1. Issues and Challenges of public Health Practice
Prof. Dr. M.R. Chhetri
Chitwan Medical College

2. You can’t live a perfect day without doing something for someone who will never be able to repay you..

9. Accident

10. Nepal has made progress in raising the health status and living standards of the population .

11. The country continues to be suffered by the double burden: persistent problems of infectious diseases along with emerging epidemics and increasing trends of lifestyle-related non-communicable diseases.

12. The free essential care policy has become one of the popular programme, however, it has undermined demand for community based health insurance.

13. The free essential care policy itself has focused largely on provision of drugs and has not addressed the extra demands placed on human resources and facility running costs resulting from additional utilisation.

14. Additionally, policies do not always deliver what they promise
Additionally, policies do not always deliver what they promise. Very little efforts have been made to support research and knowledge development and their applications for improving public health.

15. Likewise, financial, social, political and governance factors have been critical barriers to implementing an effective public health system in Nepal

16. Critical Appraisal

17. National Health System of Nepal
Organized as
Central, regional & district health system and primary health care
District health system integrated with preventive, promotive and curative services.

18. Types of Health Care Systems
Allopathic system or modern medicine
Oriental or traditional medicine e.g.-
Ayurveda, Homeopathy/Unani/Naturopathy

19. Health Care System at District Level
DHO/DPHO
Hospital
Primary health care center
Health post
Outreach clinics
FCHVs

20. Barriers to Health Service Delivery
Socio-cultural barriers
Financial barrier ( 31% below poverty line
Gender barrier (health professionals/low status of women)
Geographical/topographical barrier
Communication & Language
Program & service barriers

21. Health Disparities in Rural Area
High morbidity and mortality rate
Low nutritional status (specially in women &
children)
Poor clinical and inadequate public health services
Low affordability and accessibility

22. Budget for Health Care

23. Barriers of Health System
Equity and equality – equal access for equal
need
Human resource for health distribution.
Poverty and health
Coordination and collaboration
Resource distribution
Accessibility and affordability

24. Barrier to HR utilization
Poor incentive
Poor monitoring and performance appraisal system
Poor supervision and supportive supervision
Lack of necessary instrument/ equipment/ infrastructure
Security problem

25. Mechanism of retention

26. Govt. policy
Provides study opportunity to people who work in rural areas (ANM, CMA, MD, MPH etc)
Skill enhance policy
Short and long term training (SBA, epidemic management, public health training, Bio medical engineering)
National and international seminar

27. Efforts for retention of health work force
Nepal Government
CTEVT
Scholarship for MBBS study.
Mandatory services in rural area
Rural service mandatory for promotion

28. Nick Simons Institute MDGP program Anaesthiologist
Anesthesia assistant
SBA training
MLP

29. Patan Academy of Health Science
Admission priority to:
Rural area /remote area
Commitment and willing to work in rural area
Experiences of rural area services
50 percent scholarship to 24 students
Full scholarship by Academy and DDC

30. Pokhara University 20 percent scholarship in all subjects
Mandatory to work in rural area as recommended by University
Scholarship in affiliated colleges

31. International and national organizations

32. To ensure the availability and accessibility of public health services for the entire population and in particular for the most vulnerable and under-privileged groups, some major issues and challenges have to be addressed urgently.

33. Human resource management (e.g. shortage, mismatching and brain drain)

34. Proper man in proper place

35. Communicable and non communicable diseases including mental illness and geriatric problems should be addressed.

36. Careful watch about towards emerging and re emerging diseases.

37. Coverage and distribution of services

38. Accessibility and affordability of clinical and public health service

39. Social and political issues.

40. To address these issues and overcome the challenges evidenced based research and application of findings will be more useful.

43. Thank you