ta i a i a a a a i
ma ma ag m t i a i a
ta i m ta a i at a a i ia ita i i a
it g m t
a ag m it i g a a i a a a a i i a t a
a m g ma ag m t at a a
t i a i a ii m it i g a a a a i a t
a t i i i a it i
5.8.1 Early Warning and Reporting System(EWARS)
i a ita a i a t m t t ita
imm iat a t i i g t i i it i a a t a a
i a ti ig t i m t t i mi t at a
i a t a t t a
t a ta i i ti it a a t it i it i
it i it i a it i a a i a it i at
ita a m i a g a a a a it t t
t ta m t it i it i a t ta i ia iti t
ita m i a g i i g t i at ita
mai i t t gt t i ma t a i
i a a t i a mt i t i t a t a i itat m t t a
t a i t a i t am at a i ia a a ti ig
t i m t t a t t t at a
i a it t a t a
Main Objectives:
a m i a m t i ata a i i a i at
im ta
m it a i t i i a t g a i a t
ita i at a a a
i a a i g ig a i a i a a t t t t a

i i at a t a a t t a a i ga a t g
i t
i mi at ata i ma i i a t g a a iat a
t m
The four basic elements of surveillance that were the cornerstones of EWARS development:
a im ita i a t a a a t
a at i i i ga a a t i i g mi
ta t i ma t m a
mm iat i ma a a m ii a i ga a t t
Information flow mechanism and control room responsibilities:
it t imm iat t g t t a t t m
a a t i t at mt a m a at t t
at i t at i i at t a i a it i a
at a i
ii a at i t t a i a
a i i g mt it a at i t at i
t a t it
A control room is functioning regularly under disease surveillance and research section of EDCD.
Main activities of control room are:
ai t a a it a a m i a m t ata i m
it
a i ata m it
m it i g i a t a i g
a t i t a a t i t
i a t i a i mi at a t a
i ia at a t i a it a t a t ta
i a a t t it
g i t a a i ga g t m a at a i mi at i i a
a at it
5.8.2 Water quality monitoring and surveillance
Background
a a i i g at a it ta a i m t a t
ii at t a tt ta g t t a i t i a a a
i i g at ta a a t i ii i t ta t a i
t ta g t
tat i t ta a i it at a a a it i ag i a i t
t at a it i a a i t t at a it i a
i i i gt t g i i at a it i a mmi t
i t a m t i i a i a a a
i i ga m m ta g i i tat t at t i i t tt
at a it i a t g i it ia m t at a i ia
a a a g m t m ta t t i a i i t
i t i t Ba t a a i a t am at i t i t a tt g a
i a it i iti t
i i g at i a t t a igi a t i at a m ta
i t a t a a ta i it i i g at i i i a ti t t
t t i at m g im m t t a it a i i it ag
a a i it a it at i a i m m ta t t a it t
t i i g at i
Main objectives of Water quality surveillance:
at a it i a m t g a
im m t at a it i a a i
ai t a i ii at a it i a t a t
ta
i a tm t g a t at a it i a a at a t a
i g a a t ta a t at a it i a a at a t
plan
i a ta iat at a it i a mmi a i ii
mmi a
g a m it i g i i g at a it m ai a iti it
g a i a at i a a i at it i t ta
a it i a
a a a it ma t g t ai i g m g a t g amm
t i a at a it t iti t
a i itat t g at a it t at iti t i t a a a a i a
at i a i mi i t at iti t i t a a a a
i i g at iti t m t t ai ga i a
ma t m a i a t t i ga i a
Issues
Issuesand
andRecommendation
Recommendation
SN Issues Recommendation
 Vacant post of medical recorder should be fulfilled
 Create posts for medical recorder in hospitals with
Inadequate resources for sentinel no/lack of sanctioned posts
1
sites operation  Allocation of necessary budget for EWARSorientation,
data verification and strengthening of infrastructures
of sentinel sites
Limited prompt response for disease
Disease investigation guideline should be prepared and case
2 control and prevention after
base investigation should be done
reporting
 Regular and immediate feedback/supportto sentinel
Limited feedback/support to
3 sitesfrom EDCD as well as Health Directorate
sentinels sites
 Regular onsite coaching to sites
Including retrospective data analysis and
4 Retrospectives data analysis
publish/disseminate its major findings
5 Inconsistency of data Data from EWARS may not match with HMIS data

Chapter 6
i ga ia it
6. NURSING AND
SOCIAL SECURITY
6.1 Background
i ga ia it i i i a ta i i B a i i i
a it at i t g a a it m t i g a it i ai m
i i g a i g i a ii m it i g a a i ita ai a t
i g mi i at a mm it i g i a t a a g iat i
a g a i g amm a g it t atm t a ma ag m t a i i
t i a t im i a i at i t ita i ii i a
i m t a ii a t at at ia m i i
i t at g ta a t a g i i
6.2 Organizational Arrangements
i ga ia it i ii a t B i
a it a gi
Box 6.2.1: Sections under the Nursing and Social Security Division
i g a a it m t
iat i a Ba i a ag m t
ia at it
6.2.1. Nursing Capacity Development Section:-
i at a at a a i itat t ag i t m t a
im m ta i t at g ta a t a g i i t mai tai a it i
i g i
i at a a i itat t ag i t m t a ta a
t a g i i t a m ii ai a m t t ma
i i g i
a a it i gi at a m i i i g ta a
a a it i i g i
i at a a at t i g a a g i i ga i g
ia i a i i g a
it a t ag i i i g a a at at i i
t at gi ta a t a g i i t
t a at a i t a it i i g a a i g i
i i g ia i i g a a a i
i at a a i itat i t ai t a aim t a m t a it
mm it a mi i a a a i
i at mm i at a at a a i itat t ag i t
m ta m i g i i at
i at a a i itat t ag i t m t a m
mm it i g a i
i ga ia it
mi i a a it a i
a at a i at it t ag i i i g i ga mi i
ma a i g a a it i i g m t ma ag m t
t t i at i g a mi i i g a i
6.2.2 Geriatric and Gender Based Violence Management Section :-
i at a at a a i itat t ag i t m t i
t at g ta a t a g i i t m a i g a
i g a i i t g iat i a t at a i
i at a a i itat i a it at i t a t mg
a i
t ta a t a g i i t t atm t a ma ag m t g
a i
it a a i itat i ta i
i at it a ag i ta ga i a t at i t
g iat i a g a i
t t mat ia t i a it at i it m ai
g iat i i i m a t at i t i i i at t
t t a
i t i a ti m g a a it at a i g iat i at a
a ma ag m t g a i
6.2.3 Social Health Security Section:-
t i t at g ta a t a g i i t ga i g a a a
ii ita a i t t ta g t a
a ma ag m t Bi a a ag i a a i g amm t atm t i at
i i ia it it a t ii a ag m t t
a
a i a at t i ta a a t at at ia
m ii

i ga ia it
6. 1 Nursing Capacity Development Section

6.1 Background
i ga ia it i ii a t i t i a
gi
i at a at a a i itat t ag i t m ta im
m ta i t at g ta a t a g i i t mai tai a it i i g
i
i at a a i itat t ag i t m t a ta a
t a g i i t a m ii ai a m t t ma
i i g i
a a it i gi at a m i i i g ta a
a a it i i g i
i at a a at t i g a a g i i ga i g ia i a
i i g a
it a t ag i i i g a a at at i i
t at gi ta a t a g i i t
t a at a i t a it i i g a a i g i
i i g ia i i g a a a i
i at a a i itat i t ai t a aim t a m t a it
mm it a mi i a a a i
i at mm i at a at a a i itat t ag i t
m ta m i g i i at
mm it i g a i
mi i a a it a i
a at a i at it t ag i i i g i g a mi i
ma a i g a a it i i g m t ma ag m t
t t i at i g a mi i i g a i
ote eacuse of new section, no rogram is carried out in the F 20 5 However, rogram will
be ro osed and run smoothly in F 20

i ga ia it
6.2 Geriatric and Gender Based Violence

6.2.1 Background
The specific functions of this section are given below:
i at a at a a i itat t ag i t m t
i t at g ta a t a g i i m a i ga t a
i at a a i itat t ag i t m ta m
i g a i i t g iat i a t at a i
i at a a i itat i a it at i t a t m
g a i
t ta a t a g i i t t atm t a ma ag m t
g a i
it a a i itat i t ta i
i at it a ag i ta ga i a t at i t
g iat i a g a i
t mat ia t i a it at i it m ai
g iat i i i ma t at i t i i i at t
t t
a
i t i a ta g i a m g a a it at a i
g iat i at a a ma ag m t g a i
A. Geriatric
Geriatric Ward Establishment Program
Background:
a ta i g iat i a i t a ita i i g g iat i i i

i t ita a t t t ita a a t mt ita i B ata
B a at a a t a t i t g iat i i a ii t
tat a i i it i t i imit a a it a
iat i it imit a a it imit a a ai a i it t a t g iat i

i m ti i g a at g iat i ma a ma a a t ta a a
a ig a g i ita i i g g iat i i i i i tt a g iat i
a t ig i i at ita a a g ma g iat i i
i a a i g iat i i t t a a tm t i ita i i g
ma at g iat i i i i at a t a i g ita
t i i i a a a a a ma a g i t t ma ag gi a m i a
g a g t a i t a mi a iat i a t t am it
a ia i at a i t a g iat i a t a
ta t t g iat i m i i mm a ma ita
i i g g iat i i a a it t ai ma g iat i i a a
ma a g m t ma g iat i m i i i g t ai i g
a ia i t ai i g i it i a m t
1
ata ita ata a m at a i a a a i g ita i B a at ita
t gi a ita aa a m at a i B i ita ag ita a ga i
B i aa t t at a i m i i ita B t a

i ga ia it
i i g iat i a ta i a gi g a i
im a t g i tt i a ti g iat i i
i at i t i i i g i a ma ag m t m a
a ia i am imm i a
ig ma g iat i i i ita B ata aa a B a at
t a t t i m m a t t a t
imit i a i t t a t
ii ag it ia g iat i i i
B. Gender Based Violence Management Program
Background:
a i B i aga ma ig t i a a i at i
im a t t i a a m ta at t i i i a i a i a a i a
ia a mi t t i t B i a t a a t t i it igi a
i mi tat a i a t i a g ga i a g it a
aa t imi a i gai t m B a i
t at i i t agai t a ma a i a ma i t at a t m
i at ti a t t at i i t i a m ta a am i g t at
a t i a t i a i t B i i at a i a t
i i ti a i t t g m a a a t g i i t
i gai t m a i i t ma i ta t i g i a it
m t a a ta ig i a t t i mi g a a i i t
m at B i t t t ia m t at i gai t
m a i it i it at a a a ta it
a t a a a gai t B t i i t g at i t i
B ta i i g ita a t i i a ag m t t
i i at t ta i m t i B t a
ta i i iti t t m i ta i i a t
i t t m t a a t t i a i m ta
i i gi t t t gt t t m a a a it i t i i t a
i t mi t a a a i a i i a i t g i t m
t gt i g i ita a at i i i g i a
i t atm t ia i g a m i ga i a i at it
m t a ag i t at i i a t a m ga t a
it a a i ita a i t ia i t at i a i
a ma at t i i t B i B a i m
a at i a tt i a ai a mt t a t i i

i ga ia it
Services OCMCs are mandated to provide
The ‘Hospital-based OCMC Operational Manual’ (MoHP 2011) says that OCMCs shall provide the
following seven kinds of services through multi-faceted coordination with other agencies:
 Health services – Immediate treatment of physical and mental health needs of GBV
survivors with OCMCs having to stock the equipment and the free health service medicines
to provide these services.
 Medico-legal examination and reporting.
 Psycho-social counselling to survivors and perpetrators.
 Legal service- counselling and support to survivors through district attorneys and legal
counsellors.
 Safe homes — by directing survivors to safe shelter homes.
 Security – by working with the police and district administration offices to provide security
to survivors in hospitals, safe houses, and in their communities.
 Rehabilitation – by providing further counselling, education, vocational skills training and
other livelihoods support.
GBV
B cuts
t aacross caste-ethnicity,
a t t i it religion igi aand socioeconomic
i mi statustat and a isi prevalent a t ini alla
ggeographical
g a i a settings, g tthough g iin different
i t formsm aand mag magnitude,
it making
ma i g prevention and a response
crucial
ia nationwide
a i 2
. The Nepal a Demographic
m g a i aand Health a t Survey (NDHS, 2016) found that t at22 percent t
m ag a i i a i
of women aged 15–49 had experienced physical violence at some point since age 15, whileat m i t i ag i 7
percent t had
a experienced
i sexuala violence.
i The main maiperpetrator t atof physical iorasexual violencea i was
their husband. Women’s experience of spousal violence varies by ecological zone. Close to one-t
a t i a m i a i a i gi a
t i m i t ai i i a a
third of women in the Terai (32%) experienced physical, sexual or emotional violence compared to
m a i m a
t i i a tai a a i a at i m a
one-fifth in Hill (20%) and Mountain (19%) areas. Divorced, separated or widowed women are more
m i t a i a i t a t ma i m
likelya to have experienced
t aspousal
a violence
t m (48%)i than currently a i married women t (26%). Thet
education
m level of the
a husband
a affects a women’s a risk of
i spousal violence.
a i Forty-four m a percentt of
women t whosem husband has ano education a m had t texperienced aspousal i g violence
at compared
ig to 14g
i
percent of women i g whose i husband
t mmhad acompleted i a schooltaleaving
the t t t i i ort higher.
certificate t t
aReporting
t i a gma a i g t i a a
violence or seeking help is not common as survivors are reluctant to report incidents t i t ito
m
the authorities a fear of stigmatisation,
for i a i a the violence
fuelling a i and lack a of support
ti m a Two-
services.
g t
thirds of women who have experienced any physical or sexual violence have not informed anyone
or sought
6.2.2 Majorhelp.
Achievements in fiscal year 2075/76
6.2.2 Major Achievements in fiscal year 2075/76
ata t a t i a g t at t t ta a a m i t a
MoHP data extracted in Falgun 2076 shows that the total annual number of OCMC clients has
a m i a g a ii t i
increased from
a 187 in 2069/70 (2011/12)
g a i i (based m on ma
seven reporting facilities)t to 6,992
i tin Ba
2075/76
(2018/19) based on ata
45 reporting
i a afacilities.
a t Women a a make
a t a up over
a ma 90 percent of clients. t Based
a a on
2075/76
a a (2018/19)a a adata,
t t physical
g t aassault, sexualt assault
a aand arape make i aupa 72a percent
ti of all cases.
t
Rape and sexual assault together are 38 percent of all cases, and physical assault is 34 percent.
m a i a a a i t at a t t a i i i
Thea number
i a ma of cases of physical and
a t a sexual violence that are
matreported to any service provider
a min
Nepal is a small proportion of actual occurrence. To estimate how well OCMCs reach women
i it at a a a m ga i a at at ma a
i it at a
2Ministry of Health, Nepal; New ERA; and ICF. 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal:
Ministry of Health, Nepal.

seeking help for physical or sexual violence, we calculated the number of OCMC clients in one year
as a percentage of the estimated number of women seeking help using i gcensus
a ia andit estimates
data
i g and sexual
of physical i aviolenceafrom i the Nepala Demographic
at t mand Health Survey
i t i(NDHS, 2016).
a The
a a tag t mat m m i g i g ata
crude estimation is that OCMCs served between 3–4 percent of women who sought help fora mat
i a a a i mt a m ga i a at
physical or sexual
ma violence
i t at in 2075/76 (2018/19).
t Coveraget variesmby provinceg but
t the headline
message
i a is that acoverage
i isi extremely low and thereagis much
a i more fori the tgovernment
t a i to do to
m ag i t at ag i t
improve survivors’ access to services. m a t i m m t g m t t t
im i a t i
6.2.3 Analysis of OCMC utilisation data
6.2.3 Analysis of OCMC utilisation data
The number of OCMCs has increased from seven in 2011/12 to the planned 69 by the end of FY
2075/76m(2019/20). MoHPa i dataa extracted
m in March
i 2020t shows
t athat the total
t annual number of
ata t a t i a t at t t ta a a m
OCMC clients has increased
i t a i a
from
m
187i
in 2011/12a (based on seven reporting
g a ii
facilities)
t
to
i
6,992 in
2018/19 (based
a on 45 reporting
g afacilities).
ii (see
a Table 1).
Table 1:
Table 1: Total number of Clients by year and number of reporting hospitals

Year Total # clients # hospitals reported data
2011/12 187 7
2012/13 545 12
2013/14 1,049 14
2014/15 1,730 15
2015/16 2,004 17
2016/17 2,924 22
2017/18 4,372 37
2018/19 (2075/76) 6,992 45
Source: GESI/MoHP
Women make up the overwhelming majority of OCMC clients, representing over 90 percent of
m ma t mi g ma it i t g t
clients.
i t The average
a ag number
m of iclients
t served per OCMC a i has aincreased over
m timeg (see figurei 1). This
reflectst increasing
i a i g capacity
a a it of OCMCsitwith t the
i t introductiont of the
B GBVi i a Clinical
t Protocol
i in 2015,
i i t a a a a i a t i t ia
revision of the OCMC Operational Manual in 2016 and the introduction of psychosocial counsellingi g
t ai i g i a m i ga t ai i g i
training in 2012/13 and medico-legal training in 2018/19.

i ga ia it
Figure 1: Average number of clients per OCMC by fiscal year 2011-12 to 2018-19
180
160
140
120
100
80
60
40
20
0
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Source: GESI/MoHP
igSignificant
i a t i diversity
it i tin theareadiness
i a and use of OCMCs i is well known. ig Figure 2 presents
t a a annual
i
t at t at a a a i a t t i i it a a
client use at five OCMCs that have been operational since 2011/12 and reflects this diversity.
aa a i g ita a ta i i t i t a ta a ita a a a iti t t a ig
Gajendra
at Narayan
i t i t Singhm a hospital
t t (Saptarii tdistrict)
i t aand Hetauda
a a a ahospitalita (Makawanpur
i at i district)
ai a both
are
ta highly
a populated
ita i districts
at at icompared a iato othert 3 districts.
a i Gajendra t t Narayan a hospitali is located
t a in
aTerai
t andm Hetauda a thospital isi located
g Bat i hill. The
a variation
a iof athe i cases
i a is due
ta to thet population,
a a
socio-cultural itafactor,
i number of partnersta a working
a a on GBVa aissues
a a and leadership
ita a anda initiatives
a itaken
i by the OCMC focal a andmhospital tchief.a OCMCs i a of Hetauda
it a and t Gajendra a a i at a
Narayan hospitals are very
ita i a i i g i a it i t ita i a i im
active and visible. They possess active multi-sectoral coordination with partners, focal persons are
a t a a a t imi a a
dedicated and hospital chiefs are supportive including effective coordination within the hospital.
Initially, Phidim (Panchthar) was active due to similar reasons.

i ga ia it
Figure 2:
Figure 2: Total
Total number
number of
of clients
clientsbybyyear
yearatatfive
fiveOCMCs
OCMCsoperational since
operational FY FY
since 2011/12 to 2018/19
2011/12 to 2018/19
Figure 2: Total number of clients by year at five OCMCs operational since FY 2011/12 to 2018/19
600
600 Hetauda Hospital
Hetauda Hospital 542
500 542
District Hospital Fidim, Panchthar
500 District Hospital Fidim, Panchthar
Gajendra Narayan Singh 411
400
Sagarmatha
Gajendra Zonal Hospital
Narayan Singh
400 411
Sagarmatha Zonal
Damauli Hospital Hospital
321
300 Damauli Hospital
321
300 Dhaulagiri Regional Hospital
Dhaulagiri Regional Hospital
200 199
200 199
100 95
83 76
100 62 58 95 69
83
47 51 50 49 76
62 58 69
21 47 51 50 49
0
21
0 2068/69 2069/70 2070/71 2071/72 2072/73 2073/74 2074/75 2075/76
2068/69 2069/70 2070/71 2071/72 2072/73 2073/74 2074/75 2075/76
Source: GESI/MoHP
Source: GESI/MoHP
6.2.4 Type of violence
6.2.4
6.2.4 Type
Recording of
Type ofof violence
the type of violence experienced by clients was introduced during the OCMC pilot
violence
Recording of the
period. Using type of
2075/76 violence as
(2018/19) experienced
the fullestby clients
year was introduced
of reporting to date,during
we see thethat
OCMC pilot
physical
period.i g
Using t t
2075/76 i
(2018/19) as the i fullest year i of t a i
reportingt to date, we i g
see
assault, sexual assault and rape make up 72 percent of all cases. Rape and sexual assault togethert that i t
physical
arei38 percent
assault, i g of
sexual assault and and
all cases, a up
rapephysical
make tassault ist34 percent.
72 percent aof all cases. Rape
g t and
atsexual assault
t attogether
i a
aarea38tpercenta ofa all
a cases,
t a and a physical
ma assault is 34 percent.t a a a a a a a tt g t
Figure 3: Type of violence recorded for all OCMC cases in FY 2018/19
aFigure 3: Typetof violence
a a recorded
a i a a a ti
for all OCMC cases in FY 2018/19
t
Figure 3: Type of violence recorded for all OCMC cases in FY 2018/19
Rape
Rape 960
Sexual assault 960 1660
Sexual assault 1660
Physical assault 732
Physical assault 732
101
Forced marriage (child marriage)
and traficking 101
Forced marriage (child marriage)
and traficking 1017
Denial of resources
1017
Denial of resources
Emotional abuse 2355
Emotional abuse 2355
Source: GESI/MoHP
Source: GESI/MoHP

i ga ia it
a ig g a g m i a a a i at t a m a
a i t ii g ai i g ia m gi mi ma t a a ta i it a
i g i agai t i a t m ag t at a i
a t i a a i a g t t a i a t
gg t it i i i a i i i m i a a t at m i a
i g t t at i i it i ma ig ami a t i at
t a t i a i t a i g a a i t
6.2.5 Enabling Factors
ma t a ai i t at t i gg a
a t a
ita a
mmitm t t i i a a i g a t t i
a i t g at mmitm t t B a t ita
m at ta a im t a it a ita i a i t t i B
t i a a ia m t i i it t ita t i i a i a a i t
t i
i a i a t a ita t a i g t t
a B a t a t a ag i ita
a tm t a m i ga ai mmi i a
a a i ita t
a it a i ta a t ai i g ta a ta t ii
a a i t mai t a i t a it a it a i a
m a i ita t a a i t a g a t t m
t g t i mi a i ma a t i a B i t g
a i a t m ia
a ii g i g i a am aig agai t B i a mm i
g a m it i g a i
6.2.6 Issues and Constraints
a i a g a a t t at gi g a i t at a im a gt
i g i t ai m a a g t g a i m t
it im ta t im i a ig t a t it i ga i a a g
t t m a t at i t iti t ita mai a a i a t i a i at
m t a i t at a a ai a at t i g i i ga ga i
a m am a i mi i t a a a g m t it i t it
t a i at i g a
t at gi i at
t i t a m i t i it m i
a ii a
t m a t i i i i g
a m a a i ita i a t
a ita i i g i t m i t i a ga t t
a t ia t i a a m iti g t
t at t m a t m i t at a a i i a g
i i i at a t i it a

i ga ia it
i a a a a ai m t t m i a t t g t
i a ga i a m a a i ita i a ma it t t
a mm a a a i ita a t i t a i t a i
m it i a i i a t m ta i i a a a a g
ma a ai a i it i a ma t a ta a i
B a at t ai i g a ta t a ii it ta a at
t ta a tm t i it a a t g a i it ta ia ta t
ta a i im i a a a it a i i
ta a a it a m t ta a a g i i a at t ai i g t i i a
t a a a a a m i ga t ai i g t t
ta i ami a a i m a t a m i ga t at ta
i t a ia i g t ai i g a i a i tm t
i a a ta t t a a it a m t
i i a t ta i i g i i a m i ga t ai i g a B a
ia i g t ai i g ig ta t i ita it i a at
a a a g m t a a i t a a a ga im a t i i ga i g
i ia i a i g B i m
m mi a at a a i at m a i t
a a g i i ma i g it i t t mai tai i a i i i g i
a a a i ita m a t i g m m ta a g i a
t igg t a g a am ta t
i it at a a Ba i i i a t i it at a a
t i i a ag m t t a a a a

i ga ia it
6.3 Social Health Security

6.3.1 Background
ia at it a ta i i B a i i t atm t
a ma ag m t a i i ig t t i a t im i a i at i t
ita t i m i a a a m ta ii
a t at at t i t at g ta a t a g i i
i t i B a gi
B ia at it
t i t at g ta a t a g i i t ga i g a
a a ii ita a i t t ta g t a
a ma ag m t Bi a a ag i a a i g amm t atm t
i at i i a a
i a at t i ta a a t at
at t

i ga ia it
6.3.1 Bipanna Nagrik Aaushadi Upchar Programme
6.3.1.1 Background
g a a t i B a gi
B a a t g amm
Goal a ag t ii t atm t t im i i
• Objectives —
i t i tt ita m i a a t atm t
ii i a at t i ta a g i i a t
Bi a a ag i a a i g amm
Major ongoing activities
m i i i m ia at it i t i g
i g im i a i t t at i at i
t atm t t a t ia i t ita i a
i i g a at i a t a ma a i i t a ma i a i i
im i a a i a i a a mia i a
i a t t t a ta a t a
ia i i
ta a t mat t t t t a
a ta a ta t t a t a
m i a t atm t tai i i a t
i ga i t a g a a ai i a gi t
a m g a
i t t a t t it m a t ma ag i t
ii t atm t t im i i i m m t m
a t m a at i a i a ma i a
i a mia a ma a a m a i
i a a t i a a t t a t i m a t
t a m a t m im i a i a
t i m t ii t atm t t im i i i
m tai a i a
m a t i t i ta a tm i a t

i ga ia it
Table 6.3.1.1: Total num ber of im pov eris hed patients ( both new and old) prov ided with
treatm ent s upport for s erious dis eas es , 2075/ 76
K idney
Traum atic Spinal Inj ury

Traum atic Head Inj ury
Sickle Cell Anem ia

Alz heim er' s
Parkins on' s
K idney Trans plant
K idney Treatm ent
K idney Peritoneal
Cancer
Nam e of
Heart
Total
S.N.
Haem odialy s is
Hos pitals / particular
dialy s is
K idney
N ati onal ac ad em y of
1 h ealth s c i enc es , B i r
h os pi tal, K ath m and u 66 0 188 14 0 253 4 3 4 3 0 0 2812
T ri b h uw an uni v ers i ty ,
2 teac h i ng h os pi talm
M ah araj g unj 124 11 19 55 0 502 7 9 209 1 0 93 7
P atan ac ad em y of
3 h ealth s c i enc e, patan 99 0 13 8 0
h os pi tal 93 1681 24 2 80 69 0 2186
B . P . K oi rala i ns ti tute
4 of h ealth s c i enc e,
Dh aran 14 8 9 25 0 621 4 23 129 0 188 3 0 0 1573
P ropk ar M aterni ty
5 W om ens Hos pi tal, 0 0 0 0 0
T h apath ali 16 0 0 0 0 0 16
Sah i d G ang alal N .
6 Heart c entre, 0 0 0 0 2709
B ans b ari 0 0 0 0 0 0 2709
C i v i l s erv i c e Hos pi tal,
7 0
M i nb h aw an 0 0 0 0 2275 0 0 0 0 95 23 70
M anm oh an C ard i o
8 T h orac i c , V as c ular 0 0 0 0 879
& T C 0 0 0 0 0 0 879
B . P . K oi rala
9 M em ori y al C anc er 0 0 0 0 0
Hos pi tal, B h aratpur 15554 0 0 0 0 15554
Sah i d Dh arm a B h ak ta
10 T rans plant C entre,
B h ak tapur 197 63 0 183 0 0 0 0 0 0 0 4 4 3
P ok h ara Ac ad em y of
11 Health Sc i enc e, 104 0 0 0 0
P ok h ara 0 0 0 0 0 104
N aray ani
12 3 8 0 0 0 0
h os pi tal,B i rg unj 0 0 0 0 0 0 3 8
Rapti Ac ad em y of
13
Health Sc i enc e, Dang 3 3 0 0 0 0 0 0 0 0 0 89 122
M ec h i Hos pi tal,
14 4 1 0 0 0 0
B h ad rapur, J h apa 0 0 0 0 0 0 4 1
K os h i Hos pi tal,
15
M orang 3 4 0 0 0 0 174 0 0 0 0 0 208

i ga ia it
K idney

Sickle Cell Anem ia

Alz heim er' s
Parkins on' s
K idney Trans plant
K idney Treatm ent
K idney Peritoneal
Cancer
Nam e of
Heart
Total
S.N.
Haem odialy s is
dialy s is
C h arak M em ori y al K idney
3 6 Hos pi tal P v t, K as k i
pok h ara 4 8 10 0 0 0 0 0 0 0 0 0 58
Hi m al Hops i tal P v t,
3 7
G y anes w ar, K tm 3 4 0 0 0 0 0 0 0 0 0 0 3 4
V ay od a Hos pi tal P v t,
3 8
B alk h u 3 0 0 0 0 5 0 0 0 0 0 0 3 5
K ath m and u C anc er
3 9 C enter, T ath ali ,
B h ak tapur 0 0 0 0 0 652 0 0 0 0 0 652
V enus h os pi tal
4 0 pv t. ltd , B anes h w or,
K ath m and u 4 3 0 0 0 0 0 0 0 0 0 0 4 3
N ati onal T ram a
4 1 C enter,
M ah ab aud d h a, K tm 0 0 0 0 0 0 0 14 1 3 61 0 0 502
N ob el M ed i c al C olleg e
4 2 T eac h i ng
Hos pi tal,B i ratnag ar 85 10 0 0 895 0 202 3 20 83 15 0 1610
N epal C anc er
4 3 Hos pi tal & rearc h
c enter, L ali tpur 0 0 0 0 0 3 03 8 0 0 0 0 0 3 03 8
G rand i I nternati onal
4 4
Hos pi tal P v t, Dh apas i 4 2 0 0 0 0 0 0 0 0 0 0 4 2
C ri m s on Hos pi tal ,
4 5
M ani g ram Rupand eh i 4 6 0 0 0 79 0 0 4 3 9 0 0 177
G reenc i ty Hos pi tal
4 6 pv t. L td , Dh apas i ,
K ath m and u 53 0 0 0 0 0 0 0 0 0 0 53
O M h os pi tal and
4 7
Res earc h C enter 4 8 0 0 0 0 0 0 0 0 0 4 8
N euro C ard i o
4 8 M ulti s pec i ali ty
Hos pi tal, B i ratnag ar 0 0 0 0 4 3 0 0 121 2 0 0 166
P urna T ung B i rta c i ty
4 9
Hos pi tal, J h apa 3 4 0 0 0 0 0 0 0 0 0 0 3 4
J anak i Health C are
50 and Res earc h C enter
P v t. L td 3 9 0 0 0 0 0 0 0 0 0 0 3 9
Dh uli k h el Hos pi tal,
51
K av re 14 0 0 0 10 122 0 0 3 0 0 0 176
O M s h ah i P ath i v ara
52
Hos pi tal, J h apa 66 0 0 0 0 0 0 0 0 0 0 66
K i s t M ed i c al C olleg e,
53 T eac h i ng Hos pi tal,
L ali tpur 57 0 0 0 0 0 0 0 0 0 0 57
54 L ak e c i ty and c ri ti c al 3 8 0 0 0 0 0 0 0 0 0 0 3 8

i ga ia it
K idney

Sickle Cell Anem ia

Alz heim er' s
Parkins on' s
K idney Trans plant
K idney Treatm ent
K idney Peritoneal
Cancer
Nam e of
Heart
Total
S.N.
Haem odialy s is
dialy s is
16
J anak pur Hos pi tal, K idney
4 4
J anak pur 0 0 0 0 0 0 0 0 0 0 4 4
B h eri Hos ppi tal,
17
B ank e 12 0 0 0 0 0 0 0 0 0 167 179
Seti onal h os pi tal,
18
k ai lali 62 0 0 0 0 0 0 0 0 0 270 3 3 2
N epal M ed i c al
19 18 0 0 0 0 0 0 0 0 0
C olleg e J orpati 126 14 4
G and ak i M ed i c al
20 0 0 0 0 0 0 0 0 0
C olleg e, P ok h ara 4 1 7 4 8
U ni v ers al C olleg eof
21 M ed i c al Sc i enc es , 104 0 0 0 0 0 0 0 0 0 0
B h ai rah aw a 104
C h i tw al M ed i c al
22 C olleg e T eac h i ng 0 0 0
Hos pi tal, C h i tw an 88 3 22 50 0 3 2 16 4 0 512
C olleg e O f M ed i c al
23 0 0 0
Sc i enc es , C h i tw an 99 16 0 12 4 2 3 3 2 0 204
N epalg unj M ed i c al
24 95 0 0 0 0
C olleg e, B ank e 0 0 0 0 0 95
M ani pal M ed i c al
25 c olleg e, T eac h i ng
Hops i tal pok h ara 3 7 20 0 0 90 127 0 12 6 0 0 292
B h ak tapur C anc er
26 0 0 0 0 0
Hos pi tal, B h ak tapur 8829 0 0 0 0 0 8829
N ati onal K i d ny e
27
C entre, B anas th ali 64 5 12 0 0 0 0 0 0 0 0 0 657
G old en Hos pi tal
28 4 5 0 0 0 0
pv t. L td , B i ratnag ar 0 0 3 5 4 0 0 84
B & B Hos pi tal,
29 0 0 0 0
G w ark o 17 4 5 0 0 0 0 0 62
Aarog y a h ealth
3 0 24 6 61 0 0 0
prati s th an, P ulc h ow k 0 0 0 0 0 0 3 07
N ati onal d y aly s i s
3 1 14 8 0 0 0 0
c enter, B as h und ara 0 0 0 0 0 0 14 8
C anc er c are nepal,
3 2 0 0 0 0 0
J aw alak h el 727 0 0 0 0 0 727
Si d d h arath a C i ty
3 3
Hos pi tal P v t, B utw al 4 8 0 0 0 0 0 0 0 0 0 0 4 8
Alk a Hos pi tal P v t,
3 4
J aw alak h el 50 0 0 0 0 0 0 0 0 0 0 50
G autam B ud d h a
Sam ud ay ek Heart
3 5
Hos pi tal, B utw al,
Rupand eh i 267 0 0 0 1066 0 0 0 0 0 0 13 3 3

K idney

i ga ia it
Sickle Cell Anem ia

Alz heim er' s
Inj ury on' s
K idney Trans plant
Treatm ent
K idney Peritoneal
Cancer
Nam e of
Heart
Total
S.N.
K idney
Haem odialy s is
Parkins

Sickle Cell Anem ia

ent s is
K idney
Alz heim er' s

Traum atic Head
Parkins on' s
K idney Treatm dialy
plant
K idney Peritoneal
Cancer
Nam e of
Heart
Total
S.N.
Haem odialy s is
K idney
K idney Trans
dialy s is
K idney
c are Hos pi tal,
pok h ara
Spi nal I nj ury
55 c are Hos pi tal,
Reh ab i li tati on C entre 0 0 0 0 0 0 0 0 4 63 0 0 4 63
pok h ara
Spi nal I nj ury B h aratpur Hos pi tal,
5556 67
RehB h abaratpur i li tati on C entre 0 0 00 00 00 00 00 00 4 63 0 0 60 0 0 4 63 0 127
B h B aratpur lue C rosHos s Hos pi tal, pi tal
5657 67 3 0
B h P aratpur v t. L td . 0 00 00 00 00 00 00 600 0 0 0 0 127 0 3 0
B lue Sh ree C ros B s i rend Hos pira tal
5758 108 0
P v Hos t. L tdpi . tal, C h auni , K tm 3 0 00 00 00 00 00 00 00 0 0 0 0 3 0 0 108
Sh N ree ati B onal i rend C ra i ty Hos pi tal108
5859 0 0 00 00 00 00
HosP v pit. tal, L td C . ,h B auni h aratpur , K tm 0
162 00 00 0 0 0 0 108 0 162
N ati N epal onal P C oli i ty c Hos e Hos pi talpi tal, 0
59
60 P v t. L td . , B h aratpur 3 3 0 0 0 0
162 0 0 0 0 0 162
K tm 0 0 0 0 0 0 0 0 0 0 3 3
N epal P oli c e Hos pi tal,
60 3 3
61 K tmG h od ag od h i Hos pi tal 0 0 0 0 0 0 0 0 0 0 3 3
G h P odv t. agL odtd . h i Hos pi tal 0 0 0 0 0 0 0 0 0 0 4 05 4 05
61
62 P v K t.anti L td . C h i ld ren 0 0 0 00 94 0 00 00 0 0 0 0 4 05 4 05
K anti Hos C pih tal, i ld ren K tm 13 9 0 0 0 0 0 23 3
62 0 0 94 0 0
HosSumpi tal, eruK tmC om m uni ty 13 9 0 0 0 0 0 23 3
63
SumHoseru pi tal C om P vm t.uniL tdty . 3 1 0 4 72 0 0 0 0 0 0 0 0 503
63
HosRapti pi talHos P v t. piL tdtal, . 3 1 0 4 72 0 0 0 0 0 0 0 0 503
64 Rapti Hos pi tal, 17
64 T uls i pur 17 0 0 0 0 0 0 0 0 0 0 17
T ulsDh i pur aulag i ri Hos pi tal, 0 0 0 0 0 0 0 0 0 0 17
65 Dh aulag i ri Hos pi tal, 6
65 B ag lung 6 0 0 0 0 0 0 0 0 0 0 6
B ag lung 0 0 0 0 0 0 0 0 0 0 6
Surk h et P rov i nc i al
66
66 Surk h et P rov i nc i al
23
23
HosHospi tal, pi tal, SurkSurk h eth et 0 00 00 00 00 00 00 00 0 0 0 0 23 0 23
N ati N ati onal onal M edM i edc ali c al
6767 C ollege, Be,i rgB unj i rg unj
C olleg 79 79 0 00 00 00 00 00 00 00 0 0 0 0 79 0 79
SusSush i lh K i loiK rala oi rala C ancC anc er er
6868
HosHospi tal, pi tal, B ankB ank e e 0 0 0 00 00 00 071 71
0 00 00 0 0 0 0 71 0 71
G ajG end ra N
aj end ra N aray an aray an
Si ngSi ngh Hos h Hos pi tal,
pi tal,
6969
RajRaj b i raj b i raj
11 11 0 00 00 00 00 00 00 00 0 0 0 0 11 0 11
Total 4 14 0 221 93 6 252 6828 3 7121 3 77 761 154 7 121 1026 53 3 3 0
Total 4 14 0 221 93 6 252 6828 3 7121 3 77 761 154 7 121 1026 53 3 3 0
Source: N SSD, DoHS
Source: N SSD, DoHS
Table 6.3.1.2: Is s ues , challenges and recom m endations — Bipanna Nagrik Aaus hadi Upchar
Table 6.3.1.2:
Program m e Is s ues , challenges and recom m endations — Bipanna Nagrik Aaus hadi Upchar
Program m e
Is s ues and challenges General recom m endations
I ns uf f i c i ent b ud g et/ Is s fues
und and
f or i m challenges
pov eri s h ed P rov i d e ad eq uate f und General recom m th endations
s or i nc orporate i s prog ram m e
N I epales
ns uf f i c ei ent b ud to
c i ti z ens g et/ f unds erif ous
treat or i m h ealth
pov eric ond
s h edi ti ons . w i th h Pealth
rov i d i nse uranc
ad eq e.uate f und s or i nc orporate th i s prog ram m e
T Nh eepales
m oni tori e c ngi ti z ofenspubtoli ctreat
and pri s eriv ate
ous h h ealth
ealth c ond i ti ons . li w s h i tha tas
E s tab h ealth
k f orc i ens thuranc e. i s e reg ularly to th e
at s uperv
f acT h i lieti m es oni
. tori ng of pub li c and pri v ate h ealth pub li c E and
s tab prili s v h ate h ealth
a tas k f orcf ac ei li thti esat. s uperv i s e reg ularly to th e
f ac i li ti es . pub li c and pri v ate h ealth f ac i li ti es .

i ga ia it
6.3.2 FCHV Programme 6.3.2 FCHV Programme
6.3.2.1 Background
6.3.2.1 Background
Theggovernment
m t i initiated
i at tthe Female
ma Community
mm it Healtha t Volunteert (FCHV) Programme
g amm ini 2045/46
i i t i t a a it t a i t i t t a i a one FCHV wasa
(1988/1989) in 27 districts and expanded it to all 77 districts thereafter. Initially
aappointed
i t a a a a a a a t at a i t i
per ward and followed by a population-based approach that was introduced in 28 districts
iti t i a t i g i a g a a
in 2050 (1993/94). There are currently 51,420 FCHVs working in Nepal. The goal and objectives of
t g amm a i t i B
the programme are listed in Box 6.3.2.1
Box 6.3.2.1: Goal and objectives of the FCHV Programme
Goal — Improve the health of local community peoples by promoting public health. This includes imparting
knowledge and skills for empowering women, increasing awareness on health related issues and involving
local institutions in promoting health care.
Objectives — i) Mobilise a pool of motivated volunteers to connect health programmes with communities and
to provide community-based health services, ii) activate women to tackle common health problems by
imparting relevant knowledge and skills; iii) increase community participation in improving health, iv) develop
FCHVs as health motivators and v) increase the demand of health care services among community people.
FCHVsaare selected
t by health
at m mothers'
t ggroups. FCHVs are
a provided
i with
it 9 days
a basic
a i training
t ai i gand
a 9
days
a refresher training
t ai i g following
i g which
i t they receive medicine
i m i i kit
it boxes, manuals,
ma a flipcharts,
i at ward
a
registers,
gi t IECmat
materials,
ia aandaan FCHV bag, ag signboard
ig a and
a identity
i t card.
a Family
ami planning
a i gdevicesi (pills
i
aand condoms m only), i iron ta t vitamin
tablets, itami A capsules,
a a ORS are
and a supplied i to
t them
t mthrough
t g health
at
afacilities.
ii
Themamajor role of FCHVsi isttoaadvocate

at healthy
a t behaviour
a i amongg mothers
am m t and
a community
mm it people tot
promote
m t asafemmotherhood,
t child
i health,
a t family
ami planning
a i g anda other
t community
mm it baseda healtha t issues
i
aand service
i delivery.
i i t i t condoms
FCHVs distribute m and
a pills,i ORS packets
a t anda vitamin
itami A capsules,
a t at
treat
m ia cases,
pneumonia a i
refer serious a tto health
cases a t iinstitution
t a motivate
and m at and
a educateat localapeople on
a t a i at a i a i t i t i ta t t g a t
healthy behaviour related activities. They also distribute iron tablets to pregnant women. m
The ggovernment
m t isi committed
mmi to increase
t i the a morale
t andaparticipation
m a a of i FCHVs
a for community
mm itPolicies,
health. a t strategies
i i andt at gi
guidelinesa have g i been
i developed
a a
and updated accordingly atto
astrengthen
i g the
t programme.
t gt t The FCHV
g amm g amm t at g a i
programme strategy was revised in 2067 (2010) to promote a i
t
strengthened mnational
t a t programme.
gt a fiscal
In a year g amm
2064/65 MoHa established
a FCHV funds taof iNPR
50,000 in each VDC mainly to i promote
a mai generation
income t m tactivities.
i m FCHVs g aare recognised
a i for having a
g i a i g a a ma i i g mat a a i m ta it a g a
played a major role in reducing maternal and child mortality and general fertility through
it t g mm it a at g amm
community-based health programmes.
 Dress allowance for FCHVs increased from NPR 7,500 to NPR 10,000.
a a i a m t
 Since 2071/72 the government has allocated budget for farewell to FCHVs over 60 years of age
i t g m t a a at g t a t a
agas arecommended
mm by healthamothers’
t m t groups.g
 Thet aitraining,
i g orientation
i ta aandmmobilization
ii a of FCHVs for national
a a health
a t programmes.
g amm
Bia a i m g a a a at t m

 Biannual FCHV review meeting was held and FCHV Day celebrated on 5th th iDecember.
• B i annual F C HV rev i ew m eeti ng w as h eld and F C HV Day c eleb rated on 5 Decgema b er. ia it
6.3.2.3 Major
 6.3.2.3 Major
Biannual
achievements
FCHVachievements
review
in 2075/76
in 2075/76 th
6.3.2.3 Maj or achiev em meeting was held
ents in 2075/ 76 and FCHV Day celebrated on 5 December.
1. Progress
g Major reports,
t , wwhich provide the basis for the following analysis, a s iis , thtthat
at i ininf fiscala y year 2075/76,the
6.3.2.3
1. P rog h i i c h prov in
achievements
res s reports ii d 2075/76
etth e b aas ii s f ortth e f ollow ii ngg aanaly at i s c al a 2075/76,th
ear te
number of mothers participatinga ng gi in health mother's group
g m meetings
m ng s w were
g ere i ncincreased,
i ed a, d despite of that
numm b er of m m otht ers parti
a c i ipati ni h ealtha t m moth ter' s g roup eeti reas es pi te of itth at
1. Progress
t FCHVs
at reports,
distributed which provide the basis
i t i tfewer pills,i condomsmin icomparisons for the following analysis, that in fiscal year
m a i tot fiscala yeara 2074/75. However, FCHVs 2075/76,the
F C HV s d i s tri b uted f ew er pi lls , c ond om s i n c om pari s ons to f i s c al y ear 2074 /75. How ev er, F C HV s
i t i tof mothers
number
distributed mmorei iron ta t iin comparisons
participating
tablet mhealth
in a i mother'stto fiscal
a groupa 2074/75.
year a increased,
meetings(Table
were 6.3.2.1 and a despite
ig 6.3.2.1)
Figure of that
d i s tri b uted m ore i ron tab let i n c om pari s ons to f i s c al y ear 2074 /75. (T ab le 6. 3 . 2. 1 and F i g ure 6. 3 . 2. 1)
FCHVs distributed fewer pills, condoms in comparisons to fiscal year 2074/75. However, FCHVs
Table 6.3.2.1:
distributed Trend of services provided byfiscal FCHVs 2074/75. (Table 6.3.2.1 and Figure 6.3.2.1)
T ab le 6. 3 . 2.more
1: iron
T rendtablet
of s ervin i comparisons
c es prov i d ed to b y F C HV year
s
Services 2073/2074 2074/2075 2075/2076
Table 6.3.2.1: Serv i c es of services provided by
Trend 2073FCHVs
/2074 2074 /2075 2075/2076
Pills distribution (no. cycles) 808,138 697,852 692,010
P i lls d i s tri b utiServices
on (no. c y c les ) 2073/2074
808,13 8 2074/2075
697,852 2075/2076
692,010
Pills distribution (no. cycles) 808,138 697,852 692,010

Condom distribution (pieces) 9,983,379 9,006,248 8,759,624
C ond om d i s tri b uti on (pi ec es ) 9,983 ,3 79 9,006,24 8 8,759,624
Condom distribution (pieces) 9,983,379 9,006,248 8,759,624

Iron tablet distribution 717,267 664,162 718,285
I ron tab let d i s tri b uti on 717,267 664 ,162 718,285
Iron tablet distribution 717,267 664,162 718,285

ealth mother’s group meetings 506,909
506,909 517,285
517,285 520,101
520,101
Health m oth er’ s g roup m eeti ng s
ealth mother’s group meetings 506,909 517,285 520,101

Source:
Sourc e: HMIS/DoHS
I HM I S/DoHS
Figure 6.3.2.1:
6. 3 . 2. 1: FFCHV
F i g ure HMIS/DoHS C HV ccontribution on s selected
ontri b uti on on elec ted h health
ealth s services
erv i c es i in
n F FY 2073/74
Y 2073 2075/76(,000)
/74 – 2075/76 (,000)
Source:
Figure 6.3.2.1: FCHV contribution on selected health services in FY 2073/74 2075/76 (,000)
2075/2076
2075/2076 2074/2075
2074 /2075 2073/74
2073 /74
2075/2076 2074/2075 2073/74

ealth mother’s group meet ngs
Health m oth er’ s g roup m eeti ng s
ealth mother’s group meet ngs

Iron tablet distribution
I ron tab let d i s tri b uti on
Iron tablet distribution

Condom distribution (pieces)
C ond om d i s tri b uti on (pi ec es )
Condom distribution (pieces)

Pills distribution (no. cycles)
P i lls d i s tri b uti on (no. c y c les )
0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000
Pills distribution (no. cycles) 0 2,000,000 4 ,000,000 6,000,000 8,000,000 10,000,000 12,000,000
Source:
Sourc e: HMIS/DoHS
I HM I S/DoHS 0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000
Source: HMIS/DoHS

i ga ia it
2. In 2075/76 tthey iinitiatedi at baby
a tto m mother
t skin-to-skin
i t i contact
ta t aafter delivery
i iin 85,223 cases,
a
2. In
aapplied
i 2075/76 they
chlorhexidine initiated baby
i i tto tthe umbilicus
m ii to mother skin-to-skin
aafter delivery
i contact
for 74,977 casesaafteraand ensured85,223
delivery in tthe ta cases,
taking
i g of
miapplied tchlorhexidine
misoprostol for preventttoPPH thein
i umbilicus aafter
16,561cases adelivery
(Table for 74,977 cases and ensured the taking of
6.3.2.2).
misoprostol for prevent PPH in 16,561cases (Table 6.3.2.2).
Table 6.3.2.2: Support provided byFCHVs for home deliveries, 2075/76
Table 6.3.2.2: Support provided byFCHVs for home deliveries, 2075/76
Initiating skin-to-skin Chlorhexidine applied Ensured
Province Initiating skin-to-skin
contact after birth Chlorhexidine
on umbilicusapplied Ensured
misoprostol tablets
Province contact after birth on umbilicus misoprostoltakentablets
taken
Province 1 13,735 13,243 3,873
Province 1 13,735 13,243 3,873
Province 2 40,780 34,726 4,243
Province 2 40,780 34,726 4,243
Bagmati i 6,922 5,275 2,612
Bagmati i 6,922 5,275 2,612
Gandaki Province 2,851 2,796 772
Gandaki
Province 5 Province 2,851
10,823 2,796
9,199 772
2,243
Province
Karnali 5
Province 10,823
6,231 9,199
6,185 2,243
2,047
Karnali Province
Sudurpashchim Province 6,231
3,881 6,185
3,553 2,047
771
Sudurpashchim Province 3,881 3,553 771
National 85,223 74,977 16,561
National 85,223 74,977 16,561
Source: HMIS/DoHS
Source: HMIS/DoHS
Support
Support for homhomee deliveries
deliv eries
Support for home deliveries
FCHVs supported t iin home m deliveries
i i ttoo. In 2075/76 (Table a i it
6.3.2.3), FCHVs visit-newborn & PP
FCHVs
t
Mothers- supported in home
hours o Bi rth, deliveries
t on 3rd day too.
a of BiIn 2075/76 (Table
t aand on 7th
Birth t day 6.3.2.3),
a of Bi FCHVs visit-newborn
t were 75,522, 84,009
Birth & aand
PP
Mothers-
84,202 hours o rth, on 3rd day of Birth and on 7th day of Birth were 75,522, 84,009 and
respectively.
84,202 respectively.
Table 6.3.2.3: FCHVs support for home deliveries
Table 6.3.2.3: FCHVs support for home deliveries
Home Delivery-visit- Home Delivery-visit- Home Delivery-visit-
Home Delivery-visit-
newborn& PP Home Delivery-visit-
newborn& PP Home Delivery-visit-
newborn& PP
newborn&
Mothers- PP
hours o newborn& PP
Mothers- 3rd day of newborn&
Mothers-7th day ofPP
Province Mothers-Birth hours o Mothers- 3rd day of
Birth Mothers-7th
Birth day of
Province Birth Birth Birth
Province 1 10,887 13,048 13,154
Province 1 10,887 13,048 13,154
Province 2 37,400 37,572 37,767
Province 2 37,400 37,572 37,767
Bagmati i 6,025 6,173 6,221
Bagmati i 6,025 6,173 6,221
GandakiProvince 2,605 3,176 3,741
GandakiProvince 2,605 3,176 3,741
Province 5 8,478 12,967 12,301
Province 5 8,478 12,967 12,301
Karnali Province 6,074 5,778 5,289
Karnali Province 6,074 5,778 5,289
Sudurpashchim Province 4,053 5,295 5,729
Sudurpashchim Province 4,053 5,295 5,729
National 75,522 84,009 84,202
National 75,522 84,009 84,202
Source: HMIS/DoHS
Source: HMIS/DoHS

i ga ia it
Nutrition services
Nutrition services provided by
by FCHVs
FCHVs at
at the
theHousehold
Householdlevel
level
ti
Nutrition i were provided
services i by FCHVs in i2075/76 (Tablea 6.3.2.4). Breast
B Feeding<1
at i hour
g of Birth
Nutrition
Bi t a services
i t i provided byit FCHVs at the Household
a level
and distribution of PP Vit A were 89897 and 161499 respectively.
Table
Table 6.3.2.4:
Nutrition Nutrition
services
6.3.2.4: serviceprovided
were provided
Nutrition service providedbyby
by FCHVs FCHVs
inFCHVs atat
2075/76 the Household
(Table
the level Feeding<1 hour of Birth
6.3.2.4).level
Household Breast
and distribution of PP Vit A were 89897 and 161499 respectively.
Province Breast Feeding<1 hour of Birth Distribution of PP Vit A
Table 6.3.2.4: Nutrition service provided by FCHVs at the Household level
Province 1 14,672 31,484
Province 2 43,158 63,323.2
Province Breast Feeding<1 hour of Birth Distribution of PP Vit A
Bagmati i 7,613 18,610
Province 1 14,672 31,484
Gandaki Province 3,065 8,232
Province 2 43,158 63,323.2
Province 5 10,322 20,232
Bagmati i 7,613 18,610
Karnali Province 6,787 11,116
Gandaki Province 3,065 8,232
Sudurpashchim Province 4,280 8,502
Province 5 10,322 20,232
Nepal 89,897 161,499
Karnali Province 6,787 11,116
Source: HMIS/DoHS 4,280 8,502
Sudurpashchim Province
Nepal
IMAM services 89,897level
provided by FCHVs at the Household 161,499
IMAM
Source:services provided by FCHVs at the Household level
HMIS/DoHS
IMAM services were provided by FCHVs in 2075/76 (Table 6.3.2.5). Screening of children through
IMAM services provided by
i FCHVs at the iHousehold level
MUAC and icategorized their nutritional status a 9,334 are SAM, 86,475
as follows, i g are MAM
i t 247
while g
a asat
screened g i where
oedema t i as 2,935,281
ti a tat a
are normal children as awell by FCHVs. a i
a ma a a ma i
IMAM services were provided by FCHVs in 2075/76 (Table 6.3.2.5). Screening of children through
Table 6.3.2.5:
MUAC IMAM service
and categorized their provided
nutritionalbystatus
FCHVsasatfollows,
the Household level
9,334 are SAM, 86,475 are MAM while 247
screened as oedema where as 2,935,281 are normal children as well by FCHVs.
Table 6.3.2.5: IMAM service MUAC-
provided by FCHVsMUAC- MUAC-level
at the Household MUAC-Screening-
Screening-Red- Screening-
Table 6.3.2.5: IMAM service provided by FCHVs at the Household Screening-
level Green-Normal
Province SAM Yellow-MAM Oedema
MUAC- MUAC- MUAC-
Province 1 591 6,201 27 239,311
MUAC-Screening-
Screening-Red- Screening- Screening-
Province 2 3,059 20,358 127 541,516
Green-Normal
Province SAM Yellow-MAM Oedema
Bagmati i 688 6,276 10 828,528
Province 1 591 6,201 27 239,311
Gandaki Province 118 417 0 86,832
Province 2 3,059 20,358 127 541,516
Province 5 559 2,394 2 189,443
Bagmati i 688 6,276 10 828,528
Karnali Province 1,656 17,244 25 393,687
Gandaki Province 118 417 0 86,832
Sudurpashchim
Province 725
559 8,320
2,394 29
2 110,890
189,443
Province5
Karnali Province 1,656 17,244 25 393,687
Nepal 9,334 86,475 247 2,935,281
Sudurpashchim
Source: HMIS/DoHS 725 8,320 29 110,890
Province
Nepal 9,334 86,475 247 2,935,281
Source: HMIS/DoHS

a i
6.3.4
6.3.4Issues
Issues and
and constraints
constraints
Table
Table6.3.4.1:
6.3.4.1: Issues and constraints
Issues and constraints——FCHVs
FCHVs
Issues and constraints Recommendations Responsibility

Low utilization of FCHV Fund Strictly implement guidelines and audit NSSD, DHOs, HFs,
FCHV fund every year Health Section of
local level, rural
municipalities,
municipalities,
sub-metro and
metro
municipalities
FCHV are not interested in farewell Rethink the farewell package NSSD, DHOs,
programmes Implement revised FCHV strategy (1 st Health Section of
amendment_2076) local level, rural,
municipalities,
sub-metro and
metro
municipalities
Decreasing work performance of Motivate FCHV through FCHV Review NSSD, DHOs, HFs,
FCHV meeting and orientation for FCHV on Health Section of
related program local level, rural,
municipalities,
sub-metro and
metro
municipalities

Chapter 7
a i
CURATIVE SERVICE
A.Background
a i i ii i i ii a tm t at i
t t t i ga i t a m i it at a a g
i t ai i g a t m it i mi i t it a m
i t t t a i itat t t i t t i t gi i g a a
a i i ii a ta i it i a tm t at i i a
i i ii a i it t i t a gi g t t t at i a ta i
a t g t a i ii a t am a i
i it
i g t t i t a am t a t at t m a
i t a i t t ta t i t a i a a t
i a a i ti a t m t t iti t a a gi agi
a ita a a t ia i t a ita i a i a a ig
t t at t ma it a i i mi t ia i t atm ti a
a i t t m a at a i t a a t t m a a gm
a im i i g gi a ia i a t i a t mt
t t t i
ma i i it i t i t ai at i tg aa t
t a a g at a i at t ta i at a ga
ia i t a ita a i at a i a a at
i
a t i i ii i t a a at i a i t g it
t i t am
ita i it i g a t gt i g
Ba i at a m g a ag m t a
a a at
B.Sections under Curative Service Division and their key functions

1. Hospital Service Monitoring and Strengthening Section
a it a i g i a a it ta a t m a ga i g ita
t gt
a it m t a t i at a i at i t
at a i m a g a i t at g a it ia
a i itat t gi t a a a g a t ia i a t a
ita
a it m t a a i t at gi a g i i ga i g
gi t a g a a m it i g i at a g m ta ita i g m
i i i i
i i a m it i g t ita m m a it i
a ag m t a ia i at a t a a a a i t a a ta a
a i itat t m ta i t ai a t t m i i i t m
a i
a it t m t at t im m a g a i t at gi
it ia t
i at m t a ma ag m t a a t a a t ai i g
t
m at ta a t atm t t
a g i ta i a i gt
t i g a m it i g g i i t ita a ma a at a ii
m a ta a a mi ia i ta a
aa t ai i g mat ia a a ga t t ai i g at
ai
2. Basic Health and Emergency Management Section

a ma ag m t Ba i at i a i g t a t m
a i it at t
t mi i g t a it ia ai at i
ii m it i g a a a t a it ai at i
a a t ai at i a i at t a a
t t im m t i i g a
i a a t i ai at a i a t m g i a
a ai a i it a ia a a
t t a a a t ai at i
a i itat ma a i it ia t a g i i t ma
m g at a i
a i itat ma a i it ia t a g i i ga i g
a t ma
a it t im m ta m it i g a g a m g i a
a i
3. Eye, ENT and Oral Health Section

a i itat m a a a i ta a t a g i i at
t at
t i
t a at i
a a t a a at a i at t a a
t t im m t i i g a
a i ita a i a i t ga it at a a at i t
a a at i t ma
t a at t a a at i
C. Minimum Service Standards for Hospitals

i im m i ta a ita i t i a i a a ai a i it
t ma i m t t ita t i mi im m i t at a t
mt m i t tai aa i ii a m t i
ia t at a t mi i t a a it ita t a i g
i m t i a i a it at i ii
ita tt ma mi im m it ia i t i t i it
i t a i a it t ma im m ta a i it i i t t a a
g am i a it im m t t a it i ti t i m t i it
ma i a i g t i t t tai tt ta a a g
a i
a i
t a at a i it t at am g t at a ii t at
a t t m a a ai i m t it m a t ig i g
a i ig i g a i a t ig i g a t m m t t t
a a at a a ig t i ii a ai a i it a i a
i m t ta a a t a a a a a i a at
i i a a ii a i t a m a imi a i a a
a a mi g it a i g t at i mi im m i ta a a t i
iti t ita a a i tt ti t i a it i i ita
it i ta im g a ma ag m t i i a a t i i
ag t t it t g t mi im m i ta a ita
a a t a a at t am m t t a ii iti t
ita t t ima ita ii a m t t t t
i t i t gi i g it m a i a i g a
t t a t i a i at a ta a m g ig
ii a m t g i i g m t a t
a a a at i i a it a i at a i
i at i t a t g at at at t m t
ta a a at t t at g a i i at t
ta i m t a a g a i g ta a t t imit t t m
a i a m i t ma
aa t ita t
mi im m i t at a t i t
at a ii a a t a t
i ga i a g at t a ami a ii t i a
ta a i i a i at ii ita i a t
a m i a ta g t g m t ita t i at
t a i ga a a tt m t t t m gi g t t
t a ga i i t ma a a a ag m t
i i a i a ag m t a ita t i a ag m t t a a
i t m i t t at t i t a a ia t at a am ta t
ta i i t a a it ima ita it g a i t a t ta
t ta a it t ta t i ta a m a i g
g a a ma ag m t a a ig tag ta a m a i g i i a
i ma ag m t a a ig tag a ta a m a i g t
i ma ag m t a a ig tag a a ma ag m t i
t mi im m ta a i i i a i ma ag m t a t i t
a ita t i ma ag m t a
a m t a t t ta a a i g a i t
ig t g a ama ag m t i ig i t at
i i a i ma ag m t i ig i a t at ita t
i ma ag m t i ig i m t ig tag
t gi t a t ita a a it i
i i ita m a t i g it a a a t i t
ga a a t at a t a t g t m t t a a t at ma
t t i a a a ia i t a ma ag ia mmitm t a i g i
it im m ta g i i t at i a m ta
a ga i a a a m ta ti i g ma

management (Section III) is weighed in 20%. The sum of these weighed percentage of the
subsections give the overall MSS score of the hospitals and based on it colour code will be
provided. This MSS Score for hospitals measure the existing situation and enables to identify the
gap areas that are to be addressed through the development of the actions plan that demands
both technical and financial inputs and managerial commitments. The overall process is guided
by its implementation guideline that describes on sequences of self-assessment and follow up
a workshops i and gap identification for action plan development and striving for optimal MSS
Score.
 i Ministry
it a t aand Population
of Health a t i tot implement
strives im m MSS t in hospitals
i ita ta i
for establishing i g
aenabling
i g environment
i m t atat servicei delivery
i i t t g a a a ai a i
point through preparedness and availability for qualityit a it
i
service i i t tot the users. Nott being
provision i gana exhaustive
a list ioftfacilities
a i i and services,
a i
hospitals areita a
ag t t i m t a g t t
encouraged to strive for betterment and go beyond the defined set of minimum standards mi im m ta a
whenever t their
i resources support.t
 Minimum Service Standards (MSS) for hospitals were previously lead by Curative Service
i Division,
im m Ministry i oftaHealth
a and Population. Nowita i a
in changing context, as per ToR of Division the
a i
i ii i it at a a i a gi g t t a i ii t
programme will run by Curative Service Division, DoHS. Following is the progress data regarding
g amm i a i i ii i gi t g ata ga i g
Minimum Service Standards (MSS) score of 84 district level hospitals of F/Y 2075/76.
i im m i ta a iti t ita
7.2.4 MSS Score of Hospitals fiscal year 2075/76 by province
i im m i ta a ita i i a a
S N Clus ter H os p ital
f. Follow up 3
a. W ork s hop
b . W ork s hop
c. W ork s hop
h. Follow up
d. Follow up
e. Follow up
g. Follow up
1
4
2
5
1 C1 Gaur H os p ital ( R autahat) 2 7 % 34% 47 % 46 % 5 1% 45 % 44% 48 %
2 J ales hwor D is trict H os p ital 2 8 % 42 % 45 % 35 % 6 2 % 39 % 47 % 6 8 %

