Emergence of preventive and vertical health programmes in nepal

2. Emergence and Expansion
 The Department of Health Services was established in 1953,
under Ministry of Health, which carry out the responsibility
of promotion, regulation and management of hospitals,
government traditional Ayurvedic Dispensaries/School and a
unit for production of Ayurvedic medicines.

3.  At the beginning in the mid 50s, Nepal started five year
development plans.
 During that period, the health plans focus on
institutionalization of curative health services.

4.  The preventive health care was begin with establishment of
Vector Borne Disease Control Unit in Dang in 1951 to
control Malaria where as the promotive health care was
institutionalized by establishing the Health Education
Section in 1961 under Department of Health Services.

5.  The period of late fifties and sixties was most promising in
prevention and control of infectious diseases like malaria,
tuberculosis, leprosy and smallpox, which were recognized as
serious public health problems.

6. In this regard, the projects established in the country were as
following -
 Malaria Eradication Project in 1958
 Leprosy Control Project in 1964
 Tuberculosis Control Project in 1965
 Smallpox Eradication Project in 1967
 Family Planning and Maternal Child Health Project in 1968
 Following the official eradication of smallpox, this project was
converted into the Expanded Programme of Immunization (EPI)
in 1977.

7.  These programs were existed as vertical projects in which
foreign assistance was the major source of funding to provide
various health services.
 During the period considerable attention was given in human
resource development and control of epidemic situation.

8. Malaria Control
 The history of malaria, or awal as was known in the country has
been recounted already.
 The locals here, as elsewhere in the world, believed it to emanate
from swamps, marshes and similar environment.
 In fact people, having lived in such areas, believed that the
condition was caused by bad air or mala aria.
 Thus originated the name for the symptoms which later turned out
to be caused, not by bad air, but by a parasite aided by its vector,
the mosquito.

9.  Since 1955 Nepal attempted for four years to try to eradicate
malaria.
 After a period of 12 years it was noted that there was a
marked reduction in the number of malaria cases.
 After a further five years the picture had changed, perhaps
because the mosquitoes had developed resistance to DDT.
 Seeing that eradication now seemed an impossible task, WHO
in 1976 advised to change to a Malaria Control Programme
instead.

10.  Because of its geographical situation 67 out of the 75 districts
are considered malarious.
 As of 1982, fifty districts were served with regular anti
malarious services whilst the 21 hill districts with irregular
transmission provided drug supply through health posts.
 Maximum resurgence of malaria was seen in the central region
where there were as many as 15,594 cases in 1991.

11. Integration:
 By the late sixties both USAID and WHO had come around to
the thinking that the Nepalese health services needed to be
integrated. This led naturally on to the proposal of trying the
process in two districts viz. Kaski and Bara, which were dissimilar
in terms of location, living styles etc.
 The administrative aspects were first handled by Community
Health and Integration Division (CHID).

12. Integration:
 A Central Integration Board (CIB) was also formed. As time
went on, 4 more districts were added.
 In 1980 however, both the CHID and CIB were disbanded and
a new Integrated Community Health Services Development
Project (ICHSDP) was formed as per the Development Boards
Act of 1956.

13.  The various slogans of WHO starting from Basic Minimum
Health Needs culminated ultimately in the Health For All 2000
(HFA 2000) strategy of 1978.
 This in course of time, following acceptance by the world at the
Alma Ata Conference of 1978, became the “Health Call of the
World”.
 By 1987 the MoH decided to integrate all the vertically run
programmes. The Department of Health Services was done away
with and the Ministry took over the overall functioning.
 The District Public Health Offices were established. By this time
the ICHSDP had a total of 23 integrated districts under it.

14.  All these now came under the newly established Public Health
Division, which also became the central focal point for the
DPHOs.
 In June 1996, during the time that the three party coalition
government of NC, RPP and NSP was in power, the Malaria
Research and Training Centre at Hetauda was converted into the
Vector Borne Disease Centre with the aid of USAID.
 This centre has been designated the focal point for the fight
against vector borne diseases such as malaria, kala-azar and
Japanese encephalitis.

16. Strengths
 Services are provided in integrated way under single umbrella
 No need of separate infrastructure for each and every programme
 Maximum utilization of resources
 No need of separate health workforce for each and every programme
 Time saving while providing services in integrated way
 Easy to carry out supervision as integrated supervision
 Easy management of services
 Low management and administrative cost
 Increased effectiveness and efficacy
 No duplication of work/services
 Team building
 Integrated Information collection
 No confusion among beneficiaries as they get all services at one places
 Strengthened organizational capacity

17. Weaknesses
 Complexity in service delivery
 Difficulty in time managing for each and every services
 May be low quality services due to emphasis in all services
 Difficulty in resource allocation in particular programme and service
 High workload to health workers
 Complexity in administration and management
 Difficulty in appropriate management of resources
 Poor supervision to particular service due to its focus on all services
 Human resource constraints as they may not have skill and knowledge to
manage all services
 Conflicts b/n projects/programs
 Problem in maintaining information as huge information is collected in
integrated way

18. Opportunities
 Favorable government policy: National health policy 1991
 Involvement of bilateral and multiple partners for integration
process
 Favorable international Environment: Evolution of Primary
Health care concept in Alma Ata Conference in 1978 and Health
for all by the year 2000
 Availability for international funds for integrated services
 Developed mechanism for health information management

19. Threats
 Lack of political commitment
 Political instability, rapid change in government
 Ambitious health workforce wants to work in urban area only
 Geographical difficulties
 Internal resource constraints
 Weak infrastructures for providing integrated services
 Poor road/without road and transportation facility

20. Thank You!