Health System Management Field Program
Campus Presentation
Prepared by
Group A3
MBBS 40th Batch
Group Members
S.No.
Name
Roll Numbers
1
Amrit Pandey
1922
2
Gunjan Agrawal
1942
3
Nabin Ayer (Group Leader)
1954
4
Pradeep Oli
1957
5
Sachet Subedi
1967
6
Samir Sedhai
1970
7
Susmita Khatiwada
1982
8
Uday Pandey
1986
Field Sites and Activities
S.No.
Sites
Duration
Tasks Performed
1.
Gulmi Hospital and Resunga
Municipality, Resunga, Gulmi
Day 1 to 21
• Hospital profile
• Municipality profile
2.
Syangja Hospital and Putalibazar
Municipality, Putalibazar,
Syangja
Day 22 to 42
• Five year action plan
3.
United Mission Hospital Tansen,
Tansen Palpa
Day 43 to 63
• Critical Analysis
• Epidemiological Study
Objectives
General Objectives:
• To acquire vital knowledge and insight into the management of the country's
health system, and to cultivate the essential skills and concepts needed for
efficiently managing municipal health systems.
Specific Objectives :
• To collect relevant information from different sources, analyze and interpret
• To describe the health service delivery mechanism at regional, district and
community level
• To prepare hospital profile and municipality health profile
• To analyze prevalence and epidemiological trend of health problems
• To critically analyze the health system management and produce alternative
solutions
• To prepare five year plan to address a particular problem
• To disseminate the information and effectively advocate
Methodology
Study Areas:
• Gulmi - Gulmi Hospital and Resunga Municipality
• Syangja - Syangja Hospital and Putalibazar Municipality
• Palpa - United Mission Hospital Tansen
Methodology (continued):
Study Design:
• Descriptive observational studies for hospital and municipal profiles
• Descriptive cross-sectional study for critical analysis
• Descriptive retrospective study for epidemiological study of the selected disease
Methodology (continued):
Study Population:
• Patients presenting for OPD services
Study Data:
• Secondary for quantitative data
• Interview from concerned authorities for qualitative data
Study Duration:
• 9 weeks
Tools and Techniques
Hospital Profile
Technique
Tools
Source of Information
Key informant
interview
Interview guidelines
Medical Superintendent, Administrator,
Consultants, Medical Officers, Nurses,
Radiographer, Emergency in charge,
Department in charges, laboratory
personnel and other hospital staffs of
Gulmi Hospital
Observation
Observation checklists
Gulmi Hospital premises
Record review
Record review format
Hospital Patient Records of Gulmi
Hospital
Literature review
Literature review format
Minimum Service Standards, MoHP
Municipal and Municipal Health Profile
Technique
Tools
Source of Information
Key informant
interview
Interview guidelines
Administrative In-charge, Health
section chief of Resunga Municipality
Health Office Chief
Observation
Observation checklists
Resunga Municipality Office
Record review
Record review format
Municipality Records, Records at
Health Office
Literature review
Literature review format
Resunga Municipality Annual Report
2079/80
Critical Analysis
Technique
Tools
Source of Information
Key informant
interview
Interview guidelines
HR Manager,Medical Supervisor,
Emergency In-charge, Emergency
Patients of UMHT
Observation
Observation checklists
Emergency Ward of UMHT
Record review
Record review format
Emergency records of UMHT
Literature review
Literature review format
Hospital Management
Strengthening Program
(HMSP)
Epidemiological Study
Technique
Tools
Source of Information
Key informant
interview
Interview guidelines
Doctors of internal medicine
department
Record review
Record review format
Hospital In-patient Records,
Annual Reports of 3 fiscal year
(2077/78, 2078/79, 079/80),
Literature review
Literature review format
Class notes, Standard textbooks, HMIS
Reports of the past three fiscal years,
DoHS Annual Report
5 year plan on Safe Motherhood
S.N.
Activities
Technique
Tools
Remarks
1.
Selection topic
Secondary data review
Key informant Interview
Data review format
Interview guidelines
Annual Report DOHS (2079/80)
District Health Report, Syangja
Records from Putalibazar Municipality
2.
