Organization Structure of Public Health System in Nepal.
Organization Profile (Structure, Functions, Roles, Responsibilities, ToR): http://bit.ly/HealthsystemsNepal
Organization Structure of Public Health System in Nepal | Health System Nepal | Current Health system of Nepal | Organization Structure of Nepalese Health System | Public Health System | Health Governance System in Nepal |Health Organization Profile | https://publichealthupdate.com |
More updates: https://publichealthupdate.com
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.
Mode of Human Resource for Health Production in Nepal
Various Academic and Non Academic Institutes and Councils producing all sorts of Human Resource for Health in Nepal.
Organization Structure of Public Health System in Nepal.
Organization Profile (Structure, Functions, Roles, Responsibilities, ToR): http://bit.ly/HealthsystemsNepal
Organization Structure of Public Health System in Nepal | Health System Nepal | Current Health system of Nepal | Organization Structure of Nepalese Health System | Public Health System | Health Governance System in Nepal |Health Organization Profile | https://publichealthupdate.com |
More updates: https://publichealthupdate.com
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.
Mode of Human Resource for Health Production in Nepal
Various Academic and Non Academic Institutes and Councils producing all sorts of Human Resource for Health in Nepal.
This presentation deals with advent of NRHM, backdrop of public health scenario prior to NRHM & discusses in details vision & core strategy of NRHM. It focuses on different schemes related to maternal & child health under NRHM with special reference to Maharashtra.
RMNCH+A is a NEW approach to address the health problems Mother, Newborn, Child & Adolescence simultaneously at different stages of life through 'CONTINUUM OF CARE'.
Hope this presentation will help to have a glimpse of the program.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
1. Presented by:
439. Dip Narayan
441. Laxmi
Assignment
Subject: Health System Management
Assigned by: Assistant Prof. Narayan Subedi
Date of presentation: 11th Apr 2016
BPH 26th Batch, Maharajgunj Medical Campus, Institute of Medicine, TU, Kathmandu, Nepal
3. PRESENTATION OUTLINE
• Background
• Review of NHSP-IP I
• Rationale for NHSP-IP II
• Vision, Mission, Goals and Objectives
• Program and services
• Roles of Non-state actors
• Structure, System, Institution and Governance
• Research, Monitoring and Evaluation
• Health Financing
• Achievements
• Shortcomings
4. BACKGROUND
• Strengthening of Health system utilizing principles of Health sector reforms in
areas such as universal coverage , improving health equity ,increasing access and
utilization of quality essential health care ,improving community involvement and
accountability through decentralization was need of the time.
• Ministry level umbrella programme in health, based on SWAp & health sector
reform
• NHSP-IP 1 was of six years while NHSP-IP 2 was of 5 years
5. REVIEW OF NHSP-IP (2004-2010)
OUTPUTS
Output 1 Increased Access to and Utilization of
EHCS
Progressed but disparity/inequity remains
challenge and scope of EHCS was limited
Output 2 Decentralized Management of
Health Facilities
Not much progress particularly in local level
Output 3 Public-Private Partnerships Not convincing despite some progress
Output 4 Sector Management Aid effectiveness has not improved as hoped
Decentralization Forum was established in 2007
Output 5 Sustainable Financing Free health services but sustainability was still problem
Output 6 Sector Physical Assets management
and Procurement of Goods
Seventy-five percent of health and sub-health posts had
stock outs between March 2008 and March 2009
Output 7 Human Resources for Health 76 percent of health personnel posts were filled in
comparison to sanctioned posts (MoHP, 2006)
Output 8 HMIS Improvements Pilot study on HSIS
6. RATIONALE FOR NHSP-IP 2
• Remaining constraints in access and utilization of essential health care services
(disparities)
• Sustainability issues in health financing
• Need of improving health systems and achieving efficiency improvements
7. POLICY ENVIRONMENT
NHSP-II was based on the following policy documents
• Interim constitution
• Three-year interim plan
• Health Sector Strategy: an agenda for reform
• National compact: international health partnership plus
• Local self governance act
• Second long-term health plan 1997-2017
• National foreign aid policy (draft)
8. VISION/MISSION FOR THE HEALTH SECTOR-NHSP-IP2
Vision statement
• To improve the health and nutritional status of the Nepali population and provide
equal opportunity for all to receive quality health care services free of charge or
affordable thereby contributing to poverty alleviation.
Mission statement
• The ministry will promote the health of Nepal's people by facilitating access to and
utilization of essential health care and other health services, emphasizing services
to women, children, poor and excluded, and changing risky life styles and
behaviors of most at-risk populations through behavior change and
communication interventions.
9. GOAL
To reduce morbidity and mortality from common health problems by ensuring
accessible, affordable, quality health care services.
