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Primary health care outreach clinic and EPI
- 1. PRESENTED BY Namita Banskota BPH 6th sem
- 2. Primary Health Care Outreach (PHC/ORC) program was started in 1994 (2051 BS) with an aim to improve access to some basic health services including family planning and safe motherhood services for rural households. PHC/ORC clinics are the extension of, HPs at the community level. The primary responsibility for conducting the PHC outreach clinics lies with ANMs, AHW. Female Community Health Volunteers (FCHVs) and other local NGOs/CBOs support service providers in conducting PHC/ORC clinics and also for recording/ reporting and other support activities.
- 3. Based on the local needs PHC outreach clinics are conducted every month at fixed locations on specific dates and time. The clinics are held at locations not more than half an hour’s walking distance or the population residing in that area. .
- 4. According to PHC/ORC strategy, following services are provided by PHC/ORC. Safe Motherhood & Newborn Care • Antinantal, postnatal, and newborn care • Iron distribution • Referral if danger signs identified Family Planning • DMPA, (Depo-provera) Pills and Condom • Monitoring of continuous users • Education and counseling on FP methods and emergency contraception • Counseling and referral for IUCD, Implant and VSC service • Tracing defaulter
- 5. . Child health • Growth monitoring of under 3 years child • Treatment of pneumonia and diarrhoea Health education and counselling • Family planning • Maternal and newborrn • Child health • STI,HIV/AIDS • Adolescent sexual and reproductive health First aid • Minor treatment and referral of complicated cases
- 6. • In 2075/76 , 2.8 milllion people were served at 138,125 outreach clinics. • Total of 138,125 clinics were run which represents 92% of the targeted number i.e. 1,657,500 in a year. • The total number of people provided eith deworming tablets is 76752, iron tablets is 279011 and vit A for postpartum is 39317.
- 9. Deworming tablets Vit A for postpartum Iron tablets
- 10. 2073/74 2074/75 2075/76 Primary treatment Depo (number) ANC PNC Growth monitoring
- 11. Issues • All the PHC/ORC are not functional. • No regular supply of drugs. • No performance appraisal. • No incenttives for motivation to service provider. Recommendation • Functionalize all PHC/ORC by solving issues at all levels • Incentives service. • Appraisal of the workers.
- 12. WHO initiated the Expanded Program on Immunization (EPI) in May 1974 with the objective to vaccinate children throughout the world. National Immunization Program (Expanded Program on Immunization) was started in 2034 BS and is a priority 1 program. It is one of the successful public health program and achieved milestones contributing to reduction in morbidity and mortality of vaccine preventable diseases. Previously Eleven antigens are provided through the national programme to eligible infants, children and mothers through more than 16,000 outreach sessions, including in geographically and economically hard-to-reach and marginalized communities. Now government added more antigens to control diarrhea caused by rotavirus & FIPV.
- 13. In 2043 BS, Nepal had started 2 vaccines namely BCG and DPT through EPI in 3 districts: Dhanusa, Rupandehi and Sindhupalchowk. In 2036/37, two vaccines namely polio & measles were added By 2045 B.S, the EPI throughout the all districts for six major killer diseases Hepatitis B was initiated in 2060 B.S, JE in 2063 B.S and Haemophilus Influenza type b (Hib) in 2066 B.S. MR vaccine was introduces as routine immunization since FY 2070/71. Inactivated Polio Vaccine (IPV) was introduced in 2071 B.S in routine immunization.
- 14. Nepal has been declared as a polio free country in 27th March 2014 A.D. The last case of polio myelitis was observed in August 2010 in Rautahat. Maternal and neonatal tetanus elimination status has been sustained since 2005. The progress towards the measles elimination and control of rubella /congenital rubella syndrome by 2019 is in progress.
- 15. To reduce child mortality, morbidity and disability associated with vaccine preventable diseases (VPDs).
- 16. To achieve & maintain at least 90% vaccine coverage for all antigens at national and district level To ensure access to vaccines of assured quality and with appropriate waste management To achieve and maintain polio free status To maintain maternal and neonatal tetanus elimination status To initiate measles elimination To accelerate control of vpds through induction of new & underused vaccines. To strengthen and expand vpd surveillance continue to expand immunization beyond infancy.
- 17. Under 1 year children for BCG, DPT-HepB-Hib, OPV, IPV, PCV and Measles/ Rubella1 (MR1) vaccine. Twelve months children for JE 15 months children for MRSD Pregnant women for Tetanus Toxoid containing (Td) vaccine.
- 18. Successful cost-effective programme Beneficial in to control VPDs Willingness to educate people about the importance of getting immunized Maintained timely reporting Community health worker and FCHV are mobilized Regular and timely conduction of EPI clinic
- 19. Community level supervision and monitoring system is poor Inadequate physical infrastructure Lack of performance based appraisal system Improper maintenance of cold chain Inadequate allocation of transportation cost Inadequate number of immunization clinic
- 20. Involvement of local level for support Supporting partners like UNICEF, Plan Nepal etc. Provided free health services by the government Extra incentive for field workers
- 21. Heavy work load Incentive focused Geographical difficulties Natural calamities like flood, land slide etc.
- 22. Incentives of service. Distribution of workload. Conducting integrated programs so that the consumers will be attracted and use the service. Appraisal of the workers. Maintanance of cold chain.
- 23. THANK YOU