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Stunting and Wasting, a major threat for child survival and development of South Asian Nations

by Public Health Update May 16, 2018
written by Public Health Update

Stunting and Wasting, a major threat for child survival and development of South Asian Nations

UNICEF/ Press release (Kathmandu, 16 May 2017) – A regional conference organized jointly by the South Asian Association for Regional Cooperation (SAARC) and the United Nations Children’s Fund (UNICEF) will identify actions to accelerate progress in the care of severely wasted children, which affects 8 million children in South Asia. It brings together, for the first time, government representatives, UN partners and civil society organizations from across South Asia, together with regional and global experts on nutrition to exchange regional analyses, expertise and experience on addressing wasting in the context of overall nutrition programming.
South Asia remains the epicentre of the global child wasting and stunting crisis. Severe wasting compromises the ability of children to grow and develop to their full potential, contributing to stunted growth and cognitive deficits as well as increased mortality risk. The costs of inaction to families and nations are considerable – stunted children earn 20 percent less as adults compared to non-stunted children, constraining economic growth across the region. 
“The first priority is ensuring the healthy growth and development of children. This requires interventions to improve women’s nutrition before and during pregnancy, actions to support breastfeeding from the very first hour of life, interventions to improve the quality of food for young children, and programmes to protect children from infections. And when these prevention efforts fail and children become severely wasted, it is critical they receive appropriate care and treatment to safeguard their lives, growth and development,” said Jean Gough, Regional Director for UNICEF in South Asia.
Across South Asia, less than five percent of the 8 million severely wasted children are receiving appropriate care and treatment. This low coverage is adding to the burden of mortality and morbidity in young children and limiting the growth and development of the untreated millions. Early detection and treatment of wasting is one powerful action to reduce stunting and its negative impacts. 
“Investing in the capacity of communities, community-based organizations and civil society groups to identify and address undernutrition within their communities is the core of our endeavours for a collective approach to nutrition in South Asia. This investment is the key to unlocking the potential of this generation and the next,” said Amjad Hussain Sial, Secretary General of the South Asian Association for Regional Cooperation (SAARC). 
Community-based approaches are indeed critical to preventing and treating severe wasting.  Over 50 countries have adopted community-based management of severe wasting, including Afghanistan, Nepal and Pakistan. This community-based care approaches are already saving thousands of lives and safeguarding the growth and development of many more Children by bringing more affordable services closer to families. 

UNICEF

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ReportsResearch & Publication

Barriers to Family Planning Use in Eastern Nepal: Results from a Mixed Methods Study

by Public Health Update May 15, 2018
written by Public Health Update

Barriers to Family Planning Use in Eastern Nepal: Results from a Mixed Methods Study

DHS Qualitative Research Studies 21

May 2018 This publication was produced for review by the United States Agency for International Development (USAID). It was prepared by Sarah Staveteig, Neera Shrestha, Sunita Gurung, and Kathryn T. Kampa.

ABSTRACT

Faced with stagnant contraceptive prevalence, the Government of Nepal has recently ramped up efforts to reduce barriers to family planning, to increase methods and services available, and to satisfy the demand for modern contraception. This study, which took place in Eastern Nepal, was a follow-up to the 2016 Nepal Demographic and Health Survey (NDHS). The follow-up study reinterviewed a sample of married female NDHS respondents age 15-39 in 17 clusters of Province 1, typically within a week following their NDHS interview (90% response rate, n=194). It included a range of in-depth questions about family planning use, fertility preferences, and perceived barriers to family planning. In line with an earlier study in Ghana, the study found an underreporting of traditional method use in the NDHS. Husbands had an important role in family planning, with about half of all users reporting that their husband had specifically suggested the current method. This was disproportionately the case for women who reported using condoms, withdrawal, and periodic abstinence.
Nepal is a major labor exporting country. Unsurprisingly, their husband’s absence was the main reason women cited for not using contraception. Respondents tended to be poorly prepared for using contraception when their husbands returned home, often intending to start a hormonal method only after he arrived. Most respondents were in regular contact with nonresident husbands, but many reported not feeling comfortable broaching the issue of contraceptive preparedness before their husband’s return. Nearly all study respondents knew about family planning methods and where to obtain contraceptives. Women’s main concern was finding a suitable method, typically described as one that did not cause undesirable side effects. Fear of health hazards and side effects of commodity-based contraception was a theme in about a third of the interviews. Among women who used traditional methods or did not use any method, the major source for their concerns about health hazards and side effects of modern methods appeared to be the views of their husbands. Access to contraceptives was rarely reported as a reason for nonuse, but discussions revealed a number of access-related barriers to commodity-based methods, including geographic inaccessibility, limited or inconsistent provider operating hours, and a small number of method types locally available. Female community health volunteers helped bridge this gap in some rural communities, but could only dispense condoms and re-supply pills.
A more subtle barrier to access was that condoms, pills, and injectables were sometimes perceived as the entire universe of available commodity-based contraceptives, indicating a lack of method diversity in several communities. However, despite these challenges, women and couples who were motivated to use commodity-based methods of contraception were nearly always successful in their efforts, for example, by paying for contraceptives at local pharmacies rather than traveling long distances to obtain them for free at government health posts, or opting for their second-choice method. Unfortunately, upon receiving their method from pharmacies, they were not usually counseled about possible side effects or the time needed for the method to provide protective effects. Overall, the findings suggest that improved family planning messaging, broader availability of long-term methods, expanded and reliable operating hours, consistent supplies, and more counseling would improve contraceptive uptake and continuation in Eastern Nepal. The study also provides lessons learned for future follow-up studies as well as implications for large-scale survey measurement of family planning worldwide.
Staveteig, Sarah, Neera Shrestha, Sunita Gurung, and Kathryn T. Kampa. 2018. Barriers to Family Planning Use in Eastern Nepal: Results from a Mixed Methods Study. DHS Qualitative Research Studies No. 21. Rockville, Maryland, USA: ICF.

