The 2nd NESCOM conference was held on Raddison hotel, Lazimpat. The program started at 9: 30 AM. Inauguration session was hosted by Dr Pallavi Koirala and Dr Nikita Bhattarai. They talked about first NESCOM conference and the positive changes it brought. To chair the inauguration session, Prof Dr Nilambar Jha was called. Chief guest Prof Jay Prakash Muliyil was called to the dias. Other delegates (Dr Roshan Pokhrel and Mr Mahendra Shrestha) was called on dias. Organizing President Dr Gajananda Prakash Bhandari addressed and acknowledged the contribution of different delegates. Khada and bouquet was provided to dice member and official inauguration was done by lighting the Panas. Welcome speech was delivered by Dr. Puspanjali Adhikari (organizing secretary). She acknowledged all the chairperson and delegates. She talked about the potential of community graduates and how they can advocate for sustainable health and research.
Dr. Gajananda Prakash Bhandari talked about roles of community medicine graduates in the Federal health context of Nepal. He highlighted the fact that BPKIHS was first institution to start MD community. He talked about the different expertise in health where community medicine graduates can work like researcher, development sector expert, academician and clinical practioners as well. He also pointed that the only area where community medicine graduates are not able to work is “Government sector of Nepal”. He consistently highlighted about the competency of community medicine graduates. He ended his speech by thanking all the sponsors (World bank, Save the children, Leprosy mission center, TREIN).
Oration ceremony was started and chaired by Dr Nilambar Jha to Prof Dr J.P Muliyil. On his speech, Prof Muliyil talked about his struggle days from MBBS days. He talked about his journey and his experiences. He shared his experiences with dealing the different cases like tetanus in CMC Vellore. He said how these experiences changed his perception towards life. His journey of becoming epidemiologist was graced when he opted area of Leprosy as it was most neglected and stigmatized area. He talked about the differences between clinician and epidemiologist. He gave example of “thrombophlebitis obliterans” known as Berger’s disease and how Berger made the mistake of identifying risk factor of disease ‘as jew’ instead of ‘smoking’ due to lack of knowledge about natural history of disease and selection bias in this case. He encouraged all to be the ‘agent of change’.
Felicitation of MD community medicine graduates Dr Sanjeev Raj Bhandari and Dr Sagar Ratna Shakya was done by Dr Roshan Pokharel and Mr Mahendra Shrestha respectively. He acknowledged the gap in the government sector for community medicine graduates and gave assurance to take this matter more seriously. He also acknowledged the remarkable work done by these health force at the time of outbreaks. Dr Roshan Pokharel also highlighted the fact about lack of epidemiologist in Government sector and how important they are during outbreaks. He also assured to help these graduates to work with Government and take this matter forward. Dr Nilambar Jha then concluded the inauguration program by acknowledging all the chairperson. He shared his experience as a first ever community medicine graduate in Nepal and his struggles. He shared his dream of having an association long back then and how pleased he was today to see all those becoming real.
Plenary Session:
“Need of Community Medicine in the Evolving Context of Public Health”
The session was moderated by Dr. Abhinav Vaidhya.
The session began with an introductory presentation on “Community Medicine graduates and residents in Nepal” by Dr. Pranil Man Singh Pradhan.
His presentation was mainly focused on explaining the updates about the various areas and fields our community medicine graduates are being involved in and their contributions.
He highlighted their involvement in various national programs like technical input programs, Epidemic and pandemic preparedness response team programmes,Outbreak investigations,Verbal autopsy, Mass casualties, Mental health programmes, Hospital preparedness for emergencies, NCDs- pen package,step surveys,etc.
Also enlighted good performances of our graduates; giving one good example of them being involved in and showing their best effort in the quarantine program in Kharipati of 15 days of 175 nepalese students brought back from China;also appreciated our graduates for serving in help desk in TIA for covid-19 screening program.
He also highlighted that still the majority of community medicine graduates are more involved in academics rather than other fields and eventually our graduates being involved in government sectors,though few no. at present, was hopeful that the number will increase gradually.
