Maternal Health Programs in Nepal

In Nepal, maternal mortality ratio (MMR) decreased substantially between 1996 and 2006, from 539 to 281 deaths per 100,000 births (Ministry of Health and Population [MOHP], New ERA, and Macro International Inc., 2007). Improvements in maternal health services have been key in reducing the country’s MMR. The National Safe Motherhood Program has made significant progress in terms of development of policies and protocols as well as expansion of the role of service providers such as staff nurses and auxiliary nurse midwives. The Policy on Skilled Birth Attendants, endorsed in 2006 by the MOHP, specifically identifies the importance of skilled birth attendants (SBAs) at every birth and embodies the government’s commitment to training and deploying doctors, nurses, and auxiliary nurse midwives with the required skills across the country. By the end of 2008-2009, the birth preparedness package (BPP) had been rolled out in all 75 districts. Similarly, a maternity incentive scheme was adopted in 2005 to encourage women to use health facilities for maternity care and improve access to maternity care services (MOHP, 2011).

The health care services that a woman receives during pregnancy, childbirth, and the immediate postnatal period are important for the survival and well-being of both the mother and the child. The components are

  • Family planning
  • Antenatal Care
  • Labor & Delivery
  • Postpartum Care
  • Neonatal Care

 

Family Planning Program

Family planning continues to be a priority for the government of Nepal. By limiting births, preventing closely spaced births or births to very young or old mothers, infant, child and maternal mortality can be reduced. It can prevent at least 25% of all maternal deaths.
Family planning services are designed to provide a constellation of contraceptive methods/services that reduce fertility, enhance maternal and neonatal health, child survival, and contribute to bringing about a balance in population growth and socio?economic development, resulting in an environment that will help the Nepalese people improve their quality of life.

 

Major activities taken by MOHP

  • Voluntary Surgical Contraception (VSC)
  •  Spacing Methods
  •  FP Counseling
  •  Referral

 

National Safe Motherhood Program

The goal of the National Safe Motherhood Program is to reduce maternal and neonatal mortalities by addressing factors related to various morbidities, death and disability caused by complications of pregnancy and childbirth. Global evidence shows that all pregnancies are at risk, and complications during pregnancy, delivery and the postnatal period are difficult to predict. Experience also shows that three key delays are of critical importance to the outcomes of an obstetric emergency:

(i) delay in seeking care,
(ii) delay in reaching care, and
(iii) delay in receiving care.

To reduce the risks associated with pregnancy and childbirth and address these delays, three major strategies have been adopted in Nepal:

1.    Promoting birth preparedness and complication readiness including awareness raising and improving the availability of funds, transport and blood supplies.
2.    Encouraging for institutional delivery.
3.    Expansion of 24?hour emergency obstetric care services (basic and comprehensive) at selected public health facilities in every district

Since its initiation in 1997, the Safe Motherhood Program has made significant progress in terms of the development of policies and protocols as well as expansion in the role of service providers such as staff nurses and ANMs in life saving skills. The policy on skilled birth attendants endorsed in 2006 by MoHP specifically identifies the importance of skilled birth attendance at every birth and embodies the Government’s commitment to training and deploying doctors and nurses/ANMs with the required skills across the country. Similarly, endorsement of revised National Blood Transfusion Policy 2006 is also a significant step towards ensuring the availability of safe blood supplies in the event of an emergency.

In order to ensure focused and coordinated efforts among the various stakeholders involved in safe motherhood and neonatal health programming, government and non?government, national and international, the National Safe Motherhood Plan (2002?2017) has been revised, with wide partner participation. The revised Safe Motherhood and Neonatal Health Long Term Plan (SMNHLTP 2006?2017) includes recent developments not adequately covered in the original plan. These include:

  • Recognition of the importance of addressing neonatal health as an integral part of safe motherhood programming;
  • The policy for skilled birth attendants;
  • Health sector reform initiatives;
  • Legalization of abortion and the integration of safe abortion services under the safe motherhood umbrella;
  • Addressing the increasing problem of mother to child transmission of HIV/AIDS; and
  • Recognition of the importance of equity and access efforts to ensure that most needy women can access the services they need.

Major activities:
1.    Birth Preparedness Package and MNH Activities at Community Level
2.    Rural Ultra Sound Program
3.    Uterine Prolapse
4.    Human Resource
5.    Equity and Access Program (Samata Ra Pahunch Karyakaram)
6.    Emergency Referral Fund
7.    Maternal & Neonatal Health Update (clinical update for ANMs and Staff Nurse)
8.    Safe Abortion Services
9.    Aama Surakchhya Program and Antenatal Incentive Program

 

References

Department of Health Services, Anual Report 2009/10. 2011, Ministry of Health and Population, Government of Nepal.
Department of Health Services, Anual Report 2010/11. 2012, Ministry of Health and Population, Government of Nepal.
Ministry of Health and Population, N.E., and ICF International), Nepal Demographic and Health Survey Report 2011. 2012, Ministry of Health and Population, Government of Nepal.


My education includes training in medicine, public health, clinical research, biostatistics and health response in complex emergency. I have more than seven years of experiences in health research (Survey, Case control studies, Randomised Controlled Trials (RCT), Health Policy and Systems Research). My areas of expertise also include the project management particularly in health sector. I have also experience and interest to work in health emergency in large population in disaster setting.

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