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Post-disaster Health Promotion Project in Dhading District, Nepal

Publication date:2019-06-04
 
By Masamine Jimba
(Professor, Department of Community and Global Health,
Graduate School of Medicine, the University of Tokyo)
 

Female health volunteers having a meeting
The catastrophic quake hit Nepal on 25 April 2015 and it affected the lives of millions, leaving over 9,000 dead with more than 18,000 wounded. About 20% of the total population was seriously afflicted by the calamity, followed by a segment of 17% whose lives were devastated in one way or another. 31 out of all 75 districts suffered a tremendous damage with 14 of them being completely destroyed.

The extensive damage was a major blow to Nepal’s health and education sectors. Especially, many mothers and children were cut down access to medical and educational services. According to the local disaster evaluation, 446 state-run medical facilities and 16 private hospitals collapsed, while 765 clinics were half-destroyed. In the most severely-hit 14 districts, about 84 % of medical facilities (375 out of 446) were totally ruined. As a result, this made it even more difficult for the so-called vulnerable groups (the injured, women and children) to receive appropriate medical care.

Our project site, Dhading, was one of the most harshly damaged areas in the nation. The death toll was expected to reach 733 and a number of people were injured. Only seven out of 53 local medical facilities were able to remain intact. Schools and academic institutions were no exception as 70,000 students had been affected nationwide. Because the public sector was crippled, people in Nepal needed to protect themselves from health risks as they could not fully rely on governmental assistance.
 

Prof. Jimba at the National Consultative
Meeting

Dhading District stakeholder meeting


In response to this critical situation, Green Tara Nepal (GTN), a Nepal-based NGO, promptly carried out an initial assessment to grasp the extent of the damage in the locality. Their focus was primarily on basic services such as food supply, shelters, water and hygiene, followed by psycho-social support and basic education. Since the national health system was not functioning in the immediate aftermath, securing shelters had been a must for the protection of adolescent girls and women in particular. In short, the safety and security of women in less-privileged communities was at the top of the agenda.

While continuing its relief effort within the limited capacity, GTN decided to work jointly with the University of Tokyo to launch the Post-disaster Health Promotion Project (PDHP Project). Later that year, the project began in Dhading District with the support of the Association of Medical Doctors of Asia (AMDA) and Japan Medical Association (JMA). The target beneficiaries were women and children.

Volunteer group formed by mothers (1)

Volunteer group formed by mothers (2)

 

Objective:

The project was aimed at 1) uplifting the quality of reproductive health of adolescent girls and women (also focusing on the new-born infants), and 2) improving family planning services.
 

Target area/audience:

The project chose the most underprivileged communities within seven Village Development Committees (VDCs) which were severely affected by the disaster. Women and students of reproductive age were the target audience of the project.
 

Partnership:

PDHP was made possible thanks to AMDA and JMA’s financial assistance as well as technical assistance provided by the University of Tokyo. Green Tara Trust, Liverpool John Moores University (UK), Karuna Trust (UK) and Karuna Germany also gave support to allow a diverse range of activities.
 

Project Period:

From July 2015 to January 2019
(A community-level project intervention began in January 2016 after the preparatory period.)
 

Phase 1: Preparation (July 2015 – December 2015)

For the initial six months, GTN focused on budget coordination, project planning and official application procedures. In October 2015, GTN held a nationwide stakeholder meeting with the scope of drafting a relief program for disaster-stricken communities.
 

Phase2: Project launch (January 2016 – January 2019)

From January 2016, GTN started to work with a voluntary group of mothers, Female community health volunteers (FCHVs), medical facilities, schools, VDCs to organize various activities in local schools and communities.
 

Phase 3: Project wrap-up (April 2018 – January 2019)

GTN submitted an activity report to each village while all of its stakeholders (who were involved with the project from the initial planning) shared the outcome on the national level.  
 

Teachers’ training (2017)

Teachers’ follow-up training (2019)

 

Outcome:

Throughout the project period, the total number of beneficiaries was 46,125: of total, 17,285 were directly benefitted from the project, while 28,840 were indirect beneficiaries that received health-related information and services. As planned at the beginning, most of the beneficiaries were adolescent girls and women. However, it is worth noting that decision making of the girls and women had often been at the hands of men and adolescent boys.
 

Findings from the surveys before and after the project:

Five goals were set at the beginning of the program. The team investigated the shifts in the main indexes based on the quantitative data collected through household sample surveys.
 

Issues:

There were several factors that hindered the increase in the number of recipients who receive infant and maternal care. They were, namely, 1) geographical restrictions, 2) interspersed houses, and 3) the lack of manpower that handles the transfer of pregnant mothers to child delivery facilities.

The remaining issue for the target region is how to let women receive the care continuously throughout their pregnancy to postpartum period (including the infant care). Overall, the issues could be categorized into three categories: 1) external issues, 2) issues pertaining to project management, and 3) organizational matters.
 

Conclusion/suggestions:

The health promotion in the field of maternal and infant care had been overlooked since the 2015 earthquake. In this regard, the project in Dhading was truly a unique one as most of foreign aid providers were focusing on rehabilitation of social infrastructure and other services during the post disaster period. Taking such a situation into consideration, the project succeeded in fulfilling the potential health needs.

Through the surveys conducted before and after the project, most of the goals were met and remarkable improvement was seen in both pre/post birth care. On the other hand, the mental health index showed limited difference. In addition, contrary to the goal we set to reduce teenage marriage and pregnancy, their numbers increased.

Through participatory approach, PDHP worked at strengthening the framework of community development. Likewise, the team closely collaborated with the University of Tokyo, thereby enabling them to receive the technical assistance they needed. PDHP came to fruition through successful preparation, project planning, baseline survey, project launch and monitoring, outcome sharing, and evaluation.

As we convened a committee meeting to mark the beginning of the project, in closing, we held a promotional meeting to wrap it up as our final work.
 

Members of the Children’s Club
holding an annual schedule

Women’s volunteer group attending
a workshop for making sanitary napkins

    •  GPSP Medical Mission (Promotion of Health)
    •  Nepal
    •  2019
    •  ER & Reconstruction

 
 
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