1.

Chapter III:
Hospital Profile
(1) Ilam Hospital
Introduction
Ilam hospital was established in the year 1987 BS as a three room’s dispensary. Later in 1994 it
was upgraded to a hospital. From 2030 BS hospital started its inward service with 15 bed under
the government of Nepal and later it was upgraded to 25 bed hospital in the year 2061 BS and
further upgraded to 50 bed hospital in the year 2072 BS. Currently hospital is operating as 50 bed
hospital monitored by development and cooperation committee formed in the year 2044 BS.
Hospital is currently under the control of federal governance and act as a secondary level health
center for the people of Ilam and Taplejung district. In the year 2075/76 this hospital was ranked
1st in province 1 as per minimum service standards criteria.
[ Source: Interview with the Hospital
manager]
Methodology
The following techniques, tools and sources were used to create the hospital profile:
Techniques, tools and sources for hospital management study is stated in the following table :
Technique  Tools  Source of Information 
Observation  Observation Ilam district hospital, Ilam
checklist 
Interview  Interview  Medical Superintendent
guidelines  Hospital Manager
Medical Record Supervisor
Medical Officers
Department in-charges
Other hospital staff 
Record Record review Hospital In-patient Records
review  format  Ilam Hospital Annual Report 2074/75, 75/76
and 76/77
Literature Literature review Annual Report 2075/76, Province 1
review  format 

Findings
The management of Ilam hospital was studied as per WHO six pillars of health system
management under the following heading.
 I. Service delivery 
II. Health Workforce
III. Health Information system
IV. Logistic management
V. Financing
VI. Leadership / Governance 
Service delivery
 OPD service.

 Indoor service

 Emergency service

 Laboratory service with culture

 Thyroid function test

 Ultrasound, digital x- ray

 Gene expert service

 Delivery service , caesarean section

 Safe abortion service, safe abort pharmacy service

 Pharmacy dental service

 Art services, anti rabies vaccine service

 Ambulance service health insurance programme

 Social service unit

 Eye clinic
`
 OCMC service

Emergency services
Infrastructure

Emergency was on the left of entrance gate and was easily accessible for the ambulance. There
were 6 seprate rooms
1. Main emergency room with triage(yellow,green,red)
2. Changing room
 3. Dressing room
4. ECG
5. Electricity backup room
6. Pharmacy

There was a nursing station in the emergency room having a HA available all the time. 8beds
were there in emergency room seprated according to triage with 2 beds allocated to red area, 6
for yellow, 6 chairs for green zone with 5 iv stands .
There were 2 toilets 1 for staff, 1 for patients. The ventilation and lighting condition of all the
rooms were satisfactory.There was a disaster management kit in the emergency department.
There was also a rapid response unit for disaster managment and hospital wide distress alarm.
The fire assistance was provided by a fire extinguisher cylinder. There were 2 waiting areas both
in and outside the emergency room.There was also a police room for RTA cases.

Equipments used in the hospital are as followed in table:

S.No. Name of the equipment Quantity

1. Oxygen cylinder 12
2. Oxygen pipeline 1
3. IV stand 5
4. ECG 1
5. Weighing Scale 2(1Adult+1 Pedia)
6. Suction Machine 1
7. Nebulizer 1
8. Stretcher 1
9. Ambu Bag Present(pedia+
adult)
10. Wheel Chair Present
11. Dressing table 1
12. Laryngoscope 3
13. Telephone 1
14. Autoclave 1
15. Otoscope set 1
16. N.G. Tube Present
17. Gastric Lavage set 1
18. Tongue depressor Present
19. Monitor 6
20. Glucometer 1
21. Suture set Present
22. Incision and Drainage set Present
 23. Pulse Oximeter Present

24. I.V canula Present

25. Note sheet Present
26. Sphygnomanometer Present
27. Adhesive paper tape Present
28. Portex tube Present
29. Bag valve masks Present
30. Splints Present
.
Human Resource

Table 3.1: Emergency Department Human Resources

Position Number
HA 3 (5 sanctioned posts)
CMA 1
Paying volunteer (CMA) 4
Helper 3
Sweeper 1
Security guards 3

