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