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National Annual Review 2017/18
Dr Dipendra Raman Singh
Chief, Quality Assessment and Regulation Division
Ministry of Health and Population
Councils/Academia/Hospital Services
Contents
Councils- Nepal Medical Council, Nepal Nursing Council, Nepal Ayurvedic Medical Council, Nepal Health Professional Council, NPC, NHRC
Academia/Hospitals
Minimum Standard of government hospitals
Private institutes
Standardization
Qualified Human Resources Increase Service Quality
Academia
Quality process/ Accreditations
( Councils)
COUNCILS/Academia/Hospitals…
Inputs
Output Health Facilities
Councils Total Academia
Total HR productions 2017/total
Achievements Issues
Bachelors Master and above
NMC 26 ( 2 not functioning)
2435 (21413)
569 (6079)
Ethical Guidelines, Accreditation Standards of MBBS/BDS, Regulations of Post Graduate Med Education: MD/MS ,DM/MCh, MDS Revised Act of NMC (Submitted to MOH)
Quality health services- healthy population- country economy
NNC 218( PCL 120+ Bachelors 88 +Masters and above 10)
77302(PCL and Below) 7895(Bachelor)
NA • Revised accreditation/ monitoring/ feasibility/ self assessment tools
• Curriculum of PCL midwifery education • The code of conduct for nurses and
midwives • online registration for master level of nursing • Bachelor level of midwifery education at
Karnali • Bachelor level nursing education in oncology • Online form submission in the license
examination
•mushrooming colleges •uniformity among the educational institutions •nurse- patient ratio, inappropriate posting, low wage
Councils Total Academia
Total HR productions 2017/total
Achievements Issues
Bachelors Master and above
NHPC
217 ( 2 not functioning)
1136
177
•Online registration system of new applicants •Control quality education of student going abroad through permission letter to eligible prospective students •NHPC new building has been completed.
•Quality health services- healthy population- country economy
•mushrooming colleges •uniformity among the educational institutions
NAMC
17 120(PCL and Below)89 (Bachelor)
2 NA NA
NPC NA NA NA NA NA
Major accomplishment of NHRC last year
Regulation and Governance of Health Research in the country -(Established
online submission system, approved 699 health research projects, and established 10 Institutional
Review Committees in Academic Institutions)
Health Research Capacity building -(training to 500 researchers and 63 research
grants)
Evidence generation -(Prevalence of mental health, NCDs, climate change and health,
DLI, population based cancer registry, outbreak investigation, traditional and complementary
medicines, human resources for health, electronic medical record, Sickle cell disorder, health
insurance, BOD)
Promoting the use of evidences -(Organized national summit of health and population
scientists (1200), capacity building workshop on using evidence on policy making (40), developed
10 policy briefs, contributed to develop H-NAP, participated in steering and technical working
group formed by GoN to develop Act, policy, plan, strategy and standards)
Additional activities planned and budget request (Establishment of clinical trial registry in Nepal, establishing liaison office of council in seven
provinces, NCD STEPS survey and total requested additional amount NRS. 3 Corer)
Fiscal progress =100% and Financial progress =100%
6
VIEW of KAHS
Teaching Hospital
Progress on Key Indicators SN Indicators 2072/73 2073/74 2074/75
1 Total OPD clients 24826 26428 39942
2 Total emergency clients 3276 3506 4347
3 Total inpatients 6318 6643 8235
4 Bed occupancy rate 40 43 49
5 Average length of stay 4 4.4 4.5
6 CS rate (out of total delivery) 7.15 11.46 15.63
7 Hospital death rate 0.64 0.84 0.59
8 Surgery related death rate 0 0 0.011
9 Average number of radiographic images per day 28 34 53
10 Average number of laboratory tests per day 136 157 233
11 Clients served by OCMC 29 35 11
12 Clients served by SSU - 29 255
Hospital Death FY 2074/75 Particular Number
Number of Maternal Deaths at Hospital 0
Number of Neonatal Death at Hospital 15
Number of Perinatal Deaths in hospital 43
Number of still births 29
Number of early neonatal deaths 14
Number of hospital maternal deaths reviewed 0
Major responses taken to prevent similar maternal and perinatal deaths in future : Plan for NICU, training
Causes of Death
Perinatal: Birth Asphyxia, Premature, Trauma, LBW, Congenital Deformity ,Neonatal Sepsis etc.
