A Study on Sanepa Health Centre

Sanepa, Lalitpur, Nepal

Prepared By

Thakur Psd Lamsal

An Internship report submitted towards partial fulfillment of the requirements of

Bachelor of Health Care Management (BHCM)

“Awarded to Pokhara University”

National Open College

Sanepa, Lalitpur

February, 2009

i

A Study on Sanepa Health Centre

Sanepa, Lalitpur, Nepal

Prepared By:

Thakur Psd. Lamsal

An Internship report submitted towards partial fulfillment of the requirement of

Bachelor of Health Care Management (BHCM)

“Awarded to Pokhara University”

National Open College

Sanepa, Lalitpur, Nepal

February, 2009

ii

Acknowledgement

It is a great pleasure to submit my practicum an internship study report on “Sanepa

Health Centre” ( an community based organization ), Lalitpur as partial fulfillment of

the requirement for the degree “Bachelor In Healthcare Management ”.

I am grateful to “National Open College” affiliated to Pokhara University for

providing me opportunities to study and prepare the report of the Sanepa Health Centre

that is working for community development and Health Care Services.

I wish to express my heartful gratitude to the Advisor Mrs. Ranjana Shrestha Principle

Prof.; Mrs. .Kabita Khanal Program Coordinator , for their kind and cordial advisory

guidance to successful complete this study report in this state.

I am really thankful to Mr. Balmukund Khanal Secretary of Sanepa Health Centre and

Mr. Bishwodas Amatya Vice-President of SHC and coordinator co-workers of SHC for

providing assistances to complete this study report.

Last but not the least, I appreciate the comfort and intimate supports of my all colleagues

of “ Bachelor of Health Care Management” of National Open College as well as

Administrative and supportive staffs of NOC.

Sincerely yours,

Thakur Psd. Lamsal

March,2009

iii

Faculty of Management Studies

Pokhara University

Recommendation

This is certify that the Sanepa Health Centre Internship report tilted

A Study on Sanepa Health Centre , Sanepa, Lalitpur

Prepared By:

Thakur Psd. Lamsal

Has been prepared and Submitted as approved by this college.

This internship report is forwarded to Pokhara University.

Place:Sanepa,Lalitpur

Lalitpur, Nepal

BHCM Program

Coordinator

BHCM Program

National Open College

Date: February, 2009

iv

Faculty of Management Studies

Pokhara University

Recommendation

This is certify that the Sanepa Health Centre Internship report tilted

A Study on Sanepa Health Centre, Sanepa, Lalitpur

Prepared By:

Thakur Psd Lamsal

Submitted towards partial fulfillment to the required for the degree

“Bachelor of Health Care Management ’’ The following panel of has been approved of

Health care management the following panel of examiners.

S.N. Name Designation Signature/Date

v

Tables of Contents

Contents Page No:

Acknowledgement III

Certification of Authority IV

Recommendation V

Approval Letters VI

Tables of Content VII

List of Figures X

List of Tables XI

Abbreviations XII

Abstract XIV

1. Introduction and Methodology

1.1 Introduction 1

1.2 Background of the Study 1

1.3 Purpose and Objectives 2

1.4 Organization Paper 3

1.5 Methodology 3

1.6 Scope of the Study 4

2. Organization Under Study

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2.1 History 5

2.2 Promoter 9

2.3 Management (Governing Board/Executive Board) 9

2.4 Philosophy/Vision and Mission 11

2.5 Location and Layout 11

2.6 Staffing and organ gram 12

2.7 Services Rendered including Statistics 12

2.8 Future Plan 15

3. Programs

3.1 Expanded Program on Immunization

3.1.1 Magnitude of the Health Program 16

3.1.2 Service Area 16

3.1.3 Program Objectives 16

3.1.4 Target Population 17

3.1.5 Implementation 17

3.1.6 Monitoring and Evaluation 17

3.1.7 Outcomes 18

3.2 Family Planning

3.2.1 Magnitude of the Health Program 19

3.2.2 Service Area 19

3.2.3 Program Objectives 19

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3.2.4 Target Population 20

3.2.5 Implementation 20

3.2.6 Monitoring and Evaluation 20

3.2.7 Outcomes 22

4. Administrations

4.1 Human Resources/Personnel Management 23

4.2 Finance (Including budgetary control accounting and materials) 25

4.3 Health Communication, Planning and Management 28

4.4 Management Information System 29

5. Analysis and Findings

5.1 Analysis (Financial sustainability, Costing, work flow,

Productive, Quality) 30

5.2 Findings 36

5.3 Critical Observation 36

6. Conclusion 37

References 38

Appendix 39

Bibliography

List of Figures: Page. No.

viii

1. Location and Layout of Sanepa Health Center 11

2. Organogram of SHC 12

3. The HIMS of SHC 29

4. Graphical Representation of Immunization coverage

in FY 2061 to 2065 30

5. Graphical Representation of Immunization Coverage in FY 2061 to 2065 30

6. Graphical representation of monthly coverage of vaccination in 2063 32

7. Graphical representation of monthly coverage of vaccination in 2064 33

8. Graphical representation of family planning Coverage in FY 2061 to 2065 35

List of Tables Page. No.

