Emergence and Expansion The Department of Health Services was established in 1953,

under Ministry of Health, which carry out the responsibility

of promotion, regulation and management of hospitals,

government traditional Ayurvedic Dispensaries/School and a

unit for production of Ayurvedic medicines.

At the beginning in the mid 50s, Nepal started five year

development plans.

During that period, the health plans focus on

institutionalization of curative health services.

The preventive health care was begin with establishment of

Vector Borne Disease Control Unit in Dang in 1951 to

control Malaria where as the promotive health care was

institutionalized by establishing the Health Education

Section in 1961 under Department of Health Services.

The period of late fifties and sixties was most promising in

prevention and control of infectious diseases like malaria,

tuberculosis, leprosy and smallpox, which were recognized as

serious public health problems.

In this regard, the projects established in the country were as following -

Malaria Eradication Project in 1958

Leprosy Control Project in 1964

Tuberculosis Control Project in 1965

Smallpox Eradication Project in 1967

Family Planning and Maternal Child Health Project in 1968

Following the official eradication of smallpox, this project was converted into the Expanded Programme of Immunization (EPI) in 1977.

These programs were existed as vertical projects in which

foreign assistance was the major source of funding to provide

various health services.

During the period considerable attention was given in human

resource development and control of epidemic situation.

Malaria Control The history of malaria, or awal as was known in the country has

been recounted already.

The locals here, as elsewhere in the world, believed it to emanate

from swamps, marshes and similar environment.

In fact people, having lived in such areas, believed that the

condition was caused by bad air or mala aria.

Thus originated the name for the symptoms which later turned out

to be caused, not by bad air, but by a parasite aided by its vector,

the mosquito.

Since 1955 Nepal attempted for four years to try to eradicate

malaria.

After a period of 12 years it was noted that there was a

marked reduction in the number of malaria cases.

After a further five years the picture had changed, perhaps

because the mosquitoes had developed resistance to DDT.

Seeing that eradication now seemed an impossible task, WHO

in 1976 advised to change to a Malaria Control Programme

instead.

Because of its geographical situation 67 out of the 75 districts

are considered malarious.

As of 1982, fifty districts were served with regular anti

malarious services whilst the 21 hill districts with irregular

transmission provided drug supply through health posts.

Maximum resurgence of malaria was seen in the central region

where there were as many as 15,594 cases in 1991.

Integration: By the late sixties both USAID and WHO had come around to

the thinking that the Nepalese health services needed to be

integrated. This led naturally on to the proposal of trying the

process in two districts viz. Kaski and Bara, which were dissimilar

in terms of location, living styles etc.

The administrative aspects were first handled by Community

Health and Integration Division (CHID).

Integration: A Central Integration Board (CIB) was also formed. As time

went on, 4 more districts were added.

In 1980 however, both the CHID and CIB were disbanded and

a new Integrated Community Health Services Development

Project (ICHSDP) was formed as per the Development Boards

Act of 1956.

The various slogans of WHO starting from Basic Minimum Health Needs culminated ultimately in the Health For All 2000 (HFA 2000) strategy of 1978.

This in course of time, following acceptance by the world at the Alma Ata Conference of 1978, became the “Health Call of the World”.

By 1987 the MoH decided to integrate all the vertically run programmes. The Department of Health Services was done away with and the Ministry took over the overall functioning.

The District Public Health Offices were established. By this time the ICHSDP had a total of 23 integrated districts under it.

All these now came under the newly established Public Health

Division, which also became the central focal point for the

DPHOs.

In June 1996, during the time that the three party coalition

government of NC, RPP and NSP was in power, the Malaria

Research and Training Centre at Hetauda was converted into the

Vector Borne Disease Centre with the aid of USAID.

This centre has been designated the focal point for the fight

against vector borne diseases such as malaria, kala-azar and

Japanese encephalitis.

Strengths Services are provided in integrated way under single umbrella

No need of separate infrastructure for each and every programme

Maximum utilization of resources

No need of separate health workforce for each and every programme

Time saving while providing services in integrated way

Easy to carry out supervision as integrated supervision

Easy management of services

Low management and administrative cost

Increased effectiveness and efficacy

No duplication of work/services

Team building

Integrated Information collection

No confusion among beneficiaries as they get all services at one places

Strengthened organizational capacity

Weaknesses

Complexity in service delivery

Difficulty in time managing for each and every services

May be low quality services due to emphasis in all services

Difficulty in resource allocation in particular programme and service

High workload to health workers

Complexity in administration and management

Difficulty in appropriate management of resources

Poor supervision to particular service due to its focus on all services

Human resource constraints as they may not have skill and knowledge to manage all services

Conflicts b/n projects/programs

Problem in maintaining information as huge information is collected in integrated way

Opportunities Favorable government policy: National health policy 1991

Involvement of bilateral and multiple partners for integration

process

Favorable international Environment: Evolution of Primary

Health care concept in Alma Ata Conference in 1978 and Health

for all by the year 2000

Availability for international funds for integrated services

Developed mechanism for health information management

Threats Lack of political commitment

Political instability, rapid change in government

Ambitious health workforce wants to work in urban area only

Geographical difficulties

Internal resource constraints

Weak infrastructures for providing integrated services

Poor road/without road and transportation facility

Thank You!