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1.3 THE HEALTH CARE SYSTEM 1.3.1 Overview The government of Nepal, through the Ministry of Health (MoH), provides leadership for the entire process of health policy and strategy formulation, program development, and service delivery. The main functions of the MoH include coordination, planning and policy development, fostering support for health policies and plans, implementation of plans, and monitoring and evaluation. The MoH also works to ensure adequate health care financing. Various mechanisms facilitate the participation of other stakeholders, including civil society, the private sector, and development partners, in setting the health policy agenda in Nepal; among these mechanisms are the 2014 NHP, the NHSS, and the National Periodic Plan (2016-2019). Nepal’s health system consists of a traditional medicine (Ayurveda, unani, homeopathy etc) and modern medical health care system. Typically, there is at least one health facility in each village development committee (VDC), one primary health care center in each electoral constituency, and one hospital at the district level to provide curative services. The health care delivery system seeks to maintain a good balance between meeting curative care needs and addressing preventive, promotive, and rehabilitative needs. In the public health system, services are delivered at the primary, secondary, and tertiary levels. Primary level: This level comprises female community health volunteers (FCHVs), primary health care outreach clinics (PHC/ORCs), community health units (CHUs), Expanded Program on Immunization (EPI) clinics, health posts (HPs), birthing centers, urban health centers, primary health care centers (PHCCs), and community/rural hospitals. Service delivery at this level is largely the responsibility of medical officers, health assistants, staff nurses, auxiliary health workers, auxiliary nurse midwives, and FCHVs, who provide a range of mostly promotive and preventable services in addition to some curative services. FCHVs actively work at the community level making door-to-door visits to offer promotive and preventive services. All of the facilities mentioned above provide curative services in addition to promotive and preventive services. Secondary level: Secondary-level services are delivered by district hospitals. These are first referral points from the primary-level health facilities and provide inpatient, outpatient, emergency, and comprehensive emergency obstetric and neonatal care services for their target populations. Tertiary level: Tertiary-level services are provided by zonal, subregional, regional, and central hospitals. These institutions are second-level referral points for districts and also provide other services in their catchment areas. Central hospitals offer professional training, conduct research, and provide support to the districts. 1.3.2 Governance Structure at the National Level The Ministry of Health is responsible for stewardship and regulatory functions in addition to health service delivery. The MoH, through its various departments, sets the agenda for health care in Nepal in collaboration with other stakeholders. It is responsible for developing, reviewing, and enforcing health and related policies; spearheading health sector reforms; regulating the health sector, including the private sector; developing and reviewing service delivery standards, norms, and management protocols and ensuring that they are communicated to lower-level institutions; planning and mobilizing health resources, including allocation and management; coordinating research and surveys; and overseeing monitoring and evaluation. The MoH consists of five divisions, three departments, and five centers at the national level (Figure 1.1). 6 • Overview of the Health System in Nepal
Figure 1.1 Ministry of Health divisions, centers, and departments Ministry of Health Policy, Planning and International Cooperation Division Public Health Administration, Monitoring and Evaluation Division Curative Service Division Human Resources and Financial Management Division General Administration Division Department of Ayurveda Department of Health Services Department of Drug Administration Management Division Family Health Division Child Health Division Primary Health Care Revitalization Division Epidemiology and Disease Control Division Leprosy Control Division Logistics Management Division National Centre for AIDS and STD Control National Health Training Centre National Tuberculosis Centre National Public Health Laboratory National Health Education, Information and Communication Centre As Figure 1.2 shows, the MoH provides health services through a network of three departments, five regional health offices, five autonomous bodies, six professional councils, 27 zonal and regional hospitals, 19 medical college teaching hospitals, 76 district-level hospitals, and 364 private hospitals. Seventy-five district health offices manage basic health care service delivery through a network of 76 district-level hospitals, 204 PHCCs, 329 UHCs, 3,805 health posts, 250 community health units, 12,908 PHC/ORCs, and 16,355 EPI outreach clinics across the country. Overview of the Health System in Nepal • 7
Page 1: Nepal Health Facility Survey 2015 F
Page 4 and 5: This report presents findings of th
Page 6 and 7: 3 FACILITY-LEVEL INFRASTRUCTURE, RE
Page 8 and 9: 7 DELIVERY AND NEWBORN CARE .......