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1. List of chief guest in Opening Ceremony 7

2. Management and Governing body of Sanepa Health Canter 9

3. List of doctors , paramedical, officers, and volunteers in SHC 13

4. List of specialties doctors , Health professionals, and volunteers in SHC 23

5. List of fixed deposit fund in SHC 25-26

6. Audit report of fiscal year 2063/64 27

7. Immunization coverage in FY n2061 to 2065 30

8. Monthly coverage of Vaccination in FY 2063 31

9. Monthly coverage of Vaccination in FY 2064 33

10. Family Planning coverage in FY 2061 to 2065 34

Abbreviations

x

ANM Auxiliary Nursing Midwife

AHW Assistant Health Worker

ARI Acute Respiratory Infection

ANC Ante- Natal Care

AIDS Acquired Immune Deficiency Syndrome

BHCM Bachelor In Health Care Management

CPR Contraceptive Prevalence Rate

CDP Community Drug Program

DPT Diphtheria Pertusis Tetanus

DOTS Directly Observation Treatment Services

HP Health Post

HIMS Health Information Management System

IUCD Intra Uterine Contraceptive Device

IEC Information Education Communication

MOH Ministry Of Health

MCHW Maternal Child Health Worker

PHC Primary Health Care

PNC Post Natal Care

SHC Sanepa Health Centre

SHP Sub Health Post

Abstract

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This BHCM Internship study is carried out in Sanepa Health Centre located in Mohan

Chautari of Lalitpur district Ward No. -2 of country Nepal. This Internship study is

basically focused on managerial aspects and planning sides of Sanepa Health Centre and

its mobile health camps organized by SHC. The main objectives of this practicum which

was performed for 6 weeks is to studying management practices adopted by SHC as well

as how it has delivered its services to Sanepa Community and its surroundings. Data and

Facts included in this reports were collected by direct observation, Interviews , and

Recorded information from top management level to front line management. Sanepa

Health Centre is totally independent community health centre so the donation and

promoters are from Sanepa Community and other. We found good relationship and

coordination between volunteer doctors, health professionals, donors organizations ,

members, Nurses from Lalitpur Nursing Campus.

Sanepa Health Centre is providing quality care to poor and needy peoples, free of cost. It

has run all major programs in effective way through trained manpower, effective medical

practices, under continuous supervision of clinicians. In the same it has gained its success

in conducting various programs with close association with NGOs, INGOs, Lalitpur

Nursing Campus, Star Hospital etc.

As being student of Health Care Management, We have learnt about Public Relation,

Community Participation, Social Work practices, Management Practices and Its

implementation. SHC has its limitation such as not full utilization of their building as

there is only morning counter, not day and evening. SHC has not association with NGOs

and INGOs which is one strategy to boast up of the community health Center, this is

lacking in SHC. The record keeping system is only manually.

Chapter 1

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1. Introduction and Methodology

1.1. Introduction

Health is the fundamental human right of all citizen of a nation. Health is related to the

overall development of the country and it is sensitive issue. It is the duty of nation to

provide health care services to its citizens.

Health is defined by WHO as, “Health is the state of complete physical, mental and

social well beings and not merely absence of disease and infirmity.” – WHO (1948)

Health care services are rendered through various systems. In Nepal, various form s of

Healthcare delivery system. These are ranging from the Governmental bodies, National

and International bodies, and public and well as private sectors. Among them, Sanepa

Health Centre is such type of unique health care organization located in Mohan Chautari

of Lalitpur district ward No-2, Sanepa Health Centre was established in 1987 as small

unit of self help organization has now actively and regularly providing varied medical

services to the poor and needy people, with minimal cost.

Sanepa Health Centre was created by four or five service loving persons of sanepa, with

the help of local doctors and nurses.

1.2. Background of the Study

Sanepa Health Centre is the community health centre of Sanepa. There administrative

and clinical works are carried out by local doctors and managing board. To run any

institution in effective and efficient way there is need of professionals or health

managers. The demand of professionally trained administrator is increasing day by day in

order to control over the management activities because the health sector in todays time

are facing different problems from the management perspectives point of views.

Therefore services rendered to the patients many not be satisfactory.

xiii

However in this challenging and competitive time , there is necessary of skilled

administrator. In addition for the fulfillment of BHCM degree and to provide better

opportunities to gain practical knowledge about different management practices, National

Open College has assigned observation visit of BHCM 5 th semester student. During the

observation visit, each of student used to stay in Sanepa Health Centre from 7:00 AM to

9:00 AM. They used to study the functioning of SHC, so that they can learn practical

knowledge how to handle the different programs and activities. They also collected the

relevant and sufficient data and information of their respective services for the

preparation of practicum report. A s well as they also visit health camps organized by

SHC. These student have work hard in the process of collecting information required for

the report.

1.3. Purpose and Objectives

Purpose

The main purpose of this practical study is to learn about management system of

“Sanepa Health Centre”. For this following are the objectives :

Objectives

1. To observe the activities perform by Sanepa Health Centre and understand from

managerial aspects.

2. To observe the nature service rendered by SHC.

3. To study the problem related to management.

4. To collect and analyze data.

5. To study organization and management of services and prepare the

comprehensive report.

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1.4. Organization of the Paper

The practical report will be divided into six chapters namely, Introduction and

Methodology, Organization under Study, Programs, Administration, Analysis and

Findings and Conclusion.

Chapter 1 Introduction and Methodology includes Introduction of the Department,

Background of the Study, Purpose and Objective, Organization Paper, Methodology and

Scope of the Study.

Chapter 2 Organization Under Study includes History of Sanepa Health Centre,

Promoters, Management (Composition of Government Body/Executive

Body),Philosophy/Vision and Mission, Location and Layout, Staffing(Including

Ogranogram), Services Rendered and Future Plans.

