Virtual Ultrasound Mentoring Program

Success (+)

To enhance the clinical competencies of the SBAs who have completed our initial ultrasound training program, we launched a virtual ultrasound mentoring program via Zoom.

We invited a radiologist and master trainer from the National USG training site to facilitate meetings so service providers could share their day-to-day utilization challenges and receive constructive feedback.

Two virtual meetings have been held, serving 30 SBAs thus far.

Program Completion In Dhading

Success (+)

The OHW program in Dhading has been successfully completed, and all activities fully handed over to the local government and stakeholders!

Given current travel restrictions due to the pandemic, the district’s endline survey is planned for the end of 2021.

Effects of the Pandemic on our Programs

Challenge (!)

The ongoing pandemic continues to present challenges for our team.

While our field teams have gone above and beyond to catch up after the lockdown in Q2,  some activities will have to be rolled into 2021.

We delayed the start of transition to the end of Q1 in four of our program districts (Khotang, Taplejung, Sankuwasabha, and Okhaldhunga) to complete our program targets in these districts prior to transitioning them out.

We also extended the set-up phase to the end of Q1 in Parbat, Mygadi, and Sarlahi to complete our baseline surveys.

To read more about our COVID-19 Response, click here.

Dissolution of the House of Representatives

Challenge (!)

Following political turmoil and disputes within the ruling party, the President of Nepal dissolved the House of Representative (HoR) in December, calling for its election in two phases on April 30 and May 10, 2021.

These ongoing internal conflicts could impact our programs by creating delays in our five-year renewal agreement with the Social Welfare Council and delays in our general program implementation plans.

Dartmouth College - External Impact Assessment

Research & Development Update

The Dartmouth-led team resumed their activities after a nine-month delay due to the pandemic.

The protocol was modified to consider the new COVID-19 safety protocols and modifications to our data collection instruments in an effort to differentiate the effect of our program from the impact of COVID-19 on access to and utilization of MNH services.

Approval for these modifications was obtained from the Nepal Health Research Council. New field teams were hired and trained.

We expect phase - 1 of the fieldwork (data collection process) to be completed by the end of Q1 2021.

DHIS-2

Research & Development Update

DHIS-2 is the electronic version of the current aggregated service delivery data reporting system collected in each health facility.

OHW is assisting the government in transitioning the current paper-based process to the electronic version in three of our current districts (Sindhupalchok, Sankhuwasabha, and Terhathum).

This quarter, our team completed training sessions with 103 healthcare workers despite the pandemic.

Data collected from the facilities enrolled in the program show significant improvement in both timeliness and quality of reporting.

As of the end of 2020, this program’s rollout has now been completed in all palikas nationwide.

HMIS 3.6.1

Research & Development Update

HMIS 3.6.1 is a pilot study of an individual patient record system that does not aggregate service delivery data.

We had planned to have completed this pilot project by the end of 2020.

As with many other research projects, our project was interrupted by the COVID pandemic.

This quarter we continued to provide on-site coaching and support for the 20 SBAs that were trained prior to the lockdown.

The remaining 65 SBAs requiring training will receive it by the end of Q2 2021.

Maternal and Newborn Health (MNH) Emergencies Helpline

Research & Development Update

OHW developed a helpline to assist rural MNH services providers in clinical decision-making.

This program was designed in anticipation of scenarios where rural health services providers might be faced with an MNH emergency in which referral to a higher facility might be delayed or not be possible at all given the impact on travel accessibility due to the pandemic and remoteness.

We enrolled another 2 facilities in this program during Q4 bringing the total number enrolled to 781.

During Q4, 87 emergencies (pregnant women/newborns in distress at a rural health facility were managed through the helpline.

Telehealth Program for Rural Health Facilities

Research & Development Update

This program allows Skilled Birth Attendants to provide cellphone-based consultations for pregnant women (antenatal care) and recently delivered women (postnatal care).

This ensures that all women can still receive the health education and support they need during this vulnerable period while limiting unnecessary exposure to COVID-19.

Including the 127 health facilities enrolled in Q4 alone, we have rolled out this program in 583 health facilities in total, impacting 4,424 pregnant women with ANC services and 3,030 postpartum mothers with PNC services.

Continuum of Care Simulation-Based Mentorship Program for SBAs

Research & Development Update

We received 50 sets of birth simulators and skills trainers donated by Laerdal Global Health to implement this mentorship program.