( M ahottari)
3 K alaiya H os p ital ( Bara) 2 7 % 5 3% 6 3% 6 5 % 6 7 % 7 7 % 6 2 % 6 4%
4 M alangwa H os p ital ( S arlahi) 2 9 % 2 7 % 43% 2 6 % 32 % 30 % 5 1% 0 %
5 C2 J iri H os p ital ( D olk ha) 7 5 % 8 6 % 9 0 % 7 9 % 8 8 % 8 1% 0 % 0 %
6 R amechhap D is trict H os p ital 5 4% 6 9 % 7 3% 6 6 % 7 7 % 7 1% 0 % 0 %
7 S indhuli D is trict H os p ital 6 2 % 8 1% 8 5 % 8 0 % 8 2 % 9 6 % 0 % 0 %
8 C3 Bardib as H os p ital, M ahottari 34% 5 9 % 7 1% 5 2 % 47 % 45 % 0 % 0 %
9 Chandranigap ur H os p ital 31% 6 1% 7 7 % 41% 6 7 % 0 % 0 % 0 %

( R autahat)
10 Pok hariya H os p ital ( Pars a) 47 % 40 % 6 2 % 6 2 % 48 % 5 5 % 0 % 0 %
11 C4 D hading H os p ital 6 9 % 8 7 % 9 3% 8 9 % 0 % 0 % 0 % 0 %
12 R as uwa D is trict H os p ital 37 % 5 4% 7 0 % 6 8 % 0 % 0 % 0 % 0 %
13 T ris huli H os p ital ( N uwak ot) 7 2 % 7 7 % 7 9 % 6 8 % 0 % 0 % 0 % 0 %
14 C5 Bagauda H os p ital ( Chitwan) 41% 5 7 % 6 5 % 5 0 % 0 % 0 % 0 % 0 %
15 Bak ulaharR atnanagar H os p ital 5 2 % 5 5 % 7 1% 7 6 % 0 % 0 % 0 % 0 %

( Chitwan)
16 H etauda H os p ital 49 % 7 0 % 7 2 % 6 7 % 0 % 0 % 0 % 0 %
17 C6 Chautara H os p ital 45 % 7 6 % 8 2 % 6 6 % 0 % 0 % 0 % 0 %
( S indhup alchowk )
18 M ethink ot H os p ital 6 1% 6 3% 7 3% 6 1% 0 % 0 % 0 % 0 %
19 E 1 I lam D is trict H os p ital 6 0 % 7 2 % 7 5 % 5 5 % 5 9 % 6 1% 7 3% 7 2 %
20 Panchthar D is trict H os p ital 47 % 6 2 % 7 2 % 5 7 % 5 9 % 6 0 % 6 8 % 7 9 %
2 1 T ap lej ung D is trict H os p ital 36 % 5 3% 6 9 % 5 1% 7 5 % 7 5 % 7 5 % 7 2 %
22 E 2 Bhoj p ur D is trict H os p ital 48 % 5 5 % 8 4% 6 0 % 6 3% 6 6 % 0 % 0 %
2 3 S ank huwas ab ha D is trict 5 2 % 6 5 % 7 8 % 6 8 % 7 0 % 8 1% 0 % 0 %

H os p ital
24 T erhathum D is trict H os p ital 42 % 6 1% 6 1% 7 7 % 7 2 % 7 4% 0 % 0 %
2 5 E 3 Gaighat H os p ital, U dayap ur 5 7 % 7 2 % 8 5 % 6 5 % 6 2 % 0 % 0 % 0 %
26 K atari H os p ital ( U dayap ur) 40 % 6 0 % 6 7 % 5 3% 7 3% 0 % 0 % 0 %
2 7 K hotang D is trict H os p ital 40 % 7 5 % 8 7 % 6 0 % 6 3% 7 0 % 0 % 0 %
28 E 4 Phap lu H os p ital, S oluk humb u 6 0 % 6 6 % 8 2 % 7 5 % 0 % 0 % 0 % 0 %

19 E 1 I lam D is trict H os p ital 6 0 % 7 2 % 7 5 % 5 5 % 5 9 % 6 1% 7 3% 7 2 %
20 Panchthar D is trict H os p ital 47 % 6 2 % 7 2 % 5 7 % 5 9 % 6 0 % 6 8 % 7 9 %
2 1 T ap lej ung D is trict H os p ital 36 % 5 3% 6 9 % 5 1% 7 5 % 7 5 % 7 5 % 7 2 %
22 E 2 Bhoj p ur D is trict H os p ital 48 % 5 5 % 8 4% 6 0 % 6 3% 6 6 % 0 % 0 %
2 3 S ank huwas ab ha D is trict 5 2 % 6 5 % 7 8 % 6 8 % 7 0 % 8 1% a0 % 0 % i

H os p ital
24 T erhathum D is trict H os p ital 42 % 6 1% 6 1% 7 7 % 7 2 % 7 4% 0 % 0 %
2 5 E 3 Gaighat H os p ital, U dayap ur 5 7 % 7 2 % 8 5 % 6 5 % 6 2 % 0 % 0 % 0 %
26 K atari H os p ital ( U dayap ur) 40 % 6 0 % 6 7 % 5 3% 7 3% 0 % 0 % 0 %
2 7 K hotang D is trict H os p ital 40 % 7 5 % 8 7 % 6 0 % 6 3% 7 0 % 0 % 0 %
28 E 4 Phap lu H os p ital, S oluk humb u 6 0 % 6 6 % 8 2 % 7 5 % 0 % 0 % 0 % 0 %
2 9 R umj atar H os p ital, 48 % 6 4% 7 5 % 8 0 % 0 % 0 % 0 % 0 %

O k haldhunga
30 E 5 D hank uta D is trict H os p ital 7 6 % 8 9 % 9 4% 9 0 % 0 % 0 % 0 % 0 %
31 I naruwa H os p ital, S uns ari 40 % 5 9 % 6 9 % 5 1% 0 % 0 % 0 % 0 %
32 R angeli H os p ital, M orang 40 % 7 6 % 8 2 % 6 1% 0 % 0 % 0 % 0 %
33 E 6 Bhardaha H os p ital ( S ap tari) 42 % 6 0 % 6 9 % 5 7 % 0 % 0 % 0 % 0 %
34 L ahan D is trict H os p ital ( S iraha) 5 9 % 6 9 % 8 1% 6 8 % 0 % 0 % 0 % 0 %
35 S iraha D is trict H os p ital ( S iraha) 41% 7 6 % 8 1% 5 1% 0 % 0 % 0 % 0 %
36 E 7 D amak H os p ital, J hap a 48 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
37 M angalb are H os p ital, M orang 49 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
38 F1 A chham D is trict H os p ital 45 % 6 0 % 7 5 % 7 2 % 7 0 % 8 8 % 9 0 % 8 9 %
39 Baj ura D is trict H os p ital 47 % 45 % 7 0 % 5 6 % 5 3% 6 7 % 6 5 % 6 7 %
40 D oti D is trict H os p ital 45 % 7 5 % 7 6 % 5 3% 47 % 5 9 % 6 8 % 7 3%
41 F2 Baitadi D is trict H os p ital 48 % 7 2 % 7 4% 7 0 % 6 1% 6 5 % 0 % 0 %
42 Baj hang D is trict H os p ital 5 3% 7 7 % 8 3% 8 7 % 8 4% 8 1% 8 0 % 0 %
43 D archula D is trict H os p ital 35 % 5 7 % 6 7 % 7 3% 7 5 % 7 5 % 8 2 % 0 %
44 Gok ules hwor H os p ital 39 % 5 9 % 6 8 % 7 0 % 5 8 % 6 6 % 8 2 % 0 %
45 F3 J ogb udha H os p ital 5 0 % 7 3% 7 7 % 8 2 % 0 % 0 % 0 % 0 %

( D adeldhura)
46 M alak het H os p ital 2 8 % 39 % 5 1% 49 % 0 % 0 % 0 % 0 %
47 T ik ap ur H os p ital ( K ailali) 48 % 8 4% 8 8 % 8 2 % 0 % 0 % 0 % 0 %
48 M 1 Pyuthan D is trict H os p ital 48 % 6 1% 6 9 % 6 4% 5 9 % 7 6 % 7 2 % 6 4%
49 R olp a D is trict H os p ital 43% 5 9 % 6 3% 6 7 % 6 7 % 6 6 % 7 3% 7 0 %
50 R uk um D is trict H os p ital 5 6 % 5 2 % 7 5 % 43% 5 0 % 32 % 5 7 % 7 1%
5 1 S alyan D is trict H os p ital 49 % 7 2 % 7 8 % 5 7 % 6 4% 6 7 % 7 8 % 7 5 %
52 M 2 D ailek h D is trict H os p ital 6 0 % 7 3% 7 1% 6 9 % 8 2 % 8 7 % 9 1% 0 %
5 3 D ullu H os p ital 38 % 42 % 6 5 % 6 9 % 7 2 % 5 8 % 6 5 % 0 %
54 Gulariya D is trict H os p ital, 5 8 % 8 1% 8 5 % 7 6 % 7 3% 8 0 % 8 8 % 0 %
Bardiya
5 5 M ehelk una H os p ital, S urk het 36 % 47 % 5 5 % 5 9 % 48 % 6 2 % 7 6 % 0 %
56 M 3 K alik ot D is trict H os p ital 35 % 7 1% 8 9 % 8 0 % 6 5 % 6 7 % 0 % 0 %
5 7 M ugu D is trict H os p ital 2 4% 40 % 7 5 % 5 9 % 47 % 0 % 0 % 0 %
58 M 4 D olp a D is trict H os p ital 6 9 % 0 % 5 9 % 7 3% 0 % 0 % 0 % 0 %

5 9 M 5 H umla D is trict H os p ital 39 % 0 % 5 2 % 6 5 % 0 % 0 % 0 % 0 %
60 M 6 J aj ark ot D is trict H os p ital 38 % 48 % 6 8 % 5 8 % 0 % 0 % 0 % 0 %
6 1 M 7 L amahi H os p ital, D ang 42 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
62 W 1 A rgak hanchi D is trict H os p ital 5 8 % 7 6 % 8 5 % 7 6 % 5 9 % 5 9 % 6 8 % 0 %

52
5 3 D ullu H os p ital 38 % 42 % 6 5 % 6 9 % 7 2 % 5 8 % 6 5 % 0 %
54 Gulariya D is trict H os p ital, 5 8 % 8 1% 8 5 % 7 6 % 7 3% 8 0 % 8 8 % 0 %
Bardiya
5 5 M ehelk una H os p ital, S urk het 36 % 47 % 5 5 % 5 9 % 48 % 6 2 % 7 6 % 0 %
56 M 3 K alik ot D is trict H os p ital 35 % 7 1% 8 9 % 8 0 % 6 5 % 6 7 % 0 % 0 %
5 7 a M i ugu D is trict H os p ital 2 4% 40 % 7 5 % 5 9 % 47 % 0 % 0 % 0 %
58 M 4 D olp a D is trict H os p ital 6 9 % 0 % 5 9 % 7 3% 0 % 0 % 0 % 0 %
5 9 M 5 H umla D is trict H os p ital 39 % 0 % 5 2 % 6 5 % 0 % 0 % 0 % 0 %
60 M 6 J aj ark ot D is trict H os p ital 38 % 48 % 6 8 % 5 8 % 0 % 0 % 0 % 0 %
6 1 M 7 L amahi H os p ital, D ang 42 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
62 W 1 A rgak hanchi D is trict H os p ital 5 8 % 7 6 % 8 5 % 7 6 % 5 9 % 5 9 % 6 8 % 0 %
6 3 Bhim H os p ital, R up andehi 5 9 % 6 9 % 6 3% 5 9 % 6 0 % 7 6 % 7 8 % 0 %

( Bhairawa)
64 T amghas D is trict H os p ital 5 7 % 7 2 % 7 8 % 6 9 % 7 3% 6 9 % 7 1% 0 %

( Gulmi)
6 5 T aulihawa D is trict H os p ital 46 % 5 7 % 7 4% 5 3% 5 7 % 7 6 % 7 8 % 7 4%
( K ap ilv as tu)
66 W 2 M us tang D is trict H os p ital 5 8 % 6 4% 7 2 % 5 2 % 5 8 % 6 1% 0 % 0 %
6 7 M yagdi D is trict H os p ital 7 5 % 8 9 % 9 1% 8 5 % 8 2 % 8 4% 0 % 0 %
68 Parb at D is trict H os p ital 5 3% 8 4% 9 1% 5 9 % 5 6 % 6 4% 0 % 0 %
6 9 W 3 Bandip ur H os p ital 45 % 5 2 % 5 5 % 6 6 % 6 9 % 7 2 % 0 % 0 %
70 D amauli H os p ital 44% 7 8 % 6 9 % 7 1% 7 2 % 7 5 % 0 % 0 %
7 1 W 4 Gork ha D is trict H os p ital 7 1% 7 5 % 7 8 % 8 0 % 0 % 0 % 0 % 0 %
72 M anang D is trict H os p ital 39 % 5 7 % 6 5 % 6 2 % 0 % 0 % 0 % 0 %
7 3 W 5 Pip ara H os p ital, K ap ilv as tu 5 0 % 5 1% 5 5 % 5 4% 0 % 0 % 0 % 0 %
74 Prithiv i Chandra H os p ital, 6 1% 5 7 % 7 4% 6 0 % 0 % 0 % 0 % 0 %

N awalParas i
7 5 S hiv araj H os p ital ( K ap ilv as tu) 5 2 % 6 0 % 7 5 % 7 9 % 0 % 0 % 0 % 0 %
76 W 6 Palp a D is trict H os p ital 47 % 6 5 % 7 1% 6 0 % 0 % 0 % 0 % 0 %
7 7 R amp ur H os p ital, Palp a 5 9 % 7 3% 6 8 % 7 3% 0 % 0 % 0 % 0 %
78 S yangj a D is trict H os p ital 5 9 % 7 4% 7 8 % 7 5 % 0 % 0 % 0 % 0 %
7 9 W 7 Chap ak ot H os p ital, S yangj a 2 9 % 42 % 0 % 0 % 0 % 0 % 0 % 0 %
80 Chis ap ani H os p ital, Bardaghat, 38 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %

N awalp aras i
8 1 M atriS is huM iteri H os p ital, 6 9 % 9 0 % 0 % 0 % 0 % 0 % 0 % 0 %

Batalichaur, K as k i
82 S is uwa H os p ital, K as k i 41% 6 5 % 0 % 0 % 0 % 0 % 0 % 0 %
8 3 S undar Bazar H os p ital, 38 % 6 3% 0 % 0 % 0 % 0 % 0 % 0 %

L amj ung
A v e rage s core 4 8 % 6 4 % 7 3% 6 5 % 6 4 % 6 7 % 7 1% 7 2%
T otal numb er of hos p ital where the ev ents 8 3 7 7 7 5 7 5 45 41 2 5 13
was conducted
Source: CSD, DoHS

a i
7.1 Inpatients/OPD Services

Background 7.1 Inpatients/ OPD services
m t a i mmi t im i gt a t tat a a a
i i g ig
Background a it at i i aim t i m t iag i a
t atm t a t a m a at t t ita iag i a
The Government
a m a im of Nepal
a is committed
ta i to improving
at i the
t healtht status oftrural
a and iagurbani peoplea tby delivering high-
qualitymhealth services. The policy aims to provide prompt diagnosis and treatment, and to refer cases from PHCCs
and health posts to hospitals. Diagnostic services and referral mechanisms have been established at different levels to
supportmearly diagnosis t gof health m problems.
t ga i i g a at a i m g a
i a t i ag t t t ia i i i m
gIn December i 2006
a thet government
i t began providing
i t i t essential
ita ahealth careaservicesa (emergency
i at anda tinpatient services)
freet of
i charget to destitute, poor, t imdisabled,t senior citizens, a FCHVs,aivictims
t at of gender i violence
a t andigothers
t in up to 25-
t bedadistrict
i a hospitals
t i and PHCCs andt afor all citizens
i t a
at health posts in October 2007.The Interim Constitution of Nepal,
2007said that every citizen has the right to basic health services free of costs as provided by the law.
a a i i t m i it m ta it i gt
The
a overall
iag objective
i i ofa DoHS
a on curative
i i g aservicesiat is toa reducemmorbidity,
t t atm mortality
t by ensuring
mai t at gi thet early diagnosis of
adiseases
i t and
i a providing
i t i appropriate
B and prompt treatment. The main strategies to achieve this are listed in Box 5.1.
Box 7.1.1: Curative service strategies

 To make curative health services available in an integrated way in rural areas through health
posts and PHCCs.
 To establish hospitals on the basis of population density and patient load with at least one
hospital per district.
 To establish zonal and regional hospitals to provide specialized services related to paediatrics,
gynaecology, general surgery, general medicine, eye care, dermatology, orthopaedics and
psychiatry.
 To equip central hospitals with sophisticated diagnostic and other facilities to provide
specialised and super-specialty services.
Specialist curative care services will be extended to remote areas, as and when required,
through mobile teams.
 To extend referral systems to provide rural people with access to services from modern well
equipped hospitals.
 To strengthen diagnostic services such as laboratories and X-ray services at hospitals.
 To extend service provision through more outreach clinics and by considering the relocation of
existing facilities.
 To provide basic curative services free in up to 25 bed hospitals.
 To promote private medical colleges, hospitals, nursing homes and hospitals run by INGOs,
NGOs and private practitioners to complement public health care provision.
Major Activities and Achievements in the fiscal year 2075/76

Major Activities and Achievements in the fiscal year 2075/76
a
Curative a t services
health i i
were provided at all
at a health
a t facilities
a i i including
i i goutpatient,
t a temergency
m g and a inpatient care and
i free
a health
t a services.
a a t services
Inpatient i were aprovided
t ati all levels of hospitals
i at including
a INGO anditaNGO run hospitals,
i privatei gmedicala college hospitals,itanursingi at
homes and private hospitals. Medical campsa werei organised
m i a g ita i g m at mainly in
ita
remote areas. i a am ga i mai i m t a a

a i
1. Hospital reporting
i a i t ig t ita it i t i i
Hospital reporting i ita a i ita a
Hospital reporting
Five hundred and sixty Eight hospitals were listed in the HMIS under DoHS in 2075/76, of which 125 (6.5%) were public
a and sixty Eight
Five hundred t i were
a listed in the HMISt under DoHS ini2075/76,ita of which mi i m public
t
hospitals and 1796 (93.49%) hospitals
non-public hospitals (Table 1). 125 (6.5%) were
t a
hospitals and 1796 (93.49%) non-public hospitals (Table 1).
 88 percent of public i and a34.1 percent
m tof non-public g hospitalstsubmission m of monthly treports (Table i 1); ita a
 The 88 percent of publicalland
HMIS received 12 34.1 percent
monthly of non-public
progress reports hospitals
from 77.6 submission
percent of of monthly
public reports
hospitals and (Table
14.4 1); of
percent
t i ita a
The HMIS received
 non-public hospitals all 12 monthly(Table
progress
2); reportsitafrom 77.6 percent of public hospitals and 14.4 percent of
a t t respectively t a mi a m t g t it
non-public
 half (7) out hospitals
of the 13 respectively
tertiary level (Table 2);
hospitals submitted all 12 monthly progress reports, with secondary A
a ita a i g t a i m t t mi i a m t
half (7) out
 hospitals of the 13 tertiary level hospitals,submitted all 12 monthly progress reports, with secondary A
g having 56t out a of 60 achievement
a B 93.3 ita % report submission tall 12 month progress
t mireportaand m t
hospitals having
secondary 56 out100%
Bl hospitals of 60 achievement , 93.3 % reportallsubmission all 12 month progress reportreport
and
g
secondary Bl
t 100% (( 77 out
hospitals out
of 7)report
of
t
7)report
submitted
mi
submitted
amall 12
g amonth
12 month
progress
t a report
progress report
only 87.9%
only 87.9% report
submitted among all report (Table 3).
submitted among all report (Table 3).
Table1: 1: Hospital
Table Hospitalreporting status,
reporting status, FY FY 2075/76
2075/76
Table 1: Hospital reporting status, FY 2075/76
Submission of Monthly Report
No. of Hospital SubmissionPublic
of Monthly Report Total
No. of Hospital Non Public
Province Non Public Public Total
Province Non
Non
Public Public Total No. % No. % No. %
1 Province 1 Public96 Public
19 Total
115 No.
587 %51.0 No.228 %100.0 No.
815 % 59.1
21 Province
Province 21 96
148 19
13 115
161 587
475 51.0
26.9 228
152 100.0
97.4 815
627 59.1
32.6
32 Bagmati
ProvinceProvince
2 148
1301 13
35 161
1336 475
4759 26.9
30.5 152
271 97.4
64.5 627
5030 32.6
31.4
43 Gandaki
Bagmati Province
Province 1301
65 35
16 1336
81 4759
476 30.5
61.0 271
176 64.5
91.7 5030
652 31.4
67.1
4 Gandaki
5 Province 5 Province 65
111 16
17 81
128 476
466 61.0
35.0 176
192 91.7
94.1 652
658 67.1
42.8
5 Province 5
6 Karnali Province 111
43 17
12 128
55 466
350 35.0
70.9 192
144 94.1
100.0 658
494 42.8
77.4
6 Karnali Province
7 Sudurpashchim 43 12 55 350 70.9 144 100.0 494 77.4
7 Sudurpashchim
Province 32 13 45 215 56.0 155 99.4 370 68.5
Province Total 32
1796 13
125 45
1921 215
7328 56.0
34.1 155
1318 99.4
87.87 370
8646 68.5
37.6
Total 1796 125 1921 7328 34.1 1318 87.87 8646 37.6
Source: HMIS, DoHS

Source: HMIS, DoHS
Table 2: Hospital submitting all 12 monthly progress reports, FY 2075/76
Table2:2: Hospital
Table Hospitalsubmi
submittingngallall1212 monthly
monthly progress
progress reports,
reports, FY 2075/76
FY 2075/76
Hospital Reporting 12 months a year
No. of Hospital Hospital Reporting 12 months a yearTotal
No. of Hospital Non Public Public
Province Non Public Public Total
Province Non
Non
Public Public Total No. % No. % No. %
1 Province 1 Public
96 Public
19 Total
115 No.
35 %
36.5 No.
19 %
100.0 No.
54 %
47.0
1 Province
2 Province 2 1 96
148 19
13 115
161 35
21 36.5
14.2 19
11 100.0
84.6 54
32 47.0
19.9
2 Bagmati
Province 2 i 148
1301 13
35 161
1336 21
140 14.2
10.8 11
15 84.6
42.9 32
155 19.9
11.6
Bagmati i
4 Gandaki Province 1301
65 35
16 1336
81 140
23 10.8
35.4 15
12 42.9
75.0 155
35 11.6
43.2
54 Province
Gandaki Province
5 65
111 16
17 81
128 23
22 35.4
19.8 12
16 75.0
94.1 35
38 43.2
29.7
65 Karnali
Province 5
Province 111
43 17
12 128
55 22
14 19.8
32.6 16
12 94.1
100.0 38
26 29.7
47.3
76 Sudurpashchim
Karnali Province 43 12 55 14 32.6 12 100.0 26 47.3
7 Sudurpashchim
Province 32 13 45 4 12.5 12 92.3 16 35.6
Province Total 1796 32 12513 45
1921 4
259 12.5
14.4 12
97 92.3
77.6 16
356 35.6
18.5
Total 1796 125 1921 259 14.4 97 77.6 356 18.5
Source: HMIS, DoHS
Source: HMIS, DoHS

a i
Table 3: Status
Table 3:
of different levels of hospitals submi ng all 12 monthly reports, FY 2075/76
Status of different levels of hospitals submitting all 12 monthly reports, FY 2075/76
No. of 12 months reporting No. of Reports
Type of Hospital
Hospital No. % Expected Received %
ACADEMY 6 5 83.3 72 61 84.7
GENERAL HOSPITAL 6 0 0.0 72 21 29.2
LABORATORY 1 0 0.0 12 0 0.0
OTHER HEALTH FACILITY 1 0 0.0 12 0 0.0
PRIMARY HOSPITAL 27 21 77.8 324 303 93.5
SECONDARY A HOSPITAL 60 56 93.3 720 715 99.3
SECONDARY B HOSPITAL 7 7 100.0 84 84 100.0
SPECIALIZED HOSPITAL 4 1 25.0 48 12 25.0
TERTIARY HOSPITAL 13 7 53.8 156 122 78.2
Total 125 97 77.6 1500 1318 87.9
Source: HMIS, DoHS

2. Inpatient
Inpatient services
services
Inpatient services are provided through inpatient departments at public and non-public hospitals. Note that the
a t i a i t g i a t a tm t at i a i ita
following findings should be interpreted with caution because of incomplete progress reporting (see above).
t t at t i g i g i t t it a a i m t g
g
Bed Occupancy a
Rates, FY 2075/76
 Federal -level government hospitals that submitted all 12 monthly reports ranged from bed occupancy rate 20.0
3. Bed Occupancy
percent in KarnaliRates, FY 2075/76
Academy of Health Science to 218.0 percent in Koshi Hospital, Biratnagar, 11 federal level
hospital no reporting (Figure 1);
 Provincea level hospitals
g m t from (110.0%)
ranged ita t at miDistrict
in Humla a Hospital
m tot0.03 percent t inaLumbini
g m
provincial
Hospitala due toatincomplete report
t i anda5 provincial
a i a hospital
m a treporti (Figuret 2).
has no ti i
 ita Bi at aga a ita g ig
Primary level hospitals ranged from 69.3 percent at Bhardaha hospital , Saptari to 0.92 percent at Lamahi
i ita a g m
Hospital, Dang Due to incomplete report) (Figure 3).
i ma i t i t ita t ti
m i i i ia ita t i m t t a i ia ita a t
ig
Figure 1:
ima Bed occupancy
itaratea(ing%) of Federal
m -level public
t athospitals,
B a a FY a 2075/76
ita a ta i t t
at ama i ita a g t i m t t ig

a i
Figure 1: Bed occupancy rate (in ) of Federal -level public hospitals, FY 2075/76
KOSHI HOSPITAL 218.8

SHAHID GANGALAL NATIONAL HEART… 97.2
MENTAL HOSPITAL_ LALITPUR 85.9
PAROPAKAR MATERNITY & WOMEN'S… 83.3
BHERI HOSPITAL BANKE 77.3
BHARATPUR HOSPITAL_ CHITWAN 70.7
POKHARA ACADAMY OF HEALTH… 70.4
PAHS (PATAN HOSPITAL) LALITPUR 69.2
KANTI CHILDREN… 67.6
ARMED POLICE FORCE (APF)… 67.6
NAMS (BIR HOSPITAL) KATHMANDU 62.5
NATIONAL TRAUMA… 61.6
Ram Raja Prasad Singh Academy of… 52.2
DADELDHURA HOSPITAL 46.1
RAPTI ACADEMY OF HEALTH SCIENCE 45.8
SUKRARAJ TROPICAL… 34.1
SHAHID DHARMABHAKTA NATIONAL… 33.5
TEACHING HOSPITAL (TRIBHUVAN… 28.9
KARNALI ACADEMY OF HEALTH… 20
TU Manmohan Cardiovascular… 0
PATAN ACADEMY OF HEALTH… 0
NEPAL POLICE HOSPITAL_KATHMANDU 0
NATIONAL TUBERCULOSIS… 0
NATIONAL PUBLIC HEALTH… 0
GP KOIRALA NATIONAL CENTER FOR… 0
CHHETRAPATI PARIBAR KALYAN… 0
BP KOIRALA CANCER… 0
BIRENDRA ARMY… 0
NARAYANI HOSPITAL 0
CIVIL SERVICES HOSPITAL_KATHMANDU 0
0 50 100 150 200 250

a i
Figure 2: Bed occupancy for Provincial hospitals, FY 2075/76
Figure 2: Bed occupancy for Provincial hospitals, FY 2075/76
DISTRICT HOSPITAL_ DOTI 35.7

GULMI HOSPITAL 35
PRITHIV CHANDRA HOSPITAL_… 34.7
DISTRICT HOSPITAL_ KHOTANG 34.7
GAUR HOSPITAL_ RAUTAHAT 34.4
DISTRICT HOSPITAL_ ILAM 34.2
BARDIBAS HOSPITAL_ MAHOTTARI 33.7
MATRI SHISHU MITERI (Bataulechaur)… 33.6
MAHAKALI ZONAL… 32.9
RAM UMA SMARAK… 32.6
DISTRICT HOSPITAL_ DARCHULA 32.5
BHAKTAPUR HOSPITAL _BHAKTAPUR 32.5
MEHELKUNA HOSPITAL_SURKHET 32.4
DISTRICT HOSPITAL_ UDAYAPUR 31.8
KALAIYA DISTRICT HOSPITAL_ BARA 31.3
DISTRICT HOSPITAL_ DHANKUTA 31.1
DISTRICT HOSPITAL_ DHADING 30.5
DISTRICT HOSPITAL_ GORKHA 29.7
POKHARIYA HOSPITAL_PARSA 27.3
DISTRICT HOSPITAL_ JAJARKOT 26.5
DISTRICT HOSPITAL_ SIRAHA 25.8
DISTRICT HOSPITAL_ SOLUKHUMBU 23.3
BARDIYA HOSPITAL GULARIYA 23.3
JOGBUDA HOSPITAL_DADELDHURA 22.6
DISTRICT HOSPITAL_ PARBAT 20.9
GOKULESHWOR HOSPITAL_DARCHAULA 19.5
DISTRICT HOSPITAL_ DOLPA 17.8
MALAKHETI HOSPITAL_KAILALI 14.2
DAMAULI DISTRICT HOSPITAL_ TANAHU 14
DISTRICT HOSPITAL_ BAITADI 12.8
DISTRICT HOSPITAL _ RASUWA 11.4
DISTRICT HOSPITAL_MUSTANG 9.5
DISTRICT HOSPITAL_ MANANG 1.7
MALANGAWA DISTRICT HOSPITAL_… 0.33
PROVINCIAL HOSPITAL LUMBINI… 0.03
DISTRICT HOSPITAL_ SYANGJA 0
BHIM HOSPITAL_ RUPANDEHI 0
0 5 10 15 20 25 30 35 40

a i
SIMIKOT DISTRICT HOSPITAL_ HUMLA 110

106.2
PROVINCIAL HOSPITAL SURKHET… 83.5
72.9
HEATUDA HOSPITAL_ MAKWANPUR 70.8
70.3
BHARADAH HOSPITAL_SAPTARI 69.3
68.1
ROLPA HOSPITAL REUGHA 67.6
66.5
DISTRICT HOSPITAL_ ACHHAM 66.1
64.3
DISTRICT HOSPITAL_ SALYAN 62.7
61.4
PROVINCIAL HOSPITAL JANAKPUR 57.7
56.5
SETI ZONAL HOSPITAL_ KAILALI 54.1
53.8
DISTRICT HOSPITAL_ PANCHATHAR 52.8
49.9
DISTRICT HOSPITAL_ DAILEKH 47.5
46.7
DISTRICT TRISULI HOSPITAL_ NUWAKOT 46.5
46.2
DISTRICT HOSPITAL_MYAGDI 45.4
44.7
DISTRICT HOSPITAL_ KALIKOT 44.6
41.1
DISTRICT HOSPITAL_ BAJHANG 40.6
40.4
TIKAPUR HOSPITAL_ KAILALI 39
37.5
DHAULAGIRI ZONAL… 37.1
36.7
RUMJATAR HOSPITAL_ OKHALDHUNGA 0
0
CHANDRANIGAHAPUR HOSPTIAL_… 0
0 20 40 60 80 100 120

a i
Figure 3: Bed occupancy in Primary level hospitals , FY 2075/76

DULLU HOSPITAL_DAILEKH 44.3
AANPPIPAL HOSPITAL_GORKHA 32.7
BANDIPUR HOSPITAL_ TANAHU 32.4
BAGHAUDA HOSPTIAL_CHITAWAN 30.8
KATARI HOSPITAL_ UDAYPUR 22.2
BAKULAHAR HOSPITAL_CHITAWAN 17.9
Chisapani Hospital, Nawalparasi 15
MALAKHETI HOSPITAL_KAILALI 14.2
MANGALBARE Hospital MORANG 13
DAMAK HOSPITAL_JHAPA 10.6
Sundarbazar_hospital_Lamjung 9.4
METHINKOT HOSPITAL_KAVRE 9
PIPARA HOSPITAL_KAPILBASTU 4.1
SHISHUWA HOSPITAL_KASKI 2.7
LAMAHI HOSPITAL_DANG 0.92
CHAPAKOT HOSPITAL_SYANGJA 0
SHIVRAJ HOSPITAL_ BAHADURGANJ_… 0
0 10 20 30 40 50 60 70 80
Average length of stay — In fiscal year 2075/76, the average length of stay by inpatients:
 at Federal-level government hospitals ranged from 3.2 days at Bheri Hospital to 28.6 days at the Sahid
National Heart Center. 14 Federal hospital are no reporting (Figure 4);
 at provincial hospitals ranged from 0.73 day at Bardibas hospitals to 9.8 days at Pyuthan District hosp
(Figure 5); and
in other
 Annual
DoHS, district
Report level
2075/76 hospitals ranged from 0.14 day at, Lamahi hospital to 6.8 days in Chisapani hosp
(2018/19)
Figure 6).
a i
4. Average length of stay — In fiscal year 2075/76, the average length of stay by inpatients:
at a g m t ita a g m a at B i ita t a at
t a i a ga ag a a at t a ita a g ig
at i ia ita a g m a at Ba i a ita t a at t a
iti t ita ig a
i t iti t ita a g m a at ama i ita t a i
ia a i ita ig
Figure 4: Average length of stay by
Figure 4:inpatients
Average lengthin Federal
of stay -levelin hospitals,
by inpatients FY 2075/76
Federal -level hospitals, FY 2075/76
28.6
MENTAL HOSPITAL_… 21.1
11.4
NATIONAL TRAUMA… 11.2
8.7 Figure 5: Average leng
NAMS (BIR HOSPITAL)… 6.9 in Province level hospit
6.8
SUKRARAJ TROPICAL… 6.3
6.1
KOSHI HOSPITAL 5.1
4.3
BHARATPUR HOSPITAL_… 4.3 BHAKTAPUR HOSPITAL
4.2 DISTRICT HOSPITAL_
PAROPAKAR… 3.8
3.3 BHARADAH
BHERI HOSPITAL BANKE 3.2 DISTRICT HOSPITAL _
0
TEACHING HOSPITAL… 0 DISTRICT HOSPITAL_
0 DISTRICT HOSPITAL_
PATAN ACADEMY OF… 0
0 DHAULAGIRI ZONAL
NEPAL POLICE… 0
NATIONAL PUBLIC… 0 DISTRICT HOSPITAL_
0
GP KOIRALA NATIONAL… 0 DISTRICT HOSPITAL_
0 SETI ZONAL HOSPITAL_
CHHETRAPATI PARIBAR… 0
BIRENDRA ARMY… 0 DISTRICT HOSPITAL_
0 10 20 30 40 DISTRICT HOSPITAL_
DISTRICT HOSPITAL_
TIKAPUR HOSPITAL_
BARDIYA HOSPITAL
BARDIBAS HOSPITAL_
BHIM HOSPITAL_
21.1
1.4
1.2
Figure 5: Average length of stay by inpatients
in Province level hospitals, FY 2075/76 a i
Figure 5: Average length of stay by inpatients in Province level hospitals, FY 2075/76
BHAKTAPUR HOSPITAL… 4.9

3.7
DISTRICT HOSPITAL_… 3.5
3.3
BHARADAH… 3.3
3
DISTRICT HOSPITAL _… 2.9
2.8
2.8
2.8
DHAULAGIRI ZONAL… 2.8
2.8
2.6
2.6
2.5
SETI ZONAL HOSPITAL_… 2.4
2.3
2.3
2.3
20 30 40 DISTRICT HOSPITAL_… 2.2
2.1
2.1
TIKAPUR HOSPITAL_… 2
1.9
BARDIYA HOSPITAL… 1.9
1.4
BARDIBAS HOSPITAL_… 0.73
0
BHIM HOSPITAL_… 0
0 2 4 6

a i
PYUTHAN HOSPITAL 9.8

4.4
DISTRICT HOSPITAL_MUSTANG 3.8
3.6
PROVINCIAL HOSPITAL JANAKPUR 3.4
3.3
DISTRICT HOSPITAL_ TERHATHUM 3.2
3.1
DISTRICT HOSPITAL_ TAPLEJUNG 3.1
3
HEATUDA HOSPITAL_ MAKWANPUR 3
2.9
DISTRICT HOSPITAL_ SIRAHA 2.9
2.8
DISTRICT HOSPITAL_ UDAYAPUR 2.7
2.7
ROLPA HOSPITAL REUGHA 2.6
2.6
PROVINCIAL HOSPITAL SURKHET… 2.5
2.4
2.3
DISTRICT TRISULI HOSPITAL_ NUWAKOT 2.3
2.2
PRITHIV BIR HOSPITAL_ KAPILBASTU 2.2
2.2
DISTRICT HOSPITAL_ SUNSARI 2
1.8
1.3
1.2
KALAIYA DISTRICT HOSPITAL_ BARA 1.1
0
MALANGAWA DISTRICT HOSPITAL_… 0
0
0 2 4 6 8 10 12
Figure 6: Average length of stay by inpatients in other Primary level hospitals, FY 2075/76

a i
Figure 6: Average length of stay by inpatients in other Primary level hospitals, FY 2075/76
Chisapani Hospital, Nawalparasi 6.8
BAGHAUDA HOSPTIAL_CHITAWAN 3.3
BAKULAHAR HOSPITAL_CHITAWAN 3.2
AANPPIPAL HOSPITAL_GORKHA 2.9
BANDIPUR HOSPITAL_ TANAHU 2.8
KATARI HOSPITAL_ UDAYPUR 2.5
DAMAK HOSPITAL_JHAPA 2.5
DULLU HOSPITAL_DAILEKH 2.2
Sundarbazar_hospital_Lamjung 2
PIPARA HOSPITAL_KAPILBASTU 0.43
SHISHUWA HOSPITAL_KASKI 0.21
LAMAHI HOSPITAL_DANG 0.14
MALAKHETI HOSPITAL_KAILALI 0
0 1 2 3 4 5 6 7 8
Hospital use
The use of hospitals is measured in this section according to emergency room attendance and total
outpatient and inpatient admissions

a i
5. Hos pital us e
ita i m a i t i a i gt m g ma a a t ta
t a ta i a t a mi i
ita m g a a a at ita it g gi a a
m g a ita Bi ia t ig ta a at it m g
a i ta ita t t ig
m g i ia ita i ia ita a t ig ta a at it m g
it i aa ita a t t ig
m g ima ita a ta ita a t ig t a a at it m g
a i a a iga a ita a ta at a t at ig
Figure 7: Emergency ward attendance in Federal level hospitals, FY 2075/76
NAMS (BIR HOSPITAL) KATHMANDU 56840

KANTI CHILDREN HOSPITAL_KATHMANDU 55514
BHARATPUR HOSPITAL_ CHITWAN 46775
PAHS (PATAN HOSPITAL) LALITPUR 46364
NARAYANI HOSPITAL 41584
POKHARA ACADAMY OF HEALTH SCIENCE 39704
KOSHI HOSPITAL 28499
PAROPAKAR MATERNITY & WOMEN'S… 27911
CIVIL SERVICES HOSPITAL_KATHMANDU 19872
NATIONAL TRAUMA CENTER_KATHMANDU 19269
BHERI HOSPITAL BANKE 16198
RAPTI ACADEMY OF HEALTH SCIENCE 13325
Ram Raja Prasad Singh Academy of Health… 10581
SUKRARAJ TROPICAL HOSPITAL_KATHMANDU 8487
DADELDHURA HOSPITAL 5712
KARNALI ACADEMY OF HEALTH… 5400
ARMED POLICE FORCE (APF)… 1861
MENTAL HOSPITAL_ LALITPUR 655
TU Manmohan Cardiovascular Transplant… 0
TEACHING HOSPITAL (TRIBHUVAN… 0
SHAHID GANGALAL NATIONAL HEART… 0
SHAHID DHARMABHAKTA NATIONAL… 0
PATAN ACADEMY OF HEALTH… 0
BP KOIRALA CANCER HOSPITAL_CHITAWAN 0
BIRENDRA ARMY HOSPITAL_KATHMANDU 0
0 10000 20000 30000 40000 50000 60000
Figure 8: DoHS, Annual

Emergency ward attendance at provincial hospitals, Report 2075/76 (2018/19)
FY 2075/76
a i
Figure 8: Emergency ward attendance at provincial hospitals, FY 2075/76
PROVINCIAL HOSPITAL LUMBINI RUPANDEHI 53729

34739
PROVINCIAL HOSPITAL JANAKPUR 27566
23877
MECHI ZONAL HOSPITAL_ JHAPA 20005
19537
18311
11101
PROVINCIAL HOSPITAL SURKHET KARNALI 9913
8594
DISTRICT HOSPITAL_MYAGDI 7905
7856
DISTRICT HOSPITAL_ UDAYAPUR 7346
7292
PRITHIV CHANDRA HOSPITAL_… 7123
6952
GULMI HOSPITAL 6885
5703
4954
MEHELKUNA HOSPITAL_SURKHET 4610
4507
DISTRICT HOSPITAL_ TERHATHUM 3928
3612
ROLPA HOSPITAL REUGHA 3591
3579
PALPA HOSPITAL TANSEN 3224
3092
GOKULESHWOR HOSPITAL_DARCHAULA 2791
1733
JOGBUDA HOSPITAL_DADELDHURA 1599
1054
655
0 10000 20000 30000 40000 50000 60000

a i
DISTRICT HOSPITAL_ PANCHATHAR 17124

16471
DHAULAGIRI ZONAL… 12342
11818
DISTRICT HOSPITAL_ DHADING 10730
9229
DISTRICT HOSPITAL_… 8754
8577
BARDIYA HOSPITAL GULARIYA 7165
7017
6361
ARGHAKHANCHI HOSPITAL… 6331
5993
DISTRICT HOSPITAL_ KHOTANG 5649
5470
BARDIBAS HOSPITAL_ MAHOTTARI 5118
3530
DISTRICT HOSPITAL_ BAJHANG 3401
3105
DISTRICT HOSPITAL_ PARBAT 3027
3015
2622
DISTRICT HOSPITAL_ BHOJPUR 2343
2336
DISTRICT HOSPITAL_ DOTI 2074
2061
DISTRICT HOSPITAL_ SALYAN 1909
1566
BHARADAH HOSPITAL_SAPTARI 1329
1304
DISTRICT HOSPITAL_ MUGU 1261
937
DISTRICT HOSPITAL _ RASUWA 933
391
0 5000 10000 15000 20000
Figure 9: Emergency ward attendances at primary level hospitals, FY 2075/76

a i
Figure 9: Emergency ward attendances at primary level hospitals, FY 2075/76
DISTRICT HOSPITAL_ DHANKUTA 9229

KATARI HOSPITAL_ UDAYPUR 6730
BAKULAHAR HOSPITAL_CHITAWAN 5291
LAMAHI HOSPITAL_DANG 3762
POKHARIYA HOSPITAL_PARSA 3612
MATRI SHISHU MITERI (Bataulechaur)… 3579
GOKULESHWOR… 2791
BANDIPUR HOSPITAL_ TANAHU 2189
BAGHAUDA HOSPTIAL_CHITAWAN 1863
DAMAK HOSPITAL_JHAPA 1534
DULLU HOSPITAL_DAILEKH 1255
AANPPIPAL HOSPITAL_GORKHA 719
PIPARA HOSPITAL_KAPILBASTU 676
SHISHUWA HOSPITAL_KASKI 153
0 2000 4000 6000 8000 10000
u Outpatient
6. e e ce in
attendance inthe
thefiscal
fiscal uear
uear 2075/76
2075/76 at hospitals
at hospitals with fullwith full progress
progress reporting was as foll
reporting was
as follows :
 Outpatient attendance at Federal level hospitals ranged from 44317 at Karnali Academy of Hea
t a
Science t,aJumla a toat a
22 at Civil ServiceitaHospital
a g most m of federal
at a ahospitals
i a m are no reporting of OPD
at i ma t at i i i ita m t a ita a
morbidity g (Figure
m i it10). ig
 Outpatient attendance ati Provincial
t a t a a at ia ita hospitals
a g m a
ranged from t54403
at a patients
a ita at Palpa Hospital Ta
a t at i ia ita ig
to t227a at t aSeti provincial
a at imaHospital (Figure ita a11).g m at Ba a a ita
ita a t at i a ita a i a t ig
 Outpatient attendance at Primary level hospitals ranged from 89600 at Bakulahar Hospital,
t a t i it a t a a i g a g t t ta i t a
Chitawan
a ig to 13 at Shivraj hospital, Kapilbastu (Figure 12).
 New outpatient visits accounted for a varying range of the proportion of total clients across Ne
(Figure 13).
Figure 10: Outpatient attendance at Federal level hospitals, FY 2075/76

a i
Figure 10: Outpatient attendance at Federal level hospitals, FY 2075/76
44317
DADELDHURA HOSPITAL 22802
8452
MENTAL HOSPITAL_ LALITPUR 6626
203
CIVIL SERVICES… 22
0
TEACHING HOSPITAL (TRIBHUVAN… 0
0
SHAHID GANGALAL NATIONAL HEART… 0
0
RAPTI ACADEMY OF HEALTH SCIENCE 0
0
POKHARA ACADAMY OF HEALTH… 0
0
PAROPAKAR MATERNITY & WOMEN'S… 0
0
0
NATIONAL TRAUMA… 0
0
NARAYANI HOSPITAL 0
0
KOSHI HOSPITAL 0
0
0
BIRENDRA ARMY… 0
0
BHARATPUR HOSPITAL_ CHITWAN 0
0 10000 20000 30000 40000 50000
Figure 11: Outpatient attendance at provincial hospitals, FY 2075/76

a i
Figure 11: Outpatient attendance at provincial hospitals, FY 2075/76

DISTRICT HOSPITAL_ ILAM 38460
DISTRICT HOSPITAL_ DHADING 34788
DISTRICT HOSPITAL_ GORKHA 31949
DISTRICT HOSPITAL_ SALYAN 21234
DISTRICT HOSPITAL_ RUKUM 16821
DISTRICT HOSPITAL_ PARBAT 16490
DISTRICT HOSPITAL_ BAJURA 16330
DISTRICT HOSPITAL_ DARCHULA 16224
DISTRICT HOSPITAL_ BAJHANG 14318
DISTRICT HOSPITAL_ ACHHAM 14154
DISTRICT HOSPITAL_ KALIKOT 13668
DISTRICT HOSPITAL_ DAILEKH 13135
DISTRICT HOSPITAL_ BAITADI 11920
DISTRICT HOSPITAL_ DOLPA 11065
DISTRICT HOSPITAL_ DOTI 9911
DISTRICT HOSPITAL_ BHOJPUR 8799
DISTRICT HOSPITAL_ RAMECHHAP 8572
DISTRICT HOSPITAL_ JAJARKOT 7801
ARGHAKHANCHI HOSPITAL… 4432
DISTRICT HOSPITAL _ RASUWA 4306
DISTRICT HOSPITAL_ MANANG 2094
DISTRICT HOSPITAL_ PANCHATHAR 0
DHAULAGIRI ZONAL… 0
DAMAULI DISTRICT HOSPITAL_… 0
BHAKTAPUR HOSPITAL _BHAKTAPUR 0
0 10000 20000 30000 40000 50000

a i

51221
DISTRICT HOSPITAL_ SINDHULI 34249
32874
GULMI HOSPITAL 31952
28419
24149
19897
DISTRICT HOSPITAL_ SIRAHA 19613
19229
DISTRICT HOSPITAL_ TAPLEJUNG 18534
15648
RAM UMA SMARAK HOSPITAL_LAHAN_ SIRAHA 15167
14293
PRITHIV CHANDRA HOSPITAL_ NAWALPARASI 13990
13290
12396
10127
DISTRICT HOSPITAL_MUSTANG 6370
5946
DISTRICT HOSPITAL_ SOLUKHUMBU 4262
2378
PRITHIV BIR HOSPITAL_ KAPILBASTU 2274
430
TIKAPUR HOSPITAL_ KAILALI 305
227
RAPTI ZONAL HOSPITAL_DANG 1
0
0
MALANGAWA DISTRICT HOSPITAL_ SARLAHI 0
0
0
0 10000 20000 30000 40000 50000 60000
Figure 12: Outpatient attendance at primary level hospitals, FY 2075/76

a i
Figure 12: Outpatient attendance at primary level hospitals, FY 2075/76

MATRI SHISHU MITERI… 13290
GOKULESHWOR… 10127
0 20000 40000 60000 80000 100000
Figure 13: Percentage of new outpatient visits among total population, FY 2075/76

a i
Figure 13: Percentage of new outpatient visits among total population, FY 2075/76
Inpatient attendance in 2075/76 at hospitals with full progress reporting was as follows:
7. Inpatient
Bharatpurattendance in 2075/76
Hospital, Chitawan had at
thehospitals with full
most inpatient progress40562
admissions reporting
with was as follows:
the Mental Hospital,
Patan having the fewest (508) some federal hospital had no report (Figure 14)
B a at public provincial
 Among ita ita a Janakpur
hospitals, a t m t i a Hospital
Provincial t a mihad ithe most inpatient
it admissions
t ta
ita ata a i g t t m a ita a t ig
(20397), while Malangawa District Hospital, sarlahi had the fewest (76) some provincial hospital
m g i i ia ita a a i ia ita a t m t i a t
had
a mino ireported (Figure 15).
i a a ga a i t i t ita a a i a t t m
 Among i primary
ia hospitals
ita a Bardibast Hospital,ig Mahotary recorded the most inpatient admissions
(2355)
m gwhile Chapakotita
ima Hospital
Ba syangja
i a recorded
ita athe ta
fewest (6) (Figure
t 16).
m ti a t a mi i
i a a t ita a g a t t ig

a i
Figure 14: Inpatient admissions at Federal Figure 15: Inpatient admissions at provincial
level hospitals, FY 2075/76 hospitals, FY 2075/76
BHARATPUR HOSPITAL_ CHITWAN CHANDRANIGAHAPUR

40562HOSPTIAL_…
PAROPAKAR MATERNITY & WOMEN'S… 28092 3557
BHARATPUR HOSPITAL_ CHITWANDISTRICT HOSPITAL_ SALYAN 40562 3487
PAHS (PATAN HOSPITAL) LALITPUR 21966.5
PAROPAKAR MATERNITY & WOMEN'S… 28092 3404
POKHARA ACADAMY OF HEALTH… 20669HOSPITAL_ PANCHATHAR
DISTRICT 3134
PAHS
KOSHI(PATAN HOSPITAL) LALITPUR
HOSPITAL 20171 21966.5 3062
POKHARA
NARAYANI ACADAMY OF HEALTH
HOSPITAL 18545… 20669
2638
BHERI HOSPITAL BANKE KOSHI HOSPITAL 13574
BARDIBAS HOSPITAL_ MAHOTTARI 20171 2355
NAMS (BIR HOSPITAL) KATHMANDU 12068 2326
NARAYANI HOSPITAL 18545
KANTI CHILDREN… 10083
BHERI HOSPITAL BANKE
CIVIL SERVICES… 13574 2218
9285 DISTRICT HOSPITAL_ DHADING 2014
NAMS
Ram Raja Prasad Singh(BIR HOSPITAL)
Academy of… KATHMANDU
8372 12068 1940
RAPTI ACADEMY OF HEALTH SCIENCE KANTI CHILDREN…
6525 DISTRICT HOSPITAL_…
10083 1935
SHAHID GANGALAL NATIONAL HEART… CIVIL 6232 1864
SERVICES …
DISTRICT 9285ACHHAM
HOSPITAL_ 1743
NATIONAL TRAUMA… 4016 1597
Ram Raja Prasad Singh Academy of… 8372
KARNALI ACADEMY OF HEALTH… 3307 DISTRICT HOSPITAL_… 1522
RAPTI ACADEMY
DADELDHURA HOSPITALOF HEALTH
2973
SCIENCE 6525 1520
SHAHID (TRIBHUVAN…
GANGALAL NATIONAL DISTRICT
HEART… HOSPITAL_
6232 KHOTANG 1493
TEACHING HOSPITAL 2311
1327
SUKRARAJ TROPICAL… NATIONAL TRAUMADISTRICT
2073 … 4016
HOSPITAL_ PARBAT 1219
SHAHID DHARMABHAKTA NATIONAL…
KARNALI ACADEMY1793OF HEALTH… 1215
3307
BHARADAH HOSPITAL_SAPTARI
ARMED POLICE FORCE (APF)… 734 1154
DADELDHURA HOSPITAL 2973 1113
MENTAL HOSPITAL_ LALITPUR 508 DAMAULI DISTRICT HOSPITAL_… 1110
TEACHING HOSPITAL
TU Manmohan Cardiovascular… 0 (TRIBHUVAN … 2311 1044
PATAN ACADEMY OF HEALTH… 0SUKRARAJ TROPICAL … 2073
965
SHAHID DHARMABHAKTA
NEPAL POLICE HOSPITAL_KATHMANDU 0 NATIONAL… DISTRICT 1793HOSPITAL_ DOTI 807
ARMED POLICE FORCE (APF)… 734 567
NATIONAL PUBLIC HEALTH… 0 DISTRICT HOSPITAL_ DOLPA 296
MENTAL HOSPITAL_ LALITPUR 508 224
TU Manmohan Cardiovascular DISTRICT
… 0 HOSPITAL_ MANANG 29
PATAN
BP KOIRALA ACADEMY
CANCER… 0 OF HEALTH… 0 0 500 1000 1500 2000 2500 3000 3500 4000
NEPALBIRENDRA ARMY… 0
POLICE HOSPITAL_KATHMANDU 0
NATIONAL
0 TUBERCULOSIS … 0 40000 50000
10000 20000 30000
BP KOIRALA CANCER… 0
BIRENDRA ARMY… 0
0 10000 20000 30000 40000 50000
Figure 14:
Inpat
\ ient admissions at
Federal level
hospitals, FY
2075/76
a i
issions at Federal Figure 15: Inpatient admissions at provincial
hospitals, FY 2075/76
_ CHITWAN CHANDRANIGAHAPUR
40562HOSPTIAL_…
WOMEN'S… 28092 3557
) LALITPUR 21966.5
CHANDRANIGAHAPUR
DISTRICT HOSPITAL_ SALYAN HOSPTIAL_… 3487
3404 3557
OF HEALTH… 20669HOSPITAL_ PANCHATHAR
DISTRICT 3134
DISTRICT HOSPITAL_ SALYAN 3062 3487
I HOSPITAL 20171
BHIM HOSPITAL_ RUPANDEHI 2784 3404
I HOSPITAL 18545
DISTRICT HOSPITAL_ PANCHATHAR 2638 3134
TAL BANKE 13574
BARDIBAS HOSPITAL_ MAHOTTARI 2355 3062
THMANDU 12068 2326
BHIM HOSPITAL_
BARDIYA HOSPITAL GULARIYA
RUPANDEHI 2784
CHILDREN… 10083 2310
2218 2638
L SERVICES… 9285 BARDIBAS HOSPITAL_ MAHOTTARI
DISTRICT HOSPITAL_ DHADING 2014 2355
Academy of… 8372 1940 2326
TH SCIENCE 6525 DISTRICT HOSPITAL_… 1935
NAL HEART… 6232 1864
DISTRICT HOSPITAL_ ACHHAM 1743 2218
L TRAUMA… 4016 DISTRICT HOSPITAL_ DHADING 1597 2014
OF HEALTH… 3307 DISTRICT HOSPITAL_… 1522 1940
A HOSPITAL 2973 DISTRICT HOSPITAL_…1520 1935
RIBHUVAN… 2311
1327
1864
J TROPICAL… 2073 DISTRICTPARBAT
DISTRICT HOSPITAL_ HOSPITAL_ ACHHAM 1219 1743
NATIONAL… 1793 1215 1597
ORCE (APF)… 734 BHARADAH HOSPITAL_SAPTARI
DISTRICT HOSPITAL_ …
1154 1522
1113
_ LALITPUR 508 DAMAULI DISTRICT HOSPITAL_…
1520
1110
diovascular… 0 DISTRICT HOSPITAL_ KHOTANG 1044 1493
OF HEALTH… 0 DISTRICT HOSPITAL_ MUGU 1004 1327
THMANDU 0 DISTRICT HOSPITAL_ PARBAT
965 1219
DISTRICT HOSPITAL_ DOTI 807 1215
ERCULOSIS… 0 567
LIC HEALTH… 0 DISTRICTBHARADAH HOSPITAL_SAPTARI
HOSPITAL_ DOLPA 296 1154
ENTER FOR… 0 224 1113
AR KALYAN…
DAMAULI
DISTRICT HOSPITAL_ DISTRICT29HOSPITAL_…
MANANG 1110
0
LA CANCER…
1044
0 500 1000 1500 2000 2500 3000 3500 4000
0
DRA ARMY… 0
965
0 DISTRICT HOSPITAL_ DOTI
10000 20000 30000 40000 50000 807
567
DISTRICT HOSPITAL_ DOLPA 296
224
DISTRICT HOSPITAL_ MANANG 29
0 500 1000 1500 2000 2500 3000 3500 4000

a i

20082
PROVINCIAL HOSPITAL LUMBINI RUPANDEHI 19309
13865
7508
KALAIYA DISTRICT HOSPITAL_ BARA 4635
4414
RAPTI ZONAL HOSPITAL_DANG 4376
4284
PYUTHAN HOSPITAL 3919
3622
PRITHIV BIR HOSPITAL_ KAPILBASTU 2975
2781
DISTRICT TRISULI HOSPITAL_ NUWAKOT 2757
2718
2611
DISTRICT HOSPITAL_ SINDHULI 2183
2159
DISTRICT HOSPITAL_ TAPLEJUNG 1689
1607
GULMI HOSPITAL 1522
1450
1134
DISTRICT HOSPITAL_ TERHATHUM 1084
1058
901
DISTRICT HOSPITAL_ SOLUKHUMBU 829
783
696
360
157
MALANGAWA DISTRICT HOSPITAL_ SARLAHI 76
0 5000 10000 15000 20000 25000

a i
FigureFigure 16: Inpatient
16: Inpatient admissionsadmissions
at primary at primary
level levelFYhospitals,
hospitals, 2075/76 FY 2075/76