Chapter 3 Programs Includes Mangnitude of Health Programs, Services Area, Target

Population, Program Objetives Implementation , monitoring and Evaluation, Outcome

(Target, Beneficiaries and Finance).

Chapter 4 Administration includes Human Resource /Personnel Management, Finance

(Includes budgetary control accounting, and materials), Health Communication Planning

and Management (promoters and awareness) and Management Information System.

Chapter 5 Analysis and Findings includes analysis (financial sustainability, costing ,

work flow, productivity and quality), Finding Critical Observation.

Chapter 6 Conclusion includes conclusion of the various programs and Sanepa Health

Centre under the study with the References and Appendix.

1.5. Methodology

All the data collected in this report of the Sanepa Health Centre is both Primary and

Secondary data. Primary data is collected from the discussion with the Administrator

Supervisor and Administrative staffs Secondary data is collected from annual reported

record and internet browser.

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1.6. Scope of the study

It deals with :

a. Significance of study:

The study deals with the complete knowledge of the concern services from the

management perspective point of view gained by the researcher. This study also helps the

health care provider to know the problems and weakness in their management so that

they can evaluate themselves and take corrective actions to perform better.

b. Limitations of the study

This study is limited to only one concerned service of the Sanepa Health Centre. It may

not be applicable to other health care organizations.

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Chapter 2

2. Organization under Study

2.1. History

The concept of Health Care Services in Nepal was introduction at 1768-1888 as an

Ayurvedic medicine in National Health System. After that on 1889-1948 Modern Health

Care was established with Hospital and Medical Dispensaries at Administration

Headquarters.

In 1951, periodic development plans introduced with the objectives of increasing gross

domestic products provide employment and improve living standards of the people. The

Department of Health Services were established in 1953 under the Ministry of Health.

DOHS carry out the responsibility promotion, regulation, and management of the

hospitals,Ayurvedic Dispenseries/school and unit of product of Ayuervedic medicines.

On the other side the preventive health care was beginning with establishment of vector

born diseases control unit in Dang in 1951. Then in 1954 NGOs started to provide Health

Care Services.

During the first five year plan(1956-61) the ministry of health established 33 hospitals in

the urbanization areas like Kathmandu, Biratnagar, Sunsari, Nepalgung, Dhankuta, and

Dharan. Ministry of health prepared the first plan to establish a modern health system in

1956. Various types of health programmed were existed as vertical project in which

foreign assistance was the major source of funding to provide different types of the health

services.

In 1962 many District Hospital, Zonal Hospital at Zonal Headquarters was established as

well as vertical projects was also established. Then after in 1968 single specialty hospitals

was established with the providing quality health services in specific services. Such as

Kanti Children’s Hospital, Eye Hospital, Basic Health Care Services as Health-Post,

Appointment of village health workers, Health Manpower training program transferred

by IOM by MOH was started in 1972.

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First Long Term Plan was established on 1975-1990 for the First Perspective Health Plan,

formulated with a calendar of operations for the 5th , 6th, and 7th five year plans with

emphasis on provision of comprehensive basic health services. 5th five year development

plan(1975-1979) was to provide minimum health care to maximum number of people. In

1978 the government started the integrated community health services development

project which was entrust with the responsibility of integrated vertical programmers and

expanding basic health service up to the community level and providing health care to

doorsteps of the people. In 1978, after the acceptance of Primary Health Care by the Year

200(HFA-2000) by the countries of the worlds s key to the attainment of Health for All

by the Year 2000 A.D. Nepal stared to expand and strengthen integrated approach to

meet the national goal.

The sixth and seventh five year development plan (1979-1991) was the era of integration

and minimum health services to the doorsteps to the people of the country. The concept

of “Integration” was promoted to organize health care in rural area of the country.

One major aspect of integration is that the single purpose health workers in the vertical

health programmers were to be converted into the multipurpose health workers who

would combine the work of vertical workers such as Malaria, Leprosy, Smallpox, and

Family Planning and also provide preventive care, health education and simple health

care.

A pilot study was done on integration and community health approach for health services

delivery and the success was enough to introduce the programmed in the country in 1978.

The government started integration of vertical programmer activities in the main stream

of the health services.

In 1978 Health For All, Primary Health Care was established to provide various health

services to people and female community health volunteer. Regional Hospital, NGOs

hospital, Limited Private Health Facilities, Integration of Vertical Health Programs with

the basic health service was established in 1984.

In 1991 National Health Policy was established with establishment of Sub-Health Post,

large scale private hospitals, Medical Colleges, Teachings and Training Schools and

xviii

Integration of Hospital and Public Health Office under District Health Office with

Community Drug Program, National Level, Regional , Zonal Level, District Level and

Electro constituency. After establishment of District health post and sub health post and

carried to all administrative and technical works to promote health standard of people.

History of Sanepa Health Centre

Sanepa Health Center was established in 2045 B.S.(1959 AD). It was established before

20 years ago when the Shanta Bhawan Aspatal Was shifted to recent Patal Hospital Area.

Sanepa Health Centre is a community based health care organization. The Sanepa Health

Centre was established by four or five services loving persons of Sanepa, with the help

of local doctors and nurses. Sanepa Health Organization is providing free health care

services to the poor and needy people of Sanepa and adjoining areas. Located at Mohan

Chautari of Sanepa of Lalitpur District of Nepal .

