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Nepal

Nepal, a landlocked country between India and China, is home to 26 million people belonging to roughly 100 ethnic and caste groups. The country is divided into three distinct zones-mountains, hills, and plains-which present major obstacles to accessing adequate health care; those who live in remote mountain villages are often more than a day's walk from health care services. The landscape, as well as prevalent misconceptions about modern contraceptives, has resulted in high unmet need for family planning, with 25% of Nepalese women—and 38% of postpartum Nepalese women—lacking access to modern methods of contraception.

Major Achievements

Since the 1980s, EngenderHealth has worked with the Nepalese government, international and local NGOs, and members of the private sector to strengthen family planning and maternal health services in Nepal by supporting positive policy change, training health care professionals, and establishing systems for quality assurance. Under the USAID-supported Nepal Family Health Program II (NFHP), EngenderHealth worked with John Snow, Inc. and the Nepal Ministry of Health and Population (MOHP) to strengthen access to high-quality family planning and maternal, neonatal, and child health services at all levels. NFHP II took several approaches to improving the quality of services throughout the country, including regular visits to assess technical need and onsite coaching, feedback, and training. NFHP II also implemented targeted programs in several hospitals to increase access to family planning among postpartum women.

EngenderHealth focused on several key areas, including:

Addressing Myths and Misconceptions about Contraceptives
There are many misconceptions among Nepalese people about the use and effectiveness of modern contraceptive methods. This has contributed to a slow rise in acceptance of modern family planning methods throughout the country. After extensive research, EngenderHealth—in coordination with the Nepal Family Health Department (FHD)—published a booklet summarizing common myths about fertility and contraception among service providers and outlining information to counter these misconceptions. This document was designed as a resource for family planning service providers and has been incorporated into training materials.

Improving Access to Family Planning for Postpartum Women
In partnership with the Nepalese Government, USAID, and UNFPA, EngenderHealth/NFHP II conducted a strategic review to examine the current status of family planning programming and provide guidance for achieving family planning goals. Using this research, EngenderHealth developed a training package for service providers working in family planning clinics, maternal health clinics and wards, and other settings to educate them about the importance of addressing the unique contraceptive needs of postpartum women, train them in counseling these women, and increase coordination across clinics and wards.

Increasing Access to Postabortion Care Services
EngenderHealth played a critical role in improving Postabortion Care (PAC) services in Nepal. In coordination with the FHD, EngenderHealth worked to improve and maintain the quality of PAC services in 20 districts, with an emphasis on increasing access to services, such as manual vacuum aspiration (MVA) procedures, postabortion family planning counseling and timely referrals. EngenderHealth also advocated for the integration of PAC services into routine maternal health care.

Promoting Maternal and Newborn Health
Five primary causes of maternal mortality in Nepal include postpartum hemorrhage, obstructed labor, eclampsia, sepsis, and abortion-related complications. As part of the NFHP II, EngenderHealth developed a three-day training program for maternal and newborn health service providers in rural health facilities. The program aimed to equip them with the knowledge and skills to prevent postpartum hemorrhage with active management of the third stage of labor, obstructed labor with use of the partograph, severe pre-eclampsia with magnesium sulfate, and asphyxia with neonatal resuscitation. EngenderHealth also designed and implemented a community-based program to prevent postpartum hemorrhage with the use of misoprostol for women who deliver at home.

Developing National Medical Standards
EngenderHealth provided technical support to the MOHP for the development of national medical standards for reproductive and maternal health services that will serve as a country-specific reference document for designing manuals, curricula, clinical protocols, and other resources that support patient care and service provision.

Previous Work
EngenderHealth previously supported the work of the USAID-funded Nepal Social Marketing and Franchise Project (N-MARC). The mission was to increase the availability and sustained use of family planning, maternal and child health services, and HIV and sexually transmitted infection (STI) prevention services in Nepal through the private sector. Under its subcontract to AED, EngenderHealth played a key role in supporting franchised private provider network programs, overseeing health providers' training, and performing quality improvement and quality assurance monitoring of family planning and STI treatment.

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