Activities carried out:
- 1. A situation assessment study on pesticide use and its health effects in Chitwan District have been conducted and the findings of the study were disseminated to the local government. The data is also being used by local government agencies.
- 2. Participatory planning workshop was conducted among different groups of stakeholders in Shivanagar, ward 14 of Bharatpur metropolitan so as to prepare detail implementation plan for the year. This was a collaborative effort of ward and FHEN project.
- 3. Farmers Field School (FFS) at Shivanagar is being successful. Farmers recently had an exposure tour to different places of Chitwan to internalize different successful examples of adopting Integrated Pest Management.
- 4. Refresher training to local farmers from phase 1 of FHEN has been completed. It was about safe handling of pesticides and farmers’ role in pesticide minimization.
- 5. Sensitization training was conducted among pesticide sprayers about safety measure while handling pesticides and personal protective equipment are distributed to them to provoke behavior change
- 6. Three day training was conducted targeting pesticide retailers for their awareness on safe handling of pesticides and motivation to influence farmers in the same line. Pesticide retailers have now become change agents in pesticide minimization campaigns.
- 7. Various awareness and advocacy campaigns are ongoing for promoting safe and healthy food production with ensured health of farmers and consumers.
- 8. The existing activities and outcomes of the project are being reflected in local and national media and newspapers.
- 9. Local government is found to incorporate the concept of project in their plans and programs. For example, Rapti municipality has developed ‘Pesticide Minimization Act’ and is currently conducting various programs of Integrated Pest Management Movement.
- 1. Training for Community Pharmacists
The misuse and overuse of antimicrobial drugs is accelerating the development of resistance, this is especially observed when antimicrobials are available over the counter. Studies showed that more than 50 percent of antibiotics are sold without prescription globally, the situation in Nepal is even worse. Hence, GARP-Nepal in collaboration with Department of Drug Administration developed a training manual for community pharmacists to equip them with required knowledge on prudent use and sale of antimicrobials to limit the spread of resistance.
A Training of Trainers (TOT) program was organized at Department of Drug Administration (DDA) meeting hall for training the participants representing DDA, National Medicine Laboratory (NML), National Health Education, Information and Communication Centre (NHEICC) and National Health Training Centre (NHTC) on the burning issue of Antimicrobial Resistance. These trainers will then be providing successive trainings to community pharmacists and drug retailers.
- 2. Orientation Program on Antimicrobial Stewardship (ASP) at Chitwan Medical College
Introduction of Antimicrobial Stewardship Programs (ASP) in health facilities have been found to be effective in bringing about a decrease of 22-36% in antimicrobial use. Working towards this, GARP Nepal together with DDA has initiated to start ASP Program across various institutions in the country and has prepared a Policy document ASP. An orientation program on ASP was organized at Chitwan Medical College to facilitate implementation of ASP at CMC.
Important accomplishments of FHEN in second quarter:
Several activities were accomplished in the second quarter. Out of many, major developments in the second quarter were:
- Completion of municipal level orientation program at all project areas
Due to the restructuring of the government, district level government offices were dissolved and all the responsibilities and authorities were handed over to the municipality. Therefore for the purpose of coordination, the idea of orientation program in each municipality was conceived. Accordingly, separate orientation programs were organized in four different municipalities. Mayors, chief of health section, agriculture section and NGO section, representatives from local agriculture cooperatives, farmers, health workers and social workers attended the program. Crucial feedback was obtained from the participants basically on the need to coordinate with local level for the effective implementation of the project activities.
- Conduction of workshop on participatory development to FHEN staffs
The workshop was facilitated by Ms. Homa Thakali. The workshop was mainly designed to help field based staffs for the proper management of challenges being faced during the implementation phase and to enhance their skills. It included topics such as coordination, negotiation, attitude, development and development approaches, sustainable development, presentation, facilitation skills, development workers and their characteristics, effective feedback, field visit and assertive communication skill.
