- Dr. Bikas Lamichhane Regional Director, MWRHD, Surkhet A GLIMPSE OF MID-WESTERN REGION - Dr. Bikas Lamichhane Regional Director, MWRHD, Surkhet 2070 Mansir 11 ( Nov 26-2013 )

BASIC INFORMATIONS Indicator MWR Nepal Population Land Area sq.km. 3546682 26494504 Land Area sq.km. 42378 147281 Cultivated Land 8%  18% Over all Literacy % 64.21 65.94 Per capita Income (PPP US $) 1192 1597 Life Expectancy 57.21 64.1 Districts with HDI Value <0.4 10 15 Population below poverty line 31.68 25.16 Toilet Users Households % 51.41 61.83 ODF Districts 2  10 Improved Drinking Water user Hhlds % 75.14 85.35 Iodised Salt User %( > 15 PPM) 55.2 72.3 Source : NPHC 2011, HDR, NLSS 2010-11, NMICS-2010 BASIC INFORMATIONS

POPULATION DISTRIBUTION & ACCESS TO HFs Humla Population per Doctor = 31952 9 Mugu Population per Nurse = 4648 Jumla Kalikot Dolpa Dailekh Jajarkot Rukum Surkhet Bardiya Salyan Rolpa Banke Pyuthan Dang Source : NPHC 2011, NLSS 2010-11

PUBLIC HEALTH FACILITIES Total Public HFs = 599 Population per HF = 5921 No. of SHP Upgraded to HP In 2069/70 = 67

PRIVATE HEALTH FACILITIES District Numbers Pyuthan 1 Rolpa 2 Rukum Salyan 4 Dang 14 Banke 18 Bardiya Surkhet 8 Humla No. Of Private Institutes Aproved By RHD till now = 51 HF Type Numbers Hospital 25 Polyclinic 8 Lab 6 Dental Hospital/Clinic 4 Clinic/Medical Nurshing Home 2 Eye Hospital 1 Technical Institute No. Of Private Institutes Aproved By RHD in 2069/70 = 17

HUMAN RESOURCE SITUATION Vacant Posts = 26.85%

HUMAN RESOURCE SITUATION

HUMAN RESOURCE SITUATION Doctor Vacant = 62.16%

EONC SITES ,BIRTHING CENTERS & SAS Expected Live Birth per Birthing center in Average= 266 PHCC HP SHP Ayurved Hospital Total 11 168 153 1 350 EONC Sites : CEONC Sites BEONC Sites Total Govt. Hospitals Pvt. Hospitals Hospitals (Govt.) PHCCs 7 4 10 17 38 Safe Abortion Service Sites : Number of EONC Sites per 500,000 Population = 7 Government Other Total 43 21 64

Ambulance Service Situation Districts Public Private/NGO Total Registered Functional Dang 11 24 35 Banke 2 1 26 25 Surkhet 4 13 17 Bardiya 5 7 12 Pyuthan 3 8 6 Rolpa Rukum Dailekh Jumla Salyan Jajarkot MW Region 34 29 79 77 113 106 * Districts with no functional Ambulance are : Kalikot, Dolpa, Mugu & Humla

ACHIEVEMENTS TOWARDS NHSP-II   No. Of HF /5000 Population % of dist.with at least one public HF providing all CEONC function % of Healthposts with Birthing Centers % Of safe abortion Sites % of HF with at least 5 FP Methods MWR 0.8 53 61 100 (64)  16 National 0.5 68 79 91 13 Target 2015 1 76 ≥80 ≥90 60

ACHIEVEMENTS TOWARDS NHSP-II Indicators 2001 2006 2011 Target 2015 MWR Nepal TFR 4.6 4.1 3.5 3.1 3.2 2.6 2.5 IMR 72.9 64 97 48 58 46 32 % Stunted< 5 yrs 53.8 51 57.9 49 50.3 40.5 28 % Under weight <5 yrs 52.2 43 43.4 39 36.9 28.8 29 % Wasted < 5 yrs 8.2 11 11.6 13 11.3 10.9 5 Source : NDHS

ACHIEVEMENTS TOWARDS NHSP-II Indicators 2001 2006 2011 Target 2015 MWR Nepal % Infant breast fed within 1hrs 65.5 31 32.5 35 46.8 44.5 60 Neonatal mortality rate 40.5 39 57 33 34 16 Unmet need for Family planning   27.8 24.6 26.1 27 18 CPR 35.4 43 44.2 42.8 43.2 67 Source : NDHS

ROUTINE IMMUNIZATION COVERAGE :MWR EPI ROUTINE IMMUNIZATION COVERAGE :MWR

MEASLES COVERAGE EPI

IRON DISTRIBUTION COVERAGE AMONG PREGNANT WOMEN (NEW) NUTRITION IRON DISTRIBUTION COVERAGE AMONG PREGNANT WOMEN (NEW)

