Improved family planning, maternal and child health care in Nepal

NEPAL FAMILY HEALTH PROGRAM (NFHP)

understanding and playing a more active role in promoting and services. supporting ser vices.
In Nepal, the provision of health care to rural communities is one of the main challenges. Health and reproductive health indicators are amongst the worst in the world, yet the remoteness of many villages and an evolving organizational structure are major constraints to improving family planning and maternal and child health care. In response to this situation, CARE Nepal is collaborating with other partners, including the Ministry of Health, JSI and USAID on the Nepal Family Health Program (NFHP). The goals of the program are to strengthen health service delivery mechanisms and increase the utilization of Family Planning/Maternal and Child Health (FP/MCH) services at household and community level. The CARE Nepal input to the program will be implemented in seven districts over a five year period from July 2002 to December 2006. The focus is on an integrated program in which community, district and national components are coordinated, interlinked and mutually supportive.

In the District
At present, the provision of FP/MCH services from community to district hospital is inadequate and uneven. Thus the NFHP works closely with the District Public Health Office (DPHO) to

In the community
The main focus of the NFHP is at household and community level This is where clients meet providers, where behaviors are changed and where the most opportunities exist for protecting the health of Nepali families. The front line providers in health service delivery systems are community health workers i.e. Female Community Health Volunteers (FCHVs), Maternal Child Health Workers (MCHWs) and Village Health Workers (VHWs). Their work at village level is reinforced by the community health facilities. The NFHP aims to strengthen these facilities along with the role of the FCHVs. Nationwide, there are about 46,000 FCHVs working in remote areas. Communities increasingly look to the FCHVs for advice or guidance on health issues. Thus, a large part of improving

Donor United States Agency for International Development (USAID) in Nepal Managing Partner JSI Research &Training Institute Co-managing Partner Engender Health Implementing Partners JHU/CCP, JHPIEGO Collaborating Partners CARE Nepal, ADRA, Save the Children US, MASS, NFCC, NTAG Target Groups (for CARE Nepal) 3,166,43 people

Female Community Helath Volunteers looking for danger signs of pneumonia in Dhanusha district

N E P A L

F A M I L Y

Program Period July 2002 December 2006

H E A L T H

W e foresee local government and civil society having a better

These advances will strategically place the FCHV as a capable focal person for health information and services in her community and increase her ability to refer patients to other health services such as those provided by MCHWs, VHWs and at health facilities.

P R O G R A M

community based services is to strengthen this role. FCHVs receive training to enhance their technical and communication skills to enable them to fulfill one of the key functions of transmitting health messages at household level and encouraging the community to seek timely health care. They will also benefit from improved support in terms of financial and in-kind incentives as well as more active community support from the Village Development Committees and health facility management committees on staffing and managerial issues. Support to health posts and outreach clinics and provision of medications and birthing kits to MCHWs, for example, will also be part of the program to strengthen healthcare in the community.

improve the delivery of FP/MCH and reproductive health at all levels. The CARE Nepal contribution to the NFHP will develop the technical capacity and the management systems of the DPHO in 7 core program districts and provide limited support in monitoring and supervision in all the targeted districts. CARE Nepal will implement this part of the program in seven of the core districts, Kanchanpur, Mahottari and Dhanusha in the first three years and Nawalparasi, Chitwan, Parsa and Bajura in the last three years. Up to 4 program officers will be placed in each DPHO and will provide community targeted technical inputs in a number of ways. One of the key elements of the NFHP is strengthening supervision and support systems at community level by the DPHOs. The program officers will provide orientation on how to better support community health workers. The expected outcome will be improved performance of community workers and better quality services. At district level program officers will also provide in-service training, technical support and advise on organizational systems that will contribute positively to the provision of services at health facilities within the district. The performance of district hospitals regarding FP/MCH will be improved and quality assurance activities undertaken. Training will be conducted at hospitals and systems will be assessed and improved such as those related to client referral. In addition health facility management committees will be reactivated and forums enhanced to exchange best practice.

Nepal Family Health Program Areas

I phase: Kanchanpur, Mahottari and Dhanusha II phase: Nawalparasi, Chitwan, Parsa and Bajura

Bajura

Kanchanpur

Nawalparasi Chitwan Parsa Mahottari

Nepal Family Health Program

Dhanusa

W e envision a more systematic

national approach to programs with better support systems and the ability to recognize and apply learned. lessons learned.

goal of decreasing the child mortality rate to 70 per 1000 live births by 2006. A strong component of the whole program will be a range of Information Education and Communication and Behavior Change Interventions (IEC/ BCI) at all levels from national radio shows and campaigns to communications skills training for FCHVs. The partners involved in the NFHP expect that as a result of this program communities will be more active in supporting their local health care services, local providers will provide higher quality and more sustainable services and the demand and utilization of FP/MCH services will increase. The results of this program will be measured gradually, yet tangibly, over time, by improved health and reproductive health indicators that will clearly illustrate that Nepalese people are being provided with the basic services they have a right to demand.

At the National Level

Despite the organizational challenges of a limited national capacity to support district and community health systems and FP/MCH programs, there are a number of strategies the NFHP has identified which will build the institutional capacity of district based health providers within the Ministry of Health (MoH) in the five year period. The strengthened institutional, technical and management capabilities of health facilities will help to address the unmet needs for quality family planning services in Nepal. Moreover, NGO coordination and Integrated Health Logistics will be mobilized to support the strategic development of national FP/MCH programming within the Family Health Division, which provides services related to Family Planning, CB-IMCI, FCHV, Safe Motherhood and the Vitamin A program. Nepals National Vitamin A Program (NVAP) is considered one of the worlds most successful community based health programs. It has contributed significantly to a reduction of 24% in the mortality rate of under-fives. The NFHP will provide technical assistance to ensure that quality and high coverage is maintained to help the MoH achieve the national

NFHP

Janakpur Office Ramananda Chowk Ward 12, Dhanusha

Tel: 041-523309, Fax: 041-523309 e-mail: jpur@carenepal.org URL: www.carenepal.org
Published Date: April, 2003

Behavioral change and communication in health education, Mahottari