ANNUAL HEALTH REPORT- 2076/77 (2019/20)-DoHS
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The annual report of the Department of Health Services (DoHS) for fiscal year 2076/77 (2019/20) is the twenty-sixth consecutive report of its kind. This report focuses on the objectives, targets and strategies adopted by Nepal’s health programmes and analyses their major achievements and highlights trends in service coverage over three fiscal years. This report also identifies issues, problems and constraints and suggests actions to be taken by health institutions for further improvements.

The main institutions that delivered basic health services in 2076/77 were the 134 public hospitals including other ministries, the 2,277 non-public health facilities, the 194 primary health care centres (PHCCs) and the 3,767 health posts. Primary health care services were also provided by 11,589 Primary Health Care Outreach Clinic (PHCORC) sites. A total of 16,698 Expanded Programme of Immunization (EPI) clinics provided immunization services. These services were supported by 49,481 Female Community Health Volunteers (FCHV). The information on the achievements of the public health system, NGOs, INGOs and private health facilities were collected by DoHS’s Health Management Information System (HMIS).

Contents Highlights

Executive Summary

The annual report of the Department of Health Services (DoHS) for fiscal year 2076/77 (2019/20) is
the twenty-sixth consecutive report of its kind. This report focuses on the objectives, targets and
strategies adopted by Nepal’s health programmes and analyses their major achievements and
highlights trends in service coverage over three fiscal years. This report also identifies issues,
problems and constraints and suggests actions to be taken by health institutions for further
The main institutions that delivered basic health services in 2076/77 were the 134 public hospitals
including other ministries, the 2,277 non-public health facilities, the 194 primary health care centres
(PHCCs) and the 3,767 health posts. Primary health care services were also provided by 11,589
Primary Health Care Outreach Clinic (PHCORC) sites. A total of 16,698 Expanded Programme of
Immunization (EPI) clinics provided immunization services. These services were supported by 49,481
Female Community Health Volunteers (FCHV). The information on the achievements of the public
health system, NGOs, INGOs and private health facilities were collected by DoHS’s Health
Management Information System (HMIS).

Progress of other departments under MoHP:

Department of Drug Administration (DoA)
Government of Nepal has promulgated the Drug Act 1978, to prohibit the misuse or abuse of
medicines and allied pharmaceutical materials as well as the false or misleading information relating
to efficacy and use of medicines and to regulate and control the production, marketing, distribution,
export-import, storage and utilization of those medicines which are not safe for the use of the
people, efficacious and of standard quality.
In accordance with the objectives of the National Health Policy 1991, the National Drug Policy 1995
has been formulated and implemented. It focuses on establishing co-ordination among government,
non-government and private organizations involved in the activities related to medicine production,
import, export, storage, supply, sales, distribution, quality assessment, regulatory control, rational
use and information flow. Achieving the aims and objectives of National Drug Policy is another
important area for DDA.

Department of Ayurveda and Alternative Medicine (DoAA)
The primarily manages the delivery of Ayurveda & Alternative Medicine services and promotes
healthy lifestyles through its network facilities all across the country. The Department of Ayurveda &
Alternative Medicine, one of the three departments of the Ministry of Health & Population (MoHP)
is responsible for programming, management of information, and supervision, monitoring and
evaluation of the Ayurveda Service programs. Fifteen plan of government of Nepal (2019/20-
2023/24) has guided planned development & expansion of Ayurveda, Naturopathy, Homeopathy &
other alternative medicines.
Ayurveda is an ancient medical system and indigenous to Nepal with deep roots. The sources of
Ayurvedic medicine are medicinal herbs, minerals and animal products. The system works through
simple and therapeutic measures along with promotive, preventive, curative and rehabilitative
health of people. Ayurveda health services are being delivered through one Central Ayurveda
Hospital (Nardevi), one Provincial Hospital (Dang), 14 Zonal Ayurveda Dispensaries, 61 District
Ayurveda Health Centers and 305 Ayurveda dispensaries across the country. The Ayurveda and

Alternative Medicine unit in the Ministry of Health & population (MoHP) is responsible for
formulating policies and guidelines for Ayurveda and other traditional medical system.

Programs under Department of Health Services:

National Immunization Program (NIP)
National Immunization Program (NIP) was started in 2034 BS and is a priority 1 program of
Government of Nepal. It is one of the successful public health programs of Ministry of Health and
Population, and has achieved several milestones contributing to the reduction in child morbidity and
mortality associated with vaccine-preventable diseases. In July 2019 (FY 2076/77) Nepal along with
Bangladesh, Bhutan, Nepal and Thailand become the first countries in WHO South-East Asia Region
to achieve Hepatitis B control, with prevalence of the deadly disease dropping to less than one per
cent among five-year-old children through immunization.
In FY 2076/77, Nepal became one of the few countries to complete its nation-wide vaccination
campaign as well as introduce a new vaccine (Rota Virus Vaccine) in its routine immunization even
during the COVID-19 pandemic. Rotavirus vaccine which is one of the major causes of child mortality
was introduced in NIP on 02 July 2020 with GAVI support to combat diarrhoeal diseases due to
rotavirus. This was integrated with hygiene promotion through routine immunization in NIP.

The nation-wide Measles Rubella Supplementary Immunization Activity (MRSIA vaccination
campaign) for children above 9 months to under 5 years was conducted in FY 2076/77 in two
phases: First phase was conducted in Province 1, Province 2 and Lumbini Province in the month of
Falgun 2076 and Second phase in Province 3, Gandaki Province, Karnali Province and Sudurpashchim
Province in the month of Chaitra 2076 extended till Ashad 2077 due to COVID-19 pandemic.One
dose of bOPV vaccination during the MR SIA was given to under 5 years age children in selected 19
high-riskdistricts in Terai. The administrative national coverage achieved for MRSIA was 101% and
for bOPV SIA, the coverage (in 19 selected districts) was 112%.
National administrative coverage of BCG is 86% which has decreased by 5 percentage points, DTPHepB-
Hib3 has decreased by 8 percentage points and OPV3 which has decreased by 7 percentage
points in FY 2076/77 compared to the previous year. PCV 3 coverage is 78% which has decreased by
3 percentage points, whereas the coverage of MR1 is 80% which has decreased by 4 percentage
points compared to 2075/76. MR2 coverage is 71% which has decreased by 2 percentage points
compared to the previous FY 2075/76. For measles elimination, high coverage of both MR 1 and 2
are required (≥ 95%). Therefore, coverage of both MR 1 and MR 2 is still not satisfactory. In FY
2076/77, the coverage of JE vaccine is 78% which has decreased by 3 percentage points compared to
the previous year. The coverage of fIPV is 69% in FY 2076/77. There was sharp decline of all
vaccination coverage due to COVID-19 pandemic and lockdown. Nevertheless, the program was able
to bring back its monthly vaccination coverage at or above its pre-pandemic level before the end of
FY 2076/77. However, the decline of vaccination coverage due to COVID-19 pandemic affected the
overall annual vaccination coverage with decrease in coverage of almost all vaccine in the FY

