This document summarizes the program, progress and achievements of Logistic …dohslmd.gov.np/web/uploads/source/health logistic report... · 2020. 9. 6. · This document summarizes

This document summarizes the program, progress and achievements of Logistic Management Section for the periods 2074/75 to 2075/76 and major half yearly progress of FY 2076/77 &

brief logistic management report of COVID-19.

ADRA Adventist Development and Relief AgencyAPP Annual Procurement PlanAPR Actual Procurement RateASL Authorized Stock LevelBCG Bacille Calmette GuerinBoQ Bill of QuantityBHL Basic Health LogisticsBHS Basic Health ServicesCAPP Consolidated Procurement PlanCAO Chief Administrative OfficerCBS Central Bidding SystemCSD Curative Service DivisionCER Cost Estimate RatesCMC CAPP Monitoring CommitteeCMS Central Medical StoresCOVID Corona Virus Infectious DiseaseCS Catalogue ShoppingDDA Department of Drug AdministrationDFID Department of International Development, UKDG Director GeneralDHIS District Health Information SystemDP Direct PurchaseDPT Diphtheria, Pertussis, and TetanusDoHS Department of Health Servicese-GP electronic Government ProcurementEDCD Epidemiology and Disease Control DivisionEDL Essential Drug ListEDP External Development PartnerEOP Emergency Order PointEPI Expanded Programme of ImmunizationEVM Effective Vaccine MonitoringFA Framework ArrangementFASP Forecasting and Supply PlanFCGO Finance Controller General OfficeFED Free Essential DrugFEFO First Expire First OutFP/RH Family Planning and Reproductive Health FWD Family Welfare Division FPAN Family Planning Association of NepalFY Fiscal Year GAVI The Global Alliance for VaccineGHRM Grievance Handling and Redressal MechanismGHSC-PSM Global Health Supply Chain – Procurement and Supply Chain ManagementGHRM Grievance Handling and Redressal MechanismGIZ Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbHGoN Government of Nepal

ACRONYMS

HF Health FacilityHI Health InspectionHMIS Health Management Information SystemHSP Health Service ProviderHP Health PostHR Human ResourcesHO Health Office ICB International Competitive BiddingICT Information and Communication TechnologyIFB Invitation for BiddingINGO International Non-Government OrganizationIUCD Intra Uterine Contraceptive DeviceIMS Information Management SystemJE Japanese Encephalitis KPI Key Performance IndicatorsLARC Long Acting Reversible ContraceptionLLG Local Level GovernmentLMD Logistics Management DivisionLMIS Logistics Management Information SystemLMS Logistics Management SectionLWG Logistics Working GroupMCH Maternal and Child Health MD Management DivisionMDVP Multi Dose Vial PolicyM&E Monitoring and EvaluationMDAC Ministerial Development Action CommitteeMNCH Maternal Neonatal and Child Health MoHP Ministry of Health and PopulationMoSD Ministry of Social DevelopmentMoSoH Month of Stock on HandMPP Master Procurement PlanMR Measles and Rubella MRP Maximum Retail PriceMYP Multi-Year ProcurementMSI Marie Stopes InternationalNCASC National Center for AIDS and STD ControlNCB National Competitive BiddingNGO Non-Government OrganizationNHP National Health Programme NHEICC National Health Education, Information and Communication CentreNHTC National Health Training CenterNPHL National Public Health LaboratoryNTC National Tuberculosis CenterNIP National Immunization ProgrammeNHSSP Nepal Health Sector Support ProgrammeOPV Oral Polio VaccinePCV Pneumococcal Conjugate VaccinePHCT Provincial Health Coordination Team

PHAMED Public Health Administration Monitoring and Evaluation DivisionPHD Province Health DirectoratePHLMC Province Health Logistics Management CentrePIP Procurement Improvement PlanPPA Public Procurement ActPPS Public Procurement SystemPSCM Procurement and Supply Chain ManagementPPSF Public Procurement Strategic FrameworkPPMO Public Procurement Monitoring OfficePPR Public Procurement RegulationPHCC Primary Health Care CenterPHD Provincial Health DirectoratePHLMC Provincial Health Logistic Management CenterRDQA Routine Data Quality AssessmentSBD Standard Bidding DocumentSC Supply ChainSCMWG Supply Chain Management Working GroupSDP Service Delivery PointSoH Stock on HandSQ Sealed Quotation MethodPHTC Province Health Training CenterSCI Save the Children InternationalSCM Supply Chain ManagementSDG Sustainable Development GoalSDP Service Delivery PointSNG Sub National Government SOP Standard Operating ProcedureToR Terms of ReferencesToT Training of TrainersTSB Technical Specification BankTTF Thematic Trust FundsUAT User Acceptance TestsUNFPA United Nations Population FundUNICEF United Nations Children’s FundUSAID United States Agency for International DevelopmentVFM Value for MoneyWHO World Health Organization

TABLE OF CONTENTSEXECUTIVE SUMMARYCHAPTER 1 INTRODUCTION 1. Background 2. Strategic Procurement 3. Logistics Cycle 4. Six Rights of Logistics 5. Quality Assurance Mechanism

CHAPTER 2 ORGANIZATIONAL STRUCTURE Federal Level 1. Organogram of logistics management section 2 Scope of Work and ToR of Management Division and Logistic Management Section Province Level 3. Provincial Health Logistics Management Centers (PHLMC) 4. Local Level 5. Logistic Management functions at different level

CHAPTER 3 MAJOR LOGISTICS ACTIVITIESA. Procurement

1. Strengthening Pre-bid Information Systems 1.1. Technical Specification Bank 1.2. Technical Specification Bank (TSB) Steps and Reports 1.3. Cost Estimation Practices 1.4. Quantification and forecasting 1.5. Quarterly Pipeline Monitoring 2. Standard Procurement Planning 2.1. CAPP Initiatives 2.2. Procurement Modality Analysis 2.3. Procurement Type Usage 2.4. Segregation of Categories Used3. Standardization of Procurement Process 3.1. Usage of Standard Bidding Documents 3.2. Solicitation Periods 3.3. Bid Evaluation and Approval 3.4. ICT Initiatives in Solicitation of Bid 3.5. Contract Management4. Other Initiatives 4.1. Grievance Handling Mechanism 4.2. Supplier’s Conference 4.3. Market Analysis of Pharmaceuticals

B. Supply Chain Management 1 Storage, Distribution and Inventory Management1.1 Storage Guideline (13 Points)1.2 Important Terms Used in Supply Chain Management

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3131313132333436363637373838383839394040404040

41414141

C. Logistic Management Information System (LMIS) 1. Quarterly LMIS Reporting and Scheduling2. LMIS Activities3. Electronics Logistics Management Information System (eLMIS)

I. eLMIS Implementation Expected Outcomes II. eLMIS Implementation Requirements III. eLMIS Intervention and Current Sites IV. eLMIS Implementation V. eLMIS Implementation Assessment and Adjustments Based on Lesson Learn VI. COVID-19 Items Incorporated and eLMIS Reporting Tools VII. eLMIS Scale-up Plan Approved and Rollout Team Mobilization VIII. Data Governance

4. Online Information Management System (IMS) Support 5. Routine Data Quality Assessment (RDQA)

D. Effective Vaccine Management I. Goal II. Objectives of Cold chain and Vaccine Management III. CMYP IV. Vaccines

V. Cold Chain Equipments for Storage and Transportation VI. Progress and Activities VII. Wastage Rate of Vaccines-HMIS VIII. Repair and Maintenance Status of Cold Chain Equipments

E. Repair and Maintenance of Biomedical EquipmentsF. Expired Drugs ManagementG. Supply Chain Management Working Group (SCMWG)

CHAPTER 4 CAPACITY BUILDING AND SYSTEM ENHANCEMENT 1. Capacity Building: Provincial and Local level Training on BHL and PPS

1.1 Capacity Building for Procurement I. Workshop, Training and Technical Support II. Procurement Clinic III. Monitoring Management through Committee Approach

2. Basic Health Logistics and Public Procurement System Training Manual I. Training of Trainers (TOT) on BHL and PPS II. Training on Existing Package in 2075 III. Training Package Revision in 2075 IV. TOT on BHL and PPS Package Revised in 2075 V. TOT on BHL and PPS Package Revised in 2076 VI. Capacity Strengthening on BHL and PPS at Local and HF Level in 2075 VII. Capacity Strengthening on BHL at HF level

3. LMIS tools updated 4. New Ma. Le. Pa Forms and Formats 5. Capacity Development on eLMIS Implementation (Journey)

I. Software Customization II. Master Data Finalization

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494949494949495252

535455

60606060606161616262626263646667676767

III. eLMIS Familiarization Workshop IV. eLMIS Training Curriculum Finalization V. Training of Trainers (ToT) on eLMIS VI. User Acceptance Tests (UAT) on eLMIS VII. User’s Group Training VIII. Develop Support Mechanism and Helpdesk IX. eLMIS Standard Operating Procedures X. Software Updates XI. eLMIS monitoring and data utility for decision making XII. eLMIS operational monitoring XIII. eLMIS implementation assessment and adjustments based on lesson learnt XIV. eLMIS review workshop

CHAPTER 5 TRENDS OF LOGISTICS INDICATOR 1. Procurement and Supply Chain Management of Commodities in Federal Context 2. Availability of Key Commodities 3. Reporting Status

CHAPTER 6 PLANNING, MONITORING AND EVALUATION 1. Major activities conducted 2. Budget Contribution in Red Book3. EVM Activity4. PHLMC progress 5. COVID-19 Logistics Management Activities 6. Issues in Logistic Management 7. Nepal health sector strategy 2015-2020, output and key intervention for procurement and supply chain management 8. DLI Indicators Related to PSCM CHAPTER 7 CASE STORY

CHAPTER 8 MONITORING/SUPERVISION/WORKSHOP/SEMINAR

CHAPTER 9 PARTNER CONTRIBUTION FOR LOGISTICS MANAGEMENT

BIBLIOGRAPHY

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100106110113119121129135136142149150153158176177

ANNEXES 1. COVID-19 Logistics information 2. eLMIS Piloting and Scale-up Live Sites3. Procurement Status FY 2076/774. Disbursement linked Indicator (DLI Target Vs Progress) 5. Available Cold Chain Equipment 6. Expired Medicines List7. Biomedical Equipments Maintenance8. Gazzete Notice for Drug Price9. Store Management Instruction (13 Points)10. Greivance Handling and Readdressal Mechanism Report11. Auctioning Report12. Guidelines for use of PPE13. Procurement on Special Condition - PPA 2063 (2007)14. FY 2077/78 Activities and Budget : Management Division 15. FY 2077/78 Activities and Budget : Province and Local Level16. ToR of MD Sections 17. Picture Gallery

HEALTH LOGISTICS REPORT

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EXECUTIVE SUMMARYStrong Logistics Management System is crucial for quality health services. No commodities No Program is starting slogan with availability of quality medicines, health commodities round the year is the major part to achieve logistics goals and objectives in health service delivery System. To meet this motto Logistics Management Division (LMD) was established in FY 2051/52 (AD 1994) under the Department of Health Services (DoHS). Logistic Management Section (LMS) is responsible for logistic management after federalism with revised structure role and responsibilities.

LMS has procurement, storage, cold chain, vaccine management and supply units as well as functional logistic management information resource center. Major role of LMS is to forecast, quantify, procure, store, distribute/transport of program commodities, e.g. essential medicines, vaccines, Family Planning and Reproductive Health (FP/RH) Commodities, biomedical equipment’s including procurement and distribution of transportation vehicles, ambulances, refrigerator van and proper disposal and auctioning of de-junking of commodities, equipment’s, furniture etc. Maintenance of biomedical equipment’s, transport vehicle and construction of Central, Provincial, District and local level warehouses are also an important function under logistic system for this we have to coordinate with other section as well.

Supply chain management is based on information i.e. Logistic Management Information System (LMIS). LMIS is vital function and quarterly reporting system which is compiled and analyzed by concerned authorities of all the levels of government. LMIS is functioning at Health Post (HP), Primary Health Care Center (PHCC), primary and secondary hospitals and it needs to be expanded up to all health facilities including tertiary hospitals. Currently COVID-19 logistics management information system has been initiated in federal and provincial hospitals and it should be strengthened in wider scale for all the commodities and biomedical equipment.

It is extremely important to have quality drug, vaccine, commodities and biomedical equipment management for quality health services. As per constitution of Nepal and its functional analysis logistics functions are primarily accomplished by local level government, as well as provincial health logistics management center has been established in 6 provinces, in karnali province they have revised organogram with logistics section in Provincial Health Directorate.

Major functions at federal level are policy, planning, act, rule, regulation, standards, facilitations to provincial and local level, guidelines and management of Vaccines, Commodities, buffer stock, program items including campaign and emergency health logistics management in case of health emergency and disaster.As of these two fiscal years’ review, Logistic Division Section has made significant contribution in terms of procurement planning, strengthening storage capacity as well as human resource capacity development in the context of federalism:

• LMS has developed and approved standard technical specifications of medical equipment, medicines, vaccines, surgical consumables and contraceptives; and published it in the Technical Specification Bank (TSB). Thus, as of date there are 121 technical specifications of pharmaceuticals and 1109 specifications of medical equipment are available at the TSB

• Supply Chain Working Group has been formed and functional at both federal and provincial level.

• Annual Procurement Plan (APP) and Consolidated Procurement Plan (CAPP): APP and CAPP is maintained in consultation with division and center of DoHS.

• LMS/MD developed the forecasting and supply plan guidebook and workbook


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This report is a compilation of information about health logistics activities that includes brief background, policies, strategies, coverage, achievements and pertaining issues. It includes two fiscal years and half yearly major outputs of this fiscal year as well as Covid-19 logistic information up to Jestha 2077, this report includes added information on cold-chain and biomedical equipment’s, expiry of medicine, rate list of some drugs and some information about PHLMCs and LLGs. In summary, following are the key activities and achievements:

• Consensus Forecasting 2076/77 was carried out with national quantification of program drugs and EPI vaccines for the FY 2076/77 (2019/2020).

• The standard time taken for Bid Evaluation and Approval in FY 2074/75 (2018/19) reduced to average 41 days in ICB and average 31 days in NCB, which shows improvement from the previous period. ie. 45 days and

• LMD/DoHS is improving the use of ICT in bid proceedings since FY 2071/72 (2014/15). In FY 2072/73 (2016/17) LMS has used almost all bids (99.43%) through eGP I.

• To ensure Health Systems competency in delivering the required LMIS functions, a total of 121 health staff received Training of Trainers (TOT) on Basic Health Logistics and Public Procurement System, 591 participants attended municipality level training and 636 participants attended health facility level training on basic logistics.

• The training of 24 eLMIS master trainers were produced on Falgun 2074 as a cadre of government trainers from DoHS; LMD

• Training Manual Revision to adopt in the revised context of federalism, Capacity strengthening on basic logistics to HSPs at Municipalities and health facilities, and Capacity development on LMIS and eLMIS review workshops.

• eLMIS implemented and scaled up in in all provincial and central warehouses and up to Palika level in Province 5 and Karnali Province.

Logistics Management Information System (LMIS) is core component of overall logistics management. This is high time to implement electronic Logistics Management Information System (eLMIS) in all level of government and health institutions to get real time data on Logistics Management. Now, LMS is going to rollout and implement eLMIS to all institution accordingly eLMIS scale-up plan approved on 2077/02/01 by MoHP (Secretary level Decision) and roll out plan is approved by DoHS on Jestha 8, 2077. Now, LMS rollout and implement eLMIS to all institution as per the approved plan. Hope gaps on planning because of data error and unavailability will be solved by real time logistics information system of eLMIS.

Despite these achievements, there are some issues to be addressed, such evidence-based planning based on real time logistics information. Procurement, storage, timely supply and quality assurance are major areas in logistics management. Stock out of FP and MNH commodities has been persistently reported over the period of years, which needs to be addressed. Hence, Logistics Management System strengthening should be a priority for quality health services.

Area of eLMIS is broad in the context of Covid-19 also there was immediate need of realtime data of logistics which was a challenge as well as an opportunity so in this context we have started in hospital & province as well as in some palika. For the effective LMIS system we need resource including appropriate H.R. at all level.


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1. BACKGROUNDNepal is a federal democratic republic country with 3 tier of governments - Federal Government, Provincial Governments (7), and Local Government (753). The constitution has mentioned basic health and sanitation as citizen’s fundamental right. The Health System of Nepal is based on Universal Health Coverage, in the federal context, Ministry of Health and Population (MoHP) has three Departments namely Department of Health Services, Department of Ayurveda, Department of Drug Administration. MoHP has developed health policy 2076 with high priority for Universal Health Coverage. In the new structure of MoHP from FY 2075/76, there are 5 Divisions and 5 Centers under the Department of Health Services. Among them one of the Division is Management Division.

Management Division (MD) was established under the Department of Health Services (DoHS), MoHP in 2050/51 (1993) as Logistic Management Division (LMD) with a network of central and five regional medical stores, and seventy-five district level stores for strengthening supply chain management with evidence based decision making using the analysis of Logistics Management Information System(LMIS) data and Inventory Management System. In the federal context logistic management section in DoHS, 6 Provincial Health Logistic Management Center (PHLMC) one logistic management section in Karnali province,77 Health Office, 753 Local Government (Health Unit) and 6934 Service Delivery Points are functioning for health service delivery. Logistics function is to ensure a regular supply of medicines, equipment, and vaccines for the effective operation of health services in consultation with all health agencies and institutions.

The Logistic Management Section is responsible overall logistic management of department & vaccine, commodity management at national level. The Terms of References (ToR) of MD is responsible for logistic management, the focal point for information management, planning, coordination, supervision, and the monitoring and evaluation of health programmes. This section is also responsible for monitoring the quality of air, water and food products. It also monitors the construction and maintenance of public health institution buildings and supports the maintenance of medical equipment. More activities assigned to this division include including policy and planning related to health infrastructure and logistics management.

A key prerequisite for achieving significant improvements in health sector procurement is to have sustained high-level integrity leadership to create the accountability that will motivate various agencies to achieve the results for which they are responsible. The Ministry of Health and Population (MoHP), working closely with the Ministry of Finance, public procurement management office (PPMO) is well placed to create that inter/intra-ministerial accountability to coordinate the health sector procurement plan and programmes.

CHAPTER 1INTRODUCTION


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The goal of the LMD restructuring is 'to improve efficiency and effectiveness in the health sector procurement, distribution, quality assurance, management of drugs and equipment & services to ensure value for money in the context of federalism. The outcomes of the LMD restructuring are to:

• Ownership at province and local level• Strengthen health sector procurement.• Improve supply-chain management to put in place.• Strengthen effective partnership mechanism• Institutionalize the internal control system to reduce fiduciary risks in procurement and rational

distribution.The logistics management contributes directly towards achieving the goals envisioned in the National Health Policy 2076. The NHP 2076 aspires to provide Universal health coverage (including prevention, promotion, treatment, rehabilitation and palliative care) for all Nepalese citizens. In addition, it has a key role towards the attainment of Public health act 2018, for ensuring availability of the basic health services (BHS) to all citizens, as well as the Safe Motherhood and Reproductive Health Rights Act 2018 which guarantees universal access of RH services including commodities to all women and girls in Need.

The 15th Five Year Development Plan (2019/20-2023/24) of Government of Nepal highlights the important aspects of logistic management pertaining to: Regulation of production, import, storage, distribution and utilization of medical equipment's, drugs and supplies; and Increase use of evidence-based decision making by strengthening health information system.

GoalQuality health commodities available at health facilities and community level round the year.

Overall ObjectiveTo plan and carry out the logistics activities for the uninterrupted supply of essential medicines, vaccines, contraceptives, equipment, HMIS/LMIS forms and allied commodities (including repair and maintenance of bio-medical equipment) for the efficient delivery of healthcare services from the health institutions of government of Nepal in the country.

Procurement and supply chain system ensures that essential products, necessary for program success and must be consistently available to customer. Public health program is linked directly to an effective and efficient supply chain Management. Modern supply chain management focuses more on people than goods. It is the people who make supply chain work and the customers who are served by the supply chain. Therefore, the goal of the Health Logistics System is to make available quality health commodities at health facilities and community level round the year.

2. STRATEGIC PROCUREMENTStrategic procurement is a systematic and fact-based approach for optimizing logistic management in improving the overall value proposition. Within logistic management section there is procurement unit; Logistic management section is in constant communication and coordination starting from consensus forecasting, quantification, and preparation of annual procurement plan with other divisions and centers. Every quarter, the status of procurement, supply schedule is reviewed in a pipeline meeting. LMS often time holds meeting with vendors to improve procurement. Thus, the strategic procurement is directed toward:


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• Value for money• Better service delivery• Improve the quality of goods and services• Increased profits• Good governance• Economic development

Objectives• To promote efficiency in Logistic Management • To ensure system is a fair, transparent and non-discriminatory manner to obtain Value for

money• To ensure timely procurement and supply of essential medicines, vaccines, contraceptives,

equipment, HMIS/LMIS forms and allied commodities uninterrupted (including coordination for repair and maintenance of bio-medical equipment) in equitable manner.

Strategies• Logistics planning for procurement, storage and distribution of essential health care

commodities.• Introduce effective and efficient procurement mechanisms like Multi-Year Procurement (MYP),

Central Bidding System (CBS) for programme items and E-Bidding.• Use of LMIS information in the decision making at all levels.• Strengthen physical facilities at the central, provincial, district and local level governments for

the storage and distribution of health commodities.• Promote web based LMIS and equipment/expendable items inventory system in local level

government and province.• Repair and maintenance of bio-medical equipment, instruments, cold-store and transportation

vehicles.• Capacity building and enhancement of human resources on logistics management at all levels.• Implement and facilitate for effective logistic management at all level and effective pull

system for year-round availability of Essential Drugs, Vaccines and other health commodities at all levels (Federal, Provincial, and Local Level Governments).

3. LOGISTICS CYCLE

LMISPipeline Monitoring

Organization & StaffingBudgeting Supervision

Evaluation

ServingCustomers

POLICY

ADAPTABILITY

Quantification&

Procurement

InventoryManagement

Storage &Distribution

ProductSelection

Qua

lity M

onitoring Quality MonitoringQ

uality MonitoringQuality Monito

ring


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KEY DEFINITIONSSupply chain: refers to flow of products, services, resources, and information that ultimately fulfill customer’s requestSupply chain management is the process of managing and coordinating flows of goods, services, information, and resources from the source to end-users.Logistics management: refers to management of what happens within an organization while purchasing and delivering products/materials from suppliers to end-usersLogistics cycle: shows how the different components of health supply chain systems are interdependent Product Selection: Product selection is done based on the Essential Drug List (EDL) and standard treatment guidelines Quantification: Quantification is the process of estimating quantities and costs of health products and determining when they should be delivered to ensure an uninterrupted supply. Procurement: Procurement is a critical function within the supply chain that ensures health products are purchased and made available to customers as planned.Inventory Management: After products have been procured and received, they must be stored until needed. The inventory manager is responsible for overseeing product storage in service delivery points before and after distribution. Storage and distribution: Proper storage and distribution are needed to ensure product reach the end-users without their quality being compromised.Serving customers: The logistics system is designed to optimize customer service. Each person who works in logistics must remember that he or she selects, procures, stores, or distributes products to meet customer needs. Logistics management information system (LMIS): A logistics management information system (LMIS) is a system of records and reports, whether paper-based or electronic, used to aggregate, analyze, validate, and display data from all levels of the logistics system. This is also known as the heart of logistics cycleOther activities at the heart of the logistics cycle: Other activities that help to drive or support the logistics cycle include organization and staffing/supply chain workforce, budget/financing, supervision, and monitoring and evaluation/performance management and risk management. Policy and Legislation: These are government regulations and procedures which affect all elements of a logistics system. Adaptability: The adaptability of the logistics system is the ability to obtain resources needed to address increase in demand. Quality monitoring: It is important to understand the role of quality monitoring in ensuring an efficient and effective logistics system. Quality monitoring refers not only to the quality of the product, but also to the quality of service. Quality monitoring should be four times as following:

▸ Between product selection and quantification and procurement to emphasize why quality monitoring is important role in selection quantifying and procuring the right products.

▸ Between quantification and procurement and inventory management to ensure quality of health commodities during distribution and at the time of receipt.

▸ Between inventory management and serving customers to ensure quality is maintained during storage and when patient receive them for use.

▸ Between serving customers and product selection to determine if customers are satisfied with quality of both products and service they received.


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4. SIX RIGHTS OF LOGISTICS

SIX RIGHTS OF

LOGISTICS

THE RIGHTGOODS

IN THE RIGHT

QUANTITIES

IN THE RIGHT

CONDITION

TO THE RIGHTPLACE

AT THERIGHTTIME

FOR THERIGHTCOST

5. QUALITY ASSURANCE MECHANISMQuality assurance in procurement is an approach of preventing defects in supplied products and avoiding problems when delivering products or services to the people. Thus quality assurance mechanism involve implementation of inspection and structured testing as a measure of quality assurance. It comprises administrative and procedural activities implemented, so that the requirements will be fulfilled as ‘fit for purpose’. A systematic measurement, comparison with a standard, monitoring of processes, testing and inspection are major components of quality assurance mechanism. A quality is all about meeting the needs and expectations of user with respect to functionality, design, reliability, durability, and price. And, quality assurance is a positive declaration on a product or service, which gives confidence or guarantee that the product will work without any problems as per the expectations or requirements, there will be no side and adverse effect.

LMS is well familiar and sensible about the need of quality assurance in the goods and services procured and distributed to the needy people. LMS takes all measures of quality assurance since from the need identification, developing specification, evaluation of bids and award to production and delivery of goods by the suppliers. Similarly, the measures are taken in storing, distributing to the service points and delivering to the people. Following are major procedures in quality assurance mechanism:

Importance of effective logistics• Effective supply chain enhances quality of care by providing adequate, appropriate supplies to

health facilities and increasing professional satisfaction to deliver a higher quality of service.• Effective supply chain improves cost efficiency and effectiveness by reducing losses due to

overstock, expiry, damage and pilferage.• An effective supply chain system includes the following components:

▸ Warehouses from central, intermediary and other storage facilities where health commodities are held until given to another facility or patients.

▸ Transportation assets from large trucks to smaller trucks that move products from the warehouses to health facilities

▸ Maintained Coldchain from factory to client and patients.▸ Service delivery point where customers receive the products that they need. These include

hospitals, primary health centers and health posts. Patients may also receive products in the community from community health worker.


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Standardization of Technical Specifications:The first step of quality control and assurance in procurement is defining specifications. So, LMS has developed and approved standard technical specifications of medical equipment, medicines, vaccines, surgical consumables and contraceptives; and published it in the Technical specification Bank (TSB). LMS uses only the approved specifications from TSB in all its procurement. Certain standards are mandatory in all the medical equipment as applicable like:

• IEC 60601 – medical equipment (in patient environment)• IEC 61010 – laboratory equipment• IEC 60335-1 and -2-24 – refrigerators and freezers (electrical safety) and also relevant section

of WHO E003• CE or USFDA, European CE• The units are used as metric unit or SI units

Similarly, in case of Pharmaceutical items, requirement of pharmacopoeia specifications in general, by dosage form and monograph specifications are given. The monograph specification includes the various test requirements as specified in the pharmacopoeia are also given. Similarly, packaging specifications for a specific item has also been mentioned. These specifications eases in the technical evaluation. These specifications are also helpful both PSI and PDI processes as well as in laboratory quality testing processes. Every pharmaceutical item must have been manufactured by at least WHO recommended guidelines and duly certified by the respective regulatory authority. Some of the products like vaccines and hormonal contraceptives are required to meet the WHO-PQ standard. Nutritional products are followed the UNICEF and WFP standards, whereas insecticides are to be recommended by WHOPES.

Use of Standard Bidding Document:LMS uses only the standard bidding documents prescribed by the PPMO and uses the eGP portal of PPMO. The eligibility, and qualification criteria are used standard in order to select the quality and tested goods. Evaluation of bid and award are based on the compliance of pre-defined criteria on the bidding documents.

Pre-shipment and Post-delivery Inspection and Tests:As per the requirement the goods ordered are inspected at the production site before dispatching by an independent agency and tested at the approved laboratory. Similarly, the goods are tested after receipt at LMS warehouse. Medical equipment are inspected and tested individually in presence of the supplier. Verification of technical specification and its functional outputs are checked. Whereas medicines and other goods are tested by sampling. For sampling, generally the number of batches are determined as per the square root formula. Then for the number of batches all batches are selected by system attic random sampling method. The samples are taken from the boxes/packages which are again determined by square root formula from each batch selected. All medicines are tested in ISO 17025:2005 certified laboratories or National Medicine Laboratory items. The testing protocols are adapted as per the respective claimed pharmacopeia monograph. LMS keeps a separate control sample of each sample tested for verification, if any adverse results noticed in future.

Standardized Storage and Distribution:The received goods are stored in a well standard warehouses and then supplied to the provinces and other health institutions as per the supply chain principles. A Good Storage Practice and Good Distribution Practices are followed in storage and distribution stages. The vaccines and


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other medicines requiring cold chain are stored and carried with well-equipped cold chain stores and by cold chain carriers. Standard procedures requiring loading, unloading and transportation are followed.

There is in need of a Quality Assurance Institution for medical equipment, medicines and other health products. Despite, there are Department of Food Technology and Quality Control for assuring the quality in food product and nutritious food, and Department of Drugs Administration (DDA) for regulating drugs and its raw materials in Nepal. DDA regulates the drugs by issuing GMP Certification, batch validation, issuing Production License, Import License and Marketing License; which are means of quality assurance of pharmaceutical products. But, the role of DDA is seen as market surveillance rather than certification. Initiation by DDA has been taken to regulate and certify the quality of medical equipment also, which is not yet accomplished. DDA has the responsibility of medical products which also includes personal protective equipment’s as well.

We are also using private laboratories for samoe quality test in the days to come it should be strengthen at federal, province and some strategic areas to assure the quality of drugs and commodities.


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CHAPTER 2ORGANIZATIONAL STRUCTURE

FEDERAL LEVEL1. ORGANOGRAM OF LOGISTICS MANAGEMENT SECTION

Logistics Management Section

Section Chief (SPHA 9/10 level HI)

Public Health officer

(7/8 Level/H.I)

Section officer (2)Gazetted third class Admin/ G

Admin)

Pharmacy Officer (7/8

level H. Pharmacy)

Biomedical Engineer (7/8

level H. Bibidh)

Mechanical Engineer

(Gazeted third class Eng/M.Eng)

Computer officer

(Gazeted third class/ Bibidh)

Health Assistant (5,6,7

level/H.I)

C.C.A.-3 (4,5,6 level /H.I)

Integrated Health Management Information

Section

Environmental health and healthcare waste

management Section

Infrastructure Development Section

Ministry of Health and Population (MoHP)

Department of Health Service (DoHS)

Management Division

2. SCOPE OF WORK AND TOR OF LOGISTICS MANAGEMENT SECTION• Support the MoHP to develop national policies, acts, rules, guidelines, quality standards,

protocols about the procurement and supply (of drugs and equipment)• Support MoHP to prepare the standard and specification bank of drugs and health equipment

at national level• Procurement and supply (in provinces) of essential health items like vaccines and family

planning devices• Facilitate the province and local levels in procurement and supply of required drugs and

equipment• Coordinate and facilitate to institutionalize the supply management information system at

national level• Manage essential equipment in the agencies under the DoHS


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PROVINCE LEVEL

3. PROVINCIAL HEALTH LOGISTICS MANAGEMENT CENTERS (PHLMC)

Ministry of Social Development (MoSD)

Provincial Health Directorate-7+1 Logistics Management

Section

Provincial Health Logistic Management Center

(PHLMC) – 6

Hospital development and curative service division

Policy, law, standards, planning and public health division Provincial Health

Training Center

Health Office – 77Terms of Reference (PHLMC) • Planning, monitoring and

procurement section• Storage, distribution and

technical support section• Administration Section

Director(11 Level/PHA/GHS/HI/Pharmacy/IM)

Pharmacy Officer(7/8 Level

H.Pharmacy)

Biomedical Engineer

(7/8 Level H.Bibidh)

Section Officer(Gazeted Third Class

Admin/G.Admin)

Account Officer(Gazeted Third Class Account)

Pharmacy Assistant

(5/6/7 Level /Pharmacy)

Computer Operator

(5 Level/Bibidh)

Refrigeration Technician

(5/6 Level Eng /Electrical)

C.C.A-2(4/5/6 Level/H.I)

Heavy Vehicle Driver

(No class Eng /Mechanical)

Light Vehicle Driver-2

(No class Eng /Mechanical)

Office Assistant(No class Admin/GA)

Loader Packer-2(No class

Admin/GA)

(SPHA 9/10 Level HI)

Provincial Health Logistics Management Centers (PHLMC) are established in six provinces under Ministry of Social Development (MoSD) to ensure round year availability of medicines, equipment and materials and to strengthen supply chain management system in the province. There are three different offices at provincial level for health service management which includes Ministry of Social Development (MoSD), Provincial Health Directorate (PHD) and Provincial Health Logistics Management Centers (PHLMC).In Karnali province there is logistics management section within Provincial Health Directorate (Revised Organogram by province).


28

4. LOCAL LEVEL

There are store at each 77 Health offices within the province’s majority have designated standard warehouses some have old storage rooms which includes cold chain facility.

Local level governments are in the process of gradual improvement to institutionalize the logistics management system in place. Some Palika have proper facility for storage including cold chain but some have to be improved.

5. LOGISTIC MANAGEMENT FUNCTIONS AT DIFFERENT LEVEL5.1 FEDERAL LEVELLogistics Management Section (LMS) is one of the core sections of Management Division. The major purpose of the LMS is to forecast, procure, store and distribute health commodities, equipment and instruments to districts and health facilities to enable the provision of basic healthcare services. It is also responsible for repairing and maintaining bio‐medical equipment, instruments and transport vehicles. Since establishment of LMS, has made continuous effort to bring improvement in the health logistics system. The major activities are as follows:

• Annual Procurement Plan (APP) and Consolidated Procurement Plan (CAPP): APP and CAPP is maintained in consultation with division and center of DoHS.

• Facilitation on provincial and local level to prepare on procurement plan and procedure: Onsite coaching and training.

• Facilitation on forecasting and quantification of program commodities and medicines at Federal, Province and Local Level: Training and feedback.

• Procure, storage, distribution, re-distribution, transportation / reverse logistics of medicines, equipment of Health commodities at federal, provincial, district and local level.

• Proper management / safe disposal of expired, breakage, unused, medicines, health commodities and biomedical equipment: Some initiation has been started.

• Strengthen Logistics Management Information System (LMIS) and eLMIS: Logistic Management Information Resource Center (LMISRC). Currently LMIS system is in place and expansion of eLMIS is in the process.

• Strengthen storage capacity and good practice.

5.2 PROVINCE LEVELMajor Functions of PHLMC:

• Based on provincial need and as per national standard prepare guidelines and standards to support policy and law related to procurement and supply of medicine and commodities

Metropolitan City/ Sub Metropolitan City/ Municipality/ Rural Municipality

Basic Health Facilities

Health Section


29

• Prepare provincial health logistics supply plan• Regular storage and supply of instruments, equipment, medicines and other health logistics as

per need of health facilities or health service delivery units• Management of provincial buffer stock of medicine and health related materials for the

emergency situation• Facilitate and coordinate for regular procurement and supply of instruments, equipment,

medicines and other health logistics to the local level government entity.

Current status of PHLMC functionality • Procurement planning: PLHMC has been preparing regular procurement plan based on past

consumption record, morbidity data and changed population structure of local government entity.

• Receive and supply: PLHMC has been receiving regular supply essential medicine, vaccine and FP commodities from federal MoHP/DoHS warehouse. Annually PLHMC perform own procurement of medicine, equipment and materials as per annual plan. The budget for procurement used from federal government as conditional and provincial government as unconditional grant.

• Storage: PHLMC performs regular storage of medicine, vaccine, contraceptives, nutrition supplements and other health logistics as per standards and protocols. Cold chain has been maintained for storing vaccine and other lifesaving drugs.

• Technical backup, Supervision and Monitoring: PHLMC extends technical support and onsite coaching to health office and local government entity to strengthen Supply Chain Management (SCM).

• Coordination: PHLMC has been performing regular coordination between MoSD, MoHP and local government related to SCM and regular supply of medicines and commodities.

• Supply Chain Management (SCM) Working Group: The technical network of government and EDPs has formed and functional in various provinces including Sudurpashchim province. SCM working group intended to support PHLMC to strengthen SCM in the provinces

• Provincial Health Coordination Team (PHCT): A wider network of government and health sector EDPs working in provinces has been formed and functional. Issues related to health logistics and SCM regularly discussed in the forum.

5.3 HEALTH OFFICEHealth Offices are established at district level with changed role and responsibilities. Before the federalism District Health Office had over all responsibility of Health System Management of the district. But now district has limited responsibility of coordination, monitoring and technical supervision and facilitation of the health services in the district. District coordinates with Local Level Governments and LLGs coordinates to the Service Delivery Points. In terms of Supply Chain Management districts receive commodities from PHLMCs and supply to the LLGs.

Current status of district level functionality • Procurement planning: Health office has no budget to procure commodities district only

support receiving the commodities from province and supplying to the LLGs. • Receive and supply: It has been receiving regular supply essential medicine, vaccine and FP

commodities from PHLMC and supply to the LLGs. In terms of vaccine District supply directly to the Service Delivery Points (SDP).

• Storage: It performs regular storage of medicine, vaccine, contraceptives, nutrition supplements and other health logistics as per standards and protocols. Cold Chain has been maintained for


30

storing vaccine and other lifesaving drugs.• Technical backstop: It extends technical support and onsite coaching to LLGs and SDPs to

strengthen SCM.• Coordination: It has been performing regular coordination between Province, local government

and SDPs related to SCM and regular supply of medicines and commodities. • Capacity enhancement & facilitation: Health office currently act as a technical back-up for

each Palika & SDPs, onsite coaching, feedback & facilitation are most important functions for logistics management.

• Integrated information system: Facilitation and monitor the district level HMIS, LMIS, DHIS2 and other information system.

5.4 LOCAL LEVELLocal Level Government has major responsibility of Management of health logistics for effective and efficient health service delivery among community level service delivery points. LLGs are accountable for round year availability of medicines, equipment and materials to strengthen supply chain management system in the SDPs of its catchment area for the effective health service delivery.

Current status of local level functionality • Procurement planning: LLG has authority of planning, quantification and forecasting of

health commodities as well as it to procure commodities district only support receives the commodities from district and supply to the SDPs.

• Receive and supply: LLG has been receiving regular supply essential medicine, vaccine and FP commodities from districts and supply to the SDPs.

• Storage: LLG performs regular storage of medicine, contraceptives, nutrition supplements and other health logistics as per standards and protocols.

• Supervision and Monitoring: LLG extends technical support and onsite coaching to SDPs to strengthen SCM.

• Coordination: LLG has been performing regular coordination with district and SDPs related to SCM and regular supply of medicines and commodities.

• Logistics Management Information System (LMIS): LMIS is core function for effective logistics management & good governance. Collection, compilation, data entry of quarterly LMIS report and analysis, planning for necessary quantity of commodities for Health Facilities.

