Wednesday, 16 December 2015

Foreign Aid crippling down Nepal and Nepali

Historically Nepal was prosperous nation in South Asia proves from Nepal's historical facts since Nepal has trade with Tibet and China and there was no open borders for foreign aid to come.

BUT once foreign aid start to come in Nepal in the name of missionaries in 1960s then Nepal economic status started to go down due to increase corruption because of the greed of our rulers and ruling class mindset I suppose since they are the one who handle foreign aids.

I completely agreed with Dambisa Moyo, 44, a Zambian national and has a PhD in economics from the St. Anthony’s College, Oxford University who previously worked as a consultant at Goldman Sachs and as an economist for the World Bank asserted in her famous acclaimed book titled "Dead Aid, Why Aid Is Not Working and How There is Another Way for Africa."

She said that,

“I have dedicated many years to economic study up to the PhD level, to analyze and understand the inherent weaknesses of aid, and why aid policies have consistently failed to deliver on economic growth and poverty alleviation. To this, I add my experience working as a consultant at the World Bank, and being born and raised in Zambia, one of the poorest aid-recipients in the world. This first-hand knowledge and experience has highlighted for me the legacy of failures of aid, and provided me with a unique understanding of not only the failures of the aid system but also of the tools for what could bring African economic success.”

In fact, Dambisa does not criticise emergency and humanitarian aid, she welcomes it. The problem is the government to government, IMF, WB and other non-binding economic growth support which has not worked in the last 50 years. It has successfully made African economies dependent on life support.

I realised that Nepal is in the same position as Moyo stated thus she can't uplift her and her children are becoming poorer and poorer in the region because of too much dependency on foreign aids and international communities are pouring foreign aid on her for not to allow her to work independently because if she works independently then she'll be like other neighbouring nations who get less aid. Therefore, to keep our ruler in slavery mindset pouring foreign aid on her is best way to do.

It is crucial for everyone of us to understand WHY more foreign aid is pouring in Nepal but WHY not in other South Asian countries. What is the hidden interest of western world on Nepal ? That's the BIG Question that we need to pose and find out for the sake of humanity and prosperity of everyone of us!!

Sunday, 6 December 2015

Promote access to Skilled Birth Attendants rather than institutional birth in Nepal

I posted below write up on 5 December as a discussion in the Global Health Nursing and Midwifery (accessed from in which group moderator, Elizabeth Glaser made her remarks and I addressed her concerns accordingly. 

In the context of Nepal working in remote and rural hill districts after the two recent devastated earthquakes hit Nepal that took around 9000 lives I strongly realised it is paramount to promote access to skilled birth attendants rather than promoting institutional birth that the government of Nepal is doing since last decade with the support of DFID/UKaid and else donor agencies to bring all pregnant women to give birth at a health facility which is not practical and feasible solution especially for those women who are living in rural and remote hill and mountain districts because to get to nearby health facilities it takes minimum 2 to 5 hours walk within their own Village Development Committees. Therefore, it is essential to change and adopt the strategies based on the geo-ecological regions of the nations because strategies that work in plain areas will definitely not work in hill and mountainous regions. Besides, socio-cultural factors also hinder utilisation of the services. 

With the support of UNICEF we, from Midwifery Society of Nepal mobilised 25 nurses to restrengthen and re-stablish birthing services in six most earthquake affected districts namely Sindhupalchok, Nuwakot, Dhading, Rasuwa, Gorkha, and Dolkha and came to understand actual situation that pregnant and labouring women are facing to get to nearby health facilities how much they have to struggle within their family because of socio-economic status related to cultural taboos and transportation barrier although maternity service is free of charge in the health facility. However, in the village where ambulance has access labouring women to take from home to health facility family members have to pay NPR 2000 for one way for half an hour drive which is far more costly than the money that the government pay back (NPR 1000) to labouring women if they give birth at a health facility. Moreover, in many hill and mountainous districts there is no access of transportation so labouring women have to carry in a local stretcher by men. In Nepal due to large number of male migrant workers going abroad it is very difficult to find out men in the villages. Our nurse who had been deployed for 3 months in the epi centre of 25 April 2015 earthquake, Barpark of Gorkha district told us that to refer to complicated deliveries to the higher centre in Kathmandu villagers take loan of around NPR 200,000 to hire helicopter just for one way and it takes family a year or more to repay back the loan that they had taken in emergency situation to save the lives of labouring women and babies. Another our nurse who had been deployed in hiil, Rasuwa district remote Village shared us that during her 3 months stayed there she has assisted only one birth at a health facility and for rest of the births (7) they went to labouring women houses because they couldn't bring her at a health facility. 
Therefore, to reduce maternal and neonatal deaths it is important to promote skilled attendant births rather than promoting institutional births. Nepal neonatal deaths remain stagnant since 2006 to 2011 as demonstrated by the Nepal Demographic Health Survey 2011. Similarly, maternal death has not reduced that much despite the government of Nepal is promoting institutional births training less educated human resource, Auxiliary Nurse-Midwives as a skilled birth attendants. According to the Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division Nepal maternal deaths is 258 per 100,000 which falls among 46 highest maternal deaths nations in the world and 2nd most maternal deaths occurring nation in South Asia after Afghanistan.
What's can be the suggestions and thoughts in improving maternal and neonatal health status in the context of Nepal where main barrier is its geo-ecological regions unlike other countries? I am thinking about Afghanistan model of strategies for producing community midwives training local eligible women/girls as a midwife based on the ICM standard and deployed them in their own village so that they will serve their community.

