Primary Health Care Revitalization in Nepal

Introduction

The Government of Nepal (GON), as a signatory to the Alma Ata Declaration of 1978, is fully aware of the significance of maintaining adherence to Primary Health Care (PHC) techniques for the creation of coordinated, high-quality health care services for residents of both rural and urban areas. PHC must be planned for and carried out within the framework of general development because it is a strategy for social and economic advancement.

Components and Functions of PHCRD

• Health Education Program
  • The National Health Education, Information and Communication Center (NHEICC), formerly a division of the Department of Health and Human Services, was established in 1998 as an independent organization with the mission to increase public health awareness in order to promote health and prevent disease by fully utilizing available community resources. To prevent communicable diseases, water-borne diseases, feco-oral diseases, TB, leprosy, and to promote healthy behavior, use of family planning, and safe motherhood, the Center has created and disseminated audio-visual aids, media programs, TV spots, calendars with health messages, flip charts, and many other materials.
• Nutrition
  • The Department of Health and Human Services (DoHS) developed a nutrition section as early as 1970 to support and train health professionals in nutrition education, prevention, and treatment of protein and energy malnutrition as well as deficiencies in micronutrients, vitamin A, and iodine. Nutrition is one of Nepal's major challenges, especially for nursing mothers and kids under the age of five, according to nutritional studies conducted in various years. DoHS collaborates with initiatives in agriculture, education, women's empowerment, and poverty alleviation to enhance the nutritional status of children through a variety of activities.
• Water and Sanitation
  • Different departments outside of the MOH established an initiative to promote water and sanitation. The Ministry of Local Development, the Ministries of Housing and Physical Planning, and the Department of Drinking Water and Sewerage are the primary providers of clean, safe water to drink and better sanitation in the nation. With support from the World Bank and the Asian Development Bank and with the help of the local community, which included a council of water users, the GoN initiated a special program in 1987 because water and sanitation have been defined as one of the fundamental necessities. At the request of the UN, Nepal observed the International Drinking Water Supply and Sanitation Decade (1981–90).
• FP/MCH
  • Family planning and maternal and child health care services have been given top emphasis in the delivery of healthcare through public health facilities since the early 1980s. PHO services are offered at District Health Office clinics as well as facilities at the Primary Health Care Center (PHCC), Health Post (HP), and Sub Health Post (SHP) levels. Female Community Health Volunteers (FCHVs) at the household level counsel mothers and disperse oral rehydration packets, condoms, tablets, folic acid, and vitamin A. In addition to conducting home visits, the Maternal and Child Health Worker (MCHW) job was developed and trained to offer ANC, delivery, and postpartum care from SHP. Additionally, they were taught how to handle complicated obstetric cases with first aid before referring the patient to the proper care facility. They received an Emergency Obstetric Kit box (EOC Kit) filled with obstetric medications that could save their lives.
• Expanded Program of Immunization
  • Following the success of the smallpox eradication effort, which began actively reducing morbidity and mortality from diseases that might be prevented by vaccination in children under the age of five, the Expanded Program for Immunization (EPI) was introduced. The vaccine against diseases like Polio, Tetanus, Measles, TB, Diphtheria, and Whooping Cough was covered. Health professionals at the community level (VHW/MCHWs) distributed vaccines through the PHC service delivery network. Due to the PHC method, vaccination coverage increased from BCG-32%, DPT * 3 -16%, and measles - 12% in the year 1980 to 83%, 89%, and 85% respectively in the year 2005.
• Control of Locally Endemic Diseases
  • Through the national Control of Diarrheal Disease (CDD) Program, the DoHS made significant efforts to control diarrheal diseases among children under the age of five. 45,000 kids died of diarrhea in 1986. The incidence of diarrhea has significantly decreased among children under 5 years of age as a result of a national program that has placed a strong priority on reducing diarrheal morbidity and death. Oral rehydration solution distribution, the creation of ORT stations, and extensive health education were the programs that were implemented. In the last five years, the percentage of severe diarrhea has declined from 10% to 4%, and the annual case fatality rate has decreased. In a similar vein, the Acute Respiratory Infection (ARI) Program was launched with the goal of reducing pediatric ARI-related mortality. The knowledge and expertise of health professionals are crucial to the community-based ARI management approach. In the last five years, the case fatality rate for severe pneumonia has decreased from 13 to 4 per 1000. Over a 15-year period, the infant mortality rate (IMR) has decreased by 41%. The mortality rate for children under 5 has been decreased by 48%, from 117 fatalities per 1000 live births to 61.
• Control of Locally Endemic Diseases 
  • To treat common illnesses and injuries, MoPH provides infrastructure ranging from SHP level to tertiary care centers. In addition to private nursing homes in metropolitan areas, private sector providers primarily the new medical institutions have constructed enormous infrastructure for this. The NGO sector has proved useful in delivering services in rural locations. Because of the challenging geography, injury has been an important aspect of health care. In the rural districts, general practitioners with expertise in bone setting are employed. A trauma center is being built for referral needs. As part of routine HMIS activities, the precise number of OPD attendants encompassing health, other GON facilities, and the private sector needs to be compiled.
• Essential drugs
  • According to reports, the accessibility of medicines and other healthcare supplies has increased over time. The recently finished Joint Annual Review of NHSPIP noted in its Aide-Memoire that while progress has been made in the areas of drug procurement, logistics, and availability, the system's stability will be put to the test by the free care policy. The "Pull" approach should be put into place more quickly because first results are positive. When services are made available for free and demand rises, this will ensure that pharmaceuticals are available in all institutions.

