Reaching the Hard to Reach

PART 1: Beyond Geographic Barriers

Suchi Gaur, Ph.D., HOPE’s Communication Specialist in Southeast Asia, visited outlying regions of Nepal where Project HOPE is working to improve health for mothers and children in the most challenging geographic conditions. This is the first in a three-part blog series about her experiences.

When most people spoke of Nepal prior to 2015, they referred to the beautiful landscapes, Buddhist shrines, Mount Everest. But after the April 2015 earthquake, people began to look at Nepal differently. The earthquake exposed existing issues in the regional corners of Nepal and also brought new problems, particularly regarding access to health care services and resources.

Health indicators are poor in rural Nepal, compared to national and district data, especially in the remote Makwanpur area, where access to health care is especially challenging. Project HOPE’s SPARSH-M program for maternal and child health operates in five Village Development Committees (VDCs) of this district, within the marginalized and disadvantaged Chepang and Tamang communities. The program is funded by the Center for Disaster Philanthropy and Project HOPE, and implemented in collaboration with the Nepal Public Health Foundation.

During my recent visit to the program site in Makwanpur’s Raksirang block area, I got an opportunity to not only meet and train the local field team at Hetauda, Makwanpur, but also travel across to Raksirang and interact with the team as they engaged with mothers and adolescent girls, strengthening the health program at the very basic, ground level.

Early morning, as we drove to the local village, we crossed a semi-dry riverbed for a few miles to reach the Raksirang VDC. With untimely rain and water filling up the cervices of the riverbed, our travel turned difficult. While the team discussed going back to the local office or going towards the VDC, I looked around and realized that this region can be completely cut off from the mainland during the monsoon season. The fact that this is one of the most inaccessible and marginalized areas of the country made me think about a complexity of issues regarding community mobilization, the presence or  absence of local governance and support, the presence or absence of health facilities and sustainability factors associated with every single health activity implemented in the region.

I observed how this community struggled with traveling all the way from different villages situated on different hills to use these services and imagined how hard it would be for a pregnant woman to walk down to meet the health care provider.

I observed how this community struggled with traveling
all the way from different villages situated on different hills
to use these services and imagined how hard it would be for
a pregnant woman to walk down to meet the health care provider.

Eventually, we managed to reach the entry point for the VDC. With a steep walk to the main area, and no designated walk-way, we managed to reach a flat area, which was the center for all services in the VDC. A quiet, unhygienic and unplanned place, I realized how difficult it must be for the people living on different hills and villages to get to this location to access basic health services.

With SPARSH-M, one of the key objectives has been to improve access and utilization of maternal, neonatal, child health, nutrition services and hygiene practices.  I observed how this community struggled with traveling all the way from different villages situated on different hills to use these services and immediately imagined how hard it would be for a pregnant woman to walk down to meet the health care provider.

I am proud that HOPE’s SPARSH-M program is working to address this major challenge in maternal and neonatal health in this remote region, including ensuring that health services are available in every VDC, in an accessible way: training health staff, providing a mobile skilled birth attendant as well as a social mobilizer to act as an immediate help in times of stress.