Kapil Gyawali

1
Kapil Gyawali

• I/NGO Role in Health Sector In Terai

2
Considering the role of NGOs
The following quotes suggest some different
opinions of the role of NGOs.
C civil society is not just a resting place
for social movements on their way to the state.
It is meaningful and sometimes crucial as a site
of political action in its own right.

• A NGOs are tugboats in international channels.

B social movements take an unlikely idea, make
it seem feasible, and then put it into practice.
D the rise of the global idiots any group
with a fax machine and a modem has the potential
to distort public debate .
3
Role of NGOs

• Enhancing the knowledge base
• Advocacy and lobbying
• Membership in national delegations
• Contribution to compliance review and enforcement
  as well as dispute settlement procedures
• Ensuring transparency
• Supporting international secretariats
• Broader functions of NGOs in international
  environmental governance

4
SHN/WATSAN project In Terai
Wel-Come Namastae
5
Background

• WAT/SAN contribute at various levels to address
  the health and nutrition problems of school-age
  children in Terai.
• The SHN program aims to improve the health and
  nutrition status of school children, thereby
  leading to improved school performance.
• From August 2007, SC/USA with partnership
  districts level NGOs, whih has scaled up the SHN
  program with SC/It and Media Friends support to
  include Water and Sanitation (Wat/San) activities
  in terai districts of Nepal.
• The WAT/SAN program focuses on behavior related
  areas which primarily lay emphasis on school
  based activities that aims to practice healthy
  behaviors related to nutrition, hygiene, and
  other practices for the participating children

6
NGO Role on SHN/WATSAN project

• NGOs play a crucial role in advancing and
  improving the effectiveness of deworming in the
  context of School Health and Nutrition (SHN)
  programmes.
• With experienced staff, technical expertise and
  strong local and national links, NGOs are able to
  pilot and scale-up model SHN programmes
  (including deworming) and carry out operational
  research.
• NGOs also influence national policy and advocate
  for and support the development and
  implementation of national SHN programmes.

7
Major activities under SHN/WATSAN project

• Weekly Iron supplementation for 13 weeks
• Semiannual de-worming to school children
• Hearing, Vision and Dental screening
• First Aid service management at school
• Installation of hand pumps for drinking water,
  Arsenic test and coliform test
• Construction of separate toilet for boys and
  girls
• Hand washing facilities
• Support for waste disposal system development
• SHN Management Training to Teachers and Health
  Workers
• Health education and demonstration sessions by
  trained teachers
• Child Initiative Program
• Program Coordination meeting at different levels
• Formation of District SHN Coordination Committee
  at district level
• Supervision, Monitoring and Evaluation

8
Objectives

• To ensure that a better health status in enjoyed
  by all Nepalese children through the promotion
  and implementation of School Health and Nutrition
  program at national level.

9

• Odds ratios is 0.44, CI (0.34 - 0.58) and
  chi-square (p000001) at 95 confident interval,
  according to this analysis the aneamia rate was
  significantly reduced before and after program in
  Terai, the prevalence of anaemia, 35.3 and 24.1
  of the sampled children had anaemia baseline and
  endline.
• Similarly odds ratios is 0.50, CI (0.39 - 0.64)
  and chi-square (p000001) at 95 confident
  interval, according to this analysis the
  prevalence rate of helminthes was significantly
  reduced before (52) and after project (35).

10
Quality of Services

• The overall quality of the health and nutrition
  services provided by the SHN/WATSAN project was
  very good.
• The quality has been assessed in terms of
  satisfaction by the students and concern groups
  for various services and processes, services
  provided through the Project, the technical
  competency of the providers and the quality of
  trainings offered.
• Students were found to be more satisfied and were
  also pleased with the program. They were very
  happy and comfortable with the service.

11
Coordination and coherence with national
policy/strategy

• School, Health and Nutrition addresses the
  critical health and nutrition factors that keep
  children out of school and inhibit their ability
  to learn.
• SHN is an integral part of education sector
  efforts to increase the access to and quality of
  primary education in terai.
• Many INGOs/NGOs, UN organizations, multilateral
  and bilateral agencies have been implementing or
  supporting the implementation in the various
  school health, nutrition and sanitation programs
  in different district of the country.
• For this reason, there is need for alignment and
  harmonization of the school health and nutrition
  activities to avoid duplication and improve the
  synergies among all the stakeholders involved in
  School Health Program.

12
Efficiency and effectiveness of the Project

• The project was designed to implement SNH/WATSAN
  in three districts Siraha, Kailali and
  Kanchanpur
• Schools were selected in coordination and
  consultation with district stakeholders.
• The design and strategic approaches were found to
  be effective and efficient.
• The role of the NGOs role maximum but DEO and
  DPHO to monitor the program was found to be
  minimal.

13
Resource utilization

• The programme schedule of WATSAN activities were
  very tight and human resource of NGOs were used
  effective and efficiently. The project also used
  school teachers as focal person to provide school
  level services. The use of school students and
  SMC for dissemination about the activities of
  SHN/WATSAN, communication, de-worming campaign
  and management was found effective.

14
Ownership, contributions and commitment by the
stakeholders

• Creation of ownership of the projects among the
  concerned stakeholders can help continue and
  sustain the project activities even after phasing
  out the project.
• The project attempted to build the ownership
  among the stakeholders by involving them in
  planning, organizing and implementing the project
  activities.
• From the initial phase, DPHOs, EDOs, SMCs and
  other local stakeholders showed their interest
  and commitments toward program and other project
  activities.
• It was also found that DPHOs, EDOs and school
  teachers contributed to the project activities
  according to their capacity.

15
Best practices

• Painting key message of WATSAN in toilet wall is
  effective for proper use of the toilet.
• Making boundary with lock for hand pump
  installation is effective in preventing the
  stealing of hand pump heads.

16
Successes

• Retention and attendance rates have increased
• Increased use of toilets by school children
• Decreased illness among school children,
  particularly diarrheal episodes
• Improved personal hygiene among school children
• Increased number of school children wearing
  slippers to school
• Decreased in number of adolescents smoking
• Increase in number of school children using local
  health facilities due to improved linkages
  between schools and health facilities
• Child Clubs are playing vital role in upkeep of
  new WatSan facilities

17
Challenges

• Community awareness of and involvement in
  programming is low
• Routine monitoring tools and capacity are weak,
  particularly among DEO and DPHO staff
• Focal teachers are not fully retaining
  information received during SHN/WatSan training
• De-worming tablets are not received on time in
  the district and distribution is often disrupted
• Programming only focuses on public government
  schools and children in private schools are not
  receiving services although they are often just
  as needy
• Although latrines and water sources have been
  built they are difficult to maintain often
  resulting in the closure of schools on hot days

18
LESSONS LEARNED

• Current programming strategy does not put enough
  focus into building community awareness and
  ownership of program which leads to little
  respect of and concern for the maintenance of new
  facilities.
• Knowledge of SHN/WatSan practices and behaviors
  is not being filtered into the larger community
  and thus it is difficult for children to practice
  what they learn in school as the demand for
  improved hygiene, nutrition, health etc. is not
  yet seen in the community.

19
Thank You