Sanepa Health Centre celebrates it’s annual function in the month of Baisakha in every

year as birth anniversary. This celebration is well attended by the residents of the Sanepa

Community and dignities of Lalitpur. This celebration is celebrated not only as birth

anniversary but as a local festival to honor the volunteers and donors. Prime Ministers as

well as Ministers are usually the chief guest for this celebration.

Following are the lists of distinguished delegates and date who attended Sanepa Health

Centre’s anniversary programs.

S.N. Date Name of Delegates Designation

1. 2042/02/02 Rudra Psd. Giri Health minister

2. 2045/01/18 Kesar Bhadur Bista Education and Cultural

Minster

3. 2046/01/18 Rabindranath Sharma Industrial Minister

4. 2047 Sahana Pradhan Industrial Minister

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5. 2048 Krishna Pd. Bhattrai Prime minister

6. 2049 Krishna Pd. Bhattrai Former Minister

7. 2050 Krishna Pd. Bhattrai Former Minister

8. 2051 Krishna Pd. Bhattrai Former Minister

9. 2052 Manmohan Adhikari Prime minister

10. 2053 Balaram Ghartimagar Physical Planning and

development

11. 2054 Bamdev Gautam Vice Minister

12. 2055 Sailaja Acharya Vice Minister

13. 2056 Dr. Ram Baran Yadav Health Minister

14. 2057 Govinda Raj Joshi Home Minister

15. 2058 Tara nath Ranabhat Speaker

16. 2059 Sarad Singh Bhandari Health Minister

17. 2060 Parsu Narayan chaudhary President Raj parisad

18. 2061 Dr. Shankar Sharma Vice –President, National

Planning Commission

19. 2062 Buddhi Raj Bajracharya Cultural and Tourism Minister

20. 2063 Amik Sherchan Vice Minister

21. 2064 Sahana Pradhan Foreign Minister

Table no. 1. lists of distinguished delegates and date who attended Sanepa Health

Centre’s anniversary programs.

2.2. Promoters

xx

The Sanepa Health Centre is a totally community based Health Centre so the promoters

and donors are local peoples and members. There are 130 monthly and annually donors

for SHC. There are 16 doctors and 7 other health professionals involve in SHC. The

organization donors are Lalitpur Sub- Metropolitan and Lalitpur development

Committee.

2.3. Management /Government Body

Sanepa Health Centre is a community based health centre. It has services which is

targeted to local people who are needy and seek.

The Sanepa Health Centre consists of various dynamic members for its operational work.

Following are the current members of Executive Member of This Sanepa Health Centre.

xxi

Table no. 2.

Management

Body

President

Vice President

Member Secretary

Dr. Achut Mani Achary

Dr. Laxami K.C.

Dr. Gaya Prasad Baral

Shyam Sundarlal Chhachhapaati

Dr. Madan Kumar Piya

Chandra Bhadur Silwal

Dr. Bramma Dev Jha

Bishwa Das Amatya

Dr. S.K. Pradhan

Balmukund khanal

Dr. Harihar Khanal

Treasurer Jina Shrestha

Dr.Yosodhara Pradhan

Member Dr.Yosodhara Pradhan

Dr.Tekendra Karki

Rebecca Singa

Dr.Nasibman Singh Pradhan

Bhairab Gorkhali

Dr. Deevendra Maharjan

Nati Maharjan

Dr. Toran K.C.

Purna Kumari Shrestha

Dr. J.N. Giri

Madan Amatya

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2.4. Philosophy/Mission and Vision

Sanepa Health Centre has following Mission, Vision and Philosophy:-

Sanepa Health Centre has dream of establishing Community Hospital .

To ensure coordination and cooperation among the member health

centre.

To strengthen management capacity of members institution through

training.

To promote Public Health awareness among the population in Sanepa.

2.5. Location and Layout

Sanepa Health Centre is located at Mohan Chautari,Sanepa,Chakrapat,Lalitpur district of

Nepal.

N Sanepa

kalanki Sanepa chowk Sadobatto

S

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Sanepa Health Centre

Star Hospital

2.6. Staffing including organ gram

Fig. no.2. Organogram of SHC

2.7. Services Rendered/Different Programs

Sanepa Health Centre has following Current Health Services and Programs:-

Medical Services

Sanepa Health Centre is an unique organization run by local people for the welfare of

local people. It provides regularity, continuity and trustworthy services with having

motto of organization since its inspection. Services is rendered 360 days out of 365

days into a year. The medical services provided, through, free of cost, is standard and

rendered by qualified doctors and health workers. The medical services is provided

xxiv

Executive Board

Administrator Doctors Para medicals

Volunteers

Volunteers NursesPeon

two hours in the morning from 7:00 AM to 9:AM. A nominal registration fee the Rs.

10.00 and 5.00 is charged for the new and old patients respectively. Registration is

done by local volunteers.

Medical services includes medical treatment ,Immunization, Family Planning etc. The

medical services provided over the years in the expanding scale are in respect of the

diseases relating to children, skin, chest, cancer, gynecological, ear, eye, throat, heart,

dental, and other general medications. Treatment of minor trauma, injection, wound

dressing services, asthma inhalation services and miscellaneous minor problems are

attended by experienced health workers. Specialty clinics fall on the day specialist

come to the clinic. Patan Hospital has been kind to accepts referrals since last ten

years.