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Global Health NewsPublic Health News

WHO plan to eliminate industrially-produced trans-fatty acids from global food supply

by Public Health Update May 14, 2018
written by Public Health Update

WHO today released REPLACE, a step-by-step guide for the elimination of industrially-produced trans-fatty acids from the global food supply.

Eliminating trans fats is key to protecting health and saving lives: WHO estimates that every year, trans fat intake leads to  more than 500,000 deaths of people from cardiovascular disease.
Industrially-produced trans fats are contained in hardened vegetable fats, such as margarine and ghee, and are often present in snack food, baked foods, and fried foods. Manufacturers  often use them as they have a longer shelf life than other fats. But healthier alternatives can be used that would not affect taste or cost of food.
“WHO calls on governments to use the REPLACE action package to eliminate industrially-produced trans-fatty acids from the food supply,”said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Implementing the six strategic actions in the REPLACE package will help  achieve the elimination of trans fat, and represent a major victory in  the  global  fight against cardiovascular disease.”
REPLACE provides six strategic actions to ensure the prompt, complete, and sustained elimination of industrially-produced trans fats from the food supply:

  • REview dietary sources of industrially-produced trans fats and the landscape for required policy change.
  • Promote the replacement of industrially-produced trans fats with healthier fats and oils.
  • Legislate or enact regulatory actions to eliminate industrially-produced trans fats.
  • Assess and monitor trans fats content in the food supply and changes in trans fat consumption in the population.
  • Create awareness of the negative health impact of trans fats among policy makers, producers, suppliers, and the public.
  • Enforce compliance of policies and regulations.

Several high-income countries have virtually eliminated industrially-produced trans fats through legally imposed limits on the amount that can be contained in packaged food. Some governments have implemented nationwide bans on partially hydrogenated oils, the main source of industrially-produced trans fats.
In Denmark, the first country to mandate restrictions on industrially-produced trans fats, the trans fat content of food products declined dramatically and cardiovascular disease deaths declined more quickly than in comparable OECD countries.
“New York City eliminated industrially-produced trans fat a decade ago, following Denmark’s lead,” said Dr. Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies. “Trans fat is an unnecessary toxic chemical that kills, and there’s no reason people around the world should continue to be exposed.”
Action is needed in low- and middle-income countries, where controls of use of industrially-produced trans fats are often weaker, to ensure that the benefits are felt equally around the world. 
WHO Global Ambassador for Noncommunicable Diseases, Michael R. Bloomberg, a three-term mayor of New York city and the founder of Bloomberg Philanthropies, said: “Banning trans fats in New York City helped reduce the number of heart attacks without changing the taste or cost of food, and eliminating their use around the world can save millions of lives. A comprehensive approach to tobacco control allowed us to make more progress globally over the last decade than almost anyone thought possible – now, a similar approach to trans fat can help us make that kind of progress against cardiovascular disease, another of the world’s leading causes of preventable death.”
Elimination of industrially-produced trans fats from the global food supply has been identified as one of the priority targets of WHO’s strategic plan, the draft 13th General Programme of Work (GPW13) which will guide the work of WHO in 2019 – 2023. GPW13 is on the agenda of  the 71st World Health Assembly that will be held in Geneva on 21 – 26 May 2018. As part of the U.N.’s Sustainable Development Goals, the global community has committed to reducing premature death from noncommunicable diseases by one-third by 2030. Global elimination of industrially-produced trans fats can help achieve this goal.
“Why should our children have such an unsafe ingredient in their foods?” asks Dr Tedros. “The world is now embarking on the UN Decade of Action on Nutrition, using it as a driver for improved access to healthy food and nutrition. WHO is also using this milestone to work with governments, the food industry, academia and civil society to make food systems healthier for future generations, including by eliminating industrially-produced trans fats.”

