Safe Motherhood Program in Nepal: Challenges and Way ForwardKusumsheela Bhatta
The safe motherhood programme is one of the priority programme of Nepal. The goal of the National Safe Motherhood Program is to reduce maternal and neonatal morbidity and mortality and to improve the maternal and neonatal health through preventive and promotive activities as well as by addressing avoidable factors that cause death during pregnancy, childbirth and postpartum period. This presentation incorporates historical context, introduction, major achievements, actors, what Went Well, what didn’t go well, limitations, challenges, way forward of Safe Motherhood Program in Nepal.
Unit 3.2 national safe motherhood policy 1998chetraj pandit
The 1998 Safe Motherhood Policy in Nepal aimed to reduce maternal mortality and morbidity. Its objectives were to increase access, availability, and utilization of maternal health services; strengthen the capacity of maternal healthcare providers; strengthen referral services for maternity care; raise public awareness of maternal health and safe motherhood; and improve the legal and socioeconomic status of women. The strategies included promoting inter-sectoral collaboration, strengthening and expanding delivery services by skilled birth attendants and emergency obstetric care at all levels, supporting activities to raise the status of women, and promoting research on safe motherhood.
Nepal Health Sector Program Implementation Plan II (NHSP-IP2)Dip Narayan Thakur
The document summarizes Nepal's Health Sector Implementation Plan II (NHSP-IP II). NHSP-IP II aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and utilization of essential health services. It reviewed achievements and shortcomings of NHSP-IP I and outlined NHSP-IP II's vision, goals, strategies, and financing plans. Key points included reducing morbidity and mortality through accessible, affordable, quality care; addressing sustainability issues in health financing; and achieving greater efficiency through health systems strengthening. Progress was made in areas like immunization and maternal health, but challenges remained around nutrition, non-communicable diseases, and equity gaps.
The National Health Policy was adopted in 1991 in Nepal with the primary objective of extending primary health care services to the rural population. It had 15 components including preventive, promotive, and curative health services. Some key achievements include establishing new sub-health posts and primary health centers in all districts to improve access to basic services. Community participation in health services increased through over 50,000 female community health volunteers. However, some targets around hospital expansion and developing specialized services were not fully realized. Overall the policy helped reduce child mortality but challenges remain around human resource development, management, and inter-sectoral coordination.
Adolescent sexual and reproductive health (ASRH) in Nepal Public Health
1) The document outlines Nepal's Adolescent Sexual and Reproductive Health (ASRH) strategy, which aims to promote the health of adolescents aged 10-19.
2) Key achievements include expanding ASRH services to 75 of 77 districts, establishing 6 ASRH clinical training sites, and training over 1,700 health workers.
3) Challenges include high rates of early marriage, low contraceptive use among adolescents, and a need for more trained staff and resources for the ASRH program.
Nepal has one of the highest maternal mortality rates in the world. Abortion was legalized in 2002 through amendments to the Muluki Ain, Nepal's legal code, in order to make safe abortion services available nationwide. Previously, the Muluki Ain prohibited abortion and punished women for having abortions. The amendments conditionally liberalized abortion by allowing it up to 12 weeks with woman's consent and up to 28 weeks if her life or health is at risk. The Right to Safe Motherhood and Reproductive Health Act of 2018 further expanded access by allowing abortion up to 28 weeks in cases of rape, incest, HIV/AIDS, or fetal defects.
Unit 3.7 health sector stratigies 2004 agenda for reformchetraj pandit
This document outlines Nepal's health sector strategy from 2004. It draws on several key government health documents from 1991-2001. The strategy aims to reduce poverty and achieve Millennium Development Goals by focusing on essential health services for the poor, including safe motherhood, child health, and communicable disease control. It seeks to [1] ensure the poor have access to essential health care, [2] give local bodies responsibility for managing health facilities, and [3] recognize the roles of private and nonprofit sectors in service delivery. Sector management outputs include [1] coordinated planning and financing within the Ministry of Health, [2] sustainable health financing schemes, [3] effective management of assets and supplies, [4]
This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
Safe Motherhood Program in Nepal: Challenges and Way ForwardKusumsheela Bhatta
The safe motherhood programme is one of the priority programme of Nepal. The goal of the National Safe Motherhood Program is to reduce maternal and neonatal morbidity and mortality and to improve the maternal and neonatal health through preventive and promotive activities as well as by addressing avoidable factors that cause death during pregnancy, childbirth and postpartum period. This presentation incorporates historical context, introduction, major achievements, actors, what Went Well, what didn’t go well, limitations, challenges, way forward of Safe Motherhood Program in Nepal.
Unit 3.2 national safe motherhood policy 1998chetraj pandit
The 1998 Safe Motherhood Policy in Nepal aimed to reduce maternal mortality and morbidity. Its objectives were to increase access, availability, and utilization of maternal health services; strengthen the capacity of maternal healthcare providers; strengthen referral services for maternity care; raise public awareness of maternal health and safe motherhood; and improve the legal and socioeconomic status of women. The strategies included promoting inter-sectoral collaboration, strengthening and expanding delivery services by skilled birth attendants and emergency obstetric care at all levels, supporting activities to raise the status of women, and promoting research on safe motherhood.
Nepal Health Sector Program Implementation Plan II (NHSP-IP2)Dip Narayan Thakur
The document summarizes Nepal's Health Sector Implementation Plan II (NHSP-IP II). NHSP-IP II aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and utilization of essential health services. It reviewed achievements and shortcomings of NHSP-IP I and outlined NHSP-IP II's vision, goals, strategies, and financing plans. Key points included reducing morbidity and mortality through accessible, affordable, quality care; addressing sustainability issues in health financing; and achieving greater efficiency through health systems strengthening. Progress was made in areas like immunization and maternal health, but challenges remained around nutrition, non-communicable diseases, and equity gaps.
The National Health Policy was adopted in 1991 in Nepal with the primary objective of extending primary health care services to the rural population. It had 15 components including preventive, promotive, and curative health services. Some key achievements include establishing new sub-health posts and primary health centers in all districts to improve access to basic services. Community participation in health services increased through over 50,000 female community health volunteers. However, some targets around hospital expansion and developing specialized services were not fully realized. Overall the policy helped reduce child mortality but challenges remain around human resource development, management, and inter-sectoral coordination.
Adolescent sexual and reproductive health (ASRH) in Nepal Public Health
1) The document outlines Nepal's Adolescent Sexual and Reproductive Health (ASRH) strategy, which aims to promote the health of adolescents aged 10-19.
2) Key achievements include expanding ASRH services to 75 of 77 districts, establishing 6 ASRH clinical training sites, and training over 1,700 health workers.
3) Challenges include high rates of early marriage, low contraceptive use among adolescents, and a need for more trained staff and resources for the ASRH program.
Nepal has one of the highest maternal mortality rates in the world. Abortion was legalized in 2002 through amendments to the Muluki Ain, Nepal's legal code, in order to make safe abortion services available nationwide. Previously, the Muluki Ain prohibited abortion and punished women for having abortions. The amendments conditionally liberalized abortion by allowing it up to 12 weeks with woman's consent and up to 28 weeks if her life or health is at risk. The Right to Safe Motherhood and Reproductive Health Act of 2018 further expanded access by allowing abortion up to 28 weeks in cases of rape, incest, HIV/AIDS, or fetal defects.
