Annual Report 2009

RECPHEC Resource Centre for Primary Health Care Bagbazar, Kathmandu, Nepal P.O.box 117, Fax: 4225675, phone: 4243891 e-mail:[email protected], www.recphec.org.np Table of Contents

Executive Directors Note

Policy Advocacy realizing peoples right to health ------1

Promoting indigenous health system ------7

Urban Health promotion ------8

Comprehensive HIV/AIDS Program for migrant workers------15

Solidarity with global tobacco control campaign ------18 collective Efforts of community empowerment ------24

Information & Documentation right to information ------30

Publication sharing knowledge & information ------31

NGO Networking a collaborative efforts------35

Health Rights and Tobacco district network------35

Fund flow accountability statement

Ogranisational Profile EXECUTIVE DIRECTOR’S NOTE

RECPHEC stepped into another milestone of advocating peoples rights to health. The commitment made by the Government of Republic Nepal has further strengthened with the introduction of free maternal service under “Ama Surakshya Karyakram” in addition to Free Essential Health Service. The three year’s interim health plan is in the final stage of implementation and government is exercising to formulate Second Nepal Health Sector Implementation Plan 2010-2015 to meet the MDG health target in line with constitutional provision of Health as basic right of the people. In this process it is worth while to mention here that I have been nominated as a civil society member in the Steering Committee formed under the chair membership of Hon’ble Minister of Health and Population. The Committee has designated me as a Coordinator of ‘Role of Non- State Sector’ thematic group to formulate NHSP II. Hence RECPHEC has opportunity to put NGO/INGO and Private Sector together in drafting the plan for the next five years. In addition this year RECPHEC is also privileged of managing South East Regional workshop on FCTC Guidelines as Co-organizer in Kathmandu. In order to strengthen its efforts of health policy advocacy, this year RECPHEC has been successful in bringing health journalists into one forum and sensitized them on health rights and tobacco issue. Two separate advocacy kits have been published and disseminated to all Constitutional Assembly members. In addition, to understand the ground reality on peoples access to health, two separate field study have been undertaken; one is on Effectiveness of Essential Health Services and secondly on Ayurvedic Health Services. The outcome of these field survey report have helped in further strengthening our collective efforts in universal access to health and quality services. The year 2009 brought additional programme intervention. One is working with Migrant workers on HIV/AIDS issue and secondly mobilizing community of 48 districts on Essential health services and Tobacco Control Campaign under Public Service Announcement of these FM Radio Stations. We have certainly made some headway in realizing peoples right to information. Besides, our efforts in Urban Health issues: noise pollution, vehicle regulated zone and zero waste campaign took momentum in the Kathmandu valley. Traffic Police, Transport Management Division, Luza Nepal, Super Markets and Boarding Schools including Centre Zoo and Thamel Tourism Development Board have joined hands with us in this movement . These voluntary collaborative efforts with commitment have certainly helped in bringing positive change in reducing noise and environment pollution in the valley. The continuation of outreach programme in Udayapur, Saptari and Gorkha district have contributed in empowering poor and marginalized rural community by strengthening their organizational capacity and leadership development, Information and Documentation Unit has been updated to meet the demand. The digitalization process is underway. The publication division has been equipped with desktop publication . The financial department has one more additional staff realizing the need to submit monthly, periodical financial reports to different external development partners. The organization which was established in 1989 and finally registered in 1991 has now grown as national organization with 48 district level Health Rights and Tobacco Control Network with more than 700 affiliated NGO members. Hence RECPHEC has now been able to mobilize these member organizational and their more than 3000 volunteers on health and development issues to give national and global impact. It is quite formulate to mention here that RECPHEC has been able to establish long term partnership with EED Germany, without EED support RECPHEC may not achieve such an encouraging outcome. Our sincere gratitude goes to the EED for their genuine concern on the people of Nepal. This year we had new partner organization Family Planning Association of Nepal under Global Fund. Our partnership with OXFAM GB, Campaign for Tobacco Free Initiative under Bloomberg International and Health Bridge, Canada have further strengthened our movement. This year we have also had cooperation with Ministry of Health & Population. RECPHEC would like to express heartfelt thanks to all our EDPs, Government, Civil Society, Media and the people with which we are working together. Let the new year 2010 be more productive in our health and development efforts. With best wishes,

Shanta Lall Mulmi Executive Director

January 2010 Annual Report 2009

POLICY ADVOCACY REALIZING PEOPLES RIGHT TO HEALTH

Government of Nepal declared a free essential health service (FHS) from the beginning. It supports civil services policy on October 2007 and implemented society interventions in three VDCS of each three from January 2008, with the aim to bring basic health districts (Dailekh: Seri, Baraha and Goganpani VDCs, services within the reach, particularly of the poor Surkhet: Maintada, Gumi and Chhinchu VDCs, and and excluded groups through all health and sub- Bardiya: Mainapokhar, Deudakala and Sorahawa) in health posts (SHP). The Governments declaration the mid-western region of the country. Selection of and subsequent action were a part of the these districts is made based on the prevalence of commitment of government, policy makers, political high level of poverty, backwardness, poor health parties, and other stakeholders working for the poor, condition that predict several health hazards. marginalized, and socially excluded people emphasizing inclusive development with Dalits, The overall objective of the project is to improve Janajatis (ethnic groups) and women at the centre access to quality basic health services for poor and of the programs. marginalized groups in rural areas. The specific objectives are to: 1. increase awareness and The Interim Constitution 2007 guaranteed Nepalese understanding among the main actors and citizens’ right to basic health services as stakeholders (e.g.: staff and users of services, policy fundamental rights. In line with the constitutional makers and civil society organizations) on the main provision, the Three-Year Interim Plan (2007-2010) issues regarding delivery of health services to the strongly emphasized citizens’ fundamental right to poor and marginalized groups. 2. increase capacity improved health service through equal access to of civil society groups to advocate for, and to monitor quality health services without any discrimination and support implementation of pro-poor health by region, class, gender, ethnicity, religion, political policies/mechanisms. 3. influence government and belief, and social and economic status. policy makers of concerned ministries for effective delivery of health services in rural areas. Despite declared policy, access to health facilities remains a key issue of concern particularly in Activities conducted under essential health geographically disadvantaged areas and among the service during the year were as follows: most marginalized groups. Unavailability of adequate human resources and all necessary drugs National Consultation are some of the key obstacles to utilization of Free Health Services (FHS). Field level implementers of A national consultation on Free Health Services was FHS such as members of HP/SHP management held on 26th April 2009 with 47 representative of committees, heath service monitoring committees, HRTC Networks. In the consultation, findings of the auxiliary nurse mid-wife (ANM) are not fully aware study held on “Free Health Service: and compilation of the scope, limitations and implementation of issues at district consultations were shared. The priorities of FHS. Lack of knowledge among the Chief of District Public Health Office-Kathmandu implementers and even the responsible persons presented paper on free health service program, has led to the poor performance of FHS delivery. whereas Dr. B.K. Subedi, Family Health Division Similarly, lack of information, and awareness, weak presented paper on Free Maternity Service and function of monitoring mechanism, resource crunch Mother Security Program. The representative of and inadequate supply of World Health Organization medicines in health institutions and a civil society that are supposed to provide free representative Dr. Bharat health services, have put the Pradhan also addressed in FHS scheme in jeopardy. the program. The national consultation built common RECPHEC has been understanding among the implementing Essential participants about the Services Campaign (ESC) with issues to be dealt by particular focus on free health stakeholders in the future.

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District Consultations • There has been difficulty in identifying real target population, especially the poor. • Psychology and Behavior of the Service Recipients HRTC organized district consultations on • Not confident with Free Health Service Program ‘Challenges and Way Out of the Implementation of • People come to get medicine without any sickness and Free Health Service Program’ in 40 districts of Nepal. guardians come to get medicine instead of patients • Medicines are requested at health posts with the prescriptions from regional hospitals. These consultations focused mainly on human Roles of Civil Society and Media resources, presence of health workers, monitoring • Civil Society and Media have not been able to play active mechanism policy and implementation processes, role for the effectiveness of FHSP. status of medicine supplied, role of civil society etc. • They have not been able to disseminate proper information about FHSP (Difference in understanding among service The major outputs of the district consultations were providers and service recipients due to the lack of proper as follows: Health workers provided additional information dissemination) commitment for the effectiveness of the free health Role/Ethics of Health Professionals service program. Different stakeholders realized the • Since private and professional health workers put patients need of cooperation of all stakeholders for for profit making business, it has obstructed them to reach coordinated and joint actions for the effectiveness FHSP of the program. All participants in the consultation program express commitment to improve equitable Field Study: Bringing Grass Roots People for access to poor and deprived to heath services. Major Policy Inputs issues discussed were: Free Health Service: Rhetoric or Reality? A Case General Study on the Effectiveness of Free Health Service • After the initiation FHS program, there has been slight in Nepal improvement in people’s access to the health sector. • There has been increasing flow of the patients in the health In order to highlight implications and effectiveness of organizations the free health service policy and program of the • It has not reached to the HeHmajority of the people, especially the marginalized class, region and communities government into the public sphere, RECPHEC has • It is appreciative, since it was brought without analyzing made a qualitative study to document and analyze resources it has created some problem the extent to which free health service policies of • It has not been effective due to lack of awareness, HR, physical infrastructure and economic sources. government have actually addressed the health issues Access to Information of poor and marginalized people, identify the policy • People especially from the target population are not well gaps and capacity needs including the lacunae in informed about the program. professional ethics of the health workers, assess the Access to free Medicine role, contribution and capacity of CSO activist’s vis- • There is a lack of universal access to free medicines à-vis effective delivery of health services and provide • Since the size of listed medicines is short, people have to go private clinics for additional medicines. an evidence-based scenario for the effectiveness of Access to Service, Physical Infrastructure and Equipments the free health service scheme in terms of the extent • There is a lack of adequate physical infrastructure in health to which it has benefited the poor and marginalized organizations communities, and derive from it key recommendations • Unavailability of essential equipments in district hospitals. It is difficult for the patients in hilly areas to go to health to policy makers and CSOs. organizations. • Lack of delivery room for delivery cases in health posts The study was conducted in 4 districts; Bardiya and people are compelled to do unsafe delivery at home. (Mainapokhar SHP, District Hospital), Dailkeh (Barah • Access to Services by professional human resources • There are no health workers in the sub/health posts. Those PHCC, District Hospital, DHO), Surkhet (Katuka SHP, working visit district head quarter for meetings. Chhinchu SHP, DHO) and Dadeldhura (Jogbuda SHP, • Since health workers in the sub/health posts are from District Hospital). The study has identified the following central and regions, they cannot stay consistently there. points to improve FHSP in the future: Management • There is weak management in hospitals and health posts Lessons Learned Why health posts has not been handed over to VDC • Time based piloting initiative is necessary before implementing offices? any of the national level policies and programs. Monitoring The successful implementation of FHSP requires enough • Very weak monitoring for human resource mobilization preparation in terms of human resource mobilization • Difficulty in getting timely medicine with low quality/cure including the continuing education of health professional, due to the lack of proper monitoring mechanism. financial resource mobilization, political commitment and Other inputs of Female Health Workers are not evaluated • effective communication mechanism except medicine distribution and delivery cases. • Health Workers provide better treatment to the patients in Community level monitoring mechanism can be effective private clinics than in government hospitals. in ensuring effective implementation of FHS through SHP • Government policy is limited to accessible groups only. and HP. Such monitoring also enhances the sustainability • Marginalized people yet to realize the FHSP of monitoring mechanism.

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Social audit of health facilities can contribute in making hospital for delivery. In order to inform people at large them transparent. It can also strengthen the community about the Free Health Service Program of the GoN, level monitoring of free health service by establishing information as right of people. RECPHEC broadcasted the Media Jingle through 45 The use of Objectively Verifiable Indicators (OVIs) in FM radio stations in the following 45 districts. identifying the target groups contributes in shortening the procedures and increases access of the real poor. The In order to analyze the effectiveness and to better use of hard to verify or subjective indicators makes the process cumbersome and makes the access the services impact of Radio Jingles on Free Health Service, to real poor quiet difficult. RECPHEC organized an interactive focal group Conclusion: The declaration of the GON regarding free health discussions program in 47 districts of Nepal. Under service delivery came with the commitment of government in this activity, three community groups like mother respecting people’s right to health and program implementation groups, saving groups, farmers group and radio kept up the spirit of Interim Constitution of Nepal, 2007. The scope of the program has been increasing over the time. In listener’s clubs in each district were encouraged to the meantime, the program could not be as effective as listen to the radio jingles. Later, HRTC district expected due to lack of enough preparation, inadequate network’s representative organized interactions with mobilization of resources and dysfunctional status of these groups with the presence of representatives implementing health facilities. However, the commitment and efforts shown by government is praiseworthy and requires from FM radios aimed at further improvement in jingle additional back up by the civil society organizations and general presentations. The FM radio representatives recorded public. There is a need to focus on institutional strengthening the discussion and presented them to the District to make the health systems functional enough to catch the Public Health Officer. The discussions of the meeting momentum. were broadcasted through the respective FMs. RecommendationsShort term: The initiatives that can be taken within short period of time include (i) form a FHS unit at central level under DOHS, (ii) national day celebration, (iii) Advocating Parliament (CA) Members rethink the delivery mechanism and institutional arrangement, (iv) strengthen monitoring committee, (v) develop joint planning Advocacy kit on on free health service program and mechanism to attract resources from DDC and VDCs, and health policy issues was specially designed by (vi) invite and involve external developing partners (EDPs) to arrange additional technical and financial support in RECPHEC for CA Members in order to sensitize strengthening FHS. them. Hon’ble Minister for Constituent Assembly, Long term: As the country is currently in the process of Parliamentary Affairs and writing new constitution through constituent assembly, the Federalism, Dr. Minendra possible reform initiatives and options are categorized under Rizal released the the recommendations for long term period. Some of the advocacy kit in the recommendations include (i) identify and go for reform initiatives that can improve the current system of health presence of the CA delivery, (ii) introduce and develop strong mechanism to target Members Thamatic the poor and (iii) implement performance based incentives Group for Women and scheme. the representatives from civil society 11th RECPHEC contracted out Research Action and September 2009. Altogether 59 participants Development Action to carry out the study. A five- participated in this public release program. Mr. Shanta person team and three representatives from the Lall Mulmi, Executive Director, presented the major respective HRTC districts were also involved in the points of advocacy kit on “Free Health Services” in study process as research assistants. The research the workshop. Major issues raised were: assistants were given orientation in Nepalgunj from 21st-22nd March 2009 prior to initiate data collection • It’s the right of the citizen to get FHS but not a charity by the government. at the field. • Health is the most important thing for the people. It is the responsibility of the government to provide FHS to the people. Public service announcement communicating • More than 75% of all diseases are related to poor drinking water supply so it should be purified before it is drinkable. with people • Private hospitals and 80% of doctors are situated at urban areas . There should be a policy so that they serve people RECPHEC developed a 47 second long radio jingle at rural areas at any cost. • Poor and deprived people have no access to health services. which covers both information related to FHSP and Does the government have enough funds for all the maternity health care. The Jingle contain message expenses to health services or not? CA members should on how to get FHSP in their community and has stress on the reproductive health rights of the women while writing down the constitution of Nepal. called on the people to get benefit by receiving the • Nepalese government cannot provide FHS on long run. To service free of cost. It also informs about free maternity make all people universal to the health, social insurance is services and receives transportation facility being the most important. Distributing free medicines to all cannot be named as free health services. For this there should be provided by the government for women who go to development of health system which includes availability of 3 Annual Report 2009

manpower in that place, proper supply of medicines and working in remote areas, regular supply of all free diagnostics, adequate promotive and preventive services, medicines and strengthening of monitoring physical infrastructures and rules and regulation etc. mechanism. It also extended full support and • Public awareness and participation are very important for the people in the rural areas. Ayurved also plays a vital role cooperation from civil society in the Government’s in health. Allopathic medicine is not only the solution of the efforts to bring frees of cost health services and disease. maternity health care within the reach of all citizens, • Government started with targeted free care to make FHS as especially the poor and marginalized ones.” a right of a citizen. It is not only providing medicines and services but to put together whole system in a right direction. This is not the time to look back but go ahead. CA members Press Conference should think and help in strengthening this program. Nepal is providing FHS with 6.4% budget only and has set an example in the world. There is nothing like poor countries health After having submitted memorandum to the Prime system should be weak. Despite all the problems Nepal’s Minister RECPHEC, FEDWASUN and Oxfam GB health indicators shows that it is better than India. Nepal jointly organized a press conference at RECPHEC office on 21st September 2009. In the Submission of People’s Agenda for Health press conference the memorandum submitted to Rights the Prime Minister was made public and shared few discussions, the joint letter sent by International A team represented by Mr. Shanta Lall Mulmi, Confederation of Mid Wives, International Executive Director, RECPHEC, Mr. Wayne Gum, Paediatricians Association, International Federation Country Director, Oxfam GB Nepal, Mr. Rajendra of Gynaecologists and Obstetrics and International Aryal, Chairperson, FEDWASUN, Mr. Ram Council of Nurses about the meeting of Gordon Bahadur Rawat, Health Rights and Tobacco Control Brown and Leaders of Developing countries in the Network, Mr. Binaya Dhital, Oxfam GB Nepal, Mr. United Nations General Assembly. Bal Krishna Kattel, Oxfam GB Nepal and Mr. Govind Shrestha, RECPHEC submitted the memorandum It also distributed a newsletter ‘Your Money or Your to the Right Hon’ble Prime Minister Madhav Kumar Life: Will Leaders Act Now to save Lives and Make on the raised issue at the district consultations. Health Care Free in Poor Countries’ published by Oxfam International to the Journalists. The press The memorandum was submitted just before his release was also sent to number of media. visit to the UN General Assembly as the head of a delegation. The UNGA was to witness a renewed Project sharing workshop pledge from the British Prime A one-day project inception workshop was Minister, Mr. Gordon organized in Dailekh, Surkhet and Bardiya involving Brown to expand the the district level stakeholders including district level existing health care government officials of concerned departments, schemes in seven former members of DDC, NGO workers, user developing countries committee members, women, Dalit, Janajati and including Nepal. The other community leaders on 27th and 29th August memorandum and 1st September 2009. FEDWASUN and comprised health RECPHEC presented their separate presentations related information in the Interim Constitution 2007, concerning the nature and scope of the project. Three-Year Interim Plan (2007-2010), GON announcement regarding free health service and Likewise, RECPHEC and FEDWASUN jointly free maternity and International Health Partnership oriented nature and scope of the project to the HRTC (IHP). and FEDWASUN district networks of Surkhet and Bardia on 27th August and 1st Sept 2009 “The memorandum also urged Rt. Hon’ble Prime respectively. Minister to prudently reciprocate the goodwill to be expressed through his offer by the British Prime Production and dissemination of information Minister, Mr. Gordon Brown at the UNGA by according materials top priority under the new support to massive and effective dissemination of information on the free health services in the rural and remote areas, capacity In order to inform the users of health facilities and building of health workers so as to provide quality people in general, 2000 copies of pamphlet cum health services, introduction of incentives for career posters were published. The posters carried development of the doctors and other health workers information about the policy scope of the free health

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service and maternity health care. Free health equip them with knowledge and skills to run effective services and the list of few diseases that could be advocacy and campaign. The major sessions of the treated with freely distributed drugs are stated in training were on Importance and Effectiveness of one poster. It also appealed people not to buy drugs Advocacy, Sectors those are freely distributed from private clinics. of Governance, Another poster informs that maternity services are Advocacy Strategy available at free of cost from all the health Development, organizations. It also informed about transportation Opportunities and facility (coding rates for different ecological zones) Challenges of given by the government to the mothers who give Advocacy, Targets birth to babies at hospitals. and Partners of Advocacy. A total of 34 participants including two Advocacy strategy content discussion workshop facilitators were there in the training.

In order to discuss and finalize the content of an Workshop with free health service implementers advocacy strategy on essential health services including FHS and maternity health care and drinking In order to aware the scope, limitation and water and sanitation, a two-day workshop was implementation priorities of free health services organized in Lalitpur district from 20-21 August 2009. among field level implementers, HRTC of Bardia, RECPHEC and FEDWASUN presented the issues Surkhet, and Dailekh organized a workshop in the and learning they have gained throughout their respective districts by making the representation of interventions in Free Health Service and Drinking Health Post/Sub Health Posts, Health Post Water and about the policies and gaps of Management Committee, Health Service Monitoring government policies. In the workshop, participants Committees, Auxiliary Nurse Mid-wife from the in groups exercised goal, objectives, and advocacy project VDCs(Dailekh: Seri, Baraha and Goganpani targets including opponents, partners, tactics/ VDCs, Surkhet: Maintada, Gumi and Chhinchu activities, and motivational activities for advocating VDCs, and Bardiya: Mainapokhar, Deudakala and members/organizations Sorahawa). for the advocacy strategy. Two In-charge of Primary Health Centre, Bardia informed Representatives each the participants about free health service. Some of from HRTC district the issues raised in the discussions were as networks and follows: All drugs were not available at heath FEDWASUN district organizations, no regular availability of the networks joined this workshop. medicines, people comes to get medicine with prescription of hospitals, misuse of medicines due Development of advocacy strategy to free service and drugs should not be free for others than target population. RECPHEC has developed an advocacy strategy for advocating issues related to Essential Health Service Interaction workshop with community users Campaign and Essential Drinking Water and Sanitation Campaign. The strategies include Goal, A one-day interaction workshop with community Objectives, Key Messages, Friends, Opponents, users was organized one in each project VDCs of Tactics/Activities, and Motivational Activities, Time the three districts. In the interaction, HRTC of the respective districts presented the major points of Bound and Monitoring and Evaluation components Free Health service Program and Safe Maternity including its backgrounds. Separate strategies were Service to the community people and had open developed for two different campaigns. discussions. The interactions made the community people know about the Training on advocacy and presentation skills facilities available in Free Health Service A four- day advocacy and presentation skills training Program. Some of the was organized in Nepalgunj from 22 to 25 November important information 2009 for RECPHEC, FEDWASUN, project district reported from the networks of HRTCN and FEDWASUN and selected interactions was as representatives of the respective project VDCs to follows.

