SHARING ON PRE-JAR VISIT OF KAILALI & DADELDHURA FEB 09-13, 2015

Transcription

1 SHARING ON PRE-JAR VISIT OF KAILALI & DADELDHURA FEB 09-13, 2015

2 PARTICIPATION MOHP MANAGEMENT DIVISION CHD LMD NHEICC UNICEF UNFPA KOICA GIZ CARE USAID

3 OBJECTIVES To observe progress on readiness of implementation of health insurance scheme in Kailali To observe implementation of community ANM program in Dadeldhura

4 INSURANCE PROGRAM KAILALI

5 ORGANIZATIONAL STRUCTURE

6 PROGRESS AND PLAN NSHI District Unit established in Kailali What the unit has done Held orientation workshop about the insurance for DPHO, DDC, public health facilities (120 participants) Preparing contracts with the service providers Finished w/ IMIS training What the unit will do Participate in additional trainings on IMIS and SOP Sign contacts w/ service providers Hire enrollment assistants Conduct awareness campaign on the health insurance

7 OBSERVATION 1 NSHI District Unit Low capacity and insufficient office setup Central-level support required to improve their knowledge on health insurance, management capacity, coordination and reporting system Need to clarify TOR

8 OBSERVATION 2 Kailali DPHO and DDC Welcome and willingness to implement the health insurance scheme (ex. suggest their potential roles by themselves) DPHO : Monitor and coordination w/ service providers DDC : Coordination w/ VDCs and monitor social mobilizers for awareness campaign (FM radio, citizen forum, FCHV etc.) Asked for official instruction with guidelines from centrallevel to clarify their roles and responsibilities in terms of implementation of the insurance scheme

9 OBSERVATION 3 Service Provider ( 7 ) - Seti zonal and Malakheti Hosp. High utilization of services (covering Kailali & even neighboring districts) Referral mechanism Ask for sufficient support to improve their service readiness prior to implementation of the insurance Fulfill sanctioned posts (MDs) Drugs Equipment Seti Zonal Hosp. Free Services+ NSHI 2 District Hosp. (Tikapur and Malakheti) Free Services+ NSHI 4 PHCCs Free Services+ NSHI 37 HP/SHPs Free Services

10 RECOMMENDATION Central-level Central-level organizational setup needs to be done - Social Health Security Development Committee needs to function soon NSHI operational guidelines, SOP, related official documents(from MOHP/UNIT to other related ministries) to pass down to the 3 districts Strengthen capacity of NSHI district unit Prioritize fulfilling doctors, supply of drugs and equips in the 3 districts Incorporate in MCPM indicators

11 RECOMMENDATION District-level Organize regular meetings among the Unit, DPHO and DDC to share progress and discuss effective social mobilization method at district level Incorporate NSHI into district periodic and annual plan Utilize collaborative framework (CF) as an opportunity Incorporate lessons learnt from social security unit Develop district level resource pool on insurance

12 COMMUNITY ANM PROGRAM DADELDHURA

13 BACKGROUND Community ANM program started in community ANMs recruited 2-5 ANM assigned per VDC 2-3 wards are being assigned to each community ANMs Get monthly salary of NPR A 3-day induction training was offered before placement

14 WHAT C0MMUNITY ANM DOES Collect socio-demographic and health information Health education using BPP and other tools Support FCHV in mothers group meeting School health education Home visit of pregnant and postpartum mother FP counseling, support outreach clinic Growth monitoring and nutrition education Link missed child to immunization Weekly reporting in health facility (HF) Qualified female HW in the community is a strength

15 CHANGES More accurate data available Ward-wise listing of pregnant mother Improvement in health indicators ANC (30 to79%) PNC (0 to 77%) CPR (34 to 44%) Immunization- 11 fully immunized VDC Institutional delivery: (34 to 61%) Community acceptance/engagement FCHVs are happy- reinforce the messages Mothers group are regular Some VDCs managed waiting rooms VDC watch group has EOC fund

16 INNOVATION Immunization record on birth certificate Hand washing technology Community score card

17 CHALLENGES Remote wards are still remote-distance and security High drop out rate (36.66%) High demands for treatment role Overlap with FCHV Same remuneration for all Many staff in HP: contractual ANM from NPC, District, VDC Peer support and mentoring Record keeping (bulky and heavy) Home delivery still high

18 RECOMMENDATION A standard induction package Annual review with health workers at HF Multi-year contract Basic salary should be equal of government ANM with additional field allowance as per remoteness Treatment roles of FCHV Community health unit with birthing facility Supervision & monitoring linked with onsite coaching Revision of TOR (include NCD, social security) Local partnership for scale-up Maternity waiting room

19 MEMORIES

20 MEMORIES

21 THANKS FOR YOUR TIME