The emergency was supervised by the emergency in-charge, who was a health assistant. A
medical officer was always on-call. The staff members worked in three shifts in order to give 24
hrs’ emergency service. Since many allotted posts are vacant required human resources are
recruited using local resources.
i. Services
Ilam hospital provides 24 hour emergency services About 30-35 patient. The pharmacy inside
the emergency building provided medications for patients. There was also a rapid response team
for disaster management. The hospital received referrals from the peripheral centers in the
district while patients here are referred to Mechi Provincial Hospital, Nobel Medical College &
Teaching Hospital and BP Koirala Institute of Health Sciences (BPKIHS), Dharan; as per the
requirements.
 Figure 3.1: Number of emergency patients by FY at Ilam Hospital

14000

12000

10000

8000

6000

4000

2000

0
2074/75 2075/76 2076/77

(Source: Hospital records, Ilam Hospital)

i. OPD services:
a. Infrastructre.OPD was located 20 meters away from the main entrance on the second floor of
the four stotred building and was accessible for wheelchair. There was an information corner to
assist the visitors. Proper sign boards were there indicating the way to OPD. Waiting area was
present both outside and inside the OPD. The waiting room had chairs with instructions for
social distancing. The waiting area was spacious with facility of drinking water and fire
extinguisher in the hallway. There were seven rooms for OPD which were:
i. Two for OBGYN
ii. One for General Practice
 iii. One for dentistry
iv. Three for MOs
There were other seper rooms like abortion unit, social service, dental registration room adjacent
to dental OPD and a dental X-Ray room besides dental OPD.
The eye care center Ilam operated by collaboration of Nepal Netrajyoti Sangh and Biratnagar
Eye Hospital was present on top floor of the OPD building.
All rooms had satisfactory lighting and sanitary conditions. Washbasins with soap and water was
present in each room. The OPD room was well furnished. Separate beds were available for
examinations and privacy was maintained using curtains. All required instruments were present
in every OPD rooms. Gloves and hand sanitizers were present at the physicians desk. The dental
OPD was fully equipped and had three dental chairs.
b. Cost
There were three types of OPD tickets:
i. for noninsured patients costing Rs 30
ii. free tickets for patients who fall in the category of ultra-poor individuals, gender
based violence victims, senior citizens above seventy years and widows all under
social service unit
iii. free tickets for those patients who were insured by government of Nepal.

Medical OPD service runs from 10 am - 3 pm from Sunday to Thursday and half day in Friday.
The room for medical OPD which is of adequate size, well-ventilated, air conditioner, equipped
with necessary instruments (sphygmomanometer, X-ray screen, examination bed). About 60-70
patients visit medical OPD every day.
c. Human resources:
It included technical and non-technical staffs.
i. One MDGP
ii. One Obstetrician
iii. One Anesthesiologist
iv. Three Medical Officers
v. Two Dentists
vi. One Dental Hygienist
vii. Two Staffs On Counter
viii. Two Office Assistants.
d. Services:
On average, 100 patients received OPD services per day. Out of them, 60-70 were insured. OPD
services were provided six days a week. It remained closed on Saturdays and public holidays.
OPD registration were done from 10 Am to 12 PM on Fridays and 10 AM to 1 PM on other
weekdays. Break was from 1 PM to 2 PM. OPD schedule was from 10 AM to 3 PM on Sundays
to Thursday. However, after 2 PM, only reports of the patients were reviewed. Crowding was
avoided during OPD hours by restricting single visitor per patient.
The services providers in general OPD were general practitioner and medical officers and
provided services related to medicine, surgery, pediatrics and orthopedics.
Gynecological and obstetrics services were provided in the respective rooms.
Regular eye checkup was done by ophthalmic assistant during ophthalmology OPD.
Dental services were provided by two dentists and a dental hygienist. The services included tooth
extraction, scaling, root canal treatment, dental X-Ray, filling and restoration.

