Examination of the organizational, administrative, and financial structures of the community health and integration project of the Ministry of Health, Nepal

The lack of fiscal and financial management systems is the CHIP's greatest problem. In addition, the CHIP headquarters is inadequate and the CHIP staff too small to accomplish stated objectives. In terms of the logistical support system, the supply of drugs and equipment for health facilities is inadequate and their distribution and storage poor; the private drug contractor is often slow, inefficient, and expensive. Continuing, administrative and personal procedures are lacking and supervision is insufficient at all levels. The reporting system is too complex and the reporting staff inadequate. Training for village health workers is too short. Lastly, a proposal for 1981-82 CHIP activities is too vague. Technical problems include the continued incidence of malaria in several integrated districts; differences in the efficiency of health care delivery in the six project districts; and the lack of an adequate methodology and process for identifying districts ready for integration. Further, family planning services lack good organization, contraceptives are frequently stored improperly, and laparoscopy is used more frequently than the simpler mini-laparotomy. Nineteen recommendations are made to address the above problems.