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                                                           Nepal  Projects                                                                    Updates  September-­‐October,  2015    

   

September-­‐October  2015  

Real  Medicine  Foundation  11700  National  Blvd,  Suite  234  Los  Angeles,  CA  90064  +1.310.820.4502  

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1. Model  Village  Project  (Arupokhari,  Gorkha)    

The  Model  Village  Project  (MVP)  is  a  RMF  pilot  initiative  in  Nepal  that  aims  to  contribute  to  the  improvement  of  education,  health  and  livelihoods  of  the  community  in  Gorkha  through  support  of  the  schools,  health  posts  and  other  community-­‐based   institutions.  The  project   is  based   in  Arupokhari,  one  of   the  villages   in  Gorkha,  where  RMF  has   started  supporting   the   reconstruction  and   rehabilitation  of   the  village.  Gorkha  district  was  the  epicenter  of  the  earthquake  where  over  91%  of  houses  have  been  irrevocably  damaged,  along  with  over  95%  of  schools  and  90%  of  health  facilities.  Arupokhari  is  a  remote  village  in  Northern  Gorkha,  which  is  close  to   the   epicenter   of   the   April   25th   Mega   Earthquake.   Out   of   1,350   households,   1,226   houses   have   been  completely  destroyed  in  this  village.      

 Progress:    

Completed   (Saraswati   Peace   School   catering   the   conflict   affected,   poor,   marginalized   and   earth-­‐quake  affected  children):    

• RMF  supported  pre-­‐fab  house  has  been  installed   in  the  school.  Lack  of  quality  education   is  often  accorded  to  lack  of  well-­‐qualified  teachers  in  the  rural  areas.  The  school  has  placed  three  qualified  teachers,  hired  from  the  Kathmandu  area  and  placed  at  the  school  for  a  good  salary.  The  presence  of   these   teachers   is   essential   to   the   school,   as   the   standard   of   the   education   and   children’s  performance   has   been   raised   after   bringing   them   in.  However,   school   had   faced   challenges   in  teachers’  retention  due  to  lack  of  safe  housing  facilities.  Therefore,  this  pre-­‐fab  house  will  not  only  provide   safe   and   quality   housing   option   to   the   teachers   but   will   also   contribute   to   boost   their  morale,  which  has  been   severely   affected  due   to   the   earthquake   and   the   following   aftershocks.  We  aim  that  this  support  will  contribute  to  the  overall  improvement  of  children’s  performance  at  the  school.      

 Prefab  Building  Construction    

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• RMF  will  be  taking  up  a  local  health  clinic  in  the  area  from  November  on.  Currently,  we  are  in  the  process  of  signing  a  MOU  with  the  District  Health  Office  for  this  purpose.    

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2. Orphanage  Support  and  Support  to  the  Nepal  Children’s  Organisation      

RMF  is  supporting  Nepal  Children’s  Organisation  (NCO)  to  improve  the  current  conditions  of  the  children  at  their   orphanages,   particularly   to   improve   the   health,   nutrition,   sanitation,   and   hygiene   status   of   the  children.      The   25th   April   earthquake   in   Nepal   caused   significant   damage   and   destruction   to   buildings   and  infrastructure,  one  of  which  was  the  83  year  old  building  of  Nepal  Children's  Organization  (NCO),  rendering  children  in  the  orphanage  homeless  once  again.    After  destruction  of   the  orphanage  building,  younger  children  have  been  shifted  to  a  nearby  government  office  while  the  others  have  been  taken  to  a  children's  home  in  Shifal.  The  present  situation  of  the  children  and   staff   working   for   them   is   horrific.   They   are   suffering   every   day   in   overcrowded   rooms   which   are  occupied   not   only   by   children   and   staff   but   also   by   their   belongings.   Due   to   inappropriate   ventilation  systems  of  the  rooms,   infants  have  started  suffering  from  respiratory  difficulties.  This   is  causing  infants   in  these  locations  to  be  seriously  ill.  Several  of  the  babies  are  already  in  Intensive  Care  Units  at  hospitals.  Not  only   infants,   children  of   all   ages   are   suffering   from  various  diseases   or   other   physical   and  mental   health  issues  due  to  their  appalling  living  conditions.    NCO  is  planning  to  construct  earthquake  resistant  houses  for  about  100  children  as  safe  housing  for  them  is  of   immediate   need.   For   that,   NCO   has   chosen   to   build   prefabricated   houses   on   7740   sq   ft   land.  Prefabricated  homes  are  the  buildings  of  choice  for  the  children  as  they  are  not  only  safe  and  energy  saving  but   also   earthquake   resistant.  And  as  Kathmandu   is   active   in   seismic   activity   it   is   recommended   to  have  something  lighter  and  safer  to  raise  the  children.  Additionally,  as  time  is  also  a  pressing  issue,  prefabricated  houses  which  are  quick  to  build  are  a  good  option.    RMF   is  planning   to   support  NCO  with  a  pre-­‐fab  house   that  will   provide   shelter   for  20   toddlers,   currently  forced  to  live  under  precarious  conditions.      

