दोलखा स्वास्थ्य प्रवर्धन परियोजना
Promotion of Child, Adolescent and Maternal Health Promotion Project- Dolakha
Green Tara Nepal (GTN) is a non-governmental, non-political and non-profit organization established
in 2007. GTN is registered with the Kathmandu District Administration (Registration Number: 632-
2064/65) and the Social Welfare Council in Nepal (Affiliation number: 24077/2064). GTN has been
established with the aims to improve health, education and well-being in rural Nepal through
behavior change and community-based approaches by promoting health and strengthening public
health services. At the national level, GTN works to improve the impact of public health services.
Besides, GTN has extensive work experience throughout Nepal. GTN is currently active in 13 districts
of Nepal and provides indirect technical assistance in another 24 districts in the areas of health
promotion, health system strengthening, women empowerment, service demand mobilization,
evidence-based health policy, advocacy, training and social mobilization.
ChildAid Network (CAN) –a Germany based non-government organization has been supporting rural
communities in Nepal for improving health, education, livelihood and community development. Since
2019 CAN has been working partnering with GTN to address the need of integrated health promotion
activities for improving health and wellbeing of the mothers and children in the rural communities of
Ramechhap and Dolakha districts. Recently recognizing the need of health promotion activities both at
the schools and communities, as well as the activities enhancing the public heath structure and system
for increasing access of health care and sustainability, CAN has provided financial and technical
support to GTN to implement ‘Promotion of Child, Adolescent and Maternal Health Project’ in Dolakha
district of Nepal.
Health issues of women and children are mostly neglected in Nepal. Their right to access proper
information and services are mostly dominated. Women including adolescents face disparities in
health and social care all over the country, especially in rural communities of Nepal. Child care is also
poor due to illiteracy, improper knowledge, skills and access of health care services. Education system
in public owned schools are not only poor but they lack safe drinking water, healthy and hygienic
environment; toilets with proper cleanliness and supply of water, provision of sanitary pads for girls to
use during menstruation and their management. Similarly, public health systems lack skills to provide
available services like promotional, preventive and curative, with proper respect to the service seekers
esp. women and adolescent girls; and these facilities also lack equipment, medicines, IEC materials and
adequate number of staffs; besides lacking proper coordination and communication with authorities at
local, provincial and federal levels. Green Tara Nepal (GTN) has been working for health promotion
since its establishment, Dolakha Health Promotion (DHP) Project is expected to address these
problems in collaboration with schools, FCHVs, local health facilities, rural communities and
2. Context and significance of the project
Maternal mortality is still high in Nepal (239/100000 live birth in 2016). Though the government is
increasingly committed to eliminating inequalities in health care and has recently focused on
improving access to services for the needy population, especially in rural areas, the country still faces
many health challenges. The latest 'Nepal Health Facility Survey'; clearly shows how difficult it is to provide quality health services, retain qualified professionals and ensure regular availability of
primary health care commodities, especially in rural areas. The lack of coordination between the
different levels of government as well as the lack of organizational and planning capacities at the local
authorities, which leads to the fact that, for example, required consumables and the medicines
provided free of charge by the government are usually not available in the health stations. The Health
Facility Operation and Management Committee (HFOMC), which is responsible for the management of
the health facilities, but, they usually meet irregularly, often without an agenda, and hardly any binding
decisions are taken. Basically, it can be said that these problems are based on causes in two areas. On
the one hand, the population lacks awareness of key health issues and knowledge about the services
that the government is supposed to offer free of charge. Secondly, the local health system is weak.
Lack of awareness about basic hygiene practices, the presence of preventable diseases and illnesses,
lack of access to health care and poor hygienic infrastructure in schools, increase the health risks for
school children. In the target area, knowledge about hygiene, proper waste disposal and health as well
as access to adequate WASH facilities among school children including availability of sanitary pads and
knowledge of MHM among adolescent girls are still insufficient and are not addressed by schools.