LOGISTICS MANAGEMENTFUNCTIONS

Procurement

WorkshopInformation

Management

Monitoring

Evaluation

Supply Chain Management

Storage

Planning

Training

Quality Assurance


31

CHAPTER 3MAJOR LOGISTICS ACTIVITIES

A. PROCUREMENT The principles of economy, efficiency, efficacy, competition, accountability, and transparency in procurement procedures as well as Logistics management seek and lead towards Value for Money (VFM) of health expenditures. Quality service delivery comes along with the procurement of quality medicines and equipment.Logistics Management Section (LMS) is responsible for implementing procurement functions in federal level. Before the devolution of the procurement functions to the provinces and local levels FY 2075/076 (2018/19) the responsibility was confined with then Logistics Management Division (LMD) of DoHS. The functions of then LMD and now LMS has been internalized through the procurement and distribution of free essential drugs and equipment at all levels by implementing following four pillars of improvements:

i) pre-bid information systems like, TSB and LMIS improvements; ii) efficient procurement planning like APP, MPP and CAPP; iii) strengthening standard procurement process through executing health sectoral new SBDs and e-GP system; and iv) enhancing capacity building program on local, province and federal level.

1. STRENGTHENING PRE-BID INFORMATION SYSTEMSPre-bid information management is very crucial for effective bidding procedures. Some legal requirements to initiate bidding process are mandatory as per PPA and PPR. Technical Specifications, Cost Estimates and SBDs preparations and approvals before bid are mandatory and very crucial for effective, transparent and competitive bidding procedures. In this regard, DoHS-LMS have been reforming these preparation and approval process and its timing by using ICT applications before the bidding procedure. Strengthening of pre-bid information and planning systems mainly includes Market analysis, TSB, Cost Estimation, SBDs preparation and APP/MPP approvals and their timeliness.

1.1 TECHNICAL SPECIFICATION BANK Technical Specification is a legal document mandatorily required for procurement management initiation as per PPA and PPR. Without this document procurement proceeding cannot be started and due to the reason, it is operationalized in a formal manner in every institution. In LMS/DoHS, Technical Specification Bank (TSB) is a bank, operated through software, containing the technical specifications of pharmaceuticals and medical equipment. It was designed and operated in FY 2071/72 (2015/16) and updated with standard coding of pharmaceuticals and equipment in FY 2073/74 (2017/18). FY 2073/74 commonly used free essential 108 pharmaceuticals and 1089 equipment had been uploaded with their unique codes in modified TSB system in LMD’s website. It is open to use for all users even outside of health sector also.


32

A guideline for use of TSB was prepared and an orientation training to the staff of DoHS have conducted in FY 2073/74 for its effective usage. At present, almost all Technical Specifications of drugs and equipment are used from TSB for the required bidding process in DoHS. The technical specifications are prepared by the divisions themselves and these divisions are using TSB only for the reference. In FY 2075/076 (2018/19) additional 13 technical specifications of pharmaceuticals including vaccines and hormones and 20 specifications of equipment are endorsed and uploaded in the TSB system. Thus, as of date there are 121 technical specifications of pharmaceuticals and 1109 specifications of medical equipment are available at the TSB. At this moment more than 800 TSB users (individuals/institutions including all users from local to federal level) are registered in the TSB. Similarly, more than 20,000 downloads and more than 13,000 searches for different specifications are recorded (MD/IT 2020)

The updating of TSB is a continuous process. Hence in current fiscal year there are 208 pharmaceutical specifications are updated and in the process of uploading in the TSB after completing the agreed procedure. Similarly, updating of technical specifications of medical equipment are also in process.

1.2 TECHNICAL SPECIFICATION BANK (TSB) STEPS AND REPORTINTRODUCTIONTechnical Specification Bank (TSB) is a web based system which is in operational from 2017/10/11manages technical specification documents of medical equipment and Pharmaceuticals goods. Specifications are first drafted and uploaded to the system by authorized user. The system will auto generate the codes of the specifications formulated by Logistics Management Division (LMD). The specification documents are then published to registered users for downloading. The system provides easy and user friendly interface for document uploading, search and downloading.

APPLICATION USER CASES

SUPER ADMIN ADMIN REGISTERED USERS/END USERS

Can change all the possible setting and documents of the system



• Since the time of TSB being functional, total 1,008 numbers of users have requested for registration and been registered in the TSB for accessing the specifications related to medical equipment and pharmaceutics where till date officially approved and accepted specifications of 1,089 types medical equipment and 108 types of pharmaceutics have been updated in the TSB.

TOTAL NO. OF TECHNICAL SPECIFICATIONS UPLOADED IN THE TSB

MEDICAL EQUIPMENTS PHARMACEUTICS

1,089 108

• REGISTERED USERS / END USERS:(under categories: individual, private entities/suppliers and government entities/institutions)


33

1.3 COST ESTIMATION PRACTICESCost Estimate is an unambiguous document required for procurement initiation. PPA and PPR have mandatory provision to prepare and approval of Cost Estimate before solicitation of bids. While preparing the Cost Estimates following common procedures are adopted:

• Collection of last years and current years’ actual rates of procurement; • Prevailing market rate; • Other prevailing market rates and additional transportation, taxes and other logistical costs;

and• Any other official rates published/announced by agencies like Chamber of Commerce, wherever

available.

Following the PPA and PPR provisions, cost estimation of medicines and equipment is very common legal practice in LMS before beginning of procurement process. Besides, DDA as a regulatory authority have published the maximum retail price (MRP) of 96 drugs in Shrawan 2072 (August 2015) for general purposes, which may also be the basis of cost estimates practices in then LMD. But this MRP issuance of drugs does not cover all free and essential drugs that LMD procured before. So LMS considered these MRPs only as reference rates and did not take principle considerations while preparing the cost estimation of drugs before procurement process.

LMS also kept previous years’ actual procurement rates records. Prevailing local market official rates are collected direct from markets and other rates are collected from big purchasers like Bir Hospital, Patan Hospital and TU Teaching Hospitals. Keeping all these considerations, the final cost estimate rates (CER) are approved by the DG of DoHS.

It seems to be a common practice of approval of cost estimates along with technical specifications before the IFB notice publication in almost all bids.

REGISTERED USERS/ END USERS

INDIVIDUAL PRIVATE ENTITIES/SUPPLIERS

GOVERNMENT ENTITIES/ INSTITUTIONS

NO. OF USERS 450 308 250

• ACTIVITIES BY USERS: Total 49260 No.s of activitiesACTIVITIES

SEARCHING OF SPECIFICATION DOWNLOADING OF SPECIFICATION

Ratio/FrequencyBoth almost equal in numbers (in every case of login by users, technical spec-ifications are searched and most of the times serched technical specificaions are downloaded)

OVERALL SUMMARY IN TABULAR FORM:

PARTICULARS NUMBERS

Total No. of users registered 1,008

No. of medical equipments in TSB 1,089

No. of Pharmaceutics in TSB 108

Avereage No. of user requests currently 4

Average No. of user requests overall 2-3

Total No. of activites till now 49,260

Avereage No. of activities (Daily) 50-60


34

SN NAME OF DRUGS DDA MRP 2015

CER OF LMD

APR OF LMD

% OF LMD APR WITH DDA MRP

YEAR OF CER AND

APR1 Amoxicillin 250mg DT 5.00 2.45 1.94 61% low 2073/74

2 Amoxicillin Capsule 500mg 8.00 3.29 2.89 64% low 2073/74

3 Azithromycin Tablet 250mg 17.45 8.70 4.30 75% low 2073/74

4 Azithromycin Tablet 500mg 30.00 12.28 8.37 72% low 2073/74

5 Ceftriaxone powder for Injection 1g 90.00 32.38 27.58 69% low 2073/74

6 Ciprofloxacin Tablet 500mg 8.00 3.69 2.05 74% low 2073/74

7 Fluconazole Capsule 150mg 24.00 9.69 3.65 85% low 2073/74

8 Amlodipine Tablet 5mg 5.00 1.45 0.35 93% low 2073/74

9 Tinidazole Tablet 500mg 5.00 3.15 1.27 75% low 2072/73

10 Metformin Tablet 500mg 2.00 1.22 0.42 79% low 2072/73

11 Alprazolam Tablet 0.25mg 1.70 0.97 0.49 71% low 2072/73 Source: Nepal Rajpatra; Part-5, Section-65, Number-12; August 03, 2015 and LMD procurement records.

1.4 QUANTIFICATIONS AND FORECASTINGQuantificationCommodity security is essential for the effective delivery of quality health services. It exists when people are able to choose, obtain and use products whenever they need them. Quantification is one of the major functions of logistics cycle. It is the process of estimating the quantities and costs of the product required for a specific health program (or service) and determining when the products should be delivered to ensure an uninterrupted supply for the program. Quantification is critical to supply chain management because it links information on services and commodities from the facility level to program policies and plans at the national level which is then used to inform decision makers for financing and procurement of commodities. It included the forecasting and supply plan (FASP).

ForecastingForecasting is estimating the quantity of each product that will be dispensed to customers during a future period usually two or more years. Different types of data and information are required during each step of quantification. Data from the health management information system (HMIS) and logistics management information system (LMIS) were provided to the participants including consumption data, demographic data, morbidity data and program

. GoN/MoH have published MRP of common and essential drugs as Gazette Notifi cation in Nepal Rajpatra; Part-5, Section-65, Number-12; August 03, 2015 (Shrawan 18, 2072); Ministry of Law and Justice(MoLJ)

We can see two scenarios; one is based on per unit CER and actual procurement rate (APR) of LMD itself and another scenario is the comparisons of MRP issued by DDA and APR of LMD practices of FY 2072/73 to 2073/74 (2016/17 to 2017/18).

There is no procurement of free essential drugs (FED) in FY 2074/75 (2018/19) as the responsibility was under provinces and local governments. Table-1 summarizes the MRP of DDA with CER and APR comparisons of DoHS practices on cost estimation for 11 FED which are common among the DDA price list and LMD procurement list. Comparing the MRP and actual APR of these 11 drugs in FY 2072/73 (2016/17) and FY 2073/74 (2017/18), it is found vast differences in MRP and ARP almost ranges between 61-93% low bidding value as against of MRP.

TABLE 1: ANALYSIS OF MRP AND APR IN FY 2072/73 TO 2073/74 (2016/17 AND 2017/18)


35

considerations such as non-communicable diseases, mental health and family planning programs have special considerations such as unmet needs, contraceptive prevalence rate, infertility, spousal separation and method mix. In addition, policy documents were also referred frequently.

Supply plan helps to ensure continuous supply within the maximum and minimum levels, that entails coordinating timing of funding disbursement from multiple sources with procurement lead times, delivery schedules and ensuring buffer stock.Every year, the working group forecasts for coming three-year period with periodic review. The group consists of representation from various divisions under DoHS/MOHP, districts, social marketing organizations and EDPs.

Activities in FY 2076/77Forecasting and Supply Plan GuidebookTo institutionalize MoHP capacity for evidence-based, coordinated forecasting and supply planning of health commodities at all levels of the supply chain in the federal structure, MD developed the forecasting and supply plan guidebook and workbook with support from GHSC-PSM which was approved and endorsed by DoHS.

Consensus Forecasting 2076/77MD organized 2-days workshop on national quantification of program drugs and EPI vaccines for the FY 2076/77 (2019/2020) on April 4-5, 2019 with the support of GHSC-PSM. Participants conducted data analysis, assumption building, forecasting and supply planning exercises. The team produced a national forecast and supply plan for 700 items for FY 2076/77 (2019/2020) for all divisions and centers. The estimated budget for this forecast is NPR. 4.60 billion.

Establish Quantification Capacity at ProvincesDuring FY 2076/77, MD with the support of GHSC-PSM project provided technical assistance to three provinces in quantification of health commodities in Province 5, Province 1 and Sudhurpaschim Pradesh based on data generated from eLMIS and HMIS data. It helped provinces to systematically forecast commodity requirements and estimate costs for uninterrupted supplies of health commodities.

Program Division Budget share for Health Commodities - FY 2076/77 (2019/20 )(Total Budget NPR. 4.60 billion)

NIP 52%

Epidemiology 22%

Eye, ENT and OralHealth 4%

Mental Health 2%

NPHL 3%

HIV/AIDS/STD 3%

Tuberculosis 6% FP Program 6%

Safe MotherhoodProgram 2%

NIP

Eye, ENT and Oral HealthEpidemiology

Mental Health

NPHLHIV/AIDS/STD

Tuberculosis

FP Program

Safe Motherhood Program


36

Develop Quantification Capacity for Local Level GovernmentsThe quantification of health commodities at the central level has been effective to determine the quantities for the next fiscal year. In recent federal context, LMS organized the trainings to build capacity of provinces and LLGs health staff using quantification guidebook and workbook in all the seven provinces including Province 1, Province 2, Bagmati Province, Gandaki Province, Province 5, Karnali Province and Sudhurpaschim Province. The objective of the training was to ensure that dedicated supply chain workforce (health coordinators) are in place and have appropriate skills to manage health commodities. Further, in order to maximize utilization of the resources, GHSC-PSM field staff was also trained to carry out the FASP activities in provinces and LLGs to ensure continuous support and close coordination in training other LLGs.

1.5 QUARTERLY PIPELINE MONITORING To be successful, public health programs must always have enough medicines and supplies to meet the needs of their clients. At the same time, programs must avoid surpluses that waste products and money. In each quarter, LMS conducts Quarterly Pipeline Review meetings to review, monitor, and evaluate the procurement, shipment, distribution, transportation and stock status of selected key commodities. The meeting is participated by program divisions and centers of DoHS, external donor partners and stakeholders like social marketing agency. In the meetings shipment schedules, shipment status (planned, ordered and received), actual consumption and months-of-stock-on-hand of health commodities were discussed.

In the FY 2076/77, LMS organized three quarterly pipeline monitoring meetings on Nov 26, 2018, Feb 22, 2019 and July 31, 2019 to share the stock status of the 37 key commodities including FP, EPI Vaccines and some program commodities. This forum reviewed stock status, orders and shipment status and took actions for smooth distribution to avoid stock out and overstock and rescheduling of the pipeline shipment as per requirement.

2. STANDARD PROCUREMENT PLANNINGDoHS have started the procurement planning process by preparing APP and MPP since the year 2007 after the enactment of PPA and PPR. Then LMD is preparing and monitoring CAPP each year since FY 2010/11 in some limited program activity of DoHS. However, these efforts were centered and limited to the pool funded procurement activities and their consolidation in those days. Since 2012/13 LMS have been spending its much more time and effort to consolidate APPs of various divisions under DoHS.

2.1 CAPP INITIATIVESSince 2012/13 CAPP preparation begun in DoHS applying as a broader approach and started incorporating it’s all divisions into it. CAPP Monitoring Committee is formed in DoHS and endorsed by MoHP in 2017/18. The committee is monitoring the progress of CAPP execution quarterly. Table-2 shows CAPP values of different divisions under DoHS and actual execution in values in 2016-17 to 2018/19.

TABLE 2: CAPP OF DOHS AND ACTUAL EXECUTION IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19) (IN NPR MILLION)

SN DIVISION OF DOHS

2072/73 CAPP PLAN

2072/73 CAPP ACTUALS

2073/74 CAPP PLAN

2073/74 CAPP

ACTUALS

2074/75* CAPP PLAN

2074/75* CAPP

ACTUALS

1 LMD 1285.87 1285.87 218.54 80.86 517.70 282.57

2 CHD 881.92 566.82 655.40 378.41 424.77 389.43


37

3 FHD 912.65 236.22 368.50 224.15 279.30 264.38

4 EDCD 161.32 160.28 378.09 309.24 321.11 237.47

5 MD 69.20 43.66 72.00 24.66 32.60 28.51

6 PHCRD 814.23 606.38 1031.52 587.87 - -

7 LCD - - 4.5 0.99 - -

8 NSSD - - - - 1.30 0.79

Total 4125.19 2899.23 2728.55 1606.18 1576.78 1203.15Source: Various Years CAPP data of DoHS.

* In 2018/19 the divisions under DoHS are restructured, but the budget was allocated as per previous structure.

2.2 PROCUREMENT MODALITY ANALYSIS:LMD/DoHS is using open, competitive and transparent modality of bidding in practice, In 2016/17 total number of contracts was 175 whereas it is reduced in 2017/18 to118 only and that in 2018/19 is 73. Main reason for this scenario is the reduction in CAPP budget due to the devolved procurement in local and province level.

TABLE 3: NUMBER OF CONTRACTS BY MODALITY

SN PROCUREMENT MODALITY2016/17 2017/18 2018/19

NOS. OF CONTRACS % NOS. OF

CONTRACS % NOS. OF CONTRACS %

1 Open Bid Method (ICB) 116 66.29 57 48.31 23 21.50

2 Open Bid Method (NCB) 34 19.43 39 33.05 32 43.84

3 Sealed Quotation Method (SQ) 9 5.14 20 16.95 10 13.70

4 Catalogue Shopping (CS) 13 7.43 0 0.00 0 0.00

5 Direct Purchase (DP) 3 1.71 2 1.69 8 1.96

Total Contract 175 100 118 100 73 100Source: Various Years CAPP data of DoHS

2.3 PROCUREMENT TYPE USAGE:Among all other procurement types, Goods (drugs and equipment) procurement is popular purchasing type in LMD/DoHS as its weightage is 96% in 2016/17 and slightly decreased to 93.22% in 2017/18 and it is only 89.04% in 2018/19. It consists of procurement of drugs, medical equipment, instruments, contraceptives, cold chain equipment, insecticides and other goods.

TABLE 4: SELECTION OF PROCUREMENT MODALITY & TYPE IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19)

SN

PROCUREMENT TYPE 2016/17 2017/18 2018/19

PROCUREMENT MODALITY

GO

OD

S

CIV

IL W

OR

KS

CO

NS

ULT

ING

S

ERV

ICES

NO

N-

CO

NS

ULT

ING

SER

VIC

ES

GO

OD

S

CIV

IL W

OR

KS

CO

NS

ULT

ING

S

ERV

ICES

NO

N-

CO

NS

ULT

ING

SER

VIC

ES

GO

OD

S

CIV

IL W

OR

KS

CO

NS

ULT

ING

S

ERV

ICES

NO

N-

CO

NS

ULT

ING

SER

VIC

ES

1 Open Bid Method (ICB) 116 - - - 57 - - - 23 - - -

2 Open Bid Method (NCB) 28 4 2 - 33 2 3 1 26 2 3 1

3 Sealed Quotation Method (SQ) 8 - - 1 18 1 - 1 8 1 - 1

4 Catalogue Shopping (CS) 13 - - - - - - - - - - -

5 Direct Purchase (DP) 3 - - - 2 - - - 8 - - -

Total 168 4 2 1 110 3 3 2 65 3 3 2

% of Type of Procurement 96.00 2.29 1.14 0.57 93.22 2.54 2.54 1.70 89.04 4.11 4.11 2.74

Source: Various Years CAPP data of DoHS


38

2.4 SEGREGATION OF CATEGORIES USEDBy segregating the total procurement needs of DoHS into 6 categories like drugs, medical equipment, civil works, Services, office supplies and vehicles, it seems to be an open bid method is most commonly used method. It comprises the highest value (44.6% in 2016/17, 55.9 % in 2017/18 and 43.3% in 2018/19) in procurement of drugs, and second is the procurement of medical equipment (43.4% in 2016/17, 23.7% in 2017/18 and 30.1% in 2018/19) in the type of procurement involved in LMD/DoHS with using open bid method as a prime method.

3. STANDARDIZATION OF PROCUREMENT PROCESSAfter the introduction of PIP, 2014 LMD/DoHS started the standardization process of procurement system. In 2017/18 PIP revisited, restructured and endorsed by MoHP and implemented as a prime and live document as a procurement reform initiative. Following are some highlights of the achievements of the standardization of procurement process as per PIP update:

3.1 USAGE OF STANDARD BIDDING DOCUMENTS:All bidding documents are mandatorily referenced from the SBDs issued by the PPMO and used as per PPA and PPR. There are not any separate health sectoral standard bidding documents endorsed by PPMO yet. However, LMD/DoHS have drafted three sets of health sectoral specific SBDs for the procurement of drugs and equipment and sent them to PPMO for endorsement. One of them is SBD for Framework Arrangements. Several follow up and discussion meeting with PPMO have been conducted in FY 2018/19 as efforts for approvals.

In DoHS, it is very common practice that almost all Bidding Documents are approved by DG before the IFB notice publication. Since 2017/18, the online e-GP portal of PPMO have been used for bidding procedures in LMD and IFB publication also came through electronically. However, e-GP includes common SBDs for all, DoHS is practicing the e-GP with no health sectoral specific SBDs for the procurement of drugs and equipment.

3.2 SOLICITATION PERIODS: Bid publication and preparation time in practice is minimum of 30 days for NCB and 45 days for ICB as per PPA and PPR. Since LMD/DoHS is using open bid method of ICB and NCB type,

TABLE 5: CATEGORY OF PROCUREMENT MODALITY & TYPE IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19)

SN

PROCUREMENT TYPE 2016/17 2017/18 2018/19

PROCUREMENT MODALITY

DR

UG

S

EQU

IPM

ENT

OFF

ICE

SU

PPLI

ES

VEH

ICLE

S

CIV

IL W

OR

KS

SER

VIC

ES

DR

UG

S

EQU

IPM

ENT

OFF

ICE

SU

PPLI

ES

VEH

ICLE

S

CIV

IL W

OR

KS

SER

VIC

ES

DR

UG

S

EQU

IPM

ENT

OFF

ICE

SU

PPLI

ES

VEH

ICLE

S

CIV

IL W

OR

KS

SER

VIC

ES

1 Open Bid Method (ICB) 61 52 - 3 - - 53 3 - 1 - - 16 7 - - - -

2 Open Bid Method (NCB) 8 9 9 2 4 2 6 17 6 4 2 4 6 13 6 1 2 4

3Sealed Quotation Method (SQ)

6 2 - - - 1 5 8 3 2 1 1 1 1 6 - 1 1

4 Catalogue Shopping (CS) - 13 - - - - - - - - - - - - - - - -

5 Direct Purchase (DP) 3 - - - - - 2 - - - - - 2 1 5 - - -

Total 78 76 9 5 4 3 66 28 9 7 3 5 25 22 17 1 3 5

% of Type of Procurement 44.6 43.4 5.14 2.86 2.29 1.71 55.9 23.7 7.63 5.93 2.54 4.24 34.3 30.1 23.3 1.37 4.11 6.85

Source: Various Years CAPP data of DoHS


39

almost all bids have been processed in a transparent and non-discriminant way, given wide range of standard time period (30 days for NCB and 45 days in ICB) for bid preparation and submission, except the time used in SQ and DC methods.

Public bid opening is held immediately after the deadline of submission of bid as per the stipulated date and time on bidding document. A systematic practice of bid opening report has been established. With exception of extended bid submission time, no bids have been seen delayed for bid opening.

3.3 BID EVALUATION AND APPROVAL: Bid evaluation and approval standard time is maximum of 120 days as per PPA and PPR. All ICB bids in LMS are evaluated within the maximum period of 90 days of time and all NCB bids are evaluated within the maximum period of 35 days of time in FY 2073/74 (2017/18). These periods in FY 2072/73 (2016/17) were 120 days for ICB and 90 days for NCB respectively. An effort of e-GP II execution in 2017/18 sharply reduced the time of bid evaluation and approval. The evaluation period in FY 2074/75 (2018/19) reduced to average 41 days in ICB and average 31 days in NCB. So, all procurement of drugs and equipment has improved to a good timing of bid evaluation and approval.

3.4 ICT INITIATIVES IN SOLICITATIONS OF BID:LMD/DoHS is improving the use of ICT in bid proceedings since FY 2071/72 (2014/15). In FY 2072/73 (2016/17) LMS has used almost all bids (99.43%) through eGP I, i.e, offline bidding medium issued by PPMO which is up to the bid submission only and other processes have completed manually. In FY 2073/74 (2017/18) LMS started the technical preparation for online eGP II which includes online bidding and evaluation process and started to use it in all modality of bidding process of procurement. About 59% of bids in contract value are processed and contracted through this system in this year. Following tables summarize the overall procurement proceedings of different divisions of DoHS in FY 2073/74 (2017/18) through e-GP.

The Table 6 shows impressive improvements in the usage of eGP system in bidding procedures. Almost 83% of bids in contract value have been processed through eGP and rests of 17% are from manual methods of bid which include some Direct Contracts too. Among total proceedings of FY 2073/74 (2017/18), 58.51% of bids in contract value are processed through online eGP II and 24.28% of bids in contract value are processed through offline eGP I procedures. Comparing to this, use of online eGP II in FY 2074/75 (2018/19) is increased at the highest level 97.8 % of CAPP value. After initiation of eGP II, the use of eGP I has been null.

TABLE 6: BIDDING MEDIUM USED IN TERMS OF ACTUAL CONTRACT AMOUNT IN FY 2072/73 TO 2074/75 (2016/17 TO 2018/19)

BIDING MEDIUM

2072/73 2073/74 2074/75

CONTRACT AMOUNT IN MILLIONS

% PERCENTAGECONTRACT AMOUNT IN MILLIONS

% PERCENTAGECONTRACT AMOUNT IN MILLIONS

% PERCENTAGE

e-GP I 2882.70 99.43 389.99 24.28 - -

e-GP II - - 939.76 58.51 1,176.69 97.8

Other 16.53 0.57 276.44 17.21 26.46 2.2

Total 2899.23 100 1,606.18 100 1,203.15 100Source: Various Years CAPP data of DoHS


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3.5 CONTRACT MANAGEMENT:Contract management in procurement is very challenging and crucial activity. It covers the period of commencement of contract to the completion of contractual liability and requires high level of monitoring to develop the mutual understanding to perform the contractual liabilities of both sides. Contract management activity has been practiced in LMS. Previously in 2069 – 2072 (2012 – 2015) a simple software of Contract Management System (CMS) was in use for monitoring of the active contracts in hand. However, LMD could not continue the institutional capacity to use this software for monitoring the contracts in hand. The eGP modules of PPMIS have not been in practice to monitor the contract management. CAPP-MC have been reported through manual efforts preparing into the Excel sheets from individual active contract files. Development of new CMS is planned to embed in the eCAPP system of TABUCS.

4. OTHER INITIATIVES4.1 GRIEVANCE HANDLING MECHANISM:Grievance Handling and Redressal Mechanism is an important phenomenon in procurement and supply chain management, however, not given very much importance in our context. So, in FY 2073/74 (2017/18) a concept paper on the ICT based Grievance Handling and Redressal Mechanism (GHRM) have been endorsed by DoHS on behalf of MoHP and system software developed, approved and executed in FY 2074/75 (2018/19). This GHRM is installed in MD/DoHS reported 55 grievances handled by the system in FY 2074/75 (2018/19). Annual Report on grievances received and resolved through GHRM system is available on the website of MD.

4.2 SUPPLIERS’ CONFERENCETo facilitate in use of eGP, TSB, GHRM system and online information on the MD website to the potential suppliers as well as to strengthen the bidding capacity of the suppliers with providing the knowhow about the important requirements of bidding procedure and lodging complaints and grievances related to procurement and supply chain through web-based GHRM then LMD and now MD is organizing periodic Suppliers’ Conference. The first Suppliers’ Conference was organized on 14 Mangsir 2074 (30 November 2017). Feeling the encouraging response of first Suppliers' Conference and realizing the need of periodic interaction with suppliers, second Suppliers' Conference was organized on 15 Baishakh 2076 (28 April 2019).

4.3 MARKET ANALYSIS OF PHARMACEUTICALSA large number of medical goods and services including medicines, vaccines, contraceptives, equipment, instruments and accessories are procured by all spheres of Governments. In the devolved context, since FY 2074/75 (2018-19), either local or the provincial governments at SNG level make most of the procurements of free and essential medicine. The procurement agencies do not have an updated information regarding the availability of items under the defined specifications. A large variation is observed in the prices offered by the suppliers in different institutions. Similarly, the capacity of Nepalese pharmaceutical industries in producing the free essential medicine in Nepal was not known yet. So, with the support from NHSSP a market analysis of essential medicines in Nepalese markets is done to assess the production cycle and availability of essential medicines manufactured by the domestic pharmaceutical industries in Nepal. The objectives were to assess the type of essential medicines, their dosage forms and strengths available; estimate the production capacity, compare the technical specifications and analyses the cost of medicines. The study also covered the procurement prices of essential medicines procured by Management Division, Provinces and some Palika as well as hospitals. The findings of the study are remained to disseminate among the stakeholders.


41

B. SUPPLY CHAIN MANAGEMENTSupply chain management (SCM) is the oversight of materials, information, and finances as they move in a process from supplier to manufacturer to wholesaler to retailer to consumer. Supply chain management involves coordinating and integrating these flows both within and among companies. It is said that the ultimate goal of any effective supply chain management system is to reduce inventory (with the assumption that products are available when needed).In many countries the public sector distribution system or the supply chain frequently hybridized onto the existing administrative structure. Though it looks convenient administratively, however, distribution system should be based on functional, technical, and financial considerations. Streamlining the supply chain can often yield substantial result and cost savings.To determine the minimum levels required the supply chain managers must consider the total pipeline lengths; desired frequency and delivery speed; cost of transport, storage, handling; and operational constraints.

Basic elements for supply chain management1. STORAGE, DISTRIBUTION AND INVENTORY MANAGEMENT:

1.1 Storage guideline (13 Points) I. Keep medicines in upright position, don’t touch into the wall II. Store should be dry and cross ventilation with ceiling heat insulation III. There should be sufficient light in the store IV. Stock should be arranged within each zone accordingly order system V. Stock should be stored off floor on pallets, on pallet racks or on shelves VI. Cleaning and inspection, protect from insects, rates and animals VII. Separation of wastage and expired items and process to dispose and destroy VIII. Recording of stock movements IX. Security management in store X. Cold Chain maintained to required items XI. Arrangement of fire extinguisher in the store XII. Follow FEFO system XIII. Keep away from heat and electricity to prevent rubber, latex made items

1.2 IMPORTANT TERMS USED IN SUPPLY CHAIN MANAGEMENT I. Pipeline: Pipeline is the entire chain of storage facilities and transportation links

through which supply move from manufacturer to customer. II. Lead-time: The time interval between the date a product is ordered and the date it

is received and available for use. Lead-time varies depending on the system, speed of deliveries, availability and reliability of transport, geographical accessibility, and weather.

III. FEFO: First-to-expire, first out is an inventory management system that ensures the products with the earliest expiry date are the first products issued. This system moves older stock first to prevent expires.

IV. Shelf-life: The length of time a material (drug and other essential items) may be stored without affecting the usability, safety, purity, or potency of the item.

V. Maximum/Minimum (Max/Min): An inventory control method that requires each facility to set maximum and minimum desired stock levels for each item to ensure that quantities fall within the established range. This range depends on available storage facility, transportation facility, weather condition, and geographical accessibility. All health institution should be determined their Max and Min Quantity of each, and


42

every item based on consumption, morbidity and population. It is also based on the nature of commodity, lead time, reporting time.

VI. ASL: Authorized Stock Level (ASL) refers to the maximum allowed stock level of drugs and other programs items. It is different for different items.

VII. EOP: Emergency Order Point (EOP) refers to the minimum allowed stock level of drugs and program items. EOP is different for different level. If it falls below the minimum authorized level an emergency order has to be made to concerned bodies.

VIII. Under-stock: supply chain imbalance that occurs when stocks fall below the established minimum. This may result in un-served customers.

IX. Overstock: Overstock is supply imbalance that occurs when stocks exceed the established maximum. This may result in losses due to expiry.

X. Stock-out: Stock-out is depleted supply of a given product or products; a zero-stock balance.

XI. Buffer-stock: Buffer-stock is a stock proportion of total supply that is kept for contingencies. This is directly related with disaster management.

XII. PUSH System: Push system is a distribution system in which the higher-level facility decides what health commodities to push through the supply chain, how much to push, and where and when to push in the supply chain.

XIII. PULL System: Pull system is a distribution system in which each lower level facility pulls essential health commodities through the supply chain by requisitioning (ordering) the required quantity at the time the essential health commodities are needed.

XIV. MoSoH: Month of Stock on Hand (MoSoH) is a stock of drugs and other program items in month derived dividing total stocks by monthly dispense.

XV. Inventory Control: It is a procedure that governs how supplies are received, stored, handled, and issued.

2. Inventory Management is a discipline primarily about specifying the shape and placement of stocked goods. It is required at different locations within a facility or within many locations of a supply network to precede the regular and planned course of production and stock of materials.New Forms and Formats: LMS is used now the new following Ma.Le.Pa Forms and Formats for inventory management which were circulated by Nepal Government FCGO.

Table below shows that the approval of Finance Audit Office has been decided dated 2076/02/19 according to letter dispatched no 322 dated 2076/03/01 FCGO Nepal as new Ma.Le.Pa Forms and Formats 13 out of 18 which are used in inventory management and should be implemented by all 3 level of governments.


43

2.1 Disposal and auctioning: Proper management of wastage and expired items in the store is another big challenge, should be destroy or proper dispose of these items away from environmental effect and follow accordingly guidelines (Auctioning/Destroy/Disposal Guideline 2067) and WHO Pharmaceutical Waste disposal Guideline. Pharmaceutical waste and as well as general waste can be disposing or destroy or auction or the wastage/expired or unused materials according to finance administrative regulations 2056 section 106 ka after the filled of stock inspection report form 410 and annual stock status form 413. Provision of subsidy, it is the only authority of secretary, government committee and ministry council.

MD/LMS also core work is the auctioning or disposed or destroy of waste and old materials including pharmaceutical waste in every year accordingly guidelines and government regulations

C. LOGISTICS MANAGEMENT INFORMATION SYSTEM (LMIS):LMIS in Nepal has a long history. As a part of strengthening the logistics system in 2052 (1995), LMIS was introduced and scaled up across the nation by 2054 (1997). Every quarter, more than 4,000 health institutions send LMIS reports in paper to LMIS Unit at LMD, where they are manually entered in the LMIS system installed. In 2065 (2008), LMD introduced web based LMIS up to the district level. In web based LMIS, districts, regions, and central warehouses keep transaction records and upload in the web at the end of each month. Moving a step forward, in 2073 (2016), the monthly web based LMIS was transformed to real-time online inventory management system (Online IMS) up to the district level. An integrated data repository is developed so that all historical data are accumulated in one system. LMIS is the important part for effective logistics management because LMIS data is used for planning, quantification, pipeline monitoring, supply plan, storage, distribution of commodities as decision making as soon.

Combines the forms and procedures required for gathering and organizing logistics information. The LMIS gathers information—quantities of product dispensed to users, stock levels, stock losses, Batch, Expiry and moves this data required for supply chain management through the system.

S. NO. NAME OF MA. LE. PA. FORM OLD MA.LE.PA NO. NEW MA.LE.PA NO.

1 Requisition 51 4012 Purchase Order 45 4023 Commodity Received 46 4034 Issue Through Requisition 51 4045 Commodity Issued 48 4066 Expandable Commodities 52 4077 Non-Expandable Commodities 47 4088 Bin Card - 4099 Commodity Dispose 50 410

10 Stock Inspection Report 49 41111 Sub Stock Ledger - 41212 Annual stock Status 57 41313 Maintenance and protection record keeping - 414


44

1. QUARTERLY LMIS REPORTING AND SCHEDULINGAll SDPs sites should prepare their LMIS report on the quarterly basis as fulfill the all report part as available of commodities are there as follow instruction or Audio Visual Aids (can access from website: www.dohslmd.gov.np). Then send the report 1 copy (Blue) to Local Level, 1 copy CC (Yellow) to Health Office and 1 copy (White) keep into office copy. Send the report as following schedule:

PurposeSystem of records and reports that use to collect, organize, and present logistics data gathered across all levels of the system to improve management decisions that govern the logistics system.

S.NO REPORTING MONTHS QUARTER DEADLINE TO SEND FROM HFS

DEADLINE TO ENTER THE DATA BY HEALTH OFFICE AND LLGS

1 Shrawan, Bhadra and Ashwin 1st Within Kartik 7 Within Kartik 15

2 Kartik, Mangsir and Poush 2nd Within Magh 7 Within Magh 15

3 Magh, Falgun and Chaitra 3rd Within Baisakh 7 Within Baisakh 15

4 Baisakh, Jestha and Ashad 4th Within Shrawan 7 Within Shrawan 15

2. LMIS ACTIVITIES• LMIS resource centre: well-equipped training/meeting hall with data bank, data analysis and system control• LMIS supporting centre: Technical human resources to tackles on LMIS/eLMIS problems• M&E on LMIS/eLMIS: Stock monitoring, site visit, report generations• Audio Visual Aids development for instruction to fill quarterly LMIS report• Printing and distribution of LMIS forms and stock book to all 6000+Health Facilities.

3. E-ELECTRONIC LOGISTICS MANAGEMENT INFORMATION SYSTEM (ELMIS)The Ministry of Health and Population's (MoHP) overarching Nepal Health Sector Strategy, (NHSS), 2016-2021, Outcome 9.1 calls for the improved delivery of health care services using evidence-based decision making at all levels of supply chain. In line with this, MD introduced Electronics Logistics Management Information System (eLMIS) with Support of GHSC-PSM as an improved logistics management information system for informed and evidence-based decision making to strengthen public health supply chain management in Nepal. The software vendor in joint venture with a Nepali local company was selected to implement eLMIS in Ashwin 2074. Joint venture with local company was prioritized from initial conceptualization to ensure sustainability of the solution.

eLMIS has two major capability modules; reporting and transactional capabilities. Both options are used to ensure both the availability and visibility of data for informed decision making to ensure continuous availability of health commodities to end users.

A well-designed, well-operated supply chain driven by accurate and timely logistics data, inventory and pipeline information is critical to the success of any health system. Supply chain managers need to have clear visibility into all supply chain components such as forecasting, quantification, procurement, warehousing, inventory, distribution, pipeline information as well as funding, and policy.

As technology continues to evolve, public health systems policy makers and planners are looking for real time accurate data to make health commodities available at all levels of


45

supply chain interruptedly. Traditional paper-based system no more suffices their need to serve the end users.

Introduction of automated eLMIS, program managers will have quicker access to aggregate and/ or specific data at their fingertips. eLMIS is the real time data system. Till the date, progress of eLMIS live from all Federal, Provincial health institutions and partial District, Local and SDP level.

I. eLMIS implementation expected outcomes The overall benefits of eLMIS implementation will be three-fold:

Strategic impacts• Availability of logistics data for measuring SC Performance. • Capture and analyze logistics data for informed decision making• Availability of real-time data enables MoHP to strengthen supply and demand planning, optimize transportation processes, control inventory costs and minimize risks that lead to Stockouts, expiries and wastage.• Capability to set up and report on KPIs for FP, MNCH, Vaccines, Essential drugs programs • Integration with Health information system for visibility and analytics• Full visibility and real time data for management of SCM.

Operational impacts• Reduced cycle time for doing some SC activities (e.g. Order processing and reporting)• Improved efficiencies in capturing consumption and other critical SC data• Reduced LOE required to prepare and process orders • Provided capabilities to SC performance enabling PHLMC, DHO, SDPs, and MD/DoHS of MoHP to make accurate decisions within appropriate timelines• Provided end-to-end visibility into operational data on a real time basis

Public health impacts• Increased availability of health commodities at SDPs • Reduced stockouts of health commodities

Outputs of eLMIS• Brief status of institutional strengths for its readiness in implementing eLMIS• Immediate needs to functionalize local governance system for eLIMS• Improved logistics management information system for supply chain planning including quantification, forecasting, procurement planning and monitoring of health commodities.• Strengthened supply chain management.• Enhance local level institutional capacity for procurement and supply chain management.