“Our  toddlers'  boys  now  are  in  the  small  room  sharing  the  whole  thing  including  caretakers.  The  room  is  jam-­‐packed  for  children  to  stay  and  difficult  for  caretakers  to  take  care  of  them.  In  past  we  used  to  have  a   bigger   space   for   each   of   our   toddlers   where   they   have   enjoyed   their   freedom   to   fullest.  We   had   a  separate  block  for  young  boys  and  mothers  taking  care  of  them.  But  because  of  unimaginable  magnitude  of  earthquake  which  has  hit  Nepal  has  made  our  children  homeless.”    -­‐  Director,  NCO    

 With   the   recommendation   from   engineers   and   designers,   the   plan   is   to   construct   1100   sq.   feet  prefabricated  house  within  the  premise  of  Balmandir.        They  have  selected  this  place  since  it  is  close  to  the  main  access  and  will  not  take  long  for  caretakers  to  rush  toddlers  to  the  hospitals  or  evacuate  them  in  an  emergency  situation.  

The  entire  construction  accountability  will  be  given  to  the  contractor  and  intended  to  come  to  an  end  of  the  project  by  the  end  of  December,  2015.    

Area Plan:

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                               Total  Square  Feet:  4740  

 

 

 

 

 

                                                                 1200  sq.  ft                                              1600  sq.  ft                                                            1700  sq.  ft  

 

   

 

 

 

                                                                                                                     

 

 

 

 

 

1400  sq.  ft  

 

 

 

 

 

1100  sq.  ft  

Sagarmatha  House-­‐  Infant  :  30  

30  

Dhaulagiri  -­‐20  Disable    

1Kids  

 

 

Kanchanjanga-­‐25  kids.  2  floors  

Machhapuchre-­‐  30  girls,  2  floors  

Manaslu-­‐20  boys,  2  floors  

Water  plant  

 

Security  Guard    

 

Annapurna  House  

Existing  Kitchen  

2700  

sq.  ft  

4740  sq.  ft  

First  Aid  Room  

                   Play  Ground  

 

RMF  to  support  in  the  construction  of  Manaslu  House:  

Manaslu  House  is  designed  for  20  boys  and  is  of  2  floors.  Total  area  of  this  house  will  be  1100  sqft.  and  will  consist  of  4  rooms,  1  toilet,  1  laundry  room  and  1  store  room.  