ANTIHELMENTHIC SUPPLEMENTATION COVERAGE AMONG PREG. WOMEN NUTRITION ANTIHELMENTHIC SUPPLEMENTATION COVERAGE AMONG PREG. WOMEN

VITAMIN A SUPPLEMENTATION COVERAGE AMONG POSTPARTUM MOTHERS NUTRITION VITAMIN A SUPPLEMENTATION COVERAGE AMONG POSTPARTUM MOTHERS

ANC 4TH VISIT AS % OF EXPECTED PREGNANCY SAFE MOTHERHOOD 80

DELIVERY BY SBA AS % OF EXPECTED PREGNANCY SAFE MOTHERHOOD

DISTRICTS CATEGORIZED BASED ON DELIVERY BY SBA SAFE MOTHERHOOD DISTRICTS CATEGORIZED BASED ON DELIVERY BY SBA <20% delivery 20-40% delivery 40-60% delivery >60% delivery FY 2012/2013 (2069/2070)  1 District Dolpa (18%)   9 districts Bardiya (39%) , Kalikot (33%) , Rukum (33%), Humla, Pyuthan (25%), Rolpa (30%), Salyan (29%) , Jajarkot (21%), Jumla (29%) 3 Districts Dang (45%) Mugu (40%) Surkhet (53%) 2 Districts  Banke (61%) Dailekh (62%) FY 2011/2012(2068/2069) No Districts 10 Districts Pyuthan (20%), Dolpa (21%) Rukum (22%), Jajarkot 24%) Salyan (26%), Rolpa (26%) Jumla (29%), Humla (32%) Kalikot (35%), Bardiya (37%) 4 Districts Dang (43%) Mugu (47%) Dailekh (57%) Surkhet (59%) 1 District Banke (86%) (Referral center) NHSP-II target is 60% MWRHD Surkhet www.mwrhd.gov.np email: rhdsurkhet@gmail.com

% OF INSTITUTIONAL DELIVERY AS EXPECTED PREGNANCY SAFE MOTHERHOOD % OF INSTITUTIONAL DELIVERY AS EXPECTED PREGNANCY National 44 %

CONTRACEPTIVE PREVALENCE RATE FAMILY PLANNING 11 Districts CPR Below than National CPR

DISTRICTS CATEGORIZED BASED ON CPR FAMILY PLANNING <30% 30-40% 40-50% >50% 2069/2070 Mugu, Dolpa,Rukum,, Kalikot, Jajarkot 5 DISTRICTS Humla, Jumla Salyan, Dailekh 4 DISTRICTS  Rolpa, Banke Dang, Pyuthan Bardiya Surkhet   2 DISTRICTS  2068/2069 Jajarkot Kalikot Rukum 3 DISTRICTS Pyuthan, Rolpa Dolpa, Humla Dailekh, Salyan, Mugu 7 DISTRICTS Banke Dang Jumla 3 DISTRICTS  2067/2068 Rukum, Kalikot Dolpa, Mugu Jajarkot, Dailekh Salyan, Rolpa Bardiya, Dang Pyuthan, Jumla, Humla

% OF HEALTH POSTS WITH 5 FAMILY PLANNING METHODS Below 16 (Regional) = 8 Districts

PROPORTION OF NEW VSC PROVIDED ( Target vs Achivement) FAMILY PLANNING PROPORTION OF NEW VSC PROVIDED ( Target vs Achivement) Increasing Decreasing

TB CASE FINDING RATE (%) MDG Target Less than 60 – 5 DISTRICTS

TREATMENT SUCCESS RATE TB TREATMENT SUCCESS RATE All Districts above 80% MDG Target In Jumla 100% case finding and 100% Treatment Success

TOP 10 DISEASES ON THE BASIS OF NUMBER OF PATIENTS % 1 Respiratory Tract Infection (Upper, Lower, Pneumonia) 15.4 2 Skin Diseases (Scabies,Impetigo, abscess,Eczema, Fungal infection) 12.4 3 Diarrhoeal Diseases (Diarrhoea,Dysentry) 9.9 4 Headache (Migraine) 7.3 5 Gastritis (APD) 7.2 6 Intestinal Worms (Abdominal Pain) 7.1 7 Typhoid (Enteric Fever) 4.1 8 Falls/Injuries/Fractures 3.0 9 Conjunctivitis 2.9 10 Oral (Ulcer, mucosa and other related diseases, Dental) 2.8

ANNUAL PROGRESS S.N Name of District Number of Activities %Achivement % Expenditure 1 Banke 180 92 87 2 Bardiya 197 83 74 3 Dailekh 170 95 89 4 Dang 182 98 91 5 Dolpa 134 81 6 Humla 139 99 7 Jajarkot 156 90 8 Jumla 141 94 9 Kalikot 171 100 96 10 Mugu 131 11 Pyuthan 166 85 12 Rolpa 150 86 13 Rukum 14 Salyan 132 15 Surkhet 181 16  RHD 57 Regional Total 2428 ANNUAL PROGRESS

