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Cholera (हैजा): हैजालाई जनस्वास्थ्य र John Snow लाई epidemiology का पिता भनिन्छ । यसको कारण ,एक “हैजा” पाहिलो रोग हो जसले रोग र सरसफाईको सम्बन्ध हुन्छ भन्ने नयाँ धारणाको विकास गर्दै जन-स्वास्थ्य को अवधारणालाई उजागर गर्‍यो।दुई  John Snow ले पहिलो पटक रोगको (हैजा) कारणहरूको वैज्ञानिक तरिकाले अध्ययन अनुसन्धान गरे । १८ औं शताब्दीतिर युरोपमा औद्योगिक क्रान्तीको सुरुवात भयो । औद्योगिक क्रान्तीको प्रत्यक्ष असर बसाइसराई,सहरिकरण ,फोहर उत्सर्जन ,वातावरण प्रदूषण आदिमा पर्नगयो । युरोपका बिभिन्न सहर हरुमा पटक पटक हैजाको महामारी देखिन थाल्यो ।  सन् १८३२ मा बेलायतको सोहो जिल्लामा Cholera (हैजा) महामारी फैलियो । प्रवकता Edward Chadwick ले Cholera (हैजा) महामारीको अध्ययन गरी बेलायत सरकारलाई फोहरको उचित ब्यवस्थापन गर्न अपिल गरे । सरकाले उनको अपिललाई स्वीकार गर्दै सन् १८४८ मा “जन स्वास्थ्य ऐन १८४८” लागु गर्‍यो। जनस्वास्थ्यको इतिहासमा यसलाई ठुलो उपलब्धिको रुपमा हेरिन्छ । यसैगरी John Snow ले १८४८ देखि १८५४ सम्म अध्ययन अनुसन्धान गरी Cholera (हैजा)  र फोहर पिउने पानी (Unsafe Drinking Water) बिचमा सम्बन्ध रहेको प्रमाणित गरे । जन-स्वास्थ्य अर्को ठुलो उपलब्धि हो । Cause and Effect (कारण र असर): औद्योगिक क्रान्ति संगै सूक्ष्म जगतको अवलोकन गर्न मानवजाती सफल भयो । सन् १८ औं सताब्दीको अन्त्य सम्म पनि रोगको कारण पत्ता लागेको थिएन । हरेक ब्यक्ति समुदायका रोग हुने कारणहरु प्रती फरक फरक धारणाहरु थिए ।जस्तै ;  supernatural belief, theory of evil, impure blood, miasmatic theory etc. सन् १८५४ मा किंटाणु (ब्याक्टेरिया) को खोज संगै रोगको कारण पत्ता लागेको देखिन्छ । Louise Pasteur ले सन् १८६० मा प्रतिपादित गरेको “Germ theory of disease” ले अन्य चलिआएका बिभिन्न विश्वास, सिद्धान्त लाई खारेज गर्दै नयाँ सिद्धान्त को स्थापना गरे । UN, WHO र Nepal : पहिलो विश्वयुद्धपछि सन् १९२० मा विश्वका राष्ट्रहरूले अन्तर्राष्ट्रिय सहकार्यका लागि “लिग अफ नेशन्स” स्थापना गरे। यद्यपि, यो संस्था लामो समयसम्म प्रभावकारी रूपमा सञ्चालन हुन सकेन। दोस्रो विश्वयुद्धपछि विश्व शान्ति, सुरक्षा र सहकारिताको प्रवर्द्धनका लागि सन् १९४५ मा संयुक्त राष्ट्र सङ्घको स्थापना भयो। सन् १९४८ मा संयुक्त राष्ट्र सङ्घले विश्व स्वास्थ्य सङ्गठन (WHO) को स्थापना गर्‍यो, जसको उद्देश्य विश्वभरका नागरिकले भेदभावरहित र न्यायपूर्ण रूपमा उच्चतम स्वास्थ्य सेवा प्राप्त गर्न सकून् भन्ने थियो। नेपालमा राणा शासनको अन्त्यसँगै वि.सं. २००७ (सन् १९५१) मा प्रजातन्त्रको सुरुवात भयो। प्रजातन्त्रको प्रारम्भसँगै नेपालले विश्व समुदायसँग अन्तर्राष्ट्रिय सम्बन्ध विस्तार गर्न थाल्यो। सन् १९५४ मा नेपाल संयुक्त राष्ट्र सङ्घको सदस्य बन्यो। राष्ट्रको योजनाबद्ध आर्थिक विकासका लागि वि.सं. २०१३ (सन् १९५६) बाट आवधिक योजनाहरू शुरू भए। शिक्षा, स्वास्थ्य, कृषि, व्यापार, पर्यटन र अन्य पूर्वाधार विकासका लागि राष्ट्रिय योजना आयोगले आवधिक योजनाहरूको तर्जुमा शुरू गर्‍यो। वि.सं. २०१७ (सन् १९६१) मा राजा महेन्द्रले सत्ता हत्याएर ३० वर्ष (वि.सं. २०१७–२०४७) सम्म पञ्चायती व्यवस्था लागू गरे। यो अवधिमा स्वास्थ्य क्षेत्रमा नीतिगत रूपमा औलो उन्मूलन, खोप सेवा र परिवार नियोजन कार्यक्रमबाहेक अन्य उल्लेखनीय उपलब्धिहरू हासिल भयेको देखिदैन। 30th World Health Assembly सन् १९७७ सम्म पनि विश्वका आधाभन्दा बढी नागरिकहरू आधारभूत स्वास्थ्य सेवाबाट वञ्चित थिए। धनी र गरिब व्यक्ति तथा राष्ट्रहरूबीच स्वास्थ्य सेवामा ठूलो असमानता कायम थियो। सन् १९७७ मा विश्व स्वास्थ्य सङ्गठन (WHO) को ३०औँ अन्तर्राष्ट्रिय सम्मेलनले हरेक राष्ट्र र WHO को आगामी लक्ष्य “सन् २००० सम्म सबैका लागि स्वास्थ्य” लाई प्रस्ताव गर्‍यो। यस लक्ष्य प्राप्तिका लागि WHO ले दुईवटा योजना बनायो: तत्कालीन र दीर्घकालीन। तत्कालीन योजनाअन्तर्गत सबै नागरिकलाई न्यूनतम आधारभूत स्वास्थ्य सेवाको पहुँच र सक्रिय समुदायिक सहभागिता कायम गरि गुणस्तरीय सामाजिक जीवनयापन गर्न सक्षम हुने।