Reaching urban poor in providing maternal & child health including SRHS through nurse-midwives led birthing centre
Location
Nurses or midwives if committed to contribute in improving maternal health they can do it. This has been proven by Nepalese nurses, establishing birthing centre in their own initiation and individual financial contribution that provide high quality, affordable health care services to urban poor families in the locality.
About You
Section 1: About You
First Name
Laxmi
Last Name
Tamang
Website
Organization
Aadharbhut Prasuti Sewa Kendra (Free-standing Nurse-midwives led birthing centre)
Country
Nepal
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?
No
Section 2: About Your Organization
Organization Name
Aadharbhut Prasuti Sewa Kendra (Free-standing Nurse-midwives led birthing centre)
Organization Website
Organization Phone
977-1-4272326
Organization Address
PO Box 8975, EPC 2946, Kalanki, Kathmandu
Organization Country
Nepal
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Your idea
Name Your Project
Reaching urban poor in providing maternal & child health including SRHS through nurse-midwives led birthing centre
Country your work focuses on
Nepal
Describe Your Idea
Nurses or midwives if committed to contribute in improving maternal health they can do it. This has been proven by Nepalese nurses, establishing birthing centre in their own initiation and individual financial contribution that provide high quality, affordable health care services to urban poor families in the locality.
Website URL
Innovation
What makes your idea unique?
Since this is the first and only nurse-midwives led free-standing privatly run birthing centre in Nepal that provides 24 hours in a day, 7-days a week free maternity care services for healthy pregnancies and healthy mothers this initiative is itself innovative because this is the first and only initiative taken by Nepalese nurses in a low resource setting, where they have never ever taken such a step independently.
What makes also my idea unique is that nurses work together to take care of the mothers, youth and children, this will only make them stronger as a team. Since our centre is managed and staffed by nurses they are there during the whole pregnancy, encourage the mother to do at least four check ups during the pregnancy and assistance mother for their normal deliveries. They provide wholistic care to mothers and babies.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
To date we have served more than 10000 women and children. Urban poor families are benefitting by accessing 24 hours a day, 7-days a week SRH and child health services. Pregnant and labouring women have been empowered and feel confident to take care for their health. Couples who wish to give normal birth in a home-like environment under the direct supervision of skilled birth attendents and in the presence of spouse or relatives are getting place to do so. Women are getting women-centered care in a home-like relaxed and friendly environment for the birth of their baby. Besides, student nurses are getting exposure for their clinical placement in the nurse-midwives led birthing centre from where they are learning evidence-based care and also getting confident to take such initiative in their own in the future in the partnership with colleagues. Additionally, nursing students who are waiting for your final results are getting place to get hands-on clinical practice and exposure under direct supervision of senior nurse-midwives.
Problem
In a city like Kathmandu valley where majority of the rural people have been migrated for the employment have limited access to maternal and reproductive health services. Therefore, they are forced to go to nearby pharmacy retailers for their health problems and family planning services. There are no health health facilities serving urban poor families to provide such services. Surprisingly, still many women are giving birth at home in their own without the assistance of skilled birth attendents in unsafe environment.
Actions
Establishment of free-standing birthing centre managed and staffed by nurse-midwives in the strategic location where mostly urban poor are residing.
Provides following SRH and child health services:
1. Family Planning and Gynecology:
- Contraceptive counseling and methods
- Pap smears
- HIV and STI counseling, testing and management
- Obs/Gynae consultation
- Comprehensive Abortion Care
- Youth Friendly Services
2. Maternity:
- Prenatal check-up and counseling
- Skilled nurse-midwife attended births in a home-like environment accompanied by husband or relative
- Linkages for complicated deliveries at the tertiary level hospitals
- Breast-feeding assistance
- Post partum and follow-up care including home-visits
3. Child Health:
- Newborn care
- Immunization
- Integrated Management of Childhood Illness
- Growth Monitoring and nutrition education
4. Other Services Available:
- Ultrasounds
- Pharmacy
- Laboratory
- Biannual Free Women’s Health Camp
- Home visits
- Community awareness raising activities
- Minor Illness treatment and management
- Nursing student clinical placement
- Volunteering opportunities for newly graduate nursing stude
Results
Urban poor women, youth, and young families have access to high quality and affordable maternal, child including sexual and reproductive health care services any time as per their convinence. Women are aware of their reproductive health rights. Women and adolescent are educated and counselled for the prevention and promotion of their including their children and family health. Childbearing Couples have access to home-like relaxed and friendly environment for the birth of their baby under direct supervision and assistance of skilled birth attendents. Nursing colleges are getting clinical placement site for exposure of their students. Periurban women are benefitting from biannual free women's health camps.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Our strenthens such as good coordination and collaboration with Ministry of Health & Population (MoHP); goodwill and recognition from the MoHP; competent team members; and committed founder chairperson and managing director to do good and better in the field of RH/Midwifery service/practice in the country will take our initiative to be successful over the next three years.
