Page 67 – Public Health Update

Nepal Health Facility Survey 2021(Final Report)

by Public Health Update September 14, 2022

Overview

The 2021 Nepal Health Facility Survey (NHFS) is the second survey of its kind following the one conducted in 2015. It was designed to provide information on the availability of basic health care services and the readiness of health facilities to provide quality services to clients.

The survey was implemented by New ERA under the aegis of the Ministry of Health and Population (MoHP). ICF provided technical assistance through The DHS Program, which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs. The survey received funding from the United States Agency for International Development (USAID); UK’s Foreign, Commonwealth & Development Office (FCDO); and the United Nations Population Fund (UNFPA). The data collection was planned for early 2020 but was pushed back by 1 year due to the pandemic.

Key findings – The 2015 Nepal Health Facility Survey (2015 NHFS)

The 2021 NHFS is an assessment of health facilities in the formal sector of Nepal. It was designed to provide a comprehensive picture of the strengths and weaknesses of the service delivery environment for each assessed service. The 2021 NHFS collected information from all facilities managed by the government and by private not-for-profit nongovernmental organizations (NGOs), private for-profit organizations, and mission/faith organizations in all 77 districts of the country. The survey was also designed to provide representative results for each of the seven provinces and by facility type. In addition, this survey will provide an endline for the Nepal Health Sector Strategy 2016–2022.

Key findings of the 2021 NHFS

FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, GENERAL SERVICE READINESS, AND QUALITY OF CARE

Three quarters of all health facilities in Nepal offer a full package of basic client services (outpatient curative care for sick children, child growth monitoring, child vaccinations, any modern method of family planning, antenatal care [ANC], and services for STIs). This represents a clear improvement since the 2015 NHFS, when only around 6 in 10 facilities were assessed as having a full package of basic services.
Facilities were somewhat more likely in 2021 (17%) than in 2015 (11%) to have all six of the basic amenities (regular electricity, an improved water source, visual and auditory privacy, a client latrine, communication equipment, and emergency transport) considered essential for rendering quality client services. More than 3 in 10 facilities in the Bagmati province (31%) have all of the basic amenities, as compared with less than 1 in 10 facilities in Madhesh (8%) and Karnali (7%).
The availability of personal protective equipment improved at health facilities between the 2015 and 2021 surveys. For example, the percentage of facilities that had masks available increased from 19% to 82%, and facilities were almost six times as likely to have gowns/aprons available in 2021 (53%) as in 2015 (9%).
With the exception of emergency transport (80%), less than half of all facilities in Nepal have any of the supplies and services (self-inflating bag and mask, pulse oximeter, oxygen-filled cylinders, inpatient care, overnight observation beds, communication equipment) considered essential in providing COVID-19 care.
Basic diagnostic testing capacity is limited in most health facilities; facilities are most likely to have the capacity for pregnancy (43%) and malaria (36%) testing and least likely to have HIV testing capacity (5%).
Half of facilities conduct regular management meetings, and a similar percentage involve the community in these meetings.
The percentage of facilities reporting both routine staff training and personal supervision was lower in 2021 (55%) than in 2015 (69%).
Only 6% of facilities reported having an outbreak management plan, 36% of facilities completed a financial audit in the last fiscal year, and 69% of PHCCs and hospitals implement the government’s social security health insurance scheme.

CHILD HEALTH AND IMMUNIZATION SERVICES

Virtually all health facilities in Nepal offer curative care for children, and around 9 in 10 facilities offer growth monitoring and routine vaccination services. Routine vitamin A supplementation is offered in 88% of facilities.
Outpatient curative care for sick children and growth monitoring services are available 5 or more days per week in almost all health facilities offering these services.
Very few facilities delivering curative care for children have all of the equipment and trained staff considered necessary to provide quality care for sick children, with facilities most often lacking length or height boards (39%), pediatric stethoscopes (13%), and staff with training in maternal, infant, and young child nutrition (12%).
Nine in 10 facilities providing child curative care have alcohol-based disinfectant and latex gloves, and 8 in 10 have medical masks. Overall, however, only 1% have all of the infection prevention items needed to deliver services safely.
Laboratory testing capacity is also limited, with only 12% of facilities able to conduct hemoglobin and malaria testing and stool microscopy.
Routine vaccinations are available at least 1–2 days per week in more than 8 in 10 facilities that offer vaccinations. Facilities generally obtain the vaccines they administer from a higher level center and store the vaccines only for a short time as per policy. Only 6% of facilities have all of the components necessary for quality immunization services.
Around two-thirds of providers of child health services have received recent supervision, and around 1 in 5 providers have received recent in-service training related to child health.
Providers assessed all three main symptoms of childhood illness (fever, cough/difficulty breathing, and diarrhea) in 28% of observed consultations. They checked for all four major danger signs (ability to eat or drink anything, vomiting, convulsions, and unconsciousness/ lethargy) in less than 1% of consultations.