Panel Discussion
The list of the panellists was:
- Prof Dr. J.P. Muliyil
- Prof Dr. Nilambar Jha
- Dr. Reuben Samuel
- Dr. Gambhir Shrestha
- Dr. Pranil Man Singh Pradhan
The paneslist were asked various questions and discussion was carried on as:
1.Dr. Reuben Samuel
On first question,he was asked to share a bit about the changing burden of diseases, globally and regionally.
He mentioned the increasing trend of morbidity and mortality of NCDs like Dementia, hypertension, diabetes,etc; persistence and re-emerging of Infectious Disease as the world is at demographic and epidemiologic transition phase and there are major climatic changes in the world.
Next question was what were the things needed to improve in the MD community medicine cadres in terms of public health or other skills for being salable in the international market.
He highlighted that there is lack of clarity regarding our own aims and objectives among ourselves, there is necessity of more field works, aspiring more skills and experiments in our graduates before entering to any organisations, NGOs, INGOs, etc as our community medicine is such a subject where we will learn from the community, in the community and for the community.
Also stated that the problem lies at the level of the health system and we need to improve from that level.
2.Prof. Dr. J. P. Muliyil, CMC Vellore
The question was what were the potentials the community medicine graduates should have in tackling the changing situation of disease burden; whether they have enough skills ; whether they are equipped and prepared for these changing scenarios.
He mentioned that they surely do have potential but they are in need of adequate training and should be more communicative, more energetic, more productive, hard working with clear goals and vision, need bigger inputs, more partnerships and collaborations with health sectors, greater health promotion campaigns,etc as their job to transform the whole society rather than the individual and it certainly will take longer time and hard effort.
3.Prof. Dr. Nilambar Jha, BPKIHS(President NESCOM)
He was asked a question about the current status of PG training in Nepal and his thoughts on the MD Community Medicine teaching in Nepal and how well the graduates are being trained.
He emphasized that every trainers including community medicine trainers should be competent as a good care provider, good decision maker, good researcher, good communicator, good community leader and good manager.
He also stated that he was sorry to say that the training of the community medicine graduates and residents is not enough in Nepal, trainings are not being done in the way it could have been done. Also highlighted that there is poor teaching and training from undergraduate level, so this should be improved from ground level.
He highlighted that though we are not getting good posts in government, we should explore ourselves and make ourselves more competent in various areas and fields of community medicine and create horizon
4.Dr. Gambhir Shrestha, BPKMCH
He shared his experience being government employee and gave brief information about his journey from completion of MD community medicine to present day, his involvements in various government programs like IMNCI, child health division, SNCU manual making(involved for first time), budgeting system, manual making for cervical cancer, breast cancer, oral cancer;
He highlighted that he found his own path and is paid off well for his hard work and tried to encourage other graduates with his story of journey.
5. Dr. Pranil Man Singh Pradhan
He shared his view regarding difficulties and hurdles the graduates are facing in having government seats and positions in community medicine.
TECHNICAL SESSION 1: National Health System Needs and Gaps on Cardiovascular Disease Prevention and Management in Nepal.
This session was chaired by Prof Dr. Nilambar JhA, professor BPKIHS, Dharan and Prof DR. Vinutha Silvanus, associate professor and head, Nepal Medical College. The presenters were allocated 8 minutes for each presentation and 2 minutes for discussion.
The presenters on this session were-
- Rasmi Maharjan
- Dr .Pranil Man Singh Pradhan,
- Bobby Thapa
- Punya Shorisuwa
- Anmol Shrestha
- Sujata Sapkota
- Abha Shrestha
- Surya Parajuli
1. CVD Translational Research and needs assessment brief introduction-Dr.Rashmi Maharjan
• The objectives of the research for need assessment was to assess the CVD burden and severity in Nepal and to assess national level infrastructure and capacity for CVD prevention and management for which they assessed the existing infrastructure and capacity of country to fight with CVD. The ethical clearance was obtained from NHRC. Then they formed assessment team and identified potential stake holders and drafts some assessment plan. Health system of the country was assessed with 6 building blocks I.e. 1)leadership and governance, 2)health financing, 3)health service delivery, 4)human resource for health 5)medical products and technologies 6)health information systems. First stake holders meeting was done and then task force was formed which included members from MOHP, assigned research fellows and co-investigators and divided into 6 blocks.