There are two main sources for trans fats: natural sources (in the dairy products and meat of ruminants such as cows and sheep) and industrially-produced sources (partially hydrogenated oils).
Partially hydrogenated oils were first introduced into the food supply in the early 20th century as a replacement for butter, and became more popular in the 1950s through 1970s with the discovery of the negative health impacts of saturated fatty acids. Partially hydrogenated oils are primarily used for deep frying and as an ingredient in baked goods; they can be replaced in both.
WHO recommends that the total trans fat intake be limited to less than 1% of total energy intake, which translates to less than 2.2 g/day with a 2,000-calorie diet. Trans fats increases levels of LDL-cholesterol, a well-accepted biomarker for cardiovascular disease risk, and decreases levels of HDL-cholesterol, which carry away cholesterol from arteries and transport it to the liver, that secretes it into the bile. Diets high in trans fat increase heart disease risk by 21% and deaths by 28%. Replacing trans fats with unsaturated fatty acids decreases the risk of heart disease, in part, by ameliorating the negative effects of trans fats on blood lipids. In addition, there are indications that trans fat may increase inflammation and endothelial dysfunction.

News Release (14 May 2018) WHO

READ MORE: http://www.who.int/nutrition/topics/replace-transfat/

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National Plan, Policy & GuidelinesNotice

NHRC approval processing fee (Effective from March 7, 2018)

by Public Health Update May 13, 2018
written by Public Health Update

NHRC approval processing fee (Effective from March 7, 2018)

The NHRC was established to promote responsible conduct of health research and as such is authorized to regulate all health-related research conducted in Nepal. Through the ethics review process, research that is not scientifically and ethically sound will not be approved. The NHRC has developed the National Ethical Guidelines for Health Research in Nepal and formed Ethical Review Board (ERB) to regulate research conduct in Nepal. Similarly, Institutional Review Committees (IRCs) have been formed in different institutions and are responsible for ethical review process.

Elements of the Ethics Review Process

Technical Review by the Reviewers: Submitted proposals are screened for completeness and reviewed by the internal reviewer. The proposal is then assigned to external subject experts to review the the scientific and technical content.
Communication of review to the researcher: Reviewers’ feedback is given to the researcher(s) who must then respond to the comments.
Ethical Review: Technically and scientifically sound proposals that have addressed reviewers’ comments are then submitted to the Member-Secretary of the Ethical Review Board (ERB) for a thorough discussion in an ERB meeting for ethical approval.
Decision Making: Normally the ERB will make approval decisions by consensus, but the majority will rule if the timely agreement is not reached. The ERB may offer conditional approval with specific suggestions to the researcher or may disapprove the proposal with clear and compelling reasons.
Communicating a Decision: The Member Secretary, on behalf of the ERB, will deliver the decision to the researchers in written form within two weeks of ERB meeting.
Follow-Up: ERB monitors the progress of all approved studies. ERB has the right to monitor approved studies from the time the approval until the completion or termination of the research.

Flowchart of Ethical Review Process

flowchart

Submission Process

  • ONLINE SYSTEM

Processing Fee:

  • For Nepalese students studying inside Nepal (Thesis)- Self funded is NRs. 1,000.00
  • For Nepalese students studying outside Nepal (Thesis)- Self funded is NRs. 10,000.00
  • For Nepalese researchers, if the total budget of the study is below NRs 2,00,000(<$2,000), the ethical approval fee is NRs 5,000($50).
  • For budget between NRs. 2,00,000($2,000) to NRs 10,00,000(<$10,000), the ethical approval fee is NRs. 10,000($100).
  • For international students (thesis), international researchers & international researchers involvement in any health researches with budget up to $10,000, ethical approval fee is USD 200.
  • For proposals with budget up to $5,00,000 for national & international researchers, ethical approval fee is 3% of total budget.
  • For proposals with budget up to $10,00,000 for national & international researchers, ethical approval fee for first $5,00,000 3% of total budget & for second ($5,00,000-$10,00,000) 1.5% of the total budget (additional)
  • For proposals with budget above $10,00,000 for national & international researchers, ethical approval fee for first $5,00,000 3% of total budget & for second ($5,00,000-$10,00,000) 1.5% of the total budget (additional), for third above (-$10,00,000) 1% of total budget (additional)

new 1

Duration:

It usually takes four to eight weeks to get ethical approval depending upon the nature of the proposal. Proposals with serious ethical concerns might take more than eight weeks. Extra time should be alloted in case the ERB needs additional information. 
For more information: visit NHRC website

Important Notice: Revised Ethical Approval Fee Structure with effective from 2074-01-26 (09 May 2017) – NHRC

Declaration of 4th National Summit of Health and Population Scientists in Nepal

 

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International Plan, Policy & GuidelinesNational Plan, Policy & GuidelinesResearch & Publication

Nepal–WHO Country Cooperation Strategy (CCS) 2018–2022

by Public Health Update May 13, 2018
written by Public Health Update

2 May 2018
The Nepal–WHO Country Cooperation Strategy (2018–2022) was launched on 2 May 2018 jointly by Hon’ble State Minister for Health and Population Ms Padma Aryal, Secretary Ministry of Health and Population Dr Pushpa Chaudhary, WHO Assistant Director-General Dr Ren Minghui and WHO Representative to Nepal Dr Jos Vandelaer in the presence of all key stakeholders.
The Country Cooperation Strategy (CCS) provides a medium-term strategic vision for World Health Organization’s cooperation with a particular Member State in support of that country’s national health polices, strategies and plans. This Country Cooperation Strategy guides World Health Organization’s work in Nepal 2018–2022. This strategy is informed by the aspirations of the National Health Policy (2014), Nepal Health Sector Strategy (2015–2020), international commitments made by the Government of Nepal, Sustainable Development Goals (SDGs), WHO’s Regional Flagship Priorities and the Thirteenth General Programme of Work. 
This strategy is the third of its kind and builds on the lessons learnt from past performance. The strategy serves as a roadmap to drive the collaborative work between WHO and the Government of Nepal, and also involve other health sector stakeholders.

Four Strategic Priorities have been identified in the CCS:

  1. Advancing universal health coverage in a federalized governance structure,
  2. Effective delivery of priority public health programmes,
  3. Enhance health security and disaster preparedness and response,
  4. Multisectoral engagement and partnerships for improved health outcomes.

DOWNLOAD (The Nepal–WHO Country Cooperation Strategy (2018–2022))

WHO

DOWNLOAD (The Nepal–WHO Country Cooperation Strategy (2018–2022)

WHO COUNTRY WEBSITE 

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Social Health Security (Health Insurance) Program in Nepal
Public HealthHealth InsuranceHealth SystemsNational Plan, Policy & GuidelinesPublic Health NotesPublic Health ProgramsResearch & Publication

Social Health Security (Health Insurance) Program in Nepal

by Public Health Update May 13, 2018
written by Public Health Update

The Social Health Security Program (SHSP) is a social protection program of the Government of Nepal that aims to enable its citizens to access quality health care services without placing a financial burden on them. The households, communities and government are directly involved in this program. SHSP helps prevent people from falling into poverty due to health care costs i.e. catastrophic expenditure due to accidents or disease by combining prepayment and risk pooling with mutual support. This program also advocates towards quality health services. This program attempts to address barriers in health service utilization and ensure equity and access of poor and disadvantaged groups as a means to achieve Universal Health Coverage.

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Historical Background

An early initiative to health insurance in Nepal began from 1976 through United Mission to Nepal (UMN) as Lalitpur Medical Insurance Scheme in Ashrang, which was later expanded to other facilities. The government funded community-based health insurance program was initiated in 2003 in two districts and expanded to additional four districts in 2005/06. National Health Insurance Policy was passed by Government of Nepal in 2014. In 9th Feb 2015, the ordinance for formation of Social Health Security Development Committee was passed by Government of Nepal and published in the Nepal Gazette. In FY 2071/72, the Government of Nepal had announced to roll out SHSP to three districts (Kailai, Baglung and Illam) but the enrollment process at Kailali was started only from 25 Chaitra 2072 (07 April 2016) and at Baglung and Ilam from 15 Asar 2073(29 June 2016). SHS program hopes to provide an important contribution for helping Nepal shift from the list of Least Developed Countries to Middle Income Developing Countries by the end of 2022. The Social Health Security Development Committee aims to expand this program to all districts by 2020.


