According to statistics released by the Ministry of Health and Population of Nepal, the maternal mortality ratio is at 229 maternal deaths per 100,000 live births throughout the country as of 2018. While all women have the right to access services and facilities for safe childbirth, many women in Nepal deliver children at home in part due to insufficient healthcare infrastructure. In remote areas, it is difficult to access prenatal and postnatal care systems, resulting in many women being unable to receive proper obstetric care upon pregnancy. Accordingly, from 2013 to 2021, KOICA provided support amounting to 5.4 million dollars to carry out the project to improve the maternal and child health environment in Nepal’s Mugu District, one of the country’s most mountainous rural areas.
Enhancing medical infrastructure through new maternal and child health unit
The targeted Mugu district, located in Karnali Province in Nepal, is a remote area with a relatively low UN Human Development Index (HDI)1). Difficulties in accessing a healthcare system led to mothers in the region giving birth in non-medical facilities. Only 56.5% of pregnant mothers residing in Mugu district gave birth in hos-pitals, indicating that one in two mothers give birth in an environment without the presence of healthcare professionals.
The low percentage of births in medical facilities in Mugu district was attributable to difficulties in accessing high-quality healthcare facilities, proper medical equipment, and a low level of public awareness on the importance of healthcare. The Mugu District Hospital is the only general hospital in the region and receives about 86,000 patients annually, as of 2020. Meanwhile, the facility was in need of updated medical equipment and capacity-strengthening for its medical staff.
It was critical to establish medical facilities that mothers could easily access. Accordingly, KOICA embarked on its plans to improve the hospital infrastructure of the Mugu district by first tearing down three existing buildings and constructing a two-story ward centered on maternal and child health.
The new building consists of an inpatient ward (delivery room, operating room, hospitalization room) and an outpatient ward (emergency room, gynecology, pediatrics) where pregnant women can receive adequate prenatal or postnatal treatment or give birth. In addition, KOICA provided about 20 items of medical equipment necessary for adequate childbirth and newborn healthcare services, such as oxygen generators, X-ray imaging devices, and blood and urine test analyzers. The government is determined to spare no support necessary to train medical staff of district hospitals and to help enhance the capacity of healthcare operation professionals. As a result, the Mugu district hospital was rejuvenated to become a healthcare facility that delivers comprehensive high-quality medical services in Karnali province, in which Mugu district is located.
Small steps toward big changes: Making health clinics cleaner and safer
KOICA’s efforts also included the improvement of maternal and child health services through support for local public health clinics, where small-scale birthing centers were set up. In remote mountainous regions such as the Mugu district, many pregnant women simply do not have access to a district hospital; long travel distances and the income level of residents render hospital visits particularly difficult.
Until now, there were few public health clinics as alternatives to regional hospitals, but such facilities possessed limited medicine, medical equipment, or medical professionals. Maternity facilities were in need of additional heating equipment, spaces with privacy, water and electricity facilities, and toilets and toilet accessories in order to ensure a suitable and safe environment for birthing mothers.
For these reasons, many pregnant women in Mugu district had chosen to give birth at home, leading to heightened risk factors related to the maternal mortality rate. In fact, the main causes of maternal death in Nepal were postpartum hemorrhage and sepsis, both of which were caused by inadequate postpartum care. In terms of infant mortality, infection and hypothermia were the main causes of death for infants under 2 months of age, and pneumonia, diarrhea, measles, and malnutrition were the main causes of death for children between 2 months and 5 years of age. All of these causes were assessed as illnesses that can be easily treated and cured with proper care at medical facilities.
To tackle this issue, KOICA carried out renovation work to enhance sanitary facilities (water, toilets, electricity) for six public health centers in Mugu district, which are located within 8 hours from the district hospital. In addition, medical equipment and supplies along with medicine were provided to improve the condition of maternal and child healthcare in the region.
KOICA also provided medical professional capacity-building training in public health clinics. Mugu district hospital and public health clinic staff attended field trips to visit areas with well-established medical infrastructure while participating in workshops together with health experts on a regular basis. Furthermore, through activities such as regular monitoring of the use of public health centers, KOICA successfully provided training programs on health data management and medical resources management, contributing to strengthening the management and capacity of healthcare institutions.
Public awareness rises, more and more patients foray to the enhanced medical facilities
Through enhanced medical facilities, this project aimed to truly impact and benefit mothers and children. Accordingly, from 2018 to 2020, KOICA collaborated with UNICEF to carry out a campaign to raise residents’ awareness on maternal and child health.
In the Nepalese caste system, some faced a lack of adequate health care due to a prevalent gap between groups. Gender inequality had often left women less educated and with low health literacy, resulting in infrequent visits to medical facilities or barriers to adequate knowledge on breastfeeding or child healthcare.
To ensure that women could learn the significance of hospital visits, it was nec¬essary to provide residents with health education to improve health literacy. As part of such efforts, KOICA provided training on topics such as maternal and child health, environmental hygiene, and local health and environment. In addition, KOICA supported the education of female health volunteers and women’s health associations. Upon completion of the training, the trainees participated in health environment improvement activities for each village while visiting pregnant and breastfeeding women of underprivileged groups to share information such as at-home health knowledge or how to access healthcare services. Furthermore, through local radio advertising, health education campaign messages were continuously delivered to increase health literacy and encourage people toward healthy behavior.
Change that starts within the local community contributes to 80.3% of the medical facility delivery rate
What makes this project and its achievement meaningful was the change observed among residents of the local community. KOICA strived to improve medical facilities and conducted maternal and child health and gender awareness training, resulting in improved awareness on gender discrimination, childbirth and childrearing. KOICA’s project encouraged husbands and parents-in-law to become more health literate through training on gender equality and maternal and child health, improving gender discriminatory issues within households. After this project, the rate of fathers who participated in and completed maternal and child health training in the Mugu district reached a whopping 84%.
Changes in health awareness are also proved by statistics showing the number of people using local medical facilities. The rate of medical facility childbirth delivery in Mugu district had been at 56.5% until the kick-off of the project, and jumped to 80.3% post-implementation.
Meanwhile, the construction of a new medical building at Mugu District Hospital contributed not only to improving the maternal and child healthcare system but also to enhancing the local medical infrastructure overall. In fact, during the COVID-19 pandemic, the Mugu district has used the hospital as an isolation center to provide COVID-19 vaccination and treatment and as a medical facility to manage patients with fever. Furthermore, it has played a pivotal role in preventing the spread of infectious diseases in the community through efforts such as infection control training for healthcare workers, tempo¬rary research support for COVID-19, and contact tracing for COVID-19. In October 2021, a bus crash that occurred near the hospital resulted in 28 casualties, and the enhanced medical and healthcare system helped the medical process for the victims run smoothly.
KOICA hopes that the improved infrastructure and awareness of residents in Mugu district will sustainably contribute to improving health care services and reducing maternal mortality in the region. The project could serve as a launching pad for enhancements in the healthcare system nationwide, contributing to a safe envi-ronment for childbirth and in lowering the maternal mortality rate in Nepal.
1) Numerical value that the United Nations Development Program (UNDP) evaluates the level of advancement of each country based on literacy rate, average life expectancy, and real national income per capita.