Progress:    

RMF  nurses  who  are  based  at  their  centers  have  completed  the  following  activities  during  their  first  month  of  placement:  

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• Performed  different  medical  procedures  such  as  dressing,  nebulization  etc.  • Assisted  Physiotherapist  in  providing  physiotherapy  to  several  liable  children  • Monitored  vital  signs  • Medication  done  as  per  the  requirement  of  house  mothers,  children  and  other  staffs  • First  Aid  treatment  has  been  given  to  several  children  • Created  awareness  among  housemothers  and  children  regarding  sanitation,  personal  hygiene,  

and  healthy  habits  etc.  • Helped  maintaining  sanitation  of  the  organization  clean  and  healthy  • Visited  Teaching  Hospital  frequently  for  check  up  and  follow  up  on  hospitalized  children    

   RMF  Nurses  at  the  NCO  with  children  and  housemothers:      

       

               

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3. Rebuilding  and  long-­‐term  Support  to  Schools  and  Model  Village  in  Sindhupalchowk      Real  Medicine  Foundation  has  partnered  with  Seven  Summits  Women  and  White  Girl  In  Nepal  to  reconstruct  schools,   health   posts   and   other   damaged   public   structures   in   Bhotenamlang,   Sindhupalchowk   to   provide  immediate   relief   and   long-­‐term   support   to   the   people   of   Sindhupalchowk   district,   one   of   the   areas,  significantly  affected  by  the  earthquake.      

   

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Progress:    

• We  are  providing  afternoon  meals  to  2,064  students  from  8  schools.    • Team  members  at  Seven  Summits  Women  have  made  a  trip  to  Sindhupalchowk.  The  field  trip  aimed  

to  carry  out  needs  assessment  at  the  schools.  Following  the  trip,  infrastructural  support  to  rebuilding  Shree  Ganesh  Lower  Secondary  School  has  been  secured  and  construction  works  will  commence  soon.    

• One   trip   carrying   major   purchases   of   stationery   for   children   has   been   transported   and   will   be  distributed  once  the  schools  will  reopen,  which  has  been  closed  for  the  festival  holidays.    

• The  team  has  also  carried  out  consultations  with  women’s  groups  who  have  taken  tailoring/  sewing  training  but  haven’t  been  able  to  use  their  skills  due  to  lack  of  resources  and  market  access.  Our  plan  is   to   mobilize   these   women’s   groups   to   prepare   school   uniforms   for   the   8   project   schools,  contributing  to  their  livelihoods  as  well  as  helping  them  enhance  their  skills.    

   

4.  Support  to  Kanti  Children’s  Hospital  –  The  Only  Referral  Level  Children’s  Hospital  of  Nepal

Kanti  Children’s  Hospital  is  the  only  government  referral  level  Children’s  Hospital  of  Nepal.  The  hospital  was  established   in  1963  as  a  general  hospital  with  50  beds,  and  today  has  a  capacity  of  320  beds.  The  hospital  treats   children   up   to   the   age   of   14   from   all   over   the   country,   a   total   target   population   of   13-­‐14   million  children.   Following   the   earthquake,   where   parts   of   hospital   building  were   damaged,   there   is   in   general   a  need  for  equipment  and  capacity  building  for  better  health  service  delivery.      RMF  supported  the  local  NGO  (Social  Action  Volunteers-­‐  SAV)  based  at  Kanti  Children’s  Hospital  to  conduct  health  camps  in  one  of  the  earthquake-­‐affected  areas  in  Nuwakot  district.  In  the  previous  month,  RMF  had  supported  the  hospital  with  medicines  and  medical  supplies,  among  which  some  of  the  medicines  were  also  distributed  through  the  health  camps  with  support  of  5  doctors  from  the  hospital.    

 Currently,  RMF  is  preparing  to  support  Kanti  Children’s  Hospital  through  a  longer-­‐term  partnership.  Currently,  the  NGO  based  at  Kanti   is  supporting  the  hospital   through  provision  of   free   lodging  to  the  families  of  ultra  poor   children   inside   the  hospital   premises,   providing   poor   children   (around  300   in   the   in   cost-­‐free  wards)  with  nutritious  food,  coordinating  with  donors  or  even  purchasing  expensive  medicines  that  these  children’s  families  couldn’t  afford,  organizing  trips/  excursions  for  children  at  the  cancer  ward,  running  entertainment/  play  sections  for  the  children  to  make  the  hospital  more  child-­‐friendly,  and  organizing/  storing  blood  as  and  when  required.  Due  to  lack  of  funds,  the  NGO  is  going  to  withdraw  their  support  to  these  children  from  very  poor  economic  backgrounds  and  reduce  their  activities.  They  could  potentially  close  down  if  any  support  isn’t  secured  in  near  future.      In   this   light,   RMF   is   looking   into   possibilities   of   continuing   these   initiations   to   ensure   that   these   critical  services  to  the  children  at  the  only  Children’s  Hospital  in  Nepal  are  continued.        

