Development of Health Services in Pokhara
Ms.Lal Kumari Gurung
Campus Chief, TU IOM, Pokhara Campus
1. Introduction: Prelude
Pokhara is a pleasant and naturally beautiful city. It is amazing and attractive city in kaski district, Gandaki zone, in western part of Nepal. When the world Pokhara sweeps in our ear as an appealing music and whispers as a blowing tender of nature and out flows the heart with so much wonderful feelings. The greenery lying underneath the skies. It seems itself; Smiling on endearning hospitality more embellishes its possession an extremes beauty (Khadka 2003).
Visit to Pokhara can be an exhilarating experience both spiritually and as well as visually. Some of the most spectacular views from Pokhara area include lakes, falls, deep valleys terraced with fields, revers and caves. Some of the most magnificent mountain peaks in the background which are visible almost throught the year are testimony to the enduring beauty of the place.The tranquility of the inspiring nature adds more the fragrance of this real heaven. Pokhara is known as “Cheerapunzi”, “City of the Lakes” of Nepal. What is most fascinating about Pokhara is the variety of ethnicity, Cultures, customs and religious affiliations it attracts and where all converage to spread the massage of hope and peace. There are Hindus, Baudha, Muslims, Chirstian and Shikhas; Priests of various ethnic backgrounds perform religious functions and rituals during celebrating local and national level festivals. These are widely accepted by all the devotees.
There has been a rapid expansion, change the challenges in the field of development of different sectors such as in education, agriculture, irrigation, commerce, industry, forestry, handicrafts, communication, transportation, geographic conservation, tourism and health. “Development is the most important challenge facing the human life” (World Bank, 1991).
1.1 The term health
“Health is a state of complete physical, Mental and social well being and not merely an absence of disease or inpfirmity” (WHO, 1978). In recent year this statement has been amplified to include the ability to lead a “socially and economically productive life” (WHO), 1978). In recent years, we have acquired a new philosophy of health that may be stated as below:
Health is a fundamental human right.
Health is the essence of productive life and not the result of ever increasing expenditure on medical care.
Health is intersectoral.
Health is an integral part of development.
Health is central to the concept of quality of life.
Health involves individuals, state and international responsibility.
Health and its maintenance is a major social investment.
Health is worldwide social goal.
Therefore health is multifactorial. The factors, which influence health, lie both within the individual and externally within the society in which he or she lives. Conceptually, the health of individual and the whole community may be considered to be the result of many interactions. See figure 1.
1.2 The factors (determinants) influencing health in Nepal
- Human biology: Physical and mental traits of every human being are to some extent determinanted by the nature of his genes at the movement of conception. A number of diseases are genetic origin such as mental retardation and some types of diabetes.
- Behavioural and socio-cultural conditions: Lifestyle-the way people live, reflecting the whole reng of socio values, attitudes and activities. It is composed of cultural and behavioural patterns lifelong personal habits (eg. Smoking, alcoholism) that have development through processes of socialization. Lifestyels are learnt through social interaction with parents peer groups and siblings and through school and mass media. Health requires the promotion of healthy life styles. Current-day health problems in development countries (eg.coronary heart disease, obesity, lung cancer, drug addiction) are associated with lifestyles changes. In developing countries where traditional life style still persists, risk of illness and death are connected with lack of sanitation, poor nutrition, personal hygiene, elementary human habits, customs and cultural patterns.
- Environment: Internaland External: First Hippocrates related disease to environment, eg climate, water, air e.t.c. internal environment of man pertains to functioning inside the Boyd. External a macro-Environment consists of these things to which man is exposed after conception. These are physical, biological and psychological components which can affect the health of man.
- Socio-economic Conditions: For the majority of the world’s people, health status is determined primarily by their level of socio-economic, development e.g per capita gross National Product (GNP), education, nutrition employment, housing, the political system of the country. Health care system is influenced very much directly by the political system.Often the main obstacles to the implementation of health technologies are not technical but rather political.Benerij (1985) describes that decisions concerning resources allocation,human resource policy, choice of technology and the degree to which health services are made available and accessible to defferent segments of the society are examples of the manner in which the political system can shape community health services.
