Female community health workers attend a class in the Bardiya District Hospital in Bardiya, Western Nepal. Photo credit: Suzanne Lee/Save the Children.

Save the Children works with district health offices to build the capacity of female community health workers who are on the frontline of health service provision like ante-natal and post-natal care in Nepal. They also work with communities to reduce child marriage and teenage pregnancy especially in rural areas.

In Nepal, Banas Ram and his wife Khetrani were blessed with a baby boy after 20 years of marriage but their happiness had a complicated twist. Khetrani was brought to the hospital in a bullock cart from her village almost an hour away from the health post in Dhodari in Bardiya district. Her baby had suffocated and the placenta had already detached.

Auxiliary Nurse Midwife Pushpa and Jhamkali, Maternal and Child Health Worker helped her give birth but the baby was not breathing. While Pushpa worked on saving the mother, Jhamkali started cleaning the baby’s wind pipe. After being assured that the mother would live, Pushpa and Jhamkali started resuscitating the baby. They didn’t give up: after 35 minutes the baby final started breathing and crying. The two health workers immediately called an ambulance to avert any danger to the baby. Pushpa went along with the mother and father to the Bheri Zonal Hospital, the biggest hospital in the region at 1 in the morning, admitted the baby at the Neonatal Intensive Care Unit to make sure that the baby got the best possible chance at living. This is why Save the Children Nepal is campaigning skilled health workers, in every village so that ever baby born has an equal chance of surviving.

Neonatal mortality rate  (per 1,000 live births) (2011) 27
Under-five mortality rate (per 1,000 live births) (2011) 48
Maternal mortality ratio (per 100,000 live births) (2010) 170
Number of doctors, nurses and midwives per 10,000 people (2010) 2.1
Births attended by skilled personnel (2011) 36%
Total expenditure on health as a percentage of gross domestic product (2011) 5.4%
General government expenditure on health as a percentage of total expenditure on health (2011) 39.3%

Although many essential services in Nepal are nominally free of charge, particularly to poor and marginalized groups, there is evidence of inadequate resources to meet demand, and out-of-pocket payments constitute 62% of total health expenditure.

As a low-income country with predominantly rural population, communicable diseases remain the greatest challenge, although their burden is declining. Furthermore, Nepal has made good progress towards reducing maternal and infant mortality, and is on track to meet both MDG 4 and 5.

However, availability of physicians, nurses and midwives is still low, and with limited likelihood of scaling up to meet indicative thresholds by 2035. Community health workers play an important role in the provision frontline of health services such as ante-natal and post-natal care. There may also be challenges in acceptability with only a quarter of female physicians and a ratio of nurses to physicians below the OECD average. Regulation and accreditation mechanisms are in place through the various health professional councils. However, the evidence points to challenges in motivation, retention and performance of the health workforce, which the current HRH Strategic Plan (2011-2015) is attempting to address.

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