दीर्घकालीन योजनाअन्तर्गत हरेक नागरिकले उच्चतम स्वास्थ्यको आनन्द लिन सक्नेछन भन्ने लक्ष्य निर्धारण गरियो।  Alma-Ata Conference 1978 स्वास्थ्य क्षेत्रमा रहेको असमानतालाई सम्बोधन गर्न सन् १९७८ सेप्टेम्बर ६–१२ मा Kazakhstan को Alma-Ata शहरमा विश्व स्वास्थ्य सङ्गठन (WHO) र युनिसेफको (UNICEF) संयुक्त पहलमा एक अन्तर्राष्ट्रिय सम्मेलन आयोजना गरियो। यस सम्मेलनले राष्ट्रभित्र(within Country)  र राष्ट्रहरूबीच (Between countries) स्वास्थ्य सेवामा रहेको असमानता हटाउने निर्णय गर्‍यो।जुन राजनीतिक, सामाजिक र आर्थिक रूपमा स्वीकार्य पनि थिएन। साथै, यो सम्मेलनले विश्व स्वास्थ्य सङ्गठनको “सन् २००० सम्म सबैका लागि स्वास्थ्य” (Health for All by 2000) नीतिलाई अङ्गीकार गर्न सबै राष्ट्रहरूलाई प्रोत्साहित गर्‍यो। हरेक राष्ट्रको स्वास्थ्य प्रणालीमा “प्राथमिक स्वास्थ्य सेवा”लाई प्रभावकारी रूपमा सञ्चालन गर्न, यो सम्मेलनले सबै राष्ट्र, सङ्घ, संस्था र सङ्गठनहरूलाई नयाँ नीति तथा योजना बनाएर कार्यान्वयन गर्न मार्गदर्शन प्रदान गर्‍यो। Peoples Movement in 1990 वि.सं. २०४६ को जनआन्दोलनसँगै नेपालमा ३० वर्षदेखि कायम पञ्चायती शासन व्यवस्थाको अन्त्य भयो। वि.सं. २००७ देखि २०४७ साल सम्म नेपाली जनता स्वास्थ्य क्षेत्रमा समान पहुँचबाट वञ्चित थिए। वि.सं. २०४६ को राजनीतिक परिवर्तनले सम्पूर्ण देश र जनतालाई पुनः आशावादी बनायो। अब हरेक नागरिकका आधारभूत मौलिक अधिकार सुनिश्चित हुने छन् , गरिबी उन्मूलन हुनेछ र स्वास्थ्य सेवामा सबैको समान पहुँच हुनेछ जस्ता आशाहरू पलाउन थाले। First National Health Policy 1991 नेपालमा स्वास्थ्य सेवामा सबै वर्गको न्यून पहुँच थियो। हरेक १ लाख ६८ हजार जनसङ्ख्यामा एक अस्पताल, ग्रामीण क्षेत्रमा हरेक ९२ हजार जनसङ्ख्यामा एक चिकित्सक, र ४ हजार जनसङ्ख्यामा एक शय्या (बेड) उपलब्ध थियो। यसैगरी, उच्च मातृ मृत्युदर (८.५ प्रति १,०००), पाँच वर्षमुनिका बालबालिकाको उच्च मृत्युदर (१९७ प्रति १,०००), लगायत अन्य सूचकहरूले नेपालको कमजोर स्वास्थ्य अवस्थालाई स्पष्ट दरसाउँथे । यी समस्यालाई मध्यनजर गर्दै वि.सं. २०४८ (सन् १९९१) मा नेपालको पहिलो स्वास्थ्य नीति जारी गरियो। यस नीतिको प्रमुख लक्ष्य “आधारभूत प्राथमिक स्वास्थ्य सेवा” लाई विस्तार गरी सबै नागरिकको पहुँचमा पुर्‍याउनु थियो। साथै, राज्यको स्वास्थ्य प्रणालीलाई सुदृढ बनाएर ग्रामीण तहसम्म प्रतिकारात्मक, प्रवर्द्धनमूलक, र उपचारात्मक सेवाहरूको विस्तार गर्ने उद्देश्य रहेको थियो। SLTHP 1997-2017 वि.सं. २०४८ (सन् १९९१) मा जारी पहिलो स्वास्थ्य नीतिलाई आधार बनाएर आगामी २० वर्षका लागि मार्गदर्शन प्रदान गर्न श्री ५ को सरकारको स्वास्थ्य मन्त्रालयद्वारा वि.सं. २०५४ (सन् १९९७) देखि २०७४ (सन् २०१७) सम्मका लागि दोस्रो दीर्घकालीन स्वास्थ्य योजना लागू गरियो। यस योजनाको प्रमुख लक्ष्य स्वास्थ्य सेवाको पहुँच बाट वञ्चित रहेका महिला, बालबालिका, ग्रामीण बासिन्दा, गरिब, जोखिममा रहेका वर्ग र सीमान्तकृत समुदायका आधारभूत स्वास्थ्य आवश्यकताहरू पूरा गर्नु थियो। साथै, अत्यावश्यक स्वास्थ्य सेवाहरू (Essential Health Care Services) लाई जिल्ला तहसम्म विकेन्द्रीकृत गर्ने उद्देश्य थियो ।   MDG –SDG सन् २००० मा संयुक्त राष्ट्र सङ्घद्वारा सहस्राब्दी विकास लक्ष्य (Millennium Development Goals -MDG) को घोषणापत्र जारी गरियो। यसको प्रमुख उद्देश्य सन् २०१५ सम्ममा विश्वमा रहेको गरिबी, भोकमरी, अशिक्षा, रोग, र लैङ्गिक असमानता घटाएर सामाजिक र आर्थिक विकासलाई प्रवर्द्धन गर्नु थियो। नेपालसहित १८९ देशहरूले यी लक्ष्यप्रति प्रतिबद्धता जनाएका थिए। MDG का आठवटा लक्ष्यमध्ये तीनवटा लक्ष्य प्रत्यक्ष रूपमा स्वास्थ्यसँग सम्बन्धित थिए: ४) बाल मृत्युदर घटाउने, ५) मातृ स्वास्थ्य सुधार गर्ने, र ६) एचआईभी, मलेरिया तथा अन्य रोगहरूसँग लड्ने। सन् २०१५ को सेप्टेम्बर २५ मा दिगो विकास लक्ष्य (Sustainable Development Goals – SDG) को घोषणापत्र “विश्वव्यापी परिवर्तनका लागि: दिगो लक्ष्य २०३०” लाई १९३ संयुक्त राष्ट्र सङ्घका सदस्य देशहरूको सहभागितामा कार्यान्वयनमा

