This document summarizes a review of health service planning in Nepal from the provincial to local levels. It describes the new federal system of government in Nepal with three tiers (federal, provincial, local). At the local level in Pokhara Metropolitan City, the findings show 41 health facilities serving 479,000 people. A top-down and bottom-up approach is used for health program and budget planning. At the provincial level, the Gandaki Province health directorate provides technical support to 11 districts. The challenges of implementing health planning under federalism include coordination between levels of government and building capacity of newly elected local bodies. Recommendations focus on collaboration, clarifying roles, training, and strengthening infrastructure and resources at the
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.
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.
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
New Organogram of Nepalese Health System (Please check the updated slides on ...Prabesh Ghimire
This slide has been updated to accommodate the recent changes. Please check the following link for the updated presentation:
https://www.slideshare.net/PrabeshGhimire/organogram-organization-structure-of-nepalese-health-system-updated-nov-2021
FCHVs are trusted members of the community who have promoted positive behaviors related to safe motherhood, child health, family planning and other various health related areas. This slide covers a comprehensive ideas regarding the FCHVs, their functions, roles and status in Nepal.
A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures.In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.
The Basics of Monitoring, Evaluation and Supervision of Health Services in NepalDeepak Karki
This presentation has made to health workers who have more than two decades of experience of managing/implementing public health programs in Nepal, especially at district level and below.
Health System Management Field Program 4th yearAbiral Wagle
On a two month long field program from 17th Falgun 2077 to 15th Baisakh 2078 , we Group D2 had Placements in different settings- Primary Hospital Class B (Highway Community Hospital), Primary Hospital Class A (Dhading District Hospital), Secondary Hospital (Hetauda Regional Hospital), Rural Municipality (Benighat Rorang) and Municipality (Neelakantha)
The findings from the field program are summarized as:
-Overall municipal profile and municipal health profile of Benighat Rorang Rural Municipality
-Hospital Profile of Highway Community Hospital
-Epidemiological trend analysis of AGE cases in Hetauda Hospital
-Five-year plan on strengthening TB program in Neelakantha Municipality
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
New Organogram of Nepalese Health System (Please check the updated slides on ...Prabesh Ghimire
This slide has been updated to accommodate the recent changes. Please check the following link for the updated presentation:
https://www.slideshare.net/PrabeshGhimire/organogram-organization-structure-of-nepalese-health-system-updated-nov-2021
FCHVs are trusted members of the community who have promoted positive behaviors related to safe motherhood, child health, family planning and other various health related areas. This slide covers a comprehensive ideas regarding the FCHVs, their functions, roles and status in Nepal.
A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures.In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.
The Basics of Monitoring, Evaluation and Supervision of Health Services in NepalDeepak Karki
This presentation has made to health workers who have more than two decades of experience of managing/implementing public health programs in Nepal, especially at district level and below.
Health System Management Field Program 4th yearAbiral Wagle
On a two month long field program from 17th Falgun 2077 to 15th Baisakh 2078 , we Group D2 had Placements in different settings- Primary Hospital Class B (Highway Community Hospital), Primary Hospital Class A (Dhading District Hospital), Secondary Hospital (Hetauda Regional Hospital), Rural Municipality (Benighat Rorang) and Municipality (Neelakantha)
The findings from the field program are summarized as:
-Overall municipal profile and municipal health profile of Benighat Rorang Rural Municipality
-Hospital Profile of Highway Community Hospital
-Epidemiological trend analysis of AGE cases in Hetauda Hospital
-Five-year plan on strengthening TB program in Neelakantha Municipality
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.
Community Health Strategy Implementation Guide 2007chskenya
This is the community Health Implementation guideline for CHS Kenya. Community Health Services Kenya is the body mandated to offer quality health services to Kenyans at community level. This guideline outlines how the strategy is implemented to ensure that each Kenyan has access to quality health services
For More Information Visit http://chs.health.go.ke
CBHI Initiative in Ethiopia Design, Implementation and ChallengesHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Regular program of the Ministry of Federal Affairs & Local Development (MoFALD) & Local Governance and Community Development (LGCDP), Government of Nepal. This annual Western regional review and progress report meeting was held in Pokhara August 31 - Sept 1, 2015 at UDTC, Pokhara.
