Morang District Profile & Annual Report: 2061/62 Fiscal Year
Morang District Profile & Annual Report: 2061/62 Fiscal Year
District Profile
&
Annual Report
2061/62
Fiscal Year
Editor
Nawa Raj Subba
Ministry of Health
Department of Health Services
Eastern Regional Heath Directorate
District Public Health Office
Morang, Nepal
1
CHAPTER 2
INTRODUCTION
MORANG: General Background
Historically, Morang district has been derived from Mawarang, the name of Kirati administrative zone
during regime of Kirati king Hang.1 Gograha was its older name of present Biratnagar; headquarter of the
district and Koshi zone, coined during Ranna regime which is connected with the name of King Birat of
Mahabharat era. Now people believe that the capital of King Birat of that Mahabharat era was located at
present Budhanagar V.D.C. which is 10 Km south east from Biratnagar. Morang district is one of the
Eastern Terai district comprising 65 VDCs where 66 governmental health institutions are available for
providing Primary Health Care services.
As per Human Development Indicators published by UNDP, Morang district is found in first position in
Eastern development region.
3
CHAPTER 2
Population: 914799
Male: 458772
Female: 456027
Under 1 year's population: 22870
Under 3 year's population: 70352
Under 5 year's population: 118289
MWRA: 174510
Expected Pregnancy: 34945
Major Achievements
1. CHILD HEALTH
1.1.1 Background:
EPI is a priority national programme of HMG/N which has been running nation wide since 1989. Active
surveillance system is weak; therefore it is difficult to measure the impact of the programme. However,
there is no doubt that the programme has contributed significantly towards reduction of infant and child
mortality as evidence by reduction of IMR and U5MR over the last decade3. According to the Annual
Report published by Ministry of Health, Department of Health Services4 noted that measles vaccine
coverage rate of Rauthahat was 120 percent, National 85 percent, Eastern development region 88 percent
and Morang 95 percent in FY 2060/61. However the BCHIMES5 survey conducted in early 2000 and
DHS survey 20016 indicate that the actual coverage is lower than the reported coverage by 5-10%. The
Multi Year Plan of Action 2002-2007 (MYPOA) has set six objectives: 1) increasing routine
immunization coverage to >90% and maintain the level; 2) eradication of poliomyelitis by 2005; 3)
elimination of MNT by 2005; 4) reduction of measles cases and deaths; and 5) introduction of Hep-B
vaccine and 6) promotion of safe injection practices in immunization programme.
1.1.2 Objectives:
• To eliminate neonatal tetanus (less than 1 cases per 1000 live births) by the year 2005;
• To reduce measles cases by 90% and measles death by 95% from the previous level by the year
2005.
• To obtain certificate of poliomyelitis eradication by the year 2005.
• To introduce new vaccine (Hepatitis B).
1.1.3 Targets:
The target population for BCG, DPT, OPV, and Measles vaccines is all infants under one year (12
months) of age. For TT+, the target population is all pregnant women. The EPI covers all the 16 districts
in eastern region. It aims to have uniform coverage in all the districts and sustain high levels of coverage
(i.e. at least 80% for BCG, DPT 3, OPV 3, and Measles in children under one year and 80% coverage for
TT+ vaccine in pregnant women.
4
1.1.4 Strategies:
• Immunization service delivery mainly through outreach sessions, provision of immunization
services by conducting 3-5 sessions per VDC per month, in the district.
• Use of all fixed sites to increase immunization coverage. EPI services provided through fixed
health facilities including Hospitals, PHC, HP, SHP and other health clinics.
• Supplementary immunization activities (NIDs, SNIDs, Mopping up) for polio eradication and
MNTE activities for maternal and neonatal tetanus elimination.
• Control of outbreak of VPDs through appropriate interventions.
1.1.5 Analysis:
Trend of measles
Trend of Measles Vaccination Coverage vaccination seems running
100 above 75 percent over past
90
90 95 7 years. This year
80
76 77 75 82 83 coverage was dropped to
70
60
50
82 percent due to measles
40 campaign, frequent
30
20 movement of health
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0
workers due to series of
trainings, and shortage of
1998/99
1999/00
2000/01
2001/02
2002/03
2003/04
2004/05 vaccine supply for three
months.
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Table 3 VDC wise BCG coverage in Morang
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Table 4 VDC wise DPT 3 Coverage in Morang district
DPT 3 coverage is heterogeneous which ranges from Aamgachi 210 percent to Urlabari 46 percent in the
district.