Maternal:---
Finance: Operating Budget (2074/75)
Budget Budget Allocated
Budget Released
Budget Expenditure
Irregularities (BERUJU)
Amount Clearances % Clearances
Capital 40,86,80,000 40,86,80,000 40,82,36,188 8,35,119.12 - -
Recurrent 17,54,00,000 17,54,00,000 17,53,85,008
Total 58,40,80,000 58,40,80,000 58,36,21,196
HDC Budget (2074/75)
Amount generated (income)
Expenditure Balance
Irregularities (BERUJU)
Amount Clearances % Clearances
4,51,83,927.61
4,51,83,927.61 - - - -
KAHS Working Districts
Jumla Humla Dolpa Mugu Kalikot Jajarkot Dailekh Surkhet Rukum Salyan Bajhang Bajura Achham
Karnali Bheri Rapti Seti
Karnali Province- 10 dist. Sudurpasim
Province- 3 dist.
Academic Programs Programs Commencing on No. of Batches Total students
1. Post graduate
-MDGP Inspection by NMC
2. Graduate
- MBBS Preparing Curriculum,faculties,Lab
BACHELOR IN MIDWIFERY
Started since 2nd Marga 2075
1st 10
BACHELOR IN PUBLIC HEALTH
BPH Just finished Entrance exam
1st batch 20
3. PCL
- Nursing PCL 40 in each batch 120
- General medicine Health Assistant 40 in each batch 120
-Anesthesia Assistant 4 in each batch 4
BPKIHS- Hospital Services
13
Services (In Number) 2072/73 2073/74 2074/75
OPD New Cases 292989 350376 380345
Emergency Visits 59030 64051 65424
Inpatients Admitted 41877 46312 46055
Inpatients Discharge 41935 45791 45310
Total Hospital Deaths 409 498 358
Total Delivery
ND 7127 7443 7000
Vacuum 183 259 261
C/S 3117 3509 3546
Surgery
Major 11922 13604 14031
Intermediate 4651 4602 4348
Minor 7150 8023 8144
Safe Abortion
Services
CAC 83 90 80
PAC 625 561 505
D&E,D&C ,MA 389 355 328
Referral Cases out In - - -
Out 116 188 154
BPKIHS- Hospital Major Indicators
14
indicators 2072/7
3
2073/74 2074/75
Bed occupancy rate 70.5 79.2 72.4
Average length of stay 3.8 3.8 3.5
Throughput 55.0 60.0 61.0
Bed turnover interval 2.9 2.3 2.5
Infection rate among surgical cases 3.7% 3.5% 2.9%
Surgery related death rate (%) 0.45% 0.42% 0.21%
Death Rate among In-patients (Gross) 1.0% 1.1% 1.0%
Doctor: In-patient Ratio 1:142.0
4
1:154.9 1:153.5
Doctor: Out patient Ratio 1:1828.
4
1:2149.7 1:2246.3
Nurse: In-patient Ratio 1:67.5 1:83.4 1:83.2
MSS
Consumer Satisfaction Increase Service Utilization
Resources HR, Physical Infrastructure,
Equipment and Supplies
Quality health Service(process)
Hospital Based Services
Inputs
Output
Central Hospitals and Health Academies
Central Hospitals
1. Bir Hospital
2. Paropakar Maternity & Women’s Hospital
3. Kanti Children Hospital
4. Mental Hospital
5. Sukraraj Tropical Diseases Hospital
6. Shahid Gangalal National Heart Center
7. National Trauma Centre
Health Academies
1. BP Koirala Institute of Health Sciences
2. TU Teaching Hospital
3. Patan Academy of Health Sciences
4. Pokhara Academy of Health Sciences
5. Karnali Academy of Health Sciences
Armed Police Hospital
Nepal Police Hospital
Total OPD Clients
0
50000
100000
150000
200000
250000
300000
350000
400000
2072/73
2073/74
2074/75
Total Emergency Clients
0
10000
20000
30000
40000
50000
60000
2072/73
2073/74
2074/75
Total Inpatients
0
5000
10000
15000
20000
25000
30000
2072/73
2073/74
2074/75
Average Length of Stay
8
4 4
20
4
7
15 13
5 7
4 6
20
3
7
14 12
5
8
4 6
23
4 2
12 13
5
0
5
10
15
20
25
2072/73
2073/74
2074/75
