Wednesday, February 11, 2015

KOICA and UNICEF Representatives visit Baitadi and Dadeldhura

By Hyung Joon Kim

Korea International Cooperation Agency (KOICA) and UNICEF officials, including Ms. Haeng Lan Jo, Representative of KOICA Nepal and Mr. Tomoo Hozumi, UNICEF Representative to Nepal, visited Baitadi and Dadeldhura districts last month to review first-hand the impact of the organizations’ efforts to improve the health status of the children and women in far western Nepal. Since 2013, KOICA has been partnering with UNICEF to support the Government of Nepal in implementing programmes that improve maternal and neonatal care for unreached populations in 15 districts.. KOICA has pledged US$ 4.5 million for three years to UNICEF Nepal’s Maternal and Child Health programme. 

UNICEF and KOICA team stands in front of Siddheswor Sub Health Post in Baitadi district. UNICEF Nepal/2015/HKim      
Despite many challenges, Nepal is one of the few countries “on track” to achieve Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health).

One of the success factors behind the achievements is the commitment of the Government of Nepal to improve the lives of its children and women. KOICA and UNICEF have been working closely with the Government to support the latter in this journey together with other development partners.

During this trip, the team witnessed the dedication of often unsung heroes - health workers, mothers’ group members, female community health volunteers (FCHVs) and others working tirelessly in the remote parts of the nation. Throughout the visit, KOICA and UNICEF staff were able to interact with these heroes, who make real and lasting changes for the health of children and women.

Local ownership matters

In Siddheshwor Village Development Committee (VDC) in Baitadi, the team learned about how the community has been utilizing locally mobilized resources to improve the quality of the maternal and child health service

“Our VDC has invested almost US$ 15,000 to upgrade birthing centers, to purchase a refrigerator for vaccine storage and to strengthen an incentive scheme for FCHVs,” said Mr. Madan Mahara, Sub Health Post In Charge.

Mr. Madan Mahara, SHP in-charge presents the list of services in the facility. UNICEF Nepal/2015/HKim  
Mr. Mahara also added that the VDC had received continuous support from UNICEF for the establishment of Health Watch Group, emergency fund for safe delivery, prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services as well as immunization programme.

Full immunization saves lives

Next stop for the team was a visit to Gwallekh VDC in Baitadi to attend a celebration ceremony of full immunisation coverage of children in the VDC.

The road to the remote VDC was extremely muddy - remnants of a recent rain. The team members placed rocks in the tracks for their vehicles to be able proceed to the VDC.

Everyone helps move rocks to the muddy road. UNICEF Nepal/2015/HKim      
The celebration at Gwallekh started with a song composed by local students emphasizing the importance of full immunization. During the congratulatory remarks, Mr. Hozumi highlighted the contribution of the Korean Government.

“We, in UNICEF, are very proud to be part of this public health milestone, but it would not been possible without very generous support from Korean Government to achieve the health improvement in this district," Mr. Hozumi said. "When all the stakeholders from Village Development Committee (VDC), health workers, FCHVs, local politicians, and even donors work together, we can make a big difference in the lives of children and women."

Mr. Tomoo Hozumi, Representative of UNICEF Nepal office delivers his speech in the event to celebrate full immunisation of Gwallekh VDC. UNICEF Nepal/2015/HKim  
Ms. Jo also congratulated the VDC, and said, “On behalf of the Korean Government, I would like to express my sincere congratulations to the full immunisation VDC status and wish that all the children in this village will stay healthy and prosperous.”

Ms. Haeng Lan Jo, Representative of KOICA Nepal office delivers her speech. UNICEF Nepal/2015/HKim   
Evidence-based planning approach delivers results

Baitadi is among the first districts in Nepal supported by UNICEF for evidence-based district level planning process.

Dr. Guna Raj Awasti, District Health Officer, shared the progress of the evidence-based planning with all stakeholders in the districts. The district had a significant improvement in terms of the rate of institution delivery from 29 per cent in 2013/14 to 42 per cent in 2014/15. Budget allocation from VDCs) to Health has also increased from US$ 5,000 in 2013/14 to US$ 100,000 in 2014/15.

Baitadi DHO explains the district hospital facilities and services to the representatives from KOICA and UNICEF. UNICEF Nepal/2015/HKim     
On the same day, BCG and Measles-Rubella (MR) vaccines arrived in the Baitadi District after a few months of national shortage. UNICEF had assisted the Ministry of Health and Population in procuring the essential vaccines for children in Nepal.

“This is a good example of partnership between the Government and UNICEF," Dr. Awasti said. "We are delighted to be able to provide BCG and MR vaccination again from today."