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Table 5 VDC wise Measles vaccine coverage in Morang
DPT 3 coverage is heterogeneous which ranges from Aamgachi 180 percent to Motipur 45 percent in the
district.
8
Measles Campaign 2061
About half of VDCs of Morang district is having coverage more than 80 percent and drop out rate less
than 10 percent. District average falls under the category 2.
9
1.2 Nutrition
1.2.1 Background:
Malnutrition is a major health problem among the children and women of childbearing age in the country.
Growth monitoring, micro-nutrients distribution, de-worming, Vitamin "A” distribution, promotion of
breastfeeding and control of anemia are being carried out in order to promote health of child and women
under the nutrition program.
1.2.2 Objectives:
• To reduce protein malnutrition among the children under 3 years of age through multi sartorial approach.
• To eliminate Iodine deficiency disorder and vitamin a deficiency by 2005;
• To reduce prevalence of anemia to less than one third by the year 2010;
• To reduce the incidence of low birth –weight to less than 10% of all births by the year 2005.
1.2.3 Target:
• Reduction of sever and moderate malnutrition among children under 3 years of age to half of the
1990 level by the year 2005;
• Reduction of iron deficiency anemia of expected pregnancies by one third of the 1990; Level by
the year 2005.
• Reduction of vitamin "A" deficiency among children under five years of age by 90% in all districts
by preventive measures by the year 2005.
1.2.4 Strategies:
• Promote, facilitate and utilize community participation and involvement for all nutrition activities.
• Integrate/incorporate EPI/FP/MCH and related activities in the nutrition plans.
1.2.5 Analysis:
10
Table 8 VDC wise New growth monitoring in Morang
New growth monitoring coverage is heterogeneous which ranges from Dulari 154 percent to Biratnagar 16
percent in the district.
11
Growth monitoring for 0-3 yr. children was done by 60 percent. Likewise, 0-5 yrs. children were covered
by 100 percent in Vitamin A and deworming. Prevalence of anaemia under three year children was 58
percent in the district. According to Nepal Micro Nutrient Survey 19987, the prevalence of current night
blindness was high among pregnant women (6.1%) with the highest rates recorded in East Terai (13.4%)
and East hills (9.3%). The survey noted that more than 1% of all school aged children had night blindness
with the prevalence increasing with age. There has been little improvement in the nutritional status of
children as measured by stunting over the last 23 years. The prevalence of stunting among 6-59 months
has reduced by only 15.3 percentage points, from 69.4% to 54.1%. Thus, it is clear that past programmes
and policies have not been sufficient and/or appropriate.
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1.3 Control of Diarrhoeal Disease (CDD)
1.31 BACKGROUND:
Diarrhoeal disease is one of the major public health problems among under 5 years of children in the
region and holds 3rd. position in OPD visit. Death rate is also quit high among less than 5 years of age.
Case management service is provided through all health facilities. Community volunteers are serving as
primary ORS providers at the community level. ORT corners are being established gradually in
PHC/HP/SHP.
1.3.2 OBJECTIVES:
• To reduce the mortality due to diarrhoea and dehydration (from estimated 30000 deaths per year)
to a minimum and
• To reduce morbidity from 3.3 episodes per child per year to a minimum.
1.3.3 TARGETS:
• To reduce mortality rate due to diarrhoeal disease by 50% in under 5 years of children
• To reduce morbidity rate due to diarrhoeal disease by 20% in under 5 years of children.
• To raise accessibility of ORS to target population by 90%.
• To raise awareness about ORS use in the treatment of diarrhoea
1.3.4 STRATEGIES:
• By increasing awareness in the community through mobilization of community health workers and
volunteers.
• By ensuring availability of ORS packets and antibiotics.
• By establishing ORT corners in all peripheral health institutions.
DPHO Morang failed to achieve the target to purchase ORS. It has taken initiative for purchasing ORS
from Royal Drugs Limited (RD) in time. But RD and its suppliers informed inability of supply very late.
After getting the report from RD and its suppliers, DPHO Morang adopted another option of purchasing
ORS from free market. Suppliers from open market also proved to be unable for supplying the full
requirement of ORS. We asked for support from Logistic Management for additional supply. Nepal
Family Health Programme (NFHP) played important role by supporting to maintain the EOP level of store
located in all institutions around the year. With the help of NFHP we took 5000 packets of ORS from
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District Health Office Sunsari to maintain the buffer stock of ORS. Under these circumstances, DPHO
Morang issued letters to all under health institutions to maintain their EOP level by purchasing ORS by
their CDP programme as per required. Health institutions used to buy ORS from market as a part of CDP
programme following its regulation.
