Contribute to improve maternal, newborn and adolescent health (MNAH)

Background:

In Nepal, despite a lot of progress has been made during the last decade in terms of decrease of mortality rates for women and new-borns and coverage of maternal and newborn healthcare services, the public health system is characterized by important shortcomings: notably, lack of human resources, medical material and equipment, and supervision are leading causes for the poor care offered in the health facilities to pregnant women and new-borns. In addition, according to an analysis done by our partner NGO, health facility staff shows poor interpersonal communication skills with pregnant women and their families, often mistreats women during care, regularly does not respect privacy and confidentiality of women, and frequently practices medical procedures that are not necessary for the health of the women, or without the patients’ consent. The 2021 Nepal Health Facility Survey confirmed that counselling to women and families during pregnancy is insufficient: only 38% of mothers are counselled on birth preparedness and complication readiness, 23% on at least three danger signs in pregnancy, 16% on new-borns care, only 2% receive an early initiation of breastfeeding, and 2% are informed on vaccination to the child. 28% of the health care providers maintain privacy with divider between beds; and 18% of the staff scolds or treated the clients disrespectfully. Only 54% of the staff explained the procedures in a language the client can understand and encourage the client to ask questions. 23% of postpartum women interviewed after their delivery reported that the staff had scolded them or treated them disrespectfully.

Adolescent sexual and reproductive health (ASRH) is problematic in Nepal. According to information collected by our partner organisation, ASRH related issues are not discussed in communities/families, and adolescents continue to be exposed to many myths and misconceptions due to low awareness among the population. Sexual relations before marriage are socially unaccepted in Nepal. Adolescents' and young people's concerns about sexuality and the physical and mental changes associated with it are not openly discussed within the families. 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 marriages and unwanted pregnancies. Nearly 50% of the adolescent pregnancies in Nepal are unwanted. Only about 23% of the adolescents use family planning in Nepal. This situation is the result of the poor quality of education and health services.

A first component aims at contributing to improve the health of disadvantaged pregnant women/mothers and new-borns mostly living in disadvantaged suburbs of industrial areas in three districts of Lumbini province. This axe builds on the positive experiences of the first phase 2022-2023. During this period, the programme has trained 220 health facility staff (nurses, paramedics and administrative staff) in 20 health centers located in the districts of Nawalparasi, Rupandehi and Kapilvastu, as well as stakeholders at municipality, district and provincial level in maternal and new-born respectful care (RMNC) to improve how women and newborns are treated during care. This has been done in close cooperation with the National Health Training Centre (NHTC) which was involved in the elaboration of training material. Representatives of NHTC have been part of the master trainers’ group that elaborated a trainers’ handbook and guidelines for trainers and trainers’ reference materials and also trained the group of trainers on this basis.

A second component of the programme aims at contributing to improve the sexual and reproductive health of adolescents (ASHR) living in disadvantaged suburbs of industrial areas in the same three districts than the RMNC component. This component has been newly developed based on the context analysis and the needs identified in this field (see point 1). The programme will intervene in both public schools at secondary level and health centres. A trainers’ team will be formed and trained in the fields of CSE (comprehensive sexuality education) and ASHR, based on training material developed by the Ministry of Education, and Ministry of Health and Population.

• The present fund request covers the years 2024-2025, the two first years of the overall programme duration from 2024 to 2028.
• The impact of the programme is to contribute to improve the maternal, new-born and adolescent health in the districts of Nawalparasi, Rupandehi and Kapilvastu in Lumbini Province.
• Indicators: Increase of % of pregnant women giving birth at health facilities (baseline: 88%, target 2024: 90%, target 2025: 94%).
• Increase of % of adolescents who know about safe sexual practices (baseline: 37.1%, target 2023: 70%, target 2025: 80%).

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