Glimpse of Annual Report

Transcription

1 Glimpse of Annual Report FY 2065/66 (2008/2009) GOVERNMENT OF NEPAL MINISTRY OF HEALTH AND POPULATION DEPARTMENT OF HEALTH SERVICES KATHMANDU

2 TABLE OF CONTENTS Heading Page INTRODUCTION Health Service Coverage: Fact Sheet 1 National Policies and Plans 6 Organizational Structure of Department of Health Services 9 CHILD HEALTH PROGRAMME National Immunization Programme 10 Community Based Integrated Management of Childhood Illness (CB- IMCI) Programme 14 Nutrition Programme 17 FAMILY HEALTH PROGRAMME Family Planning Programme 21 Safe Motherhood and Newborn Care Health Programme 25 Female Community Health Voluntary Programme 26 Primary Health Care Outreach Clinic Programme 26 DISEASE CONTROL PROGRAMME Malaria Control Programme 29 Kala-azar Elimination Programme 31 Lymphatic Filariasis Programme 31 National Tuberculosis Control Programme 32 Leprosy Control Programme 34 HIV/AIDS and STI Control Programme 35 OPD morbidity services 38 SUPPORTING PROGRAMME National Health Training Programme 40 National Health Education, Information and Communication Programme 47 Logistics Management 53 National Public Health Laboratory Services 56 Administrative Management 60 Financial Management 64 Management Division s Programme 66 Target Population Fiscal Year 2065/2066 (2008/2009) 71 Major Findings of Nepal Demographic and Health Survey Key Findings of Nepal Maternal Mortality and Morbidity Study Acronyms 78 ANNEX

3 1. INTRODUCTION This Glimpse of Annual report is the byproduct of the comprehensive Annual Report published by the Department of Health services based on the annual performances of the major programmes carried out through the net work of its health facilities from the community level to central levels during the fiscal year 2065/66 (2008/2009). The health facilities net work comprises from the Sub- Health Post situated to VDC level to central level as shown in the organizational structures of the Department of Health Services. This is the third series in terms of its publication with the primary objective of meeting the ever increasing demand of the readers especially for those who need to update the information on health service coverage with the help of selected indicators. The detail contents of the glimpse are provided in the table of content. The Basic health care services within the network of the DoHS are presented with Division/ Center internal organogram together with areas of programme responsibility and their major objectives. Major programme performance during the fiscal year 2065/66 (2008/2009) were presented in successive tables based on selected indicators. The information and statistics used in this report is based on the data collected by the Health Management Information System (HMIS) of Management Division, Department of Health Services, Ministry of Health and Population. 1.1 Health Service Coverage Facts and figures for the three consecutive fiscal years by programme are being provided with the help of selected indicators based on the services rendered from the net work of the DoHS infrastructure situated up to the community level. During the fiscal year 2065/66 immunization services 1 Department of Health Services

4 coverage by different antigen was found to be in declining trend over the period of three years. However the vaccine coverage has been able to maintain in BCG is 85%, DPT-3 is 81%, Polio-3 is 81% and Measles is 75 percent. In case of TT-2 Immunization to pregnant women the coverage has reduced by 7.0 percent this fiscal year 2064/65 compared to last fiscal year 2064/65. The growth monitoring services to <3 years children has been improvement more than 3 percent during this fiscal year compared to the earlier period 2064/65. The reported incidence of ARI has increased by 614 to 765 per 1,000 under five year population. Although the reported incidence of ARI has increased but the reported severity of disease (proportion of sever pneumonia among new cases) have declined to 0.59 from 0.78 in 2064/65. Similarly, in the case of diarrhoeal diseases also the incidence has increased to 488 per1,000 under five years population compared to 378 per1,000 in last fiscal year, but the severity of dehydration has decreased to 0.58% from 0.90% in fiscal year 2064/65 whereas Case Fatality Rate was decreasing trend as of the previous fiscal 2063/64. Antenatal first visit as percent of expected pregnancies has marginally decreased by 1 percent (67% vs. 68%) during this fiscal year compared to last fiscal year 2064/65. From the last fiscal year the delivery by skill birth attendants (Dr. Nurse and ANMs) at health facility and at home were separately reported against the delivery conducted by the health workers. Of the total delivery conducted by the health workers as a percentage of expected pregnancies 32 percent about 19 percent were attended by SBAs. The reported postnatal services coverage remained almost static during this fiscal year compared to last year. Due to the strengthening of different safe motherhood 2 Department of Health Services

