From 2014/2015, Ministry of Health (MoH) started providing block grant to district hospitals of Nepal ranging from two to five million rupees. This document is a translation of the Management Division's Guideline on the use of grant.

1. March 2016
Unofficial Translation by TIMSINA DEEPAK
For internal use only
Essence of the Management Division's (MD) Guideline (2015/2016)
on
Quality and Service Improvement of District Hospitals
In the FY 2014/15, Management Division allocated a grant of 2-5 Million Rupees to the District Hospitals
(DH) of Nepal under the budget sub-head 370804, for the strengthening of the hospitals and providing
quality of services.
In the FY 2015/16, grant of 1.6-5 million Rupees has been allocated to the District Hospitals for the
same.
Objective of the program:
Strengthen the management functions of the hospitals to ensure the provision of basic health services.
Procedures for the execution of the activities:
1. It is mandatory to form a separate Operation Committee (OC) with 13 members, as follows:
Representative Position
1 Chairperson, Hospital Development Committee (1) Chairperson
2 Representatives from HDC and DAO including Officer from DAO (2) Members
3 Chief, District (Public) Health Office (1) Member
4 Chief/Matron, District Hospital Nursing Section (1) Member
5 Sr. AHW or HA or PHI or PHO from DH (1) Member
6 Medical Recorder or Statistician from DH (1) Member
7 Lab personnel from DH (1) Member
8 Personnel from Radiology Unit (1) Member
9 Representative from Users' Committee (1) Member
10 Chief, Account Section of DH (1) Member
11 Store Keeper, DH (1) Member
12 Medical Superintendent of DH (1) Member
Secretary
Total- 13 members
2. Major roles and responsibilities of the Operation Committee includes:
 Ensure the amount of grant provided by MD.
 Hold the meeting of the OC at least tri-annually.
 Need identification as per Minimum Service Standards (MSS).
 Identify activities based on the defined 9 headings (table 2).
 Analyze the progresses made in the previous

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 Organize Social Audit of the program and hospital progresses for the whole fiscal year and
submit the reports to the concerned departments/divisions in DoHS/MoH.
 Report to DoHS, MD and RHD tri-annually and annually.
 Ensure that TABUCS is used for financial management
1. HDC meeting and Social Audit upto NPR 100,000
2 Repair and maintenance of physical infrastructure 20%
3 Waste management and IP 15%
4 Electricity, drinking water and sewage disposal 15%
5 Strengthen the clinical services/purchase of equipments 25%
6 Establish pharmacy in hospitals and strengthening it 10%
7 Strengthening HMIS in hospitals 6%
8 Furnishing hospital/purchase of necessary furnitures 5%
9 Strengthen other services for clients 4%
Note: NPR 100,000/- for S.N.1 is deducted from the budget first and the remaining amount is calculated
as 100% for allocating to different activities (2-9).
Key functions to be carried out under this program include:
1. HDC and OC Meeting Cost and Social Audit:
o Refreshment and allowance for participants of the meetings, allowance for triannual
report preparation committee (1 day allowance to 5 persons).
o Organize social audit of DH.
2. Repair and maintenance of physical infrastructure:
 Priority has to be given to repair and maintain such structures that promote the service
delivery. For example: repair of windows, floor, walls, ceiling, lab, x-ray, emergency,
OPD, Indoor, OT, Labor room, waiting space, toilets etc.
 Other small infrastructure works that strengthen the services directly or indirectly like
retention wall, compound walls, paving paths etc.
3. Waste Management and IP:
 Manage waste as per the 'Health Care Waste Management Guideline 2014'.
 The first priority has to be given to the purchase and operation of autoclave for
sterilization of the waste.
 Other items include needle cutter/needle destroyer, trolley for transportation of the
waste, colored buckets for waste segregation at source, gears for sweepers not
exceeding NPR 50,000/-
4. Electricity, drinking water and sewage disposal:

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 Payment of the due bills ensuring that the hospital uses electricity on need base with
efficiency. The personal consumption of the electricity in quarter buildings cannot be
paid with this grant.
 Other costs include drinking water supply, sanitation, washing and cleaning facilities for
the hospitals and patients, source protection, repair and maintenance of pipeline,
construction of reservoir or underground storage tanks, sewage disposal etc.
 Heating labor room and postnatal wards.
5. Strengthen Clinical services/purchase of equipment:
 Assess equipment as per MSS and process for the procurement as per the specification -
spec.dohslmd.gov.np
 Regular repair and maintenance of x-ray, ultrasound, ECG, purchase of x-ray films, gel
and papers etc.
 Repair and maintenance of lab room, supply chemicals and reagents which are required
for the lab but not enlisted in the central supply.
6. Establish pharmacy in hospitals and strengthen it:
 Establish pharmacy as per Hospital Pharmacy Guidelines 2070.
 Ensure the pharmacy supplies drugs as per MSS.
7. Strengthen HMIS in Hospitals:
 Costs include purchase and management of cards, registers, papers, computer, printer,
UPS, scanner, email, internet service etc for the medical record section, cupboards,
patient files, rack, tables, chairs etc.
 Every hospital needs to make online entry of the service data.
 Analyze the service data tri-annually and share the results in the meeting.
 Establish paging system of District Hospitals and advocacy through local FMs.
8. Furnishing hospital/purchase of necessary furniture:
 Manage furniture for OPD, waiting space, Indoor etc.
9. Strengthen other services for clients:
 Costs include the drugs, equipment or furniture items which are not covered in S.N. 2-8
like life saving drugs, screens, curtains, pillow, blankets, bedsheets, lighting for wards
etc.
Annex-7
Tri-annual Report
Name of the hospital : …………….

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Duration: ………….. Reporting date:……………
S.N. Sub-activities Allocated budget Expenditure Major
achievements in
bullets
1 HDC meeting and Social Audit 
2 Repair and maintenance of
physical infrastructure
3 Waste management and IP
4 Electricity, drinking water and
sewage disposal
5 Strengthen the clinical
services/purchase of equipments
6 Establish pharmacy in hospitals
and strengthening it
7 Strengthening HMIS in hospitals
8 Furnishing hospital/purchase of
necessary furnitures
9 Strengthen other services for
clients