Nepal Multiple Indicator Cluster Survey 2019 (NMICS 2019): Key findings

FAMILY PLANNING SERVICES

A large majority (98%) of health facilities in Nepal offer (i.e., provide, prescribe, counsel, or refer clients on) at least one of the following temporary modern methods of family planning: oral contraceptive pills, male condoms, injectables (Depo), implants, or intrauterine contraceptive devices (IUDs). Around 4 in 10 facilities offer male or female sterilization.
95% or more of all facilities offering modern family planning methods provide male condoms, oral contraceptive pills, or injectables to clients at the facility. However, less than half of facilities offering modern family planning methods are able to provide implants (41%) or IUDs (29%). Female or male sterilization services are provided at only 2% of the facilities where modern family planning methods are offered.
92% of health facilities that provide temporary family planning methods actually had every method they provide available at the facility on the day of the NHFS visit.
A majority of facilities offering family planning services have most of the basic equipment required for quality service delivery; however, only around 1 in 5 have the national family planning guidelines available or have staff who received in-service training relating to family planning in the past 24 months.
Overall, the environment for family planning counseling is poor. Visual and auditory privacy and confidentiality were assured in only 12% of all family planning consultations observed in the survey.
Method-specific side effects were discussed in only 38% of all observed family planning consultations. There was almost no discussion of STIs or condom use in the consultations.
Two-thirds of interviewed family planning providers reported that they had been personally supervised during the 6 months before the survey. Less than 1 in 10 providers had had any in-service family planning training in the 24 months before the survey.

ANTENATAL CARE

Almost all (98%) health facilities in Nepal offer ANC services.
Three quarters or more of facilities offering ANC have the basic equipment required to deliver quality services, with the exception of a tape to measure fundal height. A majority also have essential infection control items and supplies except for a needle cutter and a waste receptacle.
Only around one quarter of facilities offering ANC had staff with recent training in ANC available on the day of the assessment, and relatively few had either ANC service (11%) or infection prevention (7%) guidelines.
More than 6 in 10 ANC providers had received personal supervision in the 6 months preceding the survey.
Almost all health facilities offering ANC (95%) had essential ANC medicines (iron and folic acid combined tablets and albendazole tablets) available.
Testing capacity was much more limited, with only around 1 in 4 facilities offering ANC care able to conduct hemoglobin, urine protein, or urine glucose tests. Only 3% of facilities were able to conduct all three tests.
In the great majority of the ANC consultations observed in the NHFS, the client’s blood pressure (93%) and weight (89%) were assessed. Providers checked the fetal position and listened to the fetal heartbeat in around 7 in 10 consultations.
Two-thirds of ANC clients were given or prescribed iron or folic acid, and around one-fifth received or were prescribed albendazole.
Clients mentioned or providers asked and/or counseled about at least one of eight risk symptoms in 63% of the observed ANC consultations, most often severe abdominal pain. All eight risk symptoms were discussed in less than 1% of consultations.
In general, facilities offering ANC lacked trained staff, diagnostics, and medicines needed for the provision of malaria services.
Only 11% of hospitals and PHCCs offering ANC provided any prevention of mother-to-child transmission (PMTCT) of HIV services.

DELIVERY AND NEWBORN CARE

Just over half of health facilities in Nepal provide normal vaginal delivery services. As expected, cesarean deliveries are available at only a small proportion of facilities (5%), mainly hospitals.
Eight in 10 facilities that offer normal delivery care services have emergency transport available, and a majority of facilities (66%–99%) have all of the equipment items necessary for providing quality care other than a vacuum extractor (23%) and a vacuum aspiration or manual vacuum aspiration kit (21%).
Only around one-fifth of facilities offering normal vaginal delivery services had all of the medicines essential for quality delivery care. Facilities were even less likely to have all of the essential medicines for newborn care (2%).
Around 3 in 10 facilities that offer normal vaginal delivery services had at least one interviewed staff member with recent training in delivery care, and only 13% had guidelines for delivery care available on the day of the assessment.
Only a minority of hospitals and PHCCs offering normal vaginal deliveries had performed all basic emergency obstetric and newborn care (BEmONC) signal functions (13%) or all comprehensive emergency obstetric and newborn care (CEmONC) signal functions (11%) at least once in the 3 months preceding the survey.
90% or more of facilities reported that they routinely carry out a number of essential newborn care functions, including keeping the infant warm, starting breastfeeding soon after birth, and putting the baby skin to skin on the mother’s abdomen.
63% of interviewed delivery care providers received personal supervision in the 6 months before the assessment, but only 16% received in-service training during the 24 months preceding the assessment.
Only a minority of women reported that they received comprehensive checks and advice on key aspects of postpartum (8%) or newborn (19%) care before they were discharged from the facility where they delivered.
23% of postpartum women interviewed after their delivery reported that the staff had scolded them or treated them disrespectfully.

HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS

One in 20 health facilities in Nepal have a system to support clients needing HIV testing and counseling. Around three quarters of these facilities are able to offer HIV testing at the facility to clients.
Relatively few facilities (9%) offering HIV testing and counseling services had all of the items needed for delivering quality services available on the day of the assessment visit.
Similarly, few facilities offering HIV testing (10%) had all infection prevention items at the service site on the day of the NHFS assessment. In facilities offering laboratory testing, 18% had all infection prevention items available in the laboratory.
Slightly more than half (56%) of the HIV service providers interviewed in the NHFS reported receiving personal supervision in the 6 months before the survey. However, very few had recent training related to either HIV counseling (3%) or testing (2%).
8% of all health facilities in Nepal offer at least one HIV/AIDS care and support service.
13% of hospitals and PHCCs offer antiretroviral therapy (ART) services.
More than 8 in 10 facilities offer STI services. A lack of availability of trained staff, STI guidelines, and testing capacity serves as a major constraint on the provision of quality STI services.