5 services such as comprehensive abortion care, maternity incentive scheme, basic and comprehensive EOC services are being carried out as planned. The reported CPR (unadjusted) is slightly decreased by 0.37 percent in the review period compared to last fiscal year 2064/65. The slightly decline was observed in the spacing methods e.g. Pills, Depo, IUCD and Norplant. For other family planning methods e.g. Condom and Sterilization methods increased in the review period. Annual blood slide examination rate had marginally declined by 0.05 percent compared to last year and API decreased to 0.18 per 1,000 population at the same time proportion of Pf had increased to from 17.0 percent last fiscal year 2064/65. The incidence of Kala-azar per 10,000 population dropped by 1.33 compared to 1.71 last fiscal year. The DOTS programme had covered all 75 districts and expanded the treatment centers from 1,079 to 1,251 in fiscal year 2065/66. Case finding rate was improved by 3 percent and treatment success rate was increased by 1.0 percent compared to the reporting year. Leprosy Prevalence Rate (PR) has been in declining trend from 1.42 to 1.09 per 10,000 population in this fiscal year. The estimated HIV/AIDS cases stand at about 70,000 where the reported cumulative HIV/AIDS cases remains at 14,787. The Laboratory services network has expanded. During the current fiscal year, the OPD services at SHP and HP was made free and in PHCC and up to 25 bedded district level hospital selected groups of people were also provided free services reflecting an tangible increment from percent in last fiscal year 2064/65 to percent in this reporting year of OPD new visit as percent of total population. 1.2 Health Service Coverage: 3 Department of Health Services

6 Fact Sheet FY 2063/64 (2006/2007) to 2065/66 (2008/2009) REPORTING STATUS 2063/ / /66 Hospital 82% 90% 79% PHCC/HC 98% 99% 97% HP 99% 99% 97% Sub Health Post 98% 97% 96% PHC-ORC clinics 75% 81% 80% FCHV 82% 82% 86% NGO/Private Sector/Others 67% 68% 67% EXPANDED PROGRAMME ON IMMUNIZATION 1 BCG Coverage 91% 87% 85% 2 DPT-3 Coverage 84% 82% 81% 3 Polio-3 Coverage 84% 82% 81% 4 Measles Coverage 83% 79% 75% 5 % of Pregnant women receiving TT-2 50% 42% 35% NUTRITION PROGRAMME 6 % of Pregnant women receiving Iron tablets 84% 74% 73% 7 % of Postpartum Mother receiving Vitamin A 51% 45% 46% ACUTE RESPIRATORY INFECTION (ARI) 8 9 Reported Incidence of ARI/1,000 <5 Children New Visits Annual Reported Incidence of Pneumonia (Mild + Severe)/1,000 among <5 Children New Visits Proportion of Severe Pneumonia among New Cases Case Fatality Rate/1,000 <5 Children CONTROL OF DIARRHOEAL DISEASES (CDD) Incidence of Diarrhoea/1,000 <5 Children New 12 Cases % of Severe Dehydration among Total New Cases 1.0% 0.90% 0.58% 14 Case Fatality Rate/1,000 <5 Children SAFE MOTHERHOOD PROGRAMME 4 Department of Health Services

7 REPORTING STATUS 2063/ / /66 15 Antenatal First Visits as % of Expected Pregnancies 72% 68% 67% Delivery Conducted by SBA at Health Facility as % of expected pregnancy Delivery Conducted by SBA at Home as % of expected pregnancy Delivery Conducted by Other than SBA at Health Facility as % of expected pregnancy Delivery Conducted by Other than SBA at Home as % of expected pregnancy Deliveries Conducted by Health Workers as % of Expected Pregnancies % 15.86% % 3.08% % 1.37% % 11.27% 29.70% 31.60% 31.57% Deliveries Conducted at Health Facilities as % of Expected Pregnancies 15.30% 15.90% 17.23% Deliveries Conducted by Health Workers at home as % of Expected Pregnancies 14.40% 16.60% 14.35% 23 PNC First Visits as % of Expected Pregnancies 39.50% 37.70% 37.42% FAMILY PLANNING PROGRAMME 24 Contraceptive Prevalence Rate (Modern Method)* 42.10% 40.90% 40.53% 25 Condoms (CPR Method Mix) 2.60% 2.50% 3.00% 26 Pills 2.80% 2.70% 2.61% 27 Depo Provera 10.10% 8.80% 8.41% 28 IUCD 1.10% 1.10% 1.02% 29 Norplant 1.30% 1.30% 1.16% 30 Sterilization 24.30% 24.50% 25.39% MALARIA / KALA-AZAR CONTROL PROGRAMME Annual Blood Slide Examination Rate (ABER) per % 0.80% 0.75% 32 Annual Parasite Incidence (API) per 1, Proportion P.falciparum (PF%) 25.00% 17.00% 22.18% 34 Clinical Malaria Incidence (CMI) /1, Incidence of Kala-azar /10,000 Risk Population TUBERCULOSIS CONTROL PROGRAMME 36 Treatment Success Rate on DOTS 89% 88% 89% 5 Department of Health Services