Situation
Analysis
Secondary Data review
Interview with Stakeholders
Data review formats
Interview guidelines
District Health report, Syangja
Records from Syangja municipality
Key informants: Health Coordinator
Medical Superintendent, Syangja
Hospital
3.
Stakeholder
Analysis
Interview with Stakeholders
Interview guidelines
Stakeholders:
Health Coordinator, Putalibazar
Muncipality, Health Office, Birthing
center Staffs Peripheral Institutions
chief
5 year plan of Safe Motherhood
S.N.
Activities
Tools
Sources
Problem Analysis
Technique
Key Informant interview
4.
Interview Guidelines
Key Informants: Health coordinator
Sr. Health Officer, Health Office,
Syangja
5.
Objective Analysis
Key Informant Interview
Interview
guidelines
Key Informants: Health
coordinator , Sr. Health Officer,
Health office, Syangja
6.
Logical Matrix
Analysis
Group Discussion
Logical Framework
Matrix
7.
Budget Estimation
Key informant Interview
Interview
Guidelines
Members of Health division,
Putalibazaar Municipality.
Sr. Health Officer, Health Office,
Syangja
Key Informants:
Health coordinator, Syangja
Municipality, Finance Officer,
Putalibazar Municipality ,Syangja
Health Service Delivery : Structure
Municipal and Municipal Health Profile
Resunga Municipality
Resunga Municipality
• Area = 83.74 sq. km.
• Province = Lumbini
• District = Gulmi
• Wards = 14
Resunga Municipality Organizational
Structure
Municipal
Assembly
Municipality
Office
Mayor
Deputy Mayor
Judiciary
Committee
Chief
Administrative
Officer
Resunga Municipality Organizational
Structure
Administration
Section
Economic
Administrative
Section
Revenue Section
Account Section
Chief
Administrative
Officer
IT Section
Education
Section
Public Health
Section
Technical Section
Vetenirary
Section
Resunga Municipality Health System
• There are currently 3 staffs in the health unit of the municipality which includes Health Unit Chief
(Sr. ANM), 2 Sr. AHWs.
Resunga Municipality Health System
Resunga Municipality Health System
Management
• There are 4 health posts, 10 basic health service centres, 2 Urban health centres, total 16 institutes
in 14 wards that fall under the health section of the municipality.
Resunga Municipality Health System Budget
• Top down: mostly
• Bottom up: few, from local level
• Source: mostly handled by Account section
• Utilization: According to guideline, no difficulty in utilization
Resunga Municipality Health System Logistics
• Mostly bought from top down budget.
• For other items (eg, Stationery): coordination with Store section.
• Demand and Supply: enough
• Information on logistics for health unit handled by health unit itself.
Resunga Municipality Health System Planning
• No 5 year plan.
• Yearly planning is done.
• Top down planning done according to budget and respective guidelines.
• Bottom up planning done as per necessity.
• For this fiscal year, planning for: Nutrition and Adolescent friendly Municipality.
• Adolescent friendly: orientation, easy health access regarding family planning/mental health for
adolescents organized by health section of municipality but there is no specific focal person.
Resunga Municipality Health System
Coordination
• Coordination with health institutions in wards, with planning, account, education units.
Resunga Municipality Health System
Recording and Reporting
• Hard copy, soft copy both
• No specific guideline
• No specific committee
• No problem while utilizing information
Resunga Municipality Health System
Monitoring
• Monthly meeting with units' head.
• Analysis of data.
• Discuss planning and program for institutes.
Resunga Municipality Health System
Evaluation
• Done in monthly meeting.
• Also done as needed every 3 months or 6 months.
Resunga Municipality Health System Data
Total Service Users
New Service Users
Service Receivers
Vaccination Status
CB-IMNCI
Nutrition Program
ANC Visits
Hospital Deliveries
Breastfeeding
Contraceptives
TB Treatment
Hospital Profile
IPO Model
• Input
• Infrastructure
• Human resource
• Logistics
• Finance
• Process
• Planning
• Organization
• Direction
• Recording and reporting
• Coordination and Communication
• Supervision and Monitoring
• Output
• Health Programs and Services
45
Organizational Structure
46
47
Logistics
• The procurement committee decides upon the purchase.
