This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.

1. Health Care Delivery
System In Nepal
(2072/2073 Annual Report)
-7th semester mbbs
Nobel Medical College
Nischal Shrestha
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2. • Health care system of Nepal is managed by Ministry of Health( MoH).
• The main institutions that delivered basic health services in 2072/73
were
- 104 public hospitals,
- 303 private hospitals,
- 202 primary health care centres (PHCCs)
- and 3,803 health posts.
- Primary health care services were also provided by 12,660 primary
health care outreach clinic (PHC-ORC) sites. A total of 16,134 Expanded
Programme of Immunisation (EPI) clinics provided immunisation
services. These services were supported by 49,523 female community
health volunteers (FCHV).
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3. • Primary health care outreach clinics — PHC-ORCs should be
conducted every month at fixed locations in all VDCs on specific dates
and time to extend basic health care services to communities. The clinics
are conducted within half an hour’s walking distance for local people.
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4. Outreach clinic importance
• Outreach is an activity of providing services to any populations who
might not otherwise have access to those services.
• It offers basic health services in rural communities that are far from
health post or hospitals.
• It is very helpful for older adults, pregnant & lactating women, small
children etc.
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5. • Female community health volunteers (FCHV)— Nepal’s 51,470 FCHVs
promote safe motherhood, child health and family planning, and provide other
community based health services to promote health and the healthy behaviour
of mothers and community people with support from health workers and
health facilities.
• FCHVs contribute significantly to distributing oral contraceptive pills, condoms
and oral rehydration solution (ORS) and to counselling and referring mothers to
health facilities.
• FCHVs distributed 10 million packets of condoms FY 2072/73. Service statistics
show that more than a half of diarrhoea and ARI cases were treated by FCHVs
in this year.
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6. • (FCHV) program started in 1988 (2045 B.S.). In the early years of program
initiation, married women of reproductive age were selected as FCHVs and
assigned to promote and distribute the birth-spacing commodities such as
condoms and pills, with the sole purpose of supporting family planning
program in Nepal.
• Currently, over 52,000 FCHVs are actively working—roughly one in 500 people
or at least one in each ward of Village Development Committee.
• The current FCHV guideline has provisioned that the FCHVs must be married
and reside in the ward where they are expected to serve.
• Over past three decades, FCHVs’ roles have gradually expanded beyond family
planning program and especially are focused on maternal and child health
services at a large scale.
• programs such as National Immunization Program, Birth Preparedness Package,
Community-Based Integrated Management of Neonatal and Childhood Illness
(CB-IMNCI), Integrated Management of Acute Malnutrition, Infant and Young
Child Feeding, and Family Planning program
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7. • The major role of FCHVs is to advocate healthy behaviour by mothers
and community people to
- promote safe motherhood, child health, and family planning and other
community based health issues and service delivery.
- FCHVs distribute condoms and pills, ORS packets and vitamin A capsules,
treat pneumonia cases, refer serious cases to health institution and
motivate and educate local people on healthy behaviour.
- They also distribute iron tablets to pregnant women
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10. • The contraceptive prevalence rate (CPR) is the main indicator for
monitoring the achievements of the National Family Planning
Programme.
• The CPR for the use of modern family planning methods remained at
43% nationally in 2072/73.
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11. • Health training — The National Health Training Centre is the apex body
for human resource development in Nepal’s health sector.
The NHTC has
- five regional training centres,
- one sub-regional centre,
- 34 clinical training sites and
- 75 district training units.
• In 2072/73 NHTC developed and revised a number of training manuals
and initiated a number of new training programmes including on primary
trauma care management, on-the-job training for gynaecologists and
obstetric fistula training.
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12. • Health education, information and communication —The National
Health Education, Information and Communication Centre (NHEICC) is
responsible for health promotion, education and communication for all MoH
health services and programmes. It is thus responsible for creating more
demand for health care services.
• The main 2072/72 achievements at the central level were
- the development and implementation of policies, strategies, and programmes;
- the development of programme guidelines and the development, production
and broadcasting of health messages through various media.
- At the district level the centre ran sensitisation programmes for preventing and
controlling epidemics, produced need-based IEC materials and distributed IEC
materials to health facilities.
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13. •Logistics management — The Logistics Management Division
(LMD) supports the procurement (act of obtaining or buying goods
and service) of equipment, vaccines, family planning commodities (items)
and free health drugs by programme divisions and centres. Its major
function is to forecast (calculate or estimate), quantify (measure),
procure, store and distribute health commodities, equipment,
instruments and to repair and maintain biomedical equipment and
transport vehicles.
• In 2072/73, LMD carried out regional procurement and supply chain
workshops in all regions to address problems and issues faced by district
health offices on procurement and supply chain management
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14. • Health laboratory services — The National Public Health Laboratory
(NPHL) is the nodal institute for building capacity building and for the
development of the public health laboratory sector.
• There are diagnostic health laboratories in 8 central hospitals, 3 regional
hospitals, 3 sub-regional hospitals, 10 zonal hospitals, 62 district
hospitals, 16 other district level hospitals, 202 PHCCs and more than
1,500 private health institutions.
• In 2072/73, NPHL provided eight types of routine and specialized
laboratory services with more biochemistry, haematology, parasitology,
immunology, virology, endocrinology, and microbiology tests carried out
than in the previous year.
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15. National Health Care System
• Health care system of Nepal is managed by Ministry of
Health( MoH).
• MoH is responsible for making necessary arrangements and
formulation of policies for effective delivery of :
– Curative Services
– Disease Prevention
– Health Promotion
– Establishment of Primary Health Care System
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16. Levels Of Health Care System
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• Tertiary
Level
Secondary
level
Primary
level
Central
hospital
s
Regional
hospitals
Zonal
hospitals
District
hospitals
Primary
health
care
system
Health
post
FCHV,
PHC-ORC,
EPI-ORC