CBIMNCI TREATMENT CHART BOOKLET

CB-IMNCI is an integration of CB-IMCI and CB-NCP Programs as per the decision of MoH on 2071/6/28(October 14, 2014). 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, Diarrhoea, Malaria, Measles and Malnutrition among under 5 year’s children in a holistic way. CBIMNCI TREATMENT CHART BOOKLET Community Based-Integrated Management of Childhood Illness (CB-IMCI) In Nepal, Child survival intervention began when Control of Diarrhoeal Disease (CDD) Program was initiated in 1983. Further, Acute Respiratory Infection (ARI) Control Program was initiated in 1987. To maximize the ARI related services at the household level, referral model and treatment model at the community level were piloted. An evaluation of this intervention in 1997 revealed that treatment model was more effective and popular in the community than referral model. In 1997/98, ARI intervention was combined with CDD and named as CB-AC program. One year later two more components, nutrition and immunization, were also incorporated in the CBAC program. IMCI program was piloted in Mahottari district and was extended to the community level as well. Finally, the government decided to merge the CBAC into IMCI in 1999 and named it as Community-Based Integrated Management of Childhood Illness (CB-IMCI). CB-IMCI included the major childhood killer diseases like pneumonia, diarrhoea, malaria, measles, and malnutrition. The strategies adopted in IMCI were improving knowledge and case management skills of health service providers, overall health systems strengthening and improving community and household level care practices. After piloting of low osmolar ORS and Zinc supplementation, it was incorporated in CB-IMCI program in 2005. Nationwide implementation of CB- IMCI was completed in 2009 and revised in 2012 incorporating important new interventions. Community-BasedNew Born Care Program Up to 2005, Nepal had made a huge progress in reduction of under-five and infant mortality, however,the reduction of neonatal mortality was observed to bevery sluggish because the country had notargeted interventions for newborns especially at community level. State of world report, WHOshowed that major causes of mortality were infections, asphyxia, low birth weight and hypothermia.The Government of Nepal formulated the National Neonatal Health Strategy 2004. Based on this‘Community-Based New Born Care Program (CB-NCP)’ was designed in 2007, and piloted in 2009.CB-NCP incorporated seven strategic interventions: behaviour change communication, promotionof institutional delivery, postnatal care, management of neonatal sepsis, care of low birth weightnewborns, prevention and management of hypothermia and recognition and resuscitation of birthasphyxia. Furthermore, in September 2011, Ministry of Health and Population decided to implementthe Chlorhexidine (CHX) Digluconate (7.1% w/v) aiming to prevent umbilical infection of the newborn.The government decided to scale up CB-NCP and simultaneously, the program was evaluated in 10piloted districts. Upto 2014, CB-NCP was implemented in 41 districts covering 70% population. Free Newborn Care Services The Government of Nepal (GoN) has made provisions on treating sick newborn free of cost through alltiers of its health care delivery outlets. The aim of this program is to prevent any sorts of deprivationto health care services of the newborn due to poverty. Based on the treatment services offered to thesick-newborn, the services are classified into 3 packages: A, B and C. The new born corners in healposts and PHCs offer Package ‘A’, district hospitals with Special Newborn Care Unit (SNCU) offer Package‘B’ and zonal hospitals and other tertiary hospitals offering Neonatal Intensive Care Unit (NICU) provideservices for Package ‘C’. The government has made provisions of required budget and issued directivesto implement the free newborn care packages in Nepal. The goal of the Free Newborn Care ServicePackage is to achieve the sustainable development goal through increasing access of the newborn careservices to reduce newborn mortality. The program makes the provision of disbursing Cost of Care torespective health institutions required for providing free care to inpatient sick newborns. Goals, targets, objectives, strategies, interventions and activities of CBIMNCI