Our organisation future plan such as establishing a training site for FP/SBA), playing key role in contributing to produce professional midwives program in accordance with the National SBA Policy, 2006 Long term (Pre-service) Measures in contributing to achieving MDG 4 & 5; and expansion of its services are also the initiative that our organisation is planning to carried out over the next three years.
What would prevent your project from being a success?
Financial matter is preventing our project from being a success. This is because initially each of the group member has contributed NRs. 100,000/- from their own pocket. They were quite committed and active but as the time passes they are becoming inactive because they are not getting any recognition for time contribution which they are providing for shift duties. Little revenue generated from the services is not adequate even to pay staff salaries, house rent and other operational costs. This is also because of the government policy to pay 5% tax in the health service. Financial matter has also prevented us for the expansion of our services. It has also hindering to maintain solidarity among members.
How many people will your project serve annually?
More than 10,000
What is the average monthly household income in your target community, in US Dollars?
$50 - 100
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Operating for 1‐5 years
Is your organization a
For‐profit
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
District Public Health Office-an government health institution
How long has this organization been operating?
1‐5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have a non-monetary partnerships with NGOs?
Yes
Does your organization have a non-monetary partnerships with businesses?
Yes
Does your organization have a non-monetary partnerships with government?
Yes
Please tell us more about how these partnerships are critical to the success of your innovation.
Our organisation has signed MoU with with the Kathmandu Model Hospital managed by Phect (NGO)to make referral for cases who need high level of management and care that cannot be managed from our centre. Similar kind of partnership we've with the Population Service International (INGO) but in this case we provide platform to them to provide IUCD services to women around the locality and our centre manage the referral cases if complications arise to those women. Likewise, we've partnership with Human Development Resource Institute (NGO) for the on-the-job training of their nursing students. Our organisation has formal corresponded with B & B Medical College Pvt Ltd (private) for the clinical placement of their nursing students in our centre. Our organisation has very good coordination and collaboration with the District Health Office, Kathmandu (Government)from where we bring vaccines routine immunisation and family planning devices in a monthly basis to run FP/MCH clinic and we send report to them in a monthly basis. Besides, our organisation has signed MoU with the District Health Office last year on September to provide maternity service free of cost as per the government policy.
What are the three most important actions needed to grow your initiative or organization?
The three most improtant actions that are needed to grow our initiative include institutional development to make financially sustainalbe and expansion of its services; maintaining solidarity among members; and maintaining professional standard of quality of care and services.
The Story
What was the defining moment that you led to this innovation?
In April 2007, after I returned from completing my Master of Public Health degree in Australia, I started to work as a lecturer in a private health science college that offered a bachelor of public health and a nursing program. I noticed that health education has been privatized and the fees charged by such colleges are extremely high. These colleges are mainly established by business people to generate money; therefore, quality of education is not the priority. Students would graduate having had academic experience with limited faculty members and poor practical exposure in clinical and field placement. This worried me, as I thought about how these students would be able to compete with other candidates to find jobs after graduation. On the other hand, faculty members were low paid and expected to work longer hours with no additional benefits. As a result, I was not satisfied with what I was doing and felt exploited because I thought I am playing a major role in ruining the future of the students.
