The document provides information on district health services management in Nepal. It discusses the background and organization of District Health Offices (DHOs), their roles and responsibilities, programs managed, staffing patterns, and job descriptions for key positions like the Chief of DHO, Public Health Chief, and Public Health Officer. The functions of DHOs have now been transitioned to new Health Offices under provincial health directorates.

1. By:
Vijaya Laxmi Shrestha
Lecturer (MPH, M. Phil)
UNIT 4: District Health
Services Management

2. District Health Services Management
Background
District Health Office (DHO) was established on the
basis of the concept of decentralization policy.The
public health office and hospital at the district level
used to come under the joint coordination of the
district health office.
It provides the preventive, promotive and curative
services.The D(P)HO play a vital role in improving
the health status of rural people through the
approach of PHC.

3. contd...
 The D(P)HO have the responsibilities of providing
preventive, promotive and minor treatment services
through district hospitals, PHCs and Health Posts.
 The Sub Health Posts have been dissolved since
2071/72.A health post is the first contact point
for basic health services.
 The DPHS will have the responsibility of assuring
needed additional treatment services through an
effective referral system.
 Currently, all the DHOs and DPHOs have been
changed into Health Offices.

4. contd....
 The seven-provincial health directorates provide
technical backstopping and programme monitoring
to district health systems and come directly under
Ministry of Social Development of Province.
 Furthermore, Cabinet has decided to establish one
health office in 77 districts which are under
provincial health directorate.
 Currently, there are only Health Offices in the
district.
 There is no provision of DHO or DPHO any more.

5. Organogram of DHO/DPHO
District Health Office
Public Health Section
Hospital
OPD
Indoor
Emergency
X-ray
Laboratory
Administration
Section
Account
Section
Store
Family Health
Section
Child Health
Section
Disease
Control
Section
Health
Promotion &
Training Section
Statistical
Section
CB-IMNCI
Program
Immunization
Program
Laboratory
TB, Leprosy
andAIDS
Control
Program
Malaria /
Kalazar/
Filaria
Program
Environmental
Health,
Occupational
Health, Oral
Health, School
Health, Mental
Health, Control
of Deafness and
Blindness
Nutrition
Program
FP Program
SM Program
FCHV
Program
PHC/ORC
Program
ASRH Program

6. Staffing pattern in DHO/DPHO (Old)
Technical Section
 DHO chief 1
 Public Health Officer 1
 EPI Supervisor 1
 Family Planning Supervisor 1
 TB & Leprosy Supervisor 1
 Health EducationTechnician 1
 Vector ControlAssistant 1
 Public Health Nurse 1
 HealthAssistant 2
 Statistical Assistant 1
 Cold ChainAssistant 1

7. Contd…
Administrative Section
 Subba 1
 Typist 1
 Accountant 1
 SubAccountant 1
 Store Keeper 1
 Driver 1
 OfficeAssistant 3

8. Staffing Pattern in Health Office (New)
 HealthAdministrator (9/10th Level)- 1
 Public Health Officer (7th/8th level)- 1
 Supervisor (5th /6th level)- 3 ( PHN is must)
 LabTechnician (5th /6th level)- 1
 Statistician 1
 Accountant 1
 Administration Officer 1
 Driver 1
 OfficeAssistant 2

9. Major Functions/Role of DHO/DPHO
1. Prepare plan for preventive, promotive and curative
programme to be conducted in the district and monitor
and supervise the programme activities.
2. Prepare training plans and conduct such training in the
district, in co-ordination with (Regional) HealthTraining
Centre.
3. Responsible for all day to day administration, account &
technical issues.
4. Implement all community based health programs &
promote community participation

10. Contd…
6. Receive and manage the supply of vaccines, drugs,
equipment and other resources
7. Provide vaccines, drugs and other necessary
supplies to the PHCs, HPs in time.
8. Manage accurate record keeping and timely
reporting.
9. Coordination and supervision of all GOs, NGOs &
private sectors within the district
10. Management of all public health facilities under
DHO, i.e. PHCC, HP

11. Contd….
11. Management and control over local health budget
12. Promotion of inter-sectoral coordination within
the district and with central & regional level
13. Conduct operational research
14. Represent MoH/DoHS in all district level
meetings & occasions
15. Participate in regional, central and international
planning meetings, discussion forums, workshops
& seminars etc.

12. Role and Responsibilities of Health
Offices (New)
 Under the provincial Health directorate coordinate,
facilitate, support and implement the health programs in
coordination with provincial and local government
 Planning, storage and distribution of the required
logistics including drugs, vaccines and others for their
catchment areas
 Facilitate and coordinate public health and vector
surveillance as well as disaster management
 Facilitate, coordinate and support the public health
campaigns

13. contd...
 Coordinate with local government and health bodies
 Analyze the Integrated HMIS and plan accordingly and
facilitate and provide feedback to local institutions.
 Plan, facilitate and coordinate to maximize the health service
access and utilization
 Supervision and monitoring to the government/private
/collaborative health institutions
 Develop institutional and human resource technical capacity
 Conduct, coordinate and facilitate all the province
specific and regular health programs such as
TB/Leprosy control, family planning, safe motherhood,
nutrition etc.