National health policy 1991 (2048 BS) of Nepal

BACKGROUND OF NATIONAL HEALTH POLICY 1991AD The present low level of health status is attributable to lack of political commitment, inappropriate strategies, and weaknesses in implementation of health programmes up to the grass root level during the past 30 years. Because of these weaknesses, even now the crude death rate is 16 per thousand, crude birth rate is 41 per thousand, child mortality rate is 107 per thousand, maternal mortality rate is 8.5 per thousand, and mortality rate of children below 5 years is 197 per thousand. These facts and figures have confirmed Nepal as an underdeveloped and backward nation. Regarding health services delivery, there is one hospital for 168 thousand persons and one doctor for 92 thousand persons in the rural areas. Likewise, only one hospital bed is available for nearly 4 thousand persons. There is only one Health post for 24 thousand rural persons, which indicates the inadequacy of PHC services at the rural level. MAIN DEFICIENCIES IN PREVIOUS HEALTH SERVICES RATIONALE OF THE NATIONAL HEALTH POLICY 1991 In order to bring about improvement in the present health conditions of the Nepalese people adversely affected by the previous weaknesses and to fulfill the commitment of the present government in the health sector, it is necessary to have a new health policy. OBJECTIVES OF THE NATIONAL HEALTH POLICY 1991 The primary objectives of the proposed Health Policy are to upgrade the health standards of the majority of the rural population by extending Basic Primary Health Services up to the village level and to provide the opportunity to the rural people to obtain the benefits of modern medical facilities by making the facilities accessible to them. TARGETS OF THE NATIONAL HEALTH POLICY 1991 By the year 2000 A.D., the following targets will be attained: Indicators Current (1991) Target for 2000 AD Infant Mortality Rate (per 1000) 107 50 Child Mortality Rate (<5 years, per 1000) 197 70 Total Fertility Rate 5.8 4.0 Maternal Mortality Rate (per 1000) 8.5 4.0 Average Life Expectancy (years) 53 65 PROPOSED HEALTH POLICY 1. PREVENTIVE HEALTH SERVICES The services that are provided for the prevention of diseases fall under the Preventive Health Services. Under these, priority will be given to those programmes which directly help reduce infant and child mortality rates. These services will be provided in an integrated way through sub-health care centers at the rural level. The main programmes under this service are as follows: 2. PROMOTIVE HEALTH SERVICES The programmes which enable persons and communities to live healthy lives are included under promotive services. 1) Health Education and Information One of the main reasons for the low health standards of the people is the lack of public awareness of health matters. Therefore, health education will be provided in an effective manner from centre to rural levels. For this, political workers, teachers, students, social organizations, women and volunteers will be mobilized extensively up to the ward level. 2) Nutrition Priority programmes will be promotion of breast-feeding, growth monitoring, prevention of iodine deficiency disorders, iron and vitamin A deficiency, and health education to enable mothers to meet the daily requirements of children through locally available resources. 3) Environmental Health Programmes to inform the people about personal hygiene through various media, to collect and manage solid wastes, to inspect and examine hotel foods, drinking water and other edible products, to manage construction of general latrines and urinals, will be initiated in a coordinated manner. 3. CURATIVE HEALTH SERVICES The following curative health services will be made available at Central, District and Village levels: 4. BASIC PRIMARY HEALTH SERVICES 5. COMMUNITY PARTICIPATION IN HEALTH SERVICES Community involvement will be sought at each level of health care. Participation of women volunteers, traditional birth attendants (sudenies) and local leaders of various social organizations will be mobilized for health programmes at ward levels. 6. ORGANIZATIONS AND MANAGEMENT 7. DEVELOPMENT AND MANAGEMENT OF HEALTH MANPOWER i. Capable manpower required for various health facilities will be developed in a planned manner. ii. Necessary cooperation will be extended for institutional development of the Institute of Medicine, the main organization of the country producing health manpower, in order to raise its production capacity. iii. Necessary arrangements for training in foreign countries will be made in order to produce those categories of manpower, which cannot be produced within the country. iv. The Training Centres under the Ministry of Health will be strengthened institutionally and their production capacity will be raised, as required. v. Necessary reforms will be made in transfer, promotion and career development procedures for the health personnel at various levels. vi. Arrangements will be made to provide special benefits for doctors and other health personnel to encourage them to work in remote rural areas. 8. PRIVATE, NON-GOVERNMENT AND INTER SECTORAL COORDINATION i. If someone in the private sector wants to extend health services through the establishment of hospitals, health units, nursing homes, without any financial liability to His Majesty’s Government, such institutions may be operated after having obtained necessary permission from His Majesty’s Government and subject to minimum standards as prescribed. ii. Non-Government Organizations and Associations will be encouraged to provide health services under the prescribed policies of His Majesty’s Government. iii. Necessary coordination will be maintained at each level with the health related sectors including Agriculture, Education, Drinking Water and Local Development. 9. AYURVED AND OTHER TRADITIONAL HEALTH SYSTEMS i. The Ayurvedic system will be developed in a gradual manner. Organizational structures for different levels will be prepared separately. This section of medicine will be developed and expanded on the basis of evaluation of services through research. ii. Encouragement will be provided, as possible, to other traditional health systems like Unani, Homeopathic and Naturopathy. 10. DRUG SUPPLY i. In order to bring about improvements in the supply of drugs in government health organizations as well as those operated under private sector, the domestic production of essential drugs will be increased. In the meantime, the quality of the drugs will also be upgraded by effective implementation of the National Drug Policy.

नेपाल र जनस्वास्थ्य (Nepal and Public Health)

