Health Service Support

The Health Service in Rural Nepal

There is a governmental health service system in Nepal which is based very much on primary care:

Every “Village Development Committee” (VDC) - this is the name for the political community unit, in general between 2,000 and 6,000 inhabitants - is served by one Sub Health Post, staffed by three trained health workers and one caretaker.
These Sub Health Posts (SHPs) provide a primary care service which includes treatment of simple illnesses, contraceptive services and childhood vaccinations.
Three to four of these SHPs report to one Health Post, which has more highly trained staff and a slightly higher allocation of medicines per year, and about 9-10 SHPs refer to one Primary Care Centre, where on paper there should be a doctor and trained nurses.

The next level from this is secondary care - the district hospital. In theory every district hospital has 3-5 doctors and approximately 30 ancillary staff.
In reality, these hospitals which cover a population of 150,000 to 300,000 people often only have one doctor, and that only for part of the year, and health care is given by nurses and other staff. - Any emergencies often have to be referred to the nearest regional hospital - often many hours of unreliable transport away.

The main problem of the health service provision is not so much poor planning - on paper, the format seems quite good for a poor developing country - but in the implementation:
Even when everything does go to plan, the yearly medicine allocation to the health centres is insufficient, so they often run our of essential medicines months before the next delivery is due, and replacement of broken or lost equipment is almost impossible.
Many health centres still have no purpose built accommodation, but have to work out of a village home with no light and mud walls and floor - which is difficult to maintain clean. Where there is a purpose built health centre, often it is cramped and poorly maintained.

Sub-Health Post Building in Bihi (Gorkha)

Moreover, the more remote an area is, the less likely it is that the health centres will be fully staffed - even if staff do come to their post, they are often absent for long periods of time, partly because in those remote areas there are no local people with the relevant qualifications and anyone not born there can find the harsh living conditions to difficult;
Logistics are also more difficult, so often essential medicines (which are insufficient in quantity anyway) and vaccines never reach their destination.
Moreover, many remote areas have been regularly visited by Maoist rebels who extorted money from anyone with an income (i.e. teachers and health workers), which led to even higher numbers of staff abandoning their posts… Although there is now again a real hope for peace in Nepal, the after-effects of this insecurity will still last some time.

PHASE Community Health Projects

PHASE Worldwide is supporting existing governmental health centres with improved buildings, essential equipment and medicines, and most importantly, staff support: where possible, we support existing governmental staff to stay in their post by giving them extra training, sometimes financial incentives, and more supervision: Sometimes these health workers are just frustrated by the impossibility of providing a good service with the woefully insufficient logistics they have to cope with - if they are well supported, some of them are quite happy to return to and remain in their posts.

In addition to motivating governmental health workers to fulfil their duties effectively, we liaise with the district health offices and employ health workers through PHASE’s Nepalese partner organisation.

PHASE health worker checking nutrition status

Usually our health workers are “Auxiliary Nurse Midwives” (ANMs), who have experience in antenatal care and delivery care, and replace or supplement the skills of the governmental community health workers.

They are the heart of our health programmes, and combine in their work the roles of doctor, nurse, midwife, pharmacist, cleaner, cook, and often teacher - sometimes serving a catchment population of over 5,000 people!
Besides their presence in the governmental health centres, they usually also run outreach clinics in the less accessible part of the community, help with vaccination campaigns, conduct home visits and home deliveries and give health education to the school children and mothers groups.
They also act as PHASE agents in the villages, coordinating the other programmes when no other PHASE staff is resident in their work area.

Please see PHASE project areas and PHASE Nepal pages for more details.

Apart from the Primary care projects described above, PHASE also is involved in a cooperation to prevent deaths from cervical cancer in Nepal. Please click here to read more.