Model sub health post for safer and healthier life
December 2010; The Badalamjee village located at a distance of 16 kms from the district headquarters of Dailekh was suffering due to lack of proper health services. The patients, mainly the pregnant mothers suffered during child birth due to the dilapidated condition of the old sub health post lacking basic facilities such as electricity, water, proper delivery room and the irregular presence of health attendants.
Little did these people with very less education know how vulnerable they were to different kinds of infections by having the grounds of the sub health post as a grazing place for the cattle. The district official says, “Earlier, the sub health post lacked proper beds and women were required to bring a bucket of water and a sack to lie down when it was time to deliver babies. At times, when the queue was long, the women were kept waiting, lying in the same ground where the cattle grazed every day.”
It was a boon for the community when the Quick Impact and Peace Support Initiative (QIPSI) programme under the UNDP supported Decentralized Local Governance Support Programme(DLGSP), two years ago chose the village to implement small infrastructure activities. There are a total of 993 households (338 Dalits, 58 Muslims and 597 others) in Badalamjee village.
Under the popular demand of the villagers and seeing the plight of women/mothers, the decision was taken at the village assembly meeting to fund a small well-equipped sub health post, addressing different health care issues including emergency and obstetrics with enough health attendants. The meeting was attended by district Government officials, teachers, political party representatives and community leaders.
To start with, the technicians estimated the cost for the construction of the health post. A Construction Committee was formed with clear duties and responsibilities under Moti Ram Adhikary, Chairperson of the Users Committee. For transparency purpose, a signboard was placed in the project site with all the details of the cost.
The new sub health post building was constructed at the total cost of Rs.370, 196. Out of the total cost, the QIPSI grant was Rs.277,647 and community contribution was Rs.92,549. The sub health post was constructed within a period of 8 months.
Today there is a post delivery room and a waiting room for a family member attending the patient. A small toilet has been constructed at the cost of Rs. 9000 from the support of the Village Development Committee. Through the programme, adequate facilities are now made available in the new sub health post including two beds for child birth.
The sub health post receives 20-30 patients everyday. About 14 women in average come for child delivery every month from this village and from three adjoining villages. As a result, there is less load in the hospital at the district headquarters. The rural people feel that they are receiving good treatment for normal illnesses.
Jhupkala BK, 25, recently had a baby delivered in this newly constructed sub health post. She is happy that she got herself regularly checked and received the necessary vaccinations. She says, “I received necessary vitamins and vaccinations free of cost. I faced no problems as such, rather I was taken care of very well. We women folks are relieved because we have this new well equipped sub health post in this village.”
The Government (Department of Health) sent in senior staff last year after the new building was constructed. Currently the sub health post has a Senior Auxiliary Health Worker, an Auxiliary Nurse Midwife and an Office Assistant provided by the Government. Additionally, one Auxiliary Nurse Midwife is supported by the Village Development Committee. Also, in addition to the free distribution of iron capsules and vitamins , the Government provides an allowance ranging from Rs. 1500– Rs. 500 ( depending on the geographic region i.e the Mountain, hill and terai) to mothers who come to the sub health post for check up and delivery. Enough incentives are given to the staff to motivate them to provide good health care services. The allowance for an Auxiliary Nurse Midwife per delivery is Rs. 300.
To improve maternal health services, the Government has placed Female Community Health Volunteers (FCHVs) through the Department of Health in all the wards of the Village Development Committees. Maternity kits are provided to FCHVs who attend deliveries, reaching their patients who cannot travel to the sub health post.
The three delays—seeking, reaching and receiving care are important causes of poor maternal health status in Nepal. Some 40 per cent deaths occur at home, 14 per cent in transit to health facility and 41 per cent in a health facility.
About 73 per cent of births still take place at home in Nepal, with 55.7 per cent of women being assisted by traditional birth attendants and relatives. Lack of availability of qualified staff is identified as an important challenge, particularly in remote districts like Dailekh.
While there is still a long way to go to address maternal mortality and basic health care, the recent 20th edition of the Human Development Report places Nepal among the ‘top ten movers’ over the last 40 years in terms of health and education. Thanks to strong policies and commitments !
Nepal also received the Millennium Development Goals award for its outstanding achievement in reducing maternal mortality. However challenges still remain in many rural areas due to geographical constraints.