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It is better to go to the local health post first. If the patients community members. In the assemblies, village are referred to higher level due to complexity of the diseases they get priority there. focal person oriented the participants about the Drugs provided by the health workers should be campaign and encouraged participants for open consumed rather than saying that they provided only discussion. Participation from Health Post In- Paracetamole. In addition to the travel expenses for taking maternity Charges, Health Management Committee services from health organizations, government born Chairperson and political party sister organizations three to five thousand rupees for complex maternity were also there in the meeting. The committees were cases. formed in consensus. The user committee members In the interactions, community people after blamed gave away commitment for their regular monitoring health workers for their misbehavior and for their drugs at health organizations. direct or indirect call to come to their private clinics. Questions were also raised about the possibility of Training to CSO members on monitoring and delivery on the way to health organizations while reporting/documentation skills going to attend delivery. Community also raised question about registration of some females who In order to support the government in implementing were never pregnant. This mal practice to the Free Health Service, RECPHEC under the ESC has guideline that a Female Health Worker has to provide developed a civil society monitoring mechanism/ services for 5 pregnant women. A total of 259 tools to be applied by civil society at different levels. participants participated in the workshops. Following the development of the monitoring District level workshop with policy implementers mechanism/tools (1), a five-day training including field exercise was conducted in Nepaljung from 26- The HRTCN-Dailekh organized a day long workshop 30 November 2009 for the members of district on 19th December 2009 at Laxmi High School, networks and FH Service User’s Groups. Itikhola Baraha VDC involving the district level policy MAJOR ACHIEVEMENTS implementers to remind the district level policy There has been increased knowledge and understanding implementers of the government policies and of FHS implementers among the Health Organization programs for promoting health service and Management Committee In-charges and sister encourage them for its implementation. This organizations of political parties at the VDC level. They not only built their understanding about their role but workshop was organized after having organized also got surprised of knowing their role in the FHSP. interactions at Seri, Baraha and Goganpani VDCs There has been increased knowledge and understanding with local communities on implementation status of community people on FHSP. They are clearer about of FHSP. Representatives of Health User’s the facilities available in health organizations and are Committees, Health Management Committees, convinced to take the services. For the implementing ESC, one health user’s committee FCHVs participated in the workshop. The findings in each project district has been formed. They will be of the group discussions were as follows. taking part for advocacy and monitoring of health There is need of frequent training to the FCHVs to update services at the VDC level. their knowledge on health services Advocacy Strategy and Mechanism to be applied by the Fixation of monthly salary for the FCHVs project partners at different levels. Necessary of essential services drugs for fever, Developed a Monitoring and Documentation tools to be dysentery, head ache etc must be in the bags of FCHVs. applied by project partners at different levels. The structure of the Health Management Committee does Project partners have increased their capacity on not seem to be appropriate for the conduction of meeting. advocacy, presentation, monitoring and documentation All members are busy in their own business. skills. There are lots of challenges before Health User ISSUES/CHALLENGES/LEARNINIG: Committees. They have to have adequate knowledge to face these challenges. RECPHEC had to make enormous effort in following up district HRTC networks to accomplish activities. Formation/mobilization of health users groups Monitoring effect of the radio jingle broadcasted through FM radios itself is a challenging task. RECPHEC have planned for engaging district HRTC including collection In order to contribute voluntary support of health of data of some health posts in the respective districts. users in the implementation process of FHS for the Community people have increased expectation after the increased effectiveness of the services, RECPHEC formation user committees through HRTC has formed one Health User There still a question about the strong involvement of the district as well VDC focal persons to implement Committee in each project VDC of all the three activities at the local level including monitoring and project districts. In the case of Dailekh district, VDC documentation due to low motivational packages for them. level meetings were organized by making Concerns are still there to involve health workers in the representations from mothers groups, women campaign activities as they are already accustomed of getting meeting allowances in similar government groups, farmers groups and saving groups and other activities.

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PROMOTING INDIGENOUS HEALTH SYSTEM

Our modern life style has made us, perpetually move Karnali, Rapti, Mahakali, where districts are Jhapa, away from our natural balanced state. The food we Dhankuta, Makanwanpur, Kathmandu, Butawal, eat, the air and noise pollution we face, the stress Parbat, Surkhet, Jumal, Doti, Kanchanpur were at work, poor exercise, a lack of selected for this research program. balance living and competing interest The main objective of the research in work place and family all add up was to find out the service provided to build toxin that lead various in government ayurveda health diseases are collecting in various centers. The Principal Investigator parts of the body. Ayurveda and of the research is Dr Shyam Mani alternative therapy recommends a Adhikari, Research Associate/ Co- system of purification with natural Investigator is Dr Sarita Shrestha ingredients and therapies to clear all and similarly, Dr Sumana the toxins collected on various parts Thasineku and Ms Chandra Kiran of our body. Among them, ayurveda Shrestha, RECPHEC was also has been more established. Ayurveda is a traditional involved on this research program as research medical system practicing around 5000 years back assistant. which is the source and knowledge of the initial With the study of all the policies, planning, essential stages of the development of all medicines. lists of medicines, primary care and the existing The primary objective of Ayurveda is to treat the root infrastructures it shows that Ayurveda is extremely cause of a problem and not the symptoms by looking valuable. However, the challenge is, as per its at individuals as unique entities, with a combination policies and planning the government has not been of appraisal in physical, mental and a holistic able to implement it properly. Physical approach. Ayurveda can provide healing to people infrastructure, human resources and enough funding who want to be healed through diet and lifestyle is lacking from the central to district level ayurveda changes. Its therapies progress is achieved through health service institutions and on the other hand natural methods. However, corporization and the exiting infrastructure, human resources and the fragmentation of some products for profit in the name budget is not of Ayurveda or indigenous health are to deplored appropriately organized and prevented. Considering a need of a common and used. After this platform to address different issues related to study the following Ayurveda and alternative health care, RECPHEC recommendations were initiated some activities primarily in ayurveda. made for improvement in: physical and Information/Dissemination administration, drug production and distribution, service and programs, Updating is an essential part for promoting health human resources management and training, education, diagnosis and treatment, research and documentation, reporting system and management training self care. Thus, 43 new documents including & coordination and cooperation articles on traditional system of medicine are collected and catalogued in different subjects, i.e. Publications ayurveda, homeopathy, naturopathy, spiritual healing etc. We have total 315 monographs, articles on RECPHEC published 5000 leaflets about the service traditional system of medicine. & facilities available in the government ayurvedic health institutions including rational use of drugs & Existing government Ayurveda health services a posters targeting general people on the information on plantation, preservation, and promotion on Following the recommendation for a research from medicinal plants. These IEC materials were the a workshop on the role of ayurveda in distributed to Dept. of Health Services, District sustainable health services RECPHEC initiated to Ayurveda hospitals, Regional Ayurveda Hospitals conduct the research on ayurveda health January and related institutions. Likewise, the posters were to June 2009 in 5 Development Region. 2-districts distributed to health post, sub-health post, schools, of every region 10 Zonal hospitals: Mechi, Koshi, Narayani, Bagmati, Gandaki, Lumbini, Bheri, local NGOs and our HRTC in 48 districts.

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URBAN HEALTH PROMOTION

The Kathmandu valley is rich in socio-cultural four wheelers has been developed around the diversity with infinite historic, artistic, and cultural periphery of Thamel. A taxi stand has been interests. The significance of these assets of the established at the entrance of Thamel through Tridevi city is diminishing these days. There is adverse Marg. Moreover, many infrastructures have been impact on environment and human health due to developed to support the program. A regular unmanaged solid waste. Lack of sustainable and monitoring is also going on to make the program clean technology to manage solid waste of the city more effective. is having a significant impact on Urban Health. The problem of solid waste management must be TTDC, considering its successful history of vehicle addressed to improve the environmental health. The free zone, is once again exercising to develop it as health effects are linked to occupational hazards vehicle free zone, which was discontinued before and to exposures of local poor populations to the due to the lack of sustainable funding mechanism. contaminated waste. The current status of the waste TTDC, in close coordination with RECPHEC has management in the Kathmandu valley needs an conducted several meetings with Kathmandu urgent attention, and this project targets to take a Metropolitan City Office, Traffic Police, Chief District ZERO Waste Approach to minimize the impact of Office, and other stakeholders. An interaction waste in urban health sector. program is planned with local dwellers in near future.

Though the Government of Nepal is making its effort Vehicle Regulated Zone at Ashan to manage it properly, it seems inadequate. However local NGOs and private bodies involved in the Ashan is the marketplace and ancient area of the management mostly focused on the collection, but capital, where indigenous people Newars of the continued to dump in environmentally unsound way. valley reside. It is one of the most crowded areas of It is to be noted that the waste is a resource in the city. Considering the importance of the area as disguise. Solid waste (garbage), hazardous waste, a business hub, and hurdles that people has to face liquid waste and other waste would have produced while walking around due to the flow of traffic, Ashan resources such as energy, compost, water and should be declared as a vehicle regulated zone. reusable materials. Zero waste is an approach to RECPHEC has taken an initiative in this regard and make an endeavor for zero solid and hazardous a meeting has been conducted with Ashan waste, zero emissions to air, water and land, zero Management Committee and other stakeholders. waste in production and administrative activities, zero Combating Noise Pollution waste in product life, zero toxics and 100 per cent resource efficiency. Hence, the project aims to make Noise pollution in the Kathmandu Valley is a community in Lalitpur Sub-metropolitan City an excessively high. The excessive and not needed environmentally sound livable city, a model eco-city. use of horn by public as well as private vehicles is common. Moreover, the use of pressure horn, Roads for People although prohibited, is in frequent use. Though there Vehicle Regulated Zone at Thamel are many other sources of noises pollution, vehicular noise is taken as a major source of noise in the RECPHEC has taken initiation to declare Thamel city. Considering this, RECPHEC conducted a week- (a tourist hub) as a “vehicle regulated zone” on 25th long campaign on “Combating Noise Pollution” from July 2007 and was later implemented from 27th 22nd-27th November 2009. The following activities September 2007. Thamel Tourism Development were carried out during the campaign: Committee (TTDC) in close association with Kathmandu Metropolitan City, Traffic Police and Hoarding Board Placed: Though hospital areas are Tourist Police and other stakeholders has formed declared as “Horn Restricted Zone” by the Steering Coordination Committee and Rapid Action government and there is a provision Rs. 200 fine, it Committee. Similarly, a paid parking lot for two and has not been strictly enforced yet. The Hospital area

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doesn’t comprise a visible board “No Horn Please”. & LUZZA Nepal and staffs, teachers from respected Taking into account, colleges attended the orientation program. Assistant RECPHEC has Sub-Inspector Mr. Hari Saran Paudel made placed the horn presentation on the traffic rules/ regulations. restricted zone board Inspector Mr. Bal Krishna Pokharel and Sub- on 8th November inspector Kaman Singh Khatri briefed students on 2009 at the premises working modalities while they will be deployed as of one of the oldest, volunteers at public places. Ms. Anusuya Joshi from Bir Hospital. RECPHEC made presentation on ‘Combating noise Pollution” and discussed on campaign activities and Press Meet: RECPHEC organized a press meet on role of volunteers. 17th November 2009 at Media Mission, Bagbazaar. The program mainly highlighted on the health Campaign on “Combating Noise pollution” consequences of the noise pollution caused by excessive use of vehicular horn, publicized the A campaign was organized from 22-27 November campaign programs. Mr. Shanta Lall Mulmi, 2009 in the Kathmandu valley to address the effect Executive Director of RECPHEC welcomed all the caused by the use of unnecessary horn on health participants and appealed media to highlight the and environment. The following activities were carried issue to make the campaign more effective. He out during the campaign. emphasized on the need to make the Kathmandu a Sound Level Monitoring: Sound Level was livable city with environmentally sound environment. recorded at five proposed places such as Bir Ms. Anusuya Joshi, Program Officer, Urban Health hospital, Patan hospital, Jamal, Koteshwor, and Program briefly highlighted on the campaign program Bagbazaar. In addition, sound level was recorded at and informed that the campaign is primarily focused Ratnapark, Sundhara and Lagankhel as well. A on monitoring vehicular noise at various places in continuous monitoring at various places showed that the Valley and examining the impact of unnecessary Patan hospital area is more vulnerable to noise honking. She informed that almost 100 college pollution due to unnecessary use of horn. The volunteers will be observation showed that the flow of vehicle is high mobilized at 8 in narrow road, and the public vehicle also stopover different hubs of the in front of the hospital, which causes traffic jam city to distribute frequently. In Patan hospital area, sound level up stickers and to 120 dB was recorded, whilst the average was leaflets. Mr. Kaman 72 dB. Bir hospital area recorded in an average 69 Singh Khatri, Sub- dB, whilst at the hospital room it ranged from 50 Inspector from to 60 dB. Bag bazaar area recorded low level Traffic Police amongst all the spots, an average of 60. However, expressed that the during traffic jam in the area, it reaches up to 95 high level of noise pollution in the valley is due to dB. Narrow road and Bhaktapur bus stop are the lack of awareness on drivers. He estimated that at main causes of jam at Bagbazaar area. least 95 percent drivers are not aware about the Distribution of Sticker and Leaflet: Almost 100 impact of honking on the general public. Mr. Dola volunteers were placed at 8 different bus pocket of Nath Khanal, General Secretary of National the valley; Ratnapark, Sundhara, Jamal, Bagbazaar, Federation of Nepal Transport Entrepreneurs Singhadurbar, New Baneshwor, Koteshwor, and stressed on the need to have an effective policy Lagankhel. Each group of volunteers was led by a regarding the issue. Dr. Mathura Prasad Shrestha, monitor from LUZZA Nepal and a traffic police. The Chairman of RECPHEC clarified the significance of volunteers distributed almost 8,000 stickers and the role of media on public health issues and public 13,000 leaflets to the vehicles such as microbus, awareness programs, and requested media to minibus, taxi, car, tempo, and motorcycle. Traffic support the campaign. police supported to convince the vehicle drivers to Volunteers Orientation: An orientation program was paste sticker in their vehicle. Moreover, 20 mobile organized for almost 100 volunteers to be mobilized volunteers in 4 groups were mobilized at parking during campaign week, on 20th November 2009 at lots in New Road, KhichaPokhari, Maha Baudha, Metropolitan Traffic Police Office, Ramshahpath. Bhotahiti, Jamal, King’s Way, Lagankhel area to Almost 100 students 3 different Colleges, RECPHEC distribute stickers and leaflets.

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Banner Display: Banners with the Similarly, the use of musical horn message “Horn Restricted Zone-Bir are in practice to attract Hospital” was displayed at the passengers, is found to be more periphery of Bir Hospital on 25th- annoying and irritating. Traffic 26th November 2009 by the students police are the most vulnerable of Xavier International College. population affected from the use of excessive horn. In comparison Survey: A questionnaire was to the number of vehicles, the developed to interview drivers/ targeted number of stickers and vehicle owners to know about their leaflets is negligible. The targeted understanding on rules/regulation on noise pollution, 5,000 stickers and 5,000 leaflets were distributed and its effect to health and environment. Almost in 2 days so an addition of 5,000 stickers and 10,000 350 respondents were sampled from various hubs leaflets were printed. Some vehicle drivers showed of the city. enthusiasm and committed not to use horn unnecessarily, however some were furious and didn’t Rally: A rally was organized on 27th November 2009 paste sticker on their vehicle. to create awareness amongst vehicle users about the health hazards of excess use of horn. The Outcome procession went around the city. Almost 150 college students, representatives from various organizations, Department of Transportation Management, RECPHEC and LUZZA Nepal members participated Government of Nepal, published notice on “Ban on in the rally. The procession used footpath and Pressure Horn” in National Newspaper on November crossing bridge, which was an 27, 2009. According to the example to others, otherwise such notice, vehicles are prohibited rally used to disturb the traffic in the to change the structure than that valley. at the time of purchase as the provision made by Article 39 (1) RECPHEC organized the rally with of the Vehicle and transport close coordination with Traffic Police Management Act. Those who and LUZZA Nepal. Students from 3 violate the rule by fixing Colleges participated in the rally with pressure horn on the vehicle are great excitement. Mr. Kaman Singh alerted to change it within Khatri, Sub-Inspector of Traffic December 12, 2009, otherwise Police escorted the rally with 8 other they would be fined as the traffic polices. Mr. Ritesh Gurung, Co-coordinator provision made in Article 160 (2) kha. According to of Xavier International College led college students. the Metropolitan Traffic Police Division (MTPD), the ban will enforce from 13th December 2009 for a week Lesson Learned from “Combating Noise to remove it has been given to the vehicle owners. Pollution” Campaign Those who violates the ban will be charged a fine of Rs. 500/- to Rs. 5,000/- To make the monitoring Almost 8, 97,467 registered vehicles run all over more effective, MTPD have kept vigilant at major the country, out of which 4,44,000 are in Bagmati intersections with special focus on hospital and Zone only. Only in Bagmati Zone, 3,30,861 school areas. The traffic police have given authority motorcycles are registered. In the proportion of to seize and remove pressure horn including all forms vehicle in use, the number of human resources in of musical horns. traffic to control it is very few. One traffic personnel has to look after 1.6 km road, 501 vehicles, and Massive Media Coverage: 3,838 people. Roads are very narrow for huge number of vehicles. Moreover, people are not aware of rules/ News coverage of press meet on Nepal One, regulations, legal provisions and health hazards Sagarmatha TV, Nepal Television - Hamro regarding noise pollution. Thus, traffic jam, road Kathmandu Program on17th November 2009. crossing from undesignated points, driver’s habit, “Chittikka Program” dedicated on “Combating bus stop at inappropriate places, unregulated and Noise Pollution” on Sagarmatha FM with an indiscrimate parking of vehicles along with the roads interview with Mr. SitaRam Hathechu, Traffic Police and over taking of other vehicle are the causes and Mr. Rishikesh Ghimire, National Federation traffic jam that also caused excessive use of horn. of Nepal Transport Entrepreneurs. In the program,

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Mr. Hathechu showed his commitment to take Zone’, and demonstration community for ‘ZERO necessary action against pressure horn. Waste Approach’. Interview on health hazards of Noise Pollution with Dr. Mathura Prasad Shrestha, President of Feasibility Study: A feasibility study was th RECPHEC was aired on Maitri FM on 19 conducted by random sampling from all 14 Toles of November 2009. Interview with Ms. Anusuya Joshi, Program Officer the ward No. 20 of Lalitpur Sub-Metropolitan City, of RECPHEC on the campaign program of Noise the targeted demonstration community. (Annex-2) Pollution on Maitri FM on 19th November, 2009. Interview with Ms. Anusuya Joshi, Program Officer Development of Demonstration Community: of RECPHEC on the campaign program of Noise LUZZA Nepal, a local NGO, has been appointed as Pollution on Metro FM on 20th November, 2009. a partner organization, and given all the Response/Highlights of the campaign with Ms. responsibilities to develop a ward no. 20 of LSMC Anusuya Joshi, Program Officer of RECPHEC on as a demonstration community. The following th “Chittikka Program” of Sagarmatha FM on 24 activities were carried out. November 2009. News on Press Meet and the campaign on the National Dailies/Magazine: The Kathmandu Post, Orientation to volunteers: An orientation program to The Himalayan Times, The Rising Nepal, Nagarik, the volunteers to be mobilized in the community Samacharpatra, Hasana. was conducted for 14 volunteers, 7 volunteers from Continuous news/message of the campaign on LUZZA Nepal and 7 volunteers from the Women’s FMs. Group of the community. Mr. Shanta Lall Mulmi, Almost 500 Pressure horns captured in a week Executive Director of RECPHEC highlighted on the time from many vehicles by traffic police. objective of the project. Ms. Anusuya Joshi, Nepal Credit and Commerce Bank Ltd. sponsored Program Officer of RECPHEC presented the caps for volunteers. Similarly, Sanduk Cooperative Limited sponsored jackets for volunteers. concept of Zero Waste Hotel Association of Nepal appreciated the and how to implement it campaign program and considering noise to the community. Mr. pollution as a nuisance, and one of the Chakra Mehar impediments for tourism industry, showed Bajracharya, social willingness to support the program. activist of the Pacific Asia Travel Association also showed community, Mr. Ram concern and was enthusiastic about the Krishna Shrestha, Ward campaign. Secretary of ward no. 20, LSMC, Ms. Sayaka Employees of Nepal Airlines Cooperation appreciated the campaign program and Yaoya, JOCV and Ms. Krishna Barahi, Jagaruk discussed on ill effects of noise coming from the Mahila Bikash Samuha encouraged the volunteers road to their health and working performance. to work in the community. Ms. Barahi provided information on types of plastic waste and importance Towards ZERO Waste of its segregation for reuse and recycling.

Demonstration Community Orientation in the community: All the 14 volunteers of LUZZA Nepal and Women’s Group were mobilized RECPHEC in close coordination with Lalitpur Sub- to each household of the community to inform metropolitan City (LSMC) and local organization community people about ZERO waste approach LUZZA Nepal developed Ward No. 20 of LSMC as a and aware them about the harm of polythene bags. demonstration community with ZERO Waste Moreover, database of the entire household has Approach. The following activities were carried out been prepared. in line with the program. Collection/ Transfer of Waste: The Working Committee: A working collection of plastic waste is committee was formed with the ongoing from February 2009 from representatives from Ward No. 20 the community under the program. office of LSMC, RECPHEC, LUZZA Thus collected plastic waste such Nepal, and Women’s Group of as polythene bags, other plastic Ward No. 20 as its member to bags, packaging materials etc are develop the ward as a model completely reused and recycled. community for ‘Polythene Free This practice has prevented

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dumping of these materials on the road, and public consumer’s forum, manufacturers and local NGOs places which have make chowks (open places) safe and different stakeholders to pressurize the to play for children. Similarly, the organic waste (bio- government to degradable) collection is ongoing from June 2009. formulate a Before the collection of the organic waste, concrete policy on community people were encouraged to segregate it. In this regard, the waste based on its characteristics. Almost 250 consultative buckets provided by LSMC were distributed in the workshop on the community to collect the organic waste separately. “Need of Production, Processing of the Waste: Out of 600 households Distribution, Use and Disposal Regulation Policy of the community, the organic waste from 200 for Polythene Bag” was conducted on 10th August households will be managed with bio-methanation 2009 Monday. method. The plant has been installed at the Advocacy Materials: Leaflet and posters with the premises of Environment and Sanitation Division of slogan “kflnlyg] x6fcf,+} jftfj/0f hfufcf] ”+} and negative effects LSMC, Balkumari. The plant is comprises of of using polythene bags, and stickers with collection tank, digester (bio-methanation tank), “Polythene Free Zone” has been developed and pumps and other supporting infrastructure for the printed. Similarly, posters encouraging customers distribution of collected methane gas, fertilizer and to bring bag from home has been designed and water. printed.

Similarly, waste from 200 households is being Production of Alternative: Almost 1000 cloth bags managed by community composting, with the was produced and distributed to every household of support of Japan International Cooperation Agency the targeted model community. Moreover, it was (JICA). Representatives from 200 households were made available at every shopping center and trained with Takakura Home Composting Method. shopkeepers were motivated to encourage They were provided with compost bin as well. The customers to use alternative to polythene. Similarly, household composting program was also supported RECPHEC is encouraging supermarkets and by JICA and Solid Waste Management and departmental stores to produce cloth and paper Resource Mobilization Centre (SWMRMC). bags.

