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Eval Report Styles Only UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES EVALUATION AND POLICY ANALYSIS UNIT Refugee health in Nepal Joint UNHCR-WHO evaluation of health and health programmes in Bhutanese refugee camps in Nepal Muireann Brennan, Oleg Bilukha Marleen Bosmans, B.R Dahal, EPAU/2005/04 Kandarpa Chandra Jha April 2005 Evaluation and Policy Analysis Unit UNHCR’s Evaluation and Policy Analysis Unit (EPAU) is committed to the systematic examination and assessment of UNHCR projects, programmes, policies and practices. EPAU also promotes rigorous research on issues related to the work of UNHCR and encourages an active exchange of ideas and information between humanitarian practitioners, policymakers and the academic community. All of these activities are undertaken with the purpose of enhancing UNHCR’s capacity to fulfill its mandate on behalf of refugees and other people of concern to the organization. The work of the unit is guided by the principles of transparency, independence, consultation, relevance and integrity. Evaluation and Policy Analysis Unit United Nations High Commissioner for Refugees Case Postale 2500 1211 Geneva 2 Switzerland Tel: (41 22) 739 8949 Fax: (41 22) 739 7344 e-mail: [email protected] internet: www.unhcr.org/epau All EPAU evaluation reports are placed in the public domain. Electronic versions are posted on the UNHCR website and hard copies can be obtained by contacting EPAU. They may be quoted, cited and copied, provided that the source is acknowledged. The views expressed in EPAU publications are not necessarily those of UNHCR. The designations and maps used do not imply the expression of any opinion or recognition on the part of UNHCR concerning the legal status of a territory or of its authorities. This evaluation report is one of a series of three health evaluations conducted in late 2003 among refugee populations. The purpose of these evaluations is not only to improve health service delivery to those populations, but also to act as pilot evaluations for a broader "Inter-agency Health Services Evaluation in Humanitarian Crises" initiative. This initiative was launched by a group of non-governmental organizations, UN agencies, and academic institutions, and was stimulated by the lack of coherent, routine evaluations of the health of affected populations in crises. It has received funds from the US Bureau for Population, Refugees, and Migration. The experience of these evaluations will inform the development of a standardized health evaluation framework for use in responding to humanitarian crises. Table of Content Executive Summary and Recommendations.................................................................... 1 Main observations............................................................................................................... 1 Major recommendations ..................................................................................................... 2 Introduction............................................................................................................................ 3 External Context................................................................................................................. 3 Internal Context.................................................................................................................. 3 Methodology .......................................................................................................................... 5 Evaluation Team Composition............................................................................................ 5 Camp Selection ................................................................................................................... 5 Quantitative Methods - Health........................................................................................... 5 Quantitative Methods - Nutrition...................................................................................... 6 Qualitative Research - Sexual and Reproductive Health.................................................... 6 Qualitative Methods - Nutrition ........................................................................................ 7 Findings and Recommendations ........................................................................................ 9 Demographic Data.............................................................................................................. 9 Crude and Under-five Mortality Rates ............................................................................ 10 Other Selected Mortality Rates. ....................................................................................... 11 Verification of mortality reporting in Beldangi I.............................................................. 12 Morbidity.......................................................................................................................... 14 Quality of Health Service Delivery................................................................................... 16 Basic Health Units .................................................................................................................16 Primary Health Care Centres (PHCC)................................................................................18 Specific Health Programmes and Cross Cutting Issues ................................................... 19 Communicable Disease Control..........................................................................................19 Extended Programme on Immunisation (EPI)..................................................................20 Mental health .........................................................................................................................20 Essential Drugs and Supplies ..............................................................................................20 Health Education...................................................................................................................20 Chronic Diseases ...................................................................................................................21 The Health Information System (HIS)................................................................................21 Nutrition........................................................................................................................... 21 Annual Nutrition Surveys - Major Trends.........................................................................21 Methodological Issues with Nutrition Surveys.................................................................22 Growth Monitoring .......................................................................................................... 23 Mass Nutrition Screening ................................................................................................ 24 Supplementary Feeding Programmes............................................................................... 25 Therapeutic Feeding Programmes (TFP).......................................................................... 28 Distribution of General Rations and Food Basket Monitoring ........................................ 28 Micronutrient Deficiencies............................................................................................... 29 Eating Habits and Attitudes towards Foods..................................................................... 31 Feeding of Infants and Young Children. .......................................................................... 32 Reproductive Health ......................................................................................................... 33 Overall Programme...............................................................................................................33 KAP Survey............................................................................................................................34 Reproductive Health Unit (RHU) .......................................................................................34 Lack of Privacy, Confidentiality and the Proportion of Female Staff ............................35 Family Planning.....................................................................................................................36 Antenatal Care, Deliveries, Abortion and Post-abortion Care........................................37 STI/HIV/AIDS Knowledge and Awareness ....................................................................39 Counselling and Treatment .................................................................................................40 Sexual and Gender-based Violence ................................................................................... 41 Referral System and SGBV Prevention Programmes .......................................................41 Information and Communication .......................................................................................43 Attitudes toward Victims of SGBV .....................................................................................44 Recognition of Polygamy and Domestic Violence............................................................45 Early Marriage, Early Pregnancy and School Dropout....................................................46 Sexual Education and SRH Provisions...............................................................................47 Youth Programmes ...............................................................................................................48
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