Safe Motherhood in Nepal

News and Events

Increasing Access to Safe Motherhood Services in Remote Areas

The Nepal Living Standards Survey 2003/04 estimates that over the whole country an average of 62% of households have access to a health post within 30 minutes travel time, but in mountain and hill areas this falls to only 37% and 51% respectively. Even more critically, access to emergency obstetric care in mountain and remote hill areas is severely limited or not available within a reasonable travel time. It is thought that, as a general rule, if people live more than four hours’ journey from a health facility they will not go. Even if they do, in an obstetric emergency case there is a strong possibility that the woman will die on the way.

Two approaches currently being piloted to address this situation are telemedicine (using CDMA phones) and public private partnerships with medical colleges. Use of CDMA phones to access higher level technical advice is being piloted in Solukhumbu, Rupandehi and Dailekh districts. Local health workers can use the CDMA phone to call the doctor at the district or zonal hospital for help in managing and making referral decisions for obstetric emergencies. Not only can this enable them to provide better immediate care, but it also gives time for the referral centre to prepare for the arrival of a case. By later this year information and a report should be available about how this is working. In Solukhumbu, nurses from the district hospital have also been issued portable ultrasonic equipment, with which they visit village clinics to provide checkups for pregnant women. This enables potentially high risk cases (such as twins, abnormal positioning, placenta previa etc) to be identified in time to go to the district hospital for the birth. The women can travel ahead of the expected delivery date and stay comfortably in the adjacent maternity waiting home.

In Dailekh, an agreement has been signed between the government district hospital and the Nepalgunj Medical College, a private enterprise. Through this non-profit agreement, the medical college will provide on the job training for the Dailekh doctors, nurses and support staff and will cover caesarean section services in Dailekh with their own trained doctors. This has the mutual advantage of providing experience for the medical college doctors and services for the women of Dailekh.

SSMP/ Options is working with the government and other safe motherhood stakeholders to develop other strategies for improving services for women in remote areas.