Page 11 and 12: TABLES AND FIGURES 1 OVERVIEW OF TH
Page 13 and 14: Figure 4.3 Trends in early childhoo
Page 15 and 16: Table 7.12 Postpartum exit delivery
Page 17: PREFACE T his is the first comprehe
Page 21 and 22: ACKNOWLEDGMENTS T he 2015 Nepal Hea
Page 23: LIST OF CONTRIBUTORS Chapter 1 Ram
Page 26 and 27: GDP HA HDC HFOMC HIV HLD HMIS HP HT
Page 28 and 29: VDC VDRL WHO village development co
Page 30 and 31: Eighty-five percent of facilities o
Page 32 and 33: Five percent of all facilities offe
Page 34 and 35: xxxii • Map of Nepal
Page 36 and 37: According to the 2013 Global Burden
Page 38 and 39: 1.2.3 Nepal Health Sector Program T
Page 42 and 43: Figure 1.2 Health service delivery
Page 44 and 45: prepared on an incremental basis ac
Page 47 and 48: METHODOLOGY 2 2.1 OVERVIEW T he 201
Page 49 and 50: Health Facility Operation and Manag
Page 51 and 52: Assess the computer programs (CAPI
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Page 55 and 56: Table 2.2 Results of facility conta
Page 57 and 58: Table 2.4 Distribution of providers
Page 59 and 60: 2.5.3 Sample for Observations and E
Page 61 and 62: Table 2.8 Distribution of observed
Page 63 and 64: FACILITY-LEVEL INFRASTRUCTURE, RESO
Page 65 and 66: Table 3.1 Availability of specific
Page 67 and 68: Figure 3.1 Availability of basic cl
Page 69 and 70: Overall, around three fourths of pr
Page 71 and 72: 3.3.3 Standard Precautions for Infe
Page 73 and 74: PHCCs, HPs, or UHCs had all of the
Page 75 and 76: Table 3.6 Capacity for processing e
Page 77 and 78: Table 3.7.2 Laboratory diagnostic c
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Page 87 and 88: Table 3.13 HMIS status: HMIS report
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types, PHCCs (78 percent) were leas
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Table 3.19 Average number of client
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and counseling of clients on at lea
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Table 3.20c Compliance with service
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Table 3.21b Provision of quality fa
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Table 3.22 Financial audit, disaste
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CHILD HEALTH SERVICES 4 Key Finding
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According to the 2011 Nepal Demogra
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Figure 4.3 Trends in early childhoo
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4.2.2 Vitamin A Supplementation The
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Table 4.4 Guidelines, trained staff
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Figure 4.6 Items for infection cont
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Figure 4.7 Availability of essentia
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Figure 4.8 Vaccine storage (N=816)
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Table 4.11.1 Assessments and examin
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4.4.1 Full Assessment IMCI/IMNCI Ge
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4.5 CLIENT OPINIONS Before leaving
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With regard to the topics of in-ser
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Service readiness. Section 5.3, inc
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Table 5.1 Availability of family pl
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Table 5.3.1 Family planning service
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Table 5.4.1 Methods of family plann
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5.3 SERVICE READINESS 5.3.1 Service
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Table 5.7 Items for infection contr
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Table 5.8.1 Client history and phys
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Privacy during a family planning co
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Table 5.10.1 Components of counseli
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Table 5.11.1 Feedback from family p
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5.6.2 Training Continual training f
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ANTENATAL CARE 6 Key Findings Abou
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Facilities providing ANC services i
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6.2). Fifty-three percent of the fa
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6.3.4 Medicines The national antena
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who are anemic. Only around 4 in 10
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Physical Examinations and Preventiv
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Table 6.8.2 Basic physical examinat
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Table 6.9.1 Content of antenatal ca
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Table 6.9a.1 Content of antenatal c
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Table 6.10.1 Content of antenatal c
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6.5.1 Client Knowledge Tables 6.11.
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Table 6.12.2 Feedback from antenata
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With regard to supervision of ANC p
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Table 6.16 Guidelines, trained staf
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DELIVERY AND NEWBORN CARE 7 Key Fin
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A quarter of facilities that offer
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Table 7.3.2 Medicines and commoditi
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than facilities in the hill (75 per
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Considering the signal functions se
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Table 7.6 presents the proportion o
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7.6 BASIC MANAGEMENT AND ADMINISTRA
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Table 7.10 Training for providers o
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Table 7.12 Postpartum exit delivery
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Table 7.13.2 Postpartum check/advic
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new infections have dropped to belo
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Table 8.1 Availability of HIV testi
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had waste receptacles. Half of the
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176 • HIV/AIDS and Sexually Trans
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Good record-keeping systems to trac
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premature babies, and stillborn bir
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To be considered ready to provide S
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Chronic respiratory diseases. Secti
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Table 9.2 Diagnostic capacity and e
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Figure 9.3 Items to support quality
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have spacers for inhalers. The latt
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Figure 9.6 Medicines and commoditie
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Although the number of TB cases and
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Only one-third of facilities in Nep
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terai (13 percent) regions. Similar
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MALARIA 11 Key Findings Half of Ne
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years, ACT stocks at health facilit
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Table 11.2 Availability of malaria
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11.4.2 Treatment Readiness to Treat
