Government of Ministry of Health and Population CASE STUDY

Inspiring through actions A rural municipality’s experience with health reform offers testament to the potential for change at the community level under good leadership and prioritization

o understand how crucial Brahmins and people from the marginalized the foundation for cooperation. For this, strong leadership is for social Dalit community, spread across six wards. he began to hold frequent meetings and transformation, one need to look dialogues with both government officials no further than the When the Chairperson first took office including the health workers. RuralT Municipality and the radical change following the local elections, the state of that healthcare service delivery has recently healthcare services in the rural municipality The Chairperson was also determined undergone therein. Playing a central role in was far from ideal. The five existing health to utilize the expertise and experience this is the rural municipality’s Chairperson posts were ill-equipped and health workers of health professionals to create a more whose proactive, people-centric approach to were in short supply. In fact, locals were forward-looking environment overall. the issue has given the healthcare system in forced to walk two hours to get to the During consultations – both formal and the area a much-needed uplift. nearest district-level facility, even for minor informal – he urged health staff and facility ailments. Not surprisingly, there was a in-charges to share not only their concerns Located in District in far-western general sense of dissatisfaction with health but also innovative ideas for policies and Nepal, present-day Ajayameru was formed facilities among Ajayameru residents. programmes to improve public health in 2017 by the merging of five former Village services. As a result of these discussions, Development Committees – Dewaldibaypur, Recognizing the need for affordable and various schemes were reviewed and re- , Bhadrapur, Ajayameru and Samaeji accessible healthcare, the Chairperson knew designed according to local requirements. – as part of the country’s shift to a federal he had to get the ball rolling quickly. The system of governance. It comprises a first step was to gain the confidence and That health reformh as increasingly become population of 17,066, dominated by , ownership of stakeholders, thereby setting a priority for Ajayameru is evident in its budget allotment. In the fiscal year 2017/18, in CHU by the newly elected local n Distribution of free of locally- around NRs. 4,500,000 was allocated to representatives. manufactured high-nutrient flour – a healthcare. This was increased by nearly one mix of soybeans, corn, wheat and third (31%) to NRS 5,900,000 in 2018/19. n Revamping of all five health posts with barley – and clarified cow butter to essential equipment, including for mothers as part of the Golden 1,000 Thanks to these focused efforts, the health birthing facilities, as well as laboratory Days campaign through health sector in Ajayameru witnessed various and nebulizer services. facilities. positive developments in the fiscal year 2017/18. These included: n Increased uptake of maternal and The role played by the chairperson in these child health services, including milestones was well acknowledged during a n Unveiling of the Health and Sanitation institutional delivery thanks to a) recent discussion between the Department Act 2075 (2018), one of the first provision of performance-based of International Development (DFID)-funded municipalities to have its own Act. incentives to Female Community Nepal Health Sector Service Programme The Act is in the link http://www. Health Volunteers; b) coverage of (NHSSP) and stakeholders. An apparent ajayamerumun.gov.np/act-law- mobile phone costs for Auxiliary display of team work was seen at the directives. The Act delves into basic Nurse Midwives working at health interaction when health coordinators praised health services provider and its facilities; and c) provision of packages the Chairperson’s dedication to reform management while discussing on containing food and hygiene items to and strengthening of the health system, standards to establish and operate pregnant women to encourage them often going beyond the call of duty. As an health facilities. It also includes to get regular ante-natal check-ups. example, they cited the time the chairperson provisions for health professional had liaised with an NGO to bring dental n Introduction of hand-washing and health volunteers and provisions equipment from Kathmandu for a health equipment and nail-cutting services for procurement, storage and post in Ajayameru. distribution of medicines and health at health facilities. Over 1,000 people equipment. It also sets out minimum benefitted from these services in the Of course, with Nepal having newly cost and quality for health services fiscal year 2017/18. transitioned to a federalized administrative and provisions for social security set-up and responsibilities now devolved n Provision of computers and printers to monitoring among others. to provincial and local levels, there remain all health facilities. numerous issues to iron out. Clarity, for n Establishment of two new Community n Installment of CCTVs and instance, is still lacking on certain conceptual, Health Units (CHUs), one of which e-attendance system for staff in all programmatic and policy areas, with guidance also functions as a birthing centre and health facilities. and support yet to come from the federal level. two more CHUs will be added in FY There are also logistical hurdles to overcome, 2076/77. n Mobilizing community health workers including acquiring an office building. (CHW) to conduct community-level n The CHU of Ward No. 6 is being health-related activities. Each ward All these challenges make what Ajayameru upgraded to health post. The federal has a designated CHW responsible has achieved so far in terms of health reform government has already allocated for regular outreach campaigns and all the more impressive. And with the budget for the construction of the collecting information on the health Chairperson at the helm, there is likely to be health post building. The laboratory status of their respective wards. more to celebrate in the days to come. and birthing centre were added