MATRI SHISHU MITERI (Bataulechaur)… 901
GOKULESHWOR… 783
0 500 1000 1500 2000 2500

a i
Disease analysis
8. Disease analysis
o t e m ori i eam og i a te — Ina fiscal
a year 2075/76other
t i chronic
t obstructive
m apulmonary
i a a t m i a t a mi i i a t at
disease is the number one reason for inpatient admission (13,412) followed by Cholelithothiasis disease
a m t t a it t ia i
(7191)
i a (Figure 18).ig
Figure
Figure5.18:
5.18:Top ten
Topinpatient morbidities
ten inpatient in FY 2075/76
morbidities in FY 2075/76
J44 Other chronic obstructive pulmonary… 13412

A09 Diarrhoea and gastroenteritis of… 12839
J18 Pneumonia, organism unspecified 12281
N39 Other disorders of urinary system 11569
T14 Injury of unspecified body region 11089
I10 Essential (primary) hypertension 8633
A010 Typhoid fever 8553
J22 Unspecified acute lower respiratory… 7932
K37 Unspecified appendicitis 7352
K80 Cholelithiasis 7191
0 2000 4000 6000 8000 10000 12000 14000 16000
Source: HMIS
9. Total
Total patients
patients —— In 2075/76 Nepal’s a the
t HMIS recorded 1045062 patientsa t (female
ma 62.47%–male
ma 37.53%)
i g i ag ma t ita a t i m
being discharged
a from all types of hospitals
i (Table 5).Of i thist number
i i995414
a im (91.22%)
m t were
t tarecorded as
cured or recovered, while 19756 (1.81%) did not show clinical improvement A total oft 5659
a t i it i a mi i i a a i (0.51%)
m t a a a mi i t a t ag t a
patients
t a a adied within
t i 48 a hours
t of admission
ag whilea , whereas 6228(0.57%) patients died more than 48 hours
after admission. Most patients were aged between 20-29 years (25.75%), More than a half of the
a
inpatients a
were taged
m 15-49i it years
ag (59%).
a a ita
Table 5: Inpatient morbidity by age and sex, all hospitals, FY 2075/76
Table 5: Inpatient morbidity by age and sex, all hospitals, FY 2075/76

29 Days - 1 Year
01 - 04 Years
05 - 14 Years
15 - 19 Years
30 - 39 Years
40 - 49 Years
50 - 59 Years
20 - 29 Years
≥ 60 Years
Total
Age Group
29 Days - 1 Year
01 - 04 Years
05 - 14 Years
15 - 19 Years
20 - 29 Years
30 - 39 Years
40 - 49 Years
50 - 59 Years
≤ 28 days
Group25514
AgeFemale 15841 20752 28994 59400 214059 95718 54229 48755 70765 634027
Recovered/Cure Male 31318 23581 29573 40218 30201 53220 49555 47671 48501 7549 361387
Female 325 391 334 632 700 1260 1218 1158 1293 2392 9703
Not Improved Male 463 565 401 692 608 1083 1032 1104 1231 2874 10053
Female 545 473 407 806 1004 2640 1223 1346 855 1972 11271
Referred Out Male 810Female
760 25514
607 879 15841
563 20752
971 28994955 59400
902 1061 214059
2227 95718
9735 54229 48755
Female 1166 725 799 1008 1572 4060 2350 1748 2006 4771 20205
Recovered/Cure
DOR/LAMA/DAMA Male 1577Male1058 313181340 23581
1221 1211 29573 2090
2348 40218
2026 30201
2097 53220
5101 49555
20069
47671 48501
Female 58
Female 60325 98 391
67 91 334 190 632 120 700
377 104 1260
188 1218
1353 1158 1293
Absconded Male 59 69 105 124 377 163 145 124 99 173 1438
Not Improved
Deaths in < 48 Female 253Male70 463 65 565
37 73 401 195 692 227 608
195 347 1083
955 1032
2417 1104 1231
Referred Out
Hours Male 387 123
Female 545
47 66 473 96 407 267 806 380 1004
199 438 2640
1239 1223
3242 1346 855
Female 176 77 53 93 93 184 204 267 384 1170 2701
Hours Male 287 141 76 91 102 215 292 397 480 1446 3527
Female 28037 17644 22442 31696 62933 222775 101098 59095 53744 82213 681677
DoHS, Annual Report
% 2075/76
55.45 (2018/19)
59.85 58.80 57.80 34.51 20.71 34.94 47.12 50.08 20.04 37.53
Male 34901 26297 32030 43410 33158 58199 54283 52657 53907 20609 409451
Total
% 55.45 59.85 58.80 57.80 34.51 20.71 34.94 47.12 50.08 20.04 37.53
Total 62938 43941 54472 75106 96091 280974 155381 111752 107651 102822 1091128
% 5.77 4.03 4.99 6.88 8.81 25.75 14.24 10.24 9.87 9.42 100.00
Source: HMIS, DoHS

Note: LAMA = left against medical advice , DAMA discharged against medical advice
Female 545 473 407 806 1004 2640 1223 1346 855 1972 11271
Referred Out Male 810 %760 607 55.45
879 563 59.85
971 58.80955
902 57.80
1061 34.51
2227 20.71
9735
34.94 47
Female 1166
Male
725 799
34901
1008 1572
26297
4060
320301748
2350
43410
2006
33158
4771
58199
20205
54283 52
DOR/LAMA/DAMA Total Male 1577 1058 1221 1340 1211 2348 2090 2026 2097 5101 20069
Female 58 %67 60 55.45 59.85
98 91 377 58.80120
190 57.80 34.51
104 188 20.71
1353 34.94 47
Absconded Male 59 69 105 124 377 163 145 124 99 173 1438
Deaths in < 48 Female 253 Total
70 37 62938
65 73 43941
195 54472227
195 75106
347 96091
955 280974
2417 155381 11
Hours Male 387 123 47 66 96 199 267 380 438 1239 3242
a i Female 176 %77 53 5.77
93 93 4.03
184 4.99 267
204 6.88
384 8.81
1170 25.75
2701 14.24 10
Hours Male 287 141 76 91 102 215 292 397 480 1446 3527
Female 28037 17644 22442 31696 62933 222775 101098 59095 53744 82213 681677
Source: HMIS, DoHS % 55.45 59.85 58.80 57.80 34.51 20.71 34.94 47.12 50.08 20.04 37.53
Male 34901 26297 32030 43410 33158 58199 54283 52657 53907 20609 409451
Total
o e: LAMA = left against medical advice , DAMA discharged against medical advice
% 55.45 59.85 58.80 57.80 34.51 20.71 34.94 47.12 50.08 20.04 37.53
Total 62938 43941 54472 75106 96091 280974 155381 111752 107651 102822 1091128
Outpatient consultations — The top-most reason for outpatient consultations in 2075/76 was for Gastr
% 5.77 4.03 4.99 6.88 8.81 25.75 14.24 10.24 9.87 9.42 100.00
(APD) (5.84%),
Source: HMIS, DoHS followed by upper respiratory tract infection (5.81%) (Figure 5.19).
Note: LAMA = left against medical advice , DAMA discharged against medical advice
t agai t m i a a i i ag agai t m i a a i
Outpatient consultations
t a t ta The top-most reason
t formoutpatient
t a consultations tin a2075/76t was for ta i a
Gastritis (APD) (5.84%), followed by upper respiratory tract infection (5.81%) (Figure 5.19).
ati i at t a ti ig
Figure 19: Top ten reasons (%) for outpatient consultations, FY 2075/76
Figure
Figure 19:19: Top
Top ten reasons
ten reasons ( ) forconsultations,
(%) for outpatient outpatient consultations, FY 2075/76
FY 2075/76
Gastritis (APD) 1341855

Upper Respiratory Tract Infection… 1335016
Headache 1142177
ARI/Lower Respiratory Tract… 948830
OPD-Morbidity-Orthopaedic… 912091
PUO 687103
Communicable-Water/Food Borne-… 609256
Skin Diseases-Fungal Infection… 566337
Orthopaedic Problems-… 558172
Skin Diseases-Scabies Cases 557645
0 500000 1000000 1500000
10. Disease types — t m i a t am gi a t a t a t i i
t m ai i a a m ia ga i m i a
m ia i a a t t i i a a
am g t a t i a t ta at a am g a at
t m ia ai a
ia a a ga t t i a t a i g a i a t at i a
a t i a a
mi i mm i a a mm i a i a t t a t i
mm i a mm i a a

 among the 144 cases of vector borne diseases total death case 3, among 61 cases 2 death
reported from Viral Encephalitis (Table 7);
 diarrhoea and gastroenteritis was the leading cause of inpatient waterborne disease (A09 :12839
cases), followed by typhoid fever (A010: 8553 cases) (Table 8);
 22.9million communicable and non-communicable diseases were reported by outpatients in
2075/76 (communicable 11.46%, non-communicable 88.58%) (Table 9)
a i
Table 6:
Table Breakdown
6: Breakdown of of airbornedisease
airborne diseasecases
cases among
among inpatients,
inpatients,FYFY
2074/75
2074/75
Inpatient Morbidity Cases Inpatient Morbidity Deaths

ICD Code and Name
Female Male Total Female Male Total
A15 Respiratory tuberculosis,

bacteriologically and histologically
confirmed 97 197 294 1 4 5
A150 Tuberculosis of lung, confirmed by
sputum microscopy with or without
culture 45 83 128 4 7 11
culture only 8 17 25 1 1
A152 Tuberculosis of lung, confirmed
histologically 4 0 4 0 0
unspecified means 2 3 5 0
A154 Tuberculosis of intrathoracic lymph
nodes, confirmed bacteriologically and
histologically 1 0 1 0
A155 Tuberculosis of larynx, trachea and
bronchus, confirmed bacteriologically
and histologically 0 1 1 0
A156 Tuberculous pleurisy, confirmed
bacteriologically and histologically 3 3 6 0
A157 Primary respiratory tuberculosis,
confirmed bacteriologically and
A158 Other respiratory tuberculosis,
confirmed bacteriologically and
A159 Respiratory tuberculosis
unspecified, confirmed bacteriologically
and histologically 9 5 14 0
A16 Respiratory tuberculosis, not
confirmed bacteriologically or
histologically 49 109 158 2 1 3
A160 Tuberculosis of lung,
bacteriologically and histologically
negative 21 30 51 3 3 6
A161 Tuberculosis of lung, bacteriological

and histological examination not done 6 5 11 0 0 0
A162 Tuberculosis of lung, without
mention of bacteriological or histological
confirmation 46 55 101 0 4 4
A164 Tuberculosis of larynx, trachea and
bronchus, without mention of
bacteriological or histological
confirmation
DoHS, Annual Report 2075/76 (2018/19) 2 1 3 0 0
A165 Tuberculous pleurisy, without
without mention of bacteriological or
histological confirmation 17 22 39 0
A161 Tuberculosis of lung, bacteriological
and histological examination not done 6 5 11 0 0 0
A162 Tuberculosis of lung, without
A164
a Tuberculosis
i of larynx, trachea and
bronchus, without mention of
confirmation 2 1 3 0 0
A165 Tuberculous pleurisy, without
without mention of bacteriological or
histological confirmation 17 22 39 0
A169 Respiratory tuberculosis
unspecified, without mention of
confirmation 144 237 381 3 9 12
A17 Tuberculosis of nervous system 3 3 6 0
A170 Tuberculous meningitis 16 26 42 2 3 5
A171 Meningeal tuberculoma 0 1 1 0 0 0
A178 Other tuberculosis of nervous
system 3 3 6 0
A18 Tuberculosis of other organs 44 93 137 0 4 4
A182
A180 Tuberculous
Tuberculosis peripheral
of bones and joints 15 14 29 0 0 0
lymphadenopathy
A181 Tuberculosis of genitourinary 8 8 16 0 0
A183
systemTuberculosis of intestines, 3 0 3 0
peritoneum and mesenteric glands 28 37 65 0 1 1
A187 Tuberculosis of adrenal glands 0 1 1 0
A188 Tuberculosis of other specified
organs 3 8 11 0
A19 Miliary tuberculosis 8 14 22 1 2 3
A190 Acute miliary tuberculosis of a
single specified site 1 0 1 0
A191 Acute miliary tuberculosis of
multiple sites 1 0 1 0
A192 Acute miliary tuberculosis,
unspecified 0 1 1 0 0
A199 Miliary tuberculosis, unspecified 5 16 21 0 0 0
G03 Meningitis due to other and
unspecified causes 85 115 200 2 3 5
G030 Nonpyogenic meningitis 1 4 5 0 1 1
G031 Chronic meningitis 0 2 2 1 1
G038 Meningitis due to other specified
causes 0 1 1 0
G039 Meningitis, unspecified 134 170 304 4 11 15
J02 Acute pharyngitis 206 215 421 6 7 13
J020 Streptococcal pharyngitis 2 5 7 2 2
J029 Acute pharyngitis, unspecified 28 45 73 0 0 0
J03 Acute tonsillitis 1498 1382 2880 48 38 86
J030 Streptococcal tonsillitis 24 11 35 0 0
J038 Acute tonsillitis due to other
specified organisms 10 12 22 0 0 0
J039 Acute tonsillitis, unspecified 304 272 576 2 1 3
J18 Pneumonia, organism unspecified 5668 6613 12281 397 335 732
J180 Bronchopneumonia, unspecified 74 110 DoHS,
184 Annual0Report 2075/76
0 (2018/19)
0
J181 Lobar pneumonia, unspecified 79 70 149 7 6 13
J182 Hypostatic pneumonia, unspecified 61 34 95 46 25 71
J188 Other pneumonia, organism
J189 Pneumonia, unspecified 2380 2842 5222 68 90 158
J02 Acute pharyngitis 206 215 421 6 7 13
J020 Streptococcal pharyngitis 2 5 7 2 2
J029 Acute pharyngitis, unspecified 28 45 73 0 0 0
J03 Acute tonsillitis 1498 1382 2880 48 38 86
J030 Streptococcal tonsillitis 24 11 35 0 0
J038 Acute tonsillitis due to other
specified organisms 10 12 22 0 0 a 0 i
J039 Acute tonsillitis, unspecified 304 272 576 2 1 3
J18 Pneumonia, organism unspecified 5668 6613 12281 397 335 732
J180 Bronchopneumonia, unspecified 74 110 184 0 0 0
J181 Lobar pneumonia, unspecified 79 70 149 7 6 13
J182 Hypostatic pneumonia, unspecified 61 34 95 46 25 71
J188 Other pneumonia, organism
J189 Pneumonia, unspecified 2380 2842 5222 68 90 158
J40 Bronchitis, not specified as acute or
chronic 739 917 1656 49 47 96
Total 11915 13841 25756 647 605 1252
Table7:7:Breakdown
Table Breakdown of vector
of vector borne borne diseases
diseases among among inpatients,
inpatients, FY 2074/75
FY 2074/75
Inpatient Morbidity Cases Inpatient Morbidity Deaths

ICD Code and Name
Female Male Total Female Male Total
A50 Congenital syphilis 1 2 3 0
A86 Unspecified viral
encephalitis 27 34 61 2 0 2
B50 Plasmodium
falciparum malaria 0 2 2 1 1
B500 Plasmodium
falciparum malaria with
cerebral complications 1 1 2 0 0
B509 Plasmodium
falciparum malaria,
B51 Plasmodium vivax
malaria 5 7 12 0
B519 Plasmodium vivax
malaria without
complication 7 8 15 0 0
B54 Unspecified malaria 13 14 27 0 0 0
B559 Leishmaniasis,
unspecified 5 4 9 0
Total 62 82 144 2 1 3
Table 8: Water borne diseases among inpatients, FY 2075/76

Inpatients
Inpatients Death
ICD 10 Case Total
Female Male Female Male
A00 Cholera 43 34 77 0
A00.0
DoHS, Cholera
Annual due2075/76
Report to Vibrio cholerae 01,
(2018/19)
biovar cholerae 28 13 41 2 1
A00.1 Cholera due to Vibrio cholerae 01,
biovar eltor 10 8 18 0
a i
Table
Table 8:
8: Water borne diseases among inpatients, FY 2075/76
Water borne diseases among inpatients, FY 2075/76
Inpatients Case Inpatients Death

ICD 10 Total Total
Female Male Female Male
A00 Cholera 43 34 77 0 1 1
biovar cholerae 28 13 41 2 1 3
biovar eltor 10 8 18 0 0 0
A00.9 Cholera, unspecified 64 35 99 29 20 49

A01 Typhoid and paratyphoid fevers 1960 1969 3929 43 46 89
A010 Typhoid fever 4432 4121 8553 45 61 106
A011 Paratyphoid fever A 53 74 127 0 0 0
A014 Paratyphoid fever, unspecified 40 37 77 0
A03 Shigellosis 35 27 62 0 0 0
A030 Shigellosis due to Shigella
dysenteriae 3 6 9 0
A038 Other shigellosis 16 24 40 0 0 0
A039 Shigellosis, unspecified 108 82 190 0 2 2
A06 Amoebiasis 133 112 245 0 2 2
A060 Acute amoebic dysentery 53 53 106 1 2 3
A061 Chronic intestinal amoebiasis 5 7 12 0 0 0
A062 Amoebic nondysenteric colitis 1 0 1 0
A064 Amoebic liver abscess 0 5 5 0 0
A065 Amoebic lung abscess 16 3 19 0
A066 Amoebic brain abscess 6 5 11 0
A067 Cutaneous amoebiasis 4 6 10 1 1
A068 Amoebic infection of other sites 0 3 3 0
A069 Amoebiasis, unspecified 114 97 211 3 1 4
A09 Diarrhoea and gastroenteritis of
presumed infectious origin 6543 6296 12839 113 84 197
B15 Acute hepatitis A 48 56 104 1 1 2
B150 Hepatitis A with hepatic coma 12 13 25 1 1
B159 Hepatitis A without hepatic coma 40 77 117 2 1 3
B16 Acute hepatitis B 11 27 38 0 2 2
B161 Acute hepatitis B with delta-agent
(coinfection) without hepatic coma 1 0 1 0
B169 Acute hepatitis B without delta-
agent and without hepatic coma 24 48 72 1 0 1
B17 Other acute viral hepatitis 36 61 97 1 0 1
B170 Acute delta-(super)infection of
hepatitis B carrier 2 0 2 0
B172 Acute hepatitis E 5 12 17 1 0 1
E86 Volume depletion 162 151 313 0 2 2
K52 Other noninfective gastroenteritis
and colitis 80 72 152 4 2 6
K520 Gastroenteritis and colitis due to
radiation 3 0 3 0
K521 Toxic gastroenteritis and colitis 2 2 4 0
K522 Allergic and dietetic gastroenteritis
and colitis 1 0 1 0
K528 Other specified noninfective
gastroenteritis and colitis 6 4 10 0 0 0
K529 Noninfective gastroenteritis and
colitis, unspecified 247 250 497 0 0
R17 Unspecified jaundice 352 397 749 45 44 89
Total 14699 14187 28886 291 274 565
Table 9: Communicable and non-communicable diseases among outpatients by province,
FY 2075/76
Communicable Non-Communicable
Province Total
Cases % Cases %
366901 9.92 3329450 90.07 3696351
Province 1
686147 19.34 2861653 80.66 3547800
Province 2
440359 8.2 4892851 91.74 5333210
Province 3
230585 8.70 2418414 91.29 2648999
Province 4
449280 11.14 3580429 88.85 4029709
Province 5
223966 13.75 1403883 86.24 1627849
Province 6
233895 11.30 1834345 88.69 2068240
and colitis
and colitis
gastroenteritis and colitis 6 4 10
K529 Noninfective
gastroenteritis andgastroenteritis
colitis and 6 4 10
colitis, unspecified 247 250 497
K529 Noninfective gastroenteritis and
R17 Unspecified jaundice 352 397 a i 749
colitis, unspecified 247 250 497
Total 14699 14187 28886 2
Table
R179: Communicable
Unspecified jaundiceand non-communicable diseases among
352outpatients by province,
397 749
Table 9: Communicable and non-communicable diseases among outpatients by province,
FY 2075/76 Total 14699 14187 28886 2
Table
FY 9: Communicable and non-communicable diseases among outpatients by province,
2075/76
Province
FY 2075/76 Total
Cases % Cases %
Province Total
Province 1 366901
Cases 9.92
% 3329450
Cases 90.07
% 3696351
Province21 366901 9.92 3329450 90.07 3696351

Province 686147 19.34 2861653 80.66 3547800
ProvinceProvince
Bagmati 2 686147
440359 19.34
8.2 2861653
4892851 80.66
91.74 3547800
5333210
Bagmati Province
a a i Province 440359
230585 8.2
8.70 4892851
2418414 91.74
91.29 5333210
2648999
a a i Province 230585
449280 8.70
11.14 2418414
3580429 91.29
88.85 2648999
4029709
Province 5
Province 5
a a i Province 449280 11.14 3580429 88.85 4029709
223966 13.75 1403883 86.24 1627849
a a i Province 223966 13.75 1403883 86.24 1627849
a im Province 233895 11.30 1834345 88.69 2068240
a aa im Province 233895 11.30 1834345 88.69 2068240

11.46 88.53 22952158
Nepal 11.46 88.53 22952158
2631133 20321025
Nepal
2631133 20321025
11. Communicable and non-communicable diseases (inpatients)

Communicable and non-communicable diseases (inpatients)
aCommunicable and non-communicable
ta a diseases t
(inpatients) ita i t
e — In 2075/76, 446811 cases were discharged to hospital, of which 92.1 percent were non-
mm i a i a a a a m t a m a ma
communicable
e mm disease 446811
— In 2075/76, cases (Table
casesa5.10).
weremmThere were nearly five times
discharged as many non-communicable
i a i a at i a toi hospital,
a atof which 92.1 percent were non-
disease deaths asdisease
communicable communicable disease
cases (Table deaths.
5.10). There were nearly five times as many non-communicable
disease deaths
Table as communicable disease deaths.
Table10:
10: Communicable
Communicable and
andnon-communicable diseasecases
non-communicable disease casesand
anddeaths
deaths (inpatients),
(inpatients), FY
FY 2075/76
2075/76
Table 10: Communicable and non-communicable disease
Diseases cases and deaths
Cases % (inpatients),
Deaths FY 2075/76
%
Diseases 35281
Cases % Deaths %
Communicable 7.89 716 6.67
35281
Communicable 411530 7.89 716 6.67
Non-communicable 92.1 10010 93.32
411530
Non-communicable
Total 446811 92.1
100 10010
10726 93.32
100
Total 446811 100 10726 100

Causea of deathi — Regarding the causes of death (and morbidity) among inpatients in FY 2075/76:
12. Cause of death

The leading — ofgadeath
cause i g tamong
a inpatients
at was
a ‘Unknown
m i it and am unspecified
gi a tcause
i of morbidity
(1332) (Figure 22).
a i g a at am gi a t a a i a
m i it ig
Figure
Figure22:
22:Top Top
10 causes of death
10 causes among
of death inpatients,
among FY 2075/76
inpatients, FY 2075/76
R69 Unknown and unspecified causes of… 1332

J18 Pneumonia, organism unspecified 732
O80 Single spontaneous delivery 405
J44 Other chronic obstructive pulmonary… 393
J22 Unspecified acute lower respiratory… 238
R50 Fever of unknown origin 215
N39 Other disorders of urinary system 207
A09 Diarrhoea and gastroenteritis of… 197
T14 Injury of unspecified body region 173
J189 Pneumonia, unspecified 158
0 200 400 600 800 1000 1200 1400
Surgeries — 163425 majormasurgeries

13. Surgeries —
were performedmin the
g i
reporting period
i t g
(combined
i m i
inpatient and
outpatient
i a t asurgeries)
t a of which
t g61.14
i percenti were female cases
t (Figurema23). Aatotal ofig72643 minor surgical
procedures
t ta were
miperformed gi a on hospital outpatients while
m 72507 were
ita performed
t a t oni an inpatient basis.
m
Females accounted fora 49.02
i apercentt a of
i all minor
ma surgeries.
a t More of the minor emergency
t a misurgery cases
g i t mi m g g a ma t a ma
were males than females
Figure 23: Surgeries in hospitals, FY 2075/76

Figure 23: Surgeries in hospitals, FY 2075/76
Male Female
120000
99930
100000
80000
63495
60000
40000
3686935774 3505137456
23936
18951
20000
0
Major Surgeries Outpatients Minor Inpatients Minor Emergency Minor
Surgeries Surgeries Surgeries
De er e —333,218 deliveries were conducted in Health Facilities in 2075/76

DoHS, of which
Annual Report 79.5 percent
2075/76 (2018/19)
happened through spontaneous labour, 18.2 percent through caesarean sections and 2.3 percent were
vacuum assisted (Figure 24).
Figure 24: Deliveries in hospitals, FY 2075/76
C/S Vaccum or Forceps normal

18951
20000
0
Major Surgeries Outpatients Minor Inpatients Minor Emergency Minor
Surgeries Surgeries Surgeries
a i
De er e —333,218 deliveries
14. Deliveries — i i
were conducted
t i
in Health Facilities
at a ii i
in 2075/76
i
of which 79.5 perc
happenedt a throught spontaneous
g ta labour,
a 18.2 percent
t t through
g a caesarean
a a sections
a and 2.3 percent w
vacuum t assisted
a (Figure
m a i t 24).ig
Figure24:24:
Figure Deliveries
Deliveries in hospitals,
in hospitals, FY 2075/76
FY 2075/76
C/S Vaccum or Forceps normal
18.2
2.3
79.5 Normal
Delivery:
333218
t Please
Note: a see Annex 3mfor more
tai details.
15. Hospital
Hospital Broughtdeaths
Brought deaths and
and Post-mortem
Post-mortem cases — In—
cases FYIn
2075/76:
FY 2075/76:
 g t a dead
3417 brought a tot hospital
ita cases
ma (60% male–40%
ma a female) andita7547
tm t m post-mortem ca
hospital
a ma ma t t t a
(64% males–37% females) were reported to the HMIS (Table 11).
Table 11:
Table 11:Hospital brought
Hospital dead anddead
brought post-mortem cases, FY 2075/76
and post-mortem cases, FY 2075/76
Female % Male % Total
Brought dead 1359 40 2058 60 3417
Post-mortem done 2724 36 4823 64 7547
Total 4083 37 6881 63 10964

a i
7.2 Human Organ Transplant Services

7.2.1 Introduction
a i a ma B a ta a a a a t t B a ta i i t i it
at a a t t gt a a ga t a a ta i
i t
t i t tat it i m it t i t it i a a it
ta i m t it a t it i ga t a a ta t a i
i a a i a a t g a i t a a a t a
7.2.2 Major Milestones of Shahid Dharmabhakta National Transplant Center (SDNTC)

ta i m t a
i a ia i i m
i ta a ta ta t m a a
m ia i i tat m a
ma ga a a ta t a
t ai a g i a a ta
i a a ia g m
ma ga a a t g a m
i t i a a ta m
i a a ta i
i a a ta
a a ta m a ai a a
i i a a ta
t a a i i ta a ta i a a a
t i a a ta i ta a t t at i ag
m a t g
7.2.3 Objectives
t gt a a ga t a a ta i i t t
i a a ia i i ta a ta
i ig a it a t a at a i t
ta a at t ma ga t a a tt ta t tat i a
t ga ai i a
a at i i t
ga i a t am a a t a i i a
t a a a i t ai a a ga i g ga ai ga
ta a ta a ga a
ig ma i i g t t t ai i g i a i a t
i t a t i a t t
7.2.4 Major achievements of FY 2075/76

st
i gat a a
i i ta a ta i a
t i ta a ta m a ai a t i m i a
a i t i ta a t i t
ma t a m t i a ma
Status of health care services, fiscal year 2075/76

m a t i a t a t a i a ma a i t
a t i t a t a tm t i t at a mi i a i ag
a m t imi a it a

a i
mi g i a ma g i i t m i
ta a ta a at m t i m i ai ia i
a m i t i a a a a ig t a
a i t ia i i m i t i
7.2.5 Status of specialized diagnostic services

m a t t i a m ta t t a
a a a i t a a imi a t m
a i t at t a i ga a a
t ta m B a a t at B a
tat ma at B a a t i a a a t
t a t ta ta i t i a a t i a
ta t m a ig t a t at i a
7.2.6 Status of Financial Resources,

t ta g t it i t a
7.2.7 Physical infrastructures at SDNTC- FY 2075/76
ita a a i
B i i g
ita m a at
t at t a ai a
ta at t a ai a
m a i g
a i a i m t
a ma i
a at i m t Bi mi t mat g mi t a a
a t mat imm a a a a a t mat ta mi t m
a t mat ag a a a t a t mat mat g a a
ia i a i
a i m t at it i g m
i m i at a a
i a
at a
i ta
m at a
a
t g B a ag t m
m
B
B
at

 TEE Probe
 PCA Pump
 EBUS
 ECMO
 ABP
 Halter
a  i
TMT
7.2.8 Status of House Keeping at SDBNTC, FY 2075/76
7.2.8 Status of House Keeping at SDBNTC, FY 2075/76
SN Activities Remarks
1 Cleanliness of the hospital Satisfactory
2 Maintenance of hospital premises Satisfactory
3 Sanitation Satisfactory
4 Health care waste management Satisfactory
5 Safe drinking water Satisfactory
6 Canteen Satisfactory
7 Triage system Satisfactory
8 Hospital parking Poor
9 Hospital garden Poor
7.2.9 Challenges:
a a a
a a at a
7.2.9 Aims of SDBNTC in FY 2075/76
t ma i a a g am ga ai ga a a
ta a ta a t a
m t t ma i i at g i t g t i
t ai i g a t i a t
t at a t i ta a t a
t at a t i ta a ta at g m t
a t a a it t
t t a am ia t a at i i t
7.2.10 Available Services of Shahid Dharmabhakta National Transplant Center
i a a t
i a a t
g m i i a ma a g g it a
a ma t at t i
g i i B t
at t g at g
at i ta
a a i t t m
B
a t B a Bi t a
i g
a i g a i t a i a a g
g
at g
B
g ita at
a g
a at g
B
a i g am
B g Bi
a i iag i
a
ta
at g
ga a
i t a
a ma
a i
7.3 Homoeopathic Services

7.3.1 BACKGROUND 7.3 Homoeopathic Services
7.3.1am a
BACKGROUND ma ma a i m at i t m t a a
Dr.t amuel
i H i ahnemann
i a of ermany i i had
a discovered
imi ia imi i a system
omoeopathic t i i two
before i i half
and
t centuries.
a i Thisig isabased m
on tfi m i it of aimiliat imilibus urantur . edicine is provided on the
ed principals
basis of sign and symptom e hibited by patients.
i t ita i i g m at i i t t a i t i t
is the only
m oneathospital
i tproviding
mi homoeopathic
mi a aservices to the people
a i g of Nepal
i in the tpublic
a sector. The
homoeopathic
ita i system is
i economic, easy and effective having ero side effect as well. The hospital
provides PD service only.
7.3.2
7.3.2STRATEGIES
STRATEGIESADOPTED
ADOPTED
This is the only one hospital of omeopathy in Nepal. This system is economic, easy and
i i t ita m at i a i t mi mi a a i t
convenient, covering most of the diseases with no side effect from the medicine being used.
i gm t t i a it i t mt m i i i g a t a
PD
t m patients are
B t outnumbered.
t a But, due toalack at
ma of manpower
g a andi pathology
t i a lab IPD tis not
atmin t
action.
i The treatment
i provided
t here is free of cost.
7.3.3 SUMMARY OF ACHIEVEMENT

7.3.3 SUMMARY OF ACHIEVEMENT
m
The number of apatients
t i iis increasing
a i g a day by
a day.
m omet of the referred
a acasesa are
t also
at treated i
aheregi likei allergic
i a ia a urticaria,
rhinitis, g a a laryngeal
i ma papilloma,
a t P Di andi other
a ta diseases.
skin i i
Total
i service provideda in FYmma i i a
2075/76 are summari ed in Table 7.1
Table
Table7.1:
7.1:Description
Descriptionofofpatients
patientsvisited
visitedininHospital,
Hospital,fiscal
fiscalyear
year2075/76
2075/76
Particular Number of Patients
eneral edicine 5,302
kin 21,125
.N.T 3,135
ye 2,025
Dental 1, 06
yn/ bs. 2,530
ther ,525
Total Patients 84,448
7.3.4HEALTH
7.3.4 HEALTHCAMP
CAMPSERVICES:
SERVICES:FISCAL
FISCALYEAR
YEAR2075/76
2075/76
1. Bethan chowk Gaupalika ,Dhunkharka {Health post}, Kavre
B t Total
a numberaof patients
a i a 600 a a at t a
ta alem350 a t
a Female 250
ma
2. Kakani Gaupalika { Kakani PHC }, Nuwakot
a aTotal
i anumber
a i aof patients
a a i 05 a t
ta alem225 a t
a Female 1 0
ma

a i
7.3.5 Summary of
.3.5 Summary of Financial
Financial Allocation
Allocation and
and Expenditure
Expenditure
SummaryofofFinancial
Summary FinancialAllocation
Allocationand
andExpenditure
Expenditure
Fiscal Year Regular Budget in Rs Development Budget in Rs Total Budget in Rs
(in thousand) (in thousand) (in thousand)
2075/76 13,600 2,000 15,600
7.3.6 Constraints
7.3.6 Constraints
i. Lack of doctors, paramedics and other staffs made ineffectiveness in its services.
i a t a am i a t ta ma i i it i
ii. Doctors and other staff are not provided with higher training and education.
ii t a t ta a t i it ig t ai i g a a
iii. There is high need of pathology lab.
iii i ig at g a
7.3.7 Conclusion:
7.3.7 Conclusion:
This homeopathy hospital is central level hospital. It needs to be ungraded. People of
i m at ita i ta ita t t ga at ma
Kathmandu valley and nearby districts can take free and convenient service of the hospital.
a a a i t i t a ta a i t i t ita a m
People far from Kathmandu valley are not able to take the benefits provided by this hospital. It
at ma a a t a t ta t t i t i ita t i a t i
is essential to provide service at all the 7 provinces of Nepal
i at a t i a

Chapter 8
g g am
SUPPORTING PROGRAMS
8.1 Health Training

8.1.1 Background:
a a at ai i g t a ta i i a t aa
i a ga g a t ai i g a i t a a t it t ai i g
a i i i it t a a at ai i g t at g a a i gt t t
i t i ii a t g a i t i t t i a a ma ag ia a a it
at i i at a t i a it at a i t a ai t ig t
a t tat ai i a i ia t ai i g t a ta
at a i a at ma aa B t a ta a ga i a i i a t ai i g it t
at t t ai i g a a tm t i ii a t t i it at a
a a i at a t t i ia at t ai i g t t
ti g t m t t ta g t ii i t a a at i B a a at
t t at g a tai a m t a
8.1.2 Goal:
a g a i t i at i a a ma ag ia a a it at i i
at a t i a it at a i t a a ai m t t m m at
tat
8.1.3 Objectives:
ta a i t t ai i g a i g a ag i ai i a i a t
a a a a i t t ai i g
ga i a ti i t ai i g t a t t t a t t
t a it a a i gt i i m t
t a it t ai i g a i i tm a im i a t a a
ta a a t a t a a it i t t ai i g it
a ta m t i a t ai i g a a
t gt m a i ma a a it t t ai i g a t
8.1.4 Strategies:
i g ta a i i g a a i g t ai i g a i a i i a t ai i g it
i ga ta a i i g t ai i g a ag
t a a a it m t t ai i g it
g i i i t t m a g t m t ai i g a a a
i m t
t g a ga i t a i i g t ai i g a i
i g i it i a a m t ga i a
t gt i g ai i g ma a ag m t t m a t ai at
a i ia a a

8.1.5 Training Netw ork of NH TC:
g g am
National health training network co- ordinates and supports seven Provincial Health Training
8.1.5 Training
CenterNetwork
( previousof Regional
NHTC: Health Training Centers/ Sub- Regional Health Training Center)
currently established under M inistry of Social development ( M OSD) of each Province and 4 9
a a a t t ai i g t i at a t i ia at ai i g t
i clinicalgitraining
a sites
a t ( F igure
ai i8 . g1 . 2 ) . The
t hospital- based
gi training
a a sites
t conduct
ai i g F amily
t Planning, t
ta i Sk illed B irth iAttendance,
it M iaid- L evel Practicum,
m t Safe Abortion a Services,
i Rural
a USG i, Anesthesia
i a t ai i g
it ig ita a t ai i g it t ami a i g i Bi t
Assistant, Pediatric Nursing, M edico- L egal and other types of training program. The new
a i a m a i a t ia i ta t iat i
i g organizi ational
gastructure
a t and ttraining network
t ai i gare asgshown
am in below. ga i a a t t a
t ai i g Figure
t 8.1.1 a New
a O rganizi ational Structure of NH TC:
Figure 8.1.1 New Organizational National

StructureH of NHTC:
ealth Training Center
Training Skill Development Training Administration

MaterialDevelopmen Section Accreditation and Section
t Section Regulation Section
Figure 8.1.1Training co-ordination W ings:
Training Netw ork

i a a a a it
NH TC

g g am
8.1.6
8.1.6Different
DifferentClinical Training
Clinical Sites accredited
TrainingSites by NHTC:
accredited by NH TC:
National Health Training Centre provides following training through different training sites as
a a at ai i g t i i g t ai i g t g i t t ai i g it a i t
listed below.
i i a ttraining
Clinical ai i g itsites
S.N Number Name of the training site site accredited for
Province 1
1 1 F PAN, Charali, J hapa Implant, IUCD, M inilap, NSV
2 2 AM DA Hospital, Damak , J hapa SB A, RUSG , M L P, AAC
3 3 M echi Provincial Hospital, B hadrapur, J hapa M L P
4 4 F PAN, Itahari G B V , PoP, SB A, ASB A, B RH, V IA
Cryo, CAC, M A
5 5 B PK IHS, Dharan PNC, V IA
6 6 K oshi Hospital, B iratnagar RH, PPIUCD, SB A, SAS, G B V , IP, COPF
Counseling, ASRH, G B V
7 7 Nobel M edical College, B iratnagar PPIUCD
8 8 Udayapur Hospital, G aighat G B V
9 9 Inaruwa Hospital, Sunsari G B V
1 0 1 0 Ok haldhunga Community Hospital M L P, G B V
Province 2
1 1 1 G aj endra Narayan Singh Hospital, Raj biraj RH
1 2 2 Province Hospital, J anak pur RH
1 3 3 Narayani Hospital, B irgunj SB A, PPIUCD
1 4 4 F PAN, J hanak pur, Dhanusa Implant, IUCD, M inilap
Bagmati province
1 5 1 Paropak ar M aternity and W omen' s Hospital, ASB A, SB A, Implant, IUCD, PPIUCD,
K athmandu ASRH, G B V , AAC, RUSG , CNC( SNCU) ,
V IA/ CRY O, STI, SAS ( CAC, M A, 2nd
Trimester Abortion Care) , M inilap
1 6 2 CF W C, Chhetrapati, K athmandu F P, ASRH
1 7 3 B hak tapur Hospital, B hak tapur ASRH
1 8 4 F PAN, Pulchowk F P, SAS
1 9 5 M SS, Satdobato F P, SAS
20 6 F PAN, Chitwan F P, SAS
21 7 M SS, Narayanghat F P, SAS
22 8 B haratpur Hospital, Chitwan ASB A, SB A, M L P, SAS, OTTM , G B V
23 9 PHE CT Nepal K irtipur Hospital, K athmandu SB A, F P, V IA
24 1 0 PHE CT Nepal M odel Hospital, K athmandu SAS, V IA, AAC
25 1 1 Nepal M edical College, K athmandu 2nd Trimester Abortion Care, SAS
26 1 2 Army Hospital, Chhauni, K athmandu SB A, F P
27 1 3 TUTH, M aharaj gunj , K athmandu NICU, ICU, OTTM , PNM , M edicolegal
28 1 4 K anti Children Hospital, K athmandu Pediatric Nursing care
29 1 5 Nepal Cancer Care F oundation, L alitpur V IA/ CRY O
Gandaki province
3 0 1 Pok hara Academy of Health Science, RH, G B V , AAC
Pok hara
3 1 2 Community Hospital, L amj ung SB A, M L P
3 2 3 Dhaulagiri Provincial Hospital, B aglung SB A, M L P
Province 5
3 3 1 L umbiniProvince Hospital, B utwal SB A, SAS, G B V
3 4 2 B him Hospital, B hairahawa SB A
3 5 3 AM DA Hospital, B utwal OTTM
3 6 4 F PAN, B utwal F P, SAS
3 7 5 M SS, Chandrauta, K apilvastu F P, SAS
3 8 6 L umbini M edical college, Palpa F P, RH
3 9 7 F PAN, Dang F P
4 0 8 B heri Hospital, Nepalgunj RH, G B V
4 1 9 M ission Hospital, Palpa SB A, M L P
Karnali province
DoHS,4 2 Annual 1 Report 2075/76 (2018/19)Hospital, Surk het
K arnali Provincial SB A, F P ( Implant, IUCD, NSV , M inilap)
4 3 2 K arnali Academic of Health Science, J umla SB A, IP
Sudurpaschhim province
4 4 1 Seti Provincial Hospital, Dhangadhi RH, G B V , M L P
4 5 2 M ahak ali Provincial Hospital, K anchanpur SB A
4 6 3 F PAN, K anchanpur F P
4 7 4 Dadeldhura Hospital SB A, M L P
4 8 5 B ayalpata Hospital, Achham M L P
3 6 4 F PAN, B utwal F P, SAS
3 7 5 M SS, Chandrauta, K apilvastu F P, SAS
3 8 6 L umbini M edical college, Palpa F P, RH
3 9 7 F PAN, Dang F P
4 0 g8 g am B heri Hospital, Nepalgunj RH, G B V
4 1 9 M ission Hospital, Palpa SB A, M L P
Karnali province
4 2 1 K arnali Provincial Hospital, Surk het SB A, F P ( Implant, IUCD, NSV , M inilap)
4 3 2 K arnali Academic of Health Science, J umla SB A, IP
Sudurpaschhim province
4 4 1 Seti Provincial Hospital, Dhangadhi RH, G B V , M L P
4 5 2 M ahak ali Provincial Hospital, K anchanpur SB A
4 6 3 F PAN, K anchanpur F P
4 7 4 Dadeldhura Hospital SB A, M L P
4 8 5 B ayalpata Hospital, Achham M L P
4 9 6 AchhamHospital, M angalsen M A
Figure 8.1.2: Province level training sites
1. Seti Province Hospital, Dhangadi

2. Mahakaliprovince Hospital, Mahendranagar 1. PMWH, Kathmandu
3. FPAN, Kanchanpur 2. CFWC, Chhetrapati, Kathmandu
4. Dadeldhura Hospital 3. FPAN, Pulchok
5. Bayalpata Hospital, Achham 4. Bhaktapur Hospital, Bhaktapur
6. Achham hospital, Mangalsen 1. Karnali province Hospital,Surkhet 5. MSS Satdobato
2. Karnali Academy of Health 6. FPAN, Chitwan
Sciences, Jumla 7. MSS, Narayanghat
8.Bharatpur Hospital, Chitwan
1. Pokhara Academy of 9. PHECT Nepal kritipur Hospital
Health science, Pokhara 10. PHECT Nepal Model Hospital
2. Dhaulagiri province 11. Nepal Medical College (NMC)
Hospital, Baglung 12. Army Hospital, Chauni
3. Community Hospital, 13. TUTH, Maharajgunj
lamjung 14.Kanti Children's Hospital
Sudurpaschhim 15. Nepal cancer care Foundation,
Karnali
Gandaki
Bagmati
1. Lumbini Province Hospital, Butwal
2. Bhim Hospital, Bhairahawa
3. AMDA Hospital, Butwal
4. FPAN Butwal
5. MSS, Chandrauta, kapilvastu
6. Lumbini Medical College, Palpa
7. FPAN, Dang 1. Gajendra Narayan singh
8. Bheri Hospital, Nepalgunj Hospital, Rajbiraj,
9. Mission Hospital, Palpa 2. Province Hospital, Janakpur 1. BPKIHS, Dharan
3. Narayani Hospital, Birgunj 2. Mechi provincial Hospital,Jhapa
4. FPAN, Janakpurdham, 3. Koshi Hospital, Biratnagar
Dhanusa 4. AMDA Hospital, Damak, Jhapa
5. Novel Medical College, Biratnagar
6. Okhaldhunga community Hospital
7. Udayapur Hospital, Gaighat
8. Inaruwa Hospital, Sunsari
9. FPAN, Itahari
10. F PAN, Charali, J hapa
F igure 8 . 1 . 2: Province level training sites

g g am
8.1.7 MAJOR ACTIVITIES CONDUCTED BY NHTC
8.1.7.1 Training Material Development
i gt ai i g at ia m t i t t ai i g ma a
i t i a it t m t a m t at i i a
i ma ag m t ima a ma a a ag a am i a ta imat a g a
a t m a t a ia a B a ma ag m t iat i i g a a a
i t Ba i i t a i ia i a ag i ta i at a
a i g at a i ta a t a i it a a ma ag m t mmi
i t a i g a ag a t ii a
m ti a m t ma i ia i ta
a a at a a t Ba i i t B t a gi a ag m t
ia i g at i ai i g at t g at
at a a t ma ag m t a t Ba B at at t i i m ta
at at a a t ma ag m t a ga i a a a a it m t
a i ga t ai i g t
8.1.7.2. Skill Development
t ai a ma t ai i g g am at i ia a a i it ia
m ti i t i ta i g t mai i ta i g
i i t ai i g g am t i ia at ai i g t ta
i m at ai i g ai ia i i a t ai i g
i ga a t m t t ai i g g am ma ag m t g i i
it g i i t ai i g ma a m t a ii m it i g g am a
t a i itat t i ia g t ai i g g am
The Skill Development Section of NHTC conducted the following types of training:
a. P re-service training: i t t i t ai i g t i ma i
Bi m i a i m t gi i g m t a t ia i ta t a
a it B t ai i g i ta g t t t i g a at i a
i m i a i m t t i ia a t ai i g m t m a ai
mai t a at a i m t a a a m i a i
i i a i a a i i t ai i g i i ig a a ta
i i gt t ta a at i ta t a t a i at t i
a a ga a t a i t ai m g g i
ia t a a a i i a ita i t a a t i gi t
b . I n service trainings: i g a t i tt i i t ai i g t
1. U p grading T raining: i g a i g t ai i g a ig a t a t
i ii a t t ai i g a ag aim t t i t im m t
g am a im ma a g a i g t ai i g a
a at
2 . C omp etency and clinical-b ased training: ga i ai m t a i i a a

t ai i g i g g m t at i i a it m i i a t ai i g
it t ga t g a i t i i i m i i a a a

upgrading training were planned and held at NHTC.
2 . C omp etency and clinical- b ased training : NHTC organiz e various competency and
clinical based training for ex isting government health work ers in coordination with
multiple clinical training sites to upgrade the k nowledge and sk ills of the service
g g am in multiple clinical areas. These in- service trainings are based on local need and
providers
i i
t aidemand
i g a anda are supported,
a a
developed, ma a a according
and updated t to the nationala and
at a international
i g t t practice
a aanda scientific
i t evidence.
a a Twenty
a acoursesi are offered
i which are listed
t
a i a it i
in box below:
Types of Upgrading and Competency and Clinical-based Training Courses

U p g rading C omp etency and clinical b ased cou rses
cou rses
 Senior aux iliary  Sk illed birth attendance  M id- level practicum ( M L P)
health  Advanced sk illed birth  Palliative care
work er training attendance  Pediatric nursing care
( 6 months)  Rural ultrasonography ( USG )  G ender based training
 Senior aux iliary for nurses  Clinical training sk ills
nurse- midwife  M edicolegal Training ( CTS)
( 6 months)  Non- scalpel vasectomy  Operation theatre techniq ue
 Aux iliary  Intrauterine Contraceptive and management ( OTTM )
nurse- midwife Device ( IUCD)  Infection prevention ( IP)
Padnam ( P) ( 6  Postpartum intrauterine  M ental health
months) contraceptive device  Comprehensive family
 Aux iliary ( PPIUCD) planning ( CoF P) counseling
health work er- P  M inilaps  Primary trauma care ( PTC)
( 6 months)  Implants and emergency trauma
 Aux iliary  Safe abortion services management ( E TM )
health  Comprehensive abortion care  Adolescent and sex ual
work er( 1 5  M edical abortion reproductive health ( ASRH)
months)  Pack ages of E ssential Non-
 Aux iliary communicable Diseases
nurse- midwife
( 1 8 months)
3 . R efresher training : A range of refresher trainings are conducted as per the needs of
3 . Refresherdivisions
training: anda centers
g t ai the
to develop i g sk aills for implementing
t a t new programs i i and
i to
a t t improve j tob performance.
i im In m this gfiscal yearg am a t im ma
207 5/ 7 6 , the refresher training courses
t i a a t t ai i g i i it a a t B
ami
includea fori skg ailled birth
a ia attendants
a ( SB As) , V IA/ CRY O, F amily planning and Palliative
care.
. Orientation programs: t t i ii a t t i ta
4 . Orientation p rog rams: NHTC supports the divisions and centers to develop orientation
a ag a a t ai g i ta at a at
i i g ages and
pack a t preparea i it pools of
a trainers
a fora conducting
ag m t orientations
mmi m and
for health m non-
a i ta healthg work am ers including
a i g at fora Health F acility Operation and M anagement Committee
288 DoHS, Annual Report 2075/76 (2018/19)
( HF OM C) members and orientation program on planning at local levels.
5 . B asic training : B asic trainings are organiz ed for F emale Community Health V olunteers
(FCHVs) who are newly recruited by the local mother’s group among the member. The
duration of this course is 1 8 days. This training is not being conducted
6 . S erv ice I ndu ction training : NHTC has begun providing induction training for newly
g g am
5. B asic training: Ba i t ai i g a ga i ma mm it at t
a it t a m t g am gt m m a
t i i a i t ai i g i t i g t
. Service Induction training: a g i i g i t ai i g

it a ga t at a at i g m
m t a i g a a i a at i i i i
7 . O thers:
t t ai i g i
ai i g t a a ga B g ta t t m B
Bi m i a i m t a i ta t t ai i g B
Bi m i a i m t t ai i g ai a at a
8.1.7.3. Training Accreditation and Regulation
ita a g a i i a i ga iat i i a a
m
t a t ai i g a
t ai i g it t m t a it
i i g t ai i g i i i t m it a g at a i g
mat ia i i m a t ai i g g am t t i ii a t
a t g at ta i m a g i i t
a ta a i mai tai i g a it t ai i g i i a i t m t ai i g
g am i a m t t ai i g m it i g a a t
it a it it a i t i ta
8.1.7.4. Institutional Capacity Development
t i ga i t i t a a a it m t t ai i g
• Physical facilities:
t a i itat i at t m t ita a t ai i g it a
t a ma g it t i it i a t a at i a
a ii a i m t
• Training program development:
t t ai i g g am a t a t ta a
a i itat i a t i ii t i a t ai i g it a a
im m t a ma ag i t t ai i g a t t ai i g im m ti i a
a a a it t a m t at i at i a m i a
g
• Capacity building:
t a a it ta a i ia ta ii t t ai i g a
m t ia i a a t t gt a a g a i ta
i i ga t it t a i at i i t a a a i t a a mi a
t ai i g a i t g am

g g am
• Training Working Group:
ig ai i g i g i m i t a i i
m i t m m i g m t a t a m t at i m t
g a ai t i t ai i g a it im m t i m m t a a
t ai i g a ita
• Training Information Management System (TIMS)
ai i g ma a ag m t t mi a a i a t ma ag t t ai i g i g
ga a at a t ai a i t ai i g it a i i
ti a a i a i t a i ma ag a t ai i g at
ata i i g t ai a a i a t t ai i g i ma t ai i g g a
a i a i i it i t a it a i i i a ta a ga i a
t a a t a it t ai i g it a a it im m t i t t ai i g
t ma i i i t i a a a i t mai tai t ai
gi t a t m it i
8.1.7.5. Follow –up Enhancement (FEP):
a a at ai i g t a i i g ai i i t ai i g t im
at i ii it a t a i t a t a tai i g a i i gt
i t at t a at t i it i i t at t tai t g a i
at a a m t i a t i ga a a i
i a a it i im t t i i at a a a m t
g am i
a a i g t g a i t ai t t ga a i it
a i g a it a a t a i g i m t i t m g i m t
t am t t am a i a t t ai a t a i it a a
a ag m t mmi i a ta ta t at t a
t ga g am a
a t t g a i t t ai
i it a i g a ga i g
a t a i g i m t a it
a a i g t a t ta Bi t i g t i a
ta
8.1.9 Annual target and achievements
a. Program activities
a a i m t it a a t ai i g ta g t i a t ai a t
am g i ma a ma t ai i t a i g t ai i g
a i a m ma a a i i gm t a t t ai i g ta g t
i a ia a B iat i i ga
t ai i g a i a g a a a ia g a i
t

activities, NHTC has performed remark ably by achieving more than 1 00% of the training target
in V IA/ CRY O, CoF P, ASRH, Palliative Care, SB A, NICU, PPIUCD, PE N, Pediatric Nursing
and Infection prevention training. The overall physical progress was 1 04 . 1 0 and financial
progress was 91 . 23 in the F Y 207 5/ 7 6 .
g g am
b. Budget and Ex penditure
B g ta it
The data shows thepercentage of budget spent with respect to budget allocation in F Y 207 5/ 7 6
ata t tag g t t it tt g ta a i
m a
compared tto previous
i F Y s.
tat Status
g t aof budget
a allocation
a a and
ia financial
g i progress
t in three consecutive
a a fiscal years
Budget FY 2073/074 FY 2074/075 FY 2075/076
(in NRs ‘000) (in NRs ‘000) (in NRs ‘000)FY
A l l oca t ed E x p en d i t ure A l l oca t ed E x p en d i t ure A l l oca t ed E x p en d i t ure
B ud g et (% ) B ud g et (% ) B ud g et (% )
Central level 1 8 8 , 4 50 8 0. 6 2 204 , 1 4 9 90. 3 1 0, 3 7 , 00 91 . 23
8.1.10.
8.1.10.ISSUES AND
ISSUES RECOMMENDATIONS:
AND RECO MMENDATIO NS:
M a aj ori issues, problems m raised t i year’s
ai atatthis a national
a aanda regional
gi review
a imeetings
m areg listed
a in it i
aTable. Ma a j or Is s uesa a n d R ecom
mmm en d aa t i on s
 M anage a separate pool of trainers from  Consolidate the overall training needs of health
different disciplines service providers
 Unplanned selection of participants:  Consolidate all training program run by
– Training plan for program and service divisions and centers through NHTC.
( district and respective division)  Improve the q uality of training by regularly
– Training as incentives rather than need updating trainers, by post- training follow- up, by
based and carrier development preparing a roster of master trainers and by
 Multi‐door trainings ensuring training q uality as per guidelines
 L ack of strategic and uncoordinated  Recogniz e competency based training for career
approach to training, e. g. staff may be development
trained but lack the eq uipment req uired or  Design and develop practical training which
opportunities to practice their sk ills. encourages ‘learning by doing’ and links
 F ocus of training on transfer of k nowledge directly to an individual’s job/ tasks
( theory) rather than developing practical  E stablish a national health resource unit at
sk ills NHTC
 Inadeq uate training follow up mechanism  Rapidly assess the needs of NHTC, RHTCs and
training sites including infrastructure and human
resources.
 M ak e transfer policies and guidelines
 Revise the selection criteria for upgrading
training
 Develop regulating bodies to ensure q uality and
standard of training

g g am
8.2 Vector Borne Disease Research and Training

8.2.1 Introduction
t B i a a a ai i g t B a ta i i t a
it t am a a ia a a ai i g t t a a a ia a i a
ga i a i a am a B i ma it t i g it i ga a
i t i i a a t ai i g B i i g a a ia a a a a g
i g a a m a a ia i t a a a ai
8.2.2 Major activities carried out in fiscal year 2075/76
Training:
8.2.2.1. VBDs training for health workers
t i t ai i g i t at t g i a t gt ma ag m t
a a it at B i a a B t ai i g a t i mi
a ia a i at iti t m t gi t a i i a ai i t
ta g a i i t ta i i g
a t ai B
8.2.2.2 VBDs training for physicians, pediatricians and medical officers
t i t ai i g i t i t t a i a t t atm t t B
a t a i itat a iag i a a iat t atm t B t ai i g a
t i i g ita a ta i a ita a ama ita a a i ia
iat i ia m i a g ai t a a i itat t ta t i t i
t a a
8.2.2.3 Malaria microscopy training
ig t mi i ma a a ia i i tg ta a t i
ma a ia iag i B i i i g ai a ma a ia mi t ai i g t
a at t i ia a i ta t i g i t ma a ia mi a a t
m t t ma at mi i t
8.2.2.3.1 The basic malaria microscopic training
i t ai i g i i t t i t a at a t ma a ia
mi a a i i ma a ia iag i t i a it t a
t i i i g m a aa tai i g a mi i ami a
ma a ia a a it t t m t i t ai i g i t i a i ma a ia
mi a it iag i a t a i i i i a iag i a
i a m i m a a it t ta t ai i a i ma a ia
mi at B
8.2.2.3.2 The refresher malaria microscopy training
i a t ai i g i i t t i t t a i tai ai

g g am
mi t ai i g t at a ga t i i ma a ia mi a t
t gt t ma a ia mi a at i i ma a ia mi i t i t t ta
t ai
8.3. Early warning and reporting system on-site coaching programme
a a i g a g t m it a i g i t im
i g g t m t gt i a t m B a t i mi t a
i a a ag m a m t g g amm a t i
ita t ta a i at i i g m i a i t t m i a
a m i a im i a m t t g a im i
t i t ita
8.4. Molecular diagnosis of Malaria and dengue using PCR at VBDRTC
B i iag i a it a a i a a t a
i ga ma a ia a t i g g i a t ta m am
i ga t t m g i am
g g a mai i g mi it g g
8.5 Research activities
8.5.1 Serotyping of dengue virus and entomological survey of its vectors in Gandaki
province
Introduction
a g t a a it a a mi g im a t t ma at
a t a a mi m i t i i g
imm it t ti t t ma i a t i i g
g g t i a g t t i ma agi g
a a a t t mi g t a a i ga iat
t t m t
8.5.2 Methods
i ita a a t a a i m g t t at
i g g a am g a i a t i g t atm t i i t ita m i a
g i g m i at a mm it g m t ita i g ta a
ai B am t t m g g a g
a i a m am a t i g g i i g
8.5.3 Results
t ta g a a t i m ga i i i a t
i ma t a t a t g i m am t
i am t t i g g i i g a m m g
i am g g a mai i g mi it g
g i g t g i i a ima t g
t a mi i i a a g it i t ig i a t i ig it

g g am
8.5.4 Conclusion and Recommendation
t g a t t t i g a mi a t i a g
t i t a i aa t
ita t a it i g
i t i t a g it a g t t i ma
i a a i a t t t i i g i mi g g i it
a i g it ma m a ai t m tai t t t gt t g
t a i a t a a i a a it at a im i g B
i a t m
8.6 Study on Microepidemiology of PKDL
8.6.1 Introduction
i i a a im ta t i a i i t i t a t atm t
a im ta t imi a t t m tt a
at i a t t at aaa a a t i i a t i g
m tt a i ma ia a ii am g at ta t i i g
t g t a i g a a m tt a t tat it i a
a t i i g it a
8.6.2 Methods
t t t a t m a t i a a a g ai
a ta i a ia a iti t i a t ig mi aa a a a
am g t a t t at a
8.6.3 Results
8.6.3.1 Prevalence and risk of PKDL in previously treated Kala-azar cases
t t a a i t at aa a a it
it i it m t i i B a t a gim
i ma m t i i B a a i it i t atm t
a i t atm t gim i m t i i B t atm t a i i ma
m t i i B t atm t t ta m a t t at
g a t t a at a a it i t at g
t a at a t i a iat a a i a ig i a t a iat it
i a at it i t atm t i t at aa a a B t
i g mai i t ig i a t i t m gi g i m a t
i t a it i t a a a a a a t atm t it i a a
it i a g i a im ta t a g a t a t t
a ig i a t t i t a t a t ag g
8.6.3.2 Leishmania donovani infection in healthy individuals
t at i i i a i i gt g t it a a i g
t t it a a a a i gt a

g g am
8.6.3.3 Entomological findings
t i ag it a m t ai i a a iti t i t
t a i g t a ag ii i a i g t a t
t mi a i a ata i a i g t m ia i a t mt
a a t a a aa a a t i t m
ag i a a t a i a t g i a a i at
t a mi i t aa a a i t a a
8.7 Entomological activities
8.7.1 Insecticide susceptibility status of Anopheles fluviatilis against different insecticides
a t ma ia i m it it
a m t i m ta it imi a t t i a t
ma ia i m it it am a a t i a
m ta it i t i a t ma ia i m it
t m ta it m ta it a i
i it t t m t a t ma
ia i m it it a at i a i t it B i a t
m it t m i ata i ag a a i t i ta i it t t
m at B
8.7.2 Insecticide susceptibility status of malaria vector Anopheles annularis agains