This presentation is the summary of the same, and progress report from LGCDP Pokhara office. ICT for Development and e-Governance in Nepal has been depicted in the work.
A PROPOSAL ON WORKPLACE HEALTH PROMOTION, EDUCATION AND COMMUNICATION PROGRAM...Mohammad Aslam Shaiekh
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Practicum presentation on Safe Motherhood Program (SMP) and Maternal and Peri...Mohammad Aslam Shaiekh
Practicum presentation on Safe Motherhood Program (SMP) and Maternal and Perinatal Death Surveillance and Response (MPDSR) Program in MNH Section of Family Welfare Division
Practicum presentation on Safe Motherhood Program (SMP) and Maternal and Peri...Mohammad Aslam Shaiekh
Practicum presentation on Safe Motherhood Program (SMP) and Maternal and Perinatal Death Surveillance and Response (MPDSR) Program in MNH Section of Family Welfare Division
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
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Anti ulcer drugs and their Advance pharmacology ||
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Review of current health service planning in Nepal from province to local level
1. Practical Skill Development
on
Review of current health service
planning in Nepal from province to
local level
( PSD work was carried out in the partial fulfillment of PSD 525 Public Health
Service Management)
Presented by
Group A
MPH II Semester
School of Health and Alied Sciences
Pokhara University
15/10/2020
2. Group Members
Name of Students
Mohammad Aslam Shaiekh
Selina Shiwakoti
Nabin Prasad Chaudahry
Jene Shrestha
5/10/2020 2
3. Introduction
• Process of setting goals and choosing the actions to
achieve these goals.
• Nepal’s new Constitution envisions three tiers of
Governments in Nepal (Federal, provincial and local)
• Seven provinces of Nepal were formed on 20
September 2015.(1)
• Each district (77) has local units.
• It includes : 6 metropolitan Cities, 11 Sub-
Metropolitan Cities, 276 Municipalities and 460
Rural Municipalities. (2)
35/10/2020
4. Introduction
• In provincial and local health system, bottom-up and
top-down approach for effective is followed, in
Gandaki Province.(3)
• Health planning is done on the basis of budget. (4, 5,
6)
• Budgeting every year is based on unconditional
budget and conditional budget provided by federal
government to provincial and local
governments.(4,5,6)
45/10/2020
5. Rationale of the study
• The government of Nepal has adopted the new
federal system and experiencing the different
strategies to govern the federal, provincial and
local government system which is very new
concept.
• Changing different structure, organogram,
staffing pattern, role and responsibility and the
planning and budgeting system may be differ in
each level of government system.
55/10/2020
6. Objectives:
General Objective:
• To review the current health planning and budgeting
system from province to local level in Nepal.
Specific Objectives:
• To explore the health program planning system in
provincial and local level.
• To explore the health budget planning system in
provincial and local level.
• To identify the challenges of implementing the health
system planning and budgeting in federal system of
Nepal.
65/10/2020
7. Methodology:
Study area:
Two government organizations were visited
• At Province Level: Health Directorate, Gandaki
Province
• At Local Level: Pokhara Metropolitan city, Kaski
Field visit duration:
• The duration of this field practice was 3 days
(21-23 April 2019).
75/10/2020
8. Methodology
Technique and tools used for Review of System:
• Rapport building through the phone call with
focal person of PHD to confirm the date for
visiting the PHD to collect the required
information
• Interaction
• Meeting - formal and informal
85/10/2020
9. Findings and Results
At Local Level:
Pokhara Metropolitan city :Total Population
4,79,000
• 33 wards
• 41 service outlets : It includes
1 Hospital,
2 PHCs,
1 Urban Health Promotion Centre,
2 Ayurvedic Dispensary,
16 Urban Health Clinics and
19 Health Posts
95/10/2020
10. Findings and Results
• 88 PHC-ORC,
• 112 immunization clinics and
• 654 FCHVs
• Monitoring of FCHVs by Metropolitan City at
every 6 months
• At every 3rd day of month, the monthly meeting
of in-charge of health facilities was conducted,
review of progress report was done, and the
information was reported in HMIS 9.3.
