First District

Presentation
Presented By:
BPH 7th Semester(Group B, Rupandahi District)
LA Grandee International College
Simalchaur -5 Pokhara

4/6/19 1
 Group Members

4/6/19 2
 Contents
• Objectives of Presentation
• District Profile
• Map Of Rupandahi District
• Demographic Information
• Achievement/Analysis of Health Indicator
• Visit to Basantapur PHCC, Hatibangai HP, Padsari HP, SUAAHARA,
ADRA NEPAL.
• Top Ten Diseases Of Rupandahi District.
4/6/19 3
 Objectives Of Our Presentation
1) To overview the district profile of Rupandehi district.
2) To overview the past and current trends of different programs and its
components like safe motherhood , family planning, immunization and
CBIMNCI.
3) To overview the past and current trends of different diseases such as
Leprosy, Tuberculosis, HIV-AIDS , Malaria.
4) To know the current status of different organizations like PHCC, HP,
NGOs/INGOs.
5) To know about the current status of top ten diseases of Rupandehi district.

4/6/19 4
 District Profile
• Rupandehi district in the Lumbini Zone comes under the western
development region. Lumbini, the birthplace of Lord Buddha, the light of
Asia, falls under this district.
Geo-Political Boarders:
• East – Nawalparasi
• West – Kapilbastu
• North – Palpa
• South – Uttar Pradesh, India

4/6/19 5
 Map Of Rupandehi District

4/6/19 6
1
Province 5 Number

2 Zone Lumbini

3 District Rupandehi

4 Headquarter Bhairahawa

5 Number of Sub Metropolitan City 1

6 Number of Municipalities 5

7 Number of electoral region 7

8 4/6/19
Number of Rural Municipality 10 7
 Demographic Information
Total Population
: 8,80,196
Total Households
: 1,63,916
Population Density
: 647
Average Household Size
: 5.37
Annual Population Growth Rate
: 2.17
Population Doubling Time
: 32 Years
Urban Population
: 4,24,366
Rural Population
: 4,55,780
Sex Ratio
4/6/19 : 96.47 8
 Achievement/Analysis of Health
Indicator

4/6/19 9
 Safe Motherhood Programme
• The goal of national safe motherhood programme is to reduce maternal
and neonatal mortalities by addressing factors related to various
morbidities, death and disability caused by complications of pregnancy
and childbirth.
• Global evidence shows that all pregnancies are at risk, and complications
during pregnancy, delivery and the postnatal period are difficult to
predict.

4/6/19 10
 Activities
• Birth preparedness package (BPP) and MNH activities at Community Level
• Reproductive health morbidity prevention program
-Uterine Prolapsed
-Cervical cancer screening and prevention training
-Obstetric Fistula screening
• Human Resource development
• Emergency referral funds
• Safe Abortion services
• Nyano Jhola Program
• Aama Program
4/6/19 11
 Percentage of ANC 1st visit as per protocal among ANC 1st visit any time
100
91
90

80

70
70 67

60
Percentage

50

40

30

20

10

0
4/6/19 12
 ANC 4 time visits (as protocol) as % of expected live birth
75
74
74

73
72
72
Percentage

71

70
69
69

68

67

66
4/6/19 13
 % of institutional delivery among expected live births
140
128

120
109
100
100
Percentage

80

60

40

20

0
4/6/19 14
 Delivery conducted by SBA (at HF & Home) as % of expected live births

140
125
120

104 106
100
Percentage

80

60

40

20

0
4/6/19 15
 % of women receiving ANC incentives among total institutional deliveries
45

40 39

35
35
31
30
Percentage

25

20

15

10

0
4/6/19 16
 SWOT ANALYSIS
• Strengths
1.Provision of incentives to clients of safe motherhood program.
2.Mobile reporting system.

• Weakness
1.Home deliveries are still in practice.
2.Although incentive is doubled, clients are not receiving incentive
timely as per protocal.

4/6/19 17
• Opportunities
1.Receive safe delivery services by different birthing centers.
2.Receive transportation (incentive) cost and Nyano Jhola.
3.Receive ANC and PNC services.
• Threats
1.Difficult geographical topography and no transportation facility.
2.Inadequate awareness in people about importance of institutional
delivery.
3.Less awareness in people about the incentive provided by Aama
Surachya program.