II. eLMIS implementation requirementsFollowing resources are required for effective operationalization of eLMIS: • A computer installed with Windows Operating System and a printer in case of online and

offline module• Internet connection of minimal 512 Kbps. • Uninterrupted smooth speed in case of online module.• Availability of seldom signal of Internet for periodic data synchronization in case of offline

module.


46

• Mobile signal of at least 2G/GPRS for mobile module for health facilities.

Medical stores at different levels, for example, stores of Palikas (Rural Municipalities and Municipalities) and above are recommended to use Online module.

Health Facilities that serves as service delivery point can use online module if they have uninterrupted internet service above 512 kbps; or offline module if uninterrupted internet service is not available. Smaller health facilities can also opt to use mobile module for reporting needs.

Human resource having knowledge of public health supply chain of responsible level with basic computer skills. • Inventory management, supply chain management skills for storekeeper level• Supply chain management and data interpretation skills for health managers • Data driven decision making for executives and decision makers.

III. eLMIS Intervention and Current SitesCurrently eLMIS is used as repository of paper based quarterly LMIS reports from 6000+ health facilities throughout the country. In addition to LMIS reports data entry, eLMIS also serves as a centralized warehouse and inventory management system for day-to-day transactional operations. Since 1st Baishakh 2075, the eLMIS system has attained operational capacity in 129 sites. eLMIS is currently operational at Central Medical Stores (CMS): Family Planning Store, Cold Chain Store, NCASC, EDCD, NTC, and at Pathlaiya CMS, Provincial Medical Stores (PMS) of Butwal, Nepalgunj, Pokhara and Janakpur; all 77 health office (out of which 55 are using eLMIS for consumption data entry), 18 local municipalities aka local level governments (LLGs), 23 health facilities.

In order to facilitate smooth operations of eLMIS, three levels of support were established. First level (L1) of support is provided remotely by helpdesk. User can access helpdesk using a tollfree number, SMS or email. Second level (L2) support is provided through LMIS Officers. These officers are seconded at central stores, provincial stores and selected health offices to provide on-the-job support to all eLMIS operating sites. Level three support (L3) is provided by software vendor. The level three support provide services in case of any changes required on software and bug fixing. As system is already stabilized after being on operation for more than 2 years, majority of the of the support issues are resolved by local Nepali company as part of L1 & L2 support.

IV. eLMIS Implementation: eLMIS was rolled out on three stages to ensure the eLMIS implementation follows the commodity flow cycle. a. In Stage 1, which ended in Baishakh 2075, eLMIS was implemented and operationalized

in 10 sites (6 CMS, 2 RMS and 2 district stores) including the Family Planning Store Teku, the Vaccine and Cold Chain Store Teku, the National Centre for AIDS and STD Control (NCASC) store Teku, the LMIS Centre Teku, the National Tuberculosis Center (NTC) Thimi, the Central Medical Store (CMS) Pathlaiya, the Regional Medical Store Butwal, the Regional Medical Store Nepalgunj, and Bardiya and Surkhet district stores.

b. In Stage 2, which ended in Ashadh 2075, the eLMIS was implemented and operationalized in 20 district stores and offline modules deployed at Humla, Jumla, Kalikot, Mugu and Dolpa district stores, which have limited internet access.


47

c. In Stage 3, which ended in Bhadra 2075, eLMIS was implemented and operationalized at four local level governments of Bardiya and Surkhet and 23 of their health facilities.

V. eLMIS implementation assessment and adjustments based on lesson learnt:Management Division assessed eLMIS operational sites in Mangsir through support from GHSC-PSM project in Mangsir 2075. Assessments was conducted at representative eLMIS operational sites, this included all level of supply chain (i.e. CMS, PMS, district, LLGs and SDPs) and all types of eLMIS modules (i.e. online, offline and mobile modules of eLMIS). The recommendations of assessment were adopted into eLMIS as lesson learnt.

VI. COVID-19 Items Incorporated and Reporting ToolsLogistics Management Section has supply COVID-19 items to the NPHL, PHLMC, PHD, HO, COVID-19 Treatment Hospitals and Clinics. COVID-19 items are incorporated in reporting systems (LMIS/eLMIS). LMS finalize a tool for COVID-19 items reporting as daily, weekly, monthly and as per required.

VII. eLMIS scale-up Plan Approval and Rollout Team MobilizationeLMIS scale-up approach, modality and requirements were prepared. Plan for all remains health institutions within 2077. Approval of eLMIS Scale-Up Plan on 2077/02/01 (Secretary Level decision MoHP) and Team Mobilization Rollout Plan has been approved on 2077/02/08 (AD May 21, 2020) –DoHS level decision.

VIII. Data GovernanceOn Paush 18, 2074 (January 2, 2018), the project presented the master data it had compiled for the eLMIS to a meeting of the LMIS Task Force including PHAMED and MoHP representatives. This data is interoperable with the District Health Information System (DHIS), the Technical Specifications Bank and the Department of Drug Administration’s management information system. Subsequently, on Magh 26, 2074 (February 9, 2018), the project discussed the sharing of master data, including for the eLMIS, with PHAMED and LMD officials, NHSSP’s M&E Advisor and a representative of MoHP’s Health Registry. LMD shared the master data with PHAMED on Chaitra 8, 2074 (March 22, 2018).

In mid-2018, the health facilities part of the Health Registry went live and can be accessed http://182.93.95.152:8088/health-registry/ The project acquired a full listing of health facilities and is now working with Bileeta to standardize it in the eLMIS to ensure interoperability between the eLMIS and the Health Registry.

4. ONLINE INVENTORY MANAGEMENT SYSTEM (IMS) SUPPORTThe project is also supporting Online Inventory Management System (IMS) to run a helpdesk for the system. The helpdesk continued to receive and deal with issues and queries about the system. Support team is also responsible for following up with districts for regular transactions in the Online IMS, consumption reporting, data monitoring and reporting, and negative balance verification and corrections. The support will continue until eLMIS is completely rollout in all sites.

5. ROUTINE DATA QUALITY ASSESSMENT (RDQA)Management Division has facing key challenge on quarterly basis LMIS reporting on its quality as timeliness, accuracy, completeness, fairness, consistency, validity, reliability. MD were


48

initiated to improve data quality by RDQA. The overall objective of the RDQA assessment was to access data quality information by the Logistics management division from its distribution wings in obtaining its goals and objectives and to get recommendation for further improvement of the supply chain management. Logistics Management Division (LMD) began data quality assessment from 2073 (2017). Information required for the assessment was collected using RDQA tools developed by Measure Evaluation funded by USAID. The assessment was conducted in five provinces (1,2, 3, 6 and 7) covering five districts, each district including one health/public health offices, one PHCCs and two health posts. The assessment was carried out under the overall supervision of the senior members of the assessment team. Data collection was carried out during April – May 2018 and 2019 (FY 2075 and 2075) which lies in 2nd quarter of LMIS reporting period. A one-day debriefing workshop among the LMD's staff was organized at LMD premises to share experiences gained by the field teams during data collection. The workshop was instrumental for providing necessary feedback and guidance to the field team.

Gap analysis and action taken (RDQA):S. N GAPS ACTION TAKEN RESPONSIBILITY

1 Lack of M&E from all levels Regular M&E Federal, Province and Local

2 No feedback mechanism Revive the feedback mechanism from all levels Federal, Province and Local

3 Gaps on LMIS training Need for LMIS training for all SDP sites Federal and Province

System Assessment Results by Level of the Reporting System

I - M&E Structure, Functions and Capabilities

II - Indicator Definations and Reporting Guidelines

III - Data-Collection and Reporting Forms and Tools

IV - Data Management Processes

Service DeliverySite Average

District SiteSite Average

Cetral Level: CentralWarehouse, Teku

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50


49

D. EFFECTIVE VACCINE MONITORING (EVM)National Immunization Program (NIP) is priority one and successful program in Nepal. It has a great role and responsibility of cold chain and vaccine management behind the success of Immunization program. Expanded Program of Immunization (EPI) was started in 1979 (2074-75) after the eradication of Smallpox in Nepal. At the starting time, Vaccination program was introduced in three districts they are Dhanusha, Rupandehi and Sindhupalchok. There were only four antigens, which were BCG and DPT. Now, eleven antigens are in use and near future Nepal is going to introduce ROTA vaccine. At the starting period of Cold chain & Vaccine Management, there were only three cold rooms in Nepal. They are each in Kathmandu, Kailali and Biratnagar. Now, we have nine cold rooms in Central Vaccine Store, Teku and twenty are in other part of the country.

I. GoalEffective Vaccine Management has a great role for the success of NIP. Now, WHO & UNICEF has prepared Standard Operating Procedure (SOP) on Effective Vaccine Management (EVM). It has 9 indicators. They do EVM Assessment in every three years. Every country should have eighty percent in each indicator in EVM Assessment. Our main goal is to obtain more than eighty percent in EVM Assessment.

II. Objectives of Cold chain & Vaccine ManagementMain objective of the Cold chain & Vaccine Management is to store and distribution of vaccines in time with maintaining the quality of vaccines.

Overall goal is reduction of morbidity, mortality and disability associated with vaccine preventable diseases.

III. CMYP▸ Ensure access to vaccine od assured quality and with appropriate waste management.▸ Logistics Management under DoHS, is responsible for the procurement of vaccine and cold

chain also has a section to handle the vaccine and cold chain. Under this division there are regional and district vaccine stores, reporting the status of vaccine and cold chain.

▸ Management Division Under DoHS responsible to collect information on administrative coverage.

IV. VaccinesEleven antigens are in use in Nepal till Now. They are BCG, DPT-HepB-Hib, OPV, MR, JE, Td, PCV & IPV. ROTA vaccine is going to introduce in Nepal from Jun.-Jul. 2020.

V. Cold chain Equipment for Storage and TransportationWHO has advised to use only WHO prequalified cold chain equipment for the vaccine management of National Immunization Program (NIP) Nepal is following the WHO Guidelines and WHO PQS. The WHO PQS list is updating time by time. GON has advised to use only WHO prequalified cold chain equipment in NIP. This equipment is specially manufactured to store the vaccines and that kind of equipment has more holdover time.

VI. Progress and activitiesCold chain and Vaccine Management Unit, Logistics Management Section, Management Division


50

is doing all kind of management activities for vaccine management (shipment plan, pipeline monitoring, receiving, storing and distribution of vaccines, maintaining and monitoring of temperature by using the devices). This unit is coordinating with Child Health and Immunization Service Section under the Family Welfare, Division to do the forecasting and quantification of vaccines and EPI accessories.

Forecasted vs Supply Status of Vaccines in doses form (last three years)Forecasting methods for vaccines & syringes are based on no of EPI session, target population, coverage percentage, no of doses and wastage multiplication factor. We have a supply schedule and distribution quantities/list to supply the vaccines and syringes to PHLMC and Health Offices. Distribution quantities are calculated as per the stock status, estimated monthly consumption, minimum and maximum stock level of vaccines at the institution. We can compare the forested vs. supplied status of vaccines as follows:

Forecasted vs Supply Status of Vaccines in doses form (current year)

2073-74 2074-75 2075-76

2076/77 Forecasted 2076/77 Supplied

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

4500000

Items BCG bOPV MR JE Td PCV IPVDPT-HepB-Hib

4028

340

4028

340

4028

340

3340

00

0

3020

00

0

2385

400

2385

400

2385

400

2346

350

2183

500

2385

400

2385

400

2385

400

210

2650

2385

400

2695

370

2695

370

2695

370

2141

320

1934

150

2122

600

2122

600

2122

600

2038

732

1766

800

180

8990

180

8990

180

8990

1489

00

0

1386

00

0

1257

105

1257

105

1257

105

8725

00

9424

00 14

00

00

016

5080

0

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

4500000

BCG bOPV MRJE Td PCV4 IPVDPT-HepB-Hib

3975

040

2320

00

0

220

6810

1078

00

0

220

6810

1540

750

1080

00

0

990

00

0

2199

400

1611

900

1328

510

1055

00

0 1452

405

930

190

1963

692

4660

00


51

Prices of Vaccines in USD

Comparative Price of GoN vs GAVI Funded Vaccine in USDGovernment of Nepal is providing the budget to procure BCG, OPV, MR, JE, Td and syringes. Likewise, GAVI is supporting DPT-HepB-Hib, PCV, IPV with their syringe’s safety boxes. UNICEF is procuring and supplying the vaccines for GAVI supporting vaccines as per the MOU of GAVI & GON.

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

Items BCG bOPV MR JE Td PCV IPVDPT-HepB-Hib

2955

00

250

500

2265

00

190

3150

1994

397.

518

5597

5

4231

71

3974

00

.85

450

670

.5

1776

248.

83

1411

129.

8812

7460

4.85

6432

78

540

950

5465

92

1684

10

1637

9015

2460

710

550

0

6218

132.

666

2550

0

1155

560

2073-75 2074-76 2075-77

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

9000000

10000000

2073-75 2074-76 2075-77

330

660

7.83

2650

827.

35

2763

770

.73

900

8650

8481

475

9368

090

.1

GoN Procured-BCG, OPV, JE, MR I, Td GAVI funded-Penta, PCV, IPV


52

VII. Wastage Rate of Vaccines - HMISGovernment of Nepal / National Immunization Program (NIP) has policy for forecasting and quantification of vaccines and syringes as per the guideline of WHO. Forecasting for BCG is based on the EPI Session of the country. Nepal is following MDVP. As per the MDVP, 15 percent is acceptable for DPT-HepB-Hib, OPV, Td. Reconstitute vaccines MR has 40 and JE has 50 per-cent wastage on the basis of geographical and session size in Nepal.

Wastage minimization should be a priority action from each level. Which has direct effect on resource generation

VIII. Repair and Maintenance Status of Cold Chain EquipmentRepair and Maintenance of Cold Chain Equipment is a main part in Vaccine Management. Quality of the vaccine cannot be maintained without cold chain. Therefore, regular tempera-ture monitoring and maintenance of cold chain equipment are very fundamental activities in NIP and Vaccine Management. We have Mechanical Engineers (ME) in CVS and Refrigerator Technicians (RT) in PHLMC. They are doing repair and maintenance of cold chain equipment at sanctioned office and districts as well as health facilities.

0

20

40

60

80

100

51 4950

45.8

45.7

48

34.5

90

48

25 23.426

22.4

22.523

27.410 13.612

74.8

84

80.5

BCG bOPV MR JE Td PCV IPVDPT-HepB-Hib

2073-74 2074-75 2075-76


53

GOVERNMENT STRUCTURE PROVINCE NAME OF HFS UNDER MAINTENACE PROJECT

Federal

Province 1 Koshi Hospital

Province 2 Gajendra Narayan Singh Sagarmatha Hospital, Narayani Hospital

Bagmati Bharatpur Hospital

Gandaki Pokhara Academy of Health Science

Province 5 Rapti Academy of Health Science

Karnali Karnali Academy of Health Science

Sudurpashchim Dadeldhura Hospital

Provincial level

Province 1

Bhojpur Hospital, Dhankuta Hospital, IIam Hospital, Khotang Hospital, Mechi Hospital, Okhaldhunga Hospital, Panchthar Hospital, Sankhuwasabha Hospital, Solukhumbu Hospital, Sunsari Hospital, Taplejung Hospital, Terhathum Hospital, Udayapur Hospital

Province 2Bara Hospital, JanakpurHospital, Mahottari Hospital, Ram Kumar Uma Prasad Memorial Hospital, Rautahat Hospital, Sarlahi Hospital, Siraha Hospital

Bagmati Dhading Hospital, Hetauda Hospital, Nuwakot Hospital, Ramechhap Hospital, Rasuwa Hospital, Sindhuli Hospital, Sindhupalchok Hospital

GandakiDhaulagiri Hospital, Gorkha Hospital, Lamjung Community Hospital, Manang Hospital, Mustang Hospital, Myagdi Hospital, Parbat Hospital, Syangja Hospital, Tanahun Hospital

Province 5

Arghakhanchi Hospital, Bheri Hospital, Bhim Hospital, Gulariya Hospital Bardiya, Gulmi Hospital, Kapilvastu Hospital, Lumbini Hospital, Palpa Hospital, Pipara Hospital, Prithvi Chandra Hospital, Pyuthan Hospital, Rampur Hospital, Rapti Hospital, Rolpa Hospital

KarnaliDailekh Hospital, Dolpa Hospital, Humla Hospital, Jajarkot Hospital, Kalikot Hospital, Mehelkuna Hospital, Mugu Hospital, Rukum Hospital, Salyan Hospital, Surkhet Hospital

SudurpashchimAchham Hospital, Baitadi Hospital, Bajhang Hospital, Bajura Hospital, Darchula Hospital, Doti Hospital, Mahakali Hospital, Seti Hospital, Tikapur Hospital

Local Level

Province 1 Katari Hospital, Rangeli Hospital

Province 2 Bardibas Hospital, Bhardah Hospital, Chandranigahapur Hospital, Pokhariya Hospital

Bagmati Baghauda Hospital, BakulaharRatnanagar Hospital, Jiri Hospital, Methinkot Hospital

Gandaki Bandipur Hospital

Province 5 Shivraj Hospital

Karnali Dullu Hospital

Sudurpashchim Gokuleshwar Hospital, Jogbuda Hospital, Malakheti HospitalBiomedical equipment list of hospital is attached in Annex …..

E. REPAIR AND MAINTENANCE STATUS OF BIOMEDICAL EQUIPMENTInventory of different Health facilities (HFs) which are under the Nationwide outsourcing Main-tenance Project are kept in the software called Planning and Management of Assets in Health Services (PLAMAHS). It contains the inventory details of Bill of Quantity (BoQ) items. In this proj-ect, Equipment Descriptor are limited to 86 type. In the software we have the detail equipment descriptor of 86 type depending upon the functionality with the particular equipment type. The inventory details are updated during every Maintenance Contractor (MC) intervention. According to the government structure Central, Provincial and Local level in different provinces. We have made the inventory of the BoQ type equipment. They are given below with the Health Facilities name.

Table below shows that involvement of Health Care Centres of different federal area maintained biomedical equipments (Detail inventory of biomedical equipments repaired and maintained with its categorized is mentioned in annex)


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F. EXPIRED DRUGS MANAGEMENTExpired drugs management is one of the major activities of health logistic and supply chain management. Expired drugs imply financial losses because they should no longer be distributed and must be discarded. WHO guideline for the safe disposal of expired drugs says expired drugs must be disposed of safely, without harming people and the environment.

There is gap on knowledge and practice of expired drugs management and proper disposal. High number of expiries shows gap on proper planning and quantification and mobilization in needy health facilities as well as data validity used for the planning. Provinces and district as well as community level health facilities are managing locally disposal of expired drugs with local resources and knowledge but not as the standard procedure.

SOME EXPIRED MEDICINES, ITEMS OF MNCH DRUGS IN FISCAL YEAR 2074/75 AND 2075/76

DRUGS STATE 1 STATE 2 STATE 3 STATE 4 STATE 5 STATE 6 STATE 7 TOTAL

Oral Rehydration Salt Powder Packet

0 0 4300 0 0 20 0 4320

ORS + Zinc Packet 0 0 0 0 244 0 0 244

Sulphamethoxazole 100 mg + Trimethoprim 20 mg Dispersible Tablet

0 0 0 0 10200 0 0 10200

Zinc Sulphate 20 mg Tablet 27000 0 0 0 229860 21159 0 278019

Ferrous Sulphate 60 mg + Folic Acid Tab 0.4 mg Tablet

0 0 397890 0 26600 30061 0 454551

Chlorhexidine Gel 4% (Navi Malam) Tube

0 0 0 0 1139 0 0 1139

Oxytocin 10 IU / ml Injection

0 0 0 0 0 50 0 50

Oxytocin 5 IU / ml Injection 0 0 710 0 2525 35 0 3270

Gentamycin 80 mg/ml 2ml Injection

0 0 0 0 1330 0 0 1330

Amoxycillin 125 mg Dispersible Tablet

0 0 0 0 98980 0 0 98980

Source: eLMIS

Data shows higher number of expiries of Zinc Tablet and ferrous sulphate among MNCH drugs in last two fiscal years. The expiry of Zinc is higher in province 5 in comparison to other provinces and Ferrous Sulphate expiry is higher in province 3. The number of expiries is higher in the group of tuberculosis, HIV and antihypertensive drugs as well. (detail list of expired drugs is attached in the annex)There are some items which is based on eLMIS but due to not updated record it may be not represent exact figure which should be updated timely and mobilization should be one of the activities for logistics management as per consumption.


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G. SUPPLY CHAIN MANAGEMENT WORKING GROUP (SCMWG)Supply Chain Management Working GroupThe SCMWG will be a group of logistics and supply chain expert from MoHP, development partners vand stakeholders working together to achieve specific goals. Its mandate will focus on improving the performance of the supply chain of all health commodities, with a focus on innovation, capacity, and stakeholder collaboration to enhance the health commodity supply chain management performance in Nepal.

GoalRound the year uninterrupted availability of quality essential drugs and health commodities at service delivery points.

Purpose• To identify gaps within the health logistics system.• To identify common interests and exchange views about health logistics issues.• To take timely action on critical logistics problems such as stock outs, overstock and distribution

decisions.• To facilitate on plans, procure, store, distribute as required by federal, province and local level

governments• To take way forward in the critical issues on logistics• To formulate SCMWG in federal, province and district Level• To facilitate on basic logistics capacity enhancements, LMIS, pipeline, forecasting, quantification

in federal, province and local level• To monitor the ongoing logistics activities. TaskThe working group will provide a platform for exchange of ideas / concept, good practices, and forge collaboration on the essential drugs and health commodities supply chain in Nepal. It will work toward ensuring efficient quality health commodities supply chain from central to province, province to district, district to health facilities and ultimately to client.

Specifically, the SCMWG works on following components:

Supply Chain Innovation• Identify issues, challenges and opportunities in health logistics system in Nepal.• Collaborate to introduce best practices and procedures in health logistics systems.• Oversight the overall logistics system.• Identify and come up with innovations that will improve supply chain performance and great

impact on health outcomes

Capacity Building• Identify workforce requirements and continuous development, requisite tools, knowledge and

expertise to build capacity that will enhance competitiveness within the health logistics system such as technology and change management.

Performance Measurement• Identify performance measurement gaps within the health logistics system and develop a

performance measurement framework.


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• Identify common interests and exchange views about issues in support of the Essential Drugs and Health Commodity Supply Chain.

• Share or exchange supply chain related success stories and lesson learnt

11.1 Rationale of SCMWG formation• Adapt supply chain related policies and strategies consistent with federal system of the country• Adapt new structure and functions within the given framework of MoHP/DoHS• Expand partners and stakeholders for supply chain management strengthening at different

tiers of governance• Develop a more structured approach to tackle logistic issues.• Assess effectiveness and efficiency of present health logistics system• Bring improvement in the systems to increase availability of health commodities at all levels• Monitoring of logistics indicators including such as stockout, reporting rate, stock according to

plan, on-time delivery, order fill rate and world bank DLI at all levels • Continuous monitoring and periodic evaluation of the logistics system for informed decision

making• Facilitation on pipeline/forecasting and quantification in federal, province and local level• Advise and adopt right processes to manage, organized/cleaned, receive and distribute health

commodities, batch management, adjustments, disposal and safety of warehouse/store at each level of supply chain

• Update SOPs periodically based on learning and best international practices• Manage to provide knowledge and skill to all health professionals on basic health logistics, paper

based LMIS and electronic LMIS• Supportive supervision/monitoring/onsite coaching/mentoring/facilitation as require

strengthening supply chain management at all levels in coordination with supply chain partners • Formulate federal, province and district level logistics management working group to strengthen

of supply chain management at all levels• Supply plan monitoring for uninterrupted availability of health commodities at federal, province,

districts/local level• Establishment and operationalize of LMIS unit to analyze logistics data at Province Health

Logistics Management Centre (PHLMC)• Upgrade eLMIS periodically based on the user experience and evolving needs to strengthen

supply chain functions

11.2 Scope of Work (SOW) of SCMWGSpecifically, this SCMWG would be responsible for following activities but not limiting to it:• Organize quarterly meeting to review performance management and improvement• Organize annual meeting on national consensus of health commodity forecasting• Organize quarterly national pipeline review meetings • Assist in preparing annual work plan• Coordination and cooperation with all development partners supporting health logistics

management• Plan for the efficient management on procurement, storage, distribution and transportation of

health commodities• Review policy and strategies• Periodic review of national guidelines on supply chain management• Review and update eLMIS as per requirement• Assess logistics gaps


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• Plan to prioritize supervision and monitoring the logistics activities in needed areas • Provide decision in logistics activities• Plan for supply chain workforce development and opportunity for internship to health personnel• Undertake periodic review and take immediate action on critical supply chain issues.• Constitute under SCMWG Task Force for governing regular activities

11.3 Provision of SCMWG MeetingMeeting should be arranged at least Quarterly or as per the need of the group.

11.4 Anticipated Outcomes• Provide a forum for a meaningful action, exchange of experiences and ideas to resolve supply

chain management issues.• Timely and efficient decision making of procurement and distribution of health logistics operations • Ensure uninterrupted supply of health commodities at all levels of the supply chain to ensure

uninterrupted quality health services

11.5 Proposed SCMWG MembersFederal level: SCMWG will be chaired by Director of Management Division. The SCMWG will consist of 22 individuals and concern division and other key stakeholders will be invited as per need:

S.N. MEMBERS ASSIGN POSITION NO. OF PERSON

1. Director of Management Division Chairperson 1

2. Chief of Logistics Management Section Co-Chair 1

3. Chief Finance Controller, DoHS Member 1

4. Legal Officer, DoHS Member 1

5. MoHP Member 1

6. PPMO Member 1

7. FWD Member 1

8. EDCD Member 1

9. CSD Member 1

10. NCASC Member 1

11. NTC Member 1

12. NPHL Member 1

13. World Bank Nepal Member 1

14. WHO Nepal Member 1

15. GIZ Member 1

16. USAID Nepal Member 1

17. GHSC-PSM Nepal Member 1

18. UNICEF Nepal Member 1

19. UNFPA Nepal Member 1

20. ADRA Nepal Member 1

21. DFID Nepal Member 1

22. Officer – Supply management Member Secretary 1

Total 22


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* Partners directly supporting in logistic management will be member as well as partners without logistic support plan will not be as a member.

A focal person (Secretary), who is responsible for coordinating the activities of SCMWG such as: conducting meeting and necessary follow-up; follow-up action plan; preparing and circulating minutes.

Province level: Proposed SCMWG at provincial level will be chaired by Director of Province Health Logistics Management Centre. The SCMWG will consist of 13 individuals and concern division and other key stakeholders will be invited as per need:


1. Director of Province Health Logistics Management Centre Chairperson 1

2. Division/Section chief, Province Health Logistics Management Centre Co-Chairperson 1

3. Division chief Province health directorate Member 1

4. MoSD/Health Division Member 1

5. Chief Finance Comptroller, Province Finance Member 1

6. PPHLC, Section Chief Member 1

7. Section Chief, Province Health Training Center Member 1

8. Chief Health Office-local district Member 1

9. Health Logistics Related pharmacist (hospital) Member 1

10. Statistics officer Member 1

11. Representative of NGO/INGO Member 2

12. Focal Person Province HLM centers Member Secretary 1

Total 13

A focal person (Secretary), who is responsible for coordinating the activities of SCMWG such as: conducting meeting and necessary follow-up; follow-up action plan; preparing and circulating minutes.

District level: Proposed SCMWG at district level will be chaired by Chief of Health Office. The SCMWG will consist of 11 individuals and concern and other key stakeholders will be invited as per need:


1 Chief, Health Office Chairperson 1

2 Health Office Finance Section Member 1

3 Health Office Admin Section Member 1

4 Health Office Store In charge* Member 1

5Health Logistics Related pharmacist (Hospital - 1 and PHI/HO - 1) and Computer Assistant (Hospital - 1 and PHI/HO - 1)

Member 4

6 Health Section Coordinator Member 1

7 Representative of NGO/INGO Member 2

8 Focal Person Health Office LMIS Sections* Member Secretary

TOTAL 12


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11.6 Standards of SCMWG Meeting• Meeting should be arranged at least quarterly or when necessary.• Set up the clear agenda of the meeting and ensure that its content is within the SOW.• Ensure that the agenda for the meeting are provided sufficiently in advance, presented in

comprehensive way for effective discussion.• Minutes of each SCMWG meeting is circulated to all members within 5 working days after the

meeting.• SCMWG can invite special expert- as deemed necessary upon the nature of the program or

issues.

A focal person (Secretary), who is responsible for coordinating the activities of LMWG such as: conducting meeting and necessary follow-up; follow-up action plan; preparing and circulating minutes.

Local level: Proposed SCMWG at local level will be chaired by Chief Administrative Officer (CAO) of Local Level. The SCMWG will consist of 8 individuals and concern and other key stakeholders will be invited as per need:


1. Chief Administrative Officer Chairperson 1

2. Chief of Health Facilities (Senior Most Health Worker among HF/Health Coordinator)

Co-Chair 1

3. Health Coordinator Member 1

3. Chief, finance section Member 1

4. Store In charge Member 1

5. Health Sub Coordinator/Health worker Member 1

6. Health Logistics Related pharmacist and representative of NGO/INGO

Member 1

7. Health worker/storekeeper Secretary 1

Total 8


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CHAPTER 4CAPACITY BUILDING AND SYSTEM ENHANCEMENT

CAPACITY ENHANCEMENT IS BASED ON TRAINING, WORKSHOP, ONSITE COACHING, FEEDBACK, MONITORING, MANUAL AND GUIDANCE

1. CAPACITY BUILDING: PROVINCIAL AND LOCAL LEVEL TRAINING ON BHL AND PPSTo ensure continues knowledge management of the health service providers, various Provincial and local level training on LMIS/Basic logistics for HSPs is being provided. Three different types of trainings were conducted on Basic Health Logistics (BHL) and Public Procurement System (PPS). Training of Trainers, Basic Health Logistics and Public Procurement System for municipal level staff and Basic health logistics management training for health facility level staff.

1.1 CAPACITY BUILDING FOR PROCUREMENT Capacity to execute the plan and programs in all level is very crucial for results. However, capacity building program in both institutional and human resource level has been planned in PIP, but the execution progress is not very encouraging. PIP envisages standard procurement procedure, quality assurance, grievance handling, supply chain management and HR capacity building programs. Some of them are executed in FY 2073/74 and 2074/75 (2017/18 and 2018/19) as outlined below.

I. Workshop, Training and Technical SupportLMS organized several workshops on TSB, CAPP, SOP on Procurement Management. Two SOPs on procurement management and eGP operation have been prepared, endorsed and distributed to local and provincial levels in FY 2073/74 (2017/18) with technical support through NHSSP and extensive technical support and capacity building program for Sub-National Governments (SNGs) level have been enhanced in FY 2074/75 (2018/19). Before eGP execution in LMD, 2 type of eGP training for DoHS staff have been conducted with the help of PPMO. After the completion of eGP training of DoHS staff, online eGP II system executed in DoHS since Mangsir 2074 (November 2017).

Some training module and its session plans are designed with the cooperation of PPMO. Logistic and Procurement Management Training Manual reviewed in FY 2074/75 (2018/19). In FY 2074/75 (2018/19) SNGs level capacity enhancement programs have launched several times in all provinces on the different topics like Forecasting and Quantification (7), Procurement Planning (7), eGP operation (7) and Trainers Training (TOT) in three provinces. Similarly, two eGP trainings in procurement were conducted at the central level; and four provincial/local level trainings were conducted in FY 2074/75 (2018/19).

II. Procurement ClinicProcurement Clinic is a troubleshooting approach applied in various cases of procurement


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TABLE 7: TOT ON BASIC HEALTH LOGISTIC MANAGEMENT AND PUBLIC PROCUREMENT TRAINING CONDUCTED IN FY 2075 AND 2076 (2018 AND 2019)

S. N VENUE PARTICIPANTS FROM # PARTICIPANTS

1 Nepalgunj Province 5 & Sudurpachim 23

2 Pokhara Province 5 & Bagmati 25

3 Biratnagar Province 1 & 2 12

Total in FY 2075 (2018) 604 Hetauda Province 1, 2 & Bagmati 16

5 Dhangadhi Sudurpachim 25

6 Biratnagar Province 1, 2 & Bagmati 20

Total in FY 2076 (2019) 61Grand total in FY 2075 & FY 2076 (2018 & 2019) 121

occurred in all divisions of DoHS. Basically, it is an advisory function for decision makers on procurement. The Procurement Clinic services are provided to other health sector procurement entities in all spheres of governments.

III. Monitoring Management through Committee approach:LMS believes in participatory approach of planning and monitoring. In order to strengthen, monitor, and sustain the initiatives, in FY 2073/74 (2017/18) MoHP has formed CAPP Monitoring Committee (CMC) under the leadership of Director General of the DoHS and endorsed its TOR to monitor overall matters of procurement and supply chain management. The ToR of CMC have been endorsed by the secretary of the MoHP with the provision of submitting their progress report to the MoHP PFM committee. DoHS has formed and expanded the technical committees governing by CMC as Logistics Working Group (LWG), Logistics Management Information System Task Force and Technical Committee for the Technical Specification Bank in DoHS. These all institutional setup have been completed in FY 2073/74 (2017/18).

2. BASIC HEALTH LOGISTIC AND PUBLIC PROCUREMENT SYSTEM TRAINING METHOD The Basic Health Logistics Training Manual was first developed in 2056 (2000-2001 AD) to enhance the capacity of personnel involved in supply chain management of health commodities. Five years late in 2005-06 the manual was revised after the implementation of pull system. Since then the manuals were not revised and many changes in logistics management have had occurred. Realizing this LMD took lead to revise the manual incorporating many new components. Forecasting, data quality and pipeline monitoring were added in 2017. The country is already in federal structure; local bodies need to have capacity of supply chain management of health commodities. The new revised manual is expected to assist them for the capacity enhancement in supply chain management, procurement, recording/reporting and use of data for evidence-based decision making.

I. Training of Trainers (TOT) on Basic Health Logistics and Public Procurement SystemThe main objective of the TOT was to train participants on basic logistic management and enable them to conduct and facilitate trainings in their respective district/Municipalities post the training. The participants were selected with close coordination with Logistic Management Section (LMS). Although, there were a total of 104 participants including trainers, experts, MD’s staff in 4 events organized in Biratnagar, Dhulikhel, Nepalgunj and Pokhara but 60 participants from provincial & HF level were certified as trainers on Basic health logistics management in FY 2074 (2018) and 61 trainers in FY 2075 (2019).


62

II. Training on Existing Package in 2075 A four-day ToT on Basic Logistic Management was conducted during 13 – 16 Ashad 2075 (27 - 30 June 2018) at Biratnagar with the purpose of facilitating the training to health workers at local level. Altogether, 40 participants (including 25 core trainees) from province one and two were attended the training. Basic Health Logistics trainer’s handbook was used to deliver all sessions which is designed by Logistics Management Division (LMD), Department of Health Services (DoHS). The training focused on logistics management system, storing medicine and supplies, physical inventory management, recording and reporting, authorized stock level (ASL), emergency order point (EOP), dispose and handover etc.

At the end of the training, reflection of the training has been obtained from the participants. There are few structural changes suggested in the new federal context. Similarly, experts and participants were agreed to include sessions like forecasting and procurement in humanitarian situation and proposed to revise the training module prior to the endorsement. After the training, LMD has formed a technical working group to incorporate all suggestions and compliments.

III. Training Package Revision in FY 2075A three-day workshop on training package revision of Basic Health Logistics and Public Procurement System Training was successfully completed in Dhulikhel during Shrawan 4 – 6, 2075 (July 20-22, 2018). Feedbacks obtained in the workshop from the experts and support agencies on Participants Handbook and Trainers 'Guide for Basic Health Logistics and Public Procurement System were incorporated in the revised package and indorsed by Management Division and Department of Health Services.

A total of 19 experts participated in the workshop including Chief Procurement Section- Under Secretary Mr. Babu Ram Lamichhane, LMD, Chief Finance Controller Mr. Madhu Pokharel DoHS, Account Officer Mr. Tanka Prasad Paudyal LMD and legal Officer Mr. Shree Krishna Poudel from DoHS and representatives from NHSSP, GiZ, UNFPA, ADRA Nepal.

IV. Training of Trainers on Revised Package in FY 2075Two events of training of trainers on Basic Health Logistics and Public Procurement System were organized in Nepalgunj and Pokhara. These ToT were conducted with the leadership of Management Division, Logistic Section with Technical Assistance and Financial Support from ADRA Nepal. The training sought to prepare trainers on Basic Health Logistics and Public Procurement Training for procurement of health commodities. Altogether 45 participants from Palikas, MoSD, UNFPA, JSI, PSM and ADRA attended the training successfully.

Basic Health Logistics trainer’s handbook was used to deliver all sessions which is designed by Logistics Management Division (LMD), Department of Health Services (DoHS). The training focused on logistics management system, storing medicine and supplies, physical inventory management, recording and reporting, authorized stock level (ASL), emergency order point (EOP), dispose and handover etc.

V. Training of Trainers on Revised Package in FY 2076Three events of training of trainers on Basic Health Logistics and Public Procurement System were organized in Hetauda, Dhangadhi & Biratnagar. These ToT were conducted with the leadership of Management Division, Logistic Section with Technical Assistance and Financial


63

TABLE 8 MUNICIPALITY LEVEL 4 DAYS TRAINING IN 2018

SN DISTRICT/ MUNICIPALITY BATCHES PARTICIPANTS

1 Bajura 1 26

2 Baitadi 2 37

3 Achham 1 31

4 Bajhang 2 44

5 Arghakhachi 1 21

6 Kapilbastu 1 33

7 Pyuthan 1 29

8 Rupandehi 2 52

9 Rukum 1 24

10 Rolpa 1 29

11 Rautahat 2 55

12 Sarlahi 2 56

13 Sunsari 2 33

14 Udaypur 1 26

15 Godawari Municipality 1 13

16 Nepalgunj SMC 2 29

17 Bidur Municipality 1 19

18 Nilkantha Municipality 1 20

19 Madhyapur Thimi Municipality 1 14

Total 25 591

Support from ADRA Nepal. The major objective of the TOT was to train participants on basic logistic management and enable them to conduct and facilitate trainings in their respective district/Municipalities post the training. A total 61 participants were attended from Palikas, MoSD of provinces 1,2, Bagmati & Sudurpachim, UNFPA and ADRA.

Additionally, in collaboration with Management Division/Logistic Management Section and GIZ/ Support to the Health Sector Programme (S2HSP) conducted 5 days ToT to Chief Administrative Officer, finance chief, health coordinator, sub coordinator and Social Development Officer of five municipalities (Nepalgunj SMC, Godawari Municipality, Nilkantha Municipality, Madhyapur Thimi Municipality and Bidur Municipality), altogether 24 participants were trained.