OPD Visits

53623

45448

36311

FA 74/75 FA 75/76 FA 76/77

 Figure 2: Three year trend of Number of OPD visits
e. Equipment
Department Equipment Used
General Practice 1. Stethoscope
2. Torch
3. Thermometer
4. Sphygmomanometer
5. Bathroom scale
6. Tongue depressor
7. Measuring tape
8. Tuning fork
9. Knee hammer
OBGYN 1. Fetoscope
2. Speculum
3. Examination lamp
Dentistry 1. Dental chair
2. Scaling machine
3. Dental X-Ray

f. Recordkeeping:
Record keeping of OPD cases was done electronically and register were maintained by
consultants.
g. Constraints:
Medical records from OPD wasn’t maintained properly so the data obtained wasn’t accurate
enough to project the trend of disease. Procedure which should have been performed in
separate procedure room were performed in the procedure room of emergency department.
ii. Indoor services
The indoor services were divided into General ward and Maternity ward. Furthermore, newly
established but not yet operational ICU was present along with the general ward.
a. Infrastructure:
Indoor department was located on the ground floor of main hospital building,having 42 beds
for indoor services. Although all of them could be propped up, six of them were practically
functional.
The beds were divided among general ward, maternity ward, safe abortion ward, SNCU, ICU,
cabin and OCMC.
The wards had proper waste management system with color coded bins. Drinking water was
easily accessible. Each bed had one patient and each patient was provided with a drawer and a
stool for a visitor. There were two curtains in the ward for privacy.
There were two cabins with attached bathroom, televisions and bed for visitors. Ventilation and
lighting were adequately maintained.
 The entire ward was under CCTV surveillance. There was uninterrupted power supply due to
availability of a backup generator.

Description Number
Beds Sanctioned by Government 50
Total operational bed 50
Total inpatient beds 42
Emergency beds 8
Cabin 2

b. Cost:
General beds were free of cost whereas, cabins cost Rs 500 per day.
c. Human resources:
A medical officer was on call.
Five nursing staffs were posted in the wards.
i. A nursing officer
ii. Eight staff nurses
iii. One SHNI
iv. One HNI
v. Two ANMs
vi. Supporting staffs: 7
d. Services:
Patients who reqiured medicine,surgery,pediatrics,obg/gyne and orthopedics services were
admitted there. Two round were taken daily once in the morning and evening.
Rank Disease Cases Death Mortality rate
1. UTI 113 0 0
2. AE of COPD 65 1 1.53%
3. Neonatal jaundice 62 0 0
4. Pneumonia 61 0 0
5. Fever 60 0 0
6. LRTI/ARI 52 0 0
7. Neonatal sepsis 42 1 2.38%
8. Hyperemesis Gravidarum 42 0 0
9. Tonsillitis 38 0 0
10. URTI 36 0 0
 Table 2: Top 10 diseases among in-patients in FY 2076/77

