I/NGO Role in Health Sector In Terai

Kapil Gyawali

Considering the role of NGOs

The following quotes suggest some different opinions of the role of NGOs.

[A] NGOs are tugboats in international channels.

[B] social movements take an unlikely idea, make it seem feasible, and then put it into practice.

[C] …civil society is not just a resting place for social movements on their way to the state. It is meaningful and sometimes crucial as a site of political action in its own right . [D] the rise of the global idiots … any group with a fax machine and a modem has the potential to distort public debate .

Role of NGOs

• Enhancing the knowledge base • Advocacy and lobbying • Membership in national delegations • Contribution to compliance review and enforcement as well as dispute settlement procedures • Ensuring transparency • Supporting international secretariats • Broader functions of NGOs in international environmental governance

SHN/WATSAN project In Terai

Background

• WAT/SAN contribute at various levels to address the health and nutrition problems of school-age children in Terai.

• The SHN program aims to improve the health and nutrition status of school children, thereby leading to improved school performance.

• From August 2007, SC/USA with partnership districts level NGOs, whih has scaled up the SHN program with SC/It and Media Friends support to include Water and Sanitation (Wat/San) activities in terai districts of Nepal.

• The WAT/SAN program focuses on behavior related areas which primarily lay emphasis on school based activities that aims to practice healthy behaviors related to nutrition, hygiene, and other practices for the participating children

NGO Role

on SHN/WATSAN project

• NGOs play a crucial role in advancing and improving the effectiveness of deworming in the context of School Health and Nutrition (SHN) programmes.

• With experienced staff, technical expertise and strong local and national links, NGOs are able to pilot and scale-up model SHN programmes (including deworming) and carry out operational research.

• NGOs also influence national policy and advocate for and support the development and implementation of national SHN programmes.

Major activities under SHN/WATSAN project

• Weekly Iron supplementation for 13 weeks • Semiannual de-worming to school children • Hearing, Vision and Dental screening • First Aid service management at school • Installation of hand pumps for drinking water, Arsenic test and coliform test • Construction of separate toilet for boys and girls • Hand washing facilities • Support for waste disposal system development • SHN Management Training to Teachers and Health Workers • Health education and demonstration sessions by trained teachers • Child Initiative Program • Program Coordination meeting at different levels • Formation of District SHN Coordination Committee at district level • Supervision, Monitoring and Evaluation

Objectives

• To ensure that a better health status in enjoyed by all Nepalese children through the promotion and implementation of School Health and Nutrition program at national level.

• Odds ratios is 0.44, CI (0.34 - 0.58) and chi-square (p=000001) at 95% confident interval, according to this analysis the aneamia rate was significantly reduced before and after program in Terai, the prevalence of anaemia, 35.3% and 24.1% of the sampled children had anaemia baseline and endline.

• Similarly odds ratios is 0.50, CI (0.39 - 0.64) and chi-square (p=000001) at 95% confident interval, according to this analysis the prevalence rate of helminthes was significantly reduced before (52%) and after project (35%).

Quality of Services

• The overall quality of the health and nutrition services provided by the SHN/WATSAN project was very good.

• The quality has been assessed in terms of satisfaction by the students and concern groups for various services and processes, services provided through the Project, the technical competency of the providers and the quality of trainings offered.

• Students were found to be more satisfied and were also pleased with the program. They were very happy and comfortable with the service.

Coordination and coherence with national policy/strategy

• School, Health and Nutrition addresses the critical health and nutrition factors that keep children out of school and inhibit their ability to learn.

• SHN is an integral part of education sector efforts to increase the access to and quality of primary education in terai.

• Many INGOs/NGOs, UN organizations, multilateral and bilateral agencies have been implementing or supporting the implementation in the various school health, nutrition and sanitation programs in different district of the country.

• For this reason, there is need for alignment and harmonization of the school health and nutrition activities to avoid duplication and improve the synergies among all the stakeholders involved in School Health Program.

Efficiency and effectiveness of the Project

• The project was designed to implement SNH/WATSAN in three districts; Siraha, Kailali and Kanchanpur • Schools were selected in coordination and consultation with district stakeholders. • The design and strategic approaches were found to be effective and efficient.

• The role of the NGOs role maximum but DEO and DPHO to monitor the program was found to be minimal.

Resource utilization

• The programme schedule of WATSAN activities were very tight and human resource of NGOs were used effective and efficiently. The project also used school teachers as focal person to provide school level services. The use of school students and SMC for dissemination about the activities of SHN/WATSAN, communication, de-worming campaign and management was found effective.

Ownership, contributions and commitment by the stakeholders

• Creation of ownership of the projects among the concerned stakeholders can help continue and sustain the project activities even after phasing out the project.

• The project attempted to build the ownership among the stakeholders by involving them in planning, organizing and implementing the project activities.

• From the initial phase, DPHOs, EDOs, SMCs and other local stakeholders showed their interest and commitments toward program and other project activities.

• It was also found that DPHOs, EDOs and school teachers contributed to the project activities according to their capacity.

Best practices

• Painting key message of WATSAN in toilet wall is effective for proper use of the toilet.

• Making boundary with lock for hand pump installation is effective in preventing the stealing of hand pump heads.

Successes

• Retention and attendance rates have increased • Increased use of toilets by school children • Decreased illness among school children, particularly diarrheal episodes • Improved personal hygiene among school children • Increased number of school children wearing slippers to school • Decreased in number of adolescents smoking • Increase in number of school children using local health facilities due to improved linkages between schools and health facilities • Child Clubs are playing vital role in upkeep of new WatSan facilities

Challenges

• Community awareness of and involvement in programming is low • Routine monitoring tools and capacity are weak, particularly among DEO and DPHO staff • Focal teachers are not fully retaining information received during SHN/WatSan training • De-worming tablets are not received on time in the district and distribution is often disrupted • Programming only focuses on public government schools and children in private schools are not receiving services although they are often just as needy • Although latrines and water sources have been built they are difficult to maintain often resulting in the closure of schools on hot days

LESSONS LEARNED

• Current programming strategy does not put enough focus into building community awareness and ownership of program which leads to little respect of and concern for the maintenance of new facilities.

• Knowledge of SHN/WatSan practices and behaviors is not being filtered into the larger community and thus it is difficult for children to practice what they learn in school as the demand for improved hygiene, nutrition, health etc. is not yet seen in the community.