• Goods valued up to 10,00,000 can be procured with a single quotation.
• For goods valued between >10,00,000 and <20,00,000, sealed quotation is required.
• Minimum three suppliers are required.
• Tender calls are made for goods exceeding 20 lakhs.
48
Management of expired logistics
• A First Expired First Out (FEFO) principle is followed for inventory management.
49
Finance
50
Budgeting
• Budget for the operating expenses is provided by the MoHP with federal government,
provincial government and the internal revenue of the hospital.
51
Audit
• The hospital runs its audit once a year internally and externally.
• Internal audit is done as per the feasibility by कोष तथा लेखा नियन्त्रक कायाा लय
• External audit is done by महालेखा परीक्षक कायाा लय
52
Hospital Development Committee
• There are 5 members in the Hospital Development Committee including Chairperson of the
committee, Mayor of Resunga Municipality, Chief District Officer, Senior Medical Superintendent
and a member of the committee.
53
Planning
• The overall planning of the hospital is done by the committee formed for the same purpose.
• Budget for the planning comes from the MoHP with federal government, provincial government and
the internal revenue of the hospital.
• Planning is done on the 1st month of the fiscal year.
• Additionally, meeting of the Hospital Development Committee, staffs takes place monthly as well as
when needed to add up new changes to the planning process.
54
Recording and Reporting
• The recording is done using HMIS tools and reporting is done every month.
• EWARS tools is also used for reporting communicable diseases.
• Daily patient records are done manually.
55
Coordination and Communication
• The hospital coordinates and communicates with the local bodies specially in the health related
programs where speciality and manpower of the hospital is required.
56
Supervision and Monitoring
• Daily supervision and monitoring of hospital services are done by the respective incharges.
• Internal analysis is performed by Medical Superintendent and Administrative head.
• Self analysis is also done by using checklist of Minimum Service Standards.
• Officials from MoHP also visit the hospital occasionally for supervision and monitoring.
57
No. of Emergency patients by fiscal year
58
OPD Services of Past 3 Fiscal Years
59
Inpatient Visit in Past 3 Fiscal Years
60
Types of Delivery in Last 3 Fiscal Year
Types of delivery
FY 077/78
FY 078/79
FY 079/80
Normal
527
534
494
CS
168
226
157
Vaccum/Forceps
17
8
3
Total
712
768
654
61
Family Planning New Acceptors
62
Surgical Intervention
63
Services
2077/78
2078/79
2079/80
X-ray
8801
15031
18373
Ultrasonogram
(USG)
Electrocardiogram
(ECG)
Lab services
5899
7268
7931
2807
4800
6868
21285
28412
31080
64
Other Services:
• Medicolegal Services
• Dialysis Service
Critical Analysis in Emergency Services
of United Mission Hospital Tansen
Strengths:
• There were upgraded modern Beds in ER.
• Separate Procedure Room available.
• Well-lit and Well-ventilated room.
• Hospital provides 24-hr emergency services
• Laboratory and imaging services available 24-hr round the clock.
• Emergency Surgical services available round the clock.
• Regular trainings are provided to ER staffs.
• Hospital has prepared its own Mass Casualty management protocol.
• Activities of ER are reviewed in every 3-months
• Availability of oxygen, defibrillator and cardiac monitors.
Weakness:
• No separate Observation room in Emergency department.
• There were no separate entry and exit doors.
• Unavailability of CT in Emergency ward which is crucial in cases of
neurovascular emergencies.
• Human resource management in ER during peak hours is same as that of normal
period.
• No provision of automated digitalized records of patients admitted in ER.
• Doctors are only on call during the night-shifts which may delay in making lifesaving decisions during the time.
Opportunities:
• Additional human resources can be mobilized during peak hours in Emergency
ward.