105/10/2020
11. Findings and Results:
• System of top-down and bottom up approach for
program planning and budget planning.
• Top down approach is using for conditional
health program planning and budgeting and
bottom up approach is using for unconditional
budget planning for health in metropolitan city
5/10/2020 11
13. Ministry of Finance
Resources allocation
National Planning Communication (NPC)
Final recommendation for budgetary allocation
EDPS/Donor agencies
Resources allocation
Line agencies/Ministry
Recommendation for budget
(MOHP, MOE, MoFAGA),
MoPIT, MWCSC, DoHS
Ministry of federal affair and
general administration, ministry
of education, ministry of physical
infrastructure and transport,
Ministry of women, children and
senior citizen,
Ministry of water supply and
sewage
Ministry of forest and
environment
(Multi-lateral/Bi-lateral
agencies,
I/NGOs)
District Coordination
Committee
Municipality/Rural Municipality
Assembly/Council (Prioritize,
coordination, fund allocation and
approval
Need collection, Ward health
planning and prioritization
workshop
Basic Health facilities
(PHCC, HP, UHC, CHU)
PHC/ORC, FCHVs)
NGOs /CBOs, Child club,
youth clubs and INGOs.
Agriculture, livestock,
education sectors
135/10/2020
FederalgovernmentLocalGovernment
Source: MOHP, MoFAGA
14. Revenue and consulting
committee:
1.Rural/Municipality vice-chair person/deputy-chief
- Coordinator
2.Rural/Municipality executive officer
- Member
3. Allocated 2 respected member including 1 female by
Municipality - Member
4. Local Federation of Nepalese chambers of
commerce and industry chief or representative
- 2 Member
5.Rural/Municipality revenue- section officer
- Secretary member
145/10/2020
15. Resource estimation and budget
ceiling allocation committee:
• Rural/Municipality chairperson/Mayor
- Coordinator
• Rural/Municipality deputy-chairperson/deputy-
Mayor - Member
• Representative member(female, dalit and
municipal member) allocated by
rural/municipality chairperson/Mayor
- 3 members
• Rural/Municipality Planning section chief
- Member Secretary
155/10/2020
16. Program planning and
budgeting Committee
• Rural/Municipality chairperson/Mayor
- Coordinator
• Sector wide officer or representatives 6 members
- Members
• Rural/Municipality executive officer
- Secretary Member
165/10/2020
17. Health Planning and budgeting
process at Provincial Level
• 11 Districts in the Gandaki province
• Provincial health directorate under the MoSD.
• Each district have health offices under the
province, which technically support local level
health facilities.
• Provincial Assembly prioritizes, coordinates for
fund resource allocation and forward for review
and approval of health program and budget to
health directorate.
175/10/2020
18. Ministry of Finance
Resources allocation
National Planning Communication (NPC)
Final recommendation for budgetary allocation
Ministry of federal affair and
general administration, ministry
of education, ministry of physical
infrastructure and transport,
Ministry of women, children and
senior citizen,
Ministry of water supply and
sewage
Ministry of forest and
environment
EDPS/Donor agencies
Resources allocation
Line agencies/Ministry
Recommendation for budget
(MOHP, MOE, MoFAGA),
MoPIT, MWCSC, DoHS(Multi-lateral/Bi-lateral
agencies,
I/NGOs)
Ministry of social
development-7
Multi-lateral and Bi-lateral
agencies, I/NGOs,
Agriculture, livestock,
education
Provincial Health Directorate-
7
FederalgovernmentProvincialgovernment
Health Office
Provincial Assembly/Council
(Prioritization, coordination,
fund allocation, and approval
18Source: MOHP, MoFAGA5/10/2020
22. Planning and Budgeting
Process and Time Frame:
22
Source: Local level planning and budget drafting guidelines-2074
5/10/2020
23. Strengths
• Decentralization process reduce
disparities in access, and improve health
outcomes.
