Recognizing the distinct challenges of Nepal's diverse terrain, there are two different project interventions within this commitment (but with similar objectives) - one in the remote mountainous district of Solukhumbu (home to Mt. Everest), the other in the flat, hot, more heavily populated southern district of Rupendehi.
The first covers the entire district and supports government community maternal health staff to work differently - providing home based ante-natal, post natal care and increased access to skilled delivery, enhancing that provided in health posts.
The second uses community-based approaches to utilize and coordinate local women's groups as vehicles for improved knowledge, awareness and action for improved care in pregnancy for mother and baby (plus wider benefits for gender inequity). There are detailed work plans and planning documents in place for the different initiatives. A brief overview would include:
1. Initial scoping and problem identification - discussions with key informants, partners and stakeholders to assess current practices and service functioning.
2. Early data gathering, partner negotiation and agreements, provisional project/service planning and design (review pending further data and analysis).
3. Development/design of project structures, methods, data collection and management tools, reporting mechanisms.
4. Needs assessment, data gathering (combined sources - some gathered pre start of initiative and some during first period of activity).
5. Recruitment of key staff - orientation and project-specific training for staff, partner implementers, local communities, government, NGO agencies, other stakeholders.
6. Initiatives implementation.
7. Data gathering, quarterly project monitoring - share data with relevant stakeholders.
8. Periodic project implementation review (leading to amendments as required).
9. Mid term evaluation of initiatives and sharing of findings.
10. Collate key findings from data early in Year 3 for dissemination & advocacy to governmental, policy/decision makers re mainstreaming.
11. End point evaluation. Discussions with local implementers about absorbtion options.
Despite recent improvements, maternal and newborn health remains very poor in Nepal, with low rates of antenatal care, skilled attendance at delivery and post natal care - resulting in avoidable death, common injury and suffering for both women and babies. The 'Lifetime Risk' for a Nepalese woman of dying as a result of pregnancy or childbirth currently stands at 1:31 (as compared to 1:4800 for women in the US or 1:75 on average for women in other developing countries). In addition to that, approximately half of all childhood mortality under five years actually occurs in the first 28 days of life.
Nepal is a small country but geographically and ethnically diverse. With the exception of the urban minority, the majority of the population remain rural and have very limited access to the care they need to ensure safer pregnancies and births for mothers and babies. There are improvements in government systems under development but for the most marginalised or remote it will be a long time before these have any impact.
One model of care cannot succeed across all such diverse terrains and CWS has previous experience in developing new models for paediatric primary care. Therefore in recognition of the indivisible relationship between maternal and newborn/child health CWS has committed to working with Nepali NGO and governmental partners to develop different approaches that can achieve similar outcomes for communities in very different parts of the country and facing different challenges.
CWS would welcome interest from prospective funding partners to support these particular initiatives and also their potential scaling.
Similarly, any opportunities to promote or share experience, or disseminate evidence-based findings as further data emerges from these projects.
OFFERING: Best Practice Information
CWS welcome the opportunity to share practice and evidence based developments that may be of benefit in other settings. Similarly, they are well placed within some parts of the health sector in-country and would be happy to share links and information with others.