OHW is working with Laerdal Global Health to design and implement this simulation-based training program.

The training manual draft is currently under review and is expected to be finalized by the end of Q1.

We expect to start the first batch of training in Dolakha and Udayapur as soon as the manual is completed.

Rural Ultrasound Training Curriculum Revision

Research & Development Update

Based on the recommendations from our evaluation of the rural ultrasound training program, we began to revise the current training package to make it a competency-based standard curriculum in order to improve the quality of service delivery.

We are working in partnership with the National Health Training Center (NHTC) who recently formed an expert technical working group for this curriculum revision process.

We expect the curriculum revision to be completed by the end of Q2 2021.

Story from the field

Building a culture of sustainable safe motherhood system in rural Nepal

One Heart Worldwide’s partnership with Nepal’s rural municipalities for upgrading birthing centers is helping the Nepal Government’s effort to enhance the quality of maternal care for new mothers who live in the most remote parts of the country. This story focuses on the success of the partnership in a rural municipality in Khotang, one of the country’s most remote districts.

By Naresh Newar in Khotang, Nepal

Birthing Center featured in the story is sponsored by Thankyou.
Thankyou. is a longtime partner of One Heart and we are forever grateful for their continued support—through natural disasters and global pandemics!

Nisha with her son Nirjal. Both survived a complicated pregnancy with help of nurses at the birthing centre.

“I am so lucky that the health post did so much to save both of us. I feel so relieved thinking about how so many mothers like me feel so safe.”

Nisha cuddles her four-month-old son, Nirjal, trying hard to keep him warm from the chilly weather in the rural municipality of Diprung Chiuchumma.

Winter is harsh in the area.

Most of the time, she is unable to use the electric heater to keep her room warm due to constant power outages.

Her only alternative is firewood, but she is afraid the smoke will cause indoor pollution and damage both of their health.

This rural municipality is nestled in Khotang, which is considered to be one of Nepal’s most remote hill districts.

It adjoins Solukhumbu, the home district of Mount Everest, to the north.

Like many rural municipalities of the district, Nisha’s home is not easily accessible by road, and due to seasonal weather changes, most villages lack road access throughout the year.

Even during the dry winter season, the motorable roads can be dangerous.

With the high risks for transportation and the far distance, commodities become expensive for the locals to buy.

This is the reason why most of the young men in this municipality have headed down to towns and cities for livelihood opportunities to support their families.

Nisha’s husband has also temporarily migrated to the far-off town of Hetauda where he works as a cook in a restaurant to support Nisha, their son, and his elderly parents.

Their family used to depend on farming for a livelihood, but they couldn’t survive due to low farm productivity.

The costs for maintaining productive farmland doesn’t come cheap, as it is expensive to buy seeds, compost, fertilizer, and farm laborers.

Water supply is also scarce and the irrigation system is underdeveloped.

Most families depend on food imports like rice, grains, vegetables, and other essential commodities transported from the southern plains – known as the Terai.

Despite the hardship in the village, the one thing that local communities feel relieved about is the improved maternal healthcare system largely promoted through the success of the birthing center at Sapta Chhitapokhari Health Post,

Sapta Chhitapokhari Health Post was upgraded in 2018 by the local municipality with the help of One Heart Worldwide (OHW) as its development partner.

“I am so lucky that the health post did so much to save both of us. I feel so relieved thinking about how so many mothers like me feel so safe,” says Nisha, as she hugs and kisses her little four-month-old son.

There was a complication during Nisha’s delivery.

Her baby was in the breech position—which is considered high risk for the infant.

The team worked for 13 hours to save the child.

Nisha was in grief thinking that her child was dying when he didn’t make a sound.

Finally, after two hours of unknowns, the baby cried.

Diprung Chiuchumma rural municipality.

Both OHW and the Diprung Chiuchumma Rural Municipality have equally invested in renovating the health post.

The health post is now equipped with:

• new high-quality medical equipment,

• an ultrasound machine,

• beds,

• heaters,

• a solar suitcase (solar electric system with highly efficient lighting and power for mobile communication and medical appliances),

• and built a functional toilet and water supply system.

The nurses were sponsored for professional training in Kathmandu-based Paropakar Maternity and Women’s Hospital – the biggest maternity hospital in Nepal - to become skilled birth attendants (SBAs).

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Kopila, who received the SBA training, recalls how the partnership initiative has transformed their maternity services.