Cholera (हैजा): हैजालाई जनस्वास्थ्य र John Snow लाई epidemiology का पिता भनिन्छ । यसको कारण ,एक “हैजा” पाहिलो रोग हो जसले रोग र सरसफाईको सम्बन्ध हुन्छ भन्ने नयाँ धारणाको विकास गर्दै जन-स्वास्थ्य को अवधारणालाई उजागर गर्‍यो।दुई  John Snow ले पहिलो पटक रोगको (हैजा) कारणहरूको वैज्ञानिक तरिकाले अध्ययन अनुसन्धान गरे । १८ औं शताब्दीतिर युरोपमा औद्योगिक क्रान्तीको सुरुवात भयो । औद्योगिक क्रान्तीको प्रत्यक्ष असर बसाइसराई,सहरिकरण ,फोहर उत्सर्जन ,वातावरण प्रदूषण आदिमा पर्नगयो । युरोपका बिभिन्न सहर हरुमा पटक पटक हैजाको महामारी देखिन थाल्यो ।  सन् १८३२ मा बेलायतको सोहो जिल्लामा Cholera (हैजा) महामारी फैलियो । प्रवकता Edward Chadwick ले Cholera (हैजा) महामारीको अध्ययन गरी बेलायत सरकारलाई फोहरको उचित ब्यवस्थापन गर्न अपिल गरे । सरकाले उनको अपिललाई स्वीकार गर्दै सन् १८४८ मा “जन स्वास्थ्य ऐन १८४८” लागु गर्‍यो। जनस्वास्थ्यको इतिहासमा यसलाई ठुलो उपलब्धिको रुपमा हेरिन्छ । यसैगरी John Snow ले १८४८ देखि १८५४ सम्म अध्ययन अनुसन्धान गरी Cholera (हैजा)  र फोहर पिउने पानी (Unsafe Drinking Water) बिचमा सम्बन्ध रहेको प्रमाणित गरे । जन-स्वास्थ्य अर्को ठुलो उपलब्धि हो । Cause and Effect (कारण र असर): औद्योगिक क्रान्ति संगै सूक्ष्म जगतको अवलोकन गर्न मानवजाती सफल भयो । सन् १८ औं सताब्दीको अन्त्य सम्म पनि रोगको कारण पत्ता लागेको थिएन । हरेक ब्यक्ति समुदायका रोग हुने कारणहरु प्रती फरक फरक धारणाहरु थिए ।जस्तै ;  supernatural belief, theory of evil, impure blood, miasmatic theory etc. सन् १८५४ मा किंटाणु (ब्याक्टेरिया) को खोज संगै रोगको कारण पत्ता लागेको देखिन्छ । Louise Pasteur ले सन् १८६० मा प्रतिपादित गरेको “Germ theory of disease” ले अन्य चलिआएका बिभिन्न विश्वास, सिद्धान्त लाई खारेज गर्दै नयाँ सिद्धान्त को स्थापना गरे । UN, WHO र Nepal : पहिलो विश्वयुद्धपछि सन् १९२० मा विश्वका राष्ट्रहरूले अन्तर्राष्ट्रिय सहकार्यका लागि “लिग अफ नेशन्स” स्थापना गरे। यद्यपि, यो संस्था लामो समयसम्म प्रभावकारी रूपमा सञ्चालन हुन सकेन। दोस्रो विश्वयुद्धपछि विश्व शान्ति, सुरक्षा र सहकारिताको प्रवर्द्धनका लागि सन् १९४५ मा संयुक्त राष्ट्र सङ्घको स्थापना भयो। सन् १९४८ मा संयुक्त राष्ट्र सङ्घले विश्व स्वास्थ्य सङ्गठन (WHO) को स्थापना गर्‍यो, जसको उद्देश्य विश्वभरका नागरिकले भेदभावरहित र न्यायपूर्ण रूपमा उच्चतम स्वास्थ्य सेवा प्राप्त गर्न सकून् भन्ने थियो। नेपालमा राणा शासनको अन्त्यसँगै वि.सं. २००७ (सन् १९५१) मा प्रजातन्त्रको सुरुवात भयो। प्रजातन्त्रको प्रारम्भसँगै नेपालले विश्व समुदायसँग अन्तर्राष्ट्रिय सम्बन्ध विस्तार गर्न थाल्यो। सन् १९५४ मा नेपाल संयुक्त राष्ट्र सङ्घको सदस्य बन्यो। राष्ट्रको योजनाबद्ध आर्थिक विकासका लागि वि.सं. २०१३ (सन् १९५६) बाट आवधिक योजनाहरू शुरू भए। शिक्षा, स्वास्थ्य, कृषि, व्यापार, पर्यटन र अन्य पूर्वाधार विकासका लागि राष्ट्रिय योजना आयोगले आवधिक योजनाहरूको तर्जुमा शुरू गर्‍यो। वि.सं. २०१७ (सन् १९६१) मा राजा महेन्द्रले सत्ता हत्याएर ३० वर्ष (वि.सं. २०१७–२०४७) सम्म पञ्चायती व्यवस्था लागू गरे। यो अवधिमा स्वास्थ्य क्षेत्रमा नीतिगत रूपमा औलो उन्मूलन, खोप सेवा र परिवार नियोजन कार्यक्रमबाहेक अन्य उल्लेखनीय उपलब्धिहरू हासिल भयेको देखिदैन। 30th World Health Assembly सन् १९७७ सम्म पनि विश्वका आधाभन्दा बढी नागरिकहरू आधारभूत स्वास्थ्य सेवाबाट वञ्चित थिए। धनी र गरिब व्यक्ति तथा राष्ट्रहरूबीच स्वास्थ्य सेवामा ठूलो असमानता कायम थियो। सन् १९७७ मा विश्व स्वास्थ्य सङ्गठन (WHO) को ३०औँ अन्तर्राष्ट्रिय सम्मेलनले हरेक राष्ट्र र WHO को आगामी लक्ष्य “सन् २००० सम्म सबैका लागि स्वास्थ्य” लाई प्रस्ताव गर्‍यो। यस लक्ष्य प्राप्तिका लागि WHO ले दुईवटा योजना बनायो: तत्कालीन र दीर्घकालीन। तत्कालीन योजनाअन्तर्गत सबै नागरिकलाई न्यूनतम आधारभूत स्वास्थ्य सेवाको पहुँच र सक्रिय समुदायिक सहभागिता कायम गरि गुणस्तरीय सामाजिक जीवनयापन गर्न सक्षम हुने।