National Annual Review 2074 -...
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National Annual Review 2074 Chuda Mani Bhandari Deputy Director General Department of Health Services Ministry of Health,Nepal
Transcript of National Annual Review 2074 -...
National Annual Review 2074
Chuda Mani BhandariDeputy Director General
Department of Health ServicesMinistry of Health,Nepal
Child health … 139
91
61 5439
28 27 24 20
0
20
40
60
80
100
120
140
160
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
Target2020
Target2022
Target2025
Target2030
Under five child mortality rate* (SDG 3.2.1 and NHSS RF G2)
Deaths per 1,000
livebirths
58
3933 33
2118 16 14 12
0
10
20
30
40
50
60
70
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
Target2020
Target2022
Target2025
Target2030
Neonatal mortality rate* (SDG 3 2 2 and NHSS RF G3)
Deaths per 1,000
43
66
83 8778
90 95 97 99
0
20
40
60
80
100
120
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
Target2020
Target2022
Target2025
Target2030
Immunization coverage (all vaccines)***(NHSS RF OC3.2)
%
0
10
20
30
40
50
60
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
Target2020
Target2022
Target2025
Target2030
Stunted children (height for age)^ (SDG 2.2.1 and NHSS RF G5)
48 51 49
4136
3128
2419
%
Under five mortality Neonatal mortality
Immunization coverageStunting
Maternal health and family planning…
0102030405060708090
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
Target2020
Target2022
Target2025
Target2030
Institutional deliveries(SDG 3.8.2 and NHSS RF OC3.3)
8 918
35
5770 74 79
90
% 2635
44 4343
52 53 56 60
010203040506070
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
Target2020
Target2022
Target2025
Target2030
Contraceptive prevalence of any modern methods (SDG 3.7.2)
%
3128
25
2724
21 19 1815
0
5
10
15
20
25
30
35
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
Target2020
Target2022
Target2025
Target2030
Unmet need of family planning
%
Unmet need for family planning
Institutional delivery Contraceptive Prevalence Rate (CPR)
0
5
10
15
20
25
30
35
40
NDHS1996
NDHS2001
NDHS2006
NDHS2011
NDHS2016
%
FP Unmet Need by Ecological Zone (1996‐2016)
Mountain
Hill
Terai
Non‐communicable Disease …
Percent of women and men age 15 and above Percent of women and men age 15 and above
Prevalence of hypertension by wealth Blood Pressure Status
Health Offices at Different Level
Ministry of Health 1Department 3Regional Health Directorate 5Regional Health Training Centers 5Regional Medical Store 5District Health Offices 50District Public Health Offices 25
Health Service Delivery NetworksHFs type Number
Central Hospitals 6
Regional Hospitals 3
Sub Regional Hospitals 3
Zonal Hospitals 10
District Hospitals 52
District Level Hospitals 32
PHCs 198
HPs 3805
UHCs 235
CHUs 188
Private Health Facilities 1723
Source: HMIS
Reporting Status (%) FY 2073/74
Source: HMIS
Human Resources
Summary of Staffs under DoHS
Total Officer 4205Total Sectioned post 38174Technical Staffs 31474Non‐Technical staffs 6700
Department of Health Services
Total Sectioned post 196Total Full filled 180Total Vacant 16
HMIS Reporting Status (%) FY 2072/73
73
12
100 9789
10091
100 99
84
60
71
97
69
9081
9187
0
20
40
60
80
100
120
Source: HMIS
LMIS Reporting Status in 2073/74
88 8781
88 8795
79
94
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
National Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7
Situation
Immunization coverage and drop out rate
