Green Tara Nepal has been implementing Post-Disaster Health Promotion Project in seven Village Development Committee (VDCs) in Dhading district, Nepal.
Key FeaturesFunding/Partner Agency: Green Tara Trust UK, Karuna Trust, Karuna Germany, Liverpool of John Moores University (LJMU) UK, Global Giving and The University of Tokyo (UTOKYO)
Project Period: 2016-2018
Project District: Dhading
Gumdi, Phulkharka, Dhuwakot, Khalte, Sunaulabazaar (current- Nilkantha municipality), Bhumesthan and Tasrpu
Total staff (at present) Project staff- 8 (full-time), 3 part-time
Dhading is one of the districts, which was most heavily impacted by the April earthquake and series of after-shocks. The district is bordered with Kathmandu and Nuwakot in the east, Makwanpur and Chitwan in the south, Gorkha in the west, and Rasuwa and Tibet in the north. It is one of the most diverse districts in Nepal in terms of geography, population and development.
The total population of Dhading is 336,067. Seven hundred and thirty three people were killed during the earthquake, and many more injured. The Government of Nepal (GON) estimated that 20,000 buildings were completely destroyed and another 15,000 buildings damaged. According to initial assessment reports, 90% of houses in 21 Village Development Committees (VDCs) were completely damaged, 70% of houses in 18 VDCs partially damaged and less than 70% of the households had some damage in the remaining VDCs. The education sector was also highly affected by the earthquake, with damage to class rooms, furniture, libraries, computers and other equipment. The GON report revealed that school education sector faced 88.8% of the total damages and losses faced by the entire social sector. In total, 8,242 community (public) schools were affected, 25,134 classrooms fully destroyed and another 22,097 were partially damaged.
District stakeholders, key informants and DHO annual report suggested that strengthening demand for maternal and child health services are a crucial need in the district. Focus on increasing utilization of maternal, neonatal and child health services, especially among Tamang, Dalits and Chepang ethnic groups is a key priority. They also revealed the importance of targeting MNCH activities after the disaster. GTN has expertise of working in the field of maternal and child health for more than a decade. Evidences suggests that Dalit and ethnic population of Nepal are deprived of basic health services, Therefore, GTN current project is targeted towards the VDCs, where population of Dalits and ethnic groups are higher than the district ratio.
Green Tara Nepal (GTN) with funding from several partners; Green Tara Trust UK, Karuna Trust, Karuna Germany, Liverpool of John Moores University (LJMU) UK has been implementing a community focused post-disaster health promotion project in Dhading. The University of Tokyo (UTOKYO) also has been supporting for a few community and school focused activities. The project plans to set up a local system for engaging community.
Objectives• Improving basic care and services from pregnancy to post-partum period
• Delaying marriage and pregnancy, behavior change of adolescents (KAP/B) on ASRH issues, menstruation hygiene, attitudes towards marriage, sex, GBV relationship, etc.
• Promote psycho-social support and strengthen referral system
• Establishing a close coordination and cooperation at local level
Approach/strategiesGTN activities are focused on health promotion approach in disaster affected VDCs. The programmes are centred around women empowerment and promoting health of the women and children. The programmes are designed to be evidence-based with public health impact at scale. Participatory approach targeting groups and individuals for sustaining behaviours and existing system is the key of the programme implementation.
• Promote evidence-based health promotion approach
• Engage local stakeholders from the beginning of the programme
• Align with local systems and structures for project sustainability
• Cost-effective approach targeting individuals and groups
• Women and adolescent girls focussed since they are vulnerable population in post-disaster situation
Expected outcomes• Increased utilisation of ANC, institutional delivery and PNC by pregnant women in target communities
• Increased essential newborn care practices by 20%
• Increased age of marriage and pregnancy among adolescents.
• Established system for identification and prompt referrals for psychosocial problems.
• Strengthened capacity of local stakeholders (teachers, adolescent girls and boys, women, FCHVs,) for creating an enabling environment to deal with maternal health issues
Major activities at the community level are;
• Needs assessment/Baseline study: Conduct a rapid situation analysis in all targeted communities. Existing resources and gaps in promoting accessing maternal and child health services should be discussed during the need assessment period.
• Meeting with local stakeholders: Sharing findings of the assessment to local government officials (VDC and local health facility).
• Training and coaching of FCHVs: They are the frontline health workers in each ward, who are largely engaged in health promotion activities. They facilitate in accessing health services and promotion of MNCH services. They support the HPs and SMs to organize group meetings and home visits.
• Organise group meetings
HPs in close coordination with FCHVs organize regular group meetings. Group discussions are being held using participatory approach. This includes community mobilizations for identifying and addressing the local health problems.
• Home visits and inter-personal communications: HPs make follow-up visits at the household level. They discuss with the family members and support to access recommended health services.
• Coordination meetings: We will establish a good relationship with local VDC authority, health facility and other NGOs working in those VDCs.
• Monitoring and supportive supervisions: GTN central level staff monitor the field activities at least once a month. Besides, Social Welfare Council (SWC), District Development Committee (DDC) and District Health Office (DHO) also monitor the activities in community level.
District level: Findings and lessons learned are shared regularly with district stakeholders to ensure their engagement from the beginning of the project.
National level: National level activities include development of curriculum, central level coordination and communication with stakeholders.
Key achievements• Established a good rapport with stakeholders in every level
• Capacitated relevant stakeholders by enhancing their skill to work in grassroots level
• Mobilised FCHVs and women’s groups in all 63 wards of the targeted communities
• Mobilise adolescent groups (male and female) at school for promoting sexual and reproductive health
• Conducting school-based menstruation hygiene promotion and ASRH activities
Next planThe activities at local level will be shaped out well in consultation with local stakeholders.