UNIT 2.CENTRAL HEALTH SERVICES MANAGEMENT

Presenter Sunita RajbanshiBPH 6th semester,KHSC

OUTLINE1.Organizational structure of health services

2.Description and analysis of roles and responsibilities of divisions and centres of DOHS.

3.Intersectoral coordination between all levels.

There are three Departments under the MoHP: Department of Health Services (DoHS), Department of Ayurveda (DoA) and Department of Drug Administration (DDA).

The DoHS and other departments are responsible for formulating programs as per policy and plans, implementation, use of financial resources and accountability, and monitoring and evaluation.

DDA is the regulatory authority for assuring the quality and regulating the import, export, production, sale and distribution of drugs.

Introduction

Department of Ayurveda offer Ayurvedic care to the people and also implement health promotional activities.

The overall purpose of the Department of Health Services (DoHS) is to deliver preventive, promotive and curative health services throughout nepal. The DoHS is one of three departments under Ministry of Health (MoH).

Director General (DG) is the organisational head of the

DoHS.

ORGANIZATIONAL STRUCTURE OF HEALTH SERVICES

Central ,Regional and district Level

ROLES OF SEVEN DIVISIONS: Management Division with infrastructure,

planning, quality of care, management information system and free medication & treatment for very severe disease to impoverished Nepalise citizens.

Child Health Division covering EPI, Nutrition and CB‐IMCI and Newborn care.

Logistics Management Division covers procurement, supplies and management of logistics, equipment and services required by DoHS and below level.

Epidemiology and Disease Control Division with the responsibility of controlling epidemics, pandemic and endemic diseases as well as treatment of animal bites.

Primary Health Care Revitalization Division with the responsibility of carrying out activities for primary health care.

Family Health Division with the responsibility of reproductive health care, including safe motherhood and neonatal health, adolescent health, family planning and Female Community Health Volunteers (FCHVs).

Leprosy Control Division with the responsibility of  reducing the burden of leprosy and to break channel of transmission of leprosy from person to persons by providing quality services to all the affected community.

ROLES OF CENTRES OF DOHS1.National Tuberculosis centre(NTC) engage public

and private health care providers to ensure provision of quality TB services in line with NTP policy, International Standard of TB Care (ISTC) and Patient Charter

2. National Health Training Centre (NHTC). The NHTC coordinates all training programs of the respective Divisions and implements training by sharing common inputs and reducing the travelling time of care providers.

3.National Public Health Laboratory (NPHL) Extend laboratory services in all hospital and health care institution  upto PHC level,develop NPHL as national reference laboratory for diagnostic and public health services,address the diagnostic needs due to emerging and re-emerging diseases.

4.National Centre for AIDS and STD Control (NCASC) work to achieve universal access to HIV prevention, treatment, care and support and with all stakeholders.

5.National Health Education, Information and Communication Centre (NHEICC). All IEC/BCC‐related activities are coordinated by NHIECC. These centres support the delivery of EHCS and work in close coordination with the respective Divisions.

ROLES AND RESPONSIBILITIES OF DOHS To provide GoN (Government of Nepal) necessary

technical advice in formulating health related policies, develop and expand health institutions established in line with these policies.

To determine requirement of manpower for health institutions and develop such manpower by preparing short and long term plans.

To ensure supply of drugs, equipment, instruments and other material at regional level by properly managing these resources.

To mobilize assistance in the implementation of approved programmes by preparing, asking for preparation of objective programmes related to various aspects of public health (family health, family planning, child health, infectious disease control, eradication of malnutrition, control of AIDS and STDs).

To manage the immediate solution of problems arising from natural disasters and epidemics.

To establish relationships with foreign countries and international institutions with the objective of enhancing effectiveness and developing health services and assist the Ministry of Health in receiving foreign aid by clearly identifying the area of cooperation.

To create a conducive atmosphere to encourage the private sector, non-governmental organizations and foreign institutions to participate in health services, maintain relation and coordination, control quality of health services by regular supervision and inspection.

To systematically maintain data, statements and information regarding health services, update and publish them as required.

To fix designated positions of employees up to gazetted 2nd class, inter-directorate transfer, initiate departmental action and provide reward, etc.

To clear audit irregularities of central level offices, projects and regional level offices.

INTERSECTORAL COORDINATION BETWEEN ALL LEVELS INCLUDING :

1.Central level(Between the ministries)2.District levels(Districts line authorities)

3.Grass Root Levels(Local Level line organization)4.Coordination within the system

At the regional level there are five Regional Health Directorates (RHDs) providing technical backstopping as well as program monitoring to the districts.

The RHDs are directly under the MoHP.

There are regional, sub‐regional and zonal hospitals, which have been given decentralised authority through the formation of Hospital Development Boards.

In addition, there are training centres, laboratories, TB centres (in some regions) and medical stores at the regional level.

At the district level, the structure varies between districts. Fifty nine districts are managed by the District Health Office (DHO), whereas the remaining sixteen are managed solely by the DPHO.

The DPHOs and DHOs are responsible for implementing essential health care services (EHCS) and monitor activities and outputs of District Hospitals, Primary Health Care Centres (PHCCs), Health Posts (HPs).

A health post is the first institutional contact point for basic health services.

HPs and PHC monitor the activities of FCHVs as well as community‐based activities by PHC outreach clinics and EPI clinics.

In addition, HP also functions as the referral centre of FCHVs as well as a venue for community based activities such as PHC/ORC and EPI clinics.

The health post offers the same package of SHPs plus birthing centres in the respective VDC.

Each level is referral point in a network from Health Post (HP) to Primary Health Care Centre (PHCC), on to district, zonal sub‐regional and regional hospitals, and finally to tertiary level hospitals.

This referral hierarchy has been designed to ensure that the majority of population receive public health and minor treatment in places accessible to them and at a price they can afford.

Central level determine requirement of manpower for health institution and develop such ,manpower by preparing short term and long term plans.

Central level also supply drugs equipment ,instruments and other materials at regional level by properly managing the resources.

Inversely, the system works as a supporting mechanism for lower levels by providing logistical,

financial, supervisory, and technical support from the centre to the periphery.

REFERENCE Neupane Dinesh,khanal Vishnu,”A

text book of health service management in Nepal”2010 edition,Vidyarthi pustak Bhandar.

www.dohs.gov.np Annual report of fiscal year 2070/71 www.nphl.gov.np www.ncasc.gov.np

Thank you