<=28 29 1-4yrs 5- 15-19 20-29 30-39 40-49 50-59 >= Total

days days- 14yrs yrs yrs yrs yrs yrs 60yrs
1year
Recover / Female 46 8 37 36 218 923 313 62 39 92 1774
cured
Male 57 16 46 44 14 23 29 12 22 60 323
Referred Female 7 0 1 5 2 22 14 8 5 11 75
out
Male 10 5 1 5 2 4 6 4 6 15 58
DOR / Female 4 1 1 0 3 10 7 2 3 6 37
LAMA
Male 1 2 2 1 0 1 0 2 2 9 20
Absconded Female 0 0 0 0 1 1 0 0 0 0 2
Male 0 0 0 0 0 0 0 0 0 0 0
Death <48 Female 0 0 0 0 0 0 0 0 0 0 0
hrs
Male 0 0 0 0 0 0 0 0 0 0 0
Death >= Female 0 0 0 0 0 0 0 0 0 0 0
48 hrs
Male 0 0 0 0 0 0 0 0 0 2 2
Female 57 9 39 41 224 956 334 72 47 109 1888
% 45.60 28.13 44.32 45.05 93.33 97.15 90.51 80.00 61.04 55.90 82.41
Male 68 23 49 50 16 28 35 18 30 86 403
Total
% 54.40 71.88 55.68 54.95 6.67 2.85 9.49 2.00 38.96 44.10 17.59
Total 125 32 88 91 240 984 369 90 77 195 2291
% 5.46 1.40 3.84 3.97 10.48 42.95 16.11 3.93 3.36 8.51 100
Table 3: Inpatient Morbidity by age and sex 76/77
e. Equipment:
Nursing station was situated near the entrance of the ward with necessary equipment, documents
and essential medicines. Portable ECG machine was present.
f. Record keeping:
Health records were maintained using registers and computers and updated periodically due to
lack of human resources.
Constraints:
Human resources were severely insufficient. There wasn’t a separate procedure room and the
ECG in use was shared between emergency department and inpatient ward.
iii. Operative Services
a. Infrastructure:
there was an operation theater located in first floor of indoor block and a procedure room in
the emergency department. there were two OT tables, one for minor and one for major
operations. Emergency backup of electricity was present.
b. Cost:
Charges for operative procedure
SN Procedure Charges
Major procedures
1. I&D medium Rs 1000
2. I&D small Rs 200
3. I&D breast abscess under IV anesthesia Rs 1500
4. I&D breast abscess under LA Rs 1000
Minor Procedure
5. Corn out major Rs 300
6. Corn out small Rs 250
7. Foreign body removal Ent Rs 300
8. Lipoma or cyst excision under LA Rs 500
Dressing
9. Dressing major Rs 50
10. Dressing small Rs 20
11. Syringing Rs 100
Plaster
12. Cast Rs 750
13. Dislocation Rs 1000
14. Dislocation fracture Rs 1000
15. Posterior Rs 500
16. Plaster removal Rs 100
Suture
17. Suture large(more than 5 stitches) Rs 500
18. Suture medium(5 stitches) Rs 250
19. Suture small(2 stitches) Rs 100
20. Suture out Rs 50
 c. Human resources:
Operative services were provided by a team of
i. One obstetricians
ii. One anesthesiologist
iii. Two anesthesia assistants
iv. Four OT trained nurses
v. One office assistant
d. Services:
most of the operations were emergency operations with major services being Cesarian section
and incision and drainage.
e. Equipment:
i. Two OT tables
ii. One Boyles machine
iii. One cautery machine
iv. One OT light
v. 5 suction machines
vi. One anesthesia machine
vii. ECG
viii. Portable light
ix. Mobile monitor
x. Autoclave machine
xi. Patient trolley
xii. IV stands
xiii. Instrument trolleys
xiv. CS set, I&D set, Minor OT set, dressing set, Suture set, Suture removal set, MVA set,
laparotomy set and appendectomy set
f. Record keeping:
Electronic system of record keeping was used.
g. Constraints:
Fumigation wasn’t done regularly. Surgery department is not present. Even the simplest
surgeries like appendectomy wasn’t being performed due to lack of human resources.

iv. Labor Services:

a. Infrastructure:
labor services were provided on the first floor of the main hospital building.
There were six rooms which includes a pre labor room, a delivery room, an operation theater, a
post-operative ward, a store room and a changing room. The labor room had two delivery beds
with one examination lamp.
The wards had proper waste management system with color coded bins.
b. Cost:
maternity services were provided free of cost. Cabins cost Rs 500 per day.
c. Human resources:
i. Senior staff nurse
 ii. Three staff nurses OT trained
iii. Three ANMs
iv. Two obstetricians
d. Services:
the hospital provides normal delivery services, vacuum assisted delivery, cesarian section,
safe abortion services and family planning services. Under safe motherhood program nyano
jhola program was conducted. Two sets of clothes for newborn and mother, one set of
wrapper, mat for baby and gown for mother were provided. Furthermore, an allowance of Rs
2000 was provided to the mother and extra Rs 800 if all four ANC visits were completed.

Delivery in Ilam Hospital

1000 919 74/75 75/76 76/77
900 832
800
700 652
600
500
400
300 239
200 168
122
100 34 35
15
0
Total Normal Delivery Total vacuum/ forceps Total CS delivery
delivery

Figure 3: Three year trend of different types of delivery in Ilam Hospital

Number
Obstetrics complication
74/75 75/76 76/77
Ectopic Pregnancy 0 0 1
Abortion Complication 91 93 91
Pregnancy Induced Hypertension 0 2 3
Severe/pre-eclampsia 1 0 0
Eclampsia 0 0 0
Hyperemesis gravidarum 14 22 42
Ante-partum hemorrhage 1 1 1
Prolonged labor 2 1 3
Obstructed labor 0 3 1
Ruptured uterus 0 0 0
Post-partum hemorrhage 6 3 11
Retained placenta 34 32 29
Puerperal sepsis 5 10 7
Other complications 22 6 2
Table 4: Three year trend of Obstetrics complication in Ilam Hospital
New Acceptors 74/75 75/76 76/77
Pills 68 52 120
Depo 58 51 65
IUCD 11 2 10
Implant 28 27 57
Sterilization 2 2 8
Table 5: New acceptors of Family planning by Fiscal Year

