<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8879c7e80680e092e49jpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Phediguth village in Okhaldhunga where poor roads make access to health facilities difficult for complicated maternity cases. All photos: NARESH NEWAR</figcaption></figure>Stories of birthing are not the kind of conversation that children in Nepal usually have with their mothers. Surya Bhatta’s career path, however, took a new turn when his mother shared her own story of how she survived a near-death complication when she was giving birth to his elder sister.His mother was married at 11, and had her first baby at 16. Access to health services in their home village in Dhading was limited at the time, and she suffered from severe postpartum complications.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd88b9c7e80680e092e4ajpeg.jpg" alt="" width="640" height="364"><figcaption> </figcaption></figure>“Luckily, my mother survived but we all know many Nepali mothers still face similar risks due to poor maternal health,” says Bhatta, now executive director of One Heart Worldwide (OHW), a US-based organisation working in Nepal.At 34 Bhatta is proud to be playing a role to save the lives of mothers like his mother. Although the country has made vast improvements in reducing the maternal mortality rate from 539 per 100,000 live births 25 years ago to 240 today, it is still unacceptably high.An estimated 2,000 new <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/&amp;source=gmail&amp;ust=1615874753197000&amp;usg=AFQjCNEu5wCZ54G1e7vKzay3LB7DTXI7mA">mothers still die</a> in Nepal every year —  most of them because health posts are not properly equipped and staffed. The maternal mortality rate also went up in 2020 because the lockdown and pandemic prevented many mothers from getting to hospitals or birthing centres.Bhatta and his colleagues have been working to improve maternal neonatal health care, and with a 70-strong team is setting up birthing centres and hospitals in Nepal’s most remote districts to upgrade care for mothers and babies.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd88e9c7e80680e092e4bjpeg.jpg" alt="" width="200" height="191">Starting from five villages of Baglung in 2010, One Heart has expanded to 21 districts and helped renovate and equip more than 500 birthing centres in 164 municipalities where road access is still limited. The centres work with local municipalities on a cost-sharing public-private-partnership formula.https://www.youtube.com/watch?v=tVA--CRk3nMMany government health posts in rural municipality wards are under-resourced and often struggle to even buy standard maternity delivery beds and lifesaving equipment. There is inadequate <a href="https://www.nepalitimes.com/banner/federalism-leaves-nepals-medical-sector-ailing/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/federalism-leaves-nepals-medical-sector-ailing/&amp;source=gmail&amp;ust=1615874753197000&amp;usg=AFQjCNEX5KH1MBkZwv3gDbQd0uKEItLdXg">infrastructure</a> for pre-natal, delivery and post-natal care, and a chronic shortage of trained midwives in rural areas.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd88f9c7e80680e092e4cjpeg.jpg" alt="" width="1500" height="1710"><figcaption> </figcaption></figure>Nurses are not trained to handle complicated cases during and after delivery, and as frontline maternity workers face the wrath of local communities when mothers and babies die.Bhatta and his team have zeroed in on training nurses at health posts to become skilled birth attendants, an intervention that directly saves lives. One Heart’s trained nurses and renovated birthing centres now care for more than 72,000 pregnant women across Nepal annually.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8929c7e80680e092e4djpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>“Even during the pandemic rural municipalities were able to find resources to share half the cost of construction to renovate the birthing centres,” says Bhatta who works in partnership with local governments and community groups.Bhatta sets program priorities after consultation with local elected representatives, tries to raise money locally, and then tops it up by competing globally for international grants. He says, “We can’t make our people always dependant on international aid. We need to be innovative by taking risks with new ideas.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8959c7e80680e092e4ejpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>The partnership approach for upgrading birthing centres through cost-sharing is innovative, and one that encourages local ownership, clearly outlining outcomes. It went ahead because local governments under Nepal’s new federal structure were willing to start implementation immediately.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd8989c7e80680e092e4fjpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>“Entrepreneurship is needed in the social sector not for profit making, but for creating quality service that can go up to scale,” explains Bhatta. “Social entrepreneurship is all about evidence-based work that guide organisations to reduce risks and help improve through sustainable local health systems. There are challenges in Nepal, but there are so many opportunities to overcome them through partnerships like this.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111152/636cd89b9c7e80680e092e50jpeg.jpg" alt="" width="1500" height="964"><figcaption> </figcaption></figure>Bhatta makes a case for Nepalis to return home after higher education overseas, just as he himself did after graduating from Dartmouth in the United States, fulfilling the promise he had made to his mother that he would make a difference for as many Nepali mothers like her as possible.He says, “I am proud of the team we have built, I feel we are making a difference especially for rural communities. What can be more fulfilling than helping save lives?