• For methodology all available online data sources, policies, acts, were collected. Key informant guides were developed to fill the gaps and conducted key interviews. All the interviews were audio recorded and was prepared for thematic analysis. Two members coded all interview independently and calculated inter-coder agreement. The funder organization was National Heart, lung and blood Institute (NHLBI), National institute of health (NIH).
2. Leadership and Governance – Dr.Pranil Man Singh Pradhan
• The speaker gave brief introduction about good governance in the health sector and said that countries need effective policymaking, transparent rules, open information, and active participation by all stakeholders in the health sector for an effective health care intervention to work. Under leadership and government there were 7 topical areas and every topical areas had specific indicators which were followed to measure leadership and governance.
• Dr.Pradhan recommended to establish committee by MoHP to formulate effective strategies for better coordination with civil society organizations like Nepal Heart Foundation and Cardiac Society of Nepal and to establish consultative working groups by MoHP with private sector representatives to improve reporting from private health service providers. Furthermore, he recommended to designate workforce for specific programs by MoHP to help in monitoring the enforcement of health sector regulations and to allocate funding to encourage research in the field of CVD and work towards developing CVD specific guidelines and protocols.
3. Human resource for health-Ms.Bobby Thapa
Ms.Thapa gave brief introduction about Human resource for health. In this building block there were 7 topical areas and 26 indicators. The 7 topical areas were-
1) Current HRH situation (1-4)
2) HRH management systems(5-9)
3) Policy making of HRH(10-12)
4) Financing HRH(13-16)
5) Educating and training HRH(17-21)
6) Partnership in HRH(22-24)
7) Leaderships in HRH(25-26)
She talked about the ratio of different health personal, total number by cadre and sector which was more in public sector than private sector, number of health care worker by geographic distribution which was more in hilly region compared to terai and mountain region, and trends of the past five years in current HRH situation where the number of sanctioned post has decreased from 2011 to 2014.
Ms.Thapa then talked about Human resources for Health Management System. She talked about existence of comprehensive HRH plan with budget and about HRH strategic plan 2011-2015 which was one of the guiding tool. She then talked about availability of strategic and operational HRM functions at the national and local levels. Then the speaker spoke about enabling environment existing for health workers to achieve goals and targets, availability of and use of HRH information systems and availability of mechanisms used to monitor and improve health worker performance, productivity and expectations.
Ms.Thapa then also talked about another topical area i.e, policy and planning of HRH. She talked about existence of and use of up-to-date HRH policies, existence of clear and up-to-date scopes and practice and about employment polices documented and used under public service committee Act 2066B.S.
She then talked about next topical area of education and training where she talked about number of pre-service and in-service training institutions and about production of new health care workers for cardiovascular diseases in response to needs of the health care system. She also spoke about evidence of pre-service education curriculum which was updated regularly, frequency quality and alignment of in-service training to health priorities and workforce needs and also about ratio of rural vs urban admissions and graduates. She then recommended for regular updating and establishment of systematic network with private sectors, expanding the collaboration between MoHP and different councils as well as private sector and Universities. She also mentioned about the regular monitoring of organization management as well as performance based evaluation by Quality standardization and Regulation Division.
4. Health Service Delivery and Infrastructure-Punya Shori Suwal
• Ms.Suwal briefly talked about organization of health system, referral system, and financial access to health services and user fee exemption in the health services. She also talked about coverage, utilization and demand for health services and talked about equity and quality in the delivery of health services and its outcome. She recommended for strengthening multi-sectorial coordination for CVD/NCD prevention and control, service expansion and implementation (e.g. PEN) at health facilities across the country. She also added that adequate recruitment, retention, development and utilization of human resources was needed and proper referral mechanism development and circulation of information regarding the services provided by different centers for effective referral should be there.
