practicum presentation. (family planning association of Nepal, Kaski Branch)

1. Presented by: Sirjana Tiwari
MPH 4th Sem (PHSM)
School of Health and allied Science
Pokhara University
Supervised by: Nand Ram Gahatraj
Lecturer
School of Health and allied Science
Pokhara University

2. Working District Of FPAN (37)
2

3. INTRODUCTION
• FPAN established in 1959, (FPAN) is a member association of
the International Planned Parenthood Federation (IPPF), a
major partner of the Government of Nepal’s national family
planning program, contributing larger number of all FP
services in Nepal .
• FPAN is the Nepal’s first national sexual and reproductive
health service delivery and advocacy organization, works to
provide critical health services to poor, marginalized, socially
excluded, and underserved communities, including sex
workers, people living with HIV ,LGBTI people, injecting
drug users, men who have sex with men, migrant workers, and
survivors of gender-based violence (GBV).
3

4. Organizational structure of
FPAN
Central Assembly
Central Committee
Branch Assembly
Branch committee
4

5. Objectives of internship/practicum
General objectives: to earn practical knowledge about the
systems, services and managerial aspects of FPAN, Kaski
through direct participation and/or observation in the different
sections of the organization as an intern.
Specific Objectives
• To present an overview of FPAN Kaski
• To analyze critically the managerial aspects of FPAN Kaski
through POSDCoRB (Planning, Organizing, Staffing,
Directing, Coordinating, Reporting and Budgeting) approach.
• To analyze different programs running under FPAN Kaski and
perform trend analysis
• To conduct a Mini-action Project on prioritized problem
5

6. METHODOLOGY
• Study Design: Cross-sectional
• Study Area: FPAN, Kaski Branch, Upakar Marg, PNP-12.
• Study Duration: Three weeks (17th December – 6th January,
2018).
Tool Technique Respondent
Unstructured interview
guidelines
Kaski Structural and semi
structural interview
Branch Manager and
staffs of FPAN
Observation Checklist Observation Store, waste management,
sanitation, building space,
infrastructure
Record review format Record review Records and reports,
Annual report
6

7. Data collection
• Data trend of various indicators obtained from
- Past three years annual reports of FPAN, Kaski and National
Annual Report (FY 2070/71– FY 2072/73) Four years AGM
reports (2013 – 2016).
Data entry and analysis
• Data entry and analysis were done via MS- Excel 2013
version. ◦ Data were analyzed by preparing tables, charts and
line graphs.
Ethical Consideration
• Verbal informed consent were taken from FPAN before
practicum has started
• The official letter was submitted from the university to FPAN
Kaski.
• Assurance of the confidentiality on sensitive issues with FPAN
was done. 7

8. RESULTS AND DISCUSSION
planning
Circulation of guideline by program division to all branches
Preparation of Annual plan by all FPAN branches
Submission of Annual Plan by all branches to program division
Completion of budgetary exercise by finance division
Submission of Annual plan to IPPF SARO for comments
Submission of Annual Plan by DG to CEC
Final approval of Annual plan by CEC
8

9. Organization and Staffing
Community
Clinic
General Council
Branch Executive Committee
Senior Branch Manager
Sub-Committee, Youth
Committee
Account Officer- 1 Senior Medical Officer-1
Branch Clinic Delivery center
Staff Nurse- 2
Lab Technician-1
SANM/SAHW-2
Clinical Helper-1
Cleaner-1
Community
clinic Baglung
Staff Nurse/HA-2
CC-11
Peer Educator-1
Outreach Worker-1
Staff Nurse/HA-1
SAHW-1
Office Assistant-1
CC-2
Staff Nurse-2
Office Assistant-1
CC-2
Office Assistant-1
Watchman-1 9

10. Directing
• Leadership style is participatory within branch level and
autocratic by the central level to branch level. Branch office
follow the rules , regulation and guideline provided from
central office.
• Branch Manager delegates authority and responsibilities to the
sub- ordination in his absence at office.
• Decision making system of FPAN is from head office to
branches.
10

11. Co-ordination
• Vertical Co-ordination: Head office to branch office
• Horizontal coordination: DPHO, other NGOS
working on HIV/Aids, safe motherhood and family
planning.
11

