Necha Community Hospital

Providing simple health services could change the lives’ of thousands living in impoverished and isolated mountain areas of Nepal. The Asian Heritage Foundation (AHF) initiated and supports a Community Hospital on the foothills of the Mt. Everest, following the World Health Organization (WHO) Nepal’ key policy principles:
• equity in access of health,
• decentralized delivery of health care,
• community, private and NGO participation,
• greater socio economic inclusion and improved health outcomes for the poor.

Serene mountain ranges, smiling people and beautiful hill villages attract each year more than 300 thousand foreigners to Nepal, making the tourist sector Nepal’s most important industry. Despite the benefits for the tourist centre’s as Kathmandu and Pokhara as well as the tea houses along popular treks, 80% of the population is still living in medieval conditions; facing lack of electricity, clean drinking water and proper sanitation. Nepal’s rural population live of the land earning less than 2 dollars a day and is struggling to overcome the damage of more than a decade of  civil conflict. 

Services offered at the Hospital

Hospital services are carried out by a general doctor and a team of heath assistants and nurses. The management committee is responsible for supervision of the hospital. Asian Heritage Foundation Nepal is committed to support the hospital for the next 7 years with a view to provide access to primary heath care services for people in Solukhumbu, Okhaldhunga and Khotang. Currently, the hospital is offering the following services:

Out Patient Services:
Except on official holidays, the registration of  outpatients is open from 9 am till 11am and from 1 pm till 3 pm. On Fridays, which is a half working day, the registration is open from 9 am till 11 am. Registration is necessary for each visit at the hospital. Patients are requested to pay Rs. 25 for a new registration and Rs.10 in case of a follow up registration. Patients that are unable to pay the hospital services are offered a free registration and are requested to meet the hospital Director.

Inpatient Services:
The patients staying at the hospital for treatment are admitted by the doctor. Each inpatient is requested to deposit Rs. 500 upon admission, which will later be refunded. Staying at the hospital inpatients will be charged Rs. 50 per day and offered meals twice a day up to the allocated budget. Medicine and investigations done while admitted are billed to the patient afterwards. In case patients are unable to cover the hospital bill they are offered free services. Only the hospital Director holds the right to grant free services.

Pharmacy:
The hospital pharmacy is open for 24 hours, 7 days a week. All the patients, whether they are out patient or admitted at the hospital, can get medicines from the pharmacy. For patients seen in emergencies, medicines are provided at any time.

Dressing & Injections:
Dressings, injections etc are prescribed by the hospital doctor. The dressing and injection room is open for 24 hours. On holidays a limited schedule applies, with opening hours from 10 am to 12 am.

Maternity Care:
Basic Emergency Obstetric & Neonatal Care ( BEONC ) is available 24 hours a day. Maternity services provided by the hospital are free for all. Women who come for their first and second delivery will get 1500 rupees transport subsidy from the Ministry of Health. Comprehensive Abortion Care (CAC) up to twelve weeks of pregnancy is also provided by the trained doctors. This service is offered against payment of Rs. 1000.

Fetal Monitoring :
Fetal Monitoring if necessary, is done for free at the Maternity Centre.

Consultation:
Specialists and colleagues are consulted over the internet and possible services are rendered to the patients.

Referrals:
Patients are usually referred to appropriate hospitals in Phaplu, Solukhumbu district hospital, Okhaldhunga district hospital, Rumjatar hospital or hospitals in Kathmandu as per requirement.

Development Programme

After a set up phase of 12 months the Hospital is running since the end of March 2010. The results of the first 3 months  are as follows:
• Over 300 health checks and small curative treatments;
• 16 patients admitted for emergency treatments; 
• 2 referrals to specialized hospitals.

CURRENT STATUS: DEVELOPMENT STAGE 1
PLANNING: PROCUREMENT OF LABORATORY EQUIPMENT & X RAY AND ELECTICITY SUPPLY THROUG SOLAR SYSTEM

AHF Nepal has indicated 4 incremental development stages following a natural lifeline of the hospital for the next 7 years.

Stage 1
First aid equipment is available and the hospital has the capacity of a ‘health post’ enhanced with a medical doctor and in-patient-department. The medicines for common diseases are available and the medical assistants have basic knowledge and experience to assist the doctor and perform daily clinical duties or assist in child deliveries and child health care. The services of the hospital are focused on curing common diseases, emergency cases management and referral in case of complex interventions. The management team of the hospital is at the beginning of a learning process, relations are still informal and uncertain. The foundation provides structure and builds confidence among the members by telling what needs to be done. 

Stage 2
A ‘basic hospital’ is established with additional laboratory supplies and X-Ray facilities to enable technical assessments. Consequently, solar technology is installed to meet the increased power (electricity) needs. To utilize the new capacity and ensure quality services, hospital staff is trained to handle equipment per directions of the doctor. As the quality of existing services improves significantly the hospital starts to organize awareness programmes on prevalent health issues. Referrals diminish in this stage as a result of the increased capacity to diagnose. The management of the hospital understands its role and the foundation promotes good governance practices by organizing workshops. 

Stage 3
Dental facilities and an eye clinic add a new dimension to the hospital and together with the arrival of sophisticated laboratory equipment the medical capacity is at par with a ‘core hospital’. New staff members are recruited to operate and maintain  specialist equipment.  Existing health assistants & midwives continues to enroll in training programmes to guarantee quality services and to work independently. At this stage the hospital  has a wide service spectrum while consolidating its superior quality record and awareness programmes. Referrals are next to zero and the hospital provides assistance to health posts in the region. The Management Committee of the hospital is competent to manage the hospital effectively. The foundation is motivating the team members and provides training through professional coaches.

Stage 4
The final stage ‘advanced hospital’ is completed with the opening of Surgical care (Operation Theatre) facilities. In this stage the hospital is a primary health institute in the region. The staff is enabled to fulfill a wide range of tasks from general to complicated cases, at all disciplines and levels. An intensive educational programme is launched to keep the staff updated about contemporary medical practices. The services of the hospital are focused on inclusive treatments with referrals only in case of specialist treatment or complex surgeries. Next to awareness raising, the hospital promotes health improvement interventions such as improved cooking stoves, health service cards, etc. The Management Committee of the hospital takes responsibility of managing all resources efficiently.  The foundation is phasing out or steps in if requested.
 

AHF Nepal is dedicated to support the Hospital for 7 years aspiring to establish and guarantee high quality services and self-dependency. The sustainability strategy exists of 4 priorities which are integrated in our support package.

Providing management coaching as part of the organizational development strategy for the members of the governance body through raising awareness and providing coaching about their role and responsibilities. It will enable the committee members to perform an effective participative decision making process.

Providing vocational training for members of the sub committees and paramedics. It will ensure compliance with quality standards and effective support of the management of the hospital.  

Promoting income generating models such as, admission fees, memberships and insurances and tourism to cover the financial needs of the hospital.