Unit 3.7 health sector stratigies 2004 agenda for reformchetraj pandit
This document outlines Nepal's health sector strategy from 2004. It draws on several key government health documents from 1991-2001. The strategy aims to reduce poverty and achieve Millennium Development Goals by focusing on essential health services for the poor, including safe motherhood, child health, and communicable disease control. It seeks to [1] ensure the poor have access to essential health care, [2] give local bodies responsibility for managing health facilities, and [3] recognize the roles of private and nonprofit sectors in service delivery. Sector management outputs include [1] coordinated planning and financing within the Ministry of Health, [2] sustainable health financing schemes, [3] effective management of assets and supplies, [4]
This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
The document outlines Nepal's Safe Motherhood Programme which aims to reduce maternal and neonatal morbidity and mortality through various strategies and activities. The major strategies include promoting birth preparedness, expanding 24-hour birthing facilities, and emergency obstetric care services. Key activities involve community-level maternal and newborn interventions, expanding service delivery sites, emergency referral funds, and programs to provide free delivery services and newborn supplies. The goals are to address delays in seeking and receiving care and improve access to institutional deliveries and emergency obstetric services.
The National Health Education, Information and Communication Center (NHEICC) was established in 1993 as the top health program in Nepal. It aims to raise health awareness, promote health, and change behaviors through integrated education and communication. NHEICC has five sections and is responsible for organizing advocacy, developing health policies and strategies, and disseminating health messages through various media channels. It conducts a variety of activities at the national, regional, district, and community levels, including producing educational materials, implementing media campaigns, and providing training to health workers.
This document provides an overview and review of Nepal's 1991 National Health Policy and the need for a new health policy. It summarizes the key objectives and components of the 1991 policy, including priorities for preventive, promotive and curative health services. It then reviews progress made against the 1991 policy goals. Several new health policies, strategies and plans have been introduced since 1991 to address issues not covered previously. The document argues that while progress has been made in some areas, the 1991 policy is now outdated given changes over the last 20 years and a new health policy is needed.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
1. Health system development concerns how a country organizes its health sector functions including health services, workforce, financing, and policies.
2. Nepal has developed its health system over three historical periods from ancient to modern times, establishing hospitals, clinics, and public health programs at
The document discusses Nepal's family planning program. The main points are:
1) Family planning is a priority in Nepal to improve health outcomes and economic development. It aims to ensure individuals can fulfill reproductive needs through informed choice of contraceptive methods.
2) The government, NGOs, and private sector provide a range of temporary and permanent family planning methods through health facilities. Community health volunteers also provide information and some methods.
3) National policies emphasize increasing access, integrating services, and engaging both males and females in planning their families to improve their quality of life.
Brief Overview of Management of Safe Motherhood and Newborn Health Services i...Mohammad Aslam Shaiekh
The document provides an overview of the management of safe motherhood and newborn health services in Nepal. It discusses the goals and strategies of the Safe Motherhood and Newborn Health Program, which aims to reduce maternal and neonatal mortality through preventative activities and addressing delays in seeking and receiving care. Major activities outlined include birth preparedness, rural ultrasound programs, reproductive health services, expanding health facilities, training health workers, and demand-side financing incentives for institutional deliveries. It also reviews the program's status, management perspectives using the POSDCORB framework, and identifies issues such as high maternal mortality and the need to establish effective referral mechanisms.
Comprehensive Field Practice (CFP) : District Health Service Management Mohammad Aslam Shaiekh
The document summarizes the activities and learnings of a group of public health students during their 30-day field placement in Surkhet District, Nepal. The group conducted various assessments of the district's health management system including a secondary data review, critical analysis using SWOT, an epidemiological study on major health issues, and a mini action project on plastic waste reduction. Key findings included gaps in safe motherhood services, increasing HIV trends, and issues with logistics management and data reporting. The placement helped the students gain important academic and management skills applicable to their public health careers.
This document summarizes the child health program in Nepal. It discusses the main medical causes of infant mortality and morbidity, including low birth weight, respiratory infections, diarrhea, and malnutrition. It then outlines Nepal's national immunization program, which aims to increase vaccination coverage and prevent diseases like polio, measles, and tetanus. The program is guided by national health strategies and goals to reduce child mortality and morbidity from vaccine-preventable illnesses. Key activities discussed include vaccinator training, polio campaigns, and integrated disease surveillance.
The document summarizes Nepal's Community Based Integrated Management of Newborn Care (Neonatal care) and Childhood Illness (CB-IMNCI) program. The key points are:
[1] CB-IMNCI aims to reduce neonatal and under-5 mortality by promoting essential newborn care, managing major causes of illness in newborns and children, and improving access to health services.
[2] It integrates newborn care programs with childhood illness management. Major interventions include birth preparedness, essential newborn care, treatment of neonatal sepsis, and management of childhood illnesses like pneumonia and diarrhea.
[3] The goal is to achieve targets for reducing under-5 and
The National Health Policy of 1991 aimed to extend primary health care services to rural Nepal and upgrade health standards for the rural population. The key objectives were to provide preventive, promotive and curative services at the village level to reduce infant and child mortality using an integrated primary health care approach. While many targets were achieved, such as establishing health infrastructure across the country, issues remained such as inadequate resources, lack of coordination between sectors, and disparities in health standards and access between rural and urban populations.
The document summarizes Nepal's family planning program. The main objectives are to improve health outcomes for mothers and children by increasing access to quality family planning services, especially for rural and marginalized groups. Key activities include providing various contraceptive methods through both institutions and mobile clinics. While contraceptive use and access have increased over time, challenges remain such as high unmet need and an overreliance on emergency contraception and abortion. Recommendations focus on strengthening access to long-acting reversible contraceptives and services for adolescents.
Health education and promotion in nepalAmrit Dangi
This document discusses the history of health promotion and education in Nepal. It outlines key initiatives from ancient times through the modern era. Some of the major developments include the use of Ayurveda practices in ancient times, plague elimination efforts by missionaries in medieval times, the introduction of vaccination and sanitation campaigns in the Rana regime, and the establishment of the National Health Education Information and Communication Centre in 1993 to coordinate health promotion programs. The document shows how health promotion has increasingly become a priority and systematic part of national health plans and policies over time in Nepal.
The National Neonatal Strategy aims to improve newborn health and survival in Nepal. It was developed based on a situation analysis and expert recommendations. The goals are to increase adoption of healthy newborn care practices and strengthen neonatal health services at all levels. Key interventions include developing policies and guidelines, behavior change communication, strengthening service delivery through training health workers and improving facilities, better program management, and conducting operational research. The strategy provides an evidence-based framework to guide stakeholders in improving neonatal outcomes in Nepal.
The document outlines Nepal's multi-sector nutrition plan to reduce undernutrition among women and children. The objectives are to update on the current nutrition situation and share the plan and its implementation arrangements. It provides an overview of the plan which was prepared in close consultation with several key ministries. The plan aims to accelerate reduction of undernutrition through multi-sector interventions focusing on the critical window of opportunity from pregnancy to age two. It establishes leadership and coordination structures and outlines strategic objectives and results across sectors including health, agriculture, education, and local development to holistically address the causes of undernutrition.