- Development of IEC materials
Two IEC materials have been prepared in second quarter of FHEN. One was leaflet about the introduction of the FHEN project and another was about the crucial points regarding the health dimension of the pesticide use and the need to follow waiting period.
- Conduction of awareness campaign on pesticides minimization at Ratnanagar Festival
Ratnangar Festival is a festival organized every year where large number of people visit from all the areas of Chitwan District and neighboring districts. The festival has various knowledge generating messages with stalls, foods and entertainment facilities. Therefore it was realized that it could be a centre of attraction to people from the project working areas as well. Thus, as a part of advocacy a stall was set up from 15th of January 2018 for a week with the objective to sensitize audience (especially farmers, students) about the health hazards of pesticide use and its safety measures.
- Advocacy workshop at Bharatpur metropolitan city to all ward chairpersons and metropolitan officials
The objectives of the advocacy program were to sensitize municipal officials and ward chairpersons about the need to address the growing use of pesticides and ensuring people’s health and to discuss on different alternatives on how the issue can be addressed at local level. During the presentation, Project Manager, FHEN explained about the situation of pesticide use in Chitwan District sharing some data from baseline survey and their hazardous effects in health and shared the possible ways to mitigate the problem from the local level. Ward chairpersons realizing the issue of irrational pesticide use have addressed the Mayor of Bharatpur metropolitan, and they advocated for:
- The need to address the issue of Indian border which is allowing the import of banned pesticides and vegetables with excessive amount of pesticide residues.
- To regulate the pesticide use in crops and poultry. Sensitize farmers and also address the issue of suicide due to the use of pesticides.
- Educate school children about the precautions to be taken at home while handling pesticides and influence their parents through them.
- The need to work on market management and price for IPM products and establish a lab which can measure the pesticide residues in vegetables and crops in Chitwan.
- The need for strict supervision and monitoring to pesticide retailers to check the sales of banned pesticides.
- The need to work for the management of safe disposal of pesticides.
- Completion of baseline survey in Chitwan District
Baseline survey was conducted successfully. Ethical approval letter from Institution Review Board of Nepal Health Research Council was also obtained.
Major findings of the baseline survey with regards to Chitwan district are:
- From the baseline survey it was found that out of 790 farmers, 92% of farmers use some kind of pesticides in their farm. Among them, 58% use only chemical pesticides in their farm. About 32% use both botanical and chemical pesticides in similar proportions. About 10 percent use botanical pesticides in their kitchen garden and chemical pesticides in commercial farm. One percent use botanical pesticides only and 1% use pesticides rarely.
- Among all study participants, 75% were found to use any one type of Personal Protective Equipment (PPE). Most commonly used PPE were mask and full sleeved shirts and pants.
- Regarding the duration of pesticide use, almost half of farmers revealed that they are using pesticides since more than a decade.
- Regarding health effects of pesticide use, about 18% of farmers were found to have suffered from any illness related to pesticide use in last year. Most common complaints reported were skin allergies, irritation, muscle twitching, dizziness and severe headache.
- Having realized the need to address the issue of unregulated and hazardous pesticide, majority of farmers have urged local government to work on the issue. According to them following steps can be taken by local government so that excessive use of chemical pesticides would be minimized:
- Provisions of subsidy to farmers who are willing to practice alternatives of chemical pesticides because they may suffer from loss due to lower production for the initial few years.
- Local government was urged to develop pesticide minimization and regulation act for their area. Also the need for conducting IPM/organic farming training and conduct awareness campaigns to sensitize farmers and communities on harmful effects of pesticide use.
- Also farmers have pointed out the need to intervene to the consumers so that they are able to realize the importance and select organic or IPM products. This will ultimately create demand for those items in the market and thus will give space to farmers.
- Finally farmers suggest the need to manage the market so that local farmers get opportunity to sell their products by their own (not through brokers) and be able decide the cost of their production by themselves.