• A CT machine can be made available with 24-hr services.
• Digitalization of medical records could be done which will make the patient’s
medical record more easily accessible and retrievable.
• The hospital can coordinate with organizations like local Red Cross societies
which will be helpful in managing cases during mass casualties.
Threats:
• Patient crowding and overflow can occur in the emergency ward if no measures
are taken to expand the ward.
• Manpower and infrastructure issues may arise while installing new equipments.
• Financial problems can arise if efforts are made to introduce additional manpower.
• Hindrance in service delivery may arise due to hesitance of new consultants to
work in the hospital.
Five Year Plan on Safe Motherhood
Situation Analysis
Indicators
National
Gandaki
Syangja
Putalibazar
2078/79
2079/80
2078/79
2079/80
2078/79
2079/80
2078/79
2079/80
Percentage of
pregnant women who
had four ANC check
ups as per protocol
(4th, 6th, 8th and 9th
month)
79.2
93.5
135
134.5
64.5
105.7
89.9
234
Pregnant women
who attended first
ANC visit (any time)
80
81
126.3
103.7
183.8
132.9
% of institutional
deliveries
79
83.4
64.4
67.9
33.1
30.5
85.8
71
% of births attended
by a skilled birth
attendant (SBA)
75
80
63.5
66
Percentage of women
who had 3 PNC
check-ups as per
protocol (1st within
24 hours, 2nd within
72 hours and
3rd within 7 days of
delivery)
40.8
44.2
35.5
42.3
% of pregnant
women who received
Td2 and Td2+
72
72
58.7
60
Maternal mortality
ratio per 100,000 live
birth
151
Neonatal Mortality
rate per 1000 live
births
33
% of pregnancies
terminated by
induced procedure at
health facility
14.2
161
7.5
25
25.9
41
48
42.8
62
79
73
71
0
0
0
0
0
0.1
0
0
19.9
24.1
28
25.5
Indicators
2077/78
Putalibazar Municipality
2078/79
2079/80
Percentage of pregnant women
who had four ANC check
ups as per protocol (4th, 6th,
8th and 9th month)
40
89.9
234
Pregnant women who attended
first ANC visit (any time)
108.3
183.8
132.9
64
85.8
71
0
0
42.8
28
62
79
0
0
0
0
0
0
28
25.5
73
71
% of institutional deliveries
% of births attended by a
skilled birth attendant (SBA)
Percentage of women who had 3
PNC check-ups as per
protocol (1st within 24 hours,
2nd within 72 hours and
3rd within 7 days of delivery)
Maternal mortality ratio per
100,000 live birth
Neonatal Mortality rate per
1000 live births
% of pregnancies terminated by
induced procedure at
health facility
% of pregnant women who
received Td2 and Td2+
28
69
Stakeholder Analysis
Stakeholders
Problem
Interest
Potential
Linkages
Municipality Office
There was no such
problem for the safe
motherhood program.
They are interested to
further decrease home
deliveries to zero.
They are interested to
make all existing
deliveries to be
attended by SBA.
Nutrition program to
the Postpartum
mother is conducted
supporting Safe
motherhood.
There is separate
allocation of budget
for transportation and
ANC checkup to
pregnant mother after
institutional delivery.
Outreach clinic were
also focused on the
Safe Motherhood
program.
Resources provided by
the federal and
provincial government.
Health institutions and
academic institutions
for the
implementation of
program
INGOs
Local medias
Stakeholder Analysis
Stakeholders
Problem
Interest
Potential
Linkages
MCH clinic Incharge
Immunization is
provided on only one
day a week.
They wish having
immunization services
at least two or three
days a week. They
wished increase in
human resources as
only 2 people are
available now.
There is availability of
all required lab tests
Availability of ANC
checkup,
immunization and
family planning.
Resources and
facilities from the
federal and provincial
government. District
health office for
vaccines and other
essential supplies.
Municipality and other
health institutions.
Stakeholder Analysis
Stakeholders
Problem
Interest
Potential
Linkages
Birthing Center Staffs
Portable USG
machines are not
available in some
birthing center.