This document outlines a presentation on Nepal's National Health Policy 2071, which was approved in July 2014. It provides background on Nepal's past health experiences, current health context, and key problems and challenges in the health system. The presentation describes the need for a new health policy to address these issues. The policy's vision, mission, goals, and 14 policy areas with 120 total strategies are summarized. The presentation also discusses organizational management, financial sources, monitoring, risks, and new areas addressed by the new health policy.
Review of health planning &budgeting from province to local level in federal ...Mohammad Aslam Shaiekh
The document reviews the current health service planning system from the province to local level in Nepal.
At the local level, there is a system of top-down and bottom-up approaches for program and budget planning. The health facilities provide services and local health committees provide input into planning and prioritization.
At the provincial level, the health directorate oversees health offices in the districts and reviews and approves local health budgets and plans. The provincial health directorate then sends the provincial health program and budget to the Ministry of Social Development for approval before being sent to the federal government.
The planning process involves input from the community level up to the provincial and federal levels over a period of months, with local
Sector-wide approaches (SWAps) in health were developed in the 1990s in response to fragmented donor projects and prescriptive lending. SWAps aim to support government-led health sector policies and strategies through coordinated funding that supports national health plans. The goals of SWAps include increased government leadership, improved donor coordination, strengthened health sector management, and more coherent sector policy and planning. However, implementing SWAps effectively requires strong government commitment and leadership as well as transparent negotiation between donors and government to account for local context. It may take 5-10 years of sustained implementation before SWAps significantly impact health outcomes.
The Nepal Health Sector Strategy (NHSS) 2015-2020 provides strategic guidance for the health sector over five years. Its goal is to improve health status through accountable and equitable health services. NHSS outlines nine outcomes, including rebuilding health systems and improving quality of care. It identifies key outputs needed to achieve each outcome, along with interventions, indicators, targets, data sources, and timelines to monitor progress in strengthening Nepal's health sector.
Adolescent Sexual and Reproduction Health PresentationDeepak TIMSINA
ADRA worked to scale-up ASRH programme in Kalikot District through its Strengthening Reproductive Health (SRH) project. I worked as a 'Training Officer' in ADRA from 2012-2013.
Maternal Health in Nepal _Saroj Rimal.pptxsarojrimal7
This document summarizes a presentation on maternal health in Nepal. It begins with background information on maternal health and maternal mortality globally and in Nepal. It then discusses Nepal's status and trends in maternal health indicators like the maternal mortality ratio over time. It also covers Nepal's obstetric transition stage, the evolution of maternal health policies, current programs and strategies to promote skilled birth attendance and institutional deliveries. Issues and challenges in achieving lower maternal and neonatal mortality rates are also presented.
The document outlines Nepal's Safe Motherhood Programme which aims to reduce maternal and neonatal morbidity and mortality through various strategies and activities. The major strategies include promoting birth preparedness, expanding 24-hour birthing facilities, and emergency obstetric care services. Key activities involve community-level maternal and newborn interventions, expanding service delivery sites, emergency referral funds, and programs to provide free delivery services and newborn supplies. The goals are to address delays in seeking and receiving care and improve access to institutional deliveries and emergency obstetric services.
The National Health Education, Information and Communication Center (NHEICC) was established in 1993 as the top health program in Nepal. It aims to raise health awareness, promote health, and change behaviors through integrated education and communication. NHEICC has five sections and is responsible for organizing advocacy, developing health policies and strategies, and disseminating health messages through various media channels. It conducts a variety of activities at the national, regional, district, and community levels, including producing educational materials, implementing media campaigns, and providing training to health workers.
This document provides an overview and review of Nepal's 1991 National Health Policy and the need for a new health policy. It summarizes the key objectives and components of the 1991 policy, including priorities for preventive, promotive and curative health services. It then reviews progress made against the 1991 policy goals. Several new health policies, strategies and plans have been introduced since 1991 to address issues not covered previously. The document argues that while progress has been made in some areas, the 1991 policy is now outdated given changes over the last 20 years and a new health policy is needed.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
1. Health system development concerns how a country organizes its health sector functions including health services, workforce, financing, and policies.
2. Nepal has developed its health system over three historical periods from ancient to modern times, establishing hospitals, clinics, and public health programs at
The document discusses Nepal's family planning program. The main points are:
1) Family planning is a priority in Nepal to improve health outcomes and economic development. It aims to ensure individuals can fulfill reproductive needs through informed choice of contraceptive methods.
2) The government, NGOs, and private sector provide a range of temporary and permanent family planning methods through health facilities. Community health volunteers also provide information and some methods.
3) National policies emphasize increasing access, integrating services, and engaging both males and females in planning their families to improve their quality of life.
Brief Overview of Management of Safe Motherhood and Newborn Health Services i...Mohammad Aslam Shaiekh
The document provides an overview of the management of safe motherhood and newborn health services in Nepal. It discusses the goals and strategies of the Safe Motherhood and Newborn Health Program, which aims to reduce maternal and neonatal mortality through preventative activities and addressing delays in seeking and receiving care. Major activities outlined include birth preparedness, rural ultrasound programs, reproductive health services, expanding health facilities, training health workers, and demand-side financing incentives for institutional deliveries. It also reviews the program's status, management perspectives using the POSDCORB framework, and identifies issues such as high maternal mortality and the need to establish effective referral mechanisms.
Comprehensive Field Practice (CFP) : District Health Service Management Mohammad Aslam Shaiekh
The document summarizes the activities and learnings of a group of public health students during their 30-day field placement in Surkhet District, Nepal. The group conducted various assessments of the district's health management system including a secondary data review, critical analysis using SWOT, an epidemiological study on major health issues, and a mini action project on plastic waste reduction. Key findings included gaps in safe motherhood services, increasing HIV trends, and issues with logistics management and data reporting. The placement helped the students gain important academic and management skills applicable to their public health careers.
This document summarizes the child health program in Nepal. It discusses the main medical causes of infant mortality and morbidity, including low birth weight, respiratory infections, diarrhea, and malnutrition. It then outlines Nepal's national immunization program, which aims to increase vaccination coverage and prevent diseases like polio, measles, and tetanus. The program is guided by national health strategies and goals to reduce child mortality and morbidity from vaccine-preventable illnesses. Key activities discussed include vaccinator training, polio campaigns, and integrated disease surveillance.
The document summarizes Nepal's Community Based Integrated Management of Newborn Care (Neonatal care) and Childhood Illness (CB-IMNCI) program. The key points are:
[1] CB-IMNCI aims to reduce neonatal and under-5 mortality by promoting essential newborn care, managing major causes of illness in newborns and children, and improving access to health services.
[2] It integrates newborn care programs with childhood illness management. Major interventions include birth preparedness, essential newborn care, treatment of neonatal sepsis, and management of childhood illnesses like pneumonia and diarrhea.
[3] The goal is to achieve targets for reducing under-5 and
The National Health Policy of 1991 aimed to extend primary health care services to rural Nepal and upgrade health standards for the rural population. The key objectives were to provide preventive, promotive and curative services at the village level to reduce infant and child mortality using an integrated primary health care approach. While many targets were achieved, such as establishing health infrastructure across the country, issues remained such as inadequate resources, lack of coordination between sectors, and disparities in health standards and access between rural and urban populations.