Top Ten Morbidity Rank Disease
1 Gastritis (APD)
2 Upper Respiratory Tract Infection (URTI) Cases
3 ARI/Lower Respiratory Tract Infection (LRTI) Cases
4 Falls/Injuries/Fractures
5 Urinary Tract Infection (UTI) Cases
6 Acute Gastro-Enteritis (AGE) Cases
7 Headache
8 Typhoid (Enteric Fever) Cases
9 Hypertension
10 Abdominal pain
Finance Data: Budget expenditure (2074/75)
Central Hospitals Budget
Released (Rs)
Expenditure (Rs)
Expenditure (%)
Remarks
Bir Hospital 1277500000 1277500000 100
Paropakar Maternity & Women’s Hospital 296896000 296618000 99.9
Kanti Children Hospital 222087000 216712000 97.6
Mental Hospital 39070844 39070844 100
Sukraraj Tropical Diseases Hospital 116643632 116643632 100
Shahid Gangalal National Heart Center 1584091000 1515494000 95.7
National Trauma Centre 202304000 202156736 99.9
Patan Hospital 1729198033 1729198033 100
BPKIHS 678492000 434736000 64
KAHS 58,40,80,000 58,36,21,196 99.9
Finance Data: HDC Budget expenditure (2074/75)
Central Hospitals Income
(Rs) Expenditure
(Rs) Balance
(Rs) Remarks
Bir Hospital 335000000 339711856 -4711856 .
Paropakar Maternity & Women’s Hospital 179593000 172015000 7578000
Kanti Children Hospital 124898600 130852496 12786149
Mental Hospital 56292180 26391591 29900589
Sukraraj Tropical Diseases Hospital 61879594 61666329 213265
Shahid Gangalal National Heart Center 1584091000 1515494000 68597000
National Trauma Centre 115127441 102300995 12826446
Patan Hospital - - - Not
reported.
KAHS 4,51,83,927.61
4,51,83,927.61
BPKIHS Not reported.
Finance Data: Irregularities Clearance (2074/75)
Central Hospitals Irregularities
(Rs) Clearance
(Rs) Clearance
(%) Remarks
Bir Hospital 2034417000 108144000 5
Paropakar Maternity & Women’s Hospital 170134000 43570000 26
Kanti Children Hospital 132719000 27461573 21
Mental Hospital 2578000 1623000 63
Sukraraj Tropical Diseases Hospital 4817000 524692 11
Shahid Gangalal National Heart Center 0
National Trauma Centre - - - Not Audited
Patan Hospital 62757829 16345890 26
Finance Data: Share of Gov in Total Budget (2074/75)
Central Hospitals Gov Share
(%) Remarks
Bir Hospital 79 Paropakar Maternity & Women’s Hospital 62 Kanti Children Hospital 64 Mental Hospital 41 Sukraraj Tropical Diseases Hospital 65 Shahid Gangalal National Heart Center 50 National Trauma Centre
100 प्रतिवेदन प्राप्ि नभएको
Patan Hospital 100
प्रतिवेदन प्राप्ि नभएको
Human Resource Sanctioned/Fulfilled (2074/75)
Central Hospitals Consultant Medical Officer
Staff Nurses
Medical recorder
Paramedics & Others
Bir Hospital 112/95(८५%) 114/94 198/198 15/15 79/110
Paropakar Maternity & Women’s Hospital 25/22 41/55 173/173 6/3 37/37
Kanti Children Hospital 26/23 39/6 84/74 3/3 19/19
Mental Hospital 10/4 6/3 11/10 1/1 46/31
Sukraraj Tropical Diseases Hospital 15/9 11/10 50/63 2/2 24/34
Shahid Gangalal National Heart Center 50 34 246 1 105
National Trauma Centre 31/18 31/7 147/130 1/1 33/24
Patan Hospital 19 108 495 6 104
Human Resource Management Key Issues:
Inadequate consultants, medical officers, nurses, paramedics
Training to health workers
Fulfilment and retention of doctors, especially Anesthesia, Tropical, infectious disease) (Sukraraj)
Salary discrepancy among public hospitals within the valley is a major cause for staff turnover (Kanti).