The few available ones
too, are nonfunctional.
There is no facility for
anomaly scan in the
district.
They wished to have
portable USG machine
in every birthing
center.
Skilled birth attendant
are available in all
birthing centers.
All birthing center are
well equipped with
logistic as per there
need. Beds are
sufficient according to
patient flow.
Resources and logistics
provided by local
government.
Problem Analysis
Objective Analysis
Safe Mother and child
Increased Number of
Institutional Deliveries
Increased safe termination
of pregnancies by induced
procedure at health facility
Promote Human
Resources Development
and capacity building
Increase equity, assets and
utilization of safe
motherhood services
Making Availability
and adequate Physical
assets and Health
commodities
Increase awareness about
the health risks of unsafe
termination of pregnancy
Increased number of deliveries
attended by Skilled Birth
Attendant
develop strategies that
generate demand for SBAs
and also reduce financial,
geographic and cultural
barriers to such services.
Regular Monitoring of safe
motherhood knowledge
through community survey
Objective and Strategies
• The objectives and strategies are aligned with the National Safe Motherhood and Newborn
Health Road Map 2030 endorsed by the Government of Nepal and the Global Strategy for
Women's, Children's, and Adolescents' Health (2016-2030) endorsed by the World Health
Organization (WHO).
Vision
• Putalibazar Municipality striving towards zero maternal deaths, disease, and suffering related
to pregnancy and childbirth, through a comprehensive Safe Motherhood Program.
Goal
• To significantly improve maternal health outcomes in Putalibazar Municipality by addressing
factors contributing to pregnancy-related complications and promoting early identification and
access to essential healthcare services.
Objective and Strategies
• Objective 1: Strengthen the integration of comprehensive maternal health
services, including
• Preconceptional counseling and screening for high-risk factors.
• Antenatal care with early identification and management of potential health complications.
• Skilled birth attendance to ensure safe delivery and immediate newborn care.
• Objective 2: Strengthen community engagement to promote healthy behaviors
and advocate for improved access to healthcare services, contributing to a
healthier environment for mothers and newborns.
• Promote healthy habits within the community through existing outreach programs,
emphasizing: Balanced diet and importance of good nutrition during pregnancy and for overall
health. Benefits of regular health checkups for early detection of potential health issues.
• Advocate for: Increased access to essential healthcare services within the community, focusing
on facilities frequented by pregnant women and mothers.
• Collaboration with relevant health authorities to explore the possibility of incorporating
targeted awareness campaigns on the importance of Safe Motherhood and Chid Health Care.
• Objective 3: Guarantee a reliable and efficient supply chain for essential
maternal healthcare resources.
• Secure a consistent supply of essential medicines, equipment, and supplies required for
comprehensive maternal healthcare services.
• Implement effective logistics management systems to ensure: Proper storage and handling of
medicines, equipment, and supplies according to recommended guidelines.
• Timely distribution of resources to healthcare facilities serving pregnant women and mothers.
• Inventory management to maintain adequate stock levels and prevent stockouts.
• Objective 4: Strengthen referral mechanisms and healthcare worker capacity to
ensure early detection and management of potential health complications during
pregnancy and the postpartum period.
• Establish a comprehensive referral network connecting the Safe Motherhood program with various
healthcare specialists and facilities. This network should include Obstetricians and gynecologists for
specialized care during pregnancy and childbirth. Pediatricians for essential newborn care. Other
relevant specialists based on identified needs within the community (e.g., nutritionists, mental health
professionals).
• Enhance the knowledge and skills of healthcare workers involved in the Safe Motherhood program:
Training on early identification of potential health complications throughout pregnancy and the
postpartum period.
• Effective communication skills to guide women on the importance of regular checkups and seeking
timely medical attention when needed.
• Objective 5: Advocate for improved access to comprehensive healthcare services to
address the health needs of mothers and newborns throughout pregnancy and the
postpartum period.
• Collaborate with relevant healthcare authorities to: Advocate for the integration of essential maternal
health services within existing healthcare facilities frequented by pregnant women and mothers.
