Establishment and Operation of
Anarmani-3 Jhapa district, Nepa
Background
Located between India and China, Nepal is a geographically diverse country consisting of a variety of landscapes ranging from the flat Terai plains of the south, the central mid-hills region to the foothills and up in to the majestic Himalayan mountain range. It covers 147,181 square kilometer of which only 17% is cultivable. The per capita income of the country is $ 210 per year, among the lowest in the world.
90% of the population depends upon agriculture as the primary occupation. The average life expectancy rates of Nepali people is very low i.e. male 58.6 and female 57.9 and there are various reason behind this of which major are low literacy rate, low living standard, high poverty and above all unavailability of adequate health service. Accessibility of human being to health facilities is one of the basic human needs. Health is wealth, sound physical and mental state is essential for all and without which nothing can be done properly. The national health policy's main thrust is to increase accessibility of the rural population to health services. This has been envisaged through the series of health facilities including sub health post, health post, primary health care centre, hospitals etc. But many people reside in rural area do not have the access to health service because the services available at these levels are inadequate and they can not afford private clinic and nursing home.
At present primary health care level services are available in the sub health post (SHP), health post (HP) and primary health care centres (PHC), these provide basic integrated promotive, preventive and curative primary health care services and the PHCs provide both preventive and curative services including emergency cases. The secondary and tertiary level health services are available at district, zonal/regional and central hospitals. The district hospital with 15-25 beds is considered the main health institution at district level that serves as first referral centre. The regional and zonal hospitals serves as secondary referral centres where specialist services are available and the hospitals at centre level are tertiary referral centre having better facilities and experts. The infrastructure, facilities, human resources and services in HP, SHP, PHC, district and zonal hospital are inadequate to deal with many health problems. People are unable to get proper services from those health institutions. Therefore many private sector health institution established as a substitute of existing government supported health institution to provide service to the people. But most of the private sector health institutions are concentrated in urban area like Kathmandu , Pokhara, Biratnagar etc. and the service is highly expensive and inaccessible for those reside in remote places.
Mechi zone lies to the east part of Nepal and it is bordered with India to the east and south, China Darjeeling
Introduction of the proposed project
Regarding the need this project concept paper has been designed to establish and operate a health institution entitle ‘Mechi Model Hospital
Vision
Health service for all
· To provide quality health service to the people of Mechi zone and
adjacent area of Koshi zone
· To organise health camp within Mechi zone as per need
· To conduct simple research and case studies in health sector
· To provide free service to the disadvantaged people.
· To establish functional linkage with other health institution.
To conduct school Health Programme (SHP
Objective
The main immediate objective of the project is to establish well equipped health institution in accessible place of Jhapa district.
Strategies
A. Project location
The institution will be established in Anarmani VDC- 3, Jhapa District. The location is adjacent to East West highway (Mahendra highway) near Birtamod, the famous trade centre of the Mechi zone. Various types of transportation facilities available from Birtamod and other parts to reach the location.
B. Area coverage
The institution will provide services to the people from Mechi and some part of Koshi zone. The place is linked with Ilam, Panchthar and Taplejung district by Mechi highway and Birtamod is the junction for hill districts of Mechi.
C. Type of services
The institution will act as multidisciplinary health centre by providing both preventive and curative health services. The major services are listed below
1. OPD- Out patient door
2. Indoor
3. Surgery
4. Emergency
5. Camp
The OPD service include
· Surgical
· Medical
· Maternity/Child health
· Obstetrics & Gynaecology
· Orthopedic Surgery
· ENT & HNS
· Dental Surgery
· Radiology
· Pathology
The indoor service include
· Surgery
· Medicine
· MCH
· Gynaecology
Surgery
· Major
· Minor
Emergency
· Any Medical , Surgical & RTA clients
The institution will provide services on charge or free basis. If customers can afford the services they are supposed to pay for services. The disadvantaged and needy people can be provided free service in some extent.Project concept
Multidisciplinary service
The need of health service differs as per the nature of problem. Therefore the institution will provide specialist services to handle different types of cases. Nobody will be back without treatment- the major goal of the institution and to achieve the same the institution will provide multidisciplinary service to the clients.
Research
The institution will conduct the research activities and case studies as per need. The finding of such research will be helpful for the over all health sector.
Infrastructure
The institution will develop the necessary infrastructure that help to provide quality health service to the clients.
Human resource
Sound human resource is the foundation of the institution. Considering the same fact the institution will manage the appropriate and efficient human resource to provide quality health service.
Prompt service
As the health problems are highly sensitive to time factor and any types of delay in the services are dangerous. Considering the same the institution will avoid any types of delay and provide prompt and appropriate service.
Environment friendly
Hospital waste is very dangerous from environment point of view. Many hospital both Government and private sector are not giving importance for proper management of hospital waste and this situation is creating environment pollution. The institution is highly sensitive toward environment and it won’t allow any bad impact to the environment. It will manage the waste by environment friendly way. It will apply different methods to manage different types of waste for example biotechnology for degradable solid waste, collection and delivery of non-degradable solid waste to recycling plants, safe dumping and burning of chemical waste, water recycling to be used in garden, washing etc. The institution will also establish greenery to create fresh and healthy environment.