Followings are the current weekly Specialty clinic run by the specialist :

Days Name of Attending Doctor Specialist

Sunday

Dr. Yoshodhara Pradhan Gynecologist

Dr. Laxmi R. Giri Gynecologist

Dr. J.N. Giri Physician

Dr. Deevendra Maharjan Physician

Monday Dr. Bramma Dev Jha Physician

Tuesday

Dr. Hari Har Khanal Cardiologist

Dr. Premal Kumar Joshi ENT

Thursday

Dr.Nasib Man Singh

Pradhan

Orthopedics

Dr. Madan Kumar Piya Chest,Oncology

Dr. Toran K.C. ENT

xxv

Friday Dr. Achyut Mani Acharya Pediatrics

Saturday

Dr. S. K. Pradhan Dental

Dr. J. N. Giri Physician

Dr. Tekendra Karki Pediatrics

Dr. Jaya Prasad Baral Venerologist

Dr. Men Kaji Shrestha Ultasonologist

Para Medical Persons Mr. Ramhari K.C.

Mr. Binod Bista

Mr. Chatagi.

Mrs. Krishna Sharma

Mr. Mohanwadan Tamrakar

Mr. Khadak Bdr. Thapa.

Volunteers Mr. Bishwa Das Amatya

Mr. Chandra Bdr. Silwal

Mr. Balmukunda Khanal

Mrs. Vhairaja Gorkhali

Mr. Nati Marjhan

xxvi

Table no. 3. current weekly Specialty clinic run by the specialist

Mobile Health Camps

Sanepa Health Centre offers mobile health camps to surroundings districts twice a year.

Free-Medical Check-ups

Medicine Distributions

Environmental Programs

Social Welfare

Spiritual Programs

2.8. Future Plan

Sanepa Health Centre has followings future plans:-

To make a community Hospital in near future.

To equipped to Laboratory Facilities with modern Technology.

To Make community hall.

To make a community park.

To extended health services to remote areas.

To installed a x-ray machine in near futures.

xxvii

Chapter 3

3. Programs

Sanepa Health Centre of Lalitpur district has launched all together 2 programs which are

given below.

Immunization Program

Family Planning Program

3.1. Expanded Program on Immunization (EPI)

31.1. Magnitude of Health Program

EPI is considered as one of the most-cost effective health intervention. Vaccine

preventable disease are routinely reported through the MIS complemented by

appropriate surveillance and outbreak response . The immediate objectives of the EPI

programs are to eliminate Neonatal Tetanus(NNT), to reduce measles morbidity and to

eradicate poliomyelitis. Thus these program has been greatly focused by Sanepa Health

Centre through its outreach camps and programs.

3.1.2. Services Areas

The services area of Sanepa Health Centre is Sanepa Community and its neighboring

community like Balkhu, Teku, Kupondol, Kuleshwor etc.

3.1.3. Program Objectives

The main objectives of Expanded Program on Immunization are as follows:-

To eliminate child mortality and morbidity rate.

To target all the pregnancy woman TT2+.

To provide vaccination services

To decrease Infants (<1 year) death rate due to lack of vaccination.

To give vaccination services to poor and needy people.

To obtain about 100% vaccine coverage in Sanepa.

xxviii

3.1.4. Target Population

In Sanepa Health Centre, all infants, children’s and woman of reproductive age are the

target population of this program. This is program is for permanent residents and

temporary population of Sanepa as well as neighboring Community.

3.1.5. Implementation

By providing immunization service through different camps and health clubs

collaboration in Sanepa and its surroundings.

By providing public awareness program.

By providing immunization program throughout the year that is every 1st and 15th

of the months.

3.1.6. Monitoring and Evaluation

Monitoring and evaluation is done after completing the all control program and it is done on the

basis of data collection from different wards. The work done by the health clinic in charge and the

final report is submitted to the Sthaniya Bivag. There was no any routine monitoring and

evaluation of the services by the Sthaniya Bivag. However, sometimes, staffs from Sthaniya

Bivag visit the health post. For the evaluation following indicators are used as follows;

The indicators used for the program of immunization are as follows;

Coverage

Coverage = Total no. of infant(<1 yrs) immunized X 100

Total population of <1 yrs

Dropout rate

BCG vs. measles

No. of immunized by BCG – No. of immunized by measles X 100

No. of immunized by BCG

DPT-1 vs. DPT-3

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No. of immunized by DPT-1 –No. of immunized by DPt-3X 100

No. of immunized by DPT-1

Polio-1 vs. polio-3

No. of immunized by polio-1 – No. of immunized by polio-3 X 100

No. of immunized by polio-1

Wastage rate

Total vaccine expenditure in dose – Total shots(including all) X 100

Total vaccine expenditure in dose

Monitoring and Evaluation is done through monthly basis. In Sanepa Health Centre there

are three programs. The Program is on 1st and 15th on the every month. In order to

increase the health service in effective and efficient way these major tools, other

monitoring, and evaluating each upgraded in Sanepa through local doctors involvements,

local health professionals, volunteers bodies etc.

3.1.7. Outcomes

Due to effective implementation of Immunization the coverage BCG, DPT, Polio,

Measles from FY 063 to 064 is in increasing rate.

Overall observation of immunization coverage by SHC in FY 2061 to 2064 is

increasing by 5percantage due to service expansion and publicity.

xxx

3. Programs

3.2. Family Planning

3.2.1. Introduction of Family Planning

According to National Health Policy 2048, Family Planning Program has been introduced

in order to reduce growing population through different program. National Health Policy

(1991) related to National Reproductive Health and Family Planning (RH/FP)

programmed is to expand and sustain adequate quality family planning services to the

community level through all health facilities, hospitals, primary health centers, health

post, sub-health post. Mobile voluntary surgical contraception (VSC), Contraceptives

measures such as condoms, Pills are distributed from SHC.