दीर्घकालीन योजनाअन्तर्गत हरेक नागरिकले उच्चतम स्वास्थ्यको आनन्द लिन सक्नेछन भन्ने लक्ष्य निर्धारण गरियो।  Alma-Ata Conference 1978 स्वास्थ्य क्षेत्रमा रहेको असमानतालाई सम्बोधन गर्न सन् १९७८ सेप्टेम्बर ६–१२ मा Kazakhstan को Alma-Ata शहरमा विश्व स्वास्थ्य सङ्गठन (WHO) र युनिसेफको (UNICEF) संयुक्त पहलमा एक अन्तर्राष्ट्रिय सम्मेलन आयोजना गरियो। यस सम्मेलनले राष्ट्रभित्र(within Country)  र राष्ट्रहरूबीच (Between countries) स्वास्थ्य सेवामा रहेको असमानता हटाउने निर्णय गर्‍यो।जुन राजनीतिक, सामाजिक र आर्थिक रूपमा स्वीकार्य पनि थिएन। साथै, यो सम्मेलनले विश्व स्वास्थ्य सङ्गठनको “सन् २००० सम्म सबैका लागि स्वास्थ्य” (Health for All by 2000) नीतिलाई अङ्गीकार गर्न सबै राष्ट्रहरूलाई प्रोत्साहित गर्‍यो। हरेक राष्ट्रको स्वास्थ्य प्रणालीमा “प्राथमिक स्वास्थ्य सेवा”लाई प्रभावकारी रूपमा सञ्चालन गर्न, यो सम्मेलनले सबै राष्ट्र, सङ्घ, संस्था र सङ्गठनहरूलाई नयाँ नीति तथा योजना बनाएर कार्यान्वयन गर्न मार्गदर्शन प्रदान गर्‍यो। Peoples Movement in 1990 वि.सं. २०४६ को जनआन्दोलनसँगै नेपालमा ३० वर्षदेखि कायम पञ्चायती शासन व्यवस्थाको अन्त्य भयो। वि.सं. २००७ देखि २०४७ साल सम्म नेपाली जनता स्वास्थ्य क्षेत्रमा समान पहुँचबाट वञ्चित थिए। वि.सं. २०४६ को राजनीतिक परिवर्तनले सम्पूर्ण देश र जनतालाई पुनः आशावादी बनायो। अब हरेक नागरिकका आधारभूत मौलिक अधिकार सुनिश्चित हुने छन् , गरिबी उन्मूलन हुनेछ र स्वास्थ्य सेवामा सबैको समान पहुँच हुनेछ जस्ता आशाहरू पलाउन थाले। First National Health Policy 1991 नेपालमा स्वास्थ्य सेवामा सबै वर्गको न्यून पहुँच थियो। हरेक १ लाख ६८ हजार जनसङ्ख्यामा एक अस्पताल, ग्रामीण क्षेत्रमा हरेक ९२ हजार जनसङ्ख्यामा एक चिकित्सक, र ४ हजार जनसङ्ख्यामा एक शय्या (बेड) उपलब्ध थियो। यसैगरी, उच्च मातृ मृत्युदर (८.५ प्रति १,०००), पाँच वर्षमुनिका बालबालिकाको उच्च मृत्युदर (१९७ प्रति १,०००), लगायत अन्य सूचकहरूले नेपालको कमजोर स्वास्थ्य अवस्थालाई स्पष्ट दरसाउँथे । यी समस्यालाई मध्यनजर गर्दै वि.सं. २०४८ (सन् १९९१) मा नेपालको पहिलो स्वास्थ्य नीति जारी गरियो। यस नीतिको प्रमुख लक्ष्य “आधारभूत प्राथमिक स्वास्थ्य सेवा” लाई विस्तार गरी सबै नागरिकको पहुँचमा पुर्‍याउनु थियो। साथै, राज्यको स्वास्थ्य प्रणालीलाई सुदृढ बनाएर ग्रामीण तहसम्म प्रतिकारात्मक, प्रवर्द्धनमूलक, र उपचारात्मक सेवाहरूको विस्तार गर्ने उद्देश्य रहेको थियो। SLTHP 1997-2017 वि.सं. २०४८ (सन् १९९१) मा जारी पहिलो स्वास्थ्य नीतिलाई आधार बनाएर आगामी २० वर्षका लागि मार्गदर्शन प्रदान गर्न श्री ५ को सरकारको स्वास्थ्य मन्त्रालयद्वारा वि.सं. २०५४ (सन् १९९७) देखि २०७४ (सन् २०१७) सम्मका लागि दोस्रो दीर्घकालीन स्वास्थ्य योजना लागू गरियो। यस योजनाको प्रमुख लक्ष्य स्वास्थ्य सेवाको पहुँच बाट वञ्चित रहेका महिला, बालबालिका, ग्रामीण बासिन्दा, गरिब, जोखिममा रहेका वर्ग र सीमान्तकृत समुदायका आधारभूत स्वास्थ्य आवश्यकताहरू पूरा गर्नु थियो। साथै, अत्यावश्यक स्वास्थ्य सेवाहरू (Essential Health Care Services) लाई जिल्ला तहसम्म विकेन्द्रीकृत गर्ने उद्देश्य थियो ।   MDG –SDG सन् २००० मा संयुक्त राष्ट्र सङ्घद्वारा सहस्राब्दी विकास लक्ष्य (Millennium Development Goals -MDG) को घोषणापत्र जारी गरियो। यसको प्रमुख उद्देश्य सन् २०१५ सम्ममा विश्वमा रहेको गरिबी, भोकमरी, अशिक्षा, रोग, र लैङ्गिक असमानता घटाएर सामाजिक र आर्थिक विकासलाई प्रवर्द्धन गर्नु थियो। नेपालसहित १८९ देशहरूले यी लक्ष्यप्रति प्रतिबद्धता जनाएका थिए। MDG का आठवटा लक्ष्यमध्ये तीनवटा लक्ष्य प्रत्यक्ष रूपमा स्वास्थ्यसँग सम्बन्धित थिए: ४) बाल मृत्युदर घटाउने, ५) मातृ स्वास्थ्य सुधार गर्ने, र ६) एचआईभी, मलेरिया तथा अन्य रोगहरूसँग लड्ने। सन् २०१५ को सेप्टेम्बर २५ मा दिगो विकास लक्ष्य (Sustainable Development