- Aging of the population: Major concern of rapid population of people aged 60 and over, is the increased prevalence of chronic diseases and disabilities both being conditions that tend to accompany the aging process and deserve special attention.
- Gender : The 1990s have witnessed an increased concentration on women’s issues.The Global Commissions on women’s Health was established in 1993.Gender has long been an important issues indevelopment activities in Nepal but it appears that there is still confusion, lack of clarity and direction concerning the implernentation of gender basesd dactivities. The root of therse problems lies in the absence and understanding of the socio-cultural factors that influence the institutional and process that hinder gender mainstreaming.
- Inter/Multisectoral Relationship: 21st century is more related to two interconnected revolutions, in information and in communication. The development of these technologies offers tremendous opportunities in providing an easy and instant access to medical information once difficult to retrieve. It contributes to dissemination of information worldwide, serving the needs of many health professional, programme managers, researchers, the mass media and the public. Hence it is pivotal to all seeking to expand and improve the quality of life of individual or community.Other contributions to the health of population derive from systems outside the formal health care system, i.e health related systems, such as food and agriculture, education, industry, social welfare, rural development. Also adaptation of policies in the economic and social fields that would assist in raising the standard of living.
- 8. Health services : The term health and family health care services covers a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion of health.In 1977, world Health Orgaization (WHO) declared slogal “Health for all by the year 2000”. In 1978, the Alma Ata Declaration was Primary Health Care (PHC). Since then the medical education system and health services system in Nepal has been according to the meaning, elements and principles of PHC.
1.3 Meaning of PHC
In 1978, the international conference of PHC held at Alma Ata USSR, declared that PHC is the sky to attaining the goal of “Health for all by the year 2000 AD”. PHC is based on practically, scientifically sound and socially acceptable methods and technology.It should be made universally accessible to individuals and families in their community through their full participation and at an affordable cost on a continuing basis to maintain at every stage of their development.PHC takes place at the first contact between the individuals and the national health systems, as close as possible to where people live and work. It is the first element in a continuing health care process and forms an integral part of the country’s health system.
1.4 Elements of PHC
The declaration of Alma Ata defines the eight essential of PHC or eight components as a package of services.
Education concerning previling health problems and the methods of preventing and controlling those changes personal and social habits.
Locally endemic diseases-Prevention and control of locally endemic disease and injuries e.g. Malaria, goiter and vitamin A deficiency.
Environmental santitaion- An adequate supply of safe water and basic sanitation.80% of world’s disease is related to lack of safe water and sanitation.
Meternal and child health including Family Planning.Maternal Moratality rate 4.5/1000.Infant Mortality Rate 92/1000 live births. 10% of babies die before their first birth day.Literacy Rate 56.9%.
Essential drugs-provision of essential drugs to individual, families and communities. Up to 50% of health budget are spent on durgs. There are Community Drug Programme (CDP) in HPs and in PCHs.
Nutrition-provision of food supply and proper nutrition.Arround 2/3 of under five children in the developing countries are malnourished.
Treatment-Appropriate treatment of common diseases and injuries.
Safety against diseases-Immunization against major infectious and combating others like Malaria, Tuberculosis, goiter and malnutrition.
Latteradded the Dental and Mental care.
1.5 Principles of PHC
1.5.1 Accessibility of health services to all populations.
1.5.2 Maximum individual and and community involvement in the planning and operation of health care services.
1.5.3 Emphasis on services that are prevendtive and promotive rather than curative services only.
1.5.4 Use of appropriate technology.
1.5.5 Integration of health development with total overall social and economic development.
1.6 Reproducdtive Health (RH)
Since early 1990s the health care system dimension is pertaining to the concept of Reproductive Health Care System. “Reproductive Health is a condition in which reproduction is accomplished in a state of complete physical, mental and social well being and not merely as the absence of disease and disorder of the reproductive process” WHO. This definition implies the. (a) Women and men have the ability to reproduce as well as to regulate their fertility. (b) Women are able to go through pregnancy and childbirth safely.(c) The out come of pregnancy is successful in term of maternal on infant survival and (d) Couples should be able to have sexual relationship free of the fear of unwanted pregnancies and contracting disease. It is obvious from the above definition that the reproductive health is a multi-sectoral entity. The attainment of which requires harmonized efforts from sectors other than health. Health rights and reproductive health advocates increasingly are working together to advance women’s and men’s well-being.(But many times women are violence. See Chart 1). The modern human rights system is based on a series of legally binding international treaties that makes use of principles of ethics and social justice, many of which are directly relevant to reproductive health care. By placing reproductive health in a broader context, a rights-based approach can provide tools to analyze the root causes of health problems and ineguities in service delivery. By emphasizing fundamental values, must notably respect for clients and their reproductive decisions.
