Our Work

Background

 Among the factors contributing the child survival in Nepal, successful delivery of vaccines is essential to prevent deaths and disability due to disease. However, the constrains still remains in terms of the scare human resources unable to cope up with the new requirement for temperature sensitive vaccines, and also to the cold chain equipment which needs maintenance and repair on a periodic basis, real time information on the equipment status and stock management of the vaccines.

HEAL Group Staff provided technical assistance to Ministry of Health and Population harnessing the individual capacity in improving the efficiency of supply chain management (SCM), strengthening the vaccine information system (VIM) and human resource for vaccine management (HRVM).

HEAL Group staff provided technical assistance to MoHP at one central, 5 regional and 30 district vaccine stores for strengthening the human resource capacity of implementing the standard operational protocol for effective vaccine management, providing technical assistance for scientific delivery and stock management of the vaccines, capacity transfer for cold chain equipment maintenance and repair, optimizing the cold chain space and rooms by auctioning and disposing the old and poor performing equipment. The joint technical assistance will support the central Ministry of Health to develop specification for cold chain equipment and equipment forecast, create a cool chain equipment informational website hub and develop plans for rational equipment replacement and expansion planning and develop infrastructure to improve installation and repair services.

Project Areas: Six regional medical stores and 30 districts

Project Activities:

Formation of Central Level Multi-Stakeholder Effective Vaccine Management Monitoring

Team to plan and review the progress:

The first meeting of multi-stakeholder effective vaccine management monitoring team was conducted in Jan 23, 2014 with chairmanship of LMD director. The participants were Bade Babu Thapa, Chief of Cold Chain and Supply Unit, LMD; Mukunda Raj Gautam, Chief EPI Section of CHD, representatives from UNICEF, WHO and Lifeline Nepal. The meeting decided to have meeting in 3rd or fourth week of each month.

Review meeting of the Multi-stakeholder Effective Vaccine Management Monitoring Team

Meeting is being held each month during PCA period. Until July 2015, seventh meeting is completed. In each meeting program progress were reviewed.

Development of the revised standard operating Procedure for Effective Vaccine Management

2nd Multi-stakeholder Effective Vaccine Management, Monitoring Team Meeting held on March 21, 2015, decided to form a working committee with the following personnel:

1) Mukunda Raj Gautam, Chief, EPI Section, CHD, Coordinator

2) Badebabu Thapa, Chief, Cold Chain and Vaccine Supply Unit, LMD, Member

3) Bijaya Kranti Shakya, NTHC, Member

4) Om Prasad Upadhyay, EPISO Cold Chain and vaccine distribution section, LMD, Member

5) Siva Subedi, UNICEF, Member

Development of the training manuals, job aids, quality monitoring checklist for EVM

The working group finalized EVM SOP and developed trainers' manual and participants' handbook. Approval of EVP SOP, trainers' manual and participants' handbook was proposed to be completed in June 2015. They also developed quality monitoring checklists for each activity.

 Central level Training of Trainers on SOP for EVM

Central level TOT on SOP for EVM was conducted on July 18- 23, 2015 with 21 participants. Similarly the regional level TOT was also completed in two batches with 34 participants.

Review and adapt the cold chain equipment specification and forecast for next 5 years at central, regional and district level.

Review and adapt the web-based vaccine status and stock management software

A meeting was held on April 3, 2015 with participation from EPI Section from Child Health Division, Cold Chain and Supply Unit, LMD, WHO to review the existing IMS software implemented by LMD. The meeting suggested adopting IMS software for online reporting of vaccine. The contract was outsourced to Software engineer - Sandesh Maharjan with the deadline to complete by May 10, 2015.

Orientation to the Central level staff on web-based vaccine status and stock management

System for online vaccine reporting was developed and we held orientation program on it on

29th July, 2015. Data entry to test the effectiveness in implementation of the system is going on and HEAL Group has monitored the effectiveness of the system by collecting the reports from the users of the system.

Support auctioning/disposal of non-functional cold chain equipment at central level

Auctioning process carried in Pathlaiya cold chain stores. The auctioning process also completed in Central cold chain store in Teku.