8 REPORTING STATUS 2063/ / /66 37 Sputum Conversion Rate 88% 88% 88% LEPROSY CONTROL PROGRAMME 38 New Case Detection Rate (NCDR) /10, Prevalence Rate (PR) /10, Disability Rate Grade 2 Among New Cases HIV/AIDS PROGRAMME 41 Cumulative HIV/AIDS reported cases 9,756 12,004 14, Estimated HIV/AIDS cases 64,180 70,000 70,000 CURATIVE SERVICES 43 Total OPD New Visits 8,797,639 12,137,059 18,947, Total OPD New Visits as % of Total Population 33.50% 45.30% 69.19% * Unadjusted Source: HMIS/MD, DoHS 1.3 National Policies and Plans National Health Policy, 1991 The objective of the National health policy of 1991 was to bring improvements in the health status of the people by extending the primary health care system to largely underserved rural populations by prioritizing the programmes which directly helps to reduce morbidity and mortality prevailing in the rural mass. Besides the preventive, promotive and curative health services the policy has addressed many other areas too. For detail, readers are requested to refer the DoHS main annual report. Currently the policies, programmes, actions and activities of MoHP were directed by the spirit and feelings of the last Jana Andolan (people s movement) 2062/63 (2006/07) Second Long Term Health Plan (SLTHP), The Ministry of Health and Population developed a 20 year Second Long Term Health Plan (FY 2054/ /75) to guide health sector development 6 Department of Health Services

9 for the overall improvement in people s health and to guide the periodic five year plans to achieve the long term goals. It has set objectives, targets to be achieved by the end of the plan, services to be delivered based on the essential health care services which are highly cost effective. Promotive and preventive activities were prioritized based on primary health care principles Nepal Health Sector Programme (NHSP-IP) Nepal Health Sector Programme, based on the Health Sector Strategy: An Agenda for Change is a sector wide programme focused on performance result. The policy reform milestones are outlined in the Nepal Health Sector Program Implementation Plan. It aims to expand access to and increasing the use of essential health care services, especially for the underserved. The programme focused on performance results. It has set eight outputs of which three outputs are designed for strengthening the delivery of services such as delivery of essential health care services, decentralized management and public private partnership and five outputs are designed to improve the institutional capacity with improved management Millennium Development Goals At the Millennium Summit of 2000, the member states of the United Nations adopted the Millennium Declaration with the aim of bringing peace, security and development to all the people. The MDG outline major development priorities to be achieved by the year Numerical targets are set for each goal. It has eight goals, eighteen targets and forty eight indicators to be monitored. Of the eight goals MoHP is directly responsible for three Goals i.e. Goal Number 4, 5 and 6. Target were set to reduce by two third for under five mortality, three-quarter for maternal mortality ratio and have halted by Department of Health Services

10 and begun to reverse the spread of HIV/AIDS and have halted by 2015 and begun to reverse the incidence of malaria and other diseases Three Year Interim Plan (2007/ /10) The plan seeks to establish the right of the citizen to free basic health services as per the principles of primary health services. Special programs will be launched in an integrated manner with participation of government, private sector and NGOs to increase the citizens' access to basic health services targeting those deprived of health care such as indigenous nationalities (Adibasi, Janajati), Dalits, people with disability and Madhesi people. Research in the health sector will be encouraged, promoted and expanded Free Health Care Strategy After the second popular people s movement of April 2006 (Jana Andolan II) the policies, programmes, activities and action s of MoHP s officials are driven by the spirit and feeling of the movements. There has been a growing expectation of the people seeking for the basic health services to improve their living condition. Among the various expectations, demand for free health care services is one among them. Primary health care has been incorporated in the Interim Constitution of Nepal as a Citizen s fundamental right, including a provision that primary health care be made free of cost. In this context the government has decided to provide emergency and inpatient services free of charge to poor, destitute, underserved, elderly citizen, people living with physical and psychological disability, and female community health volunteers (FCHVs) up to 25 bedded district hospitals and PHCCs. Furthermore, the GoN decided to provide essential health care services free of charge at all health post and sub- health posts. 8 Department of Health Services

11 Organizational Structure of the Department of Health Services MINISTRY OF HEALTH AND POPULATION DEPARTMENT OF HEALTH SERVICES D I V I S I O N S C E N T R E S MD CHD FHD LMD LCD EDCD PHCRD NTC NHTC NPHL NCASC NHEICC CENTRAL LEVEL CENTRAL HOSPITALS - 8 REGIONAL HEALTH DIRECTORATE - 5 REGIONAL LEVEL - 5 REGIONAL HOSPITAL 3 SUB-REGIONAL HOSPITAL - 2 REGIONAL TRAINING CENTRE - 5 REGIONAL MEDICAL STORE - 5 REGIONAL TB CENTRE - 1 ZONAL LEVEL - 14 ZONAL HOSPITAL - 10 DISTRICT LEVEL - 75 ELECTORAL CONSTITUENCY LEVEL DISTRICT PUBLIC HEALTH OFFICE - 15 DISTRICT HOSPITAL - 65 PRIMARY HEALTH CARE CENTRE/ HEALTH CENTRE DISTRICT HEALTH OFFICE - 60 VDC, MUNICIPALITY LEVEL HEALTH POST SUB-HEALTH POST - 3,134 COMMUNITY LEVEL FCHV 48,549 PHC/ORC CLINIC 13,811 EPI OUTREACH CLINIC 16,260 Acronyms MD Management Division NHTC National Health Training Centre FHD Family Health Division NTC National Tuberculosis Centre CHD Child Health Division NCASC National Centre for AIDS and STD Control EDCD Epidemiology and Disease Control Division NPHL National Public Health Laboratory LMD Logistics Management Division FCHV Female Community Health Volunteer LCD Leprosy Control Division PHC/ORC Primary Health Care Outreach Clinic PHCRD Primary Health Care Revitalization Division EPI Expanded Programme on Immunisation NHEICC National Health Education, Information and Communication Centre 9 Department of Health Services