The document summarizes Nepal's family planning program. The main objectives are to improve health outcomes for mothers and children by increasing access to quality family planning services, especially for rural and marginalized groups. Key activities include providing various contraceptive methods through both institutions and mobile clinics. While contraceptive use and access have increased over time, challenges remain such as high unmet need and an overreliance on emergency contraception and abortion. Recommendations focus on strengthening access to long-acting reversible contraceptives and services for adolescents.
Health education and promotion in nepalAmrit Dangi
This document discusses the history of health promotion and education in Nepal. It outlines key initiatives from ancient times through the modern era. Some of the major developments include the use of Ayurveda practices in ancient times, plague elimination efforts by missionaries in medieval times, the introduction of vaccination and sanitation campaigns in the Rana regime, and the establishment of the National Health Education Information and Communication Centre in 1993 to coordinate health promotion programs. The document shows how health promotion has increasingly become a priority and systematic part of national health plans and policies over time in Nepal.
The National Neonatal Strategy aims to improve newborn health and survival in Nepal. It was developed based on a situation analysis and expert recommendations. The goals are to increase adoption of healthy newborn care practices and strengthen neonatal health services at all levels. Key interventions include developing policies and guidelines, behavior change communication, strengthening service delivery through training health workers and improving facilities, better program management, and conducting operational research. The strategy provides an evidence-based framework to guide stakeholders in improving neonatal outcomes in Nepal.
The document outlines Nepal's multi-sector nutrition plan to reduce undernutrition among women and children. The objectives are to update on the current nutrition situation and share the plan and its implementation arrangements. It provides an overview of the plan which was prepared in close consultation with several key ministries. The plan aims to accelerate reduction of undernutrition through multi-sector interventions focusing on the critical window of opportunity from pregnancy to age two. It establishes leadership and coordination structures and outlines strategic objectives and results across sectors including health, agriculture, education, and local development to holistically address the causes of undernutrition.
This document outlines a presentation on Nepal's National Health Policy 2071, which was approved in July 2014. It provides background on Nepal's past health experiences, current health context, and key problems and challenges in the health system. The presentation describes the need for a new health policy to address these issues. The policy's vision, mission, goals, and 14 policy areas with 120 total strategies are summarized. The presentation also discusses organizational management, financial sources, monitoring, risks, and new areas addressed by the new health policy.
Review of health planning &budgeting from province to local level in federal ...Mohammad Aslam Shaiekh
The document reviews the current health service planning system from the province to local level in Nepal.
At the local level, there is a system of top-down and bottom-up approaches for program and budget planning. The health facilities provide services and local health committees provide input into planning and prioritization.
At the provincial level, the health directorate oversees health offices in the districts and reviews and approves local health budgets and plans. The provincial health directorate then sends the provincial health program and budget to the Ministry of Social Development for approval before being sent to the federal government.
The planning process involves input from the community level up to the provincial and federal levels over a period of months, with local
Sector-wide approaches (SWAps) in health were developed in the 1990s in response to fragmented donor projects and prescriptive lending. SWAps aim to support government-led health sector policies and strategies through coordinated funding that supports national health plans. The goals of SWAps include increased government leadership, improved donor coordination, strengthened health sector management, and more coherent sector policy and planning. However, implementing SWAps effectively requires strong government commitment and leadership as well as transparent negotiation between donors and government to account for local context. It may take 5-10 years of sustained implementation before SWAps significantly impact health outcomes.
The Nepal Health Sector Strategy (NHSS) 2015-2020 provides strategic guidance for the health sector over five years. Its goal is to improve health status through accountable and equitable health services. NHSS outlines nine outcomes, including rebuilding health systems and improving quality of care. It identifies key outputs needed to achieve each outcome, along with interventions, indicators, targets, data sources, and timelines to monitor progress in strengthening Nepal's health sector.
Adolescent Sexual and Reproduction Health PresentationDeepak TIMSINA
ADRA worked to scale-up ASRH programme in Kalikot District through its Strengthening Reproductive Health (SRH) project. I worked as a 'Training Officer' in ADRA from 2012-2013.
Maternal Health in Nepal _Saroj Rimal.pptxsarojrimal7
This document summarizes a presentation on maternal health in Nepal. It begins with background information on maternal health and maternal mortality globally and in Nepal. It then discusses Nepal's status and trends in maternal health indicators like the maternal mortality ratio over time. It also covers Nepal's obstetric transition stage, the evolution of maternal health policies, current programs and strategies to promote skilled birth attendance and institutional deliveries. Issues and challenges in achieving lower maternal and neonatal mortality rates are also presented.
The Positive Impact of Public Health Midwives for Nations Wellbeing through P...ijtsrd
1. Public Health Midwives (PHMs) have played an important role in Sri Lanka's primary healthcare system for over a century, providing maternal and child health services, especially in rural areas where access to healthcare is limited.
2. The study finds that PHMs' performance management in Sri Lanka is inadequately implemented, with deficiencies in setting performance goals and standards, performance reviews, career growth opportunities, and compensation.
3. By strengthening PHM training programs and increasing their numbers through expanded public funding, Sri Lanka can better maintain essential rural healthcare workers and improve national health outcomes like reduced maternal and child mortality.
This document outlines India's strategic approach to reproductive, maternal, newborn, child and adolescent health (RMNCH+A). It recognizes that these areas are interlinked and cannot be addressed in isolation. The approach aims to provide integrated services across the lifecycle from adolescence through pregnancy and childbirth. It seeks to strengthen health systems, accelerate progress towards national health goals, and guide state implementation plans to improve maternal and child health outcomes, especially in high-focus districts and vulnerable populations.
This document outlines India's strategic approach to reproductive, maternal, newborn, child and adolescent health (RMNCH+A). It recognizes that these areas are interlinked and cannot be addressed in isolation. The approach aims to provide integrated services across the lifecycle from adolescence through pregnancy and childbirth. It emphasizes establishing continuity of care between community and health facilities to improve outcomes and achieve national health goals and Millennium Development Goals 4 and 5 on maternal and child health.
Critical Review of NHSS-IP_Sagar Parajuli.pptxSagarParajuli9
This presentation is prepared as part of the Course assignment of “Public Health Service Management” for the Master's Degree of Public Health (MPH), Pokhara University and can be used as reference materials. The content and facts included in the presentation are as of information available till February 2023 and no conflict of interest is associated with the presentation. The presentation is prepared by Sagar Parajuli.
Family planning, Poverty and Economic developmentShikha Basnet
The document discusses family planning and its relationship to poverty reduction and economic development. It provides definitions of family planning and outlines its benefits, including improved health outcomes for mothers and children as well as empowerment of women. Family planning is characterized as a cost-effective intervention. The document then discusses global trends in contraceptive use and unmet need for family planning. It also provides regional overviews of family planning for South and Southeast Asia as well as scenarios specifically for Nepal. Major family planning activities and challenges to uptake are outlined. Poverty is then defined and its multidimensional causes and measurement approaches are briefly explained, followed by the global scenario of poverty.