5. Health management information system- Dr. Anmol Shrestha
• Dr.Shrestha talked briefly about the Health information system, availability of financial and/or physical resources to support HIS related items within MOHP/central budget, availability at each level of a sufficient number of qualified personnel and infrastructure to compile and analyze information. He further added that NCD including CVD should be separately represented in HIS and private sector stakeholders should be involved as a part of HIS coordination committee. He also recommended to revise HIS guidelines to better align the needs of users with current changing federal structure and the Need of robust data collection and reporting at grass root level.
6. Medical products and technology-Dr. Sujata Sapkota
• Dr.Sapkota talked about medical products, vaccines and technologies. She also talked about pharmaceutical laws, policies, and regulation. She said that the Department of Drug Administration and the National Medical Laboratory should be strengthened and Medicine registration and inspection activities should involve in-depth on-site inspections of the processes. She also added that the loopholes in medicine storage and distribution should be addressed and recommended for development of national level guidelines; their endorsement and implementation.
7. Health Financing-Dr. Abha Shrestha and Dr. Surya B. Parajuli
• Dr. Shrestha said for any better health system to perform risk pooling, creating appropriate incentives for quality services provision from all providers and allocating resources to most effective efficient and equitable interventions and services irrespective of sector was needed. She then talked about 4 different topical areas
Topical Area A: Amount and sources of financial resources
• Where she talked about Total expenditure on cardiovascular health (THE) which was 0.127 % of GDP (2.86 Billion) and Per capita Total Health expenditure at international dollar rate was USD 49 (NPR 5,216). The general government expenditure on health (GGHE) as percentage of total government expenditure was 8.15% and General government expenditure on health as a percentage of total health expenditure was 26.66% of THE (40.31 NPR Billion)
• External resources for health as a percentage of total health spending was 10.96 % of THE and Out-of-pocket expenditure on health as a percentage of total expenditure on health was 51.88% of THE.
Topical Area B: Ministry of Health Budget and Expenditure
• Trends in MOHP planned and realized expenditures
• Government spending on health as a share of the gross domestic product was 1.4% in FY 2014/15 to 1.9% in FY 2017/18 while Health sector budget was –NPR 37.8bn in FY 2014/15 to NPR 65.3bn in FY 2018/19.
• Per Capita Government Spending was –NPR 966 in FY 2013/14 to NPR 1819(USD 9.8 to 17.7) in FY 2017/18.
She then talked about MOHP budget process and allocation structure. Dr. Shrestha then talked about Federal, Provincial and Local government budget allocated for CVD and Government budget spent on outpatient/inpatient care of patients with cardiovascular diseases. She then spoke about recurrent government health budget allocation and Local-level spending authority and institutional capacity.
Topical Area C: Health Insurance – Dr.Surya B.Parajuli talked about Population coverage of the health insurance schemes for cardiovascular diseases which was – 22228 members of 15 districts while Services covered by health insurance was 36 CVD related health services.
• They talked about Topical Area D: Out of Pocket Payments. He then recommended that although burden of CVDs is increasing in Nepal, allocation of public resources is limited which is causing higher out of pocket expenditure in Nepal so there should be allocation of resources as per diseases burden of the country for prevention, control and treatment
Technical Session III
“Lessons Learnt on Antimicrobial Stewardship in a Community Run Hospital”
Presentor : Mr Kshitij Karki
The session was jointly chaired by Dr Deepak Kumar Yadav and Dr. Prajjwal Pyakurel.
The presenter highlighted that the antimicrobial resistance is the emerging public health problem in Nepal which is in increasing trend globally and nationally.
He also mentioned about the actions of antimicrobial stewardship program in a community run hospital like promoting rational use of antibiotics,minimizing the increasing trend of AMR rates, providing knowledge regarding where and when not to prescribe antibiotics, reducing further spread of AMR.
He stated that post-prescription review and feedback (PPRF) program was a common approach which included:
A review of antimicrobial use 48 to 72 hours after initiation, coupled with feedback from a physician champion as to whether treatment should be modified or stopped.
In Nepal, the PPRF program included:
- Training of the microbiologists to document resistance pattern.
- A collaborative development of prescribing guidelines
- Training workshops.