4/6/19 18
 Family Planning
• Family planning is one of priority program of Government of Nepal,
MOHP.
• It is also considered as a component of reproductive health package and
essential health care services of Nepal Health Sector Program II (2010-
2015).
• The main aim of the National Family Planning Program is to ensure that
individuals and couples are able to fulfill their reproductive needs by
using appropriate family planning methods based on informed choice.

4/6/19 19
 Objectives
General objective:
• To improve the health status of all people through informed choice on accessing and using
voluntary family planning.

Specific objectives:
• To increase access to and the use of quality family planning services that are safe, effective and
acceptable to individuals and couples
• To increase and sustain contraceptive use, and reduce unmet need for family planning,
unintended pregnancies and contraception discontinuation.
• To create an enabling environment for increasing access to quality family planning services to
men and women including adolescents.
• To increase the demand for family planning services by implementing strategic behaviour
change communication activities.

4/6/19 20
 FP new acceptors as % of MWRA
30

26
25

21
20
Percentage

15
12.29

10

4/6/19 21
 FP new acceptor-IUCD
1400

1200

1000

800
Numbers

1309
600

400 766 724

200

4/6/19 22
 FP new acceptors-implant

3500

3000

2500
Number

2000 3422

2581
1500 2170

1000

500

4/6/19 23
 FP new acceptor-pills
16000
14438
14000
12380
12000

10000
Numbers

8000

6000
4973

4000

2000

4/6/19 24
 FP new acceptor-Depo
30000

25000 23829

20473
20000
Number

15000

10000

6157
5000

0
4/6/19 25
 Contraceptive prevalence rate(CPR)

50
45
40
35
30
Percentage

25 47.57

20 41

15 31.36

10
5
0

4/6/19 26
 current user at the end of FY-condom distributi on
2500000

2000000

1500000
Numbers

1000000 2045741
1867713
1623614

500000

4/6/19 27
 Current user at the end of FY-condom CYP
18000
16638
16000

14000
12451
12000
10824
10000
number

8000

6000

4000

2000

4/6/19 28
 Current users at the end of fiscal year-pills

16000
14000
Number

12000
10000 15568

8000 12380

6000
4000 4107

2000
0

4/6/19 29
 Current users at the end of FY-Depo
30000
27414

25000

20473
20000
Number

15000

8873
10000

5000

4/6/19 30
 Current user at the end of FY-IUCD

4000

3500

3000
Number

2500
3741

2000 3230
2725
1500

1000

500

4/6/19 31
 Current user at the end of FY- Implant

12000

10000

8000
Number

11530

6000
8768
7334

4000

2000

4/6/19 32
National Immunization program
 The immunization program is one of the government’s highest priority programs.
 Immunization is considered as one of the most cost effective health interventions to
reduce the deaths of children and mothers from vaccine preventable diseases(VPDs)
and has contributed in achieving Millennium Development Goal (MDG) 4 and 5
since its introduction in 2000 and now it is working to achieve SDG 3 since 2016 to
2030.
 NIP provides vaccination against 11 major killer diseases.
 All the vaccines under NIP are given under free of cost and this program is
implemented in all the districts of the country.

4/6/19 33
 Immunization profile of Rupandehi
NIP in Rupandehi provides vaccination against TB(BCG),diphtheria-
tetanus-hepatitis B and haemophilus influenza B(DPT-HEP B-
HiB),poliomyelitis(OPV),PCV,measles-rubella and JE vaccine.
NIP in Rupandehi covers 10 rural municipalities and 5 municipalities.
Routine immunization services are provided through public health
facilities, private hospitals,medical colleges,urban clinics, outreach
session and mobile team.

