Académique Documents
Professionnel Documents
Culture Documents
Prepared By
Thakur Psd Lamsal
i
A Study on Sanepa Health Centre
Prepared By:
Thakur Psd. Lamsal
February, 2009
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Acknowledgement
I wish to express my heartful gratitude to the Advisor Mrs. Ranjana Shrestha Principle
Prof.; Mrs. .Kabita Khanal Program Coordinator , for their kind and cordial advisory
guidance to successful complete this study report in this state.
I am really thankful to Mr. Balmukund Khanal Secretary of Sanepa Health Centre and
Mr. Bishwodas Amatya Vice-President of SHC and coordinator co-workers of SHC for
providing assistances to complete this study report.
Last but not the least, I appreciate the comfort and intimate supports of my all colleagues
of “ Bachelor of Health Care Management” of National Open College as well as
Administrative and supportive staffs of NOC.
Sincerely yours,
March,2009
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Faculty of Management Studies
Pokhara University
Recommendation
This is certify that the Sanepa Health Centre Internship report tilted
A Study on Sanepa Health Centre , Sanepa, Lalitpur
Prepared By:
Thakur Psd. Lamsal
Place:Sanepa,Lalitpur Coordinator
Lalitpur, Nepal BHCM Program
BHCM Program National Open College
Date: February, 2009
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Faculty of Management Studies
Pokhara University
Recommendation
This is certify that the Sanepa Health Centre Internship report tilted
A Study on Sanepa Health Centre, Sanepa, Lalitpur
Prepared By:
Thakur Psd Lamsal
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Tables of Contents
Acknowledgement III
Certification of Authority IV
Recommendation V
Approval Letters VI
List of Figures X
List of Tables XI
Abbreviations XII
Abstract XIV
1.1 Introduction 1
1.5 Methodology 3
1.6 Scope of the Study 4
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2.1 History 5
2.2 Promoter 9
3. Programs
3.1.5 Implementation 17
3.1.7 Outcomes 18
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3.2.4 Target Population 20
3.2.5 Implementation 20
3.2.7 Outcomes 22
4. Administrations
Productive, Quality) 30
5.2 Findings 36
6. Conclusion 37
References 38
Appendix 39
Bibliography
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1. Location and Layout of Sanepa Health Center 11
2. Organogram of SHC 12
in FY 2061 to 2065 30
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List of Tables Page. No.
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Abbreviations
HP Health Post
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IEC Information Education Communication
Abstract
This BHCM Internship study is carried out in Sanepa Health Centre located in Mohan
Chautari of Lalitpur district Ward No. -2 of country Nepal. This Internship study is
basically focused on managerial aspects and planning sides of Sanepa Health Centre and
its mobile health camps organized by SHC. The main objectives of this practicum which
was performed for 6 weeks is to studying management practices adopted by SHC as well
as how it has delivered its services to Sanepa Community and its surroundings. Data and
Facts included in this reports were collected by direct observation, Interviews , and
Recorded information from top management level to front line management. Sanepa
Health Centre is totally independent community health centre so the donation and
promoters are from Sanepa Community and other. We found good relationship and
coordination between volunteer doctors, health professionals, donors organizations ,
members, Nurses from Lalitpur Nursing Campus.
Sanepa Health Centre is providing quality care to poor and needy peoples, free of cost. It
has run all major programs in effective way through trained manpower, effective medical
practices, under continuous supervision of clinicians. In the same it has gained its success
in conducting various programs with close association with NGOs, INGOs, Lalitpur
Nursing Campus, Star Hospital etc.
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As being student of Health Care Management, We have learnt about Public Relation,
Community Participation, Social Work practices, Management Practices and Its
implementation. SHC has its limitation such as not full utilization of their building as
there is only morning counter, not day and evening. SHC has not association with NGOs
and INGOs which is one strategy to boast up of the community health Center, this is
lacking in SHC. The record keeping system is only manually.