Campaign against the Use of Polythene Bags Advocacy/ Awareness Campaign

A massive campaign against the use of Polythene Press Meet on the Campaign against the use of bag was conducted in Lalitpur to aware people on Polythene Bags: A press meet was conducted on its negative 2nd March 2009 Monday at Lalitpur Convention effects. Centre, Pulchowk, Lalitpur to inform all the Volunteers were stakeholders about the campaign against the use mobilized at of polythene bags started from 15th March, 2009. supermarkets/ The campaign was organized with initiation of departmental RECPHEC in association with Lalitpur Sub- stores to metropolitan City Office and LUZZA Nepal. Mr. distribute Shanta Lall Mulmi welcomed all the participants leaflets, and to and highlighted on the objective of the campaign. motivate There was the representation from print media, customers to carry reusable bags from home. electronic media, representatives of supermarkets/ RECPHEC is strongly advocating with policymakers stores working together to support the campaign to bring a concrete policy to address the issue. It and other stakeholders. has conducted the following activities in association with local NGOs. Mr. Rupak Bhattarai of Namaste Supermarket made public the commitment made by almost 30 Policy Advocacy: Though there are many legal supermarkets/ stores who had committed to policies that regulate the solid waste management, participate in the campaign Moreover, Mr. Pradeep it has not been enforced effectively. A series of Amatya, Chief of Environment and Sanitation Division meetings has been conducted with line ministries, of LSMC highlighted on the Waste Management government organizations, municipalities, Scenario and Practice at LSMC. Furthermore, Ms. 12 Annual Report 2009

Sayaka Yayoya, JICA volunteer to Environment and was announced in the end of every month. Sanitation Division, LSMC highlighted on the significance of the campaign on waste management Distribution of Paper Bags: In Nepal, almost two at LSMC. She further added that the campaign will decades back most of the shopkeepers used to be success only if there will be coalition among all prepare paper bags required for own shop. However, the stakeholders. some shopkeepers used to buy it from others, and some people used to earn money by paper bag Mr. Sudhir Pradhnang, Managing Director of making business. Later on, these paper bags were SALEWAYS Supermarket briefed on the economic replaced by polythene bags. To promote the early aspects of the use of polythene bags. He informed trend of the use of paper bag, almost 5000 paper that if customers bring their own bag from home, bags were distributed to retailers located at the main there will be a huge saving of supermarkets and hub of the LSMC, Lagankhel, Mangal bazaar, stores as they are providing polythene bags free of Khumaltar. cost. Ms. Anusuya Joshi made presentation of the “campaign against the use of polythene bags”. She Model Community: Various programs were highlighted on the requisite of the campaign at LSMC organized at Ward No. 20 of LSMC to develop it as and briefed on the negative aspects of the use of a model community as a part of the campaign polythene bags. She further highlighted on the against the use of polythene bags. RECPHEC in programs offered during the campaign period to association with Ward No. 20 Office of LSMC, LUZZA encourage customers to carry bag from home. Prof. Nepal, and local Women’s Group has committed to Dr. Mathura Prasad Shrestha stressed on the declare the community “Polythene Free environmental and health consequences of the Community” by the end of 2009. Almost 20 improper use and as the mode of disposal of volunteers of Women’s Group and LUZZA Nepal have polythene bags. been mobilized in the community to aware local people about the harm of polythene bags and Rally: A rally was organized on 15th March 2009: discourage its use. By the end of June, 6 schools The campaign started on 15th March 2009 with a from the community declared itself as “Polythene rally. The procession with almost 150 participants Free Zone”. rallied through Manbhawan, Jawalakhel, Pulchowk and Kupondole. Almost 80 students from two Rally: A rally was organized on 28th March, 2009 on Schools and teachers participated in the rally. the final day of the campaign from Home Grocer, Similarly, representatives from Lalitpur Sub- Manbhawan. The procession with almost 250 metropolitan City Office, staffs RECPHEC and participants traveled through Jawalakhel and finally LUZZA Nepal, members of Women’s group, ended at Namaste Supermarket Pulchowk. Almost Volunteers, and representatives from supermarkets 140 students from four schools and teachers and stores participated in the rally. Clothe bags and participated in the rally. Similarly, representatives paper bags were distributed in the supermarkets from Lalitpur Sub-metropolitan City Office, staffs and stores. Similarly, leaflets on the campaign and RECPHEC and LUZZA, members of women’s group, information brochure on polythene bags were volunteers and representatives from supermarkets distributed to public. A public announcement was and stores participated in the rally. There was made on the negative aspects of the use of representation from other organizations such as polythene bags and request was made to carry bag ECCA, Explore Nepal, Centre for International from home to minimize the use of polythene bags. Migration and Development, National Business Initiative. A public announcement was made on the Coupon and Lucky Draw System at negative aspects of the use of polythene bags, and Supermarkets/Stores: A gift coupon system and pamphlets and leaflets were distributed. lucky draw system was incepted in 3 supermarkets and 25 departmental stores at Lalitpur Lucky Draw Program: As per the Sub metropolitan City to encourage lucky draw system incepted in the customers to bring bag from home. The supermarkets/stores to encourage customer who will bring his/her customers to bring own bag from shopping bag from home and won’t take home, which announces the winner polythene bag from the shop, he/she will once on the last day of the month, be provided with a gift coupon for saving the first program was conducted on polythene bag of the shop. Lucky draw April 13, 2009 Monday at 11 AM at

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Namaste Supermarket, Pulchowk. Customers Mr. is organizing documentary show at different schools, Santosh and Mr. Bhuwan Khadka were the winner colleges, and communities under its public of the luck draw. They were presented a Solar Lamp awareness program. that cost 1200/- sponsored by Shree Padma -Mangal Memorial Fund that costs 1200/- each. Similarly, Declaration of Polythene Free Zone at Central second, third, and forth lucky draw was conducted Zoo: The Central Zoo located at Jawalakhel, Patan at the end of the following months at Saleways which is the only zoo of the country declared it as a Supermarket, Gemini Supermarket, and Home “Polythene Free Zone” from 5th June, 2009. Grocer respectively. RECPHEC worked with the zoo by mobilizing 6 volunteers for monitoring and evaluation of the Media Campaign: A Public Service Announcement program for two months. RECPHEC also provided on the campaign was made in Nepal Television 100 cloth bags to Zoo. Ms. Anusuya Joshi from through “Hamro Kathmandu” program for 10 days RECPHEC handed over the bags to the zoo 20 spots. The television program exclusively covered representative. Ms. Sayaka Yaoya also participated entire activities of the campaign and telecasted in during the program at LSMC. The visitors who bring its news section. Similarly, 248 spots of social jingle the stuffs in plastic will be provided the bag with of 30 seconds were aired through Maitri F M 99.4. some deposit fee, which will be given back to them The campaign news was aired on Maitri FM News on the return of bag. at 8 AM frequently. Moreover, Sagarmatha FM dedicated two episodes of its program of 30 minutes At the same time, six schools out of 10 at Ward each on Environment and Health “Chittikka”. Mr. No. 20 declared itself as “Polythene Free Zone” as Shanta Lall Mulmi, Executive Director of RECPHEC, a part of “Towards ZERO Waste: model community” Ms. Anusuya Joshi, campaign coordinator of program. Mr. Chakra Mehar Bajracharya, Advisor of RECPHEC, Ms. Anju Subedi, volunteer of LUZZA LUZZA Nepal, handed over letter of appreciation to Nepal, and Mr. Rupak Bhattarai, Manager of all the schools on the occasion. Prior to this, Namaste Supermarket were interviewed during the RECPHEC has conducted awareness program in program. all the schools.

Participation in the Exhibition: Lalitpur Sub- Learning of the project metropolitan City Office in co-ordination with LUZZA Nepal, city volunteers and ECCA Nepal organized The project being the first of its kind in the country, an Exhibition on 5th June, 2009 at LSMC premises. many people are enthusiastic and are supporting RECPHEC also participated actively and the activities. The project has linked civil societies disseminated all its ongoing activities on “Promoting and government agencies, and has become a good Eco-cities in Nepal” program during the exhibition. example of public private partnership. People feel Posters and pamphlets on “Polythene Bags” and so convenient in using polythene bags, and therefore publications of RECPHEC were distributed. All the availability of similar kind of alternative bag is art from art competition was displayed at the same necessary to discourage the use of polythene bags venue. Almost 1500 visitors observed the exhibition. along with massive awareness program. People throw garbage without segregating it. To a sample Documentary Production and Show: RECPHEC population, dustbin was distributed for segregation has prepared 15 minutes’ documentary on the of waste, which encouraged them to practice waste “Campaign against the Use of Polythene Bag”. The segregation. The unstable political situation in the documentary was shown frequently during the country is an impediment for enforcing the programs exhibition organized at LSMC on the occasion of timely and more effectively. Similarly, lengthy World Environment Day for groups from schools, administrative procedure of the government colleges, and public by agencies, and lack of technical expertise has making arrangement of caused delay on some of the activities. Moreover, different show time for price hiking in the country has resulted in budgetary different groups. constrain, which has affected the purchase of noise Moreover, the meter, construction of bio-methanation plant, documentary was publication of advocacy materials and some telecasted from ABC awareness programs. channel TV on 8th & 9th June, 2009. RECPHEC

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COMPREHENSIVE HIV/AIDS PROGRAM FOR MIGRANT WORKERS

Nepal faces an increasing HIV prevalence among the most at risk populations such as migrant workers. and Lalitpur district which are major points to our The Majority of HIV cases, an estimated 46% have outreach clients, where the outreach workers create been registered among the seasonal and long-term demand for VCT and STI Services. labor migrants, who further put their spouses at risk BCC : 19,500 persons of HIV infection. Most of the people go aboard for Condom Distribution : 97,500 condoms labor and return home with HIV from foreign STI Diagnosis and Treatment : 1550 persons countries. It is compulsory to test HIV during pre- VCT : 4000 persons departure and after arrival of every person in the Pre-departure : 2451 persons country. Taking into account, RECPHEC is working for migrant workers under the Comprehensive HIV/ AIDS Program in Kathmandu district. Our main approaches are through outreach clients who come to manpower agencies to go abroad for Under this program, prevention efforts and good earning. The major approach of the project to community outreach, through outreach education reach the clients is through manpower agencies. and interpersonal communication is completed to The other is VCT/STI services by static and mobile reduce the HIV stigma and lower the barriers to staffs. A VCT center run under RECPHEC provides accessing HIV/AIDS treatment and counseling services for VCT/STI services. Since the migrant services. The program aims to reduce the percentage workers have limited time of stay in Kathmandu of HIV among labor migrants by strengthening before going, most of the VCT/STI services have to testing and counseling services. The program be done through mobile clinics. Therefore, static as expects to reach people living with HIV and AIDS well as mobile clinics were run under this project. (PLHA) with anti-retroviral treatment (ART) and Migrant workers and their spouses throughout the opportunistic infection (OI) drugs and services. Nepal are the target people of the project. The following BCC, Condom Distribution, STI Diagnosis, The goal of this program is to reduce HIV and Treatment, VCT and Pre Departure Orientation transmission in Nepal and enhance the quality of targets were fulfilled in this comprehensive HIV/AIDS life of PLHA in the country, focusing on the west, program. mid-west, and far-west development regions of Nepal. The main objectives are to promote the BCC Outreach adoption of safe behaviors among the most at risk populations, especially labor migrants and their Since man power agencies spouses through increased access and availability are the most important of prevention programs and to expand access and spots for the team members coverage of quality HIV testing and counseling and to reach the clients i.e. the STI diagnosis and treatment. migrant workers. For this mapping Though the project was implemented was done, in Kathmandu district, all the labor according to the responsibility of migrants of Nepal departing abroad each outreach workers and through Kathmandu valley via air are existence of man power agencies the key target groups of this project. in various parts of Kathmandu and Manpower agencies, training Lalitpur city. institutions and health clinics are the point to reach target population. 12 outreach workers and 2 These institutions lie in Kathmandu information and counseling

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facilitators for the BCC services were recruited for education, outreach and personal communication. All these outreach workers were mobilized at different manpower agencies, authorized health clinics and training centers where labor migrants widen their knowledge and skill required when they go aboard. BCC program covers Kathmandu Municipality and some nearby VDC BCC according to Age and Sex Series1 (inside the ring 12000 10873 road and some 10000 8571 orientation related to their health and job, the 8000 VDCs). A total of 6000 manpower agencies does not provide complete 4000 2411 information on HIV/AIDS/STI, consequences of 23,841 clients # of outreach 1027 685 2000 11 162 12 80 were outreached. 0 unsafe sex practice. An Outreach worker fulfills this FMFMFMFMFM type of gap and gives them enough information Age and Sex <14 15-24 25-34 35-44 45> The age and sex about STI, HIV/AIDS and its consequences in their wise clients outreached, shows that most of the job. RECPHEC facilitated 2451 such pre-departure migrant people’s are from young people from 25-34 orientation classes. age group. Females from 15-24 age groups go abroad more than other age groups. 15th National Condom Day

Orientation & Sensitization to community leaders RECPHEC celebrated 15th National Condom Day on 10th October 2009. It distributed 25244 condoms An interactive workshop entitled ‘Reduction of HIV/ and 1205 IEC AIDS Risk and Safe Migration was conducted on materials at 24th June 2009 in Kathmandu. A total of 53 Basantapur by participants from manpower agencies, polyclinic/ mobilizing 10 health centers, training centers, pre-departure outreachPredeparture workers according and to orientation centers, manpower’s association, District gender 4 local volunteers.F A Public Health Department, Department of Foreign 6% rally went through the Employment, Family Planning Association of Nepal M Kathmandu city on F participated in this workshop . A Paper was presented the occasion of by Aparna Bhatta, health person who recently done national condom day. M25,244 condoms were a research in HIV/AIDS in different districts of far- 94% distributed on the occasion of 15th National Condom western region of Nepal. This program was focused Day, 2009. mainly on ongoing issue of HIV/AIDS and safe labor migration. IEC materials/condom distribution The main outcome of this workshop was: information RECPHEC distributed 41,928 IEC materials to the should deliver from national level media like Radio clients regarding information related to HIV/AIDS, Nepal which covers most part of Nepal, compulsory STI, and VCT. The IEC materials were collected from policy of medical check-up should be developed for Family Planning Association of Nepal, District Public returning people. Ministry of the health should take Health Office, and National Center for AIDS STI leading role to develop the policy for safe migration Control (NCASC) and other Non Government and prevent illegitimate labor migrants. Organizations. Pre-departure Orientation Condom distribution is a part of BCC for this condom were distributed during outreach activities. A total Government of Nepal has made strict rules for labor of 121,814 condoms were distributed to the clients migrant to take basic orientation class of 2-days on during outreach services and few during the different issues before departing abroad which is celebration of National Condom Day and 25,244 compulsory to get permission by Nepalese condoms were distributed on the occasion of 15th government for every labor migrant. Though pre- National Condom Day, 2009. departure orientation centre takes 2 days for basic

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World AIDS DAY -2009 STI among the labor migrant, because most of them were male and adolescent and unmarried. Usually RECPHEC celebrated World AIDS DAY 2009 by STI cases are seen in female. Since the number of participating in national level rally program. Rally female migrants was very few in number, we assume went around from Tripureshwor Thasarath Rangasala that we were unable to reach the agreed target. - Newroad - Asan - Indra Chowk - Ratna Hoarding Board installment Park - Khulla Manch with all project staff. A hoarding board was installed in Thankot near to All the outreach Nagdhugga hoping that travelers who enter the staffs participated in Kathamandu Valley this rally. RECPHEC through Thankot can also display HIV/ read easily the message AIDS related for the labor migrant for materials on the occasion of World AIDS Day. safe foreign employment and VCT STI/VCT & ICC Center centre. This board is specially focused for 2 ICC centers have been established and in operation those labor migrants since then. One is attached with STI/VCT service who are going or preparing to go aboard for labor in centre in Narayangopal Chowk and another is near future. operated by partner organization, Youth Power Nepal in Anamnagar Kathmandu. Learning

Through the VCT center, a total of 5211 clients were • DPHO and other organizations are also the reached, which is 130.28%. A total of five HIV sources of IEC Materials and Condoms. positive clients where recorded among the tested. • Mobile VCT and STI Services are appropriate Clients were referred at VCT centre by outreach for Oversees Migrant Workers. workers and local stakeholders working in the same • Clients can be reached in Skill Training Centers, field. Mobile VCT was also conducted in different Pre Departure Orientation C lasses and manpower, health clinic, and training centre for easy Authorized Health Clinics. access of the VCT services. • One to one outreach is necessary for quality outreach. The above figure shows that highest number of HIV test was found in between 15-49 age groups. Only Issues and Concerns a person less than 14 year was tested similarly 50 and above group 22 persons were tested. It indicates • Limited spaces to outreach clients at Man that people from 15-49 mostly go aboard for labor Power Agencies than those from other age group. All tests were done • Ensuring quality services with limited time of according to national HIV test protocol. Positive clients clients were referred to related service providing • Contradiction of our VCT services in the health centers for further treatment and care. clinics with VCT guideline • Timely availability of IEC materials, condoms This center has provided a service for targeted labor and kits/drugs in principle recipient migrant people for diagnosis and treatment service • Reaching STI Target of sexually transmitted infection. Some labor migrant • Follow up of first year’s clients would be a difficult people visited the STI/VCT service centre at their task own initiative. In course of providing services, it was found that most of the people didn’t have time to visit VCT centre. Therefore, staffs were encouraged to operate mobile clinics to meet the requirements of the clients to operate clinics in the training centers or where they were outreached. It found insignificant

17 Annual Report 2009

SOLIDARITY WITH GLOBAL TOBACCO CONTROL CAMPAIGN

Nepal signed the FCTC treaty on 3rd December In order to bring comprehensive tobacco control law 2003. Finally, Nepalese government ratified FCTC and its effective implementation continued lobby and on 7th November 2006 after continuous pressure pressure the concerned authorities by civil societies from various NGOs and civil societies. After are still very much important tasks and challenges. ratification of FCTC, the government drafted Tobacco RECPHEC has been taking a key initiative in Control Law in collaboration with RECPHEC. developing anti-tobacco network at the central and district levels advocating on a variety of health issues As it is expedient to maintain the health, decency, and anti-tobacco campaign. behavior, convenience, and economic interest of the public in general and to regulate and prohibit the RECPHEC is continuously pressurizing the manufacture, use sale and distribution of tobacco government for the enactment of Tobacco Control products as well as to fulfill the international Law with collective action of media group and obligation as a state party to the Framework strength of its 48 Health Rights and Tobacco Control Convention on Tobacco Control. (HRTC) district network with more than 700 NGOs and community based groups. It has been able to And the commitment made by the government to develop working relation with government, strong and table much awaited Tobacco Control Law in this committed group of media was organized and summer session and the commitment made by all strengthened district networks. The level of public leading political parties to immediately pass the law awareness has been raised and GOs/NGOs and from the parliament, the much awaited Act for other institutions have already declared tobacco free Regulation and Prohibition of the Tobacco Products, zones. 2064 draft has been finally tabled at the Parliament Secretariat on 3rd January 2010. Central level

The proposed law clearly mentioned about An interaction program on World No Tobacco prohibition on the use of tobacco and smoking, non- smoking or tobacco free zone: public places An interaction program was organized on World No including hotel, restaurant, motels, institute, office, Tobacco Day 2009 with the theme of “Tobacco Health sports complex and any places of public gathering Warnings” by National Health Education Information will be smoke free, regulation on production or the and Communication Center (NHEICC), Ministry of use of tobacco products; label, trademark, wrapper Health and Population on 31st May 2009 at National and packing, submission of particulars, information Health Training Center, Teku, Kathmandu. of health warning, ban on advertisement and Representatives from Ministry of Health, NGOs and sponsorship, restriction on sale and distribution & media persons participated in this program. offence and punishment and also it has provision of progressive health tax in addition to regular revenue There was total of charge 2-paper presentation: first Now that the Act for Regulation and Prohibition of paper on Global the Tobacco Products has been tabled, it will be Health Warnings reviewed by the bill committee. To avoid any further by Mr. Shanta Lall delay and pass this act within limited time frame, Mulmi, Executive we all the tobacco control advocating organizations Director of must go ahead for a massive campaign to lobby RECPHEC and the second paper on Tobacco and and appeal the Members of Parliament to pass the Tobacco Health Warnings was presented by Dr. Tobacco Control Law as soon as possible for the Baburam Marashini, Senior Health Administer, health of the Nepalese people. Ministry of Health. Poster on Tobacco Health

18 Annual Report 2009

Warning, which was published by RECPHEC, was Lobbying with Health Committee of the distributed at this program. parliament Orientation to the Parliamentarians, media, civil RECPHEC published 2000 copies of poster on society and political parties National Level Conference involving civil society, Global Health Warning in association with National NGOs/INGOs, GOs, Donors and law Health Education Information and Communication enforcement agencies. Center (NHEICC), Ministry of Health and Population. Formation of inter-ministerial coordination and This poster was sent to 47 districts prior to organize implementation committee. to World No Tobacco Day 2009 at the district level. “Autonomous Tobacco Control Authority” under the Ministry of Health and Population ‘Regional Conference on the Guidelines of the Formation of by-laws and endorsement by the Articles 5.3, 8, 11 and 13 of the WHO Framework Council of Ministers. Convention on Tobacco Control (FCTC) Formation and mobilization of community based Watch Groups including child rights forums for sensitization and enforcement of Tobacco ‘Regional Conference on the Guidelines of the Control Law. Articles 5.3, 8, 11 and 13 of the WHO Framework Sensitization of Health Rights and Tobacco Convention on Tobacco Control (FCTC)’ was Control Network at 48 districts of Nepal and organized by Ministry of Health and Population other stakeholders at grassroots, district and Government on Nepal & Framework Convention national level. Alliance (FCA) and co-hosted by RECPHEC from Designing, developing and pre-testing of 15-17 December 2009 at Hotel Himalaya, Lalitpur. graphic warnings on tobacco products.

The main goal of this program is to engage both Mobilize Print & Electronic Media government and civil society representatives from the WHO-SEARO Region towards the effective Community FM Stations: Public Debate & implementation of these guidelines and provide a Awareness Campaign platform to discuss necessary changes in existing laws and regulations. Maitri FM 99.4 a community radio station broadcasted weekly half an hour program “Amulya Dr. Sudha Sharma and Dr. Praveen Mishra, Jeevan” from 2nd March 2009 for a period of six Secretaries, Ministry of Health and Population also months to make aware on the use of tobacco related took part products and to pressurize the government to pass on the and implement the tobacco control as soon as inauguration possible and to initiate public debate on different program. dimension of tobacco. Dr, Alexander The target population is all the listeners especially Andjapardze, the youths and people who are affected directly and WR, Who indirectly by tobacco. A special gift (RECPHEC Country Publications on tobacco and other health issues) Office Nepal, Ms. Shobha John, Regional Board was provided to one lucky winner among the Member, Framework Convention Alliance, Dr. Prakit telephone callers. Social Messages that is aired Vathesatogkit, Action on Smoking and Health through Maitri FM are as follows: Foundation Thailand, Dr. Olcott Guanasekera, Alcohol and Drug Information Centre Sri Lanka, Make public places, offices, public vehicles, public Ulysses Dorotheo, Regional Coordinator (ASEAN- buildings, and public program tobacco free. WPRO), Philippines also participated in this Sale of tobacco products is a social crime. program. Community FM Stations: Health Right & A total of 21 participants from the SEARO Region, Tobacco Control District Network (HRTC) Bangladesh, Bhutan, India, Indonesia, Maldives, a. Weekly Program Myanmar, Nepal & Sri Lanka participated in this regional conference. Nepal set the main priority to RECPHEC mobilized Health Rights & Tobacco pass the Tobacco Control Law from the Parliament Control District Network (HRTC) at 47 districts as soon as possible for this: to develop program and aired it through

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Community FM Stations every week at district Television Programs level to sensitize and educate district and “Swasthya Sarokar” a TV program was community level people for the tobacco broadcasted on ABC television on 2nd March 2009. campaign. A program on Tobacco Control Act was aired on ABC television on April 2009 Every week a half an hour program on tobacco Swasthya Sarokar (Health Show), ABC Television issues plus radio jingle (short catchy phrases was telecasted on 11th & 12th April 2009 on tobacco) was developed by RECPHEC and Hamro swasthya (Our Life) program with special is broadcasted through community FM station focus on Tobacco Control Law was telecasted 3rd to create awareness to the local people of the June 2009. in each districts. Video program on the use of tobacco was telecasted on June 2009. Nepal Television telecasted TV Debate Program b. Radio Jingle under Public Service Jana Sarokar, a public concern program was aired Announcement (PSA) through National Radio Station; Radio Nepal was Nepali language is called the national language aired on 7th June 2009. of Nepal. The indigenous speak in their native “Swasthaya Sarokar” ABC Television on 13th languages among themselves and within the September 2009 area where there live. Hence, many districts “Health is Wealth” I, II ABC Television on 24th have redeveloped the jingles on their local September 2009. languages; so that the information flow through Sensitize and pressurize policy makers FM reaches to the mass with much clarity. A National Consultation: Sharing of District Outdoor Public Hearing & Debate Initiatives An outdoor public hearing (Sarwajanik Sunuwai) A National Consultation with the representation of program was organized by RECPHEC in 47 district network of Health Rights and Tobacco association with Child Workers in Nepal (CWIN) at Control was organized on 27th April 2009 at Yak Open Theater, Tudhikhel, Kathmandu on 4th June Place, Lalitpur. The main objective of the 2009. Dr. Dirgha Singh Bam, Health Secretary consultation was to discuss about the Tobacco Ministry of health & Population, Mr. Shanta Lall Control Law, which is not yet passed by the Mulmi, Executive Director RECPHEC and Mr. Jyoti Baniya, Consumer Protection Forum Nepal responded to the queries of the audience. Hundreds of people including students were present in this public hearing program.

