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Originally produced for UNICEF

Bina Tuladhar, (right) with two of her fellow health volunteers in Bungamati. "When I see the outreach clinic so full of women and children I feel very good. We all come here to learn how to stay healthy. This is something new for us. We had not realized before that staying healthy rested in our own hands."

Women bring their children to an outreach clinic held every month in the courtyard of the ancient Machhendranath Temple in Bungamati, a small town located in the Kathmandu Valley, Nepal.

Below : Village Health Worker Gyana Devi Tuladhar grew up in Bungamati. She runs 3 outreach clinics in different parts of the town. There are more than 16,000 outreach clinics in Nepal operated by Village Health Workers based in more that 3,000 sub-health posts.

Temple campaign

Once a month, a pilgrimage shelter beside the famous Machhendranath temple in Bungamati – a small town located in the Kathmandu Valley – is transformed into a bustling outreach clinic. "The temple is familiar and close to home," said Village Health Worker Gyan Devi Tuladhar who grew up in Bungamati and trained as a VHW through a programme sponsored by UNICEF.

Before the outreach clinic was established three years ago, immunizations were only available through the health post situated on the outskirts of the town. "It was too far away for most women," said Gyan. "Even if they knew about the importance of immunization and regular weighing of their young children, most women were too busy with household chores and fieldwork to make the journey to the health post, which would take up most of the day."

Today Gyan provides monthly outreach services at three different locations in the town (Village Development Committee). Each has become a social event for the women of the neighbourhood. "They come to catch up on the local news while also learning about nutrition, getting immunizations, and having their babies weighed," said Gyan.

A Matter of Political Will
Nepal's government policy is to have three to five outreach immunization sessions per Village Development Committee, depending on its size. The establishment of outreach clinics in Bungamati was facilitated by Prem Bhakta Maharjan, who became Chairman of the Village Development Committee nine years ago. "Like most other political leaders I was more concerned about roads and bridges, and making sure the buses had enough space to park in the village square. Today, public health is one of the most important issues on the agenda of the town and everyone is involved."

Prem Bhakta first became aware of public health as a key development issue for the town after a young woman known to his family died in childbirth. "We were shocked by the news of her death. I asked many questions about why it had happened and realized that such tragedies could be avoided if we had better health services for women and children."
The Village Development Committee was already working with UNICEF to improve sanitation in Bungamati. Prem Bhakta discussed the situation with UNICEF staff, and then signed on to take a health worker training-of-trainers course also sponsored by UNICEF.

He said, "I soon learned that providing better health services meant bringing health care closer to the community. Too many of our people were going to faith healers because that was the tradition and the faith healers lived right in the community. They were accessible." The challenge, he said, was to make regular health services more accessible, particularly immunization, growth monitoring, prenatal and postnatal care and activities that would encourage better nutrition and better sanitation.

The neighbourhood outreach clinics, such as the one located in the pilgrim shelter at the Machhendranath Temple, were launched with help from the Female Community Health Volunteers (FCHV), who are found in every ward in the country. The FCHVs were charged with ensuring that all families knew about the outreach clinics, about the services available and how valuable these were for mothers and infants. Prem Bhakta himself helped to train some of the FCHVs to be more effective in encouraging women to use outreach services.

Women Mobilizing Communities for Better Health
Bina Tuladhar has been an FCHV for five years. When she first started going door-to-door to ask women to attend the outreach clinic the response was not always positive. "People said that they had never come to clinics at the temple before so why should they start now. We explained that the outreach clinic would be much easier to get to. Their children would be weighed and immunized and protected from diseases. Gradually the news spread and now the clinics are always busy."

Bina displayed an exercise book listing the names and ages of all the children under five years old living in her ward. "I visit all of them at least once every two months. If a child gets sick the mother often comes to me first and then I tell her to go to see the Village Health Worker for treatment." From the list she could tell which children were falling behind in their immunizations and used this to encourage families to catch-up.

Bina Tuladhar adds, "When I see the outreach clinic so full of women and children I feel very good. We all come here to learn how to stay healthy. This is something new for us. We had not realized before that staying healthy rested in our own hands."
The Village Development Committee has now begun building a new health centre located in the middle of the town.

Prem Bhakta said that when he became Chairman in Bungamati, the town had the reputation for being one of the dirtiest in the Kathmandu Valley. "Today we are in a much better situation. Our streets are clean, our women and children are healthier, immunization and other activities to protect health are increasing."