Community-based care through Community Auxiliary Nurse Midwives (ANM)

On the third day, the team visited Dadeldhura District Hospital to learn about the community ANM program. UNICEF has been supporting the Ministry of Health and Population to pilot this programme in the district. There are total 60 ANMs working in the district, and one Community ANM is in charge of overseeing three wards in a VDC When recruiting the ANM, the district health office gives priority to local female ANM given their local knowledge, network and sense of accountability to their communities.

A community ANM and a FCHV explain about birth preparedness package to mothers group. @UNICEF Nepal/2015/HKim 
The Community ANMs' responsibilities vary from preventive services to monitoring and supervision. They conduct door-to-door surveys in their catchment area in collaboration with FCHVs and maintain demographic and health information. They conduct monthly home visits to ensure that every pregnant woman in their village completes four antenatal check-ups, goes through institutional delivery, as well as completes postnatal care checkups, both for the mother and child. They also work with FCHVs to mobilise mothers' groups to promote positive health behaviours as well as to conduct reproductive health promotion sessions.  These sessions include information dissemination and awareness generation on gender-based violence in schools.

Community ANMs holds an orientation session on reproductive and sexual health for adolescents in a school. UNICEFNepal/2015/HKim
Highlighting the achievements of the programme, the focal person of the Community ANM Programme in Dadeldhura District Health Office said, “Our expected outcomes through the Community ANM Programme is 90 per cent coverage with four antenatal care checkups and three postnatal care checkups, 80 per cent coverage with institutional delivery, increase in timely referral, achievement of Open Defecation Free District and full immunisation wards, and 100 per cent coverage with Tetanus Toxoid immunisation and iron supplementation of pregnant women.”

Mr. Dan Bahadur Bhatta, health post in-charge explains the progress after introduction of community ANM in their VDC. UNICEFNepal/2015/HKim

In Aalital VDC,  the  health post in-charge explained the improvements in the VDC after the launch of the community ANM programme. There was a huge increase of service utilisation in the last six months.  The coverage of four antenatal checkups increased from 34 per cent in 2013/14 to 66 per cent in 2014/15.  Similarly, three postnatal checkups jumped from 5 per cent to 93 per cent, and institutional delivery from 30 per cent to 60 per cent during the same period.

The stakeholders, including local politicians, FCHVs, Ward Citizens Forum members and local journalists expressed their appreciation to the positive changes that Community ANM has brought in the village.

A member of health facility management committee member shares his impression how the community ANM brings a change to the village. UNICEFNepal/2015/HKim
One local politician shared his reflection on the Community ANM program by saying, “Now, we feel that health services has come closer to our community.”

Every child counts: a full immunisation VDC leads to a full birth registration VDC

Aalital VDC has developed a simple yet innovative way to encourage all parents to register their children’s births.  Tapping on its strong health network and high immunisation coverage, the VDC decided to link the immunisation record with birth registration. They added an immunisation card on the back of the birth certificate. This has encouraged parents and caregivers to register the birth of their children when they come for immunisation.

 “Every parent wants their children to be healthy, so we leveraged our status as a fully immunised VDC to increase birth registration," Mr. Bhatta said. "Our villagers now realise that both birth registration and full immunisation are parents’ prime responsibility for their children."
Front page with birth certificate and back page with an immunization record. UNICEFNepal/2015/HKim
"We are very proud to be the first VDC in Nepal linking immunisation with birth registration. This small change contributed to our VDC achieving a full birth registration status as well,”

Partnership makes a difference

Ms. Jo summarised her learning during the trip by saying, “We were able to observe the real changes made in the field through UNICEF’s programmes. In particular, I was amazed how UNICEF is closely working with both central and district level government to cascade the impact down to the community levels. I’d like to appreciate UNICEF’s ongoing efforts to improve the lives of Nepali children and women.”

Ms. Jo, Representative of KOICA Nepal office holds a baby during growth monitoring session. UNICEFNepal/2015/HKim
Mr. Hozumi noted, “generous support has provided us with an excellent opportunity to support the Government of Nepal to intensify national and sub-national efforts for maternal and newborn survival among the most disadvantaged and vulnerable districts. Notable achievements and progress toward expanding quality maternal and child health services have been observed from the policy to community levels in the 15 target districts. UNICEF Nepal is extremely grateful to the Government of Korea for its assistance and looks forward to further collaboration for the betterment of children and women in Nepal.”

Mr. Tomoo Hozumi, Representative of UNICEF Nepal office measures a baby’s weight. UNICEFNepal/2015/HKim

Wednesday, January 28, 2015

Jajarkot becomes ODF amidst fanfare and rain!