Health Secretary committed to the public to make necessary arrangement to table the bill in the parliament within a week if the Parliament process will not be disturbed by the opposition party. People parliament, tobacco smoking and health and other questioned about the delay of Tobacco Control Law issues of tobacco. Implementation. Mr. Dinesh Sharma, one of the leading Satellite TV channel “Kantipur Television” conducted the program. This program was aired on There were a total of five paper presentations: 5th June 2009 from 9-10pm. Tobacco Smoking & Health by Dr. Rajendra Baral, Consultant Clinical Oncologist & Medical Director Bhaktapur Cancer Hospital; Mr.Hom Lal Shrestha, Non-Smokers Rights, Mr. Babu Kaji Baniya, Under Secretary, Ministry of Health; Tobacco Health Warnings, Ms. Reetu Pradhan, Program Officer RECPHEC and Tobacco Control & Children, Ms. Sumnima Tuladhar, Program Coordinator, Child Workers in Nepal (CWIN).

20 Annual Report 2009

A total of 95 participants from Ministry of Health, 1. Effect of smoking on beauty of women, Annapurna Post, Daily Newspaper, Nepali Tobacco Advocating organizations, HRTC district 2. Draft of the Tobacco Control Law is nowhere, Raising network, National Pressure Group against Tobacco, Nepal, English 3. Act must to passed TCL in Nepal, monthly health Doctors, NGO and Media Persons participated in magazine, Nepal ko Swasthya, Nepali this consultation program. 4. Smoking & human health, monthly youth magazine, Yuvamunch, Nepali 5. Smoking a slow poison, monthly youth magazine, Establish & strengthen network with media Yuvamunch, Nepali organizations. 6. Uncomplicated but complicated problem, Gorkhapatra, Nepali 7. Tobacco Control Law and its Implementation, Annapura Media Sensitization on Tobacco Control Post, Nepali 8. Second hand smoking: cancer threat those who don’t RECPHEC organized “Media Sensitization Training smoke, Nepali on Tobacco Control Law” in association with Society of Health Concern Journalist (SOHCOJ/Nepal) from Workshop on Role of Media in Tobacco Control 1st-2nd April 2009 with the journalists associated Nepal ratified FCTC and Ministry of Health and with various national media in Kathmandu to Population in support of civil society has already sensitize the journalists on tobacco issues and for drafted and presented the “Tobacco Control and their active role in pressurizing the government for Regulation Act” before the Council of Ministers the endorsement of Tobacco Control Act in Nepal. A (Cabinet) for parliamentary debate and endorsement. total of 31 journalists representing from different print However, Nepalese media, which has been very & electronic media participated in this media much effective to advocate on the public issues of sensitization training program. importance, is not found active to raise about Tobacco Control. It has not only deprived Nepalese There were a total of four presentations on this 2- people of adequate information about the day sensitization program: A paper on Framework consequences of tobacco use, but also did not Convention on Tobacco Control improve the policy maker’s and (FCTC) by Mr. Babu Kaji parliamentarian’s sensitivity Baniya, Under Secretary Law towards the need of Tobacco and Ministry of Health. Second Control law in Nepal. paper was on Role of Media on Tobacco Control Law, by Considering this, RECPHEC Senior Journalist, Mr. Shiva organized a one-day interaction Gaule. Third paper on program on “Role of Media on Implementation of Free Health Tobacco Control” on 26th February Services of Government by Mr. 2009 with the journalists associated with various national media in Toya Dahal, Health Journalist & General Secretary Kathmandu to sensitize journalists and media for of SOHCOJ/Nepal and the final paper on Smoking their active role in delivering messages for & its Impact on Health were presented by Mr. pressurizing the government for the endorsement Shanta Lall Mulmi, Executive Director, RECPHEC. of Tobacco Control Act in Nepal. A total of 40 There was an extensive discussion on each paper journalists and media person participated in this presentation. The interaction not only helped in program. On this program Mr. Shanta Lall Mulmi, identifying the probable areas of interventions by the Executive Director, RECPHEC presented a paper concerned stakeholders but also helped in forging on The Role of Media in Tobacco Control and Mr. effective strategy for the subsequent plan of action Shiva Gaule, Senior Journalist and Ex-Vice in days to come. President of Nepal Journalist Association presented a paper on Media Role for the reduction of tobacco. Fellowship to Journalists All the participants gave their individual commitment Fellowship provided to one, English and a Nepali in the last session of this workshop to work for this Newspaper for investigative journalism on the case tobacco control campaign. study, total revenue collection on tobacco issue and Tobacco Control Law. Feature articles have been Legal Consultative Meeting published on different new daily’s on tobacco issues. RECPHEC organized “Inter-ministerial Legal Almost all the news daily and health magazines Officers Consultation for the adoption of the FCTC have published feature articles. 21 Annual Report 2009

and Tobacco Control Law” on 17th July 2009 at professional expertise in further strengthening RECPHEC office, Bagbazar to brief about the FCTC advocacy campaign. and Tobacco Control Law and its obligation of concerned Ministries and to build a strong pressure The main objective of this national consultation is to introduce and implement the Tobacco Control and to review the present status of much awaited Regulating Act, 2063. “Tobacco Control and Regulation Act” and pressure the government to table the Act in the CA, to have Nine legal officers political commitment of political leaders and key from the different decision makers and to involve former bureaucrats ministries such as the by using the professional expertise and Ministry of Information experiences. Former health ministers, health & Communication, secretaries including anti-tobacco advocates with Ministry of Industries, media representatives participated in this national Ministry of Law & Justice, Ministry of Agriculture & consultation. A total of 63 participants participated Commerce and representatives from National in this consultative meeting. Planning Commission and Parliament Secretaries and RECPHEC staffs participated in this program. A total of three presentations: “Tobacco and Non- Communicable diseases” by Dr. Ram Prasad There was a general discussion on the health and Shrestha, Health Horizon Nepal; “Status of FCTC use of tobacco as well as Ministries obligation and and Regulatory Law in Nepal” by Mr. Babukaji various other aspects of tobacco control. Legal Baniya, Under Secretary, Ministry of Health & Officers from the concerned Ministries and others Population and “Anti-tobacco Campaign: Some said this meeting has contributed more information Lesson Learnt” by Ms. Reetu Pradhan, RECPHEC. about FCTC and their obligations. They expressed More emphasis was given to explore the expertise their eagerness to assist from their side to pass of Political Leaders and former bureaucrats. and implement tobacco control law. Lastly “Declaration of commitment” was released As an advocacy of our tobacco campaign to pass as an outcome of the meeting. After the open the Tobacco Control Law as soon as possible an session “Adoption of Declaration” a joint appeal to adhoc working group of these legal officers from the government was released. various ministries were formed to review whenever need arises. They have expressed their keenness Joint Appeal to the Government to pass and implement tobacco control law in the Since 4000 years people have been consuming tobacco Inter-ministerial legal officer’s consultation at and tobacco products. Nicotine content in cigarette makes RECPHEC. Legal officers from each ministry from the smokers addictive to tobacco which makes them unable the working group have committed to review the to quit smoking. In 16th century it was disclosed to the world policy of the concerned ministries on tobacco control that consumption of tobacco causes deadly diseases. Later World Health Organization (WHO) confirmed that tobacco policy and advocate for making necessary changes smoking is hazardous to human health and it has proved which contradicts to the tobacco control and that tobacco is one of the main elements causing cancer, regulation law. heart problem, lung cancer and many other diseases. With all this, WHO assumes, every year 50 million people are killed due to tobacco consumption. Tobacco Control in Nepal: Some Challenges For this, World Health Assembly adopted this legally binding international treaty, Framework Convention on Tobacco RECPHEC in association with Health Horizons Control (FCTC) on 21st May 2003. It provides basic tools Nepal organized Consultative Meeting on “Tobacco for the member countries to enact comprehensive tobacco Control In Nepal: control legislation. So far a total of 164 countries have ratified Some FCTC and 154 countries of the world have implemented tobacco control law as per FCTC provision. Nepal signed Challenges” on this treaty on 3rd December 2003 and finally ratified on 7th 7th June 2009 at November 2006. Nevertheless, Nepal hasn’t still passed Hotel Himalaya, and implemented the Tobacco Control Law. Lalitpur with We appeal the government with all the former Health former Health Ministers and Health Secretaries who have worked in Ministers and responsible post in the Ministry of Health for the health problems of Nepal and its people to pass and implement Health Tobacco Control Law as soon as possible for the health of Secretaries to share their experiences and to the Nepalese citizen.

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Tobacco Control Campaign in Absence of Review Progress under the TFK grant Nepal R11-01 Tobacco Control Law RECPHEC had a meeting with Ms. Anuradha In Nepal, smoking prevalence is very high and the Khanal, Program Officer, International Grants, percentage of female smokers is even higher. More Campaign for Tobacco Free Kids from 4th to 5th than 75% of its populations are into excessive January 11, 2010 to review progress under the TFK smoking. The reduction of the tobacco consumption grant Nepal R11-01 and discuss work plan for the and the use of such harmful elements in the society next 6 months. Mr. Shanta Lall Mulmi presented a are not easy tasks. Tobacco cannot only controlled paper on RECPHEC Initiative in 2009, Ms. Reetu by enactment and implementation of Tobacco Pradhan, Program Officer, International Grant Control Law. Project; TFK presented a paper on Activities work Anti-tobacco campaign activities should be done plan, International Grant, TFK. Mr. Bal Sagar Giri, aiming at raising public awareness on impact of Under Secretary (Law), Ministry of Health and tobacco use and advocating for a tobacco control Population explained about the Parliamentary by state laws and regulations. Strong and effective process for tobacco control legislation of Nepal. advocacy groups and the people at district and Also discuss about the existing and possible future regional level help public pressure at grassroots level collaboration with MOHP, other NGOS working in and helps control tobacco use. In order to make the tobacco control. people aware on the harmful effect of tobacco and also to create public pressure people are initiating HRTC Field Visit Program different programs in this anti-tobacco campaign. Mr. Shanta Lall Mulmi, Executive Director and Ms. Considering this 47 Health Rights & Tobacco Control Reetu Pradhan, Program Officer, International Grant, (HRTC) district network organized a thematic TFK went for field visit program of Chitwan, workshop on “Tobacco Control Campaign in the Nawalparasi, Rupendehi, Kapilvastu, Syangja, Absence of Tobacco Control Law”. Kaski, Tanahun, Campaign on “Second hand smoking” Lamjung and Gorkha Health Campaign to make tobacco free vehicle was Rights and organized from 22nd- 27th November 2009 to Tobacco address the effect of second hand smoking & make Control tobacco free vehicles. Almost 100 volunteers were (HRTC) district placed at 8 different hubs of the; Ratnapark, network of Nepal to review all the activities which Sundhara, Jamal, Bagbazaar, Singhadurbar, New are going on at the district level and about the future Baneshwor, Koteshwor, and Lagankhel. planning of HRTC district networks.

These volunteers distributed and pasted almost Publication of Advocacy Materials 6,000 stickers on different vehicles such as microbus, minibus, taxi, car, tempo, and motorcycle. Advocacy is the key strength of RECPHEC in terms Traffic police also supported to convince the vehicle of health issues and has been the basis for most of drivers to paste sticker in their vehicle. Moreover, the work that we do. Through the immense response 20 volunteers in 4 groups were mobilized at parking of the advocacy materials developed by RECPHEC lots in New Road, Khichapokhari, Maha Baudha, from the anti-tobacco activists from the HRTC district Bhotahiti, Jamal, King’s Way, Lagankhel area to network, it has developed two new posters and a distribute stickers and leaflets. sticker in Nepali Language. These developed materials were also sent to 47 HRTC district network On the last day a rally was organized to promote of Nepal for district network groups including tobacco free vehicles. Stickers were also distributed Ministry of Health and Population, WHO Country in this rally. For the Campaign to make tobacco Office, NGO Anti-tobacco advocating organization, free vehicle RECPHEC printed a sticker on tobacco and media. free vehicle.

23 Annual Report 2009

COLLECTIVE EFFORTS OF COMMUNITY EMPOWERMENT

RECPHEC has been making concerted efforts in Outreach program has lead to increase in the literacy addressing health issues through empowering the rate of target project area, encourage women to rural people. For this, it has been mobilizing rural participate in collective saving and empower women women to assert their rights by empowering them to utilize the credit facility with low interest available and by building capacity to uplift their economic through saving groups, aware rural community for status by implementing various programs in different better health behavior and sanitation, providing better communities. The outreach program implemented reproductive health service through CHFs and at the community level, has contributed in the areas encourage them to refer the patients to the nearest of: 1. NFE classes (Non-formal Education) 2. Saving health post, enable target group to generate income and credit group formation 3. Toilet support 4. through skill trainings, strengthen public health Drinking water support 5. Skill training program 6. posts and its service delivery mechanism at Community Health Facilitators (CHF), training/ community level, and mobilize local NGOs and mobilization 7. Awareness campaigns. CBOs in conducting health related campaigns.

Accomplished activities from January to June In the project areas, people live in rural areas and 2009 depend on subsistence farming for their livelihoods. Household food security and poor nutrition are still The entry to outreach programs at community level major concerns. Most households have little or no is Non-Formal Education (NFE) classes followed access to basic social services such as primary by saving and credit groups (women’s groups) which health care, education, clean drinking water and are implemented effectively followed by support to sanitation services. They is high rates of illiteracy community development programs. The approach and are also concentrated in specific ethnic, caste to start outreach program with NFE classes helps and minority groups, particularly those of the lowest mobilize the target beneficiary to involve them in caste (dalits) and indigenous peoples (janajatis). The follow up activities for their empowerment and most vulnerable and marginalized groups are the continuation of saving and credit group. lowest social castes, indigenous peoples differently disabled people and women. RECPHEC has formed local level committee at the Focusing this, RECPHEC is working in such community level in the 8 working areas of Udayapur selected VDCs of Udayapur, Saptari and Gorkha. It and Saptari districts with the slogan “local is working in 4 VDCs of Udayapur District: Basaha, participation to develop our village”. A meeting was Chaudandi, Sundarpur & Beltar and 4VDCs of organized at the VDC level with those people who Saptari District: Fattepur, Odhara, Kamalpur & were involved in the community development Ghoganpur and 8 VDCs of Gorkha District: Bakrang, program at the community level. From this meeting Taklung, Bungkot, Finam, Ghirung, Taplae, a committee was formed in each VDCs which will Aarupokhari & Pandrung. work for the upliftment of the area on their own with the support of RECPHEC. With the support from It is involving the community people in different skill RECPHEC different programs have been organized development programs to enhance their income at the VDC level. In Ghoganpur and Kamalpur VDCs generating activities. Gender-based training, group HIV/AIDS awareness program, public hearing formation and organizational capacity building program, dress designing and stitching program and training have also contributed in mobilizing them. It saving group mobilization programs is going on with is committed to help the poor and the marginalized the initiation of these committees. to liberate them from high interest loan from the local landlords. It also advocates the women and deprived Non-formal Education (NFE) communities to get organized in order to assert their rights and to render local public and private services The non-formal education program (NFE) is structures people oriented. continuing in order to build critical awareness among

24 Annual Report 2009

women with literacy skill of the project area. These at Udayapur and Saptari District. Total of OSP classes are initiated to provide these women with children enrolled in school are as follows further knowledge on health, skills and current issues of the community. They are also given relevant NFE Centers Class: 1 Class: 2 Class: 3 Class: 4 Total Ghoganpur 6 33 38 29 106 knowledge on HIV/AIDS in order to reduce the risk Kamalpur 54 38 41 1 134 of HIV/AIDS among people. This year 425 (of which Basaha 13 26 28 11 78 Chaudandi - 2 21 39 62 75 are dalit) NFE participants graduated from Total 73 99 128 80 380 Udayapur and Saptari Districts in an evaluation made on NFE program. NFE program at one center is Children education, a six months program was also running at Aroupokhari VDC Gorkha. started in ward no. 9, Aroupokhari VDC Gorkha in two centers by Swasthya Sudhar Samuha in Practical literacy program is a good start, which association with Santoshi Mahila Samuha. This has revealed its dynamism with practical extension program is especially focused to those children in a post literacy class. Post literacy classes have between 6-10 years, who are unable to go to school been organized three days a week. The classes since schools are located very far from this ward. include some of the desiring and competent Total of 41 children of this area have joined this class. participants who previously completed NFE program. They are encouraged to save and mobilize Maternal and child health services through their funds within the group. It has become a forum Health Facilitators for discussion on different social issues as well. Wide ranges of activities related to socio-economic The main focus of this program is the improvement issues take place: saving and credit, kitchen of service delivery for gardening, animal husbandry, fruit sapling distribution, family toilet, women, empowerment drinking water, video shows, health and capacity building education, legal awareness, gender of rural women. The awareness, safe motherhood and family service delivery related planning are some of the major activities include activities to empower the communities training to Community to further their own development. Out Health Facilitator of the total 425 NFE participants 377 (CHF) for maternal of them participated in the post literacy health, awareness on classes. Uterus Vaginal Prolapse (UVP), educational exposure visit to CHFs, and practical training on Out of School Program (OSP) UVP. RECPHEC not only empowers and enhances public awareness by community initiatives in Majority of the children in the project area leave improving health of its people but also assists and school after some years because of their socio- strengthens sub-health posts in the project areas. economic condition. RECPHEC has trained Traditional Birth Attendants Focusing these (Sudenis) and using them to improve the reproductive children the Out health of the people. Although the government has of School (OSP) decided free institutionalized maternity services plus on basic monitory incentives majority of births at homes are education is assisted by sudenis, which are easily available, and implemented accepted by the community. These sudenis can mainly in the therefore, become a link between the homes and project areas of the health facilities. Their roles in the communities Udayapur and will remain significant till alternative maternity Saptari targeting the marginalized communities to services with trained health professionals will be prepare them for formal schooling. After the operational. completion of OSP program, children from the age group between 8-14 years are enrolled in school. RECPHEC has been providing trainings to these This year total of 380 children’s are enrolled in school TBAs since last 11 years and using them to improve

25 Annual Report 2009

reproductive health. The trained TBAs are working because of weakening of uterine supports induced also as village level health facilitators in preventive by early child bearing, multiple child births, lack of health education programs. They are also working spacing between births, unskilled supervision of to create awareness on other issues as uterus deliveries. Further strain on the weakened supports prolapse, HIV/AIDS and tobacco related problems is imposed by prolonged hours of working in the and their prevention. There are 97 active traditional fields in a squatting position that result in increase birth attendants working in Udayapur and Saptari intra-abdominal pressure. provided maternal delivery service to 355 patients In Nepal many women are suffering from various and 37 TBAs in Gorkha districts. gynecological problems. They don’t seek any treatment unless and until the problem gets The Traditional Birth Attendants (TBAs) known as complicated and hamper the daily activities of the “Community Health Facilitator” of RECPHEC rather women. One of the most prevalent morbidity than “Sudeni” (birth attendants) has changed their problems is Utero-vaginal Prolapse (UVP). In social status and has encouraged them to work at the outreach program areas, the sufferers of UVP are community. Every month these TBAs sit for a meeting high. Considering this RECPHEC has been initiating where they share their experiences, learn new things different camps and counseling for the Utero-vaginal on reproductive health, maternal health etc. Prolapse sufferers. A survey was done in Ghoganpur and Kamalpur VDCs of Saptari district to see the number of 5 Health Camp especially focusing the Utero-vaginal pregnant women’s in the area. In Ghoganpur a total Prolapse cases was organized in Udayapur and of 65 houses and 77 houses in Kamalpur VDC were Saptari districts. In these health camp a total of marked with flags to indicate the pregnant women’s 133 UVP cases were counseled and primary care house. Especial health education program was was provided to them. Likewise a training and organized for the pregnant women of these areas. counseling program and primary care for the UVP After the marking of the houses, pregnant women sufferers were organized in Aroupokhari Gorkha. In are easily getting free iron tablets, TT vaccination Gorkha 34 participants participated in the training and of course the good diet and love from the family. program and a total of 550 UVP sufferers were provided with primary care and counseling. Women’s reproductive health Healthy environment A 2-day training program on women’s reproductive health was organized in Fattepur. The main objective The sanitation and environment of the project area of the training program is to give information on is very fragile and inadequate for the local women’s reproductive health, community. There is a need for toilets, women’s reproductive health drainage facilities, water supply and problems and prevention, health smoke-free kitchen for the community checkup and curative processes. sanitation for healthy environment. For After the training program a health this drinking RECPHEC has been camp was also organized where motivating the villagers for safe 61 women with reproductive health drinking water facilities, family toilets problems were provided with free and smokeless stoves. health checkup, treated and counseled free medicines were also provided. Drinking water facilities have strong impacts to ease domestic work burdens of women and girls and to Utero-vaginal Prolapse improve health status of the community. One of the targets of outreach activities is to improve the drinking water systems. Local people are motivated The incidence of to get clean drinking water. Maintenance of a tube Utero-vaginal well has benefited 25 households in Ghoganpur VDC Prolapse (UVP) is of Saptari District. This year maintenance of 5 high in young drinking water system was completed Aroupokhari women in the rural and Asrang VDC in Gorkha. A total of 121 household population of have benefited from the maintenance of these developing drinking water systems. countries, possibly

26 Annual Report 2009

RECPHEC is putting its best effort to motivate all Public hearing program villagers to construct toilets. The local people have developed better sanitation habits and thus their Government of Nepal health is improving. Many families are benefited by declared a free this and are helping essential health to better the health services policy in situation and 2007 with the aim of productive capacity bringing basic health of people. This year services to be a total of 200 family delivered through all health and sub- toilets were health posts (SHP) within the reach of particularly constructed in the poor and excluded groups. The Interim Udayapur and Constitution 2007 has guaranteed Nepalese Saptari districts. With the local participation, the citizens’ right to basic health services as use of local resources and with the awareness fundamental rights. In line with the constitutional campaign with the slogan “Keep the toilet clean and provision, the Three-Year Interim Plan has strongly stay away from all the diseases”. emphasized citizens’ fundamental right to improved health service through access to quality health. Different awareness activities such as hoarding placed, posters Despite the policy, access to health distributed, street facilities remains a key issue of concern drama, rally and particularly among the most marginalized interaction programs groups. Unavailability of adequate human were organized in resources and necessary drugs are some Asrang and Aroupokhari of the key obstacles. Field level VDCs to create implementers are not fully aware of the awareness among the scope, limitation and implementation local community on priorities of FHS. health and sanitation Considering this RECPHEC organized a public and to construct toilets to stay healthy. Altogether hearing programs on the 100 family “People’s access to free toilets in health services” to create Asrang, awareness on free health Aroupokhari program in Odhara, and Bungkot Ghoganpur, Fattepur and VDCs of Kamapur VDCs with the Gorkha and participation of the village weredevelopment committee members, political parties, constructed NGOs, TBAs and the community people. A total of with the 381 people participated in these public hearing initiation of the community people. programs.

