Institutional framework DOHS and millennium development goals (MDGs)

The Department of Health Services is one of three departments under the Ministry of Health and Population and have a different level of Institutional framework. Millennium development goals aim to bring peace, security, and development to all people.

The institutional framework of the department of health services

The overall purpose of the Department of Health Services is to deliver preventive, promotive and curative health services throughout the country. The Department of Health Services is one of three departments under the Ministry of Health and Population.  As seen in Figure the organizational structure of the MoHP outlines how different levels of the health system related to form a network under the DoHS.

According to the institutional framework of the DoHS and MoHP, the Sub Health Post (SHP) from an institutional perspective, is the first contact point for basic health services. However, in reality, the SHP is the referral center of the volunteer cadres like TBAs and FCHVs as well as a venue for community-based activities such as PHC outreach clinics and EPI clinics. Each level above the SHP is a referral point in a network from SHP to HP to PHCC, and to the district, zonal and regional hospitals, and finally to specialty tertiary care centers in Kathmandu.  This referral hierarchy has been designed to ensure that the majority of the population receive public health and minor treatment in places accessible to them and at a price they can afford.  Inversely, the system works as a supporting mechanism for lower levels by providing logistical, financial, supervisory, and technical support from the center to the periphery.
Organizational Structure of the Department of Health Services

MDManagement DivisionNTCNational Tuberculosis Centre
FHDFamily Health DivisionNCASCNational Centre for AIDS and STD Control
CHDChild Health DivisionNPHLNational Public Health Laboratory
EDCDEpidemiology and Disease Control DivisionFCHVFemale Community Health Volunteer
LMDLogistics Management DivisionTBATraditional Birth Attendant
LCDLeprosy Control DivisionPHC/ORCPrimary Health Care Outreach Clinic
NHTCNational Health Training CentreEPIExpanded Programme on Immunisation
NHEICCNational Health Education, Information and Communication Centre  

Millennium Development Goals (MDGs)

At the millennium summit of September 2000, the member states of the United Nations adopted the Millennium Declaration, which aims to bring peace, security, and development to all people. The Millennium Development Goals (MDGs), drawn from the Millennium Declaration, are a groundbreaking international development agenda for the 21st century to which all nations are committed. The MDGs outline major development priorities to be achieved by 2015. Numerical targets are set for each goal and are to be monitored through 48 indicators. The MDGs are:

  • Goal 1. Eradicate extreme poverty and hunger
  • Goal 2.  Achieve universal primary education
  • Goal 3.  Promote gender equality and empower women
  • Goal 4.  Reduce child mortality
  • Goal 5.  Improve maternal health
  • Goal 6.  Combat HIV/AIDS, Malaria and other diseases
  • Goal 7.  Ensure environmental sustainability
  • Goal 8.  Develop a global partnership for development

Note: Goals no. 4, 5 & 6 are directly related to MoHP/GoN.

Since GoN endorsed the Millennium Declaration, Nepal has been committed to achieving the MDGs. As the primary medium-term strategy and implementation plan for achieving the MDGs, the country’s Tenth Plan (Poverty Reduction Strategy Paper 2002/2003  2006/2007) has incorporated the MDGs into its strategic framework, and has highlighted the importance of improving the monitoring mechanism.

Targets: The targets based on the above goals of MDGs are as follows:

  • Target 1. Halve between 1990 and 2015, the proportion of people whose income is less than one dollar a day;
  • Target 2. Halve between 1990 and 2015, the proportion of people who suffer from hunger;
  • Target 3. Ensure that, by 2015, children everywhere, boys and girls alive, will be able to complete primary schooling;
  • Target 4. Eliminate gender disparity in primary and secondary education, preferably by 2005, and at all levels of education no later than 2015;
  • Target 5. Reduce by two-thirds between 1990 and 2015 the under 5 mortality rate;
  • Target 6. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio;
  • Target 7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS;
  • Target 8. To have halted by 2015 and begun to reverse the incidence of malaria and other diseases;
  • Target 9. Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources;
  • Target 10. Halve by 2015, the population without sustainable access to safe drinking water and basic sanitation;
  • Target 11. This target is related to develop a global partnership for development;
  • Target 12. Develop further an open, rule-based, predictable, non-discriminatory trading and financial system, includes a commitment to good governance, development, and poverty reduction-both nationally and internationally;
  • Target 13. Address the special needs of the LDCs, includes: tariff and quota-free access for LDC exports; enhanced program of debt relief for HIPC; and cancellation of official bilateral debt; and more generous ODA for countries committed to poverty reduction;
  • Target 14. Address the special needs of landlocked developing countries and small island developing states;
  • Target 15. Deal in a comprehensive manner with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term;
  • Target 16. In cooperation with developing countries, develop and implement strategies for decent and productive work for youth;
  • Target 17. In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries;
  • Target 18. In cooperation with the private sector, make available the benefits of new techniques, especially information and communications.

Among all the above targets, the targets and their respective indicators which are directly related to MoHP are as follows:

Relates toIndicators In 1990 In 2005 In 2015
  Target 5 Infant Mortality Rate 108 34
 Under five years mortality rate 162 54
 Proportion of one year olds immunized against Measles 42 90
 Target 6Maternal Mortality Ratio 850 or 515 213 or 134
 Percentage of deliveries attended by health care providers (Doctors/Nurses/Auxiliary Nurse Midwives) 7 60
Target 7HIV Prevalence among (15-49) years of age (in %) NA 0.5
Contraceptive Prevalence rate including condom (in %) 24 NA
Target 8Prevalence rate associated with malaria (no. of cases per 10,000 people at risk) 115
Proportion of population in malaria risk areas using effective malaria prevention measures NA
Slide Positivity Rate (SPR) 5.1
Prevalence associated with Tuberculosis 460
Death rates associated with Tuberculosis 43  
The proportion of Tuberculosis cases detected NA  
The proportion of Tuberculosis cases cured under DOTS NA  

Source:  Millennium Development Goals

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