Page 24 – Public Health Update

DoHS Annual Health Report 2079/80

by Public Health Update February 27, 2024

Overview

This Annual Health Report (AHR) is for fiscal year (FY) 2079/80. It serves as a comprehensive document within the health sector, fulfilling the dual purpose of monitoring progress of annual programs and providing a detailed documentation of various facets including the health scenario, guiding documents/milestones, major activities of the fiscal year (FY), program/service status and strategic analysis of the strength, weakness, opportunity, and threat for the programs and service delivery.

The annually compiled comprehensive health sector report stands as a pivotal document, serving as a thorough monitoring and evaluation tool for the progress of planned programs, analysing shifts in coverage and utilization statistics. This indispensable record not only offers a snapshot of the sector’s advancements but also traces its evolution over time. This marks the 29th consecutive publication of its kind and the 7th Annual Report since the reorganization of MoHP.

Rationale

The report serves a dual purpose, functioning as both an annual program monitoring report and a comprehensive document covering various aspects, including:

Health Scenario: An overview of the prevailing health issues at the federal and provincial level.
The local level details are included in the respective provincial level annual reports, needful information at programmatic level for local levels have also been included as per need felt by the respective programs
Guiding documents and milestones: Salient features of the key guiding documents and milestones relevant to health programs.
Major activities in FY 2079/80: A comprehensive account of the significant activities carried out in health sector and related programs/services during the fiscal year
Status of program/service indicators: Monitoring of the status of the pertinent program/services providing insights into achievements and areas that require attention
SWOT Analysis: A strategic analysis covering the strength, weakness, opportunity, and threat (SWOT) pertaining to the programs and services.
The timely release of the annual report assumes crucial importance, as it establishes a vital link between service delivery and evidence-informed decision-making and planning for future programs. This dynamic and insightful report not only reflects the health sector’s current standing but also guides future initiatives towards more effective and impactful healthcare strategies and action.

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Nepal National Health Accounts 2018/19 and 2019/20

by Public Health Update February 22, 2024

written by Public Health Update

This is the eighth round of Nepal National Health Accounts based on the System of Health Accounts (SHA) 2011 Framework, covering FYs 2018/19 and 2019/20.

The Nepal National Health Accounts 2018/19 to 2019/20 report was prepared adhering to the System of Health Accounts 2011 (SHA 2011), a global standard framework for producing health accounts with necessary refinements relevant to the country context. The report provides estimates of healthcare expenditures within Nepal’s health system, utilizing predetermined expenditure boundaries, data sources, classification codes, and estimation methodology. All reasonable precautions have been taken to justify the information presented in this publication, and the estimates presented in this report could be further improved.

In this round of NHA, current health expenditure (CHE) in nominal prices was estimated at NPR 171.5 billion and NPR 202.5 billion and capital expenditure at NPR 12.3 billion and NPR 20.9 billion in FYs 2018/19 and 2019/20, respectively.
Total Health Expenditure (THE) was estimated at NPR 183.8 billion (USD 1.6 billion) and NPR 223.43 billion (USD 1.9 billion), equivalent to 5.3% and 5.8% of GDP, and per capita total health expenditure was estimated at NPR 6,188.4 (USD 54.7) and NPR 7418.8 (USD 63.6) in FYs 2018/19 and 2019/20, respectively.
General Government Health Expenditure (GGHE), including current and capital expenditure, amounted to NPR 57.7 billion (USD 0.5 billion) and NPR 85.6 billion (USD 0.7 billion), which were 5.6% and 8.0% of General Government Expenditure (GGE) in the FYs 2018/19 and 2019/20, respectively.
The share of GGHE in CHE increased from 26.5% in FY 2018/19 to 31.9% in FY 2019/20. At the federal level, the Ministry of Health and Population (MoHP) was the largest agency for managing government health expenditure, accounting for about 24.5% of GGHE, followed by provincial and local governments with about 0.6% and 9.1%, and other ministries and public bodies with 8.1% in FY 2018/19. Curative care accounted for the largest share of government health expenditure, followed by preventive care.
Total external funding for health was estimated at 11.9% and 10.5% of CHE in the FYs 2018/19 and 2019/20, which includes direct foreign transfers and foreign transfers distributed for health through the government.

Household OOP payments for health care were the largest source and payer for their health care, with a share of 57.9% and 54.2% of the current health expenditure in FYs 2018/19 and 2019/20, respectively.