Need for Social Health Security (Health Insurance) Program

Social Health Security (Health Insurance) Program is needed to improve the health situation of the people of Nepal. Specifically, this program is needed to;

  • increase accessibility to, and equity in, the provision of health care services by removing financial barriers to the use of health care services, focusing on the poor and marginalized;
  • promote pre-payment and risk pooling mechanisms to mobilize financial resources for health in an equitable manner;
  • encourage output-oriented expenditure in the health sector and improve the effectiveness, efficiency, accountability and quality of care in the delivery of health care services;
  • strengthen health systems in an integrated manner; and
  • improve the health seeking behaviour of the public through clear entitlement procedures, awareness raising and behaviour change communication.

Long-Term Goal

  • The long term goal is to improve the overall health status of Nepalese Citizens.

Objectives

Main Objective

  • To ensure Universal Health Coverage by increasing access to, and utilization of necessary quality health services.

Specific objectives

  • To increase the financial protection of the public by promoting pre-payment and risk pooling in the health sector;
  • To mobilize financial resources in an equitable manner; and
  • To improve the effectiveness, efficiency, accountability and quality of care in the delivery of health care services.

Strategies

  • Increasing participation of communities towards health insurance program by providing special protection to the poor and marginalized and
  • Extending coordination and cooperation with government and nongovernment service provider health institutions for gradual expansion of health insurance program throughout the country.

Key Features 

Following are the key features of Social Health Security Program as provisioned in the Social Health Security Program Standard Operation Procedure (SOP)/Rule 2014

  • It is a voluntary program based on family contributions.
  • It provides subsidized rates for families whose members have a poverty identity card.
  • Enrollment continues throughout the year in implemented districts.
  • Insurees have to renew their membership through annual contributions.
  • Insurees have to choose their first service point but can also access services from government PHCCs and hospitals and listed private hospitals.
  • Insurees can access specialized services elsewhere that are not available at the first service point on production of a referral slip from their first contact point.
  • It is cash-less system for members seeking health services. Upon presenting their SHSP membership ID card at a health facility, members are able to receive the health services and drugs covered by the benefit package without having to pay at any stage.
  • For emergencies, insurees can access services from any service point without a referral slip.
  • The program is IT-based with enrollment assistants using smartphones.
  • Purchaser-Provider Split: SHSDC acts as the service purchaser while government and listed private hospitals provide the services.

Contribution Amount

  • NPR 3,500 (35 USD) per year for a family up to 5 members.
  • NPR 700 (7 USD) for every additional family member.
  • 2% payroll contribution for formal sector.
  • 100% subsidy for families of  ultra poor, HIV, MDR-TB, Leprosy, severe disability patients etc.
  • 100% subsidy for elderly population above 70 years

Benefit Package

  • Promotive, Preventive and Curative services §Outpatient, inpatient and emergency care.
  • Public and private health facilities §Benefit ceiling NPR 100,000 (1000 USD) per year per family of up to 5 members.
  • With an extra NPR 20,000 (200 USD) for each additional member [up to a total of NPR 200,000 (2000 USD)].
  • Additional NPR 100,000 (1000 USD) for each elderly population.
  • Additional NPR 100,000 (1000 USD) for patient with eight chronic diseases  

Policy Provision 
Constitution of Nepal 2014
In ‘Part Three: Fundamental Rights and Duties’

– Article 35 has provision for right to free basic health services under which following provisions have been made

  • Every citizen shall have the right to free basic health services from the State, and no one shall be deprived of emergency health services
  • Every person shall have the right to get information about his or her medical treatment.
  • Every citizen shall have equal access to health services.

– Article 43 has provision of Right to Social Security under which following provisions are made

  • The indigent citizens, incapacitated and helpless citizens, helpless single women, citizens with disabilities, children, citizens who cannot take care themselves and citizens belonging to the tribes on the verge of extinction shall have the right to social security, in accordance with law.

In ‘Part 4: Directive Principles, Policies, and Responsibilities of the State’

  • The point no. 15 included in the ‘policies relating to basic needs of the citizens [part 4-51(h)] under policies of the state ensures access to medical treatment while ensuring citizen’s health insurance.
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Health Insurance Act 2017

  • A Health Insurance bill was approved by the parliament on 10 October 2017 (24 Ashwin 2074 B.S).
  • This act makes provisions for enrollment of government employees and families of foreign employment into health insurance program.
  • According to the act, the responsibility for enrolling children, elderly and differently abled persons are entrusted to their respective parents or caretakers.
  • Families are considered as the unit for enrollment into health insurance program.

