This is home assignment prepared by me, on SBA strengthening in one district of Nepal. Hope it will help you.

1. INTERNAL ASSESSMENT
2073
Project planning and development
BPH Fourth Year
Home Assignment
Submitted to:
Associate Prof. Dr. Archana Amatya
Department of Community Medicine and Public Health
Maharajgunj Medical Campus
Institute of Medicine
Tribhuvan University
Kathmandu, Nepal
Submitted by:
Dip Narayan Thakur
Roll no. 439
BPH 26th Batch (4th Year)

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Assignment
You are the DPHO of Myagdi district, where safe abortion services have been introduced in the district
hospital since 2065. However it has not been able to establish well due to various reasons like
misconceptions of the hospital, lack of staff at the abortion clinic, poor infrastructure, etc. to name a few
and the public seek services at local untrained personnel. This year 2073/74 the GoN hasgiven a budget
of NRs. 200,000 to upgrade the abortion centers. Develop a comprehensive log frame in this regard.
Safe abortion, a component of comprehensive reproductive health services, is the termination of a
pregnancy by trained health care providers using correct, sanitary technique and proper equipment – is a
simple, lifesaving health service.(1) In contrast, unsafe abortion is the procedure for terminating unwanted
pregnancy either by person lacking the necessary skills or in an environment lacking the minimal medical
standards or both.
Safe abortion service which includes family planning counselling and contraceptive supplies; antenatal,
delivery and post-partum care;accesstosafe abortion services;counselling and care afterall abortions, safe
unsafe, as well as miscarriages; prevention care and treatment for sexually transmitted infections; and
programs that prevent violence against women and provide care and support should be accessible to and
affordable for all women, married or not.
Unsafe abortion is major public health problem in many countries particularly in developing world. Each
year 44 million abortions take place worldwide, nearly half of them safely and the rest unsafely. According
to recent study, by WHO and Guttmacher Institute, reveals that one fourth of the pregnancies ends in
abortion worldwide, out of which 90% occurs in the developing world, where there is lack of access to safe
abortion care.(2)
It is estimated that safe abortion care can prevent nearly all deaths (70,000) and disabilities (5 million) from
unsafe abortion annually and saves an US$ 680 million in health system cost for treating serious
complications due to unsafe abortion. It is also saves US$ 6 billion to treat post abortion infertility from
unsafe abortion and US$ 930 million to society and individuals in lost income due to death or disability
resulting from unsafe abortion. Not only this, it allows women and families to address consequences of
contraceptive method failure.
Health system needs to support the delivery of safe abortion services, address the policy needs, broadening
the legal grounds for safe abortion services, ensure universal access to safe abortion services, and provide
knowledge about laws, services and importance of safe abortion care to all. Besides, evidence based
national standards and guidelines for safe abortion care,development of skilled health professionals and
equipped health facilities and ensure social safety net for poor women i.e. pro-poor health services.
In context of Nepal, current national health policy-2014 offers support for integration of family planning
and reproductive health, with one component of safe abortion services. It advocates for adolescent and
women friendly health services.(3) Similarly, National Health Sector Strategy 2015-2020 has also included
safe abortion services in the essential health care package.(4) Besides, National Policy on Safe Abortion-
2060 is main document guiding the safe abortion services in Nepal.
According to safe abortion law-2002 in Nepal, abortion is legal in the following context:
 Up to 12 weeks gestation for any indication, by request
 Up to 18 weeks gestation in the case of rape or incest
 At any time during pregnancy if mental/physical health or life of the pregnant woman is at risk
(approval from a medical practitioner required)

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 At any time during pregnancy if the fetus is deformed and incompatible with life (approval from a
medical practitioner required)
Additional considerations:
 Only providers certified in safe abortion care are eligible to provide induced abortion services;
 The pregnant woman alone has the right to choose to continue or discontinue pregnancy
 In the case of minors (< 16 years of age) or mental incompetence, a legal guardian must give consent
 Pregnancy termination on the basis of sex selection is prohibited
Myagdi district lies in western Nepal. Despite the start of safe abortion service at district hospital in 2065
BS, it has not been able to establish well due to various reasons like misconception of the hospital, lack of
staffs at abortion clinics, poor infrastructures, etc. On the other hand, people seek services at local level
from untrained personnel leading to unsafe abortion practices and related complications. While looking at
the service indicators, it doesn’t sounds impressive. So GoN has decided to upgrade abortion care centers
and allocated budget for the purpose.
Situation analysis
Situation analysis is the most important step to any planning. Based on review of various secondary source
data and interaction with stakeholders in the Reproductive Health Coordination Committee (RHCC)
meeting, we conclude to the following findings, which is shown in SWOT analysis format.
Strength Weakness
Abortion law
Policy on safe abortion
Safe abortion manual/protocol and guidelines
Safe abortion service already started
Poor post abortion counselling
High rate of unsafe abortion practices
Lack of staffs at abortion clinics
Lack of infrastructures
Confidentiality issues and lack of youth friendly
health practices
Poor reporting from health institution esp. private
ones
Opportunity Threat
Support from non-state actors in providing
services
Programs in which safe abortion services can be
integrated are priority program of MoH, like
family planning programs
Budget specially allocated for safe abortion
services
Cultural beliefs (abortion is considered sin in
some cultures)
Strategies
 Safe abortion center upgrading
 Capacity building of safe abortion service providers through training
 Encourage non-state actors in health to provide awareness,counseling and safe abortion services
 Integrate safe abortion service with FP services
 IEC/ BCC intervention as well as active involvement of FCHV and mother’s group to increase
awareness about safe abortion services