For DPT-HepB-Hib3, MR1 and Td2/Td2+, Province 2 has reported the highest coverage, whereas for
MR2, Lumbini Province has reported the highest coverage. Bagmati Province has reported relatively
lower coverages for these four antigens and the reporting rate for immunization dataset in HMIS for
Bagmati Province is the lowest (62.8%), which needs to be improved. The national dropout rates for
BCG vs MR1 and DPT-HepB-Hib1 vs MR1 have decreased compared to previous year showing

improvement while DPT-HepB-Hib1 vs DPT-HepB-Hib3 has increased but all drop-out rates are
within 10%.
During the FY 2076/77, Nepal was able to maintain the cardinal surveillance performance indicators
for polio surveillance and measles-rubella surveillance which was above the global standards. The
achieved Non-Polio Acute Flaccid Paralysis (NP AFP) rate was 3.17 and Non-Measles Non-Rubella
(NMNR) rate was 3.78 for FY 2076/77.

Integrated Management of Neonatal and Childhood Illnesses
IMNCI is an integration of CB-IMCI and CB-NCP Programs as per the decision of MoHP on 2071/6/28
(October 14, 2015). This integrated package of child‐survival intervention addresses the major
problems of sick newborn such as birth asphyxia, bacterial infection, jaundice, hypothermia, low
birth-weight, counseling of breastfeeding. It also maintains its aim to address major childhood
illnesses like Pneumonia, Diarrhea, Malaria, Measles and Malnutrition among under 5 year’s children
in a holistic way.
In FY 2076/77, a total of 42,897 newborns cases were registered and treated at health facilities and
PHC/ORC which is higher than that of previous FY by 13,788 cases. Province 1 had highest number of
registered cases (7,945) with least in Gandaki province (2,787). Out of total registered cases in FY
2076/77, 9.89% cases were classified as Possible Severe Bacterial Infection (PSBI) which is slightly
less than that of previous year (11.7%).
The proportion of PSBI was highest in Karnali Province (17.7 %) and least in Gandaki Province (6.9%).
Among the total registered cases at the national level (HF and PHC-ORC level), 50.9 percent cases
were classified as LBI, 3.4 percent as Jaundice, and 3.3 percent as Low Birth weight or Breast Feeding
Problem. The proportion of LBI increases than that of previous year (from 43.7% to 50.9%) but the
proportion of Jaundice and LBW decreased compared to last year. Among the total registered cases
the proportion of LBI was highest in province 2 (61.4%) followed by Province 1 (57.1%) with the least
in Lumbini Province (37.4%). Among total cases, 4.4% percent cases were referred and 0.26 percent
were reported dead from health facilities and PHC-ORC level. 10,828 sick newborn were identified
by FCHV. Among them 18.5% were treated with amoxicillin and referred. 936 newborn were
identified dead by FCHV.

Total 10,13,002 cases of diarrhoea was identified by HF, ORC and FCHV in total where 3,14,909 were
identified at HF and ORC whereas 6,98,093 were identified by FCHV on 2-59 months children.
Likewise 20,13,891 2-59 children were estimated to have been prone to diarrohea. The incidence of
diarrhoea was 350/1000 and the case fatality rate was 0.15/1000 under 5 children. 94.8 percent of
diarrhoeal cases children were treated with zinc and ORS including HF, ORC and FCHV whereas 0.27
percent were given IV fluids.
Similarly, estimated 30,13,891 under 5 children were estimated to have been prone to ARI. Total
7,96,709 children were identified to have ARI in HF and ORC in FY 2076/77 which is 594/1000 under
5 years children. Among total ARI cases found in HF and ORC, 16.2 percent were identified having
pneumonia whereas 0.22 have severe pneumonia. 156 percent of pneumonia cases were treated
with antibiotic. 105 under five children died due to ARI in HF and ORC with case fatality rate of 0.13
per 1000. In FY 2076/77, 9,93,402 ARI cases were identified by FCHV.
The total of 92 falciparum and 439 non falciparum malaria cases, 922 measles cases, 90384 ear
infection, 6,365 severe malnutrition and 3,768 anaemia cases were identified among under five
children as per CBIMNCI protocol.

The National Nutrition Programme is priority programme of the government. It aims to achieve the
nutrition well-being of all people so that they can maintain a healthy life and contribute to the
country’s socioeconomic development. There is a high-level commitment to improve the nutritional
status especially of Adolescence, Pregnant and Lactating mother, and Children under five.
In the FY 2076/77 the percentage of new-born with low birth weight (<2.5 kg) was13 %. Nationally in
these fiscal years average number of growth monitoring visit per child (0-23) months is 3.1. Sixty five
percent of the children age 0-23 months were registered for growth monitoring. From these 2.8 % of
the children were reported as underweight. During growth monitoring, 30% children were
exclusively breastfed, 6-8 months registered for growth monitoring who receive solid, semi solid or
soft foods was 30%.

Total 6567 children of 6 to 59 months with SAM admitted in outpatient therapeutic centers. Among
all discharged SAM cases, 75 percent were recovered, less than 1 percent died and 24 percent were
defaulter. Similarly, 1671 children were admitted in Nutrition Rehabilitation Home (NRH). Out of
these children 836 were male 835 were female. Among these NRH children 1670 children were less
than five years, 1 were more than or equal to five years. From these total discharge children were

  • In context of micronutrient supplementation, the compliance of taking 180 IFA tablets
    throughout the pregnancy is 44 percentand post-partum women receiving IFA tablet is 31%. 56%.
    Average 33 percent of children aged 6 to 23 months had taken their first cycle of MNP in the
    programme districts. Households using adequately iodized is 95 percent. Vitamin A supplementation
    coverage is around 85% and deworming tablet distribution coverage is 85%. Likewise, coverage of
    school deworming is 15 percent for girls and 16 percent for boys.