Installations of improved smokeless stoves are Citizen Charter promoted by RECPHEC in order to reduce pressure on forest and fuel wood with active participation of RECPHEC placed citizen charter on free health local community. This will improve environment as services and its process provided by the sub-health well as health of people. This initiative on smokeless posts at 7 sub-health posts in outreach program stove has certainly reduced the time for collecting areas of Udayapur and Saptari district to aware fuel wood, reduced the health problems of the women the general public on free health service program. who are the main users and has definitely improved households’ indoor environment. 95 smokeless After the free health service program, the sub-health stoves were constructed at Aroupokhari, Asrnag, post people are not able to provide the health Bungkot VDCs of Gorkha. checkup sheet to the patients because of inadequate quantity supplied by 27 Annual Report 2009

the government. Considering this, RECPHEC also economic activities that are effective in absorbing printer 30 thousand health checkup sheets of which the female workforce in these communities. This 4-5thousand copies are provided to each sub-health program is mainly run in the project area to involve posts. the community women’s in different skill development programs to enhance their capacity and income to Liberation from Loan: Saving & Credit facility uplift their economic In Udayapur, Saptari and Gorkha districts many status. women’s groups have now developed saving funds. Considering this There are altogether 41 active saving groups in RECPHEC has Udayapur and Saptari Districts and 35 in Gorkha initiated dress District that are involved in different activities of design and RECPHEC. They are collecting and operating their stitching fund by providing loan within group members for training, candle different income generation activities, in community making, pickle development activities and in solving financial related making, kitchen gardening, fruit sapling distribution, personal problems. This process has minimized the animal husbandry programs in outreach program burden of loan from moneylenders with high interest. areas. Besides saving, discussion forum on different issue such as health, animal husbandry, agriculture and This six-month dress design and stitching training management of natural resources was organized in was completed in Basaha VDC with 18 students every meeting of the saving groups. with more learning’s to accomplish something on their own. The saving groups, who are also the part Women’s of the post literacy classes and from local NGOs, awareness participated in this dress design and stitching campaign was classes in Barkhe Danda, Basaha VDC. Local organized in management committee is formed to run this Arupokhari with program effectively. Likewise a 3-months dress capacity design and stitching training was completed in development Aroupokhari and Bungkot VDCs of Gorkha also. program & leadership Community newsletter: “Kosheli” development program and women’s health programs. 91 Representatives from 9 saving groups participated Realizing the right to information to the community in these women’s awareness programs. Likewise people RECPHEC is saving group formation and management, gender regularly publishing training and free health education programs were “Kosheli” from Saptari also organized in Bungkot VDC of Gorkha. A total Field Office. It informs of 106 men and women’s participated in these about the field programs to programs. create awareness among the rural communities on Swathya Sudhar Samuha in association with health issues in simple Srijanshil Mahila Samuha (a women’s group) with language. The bulletin the help of the local community, GOs/NGOs covers the accomplished constructed a community building in Aroupokhari- planned activities of 7. This community building will be used by the local RECPHEC’s and community people for organizing meetings, trainings information on different diseases, seasonal and interaction programs. From this the saving group cultivation and other matters such as prevention of will add some fund to their savings to use it in income the use of tobacco, STD and HIV/AIDS awareness generating and community development activities. etc with community participation. This bulletin is distributed to the various organizations, health posts Skill Development and Income Generation for and sub-health posts, NFE classes, and local CBOs, economic empowerment which play a vital role in sensitizing the people on health and development issues. Total of 700 copies Saving and credit program provides the driving force of 12th issue of Kosheli bulletin is published and to help the illiterate rural women to start small scale distributed. 28 Annual Report 2009

OUTREACH PROGRAM:JANUARY TO DECEMBER 2009

Program Target Group Numbers

Aroupokhari, Ashrang & Taple VDC of Gorkha NFE classes community women 22 participants School health program (2-weeks) 325 schools children 4 schools Children Education Program (6-months) 41 children 2 centers TBAs management TBAs once a month Training on Uterus Prolapsed Sufferers 34 participants Primary care of the uterus prolapsed sufferers Sufferers 550 suffers Smokeless stove Community people 45 Family toilets Community People 50 Stretcher distribution Community people 11 to saving groups/club Maintenance of Drinking water systems Community people 5 Candle making training program Women's group 15 Candle making machine Women's group 4 machine Irrigation pipe provided Farmers group 200 meter Maintenance community building Women group 2 Hoarding on women’s health Community people 1 Women’s awareness campaign 9 Womens group 91 participants Awareness campaign Womens group 94 representatives Refresher of stitching training (3-months) Womens saving group 12 participants Anti-tobacco campaign Community people continuous program HIV/AIDS training program Womens group 136 participants Bungkot VDC of Gorkha PRA Ward no: 3,8 & 9 3 Saving group formation & training program 3 saving groups 30 participants Free health services education program Community people 106 participants Gender training Saving groups 30 representatives Family toilet program Community people 50 Smokeless stove Community people 50 Pickle making training 3 saving groups 20 representatives Stitching training (3months) 3 saving groups 20 representatives HIV/AIDS counseling center Community people 74 were counseled Udayapur & Saptari Districts Planning for 2009 Working areas 8 VDCs OSP facilitators refresher training OSP facilitators 19 Enrollment of OSP students in formal school OSP students 235 OSP classes Kamalpur, Ghoganpur 19 classes NFE facilitators refresher training NFE faclilitator 18 Evaluation of NFE classes NFE participants 425 Survey of TBAs working in program areas TBAs 86 Marking of the pregnant women’s house Pregnant women 65 HH Health camp on Uterus prolapsed Surffers 26 Uterus proplase training ANM& TBAs 11 Uterus proplase counseling & camp 3VDCs 133 sufferers Women’s reproductive health training ANM, Sub-health assistants, TBAs 17 participants Interaction program on the role of CHFs TBAs & chiefs of sub-health posts 1 Ayurvedic techniques of healing Healer, saving groups & TBAs 1 Maintenance of tube well 25 household of Ghoganpur 1 Toilet sets distributed NFE participants 200 Kitchen gardening training Saving groups 25 Kitchen gardening training & group formation Dalit Jati and Musahars 19 participants Fruit sapling distribution NFE participants 3504 Animal husbandry training Saving groups 14 participants Public hearing program 4 VDCs 381 participants Youth awareness program 12-16 years Muslim youths 39 participants 6 months stitching & designing training NFE and saving groups 18 participants Awareness program on tobacco Community people Continous Survey of dalit & marginalized communities Dalit community areas 18 areas Committee formed Working areas 8 VDCS Publication of RECPHEC Kosheli: 12& 13 Issue Community people 700 copies each

29 Annual Report 2009

INFORMATION & DOCUMENTATION RIGHT TO INFORMATION

Health literacy, the ability to obtain, process, and Health Clearing House understand basic health information and services to make appropriate health decisions is essential RECPHEC has been facilitating to provide HIV/AIDS to promote healthy people and communities. There IEC materials through its Clearing House service is an urgent need to address the gap between the since 1997, where 12 different organizations supply health information currently available and use this 44 different IEC materials. RECPHEC extended to information to make life-altering decisions. Different health clearing house from HIV/AIDS. The strategies are to be considered for policymakers, transaction this year is NRs. 5,76,524. health care administrators, educators and health care and public health professionals. RECPHEC is To share the information existence & its promotion/ providing health information by its Information & dissemination is extremely essential. Hence, Documentation Unit. website of Clearing House has been developed. The cover page, price, publisher, type and summary of On going activities: IEC Materials will be available in the web page.

Collection: Collection and updating is an essential Information dissemination and marketing work. 85 documents were collected on different subjects: traditional system of medicine, health The Unit participated in the different book and IEC policy, HIV/AIDS, reproductive health etc which are material exhibitions for information dissemination : catalogued. Participated in book exhibition & disseminated information Services:Different services were provided to users on “Promoting Eco-cities in Nepal” on June 5, 2009 at such as; Reference service, Referral service, Lalitpur Sub-Metropolitan on the occasion of World Environment Day. Around 1500 visitors observed our Reprography service, Information searching in materials. different databases, Bibliography, Clearing house, Likewise, the STD/HIV/AIDS IEC materials were displayed paper clippings on June 24, 2009 at “Workshop on Reduction of HIV/ AIDs Risk and Safe Migration at Hotel Malla. Paper clippings: The information from paper clippings Participated in book are more demanded by users in different topics. exhibition on the Presently, the newspaper clippings are filed in interaction program different 45 main subjects and 60 sub subjects from on Women’s Health 10 national newspapers: Abortion Child Health & and Development on 29 th July organized development, Community Health & development, by Women’s Studies Conflict/Peace, Constitution/Constituent Assembly, program in which Dental & Oral Health, Diarrhea, Disability & more than 75 Rehabilitation, Diseases Donation/Fund, Drugs, participants observed and purchased our publications. Elder’s Health, Environment, Epidemic,Family Planning & Population, Flue, Free - Health Services, Participated on Condom day in 10th October 2009 organized by Nepal Red Cross Society in disseminating Gender & Women Development, Globalization, the information on condom, safer sex, family planning , Government, Health Education, Health Services HIV/ STI, and HIV/AIDS, around 2000 visitors visited our stall. AIDS, Hospital management, IT/Library Science/ On the occasion of the AIDS Day IDU particpated on the Journalism, Medicinal Plant/Herbal medicine, book/IEC exhibition at Tundikhel, Kathmandu where many Mental Health, Migrant Workers, Mother & Child IEC were freely distributed. Health, Nutrition, Organizations, Patient doctor relation (HMPDR), Primary Health Care, Property Human Resource development Right, Psycho-Social Health, Public security, Sex Srijana Bhatta, library assistant, IDU participated Worker, Sexuality, Social science & health science, in the 3-months library training organized by Tobacco Traditional System of Medicine, Trafficking, LIMISEC. Tuberculosis Violence and Women’s Health 30 Annual Report 2009

PUBLICATION SHARING KNOWLEDGE AND INFORMATION

Since last 20 years, RECPHEC has been regularly Diamond Jubilee Issue. In this issue, most of the publishing various publications on pertinent health articles are written as a memento by different issues for the community people. It also publishes persons. The high level government’s personnel have posters, pamphlets, stickers, leaflets, books, etc. also extended heartfelt greetings and wishes for this RECPHEC started by publishing Bhalakusari issue. This issue contains Wishes, Reminiscence, newsletter in 1990. This section publishes different Reader’s Letters, Health Topic and Syllabus. Punya materials for RECPHEC in order to give additional Prasad Neupane, a Secretary of Women, Child & information related to the health at the community Social Welfare Ministry and Dr. Dhirgha Singh Bam, level and as advocacy tool for policy makers. Secretary of Health & Population Ministry have Bhalakusari is one of the first publications of expressed devout greetings and wishes for this RECPHEC and another is Mahila Swasthya issue. newsletters. Nirmala Sharma, Chandra Kiran Shrestha, Keshab These newsletters are circulated in the primary Thapa and Dr. Sita Ram Shrestha have inscribed health care and development units in 75 districts of the reminiscence articles in this issue. There are the country. It is primarily distributed through outs different readers’ feedbacks on Bhalakusari and the District Health Office NGOs, INGOs network, Mahila Swasthya as well. Dr. Aruna Uprety has women’s development section and District Health written about some of the household tips on herbal Offices. These newsletters are also directly mailed medicines that are being used from generations to to the different service providers such as health cure different diseases. Dr. Shankar Bahadur posts, schools, front line health workers and other Shrestha has written about Fileria (Hatti Paile Rog) social organizations. These materials are also which is found in the terai (plains) regions of Nepal. circulated through literacy classes also. It is Similarly, Dr. Mathura Prasad Shrestha, Chairperson established as a most effective and credible health of RECPHEC has written about Equity & Health. source newsletters at the community level. It has been noted that health workers had relatively better Bhalakusari Issue 101: This issue specially access to the newsletters which also serve as tool discusses about Piles, a pain caused by venous for their continuous education. swelling at or inside the anal sphincter (a ring of muscle that contracts to close an opening). Piles Brief outlines of different issues published patients usually feel uneasy to go to the doctor and from January to June 2009: tell their problem to others also. So, most of them hesitate to go for check up at the hospital or clinic Bhalakusari because they lack information about this disease. This issue has provided adequate information on Bhalakusari is published in bimonthly basis. It piles and the method of treatment that one can get attempts to communicate from a junior health person (HA, CMA, updated knowledge resource and ANM) at the community level. This article empower the front line health especially contains the home treatment for workers. It provides information piles problems on current trends of health and diseases and changing practices This issue also talks about tobacco control of disease’s treatment technique situation in Nepal. Plus use of lemon as a to the health workers. It also home remedy to restore health. serves the public, providing health-related information and Bhalakusari Issue 102: Diarrhea has issues. claimed hundreds of life in the remote areas of far western districts of Nepal. Thousands Bhalakusari Issue 100: of people in almost all the VDCs of these Bhalakusari 100 issue is the districts suffered from diarrhea due to 31 Annual Report 2009

contaminated water and foods. It takes nearly a day health and severe sodium restriction, moderate or two to reach nearby hospital, health centre, sodium restriction and mild sodium restriction and health post and sub-health posts. Because of severe need of fiber. infection and dehydration, people died within two three hours after the symptoms. Lack of information The 2nd article on this issue deals on the constipation in the affected areas has prevented further loss of problem, a common disturbance of the digestive lives. Considering this, this issue focused on diarrhea tract. In this condition, the bowels do not move to disseminate more information to the rural regularly, or are not completely emptied and this community people on the prevention method from condition is the chief cause of many diseases as it further loss of lives. produces toxins which find their way into the bloodstream and are carried to all parts of the body. Swine flu virus has infected thousands of people in Appendicitis, rheumatism, arthritis, high blood 125 countries and territories and caused hundreds pressure, cataract and cancer are some of the of deaths worldwide according to the WHO figures. diseases in which chronic constipation is an Government has positioned health personal at the important predisposing factor. The other symptoms international airport terminal to check the incoming include a coated tongue, foul breath, loss of tourists. After the flu hit India the government has appetite, headache, dizziness, dark circles under placed special force at the border area due to the the eyes, depression, nausea, pimples on the face, open border. Till now few infected have been found ulcer in the mouth, constant fullness in the abdomen, in Nepal. Considering this, this issue has focused diarrhea alternating with constipation, varicose veins, on swine flu and its prevention method to aware the pain in the lumbar region, acidity, heart burn, and community people. insomnia.

Bhalakusari Issue 103: In this issue, the 1st article Mahila Swasthya is about swine flu virus (H1N1) ’’How to save from Swine flu’. It deals mainly about its symptoms, how Women’s Health is published in quarterly basis. It contagious it is, how to protect oneself, precaution mainly focus on gender, women’s health and rights a health person should take etc. 2nd article deals of women for active and conscious participation in on sugar disease–diabetes to sensitize the diabetic social economic, cultural and political decision people on the physical exercise and the right food making at the local and national level. This newsletter for the patients. is circulated in primary healthy care and development units of all the 75 districts of the country Thousands of people died in western Nepal due to and also in the Nepali speaking zones of North India. the outbreak of diarrhea. To capacitate health workers on those areas in managing the problem Mahila Swasthya Issue 50: This is the Golden appropriately including the proper referral options Jubilee Issue of the Women’s Health News Letter. the 3rd article is focused on diarrhea and its Reminiscence, reader’s feedback, women’s health treatment method. The fourth article was on HIV/ and policies of women’s health are the general topics AIDS and migrant worker. on this issue. In this issue, most of the articles are written as a memento by different persons. Bhalakusari 104 Issue: Junk food is an informal term applied to some foods which are perceived to Komal Bhattarai, have little or no nutritional value and considered Sunita KC, Dr.Aruna unhealthy to consume at all. Our society like many Uprety. Dr Mira Ojha others has not been able to resist the junk food has inscribed the invasion. The triple combination of fast, cheap and reminiscence tasty has made junk food irresistible and a very articles in this issue. convenient substitute to regular meals. Our dietary Different readers’ habits have changed so much that we very rarely feedbacks are also have more than one proper meal. Considering this, included on this bhalakusari 104 issue has focused on junk food. Mahila Swasthya . The 2nd article deals with the different food suitable Dr. Aruna Uprety has for different season. written an article Bhalakusari 105 Issue: Dr. Jaya Pradhan has about Uterus written an article the uses of sodium and fiber for prolapse and Dr.

32 Annual Report 2009

Sunita KC has written about maternal mortality, Mahila Swasthya 52: This issue mainly focused question of unwanted pregnancy and denial of on Menstruation a biological cycle occurring in reproductive rights are some of the unaddressed female mammals of reproductive age that prepares issues. Similarly, Jyoti Paudel and Sushma Thapa the body for pregnancy. At the stage of fertilization have addressed about the women health and if fertilization does not occur the uterine lining breaks convention on elimination of all discrimination of the down this causes the loss of blood that marks women in the world. Mahila Swasthya’s regular menstruation. It is very common that many faces readers’ has written poems which is very inspiring. serious problem during menstrual cycle. These problems can be related to the length or frequency Mahila Swasthya Issue 51: This issue discusses of your periods, the amount of flow, or irregular about osteoporosis and reproductive health. periods, or periods that come regularly but with longer Dr. Aruna Uprety has pen down on the topics intervals in between. “Osteoporosis as Silent Disease”. Dr. Chakra Raj Pandey has written about ‘The easy way out of the Publication of User-friendly IEC Materials backbone pain problem”. Similarly, Dr. Meera Ojha has inscribed on the topics “Women’s disease also Advocacy is the key strength of RECPHEC in terms causes the backbone pain”. of health issues and has been the basis for most of the work that we do. In response to the high demand Osteoporosis is an abnormal loss of bony tissue from the anti-tobacco activists RECPHEC has resulting in fragile porous bones, most common in reprinted and published different posters and leaflet. post-menopausal women. Osteoporosis is also These developed materials are sent to the all the known as the silent disease which is seen in the district network groups. adult person, it increases risk of bone fractures. Someone with osteoporosis in a minor accident or Publication of Advocacy Materials even a hug can result in a broken wrist, hip or spinal fracture. Osteoporosis affects million Nepalese and Printed 1000 copies of sticker on “tobacco free of which 80% of them are women. residence” Reprinted 2 posters each 1000 copies on Although bones may seem like hard lifeless tobacco. structures, in reality they are living tissue, constantly Printed 2000 copies poster on “tobacco free breaking down and building back up. Calcium, a youths” on World No Tobacco Day. Printed 200 copies pamphlets on Framework mineral that contributes to bone density and Convention on Tobacco Control. strength, is constantly depleted through waste and 5000 copies of poster on “Save Your Children sweat. It is then renewed with calcium from the from Tobacco Smoke” bones, where 99 percent of calcium is stored. After 2000 copies of sticker on “Don’t Smoke While about age 30, calcium is taken from the bones faster You Are Driving, It Can Affect Your Family” than it can be replaced by diet. The body’s ability to Published 2000 copies of poster on “Global absorb dietary calcium also decreases with aging. Tobacco Health Warning” in association with Most women 65 and over absorb less than 50 National NHEICC, MOHP percent of their dietary calcium. As a result, the Booklets on Gutka (chewing tobacco) and Bidi bones become less dense. This is bone loss, which (hand- rolled smoking stick) 1000 copies is a normal part of aging. Reprinted 1000 copies of leaflet on chewing tobacco. The regular intake of medicine and proper rest are Published 300 copies of booklet on FCTC the best solution to prevent from the backbone document in Nepali. problem. The main causes of back problem are the Pocket Diary 2009 with health an tobacco wrong body gesture (motion of hands or body that control messages was published help to express feeling) and posture, the obesity Advocacy Kit for parliamentarians with and the lack of the physical exercises. information related to health information Approximately, 1/3rd of the patients in the clinics Junk Food: Contents in soft Drinks? a are the victim of the back problem in Nepal. This booklet on the harmful effects of soft or cold issue specially focused about osteoporosis in order drinks to provide more information on this and ways to HIV/AIDS Manual: Care and Support of HIV lessen its problem. Positive and Peoples’ living with AIDS

33 Annual Report 2009

Tobacco Products plan for three year, free health and problem in Nepal, Tobacco, FCTC and duty of government to control Gutka is a powdery, light brownish to white Tobacco trade, alcohol, women’s health situation, substance, dry HIV/AIDS, Consumer Rights, Nutrition, Diarrhea, mixture of crushed and Tuberculosis, leprosy, heart disease, blood areca nut, pressure and diabetes situation in Nepal. RECPHEC tobacco, catechu, planned to release this Advocacy Kit by the Speaker lime (calcium of the Parliament hydroxide), aromas and Advocacy Kit on Free Health Services flavoring as well as other addictives. Its found in the market in different As Nepal is in the process of constitution drafting names like pan masala, mawa, kharra, khaini. Bidi process, RECPHEC has published a user-friendly is a deadly smoking stick made from a small Advocacy Kit for the amount of tobacco Constituent Assembly hand rolled in a Members on Free Health dried tendu leaf and Service in order to tied with thread. As sensitize the members on the bidi wrapper health issues. The kit lacks porosity, a contains information on bidi requires more Plan and Status of Health frequent puffing in Nepal, introduction of than a cigarette. It Free Health Service generates slightly higher nicotine in blood compared Program, issues that to conventional cigarette smoking. came up at the district consultations organized in 43 districts and study There is excessive use of these products by male report and appeal to the Constituent Assembly. and females more than cigarette smoking mainly in Terai region and the rural areas of Nepal. Advocacy Materials on Plastic Bags: A small Considering this, RECPHEC published two booklets leaflet and posters with the slogan kflnlyg] x6fcf,+} on Gutka (chewing tobacco) and Bidi (hand- rolled and negative effects of using smoking stick) 1000 copies each to disseminate jftfj/0f hf]ufcf}+ information among the people on the adverse health polythene bags, and stickers with “Polythene Free consequences of tobacco products. Zone” has been developed and printed. Similarly, posters encouraging customers to bring bag from Advocacy Kit for the Parliamentarian: home has been designed and printed.

RECPHEC has produced an Advocacy Kit in 1997 Coupon for Lucky Draw System: A gift coupon for parliamentarians on the health right of people. It was developed by RECPHEC for a lucky draw organized a workshop for advocating the issues program incepted in 3 supermarkets and 25 related to consumers’ rights, women’s’ health and departmental stores at Lalitpur to encourage the responsibilities of the parliamentarians. customers to bring bag from home. RECPHEC distributed an Advocacy Kit for all the participating parliamentarians. This year RECPHEC revised and edited the advocacy kit with more information related to health: Tobacco and alcohol, FCTC, Role of Constituent Assembly in Tobacco Control Law and Health situation, health policy and Interim

34 Annual Report 2009

NGO NETWORKING A COLLABORATIVE EFFORT

Study Tour on Tobacco Control Advocacy FCA Briefing meeting held on 27th June. Mr. B. K. Baniya, Under Secretary Law also participated in In order to develop functional network and develop this meeting. Nepal contributed in lobby South Asian professional expertise in the different dimension of delegate, prepare article for FCA bulletin which was Tobacco Control, Mr. published on 3rd July 2009 entitled “ Illicit Trade Shanta Lall Mulmi visited and Open Border: Nepal”. Sydney Australia on the invitation of Action on Appointment of Country Researcher for IHP+ Smoking and Health (ASH) from 27th January to 2nd The International Health Partnership and related February 2009. He also initiatives (IHP+) is a partnership between made a study visit to ASH international health agencies, bilateral donors, civil Australia, Cancer Council and Heart Foundation, society organization and recipients’ government. It Cancer Institute and follow up meeting with FCA was launched in September 2007 in order to respond Chair Ms. Mary Asunta. to the MDG challenge that called for all signatories to accelerate action to scale-up coverage and use 14th World conference on Tobacco or Health of health services and deliver improved outcomes against the health related MDGs and universal Pre-conference meeting of Bloomberg Partners access commitments. Nepal is one of the signatory of this initiative. In order to facilitate the country Mr. Shanta Lall Mulmi, Executive Director, process, Mr. Shanta Lall Mulmi, Executive Director RECPHEC participated on the FCA Pre-conference of RECPHEC has been appointed as country meeting of Bloomberg Partners in Mumbai from 5th Researcher of IHP+ in Nepal. - 7th March 2009. In this thematic workshop Mr. Mulmi presented a paper on “Alliance Building”. The Second Nepal Health Sector Reform Program participants were very much encouraged with Deputy Mayor of New York for his enlightening As for the ministerial decision, Mr. Shanta Lall Mulmi presentation. has been nominated to the High Level Technical Advisory Committee to prepare draft of the Second 14th World conference on Tobacco or Health Nepal Health Sector Program Strategic Plan 2010- 2015. Mr. Mulmi is contributing as a member of the The conference which was started on 8th March committee and also as a convener of Engagement had more than 2000 delegates from more than 120 of Non-state Sector Thematic Group. countries. Mr. Mulmi presented a paper on “Advocating Political Regional Meeting on Tobacco Parties in Tobacco in Mr. Purna Bhakta Duwal, Mr. Anil Neupne and Mr. Nepal” in one of the Bhakta Thapa health thematic session. journalists from Nepal The conference participated on the concluded on 12th regional meeting on March with Mumbai “Experience Sharing on Declaration and selection of the next WCTOH as Tobacco Control” from 21st Singapore. to 22nd April 2009 in Bangladesh organized by The Union and Work of Third Session of the Inter-governmental Better Bangladesh (WBB). Participant from Negotiation Body INB3 meeting Srilanka, Thailand and Indonesia also participated on this meeting. Nepal made the presentation on Under the FCA sponsorship Mr. Shanta Lall Mulmi massive media campaign on tobacco control at the participated in INB3 meeting held at Geneva fro 28th central level and at the 48 district with the initiation June to 5th July 2009. He also participated in the of the HRTC District Network.