4/6/19 34
• The distribution centers are Lumbini PHC, Majgawa HP and Butwal sub
metropolitan
There are altogether 10 supply centers of vaccine in Rupandehi.They are:
1) Rayapur PHC 6) Motipur PHC
2) Majhganwa HP 7) Parroha HP
3) Faryana HP 8) Dhagdae PHC
4) Karmahawa HP 9)Ha. farsatikar
5) Chhapiya HP 10) Herwani HP

4/6/19 35
 Vaccines Coverage

BCG coverage
140 130

120
103
99
100
Percentage

80

60

40

20

0
4/6/19 36
 DPT-HepB-Hib3 Coverage
95
94
94

93

92
91
91
Percentage

90

89
88
88

87

86

85
4/6/19 37
 PCV 3 Coverage
94
93

92

90
89
Percentage

88

86
86

84

82
4/6/19 38
 IPV Coverage

90
80
70
Percentage

60
84
50
40
30
20 12

10
0
4/6/19 39
 Measles/Rubella 1st Coverage

93
92
91
Percentage

90
93
89
88
89
87
87
86
85
84

4/6/19 40
 Measles/Rubella 2nd coverage

80

70

60
Percentage

50
76

40 67.29

30
37.56

20

10

0
4/6/19 41
 JE coverage
90

87

85

79
80
Percentage

75
73

70

65
4/6/19 42
 Dropout rate
Drop-out rate BCG Vs measles/rubella

100%

90%

80%
Percentage

70%
18 14 33
60%

50%

40%

30%

20%

10%

0%

4/6/19 43
• DPT-Hepb-Hib-1 VS 3

Dropout rate DPT-Hep b-Hib -1 Vs. 3

4.5
4
4
3.5
3 3
3
Percentage

2.5
2
1.5
1
0.5
0
4/6/19 44
 Wastage rate
Wastage rate BCG
70

60

50
Percentage

40

30 61
51
46
20

10

4/6/19 45
 Wastage rate DPT-HepB -Hip

• 100%
90%
80%
70%
Percentage

60% 6 10 2

50%
40%
30%
20%
10%
0%

4/6/19 46
 Wastage rate of MR
30 28

25

20 19
Percentage

1513

10

0
4/6/19 47
 PCV Wastage rate
6

5
5

4
4
Percentage

3
3

0
4/6/19 48
 JE Wastage rate

35

30

25
Percentage

20 34

29

15
19

10

0
4/6/19 49
 TD Wastage rate

20
18
16
14
Percentage

12 19

10
8 12

9
6
4
2
0

4/6/19 50
 SWOT Analysis
• Strength
Strong BCG coverage
Drop-out rate is low
Vaccine wastage rate is low
Effective cold chain maintenance.
• Weakness
Lack of immunization services in Community centers.
Inadequate supply of vaccine(JE).

4/6/19 51
• Opportunities
GAVI has been supporting Nepal in the field of immunization.
Effective implementation of NIP
 Threats
Political instability
Geographical barrier

4/6/19 52
 CB-IMNCI
• Community Based Integrated Management of Neonatal and Childhood
Illness (CB‐IMNCI) Program is an integrated package of child‐survival
interventions and addresses major childhood killer diseases like
Pneumonia, Diarrhea, Malaria, Measles and Malnutrition in 2 months to
5 years children in a holistic way.
• CB‐IMNCI also includes management of infection, Jaundice,
Hypothermia and counseling on breastfeeding for young infants less than
2 months of age. With the implementation of this package children are
diagnosed early and treated appropriately for major childhood illnesses
at the health facility and community level.

4/6/19 53
 Objectives
• To reduce neonatal morbidity and mortality by promoting essential
newborn care services.
• To reduce neonatal morbidity and mortality by managing major causes of
illness
• To reduce morbidity and mortality by managing major causes of illness
among under 5 years children

4/6/19 54
 Components of the CBIMNCI strategy
• Improving the case management skills of health workers
• Improving the health system for effective management of childhood illness
• Improving family and community practices

4/6/19 55
 Incidence of ARI/1000 U5 Children
356
354
354

352

350

348 347
Per 1000

346

344 343
342

340

338

336

4/6/19 56
 Incidence of Diarrhoea/1000 U5 Children
320 318

315

310

305
Per 1000

300 298

295 294

290

285

280

4/6/19 57
 % Of Severe Dehydration Among Total Cases
0.08
0.07
0.07

0.06

0.05
Percentage

0.04
0.03
0.03

0.02

0.01
0
0

4/6/19 58
Vitamin "A" Mass Distribution Coverage as % of 6 to 59 months children (1st Round)
92
91
90
90

