Health Education for Expectant Fathers in Rural Nepal

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Health Education for Expectant Fathers in Rural Nepal

Nepal
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$100,000 - $250,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

In very remote regions of Nepal, often only the husband is present during childbirth and it is usually men who have to make a decision to call for help. We will develop health education classes for the husbands of pregnant women and train peer educators to disseminate health messages.

About Project

Problem: What problem is this project trying to address?

Nepal is one of the poorest performing countries for MDG 5 (Maternal Health) in the world. This is mostly due to the fact that only 19% of births are attended by a skilled health professional. In the remote areas where we are currently working, even fewer women access antenatal care as often as they should, or call a health worker when they go into labour. One main reason for this is that the settlements are so scattered in the mountainous landscape, that many families live more than 3 hours walk away from the nearest health centre. Although our health workers do a lot of outreach work and try to encourage women to call them when they go into labour, our own research shows that in some areas in 60% of cases the woman’s husband is the only person available to help her during labour and childbirth. If the attendant doesn’t know how to care for mother and newborn, and doesn’t call for help in case of complications, this can lead to serious consequences for mother and child.

Solution: What is the proposed solution? Please be specific!

Very few women in the very remote areas of Nepal access antenatal care or call a health worker when they go into labour. Our own research shows that in some areas in 60% of cases the woman’s husband is the only person available to help her during labour and childbirth. We know that many husbands avoid getting involved in issues of women’s health, but clearly in the absence of other women in the household, men are instrumental in ensuring that women get the care they need. We assume that if men were better informed about potential problems in childbirth and the basic care for mother and newborn, they would be more likely to call for help in time and to provide appropriate first aid in cases of problems. There have been trials of health education for husbands in Nepal, but only in an urban antenatal clinic setting, where most women have comparatively good access to maternity care already. We propose to run health education classes for groups of prospective fathers, using trained peer educators. We are planning to compare villages with and without this intervention for outcomes such as the number of antenatal checks the mothers-to-be attend and the percentage of families that call the health worker at the birth.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

PHASE already runs primary care projects with an emphasis on maternal and child health in very remote areas of Nepal (up to 6 days walk from the nearest road). PHASE health workers spend a lot of time raising awareness of important health issues in the community and actively encourage women to attend for antenatal care and to call the health worker when they go into labour. Already, PHASE project areas have an average percentage of attended deliveries that is more than 40% higher than the national average (27% as opposed to 19%), in spite of the fact that they are all remote rural areas, where access in general is much worse. PHASE health workers also actively promote birth spacing with effective family planning methods and improve child health by providing health education, preventive health measures and treatment to sick children. In 2009/10 over 40,000 patients were seen and treated in PHASE supported health centres and over 200 babies were delivered safely.
About You
Organization:
PHASE Worldwide
Section 1: You
First Name

Gerda

Last Name

Pohl

Organization

PHASE Worldwide

Country

, ROT

Section 2: Your Organization
Organization Name

PHASE Worldwide

Organization Phone

01709 789004

Organization Address

Reginald Arthur House, Percy Street, Rotherham S65 1ED

Organization Country
Your idea
Country and state your work focuses on

, GA

Innovation
Do you have a patent for this idea?

Impact
Actions

We already have a strong system of user involvement and accountability in our health project areas, but for this project we are going to pay particular attention to the opinions of the intended target group – young fathers and mothers.
We will ensure that the groups sessions are set up in such a way that men find it enjoyable and not embarrassing to attend, and will also ask women what they think their husbands should know.
We are also going to keep a control area, to check on the actual impact of the intervention.
The intervention will almost certainly consist of a serious of group meetings with 3-4 different topics, spread throughout the year, which will allow all expectant fathers to attend at least 1 or 2 during the pregnancy.
Health workers will actively seek out the husbands of pregnant women to ensure good participation.
We will also use peer educators to increase acceptability and attendance rates.