Chapter 1
1.1. Introduction
Health is the fundamental human right of all citizen of a nation. Health is related to the
overall development of the country and it is sensitive issue. It is the duty of nation to
provide health care services to its citizens.
Health is defined by WHO as, “Health is the state of complete physical, mental and
social well beings and not merely absence of disease and infirmity.” – WHO (1948)
Health care services are rendered through various systems. In Nepal, various form s of
Healthcare delivery system. These are ranging from the Governmental bodies, National
and International bodies, and public and well as private sectors. Among them, Sanepa
Health Centre is such type of unique health care organization located in Mohan Chautari
of Lalitpur district ward No-2, Sanepa Health Centre was established in 1987 as small
unit of self help organization has now actively and regularly providing varied medical
services to the poor and needy people, with minimal cost.
Sanepa Health Centre was created by four or five service loving persons of sanepa, with
the help of local doctors and nurses.
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1.2. Background of the Study
Sanepa Health Centre is the community health centre of Sanepa. There administrative
and clinical works are carried out by local doctors and managing board. To run any
institution in effective and efficient way there is need of professionals or health
managers. The demand of professionally trained administrator is increasing day by day in
order to control over the management activities because the health sector in todays time
are facing different problems from the management perspectives point of views.
Therefore services rendered to the patients many not be satisfactory.
Purpose
The main purpose of this practical study is to learn about management system of
“Sanepa Health Centre”. For this following are the objectives :
Objectives
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1. To observe the activities perform by Sanepa Health Centre and understand from
managerial aspects.
2. To observe the nature service rendered by SHC.
3. To study the problem related to management.
4. To collect and analyze data.
5. To study organization and management of services and prepare the
comprehensive report.
The practical report will be divided into six chapters namely, Introduction and
Methodology, Organization under Study, Programs, Administration, Analysis and
Findings and Conclusion.
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Chapter 5 Analysis and Findings includes analysis (financial sustainability, costing ,
work flow, productivity and quality), Finding Critical Observation.
Chapter 6 Conclusion includes conclusion of the various programs and Sanepa Health
Centre under the study with the References and Appendix.
1.5. Methodology
All the data collected in this report of the Sanepa Health Centre is both Primary and
Secondary data. Primary data is collected from the discussion with the Administrator
Supervisor and Administrative staffs Secondary data is collected from annual reported
record and internet browser.
It deals with :
a. Significance of study:
The study deals with the complete knowledge of the concern services from the
management perspective point of view gained by the researcher. This study also helps the
health care provider to know the problems and weakness in their management so that
they can evaluate themselves and take corrective actions to perform better.
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Chapter 2
2.1. History
In 1951, periodic development plans introduced with the objectives of increasing gross
domestic products provide employment and improve living standards of the people. The
Department of Health Services were established in 1953 under the Ministry of Health.
DOHS carry out the responsibility promotion, regulation, and management of the
hospitals,Ayurvedic Dispenseries/school and unit of product of Ayuervedic medicines. On
the other side the preventive health care was beginning with establishment of vector born
diseases control unit in Dang in 1951. Then in 1954 NGOs started to provide Health Care
Services.
During the first five year plan(1956-61) the ministry of health established 33 hospitals in
the urbanization areas like Kathmandu, Biratnagar, Sunsari, Nepalgung, Dhankuta, and
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Dharan. Ministry of health prepared the first plan to establish a modern health system in
1956. Various types of health programmed were existed as vertical project in which
foreign assistance was the major source of funding to provide different types of the health
services.
In 1962 many District Hospital, Zonal Hospital at Zonal Headquarters was established as
well as vertical projects was also established. Then after in 1968 single specialty hospitals
was established with the providing quality health services in specific services. Such as
Kanti Children’s Hospital, Eye Hospital, Basic Health Care Services as Health-Post,
Appointment of village health workers, Health Manpower training program transferred
by IOM by MOH was started in 1972.
