Current co-ordination mechanism of health system in NepalPrakashRajSharma
Coordination is the process of linking together the activities of various departments & people to achieve unity of action and harmonization of efforts for attaining organizational goals.
It is a planned collaboration of two or more persons, departments, programs or organizations who are concern with achieving a common goal.
In Nepal, Coordination in Health Sector occurs in three levels:
1. Coordination at Federal Level
2. Coordination at Provincial Level
3. Coordination at Local Level
Current co-ordination mechanism of health system in NepalPrakashRajSharma
Coordination is the process of linking together the activities of various departments & people to achieve unity of action and harmonization of efforts for attaining organizational goals.
It is a planned collaboration of two or more persons, departments, programs or organizations who are concern with achieving a common goal.
In Nepal, Coordination in Health Sector occurs in three levels:
1. Coordination at Federal Level
2. Coordination at Provincial Level
3. Coordination at Local Level
Intersectoral coordination and and community participation is a key to success in health sector in India. This is a unique opportunity to play our role for better, healthy and happy society. One can enjoy and achieve the goals of health objectives through these techniques in the field/community setup.
The Basics of Monitoring, Evaluation and Supervision of Health Services in NepalDeepak Karki
This presentation has made to health workers who have more than two decades of experience of managing/implementing public health programs in Nepal, especially at district level and below.
Intersectoral coordination and and community participation is a key to success in health sector in India. This is a unique opportunity to play our role for better, healthy and happy society. One can enjoy and achieve the goals of health objectives through these techniques in the field/community setup.
The Basics of Monitoring, Evaluation and Supervision of Health Services in NepalDeepak Karki
This presentation has made to health workers who have more than two decades of experience of managing/implementing public health programs in Nepal, especially at district level and below.
In support of the implementation of Tanzania's National Nutrition Strategy, the Mwanzo Bora Nutrition Program conducted an analysis of the Social and Behavior Change Communication (SBCC) Landscape for Nutrition. This presentation provides an overview of this work.
Sustaining quality approaches for locally embedded community health services ...REACHOUTCONSORTIUMSLIDES
This presentation was given at the Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services Symposium which was held in September 2016
SBI Youth for India Fellowship 2016-17 - ANKUR CHHABRAAnkur Chhabra
Health Promotion - Social behaviour change communication and community mobilisation to address the issue of maternal and child malnutrition in Palghar district, Maharashtra
Cooking skills are critical for achieving health and sustainable dietary goals and yet they are in general decline in the UK. Community based cooking skills projects that aim to fill this skills gap are also in decline due to cut backs in public funding. Since cooking skills projects are diverse in scope (i.e. target group, model of intervention and intended outcome) and there is a lack of centralised support for them at the national level (in England); standards and requirements demanded by those commissioning them at the local level can vary and be unrealistic.
Improving population health requires targeted policy, system and environmental (PSE) change interventions. As respected members of their communities, healthcare providers are uniquely positioned to advance PSE interventions by leveraging their clinical experiences and patient stories to provide context and scope to the public health issue.
During this workshop we will:
--Discuss the impact of social determinants of health on chronic disease and student health outcomes.
--Provide an overview of evidenced-based PSE interventions aimed at increasing access to healthy food and beverages and/or physical activity within the school setting.
--Highlight case studies of practicing healthcare providers who have been able to successfully advance PSE change within the school setting, particularly as it relates to obesity prevention efforts.
--Practice effective communication strategies to hone one’s voice and message as a means to successfully engage elected officials and key decision makers on important health policy issues.
Material for this training will be adapted from the successful Champion Provider Fellowship program- a program aimed at increasing healthcare providers’ capacity to engage in community change efforts within a broad range of settings. The primary audience for this workshop is practicing healthcare providers, however, all individuals with an interest in learning more about these topics are welcome to attend. All workshop attendees will receive a copy of the Champion Provider Fellowship’s PSE Playbook: Implementing Policy, System and Environmental Change in Our Communities.
Get the handouts:
http://faturl.com/~wftWl6
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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VERIFICATION AND VALIDATION TOOLKIT Determining Performance Characteristics o...
Bringing Behavior Change Interventions to Scale: Practical Challenges and Responses Presentation 2
1. SCALING UP SBC:
LESSONS FROM NEPAL
September 26, 2017 Global Health Practitioners Conference
Jennifer Nielsen, PhD, Senior Nutrition Advisor
2. • Nepal is making impressive strides in health and nutrition despite major
challenges, including the continuing earthquake recovery and moving to
a new constitution and moving to a federal structure.