Safe Abortion 74/75 75/76 76/77

Services Medical Surgical Total Medical Surgical Total Medical Surgical Total

Women <20
13 6 19 15 1 16 15 3 18
who yrs
received
abortion >= 20
services 97 99 196 147 8 155 240 57 297
yrs

Women
Short
who NA NA 148 25 59 84 136 25 161
term
adopted
family
planning Long
after NA NA 43 13 21 34 45 17 62
term
abortion
Women who
received PAC 93 107 96
services
 Table 6: Safe abortion service usage at Ilam Hospital
e. Equipment:
i. Instruments in pre-labor room
1. CTG,
2. Partograph,
3. Doppler USG
ii. Instruments In Labor Room
1. Sterile Delivery Instrument Set, Suture Set, MVA Set, Episiotomy Set, Vacuum
Set, Condom Tamponade Insertion And Removal Set, Iv Set, Dressing Set,
Forceps Set, Cervical Tear Inspection Set, Catheter Set, Shock Management Box
2. IUCD
3. Essential Medications Like Mgso4, Nifedipine Tablets, Etc., Oxytocin Injection
4. Cord Ties, Navi Malam
5. Suction Catheter
6. Resuscitation Tray
7. Radiant Warmer, Weighing Machine
8. Speculum
9. Gauge Pad, Gloves , Needle, Syringe,
10. Fetoscope
f. Record keeping:
Records were kept electronically.
Constraints:
Human Resources were lacking. NICU wasn’t present. Pediatrician wasn’t available.

1. Laboratory services

i. Planning and Infrastructures

There was 1 room for sample collection, 2 rooms for sample processing and 1 staff room. All the
rooms were well lighted, well ventilated. Colored bins were used for waste collection.
Name of instruments Quantity
Microscope 1
Fully automated biochemistry analyzer 1
Fully automated hematology analyzer 1
Incubator 1
Chemical balancer 1
Electrolyte analyzer 1
Hot air oven 1
Refrigerator 1
 Centrifuge 1
Counting chamber 1
DLC counter 1
Pipettes, glass ware 1
Computer with printer 1
Water bath 1
Disposable test-tube 1
Blood bank refrigerator 1
Ordinary centrifuge 1
Generator 60 KVA 1

ii. Human Resources

Designation Numbers
Lab technician 3
Lab assistant 2
Lab 1
technologist
Microbiologist 0
Gene Expert 0
Table 3. 10 Human resource of laboratory services
Source: Hospital administration
iii. Services
The hospital provided lab services 24 hours a day and all days of week. The samples were
obtained from Emergency department, In-patient department and OPD. The samples analyzed
were blood, urine, stool, pus and semen. The following markers and indicators were analyzed:
● Urine: R/E, M/E, HCG 
● Stool: R/E, M/E, Occult blood
● Blood:
● Biochemistry:  Blood Sugar, Electrolytes, Urea, Protein, Calcium, Amylase, Albumin,
LFT (Bilirubin - Total and Direct, ALT, AST), Serum ALP, Lipid profile, Serum
Cholesterol, Triglyceride, HDL, LDL
● Hematology:  Hb, RBC, Platelet, TLC, DLC, Bleeding time, Clotting time, PT/INR
● Immunology:  RPR, HbsAg, HIV, HCV, Blood grouping, Rh typing,
● Rheumatic factor:  ASO, CRP, Mantoux, Widal test
● Semen analysis
● Special tests: TFT, HbA1C, Micro albumin
 ● Bacteriology: Staining and microscopy, Culture and Antibiotic Sensitivity Test Reports
were distributed to the patient on the same day the tests were completed (except AFB and
Culture).

Fiscal year Total number of lab tests

2074/75 89496
2075/76 108514
2076/77 134145
 Table 3. 11 Indicator for service provided by laboratory of Ilam Hospital
Source: HMIS data, Ilam hospital

iv. Constraints
Safety box for sputum AFB was not present. Automated machines were not sufficient. There
was lack of qualified manpower. There was no easy access to maintenance services due to which
patient care was hampered for days (Source: Interview with Lab In-charge).