88

86
Percentage

84

82
81
80

78

76

4/6/19 59
 Vitamin "A" Mass Distribution Coverage as % of 6 to 59 months children (2nd Round)
100
99

98

96
Percentage

94

92 92
92

90

88

4/6/19 60
% of children aged 0- 6 months registered for growth monitoring, exclusively breastfed for the first six months
120

99
100

80
Percentage

60 55.05 55.28

40

20

4/6/19 61
Strength Weakness

Integrated program on illness of children Inadequate logistics supply- timer, Zinc,

Cotrim P

Good Training Package Inadequate supportive

supervision

International Support Low coverage of Zinc for

treatment of Diarrhea with ORS

A wide net working across the country Inadequate preparedness and response to diarrhea
outbreaks

Active participation by community and FCHVs Inadequate performance

capacity of Focal Person

4/6/19 62
 Disease Control Programme(Tuberculosis)
• Tuberculosis (TB) is a major public health problem in Nepal.
• About 45 percent of the total population is infected with TB, of which
60 percent are adult.
• Every year 40,000 people develop active TB, of whom 20,000 have
infectious pulmonary disease.
• These 20,000 are able to spread the disease to others.
• Treatment by Directly Observed Treatment Short course (DOTS) has
reduced the number of deaths; however 5,000-7,000 people still die per
year from TB.

4/6/19 63
 TB case finding rate
80
Percentage

70 67
60 57
50
50
40
30
20
10
0
2072/73 2073/74 2074/75
Fiscal Year

4/6/19 64
Per Lakhs cases Case notification rate( PBC new & repalse)
90
82
80
70
59 61
60
50
40
30
20
10
0
2072/73 2073/74 2074/75

Fiscal Year

4/6/19 65
 Sputum conversion rate
90.5
Percentage

90
90

89.5
89
89

88.5
88
88

87.5

87

4/6/19 66
 Treatment success rate (All PBC )
92.2
Percentage

92 92
92
91.8
91.6
91.4
91.2
91
91
90.8
90.6
90.4
2072/73 2073/74 2074/75
Fiscal Year
4/6/19 67
 Leprosy
• Leprosy has existed in Nepal since time immemorial and was recognized
as a major Public Health problem as early as 1950.
• The program was integrated into the general health services in 1987.
• By 1996 MDT was expanded to all 75 districts.
• In Rupandehi, MDT service is being delivered through all the public
health facilities (PHCs, HPs ).
• Health care providers serving at community based health facilities had
undergone Comprehensive Leprosy Training (CLT) and are effectively
providing MDT service over the years.

4/6/19 68
 Register prevalence rate/10000 population
2.5 2.35

2
Per Ten Thousand

1.5

1.01 0.95
1

0.5

0
4/6/19 69
 Number of grade 2 disability among new cases
30
26
25

20

15

10

0
0 0
4/6/19 70
 Snake Bite
• The conditions resulting from the bite of a venomous snake are
characterized by variable symptoms (pain and swelling at the puncture
site, blurred vision, difficulty in breathing, or internal bleeding).
Snake bite situation 2071/72
• Total Number of snake bite :2206
• Number of death due to snake bite:157
• Anti snake venom serum expenditure:3370
• Number of death due to snake bite:5

4/6/19 71
 National malaria programme in Nepal
• Malaria control project in Nepal was first initiated in 1954 with the
support from USAID with the objective of controlling malaria, mainly in
Terai belt)of central Nepal.
• In 1958, national malaria eradication program was launched with the
objective of eradicating malaria from the country.
• Due to various reasons the eradication concept reverted to control program
in 1978.
• In 1998, Roll Back Malaria (RBM) initiative was launched to control
malaria transmission