     Indoor  and  Outdoor  Playrooms  supported  by  SAV:  

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SAV  providing  accommodation  to  the  families  of  the  very  needy  patients  at  different  wards  in  the  hospital:  

     

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5. Partnership  with  MOHP,  UNFPA,  WHO  and  GIZ  to  foster  Midwifery  education  in  Nepal  

Discussions   with   UNFPA   for   a   partnership   to   support   Professional   Midwifery   education   in   Nepal   have  progressed  wherein  RMF  will  be  part  of  the  "Collaborative  Partnership  Agreement  for  Supporting  Midwifery  Education  and  Cadre   in  Nepal"  between  Ministry  of  Health  and  Population,  UNFPA,  GIZ  and  WHO.    RMF   is  discussing  the  components  of  the  agreement  and  is  aiming  to  take  up  the  elements  as  per  our  objectives  and  expertise,  especially  addressing  human  resources  and  infrastructural  needs.    

 Background:    

After   the   earthquake,   up   to   90%   of   health   facilities   in   many   rural   areas   are   known   to   be   damaged   or  destroyed.   For   example,   in   Rasuwa   district,   up   to   78%   of   district   health   facilities   are   reported   to   be  completely  demolished,  and  only  two  health  posts  remain  functional.  Hospitals  in  district  capitals,  including  Kathmandu,  have  been  overwhelmed,  medical  supplies  severely  depleted  and  capacities  overstretched.  Out  of  a  total  of  352  birthing  centers,  115  were  totally  damaged  and  137  partially  damaged.  Overall,  the  April  25  earthquake  affected  some  8  million  people,  including  2  million  women  of  reproductive  age  and  over  126,000  pregnant  women.    

Even  before  the  earthquake,  out  of  an  estimated  total  population  of  27.5  million,  23  million  (84%)  were  living  in  rural  areas  and  7.4  million  (27%)  were  women  of  reproductive  age  in  2012;  the  total  fertility  rate  was  2.3.  By  2030,  the  population  is  projected  to  increase  by  20%  to  32.9  million.    

To   achieve   universal   access   to   sexual,   reproductive,  maternal   and   newborn   care,  midwifery   services  must  respond   to   0.9  million   pregnancies   per   annum  by   2030,   85%  of   these   in   rural   settings.   The   health   system  implications   include   how   best   to   configure   and   equitably   deploy   the   sexual,   reproductive,   maternal   and  newborn   health   (SRMNH)  workforce   to   cover   at   least   70.2  million   antenatal   visits,   10.9  million   births   and  43.7   million   post-­‐partum/postnatal   visits   between   2012   and   2030.   (UNFPA,   2014)   There   is   a   dearth   of  professional  midwives  to  cater  to  the  current  and  growing  need;  their  roles  will  be  instrumental  in  improving  maternal  and  child  health  in  rural  areas.  