This document provides a summary of Bangladesh's National Strategy for Maternal Health 2019-2030. The strategy was developed by the Ministry of Health and Family Welfare to guide maternal health services in Bangladesh from 2019-2030. It aims to reduce maternal mortality and ensure quality maternal health services across seven key strategies: 1) service delivery along the continuum of care, 2) strengthening the health system, 3) reducing inequities, 4) improving quality of care, 5) community empowerment and engagement, 6) multi-sector involvement and action, and 7) implementation and impact evaluation. The strategy was informed by over 100 technical experts and is intended to standardize maternal health services and help Bangladesh achieve its maternal health targets by 20
National Strategic Plan for Malaria Elimination in India (2017 2022).Anup Soans
The National strategy on malaria control has undergone a paradigm shift with the introduction of new interventions for case management and vector control, namely rapid diagnostic tests, artemisinin based combination therapy and long lasting
Insecticide impregnated nets. Modern concepts in monitoring and evaluation have]also been incorporated into the programme which take account of the new interventions. A Strategic Action Plan for malaria control has accordingly been prepared by the
Directorate of NVBDCP focussed around the package of these new interventions to decrease malaria transmission and increase access and improve quality of curative services over the 11th five year plan period (2007-12) and beyond.
Public private partnership in safemotherhood program in NepalBidhya Basnet
The document discusses public private partnerships in Nepal's Safemotherhood program. It provides definitions of key terms, describes the status and activities of the program, and outlines various PPP models used. The program aims to reduce maternal and neonatal mortality by improving access to antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care. It partners with various organizations to implement activities like community mobilization, ultrasound programs, and expanding emergency referral services. However, partnerships face limitations like unclear policies, weak coordination, and a lack of regulatory frameworks and research on the private health sector.
Neonatal Health in Nepal _ Saroj Rimal.pptxsarojrimal7
The document describes about the History, trends and programs to improves the neonatal health of nepal. It will helps to know and understand the current programs and what was done before for the health of neonates and childrens in nepal. Mostly used for Public health, Nursing and Medical students. The document is developed on 2023 so, the policies and programs after 2023 was not encorporated in this document.
This document provides the framework for implementation of India's National Health Mission from 2012-2017. It lays out the vision, guiding principles, and core values of the NHM, which include attaining universal access to equitable, affordable, and quality healthcare. The key goals are to enable achievement of the vision, make the system responsive to citizen needs, build partnerships to realize health goals, focus on survival and well-being of women and children, reduce disease burden, and ensure financial protection for households. The strategies to achieve these goals include supporting state health system strengthening, building state and district capacity for decentralized outcome-based planning, enabling integrated facility development, and creating district knowledge centers.
The National Health Policy 2017 aims to achieve the highest level of health and well-being for all Indians through preventive and promotive healthcare. Key goals include attaining universal health coverage, improving quality of care, reducing costs, and lowering rates of maternal and child mortality. The policy focuses on increasing investment in health, strengthening primary care services, addressing non-communicable and infectious diseases, expanding health infrastructure and the healthcare workforce, and aligning the private sector with public health objectives. It outlines specific targets to be achieved by 2025 related to life expectancy, mortality rates, disease burdens, health system coverage and performance, and health system strengthening.
The National Health Policy 2017 aims to achieve the highest level of health and well-being for all Indians through preventive and promotive healthcare. Key goals include attaining universal health coverage, reducing catastrophic health expenditures, and increasing public health spending to 2.5% of GDP. The policy emphasizes preventive care, inter-sectoral coordination to address social determinants of health, and expanding primary healthcare services. It also aims to strengthen regulation of private healthcare and ensure its alignment with public health objectives. Specific targets are outlined to reduce mortality, disease burden, and improve health system performance by 2025.
The document outlines the goals and strategies of India's Reproductive, Maternal, Newborn, Child PLUS Adolescent Health (RMNCH+A) program. The goals include increasing coverage of key interventions like facility births, antenatal care, immunizations, and reducing issues like anemia and malnutrition. The program aims to provide continuum of care across the life stages of reproduction, pregnancy, childbirth, newborn, child, and adolescent. It focuses on community and facility-based interventions like immunization drives, nutrition programs, reproductive healthcare, and strengthening health systems. Key challenges include addressing adolescent health and improving implementation through use of data and timely payments.
Final APR communicaiton strategy master copy (002)Sheeba Afghani
This document presents an integrated advocacy, social mobilization, and communication strategy and action plan to support priorities outlined in Uganda's 'A Promise Renewed' plan and 'Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity'. The strategy takes an integrated approach focusing on the critical time period along the continuum of care. It identifies target audiences and barriers to behavior change. Key strategies include behavior change communication, social mobilization, and advocacy. The strategy also prioritizes male involvement and health worker motivation. An action plan and training components are included to build capacity at district and community levels for implementation.
The Ministry of Health and Family Welfare published the first Annual Report to the People on Health in September 2010. The report’s objective was to examine critical macro-level issues related to health, in particular, the constraints faced by the government in providing universal healthcare, and the challenges in the organisation, financing and governance of health services.
The report provides information about key health indicators such as life expectancy at birth, infant mortality and maternal mortality, and explains the variation in their numbers in different states. It also provides an overview of the National Rural Health Mission (NRHM), which was launched in 2005 to revitalise and scale up basic health services in rural areas. Besides this, it discusses the non-availability of skilled healthcare providers and their uneven distribution across the country, and suggests remedies for this problem.
Lastly, the report lists key policy issues related to health that, according to the ministry, need to be debated widely and drafted into a new health policy. Some of these issues are increased public investment in healthcare, public-private partnerships in the health sector, access to safe drinking water and sanitation, good quality education for healthcare providers, use of modern technology and technological audits of the sector, rising out-of-pocket expenditure on drugs, reduced emphasis on preventive healthcare, limited participation of community organisations, and investment of the states in primary healthcare.
Similar to National Safe Motherhood Plan 2002-2017 (Revised Safe Motherhood and Neonatal Health Long-Term Plan 2006-2017).pptx (20)
this slide belongs to the topics on Carrer development.
it includes the types and steps of Carrer development.
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Sustainable Development Goals Progress Assessment Related to Environment and ...SushantLuitel1
The document discusses Nepal's progress on achieving several UN Sustainable Development Goals related to the environment and climate change. It notes that Nepal has made policies and plans to align with international agreements on climate change. However, it faces ongoing challenges to increasing awareness, adopting multi-sectoral partnerships, addressing capacity issues, and focusing on disaster risk reduction. Key priority areas identified for further action include generating more community-level climate change awareness, preparing localized adaptation plans, strengthening climate impact data collection, and providing financial and technological support for climate initiatives at provincial and local levels.
The document discusses vitamins, their classification, sources, and recommended daily allowances. It covers Vitamins A, D, E, K, and the B vitamins (thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid, cobalamin, ascorbic acid). For each vitamin, it provides information on deficiency diseases, rich dietary sources, and recommended intake amounts for different age groups and physiological states.