Nutrition in emergencies (NIE)
In addition to the regular programme, Nutrition Section of Family Welfare Division (FWD) of
DoHS/MoHP also provides essential and high-quality nutrition services in any types of emergencies.
Nutrition cluster in Nepal is very active lead by the Nutrition Section Family Welfare Division (FWD)
of Ministry of Health and Population (MoHP) co-leading with UNICEF. With the guidance of national
nutrition cluster, provincial nutrition clusters are formed, capacitated and activated in 7 provinces
(one in each province) led by concerned Provincial Health Directorates (PHD), and ongoing active
mobilization for the management of Nutrition in emergency preparedness and response in COVID-19
context. NiE interventions focuses on the adolescent populations, pregnant and lactating women
(PLWs) and children under five years of age as they are nutritionally the most vulnerable during any
type of emergency. Under NiE, following five pillar interventions are implemented in the affected
areas of the country.
Promotion, protection, and support to breast feeding of infant and young children aged
0-23 months.
Promotion of proper complementary feeding to the infant and young children aged 6-23
Management of moderate acute malnutrition (MAM) among the children aged 6-59
months and among PLWs through targeted supplementary feeding program (TSFP).
Management of severe acute malnutrition among the children aged 6-59 months
through therapeutic feeding.
Intensification of Micronutrient supplementation for children and women including MNP
and vitamin A for children aged 6-59 months, IFA for pregnant and postnatal women.

(a) Nutrition in emergency preparedness for response:
In nutrition cluster have more than 30 members agencies including Government, UN, Donors,
INGOs, local NGOs and professional expert organizations. After COVID-19 pandemic affected in
Nepal, 29 nutrition cluster meeting held jointly with provincial nutrition clusters of 7 provinces. To
strengthen the nutrition in emergency preparedness and response actions, nutrition cluster has
formed, capacitated and activates 7 technical working groups (TWG) and TWG have been providing
technical assistance on different aspects of nutrition in emergency preparedness and response
IYCF working group
IMAM working group
Micro-nutrient working group
Information management working group
Assessment working group
BCC working group
Nutrition in emergency preparedness and response planning TWG
In FY 2076/77, following preparedness actions were implemented:
Comprehensive nutrition specific interventions (CNSI) training has been ongoing
throughout the country and CNSI has strong chapter for NiE which is a strong part of
capacity building actions.
Formed, capacitated and activate nutrition clusters in all 7 provinces (one in each

Prepared/revised three nutrition in emergencies preparedness and response plan to
address nutrition issues in COVID-19 context, monsoon, earthquake and cold wave
Ongoing nutrition interventions tracking of each of the member agencies in each
month so that status of nutrition interventions has been identified nationwide.
Updated the nutrition cluster roster and mobilizing the trained human resources in
Prepared and ongoing implementation of nutrition emergency preparedness and
response plan in all 7 provinces to address nutrition issues in COVID-19 context and
monsoon flood/landslides.
Prepositioned essential nutrition commodities indifferent 8 strategic locations such
as Central Medical Store Pathalaiya, Bara and 7 medical stores of Provincial Health
Logistic Management Center of all 7 provinces.
Nutrition cluster developed different 7 guidelines to initiate the nutrition response
in COVID-19 context as; (i) Infant and Young Child Feeding (IYCF) interim guideline,
(ii) Integrated Management of Acute Malnutrition (IMAM) interim guideline, (iii)
Behavior change communication (BCC) guidance note, (iv) Blanket Supplementary
Feeding (BSFP) interim guideline, (v) National Vitamin A campaign guideline, (vi)
COVID Nutrition guideline with 8 menus targeting to COVID-19 infected people; (vii)
NRH interim guideline, and (viii) guideline for nutrition information system (NiS).

(b) Nutrition in emergency response:
In the COVID-19 context, nutrition cluster mobilized to all cluster partners, health workers and
FCHVs throughout the country. In this context, the following are the outcomes of nutrition cluster in

Treated 7,432 under five years children nationwide with severe acute malnutrition (SAM)
from different 623 outpatient therapeutic centers located in different health facilities and
21 nutrition rehabilitation homes (NRH) located in different hospitals
Provided Supercereal to 193,751 children aged 6-23 months and 283,410 pregnant and
lactating women for the prevention of malnutrition.
Provided relief package of nutritious foods to 118,029 households nationwide
Reached 4,358,880 households nationwide with radio messages on nutrition and COVID-19
through 210 FM radio services nationwide.
Reached 2,845,917 households with IYCF messages through SMS services.
Reached 1,083,769 pregnant & lactating women with IYCF and maternal nutrition messages
through SMS services.
Counselled 1,058,339 pregnant and lactating women on IYCF and maternal nutrition
through telephone and home visits.

Safe Motherhood and Newborn Health
Family Welfare Division (FWD) has been implementing National Safe Motherhood Programme to
reduce maternal and neonatal morbidity and mortality and improve maternal and neonatal health
through preventive and promotive activities and, by addressing avoidable factors that cause death
during pregnancy, childbirth and the postpartum period.
The percentage of pregnant women attending at least 4 ANC visits as per the protocol has increased
from 50 percent in 2074/75 and 56 percent in 2075/76 to 56.5 percent in 2076/77. Institutional
deliveries as percentage of expected live births have increased to 65.6 percent in 2076/77 from 55
and 63 percent in FY 2074/75 and FY 2075/76 respectively. The percent of institutional deliveries
conducted through CS in the FY 2076/77 increased upto 20 percent as compared 18 percent in the
FY2075/76.The percentage of births attended by SBA increased to 62.3 percent in FY 2076/77 from
60 percent FY 2075/76 and 52 percent from FY 2074/75. In FY 2075/2076, total 320 Municipals of
33 districts while in FY 2076/2077, 528 Municipals of 51 districts implemented onsite clinical
coaching and mentoring program based on coaching/mentoring guideline and Tool. The proportion
of mothers attending three PNC visits as per the protocol increased slightly from 16 percent in FY
2075/76 to 18.8 percent in FY 2076/77.