Health worker patient ratio (2017/18)
Central Hospitals
Doctor: In patient
Doctor: Out patient
Nurse: In patient
Bir 1:65 1:1873 1:62
Paropakar Maternity
1: 13 (per day)
1:67 (per day)
1:9 (per day)
Kanti 1:264 1:3751 1:106
Mental 1:158 1:6827 1:53
Sukraraj 1:18 1:292 1:53
Gangalal 1:153 1:3832 1:52
Trauma 1:101 1:1781
1:24
Police 1:6 1:19 1:21
Patan 1:100 1:1677 1:50
Hospital Waste Management
Bio-degradable waste (e.g. Placenta) are used for bio-gas production.
Resale of non-biodegradable waste after autoclaving (Maternity)
Recycle/reuse of some hospital waste product (Maternity)
Collaboration & cooperation with Metropolitan (Teku)
Average Rs.1000/Day income from waste management (Bir)
Infections waste autoclaving (Bir)
Needles and other infected wastes are collected separately (Kanti)
Reusable wastes are sent for recycling (Kanti)
Shredding and sterilization machine (ECODAS company, France - 350 lits
- process volume) in use. (Trauma Centre)
Quality of Care at Point of Delivery
IP Practice as per WHO Standard (Maternity)
QI tools checked periodically (Maternity)
Molecular Lab established: Real-Time PCR available (TDH, Teku)
Maternal and Perinatal Death Surveillance and Response system is operational (Maternity)
Pharmacy Management Pharmacy guideline is followed (Maternity)
Inventories are maintained as per FIFO mechanism (Maternity)
Drugs are dispensed properly to patients with proper counselling (Maternity)
In process of developing generic prescription (Maternity)
Inadequate pharmacy staff (Teku)
Limited seed money (Teku)
Unavailability and shortage of medicines due to Public procurement Act and Regulation (Bir)
Not able to start Clinical Pharmacy Service, Pharmacovigillance Center (Bir)
Pharmacy Management … Training Need
– Inventory Management system, Adverse Drug Reaction Monitoring, Dispensing, Communication skill, Narcotic Medicine Management, Storage of Medicine etc. (Bir)
– Procurement process (Kanti)
Hospital Pharmacy Directive 2072 needs to be revised (Bir)
Investment: 80 lakhs; Monthly sale: 24 lakhs; monthly net income: 7 lakhs (Kanti)
Free distribution of medicines to Police personnel, families and retired Police (Police Hospital)
‘Sajha Pharmacy’ within hospital premises (Police Hospital)
Information Management Key Issues
incompleteness(time/templates) in Reporting from central hospitals to the national database (HMIS) (mostly cover page only )– compromising quality and use of data for policy and programme
Many APPLICABLE cells of the report are left blank
Some hospitals submit aggregate report at the end of the fiscal year only
Submitted reports include unrealistic data, e.g.,: o Average length of stay: 66.8
o Average No. X-Ray/Day: 1815
o Average No. lab text/Day: 32,334 (where as same hospital reports average of 662 clients/Day)
Reporting status (2years) and number of Medical Recorders of selected hospitals
Hospitals 2073/
74 2074/
75
Medical recorders (Filled/Sanc.)
2074/75
Bir 100 100 15/15
Maternity 92 92 6/3
Kanti 100 100 3/3
Mental 100 100 1/1
Sukraraj 100 92 2/2
Gangalal 67 100 1
Trauma 100 100 1/1
Police 17 6
Patan 100 100 15/15
Teaching 33 25 na
BPKISH 100 100 na
जन स्वास््य सेवा सम्बन्धमा ब्यवस्था गनन बनेको बबधेक, २०७५, (परिछेद ९, दफा ६०) प्रतिबेदन पेश गने सम्बन्न्ध प्राबधान
Information Management: Immediate actions to be taken
Timely reporting to the national database
Regular review of the hospital statistics & review meetings between HMIS/programme divisions and hospitals
Regular analysis of hospital statistics for programme, policy and hospital management
Scale up electronic health record (EHR) systems
Link the grant to hospital with quality of the report
Innovations Randomized controlled trial to compare two different doses of maternal B12
supplementation in improving infant B12 deficiency and neurodevelopment research is on going (Maternity Hospital)
Separate OPD for senior citizen (Bir Hospital)
Satellite OPD in Bhaisepati (Maternity Hospital)
Adult vaccination Clinic (Teku)
Travel Medicine Counseling services (Teku).