National Health Policy 2014

This policy states that

  • In order to ensure delivery of an accessible health service by making financial management sustainable, a nationwide insurance policy will be implemented by making law and implementation guidelines. Those who are unable and financially poor will be provided subsidies.
  • As a fundamental right of citizens, provision for obtaining quality health care will be ensured.
  • In order to ensure the health services provisioned by the state is accessible to poor, marginalized and vulnerable communities; based on equality and social justice, programs will be designed and implemented accordingly.
  • Resources obtained from internal and external agencies will be mobilized for effective implementation of this policy and the programs formulated under this policy.

National Health Insurance Policy 2014

  • National Health Insurance Policy 2014 was implemented after endorsement by cabinet decision of 25th April 2014 of GoN. The main objective of this policy is to ensure universal health coverage by increasing access to, and utilization of, necessary quality health services.

Ordinance for formation of Social Health Security Development Committee 2015

  • Social Health Security Development Committee (SHSDC) is established to provide Health security coverage and ensure access, utilization of quality health services at an affordable cost for all citizens of Nepal. SHSDC is formed under Development Act, 2013 BS (1958 A.D.) and published in Nepal gazette in 09 February 2015.
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Social Health Security Program Operating Rule, 2015

  • As per the ordinance for formation of Social Health Security Program, to operationalize the Social Health Security Program, cabinet endorsed Standard Operating Procedure (SOP) on 18th Sept 2015.It provides basis for the operation of the Social Health Security Program.

Nepal Health Sector Strategy (NHSS 2015 – 2020)

Nepal Health Sector Strategy (2015-20) states that:

“In order to move towards UHC, NHSS lays out the necessary service delivery arrangements. It calls for basic health services, which is delivered free of charge to the citizens, and defines the Basic Health Package. Services that are beyond the scope of basic health package are delivered through different social health protection arrangements, including health insurance”.

Sustainable Development Goals

  • Sustainable Development Goal aims to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all by 2030.
  • It also aims to implement nationally appropriate social protection systems and measures for all, by 2030 achieve substantial coverage of the poor and the vulnerable.

Guidelines for Selection of Enrollment Assistants (Second Amendment), 2074 BS

  • Provisions in the Guidelines for selection of enrollment assistants of Social Health Security (Health Insurance) Program (Second Amendment, 2074).

SOURCE OF INFORMATION: 

  • Annual Report FY 2073/74 (2016/17) Social Health Security Program 


Recommended reading

  • Health Insurance Packages of Non-life Insurance Companies in Nepal
  • COVID-19 Insurance Scheme in Nepal (CORONA Insurance)
  • Social Health Security (Health Insurance) Program in Nepal
  • Medical Treatment of Deprived Citizens (Bipanna Nagarik Kosh), MoHP


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May 13, 2018 0 comments
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PH Important DayPublic Health

Nurses: A voice to lead – Health is a Human Right #International Nurses Day

by Public Health Update May 12, 2018
written by Public Health Update

Nurses: A voice to lead – Health is a Human Right #International Nurses Day

May 12th 2018
Nurses have many roles: they provide and manage personal care and treatment, work with families and communities, and play a central part in public health and controlling disease and infection. Nurses are often the first and sometimes the only health professional that people see and the quality of their initial assessment, care and treatment is vital.
International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale’s birth. (WHO SEARO)
It all began in 1953, when Dorothy Sutherland, an official with the U.S. Department of Health, Education and Welfare, contacted President Dwight D. Eisenhower proposing he proclaim a “Nurses’ Day”. However, he did not approve her proposal at that time. The International Council of Nurses has celebrated on May 12th since 1965.
May 12th is an important date to all nurses, as it is the anniversary of the birth of Florence Nightingale, who is widely considered the founder of modern nursing. In January 1974, this day was finally officially made International Nurses Day. Each year since then, ICN prepares and distributes something called the International Nurses’ Day Kit which contains educational and public information materials, for use by nurses everywhere. (dayoftheyear.com)32215186 1245219382275366 7077677457481924608 n

The right to health and the ICN focus for the year Why is ICN focusing on health as a human right?