A total of 912 sites for MA, 604 sites for both MA and MVA and 22 sites for abortion in/after second
trimester were listed to provide safe abortion services till the FY 2076/77. Similarly, a total of 1,833
ANMs for MA, 743 nurses and 1,853 doctors (MBBS) for MA/MVA and 92 OBGYN or MDGPs have
been listed for in/after second trimester safe abortion services till the FY 2076 /77. The number of
safe abortion service users has decreased notably in this FY in comparison to last FYs. Total 87869
women have received safe abortion services (Comprehensive Abortion Care) in FY 2076/77 while
95746 in 2075/76 and 98,640 in 2074/75 had received safe abortion service (Comprehensive
abortion care). Among the total 87,869 women who had received safe abortion service, 60,338
women had received medical abortion whereas remaining 9,166 women had received surgical
abortion in the FY 2076/77.

Family Planning and Reproductive Health
National family planning programme (FP) in 2076/77 experienced a downturn in uptake of family planning
services both at National and Provincial. The modern contraceptive prevalence rate (adjusted mCPR)
for modern FP at national level is 37%. Province 2 has the highest mCPR of 44% while Bagmati
Province the lowest (32%). Nationally, current users (absolute numbers) of all modern methods have
decreased by 61,229 in 2076/77 than in previous year. The number of districts with mCPR below
30% has decreased from 13 in 2075/76 to 12 in 2076/77 indicating performance improvement

among the low mCPR districts. The current users of permanent methods as percentage of MWRA are
in decreasing trend while that of long acting reversible contraceptive (LARCs) is in increasing trend at
National level as well in Provinces except Province 2 and Bagmati. Among the total VSC users,
Female sterilization has the greatest share in Province 2, Province 1 and lumbini. Compared to SARCs
(short acting reversible contraceptives—pills and Depo), LARCs has low defaulter rate (IUCD-8%,
Implant-11%).The defaulter rate of IUCD and implant is in decreasing trend.
Depo (39%) occupies the greatest part of the contraceptive method mix for all method new
acceptors, followed by condom (23%), pills(21%), implant (12%), IUCD (2%), female sterilization (ML
2%) and lastly male sterilization (NSV 1%) in 2076/77. Nationally, new acceptors of all modern
methods (absolute numbers) have decreased by approx. 78,000. Immediate Postpartum family
planning uptake as proportion of total facility delivery in decreasing trend. Proportion of all
postpartum contraceptives (IUCD, Implant, tubectomy) has decreased in 2076/77 compared to
2075/76. Contraceptive uptake among total reported abortion services is 73%, but only 15% have
used LARCs indicating women after abortion are relying on less effective methods.

Adolescent sexual and reproductive health
National Adolescent Sexual and Reproductive Health (ASRH) is one of the priority programs of Family
welfare Division. Nepal is one of the country in South Asia to endorse the first National Adolescent
Health and Development) NAHD) Strategy in 2000 which was revised in 2018. Adolescents aged 10 to
19 constitute 24% (6.4 million) of the population in Nepal. The National ASRH program has been
gradually scaled up to 74 of the 77 districts (Khotang, Chitawan, Tanahu not implemented in this
three district) 1,331 health facilities till the end of current fiscal year 2076/77.
In Fiscal year 2076/76, ANC 1stcheckup in women less than 20 years is highest in province 2, followed
by province 1, Bagmati. Gandaki province remains the lowest in 1st antenatal checkups in age below
20 years women amongst all provinces. Likewise, the new acceptors for the modern method of
family planning except condom is highest in Karnali where as Surdurpaschim remain lowest among
women below 20 years of age. Among the contraceptive, depo (57.2%) remains the most preferred
choice followed by pills (30.6%) among women below 20 years of age. The number of adolescents
(<20 years) receiving the safe abortion services has decreased at National level and in all provinces
except for Lumbini Province. Sudurpaschim Province has the lowest numbers of adolescents
receiving safe abortion services in FY 2075/76 and 2076/77 compared to the other provinces.

High rates of child marriage, low contraceptive use among adolescent population and Lack of
disaggregated ASRH data (by age/sex) and integration in HMIS still remains the strong challenges for
the effective implementation of the ASRH program in the nation. However utilizing the minimum
resources to the maximum capacity Adolescent friendly health listed health facility has been reached
to 1,331 and certified sites are 104 nationwide ensuring rights of every adolescent to quality sexual
and reproductive health rights through information counseling and health services with integration
to the other sectors.
Primary Health Care Outreach Clinics
Based on the local needs PHC/ORCs are conducted every month at fixed locations of the VDC on
specific dates and time. The clinics are conducted within half an hour’s walking distance for the
population residing in that area. Primary health care outreach clinics (PHC/ORC) extend basic health
care services to the community level.
In 2076/77, 2.1 million people were served from 143,761 outreach clinics. A total of 143,761 clinics
were run which represents 76% of the targeted number. There has been slight decrease in

conduction of PHC-ORC Clinics and an average 16 clients were served per day per outreach clinic.
This reduction in PHC-ORC conduction and clients served may be largely attributed to the effects of
COVID-19 pandemic.
Nepal has surpassed the Millennium Development Goal 6 by reducing malaria morbidity and
mortality rates by more than 50% in 2010 as compared to 2000. Therefore, Government of Nepal
has set a vision of Malaria free Nepal by 2025. Current National Malaria Strategic Plan (NMSP) 2014-
2025 was developed based on the epidemiology of malaria derived from 2012 micro-stratification.
The aim of NMSP is to attain “Malaria Free Nepal by 2025”. For assessing the risk areas, program has
been conducting micro-stratification on annual basis.

Total positive cases of malaria slightly decreased from 1065 in 2075/76 to 619 in 2076/77 to, where
102 cases are indigenous cases and 517 are imported. The trend of indigenous is decreasing trend
however, the number of imported cases is still high. As compared to the previous year, the
proportion of P. falciparum infections has increased from 5.4% in FY 2075/76 to 9.05 in 2076/77.
This proportion is high which is due to high number of imported P. falciparum cases. The trend of
indigenous pf malaria cases are decreasing while imported cases of pf are in increasing trend. The
trend of clinically malaria cases and major indicators for malaria program;Test positivity rate (TPR),
Annual Parasite Incidence Rate (API) and Annual Blood Examination Rate (ABER) are in positive
trend. In addition, pf and pv malaria cases also decreasing year by year, mainly due to increased
coverage of RDT, microscopic laboratory service at peripheral level, active surveillance, coverage of
vector control measures (LLINs& IRS) in high and moderate areas and increased socio-economic
status of community people.