Alphacypermethrin and Lambdacyhalothrin
t t a t ma a
ai m it t m
a a i i ag a m a a iti t agai t a m t i
m ta it a t agai t am a a t i
m ta it t tai t i t it i ta a i a t a t ma
a ai m it t agai t ig ta
a m t i a m ta it a
8.7.3 Entomological survey of dengue vectors in different localities of Pokhara

metropolitan city during Pre and post monsoon priod.
t t m gi a a t t mi t i g a itat a a
m it i i g a tm a m it a
a i ti i t ai a aa t ita it a i i t i t i gt
m i t a at i g tai
i t i i i aa at ai t ag i t a ag ga t t t tt
m it i g a itat m g t
i a a m gt at i g tai i t
i t it m it a a a tai B t
a a i a m ga t at i g
tai i t ig t i it tag m it a a a i
a m a t m i t m ta m ai t t
a t t ta a t m i t t
at i g tai t a m g a t tag

g g am
breeding habitats. Amonga thesei surveyed t a houses, 4 9 ( 4 6 . 6 %) ahouses g werei foundmpositive fort A m ed es gi a
larvae. Among these 4 3 6 water- holding containers inspected, 1 03 ( 23 . 6 %) were found infested with
A ed es mosq a uito larvae.a t atoverall
The t House hold, m Container, it i and Pupal
B ruto a gIndicesawere 4 6 . 6 6 , 23a . 6 2, i t
i t i t a i t ta
98 . 09. 00 and 3 04 . 7 6 respectively. Among all the water- holding containers inspected, at i g tai highesti t am g
positivity
i t it
percentage of A ed es mosq uito larvae was recorded in plastic drums ( 8 . 8 %) , followed by automobile tyres m it a a i g t
m ( 7 . 4 %) , metal a drums t ( 2. 3 t tt
%) , paint buck et ( 1 . 9%) , plastic m
buck et ( 1 it
. 4 %) i g a itat
respectively. A total of m
3 20 pupae
t were collected from m different
g t types of water- holding containers. All collected i pupae were emerged m itadulta a
stage. 1 8 2 ( 56 . 9%) were A ed es a l b op i ct us and 1 3 8 ( 4 3 . 1 %) A ed es a eg y p t i . This pre- monsoon
a t m gi a i i B a a
entomological survey also revealed that both A ed es mosq uito species A ed es a eg y p t i and A ed es a l b op i ct us
m ex gisted
co- a tin theat surveyed ilocalities.
g taiA totali of 21 1 t water-igholding t containers i it tag among surveyed
inspected m it
a6 0 ahouses, a 96 ( 4 5. 5%)i were a found infested
m with A ed es mosq uitot larvae duringmpost ta m on s m
oon s ea s on to a
t
detect the presence a ofaA ed es mosq uito i gbreeding habitats froma207 5/ 07 / 1 5 to 207 5/ 07 a/ 1 7 . mi Amongat these
houses, 4 2 ( 7 0. 00%) t ta were found t a
positive for A ed aes mosq a
uito larvae. m g i t a t tag
The overall entomological indices
HI, CI, B I and PI were 7 0. 00, 4 5. 5, 1 6 0. 00 and 3 6 3 . 3 3 respectively. Among all the water- holding
a g a a i t
containers inspected, highest positivity percentage of A ed es mosq uito larvae was recorded in plastic
drums ( 23 . 2%) , followed by tyres ( 9. 9%) , metal drums ( 5. 2%) , plastic pots ( 3 . 3 %) , plastic j ars ( 1 . 4 %) ,
8.7.4 fridgeEntomological
vessels ( 1 . 0%) , survey of dengue
plastic bottles ( 1 . 0%)vectorsand milkof crateDharan( 0. 5%) respectively. A total of 1 3 4 collected
and rared pupae were emerged into adult stage were 7 0 ( 52. 2%) A ed es a eg y p t i and 6 4 ( 4 7 . 7 %) A ed es
a l b op ti ct usmi. t i g a itat a a m it i a t ta
i i t ai a aa m t ita it ai
8.7.4 Entomological survey of dengue vectors of Dharan
iti t m t m g
Toi determine the breeding
m it a and
habitats a prevalence
a of A edates mosq uito
i gspecies,
tai a total of 1 02 i houses t werem g
surveyed in different localities of ward no. 1 5 of Dharan sub- metropolitan city, Sunsari district from
t 207 6 / 03 / 1 0 to
at 207 6 / 03 i/ 1 g6 . Amongtai surveyed houses, 6 5 ( 6 3 . 7 %) housesi twere found
it m it a a
positive for A ed es
ig uito larvae. Overall,
mosq t m gi3 6 1 a water- i i holding containers were inspected.
i g t i Among these 3 6 1 awater- holding B a
containers, 1 1 8 ( 3 2. 6 %) were a found infested with A ed mes mosq g a uito
t larvae. at High levelsi g of tai i
entomological t
ig
indicest were observed
tag during thismsurvey.it The a overall
a aHI, CI, B I andi PI were a 6 3 .7 , m 3 2. 6 , 1 1 5. 6 and 1 28 . 4
respectively. t Among alla the water- t holdingacontainers
t m i inspected,
t a percentage
highest m ta ofmA ed es mosq uito
larvae was recorded in plastic drums ( 1 3 . 5%) , followed by flower pot ( 4 . 1 4 %) , plastic pot ( 3 . 6 %) ,
t ta a t m i tt at i g tai m g
automobile tyre ( 2. 7 %) and metal drum ( 1 . 6 %) respectively. A total of 1 3 1 pupae were collected from
i different
t a ttypes tagof water-
m holding gt a g a
containers emerged into adults stage. Among these, 1 24 ( 94 . 6 %) were a i t t
a t at a g i t m t a t m it i i t
A ed es a eg y p t i and 7 ( 5. 3 %) A ed es a l b op i ct us . It revealed that A ed es a eg y p t i is the most prevalent A ed es a i
mosq uito species in the surveyed localities.
8.8. Financial Achievement
8.8. Financial Achievement
Fiscal Allocated Total Expen Remaining Irregularity Irregularity to
year budget Expenses ses % Regulated be regulated
(cumulative)
22,600,000.00 16,366,998.55 72 6,233,001.45 0 29,700.00
30,030,000.00 15,235,068.58 51 14,794,931.42 0 1015973.10
23260000 20459136.09 87.9 2800863.91 1015973.10 0
8.9. Problems/ constrains

S. N Problems/ constrains Action to be taken Responsibility
VBDRTC’s Office & dormaory for trainees is Health office & Educational Directorate VBDRTC & MoHP
occupied by health office Makawanpur and to be managed in other place. /MoSD
educational directorate, Hetauda.
Old infrastructure: dormitory, office building and Hostels, office and staff quarters to be VBDRTC/MOHP
quarters. renovated.
Vacant post: parasitologist, entomologist & VCO Vacant post needs to be filled VBDRTC/MOHP
Lack of vehicles for training, research, surveys and At least one vechicle should be provided VBDRTC/MOHP
outbreak investigation of VBDs. for field program.
Lack of sanctioned post for microbiologist, O & M survey to be done to revitalize VBDRTC/MOHP
epidemiologist, research officer and statistical VBDRTC.
officer.

g g am
8.3 Health Education Information and Communication

8.3.1 Background
a a at a
ma a mm i a t i t a
t i it at a
a a i g im m g m it i g a a a g
a at m a a mm i a g amm i i g i i
a a t t i g i t a a at mm i a i
a t a a at i mm i a t at gi a t at at a
a
i i t t t at g amm a i t a i a aat
g a a t g at m a i ma a mm i a a a
t i t a a at m a a mm i a g amm
i i g m t a at i i a t a a ia m i i a a
ma g a i a g a mm it a ia a g t at gi t im m t it
g amm
8.3.2 Vision:
aii at a i a ga i
8.3.3 Goal:
g a i t ti t t t a ai m t t ig t at t
t a
8.3.4 Objectives:
g a a i ma a mm i a at i t ai
at a a t a a m a t m t im at tat a t
t i a t g t t t t m a t g ia
a ai a
The specific objectives of NHEICC are listed below:
m ii a m a ta i a mm i a m m ia a m t
t ai at a a g a m t at a i am g t
g a i
t gt a a im m t a t mm i a g amm at a
g at t a m ii t im m t at mm i a
g amm
tt a t i i mi a a i a at at m ag
i ma a mat ia i ti
a a a it at mm i a t a i mi at
a it t a t i i ma a iat m ag a i ma
i a it a t m ag a i ma t g a iat m ia a
m t t t i t i a i a t m ag a
i ma

g g am
8.3.5 Strategies:
a ia m ii a a a i a g mm i a a t ma
t at gi at m a a mm i a i t at gi a a
a g it a t i i g at i i a at i
a i i
m m g a i t g at a a a at mm i a
g amm
i ga at g t at mm i a g amm
i a g a a a g it a ta t g t i a
mmi a t m a
i g im m ta at mm i a g am t g at
i at t at a a g m t i a i ia a a i
a t ai ma
i i i g mm i a m ia m t a mat ia t i a
a m at
ta a i i g a t m ag a i ma i mit a a iat
i g tai m t a a it a a mat i mi a g at
m ag a i ma
i g t at a ta i mi at a t m ag a i ma a ta i g
t m a t i
agi g t m ia t i mi at m ag a i ma at i
agi g t i mi a a t m ag a i ma t g i
i at a t i
i agi g m ag a i ma t at i a m t at
i i i g i t i a m ag a i ma i mi a
B i i g t a a it at t a a im m t at mm i a
g amm
i g t a it i mit a ta a i a a t m ag a mat ia
t g t i a mmi
t i g mm i a t gi at m a at
mm i a
i a g it a a mia i i g t a a it at at
m a at mm i a
t gt i g m it i g a ii a i t t mi t ga i
g a t a a am g ta g t a i a i i
8.3.6 Major activities and achievement by federal, province and district level in 2075/76
at a i ma a mm i a at m a i t at a i
t a i t g i a it i t i g ta ta

 Strengthening monitoring and supervision activities to determine the gaps in knowledge,
attitudes and practices among target audiences and service providers.
8.3.6 Major activities and achievement by federal, province and district level in 2075/76
Health education, information and communication (health promotion) activities that were carried
out by federal level in the reporting period are listed in the following table (table 8.3.1). g g am
Table 8.3.1: Major activities carried out by federal level in 2075/76

 Development, production and distribution of IEC  Health awareness and communication
materials to stakeholders, regional medical stores, program on mental health and birth
DHOs and DPHOs. defect
 Development, production and broadcasting of  Pen-package promotion regarding the
health messages through radio, television, and Control of non-communicable
newspapers (printed and electronic). diseases.
 Golden 1000 days promotion communication  Communication programme on
campaign tobacco control and regulation.
 Communication programme on IMNCI,  Communication programme on
immunization, nutrition. communicable disease and epidemic
prevention.
 Health promotion program’s national commitment  School and adolescent friendly service
message dissemination on Merobarsha centre, safe motherhood, delay
pratibaddhata; swasthya prati jimmewar : marriage and family planning related
pratibaddhata; swasthya prati jimmewar : marriage and family planning related
samriddhiko aadhar inter-personal, social mobilization and
samriddhiko aadhar inter-personal, social mobilization and
mass communication programme
mass communication programme
 Health promotion, reproductive and child health,  Dissemination of messages and
 Health promotion, reproductive and child
free health, communicable and non-communicable health,  Dissemination
information of messages
through popularand
online
free health,
disease communicable
prevention andmaterials
related IEC non-communicable
printing information through popular online
media
disease prevention related IEC materials printing
and distribution media
and distribution
 Broadcasting of health messages through Radio  Communication programme on risk
 Broadcasting
Nepal and Nepal of health messages
television through
in packages Radio
including Communication
 factors programme diseases
of non-communicable on risk
Nepal and Nepal television in packages
Jeevanchakra, Janaswasthya radio program, including through social mobilization, diseases
factors of non-communicable
Jeevanchakra, Janaswasthya
Janaswasthya Bahas. radio program, through socialcommunication,
interpersonal mobilization,
Janaswasthya Bahas. interpersonal communication,
electronic and print media.
Source: NHEICC electronic and print media.
Source: NHEICC
Health education, information and communication (health promotion) activities that were carried
Health
out education,
a tby provincial
a iinformation
and ma level
district and
a incommunication
mm
the (health
i a period
reporting aaret promotion)
m in theactivities
listed a i that
following were
t at
table carried
(table a i
out
t by
8.3.2). provincial
i ia and
a district
i t i tlevel ini the
t reporting period
g i are listed
a i in
t the
i following
t table
i g (table
ta ta
8.3.2).
Table 8.3.2: Major activities carried out by Province and District level in 2075/76
Table 8.3.2: Major
 Hygiene activitiesprogrammes
and sanitation carried out by forProvince and
 District
Publication level
of in 2075/76
health messages in print
 Hygiene
preventing andand
sanitation programmes
controlling epidemics.for Publication of health messages in print
 media.
preventing and controlling epidemics. media.
 Production of need-based IEC materials.  Community interaction programmes for
 Production of need-based IEC materials. Community
 promoting interaction
health programmes for
services.
 Distribution of IEC materials to health promoting health
 Celebration of world services.
health day and other
 Distribution
facilities. of IEC materials to health Celebration
 health relatedofdays,
world health
week andday and other
months.
facilities.
 Production and airing of health programmes health related days, week and months.
 Production
and messages andthrough
airing of health
local FM programmes
radio on
and messages
different healththrough
issues. local FM radio on
Source:different
NHEICC health issues.
Source: NHEICC
8.3.7Trend
8.3.7 rendprogram
pro ram analysis
analysis by by federal,
federal, provincial and district level
provincial and district level
8.3.7 rend pro ram analysis by federal, provincial and district level
The physical and financial achievement in the year 2075/76 regarding Health education, information
i a a a ia a i m t i t a ga i g at a
The
and physical and financial
communication achievement
(health promotion)in programme
the year 2075/76 regarding
by federal levelHealth
was 95education,
percent information
and 76.41
i ma a mm i a at m g amm a a t
ia a level
and communication (health promotion) programme by federal report
level was 95 percent and 76.41
a percent respectively.
t Provincial andi district i t i achievement
t a i m t was not t aobtained
t taiin thei
t percent
reportingrespectively.
year.
g The
a trend Provincial
t is shown
i and district
in the level
i following
t i achievement
table a report was not obtained in the
(Table 8.3.3)
g ta
reporting year. The trend is shown in the following table (Table 8.3.3)
TableAnnual
DoHS, 8.3.3: Percentage trend
Report 2075/76 of physical and financial achievement by federal, provincial and
(2018/19)
district level in 2073/74 to 2075/76.
Table 8.3.3: Percentage trend of physical and financial achievement by federal, provincial and
Programme
district level in 2073/74 to 2075/76. 2073/74 2074/75 2075/76
Programme Physical 2073/74Financial Physical2074/75Financial Physical
2075/76Financial
Federal Level 90.13
Physical 69.55
Financial 56.04
Physical 79.12
Financial 95
Physical 76.41
Financial
Provincial
Federal and District
Level 90.13 69.55 56.04 79.12 95 76.41
73.00 72.92 85 83 NA NA
Level
Provincial and District
8.3.7 rend pro ram analysis by federal, provincial and district level
The physical and financial achievement in the year 2075/76 regarding Health education, information
and communication (health promotion) programme by federal level was 95 percent and 76.41
percent respectively. Provincial and district level achievement report was not obtained in the
reportinggyear.g The
am trend is shown in the following table (Table 8.3.3)
Table 8.3.3: Percentage trend of physical and financial achievement by federal, provincial and
district level in 2073/74 to 2075/76.
Programme 2073/74 2074/75 2075/76
Physical Financial Physical Financial Physical Financial
Federal Level 90.13 69.55 56.04 79.12 95 76.41
Provincial and District
73.00 72.92 85 83 NA NA
Level
Source: NHEICC
8.3.8 Strength, Weakness and Challenges:

8.3.8 tren th, ea ness and hallen es
The tstrength,
gt weakness
a aand challenges
a g of Health a t education,
a i ma and
information a communication
mm i a (health
at
m g amm i t g a a i t i g ta
promotion) programme in the reporting year are shown in the following table.
Table 8.3.4: Strength, Weakness and Challenges

tren th ea ness hallen es
 National health  Limited human resource for  Inadequate compliance
communication policy, health promotion at federal with National Health
strategy and directive are in and province level. Communication Policy
place.  No human resource for health (NHCP), guidelines and
 Good organizational promotion at local level. directives.
structure at  No organizational structure for  Less emphasis in health
federal/province level for health promotion program at promotion activities
health promotion program. local level. according to changing
 Behaviour change disease pattern.
communication for health  Inadequate allocation of
approach has been budget on the basis of
developed in line with planned programs.
national health
communication policy
2012.
 Programmes flow from
federal to province and
local level.

g g am
8.4 Health Service Management

Background
The Management Division(MD) is responsible for DoHS’s general management functions. DoHS’s
a ag m t i i i i i g a ma ag m t
revised
i Terms
m of References (ToR) of MD describing
i i g it a tthe focal
it as a point
i t for information
i ma
management,
ma ag m t a i g planning, coordination,
i a supervision,
ii forecast,
at quantify,
a procure, distribute
i t i t health
at
commodities
mm i fort the health
a t afacilities
ii aandtthe m monitoring
it i g aand evaluation
a a of health
a t programmes.
g amm The
idivision
i i i isaalso responsible
i form it i g tthe quality
monitoring a it of ai i m t health,
air, environment a t health
a t care
a waste
at
ma ag m t water
management, at aand sanitation.
a ita t aalso m
It it
monitors tthe construction
t a maintenance
and mai t a of publici
a t i institution
health t i i g aand supports
buildings t tthe mai t a
maintenance m i a equipment.
of medical i m t Itt also
a involved
i
ai a mai t a i m i a i m t i t m t a t ta ta i
repair and maintenance of bio-medical equipment, instruments and the transportation vehicles.
a i a ig t t i i ii i i i g i a a i g at t at
More activities assigned to this division include including policy and planning related to health
i at t a gi ma ag m t a t at gi t a ag m t i i i
a infrastructure
i t i B and logistic management. The objectives and strategies of the Management Division
are listed in Box 8.4.1
Objectives — The Management Division aims to support health programmes and DoHS to deliver
health services through the following specific objectives:
 Facilitate and coordinate among concerned divisions and centres to prepare annual plans,
programmes and to make necessary arrangements to get approval from the National
Planning Commission (NPC) and Ministry of Finance.
 Make arrangements for the preparation and compilation of annual budgets and
programmes of province and local levels.
 Monitor programme implementation status and carryout periodic performance reviews.
 Manage integrated health information system.
 Manage and coordinate the construction and maintenance of buildings and other public
health infrastructure including the maintenance of biomedical equipment.
 Support MoHP to develop and implement environmental health, health care waste
management and drinking water-related policies, directives and guidelines
 Support MoHP to develop and update national-level specification bank for drugs and health
equipment's.
 To plan and carry out the logistics activities for the uninterrupted supply of essential
medicines, vaccines, contraceptives, equipment, HMIS/LMIS forms and allied commodities
for the efficient delivery of healthcare services from the health institutions of government
of Nepal in the country.
Strategies
 Make arrangements to collect and analyse health information and use it to support the
planning, monitoring, and evaluation of health programmes
 Strengthen bottom-up planning from community to central levels via the optimum use of
available resources including health service information.
 Support MoHP to Conduct and expand regular periodic performance reviews and use
outcomes for improvements down to community level.

g g am
 Strengthen and guide the monitoring and supervision system at all levels.
 Establish a central data bank linking HMIS with the Human Resources Management
 Informationand
Strengthen System
guide(HURIS), health facility
the monitoring and work force
and supervision system registry, surveillances, HIIS,
at all levels.
 LMIS, finance,
Establish surveys,
a central data censuses
bank linkingandHMIS
otherwith
sources of information.
the Human Resources Management
 Expand computerized information systems at all levels.
Information System (HURIS), health facility and work force registry, surveillances, HIIS,
 Monitor
LMIS, the health
finance, surveys, services provided
censuses by state
and other and non-state
sources health institutions.
of information.
 Developcomputerized
Expand and implement construction,
information repairatand
systems maintenance plans for public health
all levels.
 facilities the
Monitor andhealth
for biomedical equipment.
services provided by state and non-state health institutions.
 The routine
Develop andmanagement of integratedrepair
implement construction, health service
and Information.
maintenance plans for public health
 Develop
facilities and implement integrated
for biomedical equipment. supervision and monitoring plans.
 Establish
The routine and develop required
management infrastructure,
of integrated health human
service resource
Information. and guidelines to conduct
 other assigned
Develop designated
and implement and non-routine
integrated works.
supervision and monitoring plans.
 Logistics planning
Establish and develop for forecasting, quantification,
required infrastructure, procurement,
human resource and storage and distribution
guidelines to conduct of
healthassigned
other commodities.
designated and non-routine works.
 Introduce effective
Logistics planning for and efficient procurement
forecasting, mechanisms
quantification, procurement, like storage
e-Bidding,ande distribution
Submission. of
 Use of commodities.
health LMIS information and real-time data in the decision making.
 Strengtheneffective
Introduce physicaland facilities at the
efficient Federal, Provincial,
procurement mechanisms District
likeand Local level
e-Bidding, for the
e Submission.
 storage
Use and information
of LMIS distribution of andhealth commodities.
real-time data in the decision making.
 Promote Online
Strengthen Inventory
physical Management
facilities System
at the Federal, and Non-Expendable/Expendable
Provincial, District and Local level for the Items
Inventory System in Federal, Provincial,
storage and distribution of health commodities. District and Local level warehouses.
 Auctioning
Promote of non-functional
Online cold chain equipment's/furniture,
Inventory Management vehicle etc.
System and Non-Expendable/Expendable Items
 Repair andSystem
Inventory maintenance of bio-medical,
in Federal, cold chain
Provincial, District andequipment's/instruments
Local level warehouses. and
 transportation
Auctioning vehicles.
of non-functional cold chain equipment's/furniture, vehicle etc.
 Capacity building of required
Repair and maintenance of bio-medical, human resources on logistics
cold chain management regarding
equipment's/instruments and public
procurement, e-bidding,
transportation vehicles. e-procurement, and online Inventory Management System at all
 levels. building of required human resources on logistics management regarding public
Capacity
 Implement effective
procurement, e-bidding, Pull e-procurement,
System for year-round availability
and online Inventory of Essential
ManagementDrugsSystem
and other
at all
health
levels. commodities at all levels (Federal, Provincial, District and Local level Health
 Facilities). effective Pull System for year-round availability of Essential Drugs and other
Implement
 Improvement
health in procurement
commodities at all levelsand supply Provincial,
(Federal, chain of health commodities,
District and Local levelworking on
Health
procurement reform and restructuring of federal, provincial and district stores.
Facilities).
 Formation of IHIMS
Improvement Working Group
in procurement at Federal
and supply chainand Provincial
of health levels.
commodities, working on
procurement reform and restructuring of federal, provincial and district stores.
 Formation of IHIMS Working Group at Federal and Provincial levels.
Organizational
The Management arrangements
Division has four sections and one unit for the overall management of functions
and service delivery (Box 8.4.2 ). The specific functions of sections and units are given below:
a ag m t i i i a a it t a ma ag m t
The Management Division has four sections and one unit for the overall management of functions
a i i B i a it a gi
and service deliveryhealth
 Integrated (Box 8.4.2 ). The specific
information Sectionfunctions of sections and units are given below:
 Environmental health and health related waste management Section
Health Infrastructure
 Integrated Development
health information Section
Section
Logistic Management
 Environmental Section
health and health related waste management Section
 Health Infrastructure Development Section
 Logistic Management Section

g g am
8.4.1. The Integrated Health Information Management Section
a ag health
manages a t service
i iinformation
ma from m community
mm it to
t the
t DoHS level. Thisi system
t mprovides
i the
t
a i i ma a i g m it i g a a a t a t t m at a
basic information for planning, monitoring and evaluation of the health system at all levels. The
ma
major functions of tthe HMIS are
a listed
i t in i Box
B 8.4.3
 Facilitate MoHP to develop national level policies, plans, regulation, guidelines, standards
and protocols related to integrated information system.
 Timely update and making information digital friendly for effective management and health
information.
 Develop, expand and institutionalize existing health sector information system such as
HMIS, LMIS, HIIS etc as an integrated information system.
 Identification and revision of sector wise health indication for national level health
information.
 Develop periodic and annual health reports and disseminate the funding based on rigorous
analysis and existing health information.
 Facilitate for capacity building and health personnel for institutionalization of integrated
information system at different level.
 Coordination and cooperation with provincial and local level government for health-related
information management system development and implementation.
 Facilitate division of DoHS for developing annual work plan and budget.
 Prepare and document monthly, trimester and annual progress and various activities
conducting by divisions under DoHS and need based reporting to MoHP.
 Provide support to MoHP on behalf of DoHS for development of overall plan.
 Improve online data entry mechanisms in all districts and hospitals and gradually extend
online data entry to below districts level health facilities. Online data entry mechanism will
be established in provinces and local levels.
 Establish a uniform and continuous reporting system from government and non-
government health service providers so that all health services provided by government and
non-government providers are reported and published.
 Verify, process and analyse collected data and operate a databank.
 Provide feedback on achievements, coverage, continuity and quality of health services to
programme divisions and centres, RHDs, hospitals, DHOs and DPHOs. Databased feedback
will be provided to provinces.
 Disseminate health information through efficient methods and technologies.
 Improve the information management system using modern information technology.
 Update HMIS tools as per the needs of programme divisions and centres.
 Update geo-information of health facilities.
 Provide HMIS and DHIS 2 tracking as per needed.
Nepal’s
a health
a t sectort needs aaccurate,
at comprehensive
m i and
a disaggregated
i agg gat data ata tot gauge
ga g itsit
performance,
ma to
t i identify iinequalities
ai between
t social groups
ia g and geographic
a g ga i a a t areas, to plan
a future
t
i interventions,
t aand tto enable
a tthe m
monitoring
it i g of NHSP-2 and
a NHSS targets
ta g t to
t providei evidence
i tot
i inform
m strategic
t at gi aand policy
i level decisions.
ii
The current
The current HMIS
gHMISgsoftware
software
am system (DHIS
system (DHIS 22 software)
software) meet
meet the
the basic
basic requirements
requirements of of the
the recently
recently
revised HMIS.
revised HMIS. Existing
Existing software
software related
related errors
errors have
have been
been resolved withwith upgrading
upgrading of of System to to dHIS
dHIS
t a t m a mresolvedtt ai i m t System t t
2.3. Few
2.3. Few problemsirelated
i problems related
g to to aNepali
NepaliatCalender
Calender arearea on
on the
the progress
progress of
ofitsorting
sorting out
g a out with the
i gwith the help
t mhelp
t ofof
developers.mNew
DHIS 22 developers.
DHIS NewatDashboards
t
Dashboards a for
i adifferent
for differenta level
level tgovernments
g
governments have been
have g developed
been t it t which
developed which
will facilitate program managersa and a policy managers
i t to monitor
g m time
real t ahealth situation. There iis
will facilitate
i a i itatprogram g ammanagers
ma ag and a policyi managers
ma ag totmonitor
m it realatime m healtha t situation.
it a There isi
still software
still softwarea related
related
at errors
errors seen
seen which
which are
are raised
raised
i a ai due
due to
to calendar
calendar
t a and
and
a a other
other
t issue.
issue.
i
8.4.2. Health Infrastructure Development Section

cti ss ttofeethe
Functions
cti eahealth
ea tt ii rastr
rastr ct re
re eve
eve
infrastructure
ct ee tt Secti
DevelopmentSectiSection
are iste
are iste ii
are listed in Box 8.4.4
 Support MoHP
Support MoHP forfor development
development of of national
national level
level policy,
policy, regulation
regulation and
and standards
standards related
related to
to
physical structure
physical structure ofof health
health facilities
facilities and
and health
health equipment's.
equipment's.
 Maintain the
Maintain the updated
updated record
record and
and upgradation
upgradation ofof physical
physical infrastructure
infrastructure and
and health
health
equipment.
equipment.
 Facilitate health
Facilitate health facilities
facilities to
to develop
develop national
national plan
plan for
for need
need based
based infrastructure
infrastructure
development.
development.
 Coordination with
Coordination with concerned
concerned authorities
authorities for
for basic
basic infrastructure
infrastructure management
management of of health
health
facilities.
facilities.
 Facilitate for
Facilitate for development
development update
update andand monitoring
monitoring of of hospital
hospital code
code ofof conduct.
conduct.
Facilitate for supervision,
supervision, monitoring
monitoring andand quality
quality control
control ofof health
health infrastructure
infrastructure and
and
equipment.
equipment.
 Identifying the
Identifying the status
status of
of and
and maintaining
maintaining medical
medical equipment;
equipment;
 Rolling out
Rolling out the
the out
out sourcing
sourcing of of maintenance
maintenance contract
contract nationwide.
nationwide.
 Coordinating with
Coordinating with government
government agencies
agencies and
and other
other stakeholders
stakeholders for
for the
the maintenance
maintenance of of
health facility
health facility and
and hospital
hospital medical
medical equipment.
equipment.
 Manage and
Manage and mobilize
mobilize biomedical
biomedical engineer
engineer and
and other
other human
human resources.
resources.
8.4.3. Environment health and health related waste management section

As per
As per the
thet work
work description
description approved
i approved
a from council
from council
m ofiministers
of ministers federal gvernemtn
mi i tfederal gvernemtn
a g is responsible
is
mt responsible
i for
for
i
development and
m t monitoring
a m it and
i g evaluation
a a a guideline,
g i i logical
gi framework,
a am
development and monitoring and evaluation guideline, logical framework, quality standard for qualitya it standard
ta a for
i i water,
drinking g at food and a airaiquality.
a it This isection wasaestablish
ta i tot implement
im m tthe t above
a function of
of
drinking water, food and air quality. This section was establish to implement the above function
thet federal a g
governement.m t
Detail tai t
terms mof reference of t
this i
section is i i
included in i B
Box 8.4.5
the federal governement. Detail terms of reference of this section is included in Box 8.4.5
 Support and
Support and facilitate
facilitate MoHP
MoHP toto develop
develop environmental
environmental mental
mental health
health related
related policy,
policy,
guideline, directions
guideline, directions and
and standards.
standards.
Facilitate for carrying
carrying out
out regular
regular surveillance
surveillance and
and studies
studies related
related to
to impact
impact and
and drinking
drinking
water, air
water, air and
and overall
overall environmental
environmental on on health
health status
status and
and support
support for
for environmental
environmental
pollution control.
pollution control.
 Support MoHP
Support MoHP forfor development
development of of national
national laws,
laws, policies,
policies, plans,
plans, standards
standards and
and protocols
protocols
for health-related
for health-related waste
waste management.
management.
Facilitate for scientific
scientific management
management of of health-related
health-related wastages
wastages released
released for
for different
different health
health
facilities under federal, provincial and local level government.
facilities under federal, provincial and local level government.
g g am
Carry
 Carry outout monitoring
monitoring andand central
central activities
activities forfor scientificmanagement
scientific management of health-related
Carry out monitoring and central activities for scientific managementofofhealth-related
health-related
wastages
wastages released
released from
from health
health facilities
facilities under
under federalgovernment.
federal government.
wastages released from health facilities under federal government.
8.4.4. Logistic Management Section
e eecti cti t e gistic a age e t secti are iste i

cti t ett egisticgistica age
gi ag emtesecti
a age tt secti areare
a iste i ti i i B
iste
Major functions of the Logistic Management Section
Major functions
Major functionsof the Logistic
of the LogisticManagement
Management Section
Section
 Support MoHP for development of procurement and supply related national laws, policies,
 Support
SupportMoHP for for
MoHP development
development of procurement
of procurement andand supply
supplyrelated
relatednational
nationallaws,
laws,policies,
policies,
guidelines, quality standards, protocols.
 Support MoHP to prepare national level standard and specification bank for drugs, health
 Support
Support MoHPMoHP to prepare
to prepare national
national level
level standard
standard andand specificationbank
specification bankforfordrugs,
drugs,health
health
related tools and equipment.
related
related toolstools
andand equipment.
equipment.
 Procurement of vaccine, family planning commodities and other essential health commodities
 Procurement
Procurement of vaccine,
of vaccine, family
family planning
planning commodities
commodities and
and otheressential
other essentialhealth
healthcommodities
commodities
to the province.
to the
to the province.
province.
 Facilitate federal and local level government for procurement and supply of the essential
Facilitate
Facilitate federal
federal and local level government forfor procurementand andsupply
supplyofofthe
theessential
essential
 medicines andand local
equipment. level government procurement
medicinesandand equipment.
medicines
Coordination equipment.
and facilitation to develop and institutionalize logistic information system at the
 Coordination
Coordination andand facilitation
facilitation to develop
to develop andand institutionalizelogistic
institutionalize logisticinformation
informationsystem
systemat atthe
the
national level.
national level.
national level.
Management of essential commodities at the health facilities under DoHS.
 Management of essential commodities at the health facilities under DoHS.
 Management of essential commodities at the health facilities under DoHS.
Major ongoing activities

The following innovative activities were conducted on a regular or ad-hoc basis in 2075/76
The following innovative activities were conducted on a regular or ad-hoc basis in 2075/76
Thealongside
followingthe i innovative
g above-mentioned
i a activities
a iregular conductedt on a aregular
werefunctions. g a or ad-hoc a a i ini 2075/76
basis
a alongside
g i t theaabove-mentioned
m regular
g a functions.
alongside the above-mentioned regular functions.
a ea t rastr ct re r ati S ste — The HIIS is expected to provide the basis for decision
a ealth
a)making ea t Infrastructure
rastr ct re Information
r ati S ste System— The — as HIIS is expected i resource to tprovide
t the basis i t forsystemdecision
a i is
a ea t on building
rastr ct reconstruction
r ati and S stemaintenance
— The HIIS well
is as for
expected to provide allocation.
the basisThe for decision
making
i i ma i g on building construction
i i g and
t maintenance
a mai t a as well as afor resource
a allocation. The
a a system is
in process
making on of completion
building after which
construction and it will be regularly
maintenance as wellupdated.
as for resource allocation. The system is
intprocess
m i i of completion m after which a it will bei regularly
it i g a
updated. at
in process of completion after which it will be regularly updated.
b)bb Building
i i g c construction
str cti a
i i g c str cti a and
ai temaintenance—
a ce— The Management
ai te a ce— The Management a Division
ag m toversees
Division i i i the
oversees
construction
the construction t
b and i t imaintenance
g c str
a cti
mai oft ahealth
a facility
ai te a at buildings
ce—
a i The
it iand i other
Management
g a
and maintenance of health facility buildings and other infrastructure in partnership with the
infrastructure
t Division
i a t in partnership
oversees
t i the
a t with
construction
i it the
t
andDepartment
a tm t of
maintenance
Department of of
Urban
Urban
Development
ahealth facility
Development t aand
m buildings Building
and BBuilding
i and Construction
i g other (DUDBC).
t infrastructure
Construction (DUDBC).B in All
All
maintenance
mai t a with
partnership
maintenance
within
it i
the
within
a
health
Department t a i i
facilities
of Urban mi
premises aand
Development t
construction
and Building a
and mai t
maintenance a
Construction works works
(DUDBC). costing g less
All less t
than
maintenancea one mi
millioni
health facilities premises and construction and maintenance costing than one withinmillion
were i
disbursed tthroughg t a ag m t i i i t t
healthwere facilities premises andthe Management
construction andDivision
maintenance till 2074/075.
works costingAll other lessconstruction
than one millionworks
costing g disbursed
mmore tthan a through
one mi the
i Management
million iis done tthrough gDivision
DUDBC. BtillSince
2074/075.
i 2061/062,
All other
2031
construction
a i i have
facilities a works
been
werecosting
i disbursed
t i more
i through
than onethe Management
million is done
i i Division
through
a DUDBC.
t till 2074/075.
Since
a t 2061/062,
i i All
g other
2031
t construction
facilities
t have
g works
been B
builtmore
costing while than in 2075/076
one NPR 4,871
million is done billion was spent
through DUDBC. on health
Since building construction
2061/062, 2031 through
facilities have DUDBC
been
built
a while in 2075/076 NPR mmi 4,871 billion
m it wast spent on health building construction through DUDBC
(Table 8.4.1). An MoHP committee monitors these works.
built(Table
while8.4.1).in 2075/076
An MoHP NPRcommittee
4,871 billion was spent
monitors theseon health building construction through DUDBC
works.
Table 8.4.1: Summary of building construction by DUDBC (2061/062 – 2075/076)
(Table 8.4.1). An MoHP committee monitors these works.
Detail Number
Detail Number
Total number of health facilities Detailbuilt 2031
Number
Total number of health facilities built 2031
Number
Total number ofof
facilities
healthunder construction
facilities built 342
2031
Number of facilities under construction 342
Near of
Number to completion facilities 158
Near to facilities
completion under construction
facilities 342
158
Completed/handed
Near over facilities
to completion facilities 1689*
158
Completed/handed over facilities 1689*
Budget allocated (in NPR) in 2075/076 6,11,34,00,000
Completed/handed
Budget allocatedover facilities
(in NPR) in 2075/076 1689*
6,11,34,00,000
Expenditure (in NPR) in 2075/076 4,87,16,00,000 (79.69%)
Budget allocated(in
Expenditure (inNPR)
NPR)inin2075/076
2075/076 6,11,34,00,000
4,87,16,00,000 (79.69%)
Expenditure (in Report
DoHS, Annual NPR) in2075/76
2075/076
(2018/19) 4,87,16,00,000 (79.69%)
g g am
t m t a a ii a ii a m t t a a m ti
Table 8.4.2: Building construction scenario in previous five years from DUDBC.
Health posts with birthing centres 200 101 275 - -
Doctors’quarters - - 20 - 1
Staff quarters - - 36 - -
PHCCs 7 2 6 - -
Birthing centres 20 5 8 - -
District health stores - - - - -
BEOC buildings - - - - -
CEOC buildings - - - - -
Public health office buildings 3 2 - - -
District hospital buildings 6 5 3 - 6
Regional hospital buildings 1 - - -
15 bedded hospital building 3 2 - -
Zonal hospital buildings 2 2 - -
Sub-regional hospital buildings 2 - -
Maternity units in zonal hospitals 1 - -
Emergency blocks in district hospitals 1 - -
Block A buildings in districts - - -
d) Health facility upgrading— a ag m t i i i a ta t t ga i g

ea t a aci it gra i g—i The t i t Management
ita tDivision has started ita thei process it tof upgrading
g a i gPHCCs a
and below a t 15 bed t tdistricta t hospitalst a up to ig 15 bed hospitals.
a ii tIn at
line awith
t the upgrading ita of all sub-
i g
health
taiposts to health iposts i i and higher t level
ma facilities
a tommat least a 15 bed m hospitals following
ag icertaina
a
procedures, division acollects demand and recommendations from concerned agencies and process
for approval.
e) Logistics Management Information System (LMIS) - i it a ta i i
e) itgistics
t taat age ei t r tati Sa ste ag m t S tThis m unit
i was testablished
a a in 1994. LMISi unit ia
justa started Online
a Inventory
i t i t aManagement System t in
t 2t Central Warehouses,
a g a 5 iprovincial a
warehouses
t t t and 77
gi District Warehouses.
ma ag m t i i i After athe restructure
m i of
a it Nepal's governance
a in federal
i g a i
structure,
tt the
g logistic
gi management
ma ag m t division was demolished a ag mandt itsi functions
ii area being
tm tcarried aout t
throughi logistica management section gi aunder
ag mManagement
t a Division of aDepartmenta a i of aHealth t
Services.
t mMajor t Functions of Logistic t mManagement
a t section
a t a iare i collection
a t and analysis
t of quarterly
aa
(three monthly)
ga LMIS
i mi a reports from
i all
ma of the
t health facilities across the country; preparation,
reporting and dissemination of information to:
 Forecast a tannual
a a requirements
i m t of commodities mm i for publici health a t programg am including
i i g family
ami
a i g maternal,
planning, mat a neonatal ata and a child i health,
a t HIV and a AIDS commodities,
mm i a i
vaccines, a
and
EssentialaDrugs; g
 Help tot ensure demand ma and a supply of drugs, g vaccines,
a i ta
contraceptives, essential a medical
m i a aand
cold chain ai supplies i atatalla levels;
 Quarterly monitor the national pipeline and stock level of key health
DoHS, commodities.
Annual Report 2075/76 (2018/19)
g g am
at m it t a a i i a t at mm i
The following are the major activities conducted by the Management Division in 2075/76:
t t a a a ma i g
a i g t m
a a a i t at ma i i ata ai
a ag t i ta iti t m t a i t m i
a at i t
a m t i
a i t a iti t t a t
ta t t ai i g it at a ai a
at i a g t g tt t
a g t i ga i ga gt
i tat a t ai at at a a t ma ag m t
i ta a t ai i g at a a t ma ag m t t i a a ta
a t i t ma ag m t a g a a m t t ag
iti a ta ta at mm i t a at a ii t i
at a i a
t m t a i m t a g a a
a m i i a i ta i m t i t m i i g
a a i mm i
t a a iti t m i i a i ta i m t a a i
mm i
t im m ta a i g Ba a i
m i a ti t i t a ag m t t m at a i ia a a
t a a it i i g i i t a ag m t t m t a t
m t i ta t i g t g t t it i
a
t a a it i i g i m t ta g a it i a
i m t it i g t i ia a ama ag a t
a a it i i g at a a i ta t ta i ia a a
ta a a g i a i a ag m t
i a i g a a i g a i m t mat ia a t at
mm i
i a it a t a t gt i g ai a a it t g
t i iat ii t ai i m t a a ai a mai t a
ig at a
a ag t mai tai t i m i a i m t ma i i a ta t i
m m t a m it t m ta a i a a g i t
iti t
i at it a m t at g at gi ma ag m t
i a m it t gi a i a m i a t
t ata a it m t

g g am
Issues, challenges and recommendations
Table 8.4.5: Issues, challenges and recommendations — health service management

—
Inadequate quality human resources Produce and appoint skilled human resources
Individualized planning in divisions and Ensure strategic joint central annual planning and budgeting
centres (due partly to time constraints)and under the Management Division for one-door planning from
negligible bottom-up planning DoHS and promote bottom up planning to address district
specific issues
Insufficient budget for building health Provide funds and human resource support for upgraded
facility and hospital buildings. health facilities.
Health facility buildings construction Mandatory supervision and approval by concerned health
delayed and obstructed (around 2% sick facilities before payment for building construction.
projects). Self-dependence for health facility building construction in the
long term.
The standardization of public hospitals Strategic planning to bring public hospitals to design standard
as per guidelines
The lack of WASH guidelines for health Develop WASH guidelines
facilities and hospitals
Insufficient and poor implementation of Expand programme and budget for health care waste
waste management guidelines by health management as per guidelines
facilities and hospitals
Information flow from lower level health Provide more budgetary support for data quality and its timely
facilities and data quality issues flow from lower level health facilities to DHOs and DPHOs and
make reporting to DoHS’s information system mandatory for
all hospitals
The monitoring of private health care Establish a task force or outsource the supervision of private
health facilities
Low Budget in Drug Procurement and Budget will be revised as demand in next year.
supply in local level
Capacity building in procurement, LMS has planned to conduct that training at all provinces.
forecasting, quantification and LMIS
Management of Expired, Wastage and LMS will collect those materials from all provinces and
unused materials destroy or disposed as process.
Inadequate of HMIS/LMIS tools and late Tools will be supplied in time and adequately
supply
High demand of required equipments LMS will demand budget for equipment procurement.
Table 6.8.6: Specific recommendations — health service management
 Endorse proposed Central Coordination Committee and Technical Committee MoH, DoHS-
 Form joint taskforce representing MoH, DoHS-MD, RHDs and DUDBC officials to MD,PPICD,RHDs,
assess delayed and ongoing infrastructure projects and make planDoHS, Annual
to address Report 2075/76 (2018/19)
issues
Capacity building in procurement, LMS has planned to conduct that training at all provinces.
forecasting, quantification and LMIS
Management of Expired, Wastage and LMS will collect those materials from all provinces and
unused materials destroy or disposed as process.
Inadequate of HMIS/LMIS tools and late Tools will be supplied in time and adequately
supply
High demand of required equipments g g am
LMS will demand budget for equipment procurement.
 Endorse proposed Central Coordination Committee and Technical Committee MoH, DoHS-
 Form joint taskforce representing MoH, DoHS-MD, RHDs and DUDBC officials to MD,PPICD,RHDs,
assess delayed and ongoing infrastructure projects and make plan to address issues
 Operationalise joint monitoring team for the field monitoring of construction projects DHOs, DPHOs
 Endorse standard building design and guidelines
 Develop a building planning cycle
 Establish/strengthen a health infrastructure section with adequate capacity at central
and regional levels to be responsible for construction related planning and budgeting.
 Update and strictly implement land development criteria considering geographical
variation, urban/rural settings (guidelines have been endorsed by MoH with
ministerial decision).
 Assess regional, sub-regional, and zonal hospitals against standard guidelines and
develop standardization plan.
 Develop mechanism to standardise PHC-ORC structures in coordination with
communities.
 Initiate and continue measures to functionalise and regularize all routine information MoH, DoHS-
systems including TABUCS. MD,PPICD,RHDs,
 Roll-out routine data quality assessment mechanisms at all levels. DHOs, DPHOs
 The monthly generation of data from all data platforms; sharing and review with
concerned programmes, divisions, RHDs, DHOs, DPHOs, and hospitals.
 Provide data access through public portal, including meta-data and resources.
 Ensure interoperability among all existing management information systems.
 Develop and implement a long-term survey plan.
 Update and implement integrated supervision checklist, supervision plan and All levels
feedback tools.
 Deploy functional feedback mechanism with provision of coaching and mentoring
services.
 Develop monthly integrated online supervision calendar and submit to higher
authority to monitor effective execution at all levels.

g g am
8.4.4 Logistic Management
8.4.4.1 Background
i t ma ag m t gi i ia a a i t i at
i a a i g ig t i a i g a it at a i gi
a ag m t i i i a ta i t a tm t at i i
it a t ta a gi a m i a t a a iti t t
ma a t at a t a iti t at mm i
t at a ii g m t a t a i ai a mai t a
i m i a i m t i t m t a t ta ta i
t t ma t ma ag m t gi a ag m t t ma gi t m
it a ta i i i it i t t ta t
a ag m t
t mi ta a gi a a a iti t a i
t t t a g a i a t t t gi ma ag m t i i i
a m i a it a i g a i tt g gi ma ag m t
a ag m t i i i a tm t at i a gi a ag m t
a a a a i at t m t t ma t at
a ii a t t aa ga i mi a i ma t
at a a i m t mm i i at g am i i g ami
a i g mat a ata a i at a mm i a i a
a g
t ma a g a i ta a m i a a
ai i at a
at m it t a a i i a t at mm i
Goal
a it at mm i a ai a at at a ii a mm it t a
Overall Objective
a a a tt gi a i t i t t a m i i
a i ta i m t m a a i mm i i i g ai
a mai t a i m i a i m t t i t i at a i m
t at i t g m t a i t t
Strategies
gi a i g a g a a m t t ag a iti
at mm i
t a i t m tm a i m i Bi i g mi i
i ma a a m ata i t i i ma i g t g ata i i i it i
t i gi ma ag m t i ma t m
t gt i a a ii at t ta gi a gi a a iti t t
t ag a iti at mm i
m t i t a ag m t t m a a a t m
t t mi ta gi a a iti t a

g g am
i g a ai i m t it i t
ai a mai t a i m i a ai i m ti t m t a ta ta
i
a a it i i g i ma gi ma ag m t ga i g i
m t i i g m t a i t a ag m t t m at ta
gi a a iti t
m m t t m a a ai a i it a g a t at
mm i at a ta gi a i t i ta at a ii
m m t i m t a ai at mm i i g
m t ma t t i g a i ia a iti t t
ma gi i g at ta a i ia
8.4.4.2 Major Activities
a t i t ma ag m t a g a a m t t ag
iti a ta ta at mm i t a at a ii t i
at a i a
t m t a i m t a g a a
a m i i a i ta i m t i t m i i g
a a i mm i
t a a iti t m i i a i ta i m t a a i
mm i
ma m m gi i g at ta t gi i
a ag t i ta iti t m t a i t m i
a at i t
t im m ta a i g Ba a i
m i a ti t i t a ag m t t m at t i ia a a
t a a it i i g i i t a ag m t t m t a
t m t i ta t i g t g t t it i
a
t a a it i i g i m t ta g a it i a
i m t it i g t i ia a a
ma ag a t
a a it i i g at a a i ta t ta i ia a a
ta a a g i a i a ag m t
i a i g a a i g a i m t mat ia a t at
mm i
i a it a t a i i i a t gt i g
ai a a it t g ti i a t ii t ai i m ta a ai a
mai t a ig at a
a ag t mai tai t i m i a i m t ma i i a ta t i
m m t a m it t m ta a i a a g i t
iti t
i at it a m t at g at gi ma ag m t
i a m it t gi a i a m i a t
t ata a it m t
m m t m i i g am i t i a m tai iti t

g g am
8.4.4.3 Analysis of Achievement
8.4.4.3
8.4.4.3 Analysis
Analysis of Achievement
of Achievement
LMIS Reporting Status
LMISLMIS Reporting
Reporting Status
Status
 Review and optimization of information flow for the LMIS reports
 Review and optimization of information flow for the LMIS reports
With new Federal i a structures mi a in place, i mainformation flow t t
acrossWith thenew supplyFederal
chainstructures
levels wasin unclear place, information
resulting in flow LMIS Reporting Rate
it
across the a
supply t t
chain i
levels a was i unclearma resulting a in
difficulties in decision-making on supply quantities. To LMIS Reporting Rate
t ai a a gi i i
difficulties in decision-making on supply quantities. To
resolve ithe ma i g MD together ina technical assistance t In FY 2074-75 Q4, the
i challenges,
resolve the challenges, In FY 2074-75 Q4, the
with GHSC-PSM
a g reviewed t MD together
t gexisting iSOPst andinithe atechnical
a i taassistance
information itreporting rate was only 30%,
flowwithprocessGHSC-PSM i reviewed
and advocated existing
i with g the MoHP SOPs
a tand the information
to istreamline
ma reporting
whereas, rate wasQ4,
in FY 2075-76 only 30%,
flow process
the LMIS a a and
reporting at
advocated
processes. it MoHP
t withissuedthet MoHP t am
letters i streamline
toto t
the whereas,
the reporting in FY
rate 2075-76 Q4,
increased
the LMIS
Ministry g reporting
of Federal processes.
Affairs i
and GeneralMoHP issued t t
Administration i i t
letters to themore than the reporting
two-fold torate increased
76%.
a
Ministryandofthe ai a
Federal a
Affairs mi i t a
and General a t more than two-fold to 76%.
(MoFAGA) office of the provincial Chief Administration
Minister
t i ia i i it gg ga tIn FY 2074-75, the quarterly
(MoFAGA)
suggesting and thetooffice
a process of the the
streamline provincial Chief Minister
LMIS reporting In reporting
FY 2074-75, the quarterly
t am i t g t m a a average rate was
asuggesting
system. MoFAGA ia process
has
a a uploaded to streamline
t aa new the SOPitLMIS reporting
circular
it it 65%, average reporting
a whereas, rate was
in FY 2075-76, it
system.
addressed to
t t MoFAGA
all LLGs on has
its
t uploaded
websiteim withi ita a
copy new to the SOP
officecircular
ta a increased 65%,towhereas,
78%. in FY 2075-76, it
of the Prime Minister.
addressed t on its website
GHSC-PSM
to all LLGs t andwith
staff FSOs aa copya to the
followed upt toffice
t increased to 78%.
to ensure
of the i theia letter
Prime iMinister.
was alsoGHSC-PSM
sent to thestaff Provincial
and FSOs Chiefs.
followed up
to ensure the letter was also sent to the Provincial Chiefs.
Improving trend in reporting rate
Improving trend in reporting rate
90 Q2
Improving trend in reporting
2075/76rate
Q1 2075/76 2075/76 Q3 2075/76 Q4
802075/76 75 75 76
2075/76 Q1 90 Q2 71 72 Q3
2075/76 2075/76 Q4
70 65 75 75 76
80 71 72
60 70 65
LMIS REPORTING PERCENTAGE

50 45
60
LMIS REPORTING PERCENTAGE

40 50 45
30 40
30 20
10 5 20
0 10 5
Oct-18 Dec-18 Feb-19 Mar-19 May-19 Jul-19 Aug-19 Oct-19 Dec-19 Jan-20 Mar-20
0
These efforts to review the SOPs and follow-up on application implementation have resulted in
Oct-18 Dec-18 Feb-19 Mar-19 May-19 Jul-19 Aug-19 Oct-19 Dec-19 Jan-20 Mar-20
improved reporting t t rates. i The t reporting a rate for FY 2074/75 a i Q4 a was im onlym 30%
ta whereas a the t i
These efforts to review the SOPs and follow-up on application implementation have resulted in
im g at g at
reporting rate for FY 2075/76 Q4 has increased more than two-fold to 76%. The quarterly a a t g
improved reporting
at reporting rate of FY rates. The
a 2074/75
i reporting
a wasm 65%,rate for FY
t a whereas,
t 2074/75 Q4 was only 30%
tin FY 2075/76,a itt increased whereas
a ag to the g
average
reporting
at rate for FYa 2075/76 Q4 ahasi increased more it i than a two-fold
t to im
76%. i The quarterlyg
78%.,Timeliness of reporting improved significantly after the implementation of data entry in
im ig i a trate
average reporting a of t FY im m ta
2074/75 was 65%,ata t i in aFY
whereas, t 2075/76,i t it increased
iti t to
health office in the district.
78%.,Timeliness of reporting improved significantly after the implementation of data entry in
• GHSC-PSM providing training to 371 LLGs in conjunction with the DHIS2 training
health office in the district.
 GHSC-PSM providing training to 371 LLGs in conjunction with the DHIS2 training
1. eLMIS implementation in Province 5 & 6:
1.  GHSC-PSM providing training
eLMIS implementation to 3715LLGs
in Province & 6: in conjunction with the DHIS2 training
a
MD/LMS has successfully im m
implemented the tElectronic
t t i Management
Logistics gi a agInformation
m t ma
System t m
1. eLMISi aimplementation
i t a m in
i aProvince
t t 5 & 6: i ia m i a t
(eLMIS) in all six central medical stores, two provincial medical stores (PMS), 22 district stores within i t i t t it i
MD/LMS
Provinces i has
5 and athe support
i t implemented
6 insuccessfully of USAID t GHSC-PSM
the Electronic
project inLogistics
this FY. t i Management
t i Information System
(eLMIS) in all six central medical stores, two provincial medical stores (PMS), 22 district stores within
Provinces 5 and 6 in the support of USAID GHSC-PSM project in this DoHS,
FY. Annual Report 2075/76 (2018/19)
g g am
im m ta at a g m ta at a ii t a i t
t a t mat a g m t a t i at a ii i tag a a t t
g a t t gi i g a g i ii t i a a g m t
at mm it m t a a t a m i i ai t m
Ba i a a t iti t a t ma t i at mm it ma ag m t i
m a t mi a a ta i at t a g m t a
t i at a ii a a t it a a a i a i a i
im m t t at a ii i a i t t a t mat t i ai a i a a
a a
tm a ima ta i m t a ta t
t gi a t ma ag at at t a ag m t i ii i
tt g at i t gg i i t a
t ai i g i a a mai m i a gg a gi
t t a i ta i t t am a a
ta a a g t ta a a g t
a it t t a i a mi a
a t a ag m t i i i
a t a a tm t a a i g i g t im m ta i
a m t t im m ta a t i a t m a t
t i it t t t tag t g
a a m t a t a i t a m im m g tag a a t
a a ta t t t am i at a a i t t
a a a a i g
m it i g a ata it i i ma i g ma a a
a at t m it a t t at t i it
t ga t t a i it at m ata a a
t i t t m at t ta a a t t a
t at m ata i t t
t t a a tm t a im m ta a i gi m
t a i amma a t i t a i
a a it ia t ta t a a it at a
t ai i iti t a a t m i
i i a m i m
t a m t
t mi t t
t mi t a a ta a a ig m t t i a
a at t t m tt a m t t t
Ba t a ta a a im m t

g g am
2. 2. Pradesh Reporting
Pradesh Status,
Reporting fiscalfiscal
Status, yearyear
2075/76
2075/76
2. Pradesh Reporting Status, fiscal year 2075/76
Figure
Figure8.4.2. Reporting
8.4.2. Reporting Status
Status
Figure 8.4.2. Reporting Status
Reporting Percentage
86.54%
Reporting Percentage
93.58% 90.64%
100.00%
90.00% 93.58% 82.09% 90.64%
100.00% 86.54% 73.68%
80.00% 64.36% 82.09%
90.00%
70.00% 73.68%
80.00%
60.00% 64.36% 50.28%
70.00%
50.00%
60.00% 50.28%
40.00%
50.00%
30.00%
40.00%
20.00%
30.00%
10.00%
20.00%
0.00%
10.00%
0.00%
3. 3. Availability of KeyofHealth
Availability Commodities
Key Health Commodities
3. Availability of Key ig Figure

Health
8.4.3 mm it Stockout
Commodities
: Commodity t t tatfiscal yeara 2075/76
Status, a
LMIS report provides data
26%
visibility oft stock istatus ata at Figure20%
8.4.3 : Commodity Stockout Status, fiscal year 2075/76
iLMIS
i i ithealth
the tprovides
reportfacility tat
leveldata ofat 15% 11% 13%
t visibility
key ahealtht of astock
icommodities
it status at 20% 26%6%
11% 10% 17% 9%
10% 9%
like a t
Condom, mm Depo,
the health facility level of i i
Pills, 15% 11% 13% 5%
ORS,mhealth
key Zinc, commodities
Vitamini A, 5% 6%
9%
Ferrous
ilike itami
Condom, Depo, Sulfate,
Pills, 10% 11% 10% 17% 9%
0% 5%
Albendazole,
atORS, Paracetamol
Zinc, a Vitamin a aA, 5%
Paracetamol
Metronidazo
Zinc 20mg
Condom
Depo
ORS
Albendazole
Pills
Vitamin A
FerrousSulphate
Ferrous
and Metronidazole
tam
Ferrous a t 400 i amg
Sulfate,
le 400mg
500mg
in mg
andi essential
a drugsa forg 0%
Albendazole, Paracetamol
free health services on a
Paracetamol
Metronidazo
Zinc 20mg
Condom
ORS
Albendazole
Depo
Pills
Vitamin A
Sulphate
and Metronidazoleat i
400 mg
le 400mg
a inquarterly basis. The figureg

