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Background
The census of 2011 identified that 17% of Nepals population live in urban areas. While Nepal may be less urbanised than its neighbours, it is also the most rapidly urbanising country in South Asia with 6.7% growth in urban compared to 2.3% growth in rural areas (Muzzini 2013). To understand how well these expanding urban communities can access health services , across six municipalities of Nepal:
HERD have been providing essential health care through the Manohara Community Health Centre (MCHC) to an urban slum community in Kathmandu since 2008. To understand the feasibility of providing EHCS quantitative clinic data was analysed.
Methods
Rapid Assessment of Municipalities:
HERD in conjunction with Primary Health Care Revitalisation Division (MoHP) visited six municipalities to conduct a rapid assessment of urban health facilities. Team members from HERD and PHCRD visited:
Birgunj
Bharatpur
Biratanagar
Bhadrapur
Sidharthanagar
Butwal
Meetings were conducted with district health officials, including the focal person for urban health in the municipality. Data was collected on the umber of urban health centres, their management, level of coordination between district health offices and the municipalities, challenges faced by the UHCs and suggestions for improvement.
Manohara Community Health Centre (MCHC):
The data from the MCHC for a period 2008 to 2014 was collected and analysed. Services analysed included TB, Immunisation, Safe Motherhood and Family Planning
Lack of clarity on roles of DPHO,
Municipalities and UHC
No guidelines for UHC operation
No supervision and monitoring
Weak coordination between DPHO
and Municipalities
No formal coordination structures or forums
Lack of staff with appropriate skill
mix to deliver services
Not all have Health assistants;
Some without Auxiliary Nurse Midwives
leading to poor ANC provision
Human resource limitations
Poor remuneration and untimely budget
release disrupting salary disbursements.
UH volunteer not recognized as national
volunteer (FCHVs)
Confusion whether recruitment is
responsibilty of District Public Health Office or
Municipality.
Limited ownership for urban health by Municipalities
Many municipalities havent allocated
resources (financial and HR) for UH
Lack of Infrastructure
Many UHCs didnt their own building; lack of
separate rooms for ANC, FP
Lack of equipment,
registers, drugs
Poor service and lack of monitoring
PO Box 24133, Kathmandu, Nepal
Tel: 4 23 80 45, 4 10 20 72
Fax: 4 10 20 16 www.herd.org.np
Health Research and
Social Development Forum (HERD)
Maharjan, U., Baral, S., Giri, S., Khimbanjar, S., Khanal, S., Rumble, C.
This work has highlighted challenges to the provision of EHCS to the urban poor. There is a need for improvements in infrastructure and for greater coordination with clear lines of responsibility established. A health centre like Manohara Community Health Centre are important to provide EHCS to the urban poor. A national Urban Health Policy and guidance are essential to delivering EHCS to the urban poor with services targeted to marginalised communities.
Municipality Municipal
Population
UHCs Staff working at UHCs
Birgunj 139,068 4 HA (3); ANM (4); AHW (4);
Helper (4)
Bharatpur 143,836 4 HA ( 2); ANM (3); CMA (1);
AHW (2); Helper (4)
Biratanagar 197,711 5 AHW (14); ANM (9)
Bhadrapur 18, 607 2 HA (2); 1 (ANM)
Sidharthanagar 65, 629
2 HA (4); ANM (4); AHW (4)
Butwal 118,462 4 HA (4); ANM (4); AHW (4)
Key Findings from Municipality Assessment
Results from Manohara clinic
The Manohara slum population is currently an estimated 4,500
population. The clinic sees an average of 10,000 patients per year.
Conclusions
Objectives
To understand current service provision of Essential Health Care Services (EHCS) to the urban poor
To analyse service delivery in one clinic for the urban poor in Kathmandu
0
50
100
150
200
250
2008 2009 2010 2011 2012 2013 2014
Totally Immunised Children by Outreach and Manohara Clinic
Outreach clinic Manohara Clinic
Family planning Clients by Ethnicity 2008-2014
Dalit
Disadvantaged Janajati
Disadvantaged non dalit terai
Religious Minorities
Relatively advantaged Janajatis
Upper caste groups
Others
Total
0
5
10
15
20
25
30
35
40
45
2009 2010 2011 2012 2013
ANC Visits: The Challenge of Providing 4 ANC Sessions
1st ANC
4th ANC
Manohara Urban Clinic
0
5
10
15
20
25
30
2008 2009 2010 2011 2012 2013 2014
Total Number of Registered TB Cases