VI. Capacity strengthening on basic logistics to HSPs at Municipalities and health facilities in FY 2075A 4-day training on Basic Health Logistics and Public Procurement System was organized in all targeted 14 districts. A letter from Management Division (MD) was circulated to the respective districts to invite the participants from Palika; such as Health Coordinators, Sub-health Coordinators and Health Store Focal Point. The main goal of the training is to improve knowledge and skill of the participants prior to work by the participants at Palika level. The trained personnel from respective Local Government who are responsible for logistic management and procurement system of health commodities including medicines and ensure the availability of adequate supply of medicine and health commodities in health facilities to provide effective health care service at Local level. A total of 25 batches of trainings were conducted which trained 591 government staff on Basic Health Logistic and Procurement system at municipality level. (see table 8)


64

a. Printing and distribution of Training Package in 2018In the financial support of UNFPA and coordination of Management Division, the developed Basic logistic and procurement training manual and trainer’s guide (training package) was printed in 2018. The printed training package was distributed to all program implemented districts and municipalities in coordination with provinces for conducting the further training in their respective HFs. Rest of the manuals were handed over to Management Division/DoHS in 2019.

b. Technical Support to Logistic Management to update training manual of BHLPPP in 2019• Basic Health Logistic and Public Procurement Process training manual and trainer’s guide

was updated by ADRA Nepal in coordination with Management Division. During the update meeting, 11 experts were participated from MD/DoHS.

• Produced two volumes of Interactive Digital Visual (HD quality video) Training Manual on LMIS (15 minutes of each documentary): one for overall procurement process and another for logistics management.

• Supported in publication of basic LMIS report• Supportive supervision/monitoring visits were conducted to monitor the ToT of BHLPPP

by Director from management division, director form health directorate of province no.3, Chief of Health division from MoSD-3 & other staff of MD, UNFPA & ADRA Nepal in 2018 & 2019.

c. Health Commodities Supply Chain - Planning skills and data driven decision-makingThe activity encompasses formulation of terms of reference in the form of meeting facilitation guidelines in the conduct of quarterly supply chain management working group (SCMWG), a

TABLE 9 HEALTH FACILITY LEVEL 2 DAYS TRAINING CONDUCTED IN 2018 & 2019

SN DISTRICT BATCHES PARTICIPANTS

1 Sunsari 2 60

2 Rolpa 2 52

3 Pyuthan 3 80

4 Rautahat 3 84

5 Sarlahi 4 115

Total in FY 2075 (2018) 14 3911 Sunsari 2 56

2 Udaypur 2 43

3 Sarlahi 2 43

4 Rautahat 2 54

5 Arghakhachi 2 49

Total in FY 2076 (2019) 10 245Grand Total in 2018 & 2019 24 636

VII. Capacity strengthening on basic logistics to HSPs at health facilitiesA 2-day training on Basic Health Logistics was organized for health facility level staff. Invitation letter was sent by DPHOs/Palika to their respective health facilities to invite two participants from each health facilities. A total of 14 batches of trainings in FY 2075 (2018) were conducted which trained 391 government staff on Basic Health Logistic system at Health Facility Level. Likewise, 245 HSPs from 10 batches of training were trained in FY 2076 (2019). The details of the accomplished activities are shown in the table 9.


65

health commodities supply chain governance forum constituted of all relevant stakeholders and development partners. The federal terms of reference for SCMWG was approved and circulated as reference document for adaptation at the province, and local level government in their formation and conduct of health commodities SCMWG meetings. So far, formal meeting was conducted at federal level on Nov 12, 2019; Pradesh 5 on Jan 10, 2020 and March 13, 2020; Sudurpaschim Pradesh on Dec 30, 2019 and April 24, 2020 and in Pradesh 2 on May 15, 2020. The Ministry of Social Development (MoSD), Province 5 on 2076/10/26 has approved a term of reference of SCMWG for Province Health Logistics Management Center (PHLMC).

In the meeting, key decisions were made to improve supply chain performance, facilitate use of eLMIS data for decision-making on pipeline, quantification, procurement and distribution and inventory management as well as good practice in storage. The Division in support of USAID has deployed contractual pharmacist in bringing about improvement in health commodities supply chain performance at central, provincial and a few health offices. As a result, there is ample improvement at functionally indicating clearly a need for review of organizational structure and creating opportunity for their integration.

SCMWG has also advocated for measures to ensure regulatory compliance for Oxytocin Injection storage condition at 2 to 8 degrees by suppliers and procurement entities (mainly at local level) and birthing centers at all levels of supply chain. conceptually, there is stakeholders (MoHP system, and partners mainly UNICEF – country, region and HQ consensus in integrating a few key life-saving commodities like ARV, ASV, Oxytocin, Mag Sulfate, and Insulin in the EPI system in the course of drawing National iSC Roadmap Design (First consultative meeting on developing road-map for iSC design at national level, 27-29 Dec 2019).

The meeting has always emphasized for generation of real-time LMIS data for evidence-based decision making, and monitoring key supply chain indicators like availability of stock according to plan, order fill rate, supply plan reviews aiming to eliminate stock-outs, near expiries or expiries, poor inventory management and processes that prevent effective supply chain operation.

In this direction, LMS, MD would like to draw attention of all stakeholders and partners for their necessary coordination and advocacy, and contribution for eLMIS implementation and monitoring of the impact at all levels of supply chain. At this stage, eLMIS is in use at all central and provincial warehouses, health offices and a few local level and health facility store in Karnali and Pradesh 5, CCMC / HEOC / MoHP, Office of DG / DoHS, and many COVID-19 treatment hospitals, and is in verge of scale-up nationally following MoHP decision on eLMIS scale up on May 14 2020 (MD letter ref no 1780 dated May 20 2020), and thus paving way for eLMIS official launch.

Until the real-time transaction and/or reporting system reaches at all types of health facilities, we would sincerely request all also for improving LMIS reporting rate as well as monitoring data quality and timeliness of reporting. Ultimately, timely availability of quality data matters in taking timely decision on intervention measures.


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d. Role and responsibilities of different level of supply chain for adequate capacity and performanceAiming to improve performance of health care delivery system overall - health workforce, organization, and delivery of patient-centered service, structural reforms were implemented In the Federal health system. Accordingly, roles and responsibilities have been redefined and implemented to bring about desired improvement in behaviors and competencies of health workers and organization, and finally to generate system capability, and sustain gains in the service delivery performance.

There is separate role and responsibilities for different level in consistence with the constitutional mandate and function of different level of federal health system - Logistic Management Section, DoHS, procurement and logistics management section of Province health directorate, PHLMC, Health Office, Local levels and the health facilities. The detail of all these roles and responsibilities is produced in the Logistics report.

A desk review on existing roles and responsibilities of supply chain organization and work force, and survey-based review of performance and capability is under way. Both these activities are expected to provide a comprehensive view of province supply chain system, current performance, processes, technologies, and human capacity, and serve as guiding document on priority activities based on key supply chain functional areas to improve supply chain performance at the province. The approach is to develop capability, measure performance, innovate intervention until gain of performance at acceptable level. Capability for system learning and improvement as long-standing practice, and emergence of new collective norms on the supply chain mandate are necessary conditions for uninterrupted availability of health commodities at all service delivery points, and therefore the patient-centered care directed towards universal health care.

3. LMIS TOOLS UPDATEDLogistics Management Information System (LMIS) is key function of the Logistics Management Section. LMIS tools are using since from 1997 all districts and SDPs. It was revised LMIS tools time to time as required. In the Federal context, need to update the LMIS tools in 2075 with the supported by Save the Children Nepal. MD organized and one day workshop to update the tools with the participation of core teams represents from DoHS/Divisions/Centres/Sections, EDPs partner and Stakeholders with following objective, output and process. Objective: Update of LMIS tools according to procurement and supply commoditiesOutput: Uniformity of reporting systemProcess: Meeting with program division/centres, Collection of feedback, finalization of commodities, finalization of tools, printing and distribution

TABLE 10: NUMBER OF ITEMS IN REVISED LMIS BY LEVEL

LMIS TOOLS FOR

REVISED TOOLS IN 2072 COMMODITY

ITEMS

OLD TOOLS COMMODITY

ITEMS

UPDATED TOOLS IN 2075 COMMODITY

ITEMS

REMARKS

District Store 232 232

203

Before 2075 there was separate tools for institutional wise but after updated new tools used integrated one form for all SDPs

District Hospital 232 232

PHC 193 193

HP 132 132

NGO 5 5 5 No change in NGO tools


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4. NEW MAA.LE.PA FORMS AND FORMATSThe tools are important for storage, distribution and recording/reporting as Ma.Le.Pa Form and LMIS for Medicines, Vaccines, Family Planning Commodities and others more. We should update the manual as changed the Ma.Le.Pa Form and other important area. Management Division will print the updated manual and will distribution and supply of manual as requirement basis. Government of Nepal (FCGO) has been circulated to replace all new Ma.Le.Pa. Forms and Formats as used in Organization. Management Division had organized a meeting for replace the new forms and formats which are used in inventory management with the participation of concern division/section and stakeholders and decided to replace all forms and formats in LMIS/eLMIS as soon as possible.

5. CAPACITY DEVELOPMENT ON eLMIS IMPLEMENTATION (JOURNEY)eLMIS journey began on Ashwin 2074 with selection of the off-the-shelf software solution for the Electronic Logistics Management Information System (eLMIS). The eLMIS project initiation meeting was held on Kartik 2074.

I. Software Customization: Software customization preparation began with the first requirement gap analysis workshop in Kartik 2074 to validate the selected software application against the business requirements by end-users themselves.

II. Master Dataset Finalization: Master health facility, health commodity and equipment, manufacturer, supplier and donor datasets were gathered, compiled and finalized in consultation with MD using authorized data sources. The final datasets were presented to MoHP eHealth unit who praised the work for facilitating the interoperability of the different health information systems. The master data was signed off by MD in Magh 2074 and migrated onto the eLMIS after the data was reviewed for quality assurance.

III. eLMIS Familiarization Workshop: A pre user acceptance test workshop was organized to familiarize users to eLMIS on Magh 2074. During this workshop eLMIS was demonstrated to all stakeholders on the configuration and customization done based on their requirements agreed on Ashar 2074 and requirement gap analysis workshop held on Kartik 2074.

IV. eLMIS Training Curriculum Finalization: The eLMIS training of trainers’ and user training curricula were developed by curriculum development sub-committee under LMIS Taskforce for the online, offline and mobile modules in English and Nepali in consultation with MD and NHTC. The curriculum was finalized and approved by NHTC on Falgun 2074.

V. Training of Trainers: The training of 24 eLMIS master trainers were produced on Falgun 2074 as a cadre of government trainers from DoHS; LMD/Management Division; central, regional and district stores; the Province 6 Regional Health Training Centre, the National Health Training Centre (NHTC) and the National Health Education, Information and Communication Centre (NHEICC).

VI. User Acceptance Tests (UAT): System was validated on UAT held on Chaitra 2074 for system endorsement by LMD at which master trainers, and MoHP, regional and district health office and service delivery point representatives ran test scenarios at all levels of the supply chain.

VII. User Trainings: eLMIS user trainings were started on Chaitra 2074 after endorsement of


68

solution on UAT. The training was conducted by master trainers from MD and Bileeta to equip participants to roll out the eLMIS online module.

VIII. Develop Support Mechanism and Helpdesk: A support structure for eLMIS users became operational from Chaitra 2074 before any site goes live on eLMIS. The establishment of a helpdesk, staffed by support engineers and support manager, located at the Management Division, provides user support through a toll-free helpline, trouble-shooting guidelines, support personnel and training. The helpdesk receives calls and emails from eLMIS users, which are logged and given support tickets. In addition, LMIS support officers were deployed at the larger sites including the Central Medical Store (Teku and Pathlaiya), RMS Butwal, RMS Nepalgunj, and Bardiya and Surkhet district stores. IX. eLMIS Standard operating procedures: The standard operating procedures for the functionality of the eLMIS was developed to address user difficulties. The SOPs was reviewed by Management Division.

X. Software updates: The eLMIS continues to get feedback for improving existing features and adding new requirements. eLMIS introduced software updates from Ashadh 2075 and has been continuously making improvements based on user feedbacks and suggestions since then to make the software more user-friendly.

XI. eLMIS monitoring and data utility for decision making: eLMIS performance dashboards were developed and updated weekly to monitor and show the use of the eLMIS at the live sites.

XII. eLMIS operational monitoring: In Ashoj 2075, senior personnel from the Management Division, USAID, GHSC-PSM, GIZ, and UNICEF visited four Banke and Bardiya eLMIS rollout sites and confirmed that eLMIS was operational at all visited sites. The team suggested the sites to utilize the information that the eLMIS generates by developing a culture of information-based decision making for inventory management. The team also recommended adequate government human resources are the key for the long-term success of the eLMIS.

XIII. eLMIS implementation assessment and adjustments based on lesson learnt: Management Division assessed eLMIS operational sites in Mangsir through support from GHSC-PSM project in Mangsir 2075. Assessments was conducted at representative eLMIS operational sites, this included all level of supply chain (i.e. CMS, PMS, district, LLGs and SDPs) and all types of eLMIS modules (i.e. online, offline and mobile modules of eLMIS). The recommendations of assessment were adopted into eLMIS as lesson learnt.

XIV. eLMIS review workshop: eLMIS workshop was organized by logistic management on Magh 3-4, 2076 (17-18 January 2020) in Dhulikhel, Kavre to share a lesson learn and experience by the users and figure out the best approach and way forward to eLMIS scale-up in remaining sites. Field level staffs, Provincial Staffs and decision level staffs from Ministry and DoHS were participated in the workshop. The purpose of this eLMIS evaluation workshop was also to assess the progress, acceptability and the effectiveness supply chain performance from the eLMIS user in the province, district, and local levels. In the workshop, the users from the district and palika expressed how eLMIS system helped them to improve inventory management and supply chain decisions making. The user recommended to scale up eLMIS as quickly as possible for the complete supply chain information. In addition, the users also expressed their concerned regarding the timely response of their eLMIS issues and suggested developing a calendar of


69

operation to address the issue raised by the province, palika, and districts. Based on the eLMIS user feedback, Chuda Mani Bhandari, Chief HCWM/Logistic Management Information System shared the findings during field level assessment and monitoring visit and Bhogendra Raj Dotel, Director of Management Division concluded the eLMIS review workshop by saying eLMIS is a policy-level decision and Management Division will forward eLMIS scale-up plan to the Ministry with all the suggestions and feedback provided by the users during these two days of the workshop with positive recommendations for eLMIS scale-up.

Participants taking photographs after the workshop.


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1. PROCUREMENT AND SUPPLY CHAIN MANAGEMENT OF ESSENTIAL DRUGS AND COMMODITIES IN FEDERAL CONTEXTThe Constitution of Nepal promulgated in 2015 confers high level of functions to the local governments. The local level restructuring and unbundling of functions between different levels of government also reiterate the fact that health service delivery will be a key function of local governments. The functions of local governments relate to their role in basic health service delivery and in leading local development. Procurement and logistics management of drugs and medical items is a key task for ensuring basic health service.

Local government has responsibility to provide quality, easily access health service to every citizen which is directly associates with the procurement and logistics management practices. Public procurement act 2063 and public procurement regulation 2064 has shown roadmap to standardize procurement practices in three level of government.

Right quantities, quality, appropriate price, date of delivery, storage environment is the major variable that has to be address while doing procurement of drugs and medical items from concern authorities. Proper procurement helps to maintain required number of medical items and drugs and helps to reduce stock out, drug expiry and ultimately reduce total cost in health sector.

The objective of proper logistic management practice is to ensure continue supply of drugs and to prevent drugs wastage in health facilities. Inadequate supply of medical item and drugs in health facilities are leading cause in deteriorating quality health service. Thus, local level government needs to highly focus and should be serious on proper procurement and logistics management of drugs and medical items.

Before federalism of Nepal- Logistics Management Division (LMD) was the major unit to quality assurance, forecast, quantify, procure, store and distribute drugs and essential commodities. Basically, the system was, Logistics Management Division sends the procure drugs and commodities to Regional Medical Store and regional medical store distribute the drugs and commodities to District Public/ Health offices. Later, D/PHO distributes the drugs and commodities to service delivery units within the district. Moreover, procurement was done by all three levels LMD (70%), D/PHO (20%), and Regional Health Directorate (10%) respectively.

It is challenging and completely new job for local government to ensure smooth and effective procurement and logistics management practice. One of the major challenges in this regard is the lack of capacity among the elected representative and municipal health unit staff. Considering this gap, capacity development of municipality staff was deemed on procurement and logistics management practice and considering the fact, logistics management unit of Management Division

CHAPTER 5TRENDS OF LOGISTIC INDICATOR


71

has developed a local level standard guideline on procurement and supply chain management to capacitate the local government. The functional analysis assignment has defined the key functions of federal, provincial and local government for procurement and supply of key commodities thus Ministry of Health and Population and Department of Health Service has clarified the list of commodities to be procured and supplied by these three tires of government to ensure the effective health service delivery. Drugs, commodities and medical equipment are supplied to local government from central medical store and provincial medical store based on the pull and push system approach.

2. AVAILABILITY OF KEY COMMODITIESThe concerned authorities aim to make year-round availability of health commodities in all health facilities. National stock out of health commodities has been steadily decreasing in last two fiscal years. The average availability of contraceptives and key MCH commodities has increased in HFs in comparison with previous fiscal years.

Though the demand and consumption of essential drugs has increased drastically after implementation of free basic health service policy up to hospital level, the stock out of the selected drugs has been reduced. The availability of health commodities is increased in health facilities is because of scale-up of Pull System, monitoring of LMIS and inventory management, health institution level logistics orientation, and other capacity building activities at various levels. There is a need to decrease the stock-outs % of essential drugs in the health facilities, for this there is need to strengthen the supply chain system from local level to health facilities and effective implementation of Pull system.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Condom Depo Implant IUD Pills Cycle

8.45%

9.96%

8.55%

12.93%

9.91%

7.60%

18.54%

18.76%

16.71%

21.71%

19.68%

22.27%

12.28%

11.09%

11.35%

2074/75 2075/76 2076/77 (half-yearly)

Stock situation of FP commodities


72

The chart gives the stockout percentage of MNH commodities in HFs in FY 2074/75 to 2076/77 health facility wise. There is distinct stockout situation seen among all key MNH commodities where dramatic difference is seen in oxytocin followed by Gentamycin, Chlorohexidine and Zinc Sulphate.

3. REPORTING STATUS3.1 LMIS REPORTING STATUSThe LMIS has helped to generate accurate and reliable feedback reports, thereby contributing to improved logistics functions like budgeting, quantifying, forecasting, procurement, storage, transportation and distribution of MCH commodities and essential drugs to be procured by the federal, province and local governments. With closely monitoring LMIS information, it has played a key role in reducing stock-out rates and increasing year-round availability of key health commodities.

Stock situation of MNH commodities

% of LMIS reporting status

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Amoxycillin ChlorhexidineGel 4% Tube

GentamycinInjection

MagnesiumSulphate

ORS Oxytocin Zinc Sulphate

23.07%

21.80%

16.28%

16.98%

24.74%

18.20%

22.90%

25.48%

18.07%

25.24%

30.30%

31.11%

14.73%

12.21%

5.69%

79.60%

59.96%

24.96%

8.19%

15.80%

10.10%

2074/75 2075/76 2076/77 (half-yearly)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

National Province 1 Province 2 BagmatiProvince

GandakiProvince

Province 5 KarnaliProvince

SudhurPaschimProvince

54.60%

72.15%

89.35%

54.38%

76.89%

90.50%

55.25%

70.55%

83.31%

50.75%

66.61%

80.56%

56.43%

60.25%

95.65%

56.48%

79.13%

96.22%

50.22%

72.02%

87.46%

60.62%

81.81%

96.92%

2074/75 2075/76 2076/77 (half-yearly)


73

LMIS is a credible information system in the MoHP and is being used in Health Sector Reform document defining procurement indicators and reporting on stock situations. LMIS, at Federal, Provincial and Local is used extensively for key logistics decision making such as forecasting, quantification, procurement and distribution of health commodities. Moreover, LMIS is being used at all levels for evidence-based logistics decision making.

Over the years, LMIS reporting trend is improving as compared to 2075/75 to 2076/77, thus National reporting status has also increased in over the years by 2076/77. After the federalism, all the functions monitoring and reporting responsibility was assigned to local government, and with the limited human resource and capacity of municipal health unit staff as well as frequent transfer of health facility and municipality human resource, due to this HF could not compile and send the reports in time.

Analyzing the Province wise reporting percentage, there has been sharp increase in Sudhurpaschim Province in over the years latest FY 2076/77 is 96.92 % reporting. Each province has shown a remarkable progress over the years with dramatic change in figures. It is the big achievement in the short period of time. MD/LMS take actions to all 77 districts to entry data on eLMIS with facilitation of training to staffs within one months supported by partner.


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PLANNING: Logistic management Section (LMS) had adopted mainly 2 types of Planning System 1. Annual Work plan and Budgeting system 2. Five years Plan.

Along with these plans LMS reviews the list of health commodities annually to be finalized for upcoming period to plan the commodities supply and reporting of them.

MONITORING: Periodic movement by the team of LMS in the ground level provide the actual information of the field which will be compiled as a field report and been shared with the team. All these movements will be as per annual plan and activities, its goals and objectives, target vs achievement etc.

EVALUATION: Based on the report of field visit and quarterly LMS report differences analysis will be done based on plan and activities and progress report on target vs achievements as monthly, bimonthly, trimester, biannual and annual. These evaluations will support to plan/modify the further activities of LMS.

1. MAJOR ACTIVITIES CONDUCTED 1.1 MAJOR ACTIVITIES CARRIED OUT DURING FY 2074/75• Construction of central medical warehouse in Pathalaiya• Procurement and distribution of Hospital Equipment, Materials• Procurement and distribution of Ambulance and Vehicles to the Hospitals and Regional Offices• Procurement and distribution of Desktop, Laptop to the Regional and District Health Offices• Quantification, forecasting, procurement and distribution of essential drugs and program

commodities • Printing and distribution of LMIS tools• Pipeline monitoring of the essential drugs and program commodities• Maintenance and repair of vehicles, biomedical/cold chain equipment and materials• Publication of 2nd 3yrs Logistics Report• Capacity building on Basic Health Logistics/LMIS• eLMIS piloting on 57 sites

1.2 MAJOR ACTIVITIES CARRIED OUT DURING FY 2075/76• Construction of Central Medical Warehouse in Teku• Procurement and distribution of Hospital Equipment, Materials, ambulance, vehicles,

computers to the Provinces and Local levels• Quantification, forecasting, procurement and distribution of essential drugs, program

commodities

CHAPTER 6PLANNING, MONITORING AND EVALUATION


75

• Pipeline monitoring of the essential drugs and program commodities• Maintenance and repair of vehicles, biomedical/cold chain equipment and materials• Printing and distribution of new updated LMIS tools• Updated of training materials: Basic Health Logistics and Public Procurement System• Publication and distribution of facilitation handbook on procurement and e-procurement

system• Publication and distribution of facilitation and workbook on Quantification• Established grievance handling and redressal mechanism by online through website• Rollout and capacity building on Basic Health Logistics/LMIS/eLMIS• Training of Trainers on Basic Health Logistics and Public Procurement to the Provinces and

Local Level Staffs

1.3 MAJOR ACTIVITIES CARRIED OUT DURING 2076/77 (HALF YEAR)• Continue construction of Central Medical Warehouse and National Vaccine warehouse in Teku• Procurement and distribution of Hospital Equipment, Materials to the Provinces and Local

levels• Quantification, forecasting, procurement and distribution of essential drugs, program

commodities • Pipeline monitoring of the essential drugs and program commodities• Maintenance and repair of vehicles, biomedical/cold chain equipment and materials• Training of Trainers on Basic Health Logistics and Public Procurement to the Provinces and

Local Level Staffs• Data entry training on eLMIS to the Province and local level staffs• Standard building design of provincial and local level warehouses• Development and distribution of LMIS tools writing instruction visual through website: www.

dohslmd.gov.np • Emergency supplies of commodities for COVID-19 prevention, control and treatment• eLMIS Scale-up process to all level health institutions focused on COVID-19 Commodities.• eLMIS Scale-up plan approved by Ministry.

2. BUDGET CONTRIBUTION IN RED BOOKCONTRIBUTION IN AMOUNT NRS in Thousand

FISCAL YEAR GON UNICEF USAID UNFPA POOL FUND TOTAL

2074/75 224400 45050 20000 500 202050 492000

2075/76 138600 5200 25300 0 145500 314600

2076/77 218385 10250 16800 0 0 245435Source: LMD/MD Budgeting and Planning

0

100000

200000

300000

400000

500000

GoN UNICEF Pool FundUNFPA TotalUSAID

2244

00

2183

85

1386

00

4920

00

2454

35

3146

00

2020

50

1455

00

50020

00

0

1680

0

2530

0

450

50

1025

0

520

0

2074/75 2075/76 2076/77


76

Table shows that govrernment contributed about 45% budget in 2074/75 and 2075/76 fiscal year whearas all partners contributed about 55% budget in two fiscal year. Similarly, GoN contributed almost 90% budget and remaining 10% budget contributed by all partners in 2076/77 fiscal year in red book.

C. PHYSICAL VS FINANCIAL

FISCAL YEAR PHYSICAL FINANCIAL

2074/75 80% 74%

2075/76 95% 75%

2076/77 (Half Year ) 70% 55%

B. CONTRIBUTION IN PERCENTAGE

FISCAL YEAR GON UNICEF USAID UNFPA POOL FUND TOTAL

2074/75 45.90% 9% 4% 0.10% 41% 100%

2075/76 44% 1.65% 8% 0% 46% 100%

2076/77 89% 4.15% 6.85% 0% 0% 100%

Comparing the physical vs financial achievements for the FY 2074/75, 2075/76 & half year of FY 2076/77 the physical achievement shows progress from 80 to 90 % similarly, the financial achievemnts shows progress from 74 to 75 % respectively.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2074/75 2075/76 2076/77 (Half Year)

80%

95%

74% 75%70%

55%

Physical Financial

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

GoN UNICEF Pool FundUNFPA TotalUSAID

45.9

0%

89%

44%

100

%

100

%

100

%

41% 46

%

4 % 6.

85%

8%

0.10

%9%

6.85

%

1.65

%

2074/75 2075/76 2076/77


77

This program was supported from UNICEF to accomplish the logistic activities through logistic management section.

Table shows that, reduced financial irregularities of MD gradually from Fiscal Year 2074/75 to 2076/77. The financial irregularities seem high in FY 74.77 in comparison to 75/76. In FY 76/77 as well seems very low clearance and high balance. But the report is up to second quarter of this FY so large amount of expended costs are in the clearance process. So, we hope we will have better performance in terms of financial clearance in this fiscal year.

FINANCIAL IRREGULARITIES NRS in Thousand

FISCAL YEAR TOTAL IRREGULARITY CLEARED BALANCE

2074/75 (LMD) 324049 169321 225723

2075/76 (LMD) 225723 131773 77851

2076/77 (Half Year) MD 77851 766 77085 Source: DoHS Finance Section

3. EVM ACTIVITY EVM ACTIVITIES VS BUDGET

2074/75 2075/76 2076/77

ALLOCATED EXPENDITURE ALLOCATED EXPENDITURE ALLOCATED EXPENDITURE

Workshop with Stakeholders 300,000 236,612 - - 253,000 303,000

Onsite coaching & PPM 800,000 769,395 - - 1,068,750 200,000

Workshop on Policy Guideline 300,000 - - - -

EVM Implementation Plan (Base line survey) - - 273,000 -

Technical Assistant on CCEOP & Orientation - - 2,266,750 750,000

Capacity building & Review & Planning - - 4,919,200 2,750,000

Total 1,400,000 1,006,007 - - 8,780,700 4,003,000

Table shows that almost AWPB activities were done in 2074/75 and 2075/76 fiscal year and more than 50% achieved in half year of 2076/77 fiscal year

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

4500000

5000000

2074/75 Allocated 2074/75 Expenditure 2076/77 Allocated 2076/77 Expenditure2075/76 Allocated 2075/76 Expenditure

Workshop withStakeholders

Onsite coaching& PPM

Workshop onPolicy Guideline

Capacity building& Review & Planning

Technical Assistanton CCEOP

& Orientation

EVM ImplementationPlan (Base line survey)


78

4. PHLMC PROGRESSMAJOR LOGISTICS ACTIVITIES DONE BY PHLMC

S.NO PROVINCE NAME/NO PROCUREMENT DONE DISTRIBUTION

ACTIVITY TRAINING WAREHOUSE CHALLENGES

1. Province # 1 Essential & ayurvedic drugs, hospital equipments, cold chain equipments, PPE & lab equipments for COVID 19 for Corona epidemic.

Essential medicines Programmed items & surgical items. Regular Vaccines.

Basic Health logistics management & public procurement training to Health Coordinators.eLMIS data entry training.

Well equipped with appropriate inventory management via eLMIS.

Inadequate rooms for employee as well as storage.Lack of manpower with the reference to the GoN sanctioned positions.No proper guidelines for new assemblies.

2. Province # 2 Essential drugs, ayurvedic drugs, hospital equipments, cold chain equipments, PPE & lab equipments for COVID 19.

Vaccine & medicines for MR camping, regular supplies of medicines and vaccines as per routine supplies.

Quantification & forecasting of essential medicine workshop to district & hospital managers.eLMIS training to district & hospital storekeepers

Provincial rented warehouse is functional with limited storage capacity.District warehouses need support for strengthening.Land purchase for provincial warehouse is in process.

Scarce HR.No office vehicle for transportation.Procurement authority is not clear at all levels.Lack of coordination in between district & Palikas.Unable to do timely reporting due to lack of trained staffs.Delayed in budget release from MoSD.

3. Bagmati Province

Double cab pickup, 4WD SUV, 32-seater minibus, essential and ayurvedic medicine, hospital equipment, LLIN, HMIS tools and COVID-19 related equipments.

Vaccine and medicine for MR camping’s, regular supplies of essential drugs and other commodities. COVID-19 management equipments.

Provincial level quantification and forecasting workshop.

Lack of sufficient storage space.District level store needs further support. Lack of sufficient manpower.

Unreliable data from districts and LLG.Necessity of SOP.Lack of skilled manpower.

4. Gandaki Province

Haemodialysis machine, essential and ayurvedic drugs. Hospital equipments.

Regular essential drugs, vaccine, medical equipments & commodities

eLMIS training to storekeeper.Quantification & forecasting workshop to district & hospital managers.

All districts warehouses are strengthened. Hospital warehouse yet to be supported.Insufficient space at province warehouse.

Difficult to get land for office building & warehouse construction.Difficult to manage damaged equipment and furniture.No clear guidelines for all level.Delayed budget release.

5. Province # 5 Essential drugs, ayurvedic drugs, hospital equipments, cold chain equipments, PPE & lab equipments for epidemic COVID 19.

Essential & ayurvedic medicine, distribution of medical & lab equipments.COVID19 related PPE and regular supplies.

Basic Health Logistic Management and public procurement training, Basic Health Logistic Management and public procurement training, EVM training, Basic logistic and public procurement & Onsite coaching and mentoring for smooth e-LMIS reporting.

Well-equipped but not sufficient space.Well maintained warehouses at districts. Need to strengthen capacity at local level by monitoring and coaching.

Lack of knowledge on forecasting and quantification.Difficult to estimate actual supply.Lack of monitoring and supervision.Warehouse at Rukum is not satisfactory and same with LLG.Duplication in procurement.

6. Karnali Province

Procurement of essential (in process) and ayurvedic medicines, HMIS tools, COVID -19 related equipment and medicine and buffer stock medicines.

Distribution of regular medicines & commodities vaccine and medicine for MR camping, medical equipments and equipment for COVID-19 management.

Provincial level quantification and forecasting workshop.

Low storage capacity, all district’s warehouses are functional further support needed. Lack of skilled manpower.

Problem being faced in supply chain.

7. Sudurpaschim Province

Ayurvedic medicine, portable lab & oxygen concentrator, IMNCI drugs, isolation beds, COVID-19 health commodities.

Essential drugs & program commodities, vaccines.

LMIS data entry.ToT for logistic management & procurement up to local level.

Does not have own building.Difficult to follow scientific logistic management technologies.Lack of updates on LMIS & store management.

Difficulty in forecasting commodity as per real need.Lack of availability of store space & manpower.

Monitoring and Supervision: It extends technical support and onsite coaching on procurement, storage, inventory, recording reporting, LMIS to Province, District and Local level for improvement on procurement and supply chain management in Health Sector.


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5. COVID-19 LOGISTICS MANAGEMENT ACTIVITIES Supply Chain Management on Disaster and Health Emergency Management is one of the key actions of the Logistics Management Section. Nepal has been faced many of disaster and health problems such as Earthquake, Flood, Landslide, Hot & Cold and epidemic/outbreak of diseases as Bird flu/Seasonal flu, Measles, Cholera, snake bite, animal bite etc.

Now, most of the countries are facing health problem of fast spreading and fatal pandemic Corona Virus Disease (COVID-19). Nepal is not absence of this disease (COVID -19). Nepal is aware and prepared all health institutions in staring time on January 2020. All provinces are prepared quarantine places as well as isolation wards in major hospitals and establishment of labs and procurement and supply chain management of essential lab equipments, reagents, kits, protective equipments, IR thermometer, disinfectants, sanitizers as demands and required side by side MD/LMS leads to connect eLMIS software to all Provinces (PHLMC), COVID Hospitals/Clinics and Health Offices for real time information of health materials and equipments for the prevention, treatment and control of COVID-19 for the regulation of demand and supply. The system focused mainly on received, distributed and stock on hand of commodities on the site.

Major Activities:• Procurement of equipments/ materials (COVID -19 Items): Thermal scanner, PPE, Gown, Face

Shield, Gaggles, N95 Mask, Face Mask, Sanitizers, IR Thermometer, PCR machines, PCR Kits, RDT Kits RNA extraction Kits VTM etc

• Received COVID-19 items from Donor Partners and others• Storage of COVID-19 items• Distribution and transportation of COVID items to all PHLMC and COVID Hospitals as per

requirement basis, districts and in some affected palikas as well as laboratories.• Recording and reporting of COVID items as daily, weekly, monthly to concern authorities.• As a new learning, at the district & palika level supply was possible/easy due to initiation of social

leader, political leaders including Hon. Parliament members ad LLG chiefs for the transportation of materials up to the sites but, needs one door supply.

Detail of Received and Supplied of COVID-19 items is in Annex …

Lesson learned, Issues and Recommendations• Guidelines for direct procurement is must to overcome such emergency• Health emergency logistics with assurance of recording and reporting is compulsory • Clear role of federal, province and local government should be in place with action plan.• Health emergency logistics management of Federal Hospital vs logistic Management Section/

DoHS to be defined prior to any emergency/disaster• One door system to be followed from government & partners at all level.• In any disaster or emergency information system to be followed one door from HEOC.

Great lesson learned during this period to be addressed as per recommended job & responsibility.


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6. ISSUES IN LOGISTICS MANAGEMENT• Procurement: Quantification, Cost estimation, Specifications, bidding documents, procurement

methods of the health commodities/equipment’s and timely procurement.• Storage/Warehousing: Central medical and vaccine store and modern warehouse design and

construction-inadequate in all level cold chain as a major issue during campaign.• Distribution/Transportation: Distribution and transportation of drugs, vaccines, health

commodities, tools and equipments throughout country-push n pull system both are using but not information based as well as maintenance is an issue.

• LMIS/eLMIS: Tools and electronic systems not being utilized by SDPs.• HRD/Training: HR and training on Procurement and SCM-trained but not in place or low

confidence.• Budget: Insufficient budget for procurement of drugs, vaccines, health commodities and

equipments• Disposal/Auctioning: Expired medicines disposal and guidelines not in place.• Quality: Quality is always has been an issue.• M&E: Standard tools for M&E for SCM at least for 5 yrs.-frequent changes made difficult.

ISSUES/CHALLENGES AND RECOMMENDATIONS (LMS)

S. NO LMS SUBTITLE ISSUES/CHALLENGES RECOMMENDATIONS RESPONSIBILITY

1 Procurement Quantification, Cost estimation, Integrated planning

Coordination with Divisions, centres, plan & follow CAPP.

DoHS/MD/LMS

2 Storage/Warehousing

Central Vaccine and Medical Warehouse

Design and construction at federal and provincial level & local level

DoHS/MD ProvinceLLGs

3 Distribution/Transportation

Distribution and transportation of vaccines, drugs and health commodities, equipment’s, tools & Issue of maintenance.

Timely distribution and transportation on demand through PPP model and refrigerator Vans. Timely maintenance. Maintenance plan & implement efficiently.

DoHS/MD/VendersProvince

4 LMIS/eLMIS Tools and electronic system

Revise tools and Scale-up the systems Fix for at least 4- 5 years

MD/PartnerProvince, Palika

5 HRD/Training Package design, BHL training and Trainers on SCM

Package design, To and onsite coaching

MD/Partner,Province

6 Disposal/Auctioning Guidelines for disposal of expired medicines

Need to incorporate in auctioning guidelines as well as make separate guidelines & followed.

MD/Partner,ProvinceLLGs.

7 Budget Insufficient annual budget for procurement of health commodities and equipments

Need to increase budget for PSCM

MoHP/DoHSProvinceLLGs.

8 Quality Quality is always has been an issue.

To be followed in every steps.Quality assurance mechanism has to be strengthened.

MoHP/DoHS/LMSProvince

9 M&E Tools for M&E Need to develop a M&E tools and responsibilities for SCM

MD/Partner

10 Mobilization & Expiry of Medicine

Mobilization of Medicine & reducing Expiry

Mobilize in needful place At all level


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OUTPUTS KEY INTERVENTIONS KEY ACHIEVEMENTS2074/75 AND 2075/76

1. Improved procurement system

1. Build capacities in procurement and quality assurance at central and decentralized levels

2. Implement Consolidated Annual Procurement Plan.

3. Widen the scope of Multi-year contracts in health products and services.

4. Pilot central bidding and local ordering approach and scale-up as appropriate

5. Lay foundations for the establishment of procurement center

1. Published the Standard Operating Procedural Handbook for Health-related Procurement.

2. Conducted procurement training in provincial level.

3. Maintained the specification bank centrally and update it periodically.

2. Improved supply chain management

1. Develop capacity in operational planning and logistics management systems in order to develop a cost effective and timely distribution system.

2. Expand warehouse capacities, including upgrading of storage facilities at regional and district levels.

3. Explore innovative approaches (e.g. PPP) and technologies to improve supply chain management between the district store and health facilities for supply management at the district level.

4. Improve management to prevent expiry of drugs and handling of expired drugs and non-functional equipment

5. Improve supply chain of Ayurvedic drugs/medicines

1. Capacity development activities conducted for store and supply chain management for seven provincial health logistic management center (PHLMC).

2. Support provided with the coordination of partners for the infrastructure of warehouses at regional, district and local level.

3. Extension of the eLMIS system in the SDPs and warehouse which is good in notifying the expiry of drugs priory is going on.

8. DLI INDICATORS RELATED TO PSCMDLI 1: Systems and organizational reforms at MoH carried out, based on Procurement Reform

Action Plan.DLI 2: Production and submission of Annual Report on grievances and received and addressed

through a web-based grievance mechanismDLI 3: Percentage of procurements done by LMD using standard specificationsDLI 4: Percentage of districts stores reporting based on LMISDLI indicators are maintained and in the process of improvements.