The second day of 2015 was an important day for Nepal, and more so for the district of Jajarkot in the mid-western hills of the country. Jajarkot was one of the most affected districts by the diarrhoea and cholera outbreak of July 2009 that had claimed about 400 lives. Almost half of the dead were from Jajarkot, and many of them were children. All 30 Village Development Committees (VDCs) of the district had been impacted. Lack of transportation and ignorance and stigma about the epidemic had exacerbated the situation.
On the 2nd of January 2015, Jajarkot became the 20th district in the country, the 1st in Bheri zone, and 5th in the mid-western region to be declared "open defecation free" (ODF), meaning every household had access to a toilet.
 A bit of background
When the epidemic had struck in 2009, only 4 out of every 10 households had a toilet. Jajarkot's leap in terms of sanitation reflected the reaction to the shock the nation had received when, in the 21st century, diarrhoeal epidemics could take so many lives!  It was a shock for UNICEF too, which had been celebrating 4 Decades of Partnership in Nepal.
Some of the headlines in the national dailies in July 2009 reflected the shock the country was reeling under.
"Whole family perishes to diarrhoea"
"Health officials flee epidemic-affected villages"
"217 die without receiving a sip of ORS"
"Difficulty in gathering mourners in funerals due to fear of infection"
The cholera outbreak was a wake-up call for the government, for UNICEF, and the people in the most impacted districts. UNICEF played a crucial role then by initiating the movement "Aligning for Action: Making Diarrhoea Epidemics a History" and making a concerted decision to be the convener for broad consensus amongst all governmental and non-governmental actors, rather than pushing for individual projects.  The movement that started in Surkhet district of the mid-west region in 2010 to chart a sanitation road-map, snowballed into a social movement that had a strong  spillover effect at the national level too, and which resulted in the launch of the National Sanitation and Hygiene Master Plan by the President of Nepal in 2011! The Plan aimed for universal sanitation coverage in the country by 2017.  
In Jajarkot, people took the sanitation movement on a massive scale. It prepared a district sanitation plan in 2011 and aimed to make the district ODF by 2015. Later, a series of sanitation workshops at the district, ilaka and VDC levels helped to develop common consensus that building toilets was an individual's responsibility. Everyone, government agencies, local and national NGOs, INGOs and UNICEF came together with joints plans and financing for WASH programmes. In four years 21,000 toilets were built, the last 13,000 toilets were built in 120 days, meaning there were 75 toilets being constructed in a single day!
In these intervening years the mid-western region made 180 per cent increment in sanitation coverage, the highest amongst all the five development regions of the country.
Jajarkot and its neighbouring district Rukum, in the mid-western region, were also the only districts amongst the 20 ODF districts where diarrhoeal incidence in under-five children had been decreasing in the last five years -- from 1070 cases to 430 cases – almost 60 per cent decrease!

ODF Celebration on 2nd January 2015
The day was meant to be one with full fanfare, planned at the end of the Jajarkot Fair celebrations.  However the weather was a big let-down.
 Banners welcomed guests to the celebration of the first district in Bheri Zone (Nepal has 14 zones) to be declared free of open defecation
 After rain seemed to be playing a spoilsport in the event, the venue was switched to the top of the hill of the district headquarters.  Revellers in small batches, started making their way uphill. 
 The view from the top...
 The celebration site was in front of the 3-storied building which is now houses the District Administrative Office, but was once used to be the palace of the Jajarkot Kings.  School children had gathered here to celebrate the crucial role played by them during the ODF movement. But once the rain started pouring, they went home.
Cultural troupes started coming in, each with their own banners. Kaley Damai (with money stuck on his cap) dances in front of banner from Jagatipur VDC that has a slogan that reads "A toilet in every home is a thing of pride, prestige and honour. That is the identity of Jagatipur with hygienic, clean and beautiful homes and yards!"
 Another troupe  does the peacock dance
 ...local drummers...
 ... and their instruments...
Sorathi dancers in one area
... a troupe of elderly men were performing their own slow dance on one side...
... and boys dressed as females from another village danced elsewhere ...
... young girls also put up a celebratory dance as more people and guests gathered... 
  ... The rain seemed to let for a bit... 
The official programme begins, seizing the moment...
 Guests are garlanded. They included members of Constituent Assembly representing Jajarkot, local government officials...
.. as well as Deputy Representative of UNICEF Nepal, Dr. Rownak Khan 
 A moment of silence in honour of the souls lost in the 2009 epidemic, and the bus accident a month earlier in which about five dozen people lost their lives.
The first recorded fatality to cholera it seems was 30-year-old Ratna Bahadur Nepali of Rokayagaun. Not knowing what his ailment was he had been treated with local herbs, but he died within a day. 
 It begins to rain again...
 ... and umbrellas start sprouting in the courtyard...
... including one to protect the video camera...
Waving the green flag -- part of the ODF declaration
 Everyone takes the oath to aim for total sanitation in the district..
 ... and sign in the banner too...
 Media representatives capture it all ...
 A line of 30 earthen jars painted blue representing every VDC of the district...

