2019 Annual Report (5)

WHO GUIDELINES:
From the 2018 WHO Guidelines for Intra-partum care : ?The UN Global Strategy for Women?s, Children?s and Adolescents?
Health seeks to ensure that not only do women survive childbirth complications if they arise, but also that they thrive and
reach their full potential for health and life. In line with this objective, this guideline brings together existing and new
recommendations that address not only the clinical requirements for a safe labor and childbirth but also meet the
psychological and emotional needs of women. It seeks to ensure that women give birth in an environment that in addition
to being safe from a medical perspective also allows them to
have a sense of control through involvement in decision
making and which leaves them with a sense of personal
achievement. Adopting a woman-centered philosophy and a
human-rights based approach opens the door to many of the
care options that women want such as the right to have a
companion of choice with them throughout the labor and birth
as well as the freedom to move around during the early stages
of labor and to choose their position for birth. These
recommendations are all evidence-based, optimize health and
well-being, and have been shown to have a positive impact on
women?s experience of childbirth.?
COMMUNITY HEALTHCARE WORKERS + VISITS
The community health team strives to create a high-quality,
low-cost, decentralized healthcare delivery system that brings
care closer to the patient. Their focus is primarily on reduction
in child mortality, community-based care delivery, counseling
and referrals, and mother mortality. Their continuous
surveillance system and enhanced primary care delivery at
clinics aim to detect and triage patients in need of care,
ensuring no one falls through the cracks.
We participated in a Community Health Workers (CHWs) visit to two homes providing group-based pre- and postnatal
care, as well as home-based integrated management of neonatal and childhood illness (IMNCI). One visit involved an
antenatal visit with a young pregnant mother, in addition to contraceptive counseling for her mother in law.
The second home visit was for a child under the age of two. During the visit the Community Health Worker established
that the child had not gained sufficient weight and counseled the mother on nutrition.
There is a focus on the control of chronic diseases (CD). All CD patients who are treated at the hospital hub receive
follow-up home care visits by a CHW who provides counseling on medication adherence, lifestyle management, and care
coordination. CHWs make regular visits to all homes in their enrolled area, providing home-based counseling, medication
adherence education, birth and emergency planning among mothers, and identifying patients who require follow-up.
It?s important to note that 1 in 25 children does not survive to their fifth birthday in Nepal. The top 3 killers for all deaths are
Ischemic Heart Disease, COPD, & Cerebrovascular disease.
Community Healthcare is focused on continuous surveillance, and the active and passive case detection of acute and
chronic conditions Pregnancy, childhood illnesses, Contraceptive use, NCDs; Counseling and Referrals which entails
CHW home visits and counseling & Referrals to ensure routine antenatal care, under 2-year old children care at local
facilities and NCD care; and Community-based Care Delivery including Healthcare at the community level, and Group
antenatal care for pregnant women (including counseling, ultrasound, lab services)
POTENTIAL FOR SCALE
Nepal has undergone a remarkable transformation over the past decade. Emerging from a civil war in 2006, it transitioned
from a unitary to a decentralized, federal republic, institutionalizing the transition over the last two years by holding
municipal elections for the first time. During this period, it also established a national health insurance scheme and passed
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