14. contd.....
 Manage for Environmental Health, Drinking
water and sanitation as well as professional health
promotion
 Perform population management related task
 Facilitate for multi sectoral coordination
 Conduct regular day to day administrative work
including finance
 Perform other tasks as guided by provincial
government.

15. Functions of Health Offices (new)
Planning
Coordination
Support
Training
Supervision
Monitoring

16. Program under DHO/DPHO/Health
Office
1. Child Health Program-It includes EPI,
Nutrition, CB-IMNCI
2. Family Health Program-It includes FP, safe
motherhood and new born care. PHC/Outreach,
FCHV,ASRH
3. Disease control Program-Malaria, Kalazar, JE,
TB, LF, Leprosy, HIV/AIDS and STD control.

17. Contd….
4. Training-It includes- Basic training for New Health
worker and Refresher training
Trainings in district:
 FCHVTraining
 HMISTraining
 CB-IMNCITraining
 CLT
 CoFP Counseling
 BPP
 IYCF
 CB-NCP

18. District Health Management
5. IEC Program
 Strengthening health education
 Review of district health education program
 Health education exhibition in community
 School health education
 Functions as a health education resource centre
 Interaction program with influential people
 Local folk and cultural program like street
drama in relation to health, messages through
FMs

19. District Health Management
 Gender sensitization workshop to health worker
 Media coverage in local print media
 FM radio program production
 Health education program promotion and
campaign
 Radio listeners group formation program
 Health education motivation program to FCHV
6. Free Health Care services-from hospital, PHC, HP

20. Programs under Health Office
All programs in an integrated manner
such as Immunization program, Family Planning
Program, Safe Motherhood Program,
TB/Leprosy control program, Nutrition
program, FCHV program,
Training, IEC activities etc.

21. Job Descriptions
 A job description is a written document that
clearly states the essential job requirements, job
duties, job responsibilities, and skills
required to perform a specific role.
 A more detailed job description will cover
how success is measured in the role so it can be
used during performance evaluations.
 It states what is to be done and how it is to be
done.

22. Importance of Job Description
Helps to recruit potential candidate
Gives clear understanding to employee
about what they are expected to do
Can be used for performance evaluation of
employee
Is useful for human resource planning,
employ development and compensation
management.

23. Job Title of Chief of DHO
Post Medical Superintendent/Senior
Public Health Officer/PHA
Level Gazetted Second Class
Service Health
Group Health Inspection
Minimum Educational
Qualification
MBBS/MD/BPH/MPH
Answerable to Regional Director/DoHS/MoHP
Relation All offices in the district
Direct supervision of DPHO/ District Hospital/
PHC/HP/SHP/PHC ORC/EPI
Clinics, FCHVs

24. Job Description of Chief of DHO
1. Planning
2. Public Health Programme
3. Hospital Related
4. Administrative Duties
5. Review of Programs
6. Training
7. Coordination
8. Supervision, monitoring and evaluation
9. Other

25. Job Title of Public Health Chief
Post Senior Public Health Officer
Level Gazetted Second Class
Service Health
Group Health Inspection
Minimum Educational
Qualification
BPH/MPH
Answerable to Regional Director/DoHS/MoHP
Relation All offices in the district
Direct supervision of DPHO/PHC/HP/SHP/PHC
ORC/EPI Clinics, FCHVs

26. Job Descriptions of Public Health Chief
1. Planning
2. Public Health Programme
3. Administrative Duties
4. Review of Programs
5. Training
6. Inter and intra sectoral Coordination
7. Budget and provision of supply
8. Supervision, monitoring and evaluation
9. Other

27. Job Title of Public Health officer
Post Public Health Officer
Level GazettedThird Class
Service Health
Group Health Inspection
Minimum Educational
Qualification
BPH
Answerable to District Health Chief
Relation All offices in the district, hospital
employees, NGOs & INGos
Direct supervision of DPHO/PHC/HP/SHP/PHC
ORC/EPI Clinics, FCHVs

28. Job Description of PHO
1. Planning
2. Family Planning Programme
3. Safe Motherhood
4. Immunization Programme
5. Nutrition Programme
6. CBIMNCI program

29. Contd…..
8. Malaria and Kala-azar
9. Tuberculosis
10. Leprosy
11. HIV/AIDS prevention Programme
12. Epidemic Control
13. Health Education Programme
14. School Health Education Programme
15. FCHV Programme

