Support to Health Workforce Through Civil Society Engagement

March 22, 2016

Executive Summary

Human Resources for Health (HRH) is a multi-sectoral issue worldwide but ignored by all. According to a definition by World Health Organization (WHO) any individual who is directly or indirectly connected to health and healthy behaviour is a human resource for health in one way or the other.

Nepal is one of the 59 countries of the world where there is crisis of human resources of health (HRH). Ineffective presence, in many places, of health facility operation and management committee (HFOMC) has resulted in irregular service delivery from the local health facility. The project ‘Support to Health Workforce Through Civil Society Engagement’, commonly addressed as HRH (Human Resource for Health), a 36 months long project (2011-2013), is under SOLID Nepal’s operation. The principal objectives of the project was to enhance engagement of civil society in policy development, implementation and monitoring for HRH and improve delivery of health care in Nepal. To achieve this, SOLID Nepal in partnership with Merlin Nepal  undertook country representative operational research on HRH situation, barriers and challenges in Nepal; national and international dissemination workshops; advocacy work at national level for appropriate development, and implementation of HRH policies; capacity building and creation of national network of NSA for advocacy on appropriate HRH; national and international campaigns on HRH; monitoring of HRH policies at field level; pilot project in 5 districts to develop innovative approaches to tackle HRH needs at grassroots level; development and dissemination of best practices.Society for Local Integrated Development Nepal (SOLID Nepal) in partnership with Save the Children and local civil society organizations (CSO) had initiated a pilot project in March 2013 in five selected VDCs of five districts viz. Sankhuwasabha, Lalitpur, Kapilvastu, Pyuthan and Darchula for nine months with the main aim to strengthen local health facility through civil society engagement. The pilot project initiatives started in March 2013 for the period of nine months i.e. till November 2013. However, the project could succeed to trap some of the improvements in the intervention area in a short period of time.

First of all, HFOMC of each VDC was reformed or revitalized; the internal conflicts were managed; and made the members aware of the roles and responsibilities. All the members of HFOMCs were provided management related training and reactivated for action. They conducted series of meetings, drafted action plans, and conducted public hearing at health facilities. Through different advocacy activities concerned local government authorities were sensitized; community people were made aware; media persons were oriented; and thus built the public opinions on the situation of the local health facilities and ways of improvements.

The health facilities were provided different supports. The major supports, the CSOs provided to local health facility through the pilot projects were the temporary recruitment of human resource like auxiliary nurse midwives (ANM), X-ray Machine Operator, Lab assistant etc. by exploring resources of HRH management available at local (VDC/DDC) level. Similarly, the need based supports like Materials & equipments /instruments, refrigerator, cupboard, wheel chair, autoclave, renovation of infrastructure like office set-up materials were provided. They also coordinated for SBA training to health workers.

As a result of the pilot project initiatives, there were increments in the number of human resources for health (HRH) in comparison to the baseline study conducted in each of the intervention VDCs just before pilot project initiatives.  The number of health service providers (all types) was increased by 15 percent in total. Four new health facilities were upgraded as birthing centres. Similarly, nine SBA trained health workers were recruited in the health facilities of the intervention area.

There was remarkable change found in the ANC visit as well. The first ANC visits increased by 15 percent and other indicators like SBA assisted delivery, PNC visits were also in the increasing trends. There used to be only 12 percent institutional delivery against expected pregnancy in total but after pilot project initiation, it reached to 16 percent, the more increase can be seen in Darchula district where institutional delivery increased by 17 percent. Availability of health workers and medicines/vaccines at local health facilities regularly, the immunisation coverage found increased to a large extent. As of expected number of children aged <1, immunisation coverage was increased by 29 percent in total. The BCG coverage was 91 percent i.e. increased by 15 percent; DPT/HepB/Hib-3 coverage was 105 percent i.e. increased by 29 percent. Similarly, OPV-3 and Measles coverage was increased by 29 and 14 percent respectively.

Improvement in quality and service was also felt by the local people in the intervention VDCs. People opined “this project has awakened the health facility staffs as well as the District Health Office.” Further they said, “After the implementation of the project, the health workers are regular, and the members of HFOMC have also realized their duty, responsibility, working field and rights”.

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