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

“What can be more fulfilling than saving lives?”

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110101152/636cca2b9c7e80680e08bb52jpeg.jpg" alt="" width="1576" height="990"/><figcaption>Rejiya Nepali died age 31 while giving birth to a baby in a Bajura village last year. Her mother Deuma now takes care of the baby and is raising Rejiya’s three other small children. Photo: ROJITA ADHIKARI</figcaption></figure>There are many reasons cited for the sharp reduction in Nepal’s maternal mortality rate (MMR), from 901 per 100,000 live births to less than 240.Among them are trained community health volunteers even in the remotest village, and the spread of the road network that allows women with complicated pregnancies to be taken to hospital.But perhaps the greatest factor is the rise in female literacy in the same period which in turn reduced the total fertility rate, and raised the average age of marriage through awareness and empowerment.However, an MMR of 240 is still unacceptably high—it translates into <a href="https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNEyyMx0axCpsUcWEbKRHHLgzuGPSg">3 deaths at childbirth every day</a>, 1,200 every year. For comparison, only two mothers out of 100,000 die at childbirth in Norway, and the figure for Sri Lanka is 30.Besides, Nepal has to reduce its MMR to 70 in the net nine years to meet the UN’s Sustainable Development Goals target. The country has already failed to meet the interim target of reducing MMR to 125 by 2020.The worrying thing is that the graph for maternal mortality has now flat-lined, mainly because government hospitals in the districts are under-equipped, under-staffed and under-funded. Many other families cannot afford delivery in private hospitals.The latest figures for 2020 have not come in, but the Covid-19 crisis may have even increased the maternal mortality rate because fewer mothers could have institutional delivery. In fact Nepal’s first Covid-19 fatality in May was a mother from Sindhupalchok who had just given birth, but her family could not get an ambulance to take her to hospital during the lockdown.Yet, if we probe the reasons for past progress it will show us the path forward. One of the factors contributing to the drop in MMR since 1990 was that the percentage of skilled birth attendants in rural health facilities went up from 4% to 53%.In the meantime, as the <a href="https://www.nepalitimes.com/here-now/nepals-air-ambulance-saves-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-air-ambulance-saves-mothers/&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNEhq1P__AvWLxpEOOdNu4rt_Dqhcw">Saglo Samaj</a> report shows, the <a href="https://www.nepalitimes.com/here-now/nepals-air-ambulance-saves-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-air-ambulance-saves-mothers/&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNEhq1P__AvWLxpEOOdNu4rt_Dqhcw">President’s Program for Women’s Upliftment</a> has been conducting <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNF1mS1v1hwk31v-3ZBK5WvJwhTItQ">free emergency airlifts</a> of post-partum mothers in remote areas facing life-or-death situations at childbirth.The eligibility process is complicated for families who do not know how to work the system, but in the past two years, the program has conducted 170 emergency rescues and saved the lives of many mothers and babies.Impressive as this is, it is not a sustainable way forward. The focus should be on decentralising medical care and making it the responsibility of provincial and municipal governments.The emphasis must be on primary health care that can prevent communicable diseases through awareness, and treat most common surgeries like broken bones, and caesarian operations at the local level.We have seen how hospital buildings are not enough, those structures need basic equipment like x-rays, anaesthesia machines, surgical units, and capable, motivated medical staff to use them.Institutional delivery is not the answer if maternity wards of hospitals are poorly-staffed, cannot conduct safe delivery in complicated cases, or do not have nurses for ante- and neo-natal care.<a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNHNJJsCYbBXtHVh1Q28U08p0ZHp8w">A family physician</a> who can perform basic orthopaedics, or deliveries including c-sections, can be more valuable than a specialised but expensive hospital that few can afford.Nepal should already have been on a war-footing in meeting the MMR 70 target by 2030, and we have no time to lose. Action must be focused on the hotspots for maternal deaths, including districts in Far-western and Karnali Provinces, and Province 2 with community-based midwife training and district birthing facilities that have life-saving services 24/7.So far, we have seen no strategy or a sense of urgency on the part of the Ministry of Health to meet the SDG target on reducing the maternal death rate. In the past year, Covid-19 has sucked much of the oxygen out of even existing efforts to upgrade medical care to make it more affordable and accessible. Pilot health insurance schemes are isolated success stories.The story of 31-year-old Rejiya Nepali of Bajura encapsulates the human tragedy of many mothers who have to give up their lives to give birth to new lives. <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNFCZrBoEfS17kWnKUGp_E8noOspwA">Nepali Times reported last year</a> about how the mother of four in a remote village in Bajura was taken in a stretcher to a nearby health post after prolonged labour.She gave birth along the way to a baby boy. But there was no one at the health post, and Nepali was being taken to the house of an Auxiliary Nurse Midwife. She died along the way.Three other mothers died during childbirth in just that one Bajura village that month.Also read:<a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNHNJJsCYbBXtHVh1Q28U08p0ZHp8w">Saving one mother at a time, </a>Bikash Gauchan<a href="https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/&amp;source=gmail&amp;ust=1612416563093000&amp;usg=AFQjCNEyyMx0axCpsUcWEbKRHHLgzuGPSg">Nepal’s air ambulances saves mothers, </a>Nepali Times