12 2. NATIONAL CHILD HEALTH PROGRAMME Child Health Division National Immunization Programme (NIP) Regular IP BCG DPT & Hep B Polio Measles TT JE Campaign NID/Sub NIDs IMCI Programme ARI/pneumonia Diarrhea Measles Malnutrition Malaria Nutrition Programme IDA control Vitamin A deficiency ID Disorder De-worming o Regular o Campaign PEM control o IYCF o Growth o Monitoring 2.1 National Immunization Program (NIP) Immunization is considered to be one of the most cost effective health interventions. It has significantly contributed in reducing the infant mortality. It has contributed a lot to tract the achievement status as laid down in the Millennium Development Goal on Child mortality reduction. The programme covers all the VDCs of the country and implement through EPI clinics. To ensure equity and high vaccine coverage, the NIP has focused to strengthen its net work in the municipalities Objectives The objectives of the National Immunization Program are: Achieve and sustain 90% coverage for DPT-3 by 2008 and of all antigens by Maintain Polio free status. 10 Department of Health Services

13 Sustain MNT elimination status. Initiate Measles elimination. Expand Vaccine Preventable Diseases (VPDs) surveillance. Accelerate control of other vaccine preventable diseases through introduction of new vaccines. Improve and sustain immunization quality. Expand immunization services beyond infancy Target Population All infants for BCG, DPT-HepB, OPV, and Measles vaccines All pregnant women for TT vaccine All 1, 2 and 3 grade students for School Immunization Programme Service Strategies Routine Immunization service is delivered through following outlets. Fixed facilities: Hospitals, PHCC, Health Posts and Sub Health Posts. Outreach services: At least three to five immunization sessions a month are conducted in each VDC. Mobile teams: This strategy is used to get access in remote geographical remote areas. Private and NGOs INGO clinic 11 Department of Health Services

14 2.1.4 Achievements Indicators National Ecological Zone Development Region Mountain Hill Terai EDR CDR WDR MWDR FWDR BCG DPT Polio Coverage (%) Measles JE TT TT TT Drop Out Rate (%) TT2 & TT2+ BCG Vs Measles DPT-1 Vs DPT-3 Polio-1 Vs Polio BCG Wastage Rage (%) DPT Polio Measles JE TT Immunization services by different variables The reported vaccination coverage during the current fiscal year has slightly decreased for all the antigens in compared to last year not only at the national level but at the ecological and development regions as well. Yet it had maintained to achieve at or above 75.4 percent at the national with fluctuating at the ecological and development regions. In case of TT-2 to pregnant women the coverage has dropped by more than 7.0 percent at all the levels. 12 Department of Health Services

15 Dropout Rate Drop- out rate for Measles when compared to BCG has increased by 1.6 percent in FY 2065/66 compared to 2064/65 at National level. The highest dropout rate was observed in the CDR (15.1 %) as in the last year and this year the lowest drop- out rate for BCG VS. Measles was observed in MWDR (5.6 %) in last FY. Vaccine wastage rate The Vaccine Wastage Rate in fiscal year 2065/66 for different antigens was as follows: BCG = 79.8%, DPT = 21.9%, Polio = 25.1% and Measles = 61.2% respectively. The wastage rate had also increased slightly during this FY SUPPLEMENTARY IMMUNIZATION ACTIVITIES National Immunization Days (NIDs) for Polio Eradication To eradicate poliomyelitis, national immunization programme continued to conduct "Intensified National Immunization Days" (INID) in two rounds started from FY 2053/54. In this FY 4,147,817 (93 %) in I round and 4,127,314 (92 %) under five years children were immunized in II round in all 75 districts Japanese Encephalitis (JE) JE is endemic in all Terai and inner Terai districts. JE surveillance is integrated with AFP surveillance. In fiscal year 2065/2065, JE immunization campaigns were conducted in highly endemic districts: Dhanusha, Mahottari, Jhapa, Kapilvastu, Nawalparasi, Parsa and Chitwan for the target population between ages 1-15 and above years by a single dose of vaccine. A total number of 3,130,659 (98 percent) were immunized through the campaigns Sustaining NT elimination and School Immunization Nepal has been able to sustain MNT elimination since In this fiscal year 2065/66 a total number of 81 Neonatal Tetanus (NT) cases had been reported through Health Management Information System (HMIS). 13 Department of Health Services

