Safe Motherhood in Nepal

The Support to the Safe Motherhood programme (SSMP) partnership agreements with UNICEF, United Mission to Nepal (UMN), Ipas and ActionAid ended during this reporting period, and as SSMP moves towards closure, the focus has been on evaluation of achievements at all levels, and ensuring their sustainability. To this end, the SSMP/ Options team and partner organisations have been actively involved in planning for the next Nepal Health Sector Programme (NHSP II, 2010-15).

Two major SSMP/ Options supported studies, the Maternal Mortality and Morbidity (MMM) Study and the Equity and Access Programme (EAP) Knowledge Attitudes and Practices (KAP) Study were completed and disseminated, providing important benchmarks on sub-sector progress and pointers for the future. Both studies highlight the importance of human resource availability in determining facility functionality. The MMM Study validates the Maternal Mortality Ratio (MMR) of the 2006 Nepal Demographic and Health Survey (NDHS), estimated at 281 deaths per 100,000 live births. However, the finding that suicide has replaced maternal causes as the leading cause of death among women of reproductive age raises urgent questions about the rights of women and underlying issues of mental health and gender based violence. SSMP/ Options is working closely with ActionAid to better understand and respond to these issues. 

The KAP study found dramatic increases in Safe Motherhood and Newborn Health (SMNH) service utilisation among targeted communities, with facility deliveries up from 20% to 40% in the three-year EAP period and the equity gap closing across social groups. This is highly relevant to NHSP II design, which is expected to carry a major equity focus.   

Evidence is emerging that the new Aama programme (combining free delivery care with maternity incentives) is a strong contributing factor to a doubling in the number of birthing centres offering 24-hour delivery services (from 254 to 532). A recent SSMP/ Options contracted study, examining the impact of Appreciative Inquiry (AI) in 50 health facilities in 28 districts, found the combined effects of Aama and AI inputs resulted in all facilities initiating 24-hour services shortly after the AI review and planning workshop and a consequent increase of 55% in institutional deliveries.

Additional DfID funding to study the impact of Free Essential Health Care Services will be used to assess Aama at household, facility and Ministry level: a six-district household study will examine usage of the scheme; an Emergency Obstetric Care (EOC) facility study will track delivery types and quality of monitoring; and a fee reimbursement study will examine the impact on facility finances. A final Rapid Assessment is also planned and a synthesis of findings from all studies will be used to inform implementation under NHSP II.

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