Elizabeth Glaser Moderator

Replied at 1:26 AM, 5 Dec 2015

Dear Laxmi,
Thank you for your thorough reporting on this matter. 
Could I ask a few questions in order to have a better understanding of the situation? 
From what you reported, a family may have to pay 2000 npr for a one way trip to a facility - which could add up to about 5% or more of a rural family's annual income? 

If a woman were to give birth in a rural village with a skilled birth attendant , how much might it cost her?
Would the skilled birth attendants have supplies to treat maternal hemorrhage or resuscitate an infant?


 Laxmi TamangReplied at 10:14 PM, 5 Dec 2015

Dear Elizabeth,
Many thanks for your concern about the issues relating to financial status of rural families and SBA. Just to let you know that despite some progress in poverty reduction in recent years, Nepal remains one of the poorest countries in the world, with a Human Development Index of 0.463, placing it 157th out of 187 countries listed in the United Nations Development Programme's Human Development Report 2013.

Over 30% of Nepalese live on less than US$14 per person, per month, according to the National Living Standards Survey conducted in 2010-2011. While the overall poverty rate for Nepal is 25%, this figure increases to 27% in rural and 42% in the mountainous region with almost equal proportion in hill region, 24%. But it ranges from 16% to 39% from eastern to far-western hill regions. The same survey shows that household having 5 or more members and 2 or more under 6 years children have higher rate of poverty that ranges from 21% to 37% and 41% to 47% respectively. Similarly, households having illiterate household heads and illiterate or below grade 5 women as family members have more poverty rate (34% and 40% respectively) compared to their counterparts. In these remote hill and mountain zones, the terrain is rugged, rainfall is low and the poor-quality soil is difficult to farm. About 80% of Nepal's people live in rural areas and depend on subsistence farming for their livelihoods. Household food insecurity and poor nutrition are major concerns in these areas, where about half of children under five years of age are undernourished. Most rural households have little or no access to primary health care, education, safe drinking water, sanitation or other basic services.

Poor rural people in Nepal generally have large families, very small landholdings or none at all, and high rates of illiteracy. They are also concentrated in specific ethnic, caste and marginalized groups, particularly those of the lowest caste (dalits), indigenous peoples (janajatis) and women. Therefore, from such situation we can imagine how much income they have in a year and have to expenses in health service although maternity service is free, mothers they don't have to pay once they arrive in a health facility. Besides, they also receive transportation cost depending upon in which ecological they live it varies. For instance, NPR 500 for low flat/plain area in which we have 20 districts, NPR 1000 for hill region and NPR 1500 for mountainous region's women if they give birth at a health facility. 

As I said maternity service in government health facilities is free, women they don't have to pay. But my major concern is to force women to come to health facility is not feasible due to rugged terrain access to nearby health facility with their own village takes minimum 2 to 5 hours depending upon their location within the Village. Anyhow government is giving the salary and allowances to an Auxiliary Nurse-Midwife (ANM) so why she just have to wait and see the way hoping that labouring women would come to give birth. In a year they hardly have 40-50 births that I came to know from the government official data and usually there are two ANMs deployed in a birthing centre within a village. ANMs are trained as a skilled birth attendants by the government of Nepal providing them two months additional training as per the National Skilled Birth Attendant Policy 2006. However, follow up evaluation found that they are not that much competent and knowledgeable as compared to Diploma Level Nurse undertaking 3 years nursing course who are called staff nurse. Currently Nepal government has 1478 health facilities functioning at the level of birthing centres in rural areas and skilled birth attendants who are working there equipped with required supplies to treat maternal hemorrhage and resuscitation a newborn. My major concern is instead of providing frequent short-term training to low level human resource investing large amount of money why not trained those existing ANMs or else who are interested to be a qualified Midwife and mobilised them in the community level as done in Afghanistan because Afghanistan has similar geographical challenge as to Nepal. I am telling this based on the national skilled birth attendants policy 2006 in which it has clearly stated in its long term measure professional midwife of bachelor level will be produced to improve maternal and neonatal health in Nepal and we, from Midwifery Association of Nepal has been advocating since its establishment in 2010.

Status of maternal mortality in Nepal and its way out

Although different organisations produced different figures relating to reduction of maternal deaths in Nepal however I was quite aware and sure that maternal mortality in Nepal has not reduced that much as it supposed to reduce since 1990 to date, 2015 due to absence of skilled competent, compassionate, caring, communicative counsellor and courageous human resource to serve women in rural areas where majority, 87% people live in Nepal. Unless and until Nepal will not have such human resource in rural setting as envisioned by the government of Nepal in the National Skilled Birth Attendants Policy 2006's long term measures in producing professional midwives maternal and neonatal deaths won't reduce to bring sustainable development in the country promoting women's and newborn's health.

According to the Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division Nepal maternal deaths is 258 per 100,000 which falls among 46 highest maternal deaths nations in the world and 2nd most maternal deaths occurring nation in South Asia after Afghanistan. I can't imagine that after Afghanistan Nepal is the 2nd most maternal deaths occurring nations. I can't believe at all how much our mindset is corrupt still in this 21st we are allowing our pregnant and labouring mothers to die despite we consider ourselves that we have achieve and succeed in improving maternal and newborn healths and also got awarded by some donor agencies. What a shame!!!

Now it is high time government of Nepal and all donor agencies working in maternal and newborn health needs to think critically to invest in maternal health for sustainable development producing human resource that is critical for the society to provide quality cost-effective respective maternity care that are affordable, accessible, available and accountable learning lesson from Sri Lanka, Pakistan and else nations in the regions.

1. WHO 2015 Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division Nepal accessed from