Kala-azar is one of the high priority public health problems of Nepal. Most of the districts have been
continuously reported new cases of Kala-azar in recent years. Therefore, to eliminate Kala-azar from
Nepal, strategies to improve health status of vulnerable and risk population has been made focusing
on endemic areas of Nepal, which leads to elimination of Kala-azar, and it no longer becomes a
public health problem. The incidence of kala-azar at national and district level has been less than
1/10,000 population since 2013. The trend of KA cases has been decreasing significantly for the last
several years. In 2076/77, there has been slight decrease in reported cases (187 Kala-azar cases)
compared to previous year (216).
Lymphatic filariasis
Lymphatic (LF) is a public health problem in Nepal. The goal of lymphatic filariasis is the people of
Nepal no longer suffer from lymphatic filariasis. As of 2076/77 MDA has been(stopped) in 50
districts. Post MDA surveillance initiated in 50 districts and morbidity management is partially in all
epidemic districts. All epidemic districts completed the six rounds of MDA in 2018. The LF
elimination program has also indirectly contributed to strengthening of health system through
training and capacity building activities. The transmission assessment survey in 13 districts in 2019 is
found that the prevalence of infection had significantly decreased. Since 2003 more than 110 million
doses of lymphatic filariasis drugs have been administered to at-risk population. A total number of
9,568 Hydrocele surgeries have been performed since 2073/74 to till 2076/77.

Dengue, a mosquito-borne disease emerged in Nepal in since 2005. The goal of national Dengue
control program is to reduce the morbidity and mortality due to dengue fever, dengue hemorrhagic
fever (DHF) and dengue shock syndrome (DSS). The number of reported dengue cases has decreased
significantly since 2010 but cases of dengue were increased in recent years. During FY 2076/77,
10,808 dengue cases were reported from 55 districts. The majority of cases have been reported
from Chitwan (2,612), Kaski (2,221)Rupandehi (1,386)and Kathmandu (1,220).
During the FY 2076/77 (2019/20), total number of 1853 new leprosy cases were detected and put
under Multi Drug Therapy (MDT). 2044 cases were under treatment and receiving MDT at the end of
the fiscal year. Registered prevalence rate of 0.69 cases per 10,000 populations at national level, 101
(5.45%) new leprosy cases of Grade 2 Disability (G2D), 141 (7.61%) new child leprosy cases and 770
(41.55%) new female leprosy cases were recorded. The low prevalence rate of leprosy might be due
to COVID-19 pandemic but early and active case detection activities, verification and validation of
records/reports of local health facility level/municipalities and capacity building of health workers
are mandatory and need to be amplified to obtain the goal of Zero Leprosy Nepal.

Health related Rehabilitation and disability management
During the FY 2076/77(2019/20), the rehabilitation situation assessment was conducted to assess
the context of rehabilitation services in Nepal. This was done following the national, provincial and
local level consultations with the stakeholder of rehabilitation. Disability inclusive COVID-19
prevention related IEC materials were developed and disseminated using social media and national
level media outlets. Likewise, to guide the essential rehabilitation services during the COVID-19
pandemic and to facilitate the rehabilitative management of COVID-19, two interim guidelines were
developed. Aligned with the policy commitments of MoHP, a rehabilitation module for HMIS was
developed in collaboration with Management Division.
Nepal has dual burden of disease and zoonotic diseases of epidemic, endemic and pandemic
potentials are major public health concerns. Globally more than 300 zoonotic diseases are identified
among which about 60 have been identified in Nepal as emerging and re-emerging diseases. No
people die of rabies or poisonous snake bites due to unavailability of anti-rabies vaccine (ARV) or
anti-snake venom serum or timely health care services and to prevent , control and manage
epidemic and outbreak of zoonosis is the is the goal of zoonosis program. Around 30,000 cases in
pets and more than human rabies cases occur each year with highest risk are in the terai. During the
fiscal year 2076/77, 52,610 dog and other animal bites cases have been reported throughout the
Nepal and cases of snake-bites cases have been reported. Among cases 4,203 were non-poisonous
and 878 were poisonous.

Tuberculosis (TB) remains a major public problem in Nepal. During this FY 2076/77, the total of
27,745cases of TB were notified and registered at NTP. Among these, 98% (27,232) were incident TB
cases (New and Relapse). Among all form of TB cases 68 %were pulmonary TB, and out of them, 80 %
were bacteriologically confirmed. Province 3 holds the highest proportion of TB cases (24%). Kathmandu
district alone holds around 42% (2,772 TB cases) of the TB cases notified from the province 3 while its

contribution is around 10% in the national total. In terms of eco-terrain distribution, Terai belt reported
more than half of cases (16,264, 59%) .Most cases were reported in the productive age group
(highest of 47% in 15-44 year of age).The childhood TB is around 6 % Out of total registered TB
cases, there were 10253 (37%) female and 17492 (63%) male.
The burden of TB can be measured in terms of incidence (defined as the number of new and relapse
cases), prevalence and mortality. WHO estimates the current prevalence of all types of TB cases for
Nepal at 117000 (416/100,000) while the number of all forms of incidence cases (newly notified
cases) is estimated at 68,000 (245/100,000).
Case notification rate (CNR) of all forms of TB is 93/100,000 whereas CNR for incident TB cases (new
and relapse) is 91/100,000 population. Among drugs sensitive TB cases registered in Fiscal Year
2075/76, 89% were treated successfully.
There are estimated around 1500 cases of DR TB annually. However, 350 to 450 MDR TB cases are
notified annually. In Fiscal Year 2076/77, 384 RR/MDR-TB cases were registered for treatment.
Among them, 78 cases (20%) were on treatment at DRTB retreatment centers of province 1, 74
cases (19%) at province 2, 67 cases (17%) at Bagmati province, 35 cases (9%) at Gandaki province, 75
cases (20%) at Lumbini Province, 4 Cases (1%) at Karnali Province and remaining 51 cases (13%) were
on DR treatment at Sudurpaschim province respectively.
TB services were provided through 4,945 treatment centers. Regarding diagnostic services, there are
765 Microscopic centers and 72 GeneXpert centers throughout the country. DRTB services were
provided through 21 treatment centers and 81 Treatment Sub-centers. Though the DRTB services
are ambulatory, facility-based services were also provided through 2 TB treatment and referral
management center5 hostels and 1 DR home
Making up 4.2% of the total estimated people living with HIV (PLHIV) (30,301), there are about
estimated 1,268 children aged up to 14 years who are living with HIV in Nepal in 2020, while the
adults aged 15 years and above account for 95.8%. Almost 71.5% of total estimated infections
(20,137) among population aged 15-49 years. By sex, males account for 54% of the total infections
and the remaining more than one-third (46%) of infections are in females. The prevalence of HIV
among 15-49 years of age group is 0.12% in 2020. Total 19,211 PLHIV are on ART treatment by the
end of FY 2076/77.

