OUR 2021 COVID RESPONSE

To respond to the request of the Government of Nepal and maintain the continued safety of rural pregnant women and their newborn infants, our COVID approach has been two-fold:

1. Provision Of Emergency Medical Equipment And Supplies 

Thanks to the generosity of our donors, we distributed $2M worth of essential emergency medical equipment and supplies (including PPE) to ensure:

1. All rural health facilities providing essential care to pregnant women and their newborn infants in our program districts could safely maintain their services.

2. Health facilities managing COVID patients had all of the necessary equipment and supplies they needed to manage patients

3. Pregnant and recently delivered women who were in isolation due to COVID had the required supplies they needed to manage their quarantine period

We provided equipment and sanitation supplies to all of the health facilities in our program districts. Thanks to our generous donors, we also supported several health facilities managing COVID patients outside of our program districts.

2. Continued Access To Quality Maternal And Newborn Health (MNH) Care 

We have learned a great deal since the beginning of the pandemic which we continue to apply in order to adapt and improve our program delivery to ensure pregnant mothers and their newborns in rural Nepal can continue to access quality MNH care. During this past quarter, we deployed the following activities:

Government service delivery guidelines training:

This activity aims to ensure that local stakeholders and health facility staff continue to adhere to appropriate guidelines for MNH service provision during the pandemic and protect the safety of mothers and newborns. We trained 965 community level healthcare providers and 94 local stakeholders on the Government’s Interim Guidelines on the  provision of Maternal, Neonatal, and Child Health (RMNCH) services.

Moving existing programs to a virtual platform:

We continue to seek new ways to apply lessons learned and incorporate various virtual platforms into our implementation strategy to allow the safe execution of our life-saving interventions during the pandemic and beyond if proven successful. We are also exploring a hybrid approach which would conduct the initial training in-person and all follow-ups remotely,  increasing the engagement frequency while saving travel time and maintaining the program’s integrity. The following program elements have already been integrated into a virtual platform:

1. Remote technical assistance to the local municipality offices throughout their annual health planning and budgeting processes (28 out of the 63 sessions implemented this quarter were conducted virtually )

2. Remote coaching and mentoring was provided to 303 rural SBAs 

3. Rural Ultrasound training follow-up: This was offered as a follow-up activities for SBAs who had previously undergone the government ultrasound training (112 virtual refresher training sessions were offered in Q2)

4. Quality of Care programs for BC: While the initial visit is done in-person, 40 follow-up visits have been implemented virtually.

Social Media support group for Rural SBAs:

Rural SBAs were already isolated prior to the pandemic. The pandemic only made things more difficult for them. Many of our SBA trainees expressed their wish to be connected to other health professionals practicing in similar conditions. To this effect,  we created a dedicated private group on Facebook for our SBAs. Facebook is quite popular in Nepal as its widespread use has been noted in recent studies, and it is easily accessible through computer, laptop, and small portable devices (tablets and smartphones). Admission to this group of 300 members and growing is vetted by an OHW staff serving as group moderator and is responsible for posting relevant information and updates.  Members are encouraged to share their challenges/experiences and supportive dialogues/discussions are fostered. We plan to invite MNH experts to present new data and provide feedback as needed. 

Ensuring availability of life-saving drugs:

Availability of essential obstetric drugs such as Oxytocin, Magnesium sulfate (MgSO4), and Misoprostol in the rural birthing centers is crucial to prevent maternal deaths. Additionally, the birthing centers staff are required to provide Misoprostol to female community health volunteers (FCHVs) to distribute to all pregnant women. This past quarter, the OHW staff reached out to 236 healthcare providers to review  their available stock of essential drugs and facilitate the procurement of missing items with the relevant municipality level government authorities. The team also ensured that all FCHVs were provided with adequate supplies of Misoprostol. The OHW staff also followed up with 2,838 FCHVs to track any maternal deaths and ensure that FCHVs are distributing Misoprostol to every pregnant woman at 8 months in their gestation period, along with appropriate counseling for birth preparedness.

Telehealth program:

The Telehealth program supports Skilled Birth Attendants in adapting their pre-COVID in-person consultations to cellphone-based consultations for pregnant women (antenatal care) and recently delivered women (postnatal care). 21 new health facilities joined our telehealth program this past quarter.  In all so far, 4,709  pregnant women and  1,974 recently delivered women were reached by medical providers in our active program districts.

Maternal and newborn health (MNH) helpline: 

This program was designed in anticipation of local providers faced with emergency MNH scenarios in which referral to a higher facility might be delayed or not be possible at all due to the COVID travel restriction. 34 new health facilities joined our MNH helpline program. With the enforced travel restrictions, the service utilization of the MNH helpline has increased significantly during Q2 with 78 phone consults and 3 mothers successfully evacuated by helicopter.

Development of COVID-related information materials:

With the approval from the National Health Education, Information, and Communication Center (NHEICC), we translated and adapted 6 infographics and 3 videos developed by Noora Health, to the Nepali context. These materials focus on COVID-19 related topics, such as home isolation, breathing exercises, and care for the elderly, high risk individuals, and COVID patients. Our team printed and distributed 2,200 sets of infographics, 1700 were distributed  to health facilities in our program districts, and 500 were included in the isolation kits we developed for COVID positive pregnant women or recently delivered women in home isolation. Additionally, these materials were shared on OHW’s Facebook page and made available on the government’s website. 

Radio messaging for pregnant women: 

We used local FM radio stations in our program districts to broadcast messaging specifically designed for pregnant and new mothers (danger signs, service use reminder, service use at the time of COVID and COVID prevention message). Each radio station broadcasted at least 10 messages per day for a total of 41,400 spots broadcasted this past quarter. 

NEW PARTNERSHIPS:

As we initiate the renewal process of our 5 year project agreement with the Social Welfare Council (SWC), we have been asked to incorporate local NGOs into our implementation process. To conform to this new mandate, we developed guidelines to identify appropriate NGO partners for our program districts and we have published a formal expression of interest to seek out these new partnerships. By the end of the year, we aim to identify an appropriate local NGO to support our community-based work for each of our 15 additional districts.

THE SECOND WAVE IN NEPAL:

At the beginning of Q2, there was not a single district in Nepal left untouched by the pandemic. The severity of Nepal’s second wave quickly overwhelmed an already fragile healthcare system struggling with shortages of oxygen cylinders, vaccines, and isolation centers. By the end of April, the Government of Nepal imposed a strict lockdown in hopes of containing this second wave of infections, which in turn impacted the delivery of our in-person program activities. By mid-May, there were more than 9,000 new infections daily. Despite the lockdown over May and June, the second wave accounted for nearly ⅔ of both new infections and deaths since the pandemic began. By the end of Q2 infection rates had decreased, though there were still nearly 2000 daily new infections reported as of June 30. By the end of Q2, the lockdown was eased, but travel restrictions were maintained, further impacting our in-person program delivery. The likelihood of a third wave in the fall is high given the slow vaccination rates and overall shortage of vaccines.

THE 2021 MONSOON SEASON

Climate change is directly impacting Nepal with monsoons rains getting progressively heavier and lasting longer each year.  Some areas saw double the amount of rain expected in just one month. The added precipitation, compounded by ongoing deforestation, created floods and landslides which destroy roads and local settlements. While our program always takes into consideration the monsoon season, the heavier rains and resulting landslides have made many areas much harder to reach and have impacted our team’s ability to deliver our COVID-relief and conduct our regular program activities.