RMF Nepal is in the process of establishing a Community Outreach Program in Kavrepalanchowk (Kavre), Central Region, an area with high maternal and child mortality rates, and poor health quality that also has been one of the areas seriously affected by the recent earthquake and is considered a high priority area by the Government of Nepal. The population of Kavrepalanchowk is 381,937; illiteracy rate: 27.39%, among them, 69.31% women.
We are working in close coordination with existing groups that are working to promote public health, such as Female Community Health Volunteers (FCHVs) and Mothers’ Groups. Through a partnership with the District Department of Women and Child Development, RMF aims to provide capacity building and support to FCHVs to hold monthly community health and nutrition awareness and training sessions, and assist FCHVs to conduct home visits for one-on-one counseling especially regarding maternal health and child nutrition. RMF will also train and form Community Health Educators (CHEs) Groups, comprising mostly of women and prioritizing those from marginalized communities, to promote maternal and child health at the district and VDC (Village Development Committees) level. CNEs will address one of the key challenges of lack of referrals as well as follow-up on referrals to ensure that all identified severely malnourished children are admitted and that feeding and care practices for moderately malnourished children have improved as per the IYCF (Infant and Young Child Feeding) counseling. The project is guided through three approaches: Identification, Treatment, and Prevention.
Following the latest WHO recommended method for screening for malnutrition, RMF will train the already existing groups in the community who have a strong presence and can ensure community ownership. A smaller group created from the existing groups, called ‘Self-Help Group’ consists of, FCHVs, RMF CHEs, Health Workers, women leaders in the community and also men’s groups to use MUAC (Mid Upper Arm Circumference) to identify malnutrition in the community. Children screened positive for malnutrition will be enrolled in CMAM services where they can be rehabilitated.
Lack of awareness on existing government subsidies and other incentives has hindered people from accessing available services. RMF CHEs can fill these gaps in the referral system by making communities aware of these services and offering tools to facilitate communication and monitor the system. RMF Nepal is replicating a very successful referral model used by RMF India. This includes tracking referrals providing a tracking method that is both low technology and low resource intensive.
RMF is liaising with the various government, non-government, I/NGOs and local stakeholders for the development of new and tailored and/or the usage of existing resources to aware the local community about issues such as maternal nutrition, hygiene, and sanitation. Through documentaries/video presentations, we will also provide successful models/ initiations in other VDCs/ districts (as we have successfully done in India).
Preventive approaches also include participation of extended family, focus on the most at-risk moderately malnourished children, and promoting greater access to local weaning and complementary foods. Our prevention approaches include providing local communities with knowledge on how to solve and avoid problems regarding nutrition, hygiene and sanitation, empowering local communities to avoid these problems by themselves. Lessons are imparted using various audio, video, pictorial and demonstrative (especially for cooking) means.
RMF Nepal aims to develop a very innovative and advanced approach to engage communities and families with malnourished children/ poor maternal child health awareness/knowledge to expand reach of the RMF CHEs and increase awareness among the community. Among others, the program aims to use mobile phones, through the installation of apps to track cases, assist in counseling families, record keeping, effective monitory, referral mechanisms and likewise. The application on the phone guides CHEs step by step through their interactions with a family, which include audio and visual prompts to help them with advice topics. The information that is collected on the phones is recorded in a nearby remote server. Moreover, community-based videos starring local role models who have adopted best health practices are produced and screened, which encourages others in the community to follow the route.
This program is expected to significantly reduce malnutrition among children under the age of 5 and cause behavior change related to health, nutrition and hygiene through health education in the targeted 8 VDCs, along with improvement in the health services and programs provided to them. The program will also help acutely malnourished children graduate from malnourished status to a healthy status. The program is expected to improve maternal health, sexual health, family planning and reduce neonatal and infant mortalities among these communities. Our results will be thoroughly monitored and our methodology will be used to replicate the program and also scale up this pilot program to a national scale. The project will target approximately 30,000 individuals (directly) from these rural VDCs and will reach approximately 200,000 individuals in total from the project and surrounding VDCs, especially through the health and hygiene awareness campaigns, house visits of our CNEs and mobilization of the school children/peer educators.