Background

The census of 2011 identified that 17% of Nepal’s 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 haven’t allocated

resources (financial and HR) for UH

Lack of Infrastructure

Many UHCs didn’t 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