Adequate menstrual hygiene management requires access to appropriate sanitation and hygiene
services, as well as access to information on understanding the menstrual cycle and how to manage
menstruation hygienically. However, adequate menstrual education is not offered to girls in schools or
mothers in the communities. Similarly, in a sample survey, 144 students were asked about their dental
hygiene and brushing habits. About 53% of the students said that they brush their teeth after breakfast
and only 45% of the students brush their teeth before going to bed. The result is tooth decay and
toothache, reported by 19% of the students. Safe drinking water is another major issue in the area. The
Multiple Indicator Cluster Survey conducted by UNICEF in 2019 showed that about 80% of the
drinking water in rural households in the project area was contaminated with E. coli.
The mothers in these rural communities face many challenges regarding family planning, safe
motherhood and child nutrition. Specialized care by obstetricians and gynecologists' is not available to
local women, and basic laboratory and radiology facilities are also far away. The mothers only find
support from the Auxiliary Nurse Midwives (ANMs) in the local health facilities, who are often
inadequately trained. The sample survey showed that only 28% of mothers received three or more
antenatal care (ANC) check-ups as recommended by the Nepalese government, and only about 8% of
them received postnatal care (PNC) check-ups. Thus, less than 10% of mothers avail the continuum of
care (4 ANC, institutional delivery and 3 PNC). This is partly due to the fact that disrespect and abuse
during institutional delivery as well as examinations is a widespread phenomenon with different
manifestations. These include physical abuse, non-consensual care, poor relationship between women
and health workers, stigmatization and discrimination.
Basic care for new-borns is equally inadequate in the region. The sample survey shows that 20% of
new-borns were bathed in the first 24 hours after birth, contrary to general recommendation, and
although breastfeeding is generally accepted in the region, only 24% of mothers exclusively breastfed
their new-born for six months. Supplementary feeding, often with contaminated food, leads to
diarrhoea and thus little nutrient intake, which has a lasting impact on new-born development. After
infancy, child nutrition is not balanced, especially in poor, marginalised families, or children are given
money for junk food (chips, crackers, etc.) especially as a substitute for the midday meal they have to
bring to school.
According to the Female Community Health Volunteers (FCHVs), pelvic organ prolapses (POP) as one
of the most common health problems among women in their community. Women in the region
generally have very few choices in family planning methods. Commonly available and used methods
are contraceptive hormone injections, oral pills and condoms. Sexual and reproductive health is not a
priority in rural Nepal. Issues are not discussed and adolescents continue to be exposed to many
myths and misconceptions due to low awareness. Adolescents' and young people's concerns about
sexuality and the physical and mental changes associated with it are not openly discussed within the
family. Village communities try to hide cases of sexual violence. For many school-age girls, the main
reasons for dropping out of school, besides economic hardship, are early marriage and unexpected
GTN’s unique Health Promotion (HP) approach addresses these issues. Health promotion plays a vital
role in transforming the health to individuals, society and the healthcare system by promoting
mobilizing change, including preventative health care. The following key issues justifies the need of
Basically, this project aims to address the following issues.
• Increased individual awareness and agency leading to healthy and hygienic environment, improved
WASH facilities in schools and communities
• Engage schoolchildren/child club members for promoting oral and menstrual hygiene
• Train and mobilize local resources
• Women group and FCHV mobilization for RH and gender roles
• Empower women leadership in local government/municipalities
• Capacitate multiple stakeholders coordinate for smooth functioning health facilities
• Changes in social norms and behaviors
Health promotion approach will be a key strategy targeting both at the schools and in communities of
the project implementation areas. We will follow Individual, Family and Community (IFC) model while
implementing the intervention. We also will coordinate with the governmental health facilities, schools
and local political leaders including local governments.
Considering local needs and priorities, we have come in conclusion to focus on health promotion
activities, in which GTN has a long experience. Despite multiple needs of the local communities, this
project will target on selective and high impact interventions. The project aims to improve i) personal
hygiene of the children including oral hygiene, ii) sexual and reproductive health of the adolescent girls
including menstrual hygiene and iii) reproductive health of the married women including pregnancy
(Antenatal, delivery, post-natal) and family planning.