• Explore the possibility of establishing outreach programs in areas with limited access to healthcare,
focusing on prenatal and postnatal care.
• Promote health awareness and education among pregnant women and mothers through: Educational
workshops and seminars on various health topics relevant to pregnancy, childbirth, and newborn care.
• Dissemination of informative materials (e.g., brochures, posters) on healthy practices, nutrition, and
early detection of potential health complications.
• Objective 6: Expand the reach and impact of the Safe Motherhood Program
across all 14 wards through strategic implementation and resource allocation.
• Increased community engagement activities.
• Deployment of additional healthcare personnel.
• Establishment of satellite clinics or outreach programs in remote areas.
• Objective 7: Mitigate the disruption of essential maternal healthcare services
during natural disasters and public health emergencies.
• Collaborate with relevant authorities: Health department: Establish communication channels
to: Stay informed about the evolving situation and public health priorities. Coordinate the
program's response efforts with broader emergency response measures.
• Disaster management agencies: Advocate for the inclusion of the program's needs within local
disaster preparedness plans, ensuring: Access to safe birthing facilities and essential supplies
in emergency shelters.
• Continuity of critical services like prenatal care and immunization for newborns.
• Objective 8: Strengthen data collection and analysis capabilities to improve
program monitoring and evaluation, leading to better maternal health
outcomes.
• Data collection: Include relevant indicators related to maternal health outcomes like prenatal
care access, birthing complications, and newborn health.
• Data analysis: Analyze collected data to identify trends, correlations, and areas where program
interventions are most effective.
• Utilize the findings to refine program strategies and resource allocation for achieving optimal
maternal health outcomes.
Targets
By the end of 2085/86:
➢ Institutional Delivery: (current 71%)
 2080/81: 80%
 2081/82: 85%
 2082/83: 90%
 2083/84: 95%
 2084/85: 99%
➢





Eight ANC visit as per protocol: (current 91%)
2080/81: 92%
2081/82: 94%
2082/83: 95%
2083/84: 98%
2084/85: 99%
➢





➢





Delivery Conducted by SBA: 42.8%
2080/81:50%
2081/82:60 %
2082/83:70 %
2083/84:80%
2084/85:90%
Four PNC checkup as per protocol: (National Target
90% by 2030, current 96.7%)
2080/81: 97%
2081/82: 98%
2082/83: 98%
2083/84: 99%
2084/85: 100% (complete PNC visit municipality)
Logical Framework Matrix
OBJECTIVES/VERIFIABLE
INDICATORS
NARRATIVE SUMMARY
MEANS OF
VERIFICATION
ASSUMPTION
GOAL
Enhance the health and well-being of
mothers, newborns, and their families in
Putalibazar municipality.




Percentage of pregnant women receiving
at least four antenatal care visits
Maternal Mortality Ratio (MMR)
Percentage of deliveries attended by
skilled birth attendants
Neonatal mortality rate
•
•
Percentage of pregnant women receiving
at least four antenatal care visits
Skilled Birth Attendance (SBA) Rate
Postnatal Care Coverage
Neonatal Immunization Coverage
Family Planning Acceptance Rate
•
HMIS data
Vital registration
data
•
system
•
Strong support and
prioritization of maternal
health initiatives from local
government authorities in
Putalibazar municipality.
Strategies to ensure the
program's long-term viability
beyond initial funding or
support.
PURPOSE
Enhance access to and utilization of essential
maternal healthcare services, contributing to
improved maternal and newborn health
outcomes in Putalibazar municipality.





•
•
HMIS data for Putalibazar
municipality
Facility delivery records
Community-based surveys




Political commitment
Alignment with National
Frameworks
Stakeholder Engagement
Willingness and acceptance
of the program's
interventions by the target
population.
Activities Timeline
S.N.
Activities
FY2080/81
FY2081/82
A. Conducting awareness program, workshop, and health program in Community
1.
Awareness program, workshop and
health program in community
2.
