“Community health at the Foot of Mt. Everest” Final Evaluation report

Background:
The Okhaldhunga health project was started in 1962 as a dispensary in the eastern part of Nepal. The dispensary was upgraded to a hospital in 1968. In the year 2003 and 2004 Okhaldhunga health project was renamed as Okhaldhunga Community Hospital with Public Health Unit (PHU) which focuses on preventive and primary health care in rural areas. The target group covered is 160,000 people.

The Okhaldhuga Community hospital through its PHU initiated a project entitled “Community Health at the foot of Mount Everest”. The strategy adopted by the hospital was to work alongside other stakeholders and strengthen the health system, infrastructure of the Government of Nepal health posts, sub-health posts and their service delivery through technical advice, training and provision of essential equipment in Okhaldhunga District.

Purpose/objective:
-The main aim of the project is to strengthen the primary health care available to people in the   peripheral parts of the district, especially women and children, in a sustainable way.

-To strengthen the hospital`s identity as a community health oriented district hospital that provides health services as the district referral centre.

Methodology:
-The approach of the evaluation is multi-disciplined and focused on understanding the challenges, opportunities and outcomes of the initiatives. The evaluation team has created a participatory process throughout the evaluation, such as `Participatory Learning and Action` (PLA) and also included Participatory Rural Appraisal (PRA) tools. The project staff contributed in workshops, focus groups, and interviews and evaluated themselves through self-reflection and dialogue. The evaluation team has used both qualitative and quantitative approaches. The following tools were used to collect data during the field trip:

-Focus group discussion (FGD)
-Timeline
-Score ranking
-“Before” and “After”
-Peer ranking
-Key informant interviews
-Case studies
-Review of project literature

Key findings:
-The result of Female Community Health Volunteer (FCHV) is a reduced number of home delivery since a majority of women go to the health institution for delivery.

-Health management committees now meet regularly and feel an ownership to their role towards the health post. The committee are monitoring the services and activities closely and regularly. As a result the health post services become very regular.

-Mothers Group and networking has led to reduced incidents of domestic violence and conflict in the community and households because of training on domestic violence. The mothers group has also led to more empowerment of women, and increased their participation in the community meetings. It has also made them more independent through social and economic activities such as income generation.

-The Child to Child programme has helped keep school, community and personal living place clean. The children and their parents have become aware of personal hygiene and good sanitation as the children who were part of C to C programme share their learning with the parents.

-C to C classes involves both school going children and non-school going children. This has given the opportunities to non-school going children to learn health education and also encouraged them to join the school for formal education.

-Radio Programme: Public Health ‘Sandesh’
Increased number of mothers visiting the hospital,  Health  posts and sub-health posts for immunization because of information through the radio programme. The radio programme has also helped collection personal donations for the treatment of poor patients.

-Gender initiatives
Working with and strengthening of Mothers Groups, Female community Health volunteers, Mother Group Network have increased participation of women in skills enhancement, education and health development and improved status of women in the society.

Because of the project interventions (the Village development Package) enrolment of girls has increased in primary and secondary schools.

Recommendations:
-The patients, stakeholders, targeted groups/committees and community are satisfied both with the Hospital and PHU and suggested it to continue and extend the project activities to cover the whole district.
-Because of growing number of patients it is recommended to seek a formal recognition for a minimum of 50 beds hospital from GoN
-Given the hospital is being extended, further investment would be needed in terms of hospital equipment
-Due to increase of pregnant women coming to the hospital, it is recommended for the expansion of existing waiting room/create a separate and larger waiting room.
-For effective coordination amongst health partners (HP, SHP, and Okhaldhunga Hospital), a health coordinator with minimum bachelor in public health qualification should be placed in DHO.
-The period of partnership with local health facilities should be 7 years including 5 year active involvement and 2 years support from distance with the provision of continuous links through learning sharing forum once a year.
-Mothers group are active at village level, but it would be good if they`re also active at district level.
-A training need assessment is recommended to identify capacity building needs for the project staff so that an HRD plan could be made for staff motivation as well as for more effective management of the project.
-For sustainability of the project, the plans and activities of the project requires to be internalized in the plan of VDC and DDCs, so that the VDCs and DDCs and DPHO are well aware of the project from the beginning and can take it on board when the project exits.

Comments from the organisation, if any:
- Overall the organization is satisfied and encouraged by the evaluation report’s findings. The positive results of the project herein reported are numerous, well in accordance with our plans, and seem sustainable. Based on these, we aim at continuing the project along the same lines as in the previous period, with some adjustments.
- Most of the recommendations given in the report are in line with the organization’s own thinking, and have either already been incorporated into the project, or will be so during the coming 5-years’ period.
- However, a couple of the minor recommendations cannot be directly implemented. Examples are that increasing the period of involvement with each VDC from 5 to 7 years will only be practically possible for some of the VDCs, due to the projects own nature with a limited time-horizon. Also, even though coordination with DHO is seen as crucial, in our view it cannot justify posting a senior staff of the project permanently in the DHO. In stead, the senior staff of the project will emphasize coordination and joint planning with DHO.