12. Recording and Reporting System
RHI-Register-Register
(Socio-demography of clients)
RH 2, 3
Contraceptives
RH 4
Abortion
RH 1
Counseling, service
CMIS- Clinical Management Information System
(Data Entry, Cabinet Management
DHIS- District Health information System
(Reporting)
12

13. Budgeting
Program Division
Branch Office
Program Division
Planning guideline is circulated to the branch offices.
Estimation per unit cost is done for all the planned activities by
branch office and incorporated in annual budge, Feedback and
comments are incorporated
Budget is reviewed and discussed at central office
Approval of Director
General
IPPF SARO
Central committee
and central Assembly
After the DG approval, the budget draft is sent to IPPF SARO for
their comments and approval.
After IPPF SARO approval, annual budget is presented by
Director General to central committee and central Assembly for
approval.
The approved budget is circulated to the central office, Branch office and project
office for the implementation
13

14. Supervision, Monitoring and
Evaluation
• Supervision and monitoring is done by the representatives
from central office regularly at interval determined by the
central office.
• Evaluation of the programs and projects are well discussed in
the Annual General Meeting.
• Statutory financial audit is conducted by an independent
auditor
• Internal Audit is conducted by in-house internal audit section
or outsourced to external audit firms
• Program Audit is done as per the requirements of Donor
agencies.
14

15. Logistic System
• FPAN, Kaski was primarily dependent on the central office for
necessary logistics and infrastructures like furniture, computer,
etc.
• It has Medicine Running Fund for purchasing medicines which
were locally purchased and sold to consumers adding 5% to
purchase cost.
• FPAN, Kaski also had Clinic Running Fund (CRF) which
financially supported logistics for Integrated SRH Service
Delivery Project. The fund is raised from the clinical services
income.
15

16. Service provided through FPAN
1. Safe abortion service
2. Pregnancy test
3. Male vasectomy
4. IUCD, implant serve
5. Other family planning
services
6. Treatment and cure of
sexually transmitted
disease
7. HIV aids testing service
8. Gynecology and other
health service
9. Counseling to youth
10. Lab service
11. Immunization service
12. Threatened incomplete
abortion
16

17. Major achievements and
Outcomes of FPAN
• Legalization of safe abortion which contributed
reduction in MMR (415/100,000 in 2000 and 239 in
2016)
• Inclusion of comprehensive sexuality education in
school curriculum
• Endorsement of Domestic Violence Control Act
which was endorsed by parliament in 2009
• Increment in allocation of national budget in family
planning (by 22% in 2074/75 )
17

18. • FPAN operates eight training centers (28%
contribution)
• Provision of Medical Abortion Service in 25
community clinics.
• Contribute 15%-20% in national reproductive health
programs
• Cervical cancer screening test by VIA method
• Roll out of DHIS2 in all service delivery points
• Starting Integrated Management Information System
18

19. Total sexual and Reproductive
service trends in five year.
19

20. Contraceptives service five year
trends
20

21. SRH Service Achievements by
Branches from Jan- sept, 2018321824
152966
145260
145038
136702
134974
130441
120520
118362
117792
101398
101006
98388
89278
87430
86434
74894
73412
69453
67704
65976
34222
31085
30782
29649
29024
27302
24220
7342
5275
5047
4043
3475
0
50000
100000
150000
200000
250000
300000
350000
Branch Performance on SRH service
21

22. Critical analysis on some major
service components
Abortion service coverage of FPAN, Kaski (2017-18)
21
312
515
569
26
351
487
582
Incomplete Ab-
Medical abortion
MVA (CAC) AB Induced
Medical abortion
Post Abortion
Care-follow-up
2017 2018
22

23. Trends of FP Service at FPAN-kaski
0
500
1000
1500
2000
2500
3000
3500
4000
2015 2017 2018
M Condom- initial C
0
500
1000
1500
2000
2500
3000
2015 2017 2018
Pills- initial consult
0
200
400
600
800
1000
1200
2015 2017 2018
Depo-Initial consult
0
100
200
300
400
500
2015 2017 2018
Implant initial
consultation
0
50
100
150
200
2015 2017 2018
IUCD insertion (
copper T 380-A)
23

24. FP service user between FPAN-
kaski (2073/74) and Nepal
Condom
11%
Pills
28%
Depo
38%
Implant
17%
IUCD
6%
24

25. Abortion service coverage
between FPAN, Kaski (2017-18)
MVA
38%
MA
62%
Abortion in FPAN,kaski
MA
56%
MVA
44%
National level Abortion
25

