DFID Funded Health Project 2014 – 2017

PHASE has recently finished running a three-year project (July 2014 – July 2017) funded by DFID which aimed to reduce maternal and child mortality among the marginalised populations of 18,000 people in far west Nepal. Through improving access to nutritious food and basic health services, and furthering women’s empowerment, we have made amazing progress in all areas.

In 2013, DFID identified the areas where this project worked as critical for two reasons:

• The amount of poverty
• The depth of poverty

The areas rank among the lowest on the Human Development Index, with 81% of people living in chronic poverty.

Since 2008 PHASE has run successful community health programmes in Malia and Melchham regions of Humla District, this project looked at food security and added health posts in three new areas – Jair in Humla District and Kolti and Wai in Bajura District.

As part of the DFID project there was funding for an external consultant to assess the project.  The consultant team spoke to 117 people who were involved in the project.  A survey also recorded responses from 1287 households, 207 of which came from the VDC of Jukot – a non-project VDC, which served as a comparison.

Project Outcomes

1: Increased capacity and reach of maternal and child healthcare provision.

In Wai and Jair PHASE updated the buildings and equipment of health posts, supplied medicines and provided further health staff and training. The services began to be used far more by the communities, and the government then appointed more staff and invested funds into the health posts.

In Kolti, Maila and Melchham, PHASE expanded its work in health to look more at livelihoods and nutrition, focusing on Integrated Management of Maternal, Neonatal and Childhood Illness (IMNCI).
In all of the project areas we exceeded our targets, and women are encouraged to attend antenatal care, deliver in the health post, and practice improved childcare and feeding practices.

2: Increased awareness and knowledge about maternal, neonatal and child health

The surveys show that there was an increase in knowledge about childcare and feeding amongst mothers, as well as increases in exclusive breastfeeding and family planning in PHASE areas. Staff and beneficiaries reported a huge increase in antenatal visits – 94% of women in PHASE areas received some antenatal care.

Compared to the non-project area of Jukot, PHASE areas had higher rates of deliveries in a health post or hospital, postnatal care, and deliveries attended by trained health workers, as well as a lower percentage of women giving birth in cow sheds. There were also notable improvements in hygiene and sanitation.

3: Greater knowledge and capacity to improve agricultural production amongst male and female farmers

To increase dietary diversity, the agricultural support focused on increasing the production of vegetables. Not only did we exceed targets for agricultural training, but the household survey in year 2 revealed an increase in female farmers using low cost irrigation methods and greenhouses. The survey further revealed that knowledge of advanced seed production was higher in PHASE areas than in Jukot.

4: Increased knowledge and capacity to improve animal husbandry among male and female farmers

PHASE supplied agricultural groups with improved breed stud goats for a goat breeding scheme. This resulted in offspring numbering in the hundreds.

5: Increased women’s empowerment

One of the biggest achievements of this project was improving gender equality in our project regions. The majority of direct beneficiaries were women who are now being fed more nutritious foods, deliver in cowsheds less frequently, and practice chaupaddi (menstrual exclusion) in a less extreme manner. There was an increase in women’s confidence and decision making via group participation, in mothers’ groups, farmers’ groups, saving and credit groups, and adult literacy groups. Savings and Credit group members felt empowered because they no longer had to ask men or money lenders for money, and adult literacy group attendees felt more confident at being able to write their names. Women are now more willing to seek antenatal care and health services, and to explain their own problems.

The final report showed that PHASE had an overwhelmingly positive reputation amongst both the people we worked with and the government. This project has changed lives.

We have achieved the following:

• Government supplied staff and a birthing centre in Wai, where previously there were no regular health services.
• In all project areas it is easier to reach a health facility.
• The numbers of women seeking health services and delivering babies with the assistance of skilled birth attendants has increased.
• Farmers are now able to grow a variety of vegetables all year round, where previously they could only be produced seasonally, generating a habit of eating vegetables on a regular basis and importantly improving the diets of pregnant women.
• Farmers have been able to sell surplus produce, resulting in extra family income
• 115 women in savings and credit groups are now able to save and borrow money independently.

The full time presence of PHASE in the communities in which we work allows us an unusual level of integration, and we were able to continually consult with beneficiaries and respond to changing scenarios, resulting in high levels of community participation. In this project we also built the capacity of local civil society organisations to advocate for higher government input into health and social services. The Health Facility Operation and Management Committees (HFOMC) and Ward Citizen Forums were strengthened, and we supported savings and credit and agricultural groups in their registration, which gave them leverage to make formal proposals to the government for support.

Finally, our mission of sustainable development was realised through projects which created a sense of ownership, such as the establishment of women’s health groups and savings and credits groups, and agricultural intervention. Participants felt empowered to employ their new skills and knowledge to improve the lives of their families and communities, resulting in tangible gains in maternal, child and family health and nutrition, environmental sanitation and hygiene, and livelihoods.