Necha Community Hospital

Necha Community Hospital This is our community hospital donated from community member for one year which is currently under construction Necha is one of the remote villages in Solukhumbu district. It is located at the heart of 17 VDCs from Solukhumbu, Okhaldhunga and Khotang districts. This area is truly remote. People live in extreme poverty. It has very poor physical infrastructure especially lack of roads, district headquarter is at two days walking distance. Besides this there is no supply of electricity, safe drinking water, sanitations. They don’t have access to better health care services and quality educations. Solukhumbu District is a home to Mt. Everest, the highest peak in the world. Every year a number of tourist visit Solukhumbu but Necha lies in the southern part of the district which unfortunately is not a route hub. As a result very few people from this area are engaged in tourism business and still agriculture remains the main source of livelihood for more than 80 percent of the people. Among various problems faced by the inhabitants of the Necha and surrounding areas, health problem seem to be more worrisome than any other. People think that health problem needs to be addressed at the earliest as a result AHF has initiated the establishment of a community hospital in Necha. Necha has one sub health post which is operated by two health workers who are employed by the government. The actual health post building is derelict and the health workers operate from a room in the VDC building. Like in most health posts, these health workers only have very basic medical knowledge and are often not consulted. Their main activity is handing out the basic medicines provided by the government (mainly paracetamol and antibiotics) and selling other medicines in their own little shop. Because this area is so remote and the medicines coming from the government in Kathmandu are few and far between, they often pass their sell-by date. People in the outer parts of the VDC’s have to walk about 3-5 hours to get to the health posts. People who live in Necha have to walk for 2 days across high passes, treacherous in the rainy season, to get to the 15-bed hospital in Phaplu or Okhaldhunga (tekenpur hospital). The sick people are carried there by stretcher or other local means such as doko, chair or bed and often die on the way. The hospital in Phaplu has basic facilities in case of more complicated illnesses people have to fly to Kathmandu to get health care. Needless to say, most of the local people cannot afford this. Access to health care is limited in Necha and surroundings area mainly because of the fact that government run health institution is almost not functioning and district hospitals are too far away. In this regard health problems can be addressed largely by improving the access to health care and establishing a community hospital is an appropriate way to start. Vision Necha community hospital strives to be the best health care service provider for the people of Necha i and surrounding VDCs. Mission To improve health outcome of poor people by providing excellent health care services along with various awareness programmes. Objectives     i. To provide basic health care services by establishing a community hospital.
    ii. To conduct various activities to raise the awareness about health, sanitation and hygiene.
    iii. Coordinate with government health institution and other organizations to improve health care services. Catchment Area and Population Community hospital is intended to serve the people of Necha and other 17 surroundings VDCs. These 18 VDCs are not only from Solukhumbu district but also from two neighboring district namely Okaldhunga and Khotang. All VDCs are at 6 hours walking distance from Necha.     i. From Solukhumbu: Necha Betghari, Necha Batase, Panchan, Salyan, Jubu, Kangel
    ii. From Okhaldhunga: Kuibhir, Pokhare, Diyale, Mamkha, Ratmata, Serna
    iii. From Khotang: Ribdung jaleshwor, R.Maheswori, Ainselukharka, Jyamire, Magpa, Dubekoldada According to the 2001 statistics, 47831 people live in this area. With the average population growth rate of 2.4% in rural areas in Nepal, the average number of inhabitants is now 56,469. Management of the Hospital Hospital is working as a community based organization and is completely managed by the community. It is important because community based organization perform vital and quite diverse function for communities, including the mobilization of labor, infrastructure development, effective management etc. Such activities are particularly important for successful and long term functioning of the hospital. So as to ensure the participation of community, two separate committees were formed, first is Advisory committee which elects a 10 member executive committee and second is sub committee. Under the overall guidance of advisory committee executive committee is responsible for management of hospital, fund raising and developing and implementing programmers. Sub committee plays a critical role in their village by either raising awareness about health, sanitation and hygiene or encouraging people to utilize the services offered by the community hospital. Infrastructure of the Hospital Being in its initial phase, the hospital is delivering service with minimal infrastructure. A house was donated by one of the members in the advisory committee. AHF Nepal will supply the medicine for the first time and from second time onwards hospital has to purchase the necessary medicine. While equipments will be purchased by AHF-Nepal once executive committee identifies the necessary equipments required for the smooth functioning of the hospital. The hospital is planning to construct its own building in the future provided the financial support from AHF-Nepal. Lack of electricity in the village impedes the functioning of equipments in laboratory including X-ray machines. To address this problem AHF-Nepal is committed to install solar panels as an alternative source of electricity.