Total Number of Incidence of Violence Against in Kaski District by Wards of Municipality
Love & False
Rape & Sexual
Epidemic of HIV/AIDS
Source: Habit Research, 2003
1.7 componets of Reproductive Health
1.7.1 Family Planning Services
Temporary Methods: Pills, Condom, Injection Depo-Provera, Norplant’s
Permanent Methods Laproscopy, Post Partum Tubectomy (PPT), Minilap and Vasectomy.
1.7.2 Safe Motherhood (Healthy Mother and Healthy Baby)
A State when the women have authority to decide whether or not to conceive. If she is willing, she should have protection and treatment any abnormal condition/complication arises due to pregnancy (antenatal, labour, postnatal).
1.7.3 Care of New Born Baby
Usually the baby is born in 280 days (40 weeks) of conception. There should be preplan, when, where, by whom and how to deliver the baby. All the needed things for mother and baby should be ready before hand.
1.7.4 Abortion : Prevention and Management
Prevention of unwanted pregnancies and unsafe abortion to reduce morbidity and morataliy number of mothers. 10% abortion is found in age group of 15 to 19 years.
1.7.5 Sexually Transmitted Diseases (STD) HIV/AIDS, Sex Education
There are about 25 STDs, people can protect themselves, if they are infected, and except HIV/AIDs other STDs can be diagnosed and treated in time. Complications of STD can spoil the future of young people.
1.7.6 Adolescence :
10 to 19 years old are called adolescence (WHO). Adolescence is simply a transition stage from childhood to adulthood. It is a stage which all young people go through to become physically, psychologically, biologically and sexually mature. It is a time of repaid change in the body, emotion, attitudes, values, intellect and relationships. Changes are triggered by homones of the pituitary gland and gonads. Hygiene of the genitals, body odour, pimples, nutrition and exercise should be dealt with. Hence they need counseling though normally they do not want it. 50% of world population is under 20 year’s age. More STDs are found in 20 to 24 years age group.
1.7.7 Sterlity : Prevention and Management
There are many reasons to occour sterility. It can be due to male side, female side or both. But usually female is blamed for that. The couple should be examined for management.
1.7.8 Menopausal Women
The menstrual cycle basically starts (menarcy) around the age of 12 to 14 years and stops in around the age of late fourt’s. There may be some disease in reproductive organs (breast, uterus) or in systems (hormones) dur to physical and physiological changes in body. Women should be checked twice in a year to protect, detect and manage the problem in time source: Gurung (2003)
2.0 Health Organisations: Government and Non-Government Organisations (NGO)
There is government and NGOs involved directly and indirectly inproviding health related services to the community in Pokhara. Many changes, modification and innovation took place in structure of government and NGOs to provide health care in Nepal. The changes were as for the need or public health problem of Nepal. These changes occurred in Pokhara also. Some of these organizations seem providing services to raise the health status of community in Pokhara or in near by areas. They serve for humanity. Humanity is one family. So selfless service fosters personal growth and peaceful individuals, families and community.
2.1 International Nepal Fellowship (INF) History at a glance
1952 Oct, Permission, received for Shinning Hospital.
1952 Nov, Arrived in Pokhara and started clinic.
1955, Green Pasture Leprosy Hospital started.
Early 1960s, Clinic opened in Baglung and Sikha.
1968, Nurses training started.
1973, Permission given for Leprosy clinic in Gorkha.
1974, The National Leprosy Control Programme started for whole of west Nepal.
1976, Shining TB clinic opened.
1977, Leprosy clinic opened in surkhet.
1978, Shinning Hospital closed and Community Health Center opened.
1978, Leprsoy clinic in Jumla opened.
1984, 150 beds extension in Gandaki Zonal hospital completed.