35 Annual Report 2009

HEALTH RIGHTS AND TOBACCO CONTROL DISTRICT NETWORK

RECPHEC started organizing Tobacco Control Program Officer presented a paper on “Health Rights District Network Groups to pressurize Concerned & Tobacco Control”. There was general discussion government agencies, create awareness among the on how to go ahead and the problems and rural community about health rights and tobacco constraints. Moreover, they agreed to work voluntarily control issues including health risky tobacco use for this tobacco movement and monitor the district and to address the legal and other advocacy needs activities regularly. Focal Persons chosen are as to effective implementation of Free Health Service follows: Program and the Tobacco Control Legislation and Regulation Laws in line with FCTC obligations. These Ms. Maheswori Neupane: Sunsari, Morang, Jhapa, Illam, Panchthar & Terathum HRTC networks are advocating for the Tobacco Mr. Madan Katwal: Bara, Parsa, Sarlahi, Mahottari, Dhanusha, Siraha, Control Law and its implementation respecting Saptari & Udayapur people’s right to live in smoke free and healthy Mr. Ram Bahadur Raut: Kapilvastu, Rupendehi, Nawalparsi, Argakhanchi, Palpa & Gulmi environment with different advocacy programs. These Ms. Sarita Gurung: Tanahu, Lamjung, Gorkha, Dhading & Chitwan networks will further work for the implementation of Mr. Hari Prasad Poudel: Sangja, Parbat, Baglung, Myagdi & Kaski Mr. Purna Lal Chuke: Banke, Bardia, Surkhet, Salyan, Dailekh, Jajarkot, Tobacco Control Law at the respective districts Kalikot & Dang following the implementation of Tobacco Control Law Mr. Krishna Singh Deuwa: Kailali, Kanchanpur, Accham, Doti, Dadeldhura, in Nepal Baitadi, Bajura, Bajhang & Darchula

At present the network groups are active in 48 (one Major activities undertaking by the network can be more districts added this year) following districts: categorized as: Kanchanpur, Bardia, Banke, Kapilvastu, Rupendehi, Baglung, Parbat, Tanahu, Chitwan, Gorkha, Tobacco control is one of the cross cutting issue Mohattari, Dhanusha, Saptari, Kaski, Nawalparasi, of all program Udayapur, Siraha, Sunsari, Morang, Jhapa, Gulmi, Mass awareness campaign Argahakhanchi, Dang, Palpa, Myagdi, Syangja, Organizing district level thematic workshop Lamjung, Dhangadi, Surkhet, Dhading Doti, Baitadi, Pressuring the government agencies, private Dadeldhura, Darchula, Kalikot, Jajarkot, Accham, sector and NGOs for declaring “Public Places” Sarlahi, Illam, Pahchathar, Terhathum, Bara, Parsa, as tobacco free zone. Salyan, Dailekh and Rautahat districts. Protecting youth from tobacco use.

Review meeting on Health Rights & Tobacco The following are the notable achievement made: Control Included chapters about tobacco in Non-Formal RECPHEC organized one-day review meeting on Education textbook 10th July 2009 with selected focal person from HRTC Published CD of Duet Songs and Dances on of five regions at RECPHEC Office. The main Tobacco Control Issues objective of this meeting is to mobilize HRTC further Many District Networks stage “Street Theatre” and to discuss about the accomplished activities at on these issues. the district level and the problem and constraints Tobacco control materials display and distribution faced while implementing the programs. Seven with orientation session selected focal persons from: Sunsari, Udayapur, Successful in making local government including Palpa, Tanahu, Myagdi, Banke, Kanchanpur District Health and District Education offices as participated in this meeting. Tobacco Free Zone Some districts were successfully in making Mr. Shanta Lall Mulmi, Executive Director of Federation of Industry and Commerce to RECPHEC highlighted on the objective of the collaborate with the tobacco control program. meeting. Further, he discussed on how to make district network more effective. Ms. Reetu Pradhan,

36 ORGANIZATIONAL PROFILE

Executive Board

Prof. Mathura P. Shrestha Chairperson Mr. Mahesh Sharma Treasurer Ms. Aparna Bhatta Member Dr. Mahesh Maskey Member Ms. Sita Gurung Member Ms. Nirmala Sharma Member Dr. Sharad Raj Onta Member Dr. Shree Krishna Shrestha Member Mr. Shanta Lall Mulmi General Secretary

Supporting Staffs

Mr. Shanta Lall Mulmi Executive Director Mr. Govind Bdr. Shrestha Program Coordinator Ms. Chandra Kiran Shrestha Information/ Documentation Officer Ms. Reetu Pradhan Program Officer Mr. Kashi Nath Marahatta Accountant Mr. Purna Bhakta Duwal Publication Officer Ms. Anushiya Joshi Program Officer Ms. Reshma Shakya Executive Secretary Ms. Bhumika Shrestha Assistant Program Officer Ms. Srijana Bhatta Library Assistant Ms. Manjushree Maharjan Admit Assistant/Receptionist Mr. Buddha Ghalan Driver/Office Assistant Mr. Shyam Lama Office Assistant Ms. Mahili Basnet Office Helper

Saptari Field Staffs

Mr. Janaki Hari Shrestha Field Program In-charge Ms. Deena Chaudhari CMA Mr. Naveen Dhakal Animator Mr. Fulkumar Sada Animator Ms. Sunita Chaudhari Animator Ms. Anita Chaudhari Animator

Partner NGOs in Gorkha

Tulsi Meher UNESCO Club Swasthya Sudhar Samuha k[[i7e[ ""dL" cfwf/et' :Jff:Yo hgtfsf ] g;lu} s{ clwsf/ xf ] eGg] cg'e'lt lbnfpg k|fylds :jf:Yo ;]jf ;|f]t s]Gb| k|of;/t /xFb} cfPsf] 5 . u0ftflGqs g]kfnn] u/]sf] lgMzNs' :Jff:Yo ;]jfsf] 3f]if0ffnfO{ d't{ ?k lbgsf nflu /]:km]sn] k|efjsf/L e"ldsf v]Nb} cfPsf] 5 . clxn ] lqjifLo{ cGtl/d :jf:Yo gLlt clGtd r/0fdf /xsf] ] 5. o; +} sf/0f :jf:Yo tyf hg;Vof+ dGqfnon ] ;g \ @)!) blv] @)!% ;Ddsf nflu k~rjifLo{ ofhgf] agfO /xsf] ] 5 . ;fsf] nflu :jf:Yo tyf hg;Vof+ dGqLsf ] cWoIftfdf ul7t ;ldltdf ;b:o xg' ] dfsf} ldnsf] ] 5 . ;f ] ;ldltdf u/} ;/sf/L Ifqsf] ] eldsf" klxNofpg ul7t pk;ldltsf ] ;of+ hssf] ] lhDdjf/L] ;dt] lbOPsf ] lyof ] . of] dfsfsf} ] pkofu] ug { /:km] s] ;kmn ePsf ] lyof] . o;u/L+} /:km] sn] ] Pkm;L6L;Lsf ] blIf0fkjL" { IfqLo] ufi7Lsf] ] ;xcfofhgf] ug {] kfPsf ] dfsfn} ] klg of ] jif { pknlJwk0f" { /xof ] . ;/sf/sf ] :Jff:Yo gLltsf ] jsfnt ug { o;jif { /:km] sn] ] ljleGg ;~rf/dfWoddf sfo/t{ kqsf/x?nfO { clwstd ?kdf kl/rfng ug{ ;kmn ePsf ] 5 . ;ljwfg;efsf+ ;b:ox?sf nflu :jf:Yo;DjlGw bO' j6f{ jsfnt ;fduL| ksfzg| u/L 5§' } klxrfg agfpg ;ssf] ]] 5 . To:t } lgMzNs' :jf:Yo af/ ] ul/Psf ] cWoog kltj| bg] / cfoj' b;DjlGw{] ul/Psf ] cWoog kltj| bgn] ] klg /:km] snfO] { efjL sfolbzf{ klxNofpg d2t ku' sf] ] 5 . ;g\ @))( df j}b]lzs /f]huf/df hfg] sfdbf/x?sf lglDt PrcfOeL÷P8\;sf] k/fdz{ / k/LIf0f ug]{ sfo{qmdsf] yfngL eof] . o;nfO{ cfufdL lbgdf klg lg/Gt/tf lbOg]5 . lgMz'Ns :jf:Yo / w'd|kfgaf/] hghfu[t ug{sf nflu $* j6f lhNnfsf ljleGg ;fd'bflos PkmPd /]l8of]x?dfkm{t sfo{qmd pTkfbg ug]{ / hg;Gb]z lbg] sfd klg ePsf] 5 . zx/L :jf:Yosf] If]qdf /]:km]sn] u/]sf sfdsfjf{xL klg pNn]vgLo g} /x]sf] kfOof] . o;cGtu{t WjgL k|b'if0f lgoGq0f, ;jf/L ;fwgsf] lglZrt If]q, z'Go kmf]x/ cleofg cflb ultljlw /x]sf 5g\ . 6«flkms k|x/L, oftfoft Joj:yf ljefu, n'h g]kfn, ljleGg ;'k/ dfs]{6x? / lghL ljBfnox?sf] pko'{Qm sfo{qmdx?df ;xeflutf /x]sf] lyof] . WjgL k|b'if0fsf] cleofg / jftfj/0f ;'wf/sf] kxnn] ubf{ ;/sf/ / gLlt lgdf{tf tyf ;DjlGwt lgsfonfO{ bafa k}bf x'g uPsf] lyof] . pbok'/, ;Kt/L / uf]/vfdf eO/x]sf sfo{qmdx?n] o;jif{ klg ul/j tyf ;LdfGts[t ;d'bfonfO{ ;+:yfut ljsf; u/fpg] sfo{n] lg/Gt/tf kfof ] . /:km] ssf] ] ;rgf" tyf clenv] ljefu klg kf7s / kof| ustf] sf{ ] dfu adflhd] sfo { ug { ;Ifd xbF' } cfPsf ] 5 . kof| ustf] sf{ ] dfu adflhd] ;f ] zfvfnfO { l8lh6n kljlwdf| nfg ] klqmof| z?' eO;ssf] ] 5 . ;g \ !(*( df :yfkgf eP klg ;g \ !((! af6 jwflgstf} kfPsf] o; ;:yfn+ ] $* j6f lhNnfdf ljleGg u/;/sf/L} ;:yfx?sf+ ] enfx?af6] ul7t :jf:Yo clwsf/ tyf ;tL' { lgoGq0f lhNnf ;~hfnx?dfkmt{ ljleGg ultljwLx? cufl8 a9fO/xsf] ] 5 . h;sf dfWodaf6 # xhf/ :jo;+ jsx?] kl/rflnt 5g \ . /:km] sn] ] OO8L hdgL;{ uF ;xsfo { ub{} cfO/x]sf] 5 . OO8Lsf] ;xof]u gkfPsf] eP /]:km]sn] olt ;fx|f] pknlJw xfl;n ug{ ;Sb}gYof] xf]nf . o;jif { kl/jf/ lgofhg] ;3+ klg Unfan] kmG8sf ;fy xfdf| ] ;xsfodf{ ;dflxt ePsf ] 5 . cS;kmfd lhaL, AnDju' ,{ xNy] ljh| Sofgf8fsf] ;xofun] ] xfdf| ] cleofgnfO { prfOdf k¥ofPsf' ] 5 . o;jif { xfdf| ] ;xsfo { :jf:Yo tyf hg;Vof+ dGqfno;uF klg xg' ku' sf] ] 5 . oL ;Dk"0f{ ;xofqLx?nfO{ wGojfb k|s6 ub}{ ;g\ @)!) nfO{ cem k|efjsf/L / pNn]vgLo agfpg] c7f]6 /]:km]ssf] /x]sf] 5 .

zfGtnfn dNdL' sfo{sf/L lgb]{zs jflifs{ kltj| bg] @))(

cS;kmfd lh=lj= gkfn,] >L jfnsi0f[ s§n,] ;r]]]tgf]] sfo{{{gLlt{{ lgdf{{{0f{{ pQm sfo{zfnfdf kl/of]hgf ;+rflnt sfoqmd{ clwst,[ cS;kmfd lh=lj= gkfn] uflj;x?sf -bn} v] M ;/L,] j/fxf / ufugkfgL,] / >L ufljGb] jxfb/' >i7,] sfoqmd{ ;of+ hs,] cTofjZos :jf:Yo ;]jf cleofg / ;v' tM{] dg6f8f,} udL' / l5Gr ' / jlbof{ M /:km] ssf] ] Ps ;o+ Qm' 6fnLn] ] ;DdfggLo cTofjZos vfg]kfgL tyf ;/;kmfO{ dgfkf} v/,] bp8fsnf] / ;f/xjf_] :jf:Yo kwfgdGqL| >L dfwj sdf/' gkfnnfO] { jxf+ cleofgsf d2fx?jf/' ] ;rtgf] ugsf{ nflu rfsL} tyf pk:jf:Yo rfsL,} :jf:Yo rfsL} ;o+ Qm' /fi6;« 3sf+ ] dxf;efdf /fi6 « kd| vsf" ] kfylds| :jf:Yo ;jf] >ft] sGb] n| ] @) / Joj:yfkg ;ldlt, :jf:Yo ;jf] cgudg' xl;otn} ] efu lng hfg ' cl3 Ps :d/0f @! cui6 @))(df b'Olbg] sfo{gLlt ;ldlt, cgdL x?sf ] kltlglwTj| /xsf] ] lyof ] . kq k:t| t' u/of\ ] . :d/0f kqdf cGtl/d ljifout 5nkmn sfo{zfnf uf]i7Lsf] kl/of]hgf uflj;sf ;d'bfosf ;ljwfg,+ lqjlifo{ ofhgf,] lgMzNs' :jf:Yo cfofhgf] Pp6f ;rtgf] sfogLlt{ lgdf0f{ pkef]Qmfx?nfO{ lgMz'Ns :jf:Yo ;]jf ;]jf sfo{qmd / cGt//fli6«o :jf:Yo u/sf] ] 5 . pQm sfozfnf{ ;v' t,{] bn} v] / sfoqmdjf/{ ] hfgsf/L lbg ] p2Zon] ] :jf:Yo ;fem]bf/Ldf pNn]v u/LPsf :jf:Yosf jlbofsf{ ;lt' hGo{ kbfy { lgoGq0f ;hfn+ / clwsf/ tyf ;lt' hGo{ kbfy { lgoGq0f ;hfn+ d2fx?' nufot lhNnf k/fdzx?df{ p7sf] vfgkfgL] tyf ;/;kmfO { dxf;3+ gkfn,] jlbof,{ bn} v] / ;v' t{] lhNnfzfvfx?n] /]:km]s, km]8jf;g / cS;kmfd lh lj :jf:Yosf d2fx?' pNnv] u/LPsf ] 5 . ;o+ Qm' ;DjlGwt ( uflj;x?df Pslbg ] cGt/lqmof gkfnsf] kltgLlwx?sf| ] ;xeflutfdf ;DkGg sfo{zfnfx?sf] cfof]hgf u/\of] . /fi6 « ;3sf+ ] dxf;efdf gkfn] nufot & ePsf ] lyof ] . sfogLltdf{ nIf, p2Zox?,] ljsf;zLn /fi6x?nfO« { jnfotsf] kwfgdGqL| sfozfnfdf{ ;dbfon' ] :jf:Yo rfsLsf} k|d"v ;Gb]z, ;fyLx?, ljkIfx?, :jf:YosdLx?n{ ] ug {] clgoldttfsf ] ljifodf >L uf8g{] afpgn| ] xfnsf ] :jf:Yo ;jfnfO] { sofsnfkx?[ / pTk/0ffTds]| sofsnfkx?,[ klg cfjfh p7fPsf lyP . lj:tf/ ug { ;xofu] ugsf{ nflu Pp6f ljzif] ;do ;Ldf nufPt cgudg' tyf dNof" sg+ j7ssf} ] cfofhgf] u/sf] n] ] dxf;efdf hfg ljifo ;dfjz] ul/Psf ] 5 . :jf:Yo pkef]Qmf]] ;ldltx? u7gM kj" { o:tf ] :d/0f kq k:t| t' u/sf] ] xf ] . ;r]]tgf]]] tyf k||:t||| ''tL''' ;Lk tflnd :jf:Yo ;:yfx?nfO+ { lgMzNs' :jf:Yo ;jf] kl/of]]]hgf]] cfbfgk|||bfg|| sfo{{{zfnf{{ sfoqmd{ kefjsf/L| 9un+ ] sfofGjog{ ug{ cTofjZos :jf:Yo ;jf] cleofg ;rfngsf+ ;3fpg ] p2Zon] ] /:km] sn] ] :jf:Yo clwfsf/ kfylds| :jf:Yo ;jf] >ft] sGb] n| ] ;v' t,{] nflu lhNnf tyf uflj; :t/sf :jf:Yo tyf ;lt' hGo{ kbfy { lgoGq0f ;hfn+ lhNnf bn} v] / jlbof{ lhNnfdf ;rfng+ ub {} u/sf] ] ;jf] cleoGtfx?nfO { ;rtgf] tyf k:t| tL' zfvfx?sf ] ;xofudf] cTofjZos :jf:Yo cTofjZos :jf:Yo ;jf] cleofg kl/ofhgf] zLk kbfg| ug {] p2Zon] ] @@ blv] @% gfe] Dj/] ;jf] cleofg ;rflnt+ ( uflj;x?df Ps jf/ ] ;/fsf/jfnfx?nfO] { hfgsf/L lbg ] p2Zon] ] @))( ;Dd Ps j6f :jf:Yo pkefQmf] ;ldltx? u7g bn} v,] ;v' t{] / jlbofdf{ cui6 @& / @* g]kfnu+hdf u/sf] ] 5 . / ;K6] Dj/] !, @))( df Pslbg ] kl/ofhgf] Pp6f ;rtgf] cfbfgkbfg| sfozfnfsf{ ] cfofhgf] ul/Psf] tyf k|:t'tL cg'''''udg tyf clen]]]]]vg ;Lk lyof] . sfozfnfdf{ kj" { lhlj; ;b:ox?, zLk tflnd tflnd u};; sfo{stf{x?, ;/sf/L sfof{no ; + rfng :jf:Yo ;:yfx?nfO+ { lgMzNs' :jf:Yo ;jf] kltlglwx?,| pkefQmf] ;ldltx?, dlxnf, ul/Psf ] lyof ] . tflnddf ;rtgfsf] ] dxTj sfoqmd{ kefjsf/L| 9un+ ] sfofGjog{ ug{ blnt, hghftL nufot cGo ;dbfosf" / kefjsf/Ltf,| zf;gsf kfqx?, ;rtgf] ;3fpg ] p2Zon] ] /:km] sn] ] cTofjZos :jf:Yo gtfx?sf] ] ;xeflutf lyof] . sfogLlt,{ ;rtgfsf] cj;/ tyf rgf' tLx?,} ;]jf cleofg cGtu{t gful/s ;dfh ;r]tgfrsf] tf/f] / ;fem]bfx? h:tf cgudg' cfhf/sf} ] lgdf0f{ u/sf] ] 5 . log} hfgsf/L ;fdu|||Lx?|| k|||sfzg|| ljifox? ;dfjz] ul/Psf ] lyof ] . cgudg' cfhf/jf/} ] lhNnf / uflj;x?sf Pp6f kf]:6/df lgMz'Ns :jf:Yo ;]jf lgMz'''''Ns :jf:Yo ;]]]]]jf kmfsn] JolQmx?sf ] Ifdtf clejl4[ ug{] sfoqmd{ / o; cGtut{ lgMzNs' jfl8g+ ] sfof{{{{{Gjogstf{{{{{x?;Fu sfo{{{{{zfnf p2Zon] ] /:km] sn] ] @^ blv] #) gfe] Dj/] cfiflwx?jf6} pkrf/ xg' ;lsg ] /fux?sf] ] @))( ;Dd gkfnu] hdf+ cgudg' tyf ljj/0f lbOPsf ] 5 eg ] csf {] kf:6/df] cfdf ufdL0f| :t/sf :jf:Yo sfoGjogstf{ x?nfO{ { clenvg] zLk tflnd kbfg| u/sf] ] 5 . ;/Iff' sfoqmd{ / o; cGtut{ lbOg ] lgMzNs' lgMzNs' :jf:Yo sfoqmdsf{ ] k/Llw, ;Ldf / o; tflndn ] ;xefuLx?sf ] kltj| bg] nufPt ;ljwf' jf/ ] hfgsf/L lbOPsf ] 5 . Kff]i6/n] sfofGjogsf{ kfyldstfx?jf/| ] ;rt] u/fpg] dfdnf syfx? tof/ ug {] zLkdf kutL| xg' ] :jf:Yo rf}sLdf ;'Ts]/L u/fp+bf ;/sf/n] p2Zon] ] jlbof,{ ;v' t{] / bn} v] lhNnfdf ckIff] /flvPsf ] 5 . tflnddf /:km] s,] cjl:yt :yf:Yo clwfsf/ tyf ;lt' hGo{ lbg] oftfoft vr{jf/] klg pNn]v u/]sf] km8jf;g,] cSkmfd lhlj gkfn,] :jf:Yo kbfy{ lgoGq0f lhNnf ;+hfnx?sf] clwfsf/ tyf ;lt' hGo{ kbfy { lgoGq0f ;hfn+ 5 . oL bO' ksf/sf| u/L hDdf ())) klt| cfofhgfdf] ;DjlGwt lhNnfx?df Ps Ps kf:6/x?] pTkfbg u//] ljt/0f u/sf] ] 5 . / :jf:Yo pkefQmf] ;ldltsf kltgLltx?sf| ] j6f sfozfnfx?sf{ ] cfofhgf] ul/Psf ] 5 . ;xeflutf /xsf] ] lyof ] .