As much as 65.6% of OOP payments for health care were for pharmaceuticals and medical supplies, followed by curative care at 26.3%.
OOP at hospitals was estimated at 20.8% of total OOP, where the majority (16.6% of total OOP) was made at private hospitals, and the OOP at public hospitals was 4.2% of total OOP.
An analysis of disease-related expenditure shows that non-communicable diseases accounted for more than half of total household OOP expenditure.
As much as 41.1% and 39.9% of CHE were spent on pharmaceuticals and medical supplies in FYs 2018/19 and 2019/20, respectively, while curative care took up about 29.8% and 33.4% of CHE, where around 18.9% and 22.1% of CHE and 10.2 and 10.6% of CHE were spent on outpatient and inpatient care, respectively.

Preventive and promotive care services claimed about 8.8% and 11.0% of CHE,FYs 2018/19 and 2019/20 respectively.

The distribution of health expenditure by province showed that Bagmati Province had the highest share of current and capital health expenditure, with provincial THE estimated at NPR 51.1 billion, followed by Koshi Province and Lumbini Province with provincial THE of NPR 30.5 billion and NPR 28.5 billion, respectively, in FY 2018/19, while in FY 2019/20 THE of Bagmati Province was 60.3 billion. Karnali Province had the lowest provincial THE, estimated at NPR 13.4 and 17.1 billion in FYs 2018/19 and 2019/20, respectively.

Screen Shot 2024 02 22 at 22.45.58 — **Major Health Expenditure Indicators**

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February 22, 2024 0 comments

National Plan, Policy & Guidelines Public Health Update Research & Publication Vaccine Preventable Diseases

Vaccine Preventable Diseases Surveillance Plan (Polio Transition Plan)

by Public Health Update February 16, 2024

written by Public Health Update

The Family Welfare Division, DoHS, MoHP, releases a new Vaccine Preventable Diseases Surveillance Plan (Polio Transition Plan) for 2079-2086 to sustain Nepal’s polio-free status and maintain continuity of polio-related activities after the Global Polio Eradication Initiative scales down its support.

Commitment, Sustainability, Universal Coverage, Collaboration, Interdependency between Polio Eradication and the Polio Transition Plan, ownership, and responsibility are the key principles of this plan.

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MR Vaccination Campaign Guideline 2080-81

February 16, 2024 0 comments

Reports Research & Publication Vaccine Preventable Diseases

Recommendations of Measles Outbreaks and Root Cause Analysis 2022-23

by Public Health Update February 16, 2024

written by Public Health Update

Overview

The measles outbreak investigation, outbreak response immunization (ORI), and root cause analysis (RCS) of the measles outbreak were conducted in 10 districts: Banke, Morang, Bajura, Kailali, Surkhet, Bardiya, Dang, Mahottari, Kanchanpur, and Sunsari. The Root Cause Analysis of the Measles Outbreak 2022-2023 identified many key programmatic areas to improve to accelerate the MR elimination goal of 2026. This is the first study Nepal has ever done to understand the real root cause analysis (RCA) of a measles outbreak. The administrative measles coverage data, measles rubella annual country report-2023, cohort of missed children in the last five years (2017-2022), findings of independent monitoring data, and RCA desk and field findings provided sufficient evidence to support the conclusion of failure to vaccinate as the prime cause of the measles outbreak in all ten measles outbreak districts.

Summary of RCA field observation and findings:

Provider-based reasons for failure to vaccinate

Three percentage (3%) Zero dose and 11% missed children were identified. (Max. Banke, Kanchanpur)
Microplanning: 54% HF only had updated & included high-risk areas (Mahottari 19%)
Knowledge gap: 79% HF know delayed schedule, 30% HF did not know maximum age limit of MR vaccination
Immunization monitoring chart used in 50% of HFs
Logistics: 23% HF faced shortage of vaccines & syringes; 38% shortage of registers/recording tools
Immunization sessions: Most of the outreach sessions run in open space or poor infrastructures, 48% HF had not run regular monthly sessions due to festival, election, HWs busy in other health programs, HR shortage
Defaulter tracking system: 29% HF fails to track

Client-based reasons for failure to vaccinate

Vaccine hesitancy was found among specific pocket areas in Banke, Mahottari and Bardiya districts.
Inadequate information on vaccination session sites, date and timing leading to missed RI doses
Seasonal migrations to different municipalities, districts, or countries.
Unaware of importance and need of vaccination and missed doses
Fear of work or wages loss among daily wage earners

Provider-based reasons for vaccine failure

Provider-based reasons for vaccine failure indicates issues with cold chain management at the local levels