A health information system (HIS) refers to a system designed to manage healthcare data, including a patient's electronic medical record, a hospital's operations, and supporting healthcare policy decisions. [HIS] has five core components: hardware, software, telecommunications, databases, and human resources/procedures. Good information management is crucial at all levels of healthcare from local to national as it provides data to policymakers, managers, and healthcare providers. A HIS aims to adequately enable information processing for patient care, administration, research, and education while considering economic and legal factors. It should provide the right information, knowledge, and data to the right people at the right time and place in the right format to support decision making and
Deforestation is the permanent removal of trees to make room for other land uses. It leads to greenhouse gas emissions and global warming by reducing the number of trees that absorb carbon dioxide. The top five causes of deforestation are agricultural expansion, livestock ranching, logging, infrastructure expansion, and overpopulation. In Nepal, over-harvesting of fuelwood and fodder, forest fires, grazing, slash and burn cultivation, and timber extraction are the major causes of deforestation. Between 1990 and 2005, Nepal lost 24.5% of its forest cover, or around 1,181,000 hectares, with an annual deforestation rate decreasing from 1.9% to 1.35% over that period
This document discusses the triple burden of disease faced by many developing countries. It describes the triple burden as the coexistence of infectious diseases, undernutrition, and emerging non-communicable diseases. Many countries now struggle with this combination of communicable diseases, malnutrition, and non-communicable diseases like heart disease and diabetes. Addressing this triple burden presents challenges for healthcare systems in developing nations. Risk factors like poverty, malnutrition, urbanization and changing lifestyles have contributed to the rise of non-communicable diseases.
The document discusses common childhood nutritional problems in Nepal and specific strategies to improve nutrition. It outlines several strategies, including promoting breastfeeding and complementary feeding, strengthening health worker nutrition skills, distributing fortified foods, supplementing pregnant/lactating women and children with iron/folate/vitamin A, and increasing awareness of nutrition's importance. The strategies target reducing low birth weight, protein-energy malnutrition, iodine deficiency, iron deficiency, vitamin A deficiency, and intestinal worm infections. Prevention and control of infectious diseases and lifestyle-related diseases are also covered.
1. Gender-based violence is violence directed against a person because of their gender and can include verbal, physical, sexual, and psychological abuse.
2. The UN defines violence against women as any act resulting in physical, sexual, or mental harm, including threats of such acts.
3. Gender-based violence is fueled by inequitable gender norms and can affect people at different stages of life, ranging from intimate partner violence to child marriage.
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or action. There are several types of diabetes classified based on etiology. Clinical features include polyuria, polydipsia, and weight loss. Diagnosis is based on fasting or post-meal blood glucose levels according to WHO criteria. Diet and lifestyle factors like obesity are strongly associated with type 2 diabetes risk. Prevention focuses on maintaining a healthy diet and weight through population-level and high-risk individual strategies. Treatment involves diet, oral medications, or insulin to control blood glucose and prevent complications. Specialized diabetes care centers provide management, education, and research.
The 2016 Nepal Demographic and Health Survey collected data on key health and demographic indicators in Nepal. Some key findings include:
- 56% of children under 5 have their births registered.
- Nearly half of households have access to improved sanitation and drinking water sources. However, 66% rely on solid fuels for cooking.
- Educational attainment is low, with two in five women and one in five men having no education. Net school attendance is 80% for primary but only 67% for secondary school.
- Regarding employment, 57% of women and 78% of men reported current employment. Most women work in agriculture compared to most men working outside of agriculture.
Cervical cancer is a type of cancer that occurs in the cervix, the lower part of the uterus. Human papillomavirus (HPV) infection plays a role in causing most cervical cancers. There are two main types of cervical cancer - squamous cell carcinoma, which begins in the squamous cells of the cervix, and adenocarcinoma, which starts in the gland cells of the cervix. Screening tests like the Pap test and HPV test can detect cervical cancer early. Risk factors include HPV infection, multiple sexual partners, smoking, and oral contraceptive use. Symptoms may include abnormal bleeding or discharge. Globally, cervical cancer causes over 300,000 deaths each year, with most occurring
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
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Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
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Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
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Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
2. Introduction
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• The overarching goal of development efforts in Nepal is to reduce poverty, as
highlighted in the Tenth Plan (Poverty Reduction Strategy Paper) 2002- 2007, and
health sector development efforts are treated as an integral part of this strategy.
• The Ministry of Health and Population (MoHP, formerly Ministry of Health) developed
the Second Long Term Health Plan (1997- 2017) as a sectoral perspective plan and the
National Safe Motherhood Long Term Plan (NSMLTP) (2002-2017) was based on this
document as a sub sector plan, in line with the Nepal Health Sector Programme
Implementation Plan (NHSP-IP) 2004-2009.
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Within the health sector, safe motherhood has been a national priority program for the
last decade and is highlighted in all major health-related policies and plans.
The Tenth Plan, the Second Long Term Health Plan, and the NSMLTP (2002-2017) all
highlight the need to reduce the high levels of mortality among women, infants, and
children.
The Millennium Development Goals (MDG) specify a two-thirds reduction in the under-
five mortality rate and a 75 percent reduction in the maternal mortality ratio by the year
2015.
The NHSP-IP draws on the Millennium Development Goals to improve the Nepalese
population's health status by utilizing essential health care services (EHCS), specifying
maternal and infant mortality, and reducing child mortality among other essential health
care indicators.
Since safe motherhood and newborn health are not purely health issues, they warrant a
multi-sectoral approach, and the role of other sectors is particularly important in
enhancing access and promoting equity.
This is acknowledged in the NSMLTP and outputs are related to programs in education,
information and communication, transport, and local development, as appropriate.
4. Rationale for Revision of the National Safe
Motherhood Long Term Plan
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In recent years many safe motherhood stakeholders, both government and non-
government, at district, regional, and national forums, have noted gaps in the
original NSMLTP and advocated for its revision and updating.
In order to retain its effectiveness as a guide to programming, the plan needs to
be treated as a rolling document, and revised regularly, in line with the changing
context of new developments.
A number of specific issues have been identified that highlight the urgent need
for revision as follows:
5. MDGs and Neonatal health:
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The NSMLTP (2002-2017) was developed before the Millennium Development Goal Country Report was prepared,
and so was unable to fully take into account the recommendations it contained.
The infant mortality rate in Nepal is declining but only slowly - child mortality declined by 34 percent between 1996
and 2001, but during the same period infant mortality declined by only 18 percent.
Since two-thirds of infant deaths occur in the neonatal period, a significant reduction in infant mortality rates depends
on a decrease in the neonatal mortality rate.
While it is understood that safe motherhood interventions do contribute to a reduction of perinatal and neonatal
mortality, in order to achieve the substantial infant and child mortality reductions encompassed by the MDGs,
additional specific newborn health interventions need to be integrated with safe motherhood programming.
The National Neonatal Health Strategy and National Neonatal Health Long Term Plan formulated in 2004 and 2005
respectively to address neonatal health issues had also not been incorporated into the previous plan.
6. Skilled birth attendance:
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The original NSMLTP (2002-2017) placed little emphasis on the importance of
skilled birth attendance in the drive to reduce maternal and neonatal mortalities.
Global standards for what constitutes skilled birth attendance and how a skilled
birth attendant (SBA) is defined have also changed significantly in the last few
years.
The National SBA Policy has been only recently formulated and endorsed, and
key points from this need to be incorporated into the current plan.
7. Health sector reform
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The NSMLTP (2002-2017) pre-dated the recent work on health sector
reform and strategy development, and the outputs of the Nepal Health
Sector Strategy and Nepal Health Sector Programme Implementation Plan
(2004- 2009) need to be included.
8. Abortion:
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The legalization of abortion under specified conditions in 2002 has resulted in an
intensive program to establish comprehensive abortion care (CAC) services in
public hospitals from 2004 and a commitment to integrating CAC into safe
motherhood programming.
This important step acknowledges the significant effect of complications due to
unsafe abortions on the high maternal mortality ratio in Nepal and was not
included in the original NSMLTP (2002-2017).
