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29 Apr 20

Strengthening Health Systems

The current global health crisis is shining a light on the importance of strong, well-equipped health systems, and the dedication of highly trained and skilled health workers. Since we began in 2005, PHASE’s work has always focused on strengthening health systems, building resilience to emergencies and improving long-term health outcomes. This work continues, as now, more than ever, Nepal faces a global health challenge which threatens to overwhelm a struggling health system, putting those living in areas with already sparse service provision and marginalised groups most at risk.  This support strengthens health systems to enable them to meet demand, adapt to change and become more resilient to crisis.

Health systems and change

Nepal is no stranger to a crisis. Decades of civil conflict, political change and the 2015 earthquakes have seen governance structures, including healthcare, change beyond recognition. A new federal political system has de-centralised government accountability and operations, with local governments holding a greater level of responsibility for decision making, funding, resource allocation and management of key services. With regards to healthcare, this presents both opportunities and challenges for the provision of healthcare services. On one hand, a shift to local decision-making presents an opportunity for a greater level of tailored service provision, which meets the needs of, and is led by local communities. It also presents an opportunity for services to adapt quickly according to local need, such as in a crisis.

However, a lack of funding, expertise and human resources has meant that local governments, particularly in remote areas, are unable to meet the demand for services, leaving hundreds of thousands without access to basic healthcare. With many remote communities being most affected by food insecurity and poverty, the need here for healthcare is particularly high. This inability to meet demand also leaves health services vulnerable to being overwhelmed in a crisis. With many remote areas not being in reach of a hospital or higher care facility, local primary healthcare services here are the front-line in any potential emergency.  Therefore, it is in these areas that PHASE prioritises support.

Equipment and training for health workers

Many health posts PHASE supports are in remote areas, with limited or no road access, especially during the rainy season. Experienced logisticians based in PHASE Nepal’s office in Kathmandu work to source and transport all essential medicines and equipment required to run the health posts all year round and ensures health workers can treat a wide range of illnesses and injuries. In areas with no hospitals within reach, these supplies are essential and ensure that equipment and medicines are available to save thousands of lives each year in a wide range of scenarios. Auxiliary Nurse Midwives live and work within each community, are able to respond quickly and have a deep understanding of community needs and the needs of the most vulnerable. ANMs are experienced health professionals and receive regular training in a wide range of topics, ranging from routine to critical care.


Public health education

Alongside treating patients, a key part of PHASE’s work is to increase public health knowledge and preventive measures. This includes child health and malnutrition, diseases, maternal and reproductive health. Auxiliary Nurse Midwives deliver training to Female Community Health Volunteers, women’s groups, health committees, teachers, schoolchildren, and traditional healers. Training focuses on practical measures to share learning with others, ensuring that key health messages are disseminated widely. This embeds knowledge within the community, promotes wider conversations around health and increases familiarity with health services and workers. Since the earthquakes in 2015, preparedness for disasters, and reducing the risk of communicable disease has been a key part of this programme, increasing awareness of handwashing, hygiene and avoiding contamination.

Locally driven

Importantly, PHASE works with the community to ensure that local voices are at the heart of healthcare delivery within the community. Local people are invited to share their thoughts, feedback and challenges every 6 months at public audits as part of PHASE’s ongoing work in each community. The aim of this is to ensure an ongoing dialogue with the community and those responsible for healthcare delivery and promote meaningful participation in and leadership in building the capacity of healthcare services.

All these aspects combined, improve resilience to system strain and crises, improves long-term health outcomes, increases trust in health services, and also holds the government accountable to provide services that are fit for purpose.

We’re continuing to closely follow updates around Covid-19 in Nepal and supporting our colleagues at PHASE Nepal. Our ongoing work continues to ensure that remote communities always have access to quality healthcare.

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