Coverage
It is noted that incidence of diarrhoeal diseases per 1000 population and percentage of severe dehydration
among new cases is in decreasing trend in Morang district. In FY 2060/61, Morang was second highest in
reporting Incidence of diarrhoea per 1000 U5 population and was lowest in reporting percentage of severe
dehydration among new cases8. This indicates the good level of awareness on control of diarrhoeal
diseases in community.
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1.4.1 Background:
Acute Respiratory Infections are one of the commonest causes of death in children under 5 years of age. It
is also a major public health problem and control of ARI is an integral part of primary health care. The
program recognizes an important role of mothers and caretakers in Identification, Home care and Referral
of pneumonia cases. Clinical experience and intervention studies have indicated that early treatment with
antibiotics can reduce mortality from pneumonia. Many pneumonia deaths occur at home, some after only
a few days of illness. The key to reducing ARI mortality is to ensure better access to and timely use of
14
correct case management of pneumonia. Morang has got community based pneumonia program, where
FCHVs treat the pneumonia cases with first line drug (Cotrimoxazole Pad. Tabs) and if child had any
danger signs they would refer to the nearest Health facilities.
1.4.2 Objectives:
• To improve the situation of child health in Nepal by reducing mortality and morbidity due to ARI
among under 5 years of children.
1.4.3 Targets:
• To reduce mortality from pneumonia in under 5 years of children.
• To reduce morbidity due to ARI in under 5 years of children.
1.4.4 Strategies:
• Raising public awareness through mobilization of community health workers and volunteers by
ensuring availability of antibiotics.
Like CDD programme, the achievement of treated Pneumonia cases is higher than its target. A reason of
this is access of service provided by FCHV at community level. It is clear that community based
pneumonia can be done, and in Nepal, has resulted in a dramatic increase in the percent of expected cases
treated. There is good evidence showing that quality of care is good, that misdiagnosis is unlikely, that
correct treatment is usual, and that referral patterns improve. It also appears that the model used for this
programme is likely to establish a foundation, which will allow community based treatment to be
sustained. The relationship between the community workers providing the treatment and the communities
they serve becomes strong, providing an incentive for the worker and ongoing service to the community.9
Coverage
Both incidence of ARI and percentage of Pneumonia among new cases are in decreasing trend in Morang
district. The contribution of FCHV in this programme has been felt and appreciated by community in
Morang.
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Graph 3 Trend of Proportion of Pneumonia among New ARI Cases
60
55
50
44 45
40 42 42 41 40
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ARI is one of the major causes of child morbidity and mortality in the district. FCHV are playing vital role
in serving ARI suffering children in the community. FCHV are trained for diagnosis and treatment of
ARI. FCHV examines a child with her timer by counting respiration rate. She offers counseling for home
treatment or treats with Cotrimoxazole or refers to health institutions.
1.5 Neonatal Health Programme or Morang Initiative for Neonatal Intervention (MINI)
Of the 130 million babies born every year, about 4 million die in the first 4 weeks of life-the neonatal
period. A similar number of babies are stillborn.10 The time has come for these health interventions for
newborn babies to be integrated into maternal and child health programmes, which in turn need to be
strengthened and expanded. Proven cost-effective interventions, delivered through a continuum-of-care
approach, can prevent millions of needless deaths and disabilities. In Nepal 3-4 neonates dies every
hour.11 Direct causes for neonatal deaths in Nepal are Infection, Birth Asphyxia trauma, Pre-maturity and
Hypothermia. DPHO Morang is proud to note that the district has been selected for piloting for Neonatal
health intervention. Since, Infant mortality rate still high in the country and major proportion of its has
been comprised by Neonatal deaths. So, infant mortality will be down until and unless decrease in
neonatal mortality. Reviews of literatures and researches have established the strategy as Neonatal
intervention. Ministry of Health has formulated policy and guidelines for neonatal health programmes in
the country. The success of Morang district's neonatal health programme opens horizon for replication of
the programme in other district of the country. DPHO Morang has made joint effort in collaboration with
JSI R&T under Morang Innovative Neonatal Intervention (MINI) since 2004.