Poorly maintained district cold room and vaccine sub-stores (vaccine are not stored in proper shelves in refrigerators)
Outreach sessions being conducted in open space and/ or in site with poor facilities
No back up plan or alternate energy source available for electricity cutoff in vaccine sub stores.
Conditioned icepacks were not changed regularly at HF level during routine immunization sessions.
Temperature monitoring not conducted regularly due to lack freeze tags, reporting forms and knowledge
Vaccines stored beyond discard point (VVM stage III) in the refrigerators.
Limited number of vaccine sub-stores available with skilled human resources at municipality or health facility.
Returned unopened vaccine vials status not being monitored regularly once received at DVS or VSS.

Recommendations

Measles Rubella Outbreak Investigation and response:

Train local RRT on measles rubella outbreak investigation and response.
Coordinate local stakeholders (school, private hospitals/clinics, medical bodies, local and religious leaders) on outbreak management and response.
Advocate and ensure utilization of local level contingency funds for measles rubella outbreak investigation and response at all local levels.
Conduct measles outbreak preparedness and response training in all districts so that local RRT can provide prompt measles outbreak response.
Ensure cross border coordination, sharing of measles outbreak information and enhance suspected measles surveillance at all points of entry.

Strengthening routine Immunization:

Update and implement micro-plan focusing on vulnerable areas with community involvement to reach zero dose and under-immunized children.
Revision of session sites including outreach session as per population density of area and current structure.
Develop local strategies to reach missed children (zero dose and under-vaccinated)
Ensure regular supportive supervision with written feedback and follow-up of supervision visit.
Update and display monitoring chart to track monthly progress on RI coverage for corrective action.
Revision and expansion of session sites including outreach session as per current structure using local resources by municipality
Provinces to advocate with municipality on provision of session site infrastructure/facilities.
Advocacy with local government and stakeholders on accelerating immunization coverages.
Cold chain management in all levels (provincial, district, sub-store).

Enhance measles and VPD surveillance:

Expand reporting units in all municipalities based on population density and availability of health facilities- public/private institution. And provinces to circulate official letter to private hospitals to be part of the VPD reporting unit.
Province to share update on VPD cases and immunization to municipality and health offices.
Ensure and plan joint supervision field visit of priority reporting units and municipalities.
For any suspected VPD cases, health facilities to inform Health office, municipality for investigation and case management.

Accountability and governance oversight:

Advocate on MR elimination goals with Immunization Coordination Committee (ICC) to track progress on MR elimination at all levels.
Local RRT to present measles outbreak root cause analysis (RCA) findings to District Immunization Coordination Committee (DICC) to accelerate MR elimination activities.
Advocate with municipality on Immunization coverage and VPD surveillance sensitivity including MR elimination progress as one of the indicators of local government institutional Self- Assessment (LISA).

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Nepal restricts trans-fatty acids in food

by Public Health Update February 14, 2024

written by Public Health Update

Kathmandu / New Delhi | February 14, 2024: The World Health Organization congratulates Nepal for restricting levels of industrially produced trans-fatty acids in the food supply through a legislation, a move aimed at promoting health and saving lives.

“Eliminating trans-fatty acids is a cost-effective measure with great health benefits in preventing premature deaths from cardiovascular diseases,” said Ms Saima Wazed, Regional Director, WHO South-East Asia.

Prioritizing prevention and control of noncommunicable diseases (NCDs) in South-East Asia Region, WHO has been supporting countries for elimination of trans-fatty acids from national food supplies, along with other measures. With Nepal’s legislation, now nearly 80% of the Region’s population – 1.6 billion people – will be potentially protected from the harms of trans-fatty acids.

Globally, 540,000 deaths every year can be attributed to intake of industrially produced trans-fatty acids. High trans-fat intake significantly increases the risk of death from cardiovascular diseases. Trans fat has no known health benefits.

In the WHO South-East Asia Region, non-communicable diseases cause 69% of the nearly 9 million deaths every year. Cardiovascular diseases are a major cause of deaths.

In 2018 WHO released REPLACE a guide of six strategies to help achieve the elimination of industrially produced trans-fatty acids. In collaboration with Resolve to Save Lives, REPLACE protocols are being implemented across the Region.

By 2022 Thailand, India and Bangladesh had adopted regulations for elimination of trans-fatty acids in food supply. Indonesia had complementary policy measures. Sri Lanka issued a regulation in 2023. Nepal issued the legislation on trans-fatty acids on 8 February.