NONCOMMUNICABLE DISEASES

96% of all health facilities in Nepal offer services for the diagnosis and/or management of chronic respiratory diseases, and 90% provide services for cardiovascular diseases.
Almost three quarters of all health facilities offer services for the diagnosis and/or management of diabetes, which is more than three times the proportion of facilities providing these services at the time of the 2015 NHFS (21%).
The availability of guidelines for provision of services and trained staff is consistently low in facilities offering services for the three NCDs.
Basic equipment such as a blood pressure apparatus, stethoscope, or weighing scale is available in most facilities offering services for the three NCDS. Other equipment, including height boards, peak flow meters, spacers for inhalers, and essential medicines, is less available.
Only one quarter of all health facilities in Nepal offer mental health services.
Only a minority of facilities offering mental health services have guidelines (27%) or a staff member with recent training in mental health care (16%). Half or less of facilities have any of the essential medicines for treating mental illnesses.

TUBERCULOSIS

Nationally, around two-thirds of all health facilities offer any tuberculosis (TB) treatment services, and 23% offer any TB diagnostic services.
Just over half of all facilities have treatment protocols in which TB drugs are delivered to the patient by a health worker at the facility, and 25% provide treatment to clients in the community.
31% of facilities offering TB services had the TB management guideline 2019 available.
17% of facilities that offer TB services had staff with recent in-service training related to TB.
TB smear microscopy was available at 12% of facilities offering TB services, while 13% had X-ray services for screening and diagnosis of TB.
Only 4% of facilities offering tuberculosis diagnosis and/or treatment services also had HIV diagnostic capacity.
Seven in 10 facilities offering TB services had medicines available on the day of the NHFS visit for the continuation phase of the TB treatment regimen.
More than 8 in 10 facilities offering TB services had in place a system to track whether TB clients were following the recommended treatment regime.

MALARIA

Just under half of Nepal’s health facilities (49%) offer malaria diagnosis and/treatment services.
Health facilities in the terai region (74%) are more likely to have malaria services available than facilities in the hill (40%) and mountain (19%) regions.
By province, malaria services were available most often in Madhesh and Lumbini (64% each).
With respect to diagnostic capacity, 74% of facilities offering malaria services had the ability to diagnose malaria on-site, primarily using rapid diagnostic tests (RDTs).
Only a minority of facilities had staff with recent training in malaria diagnosis (12%) or treatment (10%) or malaria service guidelines (13%) available at the time of the NHFS visit.
Chloroquine (31%) and primaquine (21%) tablets were the most commonly available antimalarial medicines.
Only 9% of health facilities providing malaria services had long-lasting insecticide-treated mosquito nets (LLINs) in stock for distribution.

Download: Ministry of Health and Population, Nepal; New ERA, Nepal; and ICF. 2022. Nepal Health Facility Survey 2021 Final Report. Kathmandu, Nepal: Ministry of Health and Population, Kathmandu; New ERA, Nepal; and ICF, Rockville, Maryland, USA.

WHO Health Inequality Monitoring Course Series

by Public Health Update September 12, 2022

written by Public Health Update

Overview

Now more than ever, many health inequalities across and within countries are recognized as preventable, unfair and unacceptable. Health inequality monitoring is an essential starting point for building more effective and more equitable policies, programmes, and practices. Monitoring inequalities is necessary to characterize current realities, evaluate the impact of actions, and indicate where changes are still needed. This course helps learners to become familiar with the basics of health inequality monitoring, why it is important and how it can be carried out. No prior knowledge about health inequality or experience conducting health inequality monitoring is required. The target audience for this course includes monitoring and evaluation officers, health programme managers and policy makers. The course is also suitable for anyone with a general interest in the topic of health inequality monitoring.

Health inequalities exist in every population. A health inequality refers to an observable difference in health between subgroups in a population. With the necessary data, health inequalities can be measured, compared and tracked over time.

Health inequality monitoring entails quantifying and assessing health inequalities in a defined population to inform where changes are needed to advance health equity.

This channel includes training courses about the foundations of health inequality monitoring, its application to specific topics and skill building.

New WHO eLearning course series, ‘Health Inequality Monitoring Foundations’, addresses the need for capacity strengthening in health inequality monitoring. This five-course series is delivered in a self-directed learning environment designed to meet the immediate learning needs of users. It is primarily targeted to monitoring and evaluation officers, researchers, analysts, and others with a general interest in health data and inequality monitoring.

Courses

Five new courses on the OpenWHO platform will address the need for capacity strengthening in health inequality monitoring:

The Overview course gives a general introduction to the health inequality monitoring cycle and related key terminology and concepts.
The Data sources course examines the strengths, limitations and opportunities to improve common data sources for health inequality monitoring, as well as the processes of data source mapping and data linking.
The Health data disaggregation course explores how disaggregated health data are integral across the steps of monitoring, and guides learners in assessing and reporting disaggregated data.
The Summary measures of health inequality course discusses the general characteristics of simple and complex summary measures, and guides learners through the selection, calculation, interpretation and reporting of a range of measures.
The Reporting course demonstrates the components of high-quality health inequality reporting, emphasizing purpose-driven, audience-centred, and technically rigorous approaches.

