CB-IMCI Programme

Integrated Management of Childhood Illness (IMCI) is a WHO/UNICEF developed approach to reduce mortality and morbidity associated with five major childhood illnesses such as diarrhea, ARI, measles, malnutrition and malaria, which account for about 70% of child deaths in developing countries.

Community Based Integrated Management of Childhood Illness (CB-IMCI) program in Nepal developed through the years with preceding programs such as Control of Diarrheal Disease (CDD) program initiated in 1982 and Acute Respiratory (ARI) Program initiated in 1987. Emphasis on community level involvement in Nepal started with ARI strengthening program in 1995 and for CDD in 1996. This program was commonly known as CBAC (Community Based ARI and CDD) program. The IMCI program, with its emphasis on detecting and managing multiple illness in children, was implemented in Nepal in 1997.

Initially there was a great concern over the CB-IMCI program allowing FCHVs to learn to treat pneumonia in children with antibiotics because a majority of the FCHVs could not read or write. A working group of child health professionals recommend further research to test whether FCHVs should treat pneumonia in children with Cotrimoxazole or refer cases of pneumonia to the health facility. An evaluation of this program in the four initial districts, conducted with technical support from WHO in 1997, found that FCHVs are able to deliver quality pneumonia assessment and management in the community. Additionally, in the “treatment” districts twice as many children at risk from pneumonia were identified and treated as compared to the “referral” districts.

In the CB-IMCI implemented districts, there is an increase in detection and treatment of pneumonia and correct management of diarrhea. This increase in coverage is mostly attributed to community health workers and especially the FCHVs treating and managing over half the diarrhea and ARI/pneumonia cases. 

National Immunization Programme

National Immunization Programme (NIP) is the priority program of Child Health Division and is believed to be one of the successful public health interventions of Nepal. Currently eleven antigens are provided through the routine immunization under National Immunization programme of Nepal. 

World Health Organization had initiated a program called Expanded Program on Immunization (EPI) in 1974 and many countries started implementing EPI. Expanded program on Immunization (EPI) including BCG, and DPT vaccines in Nepal started in Nepal in 1979 in three districts. However, EPI including BCG, DPT, oral polio vaccine, and Measles was expanded to all 75 districts by 1989 only. Since then, Government of Nepal is providing free immunization services to everyone regardless of their gender, socioeconomic strata without any discrimination. It is one of the accessible services of Nepal and has reached to 97% of the total population. Nepal is believed to be one of the countries recognized for the well functioning immunization system. This is also considered as the most cost effective public health programme.

The Comprehensive Multi Year Plan (cYMP), which is a 5-year plan of action, governs the National Immunization Programme (NIP) of Nepal. NIP is also guided by NHSP II, which focuses on increasing access and utilization of essential health care services to reduce disparities and considers Immunization as a package of free essential health care services. CHD leads all immunization related activities and each district is responsible for the immunization coverage of that particular district.

Goal of CMYP (comprehensive multi year plan 2011-2016)

• To reduce child, mortality, morbidity and disability associated with vaccine preventable diseases.

Objectives and Strategies of CMYP

Objective 1: Achieve and maintain at least 90% vaccination coverage for all antigens at national and district level by 2016

Key strategies:

• Increase access and utilization to vaccination by implementing (Reaching every district) RED strategies in every district 
• Enhance human resources capacity for immunization management
• Strengthen immunization monitoring system at all levels
• Strengthen communication, social mobilization, and advocacy activities
• Strengthen immunization services in the municipalities

Objective 2: Ensure access to vaccines of assured quality and with appropriate waste management

Key strategies:

• Strengthen the vaccine management system at all levels

Objective 3: Achieve and maintain polio free status

Key strategies:

• Achieve and maintain high immunity levels against Polio by strengthening routine immunization and conducting high quality national polio immunization campaigns.
• Respond adequately and timely to outbreak of poliomyelitis with appropriate vaccine.
• Achieve and maintain certification standard AFP surveillance.

Objective 4: Maintain maternal and neonatal tetanus elimination status

Key strategies:

•  Achieve and maintain at least >80% TT2+ coverage for pregnant women in every districts
• Conduct Td follow up campaigns in high risk districts
• Expand school based immunization program
• Continue surveillance of NT

Objective 5: Initiate measles elimination

Key strategies:

• Achieve and sustain high population immunity to reduce measles incidence to elimination level.
• Investigate all suspected measles like outbreaks with program response
• Use platform of measles elimination for Rubella / CRS control
•       Continue case-based measles surveillance

Objective 6: Accelerate control of vaccine-preventable diseases through introduction of new and underused vaccines

Key strategies:

• Introduction of new and under-used vaccines (rubella, pneumococcal, typhoid, rota) based on disease burden and financial sustainability

Objective 7: Strengthen and expand VPD surveillance

Key strategies:

• Expand VPD surveillance to include vaccine preventable diseases of public health concern.
• Strengthen and expand laboratory support for surveillance.

Objective 8: Continue to expand immunization beyond infancy

Key strategies:

• Consider for booster dose of currently used antigen based on evidence and protection of adult from potential VPDs.

The current National Immunization activities are guided by those strategies to meet the objectives set in comprehensive multi-year plan of Nepal.

Achievement till this date

Immunization services are provided free of cost through EPI clinics in hosptials, other health centres, mobile and outreach clinics, Non governmental organizations, private clinics. The government supplies all vaccines and immunization related logistics to these private institutions free of cost. All vaccines under National Immunization Programme are given free of cost to those private clinics, Nursing homes. 

Nepal has attained polio free status in 27th March 2014, sustained maternal and neonatal tetanus elimination since 2005, and Japanese encephalitis is in control status and conducting measles case based surveillance to meet the target of elimination by 2019.

In the fiscal year 2071/72, The national coverage of BCG is the highest of all antigens indicating almost 99% coverage, while DPT‐HepB‐Hib and OPV‐ 3 coverage are more than 91%. The measles/rubella vaccine coverage is 88% and Td2+ coverage (Td2 and Td2+) coverage is 75%. The JE coverage (31 districts) is 75%.

Objectives of LCD

• To sustain elimination of leprosy (Prevalence Rate below 1 per 10,000 population) and further reduce disease burden.
• To reduce disability due to leprosy.
• To provide high quality service for all persons affected by leprosy through integrated set-up.
• To eliminate stigma /discrimination against persons and families affected by leprosy.