Self sustainable approaches
There are certain difficulties in establishing health institution, the infrastructure, human resources and other facilities are much expensive and it needs external support in the establishment phase. Therefore, the project will be established under the financial support from interested donors but after some period it will be self sustainable. The institution, from its quality service will earn return enough to run the institute smoothly. It is estimated that the institution will do transaction of around Rs. 100,000 Nepalese currency a day from third year onward. This amount is enough to become self sustained.
Financial Management
The institution requires considerable financial investment for basic infrastructure, appliances, human resources and other facilities. No one can invest such huge amount alone. Therefore, for a certain period during the establishment phase financial assistance from external source is a must. Some interested donors will be requested for financial assistance. After full operation phase the project needs no more financial assistance from external source.
Project management
A. Project target and phasing
The following targets are tentatively proposed for a period of 5 years to be achieved in 2 phases that are establishment and full operation phases. This will enable the project for sound establishment, after implementing and developing various components and activities. The first phase is proposed to be for duration of 3 years and the second for 2 years.
Target | Phase 1 – Establishment phase | Phase 2 – Full operation phase | |||
I-yr | II-yr | III-yr | IV-yr | V-yr | |
Infrastructure | |||||
Building | 1 | 1 | |||
Ambulance | 1 | 1 | 1 | ||
Computer | 6 | ||||
Pharmacy | 1 | ||||
OT | 1 | ||||
OPD | 1 | ||||
Indoor | 1 | ||||
Pathology lab | 1 | ||||
Radiology | 1 | ||||
Human resource | 54 | 22 | 12 | ||
B. Infrastructure, Service and implementation schedule
Operation theatre
· Three Operation Theatre will provide service at a time
· OT will be well equipped
OPD block
· OPD will provide service to at least 175 Clients each day.
· The service will be provided by specialists which include Orthopedic,
Gynaecology, Medical, surgical, Maternity/Child health, Dental, ENT,
Radiology, Pathology etc.
Indoor Block
· This block will manage 100 beds for admission.
· The block consist of 20 each for Gynaecology, Medicine, Surgary and
Maternity& Child Health and 10 cabin with better facilities.
· The block will provide 24 hrs nursing care.
· The doctors will pay visit 2 times daily.
· The immediate service will be provided as per the condition of the patient.
Radiology block
· The bock include X-ray machine, USG, ECG, EEG, CT scan.
· The block provide 24 hrs service as per referral from indoor and
Emergency block as well as cases referred from external clinics,
diagnostic centre and hospitals.
Pathology lab
· The facilities include wide variety of services from general pathology to Biopsy.
· The block provide 24 hrs service as per referral from indoor and
Emergency block as well as cases referred from external clinics,
diagnostic centre and hospitals.
· Blood transfusion service will be available at any time.
Pharmacy
· The block will supply required medicine & equipment
· It provide 24 hrs service.
Emergency block
The MDGP(Family Physicians ) provide 24 hrs service for emergency patient and as per the condition it refer the case to specialist for further treatment.
Ambulance service
Three Well equipped ambulances always ready for safe transportation of the patient.
Administration block
The block will responsible for overall management of the institution.
C. Human resource requirement and phasing
It is rather easy to make plans, establish infrastructure and mechanism, but it is rather difficult to develop and retain proper human resource who are highly motivated, enthusiastic and committed. The success and sustainability of the institution depends to a very large extent on creating proper conditions. So that the human resource can grow and become productive and fulfill their aspiration.
Considering the service provision, implementation and the target the following human resource requirements and phasing are proposed for the project.
Human resources | Establishment phase | ||
I-yr | II-yr | III-yr | |
Director | 1 | 0 | 0 |
Managing officer | 1 | 0 | 0 |
Admin/Account officer | 1 | 0 | 0 |
Accountant | 1 | 1 | 0 |
Reception | 1 | 0 | 0 |
MD Doctors | 5 | 3 | 2 |
MDGP | 3 | 2 | 0 |
M.Sc. Nursing | 0 | 1 | 0 |
MBBS Doctors | 3 | 2 | 0 |
B. Sc. Nursing | 1 | 0 | 0 |
BMIT | 1 | 0 | 0 |
B.Sc. MLT | 1 | 0 | 0 |
BDS | 1 | 0 | 0 |
B Pharma | 1 | 0 | 0 |
Staff Nurse | 12 | 3 | 2 |
HA | 3 | 2 | 1 |
Lab Technician | 2 | 0 | 0 |
Diploma in pharmacy | 3 | 1 | 1 |
Radiology Tech | 3 | 1 | 1 |
House keeper | 1 | 1 | 0 |
Helper | 8 | 4 | 4 |
Driver | 1 | 1 | 1 |
Total | 54 | 22 | 12 |
D. Relationship and linkage
The functional linkage and relation will be established with various health institution listed below.
· District hospital of Ilam
· Mechi Zonal hospital of Bhadrapur Jhapa
· PHC, HP, SHP of Mechi zone.
· Central level hospital, teaching hospital and National health training centre.
· BPKIHS, Dharan.
· Private/NGO sector health institution like AMDA Damak, Lifeline Damak,
Mechi Eye Care Centre, Birtamod, Private clinics.
· Technical institution like Madan Memorial, Mechi technical,
AMDA Nepal, Pathibhara Health Institute.