4/6/19 72
 Current scenario of malaria in Nepal

47.9
52.1

Malaria No Malaria
4/6/19 73
 40

35 34.52

30

25
Percentage

20

15
9.8
10

5 3.62

0
High risk Moderate risk Low risk
Risk
4/6/19 74
 Annual Parasite Incidence
0.12
0.1
0.1

0.08
Per Thousand

0.06
0.06

0.04
0.02
0.02

0
2072/73 2073/74 2074/75
4/6/19 Fiscal Year 75
 Malaria Outbreaks in Nepal
• Since 1970, the country has overcome a number of outbreaks in 1974,
1985, 1991, 2002, 2005 and 2006.
• 1974 outbreak involves three districts namely Kapilvastu, Rupandehi and
Nawalparasi.
• The highest number of cases was observed in the 1985 and 1991
epidemics.
• No Malaria deaths have been recorded after 2012 till date.

4/6/19 76
 ACTIVITIES
• LLIN Distribution
• Insecticide spraying
• Health worker training
• Conducted operational research on malaria vector behavior and
insecticide resistance.
• Conducted regular vector control (indoor residual spraying) biannually .
• Conducted detailed case based investigation and fever surveys around
positive index cases.

4/6/19 77
 Annual Blood Examination Rate (ABRE)

1.5

1.45
1.45
1.44

1.4

1.35

1.3
1.3

1.25

1.2

4/6/19 78
 Annual blood examination rate vs Number of malaria confrimed cases
120 1.5

100 1.45

80 1.4

60 1.35

40 1.3

20 1.25

0 1.2
2072/73 2073/74 2074/75

4/6/19 no.of confrimed malari cases Annual blood examination rate 79

 HIV AIDS Program

• HIV/AIDS program is a high priority program of government of Nepal.

• Rupandehi district is following current national HIV/AIDS strategy
(2016-2020).
• Vision of the 2016-2020 HIV/AIDS strategy is 90-90-90. Here the vision
builds by HIV test , Anti –retro viral therapy and virus counting. There is
community based treatment (CBT) too.
• By looking at the trend of three years 2072/73,2073/74 and 2074/75 we
can say that HIV positive cases are increase in 2073/74 then decrease in
2074/75

4/6/19 80
 % of pregnant women who tested for HIV at an ANC checkup.
70
63
60

50

40
Percentage

40

30 26

20

10

4/6/19 81
 Number of HIV counseled & tested
25000
21893
Numbers

20000

15000
12440

10000

5689
5000

0
4/6/19 82
 Number of HIV +ve cases in the district
200

180 175

160
Numbers

145 149
140

120

100

80

60

40

20

0
4/6/19 83
 Number of persons receiving ART
1200
1109
1014
1000
860
800
Numbers

600

400

200

4/6/19 84
 Reporting Status
Hospital, PHCC,HP
120

100 100 100

100

80
Percentage

60

40

20

4/6/19 85
 % of Immunization Clinic reporting to Health Facility
101

100
100

99
Percentage

98

97
97

96
96

95

94
4/6/19 86
 % of FCHV reporting to Health Facility
100 99
98
96
94
92
Percentage

90 89
88 87
86
84
82
80
4/6/19 87
 Female Community Health Volunteers

Total number of FCHVs (Including Urban FCHVs)

1600 1511 1511
1400

1200

1000
Numbers

800

600

400

200

0
4/6/19 88
 % of Mother's Group Meeting held
100 94
9084

80
69
70

60
Percentage

50

40

30

20

10

0
4/6/19 89
 Visit To PHCC, HP And NGOs/INGOs

4/6/19 90
 Basantapur PHCC
We visited Basantapur PHCC situated in Om Satiya Rural Municipality,
about 10 km away from District headquarter of Rupandahi on the
recommendation of DHO on Jan 10 of 2019.
The objective of our visit was to:
• Observe the physical infrastructure.
• Observe the overall management system
• Know about the services provided by PHC.
• SWOT analysis of PHC.