“Ever since One Heart Worldwide helped us to rebuild our birthing center, there has been substantial improvement in maternal care in all seven wards of our rural municipality,” says Kopila.

Nurse Kopila:

“Due to the birth center, our maternal care system has improved and helped to prevent pregnancy risks and substantially increased institutional deliveries.”

She says the upgraded birthing facility has helped to prevent maternal and infant deaths, and now more mothers feel safe even during pregnancy-related complications and birthing.

Prior to this improved birthing center, deliveries were done mostly at home with very few institutional deliveries.

Now the tables have turned and there are only a handful of home delivery cases.

Kopila and other nurses at the health post used to make frequent visits to households to help in birth deliveries at homes, as most families did not see the value of institutional deliveries.

But that has now changed, and, according to the health post’s records, over 90 percent of birthing had been done at the birthing center in the last two years.

Her team has also dealt with the most complicated cases.

During our reporting, we visited the birthing center where Kopila and her team were involved in a complicated case where a young mother was going through prolonged labor for nearly twelve hours.

Her family had been waiting outside in the cold weather since 6 in the morning.

It was already 5 PM and, still, there was no sign of birth delivery.

When her team realized that it was getting risky, the team escorted the young expectant mother to the district hospital where a team of doctors and nurses were on standby.

Eventually, they did a cesarean to deliver a healthy boy at 3 the next morning.

Kopila returned at 4 AM in the cold and her daughter was alone at home.

But the next day, she was up early at 7 AM to resume her duty.

“It is a very rewarding job to see a successful delivery, and even though we are exhausted most the time, it feels great to see the joy in the faces of the families when they hold their healthy newborn,” says Kopila.

“We have a very good network system with specialists, not just in the district but also in Kathmandu, where we can call at any hour for medical advice.

If we hadn’t taken the SBA training, we would have probably taken a lot of risks that could endanger the mother’s life.

Now that we have more knowledge, we are very careful.”

She shared how in the past, prior to the SBA training, the nurses often used an oxytocin injection that can cause contractions of the uterus to increase the speed of labor.

They didn’t realize that the use of oxytocin results in excessive contractions and poses a risk to both the baby and mother.

Dhanmaya waiting for her daughter-in-law who is in labor inside the birthing center.

“It feels so good to have such a birthing facility even in our remote village so that the new mothers will not have to risk their lives and lose their babies at birth.”

“The nurses are so trained and I have full faith in them to save my daughter-in-law and our grandchild.

I wish we had such care during our time,” says Dhanmaya, who had been waiting outside the birthing center for 12 hours to hear the news of her daughter-in-law.

But she wasn’t as worried as the rest of her family.

She has full trust in the nurses and believes that mothers and infants don’t face risks like in her days.

Dhanmaya was only 15 years old when she had her first child.

Then, over the years, she had 14 children.

Four of them died during childbirth at home.

She shares how it was common during her days when women bore 14 to 15 children in her village.

She recalls how painful it was then for the young mothers.

“It feels so good to have such a birthing facility, even in our remote village, so that the new mothers will not have to risk their lives and lose their babies at birth,” explains Dhanmaya, who has witnessed frequent deaths of mothers and infants in her village. “Back then, all we did was to pray to god for help and face our fates.”

December 2020, Khotang, Nepal

Women in Healthcare Spotlight

Meet Nirmala Rai.

Nirmala is the Sapta Chhitapokhari Health Post In-Charge.

She is also one of the few women to hold such a position, where most men head the health posts.

Nirmala has been working at the Sapta Chhitapokhari Health Post for the last four years.

When she first started her job, the health post building had no birthing center.

There was no medical equipment or a proper bed or a separate room for delivery.

Unsurprisingly, the FCHVs were unable to convince the families to visit the health post for institutional delivery.

Things started to change after the renovation of the birthing center in 2018.

“In two years, we have been successful in increasing institutional deliveries, and the cases of home deliveries are almost nil,” says Nirmala.

Their records show that they have almost reached the target of 52 live births per year through institutional birth delivery.

She further explains how OHW’s support has helped them to set up a system that can make maternity care sustainable without being highly dependent on international donor funding.

“There is high morale among our staff today since the birthing center was renovated. We have so many success stories to share due to better service. We will always be indebted to One Heart Worldwide’s support.”

By Naresh Newar in Khotang, Nepal