Background of Health programmes
In FY 2018/2019, a total of 6 projects are running under a health theme in 23 sites (Table 1). Health projects in PHASE Nepal focus on the following three main objectives:
- Enhance Maternal and Child Health Services
- Support high-quality primary health care services.
- Make people aware about health and hygiene providing health education
“Integrated Community Development Programme” is the primary health project in PHASE Nepal which is being continued since 2006/2007. The program majorly focuses on improving maternal and child health (with a focus on nutrition) in the western region of Nepal. We implement preventive, promotive and curative activities supported by skilled human resources, essential medicines, equipment, and range of orientation /training to Female Community Health Volunteers (FCHVs) and community. Primary health care services, community awareness-raising activities, Maternal and child health, Emergency, First Aid and Referral are our key activities and services in health projects.
Additionally, PN also implements specific health projects for target groups, for example, Informal Waste Workers (IWWs), Construction workers, and People with Disabilities (PWDs). The “Healthy Waste Workers in Kathmandu valley”, the project was designed to improve the physical health and psychosocial well-being of the waste workers and the project site community. Mugu-Humla Link Road project under Rural Access Programme- 3 (RAP-3), attempts to ensure the health and safety of construction workers in Mugu–Humla Link Road segment by promptly treating acute illnesses and minor injuries and reducing health risks. Similarly, the urban health project at ward 19 of Kathmandu aims to enhance access to primary health care and social welfare services of PWDs.
Figure 8. PHASE Nepal’s health intervention approaches
Safe motherhood and maternal health are one of the prime focus areas of PHASE Nepal. Regular health check-up (both at health post and ORC), temporary and permanent family planning services, ante- and post-natal care (ANC and PNC), and safe delivery services are the major services that we provide to enhance maternal health in our project sites. We also provide special health education sessions for women and conduct meetings and training as relevant; for example, we conduct ANC orientation, CBIMNCI training, mothers group meeting, FCHVs meeting and other activities, such as sanitation & hygiene program (village cleaning program, menstrual hygiene orientation, and pad making training).
This fiscal year 1232 childbirths were recorded in PHASE’s working area; of them, 880 (i.e. 71%) were attended by a skilled health worker and 460 deliveries (37.33%) were conducted by PHASE Nepal’s staff. 28.57% of deliveries were unattended home deliveries and of the remainder, most were conducted by government staff in PHASE supported health facilities, and some took place other health institutions such as district and zonal hospitals (fig.9). Due to geographical difficulties, traditional beliefs and technical problems in health service delivery almost 30% of women overall still had no professional support during childbirth – this number is particularly high in Rugin of Bajura district. A total of 1752 pregnant women were assessed for 1st Antenatal check-up, among them 846 (48.84%) were tracked in 4th ANC service. Though the enrolment percentage for 4th ANC is high in this fiscal year (48.84%) compared to 27% in FY 2017/2018, the huge gap between ANC 1st and ANC 4th still exists. However, given the remoteness of the project areas, the above achievements compare very favorably
with the latest recorded average national figures (skilled attendance at delivery 57% and 4th ANC 69%). Details of maternal health services by PN in FY 2018/019 are provided in table 2 & fig9.
|ANC 1st||ANC 4th||Delivery||PNC|
Table 2.Safe motherhood service utilization
Neonatal care, children’s health check-up (at OPD), growth monitoring and nutrition status assessment and support for immunization are the major activities conducted by PHASE to enhance child health in its project sites. Besides clinical, community-level efforts like counseling to mothers, Community Based Integrated Management of Neonates and Childhood Illness (CB-IMNCI) trainings to mothers and Female Community Health Volunteers (FCHVs), Child protection and school health education are also made to improve children’s health. As we work with/for “Ultra-poor” communities in remote districts, we deal with cases of severe malnutrition in children under five years of age. Thus PN is integrating its livelihoods projects to support food security and hunger management so that issues related to nutrition of the marginalized community are addressed. The major activities of the PHASE’s integrated health program include nutrition workshops, super flour demonstrations, child growth monitoring, and healthy baby competitions. PN also supports government health facilities in immunizing children and organizes school health education in each school at the project site.
A total of 1,040 newborns were examined by PN’s health staff this fiscal year, where 9 still births and 12 neonatal deaths were experienced. More children (N=22,261) were monitored for growth compared to previous years; only 7.24% were underweight which is noticeably lower compared to previous years (fig. 10). The percentage of underweight children was highest in Dalit girls and lowest in Janajati children of either sex (fig.10 & table 3).
Figure 10. The trend of growth monitoring & underweight
Healthy baby competition and nutrition workshop events were two major events performed to address underweight. Total 1880 children and 1225 participants participated in 40 events of healthy baby competition and 24 events of nutrition workshop respectively. Sex wise distribution of same is tabulated in table 4.