- Dissemination workshop about baseline survey findings at two wards of Bharatpur metropolitan
- The dissemination workshop was held in ward level. It was completed in ward 6 and 14. The objective was to brainstorm among local stakeholders about the possible ways to address the issue of unregulated and massive pesticide use. Most of the presentations were done through bar graphs to facilitate participants for easy understanding.
- Having completed the presentation, many queries have come out from the participants regarding the process of sampling, survey participants and their distribution. After discussing the methodology of survey in detail, the session went through rigorous brainstorming on the current situation of pesticide use in the village. There were round of discussions, agreements and disagreements on what actions can be taken to mitigate the problem. And finally it was decided to take some actions on this issue and they agreed to have close meeting with all ward representatives and officials if some resources can be allocated from ward office itself for pesticide minimization. Also it was decided to do some home work on how can we proceed.
- Participatory planning in ward 14, Shivanagar, Bharatpur
- Having based on the findings of baseline survey, participatory planning was done in ward 14, Shivanagar, Bharatpur. It was conducted in close collaboration with ward office and local agriculture cooperatives. Representatives from farmers, professional sprayers, retailers, ward improvement committee, female community health volunteers, health workers, mother groups, elected members and school teachers had participated in the program. Project Manager, FHEN shared the major findings of baseline survey and it was followed by discussion among participants. The discussion was focused on how to solve the issue by the community themselves. Participants were then divided into different groups as per their occupational category to plan on how they can contribute to minimize pesticide in their ward. They have come up with detail implementation plans to be completed in a year. These plans match with the project activities plus they have developed more plans which local stakeholders should take initiation. Participants also nominated a committee among them responsible to ensure the implementation of plans and its quality. Ward chairperson also shared his commitment on behalf of ward office. This program provided an avenue for local community to communicate with local authorities face to face to work for pesticide minimization in the area. FHEN has defined its role to support local authorities for the implementation of some crucial activities as mentioned in the project plan. However, for overall reduction of harmful pesticide use, joint and collaborated efforts are necessary and should address the issue of consumer awareness and market management as well. This exercise helped to go beyond farmers to address the issue and also it will gradually develop ownership among local communities and authorities towards pesticide reduction programs. For the project it was a part of advocacy program to create a supportive environment in the ward to work for pesticide minimization.
- Conduction of Farmers’ Field School at Shivanagar, Bharatpur
After participatory planning at Shivanagar, Farmers’ Field School (FFS) has been started in collaboration with ward office. In total 30 farmers are enrolled in the program from different parts of the ward. The training consists of practical exercises to facilitate farmers to identify the useful and harmful pests in their farm and manage them with the adoption of integrated pest management approach. The training course is of 22 weeks duration.
GARP Nepal celebrated World Antibiotic Awareness Week 2017 for the third year in a row during November 13-19, in collaboration with the academic partners: Institute of Medicine, Patan Academy of Health Sciences, Kathmandu University School of Medical Sciences, B. P. Koirala Institute of Health Sciences, Agriculture and Forestry University and pharmacy Colleges. An array of activities including walkathon, essay, poster and quiz competitions, school health programs and community awareness programs were organized by the institutes to make people aware about antibiotics and antibiotic resistance. On last day of Awareness Week, GARP Nepal, Ministry of Health, Ministry of Livestock Development, FAO, WHO, OIE and the Fleming Fund jointly organized a Workshop on ‘One Health and Antimicrobial Resistance: Challenge and Way Forward’. The purpose of the workshop was to bring together all the stakeholders from human, veterinary and environmental health to tackle current situation of antimicrobial resistance from a ‘One Health’ perspective and discuss the challenges and way forward.
The animated video ‘Superbug Story: Diary of a Staph’ produced by GARP-Nepal, which explains how bacteria develop resistance to antibiotic and eventually turn into superbugs, was launched nationally and internationally during the Awareness Week.
