Q2 Report 2024

April - June

Top photo: Bhagawati Shrestha (left) leading a Training session for health workers in 2018.

Bottom photo: Bhagawati leading a donor visit to an OHW upgraded birthing center in 2023.

Dear One Heart community,

It is my absolute honor to write to you today as the new Deputy Director of One Heart Worldwide. I am assuming this role at a very exciting time for our organization, as we have several innovative projects underway.

In this new position, I oversee the team responsible for setting up the simulation-based training laboratories in seven hospitals nationwide. These laboratories will give MNH service providers much-needed hands-on experience practicing in realistic scenarios, which we expect will improve their ability to provide quality care to mothers and newborns. I am enjoying working with our partners at the hospitals, as well as Laerdal Global Health and USAID, to make this vision a reality.

To ensure the sustainability of our innovative simulation-based training methodology, the team and I are also working with the Government of Nepal to integrate the methodology into the official training curriculum for skilled birth attendants. Once this is completed, every new SBA in Nepal will have the opportunity to benefit from this improved training technique.

Lastly, we are pleased to report that the deployment of our simulation-based mentorship program across all of our active implementation districts is well underway. With the help of generous donors like you, we are currently training the clinical mentors who will provide continuing education and support to rural SBAs. The feedback from this program is already overwhelmingly positive, and we hope it will lead to improved job satisfaction among mentees.

When I began my career as an obstetric nurse, I never could have imagined that this profession would lead me to where I am today, but I am delighted it did. I can’t wait to see what the future holds for One Heart Worldwide and maternal and infant health in Nepal.

Dhanyabad from Nepal,
Bhagawati Shrestha

Program Highlights

We signed a partnership agreement with Noora Health to implement their Care Companion Program (CCP) in three hospitals in Nepal. The maternal and newborn care CCP trains family caregivers to support pregnant and postpartum women and their newborns at home. In addition to receiving on-site training in hospitals, families are connected to mobile support and health content to help answer their questions. The One Heart team will adapt program materials and train healthcare providers to deliver the CCP at the hospitals where they work. This quarter, we completed the project inception meeting at all hospital sites and began the staff hiring process for this project.
With generous support from The DAK Foundation, OHW has joined a coalition alongside organizations from five African countries to provide global mentorship on improving access to rural obstetric ultrasound (ROUSG). The goal of this coalition is to generate the type of compelling evidence required by the World Health Organization to incorporate new initiatives into its global health practices. The coalition aims to enable collective efforts in resource development, expertise sharing, and overcoming challenges through shared experiences, ultimately leading to a broader global impact. This quarter, we hired a Project Manager to support the project, which we expect to last for two years. This is an exciting opportunity for OHW to share our expertise with our coalition partners in Kenya, Uganda, Togo, Malawi, and Rwanda.
In May, we officially launched our program in Jajarkot, the district most affected by the November 2023 earthquake. Our team met with key district-level stakeholders to tailor our response to the local needs. The damage caused by the 2023 earthquake compelled us to prioritize our intervention in Jajarkot to quickly rehabilitate the severely damaged health facilities in that area. As pregnant women and infants’ unique needs are often overlooked during humanitarian response activities, our approach prioritizes restoring healthcare services for these vulnerable populations.
Work on our simulation labs continues to progress. This quarter we completed the project inception meetings and the needs assessment for each site, taking stock of the physical infrastructure, classroom furnishings, and the availability of trained human resources. We have begun procuring contractors to perform the necessary cosmetic repairs of the sites. In addition, we completed the research tool, which will examine the utilization and utility of the labs and their impact on patient outcomes after healthcare service providers receive their training.
We hosted a two-day workshop to support municipalities that required extra help with their annual health planning and budgeting process. The workshop addressed specific municipal issues and challenges related to MNH. We also conducted collaborative discussions that led to the identification of specific MNH activities that can be cost-shared between OHW and each municipality. Going forward, we are now set to build upon these health plans and the strengthened relationship with the participating municipalities.

Program Delivery

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Research & Development

In April, the Nepal Health Research Council invited One Heart to present the results of our simulation-based mentorship pilot program at the Tenth National Summit of Health and Population Scientists. The summit's theme was “Advancing Health and Population Research and Innovations: Achieving the SDGs.” The complete study and results may be found here, and a technical brief summarizing the study and results may be found here.
Three members of the One Heart team conducted a post-completion visit in the Terathum district to assess the sustainability of our program. The team visited all six municipalities and reported that two years post-completion, the health system improvements driven by the OHW intervention were maintained. All six municipalities were still prioritizing MNH in their plans. The equipment provided by OHW was still in use, and all but one BC had the necessary equipment, supplies, and essential drugs to provide quality MNH care. All but one facility had at least one trained SBA. The MNH helpline and the rural ultrasound program were appropriately maintained. The team noticed gaps in implementing the quality assessments and irregular follow-up training for healthcare providers. A set of recommendations was developed and presented to the local authorities. The One Heart team plans to use the data and lessons learned from this informal visit to develop a more formal assessment protocol and assessment tools.
The baseline study reported that 82% of the pregnant women gave birth in a health facility, and 92% received four antenatal visits per protocol. Only 20% of recently delivered women were using family planning devices. Four maternal deaths and 76 neonatal deaths were reported in the last 17 months. The major causes of neonatal deaths were perinatal infection (32%) and perinatal asphyxia (28%), both preventable with appropriate care. Out of 35 birthing centers, only 28% had a complete delivery set, 23% had a resuscitation kit, and only 64% had oxytocin available in the delivery room. Nearly 80% of these birthing centers had done minimum service standard quality assessment in the last year, and 60% had scored below 70%. This study further highlights the need for OHW to focus our intervention on the quality of MNH care provided by the health facilities.

A model health system: Jwalamukhi’s success in sustainability

The transformation of maternal and newborn health (MNH) services in Jwalamukhi Rural Municipality, Dhading District, is a testament to the success of the Network of Safety implemented by One Heart Worldwide (OHW) between 2015 and 2021.

With OHW’s support, the Maidi Health Post became a model facility, offering safe and comfortable birthing services that inspired the creation of additional maternity homes. Since OHW’s departure in 2021, local government and Female Community Health Volunteers (FCHVs) have ensured the program’s sustainability. Their efforts have led to significant improvements, including zero maternal deaths in the past three years, highlighting the lasting impact of OHW’s work in Dhading.

Read about OHW's Impact in Dhading