First Long Term Plan was established on 1975-1990 for the First Perspective Health Plan,
formulated with a calendar of operations for the 5th , 6th, and 7th five year plans with
emphasis on provision of comprehensive basic health services. 5th five year development
plan(1975-1979) was to provide minimum health care to maximum number of people. In
1978 the government started the integrated community health services development
project which was entrust with the responsibility of integrated vertical programmers and
expanding basic health service up to the community level and providing health care to
doorsteps of the people. In 1978, after the acceptance of Primary Health Care by the Year
200(HFA-2000) by the countries of the worlds s key to the attainment of Health for All
by the Year 2000 A.D. Nepal stared to expand and strengthen integrated approach to meet
the national goal.
The sixth and seventh five year development plan (1979-1991) was the era of integration
and minimum health services to the doorsteps to the people of the country. The concept
of “Integration” was promoted to organize health care in rural area of the country.
One major aspect of integration is that the single purpose health workers in the vertical
health programmers were to be converted into the multipurpose health workers who
would combine the work of vertical workers such as Malaria, Leprosy, Smallpox, and
Family Planning and also provide preventive care, health education and simple health
care.
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A pilot study was done on integration and community health approach for health services
delivery and the success was enough to introduce the programmed in the country in 1978.
The government started integration of vertical programmer activities in the main stream
of the health services.
In 1978 Health For All, Primary Health Care was established to provide various health
services to people and female community health volunteer. Regional Hospital, NGOs
hospital, Limited Private Health Facilities, Integration of Vertical Health Programs with
the basic health service was established in 1984.
In 1991 National Health Policy was established with establishment of Sub-Health Post,
large scale private hospitals, Medical Colleges, Teachings and Training Schools and
Integration of Hospital and Public Health Office under District Health Office with
Community Drug Program, National Level, Regional , Zonal Level, District Level and
Electro constituency. After establishment of District health post and sub health post and
carried to all administrative and technical works to promote health standard of people.
Sanepa Health Center was established in 2045 B.S.(1959 AD). It was established before
20 years ago when the Shanta Bhawan Aspatal Was shifted to recent Patal Hospital Area.
Sanepa Health Centre is a community based health care organization. The Sanepa Health
Centre was established by four or five services loving persons of Sanepa, with the help
of local doctors and nurses. Sanepa Health Organization is providing free health care
services to the poor and needy people of Sanepa and adjoining areas. Located at Mohan
Chautari of Sanepa of Lalitpur District of Nepal .
Sanepa Health Centre celebrates it’s annual function in the month of Baisakha in every
year as birth anniversary. This celebration is well attended by the residents of the Sanepa
Community and dignities of Lalitpur. This celebration is celebrated not only as birth
anniversary but as a local festival to honor the volunteers and donors. Prime Ministers as
well as Ministers are usually the chief guest for this celebration.
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Following are the lists of distinguished delegates and date who attended Sanepa Health
Centre’s anniversary programs.
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21. 2064 Sahana Pradhan Foreign Minister
Table no. 1. lists of distinguished delegates and date who attended Sanepa Health
Centre’s anniversary programs.
2.2. Promoters
The Sanepa Health Centre is a totally community based Health Centre so the promoters
and donors are local peoples and members. There are 130 monthly and annually donors
for SHC. There are 16 doctors and 7 other health professionals involve in SHC. The
organization donors are Lalitpur Sub- Metropolitan and Lalitpur development
Committee.
Sanepa Health Centre is a community based health centre. It has services which is
targeted to local people who are needy and seek.
The Sanepa Health Centre consists of various dynamic members for its operational work.
Following are the current members of Executive Member of This Sanepa Health Centre.
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President Dr. Achut Mani Achary
Balmukund khanal
Member
Dr. Harihar Khanal
Secretary
Dr.Yosodhara Pradhan
Dr.Tekendra Karki
Rebecca Singa
Bhairab Gorkhali
Nati Maharjan
Table no. 2.