• Strong government
commitment has achieved
major reductions in
stunting since 2001 but
more is needed
Additional NDHS 2016 data
• Child anemia: 53%
• WRA anemia: 41%
• WRA underweight: 17%
Indicator levels vary by
ecological zones and SES
CONTEXT
3. Evolving approach over multiple phases
Learning is continuous
• AAMA (2008 – 2011) CSP
• Suaahara I (2011 – 2016)
• Suaahara II (2016 – 2021)
• National Nutrition Policy and Strategy (2004)
• Sanitation and Hygiene Master Plan (2011)
• Nepal Health Sector Support Strategy
(2015 – 2021)
• Multi-Sector Nutrition Plan (2013 – 2017)
Government of Nepal
GUIDING GOVERNMENT POLICIES
4. • Integrated multi-sectoral strategy to improve nutrition
• Focus on 1,000 days period plus adolescence
• Implemented at scale (across 40 districts – social/geographic diversity)
• Special emphasis for disadvantaged groups
• Builds upon and strengthens government structures and platforms
• Rigorous research, plus ongoing monitoring data to inform programming
SUAAHARA II OVERVIEW
• Multichannel SBC strategy
integrated across all sectors
– Nutrition & Health/Family Planning
– Agriculture/Livestock
– WASH
– Education
– Gender & Social Equity
– Governance
5. Beneficiaries
1.1 million PLW
881,000 CU5
32,400 DAG HH
Train to plan & manage
Multisector Nutrition Plan at
District & VDC levels
40 districts
215,300 people
PROGRAM INPUTS, REACH AND SCALE
15,000 HH
Village Model Farmers
and Homestead Food
Production
Health workers
Trained in FP/RH
6,075
Frontline
workers trained in CHN
42,780
6. Climate smart
ag technology&
information
Engaging private
sector
Market linkages
and development
initiatives
Improved access
to microfinance
Empowerment of
women producers
Sales of surplus
agricultural
products
HH budgeting for
improved nutrition
and health
behaviors
Adolescent
Health &Life
Skills Programs
Emergency
Preparedness
& Response
Women’s decision-
making increased
Strengthening &
coordination with
government bodies
Improved access
to ag inputs &
extension services
WASH
FP
Health
Services
Mass Media &
Information
Technology
Strengthened
government
capacity
Gender & Social
Inclusion strategy
7. Improved Household Nutrition and Health Behaviors
Improved Access to Diverse and Nutrient-Rich
Foods byWomen and Children
Accelerated Roll-Out of Multi-sector Nutrition Plan
through Strengthened Local Governance
Improved
nutritional
status of
women
and
children
< 2 years
Increased Use of Quality Nutrition and Health
Services byWomen and Children
Gender Equality and Social Inclusion
Public Private Partnerships
Innovative Grants Program
Emergency Preparedness and Response Plan
Monitoring Evaluation, Research for Learning
SUAAHARA II RESULTS FRAMEWORK
Social and Behavior Change
8. LEARNINGS FROM AAMA AND SUAAHARA I
• Continuity in leadership to build on learnings
• Formative research conducted each phase
• Experience uncovered gaps in understanding for additional research
• Particularly disparities between knowledge and adoption
• Findings used continuously to improve intervention packages
• Target audience entire family not just 1000-day women
• Prioritized 10 key health, nutrition & WASH behaviors
• Feedback from monitoring data highlights those needing most focus
• Reinforced through all delivery platforms/communication channels
• Goal to reach each family 60 times over first 1,000 days
• Address women’s decision-making power, access to and
control over resources required to adopt key behaviors
9. LEARNINGS: MOVING FROM SBCC TO SBC
• Social and behavior change
includes not only
communication, but also
strategies to create an
enabling environment for
sustained behavior change
• These strategies include
development of supply systems,
services and infrastructure from
government and private sector,
as well as social support and
measures to transform social
norms
This is the major challenge
10. • Apply principle of small do-able
actions to:
• Nutrition
• Food production
• WASH
• Healthy timing and spacing of
pregnancies,
• Empowerment & equity
• Increase demand for and
quality of health and nutrition
services
• Strengthen policy coordination
at all levels across food, care
and health/WASH services
dimensions
SUAAHARA SBC OBJECTIVES
11. MULTISECTOR PLATFORMS
Village model farmers
Ag extension officers
WASH committees Citizen Awareness Centers Ward Citizen Forums
Schools Health facilities
NUTRITION MESSAGING INTEGRATED ACROSS
12. SBC CONSTANT FEEDBACK LOOP
Formative
Research
Communication
Strategy
Campaign
Design
Multi-level SBCC
Implementation
Monitoring
and
evaluation
Baseline
Research
Monthly compilation of HH & coverage checklists
Annual surveys of HH, activities, progress
13. • Monitoring via district-representative monthly data collection
and rapid ongoing feedback cycle using DHIS2 system
• Using checklists completed by field supervisors via mobile app
• Representative random sample of HH (n~3,000), FCHV (1200), VMF (600)
and health facilities (600)
• Assess coverage on 60 contact points and adoption of 10 practices