87
98
76 77
8897
85 8683 85
7178
86 8984 83
95 95
7989
95 93 90 91
0102030405060708090
100
Immunization coverage (DPT‐HepB‐Hib3)
2073/74 2072/73 2071/72
3
11
12
4 4
2
55
12
12
4
6
3
5
3
6
10
34
23
‐1
1
3
5
7
9
11
13
15
Drop out rate of DPT‐HepB‐Hib (1 vs 3)
2073/74 2072/73 2071/72
Treatment of children for pneumonia and diarrhea
152
196
150
197
184
144151
165
153
182
162155
188
175
152
184
164
178
197
159
181172
0
20
40
60
80
100
120
140
160
180
200
Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National
% of children under 5 years with pneumonia treated with antibiotics
2073/74 2072/73 2071/72
86.2
94.7
92.2
95.8
89.3
96.2
93.9
92.2
84.5
89.588.2
88.8
87.3
90.5
85.2
87.487.6
94.593.8
94.995.6 95.4
91.2
93.1
75.0
80.0
85.0
90.0
95.0
100.0
Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National
% of children under 5 years treated with zinc and ORS
2073/74 2072/73 2071/72
Institutional delivery
62.2
44.6
70.7 68.3
59.4
35.6
66.4
57.4
0
10
20
30
40
50
60
70
80
Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National
Percentage of women aged 15‐49 year giving birth in a health facility
Use of contraception
55.1
47.7
60.6
48.5 4851.1
57.352.6
0
10
20
30
40
50
60
70
Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National
Current use of contraception (any method)
Disease Control: Malaria
0.440.51
0.37
0.63
1.08
0.74
1.78
0.79
0.000.200.400.600.801.001.201.401.601.802.00
Annual blood examination rate at risk population (ABER), 2073/74
0.020.04
0.02 0.03
0.08
0.11
0.28
0.07
0.00
0.05
0.10
0.15
0.20
0.25
0.30
Annual malaria parasite incidence/1000 at risk population, 2073/74
Lymphatic Filariasis: Year‐wise MDA Coverage (2003‐2017)
81.282.5
83.182.6 85.5
76.8
81.3
79.1
67.7
73.8
68.8
69.6
71.4
72.7
0
20
40
60
80
100
120
2003 2004 2005 2006 2007 2009 2010 2011 2012 2013 2014 2015 2016 2017
Coverage %
No of people treated for HIV and on ART31
.3
20.9
32.2
10.6
59.3
4.3
53.3
52.9
27.2
41.4
21.6
92.5
8.5
70.9
22.2
11.9
31.5
14.8
32.7
1.8
13.3
0.010.020.030.040.050.060.070.080.090.0
100.0
Number of people (‘000) tested and counseled for HIV
2073/74 2072/73 2071/72
1197 1428
4082
2113 24
66
434
2824
974 12
48
3440
1785 21
58
374
2467
826 1044
3036
1560 18
97
305
2421
0500
10001500200025003000350040004500
Number of people on ART
2073/74 2072/73 2071/72
HIV testing and positive cases
Description Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 National
Number of people tested for HIV (in '000)
31.3 20.9 32.2 10.6 59.3 4.3 53.3 211.8
% of positive cases 0.8 1.9 2.2 1.2 0.8 1.0 0.5 1.0
Leprosy EliminationRegional/Province/District wise PR (2072/73)
1
2
3
4
5
Province 2: 1268(42%)
6
7
TB case finding and treatment success rate
Trend of Annual DR TB case Finding
Delivery of Free Basic Health Services
82.3
73.4
78.0
68
70
72
74
76
78
80
82
84
2073/74 2072/73 2071/72
% of free health outpatient services among estimated total population
55.5
47.942.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
2073/74 2072/73 2071/72
% of targeted group received free health services among total hospital (new) OPD visits
Free treatment services for Bipanna Nagrik
20480
80136095
64,978
127,280 125,305
‐
20,000
40,000
60,000
80,000
100,000
120,000
140,000
0
5000
10000
15000
20000
25000
2073/74 2072/73 2071/72
Free treatment to Bippna Nagrik for selected diseases
No of cases Per case expenses (NPR)
Year Exp (million)2073/74 1330.82072/73 1019.92071/72 763.7