30. Contd…..
17. Community Drug Programme
18. Budget and provision of supply
19. Monitoring and supervision
20. Conducting Programme
21. Administrative duties
22. People’s participation and community mobilization
23. Coordination
24. Others

31. Job Title of District Supervisor (HA)
Post Health Assistant
Level Non Gazetted First Class
Service Health
Group Health Inspection
Minimum Educational
Qualification
PCL in General Medicine
Answerable to DHO/PHO
Relation All offices in the district
Direct supervision of PHC/HP/SHP/PHC ORC/EPI
Clinics, FCHVs

32. Job Title of Public Health Nurse in DHO
Post Public Health Nurse
Level Non Gazetted First Class
Service Health
Group General Nursing
Minimum Educational
Qualification
PCL in Nursing (Staff Nurse)
Answerable to DHO/PHO
Relation All offices in the district
Direct supervision of PHC/HP/SHP/PHC ORC/EPI
Clinics, FCHVs

33. Job Title of District Supervisors
Post EPI/TB/Leprosy /Family
Planning/Vector Control Assistant
Level Non Gazetted First Class
Service Health
Group Health Inspection
Minimum Educational
Qualification
Certificate Level
Answerable to DHO/PHO
Relation All offices in the district
Direct supervision of PHC/HP/SHP/PHC ORC/EPI Clinics,
FCHVs

34. Job description of District
Supervisors in DHO
 Planning, implementing, budgeting of related
programs
 Collection and analysis of information
 Conduct monthly, quarterly and annual review
meetings of programs
 Attend and provideTraining
 Monitoring & supervision
 Coordination with other programs
 Guide and support field staffs
 Others

35. Grass root Health
Services
Management

36. Municipality/Rural Municipality
 There is a Health Section in every municipality and
rural municipality.
 There are 3 health workers (5th/6th/7th level) in
Municipality and 2 in rural municipality.
 It is responsible for effective implementation of
quality health services in respective areas.
 Coordinates with Health institutions and Health
offices and province level health directorate as well.
 Plans different health programs required
 Supervision and monitoring, Evaluation

37. Background
 HP and PHCs are the health institutions responsible
for providing essential health care services to the
people at grassroot level.
 HP and PHC monitor the activities of FCHVs and
also of PHC/ORCs and EPI clinics.
 In addition, HP and PHCs are the referral centre for
FCHV, PHC/ORC and EPI clinics.
 Some of the Health posts also offers the services
provided by birthing centers.

38. PHCC In charge
(Medical Officer)
Technical
Section
Administration
Section
HA/Sr.AHW- 1
Staff nurse – 1
AHW-2
ANM-3
LabAssistant – 1
upgraded AHW-1
-
Office
Assistant- 3
Organogram of PHCC

39. HP In charge
(HA/ Sr.AHW)
Technical
Section
Administration
Section
AHW-2
ANM-2
Office
Assistant-1
Organogram of HP

40. SHP In charge
(AHW)
Technical
Section
Administration
Section
MCHW-1
VHW - 1 Peon 0
Organogram of SHP

41. Job Description of PHC In-Charge
Post Medical Officer
Level GazettedThird Class
Service Health
Group General Health Service
Minimum Educational
Qualification
MBBS
Answerable to DHO
Relation PHC, Local Health Committee and
other local Offices
Direct supervision of HA,AHW, SN, LabAssistant, SHP

42. Job Description of HP In-Charge
Post HA/Sr AHW
Level Non Gazetted First Class
Service Health
Group Health Inspection
Minimum Educational
Qualification
General Medicine (PCL)/Sr.AHW
Answerable to DHO/PHO
Relation HP, Local Health Committee and
other local Offices
Direct
supervision of
AHW, ANM,VHW, SHP

43. Job Description of SHP In-Charge
Post AHW
Level Non Gazetted Second Class
Service Health
Group Health Inspection
Minimum Educational
Qualification
AHW (15 months training)
Answerable to DHO/PHO/HP/PHC
Relation Local Health Committee and other
local Offices
Direct
supervision of
MCHW,VHW, SHP

44. Functions/Programs of PHC/HP/SHP
1. Planning
2. Safe Motherhood
3. Immunization Programme
4. Nutrition Programme
5. Family Planning Programme
6. Diarrhoeal Diseases Control
7. Respiratory Diseases Control

45. Contd….
8. Malaria and Kala-azar Control Program
9. Tuberculosis Control Program
10. Leprosy Elimination Program
11. HIV/AIDS Prevention Programme
12. Epidemic Control
13. Health Education Programme
14. Environment Cleansing Programme
15. PHC Out reach Clinic Program
16. FCHV Program

46. Contd…..
17. Community Drug Programme
18. GeneralTreatment Service
19. Referral Centre
20. Monitoring and supervision
21. Medico-legal Cases
22. Procurement management
23. Administrative work
24. Coordination with Health Committee
25. Recording and Reporting
26. Others