- Training of ‘physician champions’ and master physician champions from three hospitals (Kathmandu Model, Kirtipur Hospitals and Pokhara Academy of Health Sciences/Western Regional Hospital;
- Two additional hospitals in Kathmandu – Nepal Mediciti Hospital and the Sukraraj Tropical and Infectious Disease Hospital
Program outcomes in all hospital were decrease in patient days of therapy (DOT) for both oral and IV antibiotics and decrease in patient days of therapy for Linezolid, Penicillin, and Cephalosporins, Colistin, and Aminoglycosides.
Summarizing the session,he focused that hospital-based stewardship programs can be successfully implemented in hospitals without infectious disease specialists through training of physician champions and locally relevant antibiotic prescribing guidelines could be integral part of any stewardship program.
He concluded that Stewardship Program should be integrated with infection prevention and control programs and highlighted on necessity of expanding trainings & necessity of advocacy with patients and community
Symposium I
Advancing Research Culture in Nepal in the current Public health context
The session was chaired by Dr.Mahesh Maskey and Prof.Dr.Sunil Kumar Joshi. They allocated 8 minutes for each presentation and 2 minutes for discussion.
|
Presenters |
Topics |
|
Dr.Pradeep Gyawali |
Health Research Governance for developing research culture in Nepal |
|
Dr.Meghnath Dhimal |
Health Research Governance for developing research culture in Nepal |
|
Dr. Biraj Man Karmacharya |
Advancing Research Culture in Nepal in the Current Public Health Context |
|
Dr.Santosh Dulal |
Advancing the Frontiers of Biomedical/Clinical Research via Cutting-Edge Technology |
|
Dr.Archana Shrestha |
Advancing Research Culture in Nepal in the Current Public Health Context |
He listed some of the research projects that is ongoing under his guidance like :
1. Application of Autologous Leukocyte and Platelet Rich Fibrin (L-PRF) in Leprosy Ulcers
2. A Single Center, Open Label Pilot Study to Evaluate the Safety and Efficacy of CC-11050 in Nepalese Patients with Erythema Nodosum Leprosum
3. Genetic Basis – Gene, Mutation in Tharu vs Non-Tharu in disease like thalaseemia and sickle cell Anemia
He concluded saying that there should be Collaboration with diversified (Clinicians, Mol. scientists, Public health experts, Computational etc.) team in order to bring out the best outcome of an research. And today,research should focus on pristine areas and scopes which are not done before like molecular epidemiology,molecular oncology research.
Last presentation was given by Dr. Archana Shrestha, KUSMS. Dr. Archana is an Associate Professor and Director of Translational Research at Kathmandu University School of Medical Sciences. She has previously worked as an assistant Professor at Yale School of Public Health. She has completed her Ph.D.in Epidemiology from University of Washington and has worked at various Non-Profit Organizations in the field of Epidemiology, Healthcare, Data Analysis and Statistics. Dr.Archana talked about various components for a research culture inorder to produce high outcome of a research. She highlighted us about harmonizing individual research works into institutional research work and finally into national public health works.she pointed on reward Quality Research ,Supporting researchers in terms of funding and protected time inorder to be creative and bring out innovative ideas,broaden Perspective . she highlighted about the importance of having equal partnership with international partnerns interms of publication, copyright and ownership.she concluded by saying that its high time to move beyond the risk factors for the problem and move forward towards the solution by filling the know do gap.
Scientific Session I
The session was jointly chaired by Prof. Dr. J.P. Muliyil and Dr. Neeti Singh.There were six presentations in this session.