3 jflifs{ kltj| bg] @))( l;dfGtst[[[ u/La ;dxsf"""" ]]] ;zlQms/0fdf xfdf||||| ]]]]] kof;|||||

o; sGb] n| ] ljut !# jifb{ lv] ufdL0f:t/df| rog ul/g ] gLlt /fvsf] ] lyof ] . xfn ;Dd sfo{qmd cGt{ut ;=sf= tflnd ;DkGg u/Lj, lk5l8Psf] tyf pk]lIft ju{sf] /:k] ms] ;xofu] ;ldlt 3f3gk] /' / sdnk/n' ] u/L !( j6f sIffx? ;+rfng ;zlQms/0f ug {] nIf /fvL sfoqmdx?{ ub{} Pr=cfO=eL{ P8;\ ;rtgf] ufli7] / lgMzNs" eO/x]sf]5g\ . o;jif{ # ;o #% hgf cfPsf] 5 . o; sfo{qmdn] lgDg lgb]{zs :jf:Yo pkrf/df hgtfsf ] kxr'F ljifos jfnjflnsfx?nfO{ jfnsIffdfkm{t ;fIf/ l;4fGtdf cfwfl/t 5 M :yfgLo ;dbfosf' ] ;fjhlgs{ ;g' jfO' sfoqmd{ ;DkGg u/L;ssf] agfO{ :s"n egf{ ;d]t u/fOPsf] 5 . r]tgf clej[l4sf ;fy} Ifdtfsf] ljsf; 5g \ . To:t } ;xofu] ;ldlt rfb08Ln} ] @ u/L ;+:yfut ;+u7gfTds ljsf; ug]{, sGb] | :yfkgf u/L l;nfO { s6fO[ { tflnd cfwf/e'''''t cgf}}}}}krfl/s lzIff ufpnfO{ C0f d'Qm ug]{, sd;]sd &) ;rfng+ u/L ;xofu] ul/b {} cfPsf ] 5 . ;g \ @))( df o; ;:yfn+ ]] pbok/,' ;Kt/L k|ltzt dlxnf ;fIf/ agfpg], Ps 3/ ;xof]u ;ldltx?n] art tyf C[0f / uf]/vf lhNnfdf !( j6f cgf}krfl/s kl/jf/ Ps Jofj;flos ;Lk ljsf; ug]{, kl/rfng sfoqmd{ ;rfng+ ul/ cfPsf5] . sIff ;~rfng u/L $ ;o $& hgf u/Lj w"jfF/lxt r'nf], rkL{, s/];faf/L cflbsf] tyf pk]lIft dlxnfx? ;fIf/ kfl/Psf] 5 ljsf; u/L jftfj/0f ;'wf/ ug]{ tyf afnjflnsf / dlxnfx?nfO{{{{ cfwf/e''t lzIff . cfwf/e't cgf}krfl/s lzIff k|fKt /fHosf] slif,[ :Jff:Yo, lzIffh:tf ;]jf cfwf/e'''t lzIff ul/;ssf] dlxnfx?sf nflu bf;] f| ] r/0fsf] ;'ljwfdf hgtfsf] kx'r+sf ;fy} ;]jf pbok/' / ;Kt/Lsf ;LdfGtst[ ;dbfosf' k|f}9 lzIff k9fpg] Joj:yf u/]sf] 5 . k|efjsf/L agfpg, hLjg:t/df afnaflnsfx?sf nflu cfwf/et' lzIffsf] logLx?nfO{ cgf}krfl/s lzIff;Fu;+u} ;sf/fTds kl/jt{g Nofpg] sfd ub}{ Joj:yf ;g @))( df cfocfh{g tyf art, cfPsf] 5 . klg hf/L g} /x\of] . kz'kfng, s/];faf/L, cfwf/e""t 3/w''/L ;j]]{{If0f s"n hg;+Vof dWo] vfgkfgL,] ;/;kmfO,{ rkLsf{{ ] cfwf/e"""t 3/w'''/L ;j]]]{{{If0f $) k|ltzt hgtf k|of]u, w'jfF/lxt r"nfsf] /:k] msn] ] ljut ;fndf u/sf] ] lsofsnfkn| ] cem } ;fIf/ xg' ;ssf] ] kof| u,] :jf:Yo lzIff, ;/lIft' sfo{If]q tf]sL lnPsf] ;d'bfodf cw'/f] 5}gg\ . To;df klg dft[Tj;DalGw 1fgsf] sfoqmd{ / sxL] 56k' m6' ePsfn] ] sfoIf{ qsf] dlxnf tyf :sn" hfg] hfgsf/L u/fpg] sfo{x? uflj; dWo] ;j} eGbf lk5\l8Psf ,k5f8L pd] /sf ul/G5 . kf/sf,] blnt / hghftLjusf{ ] hLjg :t/ jfnjflnsfx?sf] k|ltzt a9L 5 . p7fpg] x]t'n] To; ;d'bfox?sf] 3/w'/L To;sf/0f oL b'j} ju{nfO{ cfwf/e"t :jf:Yo ;r]]]]]tsåf/f dft[[[[[lzz''''' ;jIf0f{] kmf/d tof/ u/L @^ abfut' kZg| lzIffsf] cg'e"lt u/fpg]] o; ;+:yfn] :jf:Yo ;]]jf]] k||bfg|| kqsf] cfwf/df %@% 3/x?df ;j]{If0f cfkmgf\ ] sfoIf{ qdf] To:tf pklIft] dlxnf dft[ tyf lzz' d[To"b/df sd Nofpg] ul/of] . h; dWo] ;Kt/Lsf] 3f]3gk'/ tyf jfnjflnsfx?nfO{{ ;fIf/ agfpg] p2]Zosf ;fy dlxnfx?nfO{ dft[lzz' uflj;df !) ;d'bfodf #)! 3/x?df p2]Zon] cgf}krfl/s tyf jfn sIffx? tyf ;'8]gL tflnd lbO{ pgLx?nfO{ ;j]{If0f kmf/d e/\of] . ;~rfng u/L ;fIf/ agfp+b} cfPsf] 5 :yfgLo ufpF3/df kl/rfng ul/+b} . /]]]]]:k]]]]]ms ;xof]]]]]u ;ldlt -OsfO{{{{{_ cfPsf] 5 . ;fydf ue{jtL dlxnf u7g cgf}krfl/s} afn sIff sfo{qmd{ tyf ljjflxt dlxnfx?nfO{ ;'/lIft u7g cgf}}krfl/s} afn sIff sfo{{qmd{ ;'Ts]/L s;/L ug]{ / u/fpg] eGg] :yfgLo :jfoQ zf;g cGt{ut cfk\mgf] ;Kt/Lsf 3f]3gk'/ / sdnk'/ uflj; s'/fdf ;r]tgf tyf ;xof]u k'¥ofpFb} ufpsf+ ] pTyfg ug { :yfgLo ;xeflutf agf} If]qsf tyf pbok'/sf a;fxf / cfPsf] 5 . oL gf/fsf ;fy x/s] sfoIf{ qsf] uflj; :t/Lo rf}b08L uflj; If]qsf blnt ;'8]gLx?n] sfo{If]q /]:k]ms ;xof]u ;ldlt u7g ul/of]. OsfO{ lk5\l8Psf hghflt, k5f8Lkf/]sf tyf To; j/k/sf u7g ubf{ /]:km]s s'g} g s'g} sfo{qmddf ;d'bfosf * jif{b]lv !$ jif{sf afn uflj;x?df k|ToIf cfj4 /lx sfo{ u/L ;s]sf dlxnf aflnsfx? ljBfno lzIffaf6 dft[lzz' :jf:Yo k'?ifx?sf] e]nf u/L k|:tfljt kIfdf alGrtnfO { ( dlxg ] afn sIff ;rfng+ ;]jf k|bfg ug'{sf ;xdlt u/]sf dWo]af6 Ps sfo{ ;ldlt u/L :yfgLo ljBfno ;Dd egf { u/L lbg] ;fy} :jf:Yo lzIff tyf PrcfOeL

5 jflifs{ kltj| bg] @))(

dfl;sfx? tyf eb| enfbdLx? u/L (^ h;af6 oL Ifqsf] afl;Gbfx? Aofkf/Laf6 :jf:Yo / ljsf;sf af/]df 36]sf hgfsf ] ;xeflutf /lxof ] . o; sfoqmdn{ ] rsf]{ Aofhdf C0f lng'kg]{ jfWofTds 36gfx?sf] af/]df ufpFs} afl;GbfnfO{ ubf { lt bO' { lgsfosf ] ultljlw / sfoljlw{ kl/l:yltaf6 dQm' xg' ] cj:yfdf kusf' ] hfgsf/L lbg ] ljifoa:t ' klqsfdf ;dflji6 af/] ;j{;fw/0fn] hfg] df}sf k|fKt ul/of]. 5 . ul/Psf] lyof] . o;/L g} 3f]3gk'/, kmQ]k'/ / sdnk'/df pQm sf];]nLdf lgDg lzif{sx? ;dfa]; klg sfoqmd{ ;DkGg eof.] pkl:ylt bxfo] cfod'''''ns / ;Lkd'''''ns adflhd] 5g \ . sfo{{{{{qmd ul/Psf] lyof] . s_ :tg SofG;/af6 aRg ] pkfo pbok'/, rf}b08L uflj; If]qdf ljut pk :jf:Yo rf}sL}} gful/s j8f ;fndf cgfkrfl/s} dlxnf ;fIf/tf sIffdf v_ vfBa:t'df ePsf] ld;fj6n] kq ;DjGw xf]]]l8]] {{{Ë{{ af]]]8]] {{{{{ hghLjgdf c;/ pk :jf:Yo rfsLn} ] ul/g ] :jf:Yo pkrf/ u_ em08fn] Nofof] ue{jtL dlxnfx?sf] ;jf] / k4lt af/ ] ;j;fwf/0f{ hgtfx?nfO{ :jf:Yodf /rgfTds ;wf/' ;'- ;lrt" ug {] p2Zon] ] sfo { Ifqsf] & j6f 3_ ue{jtL dlxnfn] hfGg} kg]{ s'/fx? pk :jf:Yo rfsLx?df} gful/s j8f kqsf] ª_ tkfO{sf 3/df # 3/fo;L 8fS6/ xf]l8{Ë jf]8{ /flvof] . r_ dx lj/fdL hfFr k"""hf"" {{{ {{ ljt/0f 5_ nfdv'6[] eufpg] tLt]kftL pkof]uL pk :jf:Yo rfsLx?df} lgMzNs' btf { nfu' h_ s'v'/fsf] Kjfvaf6 lah'nL eP otf lj/fdL hfrF khf" { gkfn] ;/sf/n] ;xefuL eO{ ;fIf/ ePsf / xfn ;Dd em_ v+u hftL -;d'bfo_ Ps kl/ro kofKt| ljt/0f gu/sf] n,] ] lgMzNs' kfpg] jrt ;d"xx?df cfj4 eO{ /x]sf] `_ ;lIfKt+ kltj| bg] cfiflwx?sf} ] ;lr" / pk :jf:Yo rfsLsf} ] dlxnfx?nfO{ 5 dlxg ] l;nfO { s6[fO ;Lk 6_ afn sIff;DjGwL k|ult tflnsf lbO{ :j/f]huf/ agfpg] x]t'n] of] tflnd gful/s j8f kq ljj/0f ;dt,] #) xhf/ 7_ kmf6f] lkmr/] sflt{ssf] clGtd xKtfb]lv ;'? ul/of] . yfg 5fkL, x/s] pk :jf:Yo rfsLnfO} { % 9_ ;rf/df+ /:k] ms-kq] klqsfsf ] sl6u_+ xhf/ klt| lj/fdL khf" { pknJw u/fO { lyof] . ef}uf]lns ljs6tfsf sf/0fn] b'O{ 6f]ndf tflndsf] cfof]hgf ul/Psf]5 . rf}b08L oL c+sx? & ;o k|lt 5fkL :yfgLo Aofkf/Lsf]]]] C0faf6 d'''lQm uflj; ^ lzv/k/' / srgk+ /df' u/L @$ ;+w. ;+:yf ;/sf/L lgsfo, ;d'x, sfo{{{{{qmd hgf ;xeflutf /xsf] 5] . xfn ;Dd Hofb} cle?rLsf ;fy ;xeflux?n ] l;nfO { s6fO{ :jf:Yo If]qdf sfo{/t :jf:YosdL{ cflb pbok'/, ;Kt/L / uf]/vf lhNnfsf w]/} l;sL/xsf] 5g \ . ;+u7g / JolQmut ?kdf lgMz'Ns dlxnf ;d'xx?n] clxn] art tyf C0f ljt/0f ul/of] . sfo{qmd ;~rfngdf NofPsf 5g\ . /:k]]]]] ms]]]]] sf;]]]]] nL]]]]] cs+++++ !# ksflzt||||| dlxnfx?sf ] cflys{ tyf ;fdflhs cj:yf j[l4 ug{sf nflu o; s]Gb|sf] sfo{If]qdf o; ;:yfsf+ ] pbok/' / ;Kt/Ldf ;~rflnt ;~rflnt cgf}krfl/s sIffdf ;+nUg u|fdL0f :t/Lo sfo{qmdåf/f :jf:Yo / dlxnfx?nfO { jrt ;dx" agfO { dlxgfjf/L ljsf;sf af/]df art ug{ nufpg], art ePsf] /sd /]:km]s sf];]nL ;f]xL ;d"xsf dlxnfx?nfO{ C0f lbg], eGg] klqsfsf] pgLx?sf ] Ifdtf jl4[ tyf cfodns' ;Lk !@, !# cf +} cs+ l;sfpg], s/];faf/L;DaGwL tflnd lbg] k | sfzgnfO{ / pgLx?sf ] ;–zlQms/0fsf nflu ;xofu] o;jif{ klg ug]{ sfo{x? ub}{ cfPsf] 5 . o; ;+:yfsf] lg/Gt/tf lbOof ] . ;xof]udf pbok'/ / ;Kt/L lhNnfdf $! :jf:Yo tyf j6f / uf]/vf lhNnfdf #% j6f art ;d'bfodf eP ;d"xx?sf] u7g eO{ laleGg cfod'ns u/]sf ;fd'bflos lqmofsnfksf ;fy /]:km]ssf ljleGg ljsf;sf sfoqmd{ sfo{qmdx?df ;+nUg x'b} cfPsf 5g\ . tyf ;d'bfodf

7 jflifs{ kltj| bg] @))(

ufp+n]n] ;'tL{ lgoGq0fdf cfd;~rf/ /x]sf] lyof] . uf]i7Ldf 8f= /fh]Gb| a/fn, lyof] . of ] sfo { /Tgkfs,{ ;Gwf/f,' hdn, dfWodsf] e"ldsf af/], ;~rf/sdL{ tf]of xfdnfn] >i7,] afasfhL' aflgof,F l/t ' kwfg,| afuahf/, l;+xb/af/, gofF afg]Zj/, bfxfnn ] lgMzNs' :jf:Yo af/ ] / zfGtnfn ;lDgdf' tnfw/n' ] sfokq{ k:t| t' ug {' ePsf] sf6] Zj/] / nugvndf] a;/] ul/Psf ] lyof ] . dNdLn' ] wd' kfg| / o;sf ] c;/af/ ] sfo{ lyof] . kq kz] ug {' ePsf ] lyof ] . ;ldIff e|||||d0f ;'''''tL{{{{{ lgoGq0fsf r'''''gf}}}}}ltx? kqsf/j[[lQ OG6/g;gn] ufoG6| ;sf\ sfoqmd{ clwst[ kqsf/j[[[lQ & h'g @))( sf lbg /]:km]sn] x]Ny cg'/fwf vgfn;Fu hgj/L $ / %, @)!) g]kfnL / c+u|]hL klqsfdf sfo{/t xf/fOhg] gkfn;] usfF ] ;xsfodf{ gkfndf] df kult| ;dLIff a7ssf} ] cfofhgf] eof ] . kqsf/x?nfO { ;tL' ;DjGwL{ vfhd] ns' / ;tL' { lgoGq0f / rgf' lt} ljifos k/fdz{ ;ldIffsf nflu cd]l/sfaf6 cfPsf cg;Gwfgd' ns' ;fduL| k|sfzgsf nflu ufi7Lsf] ] cfofhgf] u¥of ] . kj" { :jf:Yo dGqLx? vgfnnfO{ sfo{sf/L lgb]{zs zfGtnfn kqsf/ jlQsf[ ] Joj:yf /:km] sn] ] u/sf] ] lyof] / k"j{ :Jff:Yo d'NdL, :jf:Yo dGqfnosf . h; cGtut{ cGgk0f" { kf:6,] /fOlhª gkfn,] ;lrjx?n ] cf–cfˆgf afn;fu/ lu/L / l/t' k|wfgn] gkfnsf] ] :jf:Yo, ojfd~r,' uf/vfkq] tyf cgej' cfbfg kbfg| gkfndf] ;tL' hGo{ a:tsf' ] l:ylt, cGo ;~rf/dfWoddf sfo{/t kqsf/ ug {' ePsf ] lyof] . ;f] sfg'gsf] cefj / eO/x]sf kqsdf/x?nfO { wd' kfg| tyf ;tL' sf{ ] ljifodf /fli6«o k/fdz{sf] ultljwL af/]df k|sfz kfg'{ k|sflzt ;dfrf/ ;fdu|Lsf] cfwf/df k|d'v p2]Zo ;'tL{ ePsf] lyof] . kqsf/jlQ[ kbfg| ul/Psf ] lyof ] . lgoGq0f tyf lgodg sfggnfo' { ;bgaf6 kfl/t u/fpgsf nflu ;/sf/nfO { bafa lbg' lkmN8 lelh6 ;tL''''' {{{{{ lgoGq0fdf ldl8ofsf ]]]]] eldsf""""" lyof] . ;~rf/sdL{;lxt ^# hgfsf] sfosf/L{ lgbzs{] zfGtnfn dNdL' / lkmN8 @^ kmj] j/Lsf| lbg /:km] sn] ] ;tL' { lgoGq0fdf ;xeflutfdf ePsf ] ;f ] sfoqmddf{ tLgj6f clws[t l/t' k|wfg lrtjg, gjnk/f;L, ldl8ofsf ] eldsf" ljifos sfoqmdsf{ ] cfofhgf] sfokq{ k:t| t' ePsf ] lyof ] . ?kGbxL,] slkna:t,' :ofªhf, sf:sL, tgx,F' u¥of ] . ;f ] ufi7Ldf] $) hgf ;~rf/sdLsf] ;'''tL'' {{{ {{ lgoGq0f sfg'''gsf'' ]]] ]] cefjdf ndh'ª / uf]/vfdf lkmN8 lelh6 u/L pkl:ylt /xsf] ] lyof ] . ;'tL' { { lgoGq0f cleofg lhNnfdf ePsf ultljlw tyf efjL ;''tL' {{ { lgoGq0f cleofg ofhgfaf/] ] 5nkmn ug {' ePsf ] lyof ] . sfg'''''gclws[[[[[t;“““““u a}}}}}7s gkfnsf] &% kltzteGbf| j9L hgtf kToIf| /:km] sn] ] ljleGg dGqfnodf sfo/t{ sfgg' ?kdf jf ckToIf| ?kdf wd' kfgaf6| ul;t| clws[tx?;“u !& h'nfO{sf lbg 5g \ . To;df klg j9Lh;f ] dlxnfx? kefljt| Pkm;L6L;L / ;'tL{ lgoGq0f sfg'g af/]df agsf] 5g\ . olx + jf:tljstfnfO { dWogh/ Ps j7ssf} ] cfofhgf] u¥of.] u/L $& j6f lhNnfdf ;tL' hGo{ j:t ' lgoGq0f tyf /x]sf :jf:Yo clwsf/ lgodg sfg'g lgdf{0f tyf ;tL' { goGq0f lhNnf u/fpgsf nflu bafa lbg] ;~hfnx?sf ] cujfO' df{ / sfg'g kfl/t u/]kl5 ;tL' { lgoGq0f sfggsf' ] cfkm;Dj4" dGqfnon ] ugkg{' {] cefjdf ;tL' { lgoGq0f sfdx?sf af/]df hfgsf/L cleofg gfds sfozfnf{ lbg' ;f] sfo{qmdsf] p2]Zo lyof] . ufi7Lx?sf] ] cfofhgf] ePsf ] lyof ] . :jf:Yo clwsf/ / ;tL''''' {{{{{ sfggdf''''' ;s08]]]]] Xof08 :dfls]]]]] Ë SoflDkog ljifos /fli6«««o«« k/fdz{{{{{ wd' kfgf6| cGo j/k/sf JolQmnfO { kg{] @& clk|nsf lbg /]:km]sn] :Jff:Yo ckToIf| c;/sf af/df] hfgsf/L lbg ] xt] n' ] clwsf/ / ;'tL{ lgoGq0f ljifos /fli6«o gfe] Da/] @@ blv] @& ;Dd uf8L rnfpbfF k/fdz{ uf]i7Lsf] cfof]hgf u¥of] . :jf:Yo wd' kfg| gu/f +} eGg ] cleofgsf ] cfofhgf] dGqfnosf sd{rf/L, cg';Gwfgstf{, ul/of] . ;ohgf :jo;+ jsx?] ljleGg * ;~rf/sdL{;lxt lhNnf ;~hfnsf :yfgdf a;/] ^ xhf/j6f l:6s/ ljt/0f k|ltlglwx?sf] ;f] uf]i7Ldf ;xeflutf ug {] tyf 6f:gF ] hgrtgf] hufpg ] sfo { ePsf]

9 jflifs{ kltj| bg] @))(

;rgf""""" tyf clenv]]]]] ;rgfsf""""" ]]]]] xsdf kTofe||||| lt"""""

:jf:Yo ;rgfsf" ] kxr,F' kljlw| / cfwf/et" gof F ylkPsf ljifox?df ;ljwfg;ef,+ ˆn," e"ldsf v]n]sf] x'G5 . /]:km]sn] ;g\ !((& ;rgf" / ;jfsf] af/ ] yfxf kfO { o;sf ] ;lx lj/fdL / 8fS6/sf] ;DaGw, a}b]lzs b]lv Pr=cfO{=eL=÷P8\;sf z}lIfs 9+un] k|of]u / lg0f{ox? ug{ ;s] sfdbf/ / lgMz'Ns :jf:Yo ;]jf /x]sf] 5 ;fduLx?| ljt/0f 3/ dfkmt{ ljlqm ljt/0f dflg;x?sf] :jf:Yo :t/ / ;dfhsf] . xfn;Dd $% j6f lSnlkª, $^ d'Vo ub}{ cfPsf] 5 . pTyfg x'g] ljZjf; ul/G5 . :jf:Yo ;]jf ljifo / ^) j6f ;x ljifo ;dflji6 tYox? / pkefQmfsf] ] dfu cg;f/' xfdLn] ;+:yf / hg:jf:Yo k|0ffnLsf] ;]jfx?sf] /x]sf] 5 . Pr=cfO=eL=÷P8{ ;sf\ ] dfq g/fvL :jf:Yo pknAwL af/ ] :jf:Yo ;rgfn" ] 7nf" ] eldsf" ;sngsf+ ljifox?M uektg,{ jfn :jf:Yo ;DaGwL ;a } zlIfs} ;fdfuLx?nfO| { ;sng+ v]n]sf] x'G5 . / ljsf;, u/L of] ;]jf lbO{ /fv]sf 5f}+ . o;} cg'?k hLjgdf ;lhnf ] ug{ hg:jf:Yo of] ;fn xfdLn] % nfv &^ xhf/ % ;o / lg0fo{ ug { tTsfn / ljsf;, @$ ?lkofFsf] ljlqm÷ljt/0f ul/of] . pknAw ;"rgf / åGå / ljlqm÷ljt/0f 3/af6 a9L eGbf a9L o;sf] pkof]usf] zflGt, JolQmx?n ] kmfObf{ lng ;sf;] \ eg/] o;af/] af/] h'g b'/L 5 ;ljwfg÷;+ ljwfg+ ;"rgf k|jå{g ug{ /]:km]sn] j]e;fO{6 To;nfO{ tTsfn} ;ef, bGt / agfPsf ] 5 . ;Djf]wg ug{' h?/L df} lvs 5 . :jf:Yo gLlt, :jf:Yo, ;"""rgfsf"" ]]] ]] ahf/ / ljt/0f ofhgfsf/,] kzf;s,| kvfnf, hg:jf:Yo ckfË / a9L eGbf a9L JolQmx?n ] :jf:Yo ;rgfx?" lj1x?nfO{ ljrf/ k'g{:yfkgf, af/] yfxf kfpg eg]/ o; o'lg6n] ljleGg u/]/ ljleGg /0fgLlt ;"rgf lng' kg]{ /fux?] af/,] bfg÷sfif,] cfifwL,} j4fj:yfsf[ ] sfoqmdx?df{ k:ts' tyf zlIfs} ;fduLsf| ] cfjZos b]lvG5 . o;}nfO{ dgg u/]/ :jf:Yo jftfj/0f, kl/jf/ lgof]hg / k|b{zg ug]{ u/]sf 5g\ eg] /]:km]ssf /:km] sn] ] ;rgf" tyf clenv] olg6dfkm' t{ hg;Vof,+ ˆn," lgzNs' :jf:Yo ;jf,] nlËs} ljleGg dfWofdaf6 :jf:Yo ;rgf," zlIfs} tyf dlxnf ljsf; e"d08nLs/0f, ;fdfu|L pknAw u/fpFb} cfPsf] 5 . Pr=cfO=eL=÷P8{ ;,\ :jf:Yo lzIff c:ktfn Joj:yfkg, cfO{6L÷nfOa]|/L÷kqsf/Ltf ;+++sng cfiflwd} ns" lj?jf÷hl8a6L,' dfgl;s /fu] ;g \ @))( df ljleGg ljifodf Ps ;o ab} lzs] /fhuf/,] dftlzz[ ' :jf:Yo, efhg] alQ; -!#@_ j6f lstfj, dfgf] u] fkm,| nv] ;+:yfx?, lj/fdL / 8fS6/sf] ;DaGw /rgfx? ;sng+ u/L oL ;fduLx?nfO| { k|fylds :jf:Yo ;]jf, ;DklQ k|Tofe'lt÷xsbfjL Dfgl;s ;fdflhs ;rLs/0f" ul/Psf ] 5 . o; olg6n' ] ljleGg ljleGg z}lIfs ;fdu|Lx? lgMz'Ns ljt/0f ;jfx?] kbfg| ub {} cfPsf ] 5 . :jf:Yo, hg;/Iff' jZofj] lQ[ ;DaGwL, ofjg} ;DaGwL ;fdflhs tyf :jf:Yo lj1fg, ug]{ sfd ;g\ @))( df klg hf/L g} cvjf/df k|||||sflzt ;"""""rgf ;tL' hGo{ kbfy { k/Dk/fuu cfiflw,} rnLa] 6L] /fv]sf] lyof] . ;fdfu||Lsf||| ]] ]]] ;++sng+++ -k]]k/]]] lSnlkË_ araLvg] l6=lj= /fu,] lx;f,+ dlxnf :jf:Yo . k|of]ustf{x?sf] dfusf] ;"rLdf /x]sf] :jf:Yo ljlqmljt/0f 3/ ;"rgfsf] ;|f]t dWo] k]k/ lSnlkª klg xf] . o;}+nfO{ dWo gh/ u/]/ of] ;fn k]k/ s'g} klg :jf:Yo tflnd, k/fdz{, lSnlkªdf $ j6f /fli6o« blgsaf6} ^ j6f cled"vLa/0f / :jf:Yo lzIffjf/] a'e\mg gofF ljifo ylkPsf] 5 . aemfpg' :jf:Yo zlIfs} ;fduLn| ] w/] } 7nf" ]