Link to the video: https://www.youtube.com/watch?v=3o5wT3KmhFo&t=7s
The 6 episode TV program ‘Bahas Ma Antibiotic’, produced by GARP Nepal in collaboration with NHEICC was telecasted on Nepal television (NTV), wherein experts from all related fields of health can be seen interacting on the rational use of antibiotics in human and animal health. In addition, an audio/visual documentary built around the issue of Antimicrobial Resistance in Nepal has been developed and is likely to be telecasted shortly.
Continuous efforts have been put into introducing the Antimicrobial Stewardship Program at Chitwan Medical College (CMC) in collaboration with DDA, as an effective systematic approach to optimizing the use of antimicrobials. An orientation program was held this past April at CMC for this purpose and was attended by the GARP Nepal team and representatives of DDA and CMC.
GARP Nepal also collaborated with Department of Drug Administration to come up with a manual to train practitioners of community pharmacies and drug retailers on the prudent sale and use of antimicrobials to limit the spread of resistance. A TOT program was run on April 2018 to train the trainers (personnel from DDA, NVL, NHEICC and NHTC) who would then provide successive trainings to the target groups with the help of the developed manual.
Likewise, a committee was formed with officials of veterinary science, for developing a training manual for veterinarians and veterinary paraprofessionals on AMR. The training manual will be used for training practitioners of medicine in animal health, in a similar module as the one for community pharmacists.
On the support of Project HOPE and CDP, Nepal Public Health Foundation has been working in the maternal neonatal child health nutrition practices in the rural areas of Makwanpur district through SPARSH-M project. Its main objective is to improve maternal neonatal and child health nutrition and hygiene practices by increasing access to related information and services. SPARSH-M is reaching to unreached population through different strategies i.e. Community mobilization, Capacity building and community outreach program and different activities i.e. capacity building, health system straightening and demand generation.
SPARSH-M project has been completed following activities in past sixth months:
Construction of maternity waiting home
Institutional delivery is low in SPARSH-M working areas due to the geographical inaccessibility to Health Centers. It is very hard for the pregnant women to visit health post during the days near to her expected date of delivery due to the geographical hardship. Many incidents of birth of baby on the road has occurred while travelling up to the health post for delivery causing life taking threats for baby and mother both. Due to these problems, Nepal Public Health Foundation with collaboration with Rakshirang Rural Municipality initiated the construction of maternity waiting home near Rakshirang Health Post in the month of December 2017 and has successfully completed the construction in April 2018. It aims to increase the institutional delivery and healthy child growth by providing the shelter to the pregnant women and her care taker during the last month of delivery.
FCHV day celebration
FCHV day is celebrated every year with the aim to honor the contribution of FCHVs on improving health status of community health status of people. This year FCHV day celebrated in the month of January 2018 with the theme. Nepal Public Health Foundation has supported financially and technically in its working areas for celebration of FCHV day. Altogether 47 female community health volunteers were honored and appreciation was done through certificates for their hard work and contribution in building healthy society.
Interaction and orientation with School teachers on MNCHN
School health program in the main activity of SPARSH-M project and School health teachers play the prime role while conducting health education program in school, and also teachers play great role in promoting healthy behaviors, positive at attitude towards health. Teachers are considered as key for changing behavior of students. Therefore, SPARSH-M had also envisioned the orientation and interaction program with school teachers on Maternal, neonatal, child health and nutrition. And in the month of November 2017, interaction and orientation with school teachers on MNCHN was conducted. Altogether, 15 school teachers were participants in the program.
- Community Health Score Board
Community score board is a two-way and ongoing participatory tool used in the assessment of the quality of health services. It is a platform where community stakeholders discuss the different aspect of health and calculate the quality of health service being provided by the health post and rank their health post within th e range of 0-50 score. Every six month SPARSH-M conducts this activity in its working areas to track the achievement and hurdles for progress in health services improvements and to assign the person to assist to solve the issues if any. In last 6 months 4 events of community health score board was conducted.