Health Sector Strategies In Nepal 

Introduction This document provides a comprehensive overview of the evolution of Nepal’s health sector strategies and implementation plans from 2003 to 2030. It summarizes the key aspects of the “Health Sector Strategy: An Agenda for Reform” (2003), the subsequent Nepal Health Sector Implementation Plans (NHSP-IP I, II), the Health Sector Strategy 2015-2020, the Health Sector Implementation Plans (NHSP-IP III), and the current National Health Sector Strategic Plan (NHSSP) 2023-2030. 1. Health Sector Strategy: An Agenda for Reform (2003) To improve the health status by providing EHCS the government set the following outputs…. Program Outputs: Sector Management Outputs:    1. Coordinated sector management, 2. Sustainable financing, 3. Improved structures and systems, 4. HR development 5. Integrated information systems. 2. Nepal Health Sector Implementation Plan I (NHSP-IP I) The program Activities fall into 3 category ; 3. Nepal Health Sector Implementation Plan II (NHSP-IP II) Timeline: 2010-2015 The Millennium development goals, the health sector strategy; agenda for reform 2003, and the first Nepal health sector program implementation plan (NHSP-IP 1) provide the basis for developing the second National Health sector implementation plan 2010-2015  Key Focus: Contribute directly to meeting the health related Millennium development Goals 1, 4, 5 and 6 Three major objectives: Value Statements 4. Health Sector Strategy (2015-2020) Timeline: 2015-2020 Guided by the National Health Policy 2014, Nepal’s Health Sector Strategy 2015-2020 (NHSS) serves as the primary instrument for the health sector, embedding the constitutional right to basic health services and a commitment to Universal Health Coverage (UHC). aiming to elevate Nepal from a Least Developed Country to a Middle Income Developing Country by 2022. Developed within the Sector Wide Approach (SWAp), the NHSS emphasizes partnership between the government and development partners, fostering multi-sectoral approaches to address social determinants of health. NHSS stands on four strategic principles: Goal: improve the health status of all people through an accountable and equitable health service delivery system. NHSS stipulates the following nine outcomes to achieve this goal: 1. Rebuilt and strengthened health systems:  2. Improved quality of care at point-of-delivery 3. Equitable utilization of health care services 4. Strengthened decentralised planning and budgeting 5. Improved sector management and governance 6. Improved sustainability of health sector financing 7. Improved healthy lifestyles and environment 8. Strengthened management of public health emergencies 9. Improved availability and use of evidence in decision-making processes 5. Nepal Health Sector Implementation Plan III (NHSP-IP III) 2016-2021 Vision : All Nepali citizen will be physical mental social and emotional healthy lead a productive and quality lives Goals :  improve health status of all the people through accountable and equitable health service delivery System  Strategies: OUTCOMES : There are nine outcomes set by NHSP-III  1. Strengthen health system 2. improve quality care 3. Equitable utilization for decentralization 5. improved sectoral management 6. health sector financing 7. improve healthy lifestyle and environment 8. management of Public Health emergency 9. evidence in decision making  6. National Health Sector Strategic Plan (NHSSP) 2023-2030 This Strategic plan is formulated as a guiding document for achieving the SDGs target in accordance with National health policy 2076. This strategy is based on ; Constitution of Nepal 2015, 15th periodic plan, Public health act 2075. Directed principles ; Strategic Objectives: Vision :  Healthy productive, responsible and Happy citizen Mission To ensure the health right of the citizen Goal Improve the health status of all citizen of the Nepal Conclusion Nepal’s health sector strategies have evolved from an initial emphasis on essential services to a comprehensive approach aimed at achieving universal health coverage and addressing the broader determinants of health. The NHSSP 2023-2030 represents the latest step in this journey, with a focus on.

First Long Term Health Plan of Nepal (1975 -1990AD)

Nepal’s First Long-Term Health Plan (FLTHP): A 15-Year Vision for Equitable Care In 1975, Nepal launched its First Long-Term Health Plan (FLTHP), a 15-year strategy (1975–1990) designed to combat political instability and inconsistent health policies. This landmark plan aimed to prioritize rural healthcare, family planning, and maternal and child health while creating a sustainable, integrated health system. Why Was the FLTHP Created? The FLTHP emerged to counter haphazard health policies influenced by political leaders and advisors. Its core goals were: Key Objectives of the First long term health plan How Was the First long term health plan Developed? Major Achievements of First long term health plan Challenges & Legacy of First long term health plan While geographical barriers and limited resources hindered full success, the FLTHP: ConclusionNepal’s First long term health plan (1975–1990) revolutionized healthcare access for rural communities and set the stage for future policies. By prioritizing equity, family planning, and resource efficiency, it remains a cornerstone of the nation’s public health journey. CTA: Explore more about Nepal’s health evolution and modern strategies on [bishtnabin.com.np] DOWNLOAD PDF file of First Long Term Health plan (FLTHP) Click here

National Ethical Guideline For Health Research In Nepal 2022

The NHRC developed the “National Ethical Guidelines for Health Research in Nepal 2022” to ensure ethical practices in health research involving human participants. These guidelines are for researchers, reviewers, sponsors, and regulatory authorities. They build on earlier versions from 1995, 2001, 2011, and 2019. The NHRC has organized workshops to educate researchers on ethical standards and address compliance issues. The 2022 guidelines focus on new ethical concerns, such as the informed consent process, the creation of Institutional Review Committees (IRCs), and issues in emerging research areas like public health emergencies and biobanking. Overall, these guidelines represent an important step forward in managing health research ethically, protecting participants’ rights and welfare while supporting valuable research. 2. Ethical Principles of Health research in Nepal 2.1 Basic Ethical Principles 2.2 General Ethical Principles 3. Roles and Responsibilities of the Researchers/Investigators (NHRC) 4. Ethical Issues in Health Research • Ensuring participant safety, especially vulnerable groups. • Assessing risks and benefits. • Maintaining transparency, privacy, and confidentiality. • Managing conflicts of interest (CoI). • Fair benefit-sharing. 4.1 Research Involving Vulnerable Populations 4.1.2 Research Involving Children 4.1.3 Research Involving Pregnant & Lactating Women 4.1.4 Research on Sexual Minorities & Sex Workers 4.1.5 Research on Tribal & Indigenous Populations 4.1.6 Research on Individuals with Mental Illness or Cognitive Impairment • Permitted if directly related to their condition. • If they pose harm to themselves/others, confidentiality may be breached for safety. 4.1.7 Research on Hierarchical Groups (Prisoners, Military, Employees, etc.) • Participation must be voluntary, with no coercion or penalties for withdrawal. 4.1.8 Research on Terminally Ill Persons 5. Informed Consent Process in Health Research Requisites The informed consent process must include information, comprehension, and voluntariness Information Researchers must provide all necessary information to potential participants. Comprehension Researchers must ensure participants understand the information provide. Voluntariness Participation must be voluntary and free from coercion Obtaining Informed Consent E-consent Electronic consent is acceptable if it meets certain criteria. Re-consent Re-consent is required in specific situations, such as protocol changes or new information affecting participation. Waiver of Consent Consent may be waived in certain circumstances, such as minimal risk studies or when consent is impractical]. Special Situations Special considerations apply for obtaining consent from vulnerable populations or in emergency research. Deception Studies Specific procedures are outlined for studies involving deception Post-consent Procedures Researchers must ensure ongoing consent and provide relevant new information to participants Documentation Proper documentation of the consent process is required This section emphasizes the importance of a thorough, ethical, and well-documented informed consent process in health research, ensuring participants’ rights and welfare are protected. Section 6: Ethical Review Process by NHRC This section describes the formation, roles, and responsibilities of the Ethical Review Board (ERB) and its processes: Formation and Composition of ERB Responsibilities of ERB Submission and Review Procedures Continuing Oversight Section 7: Specific Requirements for Specialized Research This section outlines additional guidelines for specialized types of research: Key Requirements Clinical Trials Emerging Areas of Research Section 8: Establishment of Institutional Review Committees (IRCs) of NHRC This section focuses on setting up IRCs at institutional levels: Formation of IRCs Roles and Responsibilities Capacity Building These sections collectively emphasize a robust ethical framework for health research in Nepal, ensuring participant safety and adherence to international standards. Links : NHRC : https://nhrc.gov.np Download Guideline pdf : Ethical-guideline-for-health-research-in-Nepal-2022.pdf   अनुसूची २ : Download Downlod Other Guideline Links :https://bishtnabin.com.np/plans/