3.2.2. Services Areas

The services area of Sanepa Health Centre is Sanepa Community and its neighboring

community like Balkhu, Teku, Kupondol, Kuleshwor etc.

3.2.3. Program Objectives

i. To assist individual and couple to space and limit their children.

ii. Prevent unwanted pregnancies.

iii. Improve their overall reproductive health.

iv. To increase health manpower of communities and female participation

v. To give education of safe motherhood.

vi. To provide general health check-up.

xxxi

3.2.4. Target Population

Family Planning program is mainly targeted to married and unmarried individuals and

couples of Sanepa communities and surrounding localities.

3.2.5. Implementation

In SHC Family Planning are implemented through different programs like Safe

motherhood consultation, Pills, Devo, Condoms distribution.

SHC often organizes awareness program, annual anniversary, Speech focus on

different health problems and family planning.

Availability of doctors in SHC like Gynecologist, Pediatrics, Family Physician etc

3.2.6. Monitoring and Evaluation

SHC provide Family planning monitoring by following activities .

o Family Planning Counseling :-It is important activity for assisting client

to make informed about regarding appropriate Family Planning nethod..

o Spacing method:- Spacing method includes Depo Provera , Pills,

Norplant, and IUCD which is also available in Sanepa Health Center.

o Referral :- In this SHC Condom and Pills are supplied through FCHVS.

While request for other family make informed about regular appropriate

planning method . Family Planning counseling services are provided to

potential client by FP advices. Planning services are referred to the PHC,

Clinics, hospitals or to mobile camps.

SHC evaluate Family Planning Programs through following indicators.

Total Fertility Rate :- TFR express the average number of children

a women will bear by the end of a reproductive life under

prevailing fertility conditions.

xxxii

Contractive prevalence rate: CPR express the percentage of

MWRA using any modern contraceptive devices at a point of

time.CPR is calculated as follows:

No. of current users of modern FP method

CPR= *100

Married women of reproductive age (MWRA)

3. Couple Year of Protection: CYP express the number of years for

which a couple would be protected from being pregnant by modern

contraceptive methods provided during the year. CYP is calculated as

follows:

(VSC= 13CYPs, Norplant= 5CYPs, IUCD= 8 CYPs, 13 Pills cycle=

1CYPs, 4 doses of Depo= 1CYPs, 150 Condom= 1 CYPs )

4. Methods- Specifices new acceptors as a % of MWRA : It express the

Percentage of MWRA using specific FP methods for the first time in

specific period which is calculated as follows:

Method specific new acceptors

*100

Married women of reproductive age (MWRA)

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3.2.7. Outcomes

i. Family Planning Services will be provided to couples.

ii. It is found that family planning program activities (CPR Rate) in 2063/2064 to

2064/2065 has increased from 4317 to 4524.

iii. Norplant’s and IUCD will be made availability by next year

iv. Pills, Depo, and Condoms is distributed by SCH.

iv. VSC service is provided through mobile camps.

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Chapter 4

4. Administrations

4.1. Human Resources/Personnel Management

Human Resources are one of the fundamental to handle any organization for its

effectiveness and efficiency. Therefore Sanepa Health Centre has 17volunteer specialist

Doctors, 6 others Health professionals and 5 local volunteers of Sanepa Community. The

volunteers nurses come from Lalitpur Nursing Campus.

Sanepa Health Centre is one of examples of social health organization so the services

provided by coordination, cooperation and community participation of Sanepa and

surroundings communities. Therefore administrative and medical staffs gives their

services for the motive of social work and satisfaction.T he SHC always welcomed

volunteer personnel from the country.

Followings are the current Specialty clinic run by the specialist Doctors :

Name of Attending Doctor Specialist

Dr. Yoshodhara Pradhan Gynecologist

Dr. Laxmi R. Giri Gynecologist

Dr. J.N. Giri Physician

Dr. Deevendra Maharjan Physician

Dr. Bramma Dev Jha Physician

Dr. Hari Har Khanal Cardiologist

Dr. Premal Kumar Joshi ENT

Dr.Nasib Man Singh

Pradhan

Orthopedics

xxxv

Dr. Madan Kumar Piya Chest,Oncology

Dr. Toran K.C. ENT

Dr. Achyut Mani Acharya Pediatrician

Dr. S. K. Pradhan Dental

Dr. J. N. Giri Physician

Dr. Tekendra Karki Pediatrician

Dr. Jaya Prasad Baral Venerologist

Dr. Men Kaji Shrestha Ultrasonologist

Health Professionals

Mr. Ramhari K.C.

Mr. Binod Bista

Mr. Chatagi.

Mrs. Krishna Sharma

Mr. Mohanwadan Tamrakar

Mr. Khadak Bdr. Thapa.

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Volunteers

Mr. Bishwa Das Amatya

Mr. Chandra Bdr. Silwal

Mr. Balmukunda Khanal

Mrs. Vhairaja Gorkhali

Mr. Nati Marjhan

Table no.4. Health professional in SHC.

4.2. Finance (Including budgetary control accounting and materials)

Finance is the main back bone for any organization.Sanepa Health Centre raised their

financial fund through different activities like life long membership, Temporary

membership, donors, promoters, organization , mobile health camps, advertisement

through souvenir , from the rituals speaking programs, lab tests, health services, programs

etc.