In   this   context,   a   MOU   has   been   signed   between   4   universities   by   UNFPA   and   MOHP,   which   includes  introducing   Midwifery   education   as   a   different   faculty   in   their   universities   as   a   professionally   accredited  course.  Likewise,  a  draft  Bachelor's  degree  curriculum  on  Midwifery  has  been  drafted  and  will  be  tailored  by  the   universities   to   suit   their   interests   and   this   curriculum   will   be   approved   by   the   NNC   (Nepal   Nursing  Council).  Some  of  the  pressing  needs  of  the  universities  are  as  listed  below  and  the  areas  where  RMF  would  be  supporting  is  also  under  discussion:    

 • Infrastructure  Development,  i.e.  hostel  facility,  classrooms  • Equipment,  Skills  Lab  (dummy/  anatomical  models)  • Human  resources,  faculty  development  (lack  of  quality  due  to  limited  human  resources)      

6. Community   Outreach   Program   to   improve   maternal   and   child   health   care   in  Nepal  

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RMF  Nepal   is   in   the   process   of   establishing   a   Community   Outreach   Program   in   Kavrepalanchowk,   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.  

We  will   be  working   in   close   coordination  with   existing   groups   in   rural   settings  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   aim   to  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  will  be  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  from  the  existing  group  can  be  created  called  ‘Self-­‐Help  Group’  which  would  consist  of,  FCHVs,  RMF  CHEs,  Health  Workers,  women  leaders  in  the  community  and  also  men’s  groups  to  use  MUAC  to  identify  malnutrition  in  the  community.  Children  that  have  been  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   also   hindered   people   from  accessing  the  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  will  replicate  a  very  successful  referral  model  used  by  RMF  India.  This  includes  tracking  referrals  using   a   triplicate   referral   form   that   will   provide   a   tracking   method   that   is   both   low   technology   and   low  resource  intensive.      

We   are   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.    

Preventive   approaches   will   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  will   also   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   will   be   imparted   using   various   audio,   video,   pictorial   and  demonstrative  (especially  for  cooking)  means.  

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RMF  India  has  developed  a  very  innovative  and  advanced  approach  to  engage  communities  and  families  with  malnourished   children,   expand   reach   of   the   RMF   CHEs   and   increase   awareness   among   the   community.  Among  others,  the  RMF  India  team  uses  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.  RMF  Nepal  is  adopting  and  tailoring  this  approach  to  suit  the  local  needs.  

Geographical  Coverage  

 

 

Tentative  Timeline:    

Start  Date:  1st  Week  of  November,  2015  

1.    Inception  phase:  3  months  1st  November  –  30th  November:  

• Finalize  budget  

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• Recruitment  of  HR  for  the  program  including  a  project  manager  and  a  CHE  trainer/coordinator  who  will  also  be  able  to  train  new  CHEs,  an  admin  and  finance  officer  and  16  CHEs  (2  from  and  for  each  VDC)  

• Set  up  District  office  for  the  program  • Acquire   necessary   tools   for   the   program   including   laptops,   mobile   phones,   stationary,   and  

training  and  screening  materials  • Reach   out   to   district   and   VDC   level   administrators   and   local   social   workers   including   DHOs,  

FCHVs,   Mothers’   Groups,   Community   Users’   Groups,   Forest   Users’   Groups,   OTPs   and   SCs   to  inform  and  brief  them  about  the  COP  

• Orientation  and  briefing   for   the  project  manager   regarding   the  program  and  how   to   train   the  CHEs  and  run  the  monthly  community  programs  at  a  VDC  per  month  including  video  screenings  

• Carry  out  a  introductory  health  and  hygiene  awareness  campaign  in  which  RMF  Nepal  staff  will  donate  RMF  schoolbags,  health  kits  and  stationary   items  to  1,000  students  at  schools   in   the  8  VDCs  of  the  district.  

           1st  December  –  31st  January:  

• Finalize  treatment  protocols  and  triage  for  SAM  children  • Review  initial  training  manuals  and  modules  prepared  by  UNICEF  • Prepare  facilitation  and  guide  manuals  and  flipbook  on  health  and  nutrition  • Orientation   and   training   CHEs   on   proper   hygiene,   maternal   and   child   health,   screening   and  

action   protocols,   use   of   apps   on   mobile   phones   to   track   cases,   assist   in   counseling   families,  record  keeping  and   referral  mechanisms.  Discuss  admission  and  discharge  criteria   for   children  with  SAM  

