“On the third morning, a lady came to my home with a neighbour and introduced herself. She said that she was Indira, from an organization called PHASE Nepal. She said she was an Auxiliary Nurse Midwife and does work to educate women about maternal health.” Read more about Putali Gurung’s story
PHASE Worldwide works with disadvantaged communities in very isolated Himalayan mountain villages in Nepal. Through our implementing partner PHASE Nepal we provide integrated health, education and livelihood opportunities.
Our Nepali staff initially introduce healthcare services to the villages. This allows them to develop a relationship of trust and respect, and become a part of the communities – after which they are then in a position to offer PHASE’s education and livelihood initiatives.
PHASE Fact: We are ever expanding our health projects to work with more communities. In 2014, we began supporting Kolti and Rugin in the Bajura District, Kashigaun, Kerauja and Manbu in the Gorkha District, and Rayale in the Kavre District.
Why is healthcare provision so important to the communities?
PHASE Fact: We treated 53,494 patients in the 2013-2014 period. 6,056 of these were under five years old.
In the villages PHASE works with, less than 20% of the population have a secure food supply all year round.
This causes high levels of malnutrition and diseases. Consequently, mortality rates are incredibly high – especially among children and women of childbearing age.
The main causes of the high rates of child mortality are diarrhoeal disease, measles, respiratory infection and neonatal deaths, with malnutrition playing a prominent role in many deaths.
Maternal morbidity, as well as mortality, is very high; mainly caused by haemorrhages and infections. Over 70% of pregnant women in the communities are anaemic.
The most common health problems seen in the PHASE village health posts are:
- Abdominal pain
- Back problems
- Burns and injuries
- Diarrhoeal disease
- Reproductive tract infections
- Respiratory infections
- Skin conditions, including leprosy
- Worm infestations
Nepal Stories: PHASE has helped many women during pregnancy and labour. Read how our health staff supported Nima deliver a healthy daughter after losing 3 babies, Sukmaya during a breech birth, Dolma when she had difficulty delivering the afterbirth, Kanchimaya during a prolonged labour and Pasang Lama to survive a difficult pregnancy.
PHASE Fact: Our health staff carried out 364 postnatal checks for babies and their mothers and supported 212 births of new babies in 2013-2014.
What are the key issues of the Nepali health system in remote areas?
Medicines – The insufficient yearly allocation of supplies means health centres can go months without essential medicines; sometimes medicines and vaccines never reach their destination.
Equipment – Replacement of broken or lost equipment is almost impossible.
Buildings – Health workers often operate from houses with mud walls and floors, which are difficult to clean, often dark and cold, and without electricity or lighting. The few purpose-built health centres are often cramped and poorly maintained.
Staff – Government staff are often not local to the mountainous areas, and the harsh living conditions, and lack of resources and management support leads to long periods of absenteeism. There are unlikely to be any local people with relevant qualifications or experience. Nationwide, over 70% of the healthcare workforce are volunteers and assistants with minimal qualifications and training.
Conflict – Remote areas in Nepal were regularly visited by Maoist rebels during the Civil War (1996-2006) who extorted money from health workers and teachers leading many to abandon their posts.
What does PHASE do to address these issues?
We currently have 13 Primary Healthcare Centres and 40 Nepali members of staff who work across the Bujura, Gorkha, Humla, Kavre and Sindhupalchok Districts.
We provide extra health staff and support government health workers. PHASE employs female “Auxiliary Nurse Midwives” with 18 months of training and experience in maternal and child health. These are placed in governmental health posts and work with the District Health Offices. We also employ senior health workers. They visit our Primary Healthcare Centres to support staff, and ensure good relations with the communities, District Health Offices and PHASE’s central office in Kathmandu. PHASE supports government-employed health staff by offering supervision, extra training and financial incentives.
Our health staff work as rural GPs in the communities. PHASE’s health staff work closely with the communities by offering guidance and health education sessions in a variety of different areas – including nutrition, sanitation, safe water, family planning, and maternal and child health. They provide childhood vaccinations, dental care, respond to emergencies and deliver babies, amongst treating many other illnesses and injuries. Our staff are advocates of health rights and they encourage the communities to take active participation.
PHASE Fact: In 2013-2014, we provided 1,650 sessions of community health education – including school health and village cleaning programmes – which over 15,883 people attended.
We provide medical supplies. PHASE helps support the delivery of government medicine to the mountainous villages. We also supply additional essential medicines and equipment.
Nepal Stories: How PHASE save lives with oral rehydration salts.
We support health staff’s development. PHASE runs in-post clinical supervision, coaching and training for both government-employed staff and our own Nepali staff. This is done through experienced and skilled British GPs volunteering in Nepal. Whilst they are in Nepal, they live and work with the PHASE health staff. In the 2013-2014, 12 GPs and 6 midwives volunteered with PHASE’s staff in Nepal.
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