Date: 12th January 2015
· Ishwori Devi Shrestha Chief Nurse, MOPH
· Goma Niraula Shrestha Nurshing Director, Bir Hospital
· Kiran Bajarachya President, Midwifery Society of Nepal
· Gita Dhakal Chalise Executive Board Member, AWON
· Anita Bhujel Program Manager, AWON
· Lisa Tron Volunteer (Midwife from Germany)
Action Works Nepal (AWON) is working in reproductive and sexual health right of rural women in Jumla and Kalikot districts of Karnali region in Nepal from 2010. AWON is working on raising awareness of the locals on reproductive and sexual health right, capacity enhancement of local health workers and increasing access of locals for quality health services. Recently AWON is working through two health projects, one funded by NRN UK for Miteri Birthing Center (MBC) is one remote village of Jumla and the other one through Safe Abortion Action Fund (SAAF), UK in three village development committee of Jumla.
AWON work through the national and international volunteers, experts for cross learning. In 2014 AWON work with more than twenty volunteers. Lisa Tron, a mid-wife from Germany, join Action Works Nepal for two months. She stays in Jumla and work in MBC as well as health post of three villages. She came to know about the needs, hard life and also the gap in the basic health facilities in rural areas of Nepal.
Though the national data had show satisfactory figure of maternal and infant mortality rate but the story is different in the rural area of Nepal. Women and infants are dying by shortage of medicines, lack of equipments and quality services and absence of responsible health workers, lack of ownership of the duty bearers. The blanket approach of the nation and development organization is worthless for such rural areas, need specific strategy and frequent monitoring with review in the community approach from local to national level.
AWON share and raise these issues at local, district and national level as policy advocacy to fulfill the gap in quality service delivery. AWON organized a sharing meeting with representative from Ministry of Public Health (MOPH), pioneer and experts from sexual and reproductive health in Nepal.
The meeting objective was:
· To share the present condition of sexual and reproductive health rural areas of Jumla,
· To take preventive action, support and work together sharing resources and expertise.
The major sharing was focused on:
· Absence of local health workers (ANM, Health Post in charge) in the village health post who need to be daily present and provide health services to the locals. (Most of the village health post is without the health workers) only the office assistant is available in the health post. (Found health worker coming only for two or three days in the months and if delegates visits)
· Locals are not getting the basic health services and basic medicines which are free from government. In normal sickness also they had to wait for the time when the health workers come to health post or to travel to nearest health center where they can or cannot meet the health worker again or to travel to Khalang bazaar.
· Health posts are poorly equipped with basic medical instruments, poor sanitation conditions. The sanitation conditions of the health post are very poor. ( instruments and equipments are broken and not well managed, bed seats are spotted with blood and dust, poor drinking and cleaning water availability, dirty toilets)
· Lack and gap in monitoring from the district and national authorities. (No punishment and reward system)
· Need effective strategy to work in social mobilization of the local for making aware about the sexual and reproductive health rights due to prevail of deeply rooted ill cultural practices in the areas.
· Capacity enhancement and providing incentives to the Female Community Health Volunteers (FCHVs) in the areas.
· Need good coordination with the all stake holders and service providers and should work in integrated approach with specific objectives.
· Need of effective monitoring from district and national government authorities
Commitment and remark from the MOPH
The sharing made emotional as well as reflected poor health conditions in the rural areas of Karnali, Nepal. As an NGO, AWON is pioneer and working in must challenging remote and isolated area with very sensitive issues on maternal and child health. Ishowari Devi Shrestha, Chief Nurse from MOPH extend her sincere thank to AWON team member for doing hard job and raising the issues of poor health services, poor monitoring mechanism from district and national government health authorities.
She also commit personally and professionally to share the situation in MOPH and will take action to fulfill those gaps as per her responsibilities. The experts also show there interest on visiting Jumla and helping AWON and health service providers in the area.