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Pavitra cares for her son who has epilepsy.  She was previously a migrant labourer; a challenging role, especially given her son’s condition.

Pavitra has been given a goat by Carers Worldwide, an organisation funded by UK Aid Direct, that works in Nepal with local partner, LEADS Nepal.

This is Pavitra with her son and goats.

This is Pavitra with her son and goats.

 

Carers Worldwide provides support to 1500 unpaid family carers of people living with mental health conditions or epilepsy.

Now Pavitra receives a regular income, allowing her to settle in the village with her son, and to start her own livelihood.

Carers’ tremendous commitment and the critical role that they play in the lives of relatives with mental health conditions are largely unrecognised in Nepal.

Unsupported, they can be isolated and are at a high risk of developing anxiety or depression and physical ailments, as a direct consequence of their caring responsibilities. Many carers are unable to continue their previous employment.

Child carers are frequently forced to drop out of school.

Carers and their families typically live in poverty as a result of loss of income and opportunities.

Carers Worldwide project aims to:

  • strengthen medical and counselling facilities for carers
  • promote mutual support groups
  • set up alternative care and respite arrangements
  • provide livelihoods and opportunities to develop marketable skills
  • highlight the needs of carers
  • advocate for changes in policy and practice

Improving the lives and prospects of carers has a positive effect on the lives of the relatives with mental health conditions for whom they care. The carers are able to provide a better quality of care and the overall increase in wellbeing and security of the household has huge knock-on benefits for the health and wellbeing of the relative living with a mental health condition or epilepsy.

By highlighting the existence and needs of carers across the project area with local government authorities and community organisations, over the last two years Carers Worldwide has:

  • integrated 400 carers into support groups
  • trained 200 local community health volunteers and 64 government health workers to provide appropriate health support
  • established regular counselling services in the community
  • trained and supported over 750 carers in skills and helped them to establish new sustainable livelihoods that can work with their caring responsibilities
  • provided 225 child carers with ongoing support from school authorities, enabling them to return to school
  • raised 44% of project households above the poverty line, compared to 3% at the start of the project
  • registered two Carers Associations and one Carers Cooperative to enable carers to advocate for policy change, and to work with local agencies to ensure sustainability of services established by the project.

To find out more about their work, visit www.carersworldwide.org

 


The last in a series of Joint Annual Reviews of the National Health Sector Programme II (2010-2015) took place at the Everest Hotel in Kathmandu between the 23rd and 25th February 2015.  

Nepal joint annual review

The last in a series of Joint Annual Reviews of the National Health Sector Programme II (2010-2015) took place at the Everest Hotel in Kathmandu between the 23rd and 25th February 2015. The meeting was presided over by the Minister of Health and Population and included all stakeholders in the health sector, including the public and private sectors and development partners.

The meeting highlighted the excellent progress made against ambitious targets set under the MDGs. Both maternal and Child mortality have declined sharply, and progress has been made in improving access and quality of health services. The meeting also discussed the new National Health Policy (2014) and the evolving regulatory framework in health and plans for more decentralised planning and management in the next sector programme.

The draft NHSP III was presented along with its results framework. This draft outlines the main push towards the objective of Universal Health Coverage and emphasised the need for greater equity, quality, reform and working beyond health. The new programme aims to maintain progress on MNCH outcomes and includes greater attention to the emerging burden of disease from Non-Communicable Diseases. It calls for more work to create healthy lifestyles and health environments and aims for increased collaboration between sector to achieve this. The new NHSP III documents will be published later in the year.

David Daniels, Director of MannionDaniels, worked with the Ministry of Health and Population to support the development of the new NHSP III over the preceding year (2012-3).


A new 5-year Health Sector Programme for Nepal

nep5

The new 5-year Nepal Health Sector Programme (2015-2020) will draw on the policy directions outlined in the recent National Health Policy (2014), as approved by the Cabinet.  The NHSP-III is emphasising the need for greater output-based and decentralised planning and budgeting for the sector.  The plan will also indicate the importance of ensuring financial protection for the poor and give more attention to improving quality of services across all areas of the health system.  NHSP-III will aim to build financial sustainability, better coordination and strengthened partnership with non-state partners. The MoHP will be looking at stronger regulation of the sector including measures to ensure quality of care through commercial and not-for-profit health providers. The rise in non-communicable diseases in Nepal poses a big challenge for the Ministry and in response the new plan will include components on promoting healthy lifestyles and working to create healthy environments.  An emphasis will be put on the importance of good information and self-responsibility  for health.  MannionDaniels is supporting the NHSP-III building on its earlier involvement in the Mid-Term Review of the current NHSP-II. The work on the new sector programme is on-going.