Total 2254 children were treated for diarrhoea and 1068 children were treated for pneumonia this year. Number of children treated for diarrhoea and pneumonia is comparatively low as compared to previous fiscal year (fig. 12). Ethnicity wise, mostly Brahmin/ Chettri children were treated for diarrhoea and pneumonia.
PN supported total 296 immunization events this fiscal year, where total 5287 children (2510 boys and 2777 girls) were immunized. the highest number of children (n=1494) received measles/Pneumococcal conjugate vaccine-3 (PCV-3), which may need further investigation. (details in fig. 14).
Primary Care services
PN has been supporting outpatient services in primary health care centre in its all working areas. Primary health care, maternal and child health services, and family planning are the main areas where PN is supporting health care centres. Apart from regular primary health care services, this FY, PN also supported specific target groups like Informal Waste Workers (IWWs) and People with Disabilities (PWDs) with regard to enhancing their access to primary health care services with relevant preventive measures. A new thematic area in environmental health was explored with a comprehensive scientific research on IWWs.
This year, a total of 92,902 patient contacts took place in PN supported health centres (52,527 – 56.54% – were female patients). Total 18,626 under five children were seen, where 8,737 were girls (46.90%) and 9,889 (53.09%) were boys (table 5). Upper Respiratory Tract Infection (URTI), Gastritis, and Fall injuries were the top three common cases in OPD examination (fig.15).
Counselling about family planning methods and providing family planning services (for example, providing pills, Depo-Provera injections and inserting Implants) are the key activities regarding family planning, in their working areas. Compared to the previous year depo Provera and the condom users have increased in this fiscal year (figure 16).
Other support in Primary Health care
As mentioned above, specific target group’s primary health care is being addressed through various project activities this fiscal year. Identification of target groups and support to mitigate environmental and occupational risks, improving access of health care services was the main aim of project at Sisdole and Nuwakot for IWWs. We have been providing primary health care services in collaboration with Urban Health Clinics in Kathmandu and Health Post in Sisdole, Nuwakot. Additional technical support to health facilities was provided by supporting medicines, medical equipment and supplies according to need. PHASE also has been supporting for WASH facilities at health facilities – specifically water supply. We have successfully established a drinking water supply system in Sisdole dumping site after needful coordination with government stakeholders. The project targeting PWDs of Kathmandu – 19 is at initial phase; identification of PWDs, and have identified total 80 PWDs till date.
Series of other coordination activities and outreach events was carried out with aim of enhancing primary health care services. Total 22 school deworming event was carried out in which 4292 children were dewormed, 17 outreach health checkup events were carried out in road building sites where 245 beneficiaries received primary health care services. Other activities like public audit, emergency incident management were also performed (details in table 6).
This fiscal year, about 5 types of meetings were conducted. 207 FCHVs meetings 142 HFOMC meetings and 571 mothers-group meetings were conducted/ facilitated. A total of 2900, 1988 and 11694 respectively participated in these meetings (table 7). Comparatively number of participants participating in aforementioned meetings in this fiscal year is slightly more.
Our intention is not only to provide clinical health services, but also create awareness at the community as well. In this regard, we have been conducting home visits and community health education programs, sensitization programs such as street dramas and campaigns in order to portray positive messages to the community people.
Street Drama has been conducted 22 times, once a year in all sites, with 2441 participants and various days were celebrated for awareness, it was celebrated for 39 times in presence of 2040 participants. Community health education was conducted 564 times; similarly, school health education was conducted for 397 times with participants of 10421 students. Door to door visit for raising awareness was conducted for 3325 times and participatory village cleaning was conducted for 710 times, whereas super flour making exhibition was participated by 5807 in 292 events (table 8). Comparatively, number of awareness raising events and participants are significantly high this fiscal year.
To minimize the occupational health hazards for the IWWs, PN have also distributed and oriented IWWs regarding the Personal Protective Equipment (PPE) and their proper use. Also, Behaviour Change Communication (BCC) materials was prepared and distributed to peer educator, waste workers, owners of scrap dealer and health facility, to impart knowledge, change in their behaviour in positive manner and practice safe behaviour at their work, home and community, to prevent occupational health problems. PN is also providing health education on Tetanus Toxoid, prevention from rabies, backache prevention, workplace organization and injuries from dismantling in scrap dealer, e-waste management in scrap dealer, toxic waste warning, injuries prevention, dust and air pollution, health rights to IWWs with an intention to prevent them from possible health risks and injuries arising from their occupation
Also, in the process of working with the government health staff and stakeholders, we also provide strategic orientations or trainings for different stakeholders like traditional healers, road building groups etc. First aid training, infection prevention training, personal hygiene orientation, child protection orientation etc. are some of such activities that is focused for both health facility staff and local stakeholders to uplift the quality of services that we have been providing. Details of such awareness raising events are tabulated in table 9.