 Routine Quality monitoring of regional vaccine stores`

A trip to Pokhara regional medical store was made by HEAL Group staff  and Chief of Cold Chain and Supply Unit of LMD for quality monitoring. The temperature for vaccines was well maintained. We could not make further quality monitoring trip due to involvement in supporting MOHP and DOHS in supply chain of vaccine and general logistics. Similarly HEAL Group Staffmade field visit to 14 districts for the quality monitoring. In 6 regional vaccines stores- Hetuada, Kaski, Butwal, Nepalgunj, Kaliali and Biratnagar the efficiency and effectiveness of the vaccine supply and logistic systems strengthened

 Regional level training of trainers on EVM 

Regional level TOT was conducted from August 17- 21, 2015.

Regional level training on establishing EVM quality monitoring

Due to the mega earthquake, the finalization of EVM SOP, participant’s handbook and trainers manual delayed and these activities could not conduct. Planned to conduct in July/August 2015

 Repair and maintenance of cold chain equipment

In Pathlaiya Central Cold Chain Store, there is no dedicated electricity line and 6-8 hours load shedding. However, Pathlaiya Central Cold Chain Store did have two generators to supply power during the load shedding but both of generators non-functional for long time. HEAL Group Staff repaired one of two generators. Now one walk in cooler is functional for twenty-four hours.  HEAL Group staff has been repairing cold chain equipments. Till date altogether 121 cold chain equipment are repaired in the districts.

On-site mentoring to refrigerator technician and EPI person

Second Meeting of Effective Vaccine Management Monitoring Team held on January 25, 2015 decided to hire refrigerator technicians for Biratnagar, Pathlaiya, Pokhara and Butwal Regional cold chain stores where positions of refrigerator technician were vacant. Similarly the meeting also decided to hire cold chain supervisors for Pathlaiya, Central Store Teku and Nepalgunj medical stores where the positions were vacant. The meeting also decided loaders/packers for Central Stores Teku and Pathlaiya. The meeting also decided the qualification of refrigerator technician and cold chain supervisor.

Capacity building of the refrigerator technician on maintenance and electronic temperature monitoring reporting of cold chain equipment

Once refrigerators technician and cold chain supervisors, they have been provided orientation on repair and maintenance and monitoring of report of the cold chain equipment.

 

Weekly reporting on the regional vaccine status of stock management from the regional level

Routine monthly stock status reporting from the regional level is going on. Once online reporting is initiated weekly reporting will automatically be improved.

 

Support auctioning/disposal of the non-functioning cold chain equipment and materials

Auctioning Officer visited Nepalgunj, Butwal, Pokhara, Hetauda, and Biratnagar. An auctioning process in each regional cold chain store was discussed and initiated. As per the agreement to submit the list of nonfunctional cold chain equipment in the beginning of FY 2072/2073, all submitted the list. Auctioning is completed in Syangja and Argakhachi. Process for Auctioning is going on in Baglung, Sindhuli, Gulmi, Ramechhap, Kathmandu, and Dhading. Similarly, as requested by Far-Western Regional Health Directors, HEAL Group  hires auctioning supervisors and stationed in the far-western region. With the new auctioning supervisor's initiation, auctioning was completed in RMS Dhangadhi and Doti Districts. Based on the request,  refrigerator technicians from regional cold chain stores, visit to the district and repair the refrigerator. Where nonrepairable cold chain equipment was certified for auctioning. Up to now, Technicians are able to repair altogether 93 refrigerator/freezers in different districts.

Collection and update of status and number of cold chain equipment from 30 districts and sub-districts

Inventory of cold chain equipment is prepared by WHO. HEAL Group had updated the cold chain equipment list during auctioning and repairing.

Review existing projected capacity and calculate future cold chain capacity

Calculation of cold chain capacity was completed.

Dissemination of projected cold chain capacity

The dissemination of projected cold chain capacity was shared with LMD, CHD, etc.

PLAN, an international child centered community development organization, working with children, their families, communities, organization and governments of the developing countries had initiated the MNCH Program in Nepal after the devastating earthquake, especially focusing the in two majorly affected districts (Sindhupalchok, Dolakha) along with its Partner Lifeline Nepal which has been providing technical and managerial assistance to government programs in health , education  and agriculture primarily focusing on remote , hard to reach areas to promote lives of marginalized and disadvantaged population.

The emergency response in the two districts (Sindhupalchok and Dolkha) included the immediate RH, WASH and nutritional assessment and interventions, prevention of maternal, newborn morbidity and mortality through unhindered access to basic & emergency obstetric care for ANC, safe delivery and postnatal care. Screening of children for the identification of severe acute malnutrition and referral to OTP centers had also been done at the community level through the home visits and BCC sessions.