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REFERENCES Bhandari, G. P., M. R. A
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National Centre for AIDS and STD Co
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2016 - 2021 NHSS RF INDICATORS MATR
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7 8 Radhika Bogati Nisha Khadka Sad
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QUESTIONNAIRES Appendix C Appendix
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NEPAL HEALTH FACILITY SURVEY - 2015
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FACILITY IDENTIFICATION 001 NAME OF
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FIND THE MANAGER, THE PERSON IN-CHA
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SECTION 2: GENERAL FILTER QUESTIONS
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SOURCE OF WATER 330 What is the mos
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360* Does this facility have any ro
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SECTION 4: STAFFING - MANAGEMENT -
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420X CHECK Q006 FACILITY TYPE IS FA
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HMIS FIND THE PERSON RESPONSIBLE FO
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SECTION 5: PROCESSING OF INSTRUMENT
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602 CHECK Q600 FACILITY-BASED WASTE
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SECTION 7: BASIC SUPPLIES - CLIENT
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SECTION 8: DIAGNOSTICS 800 CHECK Q1
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811* Please tell me if: (a) (b) (c
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830 Does this facility do any blood
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847C* Does this facility do any tes
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861 Does this facility do any TB te
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SECTION 9: MEDICINES AND COMMODITIE
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MEDICINES FOR NON-COMMUNICABLE DISE
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MATERNAL AND CHILD HEALTH 906* Are
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SECTION 9.2: CONTRACEPTIVE COMMODIT
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SECTION 9.3: ANTI-TB DRUGS 930 CHEC
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944* Are any of the following Fusio
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1006* ASK YOUR RESPONDENT TO SHOW Y
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SECTION 11: CHILD GROWTH MONITORING
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1210 I would like to know if the fo
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SECTION 13: FAMILY PLANNING 1300 CH
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EQUIPMENT AND SUPPLIES 1314* I woul
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INFECTION CONTROL 1350 ASSESS THE R
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1407* As part of ANC services, plea
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INFECTION CONTROL 1450 ASSESS THE R
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1509* Do you have the national guid
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SECTION 16: DELIVERY AND NEWBORN CA
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EQUIPMENT AND SUPPLIES FOR ROUTINE
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PMTCT DURING LABOR AND DELIVERY 162
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SECTION 17: MALARIA 1700 CHECK Q102
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SECTION 18: SEXUALLY TRANSMITTED IN
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1851 INFECTION CONTROL AND CONDITIO
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1910 CHECK Q1902 AND Q1908 NO TB DI
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SECTION 20: HIV TESTING AND COUNSEL
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SECTION 21: HIV TREATMENT 2100 CHEC
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SECTION 22: HIV CARE AND SUPPORT 22
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BASIC SUPPLIES AND EQUIPMENT 2330 A
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SECTION 24: MINOR SURGICAL SERVICES
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SECTION 25: CESAREAN DELIVERY 2500
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SECTION 27: BLOOD TRANSFUSION SERVI
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SECTION 30: GENERAL FACILITY LEVEL
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201* CHECK [Q103] FOR PROVIDER OCCU
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4. FAMILY PLANNING SERVICES 400 In
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DELIVERY SERVICES 506 In your curre
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7. DIAGNOSTIC SERVICES 700 In your
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808 Among the various things relate
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Sample List for ANTENATAL CARE Obse
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Sample List for ANTENATAL CARE Obse
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NO. QUESTION / OBSERVATIONS CODES F
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NO. QUESTION / OBSERVATIONS ROUTINE
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NO. QUESTION / OBSERVATIONS DANGER
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NO. QUESTIONS CODING CLASSIFICATION
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205 What is the total amount you pa
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Sample List for FAMILY PLANNING Obs
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Sample List for FAMILY PLANNING Obs
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Nepal Health Facility Survey 2015 O
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NO. QUESTIONS / OBSERVATIONS CLIENT
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NO. QUESTIONS / OBSERVATIONS FOR Q1
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NO. QUESTIONS / OBSERVATIONS CODES
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NO. QUESTIONS / OBSERVATIONS 9. IMP
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Nepal Health Facility Survey 2015 F
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Sample List for SICK CHILD Observat
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Sample List for SICK CHILD Observat
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Nepal Health Facility Survey-2015 O
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NO. 5. PROVIDER INTERACTION WITH CA
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Nepal Health Facility Survey-2015 S
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110 Has [HE/SHE] had watery and fre
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TREATMENT AND CARETAKER COMFORT LEV
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UNDERWEIGHT 136A Did the provider t
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Sample List for POST PARTUM WOMEN D
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Nepal Health Facility Survey - 2015
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200. ACCESSING CARE AND DECISION MA
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S.N. Question/Information Coding Ca
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Nepal Health Facility Survey 2015 H
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2.0 Composition, Training and Knowl
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3.0 Participation Q.N. Questions Co
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Facility No.:____________________ T
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STAFF LISTING FORM: HEALTH WORKERS
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Nepal

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