Nepali Ama

<figure><img width="945" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be6089c7e80680e087782jpeg.jpg" alt=""/><figcaption>Hupsekot Rural Municipality recently inaugurated a 10-bed coronavirus-dedicated hospital. Municipality chair Laxmi Pandey is at centre. All photos: LAXMI BASNET</figcaption></figure>After the first elections under federalism in 2017, Hupsekot became one of only two municipalities in Nepal in which <a href="https://archive.nepalitimes.com/regular-columns/guest-editorial/madam-mayor-of-jumla,918" target="_blank" rel="noopener noreferrer">women were voted both chair and deputy</a>.Laxmi Pandey of the Nepali Congress was elected chair, and Kopila Malla of the UML was voted vice-chair. In the three years since, Hupsekot in Nawalparasi district has exemplified how this has made all the difference in the quality of education, agriculture, nature conservation, and now Covid-19 control.Hupsekot is Nepal in a microcosm in more ways than one. It encompasses the Mahabharat and <a href="https://archive.nepalitimes.com/page/crushing-tale-of-Chure" target="_blank" rel="noopener noreferrer">Chure ranges</a>, as well as the Tarai, and these days when the air is clear the Annapurnas are visible to the north. Hupsekot is also an example of what is possible for the rest of Nepal.Under the 2015 Constitution a vice-chair or deputy mayor has to be a woman, but Hupsekot and <a href="https://www.nepalitimes.com/here-now/jumlas-great-leap-into-the-future/" target="_blank" rel="noopener noreferrer">Jumla elected women to both positions</a>. Now, imagine if Hupsekot was replicated in more of Nepal’s 736 municipalities and 17 metropolises. “Because both of us are women, it has been easier for us to work on delivery of social services to our people,” says municipality chair Laxmi Pandey. “In many other local governments we see the <a href="https://www.nepalitimes.com/here-now/salma-breaks-her-silence/" target="_blank" rel="noopener noreferrer">male chair and female deputy chair having disagreements</a>.”Indeed, while in Kathmandu even men from the same ruling Nepal Communist Party (NCP) <a href="https://www.nepalitimes.com/editorial/outside-looking-in/" target="_blank" rel="noopener noreferrer">are forever quarrelling</a>, here in Hupsekot it does not seem to matter that Pandey and her deputy are from different parties. <figure><img width="400" height="400" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be60a9c7e80680e087783jpeg.jpg" alt=""><figcaption>Laxmi Pandey says it helps to have a woman as both the Rural Municipality chair and deputy in order to deliver social services to the people.</figcaption></figure>“Sometimes, problems arise when there are party-based decisions from Kathmandu, but we manage to resolve them amicably,” says vice-chair Malla. “We have worked together well in the past three years.”In its very first meeting, this village municipality decided to provide Rs5,000 for institutional delivery in government facilities to promote safe motherhood. Back then the village had only one birthing centre, it has added two more in the recent years. Now, even those who can afford private hospitals go to government hospitals because services have been upgraded. So far 1,008 people have received the institutional delivery incentive.Nawalparasi district borders India, and earlier this year it became a hotspot for Covid-19, as <a href="https://www.nepalitimes.com/here-now/returnees-may-be-taking-coronavirus-to-rural-nepal/" target="_blank" rel="noopener noreferrer">Nepalis returning from India brought the virus home</a>. Hupsekot instituted a strict quarantine and contact tracing rule, and last month it opened a dedicated 10-bed hospital for coronavirus patients. <figure><img width="640" height="365" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be60d9c7e80680e087784jpeg.jpg" alt=""><figcaption>Municipality Chair Laxmi Basnet presents agriculture equipment to local farmers as part of her government's effort to keep young men from having to migrate out.</figcaption></figure>Pandey and Malla then worked together to encourage local youth as well as returnees to take up farming instead of migrating back to India or overseas for work. A big chunk of the rural municipality’s annual budget is spent on grants for communities investing in commercial agriculture. This has had a direct impact on this year’s paddy harvest, and increased the prospects for agribusiness.Hupsekot has also launched a 'School Merger Program' to address falling enrolment, and best use limited resources. Four government schools have been combined into one and discussions are underway to even merge public and private schools.