Community-Based Programme

The UNFPA supports the Government of Nepal in carrying out population and reproductive health related activities in all 75 districts of the country however The Government of Nepal and UNFPA have decided to intensify their cooperation in the decentralized context through Community Based Programme (known also as Population and Reproductive Health Integrated Project). Consequently, in line with the United Nations Development Assistance Framework and Nepal's Local Self Governance Act 1999, UNFPA has been focusing technical and financial support onto selected districts and villages in coordination with other UN agencies. Six districts Saptari, Mahottari, Rautahat, Kapilvastu, Dang and Dadeldhura, were selected for intensified attention on capacity building and addressing key reproductive health and population and development issues in an integrated manner. The following indicators and geographic criteria were used for the selection of the focus districts: the district's human development index, population size and density, population growth, contraceptive prevalence rate, and the involvement of other United Nations agencies. Due to migration, the selected districts are also areas of high risk of HIV and AIDS. Because it is not possible to cover at once each of these districts wholly, a number of focus Village Development Committees have been chosen in each district on the basis of the highest proportions of marginalized, socially excluded groups. Each of the six districts has a Project Support Unit attached to the District Development Committee. In addition, a Central Level Coordination Unit manages, monitors and supervises the decentralized activities.

UNFPA/GoN Community Based Programme aims at addressing the root causes of the conflict - poverty and social exclusion - and at reinforcing the capacity of local governance bodies (Village Development Committees, Municipalities, District Development Committees) to manage and mainstream population, reproductive health and gender issues at the district and community level. The Fund and the government also aim at empowering communities by increasing the quality and number of reproductive health services offered, and by strengthening the capacity of health delivery systems at the district and village levels.

Packag services and interventions are being implemented through partner organizations in the selected Village Development Committees of each district to increase access to reproductive health, create demand and improve gender equality by targeting socially excluded groups and communities. All programme activities are delivered to the community not only in an integrated manner but most importantly with the active participation of all social groups in planning and monitoring of the programme to achieve strengthening the reproductive health delivery system as to respond to communities' reproductive needs and rights. Aiming at responding, first of all, to the needs of the communities who have limited access to reproductive health care, the Community Based Programme's interventions, while being inclusive and universal, provide intensive facilitation and sustained support for social empowerment to socially excluded groups with priority focus on women and girls, however with due attention to men. Community based activities target youth and adolescents in and outside of the school system. The programme aims to achieve its objectives- to respond to the health sector priorities of the Government of Nepal and to support the peace process at community level- through various activities resulting in:

• strengthening the technical capacity of health-service personnel to provide client-friendly reproductive health services;
• enhancing the institutional capacity of implementing partners at district level and below to deliver quality reproductive health services;
• enhancing the skills of service providers in providing quality reproductive health services;
• increasing access to health services by people living in remote and conflict affected areas where services have been disrupted. This is achieved through Mobile Reproductive Health Units organized to bring services closer to the needy communities as well as through tertiary referral services for providing ad hoc services, such as Voluntary Surgical Contraception (VSC) and surgery to treat uterine prolapse performed by health NGOs and the private sector contracted by UNFPA;
• establishing partnerships with NGOs/ volunteer involving organizations and private sector organizations;
• advocacy with District Development Committees, Village Development Committees (VDCs), health facility management committees and other key people at district and VDC level on reproductive health, gender and social inclusion;
• social mobilization through active participation of the communities concerned;
• establishing partnerships with health facility management committees, NGOs/ volunteer involving organizations and community based organizations in support of social mobilization and in removing barriers for socially excluded groups to access key reproductive health related services;
• establishing a supportive environment for adolescent sexual and reproductive health activities meaning training community gatekeepers (teachers, both parents, local leaders, community based organizations, etc.) on adolescent sexual and reproductive health issues, especially through partnerships with NGOs/ volunteer involving organizations with relevant experience;
• promoting HIV prevention by strengthening various partnerships, including with UN agencies working on HIV and AIDS particularly targeting the far West region of the country through joint programming;
• increasing participation of youth. Here it is crucial to engage out-of-school boys and girls, provide support to peer education programme and partner with NGOs/ volunteer involving organisations and other agencies involved in livelihood training;
• strengthening the technical capacity of health-service providers on youth- friendly adolescent sexual and reproductive health services with an emphasis on adopting a positive attitude towards young people, and strengthening technical capacity of teachers on adolescent sexual and reproductive health and HIV and AIDS using student-friendly methodologies;
• enhancing the institutional and technical capacity of the districts' administration in addressing adolescent sexual and reproductive health and HIV and AIDS issues.

The focused communities under The Population and Reproductive Health Integrated Project (PARHI) received a comprehensive package of health services as defined in the National Reproductive Health Strategy (1998). In view of the fact that the public health delivery system would not be able to meet with the demands of the community in the short-term, UNFPA has deployed Mobile Reproductive Health Units (MORHU). A tipical MORHU This unit comprises of a medical doctor and auxiliary nurse midwife and the team visits focused Village Development Committees in accordance with the schedule agreed upon by the local stakeholders. In the six Community Based Programme districts (Saptari, Mahottari, Rautahat, Kabilbastu, Dang, Dadheldhura) the service package includes antenatal care, delivery, emergency obstetric care, postnatal care, post-abortion care, pregnancy complications, bleeding, uterine prolapse, sexually transmitted infections/reproductive tract infections/pelvic inflammatory diseases, suspected gender based violence, suspected side-effects of family planning methods, infertility/sub-fertility cases, other reproductive health cases, and general cases. The local village health worker gives due consideration to the socially excluded groups in the community.

The villages in which Community Based Programme has been implemented noted an increase in the utilization of reproductive health services, especially by socially excluded groups. The improvement is particularly visible in regard to the services aiming at making motherhood safer, such as antenatal and postnatal care visits, and the increase in the number of new acceptors of family planning methods. At the same time, while focusing on gender equity and social inclusion, the Community Based Programme contributed to community empowerment by raising awareness on reproductive health rights and involving the communities in the process of planning of and monitoring of the reproductive health delivery system. Analysis of data from the Community Based Programme focus Village Development Committees shows that socially excluded groups have benefited well from the Mobile Reproductive Health Units (MORHU) extended health services. The proportions of beneficiaries among the hard to reach groups such as Dalit and religious minorities were much higher than their respective population sizes. It is in line with UNFPA's principle of placing the poor and population living in the remote areas of Nepal in the center of the Fund's actions. As a result the Fund contributed to the achievement of the Health Sector Millennium Development Goals (MDGs) with improved outcomes for these groups.