OBJECTIVES
The objectives of the ministry of health and population:
Prevent common diseases, disabilities and maintain a healthy population
Improve the health of women and children
Ensure accessible, quality, and efficient health services
Promote healthy lifestyles and behaviours
10. VALUE STATEMENT
The ministry believes in
i. Equitable and quality health care services
ii. Patient/client centered health services
iii. Rights-based approach to health planning and programming
iv. Culturally- and conflict-sensitive health services
v. Gender-sensitive and socially inclusive health services
11. STRATEGIES FOR THE HEALTH SECTOR
1. Poverty reduction
2. The agenda to achieve the health MDGs by 2015
3. Essential health care services free to patients/clients and protection of families
against catastrophic health care expenditures
4. Gender equality and social inclusion
5. Access to facilities and removal of barriers to access and use
6. Human Resource Development
7. Modern Contraception and safe abortion
8. Disaster Management and Disease Outbreak Control
12. STRATEGIES FOR THE HEALTH SECTOR
9. Eradication, elimination, and control of selected vaccine preventable diseases
10. Institutionalizing health sector reform
11. Sector-wide approach: improved aid effectiveness
12. EDP harmonization and International Health Partnership
13. Improved financial management
14. Inter-sectoral coordination, especially with MLD and Education
15. Local Governance: devolution of authority
16. Health systems strengthening, especially monitoring and evaluation
13. PROGRAM AND SERVICES
Essential health care services
Family planning and population
Safe motherhood
Adolescent sexual and reproductive health
Newborn care
Child health
Communicable disease control
Non-communicable diseases
Health education and communication
Oral health care
Environmental health and hygiene
Curative services
Humanitarian response and emergency and disaster management
Ayurvedic and alternative medicine
14.
15. ROLE OF NON-STATE ACTORS
• Non-state actors (EDPs, Non-profit organizations, Profit organizations )
• Strategic direction
• Clear policy and strategy formulation
• Quality assurance
• Scaling up of successful practices
• Encourage private sector to establish and expand the specialized credible
services to rural areas
• Multi-sectoral PPP Policy Forum
16. STRUCTURE, SYSTEMS, INSTITUTIONS AND GOVERNANCE
• Sector organization, management and governance
• Free essential health
• Human resources for health
• Physical facilities, investment and maintenance
• Financial management
• Procurement and distribution
• Governance and accountability
• Strategies and institutional arrangement for GESI
17. RESEARCH, MONITORING AND EVALUATION
Constraints and challenges of current monitoring system
• Surveys are often conducted to suit special interests rather than serve the SWAP
• HMIS, for local authorities (PHIs), are still viewed as record keeping and reporting system of the DoHS
• HMIS is not directly linked to other information system (HSIS in piloting phase)
Actions during NHSP-2
• Regular supervision and monitoring
• Survey research in health sector (with EDPs)
• Review of HSIS piloting
• Health facility surveys (conduct to collect data on utilization by patient characteristics)
• Annual social audit
• Policy Research
• Conduction of economic analysis
18. HEALTH FINANCING
• Challenges to health financing
• Expenditure in health remains low at 5.3% of GDP in 2006.
• The per-capita health expenditure stood low (WHO 2008)
• The share of Government stands at 24% and EDPs (Sustainability concern) contribute 21% (of
total health expenditure)
• Out of Pocket Payment
• Responding to the challenges
• A mixed approach
• Cost recovery modality
• Microcredit
• Community Health Insurance
• Formula based Approach of resource allocation
19. HEALTH FINANCING
Financial Resource Envelope
1. ‘Low Case’ Scenario
2. ‘Middle Case’ Scenario
3. ‘High Case’ Scenario
For figures jump to last 3 slides!
20. ACHIEVEMENTS
• Impressive progress on child survival and maternal health
• Target set for NHSP II for immunization as well as for comprehensive multi-year plan 2011-
2015 has been achieved
• Number of antigens in routine immunization has increased to 11
• Community based interventions has reduced case fatality rate of pneumonia and diarrohea
• TB case detection rate and success rate has improved over the years
• Scale up of HIV/AIDS related services has significantly reduced new infection rate
• Remarkable increase in the number of health facilities providing adolescent-friendly health
services (from 78 in 2011 to 500 in 2013),
• The share of public spending in GDP has increased from 21.8% in 2010 to 23% in 2014
22. But despite this remarkable progress, out-of-pocket expenditure (OOP), which is the most unfair and
regressive way of funding health services, still constitute the largest (49%) source of funding in Nepal.