Non Communicable Diseases
Non-communicable Diseases (NCDs) are emerging as the leading cause of deaths in Nepal due to
changes in social determinants like unhealthy lifestyles, urbanization, demographic and economic
transitions. The deaths due to NCDs (cardiovascular, diabetes, cancer and respiratory disease) have
increased from 60% of all deaths in 2014 to 66% in 2018(WHO Nepal Country Profile 2018). They are
already killing more people than communicable diseases. Thus, Nepal has adapted and
contextualized the PEN intervention for primary care in low resource setting developed by WHO.
The epidemic of non-communicable disease is recognized by UN and addressed in Sustainable
Development Goal 3 i.e. “ensure healthy life and promote well-being for all at all ages” of this goal
3.4 targeted to “reduce by one third premature mortality from NCDs through prevention and
treatment and promote mental health and well-being”. PEN Implementation Plan (2016-2020) has
been developed in line with the Multi-sectoral Action Plan for prevention and control of NCDs (2014-

Mental Health
Mental health and substance abuse recognized as one of the health priorities and also addressed in
Sustainable Development Goals (SDG). Within the health goal, two targets are directly related to
mental health and substance abuse. Target 3.4 requests that countries: “By 2030, reduce by one
third premature mortality from non-communicable diseases through prevention and treatment and
promote mental health and well-being”. Target 3.5 requests that countries: “Strengthen the
prevention and treatment of substance abuse and harmful use of alcohol”. Nepal has high burden of
mental illness but there are limited interventions to address the epidemic of mental diseases
Surveillance and Research
Disease surveillance and research is an integral part of Epidemiology and Disease Control Division.
The mission of the communicable disease Surveillance program is to protect and improve the health
of Nepalese citizens by tracking and responding to the occurrence of disease in the population
across the country. In 2075/76, an additional 36 sentinel sites were established as a EWARS sentinel
sites to include 118 medical colleges and non-public hospitals. DHIS2 event captureis initiated for
reporting from sentinel sites.
Similarly, Water Quality Surveillance Central Committee (WQSCC) meeting with stakeholder and
organized water quality surveillance workshop at different districts. Surveillance of reportable
diseases is responsible for collecting, analyzing, interpreting and reporting information for infectious

Curative Service
Curative Service Division (CSD) is one of five divisions under Department of Health Services
(DoHS).The overall purpose of this division is to look after curative health service activities
throughout the country. According to the institutional framework of the DoHS and MoHP, the
health post (from an institutional perspective) is the first contact point for curative services. The
major responsibility of CSD is to provide the basic health service free of cost guaranteed by
Constitution of Nepal (Article 35). CSD regulate and co-ordinate to establish, operate and upgrade of
specialized tertiary hospitals. CSD also co-ordinate and provide Eye, ENT and Oral health services.
Minimum Service Standards (MSS) health facilities are the service readiness and availability of tool
for optimal requirement of the hospitals to provide minimum services that are expected from them.
This tool entails for preparation of service provision and elements of service utilization that are
deterministic towards functionality of hospitals to enable working environment for providers and
provide resources for quality health service provision. MSS has implemented in 100 different levels
of hospitals all over the country. Which include continuation of MSS follow up in 83 hospitals and
program was expanded in the 17 additional hospitals .

Nursing Capacity Development
The main responsibility of this section is to facilitate in the process of development of plans, policies,
strategies and programmes for strengthening various specialties of nursing and midwifery services as
well as work as focal point for nursing, midwifery services and school health programme in the
In FY 2076/77, guideline of school health and nursing service was developed. Based on it, the
programme was implemented in 13 local levels where 120 school nurses were deployed in 120
schools in province 2, Gandaki, Lumbini, Karnali and Sudurpaschim province.

The main function of this section is to develop policies, strategies, directories, programmes, etc. for
the easy access of quality health services to target groups like ultra-poor people; poor people;
helpless people; people with disabilities; senior citizens; women, men and children, victims of
gender based violence and female community health volunteers. The Ministry of Healthand
Population has established geriatric wards in 16 referral hospitals for providing free and
comprehensive for elderly people.
The numbers of One Stop Crisis Management Centres have been increased from seven in FY 2068/69
(2011/12) to 69 by the end of FY 2076/77 (2019/20) established in 64 districts and it has been
planned to scale up the service to all 77 districts by next fiscal year. A total of eight thousand three
hundred forty two (8342) were provided various service from the 64 reporting OCMCs. Women
make over 90 percent of all the clients. Thirty nine percent of the cases receiving care have been
victim of rape and sexual assault and thirty six percent of the clients have been victim of physical

Bipanna Nagarik Aaushadi Upachar Programme
The Impoverished Citizens Service Scheme of Social Health Security Section provides the funding for
impoverished Nepalese citizens to treat serious health conditions. The provisions for free medication
and treatment of severe type of diseases namely Cancer, Heart Disease, Kidney Disease, Traumatic
Head Injury, Traumatic Spinal Injury, Alzheimer’s diseases, Parkinson’s and Sickle Cell Anemia. In FY

2076/77, fifty four thousand eight hundred and eighty six (54,886) number of patients were
managed in the provision of free treatment to impoverished citizens services scheme. Top most
number of patients from Cancer (34,667), followed by Kidney (7487), Heart disease (5761), Sickle
Cell Anemia (3803), Traumatic Spinal Injury (1856), Traumatic Head Injury (840) and from
Parkinson’s diseases (364) and Alzheimer’s diseases were 117 which was lowest in number under
the provision of free treatment to impoverished citizens services scheme.

