Strengthening health care systems to improve infant health in rural Nepal

Trans R Soc Trop Med Hyg. 1989 Jan-Feb;83(1):19-22. doi: 10.1016/0035-9203(89)90691-3.


PIP: The functioning of the government primary health care system as it affects infant health in the Baglung District of Nepal, is discussed. the Baglung District is a remote rural area of 232,000 population in the western Himalayan foothills, entirely based on subsistence farming, and without drivable roads. The government has a 15-bed hospital in the district capital, 11 health posts and 80 village-based community workers (VHWs). The Save the Children Fund also has a Maternal-Child Health Clinic with an expatriot doctor and 35 staff, funded by US $88,000 in 1984-5, and caring for about 10% of the district. District health administration could be improved by setting up communication links between the district capital, health posts and VHWs. The SCF funded a newsletter publicizing immunization and family planning campaigns, which were previously unannounced. The government has also tried to decentralize the control of staffing, pay, and health campaign scheduling from the national to the district level since 1985, with mixed success. Since the hospital runs out of drugs and supplies, and the health posts lack these as well as diagnostic equipment, water and sanitation, the public usually resorts to traditional healers. It is suggested that staff rotations be made during monsoons when people cannot travel, and that supplies be upgraded during the pre-monsoon when food is limited and morbidity is higher, VHWs are usually young men with little training, supplies or respect from the community. It would be best to strengthen health posts initially, then train VHWs by associating them with the health posts. Other suggestions are to gain the respect of the traditional healers for referrals, and to emphasize cost-effective ways to improve female education and literacy.

MeSH terms

  • Child, Preschool
  • Community Health Services / organization & administration*
  • Community Health Workers
  • Female
  • Health Services Accessibility
  • Humans
  • Infant
  • Infant Mortality*
  • Nepal
  • Patient Acceptance of Health Care
  • Postnatal Care
  • Rural Health
  • Workforce