Since its arrival in Nepal in 1951, United States Agency for International Development (USAID) has actively worked in various sectors of development, health being a major focus.
From helping the country in eradicating malaria and opening up the Tarai to working proactively in mother and child health and family planning programs, in almost six decades of its operation, USAID/Nepal has worked with the Government of Nepal in achieving basic healthcare facilities for the communities.
In 2009, the agency provided the government with US$22.2 million in the health sector.
Dr Kevin A. Rushing, Mission Director of USAID/Nepal, said, “Our resources support the Government to provide sustainable, accessible, and quality basic health services to its people, particularly the poor, and strengthen its delivery systems to ensure the achievement of its 2015 Millennium Development Goals.”
And with its recently announced US$15.6 million Ghar Ghar Maa Swasthya (Healthy Homes) program, USAID will be funding the Nepal Contraceptive Retail Sales (CRS) company for social marketing activities and will also be partnering with the Academy for Educational Development, which will assist CRS to achieve self-sustainability.
In an interview with Republica, Rushing talks about USAID’s support to the health programs in Nepal and its Healthy Homes program.
Keeping in view the Millennium Development Goals 2015 that Nepal has to meet and the current situation of healtcare system in the country, what do you think needs to be done? Donor agencies are doing their part but do you think the government and its policies are good enough to battle all the healthcare issues that the country faces today?
The Nepal Government recently received a significant boost to its efforts after the leading health-sector donors signed an unprecedented joint financing arrangement. This arrangement unites donors and the government around a single, focused plan for investment and is essential to effectively improving the national health system. We see this furthering government ownership and leadership and helping to build greater equity in health service utilization. By committing its health donors to this new simplified approach, the Government of Nepal has shown great leadership and will in improving access to essential maternal and child health services including immunization and HIV/AIDS.
An important goal for Nepal over the next several years will be the elimination of measles – measles continue to cause far too many child deaths here and around the world. We must make measles elimination a high priority in the health sector plan currently under development.
Chronic and pervasive malnutrition also continue to plague women and children in Nepal, their nutritional status has not significantly improved over the last ten years. Micronutrient deficiencies and children who are underweight or stunted are far too common in Nepal. To make matters worse, food insecurity multiplies the high risk of illness and death that vulnerable families face in Nepal.
In recent years, we’ve seen the most health successes from community-based interventions that are linked to a referral system to facilities where skilled services are available. Such interventions are vital in areas of Nepal where people live too far from services.
An important example of such an intervention is the USAID-supported misoprostol pilot in Banke district where Female Community Health Volunteers contacted pregnant women and informed them about misoprostol, a medication that helps excessive bleeding during and after delivery. This is an excellent example of a community-based intervention for reaching people who may not have used health facility services previously.
Through a coordinated effort with health facilities, these people have now been able to access critical, life-saving services in their communities. The overall result was a significant reduction in maternal and neonatal mortality.
Coming to USAID’s Healthy Homes program, can you tell us a little about what this program is trying to attain and how are you going to do this?
The goal of the Ghar Ghar Maa Swasthya program is to both improve the institutional sustainability of Nepal CRS company and also to increase the accessibility and availability of health products throughout Nepal and especially in hard-to-reach rural areas. CRS’s reach is national – they are in all 75 districts and plan to cover more of those districts. Where population density is low, it is more challenging for the market to cover the transportation cost of delivering products. The program will develop strategies to cost-effectively reach more deeply distributors in rural market towns. From here non-traditional distributors will take both commodities and behavior change communication messages to the more remote villages. We will also help CRS market “for profit” family planning commodities
and strengthen CRS viability as an independent organization.
USAID has also been involved in social marketing since 1978. Sex is still a taboo and people still shy away from talking about safer sexual practices. How has the situation changed from then till now? Do you see any changes in people’s attitude, perception and level of awareness?
Talking about sex is a little less taboo than it used to be, especially among youth. In the mid ´90s condom ads could only be shown or broadcast at certain times of day. Now radio programs on reproductive health and life skills, like Saathi Sanga Manka Kurra and development talk programs from CRS and others have broadened and deepened public knowledge. One of the most popular activities of our last Social Marketing program was the short film contest, You Are No Exception, which directly addressed safer sex issues in general and HIV/AIDS. With greater public dialogue, markets have also expanded. In 1978 CRS launched its program with just one brand of condom and one pill, in Kathmandu Valley. Over the period of 1996 to 2006, use of any kind of contraception went from 26% to 44%. Now the private sector carries more than 30 brands of condoms and more than 10 brands of oral contraceptive pills. CRS introduced Depo Provera in Nepal and today is responsible for 25% of Depo distribution in Nepal.
In a developing country like Nepal, what are the major implications and barriers in terms of providing better healthcare facilities and how can it be overcome?
There is no one magic solution to the unmet health needs in Nepal. The fact is that Nepal faces a multi-dimensional challenge – from difficult geography, inadequate numbers of qualified health providers to inconsistent supplies of essential drugs and equipment, as well as tremendous poverty. We know that far too many women in Nepal are dying every day of childbirth-related causes – many of which are preventable or manageable. We know that many newborns are dying because of lack of appropriate care at birth and during the first hours and days of life. We know that many couples want to plan their families by spacing or limiting the number of children they have, but are not using family planning methods.
But we also know that great progress has been made. Much more needs to be done however and we remain steadfast in our commitment to working together to achieve Nepal’s health goals. The Nepal Health Sector Plan II tries to prioritize competing needs. Communities have to take on more responsibility and mobilize around improving the implementation of their local health budgets, local utilization of health care, and promotion of healthy behaviors. Peer education is a good way to raise awareness, especially among youth, as is school health education programming. We would like to see a greater proportion of the national budget for health and health staffing and enhancement of data analysis and data-based decision-making. With careful attention the Government can continually improve measures to improve health system access, utilization and health equity.