1985, Tribhuvan University Institute of Medicine (TU IOM) started input in Pokhara Campus.
1986, Bastibang Community Health started.
1987, Gandaki Zonal Hospital upgraded to become the western Regional Hospital.
1994, Drug Education Programme set up and HIV/AIDS work initiated.
1997, Rehabilitation Service Started for Non Leprosy patient in Green Pastures.
Release is one project of INF, working predominantly in the western region of Nepal. There are three inter dependant programmes, all focused on holistic health care and rehabilitation, they work through different mixtures of service provision, training, networking, community mobilization and advocacy. Green Pastures Hospital and Rehabilitation Center (GPHRC) provides tertiary rehabilitation facilities for people disabled by any cause, but especially those with complications due to leprosy for people disabled by any cause, but especially those with complications due to or other neuro disabilities. The AIDS and Leprsoy Programme (ALP) support leprosy control, and offers training in the HIV/AIDS leprosy related subjects.
Leprsoy, HIV/AIDS, Disability, Turberculosis People, community health and development, training and educational, development, hospital and health service development (INF 2003).
2.2 Soldier Board Hospital
In late 1950s after the IInd world War Post War Reconstruction Fund (PWRF) was established and with that fund soldier Board Hospital was established in 1955 (BS 1013 ). Source: Boudha (2003).
2.3 Gandaki Zonal Hospital
Upgraded to WRH in 1978 A.D
2.4 Western Regional Hospital
1978, Medical, Surgical, Maternity, Paediatric, Orthopedic, almost all basic health services are provided. There is 24 hours emergency service available. This is the area where TU IOM taking their different levels of students and residents PCL, under graduates and post graduates for practicum practice.
2.5 Western Regional Health Directorate: Ramghat 11
Controlling 16 districts in provision and promotion of health services to raise the health status of the communities.
2.6 District Public Health Office, Kaski, Pokhara, Ramghat
Institutional Maternal/Child Health (MCH) Clinic, Controlling 48 VDCs including Pokhara Sub-Metropolitan and Lekhnath Municipality. Having two PHCs (Bheda Bari and Sishuwa ) and twelve HPs.
2.7 Western Regional Tuberculosis Center, Ramghat
Managing “Directly Observed Treatment Scheme” (DOTS) for treatment of Tuberculosis.
2.8 Red Cross Kaski Shimal Choure
It has been providing different services for the development of the community on the basis of the following principles:
Humanity, Impartiality, Neutrality, Independence, Volunatary Service, Unity and Universality.
2.9 Red Cross Blood Bank, Ramghat 11
Collecting blood from individuals and organizations and making available to the must needed clients.
2.10 Nepal Family Planning Association Kaski, Pokhara
Launching Out many development programmes on the concept of RH, Special emphasis on MCH/FP, natrition and environmental sanitation.
2.11 WHO, UNICEF, UNEPA, UNESCO, Rotary International, Jaycees, LEO, Lions clubs, Community Support Group Naya Bazar, Naulo Ghumti, Paluwa, CBRS, CWIN, INSEC, and GONESA, Abhiyan Community Health Hospital, there are more than two dozens of organizations working on STD, HIV/AIDS control programme, Asha Clinic-Baidam, United Mission to Nepal Community Health Development Programme, Leprosy Association, Arogya Ashrum Pokhara Sub-Metropolitan Urban Based Programme, this is supported by UNICET and Natural Pathy.
3.0 Academic Health Insititutions and Research Centers
There are TU and CTEVT affiliated health institutions marching forward in different levels of academic health courses.
3.1 Manipal Institute of Medical Science, Phulwari
Managigng different level of academic programmes and providing health care- services with advance technology.
3.2 Tribhuvan University Institute of Medicine (TU IOM), Pokhara Campus, Ramghat – 12
It is the only TU IOM Campus in Western region of Nepal. Ever since its establishment 22 years ago BS 2039, 17 Falgun (1982 AD), there has been no looking back for TU IOM Pokhara Campus. It has been carrying out Proficiency Cerfificate Level (PCL) Medical Science Nursing Course. Periodically, Bachelor of Nursing Students and MDGP residents come from IOM Maharajgunj for their practicum practice in WRH, pokhara.