Building Construction by DUDBCProgress Status Summary (FY 2061/062 – 2073/74)
Total HFs: 2022
Under Construction: 693
Near Completion: 177
Completed/Handed over: 1152
Sick Projects 100 (reduced from 181)
Financial Progress
Allocation Budget (000) FY 2073/74
Expenditure(000)
% of Expenditure
3,88,60,55,000(3 arab, 88 crore)
3,65,2073,000(3 arab, 65 crore)
93.98%
Source: DUDBC
Operational
MC intervention
Out of Order
Fixing the Basics: Bio‐Medical EquipmentRapid Inventory Assessments 2014
Stock Out Situation of Key Commodities in 2073/74
4.6%
3.11%
4.78%5.49%
14.92%
6.46%
12.03%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
Condom Depo Pills ORS Zinc Iron VitaminA
CondomDepoPillsORSZincIronVitamin A
Budget Expenditure and Irregularity Clearance
Key Innovation/InitiativesChild Health Program• Expansion EIRS (Electronic Immunization registration) in Chitawan, Kaski and Bhaktapur
• Establishment of SNCU/NICU and Expansion
• Quality improvement in perinatal care program at 12 hospitals
• Establishment of IMNCI clinical training sites
• Fully nourished ward/village declaration
National Annual Health Review 2073/74
Key Innovation/InitiativesEDCD• Regular Water quality Surveillance at district level• Food quality surveillance at highway restaurants to minimize food borne diseases
• Budget allocation for Sickle cell anemia and thalassemia affected districts for treatment and management.
• Allocated budget for purchase of Wag tech machine for district to support water quality surveillance and monitoring.
• Budget allocation for Stockpiling of Medicine and other equipment for outbreak and disaster management at district level.
National Annual Health Review 2073/74
Key Innovation/InitiativesLCD• Mini Leprosy Campaign in Banke and Bardiya.
• Sustained elimination at the national level as the prevalence rate has remained intact this year
• Increased proportion of female cases and child cases as the result of early/active case detection activities
• Functional Disability Unit• Policy, Strategy and 10 year action plan• Early Case detection, referral and management
National Annual Health Review 2073/74
Key Innovation/InitiativesLMD• Logistics starts Online Inventory Management System in 1 Centre Store Pathalaiya, 5 RMS and 75 Districts
• Logistics just starting e‐Government Procurement (e‐GP) portal
MD• PHC strengthening program initiated (073/74)
074/75• Hospital Management Officer –contract (20 Hospitals)• DHIS 2 roll out in 459 HPs• Budget provision for HFs for Waste Management
National Annual Health Review 2073/74
Key Innovation/InitiativesNHTC• Blended learning approach ( NSV,IUCD, 2nd tri abortion)• Structured OJT• Trauma Management Trainings• Revision of NHT strategy (amendments in according to the federal situation)
• District level Coach and Mentor Development• Training on Non Communicable Disease [PEN Protocol]• Web based Access to training related documents (manuals andreferences etc)
• Development of Comprehensive Reproductive Health Training sites[Seti, Bheri, Paropakar Maternity,West Regional Hospitals]
National Annual Health Review 2073/74
Key Innovation/InitiativesPHCRD• Budget provisioned for additional drug availability
• Drug Specification‐Bank developed
• Urban Health Promotion Center established and conducted.
• PEN program initiated in 10 districts.
National Annual Health Review 2073/74
NHEICC• Development of Golden 1000 days communication campaign directives.
