Start Strong Project – Six Month Update

It has now been six months since the Start Strong Project, match funded by the UK Government, launched and we wanted to share an update on its progress to date! The Start Strong Project aims to improve maternal health and reduce malnutrition for 1,000 vulnerable women and their children in Rugin and Bichhaya, Bajura District, Far West Nepal between 1^st April 2022 and 31^st March 2025. Over the course of the 36 months, the project will take an integrated approach to addressing the overall aim, implementing a range of activities to:

1. Improve practice, knowledge and behaviour of maternal healthcare and the first golden 1,000 days for 1,000 women in Rugin and Bichhaya.
2. Increase the availability of high value foods and improve diet diversification through supporting 625 women with agricultural activities.
3. Embed nutritional expertise and knowledge in the community through working with 120 key stakeholders.

Back in the summer, we were happy to share that in the first quarter of the project, we were able to conduct data collection activities with all households across the two communities; start to identify and provide nutritious supplements to 30 malnourished children; and initiate mushroom cultivation activities with a selection of women. The second quarter of the project has been able to build upon the key achievements from Quarter 1 and reach even more people in Bajura, Far West Nepal.

Improving Maternal and Child Health

According to the World Health Organisation (WHO), most obstetric complications during birth can be prevented or managed if women have access to a skilled birth attendant. However, the delivery of primary healthcare faces many challenges in rural areas of Nepal, and this can result in women receiving little support during pregnancy.

Thanks to the Start Strong Project, 43 pregnant women were able to receive their first antenatal care visit; 45 pregnant women were able to receive their fourth antenatal care visit, and a total of 28 deliveries were conducted by skilled health personnel at PHASE Nepal supported health posts in the second quarter of the project. In addition, the project health team also organized orientation sessions for 58 antenatal mothers and their care givers (mother in-law and husband). Having this support throughout their pregnancy improves maternal knowledge and behaviours and reduces the risks from birth complications for women and their children.

The project doesn’t just stop at supporting mothers throughout their pregnancy though, it also supports women through their children’s Golden 1,000 Days. “The Golden 1,000 Days” refers to the time between when a woman becomes pregnant through to the time the child reaches two years of age. Through the project, two community meetings with the mothers of Golden 1,000 Days were held in Q2 to orient them on breast feeding practice and food fortification, with demonstration of the methods of super flour preparation. A total of 44 mothers took part in the meetings and as a result, mothers have reported feeding recommended foods to their children as disseminated in the community meetings.

Unfortunately, some children in the communities still experience malnutrition and in Q2 a further 25 children were identified as Severe Acute Malnutrition (SAM)/Moderate Acute Malnutrition (MAM). These children have subsequently been provided nutritious food supplements to improve their nutritional status and in follow up assessments, the nutrition status of these children was found to have improved. Project health staff regularly assess the health of the children identified as severely malnourished to determine whether improvements are continuing to be made or if further interventions are necessary.

In addition to supporting improvements to maternal and child health, the project has also supported access to primary healthcare for the two communities. A total of 2,633 patients (1,437 Female; 1,196 Male) were checked and provided with essential medicines in the reporting period, whilst project staff also conducted 106 door-to-door visits this quarter, which resulted in 1,203 people (Female 421; Male 782) benefiting from counselling on various health issues. This is an indirect benefit of the project which helps promote health and well-being in the community!

Thanks to the maternal and child health activities implemented, a total of 180 women and their children were supported to improve practice, knowledge and behaviour of maternal healthcare and the first 1,000 golden days in the second quarter of the project!

Figure 1. PHASE Nepal ANM conducting home visit

Food Security

Baseline data found that in the two project communities, Rugin and Bichhaya, less than 15% of households reported being able to produce enough food to feed their families for a full year. Poor food security can lead to high levels of malnutrition, exacerbate the problems of existing disease, and contribute to high rates of infant mortality. With over 70% of children in Rugin and Bichhaya experiencing at least one indicator of malnutrition, it is evident that improvements to food security in the community are necessary.

To help address this, the project identified and started training 100 women to rear poultry, and 178 women in vegetable farming in the second quarter of the project. The beneficiary selection process targeted the most marginalised households and households most in need of support, using a selection criterion that gave priority to households with malnourished children, people with a disability and pregnant women and lactating mothers. Women identified were trained and provided with the necessary materials and equipment, so that they can start implementing the new initiatives and introducing new foods into their diet!

PHASE Worldwide was also happy to learn that the 79 women who took part in the mushroom cultivation activities in the first quarter had all successfully grown mushrooms thanks to the project’s support. PHASE Nepal’s Agricultural Technicians will now continue helping participants through regular household visits to help build capacity and train the women in the community. This will help the women to be able to grow good yields of nutritious food, enabling them to feed their families and increase economic independence by selling any surplus crops to others.

As part of its integrated approach, the Start Strong project has been able to support 357 women through agricultural activities to date, helping to increase the availability of high value foods and improve diet diversification in the communities.

Figure 2. Poultry rearing participant with coup to keep poultry.

Embedding Knowledge

It is not only access to nutritious foods that leads to high rates of malnutrition, but also a lack of expertise and knowledge within communities.

To help reduce these levels and ensure that knowledge and expertise are built and retained within the community, the project held six Female Community Health Volunteers (FCHVs) Meetings, five Health Facilities Management Committee (HFOMC) meetings, and a network meeting in the local Rural Municipality. Through joining regular meetings, it is expected that the FCHVs will develop their own understanding and knowledge regarding maternal and child health and, over time, be able to champion this within their respective Mother’s Group Meetings, whilst conducting regular HFOMC meetings further contributes towards developing knowledge and expertise in the community!

The project has made great progress to date, already supporting 340 women and children to improve their health and 357 women through agricultural activities after just six months of the 36-month project! The activities conducted during these first six months will continue throughout the remainder of the project and over-time will start to create a positive impact in the community.

Thank you to everyone who donated to the Start Strong UK Aid Match Appeal in 2021, we look forward to providing further updates over the next few years as this exciting project continues to change lives in Nepal!

Figure 3. PHASE Nepal ANM running a nutritious food workshop

The Start Strong Project would not be possible without the support from FCDO, PHASE supporters and the Trusts and Foundations that supported the project.

Together we are changing lives in Nepal. Thank you.