Community Health at the Foot of Mount Everest; Evaluation Report 2009

Background

The main aim of the project is to strengthen the primary health care available to people in the peripheral parts of Okhaldhunga District, especially women and children, in a sustainable way.

This is done by working through the already existing HPs and SHP, and in partnership with the local population, mainly in the form of Management Committees and Women’s Groups, and with administrative bodies of the Government of Nepal (GoN). A limited strengthening of the hospital is included in the project.

Purpose/objectives

The evaluation will focus on to what extent the aims and objectives outlined in the project document have been achieved. While doing this the changes in activities and emphasis which have taken place as result of relevant changes in the national health policies of the GoN during the project period, will be kept in mind.

The sustainability of the changes achieved, both in the hospital and the community health work, will be evaluated.

The project’s impact on women’s situation in the area will be evaluated.

Which components were most effective?

Whether there was a significant unintended impact.

Methodology

- The Project Document from 2004

- The Project’s Annual Plans and Reports (Calendar years)

- The Project’s Annual Budgets and Financial Reports (Calendar years)

- The Annual Plans and Reports of OCH, including its PHU (Nepali fiscal years, i.e. starting from each 1^{st Shrawan, i.e. about 15th July)}The Public Health Unit of the Okhaldhunga Community Hospital took up the challenge of reaching out to vulnerable communities in the foothills of the Himalayas. The purpose was to strengthen the local health care delivery system, promote safe motherhood, and child health through community initiatives. There were struggles in walking to remote areas and working with backward communities in the midst of political turmoil and insecurity. The perseverance and commitment of staff is obvious in all these efforts.
The important outcomes were improved access to health post services, the community drug program, increase in family planning, safe delivery, maternal and child health. The close collaboration between the PHU and Okhaldhunga community Hospital and complementing each others services is one of the major reasons for the success of the project. The mothers groups play a central role in promoting access to health services, influencing health seeking behavior and sustaining change in the communities.

 It is difficult to measure the impact of the project in the lives of target communities. Through the efforts of the PHU a cycle of positive change has been stimulated which we believe, will lead to better quality of life and well being for women, children and the communities they live in.

Recommendations

Improve method of doing the work such as training the FCHV’s, sub-health post committee members, mothers’ group and school health program. One-time training is generally less effective and there should be a system of knowing whether the messages during the training are understood well and how the new learning has been put into practice.

Continue similar intervention in other needy VDCs.

The mother’s groups play a major role in sustaining positive change in the communities. Enable mothers’s groups to make linkages with other stakeholders’ particularly local government or even other NGOs to access resources/schemes for development. Mothers groups which have been functional for a longer period can share experiences with other newly formed groups.

Projects which have made sustainable impact in vulnerable communities have been observed to function for a period of 4 -5 years, incorporating a carefully planned phasing out strategy and periodic follow up after handing over the program to the local communities. Consider extending the next phase for 4 to 5 years to enable lasting change.

Comments from the organization

The evaluation has provided a solid appraisal of the project’s achievements and recommended constructive measures to be taken in order to make improvements.

The results have been discussed thoroughly among the project leaders and staff; followed by extended communication with the project administration of Normisjon. The recommendations were included in the new project document to be implemented during the project period 2010 – 2014.

It is important to do follow up work in the phased out VDC to support the on going program and sustain change. It is recommended that in the phased out VDC a planned follow up program be done so that the sustainability of intervention is ensured and the community is adequately prepared to continue the program.

During project implementation, periodically document the lessons learnt and the best practises, case studies and the experiences of the staff in implementing the project.

Support to Sub-health Post: Provide medical support to the sub-health post where there is no CMA. This may involve twice a week clinical services including on the job training to existing VHW and MCHW who independently manage the sub-health post.

Sub-health post management committee: The committee members may further be given training in issues focusing on management and financial control of the sub -health post. The training can also include issues related to health and disease, functioning of health infrastructure in the country and role of sub- health post. Capacity strengthening program for female committee members should be conducted.

As a part of the school health program, identify students with aptitude for learning and sharing ideas. They can be trained to identify symptoms of common illness and refer adults/ children to the sub health post / hospital ("Sano doctor", "Sano health promoter"). Children who convey health messages and refer sick persons for treatment may be specially recognized through certificates, gifts, medals.

FCHVs share health messages with mothers groups and the community members. Assess the extent to which these messages have been understood and applied by the community before any monetary compensation is given to the FCHVs.

Conduct periodic capacity strengthening programs for PHU staff on integrated community development, primary health care.

Identify potential FCHVs who will be resource persons for training other FCHVS and mothers groups and strengthen their capacity.

Explore the possibility of increasing the frequency of field visits for monitoring and supporting the project activities.