Orientation sessions to Aama Samuhas
on Safe Motherhood
3.
Special sessions on Safe motherhood
services and SRHR to school children
4.
Publication and broadcastingof
information on Safe Motherhood on TV,
radio and newspapers
5.
World Safe Motherhood Day celebration
on April 11
6.
Establishment of information boards on
Safe motherhood services in different
areas ineach ward
Experience sharing sessionsby those
who have already received safe
7.
motherhood services in Aama Samuha
Meetings
B. Resource Mobilization and Trainings
FY 2082/83
FY 2083/84
FY 2084/85
8.
9.
10.
11.
Expansion of birthing centers
Provision of waiting homes for expecting
mothers near the birthing centers
Orientation to FCHV for safemotherhood
services
Maintenance and proper functioning of
Ambulanceservices
12.
Skilled Birth Attendant training for ANMs
13.
Refresher training to all the healthcare worker
from timeto time
14.
Training on systematic andcomplete
recording and reporting of HMIS forms
C. Others
15.
16.
17.
18.
Establishment of Emergencycommunity
referral fund
Development of IEC materials on safe
motherhood and distribution to all health
institutions
Well-coordinated transportation and timely
supply of essential logistics to healthcare
facilities
Motivation to ANMs and SBA conducting most
delivery round the year through reward and
recognition programs
19.
Encouraging greater engagement of FCHVs
through rewards and incentives
20.
Promotion of Postpartum family
planning devices
21.
Nyano Jhola Program
22.
Nutrition Programs for the Pregnant
and Post-deliverywomen
23.
ANC Visit Incentives
24.
Conduction of needs-based research to
strengthen SafeMotherhood program
25.
Integrated SupportiveSupervision
Budgeting
S.No.
Fiscal Year
Budget (Rs.)
1.
2080/81
3930000
2.
2081/82
3745000
3.
2082/83
3865000
4.
2083/84
3145000
5.
2084/85
3215000
Total
17900000
Budget Allocation by Objective and Time (Budget in 1000)
S.No.
Objective
80/81
81/82
82/83
83/84
84/85
Total
1.
To conduct awareness program, workshop, and
health program in community
239
174
174
174
174
935
2.
Trainings and Resource Mobilizations
2420
2300
2420
1600
1820
10560
1281
1281
1281
1281
1281
6405
3940
3755
3875
3055
3275
17900
3.
Others
Total
Sources for the Budget
• Many of the activities delineated in the plan come under national programs for which conditional
grant is provided by the federal government. The remainder of the budget along with the budget for
supervision and monitoring is expected to be invested by the municipality office itself. The federal
government also provides Special Grant.
S.No.
Source
Amount
1.
Conditional Grants by federal government
8055000
2.
Special Grant by Provincial Government
6265000
3.
Municipality
3580000
Total
1,79,00,000
Monitoring and Evaluation
Indicators
Process Indicators
Outcome Indicators
• Number of health facilities providing
safe motherhood services.
• Number of health facilities providing
Safe delivery services.
• Number of health workers trained as
skilled birth attendants.
• Number of active FCHVs working in
notifying health issues related to
‘sunaulo 1000 dine aama’.
• Percentage of annual budget allocated
for Safe motherhood program
• Number of maternal and neonatal
deaths recorded.
• Percentage of ANC and PNC visits
• Percentage of iron, folic acid and
Vitamin A supplementation
• Number of institutional deliveries
• Percentage of birth attended by SBA.
• Number of safe abortions performed
• Number of used family planning
devices
Timing
Indicators
Timing of monitoring and
evaluation
Process indicators
Once every two months by the Health
Section of the municipality
Outcome indicators
Once every six months
Supervising Team
• The supervision, monitoring and evaluation committee shall consist of the following members:
 Mayor of the municipality
 Health Coordinator of Putalibazar municipality
 Medical Superintendent of Syangja Hospital
 Health post in-charges
 Health related experts
At the end of each supervision, the supervision team will discuss the report of the process, the
success, weaknesses, opportunities and constrains of the process based on the indicators.