Read more and enroll now

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September 12, 2022 0 comments

Seventy-fifth Session of Regional Committee for WHO South-East Asia begins

Public Health News Global Health News Health Systems Public Health Update

WHO South-East Asia Region commits to inclusive, equitable and resilient health systems

by Public Health Update September 9, 2022

written by Public Health Update

9 September 2022 News release Paro, Bhutan | 9 September 2022

The Seventy-fifth Session of the Regional Committee for WHO South-East Asia concluded here today with Member countries committing to resilient health systems, accelerating multisectoral actions to address priority health issues and reenergizing comprehensive primary health services to build societies that are more inclusive, equitable and resilient against present and future emergencies.

“We are at a history-defining juncture. Over the past two and a half years, the Region and the world have witnessed immense transformative change. It is important for us not just to spend more on health, but to spend efficiently and spend equitably. Our focus must be on vulnerable populations, we must identify them and see how best we can address their needs. We cannot leave anyone behind as we seek to drive rapid and sustained progress towards universal health coverage, health security and health for all,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia.

Building on the lessons learnt from the ongoing COVID-19 pandemic, countries committed to strengthening emergency preparedness and build health systems that are also resilient to environment and climate change.

The annual governing body meeting of WHO in the Region, which met in person for the first time since the onset of the COVID-19 pandemic after a gap of three years, adopted the Paro Declaration to address mental health through primary care and community engagement.

The Regional Committee adopted resolutions to accelerate progress against non-communicable diseases, including oral health and integrated eye care and promote social participation to strengthen primary health care in support of universal health coverage.

Recognizing that climate action is health action, the Regional Committee decided to extend the Regional Framework for Action in Building Health Systems Resilient to Climate Change (2017 – 2022) till 2027.

Member countries committed to accelerate efforts to eliminate cervical cancer and achieve end-TB targets.

The session endorsed Implementation Roadmap for the prevention and control of noncommunicable diseases in South-East Asia 2022–2030, and two action plans — for oral health in South-East Asia 2022–2030 and for integrated people-centered eye care in South-East Asia 2022–2030 were also endorsed.

The Regional Committee emphasized on the need to revitalize regional knowledge- and experience-sharing mechanisms aligned with national, regional and global goals for strengthening comprehensive people centered primary health services and health systems to respond to public health priorities, such as mental health, noncommunicable diseases, emergencies and pandemics, including COVID-19 and, more recently, monkeypox.

Member countries endorsed the Regional Strategy Roadmap on Health Security and Health System Resilience for Emergencies 2023-2027 to boost emergency preparedness, readiness, and response through capacity building and enhanced governance. The WHO South-East Asia Regional Roadmap for Diagnostic Preparedness, Integrated Laboratory Networking and Genomic Surveillance 2023-2027 was adopted to strengthen national laboratories for improved surveillance and generation of quality data on emerging and re-emerging public health threats.

Member countries sought support in building strong health information systems for evidence and good quality data to guide preparedness and response.

The Regional Committee reviewed progress reports on its previous resolutions and decisions on the regional action plan on health, environment and climate change; the Male Declaration for building health system resilience to climate change; strategic action plan to reduce the double burden of malnutrition; expanding the scope of the regional health emergency fund – SEARHEF – to fund preparedness; and strengthen emergency medical teams in the Region.

Progress against efforts to end preventable maternal, newborn and child mortality in the Region in line with the Sustainable Development Goals and global strategy on women’s children’s and adolescent health; challenges in polio eradication; and elimination of measles and rubella by 2023, was also reviewed by the Regional Committee.

9 September 2022 News release Paro, Bhutan | 9 September 2022

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September 9, 2022 0 comments

Public Health International Plan, Policy & Guidelines Quality Improvement & Infection Prevention

Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the health care facility level

by Public Health Update September 9, 2022

written by Public Health Update

Overview

Infectious disease outbreaks and epidemics are increasing in frequency, scale and impact. Health care facilities can amplify the transmission of emerging infectious diseases or multidrug-resistant organisms (MDRO) within their settings and communities. Therefore, evidence-based infection prevention and control (IPC) measures in health care facilities are critical for preventing and containing outbreaks, while still delivering safe, effective and quality health care.

This toolkit is intended to support IPC improvements for outbreak management in all such facilities, both public and private throughout the health system. Specifically, this document systematically describes a framework of overarching principles to approach the preparedness, readiness and response outbreak management phases. The document also provides a toolkit of resource links to guide specific actions for each infectious disease and/or MDRO outbreak management phase at any health facility. This document is specifically tailored to an audience of stakeholders who establish and monitor health care facility-level IPC programs including: IPC focal points, epidemiologists, public health experts, outbreak response incident managers, facility-level IPC committee(s), safety and quality leads and managers, and other facility level IPC stakeholders.

Objective

To provide stakeholders at health facilities with a set of tools for preparedness, readiness and response to infectious disease and MDRO outbreaks.

A practical framework of actions for strengthening IPC outbreak preparation, readiness and response.
A toolkit that provides resources to assist in the development of facility-level contingency or action plans to strengthen IPC outbreak preparedness, readiness and response.

