Safe Motherhood in Nepal

Well planned and managed infrastructure is a must for creating an enabling environment for better health services and for the retention of human resources. The support being provided by SSMP in this respect is described; firstly in terms of ongoing construction projects. The effects of budget capping by DfID have been to some extent mitigated by provision of government funding. The technical support being provided from SSMP in the whole process of infrastructural development is described; this work is based upon the need to ensure that SSMP-funded construction projects go ahead promptly and to a good standard. However where possible, a systematic approach to improving construction practice and standards in general is taken. A comprehensive set of proposals for the ways in which SSMP can take this work forward, are set out.

Support to the Safe Motherhood Programme Mid Term Review, Strategic Issue Paper 8 Physical Assets Management Part A: Infrastructure Part B: Equipment January 2007

Skilled attendance at childbirth is widely acknowledged as an essential part of the drive to reduce maternal and neonatal mortalities. The Government of Nepal has developed a National Skilled Birth Attendants (SBA) Policy, which targets skilled birth attendance for at least 60 percent of births by 2012. SSMP and other stakeholders supported the development of this policy and of an in-service SBA training strategy. There is now a need for a joint effort among safe motherhood and neonatal health partners, including SSMP, to implement this and develop and implement a broader implementation strategy for the overall SBA policy, covering pre-service training, deployment and retention of trained staff, including enabling environment initiatives, and access and demand work. The various components of SSMP should feed into this as a holistic process, supporting the appropriate government divisions and centres.

This paper explores the potential of public private partnerships to supplement overstretched government capacity in health service provision and training and equity and access work and describes some of the examples in Nepal. The Government has expressed commitment to the principles of partnership, but work is needed to establish institutional mechanisms and responsibilities for ensuring services are equitably available and of the required standards. SSMP has gained significant experience in some of these areas through its work with partners and the government, and will apply this learning in support of the government’s development of partnership modalities and in collaboration with the Health sector Reform Support Programme.

A sustainable health service is one that is guaranteed on an uninterrupted basis, even if it has to be financed from external sources. This is the only way that sustainability can be regarded in the context of a fragile state such as Nepal. Scaling up is not only about funding; it is also about the capacity to implement a major programme of development; to manage change; to deliver services and ensure that people can use them.