Nepal Health for Life

In Nepal caste, ethnicity, gender, education, location, and economic status all affect an individual’s access to health care.

For example, disadvantaged women such as untouchable castes, or Dalits, are less likely to attend pre- and post-natal checkups and use family planning services. Also, children from the poorest households are at the greatest risk of dying before age five.

RTI implements USAID’s Health for Life project to strengthen Nepal’s health systems and increase access to health services for marginalized and disadvantaged people.

We coordinate with the Government of Nepal’s Ministry of Health (MOH) to support the testing and roll-out of national-level policies, guidelines, and programs. Our goal is to strengthen the government’s capacity to plan, manage, and deliver high-quality and equitable family planning, maternal, newborn, and child health services (FP/MNCH).

Our project team also works in 28 districts to strengthen district and village health systems and help identify and implement best practices, partnering with a range of key local stakeholders in addition to the MOH.

Strengthening Health Governance

In 2013, Nepal’s ongoing government decentralization process was not providing the resources needed to improve health service quality at the local level. Health for Life supported the development of a Collaborative Framework for Local Health Governance between the MOH and the Ministry of Federal Affairs and Local Development (MoFALD) to overcome this challenge.

The framework outlines the roles and responsibilities of village-level health committees—called Health Facility Operations and Management Committees (HFOMCs)—intended to represent all community members, including members of marginalized groups. They are mandated to work with local governments to identify service gaps, oversee planning, and mobilize funds and resources.

To support these committees in Health for Life districts, we went beyond training and provided frequent follow-up visits and supportive supervision.

As a result, about 96% of the village health committees have now met key functionality criteria in 141 high-priority areas—most were nonfunctional at the program’s start.

In addition, village health committees have improved or expanded planning, recruiting healthcare workers, and service quality. Further, almost all communities across the project’s core districts have mobilized additional resources. In 141 of the most disadvantaged communities in targeted districts, village health committees raised about US$288,000 to fund local health plans for fiscal year 2016.

Improving Service Quality at Health Facilities

In pilot districts, our team is helping the government scale up a facility-based quality improvement system to ensure that health facilities achieve standards for FP/MNCH services.

Gaps identified by quality assurance assessments in health facilities are to be addressed by key stakeholders, including HFOMCs. HFOMCs will be empowered to maintain a budget to improve compliance at health facilities and to monitor the availability of health workers. This approach is to be fully integrated in the local annual planning and budgeting process.

We also support health facility staff to monitor quality and provision of health services, particularly those related to FP/MNCH.

Another exciting innovation in service delivery is supplementing local health worker’s efforts through the use of a mobile tracking system to remind pregnant women to visit a health facility for check-ups, delivery, and family planning counselling. As a result, from mid-2015 to November 2016:

  • An estimated 75% of all pregnant women in 39 targeted sites have been registered.

  • 78% of all registered pregnant women, including Dalits, delivered at health facilities.

  • 65% of all pregnant women, and 60% of pregnant Dalit women, attended all four recommended check-ups before their delivery.

Improving the Health-Seeking Behaviors of Adolescents, Youth, and Pregnant Women

In addition to improving service quality, Health for Life is supporting a variety of innovative methods to increase demand for quality health services.

The Radio Bahas initiative works with district health offices to improve access to and use of FP/MNCH services. Public health messaging on local radio stations combined with public hearings encourage community members to voice health-related questions and concerns.

To reach adolescents and youth with messages about sexual and reproductive health, the government launched an mHealth program with technical assistance from our team. Users are prompted to contact a hotline operated by health workers who can answer their questions. To date, nearly 200,000 adolescents and youth sent about 2.7 million text messages and received 4.9 million responses from the program.

Rebuilding Systems and Services in the Aftermath of Natural Disaster

Health for Life is also assisting communities and local governments recover and rebuild health systems and services in 10 of the 14 districts most heavily affected by Nepal’s devastating 2015 earthquakes to “build back better.”

We support community efforts to directly address key health system constraints and improve local health governance, using many of the tactics proven successful in Health for Life core districts.

In earthquake-affected areas and beyond, Health for Life will continue to strengthen health systems in Nepal, improving access to quality health services for Nepal’s most vulnerable and disadvantaged communities.