Managing pediatric services in Nepal faces many challenges. The country has a young population but inadequate child and women's hospitals. Effective hospital management requires considering cultural, developmental and health needs specific to children. These include appropriate staff training, family-centered care, and addressing disparities some children face. Future improvement needs include equitable resource allocation, supporting primary care, quality standards, and prioritizing children's well-being. The goal is for Nepal's children to realize their full potential.

1. Challenges and Effective
Management of Pediatric Services in
Nepal
Dr. R.P. Chaudhary
Board of Director
Ishan Children and Women’s Hospital
Consultant Pediatric Surgeon
Grande International Hospital, KTM

2. We know that children’s early experience of
health care affects their attitude to the health
service for the rest of their lives’’
Professor Al Aynsley Green
The National Clinical Director for Children, UK

3. What is a Hospital ?
• Important institution for the economic and
social well-being of society.
• Curative and rehabilitative functions enable
them to restore individuals to be productive
members of society and to enjoy the benefits
• Success is highly dependent on the hospital’s
managerial capability.

4. What is a Hospital ?
• Management runs the healthcare organization
and administration handles the staffing.
• But within those two general areas are several
sub-areas of concern that require years of
intense education and experience to get
right.

6. Framework of Hospital Management
Government
Policies
Technical Performance
Environment
Management
Resources
Financial
Performances

7. Pediatric Hospital infrastructure
• Hospitals are the part of social system which
again have subsystem like
– clinical , Diagnostic , Therapeutic , supportive and
utility services
• Health promotion and prevention services,
including community-based
– Research, Education, Policy and advocacy

8. Pediatric Hospital infrastructure
Should Provide :
• Operational
• Financial
• Managerial
• Human resources
• Compliance
• Training support and research

9. What are the challenges?

10. Demographics of Nepal
• Population 30,986,975
(July 2014 est.)
• Age structure :
0-14 years: 31.6%
(male ,989,268
female 4,805,381)
15-24 years: 22.6%
(male ,521,421
female 3,484,203)

11. Child care in Nepal :
• Inadequate
• Children’s hospital
– Government : one
– Private : Few
• Women and Children’s Hospital:
– Government: None
– Private: Few
• General hospital with pediatric facility:
– Regional/ sub-regional/Zonal/ teaching hospital

12. Pediatric Health Care Needs
Health and functional status
Health insurance status and adequacy of
coverage
Access to health care including types of health
services needed and any unmet needs for care
Preventive medical and dental care, and
specialty services received
Family-centeredness of child’s health care and
care coordination

13. Pediatric Health Care Needs
Access to Community-Based Services
Transition to Adulthood
Impact of child’s health on family
Demographics of child and family
Education, family structure, primary
language spoken in the home

14. Culturally Effective Pediatric Care:
• Delivery of care within the context of
– Appropriate physician knowledge
– Understanding
– Appreciation of cultural distinctions leading to
optimal health outcomes.
• Providers will thus enhance interpersonal and
communication skills

15. Pediatric Care differs from adult:
• Development:
As children mature both cognitively and
physically, their needs as consumers.
Therefore, planning a unified approach to
pediatric safety and quality
• Dependency:
Hospitalized children, especially those who
are very young and/or nonverbal, are
dependent on caregivers, parents, or others

16. Pediatric Care differs from adult:
• Different epidemiology:
Most hospitalized children require acute
episodic care unlike adult. So, they create
distinct challenges and requires a new way of
thinking.
• Demographics:
Children are more likely than other groups to
live in poverty and experience racial and
ethnic disparities in health care.

17. Can children be treated like adults ?
• They are different and need different
approach and so, to be treated accordingly
• They are not mini adults.
• have various differences:
– Anatomical
– Physiological
– Psychosocial
• Hospital management is also different

18. Which hospital is better ?
• General Hospital
• Children’s Hospital
• Women and Children’s Hospital

19. …So, how are we doing?

20. • A hospital's performance is difficult to measure
because of the high degree of subjectivity and do
not operate in isolation
• Objective is to provide quality patient care while
maintaining the financial viability
• Various factors surrounding and even within the
hospital affect its degree of success or failure
• Factors include the nature of its resources ,
competition, markets and government regulations
and incentives.

21. Challenges
• Inequitable and inefficient resource allocation
where tertiary hospitals consume disproportionate
resources and starved the primary health care
• Good quality first referral level (or district hospital)
care is crucial for reducing child mortality and for a
credible and efficient primary health care system.
• Implementation of community based integrated
management of childhood illness guidelines

22. Challenges
• Concerns of poor outcome
– under / poor treatment , over-hospitalisation, over-
diagnosis of severe illness
• Confronting potentially avoidable deaths or
suffering in children - upsetting
• Academic thought and energy is predominantly
directed towards clinical problems
• Inadequate consideration of the health system
problems in peripheral hospitals
– often understaffed, poorly equipped and with little or
no ongoing staff education

23. What are the future needs?

24. “To raise new questions, new possibilities,
to regard old problems from a new angle,
requires creative imagination and marks a
real advance in science.”
Albert Einstein

25. Components of quality improvement:
• Standards
• Assessment tools
• Participation
• Driving forces.
• Education and Training
• Institutional and Systems Support
• Research and Advocacy

26. Clinical services in the hospital should be
• To support the best clinical practice which minimizes
risk to patients
• To achieve the objective of child and family centered
care
• To promote multidisciplinary and cross-specialty
working
• To make efficient use of resources – staff, equipment
and facilities
• To ensure future flexibility to respond to changes in
service range and volume

28. Care for children in hospital should be
• Friendly and centered on the needs of the young
person
• High Quality. Policies and services should aspire to,
and attain, high standards
• Coherent in design and delivery. Should be woven
together in a coherent, integrated and cross-sector
form
• Empowering. Have opportunities to play an
effective role in the design and delivery of policies

29. Care for children in hospital should be
• Results orientated and evidence-based. High quality
research, evaluation, monitoring and review
• Equitable and non-discriminatory. All children and
young people should have access to services
• Family-orientated. Full recognition must be given to
family members – including extended family
• Supportive and respectful. Policies and services
should be respectful and supportive one

30. The Vision
The National Children’s Strategy
“Nepal should be where children are respected
as young citizens with a valued
contribution to make and a voice of their own;
where all children are cherished and
supported by family and the wider society;
where they enjoy a fulfilling childhood and
realize their potential.”

31. Conclusion:
• Pediatric care and their
hospital management are
different from adults
• They need special approach and
care, as they are the future for
any country, to be healthier
• They can be cared better in a
children friendly hospital
• It’s a team work for which
management is equally
important