This broad focus enables nurses to understand the philosophical basis of all of our practice, whether that is in health promotion, illness or trauma prevention, or in acute and chronic treatment. It enables us to locate the health effects of the social determinants of health such as sanitation, adequate food, decent housing, good working conditions, education, equality and a clean environment.4 The role of nursing in addressing the inequalities, discriminatory practices and unjust power relations in the social determinants of health was the focus of International Nurses Day (IND) 2017 (‘Nurses: A Voice to Lead–Achieving the Sustainable Development Goals’).
It allows us also to understand the health care system from a person–centred and community– centred perspective. This year’s IND builds on the messages of the 2017 IND by now exploring issues of access to health care and the impact of access issues on health outcomes. Health systems are an essential element of a healthy and equitable society. When health is viewed as a human right, there is a demand on us to take action and a responsibility to enable access to a health system. This belief should be the cornerstone of an effective system, and the benefits of this will ultimately flow to communities and countries. The right to health is more than a catch phrase for health workers, civil society groups and non–government organisations in an effort to positively change the world. In the majority of cases, the right to health is a legal instrument that can be used to hold governments and the international community to account. It can and it should be used as a constructive tool for the health sector to provide the best care for individuals, communities and populations.6 UHC and how it translates in various countries is highly contextual. Fundamentally, no one should be denied access to their country’s appropriate standard of health care because of their financial status, where the health care provided leads them deeper into poverty. A human rights perspective on health means that wherever you live, you can receive health care to assist with your health needs. (International Council for Nurse)

May 12, 2018 0 comments
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National Plan, Policy & GuidelinesResearch & Publication

संघीय निजामती सेवा ऐनको खाका

by Public Health Update May 11, 2018
written by Public Health Update


May 11, 2018 0 comments
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Public Health

Fast-track efforts to eliminate rabies: WHO

by Public Health Update May 4, 2018
written by Public Health Update

Fast-track efforts to eliminate rabies: WHO

SEAR/PR/1688

Kathmandu, 3 May 2018: The World Health Organization today called upon Member States and partners to accelerate efforts to end rabies which causes 59 000 agonizing and painful deaths globally every year, one person every nine minute, mostly children and the poor.
Eight of the 11 Member countries of WHO South-East Asia Region account for nearly 26 000 rabies deaths, 45% of the global rabies toll, as over 1.5 million people in the Region remain at risk of rabies.
“Human rabies is caused mostly by dogs and can be eliminated by increasing awareness about the disease, vaccinating dogs and most importantly by making the already available life-saving rabies vaccines, medicines, tools and technologies affordable and available to all. We can, and must break the disease cycle and save lives,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, told the global meeting ‘Driving progress towards rabies elimination’ here.
At the meeting, the global rabies partners comprising of WHO, OIE, FAO and UNICEF and rabies endemic countries from Asia-Pacific and Africa, shared and deliberated on measures to fast-track elimination of dog transmitted rabies by 2030.
Countries from Africa and Asia, including Bangladesh, Bhutan, Cambodia, India, Kenya, Nepal, Sri Lanka and Vietnam, who have assessed access, delivery and distribution of rabies post-exposure prophylaxis, shared outcomes of their studies. These studies were conducted with WHO support to enable GAVI take an informed decision to support rabies vaccines. The rabies endemic countries are seeking GAVI support to improve affordability and access to rabies vaccines for vulnerable populations, of which many are children.
WHO has been advocating for a shift from intramuscular to intradermal rabies vaccination, which is not only 60 to 80% cheaper, but is of shorter treatment regimen of just one week. Most countries in WHO South-East Asia Region are now using intradermal route for anti-rabies vaccines.
At the meeting, Member countries shared initiatives being rolled out as part of the new ‘Zero by 30: The Strategic Plan’, to be launched by WHO and partners to end dog transmitted rabies. The plan centers on One Health approach and addresses the disease in a holistic and cross-sectoral manner. It aims at preventing and responding to dog-transmitted rabies by improving awareness and education, reducing human rabies risk through expanded dog vaccinations, and improving access to healthcare, medicines and vaccines for populations at risk. The plan calls for generating and measuring impact by implementing proven effective guidelines for rabies control, and encouraging the use of innovative surveillance technologies to monitor progress towards “Zero by 30”. It also aims at continued stakeholder engagement at all levels to sustain financing for achieving “Zero by 30”.
Investing in rabies control and elimination improves equity and access to healthcare and contributes to sustainable development.

About rabies

Rabies is a viral disease that occurs in more than 150 countries and territories – is usually fatal once symptoms appear. Dog-transmitted rabies accounts for about 99% of human rabies cases. It is estimated that 59,000 people die from rabies every year.
40% of people bitten by suspect rabid animals are children under 15 years of age.
The world’s poorest are the most affected as they cannot afford treatment or transport for care. People’s livelihoods are also affected when livestock get rabies, a loss estimated at over US$ 500 million per year globally.
However, rabies is 100% preventable by ensuring access vaccines and to life-saving treatment following dog bites; and by vaccinating dogs to reduce risks and ultimately to eliminate the disease.