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Logical framework
Narrative summary Objectively verifiable
indicator
Means ofverification Risk assumption
Goal
To improve the health status of mother and
children and improve the overall quality of life of
the whole family by increasing access and
utilization of quality safe abortion services in the
Myagdi district.
Reduction in MMR
Reduction in NMR
Annual Report
HMIS
Purpose
Upgrade safe abortion center to increase access
and utilization of high quality safe abortion
services
Increased number of clients
Number of methods of safe
abortion services available
Number of safe abortion
service delivery point
Hospitalization rate for
unsafe abortion per 1000
abortion
Record review of the
center
HMIS
Study
Output
1 Increased delivery points of safe abortion
services with well build infrastructures
Number of service delivery
point with well
infrastructure
Observation
2 Maintained constant and increased range
services, including CAC and PAC,and choice
of abortion methods
Number of clients referred
Number of choice of safe
abortion services available
Number of MA drugs
available
Record review of the
center
Observation of citizen
charter
Supply availability
3 Integrated abortion care with other service like
family planning
Number of clients receiving
post abortion family
planning services
Record review of the
abortion centers
4 Increased number of trained service providers
all quality of competencies
Percentage of health
providers trained to provide
safe abortion
Provider client interaction
time
TIMS
Record review of the
training
Low turnover of
trained staffs

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5 Increased IEC sessions Number of IEC session
conducted
Record review
6 Improved system readiness and supervision Number of supervision made Record review
7 Improved recording and reporting Timeliness of reporting and
data quality verification
HMIS
LQA
Record cross checking
8 Ensure service is youth and women friendly Clients satisfaction Index
(with service)
Exit interview
Activities
1 Maintenance and retrofitting of the abortion
center buildings
Building maintained and
retrofitted
Observation
2 Hire staffs for the center in contract Number of service providers
at the center
HuRDIS
Record review of the
center
(Funding should be
provided by Hospital
Management
Committee/ MoHP)
3 Meeting with hospital management committee
and non-state actors
Number of meetings held Record review
4 Training to the staffs to increase competencies
and improve client-provider relationships and
assure confidentiality based on updated
guidelines
Number of training
conducted
Availability of updated
guidelines
Record review
Training minute
Availability of
trainers
Information and counselling availing different
safe abortion methods
Number of session
conducted
Record review
5 Record keeping and reporting properly % of reporting done HMIS
6 Supportive supervision, monitoring and
evaluation
Number of supervision made HMIS
Record review
7 Improving referrallinkage Number of referralcases Record review
8 Rewarding best performing staff Number of staffs rewarded
and rewarding criteria
Record review Motivated staffs

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Budget plan
S.N. Budget headings Unit Quantity Rate Total amount Remarks
A Human Resource Development
Training Times 1 10000 10000 Managed by NHTC
Trainers Number 1 5000 5000 Managed by NHTC
Staffs hiring Number 2 - - External funding (HMC)
TA/DA Number 5 3000 15000 Managed by NHTC
B Reconstruction Wholesome - - 50000
C Logistics
MVA Set 30 1200 36000
Misoprostol Packet 20 500 10000
Mifepristone Packet 20 500 10000
Uterine sound Number 20 500 10000
Kidney dish Number 20 100 2000
Stationaries Wholesome - - 20000
IEC materials Number 1500 20 30000 Managed by NHEICC
D Meetings Times 4 3000 12000
E Awareness and Counselling Times 6 4500 27000
F Supervision, Monitoring and
Evaluation
Times 2 5000 10000
G Reward for best performer Number 1 3000 3000
H Miscellaneous - - - 10000
Total 200000 (Excluding managed by
external sources)
Supervision, Monitoring and Evaluation
Supervision will be done bi-annually to provide needed support to the staffs and check the quality of the services being provided. Continuous
monitoring will be done based on the above logical framework to ensure the well-functioning of the safe abortion centers.
Sustainability
The process is the part of national safe motherhood program and the responsibility will be taken by DHO, Myagdi for its continuous
development and quality assurance.

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References
1. coalition Iwsh. Access to Safe Abortion is a Human Right. 2008. Available from:
http://www.despenalizacion.org.ar/pdf/publicaciones/iwhc-2008.pdf.
2. Institute G. Abortion rates declined significantly in developed countries but remained unchanged
in developing countries 2016 [cited 2016 22 May 2016]. Available from:
https://www.guttmacher.org/infographic/2016/abortion-rates-declined-significantly-developed-countries-
remained-unchanged.
3. MoHP. National Health Policy 2014. In: Population MoHa,editor. Ramshahpath, Kathmandu,
Nepal: MoHP; 2014.
4. MoHP. National Health Sector Strategy. In: DoHS, editor. Kathmandu2015.