4/6/19 91
• PHC Incharge: Dr. Bikash Bhattari
• Catchment area:
Om Satiya-4 ( Sabik Basantapur VDC)
• Physical Infrastructures:
Building
Equipment
Drug/Store

4/6/19 92
 Services Provided
• Immunization • MCH
• Family planning • Safe motherhood
• OPD services • Safe abortion service
• PHC/ORC • Lab service
• Health education and training • ANC/PNC
services
• CB-IMCI

4/6/19 93
 Staffing Pattern
S.N Post Sanctioned post Fulfilled post Vacant

1 1+(4 temporary)=5
Medical Officer 1 -

2 1
HA/S.AHW 1 -

3 1
Staff Nurse 1 -

4 3
AHW 3 -

5 3
ANM 3 -

6 1
Lab Assistant 1 -

7 2+(1 temporary)=3
Office Assistant 2 -
4/6/19 94
 SWOT Analysis
Strength
• Fulfilled staffs
• Regular health services
• High coverage of ANC and PNC
• Regular and Proper lab functioning
including serological tests
4/6/19
Weakness
• Improper waste management
and disposal
• Inadequate logistic supply
• Lack of technical person
• Improper management of
equipment storage
• Irregular supply of medicine
95
Opportunities Threats

• Referral System • No baby warmer; used heater

• Temporary staffs involvement • Confusion between Rural
Municipality and District Health
Office

4/6/19 96
4/6/19 97
4/6/19 98
 Padsari Health Post
• We visited padsari Health post on recommendation of district health
office. We have visited there on 9 Jan 2019(Wednesday).
• The objectives of the visit are:
• To observe the physical infrastructure.
• To observe the overall management system.
• To know the service provided by Health Post.
• To know the Strength, Weakness, Opportunities and Treats of Health Post.

4/6/19 99
• In-charge Name: Hansaraj Daulyaal
• Location: Padsari health post is located in Omsatiya gaupalika ward no
2. Padsari, Rupandehi.
• Catchment area: Covers ward no. 1 and 2 that includes padsari,
karbalaha, karmodada, bardihawa, birnagar, tanhawa, chhupipal,
kewataliha, gagapur
• Physical infrastructure: It has one facilated building.

4/6/19 100
 Staffing pattern
S.N. Post Sanctioned Post

1 H.A 1

2 C.M.A 2

3 A.N.M 2

4 Office Assistant 1

Total 6

4/6/19 101
Services Provided
• OPD Service • CDD/ARI Program
• Primary health care • ORC clinic
• EPI • Malaria
• Nutrition service • Leprosy
• Family Planning Program • Tuberculosis
• Safe motherhood Program • Health education
• Disease Control Program • Vitamin A and Albendazole
Distribution

4/6/19 102
Strength Weakness
Co-ordination Improper biomedical waste management.
Staffing logistics
Well managed building
Timely monitoring

Opportunities Threats
Good road access to health post Other private health institution
nearby the HP

4/6/19 103
4/6/19 104
Hatibangai Health post

We visited Hatibangai Health post on recommendation of district health

office. We have visited there on 9 Jan 2019(Wednesday).It was establish on
2048 BS.
The objectives of the visit are:
 To observe the physical infrastructure
 To observe the overall management system
 To know the service provided by Health Post
 To know the Strength, Weakness, Opportunities and Threats of Health
Post

4/6/19 105
• In-charge Name: Mr.Chandrika yadav
• Location: Hatibangai health post is located in Rupandehi.
• Catchment area: Mayadevi rural municipality ward no.7,8.
• Physical infrastructure: It has one building.

4/6/19 106
 Program/Activities
• OPD Service
• Primary health care
• EPI
• Nutrition Program
• Family Planning Program
• Safe motherhood Program
• Disease Control Program
• CDD/ARI Program

4/6/19 107
• ANC
• PNC
• ORC clinic
• Malaria
• Leprosy
• Tuberculosis
• Health education
• Vitamin A and Albendazole Distribution
• FCHVs program
• School Health Program
• Iron distribution to adolescent girls
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 SWOT Analysis:
• Strength
Good co-ordination
Full coverage
• Weakness
Infrastructure
No skill training for staffs

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• Opportunities
Good public support
Good road access to the Health Post
• Threats
Political instability
Lack of Education among service users.