Sanepa Health Centre is community based health care organization. So, the finance is

generated from the community peoples, members, Local donors and other organizations.

The Sanepa Health Care centre has various fund raising programs. Among this, the main

financial resources is a donation of the locals in a monthly basis. Its is very small and

ranges from Rs. 51 to 1000 per month per person. The name and photo of these persons

appears in each souvenir every year.

Following are the people who donate in Sanepa Health Centre’s fixed Deposit Fund

(ACHHYA KOSH)

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S.N. Name Amounts(NRs)

1. Gagat Kumari/Shyamlal Medical Treatment Kosh from Shiva

Shrestha

1,00,111

2. Shree Magavhagat GyanMahaYagya Management Committee 80,000

3. In memory of Father Amber Bdr and Mother Khim Kumari

From Ram Bdr K.C.

75,000

4. Dhalak Bdr/Om Kumari Hamal 55,555

5. Purushuttam Dev Pandey 52,000

6. In Memory of Sudha Khetan From Biharilal Khetan 51,000

7. Late. Prem Bikram Hamal’s Trust 51,000

8. Rama Sundari Treatment Trust From Alok Shrestha 50,000

9. Purna Kumari Shrestha 21,000

10. Suresh Man Shrestha 10,000

11. Sudha Shrestha 10,000

12. Jeena Shrestha 10,000

13. Patali Shrestha 5,000

Total 5,60,782

Sanepa Health Centre has strong budgetary control. The purpose of such budgetary control is control of cost and performance appraisal. They make annual audit their revenue and expenses according to the rules and regulations of the Government of Nepal . The audited fiscal year 2063/2064 budget is as follows.

Sanepa Health Centre

Auditors Reports Fiscal Year 2063/2064

xxxviii

S.N. Revenues Amount S.N. Expenses Amount

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

Bank 84,379/95

56658.62

35,85,00.00

3,53,111.13

84,518.00

25,000.00

30,000.00

1,39,538.50

3,002.00

10,000.00

80,000.00

25,000.00

1,51,112.00

51,000.00

7,500.00

1,00,000.00

15,04,940.25

1. Salary Allowance 1,02,900.00

3,57,705.00

32,500.00

21,205.27

76,753.00

63,097.00

17,500.00

15,517.00

5,415.12

52,715.00

51,344.51

4,76,000.00

4,900.00

1,58,827.88

990.47

15,04,940.25

Cash 2,278/67

Total 86,658/62

2.

3.

Medical Equipment

Shree Indreni Park Conservation

Bank Fixed Deposit 2,83,000

4. Maintenance

Cash 75,500

Total 3,58,500/00

5. Organization Operation

Donation/ interest 6. Toilet/Bathroom Construction

Registration/ lab 7. Souvenir Publication

Dev. And credit Bank

Parliament Fund

German Embassy

Membership

Advertisement

ShreeMadVhagwat Geeta Yagya

Explore Himalaya

Fixed Deposit Fund

Shuva Tara School

Park Construction

Medicine Donation

Total

8.

9.

10.

11.

12.

13.

Annual Anniversary

Telephone/Water

Consumable Goods

Non-Consumable Goods

Modhati

Nepal Bank Ltd. 1.76,000.00

HimGanga 1,00,000.00

Gorkha Finance 2,00,000.00

Total 4,76,000.00

Saving Gorkha Finance

Chalti Baink(Nepal Bank Ltd.)

Cash

Total

Table no.6. SHC Auditors Reports Fiscal Year 2063/2064

4.3. Health Communication, Planning and Management

4.3.1. Introduction

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Sanepa Health Centre organizes different awareness program, mobile camps, blood

donation program etc. SHC publish annual souvenir about the whole year’s activities.

Sanepa Health Centre organizes annual program with the participation of whole sanepa

community with the different delegates and others. Sanepa Health Centre has close

relation with patan clinic Network. SHC has active involvement in Community Health

Association (CHAL).SHC has health immunization programs on every months date of

1st and 15th day of months. The immunization schedule are polio drop, vitamin A, Family

Planning. Sanepa Health Centre has conducted health camp in following places like

Sindulpalchok, Hatwawada, Thankot etc.

Following are the major outreach clinic organized by Sanepa Health Centre.

Newakot,Kurintar- 2 times

Bhote Jatra- 10 times

Sankata 12 years Mela- 1 time

Lakuri Vhangyang-1 week health camps

SARRC Camp

Scout Camp in Godawari- 1 time

4.3.2. Objectives

i. To increase awareness and knowledge of the people.

ii. To increase positive attitude.

iii. To increase healthy behavior and participation.

iv. To raise health awareness of the people of health and to prevent diseases.

4.3.3. Goal

To provide Health awareness in Sanepa Community.

To Organize Mobile health camp in Sanepa Commuity.

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To Keep record in SHC.

4.4. Management Information System

MIS is a generic term that refers to custom designed systems that gather, store, and report

data to and make it retrievably by users. The purpose is to “help the healthcare

professionals plan, execute and control the organization activities.

Following are the Information Management System found in Sanepa Health Centre.

Fig.no.3. The HIMS of SHC

Chapter 5

5. Analysis,Findings and Critical Observation

5.1. Analysis

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Integrated Hospital

Management System

System

Patient Registration System

Medical RecordsClinical System

Administrative System

Accountings SystemFinancial SystemHRM SystemInventory System

Facilities Management System

Laboratory SystemPharmacy System

General Management System

Medical Application

The Sanepa Health Centre is our practical place and Sanepa Community is our practical

area. During our visit we analyze all programs and activities of SHC.