7. NEPAL HEALTH SECTOR STRATEGY 2015-2020, OUTPUT AND KEY INTERVENTION FOR PROCUREMENT AND SUPPLY CHAIN MANAGEMENT The output envisions reforming procurement and logistics systems responsible for forecasting, tendering, contracting, and supply chain processes. Establishment of a procurement center staffed with procurement experts will be initiated, including further capacity enhancement in supply chain management and implementation of innovative approaches to improve supply chain management.


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CHAPTER 7CASE STORY

A. IMPROVING INVENTORY MANAGEMENT AND WAREHOUSE BEST PRACTICESProper warehouse storage and practices are key for maintaining quality health commodities and a functional supply chain system and is a priority area for GHSC-PSM in Nepal. Effective and efficient management of racking and shelving simplifies the warehouse operation. A competent, motivated, skill-mixed workforce is required to ensure good storage practices, operations and that health commodities reach where they are needed most.

GHSC-PSM collaborated with the MD, Provincial Health Directorate, and Health Office mobilized FSO, LMIS Officers and pharmacist in all the districts of Sudurpaschim, Gandaki and province-2 to organize all medical DHO stores to ensure effective inventory management. This included arranging appropriate stores based on warehouse best practices, conducting a physical count, removing expired commodities, updating inventory records, building overall capacity of staff with an emphasis on inventory management, supportive supervision, teamwork, dedication, hard work and cooperation with the local government institutions can improve the storage condition and practices in sustainable approach.

During a site visit the following tasks are performed with supportive supervision as part of inventory management and warehouse best practices: • Cleaning of the storage area• Organizing of stores based on FEFO/FIFO and separation of none usable health commodities

from usable products;• Performing physical count of all health commodities in a store;• Verifying and reconciling counted stock with stock registers;• Signing and stamping reconciled quantities by relevant authority; • Updating all inventory records and tools (registers and eLMIS)• On-the job-training on inventory management and any relevant supply chain management

function.

Achham District store after reorganization and inventory support by GHSC-PSM. Photo credit: GHSC-PSM


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“we know the store should be cleaned and arranged but today we understood the real meaning of good storage practice and why it is important for the supply chain management. This is a good learning experience for us and thank you to GHSC-PSM, Provincial Heath Directorate and Management Division” – Karishma Bhatt, Storekeeper, Health Office, Dadeldhura

All the district stores of all three provinces were successfully reorganized with an updated stock balance in the system as well as segregation and record in the separate register of expired and damaged commodities. The event was highly appreciated by the district and provincial health directorates.

B. PROCUREMENT AND SUPPLY CHAIN MANAGEMENT (PSCM) OF NEPALGUNJ SUB METROPOLITAN CITYWhat we did: • Smooth supply of drugs and health

commodities is the responsibility of local government. Nepalgunj SMC realizing this fact started scientific process of PSCM such as developing procurement plan, drug forecasting, quantification and timely procurement and supply of drugs to the health facilities.

• Next, storing of drugs and supplies at right place was the major challenge addressed. SMC initiated its own medical store for smooth functioning.

With this startup, the process such as First Expiry First Out (FEFO), physical count was adopted to minimize expiry, wastage and stockout of these supplies.

• Having procurement plan, own medical store and following scientific approach of procurement system, drugs expiry and stockout problem is minimized as a result zero stockout of essential drugs.

Approaches that worked:• Rapid assessment was conducted in each health facilities to identify the major gaps and

challenges, where, observation of inventory and storeroom, structured questionnaire and discussion was adopted.

District Health Store Before Reorganization

District Health Store After Reorganization

Medical store of Nepalgunj Sub Metropolitan City


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• Participated in 5 days Training of Trainers (ToT) on Basic health logistics and public procurement system.

• Health facilities in charge and storekeeper were trained on two days’ package of basic health logistics management.

• Study visit to observe medical store of Bailpata Hospital, Accham. • coordination with health office, Banke and province medical store for timely supply of vaccine.

What next:• Digitalizing proper logistic management with connection to health facilities and municipal

medical store.• Monitoring mechanism for strengthening health facilities store management and timely

reporting with assurance of drug quality.


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A. JOINT MONITORING VISIT AND ASSESSMENT OF ELMIS PROGRAM EFFECTIVENESS IN SURKHET AND BARDIYA DISTRICTS.

It was planned to have a workshop in Bardiya with greater participation of province, local level including partners but because of important events of Ministry it was post ponded and planned to visit at the sites and quick assessment of LMIS system in field with the leadership of logistic management section and partners.

Propose of the visit:Chief Logistic Management Section, Management Division along with Acting HSS Team Manager, GHSC-PSM visited eLMIS piloted districts Surkhet and Bardiya for the assessment of field reality, its effectiveness and gaps for the improvement on January 12-13, 2020. The visit planned to interact with the eLMIS users working at field level and suggest to the central team about strength and gap of the system while deciding for the scale up approval.

Findings of the visit:Observation HO SurkhetBriefing of user:• eLMIS system was functioning well • Reminds to take action for near expiry and stock out highlighted in the dashboard• System is supporting for procurement actions by analyzing the stocks

“In overall eLMIS system has become one of the major tools to guide us in supply chain management and decision making” -Chetan Nidhi Wagle, Chief, Health Office Surkhet

Observation Mobile Site Uttarganga Health Post SurkhetBriefing of user:• The system was functioning well • Focal person eLMIS said the requisition, stock update and overall management has become easy

and accurate because of the real time data. • The focal person was just transferred at that site and coached by Pharmacy Officer to use

CHAPTER 8MONITORING/SUPERVISION/WORKSHOP/SEMINAR

System observation by LMS Chief at District Health Store Surkhet


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mobile based eLMIS system. • Only 2 hours onsite coaching was enough to the

new staffs to orient about mobile based eLMIS system.

• The focal person operated and showed all the system to the team perfectly

eLMIS is helping a lot, its very good tool and it’s a kind of lifeline in supply chain sector “Raju Basnet HC Barahatal, RM

Observation at Rajapur Municipality, Badaiyatal Rural Municipality and Jamuni Health Post, Bardiya Briefing of user:• eLMIS system has visibility and real time

data which is supporting to municipality for the procurement process, forecasting and quantification said Health Coordinator.

• Municipality is managing stock out, near expiry on time because of alert in the dashboard.

• Store was well managed now because of the system update and timely information

• eLMIS supported for quantification and forecasting based on stock analysis with real time data.

• eLMIS supported to manage the distribution and prevented misdistribution because of stock status visibility

• There were not any system related issues in Rajapur, Badaiyatal and Jamuni Health Post

“eLMIS supported us for good governance in our procurement process and financial management” -Mayor, Badaiyatal Rural Municipality

Overall Feedback received from eLMIS users in the field:• System support to address the Supply Chain Issues on time• Inventory Management has improved where the system is being well utilized• Real data available to support for the decision making related to supply chain and inventory

management • Help Desk L1, L2 was very effective and useful to the users

Recommendations• Recommended to provide authority to edit from province level authorized person• Need to provide continuous capacity building and supportive supervision• Scale up eLMIS system to other health facilities • The trained staffs from LLGS are transferred so need some training package to enhance skill of

eLMIS sites and requested to support from GHSC-PSM• eLMIS operation needs high bandwidth internet capacity so hard to operate smoothly in remote

so suggested to improve system to run in available internet capacity at field level.

Briefing of mobile application by user to LMS Chief at Uttarganga Health Post, Surkhet

Discussion with Mayor and team at Rajapur Municipality, Bardiya with Team Lead Chuda Mani Bhandari


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B. JOINT VISIT OF MANAGEMENT DIVISION AND GHSC-PSM IN SRI LANKA, 30 JAN-4FEB, 2020

Propose of the visit:Management Division officials Mr. Bhogendra Dotel, Director and Mr. Gyan Bahadur BC, GHSC-PSM Ananta Bhadra Lamichhane jointly as a team to have a joint discussion with eLMIS vendor on technical and managerial issues of eLMIS from 29th January 2020 to 3rd February 2020. These discussions were expected to strengthen collaboration between eLMIS vendor Bileeta, and Logistic Management of DoHS through in-person meetings in anticipation of the eLMIS scale-up in Nepal. After this visit, the parties will reach a consensus on eLMIS process standardization expectations and identify, understand and narrow down the difficulties of each side and mutually establish a common beneficial way forward for eLMIS service management to prepare for further scale-up implementation and operationalization.

1. Support eLMIS Service Quality Management. Technical leads from both parties shall come to a common understanding of eLMIS support service management, change management, and quality management.

2. Detailed discussions on technical, managerial, implementation and operationalization issues of eLMIS modules. Tasks include:

a. Modular discussion of the Online, Offline and Mobile modules for technical issues, synchronization and data integrity

b. System performance assurance to host at least 2,000 users andc. Meeting with technical teams to streamline the rollout issues for all parties, Bileeta, GHSC-

PSM and Management Division. d. Process standardization discussions, particularly focusing on estimation methods, root cause

analysis, impact analysis, corrective action plan and preventive action plan.

3. Detailed discussion on eLMIS sustainability aspects. Detailed discussion with Bileeta management on eLMIS server hosting in Nepal, local partner pool creation, compliance with local governance rules of Nepal (Procurement Act, Cyber Law and Information Act of Nepal), and data warehousing.

Following were expected outcomes from the visit: • Service quality management structure agreed • eLMIS sustainability expectations and policies of Nepal are shared with Bileeta• eLMIS technical and operationalization issues shared and way ahead explored

Field visit findings sharing workshop at Dhulikhel, Kabhre

Team on Bileeta Office, Sri Lanka


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Achievements a. Source code of eLMISBileeta has agreed to provide source code of eLMIS to Ministry of Health and Population (MoHP) of Nepal Government with assurance of Nepal Government that eLMIS source code would be utilized only for the propose of eLMIS in Nepal by MoHP.

b. eLMIS hosting to shift to Nepal eLMIS hosting would be shifted to Nepal immediately.

c. eLMIS Data Ownership to remain on GON and Bileeta’s access on eLMIS dataAs provisioned on contract of eLMIS, Bileeta assured MD that all data gathered in eLMIS are owned by Nepal Government itself and it hasn’t been used anywhere else. Bileeta also assured that it will never be used without MoHP consent.

d. Local Support Partner Pool Creation and Support Service Procurement by GONBileeta will train additional local IT companies to develop as eLMIS local support pool within 2020.MoHP will procure all eLMIS support services through local partners complying with Public Procurement Act of Nepal and the support service provider would subscribe or procure essential services from Bileeta.

e. eLMIS License Ceiling Bileeta has offered 20% reduction ($212,600) on existing licensing ceiling ($1,063,000). MD is clear on its stand that GoN would not bear any licensing liability for eLMIS.

f. eLMIS Software Issues and Concerns A detailed discussion was held on technical issues and concerns of eLMIS software including load test for 6000+ users. Bileeta committed to evaluate the issues and concerns that has been raised and would take necessary measures to streamline and assure that software services are received as per the agreed Service Level Agreement (SLA) and agreed Standard Operating Procedure (SOP).

g. Joint Annual Review Meetings The teams agreed to hold joint annual review meetings each year in participation of Logistic Management of DoHS, to review the software service performance of a year and to plan way-ahead for next year.

h. User License ManagementBileeta would issue user license certificates for all procured licenses that would certify to Management Division that all procured licenses are perpetual and can be used for its lifetime.


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A. GHSC-PSMThe purpose of the United States Agency for International Development (USAID) Global Health Supply Chain Program - Procurement and Supply Management (GHSC-PSM) project is to ensure the uninterrupted supply of health commodities to patients. In Nepal, the project contributes to achieving USAID/Nepal’s Country Development and Cooperation Strategy, Development Objective 3: Increased human capital and Intermediate Result: A healthier and well-nourished population by ensuring the availability of health commodities at the last mile. The project primarily works with the Management Division (MD) providing technical assistance (TA) across various foundational supply chain activities integrated across Task Orders 3 and 4.

GHSC-PSM has been working on improving supply chain functional areas such as inventory management, forecasting and supply planning, supported procurement of family planning products for social marketing, capacity building and strategies to improve supply chain performance, with a particular focus on the scale-up of eLMIS. During the implementation, GHSC-PSM worked closely with stakeholders such as MD, provincial health directorates (PHDs), district public health offices (DPHOs), local level governments (LLGs), Red Book funded supply chain pharmacists (supported by USAID at various levels of supply chain) and the USAID funded project System Strengthening for Better Health.

The project conducted a performance assessment of the Electronic Logistics Management Information System (eLMIS) operating sites in December 2018 and based on the findings of the site assessments, GHSC-PSM made enhancements to improve the system and processes, ensuring effective system utilization and supply chain best practices. The project continues to provide support through the help desk addressing and resolving issues reported by the eLMIS users. The eLMIS scale-up plan, though presented and shared with the Ministry of Health and Population (MoHP) and external development partners (EDPs), it is approved by the ministry level decision for a broader roll out to cover all provinces, districts, LLGs and SDP level gradually.

To institutionalize capacity for evidence-based and coordinated forecasting and supply planning of health commodities at all levels of the supply chain in the federal structure, GHSC-PSM developed a forecasting and supply plan guidebook and workbook endorsed by Department of Health Services (DoHS). GHSC-PSM has been providing quantification support to center and provinces to build the capacity of LLGs health staff of five provinces, as well as conducting pipeline review meetings as well.

Warehouse and inventory management activities included, delivering new storage racks and safety equipment such as trolley, pallets, fire extinguishers to five PMSs. GHSC-PSM also worked closely with Save the Children (SC) and USAID Nepal Reconstruction Engineering Services (NRES)

CHAPTER 9PARTNER CONTRIBUTION FOR LOGISTICS MANAGEMENT


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Project implemented by CDM Smith on designing the new construct warehouse in CMS Pathlaiya, to rebuild the warehouse floor to improve its’ strength to accommodate modern racking and movement of folk lift or stacker and new construction at different provinces.

The project supports the MD in managing expired commodities by collecting the list of expired and damaged commodities from PMSs and district stores through GHSC-PSM field support officers (FSOs). GHSC-PSM has been working closely with Contraceptive Retail Services (CRS) to facilitate the importation of family planning commodities for social marketing. GHSC-PSM is proud to confirm that all scheduled shipments for FY 18&19 were procured and delivered on time.

B. NHSSPNHSSP as embedded team in procurement, the majority of the activities were in continuity with the NHSS (2016-2021). It includes advisory, technical and policy implementation support for standardization of procurement with capacity enhancement by transferring of knowledge to the officials engaged in procurement. The specific contributions, but not limited to, acts of NHSSP are as follows:

• Institutionalization of the procurement planning assurance mechanism in health sector through Consolidated Annual Procurement Plan (CAPP). A new initiation for the online CAPP (e-CAPP) preparation is also designed and piloted.

• Establishment of CAPP Monitoring Committee at DoHS under the chairmanship of the Director General. A TOR of CAPP Monitoring Committee prepared and endorsed by the Secretary of MoHP.

• Preparation of Procurement Improvement Plan (PIP, 2017-2022) which is prepared and endorsed by MoHP in FY 2017/18. CAPP Monitoring Committee of DoHS are continuously monitoring the progress of the implementation of PIP.

• In FY 2018/19, a new concept has been agreed in 2018 NAR, to transform PIP into Nepal Health Sector Public Procurement Strategic Framework (PPSF) as an umbrella strategic policy document on procurement and supply chain management by including all spheres of governments. So, the PIP is reviewed to cover all spheres of health governance and prepared a comprehensive PPSF.

• The Technical Specifications Bank (TSB) was restructured with coding of specifications and systematizes in the website of DoHS in FY 2017/18 and is opened to use for all stakeholders. Prepared SOP for operation and updating of TSB.

• Coordinated e-GP II training to DoHS staffs and facilitated in implementation of e-GP II system in all bids of LMD/LMS.

• Preparation of Concept Note, design specification and technical support to prepare web-based Grievance Handling and Redressal Mechanism (GHRM) in LMS.

• Two Standard Operating Procedures (SOPs) as Procurement and supply chain handbook and facilitation handbook for electronic Government Procurement (e-GP) have been prepared, endorsed and distributed to local and provincial levels in FY 2017/18 and extensive technical support and capacity building program for SNGs level have been enhanced in FY 2018/19.

• New Standard Bidding Documents for Medical Goods prepared and sent to PPMO and MoHP for endorsement.

• A Framework Arrangement (FA) for procurement of medicines has been developed and agreed to implement in MDAC meetings. Draft Standard Bidding documents for FA prepared and sent to PPMO for review and endorsement.

• Technical support and monitoring of DLI indicators and its achievements.• Preparation of drug disposal mechanism and executed by LMD in 2017/18.


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• Training session plan have been developed for PGs and LGs capacity building in procurement management in 2017/18.

• Training sessions conducted in various procurement and supply chain management trainings conducted by LMD/LMS and other EDPS at all levels of governments. Similarly, inputs provided in revision of Logistic and Procurement Management Training Manual in FY 2017/18 and 2019/19. Facilitated to the TOT sessions on Procurement and Logistics Management.

• Procurement Clinics have been operating in DoHS and MoHP for troubleshooting in procurement management. Basically, it is an advisory function for decision makers on procurement.

• Coordination for organization of Suppliers’ Conference annually.• Market Analysis of pharmaceutical products has been done in Nepalese market to assess

the production cycle and availability of essential medicines manufactured by the domestic pharmaceutical industries in Nepal.

C. UNFPA From the beginning of its UNFPA’s seventh country program cycle (2013-2017), UNFPA through its global UNFPA Supplies Thematic Trust Funds (TTF) has been working in Nepal to ensure a secure, steady and reliable supply of quality contraceptives, and its improved access and use by strengthening the national health system.

Strengthening FP Supply Chain Management (SCM) and Ensuring Commodity Security: In 2018, UNFPA through its global UNFPA Supplies Thematic Trust Funds (TTF) provided USD 964,220 worth of commodities including 102,000 units of LARC (Implant: 86,000 and IUCD: 16,000 units); 550,000 vials of DMPA; 2.5 million condoms; 169,920 Oral Contraceptive Pills to the MoHP and key FP actors including Marie Stopes International (MSI) and Family Planning Association of Nepal. Likewise, UNFPA provided FP commodities equivalent to USD 2.1 million in 2019 in support of the National FP Program. The support for 2019 included 1,998,864 pieces of Male Condoms, 9,545 Female Condoms, 141,700 Implant, 51,000 IUDs, 6,588 ECP, 349,800 vials of DMPA; 1,759,968 cycle of Oral Contraceptive Pills & 100 k Solo shot to the MOHP and FP partners (MSI and FPAN).

UNFPA is actively engaged in the Logistics Working Group led by the Logistic Management Unit, MoHP, and the External Development Partners (EDP) SCM group and contributes towards advocating for an efficient SCM system. UNFPA has its provincial offices in Province 2, Province 5 and Sudurpaschim Province where UNFPA works closely with the Provincial health logistics management center (PHLMC) to support the provincial efforts on forecasting/quantification and capacity development at local levels in SCM. Likewise, with support from UNFPA Supplies, the piloting for Sayana Press has been initiated in two districts of Nepal from October 2019 to expand the choice of FP methods available (implemented through MSI’s DFID-funded project).

ADRA Nepal has been supporting and working in the field of Basic Logistics and supply chain management of health sector in close coordination with Management Division (MD/DoHS/MoHP) funded under UNFPA supplies with the time frame of 2018 to December 2020. In an effort to decentralize logistics decision making at the peripheral level health facilities and transfer of technology below district level, ADRA Nepal supported in “strengthening the logistics management information system” in 16 districts of provinces 1, 2, Bagmati province, 5 and SudurPachim.

This helps for real time information on stock status of key health commodities and other essential drugs at peripheral level HFs and can make evidence based logistics decision by making


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commodities available uninterruptedly and ultimately contributing to increase health services utilization by the hard-to reach population. Therefore, ADRA Nepal has contributed to strengthen Basic Health Logistics, Public Procurement System, commodity and essential drugs forecasting through capacity building activities with the support from UNFPA’s programme team.

Summary of performance achieved through this project in 2018 & 2019 are revision of the both logistics and procurement packages, three different types of trainings such as Training of Trainers, Basic Health Logistics and Public Procurement System for municipal level staff and Basic health logistics management training for health facility level staff. Altogether 121 HSPs were capacitated on ToT related to Basic Health Logistics and Public Procurement system at province level covering 1, 2, Bagmati, 5 & SudurPachim followed by 496 HSPs at municipality level and 636 HSPs at Health Facility Level. Moreover, Program Review and Planning meeting was conducted at provincial level, developed, printed & distributed the Basic logistic and procurement training manual and trainer’s guide (training package) along with monitoring & technical support visits.

D. WHO• WHO with UNICEF provides technical support for immunization and vaccine logistics which

includes technical support for preparation and submission of vaccine support yearly renewal to Gavi, the Vaccine Alliance, including projection/forecasting of Gavi-supported vaccines need; technical support for Gavi supported Cold Chain Equipment Optimization Platform application and roll-out; technical support for Effective Vaccine Management and related assessments and monitoring.

• WHO provides technical support for communicable diseases and related logistics. WHO supported coordination with other partners and NCASC to offset HIV drug shortages during the initial lockdown period in the current COVID-19 pandemic situation, donated Leprosy and Kala-azar drugs and ensures no stockout situation in the country, supported procurement of 10,000 Dengue test kits for Dengue outbreak preparedness as the procurement of Dengue test kits in the current year was impacted due to COVID-19 impact on supply chain, and collaborated with NTCC and Save the Children on supply of GeneXpert cartridge for TB. WHO coordinated with Global Fund to enable funding and coordinated shipment of Xpert Xpress CoV-2 cartridges which enabled introduction of Xpert Xperss CoV-2 test in Nepal.

• WHO provides technical support on emergencies related logistics. WHO has provided logistics technical support for emergencies such as in the major earthquake in 2015 which included about 41 WHO Medical Camp Kits, several Inter Agency Medical, Surgical and Diarrhoeal Kits, establishment of Emergency Medical Logistics Warehouses with emergency medical stockpiles, temporary hospital tents and trauma back packs in four hub hospitals; tents to set up 17 birthing centers, Inter agency Emergency Health and Diarrhoeal kits for flood related emergencies; PPE, Viral Transport Media and Oseltamivir tablets to manage disease outbreaks including influenza, etc. WHO has also provided technical support for responding to the current COVID-19 pandemic, including for national forecasting, quantification, costing, distribution plan of COVID-19 logistics including PPE, medicines, ICU items, and other items critical for various pillars of the response. WHO has also donated PPE items; laboratory diagnostic kits and oxygen concentrators. In addition, WHO has also supported the establishment of the toll-free call center; ICT and tele-conferencing facilities for four different divisions and centers of the MoHP/DoHS and completed the establishment of fully functional permanent (4) and temporary (3) Health Emergency Operations Centers (HEOC) covering all seven provinces and complete expansion and re-furbishment of the National HEOC; establishment of Emergency Medical Logistics Warehouses with emergency medical stockpiles, temporary hospital tents and trauma back


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packs in six additional hub hospitals and established the Health Desk at the arrivals terminal of the Tribhuvan International Airport – and IHR Point of Entry.

E. UNICEF“UNICEF is one of the program partners supporting to government for National Immunization Program right from the beginning when he immunization program was initiated in Nepal. The main UNICEF support in the area of vaccine and cold chain equipments. UNICEF mainly supports government in following areas: Regular supply of vaccines: UNICEF in government and GAVI, UNICEF prepared a vaccine forecast and shipment plan every year based on which vaccine including devises are supplied for both routine immunization and campaign when planned. Support in emergency: UNICEF is always upfront to support government in any emergency. During the current COVID pandemic, UNICE has supplied vaccines and syringes through chartered flight to ensure the country should not face any shortfall of vaccines. Technical support in effective vaccine management: UNICEF provide support in cold chain management to ensure vaccine’s quality. Also, provides technical support for strengthening effective vaccine management (EVM) which is conducted every three years. Supply of cold chain equipment: UNICEF with support from GAVI supporting government in the deployment high quality cold chain equipment. Currently under the Cold Chain Equipment Optimization Platform (CCEOP) initiatives, 1200 new equipments are deploying to increase the cold chain capacity in the country”

F. GIZGIZ is a public benefit federal enterprise providing services worldwide in the field of international cooperation for sustainable development. Since 1994, GIZ has been working in the health sector in Nepal. The German Federal Ministry for Economic Cooperation and Development (BMZ) is the main commissioning party. The current phase of GIZ- Support to the Health Sector Programme (S2HSP) is commissioned for the period of January 2016 to June 2021. The programme is aligned with Nepal Health Sector Strategy 2015 to 2020. It provides technical advice to government actors responsible for sectoral management the national level on planning reforms and assists in their implementation in selected districts and municipalities in the newly created provinces 3, 5, and in Sudur Paschim. The TC module concentrates on five thematic areas: (1) Social Health Protection; (2) Improved availability of qualified human resources in health; (3) Strengthening governance in health;(4) Digitalization of information systems and work processes, including improved monitoring of health-related SDGs ;and (5) promotion of adolescent health and development.

GIZ- S2HSP is providing technical assistance on individual and organizational capacity development and strengthening health governance mechanism of local, provincial and federal government. Specifically, improving the capacities of local government and its health facilities for basic health service delivery and better procurement and supply chain management for quality of health service delivery. S2HSP has provided TA in the process of development of logistic and supply chain management guideline, capacity development of local government and its health facility and establishment of their own Municipal Medical Store


94

G. SAVE THE CHILDREN Save the Children has been working together with Ministry of Health to fight against Aids, Tuberculosis and Malaria as a sole principal recipient (PR) of the Global Fund grant in Nepal since 16 July 2015 for these three diseases. Under the leadership of Save the Children, Global Fund grant is implemented in all the 75 districts of Nepal. It works for the case detection, cure management and drugs supply for Aids, Tuberculosis and Malaria.

Some of the activities enrolled by Save the Children in the procurement and supply chain are as below:• National drug consumption analysis and forecasting for Malaria, Tuberculosis and Aids.• Procurement and distribution support for these diseases.• Contribute in annual plan and budget preparation for MoHP and health division.• Partial support to expand the coverage areas of eLMIS.• Contributed to prepare the national warehouse management guideline, this guideline is under

process with other partners.• Coordinate to bring the logistic reporting system of Malaria, Tuberculosis and Aids under LMIS

of management division.• Preparation of product specification of health commodities and laboratories items.• Support SDPs with the health and laboratories commodities in all province. • Printing and distribution of IEC material for SDPs.• Warehouse management done by deploying human resources in National Centre for AIDS & STD

Control (NCASC), National Tuberculosis Centre (NTC) and Epidemiology and Disease Control Division (EDCD)


95

Chemonics. (2018/19). Annual Progress Report. Kathmandu: USAID GHSC-PSM Nepal Project.

DFID/NHSSP. (2018/19). Progress Report. Kathmandu: NHSSP Nepal.

DoHS. (2074/75-2075/76). Annual Report. Kathmandu: MD.

DoHS. (2077). Annual Report. Retrieved 2074/75 and 2075/76, from Department of Health

Services: www.dohs.gov.np

DoHS. (2016-2017). Basic Health Logistics Management Training Manual. Kathmandu: LMD.

DoHS. (2077, Jestha 10). COVID-19 Logistics Report. Retrieved from DoHS/Management Division:

www.elmis.dohslmd.gov.np

DoHS. (2074/75-2076/77 (2nd Quarter)). LMIS Progress Report. Kathmandu: MD.

DoHS. (2067). National Disposal and Auctioning Guideline. Kathmandu: LMD.

DoHS. (2019). National Pipeline Report. Kathmandu: MD.

DoHS. (2019). National Quantification Gudeline. Kathmandu: MD.

DoHS. (2014). National Supply Chain Management Guideline. Kathmandu: LMD.

DoHS. (2016-2017). Public Procurement System Training Manual. Kathmandu: LMD.

DoHS. (2072 & 2075). Three Years Logistics Report. Kathmandu: LMD.

GoN. (2076). Inventory Management New Forms & Formats. Retrieved from Financial Controller

General Office: www.fcgo.gov.np

GoN. (2077). Public Procurement Act 2064/Regulation 2067. Retrieved from Public Procurement

Monitoring Office: www.ppmo.gov.np

GoN. (2077). Reports and Guidelines. Retrieved from DoHS Management Division: www,dohslmd.

gov.np

MoHP. (2077). COVID-19 Report and Guidelines. Retrieved Baishak 2077, from Ministry of Health

and Population: www.covid19.mohp.np

MoHP. (2015). NHSS 2015-2020. Kathmandu: MoHP.

MoHP. (2075/76). Finance Progress Report. Kathmandu: MoHP-Finance.

MoHP. (2019). Joint Annual Report. Kathmandu: MoHP.

UNFPA/ADRA. (2018/19). Progress Report. Kathmandu: ADRA Nepal.

WB. (2019). World Bank Report. Kathmandu: WB.

WHO. (2015). Pharmaceutical Waste Management Guideline. Kathmandu: WHO

BIBLIOGRAPHY


96

ANNEXES


97

ख रद प रमाण सहयोग व प ज मा ा तदेश

वा यहमा भएकोनकासा

अ पताल रअ य थानमाभएको नकासा

ज मानकासा

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5 k+hf -;lh{sn Unf]A;_ -s]_ hf]/ 1,00,000 15,000 1,15,000 91,370 23,630 1,15,000 06 k+hf hf]/ 1,19,160 4,34,350 5,53,510 1,38,485 2,65,375 4,03,860 1,49,6507 Pg 95 df:s yfg 47,500 2,03,795 2,51,295 20,475 75,695 96,170 1,55,1258 Sofk - ;lh{sn Sofk yfg 39,400 11,220 50,620 13,290 28,226 41,516 9,1049 rZdf -;]km\^L_ yfg 21,550 49,599 71,149 9,159 14,166 23,325 47,82410 km]; df:s yfg 0 3,600 3,600 580 3,020 3,600 011 km]; l;N* lk; 8,540 22,650 31,190 3,045 13,502 16,547 14,64312 ;' se/ hf]/ 55,600 24,650 80,250 6,290 29,960 36,250 44,00013 ud a'̂ hf]/ 18,540 300 18,840 4,680 2,680 7,360 11,48014 k+hf x]eL *\o'̂ L hf]/ 5,200 0 5,200 2,280 1,112 3,392 1,80815 ;]lg^fOh/ 100 Pd Pn jf]tn 0 140 140 0 43 43 9716 ;]lg^fO{h/ 300 Pd Pn af]̂ n 0 3,600 3,600 1 3,187 3,188 41217 ;]lg^fOh/ 500 PdPn jf]tn 5,500 8,698 14,198 8,063 3,294 11,357 2,84118 ;]lg^fOh/ -ln^/_ ln^/ 440 3,000 3,440 520 2,920 3,440 019 ;lh{sn x'* lk; 0 2,000 2,000 0 0 0 2,00020 cfO=cf/ ydf]{ld^/ yfg 10 2,573 2,583 885 895 1,780 80321 Oo/ yd{ld^/ -sfgaf^

hfRg]_yfg 0 100 100 0 11 11 89

22 j*L Jofu lk; 0 2,400 2,400 590 785 1,375 1,02523 jo^ jfO{k Kofs]̂ 0 3,480 3,480 492 369 861 2,619

24 :k|]o/ kDk yfg 84 2 86 57 29 86 025 Snf]/f]SjLg kmf]:km]̂ a§f 0 400 400 0 0 0 40026 Snf]l/g PgPl*l;l; 45 .

55s]=lh= 4,000 0 4,000 2,500 900 3,400 600

27 ;f]l*Pd xfOkf]Snf]/fO* ;f]n';g

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28 l*; OGkm]S ]̂G^ \̂ofa= uf]̂ f 0 490 490 140 215 355 13529 kf]̂ {]an e]G^Ln]̂ / yfg 0 1 1 1 0 1 030 kf]̂ {]an lkl;cf/ d]lzg yfg 5 2 7 0 7 7 0

सामानको नाम इकाई

ldltM @)&&.#.!% ut] %M)) ah] ;Dd -xfn ;Ddsf] hDdf_

नेपाल सरकारवा य तथा जनसं या म ालय

वा य सेवा वभागयव थापन महाशाखा

:jf:Yo ;]jf ljefu, Joj:yfkg dxfzfvfdf COVID-19 ;fdu|Lx?sf] k|fKt tyf ljt/0fsf] ljj/0f

बाक प रमाण

खचअ दानी.

सं.

आपू त यव थापन शाखा

1. COVID-19 LOGISTICS INFORMATION


98

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2. eLMIS PILOTING AND SCALE-UP LIVE SITES

eLMIS PILOTING SITESS.N. PROVINCE HF TYPE HF NAME ELMIS MODULE LIVE DATE

1 Bagmati Province Central Store CW-FPED Online 2018-04-11

2 Bagmati Province Central Store CW-VCC Online 2018-06-16

3 Bagmati Province Central Store CW-NCASC Online 2018-04-16

4 Bagmati Province Central Store CW-NTCC Online 2018-04-12

5 Province 2 Central Store CW-Pathalaiya Online 2018-04-16

6 Bagmati Province Central Store CW-EDCD Online 2019-06-23

7 Bagmati Province Central Store CW- ETS Online 2019-06-24

8 Karnali Province

Province Health Logistics Management Center

RMS-Nepalgunj Online 2018-04-16

9 Province 5

Province Health Logistics Management Center

RMS-Butwal Online 2018-04-13

10 Province 5 District Health Office Dhs-Rupandehi Online 2018-05-17

11 Province 5 District Health Office Dhs-Kapilbastu Online 2018-06-10

12 Province 5 District Health Office Dhs-Nawalparasi Online 2018-05-25

13 Province 5 District Health Office Dhs-Palpa Online 2018-06-04

14 Province 5 District Health Office Dhs-Arghakhanchi Online 2018-05-27

15 Province 5 District Health Office Dhs-Gulmi Online 2018-05-16

16 Province 5 District Health Office Dwh-Dang Online 2018-06-06

17 Province 5 District Health Office Dhs-Pyuthan Online 2018-05-30

18 Province 5 District Health Office Dhs-Rolpa Online 2018-05-25

19 Province 5 District Health Office Dhs-Rukum East Online 2018-06-13

20 Province 5 District Health Office Dhs-Rukum West Online 2018-06-13

21 Province 5 District Health Office Dwh-Banke Online 2018-06-18

22 Province 5 District Health Office Dwh-Bardiya Online 2018-04-13

23 Karnali Province District Health Office Dwh-Surkhet Online 2018-04-12

24 Karnali Province District Health Office Dhs-Dailekh Online 2018-05-30

25 Karnali Province District Health Office Dhs-Jajarkot Online 2018-05-18

26 Karnali Province District Health Office Dhs-Salyan Online 2018-06-08

27 Karnali Province District Health Office Dhs-Dolpa Offline 2018-07-20


101

28 Karnali Province District Health Office Dhs-Kalikot Offline 2018-07-21

29 Karnali Province District Health Office Dhs-Jumla Offline 2018-07-17

30 Karnali Province District Health Office Dhs-Mugu Offline 2018-07-19

31 Karnali Province District Health Office Dhs-Humla Offline 2018-07-17

32 Province 5 Local Level Govenment Office LLG-Rajapur Online 2018-08-24

33 Province 5 Local Level Govenment Office LLG-Badaiyatal Online 2018-08-23

34 Karnali Province Local Level Govenment Office

LLG-Birendranagar Online 2018-08-27

35 Karnali Province Local Level Govenment Office LLG-Barahatal Online 2018-08-28

36 Province 5 Primary Health Center

Rajapur Primary Health Mobile 2018-09-02

37 Province 5 Health Post Mainapokhar Health Post Mobile 2018-08-23

38 Province 5 Health Post Kalika Health Post Mobile 2018-08-30

39 Province 5 Health Post Manpur Tapara Mobile 2018-08-27

40 Province 5 Health Post Khairi chandanpur Mobile 2018-09-04

41 Province 5 Health Post Bhimapur Mobile 2018-09-02

42 Province 5 Health Post Daulatpur Mobile 2018-08-27

43 Province 5 Health Post Badalpur Mobile 2018-08-30

44 Province 5 Health Post Naya Gaun Mobile 2018-08-29

45 Province 5 Health Post Jamuni HP Offline 2018-09-05

46 Karnali Province Health Post Jarbuta Mobile 2018-08-31

47 Karnali Province Health Post Ratu Mobile 2018-09-04

48 Karnali Province Health Post Sanilekh Mobile 2018-09-05

49 Karnali Province Health Post Lekhgaun Mobile 2018-08-31

50 Karnali Province Health Post Gadi (Bayalkanda) Mobile 2018-09-04

51 Karnali Province Health Post Katkuwa Mobile 2018-09-04

52 Karnali Province Health Post Uttarganga Mobile 2018-09-07

53 Karnali Province Health Post Latikoili Mobile 2018-09-07

54 Karnali Province Health Post Hariharpur Online 2018-08-30

55 Karnali Province Health Post Pokharikanda Mobile 2018-09-07

56 Karnali Province Health Post Taranga Mobile 2018-09-03

57 Karnali Province Health Post Kunathari Mobile 2018-09-03


102

LIVE SITES SUMMARY

S.NO PROVINCE NAME OF THE SITE SITE TYPE DISTRICT LIVE DATE LIVE DATE (B.S.)