9. Mother-to-child transmission of HIV
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It is an increasing problem.
As HIV infection rates grow, this is likely to become a major issue in the near
future for service provision As it is a recently acknowledged phenomenon,
prevention activities are not mentioned in the original NSMLTP.
Prevention of mother-to-child transmission (PMTCT) needs to be incorporated
into the current plan.
10. Equity issues
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In access and utilization of safe motherhood and neonatal health (SMNH)
services are not mentioned in the original NSMLTP and are of critical
importance if the neediest members of society are to be targeted and the MDGs
achieved.
11. Goal:
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Improved maternal and neonatal health and survival, especially of the poor and
excluded.
Key Indicators
The key indicators for this NSMNH-LTP goal are:
1. A reduction in the maternal mortality ratio from 539 per 100,000 live births to 134 per
100,000 by 2017
2. A reduction in the neonatal mortality ratio from 39 per 1,000 to 15 per 1,000 by 2017.
12. Purpose:
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Increased healthy practices, and utilization of quality maternal and
neonatal health services, especially by the poor and excluded, delivered by
a well-managed health sector.
Key indicators for this include:
Increase in the percentage of deliveries assisted by an SBA to 60% by 2017
The percentage of deliveries taking place in a health facility increased to 40% by 2017
Increase in met need for emergency obstetric care of 3% per year
Increase in met need for a cesarean section of 4% per year.
13. Eight outputs are specified in the plan, each with
individual indicators.
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1. Equity and access
2. Services
3. Public-private partnership
4. Decentralization
5. Human resource development: Skilled birth attendant strategy
6. Information management
7. Physical assets and procurement
8. Finance
14. 1. Equity and Access
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The purpose is to ensure that individuals, groups, and networks are socially
empowered to practice desired Safe Motherhood and neonatal Health (SMNH)
behaviors, leading to increased equity of and access to health services.
The key activity areas are in advocacy, social mobilization, and behavior change
communication.
15. 2. Services
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The purpose is to enhance the equitable provision of quality SMNH services.
These include focused antenatal care, delivery and newborn care by the skilled
birth attendants, postnatal care, emergency obstetric care, comprehensive
abortion care, and referral services.
Activity areas include strengthening and expansion of SMNH services,
improvement in quality of services, reaching socially excluded groups, creating
an enabling environment for services, and developing appropriate linkages.
16. 3. Public-Private Partnership
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The purpose is to increase participation of the private sector, NGOs,
community-based organizations, and professional/academic
institutions in SMNH-related public services to ensure consumers
have equitable access to affordable services.
17. 4. Decentralization
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The purpose is to enhance local government and partner capacity to
plan and oversee SMNH services in line with the Local Self
Governance Act (LSGA).
18. 5. Human Resource Development: Skilled Birth
Attendant Strategy
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The purpose is to develop and implement a strategy and plan for
human resource development in safe motherhood and neonatal
health, particularly skilled birth attendant training.
19. 6. Information Management
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The purpose is to develop a comprehensive sector-wide SMNH
information base and to incorporate and utilize this within the Health
Information System to support policy, planning, monitoring,
evaluation, and advocacy at national and local levels.
Key activity areas include information management, data collection,
and quality, access to information, and monitoring.
20. 7. Physical Assets and Procurement
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The purpose is to ensure adequate physical resources for SMNH
services along with year-round availability of SMNH-related drugs
and supplies.
Key activity areas include construction and maintenance, planning
and quality assurance, and distribution of drugs and commodities.
21. 8. Finance
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The purpose is to ensure improved sustainable financing systems for
SMNH services.
Key activity areas include mobilization of resources, alternative
financing systems, and formation of safety nets for the socially
excluded.
22. Rights-based approach
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Human rights standards relevant to maternal health include, but are not
limited to:
The right to life and survival
The right to the highest attainable standard of health
The right to decide freely the number and spacing of one’s children
The Convention for the Elimination of Discrimination against Women
(CEDAW).
23. Risks and assumptions
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1. Continuing political commitment to safe motherhood and neonatal care as a high priority in both policy and
programming, including allocation of resources
2. Effective and timely execution of the Nepal Health Sector Programme Implementation Plan
3. Social, political, and economic stability, enabling activities to be carried out as planned and resources accessed as
needed
4. Resolution of the conflict and/or development of effective strategies for working safely and effectively in conflict-
affected areas, such as using locally acceptable community workers as bridging people and using rights-based
messages and approaches
5. Elected leaders in place in the functional district and village development committees, able to facilitate devolved
decision-making, local ownership, and accountability
6. Commitment to local-level capacity building and support, combined with decentralization, to ensure quality
services.
24. Major activities in fiscal year 2077/78
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I. SMNH Roadmap 2030 provincial planning
In line with the spirit of federalism and to promote the development of
context-specific plans with need-based prioritization, Family Welfare
Division had planned for provincial orientation on the SMNH roadmap in
all 7 provinces and the development of province-specific action plans for
implementation.
In FY 2077/78, FWD completed the orientation in Province 1, Bagmati
province, Gandaki, and Karnali province. All oriented provinces have
developed their own action plan for their implementation in the process.
25. ii. Community level maternal and newborn health
interventions
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Family Welfare Division (FWD) has continued to expand and maintain
MNH activities at the community level.
A pictorial card (revised BPP card) is now attached to the MNH card of
HMIS for ensuring the availability and use of BPP messages by all
pregnant women during their antenatal visit.
FWD has provided approved MNH cards to provinces for printing in FY
2077/78 who were interested to print (provinces 1 and 5).
26. Cont…
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In 2066/67, the government approved PPH education and the distribution
of the Matri Suraksha Chakki (MSC) tablet through FCHVs to prevent
PPH during home deliveries.
For home deliveries, three Misoprostol tablets (600 mcg) are handed over
to pregnant women by FCHV at the 8th month of pregnancy and are
advised to be taken orally immediately after the delivery of the baby and
before the expulsion of the placenta.
Fifty districts were implementing the program till FY 2075/76. Further
eight districts, Gorkha, Dolakha, Solukhumbu, Parsa, Panchthar, Gulmi,
Lamjung, and Mustang, started implementing the program in the fiscal
year 2076/77.
27. Cont…
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By the end of FY 2077/78, a total of 58 districts continue
implementation of the program. NDHS (2016) shows that only 13
percent of women who gave childbirth without skilled assistance
took MSC tablets.
This calls for strengthening the existing program, as women who
delivered at home are likely to be at higher risk.
As the program is not yet implemented nationwide, monitoring is
not yet integrated into HMIS.
28. iii. SMNH Programme during COVID 19 Pandemic
situation
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1. Management of the PPH Prevention Orientation program
During the COVID-19 Pandemic situation, FWD focused on maternal
death follow-up monitoring and found the major cause of maternal deaths
was Postpartum Haemorrhage (PPH).
FWD planned and provided immediate response for implementation with
the support of partners.
29. Cont…
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As a result of the Partners’ meeting, FWD provided PPH orientation to
service providers in 22 hospitals in Lumbini Province and Karnali
Province Total of 312 participants doctors and nurses received virtual
orientation on PPH (estimation of blood loss, prevention of PPH
(AMTSL) and management and treatment of PPH (Uterotonic drugs,
management of trauma, retained placenta/tissue, Condom Balloon
Tamponade, Bimanual uterine compression, and Peripartum
Hysterectomy).
