1. Health status of the population improved
 
Most refugees from Bhutan living in Beldangi camp have been enrolled in the national health insurance scheme in April 2018. The health insurance membership will last for one year period from May 2018 to May 2019. Refugees enrolled in the Health Insurance scheme, have started accessing medical services using their insurance cards. The First service point is Damak hospital; from Damak they can be referred to AMDA hospital, Life line Hospital, Mechi Eye hospital, Koshi Zonal Hospital, BPKHIS, Nobel Medical College and Birat Medical College. With the ultimate aim of responsibly disengaging from direct health care delivery refugees (ambulatory cases) from Bhutan living in Sanischare camp access health and medical care services from local health facilities; namely Pathari Health Post and Mangalbare hospital. AMDA and UNHCR will continue with the progressive rationalization of health care delivery which began in 2015 and continued throughout 2016-2018; and do the advocacy for self-enrolment of refugees’ in health insurance in 2019. AMDA will support referrals providing ambulance services but medical referrals by AMDA from Beldangi camp will only be limited to refugees and other POC not enrolled in the insurance scheme.
 
In 2018, refugees’ from Sanischare were included in the national population planning figure of Morang district following advocacy efforts by AMDA and UNHCR. Such advocacy efforts will be redoubled to gradually include refugees in all aspects of the public health care system. In parallel, AMDA and UNHCR will continue to build the capacity of local health professionals and institutions to absorb refugees into their systems while simultaneously contributing to better standards of health care for both refugees and local residents. AMDA and UNHCR will also focus on strengthening community-based health programs for disease prevention in order to minimize gaps in service delivery during the transition.

In addition, AMDA and UNHCR will continue to closely monitor the mortality and morbidity rate, will implement preventive measures In 2019, advocacy efforts and strategic partnerships and coordination will be enhanced in order to ensure the inclusion of all the services of camps in national health services.
 
2. Special Service for person with concern with psychosocial need and Services for persons with specific needs (disabilities) strengthened
 
In 2019, AMDA will maintain two disability centres located in Beldangi and Sanischare refugee camp for providing specific services to persons with disabilities (PWDs) in the camps. For the effective functioning of the programme, disability In charge, disability programme Assistant/facilitators, occupational therapy Assistant, palliative care Assistant and care takers will be maintained in the camps. To minimize the protection risk of persons with disabilities, AMDA with UNHCR will continue to strengthen the capacity of Bhutanese Refugee Association of the Disabled (BRAD) through training and workshop in coordination and collaboration with persons with disabilities and disability organisations in the host community. BRAD programme manager will continue to manage the programme activities of BRAD including occupational therapy and Income Generating Activities (IGAs) .

BRAD members will be participating in meeting and training for capacity building. Awareness training on prevention and rehabilitation of person with disabilities will be organized for children and youth of the camps. AMDA will refer persons with disabilities to BPKIHS for Disability certification in 2019. Occupational therapy unit is planned to handed over to BRAD ensuring that, BRAD will carry out all the activities related to occupational therapy including the activities of community common fund. BRAD participants will also participate on occupational therapy activities.

AMDA will continue to identify new born and newly occurred persons with disabilities in the community through home visits. Intellectually disabled women will participate on the occupational therapy activities and other persons with disabilities will participate in Income generating activities operated by BRAD. In the palliative care centre, numbers of severely disabled children will be enrolled in 2019 and supplementary feeding/snacks for the children will be provided. AMDA will organize training for the mothers of the children attending at palliative care unit on child Care and child development to minimize protection risk of children with disabilities for mothers. Awareness raising workshop on disabilities issues will be organized for the numbers of CBOs workers. Institutional Capacity building training will be given to executive members of BRAD. Handicraft training will be organized for members of BRAD for income generation and self reliance as well as to raise community common fund. International day of persons with disabilities will be commemorating on 3 December 2019, where all the persons with disabilities will be participated.
 
AMDA and UNHCR will continue to closely monitor the mortality and morbidity rate, will implement preventive measures for both individual and group psychosocial needs, and will enhance mental health interventions through;

1. relocating mental health prescribers in pathri health post and Aamchowk UHC;
2. psychiatric consultation once a month in Damak hospital and Mangalbare hospital
3. placing psycho-social counsellors in Damak and Mangalbare hospital;
4. trainings on mental health and basic psycho-social counselling and clinical interventions both in the camps and in the host community.

To prevent substance abuse and suicidal cases in camp, Community psychosocial workers (CPSWs) will conduct hut visits and provide psychosocial counselling in the camp. They will refer the complicated cases to public health facilities. The identification and management of those abusing substances; including their affected families, as well as provision of adequate psycho-tropic drugs, will be essential components of the health program conducted by CPSWs and CHWs.