1 1 Birat Medical College Medical College Morang 6/7/2020 2/25/2077

2 1 Health Office Morang Health Office Morang 6/5/2020 2/23/2077

3 1Provincial Public Health Laboratory, Biratnagar

Provincial Laboratory Morang 6/7/2020 2/25/2077

4 Bagmati Charikot PHC, Dolakha

Primary Health Care Center Dolakha 6/10/2020 2/28/2077

5 Bagmati Dhading Hospital District Hospital Dhading 6/5/2020 2/23/2077

6 Bagmati College of Medical Science Medical College Chitwan 6/2/2020 2/20/2077

7 Bagmati Kathmandu Medical College Medical College Kathmandu 5/26/2020 2/13/2077

8 Bagmati Nepal Medical College Medical College Kathmandu 5/24/2020 2/11/2077

9 Bagmati Kist Medical College Medical College Lalitpur 5/22/2020 2/9/2077

10 Bagmati Health Office Kavrepalanchok Health Office Kavrepalanchok 5/22/2020 2/9/2077

11 Bagmati Health Office Bhaktapur Health Office Bhaktapur 5/19/2020 2/6/2077

12 Bagmati Health Office Dhading Health Office Dhading 6/1/2020 2/19/2077

13 Bagmati Health Office Dolakha Health Office Dolakha 6/10/2020 2/28/2077

14 Bagmati Health Office Lalitpur Health Office Lalitpur 5/22/2020 2/9/2077

15 Bagmati Health Office Sindhupalchowk Health Office Sindhupalchowk 6/4/2020 2/22/2077

16 Bagmati Sindhupalchowk Hospital

District Hospital Sindhupalchowk 6/4/2020 2/22/2077

17 Gandaki Gandaki Medical College Medical College Pokhara 5/31/2020 2/18/2077

18 Gandaki Manipal Medical College Medical College Pokhara 6/4/2020 2/22/2077

19 5 Bhim Hospital, Rupandehi

District Hospital Rupandehi 6/4/2020 2/22/2077

20 5 Pyuthan Hospital District Hospital Pyuthan 6/9/2020 2/27/2077

21 5 Rolpa Hospital District Hospital Rolpa 5/20/2020 2/7/2077

22 5 Devdaha Medical College Medical College Rupandehi 5/28/2020 2/15/2077

eLMIS SCALE-UP

REPORTING PERIOD 21 JUNE TO JUNE 27, 2020

Site Summary

S.NO SITE TYPE NUMBER TOTAL LIVE NUMBER THIS WEEK

1 Health Office (HO) 55 21 5

2 Hospital 61 22 4

3 Medical College 14 9 -

4 Provincial Public Health Laboratories (PPHL) 7 2 -

TOTAL 137 54 9


103

23 5 Universal College of Medical Science Medical College Rupandehi 6/4/2020 2/22/2077

24 Karnali Rukum West Hospital District Hospital Rukum West 6/5/2020 2/23/2077

25 1 Health Office Jhapa Health Office Jhapa 6/11/2020 2/29/2077

26 Bagmati Trisuli Hospital District Hospital Nuwakot 6/11/2020 2/29/2077

27 5 Kapilbastu Hospital District Hospital Kapilbastu 6/11/2020 2/29/2077

28 Gandaki Health Office Gorkha Health Office Gorkha 6/12/2020 2/30/2077

29 Gandaki Gorkha Hospital District Hospital Gorkha 6/12/2020 2/30/2077

30 Bagmati Health Office Kathmandu Health Office Kathmandu 6/14/2020 2/32/2077

31 Bagmati Health Office Nuwakot Health Office Nuwakot 6/14/2020 2/32/2077

32 Bagmati Ramechhap Hospital District Hospital Ramechhap 6/15/2020 3/1/2077

33 Bagmati Health Office Ramechhap Health Office Ramechhap 6/15/2020 3/1/2077

34 Sudur Pachim

Tikapur Hospital, Kailali

District Hospital Kailali 6/15/2020 3/1/2077

35 5 Privthvi Chandra Hospital

District Hospital

Nawalparasi West 6/16/2020 3/2/2077

36 Gandaki Health Office Tanahu Health Office Tanahu 6/17/2020 3/3/2077

37 1 Health Office Illam Health Office Illam 6/18/2020 3/4/2077

38 Gandaki Damauli Hospital District Hospital Tanahu 6/18/2020 3/4/2077

39 Sudur Pachim Health Office Kailali District

Hospital Kailali 6/18/2020 3/4/2077

40 Bagmati Sindhuli Hospital District Hospital Sindhuli 6/18/2020 3/4/2077

41 1 Illam District Hospital District Hospital Illam 6/18/2020 3/4/2077

42 Bagmati Health Office Rasuwa Health Office Rasuwa 6/19/2020 3/5/2077

43 Bagmati Health Office Sindhuli Health Office Sindhuli 6/19/2020 3/5/2077

44 Sudur Pachim

Provincial Public Health Laboratory, Dhangadi

Provincial Laboratory Kailali 6/20/2020 3/6/2077

45 Bagmati Rasuwa Hospital District Hospital Rasuwa 6/20/2020 3/6/2077

46 Gandaki Madhyabindi Hospital District Hospital

Nawalparasi East 6/21/2020 3/7/2077

47 Gandaki Health Office Lamjung Health Office Lamjung 6/22/2020 3/8/2077

48 1 Health Office Khotang Health Office Khotang 6/23/2020 3/9/2077

49 1 District Hospital Khotang

District Hospital Khotang 6/23/2020 3/9/2077

50 Sudur Pachim

Health Office Kanchanpur Health Office Kanchanpur 6/23/2020 3/9/2077

51 Gandaki District District Community Hospital

District Hospital Lamjung 6/24/2020 3/10/2077

52 1 District Hospital Panchthar

District Hospital Panchthar 6/24/2020 3/10/2077

53 Gandaki Health Office Nawalparasi East Health Office Nawalparasi

East 6/24/2020 3/10/2077

54 1 Health Office Panchthar Health Office Panchthar 6/25/2020 3/11/2077


104

LIVE SITES SUMMARY (21 JUNE TO 27 JUNE)

S.NO PROVINCE SITE NAME SITE TYPE DISTRICT LIVE DATE LIVE DATE (BS)

1 Gandaki Madhyabindi Hospital District Hospital

Nawalparasi East 6/21/2020 3/7/2077

2 Gandaki Health Office Lamjung Health Office Lamjung 6/22/2020 3/8/2077

3 1 Health Office Khotang Health Office Khotang 6/23/2020 3/9/2077

4 1 District Hospital Khotang

District Hospital Khotang 6/23/2020 3/9/2077

5 Sudur Pachim

Health Office Kanchanpur Health Office Kanchanpur 6/23/2020 3/9/2077

6 Gandaki District District Community Hospital

District Hospital Lamjung 6/24/2020 3/10/2077

7 1 District Hospital Panchthar

District Hospital Panchthar 6/24/2020 3/10/2077

8 Gandaki Health Office Nawalparasi East Health Office Nawalparasi

East 6/24/2020 3/10/2077

9 1 Health Office Panchthar Health Office Panchthar 6/25/2020 3/11/2077

ROLLOUT ACTIVITIES ONGOING SITES

S.NO PROVINCE SITE NAME SITE TYPE START DATE END DATE START DATE

(BS)END DATE

(BS)

1 Gandaki Health Office Kaski Health Office 6/25/2020 6/28/2020 3/11/2077 3/14/2077

2 1 District Hospital Okhaldhunga

District Hospital 6//27/2020 6/30/2020 3/13/2077 3/16/2077

3 1 Health Office Okhaldhunga

Health Office 6/26/2020 6/29/2020 3/12/2077 3/15/2077

4 2 Health Office Mahottari

Health Office 6/23/2020 6/28/2020 3/9/2077 3/14/2077

5 2 Jaleshowr Hospital District Hospital 6/25/2020 6/30/2020 3/11/2077 3/16/2077

6 Bagmati Health Office Chitwan

Health Office 6/25/2020 6/28/2020 3/11/2077 3/14/2077

7 Sudur Pachim

Health Office Darchula

Health Office 6/25/2020 6/29/2020 3/11/2077 3/15/2077

8 1 Health Office Taplejung

Health Office 6/26/2020 6/30/2020 3/12/2077 3/16/2077


105

PLAN ( 21 JUNE TO 27 JUNE)

S.NO PROVINCE SITE NAME SITE TYPE START DATE END DATE START DATE

(BS)END DATE

(BS)

1 Gandaki Health Office Syangja

Health Office 6/30/2020 7/2/2020 3/16/2077 3/18/2077

2 GandakiProvincial Public Health Laboratories (PPHL)- Pokhara

Provincial Public Health Laboratories (PPHL)

6/29/2020 6/29/2020 3/15/2077 3/15/2077

3 2 Health Office Dhanusa

Health Office 7/1/2020 7/4/2020 3/17/2077 3/20/2077

4 5Provincial Public Health Laboratories (PPHL)- Butwal

Provincial Public Health Laboratories (PPHL)

6/29/2020 6/30/2020 3/15/2077 3/16/2077

5 Gandaki Syangja Hospital District Hospital 7/3/2020 7/6/2020 3/19/2077 3/22/2077

6 1 Health Office Solukhumbu

Health Office 7/1/2020 7/3/2020 3/17/2077 3/19/2077

7 1 Taplejung Hospital District Hospital 6/28/2020 7/1/2020 3/14/2077 3/17/2077

8 Sudur Pachim

District Hospital Darchula

District Hospital 6/28/2020 6/30/2020 3/14/2077 3/16/2077

Note: Start date and end date of rollout may differ because of the pandemic situation. Also, It may be fluctuate based on the current running sites rollout end date.


106

3. P

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107

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108

DIVISION WISE PROCUREMENT PROGRESS AS OF JULY 15, 2020

PROCUREMENT METHOD

TOTAL NUMBER OF PROC. PACKAGE

NUMBER STARTED BIDDING PROCESSES CONTRACT SIGNED

NUMBER PLANNED VALUE (MIL.) NUMBER PLANNED

VALUE (MIL.) NUMBER PLANNED VALUE (MIL.)

ACTUAL VALUE (MIL.)

FWD

Goods 23 1,676.83 21 1,665.83 18 1,641.40 1,531.94

Works

Services 2 8.50 2 8.50 0 - -

EDCD

Goods 15 311.45 13 305.50 6 58.33 51.02

Works

Services

MD

Goods 6 74.46 2 10.00 1 7.00 5.21

Works 2 4.10 1 1.71 1 1.71 0.99

Services 2 37.20 1 2.20 1 2.20 1.68

CSD

Goods 13 677.69 8 502.95 5 256.35 194.38

Works

Services

NSSD

Goods 5 4.90 1 0.40 1 0.40 0.26

Works

Services

Total 68 2,795.13 49 2,497.09 33 1,967.39 1,785.48


109

PROCUREMENT FOR COVID-19 RESPONSE IN FY 2019/20

S.N. PROCUREMENT OF MEDICAL GOODS ANDLOGISTICS

COST ESTIMATE (NPR)

CONTRACT AMOUNT (NPR)

METHOD OF PROCUREMENT REMARKS

1 Thermal Scanner and Infrared Non Touch Hand Thermometer 15051000.00 6,396,430.54 RFQ

2 Essential Logistics For N-Corona Virus Management 15051000.00 7,222,962.00 RFQ

3 Essential Logistics For COVID-19 Response 280000000.00 276,549,430.00 RFQ Cancelled

4 Procurement of ICU Equipment & others for COVID-19 48474700.00 37,267,225.80 RFQ

5 General Bed and Accessories For Isolation Ward 51415000.00 35,482,000.00 RFQ

6 Procurement of Hand Sanitizer 1842000.00 2,034,000.00 DP

7 Hand Sanitizer 1044000.00 1,152,600.00 DP

8 Gum Boot for PPE 2320000.00 1,999,139.50 DP

9 PPE items For COVID -19 Control and Prevention 402297145.72

338,051,630.55 S-NCB

10 Laboratory items For COVID -19 56488706.00 45,216,950.00 S-NCB

11 Different items For COVID -19 Control and Prevention 58507919.60 27,461,373.00 S-NCB

12 RDT Kit for COVID-19 115418000.00 63,873,250.00 RFQ

13 Drugs for COVID-19 75000000.00 45,418,140.00 S-NCB

14 RT-PCR & RNA and VTM For COVID -19 102039101.04 311,089,000.00 S-NCB

15 RDT Kit for COVID-19 102039101.04 77,536,560.20 DP

16 ICU Consumables for COVID-19 78050000.00 29,496,479.50 S-NCB

17 Automated RNA Extraction Machine and RNA Extraction Kit 252500000.00 146,822,030.00 S-NCB

18 RDT Kit for COVID-19 9600000.00 94,500,000.00 DP

Total NPR Value 1,667,137,673.40 1,547,569,201.09


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113

5. AVAILABLE COLD CHAIN EQUIPMENT

1. COLD BOXModel: RCW 25Vaccine storage capacity: 20 LitresCool Life: 34.4HoursNo. of Ice Pack required: 24 Units (0.6 L)Purpose: Transportation of vaccines from vaccine storetodistribution centreManufactured by: B Medical, LuxembourgAvailable: CVS, PVS, DVS, HF

2. ICE LINING REFRIGERATORModel: TCW 1152 Vaccine storage capacity: 169 LitresRefrigerant: R134aTemperature Range: 2 to 8 deg. Celsius.Holdover time: 42 Hours.Purpose: Storage of vaccines Manufactured by: Electrolux,LuxembourgAvailable: CVS, PVS, DVS

3. ICE PACK FREEZERModel: TFW 800Capacity: 209 LitresRefrigerant: R134aTemperature Range: -15 to - 25 deg. Celsius.Purpose: Preparation of Ice packs at CVS, PVS & DVSManufactured by: Electrolux, LuxembourgAvailable: CVS, PVS, DVS

4. ICE LINED REFRIGERATORModel: TCW 4000 AC*Vaccine storage Capacity: 240 LitresRefrigerant: R600aTemperature Range:2 to 8 deg. Celsius.Holdover time: 77.3 HoursPurpose: Storage of Vaccines at PVS & DVS Manufactured by: B Medical, Luxemburg

*Various models like TCW 2000, TCW3000 &TCW2000DC are available Available: DVS


114

5. DEEP FREEZERModel: HBD 286Ice Pack Storage Capacity: 310 x 0.6 L Ice packRefrigerant: R134aTemperature Range: -15 to -25 deg. Celsius.Holdover time: 4.9 HoursPurpose: Preparation and Storage of Ice Pack atPVS & DVSManufactured by: Haier-Qingdao, ChinaAvailable: CVS, PVS, DVS

6. ICE LINED REFRIGERATORModel: HBC 80Vaccine storage Capacity: 61 LitresRefrigerant: R600aTemperature Range:2 to 8 deg. Celsius.Holdover time: 59.51 Hrs.Purpose: Storage of Vaccines at Distribution CentreManufactured by: Haier-Qingdao, ChinaAvailable: Municipality, HF

7. ICE LINED REFRIGERATORModel: HBD 116Ice Pack Storage Capacity: 136 X 0.6 LitresRefrigerant: R134aTemperature:2 to 8 deg. Celsius.Holdover time: 59.51 Hrs.Purpose: Preparation and Storage of Ice Pack atdistribution centreManufactured by: Haier- Qingdao,ChinaAvailable:Municipality, HF

8. ICE LINED REFRIGERATORModel: HBD 116Types of Appliance: Solar Direct drive Combined Refrigerator/freezerVaccine Storage Capacity: 37.5 LitresIce Pack Storage Capacity: 12 X 0.6 LitresRefrigerant: R600aTemperature Range:Freezer < -5 °C &Refrigerator (2 to 8) °C.Holdover time: 59.51 Hrs.Purpose: Storage of Vaccines andpreparation of Ice PackManufactured by: Haier, Qingdao,ChinaAvailable: Municipality, HF


115

9. ICE LINED REFRIGERATORModel: TCW 3000 ACVaccine storage Capacity: 150 LitresRefrigerant: R134aTemperature:2 to 8 deg. Celsius.Holdover time: 53.10 Hrs. (fridge) and3.55 Hrs. (Freezer)Purpose: Storage of Vaccines Manufactured by: B Medical, LuxemburgAvailable: DVS, HF

10. ICE LINED REFRIGERATORModel: TCW 2000 DCTypes of Appliance: Battery solar Powered Combined refrigeratorand freezerVaccine storage Capacity: 76 LitresFreezer Capacity: 30 Litres Refrigerant: R134aTemperature:2 to 8 deg. Celsius.Holdover time: 13.6 HoursPurpose: Storage of Vaccines and Preparation of Ice Packs Manufactured by: B Medical, LuxemburgAvailable: DVS, HF

11. VACCINE CARRIERModel No: BDVC 46Vaccine Storage Volume: 3.36 Litres Cool Life: 13.26 Hrs. at 43°C with 4 Ice Packs No. of Ice Pack required: 4 Units (0.6 L)Purpose: Transportation of vaccines fromdistribution centre to EPI session. Manufactured by: Nilkamal, IndiaAvailable: DVS, HF, Session

12. VACCINE CARRIERModel No: BDVC 44Vaccine Storage Volume: 1.7 Litres Cool Life: 7 Hrs. at 43°C with 4 Ice Packs No. of Ice Pack required: 4 Units (0.4 L)Purpose: Transportation of vaccines fromdistribution centre to EPI session. Manufactured by: Nilkamal, IndiaAvailable: DVS, HF, Session


116

13. WALK IN COOLERModel:Huurre*GrossCapacity: 41cm3Refrigerant: R404aTemperature Range:2 to 8 deg. Celsius.Purpose: Storage of Vaccines at CVS & PVSManufactured by: FinlandAvailable: CVS*Cooling unit changed with Danfoss Denmark

14. WALK IN COOLERModel: EMB2009MIZGross Capacity: 15 m3Refrigerant: R404aTemperature:2 to 8 deg. Celsius.Holdover time: not availablePurpose:Storage of vaccines at CVS & PVSManufactured by: Haier, Qingdao ChinaAvailable: CVS, PVS

15. WALK IN FREEZERModel:ColdbankGross capacity: 30 m3, Refrigerant: R404aTemperature:- 15 to - 25 deg. Celsius.Purpose: Storage of Heat sensitive vaccineseg. OPVManufactured by:ChinaAvailable: CVS

16. ALCOHOL THERMOMETERTemperature Range: -40 to + 50 deg. Celsius.Uses: Temperature Monitoring of VaccinesManufactured by: ChinaAvailable: CVS, PVS, DVS, HF

17. FRIDGE- TAG TYPE 2Description:30 Days Electronic Temperature LoggerPower source: Non- Replaceable BatteryBattery Shelf Life: 42 months from manufacture dateUses: Use in WIC,ILR, Cold Boxes to monitor Temperature Manufacture By:Berlinger and Co. AG, SwitzerlandAvailable: CVS, PVS, DVS, HF


117

18.FREEZE TAGDescription: Electronic Freeze IndicatorProduct Type: Irreversible freeze Indicator Temperature Range: Min. -20°C and Max. +50°CPower source: Non- Replaceable BatteryBattery Shelf Life: 60 months from manufacture dateAlarm Condition: Below -0.5°C for 60 min. Uses: Use in WIC,ILR, Cold Boxes and Vaccine carrier to monitor freezing temperatureManufacture By:Berlinger and Co. AG, MalaysiaAvailable: CVS, PVS

19. LOG TAGModel:TRIX-8Description: Interface and the freely available companion software Log Tag AnalyzerTemperature Range:- 40°C to +85°CPower source: Non- Replaceable BatteryBattery Shelf Life: 10 YearsUses: Use in WIC,ILR, Cold Boxes to monitor TemperatureManufacture By: Log Tag Recorders Ltd., ChinaAvailable: Available: CVS, PVS

20. MULTI-LOGModel: 30252 – 2CDescription: PC Interface with Multi-log SoftwareMeasuring Range: - 30°C to +70°CPower source: In-Built Battery Uses: Use in WIC, WIFManufacture By:RemonsysLimited ,UKAvailable: Available: CVS, PVS

21. BACK- UP GENERATORModel:KDF60SS3Capacity: 50 KVA, 15 KVAFuel consumption: 10 lit. per hourPurpose: Power backup at the time of power cut-offManufactured by: Wuxi Kipor Power CO.LTD. CHINAAvailable: CVS - 50 KVA, PVS-15 KVA


118

22. REFRIGERATED VANModel:Cooling Unit: Carrier-XARIOS500Capacity: Gross capacity 19 m3Refrigerant: R404aTemperature:2 to 8 deg. Celsius.Holdover time: not availablePurpose:Transportation of vaccines from CVS to PVSManufactured by: Cooling Unit: Carrier, USABody & engine: JAC, ChinaAvailable: Provincial Vaccine Store (PHLMC)

23. REFRIGERATED VANModel:Cooling Unit: HT-500ESC Body & engine:1109H-EX2Capacity:Gross capacity 20 m3Refrigerant: R404aTemperature: 2 to 8 deg. Celsius.Holdover time: not availablePurpose: to transport the vaccines from CVS to PVS & DVSManufactured by: Cooling Unit: HWASUNG THERMO S. KoreaBody & engine: TATA, IndiaAvailable: Provincial Vaccine Store (PHLMC)

24. REFRIGERATED VANModel: Cooling Unit: HT-250ESC Body & engine: TATA 407Capacity: Gross capacity:10 m3Refrigerant: R404aTemperature: 2 to 8 deg. Celsius.Holdover time: not availablePurpose: Transport the vaccines from CVS to PVS & DVSManufactured by: Cooling Unit: HWASUNG THERMO S. KoreaBody & engine: TATA, IndiaAvailable: Provincial Vaccine Store (PHLMC)


119

PROVINCE WISE TOTAL QUANTITIES EXPIRED LIST OF FY 2074/75 AND 2075/76

S.NO PRODUCTS

STA

TE 1

STA

TE 2

STA

TE 3

STA

TE 4

STA

TE 5

KA

RN

ALI

PR

OV

INC

E (S

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6)

SU

DU

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SH

CH

IM

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DES

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L EX

PIR

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SU

BTO

TAL

SU

BTO

TAL

SU

BTO

TAL

SU

BTO

TAL

SU

BTO

TAL

SU

BTO

TAL

SU

BTO

TAL

COLD CHAIN ACCESSORIES AND SYRINGES

1 Insulin Syringe 0 0 48550 0 64235 16410 0 129195

2 Syringe 2 ml 0 0 0 0 24608 867 3001 28476

NCASC PROGRAM

3 Determine HIV Test Kits (PMTCT) 0 0 299600 0 1640 20 0 301260

4 Determine HIV-1 / 2 (Complete set) 0 0 119940 0 4290 0 0 124230

5 Lopinavir/Ritonavir Oral Pellets 40mg/10/mg 0 0 12120 0 0 0 0 12120

6 RPR 0 0 484850 0 0 0 0 484850

7 TPHA Syphilis 0 0 36200 0 0 0 0 36200

8 Vacutainer (K3E 7.5 % 0.072 ml ) 3 ml 0 0 35000 0 0 0 0 35000

I.V. SOLUTION

9Compound Sodium Lactate Solution 500 ml (Ringers Lactate)

0 8270 24 0 748 104 0 9146

IMNCI PROGRAM

10 Zinc Sulphate 20 mg Tablet 27000 0 0 0 229860 21159 0 278019

INJECTIONS

11 Water for Injection 5 ml 0 0 88700 0 6345 842 0 95887

LEPROSY PROGRAM

12 Rifampicin 150 mg Capsule 0 0 3300 0 8000 0 0 11300

LIQUID SOLUTION AND POWDER (TOP/DER/EXT USE)

13 Ciprofloxacin 0.3% w / v Eye / Ear Drops 0 0 0 0 8569 2295 0 10864

14 Povidone Iodine Solution 5% 500 ml 0 0 0 0 1395 108 0 1503

MALARIA/KALA-AZAR PROGRAM

15 Diethylcarbamzipine 100 mg (DEC) Tablet 0 0 0 0 90800 3600 0 94400

NIP/VACCINES/IMMUNOLOGICAL AGENTS

16 PCV 10 -2 Dose 0 0 0 0 4001 492 0 4493

NUTRITION PROGRAM

17Ferrous Sulphate 60 mg + Folic Acid Tab 0.4 mg Tablet

0 0 397890 0 26600 30061 0 454551

18 RUTF (Ezee Paste Nut) Packet 0 0 0 0 43161 23748 0 66909

OINTMENT CREAM AND DROP

19 Chloramphenicol Eye Applicab 1% Applicab 0 0 0 0 1973 0 0 1973

6. EXPIRED MEDICINES LIST


120

ORAL SOLIDS : TABLETS/CAPSULES

20 Acyclovir 200 mg Tablet 0 0 68440 0 11740 49 0 80229

21 Allopurinol 100 mg Tablet 0 0 0 0 15700 2300 0 18000

22 Amitriptyline 25 mg Tablet 0 0 0 0 19300 4840 0 24140

23 Amlodipine 5 mg Tablet 0 0 22740 0 56660 26000 0 105400

24 Anti Cold Tab 0 0 0 0 20330 0 0 20330

25 Atenolol 50 mg Tablet 0 0 3900 0 30456 80241 0 114597

26 Azithromycin 500 mg Tablet 0 0 1370 0 3463 10 0 4843

27 Carbamazepine 400 mg Tablet 0 0 0 0 13400 3900 0 17300

28 Chlorpromazine 100 mg Tablet 0 0 0 0 9400 0 0 9400

29 Ciprofloxacin Hydrochloride 500 mg Tablet 0 0 8100 0 2200 0 0 10300

30 Doxycycline 100 mg Capsule 0 0 18400 0 750 1200 0 20350

31 Doxycycline 100 mg Tablet 0 0 12500 0 2600 3550 0 18650

32 Frusemide 40 mg Tablet 0 0 0 0 21270 100 0 21370

33 Metformin 500 mg Tablet 0 0 0 0 17590 108500 0 126090

34 Omeprazole 20 mg capsule 0 0 48 0 0 0 0 48

35 Oseltamivir 30 mg Capsule 0 0 11710 0 345 0 0 12055

36 Oseltamivir 45 mg Capsule 0 0 10480 0 1495 0 0 11975

37 Pyridoxine 25 mg Tablet 0 0 26280 0 0 0 0 26280

38 Tinidazole 500 mg Tablet 0 0 72800 0 6470 0 0 79270

39 Vitamin B Complex Tablets 0 0 14540 0 4120 15000 0 33660

Tuberculosis Program

40 Cycloserine 250 mg Capsule 0 0 283100 0 0 0 0 283100

41 Isoniazid 100 mg Tablet 0 0 50900 0 18750 150 0 69800

42 PASER 5.2 g Sachet 0 0 97725 0 0 0 0 97725

43 Pyrazinamide 400 mg Tablet 0 0 33600 0 0 0 0 33600


121

FEDERAL LEVEL HOSPITAL INVENTORY TILL 4TH PPM

SN EQUIPMENT DESCRIPTOR(ACC. PLAMAHS SYSTEM)

PROVINCE

1 2

BA

GM

ATI

GA

ND

AK

I

5

KA

RN

ALI

SU

DU

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SH

CH

IM

GR

AN

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1 Air conditioner, split type, ceiling mounted 1 1 2

2 Air conditioner, split type, wall mounted 34 41 52 49 8 1 10 195

3 Air conditioner, window type 8 1 2 11

4 Anaesthesia apparatus, Boyle’s 1 4 5

5 Anaesthesia apparatus, EMO, with OMV vaporizer 1 1

6 Anaesthesia apparatus, ventilator 7 7 7 5 4 2 2 34

7 Analyser, biochemistry 5 6 4 6 6 5 3 35

8 Analyser, blood culture 1 1 2 2 6

9 Analyser, blood gas 1 1 4 1 7

10 Analyser, electrolyte 6 5 3 10 2 26

11 Analyser, haematology 4 2 1 9 2 1 3 22

12 Analyser, immunoassay 1 1 2 1 5

13 Analyser, MTB/RIF 1 1

14 Analyser, Na/K 3 1 2 6

15 Audiometer 3 2 2 7

16 Bilirubinometer 1 1

17 Bio-safety cabinet 1 2 3

18 Cardiotocography (CTG) machine 2 2 1 5

19 CD4 counter 2 1 1 1 1 6

20 Centrifuge, bench type, electric 10 8 8 11 8 4 7 56

21 Coagulometer 1 1 1 1 2 6

22 Colonoscope (fiber optic) 1 1

23 Colorimeter 8 7 3 6 6 2 1 33

24 Colposcope 1 1 2

25 CT scanner 1 1 1 3

26 Defibrillator 2 2 6 7 2 1 20

27 Dental chair, electric 1 1 2 4

28 Dental unit, complete 4 4 6 3 2 1 2 22

29 Dialysis machine 5 5 11 21

30 Dialysis water treatment unit 1 1 2

31 Diathermy unit, short wave 1 1 1 1 1 5

32 Drill, surgical 3 3 3 1 10

33 Electrocardiograph (ECG), multi-channel 17 12 23 12 8 6 1 79

34 Electrocardiograph (ECG), single-channel 1 2 1 2 6

35 Electroconvulsive therapy (ECT) machine 1 1 2

36 Electroencephalograph (EEG) 1 1 2

37 Electrosurgical unit, argon beamer 2 2

38 Electrosurgical unit, general purpose 10 9 14 10 5 4 2 54

39 ELISA reader 1 1 1 3

40 Endoscope (fiber optic) 2 2 4 4 1 13

41 Endoscopy unit (light source) 5 4 5 7 1 22

42 Endoscopy unit ENT, with monitor 2 1 1 1 5

43 ENT treatment unit 2 2 4

44 Freezer, electric, chest 1 1

7. BIOMEDICAL EQUIPMENTS MAINTENANCE


122

45 Haemoglobinometer 2 2

46 Incubator, infant, with sensors 1 1 3 1 2 1 9

47 Incubator, laboratory 4 7 3 6 2 2 24

48 Insufflator, endoscopy / laparoscopy 2 2 2 4 1 1 12

49 Interferential therapy apparatus 3 1 1 5

50 Laparoscope (fiber optic) 1 1 1 1 4

51 Laparoscopy unit (light source) 1 2 3 1 1 8

52 Light, dental resin curing 2 2 1 5

53 Light, operating, ceiling mounted 5 7 9 8 2 2 1 34

54 Light, operating, mobile 1 1 6 3 4 15

55 Light, operating, mobile, with battery backup 6 4 2 12

56 Light, operating, mobile, with transformer 6 6 2 2 16

57 Lithotripter, intracorporeal 1 1 2

58 Microscope, binocular 13 8 5 14 6 2 6 54

59 Microscope, ENT 1 1

60 Microscope, operating 1 3 1 3 8

61 Microscope, ophthalmic 1 1

62 Monitor, fetal heart, ultrasonic, portable 1 1 2

63 Monitor, multiparameter 28 36 101 62 14 10 9 260

64 Monitor, multiparameter, centralized 1 2 3

65 Oven, drying 3 3 1 5 1 3 16

66 Oxygen concentrator 9 15 12 7 6 13 14 76

67 Phototherapy unit 4 8 12 16 2 2 4 48

68 Printer, thermal, for ultrasound scanner 3 7 8 12 4 4 3 41

69 Pulmonary function test unit 1 1

70 Pulse oximeter, with monitor 8 11 4 12 2 3 1 41

71 Pump, infusion 5 5 16 9 2 7 3 47

72 Pump, syringe 9 6 21 11 4 6 1 58

73 Refrigerator, double door, electric, medium(150 - 400 liters) 5 6 10 8 2 4 1 36

74 Refrigerator, kerosene / electric 1 1

75 Refrigerator, mortuary 2 1 2 5

76 Refrigerator, single door, electric, medium (150 - 400 liters) 20 18 8 8 3 1 6 64

77 Refrigerator, single door, electric, small (below 150 litres) 1 5 5 8 2 1 22

78 Scaler, ultrasonic 3 3 2 1 1 10

79 Scanner, ultrasonic, colour Doppler 1 1 2 1 5

80 Scanner, ultrasonic, general 1 5 3 8 2 4 2 25

81 Scanner, ultrasonic, portable 1 2 2 1 2 2 10

82 Shaker, mixer 1 1 2 2 6

83 Shaker, roller 1 1 2

84 Shaker, vortex 2 3 6 4 15

85 Sterilizing unit, dry heat 2 2 4

86 Sterilizing unit, steam, non-vacuum, automatic, M (21 - 80 ltr) 2 1 3 6

87 Sterilizing unit, steam, non-vacuum, basic, L (above 80 ltr) 2 2 2 6

88 Sterilizing unit, steam, non-vacuum, basic, M (21 - 80 ltr) 1 12 4 2 1 1 3 24

89 Sterilizing unit, steam, non-vacuum, basic, S (up to 20 ltr) 3 10 1 1 1 16


123

90 Sterilizing unit, steam, vacuum, automatic, L (above 80 ltr) 1 2 2 1 6

91 Sterilizing unit, steam, vacuum, automatic, M (21 - 80 ltr) 1 1

92 Sterilizing unit, steam, vacuum, automatic, S (up to 20 ltr) 2 2

93 Sterilizing unit, steam, vacuum, basic, L (above 80 ltr) 3 1 3 7

94 Sterilizing unit, steam, vacuum, basic, M (21 - 80 ltr) 3 2 5

95 Stimulator, muscle 1 2 1 1 2 7

96 Stimulator, neuromuscular (TENS) 1 4 1 6

97 Suction apparatus, electric 44 39 47 60 25 12 5 232

98 Table, operating, electric 4 2 7 4 1 3 21

99 Table, operating, hydraulic 7 12 1 4 2 1 2 29

100 Therapy unit, ultrasonic 1 2 2 3 4 3 15

101 Tissue processor 1 2 3

102 Traction machine, digital 1 1 1 1 1 5

103 Treadmill test (TMT) machine 1 1

104 Tympanometer 1 1 2

105 Ventilator, for emergencies and transport 3 3 1 7

106 Ventilator, intensive care 4 4 12 15 2 3 3 43

107 Warmer, infant, with sensor 9 24 18 19 2 2 11 85

108 X-ray cassette reader, incl. PC 3 2 1 1 1 1 2 11

109 X-ray film dryer, automatic 1 1 2

110 X-ray film printer 4 2 1 1 2 1 1 12

111 X-ray film processor, automatic 2 3 1 6

112 X-ray unit, dental 1 1 3 3 1 1 10

113 X-ray unit, dental, panoramic 3 3

114 X-ray unit, mobile 2 3 5 3 3 1 17

115 X-ray unit, mobile, C-arm, image intensifier 2 2 3 2 2 1 1 13

116 X-ray unit, stationary, 300 mA and above 3 3 1 3 3 2 1 16

117 X-ray unit, stationary, below 300 mA 1 1

118 X-ray unit, stationary, DR system 1 1

Total 382 459 538 547 187 130 144 2387Note: Yellow Highlight are those equipment descriptor which was removed from BoQ after the 1st PPM cycle


124

PROVINCIAL LEVEL HOSPITAL INVENTORY TILL 4TH PPM


PROVINCE

1 2

BA

GM

ATI

GA

ND

AK

I

5

KA

RN

ALI

SU

DU

RPA

SH

CH

IM

GR

AN

D

TOTA

L

1 Air conditioner, split type, wall mounted 31 45 40 22 142 16 75 371

2 Air conditioner, window type 3 1 5 9

3 Anaesthesia apparatus, Boyle's 3 2 2 2 1 10

4 Anaesthesia apparatus, EMO, with OMV vaporizer 1 1 1 1 4

5 Anaesthesia apparatus, ventilator 7 3 5 6 13 4 11 49


7 Analyser, blood culture 4 4

8 Analyser, blood gas 1 2 4 1 8

9 Analyser, electrolyte 16 4 4 11 11 8 8 62

10 Analyser, haematology 13 9 6 10 19 10 11 78

11 Analyser, immunoassay 1 1 4 1 7

12 Analyser, MTB/RIF 1 2 1 4

13 Analyser, Na/K 2 16 2 4 24

14 Arthroscope (fiber optic) 1 1

15 Audiometer 4 2 6

16 Bilirubinometer 2 1 3

17 Bio-safety cabinet 2 2

18 Cardiotocography (CTG) machine 2 2 2 6

19 CD4 counter 1 1 1 2 3 2 5 15


21 Centrifuge, haematocrit 3 3 6

22 Coagulometer 1 2 4 1 8

23 Colonoscope (fiber optic) 1 1 1 3

24 Colorimeter 39 18 9 22 42 32 23 185

25 CT scanner 1 1

26 Defibrillator 4 1 2 3 7 4 5 26

27 Dental chair, electric 1 1 2 1 4 1 10

28 Dental chair, hydraulic 1 2 1 4

29 Dental unit, complete 13 5 9 8 12 6 7 60

30 Dialysis machine 4 2 6 4 4 20

31 Dialysis water treatment unit 1 1 2 4

32 Diathermy unit, short wave 1 1 1 2 5

33 Drill, surgical 1 1 5 1 8


35 Electrocardiograph (ECG), single-channel 3 3 2 8

36 Electrosurgical unit, general purpose 28 10 7 13 32 21 22 133

37 Electrosurgical unit, ophthalmology 1 1

38 ELISA reader 2 1 3

39 Endoscope (fiber optic) 1 1 1 1 1 3 8

40 Endoscopy unit (light source) 2 1 1 2 12 7 2 27

41 Endoscopy unit ENT, with monitor 1 1 2

42 ENT treatment unit 1 1

43 Freezer, electric, chest 2 2 3 7 4 18

44 Freezer, electric, upright 2 1 1 4


125

45 Haemoglobinometer 1 1

46 Incubator, infant, transport 1 1 2 1 1 1 7

47 Incubator, infant, with sensors 8 1 3 2 6 3 6 29

48 Incubator, laboratory 27 9 12 16 23 13 17 117

49 Insufflator, endoscopy / laparoscopy 1 1 3 2 1 8

50 Interferential therapy apparatus 2 3 2 7

51 Laparoscope (fiber optic) 1 1

52 Laparoscopy unit (light source) 1 2 3

53 Light, dental resin curing 2 3 3 1 9

54 Light, operating, ceiling mounted 14 4 7 6 27 5 6 69

55 Light, operating, mobile 7 5 11 4 30 21 25 103

56 Light, operating, mobile, with battery backup 30 11 3 10 23 27 11 115

57 Light, operating, mobile, with transformer 20 1 1 15 5 1 43


59 Microscope, ENT 3 1 4

60 Microscope, operating 1 1 2

61 Microscope, ophthalmic 2 3 1 6

62 Monitor, cardiac pulse rate, mobile 1 1 2

63 Monitor, fetal heart, ultrasonic, portable 2 3 2 19 2 4 32


65 Monitor, multiparameter, centralized 1 2 3

66 Oven, drying 31 6 16 17 23 21 21 135


68 Phototherapy unit 28 12 11 16 34 10 7 118

69 Printer, thermal, for ultrasound scanner 28 14 15 17 35 24 15 148

70 Pulmonary function test unit 1 1 2

71 Pulse oximeter, with monitor 14 11 7 6 30 8 20 96

72 Pump, infusion 6 9 5 7 28 9 9 73

73 Pump, syringe 9 16 5 2 35 3 12 82

74 Refrigerator / freezer, solar powered (complete system) 2 1 3

75 Refrigerator, double door, electric, large (above 400 liters) 2 2 4

76 Refrigerator, double door, electric, medium (150 - 400 liters) 11 8 3 11 19 10 12 74

77 Refrigerator, kerosene / electric 2 2 1 1 6

78 Refrigerator, mortuary 2 1 3

79 Refrigerator, single door, electric, medium (150 - 400 liters) 45 21 24 17 74 20 35 236

80 Refrigerator, single door, electric, small (below 150 litres) 18 15 16 18 22 15 15 119

81 Scaler, ultrasonic 11 5 7 7 3 3 36

82 Scanner, ultrasonic, colour Doppler 1 1 1 2 1 2 8

83 Scanner, ultrasonic, general 27 11 11 14 19 17 13 112

84 Scanner, ultrasonic, portable 7 4 3 6 18 8 6 52

85 Shaker, mixer 6 1 3 5 15 4 7 41

86 Shaker, roller 1 2 9 1 5 18

87 Shaker, vortex 13 4 3 3 1 4 2 30

88 Sterilizing unit, dry heat 11 3 1 2 17

89 Sterilizing unit, steam, non-vacuum, automatic, L (above 80 ltr) 2 1 2 5 10

90 Sterilizing unit, steam, non-vacuum, automatic, M (21 - 80 ltr) 6 2 5 10 24 1 9 57


126

91 Sterilizing unit, steam, non-vacuum, basic, L (above 80 ltr) 1 3 3 1 3 1 1 13

92 Sterilizing unit, steam, non-vacuum, basic, M (21 - 80 ltr) 36 19 20 19 19 27 15 155

93 Sterilizing unit, steam, non-vacuum, basic, S (up to 20 ltr) 30 12 10 13 34 14 10 123

94 Sterilizing unit, steam, vacuum, automatic, L (above 80 ltr) 1 1 4 1 7

95 Sterilizing unit, steam, vacuum, automatic, M (21 - 80 ltr) 1 1 2 1 1 6

96 Sterilizing unit, steam, vacuum, automatic, S (up to 20 ltr) 1 1 1 2 5

97 Sterilizing unit, steam, vacuum, basic, L (above 80 ltr) 2 2

98 Sterilizing unit, steam, vacuum, basic, M (21 - 80 ltr) 1 2 3

99 Stimulator, muscle 2 8 4 4 2 20

100 Stimulator, neuromuscular (TENS) 1 2 3


102 Table, operating, electric 1 2 2 4 11 2 2 24

103 Table, operating, hydraulic 18 12 10 8 32 24 27 131

104 Therapy unit, ultrasonic 2 2 3 7

105 Tissue processor 1 1

106 Traction machine, digital 2 1 2 2 1 8

107 Treadmill test (TMT) machine 1 1

108 Tympanometer 1 1

109 Ventilator, for emergencies and transport 1 1 1 2 1 6

110 Ventilator, infant 2 2 1 5

111 Ventilator, intensive care 1 4 4 3 28 7 6 53


113 X-ray cassette reader, incl. PC 7 3 5 3 12 6 3 39

114 X-ray film dryer, automatic 1 2 3

115 X-ray film printer 7 3 3 5 11 9 3 41

116 X-ray film processor, automatic 7 2 2 6 5 2 3 27

117 X-ray unit, dental 10 5 6 7 9 4 4 45

118 X-ray unit, mobile 15 9 5 12 23 15 8 87

119 X-ray unit, mobile, C-arm, image intensifier 1 2 2 2 5 2 2 16

120 X-ray unit, stationary, 300 mA and above 15 9 7 6 19 10 11 77

121 X-ray unit, stationary, below 300 mA 5 1 6 6 4 5 3 30

122 X-ray unit, stationary, DR system 1 1 1 3

Total 1223 682 639 769 1884 928 915 7040

Note: Yellow Highlight are those equipment descriptor which was removed from BoQ after the 1st PPM cycle


