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22 Feb 23

Start Strong Project – Nine Month Update

The Start Strong Project, match funded by the UK Government, has now been running for nine months and we’re excited to share our progress with you! Over the course of this three-year project, we are aiming to improve maternal health and reduce malnutrition amongst 1,000 vulnerable women and their children in Rugin and Bichhaya, Bajura District, Far West Nepal. The team at PHASE Nepal will be using an integrated approach with a range of activities to achieve this, supporting families in nutrition education, access to high-value foods, and maternal and post-natal care.  

We saw great progress from Quarter 1 to Quarter 2 reaching 697 people, and have been able to build on this success to reach even more people this Quarter. Since the start of the project, we have now supported over 900 residents, supporting 205 new members across our activities during the October-December period. 

Maternal and Infant Healthcare 

Primary and maternal health care is difficult to access in rural areas which can mean new mothers are not properly supported in both their pre-natal and post-natal care. The presence of our Auxilliary Nurse Midwives, and local Health Posts and Birthing centres means that new, and expecting mothers can be regularly seen by professional healthcare workers. In the last three months, 35 women received their first antenatal care visit and 23 received their fourth antenatal care visit whilst there were also 24 deliveries attended by healthcare workers at PHASE-supported health posts.  

In combination with regular health check-ups, the project is also running activities for antenatal mothers and their caregivers to promote knowledge about maternal and child health, and to encourage attendance to antenatal care classes. This quarter 104 women and their caregivers attended the sessions, which is almost double the 58 women who attended last quarter. Supporting mothers, educating families on maternal health, and having skilled birth attendants on hand contributes to reduced maternal and neonatal mortality rates. 

Image 1: Mothers attending an antenatal care class.

Golden 1000 Days 

We don’t just support families during pregnancy, but throughout the Golden 1000 days – the 1000-day time between a woman becoming pregnant and her child reaching 2 years of age. In Q3, 53 mothers attended ‘mothers of golden 1000 days’ meetings. During these sessions, they were encouraged to attend antenatal classes, as well as being taught about the benefits of breastfeeding and food fortification in the form of making Super Flour to help fight child malnutrition. This Quarter, 54 new children were assessed for growth, and 488 children were reassessed who had been seen in previous quarters. Of these, nine children were identified as having either Severe Acute Malnutrition or Moderate Acute Malnutrition. They were then provided with nutritious food supplements and their health status became satisfactory in follow-up assessments. 

Healthy Baby Competitions 

To promote diet diversification and the inclusion of nutrient-dense foods in children’s diets, two Healthy Baby Competitions were also held in Q3 – one in Rugin and one in Bichhya. During the competition, staff assessed the health conditions, height, weight, and MUAC (mid-upper arm circumference) of the children in attendance. There were 299 children who attended across the two sites, compared to just 41 last quarter. The activity encourages nutritious food consumption as the community’s healthiest children receive prizes, and also allows for the identification and treatment of children suffering from malnutrition. From the competitions, 35 children were given food supplements, and it provided the opportunity for staff to promote knowledge about maternal and child healthcare. 

Image 2: Mothers group meeting.

Agricultural Activities  

Part of our integrated approach means that we don’t just provide medical care, but also long-term access to high-value foods and diet diversification through supporting agricultural activities. The identification of children suffering from malnutrition illustrates the issues faced by rural communities that do not have stable access to produce year-round. To improve access to nutrient-dense foods the Start Strong Project aim to support 625 women in agricultural activities, and, so far we have already supported 357 women!  

During this Quarter, seeds and technical support were given to 52 already-supported members, including polytunnel cultivation which offers a solution to the impact harsh weather conditions have on growing crops in Far West Nepal. PHASE’s Junior Agricultural Technicians carried out house visits to 279 members to facilitate capacity building, implementation of planning their livelihoods, and address specific needs – such as what to grow in different seasons and when to harvest.  

Members reported growing and consuming a range of vegetables, such as cabbage and cauliflower, you can read how this benefits families in Shantikala’s story here. However, a landslide in October 2022 meant some members of the agricultural group lost their vegetable gardens, polytunnels, and some houses which has made selling their surplus crops challenging and affected their livelihoods. 

Image 3: A lady with her project-supported chickens and chicken coop.  

Embedding Knowledge 

The final component of the project’s integrated approach is ensuring that we are helping to embed knowledge in the community, to support the long-term sustainability of the project. One way we do this is by holding nutrition training sessions with traditional healers, a total of 42 traditional healers attended sessions this quarter. PHASE staff signposted child malnutrition cases within the community and ensured the traditional healers referred the children to Health Posts for assessment and treatment. Having community leaders be aware of the signs and risks of malnutrition means this health information can be dispersed throughout the community, and hopefully increase referrals to Health Posts to treat preventable, fatal diseases. 

Image 4: Street drama performance.

Another way that we raise awareness around issues is through Street Dramas. Street Dramas are useful for targeting large groups of people, including those who may not be able to access written communication due to literacy issues. The issues addressed in these street dramas were chhaupadi (illegal, forced isolation of women during menstruation), child marriage, and maternal health issues. Two performances were shown, one in Rugin and one in Bichhya, with 178 attendees in total. These sessions highlight how violence against women and girls persists regardless of rights legislation, and spreads awareness of women’s and child’s rights. It also engages the males in the community in the hopes they support the women in the community, and challenge misconceptions that still may exist, such as negative connotations surrounding menstruation. 

Thank you and a Natural Disaster Update. 

We have seen amazing progress over the last nine months, thank you to everyone who took part in the Stay Strong UK Aid Match Appeal in 2021. We look forward to bringing you further updates as the project continues!  

As part of our update this month it is also important to address the natural disasters that have hit Nepal in the last few months. As previously shared, on the 23rd of January this year Bichhya was hit by a 5.9-magnitude earthquake. The main Health Post in Nepal was completely destroyed and the PHASE Nepal health workers are working out of a recently constructed birth centre which was also damaged. This follows the October landslide which damaged the Rugin Health Post. This has made medical treatment in the area more difficult to provide, with more mothers now having to give birth at home unattended. We are actively supporting the communities in this difficult period, however, this highlights just how vulnerable to natural disasters these areas are and how important the work PHASE carries out is. A further update will be provided as and when we have more news to share. 


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