• Monthly meetings and annual workshops to review data
• Use findings to improve SBC strategy at the local level by addressing
weaknesses in coverage of activities, contacts and hardest to change
behaviors
• Annual survey (3,600 HH) conducted by external team, same
season & tools each round, to assess progress, provide
deeper feedback
MONITORING FEEDBACK SYSTEM
14. • Monthly monitoring checklists
• Household level questions targeted to appropriate point in the life cycle
• Attendance at mothers’ group meetings
• Homestead food production practices
• FCHV activities & coverage
• Health facility services & counseling
• Community mapping census generates denominators and
identifies DAGs for better targeting
• Also allows identification of individual HH needing extra attention and
reinforcement of the particular appropriate messages
MONITORING FEEDBACK SYSTEM
15. • Scale of project facilitates local tailoring
• Staffing is substantial, with district office staff, partner
NGO teams, district and local government partners,
FCHV, community nutrition facilitators – nearly 2,000
people across the 40 districts
• Kathmandu sets minimum program standards and
guides, but teams have local autonomy for problem-
solving, creative collaborations and adapting to local
culture, challenges and needs
• Both GON and USAID recognize importance
of flexibility
• Workplans regularly updated to local realities
• Recent example: to respond to flooding emergency
Suaahara teams in affected districts trained in IMAM
• Nepal federalist structure will divide 40 districts into
>350 municipalities with local control…creating
challenges and opportunities
SUCCESS FACTORS
16. SBC APPROACHES
Communication
Strategy
Campaign
Design
• Leveraging key aspirations: family’s value of
education and child’s success in school
• Multi-channel communication to reach families with
intensive and persistent messaging on key
practices/social change
• Interpersonal communication (IPC)
• Information technologies for frontline workers
• Mother health group discussions
• Community mobilization
• Interactive radio and listener groups
• Tools to guide counseling and improve quality
(complementary feeding wheels, phone videos)
• Innovation grants and public private partnerships
to build local entrepreneurship in filling supply
barriers to adoption
17. “MOTHER KNOWS BEST” CAMPAIGN
ADAPTED TO LOCAL CONTEXT
Mothers-in-law
• Portrayed as a catalyst of change in social norms for nutrition
• Building on her central role in household decision-making
Branding umbrella
• Linked across channels (mass media, community, interpersonal)
• And issues (nutrition, WASH, health, agriculture)
18. SBC COMMUNICATIONS
Mass Media: Localized radio programs (Terai, Hills, Mountains)
• Bhanchin Aama the wise mother-in-law character - brand who also
listens to and empowers young mothers
• Serial drama to teach through stories
• Phone-in segments with main character, quizzes & contests via SMS for
audience engagement & feedback
• Chatting with my Best Friend for adolescents to promote health
19. FREQUENT (60) INTERPERSONAL CONTACTS
WITH ALL CAREGIVERS
Interpersonal
communication
Community
mobilization
Mobile
technology
- Home visits
- Health mothers group
meeting
- Radio discussion groups
- Counselling at health
contact points
- Cooking demonstrations
- Ward level interactions
- Key life event celebrations
- Community fairs
- Radio contests & awards
- Complementary food recipe
competitions
- Push messaging to
motivate and remind
- Videos & apps to guide
frontline workers
- Calls & SMS with
radio hosts
20. SUMMARY - KEY PRINCIPLES
• To close knowledge-practice gap
• Address both supply constraints through WASH
marts, outreach clinics, ag and health supply
chains, and health quality through community
scorecards and demand constraints by working
with individuals but also family & community
social norms
• Prioritize fewer behaviors and phasing
of messages
• But saturate families with the messages
appropriate to their needs (60 contacts in first
1,000 days)
• User-friendly, mobile M&E data
collection and feedback promotes data
utilization to improve SBC strategies
and targeting
21. SUMMARY - KEY PRINCIPLES
• Multiple SBCC approaches and channels appropriate to context
• Provide local teams with guidelines and QA tools but allow freedom to tailor
intervention package & SBC strategies to their context
• Specialized delivery platforms for disadvantaged groups to close gap
• Making all platforms nutrition-sensitive takes time, given Nepal’s
geographic and cultural diversity, and requires capacity building but
is the key
22. ACKNOWLEDGEMENTS
• Christopher Landry, Chief of Party, Suaahara II
• Pooja Pandey Rana, HKI/Nepal Director of Programs
• Kenda Cunningham, Senior Technical Advisor Suaahara II
• Dipak Sharma, Public-Private Partnership Manager
• Dale Davis, HKI/Nepal Country Director
• Nancy Haselow, HKI Vice President for Asia & Pacific
23. Thank you!
“The only think worse than being blind is having sight but no vision.”
-Helen Keller