ANNUAL PROGRESS : DISTRICT CATAGORIZATION >90 80-<90 60-<80 <60 Physical 13 DISTRICTS : Banke, Dailekh, Dang, Dolpa, Humla, Jajarkot, Jumla, Kalikot, Mugu, Pyuthan, Rukum, Salyan, Surkhet, Rolpa 2 DISTRICTS Bardiya, Rolpa NO DISTRICTS Financial 9 DISTRICTS Banke, Dang, Jajarkot, Jumla, Kalikot, Mugu, Salyan, Surkhet, Rolpa 5 DISTRICTS : Dailekh, Dolpa, Humla, Pyuthan, Rukum 1 DISTRICT Bardiya NO DISTRICTS

PROGRAMMEWISE ANNUAL PROGRESS IN MWR

MAJOR ACTIVITIES CARRIED OUT IN 2069/70 Uterine Prolapse camp conducted in 10 districts (Pyuthan, Rolpa, Rukum, Dang, Salyan, Banke, Bardiya, Surkhet, Dailekh, Kalikot) for 1,588 cases. DQSA Conducted in 5 districts, shared & feedback given to districts & HFs. IMCI Training conducted for newly recruited Health workers. Full immunization VDCs initiated. New 41 Birthing centers established.

MAJOR ACTIVITIES CARRIED OUT IN 2069/70 Measeles Rubela campiagn conducted in 9 districts (Dolpa, Mugu, Humla, Jumla, Kalikot, Dailekh, Jajarkot, Rukum, Salyan) Internal review surveillance conducted for Vaccine Prevetable Diseases (VPD) Special TB programmes were conducted for marginalized population & hard to reach area. Microscopy centers were expanded in Rolpa-2, Dang-1 & Banke-1 districts.

MAJOR ACTIVITIES CARRIED OUT IN 2069/70 TB/HMIS orientation programmes were conducted to reduce data variation. Management Of Community Based Rehabilitation (MCBR) training conducted. Five Health workers were awarded by RHD for best performance. Five best performer health workers including FCHV were nominated for national tuberculosis award. Hydrocele Camp conducted in Banke & Bardiya (60 cases)

MAJOR ACTIVITIES CARRIED OUT IN 2069/70 Filariasis Campiagn(MDA) in 10 districts excluding Karnali zone with 72% achievement. Recruitment of HA (45), Staff Nurse (13) , AHW (59) & ANM (73) as temprory. Total=190 Recruitment of technical assistance staffs on contract (45 persons) . Scaling up of 67 SHP to HP Beruju Submitted for regulation (Rs.7400,000 ) Vehicle handed over to DPHO Bardiya. Regular RHCT Meeting.

ISSUES & CHALLANGES Human resource (27% Vacant) , Retention. Geographical, Financial, Socio-cultural barriers for proper service accessibility. Utilization of Services Quality of Services Mobile Population Strange Health-seeking Behavior. Inadequate/Poor Infrastructure.

RHD Surkhet : New Building

RHD Surkhet New Building : Seepage in ceiling & wall

RHD Surkhet New Building : Seepage in ceiling & wall

RHD Surkhet New Building : Seepage in wall

RHD Surkhet New Building : Seepage in ceiling & wall

MW Regional Hospital : New Building

MW Regional Hospital : New Building

MW Regional Hospital : New Building Wall

MW Regional Hospital : New Building Wall

Rapti Sub-Regional Hospital’s Lab: Top Ceiling

Rapti Sub-Regional Hospital : Wall

Rapti Sub-Regional Hospital : Wall

NEED TO FOCUS Special Package of HR retention in Karnali zone. Rational Incentive Schemes. Population & topography based resource allocation. Capacity enhancement of HFOMC for effective coordination with local bodies. All actors (GoN/NGOs/INGOs/Private) need to focus jointly in rural areas , particularly poor & excluded groups

OUR PARTNERS (RHCT) 1. H4L 15.Save the Children 2. KISAN 16.NRCS/CEHP 3. GIZ- HSSP 4. Plan 5. UNFPA 6. UNICEF 7. PSI 8. ADRA 9.FHI 360(SSP) 10.CARE 11. WHO-IPD 12.WFP 13. INF 14.BNMT 15.Save the Children 16.NRCS/CEHP 17.FPAN 18.Nepalguj Medical College 19.NSI 20. MI 21.Western Hospital 22.Kausalya Memorial Hospital 23.United Hospital 24.Susma Koirala MemorialTrust 25. NHSSP 26. Sajhedari

THANK YOU