This document provides guidance and tools for decision-makers responsible for the establishment and monitoring of health care facility-level IPC programmes, including IPC focal points, epidemiologists, public health experts, or key stakeholders. This document is geared towards outbreak response incident managers and any existing facility-level IPC committee. Other users include safety and quality leads and managers, and others involved in IPC activities.
The core principles and practices of IPC are common to any facility where health care is delivered, including not only acute care facilities, but also community, primary care and long term care facilities. This toolkit is intended to support IPC improvements for outbreak management throughout the health system, both in the public and private sectors. This framework provides a stepwise approach to IPC outbreak management and the toolkit provides helpful resources. Of note, it is not designed to be an implementation guide.

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September 9, 2022 0 comments

Public Health Maternal, Newborn and Child Health National Plan, Policy & Guidelines Research & Publication

Lactation Management Centre Guideline 2079

by Public Health Update September 8, 2022

written by Public Health Update

Overview

The Family Welfare Division has released a guideline for Lactation Management Centre. This guideline aims to provide a technical requirements and guidance for the establishment and operation of the Lactation Management Centers in Nepal.

Purpose of the guideline

Ensuring timely initiation of breastfeeding and promoting breastfeeding practices.
Providing guidance to establish:
Comprehensive Lactation Management Centres (CLMCs) for donor human milk collection, storage, processing and dispensing for babies admitted in health facilities.
Lactation Management Units (LMUs) for collecting, storing and dispensing of mother’s breast milk, expressed and stored for consumption by her own baby.
Lactation Support Units (LSUs) for providing lactation support to mothers at all delivery points.

Operationalizing evidence based and standardised technical protocols for donor screening and collection, processing, storage and dispensation of human milk.

Ensuring the quality and safety of donor human milk (DHM) is the ultimate aim of these guidelines and recommendations have been made to minimise the risk of DHM to recipients.

Key definitions

Comprehensive Lactation Management Centre (CLMC): is a centre at a health facility for the purpose of providing comprehensive lactation support and management for all mothers within the hospital. Facilities for collection, screening, processing, storage and dispensing of donated human milk for babies without access to their own mother’s milk and expression and storage of mother’s own breast milk for consumption of her baby are available in CLMC.

Lactation Management Centre (LMC): is a centre established in the health facility for the purpose of providing lactation support to all mothers within the health facility for collection, storage and dispensing of mother’s own breast milk for consumption by her baby.

Donor: A lactating woman who voluntarily donates milk after screening and approval. A donor shall not receive remuneration for the donation of human milk.

Principles of donation: Donation should be done freely and voluntarily without any monetary benefits to the donor and with an understanding that the donated milk may be used to feed the baby of another mother admitted in the hospital free of any cost.

Donor Human milk: Donor Human Milk is milk expressed and voluntarily donated by lactating women other than the biological mother of the recipient. This donor human milk is pasteurized using the Holder Pasteurization Method and dispensed for use of the recipient.
Mother’s own milk: Human milk expressed for consumption by the mother’s own baby. Preterm milk: Human milk expressed within the first 4 weeks’ post-partum by a mother who delivered at or before 37 weeks of gestation.

Term milk: Human milk expressed by a mother giving birth after 37 weeks, or before 37 weeks but after 4 weeks postpartum.

Fresh raw milk: Human milk expressed within 24hrs and stored at temperature at or below +40C (+2 to + 4oC). Frozen raw milk: Human milk that has been frozen after expression and stored at –20oC.

Donor human milk-contact surfaces: All surfaces that contact donor human milk during normal course of operations. This includes utensils and food-contact surfaces of equipment, such as flasks, bottles and caps.

Collection: The act of expression and obtaining human milk.

Processing: The use of evidence based methodologies and criteria required to prepare and identify human milk for use for the recipient.

Pasteurized donor human milk: Donor human milk which has undergone process of pasteurization in a defined apparatus as per these technical guidelines.

Pasteurization: It is a process where the milk in a sealed container is heated up to 62.5oC and held at this temperature for 30 minutes followed by rapid cooling in a definite apparatus.

Thawing: To change from a frozen solid to a liquid by gradual warming ideally by transferring from the deep freezer (–20oC) to a refrigerator (+2°C to +8°C) over a period of 24 hours.

Equipment clean: Equipment that is cleaned and maintained according to manufacturer’s instructions.

Sanitize: To adequately treat donor milk and contact surfaces by a process that is effective in reducing or destroying pathogens but without adversely affecting the product or its safety for consumption.

Refrigerator: An instrument to maintain temperature from +2°C to +8°C. Deep freezer: An instrument to maintain temperature at or below –20°C.

Download Guideline: ENGLISH NEPALI

September 8, 2022 0 comments

National Guideline on Prevention, Management and Control of Dengue in Nepal

Public Health National Plan, Policy & Guidelines Public Health Update Vector-Borne Diseases(VBDs)

Step wise approach for Dengue Case Management

by Public Health Update September 8, 2022

written by Public Health Update

National Guideline on Prevention, Management and Control of Dengue in Nepal

Overview

Dengue infection is a systemic and dynamic disease and has a wide clinical spectrum that includes both severe and non severe clinical manifestations. For a disease that is complex in its manifestations, management is relatively simple, inexpensive and very effective in saving lives so long as correct and timely interventions are instituted. The key is early recognition and understanding of the clinical problems during the different phases of the disease, leading to a rational approach to case management and a good clinical outcome.