16 2.2 Community Based Integrated Management of Childhood Illness (CB-IMCI) Community Based Integrated Management of Childhood Illness (CB-IMCI) Programme is an integrated package of child-survival programmes and addresses five major killer diseases (diarrhoea, pneumonia, malnutrition, measles, and malaria) in a holistic way. At present CB-IMCI is functional both at Health facilities and Community level in 75 districts. The programme includes the following three main strategies of CDD, ARI, Nutrition and Immunization Programmes: Recognition of the danger signs of diseases related to CDD, ARI, Nutrition and Immunization. Timely referral to nearby health facilities; and Improved community support for CDD, ARI, Nutrition and Immunization through group participation and programme management Objectives To reduce under 5 mortality related to pneumonia, diarrhoea, malnutrition, measles and malaria. To reduce neonatal mortality and to strengthen new born child health care related behaviour through promotive, preventive and curative services Achievement At present CB-IMCI is functional both at Health Facilities and Community level in all 75 districts in this FY 2065/66. Diarrhoea Diarrhoea is still a leading cause of childhood morbidity and mortality in Nepal, Diarrhoeal Disease Control Program (DDCP) has been functioning since Improvement in diarrhoea case management has been used as a primary 14 Department of Health Services

17 strategy for the reduction of mortality due to diarrhoea among children under five years of age. All health facilities and FCHVs have served as the primary health providers in the treatment of Diarrhoea with Low Osmolar Oral Rehydration Solutions (ORS). Due to this approach during the current fiscal year the total number of reported cases on diarrhoea had increased more than 100 percent Diarrhoeal Incidence The following table shows the reported diarrhoeal incidence per 1,000 underfive children. The reported incidence of diarrhoea increased considerably at the national and regional level during FY 2065/66 yet the proportion of dehydrated cases have decreased significantly at all the levels due to timely case management by the community volunteers. For detail see the table given below. Situation of Diarrhoea Indicators CDD Incidence per 1000 Dehydration (Mild and Severe) among new Cases Severe Dehydration among new Cases Ecological Zone Development Region National Mountain Hill Terai EDR CDR WDR MWDR FWDR % Treated With ORS IV Fluid CDD Case Fatality % of CDD Cases at HF VHW/MCHW FCHV Department of Health Services

18 Zinc Supplementation and Low Osmolar ORS Introduction of Low Osmolar ORS and Zinc tablets was initiated in two districts as a pilot programme. By the end of FY 2065/66, Low Osmolar program was expanded to 58 districts of the country and the scaling up of the programme will be completed by the FY 2066/67. Community based New Born Care Package (CB-NCP) Interventions to reduce Neonatal mortality are high priority program of Nepal. As an urgent need to address high neonatal morality, government has initiated to pilot Community Based Newborn Care Program (CB-NCP) in an effort towards improving the neonatal health and survival in the country. The program was implemented as pilot program in eight districts in fiscal year 2065/66 (Dhankuta, Palpa, Chitwan, Dang, Kavre, Doti, Bardiya and Sunsari). In the fiscal year 2066/67 will be expanded in two more districts in Morang and Parsa. Control of Acute Respiratory Infection Programme Acute Respiratory Infection (ARI) is one of the major public health problems in Nepal among children <5 years of age. All cases of ARI are categorized by health workers into the following categories: No pneumonia Pneumonia Severe pneumonia and Very severe disease 16 Department of Health Services

19 ARI Situation Indicators National Ecological Zone Development Region Mountain Hill Terai EDR CDR WDR MWDR FWDR ARI Incidence per 1000 Incidence of Pneumonia (Mild and Severe) per 1000 Incidence of Severe Pneumonia per 1000 % of Pneumonia (Mild and Severe) among new ARI cases % of Severe Pneumonia among new ARI cases % Treated with Antibiotic ARI Case Fatality % of ARI Cases at HF VHW/MCHW FCHV The above table shows that in FY 2065/66 like diarrhoeal incidence, the reported incidence of ARI /1,000 population had also increased significantly but the severity of disease in terms of pneumonia per 1,000 <5 children has decreased in comparison to last year. The proportion of severe pneumonia cases in terms of percentage at national level has declined to 0.59 during the FY 2065/66 compared to 0.78 in last year. Disaggregated data in term of handling the ARI cases by service outlets is also presented in the table for references. 2.3 Nutrition Programme The mission of Nutrition Program is to improve the overall nutritional status of children, pregnant women, women of child bearing age and all ages through the control of general malnutrition and the prevention and control of micronutrient deficiency disorders. 17 Department of Health Services

20 2.3.1 Objectives Control of Protein Energy Malnutrition To reduce protein-energy malnutrition (PEM) in children under five years of age and women of Reproductive age to half of the 2000 level by the year 2017 Control of Iodine Deficiency Disorders To virtually eliminate iodine deficiencies disorders and sustain the elimination by the year 2017; Control of Vitamin A Deficiency Disorders To virtually eliminate vitamin A deficiency and sustain the elimination by the year 2017; Control of Anaemia To reduce the prevalence of Anaemia among Women and Children to less than 40% by the year 2017; To reduce the Infestation of intestinal worm among Children and Pregnant Women to less than 10% by 2017; Low Birth Weight To reduce the prevalence of low birth-weight to 12 percent of all births by the year 2017; Protection and Promotion of Breastfeeding To promote exclusive breastfeeding till the age of six completed months Interventions Control of Protein Energy Malnutrition (PEM) Ensure early initiation of BF within 1 hrs of birth and promotion of exclusive BF for the first 6 month. 18 Department of Health Services