Topic | Presenters |
Financing, costing and increasing investment for addressing Epidemics/ Pandemics in Nepal | Ms. Mamta Ghimire (World Bank Nepal) |
Factors associated with triple burden of malnutrition among mothers and children in Nepal : Evidence from 2016 Nepal Demographic and Health Survey | Dev Ram Sunuwar |
Impact of aerobic physical exercise on cardiovascular health of school going adolescents of Nepalgunj, Nepal | Dr. Manita Pyakurel |
Economic burden among diabetic and hypertensive residents of Inaruwa, Nepal | Dr. Roshan Dhakal |
Study on the risk factors of type II diabetes mellitus in Itahari Sub metropolitan city, Sunsari – A case control study | Dr. Jyoti Ranabhat |
The session started with the presentation of Ms. Mamta Ghimire from World Bank Nepal on “Financing, costing and increasing investment for addressing Epidemics/ Pandemics in Nepal”. The presentation was based on the need for an increase in fund for Pandemic/Epidemic preparedness in Nepal, especially in view of recent COVID
-19 outbreak.She talked about a study done by World Bank Nepal about management and organization of Pandemic/Epidemic preparedness. This study has three modules:
Module 1: Assess current financing in Pandemic /Epidemic preparedness Module 2: Cost the National Preparedness plan implementation
Module 3: Identify options to increase investment in preparedness
Key Points of Presentation
- Key finding of Module 1 are that total pandemic related budget is estimated at 2687.6 M or NPR 89.24 (US $ 0.79) in per capita terms in Nepal for FY 2019/20.This is half of the global recommendation of 1.69 US $ per
- To fully implement the costing plan in the course of 5 yrs an additional 379.65 M NPR is
- Module 2 discusses about eleven areas of command among which the highest cost demanding area is case investigation and
- Module 3 discusses investing in preparedness.Fiscal deficit has reduced from 6.7 % of GDP in FY 2018 to 1.9 % in FY 2019. Revenue grew by 17.7% driven by income tax, VAT and excise tax collections, all of which grew by more than 15%. Economic growth is expected to increase by 6% in coming years.Extra money should be invested in preparedness
- The additional budget needed to invest in preparedness can be generated through : 1.Reprioritization health sector and preparedness within health sector
- Reinforcing health specific taxes to incentivize pandemic/ epidemic risk reducing behavior.
- Earmarking portion of development assistance for health to invest in preparedness related capital expenses
The second presentation was by Mr. Dev Ram Sunuwar on “Factors associated with triple burden of malnutrition among mothers and children in Nepal : Evidence from
2016 Nepal Demographic and Health Survey”. This research showed that Nepal has low prevalence of Triple Burden of Malnutrition (TBM). Mothers of short stature, members of the richest families and older mothers are more vulnerable to TBM. A successful strategy for preventing TBM in Nepal will be the efficient implementation nationally of maternal health promotion initiatives and nutrition education programs. Findings also demonstrate that wealthy families are not to be overlooked.
The next presentation was done by Dr. Manita Pyakurel on “Impact of aerobic physical exercise on cardiovascular health of school going adolescents of Nepalgunj, Nepal”. Her study concluded that aerobic physical exercise can be implemented in school going adolescents if it is made as a part of school activity. Aerobic physical exercise in adolescent helps to decrease BMI, resting heart rate and diastolic blood pressure.
The next presentation was by Dr. Roshan Dhakal on “Economic burden among diabetic and hypertensive residents of Inaruwa, Nepal”. The study showed that the economic burden and out of pocket expenditure was high among diabetic and hypertensive population of Inaruwa.The prevalence of catastrophic health expenditure was also higher among those living below poverty-line.Non-communicable disease prevention campaigns and effective health insurance program could help to reduce burden.
The final presentation was by Dr. Jyoti Ranabhat on “Study on the risk factors of type II diabetes mellitus in Itahari Sub metropolitan city, Sunsari – A case control study”.Her study found that the percentage of individuals with hypertension was 46.1% (53% of cases and 38% of controls).The percentage of individuals with low physical activity was almost 20% (28% of cases, 13% of controls).Adequate fruits and vegetables consumption was seen as having a protective effect on diabetes. The individuals who did not take adequate fruits and vegetables had three time the risk of having diabetes (p<0.05).In the anthropometric measurements, most of the subjects (77% cases and 66% controls) were obese as per the Asian criteria for BMI,90% cases and 70% controls were obese as per the waist circumference criteria (≥90 cm for males and ≥80cm for females) indicating high central obesity,85% of the cases and 75% controls had higher than normal Waist Hip ratio (≥0.9 for males and ≥0.85 for females) and 98% of the cases and 89% of controls had higher than normal Waist Stature Ratio (≥0.5 for both sexes).This study showed three significant risk factors for diabetes; hypertension, low physical activity and inadequate fruits and vegetables consumption.