500mg
a t a i
and essential drugs for
shows among gthree
am servicest FP commodities,
mm i Condommand a Pillsi have a stockout
t tof 11% whereas a Depo is i
free health
slightly lower (10%). OutonofaMNCH and essential commodities, Paracetamol has the lowers stockout
ig t
quarterly basis.Vitamin
The figure t a a mm i a a tam a t t t
at 5% whereas
atshows a itami A showstthe stockout
t t of 26%.
among three FP commodities, Condom and Pills have stockout of 11% whereas Depo is
slightly lower (10%). Out of MNCH and essential commodities, Paracetamol has the lowers stockout
at8.4.4.4
8.4.4.4 Major
Major
5% whereas Logistics
Logistics
Vitamin AActivities
Activities
shows to tostockout
Strengthen
theStrengthen Health
ofHealth
26%. CareCare Services
Services
a. Procurement
a. MD/LMS
Procurement continued and added more commodities in the multi-year procurement. Condom,
8.4.4.4
Injectable, Major ORS, Logistics
Iron Tablets,Activities to Strengthen
Essential Drugs areHealthnow Carebeing Services
procured through multi-year
a.mechanism.
Procurement Multi-year a mechanism
a m saves every
mm i year bidding
i t and
m evaluation
a timemfor ttender. LMS m
MD/LMS
also continued
ta completed the LICB and added
a (limited
t more a commodities
international g competitive
a in the i multi-year
g processprocurement.
bidding) in g m Condom,
t coordination with
a
World
Injectable,
m a im Bank in
ORS, theIron procurement
Tablets,
a m a im a of
Essential Implants,
Drugs which
are results
now
a i i g a in
being procuring
procured
a a directly
through
m from
t the
multi-year
manufacturer
mechanism.
a intmuch
m Multi-year t lower Bcost.
mechanism
imit saves i t every
a ayearmbidding and i evaluation
i g timei for tender.
i a LMS
also
it completed Ba the i t LICB (limited m international
t m a t competitive
i bidding)
t i process
i g ini coordination
t m t with
World
ma a t Bank in
i m the procurement
t of Implants, which results in procuring directly from the
manufacturer in much lower cost.
g g am
iti t i a it a g a a t at t iti t
a at a a i ta g t tt
a iti t t ima at a ita i a i ii imi a t
m t i i g a t t m g i i ai a tt
i t i i a a
ai i g i m t t i a iti t a i it t
a ia t a t i a t
b. Forecasting and Supply Planning
a ti ia i i i g gt m a i g i m t at mm i
a t i gg at mi g t a i it i i i
g it ta m ai i ii iti t ia
ma g ga i a a
a a a i a ta t g ga i i g
i t at i t i a a ga i i t t g am
it a i a m i t ia ma g t a
The main purpose of the workshop is outlined below:
 mat t mm it a a t tat i t i i a t
i a t im a a
 i ata i mm it i m t a a g m t g t
a a
 tt ma mm it m t t
 i m a t i g i m t a a at mm it m t
 g m t mmitm t i ig t i i i g at a i
a g a a a a g mm i mm i
a i i g a mm i a i t t mi g at a
a i ata i i m ga i ata m a m i it i
a m ia g amma i a a i at t a t
g a gi i g a i g g a tm i g g a i a
a i a i g i at a a a at
mm i a am t it mm a a ta a a i a
mi t i gi ma ag m t tt i a a m im m t
imi a a a i at a m t a ga i i
a a it a i ii a it tt i a a i ta a a ia t
m m t it gi a ag m t t a a t a
Quantification Guidebook
i t ai a a it i a a i at a g a
a i g at mm i at a t ai i t a t t
a at a i ita a a ti ai t a a i a
a it t m a at ai m t a ag m t
t a a t B t a i i a
g g am
t ai i g a a a at t i
Consensus Forecasting
Consensus Forecasting
MD organized 2-days workshop on national
quantification ofgaprogram
i drugs
a and EPI vaccines a for
the FY ona Aprila 4-5, 2019
a with theg am
supportg ofaGHSC-
PSM. Participants conducted idata analysis,
a i t it
t t
assumption building, forecasting and supply a i a t
t ata a a i a m
planning exercises. The team produced a national
i i g a g a a i g
forecast and i supply plan t amfor 700 items a for a FY a
2076/77 (2019/2020)
ata for all divisions
a and centers.
it m
The estimated budget for this forecast isa NPR. i i 4.60
i
billion. a t mat g t t i
a ti i i
Establish Quantification Capacity at Provinces
Establish Quantification Capacity at Provinces
MD with support of GHSC-PSM project provided technical assistance to three provinces in
quantification ofit health commodities
t in Province 5,t Province
i 1 tand Sudhurpaschim
i a a i ta Pradesh
t t based on i i
a
data generated a
from eLMISa and
t HMIS
mm data.i i The forecast
i i a
on commodity a im anda cost a
requirements
ata provinces
estimate helped g at to procure
m thea medicine. ata at mm it i m t a t
mat i t t m i i
Develop Quantification Capacity for Local Level Governments
Develop Quantification Capacity for Local Level Governments
The quantification of health commodities at the central level has been effective to determine the
quantities for the
a next a fiscal year.
a t Considering
mm i federal at t context
t a of theacountry, MD organized
t t the
mi t
trainings ona quantification
t for tprovince
a aand local
i level
i g healtha personnel.
t t Quantification
t t ga i
guidebook t
t ai i g a a i a a a t a a
and workbook were used as resource material in all the seven provinces. Skills and knowledge from g i
a a mat ia i a t i i a g m
the training enabled health personnel realize the importance of forecasting in procurement and
t t ai i g a at a i t im ta a gi m ta
supply planning ofahealth
i g commodities
at in their
mm i respective
i t i context. t t
c. Quarterly
c. QuarterlyNational Pipeline
National Review
Pipeline Meetings
Review Meetings
Pipeline monitoring of FP commodities was started since 1997/98. It now covers FP, MNCH, EPI
Vaccines, iSyringes,
i m selected
it i g Essentialmm Drugsi and HIV/AIDS
a ta t commodities
i as well.
t National pipeline
reports area now
i used itog monitor tthe availabilitya ofgthe a stock at servicemm delivery
i points
a (SDPs)a anda toi i
monitor the procurement
t a status of key health
t m it t a ai a i it commodities. t t at i i i t a t
m it t m t tat at mm i
In each quarter, a national pipeline meeting takes place at the Logistic management section to
review, monitor,
a and
a tevaluate
a a thea procurement,
i i m shipment, g ta distribution,
a at t transportation
gi ma ag m and tstock t
status of family
i planning
m it and a other a health
at t commodities. m t i m t iti ta ta a t
tat ami a i ga t at mm i
Quarterly Pipeline Review meetings was conducted where program Divisions of DOHS, External
Donor Partners
a t andi stakeholders
i i mlike Social
g a Marketing t agency participated.
g am i i In i the meetings t a
shipment schedules, a t shipment
a tastatus (planned,
i ordered
ia aand received),
g ag actual
a i consumption
at t and
m g
months-of-stock-on-hand
i m t of 32 health commodities
i m t tat a were discussed. a i a t a m a
m t t a at mm i i
In FY 2018/19 MD organized three quarterly pipeline monitoring meetings on Aug 9, 2018; Nov 26,
2018 and Feb 22, 2019 to share ga i the t stock astatus
t ofi the
i 37m key it commodities
i gm g includingg FP, EPI
Vaccines and some program commodities. Based on evidence, decisions were taken tog cancel ora i
a t a t t tat t mm i i i
postpone or prepone or even relocation / redistribution of the stock averting a situation of stockout
or overstock and expiry. DoHS, Annual Report 2075/76 (2018/19)
g support
Achham District store after reorganization and inventory g am by GHSC-
PSM. Photo credit: GHSC-PSM
a m g am mm i Ba i ii ta t a t
a iti t t a g a it a t t t
a i
d. d. Strengthen
StrengthenStorage StorageCapacity
Capacity
Ideal storage conditions for essential drugs and commodities are required to deliver quality health
services from
a t any ag servicei delivery sites and a ensureg a optimal mmhealthi service
a utilization
i t byi consumers.a it at
Numerousi districts m a seriously i lacked i ideal
it astorage space ma for handling
at ihealth i and
a other allied m
commodities
m including i t i tvaccines. i Earlier a assessment
i a t shown ag that
a storage a space
i g was a t inadequate,
a t and
a i
securitymmwas poor,
i isore space
i g ascattered
i aini twoa or morem trooms with t atnonet ag specifically
a designed
a i a forat
storage
a and many it were a in rented abuildings. a Most
i t of themstorerooms m were it filled with
i aunusableig
commoditiest aganda junk. maEvery year i huge t quantities
i i g of drugs t t and tother health m commodities it went a
missing,mmdamagedi or a had to be destroyed. a g a g a t at mm i t
mi i g amag a t t
Logistics Management Section in technical assistance with USAID GHSC-PSM enhanced warehouse
capacitygiat the central
a ag m andtprovincei 5 tand 6i warehousea a i ta withitinstallation of storage equipment, a a and
a aofitgood
induction at t warehouse t a a practices. i Health a Commodities
a it i at ta
store theahealth office
t agof Provinces
i m t2,a
6, andi 7 were reorganized
g amaking it possible
a at
to institute mm i
supportive tsupervision
at t a t good practices.i
and
a
In the reporting period, GHSC-PSM ga i ma i g closely
worked it iwithtstakeholders
i t t – DoHS Divisionsi imainly a the
g
a
MD, provincial health directorates (PHDs) and Logistics Management Centers (PHLMCs),
districthealth offices (DPHOs), local level governments (LLGs). The purpose is to ensure availability
t g i it ta i ii mai t
of uninterruptedi supplyia ofa healtht i commodities
t at to patients.
a gi a ag m t t
i t i t at a g m t i t a ai a i it
In the reporting
i t period,
t in coordination
at with iMD, tGHSC-PSM
mm a t delivered new storage and safety
equipment – racks, trolley, pallets, fire extinguishers to five PMSs. GHSC-PSM also worked closely
with Save t the Childreng (SC) i andi USAIDi aNepal Reconstruction
it Engineering
i Services t(NRES)
ag aProjecta t
implemented i m byt CDM a Smitht on designing
a t the newg construct
i t warehouse in CMS Pathlaiya,
a to rebuild
it a floor
the warehouse t toi improve its’
a strength to accommodate
a t moderngiracking
i gand movement
i of folk t
im m t mit ig i g t t t a i at ai a t i
lift or stacker and new construction at different provinces.
t a t im it t gt t a mm at m a i ga m m t
i ta a t at i t i
Data on expired commodities was built by collecting the list of expired and damaged commodities
from PMSs and health office stores through GHSC-PSM field support officers (FSOs). In the process of
ata i mm i a it gt it i a amag mm i
importation
m of afamily a planning
t tcommodities
t g for social marketing tGHSC-PSM has facilitated
t
Contraceptive
im ta Retail Services
ami (CRS). a iAllg scheduled
mm i shipments iaforma FY 18 &g 19 were procured
a a iand
itat
deliveredton a time. tai i i m t a
i m
a. Improving Inventory Management and Warehouse Best Practices
Propera. warehouse
Improvingstorage
InventoryandManagement
practices are and key
Warehousequality
for maintaining Best Practices
health commodities and a
functional supply chain system Effective and
a t ag a
efficient management of racking and shelving
a a mai tai i g a it at
simplifies
mm the i awarehouse
a aoperation. aiA
competent,t m motivated,a skill-mixed i t ma workforce
ag m ist
required ato i ensure
g a good i storage g im practices,
i t
a and that health
operations a commodities m reach
t t
wheremtheyat i mimost.
are needed i i
t g t ag a a
MD ina collaboration
t at a t withmm i
GHSC-PSM a
supported Provincial Health Directorate, and Health Office through
mobilization of FSO,
DoHS, Annual LMIS
Report Officers
2075/76 and pharmacist in all the districts of Sudurpaschim, Gandaki and
(2018/19)
Province-2 to organize all health office stores aligning the process for effective inventory management.
This included arranging stores basedon warehouse best practices, conducting a physical count, removing
expired commodities, updating inventory records, building overall capacity of staff with an emphasis on
g g am
t a m t
i a a it t i ia at i t at a at
t g m ii a a a ma i t i a t iti t a im
a a i a i t ga i a at t a ig i g t
i t ma ag m t i i a a gi g t a a t a
ga i a t m i g i mm i a gi t i i g
a a a it ta it a m a i i t ma ag m t ii
t am i a
inventory management, asupportive asupervision, ateamwork,
it dedication,
t a ghard work
m and
t i cooperation
t with
the local government institutions.
i g a it management,
inventory i it t i g ta supervision,
supportive a m it dedication, hard work
teamwork, i i anda cooperation
a t i with t
maDuring
ag ma site
t a visit the
a following tasks
the local government institutions. t are performed with supportive supervision as part of inventory
a
management and warehouse best practices:
During a ia gsite visit
t the t ag a a tasks are performed with supportive supervision as part of inventory
following
 Cleaning of the storage area
ga i i g and warehouse
management t a best practices: a aa a
 Organizing of stores based on FEFO/FIFO and separation of none usable health commodities from
at mm i
m a
usable products; t
 Cleaningmi gofphysical
the storage area
i a count t all ahealthacommodities
t mm ini a store;
i a t
 Performing of
 Organizing of stores based on FEFO/FIFO and separation of none usable health commodities from
e ousable products;
the tore ho d e c e ed d rr ed t tod e der tood the re e i o ood tor e r ctice d
h it i Performing
i ort t or physical
the count
ch iof all health
e e commodities
t hi i in ae store;
ood r i e erie ce or d th o to GHSC-PSM
Pro i ci He th irector te d M e e t i i io ri h h tt Store ee er He th ice de dh r
e o the tore ho d e c e ed d rr ed t tod e der tood the re e i o ood tor e r ctice d
h it iVerifying
ii i ortg aand
t orreconciling
the i i gch i
counted et with
t stock e t stock
hiit i registers;
t ood egir ti e erie ce or d th o to GHSC-PSM
Pro i ciSigning
He thandirector te reconciled
stamping dM e quantities
e t i i io by relevant
ri h authority;
h tt Store ee er He th ice de dh r
ig i g a tam i g i a a ta t it
 Updating
a g aall iinventory
t records and tools
t (registers
gi and eLMIS)
 Verifying and reconciling counteda stock with stock tregisters;
a
 On-the job-training on inventory management and any relevant supply chain management function.
t
 Signing andtofai i g reconciled
stamping i t quantities
ma agby m t a authority;
relevant a a t ai ma ag m t
Reorganization Mustang Health Office Store
 Updating all inventory records and tools (registers and eLMIS)
 On-the job-training on inventory management and any relevant supply chain management function.
ReorganizationofofMustang
Reorganization Mustang Health
HealthOffice
OfficeStore
Store
Before After
All the district stores of all three provinces were successfully reorganized with an updated stock balance in
the system Before
as well as segregation and record in the separate register After of expired and damaged
commodities. The event was highly appreciated by the district and provincial health directorates.
t theidistrict
All t i t stores
t a three
of all t provinces i were successfully reorganized ga withi an updatedit astock balance
at tin
a Effective
athe system
i tVaccine tManagement
as well m asa segregation
ais onegandofgathe
record a in working
cores i areas
the separate t registera atofEffectiveness
of LMS. gi t andof damaged
expired i
vaccine a
amag
management mm widelyi depends on thet a
effective ig and a
proper iat
storage of tvaccine
commodities. The event was highly appreciated by the district and provincial health directorates. i t i
as t a
well as cold i ia
chain and a t
i supply
t atchain management. To ensure proper cold chain, LMS has mobilized Mechanical Engineers and
Refrigerator Technician
Effective Vaccine for immediate
Management is onerepair
of the of damaged
cores workingrefrigerators
areas of andLMS.
freezer to ensure of
Effectiveness effective
vaccine
vaccine
managementmanagement.
a i widely LMShad
depends
a ag m t i repaired
on the and maintenance
effective tand of
proper refrigerators
storage of
i g a aand freezers
vaccine as whenever
well as cold required.
chain and
By far, 107
supply cold
chain chain equipment
management. To has been
ensure repaired
proper cold in 50 districts.
chain, LMS hasCurrently
mobilized oneMechanical
Refrigerator Technician
Engineers
a i ma ag m t i t a t ag a i a a and
has been mobilized
Refrigerator in Biratnagar
Technician for CCE repair
for immediate repairandof maintenance in Provinceand
damaged refrigerators 1. freezer to ensure effective
ai a ai ma ag m t ai a m ii a i a
vaccine management. LMShad repaired and maintenance of refrigerators and freezers whenever required.
gi
Similarly,
By far, 107astorage ig at
capacity
cold chain i ia been
in 45 districts
equipment has were imm iat
strengthened
repaired ai amag one
by transportation
in 50 districts. Currently ig Godrej
at Sure
of Refrigerator
96 aTechnician
chill
refrigerators enabling the districts and their sub-stores to
has been mobilized in Biratnagar for CCE repair and maintenance in DoHS, store vaccine in
Provinceproper temperature to
1. Report 2075/76 (2018/19)provide
quality immunization service. Lifeline Nepal supported in distribution, Annual
installation and preventive
maintenance of refrigerators supported by UNICEF Nepal.
Similarly, storage capacity in 45 districts were strengthened by transportation of 96 Godrej Sure chill
refrigerators enabling the districts and their sub-stores to store vaccine in proper temperature to provide
quality immunization service. Lifeline Nepal supported in distribution, installation and preventive
maintenance of refrigerators supported by UNICEF Nepal.
g g am
t a i ma ag m t a ai a mai t a ig at a
i B a ai i m t a ai i iti t
t ig at i ia a m ii i Bi at aga ai a
mai t a i i
imi a t ag a a it i iti t t gt ta ta
i ig at a i gt iti t a t i t t t a i i t m at
t i a it imm i a i i i a t i iti i ta a a
mai t a ig at t a
e. Capacity Building in Logistics Management
New Intervention
Quality assurance of Inj Oxytocin
t i i g i t i m ta a t i t g a i i
t a t m at i t a i at a it a a
i t i i a at a ai ig t m m t a i g
iti a t a tmi i g t ag i i a a at i it t i
i a i g tt ma a ai a at t it i g t at a m ti i a
a it i a i t i a t i g mat a m ta it
a i t i t i it t ag i i ti t i m ia
it a i t at i t i g ga ig at i t a ai a it
t t i ai it a a i i ga mi it a i t
Real Time Inventory Management System (IMS)
Ba a i t i a t at a a g
t m t m t it i t i t a m i ma t ma a
ai ii ma i g ai i g t a m i ma at
mm i gi a ag m t t a i i a t ma a m i t
ma ag m t t m t t iti t it t mi a a a i a
i i i g i t m gi a m i ma t tat at mm i at
i t t i a t ma ai ii ma i g ai i g a i t
a i ia m i a t a iti t t it t a ia t
a a a i t im m t t i t m m t i a a
Manual Revision and Pull System Training
ai i g ma a a i i i t t t a a g i a a ai i g i t
ga i it a aim im i g g i a a t t t
a at at i t a t t a ai a i it a at m i i
a at mm i i at a ii ia t mt i at a i
Conduction of basic level logistics training
t ai gi t ai i g a t it t m i a i at
i ia a imi a t i a t i a a m ta
ai ma ag m t a a t it t m i a iti t
g g am
Development of Basic Logistics Training Manual
a ai g i a a i a t a Ba i gi ai i g
Conduction of eLMIS training:
t a t t ai i g i a i i iti t i
a i at a ii t a Ba i a i t i t
t ata a it a m ta i t ti t i t i t at a
a ia a a mai ata a it a m ti t m it a it
ata at a i it ata a a
Disposal of Unusable Health Equipment and Commodities: A Best Practice

Disposal of Unusable Health Equipment and Commodities: A Best Practice
a
Unusable a
and/or i health
expired a t commodities
mm i area a major
a ma problem form Nepal’s health
a at
system. tSafe
m
a t ag
storage conditionsi for essential drugsa ganda commodities
mm i area required i tot deliver
i quality
a it health
at
i
services t service
to i delivery
i it In addition,
sites. a i “de-junking” i gof unusable
a commodities
mm i helps clear the a
tway for
a usableacommodities.
mm i For example, ama majora made-junking drive
i g ini 1994-97
i freed up moremthan
t125,000
a a
square feet of t free spacea anda generated
g at 25 million
mi i Nepalia iRupees (NRs.) for thet
m t of Nepal’s
Government a treasury.
t a
LMS started
ta t several a aactions tto disposal
i a of unused, unwanted
a t or expired
i have
a been carried
a i outt it
items.
m
These aactivities
i include
i the
t provision
i i of technical
t i asupport in
t iauctioning
a i ofg unusablea commodities
mm i for
thetDistrict
i t for
i t saving
a space
i g ato storet tvaluable
a alifesaving
i a drugs.
i g g
f.f. Formation
Formation and action taken
and action taken ofof Logistics
LogisticsWorking
WorkingGroup
Group(LWG)
(LWG)
An aauthentic
t Group was
a formation
ma with
it 9 mmemberships
m i chaired
ai by Director
i t of Management
a ag m t Division
i ii
with
it representation
ta of Divisions,
i ii Centers
t and
a External
t a Development
m t at Partners at
at center
t level. The
LWG addressed
a major
ma issuesi regarding
ga i procurement
g m and
t asupply chain management
ai ma ag ofm health-
t
related
a t commodities.
at mm The i LWG members m will
m be extend
i on tthe basist of area
a i andanecessary
aa and also
a
plan
a a to extend
a t the Regional
t t level LWG.
gi a
8.4.4.5
8.4.4.5 Issues and
and Action
Action Taken
Taken : :
Issues Action Taken Responsibility
Low Budget in Drug Procurement Budget will be revised as demand MoHP/DoHS
and supply in local level in next year.
Capacity building in procurement, LMS has planned to conduct that DoHS/MD/LMS
forecasting, quantification and training at all provinces.
LMIS
Not functioning of telemedicine LMS will coordinate to start the DoHS/MD/LMS
program in rural areas well-functioning of telemedicine
program
Management of Expired, Wastage LMS will collect those materials DoHS/MD/LMS
and unused materials from all provinces and destroy or
disposed as process.
Inadequate of HMIS/LMIS tools Tools will be supplied in time and DoHS/MD/LMS/IHIMS
and late supply adequately
High demand of required LMS will demand budget for DoHS/MD/LMS
equipments equipment procurement.

g g am
8.5 National Public Health Laboratory
8.5.1 Introduction
a at m i i i a ita m t at a i a at a t m
it ai a at i i i iag i a a t i i
i at a i i a a t a a i a t a at i a
t t i it at a a a i ii at i
t at a a a a a i g at t a at i i t t t
a ta i i B a ta a t a at a ga it a a a i
a t a at i B
a a at i a a a t a at i a t i i at
a
at ta i m t a i t a a i at aat
a t ta ia i a a a i at a at t t a t
g at t i i a i at a i a a a i t a t
t g it a a B a B a i i BB i a gi t
i i it a a i a t
m it a at i it i t t t g it t a a it a a a
i a t a it t t g am a i i ii t g m ta
g m t a at i t t t a a t a a it a m
g amm t m it t g a it
i i i i g a m t ag t i i i a t t at
i i gt i ma a i at m g i i t a a g
it iag a ii t a at a i a a a a ia
i gt t a ai m gi g a m gi g i a a at ma
t a ta at a a a it a a i gi t a a i i g
i at t a at i a t a a B a B a i i
BB at ig at a a a i t a t
a a ai t a a i mi t at g aat i i
iagi g m gi g a m gi g i i a a a ta i t a a
a t i i a it Bi a t a i a a a a
a t t g t a a a i a t t g t
a i a t iag i a aB a t i
i i g i at a i a ta a im a g a m agi
g i g a i a t ia a t a ma t i it a ai a ti a
m a i g ia a a B ia a a a i gt a tg t i g
8.5.2 OBJECTIVES:
a a a a a at
a a i g i i a m a im m t ta a a at
i m t ag t a mi a
a mt g m t mmitm t a t t ga i a a ma ag m t
i t t a tai a a t a at i
t gt a at i g t iag i t atm t i a
a t i a i i g i B a

g g am
ta i a a ta a a at a it t m
t a it a t a at i t g a a it t m
m t ta i m t im m ta a m it i g t a a at
a at g amm a t a a g at m a im g a g at
a at i
a at a ia a ma at a at i
m it a t t i a a i a at a i i g a t a it
a t i a ta t i a a a
ag a a a a t i m a im t a it at a at
i
a ta a a a a at a a t a a i t
a t
im i a at a a t ma ag m t a
im a t at i ia a a
t gt at i t i i g a t m
t gt ia a t t m a im
t a a t i i i it a a
i i g tt mi a a
a i g ia a a B ia a a a i gt a tg t i g
8.5.3 NON-COMMUNICABLE DISEASE DEPARTMENT
a mat g Bi mi t i g a i t t at g a i g
mm i a i a a tm t B t a ia i i a i g
i m t a tm t t a mia a t m t i t i
a m g i t i a m g i at i g t a a mia i i a t
ag a a t a a a i i it a a it a a t i m a i i g
a a t g i a m t ia i i i g i
B i iag a ii m a t t at t a mat g i B B i g
a t i m ta a a tm t i a m it it
m g i at i t at a it at i ag B a at a ga i a B t a ai
a a i a a i g a i ti t
8.5.4 QUALITY CONTROL AND TRAINING SECTION:
a it t a t ai i g a i t a it at a i a t
t ai i g a ai i g it a a t i g t ai i g a a
a i a t ai i g a t ai i g a m t g a t ai i g t i i
a i i i i a m it i g t g m ta g m t a at i
Ba i i a m it i g i i i a at a a t
at g i t
a a a a it a m t t m i a i g t mt i
i t t t a i
i mi a t t a mat gi a t t a g am tai a
a a i at t a i a g a at i a i i a t t
am a tt m a a a a i t i g am a t m
i i ai g
i i i a i g B ta i i it i gt t
B g a it a i t g am t t B
3 22 DoHS, Annual Report 2075/76 (2018/19)
g g am
i tm t a t ti a t

8.5.5 NATIONAL BUREAU FOR BLOOD TRANSFUSION SERVICES:
a a B a B a i i BB i i a at i t a a
a t it im m gt a a B g amm B BB t t a
a at a m a t t m tt a i i g
i i g i i t ta a a g a at a i t
a a a at i g t a i t a mi i i a i
i a a g ma a t g a i g i a t
ta i i t B t a a a it a m ti
a i t ai i g B ta a i i g m it i g i i gB a m a a
g am i i m t t t B t i i at a t at i
8.5.6 HIV/HEPATITIS REFERENCE LABORATORY
a a a at i it at at i a B i a a i
at a at a i mai t g a m it i g t a a
at g am a t t t mai m i a it a mm g it
a a m a t t ma a a m a t
a t t i ia a a B ia a a
ia a a a a a t iag i a i t
ai mm g t g t m t
g m i B g a t t a i iag it a
B g B B B i a m i a at a
B m i B a ma a t g m a a a i B ai a
B t ga ma i
a a it t a a i a gi i g g am
ia a a i g i im t a at B a
ia a m t a ia t t m iia ita Ba g a g m
t a ia
t a a g am i a t a m it t i a tm t i
i t g t am m i t it a
a a a a a g a
at t t a g am a a it i a g at ai i g a
a a a i g a a i i BB
a a i g i g g i ta a g t i gi mi g
t t ia a t t B a a i g

g g am
FigureFigure 8.5.1:
8.5.1: HIV HIV Reference
Reference Unit
Unit (Viral load (Viral
tests load
on HBV, tests
HCV on HBV, HCV and HIV)
and HIV)
Figure 8.5.1: HIV Reference Unit (Viral load tests on HBV, HCV and HIV)
15000
10171
7573 8603
10000
15000
10171
7573 8603
10000
5000
372 202 633 217 644 240
5000
372 202 633 217 644 240
0
0 2073/74 2074/75 2075/76
2073/74 2074/75 2075/76
HBVHBV
HCV HCV
HIV HIV
8.5.78.5.7NATIONAL
NATIONAL INFLUENZA
8.5.7 NATIONAL CENTRECENTRE
INFLUENZA
INFLUENZA CENTRE
National Influenza Centre is one of the newly established and highly equipped departments of
National Influenza
National
a a Centre
Public Health
a is t one
Laboratory
i of the t newly ta
(NPHL) designated established
i
by Ministry
a and
ig
of Health andhighly
i equipped
Population
a tm t departments of
(MoHP) and
a a i a t a at ig at i it at a a
National Public
recognized Health
a by World
Laboratorya(NPHL)
g i Health Organization
t
designated
ga (WHO)
ia for thebypurpose
t
Ministry of Health
of participating
a i a in
and Population
g i WHO Global a
(MoHP) and
recognized
Influenzaby World
Programme.
a g Health
Upon such
amm Organization
recognition i (WHO)
g by WHO, NICforhasthebecome
a purpose
mmember
m m of of
participating
the
t WHO Global ina WHO Global
Influenza a i a
Surveillance Network. t
Influenza Programme. Upon such recognition by WHO, NIC has become member of the WHO Global
Influenza Surveillance
a Network.
was
i a started
a since
ta t 2004
i from Jhapa,meastern
a a part
a t of Nepal
a t with the
a aim it tto identify
aim t
the influenza
i viruses
t i from suspected
a i cases
m of influenza
t a like illness
i (ILI)
a i and
i immediate
a response
imm iatto
minimize t mi was
the circulation ofstarted
imi t
viruses since
i during 2004i from
a outbreak. Jhapa, t eastern
i g specimens
Initially, a i apart offrom
collected imNepal with
suspected t the casesmaim to identify
the influenza
of ILI were virusest
performeda from suspected
by Rapid Diagnostic mcases a i influenza
of
Test (RDT) iag identification
for liket illness i (ILI) and
of influenza a iLater on,
immediate
viruses. a response to
i at m a iag a a a i a i a a ta t it t
molecular
minimize the diagnostic assay based influenzaduringsurveillance was started specimens
with the introduction of Real-Time
i tcirculation ofa viruses im outbreak.
at a aInitially,
i a t a at collected from m suspected cases
PCR (RT-PCR) at
i g a National
mi Public Health Laboratory (NPHL) from 2009. During pandemic influenza
of ILI were performed by iRapid aDiagnostic
t a i Test (RDT) afor identification a a iaof influenza
t g t it
viruses. Later on,
outbreak ini 2009,mi NPHL
g a had iplayeda a key
t cruciali i i role together with a tmEpidemiology
t a t and Disease
i i Control i g
molecular
Divisiondiagnostic
i(EDCD), aassay
t a Department ga i based influenza
a of Health Servicessurveillance was started
includingainternational a with
a the
ig atorganizations introduction
a (WHO, a
WARUN). t of Real-Time
PCR NPHL
(RT-PCR)
has been t
at National i Public
designated Health
as National a Influenza
i Laboratory
i a Centre i (NIC)
(NPHL) a on a19from
th a 2009.
a t 2010.
April, i a During
Influenza gi a
pandemic
virus influenza
m a iag a a ta t it i a a i at i
outbreak in t2009,
isolation, NPHLa had
identification
a gplayed
and characterization
t amma
keybycrucial rolemolecular
serological
t together
at t with
i a Epidemiology
diagnostic assay were successfully
i g anda Disease Control
started within
Division (EDCD), g Departmenta of Health Services including international organizationsof (WHO,
one year and 28 isolates were shipped to WHO Collaborating Centre Summary the WARUN).
Influeza test done is as shown in figure 8.5.2 and figure 8.5.3 for 2017 and 2018 respectively
NPHL has been designated
Figure 8.5.2: as National
Total Influeza Tests done in Influenza
2017 Figure Centre (NIC)Influeza
8.5.3: Total on 19 TestsApril,
th
done in2010.
2019 Influenza virus
Figure 8.5.2: Total Influeza Tests done in 2017 Figure 8.5.3: Total Influeza Tests done in 2019
isolation, identification and characterization by serological molecular diagnostic assay were successfully
started within oneTotal yearSample
andCollected in 2018 were
28 isolates = shipped TotaltoSample
WHO Collected in 2019 =Centre
Collaborating 5786 Summary of the
1821
Influeza test done is as shown in figure 8.5.2 1381and figure 4000 8.5.3 for 2017 and 2018 respectively 3208
1500 3000
1000 2000 1183
Figure 8.5.2: Total Influeza Tests218
done in 2017 Figure 8.5.3:
498Total Influeza
869 Tests done in 2019
500 35 187 1000
0Total Sample Collected in 2018 = 0
Total Sample Collected in 2019 = 5786
A/H1N1 A/H3 Influenza Influeza A/H1N1 A/H3 Influenza Influeza A
1821 B
pdm09 Positive A&B pdm09 Positive B Positive &B
1381 4000 3208
1500 positive Positive Negative positive Negative
3000
1000 2000 1183
498 869
500 35 187 218 1000 DoHS, Annual Report 2075/76 (2018/19)
0 0
A/H1N1 A/H3 Influenza Influeza A/H1N1 A/H3 Influenza Influeza A
pdm09 Positive B A&B pdm09 Positive B Positive &B
positive Positive Negative positive Negative
g g am
8.5.8 JAPANESE ENCEPHALITIS, MEASLES AND RUBELLA LABORATORY
i a mm i a i a a g i g a t a ma
i at m i m gt m a i ta i a a t m t
m ta it at i am g t i a t a t t
m ta it a m i it a i ta i a a a ai a
a t mm i a ta i a a at i t at
ga i a a m t a i i gi a a it a a i at
a at t a tm t at i i it at a a
a i t g a i g m i it a m ta it t a i ta i a
i a a ti a i a ta it t ma im m i a it
a at a t t at i a i mt a i t a ma am
a i g m ta a t ag a i a i a a a
t t at a at g at i a t a imit t a a t
t a m t ma t a t it t i ai g
a i t i i a g am a t t i a
i i gi t a a at i ia i a a i a t a at a at
iag i i a m ma i gt m t t t i i i i a t
i a t mi i gi t i a i t g a a t t a t a at t am t mai
i i it i t mm i at i ma m t ga i g t a it a t a t
t a i im i a at a g it t a ma ga i g
i i g im a t g t ag im t ga m ta
t m i t g amm i a a a i
t i a i a a at it ai ma
i a t m ga t a a t t a a
a a it agai i g t
8.5.9 MAJOR ROUTINE ACTIVITIES OF NPHL:
a ia i
iag i i i g i a a at
i at at
a i a at a i a a a ai
m a a i a mi ia i ta i a it a a
a t B a at a t a i ga
ai i g a
gi m ta a a at i m t
ii a m it i g i i g a B
a a t a a it a m a mat g i mi t g am tai
mi i g t a t ia at g a
i tai m t a it a ita
i g a i g m i a a at at i gi a a g i i
m t ia t it a ag t a i m t i ia a a
g m t a at i
a a mi i ta

g g am
8.5.10 AMR (Antimicrobial Resistance) SURVEILLANCE ACTIVITIES
8.5.10 AMR (Antimicrobial Resistance) SURVEILLANCE ACTIVITIES
NPHL tlaboratory
a at surveillance i a on variousa i disease
i a pathogens
at g including
i i gon measles-rubella,
m a a
8.5.10 conducts
AMR (Antimicrobial Resistance) SURVEILLANCE ACTIVITIES
a a
Japanese a i i
encephalitis, influenza a a a mi ia
and antimicrobial resistancei ta i a
surveillance t m
to monitorit t
the burden of
NPHL
t conducts
i a laboratory
a t i surveillance
m i a on tvarious t atdisease
gi pathogenst including
t i on measles-rubella,
a a
these diseases
Japanese and to inform disease control strategies. Trend of the enteric fever cause and AMR are as
a a encephalitis,
i g influenza and antimicrobial resistance surveillance to monitor the burden of
shown in figureand
these diseases 8.5.4
to inform disease control strategies. Trend of the enteric fever cause and AMR are as
shown in figure 8.5.4 Figure 8.5.4: Trend of enteric fever (cause and AMR)
Figure 8.5.4: Trend of enteric fever (cause and AMR)
Figure 8.5.4: 100fever (cause and
A Trend of enteric 84 848388
S.Typhi S.Paratyphi 7581 AMR)
80
100 84 848388
500 S.Typhi S.Paratyphi A 60 7581
401 400 80
500 40
400 60
401 400 20 9 10 6 2 5 5 2 2 2 1 4 4
40
400
300 250 0
20 9 10 6 2 5 5 2 2 2 1 4 4
300
200 250 0
101
200
100 39 39
101
100
0 39 39
2073/74 2074/75 2075/76 2073/74 2074/75 2075/76
0
2073/74 2074/75 2075/76 2073/74 2074/75 2075/76
Salmonella
Salmonella
• S.Typhi s predominant than S.Paratyphi A till date however, the prevalence of S. Paratyphi A is
Salmonella i mi a indicating
tt a a at iepidemiology.
at t a a at i i
increasing annually changing
• i S.Typhi
a i gs aispredominant
a in i than
i 20-29 gS.Paratyphi
a years aage g Ai till
gi group date ghowever, the prevalence of S. Paratyphi A is
• Infection higher in mi
both sexes.
increasingi annually i indicatingachanging
ig fluoroquinolones g epidemiology.
ag third i t cephalosporin is increasing
• Resistance to and generation
• Infection is higher in 20-29 years age group in both sexes.
• MDR i ta trendt is decreasingi from 8% a in2012
t i tog 1% aby 2019. a i i i ai g
• Resistance to fluoroquinolones and third generation cephalosporin is increasing
t i ai g m i t
• MDR trend is decreasing from 8% in2012 to 1% by 2019.
Figure 8.5.5: Trend of AMR in bacterial diarrhea
Figure 8.5.5: Trend of AMR in bacterial diarrhea
2073/2074Figure2074/2075
8.5.5: Trend of2073/2074
AMR in bacterial diarrhea
2074/2075 2075/2076
100 2073/2074 2074/2075 2073/2074 2074/2075 2075/2076 85

7468746868 69 75
80
100 54 54 5757 8563
60 4850485050 42 4242 7468746868 75
80 69 63
40 54 54 5757 25
60 4850485050 42 4242
20 6 4 4
40 250 0
0
20 6 4 4 0 0
0
Shigellaspp
i i t a t g a
B ig a t ia a a t t ig a i mi at a a
ig a i at a t m t mm i ta t t a
im ta i ta t t B ta a tam i a ta i

Shigellaspp g g am
• Shifts in the prevalent serogroups have been observed
• i Before
at 2005
a i t
Shigelladysenteriaeamwas prevalent
i tami
but i a
Shigellaflexneri im
predominated afterwards.
• In 2018, 31% Shigella isolates were MDR and the most common resistant type was
Vibrio spp
simultaneuosly resistant to Beta lactams/Fluoroquinolones and Tetracyclines.
• All isolates are sensitive to Chloramphenicol, Gentamicin and Cefixime.
i i t
Vibrio spp a ga a
• Shift in serotype observed.
a a a
• 2003-2004:t V. choleraea O1 Ogawa
t ga a a a i ima
• 2005-2006: V. cholerae O1 Inaba
i a ga a
• 2007: All serotypes V. cholerae O1 Eltor Ogawa, Inaba&Hikojima
t a a i a i at a t t m a it
• Since 2008-2015 : V. cholerae O1 Ogawa
iti t i t a a ta ga a t
• In 2016 outbreak 169 cholera positive cases were isolated and reported (Mostly from lalitpur
a a t i a t a
district) of which only two were O1 Inaba rest all were of Ogawa serotype.
• Only 2 V.cholerae was reported in past year.
Figure 8.5.6 : AMR in respiratory infections
Figure68.5.6 : AMR in respiratory infections
2073/74 2074/75 2075/76 2073/74 2074/75 2075/76
70
61 61 61 61
60
4847.5 4847.5
50
41 41
40
30 22 22
20
10 10 8 8 9
10 4 4 5 5 5 5 5 4.5 5 4.5 3 3
0 0 2 2 0 2 2
0
Ampicillin ciprofloxacin Chloramphenicol Cotrimoxazole Erythromycin Penicillin G Ceftriaxone
70
60
50
40 2073/74
66 66 2074/75
30
43 2075/2076
20 38
29 29 33
10 20 16 17
0 0 0 0 0
0
Ampicillin Ciprofloxacin Ceftriaxone Cotrimoxizole Erythromycin
Streptococcus pneumonia
Streptococcus pneumonia
• Infection is higher in elderly patients (above 60 years of age)
• i ig were
2 % isolates i resistant aalso to
t third
a generation
a Cephalosporin
ag (ceftriaxone)
• iAll the
at isolates areisensitive
ta t a totdoxycycline.
t i g a a i ia
t i at a i t i
Haemophilusinfluenzae
a t i at t it a i at
t im a i ta i i ai g m i t i
a m t mm a t m a t a

• Least isolated due to its fastidious nature
•• Cotrimoxazole
Least isolated due to its fastidious
resistance nature
is increasing from 2% in 2005 to 42% in 2018.
•• Elderly
Cotrimoxazole
are mostresistance
commonly is increasing fromfrom
affected (50% 2% inpatients
2005 toabove
42% in602018.
yrs)
g g am
• Elderly are most commonly affected (50% from patients above 60 yrs)
Figure8.5.7:
Figure8.5.7:AMR MRSA
AMR in MRSA
Figure8.5.7: AMR in MRSA
120
120 99 98 96
100 91
85 99 98 96 87 88
100 79 91
80 85 74 74 73 87 88
79 64
80 74 74 73 64
60 52 64 55 5464
55 54 2073/74
60 52
40 2073/74
28 31 2074/75
40 28 31 2074/75
20 13 12 2075/76
8 8 7
20 0 0 0 13 12 0 2075/76
8 8 7
0 0 0 0 0
0
Methicillin
Methicillin resistant
resistant S.aureus
S.aureus
Methicillin resistant S.aureus
• Resistance to Gentamicin increased from 41% in 2013 to 64 % by 2018 .
•• Resistance
Resistance
i ta to chloramphenicol
t to Gentamicin
tami i i increased from
m 41%
a fluctuated i in 2013
between t to 64 %inby
9%-15% 2018years.
recent .
•• Vancomycin
Resistance
i ta t toischloramphenicol
theam
drug ofi choicefluctuated
t at between
t 9%-15%i in recent t years.
a
• aVancomycin
m i i t is the drug
g of choice
i
Figure8.5.8: AMR in ESBL producing E.coli
Figure8.5.8:AMR
Figure8.5.8: AMR in
in ESBL
ESBL producing
producingE.coli
E.coli
Chart Title
Chart Title
100 92 91 92
100
90 92 91 92
90 72 69 70 72 70 71
80 71
80 72 69 70 66 66 67 69 71 72 70 71
70 66 66 67 69
70
60
60
50
50
40 31 2074/75
40 2074/75
30 20 2331 25
30 20 16 19 23 25 2075/76
20 13 16 19 11 11 13 14 2075/76
20 7 9 13 8 11 11 913 14
10 7 9 8 2 9 2075/762
10 2 2075/762
0
0
ESBL
ESBLE.coli
E.coli
ESBL E.coli
 Increasing
Increasing resistance
resistance against carbapenems (Imipenem,meropenem)
against carbapenems (Imipenem,meropenem)isisofofmajor
majorconcern.
concern.
 aBetai g lactam-Beta
Beta i ta
lactam-Beta lactamase
agai Inhibitor
t a aInhibitor
lactamase Combination
m Combination
mi drugsare
m mdrugs arem also becoming
i becoming
also ma lesseffective.
less effective.
Bta Among
aAmong
tam Bthe ta a tama
the commonly i it
used drugs,
commonly used m i a
drugs, nitrofurantoin g a
nitrofurantoinshows a
showsless mi g
lessresistance.
resistance.
m gt mm g it a t i i ta
8.5.11 REVENUE GENERATION
g at m i t a at t g i i i a i gt
g a a a at i i i m ai it i a
8.5.11 REVENUE GENERATION
NPHL generates revenue from different laboratory testing services. There is increasing trend on revenue
generation and laboratory services provided in comparison with previous years. g g am
Figure 8.5.9: Total number of laboratory testing services provided by NPHL
Figure 8.5.9: Total number of laboratory testing services provided by NPHL
600000
501693
500000
400000
305849
300000
200000 174761
100000
0
2073/74 2074/75 2075/76
Total Tests Done
Net Revenue
120000000
105130726
100000000
80000000 76127355
60000000 56696637
Net Revenue
40000000
20000000
0
2073/74 2074/75 2075/76
Figure
Figure 8.5.10:
8.5.10: Trend
Trend of of revenuegeneration
revenue generation from
from laboratory
laboratoryservice
serviceatat
NPHL
NPHL (amount in Nrs.)
Source: NPHL/DoHS

g g am
8.5.12 Working
8.5.12 Working Structure
StructureofofNPHL
NPHL
SECTION 1: SECTION 2: SECTION 3: SECTION 4: SECTION 5:

Non Infectious Blood Bank and Quality
Communicable Diseases lab Laboratory Control and
Administrative
Disease lab Licensing and Training Unit Section
Microbiology Monitoring Unit
(AMR) Director's
Blood Safety NEQAS
Office
JE/Measles/Rubell Program
Diagnostic (National
-Routine a
Bureau for Training
and Polio/Dengue Data
surveillance Lab Blood section
Specialize Transfusion Management
d National Influenza services(NBBTS and IT Section
Center
HIV/Hepatitis Licensing, Account

Reference Lab Supervision and Section
Monitoring of
Immunolo Laboratories
Store and logistic
gy Lab
management section
BSL 3 Lab
8.5.13 CHALLENGES
8.5.13 CHALLENGES
ma a g a a t a at i a a a iat a a a
m t a at ta a i a a a ita
 The major challenges for Nepal's health laboratories are lack of appropriate laws and bylaws
mosti needed
t gfor
t alaboratory
a a it a
standardization a accreditation.
and a i m i a a at i i i
a i g a it a at i i g m t a a at i
 Insufficient budget allocation for quality assurance activities of medical laboratories which is
a a i ig a a a a t ai i g a at
a causing low quality a laboratory services in government based laboratories.
i m t a i a at m a i ma
 Lack of scholarships for higher education and advance level trainings for laboratory personnel,
m lack m ofta pro-research a t environment
a at iandi inadequate number of functional skilled human
resources. t i g i i a am ti t
 taImplementation
i m t of Health Laboratory
i ia i Guideline
at a a 2073. t ai a i at a
 iagPrevention of i out sourcing clinical sample outside country.
 t Establishment
gt i g ofiagPPHL (Provincial
i Public Health Lab.) and Decentralization of public health and
t diagnostic
gt i gservices.
 Strengthening
i i g of Diagnostic
i m tService.
 Strengthening
a ag t aNEQAS. i a
 gVendor
a licensing
i m for i aequipment.
i m t
 t KITgtand ireagent
g avalidation.
a i
 Regulation of biomedical equipment.
 Strengthening research activities.

g g am
8.6 Personnel Administration 8.6 Personnel Administration

8.6.1Background
8.6.1 Background
Human
ma resources aare the t pivotal
i ta resource for health a t care
a delivery.
i Human maresource management
ma ag m t
i involves tthe planning,
a i g motivation,
m a use, training,
t ai i development,
g m promotion,
t m transfer t a and training
a t ai of i g
employees.
m The proper placement and
a m ta use of human resources
ma is cruciali for effective
ia quality healtha it
care
a t delivery.
a iDoHS’s Personnel Administration
mi i t aSection (PAS) is responsible
i for
i routine and a
g amm aadministrative
programme mi i t a i
functions includingi gupgrading
g a i health
g a tinstitutions,
i t thettransfer
t a of health a t
workers,tthe upgrading
g a i g of health
a t workers up tot the t 7 tlevel. Accordingi tog delegated
th t gatAuthority
t ofit
i i t capacity
Ministry a a it building
i i g and
a the
t internal
i t amanagement
ma ag m oft human maresources. The objectives of PAS
aare ilisted
t iin BBox 8.6.1.
Box 8.6.1: Objectives of the Personnel Administration Section

The main objective of the section is to mobilize human resource to deliver quality health services. The
specific objectives are as follows:
 To transfer and manage all posts up to 7th level according to the delegated authority o ministry.
 To place health staff at sanctioned posts under DoHS.
 To manage human resources at the different levels under DoHS.
 To take disciplinary action according to the law.
 To manage and update personnel information of all levels and institutions under DoHS.
 To manage the posting and transfer of medical officers who completed their studies under
government scholarships.
 To execute organisation and management (O&M) surveys to establish and extend the structure of
health institutions and organizations under DoHS.
 To recommend to MoHP for approval special leave and education leave requests by health
workers.
8.6.2 Routine activities

8.6.2 Routine activities
The number of sanctioned and fulfilled posts under DoHS of fiscal year 2075/76 is given in Table
8.6.2.1
m a a t a a i gi i a
The routine responsibilities for personnel administration are as follows:
 According to the Health Service Regulations, 2055 and MoHP policy, DoHS is responsible for
the transfer
The routine of the healthfor
responsibilities workforce
personnel up to the 7th level. are as follows:
administration
 DoHS manage the upgrading of its employees to the 7th level twice a year.
 DoHS work i g t tot maintain
a t the professional
i g a discipline ofaits employees.i i i t
 t DoHS
a t house
approve a t leave, sick leave,t delivery
t t leave and other types of leave. It recommends
ma ag t g a i g it m
to MoHP for the approval of special and education t trequestt by uptto i7thalevela employees.
t mai tai t i a i i i it m
 DoHS manage the retirement of staff.
a a i a i a a t t a t mm
 The approval of resignations of staff above the 6th level is made through MoHP.
t t a a ia a a t t t m
ma ag t m t ta
a a ig a ta a t t i ma t g

g g am
Table 8.6.2.1: Type and number of DoHS workforce, fiscal year 2075/76
Table 8.6.2.1: Type and number of DoHS workforce, fiscal year 2075/76
SN Types of human resources Grade/level Sanctioned Fulfilled
1 Director General (DG) 12th 1 1
2 Director 11th (PHA) 2 2
3 Director 11th (PHA/HI) 1 0
4 Senior Health Administrator 9/10th 3 3
5 Senior Computer Officer Gazetted II 1 1
6 Senior Community Nursing Administrator 9/10th 2 2
7 Senior Public Health Administrator 9/10th 8 3
8 Chief and Deputy Chief Medical Officer 9/10th 1 2
9 Senior Consultant Dermatologist 9/10th 1 1
10 Senior Consultant Gynaecology/Obstetrics 9/10th 1 1
11 Director and Deputy Director Senior Demographer Gazetted II 1 1
12 Under Secretary Gazetted II 1 1
13 Under-Secretary (Finance) Gazetted II 1 1
14 Section Officer Gazetted III 7 7
15 Account Officer Gazetted III 2 2
16 Legal Officer Gazetted III 1 1
17 Pharmacist 7/8th 2 2
18 Senior Public Health Officer 7/8th 9 9
19 Medical Officer 8th 7 7
20 Electrical Engineer Gazetted III 1 0
21 Senior Community Nursing Officer 7/8th 7 5
22 Senior Nursing Officer 7/8th 5 5
23 Entomologist 7/8th 1 0
24 Statistics Officer Demographer Gazetted III 5 5
25 Veterinary Doctor Gazetted III 1 1
26 Computer Officer Gazetted III 3 3
27 Mechanical Engineer Gazetted III 1 1
28 Nayab Subba (Clerk) Non gazetted I 8 7
29 Health Assistant /Public Health Inspector 5/6th 6 6
30 Biomedical Engineer 7/8 th

2 0
31 Architect Engineer 7/8th 1 0
32 TB/leprosy Assistant 5/8th 1 0
33 Cold Chain Assistant 4/5th 3 3
343 3 2Lab Assistant DoHS,

4/5th Annual Report22075/76 (2018/19)
2
27 Mechanical Engineer Gazetted III 1 1
28 Nayab Subba (Clerk) Non gazetted I 8 7
29 Health Assistant /Public Health Inspector 5/6th 6 6
30 Biomedical Engineer 7/8th 2 0
31 Architect Engineer 7/8th 1 0

1 g g0 am
32 TB/leprosy Assistant 5/8th
33 Cold Chain Assistant 4/5th 3 3
34
SN Lab AssistantTypes of human resources 4/5th
Grade/level 2
Sanctioned 2
Fulfilled
35 Light Vehicle Driver Not classified 7 7
36 Office Assistant (Peon) Not classified 8 8

SN Types of human resources Grade/level Sanctioned Fulfilled
Source: PAS, DoHS
35 Light Vehicle Driver Not classified 7 7
8.6.3Office
36
8.6.3 NewAssistant
New initiatives
(Peon)
initiatives Not classified 8 8
The following new initiatives were taken from the fiscal year 2072/73:
Source: PAS, DoHS
 File tracking
i g system.
i i a ta mt a a
 New
8.6.3 Digitalinitiatives
attendance introduced within DoHS.
The following inew
 i
An t a
online g initiatives
t m of operations
calendar were taken(online
from action plan)
the fiscal of divisions
year 2072/73:and DoHS introduced.
igita a a i t it i
 File tracking system.
i anda recommendations
a a i a a i ii a i t
8.6.4Digital
Issues attendance introduced within DoHS.
Table 8.6.4.1: Issues and Recommendations.
8.6.4An online
Issues calendar
and of operations (online action plan) of divisions and DoHS introduced.
recommendations
Insufficient
Table
8.6.4 8.6.4.1:
Issues information
and Issues for strategic
and Develop a scientific health workforce transfer criteria and a
Recommendations.
recommendations
placement and transfers
Table 8.6.4.1: Issues and Recommendations. time-bound transfer management system from district to
Issues central level with the Recommendations
decentralization of authority.
Lack of functional
Insufficient database
information of DoHS
for strategic Develop aa scientific
Develop mechanism for the
health timely recruitment
workforce of contract-
transfer criteria and a
personnel
placement and transfers based health workers (ANMs and SBAs) to ensure
time-bound transfer management system from district to 24/7
services.
central level with the decentralization of authority.
Weak
Lack of management of staffof
functional database onDoHS
long leave Functionalise
Develop coordination
a mechanism mechanisms
for the between of
timely recruitment agencies
contract-
personnel concerned
based healthwith producing
workers (ANMs and deploying
and SBAs) tohuman
ensureresources
24/7
including induction training (academia, councils, training
services.
centres, MoHP)
Weak management of staff on long leave Functionalise coordination mechanisms between agencies
Placement of scholarship doctors in Tarai Authorize DoHS
concerned to place doctors
with producing at PHCCs.human resources
and deploying
and mountain districts including induction training (academia, councils, training
The one-door placement of medical officers centres,
DevelopMoHP)
and implement an incentive package to retain
Placement of scholarship doctors in Tarai doctors at PHCCstoand
Authorize DoHS in remote
place doctorsareas.
at PHCCs.
and mountain
Human resourcedistricts
placement in rural and Effectively implement the time-bound transfer of personnel
remote facilities
The one-door placement of medical officers Develop starting from district to central
and implement level with
an incentive the decentralization
package to retain
of authority.
doctors at PHCCs and in remote areas.
Monitoring
Human of doctors
resource in PHCCs
placement andand
in rural district Effectively
Initiate an implement
e-attendance thesystem in PHCCs
time-bound and 50
transfer ofbed hospitals
personnel
hospitals
remote facilities and then scale-up to all facilities and institutions
starting from district to central level with the decentralization
Weak coordination between MoHP, of authority.
MoHP and MoFALD to work together to fill health worker
department and districts for personnel posts in urban
Monitoring of doctors in PHCCs and district Initiate an health clinics
e-attendance system in PHCCs and 50 bed hospitals
management
hospitals and then scale-up to all facilities and institutions
Weak coordination between MoHP, MoHP and MoFALD to work together to fill health worker
department and districts for personnel posts in urban health clinics
management
DoHS, Annual Report 2075/76 (2018/19) 3 3 3

g g am 8.7 Financial
8.7 FinancialManagement
Management
8.7 Financial Management
8.7.1
8.7.1Background
Background
8.7.1 Background
An effective financial
a ia support t system
t m iis imimperative
a for efficient
i t health
a t service
i management.
ma ag m t The
An effective financial support system is imperative for efficient health service management. The
preparation
aa ofaannual
a budgets,
g t t the timely
m disbursement
i m t of funds, accounting,
a g reporting,g and
a
preparation
a auditing of annual
i g a aret themai budgets,
a ia ma the timely disbursement of
ag m t functions needed to funds, accounting,
t support tthe imreporting,
m ta andof
t implementation
main financial management
auditing are the main financiali management
a t programmes.
g amm a mi ifunctions
ta needed to support t the implementation aof ia
health DoHS’s Finance Administration Section (FAS) isi the focala point
i tfor financial
health
ma ag programmes.
m t a DoHS’s Finance
g amm Administrationa ia Section
ma ag (FAS)
m tis the focal apointtafor
g tfinancial
a gi
management for all DoHS programmes. The financial management objectives and targets are given
imanagement
B for all DoHS programmes. The financial management objectives and targets are given
in Box 8.7.1.
in Box 8.7.1.
Box 8.7.1: Health financial management objectives and targets
Box 8.7.1: Health financial management objectives and targets
:
:
 To support all programmes, divisions and centres for preparing their annual budgets
 To support all programmes, divisions and centres for preparing their annual budgets
 To obtain and disburse programme budgets
 To obtain and disburse programme budgets
 To keep books of accounts and collect financial reports from all public health institutions
 To keep books of accounts and collect financial reports from all public health institutions
 To prepare and submit financial reports
 To prepare and submit financial reports
 To facilitate internal and external auditing
 To facilitate internal and external auditing
 To provide financial consultations.
 To provide financial consultations.
—To achieve 100 percent expenditure of all budgets in accordance with programme work
—To achieve 100 percent expenditure of all budgets in accordance with programme work
plans within a specified times as per financial rules and regulations of the government and to
plans within a specified times as per financial rules and regulations of the government and to
maintain the recording and reporting system accurately and on time.
maintain the recording and reporting system accurately and on time.
8.7.2Achievements
8.7.2 Achievements in the fiscal year 2075/76
8.7.2 Achievementsininthethefiscal
fiscalyear
year2075/76
2075/76
Out of total National Budget of Rs. 1,315,161,700,000 a sum of Rs. 34,082,300,000 (2.59%) was
Out of total National
allocated Budget ofduring
Rs. 1,315,161,700,000 a sum Of
of Rs. 34,082,300,000 (2.59%) was
t t tafor the a health
a B sector
g t the fiscal year 2075/76.
a m the total health sector budget, Rs.a
allocated for the(22.42%)
health sector during the for
fiscal year 2075/76.ofOfprograms
the total under
health sector budget, Rs.of
a 7,639,936,209
at t a t was t allocated
i gt thea execution
a t t ta the a t Department
t g t
7,639,936,209 (22.42%) was
Health Services Network (Table allocated
8.7.1). for the execution of programs under the Department of
a a at t g am t a tm t
Health Services Network (Table 8.7.1).
at i t a
Table 8.7.1: Health
Table budget details, FY 2075/76 (NPR)
Table 8.7.1: Health
8.7.1: Health budget
budget details,
details, FY 2075/76
FY 2075/76 (NPR)(NPR)
Budget Total Recurrent % Capital % Financing %
Budget Total Recurrent % Capital % Financing %
National
National 1,315,161,700,000 845,447,500,000 64.28 313,998,200,000 23.88 155,716,000,000 11.84
budget 1,315,161,700,000 845,447,500,000 64.28 313,998,200,000 23.88 155,716,000,000 11.84
budget
Health
Health 34,082,300,000 25,511,200,000 74.85 8,571,100,000 25.15 0 0.00
budget 34,082,300,000 25,511,200,000 74.85 8,571,100,000 25.15 0 0.00
budget
Province 4,184,700,000 4,184,700,000 100.00 0 0.00 0 0.00
Province
budget 4,184,700,000 4,184,700,000 100.00 0 0.00 0 0.00
budget
Local Level 18,152,700,000 18,152,700,000 100.00 0 0.00 0 0.00
Local Level
budget 18,152,700,000 18,152,700,000 100.00 0 0.00 0 0.00
budget
Health
Health
budget 7,639,936,209 6,797,436,209 88.97 842,500,000 11.03 0 0.00
budget
under DoHS 7,639,936,209 6,797,436,209 88.97 842,500,000 11.03 0 0.00
under DoHS

g g am
Table
Table8.7.2:
8.7.2:
8.7.2: Allocation
Allocation
Allocationofof
ofhealth
health
healthbudget
budgetbyby
budget source,
bysource,
FYFY
source, 2075/76
FY2075/76
2075/76
Budget
Budget
Budget Total
Total
Total GoN
GoN
GoN % %% Donor
Donor
Donor % %%
Health
Health
Healthbudget
budget
budget
7,639,936,209
7,639,936,209
7,639,936,209 4,528,836,209
4,528,836,209
4,528,836,209 59.28
59.28
59.28 3,111,100,000
3,111,100,000
3,111,100,000 40.72
40.72
40.72
under
underDoHS
DoHS
DoHS
Table 8.7.3:
Table8.7.3: Regular
8.7.3: Regular programme
Regularprogramme
programme recurrent
recurrent
recurrentbudget,
budget,
budget, releases
releases
releasesand
andandexpenditure
expenditure by by
expenditure byprogramme
programme
programme
activities,
activities, FY
activities,FY 2075/76
FY2075/76
2075/76
Programme
Programme
Programmebudget
budget
budget Release
Release
budget
budget
Release (in (in(in
budget
Total
Totalbudget
Total budget
(in(in
budget NPR)
(inNPR)
NPR) NPR)
NPR)
NPR) Expenditure
Expenditure
(in NPR)
Expenditure (in(in
NPR)
NPR)
Budget
Budget
BudgetCode
Code
Code
No
No
No Amount
Amount
Amount % %% Amount
Amount
Amount % %% Amount
Amount
Amount % (a)% %
(a)(a)
3700123
3700123
3700123 Department
Department
Departmentofofof
Health
Health
Health 167,954,975
167,954,975
167,954,975 22.78
22.78
22.78153,903,938
153,903,938
153,903,93828.03
28.03
28.03153,903,938
153,903,938
153,903,938 28.0328.03
28.03
3700124
3700124
3700124 Department
Department
Departmentofofof
Health
Health
Health 255,000,000
255,000,000
255,000,000 34.58
34.58
34.58122,825,740
122,825,740
122,825,74022.37
22.37
22.37122,825,740
122,825,740
122,825,740 22.3722.37
22.37
3700143
3700143
3700143 District
District
DistrictHealth
Health
HealthOffices
Offices
Offices 258,478,000
258,478,000
258,478,000 35.06
35.06
35.06255,230,277
255,230,277
255,230,27746.49
46.49
46.49255,230,277
255,230,277
255,230,277 46.4946.49
46.49
Health
Health
HealthTraining
TrainingCentres
TrainingCentres
Centres
3700213
3700213
3700213 programmes
programmes
programmes 55,902,000
55,902,000
55,902,000 7.58
7.58
7.58 17,035,711
17,035,711
17,035,711 3.103.10
3.10 17,035,711
17,035,711
17,035,711 3.10 3.10
3.10
Total
Total
Total 737,334,975
737,334,975
737,334,975 100100
100 548,995,666
548,995,666
548,995,666 100100
100548,995,666
548,995,666
548,995,666 100 100
100
Table
Table8.7.4:
8.7.4:
8.7.4: Central
Central
Centrallevel
level
levelrecurrent
recurrentbudget
recurrentbudgetallocation
budget allocation
byby
allocation source
bysource
andand
source programme
andprogramme
activities,
programme activities,
FY 2075/76
FYFY2075/76
activities, 2075/76
Budget
Budget
Budget Programme
Programme
Programmebudget
budget
budget Total
Total
budget
budget
Total allocation
budget allocation
by sources
allocationbybysources
sources
Code
CodeNo
No
No heading
heading
heading GoN
GoN
GoN % %% Donor
Donor
Donor % %% TotalTotal
Total % %%
Tuberculosis
Tuberculosis
TuberculosisControl
Control
Control
3701133
3701133
3701133 Programmes
Programmes
Programmes 437,401,234.00
437,401,234.00
437,401,234.00 11.89
11.89
11.89 117,300,000.00
117,300,000.00
117,300,000.00 4.454.45
4.45554,701,234
554,701,234
554,701,234 8.78 8.78
8.78
National
National
NationalHIV/AIDS
HIV/AIDS
HIV/AIDS
3701143
3701143
3701143 Control
Control
ControlProgrammes
Programmes
164,800,000.00
164,800,000.00 4.48
4.48
4.48 359,300,000.00
359,300,000.00
359,300,000.0013.62
13.62
13.62524,100,000
524,100,000
524,100,000 8.30 8.30
8.30
3701153
3701153
3701153 FP/MCH
FP/MCH
FP/MCHProgrammes
Programmes
54,100,000.00
54,100,000.00 1.47
1.47
1.47 425,700,000.00
425,700,000.00
425,700,000.0016.14
16.14
16.14479,800,000
479,800,000
479,800,000 7.60 7.60
7.60
Integrated
Integrated
IntegratedCHD
CHD
CHD
3701163
3701163
3701163 Programme
Programme
Programme 561,700,000
561,700,000
561,700,000 15.27
15.27
15.271,427,700,000.00
1,427,700,000.00
1,427,700,000.0054.13
54.131,989,400,000
54.13 1,989,400,000
1,989,400,000 31.5031.50
31.50
Epidemiology
Epidemiology
Epidemiology
3701193
3701193
3701193 Programme
Programme
Programme 352,700,000.00
352,700,000.00
352,700,000.00 9.59
9.59
9.59 65,900,000.00
65,900,000.00
65,900,000.00 2.502.50
2.50418,600,000
418,600,000
418,600,000 6.63 6.63
6.63
Leprosy
Leprosy
LeprosyControl
Control
Control
3701203
3701203
3701203 Programme
Programme
Programme 27,000,000.00
27,000,000.00
27,000,000.00 0.73
0.73
0.73 0.00
0.00
0.00 0.000.00
0.00 27,000,000
27,000,000
27,000,000 0.43 0.43
0.43
3701213
3701213
3701213 Indent
Indent
IndentProcurement
Procurement
Procurement 107,500,000.00
107,500,000.00
107,500,000.00 2.92
2.92
2.92 36,000,000.00
36,000,000.00
36,000,000.00 1.361.36
1.36143,500,000
143,500,000
143,500,000 2.27 2.27
2.27
Hospital
Hospital
HospitalConstruction
Construction
Construction
/Management
/Management
/Management
3701223
3701223
3701223 Information
Information
InformationSystem
System
System 1,171,900,000.00
1,171,900,000.00
1,171,900,000.00 31.87
31.87
31.87 141,500,000.00
141,500,000.00
141,500,000.00 5.375.37
5.371,313,400,000
1,313,400,000
1,313,400,000 20.8020.80
20.80
3701233
3701233
3701233 NHEICC
NHEICC
NHEICCprogrammes
programmes
programmes 83,800,000.00
83,800,000.00
83,800,000.00 2.28
2.28
2.28 29,800,000.00
29,800,000.00
29,800,000.00 1.131.13
1.13113,600,000
113,600,000
113,600,000 1.80 1.80
1.80
Health
Health
HealthLaboratory
Laboratory
Laboratory
3701263
3701263
3701263 Services
Services
Services 163,300,000.00
163,300,000.00
163,300,000.00 4.44
4.44
4.44 0.00
0.00
0.00 0.000.00
0.00163,300,000
163,300,000
163,300,000 2.59 2.59
2.59
3701363
3701363
3701363 PHCRD
PHCRD
PHCRDprogrammes
programmes
481,100,000.00
481,100,000.00 13.08
13.08
13.08 5,000,000.00
5,000,000.00
5,000,000.00 0.190.19
0.19486,100,000
486,100,000
486,100,000 7.70 7.70
7.70
National
National
NationalHealth
Health
HealthTraining
Training
Training
3701243
3701243
3701243 Centre
Centre
Centreprogrammes
programmes
72,400,000.00
72,400,000.00 1.97
1.97
1.97 29,200,000.00
29,200,000.00
29,200,000.00 1.111.11
1.11101,600,000
101,600,000
101,600,000 1.61 1.61
1.61
Total
Total
Total 3,677,701,234
3,677,701,234
3,677,701,234 100100
100 2,637,400,000
2,637,400,000
2,637,400,000 100100
1006,315,101,234
6,315,101,234
6,315,101,234 100 100
100

g g am
Table 8.7.5: Central level recurrent budget released by source and programme, FY 2075/76
Programme budget Released Budget By Source
Budget
heading
Code No GoN % Donor % Total %
Tuberculosis Control
3701133 Programmes 310,396,679.45 6.73 0.00 0.00 310,396,679 5.78
National HIV/AIDS
3701143 Control Programmes 158,743,517.07 3.44 265,130,002.40 35.06 423,873,519 7.89
3701153 FP/MCH Programmes 50,290,415.00 1.09 280,876,390.00 37.14 331,166,805 6.17
Integrated CHD
3701163 Programme 524,206,592.21 11.36 58,304,438.97 7.71 582,511,031 10.84
3701193 Epidemiology Programme 237,488,637.93 5.15 11,601,761.00 1.53 249,090,399 4.64
Leprosy Control
3701203 Programme 15,690,346.00 0.34 0.00 0.00 15,690,346 0.29
3701213 Indent Procurement 82,341,012.77 1.78 14,894,968.00 1.97 97,235,981 1.81
Hospital Construction
/Management
3701223 Information System 2,494,254,630.00 54.05 87,888,790.81 11.62 2,582,143,421 48.07
3701233 NHEICC programmes 71,723,000.58 1.55 11,872,566.00 1.57 83,595,567 1.56
Health Laboratory
3701263 Services 160,394,255.10 3.48 0.00 0.00 160,394,255 2.99
3701363 PHCRD programmes 442,799,230.00 9.59 0.00 0.00 442,799,230 8.24
National Health Training
3701243 Centre programmes 66,764,517.38 1.45 25,743,782.00 3.40 92,508,299 1.72
Total 4,615,092,833 100 756,312,699 100 5,371,405,533 100
Table 8.7.6: Central level recurrent budget expenditure by source and programme, FY 2075/76
Programme budget Released Budget By Source
Budget
heading
Code No GoN % Donor % Total %
3701133 Programmes 310,396,679.45 6.73 0.00 0.00 310,396,679 5.78
National HIV/AIDS
3701143 Control Programmes 158,743,517.07 3.44 265,130,002.40 35.06 423,873,519 7.89
3701153 FP/MCH Programmes 50,290,415.00 1.09 280,876,390.00 37.14 331,166,805 6.17
Integrated CHD
3701163 Programme 524,206,592.21 11.36 58,304,438.97 7.71 582,511,031 10.84
3701193 Epidemiology Programme 237,488,637.93 5.15 11,601,761.00 1.53 249,090,399 4.64
Leprosy Control
3701203 Programme 15,690,346.00 0.34 0.00 0.00 15,690,346 0.29
3701213 Indent Procurement 82,341,012.77 1.78 14,894,968.00 1.97 97,235,981 1.81
/Management
3701223 Information System 2,494,254,630.00 54.05 87,888,790.81 11.62 2,582,143,421 48.07
3701233 NHEICC programmes 71,723,000.58 1.55 11,872,566.00 1.57 83,595,567 1.56
Health Laboratory
3701263 Services 160,394,255.10 3.48 0.00 0.00 160,394,255 2.99
3701363 PHCRD programmes 442,799,230.00 9.59 0.00 0.00 442,799,230 8.24
3701243 Centre programmes 66,764,517.38 1.45 25,743,782.00 3.40 92,508,299 1.72
Total 4,615,092,833 100 756,312,699 100 5,371,405,533 100