Early notification of dengue cases seen in primary and secondary care is crucial for identifying outbreaks and initiating an early response.

Step wise approach for case management

Step 1: Overall Assessment
Step 2: Diagnosis, Assessment of Disease Phase and Severity
Step 3: Clinical Management

1.1 History, including symptoms, past medical and family history
1.2 Physical examination, including full physical and mental assessment
1.3 Investigation, including routine laboratory tests and dengue-specific laboratory tests
2 Clinicians will diagnose whether the disease is dengue and assess its phase and severity
3.1 Disease notification
3.2 Management decisions
Depending on the clinical manifestations and other circumstances, patients may
– be sent home (Group A)
– be referred for hospital management (Group B)
– require emergency treatment and urgent referral (Group C)

Step 1 Overall Assessment
History
– date of onset of fever/illness
– quantity of oral fluid intake
– diarrhea
– urine output (frequency, volume and time of last voiding)
– assessment of warning signs
– change in mental state/seizure/dizziness
– other important relevant history, such as family or neighborhood dengue, travel to dengueendemic areas, co-existing medical conditions.

Physical examination
– assessment of mental state
– assessment of hydration status
– assessment of hemodynamic status
– checking for quiet tachypnoea/acidotic breathing/pleural effusion
– checking for abdominal tenderness/hepatomegaly/ascites
– examination for rash and bleeding manifestations
– tourniquet test (repeat if previously negative or if there is no bleeding manifestation)

Investigation
Details on investigation is provided in chapter 3
– CBC: A complete blood count should be done at the first visit (it may be normal), CBC should be repeated daily until the critical phase is over. Decreasing white blood cell and platelet counts make the diagnosis of dengue very likely.
– Hematocrit: The hematocrit in the early febrile phase could be used as the patient’s own baseline.

Note
– Leukopenia usually precedes the onset of the critical phase and has been associated with severe disease.
– A rapid decrease in platelet count, concomitant with a rising hematocrit compared to the baseline, is suggestive of progress to the plasma leakage/critical phase of the disease. These changes are usually preceded by leukopenia (≤ 4000 cells/mm3).
– In the absence of the patient’s baseline, age-specific population hematocrit levels could be used as a surrogate during the critical phase.
– Dengue-specific laboratory tests can be performed to confirm the diagnosis. However, it is not necessary for the acute management of patients, except in cases with unusual manifestations.
– Additional tests should be considered in patients with co-morbidities and severe disease as indicated.
These may include tests of liver function, glucose, serum electrolytes, urea and creatinine, bicarbonate or lactate, cardiac enzymes, electrocardiogram (ECG) and urine specific gravity.

Step 2
Diagnosis, assessment of disease phase and severity
On the basis of evaluations of the overall assessment as described above, clinicians should determine whether the disease is dengue, which phase it is in (febrile, critical or recovery), whether there are warning signs, the hydration and hemodynamic state of the patient, and whether the patient requires admission or not.

Step 3
Disease notification and management decision
Disease notification
In dengue-endemic countries like Nepal, cases of suspected, probable/highly suggestive and confirmed dengue should be notified early so that appropriate public-health measures can be initiated. Laboratory confirmation is not necessary before notification, but if available should be reported. Notification of dengue is mandatory in Nepal. It is also a part of early warning and reporting system (EWARS) and should be reported accordingly.

Management decisions
Depending on the clinical manifestations and other circumstances, patients may either
– be sent home (Group A)
– be referred for in-hospital management (Group B) or
– require emergency treatment and urgent referral (Group C)

dengue case management 04 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 05 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 06 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 07 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 08 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 09 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 10 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 11 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

dengue case management 12 — Step wise approach for Dengue Case Management (National Guideline on Prevention, Management and Control of Dengue in Nepal)

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September 8, 2022 0 comments

Humanitarian Health & Emergency Response Global Health News Public Health News Public Health Update

WHO South-East Asia Region roadmap to strengthen emergency preparedness and response

by Public Health Update September 8, 2022

written by Public Health Update

8 September 2022 News release Paro, Bhutan | 8 September 2022 (WHO)

To strengthen preparedness and response capacities for public health emergencies with multidimensional impact, a regional roadmap built on the lessons learnt from the ongoing COVID-19 pandemic is set to be rolled out in the WHO South-East Asia Region.

The COVID-19 pandemic has demonstrated that the impact of health emergencies is not just limited to health. Economies and social welfare have been majorly impacted. Globally, risks from natural and man-made hazards are also likely to result in major and frequent health emergencies given the weakened systems that the pandemic would leave, and the looming threats from climate change.

“The roadmap aims to protect the vulnerable and economies from the impact of public health emergencies by strengthening national and regional health security and health system resilience,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, at the ongoing Seventy-fifth Regional Committee Session here.

The Regional Strategy Roadmap on Health Security and Health System Resilience for Emergencies 2023-2027 has been formulated after detailed consultations with Member countries and experts, and incorporates global and regional priorities and recommendations. It seeks to boost capacities to anticipate, prevent and manage health emergencies while maintaining essential health services through enhanced governance and collaboration within and across countries in the Region.