Services offered in the Hospital Community hospital is aimed at providing basic health care to the residents of the 18 VDCs from 3 districts. Since its main objective is to provide basic health care services, following services are offered in the hospital. Ambulatory Care Center The Ambulatory Care Center at Necha Community Hospital provides services ranging from diagnosis, stitching, and wound dressing to orthopedic procedures. Services are provided on an outpatient basis Sunday through Friday 10 am to 2 pm. MBBS doctor along with nurse and other paramedics work together to deliver high-quality service in ambulatory care center. Birthing Center/Safe Motherhood Despite some progress maternal and neonatal mortality rate remains unacceptably high in Nepal. The most commonly cited barriers to use of professional skilled care in Nepal include lack of skilled providers and infrastructure, and poor quality of care. That’s why the hospital is committed to providing professional delivery care services. Necha community hospital provides a separate room for delivery. Skilled professionals (Doctor, nurse and ANM) provide service round the clock. Owing to the resource constraint only normal deliveries are being conducted. In rather complicated cases patients are referred to other hospitals. Service is not limited to delivery care we also offer antenatal and postnatal screenings. Immunization Immunization is a vital tool by which some life threatening diseases can be controlled. It is particularly instrumental for reducing infant mortality. People in this area are under served in immunization services. As a result Necha community hospital has developed a system of immunization by which we ensure that vaccines are provided to all who need it. Free immunization service is offered to children less than 5 years once in a week. This includes vaccines against malaria, measles etc. Family Planning Unwanted pregnancies and unsafe abortions contribute to maternal death. To address this problem Necha community hospital offers a free, confidential advice and information about contraception and sexual health. Distribution of free condom is another service offered which helps in preventing the further spread of HIV and other STDs as well as reducing the cases of unwanted pregnancies in the area. Laboratory Laboratory is under construction.

Programmes Besides providing healthcare services the hospital seeks to achieve its goal of improving health outcomes through various programmes. It is believed that health problems cannot be solved just by providing health services. Various other factors play an important role in improving health outcomes such as awareness about communicable diseases. People need to be aware about their health and this can be attained through various programmes. Such programmes are not limited to the premises of hospital but can go right through to the community and household level as well. The Hospital is planning to conduct following programmes over the next one year. Health education and awareness programmes Health education and awareness programmes can largely contribute to better health outcome. Especially in rural settings where people have very little access to health education and health care services such programmes are powerful in reducing diseases and sickness. Sanitation and hygiene awareness programme Members of sub committee will be active in raising awareness about importance of having toilet. They will basically disseminate the information about how toilet can contribute in reducing diarrhea and other diseases. At the same time members will also make the communities aware about basic hygiene rule such as washing hands with soap after a visit to the toilet, washing hands before cooking or serving food. Targeted audience of this programme is basically women’s group in the village as they are the main care taker of babies and other household members. AHF-Nepal is responsible for arranging necessary trainings to members of both the committees on related topics. In case sub committees can also hire health personnel such as health assistant, auxiliary health workers in their villages on a contract basis to assist sub committees. Safe Motherhood training Women in the villages are usually reluctant to go to hospital for delivery. The Main objective of safe motherhood training is to encourage women in the village to deliver baby in health institutions while this will be followed by importance about ANC, PNC, having Iron tablets during pregnancies and danger sings during pregnancies. Disseminating information regarding immunization, childhood diseases is another purpose of this training. This training will be conducted by female members of sub committee or Auxiliary nurse midwives in the village. Members will organize two days trainings in the village targeting women of child bearing age. HIV/AIDS A two day workshop on HIV/AIDS peer education training will be conducted with ten students and two teachers from each secondary school. It is assumed that participants will disseminate the information to their classmates and colleagues so that those missed out in the training will also get the information. This will be conducted once each at all working VDCs. The purpose of this two day workshop is to support participants in making behavior changes that will reduce their risk of acquiring HIV. Focus will be on information regarding transmission and prevention of HIV and AIDS. Trainings Training forms the major part of programmes. Training includes managerial skills and skills required for regularity of services and proposed programmes. Training is vital not only to manage hospital properly but also to run programmes designed by hospital effectively. In fact hospital cannot run various proposed programmes without proper training to the members of the sub committee. AHF Nepal is solely responsible for managing trainings either by organizing separately for the members or by putting members in relevant training organized by other organizations. Every year programme committee will decide on the training requirements however training should be of such a nature which aids in conducting proposed programmes smoothly, for example this year training on sanitation, safe motherhood and HIV/AIDS will be organized. Regular health check and health education classes at school Following activities are planned under this topic for this year:
    1. Regular school health education classes will be conducted in every school at least in three-month intervals. This year, classes will be conducted either by the school health teacher or non-employee health manpower.
    2. Physical check-up of the student will be conducted twice a year and sick children referred from this check up will be treated at community hospital.
    3. Appropriate sewage disposal place will be constructed in schools that do not have one yet. Proper disposal of sewage and proper use of latrine will be encouraged at every visit to the school. Celebrating special days such as world AIDS day, world TB day, Women's Day Special days such as world AIDS day, world TB day will be observed with different activities, such as street drama, student quiz contest etc. Sub committees will organize programmes in their respective VDCs in coordination with other organizations. Objective of celebration is to again raise awareness about respective diseases. It can send strong message in the mind of audience, thus making people aware about disease so that they may take necessary precaution to avoid transmission of diseases or to cure diseases.