Besides, there were other factors that led to the formation of the group. Firstly, discussing with colleagues we realized that the time is right to promote the concept of a natural birthing centre led by nurses. This is because that the Government of Nepal had developed a policy to produce skilled birth attendants to mobilize in improving maternal and neonatal health status in the country to meet the Millennium Development Goals. Despite being educated professional women, nurses had never done any sort of initiative independently or on their own. Secondly, we realized that the private sector nursing colleges are producing nurses in large numbers, but the quality of their education is lacking due to limited clinical placement in hospitals, especially for midwifery. Those nurses who had graduated from these colleges usually had to work as volunteers in private hospitals for a year to obtain the experience needed to get a job. We believed that these hospitals are exploiting our juniors because they did not even pay a minimal allowance, even though the students’ parents had invested a lot of money in their study in the belief that they would get a good job after their graduation. Thirdly, a city like Kathmandu has too many private hospitals—none of which serve poor people. in the public hospital women are not satified because of low quality care.
Tell us about the social innovator behind this idea.
I am registered nurse with public health background committed to improving women's health due to the dismal conditions and low maternal health indicators in the country. I am committed to promoting independent midwifery practice in Nepal, raising the standards of nursing and midwifery education, and working to ensure safe motherhood, reproductive health and women's empowerment.
How did you first hear about Changemakers?
Web Search (e.g., Google or Yahoo)
If through another, please provide the name of the organization or company
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Comments
I'm curious as to how you are currently funded. You already mentioned funding as one of your major problems. How do you plan to overcome this hurdle?
Dear Jake,
From the very beginning of our initiative we were quite aware about the financial sustainability of our organization. Thus, decided not to register as a NGO because NGOs are always depends upon with other donors for the funding and not try to think about their own for the sustainability of their work or project. If host (donors) are there then NGOs (parasite) are exist to do work otherwise they will die or stop working after the host leave or not funding to them.
As I've already mentioned that each of us has contributed Nepali Rupees 100,000 from our own pocket to establish the organization and charge little fees to the clients for our services. Each of us member always has to think about how we can make our organization sustainable and to do this we established our own pharmacy, laboratory and ultrasound services from where we are generating some revenues, which is not enough to run the organisation and its services. But it is helping us in some extent. At present, our organisation has around Nepali Rupees 1,000,000 debt from our members.
Besides, we are getting few nursing students for their clinical placement from where we can get little money. This is better than nothing.
In the future we are anticipating to get more nursing students for their clinical placement and also from aboard for their elective midwifery placement. We are also trying to develop our site as a family planning and skilled birth attendants training site. If we can do this then government will send their staff for the training from where we can generate revenue for the organization.
There are many non government organization in Nepal exist for the sake of human welfare. As she has mentioned they are simply a parasite of foreign financial donors. If foreign donors are genuine there to help helpless people, they should have acknowledged the situation of this organization and would have been supported.
I highly appreciate of what Laxmi Tamang and her organization is doing. Instead of of becoming a donor of well established welfare organizations where money just disappear, I would happily assist this organization financially for the generosity of desperate mothers and babies.
Thanks for a great entry! Your initiative has clearly been quite successful, and seems like a great way to increase access to health centers for the rural people who have moved to urban areas. We’re interested in learning more about your plans for financial sustainability. It’s admirable that you have been able to generate a lot of the start-up funds on your own, but since you are a private organization, have you thought of a specific funding model that would help generate revenue to sustain your center? Are people paying for your services? If so, is it expensive? Also, how are you planning on convincing people to go to these birthing centers? This region has a high percentage of women who stay home to give birth, and we would like to hear more about what your organization has done to motivate women to come to your center. Are you planning on scaling this project to rural areas as well? We look forward to your response and please remember to filter your additional comments back into your entry form so that the team can better evaluate your submission!
- Naveen Shakir, Ashoka’s Changemakers
Dear Naveen,
Thank you for your queries relating to the financial sustainability of our organization and whether or not we are planning to scaling our services to rural areas. Relating to your first question of funding model, currently we are in the process of introducing Client’s Membership scheme to generate revenue to sustain our centre. In this scheme, we will make membership only to those households who have reproductive age women or over. The annual fee for the memberships will be US $ 3.34 and they will get certain discount in our services such as diagnostic tests and procedures, consultant’s fees and medicines. Besides, they will get free counseling as per their needs. Similarly, we are also planning to promote our centre as a clinical site for the placement of nursing students and also develop training sites for family planning and skilled birth attendants.
