AusAID Maternal, Child Health and Development Program (AusAID/MACHD) Project
(January - July 1998)
Submitted to: Australian Agency for International Development (AUSAID)
C/O Australian Embassy
Submitted by: Adventist Development and Relief Agency (ADRA) Nepal
P.O. Box 4481
Implementation of the planned activities
The project has implemented its overall activities in close coordination with District Health Office (DHO) and District Education Office (DEO) as well as Village Development Committee (VDCs).
A) Womenís Literacy Program:
Women Literacy program has three levels, basic, post and self learning. Basic literacy curriculum focus on reading, writing, numeracy, health and forestry components. The forestry components is adopted from the literacy program of Nepal - Australia Community Resource Management project and Health component is developed by ADRA using references of World Education Literacy Program. The reading, writing and numeracy component is covered by standard NFE curriculum for women development by Ministry of Education (MOE) "Mahila Sakshasta Pustika" also used in ADRA Kavre Literacy Program.
∑Supervision of the literacy class:
Supervision of the literacy class has been continuously done by Field Representative, Literacy Supervisors and Field and Education officer. During this six month period a regular supervision has been done in each literacy center. The supervisions focused on quality teaching and assist facilitators to improve in the teaching methodology as well as they also mobilize the Literacy Support Committee for their best performance to reduce the dropout rate.
∑Monthly Meeting of Facilitators:
A monthly meeting was conducted in each center between facilitators and supervisors. The monthly meeting objectives is to improve the class to reduce the dropout and the facilitators has to brief their monthly progress and shared their experience problems.
A mid-term evaluation has been done in Rasuwa literacy center. Objectives of this mid-term examination is to evaluate the knowledge of the participants in different subject matter like reading, numeracy, health and forestry. This mid-term examination guide us to improve in particular topic and subject. This mid-term examination result shows that the participants are weak in numeracy, forestry, environment and some participants are not able to write yet.
∑Facilitators Refresher Training:
A six days facilitators refresher training was organized and conducted Kalikasthan in Rasuwa district. There were 15 male and six female participants in the training. The trainer were invited from Basic Primary Education Project (BPEP), Ministry of Education (MOE) and one independent trainer. The training was focused on the subject which need improvement as well as the methodology like micro teaching and participatory approach to deliver of health and forestry messages.
A final examination of Basic Literacy Class has been conducted in the month of May and June. The total number women enrolled in literacy class were 473, within this 473 participants, only 325 participants were appeared in the final examination and passed 174 participants. The dropout rate was very high due to many reasons e.g. marriage, delivery, seasonal migration (within the VDC) and pottering for living.
And those participants who were unable to complete the class were given 4 coaching class for better improvement. Re-examination will be taken after the completion of coaching class.
A coordination meeting has been organized between Literacy Participants, Facilitators, Literacy Support Committee chairman, Literacy Supervisors, Literacy Officers, Health Program Director, Educate the Children (ETC), District Health Education (DEO), etc. This coordination meeting was organized for the improvement and correction of the literacy class, also to inform ADRAís literacy class to other agency.
∑Post Test Evaluation:
A post test evaluation is done to women literacy participants with the developed pre and post test questionnaire by ADRA Monitoring Evaluation and Research Section. (For detail please refer Annex 1)
The basic literacy class was running well in 21 centers. But due to some reasons one class was closed in Ramche VDC. The reason of close is seasonal migration of the participation for shifting the animal from one place to another place for grazing.
Participants as well as facilitators goes trekking for monetary purpose. In some places facilitators and Literacy Support Committee members are not active to carry out the responsibilities. And also difficulty to find the alternative candidate as a facilitators.
B) Mother and Child Health Service Delivery:
The main objectives of the program is to raised the health status of the Mother and Child by reducing fertility rates and improving child health through health awareness and providing service delivery from PHC clinic and mobile clinic.
Total women visited for antenatal check up were 108. Among them twelve pregnant women had Tetanus Toxiod vaccine and also eight non pregnant women came for the vaccine.
317 under five children were examine in the clinic for different disease like diarrhoea 71. Acute respiratory infection 90 and malnutrition 2.
15 women had clinically diagnosed STDs and other Gynae cases were 69 in total. The major Gynecological problems are uterine protapse, secondary bleeding and pelvic inflammatory disease (PID).
Temporary Family Planning service is provided from the clinic. The permanent method vasectomy and minilaparotomy is doing in FP Camp only. Temporary FP method, Depo is very popular in Rasuwa District. 118 women had Depo-provera injection, in term of service provided, 24 women had Norplant, Condom and Pills also accepted but in a few in number. (For detail see Annex 2)
C) Mobile Clinic:
There is total 3 mobile clinic is running in Rasuwa district in 3 different VDC: Betrawati, Dandagaun and Saranthali. Before starting the mobile clinic a coordination meeting was set with DHO. Mobile clinic support committee is formed in each area to support the mobile clinic.