Goal of PHCRD

The following issues must be resolved if we are to attain health goals in general and the health MDG in particular, notwithstanding the significant progress many nations have made in integrating PHC into their health systems.

• Misunderstandings of the Primary Health Care Concept
• The cost of diseases
• Health equity Rising health-care costs
• Agreements for trade
• Interdependence of the world 
• Interdependence of the world 
• Need for additional study
• How to pay for the health system
• Integrated services are required.
• Public-private collaboration
• Climate Change

Objectives and activities of PHCRD

A three-year interim health plan covering 2007–2008 through 2009–2010 has been created. The goals and actions outlined in this plan will serve as a roadmap for future action. Some of the crucial actions during the first phase of the planning cycle are as follows in order to accomplish the goals:

• In accordance with the concepts of primary healthcare, equity, and social justice, to strengthen ongoing, high priority EHCS and accomplish MDGs.
• To restructure the healthcare system through management and training for health professionals to make it people-oriented, effective, and efficient.
• To guarantee that everyone has access to cheap, high-quality services and critical medications.
• To make public-private partnerships stronger.
• To create a planning and budgeting system that is performance-based.
• To improve the financial information system, including feedback and monitoring
• To promote the use of decentralization strategies in the delivery of health services.
• To increase the skills of the health professionals and other key players in the management and operation of healthcare facilities.

Issues challenges and action

The following health concerns and difficulties await implementation of the PHC methodology and principles:

• Changes in the population and the epidemiological transition
• Public-private collaboration
• Integrating vertical and horizontal programs to improve care quality Planning at the local level and decentralization Way ahead
• Addressing social determinants of health in order to address concerns of equity in health

Components

• National Free Health:
  • Increase outreach efforts, provide free primary care, and establish community health centers
• Social Health Protection:
  • Encourage social auditing to improve health governance
• Urban Health:
  • In conjunction with MOFALD and local governments, increase and improve primary care for residents of urban regions.
• Non-communicable Diseases:
  • Pilot and expand the PEN package for NCD with an emphasis on diabetes, chronic obstructive pulmonary disease, heart disease, and mental health.

Objectives:

• To fulfill the law's mandate of provide free basic health services to all citizens.
• To provide simple access to medical services.
• To offer high-quality medical care.
• To offer health services for the disabled, the needy, and the underprivileged in metropolitan areas.
• To effectively supply free health services in order to fulfill the MDGs for the health sector.
• To create programs and strategies for the future that are compatible with ongoing monitoring and assessment of the free medical services.
• To put health insurance into place.
• To put a mechanism into place that protects citizens' rights to a clean environment.
• To encourage community involvement for local collaboration.