As we all know that health service charges are one of the main barriers to access the services, still, we don’t provide our service free of cost. There are mainly two reasons for this. First, we have to understand that nothing is free in this world. Second, we should keep in mind if we provide free services to the clients then it won't be sustainable and also people will not value or trust up on the quality of services that we provide. Thus, we charge them negligible fees for taking our services, for instance, US$ 0.40 for new registration and US$ 0.27 for old registration for Family Planning, immunization services and general check-up. We charge US$ 2.67 for Obs/Gynae and Pediatric Consultants. Similarly, we charge US$ 18.00 for comprehensive abortion care service, which is almost similar price they have to pay in the government hospitals. Likewise, we provide free of cost maternity services to all women and provide US$ 13.34 as a travel cost to all women who give birth in our centre as per the Memorandum of Understanding signed with the Ministry of Health and Population’s Mother’s Safety Scheme Program. Moreover, we bring family planning devices and vaccines from the government health institution and provide these to the clients free of cost.
Regarding your queries on how we motivate to come clients to our centre, clients who received our services are usually motivate others to visit or bring clients to our centre. This means, counseling and quality of services are the main motivating factors for them to make other convince. Other factor could be opening hours of the services because our services are available 24-hours, 7-days in a week. Similarly, time-to-time I write newspaper articles on sexual and reproductive health related issues and maternity services and published it in the National Daily Newspapers. On the other hand, government policy and plans are also in the favor of promoting institutional childbirth and they are advocating for this.
Besides, in order to advocate about the importance of midwifery services in improving maternal and neontal health my dream came into reality by successfully registering "Midwifery Society of Nepal" last week. After seven months long (from August last year)inception phase, this organisation came into existence in my initiation and with the support of other 10 nurse-midwives who are actively involving in SMH and RH service delivery and teaching.
Initially, we thought about scaling our services to rural Nepal as well but now we have realized it is not easy because of the funds. However, we are planning to coordinate with rural districts’ Cooperative organizations in the future to scale up our model of RH service delivery.
Regards
Laxmi
Hello Laxmi Tamang,
I am impressed by the work you are doing in Nepal.
I would to know more about your personal background and driving motivation for starting your clinic. Why did you start your organization? Is there a compelling personal reason for doing so? I would appreciate you sharing a little bit of your personal life story. Also, what has been the impact of your clinic thus far? How many women have used it? How have women responded to it?
Thank you for your time and good luck with your work!
Dear Joanna,
Thank you for your interest in our initiative and queries relating to this.
Telling about my background I hold a Bachelor of Nursing Degree from Nepal and Master of Public Health Degree from the University of New South Wales, Australia. I have extensive experience working in different settings, with diverse communities, in the hospitals, national and international developmental agencies and educational institutions since 1995. I am committed to promoting independent midwifery practice in Nepal, raising the standards of nursing and midwifery education, and working to ensure safe motherhood, reproductive health and women's empowerment. Under my leadership and initiation, the first and only independent nurse-midwives-led birthing centre was established in Nepal in July 2007. After advocating and involving in establishing Midwifery Society of Nepal for last seven months, since August last year we 11 nurse-midwives representing nine different organisations were able to established a Midiwifery Society of Nepal in February this year, which was needed to advacate for midwifery services in reaching to every childbearing women especially in rural Nepal.
In April 2007, after I returned from Australia, completing my Master of Public Health degree I started to work as a lecture in one of the private health science colleges where bachelor of public health and nursing program is running. I noticed that health education is extremely privatized and fees of such colleges were extremely high. These colleges are mainly established by business people to make money therefore quality of education is not the priority of such colleges. Only with limited faculty members and poor practical exposure in the clinical and community field placement they are going to be graduated. These made me worried thinking that how these students going to be competed with other candidates to find jobs following graduation. On the other hand, faculty members are paid low salary and expected to work longer hours with no additional benefits and allowances. Due to all these reasons, I was not satisfied in what I was doing and felt myself exploited. At the same time, I felt guilty because I considered myself that I am also playing a major role in ruining the future of these students.