Female Community Health Volunteers
The major role of the Female Community Health Volunteers (FCHVs) is promotion of safe
motherhood, child health, family planning, and other community based health services to promote
health and healthy behavior of mothers and community people with support from health workers
and health facilities. At present there are 49481 FCHVs actively working all over the country. FCHVs
contributed significantly in the following activities namely; distribution of oral contraceptive pills,
condoms and Oral Rehydration Solution (ORS) packets and counseling and referring to mothers in
the health facilities for the service utilization. Even though the number of mothers participating in
health mother’s group meetings, FCHVs distributing Iron tablets, condoms and pills have increased
from the FY 2074/75 in FY 2075/76, the number have slightly decreased in FY 2076/77 due to COVID
19 pandemic and various restriction in place. FCHVs continued the support to mothers with home
deliveries by initiating skin to skin contact after birth to 64,835 women, applied chlorhexidine to
55,552 newborns and ensure the use of misoprostol in 10869 women. FCHVs also have provided
various nutrition service like breast feeding initiation within one hour of birth to 67337 newborns
and also distributed postpartum vitamin A to 127520 mothers in total. They have been providing
IMAM services at household level by doing MUAC screening of 27, 43,870 children under the age of
5 years.

Inpatients/OPD services
In the fiscal year 2076/77, curative health services were provided to outpatients, including
emergency patients, and inpatients including free health services. Inpatient services were provided
different level of hospitals including INGOs/NGOs, Private medical college hospitals, nursing homes,
and private hospitals. In this fiscal year 2076/77, 84% of the total population received outpatients
(OPD) services. 1,212,294 patients were admitted for hospital services and 1,566,318 patients
received emergency services from hospitals.
Health Training
The National Health Training Centre is the central body for human resource development in Nepal’s
health sector. The overall goal of NHTC is to build a technical and managerial capacity of health
service providers at all levels to deliver quality health care services towards attainment of the
optimum level of health status of Nepali Citizens. National health training network co-ordinates
seven Provincial Health Training Centers and 49 hospital-based clinical training sites throughout the

Vector Borne Disease Research & Training
The objective of Vector Borne Disease Research and Training Center is to fill the knowledge gap and
generate scientific evidences in the field of Vector Borne Diseases. Therefore, VBDRTC is responsible
for researchs and trainings that relate with VBDs such as Malaria, Kala-azar, Dengue, Chikungunaya,
Zica, Westnyl diseases, Lymphatic filariasis, Scrub typhus and Japanese encephalitis. In the FY
2076/77, VBDS trainings for physicians/ pediatrician, VBDs focal persons/health workers, malaria
microscopic refresher trainings for lab technicians and lab assistants were conducted to enhance
their level of knowledge and skills related with prevalent vector borne diseases.
In this fiscal year, study conducted by this center include VBD’s landscape analysis, factors associated
with transmission of Dengue Virus, susceptibility test on Anopheles fluviatilis with
Alphacypermethrin in Dhanusha, Mahottari and Sindhuli districts, the CDC bottle bioassay on
Anopheles annulariswith Lambda-cyhalothrin in Nawalpur district and entomological surveys of
dengue vector in BharatpurMeropolitant, Chitawanand Hetauda submetropolitant, Makawanpur
Health, Education, Information and Communication
National Health Education, Information and Communication Centre (NHEICC)is responsible for
health promotion activities and delivery of health information and messages using multimedia,
methods and channels up to individual level for the demand creation and increased use of available
health services under ministry of health and population.

Health Service Management
The Management Division (MD) is responsible for DoHS’s general management functions. DoHS’s
revised Terms of References (ToR) of MD describing it as the focal point for information
management, planning, coordination, supervision, and the monitoring and evaluation of health
programmes. The division is also responsible for monitoring the quality of air, water and food
products. It also monitors the construction and maintenance of public health institution buildings
and supports the maintenance of medical equipment. More activities assigned to this division
include including policy and planning related to health infrastructure and logistics management The
current HMIS software system (DHIS 2 software) meet the basic requirements of the recently revised
HMIS. Existing software related errors have been resolved with upgrading of System to DHIS 2.3.
Few problems related to Nepali Calender are on the progress of sorting out with the help of DHIS 2
Logistics Management
The main role of Logistics Management (LM) is to support in delivering quality health care services
providing by program divisions and centers through logistics supply of essential equipments, vaccines, family planning commodities and free health drugs to all regional /district stores and
health facilities. The major function of MD is to forecast, quantify, procure, store and distribute
health commodities, equipments, instruments and repairing & maintaining of the bio‐medical
equipments/instruments and transportation vehicles. The quarterly LMIS and monthly Web‐based
LMIS have facilitated evidence based logistics decision making and initiatives in annual logistics
planning, quarterly national pipeline review meetings, the consensus forecasting of health
commodities and the implementation of the pull system. MD has formed a authorized 23 members
Logistics Working Group (LWG) under the chaired of MD Director with representation of Divisions,
Centers, supporting partners and other stakeholders. LWG address all issues and challenges on
procurement and supply chain on health commodities and materials in center, region and district

Health Laboratory Services
The National Public Health Laboratory (NPHL) is an apex body that assists MoHP for preparing
medical laboratory related policy, legislation and guidelines, Support and regulates laboratory
services with activities i.e. licensing, supervision, monitoring and quality assurance of laboratories as
well as it is also the national authority for implementing the National Blood Programme (NBP) in the
In the fiscal year 2076/077, major public health related activities were carried out from NPHL are
laboratory based surveillance [AES/Japanese encephalitis, measles/rubella, polio, antimicrobial
resistance (AMR), influenza)], HIV reference unit, National Influenza Centre, BSL-3 laboratory and
outbreak investigation). It has also conducting routine and specialized diagnostic services including
services of referral laboratory for communicable and non-communicable diseases, decreasing
outsourcing of tests. It has improved the test result qualities by implementing automated reporting
system i.e. Laboratory Information System (LIS) to minimize the human errors. National External
Quality Assessment Scheme (NEQAS) ran and functioned since 1997 by NPHL for proficiency test
panel for biochemical, haematological tests and grams strain are prepared and dispatched to
participating laboratories within the country, in addition to this NPHL also participated in
international External Quality Assessment Scheme (IEQAS) for overall improvement of quality of
tests result. It supports and regulates blood transfusion service as well as organized various
workshops on planning, capacity building and conduction of various training etc. for overall
development and management of public health laboratories with introduction of latest technology.