WHO Media Centre

May 4, 2018 0 comments
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Global Health NewsPublic HealthPublic Health News

9 out of 10 people worldwide breathe polluted air, but more countries are taking action

by Public Health Update May 3, 2018
written by Public Health Update

9 out of 10 people worldwide breathe polluted air, but more countries are taking action

2 May 2018, News Release, Geneva
 Air pollution levels remain dangerously high in many parts of the world. New data from WHO shows that 9 out of 10 people breathe air containing high levels of pollutants. Updated estimations reveal an alarming death toll of 7 million people every year caused by ambient (outdoor) and household air pollution.
“Air pollution threatens us all, but the poorest and most marginalized people bear the brunt of the burden,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “It is unacceptable that over 3 billion people – most of them women and children – are still breathing deadly smoke every day from using polluting stoves and fuels in their homes. If we don’t take urgent action on air pollution, we will never come close to achieving sustainable development.”

7 million deaths every year

WHO estimates that around 7 million people die every year from exposure to fine particles in polluted air that penetrate deep into the lungs and cardiovascular system, causing diseases including stroke, heart disease, lung cancer, chronic obstructive pulmonary diseases and respiratory infections, including pneumonia.
Ambient air pollution alone caused some 4.2 million deaths in 2016, while household air pollution from cooking with polluting fuels and technologies caused an estimated 3.8 million deaths in the same period.
More than 90% of air pollution-related deaths occur in low- and middle-income countries, mainly in Asia and Africa, followed by low- and middle-income countries of the Eastern Mediterranean region, Europe and the Americas.
Around 3 billion people – more than 40% of the world’s population – still do not have access to clean cooking fuels and technologies in their homes, the main source of household air pollution. WHO has been monitoring household air pollution for more than a decade and, while the rate of access to clean fuels and technologies is increasing everywhere, improvements are not even keeping pace with population growth in many parts of the world, particularly in sub-Saharan Africa.

WHO recognizes that air pollution is a critical risk factor for noncommunicable diseases (NCDs), causing an estimated one-quarter (24%) of all adult deaths from heart disease, 25% from stroke, 43% from chronic obstructive pulmonary disease and 29% from lung cancer.

More countries taking action

More than 4300 cities in 108 countries are now included in WHO’s ambient air quality database, making this the world’s most comprehensive database on ambient air pollution. Since 2016, more than 1000 additional cities have been added to WHO’s database which shows that more countries are measuring and taking action to reduce air pollution than ever before. The database collects annual mean concentrations of fine particulate matter (PM10 and PM2.5). PM2.5 includes pollutants, such as sulfate, nitrates and black carbon, which pose the greatest risks to human health. WHO air quality recommendations call for countries to reduce their air pollution to annual mean values of 20 μg/m3 (for PM10) and 10 μg/m3 (for PM25).“Many of the world’s megacities exceed WHO’s guideline levels for air quality by more than 5 times, representing a major risk to people’s health,” says Dr Maria Neira, Director of the Department of Public Health, Social and Environmental Determinants of Health, at WHO. “We are seeing an acceleration of political interest in this global public health challenge. The increase in cities recording air pollution data reflects a commitment to air quality assessment and monitoring. Most of this increase has occurred in high-income countries, but we hope to see a similar scale-up of monitoring efforts worldwide.” 
While the latest data show ambient air pollution levels are still dangerously high in most parts of the world, they also show some positive progress. Countries are taking measures to tackle and reduce air pollution from particulate matter. For example, in just two years, India’s Pradhan Mantri Ujjwala Yojana Scheme has provided some 37 million women living below the poverty line with free LPG connections to support them to switch to clean household energy use. Mexico City has committed to cleaner vehicle standards, including a move to soot-free buses and a ban on private diesel cars by 2025.
Major sources of air pollution from particulate matter include the inefficient use of energy by households, industry, the agriculture and transport sectors, and coal-fired power plants. In some regions, sand and desert dust, waste burning and deforestation are additional sources of air pollution. Air quality can also be influenced by natural elements such as geographic, meteorological and seasonal factors.
Air pollution does not recognize borders. Improving air quality demands sustained and coordinated government action at all levels. Countries need to work together on solutions for sustainable transport, more efficient and renewable energy production and use and waste management. WHO works with many sectors including transport and energy, urban planning and rural development to support countries to tackle this problem.

World Health Organization

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Clean Air Week 19- 23 March 2018 #BreatheLife

Nepal’s air quality is worst in the world: EPI report

2018 Environmental Performance Index: Air quality top public health threat

World Asthma Day 2018: Never too early, never too late

May 3, 2018 0 comments
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