• Initially  conduct  house  to  house  visits  in  a  large  group  as  a  part  of  the  training  program  • Train   CHEs   on   how   to   conduct  monthly   community   nutrition   awareness   and   training   sessions  

including   video   screenings   and   cooking   demonstrations.   Clarification   on   roles   and  responsibilities  will  also  be  discussed  

• Hire    a  videographer  and  a  video  production  manager/editor  • Review  how  similar  programs  are  conducted  in  other  countries  • Review  and  analyze  the  current  RMF  methodology  in  a  SWOT  analysis,  decide  if  it  is  to  improve  • Analyze  operations  of  DHOs,  CMAM  services  such  as  OTPs  and  SCs  in  SWOT  analysis  and  provide  

suggestions  on  it,  and  try  to  get  funding  for  its  upgrades  if  necessary.  

2. Rolling  out/implementation:  Next  21  months:  

• Conduct  house   to  house  visits  on   the  4,451  households  of   the  8  VDCs,  prioritizing  households  with  children  under  5   first.  Screening  will  be  done  to   identify  malnourished  children  and  CHEs  will   further  advise   the   family   in  matters  of  nutrition,  maternal  health,   sanitation  and  hygiene,  sexual  health  and  family  planning.  CHEs  will  refer  children  with  SAM  to  government  centers  for  treatment  and  will  provide  some  RUTF  for  critical  cases.  

• CHEs   will   conduct   monthly   VDC   level   programs   to   educate   the   community   about   proper  nutrition,   maternal   health,   sanitation   and   hygiene,   sexual   health   and   family   planning.   These  programs   will   be   carried   out   in   collaboration   with   DHOs   and   FCHVs   if   they   have   a   strong  presence   in   the   VDC,   otherwise   it   will   be   conducted   by   CHEs   themselves.   Video   screening  starring   local   role  models   who   have   adopted   best   health   practices   will   be   shown   along   with  some  nutritious  cooking  demonstrations.  

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• Tri-­‐monthly   self   analysis   of   the   operations   and   discussions   on   how   to   improve   the   current  methodology    

• Analysis  will  be  conducted  and  suggestions  offered  on  how  different  national  level  programs  like  CMAM,   IYCF   and   IMCI   programs   can   be   improved   and   integrated   with   each   other   to   avoid  duplication  of  services  and  carry  out  a  unified  scale  up  

• CHEs   will   conduct   visits   to   DHOs,   CMAM,   IYCF   and   IMCI   services   to   help   counsel   to   families  present  there.  

Expected  Outcomes:  

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  also  expected   to   improve  maternal   health,   sexual   health,   and   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.  

 

7. Consignment  with  medical  supplies  and  equipment  for  District  Hospital  

RMF   is   supporting   the  Government’s  District   Public   Health  Office   in  Kavre   –   one   of   the  most   earthquake-­‐affected   districts   with   medicinal   supplies   and   equipment.   This   government   medical   facility   caters  to  underprivileged  and  marginalized  communities  in  Nepal.    

The  consignment  is  underway  and  has  reached  Calcutta  port.  However,  due  to  current  tensions  at  the  Indo-­‐Nepal  border,  we  are  exploring  alternatives  to  divert  the  route  and  get  the  shipment  with  medical  items  to  Nepal.    

 

 

8.  Current  fuel  crisis  hampering  humanitarian  aid  and  longer-­‐term  rebuilding  efforts  in  Nepal  

The   current   fuel   crisis   due   to   tensions   at   the   Indo-­‐Nepal   border   area   and   resulting   blockades   has   led   to  severe  shortages  of  essential  items  such  as  petrol,  diesel,  cooking  gas,  and  kerosene  in  Nepal.    

After   a   stalemate   of   8   long   years,   the   first   ever   constitution   written   by   people’s   representatives   was  promulgated  on  20th  September  2015  in  Nepal.  The  country,  however,  remained  divided,  especially  on  a  few  contentious  issues  on  social  inclusion  and  federal  demarcation.    