Epidemiological Study of COPD
Rationale
• COPD is the major public health problem in Nepal and one of the major causes of morbidity and
mortality in the world (third leading cause of death worldwide). (Source: WHO)
• COPD was one of the leading causes for morbidity and mortality in United Mission Hospital. (2nd
highest IPD diagnosis and 2nd leading cause of IPD Mortality in FY 079/ 080) (Source: Annual
Report, United Mission Hospital, 079/080)
• Mortality and morbidity due to COPD can largely be prevented and treated if managed promptly
and adequately. Example: by behavioural modification like smoking cessation, decreasing
exposure to household smoke.
Time based distribution of COPD cases
900
785
800
Number of COPD Patients
700
592
600
500
400
382
300
200
100
0
2077/78
2078/79
Fiscal Year
2079/80
Percentage of COPD cases among total inpatient cases in
last three fiscal years
Fiscal Year
2079/80
6,3
2078/79
5
2077/78
3,4
0
1
2
3
4
5
Percentage of COPD cases among all inpatient cases
6
7
Age-wise distribution of COPD in last 3 fiscal years
Agewise Distribution of COPD
400
350
300
250
200
150
100
50
0
<40
40-49
50-59
2077/78
60-69
2078/79
70-79
2079/80
80-89
>90
Sex-wise distribution of COPD in last 3 fiscal years
Sexwise Distribution of COPD
600
500
400
300
200
100
0
2077/78
2078/79
F
M
2079/80
Ethnicity-wise distribution of COPD in last 3 fiscal years
Ethnicity wise Distribution of COPD
350
300
250
200
150
100
50
0
Janajati
Brahmin/Chhetri
2077/78
2078/79
2079/80
Dalit
Risk Factors (at present)
• Cigarette-smoking or exposure to environmental tobacco smoke since childhood.
• Exposure to fumes and smoke from carbon-based cooking and heating fuels like charcoal and gas.
• Occupational hazards (exposure to chemicals and pollutants).
• Pneumonia and childhood respiratory infections.
• Age and genetic pre-disposition.
• Lower socio-economic status.
• Acute exacerbation of COPD attributed to the cold climate (in winter) and pollen (in summer).
Recommendations:
To Department of Community Medicine:
• Incorporation of Minimum Service Standards (MSS) protocols in the orientation
sessions
• Practical sessions on Budget Formulation for Five Year Plan
Recommendations:
To Gulmi Hospital:
• Increase manpower (specially in radiology) and infrastructure for delivering health
services
• Provision of quarters to the doctors
Recommendations:
To Resunga Municipality:
• Increase human resource in the health section
• Increase collaboration with NGOs/INGOs
• Greater attention to proper maintenance of health records
Recommendations:
To Syangja Hospital:
• Fulfillment of vacant post
• Effective Management of inpatient medical records.
• Management of proper Ambulance facilities.
Recommendations:
To Putalibazar Municipality:
• Regular supervision and monitoring of peripheral health institutions
• Proper recording and reporting system
Recommendations:
To United Mission Hospital Tansen:
• Management of Human Resources in ER during the Peak time.
• Improve OPD based recording and reporting.
• Expansion of the emergency services.
• Fulfillment of ENT physician and other vacant posts.
Learning Reflections:
• We learned about the basic political structure and function of health service in
local, provincial and national level
• We got exposed to various constraints faced within the current healthcare system
of Nepal to deliver services of optimum quality.
• We understood how private, governmental and non-governmental health
institutions play a coordinated role in providing health services to the general
public
• We understood detailed structure and function of community, district and
provincial hospitals in Nepal.
Learning Reflections (continued):
• We learned how a particular aspect of the health service system can be critically
analyzed, and how potential solutions can be reached
• We learned how to extract, analyze and report epidemiological data
• We learned to identify, prioritize and analyze health issues in a municipality and
create a plausible plan to mitigate the issue with available resources
• We understood various opportunities as well as constraints occurring as a result of
transition to federal system.
• Personal Lessons: Time management, Teamwork, Communication
Appreciation Letters:
Photos:
Thank you!!