Plan Nepal/Lifeline Nepal has envisioned to support result oriented essential actions on MNCHN that encompass proper sanitation and hygiene including latrine facilities, access to clean water and hand washing practices, clean delivery as well as essential breast feeding of new born, infants and young child feeding, their growth and development and appropriate nutritional care of both mother and child through home visits, BCC sessions and institution services at HFs.

Project districts: Dolakha, Sindhupalchowk

Project Objectives:

1. To resume basic health services in the earthquake affected communities of 16 VDC in Dolakha and 13 VDC in Sindhupalchok districts focusing on pregnant & lactating mothers including under five children as

• Irish tent
• Temporary toilet for tent.
• Water tank for storage (500 litre)
• Water tank for hand washing (200 litre)

1. The purpose is to improve the status of maternal and child health through balancing between the institution services at health facilities and community actions through home visit together for effective MNCHN promotion in the community.
2. The objective is to make quality MNCHN services at health facility and provide essential actions through home visit focused on safe delivery, new born baby and nutrition care and actions.
3. To improve the household health and nutrition behaviors
4. To  improve water sanitation and hygiene behaviors and practices (BCC Session)

 

Project Activities:

• Being a partner NGO, Lifeline Nepal had worked for four months at 13 VDCs of Sindhupalchowk and 16 VDCs of Dolakha in order to enhance the Community actions through home visit, nine hundred ninety five in Dolakha and seven hundred sixty one in Sindhupalchowk district were focused for functional health seeking behavior and referral system to utilize the institutional services at HFs.
• BCC sessions (fifty four in Dolakha, thirty three in Sindhupalchowk) were conducted among the pregnant, lactating mothers & under five children mothers after ANC/PNC mapping and neonatal assessment through brochures and running nutritive cooking session at CFS.
• Resumption of health services was done after RH assessment of the Health Facilities by providing one hundred seventy five Irish tents.
• Six hundred sixty two Clean Delivery kit as well as Seven Hundred Eighty Five Neonatal kit has been provided in order to prevent morbidity and mortality rate.
• BCC session was conducted throughout the program which has been further improved through delivery of five hundred warm clothes to the postnatal mothers and newborns, mothers group meeting by the FCHVs in the ward level,
• Delivery of the equipments such as cupboard, plastic chair, plastic bucket, plastic table to the health facilities, construction of the WASH facilities (temporary toilet in twenty three health facilities and water tank frame in twenty six health facilities of both working districts).
• Counsel 1,000 days women including mothers of under five children on maternal, infant and young child nutrition (MIYCN)
• Organized meeting and workshops with FCHV and Mother’s group at health facility to share the programs and collect information about ANC, PNC, & under five children and made community level awareness ceation activities
• Dissemination of MNCH promotional messages was done through five F.M. of the Sindhupalchowk namely Radio Sindhu, Radio Melamchi, Radio Planet, Youth F.M. Radio Sunkoshi similarly in Dolakha Radio Sailungee, Radio Bhimeshwor, Radio Kalinchowk, Hamro Radio were selected.
• Chief of district health officer as well as program health officer  organized monitoring visits on monthly basis to The Lifeline Nepal was supported for the conduction of such supervision visits.
• Lifeline Nepal Organized the district level coordination meetings & program review meeting with DHO to advocate for program issues (District).

Project Achievements

Outcome 1: Practices that promote optimal health & nutrition behaviors improved

1.1: Maternal and child care service utilization pattern changed

1.2 : ANC/PNC mothers  Knowledge , life skills and Health behaviors improved

1.3 : Reduced episodes of diarrheal diseases and ARI among mothers, adolescents and IYC

1.4 : Feeding behaviors improved with increased availability and access to appropriate food (in quality, quantity, frequency and safety)

Outcome 2: Improved Maternal and neonatal health

2.1 Maternal and child care service utilization pattern changed

2.2 Maternal  & newborns receive clean safe delivery and  early essential  newborn  care improved  with increased availability & access to clean delivery kit, warm clothes

Outcome 3: Resumption of Health care services

3.1 Establish and strengthen the regular health services at each Health facilities by providing accommodation tent   HWs  tent .