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Table 8.7.7: Central level capital budget
budget allocation
allocationby
by source
sourceand
andprogramme,
programme,FY
FY2075/76
2075/76
Budget Programme budget Total
Totalbudget
budgetallocation
allocationby
bysource
source
Code No heading
GoN
GoN %% Donor
Donor %% Total
Total %%
3701134 Programmes 110,400,000
110,400,000 39.84
39.84 35,100,000
35,100,000 11.83
11.83 145,500,000
145,500,000 25.36
25.36
National HIV/AIDS Control
Control
3701144 Programmes 00 0.00
0.00 13,000,000
13,000,000 4.38
4.38 13,000,000
13,000,000 2.27
2.27
3701154 FP/MCH Programmes 5,200,000
5,200,000 1.88
1.88 00 00 5,200,000
5,200,000 0.91
0.91
Integrated Child Health
3701164 Programme 58,000,000
58,000,000 20.93
20.93 108,500,000
108,500,000 36.58
36.58 166,500,000
166,500,000 29.02
29.02
3701194 Epidemiology Programme
Programme 2,600,000
2,600,000 0.94
0.94 00 00 2,600,000
2,600,000 0.45
0.45
Leprosy Control
3701204 Programme 1,300,000
1,300,000 0.47
0.47 00 00 1,300,000
1,300,000 0.23
0.23
3701214 Indent Procurement 31,100,000
31,100,000 11.22
11.22 140,000,000
140,000,000 47.20
47.20 171,100,000
171,100,000 29.82
29.82
/Management
3701224 Information System 5,600,000
5,600,000 2.02
2.02 00 00 5,600,000
5,600,000 0.98
0.98
3701234 NHEICC programmes 500,000.00
500,000.00 0.18
0.18 0.00
0.00 00 500,000
500,000 0.09
0.09
3701244 Centre 2,100,000
2,100,000 0.76
0.76 00 00 2,100,000
2,100,000 0.37
0.37
Health Laboratory
3701264 Services 34,800,000
34,800,000 12.56
12.56 00 00 34,800,000
34,800,000 6.07
6.07
Primary Health Care
3701364 Division programmes 25,500,000
25,500,000 9.20
9.20 00 0.00
0.00 25,500,000
25,500,000 4.44
4.44
Total 277,100,000
277,100,000 100
100 296,600,000
296,600,000 100
100 573,700,000
573,700,000 100
100
Table 8.7.8: Central level capital budget

budget released
released by
by source
sourceand
andprogramme,
programme,FY
FY2075/76
2075/76
Budget Programme budget heading
heading Released
Releasedbudget
budgetby
bysource
source
Code No
GoN
GoN %% Donor
Donor %% Total
Total
%%
3701134 Programmes 78,575,471.00
78,575,471.00 53.66
53.66 0.00
0.00 00 78,575,471
78,575,471 27.35
27.35
National HIV/AIDS Control
3701144 Programmes 0.00
0.00 0.00
0.00 13,000,000.00
13,000,000.00 9.23
9.23 13,000,000
13,000,000 4.53
4.53
3701154 FP/MCH Programmes 4,989,831.00
4,989,831.00 3.41
3.41 0.00
0.00 00 4,989,831
4,989,831 1.74
1.74
Integrated Child Health
3701164 Programme 4,444,606.00
4,444,606.00 3.04
3.04 7,062,500.00
7,062,500.00 5.01
5.01 11,507,106
11,507,106 4.01
4.01
3701194 Epidemiology Programme 199,520.00
199,520.00 0.14
0.14 0.00
0.00 00 199,520
199,520 0.07
0.07
3701204 Leprosy Control Programme
Programme 498,552
498,552 0.34
0.34 0.00
0.00 00 498,552
498,552 0.17
0.17
3701214 Indent Procurement 15,246,836.50
15,246,836.50 10.41
10.41 120,796,387.96
120,796,387.96 85.76
85.76 136,043,224
136,043,224 47.35
47.35
/Management Information
3701224 System 4,787,934.00
4,787,934.00 3.27
3.27 0.00
0.00 0.00
0.00 4,787,934
4,787,934 1.67
1.67
3701234 NHEICC programmes 375,900.00
375,900.00 0.26
0.26 0.00
0.00 00 375,900
375,900 0.13
0.13
3701264 Health Laboratory Services 32,623,028.00
32,623,028.00 22.28
22.28 0.00
0.00 00 32,623,028
32,623,028 11.36
11.36
Primary Health Care Division
Division
3701364 programmes 4,689,984.60
4,689,984.60 3.20
3.20 0.00
0.00 0.00
0.00 4,689,985
4,689,985 1.63
1.63
Total 146,431,663.10
146,431,663.10 100.00
100.00 140,858,887.96
140,858,887.96 100.00
100.00 287,290,551.06
287,290,551.06 100.00
100.00

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Table 8.7.9: Central
Central level
level capital
capitalbudget
budgetexpenditure
expenditureby
bysource
sourceand
andprogramme,
programme,FY
FY2075/76
2075/76
Budget Programme
Programme budget
budget heading
heading Released
Releasedbudget
budgetby
bysource
source
Code No
GoN
GoN %% Donor
Donor %% Total
Total
%%
Tuberculosis
Control
3701134 Programmes
78,575,471.00 53.66
53.66 0.00
0.00 00 78,575,471
78,575,471 27.35
27.35
National
National HIV/AIDS
HIV/AIDSControl
Control
3701144 Programmes
Programmes 0.00
0.00 0.00
0.00 13,000,000.00
13,000,000.00 9.23
9.23 13,000,000
13,000,000 4.53
4.53
3701154 FP/MCH
FP/MCH Programmes
4,989,831.00 3.41
3.41 0.00
0.00 00 4,989,831
4,989,831 1.74
1.74
Integrated
Integrated Child
Child Health
Health
3701164 Programme
Programme 4,444,606.00
4,444,606.00 3.04
3.04 7,062,500.00
7,062,500.00 5.01
5.01 11,507,106
11,507,106 4.01
4.01
3701194 Epidemiology
Epidemiology Programme
Programme 199,520.00
199,520.00 0.14
0.14 0.00
0.00 00 199,520
199,520 0.07
0.07
3701204 Leprosy
Leprosy Control
ControlProgramme
Programme 498,552
498,552 0.34
0.34 0.00
0.00 00 498,552
498,552 0.17
0.17
3701214 Indent
Indent Procurement
Procurement 15,246,836.50
15,246,836.50 10.41
10.41 120,796,387.96
120,796,387.96 85.76
85.76 136,043,224
136,043,224 47.35
47.35
Hospital
Construction
/Management
/Management Information
Information
3701224 System
System 4,787,934.00
4,787,934.00 3.27
3.27 0.00
0.00 0.00
0.00 4,787,934
4,787,934 1.67
1.67
3701234 NHEICC
NHEICC programmes
programmes 375,900.00
375,900.00 0.26
0.26 0.00
0.00 00 375,900
375,900 0.13
0.13
3701264 Health
Health Laboratory
LaboratoryServices
Services 32,623,028.00
32,623,028.00 22.28
22.28 0.00
0.00 00 32,623,028
32,623,028 11.36
11.36
Primary
Primary Health
Health Care
Care Division
Division
3701364 programmes
4,689,984.60 3.20
3.20 0.00
0.00 0.00
0.00 4,689,985
4,689,985 1.63
1.63
Total
Total 146,431,663.10
146,431,663.10 100.00
100.00 140,858,887.96
140,858,887.96 100.00
100.00 287,290,551.06
287,290,551.06 100.00
100.00
Table 8.7.10: Cumulative

Cumulative financial
financialirregularities
irregularitiesup
upto
to2075/76
2075/76(NPR
(NPRIn,000)
In,000)
Irregularity
Irregularity Irregularity clearance
Irregularity clearance Percent
Percent
amount to bebe
regularized
regularized
2,18,01,50,000
2,18,01,50,000 1,44,53,16,000
1,44,53,16,000 66.29
66.29
Table 8.7.11: Irregularity

Irregularity clearance
clearancestatus
statusof
oflast
lastthree
threeyears
yearsFY
FY2073/74
2073/74- -2075/76 (NPRInIn,000)
2075/76(NPR ,000)
Fiscal Year
Year Total irregularityTotal
amount
irregularity amount Irregularity
Irregularity Clearance
Clearance%%
clearance
clearance
2075/76 2,18,01,50,000
2,18,01,50,000 1,44,53,16,000
1,44,53,16,000 66.29
66.29
2074/75 3527321
3527321 14,39,096
14,39,096 40.80
40.80
2073/74 4,25,95,14
4,25,95,14 1,92,02,95
1,92,02,95 45.08
45.08
Source: Finance
Finance Section,
Section, DoHS
DoHS
3 3 8 DoHS, Annual Report 2075/76 (2018/19)

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8.7.3 Issues of financial management
Following major Issues of financial management are given below table:
Problems and constraints
Delay in approval of organizational structure and functionality has affected in the health budget allocation, release
and disbursement to the local level health institutions.
Still remain to ensure the rational allocation of health budget to the Provinces and local level programs and
availability of human resources.
Mismatch in the allocation of health budget to the LGs in the certain levels.
No single platform for the planning and budgeting to ensure harmonization of budget planning and program
implementation across the three layers of government.
Due to newly formed federal structure the health facility capacity remain limited to improvement of the planed
budget activities and utilization of allocated budget.
Lack of clarity "On and Off" health budget reporting mechanism in the changed context including expendityre
reporting at the local level.
Non-release of committed EDPs budgets in time.
Difficulty in keeping books of accounts and reporting according to differing software e.g. GGAS, TABUCUS, LMBIS and
RMIS
Difficulty in financial reporting procedures and reimbursement from External Development Partners (EDPs) due to
lack of trained manpower and physical facilities

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8.8 Medico-Legal Services

i ga i i i i a i ai g it i t i
a g at i t g i ma
a t a a t i ai a
t i ig g i gi i t a im a i a at m i ga i t
a i i t i i t tat i t ig
ta ta at g i a mai g m a a i g i
t a t im i m t a i a i a i i t
i i g i t a a a a a a i gi i t
a m t a g am a a im i m t a i t a a
a a a imi a i t a at it im agai t ma
t a i it a g aa t ig t t at a ai i a i
a a ig t t ig t i m im a ig t agai t t g aa t
a i i a am ta ig t t a ii m m a
a t a i a ig t t ia a ig t m i a
a a m t at it m i ga t i im m ta i a i
it a a i a a t a ig t m i ga t i a m t
i a tat
im a m t g i m i ga a it i t a it ta
a aa m t a ai t ia i i t i
it i ig m a m t t a i itat t i m t t i t t i
m i ga i i gt i ia i t i t ai
i i t a mi g it t ta a a i ga i t
a a gi t i a i t a i g ai i i i ia i t i t i
t m t i t m a it a
i it at a at t ta t i t i at ita t
t
it i a t a a i ga a t i a at at ma i
a ga i i it at
i t m i ga ami a a g mat a a a i
a m t it i i a i it a a at a
a a at ai i g t m a tm t at t t t a
i ai t ta a a g a a a ai i g
a a ta a m i ga ami a a g i ta a
m t a i g a a i it at
a a
a a ma a a t
a ma a i ami a
a ma a a a ami a
a ma a ag ma
a ma a ami a i m t t
a ma a i i a ta mai
a i i a m ai m i a g t a mi i m i ga
i t i mt i ita t mi i i ga i m
t m i a g a i ta i it a a i a t

g g am
i g at a a a i t i iti a a a a i ga i
a i i i i ai g it im m ta
i gt g i i m i ga i a ta i ga i a
mmi i m at a tt m g a ta t i i a i i
t a at i im m ta a at a i it i t
i m t at it m i ga i
i at t a i at t m i ga i a
i g i at g a i it a i g a a t i gt a at m
a t a i m i ga i t
g t a ma m i at a i i t m i t t t
m i ga i t i i i at i m t a t mi im m
ta a a gg i mt a a i ga a
a i a mi im m a i i m i i t im m ta t
ii gi ga ii g i i a ta a m t im m t t
t i t imi a i g ma a a ta a i m i ga i t
t t t ii a im m t t t it ma ta g t a i
mi im m ta a i t i i a at i ii it t g at
i it a imi a t t at a i m t a ta i m t t ta
i i it t im m ta m g a a t g t a i a
i m t m i ga i ta a

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8.9 Monitoring and Evaluation

8.9.1 Background
a a at i t ma i im t g t ma
mm i a g a i i a at t t t
a t a i t a at i ma t m i i a
a i g it a im a i t g at at t i at
i t t at i t t a i g a g g t i
a m i i g i a at ag t a t tai a m t a
m ai m it i g a i gt it ga i t at t m at i t a
g tai a tai m t am a a at t t at g
t t i t t tat t m a a
t g at i ma ma ag m t a a a
a a t i t i i it a a
m at t i it a i ag t a i g
8.9.2 Major Progress in FY 2075/76 (2018/19)
Development of Guideline
i it t a a a t t at g t a a a a at i i
t i a am ta a ia at t m i a g i i t
a t a ta a t i gt ig im m ta m it i g a
i at t m
Integrated information management
it ga t t i ma ma ag m t i t at t t a i t a i t
ta i a i t a m a im i gm t g t at a ii i
t a a ata a t a i ia a a m t
t t m a imi a i g g a m a m t g t
i ma m at a ii t t a m t m a m tt at
m at t a t i t at a mt i t at t t a tm t
at i
at t i a t t i t it i g a a a g i i t
t g m ta a at a t a ag i i g m t
i ia a a g m t t g at a a t at t ata
t i i i g t at t m t at a i at
i ma t m a i t a a t a i it gi t a t t at ta
a at a ii it i t t i a i at a i i ma i
i a a at gi t a a i t a t at a t
i ma t m t t t it i t t i i i i a it at a ii
t at a i it t
t a t t i g i ata m a t a i i
i a i at a ii mi m t t t i a at
t a ima at a t a i g ma ag t a g m t t

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i i g a i gt i a a i at i ma ma ag m t i i g
t t a ma a a g m t t t a t a i it a
i ta t i a t t a a ata a i a a mi t t
ata m a g m t t t a a t m a i g
m t i ta at ta ia m t at a g amm
ma ag a a a a ai a t it g
a ata a it m t t a t a i g a ag a
at i g a a m t a i ma a ai a t
it am g t m i t mai i ata i a
a t ma m t i g ata m t t t i a t a at a it m t i
i i gt ata t ata i a mai a t a a a
it i g a a t ma a t t ma m t mai
a i a tai m a i g a it a ata i a
mai a i i at t i a a i a t
ma a a i i g g at m i ata i a mai m
at a ii a t at m t a a t a t a i it a t m tt ma
i mai gi t m it i g t a t a t a i it m t t
i t i gi t ta a m it i g t ta a a ag
t t ma m t a i t a a i ma i
t t i ta t m t ma m t mai a t at t
t a t a i it a t m tt a i ata ma ag m t m t a a
m tt ma i a ai a i it i i at i a gg i i a t
ata i i ma i g m it i g a a a a a a ii mai
t a a im m t m t t at a ii
a igita a a a t m it ma at i i at
i i gt t am a at at i i at
Electronic Health Records
a a ag i i im m ta t i at at a t
a ii a gi t at t i ia a i i at ita
at t i g ita a ta t
i iam a t a a ta B a g ita
i a a aa a i g ita
Bagma i a t ita a a ai t ita
a a i i a agi i ita aa a m at i
i mi a a m at i
a ai i a a a ai ita
a im i a Ba a ata ita
Surveillance systems
at a a i ata at i a a a i it a a
a m ita i t a a i a ita i
mm it a a a m iti t t a a i a iti t
a g a ta at a t ag i a a ai a Ba a g i Bagma
i i i at t iti t am a a a aa mm it a i
mt i g t i a gt a i ga gt a
g g am
a i gt am i a i a t t at mt mm it ta g t i t
a mm it a i iti t a a i it a i a i ita
Early Warning and Reporting System (EWARS)
i a ita a i a t m t it ita
t i i g t i
i mi t at a
i a i t t t t a ta t i it it a a t
it i it i it i it i it i a it
i t ta i at ita a m i a g i a it a
a i it a g a a g i t a m i i
ti t t i i g i ag it t
8.9.3 Survey, research and studies
i a i gt tt a at a i it i
i i a ta it g at a i i at a t a a
ta a i a a i i i a ata i a a a
a t ti t t ai i m a at a i
a t a m a t i i t a i g a
mma i
Studies Key Findings Policy Recommendations
 28.9 % of the adults aged 15 to 69 years  As the prevalence of NCD risk factors is
were currently using tobacco found high, there should be effective
(smoked/smokeless). enforcement of NCDs risk factor
 24.2% of the adults aged 15 to 69 years prevention and control programmes
were using tobacco on daily basis.
 Average age at initiation of smoking
(years) among those who smoke daily
was 17.1 years (17.7 years in male and
18.4 years in female).
 21% prevalence of alcohol user.
 Only 3% of the sample population met
the intake of WHO recommended fruits
NCD STEPS survey 2019
and vegetables per day.

 Salt intake was found to be 9.1 grams per
day which is almost twice the WHO
recommendation
 6% of women of age 30-49 had done the
cervical test in the last five years.
 Mean BMI: 22.7 (22.6 for men and 22.8
for women), Overweight: 24% and Obese:
4%.
 Raised BP: 25% (Males-30%, females-
20%)
 10% measured to have raised BP and/ or
on treatment /medication
 21% of people measured to have raised
blood glucose and/ or on medications
 Among the surveyed population only 7%
are member of health insurance scheme

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 From January to May 2019 a total of 702

cancer cases from Kathmandu Valley. 256
new cases of cancer from Siraha, Saptari,
Population based cancer registry
Dhanusha and Mahottari and 23 new

cases from East and West Rukum were
identified.
 In 702 cases from Kathmandu Valley,
cancer incidence is higher among females
comparing to the males (379 Vs 323). The
higher incidence is found among the age
group of 70-74 years.
 In male the top leading cancer site is
lungs followed by lip and oral cavity.
 In females, breast followed by lungs,
cervix uteri.
 The prevalence of Sickle Cell disorder is  There is need of counselling to unmarried
disorder in
Mapping the availability of Ayurveda and other complementary medicine service centres in Nepal Municipalit
Sickle Cell
Bardiya
Bardiya
found 11.3% among 1 to 29 years Tharu people for their marriage to avoid Sickle
district
of
population (Sickle cell trait 10.7% and cell in their future generation
Sickle cell diseases 0.7%)
 Most of the government institution  Create national level information of
T&CM in Nepal were Ayurvedic Centres different types of T&CM practices that can
Acupuncture was commonly practiced in be available to the public would be useful
combination with Ayurveda or
in bringing all traditional system under
Naturopathy as an adjuvant therapy in
most centres. single umbrella where they could be
 T&CM were commonly practiced by recognized, regulated and connected with
qualified and registered doctors in their each other to deliver better impact on
respective system. There were also population health in Nepal.
practices done by the registered  There is a need to develop conceptual
assistants with diploma or certificate models or frameworks for each system,
degrees.
create definite regulations policies,
planning, and building network
infrastructure required for the overall
developments of all the existing T&CM in
Nepal.
 Further, there is a growing demand for
complementary medicine with the
expanding morbidity and mortality of Non-
Communicable Diseases. Many patients
seek complementary medicine along with
the conventional medicine for the
treatment of Non-Communicable Diseases.
 In this scenario research on identifying the
main scientific, policy, and practice issues
related to CAM research and explores and
translates of validated therapies into
conventional medical practice to reduce
burden of Disease due to Chronic Non-
Communicable disease is very crucial

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 High prevalence of non-communicable  Effective health promotion and chronic
 High prevalence of non-communicable  Effective health promotion and chronic
diseases (COPD: 11.7%, Diabetes: 8.5%, disease prevention program
chronic
diseases (COPD: 11.7%, Diabetes: 8.5%, disease prevention program
selectedchronic
CKD: 6.0%
6.0%and
andCAD:
CAD:2.9%).
2.9%). Effectiverehabilitation
rehabilitation programs
CKD:  Effective programs to to lessen
lessen
Most of
 Most of the
thebehavioral
behavioraland
andbiological
biologicalrisk
risk the effect
the effectforforthose
thosewho
whoarearealreadyalready
onselected
factors were more prevalent among

factors were more prevalent among men men alcohol dependent and effective awareness
alcohol dependent and effective awareness
than women. Other factors such as high andprevention
prevention programs shouldbebe started
Nepal
than women. Other factors such as high and programs should started
diseaseininNepal
LDL cholesterol,
LDL cholesterol, low
low HDL
HDL cholesterol,
cholesterol, andstrengthened
and strengthenedtotoadvocate
advocatethetherisks risks
studyon
overweight, obesity, waist-hip ratio

overweight, obesity, waist-hip ratio and and associated
associated
basedstudy
disease
abdominal obesity were noted high

abdominal obesity were noted high  BPBPscreening  screeningprograms
programs should
should bebe deployed
deployed
Population based
especiallyamong
especially amongfemales.
females. ininlarger
largernumbers
numberscatering
cateringto toa agreater
greater
coverage.
coverage.
Population
Specialinterventions
 Special interventionsneed
needto to
bebe designed
designed
forwomen
for womentotohelp
helpcounter
counter issues
issues related
related
totobody
bodymass
masswhich
which have
have long
long term
term health
health
implications.
implications.
Out of
 Out of 244
244 batches
batches ofof 20
20 generic Temperatureand
generic  Temperature andhumidity
humidityrecords
records
collected,
collected, 3737 batches
batches were
were found
found exceeded
exceededthetherecommended
recommended range in in
range
of Nepal
substandard.
substandard. both
both health
healthfacilities
facilitiesand
andRegional
Regional
 Out
Out of of identified
identified substandard
substandard Medical
MedicalStores.
Stores.
facilities of
medicines,
medicines, 23 23 (62.16%)
(62.16%) batches
batchesofof  There
carefacilities
Thereshould
shouldbebeprovision
provisiontotoassess
assess
medicines
medicines werewere supplied
supplied byby the the quality
quality ofofessential
essentialmedicines
medicines
Government
Government of of Nepal
Nepal and and 14 14 supplied in health facilities.
supplied in health facilities.
healthcare
(37.83%)
(37.83%) batches
batches ofof medicine
medicine  Stringent
Stringentrules
rulesand
andregulations
regulations should
should
samples
samples were
were purchased
purchasedfromfromlocal
local bebemade along with their effective
publichealth
made along with their effective

resources
resources implementation toto prevent
implementation prevent
 Among
Among 6262 health
healthfacilities,
facilities,only
only13%
13% substandard/counterfeit medicines
substandard/counterfeit medicines
medicinesininpublic
were
were found
found to
to follow
follow the
themedicine
medicine from from entering
entering into
intopharmaceutical
pharmaceutical
storage
storage guidelines supply
guidelines supplychain.
chain.
 All
All the
theinfrastructures
infrastructuresrequired
requiredforfor
essentialmedicines
storage
storage of medicines should bebe
of medicines should
established and maintained in all
established and maintained in all
Regional medical stores and health
Regional medical stores and health
Qualityofofessential
facilities.
facilities.
 DDA should strengthen its resources
 DDA should strengthen its resources
to ensure quality of medicines that
to ensure quality of medicines that
are widely being used in
Quality
are widely being used in

pharmaceutical market of Nepal.
pharmaceutical market of Nepal.
NHRC has plan to conduct the following studies in the coming months of FY 2019/20:
mm it a t a t mm i a i a i
a t Ba i i i
mm it a t a t mm i a i a i
a t i i a ta a am i t i t
i gt tat t a at a gi a ag m t am ga t gi i
g g am
a
a
Ba a gi t i a
a ata at
a i i a ia gi t
B i a B t i a
m t i a i i mm m it a g ta a t i
a t i i at ma a
m t i a i i mm m it a g ta a t i
a t i i at ma a
m t im a t ai ma at i t a a a a
i g t imat a g a t m a iti t i a i
a
NHRC has provided ethical approval for the following major studies in FY 2018/19
a mi i m t i iti t a a t a iat it
i i g t a ia at it m am g t i t Bag g
i i a it
i g a i t a i i it a a ai a i it a i am g g
m i a a a
ta a i iag i a t atm t t a at a i t ita a
8.9.4 Policy / Technical Briefs
it t ta a gt i i t a i i a i g i g
a ata i g i a
a i a i at a at i ma ag m t i i g i i i ami
a i g
ga i a a a a it a m t a it ia i a i im m i ta a
at a ii
a i i t g t a m iti t i i i at
m i g a it a t ma ag m t i ma t mt g a ata a it
a m t t i a i g a it
a g i at ii at a ag m t ma t m
ata
t ta at i ma ma ag m t a i t t t g a
i i t at gi a a i t ii
8.9.5 Health sector reviews with functional linkages with the planning processes
Ba t at a a t a ag i i a t t at t
i at a t g m t a t ta a i t i at
t a a i ia a i t i at t a a it t a
i a a i g g i i a t a iti t a a t g t
it g i i a i t m ta t t ta a i t i ta i
a i g mt a a i i gi t t a i a a i g
8.9.6 Challenges
imit a ai a i it a it ata t m t t at t ata at a i a

g g am
a
imit i a i i ma i g at a
imit i t g at i ma ma ag m t agi g t at a t tai t
g a a a i m t t at t
8.9.7 Way Forward
m ia m g m at a ii m t ai
igi i g gi t t a i itat m g im i g ata a it a
ata at t i t ata g a
ta a i t i ta a ag i t ai i g t i t at a a
t
i ai a a at i i a g i i it ta t a i itat
ta a i a a i t a i it it t a a ata a
igi a i t g at a ma a ag m t t m it t a a ata a
a a ia ata a t a i i at
im m ta t g i i at t i a t t
m m ta a t a i it gi t at a
a a ai t t a ta a ata it
ta a i t gt a i t ai at i i a at a
t ai a g ai i g a a at a t

Chapter 9
Chapter 9
at i
HEALTH9.1
COUNCILS
Ne al Nursing Council
9.1 Nepal Nursing Council

9.1.1 ntroduction
Nepal Nursing
9.1.1 Council (NNC) is established under Nepal Nursing Council Act 2052 (1996). It came into
Introduction
force on 2053-03-02 (16 June 1996). NNC is an autonomous body formed to maintain quality nursing
a i g i i ta i a i g i t t am
and imidwifery
t education for the provision ofi quality
a a t nursing
m and midwifery
m t mai services
tai to
a itthe public.
i ga mi i a t ii a it i ga mi i i t t
9.1.2 T ie ain functions of t e council are:
 Register the nurse and midwife through licensing examination and manage the registration of
9.1.2qualified
The main nursing/midwifery
functions of the council are:
professionals.
 Formulate policy required to operate the nursing and midwifery profession smoothly and to
gi t t a mi i t g i i g ami a a ma ag t gi t a
provide
ai better
i g mi carei to the public.
i a
 Inspect,
m at monitori and
i recognition
t at t to nursing i g a andmi midwifery
i academic
i m t institutions
a t and monitor
thei quality ofa nursing t t andi midwifery services for better nursing care.
t m it a
 Maintain the standardization g i t in i nursing
g a mi and i midwifery
a a mi i education
t a through
m it evaluating and
t a it i g a mi i i i g a
reviewing the nursing and midwifery curriculum, the terms and conditions of admission and
ai tai t ta a i a i i g a mi i a t g a a g a
examination
i i gt systems.
i g a mi i i m t t m a i a mi i a
 Formulate
ami a professional
t m code of conduct of the nursing and midwifery professionals and to take
action
m atagainst those i a professionals t who t violatei g asuch
mi code
i of conduct.
i a a t ta
 aDevelop agai the
t t scope of practicei a fori nursing
at and midwifery t professionals to determine the work
t a i g a mi i i a t t mi t
limit of nursing and midwifery professionals.
imit i g a mi i i a
 Publish i t the a annual
a Journal
a t of the
a Nepal i g Nursing
i Council.
As of June 2019 there t were 277 nursing

i ga and
mi 3i midwifery courses
i g i running
a amin gNepali g among nursing
g i i g B i g Ba i i g ma t 45, master level 12 and
college , Proficiency level nursing 121, B. Sc. nursing 50, Bachelor in nursing
a
49 Auxiliary i ia mi (ANM)
nurse-midwife i .
Table 9.1: Nursing and Midwifery education programs
Table 9.1: Nursing and Midwifery education rogra s
.N. Nursing education rogra s Nu ber
1 Auxiliary nurse Midwife (ANM) 49
2 Proficiency certificate level (PCL) 121
3 B.Sc. nursing 50
4 Bachelor in nursing science (BNS) 45
5 Master in nursing (MN/MSC) 12
Total 277
1 Bachelor in midwifery 3

at i
The NNC hadaregistered
gi t 88,675 Nepali
a i nurses (PCL 55,534
a and 33,141
a ANM) and
ig 843 foreign nurses till
2019 June.
Table
Table 9.2:9.2: Categories of
Categories of registered
registered Nurses
Nurses
SN Categories of nurses Number
1 Nurses 55,534
2 ANM 33,141
Total 88,675
1 Foreign nurses 843
9.1.3.
9.1.3. Major
Major activitiescarried
activities carried out
outbybyNNCNNCin fiscal yearyear
in fiscal 2075/76
2075/76
• Completed “midwifery educators’ training” for two batch 14 participants in each batch with
m t mi i at t ai i g t at a i a t i a at it
help of UNFPA and GIZ.
a
• Develop the code of conduct for nurses and midwives.
t t a mi i
• Started specialized online registration for master level of nursing.
ta t ia i i gi t a ma t i g
• a Expansion
i a
of bachelor level of midwifery
mi i a
education.
•i a Initiation
a
bachelor leveli g
nursing
a
education
g ma
(oncologyt
major subject).
• Approved i
curriculum
m
for
mi i
PCl midwifery
a
prepared
a
by CTEVT and MoHP.
• i gDuring
t
the t
2076 thei
council
t
held
a
three
a i
national licensing examinations
i g ami a i g g a at
for nursing
a
graduates.
t a a ta i g a t ma t m m t
• i Prepared
t i thettproposed draft
a a of NNC
ita act according
m it i g a i i itfederal system
a m t tsent
and t for Amendment.
a• Revised athe different tools such as accreditation, monitoring, feasibility, self assessment to
the all t level of education.a mi i
• Developedi the scope
g a mi i of practice
g a for midwife.
• Developed of nursing and midwife regulation.
9.1.49.1.4
WaysWays forward
forward
 aPreparation
a t for gi thet aRegistration
a i and license
ami a examination
a of bachelor
mi i level
a midwives and
aprepares
g i i guidelinei ifor
g licensing
am exams.
 Revised minimum requirements fort different level
i mi im m i m t i i g of nursing course
a i as proficiency
such
at i g a i i g ma t i g
certificate level of nursing, bachelor in nursing, masters of nursing.
m m t a ta
 Amendment
m t of gNNC a act asmi per.i a a a a i gt t a
 m Development
a i of rules
a regulations of midwifery education and practice according to the
ai tai t
federal i a
democratic t republic
at i of maNepal. i gi t
m tt a i t
 a atMaintain
t i
the online and upato date
i g t m a
informationi of
g
previously
g am
registered nurses
 Development the scope of practice for different level of nurse.
 Separate the licensing system for PCL and bachelor level nursing program.

at i
9.2 Nepal Ayurvedic Medical Council

9.2.1 Introduction
a i i a i i t a t m t g at a t
i m i i i a t a ta i t a i a i t
i i t g at a gi a i ma i t
a a ta i a a i a a a a a a i t
a t gi t it t i i a a t i i t
a mi im m i m t i a a i t i mai mmi
it a i t mi at t g m ta ai t t mi
at t g m t t i t t t t gi t t am
i mi at t g m ta gi t a mi at t g m t i
gi t igi ai a ig a tt a am i i i
a ii a gi t it t i a at a m it i
t i ig t gi t t ta i i at i i i a mai a
t i a it
9.2.2 Functions and objectives of the council
a g m t t ii a t atm t
t
t m i m i i
t mi t ai a t a t gi t t m
i t g m t t a a iti i m i i
gg t t t g m t ma i g a a gi g a a
g i a iat a a a i t i a
t mi t i m t m a mi i a ami a t m i i a a
i at t a a i t
g i t a a ai a ga t a m m i i a g a
a am i
a a t i t a t m it it im m ta
9.2.3 The number of registered members, institutions and courses are given below:
MD & Bachelor Level Programme
i a i it a am i it
it i a a g a t a a a a iat
a a i a g Bi g a a iat B
a a it i it i a a i a t Bi a i a g
ata a i a i a g a t i a iat B
Certificate Level Programme (AHA)
a ta i a a t Bi a i a g
a a ta i ig a a a t a Ba a at ma iat
ima a a a g Ba at ma iat

at i
Under CTEVT, Ayurveda Health Worker (AAHW)
ai a a a a it i a t t i a i a g
aga am a i a t t a i a a ta i
t t at i aig at a a
i i a t t a a am a a
a a i a ai i g t a a a a
a a t t i g B a at it a
Ba i a i a t t a i a Ba i a
t t mm it i i ta t a ga i ai a i
a a a am i a am a a
 Dadeldhura Paramedical Campus, Dadeldhura.
it a g a a
 Whitea Park
t i a College,
a i i Dadeldhura.
i aa a t
 Rastriya
i Prabidhik
ga a a Sikhsalaya,
a Surkhet.
a m a a aig at
 Triyuga
amNational i a Education
t t am Academy, Udayapur, Gaighat.
 Ilam Technical Institute, Ilam.t t ta a i
Baga am i i a
 Bagalamukhi Technical Institute, Itahari.
a i i a i at i i B Ba a
(NAMC- Nepal Ayurvedic Medical Council , MD - Master of Medicine, BAMMS- Bachelor of Ayurveda &
i i g B Ba a i i g
Modern Medicine
at i&taSurgery
t , BAMS-
i ia Bachelor aof Ayurveda
at Medicine & Surgery, AHA- Ayurved Health
Assistant; AAHW- Auxiliary Ayurveda Health Worker)
9.2.4 Statistics of registration persons (up to date 2075/12/26)
9.2.4 Statistics of registration persons (up to date 2075/12/26)
SN Subject Number
1 MD/MS/PG 97
2 BAMS/equivalent 708
3 Ayurveda B. Pharmacy 5
4 AHA/Equivalent 1,515
5 AAHW /TSLC 2,272
6 Traditional healers 19
7 Academic institutions 22
8 Foreigner practitioners 4
Source: NAMC

at i
9.3 Nepal Health Research Council

9.3.1 Introduction
a at a i i t a a a i a m g at a
a t t a ta i i a t a iam t a a gi t
i i it t m t a i at at a im m t t a t tat
a ma i a g a i g a
ta a i i t i a a a a a it i i g a a i t i t
a a at a a i a t mai a a i t i
t i a a t i a i a mi i i i a at a a a
a t i a i i a iat i t i a i B a B
a t a it g a g i a i t a
it a a at i a ig i g it t a a at i i a a it i i g
m a i i g a ga i i g t ai i g ai a t at
t m a t a a i t it ia m a i m gt a m t
g a a i i g at a ga t t t a i t
a t a a i t g t t t a t a
i mi a g am t a i itat ta a i g t i ma i t at
t m i i a a imi a a i itat a t a i g m i t
a t a maga i t t g t i a igita ata a a t
a
9.3.2 Major Activities in the fiscal year 2075/76
9.3.2.1 Research Project/Activities
a at a i t i t a a i it t m t
a a t ag i i at a a a a i t i gt
a it
a Ba a t mm i a i a i a
a Ba a gi t a
a Ba i g i i i a mm it Ba i a i t i t
a a ta at a
i a i m t i i at
mm i a i a i a t a
a it a i i i i at a a ii a
Bi ia i t t a g a ima ga i t
i a
ai a t a t i g a g t at i
ii i a a ita i a
i gt t i a g a a i ii i i t ga gt m m ta a
t a i i i a
ta i i g a i i a ia gi t
i i g i a i a t mi a m imat a g
a i g a a it i Ba g ammi g at
i gt ia t mi a t t a at t i i a
m t i a i i it a g ta t a m t i
a a t i at i

at i
mm it Ba t a t mm i a
i m m ta t
t m gi a a a it B i i g t a t B i a i a
9.3.2.2 Publication
i a m t i gt at a a a a t mt i i
a a a at a i it mma i ma i a
t i gt t a a ai a i g t
a a a a ima B a B a a a t
i t t a a m ta at a at ma a at a
i
t im t a Ba a gi t i a at ma a
at a i
a i ima a a a a t i i a i g t mi
i i iti t ita a at a i
ima ai B a a a a a im i a aB Bi ta B a a
Ba at i a g i Ba ii a i g at ma
a at a i a i
a t at ma a at a i
t a tB i a a mmit at a a i t i a
at ma a at a i
a at a i i it at a a a
it i g a a a a a a a B i a
t t a t a B i a t at ma a
a
a a at a i m m
a a at a i m m
a a at a i m m
a a at a i m m
9.3.2.3 Training and Workshop
t t ai i g t i tt i i t at a a t g t t ai i g
at a a m t i a a i t ai i g ata a ag m t
a a a i a a a imi a t ai i g i i g a a
ga i i i i g ta t ai i i t ga i i
i a a
9.3.2.4 Fifth National Summit
i a a mmit at a a i t i a i
t t m a it a m ti t a t t mmit
a t t a a at i it a a a B i t i it
a a t i mmit a i gi g i i at a t i i at a m
a igita at a ig ata m a i a a m t
at a a i t a a a ig i a t ti t g at i i
i t i a i ig ti t t a it a i t t it i t t t
a gi g at t m i i a ta i g t a ai a i m imm i
at i
i ga m g t a ga i i g a tai a at t m at
t a i ia a t a g m t
9.3.2.5 Ethical Clearance of Research Proposals
t i a i B a B i at a a t i a aa i
t t i Bm g t i t i a a a t mi
a i t ta a a g t t i a a a i at a a it
a i a ti i i ga it a a t i m it
am g a a a a g it m it i g a t imi a a
t a a i a a mi t i a i i ai tag
i a a a t i a i i at a i a a a
9.3.2.6 Institutional Review Committees (IRCs)
a ta i t at a a a t t t m t at a
at i t a ia i m i a g at i i i a g
a t am i t t t a i mmi a i gt
t m it i g a a ta t i
gi t a m at a a
9.3.2.7 Knowledge Management
g a ag m t t t aim t a i itat t a a a i
i t at i a a g a ag m t a i t i gt
a a
at a i it a a a i a a a ttat g a
ig a i i a m t t at t t a
t at gi g a a a g a t at gi a i i a at
a
t a t ai i a i t i t at a a a t
i a ai t g m g a a tm g ta
a at t i ma m g t ai a t a i m t
a t a tm t i i i t a ita it i t i i g i t a
t ta a a ta m ai ita a i i i t
mat t i ga a a m ta a i t a
Priority Health Research Areas 2019
at t m a
mm i a i a
mm i a i a
a i at
at a a at
ta a t a ta a
i i t a i
ti a a t
i m ta a a a at
aa t a i i
iat i at
i a a t at
at i
9.3.2 Financing Research
9.3.2 Financing Research
Figure 1: Total Research Budget of NHRC between 2063/64 to 2075/76 (NPR in Million)
Figure 1: Total Research Budget of NHRC between 2063/64 to 2075/76 (NPR in Million)
120
114
100 110.46
Budget(NRS. inmillions)
80
60
55.1 56
40 37 41
20 20 23.98 23.128 27.5

19 17.73
11
0
The above figure illustrates the total research budget of NHRC between 2063/64 to 2075/76. The
a g i t at t t ta a g t t t
Government of Nepal (GoN) covered the major source of research budget. In addition to this, External
m t a t ma a g t a i t t i
Development
t a Partners
m tarea other
t imperative
a t sources
im a of budget for research
g t in NHRC.a i
9.3.4 National Dissemination Workshops
9.3.4 National Dissemination Workshops
NHRC organized national dissemination workshop of the published studies on 08 April 2019 at NHRC
training hall Kathmandu. There were more than 70 participants from Ministry of Health and Population,
Government ga i Departments,
a a iNon-Government
mi a t
Organizations, i
Academic t Institutions
i andi individual
at
t ai i The
researchers. g aprogram
at ma m of
was held in the presence t Chief
a a Honorable
Guest i a t m i i Prime
Deputy t a t aand
Minister
Minister of Health and Population Mr. Upendra Yadav. The purpose of the dissemination workshopawas
a m t a tm t m t ga i a a mi t
i inform
to i i a policymakers,
a g am and
researchers a community
i t with the evidence i obtained t froma the studies t
im
conducted i by
i t NHRC.
a Teni research
it a t were
reports a produceda and distributeda toathea participants. t
i mi a a t i m i ma a a mm it it t i
tai mt t i t a t a iti t
t t a i a t

at i
a i a i
t
a i a i i a g at ga i a ta i a t a iam t
t t at m i m m i m t t ta m t t at a
a t t i i g ta a i t t ai i g a a m m i i
gi t i g t a g at t i a a i g t at i i i a i a a a ai
a ia a i g at a i i i a i i mm it a a t a m
i i t t it m
9.4 Nepal Medical Council
9.4.2 Progress of Nepal Medical Council:
9.4.1 Introduction
Nepal
9.4.2.1Medical Council
Licensing (NMC) is a regulatory organization established by an Act of Parliament (NMC Act
Examination
2020) that comprises 19 members. NMC is empowered to protect and promote the health and safety of the
public by ensuring proper standards in the training and practice of modern medicine, registering doctors and
a i a i t i i g ami a g a at BB B a
regulate their practice and ensuring that individual professionals have a fair and unbiased hearing at any
ia ami a tg a at m t t a t
disciplinary inquiry. The community and patients occupy a supreme position in the conduct of its multiple
m i a a
duties. ta a
9.4.2 Progress
9.4.2.2 of NepalStatus
Registration Medical Council:
9.4.2.1 Licensing Examination
Nepal Medical Council conducts Licensing Examination for undergraduates (MBBS & BDS) and Special
ma a i a i i t gi t a mai tai a i
Examination for postgraduates (MD, MS & MDS) every four months round the year to certify medical
m andi a dentaltapractitioners.
a a gi t t a g a at i
BB i ma m a a a
9.4.2.2 Registration Status
The major function of Nepal Medical Council is to register and maintain proper archives of
9.4.2.2.1 National Doctors
medical/dental practitioners as NMC Registered doctors, who have duly graduated in MBBS/ Diploma
from Nepal or abroad.
ata gi t a a t B i a i a i a
9.4.2.2.1 National Doctors
The data of registered national doctors till 2076 B.S. (2019 A.D.) in Nepal Medical Council were as follows:
UNDERGRADUATE POSTGRADUATE
Program Number of Number of Total Program Number of Number of Total
Male Female Number Male Female Number
MBBS 15,485 7,661 23,146 MD/MS 5,530 2,228 7,758
BDS 1,118 2,082 3,200
Total 16,603 9,743 26,346
Source: NMC
9.4.2.2.2 Foreign National Doctors (FND)
9.4.2.2.2 Foreign of
The provision National Doctors
temporary (FND) to foreign doctors is on the basis of recommendation of
registration
Government of Nepal, Medical Colleges or organizations related with healthcare and their academic
ii
qualification. In tfiscal
m yeara 2075/76,
gi t atotal number
t igof 185 foreign
t i doctors
t hasabeen
i registered
mm at Nepal
a
Medicalm Council
t to providea health i aservices gin various parts
ga i of
a the country.
at it at a a t i
a a miEligibility
9.4.2.2.3 a i Certificate
a a
Issuance a t ta m ig t a
Eligibility
gi t at Certificates
a were
i a provided
i t as per
i the atNMC regulations
i i aito thoseatwho possess
t minimum
t
qualification to pursue Medical Degree/ Diploma from abroad. NMC has granted Eligibility Certificates as
below Eligibility
9.4.2.2.3 mentionedCertificate
data: Issuance
SN Country UG Eligibility PG Eligibility SN Country UG PG
Eligibility Eligibility
igi i it
1 at
Australia 1 i a 2t 9g a t t
Pakistan 10 mi37im m
a i 2a t
Bangladesh i
361 a g 9 i ma 10 m a Philippines
a a 60g a t igi
2 i it
3ata China m 75 ata 45 11 Russia 7 0
4 Egypt 0 5 12 Thailand 0 1
5 Germany 2 1 13 Ukraine 2 2
6 India 35 65 14 UK 1 1
7 Japan 0 4 15 USA 1 66
8 Kyrgyz 2 0 Total 557 240
Source: NMC
9.4.2.2.2 Foreign National Doctors (FND)
The provision of temporary registration to foreign doctors is on the basis of recommendation of
Government of Nepal, Medical Colleges or organizations related with healthcare and their academic
qualification. In fiscal year 2075/76, total number of 185 foreign doctors has been registered at Nepal
Medical Council to provide health services in various parts of the country.
9.4.2.2.3 Eligibility Certificate Issuance
Eligibility Certificates were provided as per the NMC regulations to those who possess minimum
at
qualification toipursue Medical Degree/ Diploma from abroad. NMC has granted Eligibility Certificates as
below mentioned data:
SN Country UG Eligibility PG Eligibility SN Country UG PG
Eligibility Eligibility
1 Australia 1 2 9 Pakistan 10 37
2 Bangladesh 361 9 10 Philippines 60 2
3 China 75 45 11 Russia 7 0
4 Egypt 0 5 12 Thailand 0 1
5 Germany 2 1 13 Ukraine 2 2
6 India 35 65 14 UK 1 1
7 Japan 0 4 15 USA 1 66
8 Kyrgyz 2 0 Total 557 240
Source: NMC
9.4.2.2.4 Ethical Cases
a i a i a a i g ia i i g ta i g
g i i a t at it m i a a ta i t mai tai
9.4.2.2.4
ta Ethical
9.4.2.2.4 Ethical
a Cases
Cases t i at i t i i a t a a
Nepal
Nepal
im m t Medical
Medical Council
Council has
has been
been playing
playing crucial
crucial role
role in
in enforcing
enforcing code
code of
of conduct
conduct and
and developing
developing
guidelines
guidelines and
and protocols
protocols related
related with
with medical
medical and
and dental
dental professions.
professions. In
In order
order to
to maintain
maintain standard
standard of
of
conduct
conductgain
in ghealth
health services,
services,
m ai t Code
Code
gi t of
of Ethics
Ethics &&
agai t t Professional
Professional
m i a Conduct
Conducti 2017
2017 was
was
t developed
developed
a and
and
ii
implemented.
implemented.
a g at mm i g i ga a i a a
i i
Investigating
Investigating a
complaints,
complaints, t
registered
registered a
against
againsti the
the medical
medicalt services/
services/ doctors
doctors anda provision
and i a of
provision i
of enacting
enacting
m aior
penalty
penalty ortrecommending
agai t tconcerned
recommending mi
concerned t for
bodies
bodies at legal
for legalit m in
actions
actions iinacase
case of i disobedience/
of any
any a
disobedience/ a gi
fraudulent
fraudulent
found, ialso
found,alsog lies
liesunder
underthe
thesphere
sphereofofNepal
NepalMedical
MedicalCouncil.
Council.The
Thecomplaints
complaintsfiled
filedagainst
againstthe
themisconduct
misconduct
related
relatedwith
withmedical
medicalprofession
professionhave
havebeen
beenoperating
operatingininfollowing
followingprocedure:
procedure:
No.
No.ofofcomplaints
complaints Processed
Processed&&finalized
finalized Withheld
Withheld Under
Underprocess
process
5151 27
27 12
12 12
12
Source:
Source:NMC
NMC
9.4.2.2.5
9.4.2.2.5 Accreditation
Accreditation
9.4.2.2.5 Standards:
Standards:
Accreditation Standards:
Following
Followingaccreditation
accreditationstandards
standardshashasbeen
beenformulated
formulatedandandbeing
beingimplemented:
implemented:
 Accreditation
Accreditation
Following Standards
Standards
accreditation for
forMBBS (Bachelor
MBBShas
standards (Bachelor ininMedicine
Medicine&
been formulated &Bachelor
and being in
Bachelor inSurgery)
Surgery)--2017
implemented: 2017
 Accreditation
AccreditationStandards
StandardsforforBachelor
BachelorofofDental
DentalSurgery
Surgery(BDS)
(BDS)––2017
2017
 Regulations
ita for
Regulations forPostgraduate
Postgraduate
ta a Medical
Medical
BB Ba Education
Educationi(MD/
(MD/MS)i i --2017
MS) 2017
Ba i g
 Regulations
Regulations
ita for
forPostgraduate
Postgraduate
ta a Dental
Dental
Ba Education
Education (MDS
(MDS
ta Program)
Program)
g B –
– 2017
2017
 Regulations
Regulations
g a for
forSubspecialty
Subspecialty
tg a at Postgraduate
i a Medical
Postgraduate a Education
Medical Education(DM,
(DM,MCh)
MCh)––2017
2017
9.4.2.2.6 g a
9.4.2.2.6Continuing
Continuing tg a Development
Professional
Professional at
Development ta (CPD):
(CPD):a g am
 Nepalg aMedical
Nepal Medical Council
Council hasia been
has tbeen emphasizing
tg a at on
emphasizing oniupgrading
a
upgrading a medical
medical education
education and
and skills
skills of
of NMC
NMC
registered
registered doctors
doctors and
and making
making strategic
strategic plans
plans for
for its
its implementation,
implementation, therefore,
therefore, NMC
NMC successfully
successfully
9.4.2.2.6 Continuing
conducted
conducted and Professional
and completed
completed first Development
first phase
phase of
of Training(CPD):
Training of
of Trainers
Trainers (TOT)
(TOT) program
program toto produce
produce competent
competent
Human
Human Resources
Resources for
for the
the effective
effective implementation
implementation of of Continuing
Continuing Professional
Professional Development
Development (CPD)
(CPD)
a and
program
program andi has
a planned
has i to
planned atoconduct
conductmTOT
TOTaprograms
i i g ininevery
programs gevery
a i Provinces
g m i aof
Provinces ofthe acountry.
a
thecountry. i
gi t t a ma i g t at gi a it im m ta t
 In
In order
order to
to pilot
pilot the
the CPD program, Nepal Medical
Medical Council have started accrediting
accrediting CPD
CPD activities
tCPDaprogram,m Nepal
t t aCouncil have ai i started
g ai activities
g am t
conducted
conducted byby different
different organization
organization and
and granting
granting credit
credit points
points to
to participants
participants of
of such
such accredited
accredited
m t t ma t im m ta i g
programs.
programs.
i a m t g am a a a t t g am i
i has
 Council
Council t
has developed
developed tand launched
and launched software
software to
to enroll
enroll different
different organizations
organizations and
and NMC
NMC registered
registered
doctors
doctorsininthe
theonline
onlinesystem
systemandandmake
makeCPD
CPDaccreditation
accreditationsystem
systemaccessible
accessibleininthe
thecountry.
country.
9.4.2.2.7
9.4.2.2.7 ee ision
isionof
of irecti
irecti es:
es: DoHS, Annual Report 2075/76 (2018/19)
 The
The provisions
provisions mentioned
mentioned under
under Clause
Clause No.
No. 14
14 of
of Accreditation
Accreditation Standards
Standards forfor MBBS
MBBS Program
Program 2017
2017
and
and Clause
Clause No.
No. 13
13 ofof Accreditation
Accreditation Standards
Standards for
for the
the BDS
BDS Program
Program hashas been
been amended
amended asas
'candidates
'candidates enrolled
enrolled asas medical
medical graduates
graduates and
and have
have completed
completed sixsix months
months ofof their
their mandatory
mandatory
internship
internshipfrom
fromNepal
Nepalasaswell
wellas
asfrom
fromabroad
abroadboth
bothcan
canappear
appearininthe
thelicensing
licensingexamination.
examination.
 The
The council
council has
has fixed
fixed the
the age
age of
of the
the faculties
faculties teaching
teaching clinical,
clinical, dental
dental and
and basic
basic sciences.
sciences. The
The
at i
t i tt g am a i a i a ta t a i g a i
t i t ga i a a ga g it i t t a i a t a it
g am
i a a a a t i t ga i a a
gi t t i t i t ma ma a ita t ma i i t
t
9.4.2.2.7 Revision of Directives:
ii m a ita ta a BB g am
a a ita ta a t B g am a am a
a i at a m i a g a at a a m t i m t t i ma at
i t i m a a a ma a t a a a i t i i g ami a
i a t ag t a t a i g i i a ta a ai i
ma im m ag imit i i a t i a a t ma im m ag imit ta a
ai i i a
a i it i it t a a m i it at a a i
i im m ta
9.4.2.2.7 Recent Activities:
it a ma g t m i a i
i i i t m a i ta it a a iat a a
a i a i a tai m m i t a a ia i a
g at t i
i a i t i i a a t it ta a i g a a
g am
a i a i a i a g it m t a a mi
i i g a t ta t it i ii

at i
9.5 Nepal Health Professional Council

9.5.1 Introduction
a at a ii a9.5 a NepaltaHealth i t maProfessional

m Council
t
at i i a t m ii t i at i a tt ai t
a t gi t it t i a i i a ma ag a i ma a ma
9.5.1 Introduction
ii t gi t a t i am a i gt t i ai a a i gt a
Nepal Health Professional Council (NHPC), Nepal has been established to make more effective the health services in
at i a i t t m t a a i a t
Nepal, to mobilize the services of health professionals except the qualified doctors and nurses to be registered with
t a iam t i t t t a ig i a t i g Bi a Bi Bi am a
the Medical Council in a managed and scientific manner and make provisions on the registration of their names
according to their qualifications, according to “Nepal Health Professional Council Act 2053” by the Government of
Nepal andi is
g enacted
t a t
on 2053/11/3 t the Parliament in the
by a twenty
t fifth year
mm of reign
m oft His Majesty
t i t Birendra
King
t Dev.
Bir Bikram Shah t a a gi t at i a a t t a t at
i i t i i t a at i a a t t gi t i
According to article 20 of the Act, “After one year of the commencement of this Act, no personi other
t i a it a a i g t t a a t a than
i
a registered g health
a professional shall be entitled to carry on the health profession, directly or indirectly”.
Therefore all health professionals are requested to register in the Council and renew it on every five years
9.5.2 Functions,
according to the ruleduties and powers
36 of “Nepal Healthof Council Council” regulation.
Professional
9.5.2 Functions, duties and powers of Council

i gt t a t t
According to the article 4(1) of the Act
i ta i a tt a a it t m m a
The Council established pursuant to article 3 shall consist of the members as follows:
 A person nominated by the Government of Nepal from amongst the persons - Chairperson
who, having obtained at least bachelor degree in a subject related with health
profession, have been involved in the health service for at least five years
 Chairperson of Paramedicals' Association of Nepal (PAN) or a representative - Member
designated by him/her
 Chairperson of Nepal Pharmaceuticals Association or a representative designated - Member
by him/her
 Chairperson of Nepal Radiological Society or a representative designated by - Member
him/her
 Three registered health professionals nominated by the Government of Nepal - Member
from the pathology, physiotherapy and public health, on recommendation of the
Paramedicals' Association of Nepal (PAN) .
 Four health professionals elected by the registered health professionals from - Member
amongst themselves, as prescribed
 Dean of the Institute of Medicine or a representative designated by him/her - Member
 Representative, Nepal Medical Council - Member
All together there will be 13 council
t g t t i i
According to the article 9 of the Act, the functions, duties and powers of the Council shall be as follows:
 To make
According necessary
to the articlepolicies
9 of theforAct,
smoothly operating duties
the functions, the health
andprofession
powers of related activities.
the Council shall be as
 To determine the curriculum, terms of admission and policies on examination system of educational
follows:
institutions imparting teaching and learning on health profession and evaluate and review the related
matters.
ma a i i m t a gt at i at a i
 To determine the qualifications of health professionals and to provide for the registration of the names of
t mi t i m t m a mi
health professionals having required qualifications.
i a i i ami a t m
a a i t im a gt a i ga a i g at i a a at a
i t levels
9.5.3 Registration at andmaits qualification requirements
t qualification
According the mi t a ihealth
of a professionals,
a t the NHPC i will
a aregister
t intoi respective
t groups.
gi t a t
 amThe health professional
at with Master
i a a i g degree i will be registered
ai a into “Specialization” category of the related
subject.
 The health professional with Bachelor degree will be registered into “First Class” (A) category of the related
subject. DoHS, Annual Report 2075/76 (2018/19)
 The health professional with proficiency certificate level or equivalent will be registered into “Second Class”
(B) category of the related subject.
 The health professional with only one year study or course on health education or related field will be
registered into “Third Class” (C) category of the related subject.
at i
9.5.3 Registration levels and its qualification requirements
i gt ai a at i a t i gi t i t g
at i a it at g i gi t i t ia i a at g
t at t
at i a it Ba g i gi t i t i t a at g
t at t
at i a it i at i a t i gi t i t
a B at g t at t
at i a it a t at a at
i gi t i t i a at g t at t
t
a tt Ba at g t i ig ti a
a t at t i t g ta t Ba at t
t a a a a t ta ami a a i it t
a t ta Ba g tt t i m t ta ami a
9.5.4 Subject committees of the Council
t gi t a at i a t i a i t t mmi
i at t mmi
i i t mmi
a at i i t mmi
a i g t mmi
i t a a a i ita t mmi
a t mmi
ta t mmi
t m t i t mmi
i a t mi a i at at t mmi
Registration process
a i i i a i t a a iat gi t a ma mit t a i a
t t i a g it g m t a a i i a t i
a i a t t t mmi a a t a i a t t
mmi i a t a i a t t i it it mm a i
m g i ma a ii a a a a t gi t a at a
ta t i a i a t m gi t a a a ta t a ta am t
a i a t i i a a t gi t a at a a i g t i am