Nepal Health Insurance Program Download

To Download PDF Scroll down What is Nepal’s Health Insurance Program? Main Objectices (Health Insurance policy 2013) Coverage of health Insurance program (Annual report 79/80) Cumulative Coverage tabble of health Insurance Ambitious Targets for Nepal’s Future How the Health Insurance Program Works – Simple Breakdown Impressive Implementation Progress Why Health Insurance Matters for Your Family The Health Insurance Program provides a safety net that protects your family’s finances while ensuring access to quality healthcare when you need it most. With the government’s continued expansion efforts, more Nepalis than ever can benefit from this important program. Have you enrolled in Nepal’s Health Insurance Program yet? Share your experience in the comments below! SWOT Analysis of the National Health Insurance Program of Nepal A SWOT analysis evaluates the strengths, weaknesses, opportunities, and threats associated with the National Health Insurance Policy in Nepal. This framework helps to understand the policy’s potential impact and areas for improvement. Strengths Weaknesses Opportunities Threats Conclusion The National Health Insurance Policy in Nepal has the potential to significantly improve health care access and financial protection. However, addressing its weaknesses and threats while leveraging strengths and opportunities will be crucial for its successful implementation and sustainability. स्वास्थ्य बीमा बोर्ड links :https://hib.gov.np/en

Pokhara University Exam Schedule Fall 2024

  Pokhara University exam schedule has been Fall 2024 Published ! Faculty of Health Science(SHAS)  Hello, students of Pokhara University Faculty of Health Science! 👋 Exciting news for all students pursuing BPH, B.Pharm, B.Sc. MLT, B.Physiotherapy, B.Sc. MB, B.Sc. MM, and B.Optometry.it’s time to plan your study schedule accordingly. We’ve provided the details on how you can access and download the official exam routine PDF below. 📥 Download Exam Schedule PDF file from below link 👉 Download Exam Routine PDF 👉 Download Exam Centre PDF Must Remember 1.Check your program & semester-wise schedule 2024 in the PDF. 2. Mark your exam dates and start planning your preparation! 📆📚 💡 Tip: Keep a printed or saved copy of the schedule on your phone for easy access! Important Exam Guidelines to Remember 🔹 Check your exam center beforehand to avoid last-minute confusion. 🔹 Arrive at least 30 minutes before the exam starts , afterthat 🔹 Bring your admit card & student ID card—no entry without them! 🔹 Follow all university guidelines related to exam rules and regulations. 🔹 Avoid bringing restricted items like smartwatches, mobile phones, or extra papers. 📝 Stay updated with official university notices for any last-minute changes to the schedule! Final Thoughts On Exam The Fall 2024 exam Schedule season  is an important phase for all Pokhara University Health Science students. Start your exam preparation early, stay focused, and make sure to follow the exam routine properly.so We wish you all the best of luck for your upcoming exams! 🍀💯 📢 For official updates and notices, visit Pokhara University’s website. 📩 Have any questions? Drop them in the comments below, and we’ll be happy to help! 😊 Exam Controller Office Link of Exam Controller pokhara University : https://exam.pu.edu.np

Welcome to Public Health

Why This Platform Exists As public health students in Nepal, we often face unique challenges: outdated study materials, limited access to practical tools, and a gap between classroom theories and real-world knowledge. This platform was born to bridge those gaps. Public Health is your space to learn, connect, and grow—whether you’re a first-year student, an intern at a local NGO, or a professional looking to upskill. Why Public Health Matters in Nepal Public health in Nepal focuses on improving the well-being of communities through preventive care, education, and health promotion. This blog delves into major public health initiatives, including maternal and child health, sanitation, immunization, and disease control programs. It also highlights the government’s efforts, the role of NGOs, and community participation in strengthening the health system. Join Us On This Journey Subscribe for updates on new blogs, tools, and upcoming courses. Share Your Voice: Have an idea for a blog? A question about fieldwork? Comment below or reach out! Stay Curious: Public health is ever-evolving—let’s learn and adapt together. A Personal Note  As a fellow public health student, I started this platform because I believe education should empower, not overwhelm. Whether you’re analyzing data for your project or preparing for your first health camp, remember: every small step you take contributes to a healthier Nepal. Let’s grow together! Here’s to your journey in public health—may it be impactful, inspiring, and uniquely yours. Please What topics do YOU want us to cover next? Let us know in the comments! 💬 1 Comment dipakMarch 14, 2025 at 3:33 pm | EditReply please upload other notes Leave a Reply Cancel reply Logged in as admin. Edit your profile. Log out? Required fields are marked * Message*