Community members utilize essential health-care services and facilities
In the past two decades, the health sector in Nepal has witnessed an improvement in the overall health of the people. Concerted efforts resulted in a decrease in Maternal Mortality Ratio (MMR), from 539 per 100,000 live births in 1996 to 239 in 2019. Aligned with the SDGs, Nepal aims to reduce the MMR to 70 by 2030. There has been a significant decline in child mortality over the last five years reaching 28 per 1000 in 2019. Neonatal mortality dropped to 16 in 20191. Overall, the nutritional status of children has improved. Nepal Health Sector Strategy 2015-2020 outlines four strategic directions: health system reform, equitable access, improved quality of services, and multi-sectoral approaches. In the new federal setup, local governments are better positioned to initiate and implement health care activities. The main difficulty in ensuring universal health care is poor management, access to health services, in particular for the poor and marginalized communities; and maintaining quality of an already constrained public health system. A focus on preventive measures through increasing awareness can be instrumental in promoting the wellbeing of rural population. Hence, collaboration with local governments can be instrumental in strengthening local health institutions. Nepal has made notable progress in the WASH (Water, Sanitation, and Hygiene) sector though a considerable proportion of the population still lacks access to improved water supply and sanitation facilities. 85% of Nepalese households had access to improved water sources and 62% had access to sanitation facilities (Central Bureau of Statistics 2011). However, 82.2% of households are using contaminated water. In 2016, the involvement of users in the process of planning and implementation had increased to 87.3% and 87% in the water supply.
Aiming to bring universal WASH coverage to its citizens, the Government of Nepal has made considerable efforts to improve the water supply and sanitation situation in the country by formulating and enforcing several WASH policies, guidelines, and acts.
Improved health service delivery at the local level
Nepal registered notable achievements in reducing maternal, under-five, infant mortality rates, and other health indicators. National Health Policy 2019 has mandated subnational governments to equitably and efficiently deliver basic health services including provisioning preventive and promotive care on reproductive, maternal, child health, and nutrition services.
Many health facilities located in rural and remote areas lack basic infrastructure and facilities to provide basic health care services to general people. Adequacy and availability of skilled human resources and capacity of the health personnel are other major challenges in ensuring smooth delivery of health care services.
Construction/renovation of health facilities and providing equipment and basic utilities will strengthen the operational capacity of local health facilities. Capacity building of community health workforce will enhance knowledge and skills required to deliver quality and specialized health care services. Capacity building interventions for health facility operation and management committees will equip them with the know-how for operating health facilities following national standards.
- Construction/renovation of health facilities
- Support health facilities with equipment and basic utilities
- Capacity development of the health workforce
- Strengthening operation and management of PHC/ORC
- Capacity development of health facility operation and management committee
- Collaboration with LGs for strengthening health facilities and their services
Ensured access to quality WASH facilities and services
Nepal has made significant progress in expanding access to water and sanitation over the last few decades despite tremendous challenges such as poverty, difficult terrain, conflicts, and disasters. However, the functional status of water schemes and the quality of water remains poor with 71% of all water sources and 91% of those used by the poorest quintile have been found contaminated with E. coli15. More than 20% of community schools lack improved water and sanitation facilities, and 19% lack gender-segregated toilets and menstrual hygiene management facilities (UNICEF Nepal, 2019).
Although Nepal had committed to ensuring access to basic water supply and sanitation to all people by the end of 2017, the earthquakes of 2015 affected its achievement. Additionally, lack of resources, technology, and capacity of stakeholders including WASH committees mar the prospect of ensuring WASH services and facilities in rural schools and communities.
Proposed WASH facilities construction and renovation interventions including water schemes and toilet construction at schools and health facilities will ensure better WASH services for students and patients/service seekers. School-based interventions on menstrual hygiene management promote adolescent girls’ school attendance. GNI Nepal facilitates the construction and renovation of community-based water supply schemes for increasing access to quality drinking water.
In communities and at schools, GNI Nepal works together with WASH committees. These committees are local actors for developing, implementing, and maintaining WASH facilities and services. Capacity building of these committees ensures local resource mobilization, ownership of WASH facilities and services, and promotes sustainability.
- Construction/renovation of WASH facilities at school and health facilities
- Capacity development of local WASH committees
- Support school for promoting MHM facilities and services
- Construction/renovation of community water supply schemes
- Water quality surveillance and treatment
Improved Health behavior and practices
Poor sanitation and hygiene behavior and practices may intensify the spread of communicable diseases. Traditional sociocultural practices in rural areas and dismal health-seeking behavior impact the health status of the rural populace, mainly women and children. Women and children are encouraged to visit local health institutions and avail themselves of free maternal and child health care. However, only 56% of pregnant women had been found to have four ANC check-ups and 63% attended institutional deliveries. Only 68% of children were fully immunized in 2018-2019.
As is evident, community members need to be educated and sensitized on health-seeking behavior including sanitation and hygiene practices for a healthy life. Visitations to local public health institutions, good sanitation, hygiene, and healthy behavior among children, families, and communities should be encouraged through behavior change communication campaigns and interventions.
Community health and WASH literacy events will sensitize children, their families, and community members on improved sanitation and hygiene practices. Health education sessions targeted at adolescent girls and children will encourage them to adopt hygienic practices at school and support them to disseminate knowledge to their family members, and community. Public service announcements (PSAs) broadcast on local FM radio stations will reach all sections of the rural population.
At the local level, female community health volunteers (FCHVs) play a crucial role in encouraging women and children to seek maternal and child health services from local health facilities. Hence, interventions targeted at FCHVs will enhance the health-seeking behavior of community members, mainly women, and children.
- Community health and WASH literacy drives
- School-based adolescent health education
- School WASH campaigns
- PSAs and awareness-raising events on improved WASH and health-seeking behavior
- Capacity development and mobilization of FCHVs
- Basic health and nutrition sessions for pregnant and lactating women