Of course, to treat a neonate is challenging.
Programmes demands hard working of health workers
and FCHVs. Health workers are offering additional
effort for home treatment. The treatment with
Gentamycin has cured infected neonates. Community
has paid due recognition to the service providers.
Community is also getting aware even to take out their
neonates from the home for treatment. However,
FCHVs are taking this programme as both opportunity
and challenge. Series of trainings at different levels
completed. Health workers and FCHVs are now well
trained for neonatal health care. The preliminary data
analysis explains its effectiveness and acceptance.
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1.6 Community Based –Integrated Management of Child Illness (CB-IMCI)
The IMCI intervention is integrated case management of the five most important causes of childhood
deaths – ARI, Diarrhoea, Measles, Malaria and Malnutrition. The strategy includes a range of other
preventive and curative interventions, which aim to improve practices both in the health facilities and at
home.
2. Reproductive Health
2.1.1 BACKGROUND:
The main thrust of the National Health Policy (1991) related to the National Reproductive Health and
Family Planning (RH/FP) Programme is to expand and sustain adequate quality family planning services
to the community level through all health facilities. The policy also aims to encourage NGOs, social
marketing organizations, as well as private practitioners to complement and supplement government
efforts. Community-level volunteers (TBAs, FCHVs) are to be mobilized to promote condom distribution
and re-supply of oral pills. Awareness on RH/FP is to be increased through various IEC/BCC intervention
as well as active involvement of FCHVs and MGs as envisaged by the National Strategy for FCHVs.
In this regard, FP services are designed to provide a constellation of contraceptive methods that reduce
fertility, enhance maternal and neonatal health, child survival, and contribute to bringing about a balance
in population growth and socio-economic development, resulting in an environment that will help the
Nepalese people to improve their quality of life.
2.1.2 OBJECTIVES:
Within the context of RH, the main objectives of FP Programme are to assist individuals and couples to:
• Space and/or limit their children;
• Prevent unwanted pregnancies;
• Manage infertility and
• Improve their overall reproductive health.
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2.1.3 TARGETS:
• To reduce TFR from 4.1 per women to 3.5 by the end of 10th Five Year Plan and to 3.05 in 2017
• To rise the CPR to 47% by the end of 10th 5 Year Plan period and to 58.2% by 2017.
• To achieve approx. 2,293,000 couples using modern contraception by end of 10th Five Year Plan.
• To achieve approximately 536,288 Family Planning Current Users and 23,025 Voluntary Surgical
sterilizations cases in Eastern development region in 2060/61
2.1.4 STRATEGIES:
• Increasing the knowledge and understanding of the benefits of delayed marriage, birth spacing, and a
well planned family norm across the region through integrated RH/ FP/IEC and BCC activities;
• Increasing accessibility and availability of RH/FP services through a combination of approaches;
• Expanding regular year-round and mobile VSC outreach services;
• Expanding IUCD services with special emphasis on thorough counseling and follow-up services;
• Training service providers in collaboration with NHTC;
• Improving the quality of care in accordance with the NMS for contraceptive services;
• Establishing management & treatment services for complications of abortion, including FP services;
• Ensuring adequate supply & distribution of contraceptives at regional, district & below district level;
• Strengthening HMIS for better management of FP programmes;
• Ensuring effective monitoring and supervision of FP programmes and
• Re-supplying pills and distributing condom through FCHV.
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Graph 4 Trend of Contraceptive Prevalence Rate
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2.1.6 PROBLEMS/CONSTRAINTS AND ACTION TO BE TAKEN
2.2.1 BACKGROUND:
The MoH's Safe Motherhood Programme is the HMG's main thrust to reduce maternal and neonatal
mortality by addressing the high rates of death and disability caused by the complications of pregnancy
and childbirth. The past strategy of carrying out FP/MCH in an integrated manner, promoting attendance
birth through TBAs and promoting ANC visits were not adequate in addressing the issues of MMR.
Experience also showed that the avoidance of the three delays was imperative to achieve goal of reduction
of maternal mortality. Recognizing that every pregnancy is at risk, two major strategies have been
adopted, providing around the clock emergency obstetric care (either comprehensive or basic) and
ensuring the presence of skilled attendants at deliveries, especially in the home setting.