127

LOCAL LEVEL HOSPITAL INVENTORY TILL 4TH PPM


PROVINCE

1 2

BA

GM

ATI

GA

ND

AK

I

5

KA

RN

ALI

SU

DU

RPA

SH

CH

IM

GR

AN

D

TOTA

L

1 Air conditioner, split type, wall mounted 12 1 6 1 20

2 Anaesthesia apparatus, EMO, with OMV vaporizer 1 1

3 Anaesthesia apparatus, ventilator 1 1


5 Analyser, electrolyte 1 2 4 1 8

6 Analyser, haematology 2 3 4 9

7 Analyser, MTB/RIF 1 1

8 Analyser, Na/K 1 1


10 Centrifuge, haematocrit 1 1

11 Colorimeter 4 7 5 3 2 5 8 34

12 Defibrillator 1 1

13 Dental chair, electric 3 2 5

14 Dental unit, complete 3 1 4


16 Electrocardiograph (ECG), single-channel 1 1 2

17 Electrosurgical unit, general purpose 3 3 1 7

18 ELISA reader 1 1

19 Endoscopy unit (light source) 1 1

20 Freezer, electric, chest 2 2 1 1 5 11

21 Freezer, electric, upright 1 1

22 Freezer, kerosene / electric, chest 1 1

23 Incubator, infant, with sensors 1 1 2

24 Incubator, laboratory 2 2 3 1 1 2 11

25 Light, operating, ceiling mounted 2 2 4

26 Light, operating, mobile 1 1 4 1 3 10

27 Light, operating, mobile, with battery backup 2 1 3

28 Light, operating, mobile, with transformer 1 2 1 3 7


30 Monitor, fetal heart, ultrasonic, portable 1 2 3 1 7


32 Oven, drying 2 2 5 1 1 2 3 16


34 Phototherapy unit 1 3 5 1 1 1 12

35 Printer, thermal, for ultrasound scanner 3 1 3 1 1 3 12

36 Pulmonary function test unit 1 1

37 Pulse oximeter, with monitor 1 2 3 4 1 11

38 Refrigerator, double door, electric, medium (150 - 400 liters) 1 3 2 3 9

39 Refrigerator, kerosene / electric 2 2 4

40 Refrigerator, single door, electric, medium (150 - 400 liters) 4 3 3 1 3 3 17

41 Refrigerator, single door, electric, small (below 150 litres) 2 3 12 1 3 21

42 Scaler, ultrasonic 3 1 4

43 Scanner, ultrasonic, general 3 1 5 1 2 3 15


128

44 Scanner, ultrasonic, portable 2 1 2 5

45 Shaker, mixer 1 1 3 2 1 8

46 Shaker, roller 1 1 2

47 Shaker, vortex 1 1 2

48 Sterilizing unit, dry heat 2 4 3 9

49 Sterilizing unit, steam, non-vacuum, automatic, M (21 - 80 ltr) 1 1

50 Sterilizing unit, steam, non-vacuum, basic,L (above 80 ltr) 3 3

51 Sterilizing unit, steam, non-vacuum, basic, M (21 - 80 ltr) 4 6 4 4 3 21

52 Sterilizing unit, steam, non-vacuum, basic, S (up to 20 ltr) 1 5 8 4 4 22

53 Sterilizing unit, steam, vacuum, automatic,L (above 80 ltr) 1 1

54 Sterilizing unit, steam, vacuum, basic, M (21 - 80 ltr) 1 1


56 Table, operating, electric 1 1 2

57 Table, operating, hydraulic 1 3 1 5

58 Ventilator, intensive care 1 1


60 X-ray cassette reader, incl. PC 1 3 2 1 1 8

61 X-ray film dryer, automatic 1 1

62 X-ray film printer 2 2 2 1 1 8

63 X-ray film processor, automatic 1 2 3

64 X-ray unit, dental 1 3 1 5

65 X-ray unit, mobile 1 2 2 2 1 5 13

66 X-ray unit, mobile, C-arm, image intensifier 1 1

67 X-ray unit, stationary, 300 mA and above 2 1 4 2 1 2 12

68 X-ray unit, stationary, below 300 mA 4 3 1 8

69 X-ray unit, stationary, DR system 1 1

Total 131 126 231 53 39 36 114 730

Note: Yellow Highlight are those equipment descriptor which was removed from BoQ after the 1st PPM cycle


129

8. GAZZETE NOTICE FOR DRUG PRICE

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@ Amoxycillin 500 mg Tablet/Capsule *.–

# Amoxycillin 250 mg Tablet/Capsule %.–

$ Azithromycin 500 mg Tablet/Capsule #).–

% Azithromycin 250 mg Tablet/Capsule !&.$%

^ Cefixime 200 mg Tablet/Capsule @).–

& Ceftriaxone 1g Inj Vial/Ampoule ().–

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( Ciprofloxacin 500 mg Tablet/Capsule *.–

!) Fluconazole 150 mg Tablet/Capsule @$.–

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# Amlodipine 10 mg Tablet/capsule *.–

$ Losartan 25 mg Tablet/capsule $.$!

% Losartan 50 mg Tablet/capsule &.^)

^ Atorvastatin 5 mg Tablet/capsule ^.&%

!! Levonorgestrol 150 mcg tab or 2 tablets of levonorgestrol 75 mg

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!@ Nimesulide 100 mg Tablet/Capsule #.–

!# Ofloxacin 400 mg Tablet/Capsule *.–

!$ Omeprazole 20 mg Tablet/Capsule $.–

!% Pantoprazole 40 mg Tablet/Capsule *.–

!^ Tinidazole 500 mg Tablet/Capsule %.–

!& Levofloxacin 750 mg Tablet/Capsule !%.–

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( Enalapril 2.5 mg Tablet/capsule @.#)

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!! Enalapril 10 mg Tablet/capsule &.–

!@ Metoprolol 12.5 mg Tablet/capsule @.()

!# Metoprolol 25 mg Tablet/capsule $.–

!$ Metoprolol 50 mg Tablet/capsule %.#)

!% Metformin 500 mg Tablet/capsule @.–

!^ Metformin 1000 mg tab Tablet/capsule ^.–

!& Glimepride 1 mg Tablet/capsule %.#)

!* Glimepride 2 mg Tablet/capsule *.^)

!( Glimepride 3 mg Tablet/capsule !!.@)

@) Pioglitazone 15 mg tab Tablet/capsule ^.%)

@! Pioglitazone 30 mg tab Tablet/capsule !).*)

@@ Amityptalline 10 mg Tablet/capsule @.$)

@# Amityptalline 25 mg Tablet/capsule #.*)

@$ Imipramine 25 mg tab Tablet/capsule !.#@

@% Imipramine 75 mg Tablet/capsule #.–

@^ Lorazepam 1 mg Tablet/capsule @.–


132


@& Lorazepam 2 mg Tablet/capsule @.*)

@* Alprazolam 0.25mg tab Tablet/capsule !.&)

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#% Cyclophosphamaide 50 mg

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#& Cytosine Arabinoside 100 mg /vial

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$! Danazol 50 mg capsule

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$# Daunorubicin 20 mg injection

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133


$% Doxorubicin 50 mg injection

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$^ Etoposide 100 mg capsule

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$& Etoposide 100 mg/5 ml injection

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$* Flutamide 250 mg table

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$( 5 flurouracil 250 mg/ 5 ml Injection / ml

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%! Gemcitabin 1000 mg injection

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%$ Imatinib 100 tablet

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%& Methotraxate 50 mg/ml Injection/ml

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%( Mensa 200 mg Injection/ml

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^! Oxaliplatin 50 mg /vial injection

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^@ Paclitaxel 30 mg/5 ml injection

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^$ Tamoxifen 10 mg tablet

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134


^^ Vinblastin 10 mg/ pack injection

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135

9. STORE MANAGEMENT INSTRUCTION


136

10. GREIVANCE HANDLING AND READDRESSAL MECHANISM REPORT

GOVERNMENT OF NEPAL

MINISTRY OF HEALTH & POPULATION

DEPARTMENT OF HEALTH SERVICESMANAGEMENT DIVISION

LOGISTIC MANAGEMENT SECTION

ANNUAL REPORT ON GRIEVANCES RECEIVED AND RESOLVED VIA THE WEB BASED

GRIEVANCE HANDLING AND REDRESSAL MECHANISM (GHRM)


137

Yearly Report from 2018/07/1717 to 2019/07/16

S. NO RECEIVING OFFICE DETAILS NO.

1. Grievances received within the report period

Web 5

Written Letter 32

Walk-in-verbal 16

2. Grievances received based on Office Category

Head Office 5

3. Received Grievance and its Category

Free medicine is not available 2

Irregularities in procurement 49

Overstock and Expired Medicine 1

Unavailability and poor status of Equipment 1

4. Resolved Grievance and its Category


Irregularities in Procurement 49



5. Average Time Taken to Resolve the Grievance {Category wise}


Irregularities in procurement 37



6. Cumulative No of Public Users Accessing the GHRM webpage 7

Note: The average no. of days taken to resolve the grievances registered under irregularities in procurement and corruption as shown is 37. As, all of the grievances received under above category were via written letter (which were resolved manually on time) but were registered and maintained in GHRM system latter on, so the average time taken to accomplish grievances under irregularities in procurement is shown high by the GHRM system.


138

TYPE REGISTRATION NO. DETAILS REG. DATE

Grievance in procurement 07-2019-RPKIQM

Amendment requested for point 2019-06-07 no.3.11, 3.16 and 3.13 of original requirements of tender published for Apheresis Machine. Amendment requested are that The instrument should have a support of a sealer to close and separate the product bag, the instrument should have built-in centrifuge temperature sensor (important to maintain hematocrit)/ adjustable and The instrument should have a printing facility to get procedure data respectively for point no.3.11, 3.16 and 3.13.

2019-06-07

Grievance in procurement 07-2019-AOPP5K

Amendment requested for point Original no.1.1, 3.5(b), 3.5(e), 3.7 of requirements of tender published for Apheresis Machine. Amendment requested is that the instrument should be based on continuous Flow Blood Cell Separator for platelet both single/double needle technique, RBC exchange with automated fluid balance controlled system, Bone marrow processing and The system should have built in CCD camera for high interphase detection respectively for point no. 1.1, 3. 5 (b), 3.5(e) and 3.7.

2019-06-07

Grievance in procurement 07-2019-WMPMYJ

Amendment requested for point no.15 of 2019-06-07 tender published for Water Management System. Amendment requested is that Water Shredder required integrated or non integrated system in one or two separate vessel for shredding and sterilization

2019-06-07

Grievance in procurement 07-2019 WSGX4O

Amendment requested in point no.5 & 24 of original requirements of tender published for Water Management System. Amendment requested are Load Capacity higher than 20kg/hr and with water recycling system respectively for point no.5 & 24

2019-06-07

Grievance in procurement 07-2019- OQIZRO

Amendment requested in point no.4 of 2019-06-07 original requirements of tender published for Water Management System. Amendment requested is that Sterilization temperature should be higher than 721 degree celsius or more

2019-06-07

Grievance in procurement 07-2019-2UMUN7

The bid accepted for the Tender of Phototherapy Machine (DOHS/G/ICB8.6lcHDl2075-76), whose rate was 37,60,000.00 is lacking Valid European CE. So, the request is made to revise the decision of acceptance of bid

2019-06-07

Grievance in procurement 07-2019-ZBCBMZ Clarification on the CE Certificate submitted

by IWs Medi Waves Inc., Delhi. 2019-06-07

Grievance in procurement 07-2019-VTKYDM

Amendment requested in the point no.47 of original requirements of tender published for High end Ultrasound with Real Time Shear Elastography Contrast Wave Imaging, which says and that Transducers: Following transducers sholuld be offered with transducers must have Shear wave Elastography imaging mode the system (All available): Curved Array 1-6 MHzllllMlcroconvex Probe 3-I2 MHz. Amendment requested here is that Micro Convex Probe 4-8 MHz.

2019-06-07


139

Grievance in procurement 07-2019-SRP5QF

Amendment requested in the point no.35 of original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast Imaging equipment, which says that System should have real time simultaneous imaging mode that combines three modes- B-mode, SWE and rrr-micro vascular Color flow imaging modes- to visualize anatomy, tissue stiffness and blood flow simultaneously to improve the workflow. Amendment requested is that Micro vascular color mode should be removed.

2019-06-07

Grievance in procurement 07-20I9-TSQJAS

Amendment requested in the point no.33 of original requirements of tender published for: High end Ultrasound with Real Time Shear Elastography and Contrast Imaging, (during: the pre-bid meeting held on 7th June 2019,). The respective point in original requirements says that Shear wave Elastography Quantification tool (Elllipse and trace) should be able to provide Mean, Max & Min; elasticity values of the tissues in both m/s and kPA(KiloPascal) on all transducers and the amendment requested is that should be allowed in shear wave transducer only

2019-06-07

Grievance in procurement 07-209-IJHORD

Amendment requested in point no.30 of original requirements of tender published for High End Ultrasound with Real Time Shear Wave Elastography and Contrast Imaging Equipment, during pre-bid meeting held on 7th jun of 2019, which states that system should be able to generate a color coded shear wave elastogram with a reference Adjustable Numerical elasticity scale for all the applications

2019-06-07

Grievance in procurement 07-2019-URZLPl

Amendment requested in point no.28 of 2019-06-07 original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast Imaging equipment, which says that Real time Shear Wave tissue elastography imaging with Convex, Linear, Micro convex, Hockey Stick, Endo cavitary & 3D transducers wherein Only convex probe for real time shear wave should be amended.

2019-06-07

Grievance in procurement 07-2019-6ZRKQC

Amendment requested in point no.25 of original requirement of tender published for High end Ultrasound with Real Time Shear wave Grievance in 07-2019-6ZRKQC procurement Elastography And Contrast Imaging, which says the system should have facility of direct storage and retrieval of B/W' and color images in both frozen and cine loops in the inbuilt hard disk drive. In-built hard disk storage capacity of 1TB or more to be changed to In-built hard disk storage of storage capacity of 500G8 or more.

2019-06-07


140

Grievance in procurement 07-2019-WD6YD6

Amendment requested in point No.13 of original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast system should have Imaging, which says Panoramic Imaging with at least 60cm of scanning length. It should have skin line scaling markers, cuwed distance measurement tool and Zoom, pan, Rotate & Trim Facility to trim panoramic images from start or end of the panoramic capture to be changed to system should have panoramic imaging with at least 25-30 cm.

2019-06-07

Grievance in procurement 07-2019-FRJT9M

Amendment requested in point no.11 of 2019-06-07 original requirements of tender published for High end Ultrasound with Real Time Shear wave Elastography and Contrast Imaging, which says the system should have advanced color Doppler facility to position at least three spectrograms (online or offline) on a single image within the same cardiac cycle to simplify the workflow and reduce the examination time should be changed to system should have advance color Doppler position at least two spectrogram.

2019-06-07

Grievance in procurement 07-2019-VFTR8V

Amendment requested regarding the point no.10 of original requirements of tender published for High end Ultrasound with Real Time Shear wave Eastography and Contrast Imaging, which says the system should have a frame rate on receive of over 5000 frames per second or more should be 250125001400.

2019-06-07

Grievance in procurement O7-2019-SCCVUJ

Amendment requested during the Pre-bid meeting held on 7th June of 2019 requesting point no.6 original amendment requirement (which says system should have 60000 or more digital processing channels) to be made to be above 4500000 and Massive parallel beaming.

2019-06-07

Grievance in procurement 07-2019-LAPBTC

Amendment requested during Pre-bid meeting held on 7th of June 2019 regarding the removal of 3D imaging mode mentioned in the point no.4 of original requirements of Tender Published for High end Ultrasound Real Time Shear wave Elastography and Contrast Imaging

2019-06-07

Grievance in procurement O4-2OI9-TKLDER Biasness in specification. 2019-04-28

Grievance in procurement 03-2O19-KACVAI

Request for amendment of technical 2419-02-21 specifications of portable ultrasound machine (amendment of the clauses, mentioned in the attachment below, in the technical specification of slice no.44. Portable USG Machine for more participation and benefit of the hospital.

2019-02-27

Grievance in procurement 03-2O19-VZKBNK

Request for amendment of some technical specification so some equipment which details are as provided in. the attachment below.

2019-03-05

Grievance in procurement 03-2019-AXJLlS

Clarifications to be provided regarding some specifications related to Request for tender enquiry vide(ICB) IFB No: DOHS/GACB.44ILMDI2O75-76. As mentioned in the attatchment below.

2019-03-05


141

Grievance in procurement 03-2019-CZQDWF Request for amendment of the clauses in IFB

No : DOHS?G?ICB-44 /LMD/2075-76 2019-03-05

Grievance in procurement 03-2019-ECZ4BY

Request for amendment of specifications to be made in order for Konica Minolta DR Systems be able to bid.

2019-03-05

Grievance in procurement 03-2019-ENIG6E Request to amend some points in specification

regarding tender of Electro Convulsive Therapy. 2019-02-28

Grievance in procurement 03-2019-2ZOVEF Request to amend specifications regarding the

tender No: IBF No DOHS/G/ICB/44.1/LMD 2019-03-05

Grievance in procurement 03-2019-BMSVQI

Request regarding amendment in specification of Platelets Aheresis (DOHS/G/ICB -44.7 ILI|/.D I 207 5 -7 6)

2019-03-05

Grievance in procurement 03-2019-GRXTYI

Pre-bid amendment request regarding the tender No: DOHS/G/ICB-44.1/LMD/ 2075-76 FOR USG Machine Portable Color Doppler27 Nos.

2019-02-27

Grievance in procurement 03-2019-U2NQKF

Request for amendment of specifications regarding the tender published on date ebruary-1 2019 of International Competitive Bidding (ICB),IFB No: DOHS/G/ICB/44.1/LMD/2075-76 for procurement of medical equipment, some points in the compliance of needs to be revised so that most of the bidder can participate in the bidding process.

2019-03-05

Grievance in procurement 03-2019-EOKTSK

Request to make some revision in some points of compliance sheet of following mentioned slices of International Competitive Bidding (ICB), IFB No: DOHS/G/ICB/44/LMD/2075-76 for procurement for medical Equipment so that most of the bidder can participate in the bidding process.

2019-03-05

Grievance in procurement 03-2019-PMB6L1 Amendment Request for Monitor Tender

Specification. 2019-03-05

Grievance in procurement 03-2019-OKJR46 Amendment Request UCG Machine Portable

Color Doppler. 2019-03-05

Grievance in procurement 03-2019-XXXAQO

Request for change in the specifications Ref: DOHS/G/I CB-44.1/LMD/2076-76 USG MACHINE COLOR DOPPLER-27)

2019-03-05

Grievance in procurement 03-2019-HIUZJW

Request for change in the specifications Ref: DOHS/G/ICB-44.9/LMD / 2075 -76 (F1at Panel Detector Systems-5)

2019-03-05


142

11. AUCTIONING REPORT

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149

12. GUIDELINES FOR USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

Developed by expert Team of NMC and Government of Nepal with reference from WHOA. For Aerosol Generating procedures: Dental procedures, bronchoscopy, Upper GI Endoscopy, ENT procedures, Nebulization, Intubation of a patient, CPR, Non-invasive ventilation, endotracheal, suctioning, when obtaining nasopharyngeal or oropharyngeal swab, etc. In Covid-19 suspected or confirmed cases health personnel need to use the following protective equipment. Category I PPE: a. N-95 mask b. Goggles or visor c. Gloves (loose gloves acceptable) d. Water resistant OR standard disposable gowns. e. Cap: Regular DisposableB. For Non aerosol generating covid-19 suspected or confirmed patients: Health personnel need to use the following protective equipment: Category II PPE: a. Surgical mask (seal the top edge with tape) b. Goggles or visor c. Gloves (loose gloves acceptable) d. Water resistant or standard disposable gowns e. Cap: Regular disposableC. For Physicians examining the patients in the fever/screening clinics the following PPE is recommended. Category II PPE a. Surgical mask, (seal the top edge with a tape) b. Goggles or visor c. Water resistant or standard disposable gowns d. Regular disposable Cap e. Gloves (loose globes acceptable)Note: For staff involved in preliminary screening not involving direct contact, maintain spatial distance of at least 1meter, no PPE required, Use surgical mask if maintaining distance not always possible.D. For escorts or drivers, the following PPE is recommended. Category III PPE: a. Surgical masks b. Gloves c. Gowns (if physical contact expected) Follow hand hygiene and keep minimum 3 to 6 feet from the patient.E. For Laboratory staff: category II or III PPE; depending upon the chance of splash: d. surgical mask e. Gown f. loose Gloves g. Eye protection (if risk of splash)F. For staff, including health care workers involved in any activity that does not involve contact with COVID-19 patients and working in other areas of patient transit (e.g. wards, corridors). NO PPE required.For Everyone:

• Maintain 3-6 feet distance while visiting patients, if no need to touch the patients. • Mandatory hand-hygiene after each use of PPE and between patients.• Mandatory surface cleaning of bed or furniture with 0.5% Chlorine disinfectant (Virex* or similar) between each patient in OPD or in an inpatient setting.


150

13. PROCUREMENT ON SEPCIAL CONDITION - PPA

THE PUBLIC PROCUREMENT ACT, 2063 (2007)

Date of certification and publication

30 paush 2063 (14 January 2007)

ACT NUMBER 36 OF THE YEAR 2007

AN ACT MADE TO PROVIDE FOR PUBLIC PROCUREMENT

Preamble: Whereas, it is expedient to make legal provisions in order to make the procedures, processes and decisions relating to public procurement much more open, transparent, objective and reliable, obtain the maximum returns of public expenditures in an economical and rational manner by promoting competition, fairness, honesty, accountability and reliability in public procurement processes, and; ensure good governance by enhancing the managerial capacity of procurement of public entities in procuring, or causing to be procured, construction work and procuring goods, consultancy services and other services by such entities and by ensuring the equal opportunity for producers, sellers, suppliers, construction entrepreneurs or service providers to participate in public procurement processes without any discrimination;

Now, therefore, the House of Representatives has enacted this Act in the First Year of the issuance of the Proclamation of the House of Representatives, 2007.

MISCELLANEOUS

66. Provision Concerning Procurement to be Made in Special Circumstances:(1) Notwithstanding anything contained elsewhere in this Act, where the occurrence of special

circumstance has created a situation in which, if a procurement is not made immediately, the public entity will sustain further loss, the Public Entity may procure or cause to be procured immediately.

(2) The chief of the Public Entity shall have to give information of the circumstances under Sub-section (1) and the detailed description concerning the procurement to be made immediately to one level higher authority.

(3) Other provision concerning procurement to be made in special circumstances shall be as prescribed.

67. Procurement Process under this Act not to be Applied:(1) Notwithstanding anything contained elsewhere in this Act, the procurement process under

this Act need not be applied in the following conditions:-(a) If the Government of Nepal decides that procurement relating to security, strategic or

defense by application of the process in accordance with this Act is not appropriate for the interest of national security or defense , or

(b) If as per the agreement between government of Nepal and donor party, procurement is to be made in accordance with the Procurement Guidelines of a donor party.

(2) In making a decision pursuant to clause (a) of Sub-section (1), Government of Nepal shall have to state reasons for procurement and determine separate procedure related thereto as well.


151

68. Method of Communication: (1) Any document, notice, decision or other information as referred to in this Act and Regulations

made thereunder, bidding documents, documents relating to request for proposal or procurement contract as to be given by the Public Entity to a bidder, consultant or by a bidder or consultant to the Public Entity shall, unless otherwise provided for in this Act, be given in writing.

(2) In case where a notice transmitted pursuant to Sub-section (1) could not be served due to failure to trace out the address of the recipient bidder or consultant or for any other reason, a public notice shall be published in a newspaper of national circulation stating therein brief description thereof and where a notice is so published such person shall be deemed to have received the

notice.

69. Procurement Transaction May be Carried Out Through Electronic Communications Means: (1) Notwithstanding anything contained elsewhere in this Act, Government of Nepal may, by

publication of a notice in the Nepal Gazette, provide a mechanism that the Public Entity may arrange, through the means of electronic communications, invite a pre-qualification proposal, issue notice of bid invitation, prepare a short list by inviting expression of interest, invite a proposal of consultancy service, transmit bidding or pre-qualifying documents, receive bids, proposals for pre-qualification or consultancy services, conclude the procurement contract, make payment and give and receive other notices.

(2) The means of communications under Sub-section (1) shall be used in the following manner:-(a) That the content of communications in such means of communications is legally valid

and preserved,

(b) That the security of such communications means is adequate,

(c) That bidder's access to the procurement proceeding is notinappropriately restricted,

(d) That it is not in contravention of this Act and rule made thereunder and other prevailing law.

70. Legal Documents to be kept in Website: For information and convenience of general public, this Act and Regulations and Procurement Manuals made thereunder shall be kept in the website of the Public Procurement Monitoring Office.

71. Evaluation Committee to be Formed: (1) The Public Entity shall have to form an evaluation committee as prescribed for examination

and evaluation of the pre-qualification proposals, bids, expression of interest or proposals of consultancy services or sealed quotation.

(2) The functions, duties and powers of the committee formed pursuant to Sub-section (1) shall be as prescribed.


152

72. Records of Procurement Proceedings: The Public Entity shall have to keep safely the records of the documents of the procurement proceedings for a prescribed period.

73. Delegation of Power: Out of the powers conferred on him/her by this Act or rule made thereunder, a competent authority may delegate the powers other than the prescribed one, to any staff.

74. Power to Make Rules: (1) The Government of Nepal may make Rules required for implementation of the objective of

this Act.(2) Notwithstanding any thing contained in Sub-section (1), the Public Entity other than the

one as referred to in sub-clause (1) of clause (b) of Section 2 may make necessary Rules subject to the Act, Rules or Formation Order relating to such entity.

75. Repeal and Amendment: (1) The provision to Section 168 of the Traffic and Transportation Management Act, 1992 is

hereby repealed.

(2) Notwithstanding anything contained in prevailing law, legal provision relating to the procurement of the Public Entity under clause (b) of Section 2 shall be deemed to have ipso facto been so amended as to be compatible to this Act to the extent of their inconsistency with this Act.

(3) Instead of Section 7 of Financial Procedure Act, 1998, the following Section 7 has been substituted:-

"7 Procedure of Making Expenditure: Provision concerning financial administration relating to operation of government transactions and project implementation, deposit, charges, service fee, taking advance and settlement thereof, preservation of government's cash and goods-in-and property, auction, remission, and other miscellaneous provision and procedure related thereto

shall be as prescribed."

76. Saving: All the acts and proceedings relating to procurement carried out under the Financial Procedure Act, 1998 and the Financial Administrations Regulations, 1999 made thereunder and the provisions of the Act, Rule or Formation Order related to procurement of the Public Entity as referred to in sub-clause (2), (3), (4), (5) and (6) of Clause (b) of Section 2 shall be deemed to have been carried out under this Act.


153

14. F

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शाख

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६11

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फोह

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७11

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८11

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९11

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केय

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१०11

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११11

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ा से िव

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154 १४2.

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11औ

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ाधन

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आ

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१५2.

5.3.

54ोरम

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56ा

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१८2.

7.22

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भावक

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ायक

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मू

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(ई भ

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ए) त

था ई

भी ए

म ए

सुधार

योज

नाक

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िग

ािविध

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हयोग

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११००

११००

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शाख

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ोप)

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7.22

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ने क

ोचेन

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काय

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7.22

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7.25

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सवारी

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350

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काय

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1.5.

3पा

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काय

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महाश

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काय

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3.1.

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ायम

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4.1.

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काय

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४३2.

5.3.

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ायोमे

िडक

ल औ

जार

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मत सु

धार

काय

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मेत२२

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शाख

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४४2.

5.3.

46था

नीय

तह अ

नुसार

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त जन

संा

ेपणक

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सेवा

ख

रद२२

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श

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४५2.

5.3.

47२०

५१ दे

खक

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काय

मको मे

टा ड

ाटा ए

नाला

इिसस

२२४१

११

पटक

४०००

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USAID

ए ा

सु

शाख

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156

४६2.

5.3.

50

जनश

व

थापन

करार

सेवा

बाट

M ोर

सहा

यक १

जना,

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इ टी

इजि

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जना

, डा

टा ए

नािल

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ायाल

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येगी ३

जना

, कूटर

सह

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ना२२

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आ

शाख

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४७2.

5.3.

51

बायो

मेिडक

ल औ

जार

उपक

रण म

मत सु

धार

स

बबि

षय स

झौत

ा काय

ायन

का ल

ािग ब

ायोमे

िडक

ल

इजि

नयर

१० ज

ना र

जन

ा अ

िधकृ

त १ ज

ना क

रार

सेवाम

ा व

थापन

२२४१

१२

जना

८८८

२९६

२९६

२९६

USAID

आ

शाख

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४८2.

5.3.

52ा से

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ग क

मचारी

श

ासन

शाख

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िथक

श

ासन

शाख

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नशी

वथा

पन२२

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शाख

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४९2.

5.3.

53ा से

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रशर

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ो फोह

रमैला

व

थापन

तथा

सर

सफाइ

तेो प

बाट

िनर

रता स

मेत२२

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क२४

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श

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५०2.

7.22

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यत आ

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स ि

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लाप

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५१2.

7.22

.531

औजा

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करण

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सुधा

र स

बबि

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झौत

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का

ेयर प

ाटसक

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अता

लहला

इ श

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7.22

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ता

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ग स

तािल

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7.22

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देश र

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7.22

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बािष

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५५2.

7.22

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एिक

कृत

अनल

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ा सू

चना

वथा

पन त

था िड

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५६2.

7.22

.543

ितान

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ताल

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ीजी

समेतक

ा अता

लका क

मचारी

हला

इ एच

एम

आइ

एस र

डी

एच

आइ

एस त

ािलम

अिभ

मुख

करण

२२५२

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पटक

२०००

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USAID

ए ा

सु

शाख

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५७2.

7.22

.544

अता

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णरक

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अनस

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कोिच

ङ मं

ोरङ

एवं

माइ

ो िटि

चङ२२

५२२

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क१३

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शाख

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५८2.

7.22

.545

एच ए

म आ

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को अ

िभलेख

तथा

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वेदन

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५९2.

7.22

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भवन

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पुवा

धारह

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ूनतम

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ी फलो

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शाख

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६०2.

7.22

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एच ए

म आ

ई एस

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यत स

भर

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तको

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करण

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पु िव

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तांक

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157

६२2.

7.22

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कारा

गारह

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ायरत

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कमच

ारीह

लाइ

एच ए

म आ

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ी एच

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शाख

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६३2.

8.1.

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सेवा

काय

महक

ो एिक

कृत

सुपरवे

ण,

अनुग

मन, िव

शेष

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का क

ायह

को ि

नरी

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मण ख

च२२

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क

ायम

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६४2.

9.9.

3िव

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खच

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पटक

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Nा

क

ायम

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) चालु

खच

काय

मको ज

ाकु

ल ज

ा (पुँज

ीगत

र चा

लु)


158

15. F

Y 20

77/7

8 A

CTI

VIT

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AN

D B

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GET

: PR

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INC

E A

ND

LO

CA

L LE

VEL

िस नं

कोड

थान

िया

कला

पहदेश

१

देश

२बा

गमती

गक

ीेदश

५क

णाल

ीसु

पि

मज

ािज

ाहमा

१6.1.2.44

0नद

शनालय

इ एल

एम

आई

एस ÷

िड ए

च आ

इ एस

२ स

ी एिक

कृत

सिम

ा११००

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1आपूत

केऔ

षिध,

ा

न तथ

ा ा

न ज

साम

ी, सा

धन, स

ामा

ी र

ािकङ

तथा

ढुवा

नी र

पूनः

िवतर

ण स

मेत२५००

२०००

२४००

२५५०

२४००

२८००

२२५०

१६९००

३6.1.2.44

2आपूत

केएच

एम

आइ

एस /

एल ए

म आ

इ एस

सी अ

िभलेख

तथा

ित

वेदन

फारा

म एव

अनुग

मन पु

का

थानी

य तह

सक

ो लाग

ी छ

पाइ

एव िव

तरण

६९००

७५८५

६९०८

५१२५

५९८२

३५५०

३९५०

४००००

४6.1.2.44

3नद

शनालय

थानी

य तह

का

ा सं

योजक

, सह

संयोज

क ए

वं ा

सं

थाक

ा ा

किम

हला

इ देश

ा

िनदश

नालय

माफ

त िड

एच

आई

एस २

र ए

ल एम

आइ

एस स

ी तािल

म अ

िभमु

खक

रण५०९५

५०६०

४४२५

३१६०

४०५२

२९३७

३२७१

२८०००

५6.1.2.44

5नद

शनालय

तांक

गुण

र सुध

ारकाल

ािग

ा िन

दशना

लयबा

ट ा

सं

थाह

(अता

ल त

था

ा क

ायाल

य) म

ा एल

एम आ

इ एस

,

एच ए

म आ

ई एस

र िड

एच

आई

एस स

ी थल

गत

सहिज

करण

÷मेोर

ङ१२७०

७००

१२००

१०५०

१०५०

९३०

९००

७१००

६6.1.2.44

6नद

शनालय

देश

ा िन

दशना

लयबा

ट था

नीय

तहह

का

ा

संयोज

क÷स

ह संय

ोजक

ह ल

ाइ

ा क

ायमह

को य

ोजना

तजु

मा स

ी िया

कला

प१९१५

१८००

१६६५

११९०

१५३०

११५०

१२५०

१०५००

७6.1.2.44

7नद

शनालय

देश

ा िन

दशना

लय म

ाफत

ा क

ायाल

य एवं

अ

तालह

को ए

िककृ

त चौ

मािस

क ए

वं बा

िषक

समी

ा२२२०

१२००

२१३०

१८००

१९५०

१७८०

१५००

१२५८०

८6.1.2.44

9आपूत

केआ

धारभू

त आ

पूित

वथा

पन त

था

ा स

ामी ख

रद

णाली

स

ी तािल

म१०००

८००

१०००

९००

९००

११००

१०००

६७००

९6.1.2.45

0आपूत

केदेश

तथा

थािन

यतहह

को

ा स

ामीह

को प

रमाण

िन

धारण

गोि

६००

५००

७००

६००

६००

८००

७००

४५००

आ ब

२०७

७।०७

८ क

ो ािव

त क

ायम

देश

तथा

था

नय तहह

को लाग

२६४५१३


159

१०6.1.2.45

1सामािजक

देश

रमा आ

िथक

श

ासन

तथा आ

रक िन

यण

, िविभ

क

ारका

िनक

ल त

ािलम

लगाय

तका अ

िया

कला

पह०

००

००

२८८६३

०२८८६३

११6.1.2.55

8नद

शनालय

ोर ए

वं अ

यो

जनाथ

घर

टहरा

भाड

ा२४०

००

००

०२४०

४८०

१२6.1.2.55

9नद

शनालय

काय

ालय

एवं स

रसफ

ाइ क

मचारी

करार

सेवा

मा५२०

००

००

०५२०

१०४०

२३३६०

२०३४५

२१६२८

१७२७५

१९४५४

४४८००

१६३३१

१६३१९३

148

1311

1210

977

137

136

119

8510

979

8875

321

1428

1619

1416

128

4232

4326

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064

548

957

134

037

838

15ा च

ौा

ा केअ

ताल

पािल

का

िजा


160

त ाक गुण र सुधारकालािग ा कायालयबाट थानीय तह

एवं ा सं थाह मा एल एम आइ एस एच एम आई एस र िड एच आई एस एस स ी थलगत

सहिजकरण मे ो रङ

ा कायालय माफत थानीय तहह को मािसक

सूचना संकलन भे रिफकेशन एवं गुण र सुधारचौमािसक बािषक सिम ा

९८

१०१५१०६७९

१२१७८

१०८८

१८१७१८१५२०१८१६१४९८९

१२५

१३१२११६४

१३१०७१११०८

देश अ गतका ा कायालयह मा पठाएको रकमह २०७७।०७८


161

४५५

१०७६

११८७

१६१०१०१२६९

१०१०८८३९

१११०७६८४७८९

१३९

१०९

१२९

१०७९


162

sfo{qmdsf] gfdM kflnsf :t/df :jf:Yo ;+:yfx?sf] dfl;s ;"rgf ;+sng, e]l/lkms]zg Pj+ u'0f:t/ ;'wf/ ;fy} rf}dfl;s Pj+ aflif{s ;ldIff

26332 6.2.2.323

SN Palika Budget NPR(000) SN Palika Budget

NPR(000)1 फुङलीङ नगरपािलका 125 6 मैवाखोला गाउँपािलका 1492 आठराई ि वेणी गाउँपािलका 197 7 पािथभरा याङवरक गाउँपािलका 1733 फ ाङलुङ गाउँपािलका 197 8 िसिदङ्वा गाउँपािलका 1974 िम ाखोला गाउँपािलका 104 9 िसरीज ा गाउँपािलका 2215 मे रङदेन गाउँपािलका 173


NPR(000)1 िफिदम नगरपािलका 221 5 फा ुन गाउँपािलका 1732 कु ायक गाउँपािलका 125 6 िम ाजुङ गाउँपािलका 1733 तु ेवा गाउँपािलका 125 7 याङवरक गाउँपािलका 1494 फालेलुङ गाउँपािलका 125 8 िहिलहाङ गाउँपािलका 149


