Two years ago, our community people were less aware about health issues and would deliver babies at home. Most of the pregnant women would not come for antenatal checkups. To the ones who would come for services, we were not able to provide them in good quality due to lack of space and necessary equipment. There was no toilet for mothers in the delivery room and no basin for hand washing, which made it difficult for both mothers and staffs.Besides, due to lack of space, privacy of the patient could not be maintained. When we were not able to give very good services it would make us sad. Moreover, it had been such a long time after completion of my studies and I was slowly forgetting many things I had studied. We had aimed to make our ward 'zero home delivery' ward. But to reach that aim, we were lacking improvements in many areas.
In 2018, the Nepal Red Cross Society started the
'Community Empowerment for Health Promotion Program' in our Municipality. The
program has supported to activate health mothers' groups in our community. I
also visit these mothers' groups to give information related to health along
with the Red Cross staff. Now the women in our community know more about safe
motherhood than before. These mothers' groups also run safe motherhood
revolving funds to support women in need to access maternal services. Red Cross
has also supported us with much needed instruments and equipment for delivery
services such as a delivery bed, episiotomy sets, surgical drums, instrument
trolley, resuscitation set and others, which have made our work more convenient
and safe. In joint effort of Red Cross and Municipality, a birthing center with
bigger rooms has also been built. The new delivery room finally has enough
space for the delivery bed and has toilet for mothers and running water for
hand washing, which helps to ensure patient safety and infection prevention.
Nowadays, many people are coming for services because they are more aware of their health. We have enough space to maintain privacy, and have space to run short classes for adolescents on reproductive health.In addition, I also received onsite coaching to refresh my skills related to normal delivery and managing complications at birth. I am very happy to learn many new things that have come into practice like delayed cord clamping. Community people also trust us more. The number of institutional delivery is also increasing.
Until now, we have been able to reduce number of home delivery to zero in Dalim, Darpan and Dhanabara cluster of our ward. With all these improvements, I feel more confident that we can reduce number of home deliveries to zero in remaining clusters too. With clean environment, enough equipment and good skills, we can now provide quality service to our community. I have not only been able to improve my skills but also practice these skills in clean and safe environment. It has motivated me to do even better.
Background
By Anju Gautam; Senior Health Officer, Nepal Red Cross Society
Maternal and neonatal mortality is one of the major public health concerns in Nepal.The Ministry of health and population including different supporting organizations is implementing different activities to improve the maternal and neonatal health specially to address risk associated with pregnancy and childbirth. The major strategies that government of Nepal has adopted are improving the availability of services, encouraging for institutional delivery through awareness raising in the community and expansion of 24 hour basic and emergency obstetric care services. The training and deployment of skilled birth attendants is based on a policy decision from 2007, which has been a significant step to ensure availability of skill attendance at every birth. Due to all these efforts, Nepal has made remarkable progress in reducing the maternal mortality ratio from 539 /100’000 live births in 1996 to 239/100’000 live births in 2016 and 21 neonatal death per 1000 live birth (Nepal Demographic Health Survey 2016).
However, many women continue to die in childbirth, either at home without access to skilled birth attendance or in health facilities providing sub-standard obstetric care. The reasons are complex and closely connected to the overall limitation of the Nepalese health system such as low availability of services, poor service quality, poor infrastructure and lack of necessary equipment, inadequate clinical capacity of service provider due to limited follow-up and support to nurse/midwifes especially in remote areas. This results in low utilization, which is detriment to retaining skills and confidence of the nurses/midwifes. Furthermore, cultural and gender norms, poor socio-economic situation of the women, long distances, and perceived low quality of services contribute to the low demand.
Considering these all aspects, the Nepal Red Cross Society with the financial support of the Swiss Red Cross has been implementing the “Community Empowerment for Health Promotion Programme (CEHP)” in four rural municipalities in remote districts in Karnali Zone and Zone 5 of Nepal. In close coordination with the respective local governments and different other stakeholders, the project works alongside the Governments health policy to improve the health of women and children including vulnerable and marginalized population groups with focus on Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH).
The project contributes to increase the access to health services, increase quality of health service delivery and management and influences the decision and policy making through capacity building of local partners. In the communities, the CEHP supports the dialogue and link between Health Mothers' Groups and local health providers and thus fosters health literacy and supports joint health actions, such as safe motherhood revolving funds, communal transport systems. Community members also constitute the local health facility management committees, who oversee and ensure that an enabling environment to provide quality RMNCH services is in place. On the health system side, the CEHP facilitates access to capacity building for the nurses/midwifes, establishes on-site coaching and mentoring aligning with government guideline to improve skills of nurse/midwife on-the job and improves service readiness with matching grants to municipalities for infrastructure and equipment support. Health facilities in remote areas of Nepal require support in multiple aspects: resources, skills and management capacity. This short story is appreciation of the comprehensive support received by nurses/midwifes working in such remote health facilities.