2. Radiological Services

i. Planning and Infrastructures

There was one X-ray room . Lighting and ventilation of Staff room was not satisfactory. For
protection from radiation, a 16-inch wall separated the x- ray room from outside.
ii. Human Resources
X-ray service was managed by 1 staff – 0 radiographer, 1 dark room assistants and 0 helper.
iii. Instruments
There was 1 X-ray machines (300mA). There were 2 printers that printed 10x12 inches X-ray
film, 2 readers and 2 computers. There was generator backup and UPS backup for unexpected
power outs.
iv. Services
The X-ray department provided 24-hour facility as guided by the MHOMC (Government of
Nepal had assigned work from 10AM-2PM). The department also performed X-ray for
emergency cases. Lead apron was provided to staffs and pregnant women to protect from
radiation. The department provided following services: 
●Plain x ray
●Fistulogram
●Barium meal
●Cholangiogram
●IVU
Approximately 7928 X-rays were done last year.
v. Constraints
There was inadequate manpower given the 24-hour service from the X-ray department. Only one
room had to accommodate two X-ray machines which were not enough. There was a need to add
CT/MRI services in the hospital. X-ray reader was analog type which needed to be upgraded to
digital type. (Source: Interview with Radiology In-charge).

3. Ultrasound Services
There was 1 Ultrasound machine. Ultrasound services was provided by gynecologist for
gyneology-obsestrics cases only. 4264 ultrasounds were done in F/Y 2076/77.

4. ECG Services
ECG machine was present in the Emergency department which is functional. ECG was
performed by Technician as per doctor’s prescription. The technician was present on call.

5. Dispensary
i. Infrastructure
There were 2 dispensary one was located in emergency room and other was located near
opd..The pharmacy in the emergency was established in 2073. The pharmacy had two rooms-
one staff room where drugs were also stored and one dispensing room with two stations. There
was a refrigerator for storing drugs.
ii. Human resources
There were 8 nursing staff and a pharmacist running the dispensary.
iii. Services
The dispensary provided services 24 hours a day 365 days in a year. At one time there was a
stock of about 4-5 months. The pharmacy provided a wide range of medicines, consumables,
disposable items and surgical supplies.
iv. Constraints
There was no locking system for narcotic drugs. There was only one refrigerator which was not
sufficient for storing the drugs.

Infrastructure
Different parts of this hospital are distributed into 13 separate buildings, although they are quite
close to each other. The hospital spreads over and area of 32 ropanis. Most of the hospital is
wheelchair accessible.
Table 3.7: Infrastructure at Ilam Hospital
Buildings Services
1 Emergency and Pharmacy
2 Administration building
Ground Training Hall, the exterior of first floor had been rented to shops
Floor
First Floor Records department, Office of the medical superintendent, Accounts
department, Office of Hospital manager, conference hall
3 Ground X-Ray and Ultrasound rooms
Floor
First Floor Culture room, laboratory, blood collection room, waiting room,
toilets
4 Ground Inpatient rooms, Kitchen, Post-op ward, Nursing station, Postnatal
Floor ward, Office of nursing supervisor, OCMC room and 2 cabins,
toilets, waiting room
First Floor Labor room and OT, Post op ward, Nursing station, changing room,
toilets
Second OPD (7 rooms), Dental OPD, Dental procedure rooms, health
Floor education centre, Pharmacy (for free medication), ticket counter,
Abortion clinic, toilets, waiting rooms
Third FloorEye OPD and laundry room
5 Ground Canteen
Floor
First Floor ART, CSSD, DOTS, Leprosy treatment rooms
Second Residential area for Interns from BPKIHS
Floor
6 Post Mortem Room
7, 8, 9, 10, 11, Residential rooms for medical superintendent, nurses, other medical officers, and
12, 13 hospital staff

Human Resources
Table 3.8: Human resource at Ilam Hospital
Fulfilled Filled inRecruited using
Sanctioned post contract local and other
Categories (Karar)
(Number) Number Percentage resources
(Number) (Number)