However, because the majority of women do not have access to maternal healthcare services due to social,
economic, and political factors, medical interventions alone are not sufficient to reduce MMR. Specific
non-health approaches are needed. Therefore, the Safe Motherhood Programme takes a multi-sectoral
approach to include both health and non-health interventions that promote access to and utilization of
services. The long-term goal of the 15-year National Safe Motherhood Plan (2002-2017) envisages
establishment of BEOC and CEOC services in all 75 districts, skilled attendance of births & increased
access to emergency fund & transport services.
2.2.2 OBJECTIVES:
• To reduce the mortality and morbidity among pregnant women and new born during childbirth
and the postnatal period through the adaptation of a combination of health and non-health related
measure.
• To improve the quality of antenatal, natal, postnatal and neonatal care through appropriate training
of health personnel, including emergency obstetric care.
• To advocate and raise public awareness about safe motherhood related issues.
• To strengthen referral care.
• To improved legal and socio-economic status of women.
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2.2.3 TARGETS:
• To contribute to the reduction of the maternal mortality rate from estimated rate of 539/100000
live birth to 300/10000 live birth end of Tenth Five year plan.
• To reduce neo-natal mortality rate from 39-to32 per1000 live births by the end of Tenth five year
plan.
• To increase delivery by health workers to 18% by the end of Tenth plan.
• To increase % of woman attending antenatal care 4 times to 25% by end of Tenth plan.
2.2.4 STRATEGIES:
• Promoting inter-sect oral collaboration at regional district and community level.
• Strengthening and expanding basic maternal care services.
• Supporting activities that raise the status of women.
% of women with 4th visit among 1st visit 40.0 54.0 35.4
% of delivery conducted at health institutions 7.5 15.5 16.9
(Hospital/PHCC/HP/SHP) Trend of del
Number of delivery conducted in Hospital 1371 3050 4350 workers is 1
trend which
Number of delivery conducted in PHCC 941 1045 1562 coming year
% of home delivery attended by HW 9.2 6.7 4.5
Delivery conducted by Health Workers 15 22 23
PNC first visit as % of expected pregnancy 32.2 40.4 38.4
50
45
40
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Trend of delivery conducted by
30
25
health workers is 22 percent which
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22 is in increasing in Morang district.
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Table 17 VDC wise status of 4 ANC visits in Morang
ANC ANC
S.N. VDCs 4 visit % S.N. VDCs 4 visit %
First First
1 Rangeli 196 352 180 34 Sijuwa 549 234 43
2 Govindapur 254 287 113 35 Indrapur 371 157 42
3 Lakhantari 86 93 108 36 Jhorahat 350 147 42
4 Amahibariyati 251 242 96 37 Aamgachhi 194 79 41
Sis.
5 Tankisinuwari 264 95 38 251 38
250 Badahara 96
6 Kadmaha 249 205 82 39 Haraicha 454 173 38
7 Rajghat 128 104 81 40 Tandi 217 82 38
8 Darbesha 207 168 81 41 Pathari 339 128 38
9 Dangraha 208 165 79 42 Tetariya 100 37 37
10 Letang 485 369 76 43 Sundarpur 199 72 36
11 Banigama 285 212 74 44 Itahara 338 122 36
12 Amardaha 278 196 71 45 Dadarbairiya 549 180 33
13 Jhurkiya 454 309 68 46 Sis. Jahada 156 50 32
Sub Metro
14 Ramitekhola 145 68 47 4383 32
98 Brt 1390
15 Budhanagar 347 233 67 48 Mirgouliya 253 78 31
16 Bhogteni 125 65 19 49 Madhumalla 391 117 30
17 Bardanga 268 164 61 50 Hoklabari 119 35 29
18 Dainiya 338 199 59 51 Bahuni 919 268 29
19 Warangi 103 60 58 52 Dulari 529 154 29
20 Dangihat 203 116 57 53 Takuwa 211 60 28
21 Belbari 621 353 57 54 Keroun 216 61 28
22 Jante 83 45 54 55 Bhaudaha 184 51 28
23 Hattimuda 280 151 54 56 Baijanathpur 141 39 28
24 Pokhariya 126 67 53 57 Katahari 326 86 26
25 Pati 244 123 50 58 Majhare 812 209 26
26 Hasandaha 444 223 50 59 Sidraha 68 17 25
27 Thalaha 380 189 50 60 Urlabari 2788 608 22
28 Bhatigachha 208 99 48 61 Motipur 299 59 20
29 Kerabari 408 194 48 62 Singdevi 97 19 20
30 Mahadewa 95 45 47 63 Kaseni 202 38 19
31 Sanischare 563 265 47 64 Bayarban 1007 187 19
32 Yangsila 50 22 44 65 Sorabhag 709 131 18
33 Nocha 105 46 44 66 Babiyabirta 491 76 15
District 26693 10949 41
Status of 4 ANC visits in VDCs of Morang district is heterogeneous which ranges from Rangeli 180
percent to Babiyabirta 15 percent in the district.