21 Strengthen the capacity of HWs/ medical professionals regarding GM & Nutrition counseling as well as management of severely mal nourished children. Create awareness regarding the importance of appropriate and adequate nutrition for children, pregnant, lactating mothers i.e. celebrate: BF week (Aug 1-7), Nutrition week (Poush 10-16). Control of Iodine Deficiency Disease (IDD) Ensure systemic monitoring of ID salt. Increase the accessibility and market share of the two child logo ID packet salt. Create awareness of the importance of ID salt i.e. celebrate Iodine month on Feb. Strengthen implementation of ID salt Act Control of Vitamin A Deficiency (VAD) Distribute Vit A Capsules to children between 6-59 months bi-annually thru FCHVs. Supplement Vit A Capsules to Post Partum mothers. Explore the fortification of suitable foods with Vit A Control of Iron Deficiency Anaemia Ensure availability of iron/ folate supplements at all HFs, PHC/ORCs and community level. Identify suitable food vehicles for iron fortification. Increases awareness about iron rich food both animal and vegetables sources. Deworming Distribute the de-worming tab to the children aged 1-5 yrs, during Vit A capsules supplementation. Strengthen de worming program for pregnant women. 19 Department of Health Services

22 Achievements Various interventions have been carried out under the Nutrition progromme during the fiscal year which was reflected in the table below given Achievement by different variables Indicators Ecological Zone Development Region National Mountain Hill Terai EDR CDR WDR MWDR FWDR New Growth Monitoring (%) Under 1 Yrs Under 3 Yrs Under 5 Yrs Children among New visits (%) Normal Malnourished Under 3yrs Malnourished Children among Repeated visits (%) Normal Malnourished Avg. no of Growth Monitoring Visits made by Children Treated With Vitamin A (%) for 0-11 Months Months Months Months Eye Measles Chronic Diarrhoea Severe Malnutrition Children Treated for Antihelmenthis (%) % of pregnant woman receiving Antihelmenthis % of pregnant New woman receiving Repeated Iron Tabs % of postpartum Iron Tabs mothers receiving Vitamin A Iron Compliance Department of Health Services

23 3. FAMILY HEALTH PROGRAMME Family Health Division Family Planning Safe Motherhood Demography Section FCHV/ PHC-ORC Well Women Condom Pills Implant Injectable IUCD Vasectomy Tuberligation Recanalization BEOC/CEOC Birthing Center Home Delivery by Trained Health Worker Safe Abortion Service Post Abortion Care Planning & Target Setting of RH Services RH Commodity Security Monitoring of RH Services Adolescent Inferlity Elderly Women Uterine Prolapse 3.1 Introduction Family Health Division of the Department of Health Services is responsible for planning and implementation of reproductive health services in the country. The reproductive health services includes family planning, safe motherhood including newborn health, adolescent health, safe abortion service, infertility, prevention and treatment of STI/HIV/AIDS, and elderly peoples' reproductive health. Family Health Division is responsible for achieving the targets set out in the periodic plans by providing the constellation of services through public health facilities, peripheral health workers and in partnership with the NGO and private sector. 21 Department of Health Services

24 Objective The division's efforts are geared towards achieving the Millennium Development Goals especially goals 4 and 5 that aims to reduce IMR to 34, NMR to 15 and MMR to 134 by the year Special interventions This division is working to increase access to safe motherhood services through work such as creation of emergency transport, creation of emergency funds, safe delivery incentives programme and appreciative enquiry for better facility management. The division also conducts periodic and ad-hoc studies and research in the area of RH and co-ordinates research and studies carried out by other organizations in Nepal. Major achievements of the programs of Family Health Division during FY 2065/66 are as follows; 3.2 Family Planning Programme Achievement by different variables Ecological Zone Development Region Indicators National MW Mountain Hill Terai EDR CDR WDR DR FWDR Condom Pills New Depo Acceptors IUD as % of MWRA Norplant Sterilization Total Family planning programme has been monitored and evaluated basically on the basis of the selected indicators utilized by the programme people. The above indicator reflects the number of new acceptor recruited during the fiscal year against the married women of reproductive age. As every time certain number of current users do drop from the contraceptive use due to various 22 Department of Health Services

25 reasons, it helps not only to replace for the dropouts but at the same time it contribute to improve the CPR level for the reduction of TFR. During the current fiscal year the new acceptor recruitment rate in terms of temporary method as percentage of MWRA has slightly increased to against 9.46 percentages in the last fiscal year, where as in case of permanent method the new recruitment rate has decreased by marginally from 1.55 to 1.46 during the fiscal year 2065/66. The overall new acceptor recruitment rate during the fiscal year 2065/66 had improved slightly compared to last fiscal year. The slight increment in the recruitment rate has been reflected in the development region compared to last fiscal year. Indicators Current Users as % of MWRA Con dom Ecological Zone Development Region National Mountain Hill Terai EDR CDR WDR MWDR FWDR Pills Depo IUD Norplant Total Unadjusted CPR Adjusted CPR The above table shows the disaggregated contraceptive prevalence rate (CPR) prevailing at national, ecological and development regions during the end of the fiscal year of 2065/66 based on the report provided by the district health offices. During the fiscal year 2065/66 the unadjusted contraceptive prevalence rate (CPR) had decreased by 1.2 percent compared to last fiscal year. The table also provides the adjusted CPR based on the mortality and age exit factor. 23 Department of Health Services