Consultant 10 1 10 2 0
Medical Officer 4 2 50 1 0
Dental Surgeon 1 0 0 2
Physiotherapy 1 0 0 0 0
Hospital Manager 0 0 0 1 0
Nursing Officer 1 1 100 0 0
Medical Lab
1 0 0 0 0
Technologist
Radiographer 1 0 0 0 1
Darkroom
1 1 100 0 0
Assistant
Staff Nurse 6 6 100 0 6
Lab Technician 3 3 100 0 0
Health Assistant 5 2 40 1 2
Anesthesia
1 1 100 0 0
Assistant
Pharmacy
1 0 0 1 0
Assistant
Biomedical
1 0 0 0 0
Technician
Dental hygienist 1 1 100 0 0
ANM 5 3 60 0 2
AHW 0 1 0 0 5
Lab Assistant 1 2 200 0 0
Nayab Subba 1 1 100 0 0
Lekhapal 1 0 0 0 0
Kharidar 1 1 100 0 0
Computer
1 0 0 0 1
Operator
Medical Recorder 1 1 100 0 0
Counter Assistant 0 0 0 0 3
Haluka Sawari1 0 0 1 0
Chalak
Security Guard 0 0 0 0 6
Supporting Staff/
11 4 36 0 13
Sweeper
(Source: Annual Report FY 2076/77, Ilam Hospital)
As is evident, many of the sanctioned posts, especially for consultants remained unfulfilled. As
per our interview with the hospital manager, the major reason for this situation is the disinterest
in consultant doctors for working in periphery and relatively recent promotion of the hospital to a
secondary A level hospital.
Financial resources
Three tables are presented below, depicting the available financial resources and budget
allocation and expenditure by sources FY 2076/77.
Table 3.4 Financial Information
Financial information Budget Allocated
Balance at the end of Asadh 2076 7742255.55
Income from the service (fee, rent) 38458466.19
Income from donation and grant 900000.00
Total expenses 40855671.00
Balance at the end of Asadh 2077 9244960.74

Table 3.5 Federal Budget allocation and expenditure 2076/77

Programs Budget Budget Budget Irregularities
budget allocated expenditure expenditure
Amount Clearances Clearances
heading percentage
%
Capital 0 0 0 0 0 0
Recurrent 18069000 13516272 74.80 0 0 0
Total 18069000 13516272 74.80 0 0 0

Table 3.6 Provincial Budget allocation and expenditure 2076/77

Programs Budget Budget Budget Irregularities
budget allocated expenditure expenditure
Amount Clearances Clearances
heading percentage
 %
Capital 3600000 1988122 52.22 0 0 0
Recurrent 60286000 37893773.47 62.85 0 0 0
Total 63886000 39881895.47 62.42 0 0 0
(Source: Annual Report 2076/77, Ilam
Hospital)
Logistics
The logistics are under the control of the logistics department (Jinsi Shakha) and Administration.
The resource for the logistics of hospital was mainly from the funds of the Hospital Development
Committee (HDC) and government based grants. The hospital development committee took into
consideration, the requirements of hospital and utilized its funds to purchase necessary
instruments, and maintained a register of all the logistics. An office personnel has been
designated as the chief of logistics department to ensure the proper function of this entire system.

