Health System Strengthening

Since 2009, HealthRight has worked to strengthen the maternal and infant health care system in Nepal. Neonatal mortality in Nepal is 33 per 1,000 live births, accounting for 61% of under-five deaths and 72% of all infant deaths. While maternal mortality has declined in recent years, it remains unacceptably high, with 229 to 281 deaths per 100,000 live births. Further reduction of these rates presents significant health systems challenges. Safe delivery, newborn care, and postnatal care can reduce morbidity and mortality. Nepal is aiming to achieve Millennium Development Goals (MDGs) 4 and 5; however, only 36% of babies are delivered by a skilled provider, and less than half of women receive postnatal care within the first two days following delivery.

Between 2009 to 2013, HealthRight Nepal adapted and piloted maternal and neonatal near miss reviews (MNNR) in selected areas of Nepal’s Arghakhanchi district, as part of a multi-faceted effort to document and strengthen maternal and neonatal care (MNC) throughout the health system. HealthRight trained maternal health practitioners, including Female Community Health Volunteers (FCHVs), Health Facility Operation and Management Committees (HFOMCs), and other health workers to participate in near miss reviews – an important practice aimed at identifying ways to improve the quality of maternal health care.

In 2014, HealthRight Nepal received funding from the World Health Organization to undertake an implementation research project to scale up work on MNNR in Arghakhanchi through 2016. The overall goal of this study was to understand how district-wide maternal and neonatal near miss reviews can be implemented and scaled up through the existing health system in Nepal.

In December 2014 and January 2015, HealthRight facilitated two MNNR trainings in Arghakhanchi for a total of 122 health workers, including medical officers, staff nurses, auxiliary nurse midwives, health assistants and district supervisors, from 15 health facilities and the District Health Office. Following these trainings, the health facility teams began collecting near miss review data for preliminary analysis.