• Scalable at GON resources and system
• Identical to existing health and education system of Nepal.
• Covering the issues and needs of the targeted populations (mothers, children, adolescents and/or left
• Promoting evidence-based healthy behaviors
• Fostering coordination, collaboration and partnership
4. Project Area and Target population
Dolakha Health Promotion (DHP) Project covers two rural municipalities viz. Tamakoshi and
Baiteshwar, and one urban municipality –Jiri of Dolakha district. This
project covers all twenty-four wards of three municipalities with 48000
populations, 103 schools, 26 health facilities 393 FCHVs and Health
Mother groups besides elected representatives and staffs of municipalities;
members of SMCs, PTAs & HFOMCs; and other community based
stakeholders. However, the prime beneficiaries of this project are school
children, adolescents and young women.
5. Objectives of the Project
The goal of the project is: Dolakha district residents lead healthy lives into old age thanks to a strong
public health system, increased health awareness and good health practices.
The main objective of the project is: The health situation of the inhabitants of the communities of
Tamakoshi, Baiteshwor and Jiri in Dolakha district, especially that of children, adolescents and mothers,
is sustainably strengthened due to healthy behavior, a safe and health-promoting school environment
and a functioning public health system.
This project aims to achieve the following four results
Result one: 103 schools have created a health and awareness-enhancing learning environment in the
areas of physical, dental and menstrual hygiene and nutrition, and access to health services has
improved for 14,191 students.
1.1 Improving WASH facilities in schools, providing support with health and hygiene equipment, equipping model schools.
1.2 Mobilizing children's clubs to promote basic health services and health awareness.
1.3 Training of primary school teachers for primary health care and care of pupils
1.4 Promoting the health screening system for school children
1.5 SMC training on developing mechanisms to monitor school health activities
1.6 Parents-Teachers Association (PTA) meeting to mobilize support for health promotion activities in schools
1.7 Celebration of special days in schools to raise awareness and sensitization on personal, dental and menstrual hygiene.
Result two: 8,000 mothers are capacitated regarding safe motherhood, family planning and child
nutrition, as well as sexual and reproductive health.
2.1 FCHV training and regular meetings
2.2 Meetings of mother groups
2.3 Celebrations of special occasions in 24 communities
Result three: The community-based health system in Jiri, Baiteshwor and Tamakoshi is functional and
well-equipped, and staffs are skilled and motivated.
3.1 Maintenance and equipment of health facilities
3.2 Training of health facility staff (ANM)
3.3 Train health facility staff in respectful maternity care and client-friendly services
3.4 HFOMC orientation and training
Result four: The local authorities are strengthened and the level of coordination between the different
actors to improve the quality of services is enhanced so that adequate services are provided.
4.1 Joint meetings of head teachers, health station staff and representatives of the authorities
4.2 Coordination meetings at RM level
4.3 Joint monitoring with representatives of rural communities
4.4 Joint annual meeting with authorities of the rural municipalities and the district
4.5 Publication of project results and best practices
Prevention from COVID: While conducting activities, trainings, meetings etc. in the mass/groups, we
strictly follow the measures to protect participants from COVID-19 infection by distributing face
masks, hand-washing/sanitizing provision, and keeping safe physical distance.
6. Project Duration:
Officially, the tenure of the project is of 38 months since the project is effective from November 1, 2022
and valid until December 31, 2025. However, field level implementation starts from Jan 2023 to
7. Organizational detail:
Green Tara Nepal is an apolitical, non-profit making and non-governmental organization, established
in 2007. It works in research, publications, advocacy, training, program implementation and social
mobilization in a holistic community development approach.
Mr. Ram Chandra Silwal, Country Director
Green Tara Nepal (GTN)
Kathmandu Metropolish-4, Lamtangin Marg, Baluwatar, Kathmandu
977-1-4432698, email: email@example.com Web: www.greentara.org.np