21
Table 18 VDC wise status of Delivery conducted by Health Workers in Morang
Status of delivery conducted by health workers is heterogenous which ranges from Jhurkia 69 percent to
Katahari, Jhorahat, Itahara, Hattimudha and Bhaudha 0 percent in the district.
22
Table 19 VDC wise status of PNC 1st Visits in Morang
Status of delivery conducted by health workers is heterogenous which ranges from Kadmaha 87 percent to
Yangsila, Amardaha 3 percent in the district.
23
2.1.6 PROBLEMS/CONSTRAINTS AND ACTION TO BE TAKEN
With the help of supporting partners Aama Milan Kendra five VDCs are taken
as conducting piloting Youth friendly clinics in the districts. Health workers
have given training for organizing separate clinics in different days for boys
and girls in the health institutions. Now, hopeful results are coming.
3 DISEASES CONTROL
3.1.1 BACKGROUND:
Tuberculosis is one of the major public health problems in Nepal and is a leading cause of death in adults.
Introduction of treatment by Directly Observed Treatment Short Course (DOTS) has already reduced the
number of deaths in Nepal from 8000-11000 to 5000-7000. Expansion of this cost-effective and highly
successful treatment strategy, which already has proven its efficacy in Nepal, will have a reflective impact
on mortality and morbidity. The National Tuberculosis Programme’s (NTP), long term goal is to reduce
the transmission of TB to such a level that it is no longer a public health problem. The NTP operates its
diagnostic and treatment services within the general health services of the country. The basic unit of
management for diagnosis and treatment of TB patients is the district hospital and the Primary Health
Centre. Health Post acts as sub-centre for supervision of patients on DOTS in selected health posts in
different districts. Region provides support in managing TB control activities of the districts.
3.1.2 OBJECTIVES:
• To achieve 85% cure rate in new smear positive pulmonary tuberculosis
• To achieve 70% case detection ratio in new pulmonary tuberculosis
• To implement the DOTS activities in phased manner in all districts
3.1.3 TARGET:
• 85% cure rate in new smear positive cases
• 80% conversion rate in new smear positive cases
• 70% case detection rate
• Expansion of DOTS in all districts
3.1.4 STRATEGIES:
• To promote early case detection of infectious pulmonary cases through sputum smear examination
• To ensure effective chemotherapy
• Involvement of community for planning, Implementation and monitoring of T.B. control services.
24
3.1.5 ANALYSIS OF ACHIEVEMENT BY MAJOR ACTIVITIES:
25
Graph 6 Trend of TB Cure Rate
100
90
88 89 89 87 89
80
78
70
60
50
56 TB Cure rate is in increasing
40 trend in Morang.
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3.2 Leprosy
3.2.1 BACKGROUND:
Leprosy is one of the major public health problems of eastern region. It is aimed to provide diagnostic and
therapeutic services of leprosy within the general health services. MDT service is available in all health
institutions of the region. Leprosy burden is high in Terai district where as low or eliminated in hill
districts. The regional prevalence rate of leprosy is continually in decreasing trend but the new case
detection rate is not declined as expected. In 1982 leprosy PR was 17.3 per 10000 populations and finally
this value reduced to 2.81. This indicates the achievement of reduction is 83.76% and leprosy elimination
is in the positive trend.