26 CYP National Ecological Zone Development Region Mountain Hill Terai EDR CDR WDR MWDR FWDR Condom Pills Depo IUD Norplant Sterilization Total In terms of Couple Years of Protection (CYP) altogether percent of the married women of reproductive ages were being protected by the various contraceptive methods that were issued to couples. The couple years of protection has also improved by more than 1.12 percent during the current FY compared to last FY of percent. Indicators New Acceptors as % of MWRA Current Users as % of MWRA Ecological Zone Development Region National Mountain Hill Terai EDR CDR WDR MWDR FWDR Permanent Method % of VSC new Cases Prop. of VSC new acceptors at Proportion of VSC provided by Female Male HF Camp Government NGO Target Vs Achieve as % of Current Users as % of VSC new Cases Based on the above table it is clear that more than two- third of VSC services were being received by females showing low participation by male in VSC services. In terms of utilization, more than two- third of the sterilizations were 24 Department of Health Services

27 performed at the GoN facilities. So far target vs. achievement is concern the performance is in increased by 6.8 percent compared to last FY 2064/ Safe Motherhood Programme Coverage The Safe Motherhood Programme has made significant progress in terms of the development of policies and protocols as well as expanding the role of service providers such as staff nurses and ANMs in life saving skills. The Policy on Skilled Birth Attendants endorsed in 2006 by MoHP specifically identifies the importance of skilled birth attendance at every birth and embodies the Government s commitment to training and deploying doctors and nurses/anms with the required skills across the country. The revised Safe Motherhood and Neonatal Health Long Term Plan ( ) includes recent developments not adequately covered in the original plan. 1st ANC Visit as % of Expected Pregnancy Ecological Zone Development Region National Mountain Hill Terai EDR CDR WDR MWDR FWDR <20 Yrs Both (<20 and >20) Yrs Indicators 4th ANC Visit as % of Expected Pregnancy Delivery Conducted as % of Expected Pregnancy by SBA at by other than SBA at Delivery Conducted at B/CEOC among total HF delivery % of obstetric complication among total delivery % of C/S among total Institutional deliveries HF Home Total HF Home Total PNC first Visits % of FP acceptors after abortion care % of neonatal first time checkup Maternal death as % of expected Pregnancy Department of Health Services

28 The table above depicts the fact and figures on safe motherhood programme based on the different indicators covering first ANC services, at least four ANC visit, delivery by various categories of health personnel, PNC visits, Neonatal check-ups and acceptance of family planning services by those who have underwent abortion services. The reported ANC first visit has a slightly decreased compared to the fiscal year 2064/65. The four ANC visits by the pregnant women increased more than 2.0 percent in this fiscal year 2065/66 compared to last fiscal year. Deliveries conducted by the health workers as a percentage of expected pregnancies has been able to maintain static compared to last year. Of the total deliveries health facilities delivery have improved by 1.21 percent against home delivery compared to the last fiscal year. 3.4 Female Community Health Volunteer (FCHV) Programme The services rendered by the female community health volunteers specially the resupply of Oral pills, condom and distribution of ORS packet and iron tablets have been presented in the table. The contribution of FCHV in support of the programme is noteworthy as in the last year. Indicators Ecological Development Regions National Mountain Hill Terai EDR CDR WDR MWDR FWDR Pills Distribution (Cycle) Condom Distribution Persons) ORS Distribution (Pkts) Iron Tablet Distribution PHC Outreach Clinic Programme During the fiscal year 2065/66 functionality of PHC/ORC clinic have slightly decreased by more than 1.0 percent compared to last fiscal year reflecting greater number of people served in an annual basis in all the regions. 26 Department of Health Services

29 Indicators National Moun tain Ecological Hill Terai EDR CDR Development Regions WD R MWD R FWD R Total No. of PHC/ORC clinics PHC/ORC clinic Conducted (%) Average no of clients served per year EPIDEMIOLOGY AND DISEASE CONTROL PROGRAMME Epidemiology and Disease Control Division Disease Control Section Malaria Control Program o Integrated Vector Mgmt o Early Diagnosis and Prompt Treatment Kala-azar Elimination Program Epidemiology Section Surveillance(EW ARS), Epidemic Preparedness and Response Zoonotic Diseases Control o Strengthen prevention and control of outbreaks of JE o Rabies control alliance o Snakebite mgmt Filariasis Elimination Program Natural Disaster Management Section Emergency Preparedness planning and disaster response Promotion of best public health practices Prepositioning of essential health kits Leprosy Control Section Early Diagnosis and Treatment Information education and Communica tion Disability Prevention and rehabilitatio 27 Department of Health Services