30. 2. RMNCAH Interim Guideline Orientation
Programme
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As a response to the COVID-19 Pandemic situation, FWD led the
development of RMNCAH interim guideline development and orientation
to health workers to ensure the continuation of SMNH and RH services
during the national crisis situation.
More than 14,500 Health workers working at the community level
including hospitals received virtual and face-to-face orientation about
interim guidelines with the support of various partners (NHSSP, OHW,
UNFPA, SSBH, UNICEF, Care, Ipas, Su-aahara).
31. 3. Virtual SBA clinical mentors’ refresher
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Due to the inability to deliver in-person capacity building, FWD adopted a
virtual methodology to continue delivering the capacity building
initiatives, and a total of 182 SBA clinical Mentors from all 7 provinces
were involved and received Virtual SBA clinical mentors’ refresher.
32. iv. Rural Ultrasound Programme
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The Rural Ultrasound Programme aims for the timely identification of pregnant
women with risks of obstetric complication to refer to comprehensive emergency
obstetric and neonatal care (CEONC) centers.
Trained nurses (SBA) scan clients at rural PHCCs and health posts using portable
ultrasound. Women with detected abnormalities such as abnormal lies and
presentation of the fetus and placenta previa are referred to a CEONC site for the
needed services.
This program is being implemented in remote districts. In FY 2077/78, FWD
allocated a program implementation budget in 248 local levels of 30 remote
districts.
The total program implementation districts are 11 except the Terai districts (Jhapa,
Morang, and Sunsari) in Province 1, 2 districts (Myagdi and Baglung) in Gandaki,
East Rukum in Lumbini, 9 districts except for Surkhet in Karnali and 7 districts
except for Kailali and Kanchanpur in Sudurpaschim Province.
33. v. Expansion and quality improvement of service
delivery sites
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FWD continued to expand 24/7 service delivery sites like birthing centers,
BEONC, and CEONC sites at PHCCs, health posts, and hospitals. The
expansion of service sites is possible mostly due to the provision of funds to
contract short-term staff locally.
By the end of 2077/78 CEONC services were established in 72 districts among
which 71 districts were functional throughout the year except for 1 district
(Ramechhap). During the fiscal year, 7 (Taplejung, Solukhumbu, Gorkha,
Tanahu, Dailekh, Jajarkot, and Rukum) districts provided interrupted C-section
services.
Expansion of delivery services continues through the initiation of local
government. Total of 2236 health posts and 188 PHCCs were reported to have
provided (at least one) delivery service in 2077/78
34. vi. Onsite clinical coaching and mentoring
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Nepal has taken the lead in improving quality services at the point of service
delivery as a focus theme mentioned in the NHSS and its implementation plan for
2016-2021.
WHO has also given emphasis and mentioned that the on-site coaching and
clinical skill enhancement of service providers is considered one of the most
effective means to improve the knowledge, skills, and practices of health service
providers.
Onsite clinical coaching and mentoring process is an evidence-based effective
program as per outcome (improvement in knowledge, skills, and practices of
MNH service providers) found in Dolakha and Ramechhap during the transition
and recovery plan implemented after the 2072 earthquake in 2072/2073 supported
by NHSSP and 7 districts’ onsite coaching and mentoring process supported by
GIZ.
35. Cont…
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FWD had started to implement an on-site clinical coaching /mentoring
program in 2073/2074 from 16 districts and in FY 2074/2075 total of 320
Municipalities from 31 districts to enhance knowledge and skill of SBA
and non-SBA nursing staff providing delivery services at BC/BEONC and
CEONC service sites. This program has been scaled up gradually.
In FY 2075/2076, a total of 359 Municipalities of 38 districts, and in FY
2076/2077 528 Municipalities of 51 districts and in FY 2077/78, 626
Municipalities of 63 districts implemented onsite clinical coaching and
mentoring program based on coaching/mentoring guideline and tool.
36. vii. MNH readiness Hospital and BC/BEONC
Quality Improvement
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Improvement in quality-of-service delivery through self-assessment,
infection prevention demonstration, and action plan implementation is an
evidence-based effective program as per outcome found in piloting
districts, Taplejung and Hetauda hospital in FY 2070/2071.
FWD expanded MNH readiness hospital quality improvement process
(HQIP) gradually from FY 2072/73.
Till the end of FY 2077/78 the HQIP/QIP program expanded in 67
hospitals and PHCC with CEONC services in 63 districts.
37. Cont…
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The cumulative number of CEONC sites with HQIP service expansion is 7
in 2072/73, 12 in 2073/74, 35 in 2074/075, 52in 2075/076, and 57 in
2076/077, and 67 hospitals in 2077/78. Since FY 2076/77, the HQIP
process was integrated with the onsite coaching and mentoring process at
hospitals.
The process of quality improvement is also being implemented in birthing
centers in integration with SBA onsite clinical coaching/mentoring
process. Till FY 2077/078, the total QI reported BC/BEONC sites were
824 (44 in FY 2073/74, 122 in FY 2074/75 and 267 in FY 2075/76, 139 in
2076/77, 252 in 2077/78.
38. viii. Emergency referral funds
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It is estimated that 15 percent of pregnant women will develop serious
complications during their pregnancies and deliveries, and 5 to 10 percent
of them will need cesarean section deliveries (WHO, 2015) to avoid
deaths or long-term morbidity.
In cases of difficult geographical terrain and unavailable CEONC services,
it is crucial that these women are referred to appropriate centers.
To address this issue FWD allocated emergency referral funds to 53
hospitals of 52 districts in FY 2077/78 from across the 7 provinces.
A total of 6,700,000 Rupees was allocated to 53 hospitals to support
women when referrals were needed.
39. Cont…
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39
Additional about 60,000 Rupees in each Palika were allocated for the BC
and BEONC service sites s to support transport fares for women who
could not afford referral to the high facilities (nearby CEONC facilities).
The main objective of this program is to support emergency referral
transport to women from poor, Dalit, Janajati, geographically
disadvantaged, and socially and economically disadvantaged communities
who need emergency cesarean sections or complication management
during pregnancy or childbirth.
The airlifting support for immediate transfer to the higher centers is no
longer implemented by the FWD as the emergency Airlifting program is
now implemented by the Presidential Women Uplifting Programme in the
Ministry of Women, Children, and Senior Citizens
40. ix. Vitamin K1 to newborn babies
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40
In FY 2077/78, after the decision of the Ministry of Health and Population
to introduce Vit K1 injection to newborn babies for preventing Vitamin K
Deficiency Bleeding (VKDB), for the first time Family Welfare Division
allocated a budget to purchase injection of Vitamin K1 for distributing in
all BC/BEONC and CEONC sites.
Injection Vitamin K1 needs to be given to newborn IM after breastfeeding
within 1 hour of delivery.
41. x. Aama Surakshya Program and Free Newborn
Programme
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41
The government has introduced demand-side interventions to encourage
women to institutional delivery.
The Maternity Incentive Scheme, 2005 provided transport incentives to
women to deliver in health facilities.
In 2006, user fees were removed from all types of delivery care in 25 low
HDI districts and expanded nationwide under the Aama Programme in
2009.
In 2012, the separate 4 ANC incentives program was merged with the
Aama Programme.