26. Hiv/Aids and STI Services FPAN-kaski
2017 2018
87
13
333
674
Hiv C-Care/support
STI Treatment
26

27. Gynecological services FPAN-
kaski
0
500
1000
1500
2000
2500
3000
2017
2018
27

28. Lab diagnosis (FPAN-Kaski)
0
500
1000
1500
2000
2500
2015 2016 2017 2018
Pregnancy test
0
50
100
150
200
250
2015
2016
2018
28

29. Mini Action Project
• MAP was conducted to assess the quality of care in
FPAN kaski, to improve the Family planning service.
• Quantitative questionnaire related to the satisfaction
of services were asked to the clients of FPAN, Kaski.
• The interview was about 10-15 min long.
• Informed consent was taken prior to interview.
• After general evaluation, interview sheet were send to
the head office FPAN.
29

30. Rationale
• Good quality of care in family planning (FP) services
help individuals and couples to meet their
reproductive health needs safely and effectively.
• Therefore, assessment and improvement of the
quality of family planning services could enhance
family planning services utilization.
30

31. Objectives
General Objectives
• To assess quality family planning service to help
individuals and couples to meet their reproductive
health need safely and effectively.
Specific objectives
• To assess the quality gap of family planning service
• To assess the satisfaction of client in Family Planning
service of FPAN, Kaski.
31

32. Plan of Action
Activities Date
Prioritization of Problem 27th dec, 2018
Discussion with FPAN staffs 28th dec, 2018
Finalization the subject for MAP 28th dec, 2018
Planning of MAP, preparation of
questionnaire
29th dec, 2018
Implementation 30th dec, 2018
Evaluation 31st dec, 2018
32

33. Date, Venue and Time, Methodology
• Date: 30th December 2018
• Venue: FPAN Kaski, office
• Time: 2-4 PM/ one week
Methodology
• Method: Face to face interview
• Material: pen, paper, laptop, photocopy.
33

34. Results
• There was an availability of required services ie.
medical equipment, trained staffs, and information
education and communication materials (IEC) as per
client flows in FPAN, Kaski.
• The mean waiting time at the service delivery points
and consultation duration were 10-15 minutes,
respectively.
• The providers used at least one IEC/BCC material in
all of the consultation sessions.
34

35. Evaluation
• There is active participation of clients during
interview session. Positive feedback from all the
participants and health personnel.
• FPAN clients provide appropriate time for interview
without any hesitation.
• Quality of Service and Satisfaction of clients from
family Planning association of Nepal, Kaski branch
was satisfactory during conduction of Mini Action
Project.
35

36. Conclusion of Practicum
• All staffs of FPAN, kaski branch were motivated and
dedicated to their role and responsibility. FPAN, kaski send
monthly report to the head office and DPHO kaski.
• There is well conduction of Family planning clinics in remote
area of Kaski, Tanahun and other nearer districts.
• Monthly monitoring has been done mainly at lekhnath,
Baumara, Purkot FPAN offices.
• Peer education from Peer educator, Sexual and reproductive
health education to the HIV and STI clients from FPAN offices
etc.
• Furthermore, FPAN is a organization which is functioned by
charity fund and community program were organized by
volunteers. And another important things is it only take
charges for MA, MVA & for medicine with 30% discount. 36

37. Recommendations
• There is vacant post of Medical officer in FPAN,kaski so
it should be fulfilled as soon as possible.
• It should be committed to organize capacity building
programs for its volunteers to enhance their skills and
knowledge.
• At least one month practicum activities from the
University would be fruitful for students .
37

38. Lesson Learn
• Time management skill was learnt from the
very 1st day of the practicum
• Trend analysis and critical appraisal skill was
learnt
• Coordination skill was learnt in every aspect of
activities conducted during practicum
• Professional communication skill was learnt.
• Counseling with client was leant.
38

39. BIBLIOGRAPHY
• FPAN/kaski annual general report report (2015)
• FPAN/kaski annual general report report (2016)
• FPAN/kaski annual general report report (2017)
• FPAN/kaski annual general report report (2018)
• FPAN (DG) AGM presentation Dec, 2018.
• MOH/DOHS (2073/74) Annual report, Department of
Health service.
39

40. Annex
40