Dr. Toran K.C.
Management
Purna Kumari Shrestha Body
N Sanepa
Sanepa
Health Centre
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Star Hospital
Executive Board
Volunteers Nurses
Peon
Volunteers
Sanepa Health Centre has following Current Health Services and Programs:-
Medical Services
Sanepa Health Centre is an unique organization run by local people for the welfare of
local people. It provides regularity, continuity and trustworthy services with having
motto of organization since its inspection. Services is rendered 360 days out of 365
days into a year. The medical services provided, through, free of cost, is standard and
rendered by qualified doctors and health workers. The medical services is provided
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two hours in the morning from 7:00 AM to 9:AM. A nominal registration fee the Rs.
10.00 and 5.00 is charged for the new and old patients respectively. Registration is
done by local volunteers.
Medical services includes medical treatment ,Immunization, Family Planning etc. The
medical services provided over the years in the expanding scale are in respect of the
diseases relating to children, skin, chest, cancer, gynecological, ear, eye, throat, heart,
dental, and other general medications. Treatment of minor trauma, injection, wound
dressing services, asthma inhalation services and miscellaneous minor problems are
attended by experienced health workers. Specialty clinics fall on the day specialist
come to the clinic. Patan Hospital has been kind to accepts referrals since last ten
years.
Followings are the current weekly Specialty clinic run by the specialist :
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Dr. S. K. Pradhan Dental
Mr. Chatagi.
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Free-Medical Check-ups
Medicine Distributions
Environmental Programs
Social Welfare
Spiritual Programs
Chapter 3
3. Programs
Sanepa Health Centre of Lalitpur district has launched all together 2 programs which are
given below.
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Immunization Program
Family Planning Program
3.1. Expanded Program on Immunization (EPI)
The services area of Sanepa Health Centre is Sanepa Community and its neighboring
community like Balkhu, Teku, Kupondol, Kuleshwor etc.
In Sanepa Health Centre, all infants, children’s and woman of reproductive age are the
target population of this program. This is program is for permanent residents and
temporary population of Sanepa as well as neighboring Community.
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3.1.5. Implementation
Monitoring and evaluation is done after completing the all control program and it is done on the
basis of data collection from different wards. The work done by the health clinic in charge and the
final report is submitted to the Sthaniya Bivag. There was no any routine monitoring and
evaluation of the services by the Sthaniya Bivag. However, sometimes, staffs from Sthaniya
Bivag visit the health post. For the evaluation following indicators are used as follows;
Coverage
Dropout rate
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No. of immunized by polio-1 – No. of immunized by polio-3 X 100
Wastage rate
Monitoring and Evaluation is done through monthly basis. In Sanepa Health Centre there
are three programs. The Program is on 1st and 15th on the every month. In order to
increase the health service in effective and efficient way these major tools, other
monitoring, and evaluating each upgraded in Sanepa through local doctors involvements,
local health professionals, volunteers bodies etc.
3.1.7. Outcomes
3. Programs
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According to National Health Policy 2048, Family Planning Program has been introduced
in order to reduce growing population through different program. National Health Policy
(1991) related to National Reproductive Health and Family Planning (RH/FP)
programmed is to expand and sustain adequate quality family planning services to the
community level through all health facilities, hospitals, primary health centers, health
post, sub-health post. Mobile voluntary surgical contraception (VSC), Contraceptives
measures such as condoms, Pills are distributed from SHC.
The services area of Sanepa Health Centre is Sanepa Community and its neighboring
community like Balkhu, Teku, Kupondol, Kuleshwor etc.
Family Planning program is mainly targeted to married and unmarried individuals and
couples of Sanepa communities and surrounding localities.
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3.2.5. Implementation
In SHC Family Planning are implemented through different programs like Safe
motherhood consultation, Pills, Devo, Condoms distribution.