Besides, there were other factors that propel me to do something good and innovative contribution to women and society, and at the same time develop quality of nursing profession and education. I realized that it is a right time to promote the concept of natural birthing centre by nurses as the Government of Nepal has developed the policy to produce skilled birth attendants to mobilize in improving maternal and neonatal health status in the country to meet the millennium development goals. Also, being educated professional women, nurses never ever had done any sort of initiative independently on their own. Similarly, it was realized that the private sector nursing colleges are producing nurses in a large number without assuring the quality of clinical placement in acquire skills because of limited availability and exposure of clinical placement in the hospitals. Also, those nurses who are graduated from these colleges are working as a volunteer in private hospitals for a year to get job. Only after having a year experience they will be eligible getting a job. I felt and shared with my seniors and colleagues that private hospitals are exploiting our juniors because they are not even paying a minimal allowance for their labor since their parents had invested a large amount of money in their study, hoping to get a good job after their graduation. Even to get such type of volunteer job they have to knock the doors of at least 4-5 private hospitals or either should be someone there who knows them. In addition, in the city like Kathmandu despite having too many private hospitals none of them are serving for poor. There are three semi-government hospitals namely Thapathali Maternity Hospital, Maharajgunj Teaching Hospital and Patan Hospital provide maternity services. Of these, there is only one Maternity Hospital and it is the only tertiary level Maternity Hospital in Nepal that is always busiest and overloaded. It has been generally acknowledged that clients are compelled to go in this hospital because other two hospitals including private hospitals are costly and time bound. Therefore, there is no choice for women in seeking services to this Hospital. Most of the clients are not satisfying with the hospital services and complain towards health professional attitudes and behaviors. Being a largest and only tertiary level referral site for maternity and gynecological problems in the country the hospital supposed to provide high quality services for such cases. However, hospital is taking unnecessary burden of normal pregnancies and childbirths thereby compromising with the quality of services.
Considering the aforementioned situation, in a partnership and personal contribution of eleven female health professional, mainly nurse-midwives Aadharbhut Prasuti Sewa (APS) Kendra Pvt. Ltd has been established in July 2007. Being a private organization it has adopted community-based approach in delivering its services to the targeted. It provides round the clock, seven days a week child-youth-women-couple friendly maternal and child health including sexual and reproductive health services to urban poor families. It is the first and only nurse-midwives led free-standing 15-bedded birthing centre in Nepal that provides women-youth-couple centered specialized quality cost-effective integrated reproductive health services.
So far, more than 20,000 clients had used our services. However, to date only 150 women had gave birth in our centre. This is because still in Nepal nurses/midwives are not able to get social recognition for their profession and the services they provide.
Through our clinic women are getting quality cost-effective services anytime (24-hours, seven days in a week) as per their convinence from the female health professionals (nurses/midwives, consultants-Ob/Gyn and Peadiatricians), where they can express their problems without hesitation. Our mothers, women and clients are the promoter and advocators of our services.
I hope I've clearified and answered your queries. If not please feel free to contact me.
Warm regards
Laxmi Tamang
Hello Laxmi,
My name is Jessica Christen. I am a student of the National Midwifery
Institute in the USA and have been apprenticing with midwives for over
2 years. I am very passionate about helping families have healthy and
positive birth experiences.
I was curious if there was an opportunity for me to visit your
Maternity Service Center and possibly volunteer my services. My husband and I are planning a trip to India and Nepal for this coming fall (Oct 2010 till
Jan 2010). I am currently apprenticing at a Birth Center in San
Francisco, CA and would be able to bring supplies with me if you are
in need of them.
Thank you for taking the time to read this and I look forward to
hearing back from you.
Sincerely,
Jessica Christen
Dear Jessica,
Greetings from Nepal.
Nice to receive your message with your supportive thoughts and an interest of visiting and volunteering in our center. We do accept national and international volunteers. National volunteers are the backbone of our centre. You are always most welcome to Nepal and in our centre.
Let me also inform you that we, group of 11 nurses/midwives have etablished Midwifery Society of Nepal (MIDSON) in February this year to advocate for and strengthen midwifery services in Nepal. I would like to suggest you to come through them. I am a founder Joint-Secretary of MIDSON.
I think it will be easier for you to communicate in my personal email at laxtshering@yahoo.com.
Warm regards
Laxmi Tamang
I guess this is one of the best methods to help that exist. I believe that everybody agrees that if you want a person to eat fish often you shouldn't give him fish, but give him a fishing rod and teach to fish. The same about here. I've watched a film about different countries in Africa (got it at shared files SE http://www.sharedshares.com ). The Western world gives them aid but it doesn't help much as they need more and more. I guess, the kind of help that is described in the article and education are the best variants.