SYMPOSIUM SESSION 2 (5th March 2020): Session was chaired by Dr. Gisupnikh Prasiko.
There were three presentations in this session.
1.Dr. Surendra | Cancer Prevention Activities in Nepal, experiences |
2.Miss Rashmi Dhungana | Cancer Prevention in Nepal. |
3.Dr Gambhir Shrestha | Cancer prevention and control activities at a |
Dr. Surendra Bade Shrestha who was the first presenter of this session presented on Cancer Prevention Activities in Nepal, experiences and
Challenges with long term goal, programs, achievement of Cancer Education Programme 2002-2011 of NNCTR/INCTR (International Network for Cancer Treatment and Research).This organization is the first organization to introduce HPV in Nepal in 2007,and delivered HPV vaccine to 30,560 girls of age group 11-13yrs,also delivered cancer prevention service to 56000 women of 30-60 years Via programme called2002-cervical cancer screening programme(CCPS) .He also highlited on Cervical cancer as Cervical cancer is one of the must preventable cancer and together ,HPV vaccination and cervical cancer screening can prevent the majority of cervical cancers.He also talked prevention and screening strategies
of cervical carcinoma.He also enlighten the need of Comprehensive Cervical cancer prevention progamme including cervical cancer education and
Screening.
Second presentation of the session was delivered by Miss Rashmi Dhungana on “Cancer Prevention in Nepal”. She shared how the non-profit organization “Prevent Cancer Nepal (PRECAN)” focuses on reduction and prevention of Breast ,Oral and Cervical Cancer as these three cancer has
higher incidence in global as well as national scenario.
The third presenter Dr.Gambhir Shrestha presented on Activities at a national tertiary cancer hospital in Nepal Cancer prevention and control.He talked on different services provided by B.P KOIRALA MEMORIAL CANCER HOSPITAL and one of the department of total nine deapatrments works on cancer prevention control and research where he is currently working. He gave the information on top 10 cancer incidence of BPKMCH as Lungs cancer being the first one followed by cervical cancer and breast cancer.He also shared the different programme :awareness and training,cancer screening,Cancer screening program,cancer registry,research activities conducted by BPKMCH.
Concluding session
Chaired by: Prof Dr Nilambar Jha
Dr Gajananda Prakash Bhandari
Dr Puspanjali Adhikari
Dr Dipesh Tamrakar
Dr Gajananda highlighted and summarized the session with :
– Journey of second NESCOM and achievements
– Success of pre-conference in Dhulikhel
– Importance of having a position in Government sector for community medicine graduates
– Demarcation between clinical and non clinical
– Highlighted the potentials of MD community graduates
Token of appreciation was distributed to all the delegates, sponsors, organizing committee, presenters, volunteers, rapporteurs etc.
Dr Puspanjali gave closing speech and she thanked everyone who helped with the conference. She acknowledged the contribution of everyone that helped to make this conference a huge success.
Dr Nilambar Jha sir concluded the session and thanked everyone for making this conference a success.
Technical Session IV
Quality Of Newborn and School Health Nutrition
Chair : Dr.Gajananda Prakash Bhandari
Co-Chair : Dr.Khem Raj Shrama
The session was chaired by Dr.Gajananda Prakash Bhandari and co-chaired by Dr.Khem Raj Sharma. He initiated the session by allocating 6 minutes for the presentation and 2 minutes for the discussion.