Restricting trans-fatty acids is one of the measures under WHO South-East Asia Region’s ‘SEA HEARTS’ that emphasizes on united effort across all partners and all stakeholders for aligned and effective acceleration of actions to reduce deaths from cardiovascular diseases.

Nepal’s legislation on trans-fatty acids will add 30 million people to the SEA HEARTS target of protecting two billion people from the harmful effects of trans-fatty acids through best practice or complementary policy measures of WHO REPLACE by 2025.

WHO has been urging countries in the Region to focus on best-practice policies, monitoring and surveillance, to drive progress against trans-fatty acids.

Last month, Thailand was among the first five recipients of WHO certificate validating progress in eliminating industrially produced trans-fatty acids.

Eliminating trans-fatty acids from the food supply will enhance the health and wellbeing of people and also help attain the SDG targets of reducing premature mortality by one-third from noncommunicable diseases by 2030.

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February 14, 2024 0 comments

National Plan, Policy & Guidelines Public Health Public Health Programs

National Immunization Schedule, Nepal (Updated)

by Public Health Update February 3, 2024

written by Public Health Update

The National Immunization Programme (NIP) is a Priority 1 (P1) public health program of the Government of Nepal, which was launched as the Expanded Programme on Immunization in 2034 BS (1977/78). Here is the latest updated National Immunization Schedule of Nepal.

S. No.	Vaccine	Age	Route	Diseases
0	Tetanus diphtheria (Td)	Pregnant Mother: For the first pregnancy: 2 doses (1-month gap) For the second pregnancy and onwards: 1 dose	Intramuscular	Maternal and Neonatal Tetanus & Diphtheria
1.	BCG (Bacillus Calmette Guerin)	At birth (1 dose)	Intradermal	Tuberculosis
2.	Pentavalent Vaccine (Diphtheria, Pertussis, Tetanus, Hepatitis B and Hemophilus influenza B)	6, 10 and 14 weeks (3 doses)	Intramuscular	Diphtheria, pertussis, Tetanus, Hepatitis B and Haemophilus Influenza B
3.	OPV (Oral Polio Vaccine)	6 and 10 and 14 weeks (3 doses)	Oral	Polio
4.	PCV (Pneumococcal Conjugate Vaccine)	6, 10 weeks and 9 months (3 doses)	Intramuscular	Pneumococcal diseases (Meninges, ear and chest infections)
5.	Rotavirus vaccine	6 & 10 weeks (2 doses)	Oral	Rotavirus diarrhea
5.	fIPV (Fractional Injectable polio vaccine)	14 weeks and 9 months (2 doses)	Intradermal	Polio
6.	MR (Measles – Rubella)	9 and 15 months (2 doses)	Subcutaneous	Measles and Rubella
7.	JE (Japanese Encephalitis)	12 months (1 dose)	Subcutaneous	Japanese Encephalitis
8	Typhoid Vaccine	15 months (1 dose)	Intramuscular	Typhoid fever
9	HPV	Adolescent girls in grades 6-10 and out-of-school girls aged 10	Intramuscular	Cervical cancer

Immunization Schedule — **Latest updated National Immunization schedule of Nepal (2024)**

Rotavirus Vaccine (Information for Parents and Public)
Rotavirus Vaccine Guideline 2075, CHD, Department of Health Services

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February 3, 2024 3 comments

National Plan, Policy & Guidelines Non- Communicable Diseases (NCDs)Research & Publication Vaccine Preventable Diseases

HPV Vaccine Demonstration Guideline 2080

by Public Health Update February 3, 2024

written by Public Health Update

Overview

The Family Welfare Division, Department of Health Services (DoHS), releases a new guideline on HPV Vaccine Demonstration 2080 to provide guidance on the HPV vaccine demonstration program in Nepal.

Vaccine Name: Cecolin HPV Vaccine
Type: Bivalent
Manufacturing company: Xiamen Innovax BiotechCo. Limited (Innovax) China
Dose: 0.5 ml, 2 times
Efficacy: 95%

HPV vaccine demonstration sites

Koshi Hospital, Biratnagar- Koshi Province
Narayani Hospital, Birgunj- Birgunj
Paropakar Maternity & Women’s Hospital- Bagmati Province
Pokhara Academy of Health Sciences – Gandaki Province
Bheri Hospital, Nepalgunj- Lumbini Province
Province Hospital, Surkhet, Karnali Province
Daduldhura Hospital- Sudurpaschim Province