30 4.1 Goal of the Epidemiology & Disease Control Programme To eradicate, eliminate and control of epidemic prone communicable diseases including vector borne and zoonotic diseases. Enhance the health sector capacity for emergency preparedness and disaster response Objectives Epidemiology Programme Surveillance, Epidemic Preparedness and Response Develop a package for integrated disease surveillance (IDS) Strengthen existing E-EWARS surveillance of selected communicable diseases. Epidemic Preparedness, prevention and control of communicable diseases with epidemic potentials. Capacity building at central, regional and district level Disease Control Programme: Reduction in malaria morbidity by 50 percent by the year 2010 (baseline 2002) Prevention of mortality due to malaria by 90 percent in high PF prevalent areas by Prevention and control of epidemics with particular reference to P. falciparum malaria. Progressive reduction of Kala-azar case (Baseline 2005) Reduction of mortality due to Kala-azar. Reduction of Kala-azar incidence to 1 per 10,000 cases by the year 2015 at district level. 28 Department of Health Services

31 Dengue Surveillance and Prevention Programme Lymphatic Filariasis Elimination To eliminate lymphatic filariasis by the year 2015 ( 1 or less/10,000 population) To conduct mass drug administration campaign. Zoonotic Diseases Control Strengthen JE surveillance and prevention and control of outbreaks Fortify post-exposure treatment for human rabies control and snakebite management Develop a national alliance for canine rabies control Natural Disaster Management Programme To enhanced the capacities of health sector in emergency preparedness planning and disaster response by focusing on disaster prevention, mitigation and responses. 4.2 Malaria Control and Kala-azar Elimination Malaria Control The table below presents the various malaria related indicators at the national, ecological and development regions based on the data submitted by the district offices during the FY 2065/66. Blood slide examination rate has marginally decreased, API has slightly reduced, and slide positivity rate has also decreased, the proportion of Pf cases have increased to percent compared to percent last year 2064/ Department of Health Services

32 It is important to note that proportion of Pf during the FY has increased as there were no outbreaks in any part of the country. The number of clinical malaria cases reported had increased by 1.52 percent compared to last FY. Indicators Blood slide examination rate Slide positivity rate Annual parisite incidence among 1,000 population Clinical Malaria among 1,000 pop. National Moun tain Ecological Development Regions Hill Terai EDR CDR WDR MWDR FWDR Proportion of PF Prop. of imported cases among total +ve Indicators National Ecological Development Regions Moun Hill Terai EDR CDR WDR MWDR FWDR tain Proportion of Malaria cases by Age among total positive cases % of Malaria Cases by Sex <1 yrs Yrs Yrs Above 15 Yrs Female Male The above table presents the disaggregated data on proportion of malaria cases by different age sex, ecological and development regions with national level. 30 Department of Health Services

33 4.2.2 Kala-azar Elimination Programme Kala-azar is an endemic disease prevailing mostly in twelve districts (Jhapa, Morang, Saptari, Sunsari, Siraha, Udayapur, Dhanusha, Mahottari, Rautahat, Sarlahi, Bara and Parsa) confined to Eastern and Central part of the country. Since 2037 a total of 24,387 cases have been reported and 317 deaths due to Kala-azar have been recorded. Performance by indicators Indicators Nationa l Mountai n Ecological Hill Terai EDR CDR Development Regions WD R MWD R FWD R No. of Patients 1, Improved Cases 1, Incidence per 10, population Cure Rate in percent Performance of other disease programmes Lymphatic Filariasis (LF) The Terai area is highly endemic in Lymphatic Filariasis (LF) than the hilly areas. Out of 75 districts 60 districts are endemic for lymphatic filariasis in the country. The government is fully committed to eliminate the disease from the country within the stipulated time and initiated the implementation of Mass drug administration covering 21 districts with 11 million at risk population Elimination Campaign. Post exposure treatment of rabies with CCO-ARV suspected rabies animal bite cases continued. Pre-positioning of medicines and other logistics in epidemic prone districts were maintained. Epidemic responses were managed as per need from the districts as well as from the centre. 31 Department of Health Services

34 5. TUBERCULOSIS CONTROL PROGRAMME National Tuberclosis Center Administration Section Account Section Planning, Monitoring and Clinic Section Laboratory Section X-Ray Section Introduction About 45.0 percent of the total population is infected with TB of which around 60 percent are adults. Around 40,000 people develop active TB and half of them are active to spread the disease to others. DOTS were initiated in 1996 as a pilot programme in four districts and now it had covered all over the country by extending the treatment centers and sub- centers. At the national level 35,562 (Female: 12,498 and Male: 23,064) TB patients have been registered of whom 15,444 (Female: 4,448 and Male: 10,600) infectious are being treated under the DOTS strategy. 5.1 Goal To reduce the mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem. 5.2 Objectives To achieve 85.0 percent cure rate in new smear-positive pulmonary tuberculosis cases. To achieve 70.0 percent case detection ratio in new smear-positive pulmonary tuberculosis cases. Investigation Section 32 Department of Health Services