Dr Khetrapal Singh said that a Regional Health Emergency Council (RHEC) comprising of Heads of Member countries of the WHO South-East Asia Region, is being planned in line with WHO Director-General Dr Tedros’ proposal of Global Health Emergency Council. It will ensure engagement and commitment of the highest-level political leadership for preparedness and response to health emergencies in the Region to save lives and livelihood. The detailed terms of reference and operational modalities of the RHEC will be worked out in consultation with the Member States in due course.

The Region is also rolling out ‘WHO South-East Asia Regional Roadmap for Diagnostic Preparedness, Integrated Laboratory Networking and Genomic Surveillance 2023-2027’, developed to provide Member countries a range of policy options to develop sustainable strategies to improve their national laboratories and prepare their laboratory systems to improve surveillance and respond more effectively to emerging and re-emerging diseases, and other potential public health emergencies.

These roadmaps would help Member countries develop or update their National Action Plans on Health Security and strengthen whole-of-government and whole-of-society approach to enable more effective public health emergency preparedness, readiness, and response.

The Regional Strategy Roadmap on Health Security and Health System Resilience for Emergencies seeks to strengthen health security systems to reduce risks, detect early, prevent, and respond to public health emergencies as well as recover from its impact. It also seeks to strengthen governance, financing and enabling functions for emergency preparedness and surge response.

Importantly, the roadmap aims at strengthening regional alert, preparedness, and response systems, through improved regional collaboration.

The roadmap is expected to assist countries prevent or mitigate the multidimensional impact of emergencies on people and providers, protect the vulnerable, while ensuring that resilient health systems are capable of rapid recovery not just to “normalcy” but to be “built back better” post-emergency.

“A robust health system with well-developed building blocks leading to service provision with universal coverage, is not only foundational for health security but also critical for fulfilling the surge in service demand, continuity of essential services during emergencies, and for the system to bounce back to normalcy rapidly following an emergency – the three key characteristics of a resilient health system,” said Dr Khetrapal Singh.

8 September 2022 News release Paro, Bhutan | 8 September 2022 (WHO)

September 8, 2022 0 comments

Webinar Public Health Events Public Health Opportunity

NEPHA Webinar: Dengue Control Strategy and Intervention in Nepal

by Public Health Update September 7, 2022

written by Public Health Update

Nepal Public Health Association is inviting you to a scheduled Zoom meeting to discuss on the current status of dengue in Nepal.

Topic: Dengue Control Strategy and Intervention in Nepal

Time: September 9, 2022 6:00 to 7:30 PM (Friday) Kathmandu

Presenter: Dr. Gokarna Dahal, Sr. Health Administrator, Epidemiology and Disease Control Division

Commentator: Dr. Baburam Marasini, Public Health Expert, Former Director of MoHP

Moderator: Ms. Anjana Khadka, NEPHA Executive Member

Please click the link below to join our WEBINAR
Join Zoom Meeting
https://zoom.us/j/98220505504
Meeting ID: 982 2050 5504
Passcode: 857227

304010342 2070332213152414 9064866575604614022 n

September 7, 2022 0 comments

#ActOnNCDs! Keep the Momentum. Go the Extra Mile!

Public Health Global Health News Non- Communicable Diseases (NCDs)Public Health News Public Health Update

WHO South-East Asia Region to accelerate progress for NCD prevention and control

by Public Health Update September 7, 2022

written by Public Health Update

7 September 2022 News release Paro, Bhutan | 7 September 2022

The Member countries of WHO South-East Asia Region today resolved to accelerate progress for prevention and control of non-communicable diseases, including oral and eye care.

“The Region must build on the progress made in the prevention and control of noncommunicable diseases. Though trends are in the right direction, we need to accelerate efforts to achieve global, regional, and national goals,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region.

Noncommunicable diseases, including cardiovascular diseases, cancers, chronic respiratory disease and diabetes, account for almost two-thirds of all deaths in the WHO South-East Asian Region. Nearly half of these deaths occurred prematurely between the ages of 30 and 69 years in 2021. The meeting noted the continuing high burden of disease and death due to cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, large number of untreated cases of dental caries and oral health conditions, and challenges in the provision of comprehensive eye care.

The Member countries endorsed the Implementation Roadmap for the prevention and control of noncommunicable diseases in South-East Asia 2022–2030, and two action plans – for oral health in South-East Asia 2022–2030 and the Action Plan for integrated people-centered eye care in South-East Asia 2022–2030 during the ongoing Seventy-fifth Regional Committee Session of WHO South-East Asia.

The regional NCD Implementation Roadmap 2022–2030 provides strategic directions to accelerate the national NCD response through the primary health care and universal health coverage routes to improve access, coverage and quality of NCD prevention and control interventions for the achievement of the 2025 and 2030 NCD targets.

Oral diseases are among the most common NCDs in the South-East Asian Region, with cases of untreated dental caries, severe periodontal diseases and edentulism estimated to be more than 900 million in 2019. The South-East Asia Region has the highest oral cancer incidence and mortality rates among all WHO regions. The disease burden also shows strong inequalities with higher prevalence and severity in poor and disadvantaged populations. The Action Plan for Oral Health in South-East Asia 2022–2030 provides guidance to Member countries to develop impactful national actions to improve oral health through aligned approaches within the ambit of universal health coverage.

The Regional Action Plan for integrated people-centered eye care in South-East Asia 2022–2030 aims to provide ‘equitable access to high-quality, comprehensive eye health services to achieve universal eye health by 2030’ and accelerate progress towards achieving the global targets of refractive error and cataract surgery and two Regional targets for diabetic retinopathy and trachoma elimination.

