Health Promotion in rural

Nepal

Jane Stephens, Director

Green Tara Trust (UK)

Purpose of Programme• Government policy and health systems change

need to be informed by good quality evidence from the field, and vice versa

• All forms of good quality evidence need to be included- qualitative, quantitative, case studies, lessons learned from implementation of field programmes

• Create opportunities for dialogue between field, district, national and international level where all are seen as equally valuable.

Health Promotion Cycle

Health Promotion

Cycle

Programme Planning

Needs assessment

Evaluation

Implementation

Our methods

Helping communities find their own solutions to health problems

Needs assessment

• First Phase: (2006)• What is the situation on the ground?• Available data - GON, university student

projects, Gvt. and NGO programmes• Community visit, broad FGDs and IDIs- identify

main problems• Second phase:

• Needs assessment- quantitative and qualitative• Confirm problems, find out WHY problems exist

and main players

Needs assessment• Third phase:• Dissemination of findings • Fourth phase:• Negotiation of community priorities

between different groups and who will take responsibility for each part?

Young people Fertile Women Mother in laws Fathers Teachers Politicians Health workers

Programme planning from Needs Assessment

• Identified 3 major target areas• Improving antenatal attendance & quality of

care• Increasing women’s decision making power

around health decisions• Increasing number of women having trained

attendants at delivery• Participatory Action Research: monitoring by

community-empowerment & sustainable behaviour change, external monitoring by GTN staff, external evaluation

Sketching Monitoring Map in Village

Implementation – Main Activities

• 2 Government trained HW - HP for 10,000 people

• Reactivation/ formation women’s groups• Home visits• Mass events • Training for traditional healers, FCHVs• Support to health facilities: goods, mentoring• Mobile ANC clinics in areas far from health post

Implementation – Resources required• People; key community players• Skills: training in HP & PRA • Motivation to improve own and community’s

health• Infrastructure: existing buildings, health

facilities, empty community buildings• Support from main players at ALL levels• Transparent & clear health systems with people

in ‘post’• Goods: teaching materials, small incentives• Small amounts of money: transport, meetings

Implementation – Challenges• Previous NGOs providing incentives: hard to change this

behaviour• How can we encourage environment of positive

behaviour change that is sustainable in this environment?

• Critical thinking and ability to reflect• Participation requires some self-confidence and breaking

down of hierarchy; and we can only set up environment, people need to take responsibility for their own behaviour

• How can we set up the conditions for this shift in thinking and behaviour to come about in Nepal?

HP in low-resource setting: rural Nepal• Greater need and

scope of health promotion

• Advocacy in support of health promotion at all level

• Alliances & networks

• Need to move beyond disease prevention approach

Paper is freely available on the web: www.healthrenaissance.org.np/uploads/7141_24852_1_PB.pdf

Thank youContact

UK

Karunamati: doctorjane99@hotmail.com

Padmadharini: Director- gttpadmadharini@gmail.com

Nepal

Green Tara Nepal: Ram Chandra Silwal, Country Director

gttn@wlink.com.np