Madhesi    (indigenous  group  based  predominantly  in  the  Terai  Plains  region  in  Nepal)  and  Tharu  (ethnic  group  indigenous   to   Terai)   parties   opposed   the   new   constitution   stating   that   it   curtailed   the   rights   of  Madhesis,  Tharus,  Dalits   (so-­‐called-­‐untouchables),   Janajatis   (indigenous  groups)  and  other  marginalised  communities.  This   led   to  violent  protests  and  political  unrest,   leading   to   the  deaths  of  more   than  40  protestors,   civilians  and  security  officers  in  various  parts  of  the  southern  plains.      

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Indefinite  general  strike  called  by  Madhesi  parties,  amidst  curfew,  continues  to  cripple  life  across  the  region.    In   this   context,  Nepal’s   southern  neighbor  and  major   trading  partner,   India,  expressed   their  dissatisfaction  with   the   constitution,   leading   to   an   unofficial   ‘trade   blockade’   that   resulted   in   acute   shortages   of   basic  supplies   such  as  Petrol,  Diesel,  Kerosene  and  Cooking  Gas   in   the   landlocked  country  which   is   recuperating  after  the  recent  earthquake.  The  mountainous  geography  on  the  northern  side  means   limited  trade  routes  with  China,  and  almost  all  trading  points  were  destroyed  during  the  earthquake.    

India  has  however  denied  placing  an  embargo  on  Nepal  and  has  cited  security  reasons  in  the  border  areas  for  making   the   trucks  and  other  vehicles  carrying  essential   supplies   impassable.    Over  8,000   trucks  are  said   to  have  been  stranded  near  the  Indo-­‐Nepal  border.    

Following  this,  the  government  introduced  fuel  rationing  by  only  allowing  vehicles  with  odd-­‐number  plates  to  operate   on   odd   days   and   even   ones   on   even   days.   In   addition,   a   quota   system   has   also   come   into   effect  wherein  each  vehicle  is  allocated  a  certain  amount  of  fuel  per  week.    

Many  airlines  have  temporarily  suspended  flights  to  Nepal  stating  that  without  refueling  at  the  Nepal’s  only  International  Airport  in  Kathmandu,  they  wouldn’t  be  able  to  operate.  The  Jet  fuel  crisis  is  likely  to  deepen  in  days  in  come.    

The   current   fuel   crisis   has   especially   impacted   humanitarian   aid   efforts   in  Nepal   that   began   following   the  devastating  earthquakes  in  April  and  May.  In  absence  of  basic  supplies,  many  organizations  are  struggling  to  continue  their  ongoing  efforts  of  reconstruction  and  rebuilding  in  various  earthquake-­‐affected  areas.    

Right   after   the   earthquake,   RMF  was   engaged   in   providing   immediate   relief   through   distribution   of   food,  shelter  supplies,  water  filtration,  solar  lights  and  other  basic  needs  to  many  communities  in  Sindhupalchok,  Kavre,  Gorkha  and  we  are  currently  implementing  longer  term  projects  to  support  health  posts  and  schools  in  close  collaboration  with  government,  INGOs/  NGOs  and  local  stakeholders.    

In   this   light,   the   ongoing   major   fuel   crisis   is   hindering   the   efforts   of   various   international   and   national  development  organizations  and  is  impacting  the  communities  recuperating  from  the  recent  devastation.    

Schools   in   the   valley   have   begun   closing   down,   as   the   school   authorities   aren’t   able   to   provide   food   and  continue  their  operations  due  to  shortages  in  cooking  gas  and  fuel  for  school  buses.  Many  of  these  children  were  already  studying  at  the  temporary  learning  centers.  More  than  16,000  public  and  private  schools  were  destroyed  and  thousand  more  damaged  due  to  the  earthquake  (UN  OCHA,  2015).   In  Gorkha  district  alone,  90%  of   the  500  schools  have  been  destroyed  or  badly  damaged,  affecting  75,000  schoolchildren.   (Save  the  Children,  2015)