In the mobile clinic the service provided are antenatal check up, Tetanus Toxoid, under 5 children and temporary family planning method. (For detail see Annex 3)
The FP/MCH clinic faced difficulty in providing medical doctor in the clinic. The community people and the VDC are demanding a birthing center which is not included in our program.
D) Health Education:
Individual health education and counselling service is provided to the clients by the paramedical and nursing staff in FP/MCH clinic. The counselling service is provided to the FP clients, ANC cases and STD cases and health education is provided each case visited in the clinic. Health sessions are conducted in the literacy classes every alternative day.
A two days health education program is conducted in each VDC. A total of six health education training program is conducted within this six month period. The participants were selected from the respective VDC by VDC leaders and ADRA staff. There is total 18 participants in the program, among them 50% is female and 50% is male. 2 days curriculum is developed by ADRA Banepa and used same for Rasuwa.
E) VDC Orientation:
2 days of VDC orientation program was organized in total 7 VDCs. The main objectives of this orientation is to orient the VDC leaders, social workers, regarding health program of the government, responsibilities of TBAs, FCHVs, VHW. Other objectives of the program is to introduce ADRA Nepal and its activities.
A total of 15 street drama show has been done in different VDC of Rasuwa District including Dhunchhe. The main objectives of the drama is to disseminate the message regarding diarrhoea, ARI, AIDS and antenatal check up. Total eight member are comprised in the drama team.
FCHV Review Meeting was conducted in 7 VDC of Rasuwa district. A coordination meeting has been set with DHO before starting the FCHV Review Meeting.
There are total 245 FCHV in Rasuwa district. The FCHVs are responsible to conduct Motherís Group Meeting in each month in their respective ward and also FCHV provide first aid treatment, Pills, Condom, Counselling for the family planning clients and referred the cases in health institute.
In this Review Meeting, focused on Motherís Group Meeting to conduct in each fixed date of the month. In addition, of that FCHV need to participate in immunization day to assist the VHW. In the meeting other problems also discussed which has been solved by the facilitators. The facilitators were from DHO staff and ADRA staff. FCHV register has been checked and practiced how to fill the register. FCHV also mentioned their problems of that shortage of medicine, Jeevan Jal and no substitute of register book, as well as difficult to gather the mothers for the monthly meeting.
TBA initial training was conducted by DHO. There is total 135 TBAs in Rasuwa district. TBA review meeting has been conducted in some VDC. During review meeting the topic discussed were antenatal check up, post natal check up and refer all the high risk pregnancies and most importantly, assist and perform clean delivery to normal cases. ADRA distributed 5 "Safe Delivery Kit" to each TBA. TBA is advised to sell the kit to the pregnant women and revolve the kit buying from the market.
ADRA try to find out the drop out TBA and will start initial training with the coordination of DHO.
Due to high illiteracy among TBAs, they are not able to tell the importance of Safe Delivery Kit in the community. In addition, these women are mostly old and difficult to teach them.
F) Monitoring of the Activities:
The monitoring of the program has been going on at different level. For example; Field Representative and Literacy Supervisor monitor the activities of FCHVs, TBAs and literacy classes and in the same way, Health Educate, Field/Education Officer supervise and monitor Field Representatives and Literacy Supervisor activities etc.
The monitoring of the program activities is planned at each level by the use of indicators as listed in the project proposal. Monthly reports from the field and service statistics from the FP/MCH clinic are two of the main sources of in information for regular monitoring of the program.
Analyzing the quantitative results, the FP/MCH clinic has been providing maternal and child health services but the clients flow and types of cases very with seasons. The clients flow is not interesting as expected. There is good progress in literacy activities involving VDC and DEO.
G) Coordination with GO/NGO:
ADRA has been working very closely with DHO of Ministry of Health. ADRA organized FCHV review meeting and VDC orientation jointly with the DHO. ADRA is coordinating with DHO, Child Health Division (CHD) and JSI for the acute respiratory infection in the district. A memorandum of understanding letter has been set between JSI and ADRA to work closely in ARI program. Mr. Harikrishna Shah, Field/Education Officer, Mr. Ramji Ghimire, Health Educator and two DHO staff had participated Master Training for ARI in Pathalaiya, organized by JSI.
ADRA has been working with District Education Office (DEO) in Women Literacy Program. A quarterly meeting has been set for the information, suggestion and sharing the ideas.
A monthly meeting has been fixed with Dhaibung VDC chairman, social worker, club members to run the program smoothly and exchange of ideas and information. A "Contact Committee" has been formed for the further progress of work.
A coordination meeting has been done with Chief District Officer (CDO) and District Chairman. A brief information has been shared regarding program.