- Community health education and revitalization mothers group for Health
In the month of March, Raksirang Rural Municipality conducted “Community Health Education and revitalization of mothers group for Health” with an objective to engage the rural municipality in the health activities being implemented via mothers group and also to support mothers group for health. In this event SPARSH-M provided the technical support to the rural municipality to conduct the community health education and revitalization of mothers group.
- Celebration of national events
SPARSH-M is being involved in every health events organized by district public health office, central regional health directorate and health post. This year staffs of SPARSH-M participated in different national events to support the event and its successful implementation. The major events in which SPARSH-M was involved during last 6 months were, Mental Health Day, National Health Service Day, FCHV day etc.
- Strengthening of mothers group for health (MG-H)
Support for regular functioning of Mother’s Group meeting has been a regular activity of SPARSH-M in its working area. Before the implementation of the SPARSH-M there were only few mothers’ groups in some wards of rural municipality (formerly known as VDCs) which were functional and among them only some mother’s group used to discuss on health topics during their meeting. Therefore, SPARSH-M took its step ahead for reformation and revitalization of the mother’s group. Reformation and revita lization was achieved 100%. Along with this, social mobilizers (SMs) have been supporting FCHVs to run the educational and discussion sessions on components of Maternal, Neonatal Child Health and Nutrition (MNCHN). In last six month 47 FCHVs organized 294 MG-H session and among them Social Mobilizers attended 152 mother groups meeting to provide technical support. SPARSH-M, also has been supporting mother group meeting financially, monthly each mother group receives Rs. 450 for the purchase of tea and other commodities necessary for mother group.
Peer group activity is one of regular activity of SPARSH-M project. The peer group is a group of 7-15 persons with similar characteristics and with common needs. SPARSH-M has been actively involved in formation of peer groups and deliveri ng key messages of the SPARSH-M related to MNCHN and hygiene using different methods within the peer group members. In last 6 months about 119 sessions of peer group was conducted in the working area of SPARSH-M to discuss and deliver the key health messages among the various peer groups. Peer group activities
- Home visit
Home visit is a regular activity in SPARSH-M project. Each SM is assigned to reach minimum 10-12 households in a month. SM targets beneficiaries who were not covered by both mother’s group meetings and peer group activities. SM does home visits to educate and counsel beneficiaries and their family members on MNCHN and hygiene and services available in the health post of their localities. In last 6 months around 300 household was visited by the social mobilizers for the health education and counseling.
- Referral fund
Since from the beginning of the SPARSH-M project, referral fund has been an impactful act for life saving. The pregnant women and under 5 years children from ultra-poor families, who are in need of health services from higher health facilities (for BC/EoNC and severe illness) as identified by the Health post in-charge are the beneficiaries for the referral fund. SPARSH-M has been providing transportation cost as referral fund to those people from ultra-poor families, so that they could travel to the higher health facility quickly and prevent themselves and their children from the danger of complications or loss of life. In last six months total 15 ultra-poor households were benefited from referral fund.
- Support in EPI/ORC
Social mobilizers of SPARSH-M, has been actively supporting health workers regularly in all EPI/ORC clinics to meet the beneficiaries and to deliver health education messages on maternal child health nutrition and hygiene practices in mass which gathers during the EPI/ORC events.
- Water and vector borne disease prevention training
Water borne and vector borne diseases are always public health concern in the disaster prone areas as the disaster and climate change are playing great role in breeding and shifting of vector from one place to another. Disaster also makes people more vulnerable to the water and VBDs as it disrupts the normal living condition by damaging the houses, road, embankment, sewage system etc. hence, creating favorable environment for the vectors.
Makwanpur district is also high risk areas for water and vector borne diseases because it is adjacent to Tarai district, seasonal landslides, cross boarder population movement, lack of awareness, lack of health services etc. Therefore Nepal Public Health Foundation has conducted training for health worker and FCHV on Water and Vector borne diseases prevention with the aim to increase the awareness and built capacity of health workers and FCHVs on water and vector borne diseases. The training for health workers was of 5 days and that for FCHV was of 2 days.