3.3 Himalayan Eye Hospital, Gharipatan
This is the hospital where PCL Nsg, graduate and under graduate students are taken for their theory and clinical practice.
4.0 Nursing Homes and Research Centers
4.1 Fewa city Hospital and Research Center P.Ltd. Srijana Chowk
4.2 Fishtail Hospital and Research Center P.Ltd. Gairapatan
4.3 Pokhara Hospital and Research Center P.Ltd. Sabhagriha chowk
4.4 Pokhara Om Hospital, Diagnostic and Research Center P.Ltd. Bastola Thar
4.5 Padma Nursing Home P.Ltd. Newroad
4.6 Buddha Dental Care Center P.Ltd. Gairapatan
4.7 Kantipur Dental Hospital, Newroad (Opposite to Padma Nursing Home )
5.0 Pokhara Chamber of Commerce & Industry (PCCI), Gairapatan
BS 2011 Established, as Trade Association.BS 2035. Pokhara Chamber of Commerce & Industry. BS 2026 Office Construction. Since 1992 to 1994, June Collaboratd with Z.D. HTA to run the programmes.
5.1 Efforts done by Pokhara Chamber of Commerce & Industry in environmental saitation and health status development
BS 2047 Freeze donation to Red Cross Blood Bank. Cost Rs. 31,700 /-
BS 2050. Vital role in not Permitting/allowing tempos to inter Pokhara for Prevention of Pollution.
BS 2050 Latrine Construction in Kaunhu Primary School.Cost Rs. 4,255/85
BS 2050 Water Tank Construction in Gagangauda and Armala village.Cost Rs. 60,000/-
BS 2050 Environmental and tree plantation.Cost Rs.1, 56,719/-
BS 2050 Distribution of fruits and milk to different victims of natural disaster.Cost Rs. 59,227/- and 7,000/-
BS 2051 Different workshops and seminars on promotion of environmental sanitation, proper management of garbage and refuse disposal.Cost Rs. 1, 17,151/-
BS 2051 Maintaining clean environment from Mahendrapool to Chipledhunga.Cost Rs. 5, 00,000/-
BS 2051 Medicine distributed to patients with diarrhea and vomiting.Cost 15,034/11
BS 2057 provided fifty tree guards for Ranipauwa Cross Road to Regional Hospital Cross Road. This programme has been collaborated with Pokhara sub-Metropolitan.Cost Rs.59, 000/-
BS 2061 provided twenty-five tree guards and planted trees in Pokhara Chambar of Commerce Office to Gairapatan.Cost.Rs. 35,132/-
1995 AD.Nov 26 to Dec. 12 Mr. Eckharde Spreen had been done survey and submitted the findings to Pokhara Sub-Metropolitan. This is done for up-to-date planning, implementation and evaluation of development programmes.Cost.Rs. 3, 50,000/- Source: PCCI Office records.
Pokhara Chamber of Commerce & Industry has been developing basic understanding of past and management of future development plans including socio-economic factors and indigenous Knowledge regarding development of Pokhara valley.PCCI has a very pivotal role for betterment and development of Pokhara Community and near by areas. The Community service is an on going service that the Pokhara Chamber of Commerce & Industry has been providing since the past five decades. Finally on the occasion of the Golden Jublee Anniversary. I believe that remarkable continuous dedication, devotion and collaboration of the entire family will cooperate the Chamber of Commerce & Industry to build on its glorious past and movi ahead in future to raise and maintain the health status of Pokhara Community and near by areas :
References and Bibliography
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Habitat Research Pokhara (2003), Baseline Survey on Traffiking in Girls and Women in the Millennium against Traffiking in Girls and Women (JIT), Kaski, Ratna Chowk, Pokhara.
Gurung Lk (2003), Reproductive Right and Reproductive Health. Silver Jublee Publication, Family Planning Association. Kaski, Pokhara, Page 49-65.
Gurung LK (2003), Women’s Health in Nepal. Bimb. N.S.A Institute of Forestry, Pokhara, 11 (10), 9-17.
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INF (2003), Release Green Pastures Hospital and Rehabilitation Center.
Resource : Golden Jubilee Souvenir, Published By, PCCI, 2061 B.S.