NPR(000)1 ईलाम नगरपािलका 197 6 फाकफोकथुम गाउँपािलका 1492 देउमाई नगरपािलका 173 7 माईजोगमाई गाउँपािलका 1493 माई नगरपािलका 104 8 माङसेबुङ गाउँपािलका 1044 सुय दय नगरपािलका 221 9 रोङ गाउँपािलका 1255 चुलाचुली गाउँपािलका 104 10 स कपुर गाउँपािलका 149


NPR(000)1 खाँदवारी नगरपािलका 149 6 िचिचला गाउँपािलका 1042 चैनपुर नगरपािलका 173 7 भोटखोला गाउँपािलका 1043 धमदेवी नगरपािलका 104 8 मकालु गाउँपािलका 1494 पाँचखपन नगरपािलका 149 9 सभापोखरी गाउँपािलका 1045 मादी नगरपािलका 104 10 िसलीचोङ गाउँपािलका 149


NPR(000)1 ाङलुङ नगरपािलका 149 4 छथर गाउँपािलका 1732 लालीगुराँस नगरपािलका 149 5 फेदाप गाउँपािलका 1493 आठराई गाउँपािलका 197 6 मे छयायेम गाउँपािलका 104


NPR(000)1 धनकुटा नगरपािलका 104 5 चौिबसे गाउँपािलका 1972 पाि वास नगरपािलका 173 6 छथर जोरपाटी गाउँपािलका 1253 महाल ी नगरपािलका 173 7 साँगुरीगढी गाउँपािलका 221

lhNnf M ता ेजु

lhNnf M पाँचथर

lhNnf M ते थुम

lhNnf M संखुवासभा

lhNnf M इलाम

lhNnf M धनकुटा

4 सिहद भूिम गाउँपािलका 125


163


NPR(000)1 भोजपुर नगरपािलका 197 6 पौवादु ा गाउँपािलका 1732 षडान नगरपािलका 269 7 राम साद राई गाउँपािलका 1973 अ ण गाउँपािलका 173 8 सा ािसिलछो गाउँपािलका 1254 आमचोक गाउँपािलका 221 9 हतुवागढी गाउँपािलका 1735 ा केमैयुङ गाउँपािलका 245


NPR(000)1 पाकोट मझुवागढी नगरपािलका 317 6 ज ेढंुगा गाउँपािलका 1732 हलेसीतुवाचुङ नगरपािलका 293 7 िद ुङ चुइचु ा गाउँपािलका 1973 ऐसेलुखक गाउँपािलका 197 8 रावाबेसी गाउँपािलका 1974 केिपलासगढी गाउँपािलका 197 9 वराहपोखरी गाउँपािलका 1735 खोटेहाङ गाउँपािलका 245 10 साकेला गाउँपािलका 104


NPR(000)1 सोलुदुधकु नगरपािलका 245 5 नेचास ान गाउँपािलका 1492 खु ु पासाङ ामु गाउँपािलका 125 6 माहाकुलुङ गाउँपािलका 1043 मा दुधकोशी गाउँपािलका 104 7 िलखु िपके गाउँपािलका 1044 थुलुङ दुधकोशी गाउँपािलका 173 8 सोताङ गाउँपािलका 104


NPR(000)1 िस चरण नगरपािलका 269 5 मानेभ याङ गाउँपािलका 2212 खजीदे ा गाउँपािलका 173 6 मोलुङ गाउँपािलका 1973 च ादेवी गाउँपािलका 173 7 िलखु गाउँपािलका 1734 िचशंखुगढी गाउँपािलका 197 8 सुनकोशी गाउँपािलका 149


NPR(000)1 कटारी नगरपािलका 245 5 उदयपुरगढी गाउँपािलका 1492 चौद ीगढी नगरपािलका 173 6 ता ी गाउँपािलका 1493 ि युगा नगरपािलका 173 7 रौतामाई गाउँपािलका 1734 वेलका नगरपािलका 125 8 िल चुङबुङ गाउँपािलका 149


NPR(000)1 अजुनधारा नगरपािलका 104 9 कचनकवल गाउँपािलका 1732 क ाई नगरपािलका 104 10 कमल गाउँपािलका 104

lhNnf M भोजपुर

lhNnf M खोटा

lhNnf M सोलुख ु

lhNnf M ओखलढु ा

lhNnf M उदयपुर

lhNnf M झापा

3 गौरादह नगरपािलका 149 11 गौ रगंज गाउँपािलका 1254 दमक नगरपािलका 104 12 झापा गाउँपािलका 1045 िवतामोड नगरपािलका 104 13 बा दशी गाउँपािलका 1046 भ पुर नगरपािलका 104 14 बु शा गाउँपािलका 1047 मेचीनगर नगरपािलका 173 15 ह बारी गाउँपािलका 1048 िशवसता ी नगरपािलका 125


164


NPR(000)1 िवराटनगर उपमहानगरपािलका 104 10 कटहरी गाउँपािलका 1042 उलाबारी नगरपािलका 104 11 कानेपोखरी गाउँपािलका 1043 पथरी शिन रे नगरपािलका 104 12 केराबारी गाउँपािलका 1254 बेलवारी नगरपािलका 125 13 ामथान गाउँपािलका 1735 रंगेली नगरपािलका 125 14 जहदा गाउँपािलका 1496 रतुवामाई नगरपािलका 149 15 धनपालथान गाउँपािलका 1737 लेटाङ नगरपािलका 125 16 बुढीगंगा गाउँपािलका 1258 सुनवष नगरपािलका 125 17 िम ाजुङ गाउँपािलका 1259 सु र हरैचा नगरपािलका 149


NPR(000)1 इटहरी उप-महानगरपािलका 149 7 कोशी गाउँपािलका 1252 धरान उप-महानगरपािलका 104 8 गढी गाउँपािलका 1253 इन वा नगरपािलका 125 9 देवानग गाउँपािलका 1494 दुहवी नगरपािलका 173 10 बजु गाउँपािलका 1255 बराह े नगरपािलका 149 11 भो ाहा नरिसंह गाउँपािलका 1046 रामधुनी नगरपािलका 125 12 ह रनगरा गाउँपािलका 149


NPR(000)1 क न प नगरपािलका 269 10 िछ म ा गाउँपािलका 1252 खडक नगरपािलका 221 11 ितर त गाउंपािलका 1493 डा े री नगरपािलका 245 12 ितलाठीकोईलाडी गाउंपािलका 1734 राजिवराज नगरपािलका 197 13 िब ुपुर गाउँपािलका 1045 बोदेबरसाईन नगरपािलका 269 14 राजगढ गाउँपािलका 1736 श ुनाथ नगरपािलका 245 15 महादेवा गाउँपािलका 1497 सु गां नगरपािलका 269 16 पनी गाउँपािलका 1048 हनुमाननगर कंकािलनी नगरपािलका 245 17 स कोशी नगरपािलका 1049 अ ीसाइर कृ ासवरन गाउँपािलका 149 18 बलान िव ल गाउँपािलका 125


NPR(000)1 क ाणपुर नगरपािलका 293 10 कज ा नगरपािलका 1252 गोलबजार नगरपािलका 245 11 नरहा गाउँपािलका 1253 धनगढीमाई नगरपािलका 149 12 नवराजपुर गाउँपािलका 104

lhNnf M िसराहा

lhNnf M मोर

lhNnf M सुनसरी

lhNnf M स री

4 िमचया नगरपािलका 221 13 ब रयारप ी गाउँपािलका 1495 लहान नगरपािलका 341 14 भगवानपुर गाउँपािलका 1046 िसरहा नगरपािलका 341 15 ल ीपुर पतारी गाउँपािलका 1737 सुखीपुर नगरपािलका 197 16 िव ुपुर गाउँपािलका 1258 अनमा गाउँपािलका 125 17 सखुवाना ारक ी गाउँपािलका 1499 औरही गाउँपािलका 149


165


NPR(000)1 जनकपुर उपमहानगरपािलका 269 10 औरही गाउँपािलका 1492 ि रे रनाथ नगरपािलका 125 11 कमला नगरपािलका 1733 गणेशमान–चारनाथ नगरपािलका 149 12 जनकन नी गाउँपािलका 1734 धनुषाधाम नगरपािलका 125 13 बटे र गाउँपािलका 1255 नगराइन नगरपािलका 149 14 िमिथला िवहारी नगरपािलका 1496 िमिथला नगरपािलका 197 15 मु खयापि मुसहरिमया गाउँपािलक 1257 िवदेह नगरपािलका 173 16 ल ीिनया गाउँपािलका 1258 सबैला नगरपािलका 221 17 हंसपुर नगरपािलका 1979 शिहदनगर नगरपािलका 245 18 धनौजी गाउँपािलका 125


NPR(000)1 गौशाला नगरपािलका 197 9 मिटहानी नगरपािलका 1492 जले र नगरपािलका 173 10 मनरा िससवा नगरपािलका 1733 बिदबास नगरपािलका 221 11 महो री गाउँपािलका 1044 एकडारा गाउँपािलका 149 12 रामगोपालपुर नगरपािलका 1495 औरही नगरपािलका 104 13 लोहरप ी नगरपािलका 1736 िपपरा गाउँपािलका 149 14 सा ी गाउँपािलका 1497 बलवा नगरपािलका 125 15 सोनमा गाउँपािलका 1258 भँगाहा नगरपािलका 173


NPR(000)1 ई रपुर नगरपािलका 149 11 किबलासी नगरपािलका 1252 गोडैटा नगरपािलका 221 12 च घ ा गाउँपािलका 2453 मलंगवा नगरपािलका 125 13 च नगर गाउँपािलका 1254 लालब ी नगरपािलका 197 14 धनकौल गाउँपािलका 1735 बरहथवा नगरपािलका 173 15 पुरी गाउँपािलका 1256 बलरा नगरपािलका 245 16 रामनगर गाउँपािलका 1737 बागमती नगरपािलका 125 17 िव ु गाउँपािलका 1978 ह रपुर नगरपािलका 245 18 बसव रया गाउँपािलका 1009 ह रवन नगरपािलका 125 19 पसा गाउँपािलका 10010 ह रपुवा नगरपािलका 104 20 कौडेना गाउँपािलका 100


NPR(000)1 ग डा नगरपािलका 269 10 परोहा नगरपािलका 173

lhNnf M धनुषा

lhNnf M सलाही

lhNnf M रौतहट

lhNnf M महो री

2 गौर नगरपािलका 104 11 फतुवा िवजयपुर नगरपािलका 1493 च पुर नगरपािलका 149 12 बौधीमाई नगरपािलका 1494 ईशनाथ नगरपािलका 173 13 माधवनारायण नगरपािलका 2215 कटहरीया नगरपािलका 173 14 मौलापुर नगरपािलका 1046 गढीमाई नगरपािलका 173 15 राजपुर नगरपािलका 1497 गजुरा नगरपािलका 149 16 वृ ावन नगरपािलका 1498 दुगाभगवती गाउँपािलका 149 17 यमुनामाइ गाउँपािलक 1259 देवाही गोनाही नगरपािलका 149 18 राजदेवी नगरपािलका 173


166


NPR(000)1 कलैया उपमहानगरपािलका 317 9 देवताल गाउँपािलका 1492 िजतपुर-िसमरा उपमहानगरपािलका 269 10 पचरौता नगरपािलका 2213 को वी नगरपािलका 197 11 परवानीपुर गाउँपािलका 1044 िनजगढ नगरपािलका 125 12 सौनी गाउँपािलका 1045 महागढीमाई नगरपािलका 245 13 फेटा गाउँपािलका 1496 िस ौनगढ नगरपािलका 221 14 बारागढी गाउँपािलका 1737 आदश कोतवाल गाउँपािलका 149 15 सुवण गाँउपािलका 1258 करैयामाई गाउँपािलका 173 16 िव ामबुर गाउँपािलका 125


NPR(000)1 वीरग महानगरपािलका 437 8 पसागढी नगरपािलका 1492 पोख रया नगरपािलका 173 9 ब दरमाई नगरपािलका 2933 िछपहरमाई गाउँपािलका 149 10 िब बािसनी गाउँपािलका 1254 जगरनाथपुर गाउँपािलका 197 11 सखुवा सौनी गाउँपािलका 1735 धोबीनी गाउँपािलका 125 12 ठोरी (सुवणपुर) गाउँपािलका 1046 पकाहा मैनपुर गाउँपािलका 149 13 कािलकामाइ गाउँपािलका 1497 पटेवा सुगौली गाउँपािलका 125 14 जीराभवानी गाउँपािलका 125


NPR(000)1 िजरी नगरपािलका 125 6 वैते र गाउँपािलका 1492 िभमे र नगरपािलका 197 7 मेलु गाउँपािलका 1493 कािल ोक गाउँपािलका 197 8 िवगु गाउँपािलका 2214 गौरीश र गाउँपािलका 197 9 शैलु गाउँपािलका 1735 तामाकोशी गाउँपािलका 197


NPR(000)1 म ली नगरपािलका 341 5 गोकुलग ा गाउँपािलका 1732 रामेछाप नगरपािलका 197 6 दोर ा गाउँपािलका 1733 उमाकु गाउँपािलका 149 7 िलखु तामाकोशी गाउँपािलका 1734 खाँडादेवी गाउँपािलका 221 8 सुनापित गाउँपािलका 149

lhNnf M िस ुली

lhNnf M रामेछाप

lhNnf M बारा

lhNnf M पसा

lhNnf M दोलखा


NPR(000)1 कमलामाई नगरपािलका 197 6 िफ ल गाउँपािलका 1732 दुधौली नगरपािलका 269 7 म रण गाउँपािलका 1043 गोल जोर गाउँपािलका 197 8 सुनकोशी गाउँपािलका 1494 ाङलेख गाउँपािलका 149 9 ह रहरपुरगढी गाउँपािलका 1255 तीनपाटन गाउँपािलका 221


167


NPR(000)1 धुिलखेल नगरपािलका 173 8 चौरंीदेउराली गाउँपािलका 2452 नमोबु नगरपािलका 221 9 तेमाल गाउँपािलका 1973 पनौती नगरपािलका 293 10 बेथानचोक गाउँपािलका 1494 पांचखाल नगरपािलका 221 11 भु ु गाउँपािलका 2455 बनेपा नगरपािलका 149 12 महाभारत गाउँपािलका 1496 म नदेउपुर नगरपािलका 173 13 रोशी गाउँपािलका 2697 खानीखोला गाउँपािलका 149


NPR(000)1 चौतारा सागाचोकगढी नगरपािलका 245 7 पाँचपोखरी थाङपाल गाउँपािलका 2212 मेल ची नगरपािलका 293 8 बलेफी गाउँपािलका 1253 वा िवसे नगरपािलका 173 9 भोटेकोशी गाउँपािलका 1254 ई ावती गाउँपािलका 197 10 िलसंखुपाखर गाउँपािलका 1495 जुगल गाउँपािलका 173 11 सुनकोशी गाउँपािलका 1976 ि पुरासु री गाउँपािलका 173 12 हेल ु गाउँपािलका 149


NPR(000)1 उ रगया गाउँपािलका 104 4 नौकु गाउँपािलका 1042 कािलका गाउँपािलका 104 5 आमाछोिदङमो गाउँपािलका 1253 गोसाईंकु गाउँपािलका 173


NPR(000)1 िवदुर नगरपािलका 173 7 दु चे र गाउँपािलका 1972 बेलकोटगढी नगरपािलका 197 8 प क ा गाउँपािलका 1253 ककनी गाउँपािलका 173 9 ागङ गाउँपािलका 1734 िक ाङ गाउँपािलका 173 10 िलखु गाउँपािलका 1045 तादीगाउँ गाउँपािलका 149 11 िशवपुरी गाउँपािलका 2216 तारके र गाउँपािलका 149 12 सुयगढी गाउँपािलका 125


NPR(000)1 धुनीबसी नगरपािलका 104 8 ि पुरासु री गाउँपािलका 1492 नीलक नगरपािलका 197 9 था े गाउँपािलका 149

lhNnf M का ेपला ोक

lhNnf M िस ुपा चोक

lhNnf M रसुवा

lhNnf M नुवाकोट

lhNnf M धािद

3 खिनयाबास गाउँपािलका 104 10 ने ावती गाउँपािलका 1044 ग ाजमुना गाउँपािलका 149 11 बेनीघाट रोरा गाउँपािलका 1255 गजुरी गाउँपािलका 104 12 वी ाली गाउँपािलका 1046 ग छी गाउँपािलका 104 13 िस लेक गाउँपािलका 1047 ालामूखी गाउँपािलका 125


168


NPR(000)1 भरतपुर महानगरपािलका 365 5 र नगर नगरपािलका 1252 कािलका नगरपािलका 125 6 रा ी नगरपािलका 1733 खैरहनी नगरपािलका 125 7 इ ाकामना गाउँपािलका 1494 माडी नगरपािलका 125


NPR(000)1 हेटौडंा उप-महानगरपािलका 173 6 बा ती गाउँपािलका 1042 थाहा नगरपािलका 173 7 िभमफेदी गाउँपािलका 1733 ई सरोवर गाउँपािलका 125 8 मकवानपुरगढी गाउँपािलका 1254 कैलाश गाउँपािलका 125 9 मनहरी गाउँपािलका 1045 बकैया गाउँपािलका 149 10 रा रा गाउँपािलका 125


NPR(000)1 चाँगुनारायण नगरपािलका 221 3 म पुर िथमी नगरपािलका 1492 भ पुर नगरपािलका 104 4 सूयिवनायक नगरपािलका 173


NPR(000)1 लिलतपुर महानगरपािलका 173 4 को ोसोम गाउँपािलका 1732 गोदावरी नगरपािलका 341 5 बा ती गाउँपािलका 1973 महाल ी नगरपािलका 149 6 महा ाल गाउँपािलका 149


NPR(000)1 काठमा ौं महानगरपािलका 104 7 तारके र नगरपािलका 1972 कागे री–मनोहरा नगरपािलका 173 8 दि णकाली नगरपािलका 1733 कीितपुर नगरपािलका 221 9 नागाजुन नगरपािलका 1494 गोकण र नगरपािलका 149 10 बुढािनलक नगरपािलका 1735 च ािगरी नगरपािलका 293 11 शंखरापुर नगरपािलका 1736 टोखा नगरपािलका 149


NPR(000)1 गोरखा नगरपािलका 173 7 धाच गाउँपािलका 1972 पालुङटार नगरपािलका 221 8 िभमसेन गाउँपािलका 173

lhNnf M भ पुर

lhNnf M लिलतपुर

lhNnf M काठमा ौ ं

lhNnf M गोरखा

lhNnf M िचतवन

lhNnf M मकवानपुर

3 अिजरकोट गाउँपािलका 149 9 शिहद लखन गाउँपािलका 1734 आ घाट गाउँपािलका 149 10 िसरानचोक गाउँपािलका 1975 ग की गाउँपािलका 173 11 बारपाक सुलीकोट गाउँपािलका 1976 चुमनु ी गाउँपािलका 197


169


NPR(000)1 बेसीशहर नगरपािलका 197 5 ोलासोथार गाउँपािलका 1972 म नेपाल नगरपािलका 269 6 दूधपोखरी गाउँपािलका 1493 राईनास नगरपािलका 173 7 दोद गाउँपािलका 2454 सु रबजार नगरपािलका 269 8 म ाङदी गाउँपािलका 197


NPR(000)1 भानु नगरपािलका 221 6 ऋिष गाउँपािलका 1492 िभमाद नगरपािलका 173 7 िघ रङ गाउँपािलका 1043 ास नगरपािलका 245 8 देवघाट गाउँपािलका 1494 शु ाग की नगरपािलका 173 9 ा े गाउँपािलका 1045 आँबुखैरेनी गाउँपािलका 104 10 ब पुर गाउँपािलका 104


NPR(000)1 पोखरा लेखनाथ महानगरपािलका 581 4 मादी गाउँपािलका 2212 अ पूण गाउँपािलका 149 5 पा गाउँपािलका 1493 माछापुछे गाउँपािलका 221


NPR(000)1 चामे गाउँपािलका 104 3 नाशो ंगाउँपािलका 1042 नापाभूिम गाउँपािलका 104 4 मनाङ िद ाङ गाउँपािलका 197


NPR(000)1 घरपझोङ गाउँपािलका 104 4 लोम ाङ गाउँपािलका 1042 थासाङ गाउँपािलका 125 5 वा गाउँ मु े गाउँपािलका 1253 लो घेकर दामोदरकु गाउँपािलका 104


NPR(000)1 कु ा नगरपािलका 269 5 महािशला गाउँपािलका 1732 फलेवास नगरपािलका 293 6 मोदी गाउँपािलका 2213 जलजला गाउँपािलका 197 7 िवहादी गाउँपािलका 1734 पैयंू गाउँपािलका 173

lhNnf M ka{t

lhNnf M ल जु

lhNnf M तन ँ

lhNnf M का ी

lhNnf M माना

lhNnf M मु ा


NPR(000)1 ग ाङ नगरपािलका 245 7 आँिधखोला गाउँपािलका 1732 चापाकोट नगरपािलका 173 8 कालीग की गाउँपािलका 1253 पुतलीबजार नगरपािलका 269 9 फेदीखोला गाउँपािलका 1254 भीरकोट नगरपािलका 149 10 िब वा गाउँपािलका 1735 वािलङ नगरपािलका 269 11 ह रनास गाउँपािलका 1046 अजुनचौपारी गाउँपािलका 149

lhNnf M ा जा


170


NPR(000)1 बेनी नगरपािलका 197 4 मंगला गाउँपािलका 1252 अ पूण गाउँपािलका 221 5 मािलका गाउँपािलका 1733 धवलािगरी गाउँपािलका 197 6 रघुगंगा गाउँपािलका 221


NPR(000)1 ग ोट नगरपािलका 221 6 तमानखोला गाउँपािलका 1042 जैिमनी नगरपािलका 245 7 ताराखोला गाउँपािलका 1253 ढोरपाटन नगरपािलका 125 8 िनसीखोला गाउँपािलका 1254 बा ुङ नगरपािलका 269 9 विडगाड गाउँपािलका 1975 काठेखोला गाउँपािलका 197 10 वरेङ गाउँपािलका 149


NPR(000)1 कावासोती नगरपािलका 149 5 बौिदकाली गाउँपािलका 1732 गडाकोट नगरपािलका 125 6 बुिलङटार गाउँपािलका 1733 देवचुली नगरपािलका 125 7 िवनयी ि वेणी गाउँपािलका 1254 म िव दु नगरपािलका 241 8 ेकोट गाउँपािलका 104


NPR(000)1 बदघाट नगरपािलका 149 5 पा ीन न गाउँपािलका 1732 राम ाम नगरपािलका 245 6 तापपुर गाउँपािलका 2213 सुनवल नगरपािलका 104 7 सरावल गाउँपािलका 1734 सु ा गाउँपािलका 125


NPR(000)1 बुटवल उपमहानगरपािलका 104 9 कोटहीमाई गाउँपािलका 1732 ितलो मा नगरपािलका 197 10 गैडहवा गाउँपािलका 1253 देवदह नगरपािलका 104 11 मचवारी गाउँपािलका 1254 लु नी सां ृ ितक नगरपािलका 221 12 मायादेवी गाउँपािलका 125

lhNnf M नवलपरासी

lhNnf M प ेही

lhNnf M ा ी

lhNnf M बा ु

lhNnf M नवलपरासी बदघाट सु ा पूव

5 िस ाथनगर नगरपािलका 104 13 रोिहणी गाउँपािलका 1736 सैनामैना नगरपािलका 104 14 शु ोधन गाउँपािलका 1257 ओमसितया गाउँपािलका 149 15 स रीमाई गाउँपािलका 1738 क न गाउँपािलका 104 16 िसयारी गाउँपािलका 149


NPR(000)1 किपलव ु नगरपािलका 221 6 िशवराज नगरपािलका 2212 कृ नगर नगरपािलका 269 7 मायादेवी गाउँपािलका 2213 बाणगंगा नगरपािलका 197 8 यसोधरा गाउँपािलका 2214 बु भुमी नगरपािलका 269 9 िवजयनगर गाउँपािलका 1255 महाराजग नगरपािलका 245 10 शु ोधन गाउँपािलका 149

lhNnf M किपलव ु


171


NPR(000)1 तानसेन नगरपािलका 173 6 बगनासकाली गाउँपािलका 2452 रामपुर नगरपािलका 149 7 माथागढी गाउँपािलका 1973 ितनाउ गाउँपािलका 125 8 र ा गाउँपािलका 1254 िन ी गाउँपािलका 197 9 र ीकोट गाउँपािलका 2215 पूवखोला गाउँपािलका 173 10 रैनादेवी छहरा गाउँपािलका 221


NPR(000)1 भुिमका थान नगरपािलका 197 4 छ देव गाउँपािलका 1972 िशतगंगा नगरपािलका 197 5 पािणनी गाउँपािलका 2213 स खक नगरपािलका 173 6 मालारानी गाउँपािलका 173


NPR(000)1 मुिसकोट नगरपािलका 197 7 छ कोट गाउँपािलका 1732 रेसंुगा नगरपािलका 125 8 धुक ट गाउँपािलका 1973 इ ा गाउँपािलका 149 9 मदाने गाउँपािलका 1974 कालीग की गाउँपािलका 197 10 मािलका गाउँपािलका 2215 गु ीदरबार गाउँपािलका 173 11 गाउँपािलका 1976 च कोट गाउँपािलका 221 12 स वती गाउँपािलका 221


NPR(000)1 पुथा उ रगंगा गाउँपािलका 173 3 िस े गाउँपािलका 1482 भूमे गाउँपािलका 148


NPR(000)1 रो ा नगरपािलका 197 6 ीगढी गाउँपािलका 1732 ि वेणी गाउँपािलका 149 7 लुङ ी गाउँपािलका 149

lhNnf M kfNkf

lhNnf M अघाखाँची

lhNnf M गु ी

lhNnf M कुम पूव

lhNnf M रो ा

3 थवाङ गाउँपािलका 104 8 गंगादेव गाउँपािलका 1254 प रवतन गाउँपािलका 149 9 सुनछहरी गाउँपािलका 1735 माडी गाउँपािलका 125 10 सुिनल ृित गाउँपािलका 173


NPR(000)1 ूठान नगरपािलका 173 6 नौबिहनी गाउँपािलका 1732 ग ारी नगरपािलका 197 7 म रानी गाउँपािलका 1253 ऐरावती गाउँपािलका 173 8 मा वी गाउँपािलका 1494 गौमुखी गाउँपािलका 173 9 स मारानी गाउँपािलका 1045 िझम क गाउँपािलका 149

lhNnf M ूठान


172


NPR(000)1 घोराही उपमहानगरपािलका 221 6 बंगलाचुली गाउँपािलका 1252 तु ीपुर उपमहानगरपािलका 221 7 बबई गाउँपािलका 1003 लमही नगरपािलका 104 8 राजपुर गाउँपािलका 1004 गढवा गाउँपािलका 125 9 रा ी गाउँपािलका 1005 दंगीशरण गाउँपािलका 104 10 शा नगर गाउँपािलका 100


NPR(000)1 नेपालग उपमहानगरपािलका 289 5 डुडुवा गाउँपािलका 1492 कोहलपुर नगरपािलका 104 6 नरैनापुर गाउँपािलका 1733 खजुरा गाउँपािलका 173 7 बैजनाथ गाउँपािलका 1254 जानकी गाउँपािलका 173 8 रा ीसोनारी गाउँपािलका 173


NPR(000)1 गुल रया नगरपािलका 104 5 राजापुर नगरपािलका 1972 ठाकुरबाबा नगरपािलका 125 6 बारबिदया नगरपािलका 1253 बाँसगढी नगरपािलका 104 7 गे वा गाउँपािलका 1254 मधुवन नगरपािलका 125 8 बढैयाताल गाउँपािलका 149


NPR(000)1 आठिबसकोट नगरपािलका 149 4 ि वेणी गाउँपािलका 1252 चौरजहारी नगरपािलका 149 5 बाँिफकोट गाउँपािलका 1253 मुिसकोट नगरपािलका 149 6 सानीभेरी गाउँपािलका 125


NPR(000)1 बागचौर नगरपािलका 173 6 कुमाख गाउँपािलका 1492 बनगाँड कुिप े नगरपािलका 197 7 छ े री गाउँपािलका 149

lhNnf M दा

lhNnf M बाँके

lhNnf M alb{of

lhNnf M?s'd

lhNnf M स ान

3 शारदा नगरपािलका 197 8 िस कुमाख गाउँपािलका 1044 कपुरकोट गाउँपािलका 125 9 ि वेणी गाउँपािलका 1255 कािलमाटी गाउँपािलका 125 10 दामा गाउँपािलका 104


NPR(000)1 ठूलीभेरी नगरपािलका 104 5 जगदु ा गाउँपािलका 1042 ि पुरासु री नगरपािलका 149 6 डो ो बु गाउँपािलका 1043 काईके गाउँपािलका 104 7 मुड्केचुला गाउँपािलका 1044 छाका ताङसोङ गाउँपािलका 104 8 शे फो ु ो गाउँपािलका 104

lhNnf M डो ा


173


NPR(000)1 च ननाथ नगरपािलका 104 5 ितला गाउँपािलका 1492 कनकासु री गाउँपािलका 149 6 पातारासी गाउँपािलका 1253 गुिठचौर गाउँपािलका 104 7 िसंजा गाउँपािलका 1044 तातोपानी गाउँपािलका 125 8 िहमा गाउँपािलका 104


NPR(000)1 ख ाड गाउँपािलका 197 3 सो गाउँपािलका 1972 मुगुमकामारोगं गाउँपािलका 149


NPR(000)1 अदानचुली गाउँपािलका 104 5 ना खा गाउँपािलका 1252 खापुनाथ गाउँपािलका 125 6 सकगाड गाउँपािलका 1973 चंखेली गाउँपािलका 125 7 िसमकोट गाउँपािलका 1254 ताँजाकोट गाउँपािलका 104


NPR(000)1 खाँडाच नगरपािलका 104 6 पचालझरना गाउँपिलका 1002 ितलागुफा नगरपािलका 149 7 पलाता गाउँपािलका 1003 रा ोट नगरपािलका 100 8 महावै गाउँपािलका 1004 कािलका गाउँपािलका 100 9 सा ी ि वेणी गाउँपािलका 1005 नरह रनाथ गाउँपािलका 149


NPR(000)1 छेडागाड नगरपािलका 197 5 जुनीचाँदे गाउँपािलका 1252 नलगाड नगरपािलका 173 6 बारेकोट गाउँपािलका 1253 भेरी मािलका नगरपािलका 149 7 िशवालय गाउँपािलका 1044 कुसे गाउँपािलका 149

lhNnf M ा

lhNnf M कािलकोट

lhNnf M जु ा

lhNnf M मुगु

lhNnf M जाजरकोट


NPR(000)1 आठबीस नगरपािलका 173 7 डंुगे र गाउँपािलका 1252 चामु ा िब ासैनी नगरपािलका 104 8 नौमुले गाउँपािलका 1973 दु ु नगरपािलका 265 9 भगवतीमाई गाउँपािलका 1734 नारायण नगरपािलका 173 10 भैरवी गाउँपािलका 1045 गुराँस गाउँपािलका 173 11 महाबु गाउँपािलका 1496 ठाँटीकाँध गाउँपािलका 104

lhNnf M दैलेख


174


NPR(000)1 गुभाकोट नगरपािलका 197 6 िच ाड गाउँपािलका 1492 प पुरी नगरपािलका 149 7 चौकुने गाउँपािलका 1493 भेरीगंगा नगरपािलका 125 8 बराहताल गाउँपािलका 1494 लेकबेसी नगरपािलका 197 9 िस ा गाउँपािलका 2215 बीरे नगर नगरपािलका 197


NPR(000)1 ि वेणी नगरपािलका 104 6 ख ड छेडेदह गाउँपािलका 1492 बिडमािलका नगरपािलका 104 7 पा व गुफा गाउँपािलका 1043 बुढीगंगा नगरपािलका 104 8 ामीकाितक गाउँपािलका 1044 बुढीन ा नगरपािलका 125 9 िहमाली गाउँपािलका 1045 गौमुल गाउँपािलका 104


NPR(000)1 जयपृ ी नगरपािलका 149 7 तालकोट गाँउपािलका 1252 बंुगल नगरपािलका 149 8 थलारा गाँउपािलका 1493 साइपाल गाउँपािलका 104 9 दुगाथली गाँउपािलका 1044 केदार ुँ गाँउपािलका 125 10 म ा गाउँपािलका 1255 ख डछा ा गाँउपािलका 173 11 िव डिचर गाँउपािलका 1046 छिबसपािथभेरा गाँउपािलका 149 12 सूमा गाउँपािलका 104


NPR(000)1 िदपायल िसलगढी नगरपािलका 125 6 पूव चौकी गाउँपािलका 1972 िशखर नगरपािलका 245 7 बडीकेदार गाउँपािलका 1253 आदश गाउँपािलका 173 8 बोगटान गाउँपािलका 1974 के.आई.िसं. गाउँपािलका 149 9 सायल गाउँपािलका 1045 जोरायल गाउँपािलका 173


NPR(000)1 कमलबजार नगरपािलका 221 6 ढकारी गाउँपािलका 125

lhNnf M बझा

lhNnf M डोटी

lhNnf M आछाम

lhNnf M सुखत

lhNnf M बाजुरा

2 पंचदेवल िवनायक नगरपािलका 221 7 तुमाखाँद गाउँपािलका 1973 मंगलसेन नगरपािलका 221 8 बा ीगढी जयगढ गाउँपािलका 1734 साँफेवगर नगरपािलका 341 9 मे ेख गाउँपािलका 1975 चौरपाटी गाउँपािलका 173 10 रामारोशन गाउँपािलका 197


NPR(000)1 महाकाली नगरपािलका 149 6 ाँस गाउँपािलका 1492 शै िशखर नगरपािलका 173 7 मामा गाउँपािलका 1493 अिपिहमाल गाउँपािलका 104 8 मािलकाजुन गाउँपािलका 1734 दु ँ गाउँपािलका 125 9 लेकम गाउँपािलका 1255 नौगाड गाउँपािलका 125

lhNnf M दाचुला


175


NPR(000)1 दशरथच नगरपािलका 265 6 दोगडाकेदार गाउँपािलका 2172 पाटन नगरपािलका 245 7 पंचे र गाउँपािलका 1493 पुच डी नगरपािलका 269 8 िशवनाथ गाउँपािलका 1044 मेलौली नगरपािलका 173 9 िसगास गाउँपािलका 1495 डीलासैनी गाउँपािलका 125 10 सुनया गाउँपािलका 197


NPR(000)1 अमरगढी नगरपािलका 125 5 ग ापधुरा गाउँपािलका 1252 परशुराम नगरपािलका 104 6 नवदुगा गाउँपािलका 1253 अजयमे गाउँपािलका 149 7 भागे र गाउँपािलका 1004 आिलताल गाउँपािलका 104


NPR(000)1 कृ पुर नगरपािलका 100 6 माहाकाली नगरपािलका 1042 पुनवास नगरपािलका 100 7 शु ाफाँट नगरपािलका 1043 बेदकोट नगरपािलका 100 8 बेलडाँडी गाउँपािलका 1044 बेलौरी नगरपािलका 100 9 लालझाडी गाउँपािलका 1045 िभमद नगरपािलका 104


NPR(000)1 धनगढी उपमहानगरपािलका 104 8 कैलारी गाउँपािलका 1732 गोदावरी नगरपािलका 149 9 चुरे गाउँपािलका 1043 गौरीगंगा नगरपािलका 104 10 जानकी गाउँपािलका 1254 घोडाघोडी नगरपािलका 125 11 जोशीपुर गाउँपािलका 1045 िटकापुर नगरपािलका 104 12 बदगो रया गाउँपािलका 1046 भजनी नगरपािलका 125 13 मोह ाल गाउँपािलका 1047 ल कचुहा नगरपािलका 104

lhNnf M कंचनपुर

lhNnf M कैलाली

lhNnf M बैतडी

lhNnf M डडेलधुरा

Total Budget 120992


176

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16. ToR OF MD SECTIONS


177

16.PHOTO GALLERY

Banke HFL Training

Bardiya Rajapur Store

BHLTraining Sarlahi

BRT ToT 2

Bardiya Hospital Visit

Bardiya Rollout

BNM Surkhet Store

Cerificate Dist Hetauda


178

COVID-19 item recieved from US Army at MD

EDPs Contribution Meeting on SCM

eLMIS Site Visit at Surkhet

eLMIS Review Workshop Dhulikhel 2

Dhangadhi ToT

EDPs Meeting on COVID-19




179

eLMIS Study Trip Sri Lanka 1


eLMIS Visit Bardiya

Expert Consultative Meeting Kathmandu

New Ware House Construction at Teku, Kathmandu


eLMIS Visit Surkhet

GIDC Visit


180

Health Logistics Report Development Meeting

HO Arghakhachi Visit

Quantification Workshop Hetauda

Hetauda ToT

LWG Meeting at MD

Mugu Hospital

National Quantification Workshop NagarkotRajapur Meeting


181

Covid-19 Commodities Recieved at TIA, Kathmandu

Covid-19 Commodities Repacking at MD

Covid-19 Commodities Recieved at TIA, Kathmandu

Covid-19 Partners Meeting at MD

Quantification Training Biratnagar 1

Quantification Workshop Lalgadh 2

Quantification Training Lalgadh 1

LMIS Training at Dupcheshowor Gaun Palika, Nuwakot


182

Rautahat BHL1

Biratnagar Quantification Training

ToT at Dhangadhi 2

ToT at Hetauda

Repacking and Distribution of PPE Set for COVID-19

ToT at Biratnagar

ToT at Hetauda

Quantification Biratnagar


183

International Training on FP/RH Commodity Security atJaipur, india

COVID-19 Logistics Management Operations Monitoring at TIA Kathmandu 1

eLMIS Site Visit at Surkhet

eLMIS Joint Monitoring Visit at Sindhupalchok

International Training on FP/RH Commodity Security atJaipur, india

COVID-19 Logistics Management Operations Monitoring at TIA Kathmandu 2

Covid-19 Quarantine Visit at Kharipati, Bhaktapur

Partners Meeting at MD


184

LOGISTICS MANAGEMENT SECTIONSystems Being Monitored an d Managed by Logistics Management Information Resource Center:1. Website of Department of Health Services. Url: https://dohs.gov.np

2. Official Email Server/Email ID of Department of Health Services. Mail server Url: https://mail.nepal.gov.np Email ID: [email protected]

3. Website of Logistics Management Section, Management Division. Url: https://dohslmd.gov.np

4. Official Email Server/Email ID of Management Division. Mail Server Url: https://mail.nepal.gov.np Email ID: [email protected]

5. Electronic Logistics Management Information System (eLMIS ,web based application hosted under domain dohslmd.gov.np ) System & Server Management with support & coordination from GHSC-PSM

Url: https://elmis.dohslmd.gov.np

6. Technical Specification Bank (web based application hosted under the domain dohslmd.gov.np). It contains the DoHS approved specifications of health services related commodities, i.e medicine & medical equipments, based on which procurement is to be done. The system can be accessed via the website of LMS (https://dohslmd.gov.np)

7. Grievance Handling & Redressal Mechanism (web based application hosted under domain dohslmd.gov.np). The system can be accessed via the website of LMS or by the following web address: Url: https://dohslmd.gov.np/ghrm


185


186

SUPPORTED BY

UNFPA/ADRA NEPAL