Presenter | Topic |
Dr.Adish Dhungana (Save the children)
| Newborn Care Services – Evidence from Private and Public Sector |
Dr. Dhungana is a senior health and nutrition program manager and emergency health and nutrition manager at the Save the Children International. He completed MPH from Mahidol University and has 14 years of public health work experience. He highlighted the improvement in number of ANC by skilled manpower,institutional delivery and delivery by skilled manpower according to NDHS survey,2016.However ,there are many problems even in those settings like late initiation of breastfeeding ,receiving prelacteal feeding in health facilities and so on. He highlighted that regardless of policies, newborns and children under-5yrs 34% of visits pharmacy(34%) as a first point of contact for symptoms of ARI (NDHS 2016) and 27% in government hospital,8% in private hospital,31% in private clinics .He pointed out that the Pharmacies are treating newborns and children with non-standard protocol, with potential harmful practices.Futhermore ,he presented comparative datas of clinics having better adherence to appropriate assessment ,treatment and appropriate referral and follow up of sick young infants (0-59 days) as compared to private shops. He stated that Newborn care practices are not perfect within hospitals either with various problems like Staff shortages, drug shortages and equipment breakdowns happen often and may lead to unintended situation for newborns and children.
Technical Session V
Leveraging Community Engagement and
Local Government Leadership for
Strengthening Routine Immunization-A case study in Province 2.
This session was chaired by Dr. Dipesh
Tamrakar and Dr. Lee Budathoki.
In this session, presentation was done by Ms.
Beki Prasai, Health Officer of UNICEF.
The topic of the presentation was on “Leveraging Community Engagement and Local Government Leadership for Strengthening Routine Immunization : A case study in Province-2”
Key points of the Presentation:
● Nepal has made remarkable progress in reducing child mortality.National Immunization Program is the first priority program of Govt. of Nepal.
● Immunization coverage in 2018/19 for different vaccinations are : BCG – 103, Penta 1- 101, Penta 3- 86, PCV 1- 100, PCV 3- 79, JE- 75, MR 1- 84, Mr 2- 57.
● For Penta 1 vs penta 3 the Drop out trend in 2018/19 in province -2 is 14% ,for BCG vs MR-2 the dropout rate is 45%, for MR1 vs MR 2 it is 32 %.
● Problems in MR2 dropout were identified to be caregiver unawareness, social reasons and poor service experience
● Action plan was created as an intervention in this study to increase coverage of MR – 2.
The study concluded that engagement and local leadership can significantly impact supply, demand and quality of services
● Supply :Continuous and improved supply of vaccines and commodities is to be maintained, addition of health workers and immunization sites and budget allocation for additional immunization activities is needed
● Demand for budget allocation to strengthen social mobilization.Intersectoral support, especially Education, Religious leaders and Media is needed.
● Quality of services is to be monitored and supervised.Vigilance on data and reporting.
Scientific Session 2:
Prof. Nilambar Jha and Dr. Pranil Man Singh Pradhan chaired the session.
Presenters were invited to the Podium.
Dr. Prajjwal presented on “Worksite Intervention Study to Prevent Diabetes in Nepal”.
He was asked about the reasons behind failure of failed brown rice trial and the rationale behind behaviour intervention (exercise) for factory workers who are already working. Answered by Dr. Prajjwal – The main reason behind failure of brown rice trial was unavailability of brown rice and also people did not like taste. Regarding exercise for workers; the type of work, grading of activities or estimation of energy spent on work is not done ; some workers who are doing clerical works are also included in the study so behavior behaviour intervention can be helpful for the staffs.
Dr. Priya Pathak presented a study titled “Accessibility to Water, Sanitation and Hygiene amongst mothers of young children in Chitwan district Nepal”. The main finding of the study was accessibility to WASH was seen to be affected by family income of mothers.
Dr. Sandeepa Karki presented on “Behavioral risk factors for Non- communicable disease and health literacy needs of the white color workers in Nepal” – Main finding of the study : These workers had significant prevalence of hypertension risk factors so worksite intervention to reduce the risk of hypertension is required.
Dr. Sangita Rai presented study titled “A study on out of pocket health expenditure on chronic non communicable disease among elder population in Dharan sub-metropolitan, eastern Nepal. The main finding was – Mean out of pocket health expenditure of elderly was higher, elderly faced high catastrophic health expenditure and most elderly preferred private hospitals.
Session was concluded after distributing certificate to presenters.
Finally, after the end of all sessions, ‘Vote of thanks’ was offered by Dr. Pushpanjali to all the volunteers, sponsors, participants and supporters who directly and indirectly helped in organising the conference.