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18. • DoHS, the Department of Ayurveda (DoA) and the Department of
Drug Administration (DDA) come under MoH.
• DDA is the regulatory authority for assuring the quality and regulating
the import, export, production, sale and distribution of drugs. The
Department of Ayurveda offers Ayurvedic care and implements health
promotional activities.
MoH
DDADoA
DoHS
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19. •DoHS has the following six centres that have a degree of
autonomy in personnel and financial management:
- National Health Education, Information and Communication Centre (NHEICC);
- National Health Training Centre (NHTC);
- National Centre for AIDS and STD Control (NCASC);
- National Tuberculosis Centre (NTC);
- National Public Health Laboratory (NPHL) and
- Vector-Borne Disease Training and Research Centre (VBDTRC).
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Summary : 1 information cenre, 1 lab centre, 2
disease control center & 2 training center

20. Divisions Of DoHS
•
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MD (Management
Division)
CHD(ChildHealth
Division)
FHD (Family
HealthDivision)
LMD (logistic
Management Division)
EDCD(Epidemiology
and DiseaseControl
Division)
PHCRD(Primary
HealthCare
RevitalizaionDivision)
LCD (Leprosy
Control Division)

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26. • The five RHDs provide technical backstopping (support) and programme
monitoring to district health systems and come directly under MoH. The
regional> sub-regional > zonal hospitals have decentralised authority through
their hospital development boards. There are also training centres, laboratories,
TB centres (in some regions) and medical stores at the regional level.
• Each of Nepal’s districts has either a DHO or DPHO. The DPHOs and DHOs
are responsible for implementing EHCS (essential health care service) and
monitoring activities and outputs of district hospitals, primary health care
centres (PHCCs) and health posts. The public health care service delivery outlets
include health posts, PHCCs, health centres, district and other hospitals, zonal
hospitals, sub-regional hospitals, regional hospitals, and central level hospitals.
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27. • Health posts are the first institutional contact point for basic health
services. These lowest level health facilities monitor the activities of
FCHVs and the community-based activities of primary health care
outreach clinics (PHC-ORCs) and EPI clinics. In addition, they are the
referral centres of FCHVs as well as venues for community based activities
such as PHC-ORC and EPI clinics. Each level above the health post level is
a referral point in a network from PHCCs on to district, zonal sub-regional
and regional hospitals, and finally to tertiary level hospitals.
• Inversely, the system works as a supporting mechanism for lower levels by
providing logistical, financial, monitory supervisory and technical support
from the centre to the periphery.
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