Download: HPV Vaccine Demonstration Guideline 2080

VIA Algorithm

Screen Shot 2024 02 03 at 19.59.00 — VIA Algorithm

February 3, 2024 0 comments

National Plan, Policy & Guidelines Public Health Public Health Update Research & Publication Vaccine Preventable Diseases

MR Vaccination Campaign Guideline 2080-81

by Public Health Update February 3, 2024

written by Public Health Update

Overview

The Government of Nepal, Ministry of Health and Population, has decided to conduct a nationwide Measles-Rubella (MR) Vaccination Campaign from 25 February to 20 March 2024. The guideline on ‘MR Vaccination Campaign 2080-81’ is formulated to provide comprehensive guidance for vaccination efforts, with a particular focus on health workers stationed at vaccination centers, ensuring the efficient execution of vaccination sessions.

This guide offers technical guidance to managers, supervisors, and health workers at different levels, including cold chain officers and assistants, to plan, manage, and conduct the Measles-Rubella Vaccination Campaign for the fiscal year 2080-81.

Guideline and presentation slides

Download guideline

Download guideline (MR Vaccination Campaign Guideline 2080-81)
FWD, DoHS

Schedule for Missed Opportunity Vaccination in Nepal

Call for Applications: RSTMH Early Career Grants Programme 2024

by Public Health Update February 2, 2024

written by Public Health Update

The 2024 RSTMH Early Career Grants Programme is now open for applications. The Programme provides more than 200 grants every year to those early in their careers to carry out their first piece of research into tropical medicine or global health. It encourages and supports the next generation of tropical medicine and global health professionals growing their skills and networks, improving confidence and enabling the development and dissemination of interesting and innovative outcomes in tropical medicine and global health.

Early career researchers and global health professionals based anywhere in the world, who have not had research funding in their own name before, can apply for a grant of up to £5,000 (GBP) to deliver a project within one year. The projects can be on any topic related to tropical medicine and global health, from across the research spectrum of lab, translation, implementation, and policy.

Applications open: 22 January 2024 at 5pm (GMT)

Applications close: 22 April 2024 at 12pm (BST)

Who are the grants for: The RSTMH Early Career Grants are aimed at individuals who have not received a research grant of £5,000 or more in their own name before, who are able to develop and deliver their first research project

Where you are based: Applications are welcomed from researchers from anywhere in the world

Grant amount: The maximum RSTMH Early Career Grant award is £5,000 (including any taxes on relevant purchases)

Duration of grant project: Project should take up to one year to be completed and should start within 3 months of receiving funding

Topic and scope: The projects can be on any topic related to tropical medicine and global health, from across the research spectrum for example: lab, translation, implementation, and policy

How many grants are available: This year we have at least 230 grants available.

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February 2, 2024 0 comments

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Call for application for HSG Europe pre-conference scholarships

by Public Health Update February 1, 2024

written by Public Health Update

Call for application for HSG Europe pre-conference scholarships

Health Systems Global (HSG) is organising a pre-conference in Katowice, Poland, on 19-21 June 2024. The preconference is linked to the 8th Global Symposium on Health Policy and Systems Research in Nagasaki, Japan, in November 2024. With generous funding from TDR, HSG is administering a scholarship to facilitate the participation of 11 researchers (with priority given to early career researchers) based in, or originating from, a low- or middle-income country (LMIC) in the WHO Europe Region.

The following countries are eligible:
Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, Republic of Moldova, Romania, Serbia, Tajikistan, Türkiye, Turkmenistan, Ukraine, Uzbekistan.

Deadline for applications: 29 February 2024

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February 1, 2024 0 comments

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DoHS Annual Health Report 2079/80

Overview

Rationale

Related documents

Nepal National Health Accounts 2018/19 and 2019/20

Vaccine Preventable Diseases Surveillance Plan (Polio Transition Plan)

Recommendations of Measles Outbreaks and Root Cause Analysis 2022-23

Overview

Summary of RCA field observation and findings:

Recommendations

Related readings

Nepal restricts trans-fatty acids in food

National Immunization Schedule, Nepal (Updated)

Important Links

HPV Vaccine Demonstration Guideline 2080

Overview

HPV vaccine demonstration sites

VIA Algorithm

MR Vaccination Campaign Guideline 2080-81

Overview

Guideline and presentation slides

Related readings

Call for Applications: RSTMH Early Career Grants Programme 2024

Call for application for HSG Europe pre-conference scholarships

Call for application for HSG Europe pre-conference scholarships

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