Working in remote areas
Historically in Nepal, inadequate attention has been paid to improving health services for women and children in remote or mountainous areas. Remote village development committees (VDCs) in mountainous districts have fewer human resources, fewer facilities, more drug stock-outs, lower awareness levels on maternal and newborn health (MNH) issues and lower uptake of health services. This has resulted in below average health status in these areas with under-five and newborn mortality 1.5 times higher in mountain than in hill and Terai districts.
Progress has been made in understanding inequities and in developing strategic, evidence-based solutions to reach those in remote areas. More disaggregated information is now available, and we have learnt lessons from evaluations and studies on how to effectively increase access to services. Further work is needed to ensure that Nepal’s health policies, plans, service provision and budget allocations sufficiently address the health needs of women and children in Nepal’s remote areas. Continued support is needed to develop client-centred strategies, support context specific planning and potential scale-up of the interventions based on evidence as Nepal moves towards universal health coverage.
We have expertise to:
- Improve the quality and use of evidence in planning and delivery of health care so that services are better designed to meet the health needs of all of Nepal’s population.
- Develop services that are accessible to all, irrespective of location, so that those most in need have greater access to care.
- Strengthen and expand equitable delivery of quality essential health care including improving women’s access to comprehensive obstetric care in case of an emergency during childbirth.
- Design and undertake pilot evaluations of interventions to increase access to those in remote areas and ensure that results inform policy, strategy and resource allocations.
- Assess the impact and value for money of interventions to ensure the most efficient and effective use of resources.
We supported the Government of Nepal to undertake a study on women and children’s access to maternal, newborn and child health services in remote areas. Based on the recommendations we supported the design and implementation of the Remote Areas Maternal and Newborn Health Pilot Project (RAMP) in Taplejung district, eastern Nepal. RAMP informs government plans for working in remote areas and aims to increase the availability of clinical staff and medical supplies, and strengthen health facility governance to improve the quality and availability of services. The result is increased access to and use of services.
We provided direct clinical mentoring support to obstetricians and skilled birth attendants and rolled out strategies to improve access and referral for women in remote areas with obstetric complications.
We strengthened district hospitals’ abilities to provide 24/7 Comprehensive Emergency Obstetric and Newborn Care (CEmONC), and we have trained skilled birth attendants, family planning providers and medical abortion providers at strategically located Birthing Centres.
- We supported the Family Health Division to increase the number of districts that have at least one facility providing CEmONC for women experiencing complications during childbirth, from 22 districts in 2010, to 49 districts of 55 mountain and hill districts in 2015. As well as establishing these services, we helped ensure they were functioning by providing on-site clinical mentoring and management support.
- Access to and use of MNH services in remote areas has improved over the last few years. While it is still very low compared the rest of the country, deliveries assisted by skilled birth attendants increased in remote mountain districts from 19% in 2011 to 32% in 2014 and the C-section rate at population level increased from 1.4% to 2.9% in the same time frame.
The number of districts that have at least one facility providing CEmONC services increased from 22 districts in 2010, to 49 districts of 55 mountain and hill districts in 2015
Deliveries assisted by skilled birth attendants increased in remote mountain districts from 19% in 2011 to 32% in 2014