3.2.2 OBJECTIVES:
• Elimination of leprosy by the year 2005 AD (Prevalence rate below 1 cases per 10,000 population)
at national level
• Provision of MDT to all registered cases
• Prevention of disability by early detection and treatment of cases
• Reduction of social stigma by increasing awareness about the disease
3.2.3 TARGET:
• To reduce the present registered prevalence rate to < 1 per 10000 population by the middle of FY
062/063 (end of December 2005)
• To reduce impairment and disability due to leprosy resulting reduction of WHO defined disability
proportion around 5%
• To prevent leprosy transmission by early case detection and increase patient volunteer submission
more than 90%
3.2.4 STRATEGY:
• High priority will be given to undetected cases and treatment
• Increased co-operation and coordination between HMG and I/NGOs will be maintained
26
3.2.5 ANALYSIS OF ACHIEVEMENT BY MAJOR ACTIVITIES:
S.N Indicators MB PB
. 2059/60 2060/61 2061/62 2059/60 2060/61 2061/62
1. New Case 2.6 2.6 1.1 4.1 3.1 1.3
Detection Rate
2. RFT 91.8 87.0 98.9 98.7 94.0 100.0
3. Prevalence Rate 3.15 2.5 2.1 2.09 1.29 1.5
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Trend of prevalence rate of
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14 Leprosy is in decreasing trend
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8 8 8
10 but still far from its elimination
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4 5 4 stage.
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3.4.4 Strategies:
• Early diagnosis and prompt treatment of Kala–azar through strengthening of referral services at the
peripheral health Institution.
• Early detection and timely containment of epidemics.
• Protection of risk population with indoor residual spraying.
3.4.5 Analysis Of Achievement By Major Activities:
140
25
23 120 124
20 Cases
100 103
15
13 12 80
10 70
60 64
5 5.1
0 1 0.3 0.6 40 39 41 41
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27 23 27 VDCs
20 21 19 17
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/0
/0
/0
98
99
00
01
02
03
04
19
19
20
20
20
20
20
Graph 8 Kala-azar is in increasing trend in Morang Graph 9 The trend of Kala-azar, is increasing. Total
district. 41 VDCs are being affected by Kala-azar.
3.5 JE Program
Table 28 Incidence of JE
Indicators 2059/060 2060/061 2061/062
Case Incidence/100000 6.6 6.4 3.0
Number of death due to JE 6 8 3
29
3.6 AIDS and STDs Programme Targeted Activities.
3.7.1 BACKGROUND:
Curative health services aims to provide appropriate diagnosis, treatment and referral through the network
of PHC outreach to specialized hospitals. It is one of the important and highly demanded services.
Services are provided through all health facilities.
3.7.2 OBJECTIVES:
• To provide curative services to all patients reporting to the health facilities or PHC outreach sites
to reduce duration of illnesses, mortality and improved quality of life.
3.7.3 TARGETS:
• To provide service to all clients attending health facilities with appropriate diagnosis, treatment
and/or referral to specialized facilities.
3.7.4 STRATEGIES:
• Establishment and service delivery through of SHP in all the VDCs.
• Establishment and service delivery through PHCs in all electoral constituencies.
• Establishment of 3-5 out reach clinics in all VDCs for EPI and PHC-ORC.
4.2 HMIS
4.2.1 BACKGROUND:
To develop skill in record keeping, analysis and use of information for planning and supervision,
integrated HMIS implementation strategies started in 1993. Efforts are being done to utilize HMIS
information in planning, monitoring, supervision and evaluation at regional and district level.
4.2.2 OBJECTIVES:
• To monitor the coverage, continuity and quality of the health services and to assist service provider
and managers to use the data at the service delivery level.
• To assess the progress of district health programmes.
• To help districts in preparation of work plan.
4.2.3 STRATEGIES:
• Collection of information, analysis and use for planning, monitoring and management.
• Initiate bottom-up planning.
• To organize programme performance review meeting.
31
Table 35 Average number of People Served by type of health facilities per months
FY District Hosp PHC HP SHP PHC/ORC FCHV NGOs
059/060 40 184 963 663 206 30 24 409
060/061 57 187 1009 706 238 27 34 422
061/062 51 192 1311 584 248 29 43 432
4.3 LMIS
4.4.1 Background:
To acquire support and active participation of the community in primary health services, the FCHV
programme was initiated in the year of 1988/89 At present FCHVs are involved in the distribution of
condoms, pills, Vitamin "A" Capsules, ORS and also initial management of ARI cases in selected district.
They are also responsible for the dissemination of information and education in the community on FP,
EPI, Nutrition and Sanitation.
4.4.2 Objectives:
• To empower rural women with basic knowledge and skill.
• To develop in every word at least one FCHV as a health resource person who is knowledgeable,
trained and well supported by local mothers.
4.4.3 Strategies:
• Training of FCHVs basic and refresher.
• Review meeting for FCHVs trimester.
• Orientation of VDCs members for selection of FCHVs.