• Several potential opportunities for the
national healthcare system as decision-
making has been devolved to the federal,
provincial and local governments.
235/10/2020
24. Strengths
• Newly elected bodies can involve directly during
planning and budgeting in local level.
• Direct responsible for the allocation of budget
and planning as per local need and health
problem.
• Practice of good governance on planning and
budgeting of health program and activity with
full participation of local community and
stakeholders.
245/10/2020
25. Challenges at Province Level
•To ensure the uninterrupted supplies of medical
commodities and services in transition period.
• Less power of authority to provincial
government than local government and it has
just responsibilities to provide technical support
to local level and coordination between
provincial government and local government.
255/10/2020
26. Challenges at local Level:
• Issues like infrastructure development and
human resource development need to be
addressed.
• Budget disbursement is a major challenge as it is
harder to allocate and disburse budget in a
timely manner to multiple layered and widely
dispersed local authorities.
265/10/2020
27. Challenges at local Level
• Timely and effective monitoring and evaluation
of several fragmented local authorities and
agencies
• Delay in decision making could be an issue with
lack of prior experience and expertise.
275/10/2020
28. Conclusion:
• The federal governance redistributed the
decision making power and resources among the
central, provincial and local governments in all
sectors including health.
• Health system in Nepal is functioning under new
governance with Ministry of Health and
Population (MoHP) at the central level, Ministry
of Social Development at the provincial level and
health section or health department under the
local level governments.
285/10/2020
29. Conclusion
• The provincial governance contributes and
facilitate to local level governance for planning
and effective utilization of resources
• Effective coordination and communication
channels plays an important role between
different levels of governments for ensuring the
provision of basic health services, increasing
population coverage in health insurance and
other social security measures, and in providing
quality and equitable health services
5/10/2020 29
30. Recommendation
• Adequate collaboration and coordination
between different sector and tiers of government
• Clarify on job description of every Sections and
Division
• Orientation and capacity building to newly
elected bodies and health staffs on current health
planning and budgeting.
• Implementation of plan and activities on timely
manner
305/10/2020
31. Recommendation
• Scaling up the ability of local bodies to manage drug
procurement and general logistics and adequate
human and other resource in local healthcare
centers
• Proper Prioritization of Health activities
• Adequate infrastructure and human resource
management at local level through trainings and
capacity building activities
• Involvement of stakeholders and other sectors in
health system planning at local level government
need to strengthen
315/10/2020
32. Skill learning and
development:
• Exploring the information in detail through
interaction
• Cognitive skill on the process of health planning
and budgeting system in province and local level
• Familiar with the organizational structure and
staffing pattern of provincial health directorate
and health division of metropolitan city of Kaski
325/10/2020
34. REFERENCES:
1. Government of Nepal. Constitution of Nepal. http://www.
easynepalityping.com/nepali-sanvidhana. ccessed January 25, 2018.
Published 2015.
2.(MoFALD) MoFALD. Local level planning and budget Drafting guidelines.
2074. p. 1-12.
3.Hogarth J. Glossary of health care terminology. Copenhagen, World Health
Organization, Regional Office for Europe, 1975.
http://whqlibdoc.who.int/publications/9290201231.pdf WHO 1988
4.WHO | Health Systems Strengthening Glossary [Internet]. WHO. [cited 2019
May 12]. Available from:
https://www.who.int/healthsystems/hss_glossary/en/index5.html
5.Thapa R, Bam K, Tiwari P, Sinha TK, Dahal S. Implementing federalism in the
health system of Nepal: opportunities and challenges. Int J Health Policy
Manag. 2019;8(4):195–198. doi:10.15171/ijhpm.2018.121
6.Rubio DJ.The impact of decentralization of health services on health
outcomes: evidence from Canada. Appl Econ 2011;43(26)3907- 3917.
doi:10.1080/00036841003742579
345/10/2020
Health directorate review and approve the health budget and program planning and finally forward to Ministry of Social Development (MoSD) for approval of provincial program and budget.
MoSD forward it to the concerned ministry of federal government and final Federal government/National Planning Communication (NPC) Final recommendate for budgetary allocation