Immunization Coverage in FY 2061 to 2065

2061/2062 2062/2063 2063/2064 2064/2065

25637 26127 28217 29215

Table no.7. Immunization Coverage in FY 2061 to 2065

Graphical Representation of Immunization Coverage in FY 2061 to 2065

Fig. No.4. Immunization Coverage

This figure shows that in SHC immunization coverage is increasing each year. The

reason may be population increase in community and immunization program conducted

by SHC.

Monthly Coverage of Vaccination in 2063

Months BCG DPT Polio Measles Total

Baisakh 1 12 12 8 33

xlii

Jestha 8 20 18 15 61

Ashad 3 19 18 7 47

Shrawan 4 13 16 3 36

Bhadra 4 22 20 8 54

Ahswin 3 14 13 2 31

Kartik 1 16 16 13 46

Mansir 4 19 16 6 45

Poush 3 15 16 5 39

Marg 1 15 15 9 40

Falgun 1 10 12 8 31

Chaitra 1 11 11 7 30

Total 34 186 183 91 494

Table no.8. Monthly Coverage of Vaccination in 2063

Graphical Representation of Monthly Coverage of Vaccination in 2063

xliii

Fig. no.5. Graphical Representation of Monthly Coverage of Vaccination in 2063

This figure shows that in month of Jestha the Vaccination Coverage has maximum .

xliv

Monthly Coverage of Vaccination in 2064

Months BCG DPT Polio Measles Total

Baisakh 7 11 1 9 28

Jestha 3 19 19 6 47

Ashad 3 22 18 3 46

Shrawan 2 13 11 13 39

Bhadra 2 26 22 6 56

Ahswin 1 19 19 5 44

Kartik 6 12 13 6 37

Mansir 5 7 8 10 30

Poush 4 22 16 12 54

Marg 3 19 19 6 47

Falgun 2 20 18 12 52

Chaitra 1 17 17 9 44

Total 39 207 181 97 524

Table no.9. Monthly Coverage of Vaccination in 2064

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Graphical Representation of Monthly Coverage of Vaccination in 2064

Fig. no.6. Graphical Representation of Monthly Coverage of Vaccination in 2064

This figure shows Vaaccination coverage in FY 23064, here in month Bhadra and Poush

month has maximum coverage.

Family Planning Coverage in FY 2061 to 2065

2061/2062 2062/2063 2063/2064 2064/2065

3,375 3,735 4317 4,524

Table no. 10. Family Planning Coverage in FY 2061 to 2065

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Graphical Representation of Family Planning Coverage in FY 2061 to 2065

Fig No.7. Family Planning Coverage in FY 2061 to 2065

This figure shows that each year Family Planning Coverage is in increasing . The reason

is Family Planning awareness in community. The use of Contraceptive is increasing .

xlvii

5.2. Findings

i. SHC launches various programs like Immunization, Family Planning and Safe

Motherhood Awareness Program, Social-Cultural programs, Medical Services

like Gyanecology, Cardiology, Dental, ENT, General Physician, Surgery

Consultation, Oncology, Orthopedics, Diagnostic Services (Laboratory,

USG,ECG ) etc in Sanepa Community.

ii. Services are free of cost along with free medicine distribution to needy and poor

people.

iii. It is found that patients flow in immunization 063/064 has increased in 2064/2065.

5.3 . Critical Observation

No evening counter.

Lack of appropriate system of recording.

No utilization of SHC buildings.

There should be link-up with various social organizations.

No association with INGOs.

There are no day services in Saneapa Health Centre.

xlviii

Chapter 6

6. Conclusion

Sanepa Health Centre is the one of the examples of the community health centre. The

services given at SHC is the honest social work and cooperation of local doctors and

other health professionals. It is independent health centre which is run by local doctors,

promoters, organizations, local donors, volunteers, health assistant, Nurses etc .Moreover

the services is free of cost for the needy and poor people along with free medicine also.

The SHC is providing services like General physician, Cardiology, Gynecology, ENT,

Orthopedics, chest , Oncology, Dental, Pediatrics, Dermatology, programs like Family

Planning, Immunization (BCG, DPT, Polio, Measles). It has seems that SHC has crossed

20 years journey of service providing with cooperation and coordination and community

participation of local members doctors , members, promoters, donors ,and volunteers.

Here program activities are launched every month that is 1st and 15th of each month. Here

all staffs and staffing pattern is almost by volunteering and social work motives.SHC has

recording and reporting system by manually. SHC usually celebrates its anniversary in

Baisakha Month and publishes its souvenir.

SWOT analysis of the SHC are as. Strength aspect is that SHC is independent health

Center which is running since 20 years so we can say Public relation with SHC and

Sanepa community is good. SHC raises fund on their own effort and give services to poor

and needy person. Weakness of SHC is that proper planning and its implementation is

lacking. There is not target of any program and its achievement. Opportunities of SHC is

that SHC can Progress and change into Hospital in near future. Threat of SHC is that this

organization is running under financial scarce. The data shows that SHC expenses is high

than revenue so management should adopt strategy to maximize revenue.

xlix

REFERENCES:

1. Marasini;Health and Development in Nepal: Past and Present ,

JAMA,September-October,2003,42

2. Dixit Hemanga, The Quest For Health.

3. Swasthya Sewa Suman,Sanepa Health Centre, Annual Publication of Sanepa

Health Centre; 2063,2064,2065

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