Results

We expect that compared to before – and compared to the control area – in the communities where we have implemented the health education intervention the following output indicators will have improved:
1. Number of antenatal visits attended on average by pregnant women (double number of women who attend more than three times)
2. Numbers of deliveries attended by skilled health worker (increase by 50%)
3. Immediate and exclusive breastfeeding (increase by 10%)
4. Elimination of harmful practices such as early bathing of the newborn. (decrease by 50%)

We also expect a positive impact on the time given to young mothers to rest after childbirth and hygiene practices after childbirth.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

In the first year we will aim to do some baseline assessments of fathers’ knowledge about pregnancy and childbirth, will run focus groups to collect ideas of what any health education training should include and start the first pilot groups.
In order to achieve success, we need to engage the communities, particularly local opinion leaders, and to train our staff well.
In the second year, we are hoping to consolidate the education sessions and train more staff and peer educators in delivering them.
In order to be successful we need to find motivated peer educators and need to have an acceptably low staff turnover.
In the third year, we will be able to run the programme as a routine part of PHASE health programmes in more communities and will collect results.
For success, we need ongoing sufficient funding and political stability to be able to work as planned.

What would prevent your project from being a success?

the main serious threats to success would be a major political upheaval which would prevent us from continuing to work in the area or at least prevent our senior health staff from travelling.
Opposition from local opinion leaders could also affect the success of the programme.

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?

Less than $50

Does your project seek to have an impact on public policy?

Yes

Sustainability
What stage is your project in?

Idea phase

In what country?

, GA

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

PHASE Worldwide and PHASE Nepal

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 any non-monetary partnerships with NGOs?

Yes

Does your organization have any non-monetary partnerships with businesses?

Yes

Does your organization have any non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

PHASE Worldwide cooperates with several British NGOs in order to exchange expereinces and ideas and to organise joint fundraising events. We also work with businesses within our development education / school business enterprise work.
PHASE Nepal works with several NGOs in Nepal, exchanging ideas and experience. PHASE also works very closely with the District Health offices in our working areas, particularly in Gorkha, which is the area for this proposed project.
We are also part of a recently created research network, which has as its main aim the development of high quality research on participation in health.

What are the three most important actions needed to grow your initiative or organization?

1. We need to develop our partnerships with universities and larger NGOs in order to be able to disseminate our experience.
2. We then need to get dedicated funding to achieve replication of our idea.
3. We need to engage the target communities and the health workers who are going to deliver the intervention.

The Story
What was the defining moment that led you to this innovation?

PHASE has been working in the remote Northern part of Gorkha District for over 3 years now. We are currently expanding our health programmes significantly in cooperation with the District Health Office in Gorkha, trying to make regular health services available to all seven communities in this very remote area.
In the course of a mid – term evaluation of one of our project areas, we conducted a survey which showed a surprising fact:
In spite of our health workers’ best efforts, in 60% of childbirths, the only person available in the household to help the mother and newborn was the mother’s husband.
This is all the more striking as all our health education programmes so far have been targeting young expectant mothers and their mothers in law. In view of these new findings, we have been considering how to reach the men who are looking after expectant mothers.
At about the same time, PHASE became a member of a research network (SHAPEin) which aims to encourage high quality research in participation and health.
In the course of discussions within this network, we researched the literature and found that some health education to expectant fathers had already been tried in an urban antenatal clinic setting in Nepal.
We now want to try whether educating expectant fathers in how to look after pregnant women before, during and after childbirth will improve the care their wives receive.
Particularly, we will monitor whether this leads to an increase in numbers of antenatal visits and to more families calling a health worker at the time of childbirth.

Tell us about the social innovator behind this idea.

This idea really developed over a period of time and by discussions between various people: frontline health workers, PHASE Nepal management, PHASE Worldwide health advisors and SHAPEin members. In that sense, there is no single social innovator behind it.
However, the most important person to see the problem, point out the findings and get the discussion going was Jiban Karki, the Executive Director of PHASE Nepal.
Jiban grew up in a very remote village in Nepal himself and has a strong feeling of empathy with the target communities, and a passion particularly for giving children in these disadvantaged communities a chance to get an education and more life choices.
As the first step to improve a child’s life is to look after its mother in pregnancy and childbirth, Jiban has become more and more interested in maternal health, even though his background is not in a health profession but in engineering.

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