Start Strong Project: Improving Maternal Healthcare and Reducing Malnutrition

The Start Strong Project is a three-year project, starting in April 2022 and running until March 2025. PHASE Worldwide secured funds for the project through its Start Strong Campaign in early 2022, which was Match-Funded through UK Aid by the UK Government and raised a total of £294,387. 

What does the project aim to do? 

Improve the health, agriculture, and nutrition of 1,000 vulnerable women and their children in Rugin and Bichhaya, Bajura District, Far West Nepal. Through this project, we aim to create sustainable changes and an impact that lasts. Building capacity and training of Government Health Staff and Key Stakeholders ensures that once we hand over the Primary Health Care post and activities to the Nepali Government the knowledge and practices instilled remain. Through this project, PHASE aims to contribute to the United Nations Sustainable Development Goals 2 and 3: Zero Hunger, and Good Health and Well-being. 

Why is this important? 

Many studies have revealed that women who are marginalised by wealth, education, and geography have worse Maternal Mortality Rates (MMR) and less access to maternal healthcare. In Bajura the MMR is 320 per 100,000 live births which is significantly higher than the Nepal average MMR of 186 per 100,000 live births, in comparison the UK had an MMR of 7 when assessed in 2016. Maternal Mortality Rates can be reduced with regular antenatal and perinatal check-ups, yet in 2016 only 47.5% of women went to the recommended 4 antenatal care visits, and this number was divided by household wealth and geography, those with more money and those who lived closer to healthcare posts were more likely to attend all 4 ANC visits.  

Baseline surveys conducted with mothers in the village who have children aged between 6 and 59 months old revealed that 70.2% of the children were malnourished highlighting the need for consistent health checks and infant nutrition education to be given to the communities. Furthermore, many communities do not have safe birthing centres to attend; in fact, a “national survey of birthing centres reported only 5% of birthing centres satisfy the requirements of the Safe Motherhood Programme” (Nepal, Dangol, & van der Kwaak, 2020). Even when mothers attend birthing centres, only half of the nursing staff are Skilled Birth Attendants, which means many are not adequately trained especially for complicated births which put babies’ and mothers’ lives at risk. This is why it is important to us to train respected people in the community, such as Female Community Health Volunteers (FCHVs), on proper maternal healthcare practices and child health. 

The Baseline Surveys also found that less than half of the women interviewed could produce enough food from their land to meet their family’s needs for 6-12 months. Food insecurity is prevalent in the area and without access to nutritious foods, families face an increasing risk of malnutrition.  

Expected outcomes  

• Reduced overall malnutrition rates as identified by low-weight, short-height, and small MUAC (Mid. Upper arm circumference) for children aged 5 and below.  
• Increased percentage of women giving birth institutionally/attended by a skilled health professional. 
• An increased number of women attending the recommended 4 antenatal care visits. 
• Increase in knowledge, attitude to, and practice of the Golden 1,000 Days. 
• 625 women involved in agricultural activities, including, chicken rearing, mushroom cultivation, and crop support to increase access to High-Value foods year-round. 
• Promotion of self-sufficiency and long-term solutions to malnutrition and food insecurity; sustainable changes to food production and nutrition. 

How will this be done?  

The Start Strong Project is made up of three different components: Improving Maternal Healthcare and Behaviours; Increasing the Availability of Nutritious Foods; and Embedding Nutritional Expertise and Knowledge in the two communities. To do this, the project will place qualified Nepali Auxiliary Nurse Midwives and Agricultural Technicians in the communities of Rugin and Bichhayya for 3 years, starting in April 2022 and ending in March 2025 to help achieve the expected outcomes

The ANMs and FCHVs will work to provide primary healthcare to community members, and essential maternal and infant healthcare services. They will not just provide healthcare but also run a series of outreach activities relating to maternal and infant healthcare. These activities include ‘Golden 1,000 Days’ meetings for women which raise awareness of proper maternal and infant health care, alongside nutritional information, such as how to make Super Flour. Also to promote diet diversification and the inclusion of nutrient-dense foods in baby’s diets, ‘Health Baby Competitions’ will be held in the villages, which offer rewards for the healthiest babies to encourage good nutritional practices and also offers the opportunity for the FCHVs to identify any malnourished children and address the family’s needs.  

Many families rely on their agriculture as their source of food and income, but this is insecure – by providing agricultural training and resources, such as poly-tunnels, which promote consistent food consumption year-round the malnutrition rates of families in Bajura should decrease. Agricultural technicians will work to increase the availability of high-value foods through agricultural activities with 625 women. This will include  250 women receiving materials and training for mushroom cultivation, 250 women receiving chicks, feed, and training on poultry rearing, and 125 women to receive material and educational support on improving the quality and quantity of their crops. These activities and materials will empower them to have a source of income and be self-sufficient enough to provide for their families year-round. This agricultural knowledge can be shared by the women in the project with others in the community so that the practices can be embedded in the community and create long-term changes to how agriculture is approached. 

Finally, AMNs and health workers will support embedding knowledge with traditional healers and FCHVs, who are trusted community leaders, so that health information can be dispersed in the communities, increase referrals to Skilled Birth Attendants, and have knowledge and practices promoted after we hand over. 

All of these components of agriculture, nutrition education, and health awareness raising in combination reduce malnutrition among infants and improve maternal health and healthcare in the communities in which we are present.