SHC often organizes awareness program, annual anniversary, Speech focus on
different health problems and family planning.
Availability of doctors in SHC like Gynecologist, Pediatrics, Family Physician etc
o Referral:- In this SHC Condom and Pills are supplied through FCHVS.
While request for other family make informed about regular appropriate
planning method . Family Planning counseling services are provided to
potential client by FP advices. Planning services are referred to the PHC,
Clinics, hospitals or to mobile camps.
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No. of current users of modern FP method
CPR= *100
*100
3.2.7. Outcomes
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ii. It is found that family planning program activities (CPR Rate) in 2063/2064 to
2064/2065 has increased from 4317 to 4524.
Chapter 4
4. Administrations
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4.1. Human Resources/Personnel Management
Human Resources are one of the fundamental to handle any organization for its
effectiveness and efficiency. Therefore Sanepa Health Centre has 17volunteer specialist
Doctors, 6 others Health professionals and 5 local volunteers of Sanepa Community. The
volunteers nurses come from Lalitpur Nursing Campus.
Sanepa Health Centre is one of examples of social health organization so the services
provided by coordination, cooperation and community participation of Sanepa and
surroundings communities. Therefore administrative and medical staffs gives their
services for the motive of social work and satisfaction.T he SHC always welcomed
volunteer personnel from the country.
Followings are the current Specialty clinic run by the specialist Doctors :
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Dr. Tekendra Karki Pediatrician
Health Professionals
Mr. Chatagi.
Volunteers
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Table no.4. Health professional in SHC.
Finance is the main back bone for any organization.Sanepa Health Centre raised their
financial fund through different activities like life long membership, Temporary
membership, donors, promoters, organization , mobile health camps, advertisement
through souvenir , from the rituals speaking programs, lab tests, health services, programs
etc.
Sanepa Health Centre is community based health care organization. So, the finance is
generated from the community peoples, members, Local donors and other organizations.
The Sanepa Health Care centre has various fund raising programs. Among this, the main
financial resources is a donation of the locals in a monthly basis. Its is very small and
ranges from Rs. 51 to 1000 per month per person. The name and photo of these persons
appears in each souvenir every year.
Following are the people who donate in Sanepa Health Centre’s fixed Deposit Fund
(ACHHYA KOSH)
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6. In Memory of Sudha Khetan From Biharilal Khetan 51,000
Total 5,60,782
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Table no.5. Fixed deposit and donor of SHC
Sanepa Health Centre has strong budgetary control. The purpose of such budgetary
control is control of cost and performance appraisal. They make annual audit their
revenue and expenses according to the rules and regulations of the Government of Nepal
. The audited fiscal year 2063/2064 budget is as follows.
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S.N. Revenues Amount S.N. Expenses Amount
4.3.1. Introduction
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Sanepa Health Centre organizes different awareness program, mobile camps, blood
donation program etc. SHC publish annual souvenir about the whole year’s activities.
Sanepa Health Centre organizes annual program with the participation of whole sanepa
community with the different delegates and others. Sanepa Health Centre has close
relation with patan clinic Network. SHC has active involvement in Community Health
Association (CHAL).SHC has health immunization programs on every months date of
1st and 15th day of months. The immunization schedule are polio drop, vitamin A, Family
Planning. Sanepa Health Centre has conducted health camp in following places like
Sindulpalchok, Hatwawada, Thankot etc.
Following are the major outreach clinic organized by Sanepa Health Centre.
Newakot,Kurintar- 2 times
SARRC Camp
4.3.2. Objectives
iv. To raise health awareness of the people of health and to prevent diseases.
4.3.3. Goal
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• To Organize Mobile health camp in Sanepa Commuity.
MIS is a generic term that refers to custom designed systems that gather, store, and report
data to and make it retrievably by users. The purpose is to “help the healthcare
professionals plan, execute and control the organization activities.
Following are the Information Management System found in Sanepa Health Centre.
