Safe Motherhood in Nepal

Summary

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.

The Safe Motherhood Long-term Plan represents the lines of action needed to scale up services that are specifically for Safe Motherhood. In brief, these are to:
-    scale up the size of the workforce
-    conduct a programme of investment in infrastructural development
-    take positive steps to improve physical assets management
-    conduct a comprehensive programme of improvement of service delivery
-    work to improve access to and utilisation of services

However, a series of vertical interventions in the field of MNH will not achieve the desired results. Calculations of the cost of achieving safe motherhood and newborn care, frequently ignore investment costs, costs related to demand-side activity, and of generic health system improvements needed to support the effectiveness of MNH interventions in real life.

The major challenges facing Nepal in scaling up MNH are: funding, pace at which infrastructural development can be carried out; need to tailor strategies according to geographical zone; need to maximise integration of concerns; pace at which health service management can be improved; lack of a referral system; fragile political environment; and technical capacity. The way forward for SSMP must depend on judgements about the required timeframes for real change.