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 SUAAHARA
Name of INGO : Helen Keller International
Date of establishment :1915
Organization head name :Vikash Deuja
Program: SUAAHARA
Program establishment: 2011
Location : Bhatta tole, Siddhartha municipality -9 (Bhairahawa , Rupandehi)
Catchment area : Whole Rupandehi district
Goals and objectives :
•Improved health and nutrition behaviors at household and community level
•Increased
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• Increased production and consumption of diverse and nutritious foods by
women and their families
• Strengthened coordination on nutrition between government and other
stakeholders .
Program activities
• Promote the adoption of key maternal,infant and young child nutrition
practices through an extensive multi channelled behavior change strategy
including interpersonal communication activities, radio programs,biannual
nutrition weeks, and the use of mobile technology.

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• Improve the survival of mothers and their children by providing effective
counselling on the healthy timing and spacing of pregnancies.
• Improve clean water,sanitation,and hygiene (WASH) conditions by promoting
household latrine facilities and community sanitation norms including private
sector linkages for WASH technologies.
• Mobilize female community health volunteers to carry out iron folate
supplementation and de-worming campaigns for in school girls and out of
school adolescent girls.

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SUAAHARA intervention components
Suaahara works to improve supply and demand for nutrition
specific and nutrition sensitive interventions to reduce under-nutrition
among women and children less than 2 years of age.
Key Suaahara interventions are:
• Essential Nutrition Actions (ENA) to improve household behaviors related
to maternal, infant and young child nutrition (MIYCN)
• Essential Hygiene Actions (EHA) to ensure optimal hygiene and sanitation
at a household level
• Homestead food production (HFP) to improve consumption of diverse foods
especially greens and animal-source foods

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• Strengthened health services including improved counseling during sick child
visits, improved capacity to detect and treat severe acute malnutrition (SAM)
and family planning services to support healthy timing and spacing of
pregnancy
• Increase demand for such health system services as family planning, antenatal
care (ANC), postnatal care (PNC) and Integrated Management of Childhood
Illness (IMCI)

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 ADRA NEPAL
• Name of INGO- ADRA Nepal
• Date of establishment in Nepal-1987 AD
• Date of establishment in Butwal- JULY,2018
• Organization Head Name in Butwal : Tina Gurung
• Location: Kalikanagar, Butwal
• Program name:Family Planning Service Strengthening Program
• Catchment area: 5 municipalities, 10 rural municipalities,1 sub-
metropolitan(service to 36 health facilities).

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• Vision: Empower people-Effective Partnership-Transformational
programs.
• Project Objectives:
To expand availability of LARC(Long Acting Reversible Contraceptive)
through visiting service providers (VSPs) and increase access to
information on family planning for excluded women.
To increase CPR of the district.

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• Programmes:
Regular service delivery(Implant and IUCD)
FCHV Orientation
FCHV Orientation review(After 3 months)
Family planning demand generation activities
Includes Mother Group, Father Group, Boys and Girls Group
Hold interaction between couples currently using contraceptive and those
who don’t( for the effectiveness of the program).
Mobilize youth and adolescent in family planning(include quiz
contest,sports program related to family planning).

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Orientation , interaction , family planning information session with
marginalized and other hard to reach groups. For eg: driver, army etc.
Quarterly FCHV review meeting .
Implant and IUCD training to those staff of health facilities where there
are no such facilities.

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• Achievement in 2074/75:
Implant and IUCD services delivered.
Implant=578
IUCD=39
FP demand generation activities conducted to total 961 people (346 male
and 615 female).
Successfully conduction of orientation interaction and family planning
information session to 60 marginalized and other hard to reach groups(10
female and 50 male).
610 FCHV were given orientation and reviewed.
Successfully held interaction between couple currently using contraceptive
and those who don’t to 124 people (62 male 62 female).
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 Top Ten Diseases Of Rupandahi District
Disease % Disease %

1. URTI Cases 4.2 6. Muskuloskeletal Pain 3.4

2. APD 4.1 7. PUO 3.1

3. Fungal Infection 4.1 8. AGE Cases 2.6
Cases

4. Headache 3.9 9. Diarrhoea Cases 2.3

5. ARI/LRTI Cases 3.9 10. Dermatitis/Eczema Cases 2.3

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