Source: NHSS 2015-2020, Final
draft
23. SHORTCOMINGS
• Maternal and child nutrition is still problem in Nepal despite some progress
• Ever rising drug resistant TB in the country is a further challenge to be addressed in
the coming years
• Significant equity gap still continue to persist (Mid-term Review of NHSP II )
• Shifting burden of diseases and health problems is challenge
• Mental health remains a much-neglect areas, despite the fact that mental illnesses
alone count for 18% of the current NCDs burden
• Very little progress has been made in the integrated approach to information
management
24. SUGGESTED READINGS
1. Nepal health sector program implementation plan 2, 2010-2015
2. Nepal health sector strategy 2015-2020
3. Joint Annual Review Report, March 2016
4. Report of MICS 2014
5. Nepal Demographic Health Survey 2011
25. LESSON LEARNT UNDER NHSP 2
• Improved sector coordination
• Identification of priorities
• High level political commitment to fundamental reforms and changes
• Opportunities for more decentralized planning and delivery
• Sound evidence for decision making and planning and operations
• Wider application of MIS
• Need for a comprehensive health financing strategy
• Importance of human resource management
• Need to have basic but flexible packages of health care services
• Changing burden of disease patterns
• Innovations
• Need for better disaster preparedness
Source: Joint Annual Review Report 2016
Review of Nepal Health Sector Program-Implementation Plan 1
Budget and Expenditures (Health budget increased from 5.87% in 2004-5 to 7.16%in 2007-8. But declined in the two subsequent years to 6.33% and 6.24%) But spending with in health sector increased from 70% in 2004/05 to 85% in 2008/09 which was higher than NHSP I target
Reduced Mortality and Morbidity
Government will continue to increase domestic financing of health services, but sustaining and building on the achievements of the health sector will require the generous level of support from the EDPs to be sustained and increased
Essential HCS changes over time and spatial distribution and also social distribution. (Provider vs. Consumer perspectives)
Essential Health Care Services
The three objectives set out in the results framework are:
To increase access to and utilization of quality essential health care services
To reduce cultural and economic barriers to accessing health care services and harmful cultural practices in partnership with non-state actors
To improve the health system to achieve universal coverage of essential health services.
Say challenges and then say these strategic directions to combat them
Use of routine data at local and district levels is minimal because the focus is aggregation for the central government and surveys are often conducted to suit special interests rather than serve the SWAP
Regular supervision and monitoring (Training curricula, guidelines and manuals will be developed to support monitoring and evaluation activities)
Health facility surveys currently carried out in each trimester
Challenges to health financing
Expenditure in health remains low at 5.3 percent of GDP in 2006.
The per-capita health expenditure stood at USD 18.09 compared to USD 65 in Bhutan, USD 44 in Sri Lanka, USD 29 in India and USD 19 in Afghanistan (WHO 2008)
The share of Government stands at 24% and EDPs (Sustainability concern) contribute 21% (of total health expenditure)
More than 55% through out of pocket expenditure by households at the time of service
Responding
A mixed approach (lesson from success stories across globe)
Cost recovery modality (exemption criteria will be developed for poor clients/patients, and grants to facilities will be provided on the basis of the outputs they provide to patients qualifying for free or subsidized treatment)
Budget allocation based on distribution of facilities (Population, accessibility and cost of service in different places to combat inequity) AWPB process to monitor
introduction of new programmes and interventions will be assessed based on their contribution to reduce inequality
formula-based approach to resource allocation (to adjust per capita allocations to reflect the higher costs of delivering services in Hill and Mountain regions, the disease burden, and the relative poverty of the population)
Ensuring formal insurance schemes with mainly better-off recipients recover all of their costs and are not implicitly receiving subsidized access to public-sector facilities
microcredit to smooth the burden of unexpected health costs
Government have piloted community health insurance schemes for both checking catastrophic spending and other health expenditure
It is much more difficult to predict the trend in aid to the health sector. Some 58% of total EDP spending during NHSP-1 took place in the final two years, reflecting catch-up from earlier low expenditure
U5MR- from 142 per thousand live birth in 1990 to 38 in 2014
infant mortality has also decreased by 67% - from 99 per thousand live births to 33
But Neonatal MR has not reduced proportionately
NMR 53 per thousand live births in 1990 to 23 in 2014 (MICS)
Though 18% of women fall under the Body Mass Index (BMI) of 18.5 – a cut-off point, indicating thinness or acute under-nutrition (higher in terai 26%)
proportion obese women has increased to 14% (NDHS, 2011)
Nepal has achieved Polio Free Status, Measles Mortality Reduction Goal, MNT elimination status, and control of Japanese Encephalitis
CB-IMCI and CB-NCP merged to form CB-IMNCI
more than 80% of household members continue to have E. coli risk level in their water
U5MR- from 142 per thousand live birth in 1990 to 38 in 2014
infant mortality has also decreased by 67% - from 99 per thousand live births to 33
But Neonatal MR has not reduced proportionately
NMR 53 per thousand live births in 1990 to 23 in 2014 (MICS)
Though 18% of women fall under the Body Mass Index (BMI) of 18.5 – a cut-off point, indicating thinness or acute under-nutrition (higher in terai 26%)
proportion obese women has increased to 14% (NDHS, 2011)
Nepal has achieved Polio Free Status, Measles Mortality Reduction Goal, MNT elimination status, and control of Japanese Encephalitis
CB-IMCI and CB-NCP merged to form CB-IMNCI
more than 80% of household members continue to have E. coli risk level in their water
NCDs account for “more than 44% of deaths, 80% of outpatient contacts, and 39% of DALYs lost