Registration process
Each individual or institution shall fill appropriate registration form and submit the application to the
Council along with supporting documents and bank voucher. The Council will forward this application to
the respective subject committee. After evaluation of the application, the subject committee will forward
the application to the Council with its recommendation. The Council meeting will make a decision and
finally award the registration certificate. The NHPC has now started online application system for
registration and also started an entrance exam of the applicant. The Council will now award the registration
a t certificate
i only after passing of this exam.
Table9.5.5
Table 9.5.5Total
Totalnumber
number of Health
of Health Professionals
Professionals Permanent
Permanent RegisteredRegistered
Table 9.5.5.1 Summary of registration in NHPC up to 2076 Ashadh 31.
Table
S.No. 9.5.5.1 Summary of registration in NHPC up toSpecialization
Subject 2076 Ashadh 31.
First Second Third
1 Public Health 1112 3866
2 Health Education 30 76 16
3 Primary Health Care 1
4 Medicine 15297 57942
5 Medical Microbiology 138 139
6 Health Lab 34 2627 7053 16962
7 Radiography 619 1761
8 Radiotherapy 1 7 9
9 Cytrology 1 3
10 Hematology 20 8
11 Biochemistry 194 83
12 virology 10
13 Nuclear Medicine 1
14 Ayurved 181 1159
15 Homeopath 151 44
16 Unani) 13
17 Acupuncture 3 10 91 51
18 Physiotherapy 183 1337 104 75
19 Community Base Rehabilitation 1
20 Prosthetic & Arthritic 12 1
21 Dental Science 1248 779
22 Naturopathy 1 48
23 Yoga 3 9 1
24 Ophthalmic Science 12 709 1060
25 Operation Theater and Allied Health Sciences 13 55
26 Clinical Psychology 20
27 Speech and Hearing 9 69 1
28 Forensic Medicine 3
29 Perfusion Technology 3 7
30 Anaesthesia 1 62
31 Cardiology Tech. 4
32 TCM AMT 3
33 Occupational Therapy 1
34 Renal Dialysis 4
Sub Total 1778 9880 26923 76970
Total 1,15,551
Note:
 Registration procedure in online system.
 Licensing examination on the process.
Note:
 Description collection of institutes in online on the process.
Table 9.5.5.2giSummary
ta of Student Intake
i number
i 2076
t mAshadh 31
S.No. Programme Student intake S.No. Programme Student intake
i i g ami a t
No. No.
1 MPH
i i t t20 i i 10 t B.Sc. Medical Biochemistry 20
2 BPH 40 11 B. Optometry 20
3 B.Sc. MLT 20 12 PCL GM/ CMA 40
4 BPT 30 13 CMLT 30
5 CPT 40 14 PCL Radiography 30

6 M.Sc.MLT 5 15 PCL Dental Science 40
7 M.Sc. Medical Microbiology 5 16 PCL Ophthalmology 40
8 B.Sc. Medical Microbiology 20 17 TSLC MLT 40

Sub Total 1778 9880 26923 76970
Total 1,15,551
Note:
 Registration procedure in online system.
 Licensing examination on the process.
 Description collection of institutes in online on the process.
at i
Table 9.5.5.2 Summary of Student Intake number 2076 Ashadh 31
S.No.
a Programme
mma t t Student
ta intake
m S.No. a Programme Student intake
No. No.
1 MPH 20 10 B.Sc. Medical Biochemistry 20
2 BPH 40 11 B. Optometry 20
3 B.Sc. MLT 20 12 PCL GM/ CMA 40
4 BPT 30 13 CMLT 30
5 CPT 40 14 PCL Radiography 30
6 M.Sc.MLT 5 15 PCL Dental Science 40
7 M.Sc. Medical Microbiology 5 16 PCL Ophthalmology 40
8 B.Sc. Medical Microbiology 20 17 TSLC MLT 40
9 M.Sc. Medical Biochemistry 5
Source: NHPC

at i
9.6 Nepal Pharmacy Council
9.6.1 Introduction
a a ma i i ta i i t ma t a ma
i ma agi g a a g it i a i ma a a i t gi t a
am a i gt t ai a a ma i t a a ma a i ta t
a a a
9.6.2 Functions and Duties:

ta i i a a it a a ma i
i t a it a a a a ita a ma i t t
a it a ma ma a t t
i m m mmi a a gi t a a i t
ii gi t a a ma i t a a ma i ta t
9.6.3 Infrastructure and Facilities:
a a i a a i i a at a t
a ag a ia
g ta a mt g m t
9.6.4 Regular Activities:
i ami a t m a a
gi t a a ma i t a a ma i ta t a a i g tt i ami a
a ma t a i g i t
ita a ma t a i g i t
mi i ta g a g a m i i a
it i g a ii a ma g
9.6.5 Specific Activities:
ii t i gg i i g
i im m t i at t a a ii
t i i i g a ma t t
i g ig t
i it a ma i t t
ma at a i m ta
9.6.6 Approved Collegesof fiscal year 2074/75

at g am g
Ba g am g
i ma g am g

Chapter 10
a a at a
NATIONAL HEALTH
INSURANCE
10.1 Introduction
at a g am i a ia it
g am t m t a t at
aim t a it i t a t a it at a i mi imi i g a a ia
t m at a B a B i i t a tt at i a g am i
a t g g g a ma im i ga m mai t
t t it t a at i ata t i i ga
t t m m i g i at i a g am i a ami a g am ami
a t a ti am tt i t g am m ti ta
mm i a g m ta i t i i t i g am t
t m a i gi t t t at a t i ata t i it t
a i t i a m i i g a m ta i i g it m t a t i g am
a a at t a a it at i i g am a m t t a a i i at
i ia a it a a a i a a tag g a am a t
a i i a at ag i ta t t m ai a i i t i t t ait a
a t a i t at t i a i ma
10.2 Objectives:
a t a it at i it a a it
t t m a ia a i a t t a m t
t tt i a at ag
10.3 Main features of Health Insurance
ti a ta g am a ami ti ami i t m m a t
ti t a a a i a m m
m t a ti am t ta B a ia
ami i a i ga t i t a a a
a t t i m m i t g a a ti
B t t a a a ai a ami i t m m it a
a i a a a i a m m ma im m am t a ai a
a i
m t a ti am t t a i a B t t
a
a t t i t i i t a a ia i i
t at a t a ai a at t t i i t a a i m
t i t ta t i t
ti a t m m m i g at i
g am i a it m t a i ta t i g ma t
Ba t a t i a i g m ta it i at ita i t
i

a  aHIB aacts
t as the
a service purchaser while government and listed private hospitals provide the
services.
10.4 Program Implementation Status
10.4 Programa t i Implementation

a g am Status
i t am i ta t m ai a i i t i t t ait a
 HIB itacts
i as athe service
t ampurchaser
a Bag while g government
i t i t
The health insurance program in present framework is started from Kailali district on 25th, Chaitra, and listed private hospitals provide tthe
2072. g am Thenservices.
i im m t i to Illam
it is expanded i t and
i t Baglung
t t on
district i FYt 2073/74. The end of tFY 2074/75 g am the i
im
program m ist implemented
i i t i in t 36 tdistricts tof the a country. t iTill
t i the
t aendi of i FY 2075/76 i B the
i aprogram i g t is
im 10.4 mProgram
implemented t t iinImplementation
am a of Status
46gdistricts thet country t and a next 7 districts it are
B ingpipe am line.a HIB isi planning
t i t i a to
implement
The healthi a this program
insurance all
program over in the country
present as
framework well. The
is list
started of HIB
from program
Kailali launched
district on districts
25th, is as
Chaitra,
shown
2072. in Table
Then it 10.1.
is expanded to Illam and Baglung district on FY 2073/74. The end of FY 2074/75 the
program
Table 10.1:is Listimplemented
of districtsinimplementing
36 districts ofNational the country. Health TillInsurance
the end of FY 2075/76
program till FYthe program is
2075/76
implemented
Table 10.1: Listinof46 districts
districts of the country
implementing and next
National Health 7 districts
Insurance areprogram
in pipe till line.
FY HIB is planning to
2075/76
implement
SN Name thisofprogram
Provinceall over the country as well. The listDistricts of HIB program launched districts is as
1shown in Table 10.1.
Province 1 Ilam, Jhapa, Sunsari, Bhojpur, Khotang, Solukhumbu, Sankhuwasabha
2 Province 2 Rautahat, Mahottari, Parsa, Dhanusa, Siraha
3Table 10.1: BagmatiList of districts implementing National Health
Bhaktapur, Makawanpur, Insurance
Chitawan, program
Sindhuli, till FY 2075/76
Ramechhap
4 SN Name of
Gandaki Province Baglung, Myagdi, Kaski, Gorkha, Tanahun,Syanja Districts
5 1 Province
Province 5 1 Ilam, Jhapa,
Palpa, Sunsari,
Bardiya, Bhojpur, Khotang,
Arghakhanchi, Solukhumbu,
Kapilvastu, Sankhuwasabha
Rolpa, Rukum east,
2 Province 2 Rautahat,
Pyuthan,Banke Mahottari, Parsa, Dhanusa, Siraha
63 Province
Karnali 3 Bhaktapur,
Jajarkot, Makawanpur,
Surkhet, Rukum west, Chitawan, Jumla, Sindhuli,
Kalikot,Ramechhap
Mugu, Humla,Dolpa
4 Gandaki Baglung, Myagdi, Kaski, Gorkha, Tanahun,Syanja
7 SudurPaschim Kailai, Achham, Baitadi, Bajura, Bajhang, Kanchanpur, Darchula
5 Province 5 Palpa, Bardiya, Arghakhanchi, Kapilvastu, Rolpa, Rukum east,
Pyuthan,Banke
10.5 Enrollment
10.5 and
andHealth
Healthservice utilization Status of of fiscal year 2075/76
6 Enrollment Karnali service
Jajarkot,utilization
Surkhet, RukumStatus west, fiscal year
Jumla, 2075/76
Kalikot, Mugu, Humla,Dolpa
There were 13,507 people insured in FY 2072/73 and 228,113 people were insured in FY 2073/74 and
7 SudurPaschim Kailai, Achham, Baitadi, Bajura, Bajhang, Kanchanpur, Darchula
1,130,575 people were insured i in i the FY 2074/75. a A total of 147,938 peoples i reenrolled
i 16,40,879
a
peoples are active members i and 507,059 peoples are
i t utilization Status oft fiscal drop out of
ta year 2075/76 Insurees respectively in the health
10.5 Enrollment and Health service
insurancea program at the enda of FY 2075/76 . Among them 293,958 people are insured on tthe basis t of
There were 13,507 people insured in FY 2072/73 and 228,113 tpeople were insured in FY i2073/74
a m m a aand
ultra-poor
i 1,130,575
a category
g am were whose contribution
at t insured in the FY 2074/75. is paid solely
m gA ttotal by Nepal Government
m of 147,938 peoples in FY 2075/76.
a ireenrolled 16,40,879 t aiThe
people
population coverage
t a are active in health
at g members and 507,059 insurance
ti seemed to be around
i ai are drop out ofa Insurees m 14 percent of total
ti population among
peoples peoples respectively in the health
implemented
a districts. Among
ag ati the t the
aend iof FYtotal insures,
a2075/76 m about
t them 708,406
a 293,958 people have t aretaken ta health
t insured services
am from
insurance program . Among people ona the basis ofg
listed health facilities in health insurance program in FY 2075/76. Based on the number of enrollments
imultra-poor
m t category i t i t whose m contribution
g t t ta i is paid asolelyt by Nepal Government a tain FY 2075/76. at iThe
Jhapa , Chitwan
population , Palpa and
coverage Sunsari are leading toptofour districts, 14followed
percentby Kaski and Kailali, among present
m it a t a in i i health i insurance a t i seemed a be
g am aroundi of
Ba total population
t m
the enrollment
implemented status as shown in Table 10.2.
m t districts. a a itAmong
a the a atotal a insures, a iabout
a 708,406
a i g t people have i t i taken
t health services a ifrom
a
Table
listed
ai 10.2: Summary
a i health facilities
tt of numbers
in health
m t insurance of enrollment by district by province
tat a programi in aFY 2075/76. Based on the number of enrollments
S.Jhapa
N. ,Province
Chitwan , Palpa Name andofSunsari
Districtare leading Nos. of top four Drop out of followed
districts, Active by Members
Kaski and of Kailali,
No. service
present
athe enrollment mmastatus as shownm in Table Insurees
10.2. m t Insurees
iti t i Insurees takers
1 Table 10.2:Province 1 Ilam
Summary of numbers of enrollment 67073 by district 17556by province 49517 25198
2S. N. Province Jhapa
Name of District 243061
Nos. of 51962
Drop out of Active Members of 191099 No.89851
service
3 Sunsari 151621
Insurees 24343
Insurees 127278
Insurees 48203
takers
41 Province 1 Bhojpur Ilam 19776
67073 6295
17556 13481
49517 2928
25198
52 Khotang
Jhapa 23907
243061 8019
51962 15888
191099 2169
89851
63 Solukhumbu
Sunsari 5201
151621 2825
24343 2376
127278 640
48203
74 Sankhuwasabha
Bhojpur 6883
19776 62950 6883
13481 113
2928
85 i Khotang
Rautahat 23907
9870 8019
3256 15888
6614 2169
2728
96 Solukhumbu
Mahottari 5201
10821 2825
3747 2376
7074 640
1059
107 Sankhuwasabha
Parsa 6883
13938 0
3182 6883
10756 113
1838
8 Province 2 Rautahat 9870 3256 6614 2728
9 Mahottari 10821 3747 7074 1059
2
10 Parsa 13938 3182 10756 1838
11 Dhanusa 3483 11 3472 304
12 Siraha 6839 11 6828 288 2
13 Bagmati Bhaktapur 90512 16041 74471 43802
14 Makawanpur 95832 16252 79580 40308
15 Chitawan 214103 55110 DoHS, Annual 158993 Report 2075/76110228 (2018/19)
16 Sindhuli 52743 12889 39854 11070
17 Ramechhap 22882 5672 17210 4428
18 Gandaki Baglung 48934 12548 36386 16129
19 Myagdi 16545 4553 11992 7362
20 Kaski 120730 32412 88318 56848
21 Gorkha 40970 12877 28093 12879
11 Dhanusa 3483 11 3472 304
12 Siraha 6839 11 6828
a a a t 288 a
13 Province 3 Bhaktapur 90512 16041 74471 43802
14 Makawanpur 95832 16252 79580 40308
15 Chitawan 214103 55110 158993 110228
16 Sindhuli 52743 12889 39854 11070
17 Ramechhap 22882 5672 17210 4428
18 Gandaki Baglung 48934 12548 36386 16129
19 Myagdi 16545 4553 11992 7362
20 Kaski 120730 32412 88318 56848
21 Gorkha 40970 12877 28093 12879
22 Tanahun 65132 16495 48637 22794
23 Syanja 34034 12 34022 3659
24 Province 5 Palpa 147817 17766 130051 73835
25 Bardiya 78813 22742 56071 16205
26 Arghakhanchi 37057 10735 26322 8658
27 Kapilvastu 41391 8220 33171 6483
28 Rolpa 20395 8780 11615 2053
29 Rukum east 4815 2355 2460 223
30 Pyuthan 33142 9269 23873 6952
31 Banke 18183 81 18102 1870
32 Karnali Jajarkot 34400 11735 22665 6655
33 Surkhet 39743 13623 26120 15766
34 Rukum west 41972 14543 27429 16400
35 Jumla 32445 10755 21690 9258
36 Kalikot 29546 14866 14680 3678
37 Humla 2843 0 2843 1
38 Dolpa 1253 0 1253 2
39 Mugu 1383 0 1383 1
40 SudurPasc Kailali 122494 24333 98161 27971
41 him Achham 23682 9183 14499 1394
42 Baitadi 9523 4326 5197 1695
43 Bajura 24686 11042 13644 2117
44 Bajhang 27654 6637 21017 1934
45 Kanchanpur 5682 0 5682 295
46 Darchula 4129 0 4129 134
Total 2147938 507059 1640879 708406
Gender wise Insurees Trend since FY 2072/073- 2075/076

serial no. Fiscal year No. of Total Insurees Gender wise distribution
Male Female Others
1 2072/73 12623 5972 6647 4
2 2073/74 228113 107804 120277 32
3 2074/75 1130575 533829 596633 113
4 2075/76 1640879 782143 858449 287
Source: IMIS 2075/76 Ashadha 31

a a at a
10.6 Opportunities in HIP program
g am i a i t a i t tat g i i
i i
at a t a ii t m m t i gi
ma t
ig i a mmitm t
ig a t i i g ita a a it at i
at t m t gt i g g i i i g ita a ma gat i g t m
tai a a a t i ia at it t a
10.7 Challenges in HIP program
gt ta i
ai i g t m m ta a
ai a i it a a i i it a it at i
t gt i g i a ma ag m t i ma t m
a ta g t g a t i m t ta t
t a at i
agm t ia a t it g am it i a

Chapter 11
m t at t
DEVELOPMENT
PARTNERS SUPPORT
t m i i t i a t a t t m i t t i it
a t a it m t at m at a i at a a i t a a ga i a a
a a a tm t at i a g it a t i it t
ga i a a t i ag ti t a at t i a t it t g amm
t ga i a a t i ta t tai at a a i t i a
a i ta i t i a a
m t at tt g m t at t mt g a t i a a
t t im m ta t a at t t at g
i t i a i g a g m t a ig ai at a
t g m t i i tai t a a g m t at a i g t
a at t i ga a g m ta aa a i g m a i m a i at a
ag t t g m ta t at i m t Ba a a at a
it mmitm t t g a g am t at i i agai t a i a t
t a i m t i t a a a i i g at t i
mmitm t agai t m i a ag it t i it at a a
mat i i ti ai at gt

Development Partners Contributing to Health Sector in Nepal
11.1 MULTILATERAL ORGANIZATIONS

m
Geographical Health sector budget for FY

Organization Major program focus Contact details
coverage 2018/2019
UNFPA Sexual Reproductive Health and Right, Provincial presence: 2, Total allocated budget of all Office address:
t at
Family Planning , Midwifery Education, 5 and Sudur Paschim programs activities: UNFPA Nepal
RH morbidities, Adolescent Sexual of 19 districts, US$ 4,896,000 Jhamsikhel, Sanepa, Lalitpur
Reproductive Health , Health Response Tel: +977 1 5523880
to Gender Based Violence (GBV) and Total expenses of all programs Fax: +977 1 5523985
Emergency preparedness & response. activities: Email:
t
US$ 5,319,000 Nepal.office@unfpa.org

The amount includes the additional registry-np@unfpa.org
purchase of amount Web:
US$ 1,756,000 http://nepal.unfpa.org/
1) Maternal and newborn health District number: 18 Total allocated budget of all Office address:
UNICEF programs activities: UNICEF Nepal, UN House,
2) Child Health including immunization District number: 77 Pulchowk, Lalitpur
US $ 3,405,554
3) Adolescent Health District number: 18 Tel:5523200
Total expenses of all programs Fax: 5527280
4) Health System Strengthening District number: 18 activities: Email:
including emergency response kathmandu@unicef.org
District number: 41 US $ 3,405,554 Web:
5) Nutrition http://www.unicef.org/nepal
WHO Nepal  Vaccine preventable disease National Allocation (Award): 8.1m Dr Jos Vandelaer
surveillance and technical support Expenditure: 6.65 m WHO Representative
to strengthen immunization WHO Country Office for Nepal
coverage UN House,
 Strengthen public health emergency Pulchowk, Lalitpur
preparedness and response – Email: vandelaerjo@who.int
support to establish health Phone: + 977-1-552199
emergency operation centers Fax: + 977-1-5527756
(HEOCs) and strengthening hub-

hospital networks with adequate
coverage 2018/2019
stockpiles
 Support implementation of package
of essential noncommunicable
(PEN) diseases interventions and
development and update of
national protocols and frameworks
 Technical support to achieve and
sustain communicable disease
elimination and control targets –
Malaria, Lymphatic filariasis,
Trachoma, Kala-azar, Leprosy and
Tuberculosis

The World To improve efficiency in public resource Nationwide Total disbursed Office address:
Bank Group management systems of the health Budget The World Bank Group
sector in Nepal US$29.5 million Yak and Yeti Complex
Durbar Marg, Kathmandu
Tel:977-1-4236000
Fax: 977-1-4225112
Email:
infonepal@worldbank.org
Web:
https://www.worldbank.or
g/en/country/nepal
United Nations 1. Emergency Nutrition Response Emergency Nutrition Office address:

World Food Programme: Response Programme Total expenses Patandhoka Road Chakupat-
Programme was implemented in 10, Lalitpur 44600
m
The Emergency Nutrition Response five districts of US $ 701091

Program was implemented with the Province 2 (Rautahat, Tel: 977-01-5260607
following key objectives. Sarlahi, Mahottari,
Siraha and Saptari)
t at
 To prevent malnutrition among Fax: 977-1-5260607

pregnant and lactating women and Maternal and Child
children aged 6-59 months. Health and Nutrition Email:wfp.kathmandu@wfp.o
 To prevent deterioration of MAM Programme is being rg
children aged between 6 - 59 implemented in five
t
coverage 2018/2019
months into SAM. districts of Province 6
m
 To create awareness among the (Mugu, Jumla, Humla, Web: www.wfp.org

public regarding malnutrition, and Dolpa and Kalikot)
 To enhance knowledge on maternal,
t at
infant and young child feeding

practices.
The major activities implemented were:
t
 Blanket Supplementary Feeding

Programme
 Nutrition screening through MUAC
 Nutrition education
2. Maternal and Child Health and

Nutrition Programme:
United Nation World Food Programme is

continuously supported government of
Nepal in the implementation of the
Maternal and Child Health and Nutrition
Program. The program major focused
was to improve the nutrition status of
Pregnant and Lactating women (PLW)
and the children of age 6 to 23 months.
The program major focus is to enhance

maternal, infant and young child
nutrition practices and support to
enhance the basic health servicesalong
with the distribution of super cereals for
the PLW and children of age 6 to 59
months.

11.2 BILATERAL ORGANIZATIONS
Health sector budget for
Organization Major program focus Geographical coverage Contact details
FY 2018/2019
Department for  Health system strengthening, including Nationwide Total Allocated budget Office address:
International health policy, planning and budgeting, of all programme DFID Nepal, British
Development health governance and devolution activities: Embassy, Lainchaur,
(DFID) £12,350,000 financial Kathmandu,
(federalism), improving evidence science
and accountability on health including aid and £10,200,000 PO Box 106, Nepal
monitoring, evaluation, surveillance and Technical assistance Email: nepal-
research, and social accountability in the Total Expenses of all enquiries@dfid.gov.u
health sector; programme activities: k
 procurement and public financial £5,000,000 financial aid Web:

management; disbursed, and https://www.gov.uk/
 improving access to medicines including safe £8,100,000 FA is government/world/o
motherhood and family planning, gender, planned to disburse by rganisations/dfid-
equity and social inclusion; and Nov 2019 (subject to nepal
 health infrastructure and hospital achievement
retrofitting ofDisbursement Linked
 (Nepal Health Sector Programme 3 and Indicators) and
Nepal Family Planning Project) £8,500,000 technical
assistance
German Technical  Nationwide implementation of National Health District Total allocated budget of Office address:
Cooperation - GIZ Insurance number:Nationwide(43 all programs activities: Milap Road, Sanepa,
Support to the of 77 districts already Lalitpur SMC, Ward
Health Sector implemented NHI) US $2,854,332 no.2, Province 3, Nepal
m
Programme  Strengthening the health management of District number: 5 (6

(S2HSP) selected sub national government units as a part municipalities: Total expenses of all Tel: +977 1 5013088
of federal health system Madhyapur Thimi, programs activities:
t at
Nilkantha, Bidur,
 Improve the capacity of selected health sector Nepalgunj SMC, US $2,636,592 Fax: +977 1 5013078
professionals Godawari and Dhangadi)
Email:paul.rueckert@gi
z.de
t
FY 2018/2019
 Harmonization of various health information District Number:
m
system as the first element of a future national Nationwide Web:

health information platform District number: 10 www.giz.de/nepal
(Major support at
 Implementation ofrelevant approaches and federal level)
t at
strategies for dissemination on health promotion

targeting for adolescents (10-19 years) on District number: 2
reproductive health topics (Kailali, and Nuwakot)
German  Maintenance of medical equipment Office address: KfW
t
Financial o Multiyear contract outsourcing of  National level Disbursement Kathmandu Büro

Cooperation - maintenance Euro 4.77 million or Office of German
KfW  Sector Support/Pool Fund  National level USD 5.34 million Development
o Budget Support through national systems Cooperation
 Support to Social Marketing—Nepal CRS  National level Sanepa, Lalitpur,
o Procurement of OC and EC  Gorkha, Tel: 00977 1 5523228
 Reconstruction of 3 earthquake damaged Ramechhapp, Fax: 00977 1
District Hospitals Dolakha 5535693
Email:
 Improvement of Mother Child Care in
Remote Areas  Province 7 shanker.pandey@kf
o Construction, medical equipment and e- w.de
health components, particularly to kfw.kathmandu@kfw
strengthening the referral system in and .de
Web: www.kfw.de
around Dadheldhura
USAID  Maternal Newborn and Child Health District number: 47 Total Allocated Budget of Office address:
districtsthrough all programs activities: USAID/Nepal
different projects US $43,082,322 c/0 U.S. Embassy
(Suaahara II, and SSBH Building, Maharajgunj
project)
G.P.O Box: 295
District number :all 75 Tel: 01-4234000
Total Expenses of all Fax: 01-4007285
districts through
programs activities: http://nepal.usaid.gov
different projects
 Family Planning & Reproductive Health US $43,082,322
(GGMS,GHSC-PSM,
Suaahara II, SSBH, FACT,
Redbook and BA project)

FY 2018/2019
District number: 17
districts (Linkages
 HIV/AIDS and STI project)
District number: 42
districts through
 Water Sanitation and Hygiene program different projects
(SUAAHARA, SafaaPani,
Swachchta project)
District number: Stores

at central, Lumbini and
Karnali Pradesh level
and the health offices
 Global Health Supply Chain program
there in (22 districts, 4
LLGs and 23 health
facilities) through GHSC-
PSM Project
11.3 INTERNATIONAL NON-GOVERNMENT ORGANIZATIONS

Health sector budget
for FY 2018/2019
Adventists  Family Planning and Adolescent Sexual and District number: 9 Total allocated Office address:
Development and Reproductive Health (UNFPP and FPSSP) budget of all Nirbhawan, Sanepa,
m
Relief Agency  Health System Strengthening District number: 1 programs activities: Lalitpur - 3
(ADRA) Nepal  Women's Health and System Strengthening US $3117,445.00
Project District number: 4 Tel: 01-5555913, 5555914
t at
 Integrated Management of Neonatal and Child Total expenses of all Fax: 01-5554251
Health programs activities: Email: info@adranepal.org
District number: 1
US $2423,472.00 Web: www.adranepal.org
t
for FY 2018/2019
Ipas Nepal  To create an enabling environment that supports District number:28 Total allocated Office address:
m
women and girls’ access to high-quality abortion budget of all Baluwatar, Kathmandu Do
and contraceptive care. programs activities: Cha Marg, Ward No: 4
 To ensure high-quality abortion and US $: 1,820,409
Tel: 01-4420787
t at
contraceptive care are available, accessible, and

acceptable to women and girls of Nepal. Total expenses of all Fax: 01-4425378
programs activities:
 To ensure women and girls have the social Email:ipasnepal@ipas.org
US $: 1,820,409
support, knowledge, and self-efficacy to access Web: http://nepal.ipas.org/
safe abortion and contraception.
t
Birat Nepal  Tuberculosis District number: 17 Total allocated Office address:

Medical Trust budget of all Lazimpat – 2, Kathmandu,
(BNMT Nepal)  Sexual and Reproductive Health Rights (SRHR) District number: 1 programs activities: Nepal.
including Menstrual Health US $ 1,179,555.02 Tel: 977 1 4436434,
 Mental Health and Psychosocial Support Services District number: 1 4428240
(MHPSS) Total expenses of all Fax: 977 1 4439108
 Water Sanitation and Hygiene programs activities: Email:
District number: 1 US $ 1,086,066.40 bnmtnepal@bnmt.org.np
Web:
CARE Nepal/  1)Capacity building and Health system District number: 7 Total allocated Office address:
NURTURE strengthening budget of all Samata Bhawan
 2)Maternal, newborn, child health, family programs activities: Dhobighat, Lalitpur
planning US $: 870820. 00 Tel: +977-01-5522800
 3)Health governance and accountability Fax: +977-01-5521202
Total expenses of all
 4)Infrastructure and equipment support to Email:
programs activities:
birthing center carenepal@np.care.org
US $: 842252.00 Web: WWW.carenepal.org
FHI 360 Nepal USAID- and PEPFAR-funded LINKAGES Nepal 17 districts, 131 a Total allocated Gopal Bhawan, Anamika
 HIV and sexually transmitted infection (STI) d s budget: Galli, Baluwatar,
prevention education, referral and follow-up an s, US$ 3.6 million Kathmandu -4, Nepal
through online and offline platforms s an Tel: +977.1.4437173
 Condom promotion and distribution s, Total Expenditure: Fax: +977.1.4417475
 HIV testing and counseling (HTC)services n a s and US$ 2,055,028 Email:
(index testing, online-to-offline, HIV self- a n a s bhshrestha@fhi360.org

testing, community-led testing, enhanced www.fhi360.org/countries/nepal
for FY 2018/2019
peer outreach)
 STI examination and treatment services
 Referral to and linkages with antiretroviral
therapy (ART) services
 Care, support and counseling for adherence
and retention
 Gender-based violence (GBV) screening and
referral for prevention and mitigation services
 Stigma and discrimination reduction
 Demonstration/pilot study on HIV self-testing Lalitpur district
and pre-exposure prophylaxis (PrEP)

 Technical support to National Center for AIDS National level
and STD Control(NCASC) and National Public
Health Laboratory (NPHL)
 Support to national networks of key
populations and people living with HIV
UK aid- funded Fleming Fund Country Grant for 16 Total allocated
Nepal laboratories/surveillanc budget:
 Support to Antimicrobial Resistance e sites (12 human US$ 1.8 million
Containment Multispectral Steering health and 4 animal
Committee (AMRCSC), National Technical health sector) Total Expenditure:
Working Committee-AMR (NTWC) and US$ 174,685
Technical Working Groups (TWGs)
 Develop/Update AMR National Action
Plan/Protocols/Guidelines/Standard
Operating Procedures
 Capacity building: hands-on skill-based
m
trainings and onsite coaching/mentoring for

lab professionals from AMR sentinel
laboratories
t at
 Linking national reference laboratories with

External Quality Assurance in improving the
performance
 Procurement and supply of equipment and
supplies
t
for FY 2018/2019
 Renovation of selected laboratories
m
 Establishment and functioning of AMR/AMU

surveillance in AMR sentinel laboratories
(Recording and reporting, Analysis and
t at
Dissemination of the results for evidence-

based policy and planning)
Helen Keller  Suaahara II (Good Nutrition) Program District number: 42 Total allocated Office address:
International  SABAL - Nutrition - Community Resilience District number: 6 budget of all Green Block, Ward No. 10,
(HKI) Program programs activities: Chakupat, Patan, Lalitpur,
t
 Nutrition - Child Feeding ARCH 3.0 District number:1 US $16,834,102. Nepal

 Study on relationship between maternal District number:1 Total expenses of all
exposure to Mycotoxins on birth programs activities: Tel: 5260247
US $14,509,827. Fax: 5260245
Web:www.hki.org
International  Monitoring prescribing practices and Different districts. Allocated Budget: Office address: 304
Network for availability of free drugs at PHC outlets to MoHP/DoHS Surya Bikram Gyawali
Rational Use of improve rational use of medicines / Marg,Baneswor,Kathma
Drugs Standard Treatment Protocol adherence. ndu
( INRUD,Nepal)
 Provides technical support to DoHS/MoHP Tel: 4115636
to the set activities since 2009-10.
Fax: 4115515
E-mail:
kumudkafle@gmail.com
Web:www.inrud-
nepal.org.np
United Mission to  Community Health: Integrated components on District number: 10 Total allocated PO Box: 126
Nepal (UMN) MCH, Nutrition, WASH, FP,ASRH, HIV and health budget of all Thapathali, Kathmandu
system strengthening programs activities:
 Maternal and child Health District number: 2 US $521517 Tel: 4228118, 4268900
 Mental health District number: 5 Fax: 4225559

for FY 2018/2019
 ASRH and HIV District number: 2 Total expenses of all Email:
programs activities: communications@umn.org.np
Web: umn.org.np
US $580087
One Heart World-  1)Maternal and Neonatal Health District number:13 Total allocated Office address:PO Box
Wide (OHW) (Taplejung, Panchthar, budget of all 3764, House No. 496,
Ilam, Terhathum, program’s activities: Dhara Marg, Maharajgunj,
Sankhuwasabha, US $ 1,458,960 Kathmandu, Nepal
Bhojpur, Khotang, Tel: +977-1-
Okhaldhunga, Total expenses of all 4416191/4417547
Solukhumbu, program’s activities: Email:ohwnepal@oneheartworld
wide.org
Sindhupalchok, US $1,158,000
Web:www.oneheartworldwide.or

Ramechhap, Nuwakot, g
Dhading)
Plan International  Maternal and Newborn Health: Repair & District number:5 Total Allocated Office address:
Nepal, Country maintenance of birthing centres, equipment & (Sunsari, Sindhuli, Budget of all Maitri Marga, Bakhundole,
Office furniture support to birthing centre; strengthen Makawanpur,Bardiya, programs activities: Lalitpur Sub-metropolitan
outreach clinics. Jumla) Rs. 41,576,403 City Ward no. 3, Nepal
 Early Childhood Development: a) Parenting
Education to pregnant women, mothers of less Tel: +977-1-
than five years of children and other care takers of Total Expenses of all 5535580,5535560
family on responsive care and early stimulation for programs activities:
early childhood development; safety and security Rs. 40,867,663 Email;
including establishment of child play corner. Shanti.Upadhyaya@plan
-international.org
a) Reflection Dialogue and Action at community
level to address social determinants on early
childhood development.
m
Web:www.plan-
b) Support on development of National Early international.org/nepal
Childhood Development Strategy at national
level and strengthening ECD Caucus.
t at
 Community based nutrition program-

Assessment of nutritional status of children less
than five years, healthy baby competition, food
demonstration, establishment of nutrition and
t
for FY 2018/2019
WASH corners.
m
Population Women’s Health Project (WHP) Province: 1, 2, 3, 4, 5 & Total allocated Office address:
Services 7 budget of all Pulchowk, Krishnagali,
International  Improve knowledge and access to Long Acting District number: 30 programs activities: Lalitpur, Nepal
t at
Nepal (PSI Nepal) Reversible Contraception (LARC) and Safe

abortion Services through private and public US $3,965,796 Tel: 5553190. 5550620
sector: Provider training, onsite quality
assurance, distribution of commodities and Total expenses of all Fax: 5550619
equipment, and information sharing through programs activities:
t
community level mobilization and mass media. Email: info@psi.org.np

US $3,635,712
Adolescent Youth Project (AYP) Province: 5, 7 Web:www.psi.org
District number: 7
 Increase knowledge and use of family planning
products and services among adolescents and Province: 6
youth (15-24) from private sector service sites District number: 5
Health and Hygiene Activity (HHA)
 Support infection prevention at public facilities Total Province: 1, 2, 3, 4,

through provider behavior change related 6&7
activities and counseling for personal WASH
related hygiene behavior change among public District Number: 35 (7
facility clients. districts overlapping in
WHP and AYP)
FAIRMED
Foundation Nepal
1) Neglected Tropical Diseases District number: 3 Total allocated Office address:
budget of all FAIRMED Nepal, Kalika
2) Maternal and New Born Health (Kapilvastu, programs: Marg, Sanepa 2
Sindhupalchowk and Lalitpur, P O Box 10047
3) Health system strengthening, and behavior Baglung) US $509,778
change at community level Tel: 5013180
Total expenses of all
4) Disability Inclusiveness programs: Email:nepal@fairmed.ch

US $435,107 Web:www.fairmed.ch.
for FY 2018/2019
Nick Simons  Hospital Support Program - Rural Staff Support District number: 18 Total allocated Office address:
Foundation Program budget of all Box 8975, EPC 1813
International  Hospital Support Program - Rural Staff Support District number: 12 programs activities: Sanepa 2, Laltipur
(NSFI) Partnership Program US $ 3,396,420.00
 Hospital Support Program - Hospital District number: 77 Tel: 5520322, 5550318
Strengthening Management Program Total expenses of all Fax: 977-1-5554250
 Training (AAC, DBEE, MLP, SBA, ASBA, OTTM, programs activities: Email:
PEC) District number: 77 US $ 2,436,401.00 nrshrestha@nsi.edu.np
Web: nsi.edu.np

11.4 Non-Governmental Organizations
Budget for health
Organization Major program focus Geographical coverage sector for FY Contact details
2018/2019
NTAG - Nepali  Maternal and child nutrition  42 districts Total allocated Office address:
Technical Assistance (Suaahara-II) budget of all Ukti Marga, Maitighar,
Group  Multi-sectoral training to health  77 districts (NVA programs activities: Kathmandu, Nepal
workers, FCHVs and others Program) NRS. 101,316,364 GPO Box 7518
Tel: 977-1-4224884/
 Promotion and advocacy of  6 districts US $885,400 4223477/4221133
National Vitamin A Program  3 districts Total expenses of all Email:info@ntag.org.np/
 Research and surveys  Province # 2 and programs activities: deepakthapa@ntag.org.np
#6 NRS. 66,564,558 Web: http://www.ntag.org.np
US $581,705
m
Marie Stopes Sexual reproductive Health Static Center: 31 Total allocated budget Office address:
International  Family planning (static and Districts of all program Baluwatar, Kathmandu
t at
through implementing outreach services which includes activities: Tel: 01- 4419376
partner Sunaulo Parivar Steri Outreach:9 steri Fax: 01- 4420416
full range of FP methods)
Nepal team NPR 467,111,428
 Safe Abortion Services LARC Outreach: 13 Email:
 Training on reproductive health LARC team Total expenses of all Anne Lancelot
t
 Contraceptive social marketing program activities: anne.lancelot@mariestopes.org.np

Budget for health
3 82
2018/2019
m
 Adolescent Sexual Reproductive MS Ladies: 19 districts KP Upadhyay

Health NPR 448,919,597 kp.upadhyay@mariestopes. org.np
Web:www.mariestopes.org.np
t at
Nepal Red Cross Society  Preventive health(Major focused: District number:11 Total allocated Office address:
(NRCS) capacity building of community and budgetfor FY Nepal Red Cross Society, National
community based institutions through 2018/2019 of all Headquarters, Kalimati, Kathmandu,
RMNCAH, WASH,NCD, Community health programs: Nepal
BASED Health and First Aid)
t
 Curative health services(Major focused: District number: 77 US $ 2,860,289 Tel: +977 1 4270650
Eye health through Surkhet and Janaki Fax: +977 1 4271915
Eye CareHospitals, and nationwide Total expenses of all
Blood and Ambulance Services) programs activities: Email:umesh@nrcs.org /
 Emergency Health services (Major health@nrcs.org
focused: Red Cross Emergency District US $ 2288231.2
Clinic,Rural Emergency Trauma System number:77(Need based Web: www.nrcs.org
Strengthening, E-WASH and Emergency in emergency)
health preparedness and response
Family Planning  Integrated SRH services including District Number 33 Total allocated Office Address:
Association of Nepal sexuality counseling, contraceptives, budget of program Family Planning Association of Nepal
(FPAN) obstetrics, gynecological, STIs, HIV, safe activities Central Office, Pulchowk, Lalitpur
abortion and sexual/gender-based US $ 4461844 P. O. Box 486, Kathmandu, Nepal
violence.
 Comprehensive Sexuality District Number 33 Phone : 977-1-5010240, 977-1-
Education/Gender Equality and Total expenses of 5010104
Empowerment of Youth and Women. program activities Fax : 977-1-5010248
 Comprehensive abortion Care (Safe District Number 27 US $ 4350298 Email :fpandg@fpan.org.np
abortion Service). Website http://fpan.org
 Provide Minimum Initial Service
District Number 28
Package (MISP) in disaster effected
area.
Nepal Red Cross Society  Preventive health(Major focused: District number:11 Total allocated Office address:
(NRCS) capacity building of community and budgetfor of all Nepal Red Cross Society, National
community based institutions through health programs: Headquarters, Kalimati, Kathmandu,

RMNCAH, WASH,NCD, Community BASED Nepal
Budget for health
2018/2019
Health and First Aid) US $ 2,860,289
 Curative health services(Major focused: District number: 77 Tel: +977 1 4270650
Eye health through Surkhet and Janaki Total expenses of all Fax: +977 1 4271915
Eye CareHospitals, and nationwide Blood programs activities:
and Ambulance Services) Email:umesh@nrcs.org /
 Emergency Health services (Major District US $ 2288231.2 health@nrcs.org
focused: Red Cross Emergency number:77(Need based Web: www.nrcs.org
Clinic,Rural Emergency Trauma System in emergency)
Strengthening, E-WASH and Emergency
health preparedness and response

PHASE Nepal  Basic Essential Primary Health care. District:7 Total Expenses of all Office address:
 Maternal and Child Health District:7 programs activities: PHASE Nepal
 Community awareness program District:7 US $ 571,502.00 Dadhikot, Bhatkapur
 Traditional healers Training District:7 Tel: 016634038/89/11
Email: info@phasenepal.org
Web: www.phasenepal.org
Medic Mobile  Design, configuration and District number: 14 Total allocated Office address:
implementation of an open-source budget of all Medic Mobile Inc. Pvt Ltd.
mHealth toolkit for community-based programs activities: Chakupat, Lalitpur
maternal and child health care US $617,392
coordination. Use cases that are currently Tel: +977 9802024110
deployed in Nepal in partnership with Total expenses of all
m
municipalities and NGO partners include: programs activities: Email: nitin@medicmobile.org

a) Antenatal care US $528,021 www.medicmobile.org
b) Postnatal care
t at
c) MPDSR (in those districts where

Community based MPDSR has been
implemented)
3 83
t
Budget for health
2018/2019
m
Netherlands Leprosy NLR has adopted the three zero strategies Two provinces – Rs. 2,47,50,000 Himalaya Dev Sigdel
Relief (NLR Nepal) (zero transmission, zero disabilities, and Province no 1 and (225,000 USD Country Director
zero exclusion) as major pillars and set the Sudur Pachhim Pradesh Phone: 01 4784296
main targets of this project period. (23 districts) Mobile: 9846024430
t at
Both of these provinces email:

NLR focuses on; include both high and himalaya.sigdel@nlrnepal.org.np
1. Reducing disease burden due to low endemic districts in web: http://www.nlrnepal.org.np
leprosy, promotion & demonstration relation to burden of
on effectiveness of preventive disease caused by
t
measure in leprosy through PEP leprosy and disability.

interventions.
2. Disability prevention and
management.
3. Inclusive Development through
integrated approach.
The Leprosy Mission 1.Specialist tertiary care and technical Tertiary Care hospital in Total Expenditure for Country office address: Tikabhairab
Nepal support for leprosy/Lymphatic filariasis and Anandaban,Lele:1 all program activities Road, Satdobato,Lalitpur (977) 01-
disability control programs through for 2018: Nepali 5151371
Anandaban Hospital, Lele and Satellite Satellite clinics (2): Rs.212,142,438
Clinics. Biratnagar and Butwal Country Director:
2.Reconstructive surgery fixing leprosy Shovakhar Kandel
deformities, regenerative therapy (L-PRF), Partner’s sites: 3 Total Expenses for all E-mail: shovakhark@tlmnepal.org
complication (reaction and neuritis) districts (Banke, program activities for
management, (WHO) referral relapse Surkhet, Pokhara- 2019: NRs. Website:
confirmation, physiotherapy services and Green Pasture’s 182,166,300 www.tlmnepal.org
provides supportive appliances including Hospital)
orthosis/prosthesis
3. Internationally recognized clinical Self help groups: 18
research through Microbacterium districts
Laboratory in Anandaban Hospital and
social research activities through CBID and other
Community based Inclusive Development projects: Butwal,
projects Kapilvastu, Dhading,
4. Essential technical training on leprosy Banke,
and disability to global (Bangladesh, Sri Biratnagar,Morang,

Budget for health
2018/2019
Lanka, Netherlands, Mozambique etc.) and Sunsari, Rautahat,
national level governmental and non- Bare, Parsa, Chitwan,
governmental health professionals through Rupandehi, Bardiya,
Training Unit, Lele Lalitpur,Parasi, Morang,
5. Community based Inclusive Rupandehi and
Development (CBID) projects with a focus Kathmandu.
on economic empowerment, livelihood
support, stigma and discrimination
reduction and social integration of people
affected by leprosy, other disabilities and

marginalized people in several districts.
Handicap International Physical Rehabilitation Activity(PRA) All over Nepal with - Office address
specific focus on Handicap International
Karnali Pradesh 233 Sallaghari Marg, Bansbari,
Kathmandu.
Strengthening Health Sector Preparedness Bagmati Province: Total Budget:
and Response Capacity in Earthquake Dolakha, NPR.38,200,880 Contact person:
Affected and Disaster Prone Districts in Sindhupalchowk, Willy Bergogne
Nepal Rasuwa, Nuwakot and Total Expenses: Country Director
 Health and Rehabilitation Dhading NPR.41,701,088
 Health Sector Disaster Gandaki Province: Tel: +977-1-4374609 |
Preparedness Gorkha E-mail: info@nepal.hi.org
Province 5: Dang and W eb: www. hi. org
Banke
Sudurpashchim
m
Province: Dadeldhura
and Kailali
Task Shifting of Basic Physiotherapy and Province No. 2: Total Project Budget
t at
Rehabilitation Services Through Integration Dhanusha £.150,000

of Basic Physiotherapy Skills into Mid- Bagmati Province:
Level Providers Training for Paramedics in Dolakha and Dhading Total Expenses:
Nepal £.150,000
 Health and Rehabilitation
t
Budget for health
2018/2019
m
Facilitate for access of Women and Six of the most 2015 Total Project Budget
Children with Disabilities/Impairments to earthquake affected NPR.62754689.00
Healthcare and Social Protection districts:
t at
 Health and Rehabilitation Sindhupalchowk:

 Inclusive Livelihood Chautara Sangachokgadhi
 Inclusive Education Municipality
Dhading: Nilkantha
 Disaster Preparedness
Municipality
t
Dolakha: Bhimeswor
Municipality (Charikot)
and Jiri Municipality(Jiri)
Nuwakot: Bidur
Municipality
Rasuwa: Gosainkunda
Rural Municipality
Gorkha: Gorkha
Municipality
EDPs, INGOs and NGOs

ANNEXES

a i a i ti

a i a i ti
ANNEX 1 Major activities carried out in FY 2075/76
Family Welfare Division Immunization and Child health sections program activities:
SN Activities Unit Targets Achieved %
1 Provincial level ToT about National immunization program No. of 7 7 100
and micro planning for EPI focal person and health worker. times
2 FIPV launching and starting in routine immunization No. of 1 1 100

times
3 Training about Importance Child health Card/Immunization No. of 1 1 100
card and its retentioin times
4 Workshop to review and update injection safety policy, No. of 1 1 100
Multi-dose Vial vaccine policy, school td, Rota Vaccine Usage times
guideline, vaccine disposal policy and cod chain policy, DQSA
Guideline
6 Training about "Khop Kit Bag "and its guideline to No. of 2 2 100
immunization focal person of province and palika level. times
7 Planned and announced for MR-SIA campaign . No. of 1 1 100
times
Produced and supplied full immunization certificate No. of 1 100
8 according to the immunization Act.. times
9 Conduction of Outbreak Response Immunization in major No. of 1 1 100
measles outbreak area times
10 Advocacy meeting about sustainable Immunization times 1 1 100
Programme with the members of the parliament, Policy
makers, private sectors and civil society
11 Certification of Rubella and Congenital Rubella syndrome No. of 1 1 100
control by WHO SEARO. times
12 Ventilator tranining for staff working in NICU No. of 3
times
13 Provincial level workshop on CBIMNCI program Orientation No. of 7 7 100
and planning times
14 Facility based IMNCI training to health workers of district No. of 4 5 120
hospital times
15 NePeriQIP onsite mentoring for programmed implemented No. of 3 3 100
hospital times
16 SNCU level 2 training for Medical officer and No. of 7 7 100
paramedics/nursing times
17 FBIMNCI training to Medical officer No. of 3 3 100
times
18 Work shop about Early Childhood Development No. of 1 1 100
times
19 Workshop with TU/CTEVT/PU/ curriculum committee about No. of 1 1 100
inclusion and revised CBIMNCI/FBIMNCI content in times
respected curriculum
IMNCI Program
S.No. Activities Unit Targeted Completed %
1 Comprehensive Newborn Care (Level II) Training for batches 6 5 83
Medical Officers
2 FBIMNCI Training for Medical Officers batches 3 3 100
3 FBIMNCI Training for Nursing staffs and Paramedics batches 6 6 100
4 Ventilator training for NICU staffs batches 3 0 0
5 CBIMNCI related guideline revision times 1 1 100

a i a i ti
6 Workshop with curriculum development center to times 1 1 100
include/ revise IMNCI protocol
7 Early Childhood Development Workshop times 1 1 100
8 CBIMNCI orientation and planning to provinces times 7 0 0
9 Free Newborn Care Program Times 1 1 100
10 Development of IMNCI Training Manuals (Guidelines, Times 1 1 100
Handbooks etc.)
11 Quality Improvement Mentorship Times 20 0 0
12 Procurement of CBIMNCI medicines Times 1 1 100
13 Procurement of SNCU/ NICU equipment Times 1 1 100
14 Monitoring and supervision Times - - 100
Nutrition
1 National Nutrition Review, Advocacy and workshop with No. of 1 1 100
participation of health workers and allied representatives of times
all provinces
2 Regular operation of nutrition technical committee (NUTEC) No. of 1 1 100
meeting (SUAAHARA 1) times
3 Operation of Nutrition Rehabilitation Home for management No. of 1 1 100
of malnourished children (through 8 hospitals: Bheri, Seti, times
Mahakali, Dhaulagiri, Lumbini Zonal Hospital, Rapti Sub
Regional, MP Surkhet and Kanti Children Hospital).
4 Formation of Province level Multi-sector nutrition and food batch 1 0 -
security steering committee and training, orientation to the
stakeholders on it
5 Update on National nutrition policy (as per data of National No. of 1 1 100
micronutrient survey status) times
6 Review of Multi-Sector Nutrition Program (15 District - No. of 1 1 100
Taplejung, Sankhuwasabha, Solukhumbu, Bhojpur, Dolakha, times
Sindhupalchok, Rasuwa, Rupandehi, Nawalparasi, Gorkha,
Lamjung, Syangja, Myagdi, Baglung and Nuwakot)
7 Training to social development/Administrative officer and No. of 1 1 100
local health cordinator (15 District - Taplejung, times
Sankhuwasabha, Solukhumbu, Bhojpur, Dolakha,
Sindhupalchok, Rasuwa, Rupandehi, Nawalparasi, Gorkha,
Lamjung, Lamjung, and Njungu).
8 Nutrition lobby program(Breastfeeding, up to 6 weeks No. of 1 1 100
maternal safety benefits, etc.) times
9 Training and Monitoring to Center-level concerned No. of 1 1 100
Government, Inspectors, private sector stakeholders times
regarding the sale and distribution of breast milk substitute
act
10 Guideline preparation, updating and printing No. of 1 1 100
National Guidelines on Nutrition Fortification, Child times
Nutrition Week, Nutrition Campaign, Day and Special
Programs and School Health and Nutrition, Adolescent
Nutrition Guideline
11 Comprehensive Nutrition Specific Intervention package and No. of 1 1 100
integrated nutrition-related behavior change communication times
and training materials, guideline preparation, printing and
distribution
(UNICEF)
12 Training of trainers for Comprehensive Nutrition Specific No. of 1 1 100
Intervention (IYCF-MNP, IMAM, Adolescent IFA, SBCC etc.) - times
Center level

a i a i ti
13 Monitoring and Supervision of Nutrition Program No. of 1 1 100

times
14 Capacity building for nutrition related stakeholders regarding No. of 1 1 100
disaster risk reduction times
Family Planning
1 Family Planning (FP) current users Couple 3010000 2505645 83
2 VSC expected new acceptors Couple 42300 27150 64
3 IUCD expected new acceptors Couple 48000 22615 47
4 Implant expected new acceptors Couple 95000 100896 100
5 FP program strengthening through DMT, EC, MEC wheel District 15 13 87
6 Micro-planning and response actions implementation in District 3 3 100
low CPR districts
7 Support to satellite clinic for LARC methods Time 306 306 100
Printing of DMT, MEC WHEEL, Time 3 3 100
PARTOGRAPH
10 Support to Institutional Clinic District 24 24 100
Epidemiology and Disease Control Division of all sections program activities:

Annual
SN Activity Unit Achieve %
Target
Epidemic Disease Control
HR and travel costs for Health team of 4 including 2
1 No. of times 1 1 100
doctors at Tribhuwan International Airport
2 Hiring of staff for official work on agreement No. of times 1 1 100
Cost for RRT mobilization and intra sect oral coordination
for outbreak control and disaster management
Supervision and monitoring for prep Preparedness of
4 No of times 3 3 100
disaster management activities
Monitoring of food quality of restaurants located in
highway
Planning meeting at regional level on vector borne
6 disease control, disaster and epidemic and surveillance No of times 5 5 100
activities.
7 Emergency preparedness plan meeting for hospital No. of times 3 3 100
Orientation to health workers on scrub typhus, malaria,
kalaazar including other vector borne diseases
Interaction program and health message promotion
regarding cold and its effects in Terai areas
Interaction program with related stakeholders on effect
10 and management of radio nuclear and biochemical No. of times 1 1 100
disaster
11 Purchase of RRT deployment kits No. of times 1 1 100
purchase and deployment of medicine and necessary
12 equipment for epidemic and disaster management in No of times 1 1 100
related district
13 Purchase of diphtheria antitoxin, ARV and other vaccine No. of times 1 1 100
Activities to manage sickle cell anemia in affected
14 No. of times 1 1 100
districts
1 day regional level interaction program to RHD, chiefs of
Medical Colleges, chiefs of Regional/Sub-Regional/Zonal
15 No. of times 1 1 100
Hospitals, NPHL, directors of various divisions of DoHS
on sickle cell anemia and thalassemia

a i a i ti
Annual
Target
Various activities to strengthen the implementation of
IHR
Form Highway RRT to rescue the casualties in accidents
17 in major highways, orient the highway RRT and prepare No of times 1 1 100
Highway RRT mobilization guidelines
Malaria control
1 Evaluation of surveillance conducted by EDCD No. of times 1 1 100
2 Conduct annual national review meetings No. of times 1 1 100
Capacity Building orientation for medical recorders of
3 new and existing sentinel sites and people from EDCD to No. of times 1 1 100
strengthening the reporting system
Quality control of 5000 pcs of malaria slides at central
4 level & monitoring of the blood slide samples examined No of times 12 10 83
at districts for quality assurance
Multi-sector advocacy meetings at national levels to
secure support for Malaria elimination
6 Strengthen Malaria technical working group (TWG) No. of times 3 3 100
VAT and other tax for GF/SCI funded capital items and
activities
Procurement of Insecticide for Indoor residual spraying
for malaria control in endemic districts
9 Procurement of LLIN for malaria endemic districts No. of piece 1 1 100
Procurement of medicines and medical goods for malaria
10 No. of times 1 1 100
diagnosis and control
Procurement and supply of spare parts for Hudson pump
repairmen
12 Procurement of microscopy for diagnosis of malaria 1 1 100
Kala azar control
1 National review meeting on Kalaazar No. of times 1 1 100
Orientation to medical college, private hospitals,
2 teaching hospitals on treatment procedure and on active No. of times 1 1 100
case detection orientation to district with kalaazar case.
Case base surveillance and active case finding of Kala-
azar in districts
Procurement and supply of medicines and medical goods
for Kala-azar control
Procurement of Insecticide for Indoor residual spraying
in Kala-azar affected districts
Natural disaster management
Orient RRT on RH promotion in emergency and natural
1 disaster for preparation of district level contingency No. of times 4 4 100
planning
Lymphatic Filariasis elimination
1 Printing of IEC material for LF program No. of times 1 1 100
2 Surveillance of LF No. of times 1 1 100
Technical support from central level to districts regions
in LF elimination programme
4 preparation of documentary on LF No of times 1 1 100
Technical & financial support by LSTM/DFID in LF
elimination

a i a i ti
Annual
Target
Financial and technical support from RTI/USAID on LF
elimination
7 Procurement of DEC Tablet for LF MDA No of Piece 1 1 100
Zoonotic Disease
Surveillance in districts having zoonotic disease
outbreaks
Orientation to the medical officers and paramedics on
2 rational use of ARV and case management of dog bites No. of times 5 5 100
and poisonous snakebites
Training and orientation to health workers regarding
snake bites
Procurement and supply of ASVS for around 2000
4 No of item 1 1 100
persons to districts
Procurement of ARV (Cell culture vaccine) for approx
5 No of item 1 1 100
50,000 persons.
Dengue Control
Orientation on Dengue and chikungunya fever and
mosquito larva search and destroy campaign
2 National review meeting on dengue No. of times 1 1 100
Orientation to medical college, private hospitals,
teaching hospitals on management of dengue case
Procurement of RDT including G6PD for diagnosis of
vector borne diseases
Disease Surveillance and EWARS
Orientation on EWARS to doctors, health workers and
medical recorders of sentinel sites
Technical review on EWARS for medical recorders of
sentinel sites
3 Revision of EWARS guideline 2009 No. of times 1 1 100
Evaluation of different disease surveillance activities
being conducted by EDCD
Water quality surveillance
Preparation of documentary for activities conducted
according to Surveillance guideline 2070
2 Workshop on water safety surveillance at Provincial level No of times 5 5 100
Leprosy Control and Disability Management Section program activities:

Annual
Target
1 Purchase of dermatoscope and camera Set 2 2 100
2 Contract of driver and office Assistant Persons 2 2 100
Cooperation with Ayurveda & other medical system for leprosy
3 Times 1 1 100
control program
Coordination meeting of Steering, Technical and coordination
4 Times 3 3 100
committees with leprosy and disability related partners
5 Celebration of World Leprosy Day Times 1 1 100
Printing of annual report, program implementation guideline
6 Times 4 4 100
and bulletins
7 Technical monitoring and case validation Times 10 10 100
8 Trimester review meeting Times 2 2 100

a i a i ti
Annual
Target
Strengthening & monitoring of Prevention of Impairment and
9 Times 7 7 100
Disability (POID)
10 Surveillance for leprosy and disability prevention Times 2 2 100
11 In depth review of national leprosy program Times 1 1 100
Leprosy orientation for health workers of mini leprosy
12 Times 24 16 66
elimination campaign and skin camp.
Conduct reconstructive surgery camp in coordination with
13 Times 5 5 100
supporting partners.
14 Transportation for the distribution/management of MDT Times 3 3 100
Grant to National Disable Fund ( Purchase and distribution of
15 Times 1 1 100
assistive devices)
16 Cooperative grant for national seminar of dermatologists Times 1 1 100
17 Grant for leprosy affected of KhokanaArogya Ashram Times 3 3 100
Nursing and Social Security Division of all Sections program activities:

S.N. Activities Unit Targets Achieve %
1. Bi-Annual FCHV Review District 77 77 100.00
district
2 Provincial level Health Orientation for Cooperative Times 7 7 100.00
representatives and it’s members Provinces
3 Provision of free treatment to impoverished citizens as Times 3 0 0
“Bipanna Nagrik Aaushadi Programme”, release of budget
as per quarterly
4 Provision of free treatment to “Jaan Andolan Gaite” Times 3 Budget 100.00
citizens, release of budget as per quarterly released
as per in
3 quarter
Source: NSSD, DoHS
Curative Service Division of all sections program activities:

1. NCD program MTOT Places 1 1 50
2. Social Audit TOT Times 1 1 100
Conduct reconstructive surgery camp in coordination with
3. Times 7 7 100
supporting partners in the Centre and province level
Coordination meeting of Steering, Technical and
4. coordination committees with leprosy and disability related Times 3 3 100
partners
5. Mental Health TOT Times 1 1 100
6. Celebration of World Leprosy Day Times 1 1 100
7. Surveillance for leprosy and disability prevention Times 2 0 0
8. Peer group Discussion for STP Times 1 1 100
Strengthening & monitoring of Prevention of Impairment
9. Times 5 4 80
and Disability (POID)
10. Monitoring and technical support for disability programs Times 15 12 80
Development and distribution of disability related IEC
11. Times 1 1 100
materials
Preparation, printing and distribution National Guideline on
12. Times 1 1 100
disability & rehabilitation
13. National Workshop on Disability Management Times 1 1 100
14. Technical monitoring and case validation Places 10 10 100
15. Continue medical education for doctors on leprosy program Times 2 2 100
16. Purchase of drugs for leprosy complication management Times 1 1 100

a i a i ti
17. Program monitoring and supervision Places 10 10 100
17.Grant
Program monitoringofand
for strengthening supervision
referral Centre for specialized Places 10 10 100
18. Grant for strengthening of referral Centre for specialized Places 3 3 100
18.service Places 3 3 100
service
 Curative Service Division renewed 60 hospitals of 51-100 Bedded
 Curative Service Division renewed 60 hospitals of 51-100 Bedded
National Tuberculosis Control Center program activities:
Achieved Achieved
SNSN Activities
Activities Unit Target
Unit Achievement
Target %
Achievement %
Procuremet of equipments for Cultrue
1 1 Procuremet of equipments for CultrueDST labDST
expansion
lab expansion Pieces Pieces3 3 2 266.67 66.67
2 2 Procuremnet of GeneXpert
Procuremnet machine
of GeneXpert machine Pieces Pieces
18 18 13 1372.22 72.22
Construction
3 3 Construction of Chest
of Chest Hospital
Hospital percent percent
60 60 60 100.00
60 100.00
Procuremnet of Equipment for Prevalance
4 4 Procuremnet of Equipment for Prevalance SurveySurvey Pieces Pieces1 1 1 1100.00 100.00
PME workshop of NTP at national
level level Times Times3 3 33.33
5 5 PME workshop of NTP at national 1 133.33
Basic ZN MicroscpoyTraininng
6 6 Basic ZN MicroscpoyTraininng Times Times4 4
4 4100.00 100.00
7 Procurement of N95 Mask and personelproctectionutilitise Pieces 11044 3000 27.16

7 Procurement of N95 Mask and personelproctectionutilitise Pieces 11044 3000 27.16
8 Nutritional support to MDR patients person 60 12 20.00
8 Nutritional support to MDR patients person 60 12 20.00
9 Cultrue DST lab Training Times 1 1 100.00
9 Cultrue DST lab Training Times 1
3 1
100.00
10 Supply ofTB Drug to Medical Store and District Times 3 100.00
10 Supply ofTB Drug to Medical Store and District
Broadcasting of TB Related message by National level Television
Times
Times
3
200
3 100.00
50.00
11 100
1112 Broadcasting of TB Related message by National level Television
Revision of Guideline and Recording and Reporting form
Times Times
200 2 100
50.00
2 100.00
1213 Revision of Guideline and
Commomeration Recording
of World and Reporting form
TB day Times Times2 1 2 1100.00 100.00
1314 Commomeration of World
Conditional grant TB day Chest hospital
to Kalimati Times Times1 3 1 3100.00 100.00
Procurement
14 Conditional grant of
to Consumable
Kalimati Chestand Chemical for sputum
hospital Times Times3 100.00
1 3 100.00
15 Microscopy 1
Procurement of Consumable and Chemical for sputum
Procurement of Second Line Drug Times Times1 1 1100.00 100.00
1516 Microscopy 1
Procurement of Falcon Tube
1617 Procurement of Second Line Drug Times Times1 1
1 1100.00 100.00
18 Precurement of HR for National Referance Laboratory Times 6 6 100.00
17 Procurement of Falcon Tube Times 1 1 100.00
19 GeneXpert Management Training Times 9 6 66.67
18 Precurement of HR for National Referance Laboratory Times 6 6 100.00
20 Procurement of Consumable and Chemical for C/DST Times 1 1 100.00
19 GeneXpert Management Training Times 9
1200 6
66.67
21 Procurement of Digital Xray Film Pieces 1600 133.33
20 Procurement of Consumable and Chemical for C/DST
Internet Installation to DR/GeneXpert Center
Times 1
Institut 60
1 100.00
38.33
22 23
21 Procurement of Digital Xray Film Pieces 1200 1600 133.33
23 Procurement of First Line Drug TB Times 1 1 100.00
2224 Internet Installation
LQS Training to DR/GeneXpert
to Lab Personnel Center Institut Times
60 4 23 4
38.33 100.00
2325 Procurement of First Line Drug
Clinical Management TB to Medical Officer
Trainig Times Times1 5 1 3100.00 60.00
2426 LQSProcurement
Training to Lab
ofPersonnel
Cartidge for GeneXpert Machine Times Pieces4 470004 100.00
21500 45.74
2526 Clinical Management
Transportation Trainig
ofTB Drugtoto
Medical Officer
Medical store and District StoreTimes Times5 20 3 2060.00 100.00
2628 Procurement of Cartidge
Courier service for GeneXpert
for Culture Machine
/DST test Pieces Times
47000 5000
21500 45.74
3150 63.00
Supervision to TB Teatmet Center Times Times 90 20 66.67
2629 Transportation ofTB Drug to Medical store and District Store 20 60
100.00
30 Precurement of Liquid media Times 1 1 100.00
28 Courier service for Culture /DST test Times 5000 3150 63.00
31 Intraction with Stakeholder on TB Program Times 10 2 20.00
29 Supervision to TB Teatmet Center Times 90 60 66.67
32 TB Program monotoring from Province Times 30 30 100.00
30 Precurement of Liquid media
National PME workshop on TB Program
Times
Times
1
2 1
100.00
50.00
33 1
3134 Intraction with Stakeholder
DR TB Basic Training on TB Program Times Times
10 4 2 20.00
1 25.00
32 TB Program monotoring from Province Times 30 30 100.00
33 National PME workshop on TB Program Times 2 1 50.00
34 DR TB Basic Training Times 4 1 25.00

a i a i ti
National AIDS and STI Control Center program activities:
SN Activities Unit Targets Achievement %
1 Procurement of viral load machine, reagents Time
1/2 50
and accessories 1
2 IBBS study among male labor migrants event
1 0 0
throughout the country
3 DHIS -2 tracker training to ART counselor lot 2 2 100
4 Early warning indicator workshop for capacity lot
0 0
building to ART counselor 2
5 Procurement of HIV test kits event 1 1 100
6 Procurement of the ART drugs event 1 1 100
7 Procurement of STI/OIs drugs event 1 1 100
8 Procurement of nutrition pitho event 1 0 0
9 Procurement of the CD4 reagents event 1 1 100
10 Capacity building training on HIV recording and lot
1 100
reporting to ART counselor 1
11 HIV guideline update and print event 1 0 0
12 AIDS conference event 1 0 0
13 PMTCT guideline update and print event 1 1 100
14 STI syndromic case management training lot 4 4 100
15 Training to medical officer on Hepatitis c lot 1 0 0
16 CMT training manual print event 1 0 0
17 DHIS-2 strengthening training lot 1 1 100
18 AIDS day celebration event 1 1 100
19 CMT training to MO, and ART counselor lot 3 3 100
20 Meta analysis on MSM/TG event 1 1 100
21 Meta analysis on PWIDs event 1 1 100
22 Logistic data review lot 1 1 100
23 PMTCT TOT lot 3 3 100
24 Monitoring and supervision for HIV program event 12 12 100
Source: NCASC
National Health Training Center program activities:

1 Pediatric Nursing Care Training Person 70 73 104
2 X-ray User Maintenance Training Person 10 10 100
3 Anesthesia Assistant Training (HA, SN) Person 10 10 100
4 Palliative Care Training (Doctors, Nurses) Person 58 67 115
5 Induction Training for newly appointed health officers Person 160 180 112
6 Medico-legal Training (Doctors) Person 100 75 75
7 Safe Abortion Training Person 40 39 97.5
8 Basic IUCD Training Person 30 30 100
9 Transaction Accounting and Budget Control System Training Person 100 40 40
10 Screening of pre-cancer/lesion VIA/CRAYO for HW training Person 50 51 102
11 Gender Based Violence Training for Health Service Providers Person 100 100 100
12 Lab users maintenance Training Person 10 10 100
13 Cold chain users maintenance training Person 10 10 100
14 ICU training (nurses) Person 30 30 100
15 Trainer's review and refresher meetings Batch 5 5 100
16 Mental Health training for MO/HA( Prescriber) Person 25 25 100
17 Training Need Assessment (TNA) Batch 5 5 100
18 Trainer's pool preparation for different training Batch 5 5 100
19 TOT for Infection prevention and control (central and Person 25 42 168
provincial)
20 CTS Training Person 32 50 156

a i a i ti
21 Operation Theater Technique and Management(OTTM) Person 40 33 83
(nurse)
22 Diploma Training in Biomedical 24 and continuation of Person 48 48 100
2073/74 (24)
23 Rural Ultrasound training (SN) Batch 3 3 100
24 SBA Person 100 117 117
25 NICU management training (MO, SN) level 2 Person 50 52 104
26 ASBA Training Person 20 16 80
27 PPIUCD Training (Nursing staff) Person 20 31 155
28 NSV Self Paced Learning Approach Person 10 0 0
29 Vasectomy Training (MO, Group wise) 12+5 days Person 50 46 92
30 Minilab Training (MO/SN) 12 / 5 days Person 60 48 80
31 Implant Training (Nursing staff / paramedics) Person 100 90 90
32 CoFP (FP service provider) Person 48 51 106
33 ASRH Training Person 90 95 105
34 Printing training materials of different training Times 6 6 100
35 Transportation of training materials of different training in Times 5 5 100
training sites
36 Follow up Enhancement Program Times 7 5 71
37 Training materials development and revision Times 10 15 150
38 To Ton NCDs (PEN Package) for MO/HW Person 75 124 165
National Health Education Information and Communication Center program activities:

1 Communication program for Control of risk factors of NCDs times 12578 7270 58
including tobacco control
2 Health promotion program’s national commitment message times 2250 2250 100
dissemination on Merobarsha pratibaddhata; swasthya prati
jimmewar : samriddhiko aadhar
3 Communication program and daily monitoring of newspaper times 4500 4500 100
about epidemic disease control and prevention.
4 Broadcasting of Jeevan chakra and public health debate times 820 820 100
through NTV.
5 Airing of health messages and public health radio program times 2032 2032 100
through Radio Nepal
6 Continuation and implementation of Health news desks times 1 1 100
7 Conduction of health literacy campaign program times 10 10 100
8 Dissemination of messages and information through popular times 30 30 100
online media
9 Publication of health related messages and notices through times 35 35 100
national newspapers
10 SMS, Apps and IVR services through information technology times 3 1 33
center
11 IEC/BCC material development technical assistance, times 1000 10 1
coordination, supervision and template development and
distribution in provincial and local level
12 Awareness communication program for FP, SM and neonatal times 50000 50000 100
health
13 Awareness and orientation package development on anti- times 7000 5775 83
microbial resistance
14 Communication programme on child health nutrition promotion times 5000 4996 100
15 Dissemination of public health messages through nepal television times 865 570 66
and radio nepal during epidemic outbreak and disaster.
16 Risk communication program during epidemic outbreak and times 1000 986 99
disaster.

a i a i ti
17 Production and dissemination of maternal service communication times 100000 97935 98

program
18 Health promotion brain death, kidney and organ donation related times 6000 4969 83
communication program with the coordination of organ transplant
centre.
19 Health awareness and communication program on mental health times 3000 3000 100
and birth defect
20 Broadcasting of health messages and information through national times 2300 2300 100
private televisions
21 Hiring of communication officer, secretariat assistant and driver times 3 3 100
for golden 1000 days promotion program.
22 Communication program for golden 1000 days promotion. times 5000 4767 95
23 Supervision and facilitation of health promotion program in times 139 114 82
provincial and local level
National Public Health Laboratory program activities:

1. Procurement of Real Time PCR machine for Non- Piece 1 1 100
communicable diseases
2. Procurement of barcode machine and PVC card printer Piece 2 2 0
3. Construction of waiting room for patients Site 1 1 96.88
4. Procurement of server for National Blood Program software Piece 1 1 49.5
5. Procurement of fully automated biochemistry analyzer and Piece 2 2 76.46

haematology analyzer machine
6. Procurement of equipment for establishment of molecular Piece 1 1 75.37
bacteriology lab
7. Training on equipment application for equipment Person 30 30 96.58
distribution those were procured on FY 2074/75
8. Hiring microbiologists to operate regional based labs in Person 5 20 96.33
Koshi, Janakpur, Seti, Bheri and Pokhara
9. Training on bacteriology for Medical laboratory Technicians person 20 20 98.43
to operate bacteriology lab in District Hospitals.
10. Quality control management for all laboratories and BTSCs number 3 3 99.96
in Nepal.
11. Procurement of equipments and kits chemicals for National time 3 3 99.71
Influenza Centre
12. Publication of guidelines and brochures Time 1 1 91.76
13. Development of Health Laboratory Registry System software Time 1 1 88.14
14. Accreditation of laboratory time 1 1 34.49
15. Barcode management for laboratory service security and Piece 3 3 44.28
quality
16. Transportation of laboratory related equipment and Piece 3 3 100
chemicals to Health Post, District Hospitals, Zonal Hospital
and Regional and Sub-regional Hospitals
17. Training program on accreditation related biosafety and time 3 3 47.28
biosecurity for laboratory staffs
18. ToT training on operating specialized laboratory services for Person 14 14 99.67
Provincial Laboratory based staffs
19. Operation of diagnostic services in epidemic situation Time 3 3 93.34

a i a i ti
20. Operation expenses for NBBTS and for quality improvement time 3 3 97.99
in blood transfusion services
21. Research programs in NPHL time 3 3 56.27
22. Participation of International Quality Control Program Time 3 3 61.89
23. Management of sickle cell disease surveillance Time 3 3 95.89
24. Monitoring and evaluation of government based hospitals, Times 600 600 99.85
private hospitals and blood transfusion service centres
25. SMO contract of Medical Lab Technologist for sickle cell Time 5 5 87.22
program in Koshi, Lumbini, Seti, Bheri Hospitals and NPHL
26. Viral load test for Hep B and C Time 3 3 100
Management Division of all Sections program activities:

1 Repair and maintenance of physical infrastructure under the Times 8 8 100
department of health services
2 Arrangements of spare parts not listed in repair and Times 3 3 100
maintenance of tools and equipment as per the need
3 Repair and maintenance of Medical and cold chain tools Times 3 3 100
and equipment including reimbursement of remaining
expenses
4 Human resource Management: Store Assistant- 2, Civil and Person 16 16 100
Mechanical Enginee-r 2, Data Analyst- 1, Office Assistant- 3,
Computer Assistant -1, Driver -4, Sweeper (part-time) - 3
5 Human Resource Management for PAM Unit, 9-Biomedical Person 10 10 100
Engineers and 1-Public Health Officer
6 Financial administration and Irrugulatation including Times 2 2 100
conduction of staff capacity building programs
7 Monitoring and supervision of repair and maintenance of Times 3 3 100
tools and instruments/equipment by biomedical engineer
and PAM unit
8 Inquiry and admission into the hospitals for treatment of Times 3 3 100
injured in people's movement
9 Follow-up and monitoring of minimum service standards of Times 3 3 100
district level hospital and mutual fund matching
10 Development and modification including publication of new Times 3 3 100
policies, rules, directives and other documents
11 Monitoring, inspection and interaction with private, Times 3 3 100
government as well as non-government hospitals
12 Central level assistance and coordination visit to state and Times 3 3 100
local level review meetings
13 Package development and follow-up for oral health care Times 3 3 100
services under PHC settings
14 Basic / Refresher Training of Medical Recording related to Times 1 1 100
ICD-10
15 Printing of annual report of the DoHS, HMIS records, reports, Times 3 3 100
monitoring forms and monitoring booklets as well as
reimbursement of past dues.
16 Expenses for conduction of coordination meetings with Times 15 15 100
committees , divisions and sections as specified by different
directives

a i a i ti
17 Conduction of activties related to federal, provincial and Times 3 3 100
local level throgh PPP model
18 Training including material development related to Server Times 3 3 100
Management, DHIS 2, HMIS, PHAT
19 Monthly, bi-monthly and quarterly review and planning Times 3 3 100
activities of the Department of Health Services
20 Integrated supervision of health care programs Times 200 200 100
21 Fund availability and reimbursement of remaining dues of Times 3 3 100
last FY to listed hospitals to provide services for poor citizen

g am a g t
Annex 2: Program Targets for FY 2076/77
Family Welfare Division: (1) Child Health and Immunization section program activities:
SN Activities Unit Target
1 MR Guidelines and IEC materials preparation and printing times 1
2 Procurement of vaccine and vaccine related materials, Vaccine carrier, icepack, times 1
refrigerator, cold box,
3 Advocacy meeting about sustainable financial management of Immunization times 1
Programme with the members of the parliament, Policy makers, bankers,
industrialist, businessman, private sectors and civil society
4 Provincial level ToT about National immunization program and micro planning for Batch 7
EPI focal person and health worker.
5 1 days orientation to media person about NIP and AEFI central and province times 2
6 MR campaign Launching times 1
7 High level personal and media orientation about MR campaign on central level times 1
8 Development of immunization fund for sustainable immunization program times 1
9 DQSA training for Low coverage and high dropout districts times 1
10 Briefing High level officers, MoHP and national Immun. Committee, Stake batch 1
holders and partners about Rota vaccine and hygiene promotion program
introduction
11 Rota vaccine and hygiene promotion program launching times 1
12 2 days orientation to Medical officer, Medias and paediatrician about A.E.F.I in all batch 13
province
13 Media, Doctors, trade union and health workers Orientation about MR Campaign batch 7
2076 to all 7 province
14 4 days Health workers training for private institutions/palikas ( 200 no.) about batch 8
NIP, immunization session management ,EVM and vaccine and cold
management.
15 Orientation training on utilization and retention of Child health card/ Full batch 2
immunization card for some districts of province 3 and 2.
16 Introduction of HPV vaccine times 1
17 KMC strategy and guidelines Preparation times 1
18 KMC corner establishment Place 5
19 IMNCI RDQA Training
20 FBIMNCI Training batch 3
21 SNCU training for Medical Officer batch 9
22 SNCU reporting recording training batch 7
23 TOT on POCQI times 1
24 Early Child hood Development workshop times 1
25 Research on New born and Child health times 1
Family Welfare Division: (2) Nutrition section program activities:

SN Activities Unit Targets
1 National Nutrition Program Review (Two Days) – with participation of Nutrition No. of 3
Representative of all provinces times
2 Two-day capacity enhancement program of staff employed in the nutrition No. of 1
rehabilitation house times
3 Review and plan formulation of Multi-Sector Nutrition and Food security No. of 1
Directive Committee and stake holders All provinces times
4 MToT on Comprehensive Nutrition Specific Intervention package for Health No. of 9
Cordinator and Focal person of Social Development Ministry Basic Health times
Nutrition Package (18 District-Taplejung, Bhojpur, Sangja, Magdie, Palpa,
Rupandehi, Gulmi, Arghakhanchi, Banke, Puthanjan, Dang, Salan, Kailali, etc.)
5 MToT on Comprehensive Nutrition Specific Intervention package for Health No. of 15

g am a g t
Cordinator of 30 MSNP districts times
6 capacity building with concerned stakeholders on the sale and distribution of times 6
breast milk products.
7 Celebrate National Day / Month on nutrition related Programs (Breastfeeding No. of 4
Week, School Health and Nutrition Week, Iodine Month etc.) times
8 Preparation, refinement and printing of training directory for nutrition programs, No. of 1
preparation, modification and updating of micronutrient guidelines based on times
nutrition strategies.
9 Monitoring and Supervision of Nutrition Programs times 2
10 Orientation, capacity building and Planning of Disaster Risk Reduction batch 1
11 Operation of Nutrition Rehabilitation Home for malnutrition management No. of 1
(through hospital: Bheri, Koshi, Narayani, Bharatpur, Sagarmatha, Pokhara Health times
Sciences Foundation, Rapti Health Sciences Academy, Dadeldhura Hospital and
Kanti Children Hospital).
12 Purchase of Laptop and LCD for Nutriton Section times 1
13 Purchase and distribution of nutritional materials (Vit A, RUTF / RUSF, f75, F100, No. of 1
Resomal, Albendazole, MNP, Rapid Test Kit, Height / weight Machine, Shakir's times
Tape (MUAC), dummy baby and mother for breast feeding)
14 Orientation to social development Ministers team about nutrition program and No. of 1
intervention to all provinces times
15 Mother Baby Friendly Hospital (MBFHI)- 5 hospital times 1
16 Program for the Health and Education Parliamentary Committee for No. of 1
breastfeeding / nutrition promotion times
17 Production and promotion of audio-visual material to enhance nutritional No. of 1
capacity of health workers times
Family Welfare Division :(3) Newborn and IMNCI program activities:

1 Procurement of equipment for CBIMNCI program times 1
2 Procurement of SNCU/ NICU equipment times 1
3 Procurement of equipment for KMC units and KMC corners times 1
4 Development of Prematurity ( KMC) Guideline times 1
5 Development of FBIMNCI/ Newborn Coaching/ Mentoring Guideline times 1
6 Facility Based IMNCI (FB-IMNCI) ToT batch 3
7 Revision of national newborn health strategy and plans batch 2
8 FBIMNCI/Newborn Care Coaching/ Mentoring Training times 2
9 Development of Early Childhood Development Guideline times 1
10 Mentoring for SNCU/ NICU staffs times -
11 IMNCI Training for health workers in province and health offices times 7
12 Comprehensive Newborn Care (Level II) Training for MOs times 9
13 Free Newborn Care Program No. of Hosp 107
14 Research on Newborn and IMNCI related program times 2
15 ToT on Point of Care Quality Improvement (POCQI) batch 1
16 IMNCI Routine Data Quality Assessment (RDQA) ToT batch 1
Epidemiology and Disease Control program activities:

Annual
SN Activity Unit
Target
Establishment of health desk at international airport and strengthen existing
1 No. of times 1
health desk
2 Procurement of microscopy for diagnosis of malaria Quantity 11
3 Deployment of health worker team at Tribhuwan International Airport No. of times 3

g am a g t
Annual
SN Activity Unit
Target
4 Hiring of staff for official work on agreement No. of times 3
5 Conduct national annual review on Malaria, dendue and kalaazar No. of times 3
6 Conduct national workshop on free hydrocele surgery and planning meeting No. of times 1
conduction of orientation, review and planning meeting with provincial
7 No. of times 1
authorities and medical colleges on NCD and mental health
8 conduction of various activities based on IHR-2002 No of times 1
Review and revision of RRT, outbreak response and control of communicable
9 No of times 1
disease guideline based on federal context
Review and planning on zoonotic diseases focus on sankebite and rabies
10 No of times 1
treatment center.
11 Multisectoral workshop on Onehealth No of times 1
12 Mapping and prioritization of zoonotic diseases No of times 1
13 Formation of TWG on Zoonotic diseases and conduction of meetings No of times 1

orientation to different health institutions including medical colleges(doctors
14 No of times 1
and paramedics) for influenza management
preparation and demonstration to hospitals on epidemic disaster and
15 No of times 3
response
16 Review meeting on Early Warning and Reporting System (EWARS) No of times 2
17 Formation of TWG on EWARS and conduction of meetings No of times 1
18 Study and improvement on EWARS No of times 1
19 Integrated vector surveillance on malaria, kalaazar, dengue, JE etc No of times 3
20 Conduction of Mass Drug Administration (MDA) for Lymphatic Filarisis No of times 1

Interaction program with related stakeholders on effect and management of
21 No. of times 1
radio nuclear and biochemical disaster
22 Purchase of RRT deployment kits No. of times 1
23 Purchase of diphtheria antitoxin, ARV and other vaccine No. of times 1
24 Activities to manage sickle cell anemia in affected districts No. of times 1
Procurement of Insecticide for Indoor residual spraying for malaria control in
25 No. of times 1
endemic districts
26 Procurement of LLIN for malaria endemic districts No. of piece 1
Procurement of medicines and medical goods for malaria diagnosis and
27 No. of times 1
control
Technical support from central level to lower levels in LF elimination
28 No. of times 1
programme
29 Procurement of DEC Tablet for LF MDA No of Piece 1
30 Procurement and supply of ASVS for around 2000 persons to districts No of item 1
31 Procurement of ARV (Cell culture vaccine) for approx 50,000 persons. No of item 1
Leprosy Control and Disability Management activities:
Annual
SN Activity Unit
Target
1 Trimester review on leprosy Times 3

g am a g t
Annual
SN Activity Unit
Target
2 Transportation for the distribution/management of MDT Times 3
3 Celebration of World Leprosy Day Times 1
4 Printing of annual report, program implementation guideline and bulletins Times 4
Development of information system for disability, skin disease, injury and
5 Times 1
leprosy
6 Technical monitoring and case validation Times
7 Surveillance for leprosy and disability prevention Times 2
8 Orientation, planning, monitoring on post exposure prophylaxis in province Times 3
Leprosy orientation for health workers of mini leprosy elimination campaign
9 Times 24
and skin camp
Conduct reconstructive surgery camp in coordination with supporting
10 Times 5
partners.
Grant for leprosy affected of Khokana, Pokhara, Kapan and
11 Times 3
BudhanilkanthaArogya Ashram
Nursing and Social Security Division program activities:

S.N. Activities Unit Targets
1. Develop nirdesika for deployment of one nurse in every school for the management Times 1
of school health program
2. Develop guideline and standard regarding home based health care services Times 1
3. Develop e-based training package on geriatric care for health workers Times 1
4. Develop clinical protocols on chemotherapy preparation and administration, fistula Times 3
puncture and hemodialysis, ventilator care
5. Deploy nine midwives in hospitals and provide safe motherhood and midwifery Times 9
services
6. Provision of scholarship to PCL and bachelor midwives to prepare midwife as Times 30
required by Nepal
7. Develop ten continue professional development module and piloting of it in two Times 12
federal hospitals
8. Development of action plan and implementation of clinical audit program Times 1
9. Revise and update the job description of all level health workers Times 1
10. Health and nursing care service support program in government secondary schools Times 30
for school children and adolescents including menstrual hygiene management
11. Capacity assessment of nurses working in safe motherhood area and develop Times 2
standard bridge course to develop professional midwives
12. Conduct policy dialogue in Federal and Province level for nursing and midwifery Times 4
services
13. Capacity development of nurses working in hospitals running geriatric ward and Times 1
geriatric homes on geriatric care
14. Develop infection prevention and control web based training package and develop Times 2
capacity of nurses on IPC
15. Celebrate, advocate and interact on Nursing and FCHV day Times 2
16. Revision of Gender based violence clinical protocol Times 1
17. Facilitation, review, orientation and onsite mentorship for hospital and it’s staff Times 8
especially providing geriatric and GBV service
18. Regular supervision and monitoring of hospitals for quality nursing service Times 40
19. Integrated supervision of health institutions that providing SSU, OCMC, Geriatric care Times 30
and reaching the unreached program
20. Reimbursement and payment of fund quarterly to the hospitals that is listed under Times 3
impoverished citizen treatment scheme (including previous Fiscal Year due)
Source : NSSD, DoHS
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Curative Service Division: (1) Hospital Services monitoring and strengthening program activities:
1 Continuous supervision and monitoring of the hospitals for optimum quality number 95
service
2 Minimum Service Standards (MSS) implementation and follow-up in hospitals number 94
3 Formulate standard treatment protocol (STP) of diseases number 2
4 Telemedicine service extension number 1
5 registration, renewal and regulation of the specialized and tertiary level number 90
hospitals
6 Pharmacy Service strengthening in federal hospitals number 10
7 Digitalization of MSS recording and reporting system Times 1
Curative Service Division: (2) Basic & Emergency Management Section program activities:
1 Modification and extension of basic health care services based on the emergence Time 1
of diseases, availability of financial resources and local needs
2 Supervision, monitoring and evaluation of the quality of basic health services Time 1
3 Formulation of Protocol for strengthening the Emergency services. Time 1
4 Develop and implementation of Basic Health Service Package Time 1
5 Develop and implementation Emergency Service Package Time 1
Curative Services Division: (3) IENT and Oral Health Section program activities:
1 Establishment of Eye OPD in federal hospitals number 10
2 MTOT to Dental surgeons about oral health times 5
3 Training on Oral health and facial injuries to dentist working in federal hospitals times 5

1 Procuremet of equipments for Cultrue DST lab expansion Pieces 3
2 Procuremnet of GeneXpert machine Pieces 18
3 Construction of Chest Hospital person 60
4 Procuremnet of LPA machine Pieces 2
5 PME workshop of NTP at national level Times 3
7 Basic ZN MicroscpoyTraininng Times 4
8 Procurement of N95 Mask and personelproctectionutilitise Pieces 11044
9 Nutritional support to MDR patients person 60
10 Cultrue DST lab Training Times 1
11 Supply ofTB Drug to Medical Store and District Times 3
12 Broadcasting of TB Related message by National level Television Times 200
13 Revision of Guideline and Recording and Reporting form Times 2
14 Active Case Finding Program Times 3
15 Conditional grant to Kalimati Chest hospital Times 3
16 Procurement of Consumable and Chemical and Regent for sputum Microscopy Times 1
17 Procurement of Second Line Drug Times 1
18 Procurement of Falcon Tube Times 1
19 Extension of Warranty of GeneXpert Machine Times 10
20 GeneXpert Management Training Times 9
21 Income Generation Training to DRTB Patient Times 1
22 Procurement of Digital Xray Film Pieces 1200
23 Internet Installation to DR/GeneXpert Center Institut 60
24 Procurement of First Line Drug TB Times 1
25 Establishment of Quality Control Center in Province 2 and Province 5 Place 2
26 LQS Training to Lab Personnel Times 4
27 Clinical Management Trainig to Medical Officer Times 5

SN g am a g t Activities Unit Target
SN
28 Procurement of Cartidge for GeneXpert Machine Activities Unit
Pieces Target
47000
SN
28 Procurement of Cartidge for GeneXpert Activities
Machine Unit
Pieces Target
47000
29 Transportation ofTB Drug to Medical store and District Store Times 20
28
29 Procurement
Transportation of Cartidge
ofTB Drug to for GeneXpert
Medical Machine Pieces 47000
30 Courier service for Culture /DST test store and District Store Times
Times 20
5000
29
30 Transportation
Courier service ofTB
for Drug
Culture to
/DSTMedical
test store and District Store Times
Times 20
5000
31 Supervision to TB Teatmet Center Times 90
30
31 Courier service
Supervision forTeatmet
Culture Center
/DST test Times 5000
32 National PMEtoworkshop
TB on TB Program Times
Times 290
31
32 Supervision
National PME to TB Teatmet Center Times 90
33 Intraction withworkshop
Stakeholder on on TB TBProgram
Program Times
Times 102
32
33 National
Intraction PME workshop on TB Program Times 2
34 DR TB Basicwith Stakeholder on TB Program
Training Times
Times 410
33
34 Intraction with
DR TB Basic Training Stakeholder on TB Program Times
Times 10
4
34 DR TB Basic Training Times 4
National AIDS and STI Control Center program activities:
National
SN AIDS and STI Control Center programActivities activities: Unit Target
National
SN 1 AIDS and STI Control Center programActivities activities: Unit Target
Procurement ofXene Export machine , Refrigerator van , reagents and event
SN 1 Procurement ofXene Export machine Activities
, Refrigerator van , reagents and Unit
event Target
accessories 1
1 Procurement
accessories ofXene Export machine , Refrigerator van , reagents and event
2 IBBS survey among male labor migrants throughout the country event 11
2 accessories
IBBS survey among male labor migrants throughout the country event 1
3 DHIS -2 tracker training for counselors and others times 71
2 IBBS survey among male labor migrants throughout the country event 1
43 DHIS -2 tracker
Procurement of training
HIV testfor kitscounselors and others times
event 17
3 DHIS -2 tracker of training
testfor kitscounselors and others times 7
54 Procurement
Procurement of HIVARV
the drugs event
event 11
4 Procurement of HIV test kits event 1
65 Procurement of
Procurement of the ARVdrugs
STI/OIs drugs event
event 11
5 Procurement of the ARV drugs event 1
76 Procurement of
Procurement of theSTI/OIs
CD4 drugs
reagents event
event 11
6 Procurement of STI/OIs drugs event 1
87 Procurement
ToT on STI of the CD4 reagents event
event 21
7 Procurement of the CD4 reagents event 1
98 ToTsyndromic
STI on STI case management training event
lot 42
8
9 ToT on STI
STI syndromic case officer
management training event
lot 2
10 Training to medical on Hepatitis B and c lot 24
9
10 CMT STI syndromic
Training to medicalcase management training lot 4
11 training manualofficer
print on Hepatitis B and c lot
event 12
10
11 AIDSTraining
CMT day to
training medical officer
manual print on Hepatitis B and c lot
event 2
12 celebration event 11
11
12 CMT CMT
AIDS ToTtraining
day for manual
celebration print event
event 1
13 provincial facilitators lot 31
12 CMT
13 AIDS ToTday forcelebration
provincial facilitators event
lot 1
14 Logistic data review lot 13
13 CMT
14 PMTCT ToT
LogisticTOT for provincial
data review facilitators lot
lot 3
15 lot 31
14 Logistic
15 Monitoring data review
PMTCT TOTand supervision for HIV program lot
lot 1
16 event 123
15 PMTCT
16 Development TOT
Monitoring and lot 3
17 of supervision
Hepatitis Strategyfor HIV program event
event 112
16 Monitoring
17 National
Development and supervision
of Hepatitis for
Strategy HIV program event
event 12
18 Program review on HIV,STD including HEP c for health workers lot 11
17 National
18 Development Program of Hepatitis
review onStrategy
HIV,STD including HEP c for health workers event
lot 1
19` Development of guideline of HIV an STD event 11
18 National
19` Data
Development Program review on HIV,STD
of guideline of HIV an STD including HEP c for health workers lot
event 1
20 Quality assessment event 11
19` Development
20 Study
Data Quality of guideline
assessment of HIV an STD event
event 1
21 on Identification of discrimination of PLHIV event 11
20 Data
21 Review
Study onQuality assessment event 1
22 ofIdentification of discrimination of PLHIV
National HIV strategy event
event 11
21 Review
22 Study onofIdentification
National of discrimination of PLHIV
HIV strategy event
event 1
23 Establishment of IT platform using social media for PLHIV event 11
22 Review of National HIV strategy
23 Establishment of IT platform using social media for PLHIV event
event 11
23 Establishment of IT platform using social media for PLHIV event 1
National Health Training Center program activities:
National
SN Health Training Center program activities: Activities Unit Target
National
SN TrainingHealth Training Center program activities: Activities Unit Target
Material Development Section
SN Training Material Development SectionActivities Unit Target
1 Learning Resource Packages (LRP) Development and revision Times 7
1 Training
Learning Material Development
Resource Section Section
Packages (LRP) Development and revision Times 7
Skill Development
1 Learning
Skill Resource Section
Development Packages (LRP) Development and revision Times 7
1 Advanced Skilled Birth Attendants Training for doctors (ASBA Training) Person 16
Skill Development Section
21 Advanced
Rural Skilled Training
Ultrasound Birth Attendants
(Staff Nurse) Training for doctors (ASBA Training) Person
Person 2016
21 Advanced
Rural Skilled Training
Ultrasound Birth Attendants
(Staff Training for doctors (ASBA Training)
Nurse) Person
Person 16
20
3 Pediatric Nursing Care Training (Staff Nurse) Person 70
2 Rural Ultrasound Training (Staff Nurse) Person 20
43 PediatricinNursing
Diploma Biomedical Care Equipment
Training (Staff Nurse) (DBEE) training for 24 persons and
Engineering Person
Person 2470
43 Pediatric Nursing
Diploma in Biomedical Care Training
Equipment (Staff Nurse) Person 70
continuation of 24 persons from FYEngineering
2074/75 (DBEE) training for 24 persons and Person 24
4 Diploma
continuation in Biomedical
of 24for Equipment
persons Engineering (DBEE) training for 24 persons and Person 24
5 Induction training newlyfrom FY 2074/75
appointed health officers Person 55
continuation of 24 persons from FY 2074/75
65 Induction training
Medico-legal training for for
newly appointed health officers
Doctors Person
Person 12055
5 Induction training for for
newly appointed health officers Person 55
76 Medico-legal
Operation training
Theater Doctors
Management Training (OTTM) for Nurses Person
Person 120
40
6 Medico-legal training for Doctors Person 120
87 Operation
New Theater Management
Born Intensive Care Unit (NICU) Training (OTTM) for
Management Nurses
Training (Staff Nurse/Nursing Person
Person 10040
87 Operation
New Born Theater Management
Intensive
Officers) Level 2 Care Unit (NICU)Training (OTTM) for
Management Nurses
Training (Staff Nurse/Nursing Person
Person 10040
8 New Born
Officers) LevelIntensive Care Unit (NICU)
2 (ICU) Training for Nurses Management Training (Staff Nurse/Nursing Person 100
9 Intensive Care Unit Person 30
Officers) Level 2
10 ToT on screening for(ICU)
9 Intensive Care Unit pre-Training
cancer lesion for Nurses
of Cervix/ VIA/CRAYO for Medical and Person
Person 6030
10 9 Intensive
ToT on Care Unit
screening for (ICU)
pre- Training
cancer for Nurses
lesion of Cervix/ VIA/CRAYO for Medical and Person
Person 30
60
Nursing staffs
10 Nursing
ToT on screening
staffs for pre- cancer lesion of Cervix/ VIA/CRAYO for Medical and Person 60
11 Trainer's pool preparation by enhancing competency of different clinical trainers Batch 5
Nursing staffs
11 Trainer's pool preparation by enhancing competency of different clinical trainers Batch 5
11 Trainer's pool preparation by enhancing competency of different DoHS,clinical trainers
Annual Batch (2018/19)
Report 2075/76 5
g am a g t
SN
SN Activities
Activities Unit
Unit Target
Target
12
12 MTOT
MTOTon onRoad
RoadTraffic
TrafficAccident
Accident(RTA)
(RTA)andandSafety
Safety Times
Times 33
13
13 MTOT
MTOTon onOccupational
OccupationalHealth
HealthandandSafety
Safety Times
Times 22
14
14 MTOT
MTOTon onClimate
ClimateChange
Changeand andHealth
HealthImpact
Impact Times
Times 33
15
15 TOT
TOTfor
forhealth
healthworkers
workerstotoorient
orientmembers
membersofofHealthHealthFacility
FacilityOperation
Operationand and Times
Times 77
Management
ManagementCommittee
Committee(HFOMC)/Province
(HFOMC)/Provincelevel level
16
16 TOT
TOTononAnti-Microbial
Anti-MicrobialResistance
Resistance(AMR)(AMR)prevention
prevention Times
Times 77
17
17 Clinical
ClinicalTraining
TrainingSkills
Skills(CTS)
(CTS)training
training Person
Person 64
64
18
18 Anesthesia
AnesthesiaAssistant
Assistant(AA)
(AA)Training
Trainingfor forHA/SN
HA/SN Person
Person 10
10
19
19 Palliative
Palliativecare
caretraining
trainingforfordoctors
doctorsand andnurses
nurses Person
Person 64
64
20
20 Training
Trainingon onaccounting/
accounting/online
onlinerecording
recordingreporting/
reporting/TABUCS
TABUCSfor foraccount
accountstaffs
staffs Person
Person 50
50
2121 TOT
TOTononMental
MentalHealth
HealthforforMedical
MedicalOfficers/Health
Officers/HealthWorkers
Workers Times
Times 33
2222 TOT
TOTononPackage
PackageofofEssential
EssentialNon-communicable
Non-communicablediseases diseases(PEN)
(PEN) Times
Times 66
23
23 TOT
TOTononrole
roleofofhealth
healthworkers
workerstotoresponse
responseGender
GenderBased
BasedViolence
Violence(GBV)
(GBV) Batch
Batch 22
24
24 Training
Trainingforforhealth
healthworkers
workerson onBurn
BurnCare
CareManagement
Management Batch
Batch 77
25
25 Advocacy/Orientation
Advocacy/Orientationmeetings meetingson onclimate
climatechange
changeand andhealth
healthimpacts
impactswith
withpolicy
policy Times
Times 77
makers
makersofofallall77province
province
Training
TrainingAccreditation
Accreditationand andRegulation
RegulationSection
Section
11 Review
Reviewand andRefresher
Refresherworkshop/meetings
workshop/meetingswith withtrainers
trainersofofdifferent
differenttrainings
trainings Times
Times 77
22 Preparation
Preparationofoftraining
trainingaccreditation
accreditationand andregulation
regulationguideline/protocol
guideline/protocol Times
Times 55
33 Information
Informationcollection
collectionforfortrainer's
trainer'spool
poolupdate
update Times
Times 55
44 Quality
QualityImprovement
Improvement(QI) (QI)tools
toolspreparation/revision
preparation/revision Times
Times 33
55 Follow
Followup upand
andEnhancement
EnhancementProgram Program(FEP) (FEP)for
forSBA,
SBA,FP,
FP,MLP
MLPandandothers
others Times
Times 77
66 Accreditation,
Accreditation,renew
renewand andregulation
regulationmeetings
meetingswith withdifferent
differenttraining
trainingsites
sites Times
Times 77
77 Planning
Planningand andreview
reviewmeetings
meetingsfor forregulation
regulationofofquality
qualityofoftraining
trainingmaterials
materialsandand Times
Times 77
trainings
trainings
88 Accreditation/regulation
Accreditation/regulationmeetingsmeetingswith withdifferent
differentinstitutions
institutionsthat
thatprepare
preparetraining
training Times
Times 66
material
materialandandconduct
conducttrainings
trainings
National
NationalHealth
HealthEducation
EducationInformation
Informationand andCommunication
CommunicationCenter
Centerprogram
programactivities:
activities:
SN
SN Activities
Activities Unit
Unit Targets
Targets
11 Broadcasting
Broadcastingand
andAiring
Airingofofthe
themessages
messagesregarding
regardingSmoking
Smokingand
andTobacco
Tobaccoproduct
product Times
Times 11
control
controlthrough
throughprivate
privatetelevision
televisionand
andFM
FM. .
22 Airing
Airingofofhealth
healthmessages
messagesand andpublic
publichealth
healthradio
radioprogram
programthrough
throughRadio
RadioNepal.
Nepal. Times
Times 2100
2100
33 Publication
Publicationofofhealth
healthmessages,
messages,information
informationand andpress
pressrelease
releaseininnational
national Times
Times 40
40
newspapers.
newspapers.
44 Dissemination
Disseminationofofhealth
healthnews,information,or
news,information,ormessages
messagesthrough
through Times
Times 33
website,Facebook,
website,Facebook,you youtube,twitter,aps
tube,twitter,apsetc.
etc.
55 Communicable
Communicableand andepidemic
epidemicdisease
diseasecontrol
controlrelated
relatedcommunication
communicationprogram
program Times
Times 66
and
anddaily
dailynewspaper
newspapermonitoring
monitoringprogram.
program.
66 Health
Healthawareness
awarenessand andcommunication
communicationprogram
programfor fordisable
disablepeople
people Times
Times 33
77 Ear/Nose/Throat
Ear/Nose/Throatrelated
relatedhealth
healthawareness
awarenessand andcommunication
communicationprogram.
program. Times
Times 44
88 Dissemination
Disseminationofofinformation
informationand andmessages
messagesthrough
throughonline
onlinemedia
media Times
Times 33
99 Development
Developmentand anddistribution
distributionofoffederal
federalhealth
healthcommunication
communicationpolicy,
policy,strategy
strategy Times
Times 11
10
10 Broadcasting
Broadcastingofofhealth
healthrelated
relatedmessage,
message,information
informationthrough
throughnational
nationalprivate
private Times
Times 2788
2788
television
television
11
11 Health
Healthliteracy
literacycampaign
campaignprogram
programmobilization
mobilization Times
Times 11
12
12 Communication
Communicationprogramprogramon onsmoking
smokingandandtobacco
tobaccocontrol
controland
andregulation.
regulation. Times
Times 24
24
13
13 Communication
Communicationprogramprogramon onnon-communicable
non-communicabledisease diseaseprevention
preventionand andcontrol.
control. Times
Times 17
17
14
14 Health
Healthpromoting
promotingschool
schoolcampaign
campaignframework
frameworkororstrategy
strategydevelopment
developmentand and Times
Times 88
campaign
campaignconduction
conduction
15
15 Social
Socialmedia,
media,sms,sms,apsapsand
andIVR
IVRservice
servicefrom
frominformation
informationtechnology
technologycenter
center Times
Times 33
16
16 Advocacy
Advocacyand andstrategic
strategiccommunication
communicationon onoccupational,
occupational,environmental
environmentalhealth
health Times
Times 12
12
and
andAir
Airpollution,
pollution,climate
climatechange
change
17
17 Samriddha
SamriddhaNepalNepalshukhi
shukhiNepali
NepaliPromotion
PromotionProgram
Program Times
Times 55

g am a g t

18 Broadcasting of health messages, public health dialogue (Janaswasthya bahas) Times 2827
and jivan chakra through Nepal television
19 AMR awareness and orientation health promotion program Times 7
20 Communication program on brain death, kidney and organ donation Times 3
21 Communication program on fuel emission and air pollution Times 3
22 Development of print and visual materials on obstetric fistula Times 2
23 Adolescent reproductive health (8 set booklet) printing. Piece 5000
24 Health message exhibition on assembly, event, sports, health camp musical and Times 3
cultural program
25 Organization of assembly, event, sports, health camp musical and cultural Times 1
program
26 Publication and dissemination of public health related press release, information Times 12
and messages
27 Coordination program among federal, provincial and local level for the Times 3
development and expansion of health promotion activities.
Awareness and communication program on mental health Times 24
28 Awareness and communication program on IMNCI, Immunization, Diarrheal Times 12
diseases pneumonia etc.
29 Awareness and communication program on birth defect. Times 3
30 Awareness and communication program on family planning, safe motherhood Times 3
and neonatal health.
31 Awareness and communication program on family planning, safe motherhood, Times 12
neonatal and adolescent health.
32 Family planning, PPIUCD promotion and social behavioral change through inter Times 3
personal communication for hard to reach group.
33 Airing and broadcasting of messages relating to risk factors of NCDs through Times 1
Radio Nepal and Nepal Television.
34 Monitoring and facilitation at provincial and local level. Times 100
National Public Health Laboratory program activities:

1. Distribution and publicity of management, requirement and transportation of Time 3
cold chain
2. Management of quality control in government and private hospitals time 3
3. Participation in international quality control program Time 3
4. Development of NEQAS Software Time 1
5. Research activities of NPHL Time 3
6. Sickle cell surveillance management Time 3
7. Laboratory service security management Time 3
8. Management of BSL 3 Laboratory operation Time 3
9. Operational expenses for NBBTS to improve blood transfusion services time 3
10. Management of NIC, HIV, Microbiology, JE, Measles, Rubella, Hep B & C, Polio time 3
operation programs
11. Laboratory Accreditation time 1
12. Barcode management for laboratory service reliability and security number 3
13. Providing diagnostic services during epidemic outbreak time 3
14. Management of constructing infrastructures and human resources to operating time 1
Provincial Public Health Laboratory
15. Monitoring and evaluation of government hospitals, private hospitals and blood Time 50
transfusion service centre
16. Procurement of fully automated barcode labeling machine Piece 1
17. Procurement of real time PCR, HLA Machine and Extraction machine and Set 1
initiation of service for communicable disease
18. Procurement of ECLIA and ELISA machine for virology and immunology unit Set 1

g am a g t
SN
19. Construction of 2 to 8 degree cold store Activities
room Unit
Piece Target1
19.
20. Construction of
Construction of 2molecular
to 8 degree labcold store
for no room
communicable diseases Piece
Time 1 1
20.
21. Constructionand
Preparation of molecular
planning on labupgradation
for no communicable
of NPHL to diseases
National Diagnostic Centre Timetime 1 4
21. Preparation and planning
with latest technology on upgradation of NPHL to National Diagnostic Centre time 4
with latest technology
Management Division: (1) Integrated Health Information Management Section program activities:
Management
SN Division: (1) Integrated HealthActivity Information Management Section program activities: Unit Target
S N Conduction of coordination meetings Activity
of committees, divisions and sections as Unit Target
1 Times 10
Conduction
specified by of coordination
various directivesmeetings of committees, divisions and sections as
1 Times 10
specified
Monthly, by bi-monthly,
various directivesquarterly review, planning and infrastructure related
2 Times 6
development programs quarterly review, planning and infrastructure related
Monthly, bi-monthly,
2 Times 6
development
Printing andprograms
distribution of HIMS records, reports, monthly monitoring
3 Times 1
booklets
Printing and distribution of HIMS records, reports, monthly monitoring
3 Times 1
booklets
Training for Data Managers on Health Information Management and
4 Times 2
Analysis (GIS
Training for/ Data
STATA) (SO/ SAon
Managers and Medical
Health RecorderManagement
Information Assistant) and
4 Times 2
5 Training
Analysis (GISon/ data
STATA) management,
(SO/ SA andanalysis
Medical and use (PHAT)
Recorder Assistant) Times 3
65 Assistance
Training onfor dataand monitoring of
management, state and
analysis and local level reviews
use (PHAT) Times
Times 3 3
76 Preparation
Assistance for andand printing of annual
monitoring of statereport
and local level reviews Times
Times 3 2
Development of Demography Dynamic model for projection of target
87 Preparation and printing of annual report Times
Times 2 2
population
Development and health educationDynamic
of Demography materialmodelaccording to local level
for projection of target
8 Payment of Times 2
9 population andinternet service connected
health education material to HMIS branch,
according to localserver
level Times 1
management, networkservice
Payment of internet optimization,
connected procurement of firewall
to HMIS branch, server
9 Procurementnetworkof Statistical Packages for Health Information Times 1
10 management, optimization, procurement of firewall Management, Times 1
Word ProcessingofSoftware
Procurement Statisticaland Antivirus
Packages for Health Information Management,
10 Transfer and upgrade ofand
old Antivirus
database to DHIS 2as per the report from Times 1
11 Word Processing Software Times 2
Health Facility
Transfer and upgrade of old database to DHIS 2as per the report from
11 Development Times 2
12 Health Facility (customization) and use of digital recording information Times 3
systems at health facilities
Development (customization) and use of digital recording information
12 HMIS and DHIS facilities
training to staff of Central Hospital, Teaching Hospital and Times 3
13 systems at health Times 3
other hospitals (including private ones)
HMIS and DHIS training to staff of Central Hospital, Teaching Hospital and
13
14 Onsite coaching and mentoring to improve health data quality in hospitals Times
Times 3 3
other hospitals (including private ones)
15
14 Update HMIS records
Onsite coaching and report
and mentoring toforms,
improve guidelines
health data andquality
healthinindicators
hospitals Times
Times 3 2
15 Training for doctors including medical recorders from
Update HMIS records and report forms, guidelines and health indicators Central Hospital, Times 2 3
16 Times
Teaching Hospital and other hospitals (private) Mortality Statistics
Training for doctors including medical recorders from Central Hospital,
16
Management Division: (2) Infrastructure Development Section program activities: Times 3
Teaching Hospital and other hospitals (private) Mortality Statistics
SN Activity Unit Target
Management Division: (2) Infrastructure Development Section program activities:
Maintenance and improvement of physical structures within the
S1N Activity Unit
Times Target2
Department of health premises
Maintenance and improvement of physical structures within the
1 Construction of damaged boundary wall behind the National Health Times 2
2 Department of health premises Times 1
Training Center
Construction of damaged boundary wall behind the National Health
32 Procurement of Laptop-5 and Projector-1 for HIMS section Set
Times 1 6
Training Center
4 Furniture and fixtures Times 3
3 Procurement of Laptop-5 and Projector-1 for HIMS section Set 6
Biomedical tools and equipment maintenance including payments of
54 Furniture and fixtures Times
Times 3 1
previous remaining expenses
Biomedical
From Human tools and equipment
Resource Management maintenance
Contractincluding
Services:payments of
Store Assistant 1,
5 Times 1
6 previous remaining expenses
Civil and Mechanical Engineer 2, Data Analyst 1, Office Assistant 3, Computer Person 16
From Human
Assistant 1, Driver Resource
5, SweeperManagement
Part-time-3 Contract Services: Store Assistant 1,
6 Civil and Mechanical
Human Engineer 2, Data
Resource Management underAnalyst
Staff1,Administration
Office Assistantsection
3, Computer
and Person 16
7 Assistant 1, Driver 5, Sweeper Part-time-3 Person 6
Financial Administration section of DoHS
Human Resource
Human Resource Management
Managementunder for PAM Staff Administration
Unit, 10-Biomedical section and and
Engineers
87 Financial Administration section of DoHS
Person
Person 6 11
1-Public Health Officer
98 Human Resource
Activities related to Management for PAM Unit,and
financial administration 10-Biomedical
disallownaces Engineers and Times
Person 11 1
1-Public Health Officer
DoHS,
9 Annual Reportrelated
Activities 2075/76 to (2018/19)
financial administration and disallownaces Times 1
g am a g t
Waste management and sanitation within the premises of DoHS
10 Times 1
(from third party included)
Repair and maintenance of spare parts not included in the multi-year
11 Times 1
agreement after inquiry with concerned hospitals and payment
12 Monitoring of biomedical equipment maintenance work Times 3
Development of new policies, rules, directives and other documents
13 Times 2
including Revision and printing
Follow-up and monitoring of minimum standards of physical infrastructures
14 Times 3
including buildings
15 Integrated supervision of health care programs Times 100
Management Division: (3) Environment Health and Health Care Waste Management Section program
activities:
1 MTOT on Strengthening of Health Facility generated Waste Management Times 2
Onsite coaching and follow-up of solid waste management for health
2 Times 24
organization
3 Review and priting of Guidelines on Health Care Waste Management Times 1
Strengthening of programs including drinking water and sanitation WASHFIT
4 Times 2
tools
Management Division: (4) Logistic Management Section program activities:
1 Continuous construction of modern central vaccine stores Building 1
2 Continuous construction of Central Store Teku Building 1
3 Reconstruction of Pathlaiya Store Building continues Pcs 1
4 Procurement of office equipment Set 12
5 Purchase of Hospital Equipment (including payment of old contract) Times 3
6 Purchase of servers for expansion and operation of LMIS program Times 1
7 Purchase of spare parts for vaccination and cold chain management Times 1
8 Fuel and other fuels for vaccine safety and transportation Times 20
9 Pharmacist, LMIS technical service contract in store Person 25
10 To be taken in staff service consultation Person 20
11 Review and discussion with all the states about LMIS, HMIS. Times 2
12 Seminar on quantification of health products in the Union Times 1
Meetings of various committees and sub-committees related to supply
13 Times 3
management in the association
14 LMIS program expansion and operating costs Times 3
15 Management Division Website Updates Times 1
16 LMIS Forms, Stock Book Printing Times 1
17 Tools, means of transportation, maintenance of vehicles Times 3
18 Drug and equipment quality testing Times 3
Preparation of tender documents, publication of bill notice, third party
19 Times 3
insurance, vehicle tax and supply services.
Repacking, transportation, and redistribution of drugs, vaccines, and
20 Times 3
vaccines
Washing and disposing of old, expired, broken medicines and other
21 Times 7
unusable health related items
22 Capacity building for effective vaccine management Times 4
Vaccination and Coldchain Management Plan Onsite Coaching with
23 Times 50
Preventive Maintenance
24 Pre-evaluation activities for effective vaccine management Times 1
Connection and management of Coldchain Equipment Sub Centers received
25 Times 2
through UNICEF
26 Seminar on Vaccination and Cold Chain Management with Stakeholders Times 2
27 Technical evaluation of effective vaccine management work Times 3
28 Health in All Policy 13.1 Workshop Times 2
29 Technical Specification Bank Enhancement Program Times 2
30 TOT on Procurement and Basic Supply Management Times 2
31 Supervision, coordination and technical Support Times 70

Annual Health Report 2075 - 76

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Annual Health Report 2075 - 76

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Annual

Gov ernm ent of Nepal

t i g imm ia DP T Di ph th eri a, P ertus s i s , T etanus

DoHS, Annual Report 2075/76 (2018/19) i

ii DoHS, Annual Report 2075/76 (2018/19)

DoHS, Annual Report 2075/76 (2018/19) iii

iv DoHS, Annual Report 2075/76 (2018/19)

PROGRESS OF OTHER DEPARTMENTS UNDER MoHP

Department of Ayurveda and Alternative Medicine (DoAA) ima i ma ag t i

DoHS, Annual Report 2075/76 (2018/19) v

Department of Health Services under programs:

Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

a a ti g amm i i it g amm t g m t t aim t a i

Safe Motherhood and Newborn Health

Family Planning and Reproductive Health

a a ami a i g g amm i i a t i ta ami

Adolescent sexual and reproductive health

Primary Health Care Outreach Clinics

HIV/ AIDS AND STI

Non Communicable Diseases

DoHS, Annual Report 2075/76 (2018/19) x iii

Surveillance and Research

Nursing Capacity Development

Geriatric and Gender Based Violence

a ta i g iat i a i ig t a ita i i g g iat i i a

Bipanna Nagrik Aaushadi Upchar Programme

Fem ale Com m unity Health Volunteers

DoHS, Annual Report 2075/76 (2018/19) x v

Health, Education, Information and Communication

Health Service Management

Health Laboratory Services

Monitoring and Evaluation

Human Organ Transplant services

x v iii DoHS, Annual Report 2075/76 (2018/19)

Dev elopm ent Partners Support in health

DoHS, Annual Report 2075/76 (2018/19) x ix

National Health Policy, 2019

x x DoHS, Annual Report 2075/76 (2018/19)

4. Problems, Challenges and Opportunities

DoHS, Annual Report 2075/76 (2018/19) i

5. Relevance, Guiding Principles, Vision, Mission, Goal and Objectives

5.2. Guiding Principles

ii DoHS, Annual Report 2075/76 (2018/19)

DoHS, Annual Report 2075/76 (2018/19) iii

i DoHS, Annual Report 2075/76 (2018/19)

Strategies for each policy

Specialized services shall be made easily accessible through health insurance

DoHS, Annual Report 2075/76 (2018/19)

i ga i a a a t a tat a ima ita

In accordance with the concept of universal health coverage, promotional, preventive,

Collaboration and partnerships among governmental, non-governmental and private

Ayurveda, naturopathy, Yoga and homeopathy shall be developed and expanded in an

iii DoHS, Annual Report 2075/76 (2018/19)

Structures of Health Professional Councils shall be developed, expanded and improved to

Domestic production of quality drugs and technological health materials shall be

g amm t mi imi imat a g i at m a i a

a im a t at a t imm iat a iat a i mi

In order to improve nutritional situation, adulterated and harmful foods shall be

Good governance and improvement shall be ensured in policy-related, institutional and

i DoHS, Annual Report 2075/76 (2018/19)

Necessary arrangements shall be made to reduce the risks of immigration process

9. Monitoring and Evaluation