An external research team conducted a retrospective study to enumerate all maternal and neonatal deaths in the district within the last calendar year. All deaths were validated using the WHO’s verbal autopsy tool to determine the exact mortality causes. A cross-sectional survey was also conducted to assess health service utilization and health behavior-related indicators of the women who delivered a child within the last 12 months (i.e. recently delivered women).

In Khotang, between baseline (2016) and endline (2022):

• SBA attended deliveries increased by 86%

• Institutional deliveries increased by 135%

• Maternal mortality was reduced by 47%

• Newborn Mortality was reduced by 42%

These impressive results are due to the fact that when the OHW programs were initiated in 2016, only 20% of women in the district were able to access care for their pregnancies and childbirth needs. As such, our interventions were able to make a significant contribution to both access to and quality of MNH care in the district.

The Social Welfare Council (SWC) is the governmental agency responsible for the oversight of the projects implemented by non-governmental organizations in Nepal. In the first quarter of 2023, the SWC conducted an evaluation of our project in the Taplejung, Udayapur, Panchthar, Sarlahi, and Dhading districts. During fieldwork, they conducted interviews with key stakeholders, including health workers, Health Facility Operations and Management Committee (HFOMC) members, municipal health coordinators, FCHVs, heads of District Health Offices, mayors, and OHW staff.

They also observed BCs that had been upgraded by OHW. They reported that our project design was “very pertinent, including the use of a comprehensive baseline assessment allowing for the appropriate alignment to population needs, social and contextual realities. The Network of Safety approach, training conducted in close coordination with government training agencies, was highly relevant to the context and well aligned with OHW’s strategies and goals. The overall design was comprehensive, well-developed, and adaptable to changing needs and constraints. The inclusion of FCHVs to aid with community sensitization and community based follow-up with mothers and their newborn was also an important element of the design. The project adaptability during COVID-19, swift allocation of resources to deal with the pandemic was widely accepted.”

Dartmouth College in the United States and Social Sciences Baha in Nepal have completed their external evaluation. While the full report is currently being finalized, their preliminary findings reveal that OHW’s intervention has had an overall significant and positive impact on the lives of pregnant women, new mothers, and their infants, resulting in marked changes in the knowledge, behavior, and attitudes of rural women of child-bearing age. Qualitative interviews with key individuals across the study sites indicate a deep appreciation of OHW’s interventions. One major contribution repeatedly mentioned is the support provided to birthing centers and the training of SBAs. OHW’s training of HFOMCs is often the only training committee members have undergone, and even when others are mentioned, OHW’s sessions are singled out as having the most impact. Health workers also highly value OHW’s training, acknowledging that their work would not have been as effective without it, even in districts where OHW ended operations years earlier. The involvement of health workers in outreach activities has enabled reaching a much larger group of pregnant women and mothers. We look forward to making the full report publicly available as soon as possible.