This document discusses the history and development of integrated health services in Nepal. It notes that early health services focused on curative care, but later began integrating preventive aspects as well. During the 1970s, vertical health projects were established for specific diseases but had issues with duplication and coordination. This led to the concept of integrated health services being developed in the late 1960s by WHO and USAID. Pilot integrated health projects were launched in the 1970s, and full integration of districts was completed by 1990. The strengths of integrated services include providing basic care through a single system and increasing efficiency, while weaknesses include overburdened staff and lack of integrated knowledge.

1. INTEGRATED HEALTH
SERVICES
By:
Vijaya Laxmi Shrestha
Lecturer (MPH, M. Phil.)

2. Background
 Until 1st planned period, the health
services were more focused on curative
services.
 By 2nd plan, with the continuous
emphasis on curative services, more
focus was on the preventive aspects.
 Smallpox survey was started in 1962.
 Leprosy control project was started in
1963.
 Tuberculosis control project was started.
 FP/MCH services were in place.
 Malaria eradication project was in place

3. During 3rd Plan Period
 The concept of provision of rural health
services led to more health posts.
 The building of additional new health
posts in 1970 resulted in a total of 113
at the end of this period.
 Establishment of vertical projects:
◦ Leprosy eradication project in 1965
◦ Smallpox eradication project in 1967
◦ FP/MCH Project in 1968
◦ Starting of Central Health Laboratory in
1967

4. 4th Plan Period (1970-1975)
 The life expectancy was increased to
42.3 years and IMR had come down to
157/1000 live births
 Production of middle & basic level
health workers was shifted from HMG
Nepal to IOM, TU in 1972.
 Nepal had been classified as non
endemic for small pox eradication since
1973 but the last case was found in
1974.

5. contd...
 Till date, there were 348 physicians, 900
nurses by 1975.
 A total of more than 1000 basic and middle
level health workers were trained by IoM.
 DoHS trained VHWs & Panchyat based
health workers (PBHW)
 62 hospitals with 2174 beds, 33 health
centres, 351 health posts & 82 Ayurvedic
aushadhalayas were in place at the end of
this period.

6. Vertical projects were helpful in
 Controlling Malaria and human
settlement in Terai region
 Eradicating smallpox
 Great initiation in foundation of public
health programs
 Various programs were continued
after integration too.

7. Contd….
 Some drawbacks of vertical projects
were realized then such as:
◦ duplication of resources
◦ dissatisfaction of consumers
◦ lack of intersectoral coordination
◦ high cost on administrative expenses
 Then the concept of integrating health
services was thought by WHO and
USAID.

8. Integrated Health Services
 Integration is a variety of managerial and
operational changes to health systems to
bring together inputs, organization,
management and delivery of particular
service functions. Integration aims to
improve the services in relation to
efficiency and quality.
 Refers to various health services
delivered from a single health centre.
 By late 60’s, both USAID and WHO had
thought of integrating the Nepalese health
services

9. Level of Integration
 Level 1: Integration at the point of
delivery
 Level II: Integration of resource
management
 Level III: Integration of organization
and policy

10. Contd……
 It has two fundamental elements.
◦ Integration of all vertical, single purpose
projects under a common administrative
structure for each level of health
infrastructure namely – village, district,
regional and national
◦ Integration of preventive and curative care at
an affordable cost
 The need of integrated health services
was realized at the beginning of the 4th
five year plan

11. Contd……
 The policy of integration was laid down clearly
during 5th five year plan
 The administrative sectors were first handled
by Community Health and Integration Division
(CHID)
 Central Integration Board (CIB) was formed in
1970 to launch the pilot project.
 It was first started in Bara in 1971 and Kaski in
1972 as a pilot project with the aim to centrally
manage public health service being provided by
various health institutions.

12. Contd……
 With the success of these projects, the
HPs were converted to integrated HPs
providing preventive, promotive & curative
services.
 A new Integrated Community Health
Services Development Project (ICHSDP)
was formed in 1980
 By 1987, the MOH decided to integrate all
the vertically running programmes and
district heath offices were established.
 The full integration of all districts was
completed by 1987 and the central level
was by 1990

13. Strengths
 Provision of Basic Health Services from
one door policy
 Maximum use of available resources
 Increased productivity and efficiency
 Reduced duplication of Health activities
 Increased users satisfaction and
convenience
 Service delivery according to national
policy and local needs

14. Contd….
 Free and affordable charges for
consumers
 Involvement of local level manpower,
e.g. FCHVs, TBAs, MCHWs
 Sustainability, cost effectiveness, easy
accessibility and availability of service
provider
 Better recording, reporting and
evaluation
 Better coordination and cooperation

15. Weakness
 Discouraged on vertical programme
where need for such approach could
be still very high e.g., Malaria control
 Overburden, work load to service
providers
 Lack of integrated knowledge in
service providers
 Low level of staff motivation towards
their job

16. Contd…
 Insufficient infrastructure, especially in
remote areas
 Mal-distribution of resources;
concentrated in urban areas
 Low coverage of services due to
insufficient supervision, monitoring
 Fail to achieve desired output and
impact – individual programme

17. Opportunities
 Development of the national health
system
 Involvement of Multiple international
donor agencies, NGOs
 Coverage of health related components
by non- health organizations. I.e. inter-
sectoral approach.
 Technical and financial support from
outsiders
 Community efforts in health programme

18. Threats
 Geographical difficulties
 Political instability, Internal conflict
and insurgency
 Poor economic condition
 Turn over of health workers
 Donor dependence; donor oriented
programmes

19. Contd…
 Rooted cultural superstitions
 gender discrimination
 Low literacy
 Advancing private sectors
 Centralized and complex budgetary
system
 Brain Drain advent