Molecular lab established for Real-Time PCR available (Teku)
Research on emerging infectious and tropical diseases (Teku)
Psychiatric services in collaboration with CWIN (Kanti)
Mandatory health insurance for hospital staff & family members (Trauma Centre)
Along with trauma and trauma critical care, general surgery, neurosurgery, laparoscopy, endoscopy, bronchoscopy services are provided (Trauma Centre)
Issues Diagnosis of Acute Febrile Illnesses (Teku)
100% occupancy (Mental)
Equipment for advanced care: TMS, computerized ECT (Mental)
O & M survey for 20 years (Kanti)
– Inadequate doctors, nurses and paramedics (Kanti)
– Subspecialty services are being run by self- trained manpower (Kanti)
– Majority of staff (both technical and non-technical) are from HDC (Kanti)
Directives for distribution of hazard allowance (Kanti)
Game Changing Initiatives
Minimum Service standard is planned to use in all levels of hospitals/HFs.
Nepal Health Infrastructure Development Standards
2017 has been developed.
Health Facility Registry
Guidelines for Hospital Establishment, Operation and upgrading standards, 2070 (revision 2072).
Hospital Management Strengthening Program
(HMSP)
Minimum Service Standard (MSS) a tool to improve Quality Hospital Services
A brief history of HMSP cont…
• Mangsir 21, 2071 (December 2014): • MoH approves MSS for district hospitals;
• Dec 2014: • workshop phase begins in 18 district hospitals;
• Oct 2015: • workshop phase begins in 27 district hospitals;
• Sep/Oct 2016: • workshop phase begins in 30 district hospitals.
• May 2018: • Workshop phase begins in 8 upgraded hospitals.
• Dec 2017 onward: • Workshop cycle ( 3 WS) completed in 75 district level Hospitals
• June 2018 : • 1st follow up completed in 75 District level hospitals.
Governance
Organizational Management
HR management
Financial Management
Information Management / Medical Records
Quality Management
Clinical Services Management (11 Sub-sections)
Hospital Support Services Management (11 Sub-sections)
Minimum Service Standards a major tool of HMSP
8 Sections : 290 Standards: 350 score points
Achievements on MSS Score of 83 hospitals
MSS Score trend
Event No of Hospital Average MSS
Score
a. Workshop 1 83 48%
b. Workshop 2 73 64%
c. Workshop 3 75 73%
d. Follow up 1 75 65%
e. Follow up 2 45 64%
f. Follow up 3 40 67%
g. Follow up 4 18 68%
h. Follow up 5 13 72%
48
64
73
WORKSHOP 1 WORKSHOP 2 WORKSHOP 3
Average MSS Score in WS
<50 13%
50-60 11%
60-70 31%
70-80 28%
80-90 15%
>90 2%
No of Hospital as optained MSS Sore
<50
50-60
60-70
70-80
80-90
>90
Private Hospitals
२०० शैया भन्दा माथिका अस्पतालहरूको वििरण
सि.नं
.
अस्पतालको नाम र
ठेगाना
सनवेदन दताा
समसत
सस्वकृत शैया
िंख्या
सस्वकृत समसत नसवकरण
समसत
कैसियत
१. चितवन मचेिकल कलेज,
चितवन