Personnel Administration
The Personnel Administration Section {PAS) is responsible for routine and programme administrative
function. Its major functions include upgrading health institutions, the transfer of health workers,
level upgrading of health workers up to 7th level, capacity building as well as internal management
of human resources of personnel.
Financial Management
The preparation of annual budgets, the timely disbursement of funds, accounting, reporting, and
auditing are the main financial management functions needed to support the implementation of
health programs. Finance Administration Section is the focal point for financial management for all
DoHS programs. Out of total National Budget of Rs. 15,32,96,71,00,000.00 a sum of Rs.
42,67,09,00,000.00 (2.78%) was allocated for the health sector during the fiscal year 2076/77. Of
the total health sector budget, Rs. 9,32,20,00,000.00 (21.84%) was allocated for the execution of
programs under the Department of Health Services.

Monitoring and Evaluation
Monitoring and evaluation plays the significant role for operative and persuasive execution of plans,
policies, programmes and projects. Recognizing the need for a methodical, simplified, resultdriven,
reliable, and effective monitoring and evaluation system, Nepal Health Sector Strategy
(NHSS) 2015-2020 directed to improve access and operation of the health information with the use
of Information Communication Technology (ICT).It also emphasize for better and interoperable
routine health information systems, prioritizes surveys and research. Correspondingly, it endeavors
for improved and integrated health sector reviews at different levels that feed into the planning and
budgeting process. Towards achieving Universal Health Coverage (UHC) and Leave No One behind
(LNOB), the NHSS and Sustainable Development Goals (SDGs) place an emphasis on monitoring and
reducing the equity gap in the health outcomes of different population sub-groups. The details can
be obtained from result framework of National Health Sector Strategy 2015-2020.

Eye care
Nepal’s eye care programme is run by Nepal Netra Jyoti Sangh and is a successful example of an
NGO-run eye care programme. The prevalence of blindness in Nepal has reduced at the current
time. In the fiscal year 2076/77, Despite COVID-19 pandemic which created unprecedented
situation, the Eye Care System of Nepal has been able to deliver the following major achievements in
Able to provide eye treatment services to 2,197,671 patients, out of which, 226,833 (10%)
were foreigners. A total of 55,536 (29,128 men and 26,408 women) people services were
covered through national health insurance scheme.
The subspecialty eye care services were delivered to 29,024 patients
Able to provide eye care services to 585,590 people through different community outreach
Able to provide surgical services 166,492 people (including 6,554 surgeries in camps). The
majority of the eye surgeries comprised of cataract (101,921 -61%)

Human Organ Transplant services
Shahid Dharma Bhakta National Transplant Center (SDNTC) was established in 2012 by the Ministry
of Health and Population (MoHP) to strengthen and expand organ transplantation services in the
country. This center started its services merely with the OPD services, but within a few years of its
establishment, it has extended its services beyond organ transplantation.
In the fiscal year 2076/77 there were total OPDs- 22691, Admitted cases 1039, total Major OTs
including Lapcholecystectomy, PCNL, URSL, Nephrectomy, TURBT/TURP performed -218, Minor OTs
including AV Fistula, DJ Stent performed -488, Kidney Transplant performed -49, Liver Transplant
performed- 1, Coronary Angiography done- 34, Hemodialysis Services provided, Free- 18,478 & Paid-
2,042 and Total CAPD cases provided -15, lab tests done 85801, ultrasound tests and X-ray and CT
were 1915, 2032 and 583 respectively. ECG did 1593. The echocardiograph ware 900 followed by
290 endoscopy and colonoscopy. The total number of BCM done 137 and that of ABG were 102,
Kidney Biopsy done were 82.Total Physiotherapy services provided were 470 patients.

Medico-legal Services
Constitution of Nepal 2072 in its article 35 guarantees Right to Health for all Nepali citizen and in
articles 20, 21 and 22 Right to justice, Right of victim of crime and Right against Tortureguarantees
and in violation of such fundamental rights there are provisions of proper remedy or compensation.
There are other articles like article 42 Right to social justice, article 44 Right of consumers which are
partially or completely related with medico-legal field for their proper implementation in real life of

people. For effective application of above constitutional rights, medico-legal sector in Nepal must be
addressed and prioritized.
Time has compelled to recognize medico-legal field and it is shown by other way with spontaneous
appearance of more than four dozen of Nepali doctors specialized in the field of forensic. Now it is
high time for Nepal Government to facilitate the environment to utilize those experts in medicolegal
field for providing their specialist service to Nepali people. Few incidents have coming up with
the support and advocacy by MELESON (Medico-legal Society of Nepal), a registered professional
society of practicing Nepali Forensic Medicine specialists in this country.

Health Councils
The six professional health councils (Nepal Medical Council, Nepal Nursing Council, Nepal Ayurvedic
Medical Council, Nepal Health Professional Council, Nepal Pharmacy Council and Nepal Health
Research Council) accredit health-related schools and training centers and regulate care providers.

Health Insurance
The Health Insurance Program (HIP) is a social security program of the Government of Nepal that
aims to enable its citizens to access quality health care services minimizing a financial burden on
them. Health Insurance Board (HIB) is responsible to carry out the health insurance program in
Nepal. It is a family-based program. Family has to pay the contribution amount to enroll in the
program. Currently enrollment is voluntary. The households, communities, and employees of the
government organizations also can be involved in this program. This program attempts to address
barriers in health service utilization and ensure equity and access to poor and disadvantaged groups
as a means to achieve Universal Health Coverage.
The total coverage of the Health insurance program is approximately 11.92 Percent out of the total
population of Nepal. Among the total insures about 1,120,259 people have taken health services
from listed health institutions in FY 2076/77.

Development Partners Support in Health Programs
Development partners support the government health system through a sector-wide approach
(SWAp). The SWAp now supports the implementation of the new Nepal Health Sector Strategy
(NHSS, 2016–2021). The Joint Financing Arrangement (JFA) has been signed by various partners and
the government. The JFA describes in detail the arrangement for partners’ financing of the NHSS.
The JFA elaborates the pool funding arrangement and parallel financing mechanism as bilaterally
agreed between the government and the donor partners. In the current sector programme, the
World Bank has allocated all its commitment through a Program-for-Results, a tool which disburses
fund against a verifiable set of results, called Disbursement Linked Results (DLRs). UK Aid and GAVI
are also disbursing part of their commitments against some DLRs identified and agreed with the
MoHP. During the second half of the Fiscal Year 2019/2020, Development Partners reprioritized
some of their programmes to support the MoHP in its response to COVID-19 impact.

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Source : DoHS