Chapter 5
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5.1. Analysis
The Sanepa Health Centre is our practical place and Sanepa Community is our practical
area. During our visit we analyze all programs and activities of SHC.
This figure shows that in SHC immunization coverage is increasing each year. The reason
may be population increase in community and immunization program conducted by SHC.
Baisakh 1 12 12 8 33
Jestha 8 20 18 15 61
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Ashad 3 19 18 7 47
Shrawan 4 13 16 3 36
Bhadra 4 22 20 8 54
Ahswin 3 14 13 2 31
Kartik 1 16 16 13 46
Mansir 4 19 16 6 45
Poush 3 15 16 5 39
Marg 1 15 15 9 40
Falgun 1 10 12 8 31
Chaitra 1 11 11 7 30
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Fig. no.5. Graphical Representation of Monthly Coverage of Vaccination in 2063
This figure shows that in month of Jestha the Vaccination Coverage has maximum .
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Baisakh 7 11 1 9 28
Jestha 3 19 19 6 47
Ashad 3 22 18 3 46
Shrawan 2 13 11 13 39
Bhadra 2 26 22 6 56
Ahswin 1 19 19 5 44
Kartik 6 12 13 6 37
Mansir 5 7 8 10 30
Poush 4 22 16 12 54
Marg 3 19 19 6 47
Falgun 2 20 18 12 52
Chaitra 1 17 17 9 44
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Fig. no.6. Graphical Representation of Monthly Coverage of Vaccination in 2064
This figure shows Vaaccination coverage in FY 23064, here in month Bhadra and Poush
month has maximum coverage.
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Fig No.7. Family Planning Coverage in FY 2061 to 2065
This figure shows that each year Family Planning Coverage is in increasing . The reason
is Family Planning awareness in community. The use of Contraceptive is increasing .
5.2. Findings
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i. SHC launches various programs like Immunization, Family Planning and Safe
Motherhood Awareness Program, Social-Cultural programs, Medical Services like
Gyanecology, Cardiology, Dental, ENT, General Physician, Surgery Consultation,
Oncology, Orthopedics, Diagnostic Services (Laboratory, USG,ECG ) etc in
Sanepa Community.
ii. Services are free of cost along with free medicine distribution to needy and poor
people.
iii. It is found that patients flow in immunization 063/064 has increased in
2064/2065.
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Chapter 6
6. Conclusion
Sanepa Health Centre is the one of the examples of the community health centre. The
services given at SHC is the honest social work and cooperation of local doctors and
other health professionals. It is independent health centre which is run by local doctors,
promoters, organizations, local donors, volunteers, health assistant, Nurses etc .Moreover
the services is free of cost for the needy and poor people along with free medicine also.
The SHC is providing services like General physician, Cardiology, Gynecology, ENT,
Orthopedics, chest , Oncology, Dental, Pediatrics, Dermatology, programs like Family
Planning, Immunization (BCG, DPT, Polio, Measles). It has seems that SHC has crossed
20 years journey of service providing with cooperation and coordination and community
participation of local members doctors , members, promoters, donors ,and volunteers.
Here program activities are launched every month that is 1st and 15th of each month. Here
all staffs and staffing pattern is almost by volunteering and social work motives.SHC has
recording and reporting system by manually. SHC usually celebrates its anniversary in
Baisakha Month and publishes its souvenir.
SWOT analysis of the SHC are as. Strength aspect is that SHC is independent health
Center which is running since 20 years so we can say Public relation with SHC and
Sanepa community is good. SHC raises fund on their own effort and give services to poor
and needy person. Weakness of SHC is that proper planning and its implementation is
lacking. There is not target of any program and its achievement. Opportunities of SHC is
that SHC can Progress and change into Hospital in near future. Threat of SHC is that this
organization is running under financial scarce. The data shows that SHC expenses is high
than revenue so management should adopt strategy to maximize revenue.
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REFERENCES:
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