• Information technology hub established and commenced
• Development of mobile & mobile apps initiated
• Awareness program for Sickle Cell disease prevention
• Approved FCTC 2030 Party Project
Key Innovation/InitiativesFHD• To announce all facilities with at least 5 FP methods available (in 5 districts)
• Interaction with newly married couple for fertility planning & • Micro planning in low PNC districts • Birth defect plan implementation• EOC Monitoring and Micro Planning in Remote VDC• Declaration of no more home delivery VDC• Obstetric First Aid training for paramedics• Establishment of one stop crisis management center
Key Innovation/Initiatives
NCASC• IRRTTR ‐ Identify, Reach, Recommendation, Test, Treat & Retain• mHealth‐Mobile Health Technologies (SMS reminders)• Biometric and Auto dispensing tool (ADT) • Community approach ‐ Out reach ‐ In reach
Budget Allocation FY 2074/75 (in billion)
S.N Program Allocation
1 Hospital Construction, Strengthening, Maintenance and Management Information System 6.55
2 Integrated Child Health and Nutrition Program 4.613 Integrated Reproductive Health and Women's Health Program 4.154 Primary Health Revitalization Program 2.3
5 Epidemiology, Malaria and Kala-azar Control and Natural Disaster Management Program 1.38
6 National Tuberculosis Control Program 1.257 National AIDS and STD Control Program 0.978 Logistic Management 0.499 NHEICC 0.33
10 NPHL 0.2711 NHTC 0.2412 Leprosy Control 0.23
Total (Approx) 22
Budget through Local Level (conditional grant)(total 14.90 Billion)
54
30
95
1 1% 0.30%
10%
20%
30%
40%
50%
60%
Primary HealthCentre, Health
Post
Integrated DistrictHealth Program
Hospitals Ayurbed HealthCenter and
Aushadhalaya
TuberculosisControl Program
Ayurved ServicesProgram
Health Education,Information andCommunication
Percen
tage
Programs
Program IssuesCHD: Declining coverage of DPT 3 compare to 2071/2072 Distribution of vaccine and logistics as per stock requirement Trained HR in HMIS‐ specially in Nutrition Irregular ORC Services
EDCD: • Malaria case increasing in non endemic district• Confirmation of suspected and probable malaria cases• Low blood slide examination rates for Malaria elimination program• Malaria case reporting (including private sector) and case investigation• KA Cases Increasing in Non‐endemic district• Inadequate Vector Surveillance of dengue & dengue control investigation including other VBDs & NTDs• TAS and TAS failure• Poor MDA coverage in Urban Settings• Integrated vector management(vector control)• Threat of emerging and reemerging diseases such as sickle cell anemia and thalassemia• Disaster management‐Availability of resources,role responsibility,guidelines,structure
Program IssuesLCD• Quality Services & Capacity building of health Institutions & Health workers
• Focus/Pocket Area Mapping & Planning, Identify Unreached areas & plan
Surveillance: Endemic and Low Endemic(Case based, Policy and Strategy on follow‐up, including record and report)• Early case detection Vs Disability, Stop transmission, Medical Rehabilitation & Community based Rehab
• LCD as a disability focal point • Need to develop capacity • Extend services up to palika and province level
Program IssuesLMD• LMIS
• Functioning and reporting on the Online IMS • Data Quality
• Telemedicine : Not well functioning
• Condition and space of the cold room & warehouse (small ware house, warehouse with Zinc sheet)
• Drug Management: Procurement, mobilization, redistribution and disposal
• Quality assurance mechanism
• Technical human resource in the store (need for pharmacist)
• Planned supply & management,maintenance.
Program Issues
MD• Lack of Policy on Physical Assets Management (PAM) including Maintenance.• Sick project (building construction): 6.5 %, and ownership • MSS of HP (Need to develop) and PHC (to be approved by MoH)• No provision for treatment support other than 8 listed diseases• Difficult procedure for recommendation to treatment of 8 listed diseases• Need simplicity in procedure regarding kidney transplantation.• Repetition in program (in heart disease MoH and DoHS both release fund)• Guideline for HFOMC approval• Monitoring is an issue• Effective use of evidences‐HMIS,Data quality.
Program Issues
NHTC• Unplanned selection of participants
• Training plan for programme and service (district and respective division)• Training as incentives rather than need based
• Preparedness of logistics for the utilization of trained human resources• Multi‐door trainings/ Integration of training• Selection process and criteria of Snr. AHW, Snr. ANM(age and level)• Rostering of resource person and appropriate use• Integrated package
Program Issues
NTC• Low TB Case Notification (Decreasing)• Proper Management of MDR Cases‐ specially in GoN hospitals• Rapid expansion of gene‐xpert sites & digital‐xray in major TB diagnostic
facilities• Expand/Strengthen community based DOTS
Program Issues
NPHL
• Implementation of health laboratory guideline 2073
• Establish, strengthen & expand public health laboratory at all levels
• Functional blood transfusion service in all districts
• Vendor licensing, reagent and kit validation
• Role of central Agency : Super special vs routine services
Program Issues…
PHCRD• Free essential drugs‐ Lengthy and complex Procurement process
• High demand for establishment of UHC and CHU but limited budget allocation
• Use of regular stock during emergency and no support to fulfill regular stock.