 ... including this one of Dandagaon which was the first VDC to be declared ODF in Jajarkot
Village WASH Coordination Committee member and teacher from Dandagaon
Mr. Prachanda Oli talks about how they rallied to make a difference for sanitation in their village, starting from the declaration of ward # 6 of the VDC as ODF. 

Team Leader of Helvetas' Water Resources Management Programme, Mr Madan Bhatta, while highlighting the role played by his agency in the sanitation movement stressed that ODF movement would help to prevent further loss of human lives as well as financial resources in the future.  

Mr. Raj Kumar Kshetri, WASH Manager with the Swiss Red Cross in Nepalgunj outlined the poor condition in the VDCs when they first started work in the district, and how everything took a turn for the better following the district and Ilaka level sanitation conferences, and thanked everyone for their efforts on behalf of the Nepal Red Cross and the Swiss Red Cross.Mr. Rajendra Aryal, Chair of the  Federation of Drinking Water and Sanitation Users Nepal, in Kathmandu,  while appreciating the efforts of all that led to the declaration of ODF in Jajarkot, acknowledged the boost the movement got following the UN resolution of 2010 which declared water supply and sanitation as basic human rights.

UNICEF's Dr. Rownak Khan said, "ODF is the first step of sanitation ladder. The second step is to achieve “total sanitation” for the district.  This means that you not just build a toilet but ensure that you use it too. It means having safe water for drinking, practice hand washing with soap and other local level sanitation and hygiene related aspects. And more importantly we need to ensure that not just homes, but all schools have toilets as well as sufficient water supply..."

 Dignitaries under umbrellas... 
Mr. Binod Kumar Agrawal, Regional Director of Regional Monitoring and Supervision Office in Surkhet said, "Before the endorsement of the sanitation and hygiene master plan in 2011 by the government, there were different modalities of implementing WASH programmes in the districts. The government's effort in bringing the master plan helped to bring all stakeholders together and which also helped to stress the strategy that construction of toilets was the individual's responsibility. It is because of this that today Jajarkot has been able to declare itself an ODF district."Chief District Officer Mr. Jagat Bahadur Basnet, stressed that ODF status did not mean total sanitation and that everyone needed to, as per their oath, to  the commit to practicing healthy behavior by washing hands with soap and water, maintaining personal hygiene, as well as environmental sanitation too. Constituent Assembly member Ms. Rita Rawal, pointed out how ironical it was that in the 21st Century we are talking about hiding our faeces. "The rain that is pouring here today is also a message from the heavens, that water is an important factor needed to aim for total sanitation..."Time for piping hot tea in the cold rainy day...Mr. Shakti Bahadur Basnet, Constituent Assembly member outlined the important role that political parties played in the sanitation movement, and the role that they can play in the future for the district's quest to reach total sanitation. A respite in the rains... ... and the handover of the official felicitation plaque to the Local Development Officer of Jajarkot by the Regional WASH Coordination Committee Then followed the handover of plaques to partners in the sanitation movement, including UNICEF. Here Constituent Assembly  member Mr. Rajeev Shah hands over the plaque to Dr. Khan.Then the "token of love" plaque... Mr. Rajeev Shah, Constituent Assembly  member, said that although Jajarkot is making a lot of improvement, with road connection, and now with toilets in every home, yet a lot still needed to be done.  He urged partners like UNICEF, Helvetas and the Red Cross to provide support for the district's quest for total sanitation, including support for water supply projects.

At the conclusion of the programme the Local Development Officer and Chair of District WASH CC Mr. Gyan Raj Pandey thanked the contribution made by all sectors, agencies and individuals that made it possible for Jajarkot to achieve ODF status and looked forward to similar teamwork achieve the next step of total sanitation…

Then as the mist swirled in again, girls performed another dance... 
 ... and rain left its wet reminder on badges made for volunteers...
 ... as people started heading home, a glimmer of blue skies in the distance.. and a hope of a brighter days ahead.. for Jajarkot, and the nation!