32
4.4.4 Analysis of Achievement:
4.5.1 Background:
Primary Health Care (PHC) Out reach Services are extension of primary health care from PHC/HP/SHP to
the community level. Services are provided to clients / patients at per determined time and place once in a
month in three to five places of each VDCs. It aims to provide services to people residing in remote areas
with community involvement.
4.5.2 Objectives:
• To improve access and coverage of primary health care through a network of 3 to 5 out reach
clinics per VDC per month.
4.5.3 Strategies:
• Operation of outreach clinics by place and schedule involving community with basic minimum
servile package.
• Utilize the services of VHWs and MCHWs.
• Increase community involvement.
33
4.5.4 Analysis of Achievement:
4.6.1 Background
CDP programme in Morang district has been started since 2057/58 with the help of UNICF. Now
UNICEF has no programme for monitoring of this programme in the district. BNMT has its programme
on Drug Scheme Programme but only limited VDCs are taken so far till now. But by the end of FY
2061/62 district has got data of all 66 health institutions with 10 million rupees in their respective funds in
Morang district.
5.6.2 Objective
To make essential drugs available round the year with the participatory cost sharing approach.
To ensure poor and disadvantaged patient with free drugs when needed.
5.6.3 Strategies
Drug management committee will ensure all indent and procurement as per needed.
Committee will be responsible for overall management including auditing budget.
8000000 7653533
7500000
7000000 6535728
Rs
6500000
6000000
5500000
h
r
ha
us
As
Po
2
2
/6
/6
61
61
20
20
Point of Time
34
Table 42. Status of Fund of Community Drug Programme
4.7.1 Background:
Information Education Communication is one of the important components for the supporting health
program. Since 1994, IEC activities have been decentralized and districts are involved in preparing in
work-plan and developing IEC materials locally as per guideline of NHEICC.
4.7.2 Objectives:
• To raise health awareness of the people as to promote improved health status.
• To prevent disease through the effort of people themselves and through utilization available
resources.
4.7.3 Strategies:
• Promotion of IEC activities in all governmental and non-governmental agencies.
• Dissemination of information, education and communication on health issues through health and
health related workers.
• Use of individual group and mass media in health education, information and communication.
35
4.7.4 Analysis of Achievement of Major Activities:
4.8 National Health Information Education & Communication Programme Target Activities.
36
4.8.2 Health Related Special Days Observed
Table 45 Special days observed in the collaboration with partners round the year
Special days Date
1. World Population day (DPHO Morang stood first position in this occasion on district July 11
wide stall competition organized by UNFPA and Purbanchal University at Biratnagar)
2. World Breast Feeding Week August 1-7
3. Malaria Control Day August 20
4. National FCHV day October 1
5. World Leprosy day January 25
6. Iodine Deficiency Disaoder Month February
7. World TB day March 24
8. World Health Day April 7
9. World No Tobacco day May 31
37
4.12 Piloting Programmes in Collaboration with EDPs
1 Neonatal Health Programme (JSI R&T)
2 Health Insurance Programme (Ministry of Health)
3 Partners Defined Quality, PDQ (Save the Children)
4 FM Radio Programme Production and Broadcasting (Koshi and Saptakoshi FM)
SECTION 3
3 Supporting Partners
3.1 Governmental: Koshi Zonal Hospital, Rangeli Hospital, Biratnagar Sub metropolitan city, district
level line offices from Education, Agriculture, Veterinary, and Women development.
References
1
NPC, Jilla Bastugat Bibaran Morang, National Planning Commission, Statistical Section Morang, 2062
2
Report on Human Development Index, 2004
3
MoH, DoHS, National Immunization Programme of Nepal, Multi-Year Plan of Action, 2002-2007
4
MoH, DoHS, Annual Report of Ministry of Health, Department of Health Services, 2060/61 (2003/2004)
5
Between Census Household Information Monitoring and Evaluation Survey conducted by National Planning Commission,
Bureau of Statistics and UNICEF in March-May 2000.
6
MoH, DoHS/USAID, Nepal Demographic and health Survey, 2001
7
MoH, UNICEF, WHO, New Era, Nepal Micro Nutrient Status Survey, 1998
8
ERHD, Annual Report of Eastern Regional Health Directorate Dhankuta, 2060/61(2003/2004)
9
Houston R, A Short History of Nepal's Community Based Pneumonia Programme, JSI/Nepal, 2001
10
The Lancet, Newborn health: a key to child survival, 2005
11
MoH, DoHS, National neonatal Health Strategy, 2060
38