ESSENTIAL HELATH CARE SERVICES
POPULATION AND FAMILY PLANING
Over three-quarters of modern contraceptive methods are dispensed free of cost by the public sector, although non-Government sources supply 70% of the condoms, half of the contraceptive pills, 40% of the implants, and conduct 40% of voluntary surgical contraception (VSC).
NGSP-2 aims to raise the CPR by increasing BBC activities; micro-planning to target pockets of low use and unmet demand; ensuring all public health facilities offer at least 5 methods, and that district hospitals offer VSC all year; integrating family planning advice in other services to ensure that opportunities to offer timely family planning advice are fully utilized; and continuing public-private partnerships (PPP) to increase the availability of family planning services and supplies.
There will be a further increase in the coverage of the safe motherhood programme. Community services delivered by female community health volunteers (FCHVs) will be scaled up, leading to further demand creating for institutional delivery. Facilities should have adequate budget provision to enable them to respond. Access to BEOC/ CEOC facilities will continue to be extended and the programme planned in coordination with the training and deployment of staff teams to ensure that all of the requirements for CEOC are met. An ambitious SBA training strategy will be implemented, training 5,000 by 2012, and reaching full coverage (7,000) by 2015. Birthing units will be added to SHPs. Safe abortion services will be extended in remote areas based on the 6-district pilot, including medical abortion.
Child Health and Mother and Child Nutrition
Sustaining community-based Integrated Management of Childhood Illness (CB-IMCI) in all districts and maintaining and further strengthening immunization coverage remain high priorities. Further reductions in in under-five and infant mortality will be accomplished by scaling up community-based newborn care and by implementing a more comprehensive nutrition programme-a major focus NHSP-2.
Communicable Disease Control
Existing communicable disease programmes will be maintained. The Ministry will introduce an integrated disease surveillance policy and guidelines to monitor existing and new threats, such as new viruses and the impact of climate on the geographical spread of vector-born diseases, as well as strengthen the capacity of public health laboratories. The Ministry will aim to eliminate or significantly reduce three neglected tropical diseases-lymphatic filariasis, soil-transmitted helminthes, and trachoma-that are responsible for high levels of morbidity but which are readily treatable.
Non-Communicable Diseases (NCDs) and Injuries
NCDs are now responsible for more than 44% of deaths and 80% of outpatient contacts. The main response will be to expand the prevention effort through BCC to encourage healthy lifestyles. The multi-disciplinary effort will also support BCC and consider regulation and taxation measures to, for example, encourage the use of seatbelts and helmets, and discourage smoking. As a response to the growing burden of road traffic accidents, emergency capacity will be strengthened in facilities near to major highways.
As recommended by WHO, and reflecting the high incidence associated with the legacy of conflict and gender-based and domestic violence, mental health services will be added to the EHCS package. There has been a dramatic increase in suicides among women of reproductive age such that it is now the leading single cause of death. The Ministry will integrate mental health within existing and future health and social programmes; develop a low-cast and sustainable district system to provide mental health promotion, prevention and treatment; improve the quality of mental health data from the Health Monitoring Information System (HMIS) and census data; and appoint a focal person for mental health within the Ministry.
Eye, Oral and Environment Health
In collaboration with not-state actors, the Ministry will add promotional and preventive eye care. Promotional and preventive oral health care will be introduced and scaled up in schools, and improved water, air quality, sanitation, hygiene, and waste disposal will be promoted with the assistance of other ministries and non-state actors.
The extension of free services in 2007-8 resulted in a 35% increase in OPD contacts. OPD contact nevertheless remain relatively low at about 1 per capita, excluding consultants with pharmacists. The Ministry presently makes available some limited support to meet catastrophic health costs requiring referral. The referral system will be strengthened, and support will be available for referral to non-state hospitals, which have over 66% of hospitals beds.