“As a former teacher myself, I have focused on improving the education program without adding to the hardships of parents and students,” says Pandey. “And we are working to improve the quality of instruction, to make it more relevant and impart civic values.” <img width="1355" height="788" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be60f9c7e80680e087785jpeg.jpg" alt="">The rural municipality has launched an awareness drive against deep-rooted patriarchal values and <a href="https://www.nepalitimes.com/from-the-nepali-press/alarming-rise-in-violence-against-women/" target="_blank" rel="noopener noreferrer">domestic violence</a> by sensitising parents to raise their children right, and as equal. Both at home and in schools, children learn early about tolerance and responsibility, and boys and girls alike are encouraged to help out with household chores.Hupsekot has also gone further than most other municipalities by promoting local languages and dialects. A language curriculum is being developed for 60% of the district’s population for whom Magar is the mother tongue. The digital charter of the municipality is available also in the Magar language.Hupsekot’s scenic beauty and places of religious significance make it a popular destination for visitors. And the municipality is now trying to add to its eco-tourism appeal, planting 5,000 rhododendron spalings under the 'One Student One Laligurans' campaign as well as holy pipal plantations around its pilgrimage sites under a municipality subsidised program.  <figure><img width="800" height="533" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be6129c7e80680e087786jpeg.jpg" alt=""><figcaption>In August, Laxmi Pandey and Tourism Minister Yogesh Bhattarai declared the Rudrapur Gadi region a rhododendron conservation zone to encourage eco-tourism.</figcaption></figure>“Ultimately, we plan to create a natural and pristine environment and cultivate rudraksha commercially. This along with religious tourism will provide regular income for our municipality,” Pandey adds.The municipality is also working to raise income of female-led households by training women to produce value added goods from maize husk, and is already engaging them in knitting winter wear. The municipality then takes the responsibility of marketting the products.  An inter-generational skill transfer program is also in operation so that the village doesn’t have to rely only on outside trainers to learn new skills. About two years ago when the municipality advertised for two employees, some 60 <a href="https://archive.nepalitimes.com/article/nation/2000-widows-of-Nepal-earthquake-need-special-attention,2503" target="_blank" rel="noopener noreferrer">single women</a> applied for the job. During the interviews, they shared their hardships in finding a reliable source of income. While the municipality office wasn’t able to employ them all, this gave Paudel a much-needed push to plan a program specifically targetting single women. “Women in rural areas, especially single women, do not have a reliable source of income. Society looks down on them. But that won’t be the case if the local government steps in to support them,” says Pandey. Since last year, the municipality has started allocating a budget for ‘Single Women’s School’ under which widows come up with their owns plans for regular income generation. <figure><img width="800" height="544" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181140/636be6159c7e80680e087787jpeg.jpg" alt=""><figcaption>Vice-chair Kopila Malla (in brown sari) with Chair Laxmi Pandey inspect a road upgrading project in Hupsekot.</figcaption></figure>The fact that both the chair and vice chair are women helps, and they are leading the charge with progressive plans and policies. This is in stark contrast to other municipalities where the women deputies are <a href="https://www.youtube.com/watch?v=AqyjLl1qvv8" target="_blank" rel="noopener noreferrer">undermined and harassed by their male colleagues</a>.Says Pandey: “We have to use the five years we have been given by working for the people. Bitterness and dispute will only hurt our voters. Our sole focus is on fulfilling our responsibilities.”

Women leaders set example for rest of Nepal

mainNavigation

footerNavigation

opinionSubnav

safe-motherhood

“What can be more fulfilling than saving lives?”

Nepali Ama

Women leaders set example for rest of Nepal