Nepal is one of the poorest countries in South Asia with 1 in 2 people living in poverty. Nepal’s health system has little money; only approximately 5% of GDP is spent on health. The 10-year civil war (1996-2006) led to the destruction of health facilities and infrastructure, flight of medical professionals from the country, and lack of refresher training.
Conditions facing women and children in Nepal are amongst the worst in the world. Nepal is a patriarchal society with extreme gender discrimination that results in women and girls having less access to food, education, services and decision-making than men and boys – including making choices about their own health. This leads to poverty, poor health and disempowerment. Within the home, young married women typically have little control over their own bodies – they must ask permission from their husbands and mother in laws to access medical care, use contraception, and leave the house alone. Domestic and sexual violence is unfortunately very prevalent. The sex trafficking of young women also occurs.
OUR CURRENT HEALTH PROGRAMMES
NAWALPARASI – Health Promotion & Improved Facilities
Nawalparasi is a very poor area in south Nepal, characterised by remote, rural villages. Living conditions are extremely basic – most people live in wooden houses without a toilet (they use the fields) – and sanitation is poor. There are high levels of preventable disease, especially in children, and of women and babies dying because of complications in childbirth and/or unclean birth conditions. There are relatively few health facilities in the area and no public transport or taxis. Most women live within several hours walk of a health centre, so usually give birth at home with untrained assistance. The status of women is very low in this region. When initially scoping the area, the Green Tara Trust team came across many stories of domestic and sexual violence.
Since 2012, Green Tara Trust has been establishing a health promotion project in Nawalparasi, to raise awareness of maternal health, women’s rights and general health issues to a population of over 20,000 people living in remote village communities. We have been running health groups for adolescent girls and boys, pregnant women and new mothers, and mothers-in-law. One of our aims is to equip the sub health posts in the region, so that they can become ‘birthing centres’ – enabling women to receive care and give birth in safe conditions close to their home. Once equipped, the government has pledged that it will staff and maintain these centres. This will result in reduction in maternal and infant mortality in this area.
PHARPING – Maternal Health Programme
Green Tara Trust is coming to the end of a five year maternal health programme in the rural area around Pharphing, one hour to the west of Kathmandu. The programme’s main aim is to improve antenatal care for women in this area. Improved antenatal care results in fewer women dying of complications in childbirth. We also aim to see an improvement in delivery and post natal care, and reduced infant deaths in the first year of life. Underlying this, the project aims to empower women to make their own health decisions.
The programme has equipped government health facilities to enable their staff to conduct a basic antenatal check, and created a mobile antenatal service to serve women in outlying areas. Health staff also receive regular training from Green Tara Trust so they are able to perform an antenatal check to World Health Organisation standards. Community Health Volunteers and traditional healers are also trained as birth assistants.
In addition, the programme has established 60 health promotion groups, which meet regularly. Some groups are for women, pregnant women or new mothers only, others are mixed. The groups have a core programme which includes: information on how to have a healthy baby, nutrition, saving for delivery, working together to get women to hospital when they have complications, alcoholism, domestic and sexual violence. Groups come together for mass events once or twice a year to share their learning with the whole community (up to 2,000 people attend each event).
The success of the Pharping programme has been regularly monitored and evaluated by Green Tara Trust’s Research Team.
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