Improving Access to Maternal and Child Health Care and Family Planning by Strengthening the Health System and Promoting Health in Rural Areas of Nepal

PROJECT BRIEF

In Nepal, maternal, neonatal and child health (MNH) still remains a major health problem. Not only is access to information on reproductive health severely restricted, but also health services for women are scarce. Especially in rural regions of Nepal, women and adolescent girls are disadvantaged in terms of health care and access to socio-medical services. Inadequate equipment at health care facilities, the frequent lack of expertise and skills of medical staff, and the lack of access to social opportunities (especially for marginalised populations such as Dalits) result in an alarming lack of medical care for menstrual health, pregnant women, women in childbirth and young mothers, as well as for new-borns and children.

Many mothers and newborns fail to receive continuum of care from antenatal to post-partum period. This is mainly due to the demand- and supply-side barriers in health care. Major demand-side barriers consist of a lack of awareness on pregnancy and postpartum care, long distance to health facilities, geographical difficulties, inadequate transport facilities, financial constraints, and low women’s empowerment, particularly in decision-making for moving outside of the home. Major supply side barriers are unavailability of services, inaccessibility, and absenteeism of the health workers. These factors from both sides limit the women in receiving essential services.

Health provision in Bajura, like much of Nepal, has improved in recent years. However, there is still much progress to be made. For example, only 55% of women in Bajura receive sufficient iron during pregnancy; only 47% of mothers in Bajura receive 4 antenatal check-ups as per government protocols; and only 34% of women in Bajura are using family planning. Across Province Sudur Paschim, health posts remain unfilled:non-marginalised women (35%), a larger proportion of marginalised women (64%) feel it is not necessary to give birth at a health facility. The reasons for this differentiation are multiple including no or basic education, belonging to poorer and the poorest wealth quintile, distance to Health Post, and not having completed four antenatal care visits per government guidelines.

Description

This project launched in January 2021 and will terminate in December 2024 after a 36 month period. The project will improve access to maternal, neonatal and child health services, including family planning, through service quality improvements and health promotion. The mobilisation of local health workers, on-site preventive examinations and improved equipment and management of the health stations will improve the health of both mothers and children. Health services are poor or non-existent in our target areas and an increased demand cannot be met without supporting improved health and medical changes.

The project partners have identified five key areas of need:

• Health Service Provision
• Care seeking practices
• Health Education
• Discriminatory practices
• Low capacity of health workers and lack of continuous medical education

Aims and Objectives

The project aims to increase women’s access to SRH (sexual and reproductive health) services, including family planning, through service quality improvements and health promotion. The project will increase equitable access to SRH services for all members of society by mobilising local health care workers and volunteers to conduct health promotion, increased household level health checks and early intervention, and improved facilities and management at Health Posts.

60% of doctor vacancies, 14% of nurses and 24% of paramedic posts are unfilled. There is also inadequate skills-based training for health workers, and repair and maintenance of equipment is Lacking. In Sudur Paschim Province, a higher proportion of marginalised women give birth at home (47%) than non-marginalised women (26%). Compared to

Target Population and Beneficiaries

The project will work in Khaptad Chhededa rural municipality of Bajura district of Sudur Paschim province. Bajura is one of the remotest districts in Nepal with a very poor human development index. The RM is divided into seven wards and each ward has one health facility. In terms of maternity care, delivery services are provided only by three health facilities. The proposed intervention covers all seven health facilities; however, the focused interventions and intensive technical support will be provided in four health facilities where the intervention is most needed.

The project targets women, children, and adolescent girls from 38 villages in Western Nepal. The project expects to increase equitable access to safe delivery and SRH services for 5,000 women and adolescent girls and reduce the incidence of menstrual health problems resulting from the practice of Chhaupadi. Women and girls will be empowered for safe, hygienic, and dignified menstruation and birthing practices. The project will address women from all castes, religions, social economic backgrounds and age groups. The project will deliver impact at three levels, integrating medical intervention with behaviour changes.

Key Beneficiaries:

• Individual Women -improved outreach and home visits will increase the contact women have with health workers.
• Health Post services - the development of a professional outreach service will ensure Health Posts can effectively meet the demand of women, particularly those women who are prevented from leaving and/or feel too ashamed to report medical concerns.
• Adolescent Girls - MHM education will ensure adolescent girls start with hygienic and safe menstruation and will more strongly guarantee long-term change in behaviour patterns are established.
• Wider Community - will benefit from increased confidence in the health post services.

Major Activities

• Outreach and home visits to women for regular check ups and early diagnosis of disease. Home visits for pregnant mothers to ensure they complete their full cycle of antenatal and postnatal checks
• Outreach services including checks on blood pressure, anaemia and counselling on other reported issues.
• Training of health promoters who work closely with the HFOMC to ensure the service meets local needs.
• Training and support provided to the HFOMC about healthcare management, including local community members
• Training in sexual and reproductive health services for Health Post staff
• Capacity building for newly elected women and staff at the Rural Municipalities and Health Posts.
• Menstrual Health education for adolescent girls, and health promotion with Mothers Groups and the wider community to support better conditions for adolescent girls to exercise healthy choices.
• Provision of medical supplies to health facilities

Expected Outcome

5000 women and adolescent girls will have access to maternity and child health care and family planning through improved service quality and health promotion leading to improved sexual and reproductive health.

Contacts

• Ram Chandra Silwal, Country Director, Green Tara Nepal
• Kathmandu Metropolish-4,
• Lamtangin Marg,
• Baluwatar, Kathmandu
• Email: ramsilwal99@gmail.com; info@greentara.org.np
• Tel: +977 1 4432698, www.greentara.org.np

• Susanne Traud-Dubois, Chairman of the Board of Directors, Programme Manager
• Karuna Deutschland e.V.,
• Herkulesstr. 13a,
• 45127 Essen,
• gemeinnütziger Verein,
• Email: traud-dubois@karunadeutschland.org
• Tel: +49 201 45866102, www.karunadeutschland.org