Safe Motherhood in Nepal

The paper reviews global evidence supporting the use of EOC monitoring as a proxy for assessing progress towards reducing the maternal mortality ratio and the impact of safe motherhood programming. Experiences of monitoring EOC services in Nepal in 13 districts are documented, providing valuable information in support of this approach. The four indicators used to monitor service utilisation and quality of care (percentage of deliveries in an EOC facility, met need for direct obstetric complication care, met need for caesarean sections or caesarean section rate and case fatality rate) show trends of increasing utilisation over a period of eight years and a generally low case fatality rate. This reflects the effects of safe motherhood programme inputs in these districts, and further analysis of data could yield valuable information about local situations. SSMP is supporting the integration of EOC monitoring into the government Health Management Information System, moving away from district based project monitoring to a more comprehensive national approach to this important activity.

The paper describes the progress achieved in implementing the reformed abortion law in Nepal. In a few short years there have been remarkable achievements in terms of training service providers, providing services across the country, with 70 out of the 75 districts now covered and increasing public awareness of women’s right to safe abortion services. This has been due to a complex mix of factors, including a pragmatic enabling policy environment; multi-partner inputs (public private partnership); recognition of the part safe abortion services can play in the drive to reduce maternal mortality; and improved education and access to information leading to increased confidence, among younger women in particular. Strong government buy-in has been a key factor and the integration of safe abortion services into safe motherhood programming, for which SSMP has provided support.

The essential MNH package was developed by the government of Nepal, with support from partners, including SSMP, as a part of the national effort to improve maternal and neonatal health outcomes by ensuring a basic range of services at appropriate levels of health facility and at community level. International evidence supports this as an effective intervention, and it is already being used as a reference in developing training curricula and programme plans, for example in the skilled birth attendants training strategy. However, the major challenge will be to implement the package across the country. This will require extending services at peripheral levels and providing additional training to staff, which have huge cost implications. A comprehensive strategy will be required, with detailed costing exercises, which SSMP will need to be involved in supporting.