• Policy framework on Central Bidding and Local Purchasing
Personnel Management:• Lack of functional database • Insufficient information for strategic placement/transfer• Influence of pressure group over the system• HR placement in rural and remote area• Placement of scholarship doctors in Terai/ mountainous districts• One door placement of medical officers• Weak coordination between ministry ,department , region and district for administration/management
• Poor management of staff on long leave/ no departmental action• New appointment/promotion/Upgrading/padnam/posting like overlapping issues
Issues
Finance Management:• Delay in releasing budget & Program• Inadequate IT friendly A/C staff• TABUCS vs LMBIS implementation • Delay in release of donors fund • Capacity building for budget absorption• Lack of trained H/R for procurement• Huge burden of audit issues/ irregularities clearance (Improving)
Issues
DISASTER:Quick action & mobilization of MoH-District,Partners1.An Incident management system (IMS) is needed, with SOPs, to help
defining roles and responsibilities between all central bodies,revise updateguidelines,provision of proviencial RRT,EWARS
2.Any outbreak including zoonotic diseases should be considered in priority forpreparedness and response
3.Provision of emergency fund at district, province and Central levels4.Sufficient stock of essential/life saving medicines prepositioned at various
levels5.Provision of MRRT/MDRC,Surge teams for response support6.WASH and Health clusters need to work jointly for preparedness activities
and distribution of WASH items during response phase7.Immediate release of budget to the flood affected districts.
General issuesIssues
Private Sector‐ Reporting, Case Notification, Using Standard protocol, kit.
Involvement of stakeholders in dengue vector search and destroy‐EDCD
Sustaining the achievements (Full immunization, Leprosy elimiated, NT, Polio)
Surveillance (LCD, VBD, TB,)
Resource Constraints: (Building, Equipment, Impoverished, Training, Surveillance)
Capacity Building: Procurement,
Budget Constraints
Issues
Ownership of programs (Utilization of Trained HR (mechanism – transfer system‐)Darchula,Dadeldhura.
Strengthening operational research activities
Structure of major priority program in the federal context.
Budget Entry in LMBIS for Region and DistrictsNo need as previous, Entry in TABUCS
Stigma associated with different disease conditions like leprosy, HIV etc.
Development of Pharmacy Guideline for Primary Health Care
Guideline changing every year, Norms and Standards Not Uniform
General issuesInsurance program implementation versus health services
Continuation of emergency services in every settings‐eg:Birthing Center
Continuation Performance based management system
Evidence based decision planning
Updated website : Documentation and institutional memory,transparency
Integrated system vs vertical orientation
Mapping‐ planning and implementation (CHU, UHC, Equipment, Ambulances, district selection for new program)
GESI : FHD, PHCRD,MoH
Integrated/Joint Monitoring
GOVERNANCE:‘Issues/Information that are to be confidential are transparent whereas things that are to be transparent are confidential’
Some issues related to federalization
• Internalization of federal Context• Facilitating role : MoH, DoHS, RHD and Districts-up to the Palika level• Guidelines to be circulated to districts-Palika guideline either through
MOFALD or MOF & guidelines/request from ministry.• Salary of all staff ,Contract Staff• Immediate action based on the experiences , observation and issues
shared in the first day plenary session• Identify the role of DoHS-DoHS will plan accordingly.
Lets discuss,work together,more COMMUNICATION & coordination is required-
Your commitment and positive support made all success..
REVIEW FEDERALIZATION
DREAMDiscovery
DesignDESTINY
DREAMDISCOVERY
DesignDESTINY
THANKS FOR Your Attention..
Pers
onal
vie
w
THANKS FOR your hard works