11 jflifs{ kltj| bg] @))(

nueu @%) 3/w/Ldf' kmfx/d] nf} tyf >ft] cfofhgf] ul/g ] @ xKt ] cleofg ;fjhlgs{ cleofgdf :jo+;]jssf] ?kdf kl/rfng k|aGw s]Gb| tyf hfOsfsf] ;xof]udf ul/of] . @)^^ r}q @ ut] nlntk'/sf] ug{ h]leP/ OG6/g]zgn sn]h, g]kfn 6fsfs'/f sDkf]li6Ë k|lalwåfåf/f 3/ d} nugvn] blv] sk08f' n;Dd] Ps ¥ofnLsf] sn]h ckm 8]en]kd]G6 :6l8h tyf h}ljs kmf]x/af6 sDkf]i6 agfpg] tflnd cfof]hgf u/L cleofg z'? ul/of] . sfbDa/L d]df]l/on sn]hsf u/L nueu k|bfg ug{sf ;fy} sDkf]i6 aLg lat/0f cleofg cGtu{t nlntk'/ !)) hgf laBfyL{nfO{ dxfgul/o 6«flkms ul/of] . tflndsf] k|efjsfl/tf / pkdxfgu/kflnsf l:yt @* j6f Aoa:yf sfofnodf{ cledvLs/0f' tflnd sfofGjog{ dNof" sg+ klg ;do ;dodf ;k/dfs' 6÷:6f{] /df] :jo;+ js] kl/rfng lbOPsf] lyof] . eO/xsf] ] 5 . u/L kflnlyg] emfnf] kof| u] lg?T;flxt jL/ c:ktfn, kf6g c:ktfn, sf]6]Zj/, u/L 3/ af6} emf]nf Nofpg u|fxsnfO{ afuahf/ tyf hdn If]qdf WjgLsf] :t/ kf]]]]lnlyg emf]]]]nf k|||of]]]u la?4sf]]] kf| T;fxg] ugsf{' ;fy } hfgsf/Ldns" krf{ cleofg /]s8{ ul/of] . sf7df8f}+sf] sf]6]Zj/, klg lat/0f ul/of] . ;fy} afg]Zj/, l;+xb/jf/, ;'Gwf/f, Go"/f]8, xnsf' ,] afSg] ;lhnf ] / ;lhn } pknAw xg' ] ;k/dfs' 6÷:6f{] /df] kflnlygsf] ] lasNksf] /Tgkfs{, hdn, b/jf/ dfu{ nufotsf xgfn' ] kflnlyg] emfnf] hgdfg;df nfslk] o| ?kdf sk8fsf] emf]nf klg pknAw If]q / nlntk'/sf] nugv]n, hfjnfv]n, 5 / cfhefln] ahf/df o;sf ] kof| u] lgs} u/fOPsf] lyof ] eg] 3/af6} emf]nf NofO{ dunahf/+ Ifqdf] :jo;+ js] kl/rfng ul/ a9]sf] 5 . t/ o;sf] plrt k|of]u tyf kflnlyg] kof| u] gug {] ufxsnfO| { kf| T;fxg] nueu *,))) j6f :6Ls/ 6f+:g] tyf Aoa:yfkg x'g g;Sbf o;n] zx/L :j?k skg' / nlSs 8 « sf ] Aoa:yf ul/Psf] !!,))) krf{ af8\g] sfo{ ul/of] . jL/ jftfj/0fnfO{ lgs} c;/ kfl//x]sf] 5 . lyof] . c:ktfn Ifqdf] hgdfg;sf ] Wofgsif0fsf{ ;fy } o;n ] jftfj/0f dfq kb| lift' ug {] geO{ laZj jftfj/0f lbj; @))( sf ] cj;/df nflu @)^^ d+l;/ !) / !! df æxg{ dfgj tyf hgfj/sf] :jf:Yodf ;d]t n=k ' j8f g + @) sf ^ j6f laBfnonfO{ gahfcf}+, ;Eotfsf] kl/ro lbcf}+Æ c+lst k|lts"n c;/ kf/]sf] kfOG5 / ;fydf kfnlyg] dQm' Ifq] 3fif0ff] ul/Psf ] lyof ] eg] Aofg/ kbz| g{ ul/of ] . ;jf/L rfns dfem ko{6g Joj;fodf klg gsf/fTds k|efj bz] s } Ps dfq ;b/ lrl8ofvfgf klg WjgL k|b'if0fsf] c;/ tyf k/sf] ] 5 . o; +} s/fnfO' { dgg \ u//] ækflnlyg] kfnlyg] dQm' Ifq] 3fif0ff] ul/Psfdf] ;xofu] lgod÷b08hl/jfgf af/ ] rtgfsf] ] dNof" sg+ :j?k !)) j6f sk8fsf ] emfnf] / @ dlxgf ;Dd :jo;+ js] kl/rfng ul/Psf ] lyof ] . ;fy } kfnlyg] ;DaGwL Ps aQlrq[ lgdf0f{ u/L k|bz{g ul/Psf] lyof] . hgr]tgf kmnfpg} ] clekfon| ] ;f ] aQlrq[ lalelGg laBfnox? tyf ;dbfodf' kbz| g{ ug {] sfo{ e/x} sf] ] 5 . x6fcf}+, jftfj/0f hf]ufcf}+Æ eGg] gf/fsf WjgL k|||||b'''''if0f la?4sf]]]]] cleofg ug { Ps cWoog ul/of] . cWoog cg;f/' ;fy o; s]Gb|n] kf]lnlyg emf]nf k|of]u c:ktfn tyf z}lIfs ;+:yf jl/k/Lsf kfoh;f| ] ;fjhlgs{ ;jf/Lsf rfns ;fwf/0f la?4sf] cleofg g} rnfPsf] 5 . If]q æxg{ lgif]lwt If]qÆ elgP tfklg nvk9] ug { hfGg ] kfOof ] eg ] pgLx?n] kf]lnlyg emf]nfsf] plrt lasNk lagf g} Aoaxf/df Tolt nfu" ePsf] kfO{+b}g . c:ktfn Ifq] xg { lgiflwt] Ifq] /xsf] ] 1fg o;df kltaGw| nufPdf ;f ] Aoaxfl/s gxg' ] t;y{, jL/ c:ktfn If]q xg{ lgif]lwt xbf+' xb+' } klg kl/l:yltjz jf xg { ahfpg] 7x/ ub {} o; >ft] sGb] n| ] ækflnlyg] emfnf] If]q /x]sf] ;fpg @)^^ sflt{s @@ ut] afgL k/sf] sf/0f xg { ahfpg ] atfP . pTkfbg, lat/0f, k|of]u tyf la;h{g aL/ c:ktfn kl/;/df æxg { lgiflwt] IfqÆ] cleofgsf] clGtd lbg d+l;/ !@ df lgodg P]gsf] cfjZostfÆ af/] @)^^ c+lst xf]l8{Ë af]8{ h8fg ul/Psf] 5 . /Tgkfs{ l:yt zflGt afl6sf af6 Ps >fj0f @% ut] xf]6n lxdfnodf dfggLo xgaf6{ xg' ] WjgL kb| if0f' ;DaGwL hgrtgf] ¥ofnLsf] cfof]hgf ul/of] . pQm ¥ofnLdf jftfj/0f dGqL >L 7fs'/k|;fb zdf{sf] k}mnfpg] pb]Zon] @)^^ d+l;/ & b]lv laBfyL{, laleGg ;+3;+:yfsf k|ltlglw, kd| v' cfltYotfdf Ps sfozfnf{ ufi7Lsf] ] d+l;/ !@ ;Dd laleGg sfo{qmdx?sf] /]:k]ms tyf n'hM g]kfnsf k|ltlglw u/L cfof]hgf ul/of] . cfof]hgf u/L ;KtfxAofkL cleofg nueu @)) hgfsf ] ;xeflutf /xof\ ] eg] @)^^ kmfu'g !* ut] Ps kqsf/ ;+rfng ul/of] . cleofg af/] hfgsf/L ¥ofnL eb|sfnL, zlxb u]6, ;'Gwf/f, jL/ ;Dd]ngsf] cfof]hgf u/L @)^^ r}q @ lbg d+l;/ @ df Ps kqsf/ e]63f6sf] c:ktfn, hdnsf] kl/qmdf ub}{ zflGt b]lv @* ;Dd laleGg sfo{qmd u/L cfof]hgf ul/of] . afl6sf d } 6luPsf+' ] lyof ] .

13 jflifs{ kltj| bg] @))(

;fdu|L klg /flvPsf] lyof] . cf}ifwLsf] zf]if0f, dlxnf clwsf/ cflb pd]/df t xf8 lvOg] ;d:ofn] z/L/sf ;lx pkof]u gu/]sf sf/0f ;dfhdf ljifoj:t'x?nfO{ ;d]l6Psf] x'G5 . c+u k|To+u b'Vg yfN5 . xf8sf] 3gTj o;sf] k|lts'n c;/ kb}{ uPsf] c++s+++ %)M ;g\ @))( ;Ddsf] ofqfdf sd x'Fb} uP/ x'g] /f]u cl:6cf]kf]/f]l;; kl/b[ionfO{ dWogh/ u/L ;f] c+sdf dlxnf :Jff:Yo q}dfl;sn] :j0f{ ofqf to xf] . kf/fl;6fdf]nsf] ;xL pkof]u s;/L ug]{ u¥of.] dlxnf :jf:Yosf ] :j0ffÍdf{ lgoldt o; %! cf}+ c+sdf cl:6cf]kf]/f]l;;sf eGg] ljifodf Pp6f n]v /flvPsf] lyof] . :tDex?eGbf k[ys vfnsf] af/]df rrf{ ul/Psf 5g\ . c+++s !)$M o; c+sdf rfprfp, kf7\o;fdu|Lx? ;dflji6 ul/Psf lyP . ;f]xL c+sdf 9f8 b'Vg] ;d:ofM sf/0f, cfn'lrK;, rLhan, kLg6;\, kfp/f]6L, h;df dlxnf :Jff:Yosf] af/]df sljtf, lgjf/0f / pkrf/, lsg b'V5 9f8, 9f8 s]s:tf k'l/ofaGbL vfhfsf] ljsNk vf]Hg] uhn, z'esfdgf, kf7sx?sf] kq, b'Vg] ;d:ofaf6 aRg] ;lhnf pkfox?, k|of; ePsf] 5 . o; c+sdf h+s km'8 / ;+:d/0fx?, :jf:Yo, dlxnf clwsf/ tyf :qL/f]usf] sf/0fn] klg 9f8 b'V5 af/] o;sf] ljsNkaf/] vf]hd"ns ;fdu|L xslxtsf af/]df ePsf /fli6«o tyf klg pNn]v ul/Psf 5g\ . clGtd kf6f]df k|:t't ul/Psf] lyof] . o;+}u/L df};d cGt/fli6«o ;lGw, cle;lGwx?, k|hgg\ :jf:Yo lgMz'Ns ljifodf Pp6f cg;f/sf' ] efhgaf/] ] klg o; csdf+ rrf{ lgodsfg'gx? Tyf dlxnf :jf:Yo rrf{ n]v ;dflji6 ul/Psf] 5 . ePsf] 5 . ul/Psf 5g\ . c++s+++ %@M dlxnfx? dlxgfjf/Lsf] ;dodf c++s+ !)%M c+s+ !)%M of] c+sdf klg ;Gt'lnt / o; csdf+ dlxnf :jf:Yodf dlxnf :Jff:Yo xg' ] ljleGg ;d:ofaf6 kLl8t 5g \ . o;sf :j:ys/ vfgf tyf kf}li6s vfgfsf] klqsfsf] e"ldsf af/] b]jL u'?ª / s]zj ;fy } khgg| \ pd/] ;skl5] xg' ] /hgfj] lQsf[ ] af/]df rrf{ ePsf] 5 . o;df vf;u/L yfkfn] ;+:d/0ffTds cfn]v n]Vg' ePsf] ;d:ofaf6 u|l;t 5g\ . :j:ytfsf nflu ;f]l8od / kmfOa/sf] 5 . o;+}u/L sf]dn e§/fO{n] af]S;Lsf] k|of]usf ;DjGwdf ;fdu|L /flvPsf] 5 . gfddf xg' ] lx;fx?,+ ;lgtf' s;Ln] ] dftd[ To[ ' olx s'/fnfO{ b[li6ut u/L dlxnf :jf:Yo To:t} slAhot x6fpg] s]xL pkfo, / o;sf ;fdflhs sf/s tTjx? , 8f= %@ cf}+ c+sdf dlxgfjf/LM Ps k|fs[lts slAhotaf6 x'g] ;d:of / arfj6sf c?0ff pktLn]| ] cfª v:g ] ;d:ofaf/ ] rrf{ k|lqmof eGg] d'n n]v ;dflji6 ul/Psf] ;DjGwdf klg ;f] c+sdf pNn]v ul/Psf] u/]sf 5g\ . dlxnf :jf:Yo / /fHosf] lyof] . h;df dlxgfjf/L lsg x'G5, 5 . bfloTj ljifodf Hof]tL kf}8]nn] / dlxnf dlxgfjf/L s'g pd]/df ;'? x'G5, lj?4 ;j} k|sf/sf] e]befj pGd'ng ug]{ dlxgfjf/Lsf ] ;dorqm lsg kl/jtg{ xG5' To:t} vfBa:t'df ePsf] ld;fj6n] ,dlxgfjf/L xbfF' s ] s:tf ;d:of cfOk5g,{ hghLjgdf kf/]sf] c;/ af/] klg Pp6f dxf;lGwsf ] af/df] ;idf' yfkfn ] nv] nVg] ' ePsf] 5 . dlxgfjf/L / ;/;kmfO{ af/] rrf{ kl/rrf{ ;fdu|L ;f] c+sdf /x]sf] 5 . ;f] c+ssf] ul/Psf 5g\ . clGtd kftf]df sfo{ / :jf:Yo tyf c++s+++ %!M 9f8 b'Vg] /f]u ;j}sf] ;fd'lxs hl8a'6Låf/f pkrf/ eg] Pp6f n]v ;d:of xf]. vf;u/L k|hgg\ pd]/sf To:t } /hfgf] j] lQ[ xbfF' bvfkg] {] sxL] ;d:of, /flvPsf] 5 . dlxnfx?nfO{ z/L/df ePsf ljz]if dlxgfjf/Lk|lt /x]sf unt wf/0ff, xdf]{gx?n] :jf:YosdL;{ uF ;Nnfx lngkg' {] cj:yfaf/] dlxnf :jf:Yo k | fs[ lts uxlsnf] n]v k|:t't ul/Psf] 5 . k|fylds :Jff:Yo ;]jf ;|f]t ?kdf w]/} c+++s++ %#M o; c+sdf lszf]/fj:yfdf s]Gb|n] ;g\ !((% sf] ;d:ofx?af6 x'g] zfl//Ls tyf dfgl;s kl/jt{gsf ;]K6]Da/ !* cyf{t lj;+ arfPsf af/]df rrf{ ePsf] 5 . To:t} uef{j:yfdf @)%@ c;f]h @ ut]b]lv x'G5g\ . t/ ug'{kg]{ :ofxf/ ;';f/ klg c+s %# df q}dfl;s ?kdf dlxnf klg 9f8 b'Vg] ;dflji6 ePsf] 5. :jf:Yo ;]jfsf] cefj :jf:Yo klqsf k|sfzg ub{} ;d:of klg / u|fdL0f e]udf :jf:Yosf] r]tgfsf] cfPsf] 5 . o; klqsfdf ;femf cefjsf sf/0f /fhwfgLsf] Pp6f ufpFdf dlxnfx?sf ] :jf:Yodf nfUg] ;d:ofsf] tLg}hgfsf] csfndf Hofg uPsf] af/] /f]ux?, To;sf] klxrfg, ?kdf /xFb} Pp6f cfn]v klg olx c+sdf ;dflji6 pkrf/ ug]{ ljlwx?, cfPsf] 5 . ePsf] 5 . lnËe]baf6 pTkGg x'g] cem $% b]lv /f]ux?, dlxnfdfly x'g] %) jif{sf]

15 jflifs{ kltj| bg] @))(

cGt/fli6o« ;fembf/L] / ;xsfo{ ;tL' { lgoGq0f

;'''tL'' {{{ {{ lgoGq0f k}}}/aLaf/}} ]]] ]] cWoog ;'''tL'' {{{ {{ lgoGq0f / :jf:Yo;DjGwL ;Ddngdf] gkfnsf] tLghgf :jf:Yo kqsf/ e|||d0f !$ cf}}}++}}+ ++ ljZj ;Dd]]]ng]] x? k"0f{eQm b'jfn, clgn Gof}kfg] / eQm yfkf ;xeflu x'g'eof] . b o'lgogsf] ;'tL{ lgoGq0f;DjlGw ljljw kIfsf] ! ;o @) j6f bzsf] emG8 } @ xhf/ ;xof]udf js{ km/ a]6/ a+unfb]z hfgsf/L lngsf nflu o; /]:km]ssf hgfsf] ;xeflutfdf ePsf] ;f] ;Dd]ng -8An'=aL=aL_ sf] cfof]hgfdf ePsf] ;f] sfo{sf/L lgb]{zs zfGtnfn d'NdL @& * dfrb{ lv] !@ ;Dd dDaO' { 3fif0ffkq] ;Ddngdf] >Lnsf,+ yfONofG8, OG8fg] l;of,] hgj/Lb]lv @ km]j|]c/L @))( ;Dd hf/L ub}{ ;DkGg ePsf] lyof] . sfo{sf/L g]kfn / a+unfb]zsf] ;xeflutf /x]sf] lgbzs{] d'NdLn] ;f] ;Dd]ngdf g]kfndf lyof] . h;df g]kfnsf] tkm{af6 ;'tL{ lgoGq0fsf nflu /fhgLlts cfd;~rf/ cleofg / $* j6f lhNnfdf bnx?;Fu k}/aL ;DjGwdf sfo{kq k|:t't ug'{ ePsf] lyof] . cfO=Pg=aL=y|||||L= j}}}}}7s PkmP;Lsf] k|fof]hgdf zfGtnfn d'NdL cfO=Pg=aL=yL=| j7sdf} ;xeflu xg' eof' ] . h]g]efdf @* h'gb]lv % h'nfO{;Dd ;f] c:6«]lnofsf] l;8\gLdf cWoog e|d0f j7s} ePsf ] lyof ] . pxf F @& hgdf' ePsf] eO/x]sf :jf:Yo clwsf/ tyf ;'tL{ hfg' ePsf] lyof] . PS;g cg :df]lsª Pkm;LP lalkmªdf| klg ;xeflu xg' ' ePsf] lgoGq0f ;~hfnsf af/]df cg'ej PG8 x]Nysf] lgdGq0ffdf pxfF ;f]tkm{ lyof] . h;df :jf:Yo tyf hg;+Vof cfbfgk|bfg ul/Psf] lyof] . hfg ' ePsf ] xf ] . pxfnF ] c:6lnof]« SofG;/ dGqfnosf afa'sfhL aflgofFsf] klg sfplG;n tyf x[bo k|lti7fg, SofG;/ ;xeflutf /x]sf] lyof] . OlG:6Ro'6sf] klg e|d0f ug'{sf ;fy} Pkm;LPsf cWoIf df/L c;'G6f;Fu cfO=Pr=kL=sf]]]]] slG6««««« l/;r{{{{{/df 5nkmn ug'{ePsf] lyof] . lgo'''''Qm An''Dau''' {{ {{{ ;fem]]bf/;]]] ++u+++ k""j""" {{ {{{ ;Dd]]ng]]] ;]K6]Da/ @))& df cGt/fli6«o :jf:Yo / j}}}7s}} ;fem]bf/ tyf ;DjlGwt lgsfo- cfO=Pr=kL=_ / ljZj :jf:Yo Ph]G;L, /]:km]ssf sfo{sf/L lgb]{zs zfGtnfn ;xof]ustf{, gful/s ;dfh ;+u7g;Fu d'NdL ef/tsf] d'DaO{df %–& dfr{;Dd ;fem]bf/L ePsf] lyof] . h;df g]kfn ePsf ] AnDau' { ;fembf/x?sf] ] Pkm;LP kj" { klg ;xeflu /x]sf] 5 . g]kfndf x'g] ;Dd]ng / j}7sdf ;xefuL x'g'eof] . ;f] k|lqmofsf] ;xhtfsf nflu sfo{sf/L j}7sdf pxfFn] PnfoG; ljlN8ª ;DjlGw lgb]{zs zfGtnfn d'NdLnfO{ cfO=Pr=kL=sf] g]kfnsf] slG6« l/;r{/sf] ?kdf rog ul/of] .

;'''''tL{{{{{ lgoGq0f;DjGwL If]]]]]qLo ;Dd]]]]]ng sfo{kq k|:t't ug'{ ePsf] lyof] . h;df a+unfb]zsf] 9fsfdf @! clk|nb]lv @@ Go"of]s{sf pkk|d'vn] v'n]/ k|z+zf ug'{ clkn;Dd| ;DkGg ePsf ] ;tL' { lgoGq0fdf ePsf] lyof] . cg'ej cfbfgk|bfg;DjlGw If]qLo

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