- Health awareness camp and hygiene kit distribution.
With the aim to promote the healthy behaviors and enhance the awareness level of community people, Nepal Public Health Foundation conducted health awareness camp in its working areas along with hygiene kit distribution. The target beneficiaries for the hygiene kit distribution were pregnant women and mother with under 2 years children. About 1700 beneficiaries were benefited with hygiene kit.
A. Inception meeting with in-country stakeholders:
Inception Meeting was held on 21st November, 2017 between Sick kids Team and Nepal’s health and Nutrition experts, stakeholders and pioneers. With a following objectives set on a mind in order to conduct research further , meeting was conducted successfully.
a. To assess the global, regional and national prevalence and trends in under-5 stunting among LMICs from 1990 to 2017. (Explore levels and trends in stunting sub-nationally across key equity dimensions including: maternal education, household wealth, urban/rural residence, gender, geographic region).
b. To understand the major determinants globally that have successfully contributed to reductions in childhood stunting prevalence between 1990 and 2017. (Examples of determinants include: contextual factors, national or subnational interventions/policies/strategies/programs, other initiatives).
c. To undertake in-depth evaluations of policies, programs and factors in a set of countries that have had dramatic reductions in stunting (coined “exemplar nations”) to understand major contributors and success factors.
B. Development of methods and materials for quantitative/qualitative work. Field Visit and data collected from diverse group of stakeholders/experts.
C. Prepared Summary of the document on policies and programs on Nutrition in Nepal (As per template provided by Canada team)
- Timeline of policies (Format provided by Canada team)
- Merging the data sets
- Qualitative data collection: Key Informant Interview-15
- Transcribing/Translation- Completed
- Finalization of Questionnaire tool for FGD
- Themes/codes developed
1. This quarter was dedicated for office set up and accomplishing all the administrative tasks for example conducting District Level Project Advisory Committee (DPAC) meeting and getting approval letters from all the working municipalities.
2. The overall project budget has been segregated by each municipality for transparency and as per the need directed by current local governance structure.
3. Preliminary visits were done in all old working areas along with some new areas to be familiar with geography and boundaries and meeting key stakeholders and target groups were crucial for coordination to plan and implement Phase II activities.
4. Due to change of local governance structure, updated map of Chitwan was not available. Therefore, having in-depth interaction with local people, project working areas have been located.
5. Inauguration ceremony of FHEN Phase II has been planned for November. Therefore, necessary preparations were completed.
6. Baseline survey is crucial to assess the current situation of communities’ knowledge and practice about Integrated Pest Management for designing effective intervention. Therefore, necessary tools for baseline survey have been prepared.
Alternative Health Financing Project started from February 2017 with an aim of exploring health financing options to achieve Universal Health Coverage in Nepal which is in it termination phase. Since July, 2017 the following activities has been carried out. Field visits were the major events in the past three months that included in-depth interview and key-informant interview with relevant stakeholders using interview guideline.
Field visit to Baglung and Kailali was carried out in July and August respectively in order to review Social Health Security Program (SHSP) run by Government of Nepal through Social Health Security Development Committee (SHSDC). District Manager and Enrollment Officers of SHSDC, Chief and focal person for the insurance program from District Public Health Office, focal person for the program from district/zonal hospitals were interviewed in-depth for the purpose.Similarly, with an aim to review implementation status and challenges of Community based Micro Health Insurance supported by Nirdhan NGO, a visit to Banke was carried out in August.
For the purpose, program manager of Nirdhan NGO and focal person from Save the Children, the supporting organization, were interviewed in-depth.
Further, in mid-September to review one of six piloted public scheme of Community based Health Insurance by Nepal government, field visit to Dumkauli Primary Health Care Center (PHCC) of Nawalparasi district has been carried out. Medical Officer of the PHCC as well as current and past focal person of the CBHI were interviewed in group. Beside the documentation of field notes, drafting report has also been carried out. Activities to be carried out in this phase are consultation with health economists and dissemination of the final report.