२०७०।९।२९ ५७५ २०७३।३।१९ ७५० शैयाको लाचि चनवेदन दताा भएको
२. चव एण्ि चि मचेिकल
कलेज, झापा
२०७१।११।२८ ३०० २०७३।४।६ ३०० शैयाको लाचि चनवेदन दताा भएको
३. िण्िकी मचेिकल कलेज,
पोखरा
२०६९।१।२४ ३०० २०६७।१०।२४ २०७३।१०।५ ३०० शैयाको लाचि चनवेदन दताा िाथै नचवकरणको
लाचि फाइल पेश भएको
४. चकष्ट मचेिकल कलेज,
लचलतपरु
२०७०।१२।१९ १०० २०६४।११।३० ७५० शैयाको लाचि चनवेदन दताा भएको िक्कलै फायल
१०० शैयाको नचवकरणको लाचि स्वास््य िेवा
चवभािमा पठाइको
५. लचुववनी मचेिकल कलेज,
पाल्पा
२०७०।१२।१९ ४०० २०६३।९।१९ ६४२ शैयाको लाचि चनवेदन दताा भएको, अनिुमनको
लाचि िक्कलै फायल अनिुमन महाशाखामा पठाइएको
६. नोवेल मचेिकल कलेज,
चवराटनिर
२०७१।२।२ ३०० २०७३।१०।५ ९११ शैयाको लाचि चनवेदन दताा भएको, अनिुमनको
लाचि िक्कलै फाइल अनिुमन महाशाखामा पठाइएको
२०० शैया भन्दा माथिका अस्पतालहरूको वििरण
सि.नं. अस्पतालको नाम र
ठेगाना
सनवेदन दताा समसत शैया
िंख्या
सस्वकृत समसत नसवकरण समसत कैसियत
७. काठमािौ मचेिकल कलेज,
काठमािौ
२०७१।२।१९ ७५० छैन ७५० शैयाको लाचि
चनवेदन दताा भएको
८. मचणपाल मचेिकल कलेज,
पोखरा
२०७१।२।२० ७५० छैन ७५० शैयाको लाचि
चनवेदन दताा भएको
९. धचुलखले अस्पताल, काभ्रे २०६९।१।३ ७५० छैन ४५० शैयाको लाचि
चनवेदन दताा भएको
१०. यचूनभिाल मचेिकल कलेज,
भैरहवा
२०७१।२।१९ ७५० छैन ७५० शैयाको लाचि
चनवेदन दताा भएको
११. नेपालिन्ज मचेिकल कलेज,
कोहलपरु, बााँके
२०७१।३।१ ७५० छैन ७५० शैयाको लाचि
चनवेदन दताा भएको
१२. नेपाल मचेिकल कलेज,
जोरपाटी
२०७३।९।१९ ३०० छैन चनवेदन दताा भएको
१३. कलेज अफ मचेिकल
िाइन्िेज, चितवन
चनवेदन दताा िरेको ७५० छैन चनवेदन दताा भएको
२०० शैया भन्दा माथिका अस्पतालहरूको वििरण
सि.नं. अस्पतालको नाम र
ठेगाना
सनवेदन दताा समसत शैया िंख्या सस्वकृत
समसत
नसवकर
ण समसत
कैसियत
१४. देवदह मचेिकल कलेज,
रूपन्देही
चनवेदन दताा भएको १०० छैन थप शैयाको लाचि चनवेदन दताा भएको
१५. काठमािौ नेिनल मचेिकल
कलेज, काठमािौ
२०७१।२।१९ ३०० छैन ३०० शैयाको लाचि चनवेदन दताा
भएको
१६. जानकी मचेिकल कलेज,
जनकपरु
२०६६।९।२२ ३०० छैन ३०० शैयाको लाचि चनवेदन दताा
भएको
१७. नेिनल मचेिकल कलेज,
चवरिंज
७५० छैन ७५० शैयाको लाचि चनवेदन दताा
भएको
१८. चवराटनिर अस्पताल,
चवराटनिर
२०७१।२।१६ १०० २०६१।१०।७ ३०० शैयाको लाचि चनवेदन दताा
भएको, िक्कलै फायल १०० शैयाको
नचवकरणको लाचि स्वास््य िेवा
चवभािमा पठाएको
१९. नेपाल स्वास््य िेवा िहकारर
ि.स्था, काठमािौ
२०७०।३।१८ १०० छैन ३०० शैयाको लाचि चनवेदन दताा
भएको
२०० शैया भन्दा माथिका अस्पतालहरूको वििरण
सि.नं. अस्पतालको नाम र
ठेगाना
सनवेदन दताा
समसत
सस्वकृत
शैया
िंख्या
सस्वकृत
समसत
नसवकरण
समसत
कैसियत
२०. चपपलु्ि िेन्टल कलेज एण्ि
हचस्पटल, काठमािौ
२०७१।२।२३ ३०० छैन ३०० शैयाको लाचि चनवेदन दताा भउको
२१. चव एण्ि चव हचस्पटल,
ग्वाको, लचलतपरु
२०७१।२।२२ ३०० छैन ३०० शैयाको लाचि चनवेदन दताा भएको,
िक्कलै फायल १०० शैयाको नचवकरणको
लाचि स्वास््य िेवा चवभािमा पठाएको
२२. काचन्तपरु िेन्टल कलेज,
धापािी, काठमािौ
२०७१।१०।२
९
२५० छैन १५० शैयाको िेन्टल र १०० शैयाको जनरल
अस्पताल िरी २५० शैयाको लाचि चनवेदन
दताा भएको
२३. पचुलि अस्पताल ३०० छैन ३०० शैयाको लाचि चनवेदन दताा भउको
२४ मदेचिचट अस्पताल ३०० भएको ७५० शैयाको लाचि चनवेदन चदएको
Thank You