The resolution calls for strengthening policy and legislative frameworks for this purpose, as well as advancing primary health care, universal health coverage, human resources, accountability and quality of national health information systems, and the crucial role of data and information systems at all levels to promote accountability.

“Decisive leadership and political commitment can provide the policy and legislative frameworks needed to integrate high-quality, comprehensive oral health and eye health services in primary health care to achieve the targets,” Dr Singh said.

The countries committed to accelerate progress against NCDs within the ambit of universal health coverage, adopting and implementing the guidance and tools from the Implementation Roadmap for the prevention and control of noncommunicable diseases in South-East Asia 2022–2030.

WHO committed to provide adequate technical support to Member countries in the implementation of the three plans including strengthening of the related monitoring and evaluation systems, and collaborate with partners and all stakeholders for aligned and effective implementation of the Strategic Action Plans.

7 September 2022 News release Paro, Bhutan | 7 September 2022

September 7, 2022 0 comments

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WHO South-East Asia Region commits to universal access to people-centered mental health care and services

by Public Health Update September 6, 2022

written by Public Health Update

6 September 2022 News release Paro, Bhutan | 6 September 2022

To promote mental health in the Region, Member countries of WHO South-East Asia Region today adopted the Paro Declaration committing to Universal Access to People-centered Mental Health Care and Services.

“There is no health without mental health. Increasing investments in mental health, including for preventive and promotive services at the primary care level, reduces treatment costs and increases productivity, employment and quality of life,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region.

The Paro Declaration was adopted at the Ministerial Roundtable on addressing mental health through primary care and community engagement on day two of the ongoing Seventy-Fifth Session of the WHO South-East Asia Regional Committee Session.

“The Declaration urges Member countries to develop and implement multisectoral policies across the life-course to address mental health risks and reduce treatment gaps exacerbated by the COVID-19 pandemic to ensure that mental health services reach all those in need, close to where they live, without financial hardship,” the Regional Director said.

As part of the Declaration, Member countries agreed to develop country-specific targets to achieve universal primary care-oriented mental health services and mainstream mental health in policy planning, implementation, and evaluation.

The Paro Declaration also calls for increased funding for community-based mental health networks and continuous supply of medicines and rehabilitation, including occupational therapy for everyone who needed them, and strengthening of data gathering and reporting, implementation research and performance monitoring, to ensure context-sensitive improvement of mental health systems.

Around 1 in 7 people live with a mental health condition in the South-East Asia Region. The personal and economic distress and disruptions caused by the COVID-19 pandemic have widened the gaps in addressing mental health challenges, which include scarcity of human resources, low investment, stigma, inadequate prevention and promotion programmes, paucity of data, and lack of services in primary care settings.

The Declaration calls for ensuring an effective and comprehensive response to the mental health needs by establishing evidence-based and rights-oriented community mental health networks, and systematically planning for the deinstitutionalization of care for people with severe mental disorders.

Member countries committed to prioritizing fiscal space for health and universal health coverage, secure adequate investment for mental health services at the primary and secondary level, and mobilizing required additional resources in partnership with local and international stakeholders.

Strengthening capacity of primary health care system is the foundation for provision of mental health services and progress towards UHC, the health-related Sustainable Development Goals and the targets of WHO Comprehensive Mental Health Action Plan 2013–2030. Member countries committed to expanding specialized and non-specialized mental health workforce by identifying new cadres of health-care personnel who are especially trained, equipped and skilled for the delivery of mental health services at the primary care level and work as part of multidisciplinary teams within the health sector.

Community empowerment and active engagement of people with lived experience helps reduce stigma and discrimination against people with mental disorders, family members and caregivers.

Strengthening national and subnational level prevention and promotion programmes helps achieve the well-being of all by addressing suicide and self-harm, substance use, consumption of harmful digital entertainment, bullying and parenting issues. Member countries committed to lead the multisectoral mental health response by guiding and harmonizing the social, education, development and economic sectors to address determinants of mental health, such as poverty, lack of education, social isolation, emergencies and impact of climate change and set country-specific targets to achieve universal primary care-oriented mental health services.

Several Member countries in the Region have already taken action to strengthen policies, plans, laws and services to improve the mental health of populations. Replicating and scaling up successful models and innovative interventions, harnessing digital technologies and telemedicine to improve access to services and capacity-building of health-care workers, and using evidence and data for programme improvement will help make the Region withstand future mental health impacts exacerbated by humanitarian emergencies, climate change and economic downturns.

WHO Regional Committee for South-East Asia has promulgated several important resolutions related to mental health. These include alcohol consumption control – policy options; noncommunicable diseases, mental health and neurological disorders; comprehensive and coordinated efforts for the management of autism spectrum disorders and developmental disabilities; and SEA Regional Action Plan to implement the Global Strategy to reduce harmful use of alcohol.

WHO will continue to support in strengthening countries in reorienting primary care for mental health through task-sharing; capacity-building for mental health and psychosocial support during emergencies, and establishing a regional knowledge and training hub for coordinating evidence and data generation, prioritizing areas of research and facilitating exchange of experiences, based on identified needs.

6 September 2022 News release Paro, Bhutan | 6 September 2022

September 6, 2022 0 comments

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