Table 3.7: Logistic details of Ilam Hospital

Current Status Non-functional
Name of instrument Number Non- but possibly
In operation
functional repairable
Boyle's Machine 1 1 0 0
Cautery Machine 1 1 0 0
OT Bed 2 2 0 0
Radiant Warmer 1 1 0 0
OT light 1 0 0 0
Suction Machine 5 5 0 0
Anesthesia Machine 1 1 0 0
Microscope 7 3 4 0
Biochemistry Analyzer 4 4 1 0
Hematology Analyzer 1 1 0 0
Na/K Analyzer 2 2 0 0
PT INR Analyzer 1 1 0 0
Gene-Xpert Machine 1 1 0 0
Incubator 2 2 0 0
Centrifuge Machine 6 2 4 0
Refrigerator 6 5 1 0
X-ray Machine 2 2 0 0
Dental X-ray 1 1 0 0
ECG 4 3 1 0
USG Machine 2 1 1 0
Patient Monitor 5 5 0 0
Oxygen Concentrator 5 4 1 0
Nebulizer 6 3 3 2
View box 5 5 0 0
Fire Extinguisher 2 2 0 0
Dental chair 3 2 1 0
(Source: Annual Report FY 2076/77, Ilam Hospital)
(2) Process
Planning and Organization
The Hospital Development Committee (HDC) takes care of the planning and decision making
activities of issues regarding the functioning of this hospital. Regular meetings are conducted to
discuss the issues encountered in the hospital.
The chief of District Coordination Committee is the chairperson; Medical Superintendent is the
member secretary; Deputy Mayor, President of Nepal Red Cross Society of Ilam, 2 members
including a female as nominated by the ministry from among people renowned in social service
or medicine and Officer from Funds and Account controller's Office are the members of this
committee.
The roles, responsibilities and rights of the HDC include:
i. Preparation and execution of necessary plans for hospital management and operation
ii. Arrangement of essential resources for hospital operation
iii. Approval and execution of annual budget and activities for the hospital
iv. Determination of the service charge for the hospital
v. Protection and maintenance of physical infrastructure of the hospital
vi. Arrangement of free treatment for economically weak, helpless or poor patients
vii. Other activities as stated by the ministry
In addition to the HDC, although no specific internal management committees are present, the
following committees are working here:
A. Quality Improvement Committee (QIC): Led by the Chairperson of the HDC, with the MS as
the member secretary and in-charges of all departments as members, the QIC was responsible
for systemic and continuous actions leading to improvements in healthcare services and
health status.
B. Rapid Response Team: This team was comprised of the MS as the coordinator, any one
selected MO as the co-coordinator and other department in-charges, one supporting staff and
the ambulance. Its major function was to react appropriately in case of events (like disasters
or mass casualties) requiring urgent medical action.
C. Procurement Committee: This committee was composed of one staff member appointed by
the MS and 4 others (any staff member from administration, store, account and
management), and was responsible for procuring logistics needed for the hospital.
Figure 3.4: Organogram of Ilam Hospital
 Direction
A. Decision Making
Decision making is primarily the role of Hospital Development Committee. The committee holds
meeting every 1 or 2 months (total 7 in FY 2076/77) and endorses the program proposed by
different departments of the hospital.
B. Leadership
The medical superintendent acts as the main leader with active involvement in inspiration and
stimulation of employees to bring the best out of them. He coordinates with different authorities
to meet the organizational goal.

Budgeting
The Hospital Development Committee (HDC) is responsible for annual budgeting for the
hospital. The hospital runs its audit 3 times a year. Treasury Controller Office runs auditing 2
times a year. The office of the auditor general conducts its audit once a year

Recording and Reporting

There is a separate record section for maintaining and reporting the data. Hospital has an
electronic health recording system and paper records are rapidly being replaced with electronic
systems.
All the collected data is forwarded to the records department, where any non-electronic data is
entered into an electronic system and forwarded directly to the DoHS using HMIS standards on a
monthly basis, including data on EWARS, Infant and Child Health, Family Health, Community
Services, Malaria, Leprosy and Kala-azar, Tuberculosis, HIV/AIDS and STI. The HMIS
reporting rate of this hospital is 100 %.
However, the hospital has not been able to maintain OPD records (except for Dentistry
department), owing to lack of human resource and heavy patient loads despite presence of
adequate infrastructure.
Coordination and Communication
Optimum coordination and communication is maintained between different stakeholders to keep
the hospital fully operational. Coordination and communication is maintained with different non-
governmental organizations (NGOs), the municipality office, local police departments,
international non-governmental organizations (INGOs) and influential persons of society,
especially in conducting health camps in the municipality area. Regarding information
management, vaccines and drugs, the hospital also coordinated with the Health Office under
Health Directorate, Ministry of Social Development.
 Supervision and Monitoring
Supervision and monitoring is conducted every 6 months as per the Minimum service standards
(MSS). The supervising team consists of a representative from Health Ministry (Federal
Government), two representatives from Ministry of Social Development and Health Directorate
(Provincial Government), and a team from the municipality (Local Government). According to
Minimum Service Standards (MSS), the hospital ranked number 1 in province 1 in the year of
2075

i. Constraints
The hospital had only a single ambulance for emergency services. According to MSS standards,
10% of the total hospital beds should be allocated for ER of which 1% for red, 2% for yellow,
3% for green and 1% for black color coded. The green zone only had seats and not beds.