WUNRN
By Damakant Jayshi
|
KATHMANDU,
Dec 16, 2010 (IPS) - For the last 17 years, Keshari Maharjan has been going
door to door in the outskirts of the Nepali capital to tell people about the
services available at health centres in their communities, as well as about how
to prevent certain diseases.
It hasn’t
always been easy for Maharjan and other community health volunteers like her.
Indeed, she says, "It was very difficult those days when people suspected
(us) of various ill intentions."
Yet they
must have been doing something right all these years. According to Maharjan
herself, she has noticed that there has been improved awareness about
sanitation, diseases, and health centre services in the last several years.
That’s not
all, though. Manik Ratna Shakya, head of the Satungal Health Post, says,
"Along with the government’s and several donors’ incentives and
initiatives, their (the volunteers) contribution – a selfless one at that – is
the biggest in meeting the target of reducing maternity and child mortality
rates."
For sure,
it’s not an achievement to scoff at, since it means that this impoverished
Himalayan country is likely to meet the fifth Millennium Development Goal (MDG)
on improving maternal health.
In fact,
just this September, Nepal was selected by the MDG Awards Committee, in collaboration
with the United Nations Office for Partnership, to be among 49 Least Developed
Countries that posted significant achievements in relation to the MDGs. Nepal
was cited for its outstanding national leadership, commitment, and progress
towards improved maternity health.
The MDGs are
a set of eight goals that the world’s governments committed in 2000 to meet by
2015. These goals range from eradicating poverty to improving maternal and
child health, to achieving universal primary education and ensuring environmental
sustainability.
Among
But the
country has been doing so good in this regard that its National Safe Motherhood
Plan of 2002-2017 has set a more ambitious target of further reducing its MMR
to 134 per 100,000 live births. In 1990,
Notably,
too, 30 percent of births are now attended by skilled birth attendants.
Sharad Kumar
Sharma, senior demographer at the health services department of the Ministry of
Health, explains the role of the community health volunteers in this success
story: "They have lent invaluable support by spreading awareness,
persuading women (and men) to visit health posts and hospitals and take preventive
measures to reduce occurrence of diseases and complications that lead to
deaths."
Other health
experts have cited simple awareness as key in life-and-death situations.
A 2009 U.N.
Millennium Campaign study, for instance, highlights two cases in which awareness
of health services that were nearby helped in the safe delivery of an infant,
while ignorance of the medical help that was available contributed to the death
of a mother of six.
As the
report tells it, Kancchi Maya Tamang lived in a village close to
Tamang’s
aunt, who now looks after that child, now two years old, recalls, "This
was her sixth time giving birth, hence no one was worried. The actual birthing
process was easy. However, she started bleeding soon after and before anyone
could do anything, she died."
By
comparison, Jarsikala Kami, a resident of a remote village in Jumla district –
about 900 kilometres from
The
20-year-old member of the Dalit (marginalised) community had apparently been
dutifully having regular check-ups during her pregnancy. And when time came for
her to give birth, she went to the birthing centre at her village’s health post
where a skilled birth attendant was present.
It helps
that the government has set up a 24-hour delivery service in all of
Service in
the government health centres is free. The government also provides subsidies
to some private health facilities, so that these can give people free services
too. And when health workers attend to deliveries at home, they are given a
cash incentive of 300 rupees (four dollars).
But health
worker Maharjan still worries that awareness of all these is lacking in some
areas, even as complacency sets in other places. A 2010 progress report
prepared by the National Planning Commission and the United Nations Development
Programme also notes that efforts to improve maternal health in this country
continue to face challenges.
Says the
report: "The three delays – in seeking, reaching, and receiving care –
are… important (causes) of poor maternal health status in