 


Motorbike traffic in Kathmandu

MannionDaniels was contracted by HEART (Health and Education Advice and Resource Team – funded by DfID and managed by Oxford Policy Management) to participate in a Mid-Term Review of Nepal’s second Health Sector Programme (NHSP II).  This is a 5 year programme whose wide-reaching aims include:

  • Improved sector management
  • Improved service delivery
  • Improved health governance and financial management
  • Reduced cultural and economic barriers to accessing health care services
  • Strengthened human resources for health
  • Increased health knowledge and awareness
  • Improved M&E and health information systems
  • Improved physical assets and logistics management
  • Improved sustainable health financing

This project has involved a team of 9 consultants, working alongside the Nepalese Ministry of Health and Population.  During their trips to Kathmandu and Biratnagar, the team have visited health facilities, talked to district health workers, and looked at private sector facilities and pharmacies to measure the progress made in implementing strategies.

Dr Narmeen Hamid, a member of the team evaluating the improvement of health service provision, and a key consultant for MannionDaniels, finds:

“Despite the challenges of political instability, a long conflict and resource constraints, Nepal has managed to make great strides in the health sector. Bringing in the experience from another developing South Asian country, Pakistan, it was interesting to see the completely different way health is prioritized in Nepal with a much higher budget allocation, emphasis on primary rather than tertiary care and constitutional commitments to free basic health, and yet how both countries also face similar pitfalls of aid management, over-centralization and inequities that pose serious challenges to the delivery of effective health care to the people”.

Another aspect of the health sector being evaluated by the review is gender equity and social inclusion (GESI).  Dr Poonam Thapa, a member of the team evaluating GESI and a MannionDaniels’ Associate, explains its current position and importance:

GESI institutional mainstreaming is still far from being well integrated with service delivery and quality of care.  The lack of full implementation of Human Resources for Health (which is actually GESI sensitive) remains the weakest link in the system. There is hope, in that some critical training programmes are being adapted, pro-poor targeted programmes are slowly but surely being expanded and GESI operational guidelines introduced. If planning and management are even more serious about GESI, Nepal could be much closer to achieving most of the MDG targets by 2015 even in the face of current cut backs in public health investment. GESI cannot remain an option on the side for health because the full achievement of it is a necessity for the people of Nepal.”

 The team, led by David Daniels, Director at MannionDaniels, presented its findings to the Nepalese government and development partners in late January 2013.


MannionDaniels was contracted by HEART (Health and Education Advice and Resource Team, funded by DfID and managed by Oxford Policy Management) to conduct a Mid-Term Review of Nepal’s second Health Sector Programme (NHSP II).  The Government of Nepal launched NHSP II, which is a 5-year programme in July 2010. The agreement to finance and support the programme of work in NHSP II was formalised in a Joint Financing Arrangement using a Sector Wide Approach. A Mid-Term Review of NHSPII is required in line with these commitments made by the Government of Nepal, external development partners and civil society.

Nepal’s health system faces post-conflict challenges after emerging from a ten-year civil war in 2006 which halved potential economic growth. It must navigate a complex set of interrelated factors including: gender; caste; ethnicity; age; religion; disability; language; geography; corruption and poor infrastructure, all of which impact on the provision and accessibility of health services.  Despite these challenges, Nepal has experienced two decades of steady improvement in health outcomes. Progress accelerated and was accompanied by significant improvements in equality of access during the first NHSP (2004-10) and Nepal is now on track to meet the child and maternal mortality MDGs and it is estimated that NHSP1 saved 96,000 deaths and nearly 3.2 million disability-adjusted life years (DALYs).

NHSP II represents a continuation and refinement of earlier policies and plans based on implementation of cost-effective, evidence-based health interventions, some free of charge.  NHSP II’s vision is to improve the health and nutritional status of all Nepali people, especially the poor and excluded. Three main objectives in the NHSP II results framework are:

  1. Increase access to and utilisation of a package of quality essential health care services;
  2. Reduce cultural and economic barriers to accessing health care services and harmful cultural practices in partnership with non-state actors.  Fundamental to this objective is the implementation of the Gender Equality and Social Inclusion Strategy;
  3. Improve the health system to achieve universal coverage of essential health services. Fundamental to this objective is the implementation of the Governance and Accountability Action Plan.

David Daniels, Director at MannionDaniels, is leading a team of consultants contracted by Oxford Policy Management to assess progress on delivering NHSPII’s objectives. The team are undertaking a series of in-depth consultations with a broad range of health sector stakeholders to inform quantitative and qualitative measurement of progress across the following nine output areas:

  • Improved service delivery
  • Improved sector management
  • Improved health governance and financial management
  • Reduced cultural and economic barriers to accessing health care services
  • Strengthened human resources for health
  • Increased health knowledge and awareness
  • Improved M&E and health information systems
  • Improved physical assets and logistics management
  • Improved sustainable health financing

Broad based consultations with all stakeholders in the sector will be emphasised, as will collecting opinions from different client groups including those from more vulnerable or disadvantaged situations.

Findings from the MTR were presented at the Joint Annual Review in January 2013.