Fields of work Maternal/Child Health
UK Partner Rotherham NHS Foundation Trust Hospital
Developing Country Partner District Health Office Gorkha
Contact Gerda Pohl - gerda.pohl@phaseworldwide.org

Improving maternal and child health care in remote rural Nepal by supporting primary care workers

 

This project will formalise and intensify existing links between British GPs and midwives from Rotherham (and some other areas of the UK) with the District Health Office (DHO) in Gorkha District, Nepal.  The goal of this project is to improve quality of Maternal and Child Health Services in Gorkha District, Nepal.

Over several years, visits have taken place to Gorkha to train primary healthcare workers developing a close cooperation with the DHO to improve primary care, particularly Maternal and Child Health Care, in seven very remote communities in the north of the district. These areas are several days walk from the nearest road and traditionally it has been difficult to implement government health provision there.

An on-going problem is the training and professional support of health workers in these very remote areas, as the government has limited capacity for this.  Our current programme aims to assist the DHO in training and supporting health care workers in these remote communities by involving British health professionals.  Previously this has included a 3 day training course delivered to primary care workers by 2 GPs from England jointly with three doctors and one senior health worker from the DHO and Rotherham NHS Foundation Trust Hospital (RFTH) being involved by supporting senior midwives to visit Nepal and deliver an obstetric emergencies skills course to Nepalese health workers.

 

Nepal

Mother in Gorkha

Nepal ranks 142 out of 171 countries according to the UNDP Human Development Index, which takes into account a variety of development indicators, and is the 12th poorest country in the world.

The National Health Sector Plan of Nepal particularly emphasises maternal and child health services and sees improvement in this area as a major priority. Infant Mortality in Nepal is still very high in spite of recent improvements, and in addition, 48% of children under 5 years in Nepal are malnourished.  Maternal Mortality is one of the highest in the world and a recent report from the Family Health Division (Nepal Ministry of Health) showed that suicide is now the major cause of death for women aged 15 to 49, underlining an urgent need to improve recognition and management of mental health problems particularly in women.

The poorest sectors of society live largely in remote rural areas, often several days walk away from the nearest road access, where the provision of a regular health service is challenging, especially recruitment, retention and support /supervision of health professionals. Primary care (including maternal and child health services) is not provided by doctors in these areas but by health workers with very basic training. Training is usually classroom based and lecture style and not applied in practice, as in-post supervision is very hard to implement.

 

Project Summary

During the 24 months of the project 8 midwives and 8 experienced GPs will visit Nepal to conduct training sessions and in-post supervisory visits, in cooperation with Nepalese staff. In order to strengthen the link and achieve sustainability, several meetings will take place in Nepal with the District Health Officer and his senior staff, and two senior professionals from Nepal will visit England for a reciprocal visit.

 

The Charity

The link is supported and facilitated in the UK by the charity PHASE Worldwide, of which the lead GP for this project is a trustee, and in Nepal by PHASE Nepal, a registered NGO which works in the Northern part of Gorkha district in coordination with the DHO.  You can learn more about PHASE here - www.phaseworldwide.org

 

Project Indicators

  1. Increased number of attended deliveries (this is an indicator of quality, as it mostly depends on the reputation of the health workers in the villages and their ability to communicate well)
  2. Improved adherence to national and local care guidelines by healthworkers.

 

Outcomes

  1. Improved child health provision in primary care in target areas
  2. Improved quality of antenatal care and family planning provision
  3. Increased awareness and recognition of mental health issues by health workers, particularly in the context of antenatal and postnatal care
  4. Increased capacity of District Health Office to support frontline health workers

 

Outcome Indicators

  1. Improved recognition and management of Malnutrition and Diarrhoeal Disease (diagnosis increased by 10%, management according to guidelines in 75%)
  2. Increased numbers of children vaccinated (up by 15%)
  3. Higher numbers of Mothers attending more than once for antenatal care (up by 10%)
  4. Higher number of women receiving oral iron in pregnancy (up by 10%)
  5. Higher number of attended deliveries in target area (up by 10%)
  6. Increased number of women recognised to be anxious or depressed
  7. Increased contact between frontline health workers and DHO: number of phone calls and personal meetings

Mother and baby

Main project activities

  1. Four experienced midwifery trainers from Rotherham Foundation Trust Hospital will visit Nepal twice in the project period to deliver a 4 day course in emergency obstetric skills to 12 – 16 health workers each time in Gorkha town. The course is a practical skills based course focussing on problems commonly encountered in rural Nepal, and will be co-facilitated by senior staff from the Gorkha DHO
  2. One or two experienced GP trainers will deliver a week’s update training to 12 – 16 health workers in Kathmandu  in Integrated Management of Childhood Illness (IMCI) and in recognition of important mental health problems (there will be an overlap between the participants of this and the groups in #1.)
  3. At least 8 experienced GPs will visit Nepal to deliver in-post clinical skills training and supervision to health workers working in remote villages in North Gorkha, each visit lasting about a week in post
  4. One of the GP trainers will visit the Gorkha District Health Officer at least twice in the project period to review the project and consider changes
  5. Two senior health professionals from Gorkha will visit the UK to gain an insight in Primary Care and training in the UK
  6. Trained health workers with support from senior health workers will conduct  ‘public audits’; formal public meetings in the target communities to raise awareness of the programme and gather the communities’ views on maternal and child health issues
  7. Facilitated by PHASE, a baseline and final data collection will be conducted to assess the change in key indicators, this involves spending additional time during the routine data collection PHASE undertakes anyway
  8. A student from the International Development and Public Health Masters Programme of Sheffield University will be recruited to conduct an external evaluation of the programme as a Masters thesis project.

 

Project Report  from 1 August 2012 to 31 January 2013

  • Midwifery training in Kathmandu – this included most of the midwifery workers from the Gorkha area. The training is a well established course in basic obstetric life saving skills, specifically developed for the learning needs of rural health workers in Nepal, which is highly regarded by participants and shown to improve their skills.
  • 4 GPs visited the rural project area for project visits between 4 and 10 days. They concentrated on clinical skills tutorials with the health workers they were staying with, with a focus on establishing a diagnosis and communication skills with the patient; main topics included child health, women’s health and also mental health
  • We have started collecting formal feedback with semi-structured questionnaires from both GP volunteers and the staff whom they train. We also had an opportunity to ask for formal feedback from a visitor to the project area who is a doctor working in the business sector and has organisational management skills.

Contact

Gerda Pohl

Trustee, Medical Coordinator

PHASE Worldwide

www.phaseworldwide.org

gerda.pohl@phaseworldwide.org

Tel: 01709 789004

PHASE Worldwide, Reginald Arthur House, Percy Street, Rotherham, S65 1ED

Registered charity number: 1112734