3.2 Improved utilization of functional storage and distribution systems for MNCH commodities

Outcome 4: Improve water sanitation and hygiene behaviors and Hand washing practices

4.1 Improved use of  drinking water  & Hand washing behaviors  of mothers ,children  and their care givers 

4.2  increased availability & access  to  drinking  as well as hand washing at health facilities

4.3 Improved toilet use with increased availability and access to temporary toilet

HEAL Group staff successfully accomplished the project for “Strengthening the program on Zinc and ORS in treatment for childhood diarrhea” in 13 districts in 2014/15 in close consultations with Child Health Division (CHD), District (Public) Health Offices, District Development Committees and other related stakeholders with the support from Micronutrient Initiative (MI),  objectives.

Program Objectives:

• To improve utilization of Zinc and ORS through adequate counseling and explaining benefits of zinc and ORS caretakers/mothers
• To improve forecasting procuring and stock control of zinc and ORS at district level and health facility level
• To improve the recording and reporting and increase the use of HMIS for planning and corrective actions at district and health facility levels

Districts Covered: Parsa, Kavre, Mahotarrai, Morang, Jhapa, Nuwakot, Gulmi, Dolpa, Dhading, Palpa, Rautahat, Khotang, Ilam

Project Activities;

• Orientation and ToT for in-charges of Primary Health Care Center (PHCC), health post (HP) and Sub- health post (SHP) in each project district.
• Refresher orientation for FCHV in each health facility of the program district by respective health facility In-charge
• Orientation for private pharmacies at district headquarters to enhance knowledge on importance of zinc in treatment of childhood diarrhea.
• Coordination with CHD, D/PHOs, MI and other relevant stakeholders for scheduling the district ToT and orientation
• Regular monitoring to ensure that the quality of training as per standards and guidelines.

Status of Trained Personnel

SN	Districts	District Level Supervisor	Pharmaceutical	HF level Staff	VDC HFWs	VDC FCHVs	Total	Remarks
1	Parsa	26	26	86	299	739	1176
2	Kavre	15	13	94	429	914	1465
3	Mahottari	34	16	77	369	684	1180
4	Morang	24	24	79	371	597	1095
5	Jhapa	17	19	48	273	524	881
6	Nuwakot	27	25	68	216	1074	1415
7	Gulmi	17	25	80	309	997	1428
8	Dolpa	17	18	22	79	207	343
9	Dhading	18	25	52	379	464	938
10	Palpa	34	25	67	235	588	949
11	Rautahat	32	25	99	288	933	1377
12	Khotang	30	23	76	185	899	1213
13	Ilam	17	13	0	0	0	30	The orientation at the community level was dropped out in the district under new strategy
	Total	308	277	848	3432	8625	13490

 

 

 

Entrusting Lifeline Nepal with the baseline survey on ‘Healthy pregnancy and safe birth through increased access to safe motherhood services in Bajura, one of the very remote districts in Nepal, CARE NEPAL had provided the support for conduction of the survey.

Lifeline Nepal carried out the base‐line survey in the project VDCs targeting the beneficiaries and the relevant stakeholders. The findings were consolidated to establish a project-based understanding on Reproductive Health, Maternal Health, and Neonatal Health across all the VDCs of Bajura district.

The baseline survey was determined bench‐marks for target setting within each objective, as per the indicators set out in the log‐frame, to validate if the activities within the project design were sufficient in scale and scope in order to meet these targets; and to identify opportunities for the sustainability of the project. Furthermore, it served as a guideline for making amendments to the M&E guideline and plan of the project.

Project Objective: The overall objective of this baseline survey was to establish a base‐line status on Sexual Reproductive Health, Maternal and Neonatal health in Bajura district of Nepal.

 

Project District: Bajura

 

Following were the areas explored by the base‐line survey:

1. Assessment of the need of Birthing Centers and service providers to provide quality health service at birthing centers
2. Exploration of service utilization and issues, constraints and problems
3. Identification of the prevailing health and contributing social conditions and health problems affecting women of reproductive age and neonates within the project VDCs
4. Assessment of current levels of knowledge, attitudes and practice towards maternal and child health among community people
5. Identification of the status of the district/community health systems to implement maternal, neonatal and reproductive health services
6. Assessment of the status of community mobilization to ensure the access to and utilization of maternal and child health services
7. Assessment of the status of enabling factors and barriers on MNH service utilization